Relationship between body mass index, fat distribution and cardiometabolic risk factors in Indian children and adolescents.

BACKGROUND: Studies assessing the relationship of BMI and BF with cardiometabolic (CM) risks in Indian children are scarce. OBJECTIVE: To assess the occurrence of cardiometabolic risk factors in Indian children and adolescents in relation to BMI and body fat and to study their association with body fat distribution. METHODS: 286 children and adolescents (mean age 11.2 ± 2.6 years, 139 boys) were recruited from routine health checks and schools. Anthropometry and blood pressure were recorded, total body fat (BF) and fat distribution (android and gynoid) were measured by Dual Energy X-ray Absorptiometry. Fasting plasma glucose, lipid profile and insulin were also measured. RESULTS: When the study cohort was divided as per their BMI and biochemical cardiometabolic risk factors, 8% children had normal BMI with abnormal biochemical parameters while 40% children had abnormal BMI but normal biochemical parameters. CONCLUSION: There are normal weight children with cardiometabolic risks. There was an increase in the occurrence of cardiometabolic risk factors with increased android distribution of fat (p-value < 0.05).

Management of diabetic ketoacidosis in PICU.

OBJECTIVE: This study was undertaken to analyze the outcome of children with DKA treated with a modified protocol at a tertiary level teaching hospital PICU in Pune, Maharashatra. METHODS: We retrospectively analyzed case records of 12 patients (8 males and 4 females) with DKA (11 new and 1 readmission) admitted in our PICU from January 2005 to June 2006. Patients were managed according to a modified protocol (that is with less intensive biochemical monitoring when compared with standard book protocols). Laboratory parameters measured were blood glucose, urinary ketones, electrolytes, urea creatinine, arterial blood gas (ABG) and infectious screen. Treatment included fluid therapy and insulin infusion- 0.1 u/Kg short acting intravenously followed by 0.1 u/Kg/hr. No bicarbonate was administered as a bolus. RESULTS: Total fluid deficit was corrected slowly over a period of 36 hr. The median time to normalize ABG was 19 hr (5.3-39) while the median time for the urinary ketones to disappear was 1day (1-3). The child to nurse ratio was 1:2, there were 2 pediatric residents in house all 24 hr with an intensivist and pediatric endocrinologist on call. CONCLUSION: We have shown that when DKA is managed in a PICU setting using modified protocol, the outcome is good and complications such as brain edema can be prevented.

A TonB-like protein and a novel membrane protein containing an ATP-binding cassette function together in exotoxin secretion.

Protein secretion by many Gram-negative bacteria occurs via the type II pathway involving translocation across the cytoplasmic and outer membranes in separate steps. The mechanism by which metabolic energy is supplied to the translocation across the outer membrane is unknown. Here we show that two Aeromonas hydrophila inner membrane proteins, ExeA and ExeB, are required for this process. ExeB bears sequence as well as topological similarity to TonB, a protein which opens gated ports for the inward translocation of ligands across the outer membrane. ExeA is a novel membrane protein which contains a consensus ATP-binding site. Mutations in this site dramatically decreased the rate of secretion of the toxin aerolysin from the cell. ExeB was stable when overproduced in the presence of ExeA, but was degraded when synthesized in its absence, indicating that the two proteins form a complex. These results suggest that ExeA and ExeB may act together to transduce metabolic energy to the opening of a secretion port in the outer membrane.

Isolation and characterization of a second exe operon required for extracellular protein secretion in Aeromonas hydrophila.

Strain C5.84 is a Tn5-751 insertion mutant of Aeromonas hydrophila which is unable to secrete extracellular proteins, instead accumulating them in the periplasm (B. Jiang and S.P. Howard, J. Bacteriol. 173:1241-1249, 1991). A 3.5-kb BglII fragment which complements this mutation was isolated from the chromosome of the parent strain. Analysis of this fragment revealed an operon-like structure with two complete genes, exeA and exeB, a functional promoter 5' to the exeA gene, and a 13-bp inverted repeat immediately 3' to the exeB gene. Although the transposon had inserted in exeA, provision of a wild-type copy of this gene alone in trans did not restore competence for export to C5.84. Complementation required the presence of both exeA and exeB, and marker exchange mutagenesis confirmed the requirement for both gene products for secretion. In vitro expression as well as analysis of the deduced amino acid sequence of ExeA indicated that it is a hydrophilic 60-kDa protein with a consensus ATP binding site. ExeB is a 25-kDa basic protein which shares limited homology with PulB, a protein of unknown function associated with the maltose regulon of Klebsiella oxytoca, and OutB, a protein which has been shown to be required for efficient secretion in Erwinia chrysanthemi. The hydrophilic character of these proteins and preliminary localization studies suggested that they are anchored to the inner membrane. These results demonstrate the involvement of a second operon encoding a putative ATP-binding protein in the secretion of extracellular proteins from gram-negative bacteria and further suggest that the cytoplasmic compartment may play a greater role in protein translocation across the outer membrane from the periplasm than previously thought.