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PURPOSE: Detailed anatomy of the facial nerve, including the variations among different ethnic groups, is essential to prevent an iatrogenic injury. The purpose of the study was to document topographic anatomy of temporal and marginal mandibular (MM) branches of the facial nerve in relation to temporomandibular joint (TMJ) surgery. The specific aim was to demonstrate detailed course of temporal and MM nerves, their surgical implications, and to compare the results obtained with the previous studies. METHODS: The investigators implemented a prospective cadaveric study. A dissection was carried out on 52 facial halves. The facial nerve was dissected according to the instructions described in the Cunningham's dissection manual. Anatomic landmarks were selected as determined by Al-Kayat and Bramley, and results obtained were compared with previous published articles. RESULTS: The study sample was composed of 52 facial halves (males, n = 35; females, n = 17). The number of branches of temporal nerve varied in dissected facial halves from 3 (n = 37 [70%]), 2 (n = 14 [26%]), to 1 (n = 1 [2%]). The distance between the lowest concavity of the bony external auditory meatus to the point at which the facial nerve bifurcates (distance B) was considerably less in the study population (1.79 cm) when compared with the reported literature (2.3 cm). There was no significant influence of gender and cephalic index on distances measured. There was 1 branch in 15% of the dissected facial halves (1 in 52) and 2 branches in 85% (44 of 52). The MM nerve was seen coursing below the inferior border of the mandible, and in 44 (85%), the nerve was present above the inferior border of mandible all along the course. CONCLUSIONS: The topographic anatomy of the temporal and MM nerves is the same as reported in the literature. The only considerable difference was found in distance B; hence, surgical procedures involving the distance B require special consideration.
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Nervio Facial , Mandíbula , Cadáver , Nervio Facial/anatomía & histología , Femenino , Humanos , Masculino , Mandíbula/anatomía & histología , Nervio Mandibular/anatomía & histología , Estudios Prospectivos , Articulación TemporomandibularRESUMEN
PURPOSE: To propose a new scoring system for grading of chronic ocular sequelae in Stevens-Johnson syndrome (SJS). DESIGN: Reliability and validity analysis. METHODS: Participants: Four hundred eyes of 200 patients with chronic ocular SJS/toxic epidermal necrolysis (TEN) were included in the study. SETTINGS: Single-center, tertiary eye care referral center. PROCEDURE: All patients with SJS/TEN with chronic (more than 1 year) ocular sequelae were recruited for the study. Corneal, eyelid, and conjunctival signs were evaluated and given scores ranging from 0 to 5 depending on the increasing severity. Twelve signs (6 corneal, 3 conjunctival, and 3 eyelid) were evaluated to obtain the total severity score for each eye. Based on the corrected distance visual acuity (CDVA) and total score, each eye was graded using receiver operating characteristic (ROC) analysis. MAIN OUTCOME MEASURES: Correlation of CDVA with the severity score determined on the basis of 12 corneal, eyelid, and conjunctival signs. RESULTS: Mean age was 24.09 ± 10.9 years. The most common inciting agent for SJS was oral medications (85%). The scores of 12 ocular surface parameters correlated significantly with CDVA (P < .001). ROC analysis revealed 4 grades of total severity score of 0-11 (stage 0), 12-16 (stage 1), 17-22 (stage 2), and 23-53 (stage 3). The total severity score correlated significantly with logMAR visual acuity grades with an agreement of 60.7% using Cohen's kappa analysis (kappa coefficient = 0.420 ± 0.03). The most common stage of total severity score was stage 3 in 49% of eyes (196/400), followed by stage 0 (107/400, 26.7%). CONCLUSIONS: The multistep scoring system of chronic ocular features in SJS/TEN sequelae is a useful tool to grade all levels of severity. This may help to evaluate the efficacy of the surgical intervention by comparing preoperative with postoperative ocular grades.
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Enfermedades de la Conjuntiva/diagnóstico , Enfermedades de la Córnea/diagnóstico , Enfermedades de los Párpados/diagnóstico , Síndrome de Stevens-Johnson/complicaciones , Agudeza Visual , Adolescente , Adulto , Niño , Enfermedad Crónica , Conjuntiva/patología , Enfermedades de la Conjuntiva/etiología , Córnea/patología , Enfermedades de la Córnea/etiología , Progresión de la Enfermedad , Enfermedades de los Párpados/etiología , Párpados/patología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Microscopía con Lámpara de Hendidura , Síndrome de Stevens-Johnson/diagnóstico , Adulto JovenRESUMEN
To study the nutritional risk factors and status of serum 25(OH)D levels in patients with breast cancer. A total of 100 women (cases) with confirmed breast cancer (BC) matched with equal number of healthy females (controls) of similar age and socioeconomic status (SES) were included in study. Controls included were nonbreast cancer patients who accompanied the patients to a tertiary care hospital. All the subjects (cases and controls) were administered a questionnaires to collect data on socioeconomic status, dietary pattern and the frequency of food consumption using a validated food frequency questionnaire. Anthropometric assessment was done for waist and hip circumference to calculate waist to hip ratio (WHR). Non fasting blood samples were collected for serum 25-hydroxyvitamin D [25(OH)D] levels estimation using chemiluminescent immunoassay technique and total serum calcium levels by colorimetric assay technique. Serum 25(OH)D and total calcium levels were expressed in ng/ml and mg/dl. Vitamin D deficiency was defined as per the guidelines set by United States Endocrine Society. The mean age of cases and controls was 45±9 and 46±10 years respectively. On multivariate analysis, an inverse association with BC was found for less frequency of fruits consumption with an adjusted (ORs, 95% CI) (2.7, 0.5-15.7) respectively. Mushroom intake was inversely associated with risk of BC (ORs, 95% CI) (5.6, 1.9-16.6). Saturated fat intake and high WHR were significantly associated with high risk of BC with adjusted ORs, 95% CI of (3.4, 1.4-8.1) and (5, 1.4-17). A significant association (p<0.05) was found between low serum 25(OH)D levels and the risk of BC with adjusted ORs, 95% CI of (2.5, 0.9-7.4). Majority of the patients with BC were suffering from vitamin D deficiency. Dietary intake of mushrooms containing vitamin D naturally was found to be associated with decreased risk of breast cancer. A significant association was found between low serum 25(OH)D levels (<20ng/ml) with the risk of BC. Obesity as a consequence of nutritional risk factors determined by higher WHR was found to be significantly associated with the risk of BC.
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Neoplasias de la Mama/sangre , Conducta Alimentaria , Deficiencia de Vitamina D/sangre , Vitamina D/análogos & derivados , Adulto , Agaricales/química , Neoplasias de la Mama/complicaciones , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/patología , Calcio/sangre , Estudios de Casos y Controles , Femenino , Frutas/química , Humanos , Persona de Mediana Edad , Clasificación del Tumor , Obesidad/fisiopatología , Factores de Riesgo , Clase Social , Encuestas y Cuestionarios , Vitamina D/sangre , Deficiencia de Vitamina D/complicaciones , Deficiencia de Vitamina D/diagnóstico , Deficiencia de Vitamina D/patologíaRESUMEN
This cross-sectional study assessed the impact of clinical epilepsy severity and pretreatment hypsarrhythmia severity on epilepsy and cognitive outcomes in treated children with West syndrome. Thirty-three children, aged 1 to 5 years, with infantile spasms were enrolled if pretreatment EEG records were available, after completion of ≥1 year of onset of spasms. Neurodevelopment was assessed by Development Profile 3 and Gross Motor Function Classification System. Epilepsy severity in the past 1 year was determined by the Early Childhood Epilepsy Severity Score (E-Chess). Kramer Global Score of hypsarrhythmia severity was computed. Kramer Global Score (≤8) and E-Chess (≤9) in the past 1 year were associated with favorable epilepsy outcome but not neurodevelopmental or motor outcome.
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Trastornos del Conocimiento/diagnóstico , Discapacidades del Desarrollo/diagnóstico , Diagnóstico por Computador/métodos , Electroencefalografía/métodos , Trastornos del Movimiento/diagnóstico , Índice de Severidad de la Enfermedad , Espasmos Infantiles/diagnóstico , Preescolar , Estudios Transversales , Femenino , Humanos , Lactante , Masculino , Pronóstico , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadAsunto(s)
Betametasona/farmacología , Dermatitis Alérgica por Contacto/diagnóstico , Glucocorticoides/farmacología , Pruebas del Parche , Extractos Vegetales/inmunología , Piel/efectos de los fármacos , Adulto , Anciano , Asteraceae/efectos adversos , Asteraceae/inmunología , Dermatitis Alérgica por Contacto/etiología , Dermatitis Alérgica por Contacto/inmunología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Partenogénesis , Extractos Vegetales/efectos adversos , Reproducibilidad de los Resultados , Piel/inmunologíaRESUMEN
OBJECTIVE: We present our experience of success with immediate third molar transplants in young individuals while secondarily assessing factors predicting failure. STUDY DESIGN: A total of 57 cases of third molar transplant with both open and closed apices were studied in individuals aged 15 to 25 years. Factors influencing prognosis were analyzed by univariate and multivariate analysis. RESULTS: The replaced teeth included 17 maxillary molars (29.8%) and 40 mandibular molars (70.2%). After a follow-up of 19.9 ± 2.8 months, 49 cases (86%) were successful; 7 (12.3%) cases failed owing to root resorption, and 1 (1.7%) failed owing to infection. Pulp revascularization was seen in all successful cases with open apices. Proximal grinding of donor tooth was significantly associated with failure (odds ratio, 12.5; P = .025). CONCLUSIONS: Autogenous third molar transplant is an excellent and viable treatment modality. By using proper case selection and minimizing damage to the donor tooth root, high success rates can be achieved.
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Tercer Molar/trasplante , Adolescente , Adulto , Femenino , Humanos , Masculino , Tercer Molar/diagnóstico por imagen , Radiografía Panorámica , Trasplante Autólogo , Resultado del TratamientoRESUMEN
PURPOSE: The present study was planned as there is paucity of outcome data of children with infantile spasms, from India where profile of patients is different from the western world. Moreover, most previous studies have either not used strict inclusion criteria or standardized psychometric tests for developmental outcome. METHODS: Ninety-five children, aged one-to-five years under follow up for more than six months in Pediatric Neurology Clinic of a tertiary care hospital with the diagnosis of infantile spasm were enrolled in this cross-sectional study if they had completed one or more years after the onset of spasms. The study period was January-December 2011. Neurodevelopment of each child was assessed using Development Profile 3 and Gross Motor Function Classification System. History regarding epilepsy frequency and control in the last one year was taken. RESULTS: Perinatal asphyxia was the commonest etiology in 43/95 children (45.2%). Favorable neurodevelopmental outcome was observed in 8/95 patients. Favorable epilepsy outcome in 58/95 (61.1%) patients was associated with treatment lag≤3 months between apparent onset of spasms and institution of therapy {OR 2 (1.1-3.8)} and response to first line antiepileptic drug {5 (2.6-10)}. CONCLUSIONS: The commonest etiology was potentially preventable perinatal cause. Early appropriate treatment may have a favorable epilepsy outcome.
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Discapacidades del Desarrollo , Espasmos Infantiles , Resultado del Tratamiento , Hormona Adrenocorticotrópica/uso terapéutico , Anticonvulsivantes/uso terapéutico , Preescolar , Estudios de Cohortes , Discapacidades del Desarrollo/diagnóstico , Discapacidades del Desarrollo/epidemiología , Discapacidades del Desarrollo/etiología , Femenino , Humanos , India/epidemiología , Lactante , Masculino , Psicometría , Factores de Riesgo , Índice de Severidad de la Enfermedad , Espasmos Infantiles/complicaciones , Espasmos Infantiles/tratamiento farmacológico , Espasmos Infantiles/epidemiología , Estadísticas no ParamétricasRESUMEN
OBJECTIVE: To evaluate the efficacy of enalapril treatment on decline in glomerular filtration rate and reduction in proteinuria in children with chronic kidney disease (CKD). DESIGN: Open-label, randomized controlled trial. SETTING: Pediatric nephrology clinic at a tertiary-care referral hospital. INTERVENTION: Children with GFR between 15-60 mL/min/1.73 m2 were randomized to receive either enalapril at 0.4 mg/kg /day or no enalapril for 1 year. OUTCOME MEASURES: Change in GFR using 99mTc-DTPA and urine protein to creatinine ratio. Secondary outcomes included occurrence of composite outcome (30% decline in GFR or end stage renal disease) and systolic and diastolic blood pressure SDS during the study period. RESULTS: 41 children were randomized into two groups; 20 received enalapril while 21 did not receive enalapril. During 1 year, GFR decline was not different in the two groups (regression coefficient (r) 0.40, 95% CI -4.29 to 5.09, P=0.86). The mean proteinuria reduction was 65% in the enalapril group, significantly higher than control group. The difference was significant even after adjustment for blood pressure was 198.5 (CI 97.5, 299.3; P<0.001). 3 (17.6%) patients in enalapril and 7 (36.8%) in non-enalapril group attained the composite outcome. CONCLUSIONS: Enalapril is effective in reducing proteinuria in children with CKD and might be renoprotective in proteinuric CKD.
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Antihipertensivos/uso terapéutico , Enalapril/uso terapéutico , Tasa de Filtración Glomerular/efectos de los fármacos , Proteinuria/tratamiento farmacológico , Insuficiencia Renal Crónica/tratamiento farmacológico , Adolescente , Niño , Preescolar , Femenino , Humanos , Masculino , Estudios Prospectivos , Proteinuria/fisiopatología , Proteinuria/orina , Insuficiencia Renal Crónica/fisiopatología , Insuficiencia Renal Crónica/orinaRESUMEN
BACKGROUND & OBJECTIVES: Ocular infection with Chlamydia trachomatis is a major public health problem in densely populated countries like India. The true prevalence of such infections is uncertain due to insufficient data available from India. The aim of this study was to do a retrospective analysis of C. trachomatis eye infections in patients attending the outpatient department of Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, over a period of 12 years. METHODS: From 1997 to 2008, the Chlamydia laboratory received conjunctival swabs from 1281 consecutive patients for C. trachomatis detection after thorough clinical examination. Specimens were subjected to direct fluorescent antigen detection assay using monoclonal antibody based commercial kit to detect the presence of C. trachomatis antigen. RESULTS: Antigen positivity varied between 22-28 per cent. Children below 11 yr and people above the age of 60 yr showed comparatively higher antigen positivity (25.7 and 27.8%, respectively). As compared to males significantly (P<0.05) higher number of females in the age group of 31-60 yr were positive for C. trachomatis antigen. Patients with the clinical diagnosis of follicular/allergic conjunctivitis and trachoma showed higher rate of antigen positivity. INTERPRETATION & CONCLUSIONS: Northern India having dry and arid climatic conditions in most parts of the year was considered in the past as one of the trachoma hyper-endemic foci. The study indicated that laboratory proven C. trachomatis eye infection still persisted in this part of the country throughout the study period of 12 years.
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Chlamydia trachomatis , Conjuntivitis Bacteriana/epidemiología , Factores de Edad , Femenino , Técnica del Anticuerpo Fluorescente Directa , Humanos , India/epidemiología , Masculino , Prevalencia , Estudios Retrospectivos , Factores SexualesRESUMEN
BACKGROUND: The diagnostic yield of endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) over a 3-year period was analyzed. METHODS: Consecutive patients who underwent EBUS for the evaluation of pulmonary/mediastinal lesions were recruited. RESULTS: One hundred and ninety-one patients were studied (54% male, mean age, 65 years [standard deviation 11.1]). A final diagnosis of a malignant disorder was made in 151 patients (79%). Of these, EBUS-TBNA alone provided the diagnosis in 135 patients. The majority of the remaining 56 patients had reactive changes (n = 32). Nineteen patients, either because they did not respond to appropriate treatment or based on clinical indication, underwent a different procedure resulting in an additional diagnosis of malignancy in 16 patients, tuberculosis in one and indeterminate in two. The diagnostic yield of EBUS for malignant disorders was 70.7% (95% confidence interval (CI), 0.86, 0. 77). The overall ability of EBUS to achieve a definitive diagnosis (benign plus malignant) was 90.1% (95% CI, 0.85, 0. 94). Logistic regression and stepwise regression analysis revealed that older age, greater lymph node size, and the presence of intraprocedure complications significantly influenced EBUS yield for malignancy. CONCLUSION: EBUS-TBNA has a high diagnostic yield for mediastinal lesions, both benign and malignant. The yield depends on both lesion- and patient-related factors.
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PURPOSE: The present study was undertaken to test bioresorbable fixation versus titanium for equivalence in terms of clinical union and complications using the American Association of Oral and Maxillofacial Surgeons parameters of care. The study design was a randomized, controlled, equivalence trial. MATERIALS AND METHODS: A total of 40 patients were enrolled and allocated to the titanium group and bioresorbable group using a computerized randomization table. All were plated using standard plating principles. In the bioresorbable group, 2 weeks of maxillomandibular fixation was also used. Evaluation of the study endpoint was done at 8 weeks postoperatively. For statistical analysis, the upper limit of the 95% confidence interval was calculated for failure to achieve the primary outcome variable and compared with the maximal clinically acceptable difference between the standard and test modalities in the failure to achieve clinical union (delta). Delta was predetermined as 2%. The other complications were tested for significance using Fisher's exact test. RESULTS: Of the 40 patients, 21 were in the titanium group and 19 were in the bioresorbable group, with 20 men and 1 woman in the titanium group and 18 men and 1 woman in the bioresorbable group. The mean age was 28.7 years in the titanium group and 26.6 years in the bioresorbable group. In the titanium group, the complications noted were nonunion in 0%, malocclusion in 7.7%, continued postoperative swelling in 0%, chronic pain in 2%, infection in 5.2%, an inability to chew hard food after 8 weeks in 7.7%, the need for alternative treatment in 0%, and the need for reoperation in 31%. In the bioresorbable group, the complications were nonunion in 4.17%, malocclusion in 11.1%, swelling in 8.3%, chronic pain in 37.5%, infection in 0%, an inability to chew hard food in 11.1%, the need for alternative treatment in 11.1%, and need for reoperation for plate removal in 0%. CONCLUSIONS: The small sample size did not allow any meaningful conclusion to be drawn from the present study in terms of the primary question of achieving union. Both groups matched in outcomes when evaluated only on a clinical basis. The avoidance of repeat surgery for plate removal is a definite advantage of using resorbable plates. However, the results are inconclusive in favor of any particular plating system.
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Placas Óseas , Fijación Interna de Fracturas/instrumentación , Fracturas Mandibulares/cirugía , Implantes Absorbibles , Adolescente , Adulto , Distribución de Chi-Cuadrado , Intervalos de Confianza , Dioxanos , Femenino , Fracturas no Consolidadas , Humanos , Técnicas de Fijación de Maxilares/instrumentación , Masculino , Persona de Mediana Edad , Parestesia , Proyectos Piloto , Poliésteres , Complicaciones Posoperatorias , Dehiscencia de la Herida Operatoria , Titanio , Adulto JovenRESUMEN
Hepatitis C virus (HCV) infection is the most common blood-borne viral infection in haemodialysis. It causes significant morbidity and long-term mortality. Practice of universal precautions has been reported to be sufficient to prevent HCV seroconversion in dialysis units. However, the seroconversion rate remains very high in many dialysis units. A previous study from 1995 to 1998 at our own hospital without isolation showed that nosocomial transmission is the major cause of HCV seroconversion. The present study was therefore conducted with the aim to study the impact of isolation on HCV seroconversion. In this prospective cohort study, with non-probability consecutive sampling, patients with HCV infection were dialysed in an isolated room. In addition, standard universal precautions were practiced. HCV seroconversion rate was compared with the previous study. All patients with end-stage kidney disease (ESKD) admitted to our hospital for renal replacement therapy were included in the present study. At the time of admission, HCV screening was done. All anti-HCV-positive patients were dialysed in an isolated room. While on maintenance haemodialysis, all patients were monthly tested for anti-HCV, aspartate aminotransferase and alanine aminotransferase. Any patient who had HCV seroconversion was transferred to an isolated room for maintenance haemodialysis. Patients with HCV infection were managed by further testing for HCV-RNA and liver biopsy. Every patient who ultimately received renal transplantation at our hospital was also tested for HCV just prior to renal transplantation as well as 3 months after renal transplantation. HCV infection was diagnosed by detecting anti-HCV antibodies using an ELISA-based third-generation diagnostic test kit. Serum bilirubin, aspartate aminotransferase and alanine aminotransferase were assayed using standard laboratory techniques. From March 2003 to February 2006, 1,417 patients were admitted for haemodialysis in our unit. Of these 1,077 (76%) had ESKD. Mean age of patients was 42.47 +/- 16.2 (14-94) and 70.39% were males. Patients with ESKD had had more dialysis sessions (10.9 +/- 39.5 vs. 4.4 +/- 5.95, p = 0.009), more blood transfusions and more pre-existing HCV infections (4.72 vs. 1.5%, p = 0.009) than patients with acute renal failure. Of the ESKD patients, 65.7% were discharged, 9.47% died, 1.85% were shifted to chronic ambulatory peritoneal dialysis and 22.46% patients received renal transplantation. Of the patients who received renal transplantation, HCV seroconversion was detected in 2.75%. In the previous study without isolation practices, the HCV seroconversion rate in transplanted patients was 36.2%. The hazard of HCV seroconversion was 0.97 (95% CI 0.93-1.02, p = 0.2) for each additional dialysis and 1.09 (95% CI 0.88-1.36, p = 0.37) for each additional blood transfusion. The study concludes that isolation of HCV-infected patients during haemodialysis significantly decreases the HCV seroconversion rate.
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Hepacivirus , Hepatitis C/terapia , Aislamiento de Pacientes/métodos , Diálisis Renal/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hepatitis C/complicaciones , Hepatitis C/virología , Humanos , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , Fallo Renal Crónico/virología , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Aislamiento de Pacientes/tendencias , Diálisis Renal/tendencias , Adulto JovenRESUMEN
BACKGROUND: Chronic renal failure (CRF) is a debilitating condition responsible for high morbidity and mortality and is a financial burden on government and society. Because of its costs and the complexity of its treatment, proper care is available to very few patients in India. A community-based study has not been done to determine the prevalence of CRF in India. METHODS: We used a multi-stage cluster sampling method in the South Zones of Delhi. In each area, we first contacted the local social leader and explained the study and the medical information pamphlets. On pre-scheduled days, the study team canvassed the study zone. The individuals contacted responded to a detailed questionnaire, and had a physical examination, a dipstick urine test for albumin and sugar and a blood test for serum creatinine. A serum creatinine >1.8 mg% defined renal failure. A repeat test for serum creatinine was done after 8-12 weeks to confirm chronicity of renal failure. If it was >1.8 mg% after 3 months in the absence of reversible factors, CRF was diagnosed. The person found to have CRF was asked to attend a hospital renal clinic for further investigations and individualized management. RESULTS: A total of 4972 persons were contacted for the study. Their mean age was 42+/-13 years; 56% were males. Out of the 4972 who were initially approached, 4712 agreed to give the blood sample, and thus were included for the evaluation of CRF. CRF was found in 37 of them. Thus, the prevalence of CRF in that adult population was 0.785% or 7852/million. CONCLUSIONS: The prevalence of CRF in India makes it a serious problem in need of urgent efforts to contain it.
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Fallo Renal Crónico/epidemiología , Adulto , Creatinina/metabolismo , Femenino , Tasa de Filtración Glomerular , Humanos , India/epidemiología , Fallo Renal Crónico/diagnóstico , Pruebas de Función Renal , Masculino , Tasa de Depuración Metabólica , Vigilancia de la Población , PrevalenciaRESUMEN
OBJECTIVES: We aimed to evaluate eight candidate definitions of the metabolic syndrome (MS) against the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII) definition as the reference for optimally defining MS in adult Asian Indians. RESEARCH DESIGN AND METHODS: We used clinical and biochemical data from our previous cross-sectional epidemiological studies. Candidate definitions of MS were proposed by modifying the NCEP ATPIII definition. These modifications included the following: waist circumference cutoffs as >90 cm in men and >80 cm in women, BMI cutoff as >23 kg/m(2), and a measure of truncal subcutaneous fat (subscapular skinfold thickness [SST] >18 mm). RESULTS: The highest prevalence (29.9%) of MS was observed by the inclusion of modified cutoffs of waist circumference and BMI and SST in place of the existing cutoffs of waist circumference in the NCEP ATPIII criteria. Further, this modified definition showed the maximum absolute gain in the percentage of prevalence of MS over the NCEP ATPIII definition, and it was the best predictor for MS in subjects with impaired fasting glucose, type 2 diabetes, and different age-groups. The lowest percentage of prevalence of MS was observed with the definition that excluded biochemical variables and blood pressure. CONCLUSIONS: The criteria for defining MS in adult Asian Indians need revision. Inclusion of modified cutoffs of waist circumference and BMI and measures of truncal subcutaneous fat in the NCEP ATPIII definition requires further validation.
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Pueblo Asiatico , Síndrome Metabólico/diagnóstico , Síndrome Metabólico/etnología , Adulto , Índice de Masa Corporal , Estudios Transversales , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/etnología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/diagnóstico , Obesidad/etnología , Prevalencia , Relación Cintura-CaderaRESUMEN
BACKGROUND: Studies on eradication therapy in developing countries have shown a success rate of 70-85%, which is suboptimal. Duration of therapy may be an important factor dictating eradication success in such regions. AIMS: The study was undertaken to evaluate the effect of increasing the treatment period on eradication of Helicobacter pylori in duodenal ulcer disease. METHODS: A randomized trial was carried out in which 64 consecutive H. pylori-infected patients with duodenal ulcer disease were enrolled. The patients were randomized to one of the three trial arms. Therapy consisted of lansoprazole 30 mg twice a day (b.i.d.), amoxycillin 1 g b.i.d. and tinidazole 500 mg b.i.d. The treatment period was 1 week in group I, 2 weeks in group II and 3 weeks in group III. At inclusion, patients underwent endoscopy and the presence of H. pylori was documented by a positive urease test and C14 urea breath test. Four weeks after completion of eradication therapy, the patients were subjected to repeat endoscopy to assess ulcer healing and tests for H. pylori infection. RESULTS: Sixty-four patients (55 male and nine female; mean age 35.5 years) were enrolled in each group. The H. pylori eradication rate for group I (1 week of therapy) was 47.6%, that for group II (2 weeks of therapy) was 80%, and that for group III (3 weeks of therapy) was 91.3% (p =.003). The ulcer healing rates were 71.4, 80 and 95.6% in groups I, II and III, respectively (p =.09). CONCLUSIONS: The 3-week regimen significantly improved the eradication rate as compared with the 1-week regime. Increasing the duration of therapy significantly improved the chances of eradication of H. pylori in duodenal ulcer disease.