Hanumanthappa Nandeesha

Short-Term Heart Variability and Oxidative Stress in Newly Diagnosed Essential Hypertension

We sought to evaluate oxidative stress parameters like malondialdehyde, total antioxidant status, and time, frequency domain heart rate variability indices in newly diagnosed untreated hypertension. We also sought to study the correlation between heart rate variability and oxidative stress parameters in normotensive and newly diagnosed untreated essential hypertensives. Fourteen normotensive males and 36 newly diagnosed male hypertensives were enrolled for the study. Malondialdehyde, total antioxidant status, and heart rate variability in the frequency and time domain were studied in the hypertensive and normotensive group. Malondialdehyde was significantly higher in the hypertensive group, whereas total antioxidant status was significantly higher in the control group. SDNN, RR triangular index, RMSSD, log 10 low-frequency power, log 10 high-frequency power, log 10 total power, and heart rate variability during deep breathing test was significantly lower in hypertensive patients compared to normotensive controls. SDNN, RMSSD, high-frequency power, and high-frequency power normalized had significant negative correlation with malondialdehyde. Low-frequency power normalized positively correlated with malondialdehyde. Total antioxidant status had a significant negative correlation with blood pressure. The study gives further evidence for a decreased heart rate variability and elevated oxidative stress in hypertension.

Heart rate variability in middle-aged men with new-onset hypertension.

Background: It has been well established that hypertension is associated with autonomic dysregulation. Studies investigating HRV have established that hypertension is characterized by sympathetic overactivity and or attenuation of parasympathetic modulation of the heart.

Effect of antihypertensive therapy on serum lipids in newly diagnosed essential hypertensive men.

The effect of antihypertensives on serum lipids in newly diagnosed male essential hypertensive patients was studied. The participants (n = 99) were randomly allocated to receive amlodipine, atenolol, enalapril, hydrochlorothiazide, and a combination of amlodipine and atenolol. Lipid parameters were estimated before and after 8 weeks of therapy. The atenolol and thiazide group showed a significant increase in triglycerides (TGs) and very-low-density lipoprotein cholesterol (VLDL-C). High-density lipoprotein cholesterol (HDL-C) and HDL-C to low-density lipoprotein cholesterol (LDL-C) ratio were significantly increased and TC to HDL-C ratio was significantly decreased in the amlodipine and amlodipine— atenolol combination groups. In the enalapril group, we found a significant reduction in TC, TGs, VLDL-C, nonHDL-C, and TG to HDL-C ratio after treatment. It can be concluded from the present study that some drugs have beneficial effects on the lipid status, whereas others adversely affect the lipid status in hypertension.

Altered insulin sensitivity, insulin secretion and lipid profile in non-diabetic prostate carcinoma

Insulin can influence cancer risk through its effect on cell proliferation, differentiation and apoptosis. Although hyperinsulinemia is considered as a risk factor in the pathogenesis of various cancers, the data related to insulin sensitivity, insulin secretion and lipid profile is lacking in non-diabetic prostate carcinoma cases. The present study was undertaken to evaluate lipid profile parameters and insulin sensitivity and secretion using surrogate markers derived from the measurements of fasting glucose and fasting insulin. The study group comprises 27 prostate carcinoma cases and 27 controls having similar age. Fasting serum insulin, glucose and lipid profile parameters were estimated in both the groups. Insulin sensitivity was assessed by Homeostasis model assessment of insulin sensitivity and Quantitative insulin sensitivity check index. Insulin secretion was assessed by insulinogenic index. Fasting serum insulin, insulinogenic index and LDL-cholesterol were significantly increased (p < 0.05) and HOMA-IS, QUICKI and HDL-cholesterol was significantly decreased (p < 0.05) in carcinoma cases compared to controls. PSA level was significantly associated with fasting insulin (R2 = 0.150, beta = 0.387, p = 0.046) and QUICKI (R2 = 0.173, beta = -0.416, p = 0.031). Fasting insulin was significantly correlated with triglyceride (r = 0.404, p = 0.037) and HDL-cholesterol (r = -0.474, p = 0.013). The present study concludes that hyperinsulinemia associated with reduced insulin sensitivity may play a role in the pathogenesis of prostate carcinoma.

Association between Protein Bound Sialic Acid and High Sensitivity C-Reactive Protein in Prehypertension : A Possible Indication of Underlying Cardiovascular Risk

The global burden posed by cardiovascular disease due to a rising incidence of known risk factors like essential hypertension underlines an urgent need to identify other potential risk factors like dyslipidemia, elevated levels of high-sensitivity CRP (hsCRP), Apo-B, and sialic acid in prehypertensive subjects. This study sought to examine the possible alteration in the levels of hsCRP, plasma protein bound sialic acid, and other lipid risk factors and the possible interactions among these parameters in prehypertensive subjects. Forty prehypertensive and 34 normotensive male subjects were enrolled in the study. Lipid profile, hsCRP, Apo-B, sialic acid, and lipid risk ratios were estimated in both the groups. There was no significant difference between fasting glucose and BMI in either group. The levels of total cholesterol, triglycerides, direct LDL-cholesterol, non-HDL cholesterol, and Apo-B were significantly increased in prehypertensive subjects compared with controls. The risk ratios calculated as direct LDL-cholesterol/Apo-B, total cholesterol/HDL-cholesterol, non-HDL-cholesterol/HDL-cholesterol were significantly elevated in prehypertensive subjects. There was also a significant increase in hsCRP and protein bound sialic acid in prehypertensive subjects in comparison with normotensive subjects. Correlation analysis revealed a significant association between the protein bound sialic acid with hsCRP, LDL cholesterol, and LDL-C/Apo-B. The findings of the present study suggest that in prehypertension, there is an association between protein bound sialic acid and hsCRP that reflects the clustering of cardiovascular risk factors in these subjects.

Formulation of questions followed by small group discussion as a revision exercise at the end of a teaching module in biochemistry

Undergraduate medical students get fewer opportunities to clarify their doubts and to reinforce their understanding of concepts after lecture classes. There is no information available in the literature that addresses the question of usefulness of prior formulation of questions followed by small group discussion by undergraduate medical students as a revision exercise. The purpose of this work is to evaluate the effect of formulation of objective type short answer questions by undergraduate medical students followed by small group discussion on the answers of the questions prepared as a revision exercise on their understanding of the topic “amino acid metabolism” and the retention of the gain after 15 days. At the end of a regular teaching module on the topic of amino acid metabolism, undergraduate medical students were asked to prepare 16 objective type short answer questions on the various aspects of the topic as homework. Small group discussions involving 12–14 students in each group and lasting one hour were conducted on the questions and answers prepared by them in the presence of a faculty member. The effects on low, medium, and high achievers were evaluated with multiple choice questions by pre‐test and post‐tests before and after the group discussion. Formulation of questions was highly effective in improving understanding on the topic for all the students. The overall mean post‐test scores after the formulation of questions (12.6) and after the small group discussion that followed (14.7) were significantly higher than the mean pre‐test score (8.5). For high achievers, the gain from formulation of questions was higher than the gain from small group discussion. Small group discussion was highly effective for all students. The gain from small group discussion was higher among the low and medium achievers in comparison with the high achievers. The gain from the exercise was retained among the low, medium, and high achievers after 15 days. In conclusion, formulation of short answer questions followed by small group discussion on the answers of the questions prepared by the undergraduate medical students is an effective revision exercise for improving their understanding on a selected topic.

Formulation of multiple choice questions as a revision exercise at the end of a teaching module in biochemistry

The graduate medical students often get less opportunity for clarifying their doubts and to reinforce their concepts after lecture classes. Assessment of the effect of MCQ preparation by graduate medical students as a revision exercise on the topic “Mineral metabolism.” At the end of regular teaching module on the topic “Mineral metabolism,” graduate medical students were asked to prepare the stems of 15 MCQs based on the four discriminators given for each. They were told that one of the discriminators could be the answer for the MCQ and the remaining three could be the distracters. They were further guided in their task by providing few key word(s) in the stem of the expected MCQ. In the first phase of the exercise, the students attempted the MCQ preparation individually without peer consultation. In the second phase, the students participated in small group discussion to formulate the best MCQs of the group. The effects on low, medium, and high achievers were evaluated by pre and post‐tests with the same set of MCQs. Both the individual endeavor in Phase 1 and small group discussion in Phase 2 for the formulation of MCQs significantly contributed to the gain from the exercise. The gains from the individual task and from small group discussion were equal among the different categories of students. Both phases of the exercise were equally beneficial for the low, medium, and high achievers. The high and medium achievers retained the gain from the exercise even after 1 week of the exercise whereas the low achievers could not retain the gain completely. Formulation of MCQs is an effective and useful unconventional revision exercise in Biochemistry for graduate medical students.

Insulin resistance and enhanced protein glycation in men with prehypertension.

Abstract Background: Insulin resistance and hyperinsulinemia have been reported among patients with hypertension. However, little is known about insulin sensitivity in subjects with prehypertension. The aim of this study was to assess whether the metabolic characteristics of insulin resistance syndrome are present in prehypertensive subjects. Methods: Plasma fasting glucose, lipid profile, glycated hemoglobin, fructosamine and insulin concentrations were evaluated in 35 prehypertensive subjects and in 30 healthy controls. Results: Prehypertensive subjects had significantly higher levels of plasma insulin and triglycerides compared with normotensive subjects. The level of high-density lipoprotein cholesterol was significantly lower in prehypertensive subjects compared with controls. There was no significant difference in total cholesterol and low-density lipoprotein cholesterol levels. The levels of glycated hemoglobin and fructosamine were also significantly higher in prehypertensive subjects compared with controls. Plasma insulin levels were positively correlated with systolic and diastolic blood pressure in prehypertensive subjects. Similarly, plasma insulin was significantly positively correlated with triglyceride and negatively correlated with high-density lipoprotein cholesterol. Conclusions: The present study indicates that prehypertensive non-diabetic subjects have higher insulin resistance and protein glycation compared to normotensive subjects, which may contribute to the pathogenesis of prehypertension. Clin Chem Lab Med 2006;44:1457–61.

Association of elevated interleukin-17 and angiopoietin-2 with prostate size in benign prostatic hyperplasia

Abstract Introduction: Inflammation and angiogenesis are known to play a role in the development prostate tumors. The present study was designed to assess the levels of markers of inflammation and angiogenesis like interleukin-17 (IL-17) and angiopoietin-2 (ANGPT2) levels and their association with prostate size in patients with benign prostatic hyperplasia (BPH). Materials and methods: 42 BPH cases and 42 controls were enrolled in the study. IL-17 and ANGPT2 were estimated in both the groups. Results: IL-17 and ANGPT2 were significantly increased in BPH cases when compared with controls. Multivariate analysis showed that ANGPT2 predicts the prostate size in patients with BPH (R2 = 0.203, beta = 0.355, p = 0.028). Linear regression analysis showed that IL-17 was significantly associated with ANGPT2 in BPH cases (R2 = 0.129, beta – 0.359, p = 0.020). Conclusions: We conclude that IL-17 and ANGPT2 are elevated in BPH cases and ANGPT2 was associated with IL-17 and prostate size.

Relationship between matrix metalloproteinase-9 and oxidative stress in drug-free male schizophrenia: a case control study.

Abstract Background: Deregulation of synaptic plasticity and oxidative stress are reported to play a crucial role in the pathogenesis of schizophrenia. Matrix metalloproteinase-9 (MMP-9) is an extracellular protease involved in regulation of synaptic plasticity. Malondialdehyde (MDA) is a marker of lipid peroxidation which is elevated in schizophrenia. Earlier studies have reported polymorphism of MMP-9 and its association with schizophrenia. The present study was designed to assess the serum levels of MMP-9, MDA and total antioxidant status (TAS) and their association in schizophrenia. Methods: A total of 40 cases and 40 controls were included in the study. Serum MMP-9, MDA and TAS were estimated in all the subjects. Disease severity was assessed using Positive and Negative Syndrome Scale (PANSS). Results: MMP-9 and MDA were significantly increased and TAS were significantly reduced in schizophrenia cases compared to controls. MMP-9 was positively correlated with MDA (r=0.353, p=0.025) and negatively correlated with TAS (r=−0.461, p=0.003). TAS was significantly correlated with total (r=0.322, p=0.043) and negative symptom scores (r=0.336, p=0.034). Higher MMP-9 levels were associated with previous exposure to antipsychotics (p=0.032). Conclusions: MMP-9 and oxidative stress were increased and correlate well with each other in schizophrenia cases. Though total oxidant status showed positive association with disease severity, MMP-9 and MDA were not associated with the severity of the disease.