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�Red�Flower�Publication�Pvt.Ltd
Indian�Journal�of�AnatomyVolume�7�Number�1,�January�-�February�2018
DOI:�http://dx.doi.org/10.21088/ija.2�20.0022.7118.15
Original�Article
Author�s�Affiliation:�1Assistant�Professor�2II�MBBS�Student5Post�Graduate� 6Professor����ead,�Department�of�Anatomy�Assistant�Professor,�Department�of�Physiology�4Professor����ead,Department�of�Medicine,�Mahatma�Gandhi�Institute�of�MedicalSciences,�Sevagram��ardha,�Maharashtra�442102,�India.
Correspondin��Author:�Rutu�a�Bhon�le��II�MBBS�Student,Mahatma�Gandhi� Institute� of�Medical� Sciences,� Sevagram�ardha,�Maharashtra�442102,�India.
E-mail:�[email protected]
Received� �09.10.2017,�Accepted� �2�.11.2017
Anthropometric�Measurements�of��ypertensive�Patients�with�SpecialEmphasis�on�Facial�Features
Pradeep�Bokariya���Rutu�a�Bhon�le���Ruchi�Kothari��� Jyoti� Jain���Mrinmayee�Debbarma��M.R.�Shende�
Introduction
Anthropometry� is� a� biological� anthropology�orart�of�science�used�for�the�measurement�of�soft�tissueand� body� proportions� for� the� study� of� humanevolution� �1�.�Anthropometric�measurements� are
used� eventually� for� various�medical� researches.Anthropometry�is�a�branch�of�Morphometry�whichis� the� study� of� si�e� and� shape� of� biologicalcomponents� and� their� variations� in�populations.2
Morphometrics�has�gone�under� revolution� in� thelast�two�decades�as�numerous�new�techniques�havebeen�produced� to� address� shortcomings� in� theTraditional� Multivariate� Analysis� of� Lineardistances,�Angles�and�Indices����.�Analysis�of�Faceis� not� only� useful� for� Identification,� SportsMedicine,�Tele-Communications�but�also�has�gota� clinical� application� for� diagnosis� of� manydiseases��4�.
Changes� in� lifestyles,� nutrition,� and� ethniccomposition�of�populations�lead� to�changes�in�thedistribution�of� body�dimensions� (e.g.� the� obesity
Abstract
Context:�Anthropometric�measurements�are�being�used�profusely�for�various�medicalresearches.�Studieson�craniofacial�anthropometry�have�allowed�for�identification�andquantification�of�syndromic�clinical�features,planning� for� treatment,�monitoring� ofoperative� outcomes� and� sometimes� assessment� of� longitudinalchange.Considering� that�Anthropometry�can�be� important� tool� in� early�suggestion�of�diseases,� anattemptwas�made�to�study�facial�Anthropometry�in�healthy�individuals�andhypertensive�subjects.�Aim:�The�aim�ofthe�study�was�to�compare�the�Anthropometric�Measurements� in�hypertensivepatients�and�healthy�controlsubjects.�Settings� and�Design:� The� study�was� conducted� in� the�Anthropometry� section� of�Department� ofAnatomy,�Mahatma�Gandhi� Institute� of�Medical� Sciences� (MGIMS)� incollaboration�with�Department� ofMedicine.�It�was�a�cross-sectional,�Observational�study�design�incorporating�a�total�of�100subjects.��ethodsand��aterial:�Out� of�hundred� registered� for� study,� fifty�were�healthy� controls�and� fifty�patients� in� theagerange� of� �4-50� years� diagnosed� to� have� hypertension� from� Sevagram�village� (a� rural� area� in�Vidharbharegion�of�Maharshtra).�The�instruments�used�for�study�are�Stadiometer,�Digital�weighing�balance,�SpreadingCaliper,�Vernier�caliper�and�measuring�tape�and�sphygmomanometer�for�measuring�Blood�Pressure.�Variousmeasurements�were�made�pertaining�to�facial�anthropometry�andon�the�basis�of�the�findings�as�per�literatureavailable,�the�indices�calculated�are�Physiognomic�Facial�Index,�Morphological�Facial�Index,�Mandible��idth-Face��eight�Index,�Sagittal�Naso-FacialIndex,�Mandible-Face��idth�Index,�Chervin�s�Transverse�Cephalo-Facial�Index.�Results:�The�indices�thus�obtained�are�compared�for�males�and�female�s�separately.�Most�of�theindices� are� non-� significant� except�Mandible-Face��idth� Index� in� femalesand�Physiognomic�Facial� Indexand�Morphological� Facial� Index� in�males.�Conclusion:� Facial� Anthropometry�was� done� on� healthy� andhypertensivesubjects.�Though� the�data�analysis�have�not�concluded�any�change� in�facialanthropometry�inhypertensive� subjects� with� affirmation� but� the� data� obtained� forcontrol� subjects� in� Central� IndianPopulation� can� further� be� utilised� byAnthropometrics,� ,� Anatomists,� Forensic� Experts� and� Plasticsurgeons�too.
Keywords:�Anthropometry��Facial�Anthropometry���ypertensive�Patients.
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epidemic),� and� require� regular� updating� ofanthropometric� data� collections.� Studies� oncraniofacial� anthropometry� have� allowed� foridentification� and� quantification� of� syndromicclinical�features,�treatment�planning,�monitoring�ofoperative�outcomes,�and�assessment�of�longitudinalchange��5,6�.
��pertension� is� defined� as� systolic� and/ordiastolic� blood� pressure� of� 140/90� mm��g� ormore,� and/or� medication� use� for� decreasinghypertension��7,8,9�.
The� �orld� �ealth� Organi�ation� (��O)categori�es�high�blood�pressure�(BP)�as�the�top�riskfactor�for�death�rate,�accounting�for�1���of�fatalitiesglobally.�Also,�hypertension,�or�the��silent�killer��asit� is� also� known,� has� been� recogni�ed� as� animportant� risk� factor� for� cardiac� arrest,� stroke,kidney�disease,� and� increased�mortality� rates� inadults�(��O�2014)��10�.
�igh�blood�pressure,�also�called��hypertension,�is�a�serious�medical�condition.�It�happens�when�theforce�of�the�blood�pumping�through�your�arteries�istoo�strong.�The� flow�and�pressure�of�blood� in� thearteries� rises�with�each�pump�or�pulse�� this� is� thesystolic�or�higher�pressure�reading.�The�resting�orlower� pressure� between� each�pulse� is� called� thediastolic�pressure.
A�person�s�blood�pressure�reading�includes�bothfigures,�systolic/diastolic,�expressed�in�millimetresof�mercury.
�A�variety�of�symptoms�may�be�indirectly�relatedto�high�BP�but�are�not�always�caused�by�it,�such�asfacial�flushing.��Facial�flushing�occurs�when�bloodvessels�in�the�face�dilate.
Since� edema� is� also� closely� linked� withhypertension,� and� because� the� accumulation� ofan� excessive� amount� of� body� fluid� in� the� tissuespaces� between� cells� or� in� body� cavities� arenoticeable� in� the�overall� physical� appearance�ofthe�individual�especially�the�face��11�.
The� aim� of� the� study� was� to� evaluate� theAnthropometric� Measurements� in� patients� ofhypertension� and� healthy� control� subjects.Following�objectives�were�catered�to:
1. To� study� the� anthropometric� measurementsespecially� the� facial� proportions� ofhypertensive�subjects�and�healthy�controls.
2. To�compare�the�anthropometric�measurementsand� facial� proportion� of� hypertensives� andcontrol� population.� Comparison� was� doneamongst�same�sexes�in�two�groups.
Material�and�Methods
��pe�of�Stud�
It�was� a� cross-sectional,� Observational� studydesign�incorporating�a�total�of�100�subjects.
Stud���articipants
Out� of� 100,� fifty�were� healthy� controls� withSystolic�BP� �120�mm�of��g�or�Diastolic� BP��� 80mm�of��g�and�fifty�patients�in�the�age�range�of��5-50�years�diagnosed�to�have�hypertension�(SystolicBP��140mm�of��g�or�Diastolic�BP���90�mm�of��g),from� Sevagram� village� of� �ardha� region� ofMaharashtra�were� recruited� as� cases� �10�.�Out� ofthese� fifty,�22�were� females� in�both�group�and�28males�in�both�the�group.
Setting
The�study�was�conducted�in�the�Anthropometrysection� of�Department� of�Anatomy,�MahatmaGandhi� Institute� of�Medical� Sciences� (MGIMS)� incollaboration�with�Department�of�Medicine�of� thesame� institute.� It� is� a� rural� Medical�College� �hospital� located�in�a�village,�Sevagram�in��ardhadistrict�in�central�India.
�thics�Consideration
A�written� informed�consent�was�obtained� fromall�study�participants.� It�was�ensured�that�consentis�(a)given�voluntarily,�(b)fully�informed,�(c)and�isobtained� from� the�persons�who� are� competent� todo�so.
In�the�consent�form,�the�aims�of�the�study�wereexplained,� the� anticipated�benefits� and� the� risks,and�the�right�to�withdraw�from�interview�processat� any� time� without� any� reprisals.� The� use� ofconfidential� patient�data�will� be� fully�within� therecent� guidelines� from� the� Indian� Council� ofMedical� Research� (ICMR)� about� the� use� ofpersonnel� information� in� medical� research.Approval� for� conducting� the� study� from� theinstitutional�Ethics�Committee�was�received�beforecommencement�of�the�study.
Sample�Si�e
Sample� si�e� was� estimated� using� statisticalsoftware�with�following�assumptions.
Confidence�level�-�95�
Confidence�Interval-�10
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(Population�of�Sevagram�is�approximately�7000)Sample� si�e� estimated�was� 95.� Taking� this� intoaccount,�we�planned�to�go�for�total�of�100�subjectsdivided� into� two� groups� of� cases� and� controlsubjects�considering�the�economic�feasibility�as�wellas� the� time� frame� required� for� the� completion� ofthe�short�term�research.
Sampling��rocedure
By�Random�sampling�method,�samples�had�beenrecruited.
Inclusion�Criteria
1. Persons�from�age�group�of��5-50�years.
2. Diagnosed�patients�of�hypertension�will�be�thecases�and�healthy�people�of�the�same�age�groupwith�normal�Blood�Pressure�and�without�any�h/o�significant�illness�will�be�included�as�controls.
�xclusion�Criteria
� Previous�history�of�Facial��surgery�or�orthodontictreatment,
� Any�obvious�defect�or�deformity.
� Patients� suffering� from� Diabetes� ,� ThyroidDisease,� Liver� Failure,��aemolytic� Jaundice,Renal�diseases,� Psychosis� and�other�metabolicdisorders.
Anthropometric��easurements
Somatometric�measurements�were� conductedover�both�the�groups�(case�and�control)�by�the�sameindividual�at� the�same�fixed� time�as�per� standardprocedure�laid�by�Singh�P�and�Bhasin�M�(2004)��2�.
�����readth��easurements�of��ead�and��ace
A.��aximum��ead��readth
It�measures�the�straight�distance�between�the�twoeurya(eu).
�.��h�siognomic��acial��eight
It� measures� the� straight� distance� betweentrichion(tr)and�gnathion(gn)
C.��orphological��acial��eight
It� measures� the� straight� distance� betweennasion(n)and�gnathion(gn)
D.��i��gomatic��readth
�It�measures�the�straight�distance�between�the�two�ygia(�y)
�.��igonal��readth
It�measures� the� straight� distance� between� thegonia/gonion.
�.��asal��eight
It� measures� the� straight� distance� betweennasion(n)and�subnasale(sn)
����Indices�of��ace
A.��h�siognomic��acial�Index
Physiognomic� Facial� �eight� �� Bi�ygomaticBreadth��100
�.��orphological��acial�Index
Morphological� Facial� �eight� �� Bi�ygomaticBreadth�100
C.��andible��idth��ace��eight�Index
Bigonal� Breadth�Morphological� Facial��eight�100
D.�Sagittal��aso��acial�Index
Nasal��eight��Morphological�Facial��eight�100
�.��andible��ace��idth�Index
Bigonal�Breadth���Bi�ygomatic�Breadth�100
�.�Chervin�s��ransverse�Cephalo��acial�Index
Bi�ygomatic� Breadth� �� Maximum� �eadBreadth�100
Anthropometric�Instruments�used
Stadiometer,� Digital� weighing� balance,Spreading�Calliper,�Vernier�calliper�and�measuringtape.
��� measurement� was� done� using� mercurysphygmomanometer.
Data�Collection��ethod
All� the�data�were�abstracted�on�a�standardi�eddata�collection�form.�MS�excel�spreadsheet�was�used
Pradeep�Bokariya�et.�al.�/�Anthropometric�Measurements�of��ypertensive�Patients�withSpecial�Emphasis�on�Facial�Features
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to�enter�the�data�electronically.�Data�were�expressedas�mean���SD.
Statistical�Anal�sis
Chi-square� test� and� some� graphical� tools�wereemployed� for� finding� association� betweencategorical�variables.
Results
A�total�of�six�indices�were�obtained�for�both�thesexes�in�each�group.
The�findings�for�females�and�males�are�as�follows:
For�Females-
The�mean��SD�of�Physiognomic�Facial�Index�forexperimental� females� is� found� to� be� 141.71�9.98whereas�for�control�females�it�was�1�6.01�12.07.
The�mean���SD�of�Morphological�Facial�Index�forexperimental� females�was� found� to�be� 85.21�8.04whereas�for�control�females�it�was�84.99�9.26
The� Mandible� �idth-Face� �eight� Index� forexperimental�females�was�obtained�as�10�.88�10.65whereas�for�control�females�it�was�97.28�10.2�.
Sagittal� Naso-Facial� Index� for� experimentalfemales�was� estimated� as� 42.92�6.40�whereas� forcontrol�females�it�was�44.7��6.04.
Mandible-� Face��idth� Index� for� experimentalfemales�was� evaluated� as� 87.42�4.99�whereas� forcontrol�females�it�was�81.92�4.5�.
Chervind�s� transverse�Cephalo-Facial� Index� forexperimental� females�was� found� to�be� 96.�9�4.26whereas�for�control�females�it�was�96.�9�5.48.
For�Males
The�Physiognomic�Facial�Index�for�experimentalmales�was� found� to� be� 1�5.10�8.86�whereas� forcontrol�males�it�was�140.16�10.64.
The�Morphological�Facial�Index�for�experimentalmales�was�found�to�81.�1�6.59�whereas�for�controlmales�it�was�87.59�12.17.
The� Mandible� �idth-Face� �eight� Index� forexperimental�males�was�found� to�be�105.01�12.40whereas� for� control�males� it�was� 100.�8�11.15.Sagittal�Naso-Facial� Index� for�experimental�maleswas� found� to� be� 4�.69�5.76�whereas� for� controlmales�is�4�.79�9.70.
Mandible-� Face��idth� Index� for� experimentalmales� was� found� to� be� 84.74�5.88�whereas� forcontrol�males�it�was�86.80�4.89.
Chervind�s� transverse�Cephalo-Facial� Indexforexperimental�males�was� found� to� be� 101.14�7.�8whereas�for�control�males�it�was�98.91��.86.
The�data�thus�obtained�was�compared�in�controland�cases� group.�The� comparison� is� as� shown� inTable�1���2.
Individual�facial�anthropometric�indices�sex�wiseare�shown�in�Figure1�and�Figure�2.
�able��:�Comparison�of�various�indices�in�Females
�
p�Value� 0.41� 0.41� 0.09� 0.40� 0.01� 0.19�
� Non-significant� Non-significant� Non-�significant� Non-significant� Significant� Non�significant�
�able��:�Comparison�of�various�indices�in�Males
�
p�value� 0.05� 0.02� 0.10� 0.48� 0.11� 0.11�
� Significant� Significant� Non-significant� Non-significant� Non-significant� Non-significant�
�
Pradeep�Bokariya�et.�al.�/�Anthropometric�Measurements�of��ypertensive�Patients�withSpecial�Emphasis�on�Facial�Features
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Fi�.��:�The�various�charts�are�showing�depiction�of�individual�findings�obtained�in�controls�and�cases�for�Females
Pradeep�Bokariya�et.�al.�/�Anthropometric�Measurements�of��ypertensive�Patients�withSpecial�Emphasis�on�Facial�Features
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Fi�.��:�The�various�charts�are�showing�depiction�of�individual�findings�obtained�in�controls�and�cases�for�Females
Pradeep�Bokariya�et.�al.�/�Anthropometric�Measurements�of��ypertensive�Patients�withSpecial�Emphasis�on�Facial�Features
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Fi�.��:�Showing�various�charts�of�the�observations�of�different�indices�in�males�in�cases�and�control
Pradeep�Bokariya�et.�al.�/�Anthropometric�Measurements�of��ypertensive�Patients�withSpecial�Emphasis�on�Facial�Features
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Fi�.��:�Showing�various�charts�of�the�observations�of�different�indices�in�males�in�cases�and�control
Pradeep�Bokariya�et.�al.�/�Anthropometric�Measurements�of��ypertensive�Patients�withSpecial�Emphasis�on�Facial�Features
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Discussion
Facial�analysis�has�been�quite� crucial� in�studiesof�health�related�concerns��12-15�.��hile�there�arestudies� that� show�minor� anomalies� occurring� innormal� human� populations� at� low� frequencies,deviations�from�normal�values�can�be�indicative�ofa�health�problem��14,15�.
In� the� present� study,� the� variations� in� facialmorphometrics�between�diabetics�and�non-diabeticswas� explored.�The� observations� of� this� study� arenot� in�accordance�with�many� studies�which�havereported�changes�in�the�face�of�people�with�chronicdiseases�such�as�diabetes,�hypertension�and�arthritis�16,17,18�.
Based� on� the� analysis� of� landmarks� as� shapevariables,�the�face�shape�of�diabetics�was�found�tobe� rounder� and� less� tapered� compared� to� that� ofnondiabetics�in�a�study�by�Demayo�et�al�(2009)��4�.
They�analy�ed�that�there�is�a�Facial�asymmetry,drooping�of�the�brow�ridge,�compression�of�the�facetowards� center,� downward� folding� of� the� skin� inthe�area�of�the�eyes�in�Diabetics�without�any�sexualvariation� by�Geometric�Morphometrics�by� imageanalysis.
Moore� SE� et� al� (2001)��19�� analy�ed� that� Fetalalcohol�syndrome�(FAS)�and�Parietal�Fetal�alcoholsyndrome(PFAS)� have� a� facial� dysmorphologywhich�could�be�used�for�screening�Prenatal�exposureto� alcohol.� They� had� taken� total� 1�1� studypopulation�amongst�which�100�were�cases�(41�FAS,59�PFAS)�and��1�control�group�for�study�amongstwhich� 6� craniofacial� dysmorphology�have� beenexplored.
McGrath�J�et�al�(2002)��15��have�found�effectivedistinguishing�features� in�Psychotic�disorder�suchas�in�schi�ophrenia,�there�is�smaller�temporal�lobesin�patients� as� comparable� to� controls�based� uponAnthropomorphic� study.�They�have� recruited��10cases�and��0��controls�and�analy�ed�that�Psychoticdisorder� found� to� be�more� in�wider� skull� base,protruding�ears,�shorter�and�wider�palates.
Chandra� �J� et� al� (2012)� �1�� have� obtainedAnthropometric�disproportion� between� the� localpopulations�and�American�Caucasians.�They�havestudied� facial� anthropometric�measurement� in� 50males�and�50�females�of�adult�age�group�belongingto� same� ethnic� group.� They� had� used� standardanthropometric� landmarks� for� Anthropometricmeasurements�and�indices.
Solon� ECC� et� al� (2012)� �20�� � have� surveyedgeometric�morphometrics� by� Image� Analysis
amongst� hypertensive�and�non-hypertensive� andhave� come� to� a� conclusion� that� there� is� facialdysmorphology�between� hypertensive� and�non-hypertensive�patients.
Batiha�AM� (2015)� �21�� et� al� tried� to� find� anycorrelation�between� hypertensive� population� ofJordia�and�their�anthropometric�indices.�They�haveincluded�hip� circumference,�waist� circumference,height,�weight,�waist-to-hip�ratio,�and�a�body�shapeindex�in�their�study.
Conclusion
Though�the�data�analysis�have�not�concluded�anychange� in� facial� anthropometry� in� hypertensivesubjects�with�affirmation�but�the�data�obtained�forcontrol� subjects� in�Central� Indian�Population� canfurther� be�utilised� by�Anthropometrics,� ForensicExperts,�Anatomists�and�Plastic�surgeons�too.�Morefirmly�conclusion�can�be�drawn�if�study�is�carriedout�further�with�larger�number�of�subjects.
Conflicts�of�Interest
There�are�no�conflicts�of�interest�in�this�study.
Acknowled�ement
The� research� is� funded� by� MaharashtraUniversity�of��ealth� Sciences,�Nashik� under� itsSTRG�scheme�for�Undergraduate�students.
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