The underlying causes, treatment options of gut microbiota and food habits in type 2 diabetes mellitus: a narrative review.

Type 2 diabetes mellitus is a long-lasting endocrine disorder characterized by persistent hyperglycaemia, which is often triggered by an entire or relative inadequacy of insulin production or insulin resistance. As a result of resistance to insulin (IR) and an overall lack of insulin in the body, type 2 diabetes mellitus (T2DM) is a metabolic illness that is characterized by hyperglycaemia. Notably, the occurrence of vascular complications of diabetes and the advancement of IR in T2DM are accompanied by dysbiosis of the gut microbiota. Due to the difficulties in managing the disease and the dangers of multiple accompanying complications, diabetes is a chronic, progressive immune-mediated condition that plays a significant clinical and health burden on patients. The frequency and incidence of diabetes among young people have been rising worldwide. The relationship between the gut microbiota composition and the physio-pathological characteristics of T2DM proposes a novel way to monitor the condition and enhance the effectiveness of therapies. Our knowledge of the microbiota of the gut and how it affects health and illness has changed over the last 20 years. Species of the genus Eubacterium, which make up a significant portion of the core animal gut microbiome, are some of the recently discovered 'generation' of possibly helpful bacteria. In this article, we have focused on pathogenesis and therapeutic approaches towards T2DM, with a special reference to gut bacteria from ancient times to the present day.

Poverty, undernutrition and morbidity: The untold story of tea-garden workers of Alipurduar district, West Bengal.

Background: There is a paucity of information on health and nutritional status of tea-garden workers of West Bengal, which is crucial to meet their health needs by formulating appropriate public health interventions. Objectives/Aims: The objective of this study is to assess the morbidity pattern and nutritional status of tea-garden workers of West Bengal, India. Materials and Methods: The present cross-sectional study was conducted among 463 tea-garden workers of randomly selected three tea gardens of Alipurduar district of West Bengal, India, chosen by multi-stage sampling. Pre-designed and pre-tested questionnaire was used to collect information on socio-demographic and other variables by means of interview. Physical examination and anthropometric assessment were performed. The haemoglobin was estimated by the 'filter paper cyanmethemoglobin method'. Morbidities were assessed on the basis of history, clinical examination, evaluation of medical records if any and relevant laboratory investigations and classified and coded as per the 10th revision of the international classification of the diseases. Morbidity profile and nutritional status were assessed through history taking, clinical examination, review of medical records if any, anthropometric assessment and laboratory investigations. Statistical Analysis: Simple proportion was used for interpretation of point prevalence. Chi-square test was applied as the test of significance wherever applicable. Results: Out of total 463 tea-garden workers, majorities (76%) were female and from backward social class (81.2%). More than half (55.9%) were illiterate and three-fourth (67.2%) belonged to lower income quartile. Anaemia was found widespread (87.9%) and more than one-third (36.1%) of the tea-garden workers were found undernourished. Also 43.8% of the workers had airway obstruction as measured by peak expiratory flow rate. Majority (69.8%) of the garden workers had any form of morbidity. Non-communicable diseases (24.2%), musculoskeletal disorders (17.9%), skin disorders (17.7%), respiratory morbidities (16.2%), febrile illness (12.3%), gastro-intestinal disorders (8.6%), ocular problems (8.4%), vitamin and micronutrients deficiencies were found the common morbidities among tea-garden workers. Scheduled tribe caste, undernutrition and anaemia were found independent determinants of any morbidity among the tea-garden workers. Conclusions: Morbidities, anaemia and under-nutrition were found very much prevalent among tea-garden workers of West Bengal, which necessitates urgent public health interventions through multi-disciplinary approach in a focussed manner with an aim to improve the overall quality of life of the tea-garden workers.

Metabolic syndrome is not uncommon among lean non-alcoholic fatty liver disease patients as compared with those with obesity.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is associated with obesity, which is known to be associated with metabolic syndrome (MS). However, the risk factors for NAFLD in absence of obesity (leanness) is not well-studied. This study aimed to investigate and compare the clinical characteristics, metabolic associations, and cardiovascular risk factors among patients having NAFLD with (body mass index [BMI] ≥ 23 kg/m2) or without obesity (BMI < 23 kg/m2). METHODS: The cross-sectional study was conducted among the outdoor and indoor patients diagnosed as NAFLD by ultrasonography in a tertiary care teaching hospital in eastern India. Relevant anthropometric measurements, laboratory investigations, and imaging were performed. Metabolic syndrome was classified by the "International Diabetes Federation, 2005" criteria. RESULTS: Among 120 NAFLD patients, 37 (30.8%) were lean, while 83 (69.2%) were obese. The components of MS such as systolic blood pressure (lean, 138.0 ± 17.6 mmHg; obese, 137.9 ± 15.3 mmHg), diastolic blood pressure (lean, 88.9 ± 6.5 mmHg; obese, 87.3 ± 6.1 mmHg), fasting blood sugar (lean, 127.8 ± 30.8 mg/dL; obese, 135.1 ± 29.5 mg/dL), and serum triglyceride (lean, 170.5 ± 34.2 mg/dL; obese, 186.4 ± 43.8 mg/dL) were comparable among patients with obese and lean NAFLD and were more often abnormal among both the groups of NAFLD as compared with controls. CONCLUSION: The overall prevalence of MS among NAFLD study population was 64.2%. Lean NAFLD was also associated with the component of MS like obese NAFLD.

Better Predictive Value of Cancer Antigen125 (CA125) as Biomarker in Ovary and Breast Tumors and its Correlation with the Histopathological Type/Grade of the Disease.

BACKGROUND: Both ovarian/breast cancers are the most prevalent hormone-associated gynecological-cancers, where uncontrolled cellular proliferations/genetic-errors are noticed. The cancer-antigen125 (CA125), which we assessed presently is an important biomarker in the early detection/monitoring of this disease-pathogenesis. METHODS: Serum/tissue CA125 was measured by solid-phase-Enzyme-linked-immunosorbentassay in women with ovarian/breast tumors of different types (epithelial/non-epithelial; benign/ borderline/ malignant)/stages. Breast-tumor tissues were employed for histoarchitecture/DNAstability (comet) assay. Extensive protein-protein(CA125) interactions were studied by the STRING (Search-Tool-for-the-Retrieval-of-Interacting Genes/Proteins) Bioinformatics-software. RESULTS: Serum CA125 levels were <35 U/ml in 94% of benign epithelial-cases, 35-65 U/ml in 100% of borderline-tumors and >100 U/ml in the 41.17% of patients with malignant-tumors. The malignant epithelial tumor showed significantly higher (>100U/ml) CA125 than the non-epithelial malignant-tumor (<35-65 U/ml). Highly enhanced cellularity/histo-architectural impairment/unstable- DNA-materials/CA125 was found in advanced breast-cancers. The CA125 is highly metabolically interactive, especially with mesothelin impairing cell-cell adhesion and enhancing tissue anti-establishment. CONCLUSION: CA125 is a predictive-marker in ovarian/breast carcinoma depending on disease nature/stages. CA125, in combination with other tests like mesothelin/estradiol can be of great use in the better diagnosis of this disease. Not only as a detection-marker, has the CA125 played an interactive role in the disease processes. The Bioinformatics study revealed an important role of mesothelin and other mucin like proteins. Early detection and proper diagnosis are important determinants for the greater possibility of the relief from the disease like cancers. Selection of suitable biomarker combinations may increase the better diagnosis of the types and severity of this disease. Our present result has an impact on these aspects.

Green Tea (Camellia sinensis) Protects Against Arsenic Neurotoxicity via Antioxidative Mechanism and Activation of Superoxide Dismutase Activity.

BACKGROUND: Chronic arsenic-exposure even at a low-dose results in the neural impairment and motor/cognitive dysfunction. However, several preventive approaches are made mainly against hepatic/ gastrointestinal damages. Only a few investigations postulate therapeutic strategies for neural anomalies. Here, the protective role of Green tea (Camellia sinensis or CS; 10mg/ml aqueous) has been evaluated against arsenic-induced (0.6ppm/100g bw/28 days) cerebral/cerebellar tissue degeneration, oxidative-threats and neurotransmitter deregulation in female rats. METHODS AND RESULTS: The Dunnett's t test and multiple-comparison ANOVA-test suggest that arsenic significantly decreased free thiol level with an increase in lipid-peroxidised product and damages to the tissue-structure. A significant decrease in serum urate accompanied by increases in C-reactive protein and TNF-α, an acute-phase inflammatory cytokine, strongly suggests a possible mechanism of oxidative- inflammatory tissue injury being supported by the increase in lactate-dehydrogenase activity. In addition, suppression in cytosolic superoxide-dismutase (Cu-Zn isoform/SOD1; NBT reduction-test) and an insufficient protection through catalase activity culminate free radical-related damages. In-vitro, H2O2 inactivated partially-purified (dialyzed/concentrated, 6-8kd cutoff-Millipore) rat liver SOD1 and that was markedly protected by 2-mercaptoethanol. Though significant signs of toxicities were noticed at biochemical/cellular level, the present treatment did not affect DNA (DNA-fragmentation assay) in the brain tissues. The CS supplementation significantly protected serum/tissue antioxidant-components, prevented inflammatory-responses and decreased lipid-peroxidation in brain resulting in increased tissue integrity. Moreover, arsenic-induced impairment of neurotransmitters i.e. glycine, glutamate and aspartate levels in cerebral tissue were significantly restored in CS-supplemented group. CONCLUSION: Taken together, this investigation indicates the potent neuroprotective and antioxidative efficiencies of Camellia sinensis against arsenic-induced oxidative threat.

Metabolic syndrome among elderly care-home residents in southern India: A cross-sectional study.

BACKGROUND: The health of the elderly population and the emergence of noncommunicable diseases have become major public health issues in recent years. Metabolic syndrome is thought to be the main driving force for the global epidemic of cardiovascular diseases, as well as for type 2 diabetes. This cross-sectional study aimed to determine the prevalence of metabolic syndrome and its correlates among the residents of care homes for the elderly in Hyderabad city, India. METHODS: A total 114 elderly persons (aged ≥60 years) were evaluated in a cross-sectional study. Metabolic syndrome was defined by the 2005 criteria of the International Diabetes Federation. Data were collected on selected sociodemographic, behavioural and nutritional variables and cardiometabolic risk factors. Blood pressure and anthropometric measurements were also recorded. Fasting blood samples were collected for measurement of blood glucose and serum lipid levels. Univariable logistic regression was applied to investigate the associations between metabolic syndrome and known risk factors; adjusted analysis was then done by multivariable logistic regression for significant variables. RESULTS: The overall prevalence of metabolic syndrome was 42.1% (48/114) among the study population. A higher prevalence (50.9%; 27/53) was found among women. High blood pressure or taking antihypertensive medication was found to be the most common (95.8%; 46/48) cardiometabolic component. The risk of metabolic syndrome did not differ significantly by age group, sex, caste, religion, type of diet (vegetarian or non-vegetarian), educational status, behavioural factors such as tobacco use and alcohol intake, physical activity (assessed by modified Eastern Cooperative Oncology Group [ECOG] scale), or physical exercise. However, a body mass index ≥23 kg/m2 was associated with metabolic syndrome (unadjusted odds ratio [OR]: 8.97; 95% confidence interval [CI]: 3.78-21.28); adjusted OR: 9.31; 95% CI: 4.12-22.14) Conclusion: The overall prevalence of metabolic syndrome in this study population of elderly care-home residents in India was more than 40%. Further research on the burden of metabolic syndrome in the elderly population is warranted.

Diabetes in rural individuals of different nutritional status and the alarming situation demands focus more on its under-nutrition association.

OBJECTIVE: To study the relationship of nutritional-status with diabetes. DESIGN: The socioeconomics/anthropometrics, blood-glucose/systemic-hypertension are evaluated in consecutively-selected diabetic-patients. SETTING: Semi-urban/rural India. SUBJECTS: Hyperglycaemic patients (total 90/male 37). RESULTS: Blood-glucose (PP-mean ± SE) in individuals is overweight - 38.89% (226.94 ± 9.59), normal-weight - 50% (217.58 ± 1.34), underweight - 11.11% (305.50 ± 21.35) indicating most hyperglycaemia in undernourished-group (F = 6.357, p < 0.003). This group occupies higher glucose-groups in ≤140, 141-270, and ≥270 mg/dL. The blood-glucose negatively correlates with waist(r = -0.282; p < 0.01) and hip (r = -0.254; p < 0.05) circumference indicating the under-nutrition association with glucose-homeostasis (F = 7.6-8.2, p < 0.001). The higher glucose is noticed in more number of individuals in lower (<40 years) age-group (χ(2 )= 12.86; p < 0.002/ρ = -0.355; p < 0.001). The prevalence of hypertension is 28% (underweight = 20%, overweight = 27%, normal = 30%). The group of 141-270 mg/dL glucose has 45% and rest groups together have 23% hypertensive individuals relating directly, hypertension and diabetic-onset. CONCLUSIONS: Diabetes, explored in <40 years group and even more in female should be extensively studied accounting WHO categorization (1985/TRS/727) of malnutrition related diabetes (MRDM). Further, different interactive risk-factors should be properly addressed and the global-malnutrition/gender-based inequities be eradicated.

Social determinants of stunting in rural area of Wardha, Central India.

BACKGROUND: Stunting is a consequence of long term, cumulative inadequacies of health and nutrition. Health system uses underweight for growth monitoring for its simplicity. Lately there is renewed interest in stunting and especially severe acute malnutrition. Stunting is a relatively neglected indicator. It is therefore imperative to understand the causes of stunting early in infancy and childhood, so that preventive measures can be taken. Hence, the present study was undertaken to study the social determinants of stunting in rural Wardha. METHODS: The present cross-sectional study was undertaken in three Primary Health Centres (PHCs) of Wardha district with total population of 88,187. The sample was drawn from three PHC areas by 30-cluster sampling technique. Stunting was defined using WHO Child Growth Standards for 'height-for-age'. 'Height-for-age' values below 2 standard deviations were considered as stunted while below 3 standard deviations were considered 'severe stunting'. RESULT: Prevalence of stunting was observed to be 52.3% and severe stunting was 25.1%. The significant determinants of stunting were found to be age, father's education, fathers' occupation, low income, not receiving Vitamin-A supplement during last 6 months and having anaemia. Sex, caste, mother's education and mothers' occupation did not contribute significantly to the stunting. CONCLUSION: Low income and related factors such as father's education and his occupation are important determinant of the stunting. Father being the decision maker, his education is of importance. Vitamin-A supplementation and anaemia as surrogate indicators for access to health care also found out to be significant determinants of stunting.

Are institutional deliveries promoted by Janani Suraksha Yojana in a district of West Bengal, India?

'Janani Suraksha Yojana (JSY)' was implemented in India to promote institutional deliveries among the poorer section of the society. A cross-sectional study was conducted in Bankura district among 324 women who delivered in last 12 months selected through 40 cluster technique to find out institutional delivery rate, utilization of JSY during antenatal period and relation between cash benefit under JSY during antenatal period and institutional delivery. Overall institutional delivery rate was 73.1% and utilization of JSY among eligible women was 50.5%. Institutional delivery (84.0%), consumption of 100 iron-folic acid tablets (46.0%) and three or more antenatal check-ups (91.0%) were better in women who received financial assistance from JSY during antenatal period than other women. After adjustment for socio-demographic factors, JSY utilization came out to be significantly (P=0.031) associated with institutional deliveries. The study showed that cash incentive under JSY in antenatal period had positive association on institutional deliveries.

Ocular effects of long term use of topical steroids among children and adolescents with vernal keratoconjunctivitis: a prospective observational study.

Topical steroids were often irrationally used on long term basis for quick relief from ocular discomfort of inflammatory eye conditions like vernal keratoconjunctivitis in spite of their well known deleterious ocular effects. The present study was undertaken to determine the ocular effects of long term use of topical steroids among the patients with vernal keratoconjunctivitis and also to evaluate the ocular responses after withdrawal of steroids. The prospective observational study was carried out in a tertiary eye care centre of West Bengal. A total 150 referred patients of vernal keratoconjunctivitis, those used topical steroids for more than a month were included in the study. A complete set of ophthalmic examinations including measurement of intra-ocular pressure and visual acuity was carried out during registration. After withdrawal of steroids, the patients were followed-up periodically and finally evaluated after 8 weeks for any Improvement of Intra-ocular pressure and best corrected visual acuity. The data was analysed by SPSS 12.0.1 software package. Proportions were used for Interpretation. Paired t-test was used for comparison between two proportions (before and after withdrawal of steroids) and p-value <0.05 was considered as the level of significance. Though ropy mucus discharge with minimal conjunctival involvement was found the most common (74.7%) ocular manifestation, grave consequences like glaucoma was also evident among 8.7% of the study participants. Significant improvements (p<0.05) were observed for both reduction of intra-ocular pressure and visual acuity after 8 weeks of withdrawal of topical steroids. Topical steroids should be used cautiously with periodic ophthalmic examinations including intra-ocular pressure.

Skill of frontline workers implementing integrated management of neonatal and childhood illness: experience from a district of West Bengal, India.

A cross-sectional study was conducted in Purulia district, West Bengal, India, to assess the skill of 155 frontline workers implementing Integrated Management of Neonatal and Childhood Illness (IMNCI) and the logistic support thereof. The skills of counting respiratory rate, assessing immunization status in both age groups, assessment of breastfeeding in young infants and plotting of weight in a growth chart in case of children aged 2-59 months were acquired by majority of workers. Around two-thirds workers synthesized correct classification and nearly 60% gave appropriate management of at least one subgroup. In 30-40% cases, carers received feeding advices. Around 50% casesheets were complete and timely report submission rate was nearly 70%. Necessary equipments were available with majority of workers except the utensils for preparation of ORS. The supply of essential drugs varied from 33.5 to 71.6%. These findings suggest that IMNCI program offered a scope for capacity-building and infrastructure strengthening of the health system.