Impact of Knowledge, Attitude and Practice on the Management of Type 2 Diabetes Mellitus in Developing Countries: A Review

BACKGROUND

Diabetes is a major metabolic aggressive disease that has exponentially increased around the globe, including both developed and developing countries. The significant change in the lifestyle of people, attributed to the fast-paced living style and dietary conditions, are a few of the core reasons behind the disease. Multiple studies conducted in various developing countries conclude that patient education, along with adhered practices and attitudinal outlook, can significantly help in deterring the ill effects of diabetes mellitus.

OBJECTIVE

The review aimed at understanding the impact of KAP on the management of diabetes mellitus in emerging economies.

METHODS

Multi-central analytical cross-sectional and prospective studies were conducted for research in multiple countries with median per capita income of ~$4,000 (developing countries - Ethiopia, Bangladesh, Iraq, Iran, Nigeria, etc.), wherein significant difference was witnessed in the outlook of patients and related stakeholders, who had a decent score of KAP relative to ones with lower scores, towards type 2 diabetes mellitus.

RESULTS

Among all the three variables that are capable of managing diabetes - knowledge, attitude and practice (KAP) - knowledge attained a high degree of importance as it served as the initial step to control DM. In developing countries, the ratio of people with knowledge - relating to disease - is significantly dependent on age, socio-economic status and education. As per the previous studies and their corresponding results, educational awareness is of utmost importance in order to eradicate myths and wrong information around the same.

CONCLUSION

The review concludes the importance of patient counseling to modify their KAP towards the disease will be highly effective in countries like India, where the count of diabetes mellitus patients is increasing aggressively. Investment in patient counselling to improve their KAP score will significantly help in palliating the effect of this disease.

Tannase Production by Penicillium Atramentosum KM under SSF and its Applications in Wine Clarification and Tea Cream Solubilization

Tannin acyl hydrolase commonly known as tannase is an industrially important enzyme having a wide range of applications, so there is always a scope for novel tannase with better characteristics. A newly isolated tannase-yielding fungal strain identified as Penicillium atramentosum KM was used for tannase production under solid-state fermentation (SSF) using different agro residues like amla (Phyllanthus emblica), ber (Zyzyphus mauritiana), jamun (Syzygium cumini), Jamoa (Eugenia cuspidate) and keekar (Acacia nilotica) leaves. Among these substrates, maximal extracellular tannase production i.e. 170.75 U/gds and 165.56 U/gds was obtained with jamun and keekar leaves respectively at 28ºC after 96 h. A substrate to distilled water ratio of 1:2 (w/v) was found to be the best for tannase production. Supplementation of sodium nitrate (NaNO₃) as nitrogen source had enhanced tannase production both in jamun and keekar leaves. Applications of the enzyme were studied in wine clarification and tea cream solubilization. It resulted in 38.05% reduction of tannic acid content in case of jamun wine, 43.59% reduction in case of grape wine and 74% reduction in the tea extract after 3 h at 35°C.

Polymorphic variation of CYP1A1 and CYP1B1 genes in a Haryana population

Cytochrome P450 (CYP) 1A1 and CYP1B1 are important phase I xenobiotic metabolizing enzymes involved in the metabolism of numbers of toxins, endogenous hormones, and pharmaceutical drugs. Polymorphisms in these phase I genes can alter enzyme activity and are known to be associated with cancer susceptibility related to environmental toxins and hormone exposure. Their genotypes may also display ethnicity-dependent population frequencies. The present study was aimed to determine the frequencies of commonly known functional polymorphisms of CYP1A1 and CYP1B1 genes in a Haryana state population of North India. The allelic frequency of CYP1A1 polymorphism m1 (MspI) was 29.65% and m2 (Ile(462)Val) was 24.85%. The frequency of CYP1B1 polymorphism m1 (Val(432)Leu) was 45.85% and m2 (Asn(453)Ser) was 16.2%. We observed inter- and intra-ethnic variation in the frequency distribution of these polymorphisms. Analysis of polymorphisms in these genes might help in predicting the risk of cancer. Our results emphasize the need for more such studies in high-risk populations.

Therapeutic effect of probiotic dahi on plasma, aortic, and hepatic lipid profile of hypercholesterolemic rats

This study examined the effects of probiotic dahi prepared by Lactobacillus plantarum Lp9 and dahi culture in buffalo milk on lowering cholesterol in rats fed a hypercholesterolemic basal diet. Male Wistar rats were divided into 3 groups and fed with probiotic dahi, dahi, or buffalo milk for 120 days. Following the consumption of supplements (probiotic dahi, dahi or buffalo milk), the animals were fed a basal hypercholesterolemic diet. Plasma total cholesterol and triglycerides (TAGs) were decreased by 35% and 72% in rats fed with probiotic dahi group, while cholesterol levels increased by 70% and TAGs increased by 97% in buffalo milk and 59% in dahi fed groups. Supplementation of probiotic dahi further lowered plasma low-density lipoprotein (LDL) + very-low-density lipoprotein (VLDL)- cholesterol by 59%, while it elevated plasma high-density lipoprotein (HDL)-cholesterol by 116%. As a result, atherogenic index, the ratio of HDL to LDL + VLDL was markedly improved. Deposition of cholesterol and TAGs in liver and aorta were significantly reduced in rats fed with probiotic dahi. These observations suggest that probiotic dahi may have therapeutic potential to decrease plasma, hepatic and aortic lipid profile, and attenuate diet-induced hypercholesterolemia.

Association of GSTM1 and GSTT1 polymorphisms with DNA damage in coal-tar workers

DNA damage was evaluated by alkaline comet assay in peripheral blood lymphocytes of 115 coal-tar workers occupationally exposed to polycyclic aromatic hydrocarbons (PAHs) and 105 control subjects. The effect of polymorphisms of glutathione S-transferase (GST) genotypes on the DNA damage was assessed. The mean tail moment (TM) value in the coal-tar workers was significantly higher as compared to the control subjects (12.06 ± 0.55 versus 0.44 ± 0.31; P<0.05). No significant association (P>0.05) between the GSTT1 and GSTM1 genotypes and the TM values was found, however highest mean rank TM value was reported in GSTM1 null and GSTT1 null genotypes in both control and exposed subjects. Our results suggest that there is increased DNA damage in coal-tar workers due to PAHs exposure. Polymorphisms in GSTM1 and GSTT1 genes do not show significant effect (P>0.05) on DNA damage.

Effect of genetic polymorphism of GSTM1 and GSTT1 genotypes on cytogenetic biomarkers among coaltar workers

Chromosomal aberrations (CAs) in peripheral blood lymphocytes and micronuclei (MN) in exfoliated buccal cells have been used for decades as cytogenetic biomarkers to investigate genotoxicity among occupationally or environmentally exposed population. In our study, we investigated the association of increased cytogenetic damage with genetic polymorphism in glutathione-S transferase genotypes among occupationally exposed 115 coaltar workers and 105 unexposed controls. We found higher mean value of chromosome aberrations (chromatid type-2.01±1.76; chromosomal type-2.22±1.73) and buccal micronuclei (BMN-7.10±1.56) in exposed subjects when compared to referents (chromatid type-0.82±.51; chromosomal type-0.87±.54; BMN-5.09±2.88). We observed that individuals having null genotype of GSTM1 and GSTT1 have significantly higher frequency of CAs and MN. Despite of small sample size, our findings suggest a significant association between polymorphism of glutathione-S transferase genotypes and cytogenetic biomarkers which are considered as early effects of genotoxic carcinogens.

Influence of GSTM1 and GSTT1 genotypes and confounding factors on the frequency of sister chromatid exchange and micronucleus among road construction workers

In the present study, we have investigated the influence of polymorphism of GSTM1 and GSTT1 genes and confounding factors such as age, sex, exposure duration and consumption habits on cytogenetic biomarkers. Frequency of sister chromatid exchanges (SCEs), high frequency cell (HFC) and cytokinesis blocked micronuclei (CBMN) were evaluated in peripheral blood lymphocytes of 115 occupationally exposed road construction workers and 105 unexposed individuals. The distribution of null and positive genotypes of glutathione-S transferase gene was evaluated by multiplex PCR among control and exposed subjects. An increased frequency of CBMN (7.03±2.08); SCE (6.95±1.76) and HFC (6.28±1.69) were found in exposed subjects when compared to referent (CBMN - 3.35±1.10; SCE - 4.13±1.30 and HFC - 3.98±1.56). These results were found statistically significant at p<0.05. When the effect of confounding factors on the frequency of studied biomarkers was evaluated, a strong positive interaction was found. The individuals having GSTM1 and GSTT1 null genotypes had higher frequency of CBMN, SCE and HFC. The association between GSTM1 and GSTT1 genotypes and studied biomarkers was found statistically significant at p<0.05. Our findings suggest that individuals having null type of GST are more susceptible to cytogenetic damage by occupational exposure regardless of confounding factors. There is a significant effect of polymorphism of these genes on cytogenetic biomarkers which are considered as early effects of genotoxic carcinogens.

Effect of type of cryoprotectant on morphology and developmental competence of in vitro-matured buffalo (Bubalus bubalis) oocytes subjected to slow freezing or vitrification

The present study examined the effects of different cryoprotectants on morphology and developmental competence of in vitro-matured buffalo oocytes after slow freezing or vitrification. After slow freezing in dimethyl sulfoxide (DMSO), ethylene glycol (EG) or 1,2-propanediol (PROH), at 1.0 or 1.5 m each, the proportion of morphologically normal oocytes recovered was significantly higher (P < 0.05) with 1.5 than 1.0 m for all cryoprotectants and was highest (P < 0.05) for 1.5 m DMSO. Following vitrification, the percentage of morphologically normal oocytes recovered was lower (P < 0.01) for 40% EG than for 40% DMSO, 20% EG + 20% DMSO or 20% EG + 20% PROH. The most common damage, irrespective of the cryopreservation method, was loss of cumulus mass. The cleavage rate and the proportion of vitrified-warmed oocytes that developed to morulae/blastocysts were significantly higher (P < 0.01) for 20% EG + 20% DMSO than for the other groups. A higher proportion of oocytes developed to morulae (11.5% v. 4.3%) or blastocysts (5.4% v. 0.6%) after vitrification in 20% EG + 20% DMSO than after slow freezing in 1.5 m DMSO. In conclusion, vitrification was more effective than slow freezing for the cryopreservation of in vitro-matured buffalo oocytes.

Effect of slow freezing on morphology and developmental competence of buffalo (Bubalus bubalis) immature oocytes

The present study was conducted to evaluate the effects of three cryoprotectants, dimethyl sulphoxide (DMSO), ethylene glycol (EG) and 1,2-propanediol (PROH), each used at two concentrations (1.0 and 1.5 M) on the morphology, maturation rate and developmental capacity of usable quality immature buffalo oocytes subjected to slow freezing. The addition of the cryoprotectant before freezing and its dilution after thawing were carried out in a two- (for 1.0 M) or three-step manner (for 1.5 M). The incidence of damage was found to be significantly higher (P<0.05) with the lower concentration of 1.0 M, compared to that with 1.5 M for all the three cryoprotectants examined. The proportion of immature oocytes recovered in a morphologically normal state was significantly higher (P<0.05) for DMSO than those for EG or PROH at both 1.0 and 1.5 M concentrations. Among the six combinations evaluated, that of DMSO at 1.5 M concentration was found to be superior to others. Irrespective of the type or concentration of the cryoprotectant, partial or complete loss of the cumulus mass was the most prevalent damage. Following in vitro maturation, the nuclear maturation rate was significantly higher (P<0.05) for DMSO than those for EG or PROH at both 1.0 and 1.5 M concentrations. When the in vitro matured oocytes were subjected to in vitro fertilization after slow freezing, using 1.5 M DMSO as cryoprotectant, 4.5% and 0.6% of them were able to develop to morulae and blastocysts, respectively, on Day 9 post insemination, compared to 19.2% and 10.6%, respectively, for the controls. In conclusion, DMSO was more effective than EG or PROH for the slow freezing of immature buffalo oocytes and blastocysts could be produced from immature buffalo oocytes subjected to slow freezing in 1.5 M DMSO.

Isolation and characterization of embryonic stem cell-like cells from in vitro-produced buffalo (Bubalus bubalis) embryos

This study was carried out to isolate and characterize buffalo embryonic stem (ES) cell-like cells from in vitro-produced embryos. Inner cell mass (ICM) cells were isolated either mechanically or by enzymatic digestion from 120 blastocysts whereas 28 morulae were used for the isolation of blastomeres mechanically. The ICM cells/ blastomeres were cultured on mitomycin-C-treated feeder layer. Primary cell colony formation was higher (P < 0.05) for hatched blastocysts (73.1%, 30/41) than that for early/expanded blastocysts (25.3%, 20/79). However, no primary cell colonies were formed when blastomeres obtained from morulae were cultured. Primary colonies were formed in 14.1% (12/85) of intact blastocyst culture, which was significantly lower (P < 0.05) than that of 41.6% for ICM culture. These colonies were separated by enzymatic or mechanical disaggregation. Using mechanical disaggregation method, the cells remained undifferentiated and two buffalo ES cell-like cell lines (bES1, bES2) continued to grow in culture up to eight passages. However, disassociation through enzymatic method resulted in differentiation. Undifferentiated cells exhibited stem cell morphological features, normal chromosomal morphology, and expressed specific markers such as alkaline phosphatase (AP) and Oct-4. Cells formed embryoid bodies (EBs) in suspension culture; extended culture of EBs resulted in formation of cystic EBs. Following prolonged in vitro culture, these cells differentiated into several types of cells including neuron-like and epithelium-like cells. Furthermore, the vitrified-thawed ES cell-like cells also exhibited typical stem cell characteristics. In conclusion, buffalo ES cell-like cells could be isolated from in vitro-produced blastocysts and maintained in vitro for prolonged periods of time.

Dechlorination of DDT mediated by bimetallic systems

DDT dechlorination efficiencies of bimetallic systems, namely, Mg0-Zn, Mg0-Ni, and Mg0-Co were compared. All the systems transformed DDT with efficiencies exceeding 98% within 24 h. Based on GC-ECD and GC-MS analyses a step-wise and sequential dechlorination of DDT by Mg0-Zn system in 1:1 water acetone phase via 1,1 dichloro, 2,2- bis (p-chlorophenyl) ethane (DDD), 1, chloro, 2,2 bis (p-chlorophenyl) ethane (DDMS) to 2,2 bis (p-chlorophenyl) ethane (DDNS) was noted. Accumulation of DDNS as the end product indicates that all three alkyl chlorine atoms of DDT were removed by Mg0-Zn system. Mg0-Co also showed almost complete removal of DDT in water-acetone phase that was accompanied by the accumulation of DDD followed by a decline in its concentration as a function of time. On the other hand, Mg0-Ni system exhibited inefficient removal of DDT in water-acetone phase. In pure acetone phase, Mg0-Co system and Mg0-Ni dechlorinated DDT with the accumulation of DDE and DDMU as end products following 24 h of reaction. The presence of surfactants or organic solvents is required to ensure solubilization of DDT. Also addition of acid is essential to provide sufficient protons for efficient reductive dechlorination via hydrogenation. Advantage of Mg0 based dehalogenation reactions is that they occur at high rates under ambient temperatures, and pressure and oxygen need not be excluded in the reaction phase. Our studies revealed that Mg0-Zn is the best option among all tested systems due to its high reactivity and low cost, and may be used to treat DDT contaminated water.

Paediatric dentistry in the new millennium: 4. Cost-effective restorative techniques for primary molars

In the fourth article in this series the techniques for carrying out pulp therapy and stainless steel restoration in primary molars are discussed. Early pulp involvement in primary molars means that pulp therapy and the use of appropriate coronal restoration, such as stainless steel crowns, are indispensable if repetitive restoration of primary molars is to be avoided. These techniques themselves are not difficult to carry out once the child's co-operation is established and should be well within the capability of any dentist with an interest in the dental care of children.

Cross-flow microfiltration of blood through an extracorporeal device: a study in parameterization

This paper develops a new approach for the general description of membrane plasma separator performance by using dimensional analysis. Experiments involved cross-flow microfiltration of goats' blood across flatsheet polyvinylidene fluoride durapore membranes of pore size 0.65, 0.45 and 0.22 microns in a thin-channel device. Certain non-dimensional numbers are evolved which represent the grouping of relevant filtration parameters and which contribute to the global characterization of membrane-based plasmapheresis devices.

Exploiting temperature dependence to improve selectivity in membrane-based plasmapheresis

Temperature effects on cross-flow membrane plasmapheresis have been investigated with the help of hydrophillic polyvinylidene fluoride (PVDF) Durapore membranes of pore size 0.65 micron and an effective filtration area 30 cm2, using a thin-channel device (Minitan-S, Millipore Inc., U.S.A.) and goat's blood as the working fluid. The filtration and sieving properties have been characterized by evaluating normal saline (0.9 g%) flux and the sieving coefficients of albumin, immunoglobulins, and fibrinogen respectively. Runs were performed at 10 +/- 1, 20 +/- 1, 30 +/- 1 and 40 +/- 1 degree C, the various filtration parameters were measured and samples of the feed and permeate were collected during steady state. It is seen that the "effective" pore size increases with temperature increase thereby increasing flux, sieving and fouling. Exploiting temperature effects can possibly help modify the sieving spectrum in membrane-based plasmapheresis.

GABA/BZ-and NMDA-receptor interaction in digoxin-induced convulsions in rats

Digoxin (7.5 micrograms icv) induced 'pop-corn' type of convulsions and 100% mortality. The GABA-ergic agents produced varying degree of protection against digoxin-induced neurotoxicity. Diazepam (4 mg/kg) offered significant protection whereas pentobarbital (5 mg/kg) and baclofen (5 mg/kg) markedly reduced per cent mortality, but ethanol (2 g/kg), progabide (50 mg/kg) and muscimol (0.5 mg/kg) as well as GABA (50 mg/kg) could not offer significant protection in doses used. GABA-ergic agonists; GABA, baclofen, diazepam and pentobarbital when administered along with MK-801 (0.5 mg/kg) a non-competitive NMDA antagonist, a potentiation of anticonvulsant action of MK-801 was observed. MK-801 showed potent anticonvulsant profile in dose range (0.25-1 mg/kg) studied. A synergistic influence of Mg2+ and K+ ions on NMDA receptor antagonism was also observed. A role of GABA-ergic facilitation and NMDA antagonism as a potential anticonvulsant approach in digoxin-induced convulsions in rats has been suggested.