Effectiveness of Semmes Weinstein 10 gm monofilament in diabetic peripheral neuropathy taking nerve conduction and autonomic function study as reference tests.

Context: Diabetic peripheral neuropathy (DPN) if detected early can reduce the burden on the health system and prevent the development of diabetic foot ulcers and amputation. Aim: To study the effectiveness of Semmes Weinstein 10 gm monofilament in detecting DPN taking nerve conduction studies (NCS) and autonomic function testing (AFT) as reference tests. Settings and Design: Observational and comparative cross-sectional study conducted in the Physiology department AIIMS, Bhopal in collaboration with the Medicine department of the institute. Methods and Material: A total of 72 diagnosed type-2 diabetes mellitus patients were examined using Semmes Weinstein 10 gm monofilament, DPN was confirmed using NCS (Nihon Kohden Neuropack XI machine) and autonomic neuropathy was confirmed using AFT (Ewing's battery and Power lab) with heart rate variability (HRV). Diagnostic value of Semmes Weinstein 10 gm monofilament taking NCS and AFT as reference test was calculated. Statistical Analysis Used: Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) were calculated using the standard formula. Results: Sensitivity, specificity, PPV, and NPV using monofilament are 69.23%, 20%, 69.23% and 20% respectively taking NCS as reference test and 70.59%, 0, 92.30%, and 0 respectively taking AFT as reference test. Conclusions: Semmes Weinstein 10 gm monofilament is not the ideal screening test for the diagnosis of DPN. Sole clinical use of monofilament should be discouraged.

Leptin DNA Methylation and Its Association with Metabolic Risk Factors in a Northwest Indian Obese Population.

BACKGROUND: It is well established that obesity is a major health risk in diabetes and associated diseases. Epigenetic changes, specially DNA methylation, play an important role in regulation of adipokines. The objective of the present study was to evaluate the DNA methylation status at the promoter region of the leptin gene in obese individuals and its association with metabolic risk factors. METHODS: The study included obese (n=100) and non-obese (n=75) individuals aged 25-45 years, and measured their physical, biochemical parameters (glucose, insulin, and lipid profiles) and leptin, DNA methyltransferase 1 (DNMT1), and DNA methyltransferase 3 beta (DNMT3b) mRNA expressions with real-time reverse transcription-polymerase chain reaction (qRT-PCR). DNA methylation of the leptin gene at the promoter region was analyzed by methyl-specific qPCR . RESULTS: The study found that the DNA methylation level at the promoter area of the leptin gene was negatively associated with weight in obese subjects. Furthermore, study findings showed that the DNA methylation level was negatively associated with fasting insulin, glucose, homeostatic model assessment for insulin resistance, and total cholesterol. There was also a higher expression of DNMT1 and DNMT-3b in obese subjects as compared with non-obese subjects. CONCLUSION: The leptin epigenetic profile may be associated with obesity and its associated metabolic risk factors.

Autonomic Functions In Raja-yoga Meditators.

Stress, an inevitable and constant feature throughout the lifetime, induces autonomic dysfunctions, for which meditation is considered to be an antidote. So the case control study was planned including 50 Raja-yoga meditators practicing meditation for 5 years and 50 age matched non-meditators. Autonomic function tests were performed and results were compared using the Student-t test. Mean values of resting HR, SBP and DBP were less in meditators. Galvanic Skin Response in meditators was significantly more (p < 0.001). Mean increase BP response to Hand Grip Test and Cold Pressor Test was significantly less in meditators than non-meditators (p < 0.001). Standing: Lying ratio, Valsalva ratio, Inspiration: Expiration ratio and 30:15 ratios were significantly increased in meditators than non-meditators. From the results, there was shifting of the autonomic balance to parasympathetic side in Raja-yoga meditators, which suggests its utility to combat the ill effects of stress.

Effect of yoga on cardiovascular system in subjects above 40 years.

This study was conducted to examine the effect of yoga on cardiovascular function in subjects above 40 yrs of age. Pulse rate, systolic and diastolic blood pressure and Valsalva ratio were studied in 50 control subjects (not doing any type of physical exercise) and 50 study subjects who had been practicing yoga for 5 years. From the study it was observed that significant reduction in the pulse rate occurs in subjects practicing yoga (P<0.001). The difference in the mean values of systolic and diastolic blood pressure between study group and control group was also statistically significant (P<0.01 and P<0.001 respectively). The systolic and diastolic blood pressure showed significant positive correlation with age in the study group (r1 systolic= 0.631 and r1 diastolic = 0.610) as well as in the control group (r2 systolic = 0.981 and r2 diastolic = 0.864). The significance of difference between correlation coefficient of both the groups was also tested with the use of Z transformation and the difference was significant (Z systolic= 4.041 and Z diastolic= 2.901). Valsalva ratio was also found to be significantly higher in yoga practitioners than in controls (P<0.001). Our results indicate that yoga reduces the age related deterioration in cardiovascular functions.