Edema India: Executive Summary of Screening, Diagnosis, and Management of Edema.

The management of edema requires a systematic approach to screening, diagnosis, and treatment, with an essential initial assessment to differentiate between generalized and localized edema. The Association of Physicians of India (API) aimed to develop the first Indian Edema Consensus (Edema India), offering tailored recommendations for screening, diagnosing, and managing edema based on the insights from the expert panel. The panel suggested when evaluating edema symptoms, important factors to consider include the patient's current illness, medical history, risk factors, family history, and medications. Key diagnostic investigations for edema include complete blood count, cardiovascular imaging and markers, deep vein thrombosis (DVT) assessment, along with renal, hepatic, and thyroid function tests. Edema management involves a combination of pharmacologic and nonpharmacologic interventions, including limb elevation, physiotherapy, compression therapy, fluid removal, diuretics (loop diuretics: first-line therapy), and a sodium-restricted diet. The panel believed that educating patients could foster a preventive mindset, helping to prevent the worsening of edema.

Fighting infodemic: Need for robust health journalism in India.

BACKGROUND AND AIMS: Communication plays an important role in advancing public health goals as well as in greater appreciation of underlying science and public policies. It is critical at all times, be it promoting health benefits of immunisation, importance of hand hygiene or taking personal measures for prevention of non-communicable diseases. Communication assumes even greater importance in the time of emergencies like the ongoing Covid-19 pandemic. A primary vehicle for health communication is mass media like television channels, newspapers and radio channels. METHODS: An analysis of current trends shows that the messages emerging from mass media are getting further amplified and dispersed through digital outlets and social media platforms which have become immensely popular. This has also given rise to a new phenomenon called infodemic or over-abundance of information - both genuine and fake. RESULTS: The article examines role of mass media in health communication in times of pandemic and the context of infodemic. CONCLUSIONS: The analysis points to the need for improvement in health journalism to improve its quality, credibility as well as relevance in a country like India where mass media consumption is high and health literacy is low.

Dose Modification of Antidiabetic Agents in Patients with Type 2 Diabetes Mellitus and Heart Failure.

Heart failure is the most common comorbidity of diabetes. The incidence of heart failure in patients with diabetes is about 9%-22%, which is four times higher Than that in patients without diabetes. Heart failure and diabetes are collectively associated with increased morbidity and mortality compared to either condition alone. Several epidemiological studies have demonstrated an increased risk of heart failure in patients with diabetes; moreover, poor glycemic control accounts for the increased risk of heart failure. At present, several oral (metformin, sulfonylureas, thiazolidinediones, dipeptidyl peptidase-4 inhibitors, etc.) as well as injectable (insulins, glucagon-like peptide 1 receptor agonists) antidiabetic agents are available. However, optimal treatment strategy to achieve adequate glycemic control in patients with type 2 diabetes mellitus (T2DM) and heart failure has not been well studied. In the view of rising prevalence of heart failure in patients with diabetes mellitus, clinicians need to understand the potential implications of antidiabetic agents in patients with heart failure. A group of experts from across India were involved in a consensus meeting in Pondicherry during the National Insulin Summit in November 2015. They evaluated agents currently available for the treatment of diabetes looking at existing scientific evidence relevant to each class of therapy. In addition, the existing guidelines and prescribing literature available with all these agents were also reviewed. Findings from the expert evaluations were then factored into the national context incorporating personal experience and common clinical practices in India. The purpose of this consensus document is to assist the clinicians while treating patients with T2DM and heart failure.

Targeting human respiratory syncytial virus transcription anti-termination factor M2-1 to inhibit in vivo viral replication.

Human respiratory syncytial virus (hRSV) is a leading cause of acute lower respiratory tract infection in infants, elderly and immunocompromised individuals. To date, no specific antiviral drug is available to treat or prevent this disease. Here, we report that the Smoothened receptor (Smo) antagonist cyclopamine acts as a potent and selective inhibitor of in vitro and in vivo hRSV replication. Cyclopamine inhibits hRSV through a novel, Smo-independent mechanism. It specifically impairs the function of the hRSV RNA-dependent RNA polymerase complex notably by reducing expression levels of the viral anti-termination factor M2-1. The relevance of these findings is corroborated by the demonstration that a single R151K mutation in M2-1 is sufficient to confer virus resistance to cyclopamine in vitro and that cyclopamine is able to reduce virus titers in a mouse model of hRSV infection. The results of our study open a novel avenue for the development of future therapies against hRSV infection.

Clinical experience with insulin detemir, biphasic insulin aspart and insulin aspart in people with type 2 diabetes: Results from the Rajasthan cohort of the A1chieve study.

BACKGROUND: The A1chieve, a multicentric (28 countries), 24-week, non-interventional study evaluated the safety and effectiveness of insulin detemir, biphasic insulin aspart and insulin aspart in people with T2DM (n = 66,726) in routine clinical care across four continents. MATERIALS AND METHODS: Data was collected at baseline, at 12 weeks and at 24 weeks. This short communication presents the results for patients enrolled from Rajasthan, India. RESULTS: A total of 477 patients were enrolled in the study. Four different insulin analogue regimens were used in the study. Patients had started on or were switched to biphasic insulin aspart (n = 340), insulin detemir (n = 90), insulin aspart (n = 37), basal insulin plus insulin aspart (n = 7) and other insulin combinations (n = 2). At baseline glycaemic control was poor for both insulin naïve (mean HbA1c: 8.3%) and insulin user (mean HbA1c: 8.4%) groups. After 24 weeks of treatment, both the groups showed improvement in HbA1c (insulin naïve: -0.9%, insulin users: -1.2%). Major hypoglycaemic events decreased from 0.5 events/patient-year to 0.0 events/patient-year in insulin naïve group while no change from baseline (1.3 events/patients-year) was observed for insulin users. SADRs were not reported in any of the study patients. CONCLUSION: Starting or switching to insulin analogues was associated with improvement in glycaemic control with a low rate of hypoglycaemia.

Analgesic activity of fixed dose combinations of paracetamol with diclofenac sodium and paracetamol with tramadol on different pain models in healthy volunteers - A randomized double blind crossover study.

AIM: To evaluate and compare the analgesic activity of fixed dose combinations (FDC) of Paracetamol with Diclofenac sodium and Paracetamol with Tramadol on different human pain models in healthy human volunteers. MATERIALS AND METHODS: A randomized double blind crossover study was carried out in 30 healthy human volunteers using three pain models; cold-water stress test, radiant heat method, and BP cuff inflation method. The subjects were randomized into two groups of 15 each, group A received FDC of Paracetamol 500 mg with Diclofenac sodium 50 mg and group B was given a FDC of Paracetamol 375 mg and Tramadol 50 mg. All the volunteers were tested on three pain models. Observations for pain tolerance were recorded at baseline and at the interval of 30, 60, 120, and 180 minutes after drug administration. Crossover was done after a washout period of 7 days. The results of both the study periods were analyzed using an independent t-test. RESULTS: Mean age of the participants was 23±1 years and the male:female ratio was 2:1. In the radiant heat method, paracetamol with tramadol combination treatment showed a significant increase in pain tolerance at 2 hours and 3 hours (P 0.028 and 0.055 respectively) compared to paracetamol with diclofenac combination. Other two pain models did not show any significant difference in the study groups. CONCLUSION: Paracetamol with tramadol combination was more effective than paracetamol with diclofenac sodium combination on the radiant heat model. In human pain models, there is an incomplete understanding of mechanisms and activated pathways are not precisely determined that needs further evaluation.

Analysis of 35 inorganic elements in teeth in relation to caries formation.

As caries is a most common affliction of teeth, which are predominantly composed of inorganic elements, it was considered worthwhile to determine their elemental composition and to find if it bears any relation to caries formation. For this purpose, 35 inorganic elements were determined in 15 non-carious and an equal number of carious whole teeth after their dissolution in nitric acid. The results showed that out of 35 elements, strontium was the only element found to be present in significantly lower amount in carious teeth, thus strongly suggesting that its deficiency may help form caries. The decrease in Ca, Mg, Ti, P, Li, Be, V, Ni, Zn, Nb, Ag, Cd, Sb, Ba, La , W, Pb, and Bi and slight increase in K, Cr, Cu, and As was not statistically significant. However, statistically significantly greater amount of boron, manganese, molybdenum, and fluorine in the carious teeth indicates towards their possible role in predisposing or causing dental caries.

Effect of oral ingestion of different forms of silver on tissue content of some essential elements in chicks.

Silver is ingested in India in the form of varak, Ayurvedic bhasm and water contained in silver utensils, but nobody knows their effects. We have examined the effect of interaction of silver ingested in the form of varak (leaf), bhasm (ash) and water (colloidal solution) on some essential elements (Na, K, Ca, Mg, Cu, Fe and Zn) in blood, liver, spleen and kidneys of chicks. The results showed significant rise of silver in all the tissues and significant fall in copper in the blood. The greatest rise was obtained in blood silver by silver sol while it had the lowest amount of silver. Iron significantly increased in tissues but somewhat decreased in blood. Zinc content increased in all the tissues by leaf and ash but decreased by sol. No consistent pattern was seen in case of other elements.

Effect of ingestion of copper bhasm on red cell indices, iron parameters and essential elements in chicks.

In order to scientifically evaluate the effect of copper bhasm, it was orally administered in a dose of 2 mg/day for seven days to one month old male chicks. There was significant fall in total red cells, and rise in plasma iron, PCV and MCV indicating hemolysis, compensated by increased heme synthesis. A significant increase in plasma iron binding capacity points to beneficial effect of copper bhasm on liver as transferrin is synthesized in liver. Ferritin (storage iron) was unaltered in seven days treatment. The effect of copper bhasm on tissue distribution of essential elements was variable. Calcium, sodium and potassium were significantly increased in all the tissues. The last two may have been contributed by the bhasm itself. Magnesium behaviour was similar to calcium. Iron and zinc showed variable effects. Copper level in whole blood, plasma and erythrocytes increased significantly showing that copper bhasm was well absorbed and the effect observed can be ascribed to it. The bhasm was well tolerated and no growth retardation was seen.

Dynamics of pesticide residues in nectar and pollen of mustard (Brassica juncea (L.) Czern.) grown in Himachal Pradesh (India).

Residues dynamics of Endosulfan (525.00 g a.i. ha(-1)), Imidacloprid seed treatment (21 g a.i. kg(-1)), Lambdacyhalothrin (75.00 g a.i. ha(-1)) and Spiromesifen (225.00 g a.i. ha(-1)) in nectar and pollen of mustard, Brassica juncea (L.) Czern. grown in Himachal Pradesh (India) were determined through bioassay (using Drosophila melanogaster Meig. as test organism) and GC (Gas chromatographic) and HPLC (High performance liquid chromatographic) methods. In general chromatographic methods were more sensitive for the determination of above given pesticides compared to bioassay method. Average recoveries in nectar samples varied between 82.85 and 88.90% by bioassay and 91.20 and 93.55% by chromatographic techniques. In pollen samples, recoveries varied between 81.44 and 86.44% by bioassay and 88.50 and 91.30% by chromatographic methods. Imidacloprid residues were neither found in nectar nor in pollen samples at the time of sampling i.e. 50% of flowering. The order of average half life of residues was: Lambdacyhalothrin (12.45 h) < Spiromesifen (19.99 h) < Endosulfan (27.49 h) for nectar and Spiromesifen (9.69 h) < Lambdacyhalothrin (12.44 h) < Endosulfan (17.84 h) for pollen samples. It was found that Imidcloprid seed treatment was practically harmless to honey bees, whereas a waiting period of 5 days must be observed on crops sprayed with these chemicals during blooms to avoid any accidental hazards to honey bees.

Assessment of water pollution in different bleaching based paper manufacturing and textile dyeing industries in India.

Paper industries using different raw materials such as hard wood, bamboo, baggase, rice-straw and waste papers and bleaching chemicals like chlorine, hypochlorite, chlorine dioxide, hydrogen peroxide, sulphite and oxygen were studied to estimate organic pollution load and Adsorbable Organic Halides (AOX) per ton of production. The hard wood based paper industries generate higher Chemical Oxygen Demand (COD) loads (105-182 kg t(-1)) and Biochemical Oxygen Demand (BOD) loads (32.0-72 kg t(-1)) compared to the agro and waste paper based industrial effluents. The bleaching sequences such as C-EP-H-H, C-E-H-H, C-E-Do-D1 and O-Do-EOP-D1 are adopted in the paper industries and the molecular elemental chlorine free bleaching sequence discharges low AOX in the effluent. The range of AOX concentration in the final effluent from the paper industries was 0.08-0.99 kg t(-1) of production. Water consumption was in the range of 100-130 m(3) t(-1) of paper production for wood based industries and 30-50 m(3) for the waste paper based industries. Paper machine effluents are partially recycled after treatment and pulp mill black liquor are subject to chemical recovery after evaporation to reduce the water consumption and the total pollution loads. Hypochlorite bleaching units of textile bleaching processes generate more AOX (17.2-18.3 mg l(-1)) and are consuming more water (45-80 l kg(-1)) whereas alkali peroxide bleaching hardly generates the AOX in the effluents and water consumption was also comparatively less (40 l kg(-1) of yarn/cloth).

Study of 25 cases of exchange transfusion by reconstituted blood in hemolytic disease of newborn.

This study was aimed to review and establish the practice of exchange transfusion (ET) with reconstituted blood in neonates and to observe fall of bilirubin and its comparison with related studies. Twenty-five neonates diagnosed as hemolytic disease of newborn (HDN) were selected for this study, in which exchange transfusion was carried out as one of the treatments for hyperbilirubinemia. Out of the 25 cases, 15 were of Rhesus (Rh) HDN, while ABO and other blood groups constituted 6 and 4 HDN cases respectively. First, the neonates's and mother's blood samples were subjected to relevant investigations. After that, for neonates having Rh HDN, O Rh negative cells suspended in AB plasma were given, O Rh positive cells suspended in AB plasma were given to ABO HDN; and O positive cells, which were indirect Coomb's cross-matched compatible with neonates' and mother's serum / plasma, suspended in AB plasma were given to the neonates having HDN because of other blood group antibodies. The exchange transfusion (ET) was carried out taking all aseptic precautions by Push-Pull technique with double-volume exchange transfusion method. The average post-exchange fall in serum indirect bilirubin was (52.01%) in all 25 cases, which was found to be more significant than the previous studies. Looking into the superiority of the exchange transfusion in HDN by reconstituted blood, the reconstituted blood can be modified and supplied as per the requirement and conditions.

A marked enhancement in the production of a highly alkaline and thermostable pectinase by Bacillus pumilus dcsr1 in submerged fermentation by using statistical methods.

The production of a highly alkaline and thermostable pectinase of Bacillus pumilus was optimized in submerged fermentation using Plackett-Burman design and response surface methodology. Three fermentation variables (C:N ratio, K(2)HPO(4), and pH), which were identified to significantly affect pectinase production by Plackett-Burman design were further optimized using response surface methodology of central composite design (CCD). An over all 34- and 41-fold increase in enzyme production was achieved in shake flasks and lab fermenter by the optimization of variables using statistical approaches, respectively. The enzyme was optimally active at pH 10.5 and 50 degrees C, and selectively degraded only the noncellulosic gummy material of ramie (Boehmeria nivea) fibres causing 10.96% fibre weight loss, and therefore, the enzyme could find application in fibre processing industry. The use of the enzyme in fibre processing reduces the use of alkali, and the associated alkalinization of water bodies.

Hypolipidemic activity of silver preparations in chicks, Gallus serregineus.

Three silver preparations (Varak or foil, ash or Raupya bhasma and sol or colloidal solution) were fed to three groups of young, male chicks for 10 days. There was significant fall in all the plasma lipid fractions--total lipids, phospholipids, triglycerides and total cholesterol. There was a marked rise in silver content of plasma and whole blood, ranging from 4 to 13 times, suggesting that the observed hypolipidemic action may be due to silver. The administration of the three silver preparations did not cause any retardation in growth, toxic manifestation, side effect or untoward reaction.

Studies of biochemical parameters in breast cancer with and without metastasis.

The study includes 102 confirmed cases of carcinoma breast with and without metastasis and 25 healthy non-pregnant females. They were evaluated for blood levels of Ferritin, GSH, LDH, ALP, GGT and Hb before and 21 days after mastectomy. A significant increase (p<0.001) was observed in ferritin, LDH and GSH levels in cancer patients without metastasis in comparison to normal control subjects. Patients with metastasis had further elevated (p<0.001) levels of Ferritin, ALP and GGT as compared to non-metastatic patients. Mastectomy in both the cases i.e. with and without metastasis resulted in non-significant decrease in all the biochemical parameters suggesting that longer follow up could confirm post surgery decrease in the biochemical parameters. The results of the study suggest cost effective, usefulness of Ferritin, ALP, GGT and GSH/Hb ratio in differentiating breast cancer patients with and without metastasis which can be assayed in smaller laboratories.

Phytotoxic lesions of chromium in maize.

Chromium (Cr) is fairly abundant in the earth's crust and ranks fourth among the 29 elements of biological importance. Besides natural sources, Cr enters biotic components of the ecosystem in various ways. Of other major industrial sources, tanning and chrome-plating industries are prominent sources. Cr(VI) form of chromium is highly reactive and influences both plants and animals. Due to Mn present in soil, Cr(III) is oxidized to Cr(VI) which remains in soil for a long time and can affect plant growth and development. Since maize is an important food and fodder plant for human beings and cattle, a study was conducted to investigate the effects of Cr on some metabolic activities of maize (Zea mays L. cv. Ganga 5). Chromium caused visible lesions of interveinal chlorosis. Young leaves showed vein clearing. Also, a papery appearance was observed in leaves. Margins of leaves were curled and the leaves appeared pale at greater Cr exposure. Concentrations of both chlorophyll a and b were reduced by exposure to Cr, the activities of ribonuclease and phenyl phosphatase were greater while the activity of iron-porphyrin enzyme catalase was less and the activity of amylase was also much less in plants exposed to Cr. Chromium also caused retardation of soluble protein. Accumulation of Cr in roots was much at all the levels of chromium supply. Exposure to Cr resulted in reduction in grain production and quality.