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Purpose: Type 2 diabetes mellitus (T2DM) is known to produce diabetic retinopathy (DR). Pulse wave analysis (PWA) provides arterial stiffness (AS) and central hemodynamic (CH) parameters. We studied the effect of DR on AS and CH parameters in type 2 diabetics (T2D). Methods: We performed a cross-sectional study on 47 T2Ds attending a private ophthalmology clinic screened for DR by optical coherence tomography angiography and divided into NDR (non-DR), NPDR (non-proliferative DR), and PDR (proliferative DR). Mobil-o-graph (IEM, Germany) based oscillometric PWA yielded AS and CH parameters. They were further compared between groups stratified by DR with P value set at 0.05. Results: Participants had a mean age 62, mean diabetes duration 9 years, high mean BMI, and high prevalence of physical inactivity, hypertension, and poor diseases control. Significant differences were lacking in NPDR, NDR, and PDR in rate pressure product (mean 112.71 vs 116.06 vs 119.57), central pulse pressure (mean 46.50 vs 43.09 vs 42.72), stroke work (mean 153.36 vs 132.36 vs 146.08), augmentation index (mean 29.43 vs 33.14 vs 31.64), and aortic pulse wave velocity (mean 10.06 vs 9.08 vs 9.06). There was no clear pattern of distribution of most parameters among the three subgroups. Conclusion: We found a lack of association between DR and cardiovascular ageing studied by AS and hemodynamic parameters. It suggests a possible difference in risk factors for both of these aftermaths of T2DM and calls for further prospective studies with a large sample size. [ABSTRACT FROM AUTHOR]

Introduction: Type 1 Diabetes is an early onset disease that imposes significant cardiovascular risk. Arterial stiffness and central haemodynamics are immediate and discrete parameters but studied scarcely. Pulse wave analysis (PWA) allows non-invasive measurement of them which we undertook in diabetics. Methodology: We performed a case control study on 36 treated type 1 diabetics and 36 nondiabetic, normotensive, matched controls. Oscillometric pulse wave analysis (PWA) was performed by Mobil-o-Graph (IEM, Germany). Parameters were compared between case and controls. Multiple linear regressions were accomplished to find significant predictors. P < 0.05 was taken as statistical significance. Results: - Cases showed significantly raised brachial haemodynamics (blood pressure, heart rate, rate pressure product); arterial stiffness (augmentation pressure, augmentation index, pulse wave velocity, total arterial stiffness, pulse pressure amplification) and central haemodynamics (central blood pressure, cardiac output, stroke work) than controls, with statistical significance for not all. Most outcome parameters were predicted by age, HR, BP to lesser extents. Genders, presence of hypertension, glycemic control, blood pressure control, physical activity were not significantly affecting study outcomes in case group. Conclusion: Gujarati type 1 diabetics had beyond brachial blood pressure, adverse profile of discrete cardiovascular parameters; independent of conventional confounders; suggesting vascular progeria. This baseline work hints further study of these PWA parameters. [ABSTRACT FROM AUTHOR]

Introduction: Smoking is an increasingly popular indulgence in India. Assessment by routine spirometry falls short of direct functional parameter like Diffusion Lung Capacity (DLC), also known as lung transfer factor (LTF). Aim: To measure LTF amongst middle aged male smokers and to study various correlates for it. Materials and Methods: Total of 45 asymptomatic male current smok ers were enrolled for this cross-sectional study conducted at pulmonary function testing lab of Physiology Department of our college. Smoking history was evaluated and smoking index was defined by product of number smoked per day and years smoked. We used instrument Ultima PFX of Medgraphic Company. After pre syringe calibration LTF was measured by Methane mixture using protocols of ATS. Parameters measured were Dlco-uncorrected, corrected and normalized to VA (alveolar volume). Results were compared for statistical significance and significance was set as p <0.05. Results: In case group of 45(25 bidi and 20 cigarette smokers) mean age was 30 years, mean duration was 8 years, mean smoking index was 60. We found small insignificant decline in actual LTF values than predicted which was not significantly different between bidi and cigarette smokers. Duration, age and intensity of smoking were negatively and significantly correlated with LTF value while anthropometric parameters were not. Conclusion: Smoking adversely affects LTF in young asymptomatic current male smoker that further declines with severity of smoking and with duration regardless of type of smoking. With years to come, these alterations can largely be prevented by smoking cessation, at least theoretically. [ABSTRACT FROM AUTHOR]

Background: Deranged body fat and muscle mass are aftermaths of uncontrolled diabetes. Anthropometric methods like body mass index (BMI) do not give qualitative inferences like total body fat (TBF), visceral fat (VHF) or subcutaneous fat (S) that can be given by bio-electrical impedance analysis (BIA). We studied body composition of type 2 diabetics in comparison to controls matched by age-sex, weight and BMI separately. Methods: Seventy-eight under-treatment type 2 diabetics of either sex with known glycemic and lipidemic control and equal number of controls with three patterns of matching were taken from our city. We derived parameters of body composition in both groups by Omron Karada Scan (Model HBF-510, China), using the principle of tetra poplar BIA and compared them for statistical significance. Results: We found significantly more SF (30.47% ± 7.73%), VF (11.94% ± 4.97%) and TBF (33.96% ± 6.07%) and significantly lesser skeletal muscle mass (23.39% ± 4.49%) in type 2 diabetics as compared to controls, persisting even after matching with weight or BMI. On assessing qualitatively, the risk of high VF, high TBF, low skeletal muscle mass was significantly high in type 2 diabetics, which were 10.41, 3.01, 9.21 respectively for comparable BMI and 6.78, 3.51, 11.93 respectively for comparable weight. Conclusions: BIA reveals that type 2 diabetics have more ectopic fat on the expense of skeletal muscle that persists even after matching by weight or BMI, both quantitatively and qualitatively. Measurement of body composition can be included as a primary care strategy to motivate lifestyle modifications while managing metabolic deran-gements of type 2 diabetes. [ABSTRACT FROM AUTHOR]

Background and Objectives: Air pollution due to road traffic is a serious health hazard and air quality crisis in cities is mainly due to vehicular emission. Thus the persons who are continuously exposed are at an increased risk. The study was carried out to evaluate the extent of impairment in lung function in traffic police personnel compared to matched unexposed control group. Materials and Methods: A cross-sectional study was conducted to measure the spirometric parameters of 100 traffic police personnel, aged 20-55 years, working in Saurashtra region, as compared to matched control group, consisting of 100 unexposed males. Measurement of lung volumes and capacities was done with SPIROEXCEL. The statistical analysis was carried out with Graph pad instat 3. Results: Traffic police personnel had significantly declined forced vital capacity (FVC), forced expiratory volume in one second (FEV 1), slow vital capacity (SVC) and maximum voluntary ventilation (MVV) when compared with predictive normal values, which is probably due to exposure to vehicular exhaust. Comparison of test values between groups showed significantly reduced FVC, MVV and increased FEV1/FVC ratio and insignificantly declined FEV1 and SVC in cases as compared to controls. Traffic personnel with longer duration of exposure showed significantly reduced lung functions than those with shorter duration. Smokers showed lower test values as compared to non-smokers with significance only in unexposed group. Conclusion: The effect of pollution by vehicular exhausts may be responsible for these pulmonary function impairments and traffic police personnel should be offered personal protective or preventive measures. [ABSTRACT FROM AUTHOR]

Background: Exposure to Occupational noise is the major avoidable cause of permanent hearing loss that is preventable by protective measures. Present study evaluated hearing profile and effects of shift, sex, and smoking on hearing loss in plastic weavers working in textile industry exposed to impact type of noise. Materials and Methods: A cross-sectional study of hearing threshold of various shift workers of plastic weaving industries (18 males, 32 females) at various frequencies was done and effect of various factors was tested at low and high frequencies and compared at 4 kHz, 6 kHz, and 8 kHz statistically. Results: Hearing thresholds were significantly higher at high frequencies than speech frequencies, in day shift workers than night shift workers and within day shift workers more with continuous type of shift work than interrupted type. Females showed better hearing than males and for non-smokers than smokers, but the difference observed in both instances proved statistically insignificant. Conclusion: It can be concluded that the use of alternate day and night shift, interrupted day shift may be used to prevent hearing loss and for further confirmation few more studies are warranted. Being female and non smoking also proved an advantage. Comparatively, mild to moderate degree of hearing loss further reinforces the scope of prevention by hearing protective devices and interrupted shift design of work. [ABSTRACT FROM AUTHOR]

Background: The textile workers exposed to industrial noise are prone to develop hearing loss concentrated mainly at high audible frequencies. It is affected by duration of exposure and type of noise. Aims: Present study was conducted to (a) investigate hearing thresholds of textile workers by pure tone audiometry, (b) correlate thresholds at 4 kHz, 6 kHz and 8 kHz between noise exposed and unexposed group and (c) study effect of duration of exposure on hearing profile. Materials and Methods: A cross-sectional study was carried out on 50 weavers of plastic industries exposed to high levels of constant noise. Objectively, hearing defects were inquired by self-administered questionnaires. Subjectively, pure tone audiometry was carried out to measure hearing thresholds at various frequencies. It was simultaneously compared with the similar data of matched control group. Results: Prevalence of hearing loss symptom and hearing thresholds were more in exposed group than in control group. There was significant hearing loss at high frequency as compared to lower ones. Audiometry revealed notch at 4 kHz with less effect at 6 or 8 kHz, cumulative effect of duration of exposure. Conclusion: Textile weavers are more at risk to develop Occupational Noise Induced Hearing Loss (ONIHL) mainly affecting higher frequencies concentrated at 4 kHz. Despite least effects on hearing, this disease silently progresses and there is a definite scope of prevention by appropriate protective measures. [ABSTRACT FROM AUTHOR]

Background: Influence of sex on brainstem auditory evoked potential (BAEP) is not well understood with few studies in India that targets young Teenagers. Aim: Our study aimed to look into gender, head circumference, and body mass index (BMI) as a factor affecting BAEPs of healthy late teenagers. Materials and Methods: BAEP responses were elicited in age-matched teenager college students using standard protocol. Results of absolute latencies and interpeak latencies (IPLs) were compared among Male and female groups and compared for significance as such and after normalizing head size and BMI and tested for significant difference, if any. Results: Latencies and IPLs of BAEP were lower in males when compared with females, but significance was found only for the later parameter. IPLs showing significant gender difference were for I-III and III-V but not I-V. When test groups with comparable head size and BMI were compared, the difference decreased with neither of the parameter being statistically significant. Conclusion: Utility of BAEP can be optimized by establishing normative data for every setup based on BMI and head circumference along with age and gender before using it as a clinical tool. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "A Study of Effect of Shift Work, Sex and Smoking on Development of ONIHL in Plastic Weavers" by J. D. Solanki and colleagues that was published in a 2013 issue.

Background: Obesity and vascular ageing are two facets of type 2 diabetes (T2Ds) to study. The former can be studied by qualitative body fat analysis using bio-electrical impedance (BIA) and later with blood pressure by pulse wave analysis (PWA). We studied the association between BIA and PWA parameters in T2Ds., Methodology: One hundred and fifty-six T2Ds on treatment were evaluated for BIA (Omron Karada Scan, China) and PWA (IEM, Stolberg, Germany). BIA parameters (weight, BMI, total body fat, visceral fat, subcutaneous fat, skeletal muscle mass) and PWA parameters (arterial stiffness, brachial haemodynamics, aortic blood pressures, central haemodynamics) were studied. Comparison, correlation, risk association, and predictions were done with a p-value < 0.05 as statistically significant., Results: The mean age was 57.7 years, while the mean BMI was 22.8 kg/m2. The prevalence of hypertension was 50%, while the prevalence of glycaemic control was 10%. The correlation between BIA and PWA parameters in >75% instants was weak and insignificant (especially for aortic parameters and central haemodynamics). Female gender, BMI < 22.5 kg/m2, VF< 10, and low/normal TBF were associated with comparatively high PWA parameters, but inconsistently. High BMI or VF did not impose a significant Odds risk of high aortic pulse wave velocity or central pulse pressure. Visceral fat and aortic pulse wave velocities were not significantly predicted by blood pressure, BMI, and heart rate., Conclusion: Among rural type 2 diabetics with a mean BMI of 22.8 kg/m2 and poor glycaemic control, there is largely a lack of association between obesity and vascular aging, suggesting differences in time course and pathology of the two entities in type 2 diabetics. Further studies are recommended., (Copyright © 2023 Nigerian Medical Association.)

Background: Diabetic peripheral neuropathy (DPN) is common microvascular complication with lack of data from many regions. Vibration perception threshold (VPT) is an objective tool to screen vibration-based neuropathy both quantitatively and qualitatively. We studied prevalence that correlates VPT in diabetic sample population., Methods: A cross-sectional study was performed in 100 under treatment urban type 2 diabetics. Using bioesthesiometer, we tested VPT from sole of lower limbs of each participant. VPT >25 was considered as DPN. VPT was further correlated to determinants using t test, chi square, and multiple linear regressions. P < 0.05 was taken as statistically significant., Results: Mean age was 57, mean duration was 9.42 years, 40% were good glycemic, 28% were symptomatic for neuropathy, half subjects had co-existing hypertension and positive family history. VPT >25 was prevalent in 38% participants and mild, moderate, severe grades of DPN were present in 10%, 20%, 38%, respectively. VPT was associated with all three measures of glycemic control both quantitatively and qualitatively imposing significant odds risk (3.45, 2.63, 3.63 for HbA1C, FPG, 2hPG, respectively). Presence of symptoms, duration, and family history were significant predictors of VPT, whereas age, gender, hypertension, hyperlipidemia, and glycemic control were not., Conclusion: In chronic type 2 diabetics from a city Gujarat, we report 38% prevalence of DPN, related to symptoms, duration, family history, and all measures of glycemic triad. Unrelated to age and gender, VPT is superior to symptoms to detect DPN and it should be used optimally to insinuate timely preventive measures., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Family Medicine and Primary Care.)

Background: Pregnancy is associated with profound cardiovascular adaptation with altered cardiac autonomic balance. It can be studied by heart rate variability (HRV) which indicates beat to beat RR interval variation on ECG., Objective: We studied 5 min HRV in normal pregnant females divided by trimesters, compared to matched control., Methodology: We recruited 89 normal pregnant females and 30 age matched controls. Five minutes resting HRV was measured by Variowin HR, software-based instrument, by standard protocols to yield time-domain, frequency domain, and Poincare plot parameters. They were further compared between groups for difference., Results: Case groups (three based on trimesters) and control group were comparable. There was reduced HRV in case than control group, with statistical significance for all, more for frequency domain than time-domain or Poincare plot parameters. There was no pattern of HRV trend across three trimesters, but mostly second trimester was associated with major decline. Primipara revealed significantly reduced HRV than multipara, but anemia or working status was not significantly associated with HRV in case group., Conclusion: There is global HRV reduction in normal pregnancy across all trimesters, associated with primiparity. This indicates pregnancy as a significant risk with reference to altered cardiac balance and use of HRV as a good tool to assess the same., Competing Interests: There are no conflicts of interest., (Copyright: © Journal of Family Medicine and Primary Care.)

Introduction: Diabetes mellitus (DM) is a significant risk factor for nephropathy and cardiovascular morbidity. Pulse wave analysis (PWA) gives direct inference of brachial hemodynamics (BH) and central hemodynamics (CH). We studied relation of them with diabetic nephropathy (DN) among type-2 diabetics (T2D)., Methods: We studied oscillometric PWA by a cross-sectional study in 160 T2Ds. Using Mobil-o-Graph (IEM, Germany), we derived BH (blood pressure, pulse pressure index, rate pressure product) and CH (aortic pressure, cardiac index, stroke volume index, stroke work). They were further compared and associated with DN in terms of creatinine, proteinuria, and estimated glomerular filtration rate (eGFR)., Results: There were 89 males, mean age 56 years, mean duration 4.8 years, 80% hypertensive predominantly using ACE inhibitors, poor glycemic blood pressure (BP) control, mainly mild-to-moderate DN, mean eGFR 88.2, 34% prevalence of proteinuria. Arterial stiffness was high with female disadvantage. BH and CH parameters were not different with or without DN using proteinuria or eGFR (60 cutoff) criteria. BH, CH correlated insignificantly with creatinine and eGFR. Female disadvantage, correlation with bSBP and aSBP were only significant results., Conclusions: BH and CH are not related to eGFR and proteinuria in predominantly hypertensive, Gujarati diabetics with mild-to-moderate nephropathy suggesting need of other cardiovascular parameters., Competing Interests: There are no conflicts of interest., (Copyright: © 2019 Journal of Family Medicine and Primary Care.)

Introduction: Hypertension is the most prevalent noncommunicable disorder, studied in terms of brachial blood pressure. Direct parameters like central hemodynamics and arterial stiffness, though superior, are not studied much. The same can be studied by pulse-wave analysis (PWA) and we did that in euglycemic treated hypertensives., Materials and Methods: A case-control study was conducted in 258 treated euglycemic hypertensives and 258 matched controls. Oscillometric PWA was accomplished by Mobil-O-Graph (IEM, Germany). Parameters were further analyzed for the effect of gender, physical activity, body mass index (BMI) (cutoff 23), blood pressure control, and duration (cutoff 5 years). Multiple linear regressions were used to find significant predictors. P < 0.05 was taken as statistically significant., Results: Cases had significantly higher brachial arterial parameters (blood pressure, heart rate, rate pressure product), arterial stiffness (augmentation pressure, augmentation index, pulse-wave velocity, total arterial stiffness, pulse pressure amplification), and central hemodynamics (central blood pressure, cardiac output, stroke work) compared to age, gender, and BMI-matched controls. In the case group, female gender, BMI ≥ 23, and uncontrolled blood pressure were significant factors affecting results. Heart rate and pulse pressure were major predictors of study parameters. Central pressure parameters were not predicted significantly by corresponding brachial pressure parameters., Conclusion: PWA revealed the adverse profile of arterial stiffness and central hemodynamics in treated Gujarati hypertensives, associated with female gender, BMI, and blood pressure control, predicted mainly by heart rate and pulse pressure, independent of brachial blood pressure. It indicates both potential and further study of these parameters., Competing Interests: There are no conflicts of interest.

Introduction: Diabetes is a modern epidemic imposing significant cardiovascular risk. Immediate and discrete parameters such as arterial stiffness and central hemodynamics are studied scarcely. Pulse wave analysis (PWA) offers noninvasive measurement of the same and we performed that in diabetics., Materials and Methods: We performed a case-control study on 148 treated diabetic not on antihypertensive and 148 nondiabetic normotensive controls. Oscillometric PWA was performed by Mobil-O-Graph (IEM). Parameters were further analyzed for effect of gender, physical activity, body mass index (BMI; cut-off 23), glycemic control, and disease duration (cut-off 4 years). Multiple linear regressions were used to find significant predictors. P <0.05 was taken as statistical significance., Results: Cases had significantly raised brachial hemodynamics (blood pressure, heart rate, rate pressure product), arterial stiffness (augmentation pressure, augmentation index, pulse wave velocity, total arterial stiffness, pulse pressure amplification), and central hemodynamics (central blood pressure, cardiac output, stroke work) than controls. In the case group, female gender, BMI ≥ 23, and physical inactivity were the significant factors affecting results (arterial stiffness more than central hemodynamics); glycemic control and duration were not. Heart rate was the major predictor of study parameters. Brachial pressure parameters were not significant predictors of corresponding central pressure parameters., Conclusion: Gujarati diabetics not using any antihypertensive had adverse profile of beyond brachial blood pressure discrete cardiovascular parameters, independent of duration and glycemic control, related to gender, BMI, and physical activity, indicating vascular progeria in the absence of hypertension. This baseline study suggests further work on these potential parameters., Competing Interests: There are no conflicts of interest.

Background: First degree relatives (FDR) of type 2 diabetic (T2D) are predisposed for type 2 diabetes mellitus (T2DM) which accelerates cardiovascular aging. Pulse wave analysis (PWA) gives non-invasive measurement of central hemodynamics like central blood pressure (cBP), cardiac output (CO), stroke work (SW) and vascular stiffness like pulse wave velocity (PWV) and augmentation index at heart rate 75 (AIx@75)., Objective: To study PWA derived cardiovascular parameters in FDRs of T2D as compared to controls., Materials and Methods: We enrolled 117 FDRs of T2D and 117 matched controls for a cross-sectional study. We performed PWA using Mobil-o-Graph (IEM, Germany) by oscillometric method to derive cardiovascular parameters which were compared and correlated for significance. P value less than 0.05 was considered statistically significant., Results: Gender, age, height, weight, body mass index (BMI), physical activity were comparable between groups. FDRs of T2D had significantly higher blood pressure (brachial-systolic 125 vs 118, diastolic 80 vs 77, mean 100 vs 96mmHg and central- systolic 113 vs 105, diastolic 82 vs 79, pulse pressure 31 vs 28mmHg), SW (98 vs 90gm/bt), rate pressure product (RPP- 113 vs 107), PWV (5.14 vs 4.89m/s), AIx@75 (30 vs 27) than control. Dependant variables correlated with brachial BP more than age or anthropometric variables. Result did not differ by maternal or paternal inheritance in case group., Conclusions: Young, sedentary, non-obese FDRs of T2D have adverse cardiovascular profile which is suggested to worsen before or with onset of T2DM and definitely need attention for life style modification as primary prevention., (Copyright © 2017. Published by Elsevier B.V.)

Background: Co-existence of hypertension is known in three quarter of Indian type 2 diabetics, this duo having adverse additive effect on cardiovascular health including dysautonomia. Latter can be measured by simple 5min heart rate variability (HRV) using simple electrocardiogram, which if reduced indicates cardiac risk., Objective: We compared HRV parameters between hypertensive and normotensive type 2 diabetics, looking for significant difference if any., Materials and Methods: 98 hypertensive and 40 normotensive type 2 diabetics treated as outpatients were evaluated for disease control and risk stratification. Fivemin resting HRV was measured by Variowin HR, software based instrument, using standard protocols to record time domain, frequency domain and Poincare plot parameters. They were compared between groups for difference., Results: Mean age was 56 and 51 years, duration 6 years and 4 years respectively in hypertensive (HT) and normotensive (NT) group of type 2 diabetics, which did not significantly differ in distribution of risk factors. There was poor glycaemic control (one third) in both groups and good pressure control in HT group. Both groups revealed all reduced HRV parameters with significant difference in-between only for LF/HF ratio (1.29 in HT vs 2.61 in NT group)., Conclusion: Our findings of HRV suggest that in type 2 diabetics with poor glycaemic and good pressure control, hypertension as a co-existing factor does not make significant difference in cardiac dysautonomia emphasizing residual risk despite antihypertensive treatment and need for early HRV screening, strict glycaemic control and other interventions., (Copyright © 2016. Published by Elsevier B.V.)

Background: Peripheral arterial disease (PAD) is an aftermath of type 2 diabetes posing a significant health problem in developing countries. Its silent progression warrants presymptomatic screening by ankle brachial index (ABI), which cannot be applied to the whole population. We tried to measure the burden of PAD in diabetics of this region correlating various risk factors for it quantitatively and qualitatively., Materials and Methods: From various out-patient departments, 110 known under treatment type 2 diabetics were recruited. They underwent thorough assessment for general, symptomatic, medical history and risk factor screening that included 11 well-known risk factors. ABI was measured by Versadop instrument using the standard protocol with ABI <0.9 being considered as abnormal., Results: There was a high prevalence of asymptomatism, hypertension, positive family history and age <52 years in the study group. Relative risk was highest for asymptomatism followed by high body mass index, hyperlipidemia, cardiovascular disease and smoking, but less significant for age, gender, fasting sugar level, family history. More adverse ABI profile was noticed with the increase in number of five modifiable risk factors cumulatively., Conclusion: There was a high prevalence of low ABI in our region that is an evidence of PAD mainly affected by risk factors many of which were modifiable. Defining those who are at risk to develop PAD in Diabetes, one can use ABI better in early screening and prompt treatment of this complication to stop its further progression and primary prevention can be served as felt the need for health-care effectively.