Low glycaemic index diets as an intervention for obesity: a systematic review and meta-analysis

OBJECTIVES

Low glycaemic index (GI) diets may aid in weight loss by reducing postprandial blood glucose excursions, leading to more stable blood glucose concentrations and therefore a reduction in hunger. To test this hypothesis, we conducted a systematic review and meta-analysis of randomized controlled trials comparing low GI diets with other diet types.

METHODS

We included 101 studies involving 109 study arms and 8,527 participants. We meta-analysed the studies using a random-effects model and conducted subgroup analyses and meta-regression based on control diet, blood glucose control, baseline BMI and dietary GI.

RESULTS

Low GI diets resulted in small but significant improvements in body weight, BMI, LDL and total cholesterol overall, although no individual control diet was significantly different from low GI diets. Studies in people with normal blood glucose who achieved a difference in GI of 20 points or more resulted in a larger reduction in body weight (SMD = -0.26; 95% CIs [-0.43, -0.09]), and total cholesterol (SMD = -0.24; 95% CIs [-0.42, -0.05]) than studies that only achieved a smaller reduction in GI.

CONCLUSIONS

Low GI diets, especially diets achieving a substantial decrease in GI, were moderately effective in lowering body weight. However, efforts should be made to increase compliance with low GI diets, in order for them to be effective in people with overweight and obesity.

Epilepsy: public knowledge and attitude in a slum area of Karachi, Pakistan

BACKGROUND

Epilepsy is a common but widely misunderstood illness. Consequently, epileptics suffer from considerable stigmatization in society. Since no studies have detailed the misperceptions about epilepsy in our community, it is not possible to provide focused intervention aimed at eliminating this prejudice.

PURPOSE

To assess the knowledge and attitude regarding epilepsy in an adult population of a Karachi slum area.

METHODS

A face-to-face interview was conducted on 487 consenting adult non-epileptics (305 males; 182 females) who were conveniently sampled. Chi-square test was employed to calculate the variability in knowledge and attitude with demographic and other variables.

RESULTS

In all, 12.5% had never heard about epilepsy. Among the rest, 66.7% identified epilepsy as being non-infectious, while 28.2% were unaware of any treatment available for it. Among the other 71.8%, 62.7% were aware of the existence of anti-epileptic drugs. Religious/spiritual treatment was chosen as the most effective treatment by 33.1%. Males were more likely to identify epilepsy as being non-infectious (p=0.02). Nearly 18% of the respondents would not object to their child marrying an epileptic, 69.5% did not want to socially isolate the epileptics, 83.1% said epileptics could receive academic education, 85.6% said they could perform activities of daily life and 62.4% said they could become useful members of the society. Those who considered epilepsy to be infectious were more likely to carry negative attitudes towards epilepsy (p<0.01 with four attitudes).

CONCLUSIONS

Considerable gaps exist in the community's knowledge about epilepsy. Some of these may explain the prevalence of negative attitudes towards this ailment.

Effectiveness of supplemental grasp-force feedback in the presence of vision

Previous studies have shown that supplemental grasp-force feedback can improve control for users of a hand prosthesis or neuroprosthesis under conditions where vision provides little force information. Visual cues of force are widely available in everyday use, however, and may obviate the utility of supplemental force information. The purpose of the present study was to use a video-based hand neuroprosthesis simulator to determine whether grasp-force feedback can improve control in the presence of realistic visual information. Seven able-bodied subjects used the simulator to complete a simple grasp-and-hold task while controlling and viewing pre-recorded, digitised video clips of a neuroprosthesis user's hand squeezing a compliant object. The task was performed with and without supplemental force feedback presented via electrocutaneous stimulation. Subjects had to achieve and maintain the (simulated) grasp force within a target window of variable size (+/- 10-40% of full scale). Force feedback improved the success rate significantly for all target window sizes (8-16%, on average), and improved the success rate at all window sizes for six of the seven subjects. Overall, the improvement was equivalent functionally to a 35% increase in the window size. Feedback also allowed subjects to identify the direction of grasp errors more accurately, on average by 10-15%. In some cases, feedback improved the failure identification rate even if success rates were unchanged. It is thus concluded that supplemental grasp-force feedback can improve grasp control even with access to rich visual information from the hand and object.

Cell-specific expression of estrogen receptor in the human pituitary and its adenomas

Estrogen affects the synthesis and release of several pituitary hormones. The estrogen receptor (ER), a member of the steroid hormone receptor family, is thought to mediate transcriptional effects in a cell-specific fashion. We investigated whether ER is expressed in specific hormone-producing cell types in the human pituitary and its adenomas. Pituitary adenomas (n = 34) were collected at the time of surgery, and normal glands were obtained from autopsy. Expression of ER messenger ribonucleic acid (mRNA) was determined by reverse transcription-polymerase chain reaction (RT-PCR) and in situ hybridization. ER was also localized with immunohistochemistry and protein extraction. By RT-PCR, ER mRNA was found in the nontumorous pituitary and in pituitary adenomas expressing only PRL, in those producing GH and PRL, and in adenomas expressing the gonadotropic hormones. No ER mRNA was detected in adenomas expressing only GH without PRL or gonadotropins, nor in tumors producing ACTH without PRL or gonadotropins. In situ hybridization was not as sensitive or specific as RT-PCR. Biochemical analysis performed on seven tumors that were positive for ER mRNA by RT-PCR detected ER protein in only one PRL adenoma and one oncocytoma and yielded negative or equivocal results in one PRL adenoma, three GH-PRL adenomas, and one null cell adenoma. ER protein was localized by immunohistochemistry in scattered cells of the nontumorous adenohypophysis and in a few PRL and gonadotroph adenomas. We conclude that ER expression, as determined by RT-PCR, correlates with the expression of PRL or gonadotropins; in contrast, ER mRNA was not detected in adenomas that express only GH or ACTH. These findings implicate ER as a cell-specific transcription factor that may regulate cytodifferentiation in the pituitary.

Production of high quality biodiesel from novel non-edible Raphnus raphanistrum L. seed oil using copper modified montmorillonite clay catalyst

This study focused on producing high quality and yield of biodiesel from novel non-edible seed oil of abundantly available wild Raphnus raphanistrum L. using an efficient, recyclable and eco-friendly copper modified montmorillonite (MMT) clay catalyst. The maximum biodiesel yield of 83% was obtained by base catalyzed transesterification process under optimum operating conditions of methanol to oil ratio of 15:1, reaction temperature of 150 °C, reaction time of 5 h and catalyst loading of 3.5%. The synthesized catalyst and biodiesel were characterized for their structural features and chemical compositions using various state-of-the-art techniques, including x-ray diffraction, scanning electron microscopy, energy dispersive x-ray spectroscopy, Fourier transform infrared spectroscopy, nuclear magnetic resonance (¹H, ¹³C) and gas chromatography-mass spectroscopy. The fuel properties of the biodiesel were estimated including kinematic viscosity (4.36 cSt), density (0.8312 kg/L), flash point (72 °C), acid value (0.172 mgKOH/g) and sulphur content (0.0002 wt.%). These properties were compared and found in good agreement with the International Biodiesel Standards of American (ASTM-951, 6751), European Committee (EN-14214) and China GB/T 20828 (2007). The catalyst was re-used in five consecutive transesterification reactions without losing much catalytic efficiency. Overall, non-edible Raphnus raphanistrum L.. seed oil and Cu doped MMT clay catalyst appeared to be highly active, stable, and cheap contenders for future biofuel industry. However, detailed life cycle assessment (LCA) studies of Raphnus raphanistrum L. seed oil biodiesel are highly recommended to assess the technical, ecological, social and economic challenges.

Histologically advanced chronic hepatitis C treated with recombinant alpha-interferon: a randomized placebo-controlled double-blind cross-over study

Chronic hepatitis C is common in Saudi Arabia and most often presents in an advanced stage. To assess the response of patients to interferon, a randomized placebo-controlled double-blind study was undertaken. All but 1 patient had cirrhosis or fibrosis before interferon. After a 24-week observation period patients received alpha 2a interferon, 3 mega units sc tiw or placebo for 24 weeks, then the opposite treatment for another 24 weeks followed by 24 weeks of observation. Liver biopsies were performed before and after each of the treatment phases. Twenty-two out of 24 patients completed the study. The mean alanine aminotransferase (ALT) levels fell from 150.7 +/- 118.7 units/l to 91.0 +/- 42.6 units/l after 6 months interferon treatment (P = 0.03) but only 3 patients (14%) had complete normalization of mean ALT levels and 4 (18%) had > 50% reduction. The mean hepatitis activity index fell from 12.2 +/- 2.6 immediately before to 11.6 +/- 2.5 just after interferon (P = 0.4). After interferon there was an insignificant raise in 6-month mean ALT. Hepatitis C virus-RNA was positive in all 17 patients tested and remained so after treatment. Side-effects were mild and well tolerated. Alpha interferon 3 mega units tiw for 24 weeks is not an effective treatment of histologically advanced chronic hepatitis C.

Significance of beliefs and values in predicting fertility and contraceptive behaviour in Pakistan

A comparative study of 1100 women aged 25-45 years, users and non-users of modern methods of contraception, in the urban centres of Lahore and Faisalabad was conducted in 1991. The objective of the study was to investigate reproductive behaviour and the extent to which social, cultural and attitudinal variables, such as beliefs and values about family life, religiosity and fatalism, influence the fertility decision-making process. Preferences for smaller families were found to be consistently associated with modern attitudes and behaviour towards family and religious values and obligations. Family income, husband's occupation and religiosity offered no explanation of reproductive behaviour. It is concluded that cultural setting and tradition exert an important influence on reproductive behaviour, independent of economic development.

Ultra-sculpturing of seed morphotypes in selected species of genus Salvia L. and their taxonomic significance

The taxonomic importance of macromorphological and micromorphological seed characteristics was investigated using SEM of ten species of the Salvia genus from Pakistan. The aim was to identify diagnostic seed ultrastructural features that could aid in species delimitation, correct identification and phylogenetic position. The ultrastructure of Salvia varies greatly, and a wide range of unique micromorphological features have been observed. Seed micromorphological features were explored by SEM, including seed shape, colour, texture, cell outline, surface sculpturing, epidermal cell arrangement, anticlinal, and periclinal wall pattern. Seed shapes were categorized as obovate, spherical, spheroid, broadly elliptic, elliptic and oblong, mostly with a terminal hilum. Seed colours were black, light brown, dark brown, brown and yellow. Exo-morphological characters, i.e. epidermal cell arrangements, included irregular, wavy pentagonal-hexagonal, regular pentagonal-hexagonal. Cluster analysis was used to assess similar and distinct species within Salvia with a feasible explanation. Taxonomic keys were made based on micromorphological qualitative features that help to delimit species and identify them quickly within the Salvia genus. Seed morphology of ten Salvia species was described and investigated, and the diagnostic significance of features evaluated using SEM. This study analysed seed features, especially at the species level, which might provide much new taxonomic information. The results revealed that, in seed morphology, using SEM can help with taxon identification, especially at the genus and species levels.

Can isolation of Aeromonas hydrophila from human feces have any clinical significance?

A total of 27,480 stool specimens from 15,548 patients with gastroenteritis were analyzed for bacterial enteropathogens during a 4-year period between 1986-89 at a major referral center in Saudi Arabia. Bacterial pathogens were isolated from 1,152 patients, Salmonella being the most frequent, followed by Campylobacter, Shigella, and Aeromonas hydrophila. The latter bacterium was found in 58 patients; seven of them were associated with other enteric pathogens, but A. hydrophila was the only organism in 51 patients. All had gastrointestinal symptoms, the most common being diarrhea (92%), followed by abdominal pain (68%), fever (37%), and vomiting (27%). Stool specimens from 1,368 control patients were negative for A. hydrophila.

Landfill surface runoff and its effect on water quality on river Yamuna

During 2000, the estimated quantity of solid waste generated in Delhi, India was more than 9000 tones per day. This is one of the biggest sources of environmental degradation in capital city of India. Since 1950's over 12 large landfill have been packed with all kinds of nonbiodegradable and toxic waste of Delhi. The area covered is at least 1% (14.83 square kilometer) of total Delhi's area. All the landfill sites except Tilak Nagar, Hastal, and Chattarpur are located very closely (0.5-6 km) to the river Yamuna. It contributes the pollution to river Yamuna in a significant way in a form of surface runoff from landfill site especially in rainy season. The chemical analysis of leachate produced by these landfill sites and corresponding river section (at five river points) has been performed for 16 selected parameter (Temperature, Odor, pH, Turbidity, Conductivity, COD, Total Solids, Sulphide, Chloride, Nitrate, Iron) in the first stage and for 8 parameters (pH, Conductivity, COD, Total Solids, Chloride, Nitrate, Iron) in second stage. The study was conducted between August to October, 2000 (rainy season). It is clear from the study that the river water quality is affected by the presence of landfill surface runoff. Its impact can be seen in the region where the drains are meeting the river. This is one of the causes of river pollution apart from other major municipal and industrial sources.

Idiopathic chronic active hepatitis: a diagnostic and therapeutic dilemma

A 56-year-old Saudi male was admitted with abnormal liver chemistry values and a > 5-month history of lethargy, malaise, anorexia, and jaundice. Extensive investigations did not establish an etiological diagnosis. Liver histology confirmed the clinically apparent aggressive hepatitis with fibrosis but gave no clue to its etiology. The patient was empirically treated with alpha-interferon for presumed non-A, non-B hepatitis, with clinical and biochemical worsening. Interferon was discontinued and the patient was started on immunosuppression. Dramatic clinical and biochemical improvement occurred, with normalization of the liver chemistry within 4 weeks. The patient has been followed-up for 12 months and has not suffered a relapse. This case highlights the etiological heterogeneity of chronic active hepatitis. The entity of autoimmune chronic active hepatitis is unclear, and perhaps it is better defined as steroid-responsive hepatitis. Steroid-responsive hepatitis should always be considered in cases of cryptogenic chronic active hepatitis.

Recurrent meningococcal meningitis associated with deficiencies of C8 and anti-meningococcal antibody

A patient with fatal recurrent meningococcal meningitis is described. Detailed complement and immunological investigation revealed a combined deficiency of C8 and anti-meningococcal antibody. An inability to make anti-meningococcal antibody in C8 deficient patients has not been previously reported.

Primary hepatic vipoma

A 35-yr-old male presented with a 3-yr history of voluminous watery diarrhea. He had episodes of severe generalized weakness which responded to fluid and electrolyte replacement therapy. Investigations revealed a solitary liver mass and an elevated vasoactive intestinal polypeptide level. An extensive work-up did not show any other extrahepatic primary lesion. Surgical resection ameliorated all of his symptoms, accompanied by a decrease in the vasoactive intestinal polypeptide level. We believe that this patient represents a case of primary hepatic vipoma syndrome. To our present knowledge, this has not been reported previously. We discuss the clinical manifestations, investigations, and management of the case.