Study of the Efficacy of Automated Oscillometry in Evaluating Ankle-Brachial Index for the Assessment of Peripheral Arterial Disease in Diabetes Mellitus

Peripheral arterial disease (PAD) is defined as a clinical disorder in which there is stenosis or occlusion in the aorta orarteries of the limbs. Type 2 diabetes is a strong risk factor for atherosclerotic diseases including cardiovascular aswell as peripheral arteries. The risk of development of peripheral arterial disease increases three to four folds inpatients with diabetes.Most diabetic amputations are due to peripheral arterial disease (PAD), peripheral neuropathyand infection. Ankle-brachial index is helpful in assessing the prognosis in the symptomatic as well as asymptomaticpatients in contrast to the variability of pulse assessment and the physical examination. The present study included50 patients with diabetes mellitus for more than ten years, irrespective of their symptoms. ABI was calculated bydividing the ankle systolic blood pressure by the brachial systolic blood pressure of the respective sides. The lowerof the two ABI values for the legs was used to define ankle brachial index. Of 50 patients, 20 had signs of PAD amongwhom 11 (55.0%) had abnormal ABI and 9 (45.0%) had normal ABI. Out of 30 patients with no signs of PAD, 8 (26.7%)had abnormal ABI and 22 (73.3%) had normal ABI. Automated oscillometry method for evaluating ankle-brachialindex for the assessment of peripheral arterial disease in diabetes mellitus had a sensitivity of 68.18%, a specificity of85.71%, positive predictive value (PPV) of 78.95% and negative predictive value (NPV) of 77.42%. The Accuracy ofthe test was 78.0%. Thus, our study has proved that the oscillometric method of ABI is a very useful procedure fordetecting PAD. By repeating the test the sensitivity and specificity may probably increase. The oscillometric methodof performing ABI is a simple procedure, automated, easy to perform, negligible cost of the instrument, does notrequire training and can be performed as an outpatient procedure.

Association of microvascular complications of type 2 diabetes mellitus with ABO blood group

Background: Micro vascular complications are the major outcome of Type 2 Diabetes Mellitus progression, which reduces the quality of life and increases diabetic morbidity & mortality. As the incidence of type 2 diabetes is growing day by day; our search for its aetiology and pathogenesis is also ever growing to predict its risk factors and early screening for better care and prevention of its complications. Many studies have tried to link susceptibility of type 2 diabetes with ABO blood group though results have been inconsistent. The present study aims to analyse association of micro vascular complication with different blood groups if any.Methods: A cross sectional study was conducted among patients of type 2 diabetes Mellitus in a tertiary care hospital. Determination of ABO and Rh status was done by standard slide method of agglutination. Detailed information about age, gender, BMI, duration of diabetes, age of onset of diabetes was noted with the help of a proforma. The records (clinical examination and investigations done by physician) were screened for type of micro vascular complications.Results: Out of a total of 319 patients suffering from type 2 diabetes, 209 subjects (65.15%) had one or the other complications. A statistically significant (p=0.00) difference was observed between the presence or absence of complications in different blood groups. In patients with Blood group B, 76.14% presented with complications. Though Nephropathy was the most common complication observed among different blood groups, none of the type of micro vascular complication was found to be significantly associated with different blood groups.Conclusions: The findings in our study suggest that although there was a significant association between presence or absence of complications and different blood groups, but this association was not significant for different types of complications.

DPPH radical scavenging activity and contents of H2O2, malondialdehyde and proline in determining salinity tolerance in chickpea seedlings.

The involvement of 1, 1-diphenyl-2-picrylhydrazyl (DPPH) radical scavenging activity and contents of H2O2, malondialdehyde (MDA) and proline was investigated in determining salinity tolerance among seedlings of thirty chickpea (Cicer arietinum L.) genotypes having different pedigrees. Chickpea genotypes, including cultivars and advanced lines were grown for 7 days under control and salt stress (50 mM NaCl) conditions. The genotypes showed differential response to salt stress in terms of growth, DPPH radical scavenging activity and contents of H2O2, MDA and proline in seedlings. On the basis of seedling growth, the genotypes having better performance under stress conditions had reduced levels of H2O2 and MDA contents, but increased levels of proline and DPPH radical scavenging activity. Stress tolerance index for these parameters was also determined. Agglomerative hierarchal clustering by Pearson correlation coefficient grouped the genotypes into two major clusters — MC I and MC II. MC II and A1-1 sub-cluster of MC-I comprised mainly of genotypes that showed higher stress resistance levels for the respective parameters in comparison to genotypes in other sub-clusters. Thus, it is possible to identify salt-tolerant genotypes on the basis of above parameters without a field trial.

Attitude and knowledge of healthcare workers in critical areas towards deceased organ donation in a public sector hospital in India

Background. The attitude of healthcare workers towards organ donation can either facilitate or hinder the process of organ donation. We assessed the attitude of healthcare workers employed in intensive or emergency care units of our hospital towards organ donation, and the influence of various factors on willingness for self-organ donation after death. Methods. All doctors, paramedical workers, nursing staff and other staff members working in six distinct intensive or emergency care units in the hospital were requested to fill a completely anonymous, voluntary and self-administered questionnaire. Younger individuals, women and nurses constituted a majority of the study population. Results. The questionnaire completion rate was 99%. About 55% of the study population were agreeable to donating organs after death and 27% were undecided. The factors that positively influenced their willingness to donate organs after death were favourable attitude of the spouse, religious beliefs supporting organ donation, knowledge of hospital’s organ transplant programme, personal experience of the organ donation scenario, having ever donated blood or involvement in social activities, willingness to become an eye donor and willingness to become a living kidney donor. Conclusion. A largely favourable attitude towards organ donation was seen in our study population. However, the study reflects incomplete knowledge leading to confusion and thus, desire to know more among participants with respect to various aspects regarding organ donation. The factors identified that positively influence decisions regarding organ donation can be used as direct interventions.

Cardiotoxicity Profile of Snake Bite.

The present study was conducted in 80 cases of snake bite to understand their possible, biochemical and electrical cardio toxic effects. All patients were subjected to routine and specific investigation (ECG, X Ray, SGOT, CPK, CPK - MB, Troponin levels). Subjects were included in three groups, haemotoxic, neurotoxic and non - envenomed group. They were subjected to investigations at the time of admission, 24 hours and 72 hours after the admission. No significant statistical change occurred in cardiac enzymes in all groups at the time of admission. Significant statistical change occurred in LDH, CPK-MB at 24 hours and 72 hours after admission in haemotoxic group. Significant statistical change occurred in Troponin levels and CPK and SGOT at 24 hours after admission but no statistical change occurred at 72 hours after admission. But there was no statistical significant change in biochemical parameters in a neurotoxic group. At admission, there was tachycardia in 29 cases (53.7%) in haemotoxic group and in 16 cases (29.7%) at 24 hours which was statistically significant. At admission there was bradycardia in 10 cases (18.5%). In neurotoxic group there was tachycardia in 6 (60%) cases at admission and in 2 cases (20%) at 24 hours. There was bradycardia in 1 case in neurotoxic group. No significant change occurred in all groups at 72 hours. The present study showed significant statistical ECG changes at admission in the non - envenomated, neurotoxic and hemotoxic groups in the form of tachycardia or bradycardia. Also significant statistical ECG changes in the form of tachycardia was observed 24 hours after admission in hemotoxic group. It could be concluded that snake bites especially haemotoxic group carry the risk of inducing cardio toxic effects but these effects are not fatal.

Differential antioxidative response of tolerant and sensitive maize (Zea mays L.) genotypes to drought stress at reproductive stage.

The role of oxidative stress management was evaluated in two maize (Zea mays L.) genotypes — Parkash (drought-resistant) and Paras (drought-sensitive), subjected to drought stress during reproductive stage. Alterations in their antioxidant pools — glutathione (GSH) and ascorbic acid (AsA) combined with activities of enzymes glutathione reductase (GR), ascorbate peroxidase (APX), peroxidase (POX) and catalase (CAT) involved in defense against oxidative stress and stress parameters, namely chlorophyll (Chl), hydrogen peroxide (H2O2) and malondialdehyde (MDA) were investigated in flag leaves from silk emergence till maturity. The drought caused transient increase in GR, APX, POX and CAT activities in drought-tolerant genotype (Parkash) which decreased at later stages with the extended period of drought stress. However, in Paras, drought stress caused decrease in activities of GR and CAT from initial period of stress till the end of experiment, except for POX which showed slight increase in activity. A significant increase in GSH content was observed in Parkash till 35 days after silking (DAS), whereas in Paras, GSH content remained lower than irrigated till maturity. Parkash which had higher AsA and Chl contents, also showed lower H2O2 and MDA levels than Paras under drought stress conditions. However, at the later stages, decline in antioxidant enzyme activities in Parkash due to severe drought stress led to enhanced membrane damage, as revealed by the accumulation of MDA. Our data indicated that significant activation of antioxidant system in Parkash might be responsible for its drought-tolerant behavior under drought stress and helped it to cope with the stress up to a definite period. Thus, the results indicate that antioxidant status and lipid peroxidation in flag leaves can be used as indices of drought tolerance in maize plants and also as potential biochemical targets for the crop improvement programmes to develop drought-tolerant cultivars.

Response of antioxidative and ethanolic fermentation enzymes in maize seedlings of tolerant and sensitive genotypes under short term waterlogging.

Fifteen days old seedlings of waterlogging tolerant (Parkash) and sensitive (Paras) maize genotypes were subjected to short term waterlogging (18 h) under field conditions. Activities of various antioxidative and anaerobic metabolism enzymes were investigated in leaf and root tissues. Superoxide dismutase (SOD) activity increased in leaf tissue while glutathione reductase (GR) activity was enhanced in leaf as well as root in both the genotypes. However, tolerant genotype had better induction capability of SOD and GR in roots in comparison with sensitive genotype. Catalase activity increased in roots of both genotypes. Waterlogging caused strong induction in alcohol dehydrogenase activity in the roots of Paras and Parkash under stress conditions. Aldehyde dehydrogenase activity was significantly increased only in roots of Parkash in response to waterlogging. In comparison with sensitive genotype, the tolerant genotype had low H2O2 and malondialdehyde content in roots under stress conditions. The present studies suggested that tolerant genotype had a greater protective ability due to higher induced activities of antioxidant and ethanolic fermentation systems than Paras.

Role of antioxidant and anaerobic metabolism enzymes in providing tolerance to maize (Zea mays L.) seedlings against waterlogging.

The present investigation was undertaken to identify the possible mode of mechanism that could provide tolerance to maize (Zea mays L.) seedlings under waterlogging. Using cup method, a number of maize genotypes were screened on the basis of survival of the seedlings kept under waterlogging. Two tolerant (LM5 and Parkash) and three susceptible (PMH2, JH3459 and LM14) genotypes were selected for the present study. Activities of antioxidant and ethanolic fermentation enzymes and content of hydrogen peroxide (H2O2), glutathione and ascorbic acid were determined in roots of these genotypes after 72 h of waterlogging. Waterlogging treatment caused decline in activities of superoxide dismutase (SOD), catalase (CAT) and ascorbate peroxidase (APX) in all the genotypes. However, only susceptible genotypes showed slight increase in glutathione reductase (GR) activity. Significant reduction in APX/GR ratio in susceptible genotypes might be the cause of their susceptibility to waterlogging. The tolerant seedlings had higher GR activity than susceptible genotypes under unstressed conditions. Stress led to decrease in H2O2 and increase in glutathione content of both tolerant and susceptible genotypes, but only tolerant genotypes exhibited increase in ascorbic acid under waterlogging conditions. In the tolerant genotypes, all the enzymes of anaerobic metabolism viz. alcohol dehydrogenase (ADH), aldehyde dehydrogenase (ALDH) and pyruvate decarboxylase (PDC) were upregulated under waterlogging, whereas in susceptible genotypes, only ADH was upregulated, suggesting that efficient upregulation of entire anaerobic metabolic machinery is essential for providing tolerance against waterlogging. The study provides a possible mechanism for waterlogging tolerance in maize.

Evaluation of oxidative stress tolerance in maize (Zea mays L.) seedlings in response to drought.

Seedlings of selected six genotypes of maize (Zea mays L.) differing in their drought sensitivity (LM5 and Parkash drought-tolerant and PMH2, JH3459, Paras and LM14 as drought-sensitive) were exposed to 72 h drought stress at two leaf stage. Alterations in their antioxidant pools combined with activities of enzymes involved in defense against oxidative stress were investigated in leaves. Activities of some reactive oxygen species (ROS)-scavenging enzymes, catalase (CAT) and ascorbate peroxidase (APX) were enhanced in tolerant genotypes in response to drought stress. Superoxide dismutase (SOD) activity was significantly decreased in sensitive genotypes, but remained unchanged in tolerant genotypes under stress. Peroxidase (POX) activity was significantly induced in tolerant, as well as sensitive genotypes. Imposition of stress led to increase in H2O2 and malondialdehyde (MDA, a marker for lipid peroxidation) content in sensitive genotypes, while in tolerant genotypes no change was observed. Significant increase in glutathione content was observed in sensitive genotypes. Ascorbic acid pool was induced in both tolerant and sensitive genotypes, but induction was more pronounced in tolerant genotypes. Significant activation of antioxidative defence mechanisms correlated with drought-induced oxidative stress tolerance was the characteristic of the drought tolerant genotypes. These studies provide a mechanism for drought tolerance in maize seedlings.

Effect of water deficit on carbohydrate status and enzymes of carbohydrate metabolism in seedlings of wheat cultivars.

The effect of water deficit on carbohydrate status and enzymes of carbohydrate metabolism (alpha and beta amylases, sucrose phosphate synthase, sucrose synthase, acid and alkaline invertases) in wheat (Triticum aestivum L.) was investigated in the seedlings of drought-sensitive (PBW 343) and drought-tolerant (C 306) cultivars. The water deficit was induced by adding 6% mannitol (water potential -0.815 Mpa) in the growth medium. The water deficit reduced starch content in the shoots of tolerant seedlings as compared to the sensitive ones, but increased sucrose content in the shoots and roots of tolerant seedlings, indicating their protective role during stress conditions. It also decreased the alpha-amylase activity in the endosperm of seedlings of both the cultivars, but increased alpha and beta amylase activities in the shoots of tolerant ones. Sucrose phosphate synthase (SPS) activity showed a significant increase at 6 days of seedling growth (DSG) in the shoots of stressed seedlings of tolerant cultivar. However, SPS activity in the roots of stressed seedlings of sensitive cultivar was very low at 4 DSG and appeared significantly only at day 6. Sucrose synthase (SS) activity was lower in the shoots and roots of stressed seedlings of tolerant cultivar than sensitive ones at early stage of seedling growth. Higher acid invertase activity in the shoots of seedlings of tolerant cultivar appeared to be a unique characteristic of this cultivar for stress tolerance. Alkaline invertase activity, although affected under water deficit conditions, but was too low as compared to acid invertase activity to cause any significant affect on sucrose hydrolysis. In conclusion, higher sucrose content with high SPS and low acid invertase and SS activities in the roots under water deficit conditions could be responsible for drought tolerance of C 306.

Sugar signalling and gene expression in relation to carbohydrate metabolism under abiotic stresses in plants.

Sucrose is required for plant growth and development. The sugar status of plant cells is sensed by sensor proteins. The signal generated by signal transduction cascades, which could involve mitogen-activated protein kinases, protein phosphatases, Ca 2+ and calmodulins, results in appropriate gene expression. A variety of genes are either induced or repressed depending upon the status of soluble sugars. Abiotic stresses to plants result in major alterations in sugar status and hence affect the expression of various genes by down- and up-regulating their expression. Hexokinase-dependent and hexokinase-independent pathways are involved in sugar sensing. Sucrose also acts as a signal molecule as it affects the activity of a proton-sucrose symporter. The sucrose trans-porter acts as a sucrose sensor and is involved in phloem loading. Fructokinase may represent an additional sensor that bypasses hexokinase phosphorylation especially when sucrose synthase is dominant. Mutants isolated on the basis of response of germination and seedling growth to sugars and reporter-based screening protocols are being used to study the response of altered sugar status on gene expression. Common cis-acting elements in sugar signalling pathways have been identified. Transgenic plants with elevated levels of sugars/sugar alcohols like fructans, raffinose series oligosaccharides, trehalose and mannitol are tolerant to different stresses but have usually impaired growth. Efforts need to be made to have transgenic plants in which abiotic stress responsive genes are expressed only at the time of adverse environmental conditions instead of being constitutively synthesized.

Applications of inulin and oligofructose in health and nutrition.

Inulin and oligofructose belong to a class of carbohydrates known as fructans. The main sources of inulin and oligofructose that are used in the food industry are chicory and Jerusalem artichoke. Inulin and oligofructose are considered as functional food ingredients since they affect the physiological and biochemical processes in rats and human beings, resulting in better health and reduction in the risk of many diseases. Experimental studies have shown their use as bifidogenic agents, stimulating the immune system of the body, decreasing the pathogenic bacteria in the intestine, relieving constipation, decreasing the risk of osteoporosis by increasing mineral absorption, especially of calcium, reducing the risk of atherosclerosis by lowering the synthesis of triglycerides and fatty acids in the liver and decreasing their level in serum. These fructans modulate the hormonal level of insulin and glucagon, thereby regulating carbohydrate and lipid metabolism by lowering the blood glucose levels; they are also effective in lowering the blood urea and uric acid levels, thereby maintaining the nitrogen balance. Inulin and oligofructose also reduce the incidence of colon cancer. The biochemical basis of these beneficial effects of inulin and oligofructose have been discussed. Oligofructose are non cariogenic as they are not used by Streptococcus mutans to form acids and insoluble glucans that are the main culprits in dental caries. Because of the large number of health promoting functions of inulin and oligofructose, these have wide applications in various types of foods like confectionery, fruit preparations, milk desserts, yogurt and fresh cheese, baked goods, chocolate, ice cream and sauces. Inulin can also be used for the preparation of fructose syrups.