Search

Background and objective: Prolonged standing is one of the significant contributors to chronic venous insufficiency (CVI) in industry workers. Yoga is proven to be an effective therapy in treating occupational hazards. The current study aimed to investigate the effect of yoga on CVI among industry workers. Methodology: Male workers (n = 100) from machinery manufacturing industries in Bangalore meeting the inclusion and exclusion criteria were recruited for the study. The yoga group received a specifically designed yoga module for 6 days a week for 12 weeks, and the control group was offered lifestyle suggestions. Plasma homocysteine was used as the primary outcome variable, whereas Venous Clinical Severity Score, ankle brachial pressure index (ABPI), ankle and calf circumference, CVI questionnaire, and Chalder fatigue scale were assessed as secondary variables at baseline and the end of 12 weeks of intervention. Results: Eighty-eight participants (yoga = 43, control = 45) completed the study. A one-way analysis of covariates (ANCOVA) was used to determine the significant differences between groups in the post-values. A significant difference was found between groups in plasma homocysteine (partial eta squared = 0.34, p < 0.001). All variables, except for ABPI, calf circumference, and ankle circumference, had shown statistically significant differences between the yoga and control groups after 12 weeks of intervention, with moderate to high effect sizes. There were no significant adverse events associated with the intervention. Conclusions: Yoga practices can reduce the symptoms of CVI along with vascular inflammation as indicated by reduced plasma homocysteine. Overall, yoga practices are found to be safe and efficacious for managing CVI. IEC Reference Number: RES/IEC-SVYASA/184/2021 Trial Registration Number (If Clinical Trial): CTRI/2021/02/030944 [ABSTRACT FROM AUTHOR]

Background: A large proportion of amputations of lower extremity secondary to aPAD is the major cause of significant disability and hence economic burden on individual and as well as the healthcare system in developing countries like India. LEAD is characterized by a spectrum ranging from no symptoms, intermittent claudicating, pain at rest to finally non-healing wounds & gangrene. ABPI is a not only a sensitive but cost-effective screening tool for LEAD. Pulse oximetry (PO) which is a simple, noninvasive, readily available & inexpensive tool for measurement of oxygen saturation in peripheral blood (SpO2). This study was conducted to comapre (ABPI) plus Pulse oximetry with Duplex Ultrasound in detecting LEAD in Diabetes Mellitus. Material and Methods: Inclusion Criteria: Adults more than 40 years with known diagnosis of Diabetes Mellitus. Exclusion Criteria: Patient having lower limb amputation, fracture, or gangrenous limb, Patient with pedal oedema or ulcer, Previous history of hypercoagulable states, congestive heart failure, suspected arteritis, or collagen vascular diseases, Patients with coarctation of aorta & Patients with pre-existing diagnosis of lower extremity arterial disease (LEAD). Results: This study was carried out at TMMC & RC (Moradabad, UP). It was a prospective hospital based observational study. Out of 55 participant 30 (54.5%) are smoker and 25 (45.5%) are non-smoker. Among 30 smoker 29 (96.7%) are pulse oximeter positive and 1 (3.33%) are pulse oximeter negative. In our study, Right limb analysis suggestive of 75% of sensitivity, 39.1% of specificity, 63.2% of PPV and 52.9% of NPV. Right ABPI has 60% of accuracy. Left limb analysis suggestive of 65.5% sensitivity, 42.3% specificity, 55.9% PPV and 52.4% NPV. Left limb ABPI has 54.5% of accuracy. Left limb pulse oximeter method analysis suggestive of 93.1% sensitivity, 23.1% specificity, 57.4% PPV and 75% NPV. Left limb pulse oximetry method has 60% of accuracy. Average pulse oximeter analysis: 91.8% sensitivity, 22.4% specificity, 60% PPV and 68.7% NPV. Average ABPI had an accuracy of 60.9%. Conclusion: A combination of ABPI & PO is most sensitive with highest negative predictive value. These methods are simple, cost effective, quick, non-invasive and easily available tools. Hence, detection of LEAD should be a part of regular work-up of DM patients. [ABSTRACT FROM AUTHOR]

Background: The primary symptom of peripheral arterial disease (PAD) is intermittent claudication and the most common non-invasive diagnostic method is ankle brachial index. Peripheral arterial disease is usually accompanied by various other co-morbidities like type 2 diabetes mellitus, hypertension, and hypercholesterolemia. Literature suggests that when peripheral arterial disease is accompanied by type 2 diabetes mellitus, the ankle-brachial index can be falsely elevated due to medial calcification of the arteries. Therefore, an assessment of microcirculation using the toe brachial index is needed to diagnose PAD in these individuals. It has been well established that walking ability and ankle-brachial index are correlated in peripheral arterial disease. However, there is a dearth of literature on whether there is a correlation between toe brachial index (TBI) and walking ability. Therefore, the objective of the study is to find the correlation between toe brachial index and walking ability in type 2 diabetes mellitus with peripheral arterial disease. A total of 1485 participants were screened for the study, among which 133 met the inclusion criteria. Informed consent was obtained and the included participants were assessed for their demographic details. Toe brachial index was performed with the help of Doppler and 6-min walk test was performed to measure the claudication in the participants. Results: In the present study of 133 participants, we found a strong positive correlation between toe brachial index and 6-min walk distance (r = 0.911 p value < 0.05). The walking ability is directly proportional to the TBI, i.e., the lesser the values of TBI, the lesser the walking distance covered in peripheral arterial disease with type 2 diabetes mellitus. Conclusion: The present study concludes that there is a strong positive correlation between toe brachial index and 6-min walk distance. [ABSTRACT FROM AUTHOR]

Peripheral arterial disease (PAD) is one of the underdiagnosed and undertreated vascular diseases despite its significant burden in India. In India, the etiological aspects, diagnostic approaches, treatment modalities, and other preventive measures probably vary in different regions. Therefore, this consensus was developed that provides a unified approach for physicians to effectively diagnose and manage PAD in India. In this consensus, we identify that the prevalence of PAD varies from 5% to 25% in Indian setting. Both atherosclerotic and non-atherosclerotic risk factors may underlie PAD. Asymptomatic PAD remains the most common presentation of the disease. The detailed clinical history, physical changes in the lower leg skin, and examination of peripheral pulses can provide clues to the diagnosis. Ankle-brachial index and Duplex ultrasound are advised as the initial choice of diagnostic measures. Besides control of risk factors such as hypertension, diabetes, dyslipidemia, and smoking, pharmacological treatment with anti-platelet and antithrombotic drugs is advised. By efficacy, ticagrelor is considered equivalent to clopidogrel and cilostazol is advised in intermittent claudication. In the revascularization of tibio-pedal lesions, endovascular therapy is effective and arterial bypass with vein graft may be needed in difficult and extensive revascularization scenarios. In these lesions, prosthetic grafts must be avoided. Diabetic foot ulcer management is challenging as foot care among diabetics is poor. In limb, salvation should always be a priority with avoidance of amputation if possible. Stem cell therapy has been successful in PAD which can be advised to "no-option" patients to prevent amputation. Physicians should undertake effective screening of PAD and be considered "PAD Clinics" in India. [ABSTRACT FROM AUTHOR]

Background: Coronary artery disease(CAD) is a leading cause of morbidity and mortality in India. We have done this work to study prevalence of symptomatic and asymptomatic PVD in CAD patients undergoing CABG and to study whether low ankle brachial pressure index (ABPI) can be used as predictor of morbidity and mortality in CABG. Methods: Descriptive study was done enrolling continuous 80 patients who were referred for coronary artery bypass grafting. On bases of ABPI they were divided into 2 groups, group I included patients of CAD with PAD and group II included patients of CAD without PVD. Syntax score was calculated. Cardiovascular risk factors, intraoperative mortality and myocardial infarction, postoperative complications were studied. Study was performed from March 2013 up to December 2014. Results: 88.75% of patients were males and 11.25% patients were females. Mean age was 55.94±8.42. Smoking and hypertension encountered in 85% and 45.6% of all patients respectively. BMI of >30 was present in 8.75% patients. 36% patients of group I and 35 % patients of group were diabetic. Left anterior descending artery was most commonly involved vessel in 97%. Deranged RFT's were found in 29% and 8% patients in group I and II respectively. Conclusion: ABPI can be useful in assessing both the atherosclerotic risk factors and the degree of coronary involvement. ABPI is a simple and easy tool to diagnose symptomatic and asymptomatic PVD. [ABSTRACT FROM AUTHOR]

Background: Peripheral arterial disease (PAD) of lower extremities comprises a clinical spectrum that extends from asymptomatic patients to critical limb ischemia (CLI) patients. 10% to 40% of the patients are at the risk of primary amputation. This study was planned in "no-option" patients of CLI due to atherosclerotic PAD to assess the efficacy and safety of pooled, allogeneic, adult human bone marrow-derived mesenchymal stromal cells which is already approved for marketing in India for CLI due to Buerger's disease. Methods: This was a single-arm, multi-centric, phase III study where mesenchymal stromal cells was injected as 2 million cells/kg body weight in the calf muscle and around the ulcer. Twenty-four patients of lower extremity CLI due to PAD with Rutherford III-5 or III-6 and ankle–brachial pressure index ≤ 0.6 and having have at least one ulcer with area between 0.5 and 10 cm2 were included in the study. These patients were evaluated over 12 months from drug administration. Results: Over a period of 12 months, statistical significant reduction of rest pain and ulcer size along with improvement in ankle–brachial pressure index and ankle systolic was observed. The quality of life of patients improved together with increase in total walking distance and major amputation-free survival time. Conclusion: Mesenchymal stromal cells may be a feasible option to treat "no-option" patients with atherosclerotic PAD. Trial registration This study is registered prospectively in National Institutes of Health and Clinical Trials Registry—India (CTRI) website: CTRI/2018/06/014436. Registered 6th June 2018. http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=24050&EncHid=&userName=stempeutics. [ABSTRACT FROM AUTHOR]

Background: The permanent cessation of ovarian function and the transition of a woman from a reproductive to a nonreproductive life is defined as Menopause. This period is characterized by remarkable changes in menstruation and hormonal patterns as well as psychological and physiological symptoms. Objectives: The objectives of this study was to assess the Body-Mass Index, Waist-Hip Ratio, Submaximal Aerobic Capacity, Ankle-Brachial Index and Quality of Life using the SF-12 questionnaire among post-menopausal apartment dwelling women. Design: Descriptive Study Methods: 110 subjects meeting the inclusion and exclusion criteria were included in the study. The subjects were assessed based on the screening tools Body-Mass Index (BMI) and Waist- Hip Ratio. The outcome tools used to assess the risk of cardiovascular disease among post-menopausal apartment dwelling women were Ankle- Brachial Index (ABI), Six-Minute Walk Test (6MWT) and health related quality of life SF-12 Questionnaire. Results: Out of 110 subjects, 59 subjects had a BMI of 25-29.9 kg/m² and 36 subjects had a BMI of ≥30 kg/m². 56 (51%) subjects had substantially higher waist- hip ratio (≥0.85 cm). 61(55.5%) subjects had mild to moderate peripheral arterial disease on left side and 67 (60.9%) subjects had mild-moderate peripheral arterial disease on right side. The range of 6MWD is between 490-900 m. The correlation between MCS 12 and PCS 12 has an intermediate poor correlation. Conclusion: The study shows that Post- Menopausal Apartment Dwelling Women are at risk of Cardiovascular Disease. [ABSTRACT FROM AUTHOR]

This study was carried out with an aim of screening the hospital-based population through ankle-brachial pressure index measurement to identify the asymptomatic patients of peripheral arterial disease. Further association of peripheral arterial disease with other risk factors was also studied. A total of 1000 patients of a surgical unit of a university hospital, Varanasi, India, were studied for a period of 2 years. Ankle-brachial pressure index in both lower limbs was measured. Patients aged less than 18 years and patients with blood pressure less than 90/60 mm Hg were excluded. History of claudication, smoking, hypertension, diabetes, coronary artery diseases, and family history of peripheral arterial disease were recorded. Patients with an ankle-brachial pressure index less than 0.9 were labeled as a case of peripheral arterial disease. Out of 1000 patients, 35 patients were symptomatic for peripheral arterial disease and all had ankle-brachial pressure index value < 0.9. Rest 965 patients were asymptomatic, out of which 155 (16.1%) had ankle-brachial pressure index less than 0.9. Elderly male smokers were the main victims. Hypertension was associated with an increased risk for peripheral arterial disease. Out of 15 patients with a history of coronary artery disease, 12 had peripheral arterial disease. The prevalence of peripheral arterial disease in an asymptomatic hospital-based population was 16.1%. Screening by measuring ankle-brachial pressure index can help in its early detection. Risk factors modification at this stage can prevent significant morbidity due to the disease. [ABSTRACT FROM AUTHOR]

Introduction: Diabetes Mellitus (DM) is a metabolic disorder characterized by persistence hyperglycemia resulting from the defects in insulin secretion, action or both. Diabetes prevalence is rapidly increasing, especially in urban India. The changing lifestyle has majorly contributed to the increasing prevalence of diabetes. Aim: To determine the incidence of microalbuminuria and its correlation with age, sex, duration, Fasting Blood Sugar (FBS), Postprandial Blood Sugar (PPBS) and Body Mass Index (BMI). Also to detect the presence of vascular complications using Ankle Brachial Index (ABI), Pulse Wave Velocity (PWV), Augmentaion Index (AI) and microalbuminuria. Materials and Methods: The present cross-sectional study was conducted in Shri B.M. Patil Medical College, Hospital and Research Centre, Vijayapura, Karnataka, India from March 2018 to June 2018. The study included assessment of blood glucose level both fasting blood sugar and postprandial blood sugar, microalbumin levels in 100 known diabetic patients and also ABI, PWV and AI were measured using periscope instrument. Analytical test to measure the differences between two means of the two groups independent t-test was applied and multiple regressoon analysis was done. Results: Out of total 100 subjects 59% were males and 41% were females. The correlation of microalbuminuria with factors like, duration of diabetes, FBS, PPBS, PWV and AI was statistically significant with a p-value of <0.05 in this study. The correlation of duration of diabetes with factors like age, BMI, microalbuminuria was statistically significant with a p-value of <0.05. Conclusion: This study confirmed that incidence of microalbuminuria increases with duration of diabetes, poorly controlled blood sugar levels. Microalbuminuria, ABI, PWV and AI are the reliable, non invasive and simple methods used for the screening of vascular complications. [ABSTRACT FROM AUTHOR]

Background and Objectives: India is claimed to be the diabetes capital of the world. Many studies had proven that persistent hyperglycemia and associated metabolic syndrome features like hypertension, dyslipidemia and obesity contribute to the development of vascular complications. The present study aims to study the prevalence and clinical profile of microvascular and macrovascular complications in newly diagnosed type 2 diabetes mellitus patients. Methods: The study is a clinical, prospective and observational study of 100 newly detected type 2 diabetics attending medicine department outpatient/ inpatient, MMU hospital, ambala, form the subject for the study August 2018 to July 2020 (24 months) who matched the inclusion criteria. Results: In this, 62 were males and 38 were females and the mean age was 54.05±13.24 years. 44% were detected when they presented with multiple complications due to diabetes. Common complications which they presented were coronary artery disease (15%), infection (12%), stroke (6%), ulcers (4%), neuropathy (4%) and diabetic ketoacidosis (1%). The prevalence of macrovascular complications CAD, CVD and PAD was 26.0%, 8.0% and 11.0% respectively and microvascular complications retinopathy, nephropathy and neuropathy was 20.0%, 34.0% and 16.0% respectively.High incidence of complications especially microvascular and CAD occur with HbA1c of range >6.5. The correlation coefficient of FBS and PPBS in relation to HbA1c was 0.56 and 0.57 respectively. Conclusion: Smoking, increased BMI and waist circumference is associated with increased prevalence of diabetes. There is high prevalence of coronary artery disease, retinopathy and nephropathy at diagnosis.HbA1c levels predict the prevalence of complications. [ABSTRACT FROM AUTHOR]

Emerging shreds of evidence indicates that the risk of diabetic foot ulcer and associated morbidity can be reduced through the intensive glycemic control. There are very few studies which assessed the effects of glycemic control on diabetic foot problems among Indian patients. We aimed to assess the effect of glycemic control on the outcomes of diabetic foot problems among adult type 2 diabetes (T2DM) patients with foot ulcers. A cross sectional study was conducted among the T2DM patients from a tertiary care teaching hospital in South India. The demographic characters, risk factors, treatment characters, glycemic status were collected among the patients and analyzed against the outcomes of diabetic foot ulcers by reviewing their medical records. Descriptive statistics were used to present the data. The Chi-square test and ANOVA were used for was used for the categorical variables and continuous parameters to identify the factors affecting the outcomes, respectively. All analysis was performed in SPSS v21. Out of the 100 participants included in the study, 70% were male. The majority (78%) were from an age group of 40 to 70 years, and the mean age was found to be 59.91 ± 10.6 years. The mean duration of diabetes was 9.66 years. Only ankle-brachial Index score (p=0.001) was significantly associated with the type of ulcers, whereas other factors not (p>0.05). A high level of average HbA1c, BMI, ABI index and poor glycemic status was associated with a significant debridement strategy and longer duration of hospitalization; however, it was not substantial. Our study inferred that poor glycemic status is associated with a significant debridement strategy and longer duration of hospitalization. However, these findings need to be strengthened with adequately powered prospective studies. [ABSTRACT FROM AUTHOR]

Objective: Atherosclerosis is associated with arterial stiffness and can cause acute cerebral stroke or myocardial infarction. It is the most prevalent and progressive disease of recent times. Coronary artery disease (CAD) is the leading cause of morbidity and mortality in India. The objective of our study was to use the ankle-brachial index (ABI)in a high-risk populationto find out the prevalence of previously unrecognized peripheral arterial disease in the lower limbs and its correlation with coronary artery disease. Methods: We analyzed data from 100 consecutive patients with coronary arterial disease, as confirmed by coronary angiography. We measured the ankle-brachial index after coronary angiography. Patients were divided into two groups. Group A had ankle-brachial index (ABI) <0.9 and group B had ABI >0.9. ABI <0.9 was used to diagnose peripheral arterial disease. Results: We have diagnosed asymptomatic peripheral arterial disease in 74% of the patients who were subjected to a coronary angiogram and had significant coronary artery disease. In Group A, we found that 62.1% of patients had multi-vessel coronary artery disease and 12.1% had left main coronary artery disease. Conclusion: There is a significant correlation between peripheral arterial disease and coronary artery disease. Early diagnosis and treatment of the patient with PAD are important for preventing local progression of the disease and effective secondary prevention of future coronary and cerebrovascular events. [ABSTRACT FROM AUTHOR]

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a significant cause of morbidity and mortality globally. COPD is a systemic disease, cardiovascular and Peripheral Arterial Disease (PAD) are common entities in COPD. Asymptomatic, undiagnosed PAD can lead to impaired functional exercise capacity, increased morbidity and mortality. Aim: To find out the occurrence of PAD in COPD and relative contribution of PAD, severity of COPD, and Health Related Quality of Life (HRQL) on functional exercise capacity. Materials and Methods: The present study was a prospective, cross-sectional, analytical study carried out in the Department of Respiratory Medicine of a teaching institution in eastern India over a period of six months. All COPD patients diagnosed as per Global Initiative for Obstructive Lung Diseases (GOLD) criteria were recruited for the study after obtaining written informed consent. HRQL was assessed by Clinical COPD Questionnaire (CCQ). Exercise capacity was assessed by Six Minute Walk Test (6MWT) and PAD was evaluated by Ankle Brachial Index (ABI) on Ultrasound (USG) Doppler. Data were analysed using appropriate statistical tests. Mean, Standard Deviation (SD) and percentages were calculated for descriptive frequencies, p-value was calculated using Fischer’s-exact test or Chi-square test for categorical data and independent sample t-test and Kruskal Wallis test for parametric and non parametric data, respectively. Results: Out of 75 COPD patients, PAD was present in 18 (24%) patients. Majority of COPD patients (n=35; 46.6%) were in GOLD group D. There was no statistically significant difference in age, Body Mass Index (BMI) and smoking index between COPD with and without PAD. Most PAD patients were asymptomatic. In comparison to COPD without PAD, severe PAD cases had significantly less Six Minute Walk Distance (6MWD), more episodes of leg cramps and needed to stop more frequently during 6MWT. Apart from PAD, increasing severity in COPD was associated statistically significant changes in Forced Expiratory Volume in the first second (FEV1), CCQ score, 6MWD, post 6MWT Heart Rate (HR), Respiratory Rate (RR), Borg score, fatigue, Oxygen Saturation (SpO2). Conclusion: PAD is a frequent entity in COPD and can be diagnosed easily by measuring ABI. Increasing COPD severity affect HRQL and exercise capacity significantly. [ABSTRACT FROM AUTHOR]

Background and Objectives: India is claimed to be the diabetes capital of the world. Many studies had proven that persistent hyperglycemia and associated metabolic syndrome features like hypertension, dyslipidemia and obesity contribute to the development of vascular complications. The present study aims to study the prevalence and clinical profile of microvascular and macrovascular complications in newly diagnosed type 2 diabetes mellitus patients. Methods: The study is a clinical, prospective and observational study of 100 newly detected type 2 diabetics attending medicine department outpatient/ inpatient, SGRRIMHS hospital, dehradun, form the subject for the study August 2018 to July 2020 (24 months) who matched the inclusion criteria. Results: In this, 62 were males and 38 were females and the mean age was 54.05±13.24 years. 44% were detected when they presented with multiple complications due to diabetes. Common complications which they presented were coronary artery disease (15%), infection (12%), stroke (6%), ulcers (4%), neuropathy (4%) and diabetic ketoacidosis (1%). The prevalence of macrovascular complications CAD, CVD and PAD was 26.0%, 8.0% and 11.0% respectively and microvascular complications retinopathy, nephropathy and neuropathy was 20.0%, 34.0% and 16.0% respectively.High incidence of complications especially microvascular and CAD occur with HbA1c of range >6.5. The correlation coefficient of FBS and PPBS in relation to HbA1c was 0.56 and 0.57 respectively. Conclusion: Smoking, increased BMI and waist circumference is associated with increased prevalence of diabetes.There is high prevalence of coronary artery disease, retinopathy and nephropathy at diagnosis. HbA1c levels predict the prevalence of complications. [ABSTRACT FROM AUTHOR]

Background: India is considered the diabetes capital of the world. As per current practice, most of the diabetes patients go to primary care physicians for their monitoring and follow up. One of the dreaded complications of long-term diabetes is peripheral arterial disease. Methods: A cross-sectional observational study was conducted in a diabetes workshop. Totally, 48 patients were selected who satisfied the inclusion criteria. All were subjected to ankle-brachial index measurement (ABI) and doppler ultrasound was done to assess patency of the lower extremity arteries. The results were compared. The ankle-brachial index of less than 0.99 was considered abnormal. Results: Out of a total of 48 included patients 26 patients had normal ABI and 22 patients were found to have abnormal ABI. Out of those with normal ABI, 2 patients had features of peripheral arterial disease proved by doppler, whereas 3 patients with abnormal ABI had no feature of peripheral arterial disease in doppler. MedCalc software was used for statistical comparison. Conclusion: In the selected diabetic population prevalence of peripheral arterial disease was found to be 56.25%. Measurement of ABI was found to be quite a sensitive and specific method for diagnosing peripheral arterial disease of diabetics. [ABSTRACT FROM AUTHOR]

Introduction: Acute Coronary Syndrome (ACS) and Peripheral Artery Disease (PAD) represent the serious presentations of the atherosclerotic disease spectrum. PAD due to atherosclerotic disease can lead to significant morbidity and mortality with significant medical and economic burden. Aim: To study the prevalence of PAD in patients presenting with ACS in the Hill population of Northern India. Materials and Methods: Patients presenting with ACS, with acute chest pain, Electrocardiogram (ECG) changes and elevated troponins were enrolled in the study. The presence of PAD was assessed with MESI Ankle Branchial Measuring Device (MESI ABPI MD® Slovenia EU) system which uses plethysmographic sensors with an inbuilt software that automatically calculates ABI with accuracy. Patients with ABI <0.91 were further evaluated by Computed Tomography (CT) Angiography of lower limb vessels. Results: A total of 288 patients were included in the study. There were 238 (82.6%) males and 50 (17.4%) females. Majority of patients had hypertension (214, 74.3%) as the risk factor. ST-Elevation Myocardial Infarction (STEMI) was seen in 197 (68.4%) and Non-ST Elevation Myocardial Infarction (NSTEMI) in 91 (31.6%). Coronary angiography was done in 240 patients. Single vessel disease was seen in 135 (56.2%), double vessel disease in 69 (28.8%) and triple vessel disease in 36 (15%) cases. Out of overall 288 patients 9 (3.12%) had borderline ABI (ABI- >0.9 and ≤1.0) and 4 (1.38%) had abnormal ABI (ABI <0.9). CT angiography of 3 out of 4 patients with ABI <0.9 showed significant atherosclerosis of lower limb vessels. Conclusion: There was very low prevalence of PAD with ACS in this study population. [ABSTRACT FROM AUTHOR]

Background: A chronic leg ulcer (CLU) is a significant public health problem. It has various etiologies. Racial, familial, occupational, and social factors may also have an impact on the prevalence of different causes of leg ulcers. Though there are western data on the epidemiology of leg ulcer, similar data are largely unavailable from our part of the world. Aims: We undertook a study in a tertiary care center in eastern India to determine the clinical and etiological pattern of patients with CLU. Materials and Methods: Hundred consecutive patients presenting with CLU, fulfilling the criteria, were included after informed consent. Patients were subjected to proper history taking, clinical examination, routine blood test, and pus for culture and sensitivity test (where needed) along with Ankle Brachial Index (ABI). Results: Among the 100 patients, venous ulcer (34%) was predominant followed by arterial ulcer (14%), mixed arterial and venous ulcer (11%). History of smoking (56%) and obesity (BMI >25) (32%) were the common risk factors in leg ulcer patients. Fifty nine percent of the total CLU were infected and out of this, 86.4% showed growth of microorganisms.Staphylococcus aureus (39%) was the most commonly isolated organism, followed by Pseudomonas aeruginosa (15%). Eleven (24.44%) clinically diagnosed venous ulcer patients showed significantly lower ABI (<0.9) and were diagnosed as mixed ulcer (a venous ulcer with a peripheral arterial disease). Conclusion: Venous ulcer and mixed ulcer are the most common type of CLU. [ABSTRACT FROM AUTHOR]

Background: Ankle-Brachial Index (ABI) has a proven role in the baseline assessment of the individuals who are at a risk of cardiovascular diseases. Sparse data are available regarding the association of cardiovascular risk factors in type 2 diabetes mellitus (T2DM) and ABI from India. Material and Methods: A cross-sectional study was conducted at a tertiary teaching hospital in South India among patients with T2DM during the period October 2014-June 2016. ABI was measured using vascular Doppler-sphygmomanometer. Independent cardiovascular risk factors were assessed and their association with ABI was studied. Results: ABI was negatively correlated to cardiovascular risk factors such as age, body mass index, duration of T2DM, duration of hypertension and systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the entire study population as well as in both genders separately. Among females, a statistically significant association of low ABI (<0.9) was observed with SBP and duration of hypertension only, whereas, in males, SBP, DBP and duration of T2DM were significantly associated with low ABI. Of note, among the individuals with proven coronary artery disease (CAD), statistically significant association with low ABI was also observed. Conclusions: In our study, low ABI has been observed with increasing age, obesity, high systolic and DBPs, increasing the duration of diabetes and hypertension, however, with a distinctive statistically significant association in males and females. Among the individuals with documented CAD, a significant proportion had a low ABI. [ABSTRACT FROM AUTHOR]

To evaluate resource utilization and direct economic costs of care for patients treated with negative pressure wound therapy (NPWT) in comparison with standard moist wound therapy (MWT) for preparation of diabetic foot TMA wounds for skin grafting. We retrospectively analyzed 56 patients who underwent transmetatarsal amputation (TMA) for infected diabetic foot from January 2014 to April 2015 at Jain Institute of Vascular sciences (JIVAS), Bangalore. Twenty-eight patients received negative pressure wound therapy (NPWT) (VAC® KCI, TX, USA) dressing while 28 received standard MWT daily. Resource utilization, revascularization procedures, number of secondary procedures (debridement), and total cost for wound bed preparation were calculated in both groups. There was no significant difference in both groups regarding age, gender, comorbidities, and number of revascularization procedures. All patients were having ankle brachial index (ABI) more than 0.8 or ankle pressures more than 80 mmHg before enrolling to study group. MWT group required more debridement (15 vs. 2; P = 0.0001). Average number of dressing changes performed per patients were 25 (range 20-32) for MWT versus 3 (range 2-5) in NPWT group. MWT group had more OPD visits compare to NPWT (14 vs. 2; P value =0.0001). Mean duration for wound bed preparation was 24.61 ± 3.20 days (range 20-32 days) in MWT group and significantly higher than NPWT group 9.11 ± 2.38 days (range 6-15 days) (P = 0.0001; 95% CI difference 13.99 to 17.01). The average total cost for wound bed preparation of TMA wound was Rs 26,875 ± 6810.5 in MWT group and was significantly higher than compared to Rs 23,089.29 ± 6637.5 in NPWT group (P = 0.03; 95% CI difference 182.54 to 7388.89). NPWT resulted in lower resource utilization, reduced costs, and acceleration of wound bed preparation for diabetic foot TMA wound in comparison to standard MWT. [ABSTRACT FROM AUTHOR]

Aim: Although several risk factors contribute to the development of sarcopenia, whether preclinical atherosclerosis contributes to the risk of sarcopenia is not established. The present cross‐sectional study aimed to investigate if there is an association between preclinical atherosclerosis and muscle strength among two ethnic populations. Methods: Participants included individuals aged ≥40 years and enrolled in the third follow‐up examination of the Andhra Pradesh Children and Parents Study, India, and in the baseline assessments of the Nagasaki Islands Study, Japan. Preclinical atherosclerosis was evaluated by carotid intima‐media thickness, brachial‐ankle pulse wave velocity, cardio‐ankle vascular index. The association of carotid intima‐media thickness and pulse wave velocity/cardio‐ankle vascular index with handgrip strength (HGS) was analyzed separately in the sexes and for hypertensive status from the two cohorts using a multivariable linear regression model. Results: Data on a total of 1501 participants in India and 3136 participants in Japan were analyzed. Carotid intima‐media thickness was negatively associated with HGS in non‐hypertensive Indian men (B coefficient = −5.38, P = 0.036). Arterial stiffness was also associated with HGS in non‐hypertensive Indian men (B = −0.97, P = 0.001), but not in hypertensive Indian men. Same as Indian men, we found the significant associations between arterial stiffness and HGS in non‐hypertensive women in both India and Japan (B = −0.44, P = 0.020, B = −0.63, P = 0.016, respectively), but not in hypertensive women. Conclusions: The negative association between preclinical atherosclerosis and HGS was dominantly found in non‐hypertensive participants. Geriatr Gerontol Int 2018; 18: 1071–1078. [ABSTRACT FROM AUTHOR]

Aim:- To study the Ankle Brachial Index in Type 2 Diabetic individuals. Objective:- To assess Ankle Brachial Index in Type 2 Diabetic individuals with Mercury Sphygmomanometer. Abstract:- In individuals with type 2 diabetes more than 10 years there is increased chance of individual being affected with peripheral arterial disease. Total 60 individuals with type 2 diabetes less then 10 years participated in the study were examined for ankle brachial index. After analyzing the results it was found that Peripheral arterial diseases is not significant in type 2 diabetic individuals with less then 10 years and of age group 35-45yrs . Results: Peripheral arterial diseases is not significant in type 2 diabetic individuals of age group 35-45yrs. [ABSTRACT FROM AUTHOR]

Background/Aims: Vacuum compression therapy (VCT) is used as an adjunct to the treatment of diabetic ulcers. This study assessed the efficacy of VCT on lower limb vascular parameters in people with type 2 diabetes who do not have ulcers in comparison with conventional therapy for diabetes. Methods: Forty patients who had diabetes for at least 5 years were included in the study. Thorough foot evaluations, including assessments of motor, sensory and circulatory functions, were carried out. Over 4 weeks, those in the intervention group (n=20) received conventional diabetes care plus VCT and those in the control group (n=20) received conventional diabetes care alone. The circulatory function of all participants was assessed using the ankle-brachial index, skin temperature at the dorsum of the foot and capillary refill time measurements at the initial assessment, after 2 weeks of therapy, after the completion of treatment (after 4 weeks) and at 1 month follow-up post-treatment. Results were analysed using repeated ANOVA measures (Cl 95%, p<0.05). Results: Statistically significant improvements were seen in foot circulation in participants in the intervention group compared with the control group, which was maintained at 1 month follow-up after therapy had been stopped. Conclusion: VCT is an effective treatment modality to improve lower limb vascular parameters in people with type 2 diabetes and may help to prevent ulcer formation. [ABSTRACT FROM AUTHOR]

Objectives: Previous studies have demonstrated beneficial effects of regular consumption of pistachio nuts on glycemic, lipid, and oxidative stress parameters. The aim of this study was to determine its effect on vascular health, which has not been adequately studied so far. Methods: In this open label, randomized parallel-group study, 60 adults with mild dyslipidemia were randomized to lifestyle modification (LSM) alone or LSM with consumption of 80 g (in-shell) pistachios (equivalent to 40 g or 1.5 oz shelled pistachios) daily for 3 mo. Biochemical parameters, brachial artery flow-mediated vasodilation (BAFMD), and carotid-femoral and brachial-ankle pulse wave velocity (cfPWV and baPWV, respectively) were measured before and after the intervention. Results: At 3 mo, there was no change in any of the clinical or biochemical parameters in the LSM group. However, the patients in the pistachio group had a significant increase in high-density lipoprotein cholesterol (HDL-C; 35.7 ± 8.8 mg/dL versus 37.8 ± 10.1 mg/dL; P = 0.04) and a reduction in low-density lipoprotein cholesterol (137.2 ± 32.6 mg/dL versus 127.6 ± 34.0 mg/dL; P = 0.02), total cholesterol (TC)-to-HDL-C ratio (5.8 ± 1.3 mg/dL versus 5.3 ± 1.1 mg/dL; P = 0.001), and fasting blood sugar (88.8 ± 7.1 mg/dL versus 86.6 ± 6.3 mg/dL; P = 0.05). Additionally, whereas LSM alone was associated with no improvement in BAFMD or PWV, individuals in the pistachio group had significant reduction in left baPWV (1261.7 ± 187.5 cm/sec versus 1192.4 ± 152.5 cm/sec; P = 0.02) and statistically nonsignificant improvement in most other parameters, including BAFMD. As a result, at 3 mo the patients in the pistachio group had lower cfPWV (770.9 ± 96.5 cm/sec versus 846.4 ± 162.0 cm/sec; P = 0.08), lower left baPWV (1192.4 ± 152.5 cm/sec versus 1326.3 ± 253.7 cm/sec; P = 0.05), and lower average baPWV (1208.2 ± 118.4 cm/sec versus 1295.8 ± 194.1 cm/sec; P = 0.08) compared with the LSM group. Two-way analysis of variance revealed significant treatment effect of pistachio consumption on cfPWV, left baPWV, average baPWV, and BAFMD (P = 0.037, 0.01, 0.07, and 0.046, respectively). Conclusions: The present study demonstrates that regular consumption of pistachio nuts not only improves glycemic and lipid parameters, but also results in improvements in vascular stiffness and endothelial function. Importantly, these improvements were seen in apparently healthy individuals and with a diet (including pistachios) and exercise regimen that every adult individual is expected to follow. [ABSTRACT FROM AUTHOR]

Diabetes mellitus is characterized by increased central arterial stiffness and endothelial dysfunction leading to increased risk of cardiovascular complications. The aim of this study is to evaluate the effect of Curcuma longa on arterial stiffness and endothelial dysfunction in patients with type 2 diabetes mellitus. This randomized controlled trial was conducted in 136 patients of type 2 diabetes. Among them, 114 completed at least one follow-up visit and included for data analysis. Arterial stiffness parameters were measured at baseline and every month for 3 months and endothelial dysfunction markers at baseline and after 3 months of treatment with C. longa or placebo. These parameters were compared between the two groups. Both C. longa and placebo groups were comparable at baseline. After 3 months of treatment, C. longa produced significant reduction from baseline in carotid-femoral pulse wave velocity (p = .002), left brachial-ankle pulse wave velocity (p = .001), aortic augmentation pressure (p = .007), aortic augmentation index (p = .007), and aortic augmentation index at heart rate 75 (p = .018) as compared with the placebo group. Three months treatment with C. longa significantly decreases arterial stiffness as compared with placebo in type 2 diabetes mellitus patients., (© 2019 John Wiley & Sons, Ltd.)

Background: Diabetic foot is one of the most significant and devastating complication of diabetes. The objective of this study was to assess the prevalence of diabetic foot syndrome (DFS) and the associated risk factors among people with diabetes mellitus. Methods: A community based cross-sectional study was carried out among 620 subjects with diabetes mellitus (DM) in rural areas of Udupi district. The Michigan Neuropathy Screening Instrument was used to identify peripheral neuropathy. Ankle brachial index was used to identify peripheral arterial disease (PAD). Subjects with diabetic foot syndrome were classified according to the International Working Group on Diabetic Foot (IWGDF) classification system. Results: The overall prevalence of DFS was 51.8%. Among them 31.3, 11.9 and 8.5% belonged to category 1, 2 and 3 respectively. Multivariate logistic regression analysis showed advancing age, low socio-economic status, sedentary physical activity and longer duration of DM were significant independent correlates of DFS. Conclusion: The overall prevalence of DFS was high among the study population; hence the screening for foot complications should start at the time of diagnosis of diabetes integrated with sustainable patient education at primary care level by training of health care providers at primary care level. [ABSTRACT FROM AUTHOR]

Introduction: Diabetes mellitus is a major health problem in India as also the world. Peripheral arterial disease (PAD) is a known complication of diabetes which is relatively less commonly studied in comparison to other complications. The present study was undertaken to study the prevalence of PAD in diabetic patients in a teaching hospital., Materials and Methods: 200 type 2 diabetic patients from indoor as well as outdoor of a teaching hospital were included in the study. Ankle brachial pressure index was used to assess PAD. ABPI values of 0.9 or less were taken as indicative of PAD., Results: Out of 200 patients 72(36%) had evidence of PAD. There was a significant association between PAD and duration of diabetes, waist circumference, hypertension and microvascular complications., Conclusion: The prevalence of PAD in Type 2 diabetics was found to be 36% in our study. Screening for PAD should be done in all diabetic patients to detect this complication early., (© Journal of the Association of Physicians of India 2011.)

Chronic venous ulcer can often be associated with asymptomatic peripheral arterial disease (PAD), which usually remains undiagnosed adding significantly to the morbidity of these patients. The Ankle-Brachial Pressure Index (ABPI) is suggested for PAD evaluation. Many PAD studies were conducted in western countries, but there is a scarcity of data on the prevalence of PAD in clinical venous ulcer patient in developing countries. We conducted a study in a tertiary care hospital of eastern part of India to find out the prevalence of PAD in venous ulcer patients, and also to find the sensitivity of ABPI as a diagnostic tool in these patients. We evaluated clinically diagnosed patients with venous ulcer using ABPI and Colour Doppler study for the presence of PAD. Possible associations such as age, sex, body mass index (BMI), smoking, hypertension and atherosclerosis were studied. All results were analysed using the software Statistica version 6. PAD was present in 23 (27·71%) patients. Older age, longer duration, smoking, high BMI and hypertension were found to be significantly associated with PAD. A very strong level of agreement was found between venous Doppler and ABPI. Assessment for the presence of PAD is important in all clinically diagnosed venous ulcer patients. ABPI being a simple, non-invasive outpatient department (OPD)-based procedure, can be routinely used in cases of venous ulcer to find out the hidden cases of PAD even in developing countries., (© 2012 The Authors. International Wound Journal © 2012 Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

Aim: We aimed to compare Ankle-brachial index (ABI) and Carotid intima-media thickness (CIMT) as surrogate markers of significant coronary atherosclerosis in South Indians with coronary artery disease (CAD)., Methods and Results: There were two groups: CAD group (n = 59) and Control group (n = 55). Mean ABI (0.82 ± 0.06 vs. 1.16 ± 0.11, p < 0.0001) and mean CIMT (0.74 ± 0.22 mm vs. 0.45 ± 0.09 mm, p < 0.0001) were statistically different between two groups. ABI < 0.9 (sensitivity: 91.53%, specificity: 100%) and CIMT > 0.63 mm (sensitivity: 61.02%, specificity: 98.18%) implied significant CAD. ABI and CIMT were negatively correlated to one another. With increasing severity of CAD, ABI decreased but CIMT increased., Conclusion: ABI and CIMT are simple noninvasive tools providing insight into coronary atherosclerosis. They can be done at bedside and easily repeated than coronary angiography. ABI < 0.9 is a better surrogate marker of significant coronary atherosclerosis than CIMT > 0.63 mm in South Indians with CAD., (Copyright © 2013 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.)

Aims: To see whether the diabetic individuals identified by the Indian Diabetes Risk Score (IDRS) also have a higher prevalence of diabetes related complications., Methods: Type 2 diabetic subjects were selected from the Chennai Urban Rural Epidemiology Study in south India. Four field stereo retinal colour photography was done and diabetic retinopathy [DR] was classified according to Early Treatment Diabetic Retinopathy Study grading system. Coronary artery disease was diagnosed using Minnesota coding of 12-lead electrocardiograms. Diabetic peripheral neuropathy (DPN) was diagnosed if vibratory perception threshold [VPT] of the right great toe measured by biothesiometry was > or =20. The criterion for diagnosis of peripheral vascular disease (PVD) was an ankle-brachial index < 0.9. Macroalbuminuria was diagnosed if urinary albumin excretion was > or =300 microg/mg creatinine. A total of 1476 individuals who had information on all test parameters were included for analysis., Results: Subjects with IDRS score > or =60 had significantly higher prevalence of coronary artery disease (CAD) [9.2% vs. 5.4%, p = 0.043], DPN [29.2% vs. 8.8%, p < 0.001] and PVD [4.8% vs. 1.9%, p = 0.038] compared to subjects with IDRS score <60. However, the prevalence of DR and macroalbuminuria did not differ between the two IDRS subgroups. Age explained much of the observed differences in prevalence of CAD, PVD and DPN between the two IDRS subgroups., Conclusions: This study further extends the clinical usefulness of IDRS to predicting diabetic complications like CAD, PVD and DPN as well.