Serum Levels of Activin A: Predictor of Insulin Resistance and Atherosclerosis in Prediabetics

Background: Pathological effects of dysglycemia and insulin resistance on atherosclerosis and cardiac remodeling starts as early as in the prediabetic state before the onset of overt diabetes. Activin A is a molecule with multiple functions, including an important part in glucose homeostatic mechanisms as well as inflammatory processes and is therefore being researched as a useful novel biomarker for prompt recognition of the risk of cardiovascular disease (CVD) in prediabetic individuals, thereby helping in disease prognostication and early institution of therapeutic measures. Objective: The study aimed to measure serum levels of activin A in prediabetic patients and evaluate them in comparison to normoglycemic controls. The association of activin A with carotid intima media thickness (CIMT), left ventricular diastolic dysfunction (LVDD), and homeostatic assessment of insulin resistance (HOMA-IR) was also studied. Materials and methods: A total of 60 prediabetic cases and 60 normoglycemic control subjects [matched as per age, gender, and body mass index (BMI)] were recruited. Measurement of serum glucose levels (fasting and postprandial) and fasting insulin levels and glycated hemoglobin (HbA1c) levels were done in all the subjects. The values of HOMA-IR were computed using established formulae. Enzyme-linked immunosorbent assay (ELISA) kits were used for the evaluation of serum levels of activin A in both groups. Parameters for the two groups were compared. In the cases, CIMT (using B-mode ultrasound) and LVDD (using two-dimensional (2D) echocardiography) were measured and correlated with activin A levels. Results: Serum fasting insulin (mIU/L) was considerably higher in cases than in the controls (p < 0.001). HOMA-IR median [interquartile range (IQR)] was 4 (3.25–4.93) in some cases, and that in the control group was 1.2 (0.88–1.5) (p < 0.001). Serum activin A levels in the cases group had a median (IQR) of 263.55 (227.1–279.5) ng/mL, which was substantially greater as compared to the control group 159.9 (150.7–178.7) ng/mL (p < 0.001). A significant positive association of serum activin A levels with HOMA-IR (? = 0.75, p < 0.001) and CIMT (? = 0.50, p < 0.001) was found. In LVDD grade I and II groups, the serum levels of activin A were 257.86 (219.3–271.2) ng/mL and 269 (244.19–291.5) ng/mL, respectively (p = 0.12). Conclusion: A substantial proportion of morbidity and mortality related to dysglycemic states can be attributed to cardiovascular complications. Elevated levels of activin A in prediabetes can act as an indicator of subclinical CVD leading to early diagnosis and intervention.

Medical students’ perception of online learning during COVID-19 pandemic in India-a survey

Background: The COVID-19 pandemic situation has immensely affected teaching in all institutions, especially in medical colleges. To minimize the impact of lockdown, current technology enabled online learning (E-learning) to be the important method of teaching the student during the COVID-19 pandemic. Aim and Objectives: The main objective of the present study to analyze perception of online teaching approach of medical students after 1 month of online learning without faceto-face learning. Materials and Methods: A survey was conducted by distributing an online questionnaire to 710 medical students. This research study was conducted from May 15 to May 16, 2021. Data gathered from the survey were analyzed with Epi info 7.1.5.0 software. Results: A total of 452 (63.66%) were male and 258 (36.34%) were female. Learning on your own place (80.1%), ability to stay at home (72.1%), access to online materials (59.2%), and ability to record meeting (49.8%) were the most frequent advantages of e-learning selected by medical students. The majority of students chose lack of interaction with patients (66.8%), technical problems (53.9%), reduced interaction with faculty (50.3%), social isolation (44.9%) as the main disadvantages. E-learning was considered less effective than face-to-face learning in terms of increasing skills (M = 2.1, M = 4.6, respectively) (P < 0.001) and social competences (M = 2.8, M = 4.8, respectively) (P < 0.001). Conclusion: The online learning was found to be advantageous as it provided flexibility and convenience for the learners. All these factors should be considered while developing an online course to make it more effective and productive for the learner.

Probiotic and Lifestyle Modification in Obese Pediatrics with Non-Alcoholic Fatty Liver Disease

In the article, “Probiotic and Lifestyle Modification in Obese Pediatrics with Non-Alcoholic Fatty Liver Disease” [1] which appears in Volume 31, Issue 1 of Indian J Community Health, there is a correction in the disclosure of the name of the drug used in the article. At the time of the publication, we were not aware of any legal issues related to the product and the brand, otherwise we would have taken due care and would have mentioned about the “De Simone Formulation” in the article instead of the VSL#3 product. Also, the references we provided in the published article on the usage of VSL#3 in several indications should have been attributed to the De Simone Formulation.

Probiotic and Lifestyle Modification in Obese Pediatrics with Non-Alcoholic Fatty Liver Disease

Background: Non alcoholic fatty liver disease is an upcoming causes of chronic liver disease in pediatric population in Asia. Aims & Objective: To evaluate the potential of probiotic VSL#3 and Lifestyle modification in obese pediatrics with Non alcoholic fatty liver disease (NAFLD). Material & Methods: we conducted clinical trial in 106 obese children in age group of 5 to18 years and divided in to four groups;VSL#3 plus lifestyle intervention (n=26), VSL#3 (n=27), Lifestyle intervention (n=26) and Placebo (n=27) received interventions for four months. To identify NAFLD by ultrasonography, Body mass index (BMI), mid arm circumference (MAC), waist circumference (WC) and triceps skinfold thickness (TSF) were done. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), low-density lipoprotein cholesterol(LDL-c),high-density lipoprotein cholesterol (HDL-c), triglyceride (TG), cholesterol, fasting blood glucose(FBG), high sensitivity C-reactive protein (HSCRP), uric acid, obesity hormones were measured along with their dietary intake at baseline and post trial. Results: VSL#3 plus lifestyle intervention significantly the most pronounced therapy for reducing fatty liver grades, anthropometric with biochemical parameters and beneficial impact on obesity hormones (p<0.001) as compared to single therapy of VSL#3 and lifestyle intervention alone. Conclusion: Combined therapy of VSL#3 plus lifestyle intervention is promising treatment for management of NAFLD in Indian obese children.

Incidence and sero epidemiology of brucellosis from a tertiary care centre of rural Maharashtra.

Background: It is usually difficult to diagnose brucellosis clinically in the absence of specific clinical features. Hence serological testing forms the mainstay of diagnosing the disease. Seroepidemiological determinants of brucellosis in rural western Maharashtra have not been closely investigated. Aim: The present study was therefore conducted to determine the incidence and to analyze seroepidemiological determinants of Brucellosis in cases of pyrexia of unknown origin (POU) in rural western Maharashtra. Material and methods: The present hospital based cross sectional survey was carried out in Rural Medical College, Loni on 500 cases of PUO. SPSS version 20.0 was used for analysis. The serum samples were subjected to serological tests like Rose Bengal Plate Test (RBPT) and Standard Tube Agglutination Test (STAT). The inoculated agar plates were watched daily for the presence of growth Brucella on culture. Results: Males (51.6%) outnumbered females (48.4%) in the study sample. Out of 500 cases 10 samples showed the presence of Brucella agglutinins. The male female ratio in the seropositive cases was 2.33:1. Headache and joint pain was observed in 5 and 3 cases respectively. 50% samples yielded the growth of Brucella on culture. All the culture positive samples had titer of 640 IU or more. Conclusion: Agglutination test if properly performed can be used as a very dependable laboratory procedure for rapid diagnosis of Brucellosis.

A Comparative Evaluation of Levobupivacaine Hydrochloride and Levobupivacaine Hydrochloride with Dexmedetomidine in Epidural Anesthesia and Postoperative Pain Relief undergoing Infraumbilical Surgeries.

Epidural anesthesia is a versatile technique which is widely used for surgeries for providing intra- and postoperative analgesia. Several adjuvants have been used to prolong the action of the local anesthetic agent used. Aims and objectives: We performed prospective randomized, double blinded controlled study on 90 patients to compare the effects of adding of dexmedetomidine to levobupivacaine in prolonging the analgesia produced by epidural levobupivacaine alone in patients undergoing infraumbilical surgeries and also compared the duration of motor block and sedation scores. Materials and methods: Ninety American Society of Anesthesiologists (ASA) I and II patients (18-60 years), under going infraumbilical surgery, were prospectively randomized to one of two groups to receive epidural anesthesia with 17 ml of 0.5% levobupivacaine + 3 ml of normal saline (group L) or epidural anesthesia with 17 ml of 0.5% levobupivacaine with 75 mg (0.75 ml) of dexmedetomidine +2.25 ml of normal saline (group LD). Various parameters hemodynamic changes, onset time of sensory and motor blockade, highest level of sensory blockade, duration of sensory and motor block, postoperative pain using visual analog scale (VAS) score, and any side-effects were recorded and data were statistical analyzed using student’s t-test by statistics calculator SPSS software. Results: The two study groups were similar for mean age, weight and duration of surgery. Mean duration of analgesia was significantly longer in group LD (438.33 ± 38.72 min) than in group L(271.2±23.77 min); p<0.05. Onset time of sensory and motor blockade was significantly less in group LD as compared to group L; p< 0.05. Duration of sensory and motor block was significantly higher in group LD when compared tog roup L(p < 0.05). More sedation was observed in group LD. Conclusion: Dexmedetomidine in a dose of 75 µg added as an adjuvant to 0.5% levobupivacaine for epidural anesthesia, during infraumbilical surgeries, prolongs the duration of analgesia of levobupivacaine and increases postoperative sedation, without any other adverse effects.

An update on precancerous lesions of oral cavity.

Oral cancer is the most common head and neck cancer, found in 270,000 patients annually worldwide. Some cancers develop from precancerous lesions; however, there is no definitive clinico pathological factor or biomarker that reliably enables malignant transformation to be predicted in an individual patient. Early detection and early treatment of oral cancer are important for improving the survival rate of patients; prevention of oral cancer will clearly contribute most to decreasing its death rate. So correct diagnosis and timely treatment of premalignant lesions with high risk of malignant transformation may help to prevent malignant transformation.

Comparative study on the effect of chemicals on Alternaria blight in Indian mustard - A multi-location study in India.

High severity of Alternaria blight disease is a major constraint in production of rapeseed-mustard in India. The aim of this study was to investigate the suppressive potential of chemicals viz., zinc sulphate, borax, sulphur, potash and calcium sulphate, aqueous extracts viz., Eucalyptus globosus (50 g l-1) leaf extract and garlic (Allium sativum) bulb (20 g l-1) extract, cow urine and bio-agents Trichoderma harzianum, Pseudomonas fluorescence in comparison with the recommended chemical fungicide (mancozeb), against foliar disease Alternaria blight of Indian mustard [Brassica juncea (L.) Czern. and Coss] under five different geographical locations of India. Mancozeb recorded the lowest mean severity (leaf: 33.1%; pod: 26.3%) of Alternaria blight with efficacy of garlic bulb extract alone (leaf = 34.4%; pod = 27.3%) or in combination with cow urine (leaf = 34.2%; pod = 28.6%) being statistically at par with the recommended chemical fungicide. Chemicals also proved effective in reducing Alternaria blight severity on leaves and pods of Indian mustard (leaf = 36.3- 37.9%; pod = 27.5-30.1%). The effective treatments besides providing significant reduction in disease severity also enabled increase in dry seed yield of the crop (mancozeb = 2052 kg ha-1; garlic = 2006 kg ha-1; control = 1561 kg ha-1).

Dyslipidemia and Superoxide Dismutase Activity in Children with Down Syndrome.

Introduction: Down Syndrome (trisomy 21) provides an interesting natural model to study atherosclerosis, since these individuals appear to be protected from plaque formation. Methodology: We assessed the lipid levels, and superoxide dismutase (SOD) activity in 32 clinically diagnosed children of Down syndrome and 34 children matched for age and sex as controls. Results: SOD activity was found to be significantly higher (p=0.004) in children with Down Syndrome (mean=313.7 IU/ml) than in controls (mean140.2 IU/ ml). Significantly higher levels of serum triglyceride (154.7 mg/dl) and VLDL (33.9 mg/dl) were observed in Down Syndrome as compared to healthy controls (119.6 mg/dl and 23.9 mg/dl respectively; p<0.05 for each). However, the two groups did not show any significant difference in levels of serum HDL-C, LDL-C. Conclusion: The raised antioxidant activity of SOD, because of over expression of genes situated non chromosome 21, probably offers some protection against the development of atherosclerosis despite the occurrence of dyslipidemia.

Prevention of Radiation Induced Hematological Alterations by Medicinal Plant Rosmarinus Officinalis; in Mice

The modulatory influence of Rosmarinus officinalis (rosemary) leaves extract was investigated in Swiss albino mice at a dose of 3 Gy gamma radiation. For this purpose; adult Swiss albino mice were irradiated with 3 Gy gamma rays in the presence (experimental) or absence (control) of rosemary (1000 mg/kg body wt.). These animals were necropsied and their blood was collected at days 1; 3; 5; 10; 20 and 30 post-irradiation. A decrease in the number of erythrocyte and leucocyte counts; hemoglobin content and hematocrit percentage was scored in the control group; whereas a recovery pattern was recorded in experimental animals and a normal value of hematological parameters were regained by day 30 post-treatment. In irradiated group; glutathione level was registered low in the blood; whereas a significant elevation was estimated in rosemary pre-treated animals. An increase in lipid peroxidation level above normal was evident in serum of irradiated mice; while a significant decrease in such values was noted in rosemary pretreated group. The present study suggests the possible radioprotective ability of rosemary extract

Karyoanomalic frequency during radiation therapy.

AIM: To identify the relationship between the radiosensitivity of oral cancers and to evaluate the dose-dependent relationship of nuclear abnormalities by serial cytology during fractionated radiotherapy in head and neck cancer patients. MATERIALS AND METHODS: 30 patients with histologically proven cases of squamous cell carcinoma were included in the study. Serial scrape smear were taken from the tumor before and during radiotherapy (0 to 24 Gy), and stained with Giemsa and May Grunwald's stain and frequency of micronucleated, binucleated and multinucleated cells were evaluated with the help of light microscope. The counts were expressed per 1000 uninucleated cells. RESULTS: Each parameter showed a statistical increase with increase dose. Before treatment, the mean values of micronucleated cells, binucleated cells and multinucleated cells were 3.5, 10.1 and 4.2. At 4 Gy these were 7.7, 12.0 and 6.2 which further increased with radiation dose; and the mean values were 8.8, 16.2 and 14.9 at 14 Gy and 12.8, 18.5 and 15.1 at 24 Gy. After analysis of p-value, all such abnormal cells showed significant difference (p < 0.0001) with respect to normal subjects. CONCLUSION: Our study results that micronucleus assay is a very useful tool in the assessment of biological damage that can help to identify tumor radiosensitivity.

Chemopreventive action of emblica officinalis on skin carcinogenesis in mice.

Chemoprevention with food phytochemicals is currently regarded as one of the most important strategies for cancer control. Emblica officinalis (Family: Euphorbiaceae) indigenous to India, is valued for its unique tannins and flavanoids, which contain very powerful antioxidant properties. The inhibition of tumor incidences by fruit extract of this plant has been evaluated on two-stage process of skin carcinogenesis in Swiss albino mice, induced by a single application of 7, 12-dimethyabenz(a)anthrecene (100 microg / 100 microl acetone), and two weeks later, promoted by repeated application of croton oil (1% in acetone/thrice a week) till the end of the experiment (16 weeks). The tumor incidence, tumor yield, tumor burdon and cumulative number of papillomas were found to be higher in the control (without EO treatment) as compared to experimental animals (EO treated). The differences in the values of the results of experimental groups were statistically analysed and found to be significant in comparison to the control group (p< 0.05). The present study demonstrates the chemopreventive potential of Emblica officinalis fruit extract on DMBA induced skin tumorigenesis in Swiss albino mice.

Modulatory effect of Mentha piperita (Linn.) on serum phosphatases activity in Swiss albino mice against gamma irradiation.

Mentha extract (ME; 1 g/kg body wt) given orally for three consecutive days prior to whole body irradiation (8 Gy) showed modulation of activity of serum phosphatases in albino mice. Values of acid phosphatase activities were significantly higher in untreated irradiated group throughout the experiment. Irradiated animals pretreated with ME showed significant decline in acid phosphatase activity as compared to untreated irradiated animals at all autopsy intervals and attained normalcy at day 5. A marked decrease in serum alkaline phosphatase activity was recorded in both irradiated groups. However, in ME pretreated irradiated group, values of alkaline phosphatase activity remained significantly higher than untreated irradiated animals at all intervals and attained normalcy from day 5 onwards.

Double blind randomized comparative evaluation of nimesulide and paracetamol as antipyretics.

OBJECTIVE: To compare the efficacy and safety of nimesulide and paracetamol as antipyretic agents. DESIGN: Double blind, randomized clinical trial. METHODS: Hospitalized patients having fever due to a variety of infections were given either drug in a randomized manner. (Nimesulide group = 49, Paracetamol group = 50). Serial axillary temperature was recorded after drug administration and side effects monitored. RESULTS: The mean temperature after one hour of drug administration was significantly lower in nimesulide group (p < 0.05). Significantly fewer doses of nimesulide were required to bring down the temperature on the first day (p < 0.001). The mean maximum temperature recorded on second and third day was significantly lower in the nimesulide group (p < 0.05). Adverse reactions were seen in the form of epigastric pain and vomiting in one patient in Nimesulide group and three in paracetamol group. CONCLUSION: Nimesulide is more effective than paracetamol as an antipyretic agent and is safe for use in infants and children.

Poisoning in children: Indian scenario.

The retrospective data on childhood poisoning from eight regional hospitals in India has been reviewed. The demographic features and types of poisonings encountered have been compared. The analysis of the data indicated that pediatric poisonings constituted 0.23-3.3% of the total poisoning. The mortality ranged from 0.64-11.6% with highest being from Shimla. Accidental poisoning was common involving 50-90% of children below 5 years of age and males outnumbered the females. Suicidal poisoning was seen after 13 years of age and was due to drugs and household chemicals. One of the hospitals in Delhi recorded a very high incidence (66.6%) of drug poisoning in children. The drugs consumed belonged to phenothiazines, antiepileptics and antipyretics. Iron poisoning was seen in younger children. Kerosene was one of the causes of accidental poisoning at all hospitals except Shimla and rural Maharashtra were probably wood charcoal is widely used. Pesticide poisoning was more prevalent in Punjab and West Bengal whereas plant poisoning was very common in Shimla. Significant number of snake envenomation has been recorded from rural Maharashtra. Other less common accidental poisonings in children included alcohol, corrosives, heavy metals, rodenticides, detergents and disinfectants. Thus various regions in the country showed some variation in types and frequency of childhood poisoning which could be attributed to different geographical and socio-economic background.

In vitro effect of Phyllanthus amarus on hepatitis B virus.

To evaluate the effects of P. amarus on hepatitis B virus (HBV) antigens and HBV-DNA, initial ethanolic extract and subsequent fractions of the plants were prepared. The whole plant material was dried, powdered and extracted with alcohol and subsequently fractionated in hexane, chloroform, butanol and finally in water. All the material were tested for in vitro effects on HBsAg, HBeAg and HBV-DNA in serum samples positive for HBV antigens followed by the screening of respective antigens by Elisa. HBV-DNA was determined by molecular hybridization. The extracts were effective against HBV antigens, the butanol extract being the most potent. Further chromatographic fractions showed an enhanced activity. The active fractions inhibited the interaction between HBsAg/HBeAg and their corresponding antibodies suggesting anti-HBs, anti-HBe-like activity and also an effect on HBV-DNA.