Effect of methanolic extract of Dendrophthoe falcata leaves on acute hyperglycemic adult zebrafish

Background: Herbs used in medicinal practices by the indigenous healers are found to be of great importance in the management of diseases that are yet to have a cure by the available drugs. Practice of using herbs available in the vicinity by the locals as medication for ailments is a universal phenomenon. Dendropthoe falcata, an arboreal parasitic plant used in the indigenous medicine for the management of diabetes, is explored here for its acute hyperglycemic model adult zebrafishes. Aim and Objectives: The aim of the study was to determine the hypoglycemic effect of the methanolic extract of Dendrophthoe falcata leaves in alloxan-induced acute diabetic adult zebrafish. Materials and Methods: Adult zebrafishes were grouped into five groups with six fishes in each group exposing them to alloxan to induce acute hyperglycemia and then treating them with two test doses of 40 mg/dl and 60 mg/dl of the methanolic extract of the plant extract. Another group was treated with metformin with a dosage of 20 micro moles. Body mass index, blood glucose, and histopathological examination pre- and post-treatment for a period of 14 days were studied. Results: The effect of the herbal extract in both the doses was promising when compared with the standard drug metformin; however, the cytoprotective effect was very predominant with the both doses of the extract. Acute hypoglycemic was comparatively good when compared with the standard group treated with metformin. Conclusion: The antidiabetic effect of the arboreal parasitic plant has been established with a need for further exploration of this plant for a potential drug for diabetes mellitus.

Neuroimaging Profile of drug-resistant Epilepsy from a Tertiary Care Center in South India

Objectives: This study evaluated the perception and practices of health care providers (physicians, diabetologists, and endocrinologists) regarding the treatment of hypertension in patients with diabetes in India. Methods: Health care providers throughout India who treated patients with diabetes and hypertension were invited to participate in an online survey and periodic 21 virtual meetings. They were questioned about their perception and practices in managing these patients, and strategies to improve blood pressure (BP). Results: The online survey was completed by 2,513 health care providers, and 344 participated in virtual meetings. More than 50% reported that 31–50% of their patients with diabetes also had hypertension. Home BP monitoring was recommended by 88%, and lifestyle modifications were consistently recommended. Choice of antihypertensive treatment varied based on comorbidities, and a renin–angiotensin system blocker plus a calcium channel blocker (CCB) was the most common combination for dual antihypertensive therapy. Suggested strategies to improve BP control included patient awareness/education, lifestyle modifications, better follow-up/monitoring, and optimization of therapy. Conclusion: Indian health care providers were aware of clinical recommendations and practices regarding treatment of patients with diabetes and hypertension, and generally make clinical decisions consistent with current guidelines. Optimization of care for these patients is essential to reduce cardiovascular disease risk and improve patient outcomes.

Revamping the role of biofilm regulating operons in device-associated Staphylococci and Pseudomonas aeruginosa.

Extensive use of indwelling devices in modern medicine has revoked higher incidence of device associated infections and most of these devices provide an ideal surface for microbial attachment to form strong biofilms. These obnoxious biofilms are responsible for persistent infections, longer hospitalization and high mortality rate. Gene regulations in bacteria play a significant role in survival, colonization and pathogenesis. Operons being a part of gene regulatory network favour cell colonization and biofilm formation in various pathogens. This review explains the functional role of various operons in biofilm expression and regulation observed in device‑associated pathogens such as Staphylococcus aureus, Staphylococcus epidermidis and Pseudomonas aeruginosa.

Colour preference and light sensitivity in trilobite larvae of mangrove horseshoe crab, Carcinoscopius rotundicauda (Latreille, 1802).

The trilobite larvae of C. rotundicauda were tested to determine their colour preference and light sensitivity until their first moulting (25 days post hatching) under laboratory conditions. Maximum congregation size of the trilobite larvae was found in the white zone respectively where (n= 12) followed by yellow (n= 8) and orange (n= 8), which showed the larval preference for lighter zones. Morisita’s index calculation showed a clumped/aggregated distribution (yellow, blue, orange and white) and uniform/hyper dispersed distribution (green, red and black) for various colours tested. Trilobite larvae showed least preference for brighter regions while tested in the experiment [black; (n=4) and red; (n=5)]. Experiments done to determine the light sensitivity of trilobite larvae showed that the larvae had more preference towards ultraviolet lights. The maximum congregation size of 38.8 and 40.7% of the larvae was encountered under ultraviolet light, when the light sources were kept horizontal and vertical, respectively. Overall, results suggested that the trilobite larvae of C. rotundicauda, preferred light source of shorter wavelengths (UV light) and colours of lighter zone (white, yellow, orange), which might be due to their adaptation to their natural habitat for predator avoidance, prey selection and water quality.

Association of Socioeconomic Status (SES) and Social Support with Depressive Symptoms among the Elderly in Singapore

<p><b>INTRODUCTION</b>Depression in the elderly is a major public health issue. Socioeconomic status (SES) and social support are strong risk factors for depression. This study aimed to investigate the influence of SES and social support in elderly depression, and the modifying effect of social support on the relationship between SES and depression.</p><p><b>MATERIALS AND METHODS</b>A community-based survey was conducted on residents≥60 years old. Depressive symptoms were determined with scores≥5 using the 15-item Geriatric Depression Scale (GDS). Multivariable logistic regression was performed to determine the odds ratio (OR) of depressive symptoms with respect to SES and social support, and interaction terms between the two variables.</p><p><b>RESULTS</b>Of 2447 responses analysed, 188 (7.8%) respondents had depressive symptoms. Living in 2-room housing, living alone/with a domestic helper, infrequent leisure time with children/grandchildren or being childless, and feeling socially isolated were independently associated with depressive symptoms. Relative to residents living with spouse and children in 4-/5-room housing, the highest ORs for depressive symptoms were those living with spouse and children in 2-room (OR: 3.06, P<0.05), followed by living with children only in 3-room (OR: 2.98, P<0.05), and living alone/with a domestic helper in 4-/5-room (OR: 2.73, P<0.05). Living with spouse only appears to buffer against depressive symptoms across socioeconomic classes, although the effect was not statistically significant.</p><p><b>CONCLUSION</b>Low social support and low SES significantly increased the odds of depressive symptoms. The moderating effect of social support on depression was however not consistent across SES groups. Specific interventions need to target different SES groups to better help older adults at risk of developing depression.</p>

Determinants of health-related quality of life among community dwelling elderly

<p><b>INTRODUCTION</b>This study determines the associations between self-reported chronic conditions, limitations in activities of daily living and health-related quality of life (HRQoL) among community dwelling elderly in Singapore.</p><p><b>MATERIALS AND METHODS</b>A population-based cross-sectional survey was conducted among a random sample of 4200 residents from 58 blocks of dwellings in Marine Parade housing estate between April and May 2011. A structured questionnaire was used to collect data on demographic characteristics; chronic disease profile, health screenings, healthcare utilisation, physical activity, activities of daily living (ADL) and functional ability and health related quality of life. Quality of life was assessed using European Quality of life 5 Domain (EQ-5D). Ordinary least squares (OLS) regression was used to identify independent predictors of health related quality of life.</p><p><b>RESULTS</b>A total of 2454 respondents for included for analysis. Most of the respondents were females (57.2%) and aged between 65 and 74 years (48.5%). Among them, 79.1% of the respondents were Chinese. Approximately three-fourth (77.5%) of the survey respondents reported having at least one of the 13 chronic medical conditions; high blood pressure (57.7%), high blood cholesterol (51.6%), diabetes (22.9%) were the most commonly reported conditions. Independent predictors of HRQoL with greatest decrements in EQ-5D index and visual analog scores (VAS) were unemployment, self-reported depression, arthritis and osteoporosis and ADL limitations for activities such as "unable to shower", "unable to do housework" and elderly with depressive symptoms (GDS score≥5).</p><p><b>CONCLUSION</b>The study had identified predictors of HRQoL in elderly Singapore residents and also provides community-based EQ-5D index and VAS scores associated with a wide variety of chronic conditions and ADL limitations.</p>

Right-siting chronic kidney disease care-a survey of general practitioners in Singapore

<p><b>INTRODUCTION</b>Chronic kidney disease (CKD) is a major public health problem in Singapore. Efforts are being made to right-site CKD care (stage 1 to 3) from specialist outpatient clinics (SOCs) to general practitioners (GPs) to ease congestion. This study aims to identify factors influencing screening and management of CKD among GPs in Singapore.</p><p><b>MATERIALS AND METHODS</b>A survey was conducted among the 1202 GPs between April and September 2010. The survey questionnaire was developed in collaboration with experts in nephrology and general practice, it included questions about screening, awareness and management of CKD.</p><p><b>POPULATION STUDIED</b>GPs registered with the National Healthcare Group General Practitioner (NHG GP) partner database.</p><p><b>RESULTS</b>Three hundred and two GPs completed the survey. A total of 70% of the respondents were males and with their median years of practice as 18. A total of 86% of them reported screening for CKD while 50% of GPs were confident of managing patients with CKD stage 1; and 38% of GPs are aware of CKD guidelines. Majority of GPs (64%) agreed that right-siting of early CKD patients would ease congestion at SOCs. Some of the obstacles in CKD management listed by the GPs were lack of patient trust, experience and communication with the specialist and the inability of the patient to pay.</p><p><b>CONCLUSION</b>GPs screen patients for CKD, however their awareness of guidelines is limited. Opportunities exist for improving physician recognition of CKD, awareness of CKD guidelines, improving collaborative care and reimbursement for the patient and the provider. This study has identified factors which when addressed could lead to wider acceptance of CKD right-siting by both the patients and the GPs.</p>

Geriatric syndromes and depressed mood in lower-income Singaporeans with diabetes: implications for diabetes management and health promotion

<p><b>INTRODUCTION</b>This study aims to determine the association of geriatric syndromes and depressed mood among respondents with diabetes in a lower income community; and their association with self-management, lifestyle behaviour, and healthcare utilisation. This paper focuses primarily on the 114 respondents with diabetes aged 50+ to inform policy formulation at the community level.</p><p><b>MATERIALS AND METHODS</b>A pilot community health assessment was conducted in 4 blocks of 1- and 2-room apartments in Toa Payoh district from July to November 2009. Using a standard questionnaire, interviewers conducted face-to-face interviews with household members on chronic diseases, geriatric syndromes and health-related behaviour. Data were analysed using SPSSv15.</p><p><b>RESULTS</b>A total of 795 respondents were assessed with a response rate of 61.8%. Of 515 (64.8%) aged 50+ analysed in this study, 22.1% reported having diabetes, of whom 31.6% reported being depressed. Respondents with diabetes who reported being depressed had a higher prevalence of geriatric syndromes compared with those non-depressed; i.e. functional decline (30.6% vs 5.1%, P <0.001); falls (33.3% vs 10.3%, P = 0.003); stumbling (30.6% vs 10.3%, P = 0.007); urinary incontinence (33.3% vs 5.1%, P <0.001), progressive forgetfulness (27.8% vs 6.4%, P = 0.002) and poor eyesight (22.2% vs 6.4%, P = 0.014). They were less likely to comply with medications (86.1% vs 97.3%, P = 0.026) and performed exercise (13.9% vs 53.8%, P <0.001). More had hospital admissions (13.9% vs 7.7%); and they had more outpatient visits per person (2.4 visits vs 0.9 visits, P = 0.03) at Specialist Outpatient Clinics.</p><p><b>CONCLUSION</b>Geriatric syndromes were associated with the presence of depressed mood among persons with diabetes in the lower income group. As those with depressed mood had more unfavourable self-management and lifestyle behaviour, and utilise higher healthcare services, diabetes management must take these findings into consideration.</p>

The evolving role of the community pharmacist in chronic disease management - a literature review

<p><b>INTRODUCTION</b>We appraised the roles and responsibilities assigned to community pharmacists internationally and in Singapore.</p><p><b>MATERIALS AND METHODS</b>A systematic search of international peer-reviewed literature was undertaken using Medline. Grey literature was identified through generic search engines. The search period was from 1 January 1991 to 30 July 2009. The search criteria were English language manuscripts and search terms "community pharmacist", "community pharmacy", "disease management" and "roles" as a major heading. Boolean operators were used to combine the search terms. Identified abstracts were independently reviewed and the findings were presented as a narrative summary.</p><p><b>RESULTS</b>Overall, we reviewed 115 articles on an abstract level and retrieved 45 of those as full text articles for background information review and inclusion into the evidence report. Of the articles included in the review, 32% were from United Kingdom (UK). Literature highlights the multi-faceted role of the community pharmacist in disease management. Community pharmacists were involved in the management of asthma, arthritis, cardiovascular diseases, diabetes, depression, hypertension, osteoporosis and palliative care either alone or in the disease management team. Evidence of effectiveness for community pharmacy/ community pharmacist interventions exists for lipid, diabetes, and hypertension management and for preventive services such as weight management, osteoporosis prevention and fl u immunisation services. Majority of the community pharmacists in Singapore play the traditional role of dispensing. Attempts by the private community pharmacies to provide some professional services were not successful due to lack of funding. Factors found to impede the growth of community pharmacists are insufficient integration of community pharmacist input into healthcare pathways, poor relationship among pharmacists and physicians, lack of access to patient information, time constraints and inadequate compensation.</p><p><b>CONCLUSION</b>Evidence from observational studies points out the wide range of roles played by the community pharmacist and provides insights into their integration into chronic disease management programmes and health promotion.</p>

Pulmonary function profile in patients with benign goiters without symptoms of respiratory compromise and the early effect of thyroidectomy.

BACKGROUND: A large number of patients in our country develop goiters which seem to be apparently asymptomatic. Conventional radiography does not address the abnormal air flow dynamics. Flow volume loop studies have shown characteristic dampening of both inspiratory and expiratory curves. Pulmonary function tests (PFT) can provide a simple noninvasive method of assessing airway compromise. AIM: To address the effect of longstanding asymptomatic, benign goiter by performing PFT on the preoperative airway dynamics and the early postoperative changes at six weeks. SETTING AND DESIGN: Tertiary care center, Prospective study. MATERIALS AND METHODS: Sixty-four patients with benign goiters were included after they satisfied the necessary exclusion and inclusion criteria. Pulmonary function tests were performed in the pre and postoperative period. STATISTICAL ANALYSIS USED: SPSS ver. 10 software, Pearson's Bivariate correlation and students T test. Results: The preoperative PFT showed significant reduction in the Vital capacity (VC), Forced Vital Capacity (FVC), Forced expiratory volume in one second (FEV1), mid expiratory flow (MEF 25) and MEF 50 in the females and VC, FVC and FEV1 in males. Postoperatively significant improvement was observed in the tidal volume (VT) and FEV1 in the females and airway resistance in males. CONCLUSIONS: Pulmonary function tests can demonstrate the unmanifested abnormal airflow dynamics in benign asymptomatic goiters, which would have otherwise taken years to manifest. This abnormality improved after thyroidectomy, especially the forced expiratory maneuvers. The duration and weight of the goiter correlated well with reduction in FEV1 and its subsequent improvement after surgery in females.

Torsion of appendices epiploicae of the colon: a case report.

Torsion of the appendices epiploicae is a rare surgical entity. It has been described very rarely in the literature. A case of a 33-year-old female presented with acute pain abdomen in the right iliac fossa accompanied with vomiting. On per abdomen examination MacBurney's tenderness was elicited. On exploring the abdomen, the appendix was found to be normal. But one of the nearby appendices epiploicae was found to have undergone torsion. It was resected out and so also the appendix.

Evaluation of new gastro-intestinal prokinetic (ENGIP-II) study.

Non-ulcer dyspepsia is a common clinical disorder characterised by reduced gastric motility. Safety concerns have restricted use of currently available prokinetic drugs. Itopride is a new safer prokinetic drug with dopamine D2 antagonism and acetylcholinesterase inhibitory actions. The ENGIP-II study was conducted to investigate the efficacy, and safety of itopride in patients of non-ulcer dyspepsia. There were significant reductions in upper abdominal pain, heartburn frequency, gastro-oesophageal regurgitation, nausea, bloating, early satiety after meals at day 3 only; whereas significant improvements were noted in belching, anorexia at day 6 and in vomiting at day 9. Thus, ENGIP-II study shows that itopride was well tolerated patients and appears to be the drug of choice in patients with non-ulcer dyspepsia.

Evaluation of new gastro-intestinal prokinetic (ENGIP-I) study.

The ENGIP-I study was conducted to investigate the efficacy, and safety of itopride in patients of gastro-oesophageal reflux disease. There were significant reductions in heartburn frequency, heartburn severity, gastro-oesophageal regurgitation frequency at day 3 only. ENGIP-I study concluded that itopride was well tolerated by patients and appears to be the drug of choice in patients with gastro-oesophageal reflux disease.

Benign gastric teratoma--a case report.

A rare case of benign gastric teratoma occuring in a 9-month child is reported with a brief review of literature.

Cerebral malaria in rural India.

OBJECTIVE: A cross-sectional hospital based study was carried out to investigate clinical features and outcome of cerebral malaria in a rural area. METHODS: All children fulfilling inclusion criteria, were enrolled and were entered on specially designed proforma. Their peripheral smear (PS) were studied based on which the diagnosis was classified as definite cerebral malaria (DCM) and probable cerebral malaria (PCM). RESULT: There were 2991 admissions in pediatric ward, of which 1394 (46.6%) were for fever. Of 781 (56.6%) cases with fever no cause was identified. Of the 56 cases positive for malarial parasite on PS 4.3% were Plasmodium vivax (PV) and 2.8% Plasmodium falciparum (PF). Fifteen patients fulfilled the criteria for study of which 7 were DCM and 8 belonged to PCM group. Twelve (80%) were in school-going age group and M : F ratio was 2 : 1. All patients presented with fever, and CNS involvement, 66.6% had convulsion, 7 developed coma, anaemia was seen in 60%, but only 20% required blood transfusion. Splenomegaly and hepatomegaly was seen in 53.3% and 47% cases respectively.Two patients died, one each in DCM and PCM. Cerebral malaria is a serious complication of severe falciparum malaria and is seen in approximately 32% of PF positive cases. CONCLUSION: PCM is an entity which should be kept in mind when treating fever without definite focus in rural areas, because timely and specific therapy is lifesaving.