D.S. Chadha

Consensus physical activity guidelines for Asian Indians.

India is currently undergoing rapid economic, demographic, and lifestyle transformations. A key feature of the latter transformation has been inappropriate and inadequate diets and decreases in physical activity. Data from various parts of India have shown a steady increase in the prevalence of lifestyle-related diseases such as type 2 diabetes mellitus (T2DM), the metabolic syndrome, hypertension, coronary heart disease (CHD), etc., frequently in association with overweight or obesity. Comparative data show that Asian Indians are more sedentary than white Caucasians. In this review, the Consensus Group considered the available physical activity guidelines from international and Indian studies and formulated India-specific guidelines. A total of 60 min of physical activity is recommended every day for healthy Asian Indians in view of the high predisposition to develop T2DM and CHD. This should include at least 30 min of moderate-intensity aerobic activity, 15 min of work-related activity, and 15 min of muscle-strengthening exercises. For children, moderate-intensity physical activity for 60 min daily should be in the form of sport and physical activity. This consensus statement also includes physical activity guidelines for pregnant women, the elderly, and those suffering from obesity, T2DM, CHD, etc. Proper application of guidelines is likely to have a significant impact on the prevalence and management of obesity, the metabolic syndrome, T2DM, and CHD in Asian Indians.

Non-Alcoholic Fatty Liver Disease Is Closely Associated with Sub-Clinical Inflammation: A Case-Control Study on Asian Indians in North India

Objectives Association between sub-clinical inflammation and non-alcoholic fatty liver disease (NAFLD) has not been studied in Asian Indians. In this case-control study, we aimed to analyse association of NAFLD with the sub-clinical inflammation and metabolic profile in Asian Indians in north India. Methods Ultrasound diagnosed 120 cases of NAFLD were compared to 152 healthy controls without NAFLD. Anthropometric profile [body mass index (BMI), waist circumference (WC), hip circumference (HC)], high-sensitivity C-reactive protein (hs-CRP), metabolic profile [fasting blood glucose (FBG), lipid profile] and hepatic function tests [alanine aminotransferase (ALT) and aspartate aminotransferase (AST)] were recorded. Results Metabolic parameters [FBG, total cholesterol (TC), serum triglycerides (TG),low-density lipoprotein (LDL-c)], hs-CRP and prevalence of the metabolic syndrome were higher in cases as compared to controls (p-value<0.05 for all). The median (range) of hs-CRP (mg/L) for cases [2.6(0.2–13.4)] were significantly higher than in controls [1.4(0.03–11.4), p = 0.01]. Similarly, higher values of hs-CRP were obtained when subgroups of cases with obesity, abdominal obesity and the metabolic syndrome were compared to controls [2.75 (0.03–14.3) vs. 1.52 (0.04–14.3), p = 0.0010; 2.8 (0.03–14.3) vs. 1.5 (0.06–14.3), p = 0.0014 and 2.7 (0.5–14.3) vs. 1.6 (0.06–8.5), p = 0.0013, respectively. On multivariate logistic regression analysis BMI (p = 0.001), WC (p = 0.001), FBG (p = 0.002), TC (p = 0.008), TG (p = 0.002), blood pressure (p = 0.005), metabolic syndrome (p = 0.001) and hs-CRP (p = 0.003) were significantly and independently associated with NAFLD. After adjusting for significant variables, the association between high hs-CRP and NAFLD remained large and statistically significant [adjusted OR = 1.17, 95% confidence interval (CI) = 1.05–1.29]. An increase in 1 mg/dl of hs-CRP level calculated to increase the risk of developing NAFLD by 1.7 times as compared to controls after adjusting for significant variables associated with NAFLD. Conclusions In this cohort of Asian Indians in North India, presence of NAFLD showed independent relationships with sub-clinical inflammation.

Impact of obesity on the left ventricular functions and morphology of healthy Asian Indians.

BACKGROUND The aim of this study was to determine the impact of obesity on alteration of left ventricular (LV) functions and morphology in nondiabetic, nonhypertensive, and normo-lipidemic obese Asian Indians. A total of 239 consecutive Asian Indians (175 males and 64 females, ages 17-64 years) were divided into obese and nonobese groups based on body mass index (BMI), waist-to-hip circumference ratio (W-HR), and percentage of body fat (%BF). METHODS Anthropometry (BMI, W-HR), %BF, and two-dimensional echocardiography including tissue Doppler imaging (TDI) were performed for all the subjects. The unpaired t-test was applied after matching age and gender in all the comparison groups. Nonobese subjects acted as controls for the obese subjects (cases). RESULTS Obese subjects had a larger LV end-diastolic diameter (P < 0.001), LV end-systolic diameter (P < 0.001), and LV mass (P < 0.001) as compared to the nonobese subjects. Subclinical systolic dysfunction was apparent in obese subjects only on TDI in the form of reduced systolic mitral annular velocity (P = 0.009). Diastolic dysfunction, as suggested by a lower ratio of early to late transmitral ventricular filling velocity (E/A), lower early to late (Em/Am) diastolic mitral annular velocity, and a higher E/Em ratio (P < 0.001, p = 0.001 and P < 0.001, respectively), was noted in the obese cohort. In addition, the left atrial diameter (P < 0.001) was also increased in obese subjects. Alteration of LV morphology and function correlated with the anthropometric variables BMI, W-HR, and %BF. CONCLUSIONS Asian Indians with uncomplicated obesity (without associated co-morbidities) had significant morphological and functional cardiac dysfunction (systolic and diastolic), which correlated with anthropometric variables.

N-terminal pro-BNP plasma levels before and after percutaneous transvenous mitral commissurotomy for mitral stenosis

In this study, we investigated the change in N-terminal pro-brain natriuretic peptide (NT-pro-BNP) plasma levels among 44 consecutive patients with mitral stenosis, 10 min before and 24 h after undergoing percutaneous transvenous mitral commissurotomy (PTMC). The procedure was successful in all patients and a significant decline was noted in NT-pro-BNP levels. Reduction of NT-pro-BNP was more marked in patients in sinus rhythm as compared to those with atrial fibrillation. In conclusion, serial measurement of plasma NT-pro-BNP levels might be a useful noninvasive method for documenting the success of PTMC among patients in sinus rhythm.

Prevalence of aspirin resistance in Asian‐Indian patients with stable coronary artery disease

To evaluate the prevalence of pharmacological resistance to aspirin therapy by measuring platelet functions using the technique of light transmission aggregometry.

Hyperperfusion Syndrome after Carotid Artery Stenting.

Percutaneous transluminal angioplasty and stent placement of carotid arteries has become widely accepted as an alternative to endarterectomy for symptomatic patients with internal carotid artery stenosis more than 70%.1 The potential complications of carotid artery stenting (CAS) are acute neurological deficits, access-site vessel injuries, stent malfunction, stent restenosis, and baroreflex responses such as bradycardia, hypotension, and vasovagal reactions.1,2 Among these the most common and life threatening early complication is periprocedural stroke which occurs in approximately 5% cases.2 Though this is commonly due to athero-embolism, cerebral hypoperfusion, cerebral hyperperfusion and intracranial haemorrhage also contribute to it.2 Cerebral Hyperperfusion Syndrome (HPS) is an uncommon complication with a high morbidity and mortality, necessitating early recognition and aggressive management.2–5 It has bee observed after both Carotid Endarterectomy (CEA) and CAS, with an overall incidence of 0.2–0.7% in CEA and a relatively higher rate of up to 5% in CAS.3 It presents in the immediate and early post-procedural period with ipsilateral frontotemporal or retroorbital headache, nausea, vomiting and features of raised intracaranial pressure. Though intracerebral haemorrhage (ICH) is seen in over 85% cases it is not a mandatory feature of HPS. ICH occurs predominantly in the region of the basal ganglia.3–5 We present one such case.

Percutaneous removal of transvenous pacemaker leads using an extraction device

Permanent pacemaker implantation (PPI) is routinely performed at specialized cardiology centers. Though, pacemaker device and lead extraction may be necessary due to pacemaker pocket infection, infective endocarditis, or lead fracture it is an infrequently performed procedure because of the associated morbidity and mortality. Though surgical lead extraction requiring a median sternotomy and cardiopulmonary bypass is also an accepted procedure it is reserved for large vegetations or failed attempts at percutaneous removal. Newer and innovative devices for percutaneous removal of leads have been developed which have made lead extraction easier and safer. We report our experience of using interlocking stylets for percutaneously removing an infected dual chamber pacemaker and its leads.

Endovascular management of giant coronary artery aneurysm

Coronary artery aneurysms defined as localized coronary dilations with diameters atleast 1.5 times the diameters of adjacent normal coronary segments.1 It is commonly seen secondary to atherosclerosis but has also been reported in patients who have vasculitis (Kawasaki syndrome), connective tissue disorders (Ehlers-Danlos or Marfan syndrome), and in patients who have undergone interventional procedures.2–5 A growing incidence of coronary artery aneurysms have been recently described after implantation of drug-eluting stent (DES).6–8 We report one such case which was treated successfully using a covered stent.

Malplacement of endocardial pacemaker lead in the left ventricle

Lt Col Navreet Singh *, Gp Capt Hemant Madan , Brig Y.K. Arora, VSM, Brig Rajat Dutta , Col Sunil Sofat , Col Prashant Bhardwaj, VSM, Rahul Sharma , Gp Capt D.S. Chadha , Col A.K. Ghosh , Lt Col Sanjeev Sengupta f Classified Specialist (Cardiology), CH (SC), Pune-40, India b Senior Advisor (Cardiology), Army Hosp (R&R), New Delhi, India Consultant (Cardiology), Base Hosp, Delhi Cantt, India Consultant (Cardiology), Army Hosp (R&R), New Delhi, India Resident (Cardiology), Army Hosp (R&R), New Delhi, India Classified Specialist (Cardiology), MH (CTC), Pune-40, India

Ortner's syndrome: A rare cause in an elderly smoker.

Hoarseness of voice is a common complaint in the emergency room following benign illness of the upper respiratory tract, most of the time it has a short clinical course and recovers with symptomatic treatment. However hoarseness may follow recurrent laryngeal palsy referred to as Ortners syndrome (cardio-vocal syndrome) in patients with underlying cardiovascular disorders.1–4 In this paper we present a rare case of Ortners syndrome in an elderly smoker with chronic obstructive pulmonary disease (COPD) and an aneurysm of descending thoracic aorta. The available literature on this subject has been reviewed and discussed.