Comparative diagnostic utility of different urinary biomarkers during pre-albuminuric stages of non-hypertensive type 2 diabetic nephropathy

Background & objectives: Activation of renin-angiotensin system and tubulointerstitial damage might be seen in pre-albuminuria stage of diabetic nephropathy (DN). Here, diagnostic utility of four urinary biomarkers [Angiotensinogen (Angio), Interleukin (IL)-18, Neutrophil Gelatinase-Associated Lipocalin (NGAL) and Cystatin] during pre-albuminuria stages of non-hypertensive type 2 diabetes patients was studied. Methods: A total of 952 type 2 diabetes mellitus (T2DM) patients were screened for nephropathy [estimated glomerular filtration rate (eGFR) ?120 ml/min and albumin–creatinine ratio (ACR) ?30], and 120 patients were followed up for one year. At one year, they were classified into hyperfiltration (43), normoalbuminuria (29) and microalbuminuria (48) groups. Another 63 T2DM patients without nephropathy were included as controls. Hypertension, patients on angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, eGFR <60 ml/min/1.73 m2 and all proteinuric conditions were excluded. All were subjected to testing for urine protein, ACR, HbA1C, eGFR, along with urinary biomarkers (IL-18, cystatin-C, NGAL and AGT). Comparative analysis of all the diagnostic tests among different subgroups, correlation and logistic regression was done. Results: Urinary IL-18/Cr, cystatin/creatinine (Cr) and AGT/Cr levels were higher in groups of hyperfiltration (13.47, 12.11 and 8.43 mg/g), normoalbuminuria (9.24, 11.74 and 9.15 mg/g) and microalbuminuria (11.59, 14.48 and 10.24 mg/g) than controls (7.38, 8.39 and 1.26 mg/g), but NGAL/Cr was comparable. The area under receiver operating characteristic curve (AUC) and sensitivity of AGT to detect early CKD were higher than ACR and eGFR (0.91 and 90.4%, 0.6 and 40% and 0.6 and 37%, respectively). AUC values of other biomarkers, namely IL-18/Cr, cystatin/Cr and NGAL/Cr, were 0.65, 0.64 and 0.51, respectively. Angio/Cr and IL-18/ Cr showed correlation with log albuminuria (r=0.3, P=0.00, and r=0.28, P=0.00, respectively). NGAL showed correlation with log eGFR (r=0.28 P=0.00). Multivariate logistic analysis showed that odds ratio of developing nephropathy was 7.5 times with higher values of log Angio/Cr. Interpretation & conclusions: Urinary AGT showed a higher diagnostic value than ACR and eGFR followed by IL-18 and cystatin to diagnose DN during pre-albuminuric stages.

Prognostic utility of neutrophil gelatinase associated lipocalin in cardiac ICU: A prospective study

Our study aims to evaluate the role of neutrophil gelatinase associated lipocalin (NGAL) as an early surrogate marker in predicting acute kidney injury (AKI) and mortality in cardiac ICU patients. The study was conducted at SRN Hospital, excluding those with known renal diseases. Out of 152 patients, 56 developed AKI (cases) and 96 were our controls. Higher NGAL was associated with increased mortality rates (P ¼ 0.0201 and 0.0255 for serum and urinary NGAL respectively). Our study concluded that NGAL measurement at admission may be a boon in improving the outcome of cardiac ICU patients

A cross sectional overview of digital eye strain: a growing health concern in this digital age in central India (Madhya Pradesh)

Background: The physical discomfort and collection of symptoms after digital screen use for longer than two hours at a time is referred by the Vision Council as digital eye strain (DES). Common symptoms of DES are eyestrain, headache, blurred vision, dry eyes and pain in neck and shoulders. This study aims to know about the prevalence; factors associated with and awareness about preventive measures for DES among college students.Methods: A cross-sectional study was conducted for 2 months in 2017 among randomly selected 200 college students of 20 to 30 years of age in Indore city of Madhya Pradesh using a pre-designed semi-structured questionnaire.Results: Mean age of participants was 22.5 years; of which 58% were females. Of the respondents, 89.5% (179 students) reported experiencing DES. Average distance from digital screen, brightness level of digital device, use of digital device before going to sleep and awareness about appropriate distance of digital screen from eyes had statistically significant association with having digital eye strain. 98% of respondents were unaware of the term DES while >60% did not have knowledge about the harmful blue light emitted by digital devices, protective use of digital screen filters, appropriate distance of viewing digital screen and the 20-20-20 rule of taking breaks in between screen time.Conclusions: Since digital device use is a necessary evil; better ergonomic practices to avoid DES should be adopted. Opportunistic health promotion and patient education undertaken by ophthalmologists on an OPD basis is one solution.

Prevalence of attention deficit hyperactivity disorder, gender difference and its co morbidity among urban school children in a city of southern Rajasthan, India

Background: Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed disorders of childhood (3-5%). The main characteristics of attention deficit hyperactivity disorder are inattention, hyperactivity, and impulsivity. 'The Objective of this study was to study prevalence of ADHD in school aged children.Methods: A cross sectional descriptive school-based study was conducted in a private school of Udaipur from January 2017 to September 2018.' All eligible students were included. Total 1200 students were enrolled. They were assessed for the presence of ADHD using INCLEN diagnostic tool and those found positive were further assessed for the presence of co-morbid conditions using child behavior checklist (CBCL).Results: In present study out of total 1200 students 730(60.83%) were male and 470(39.17%) were female. 76 (6.3%) students out of 1200 were ADHD Positive. ADHD was more common in male students (73.7%), urban locality (57.89%), in age group 6 to 9 years (44.7%) and higher economic class (46.1%). Hyperactivity-Impulsivity type was most common type (51.32%). Male students had predominance of hyperactivity (60.7%) whereas in female student's inattention type was predominant (45%). Aggressive Behavior (19.6%) and rule breaking behavior (80.4%) was more common in male. Somatic complaints were more common in females (60%). Oppositional defiant disorder was observed in male (21.4%) and female (10%) students. 15.8% of ADHD students had learning disorder.Conclusions: Present study shows 6.3% prevalence of ADHD. Hyperactivity type of ADHD was more common in boys, while Inattention type was more common in girls. Among associated co morbid conditions - aggressive behavior, rule breaking behavior and oppositional defiant disorder (ODD) was found to be more prevalent in boys while anxious behavior, somatic complaints and social problems were more commonly found in girls. Thought problems, learning disorders and conduct disorders are also observed in ADHD students.

Impact of oral palonosetron in improving quality of life as compared to other oral 5-HT3 antagonists in delayed chemotherapy induced nausea and vomiting in patients of head and neck cancer

Background: Chemotherapy induced nausea and vomiting (CINV) remains one of the most common and debilitating complications of highly emetogenic chemotherapy (HEC). This study was undertaken to evaluate palanosetron against other 5-HT3 receptor antagonists in preventing delayed CINV with the aim of achieving complete response (CR) and improving quality of life (QoL).Methods: This was a prospective, observational study conducted on 75 histopathologically proven patients of squamous cell carcinoma of Head and Neck (H&N), who came to the Department of Radiation Oncology, Gandhi Medical College and Hamidia Hospital, Bhopal from January to December 2015. Standard protocol based chemotherapy containing highly emetogenic cisplatin based chemotherapy was administered to all the patients. For prevention of delayed chemotherapy induced nausea and vomiting all patients were prescribed oral 5-HT3 antagonists. Oral Ondansetron 4mg TDS was given to cohort 1, oral Granisetron 1 mg BD to cohort2 and oral Palanosetron 0.5mg OD was given to cohort 3. They were graded as complete response when they did not have complains of nausea and vomiting.Results: In Ondansetron, Granisetron and in Palanosetron cohort 29%, 53% and 98% patients had complete response.Conclusions: Palanosetron appears superior. Our study was conducted on handfull of patients and compared palanosetron against only two 5-HT3 receptor antagonists, so a larger study is suggested to establish the efficacy and better response of palanosetron.

Evaluation of nutraceutical properties of finger millet genotypes from mid hills of northwestern Himalayan region of India

Finger millet Eleusine coracana L., commonly called Ragi, is a rich source of phytochemicals and have number of health beneficial effects. The present study evaluated the total antioxidant activity (TAA), condensed tannins (CT), micronutrient content (Fe & Zn), diphenyl-1-picrylhydrazyl (DPPH) and 2,2′-azinobis-3-ethylbenzothiazoline-6-sulfonic acid (ABTS) radical scavenging activity, ferric reducing antioxidant power (FRAP) and phenolic compounds in 35 finger millet genotypes. The assayed genotypes showed 0.91-0.99 mg/g CT, 23.79-56.51 mM/kg TAA, 1.76-44.47 µM/g DPPH scavenging activity, 44.14-88.09 µg/mL ABTS activity, 100-463.53 µM FRAP value, 37.04-69.13 ppm Fe and 28.94-46.77 ppm Zn. HPLC analysis showed that gallic, tannic, ferulic, caffeic and o-coumaric acid to be major polyphenols in all genotypes. Principal component analysis (PCA) revealed significantly higher CT, TAA with relatively good amount of Fe and Zn in VL Ragi 146, VL Mandua 352, VL 336, VL 373, VL 325, VL 351, GPHCPB 7, GPHCPB 3, GPHCPB 52 and VR 708 genotypes. Agglomerative hierarchical cluster analysis classified the 35 genotypes into two clusters; Cluster I had higher CT, TAA, FRAP, DPPH, ABTS, while cluster II recorded higher Fe and Zn. This study clearly demonstrated the nutraceutical properties with higher antioxidant potential of identified genotypes, which can be suitably deployed for nutritional security, particularly in developing countries.

Safety of delayed umbilical cord clamping in preterm neonates of less than 34 weeks of gestation: a randomized controlled trial

OBJECTIVE: There is concern regarding the safety of delayed cord clamping (DCC) in babies born at less than 34 weeks' gestation. Therefore, the primary objective of this study was to compare the rates of hyperbilirubinemia and polycythemia during initial 7 days in infants born at less than 34 weeks' gestation and randomized to receive DCC by 120 seconds or early cord clamping (ECC) within less than 30 seconds. METHODS: One hundred pregnant women were randomly subjected to DCC or ECC at the time of birth in a tertiary referral hospital setting. Blood samples were obtained from each newborn at 48 hours and 7 days for hematocrit measurement. Serum bilirubin levels were estimated once the infant had clinically significant jaundice or at 72 hours. For the statistical analysis, the χ2 test, student's t-test, or Wilcoxon rank sum test was used. RESULTS: The hematocrit was significantly higher in the DCC group than in the ECC group (P < 0.001). None of the babies had polycythemia. Mean total serum bilirubin level was 6.6 mg/dL in the DCC group and 8.7 mg/dL in the ECC group (P < 0.001). There was no increased risk of hyperbilirubinemia in the DCC group. CONCLUSION: DCC benefits preterm neonates with no significant adverse effects.

Co-existence of Carcinoma Tongue with Pulmonary Tuberculosis.

We present the case of a 45-year-old male diagnosed to have carcinoma base of tongue, whose chest radiograph showed bilateral lung infiltrates and was referred for evaluation of suspected pulmonary metastases. Diagnostic evaluation confirmed the diagnosis of smear-positive pulmonary tuberculosis.

Coexistence of carcinoma cheek with tuberculosis: a rarity.

Coexistence of tuberculosis and cheek malignancy is a rare phenomenon and it has never been reported to the best of our knowledge. Here, we present a case of carcinoma cheek with tuberculosis in a 50 year old male patient who was successfully managed by multimodality approach by combining anti-tubercular therapy with chemotherapy and radiotherapy.

In-vitro cancer cell cytotoxicity and alpha amylase inhibition effect of seven tropical fruit residues

Objective:To determine quantitative phytochemical, anticancer and antidiabetic effect of seven Indian tropical fruit residues. Methods:In-vitro cytotoxic activity (IC50) was evaluated against cervical cancer cells (HeLa), breast cancer cells (MCF-7), hepatocellular carcinoma cells (HepG-2) and bone sarcoma cells (MG-63) and alpha amylase inhibition assay was used for antidiabetic activity. Results: Results of phytochemical analysis revealed that all residues contained remarkable amount of alkaloid, saponin, tannin and flavonoid. Notable cancer cell growth inhibition was observed for the extract from Carissa carandas pomace and Litchi sinensis seeds with IC50 values ranged from 56.72 to 89.24 μg/mL. Alpha amylase inhibition assay was measured at six different concentrations (5, 10, 25, 50, 100 and 200 mg/mL) by using different solvent extract. Results showed that Carissa carandas possessed best activity with IC50 value as 29.66 mg/mL followed by other residues in methanol extract. Conclusions:Study suggests that these fruit residues demonstrate promising antidiabetic and anticancer activity that substantiated its ethno medicinal use and may provide new molecules for the treatment of these diseases.

Prognosis V/S Etiology : Midline Papilla Reconstruction After Closure of Median Diastema.

Reconstruction of lost interdental papilla once the contact point is restored in midline diastema cases are as well important in restoring the esthetics as closure of diastema. Aim: The purpose of this study was to predict the midline papilla reconstruction in treated median diastema of variable etiology. Method : The treated sample consisted of 40 patients with variable etiology of midline diastema (6 of abnormal labial frenum, 6 of mesiodens ,8 of anodontia or microdontia, 8 of para functional habits, 6 of flared or rotated incisors and 6 of dentoalveolar disproportion) with otherwise healthy periodontium. The method used was PPI (papilla presence index) by D.Cardaropoli. Results: The study suggests that prognosis for papillary reconstruction is not good in cases of mesiodens. Conclusion: In spite of getting a good contact point, various other factors are playing a role in achieving good esthetics in cases of median diastema.

Isolation of genomic DNA from medicinal plants without liquid nitrogen.

Genomic DNA was extracted from eight medicinal plants using the present DNA extraction protocols (CTAB extraction method) with some modifications. Leaves were fixed in different fixing solutions containing absolute alcohol (99.99%), chloroform and EDTA, but without liquid nitrogen. DNA quality and quantity obtained were comparable to those isolated with liquid nitrogen, as the λ260/λ280 ratio with liquid nitrogen was in range 1.3-1.7 and with other fixing solutions it was 1.1-1.5. Absolute alcohol showed best results as fixing solution. Good quality of DNA was isolated without using liquid nitrogen from different medicinal plant species. DNA isolated by this method was suitable for various molecular biology applications.