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Biomedical subjects

M Vaz

Publications and source records attributed to M Vaz.

At least 19 recordsLinked to original sources
PubMed2006

Low maternal vitamin B12 status is associated with intrauterine growth retardation in urban South Indians.

OBJECTIVE: To assess the maternal sociodemographic, anthropometric, dietary and micronutrient status in apparently healthy pregnant women in order to determine their associations with intrauterine growth retardation (IUGR). DESIGN: Prospective observational study. SETTING: Bangalore City, India. SUBJECTS: A total of 478 women were recruited at 12.9+/-3.3 weeks of gestation and followed up at the first, second and third trimesters of pregnancy and at delivery. The dropout rate was 8.5%. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Birth weight was measured at hospital delivery. RESULTS: The mean birth weight was 2.85+/-0.45 kg. In all, 28.6% of newborns were IUGR. There was a strong inverse relationship between maternal educational level and risk of IUGR. A low body weight at baseline was also associated with a high risk of IUGR. Compared with women in the highest quartile for second trimester weight gain, those in the lowest quartile had a significantly higher adjusted odds ratio (AOR: 3.98; 95% CI: 1.83, 8.65) for IUGR. Women in the lowest tertile for serum vitamin B(12) concentration during each of the three trimesters of pregnancy had significantly higher risk of IUGR (AOR: 5.98, 9.28 and 2.81 for trimesters 1-3, respectively). CONCLUSIONS: The present study demonstrates associations between educational status, maternal weight and gestational weight gain with IUGR. Importantly, in a subsample, there were strong associations of vitamin B(12) status with IUGR, suggesting that better socioeconomic conditions, improved nutritional status and early detection of vitamin B(12) deficiency in pregnancy combined with appropriate interventions are likely to play an important role in reducing IUGR.

Adolescent↗
PubMed2006

Anthropometry and body composition of south Indian babies at birth.

OBJECTIVES: To assess the consequences on body composition of increasing birth weight in Indian babies in relation to reported values in Western babies, and to assess the relationship between maternal and neonatal anthropometry and body composition. DESIGN: Prospective observational study. SETTING: Bangalore City, India. SUBJECTS: A total of 712 women were recruited at 12.5+/-3.1 weeks of gestation (mean+/-standard deviation, SD) and followed up until delivery; 14.5% were lost to follow-up. Maternal body weight, height, mid upper-arm circumference and skinfold thicknesses were measured at recruitment. Weight and body composition of the baby (skinfold thicknesses, mid upper-arm circumference, derived arm fat index and arm muscle index; AFI and AMI, respectively) were measured at birth in hospital. RESULTS: The mean+/-SD birth weight of all newborns was 2.80+/-0.44 kg. Birth weight was significantly related to the triceps and subscapular skinfold thickness of the baby. In a small number of babies with large birth weight for gestational age, there was a relatively higher normalised AFI relative to AMI than for babies with lower or appropriate birth weight for gestational age. Maternal height and fat-free mass were significantly associated with the baby's length at birth. CONCLUSIONS: Skinfold thicknesses in Indian babies were similar to those reported in a Western population with comparable birth weights, and the relationship of AFI to birth weight appeared to be steeper in Indian babies. Thus, measures to increase birth weight in Indian babies should take into account possible adverse consequences on body composition. There were no significant relationships between maternal anthropometry and body composition at birth on multivariate analysis, except for sum of the baby's skinfold thicknesses and maternal fat-free mass (P<0.02).

Adolescent↗
PubMed2006

A simple method of measuring total daily energy expenditure and physical activity level from the heart rate in adult men.

OBJECTIVE: To evaluate a simple method that uses only a heart rate monitor to predict total energy expenditure (TEE) and physical activity level (PAL) from 24 h heart rate (HR) measurements. DESIGN: The simple method involved the determination of the physical activity ratio (PAR) from corresponding heart rate ratios (HRR) (ratio of observed to resting HR), from an individualized calibration curve relating activities with known PAR to the HRR. Several curve fits were evaluated for this curve. The PAL was calculated from minute to minute PAR. The TEE was computed as the product of the PAL and the predicted basal metabolic rate (BMR). The accuracy of the simple method was assessed by within-subject comparisons of the simple method versus the oxygen consumption - HR method and a time and motion study. SETTING: Bangalore City, India. SUBJECTS: In all, 17 healthy male subjects between 18 and 44 years were recruited for the study. INTERVENTIONS: None. RESULTS: The simple method correlated well with both the reference methods when using a calibration curve that involved the fitting of two straight lines at low and high PAR activities, respectively, to the PAR and HRR data. The mean error in TEE, as a product of BMR and PAL, was about 1%, but with limits of agreement between the methods that were about 20% of the TEE. However, the low mean error could have been due to a canceling of errors in the determination of BMR and PAL. CONCLUSIONS: The simple method is a relatively cheap, useful technique for evaluating TEE and PAL in resource-poor situations. It may particularly be of use in epidemiological investigations where population estimates of TEE and PAL are required.

Adolescent↗
PubMed2006

An epidemiological evaluation of risk factors for tuberculosis in South India: a matched case control study.

SETTING: There are limited data on risk factors associated with tuberculosis (TB) in India. OBJECTIVES: To evaluate potential socio-demographic risk factors for TB. DESIGN: Matched case-control. Cases were all new diagnoses of pulmonary TB attending as out-patients at St John's Medical College Hospital, Bangalore, India, from October 2001 to October 2003. Age- and sex-matched controls, one for each case (n = 189), were recruited among relatives accompanying non-TB in-patients in the hospital. RESULTS: Significant risk factors were low education level (OR 0.30; 95%CI 0.11-0.82), not having a separate kitchen (OR 3.26; 95%CI 1.25-8.46) and chronic disease, mainly diabetes (OR 2.44; 95%CI 1.17-5.09). High income, cooking with biomass fuels, history of smoking and alcohol consumption were not significant on multivariate analysis. Patients were respectively 11 and seven times more likely to have a BMI <18.5 (95%CI 5.62-21.98) and mid-arm circumference <24 cm (95%CI 3.87-11.89). CONCLUSIONS: In our study, TB was associated with low education level, kitchen type and diabetes, reflecting the complex interaction between non-communicable disease, urbanisation and a changing economic climate in Bangalore. The relationship between TB, the use of biomass cooking fuels and gender differentials related to fuel exposure merit further exploration. The study underscores the poor nutritional status of patients.

Adolescent↗
PubMed2006

The relationship of neonatal serum vitamin B12 status with birth weight.

Earlier studies have shown a relationship between maternal vitamin B12 status and birth weight. This study extends those findings directly in terms of neonatal vitamin B12 status and birth weight. One hundred and twelve women were followed from the first trimester of pregnancy and maternal blood was obtained in all three trimesters along with cord blood at birth of their neonates. The maternal and cord serum vitamin B12 concentrations were examined in relation to birth weight. There was a significant correlation between vitamin B12 concentration in maternal antenatal serum during each of the trimesters of pregnancy and cord serum (all P< 0.01). Neonates that were born with lower birth weights (categories of <2500 g and 2500-2999g) had significantly lower mean cord serum vitamin B12 concentrations when compared to those who were > or = 3000g (P = 0.02 and P = 0.05 respectively). A similar, however, non significant trend was observed for antenatal vitamin B12 concentrations at first and third trimesters. Cord serum vitamin B12 concentrations were significantly correlated with birth weight, up to 40 weeks of pregnancy (r=0.28, P=0.01) but not beyond that (> or =40 weeks gestation). Vitamin B12 status in the mother was related to neonatal vitamin B12 status as measured by cord serum vitamin B12 concentration. In addition, low neonatal vitamin B12 concentrations were adversely associated with low birth weights.

Adult↗
PubMed2005

Consequences of inadequate food energy and negative energy balance in humans.

Energy deficiency is probably best measured in adults by the body mass index (BMI). Acute energy deficiency (AED) is associated with body weight loss, along with changes in body composition, as well as a reduced BMR and physical activity. Chronic energy deficiency (CED) is an inadequacy in food to which individuals adapt, at some cost. Individuals with this have never 'lost' weight: they have simply grown less. They adapt to the decreased food energy by reductions in their total energy expenditure (TEE), linked mainly to a lower body size, and to their physical activity. It seems unlikely that enhanced metabolic efficiency contributes substantially to energy saving in CED. Supplementation of energy deficient individuals is accompanied by significant fat deposition; this may have deleterious consequences. Women in many developing countries achieve a successful outcome to pregnancy in spite of being chronically undernourished. Reductions in basal metabolism and behavioural changes in the form of diminished physical activity could meet most of the extra energy needed for pregnancy. Milk energy output is maintained within the expected range in undernourished lactating mothers. Energy deficiency in children is best measured by height-for-age for stunting, and weight-for-height for wasting. Deficits in behavioural and functional parameters in children exist with undernutrition, and can be reduced by early nutritional supplementation along with the appropriate environment.

Adaptation, Physiological↗
PubMed2004

Evaluation of the Asthma Life Quality test for the screening and severity assessment of asthma.

BACKGROUND: Asthma Life Quality (ALQ) test, a 20-question questionnaire developed by the American College of Allergy, Asthma and Immunology, has been shown to be useful for asthma diagnosis. We aimed to determine the relation between ALQ scores and (a) diagnosis of asthma; (b) physician's classification of asthma severity according to National Institutes of Health/Global Initiative for Asthma (GINA). METHODS: Standard translation and cultural adaptation to Portuguese was performed. Patients self-administered the ALQ in the waiting room; the attending allergist classified them, blindly for the test. The scores of nonasthmatics were compared with those of asthma patients. Asthma patients were analyzed in two severity groups: intermittent and mild persistent asthma (IMPA), and moderate and severe persistent asthma (MSPA); sensitivity, specificity, positive and negative predictive values were calculated and receiver operating characteristic curve plotted. Logistic regression analysis models were computed. RESULTS: From 283 patients, 237 tests were analyzed. Non-asthmatic patients ALQ scores (mean +/- SD) were 6 +/- 4 and, for asthmatics, 10 +/- 5 [mean difference 4.6 (95%CI 3.3-5.9)]. The odds of positive diagnosis increased 1.27 times (95%CI 1.17-1.38) for each one-unit increase in the test. For asthma severity ALQ scores were 9 +/- 4 for IMPA, 15 +/- 3 for MSPA [difference 6.0 (95%CI 4.8-7.1)]; with a sensitivity of 88% and specificity of 74% for a score of 12. The odds of MSPA increased 1.49 times (95%CI 1.28-1.74) per unit increase in ALQ. CONCLUSIONS: ALQ can help both to identify patients with asthma and to differentiate those more likely to have moderate/severe asthma. These are relevant characteristics for the possible use of this simple, self-administered questionnaire in the assessment of asthma patients needing additional medical management.

Adolescent↗
PubMed2004

Perceptions of the intensity of specific physical activities in Bangalore, South India: implications for exercise prescription.

OBJECTIVE: To assess perceptions of the intensity of specific physical activities in urban Indians and to determine whether these perceptions are dependent on age, gender, body mass index and actual physical patterns. METHOD: A self-administered questionnaire in a convenience sample of 782 adults (441 women) aged 17 to 70 years in the city of Bangalore. RESULTS: Women rated the intensity of carpentry, jogging, manual labour and walking uphill significantly higher than men. These differences persisted when they were adjusted for total daily physical activity levels and levels of discretionary exercise. In contrast, while men rated household activities such as manual washing of clothes and sweeping at higher levels than women, these differences disappeared when they were adjusted for actual levels of daily activity related to household chores. There were clear age-related changes in the perception of intensity of physical activities and these persisted even after adjustment for overall physical activity patterns. CONCLUSIONS: This study demonstrates clear age and gender-related differences in the perception of physical activities. This is important to know while motivating individuals to change physical activity patterns and assumes added importance given the recent evidence that perceived intensity of habitual activity is predictive of coronary heart disease, even at levels of activity that are below standard recommendations.

Adolescent↗
PubMed2003

Effect of imipramine on linear and nonlinear measures of heart rate variability in children.

We investigated the effects of treatment with the tricyclic antidepressant (TCA) imipramine in eight children in supine and standing postures. We used 256 seconds of real-time data for the analyses. Spectral analysis showed a significant decrease of high-frequency (HF) power (0.15-0.5 Hz), especially in the standing posture. Low frequency (LF) HF ratios were significantly higher in the standing posture after treatment, suggesting increased sympathovagal interaction. We also obtained the nonlinear measures of fractal dimension (FD), and approximate entropy (APEN). Although the FD of heart rate was significantly lower in the standing posture, APEN was significantly decreased after treatment in either posture and was the most sensitive measure in this study. These findings suggest a decreased cardiac vagal function with a relative increase in sympathetic responsiveness, which may in part be related to the cardiotoxicity of these drugs. These findings are discussed in relation to the cardiovascular side effects of TCAs.

Adolescent↗
PubMed2003

Resurfacing versus not resurfacing the patella in total knee arthroplasty: 8- to 10-year results.

Patellar resurfacing in total knee arthroplasty is a topic debated in the literature. Concerns include fracture, dislocation, loosening, and extensor mechanism injury. Residual anterior knee pain has been reported when the patella is not resurfaced. One hundred patients with osteoarthritic knees were prospectively randomized to either have their patella resurfaced or left not resurfaced. All patients were treated with a single prosthesis that featured an anatomically designed patellofemoral articulation (Anatomic Medullary Knee, DePuy, Warsaw, IN) Two patients in the unresurfaced group and one in the resurfaced group required repeat surgery for patellofemoral complications. At 8- to 10-year follow-up evaluations, Knee Society Clinical Ratings scores were not different between the 2 groups. Rates of anterior knee pain with walking and stair climbing were significantly less in the resurfaced group. Eighty percent of patients with a resurfaced patella were extremely satisfied with their total knee arthroplasty versus 48% without patellar resurfacing. When satisfied and extremely satisfied patients were grouped together, there was no difference between the 2 groups.

Aged↗
PubMed2002

Women undergoing investigation of sexual abuse in the metropolitan area of Porto Alegre, Brazil: a retrospective study.

This is a retrospective study of 1,063 examinations performed on women at the Institute for Forensic Medicine in the city of Porto Alegre, RS, Brazil, between January 1998 and December 1999, as part of an investigation of charges of sexual abuse. Most women were white (83.9% - 892), single (89.1% - 947), and were between 11 and 20 years of age (59% - 627); 40% (425) were 14 years old or younger. There was evidence of previous sexual contact in 57% (606) of the patients; 37% (393) were virgins. Evidence of recent sexual intercourse was found in 287 (27%) cases, including presence of sperm in the vagina (18% - 191), recent rupture of the hymen (7% - 74), and pregnancy (2% - 21). Physical violence was evident in 30% (319) of all cases. In cases where information regarding the perpetrator was available (39% - 415), 25% (105) consisted of family members. Further studies should be carried out in order to assess the incidence of sexual violence by family members.

Adolescent↗
PubMed2001

Integrating a primer course in biostatistics into the haematology practicals of first-year medical students in India.

CONTEXT: In India, biostatistics in the medical curriculum is usually taught as a separate course, using either "imaginary" data or data from the literature. Knowledge of statistics is particularly important in the context of "evidence-based medicine". OBJECTIVE: To evaluate the efficacy of a biostatistics course integrated into the practical haematology first-year medical course with the following special characteristics: (1) students learn statistics on data generated by and on themselves, (2) the course avoids mathematical computation,(3)the statistical exercises are linked to the learning objectives of the physiology curriculum, and (4) the course is without the threat of university examinations. METHODS: Statistical exercises were incorporated into specific haematology practicals with the aim of covering simple descriptive and inferential statistics. Statistics tests were administered, without prior information, to 60 first-year medical students before the biostatistics course, immediately following the course, and nine months later. Fifty-four students completed all three evaluations. RESULTS: Students had a poor knowledge of statistics at baseline. They substantially increased their scores in the statistics test immediately following the biostatistics course. These scores remained higher than baseline nine months after completion of the course, although there was a small decline in the absolute scores when compared with scores soon after the biostatistics course. IMPLICATIONS: Integrating biostatistics into other subjects in the medical curriculum may be an important addition to "stand alone" courses in biostatistics.

Journal Article↗
PubMed2001

Should nutritional status evaluation be included in the initial needs assessment of leprosy patients with disability prior to socio-economic.

Because of the large numbers of leprosy patients with disability and the limited resources available, it is important that socio-economic rehabilitation (SER) is targeted towards those who are most in need. Towards this purpose, current assessments of leprosy patients prior to initiating SER include the evaluation of income, assets and household possessions. Conspicuously absent is the nutritional assessment of the patient. In the absence of weight loss associated with illness, population studies indicate that undernutrition reflects poor socio-economic conditions. In this study of 151 cured leprosy patients with disability, 57% of the patients were found to be undernourished using body mass index (kg/m2) derived from body weight and height, and 10% of the patients were severely undernourished (grade III). Undernutrition in the patients was poorly though significantly correlated with personal income (r = 0.18, P < 0.05). Total household income, reported amount of money spent on food and estimated cereal intakes were not correlated with the BMI of the patient, possibly due to reporting bias and other methodological issues. We propose the inclusion of nutritional status evaluation by anthropometry as part of the initial screening of leprosy patients prior to instituting SER. We believe that this simple and objective evaluation can add to the assessment of 'threat' of economic deprivation or actual economic 'dislocation', and thus help in the prioritization of leprosy patients for SER.

Adult↗
PubMed2000

Protein and amino acid requirements in the elderly.

Estimates of protein and amino acid requirements in this paper are proposed for healthy elderly people. The estimate of protein requirement was based on nitrogen (N) balance, as well as functional indicators such as immune function or muscle strength. Data suggest that the protein requirement for nitrogen equilibrium in the elderly, is greater than 0.8 gm/kg body weight/day. There do not appear to be any adverse consequences with protein intakes that are about 1 gm/kg body weight/day. The tentative recommendation in this paper is higher than the current mean recommended intake of protein (FAO/WHO/UNU, 1985). However, because of methodological difficulties, the data does not allow for a confident prediction of what the exact level of protein intake should be. Further studies are needed to come to a firm conclusion on the exact protein requirement. Indispensable amino acid requirements based on nitrogen balance data, in the elderly, are fragmentary and conflicting. These requirements can alternatively be based on obligatory nitrogen loss, for which data is available in the elderly. The overlap of the obligatory nitrogen loss between the young and the elderly, suggest that the amino acid requirement based on this technique is similar in young and elderly individuals. Tracer based techniques measuring amino acid balance at different amino acid intakes, also support the view that there are no differences in the amino acid requirements between young and elderly people. In general, these amino acid requirement studies have been performed in healthy USA subjects, and data is needed to know if these estimates can be extended to populations from other, less-developed countries.

Aged↗
PubMed2000

The effect of leprosy-induced deformity on the nutritional status of index cases and their household members in rural South India: a socio-economic perspective.

OBJECTIVES: To determine whether the socioeconomic and nutritional status of cured leprosy patients with residual deformity, and their household members, was lower than that of cured leprosy patients without deformity. DESIGN: Cross-sectional study. SUBJECTS: One hundred and fifty-five index cases with deformity, 100 without deformity. Also 616 household members comprising 48% of the total members enumerated. MEASUREMENTS: Nutritional status was evaluated using anthropometry. Disease characteristics, socio-economic parameters and household information were recorded using a questionnaire. RESULTS: Index cases with deformity had lower community acceptance (P<0.001), and employment (P<0.001) than those cases without deformity. Households of index cases with deformity had a lower income (P<0.01) and a lower expenditure on food (P<0.05). The presence of deformity (odds ratio (OR): 2.1-3.2, P<0.01), unemployment (OR: 2.3-4.3, P<0.01) and female gender (OR: 2.4, P<0. 01) significantly increased the risk of index cases being undernourished, as judged by body mass index (BMI) alone, or BMI and mid-upper arm circumference. A low BMI (<18.5) in the index case significantly increased the odds of other adults (OR 2.2), adolescents (OR 2.9-3.8) and children (OR 2.2) in the household being undernourished. CONCLUSIONS: Cured leprosy index cases with physical deformity are more undernourished than index cases without deformity. This is associated with a reduced expenditure on food, possibly brought on by increased unemployment, and a loss of income. Undernutrition in the index case increases the risk of undernutrition in other members of the family. European Journal of Clinical Nutrition (2000) 54, 643-649.

Adolescent↗
PubMed2000

Prospective randomized clinical trial of continuous passive motion after total knee arthroplasty.

The authors report the results of a prospective randomized clinical trial using continuous passive motion after total knee arthroplasty. One hundred twenty patients were assigned randomly to one treatment group: No continuous passive motion (Group I), continuous passive motion from 0 degrees to 50 degrees and increased as tolerated (Group II), and continuous passive motion from 70 degrees to 110 degrees (Group III). The continuous passive motion was initiated in the recovery room and was maintained for a maximum of 24 hours at which point all patients began identical postoperative physiotherapy regimens. Patients were assessed preoperatively, during their hospital stay, at 6 weeks, 12 weeks, 26 weeks, and 52 weeks after their surgery. There were no statistical differences between any of the treatment groups regarding cumulative analgesic requirements, range of motion at any measured interval, length of stay (Group I, 5.1 days; Group II, 5.2 days; Group III, 5 days) or Knee Society scores. The current study does not support the use of short-term continuous passive motion after total knee replacement. A standard and a high flexion continuous passive motion protocol failed to show any advantage over physiotherapy alone in the parameters evaluated.

Analgesics↗