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Biomedical subjects

G S Wander

Publications and source records attributed to G S Wander.

At least 19 recordsLinked to original sources
PubMed2004

Hemodynamic effects of arteriovenous fistula in end-stage renal failure.

Hemodynamic parameters using Swan Ganz catheter were studied in 17 patients with end stage renal disease. The acute effects of radiocephalic AV fistula on the hemodynamic parameters were studied at 24 hours of surgery. The chronic effects were studied in 8 of these patients at 6 weeks of arteriovenous (AV) fistula. The AV fistula matured in 3 to 4 weeks time and blood flow was sufficient for hemodialysis (400 mL/min). Patients with chronic renal failure had normal or high normal hemodynamic parameters. Six weeks after the AV fistula, the cardiac index and the stroke volume index slightly increased along with a significant increase in systolic and mean systemic arterial pressure. None of the patients had significant increase in cardiac filling pressures. Although there was some fall in systemic vascular resistance index and rise in cardiac index and stroke volume index, these changes were physically small and unlikely to put any extra hemodynamic load. Thus, AV fistula in dialysis patients is not an appreciable cause of circulatory or pulmonary congestion.

Adult↗
PubMed1999

Social class, coronary risk factors and undernutrition, a double burden of diseases, in women during transition, in five Indian cities.

OBJECTIVE: To find out the association between social class and coronary risk factors in women. DESIGN AND SETTING: Cross-sectional surveys were conducted in six-twelve urban streets in each of five cities from various regions of India following a common study protocol and criteria of diagnosis. SUBJECTS AND METHODS: We randomly selected 3257 women, aged 25-64 years inclusive, from the cities of Moradabad (n=902), Trivandrum (n=760) Calcutta (n=410), Nagpur (n=405) and Bombay (n=780). Evaluation was by questionnaires validated at Moradabad. All subjects, after pooling of data, were divided into social class 1 (n=985), social class 2 (n=790), social class 3 (n=674), social class 4 (n=602) and social class 5 (n=206), based on various attributes of socioeconomic status. RESULTS: The prevalence of hypertension, diabetes mellitus, family history of coronary disease, obesity, central obesity and sedentary lifestyle were significantly associated with higher social classes and tobacco consumption was not associated with social class. Oral contraceptive intake and postmenopausal status were also more common among higher social classes, which may be due to more education and a longer lifespan among the higher social classes, respectively. Mean total cholesterol, high density lipoprotein cholesterol, systolic and diastolic blood pressure, mean body mass index and waist-hip ratio showed significant association with higher social classes. Mean age, body weight, body mass index, waist-hip ratio, systolic and diastolic blood pressure, total cholesterol and 2-h blood glucose were significantly positively correlated with social class, as assessed by Spearman's rank correlation. Higher social classes 1-3 were more common in Trivandrum and Bombay than in Moradabad. The prevalence of hypertension, diabetes mellitus and being overweight (body mass index >25 kg/m2) were also more common in Trivandrum and Bombay compared to Moradabad. Undernutrition was negatively associated with higher social classes and was more common in Moradabad and Nagpur than Trivandrum. CONCLUSIONS: Higher social classes among Indian urban women have a higher prevalence of coronary risk factors, hypertension, diabetes mellitus, being overweight, central obesity, sedentary lifestyle, family history of coronary disease, oral contraceptive intake and postmenopausal status. Mean concentrations of total and high density lipoprotein cholesterol were also significantly associated with higher social classes.

Adult↗
PubMed1999

Body fat percent by bioelectrical impedance analysis and risk of coronary artery disease among urban men with low rates of obesity: the Indian paradox.

OBJECTIVE: To determine the association between body fat percent and prevalence of coronary artery disease (CAD) and coronary risk factors in subjects with low rates of obesity. SUBJECTS AND METHODS: We randomly selected 850 men, aged 25 to 64 years. The survey methods were questionnaire and bioelectrical impedance analysis for body composition. Subjects were divided into high-fat (n = 357), over-fat (n = 230), normal-fat (n = 200) and under-fat (n = 63) based on criteria of body-fat percent analysis. RESULTS: The prevalence of CAD and the coronary-risk factors hypercholesterolemia, hypertension, diabetes, mellitus and sedentary lifestyle were significantly associated with high and moderate body fat percent despite low body-mass index (23.6+/-4.1 kg/m2). Mean total cholesterol, triglycerides and blood pressure were significantly associated with high and moderate body fat percent. The prevalence of smoking was weakly but inversely associated with high body-fat percent. Mean HDL cholesterol was positively associated with high body-fat percent. Body mass index was positively associated with high body-fat percent. CONCLUSIONS: High and moderate body-fat-percent subjects were associated with high prevalence of CAD and the coronary-risk factors hypertension, diabetes mellitus, higher body-mass index and sedentary lifestyle.

Adipose Tissue↗
PubMed1999

Preliminary study of non-psychotic disorders in people from the Indian subcontinent living in the UK and India.

OBJECTIVE: The prevalence of anxiety and depressive disorders in people of South Asian origin in the UK is not accurately known. METHOD: A population-based study of UK residents from the Indian subcontinent was screened for anxiety and depressive disorders with the Self-Rating Questionnaire (SRQ) and for life events using the brief list of threatening life events. Similar measures were administered to siblings in India. RESULTS: The UK sample included 223 Sikhs, 100 Hindus and 49 Muslims. Elevated SRQ scores were recorded in 5%, 13% and 23%, respectively, of men from these groups and in 16%, 27% and 57%, respectively, of females. Subjects reporting one or more threatening life events (most commonly unemployment and financial problems) also had raised SRQ scores. A total of 117 siblings in India reported similar SRQ scores to their index subjects in the UK, but reported more threatening life events, notably deaths and illness in the family and financial problems. CONCLUSION: This preliminary study indicates that psychiatric disorder in ethnic groups varies across religious groups. The prevalence may be high in some religious groups in association with social difficulties. The patterns of stress in India and the UK are different.

Adult↗
PubMed1998

Prevalence and risk factors of hypertension and age-specific blood pressures in five cities: a study of Indian women. NKP Salve Institute of Medical Sciences, Nagpur, India. Five City Study Group.

OBJECTIVE: To measure the prevalence of hypertension and age-specific blood pressure in urban populations from five Indian cities. Cross-sectional surveys were conducted in six-twenty urban streets in different cities from five different corners of India, using similar methods of sample selection and criteria. There were 3212 randomly selected women from Moradabad (n=902), Trivandrum (n=760), Calcutta (n=365), Nagpur (n=405) and Bombay (n=780), aged 25-64 years, inclusive. Evaluation was by a physician and a dietitian, an administered questionnaire, a physical examination and using a sphygmomanometer. The diagnosis of hypertension was based on old World Health Organisation criteria and new World Health Organisation/International Society of Hypertension criteria. The prevalence of hypertension (>140/90 mm Hg) was significantly (P<0.01) high in Trivandrum, South India (30.7%), and Bombay, West India (28.0%), compared to Moradabad, which is in northern India (22.6%), Nagpur, in central India (24.2%), and Calcutta, in east India (19.1%). Mean systolic and diastolic blood pressures were significantly higher in Trivandrum and Bombay compared to the other three cities. The overall prevalence of hypertension was 25.6% (n=823) and isolated diastolic hypertension was the most common form of hypertension (50.5%, n=1506) in the five Indian cities. According to old criteria, the overall prevalence of hypertension (>160/95 mm Hg) was 14.8% (n=481). Multivariate logistic regression analysis on pooled data from the five cities, after adjustment for age, showed that age (odds ratio 1.16), body mass index (1.68) and obesity were strongly associated with hypertension. A sedentary lifestyle and salt intake were weakly associated and alcohol intake was not a factor with these women.

Adult↗
PubMed1998

Randomized, double-blind placebo-controlled trial of coenzyme Q10 in patients with acute myocardial infarction.

The effects of oral treatment with coenzyme Q10 (120 mg/d) were compared for 28 days in 73 (intervention group A) and 71 (placebo group B) patients with acute myocardial infarction (AMI). After treatment, angina pectoris (9.5 vs. 28.1), total arrhythmias (9.5% vs. 25.3%), and poor left ventricular function (8.2% vs. 22.5%) were significantly (P < 0.05) reduced in the coenzyme Q group than placebo group. Total cardiac events, including cardiac deaths and nonfatal infarction, were also significantly reduced in the coenzyme Q10 group compared with the placebo group (15.0% vs. 30.9%, P < 0.02). The extent of cardiac disease, elevation in cardiac enzymes, and oxidative stress at entry to the study were comparable between the two groups. Lipid peroxides, diene conjugates, and malondialdehyde, which are indicators of oxidative stress, showed a greater reduction in the treatment group than in the placebo group. The antioxidants vitamin A, E, and C and beta-carotene, which were lower initially after AMI, increased more in the coenzyme Q10 group than in the placebo group. These findings suggest that coenzyme Q10 can provide rapid protective effects in patients with AMI if administered within 3 days of the onset of symptoms. More studies in a larger number of patients and long-term follow-up are needed to confirm our results.

Angina Pectoris↗
PubMed1998

Validation of tobacco and alcohol intake questionnaire in relation to food intakes for the Five City Study and a proposed classification for Indians.

Cross-sectional survey was conducted among 1806 subjects (904 men and 902 women) between 25-64 years of age. The survey instruments were questionnaires according to guidelines of WHO and other Indian studies and based on scores of various attributes of tobacco and alcohol consumption. All subjects with tobacco and alcohol consumption were classified separately into mild, moderate and heavy consumption and previous consumptions were also recorded. The overall prevalence of tobacco consumption was significantly higher in men compared to women (27.5 vs 11.6%), while mild tobacco intakes were comparable (2.0 vs 1.6%), moderate (22.2 vs 7.7%) and heavy (3.3 vs 2.2%) tobacco consumptions were significantly higher in men compared to women. The overall prevalence of alcohol consumption was 10.4% in men without any subject among women. The prevalence of moderate (6.6%) alcohol intakes was significantly higher compared to mild (1.2%) and heavy (2.5%) alcohol consumption. Whisky and country liquor were most commonly consumed alcoholic beverages. Smoking (20.7 vs 1.6%) and tobacco chewing (13.3 vs 10.7%) in men and women respectively were common modes of tobacco consumption. Tobacco consumption was significantly associated with lower consumption of vitamin C and beta-carotene and lower body mass index. These findings suggest that tobacco and alcohol consumption assessed by scores constructed on the basis of various attributes appear to be accurate and the questionnaires may be used with precision for classification and assessment in other population groups.

Adult↗
PubMed1998

Prevalence and determinants of central obesity and age-specific waist:hip ratio of people in five cities: the Indian Women's Health Study.

OBJECTIVE: To study the prevalence of central obesity and age-specific waist:hip ratio of urban women from five Indian cities. DESIGN AND SETTING: Cross-sectional surveys were conducted in 6-12 urban streets in different parts of India using similar methods of sample selection and criteria of diagnosis. SUBJECTS AND METHODS: We randomly selected 3212 women, aged 25-64 years, from Moradabad (n = 902), Trivandrum (n = 760), Calcutta (n = 365), Nagpur (n = 405), and Bombay (n = 780). Evaluation was by a questionnaire administered by a physician and a dietician, a physical examination, and anthropometric measurements. RESULTS: The overall prevalence of central obesity among the total number of women was 55.0%, with the highest prevalence in Calcutta (62.2%) and the lowest in Bombay (47.4%). Waist:hip ratio was 0.85 +/- 0.13 (mean +/- SD) with the highest ratio for women in Calcutta (0.87 +/- 0.12) and the lowest for women in Moradabad (0.84 +/- 0.16). After pooling of data from all five cities, multivariate logistic regression analysis showed that, regardless of age, body mass index (> 23 kg/m2; odds ratio 1.12), sedentary lifestyle (odds ratio 2.51), and family history of obesity (odds ratio 2.15) were strongly associated with central obesity. Excess intake of fat was weakly associated with central obesity but age was not a risk factor for central obesity, although the prevalence was highest among those aged over 55 years in Moradabad, Calcutta, and Nagpur. CONCLUSIONS: The overall prevalence of central obesity among the urban women of India has increased, more so in Calcutta and Trivandrum. Body mass index, sedentary lifestyle, and family history of excess intake of fat were significant risk factors for central obesity.

Adult↗
PubMed1997

Antioxidant effects of lovastatin and vitamin E on experimental atherosclerosis in rabbits.

The effects of the administration of vitamin E (10 mg/day) plus lovastatin (2 mg/day; group A, n = 10), lovastatin alone (2 mg/day; group B, n = 10), and placebo (group C, n = 10) were compared over 24 weeks in a randomized, single-blind controlled trial. All groups of rabbits received a trans fatty acid (TFA)-rich diet (5-10 g/day) for 36 weeks. Treatment with vitamin E plus lovastatin (group A) and lovastatin (group B) started after 12 weeks of administration of TFA-rich diet was associated with a significant but similar decline in serum cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides in both groups at 36 weeks. Lipid peroxides and diene conjugates showed a significant decline in association with a significant increase in the plasma level of vitamin E in group A rabbits at 36 weeks. However, the lovastatin group B showed a lesser but significant decrease in lipid peroxides and diene conjugates at 36 weeks, indicating that lovastatin may have antioxidant activity. In control group C, the increase in blood lipids and oxidative stress at 36 weeks was much greater than the decrease in groups A and B. After experimental lipid peroxidation at 24 weeks in all of the rabbits, 2 of 10 group B and 3 of 10 group C rabbits died due to coronary thrombosis; there were no deaths in group A. Thus antioxidant therapy with vitamin E can provide protection against death due to free radical stress. Aortic lipids and sudanophilia indicating athorosclorosis were significantly lower in groups A and B than in group C. The atherosclerotic coronary plaque sizes were significantly smaller in group A (18.5 +/- 3.6 microns) than in groups B (41.6 +/- 4.2 microns) and C (85 +/- 6.7 microns). Aortic plaque sizes were also smaller in group A than in group B and C. It is possible that antioxidant therapy with vitamin E, as an adjunct to lipid lowering with lovastatin, can provide additional benefit in the inhibition of oxidative stress and atherosclerosis. The antioxidant activity of lovastatin has not been reported, to our knowledge.

Animals↗
PubMed1995

Coronary risk factors in people from the Indian subcontinent living in west London and their siblings in India.

Several reports have shown that migrants from southeast Asia tend to have an increased risk of coronary heart disease when settled in their new country. We compared coronary risk factors in a randomly selected group of 247 migrants from the Indian subcontinent of Punjabi origin living in West London and 117 of their siblings living in the Punjab in India. The West London cohort had a greater body mass index (p < 0.001), systolic blood pressure (p = 0.0087), serum cholesterol (p < 0.001), apolipoprotein B (p < 0.001), lower high-density lipoprotein cholesterol (p < 0.05) and higher fasting blood glucose (p < 0.05) than their siblings in the Punjab. Insulin sensitivity, derived from the homoeostatic assessment mathematical model, was lower in men in West London than in their counterparts in India (p < 0.05). Indians in West London had lower beta cell function than those in the Punjab (p < 0.001). Serum lipoprotein (a) concentrations were similar in both the West London and Punjab population, but were significantly higher (p = 0.01) than those of white European populations in the UK. Increases in serum cholesterol after migration from India lead to increased coronary risk conferred by high serum lipoprotein (a) concentrations and greater insulin resistance. Such between-country comparisons are an important means of establishing the importance of coronary risk factors.

Adult↗
PubMed1995

Endothelium-derived relaxing factor is important in mediating the high output state in chronic severe anemia.

OBJECTIVES: We evaluated the endothelial and vascular smooth muscle function in patients with chronic severe anemia to determine whether increased basal nitric oxide levels contribute to the systemic vasodilation and high cardiac output seen in these patients. BACKGROUND: Patients with chronic severe anemia have a high output state due to a low systemic vascular resistance. However, the cause of the low vascular resistance is unclear. Because hemoglobin is a potent inhibitor of endothelium-derived relaxing factor, we postulated that in chronic severe anemia, low circulating hemoglobin results in reduced inhibition of endothelium-derived relaxing factor. The basal endothelium-derived relaxing factor activity therefore increases, and this contributes significantly to the low systemic vascular resistance and the hyperdynamic state seen in this condition. METHODS: Hemodynamic variables and forearm blood flow (using plethysmography) were measured in eight patients with chronic severe anemia before (hematocrit 16 +/- 2% [mean +/- SD]) and within 24 h of red blood cell transfusion (n = 6, hematocrit 30 +/- 1%) and in six control subjects. The effect on baseline blood flow of blocking endothelium-derived relaxing factor activity with NG-monomethyl-L-arginine was investigated. In addition, the effects of both endothelium-dependent and endothelium-independent vasodilators on forearm blood flow were tested. RESULTS: Baseline forearm blood flow was markedly increased in untreated patients (6.5 +/- 1.2 ml/min per 100 ml) compared with that in control subjects (2.8 +/- 0.7 ml/min per 100 ml, p < 0.0001, 95% confidence interval [CI] for difference -5 to -2.5). Red blood cell transfusion significantly reduced blood flow in the anemic patients to 3.5 +/- 1.1 ml/min per 100 ml (p < 0.001, 95% CI for difference -4.9 to -1.9), which was not significantly different from that in control subjects; increased systemic vascular resistance (796 +/- 141 to 1,230 +/- 151 dynes.s.cm-5, p < 0.001); and decreased cardiac output (4.9 +/- 0.6 to 3.5 +/- 0.5 liters/min per m2, p < 0.001). NG-monomethyl-L-arginine (16 mumol/min), a specific inhibitor of endothelium-derived relaxing factor, reduced forearm blood flow by an equal amount (p = 0.9, 95% CI for difference -0.7 to 0.8) in control subjects (0.98 +/- 0.39 ml/min) and treated patients (1.03 +/- 0.8 ml/min) but caused a threefold greater decrease in flow (2.9 +/- 0.9 ml/min) in untreated patients (p = 0.0003, 95% CI for difference between untreated patients and control subjects 1.1 to 2.7). These findings suggest increased basal endothelium-derived relaxing factor activity in patients with anemia. Stimulated forearm blood flows (both endothelium dependent and endothelium independent) were similar in all groups, confirming normal endothelial and smooth-muscle function. CONCLUSIONS: These findings support the hypothesis that enhanced basal endothelium-derived relaxing factor activity makes an important contribution to the low systemic vascular resistance in chronic severe anemia.

Adult↗
PubMed1995

Evaluation of serum lipid profile and cardiac enzyme changes in cerebrovascular accidents.

Serum lipid profile is, total cholesterol, high density lipoprotein (HDL), low density lipoprotein (LDL) and triglycerides and serum cardiac enzymes ie, creatinine phosphokinase (CPK), creatinine phosphokinase isoenzyme MB (CPK-MB), lactate dehydrogenase (LDH) and serum aspartate aminotransferase (AST/SGOT) levels were estimated in 50 cases of cerebrovascular accidents (CVA) consisting of 26 cases of cerebral haemorrhage and 24 cases of cerebral thrombosis. All analyses were made on day 1 and day 7. Serum cholesterol, LDL and triglycerides levels were significantly higher in CVA patients on day 1. Lipid level fell significantly on day 7 in respect to day 1. On comparing the lipid levels between cerebral haemorrhage and cerebral thrombosis, no significant difference was observed. Cardiac enzymes like CPK and CPK-MB were significantly raised whereas, AST/SGOT and LDH were marginally raised on day 1 in CVA patients. However, there was no change in cardiac enzyme levels between cerebral haemorrhage and cerebral thrombosis patients.

Adult↗
PubMed1994

Holter monitoring in chronic renal failure before & during dialysis.

Holter monitoring was done prospectively in 50 adult patients of chronic renal failure (CRF) before and during haemodialysis. Frequent premature ventricular contractions (PVC's) were present in 3 (6%), all during dialysis (Gp I). Sporadic PVC's were seen in 6 (12%) and rest 41 (82%) had no PVC (Gp II). Premature atrial contractions (PAC's) were frequent in 5 (10%) (one had precipitation during dialysis), sporadic in 7 (14%) and none in 38 (76%). Ventricular tachycardia (VT) was not seen. Supraventricular tachycardia (SVT) was observed in 5. No biochemical parameter correlated with arrhythmias. There was no correlation between hypotension episodes and arrhythmias. Sinus tachycardia occurred during the third and fourth hours of dialysis. This correlated with hypotensive episodes observed in 13 patients. Episodes of silent myocardial ischaemia (SMI) observed in 12 patients occurred predominantly during this period of tachycardia. Cardiac arrhythmias are infrequent in CRF and are mainly seen in patients with preexisting coronary artery disease with low ejection fractions (EF) (EF 0.37 +/- 0.2 in Gp I and 0.80 +/- 0.1 in Gp II P < 0.01) and abnormal Q waves in baseline ECG. They do not seem to contribute to occurrence of episodes of dialysis induced hypotension.

Adult↗
PubMed1993

Rate-dependent hemodynamic responses during incremental atrial pacing in chronic constrictive pericarditis before and after surgery.

Chronic constrictive pericarditis is a frequent cause of diastolic dysfunction, and results in impaired ventricular filling. Unlike in normal subjects, ventricular filling in constrictive pericarditis occurs almost entirely in the initial one third of diastole, and cardiac output is dependent predominantly on heart rate. Tachycardia impairs ventricular filling in normal subjects, but its effects in patients with constrictive pericarditis have not been studied. The effect of increasing heart rate alone with atrial pacing on the central and peripheral hemodynamics of patients with untreated chronic constrictive pericarditis before and after pericardiectomy was evaluated. Increased heart rate with atrial pacing increased cardiac output, whereas stroke volume remained unchanged up to heart rates of 140 beats/min. Further increases in heart rate resulted in reductions of cardiac output and stroke volume. There were no significant changes in ventricular filling pressures. Infusion of 300 ml of saline solution at peak pacing rates did not improve cardiac output. After successful surgical pericardiectomy, the hemodynamic effects of atrial pacing returned to normal. It is concluded that moderate tachycardia improves the hemodynamic profile of patients with constrictive pericarditis.

Adult↗
PubMed1992

Atrial fibrillation following electrical injury.

The development of atrial fibrillation in 2 patients, following an electrical shock is reported. One patient, with an underlying pre-excitation syndrome, had to be cardioverted due to rapid ventricular rate and hypotension. The other, with normal conduction, tolerated the arrhythmia well and atrial fibrillation reverted spontaneously after 24 hours.

Adult↗