Overnutrition: Current scenario & combat strategies

Large population-based surveys by the Government of India and several other regional studies have reconfirmed the coexisting burden of over- and undernutrition. While time trends from the 2nd, 3rd and 4th rounds of the National Family Health Survey show declining trends in the prevalence of the underweight, it also highlights increasing rates in the overweight/obesity. Dose-response relationships with different micro- and macronutrient consumption with overweight/obesity prevalence have been established. In this context, it was attempted to identify the specific diet pattern and socio-behavioural determinants of overnutrition along with its combat strategies. This review highlights that while the proportion of chronic energy deficiency is decreasing in India, the intake of micronutrients and food groups continues to be below the recommended dietary allowance set by the Indian Council of Medical Research. Distal factors that determine the nutritional imbalance among Indians are presented under (i) household contextual factors, (ii) peer and socio-cultural influencers, and (iii) business and neighbourhood environment. Accumulation of such factors increases the density of obesogenic environment around individuals. Further, the review offers action points at individual, society and policy levels, presented in a 'logframe matrix' for bringing convergence actions across sectors in consultation with programme managers from different ministries/departments.

Reno-protective effect of N-acetyl cysteine in patients with impaired renal function undergoing coronary angiography and interventions.

BACKGROUND: The increasingly frequent use of contrast enhanced imaging for diagnosis or interventions in patients with CAD has generated concern about avoidance of contrast induced nephropathy (CIN). Reactive oxygen species have been shown to cause CIN. OBJECTIVES: Angiographic contrasts worsen the renal function in patients with renal failure. We studied the reno-protective action of the antioxidant N-Acetyl cysteine (NAC) in patients undergoing coronary procedures. METHODS: Retrospective analysis of 51 patients with elevated serum creatinine levels (> or = 15mg%) was done, 24 of whom received NAC prior to the procedure(NAC group) and 27 who did not (Non NAC group). NAC was administered in a dose of 400 mg twice daily for four doses starting on the day prior to the procedure. Both groups of patients were hydrated with 0.45% saline at 1 ml/kg/hr for 12 hours prior to and 12 hours following the procedure. Both groups were comparable with regard to age, sex, coronary risk profile, myocardial infarction history, left ventricular function and the drugs received. Serum urea and creatinine were measured on the day prior to and the day following the angiographic procedure. RESULTS: Nine out of 51 patients developed more than 0.5mg% rise in serum creatinine level; 1 in the NAC group and 8 in the non NAC group (p<0.05), 24 hours after injection of the contrast medium. In the NAC group mean serum creatinine level decreased from 1.94 +/- 0.56 to 1.67 +/- 0.56 and blood urea from 47.58 +/- 20 to 41.58 +/- 15.1. In the non NAC group serum creatinine increased from 1.75 +/- 0.31 to 1.98 +/- 0.56 and blood urea from 44.96 +/- 15.5 to 52.85 +/- 20.1 (p<0.05). This corresponds to an increase in creatinine clearance from 30ml/min to 35.92ml/min in the NAC group and a decrease from 34.42ml/min to 29.87ml/min in the non NAC group. There was no significant difference in the levels of sodium and potassium before and after the procedure in both the groups. CONCLUSION: We conclude that prophylactit administration of N-Acetyl Cysteine along with hydration diminishes the incidence of deterioration of renal function induced by contrast agents in patients with renal insufficiency during coronary angiographic procedures.

The immunohistochemistry of solid tumours: potential problems for new laboratories.

Immunohistochemistry has become an important tool for tumour typing and has the potential to improve the histopathological diagnosis of neoplasms. However, the large number of publications on the different aspects of the technology are often contradictory. In many instances the immunochemical reactions may not be reproducible and can create problems in the diagnosis of certain tumours. The use of optimal materials and techniques enhance the sensitivity, specificity and reproducibility of these methods. In this article we discuss the common problems of tissue preparation, and antigenic variation, distribution and presentation. However, immunopathological diagnosis has to be accompanied by an in-depth and fundamental understanding of basic immunochemistry and diagnostic immunohistochemistry has to be interpreted in the context of a standard clinical and histopathological examination.

Adrenal carcinoma with reactive plasmacytosis.

An 18 year old boy presented with anaemia, congestive cardiac failure and a 'renal mass'. Preoperative and post-operative investigations demonstrated "reactive plasmacytosis" with antibodies directed against a non-functioning adrenal carcinoma. Existing literature on reactive plasmacytosis and anti-tumour antibodies is summarised.

A study on the prevalence of antibodies to Toxoplasma gondii in Singapore.

The indirect fluorescence antibody technique has been employed to study the prevalence of toxoplasma antibodies in Singapore. 42.5% of clinically suspected cases of toxoplasmosis showed antibody titres. Of these, 17.5% had titres greater than or equal to 1.64. Malays and Indians have higher positive rates compared to the main ethnic group, the Chinese. Antibody titres are found in both males and females and span through the various age groups. The possible mode of transmission is discussed and the importance of congenital toxoplasmosis is indicated.