Lentinula edodes based GIS mapping, biometabolites and antiinflamatory activity of wild edible mushrooms from tropical 'sacred grove' forests of Meghalaya, India / Mapas basados en GIS deLentinula edodes, biometabolitos y actividad antiinflamatoria de los hongos silvestres comestibles de los bosques tropicales "bosque sagrado" de Meghalaya, India

AbstractThe biodiversity rich state of Meghalaya, India located in the realms of mega-biodiversity hotspots, is home to numerous species of wild edible macrofungi that are used extensively by the mycophillic ethnic population, as a part of their traditional cuisine and medicine systems. However, habitat loss, due to deforestation and climate change, is destroying the natural population of these mushrooms, depleting their availability to the local communities. In the present investigation, a GIS guided habitat search, using Lentinula edodes as a representative species, was used in mapping the habitats of wild edible macrofungi of the study region. Sampling of around 4 000 specimens per distinct morphological type available in the traditional markets and "sacred grove" forests indicated presence of ten common genera, belonging to nine different families of wild edible mushrooms. Nutritional profiling of the representative species Lentinula edodes was carried out by evaluation of its moisture, total fat, crude protein and carbohydrates contents by standard methods. Similarly, bioactive components determination was performed by estimation of total phenols, flavonoids, ascorbic acid, β-carotene and lycopenes. Bioactivity of the mushrooms extracts was studied using the DPPH radical scavenging and Human Red Blood Cell (HRBC) membrane stabilization assays. The present investigation successfully attempted to explore remote sensing technologies and GIS (Geographic Information System) based system to predict the natural habitats of wild edible mushrooms of Meghalaya, India which we believe will lead to the generation of a mushroom specific non-wood forest resource mapping system in the near future. Results of nutritional profiling and biological activity studies on the representative species of wild edible mushrooms from the studied region revealed that it is a rich source of essential nutrients and antioxidants.

ResumenLa rica biodiversidad del estado de Meghalaya, India situado en los reinos de los hotspots mega-biodiversidad es el hogar de numerosas especies de macro hongos silvestres comestibles que se utilizan ampliamente por la población étnica micofílica como parte de su alimentación y medicina tradicional. Sin embargo, la pérdida de hábitat debido a la deforestación y el cambio climático está destruyendo la población natural de estos hongos, que agotan su disponibilidad para las poblaciones locales. En la presente investigación, se utilizó el SIG para la búsqueda guiada de hábitat usando Lentinula edodes como especie representativa en la cartografía de los hábitats de macrohongos silvestres comestibles de la región de estudio. Alrededor de cuatro mil ejemplares de distinto tipo morfológico fueron muestreados según su disponibilidad en los mercados tradicionales y los "sacred grove" (bosques sagrados) lo que indicó la presencia de diez géneros comunes pertenecientes a nueve familias de setas silvestres comestibles. Perfiles nutricionales de las especies representativas Lentinula edodes se llevaron a cabo mediante la evaluación de su humedad, grasa total, proteína cruda y contenido de carbohidratos. Del mismo modo, la determinación de componentes bioactivos se realizó por estimación de fenoles totales, flavonoides, ácido ascórbico, β-caroteno y licopeno. La bioactividad de los extractos de setas se estudió mediante la captación de radicales DPPH y el ensayo de estabilización de la membrana de glóbulos rojos de la sangre humana (hRBC). Los resultados de estudios de perfiles nutricionales y actividad biológica en hongos comestibles revelan que es una fuente rica en nutrientes esenciales y antioxidantes. La presente investigación ha intentado con éxito explorar las tecnologías de teledetección y SIG (Sistema de Información Geográfica) para predecir el hábitat natural de los hongos silvestres comestibles de Meghalaya, India que creemos dará lugar a la generación de un mapeo de los recursos forestales no madereros, específicamente de hongos, en el futuro cercano.

Epiphytic and endophytic bacteria that promote growth of ethnomedicinal plants in the subtropical forests of Meghalaya, India / Bacterias epífitas y endófitas que promueven el crecimiento de plantas etnomedicinales en los bosques subtropicales de Meghalaya, India

The present study was aimed to investigate the endophytic and epiphytic bacteria associated with selected ethnomedicinal plants from the pristine subtropical forests of Meghalaya and analyse them for plant growth promotion and antagonistic ability. This study is an attempt to explore plant associated bacteria which are beneficial to host plants, and thus aid in the conservation of ethnomedicinal plants of the studied subtropical forests, which are dwindling due to exploitation. The plant growth promotion parameters like indole acetic acid (IAA) production, mineral phosphate solubilisation, acid phosphatase activity, presence of 1-aminocyclopropane-1-carboxylic acid deaminase (ACC) gene, nitrogen fixation, cellulose digestion, chitin and pectin degradation were screened among the isolates. The study revealed significant differences in bacterial population not only between the epiphytic and endophytic microhabitats, but also amongst the host plants. Out of the 70 isolated plant associated bacteria, Bacillus sp., Serratia sp., Pseudomonas sp., Pantoea sp., and Lysinibacillus sp. showed potent plant growth promotion properties. Bacillus siamensis C53 and B. subtilis cenB showed significant antagonistic activity against the tested pathogens. This study indicated the isolates inhabiting the plants prevalent in the subtropical sacred forests could be explored for use as plant growth promoters while practising the cultivation and conservation of ethnomedicinal plants. Rev. Biol. Trop. 62 (4): 1295-1308. Epub 2014 December 01.

El presente estudio tuvo como objetivo investigar las bacterias endófitas y epífitas asociadas con plantas medicinales seleccionadas de los bosques subtropicales prístinos de Meghalaya, para estimular el crecimiento de plantas y la capacidad antagónica. Este estudio es un intento de explorar las plantas asociadas a bacterias que benefician a la planta hospedera, y así ayudar en la conservación de plantas medicinales de los bosques subtropicales estudiados, los cuales son cada vez más escasos debido a la explotación. Los parámetros de promoción de crecimiento de las plantas, tales como: índice de producción de ácido acético (IAA), solubilización de fosfato mineral, actividad de la fosfatasa ácida, presencia del gen 1-aminociclopropano-1-ácido carboxílico desaminasa (ACC), fijación de nitrógeno, digestión de celulosa, quitina y pectina fueron seleccionados entre los aislamientos. El estudio reveló diferencias significativas en la población bacteriana, no sólo entre los microhábitats epífitos y endófitos, sino también entre las plantas hospederas. De las 70 bacterias aisladas de plantas asociadas, Bacillus sp., Serratia sp., Pseudomonas sp., Pantoea sp. y Lysinibacillus sp. mostraron potentes propiedades estimulantes del crecimiento vegetal. Bacillus C53 siamensis y B. subtilis cenB mostraron actividad antagónica significativa contra los patógenos probados. Este estudio indicó que los aislamientos que habitan en las plantas predominantes en los bosques sagrados subtropicales podrían explorarse para su uso como promotores del crecimiento vegetal, mientras se practica el cultivo y conservación de plantas medicinales.

Cultivable bacterial diversity along the altitudinal zonation and vegetation range of tropical Eastern Himalaya

The Northeastern part of India sprawls over an area of 262 379km² in the Eastern Himalayan range. This constitutes a biodiversity hotspot with high levels of biodiversity and endemism; unfortunately, is also a poorly known area, especially on its microbial diversity. In this study, we assessed cultivable soil bacterial diversity and distribution from lowlands to highlands (34 to 3 990m.a.s.l.). Soil physico-chemical parameters and forest types across the different altitudes were characterized and correlated with bacterial distribution and diversity. Microbes from the soil samples were grown in Nutrient, Muller Hinton and Luria-Bertani agar plates and were initially characterized using biochemical methods. Parameters like dehydrogenase and urease activities, temperature, moisture content, pH, carbon content, bulk density of the sampled soil were measured for each site. Representative isolates were also subjected to 16S rDNA sequence analysis. A total of 155 cultivable bacterial isolates were characterized which were analyzed for richness, evenness and diversity indices. The tropical and sub-tropical forests supported higher bacterial diversity compared to temperate pine, temperate conifer, and sub-alpine rhododendron forests. The 16S rRNA phylogenetic analysis revealed that Firmicutes was the most common group followed by Proteobacteria and Bacteroidetes. Species belonging to the genera Bacillus and Pseudomonas were the most abundant. Bacterial CFU showed positive but insignificant correlation with soil parameters like pH (r=0.208), soil temperature (r=0.303), ambient temperature (r=0.443), soil carbon content (r=0.525), soil bulk density (r=0.268), soil urease (r=0.549) and soil dehydrogenase (r=0.492). Altitude (r=0.561) and soil moisture content (r=-0.051) showed negative correlation. Altitudinal gradient along with the vegetation and soil physico-chemical parameters were found to influence bacterial diversity and distribution. This study points out that this is a biome with a vast reservoir of bacteria which decrease with increasing altitudes, and highlights the microbiological importance of the poorly studied Eastern Himalayan range, justifying efforts to explore the prevalence of novel species in the biome.

La parte noreste de la India se extiende sobre una superficie de 262 379km² en la cordillera oriental del Himalaya. Es un punto de acceso con altos niveles de biodiversidad y endemismo; desafortunadamente, también es una zona poco conocida, sobre todo su diversidad microbiana. En este estudio se evaluó la diversidad de bacterias cultivables del suelo, su diversidad y distribución de las tierras bajas a las altas (34 a 3 990m.s.n.m). Se caracterizaron los parámetros físico-químicos del suelo y tipos de bosques a lo largo del gradiente altitudinal y se correlacionaron con la distribución y diversidad bacteriana. Los microbios del suelo se cultivaron en placas de agar enriquecido Muller Hinton y Luria-Bertani, e inicialmente se caracterizaron mediante métodos bioquímicos. Parámetros tales como actividad de la deshidrogenasa y ureasa, temperatura, contenido de humedad y de carbono, pH y densidad aparente del suelo se midieron en cada sitio. Aislamientos representativos también se sometieron al análisis secuencial de 16S rADN. Un total de 155 aislamientos bacterianos cultivables se caracterizaron para estimar los índices de riqueza, equidad y diversidad. Los bosques tropicales y subtropicales albergan una mayor diversidad bacteriana en comparación con los bosques templados de pino y coníferas, y los bosques subalpinos de rododendro. El análisis filogenético de 16S rARN reveló que Firmicutes fue el grupo más común, seguido de Proteobacteria y Bacteroidetes. Especies pertenecientes a los géneros Bacillus y Pseudomonas fueron las más abundantes. Las UFC bacterianas mostraron una positiva pero insignificante correlación con los parámetros del suelo, tales como pH (r=0.208), temperatura (r=0.303), temperatura ambiente (r=0.443), contenido de carbón (r=0.525), densidad aparente (r=0.268), ureasa (r=0.549) y deshidrogenasa (r=0.492). La altitud (r=-0.561) y el contenido de humedad del suelo (r=-0.051) mostraron una correlación negativa. Se encontró que el gradiente altitudinal, junto con la vegetación y los parámetros físico-químicos influyeron en la diversidad bacteriana y la distribución. Este estudio señala que este es un bioma con un vasto reservorio de bacterias que disminuyen con la altitud y pone en relieve la importancia microbiológica de la pobremente estudiada zona del este del Himalaya, lo que justifica los esfuerzos para explorar la prevalencia de nuevas especies en el bioma.

Hyperammonemic coma presenting as Hashimoto's encephalopathy.

Hyperammonemia is commonly encountered in active liver disease. Evaluation of patients having hyperammonemia with normal liver function is difficult. We present a case referred to us as undiagnosed hyperammonemic coma with normal liver function, who was subsequently diagnosed to have Hashimoto's encephalopathy. In patients with hyperammonemia without hepatic dysfunction, one must search for the presence of hypothyroidism. Hashimoto's encephalopathy though described to be rare in literature, is often underlooked. In patients with undiagnosed coma, one must look for it as it is easy to diagnose and treat.

Prevalence of metabolic syndrome in an urban Indian diabetic population using the NCEP ATP III guidelines.

OBJECTIVE: To study the prevalence of metabolic syndrome (MetS) in an urban Indian diabetic population. RESEARCH DESIGN AND METHODS: A total of 5088 type 2 diabetes patients (2908 men and 2180 women) presenting to endocrinology clinics at four centers across Mumbai (a large metropolitan city in India) were selected for the study. Anthropometric (waist circumference), clinical (blood pressure) and biochemical (serum triglycerides, HDL, fasting and post-prandial blood glucose) data were recorded. Patients receiving treatment for hypertension or dyslipidemia were also included in the study and these were considered in the diagnosis of MetS even if the parameters were normal. The National Cholesterol Education Program Adult Treatment Panel III guidelines were used to diagnose MetS. The chi-square test was used to determine statistical significance, which was taken as a p value < 0.05. RESULTS: The prevalence of MetS among urban Indian diabetic patients was 77.2% and was significantly higher in women (87.71%) as compared to men (69.33%) (p < 0.0001). The most prevalent risk factors for MetS were hypertension, followed by hypertriglyceridemia, in men, and central obesity, followed by hypertension, min women. CONCLUSIONS: MetS is highly prevalent in the urban Indian diabetic population. It should be identified by regular screening in individuals from the general population to avert or delay the progression to type 2 diabetes in order to reduce diabetes-related morbidity and mortality.

Efficacy, safety and acceptability of biphasic insulin aspart 30 in Indian patients with type 2 diabetes: results from the PRESENT study.

AIM: The Physicians' Routine Evaluation of Safety and Efficacy of NovoMix 30 Therapy (PRESENT) study was done to assess the safety and effectiveness of biphasic insulin aspart 30 (BIAsp 30) in patients with type 2 diabetes mellitus in routine clinical practice. MATERIALS AND METHODS: This was a prospective, multicentric, multinational, observational study in type 2 diabetes patients. The patients were transferred to BIAsp 30 with or without oral antidiabetic drugs (OADs). We present the results of 6 months of treatment in the Indian cohort (n = 3559) with type 2 diabetes mellitus who were inadequately controlled on current treatment. RESULTS: At three and six months, significant reductions from baseline were observed in the mean glycated haemoglobin (HbA1c) (-1.32% and -1.94%), fasting plasma glucose (-56.16 mg/dl and -75.24 mg/dl) and post-prandial plasma glucose (-88.74 mg/dl and -119.16 mg/dl) (p < 0.001). A significantly greater proportion of patients achieved target HbAlc of less than 7% at six months (31.1%), compared with baseline (3.1%), of which 70.4% did not report hypoglycaemia. The rate of total hypoglycaemia was reduced from 3.1 events per patient-year at baseline to 1.5 events per patient-year at end of the study. Episodes were mostly minor and diurnal. Except for two serious adverse drug reactions (ADRs) reported by one patient at 3 months, there were no reports of ADRs during the treatment period. More than 95% of patients and doctors were "very satisfied" or "satisfied" with BIAsp 30 treatment, compared to previous treatment. CONCLUSIONS: The use of BIAsp 30 monotherapy or in combination with OADs in clinical practice was effective and safe in poorly controlled Indian type 2 diabetes patients. Both patients and doctors showed a high degree of treatment satisfaction.

White paper on academic emergency medicine in India: INDO-US Joint Working Group (JWG).

Emergency Medicine (EM) is a new discipline for India. As Medical Council of India (MCI) makes progress in recognizing the need to develop EM residency training programs in India it is important that there exist an established training model for future faculty, residents and medical students. This INDO-US white paper makes a serious attempt to recognize the opportunities and challenges in developing academic emergency medicine in India. The contents of this white paper address the overall scenario and are not targeted towards a person, physician, body, hospital or any other associated entity. This paper emphasizes the importance of MCI recognized training in Emergency Medicine for physicians in India.

Influence of roadside pollution on the phylloplane microbial community of Alnus nepalensis (Betulaceae)

The North Eastern region of India is undergoing industrial development at a faster rate than expected. Roads form the main system of transportation and communication owing to the hilly topography of the region. Automobiles discharge a number of gaseous and trace metal contaminants. Human activities like stone grinding, road construction and sand milling also increase the atmospheric dust and heavy metal contaminant level. These contaminants get settled on leaf surfaces at roadsides and enter in contact with phylloplane microorganisms. This study compares microorganisms on leaf surfaces of alder (Alnus nepalensis (Betulaceae)) on roadside and non-roadside environments. Two sites dominated by alder were selected. One at a busy road intersection on the National Highway no. 44 in Shillong with high traffic density (8 000-9 000 heavy vehicles/day), taken as the polluted site and the other one in a forest approximately 500 m away from the roadside considered as the unpolluted site. Analysis of phylloplane microorganisms, lead, zinc, copper, cadmium and sulphur was carried out from leaves. The bacterial population was higher at the unpolluted site. Bacterial population showed a significant negative correlation with lead, zinc, copper, cadmium and sulphur. Similarly, fungal population was higher at the unpolluted site. A total of 29 fungal species were isolated from the phylloplane of A. nepalensis (polluted site 16 species; unpolluted site 28 species). Some fungal forms like Mortierella sp., Fusarium oxysporum and Aureobasidium pollulans were dominant in the polluted site. Numbers of phylloplane fungi and bacteria were significantly reduced in the polluted site. The correlation coefficient indicated a detrimental effect of metals like lead, zinc, copper, cadmium and sulphur on the microbial community of leaf surfaces. The specificity of certain fungi to the unpolluted site may be attributed to their sensitivity to pollution. The predominance of Aureobasidium pollulans, Fusarium oxysporum and Mortierella sp. in the polluted site may be due to their resistance to pollutants in roadside conditions. Rev. Biol. Trop. 56 (3): 1521-1529. Epub 2008 September 30.

La región nororiental de la India está experimentando un rápido desarrollo industrial y debido a la topografía montañosa de la región, los automóviles descargan variedad de contaminantes. Actividades humanas como moler piedra y construir caminos también aumentan el polvo atmosférico y la contaminación con metales pesados. Este estudio compara microorganismos en superficies foliares del árbol Alnus nepalensis (Betulaceae). Se estudió uno sitio en una intersección de Shillong, con alta densidad de tráfico (8 000-9 000 vehículos pesados/día), tomada como el sitio contaminado, y otro en un bosque aproximadamente a 500 m de la carretera (sitio no contaminado). Se contabilizaron bacterias, hongos, plomo, zinc, cobre, cadmio y sulfuro. La población bacteriana era más alta en el sitio no contaminado. La población bacteriana mostró una correlación negativa significativa con el contenido de plomo, cinc, cobre, cadmio y sulfuro foliares en el sitio contaminado, mientras que en el sitio no contaminado la correlación fue insignificante. La población de hongos también fue más alta en el sitio no contaminado. Un total de 29 especies de hongos fueron aislados A. nepalensis: 16 en el sitio contaminado y 28 en el no contaminado. Algunas especies de hongos como Mortierella sp., Fusarium oxysporum y Aureobasidium pollulans fueron dominantes en el sitio contaminado. El número de hongos y bacterias fue significativamente menor en el sitio contaminado. El coeficiente de correlación indicó un efecto perjudicial de metales como el plomo, el zinc, el cobre, el cadmio y el sulfuro en esta comunidad que habitan superficies de hojas. La especificidad de ciertos hongos al sitio no contaminado se puede atribuir a su sensibilidad a la contaminación. El predominio de Aureobasidium pollulans, Fusarium oxysporum y Mortierella sp. en el sitio contaminado puede ser debido a su resistencia a los agentes contaminadores.

Characterization of adult onset growth hormone deficiency syndrome in patients with hypothalamopituitary diseases: Asian Indian data.

BACKGROUND: Hardly any data is available on Adult onset growth hormone deficiency (AOGHD) in Patients with hypothalamopituitary diseases in India. AIMS: To characterize Asian Indian AOGHD syndrome in hypothalamopituitary diseases. SETTINGS AND DESIGN: Cross-sectional analysis of data from a tertiary care hospital. MATERIALS AND METHODS: Thirty patients with AOGHD were compared with 30 age-, sex-, body mass index-matched controls with respect to endocrine evaluation, biochemistry, body composition (BC), bone mineral density (BMD), cardiovascular risk profile and quality of life (QoL). STATISTICAL ANALYSIS USED: Comparisons were performed using two-tailed Student's test (SPSS Software version 10.0). RESULTS: Most of the patients had abnormal BC with central obesity [Truncal FM (%): males {33.9+/-4.4 (patient) vs. 29.31+/-6.2 (control); P -0.027}; females {39.87+/-5.93 (patient) vs. 35.76+/-3.16 (control); P - 0.025}] and poor QoL. Patients aged over 45 years did not show low bone mass or lipid abnormalities as compared to controls. Low BMD and abnormal lipid profile {Triglycerides [mg/dl]:170.55+/-72.5 (patient) vs101.24+/-31.0 (control); P -0.038}; {very low density lipoprotein cholesterol [mg/dl]: 33.54+/-14.9 (patient) vs. 20.25+/-6.18 (control); P - 0.05} was seen in female patients less than 45 years of age. Conclusions: Male and female (more than 45 years) AOGHD patients have increased cardiovascular risk factors and poor QoL while BMD is unaffected. Females less than 45 years of age have the major characteristics of AOGHD and would be the group to benefit maximally with recombinant human Growth Hormone treatment, which is similar to that in the western literature.

Sudden death due to cardiac toxoplasmosis.

The recognition of cardiac toxoplasmosis has increased in patients with acquired immunodeficiency syndrome. The functional consequences of toxoplasmosis of heart vary considerably depending on the intensity of inflammatory reaction, the extent of involvement of myocardial muscle fibers by necrosis and intramyocytic presence of tachyzoites of Toxoplasma gondii. This report describes a case of toxoplasma myocarditis that lead to fatal cardiac arrest. To the best of our knowledge, this is the first reported case of cardiac toxoplasmosis in the Indian literature, which has manifested as sudden death.

Recurrent Kimura's disease: excellent response to cyclosporine.

Kimura's disease is a chronic inflammatory disorder involving the skin, subcutaneous tissues and lymph nodes, predominantly in the head and neck region. Though surgery, intralesional or systemic steroids or radiation therapy have been the mainstay of treatment recurrence is a common problem. On the basis of occasional case report of Kimura's disease responding to cyclosporine, we attempted oral cyclosporine in our patient with dramatic improvement.

API consensus guidelines for use of antiretroviral therapy in adults (API-ART guidelines). Endorsed by the AIDS Society of India.

With rational use of antiretroviral therapy (ART), human immunodeficiency virus (HIV) infection has been transformed into a chronic manageable illness like diabetes and hypertension. These guidelines provide information on state of art, evidence based approach for use of ART in Indian context. When to initiate ART? Antiretroviral therapy is indicated for all symptomatic HIV infected persons regardless of CD4 counts and plasma viral load (PVL) levels. In asymptomatic patients, ART should be offered when the CD4 counts < 200/mm3 and should be considered in patients with CD4 counts between 200-250/mm3. Therapy is not recommended for patients with CD4 count more than 350/ mm3. Involvement of patient in all treatment decisions and assessing readiness is critical before initiating ART. What to start with? A non-nucleoside reverse transcriptase inhibitor (NNRTI) based regimen is recommended for antiretroviral naïve patients. The choice between nevirapine and efavirenz is based on differences in adverse events profiles; cost and availability of convenient fixed dose combinations and need for concomitant use of rifampicin. A backbone of 2-nucleoside reverse transcriptase inhibitors (NRTIs) is combined with the NNRTI. Various combinations and ART strategies not to be used in clinical practice has been enlisted. How to follow up? Recommendations have been made for baseline evaluation and monitoring of patients on ART. These include guidelines on laboratory and clinical evaluation. A plasma viral load at 6 months after initiation of first-line ART is strongly recommended. Yearly estimation of lipid profile has been recommended. How to identify and manage ART failure? The guidelines recognize the issue of identifying ART failure late if only CD4 counts are used for monitoring. In the absence of resistance testing various second-line regimens have been enlisted. A boosted protease inhibitor based regimen is recommended in this situation to be combined with 2-NRTIs. Special situations Recommendations have been made for use of ART in HIV-TB, HIV-HBV, and HIV-HCV co-infected patients. In patients with active TB and a CD4 count < 200/mm3, initiation of ART is recommended as soon as the anti-TB treatment is tolerated. Efavirenz is the only ARV drug, which can be safely used with rifampicin. In pregnancy use of single dose nevirapine for reducing risk of mother to child transmission of HIV is not recommended, because of the risk of development of resistance. For post-exposure prophylaxis taking ART treatment history of the source patient is crucial in designing an effective regimen.

Pulmonary hydatid cyst in HIV-1 disease.

A 36-year-old male patient, a known case of retroviral disease, presented with clinical features suggestive of pneumonia and was found to have bilateral lower zone lung consolidation which on resolution showed a cystic change on the chest radiograph. A subsequent CT scan revealed the true nature of these cysts to be ruptured pulmonary hydatid cysts showing a 'water lily sign'. The rare association of pulmonary hydatid cyst and HIV from India is described.

Plus minus lid syndrome with ataxia.

Plus minus lid syndrome is an ocular syndrome characterized by unilateral ptosis and contralateral lid retraction. Also when the ipsilateral lid is raised manually, the contralateral retracted lid does not revert. This patient presented with features of plus minus lid syndrome with ataxia due to a vascular mesencephalic lesion.

Designer insulins regimens in clinical practice--pilot multicenter Indian study.

BACKGROUND: Newer insulin analogues viz., premix insulin analogue (biphasic insulin aspart) and insulin glargine are now available in India. A multicenter all-India study was done to document the patient profile and responses to these analogues in routine clinical practice. METHODS: The study was conducted prospectively at 4 diabetes care clinics in different regions of India and collected data on the use of either of the two regimens A. Premix insulin analogue given twice-daily B. Basal-bolus analogue regimen (insulin aspart with every meal and insulin glargine once-a-day at bedtime). The centers collected all data at 3 time-points--baseline, 4 weeks later and end of 12 weeks. The study measures were FPG (fasting plasma glucose), PPPG (postprandial plasma glucose), HbA1c and insulin dose. FPG and PPPG were recorded at each of the three time points. HbA1c was recorded at baseline and end of study. Safety was assessed based on reported adverse drug reactions and occurrence of hypoglycaemias. RESULTS: Data of 145 patients was available for analysis (n=114 on premix insulin analogue and n=31 on basal-bolus analogue regimen). Baseline demography was comparable in the two groups. Both the regimens lowered all blood glucose parameters including HbA1c significantly as compared to baseline. However, the premix insulin analogue fared better than the basal-bolus regimen in lowering HbA1c (1.58 vs. 1.16% respectively; p<0.05). Also 41% more patients in the premix group could achieve target HbA1c of < 7% at the end of study. The mean insulin dose was lower with the premix analogue group at the end of 12 weeks. There was no significant difference between the two groups in terms of change in body weight. No major hypoglycaemias were reported and the percentage of patients experiencing a minor episode was lower with the premix analogue than the basal-bolus regimen both at 4 and 12 weeks (11.4 vs. 35.48%; 16.7 vs. 58.06% respectively). No adverse drug reactions were reported throughout the study. CONCLUSION: We conclude that both premix analogue administered twice a day and four times a day basal bolus regimen appear to be a convenient, safe and effective way of initiating insulin therapy in people with type-2 diabetes. The premix analogues achieves target better than the basal bolus regimen as has better compliance.

The post-prandial state and macrovascular disease: relevance to diabetes mellitus.

There is increasing evidence that the post-prandial state is an important contributing factor to the development of atherosclerosis. In non-diabetic subjects the atherosclerotic risk factors comprised in the categories of lipids, coagulation system and endothelial function may be adversely modified in the post-prandial phase. The generation of an oxidative stress may be the common pathway through which eating may induce these alterations. In diabetic patients these phenomena may be amplified by post-prandial hyperglycemia. There is a growing thought that diabetes is a cardiovascular disease.