Comparative study to evaluate retinal changes using spectral-domain optical coherence tomography in diabetics without diabetic retinopathy

Purpose: To elucidate changes in the neuro?sensory retina at the macula, using spectral?domain optical coherence tomography (SD?OCT) in type 2 diabetics without clinical signs of diabetic retinopathy, and compare with healthy subjects. Methods: This was a cross?sectional observational study, conducted at a tertiary eye institute from November 2018 to March 2020. Type 2 diabetics visiting the outpatient department with normal fundus (without any clinical signs of diabetic retinopathy) were taken as Group 1, and healthy subjects as Group 2. Both underwent recording of visual acuity, intraocular pressure (non?contact tonometry), slit?lamp anterior segment examination, fundus examination using an indirect ophthalmoscope, and macular SD?OCT. SPSS (Statistical Package for Social Sciences) version 20 [IBM SPSS statistics (IBM corp. Armonk, NY, USA released 2011)] was used to perform the statistical analysis of the data entered in the excel sheet. Results: Our study included 440 eyes of 220 subjects, divided equally into two groups. The mean age of patients with diabetes was 58.09 ± 9.42 years, and of controls 57.25 ± 8.91 years. The mean BCVA in group 1 and group 2 was 0.36 ± 0.37 and 0.21 ± 0.24 logMAR, respectively. SD?OCT showed thinning in all areas in group 1 compared to group 2, but statistically significant thinning was seen only in the central subfield (P = 0.0001), temporal parafoveal (P = 0.0001), temporal perifoveal (P = 0.0005), and nasal perifoveal areas (P = 0.023) in group 1. There was a significant inter?eye difference noted between the right and left eyes in nasal and inferior parafovea only in group 1 (P = 0.03). No significant difference was noted between males and females. Conclusion: There was significant macular thinning in diabetics compared with controls, which denotes the occurrence of neuronal damage in these eyes before clinical evidence of diabetic retinopathy.

The role of serum magnesium level in type 2 diabetes mellitus.

Background: Diabetes mellitus is one of the most common metabolic disorder and leading cause of death and disability in the world. The incidence of diabetes is increasing globally and in India. Magnesium depletion has a negative impact on glucose homeostasis and insulin sensitivity in patients with type 2 diabetes. Hypomagnesaemia can lead to development of complications in diabetes. Hence there is need for the study to explore the status of magnesium in type 2 diabetes. Objectives: To estimate and compare the serum magnesium levels in type 2 diabetes patients with age/sex matched non diabetic controls. Methods: A case control study was done in randomly chosen 100 type 2 diabetic patients and 100 non diabetic age/sex matched controls. Estimation of serum magnesium was done by enzymatic end point method. Results: 37% of diabetic patients had low serum magnesium levels (Mg2+ level ≤1.5 mg/dL) and 9 % of controls had low serum magnesium levels. The mean serum magnesium levels were 1.96 ± 0.54 mg/dL and 2.375 ± 0.449 mg/dL in diabetics and controls respectively (P value <0.0001 highly significant). Hypomagnesaemia (Mg2+ level ≤1.5 mg/dL) was correlating with retinopathy (P = 0.041 significant). Conclusion: This study demonstrated that low serum Mg2+ status is common in type 2 diabetes mellitus patients when compared to non-diabetic controls. It may be prudent in clinical practice to periodically monitor plasma Mg2+ concentration in diabetic patients. If plasma Mg2+ is low, an intervention to increase dietary intake of magnesium may be beneficial to prevent the complications.

Epidermal growth factor receptor mutation in non-small-cell lung carcinomas: A retrospective analysis of 1036 lung cancer specimens from a network of tertiary cancer care centers in India.

BACKGROUND: Epidermal growth factor receptor (EGFR) mutation plays a vital role in the prognosis of patients with lung cancer. However, there is a dearth of studies on EGFR mutation in Indian population. In this retrospective study conducted at a network of tertiary cancer care centers across India, we evaluated the proportion of EGFR mutation in patients with non‑small‑cell lung carcinomas (NSCLC). MATERIALS AND METHODS: A total of 1036 cases of non‑small lung cancer were assessed for EGFR mutation status using Scorpion amplified refractory mutation system real time polymerase chain reaction method from fine needle aspiration cytology core biopsy, pleural fluid and cell blocks. For a few cases, macro dissection of tumor from H and E slides was also performed for EGFR analysis. EGFR Status was assessed for the most commonly known driver mutations in Exons 18, 19, 20 and 21, which contributes to a total of 29 somatic mutations including the resistance mutation T790M. RESULTS: Around 39% of the cohort was female and 61% were male. Mutation was positive in 40.3% and negative (wild type) in 59.7%. There was 1.8% mutation in exon 18, 24.6% in exon 19, 1.6% in exon 20 and 12.8% in exon 21. 38.2% had a mutation in a single site and 1.1% had a mutation in two sites. Overall mutation was significant in females (50.5% vs. 33.9%) compared with males (c2 = 28.3, P < 0.001). Mutation was significant in exon 21 (16.8% vs. 10.3%, c2 = 9.44, P = 0.002) and exon 19 (30.7% vs. 20.7%, c2 = 13.2, P < 0.001) in females compared with males. CONCLUSION: EGFR is expressed differentially/ mutated in patients with NSCLC. Further studies to unravel the predictors for acquired genetic alterations of EGFR are needed.

A study of the socio-demographic profile and treatment outcome of paediatric tuberculosis patients in Bangalore Mahanagar Palike area.

Background: Tuberculosis (TB) continues to be one of the most devastating and widespread infections in the world. Of the nine million annual tuberculosis cases, about one million (11%) occur in children (under 15 years of age). Childhood tuberculosis is a neglected aspect of the tuberculosis epidemic. Objectives: To know the socio-demographic profile, type of tuberculosis and treatment outcome in paediatric tuberculosis patients Methodology:The study was conducted in nine Tuberculosis units of Bangalore city from January 2009 to December 2009. Five Tuberculosis units from the nine tuberculosis units were selected by simple random sampling, paediatric patients diagnosed as having TB and registered under RNTCP were included in the study till the sample size of 209 was reached. Data regarding socio-demographic profile and type of TB was collected and the patients were followed up to assess treatment outcome. Results: Most of the patients coming to the RNTCP centres belong to the under-privileged group. Most of the patients were in the age group of 1 to <6 years, (37.7 %), male to female ratio was observed to be 0.6:1. Majority of the patients lived in nuclear families (73.2%), belonged to low socio-economic status (95.5%) and dwelled in overcrowded houses (89.5%). 23% reported history of contact with tuberculosis patients. More than half of the patients (57.4%) were undernurished. In the study, 56.5% had pulmonary TB and 43.5 % had extra-pulmonary TB. 94.7% of the patients completed treatment. Conclusion:Paediatric tuberculosis still continues to be a major problem in one-five years of age who are undernourished and belonging to low socio-economic status.

Improving Physician Referral for Tobacco Cessation Clients of Tobacco Cessation Clinic in South India

The major burden of tobacco related diseases is borne by developing countries. Tobacco cessation is an important step in preventing mortality and morbidity due to tobacco related diseases. The objective of the study was to assess the profile of tobacco users utilizing the services of the district anti tobacco cell in Bangalore. A cross sectional study was carried out in 2009. Total of 122 persons above 18 years old, current tobacco users and who were motivated to quit were interviewed by a trained medical social worker. Information about the socio-demographic profile of the clients, details of tobacco use and nicotine dependence levels using Fagerstrom score was collected. SPSS 16.0 software was used for data analysis. The results have been presented using descriptive statistics and ANOVA tests. The study population was comprised of exclusively males. The mean age was 34.9 years. Seventy four percent (73.8%) were smokers while 26% were users of smokeless tobacco products. Fagerstrom scores showed that majority of tobacco users (54% of smokers and 63% of smokeless tobacco users) had moderate to high nicotine dependence. Most of the clients were self-referred. The average pack years of tobacco use and the mean Fagerstrom score were higher in the physician referred group indicating that physicians have access to tobacco users who could benefit the most from tobacco cessation efforts. Clients attending tobacco cessation clinics tend to have moderate to high tobacco dependence. Health care providers need to put in more efforts to refer tobacco users to tobacco cessation services. Improved physician awareness could help in stepping up tobacco cessation efforts.

Influence of galactose cataract on erythrocytic and lenticular glutathione metabolism in albino rats.

Context: Glutathione depletion has been postulated to be the prime reason for galactose cataract. The current research seeks the prospect of targeting erythrocytes to pursue the lens metabolism by studying the glutathione system. Aims: To study the activity of the glutathione-linked scavenger enzyme system in the erythrocyte and lens of rats with cataract. Materials and Methods: Experiments were conducted in 36 male albino rats weighing 80 ± 20 g of 28 days of age. The rats were divided into two major groups, viz. experimental and control. Six rats in each group were sacrificed every 10 days, for 30 days. Cataract was induced in the experimental group by feeding the rats 30% galactose (w/w). The involvement of reduced glutathione (GSH) and the linked enzymes was studied in the erythrocytes and lens of cataractous as well as control rats. Statistical Analysis: Parametric tests like one-way ANOVA and Student's ‘t’ test were used for comparison. Correlation linear plot was used to compare the erythrocyte and lens metabolism. Results: Theconcentration of GSH and the activity of linked enzymes were found decreased with the progression of cataract, and also in comparison to the control. The same linear fashion was also observed in the erythrocytes. Conclusion: Depletion of GSH was the prime factor for initiating galactose cataract in the rat model. This depletion may in turn result in enzyme inactivation leading to cross-linking of protein and glycation. The correlation analysis specifies that the biochemical mechanism in the erythrocytes and lens is similar in the rat model.

Studies on protein and taurine in normal, senile and diabetic cataractous human lenses.

An attempt has been made to explore the possible role of Taurine in cataractogenesis. Normal lenses were obtained from eye bank donors and cataractous lenses from patients who had undergone surgery for cataract extraction. Lenses were weighed and homogenised. Extraction, isolation and estimation of protein and taurine were carried out. It has been found that the lens wet weight increased progressively with the stage of maturation of cataract, i.e., from mature to hypermature which was significant and also with increase in age. Diabetic cataract group also showed an increase similar to that of senile cataract. Taurine and total protein decreases with different stages of maturation of cataract but not with age. It may be suggested that in the process of development of human senile cataract, there is (a) alteration in the structural integrity and permeability of lens membrane to protein and amino acids including taurine, (b) changes in the lens function including possible inhibition of proteins and amino acids (taurine) synthesis and transport across the cell membrane.

Respiratory functions in Kalaripayattu practitioners.

Kalaripayattu, an ancient traditional martial art form of Kerala, is considered as the basis for all martial arts viz. Karate, Kungfu, etc. physiological studies are more concentrated on Karate, Kungfu and other martial arts due to their global acceptance. Considering the limited knowledge available regarding the physiological profiles of Kalaripayattu practitioners, the present study was taken up for filling the lacunae in the field. Lung function tests were carried out in ten Kalari practitioners. Residual volume was measured by indirect method. Higher lung volumes and flow rates were achieved in Kalari practitioners compared to age and height-matched controls. Better mechanical factors and lower airway resistance influenced during Kalari practice might have benefited in improving hung volumes and flow rates.

Changes in glutathione, glutathione-linked enzymes and hexose monophosphate shunt enzymes in senile cataract.

Changes in glucose-6-phosphate dehydrogenase (G-6-PD), glutathione reductase (GSH-R), reduced glutathione (GSH), glutathione peroxidase (GSH-PO), transketolase (TK) and transaldolase (TA) were studied in lens and red blood cells (RBCs) to understand the possible biochemical mechanisms responsible for the development of senile cataract. The activity of G-6-PD was increased in lens, though not so in erythrocytes during cataractogenesis. A marked decrease was observed in GSH level and GSH-R activity in the lens and RBCs of the cataractous group. The activity of GSH-PO was remarkably high in lens but not in the erythrocytes during the maturity of cataract. The activity of TK decreased gradually in both the lens and erythrocytes. The activity of TA decreased in erythrocytes but increased in the lens with maturation of cataract.

Antioxidant enzymes and peroxidation in galactogenic cataract.

The antioxidant enzymes like catalase and superoxide dismutase (SOD) were studied in erythrocytes and lens at various stages of cataractogenesis in albino rats. The rate of peroxidation was measured by assessing the malondiadehyde (MDA) in lens and plasma. The insoluble and soluble protein fractions were measured in lens to study the protein crosslinkings in relation to the above said parameters. Cataract was induced in albino rats by feeding it with 30% galactose as part of the normal diet (w/w) for 30 days. The results show a decrease of SOD and catalase with concomitant increase of MDA and insoluble protein with the advancement of cataract.

Lung volumes in swimmers performing different styles of swimming.

The alteration of lung volumes in swimmers performing different strokes was the theme of the present study. The study was carried out due to lack of knowledge regarding the lung volumes of different strokers. As the energy expenditure, O2 consumption rate, body movements, viz. arm and leg movements differ with each stroke, the lung function status and mechanics of breathing in swimmers has to cope up with the stroke techniques. Lung volumes, viz. VC, FVC, FEV1 and RVind decrease from resting condition to after swimming performance in freestyle swimmers and butterfly stroke swimmers. The primary reason for the decline in lung volumes after exercise bout, found out from several reports is that it may be due to the fatigue of respiratory muscle. When lung volumes of different swimming strokers were compared with age and height matched controls a higher lung volume were observed in swimmers performing different strokes. Higher breath holding ability of swimmers may facilitate the increase in the strength of respiratory musculature. This may have lead to higher lung volumes in swimmers. From the results of different strokers of swimmers, it is clear that lung volumes differ with respect to the stroke technique employed by the swimmer. Here the age and height, training duration of the swimmers performing different strokes were almost matched, so it is more or less clear that lung volumes are influenced by different swarming strokes. The results of the study can be utilised for the selection trials of swimmers. The study outlines the need for research work in swimmers to be more specific with regard to strokes than generalizing swimmers of different strokes as a category together.

Pulmonary functions in workers of fertiliser and chemical industry.

The present study was undertaken to assess the pulmonary functions in fertiliser and chemical industry workers of Kerala. Pulmonary function test was performed with Vitalograph Compact-II spirometer. Exposure to different chemicals, noxious gases and particulate matter of fertiliser and chemical industry was injurious to the normal pulmonary function. Significant decline in lung volumes, viz. FVC, FEV1, FEV1/FVC% (P < 0.01) and flow rates, viz. FEF25-75%, FEF0.2-1.2, FEF25%, FEF50%, FEF75% (P < 0.01) among non-smokers and smokers than that of normal controls was observed. The findings of this study also suggest that with increased duration of exposure to industrial pollutants, lung volumes and flow rates were significantly reduced in workers.

Lipid peroxidation and diabetic retinopathy.

The high level of glucose in blood for a long duration is the main cause of the development of retinopathy. So yearly screening of patients newly diagnosed with NIDDM diabetes is recommended because rare cases of treatable diabetic retinopathy have occurred early in one course of NIDDM diabetes. Hyperglycaemia leads to non-enzymatic glycosylation of proteins and HbA1C was found increased. Antioxidants such as GSH and SOD level is found decreased in retinopathy conditions due to the higher lipid peroxidation, which is evident from high MDA and DC values. So it can be clearly stated that increase in the free radical by hyperglycaemia, lipid peroxidation and advanced glycosylation endproducts along with decreased antioxidants are the causative agents for the development of retinopathy.

Spirometric impairments in undernourished children.

The present study elucidates the effect of undernutrition on pulmonary functions in children. The study was carried out in healthy normals, wasted, wasted and stunted children. Spirometry was performed with Vitalograph Compact-II spirometer. Wasted, wasted and stunted children showed lower lung volumes, forced mid expiratory flow time and inspiratory flow rates than healthy normals. Wasted and stunted children had lower VC, FVC and FIF50% than wasted children. The reduction in lung volumes and flow rates in wasted children may be due to ventilatory muscle wasting. But in wasted and stunted children along with muscular wasting diminished skeletal growth is also a reason for lower lung functions. No airflow limitation was observed in undernourished children.

Prediction equation for lung functions in South Indian children.

Lung functions including VC, IVC, FVC, FEV0.5, FEV1, PEF, FEF0.2-1.2, FEF25-75%, FEF75-85%, PIF, FMFT, MVV(IND), peak expiratory flow at 25%, 50% and 75% of FVC, peak inspiratory flow at 75%, 50%, 25% and the ratio between different lung volumes were measured with Vitallograph Compact-II spirometer on 109 South Indian school boys in the age group of five to sixteen years. The results show an increase in "lung volumes" and "flow rates" with increase in age, height and weight. FMFT and MVV(IND) also increase with increase in anthropometric measurements. All the lung functions except FEF75-85% and the ratio between different lung volumes show significant positive correlation with age, height and weight. Regression equations were derived for predicting normal lung functions for healthy South Indian boys. Lung volumes and flow rates were lower than North Indian and foreign boys. The decrease in lung functions in South Indian boys were due to their sea level dwelling, dietary habits and comparatively lower anthropometric measurements.

Respiratory function during warm-up exercise in athletes.

The theme of the present study is to stress the importance of duration of warm-up exercise on respiratory functions in athletes. Significant improvements in athletic performance was achieved due to warm-up exercise owing to increase in blood flow, muscle and core temperature. The optimum intensity and duration are required to bring about the desired warm-up. A close examination on respiratory functions and its relationship with exercise has not been studied extensively. The present investigation is to explore the various respiratory functions in relation to the intensity and duration in preadolescent athletes before and after warm-up exercise. The results show a significant increase in vital capacity after 25 min and a significant reduction in FEV0.5, FEF75% and FEF25-75% after 45 min of warm-up exercise. The results suggest that a warm-up exercise of short duration (25 min) and mild intensity was beneficial than long duration (45 min) and intense exercise. Although the performance of athletes was not directly measured during exercise, these data demonstrate the benefit of warm-up.

Pulmonary function studies in rowers.

The present study attempts to investigate the pulmonary functions of snake boat rowers before and after rowing. This is made on 12 healthy traditional snake boat rowers ranging from age 16-23 years of Kavanattinkara boat race, Kottayam, Kerala, India. The pulmonary function tests were carried out with vitallograph compact-II spirometer. The results show a decrease in pulmonary functions "lung volumes" and "flow rates" after rowing in comparison to basal condition.