Association of Air Pollution with Risk and Severity of Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis

BACKGROUND

Obstructive Sleep Apnea (OSA) is a significant health concern characterized by recurrent upper airway blockages during sleep, causing various health issues. There's growing evidence of a link between air pollution and OSA, though research results have been inconsistent. This systematic review and meta-analysis aims to consolidate and examine data on the relationship between air pollution and OSA's risk and severity.

METHODS

A literature search across PubMed, EMBASE, and Web of Science was conducted until January 10, 2024. The selection criteria targeted studies involving OSA participants or those at risk, with quantitative air pollution assessments. The Nested Knowledge software facilitated screening and data extraction, while the Newcastle-Ottawa Scale was used for quality assessment. Meta-analyses, utilizing random-effects models, computed pooled odds ratios (ORs) for the OSA risk associated with PM2.5 and NO2 exposure, analyzed using R software version 4.3.

RESULTS

The systematic review included twelve studies, four of which were analyzed in the meta-analysis. The meta-analysis revealed diverse results on the association of PM2.5 and NO2 with OSA risk. PM2.5 exposure showed a pooled OR of 0.987 (95% CI: 0.836 to 1.138), indicating no substantial overall impact on OSA risk. Conversely, NO2 exposure was linked to a pooled OR of 1.095 (95% CI: 0.920 to 1.270), a non-significant increase in risk. Many studies found a relationship between air pollution exposure and elevated Apnea-Hypopnea Index (AHI) levels, indicating a relationship between air pollution and OSA severity.

CONCLUSION

The findings suggest air pollutants, especially NO2, might play a role in worsening OSA risk and severity, but the evidence isn't definitive. This highlights the variability of different pollutants' effects and the necessity for more research. Understanding these links is vital for shaping public health policies and clinical approaches to address OSA amidst high air pollution.

Association of neighborhood deprivation and hypertension: A systematic review and meta-analysis

BACKGROUND

Hypertension impacts nearly one billion individuals and is a primary health challenge. While traditional perspectives have focused on individual behavior and genetics as principal risk factors, recent research underscores the profound influence of socioeconomic factors within neighborhoods on the risk of hypertension. This systematic review and meta-analysis is aimed to elucidate the association between neighborhood deprivation and the risk of hypertension.

METHODS

A comprehensive literature search was conducted across PubMed, Embase, and Web of Science from inception until December 25, 2023. Observational studies defining neighborhood deprivation and reporting hypertension incidence were included. Nested Knowledge software was used for screening and data extraction, with study quality assessed using the Newcastle-Ottawa Scale. Statistical analysis was performed with R software (V 4.3), using a random-effects model to calculate the pooled relative risk (RR).

RESULTS

Twenty-six studies were included in the qualitative analysis and 22 in the meta-analysis, covering over 62 million participants. The pooled RR was 1.139 (95% CI: 1.006 - 1.290), p=0.04, indicating a higher hypertension risk in deprived neighborhoods. Subgroup analyses showed variability by country and deprivation assessment methods. RR varied from 1.00 in Japan (95% CI: 0.93-1.08) to 1.60 (95% CI: 1.07-2.39) in France and 1.57 (95% CI: 0.67-3.70) in Germany, with significant heterogeneity observed in measures of neighborhood deprivation.

CONCLUSION

Our analysis confirms a significant association between neighborhood deprivation and hypertension, underscoring the importance of socioeconomic factors in public health. It highlights the need for targeted local assessments and interventions. Future research should explore the causal mechanisms and effectiveness of interventions addressing neighborhood deprivation.

Efficacy and safety of stem cell therapy in patients with dilated cardiomyopathy: An umbrella review of systematic reviews

BACKGROUND

Stem cell therapy (SCT) has emerged as a potential therapeutic avenue, with various cell types being explored for their efficacy in treating DCM. However, the safety and efficacy of these therapies have been the subject of numerous systematic reviews. This umbrella review aims to consolidate the existing evidence on stem cell interventions for DCM, providing a comprehensive overview of the current research landscape.

METHODS

This review was conducted following the JBI and PRISMA guidelines. Systematic reviews and meta-analyses of randomized controlled trials (RCTs) evaluating the safety and efficacy of SCT for DCM were included. Outcomes such as 6MWT, LVEDD, LVEF, MACE, NYHA, and QoL, among others, were considered. A literature search was executed across databases like PubMed, Embase, Web of Science, and Cochrane Database up to October 07, 2023. The quality of the included reviews was assessed using the JBI Checklist for Systematic Reviews and Research Syntheses. Data synthesis was carried out in both narrative and tabular formats, with the GRADE criteria guiding the determination of evidence certainty.

RESULTS

Nine systematic reviews met the inclusion criteria. LVEF found to be significantly improved with SCT. LVEDD and LVEDV assessments yielded mixed results, with some reviews observing significant changes. LVESV showed consistent reductions across multiple studies. BNP concentrations post-interventions were explored in several studies, with mixed findings. Health-related quality of life (HRQL) showed varied results, with some studies noting improvements and others finding no significant differences. NYHA classifications and 6-MWT results indicated potential benefits from stem cell treatments. SCT was observed to be generally safe. The certainty of evidence was low or very low for most of outcomes.

CONCLUSION

SCT showed has shown promise in treating DCM, with many studies highlighting its safety and potential benefits. Nonetheless, the existing data has its limitations due to biases in the RCTs studies. To truly establish the benefits of SCT for DCM, future high quality RCTS, are crucial.

Comparison of health care professionals' and laypeople's knowledge, attitudes, and practices on the use of antimicrobial and antimicrobial resistance

BACKGROUND

The discovery of antimicrobials is a pioneering step in health sciences concerning preventive care and early management for infectious diseases. However, with advancements in health sciences, inappropriate knowledge, practices, and over-the-counter medications were often used by the general population in underdeveloped nations like India without thinking about its consequences which leads to the use of antimicrobials excessively or inadequately, which is also a factor for antimicrobial resistance. This quantitative study determines the awareness of healthcare professionals and laypersons about usage and resistance of antimicrobials.

METHODS AND MATERIALS

Research was carried out in rural tertiary teaching hospital of study participants were 106 nurses, 115 interns, 107 junior residents, and 97 laypersons using a "self-administered WHO questionnaire". SPSS version 27.0 software was used to analyze the data. The P value cut-off for significance was established at <.05.

RESULTS

Forty seven percent of nurses and 44% of interns consumed antimicrobials in the last month, more than interns and junior residents. Fourteen percent of interns and 13% of laypersons did not get any prescription for lastly taken antimicrobial. The majority of participants obtain prescribed antimicrobials from medical stores and pharmacies. Fifty five percent of laypersons and 59% of nurses stop taking antimicrobials when they feel better. Only 13% of nurses were aware of the proper indications of antimicrobials for the same illness. Only 22% of respondents know the term superbugs, significantly less than the other key terms related to the antimicrobials. Nurses and laypersons had some misconceptions related to the mechanism of development of antimicrobial resistance.

CONCLUSIONS

The analysis revealed that a significant lack of knowledge and various misconceptions were primarily seen in the nurses and laypersons. In contrast, medical graduates such as interns and junior residents lacked the right attitude and perspective regarding the use of antimicrobials and their resistance.

Substance Abuse Amongst Adolescents: An Issue of Public Health Significance

Adolescence is a crucial time for biological, psychological, and social development. It is also a time when substance addiction and its adverse effects are more likely to occur. Adolescents are particularly susceptible to the negative long-term effects of substance use, including mental health illnesses, sub-par academic performance, substance use disorders, and higher chances of getting addicted to alcohol and marijuana. Over the past few decades, there have been substantial changes in the types of illegal narcotics people consume. The present article deals with the review of substance abuse as a public health problem, its determinants, and implications seen among adolescents. A systematic literature search using databases such as PubMed and Google Scholar was undertaken to search all relevant literature on teenage stimulant use. The findings have been organized into categories to cover essential aspects like epidemiology, neurobiology, prevention, and treatment. The review showed that substance addiction among adolescents between 12 to 19 years is widespread, though national initiatives exist to support young employment and their development. Research on psychological risk factors for teenage substance abuse is vast, wherein conduct disorders, including aggression, impulsivity, and attention deficit hyperactivity disorder, have been mentioned as risk factors for substance use. Parents' attitudes toward drugs, alcohol, academic and peer pressure, stress, and physical outlook are key determinants. Teenage drug usage has a significant negative impact on users, families, and society as a whole. It was found that a lot has been done to provide correct intervention to those in need with the constant development of programs and rehabilitative centers to safeguard the delicate minds of youths and prevent them from using intoxicants. Still, there is much need for stringent policy and program guidelines to curb this societal menace.

The Global Impact of COVID-19 on Mental Health of General Population: A Narrative Review

Mental wellness is a crucial component of happiness. A person is happy with better relationships, financial stability, good mental health, and longevity. Disinformation, stigma, ongoing isolation, and disruption of daily activities are all quite prevalent. Any of these elements may impact one's mental health. The Ministry of Health and Family Welfare has taken several steps to address COVID's mental health concerns. In addition to frontline healthcare personnel, who engage in dealing with COVID-19, the general population's mental health was also at stake due to the unprecedented and catastrophic emergency of COVID. Various keywords, including MeSH terms, were used in PubMed and Google Scholar searches. This paper was based on previously available data and article searches on how COVID-19 affected the mental health of the general population and the elements that may influence it. Quarantine and self-isolation have been found to have affected people's daily livelihoods and behaviors, leading to increased feelings of loneliness, anxiety, dejection, insomnia, risky alcohol and drug use, self-harm, and suicidal thoughts. Many of the victims of COVID-19 who were critical survivors exhibited lasting psychological harm a year after being discharged, including high anxiety levels, melancholy, and post-traumatic stress disorder. Healthcare employees too experienced significant psychological consequences due to factors such as an excessive workload or the number of hours worked, inadequate personal safety equipment, overly enthusiastic media coverage, and a sense of being under-supported. As a result of this major disaster, mental health concerns have surfaced, perhaps leading to long-term health problems, loneliness, and guilt. To reduce this deportment, global health solutions should be used, particularly while executing the isolation/quarantine and dealing with the people with fear and vulnerability. The mental health of the general population should be at the forefront of any worldwide response.

Role of Art Therapy in the Promotion of Mental Health: A Critical Review

Art therapy is used most commonly to treat mental illnesses and can aid in controlling manifestations correlated with psychosocially challenging behaviours, slowing cognitive decline, and enhancing the quality of life. Art therapy can help people express themselves more freely, improve their mental health, and improve interpersonal relationships. The basis of art therapy is established on the idea that people can recover and feel better via artistic expression. This review examines the current research on how active participation in the arts might improve mental health. A detailed literature search was carried out utilizing essential databases such as PubMed, the WHO's mental health database, and Google and Google Scholar. This review study looks into research done on art therapy and its potential advantages for adult mental health rehabilitation. It focuses on visual art therapy since it’s a key to reducing variation within the "creative arts" and defines the peculiar elements and effectiveness of art therapy used by mental health services. It was found that the use of art therapy as an adjunct treatment showed improved mental health in patients.

WASH to control COVID-19: A rapid review

Background

Preventive public health has been suggested as methods for reducing the transmission of COVID-19. Safety and efficacy of one such public health measure: WASH intervention for COVID-19 has not been systematically reviewed. We undertook a rapid review to assess the effect of WASH intervention in reducing the incidence of COVID-19.

Methods

We conducted searches in PubMed, MEDLINE, and EMBASE. We undertook screening of studies in two stages and extracted data and assessed the quality of evidence for the primary outcome using GRADE recommendations.

Main results

We included a total of 13 studies with three studies on COVID-19 and 10 on SARS. The study found that hand washing, sterilization of hands, gargling, cleaning/shower after attending patients of COVID-19, or SARS was protective. Evidence also found that frequent washes can prevent SARS transmission among HCWs. However; one study reported that due to enhanced infection-prevention measures, front-line HCWs are more prone to hand-skin damage. The certainty of the evidence for our primary outcome as per GRADE was very low. We did not find any studies that assessed the effect of WASH on hospitalizations, and mortality due to COVID-19. Also; we did not find any study that compared WASH interventions with any other public health measures.

Conclusions

Current evidence of WASH interventions for COVID-19 is limited as it is largely based on indirect evidence from SARS. Findings from the included studies consistently show that WASH is important in reducing the number of cases during a pandemic. Timely implementation of WASH along with other public health interventions can be vital to ensure the desired success. Further good-quality studies providing direct evidence of the efficacy of WASH on COVID-19 are needed.

Gaps and Interventions across the Diagnostic Care Cascade of TB Patients at the Level of Patient, Community and Health System: A Qualitative Review of the Literature

Tuberculosis (TB) continues to be one of the important public health concerns globally, and India is among the seven countries with the largest burden of TB. There has been a consistent increase in the notifications of TB cases across the globe. However, the 2018 estimates envisage a gap of about 30% between the incident and notified cases of TB, indicating a significant number of patients who remain undiagnosed or ‘missed’. It is important to understand who is ‘missed’, find this population, and provide quality care. Given these complexities, we reviewed the diagnostic gaps in the care cascade for TB. We searched Medline via PubMed and CENTRAL databases via the Cochrane Library. The search strategy for PubMed was tailored to individual databases and was as: ((((((tuberculosis[Title/Abstract]) OR (TB[Title/Abstract])) OR (koch *[Title/Abstract])) OR (“tuberculosis”[MeSH Terms]))) AND (((diagnos *) AND (“diagnosis”[MeSH Terms])))). Furthermore, we screened the references list of the potentially relevant studies to seek additional studies. Studies retrieved from these electronic searches and relevant references included in the bibliography of those studies were reviewed. Original studies in English that assessed the causes of diagnostic gaps and interventions used to address them were included. Delays in diagnosis were found to be attributable to both the individuals’ and the health system’s capacity to diagnose and promptly commence treatment. This review provides insights into the diagnostic gaps in a cascade of care for TB and different interventions adopted in studies to close this gap. The major diagnostic gaps identified in this review are as follows: people may not have access to TB diagnostic tests, individuals are at a higher risk of missed diagnosis, services are available but people may not seek care with a diagnostic facility, and patients are not diagnosed despite reaching health facilities. Therefore, reaching the goal to End TB requires putting in place models and methods to provide prompt and quality assured diagnosis to populations at par.

Splenic Artery Embolization in Subcapsular Splenic Hematoma Secondary to Dengue Hemorrhagic Fever

Dengue hemorrhagic fever (DHF) is a common syndrome of dengue viral infection but complications such as sub-capsular splenic hematoma leading to capsular rupture in dengue are rare. We report a case of a young male who presented with fever, breathlessness, and acute abdomen. His CT of the abdomen revealed subcapsular splenic hematoma measuring 16.7 cm × 13.0 cm × 11 cm. His laboratory parameters were suggestive of anemia, thrombocytopenia, acute kidney injury, coagulopathy, and hepatopathy because of which instead of splenectomy, splenic artery embolization with ultrasound-guided splenic hemorrhage drainage was performed for his management as his clinical condition deteriorated. This case report sensitizes newer modalities of treatment of subcapsular splenic hematoma with splenic arterial embolization.

Assessment of Services at Tertiary Care Hospital Located in Central India, using ‘Kayakalp Initiative Tool’

Background: Kayakalp is an innovative initiatory started by the Health and Family Welfare Ministry through Swachh Bharat Abhiyan campaign on 15th May 2015. These instructions concentrate on advancement of desirable schemes for housekeeping facilities, pest control procedure, water sanitation, appointment & tutoring of manpower, advancement and accomplishment of appropriate cleansing procedure in terms of protocols / Standard Operating Procedures (SOPs), powerful management and inspection by the employees and inherent Machinery in the treaties linked with an organizational framework which places a bonus on excellent cleaning services and sanitary facilities. This study aims to describe the experiences and knowledge based on assessment of Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe), Wardha District using this tool. Objectives: To assess and document hospital upkeep, Sanitation, Hygiene Practices, Hygiene Promotion and to study Handling of Biomedical Waste, Infection Control and Hospital Support Services. Methodology: This cross sectional hospital based study that will be conducted at Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe), Wardha District. Apart from observation of various practices and Processes, the participants to be interviewed will be Nursing staff in-charge in different wards along with Biomedical engineers, Administrative officers and beneficiary patients. For Quantitative data collection, a kayakalp checklist will be used. Data will be collected through observation, staff interview, record keeping, and patient interview forms as per Kayakalp Initiative Tool. Results: This study would help to understand current hospital sanitation procedures, hospital hygiene, infection prevention, general maintenance, waste management, and support services, etc. and will help to improve services based on findings of the study so as to improve satisfaction of population catered by hospital and provide an ideal working environment for all stakeholders. Conclusion: This work will assist in improving hospital/facility management and will aid in improvement of sanitation and hygiene practices, it will also improve overall satisfaction of all stakeholders after due implementation of changes suggested at the end of study.

Applying visual mapping techniques to promote learning in community-based medical education activities

BACKGROUND

Teaching and learning Community-Based Medical Education (CBME) requires the active engagement of students in various activities to cover planned curricular content. CBME being multifaceted involves careful application and formation of links when attending to community health problems and public health issues. Students often depend on factual recall rather than 'engaging in', to counteract the broad and comprehensive nature of CBME. This study was conducted to assess the effectiveness of Visual mapping techniques as a learning tool in a CBME program for the subject Community Medicine and thereby assist medical undergraduate students in overcoming identified learning challenges.

METHODOLOGY

An interventional study was conducted where medical undergraduates were randomly assigned to two different groups (each group = 30). After sensitization, a broad theme was taught to both the groups as a part of community-based teaching (CBT), each week for a month. The students in the intervention group were given the assignment to draw visual maps using the mind mapping & concept mapping techniques, after each CBT session, while the control group had Question-Answer session with built-in discussion (Conventional method) by an equally qualified, experienced faculty with no mapping assignments. A surprise written examination was conducted on the topics taught, and scores of both the groups were compared. Feedback was obtained from the intervention group.

RESULTS

Mean score of the examination by the intervention group (29.85 ± 3.22) was significantly higher than and that of the control group (23.06 ± 4.09) (t = 7.14 and p < 0.05). The students shared that the assignment of drawing mind and concept maps for topics taught helped in attempting questions of the written examination by facilitating easy recall of the information learned. It aided to frame the answers to descriptive questions in a structured way with the use of keywords. However, identifying the concepts and establishing relationship between them was slightly challenging.

CONCLUSION

'Visual mapping' in the form of Mind and Concept mapping was found to be an effective learning tool for multifaceted CBME especially in promoting meaningful learning and facilitating rational thinking by the medical undergraduates.

A Systematic Review on Effect of Electronic Media among Children and Adolescents on Substance Abuse

Background:

Substance abuse is one of the most significant global public health issues among youths. Electronic media has become a part of day-to-day life for all. This systematic review is undertaken to comprehensively explore the effect of electronic media on substance abuse among children and adolescents.

Methodology:

Two review authors independently searched various electronic databases and other sources.

Selection Criteria:

Randomized control trials that assessed the effect of exposure of electronic media (defined as television, internet, gaming, mobile phones/phones, and radio) among participants in the age range of 5–19 years on substance abuse were included in the review.

Data Collection and Analysis:

Two reviewers independently extracted data. We used an approach proposed by the Cochrane Collaboration. We used GRADE profiler to assess the overall quality of the evidence.

Main Results:

We retrieved 6003 studies and found 15 studies that fulfilled our inclusion criteria. Since included studies differed in the type of intervention and reporting of outcomes, we did not undertake meta-analysis and choose to describe studies narratively. Quality of evidence was rated as “very low” due to too little information or too few data to be able to reach any conclusions.

Authors' Conclusions:

Clinicians, policymakers, and educators to partner with caregivers and youth to support electronic media use that promotes positive outcome in these areas.

Registration of Systematic Review:

This systematic review has been registered at PROSPERO International prospective register of systematic reviews (Registration number: PROSPERO 2018 CRD42018086935) available at https://www.crd.york.ac.uk/prospero/display_record.php?RecordID = 86935.

A Systematic Review on Effect of Electronic Media on Diet, Exercise, and Sexual Activity among Adolescents

Context

Electronic media has become a part of day-to-day life for all, and particularly more so for children and adolescents. Exposure to electronic media may be beneficial as well as harmful.

Aim

The aim of the study is to systematically synthesize existing published and non-published empirical evidence on the effect of exposure to electronic media on diet, exercise, and sexual activity.

Methodology

Two reviewers independently searched online databases such as MEDLINE, CENTRAL, and EMBASE. We applied no language, date, or publication restrictions.

Selection Criteria

We included randomized control trials that assessed the effect of exposure of electronic media on diet, exercise, and sexual activity in participants between 5 and 19 years.

Study Selection Data Extraction

Two reviewers independently screened studies identified in electronic search and independently extracted data and assessed the risk of bias of included studies.

Data Analysis

We had planned to use the risk ratio or odds ratio for dichotomous data, and mean difference (MD) or standardized MD for continuous data. However, as included studied differed in types of intervention and reporting of outcomes, we did not undertake meta-analysis.

Main Results

All included trials were parallel randomized controlled trials except for one that was a crossover trial. Eight studies reported the effect of electronic media on diet and exercise, two on diet, two on exercise, and one on sexual activity. Quality of evidence was rated as "very low" for all outcomes due to too little information or too few data to be able to reach to any conclusions.

Conclusions

There is a little body of evidence that limits conclusions. We need to comprehend as to how to swap undesirable effects of electronic media and make it more desirable.

Registration of Systematic Review

This systematic review has been registered at PROSPERO International prospective register of systematic reviews (Registration number: PROSPERO 2018 CRD42018086935) available at https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=86935.

Feasibility and acceptability of computer based online certifcation program for frontline community health workers of Wardha district, India

Background: In India, different types of Frontline Community Health Workers are recruited under different departments and health programmes. These include Anganwadi Workers (AWW) under ICDS, ASHA and ANMs under NRHM and health services. Training and recruitment of this staff cadre is an ongoing process. Most of the trainings are aimed at improving the knowledge and skills. A set of test is needed to assess the post training knowledge of trainees which should be feasible, acceptable and easy to administer. Team of Health Experts from DMIMSU, Wardha has developed such specifc Computer based online certifcation tests which were administered to selected Frontline Community Health Workers engaged with DMIMSU. This study was conducted to assess the feasibility and acceptability of these tests.Aims and Objectives: Team of Health Experts from DMIMSU,Wardha has developed specifc Computer based online certifcation tests which were administered to selected Frontline Community Health Workers engaged with DMIMSU. This study was conducted -1] To assess the feasibility and acceptability of Computer based online certifcation tests for frontline workers. 2] To assess the scope for generalization of these tests to entire frontline health cadre of the district.Materials and Methods: Data was collected from 30 randomly selected Frontline Health Workers who were engaged in Community Outreach Activities/Projects of DMIMS and had undergone trainings and Online Certifcation tests. Questionnaire with Likert type scoring scale was administered. Data was compiled in MS Excel and Weighted Means and proportions of responses towards agreement and disagreement were calculated.Results: Average Weighted Mean was 4.07 showing Strong Agreement towards the feasibility and acceptability. Only 10.3% participants showed disagreement towards the feasibility and acceptability of this test whereas 89.7% participants showed agreement and among them, 47.67% showed strong agreement towards the feasibility and acceptability of this test.Conclusion: These tests were found quite feasible and well accepted by Frontline Health Workers. Similar tests should be made compulsory for all Frontline Health Workers Cadre and their performance in tests should be linked to provisions of incentives and seniority benefits.Asian Journal of Medical Sciences Vol.8(2) 2017 82-85 

Ghrelin O Acyl Transferase (GOAT) as a Novel Metabolic Regulatory Enzyme

BACKGROUND

Obesity and Type 2 Diabetes Mellitus (T2DM) presents a growing threat to the global health. Evidences highlight an important role of ghrelin as a key regulator of glucose metabolism. The physiological functions of ghrelin are mediated by enzyme ghrelin-O-acyltransferase (GOAT) which is capable of generating the active form of this metabolic hormone. However, its exact mechanism of action and influence on energy balance and glucose metabolism is yet to be explored.

OBJECTIVES

To review the physiological role of GOAT in the regulation of energy balance and glucose metabolism and explore the potential therapeutic avenues of modulators of GOAT to counter the progression of obesity and T2DM.

METHODS

Publications were sought through electronic searches. The bibliographies of all papers, book, chapters and editorials were scanned and hand searches were also conducted for journals, and conference proceedings.

CONCLUSION

GOAT peptide modulates the insulin secretion as well as insulin sensitivity. Modulators of GOAT signaling like inhibitors of GOAT increases insulin secretion, enhance peripheral insulin sensitivity and thus counters obesity and T2DM. Modulators of GOAT can be a probable therapy for modifying food intake and for countering obesity and T2DM.

Ghrelin: ghrelin as a regulatory Peptide in growth hormone secretion

BACKGROUND

Ghrelin is a type of growth hormone (GH) secretagogue that stimulates the release of GH. It is a first hormone linking gastrointestinal-pituitary axis.

OBJECTIVE

This review highlights the interaction of ghrelin with GHRH and somatostatin to regulate the secretion of GH and intends to explore the possible physiological role of the ghrelin-pituitary-GH axis linkage system.

OBSERVATION

Ghrelin is highly conserved among species and is classified into octanoylated (C8:0), decanoylated (C10:0), decenoylated (C10:1) and nonacylated,ghrelin. Acylated ghrelin is the major active form of human ghrelin. The primary production site of ghrelin is the stomach, and it interacts with stomach ghrelin as well as hypothalamic GHRH and somatostatin in the regulation of pituitary GH secretion. Ghrelin stimulate GH release through the GHS receptor to increase intracellular Ca2+ ([Ca2+] levels via IP3 signal transduction pathway. Ghrelin is a specific endogenous ligand for the GHS receptor and provides a definitive proof of the occurance of a GHS-GHS receptor signalling system in the regulation of GH secretion.

CONCLUSION

Studies suggests that ghrelin is a powerful pharmacological agent that exerts a potent, time-dependent stimulation of pulsatile secretion of GH.

Risk factors of type-2 diabetes mellitus in rural Wardha: A community based study

CONTEXT:

The rise in diabetes mellitus (DM) portends a disaster of major proportion worldwide. AIM: To study the determinants of type-2 DM in people who are ≥45 years of age by selective screening methodology in rural area of Wardha district.

SETTINGS AND DESIGN:

A cross-sectional study in a rural area of Wardha district.

METHODOLOGY:

A cross-sectional population-based study was conducted among those who are at risk of developing DM, as per the WHO guidelines on Laboratory Diagnosis and monitoring of Diabetes Mellitus 2002. Blood glucose estimation was done using a blood glucose meter.

STATISTICAL ANALYSIS USED:

Multiple Logistic Regression.

RESULTS:

Eight point four nine percent of the 306 persons above the age of 45 years were diabetic. This study also revealed that the proportion of people diagnosed with DM increases with increasing age groups. Mean fasting and post meal blood glucose level (in mg%) among the study participants (nondiabetics) were 83.6 ± 1.6 and 129.9 ± 1.9 and mean fasting and post meal blood glucose level among diabetics were 138.8 ± 2.1 and 220.7 ± 1.9, respectively. The difference between the post meal blood glucose level among the diabetics and nondiabetics was statistically significant. The proportion of diabetics was more among those who had family history of diabetes (8.6%), BMI more than 25 (24.1%) and those with sedentary lifestyle (10.4%).

CONCLUSIONS:

Implementation of preventive measures to reduce the burden of diabetes is needed. Identification of the environmental factors adversely related to glucose intolerance helps evolve preventive strategies.

Use of flexible bronchoscopy for rapid diagnosis of suspected tubercular cases in rural India

Background: Reaching a correct diagnosis is a challenge for physicians treating any of the 30% to 50% of pulmonary tuberculosis patients who have negative sputum cultures or who present with no sputum.  Flexible bronchoscopy acquires special importance for these cases for whom empirical anti-tuberculosis therapy is the only option left. In our study we aimed to assess the diagnostic yield of flexible bronchoscopy in patients, suspected to have tuberculosis, whose sputum smears were negative. Methodology: In our hospital-based cross-sectional study, 42 patients were enrolled by consecutive sampling. Flexible bronchoscopy and selective bronchial washings were done in all patients.  Results: Bronchoscopy lavage smears were positive for M. tuberculosis in 10 (23.8%) patients. Fifteen (35.7%) patients had positive culture. Conclusion: Flexible bronchoscopy has an important role in the diagnosis of patients suspected to have tuberculosis, whose sputum smears are negative or who can not produce sputum.

Predictors for antenatal services and pregnancy outcome in a rural area: a prospective study in Wardha district, India

BACKGROUND

Antenatal care is essential to reduce morbidity and mortality among newborn babies and pregnant women.

AIMS

To study the pattern of utilization of antenatal services and to find out the potential predictors, their distributions and their association with antenatal care utilization and pregnancy outcomes.

SETTINGS AND DESIGN

A prospective longitudinal study was conducted in Deoli, a rural teaching area of a medical college of Wardha district, Maharashtra state.

MATERIALS AND METHODS

Medical social workers contacted all the registered 305 pregnant women in 1 month. A total of 274 women were included in the study. The response rate was 89.83%.

STATISTICAL ANALYSIS USED

Percentages, rate ratio.

RESULTS

Mean age at marriage was 19.8+/-3.6 years, and the average age at first pregnancy was 21.6+/- 4.5 years. Of the 274 pregnant women, 156 (56.9%) were pregnant for the first time (gravida 1), and the remaining 118 (43.1%) pregnant women, gravida 2 and above, had an average of 2.1 living sons and 1.9 living daughters. Only 92 (33.6%) women had undergone the minimum recommended antenatal checkup during their current pregnancy, and 188 (68.6%) women had institutional deliveries. A large proportion of women in Deoli do not receive proper health care during pregnancy and childbirth.

CONCLUSION

In Deoli, antenatal services, in spite of being essential to the care of pregnant women, are being poorly delivered.

Assessing self-care component of activities and participation domain of the international classification of functioning, disability and health (ICF) among people living with HIV/AIDS

Disability experience of persons with HIV illness has shifted from issues related to physical well-being to those concerning performance of daily life activities. This study aimed to find out the nature of self-care among people living with HIV/AIDS (PLWHA) in rural tertiary care center. The objectives were to determine reported self-care by performance qualifier of PLWHA and to find out reported self-care by capacity qualifier of PLHIV. A cross sectional study was conducted among the 194 PLHIV in rural tertiary care hospital. The Self-Care (d5) component of Activities and Participation domain (d) of the International Classification of Functioning, Disability and Health (ICF) was used. Among the 194 PLHIV patients studied, 82% were male. The average age was 36.87 years (SD+/-9.01) with a median of 35 years, varying from 15 to 65 years. Over 65% of the study group experienced one or more impairments. As HIV disease has become a more lifelong, unpredictable, but medically manageable condition, there is a need for more collaboration with other disability groups in order to identify commonalities in their experiences and to share collective concerns.