Azadirachta indica mitigates DMBA-induced hepatotoxicity: a biochemical and radiometric study

The hepatoprotective potential of aqueous Azadirachta indica leaf extract (AAILE) was assessed against DMBA-induced hepatotoxicity. DMBA (7,12-dimethylbenz[a] anthracene) treatment (40 mg/kg body weight, ip) to male Balb/c mice resulted in the derailment of liver function as revealed by extremely slow clearance of 99mTc-mebrofenin from liver, elevated levels of alkaline phosphatase (ALP) and alanine transaminase (ALT), compared to control group. In addition, elevated micronuclei score and high apoptotic index indicated hepatogenotoxicity in DMBA-treated mice. DMBA treatment also upregulated cytochrome P450 (CYP), cytochrome b5 (Cyt b5) and decreased glutathione-S-transferase activity in hepatic tissue, compared to control group. Enhanced lipid peroxidation (LPO) levels along with decreased reduced glutathione (GSH) level were also observed in DMBA group, compared to control group. AAILE co-treatment (200 mg/kg body weight, po, thrice a week) for 8 weeks followed by DMBA injection showed significant improvement in hepatic status, as revealed by normalization of 99mTc-mebrofenin clearance rate, decreased ALP and ALT levels, reduced genotoxicity in terms of micronuclei score and apoptotic index. Levels of LPO were significantly decreased along with increased hepatic GST and GSH levels in AAILE + DMBA group, compared to DMBA group. However, no significant change was observed in hepatic CYP and Cyt b5 levels, compared to DMBA group. The results indicated that AAILE effectively ameliorated DMBA-induced hepatotoxicity.

Addressing barriers to effective basal insulin therapy

Diabetes has reached epidemic proportions worldwide. It is a major health hazard particularly in developing countries like India due to the genetic susceptibility and changes in lifestyle. Glycaemic control is very poor in India as reflected by recent studies showing average HbA1c of > 9%. Insulin therapy is the mainstay of diabetes management. Currently available insulins have certain limitations. Modern insulin therapy needs to overcome these limitations to effectively achieve the optimal glycemic control. Hypoglycaemia is one of the important barrier which limits the use of insulin therapy and incidence of hypoglycaemia increases with increased variability in glucose lowering effects of Insulin when one tries to achieve stricter glycaemic targets. Fixed time administration is another important barrier, particularly for basal insulin administration that may affect the quality of life. Also the available basal insulins do not provide complete 24 hours control of fasting hyperglycaemia. Insulin degludec is designed to have a flat and stable glucose-lowering effect for more than 42 hours with less risk of hypoglycaemia. And it overcomes most of the issues with currently available basal insulins.

Increased circulatory levels of lipopolysaccharide (LPS) and zonulin signify novel biomarkers of proinflammation in patients with type 2 diabetes

Emerging data indicate that gut-derived endotoxin (metabolic endotoxemia) may contribute to low-grade systemic inflammation in insulin-resistant states. Specific gut bacteria seem to serve as lipopolysaccharide (LPS) sources and several reports claim a role for increased intestinal permeability in the genesis of metabolic disorders. Therefore, we investigated the serum levels of LPS and zonulin (ZO-1, a marker of gut permeability) along with systemic levels of tumor necrosis factor-α (TNF-α) and Interleukin-6 (IL-6) in patients with type 2 diabetes mellitus (T2DM) compared to control subjects. Study subjects were recruited from the Chennai Urban Rural Epidemiology Study [CURES], Chennai, India. Study group (n = 45 each) comprised of a) subjects with normal glucose tolerance (NGT) and (b) patients with T2DM. LPS, ZO-1, TNF-α, and IL-6 levels were measured by ELISA. Serum levels of LPS [p < 0.05], LPS activity [p < 0.001], ZO-1 [p < 0.001], TNFα [p < 0.001], and IL-6 [p < 0.001] were significantly increased in patients with T2DM compared to control subjects. Pearson correlation analysis revealed that LPS activity was significantly and positively correlated with ZO-1, fasting plasma glucose, 2 h post glucose, HbA1c, serum triglycerides, TNF-α, IL-6, and negatively correlated with HDL cholesterol. Regression analysis showed that increased LPS levels were significantly associated with type 2 diabetes [odds ratio (OR) 13.43, 95 % CI 1.998-18.9; p = 0.003]. In Asian Indians who are considered highly insulin resistant, the circulatory LPS levels, LPS activity, and ZO-1 were significantly increased in patients with type 2 diabetes and showed positive correlation with inflammatory markers and poor glycemic/lipid control.

Investigation of the morphology of longus colli among patients with neck pain using ultrasonography – a preliminary study

Objective: Longus colli provides stability to cervical spine during movements. In clinical practice, the clinicians teach exercises to longus colli to manage neck pain. The aim of this study was to investigate differences in thickness or anterior-posterior dimension (APD), shape ratio and contraction ratio of longus colli between subjects with neck pain and healthy controls. Materials and methods: A total of 12 subjects (6 with neck pain and 6 healthy controls) were recruited by predefined selection criteria. Ultrasound imaging of bilateral longus colli was conducted at the level C5-C6. Anterior-posterior dimension (APD) and lateral dimension (LD) were measured using Ultrasonography. Shape ratio (LD/APD) and contraction ratio (APD during contraction/APD during rest) were calculated. Mann-Whitney U test was used to compare the thickness of longus colli between healthy and neck pain subjects. Results and discussion: The results showed that the subjects with neck pain had smaller APD (Mean Rank=4.83, n=6) than healthy subjects (Mean Rank=8.17, n=6), U=16.00, z=-1.601 (corrected for ties), p=0.109, two tailed. Also, shape ratio showed higher values in neck pain subjects (Mean Rank=7.17, n=6) than normal subjects (Mean Rank=5.83, n=6), U=14.00, z=-0.641(corrected for ties) p=0.522, two tailed. In addition, contraction ratio was smaller in neck pain subjects (Mean Rank=4.83, n=6) than those healthy subjects (Mean Rank=8.17, n=6), U=8.00, z=- 1.601(corrected for ties) p=0.109, two tailed. Conclusion: There is a trend of reduced size of longus colli with the median of APD and smaller contraction ratio among patients with neck pain when compared to healthy controls. DOI: http://dx.doi.org/10.3329/bjms.v12i4.13692 Bangladesh Journal of Medical Science Vol. 12 No. 04 October ’13 Page 419-426

The Outcomes of Short Term Inspiratory Muscle Training (IMT) Combined with Chest Physiotherapy in Hospitalized COPD Patients

Objective: The objective of this study was to identify the outcomes of short term inspiratory muscle training (IMT) combined with chest physiotherapy (CP) on lung function, inspiratory muscle strength, exercise tolerance and quality of life of COPD patients. Materials and Methods: This randomized-controlled trial was conducted at the Terendak Armed Forces Hospital, Melaka. Eighteen hospitalized COPD patients (FEV1 50% to = 80% predicted) were randomized into intervention (IG) and control group (CG). The IG received IMT and CP treatments whilst the CG received only CP for a period of 4 weeks. Assessments of lung function (FEV1/FVC), inspiratory muscle strength (PImax), exercise tolerance (6MWT) and quality of life (SGRQ score) were taken at baseline and after 4 weeks. Results: Analysis showed IG group increased in FEV1/FVC by 19.4%, PImax by 54.7%, 6MWT by 33.2% and quality of life by 52.6% (All, p<0.05). The control group increased in FEV1/FVC by 8.7% (p>0.05), PImax by 15% (p<0.05), 6MWT by 18.9% (p<0.05) and quality of life by 15.6% (p<0.05). Conclusion: The present study has established that by combining inspiratory muscle training (IMT) and chest physiotherapy, provides superior effects on lung function, inspiratory muscle strength, exercise tolerance and quality of life among COPD patients. DOI: http://dx.doi.org/10.3329/bjms.v12i4.13302 Bangladesh Journal of Medical Science Vol. 12 No. 04 October ’13 Page 398-404

Circulating levels of high molecular weight (HMW) adiponectin and total adiponectin in relation to fat distribution, oxidative stress and inflammation in Asian Indians

Aim: To look at the association of total and high molecular weight (HMW) adiponectin with markers of fat distribution, oxidative stress and inflammation in Asian Indians.

Methods: A total of 120 subjects were chosen randomly from Chennai Urban Rural Epidemiological Study. Fasting HMW adiponectin levels, TNF-alpha and oxidized LDL were measured using ELISA. High sensitivity C reactive protein (hsCRP) was measured by a high sensitive nephelometric assay. Lipid peroxidation was measured by Tbars assay and protein carbonyl content was assessed by DNPH assay. Visceral and subcutaneous fat areas were assessed by computed tomography (CT) scan.

When stratified based on the tertiles of visceral fat, the levels of total (p = 0.03) and HMW adiponectin (p = 0.007) were highest in the first tertile followed by tertiles 2 and 3 whereas in tertiles of subcutaneous fat, there was no such trend. With increasing tertiles of Tbars, the levels of total (p = 0.03) and HMW adiponectin decreased (p = 0.002). The levels of HMW (p < 0.001) but not total adiponectin was also found to decrease with increasing tertiles of Protein carbonyl content. The levels of Total (p = 0.02) and HMW adiponectin (p = 0.004) were highest in the first tertile of oxidized LDL followed by tertile 2 and tertile 3. With increasing tertiles of TNF-alpha total (p = 0.01) and HMW adiponectin (p = 0.004) was found to decrease. With increasing tertiles of hs-CRP, Total (p = 0.005) and HMWadiponectin (p = 0.007)was found to decrease.

Conclusion: Oxidative stress markers, visceral but not subcutaneous fat and inflammation are associated with total and HMW adiponectin levles in Asian Indians.

Neurobehavioral assessment of hydroalcoholic extract of Trigonella foenum-graecum seeds in rodent models of Parkinson's disease

CONTEXT

Neuroprotective therapy to rescue dopaminergic neurons is an important trait in the management of Parkinson's disease (PD).

OBJECTIVE

The present study identified and evaluated SFSE-T, a standardized hydroalcoholic extract of Trigonella foenum-graecum L. seeds (Fabaceae), in animal models of PD.

MATERIALS AND METHODS

The identification of SFSE-T was carried out by high-performance liquid chromatography for the marker compound trigonelline (TGN). The effects of single dose oral treatment of SFSE-T (10, 30 or 100 mg/kg) were studied using animal models of PD, namely, 6-hydroxydopamine (6-OHDA)-induced unilateral lesions in rats, and 4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced neurodegeneration in C57BL/6 mice. The effects of SFSE-T on monoamino oxidase (MAO) enzyme in vitro as well as possible side effects of SFSE-T in vivo were also evaluated.

RESULTS

The concentration of TGN in a test sample of SFSE-T was found to be 82%. SFSE-T (30 mg/kg, oral) showed a significant increase in the number of ipsilateral rotations (45.67 rotations in 30-min period) as compared with vehicle control group (no rotations) when tested in 6-OHDA-induced unilateral lesioned rats. SFSE-T (30 mg/kg, oral) showed significant reversal of motor dysfunction (spontaneous motor activity scores, speed, distance traveled and number of square crossed) caused by MPTP induced lesions in C57BL/6 mice in pretreatment (1 h) schedule but not in post-treatment (1 h) schedule. SFSE-T neither showed anticholinergic effects nor showed selective MAO-B enzyme inhibition in vitro.

DISCUSSION AND CONCLUSION

SFSE-T showed reversal of motor symptoms in an animal model of PD probably through neuroprotective properties.

Real-world factors affecting adherence to insulin therapy in patients with Type 1 or Type 2 diabetes mellitus: a systematic review

AIMS

To identify real-world factors affecting adherence to insulin therapy in patients with Type 1 or Type 2 diabetes mellitus.

METHODS

A literature search was conducted in PubMed and EMBASE in November 2011 to identify studies reporting factors associated with adherence/non-adherence to insulin therapy in adults with Type 1 or Type 2 diabetes.

RESULTS

Seventeen studies were identified; six used self-reported measures and 11 used calculated measures of adherence. Most (13/17) were conducted exclusively in the USA. Four categories of factors associated with non-adherence were identified: predictive factors for non-adherence, patient-perceived barriers to adherence, type of delivery device and cost of medication. For predictive factors and patient-perceived barriers, only age, female sex and travelling were associated with non-adherence in more than one study. Fear of injections and embarrassment of injecting in public were also cited as reasons for non-adherence. Conversely, adherence was improved by initiating therapy with, or switching to, a pen device (in four studies), and by changing to an insurance scheme that lowered the financial burden on patients (in two studies).

CONCLUSIONS

Adherence to insulin therapy is generally poor. Few factors or patient-perceived barriers were consistently identified as predictive for non-adherence, although findings collectively suggest that a more flexible regimen may improve adherence. Switching to a pen device and reducing patient co-payments appear to improve adherence. Further real-world studies are warranted, especially in countries other than the USA, to identify factors associated with non-adherence and enable development of strategies to improve adherence to insulin therapy.

A multicentre, multinational, randomized, placebo-controlled, double-blind, phase 3 trial to evaluate the efficacy and safety of gemigliptin (LC15-0444) in patients with type 2 diabetes

AIM

This study was designed to assess the efficacy and safety of the dipeptidyl peptidase IV inhibitor gemigliptin (LC15-0444) 50 mg versus placebo in patients with type 2 diabetes.

METHODS

We conducted a 24-week, randomized, double-blind, placebo-controlled phase III trial in 182 patients (74 from Korea and 108 from India) with type 2 diabetes. After an initial 2 weeks of a diet and exercise programme followed by 2 weeks of a single-blind placebo run-in period, eligible patients were randomized to gemigliptin 50 mg or placebo, receiving the assigned treatment for 24 weeks. HbA1c and fasting plasma glucose (FPG) were measured periodically, and oral glucose tolerance test was performed at baseline and weeks 12 and 24.

RESULTS

At week 24, gemigliptin treatment led to significant reductions in HbA1c measurements compared to placebo (adjust mean after subtracting the placebo effect size: -0.71%, 95% confidence interval: -1.04 to -0.37%). A significantly greater proportion of patients achieved an HbA1c <7% with gemigliptin than with placebo. The placebo-subtracted FPG change from baseline at week 24 was -19.80 mg/dl. The overall incidence rates for adverse events were similar in the gemigliptin and placebo groups.

CONCLUSIONS

This study showed the efficacy and safety of gemigliptin 50 mg administered once daily as a monotherapy for type 2 diabetes patients.

Efficacy and safety of standardized extract of Trigonella foenum-graecum L seeds as an adjuvant to L-Dopa in the management of patients with Parkinson's disease

The objective of this study is to evaluate disease modifying efficacy and safety of a standardized extract of Trigonella foenum-graecum L, Fenugreek (IBHB) (family Fabaceae) as a nutritional adjuvant to Levo-dopa (L-Dopa) in Parkinson's disease (PD) patients. We conducted double-blind placebo-controlled proof of concept clinical study of IBHB capsules (300 mg, twice daily) with matching placebo for 6 months of period in 50 patients of PD stabilized on L-Dopa therapy. The efficacy outcome measures were the scores of Unified Parkinson's Disease Rating Scale (UPDRS - total and its subsections), and Hoehn and Yahr (H&Y) staging at baseline and end of 6-months treatment duration. Safety evaluation included haematology, biochemistry, urinalysis parameters and adverse event monitoring. Total UPDRS scores in IBHB treatment (0.098%) showed slower rise as opposed to steep rise (13.36%) shown by placebo. Further, Clinically Important Difference for total UPDRS scores and scores of motor subsection of UPDRS was found to be 5.3 and 4.8, respectively, in favour of IBHB treatment. Similar improvement was shown by IBHB in terms of H&Y staging as compared with placebo. IBHB was found to have excellent safety and tolerability profile. In conclusion, IBHB can be useful adjuvant treatment with L-Dopa in management of PD patients.

Ameliorative Effects of a Polyphenolic Fraction of Cinnamomum zeylanicum L. Bark in Animal Models of Inflammation and Arthritis

Cinnamon bark (Cinnamomum zeylanicum Syn C. verum, family: Lauraceae) is one of the oldest traditional medicines for inflammatory- and pain-related disorders. The objective of the present study was to evaluate the efficacy of the polyphenol fraction from Cinnamomum zeylanicum bark (CPP) in animal models of inflammation and rheumatoid arthritis. Dose-response studies of CPP (50, 100, and 200 mg/kg) used in a separate set of in vivo experiments were conducted in acute (carrageenan-induced rat paw edema), subacute (cotton pellet-induced granuloma), and sub-chronic (AIA, adjuvant-induced established polyarthrtis) models of inflammation in rats and the acetic acid-induced writhing model of pain in mice. Effects of CPP on cytokine (IL-2, IL-4, and IFNγ) release from Concanavalin (ConA)-stimulated lymphocytes were also evaluated in vitro. CPP showed a strong and dose-dependent reduction in paw volume, weight loss reversal effects against carrageenan-induced paw edema, and cotton pellet-induced granuloma models in rats. CPP (200 mg/kg p.o. for 10 days) showed a significant reduction in elevated serum TNF-α concentration without causing gastric ulcerogenicity in the AIA model in rats. CPP also demonstrated mild analgesic effects during acute treatment as evidenced by the reduction in the writhing and paw withdrawal threshold of the inflamed rat paw during the acetic acid-induced writhing model and Randall-Selitto test. CPP was found to inhibit cytokine (IL-2, IL-4, and IFNγ) release from ConA-stimulated lymphocytes in vitro. In conclusion, CPP demonstrated prominent action in animal models of inflammation and arthritis and therefore can be considered as a potential anti-rheumatic agent with disease-modifying action.

Type 2 diabetes in South Asians: similarities and differences with white Caucasian and other populations

Type 2 diabetes mellitus (T2DM) is one of the leading causes of morbidity and mortality. While all ethnic groups are affected, the prevalence of T2DM in South Asians, both in their home countries and abroad, is extremely high and is continuing to rise rapidly. Innate biological susceptibilities coupled with rapid changes in physical activity, diet, and other lifestyle behaviors are contributing factors propelling the increased burden of disease in this population. The large scope of this problem calls for investigations into the cause of increased susceptibility and preventative efforts at both the individual and population level that are aggressive, culturally sensitive, and start early. In this review, we outline the biological and environmental factors that place South Asians at elevated risk for T2DM, compared with Caucasian and other ethnic groups.

Finger millet (Ragi, Eleusine coracana L.): a review of its nutritional properties, processing, and plausible health benefits

Finger millet or ragi is one of the ancient millets in India (2300 BC), and this review focuses on its antiquity, consumption, nutrient composition, processing, and health benefits. Of all the cereals and millets, finger millet has the highest amount of calcium (344mg%) and potassium (408mg%). It has higher dietary fiber, minerals, and sulfur containing amino acids compared to white rice, the current major staple in India. Despite finger millet's rich nutrient profile, recent studies indicate lower consumption of millets in general by urban Indians. Finger millet is processed by milling, malting, fermentation, popping, and decortication. Noodles, vermicilli, pasta, Indian sweet (halwa) mixes, papads, soups, and bakery products from finger millet are also emerging. In vitro and in vivo (animal) studies indicated the blood glucose lowering, cholesterol lowering, antiulcerative, wound healing properties, etc., of finger millet. However, appropriate intervention or randomized clinical trials are lacking on these health effects. Glycemic index (GI) studies on finger millet preparations indicate low to high values, but most of the studies were conducted with outdated methodology. Hence, appropriate GI testing of finger millet preparations and short- and long-term human intervention trials may be helpful to establish evidence-based health benefits.

Antihypertensive and cardioprotective effects of the Lagenaria siceraria fruit in NG-nitro-L-arginine methyl ester (L-NAME) induced hypertensive rats

CONTEXT

Lagenaria siceraria (Molina) Standl. (Cucurbitacae) (LS) has been reported to possess cardioprotective, antihyperlipidemic, and diuretic activities.

OBJECTIVE

To evaluate antihypertensive and cardioprotective effects of the Lagenaria siceraria fruit powder in N(G)-nitro-L-arginine methyl ester (L-NAME) induced hypertension in rats.

MATERIALS AND METHODS

Male Wistar rats were divided in four groups. Control 2% gum acacia p.o., L-NAME (40 mg/kg p.o.), LS (500 mg/kg p.o.) + L-NAME (40 mg/kg p.o.), L-arginine (100 mg/kg p.o.) + L-NAME (40 mg/kg p.o.). Treatment period was 4 weeks. On day 29 serum marker enzymes, cholesterol and heamodynamic parameters were measured. Histology of heart was performed. LS powder was characterized by HPLC.

RESULT

Systolic blood pressures were increased by L-NAME (p < 0.001). In both drug treated groups systolic and diastolic blood pressures were reduced significantly (p < 0.001) compared to L-NAME. In L-NAME group significantly (p < 0.01) elevated cholesterol which was reduced (p < 0.05) by LS treatment. In L-NAME group inflammation and necrosis (0-35%) was present in heart whereas there was no change in myocardium of LS and L-arginine treated rats. Vitexin, orientin and isoorientin were detected in methanol extract of LS powder.

DISCUSSION AND CONCLUSION

L-NAME induced hypertension in rats was reduced by treatment with LS. The absence of necrosis, inflammation in the heart and significant reduction in serum cholesterol in LS and L-arginine treated rats indicated cardioprotective activity. Antioxidant activity of orientin and isoorientin appears to reduce the L-NAME induced damage. It is concluded that LS fruit possess antihypertensive and cardioprotective activity.

Improving diabetes care: multi-component cardiovascular disease risk reduction strategies for people with diabetes in South Asia--the CARRS multi-center translation trial

AIMS

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in people with diabetes in South Asia. The CARRS Translation Trial tests the effectiveness, cost-effectiveness, and sustainability of a clinic-based multi-component CVD risk reduction intervention among people with diabetes in India and Pakistan.

METHODS

We randomly assigned 1146 adults with diabetes recruited from 10 urban clinic sites, to receive usual care by physicians or to receive an integrated multi-component CVD risk reduction intervention. The intervention involves electronic health record management, decision-support prompts to the healthcare team, and the support of a care coordinator to actively facilitate patient and provider adherence to evidence-based guidelines. The primary outcome is a composite of multiple CVD risk factor control (blood glucose and either blood pressure or cholesterol, or all three). Other outcomes include control of the individual CVD risk factors, process and patient-centered measures, cost-effectiveness, and acceptability/feasibility.

CONCLUSION

The CARRS Translation Trial tests a low-cost diabetes care delivery model in urban South Asia to achieve comprehensive cardio-metabolic disease case-management of high-risk patients (clinicaltrials.gov number: NCT01212328).

Noncommunicable diseases risk factor surveillance: experience and challenge from India

Noncommunicable diseases (NCDs) are reaching epidemic proportions worldwide and in India. Surveillance of NCD risk factors are therefore needed as they could help in policy planning and implementation of preventive measures. This article will focus on the experiences gained, and challenges faced, in conducting NCD risk factor surveillance studies in India. Two major surveillance studies on NCDs were conducted in India - the World Health Organization (WHO) - Indian Council of Medical Research (ICMR) NCD risk factor surveillance study and the Integrated Disease Surveillance Project (IDSP). The WHO-ICMR study was a six-site pilot study representing six different geographical locations in India with a sample size of 44,537 including rural, peri-urban/slum and urban. Phase 1 of the IDSP was completed and included seven states in India with a sample size of 5000 per state. The NCD risk factor surveillance showed that high prevalence of diabetes, hypertension and obesity in urban areas with slightly lower prevalence rates in semi-urban and rural areas. There are several challenges in obtaining data on NCD risk factors, which include challenges in obtaining anthropometric and blood pressure measures and in assessing tobacco consumption, diet and physical activity. The challenges in field operations include contacting and convincing subjects, creating rapport, tracking subjects, climatic conditions, recall ability and interviewer skills. Success in surveillance studies depends on anticipating and managing these challenges

CONCLUSION

Improving country-level surveillance and monitoring is a valuable step in prevention and control of NCDs in India.

Clinical and molecular characterization of neonatal diabetes and monogenic syndromic diabetes in Asian Indian children

Mutations in the pancreatic ATP sensitive K(+) channel proteins [sulfonyluea receptor 1 (SUR1) and inward rectifier K(+) channel Kir6.2 (Kir6.2), encoded by ATP-binding cassette transporter subfamily C member 8 (ABCC8) and potassium channel J11 (KCNJ11), respectively], are the most common cause of neonatal diabetes. We describe the clinical presentation and molecular characterization of Asian Indian children with neonatal diabetes mellitus and monogenic syndromes of diabetes. We sequenced KCNJ11, ABCC8 and insulin (INS) genes in 33 unrelated Indian probands with onset of diabetes below one year of age. A total of 12 mutations were identified which included ABCC8 mutations in seven, KCNJ11 mutations in three and INS mutations in two children. The Asp212Tyr mutation in ABCC8 was novel. We also detected two novel mutations (Val67Met and Leu19Arg) in children with syndromic forms of diabetes like Berardinelli Seip syndrome [1-acyl-sn-glycerol-3-phosphate acyltransferase beta (AGPAT2)] and Fanconi Bickel syndrome [solute carrier family 2A2 (SLC2A2)]. Children carrying the KCNJ11 (Cys42Arg, Arg201Cys) and ABCC8 (Val86Ala, Asp212Tyr) mutations have been successfully switched over from insulin therapy to oral sulfonylurea. Our study is the first large genetic screening study of neonatal diabetes in India.

Antiosteoporotic activity of phytoestrogen-rich fraction separated from ethanol extract of aerial parts of Cissus quadrangularis in ovariectomized rats

OBJECTIVE

Cissus quadrangularis L. (C. quadrangularis L.) (Vitaceae) has been reported in Ayurveda for its antiosteoporotic activity. The study separated the phytoestrogen-rich fraction (IND-HE) from aerial parts of C. quadrangularis L. and evaluated its effect on osteoporosis caused by ovariectomy in rats.

MATERIALS AND METHODS

IND-HE was separated from the ethanol extract of C. quadrangularis. Ovariectomized female Wistar rats were divided into four groups (n = 6). Group 1: Control (distilled water), Group II: IND-HE (75 mg/kg p.o.), Group III: IND-HE (100 mg/kg p.o.) were treated once daily for 8 weeks and Group IV: standard estradiol group, received estrogen (1 mg/kg, s.c. bi-weekly). The effects on body weight were determined. DEXA (Dual energy-emission X-ray absorptimatory analysis) of whole body bone and femur was carried out. Blood was removed and analyzed for biochemical parameters. After sacrificing the animals, biomechanical study of right tibia and histopathology of pelvic bone was carried out.

RESULTS

IND-HE showed presence of phytoestrogen-rich fraction. IND-HE (75 and 100 mg/ kg) and estrogen treatment showed statistically significant increase in bone thickness, bone density and bone hardness. IND-HE (75 and 100 mg/kg) and estrogen treatment significantly increased serum estradiol. IND-HE (100 mg/kg) (P<0.05) and estrogen treatment increased serum vitamin D3 and serum calcium compared to control. Alkaline phosphatase was significantly reduced by IND-HE (100 mg/kg p.o.) and estrogen treatment. Histopathology and DEXA results indicated that IND-HE (75 and 100 mg/kg) prevented bone loss.

DISCUSSION AND CONCLUSION

These findings confirm that phytoestrogen-rich fraction (IND- HE) possess good antiosteoporotic activity.

Transcultural diabetes nutrition therapy algorithm: the Asian Indian application

India and other countries in Asia are experiencing rapidly escalating epidemics of type 2 diabetes (T2D) and cardiovascular disease. The dramatic rise in the prevalence of these illnesses has been attributed to rapid changes in demographic, socioeconomic, and nutritional factors. The rapid transition in dietary patterns in India-coupled with a sedentary lifestyle and specific socioeconomic pressures-has led to an increase in obesity and other diet-related noncommunicable diseases. Studies have shown that nutritional interventions significantly enhance metabolic control and weight loss. Current clinical practice guidelines (CPGs) are not portable to diverse cultures, constraining the applicability of this type of practical educational instrument. Therefore, a transcultural Diabetes Nutrition Algorithm (tDNA) was developed and then customized per regional variations in India. The resultant India-specific tDNA reflects differences in epidemiologic, physiologic, and nutritional aspects of disease, anthropometric cutoff points, and lifestyle interventions unique to this region of the world. Specific features of this transculturalization process for India include characteristics of a transitional economy with a persistently high poverty rate in a majority of people; higher percentage of body fat and lower muscle mass for a given body mass index; higher rate of sedentary lifestyle; elements of the thrifty phenotype; impact of festivals and holidays on adherence with clinic appointments; and the role of a systems or holistic approach to the problem that must involve politics, policy, and government. This Asian Indian tDNA promises to help guide physicians in the management of prediabetes and T2D in India in a more structured, systematic, and effective way compared with previous methods and currently available CPGs.

Relationship of body fat with insulin resistance and cardiometabolic risk factors among normal glucose-tolerant subjects

BACKGROUND

The amount of body fat, rather than the amount of excess weight, determines the health risks of obesity, type 2 diabetes mellitus, and cardiovascular disease.

AIMS

To look at the association of body fat percentage with cardiometabolic risk factors in subjects with normal glucose tolerance (NGT).

SETTINGS AND DESIGN

Cross-section study from the Chennai Urban Rural Epidemiology Study.

MATERIALS AND METHODS

Body fat was measured by Beurer body fat analyzer. Metabolic syndrome (MS) was diagnosed based on modified ATPIII guidelines.

STATISTICAL ANALYSIS

Student's t test or one-way ANOVA (with Tukey's HSD) was used to compare groups for continuous variables.

RESULTS

Body mass index, waist circumference, systolic and diastolic blood pressure, HOMA IR, serum cholesterol, and LDL cholesterol increased significantly with increasing tertiles of body fat (P<0.001). There was a linear increase in the percentage of body fat with increase in number of components of MS (no metabolic abnormality: 25 ± 11, one metabolic abnormality: 28 ± 10, two metabolic abnormalities: 33 ± 8, and three and more metabolic abnormalities: 35 ± 7) (P<0.001). Regression models showed significant association of body fat with MS after adjusting for age, gender, insulin resistance, and glycated hemoglobin (Odds ratio: 1.04, 95% confidence interval: 1.04 - 1.08, P<0.001). In linear regression analysis, body fat showed a significant association with insulin resistance after adjusting for age, gender, and glycated hemoglobin (β=0.030, P<0.001).

CONCLUSIONS

A significant association exists between body fat, MS, and cardiometabolic risk factors even among subjects with NGT.

Immunohistochemical evaluation of p53, FHIT, and IGF2 gene expression in esophageal cancer

The aim of the study was to evaluate the expression of tumor suppressor genes p53, fragile histidine triad gene (FHIT), and an oncogene insulin-like growth factor 2 (IGF2) as prognostic markers in the etiology of esophageal cancer. Immunohistochemistry (IHC) was performed in 39 archival tissue samples of different esophageal pathologies for the three genes. Abnormal p53 expression was maximum in all the cases of squamous cell carcinoma, while IGF2 expression was enhanced in squamous cell carcinoma (81%), adenocarcinoma (100%), and dysplasia of squamous epithelium (75%) samples when compared with normals (50%). To our surprise, 75% of normal tissues did not show FHIT expression, which was also not seen in 40% of dysplasias of squamous epithelium, 33.3% of adenocarcinoma, and 41% of squamous cell carcinoma. To the best of our knowledge, this is the first study evaluating IGF2 by IHC, as well as, correlating it with the expression of the two tumor suppressor genes, p53 and FHIT, in esophageal tissue. p53 expression was threefold higher than normal in dysplasias of squamous epithelium and adenocarcinoma, while it was eightfold higher in squamous cell carcinoma. IGF2 expression was low in normal and dysplasia tissue but was increased 1.97-fold in both types of malignancy. FHIT and p53 expression were well correlated in squamous cell carcinoma, supporting the observation that FHIT regulates and stabilizes p53. Altered/lowered FHIT levels may be a result of exposure to various exogenous agents; however, this could not be assessed in the present study as it was carried out on archival samples. A larger prospective study is warranted to establish the role of exogenous factors in FHIT expression.

Should waist circumference be replaced by index of central obesity (ICO) in definition of metabolic syndrome?

Waist circumference has been widely used as the parameter of central obesity in defining metabolic syndrome. Global consensus definition of metabolic syndrome has suggested various race- and gender-specific cutoffs of waist circumference for quantifying central obesity. We have earlier proposed that using index of central obesity (ICO), the need for race- and gender-specific cutoffs may be obviated. We propose that waist circumference be supplanted with index of central obesity in all definitions of metabolic syndrome. Using index of central obesity a common cutoff of 0.5 applicable across races and genders might be obtained. Moreover, it will enhance the sensitivity of definition by diagnosing subjects who are shorter than general population. Among 258 male and 242 female diabetic patients, subjects with metabolic syndrome (defined as per gender-specific waist circumference cutoffs), were found to have a common lower range of index of central obesity suggesting that a common cutoff of waist circumference may be obtained. In another study from National Health and Nutrition Examination Survey database, replacing index of central obesity with waist circumference was found to enhance the specificity and sensitivity of definition of metabolic syndrome.

Prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in urban and rural India: phase I results of the Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study

AIMS/HYPOTHESIS

This study reports the results of the first phase of a national study to determine the prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in India.

METHODS

A total of 363 primary sampling units (188 urban, 175 rural), in three states (Tamilnadu, Maharashtra and Jharkhand) and one union territory (Chandigarh) of India were sampled using a stratified multistage sampling design to survey individuals aged ≥ 20 years. The prevalence rates of diabetes and prediabetes were assessed by measurement of fasting and 2 h post glucose load capillary blood glucose.

RESULTS

Of the 16,607 individuals selected for the study, 14,277 (86%) participated, of whom 13,055 gave blood samples. The weighted prevalence of diabetes (both known and newly diagnosed) was 10.4% in Tamilnadu, 8.4% in Maharashtra, 5.3% in Jharkhand, and 13.6% in Chandigarh. The prevalences of prediabetes (impaired fasting glucose and/or impaired glucose tolerance) were 8.3%, 12.8%, 8.1% and 14.6% respectively. Multiple logistic regression analysis showed that age, male sex, family history of diabetes, urban residence, abdominal obesity, generalised obesity, hypertension and income status were significantly associated with diabetes. Significant risk factors for prediabetes were age, family history of diabetes, abdominal obesity, hypertension and income status.

CONCLUSIONS/INTERPRETATIONS

We estimate that, in 2011, Maharashtra will have 6 million individuals with diabetes and 9.2 million with prediabetes, Tamilnadu will have 4.8 million with diabetes and 3.9 million with prediabetes, Jharkhand will have 0.96 million with diabetes and 1.5 million with prediabetes, and Chandigarh will have 0.12 million with diabetes and 0.13 million with prediabetes. Projections for the whole of India would be 62.4 million people with diabetes and 77.2 million people with prediabetes.

Nutritional and sensory profile of two Indian rice varieties with different degrees of polishing

Traditional hand-pounded rice has been replaced today with highly polished white rice in the Asian Indian diets. The study aimed to evaluate the nutritional as well as the sensory differences between the brown (0% polish) and the rice milled to different degrees of polish (2.3, 4.4 and 8.0%). Bapatla and Uma (red pigmented) varieties in both raw and parboiled forms were used. The protein, fat, dietary fibre, γ-oryzanol, polyphenols, vitamin E, total antioxidant activity and free radical scavenging abilities of the brown rice decreased while the available carbohydrates increased with polishing. Sensory attributes of the cooked rice samples (whiteness, grain intactness, fluffiness, firmness, stickiness, chewiness and the cooked rice aroma) were evaluated by trained panelists. Scores for branny taste and chewiness decreased with polishing. On the whole, brown rice of both the varieties was readily accepted by the well-informed sensory trained panelists.

Estrogenic activity of friedelin rich fraction (IND-HE) separated from Cissus quadrangularis and its effect on female sexual function

Women experience menopause differently across the world, in terms of their symptomology. Many experience symptoms of menopause like hot flashes, joint pain and loss of libido. Estrogen replacement is the prescribed therapy for most of the sexual dysfunction observed in menopausal women. Many women are reluctant to use exogenous hormone therapy for treatment of menopausal symptoms and are turning to botanical and dietary supplements for relief. In the present study IND-HE (friedelin rich fraction) was studied for estrogenic activity as well as its effect on sexual behavior in overiectomized female Wistar rats.

The rats were divided into 4 groups of six rats each. The Group 1 received distilled water, Group II - IND-HE (75 mg/kg p. o.), Group III - IND-HE (100 mg/kg p. o.) and Group IV received estrogen (estradiol) (1 mg/kg in olive oil suspension, s.c. bi-weekly). The treatment period was 8 weeks. On 1 day, one month and two month of treatment the sexual behavior was studied. At the end of the treatment the blood was withdrawn from retro-orbital plexus. The animals were sacrificed and uterus was removed, weighed and histology was studied. In different group of rats estrous cycle was studied which indicate estrogenic activity and for progestogenic activity of deciduoma formation was studied.

The result indicated that IND-HE (75 and 100 mg/kg p.o.) improved sexual behavior parameters. IND-HE (75 and 100) significantly (P< 0.01) decreased darting and hopping latency. The darting frequency and hopping frequency was significantly (P< 0.01) improved in IND-HE (75 and100 mg/kg p.o.) as well as estrogen group. Lordosis interval (LI) was increased significantly in estrogen group after 1^st month (P< 0.05), and after 2^nd month (P< 0.01). IND-HE (100) treatment showed increase in LI after 1^st month (P< 0.05) remained during 2^nd month (P< 0.01). While IND-HE (75) treatment increased LI only after 2^nd month (P< 0.05).IND-HE (75 and 100 mg/kg p.o.) showed estrogenic activity as indicated by vaginal cornification, increase in uterine weight and rise in serum estrogen.

Optimization of Chromium Removal by the Indigenous Bacterium Bacillus spp. REP02 Using the Response Surface Methodology

An indigenous bacterium, Bacillus REP02, was isolated from locally sourced chromium electroplating industrial effluents. Response surface methodology was employed to optimize the five critical medium parameters responsible for higher % Cr(2+) removal by the bacterium Bacillus REP02. A three-level Box-Behnken factorial design was used to optimize K2HPO4, yeast extract, MgSO4, NH4NO3, and dextrose for Cr(2+) removal. A coefficient of determination (R (2)) value (0.93), model F-value (3.92) and its low P-value (F < 0.0008) along with lower value of coefficient of variation (5.39) indicated the fitness of response surface quadratic model during the present study. At optimum parameters of K2HPO4 (0.6 g L(-1)), yeast extract (5.5 g L(-1)), MgSO4 (0.04 g L(-1)), NH4NO3 (0.20 g L(-1)), and dextrose (12.50 g L(-1)), the model predicted 98.86% Cr(2+) removal, and experimentally, 99.08% Cr(2+) removal was found.

Glycaemic index of three Indian rice varieties

Three commonly consumed Indian rice varieties (Sona Masuri, Ponni and Surti Kolam) were tested for their glycaemic index (GI). Healthy volunteers were recruited and after an overnight fast were given a 50 g available carbohydrate portion of glucose (reference food) or different varieties of cooked rice (test foods) on separate occasions. The fasting as well as postprandial capillary blood glucose response was determined over 2 h, and the incremental area under the curve (IAUC) was calculated. The GI was calculated as the IAUC of the test food/IAUC of the reference food (glucose) × 100. The differences between the GI values for Sona Masuri (72.0 ± 4.5), Ponni (70.2 ± 3.6) and Surti Kolam (77.0 ± 4.0) rice varieties were non-significant (p = 0.606) and are all classified as high GI varieties of rice. There is an urgent need to study the GI of other commonly consumed rice varieties and to develop rice of a lower GI value.

Development of stereotactic mass spectrometry for brain tumor surgery

BACKGROUND

Surgery remains the first and most important treatment modality for the majority of solid tumors. Across a range of brain tumor types and grades, postoperative residual tumor has a great impact on prognosis. The principal challenge and objective of neurosurgical intervention is therefore to maximize tumor resection while minimizing the potential for neurological deficit by preserving critical tissue.

OBJECTIVE

To introduce the integration of desorption electrospray ionization mass spectrometry into surgery for in vivo molecular tissue characterization and intraoperative definition of tumor boundaries without systemic injection of contrast agents.

METHODS

Using a frameless stereotactic sampling approach and by integrating a 3-dimensional navigation system with an ultrasonic surgical probe, we obtained image-registered surgical specimens. The samples were analyzed with ambient desorption/ionization mass spectrometry and validated against standard histopathology. This new approach will enable neurosurgeons to detect tumor infiltration of the normal brain intraoperatively with mass spectrometry and to obtain spatially resolved molecular tissue characterization without any exogenous agent and with high sensitivity and specificity.

RESULTS

Proof of concept is presented in using mass spectrometry intraoperatively for real-time measurement of molecular structure and using that tissue characterization method to detect tumor boundaries. Multiple sampling sites within the tumor mass were defined for a patient with a recurrent left frontal oligodendroglioma, World Health Organization grade II with chromosome 1p/19q codeletion, and mass spectrometry data indicated a correlation between lipid constitution and tumor cell prevalence.

CONCLUSION

The mass spectrometry measurements reflect a complex molecular structure and are integrated with frameless stereotaxy and imaging, providing 3-dimensional molecular imaging without systemic injection of any agents, which can be implemented for surgical margins delineation of any organ and with a rapidity that allows real-time analysis.

Insulin resistance is associated with increased cardiovascular risk in Asian Indians with normal glucose tolerance--the Chennai Urban Rural Epidemiology Study (CURES-66)

OBJECTIVE

The aim of the study was to assess the association of Insulin Resistance [IR] assessed by Homeostasis Assessment model (HOMA-IR) with cardiovascular risk factors in subjects with Normal Glucose Tolerance [NGT] in Asian Indians.

METHODS

This cross-sectional study recruited subjects from the Chennai Urban Rural Epidemiology Study [CURES] an epidemiological study in a representative population of Chennai [formerly Madras], in South India. We included 1550 subjects with normal glucose tolerance, ie, fasting plasma glucose < 100 mg/dl [5.6 mmol/L] and 2 hour post load plasma glucose < 140 mg/dl [7.8 mmol/L]. IR was calculated using the homeostasis assessment model (HOMA-IR) using the formula: fasting insulin (1IU/mL) fasting glucose (mmol/L)/22.5. Metabolic syndrome [MS] was defined based on modified Adult Treatment Panel III (ATP III) guidelines.

RESULTS

HOMA-IR was found to be significantly associated with systolic blood pressure (beta = 0.100, p < 0.001), diastolic pressure (beta = 0.094, p < 0.001), total cholesterol (beta = 0.068, p = 0.005), serum triglycerides (beta = 0.105, p < 0.001), LDL cholesterol (beta = 0.118, p < 0.005), and HDL cholesterol (beta = -0.060, p < 0.001) even after adjusting age, gender and BMI. Subjects with family history of type 2 diabetes had significantly higher HOMA-IR [p = 0.011] compared to those without family history. In relation to physical activity, subjects with heavy grade activity had significantly lower HOMA-IR values compared to the light grade activity [p < 0.001] Subjects with generalized obesity [p < 0.001] and abdominal obesity [p < 0.001] had significantly higher HOMA-IR which remained statistically significant even after adjusting for age and gender. There was a linear increase in the mean values of HOMA IR with increase in number of components of MS [p for trend < 0.001]

CONCLUSION

Among Asian Indians who are known to have high risk of premature coronary artery disease and diabetes, a significant association exists between insulin resistance with cardiovascular risk factors even among NGT subjects.

Pneumococcal infections and immunization in diabetic patients

India is today facing a diabetes epidemic and has the maximum number of patients with diabetes in the world. People with diabetes are more prone to develop all types of infections. Pneumococcal infections are a common cause of morbidity and mortality, and people with diabetes are more prone to develop pneumococcal infections. With the availability of the pneumococcal vaccine, most international organizations now recommend that people with diabetes should be vaccinated against pneumococcal disease. This article tries to provide a balanced review of the place of pneumococcal vaccination in Indian diabetic patients.

Distribution of 10-year and lifetime predicted risk for cardiovascular disease in the Indian Sentinel Surveillance Study population (cross-sectional survey results)

INTRODUCTION

Cardiovascular disease (CVD) prevention guidelines recommend lifetime risk stratification for primary prevention of CVD, but no such risk stratification has been performed in India to date.

METHODS

The authors estimated short-term and lifetime predicted CVD risk among 10,054 disease-free, adult Indians in the 20-69-year age group who participated in a nationwide risk factor surveillance study. The study population was then stratified into high short-term (≥ 10% 10-year risk or diabetes), low short-term (<10%)/high lifetime and low short-term/low lifetime CVD risk groups.

RESULTS

The mean age (SD) of the study population (men=63%) was 40.8 ± 10.9 years. High short-term risk for coronary heart disease was prevalent in more than one-fifth of the population (23.5%, 95% CI 22.7 to 24.4). Nearly half of individuals with low short-term predicted risk (48.2%, 95% CI 47.1 to 49.3) had a high predicted lifetime risk for CVD. While the proportion of individuals with all optimal risk factors was 15.3% (95% CI 14.6% to 16.0%), it was 20.6% (95% CI 18.7% to 22.6%) and 8.8% (95% CI 7.7% to 10.5%) in the highest and lowest educational groups, respectively.

CONCLUSION

Approximately one in two men and three in four women in India had low short-term predicted risks for CVD in this national study, based on aggregate risk factor burden. However, two in three men and one in two women had high lifetime predicted risks for CVD, highlighting a key limitation of short-term risk stratification.

Importance of controlling diabetes early--the concept of metabolic memory, legacy effect and the case for early insulinisation

Most of the microvascular complications of diabetes are related to the degree and the length of exposure to hyperglycaemia. New data from the follow-up studies of the Diabetes Control and Complications Trial-the Epidemiology of Diabetes Intervention and Complications Study (DCCT-EDIC), and the United Kingdom Prospective Diabetes Study (UKPDS) emphasize the role of glycemic control early in the course of the disorder and its value in prevention of later complications. The phenomenon of ongoing beneficial effects on diabetic complications after a period of improved glycemic control even if followed by a return to usual (often poorer) metabolic control has been described as representing "metabolic memory" by the DCCT/EDIC investigators and as a "legacy effect" by the UKPDS investigators. This article reviews these concepts and explores the role of early use of insulin as a tool to achieve good glycemic control in type 2 diabetes.

The need for obtaining accurate nationwide estimates of diabetes prevalence in India - rationale for a national study on diabetes

According to the World Diabetes Atlas, India is projected to have around 51 million people with diabetes. However, these data are based on small sporadic studies done in some parts of the country. Even a few multi-centre studies that have been done, have several limitations. Also, marked heterogeneity between States limits the generalizability of results. Other studies done at various time periods also lack uniform methodology, do not take into consideration ethnic differences and have inadequate coverage. Thus, till date there has been no national study on the prevalence of diabetes which are truly representative of India as a whole. Moreover, the data on diabetes complications is even more scarce. Therefore, there is an urgent need for a large well-planned national study, which could provide reliable nationwide data, not only on prevalence of diabetes, but also on pre-diabetes, and the complications of diabetes in India. A study of this nature will have enormous public health impact and help policy makers to take action against diabetes in India.

Estimation of Myocardial Volume at Risk from CT Angiography

The determination of myocardial volume at risk distal to coronary stenosis provides important information for prognosis and treatment of coronary artery disease. In this paper, we present a novel computational framework for estimating the myocardial volume at risk in computed tomography angiography (CTA) imagery. Initially, epicardial and endocardial surfaces, and coronary arteries are extracted using an active contour method. Then, the extracted coronary arteries are projected onto the epicardial surface, and each point on this surface is associated with its closest coronary artery using the geodesic distance measurement. The likely myocardial region at risk on the epicardial surface caused by a stenosis is approximated by the region in which all its inner points are associated with the sub-branches distal to the stenosis on the coronary artery tree. Finally, the likely myocardial volume at risk is approximated by the volume in between the region at risk on the epicardial surface and its projection on the endocardial surface, which is expected to yield computational savings over risk volume estimation using the entire image volume. Furthermore, we expect increased accuracy since, as compared to prior work using the Euclidean distance, we employ the geodesic distance in this work. The experimental results demonstrate the effectiveness of the proposed approach on pig heart CTA datasets.