Shyam Sundar Ganguly

Prevalence of prehypertension and associated cardiovascular risk profiles among prediabetic Omani adults

BackgroundThe importance of prediabetes and prehypertension has been demonstrated in several studies especially for primary prevention of CVD. A recent community based cross-sectional study revealed that 40.9 percent Omani adults are prediabetics. This study was undertaken to estimate the prevalence of prehypertension and associated cardiovascular risk profiles in prediabetics. To best of our knowledge, this is the first report on this subject.MethodsThe study included 327 confirmed pre-diabetic Omani adults, who were analysed for their demographic, metabolic and behavioral characteristics. These characteristics were compared between the three different blood pressure groups to determine the CVD risk factors. Univariate and step-wise multiple logistic regression methods were used to carry out the analysis of the data.ResultsIn this study, the prevalence of prehypertension was 54.1 percent. Males were at higher risk of developing prehypertension as compared to females (OR = 2.30, 95% CI: 1.21, 4.38; P < 0.01). The individuals with higher BMI have two fold more risk of developing prehypertension (OR = 2.25, 95% CI: 1.26, 4.02; P < 0.01). The increased level of OGT enhanced the risk of developing prehypertension (OR = 1.26, 95% CI: 1.06, 1.50; P < 0.01).ConclusionA high prevalence of prehypertension (54.1%) exists in this study population. The major determinants of prehypertension in these prediabetic subjects were male gender, increasing dysglycemia and BMI. Appropriate intervention strategies have been suggested.

Outcomes After Rigid Bronchoscopy in Children With Suspected or Confirmed Foreign Body Aspiration: A Retrospective Study

OBJECTIVE To identify the determinants of immediate outcome after rigid bronchoscopy for suspected or confirmed foreign body (FB) aspiration. The outcome may be affected by the duration of bronchoscopy, the type of FB, the time between inhalation and removal of the FB, and the type of anesthetic induction. Arterial desaturation, bronco-laryngospasm, and the need for tracheal reintubation as complications were investigated. DESIGN A retrospective study. SETTING A single tertiary care center. PARTICIPANTS One hundred seventy-five children who underwent rigid bronchoscopy. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Age, duration after suspected or witnessed inhalation before bronchoscopy, and the type of FB had no relationship to the occurrence of complications. The prolongation of bronchoscopy beyond 30 minutes was associated with a significant increase in complications as was the use of intravenous rather than inhalation induction of anesthesia. CONCLUSIONS Reducing the bronchoscopy time may not be an option, but an awareness of the risk of complications may prompt a more intense postanesthesia monitoring strategy.

Splenectomy for haematological disorders: a single center study in 150 patients from Oman.

BACKGROUND Haematological disorders, in particular sickle cell disease (SCD) and thalassaemia, are relatively common in Oman. We report our experience of splenectomy for haematological disorders and review the literature on splenectomy role in their management. OBJECTIVES To review our experience in the management of 150 patients with haematological disorders undergoing splenectomy with emphasis on indications and outcome. To compare our experience with those reported from outside this region. METHODS The records of 150 patients who underwent splenectomy over a thirteen year period were reviewed retrospectively, analyzing the age and sex of the patients, indication for splenectomy, operative procedures, complications, peri-operative management and outcome. RESULTS Of the 150 patients, 96 (64%) had SCD and 34 (22.6%) had beta-thalassaemia; the rest comprised patients with refractory idiopathic thrombocytopenic purpura (ITP) n=12, hereditary spherocytosis (HS) n=6, and auto-immune haemolytic anaemia (AHA) n=2. In SCD patients, the main indications for splenectomy were recurrent splenic sequestration (60.4%) and hypersplenism (36.4%), whereas in thalassaemic patients it was increased requirement of packed red blood cells (PRBC) transfusion (mean 310 ml, range 242-372 of PRBC/kg/year). All patients received prophylactic antibiotics and vaccination against pneumococcal infection and when the vaccine was available for Haemophilus influenzae. PRBC and platelet concentrates as well as intravenous fluids were infused preoperatively as per protocol. Concomitant procedures at laparotomy included liver biopsy (14.6%) and cholecystectomy (8.6%). The postoperative morbidity was low (8.6%) and there was no mortality. All patients were maintained on long term penicillin and proguanil, and the mean follow-up was 4.6 years. In SCD patients splenectomy eliminated the risks of life threatening acute splenic sequestration and improved significantly the blood counts of the hypersplenic cases, while in thalassaemic patients it reduced significantly the mean transfusion requirement by 100ml PRBC/kg/year (p<0.0001). Of the patients with refractory ITP, two thirds had a good response to splenectomy (p<0.0001). All HS and AHA patients benefited from splenectomy. CONCLUSION The predominant indications for splenectomy were recurrent acute splenic sequestration and hypersplenism in SCD patients, and increased transfusion demand in the thalassaemics. Overall, splenectomy proved beneficial in eliminating the risk of splenic sequestration in SCD patients, in improving the blood counts in SCD with hypersplenism and in reducing transfusion requirement in thalassaemic patients, while in ITP group two thirds of the patients benefited.

Prevalence of Metabolic Syndrome among Prediabetic Omani Adults: A Preliminary Study

BACKGROUND Metabolic syndrome is a well-established risk factor for the development of coronary artery disease (CAD). A recent cross-sectional, community-based study revealed that 36.1% of Omani adults are prediabetic as per American Diabetes Association (ADA) criteria. The objectives of this study were to determine the prevalence of metabolic syndrome and its relationship to various risk factors in a prediabetic population. METHODS Our study included 281 Omani prediabetic adults. The anthropometric, systolic, and diastolic blood pressure measurements together with lipid profile estimation were carried out. RESULTS In this study, the prevalence of metabolic syndrome was found to be 45.9%, and the gender-based distribution was 30.8% for men and 58.9% for women. The stepwise multiple logistic regression model revealed that women are at higher risk of developing metabolic syndrome. Prediabetics with a body mass index (BMI) >or= 30.0 (kg/m(2)) and abnormal waist-to-hip ratio (WHR) have a higher risk of developing metabolic syndrome with odds ratios (OR) of 20.20 and 6.38, respectively. CONCLUSION The prevalence of metabolic syndrome in this prediabetic study population was found to be higher than that of in the general population. Certain health promotion and disease prevention measures have been suggested. To the best of our knowledge, this is the first report on this subject.

Hematopoietic stem cell transplantation in Oman

Hematopoietic SCT (HSCT) is an integral part of the management of patients with hematologic disorders. The Sultanate of Oman, with a population of 2.3 million, has an HSCT program based in the Sultan Qaboos University (SQU) hospital. Initiated in 1995, this two-bed unit continues to be the only program in the country. Between June 1995 and August 2006, a total of 128 patients underwent HSCT in this center, averaging about 10–12 transplants per year. The median age of these patients was 11 years (2 months to 45 years). Hematologic malignancies (49%) and inherited disorders (42%) constituted the major transplant indications, whereas BM failure accounted for the remaining. The majority of transplants carried out so far have been HLA-matched sibling-donor allogeneic HSCTs. Among the inherited disorders, homozygous beta-thalassemia and primary immunodeficiency are important transplant indications in this center. The approximate cost of an uncomplicated transplant in this center is US

Arterial Switch Operation: Troponin T Does Not Predict Ventilation Requirements

50 000. The success of this program has now led to the initiation of a new and larger HSCT complex to provide the opportunity for more patients to benefit from this treatment modality within the country.

Herabsetzung der retinalen Sensitivität bei Patienten mit unkontrolliertem Diabetes mellitus Typ 2 — eine Studie zur Mikroperimetrie der Makula

The aim of this study was to assess whether postoperative cardiac troponin T levels could predict ventilation requirements in infants undergoing the arterial switch operation. Cardiac troponin T was measured 6 hours after aortic cross clamping and prior to tracheal extubation in 20 consecutive patients; 10 had simple and 10 had complex (with ventricular septal defect) transposition of the great arteries. The mean plasma troponin T level prior to extubation did not differ significantly in patients who were re-intubated and those who were successfully extubated. The initial cardiac troponin T levels in the complex defect group was significantly higher than in the simple transposition group. There was no correlation between initial cardiac troponin T levels and the duration of mechanical ventilation. There was no difference in mean duration of ventilation between the 2 groups. It was concluded that the postoperative cardiac troponin T level is not a predictor of successful extubation or prolonged artificial ventilation in this subset.

A Single Daily Ultra Low-Dose of Oral Acyclovir Is Sufficient to Prevent the Occurrence of Herpes Zoster Post Hematopoietic Stem Cell Transplantation: Interim Results of a Prospective Randomized Trial

ZusammenfassungZielEvaluierung der Makulafunktion bei Patienten mit Diabetes mellitus Typ II.StudiendesignNichtrandomisierte kontrollierte Fallserie.MethodenBei 25 Patienten mit 50 Augen und nachgewiesenem Diabetes mellitus Typ II wurden das Fixationsund das Sensitivitätsmuster der Makula und die Testantwort (Latenz) mit Hilfe des Mikroperimeters MP-1 (Fa. Nidek) evaluiert und mit klinischen Befunden, aktuellen Blutzuckerwerten und fluoreszenzangiographischen Daten korreliert. Fundusveränderungen wurden anhand der ETDRS-Kriterien klassifiziert. Die Statistik erfolgte mit chi2-Tests.Ergebnisse20 Augen (40%, Grp. 1) hatten keinen Hinweis auf eine diabetische Retinopathie, 13 Augen (26%, Grp. 2) hatten eine nichtproliferative Retinopathie ohne und 17 Augen (34%, Grp. 3) eine nichtproliferative Retinopathie mit klinisch signifikantem Makulaödem. 9 Augen (36%) hatten ein seitenungleiches klinisches Bild. Abnormales unstabiles Fixationsmuster: Grp. 1: 8 (40%), Grp. 2: 7 (54%), Grp. 3: 17 (100%), reduzierte retinale Sensitivität Grp. 1: 4 (24%), Grp. 2: 8 (62%), Grp. 3:17 (85%) und verzögerte Testantwort Grp. 1: 8 (40%), Grp. 2: 4 (30%), Grp. 3: 17 (100%). Eine statistisch signifikante Anzahl von Augen (p < 0,0001) in der Studiengruppe zeigte damit unstabile Fixation, verzögerte Testantwort und subnormal retinale Sensitivät und korrelierten mit den klinischen Befunden je nach Erkrankungsstadium.SchlussfolgerungenAbnormales Fixationsmuster, reduzierte retinale Sensitivität und verzögerte Testantwort weisen auf einen stadienabhängigen Defekt der intraretinalen Ganglienzellen bei unkontrollierten hohen Blutzuckerwerten hin. Eine frühe Diagnose makulärer Komplikationen bei unkontrolliertem Diabetes kann durch die Mikroperimetrie ermöglicht werden.SummaryAimTo evaluate the macular function in patients with diabetes mellitus type II.Study designNonrandomized controlled case series.Methods25 patients (50 eyes) with diabetes mellitus Type II and 25 age-matched controls without were randomly subjected to evaluation of the fixation, retinal sensitivity and test response patterns of the macula using the Nidek Microperimeter. The findings were correlated with blood sugar levels and fluorescein angiography. Fundus changes were classified based on ETDRS criteria. Chi square test was applied for statistical analysis.Results20 eyes had no evidence of diabetic retinopathy, 13 eyes (26%) had background changes, and 17 eyes (34%) macular edema. 9 patients (36%) had an asymmetrical clinical picture. Abnormal fixation patterns: Grp. 1: 8 (40%), Grp. 2: 7 (54%), Grp. 3: 17(100%), reduced retinal sensitivity Grp. 1: 4 (24%), Grp. 2: 8 (62%), Grp. 3: 17 (85%), and delayed test response: Grp. 1: 8 (40%), Grp. 2: 4 (30%), Grp. 3: 17 (100%). A statistically significant number of eyes (p < 0.0001) in the study group showed unstable fixation, delayed test responses and subnormal retinal sensitivity correlating with the disease process.ConclusionAbnormal fixation pattern, reduced retinal sensitivity and prolonged test response indicate defective macular function and is related to the disease process in diabetics. Very early detection of diabetic macular complications in uncontrolled diabetics seems to be possible by microperimetry.