Global research trends of interleukin-6 in SARS-CoV-2 infection

IL-6 levels are significantly elevated in COVID-19 patients and are associated with poor clinical outcomes. Inhibiting IL-6 is thought to be a unique therapeutic strategy for the control of dysregulated host responses in SARS-CoV-2. The present study focuses on evaluating the research productivity of IL-6 level in SARS-CoV-2 infection using various bibliometric indicators and analysed 4510 research papers related to IL-6 levels in SARS-CoV-2 from the Scopus database and VOSViewer© tool applied for visualization. The results revealed that ascendant trends in the publications and USA, China and Italy have secured top three position in numbers of publications. Study observed that “Dagna L.” received top prolific author rank. Article entitled “Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China” received maximum of 15364 total citations, whereas “Frontiers in Immunology” and “Journal of Medical Virology” secured in top two highly productive journals in the subject with extreme link strength. With regard to organisation, “Tongji Medical College-China” reported highly dynamic organization. “Covid-19”; “SARS-Cov-2”; “Interleukin” received maximum occurrences with high link strength. In view of global mounting public health issue of COVID-19, primarily due to increased viral transmissibility and associated cytokine storm, the present study will helpful for the medical professionals to know the research trends and also library authority for updating collection development policy in the specific subject domains.

Influence of genetic variability at the ACE locus in intron 16 on Diabetic Nephropathy in T1DM patients.

Background: Diallelic [insertion/deletion (I/D)] polymorphism in the angiotensin-converting enzyme (ACE) gene has been reported inconsistently as being associated with risk of diabetic nephropathy (DN). Objective: To examine the three ACE poly-morphic variants in intron 16 for a possible role in modulating DN in T1DM patients from Kutch region, Gujarat. Design and setting: I/D polymorphism in intron 16 of the ACE gene was examined in a case-control group (280 participants with T1DM, case participants n=138; control participants n=142) for association with nephropathy. All recruited individuals were carefully phenotyped and genotyping was performed using polymerase chain reaction and gel electrophoresis methods. Suitable descriptive statistics was used for different variables. Results: No departure from Hardy-Weinberg equilibrium was observed in cases or controls. Genetic polymorphism at the ACE locus in intron 16 were significantly associated with nephropathy when analyzed either by genotype or allele frequencies and D/D variant were significantly (p=0.0002) associated with nephropathy at the 5% level. In multivariate analysis, D/D variant had an independent and strongest influence on the micro-albumin excretion (p=0.002, OR=2.11, 95% CI=1.26– 4.48). However, it did not independently change the odds of having macroalbuminuria versus microalbuminuria. Conclusion: Genotype-associated differences in ACE in intron 16, have functional consequences in genetic susceptibility to diabetic nephropathy in a population with T1DM, and thus represent a potential DN genetic susceptibility locus worthy of replication.

A study of the branching pattern of aortic arch.

The purpose of the present study is the description of the aortic arch branches variation in order to offer useful data to anatomists, radiologists, vascular, neck and thorax surgeons. Methods: A total 46 Indian adult cadavers were used. The authors investigated anatomical variation of the aortic arch and its major branches. Results : The three major branches directly originate from the aortic arch in 38 (82.6 %) ; the 3 ( 6.5%) remaining aortic arch showed only two branches and 5 (10.9 %) aortic arch showed the direct arch origin of left vertebral artery. Interpretation & conclusion: Despite the fact that the variations in question are usually asymptomatic, they may cause dyspnoea, dysphasia, intermittent claudication, misinterpretation of radiology examinations and complications during neck and thorax surgery. This study would provide an anatomical basis to assist surgeons in performing safe vascular surgery involving the aortic arch and its branches.

Effect of active smoking on glucose tolerance and lipid profile.

Background: The acute effects of cigarette smoking in smokers include dyslipidemia and impaired insulin action that leads to abnormal glucose metabolism. Both dyslipidemia and insulin resistance are well-established major risk factor for cardiovascular disease. Aims & Objective: To ascertain the prevalence of several degrees of glucose abnormalities in smokers and to assess the impact of active tobacco smoking on lipids profile in adult male population. Material and Methods: A cross-sectional study was conducted with one hundred and fifty two active adult male smokers defined by persons smoking cigarettes over 2 pack years and fifty age and Body Mass Index (BMI) matched healthy control. Smokers were classified into mild to moderate (Group I) and severe (Group II) based on the number of pack years as 2 – 10 and more than 10 respectively. Glucose tolerance was assessed according to American Diabetes Association (ADA) guidelines and standard methods were adopted to check the lipid levels. Data analyses were performed with the SPSS 15.0 statistical software. Results: An abnormal glucose metabolism was diagnosed in 66% (95% confidence interval [CI], 61.4%-71.6%) of the smokers. The mean HOMA-IR (Homeostasis model assessment-insulin resistance) in smokers was 6.8 + 3.1. Decreasing glucose tolerance was associated with insulin resistance i.e. from normal glucose tolerance condition through IGT, IFG to diabetic, the HOMA IR progressively increased (4.9 + 2.1, 6.7 + 4.2, 7.4 + 3.1 and 8.9 + 3.7 respectively). Atherogenic index as indicated by total cholesterol/HDL cholesterol and LDL cholesterol/HDL cholesterol ratio was significantly elevated in both the smoker groups as compared to non-smokers. According to the Adult Treatment Program III criteria, the metabolic syndrome was diagnosed in 44.07% (95% CI, 35.9%-47.3%) of the smokers. In fact only 10 participants (6%, 95% CI, 5.4% - 7.1%) showed good control of cardiovascular risk factors. Conclusion: Abnormalities in lipid profile and glucose tolerance are directly correlated with smoking pack years in this study. Intense education program about adverse health events of smoking should be under taken through all means.

Diabetic nephropathy: progression and pathophysiology.

Diabetic nephropathy is the leading cause of kidney disease in patients starting renal replacement therapy and affects ~30% of type 1 and type 2 diabetic patients. This review focuses on the progression and pathophysiological aspects of the condition. The natural history of diabetic nephropathy is characterized by specific renal morphological and functional alterations. Features of early diabetic renal changes are microalbuminuria (30-300mg/day), glomerular hyperfiltration, glomerular and renal hypertrophy, increased basement membrane thickness, and mesangial expansion with the accumulation of extracellular matrix proteins such as collagen, fibronectin, and laminin. Advanced diabetic nephropathy is characterized by macroalbuminuria ( >300mg/day), a progressive decline in glomerular filtration rate, decreasing creatinine clearance, glomerulosclerosis, and interstitial fibrosis. Although poor glycemic control is an important risk factor, glycemia does not fully explain why only a subset of diabetic patients progress to end stage renal disease. Several decades of extensive research has elucidated various pathways to be implicated in the development of diabetic kidney disease such as systemic and glomerular hypertension, advanced glycation endproducts and the aldose reductase system. Furthermore, hemodynamic factors, the reninangiotensin system, the endothelin system, the intracellular signaling molecule protein kinase C, transforming growth factor-ß, growth hormone, insulin like growth factors, vascular endothelial growth factor, and platelet-derived growth factor are believed to be involved in the pathogenesis. Thus, there are clearly many points at which therapeutic approaches could be tried to provide renoprotection in diabetes. It is likely that due to its complexity, targeting multiple points in altered metabolism in the diabetic kidney will be more successful in attenuating the development of diabetic nephropathy, rather than a single approach.

High risk factors for elevated excretion of albumin in diabetic subjects.

Background: Microalbuminuria refers to the excretion of albumin in the urine at a rate that exceeds normal limits but is less than the detection level for traditional dipstick methods and is considered as a marker of diabetic nephropathy. Aims: To establish the prevalence of elevated urinary albumin levels (microalbuminuria) in a sequential sample of diabetic patients and to determine its relationship with known and putative risk factors, to ascertain relationship of serum angiotensin converting enzyme (ACE) activity with diabetic incipient nephropathy. Study design: This cross-sectional analytical study included 100 control and 325 diabetic patients (180 type 2 and 145 type 1 diabetic patients) subjects attending outpatient department of the hospital. Patients having clinical albuminuria and with other causes of proteinuria were excluded. Result: Microalbuminuria was observed in 34.48% in patients with type 1 and 28.33% in patients with type 2 diabetes mellitus respectively. Having the condition was significantly associated with advanced age, poor glycaemic control, dyslipidemia (with respect to total cholesterol, triglycerides and LDL-C), smoking, body mass index and coexisting hypertension. The duration of diabetes was a significant correlate in type 1 DM subjects only. No significant association with gender, HDL-C levels, age at onset of DM, mode of treatment, socio-economic status and other lifestyle variations was found. All clinical and biochemical parameters in patient with microalbuminuria was more adversely affected than patients with normoalbuminuria. Serum angiotensin converting enzyme (ACE) levels were significantly elevated (P<0.001) in both of the diabetic groups, moreover, its levels were higher in subjects with microalbuminuria than in those without this complication (P<0.05). Conclusions: Microalbuminuria in diabetes, which represents an earlier phase in the development of clinical nephropathy, is associated with many potentially modifiable risk factors. In estimating diabetic nephropathy risk, AER is most important and should be done frequently but there are gains to be made in predictive precision by considering family history, smoking habits, glycemia, B.P.,BMI lipid levels and ACE activity. Early screening for incipient diabetic nephropathy and aggressive management of these risk factors is important in optimising the renal outcome of patients with diabetes mellitus.

Glucose tolerance & insulin response in patients with hypertension.

Background: Insulin resistance leads to impaired glucose tolerance, dyslipidemia, and other adverse cardiovascular effects. Euglycemic insulin clamp have shown that essential hypertension per se is a state of insulin resistance and has been associated with an increased incidence of diabetes Aims: To ascertain the prevalence of several degrees of glucose abnormalities in patients with hypertension and to examine the insulin secretory response to oral glucose load. Study design, Material and Method: This cross-sectional analytical study included 325 hypertensive patients (with or without diabetes)and 100 control subjects. An oral glucose tolerance test (OGTT) following WHO guidelines was performed in all subjects, with measurement of insulin at baseline and every 30 minutes after the glucose load. Results: Abnormal glucose metabolism was observed in 70.77% of patients (95% confidence interval [CI], 65.87% - 74.21%). Of the 325 patients, 29.23% patients showed normal glucose metabolism. Impaired glucose tolerance (IGT) and Impaired fasting glycemia (IFG) were diagnosed in 30.46% and 16.61% patients respectively .Total diabetic population in the hypertensive patients were 23.69% (silent previously undiagnosed diabetes mellitus was diagnosed in 9.53% of patients while 14.15%reported a previous diagnosis of diabetes mellitus).Decreasing glucose tolerance was associated with insulin resistance. From normal glucose tolerance condition through IGT, IFG to diabetic, the HOMA IR progressively increased. Results of standard OGTT and corresponding insulin response after 0, 30, 60 and 120 minutes were significantly higher in patients compared with control subjects. LVMI and severity of glucose intolerance were significantly related. Male gender, higher levels of insulin (fasting insulin/HOMA IR) and greater adiposity (BMI) were all strongly associated with the severity of glucose abnormalities. Prevalence of metabolic syndrome increased progressively with severity of glucose abnormality. Conclusions: More than two-third of the hypertensive patients exhibited different glucose abnormalities and exaggerated insulin response to glucose load (hyperinsulinemia) along with cluster of other cardiovascular risk factors, whose prevalence increases with severity of glucose intolerance.