Poornima Manjrekar

Effect of community-based yoga intervention on oxidative stress and glycemic parameters in prediabetes: A randomized controlled trial

OBJECTIVES To study the effectiveness of yoga intervention on oxidative stress, glycemic status, blood pressure and anthropometry in prediabetes. DESIGN Randomized-controlled trial. PARTICIPANTS Twenty nine prediabetes subjects aged 30-75 years. SETTING Yoga was conducted at 4 different community diabetes clinics in Mangalore, India. INTERVENTIONS Participants were randomized to either 3-month yoga or wait-list control groups. MAIN OUTCOME MEASURES Malondialdehyde, glutathione, vitamin C, vitamin E, superoxide dismutase, plasma glucose, glycated haemoglobin, BMI, waist circumference, waist-to-hip ratio and blood pressure. RESULTS Yoga intervention resulted in a significant decline in malondialdehyde (p<0.001), relative to the control group. In comparison with the control, there was a significant improvement in BMI, waist circumference, systolic blood pressure and fasting glucose levels at follow-up. No significant improvement in glycated haemoglobin, waist-to-hip ratio or any of the antioxidants was observed. CONCLUSIONS Yoga intervention may be helpful in control of oxidative stress in prediabetes subjects. Yoga can also be beneficial in reduction in BMI, waist circumference, systolic blood pressure and fasting glucose. Effect of yoga on antioxidant parameters was not evident in this study. The findings of this study need to be confirmed in larger trials involving active control groups.

Correlation of severity of coronary artery disease with insulin resistance

Background: Insulin resistance (IR) has known to be associated with coronary artery disease (CAD), but the assessment of severity of the CAD based on IR in type 2 diabetes mellitus has not been established in detail. Aims: The aim of our study was to establish the correlation between IR and the severity of CAD in type 2 diabetes mellitus. Materials and Methods: In a cross-sectional study design, 61 consecutive patients with type 2 diabetes mellitus who underwent coronary angiogram for the evaluation of CAD were recruited. Fasting blood glucose, fasting insulin levels, systolic blood pressure and total cholesterol/high density lipoprotein-cholesterol ratio were determined. Homeostasis model assessment-IR (HOMA-IR) was correlated with severity of CAD, which was measured by modified Gensini Score. Results: There was a significant correlation between log HOMA-IR and severity of CAD (r = 0.303, P = 0.009) in diabetic patients. Correlation of the Gensini Score with other known risk factors was not significant. Conclusions: The results of our study indicate that we might able to predict the severity of CAD by measure of IR.

Assessment of Oxidative Stress and Inflammation in Prediabetes- A hospital based cross-sectional Study

BACKGROUND AND AIM Prediabetes is associated with dysglycemia, obesity, inflammation and endothelial dysfunction, contributing towards the pathogenesis of cardiovascular diseases rendering them vulnerable for the same. The current study intended to explore the risk of cardiovascular disease (CVD) related with prediabetes by assessing oxidative stress and inflammation using serum interleukin-6 (IL-6), myeloperoxidase (MPO) and urine microalbumin (MA) and their correlation with fasting plasma glucose (FPG) and physical measurements. MATERIALS AND METHODS Based on FPG values, 80 subjects were grouped into prediabetes and healthy controls. IL-6 and MPO were estimated in serum sample whereas MA was estimated in random urine sample. RESULTS Prediabetes group had significantly increased (p<0.05) mean anthropometric measurements and IL-6, MPO and MA as compared to healthy controls. MPO had significant correlation with FPG (r-0.388) in the prediabetes group. IL-6 and MPO showed a positive correlation with body mass index (BMI (r-0.339, r-0.327)), waist circumference (WC (r-484, r-0.493)) and waist-to-hip ratio (WHR (r-0.430, r-0.493)) while MA did not correlate with FPG and anthropometric measurements. CONCLUSION This study suggests that prediabetes is associated with central adiposity, inflammation and oxidative stress predisposing them to an increased risk for CVD.

Serum vitamin D3levels and diffuse hair fall among the student population in South India: A case–control study

Introduction and Aims: Hair fall is a common problem faced by many younger people, which has variety of risk factors. Vitamin D3has emerged as a molecule with key role to play in various disorders. This study was done to assess its role in diffuse hair fall among student population. Materials and Methods: This was a case–control study including young adults presenting with complaints of hair fall (>100 a day) as cases, with age-matched healthy controls. Vitamin D3levels were measured in all the patients. Data analysis was done using Statistical Package for Social Sciences version 11.5 software and significance was tested using Chi-square test and binary logistic regression analysis. Results: Atotal of 44 participants were enrolled; 22 in each arm. The mean age of the study population was 20.89 years (standard deviation: 1.49). The median value of Vitamin D was 6.80 (interquartile range - 5.350–16.63) for the study population. Overall, 81.8% cases had Vitamin D deficiency compared to 45.5% of controls and this difference was statistically significant (P = 0.007). Furthermore, females had a statistically significant difference in Vitamin D levels between cases and controls. Higher level of full sleeve cloth usage, sunscreen lotion application, and lesser sun exposures were seen among cases although these differences were not statistically significant. The levels of Vitamin D3were not significantly different among Indians, nonresident Indians, and foreigners. None of the cases had normal Vitamin D values whereas 4.5% controls fell in the normal category. Conclusions: Female patients with diffuse hair fall were found to have significantly low Vitamin D3levels among student population.

Manipal diabetes coronary artery severity score

AIMS To develop a risk score, for identifying severe and complex CAD in patients with type 2 diabetes mellitus. METHODS In this cross sectional study, 179 patients with type 2 diabetes mellitus undergoing coronary angiogram for the evaluation of suspected coronary artery disease (CAD) were recruited at a tertiary-care hospital. Patients were divided into developmental (n=124) and validation (n=55) cohorts. Biochemical and anthropometric parameters were analysed. Predictors of severe and complex CAD (SYNTAX Score>22) were identified by multiple logistic regression analysis. RESULTS Insulin resistance>3.4 (OR: 21.26, 95% CI: 5.71-79.09), duration of diabetes>5years (OR: 13.50, 95% CI: 3.13-58.25), total cholesterol/HDL-C ratio>5 (OR: 2.75, 95% CI: 0.66-11.55) and waist circumference>96cm (OR: 5.08, 95% CI: 1.27-20.42) were independent predictors of severe and complex CAD, and Manipal Diabetes Coronary Artery Severity Score was developed. CONCLUSIONS The prediction of severe and complex CAD was achieved with this simple score, and thus enabling effective identification of patients beforehand, who are not likely to be suitable for angioplasty.

Microalbuminuria - A better marker in hypertensive disorders of pregnancy

To assess the role of microalbuminuria in pre-eclampsia (PE) as a diagnostic marker, we studied 40 PE cases and 40 normotensive controls at 24 ± 4 weeks of gestation in women 20-35 years of age. The patients with PE had significant microalbuminuria in comparison with the controls, in addition to deranged renal function tests. The receiver operating characteristic curve showed that microalbuminuria had the highest sensitivity (100%) and good specificity (77.6%). Microalbuminuria had the highest area under the curve (0.869) for both diagnosis of PE and renal function assessment. Microalbuminuria also had a good correlation with systolic blood pressure in the cases with mild grades of renal dysfunction. Microalbuminuria is a specific marker in PE and it also helps to assess the renal function status. Therefore, microalbuminuria may be used in the early diagnosis and management of PE patients in order to reduce the immediate and long-term complications.

Are uric acid values surrogate for insulin resistance in apparently healthy subjects across a spectrum of body mass index

Background: The concept of insulin resistance initially proposed in diabetic patients requiring high doses of insulin is now known to be associated with major public health problems, including obesity, hypertension, coronary artery disease, and metabolic syndrome. Serum uric acid (SUA) values are also elevated in the above conditions and proposed to reflect the insulin-resistant state. Objective: To determine whether SUA levels can be used as a surrogate for insulin resistance calculated as homeostatic model assessment insulin resistance (HOMA-IR) in apparently healthy, normal weight, overweight, and obese population. Materials and Methods: A cross-sectional study done in 150 subjects of both genders aged 20-40 years was divided equally based on their body mass index into three groups namely normal weight, overweight, and obese as per National Institutes of Health classification. Fasting plasma glucose, fasting serum insulin, and SUA were estimated. HOMA-IR was calculated. Results: Mean waist circumference, waist-hip ratio, fasting insulin, fasting glucose, uric acid, and HOMA-IR were found to be elevated in both overweight and obese groups. Mean uric acid levels were 4.9 mg/dL, 5.4 mg/dL, and 6.3 mg/dL and mean HOMA-IR values are 2.2, 3.3, and 7.3, respectively, in normal weight, overweight, and obese subjects. Significant correlation of uric acid with insulin resistance calculated as HOMA-IR was not found in any of the three groups. Conclusion: There was an incremental increase in fasting glucose, fasting insulin, uric acid, and HOMA-IR from normal weight to overweight to obese subjects in a systematic proportion. Significant correlation of uric acid with fasting insulin and insulin resistance was not seen and hence cannot be used as the surrogate marker for insulin resistance in the apparently healthy population.