Burden and predictors of distress among persons with type 2 diabetes mellitus: Excerpts of an observational study from Eastern India

Context

Diabetes distress (DD) is a common psychological condition distinct from depression. This is a unique, hidden emotional burden and worry that the patient experiences under ongoing treatment.

Aim

To assess the prevalence and predictors of DD among adult diabetics attending a tertiary healthcare facility.

Settings and Design

This hospital-based observational, analytical, cross-sectional study recruited 152 adult patients with type 2 diabetes.

Materials and Methods

The sociodemographic and diabetes-related information was collected with the help of a predesigned, structured proforma. Clinical and anthropometric examinations were conducted. Distress was determined by the standardized Diabetic Distress Scale (DDS). Statistical Analysis Used: The mean (SE) value was calculated for quantitative variables. The mean item score in DDS of ≥2 is taken as the presence of distress. Fisher's exact Chi-square test was done to check for association. Two-tailed significance test with a P value of < 0.05 was considered statistically significant.

Results

Majority of study participants were literate, married, and from the lower middle socioeconomic class. High blood pressure was the most common co-morbidity and tobacco use was the most prevalent addiction. The prevalence of diabetes distress was 77.0%. Emotional DD was found to be more common than regimen, interpersonal, and physician-related DD. The major determinants that emerged were young age, low socioeconomic class, physical inactivity, longer time duration to reach the hospital, associated known co-morbidities, and poor glycaemic control.

Conclusion

A target-specific and routine counseling sessions merged with pronged strategic services are essential to improve the mental health of respondents.

Expert Recommendations on Optimizing the Diagnosis and Management of Gastroesophageal Reflux Disease Associated with Comorbidities in the Indian Population

Gastroesophageal reflux disease (GERD) is among the most prevalent gastrointestinal (GI) disorders. It is known to often coexist with other chronic diseases such as asthma, chronic obstructive pulmonary disease (COPD), obesity, diabetes mellitus (DM), and hypertension. Upper endoscopy, esophageal manometry, and impedance-pH monitoring are a few invasive diagnostic options that are reserved for selected GERD patients. Symptom assessment by using questionnaires, such as the frequency scale for the symptoms of GERD (FSSG), is simple, convenient, noninvasive, and inexpensive. These questionnaires are widely used to facilitate diagnosis and appropriate treatment. Early diagnosis of GERD and timely management may improve clinical outcomes in patients. Proton pump inhibitors (PPIs) are the preferred therapy for GERD. However, evidence indicates that excessive and extended use of PPIs is linked to adverse events. An overview of the diagnosis and management of GERD, as well as an evidence-based overview of the relationship between GERD and asthma, COPD, obesity, DM, and hypertension, is presented in this review. Expert opinions and recommendations for diagnosing GERD using invasive tests and validated questionnaires have also been mentioned.

A visible light mediated alkyl sulfonylative cascade using Hantzsch esters via SO2 insertion

We hereby report a visible light mediated alkyl sulfonylative cascade cyclization of alkynyl and dialkynyl cyclohexadienones via SO₂ insertion. The protocol utilizes alkyl Hantzsch esters as the alkyl source and DABSO as the SO₂ source with 4-CzIPN as the organophotocatalyst. A variety of dihydrochromenone derivatives were obtained in good yields under mild energy efficient conditions. Additionally, fluorescence quenching and control studies were carried out to probe the mechanism.

Diphenyl Ditelluride: An Unconventional Reducing Agent in the Sulfonylative Cascade of Alkynyl Cyclohexadienones

Herein, we report a reductive hydrazo-sulfonylative difunctionalization cascade of alkynyl cyclohexadienones employing PhTeTePh as an uncommon reducing agent. Diphenyl ditelluride is a commercially available solid with a good solubility profile in most organic solvents, and this is the first report illustrating it as a reducing agent. The protocol afforded a variety of difunctionalized dihydrochromenones and dihydrobenzofuranones in good yields under relatively mild conditions. The reactions were scalable, and mechanistic studies were conducted to probe the reaction mechanism. Additionally, photophysical studies of the products were carried out, which revealed that they had significant absorption (400-450 nm) and emission (520-570 nm) in the visible region.

A metal-free four-component sulfonylation, Giese cyclization, selenylation cascade via insertion of sulfur dioxide

We hereby report a highly regio- and diastereoselective arylsulfonylation-radical cyclization-selenylation cascade of alkynyl cyclohexadienones for the facile synthesis of highly functionalized dihydrochromenones. The protocol utilizes aryldiazonium salts as aryl partners and DABSO as a benign SO₂ source and also as a redox mediator. Additionally, we also developed a visible light mediated protocol wherein diaryliodonium salts were used as the aryl partners at room temperature.

Effect of Covid-19 pandemic induced lockdown on sleep wake pattern and personal well-being of undergraduate medical students of West Bengal

Background: COVID-19 pandemic induced lockdown and the social restrictions had a profound impact on the circadian rhythm driven sleep-wake schedule of the home confined population. Aims and Objective: Our study explored the effect of COVID-19 pandemic induced lockdown on sleep wake pattern and personal well-being of medical students of West Bengal Materials and Methods: An observational, questionnaire-based online survey was conducted using the URL linked Google form. The online survey was conducted through social media platforms as per CHERRIES checklist guideline. Information on demographic profile, before and after lockdown sleep-wake pattern, social wellbeing and general lifestyle was obtained. Any student with any sleeping disorder or on drugs was excluded. Mean (SE), median, range, proportion was calculated as per attributes. Fisher’s exact chi square test and paired t test was done to test association and to compare means of the attributes. Results: The mean age of students was 20.26 years. The average daily time spent on electronic media got doubled during lockdown. Sleep disorder was reported by 53.0% male and 47.0% students. More than half of respondents reported increased napping during daytime, irregular timing for meal intake and low mood. Anxiety was present in every two out of three participants. Females gained more weight during lockdown. The gender difference in sleep duration became significant. Lockdown effect on the average daily media time was significant. The sleep disturbance at night and physical inactivity was significantly more among female students. Conclusion: COVID-19 lockdown leads to delayed sleep-wake cycle, irregular meal timings and excessive digital exposure among medical students with gender based differential impact.

Residual immune activation in HIV-Infected individuals expands monocytic-myeloid derived suppressor cells

HIV-infected individuals on combined antiretroviral therapy (ART) with virologic suppression exhibit sustained immune dysfunction. Our recent work has highlighted that monocytic myeloid derived suppressor cells (M-MDSC) are elevated in these individuals and suppress immune responses. Factors responsible for M-MDSC expansion in vivo are unknown. Here we compared circulating frequency of M-MDSC in HIV-infected persons from the US and India where HIV subtype-B or -C predominate, respectively. We further investigated soluble mediators of residual immune activation in two cohorts and determined their correlation with M-MDSC expansion. Our findings show that M-MDSC are elevated and correlate with plasma levels of IL-6 in both cohorts. Chemokines CXCL10, CCL4 and CXCL8 were also elevated in HIV-infected individuals, but did not correlate with M-MDSC. These findings support that IL-6 is important in M-MDSC expansion which is independent of HIV subtype.

Two chair test: a substitute of 6 min walk test appear cardiopulmonary reserve specific

Background

A simple and efficient exercise test possible in a small space is welcome to supplement 6 min walk test (6MWT) that demands a 100 feet corridor to perform.

Methods

The proposed two chair test (2CT) makes a person to sit and move five times between two chairs placed face to face at 5 feet apart and note the changes in pulse-rate (PR) and arterial oxygen saturation (SpO₂) at every 10 s for 2 min after that. Comparison of the post-exercise measurements (PR and SpO₂) with a repeat performance in same patients was done for reproducibility and doing the same after 6MWT and 2CT in another set of patients was meant for for acceptability. The statistical analysis was made on moment to moment change, mean maximal difference and mean cumulative difference for the measurements using p value, z-score, r value and principal component analysis (PCA).

Findings

A total of 40 and 60 volunteers were included for testing reproducibility and acceptability. On both the sets, the difference in most of comparisons between the measured variable (PR and SpO₂) showed the p values remaining insignificant (>0.05), and z-score being <1 SD of the corresponding other and the correlation coefficients (r) remaining excellent (>0.9). Furthermore, the PCA shows complete overlapping. The post-exercise changes did not corelate the walking distance in 6MWT.

Interpretation

The proposed 2CT demands small space and appears reproducible and comparable with 6MWT in terms of its post-exercise impact on PR and SpO₂. This novel test also appears more of cardiopulmonary reserve specific.

Clinical practice guidelines 2019: Indian consensus-based recommendations on influenza vaccination in adults

Influenza, a common cause of acute respiratory infections, is an important health problem worldwide, including in India. Influenza is associated with several complications; people with comorbidities and the elderly are at a higher risk for such complications. Moreover, the influenza virus constantly changes genetically, thereby worsening therapeutic outcomes. Vaccination is an effective measure for the prevention of influenza. Despite the availability of global guidelines on influenza vaccination in adults, country-specific guidelines based on regional variation in disease burden are required for better disease management in India. With this aim, the Indian Chest Society and National College of Chest Physicians of India jointly conducted an expert meeting in January 2019. The discussion was aimed at delineating evidence-based recommendations on adult influenza vaccination in India. The present article discusses expert recommendations on clinical practice guidelines to be followed in India for adult influenza vaccination, for better management of the disease burden.

Clinical practice guidelines 2019: Indian consensus-based recommendations on pneumococcal vaccination for adults

Similar to the global scenario, pneumococcal diseases are a significant health concern in India. Pneumococcal diseases occur frequently among adults and are largely preventable through vaccines. Globally, several guidelines and recommendations are available for pneumococcal vaccination in adults. However, owing to wide variations in the disease burden, regulatory landscape, and health-care system in India, such global guidelines cannot be unconditionally implemented throughout the country. To address these gaps, the Indian Chest Society and National College of Chest Physicians of India jointly conducted an expert meeting in January 2019. The aim of the discussion was to lay down specific evidence-based recommendations on adult pneumococcal vaccination for the country, with a view to further ameliorate the disease burden in the country. This article presents an overview of the closed-door discussion by the expert members on clinical practice guidelines to be followed for adult pneumococcal vaccination in India.

Visible-light mediated sulfonylation of thiols via insertion of sulfur dioxide

Photocatalytically generated sulfenyl radicals were coupled with arylsulfonyl radicals at room temperature for accessing unsymmetrical organic thiosulfonates.

Nasal smear eosinophils and allergic rhinitis

Our aim was to find out the association between nasal smear eosinophil count and allergic rhinitis (AR) and to determine a cutoff value that is significant for a diagnosis of AR. We also wanted to determine whether this count is related to the predominant symptoms, duration, or type and severity of AR, or to the presence of coexisting asthma. We selected 100 patients with a clinical diagnosis of allergic rhinitis across all age groups and an equal number of age- and sex-matched controls for the study. Their nasal smear eosinophil counts were recorded in terms of the number of eosinophils per high-power field (HPF). All patients were then clinically assessed for asthma and underwent spirometry. The data were recorded and appropriate statistical analysis done. The difference in the mean eosinophil counts of patients with AR and controls was found to be statistically significant (p = 0.000). A nasal smear eosinophil count of >0.3 per HPF had a 100% specificity and a 100% positive predictive value for AR. Asthma was associated with allergic rhinitis in 40% of patients; an association was not found between nasal smear eosinophil count and the symptoms, duration, type, and severity of allergic rhinitis or coexistent asthma. We conclude that an eosinophil count of >0.3 per HPF in nasal smears is a highly specific criterion for the diagnosis of AR. However, nasal smear eosinophil counts are poor indicators of the degree, duration, or type of upper or associated lower airway inflammation due to allergy.

PPARα gene polymorphisms modulate the association between physical activity and cardiometabolic risk

BACKGROUND AND AIMS

Habitual physical activity is understood to help prevent type 2 diabetes and atherosclerotic cardiovascular disease via beneficial effects on both metabolism and the vascular system. However, individuals do not have uniform cardiometabolic responses to physical activity. Here we explore the extent to which variation in the proliferator-activated receptor-alpha (PPARα) gene, which modulates carbohydrate and lipid metabolism, vascular function, and inflammation, predicts the overall cardiometabolic risk (CMR) profile of individuals engaging in various levels of physical activity.

METHODS AND RESULTS

917 unrelated, community volunteers (52% female, of Non-Hispanic European ancestry) aged 30-54 years, participated in the cross-sectional study. Subjects were genotyped for 5 single nucleotide polymorphisms in the PPARα gene, from which common haplotypes were defined. A continuous measure of CMR was calculated as an aggregate of 5 traditional risk factors: waist circumference, resting blood pressure, fasting serum triglycerides, HDL-cholesterol and glucose. Regression models were used to examine the main and interactive effects of physical activity and genetic variation on CMR. One common PPARα haplotype (H-23) was associated with a higher CMR. This association was moderated by daily physical activity (B = -0.11, SE = 0.053, t = -2.05, P = 0.04). Increased physical activity was associated with a steeper reduction of CMR in persons carrying the otherwise detrimental H-23 haplotype.

CONCLUSIONS

Variations in the PPARα gene appear to magnify the cardiometabolic benefits of habitual physical activity.