Integration of Non Alcoholic Fatty Liver Diseases (NAFLD) into NPCDCS programme: A recent initiative in India

Non-alcoholic fatty liver disease (NAFLD) is an emerging public health problem globally. NAFLD is one of the most common liver diseases worldwide and is the most common cause of abnormal liver enzymes in many developed countries. NAFLD is estimated to afflict approximately 1 billion individuals worldwide. An estimated 20-30 % of general population is afflicted from it globally. In India NAFLD could be a silent epidemic with its prevalence ranging from 9-32%. Studies have shown, strong association of NAFLD with major Non Communicable diseases (NCD) like Diabetes, Obesity, CVD, Chronic Kidney diseases, Cancers, etc. Perceiving the threat of NAFLD and the central role of hepatic accumulation of fat in the pathogenesis of other NCD, the Government of India (GoI) has taken steps to include NAFLD in the public health agenda. It has included it in the national NCD programme, i.e., National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) in 2021. India has become the first country in the world to start a national programme for preventive efforts for NAFLD. The present review describes public health relevance of NAFLD and the process of integration of Non Alcoholic Fatty Liver Diseases (NAFLD) into NPCDCS programme in India.

Liquid biopsy in CNS tumors: Current status & future perspectives

Precise classification of central nervous system (CNS) malignancies is vital for the treatment and prognostication. Identification of noninvasive markers can be of importance to guide treatment decisions and in monitoring treatment response. CNS tumors are classified based on morphology with an essential complement of molecular changes, including mutations, amplifications, and methylation. Neuroimaging is the mainstay for initial diagnosis and monitoring tumor response with obvious limitations of imprecise tumor typing and no information on diagnostic, predictive and prognostic markers. Liquid biopsy has evolved as a diagnostic tool in body fluids and is being investigated as a surrogate for tissue biopsy in managing primary and metastatic brain tumors. Liquid biopsy refers to analyzing biological fluids such as peripheral blood, urine, pleural effusion, ascites, and cerebrospinal fluid (CSF); however, peripheral blood remains the primary source of fluid biopsy. The analytes include cell-free DNA (cfDNA) circulating tumor cells (CTCs), circulating micro RNAs (miRNAs), circulating proteins and extracellular vesicles (EVs). Analysis of these components is actively used for early cancer detection, auxiliary staging, prognosis assessment, detection of minimal residual disease (MRD), and monitoring drug resistance in various solid tumors. In recent years, liquid biopsy has been studied in CNS tumors, and analysis of CTCs and cfDNA have become relevant research topics. In the current review, we have explained the clinical potential of liquid biopsy in CNS tumors to assist in diagnosing and predicting prognosis and response to treatment.

An online cross-sectional study of the psychosocial impact of COVID-19 lockdown on general population of Haryana, India

Background: The coronavirus disease 2019 (COVID-19) pandemic has not only posed serious medical challenges but also significant psychological, social, and economic challenges acutely as well as in the long-term. There is evidence that this pandemic has caused intense psychological distress among people which is further likely to get compounded by administrative decision of nationwide lockdown. Aim: To determine the psychosocial impact of lockdown due to COVID-19 pandemic on the general population of Haryana, India. Method: It was an online cross-sectional study conducted on the general population of Haryana from 15th April to 5th May 2020 using a snowball sampling technique. A pre-tested, self-designed questionnaire comprising three sections, viz. sociodemographic characteristics, general life during lockdown, and psychological impact, was prepared using google forms and the link was sent to the participants through social media. Results: A total of 640 participants responded to the survey within the stipulated time. The most common depressive symptoms were insomnia (56%) followed by hopelessness (45%) and irritability (36%). Hypochondriacal preoccupation and obsessional ruminations were present in 87% and 23% of the respondents respectively. Twenty seven per cent of the people experienced autonomic symptoms of anxiety. Fear of death due to COVID (68.4%) and excessive COVID-related information being circulated through news and social media (26.2%) generated maximum stress. They coped with this stress by engaging themselves with television (TV)/social media (57%) and physical exercises (48.4%). Social life followed by professional life was the most affected facet of life. Lockdown had adversely affected the family bond in one per cent of the participants. Conclusion: The study concludes that lockdown due to COVID-19 pandemic had an adverse psychosocial impact on the general population of Haryana resulting in a magnitude of psychological issues.

Evaluation of skill gaps of health-care leaders in Indian public and private sectors

Background: Indian health care is experiencing a significant shift in terms of requirement of resources and changing demographic pattern. The customer-oriented and quality conscious competitive environment has intensified the need for healthcare organizations to attain higher levels of organizational performance. Competencies of health-care leaders play a pivotal role in deciding the organizational development and strategic growth. A cross-sectional study of select health-care leaders’ of India was done from various hospitals and other health delivery agencies to identify and analyze the gaps in competencies. Objectives: The study objectives were to identify the existing leadership competencies of private and public health-care executives, assess and compare these competencies against standardized leadership models, and recommend key competencies for Indian leaders. Materials and Methods: A cross-sectional study was carried out amidst health-care leaders of India so as to assess their leadership competencies. Health-care leaders of India were identified after focused group discussion and senior health-care leaders such as Directors, Deans, CEOs, and Principals were shortlisted for this study. Two structured questionnaires were administered to health-care leaders of various hospitals in India. The ratings in the questionnaire were on a Likert scale ranging from very poor to excellent. Respondents were asked to self-evaluate various competencies and the same was analyzed using the SPSS statistical software. Interpretation of results of data analysis was done. Ethics Committee Clearance was taken from the institute where the study was done. Results: A total of 300 questionnaires were sent of which 106 questionnaires were completed and returned back by select health-care leaders, 78 were doctors and 28 were nursing executives. The study has been able to identify deficiencies in the perceived “existing competency” and “required competency” levels in the selected competencies amidst public and private sector health executives. Conclusion: The findings of this study suggest that there is deficiency in perceived “existing competency” and “required competency” levels in the selected competencies of health-care leaders both from private and public sectors. Indian health-care leaders are operating at operational level and have not graded themselves highly in transformational roles. There is a need for training to bridge the competency gap of Indian health-care leaders both in public and private sectors.

Endovascular Management of Acute Superior Mesenteric Artery Thrombosis in a Delayed Setting

Acute mesenteric ischemia [AMI] is a life-threatening situation, the diagnosis of which is often missed in early stages. Late diagnosis often precludes endovascular management as the primary treatment. The authors here present a case of seven days history of acute mesenteric ischemia in a young female, who not just benefited from endovascular management, but also a major surgical intervention was avoided andwas discharged from the hospital uneventfully. The decision to consider a patient for endovascular management in a late stage, requires a good interdisciplinary communication and successful outcome in such a scenario is rarely achieved.

Fetal Kidney Length: A Useful Parameter For Ultrasonographic Gestational Age Calculation.

Background & Objective: As the technology used in sonography has become more advanced accurate estimation of gestational age (GA) has become more demanding to plan treatments in pregnancy. Fetal kidney length (FKL) alone or its combination with other biometric parameters can be used in GA calculation more precisely in IInd&IIIrd trimester. Methodology: Two hundred three healthy pregnant females of IInd&IIIrd trimester were analyzed for GA calculation via FKL, Bi parietal diameter (BPD) and femur length (FL) using various lenear regression models. Results: Fetal kidney could be seen easily sonographically at 16thwk of gestation. FL was the most accurate single parameter (SE + 7.95 days) followed by FKL + 9.56days; BPD was the least accurate + 9.86 days. GA can be calculated most accurately by combining FKL with FL and BPD with SE + 7.12 days. Conclusion: FKL is easy to measure in IInd and IIIrd trimester and more accurate than BPD for GA estimation. So FKL could be used alone or easily incorporated into the model for dating pregnancies after 16th wk of gestation, in particular when measurements of BPD and FL are difficult.

Application of genetics and molecular biology in forensic odontology.

Various methods of Forensic Science have been applied to solve many mysteries of world including criminal investigation. Forensic odontology researches are usually associated to the dentist‘s field of action by using bite marks, dental records and radiographs plays an important role in solving many crimes. These methods help in age determination and sex identification of the people who have lost their identity after death. Nevertheless, since the development of genetics and molecular biology there were an increase in number and quality of solved cases. The present article emphasizes the importance to associate certain forensic biology areas to traditional investigation methods in human identification, especially with forensic odontology. It also shows that in some situations, teeth are an important source to genetic analysis and molecular studies. Finally it was concluded that knowledge of forensic genetics applied to traditional forensic investigations would produce an increase of information to Justice.

A profile of abortion cases in a Tertiary Care Hospital.

The present study was conducted in the Department of Obstetrics and Gynaecology in collaboration with Department of Forensic Medicine at Rohilkhand Medical College and Hospital, Bareilly, U.P. between October 2009 and September 2010. A total of 150 married women presented for termination of pregnancy were being studied. 38% of women were in the age group of 26-30 years followed by 34.7% in 18-25 years. Majority (78%) were Hindus; major chunk (74%) belonged to lower class, 57.3% were illiterates, and 74% were from rural background. 84.7% of the patients presented between 5-12 weeks of gestation for termination. Majority (63.3%) were having 1-3 deliveries. 67.3% patients had no history of prior abortion. 54.7% unsuccessfully attempted to terminate the present pregnancy by using various methods. In 30.7% of patient’s unplanned pregnancy was main reason for terminating pregnancy, followed by contraceptive failure (29.3%) and inadequate income (26.7%).

Risk factors for low birth weight (LBW) babies and its medico-legal significance.

Birth weight is the most important factor that affects infant and child mortality. This one year study was conducted in a cohort of pregnant women to study the proportion of low birth weight babies and to find out the socio-economic and maternal risk factors affecting the birth weight of newborns and its medico-legal significance. Information regarding socio-economic status, obstetric history and present pregnancy was collected. These women were followed up till their delivery and birth weight was recorded with 24 hours of delivery. Birth weight was available for 256 births. The overall prevalence of low birth weight was 34.37%. Overall mean birth weight was found to be 2.64±0.444 with 95% confidence interval of 2.59-2.69. Primigravida mothers showed the highest prevalence of low birth weight (30.86%, p< 0.001). The main factors which were significantly associated with LBW were maternal education, stature, age at delivery; short inter pregnancy interval, inadequate antenatal care, and per capita income of family.

Correlation of odontometric measures in sex determination.

Mandibular canines exhibit the greatest sexual dimorphism amongst all teeth. The present study was performed on 400 healthy volunteers (200 males, 200 females) of 17 - 21 years with the aim to investigate whether any correlation existed between odontometric measures including mandibular canine index, and sex determination. Mean value of intercanine distance was higher in males than females and the difference was statistically highly significant (p value<0.01). Comparison of mean values of left and right mandibular canine widths exhibited lesser values in females. The variation in right and left mandibular canine width between males and females was highly significant (p value<0.01). The right and left mandibular canine index (MCI) among genders showed no significant difference. A mesio-distal canine width greater than 7.3 mm was suggestive of male sex. Our study conclusively establishes the existence of a definite statistically significant sexual dimorphism in mandibular canines and that MCI is of limited value.

Removal of colour from textile effluent using cyanobacterial biomass.

The cyanobacterial species were isolated from fresh water pond of Gura-vishnoiyan and were tested for their ability to decolourise the textile effluent. The reduction in colour of textile effluent with the use of dry biomass of Cylindrospermum indicum, Nostoc calcicola, Calothrix weberi was comparatively observed after 2, 4 and 6 days, but maximum colour absorption was observed after 6 days. Calothrix weberi was found the most effective species of cyanobacteria, which can remove the colour intensity upto 85 percent after 6 days of incubation. However, Nostoc calcicola and Cylindrospermum indicum showed 45 percent and 23 percent of colour reduction respectively.

Buildup of heavy metals in soil-water-plant continuum as influenced by irrigation with contaminated effluent.

Accumulation of heavy metals in soil-water-plant continuum as a result of irrigation with metals contaminated effluent has been studied. Effluents being used for irrigating agricultural fields had normal pH 7.3-7.5, high Cr and Cl content as per the prescribed standards for irrigation. Among the heavy metals, buildup of total Iron was highest (9 times) and that of cadmium (1.3 times) was lowest in effluent irrigated soil as compared to tubewell irrigated soils. In most of the hand pump water samples, Pb, Cd and Cr were above the permissible limits for drinking. Bioaccumulation of Pb and Cr in vegetables was found to be above the critical concentrations for plant growth while Pb and Cd were above the prescribed limit in the diet of animals. Most of the heavy metals were above the maximum allowable limit in soil.

Serum adenosine deaminase levels in reactional and non-reactional leprosy.

BACKGROUND AND AIMS: Altered serum adenosine deaminase (ADA) levels have been recorded in various diseases involving lymphocytes and/or lymphoreticular system including leprosy. The study was planned to evaluate alterations in serum ADA levels, if any, in reactional and non-reactional leprosy. METHODS: Eighty patients of leprosy, comprising 60 patients of non-reactional leprosy and 20 patients of reactional leprosy were studied along with 20 normal healthy controls. Five milliliters of venous blood was collected and ADA levels were estimated by the method of Giusti (1974). RESULTS: There were 54 males and 26 females. The age of the patients ranged from 5 years to 62 years. The duration of leprosy ranged from 15 days to 3 years. The mean serum ADA level in normal controls was 10.31 +/- 0.58 u/L. The serum ADA levels were raised in leprosy patients, significantly so in multibacillary patients. The serum ADA levels were higher in patients of leprosy with reaction. CONCLUSIONS: The study showed significantly high serum ADA levels in multibacillary leprosy and this was further increased in patients of leprosy with reaction. This may be because of increased lymphoreticular activity during the reactional phases.

Isolation and characterization of NADP+-linked isocitrate dehydrogenase of germinating pea seeds (Pisum sativum).

NADP+-linked isocitrate dehydrogenase (E.C.1.1.1.42) has been purified to homogeneity from germinating pea seeds. The enzyme is a tetrameric protein (mol wt, about 146,000) made up of apparently identical monomers (subunit mol wt, about 36,000). Thermal inactivation of purified enzyme at 45 degrees and 50 degrees C shows simple first order kinetics. The enzyme shows optimum activity at pH range 7.5-8. Effect of substrate [S] on enzyme activity at different pH (6.5-8) suggests that the proton behaves formally as an "uncompetitive inhibitor". A basic group of the enzyme (site) is protonated in this pH range in the presence of substrate only, with a pKa equal to 6.78. On successive dialysis against EDTA and phosphate buffer, pH 7.8 at 0 degrees C, yields an enzymatically inactive protein showing kinetics of thermal inactivation identical to the untreated (native) enzyme. Maximum enzyme activity is observed in presence of Mn2+ and Mg2+ ions (3.75 mM). Addition of Zn2+, Cd2+, Co2+ and Ca2+ ions brings about partial recovery. Other metal ions Fe2+, Cu2+ and Ni2+ are ineffective.

Raised platelet thiobarbituric acid-reacting substances in proliferative Eales' disease.

BACKGROUND: Platelets are an elective site for oxidative stress owing to their high content of polyunsaturated fatty acid. Increased lipid peroxidation and elevated platelet thiobarbituric acid-reacting substances (TBARS) signal oxidative stress. This possibly leads to retinal neovascularization in Eales' disease. METHODS: TBARS levels were estimated in consecutive cases of Eales' disease with neovascularisation (n = 26), Eales' disease without neovascularisation (n = 17) and healthy controls (n = 17). RESULTS: Platelet TBARS levels in the cases of Eales' disease with neovascularisation, Eales' disease without neovascularisation, and healthy controls were 0.66 +/- 0.1, 0.57 +/- 0.11 and 0.42 +/- 0.14 n moles TBARS formed/hour/10(8) platelets respectively. Student's t-test showed a significant increase in platelet TBARS levels in cases with neovascularisation as compared to cases without neovascularization (p < 0.05) and healthy controls (p < 0.01). CONCLUSION: The increase in platelet TBARS levels in proliferative Eales' disease is consistent with an emerging view that lipid peroxides may be associated with retinal neovascularisation.

Ischemic nephropathy.

Atherosclerotic narrowing of the renal arteries may result in severe consequences including chronic renal ischemia, renal artery atheroembolism and renal vascular hypertension. Ischemic renal disease is increasingly recognised as a potentially treatable cause of chronic renal failure. Its precise prevalence is still poorly determined as there is no population based studies. The patients with ARD, particularly those with high grade stenosis and systolic hypertension are at very high risk for renal atrophy and renal failure. Angiogram is usually required to confirm the diagnosis. However, the diagnosis is likely in the elderly patient with systemic atherosclerosis and hypertension in whom a rapid rise in serum creatinine concentration is associated with decreased renal length. Disease is associated with high mortality when treated medically. In contrast, clinical improvement is reported after renal revascularisation. Therefore, consider the diagnosis in the patients at risk, because revascularisation (surgical or endovascular) can successfully preserve renal function in selected patients.

Protective effect of capsaicin on the osmotic fragility of human erythrocytes.

Capsaicin exerts a stabilizing effect on erythrocytes making them more resistant to lysis under hypotonic stress. The protective action of capsaicin on osmotic fragility (OF) was not receptor mediated since no dose responsive effect was observed. The results suggest that this protective effect of capsaicin on OF is due to a direct interaction of capsaicin with the erythrocyte membrane rather than due to any alteration in the intracellular metabolism of erythrocytes.

QSAR study on 1-benzyl-4[w(substituted phthalimido)alkyl]piperidines:acetyl cholinesterase inhibitors.

QSAR studies on a series of 18 piperidine derivatives, which act as acetyl cholinesterase (AchE) inhibitors, have been performed using van der Waals volume (V omega) and topochemical index (tau). Significant correlations have been obtained, which make it clear that AchE inhibition activity is controlled dominantly by topo chemical index.