The Determinants o f Leptin Levels i n Obese Diabetics and Non - Obese Diabetics: A Population - Based Cross - Sectional Study

Background: There is an established link between Hyperleptinemia and Obesity. Leptin resistance, characterized by elevated levels of circulating leptin together with disruption of hormone signalling, is an important feature of obesity. Hyperleptinemia has been demonstrated to correlate with insulin resistance. Aims and Objectives: Evaluation of Leptin In Obese and Non - Obese Diabetics. Methods: This cross - sectional study aimed to evaluate the levels of lepti n in non - obese and obese and its relationship. A total of 30 obese diabetics and 30 non - obese diabetics were involved in the study which was conducted in the Department of Physiology, Jawaharlal Nehru Medical College, Aligarh. Collected blood samples were estimated for HbA1C and leptin levels. Body Fat was estimated using Body Stat in Non - Obese Diabetics and Obese Diabetics. Results: In this study, Leptin levels were significantly higher in obese diabetics compared to non - obese diabetics. Data presents cor relations between leptin in obese with HbA1C, BMI, and Body Fat in Obese Conclusion: Elevated Leptin Levels is a strong marker of obesity which suggests Leptin Resistance

ROLE OF DNA REPAIR IN AGING AND MALIGNANCY

DNA repair enzymes are proteins that detect and repair physical damage to DNA induced by radiation, ultraviolet light, or reactive oxygen species. The repair of DNA damage prevents the loss of genetic information, the creation of double-strand breaks, and the formation of DNA crosslinks. The time-dependent reduction of functional properties is known as aging. Mitochondrial malfunction and the buildup of genetic damage are two common factors of aging. In fact, the poor maintenance of nuclear and mitochondrial DNA is likely a major factor in aging. When the DNA repair machinery isn't operating fine, DNA lesions and mutations can occur, which can lead to cancer development. In fact, the poor maintenance of nuclear and mitochondrial DNA is likely a major factor in aging. When the DNA repair enzymes isn't operating fine, DNA lesions and mutations can occur, which can lead to cancer development. The large number of alterations per cell, which can reach 105, has been identified as a driving mechanism in oncogenesis. These findings show that abnormalities in the DNA repair pathway contribute to the senescence as well as cancer. Nucleotide excision repair (NER), base excision repair (BER), double-strand break repair, mismatch repair (MMR), are all major DNA repair processes in mammalian cells. BER excises mostly oxidative and alkylation DNA damage, NER removes bulky, helix-distorting lesions from DNA (e.g., ultraviolet (UV) photodimers), MMR corrects replication errors

A PATH TO EFFECTIVE E-LEARNING IN MEDICAL EDUCATION: BARRIERS AND THEIR SOLUTION

Online learning in medical education is a relatively new concept and one which is rapidly expanding. Recently, due to the global widespread of COVID-19 pandemic, e-learning became the mainstreaming mode of teaching all over the world. Thus, it is critical to assess and work upon the potential challenges, drawbacks and barriers of effective implementation of successful e-learning. The general barriers to e- learning are often encountered as institutional or teaching method norms and technological drawbacks and behavior change in both the learner and the instructor is essential for successful implementation of e- learning in medical education. Although online course delivery has probably eliminated certain barriers that exist in face-to-face classrooms, such as geographic location, transportation issues, architectural and physical impediments, and social contexts which lead to inaccessible learning environments. Thus, it is the responsibility of the medical educators and administrators to look into these challenges and incorporate the solutions which can make begin a new era of better teaching-learning mode of education in medical education in the future This review article analyzes the prominent barriers to e-learning and solutions amongst medical educators to the implementation of online learning in medical education.

BARDET BIEDL SYNDROME IN PREGNANCY A CASE REPORT

Bardet Biedl Syndrome (BBS) is a rare idiopathic autosomal recessive disorder which affects multiple organs and organ systems. In India less than 15 cases have been reported so far. We present case of 41 year old third gravida who presented at 17 weeks of gestation. She had a suspicious history of delayed milestones in the previous child and ultrasound findings of echogenic kidneys, bilateral talipes, and polydactyly. Index child evaluation showed type-6 variant of BBS. Amniocentesis in the present pregnancy showed the same mutation in the fetus. The couple decided on termination of t pregnancy.

Sero-prevalence of toxoplasmosis among pregnant women attending an ante-natal clinic at a teaching hospital in Al Kharj, Saudi Arabia

@#Toxoplasma gondii (T. gondii) is a zoonotic infection that may be transmitted to human beings either by consumption of raw or uncooked meat or by ingesting oocysts. Toxoplasma organisms can cross blood placenta barrier and may result in congenital toxoplasmosis. About 80% of immunocompetent individuals do not show any clinical manifestations and are silent carriers of this disease. Pregnant women especially in highly prevalent areas are recommended to be screened for this disease in order to prevent the potential vertical transmission. To our knowledge no such study has been conducted in this region of Saudi Arabia. This study attempted to carry out two objectives: first, to find out the seroprevalence of T. gondii infection in pregnant women attending prenatal care services in our hospital; second, to find out risk factors associated with T. gondii seroprevalence in our patients. It was carried out in Teaching Hospital in Al-Kharj over a period of one year. All 306 pregnant women attending antenatal clinic were involved in the study. A pretested selfexplanatory questionnaire was filled out by the patients and their sera were collected to be tested for IgG and/or IgM against T. gondii. The results were then statistically analyzed using SPSS software and p-value was calculated using Pearson Chi Square test. Out of the 306 blood samples tested, 99 (32.4%) were seropositive for specific anti T. gondii IgG antibodies and 3(1%) were seropositive for IgM. This show that seroprevalence of T. gondii antibodies was high among pregnant women and the prevalence showed a significant association with age. The study recommends conducting educational programs to raise awareness among women about risk factors and precautions to be taken.

Hyperlipidemic Platelets in Blood Donors: A Correlative Study in North Indian Population

Background: Elevated plasma levels of low-density lipoproteins are an important risk factor for heart diseases and the premature start of atherosclerosis. Objectives: The aim of this study is to assess the correlation between lipid profile and platelets parameters of blood donors and to find out the association of platelet volume indices with heart diseases. Materials and methods: A cross-sectional study was done involving blood donors (n=80) from the Department of Transfusion Medicine, King George’s Medical University Lucknow (June 2015-December 2015). Medical history from blood donors by questionnaire was taken and lipid levels were analyzed by blood samples. Results: Out of 80 blood samples 30 were hyperlipidemic and 50 were normolipidemic. There was statistical significance in sex age and weight (p=0.05) in hyperlipidemic groups. Platelet parameters were also significantly higher in hyperlipidemic groups as well as a significant association was found between hyperlipidemia on the basis of the donor’s weight and platelet parameters (p=0.05). Conclusion: Elevated platelet volume indices are an increased risk of heart diseases with hyperlipidemia. Further studies on larger sample size need to establish the observation.

Comparison of NCV of Right and Left Limb in Right handed Male Subjects.

Background: Nerve Conduction Velocity is affected by various factors like age gender & temperature. Various studies have been done regarding development of brain and dominance of right or left side, some studies have found differences between left and right hand for nerve conduction. Our aim is to compare NCV of dominant limb to nondominant limb in right hand dominant subjects and to find out if different normal values should be considered in right and left hand. Methods: The Median and Common Peroneal Nerve (CPN) of dominant as well as Non- dominant limb were used for measuring Motor & Sensory Nerve Conduction Velocity (MNCV & SNCV) in age groups of 31-35 and 36- 40 years using Medicaid system. Results: We found p value was insignificant using unpaired t-test for MNCV & SNCV of Median and Common Peroneal Nerve of left and right side. Similarly, the MNCV & SNCV of dominant and nondominant limb for median and CPN were insignificant. Conclusion: Consideration of right or left side dominance is not necessary while measuring NCV in asymptomatic subjects and different set of normal values are not required for right and left hand.

Comparative Study Of Oxidant Antioxidants And Inflammatory Markers Between Obese And Non Obese Newly Diagnosed COPD Patients.

COPD has widespread systemic manifestations. Inflammation plays important role in its pathophysiology. Aim of the present study was to compare markers of oxidative stress and inflammation between obese and non obese COPD patients. The levels of pro inflammatory cytokines CRP, IL6 and TNF α were compared between obese and non-obese subjects by applying student’s t test. Oxidative imbalance was assessed by analyzing MDA and FRAP assay in same subjects. Correlation of BMI with the above study parameters was analyzed using Pearson’s test. Results indicated that levels of CRP, IL6 and TNF α were elevated in obese group as compared to non-obese group (p<0.001). Total antioxidant capacity estimated by FRAP assay was lower (p=0.005) but the levels of oxidants estimated indirectly by MDA was higher (p=0.01) in obese COPD patients. In all COPD patients included in present study BMI correlated inversely with FRAP (r=-0.546, p=0.013), FVC (r=0.548, p=0.012) and FEV1 (r=-0.865, p<0.001). Similarly BMI correlated positively with markers of inflammation namely CRP(r=0.526, p=0.017), IL6(r=0.865, p<0.001), TNF α (r=0.653,p=0.002). Positive correlation of BMI was found with MDA(r=0.536, p=0.015). Conclusion: there is higher inflammation in obesity resulting in oxidant antioxidant imbalance and lung function decline.

Gynecologic-tract sparing extra peritoneal retrograde radical cystectomy with neobladder

OBJECTIVE: We report on a series of female patients with transitional cell carcinoma of the bladder who underwent extraperitoneal retrograde radical cystectomy sparing the female reproductive organs with neobladder creation. MATERIALS AND METHODS: 14 female patients between the ages of 45 and 72 years who underwent gynecologic-tract sparing cystectomy (GTSC) with neobladder between 1997 and 2002 were retrospectively reviewed. Our surgical technique is also described. Radical cystectomy is accomplished by a retrograde method sparing the uterus, adnexa, vagina and distal urethra. An orthotopic neobladder was constructed using small bowel or sigmoid colon, brought extraperitoneally, and anastomosed to the distal urethra. RESULTS: Operating time ranged from 4.5 to six hours with a mean of 5.3 hours. Ten patients were able to void satisfactorily while four required self-catheterization for complete emptying of the bladder. Seven patients were continent day and night and another 7 reported varying degrees of daytime and nighttime incontinence. One patient died of metastases and another of pelvic recurrence. There were no urethral recurrences. Patient satisfaction with the procedure was high. CONCLUSIONS: Gynecologic-tract sparing cystectomy with orthotopic neobladder is a viable alternative in female patients with muscle invasive traditional cell carcinoma of the bladder, providing oncological safety with improved quality of life. Our extraperitoneal technique, which is an extension of our successful experience with retrograde extraperitoneal radical cystectomy in men, minimizes intraoperative complications and simplifies the management of post-operative morbidity with the neobladder.

Surgical management of renal cell carcinoma with inferior vena caval thrombus: a teaching hospital experience.

PURPOSE: To evaluate the outcome of patients of renal cell carcinoma (RCC) with inferior vena caval (IVC) thrombus treated by radical nephrectomy and IVC thrombectomy in terms of clinical and pathological factors and prognosis. MATERIALS AND METHODS: Sixty-three consecutive patients of RCC with IVC thrombus who underwent radical nephrectomy with IVC thrombectomy between June 1993 and May 2003 were included in this retrospective analysis. Data was analyzed in terms of clinical factors, such as level of thrombus and pathological factors, such as grade, local invasion and N status. RESULTS: Tumor thrombus level was infrahepatic in 35 patients, retrohepatic in 20 and suprahepatic in 8, including 5 with right atrial thrombus. The immediate post-operative mortality was 3% and the incidence of major post-operative complications was 34%, but most of them improved after conservative management except one who needed surgery for burst abdomen. The disease free survival (DFS) was 48.5%, 50.6%, 66.6% and 40% for infrahepatic, retrohepatic, suprahepatic and intra-atrial tumors, respectively. Of the histological types, patients with clear cell tumors had the best prognosis; those with granular cell had the worst prognosis (DFS of 53.5% vs 33.3%, though statistically not significant). Grade-2 tumors had better prognosis than grade-4 tumors (DFS 66.6% vs 0%, P < 0.001). Sixty-eight percent of patients without perinephric fat invasion were free of disease as compared to 31% of those with perinephric fat invasion (P < 0.01). Further, N status showed DFS of 60.9% in patients with negative nodes and 30% in patients with positive nodes (P < 0.05). CONCLUSION: Though surgery for RCC with IVC thrombus has high morbidity, it can give good results in terms of prolonged DFS in expert hands. Regarding long-term survival, pathological factors, such as local stage and grade, are more important than clinical factors, such as level of thrombus.

Continuous ambulatory peritoneal dialysis (CRPD)--an initial Indian experience.

Continuous ambulatory peritoneal dialysis (CAPD) is a widely accepted mode of renal replacement therapy. CAPD is largely underutilised in India. Twenty patients of chronic renal failure (CRF) were started on CAPD-10 on the standard straight set, 10 on the Y-set. The efficacy of CAPD was evaluated by assessment of laboratory parameters at the onset and after three months of CAPD. Significant improvements in blood, urea, serum creatinine, serum bicarbonate, serum calcium, serum phosphorous, haemoglobin level and blood pressure were observed. There was a significant deterioration in the serum lipid and protein levels on CAPD. Peritonitis was a major complication observed. On the standard set the incidence of peritonitis was one episode per 5.92 patient months compared to one episode per 19.33 patient months with the Y-set (P value = 0.05). Peritonitis occurred more frequently in the summer months. At the end of one year, 70% patients continued on CAPD, with 3 deaths, one each due to malnutrition, myocardial infarction and tunnel infection. Three patients switched over to other replacement therapies. To conclude, CAPD can emerge as a safe, viable mode of renal replacement in developing countries like India.

Protective effect of capsaicin on the osmotic fragility of human erythrocytes.

Capsaicin exerts a stabilizing effect on erythrocytes making them more resistant to lysis under hypotonic stress. The protective action of capsaicin on osmotic fragility (OF) was not receptor mediated since no dose responsive effect was observed. The results suggest that this protective effect of capsaicin on OF is due to a direct interaction of capsaicin with the erythrocyte membrane rather than due to any alteration in the intracellular metabolism of erythrocytes.

The 1996 outbreak of dengue hemorrhagic fever in Delhi, India.

A major outbreak of dengue hemorrhagic fever (DHF) affected more than 10,000 people in Delhi and neighboring areas in 1996. The outbreak started in September, peaked in October to November and lasted till early December. The clinical and laboratory data of 515 adult patients admitted to Lok Nayak Hospital, New Delhi were reviewed. Fever (100%), myalgias and malaise (96%), abdominal pain (10.2%) and vomiting (8.7%) were the prominent presenting features. Hemorrhagic manifestations were seen in all patients- a positive tourniquet test (21.2%), scattered petechial rash (23.07%), confluent rash (2.7%), epistaxis (38.4%), gum bleeds (28.06%) and hematemesis (22.86%) being the major bleeding manifestations. Hepatomegaly was observed in 96% of the patients. Laboratory investigations revealed thrombocytopenia, hemoconcentration and leukopenia. Serological confirmation with a microcapture ELISA technic was done in 143/515 patients. The mortality rate was 6.6% and, multiple bleeding manifestations, severe thrombocytopenia, hypoproteinemia and dengue shock syndrome (DSS) were associated with a higher mortality.

Senior-Loken syndrome with unusual manifestations.

The Senior-Loken syndrome, also called Hereditary Renal Retinal Dystrophy is a rare disorder that combines a juvenile nephronophthisis-like disease with tapetoretinal degeneration. We are reporting a family in which two, possibly three siblings are affected by this disorder. In addition to these two documented components of the disease, our patients also have unusual manifestations: short stature; skeletal abnormalities in the form of kyphoscoliosis, short metacarpals; and cutis laxa-unreported so far.

Angiotensin converting enzyme inhibitors and cough--a north Indian study.

Cough is an important side effect of Angiotensin Converting Enzyme Inhibitor (ACEI) therapy. The incidence of cough was investigated in a prospective 8 week study in 250 hypertensive patients receiving ACEI alone or in combination with other agents. Enalapril (5-20 mg/day), Lisinopril (5-20 mg/day), Captopril (25-75 mg/day) or Ramipril (5-15 mg/day) was prescribed to patients, who were followed up at weekly visits. Cough developed in 73 of the 250 patients i.e. an incidence of 29.2%. Females had a higher incidence of cough as compared to males--37.9% versus 15.5% (p < 0.001) and there was no significant difference in the cough incidence in the various age groups. A dry, non-productive cough developed in all patients within 4 weeks of ACEI initiation. Increased nocturnal intensity of cough was reported by 79.4% patients. Cough incidence was 34.4%, 24.3% and 18.1% in patients on Enalapril, Ramipril and Lisinopril, respectively. Cough was not dose related and was not related to smoking. There was no statistically significant difference among patients on ACEI alone or in combination with beta blockers, calcium channel blockers or diuretics. Of the 18 patients with ACEI induced cough who received Indomethacin, 50 mg bid, 8 reported complete cure and cough was reduced in intensity in the remaining ten.

Insulin-mimetic effect of (-) epicatechin on osmotic fragility of human erythrocytes.

(-) Epicatechin, a benzopyran extracted from the bark of Pterocarpus marsupium, is reported to have insulin like activity. The present work is undertaken to study the effect of insulin on erythrocyte osmotic fragility (OF) and then to evaluate the insulin-like role of (-) epicatechin on human erythrocytes. Insulin exerts a protective effect on erythrocyte OF and shows a dose response which is similar to other typical insulin effects i.e. a maximum at 0.1 nM and a lower effect at higher and lower concentration. (-) Epicatechin (1 mM) also shows protective effect, similar to insulin, on the OF. Ouabain (1 mM) has completely abolished the insulin effect on OF, and failed to have any effect on the action of (-) epicatechin, showing that (-) epicatechin and insulin act by a different mechanism of action while eliciting their protective effects on red cell OF.