Characteristics of children and adolescents with newly diagnosed Fibrocalculous pancreatitis diabetes (FCPD) and type 1 diabetes: A study from Eastern India

BACKGROUND AND AIMS

We aimed to identify clinical characteristics and biochemical parameters at presentation in newly diagnosed children and adolescents with Fibrocalculous pancreatic diabetes (FCPD) and compare them with Type 1 Diabetes (T1D) children.

METHODOLOGY

A retrospective chart review yielded 226 patients (below 18 years) who presented and fulfilled diagnostic criteria of diabetes mellitus. Classification of diabetes was based on American Diabetes Association (ADA), World Health Organization (WHO), International Society for Paediatric and Adolescent Diabetes (ISPAD), and Mohan's criteria and all patients underwent abdominal X-ray.

RESULTS

A total of 31 (13.7%) patients fulfilled criteria of FCPD and 63 (27.9%) of autoantibody positive T1D. When comparing FCPD with T1D at presentation, FCPD patients were older, 14.23 years vs 11.32 years. Fewer FCPD patients presented with Diabetic Ketoacidosis (3.2% vs 34.9%), osmotic symptoms (54.8% vs 93.7%) with significantly longer median duration of symptoms (4.0 vs 1.0 months) and had more abdominal pain (58.06% vs 6.3%) & diarrhoea (38.71% vs 1.6%) as compared to patients with T1D". FCPD patients had higher c-peptide levels (median-0.85 vs 0.61) and required higher mean dose of insulin compared to T1D (1.16 U/kg vs 1.01 U/kg). At presentation fasting plasma glucose was significantly higher in T1D than FCPD, but no difference was noted in post prandial glucose and HbA1c.

CONCLUSION

There is a significant difference in clinical characteristics and biochemical parameters at presentation between FCPD and T1D patients with a longer symptom duration but insidious course in the former. To the best of our knowledge, this is the first study to report suitable cut-offs for age, c-peptide, duration of symptoms and insulin dose requirement which could be helpful for differentiating FCPD from T1DM patients.

Humoral antibody kinetics with ChAdOx1-nCOV (Covishield™) and BBV-152 (Covaxin™) vaccine among Indian Healthcare workers: A 6-month longitudinal cross-sectional Coronavirus Vaccine-induced antibody titre (COVAT) study

BACKGROUND AND AIMS

There is limited data available on longitudinal humoral antibody dynamics following two doses of ChAdOx1-nCOV (Covishield™) and BBV-152 (Covaxin™) vaccine against SARS-CoV-2 among Indians.

METHODS

We conducted a 6-month longitudinal study in vaccinated healthcare workers by serially measuring quantitative anti-spike antibody at 3-weeks, 3-months and 6-months after the completion of second dose. Geometric mean titer (GMT) and linear mixed models were used to assess the dynamics of antibody levels at 6 months.

RESULTS

Of the 481 participants, GMT of anti-spike antibody decreased by 56% at 6-months regardless of age, gender, blood group, body-mass index and comorbidities in 360 SARS-CoV-2 naive individuals but significantly more in hypertensives. Participants with past infection had significantly higher GMT at all time points compared to the naive individuals. Among SARS-CoV-2 naive cohorts, a significantly higher GMT was noted amongst the Covishield recipients at all time points, but there was a 44% decline in GMT at 6-month compared to the peak titer period. Decline in GMT was insignificant (8%) in Covaxin recipients at 6-month despite a lower GMT at all time points vs. Covishield. There was 5.6-fold decrease in seropositivity rate at 6-month with both vaccines. Participants with type 2 diabetes mellitus have a lower seropositivity rate at all the time points. Seropositivity rate was significantly higher with Covishield vs. Covaxin at all time points except at 6-month where Covaxin recipients had a higher seropositivity rate but no difference noted in propensity-matched analysis.

CONCLUSIONS

There is waning humoral antibody response following two doses of either vaccine at six months. Covishield recipients had a higher anti-spike antibody GMT compared with Covaxin at all-time points, however a significant decline in antibody titers was seen with Covishield but not with Covaxin at 6-months.

Assessing prevalence and predictors of depression in Type 2 Diabetes Mellitus (DM) patients - The DEPDIAB study

OBJECTIVES

Depression is common in diabetes and has significant impact on health outcomes. Suicidal ideation also forms a part of the spectrum of diabetes and coexistent depression. To assess the predictors of depression as well as its prevalence in Type 2 Diabetes Mellitus (T2DM) patients, we conducted a cross sectional study entitled "DEPression in DIABetes" (DEPDIAB).

MATERIAL AND METHODS

A cohort of consecutive 1371 T2DM patients from Eastern India suffering from diabetes greater than 1 year was assessed in a cross- sectional survey in 9 different hospitals and medical polyclinics in Kolkata, India for depression by administering the 9-item PHQ - 9 and Beck depression scales. Socioeconomic status was assessed by the "Revised Kuppuswamy and B G Prasad socio-economic scales for 2016", a validated scoring system for assessing the socioeconomic status of Indian patients.

RESULTS

In our study 836 patients (60.9%) were male and 535 (39.02%) were female. 56 patients (4.1%) met the criteria for major depression and 494 patients (36.16%) for minor depression. No sign of depression was found in 816 patients (59.74%). Depression was strongly associated with younger age (18-40 years vs. >60 years) [OR-2.09; 95% CI 1.11-3.96], female sex [OR-1.31; 95% CI 1.11-2.01], low socioeconomic status [OR-2.69; 95% CI 1.34-3.79], poor compliance [OR- 5.05; 95% CI 2.79-8.13], hypoglycemia [OR 1.466; 95% CI 1.076-1.999] and difficulty in managing day-to-day activities [OR- 4.648; 95% CI 3.450-6.262] Suicidal ideation was detected in 201 patients (14.8%). Among patients who had repeated attacks of hypoglycemia (>1 episode per month), 22% experienced suicidal ideation. This was significantly higher than in patients who had not suffered from hypoglycemia (12%) (p < 0.0001). Patients with HbA1C of 7% or lower experienced statistically significantly lesser suicidal ideation than patients with a higher HbA1C (12% vs. 16.8% {p = 0.016}). Suicidal ideation did not correlate withbody mass index (BMI), fasting plasma glucose (FPG) or insulin usage.

CONCLUSIONS

We found a high prevalence of depression in T2DM patients in Eastern India. Younger age, female sex, lower socio-economic status, poor compliance, hypoglycemia, and difficulty in managing day to day activities emerged as significant predictors of depression in this study. Recurrent episodes of hypoglycemia were an independent risk factor for suicidal ideation in patients with depression. Depression was not significantly associated with co morbidities associated with T2D and surprisingly insulin usage was not associated with increased depression.

Low reflectance of carbon nanotube and nanoscroll-based thin film coatings: a case study

Research on carbon material-based thin films with low light reflectance has received significant attention for the development of high absorber coatings for stray light control applications. Herein, we report a method for the successful fabrication of stable thin films comprised of carbon nanotubes (CNTs) and nanoscrolls (CNS) on an aluminium (Al) substrate, which exhibited low reflectance of the order of 2-3% in the visible and near-infrared (NIR) spectral bands. Changes in the structural and chemical composition of pristine single-walled carbon nanotube (SWCNT) samples were analyzed after each processing step. Spectroscopy, microscopy and microstructural studies demonstrated emergence of CNS and multi-walled carbon nanotubes (MWCNTs) due to the sequential chemical processing of the sample. Transmission electron microscopy (TEM) and scanning electron microscopy (SEM) studies revealed the formation of CNS via curling and folding of graphene sheets. Microstructural investigations including SEM and atomic force microscopy (AFM) confirmed the presence of microcavities and pores on the surface of the film. These cavities and pores significantly contribute to the observed low reflectance value of CNTs, CNS compound films by trapping the incident light. Fundamental space environmental simulation tests (SEST) were performed on the coated films, that showed promising results with reflectance values almost unaltered in the visible and NIR spectral bands, demonstrating the durability of these films as potential candidates to be used in extreme space environmental conditions. This study describes the preparation, characterization, and testing of blended CNT and CNS coatings for low-light scattering applications.

Exploring Cross-Sectional Predictors of Suicide Ideation, Attempt, and Risk in Gender Incongruent Adults in India

INTRODUCTION

Suicide rates and suicidal tendencies among gender incongruent persons are higher compared to the general population. Yet little is known about the factors that are relevant for suicide-related outcomes among Indian gender incongruent individuals.

MATERIALS AND METHODS

Within a large sample of gender incongruent adults (n=120), we examined the contribution of demographic (age, assigned sex, gender identity, relationship, and addiction status) and socio-economic variables (education, profession, income, social support) in the prediction of three suicide-related outcomes: past-year suicidal thought, history of suicidal attempt and a composite measure of the two.

RESULTS

Of the entire sample, 25.8% (n=31) reported a past suicide attempt, with 18.3% (n = 22) reporting one attempt, 2.5% (n = 3) reporting two attempts, 1.7% (n = 2) reporting three attempts and 2.5% (n=3) reporting four to six attempts. The age at which the first suicide attempt occurs is mostly between 16 to 18 years. 19.26% (n = 21) reported that although they had not attempted suicide, they had given serious thought to killing themselves in the last year. A Chi-square test was conducted to ascertain each demographic variable and socio-economic marker. However, none of these proposed predictors correlated with suicide-related outcomes in our cohort.

CONCLUSIONS

The gender incongruent community is highly susceptible to suicidal behavior. Gender identity may be the risk factor for that behavior. Further study with larger population needs to identify other relevant risk factors, including gender-related victimization and mental health conditions as risk factors.

Periodontal Disease in Type 1 Diabetes Mellitus: Influence of Pubertal Stage and Glycemic Control

OBJECTIVE

Though gingivitis is common in children with type 1 diabetes mellitus (T1DM), the overall periodontal health in T1DM during the pubertal stage is less well-characterized. The study was undertaken to explore the possible influence of puberty and metabolic derangement on periodontal health in T1DM.

METHODS

In this cross-sectional study, 110 subjects between 10-18 years with T1DM and 52 healthy siblings of similar age were evaluated for pubertal stage, glycosylated hemoglobin (HbA1c), and periodontal health. Simplified oral hygiene index (OHIS), gingival index (GI), plaque index (PI), bleeding on probing (BOP), and probing depth (PPD) were evaluated at 4 sites per tooth as per 6 Ramfjord index teeth used to assess periodontal disease (PD).

RESULTS

PD not merely gingivitis was significantly higher in T1DM (84/110, 76.36%) than the control group (28/52, 53.8%) (P = .004). Irrespective of pubertal status, children with T1DM had worse GI, PI, BOP, and PPD than nondiabetic subjects, although OHIS was better in diabetes. In both T1DM and nondiabetic subjects, pubertal subjects showed significantly worse OHIS, PPD, BOP, and GI than prepubertal subjects. PD was correlated with pubertal stage, age, and HbA1c, although less strongly with the duration of diabetes. In logistic regression, pubertal stage was a stronger predictor of PD (OR = 14.26) than age (OR = 2.22), and HbA1c (OR = 1.5) rather than the presence of diabetes and its duration.

CONCLUSIONS

Though pubertal status, age, and poor glycemic control rather than the presence of diabetes and its duration are associated with gingivitis and other forms of PD, puberty had a more profound effect in the pathogenesis of PD in T1DM.

High Thyroid-stimulating Hormone Level in Down's Syndrome: A Mere Resetting of Hypothalamopituitary Axis in Subclinical Hypothyroidism?

OBJECTIVE

Hyperthyrotropinemia (HT) or reduced thyroid function in Down syndrome (DS) is not uncommon, causes range from glandular dysgenesis to altered hypothalamopituitary axis. In the present study, we have compared hypothyroid Indian children with and without DS (NDS), especially focusing on family history, goiter, and biochemical features.

METHODS

We conducted this retrospective observational study from previous medical records of children with DS (1-17 years) having an elevated TSH (≥5 mIU/L) who were consecutively referred for with HT to Endocrinology OPD of a tertiary care hospital in India. Records from hypothyroid children (1-17 years) without Down Syndrome (NDS) were evaluated as controls. Free thyroxine (FT4), anti-thyroid peroxidase (TPO) antibody were measured and congenital hypothyroidism was excluded in all subjects.

RESULTS

Thirty-four DS cases [median age 8 years (IQR: 2-14), M: F = 13:21] and 34 controls [median age 10.5 years (IQR: 7-13.25), M: F = 13:21] were comparable in terms of age and sex, Median age of presentation was significantly earlier in case of DS vs NDS [7 years vs. 10 years]. DS children had significantly less family history of thyroid disorders compared to NDS [14.7% vs 64.7%]. Goiter was significantly less common in patients with DS [DS - 32.25% vs. NDS - 73.5%, P = 0.001]. Anti-TPO antibody positivity was significantly less common in patients with DS [DS- 41% vs. NDS- 73.5%, P = 0.014].

CONCLUSION

There is a significant difference in presentation in hypothyroid children with DS compared to NDS. DS children with hypothyroidism compared to NDS, had earlier presentation, lower incidence of traceable family history, goiter, and anti-TPO-antibody positivity.

Trimester-Specific Reference Intervals for Thyroid Function Parameters in Indian Pregnant Women during Final Phase of Transition to Iodine Sufficiency

BACKGROUND

Interpretation of thyroid function tests during pregnancy depends on gestational age, method, and population-specific reference intervals. Therefore, there is a worldwide trend to establish trimester-specific levels for different populations. The aim of this study was to establish a trimester-specific reference range for thyroid function parameters during pregnancy in Indian women.

MATERIALS AND METHODS

Thyroid function tests (TSH, FT4, TT4, TT3) of 80, 76, and 73 women at 1^st, 2^nd, and 3^rd trimester, respectively, and 168 nonpregnant women were analyzed after exclusion of low UIC(<150 μg/L) and anti-TPO positivity(>35 IU/ml). Urinary iodine excretion (UIC) was assessed in all. The 2.5^th and 97.5^th percentile values were used to determine the reference ranges for thyrotropin (TSH), free thyroxine (FT4), total thyroxine (TT4), and total triiodothyronine (TT3) for each trimester of pregnancy.

RESULTS

The reference range for TSH for first trimester was 0.19-4.34 μIU/ml, for second trimester 0.46-4.57 μIU/ml, and for third trimester 0.61-4.62 μIU/ml. The reference range during three trimesters for FT4 (ng/dl) was 0.88-1.32, 0.89-1.60, and 0.87-1.54, for total T4 (μg/dl) was 5.9-12.9, 7.4-15.2, and 7.9-14.9. In nonpregnant women, FT4 was 0.83-1.34, total T4 was 5.3-11.8, and TSH was 0.79-4.29. The mean UIC in nonpregnant women was 176 ± 15.7 μg/L suggesting iodine-sufficiency in the cohort.

CONCLUSION

The trimester-specific TSH range in pregnant women in this study is not significantly different from nonpregnant reference range in the final phase of transition to iodine sufficiency in India.

Levothyroxine Absorption Test to Differentiate Pseudomalabsorption from True Malabsorption

BACKGROUND

The levothyroxine absorption test for evaluation of pseudomalabsorption in patients with primary hypothyroid is not standardised. An individual in whom a workup for malabsorption is warranted remains undefined.

METHODS

Twenty-five euthyroid, 25 newly diagnosed hypothyroid, 25 treated hypothyroid with normalised TSH, and 25 hypothyroid subjects with elevated TSH despite adequate dose of levothyroxine for more than 6 months, and 10 euthyroid subjects with true malabsorption were administered levothyroxine (10 μg/kg or maximum 600 μg) to study its absorption profile by measuring free T4 level at hourly intervals for 5 h. Results : Free T4 peaked at 3 h with marginal insignificant decline at 4 h in all groups. The increments of free T4 (between baseline and 3 h) of the four groups (except malabsorption) were not statistically different. The mean increment of free T4 in true malabsorption was 0.39 ng/dL (95% CI: 0.29-0.52) and it was 0.78 ng/dL (95% CI: 0.73-0.85) (10.4 pmol/L) for other groups combined together. The cut off of free T4 increment at 3 h from baseline above 0.40 ng/dL had a sensitivity of 97% and specificity of 80% (AUC 0.904, p < 0.001) to exclude true malabsorption.

CONCLUSION

Subjects with elevated TSH on adequate dose of LT4 can be reliably diagnosed to be non-adherent to treatment with levothyroxine absorption test. The incremental value above 0.40 ng/dL (5.14 pmol/L) at 3 h may be useful to identify individuals where workup of malabsorption is unwarranted.

An observational prospective study to evaluate the outcomes of new onset diabetes after renal transplantation (NODAT) in a tertiary care centre in eastern India

AIM

To analyse post-transplant outcomes of NODAT patients in comparison to the regular cohort (non-NODAT).

OBJECTIVES

To compare graft survival and rejection rate, patient survival rate, incidence of hospitalization (due to any cause) in between NODAT and non-NODAT groups in cases of renal transplantation.

METHODS

A single-centred prospective real-world observational study of 100 subjects who underwent renal transplantation over a period of two years. All NODAT cases evaluated for graft survival/rejection, incidence of hospitalisation/infection, mortality from all causes and compared with that of non-NODAT post-transplant recipients. Nominal categorical data between the groups are compared using Chi-square test or Fisher's exact test as appropriate. p value < 0.05 was taken to indicate a significant difference.

RESULTS

Mean number of hospital admissions of subjects was 1.38 ± 1.38 and 0.29 ± 0.56 in NODAT and Non-NODAT respectively, p < 0.0001. Nineteen out of 24 NODAT subjects and 72 out of 76 Non-NODAT subjects had graft survival, p = 0.0342. Twenty out of 24 NODAT and 74 out of 76 Non-NODAT subjects had survived, p = 0.0282.

CONCLUSIONS

NODAT leads to adverse outcomes viz. increased rate of hospitalization, reduced rates of allograft survival and patient survival.

A Cross-sectional Retrospective Analysis of Glycemic Burden and Nephropathy in an Indian Population and Formulation of a New Plan Using eGFR/HbA1c Grid Formation

Background Diabetes is a metabolic, non-communicable disease (NCD) that represents one of the major causes of morbidity and mortality worldwide. India has a huge burden of chronic kidney disease (CKD) that is associated with diabetes. Materials and methods Cross-sectional data were collected for a total of 241 patients from the authors' clinic record. A new approach for the management of patients with diabetes was proposed using a grid system, where we need to consider the Hemoglobin A1C (HbA1c) and estimated glomerular filtration rate (eGFR) values of the patient and assign a zone (green, blue, orange or red) and subsequently decide an appropriate treatment according to the assigned zone. Results We found that 20.73% of patients had decreased eGFR and only 31.12% of patients achieved target HbA1c level. A high prevalence of diabetic nephropathy (20.73%) was observed in this study population. A statistically significant difference among the four groups (zones) with respect to age (p <0.001), duration of diabetes (p = 0.024), HbA1c (p <0.001), and eGFR (p <0.001) was found. Conclusion The burden of diabetes and nephropathy is high in low-income countries and can be easily assessed by applying simple tools such as the newly proposed HbA1c/eGFR grid system to identify high-risk and medium-risk patients and adopting treatment according to the assigned zone.

Inverse Relationship Between 25 Hydroxy Vitamin D and Parathormone: Are there Two Inflection Points?

CONTEXT

There is no consensus about the inflection point for 25 hydroxy vitamin D below which the intact PTH level increases.

OBJECTIVE

Determine the relationship/inflection point between 25 hydroxy vitamin D and parathormone levels.

MATERIALS AND METHODS

We performed a population-based analysis on a nonobese cohort (n = 405).

RESULTS

Prevalence of vitamin D deficiency was 58.76% (n = 228). Vitamin D insufficiency was found in 34.56% (n = 140). An inverse relationship between 25 hydroxy vitamin D (25(OH)D) and intact PTH exist, but strength of such relationship is weak (r = -0.16, P = 0.018). With respect to the 25(OH)D cut-off of 16 ng/mL by IOM (EAR linked), proportion of persons with high intact PTH was higher in the group with lower 25(OH)D compared with higher 25(OH)D group (P = 0.005) and it was similar for RDA linked cut-off of 20 ng/mL also (P = 0.017). LOWESS method revealed two inflection points at which PTH levels change. A less conspicuous inflection point was found at 32 ng/mL (95% CI, 27-36), which reasonably corroborates with the current cutoff of definition of vitamin D sufficiency, and the second, steeper inflection point was found at 16.5 ng/ml (95% CI, 14.9-18.8) which corroborates with the IOM supported EAR linked value of 25(OH)D level in general population and possible definition of vitamin D deficiency.

CONCLUSIONS

There are possibly two inflection points at which PTH levels change in relation to 25(OH)D levels.

Liraglutide - Indian Experience

Liraglutide is an effective drug for the treatment of type 2 diabetes mellitus (T2DM). The aim of this review is to collate evidence on the real-world clinical effectiveness of liraglutide from the published Indian studies. A review of publications was conducted to identify observational studies that assessed the effectiveness of liraglutide among Indian T2DM. Total ten publications were retrieved and these observational studies are compared with the results of the liraglutide randomized controlled trial (RCT) program (Liraglutide Effect and Action in Diabetes [LEAD]). Liraglutide therapy demonstrated HbA1c reduction in the Indian population up to 2.26% and 2.54%, over 24 and 52 weeks, respectively. Among the LEAD trials, the HbA1c reduction at 24 weeks was maximum in LEAD-4 with 1.5% reduction at both doses used (1.2 and 1.8 mg) and up to 1.14% in LEAD-3 with a dose of 1.8 mg. The weight loss among Indian subjects was generally around 5 kg or more with maximum weight loss of 8.6 kg over 24 weeks. The maximal weight loss in LEAD studies was less than 3 kg with an exception of 3.24 kg in LEAD-6. In over 52 weeks of liraglutide therapy among Indian subjects, mean weight loss was 7.4 kg, which was 3.5 times more than of LEAD program. Two Indian observational studies also demonstrated significant weight loss among nondiabetic obese subjects at a much lower than that of 3 mg anti-obesity dose. Gastrointestinal (GI) events are the commonly reported adverse events with Indian studies as well as LEAD program. Liraglutide therapy produces better glycemic control and more weight loss among Indian T2DM subjects compared with RCTs conducted in western population with almost similar adverse consequences.

An observational Prospective Study to Evaluate the Preoperative Risk Factors of New-onset Diabetes Mellitus after Renal Transplantation in a Tertiary Care Centre in Eastern India

OBJECTIVES

This study aimed to determine the pre-transplant risk factors as independent predictors on the new-onset of diabetes mellitus after renal transplants (NODATs).

MATERIALS AND METHODS

A single-centred prospective real-world observational study of 100 subjects who underwent renal transplantation over a period of 2 years. All known patients with diabetes were excluded from the study. NODAT was defined according to the American Diabetes Association definition. In addition to pre-transplant workup 2 days prior to transplant, post-transplant follow-up done on weekly basis for 1^st month, every 15^th day from 1^st month to 3^rd month, monthly from 3^rd month to 12^th month. Each transplant patient followed up for 1 year post-transplant or for 6 months post-development of NODAT, whichever was later. All the pre-transplant variables namely body mass index (BMI), family history of diabetes mellitus (DM), HbA1c, fasting insulin level, fasting c-peptide level, serology for hepatitis B, C, serum magnesium level and pre-operative insulin ressistance were further compared between NODAT and non-NODAT groups at the end of the study to assess their strength of associations.

RESULTS

Among the 100 subjects included in the study, 24 developed NODAT. Risk factors namely age, family history of DM, BMI, hepatitis B and C infection, total cholesterol, triglyceride level, pre-operative HbA1c, pre-operative insulin resistance and pre-diabetes were significantly higher, whereas beta-cell function, ABO compatibility and magnesium levels being significantly lower in NODAT cohort.

CONCLUSION

The incidence of NODAT is quite high (24%). Risk of development of NODAT was related to traditional as well as novel risk factors. Key aspects lies in identifying patients at risk of developing NODAT, using traditional risk factors for early diagnosis and introducing interventions on modifiable risk factors for prevention and timely intervention.

Structural stability of coplanar 1T-2H superlattice MoS2 under high energy electron beam

Coplanar heterojunctions composed of van der Waals layered materials with different structural polymorphs have drawn immense interest recently due to low contact resistance and high carrier injection rate owing to low Schottky barrier height. Present research has largely focused on efficient exfoliation of these layered materials and their restacking to achieve better performances. We present here a microwave assisted easy, fast and efficient route to induce high concentration of metallic 1T phase in the original 2H matrix of exfoliated MoS₂ layers and thus facilitating the formation of a 1T-2H coplanar superlattice phase. High resolution transmission electron microscopy (HRTEM) investigations reveal formation of highly crystalline 1T-2H hybridized structure with sharp interface and disclose the evidence of surface ripplocations within the same exfoliated layer of MoS₂. In this work, the structural stability of 1T-2H superlattice phase during HRTEM measurements under an electron beam of energy 300 keV is reported. This structural stability could be either associated to the change in electronic configuration due to induction of the restacked hybridized phase with 1T- and 2H-regions or to the formation of the surface ripplocations. Surface ripplocations can act as an additional source of scattering centers to the electron beam and also it is possible that a pulse train of propagating ripplocations can sweep out the defects via interaction from specific areas of MoS₂ sheets.

Lean Metabolic Syndrome: A Concept or a Reality?

AIMS AND OBJECTIVES

Metabolic syndrome (MetS) is fairly common in India. International Diabetes Federation (IDF) has defined it as the presence of central obesity with region/ethnicity-specific waist circumference as a mandatory defining criterion along with the presence of two other features from dysglycemia, systolic and/or diastolic hypertension, hypertriglyceridemia, and low high-density lipoprotein. Although obesity is not prevalent in rural parts of India, especially among the underprivileged population, other individual components of the syndrome are not infrequent among these lean/nonobese persons. In this study, we evaluated the prevalence of MetS in rural West Bengal. We also examined that if those persons above the recommended cutoff for waist are excluded, and thus only lean/nonobese persons are included, and the same definition of MetS (herein termed as lean MetS) is applied (three out of four criteria), what will be the prevalence of MetS and will it be lower in the nontribal population compared to the tribal population?

MATERIALS AND METHODS

A population-based study was done in the rural area of West Bengal comprising 205 [corrected] peoples from scheduled tribe (ST) population and 200 [corrected] people from the neighborhood community from non-ST population to compare the metabolic health with respect to anthropologic and biochemical parameters.

RESULTS

The prevalence of MetS from rural areas of West Bengal was found to be 21.48% as per IDF criterion, but applying NCEP ATP III criteria, the overall prevalence of MetS rose to 31.1%. The prevalence of normal waist/lean MetS was 12.8%, and there was no significant difference between nontribals versus tribal cohort (14.6% of the nontribes versus 11.6% of the tribal cohort, P = 0.436).

CONCLUSION

A significant number of persons with nonobese/lean MetS exist in the rural area. We suggest that if region-specific waist criteria are not satisfied, the diagnosis should still be sorted by NCEP ATP III criteria.

Microbial profile of the vitreous aspirates in culture proven exogenous endophthalmitis: A 10-year retrospective study

PURPOSE

To describe the microbiological profile and clinical outcome in the eyes with culture-proven exogenous endophthalmitis.

METHODS

A retrospective analysis of 495 eyes diagnosed as exogenous endophthalmitis was performed over a period of 10 years. In all, aseptically collected aqueous and vitreous aspirates were cultured for bacteria and fungus using standard microbiological techniques. Gram-stain and KOH preparation of the specimens were also performed. The antibiotic susceptibility testing for bacterial isolates was performed by Kirby-Bauer disk diffusion method. The treatment was modified according to the antibiotic sensitivity profile. The final clinical ocular condition was divided into improved, stable or deteriorated.

RESULTS

Of 148 culture-proven endophthalmitis eyes, 137 (92.57%) were referred from elsewhere, and 11 (7.43%) belonged to our institute. Aetiologically, 76 (51.35%) eyes were post-cataract surgery, 61 (41.22%) were post-traumatic, 5 (3.38%) eyes post-intravitreal anti-vascular endothelial growth factor injection, 5 associated with corneal diseases and 1 bleb-related endophthalmitis. In 31 (20.95%) eyes, primary intravitreal antibiotics were given outside. The cultures revealed monomicrobial growth in 92.57% (n = 137) and polymicrobial growth in 7.43% (n = 11). Among the bacteria (n = 121, 81.76%), Pseudomonas species dominated overall (n = 32, 27.11%) and post-operative (n = 26, 38.23%) endophthalmitis group. Staphylococcus epidermidis (n = 14, 28%) was prominent in post-traumatic endophthalmitis group. Ninety-two percent (n = 108 isolates) of bacteria were sensitive to vancomycin. In 78 (52.7%) eyes, the clinical ocular condition improved or remained stable while deteriorated in 51 (34.46%).

CONCLUSION

A bacterial predominance was observed among causative organisms of exogenous endophthalmitis with Pseudomonas species being the most common. The appropriate surgical intervention improved or stabilised the visual acuity in nearly 50% eyes.

Gastrointestinal nematode larvae in the grazing land of cattle in Guwahati, Assam

Aim:

To know the prevalence of gastrointestinal nematode larvae (L₃) in the grazing land of cattle in Guwahati, Kamrup district, Assam.

Materials and Methods:

Pastures were collected and examined for the presence of nematode larvae (L₃) from six localities of Guwahati at monthly interval from August 2012 to July 2013. The counted larvae were then expressed as per kg dry matter of herbage (L₃/kg DM).

Results:

Examination of pastures revealed presence of nematode larvae (L₃) in pastures throughout the year which varied from 4.5 L₃/kg DM in January to a maximum of 106.33 L₃/kg DM in August. The L₃ of Haemonchus contortus, Trichostrongylus spp., Oesophagostomum spp., Cooperia spp., and Mecistocirrus spp. were recovered from pastures. The average pasture larval burden (PLB) was 34.75±3.48 L₃/kg DM. Season-wise PLB revealed the presence of 23.89±3.01, 67.54±5.41, 26.67±1.92, and 7.28±0.89 L₃/kg DM during pre-monsoon, monsoon, post-monsoon, and winter seasons, respectively. Monsoon season has significant (p<0.05) effect on PLB. However, analysis of variance of different locations with respect to season revealed that there was no significant difference but season-wise it was highly significant (p<0.01). Pearson correlation of environmental variables (temperature, relative humidity, and rainfall) with PLB revealed correlation was statistically significant with rainfall (p<0.05).

Conclusion:

This study reveals the presence of five nematode larvae (L₃) in the pastures of Guwahati, Assam throughout the year, statistically significant during monsoon season.

Larvicidal activity of few select indigenous plants of North East India against disease vector mosquitoes (Diptera: Culicidae)

Mosquitoes are the vectors of several life threatening diseases like dengue, malaria, Japanese encephalitis and lymphatic filariasis, which are widely present in the north-eastern states of India. Investigations on five local plants of north-east India, selected on the basis of their use by indigenous communities as fish poison, were carried out to study their mosquito larvicidal potential against Anopheles stephensi (malaria vector), Stegomyia aegypti (dengue vector) and Culex quinquefasciatus (lymphatic filariasis vector) mosquitoes. Crude Petroleum ether extracts of the roots of three plants viz. Derris elliptica, Linostoma decandrum and Croton tiglium were found to have remarkable larvicidal activity; D. elliptica extract was the most effective and with LC50 value of 0.307 μg/ml its activity was superior to propoxur, the standard synthetic larvicide. Half-life of larvicidal activity of D. elliptica and L. decandrum extracts ranged from 2-4 days.

Human consumption of rumen flukes of cattle in India

The practice of eating rumen flukes of cattle by a section of people living in Meghalaya, a north eastern State of India, is reported in this communication. Economically backward, some rural people belonging to Khasi, Jaintia, Garo, and Karbi tribes of Christian and Nepali communities who eat beef are accustomed to consuming cooked flukes during breakfast, meals, and also along with rice beer or alcohol. Inspection of the rumens of cattle during slaughter indicated a prevalence of flukes belonging to Cotylophoron, Paramphistomum, Calicophoron, Gastrothylax, and Fischoederius genera in 74% cases, and their collection from rumen ranged approximately from 50 g to 600 g. Biochemical analysis of flukes found 12.60% total protein, 0.78% fat, and 0.87% ash on fresh weight basis. High prevalence of flukes, easy visualization in rumen, their bulk collection, presence of nutritive value, absence of any ill effect, and lack of imminent danger of transmissibility are believed to be the rationales influencing their consumption by people. It is suggested that dietary benefits obtained from flukes might contribute to the energy transfer and inclusion in the food web.

Spatial distribution and r-DNA second internal transcribed spacer characterization of Anopheles dirus (Diptera: Culicidae) complex species in north-east India

The identity and distribution of the prevalent member species of the Anopheles dirus complex mosquitoes in the north-eastern region of India was investigated in a cross-sectional study. We altogether collected 267 individuals of An. dirus s.l. from 27 forested/forest fringed locations spread across the seven north-eastern states, identified the species using a ribosomal DNA (r-DNA) second internal transcribed spacer (ITS2) based allele specific polymerase chain reaction (ASPCR) method and sequenced the ITS2 locus in a sub set of mosquitoes. An. baimaii was identified as the main, almost exclusive (266/267), species of the Dirus complex throughout the north-east India with no intraspecific variation in the 479 base pair long ITS2 sequences in 59 of the 60 individuals sequenced. Ribosomal DNA of one individual from Assam state did not amplify in the ASPCR, possessed 786 base pair long ITS2 sequence and showed 99.7% similarity with the sequence of An. dirus species D (An. baimaii) from Yunnan province of China, later referred to as species X of the Dirus complex. These observations suggest the presence of another, possibly the new, species of the Dirus complex, sympatric with An. baimaii, in Assam warranting investigations on its distribution, biology and role in human malaria transmission in north-east India.

Evaluation of PermaNet 2.0 mosquito bednets against mosquitoes, including Anopheles minimus s.l., in India

Wash resistance and field bioefficacy of PermaNet 2.0 nets, long lasting insecticidal nets, against mosquitoes were evaluated in Assam, northeastern India. After repeated hand washings at 12-day intervals a decline in the mosquito killing ability of PermaNet nets was noted (trend chi2 38.9, p < 0.0001), yet these nets retained good insecticidal efficacy for up to 15 wash cycles, producing a 72.5% mean mortality of An. minimus 24 hours after a 3-minute exposure in World Health Organization cones after 15 washings. Significantly fewer (p < 0.001) mosquitoes were captured in self-baited landing collections in houses equipped with PermaNet nets than in houses using untreated nets in the case of culicines (p < 0.001) but not with anophelines, including An. minimus. The use of PermaNet nets resulted in noticeably fewer bites from Culex pseudovishnui (68.5%) and Cx. quinquefasciatus (70%). Blood-feeding inhibition of mosquitoes in deliberately torn PermaNet nets was seen, indicating a protective effect for those sleeping under these nets. No serious adverse effects of the PermaNet nets were reported by users.

Probing atomic migration in nanostructured multilayers: application of X-ray standing wave fields

X-ray standing wave fields, excited in periodic nanostructured multilayers during Bragg diffraction, have been used to probe atomic migration in multilayers. Ion beam induced migration of Fe impurity atoms from the C layers to the Pt layers in a Pt(Fe)/C(Fe) multilayer, where each layer is about 2 nm thick, has been detected. With a depth resolution better than 0.2 nm of this technique, the direction of Fe migration (here outward) and the change of Fe concentration in C (also Pt) layers have been determined. The results of such measurements are important for understanding the properties of multilayers, for example, the evolution of ferromagnetism in the present example [Dev, Microelectron. Eng. 83, 1721 (2006)10.1016/j.mee.2006.01.230].

Capsulorhexis in intumescent cataract

This technique of anterior capsulorhexis is for use in eyes with high intralenticular pressure and absence of red reflex as encountered in intumescent cataract. The initial steps of fashioning the anterior capsular flap and lens decompression are done under the microscope's high magnification and noncoaxial oblique illumination. Intralenticular pressure is controlled by filling the anterior chamber with a viscoelastic agent. Once the lens is decompressed, the capsulorhexis is completed with a capsule forceps and an endoilluminator is used as an oblique source of illumination. This technique allows controlled capsulorhexis in eyes with intumescent cataract.