Type 2 Diabetes and Precursors in Community Dwelling Asian Indian Adult Youth

Background

Recent studies have shown a high prevalence of Type-2-diabetes (T2DM) (24%) and prediabetes (18.1%) in Kerala. There is no community based study from South Asia regarding the prevalence of type 2 diabetes and its precursors in the young adult population. This community based study was done to find the prevalence of type 2 diabetes and its precursors in South Indian adult youth (18-30 years age) of Thiruvananthapuram district.

Research Design and Methods

Cross sectional design was used for this study. Multistage cluster sampling was used to enrol community dwelling youth of 18 to 30 years, residing in Thiruvananthapuram district. Six panchayath wards from rural and urban regions and 4 from coastal area were randomly selected as the primary sampling units. Trained staff nurses conducted the survey with the help of accredited-social-health-activists (ASHA). Socio-demographic data, anthropometry, clinical features of insulin resistance, and random capillary glucose (CG) and blood pressure were assessed and recorded. Oral Glucose tolerance test or HbA1c was done for participants with a CG ≥130 mg/dl for diagnosis of diabetes and prediabetes.

Results

A total of 1031 participants were included from the rural (n = 394), coastal (n = 269) and urban (n = 368) areas. Prevalence of hyperglycaemia i.e., T2DM and pre-diabetes was 0.48% (n = 5) and 2.4% (n = 25) respectively. Family-history of T2DM was present in 35.1% subjects. Prevalence of overweight, obesity and abdominal-obesity was 28.2%, 16.1% and 28.4% respectively. Clinical-features of insulin resistance (CFIR) were present in 27.1% subjects (acanthosis [17.7%], skin tags [1.7%] and PCOS phenotype [10.7%]). Among various anthropometric measurements and their derivatives, CFIR correlated best (r = 0.24, P < 0.01) with the product of BMI and the sum of abdominal circumference and hip circumference (Trivandrum Medical College [TMC] -adiposity-index), which is a newly proposed parameter. Hyperglycaemia was more common in males, did not correlate with waist hip ratio, and correlated best again with TMC-adiposity-index ((r = 0.13, P < 0.01).

Conclusions

The burden of insulin resistance in the young South Indian population, hitherto unknown in any community based study, has been studied for the first time. The prevalence of precursors of T2DM is high in this population. Early identification of 'at risk' individuals could provide a window of opportunity for preventing or delaying future diabetes and its long term complications. TMC adiposity index could become a valuable tool in the anthropometric assessment for predicting future T2DM.

Pre-sensitization with tuberculosis and non-tuberculosis mycobacteria and its impact on TB incidence in different age groups: Chengalpattu BCG trial revisited

Individuals pre-sensitized with Mycobacterium tuberculosis (MTB), non-tuberculosis mycobacteria, and its impact on TB incidence are relatively unexplored in a high TB burden setting. We conducted secondary data analysis of a double-blind, randomized Chengalpattu BCG trial, India. Induration to Purified Protein Derivative (PPD)-S and PPD-B were proxies for exposures to MTB and M. intracellulare respectively. Optimum cut-off for PPD-S and B were determined using Receiver-Operating Characteristic curves and induration ≥12 mm for PPD-S and ≥10 mm for PPD-B were considered strong reaction. Incidence rates of culture positive pulmonary TB per 100,000 person-years (PY) were calculated. Of 270,043 individuals with skin test results, children <14 years (n = 109,383, 64% showed strong-reaction to PPD-B and 17% to PPD-S) and adults between 25 and 34 years (n = 40,292, 98% were strong reactors to PPD-B and 73% to PPD-S). Overall incidence rate was lower in individuals with PPD-S < PPD-B (136, 95% CI: 130-141/100,000 PY) compared to individuals with PPD-S > PPD-B (447, 95% CI: 427-468/100,000 PY). Incidence rates of culture positive pulmonary TB was affected by early age of exposure to cross-reactive mycobacterial antigens represented by PPD-B and exposure to MTB represented by PPD-S during adolescence and early adulthood.

Impact of exposure of human osteoblast cells to titanium dioxide particles in-vitro

Titanium Dental implant is the most successful treatment modality to replace missing teeth today. Although titanium is considered biologically biocompatible, strong, and corrosion-free, the risk of implant failure continues due to bone loss at the expense of optimum oral health. Current research points toward the presence of titanium dioxide (TiO₂) particles leached from dental implant surface, which occurred due to mechanical and chemical insults on the surface. This study aimed to investigate the influence of TiO₂ particles of different sizes leaching from implant surfaces on Human Osteoblast cells (HOB) in-vitro. Titanium dioxide particles in both nano (NPs) and micro (MPs) size and at different concentrations were introduced to human osteoblast cells with and without treatment with vitamin C. Production of ROS was measured using H2DCFDA cellular ROS Assay Kit and MCP-1 and IL-8 cytokines released were assayed at 24 h time point using ELISA technique. Results showed a dose dependent increase in ROS production following exposure of HOB to both nano and micro particles. MCP-1 and IL-8 were released and there was minimal difference between the amount generated by nano compared with micro size particles. Treatment of HOB with antioxidant vitamin C demonstrated a significant reduction in the generation of ROS. At the same time, MCP-1 release was reduced significantly for the 100 μg/mL TiO₂ NPs and MPs after Vitamin C treatment while IL-8 release increased significantly. This study suggests a positive role played by antioxidants in the control of ROS generation and chemokines production in the peri-implant tissue environment.

Comparative Evaluation of Antibacterial Property of Bioactive Glass Alone and its Combination with Chlorhexidine against Enterococcus faecalis - An In vitro Study

CONTEXT

One of the most common organisms responsible for root canal failure even after the usage of intracanal medicament is Enterococcus faecalis. Newer medicaments with higher antibacterial efficacy against E. faecalis need to be analyzed.

AIM

The aim of this study was to compare the antibacterial property of bioactive glass (BAG) alone and its combination with chlorhexidine (CHX) against E. faecalis.

MATERIALS AND METHODS

Eighty permanent maxillary single-rooted teeth were included in the study. These teeth were randomly divided into three groups of ten teeth each. Dentin blocks were prepared. After debris and smear layer removal, dentin blocks were inoculated with E. faecalis and incubated for 7 days for biofilm formation. Medications including BAG alone and combination of CHX with BAG were placed into the dentin blocks and incubated at 37°C for 72 h. Dentinal shavings were collected, and the mean bacterial count was recorded.

STATISTICAL ANALYSIS

The comparison of colony-forming unit (CFU) counts was done using one-way analysis of variance, Tukey's post hoc test, and unpaired t-test. The analysis was done using the Statistical Package for the Social Sciences version 20.0 for Windows.

RESULTS

Based on the CFU count obtained after 72 h, compared to the control group, both Group 1 and Group 2 reduced the bacterial load effectively. In comparison with Group 1, Group 2 (combination) was found to be more effective against E. faecalis.

CONCLUSION

It can be concluded that although BAG was effective against E. faecalis, its efficacy increased significantly in combination with CHX.

Comparison of the Efficacy of K-File, Canal Brush Technique, and Sonic Irrigation Technique in the Retrievability of Calcium Hydroxide and Metapex Intracanal Medicaments from Root Canals: An In vitro Cone-Beam Computed Tomography Analysis

Background and Objectives:

At present, none of the routinely used irrigating agents and activation techniques were able to completely remove the Ca(OH)₂ intracanal medicament placed inside the root canal system during endodontic therapy. With this as the background, the aim of this study was to achieve complete removal of Ca(OH)₂ when mixed with two different vehicles, using various irrigant activation techniques such as K-file, canal brush technique, and sonic irrigation technique, from the root canals of extracted human teeth.

Materials and Methods:

Seventy-two mandibular premolar teeth with straight single root canal were selected and filled either with oil-based Metapex or calcium hydroxide powder mixed with distilled water and were activated using different activation techniques such as K-file, canal brush, and sonic MM1500 and NaOCl alone. Volumetric analysis was performed utilizing cone-beam computed tomography.

Results:

None of the irrigants used were able to completely remove Ca(OH)₂ from root canal. Sonic MM1500 showed significant removal efficacy than K-file, canal brush technique, and NaOCl for both aqueous-based and oil-based calcium hydroxide.

Conclusion:

Sonic MM1500 performed better than K-file, canal brush technique, and NaOCl in removing both Metapex and Ca(OH)₂ powder. Regardless of the vehicles and agitation technique used, the remnants of Ca(OH)₂ were present on all thirds of the canal walls.

Impact of titanium dioxide particle size on macrophage production of intracellular reactive oxygen species

OBJECTIVES

The aim of this study was to investigate the response of THP-1 monocyte-derived macrophages following exposure to titanium dioxide nanoparticles (TiO₂ NPs) and microparticles (TiO₂ MPs) in an in vitro system.

DESIGN

THP-1 monocytes were maintained in RPMI medium and transformed into M0 macrophages using Phorbol 12-myristate 13-acetate (PMA). TiO₂ particle size characterization was performed using scanning electron microscopy (SEM) and dynamic light scattering (DLS) technology. A viability study using an XTT assay was performed by treating THP-1-derived macrophages with TiO₂ NPs (<100 nm) and TiO₂ MPs (<5 μm) at concentrations ranging from 100, 50, 25, 12.5, 6.25 and 3.125 μg/mL. Macrophages were then treated with three different concentrations of NPs and MPs (5, 20 or 100 μg/mL) for 24 h, and ROS production and TiO₂ particle cellular uptake were measured using ROS assays and flow cytometry, respectively.

RESULTS

There was no significant change in the viability of THP-1 monocytes after treatment with TiO₂ NPs and MPs. The uptake of both particles was confirmed and showed an increase in ROS generation, and the MPs produced more ROS than NPs. The increase in ROS generation with NPs was concentration-dependent.

CONCLUSION

Uptake of TiO₂ NPs and MPs in macrophages at subcytotoxic levels generate ROS in a size- and dose-dependent manner.

Ror β expression in activated macrophages and dental pulp stem cells

AIM

To assess the expression of Retinoic acid-related orphan receptor beta (Ror β) in human inflamed dental pulp stem cells (hI-DPSCs) and during macrophage phenotypic conversion.

METHODOLOGY

Commercially procured THP-1 monocytes conversion to macrophages was judged by their morphology, the percentage of adherent cells and the expression of CD-14 surface marker. THP-1 macrophage cell viability following LPS, IFN-γ/IL-4, IL-13 stimulus was evaluated at 24 and 48h. The phenotypic conversion of macrophages to M1 and M2 was confirmed by flow cytometry and Western blot analysis. Cytokine release following polarization was estimated by the BD cytokine flex kit. The expression of Ror β in THP-1 macrophages and hI-DPSCs following LPS, IFN-γ/IL-4, IL-13 stimulus was assessed by Western blot analysis. Statistical significance was analysed using one-way Anova followed by Tukey's Post hoc test.

RESULTS

THP-1 monocytes pretreated with PMA (100 ng mL^-1 ) for 48 h followed by culturing in PMA-free media for another 48 h yielded cells with morphological characteristics similar to macrophages with a high percentage of adherence capability and CD-14 expression. Macrophages treated with LPS 100 ng mL^-1 and IFN-γ 20 ng mL^-1 or IL-4 20 ng mL^-1 had high expression of the respective M1 and M2 CD markers in flow cytometry and Western blot analysis. Cytokine release studies demonstrated the expression of IL-1β, TNF-α and IL-10 in the M1-polarized macrophages (P < 0.01), whilst TGF- β levels were seen in the M1 and M2-polarized macrophages. Ror β expression was upregulated when macrophages and hI-DPSCs were treated with anti-inflammatory cytokines.

CONCLUSION

Ror β was expressed in THP-1 macrophages and hI-DPSCs during their resting stage. Upregulated expression of Ror β occurred following an anti-inflammatory stimulus.

Osteogenic and odontogenic differentiation potential of dental pulp stem cells isolated from inflamed dental pulp tissues (I-DPSCs) by two different methods

Objective: The objective of the present study is to isolate stem cells from inflamed dental pulp tissues (I-DPSCs) and study the characteristic such as surface markers, osteo/odontogenic differentiation potential between the outgrowth (OG) and enzymatic digestion (COL) methods.Materials and methods: I-DPSCs harvested by both methods were analysed for Mesenchymal Stem Cell marker expression by flow cytometry. The metabolic activity of the isolated cells was assessed by MTT assay. The Alkaline Phosphatase (ALP) and Alizarin red staining was done to analyse the osteogenic potential of isolated cells. The osteo/odontogenic differentiation was done by checking the expression of Dentine Matrix Protein 1 (DMP1), Dentine Sialophosphoprotein (DSPP), ALP and Bone Gamma-Carboxyglutamate Protein (BGLAP) by Real time PCR.Results: The isolated cells were positive for MSC markers such as CD-90, CD-105 and CD-73 and negative for CD-14, CD-45 and STRO-1. MTT assay indicated that the I-DPSCs from OG method showed higher metabolic activity than cells from COL. However, the osteo/odontogenic differentiation was in favour of cells isolated by COL method.Conclusion: Although the cell metabolic rate was more in OG, the osteo/odontogenic differentiation was higher in COL, suggesting that the isolation method and culture conditions do affect the differentiation capacity of isolated cells.

Objective Assessment of Microsurgery Competency-In Search of a Validated Tool

Microsurgical skill acquisition is an integral component of training in plastic surgery. Current microsurgical training is based on the subjective Halstedian model. An ideal microsurgery assessment tool should be able to deconstruct all the subskills of microsurgery and assess them objectively and reliably. For our study, to analyze the feasibility, reliability, and validity of microsurgery skill assessment, a video-based objective structured assessment of technical skill tool was chosen. Two blinded experts evaluated 40 videos of six residents performing microsurgical anastomosis for arteriovenous fistula surgery. The generic Reznick's global rating score (GRS) and University of Western Ontario microsurgical skills acquisition/assessment (UWOMSA) instrument were used as checklists. Correlation coefficients of 0.75 to 0.80 (UWOMSA) and 0.71 to 0.77 (GRS) for interrater and intrarater reliability showed that the assessment tools were reliable. Convergent validity of the UWOMSA tool with the prevalidated GRS tool showed good agreement. The mean improvement of scores with years of residency was measured with analysis of variance. Both UWOMSA ( p -value: 0.034) and GRS ( p -value: 0.037) demonstrated significant improvement in scores from postgraduate year 1 (PGY1) to PGY2 and a less marked improvement from PGY2 to PGY3. We conclude that objective assessment of microsurgical skills in an actual clinical setting is feasible. Tools like UWOMSA are valid and reliable for microsurgery assessment and provide feedback to chart progression of learning. Acceptance and validation of such objective assessments will help to improve training and bring uniformity to microsurgery education.

Density functional theory calculations, vibration spectral analysis and molecular docking of the antimicrobial agent 6-(1,3-benzodioxol-5-ylmethyl)-5-ethyl-2-{[2-(morpholin-4-yl)ethyl] sulfanyl}pyrimidin-4(3H)-one

Vibrational spectral analysis and quantum chemical computations based on density functional theory have been performed on the antimicrobial agent 6-(1,3-benzodioxol-5-ylmethyl)-5-ethyl-2-{[2-(morpholin- 4-yl)ethyl]sulfanyl}pyrimidin-4-(3H)-one.The equilibrium structural geometry, various bonding features and harmonic vibrational wavenumbers of the title compound have been investigated using DFT-B3LYP function at 6-311++G(d, p) basis set. The detailed interpretations of the vibrational spectra have been carried out with the aid of VEDA 4 program. The various intramolecular interactions of the title compound have been exposed by natural bond orbital analysis. The FT-IR and FT-Raman spectra of the title molecule have been recorded and analyzed. Blue-shifting of the C-H wavenumber along with a decrease in the C-H bond length attribute for the formation of the C-H...O hydrogrn bonding provide an evidence for a charge transfer interaction. Also, the distribution of natural atomic charges reflects the presence of intramolecular hydrogen bonding. The analysis of the electron density of HOMO and LUMO gives an idea of the delocalization and the low value of energy gap indicates electron transfer within the molecule. Moreover, molecular docking studies revealed the possible binding of the title molecule to different antimicrobial target proteins.

Isolated Intramedullary Spinal Cysticercosis: A Case Report with Review of Literature of a Rare Presentation

A number of parasitic infections can involve the central nervous system of which neurocysticercosis (NCC) is the most common one in developing countries. Most often the brain is involved, spine and spinal cord involvement is very rare and intramedullary involvement is rarer still. Here, we report a 30-year-old male patient, with intramedullary NCC of dorsal spinal cord.

Silanated nano ZnO hybrid embedded PMMA polymer coatings on cotton fabrics for near-IR reflective, antifungal cool-textiles

Silanated nano ZnO hybrid embedded PMMA polymer coatings for cotton fabrics are developed to produce near-IR reflective, antifungal cool-textiles.

Incontinentia pigmenti

Incontinentia pigmenti or Bloch-Sulzberger syndrome, is a rare X linked dominant disorder with characteristic skin, hair, eye, dental and neurological abnormalities commonly affecting females. This article reports the clinical features and management of a 11 year old girl diagnosed with Incontinentia pigmenti.