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   Table of Contents - Current issue
Coverpage
April-June 2018
Volume 5 | Issue 2
Page Nos. 59-111

Online since Tuesday, September 11, 2018

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EDITORIAL  

Pranayama could be the best nonpharmacological and nonsurgical method of vagal nerve stimulation p. 59
Gopal Krushna Pal
DOI:10.4103/ijcep.ijcep_34_18  
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REVIEW ARTICLE Top

Molecular characterization of free radical function in redox signaling and strategies to reduce oxidative stress in cardiovascular diseases p. 61
Leta Shiferaw Melaku
DOI:10.4103/ijcep.ijcep_21_18  
Free radicals are molecules with an unpaired electron. Due to the presence of free electron, these molecules are highly reactive. At moderate concentrations, free radicals play an important role as regulatory mediators in signaling molecules in a number of normal biochemical and physiological processes. Although there are several sources of vascular reactive oxygen species (ROS), the enzyme nicotinamide adenine dinucleotide phosphate oxidase is emerging as a strong candidate for excessive ROS production that is thought to lead to vascular oxidative stress. The implication of oxidative stress in the etiology of several cardiovascular diseases suggests that strategically, nonpharmacological and pharmacological therapy represents a promising avenue for treatment.
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ORIGINAL ARTICLES Top

Persistence of oxidative stress in newly diagnosed hypothyroid patients despite effective thyroxin therapy p. 70
Nivedita Nanda, Zachariah Bobby, Abdoul Hamide
DOI:10.4103/ijcep.ijcep_22_18  
Background and Aim: We have earlier reported increased oxidative stress (OS) in newly diagnosed hypothyroid patients. However, the comprehensive effect of thyroxin supplementation on OS, insulin resistance, inflammation, and glycation levels has not been analyzed. Therefore, in the present study, we have analyzed the effect of thyroxin therapy in newly diagnosed hypothyroid patients on OS and various biochemical markers after normalization of thyroid profile. Methods: Out of 67 recently diagnosed primary hypothyroid patients, 37 patients were recruited for this study based on the criteria of strict adherence to thyroxin treatment protocol and regular follow-up. Venous blood samples were analyzed before and 6 months after initiation of therapy for glucose, thyroid and lipid profiles, insulin, ultrasensitive C-reactive protein (usCRP), and anti-thyroperoxidase (TPO) antibody. Antioxidants such as glutathione, glutathione peroxidase, catalase, and glutathione S-transferase, and oxidized products such as malondialdehyde (MDA), and protein carbonyl (PCO) levels were analyzed as parameters of OS. HbA1 and fructosamine were assayed as glycation indices, and lipid risk factor for coronary artery disease was calculated from lipid profile. The parameters were re-assayed 6 months later after normalization of thyroid profile. Results: OS (MDA; P < 0.01 and PCO; P < 0.01) did not come back to normal level despite attainment of normal thyroid profile following treatment. Dyslipidemia (P < 0.05) and inflammation (P < 0.05) were significantly associated with OS. Furthermore, levels of triglyceride, anti-TPO antibody, and usCRP were higher in patients even after successful treatment. Conclusion: OS in treated hypothyroid patients despite normalization of thyroid profile persists longer which could partly be due to the residual inflammation and/or dyslipidemia.
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Aortic blood pressure and central hemodynamics measured by noninvasive pulse wave analysis in Gujarati normotensives p. 75
Jayesh Dalpatbhai Solanki, Hemant B Mehta, Chinmay J Shah
DOI:10.4103/ijcep.ijcep_24_18  
Background and Aim: Central blood pressure (BP) and central hemodynamics are immediate and discrete parameters inferring about the cardiovascular system. They can be studied noninvasively by pulse wave analysis (PWA). Before use, these parameters need normative baseline study to set reference values. Methods: We conducted a cross-sectional study in 900 normotensives, aged 15–65 years (divided into five subgroups). Oscillometric PWA was accomplished by Mobil-O-Graph (IEM, Germany). Aortic BP, cardiac output (CO) and index, peripheral resistance, stroke volume and index, stroke work, difference between brachial and aortic systolic, and pulse pressure were the studied parameters. They were analyzed further with respect to subgroup based on age, gender, and body mass index (BMI). Multiple regressions were done to find significant predictors of central hemodynamics. P < 0.05 was taken as statistical significance. Result: There were five age-based subgroups from 15 to 65 years, showing increase in central BP- and CO-related parameters age. Males had significantly higher results than females except heart rate (HR) and peripheral resistance. BMI ≥23 was related to significantly higher results. Age, HR, height, weight, and BMI were not significant predictors of PWA parameters. Central hemodynamics were predicted by brachial BPs, systolic and diastolic more than mean or pulse. Conclusion: It is feasible to assess central hemodynamics by PWA. Age, gender, BMI, HR, and brachial pressure affect the central hemodynamics in normotensive individuals. These baseline data can be referred for the future studies in our population.
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Correlation of baseline and Isometric exercise-induced blood pressure with total body fat percentage and body mass index in female medical students p. 81
Sri Nageswari Kalluri, E Syamala Bhupathi, Vidya Ganji
DOI:10.4103/ijcep.ijcep_23_18  
Background and Aim: Studies on obese and nonobese Indian girls from minority community, spending less time in outdoor activities due to conservative restrictions imposed on them, are scanty in literature. The aim of this study were as follows: (1) Recording Baseline systolic (SBP) and diastolic blood pressure (DBP) and pressor response to isometric exercise and (2) Measurement of total body fat% (TBF), visceral fat (VF), body age (BA) and correlations with each other and with body mass index (BMI). Methods: Ninety female medical students (aged 18-22 years) filled up a detailed questionnaire and were classified as obese (BMI ≥30), overweight (BMI≥25-30, clubbed with obese, n=24) and nonobese (BMI<25, n=66) groups. Baseline DBP and SBP and DBP and SBP at 1, 2 and 3 min of isometric exercise (hand grip dynamometer Test at 30% of Tmaxvalue) were recorded. The TBF%, VF and BA were obtained using HBF-362 Karada scan. Student's t-test, Independent and paired sample comparison, Pearson's correlation coefficient, and linear regression analysis were done. Results: High baseline DBP, SBP and SBP at 2 and 3 minutes of isometric exercise in the obese group (P < 0.002, 0.003, <0.04 and <0.007 respectively) correlated positively with BMI (r = 0.4,0.4,0.35 and 0.38 respectively; P < 0.001). Significant (P < 0.001) positive correlation among TBF%, VF, versus BA (r = 0.9 and 0.88, respectively) and TBF % versus VF (r = 0.8) and linear relationship with BMI (P < 0.001, r = 0.95, 0.89, and 0.95; BA, TBF, and VF, respectively) was observed in obese group. In 50% of non-obese students having TBF% >28%, the BA was significantly higher (P < 0.03) than rest of the controls. Conclusion: Obesity is associated with increase in baseline BP and higher pressor response to isometric exercise. Higher BA and total TBF% can lead to cardiovascular anomalies within normal BMI limits and hence should be considered while classifying obesity.
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The impact of sildenafil citrate on neurotransmitter amino acid levels in brain tissue of albino rats p. 87
Hani M Abdelsalam
DOI:10.4103/ijcep.ijcep_18_18  
Background and Aim: Sildenafil citrate is an active cyclic guanosine monophosphate-specific phosphodiesterase type 5 inhibitor that is successful in the therapy of male erectile dysfunction. Previous studies have seen the behavioral changes associated with sildenafil, but they have not studied the chronic effect of sildenafil or its possibly related neurochemical changes. Therefore, in the present work, brain neurochemical alterations (excitatory and inhibitory neurotransmitter amino acids) associated with chronic administration of sildenafil citrate using male albino rats were investigated. Methods: Rats were categorized into two groups (n = 8): Group 1 received saline (0.5 ml/kg) and Group 2 received single dose of sildenafil citrate (Viagra®, Pfizer Inc.) dissolved in saline and administered at a dose of 10 mg/kg intraperitoneal (i.p) (0.5 ml) to rats in the treated group once in 3 days for a total of 8 weeks. All rats were sacrificed 24 h after the last injection. Brain area homogenate for neurotransmitter evaluation was done by high-performance liquid chromatography. Results: It has been found that the chronic i.p. injection of sildenafil citrate caused a pronounced increase in the levels of both excitatory and inhibitory amino acids in most of the brain regions studied. The maximal increase in the concentration of excitatory (glutamate and aspartate) and inhibitory (γ-aminobutyric acid and glycine) amino acids was obtained in the cerebellum. Glutamine and alanine concentration recorded the maximal increase in cerebral hemisphere of the rat brain. While the maximal increase in the levels of asparagine was recorded in the olfactory lobe, the maximal decrease in the excitatory (glutamine and asparagine) and the inhibitory (glycine and alanine) amino acids was obtained in the pons medulla, while taurine concentration showed a significant increase in pons medulla. Conclusion: Our results explained the effect of sildenafil on central neural pathways that are related to the control of sexual arousal (erection).
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Cognitive deficit is linked to cardiovascular risk in type 2 diabetes mellitus p. 94
Auroprajna Pal, Jaya Prakash Sahoo, Lalitha Venugopal, Allampali Sirisha, Gopal Krushna Pal
DOI:10.4103/ijcep.ijcep_36_18  
Background and Aim: Diabetes has been reported to be caused by sympathovagal imbalance and is associated with cardiovascular (CV) risks and a wide variety of cognitive loss. The present study was designed to assess the link of cognitive deficit with CV risks in diabetic patients. Methods: Eighty participants (forty type 2 diabetic patients and forty controls) were included in this case–control study. The rate-pressure product (RPP), heart rate variability, event-related potential (P300), and biochemical parameters were recorded in both groups. Association of various factors with RPP was studied by Pearson's correlation analysis, and the independent contribution of factors to RPP was assessed by univariate regression analysis. Results: RPP and low-frequency-to-high-frequency (LF-HF) ratio were increased in patients with diabetes. The latency of P300 was significantly prolonged in patients with diabetes and P300 latency was positively correlated with RPP, the marker of myocardial oxygen stress, in hypertensives. The Homeostatic Model Assessment of Insulin Resistance and malondialdehyde significantly correlated with RPP. The P300 had independent contribution to RPP in diabetic group. Conclusion: Type 2 diabetic patients have sympathovagal imbalance, myocardial oxygen stress, oxidative stress, and considerable cognitive impairment. The cognitive impairment could be associated with CV risks in these patients.
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Relationship between respiratory function and serum interleukin-6 level in nonobese and obese male adult subjects p. 99
Thurein Zaw, Nwe Nwe Yee, Mya Thanda Sein
DOI:10.4103/ijcep.ijcep_26_18  
Background and Aim: Proinflammatory cytokines may be the crucial factor in link between respiratory function decline and obesity. The aim of the present study is to investigate the relationship between respiratory function and serum interleukin-6 (IL-6) level in nonobese and obese male adult subjects. Methods: A community-based cross-sectional comparative study was carried out in 30 nonobese (body mass index [BMI] = 22.99 ± 1.08 Kg/m2; waist circumference [WC] = 75.27 ± 4.08 cm), 34 generally obese (BMI = 30.88 ± 0.87 Kg/m2; WC = 84.03 ± 3.02 cm), and 37 centrally obese subjects (BMI = 31.59 ± 2.11 Kg/m2; WC = 96.08 ± 3.35 cm). Spirobank II spirometer was used to measure respiratory function (forced expiratory volume in 1 s [FEV1], forced vital capacity [FVC], FEV1/FVC, peak expiratory flow rate, and average forced expiratory flow between 25% and 75% of FVC). Serum IL-6 level was measured by enzyme-linked immunosorbent assay. For comparative studies, ANOVA test was used for normally distributed data and Kruskal–Wallis test was used for screwed data. Pearson's correlation and Spearman's rho test were used for correlation studies. Results: The percentage of predicted value of all respiratory function parameters of generally obese group as well as centrally obese group was significantly lower than that of nonobese group (P < 0.05). Median and interquartile range of serum IL-6 level of nonobese group, generally obese group, and centrally obese group were 10 (10–11) pg/mL, 32 (17.5–65) pg/mL, and 52 (25–65) pg/mL, respectively. There were significant differences between the groups (P < 0.001). There was a significant positive correlation between serum IL-6 levels and BMI (r = 0.519, n = 101, P < 0.001) as well as WC (r = 0.547, n = 101, P < 0.001). All respiratory function parameters were significantly and negatively correlated with anthropometric measurements (BMI and WC) as well as serum IL-6 level. Respiratory functions were more significantly and strongly correlated with anthropometric parameters than serum IL-6. Conclusion: It was concluded that reduced respiratory function in obesity might be due to mechanical effect of obesity and systemic low-grade inflammatory effect of obesity is partly contributed.
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CASE REPORT Top

Disappearance of ventricular ectopics following 15-day practice of Pal's pranayama schedule p. 105
Gopal Krushna Pal
DOI:10.4103/ijcep.ijcep_38_18  
A 56-year-old male presented to the Cardiology Outpatient Department with symptoms of left-sided chest pain and sensation of dropped beats for the last 5 days. The chest pain was diffuse and not associated with radiation to left arm or sweating. Fifteen days of practice of Pal's pranayama schedule resulted in disappearance of chest discomfort and abolition of ventricular ectopics.
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LETTER TO EDITOR Top

Multiple choice questions in medical education: Indispensable or expendable? p. 108
Sabyasachi Sircar
DOI:10.4103/ijcep.ijcep_17_18  
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NEWS AND VIEWS Top

News and views p. 111
Priyadharsini Rajendran
DOI:10.4103/2348-8832.241042  
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