Cadmium in Human Diseases: It's More than Just a Mere Metal.

Cadmium (Cd), poisoning has been reported from all around the World, causing many deaths annually. Cd is a toxic heavy metal, and is widely present in environment. It has been reported that chronic Cd exposure is associated with kidney disease, osteoporosis, cardiovascular diseases and cancer. Smoking causes exposure to significantly higher Cd levels in humans. Tobacco smoke transports Cd into the lungs. Blood then transport it to the rest of the body where it increases effects by potentiating Cd that is already present from Cd-rich food. Other high exposures of Cd can occur with people, who live near hazardous waste sites, or factories that release Cd into the air and people who work in the metal refinery industry. Breathing of Cd can severely damage the lungs and may even cause death. Multiple studies have shown an association between environmental exposure to hazardous chemicals including toxic metals and obesity, diabetes, and metabolic syndrome. At the same time, the existing data on the impact of Cd exposure on obesity and diabetes are contradictory. On the converse, results of epidemiologic studies linking Cd exposure and Osteoporosis, overweight or obesity are far less consistent and even conflicting, also depending on differences in exposure levels. In turn, laboratory studies demonstrated that Cd adversely affects adipose tissue physiopathology through several mechanisms, thus contributing to increased insulin resistance and enhancing diabetes. However, intimate biological mechanisms linking Cd exposure with human diseases are still to be adequately investigated. Therefore, the aim of the present review was to explore the impact of Cd exposure and status on the risk of Cd in human diseases.

Heavy carbon nanodots: a new phosphorescent carbon nanostructure.

Carbon nanodots are nanometer sized fluorescent particles studied for their distinct photoluminescent properties and biocompatibility. Although extensive literature reports the modification and application of carbon nanodot fluorescence, little has been published pertaining to phosphorescence emission from carbon nanodots. The use of phosphors in biological imaging can lead to clearer detection, as the long lifetimes of phosphorescent emission permit off-gated collection that avoids noise from biological autofluorescence. Carbon nanodots present a desirable scaffold for this application, with advantageous qualities ranging from photostability to multi-color emission. This research reports the generation of a novel phosphorescent "heavy carbon" nanodot via halogenation of the carbon nanodot structure. By employing a collection pathway that effectively incorporates bromine into the nanostructure, T1 triplet character is introduced, and subsequently phosphorescence is observed in liquid media at room temperature for the first time in the nanodot literature. Further experiments are reported characterizing the conditions of observed phosphorescence and its pH-dependence. Our approach for producing "heavy carbon nanodots" is a low-cost and relatively simple method for generating the phosphorescent nanodots, which sets the foundation for its potential future use as a phosphorescent probe in application.

A Study to derive distribution of carotid intima media thickness and to determine its COrrelation with cardiovascular Risk factors in asymptomatic nationwidE Indian population (SCORE-India).

BACKGROUND: There is presently no data to describe normal distribution of carotid intima-media thickness (CIMT), an established measure of subclinical atherosclerosis, in Indian subjects. METHODS: In this multi-centric study, 1229 subjects with age ≥30 years and no previous cardiovascular disease (CVD) underwent CVD risk factor assessment and CIMT measurement. Mean far wall common carotid artery IMT was measured on both sides and averaged. RESULTS: Mean age of the subjects was 48.0±12.0 years and 54.2% were men. CIMT measurement was feasible in 1157 subjects. Mean, median and 75th percentile values of CIMT for different age-groups were derived for men and women separately. There was a progressive increase in CIMT with increasing age (P<0.001) and men had higher CIMT values than women (0.608±0.12mm vs. 0.579±0.11mm, P<0.001). The CIMT values were also higher in diabetics (0.635±0.10mm) and hypertensives (0.624±0.10mm) as compared to non-diabetics (0.589±0.12mm, P<0.001) and non-hypertensives (0.592±0.12, P 0.02) respectively. Among continuous variables, age, systolic blood pressure and fasting blood glucose had strong to modest correlation with CIMT (Pearson's r 0.524, 0.282 and 0.192 respectively, all P values <0.001), whereas body mass index, diastolic blood pressure and serum triglycerides exhibited weak but still statistically significant relationship (Pearson's r 0.069, P 0.019; Pearson's r 0.065, P 0.026; and Pearson's r 0.094, P 0.001, respectively). CONCLUSIONS: This is the first study to provide age- and gender-specific distribution of CIMT in Indian subjects free from CVD. This information should help facilitate further research and clinical work involving CIMT in India.

Long-Term Therapeutic Plasma Exchange to Prevent End-Stage Kidney Disease in Adult Severe Resistant Henoch-Schonlein Purpura Nephritis.

A 27-year-old man presented with a palpable purpuric skin rash and joint and abdominal pain in April 2010. He had acute kidney injury and his creatinine quickly deteriorated to 687 µmol/L, with associated nephrotic range proteinuria. Kidney biopsy showed crescentic Henoch-Schonlein nephritis. He was treated with intravenous cyclophosphamide and prednisolone despite which his renal function deteriorated; he required haemodialysis for a short duration and seven sessions of therapeutic plasma exchange (TPE). Renal function improved, but after discharge from hospital he suffered 2 further relapses, each with AKI, in 4 months. Cyclophosphamide was not effective and therefore Rituximab was introduced. He initially had a partial response but his renal function deteriorated despite continued therapy. TPE was the only treatment that prevented rapid renal functional deterioration. A novel long-term treatment strategy involving regular TPE every one to two weeks was initiated. This helped to slow his progression to end-stage kidney disease over a 3-year period and to prolong the need for renal replacement therapy over this time.

An observational, cross-sectional study to assess the prevalence of chronic kidney disease in type 2 diabetes patients in India (START -India).

OBJECTIVE: The primary objective of this study is to estimate the prevalence of chronic kidney disease (CKD) among type 2 diabetes mellitus (T2DM) patients in India. MATERIALS AND METHODS: This cross-sectional, observational, epidemiological, multi-center, study is enrolling T2DM patients of either gender aged 30 years or above. This study aimed to enroll a total of 3000 T2DM patients at 30 participating hospitals/clinics across India and the data from a planned interim analysis of 1500 patients are presented here. The primary endpoint of the study is to estimate proportion of T2DM patients with CKD (glomerular filtration rate [GFR] <60 ml/min/1.73 m(2) or albumin creatinine ratio [ACR] ≥30 mg/g or ≥3 mg/mmol or both). Routine treatment, as administered by the treating physician, was continued without any study specific intervention. Patients' data pertaining to demographic characteristics, medical history, current medication and physical examination were recorded. The blood/plasma and urine samples, were collected for estimation of hemoglobin A1c, microalbuminuria, serum creatinine, urine creatinine, and routine urine analysis. ACR was calculated from urine creatinine and albumin while GFR was estimated by using a modification of diet in the renal disease equation. RESULTS: Study recruited 1500 patients from 18 centers across India. The study population included 840 (56.05%) males. Mean age, body mass index and systolic blood pressure were 55.1 years, 27.4 kg/m(2) and 134.5 mmHg respectively. The mean duration of diabetes was 102.2 months. History of co-morbid diseases such as dyslipidemia, hypertension, microvascular complications and macrovascular complications was present in 657 (43.8%), 655 (43.7%), 268 (17.9%) and 104 (6.93%), respectively. This interim analysis revealed that about 46% of the T2DM patients had CKD (urinary albumin creatinine ratio (UACR) ≥30 mg/g and/or estimated GFR [eGFR] <60 mL/min/1.73 m(2)). The renal dysfunction as per eGFR criteria (<60 mL/min/1.73 m(2)) was reported in about 23% while as per UACR criteria (≥30 mg/g) it was reported in about 35% patients. CONCLUSION: This interim analysis results suggests that over 40% of T2DM patients have CKD. Despite this high number of T2DM patients with CKD, eGFR analysis shows there are almost 80% of T2DM patients still have reasonably good renal function (eGFR above 60 ml/min), which ensures less restrictions in selecting oral anti-diabetic drugs. Full study results from Start-India study will provide detail insights into the occurrence of CKD in patients with T2DM in India.

Prevalence of dyslipidemia in adult Indian diabetic patients: A cross sectional study (SOLID).

CONTEXT: India leads the world with largest number of diabetic patients and is often referred to as the diabetes capital of the world. Diabetic dyslipidemia in India is one of the main cause for Coronary Artery Disease (CAD) mortality. Although diabetes continues to be a major lifestyle condition in India, there is a lack of studies in India on whether dyslipidemia in Indian diabetics is being adequately controlled. Our study provides critical insights into the insights into proportion of diabetes patients achieving lipid goal in India. AIMS: The primary objective of our study was to assess the control of dyslipidemia in the Indian diabetic population treated with lipid lowering drugs (LLDs), as per American Diabetes Association (ADA) 2010 guidelines. SETTINGS AND DESIGN: The study was carried out in a real world Indian clinical setting involving 178 sites. This is a multicenter, noninterventional, and cross-sectional observational study. MATERIALS AND METHODS: A total of 5400 adult subjects with established type-2 diabetes mellitus (T2DM) and dyslipidemia were recruited for the study. Patients in the study were on LLD at a stable dose for at least last 3 months before the designated study visit. Routine lipid profile tests were conducted for all patients. STATISTICAL ANALYSIS USED: Descriptive statistics was used to analyze qualitative and discrete variables. Chi-square test and t-test were conducted to assess the existence of statistically significant association between the variables. RESULTS: A total of 5400 patients with T2DM from 178 centers across India were recruited. Out of the total population, 56.75% (N = 3065) of them were males. Primary end-point of low-density lipoprotein cholesterol (LDL-C) level below ADA 2010 target was achieved in a total of 48.74% (N = 2632) patients. Gender was significantly associated with lipid levels and age was significantly (P < 0.05) correlated with all lipid levels. Control rates of other lipid parameters like high-density lipoprotein cholesterol, triglyceride, and total cholesterol in the study were 60.48% (N = 3236), 57.54% (N = 3107), and 92.24% (N = 4981) respectively. Among those with overt cardiovascular disease (CVD), target LDL-C level of < 70 mg/dL was achieved in 22.87% (70 out of 306) patients. The LDL-C levels of 49.03% (N = 1768) patients who were on statin therapy were within target levels, while 53.46% (N = 634) patients who were on statin and their combinations with other LLDs had their LDL-C levels within the stipulated range. CONCLUSIONS: This study has reveled that dyslipidemia control in Indian T2DM patients is very poor with almost half of them not reaching their LDL -C goal. Dyslipidemia being one of the main risk factors for CVD in T2DM patients there is a need to treat dyslipidemia aggressively to reduce risk of future CV events.