Anthropometric indicators of obesity for identifying cardiometabolic risk factors in a rural Bangladeshi population

Aims/Introduction

The aim of the present study was to evaluate the predictive ability of body mass index (BMI), waist circumference (WC), waist‐to‐hip ratio (WHR), waist‐to‐height ratio (WHtR) and body fat percentages (BF%) for the presence of cardiometabolic risk factors, namely type 2 diabetes (DM), hypertension (HTN), dyslipidemia and metabolic syndrome (MS).

Materials and Methods

A total of 2293 subjects aged ≥20 years from rural Bangladesh were randomly selected in a population‐based, cross‐sectional survey. The association of anthropometric indicators with cardiometabolic risk conditions was assessed by using receiver operating characteristic curve analysis and adjusted odds ratios (ORs) for DM, HTN, dyslipidemia and MS.

Results

Area under the curve cut‐off values showed that the association of WHR, BF% and WC was higher than that for other indices for DM, HTN and MS, respectively, for both sexes, and WHtR for men and WHR for women for dyslipidemia. The ORs were highest for WHR for DM and WC for MS for both sexes, and WHtR for men and WC for women for HTN and dyslipidemia, respectively. The optimal cut‐off values for obesity for the present study in men and women showed BMIs of 22 and 22.8 kg/m², WHRs of 0.93 and 0.87, WHtRs of 0.52 and 0.54, BF% of 21.4 and 32.4%, and WCs of 82 and 81 cm, except for MS, which were 90 for men and 80 for women.

Conclusions

Compared with BMI, measures of central obesity, particularly WHR, WC, WHtR and BF%, showed a better association with obesity‐related cardiometabolic risk factors for both sexes.     

Primary total hip arthroplasty by cemented prosthesis in secondary osteoarthritis of the hip joint

Cemented total hip arthroplasty has been being practiced successfully all over the world for the last 5 decades. Osteoarthritis is the most common indication of total hip arthroplasty. This study was done to observe the outcome of primary total hip arthroplasty by cemented prosthesis in secondary osteoarthritis of the hip joint. This prospective study was conducted at the department of Orthopaedics, Bangabandhu Sheikh Mujib Medical University and some private hospitals in Dhaka, Bangladesh from May 2008 to December 2009. Total 21 patients were evaluated. Among them 38.1% had rheumatoid arthritis, 19.1% had ankylosing spondylitis and 42.8% had avascular necrosis. Average duration of postoperative hospital stay was 14.09 days. Regarding the functional outcome, 76.2% patients had excellent, 19.1% had good and 4.8% had fair outcome. So out of 21 cases, 95.2% had satisfactory and 4.8% had unsatisfactory outcome. Cemented total hip arthroplasty is an effective procedure for the management of secondary osteoarthritis of the hip joint.     

Pediatric-type nodal follicular lymphoma: an indolent clonal proliferation in children and adults with high proliferation index and no BCL2 rearrangement

Pediatric follicular lymphoma (PFL) is a variant of follicular lymphoma (FL) presenting as localized lymphadenopathy in children. Unlike conventional adult FL, PFL typically does not recur or progress. Clear diagnostic criteria for PFL are lacking, and it is uncertain whether this indolent lymphoma is defined by age or may occur in adults. We analyzed 27 FL in patients < 40 years of age and found that all 21 cases that lacked a BCL2 gene abnormality (BCL2-N; P < .0001) and had > 30% Ki67 fraction (high proliferation index, HPI; P = .0007) were stage I and did not progress or recur; in comparison, all 6 cases with BCL2 rearrangement and/or PI < 30% were stage III/IV, and 5 of 6 recurred or progressed. In a separate cohort of 58 adult FL (≥ 18 years of age), all 13 BCL2-N/HPI cases were stage I, and none progressed or relapsed, whereas 11 of 15 stage I cases with BCL2 gene abnormality and/or LPI relapsed or progressed (P = .0001). The adult and pediatric BCL2-N/HPI FL cases had similar morphologic features. Our results confirm the highly indolent behavior of PFL and suggest that these are characterized by HPI and absence of BCL2 gene abnormality. PFL-like cases also occur in adults and are associated with indolent behavior in this patient population.     

Comparison of the prevalence of metabolic syndrome and its association with diabetes and cardiovascular disease in the rural population of Bangladesh using the modified National Cholesterol Education Program Expert Panel Adult Treatment Panel III and International Diabetes Federation definitions

Aims/Introduction

To compare the prevalence of metabolic syndrome (MS) using the modified National Cholesterol Education Program Adult Treatment Plan III (NCEP) and the International Diabetes Federation (IDF) definitions and, using both definitions, determine and compare the association of MS, prediabetes, type 2 diabetes, hypertension (HTN) and cardiovascular disease risk (CVD).

Materials and Methods

A total of 2,293 randomly selected participants (aged ≥20 years) in a rural community in Bangladesh were investigated in a population-based cross-sectional study. Sociodemographic and anthropometric characteristics, blood pressure, blood glucose, and lipid profiles were studied. Age-adjusted data for MS and cardiometabolic risk factors were assessed, and their relationships were examined.

Results

The age-adjusted prevalence of MS was 30.7% (males 30.5%; females 30.5%) using the NCEP definition, and 24.5% (males 19.2%, females 27.5%) using the IDF definition. The prevalence of MS using the NCEP definition was also higher in study participants with prediabetes, type 2 diabetes, HTN and CVD risk. The agreement rate between both definitions was 92% (k = 0.80). The NCEP definition had a stronger association with type 2 diabetes and HTN (odds ratio 12.4 vs 5.2; odds ratio 7.0 vs 4.7, respectively) than the IDF definition. However, the odds ratios for prediabetes and CVD risk were not significantly different.

Conclusions

The prevalence of MS was higher using the NCEP definition, and was more strongly associated with prediabetes, type 2 diabetes, HTN and CVD in this Bangladeshi population.     

Obturator hernia

An elderly emaciated female patient presented with recurrent lower abdominal pain associated with nausea and vomiting due to obstruction of the small bowel. Although the Howship-Romberg sign and tender mass on digital rectal examination could not ascertained but plain X-ray abdomen shows features of acute intestinal obstruction. After resuscitation laparotomy was done and diagnosed as case of strangulated obturator hernia of Ricters type. Reduction of hernial content and resection of the gangrenous part of small bowel with end-to-end anastomosis done. The hernial defect is repaired by a proleine mesh. Abdomen closed in layers keeping a drain in right iliac fossa and pelvic cavity. The postoperative recovery was uneventful. Patient discharge with advice on 9th postoperative day.     

Comparative study of radical neck dissection vs. modified radical neck dissection in metastatic neck gland

Treatment of metastatic neck gland is an integral part of management of Head and Neck cancers, because this is the single most important prognostic determining factor. Although surgery and radio therapy with or without chemotherapy are the modalities available for treating neck gland, wide surgical excision of the whole regional lymphatic chain enblock is mostly favored. Radical Neck dissection is the operation for such disease, designed in the early part of twentieth century, still has got the validity, but a modification of that (modified radical neck dissection) is becoming popular for last few decades to reduce morbidity. In this study we compared 15 cases of radical neck dissection and equal number of modified radical neck dissection to observe the selection criteria of these two types of operations, their complications and therapeutic success. Neck deformity, shoulder pain and restricted shoulder movement are the major morbidities which are less in modified radical neck dissection. The oncologic efficacy appears as same in both procedures.     

The apelin receptor inhibits the angiotensin II type 1 receptor via allosteric trans-inhibition

Background and Purpose

The apelin receptor (APJ) is often co-expressed with the angiotensin II type-1 receptor (AT1) and acts as an endogenous counter-regulator. Apelin antagonizes Ang II signalling, but the precise molecular mechanism has not been elucidated. Understanding this interaction may lead to new therapies for the treatment of cardiovascular disease.

Experimental Approach

The physical interaction of APJ and AT1 receptors was detected by co-immunoprecipitation and bioluminescence resonance energy transfer (BRET). Functional and pharmacological interactions were measured by G-protein-dependent signalling and recruitment of β-arrestin. Allosterism and cooperativity between APJ and AT1 were measured by radioligand binding assays.

Key Results

Apelin, but not Ang II, induced APJ : AT1 heterodimerization forced AT1 into a low-affinity state, reducing Ang II binding. Likewise, apelin mediated a concentration-dependent depression in the maximal production of inositol phosphate (IP₁) and β-arrestin recruitment to AT1 in response to Ang II. The signal depression approached a limit, the magnitude of which was governed by the cooperativity indicative of a negative allosteric interaction. Fitting the data to an operational model of allosterism revealed that apelin-mediated heterodimerization significantly reduces Ang II signalling efficacy. These effects were not observed in the absence of apelin.

Conclusions and Implications

Apelin-dependent heterodimerization between APJ and AT1 causes negative allosteric regulation of AT1 function. As AT1 is significant in the pathogenesis of cardiovascular disease, these findings suggest that impaired apelin and APJ function may be a common underlying aetiology.

Linked Article

This article is commented on by Goupil et al., pp. 1101–1103 of this issue. To view this commentary visit http://dx.doi.org/10.1111/bph.12040