Prevalence and risk factors associated with undiagnosed diabetes in India: Insights from NFHS-5 national survey

Background

Undiagnosed diabetes is a significant public health concern in India, considering the accumulative burden of diabetes and its long-term complications. We have estimated the prevalence and factors associated with undiagnosed diabetes in India.

Methods

We used data from the fifth round of the National Family Health Survey (NFHS-5, 2019-21) to estimate undiagnosed diabetes prevalence aged under 50 (15-49) years. A log-binomial model with survey-adjusted Poisson regression was used to estimate the prevalence risk ratio (PR) between undiagnosed diabetes and various factors. Multinomial logistic regression analysis was performed to examine the factors associated with diagnosed diabetes (vs. healthy) and undiagnosed diabetes (vs. healthy). All the analyses were survey-weighted and stratified by gender and reported with 95% confidence intervals.

Results

The prevalence of diabetes for individuals aged 15-49 years was found to be 4.90% (4.80 to 5.00%) from the NFHS-5. Among them, the proportion of individuals with undiagnosed diabetes was 24.82% (24.07 to 25.59%), with higher among males (28.82% (26.45 to 31.30%)) than females (24.22% (23.44 to 25.01%)). The overall prevalence of undiagnosed diabetes was 1.22% (1.18 to 1.26%), with a higher prevalence among males (1.60% (1.46 to 1.76%)) than females (1.17% (1.13 to 1.21%)). Individuals who are middle-aged (45-49), have a higher body mass index (BMI), and are in a lower wealth index group, or live in the southern regions of India are at a higher risk of being undiagnosed for diabetes.

Conclusion

One in every four having diabetes is undiagnosed. The study highlights the need for public health interventions to improve diabetes screening and access to health care, particularly among middle-aged individuals, and those with higher BMI, as well as addressing lifestyle and dietary factors. The findings also reveal disparities in diabetes burden among population subgroups in India, underscoring the need for targeted efforts.

Guided imagery for anxiety disorder: Therapeutic efficacy and changes in quality of life

Background

Patients with anxiety disorder were showing severity of anxiety symptoms as well as poor quality of life. Guided imagery (GI) provides immediate relaxation, and improves the severity of anxiety symptoms and the quality of life of patients with anxiety disorder. Anxiety is a basic emotion that is required as a motivation for everyday work of life. Anxiety presents a complex cognitive, affective, physiological, and behavioral response that is related to future harm (real or perceived).

Aim

To study the efficacy of GI intervention on patients with anxiety disorder and their quality of life.

Materials and Methods

This longitudinal, interventional study was done in a state institute of mental health, psychiatric unit on 20 patients (outpatients) with anxiety disorder, diagnosed according to diagnostic criteria of research ICD-10 DCR. Patients were assessed using a sociodemographic and clinical data sheet, Hamilton anxiety scale, and World Health Organization QOL instrument, short-form (WHOQOL-BREF), Hindi version.

Results

Patients with anxiety disorder in the experimental group improved as compared with the control group significantly. The mean QOL-BREF score was also improved after intervention in the intervention group.

Conclusion

GI intervention helps reduce the severity of anxiety symptoms and improve the quality of life in patients with anxiety disorder.

Triaging of Bone Marrow for Esoteric Testing – Cost-effective and Patient-centric Approach Utilizing WHO Nomenclature for Hematolymphoid Malignancies

Introduction/Objective

Esoteric testing (ES) plays a major role in bone marrow (BM) evaluation. Providers usually order tests considering differential diagnoses based on clinical history. Hematopathologists (HP) while reviewing the BM consider modifying the standing orders. Knowledge and simple guidelines for triaging BM for ES are limited in the literature.

Methods/Case Report

Between 2015-2021, a total of 2560 BMs were selected. Initial tests that were ordered by providers were reviewed by HP considering clinical history, medical necessity, and preliminary BM morphology. Average Medicare fee schedule for 2022 was used for cost analysis. Types of ES were evaluated for Flow Cytometry (FC); Cytogenetics (CG); Fluorescence In-Situ Hybridization (FISH) and Molecular Genetics (MG). Immunostains were excluded in this study.

Results (if a Case Study enter NA)

Cases were evaluated and categorized as cytopenias, cytosis, staging, MPN, MDS, myelomas, treatment follow-up and miscellaneous indications. ES were modified based on medical necessity and blinded with insurance plans or payment status. Initial clinical orders were modified by HP as follows: FC-reduced 15%; CG-reduced 38%; FISH-modified 25%; MG-modified 40% (single assays or NGS). Overall healthcare savings by modifying tests were close to $1.2M.

Conclusion

Effective triaging of BM is a complex decision and can result in significant cost savings. Factors positively impacting these savings are: 1) expertise training in hematopathology, 2) personalized order of ES considering clinical indication, 3) peer-to- peer interaction with providers, and 4) the types of samples obtained. Collaborative efforts among pathologists and clinicians may lead to appropriate ordering of tests, cost- saving effective patient care with relevant diagnostic, therapeutic and prognostic information obtained as recommended by WHO nomenclature for hematolymphoid malignancies. In addition, established practice guidelines with personalized medicine will reduce the burden for pre-authorization when challenged with time sensitive samples obtained from cancer patients obtained thru invasive procedures.

Rice straw structure changes following green pretreatment with petha wastewater for economically viable bioethanol production

Energy efficient and environment friendly pretreatment processes for the production of biofuel have remained elusive and the research is further compounded by the high cost of processing lignocellulosic biomass-an essential factor for producing sustainable biofuels. In the last few decades, a number of pretreatment methods have been proposed, specifically chemical pretreatments but are either expensive or harmful to the environment. To address this urgent need, we propose a green pretreatment method that utilises the highly alkaline by-product, petha wastewater to pretreat the lignocellulosic waste rice straw (RS). The effectiveness of the pretreatment was analysed by monitoring both enhanced cellulose content and reducing sugar yield along with removal of hemicellulose and lignin. We found that PWW pretreatment yielded five times more reducing sugar than native RS with 10.12% increment in cellulose content. SEM and EDX studies further revealed that our process enhanced surface roughness and carbon content (from 32.19% increased to 41.59% and 41.66% for A and D, respectively) along with reduction in silica content (from 8.68% in RS to 4.30% and 7.72% for A and D, respectively). XRD and FTIR analyses indicate crystallinity index (CI) and alteration in lignocellulosic structure of RS, respectively. Decrease in CI was about 43.4% in A whereas only 4.5% in D as compared to native RS (CI 54.55%). Thereby we found PWW to be better substitute of an alkali for pretreatment of RS with negligible environmental impacts.

Use of Artificial Intelligence/Machine Learning in Cancer Research During the COVID-19 Pandemic

The cancer patients are more vulnerable and are at increased risk of COVID-19 and related outcomes due to their weakened immune systems, specially patients with lung cancer. Amid pandemic, the diagnosis, treatment, and care of cancer patients are very difficult and challenging due to several factors. In such situations, the latest technology in artificial intelligence (AI) or machine learning algorithms (ML) have potential to provide better diagnosis, treatments and cares of cancer patients. For example, the researches may use clinical and imaging data with machine learning techniques to make differences between coronavirus-related lung changes and those caused by immunotherapy and radiotherapy. During this pandemic, AI can be used to ensure we are getting the right patients enrolled speedily and more efficiently than the traditional, and complex ways in the past in cancer clinical trials. This is the appropriate time to go beyond the “research as usual” approach and update our research via AI and ML tools to care the cancer patients and discover new and more effective treatments.

Health risk assessment of pesticide residues in fruits and vegetables from farms and markets of Western Indian Himalayan region

The extensive use of pesticides in agriculture has become a very common practice in developing countries like India. Consequently, the increased concentration of residues of these hazardous pesticides in fruits and vegetables is manifested. The study aimed to assess the health hazards associated with the presence of pesticide residues in fruits and vegetables sampled from farms and markets of Kinnaur district of Himachal Pradesh (India). Residues of predominant pesticides used in the region, belonging to the group of organophosphates, pyrethroid and phthalimide, were analysed using gas chromatograph quadrupole mass spectrometer (GC-MS/MS). The pesticide extraction from the matrix was done following the modified QuEChERS method. Results indicated varying concentrations of pesticide residue in market and farm samples with farm samples more contaminated than market samples. Chronic health hazards prediction indicated that organophosphorus groups (methyl parathion and triazophos) posed health risk to children in the study area.

Long Working Hours and the Risk of Chronic Disease

A change in employment trends, in the nature of occupation and in the number of working hours has an impact on the diseases prevalent in people. Using data from a World Health Organization 2007 study on global ageing and adult health, this research looks at the effect of past work histories on the prevalence of selected chronic diseases such as hypertension, diabetes, stroke, angina and depression in India. By using a bivariate and multivariate analysis, this study shows that all the selected chronic diseases were significantly higher in urban areas, especially amongst people who were educated upto a higher secondary level and above and were from the richest wealth quintile. The chances of all these selected chronic diseases, except for depression, were also found to be significantly higher among those who were working in the non-manual sector. It was also found that the expected odds of having diabetes and stroke were significantly higher among those employees who worked for more than eight hours a day than their counterparts who worked for less than eight hours a day after adjusting important confounders. Based on these findings, the study suggests that the government should implement some specific policy measures; and take steps which will help employees cope with harmful work schedules.

Nutritional composition and antioxidant activities of 18 different wild Cantharellus mushrooms of northwestern Himalayas

A total of 18 wild edible mushrooms of Cantharellus species were collected from northwestern Himalayan region of India. The basic composition (moisture, total carbohydrates, dietary fiber, crude fat, ash, nitrogen and protein) and amino acid contents (by high-performance liquid chromatography) of these wild edible mushrooms were determined. The macronutrient profile in general revealed that the wild mushrooms were rich sources of protein and carbohydrates, and had low amounts of fat. Total phenolics and antioxidant activity from water and methanolic extracts of these mushrooms were also determined. These wild mushrooms also had significant amount of phenol content and antioxidant capacity. Studies also provide the precise antioxidant status of 18 indigenous species of mushrooms, which can serve as a useful database for the selection of mushrooms for the function of preparation of mushroom-based nutraceutics.

Identification of IgE-mediated food allergy and allergens in older children and adults with asthma and allergic rhinitis

BACKGROUND AND OBJECTIVE

Prevalence of immunoglobulin (Ig) E-mediated food allergy is primarily reported for certain pediatric populations and adults. The present study was aimed to investigate the relative prevalence of food allergy and allergens in older children and adults with asthma and allergic rhinitis.

METHODS

Patients (12-62 years) were screened using standard questionnaire and skin prick-test (SPT) with common foods and aeroallergens. Specific IgE level was determined by enzyme linked immunosorbent assay (ELISA) and allergy was established by blinded food challenges.

RESULTS

Of 1860 patients screened, 1097 (58.9%) gave history of food allergy. Of the history positive patients skin tested (n=470), 138 (29.3%) showed a marked positive reaction to food extracts. Rice elicited positive SPT reaction in maximum number of cases 29 (6.2%) followed by blackgram 28 (5.9%), lentil 26 (5.5%), citrus fruits 25 (5.3%), pea 18 (3.8%), maize 18 (3.8%) and banana 17 (3.6%). The SPT positive patients showed elevated specific IgE levels (range: 0.8-79 IU/mL) against respective food allergens than normal controls (0.73 IU/mL, mean +/- 2 SD). Food allergy was confirmed in 21/45 (46.6%) of the patients by blinded controlled food challenges. The prevalence of food allergy was estimated to be 4.5% (2.6%-6.34%) at 95% confidence interval (95% CI) in test population (n=470). Sensitisation to food was significantly associated with asthma (p = 0.0065) while aeroallergens were strongly related to rhinitis (p < 0.01).

CONCLUSIONS

Food allergy is estimated to be 4.5% in adolescents and adults with asthma, rhinitis or both. Rice, citrus fruits, blackgram and banana are identified as major allergens for inducing allergic symptoms.

Rice (Oryza sativa) allergy in rhinitis and asthma patients: a clinico-immunological study

Sensitization to foods varies in different countries reflecting a possible interaction of genetic factors, cultural and dietary habits. Rice is a major food consumed world wide and needs evaluation for IgE mediated reactions. The present study was carried out to identify rice allergy in patients of rhinitis and asthma and identify the allergenic proteins in raw and cooked rice. Of 1200 patients screened using standard questionnaire, 165 presented with history of rice allergy. Of these, 20 (12.1%) patients demonstrated marked positive skin prick test (SPT) and 13 showed significantly raised specific IgE to rice compared to normal controls. Double blind placebo controlled food challenge (DBPCFC) confirmed rice allergy in 6/10 patients. Immunoblot with hypersensitive individual patients' sera showed 14-16, 33, 56 and 60 kDa proteins as major IgE-binding components in rice. Boiled rice retained four IgE reactive proteins of 16, 23, 33 and 53 kDa. In summary, IgE-mediated rice allergy affects 0.8% [(0.42-1.58) at 95% CI] of asthma and rhinitis cases. The subjects with severe SPT reactions (4 mm or above) and specific IgE, 6.9 ng/ml to rice demonstrated positive blinded food challenge with clinical symptoms.

Sensitization to blackgram in patients with bronchial asthma and rhinitis: clinical evaluation and characterization of allergens

BACKGROUND

Legumes are important causative agents of type I hypersensitivity in south Asia and Europe but such studies are lacking in Indian population. The present study investigates blackgram sensitization in asthma and rhinitis patients and identifies immunoglobulin E (IgE)-binding proteins.

METHODS

Respiratory allergy patients were evaluated using standard questionnaire and skin prick tests (SPT) with common foods and aeroallergens. Blackgram-specific IgE level was estimated by enzyme-linked immunosorbent assay (ELISA) and sensitization was established by a double-blind, placebo-controlled food challenge (DBPCFC). The cross-reactivity of blackgram with other legumes was studied by immunobiochemical methods.

RESULT

Of 816 patients, 35 gave history of blackgram hypersensitivity. From these, 16 patients were SPT positive and 14 showed elevated specific IgE (three times of negative control) to blackgram. DBPCFC established blackgram sensitivity in four of 14 patients. Immunoblotting with individual patient's sera recognized eight most prevalent allergens of 78, 56, 47, 43, 40, 30, 28 and 16 kDa. Roasted blackgram showed six major allergens whereas 47, 43 and 28 kDa proteins retained IgE reactivity upon boiling. Blackgram extract required 14 ng of self protein for 50% ELISA inhibition whereas roasted and boiled blackgram required 16 and 120 ng protein. ELISA and immunoblot inhibition show partial inhibition to blackgram proteins by lentil, limabean and pea.

CONCLUSION

Blackgram induces IgE-mediated reactions in 1.7% of asthma and rhinitis patients and contains eight major IgE-binding components, of which six retained IgE reactivity after roasting. Blackgram shares allergenicity with lentil and limabean.

Instability of the fragile X syndrome repeat in mice: the effect of age, diet and mutations in genes that affect DNA replication, recombination and repair proficiency

Repeat expansion diseases such as fragile X syndrome (FXS) result from increases in the size of a specific tandem repeat array. In addition to large expansions, small changes in repeat number and deletions are frequently seen in FXS pedigrees. No mouse model accurately recapitulates all aspects of this instability, particularly the occurrence of large expansions. This may be due to differences between mice and humans in CIS and/or TRANS-acting factors that affect repeat stability. The identification of such factors may help reveal the expansion mechanism and allow the development of suitable animal models for these disorders. We have examined the effect of age, dietary folate, and mutations in the Werner's syndrome helicase (WRN) and TRP53 genes on FXS repeat instability in mice. WRN facilitates replication of the FXS repeat and enhances Okazaki fragment processing, thereby reducing the incidence of processes that have been suggested to lead to expansion. p53 is a protein involved in DNA damage surveillance and repair. We find two types of repeat instability in these mice, small changes in repeat number that are seen at frequencies approaching 100%, and large deletions which occur at a frequency of about 10%. The frequency of these events was independent of WRN, p53, parental age, or folate levels. The large deletions occur at the same frequency in mice homozygous and heterozygous for the repeat suggesting that they are not the result of an interallelic recombination event. In addition, no evidence of large expansions was seen. Our data thus show that the absence of repeat expansions in mice is not due to a more efficient WRN protein or p53-mediated error correction mechanism, and suggest that these proteins, or the pathways in which they are active, may not be involved in expansion in humans either. Moreover, the fact that contractions occur in the absence of expansions suggests that these processes occur by different mechanisms.

Transcription defects induced by repeat expansion: fragile X syndrome, FRAXE mental retardation, progressive myoclonus epilepsy type 1, and Friedreich ataxia

Fragile X mental retardation syndrome, FRAXE mental retardation, Progressive myoclonus epilepsy Type I, and Friedreich ataxia are members of a larger group of genetic disorders known as the Repeat Expansion Diseases. Unlike other members of this group, these four disorders all result from a primary defect in the initiation or elongation of transcription. In this review, we discuss current models for the relationship between the expanded repeat and the disease symptoms.

Deletion analysis of the dystrophin gene in Duchenne and Becker muscular dystrophy patients: use in carrier diagnosis

The dystrophin gene was analyzed in 8 Duchenne muscular dystrophy (DMD) and 10 Becker muscular dystrophy (BMD) unrelated families (22 subjects: 18 index cases and 4 sibs) for the presence of deletions by multiplex polymerase chain reaction (mPCR; 27 exons) and Southern hybridization using 8 cDMD probes. Deletions were identified in 5 DMD and 7 BMD patients (6 index cases and 1 sib). The concordance between the clinical phenotype and "reading frame hypothesis" was observed in 11/12 patients (92%). The female relatives of DMD/BMD patients with identifiable deletions were examined by quantitative mPCR. Carriers were identified in 7 families. We also describe a variation in the HindIII pattern with cDNA probe 8 and 11-14. Molecular characterization of the dystrophin gene in this study has been helpful in advising the patients concerning the inheritance of the condition, and carrier diagnosis of female relatives, and should also prove useful for prenatal diagnosis.

Fragile X syndrome and Friedreich's ataxia: two different paradigms for repeat induced transcript insufficiency

DNA repeat expansion is the genetic basis for a growing number of neurological disorders. While the largest subset of these diseases results in an increase in the length of a polyglutamine tract in the protein encoded by the affected gene, the most common form of inherited mental retardation, fragile X syndrome, and the most common inherited ataxia, Friedreich's ataxia, are both caused by expansions that are transcribed but not translated. These expansions both decrease expression of the gene in which the expanded repeat is located, but they do so by quite different mechanisms. In fragile X syndrome, CGG. CCG expansion in the 5' untranslated region of the FMR1 gene leads to hypermethylation of the repeats and the adjacent CpG-rich promoter. Methylation prevents the binding of the transcription factor alpha-Pal/NRF-1, and may indirectly affect the binding of other factors via the formation of transcriptionally silent chromatin. In Friedreich's ataxia, GAA. TTC expansion in an intron of the FRDA gene reduces expression by interfering with transcription elongation. The model that best describes the available data is transcription-driven formation of a transient purine. purine. pyrimidine DNA triplex behind an advancing RNA polymerase. This structure lassoes the RNA polymerase that caused it, trapping the enzyme on the template.

Interaction of the transcription factors USF1, USF2, and alpha -Pal/Nrf-1 with the FMR1 promoter. Implications for Fragile X mental retardation syndrome

Hypermethylation of the FMR1 promoter reduces its transcriptional activity, resulting in the mental retardation and macroorchidism characteristic of Fragile X syndrome. How exactly methylation causes transcriptional silencing is not known but is relevant if current attempts to reactivate the gene are to be successful. Understanding the effect of methylation requires a better understanding of the factors responsible for FMR1 gene expression. To this end we have identified five evolutionarily conserved transcription factor binding sites in this promoter and shown that four of them are important for transcriptional activity in neuronally derived cells. We have also shown that USF1, USF2, and alpha-Pal/Nrf-1 are the major transcription factors that bind the promoter in brain and testis extracts and suggest that elevated levels of these factors account in part for elevated FMR1 expression in these organs. We also show that methylation abolishes alpha-Pal/Nrf-1 binding to the promoter and affects binding of USF1 and USF2 to a lesser degree. Methylation may therefore inhibit FMR1 transcription not only by recruiting histone deacetylases but also by blocking transcription factor binding. This suggests that for efficient reactivation of the FMR1 promoter, significant demethylation must occur and that current approaches to gene reactivation using histone deacetylase inhibitors alone may therefore have limited effect.

Detection of deletion in the dystrophin gene of a patient with quadriceps myopathy

A 43 year old male presented with slowly progressive weakness of limbs and hypertrophy of triceps, brachioradialis and calf muscles for four years. There was thinning of quadriceps muscles in both thighs. Histological study was compatible with Becker muscular dystrophy (BMD). Genomic DNA analysis showed a deletion of the Hind III fragments, spanning exons 45-47. A junction fragment of 11.0 kb was observed along with a deletion of a 3.4 kb PstI fragment containing exon 51 in the patient, and in one of his two sisters. The clinical and laboratory characteristics in this patient are in keeping with what has been described 'quadriceps myopathy' and fall within the phenotypic variants of BMD as has been shown by others.

Molecular characterisation of Duchenne muscular dystrophy and phenotypic correlation

Dystrophin gene was analysed in 32 unrelated DMD families (46 subjects: 32 index cases and 14 sibs) for the presence of deletions by mPCR for 27 exons and cDNA probes for the entire gene. Deletions were identified in 32 patients (25 index cases and seven sibs) from 25 families. The concordance between the clinical phenotype and 'reading frame' hypothesis was observed in 24 (75%) cases. Of these, nine patients were wheelchair bound between 8-12 years of age, nine (age range 5-10 years) showed progressive difficulty in walking and six (age range 1.6-4 years) had onset of muscle weakness. One patient (CH), who was wheelchair bound at 12 years, the effect of mutation on the ORF could not be ascertained due to the presence of a junction fragment. Seven patients had inframe deletions of which four were wheelchair bound by the age of 13 years, and three (age range 5-7 years) although, ambulatory had difficulty in walking. There were eight patients who showed no deletion, of which four became wheelchair bound by the age of 12 years, four, though still ambulatory, were unable to run and tired easily. Correlation between phenotype and genotype of these DMD patients demonstrates that genetic studies of lymphocyte DNA may not always reflect the situation in the tissue involved in dystrophin, i.e. muscle. We describe a common dystrophin gene polymorphism in the Indian population with cDNA 11-14 that alters the Hind III restriction sites. Novel RFLPs were observed in 26 patients and their family members. Whether this is a polymorphism or, related to the diseased phenotype needs confirmation.

Effect of retinol on ochratoxin-produced genotoxicity in mice

Ochratoxin (1 microgram/kg body weight/day), when administered orally daily to albino Swiss mice for 14 continuous days, increased the incidence of abnormalities in mitotic and meiotic metaphase chromosomes, and the gross morphology of the sperm head; the sperm count per unit volume of caput epididymal suspension also decreased. These genotoxic effects were substantially reduced by concurrent oral administration of retinol at double the clinically therapeutic dose. It is possible that the electrophilic metabolites of ochratoxin form adducts with DNA or produce replacement-type mutations. Retinol may achieve its antigenotoxic effect by means of blocks and shunts in the ochratoxin metabolic pathway. Vitamin A-mediated cellular repair and scavenging of the mutagenic radicals can also take place. The vitamin itself has some genotoxic potential.