Screening for mental illness using GMHAT App of patients with Type 2 diabetes mellitus at a teaching institute hospital in India - A cross sectional study

People with diabetes will have some coexisting mental illness most of the time and its evaluation and management are essential for the well-being of the person. With this background, the Global Mental Health Assessment Tool (GMHAT) app was used to screen for mental illness among type 2 diabetes mellitus patients attending a tertiary care hospital in Mysore, India.

Methods

A cross-sectional study was conducted on 100 patients who were on treatment for type 2 diabetes for at least 6 months from the Out-Patient Department of KR Hospital, Mysore. Interviews were conducted using a structured GMHAT. Data were entered in MS Excel and analysed using SPSS version 21.0. Chi-square, Independent T-test/Mann-Whitney tests were used to investigate associations between the variables.

Results

The mean age of the study participants was 48.8 ± 11.6 years. Among the 100 diabetic patients, 39% (n = 39) had mental illness and among the 39 subjects, 21% had depression, 14% had anxiety disorder and 4% suffered from organic disorder. Apart from diabetes, 29, 17, 13, 27, 23 and 20% had hypertension, chronic kidney disease, liver disease, retinopathy, neuropathy and nephropathy, respectively, as comorbid conditions.

Conclusion

There is a higher prevalence of mental illness in patients with diabetes mellitus. The prevalence rate increases with an increase in the chronicity of diabetes. The use of the GMHAT app could help in rapid assessment and accurate diagnoses.

Alpha-L-fucosidase levels in patients with oral submucous fibrosis and controls: A comparative study

Background

Oral submucous fibrosis (OSMF) in recent times has been recognized as a potentially malignant disorder (PMD) with an increased risk of developing oral squamous cell carcinoma with malignant transformation rates that vary from 0.6% to 36%. Alpha-L-fucosidase (AFU) is a lysosomal enzyme that is involved in maintaining the homeostasis of fucose metabolism. In benign and malignant tumors, the cells modulate their surface by increasing fucosylation leading to uncontrolled growth.

Aims and objectives

This study was designed to estimate the levels of salivary and serum AFU in patients with OSMF and healthy controls and also to evaluate the clinical utility of salivary AFU levels over serum.

Materials and Methods

Saliva and blood samples were collected from twenty participants in both the groups (OSMF and healthy controls). Serum and salivary alpha-L-fucosidase levels were measured by enzyme-linked immunosorbent assay. The data were subjected to appropriate statistical analysis.

Results

We found a significant increase in alpha-L-fucosidase level in OSMF compared with healthy subjects. Pearson's correlation showed salivary alpha-L-fucosidase level to have superior sensitivity in detecting OSMF compared with serum alpha-L-fucosidase.

Conclusion

The outcome of this study suggests that salivary alpha-L-fucosidase can be utilized as a biomarker in early detection of oral precancer and cancer.

Ghrelin attenuates methylmercury-induced oxidative stress in neuronal cells

Methylmercury (MeHg) is a global pollutant, which can cause damage to the central nervous system at both high-acute and chronic-low exposures, especially in vulnerable populations, such as children and pregnant women. Nowadays, acute-high poisoning is rare. However, chronic exposure to low MeHg concentrations via fish consumption remains a health concern. Current therapeutic strategies for MeHg poisoning are based on the use of chelators. However, these therapies have limited efficacy. Ghrelin is a gut hormone with an important role in regulating physiologic processes. It has been reported that ghrelin plays a protective role against the toxicity of several xenobiotics. Here, we explored the role of ghrelin as a putative protector against MeHg-induced oxidative stress. Our data show that ghrelin was able to ameliorate MeHg-induced reactive oxygen species (ROS) production in primary neuronal hypothalamic and hippocampal cultures. An analogous effect was observed in mouse hypothalamic neuronal GT 1-7 cells. Using this model, our novel findings show that antioxidant protection of ghrelin against MeHg is mediated by glutathione upregulation and induction of the NRF2/NQO1 pathway.

A study of clinical profile, sequelae of COVID, and satisfaction of inpatient care at a government COVID care hospital in Karnataka

Background:

Coronavirus disease 2019 (COVID-19) is caused by SARS-CoV-2 virus has increased the morbidity and mortality across the world. The most common symptoms are fever, dry cough, tiredness, and the least common symptoms are aches and pains, sore throat, diarrhoea, conjunctivitis, headache and loss of taste or smell. In this current pandemic, the number of COVID-19 survivors being discharged from the hospital is increasing day by day and the long-term effect among the survivors is also increasing. Fatigue and dyspnea were the most reported Post COVID symptoms. The presence of these symptoms is also known as “Long COVID”. COVID-19 disease has not only affected the physical health but also the mental health of the patients which also had led to decrease in their quality of life.

Material and Methods:

A retrospective cross-sectional study was conducted among 35 patients who were admitted in District hospital in Mysuru during the month of October 2020. Purposive Sampling was adopted for selecting the patients. Data was collected through telephone after their discharge. Data were entered in Microsoft Excel sheet and analysed using SPSS trial version 23. Descriptive statistics such as percentages and proportions were calculated. To see the association between the variables, Chi-square test, Fischer’s exact test was used. P < 0.05 was taken as statistically significant.

Results:

The mean age of the study participants was 49.1 years. Majority of them had fever (68.6%) followed by Myalgia (65.7%), cough (60%), fatigue (42.9%), headache (37.1%) Majority of the patients had no symptoms after discharge (65.7%). After being discharged from the hospital, 22.9% of patients had difficulty in sleeping, 17.1% had loss of taste/smell and fatigue, 8.6% of them had breathlessness and 5.7% of the patients had a change in voice and loss of appetite.

Conclusion:

With the increasing number of cases across the world, we will most likely face an ongoing wave of COVID-19 sequelae. To Prevent this, an extensive rehabilitation program is necessary for patients during hospitalization and after discharge.

Global Awareness of Myocardial Infarction Symptoms in General Population: a Systematic Review and Meta-Analysis

Seventy percent people are able to recognize chest pain as myocardial infarction (MI) symptoms. There is no difference in awareness of MI symptoms between male and female. There is wide variation in awareness of MI symptoms. The prevalence varies from less than 5% in African countries such as Kenya, Tanzania and in Asian countries such as Nepal to as high as 90% in Germany.

Background and Objectives

Knowledge about myocardial Infarction (MI) symptoms is crucial because inadequate awareness ensures direct association with patient delay and adverse health events subsequently.

Methods

PRISMA guidelines were followed while conducting the systematic review with PROSPERO number CRD42020219802. An electronic search was conducted comprehensively through 5 databases to find those relevant articles systematically. Prevalence was calculated for each typical symptom of MI separately and subgroup analysis according to continent, country, gender and ethnicity was done. Meta-Analysis was conducted by using statistical software R version 3.4.3. A random-effects model was used.

Results

Studies from 35 different countries with 120,988,548 individuals were included in the final analysis. The prevalence of chest pain awareness was highest, while it was lowest for jaw, back, and neck pain. There was no difference in terms of awareness in males and females. Prevalence of awareness of typical MI symptoms was higher in the Caucasian white, white, and non-Hispanic white groups than in other groups. The prevalence varies from less than 5% in African countries such as Kenya, Tanzania and Asian countries such as Nepal to as high as 90% in Germany.

Conclusions

People are well aware of chest pain as a symptom of MI. However, there is limited knowledge regarding other typical symptoms of MI.

The antioxidant role of STAT3 in methylmercury-induced toxicity in mouse hypothalamic neuronal GT1-7 cell line

Oxidative stress, impairment of antioxidant defenses, and disruption of calcium homeostasis are associated with the toxicity of methylmercury (MeHg). Yet, the relative contribution and interdependence of these effects and other molecular mechanisms that mediate MeHg-induced neurotoxicity remain uncertain. The signal transducer and activator of transcription 3 (STAT3) is a transcription factor that regulates the expression of anti-apoptotic and cell cycle progression genes. In addition to its role in cell growth and survival, STAT3 regulates redox homeostasis and prevents oxidative stress by the modulation of nuclear genes that encode for electron transport complexes (ETC) and antioxidant enzymes. Here we tested the hypothesis that STAT3 contributes to the orchestration of the antioxidant defense response against MeHg injury. We show that MeHg (>1 μM) exposure induced STAT3 activation within 1 h and beyond in mouse hypothalamic neuronal GT1-7 cells in a concentration-and time-dependent manner. Pharmacological inhibition of STAT3 phosphorylation exacerbated MeHg-induced reactive oxygen species (ROS) production and antioxidant responses. Finally, treatment with the antioxidant Trolox demonstrated that MeHg-induced STAT3 activation is mediated, at least in part, by MeHg-induced ROS generation. Combined, our results demonstrated a role for the STAT3 signaling pathway as an early response to MeHg-induced oxidative stress.

A Study on Immunisation Coverage among Children in Hosakote, Mysuru

Introduction: Immunisation coverage is a vital strategy adopted by most programs on child survival globally. A robust immunisation coverage program goes a long way in controlling the Vaccine Preventable Disease (VPDs). It is very important to analyse the factors which are detrimental in achieving 100% immunisation among children. Aim: To find the extent of immunisation coverage and to identify the factors for failure of immunisation among children in the rural field practice area of Mysore Medical College & Research Institute, Mysuru. Materials and Methods: A cross-sectional was carried out from November 2019 to January 2020 on children between 0-2 years of age using the World Health Organisation (WHO) thirty clusters sampling method. The sample size was estimated to be 210. Identification of clusters was done as per the WHO manual on 30×7 cluster survey. Interview was conducted using a structured interview format in selected households with study subjects. Data was entered in Microsoft Excel sheet and analysed using chi-square test. Statistical Package for Social Sciences(SPSS) software version 23.0 was used for analysis of data. Results: Among the study participants, 131 (86%) were fully immunised and 29 (14%) were partially immunised (those who did not receive all the due vaccines till two years of age). Religion, educational status of parents and the presence or absence of immunisation card had significant (p-values=0.01, <0.05, <0.05 respectively) association with the immunisation status. The main reasons for partial immunisation were: parents being unaware of the need for returning for subsequent doses 13 (44.8%), fear of side-effects 12 (41.3%), and vaccine not being available 7 (24.1%). Coverage of all individual vaccines among the children (0-2 years) were mostly above 199 (95%). Conclusion: This study observed higher immunisation coverage as compared to that of the national immunisation coverage of 62%. In spite of efforts to increase the immunisation coverage in the country there are regional differences in the extent of this coverage which points to the need for better strategies to tackle this problem.

Free-energy-based framework for early forecasting of stem cell differentiation

Commitment of stem cells to different lineages is inherently stochastic but regulated by a range of environmental bio/chemo/mechanical cues. Here, we develop an integrated stochastic modelling framework for predicting the differentiation of hMSCs in response to a range of environmental cues, including sizes of adhesive islands, stiffness of substrates and treatment with ROCK inhibitors in both growth and mixed media. The statistical framework analyses the fluctuations of cell morphologies over approximately a 24 h period after seeding the cells in the specific environment and uses the cytoskeletal free-energy distribution to forecast the lineage the hMSCs will commit to. The cytoskeletal free energy which succinctly parametrizes the biochemical state of the cell is shown to capture hMSC commitment over a range of environments while simple morphological factors such as cell shape, tractions on their own are unable to correlate with lineages hMSCs adopt.

A Prospective Study of Pulmonary Hypertension in Patients with Chronic Kidney Disease: A New and Pernicious Complication

Pulmonary hypertension (PH) is a recently recognized complication of chronic kidney disease (CKD), especially in end-stage renal disease. It has prevalence estimates of 30%-50% and is an independent predictor of increased mortality in CKD patients. The aim of this study is to analyze the prevalence of PH in patients with CKD, its severity in different stages of CKD, and risk factors for it. One hundred and eight patients with CKD treated at Karnataka Institute of Medical Sciences, Hubli, Karnataka, between January 1, 2014, and June 30, 2015, were selected. Clinical evaluation and relevant investigations including echocardiography were done. Follow-up echocardiography was done at 3 and 6 months and assessed. The mean age of studied population was 43.53 ± 14.63 years. Sex ratio was 2.72:1 (male:female). PH was present in 47 of 108 (43.5%) cases at beginning, 41 of 83 (491.4%) at 3 months, and 32 of 64 (50%) at 6 months. The prevalence and severity of PH increased with progression of CKD stage, although not statistically significant. Heart failure with reduced ejection fraction and heart failure with preserved EF were significantly higher among PH group compared to non-PH group (P < 0.01). Mean hemoglobin in PH group was significantly lower, compared to non-PH group (P < 0.01). Mean interdialytic weight gain and central venous pressure were higher among PH group than non-PH group. Higher calcium phosphate product ≥50 was more prevalent in PH group than in non-PH group. The majority of them had moderate PH at the beginning of the study which remained same, despite being on hemodialysis. PH is a common complication in CKD patients with prevalence of 43.5%-50%. Left-sided heart failure, anemia, fluid retention, and increased calcium phosphate product are the risk factors for developing PH.