Cross-population genetic analysis revealed genetic variation and selection in the Ovar-DRB1 gene of Indian sheep breeds

In sheep, MHC variability is studied widely to explore disease association. The aim of the current study was to explore the genetic diversity of Ovar-DRB diversity across sheep breeds of India. Here, Ovar-DRB1 locus was studied across 20 sheep breeds. DRB1 was amplified (301 bp) and sequenced using a PCR-sequence-based typing approach. Results revealed a high degree of heterozygosity across breeds (mean: 73.99%). Overall mean distance for DRB1 was highest in Sangamneri (0.18) and lowest in Madgyal sheep (0.10). There was a higher rate of transition, across breeds. Further, 39 alleles were isolated in different breeds, out of which 10 were new. To allow easy access and use of the immune-polymorphic database, an online database management system was launched (http://www.mhcdbms.in/). Nucleotide content across breeds for the DRB1 region revealed the richness of GC content (59.26%). Wu-Kabat index revealed vast genetic variation across peptide binding sites (PBS) of DRB1. Residues 6, 66, 69, 52, and 81, were polymorphic showing utility for antigen presentation. All breeds were under positive selection for DRB1 locus (dN > dS). Study revealed the importance of DRB locus diversity for beta chain specifically at PBS across sheep breeds of the Indian subcontinent and presented evidence of positive selection for DRB owing to its evolutionary significance.

Ultra-high power factor of p-type Bi2Se3 for room-temperature thermoelectric applications

Achieving high zT in n-type and p-type thermoelements in similar compounds is a great challenge for device construction. Herein, we report a high-power factor of 480 μW/mK² in Ga and Mn co-doped Bi₂Se₃ along with a maximum zT of 0.25 at 303 K as a p-type thermoelement. The co-doped Ga and Mn play distinct roles in enhancing the hole concentration to 1.6 × 10¹⁹ cm^-3 with a maximized effective mass. In addition, a drastic reduction in lattice thermal conductivity of 0.5 W/mK is attained due to point defects of mass and strain field fluctuation scattering in Bi₂Se₃.

Realization of an ultra-low lattice thermal conductivity in Bi2AgxSe3 nanostructures for enhanced thermoelectric performance

Bismuth Selenide is a Tellurium free topological insulator in V-VI compounds with an excellent thermoelectric performance from room temperature to mid-temperature region. Herein, hydrothermally prepared polycrystalline Bi₂Ag_xSe₃ nanostructures have been reported for thermoelectric application. The crystal structure identification and morphology with the elemental presence were analyzed by XRD (X-ray diffraction), HR-SEM with EDS (High resolution scanning electron microscope with energy dispersive X-ray), and HR-TEM (High-resolution transmission electron microscope) measurements. The reduced lattice thermal conductivity and enhanced electrical transport properties synergistically boost the thermoelectric properties through the highly-dense stacking faults with the presence of dislocations. The IFFT (Inverse Fast Fourier Transform) pattern reveals the existence of stacking faults and dislocations. These highly dense stacking faults and dislocations act as active phonon scattering centers, which can contribute to effective phonon scattering resultsin extremely low lattice thermal conduction of 0.3 W/mK at 543 K. On the other hand, the involvement of phonon-phonon scattering primarily reduced the lattice thermal conductivity at elevated temperatures. In addition, phonon-carrier scattering was less compared to phonon-phonon scattering at elevated temperature region. Moreover, the enhancement of electrical conductivity and controlled reduction of the Seebeck coefficient plays a vital role in achieving the maximum power factor of 335 μW/mK² at 543 K due to the energy filtering effect. The synergistic combination of low thermal conduction and the maximum power factor helps to achieve the high peak zT of 0.3 at 543 K.

NRF2 activation induces NADH-reductive stress, providing a metabolic vulnerability in lung cancer

Multiple cancers regulate oxidative stress by activating the transcription factor NRF2 through mutation of its negative regulator, KEAP1. NRF2 has been studied extensively in KEAP1-mutant cancers; however, the role of this pathway in cancers with wild-type KEAP1 remains poorly understood. To answer this question, we induced NRF2 via pharmacological inactivation of KEAP1 in a panel of 50+ non-small cell lung cancer cell lines. Unexpectedly, marked decreases in viability were observed in >13% of the cell lines-an effect that was rescued by NRF2 ablation. Genome-wide and targeted CRISPR screens revealed that NRF2 induces NADH-reductive stress, through the upregulation of the NAD+-consuming enzyme ALDH3A1. Leveraging these findings, we show that cells treated with KEAP1 inhibitors or those with endogenous KEAP1 mutations are selectively vulnerable to Complex I inhibition, which impairs NADH oxidation capacity and potentiates reductive stress. Thus, we identify reductive stress as a metabolic vulnerability in NRF2-activated lung cancers.

SULT1A1-dependent sulfonation of alkylators is a lineage-dependent vulnerability of liver cancers

Adult liver malignancies, including intrahepatic cholangiocarcinoma and hepatocellular carcinoma, are the second leading cause of cancer-related deaths worldwide. Most individuals are treated with either combination chemotherapy or immunotherapy, respectively, without specific biomarkers for selection. Here using high-throughput screens, proteomics and in vitro resistance models, we identify the small molecule YC-1 as selectively active against a defined subset of cell lines derived from both liver cancer types. We demonstrate that selectivity is determined by expression of the liver-resident cytosolic sulfotransferase enzyme SULT1A1, which sulfonates YC-1. Sulfonation stimulates covalent binding of YC-1 to lysine residues in protein targets, enriching for RNA-binding factors. Computational analysis defined a wider group of structurally related SULT1A1-activated small molecules with distinct target profiles, which together constitute an untapped small-molecule class. These studies provide a foundation for preclinical development of these agents and point to the broader potential of exploiting SULT1A1 activity for selective targeting strategies.

Suppression of intrinsic thermal conductivity in Sr1-x Gd x TiO3 ceramics via phonon-point defect scattering for enhanced thermoelectric application

A substantial reduction in the thermal conductivity for strontium titanate (ABO₃) perovskite structure was realized for the A-site substitution of gadolinium (rare earth element) in SrTiO₃ ceramics. The effect of Gd³⁺ substitution on the structure, composition, and thermoelectric properties of SrTiO₃ was investigated. The substitution of Gd³⁺ in the SrTiO₃ matrix resulted in the minimalization of thermal conductivity. The thermal conductivity followed a similar trend as that of thermal diffusivity, but specific heat capacity exhibited a non-monotonic trend. The thermal conductivity is reduced to 1.05 W m^-1 K^-1 for the minimal substitutional composition (Sr_0.99Gd_0.01TiO₃) which is 30% less than that of SrTiO₃ at 303 K. The variation in the ionic radii and atomic mass of the heavier rare earth Gd³⁺ substituted over Sr²⁺ resulted in the reduction of thermal conductivity of SGTO ceramics caused by the corresponding boundary scattering at low temperatures and temperature-independent phonon-impurity scattering at high temperatures.

Mutant-IDH inhibits Interferon-TET2 signaling to promote immunoevasion and tumor maintenance in cholangiocarcinoma

Isocitrate dehydrogenase 1 mutations (mIDH1) are common in cholangiocarcinoma. (R)-2-hydroxyglutarate generated by the mIDH1 enzyme inhibits multiple a-ketoglutarate-dependent enzymes, altering epigenetics and metabolism. Here, by developing mIDH1-driven genetically engineered mouse models, we show that mIDH1 supports cholangiocarcinoma tumor maintenance through an immunoevasion program centered on dual (R)-2-hydroxyglutarate-mediated mechanisms - suppression of CD8+ T cell activity and tumor cell-autonomous inactivation of TET2 DNA demethylase. Pharmacological mIDH1 inhibition stimulates CD8+ T cell recruitment and IFN-y expression and promotes TET2-dependent induction of IFN-y response genes in tumor cells. CD8+ T cell depletion or tumor cell-specific ablation of TET2 or Interferon-gamma receptor 1 causes treatment resistance. Whereas immune checkpoint activation limits mIDH1 inhibitor efficacy, CTLA4 blockade overcomes immunosuppression, providing therapeutic synergy. The findings in this mouse model of cholangiocarcinoma demonstrate that immune function and the IFN-y-TET2 axis are essential for response to mIDH1 inhibition and suggest a novel strategy for harnessing these inhibitors therapeutically.

160 Informed Consent for Surgery at Resumption of Elective Activity After the First Wave of COVID-19

Aim

The Royal College of Surgeons of England published guidance on consent during COVID-19. Through this study, we aimed to assess our local consent adherence to these guidelines on the resumption of elective activity after the first wave of COVID-19.

Method

This prospective review of consecutive elective surgical consent forms was conducted from 20 July 2020 to 16 August 2020 at the Princess Alexandra Hospital NHS Trust, England. The primary outcome was evidence of COVID-19 risk documentation on the consent forms.

Results

A total of 116 patients’ consent forms were reviewed. Most patients were American Society of Anaesthesiologists (ASA) grade 2 (n = 70; 60.34%). Only 25 consent forms (21.55%) had COVID -19 and its associated risks documented, with registrars being the most compliant (19/46; 41.3%) followed by consultants (6/51; 11.7%). With regards to the surgical sub-specialities, general surgery, orthopaedics and ENT had the highest compliance with the guidance.

Conclusions

As the elective activity resumes, peri-operative risks of COVID-19 should be weighted in during the informed consent process, as mentioned in the latest international guidelines on consent to avoid litigation and negligence claims.

Cation disorder and bond anharmonicity synergistically boosts the thermoelectric performance of p-type AgSbSe2

Atomic bonding with simple 1D spring and ball model for the phonon–phonon interaction, which arises from 5s2 lone pair electrons.

Interleukin-8 blockade prevents activated endothelial cell mediated proliferation and chemoresistance of acute myeloid leukemia

One of the greatest challenges in treating acute myeloid leukemia (AML) is chemotherapy refractory disease. Previously, we demonstrated a novel mechanism whereby AML-induced endothelial cell (EC) activation leads to subsequent leukemia cell adherence, quiescence and chemoresistance, identifying activated ECs as potential mediators of relapse. We now show mechanistically that EC activation induces the secretion of interleukin-8 (IL-8) leading to significant expansion of non-adherent AML cells and resistance to cytarabine (Ara-C). Through crystallography and computational modeling, we identified a pocket within IL-8 responsible for receptor binding, screened for small molecules that fit within this pocket, and blocked IL-8 induced proliferation and chemo-protection of AML cells with a hit compound. Results from this study show a new therapeutic strategy for targeting the sanctuary of an activated leukemia microenvironment.

Abstract 3042: Splicing repressor HNRNPC is an indispensable and 'druggable' target in acute myeloid leukemia

Refractory and relapsed disease is the greatest challenge in acute myeloid leukemia (AML), and we have shown that blood vessels serve as sanctuary sites for AML. Using a high throughput screening assay mimicking AML in the vascular niche, we screened 31 million compounds and identified a hit compound 2470-51 that selectively killed AML cells and CD34+CD38-CD123+ AML stem cells, while sparing bone marrow-derived endothelial cells, normal hematopoietic stem and progenitor cells (HSPC) as well as CD4+ T lymphocytes from healthy volunteers. In vivo AML patient-derived xenograft modeling further validated the efficacy of 2470-51 as a selective anti-leukemic agent compared to cytarabine (conventional control). We performed quantitative proteomics combining ITRAQ differential protein expression analysis, label-free shotgun analysis and SPR imaging to identify heterogeneous nuclear ribonucleoprotein C1/C2 (hnRNPC) as the target of 2470-51. HNRNPC depletion in AML cell lines THP1, K562, MV411 and HL-60 significantly decreased cell proliferation, viability and clonogenic capacity of the AML cells. In contrast, normal mesenchymal/fibroblastic cells, endothelial cells and normal HSPCs from human umbilical cord blood specimens were unaffected by HNRNPC depletion, indicating the selective dependence of AML cells on hnRNPC. Furthermore, clinical studies using TCGA AML datasets showed significant survival advantage associated with lower HNRNPC expression. RNA-seq analyses revealed a distinct gene expression pattern suggesting widespread inhibition of Myc transcriptional targets. Using differential alternative splicing and differential transcript expression analyses, we discovered significant alternative splicing of MAX after HNRNPC depletion, resulting in MAX transcript isoforms that lacked Myc-interacting domains (“inactive” MAX). These Myc-interacting domains are necessary for the obligate heterodimerization of Myc and Max and are critical for Myc transcriptional activation. We further analyzed splicing landscapes of 578 AML patients and 33 healthy controls and identified substantial mis-splicing of mRNA in AML patients, despite the absence of somatic gene mutations of splicing factors, when compared to the healthy controls. Moreover, we found significant overexpression of “inactive” MAX isoforms in the healthy controls, while AML patients overexpressed fully functional MAX isoforms, suggesting that MAX splicing may have an important functional role in AML. Collectively, our studies show significant RNA splicing changes in AML and an essential role of HNRNPC in AML in contrast to normal hematopoietic and stromal cells where HNRNPC is dispensable. We present a pharmacologic agent for targeting HNRNPC and Myc-Max as a molecular mechanism of action. Our data indicate that hnRNPC is a critical factor in AML and inhibiting this splicing repressor may represent a new therapeutic strategy.

Citation Format: Vindhya Vijay, Amy Meacham, Lauren Katzell, Aaron Winer, Jesse Terrell, Vincent Archibald, Jodi Bubenik, Alberto Riva, Jon Boatwright, Cristina Tognon, Jeffrey Tyner, Brian Druker, Christopher Cogle. Splicing repressor HNRNPC is an indispensable and 'druggable' target in acute myeloid leukemia [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3042.

Current status of bone cementing and bone grafting for giant cell tumour of bone: a systemic review

INTRODUCTION

Extended intralesional curettage, together with bone grafting/cementing, is considered as a surgical treatment option for giant cell tumour of the bone. This study aimed to discover the efficacy and recurrence rate with the use of bone cement in giant cell tumour and to compare it with that of bone grafting.

MATERIAL AND METHODS

The present systemic review is derived from the publications in the past 10 years (2009-2018). A literature search was performed via PubMed, using suitable keywords and Boolean operators database ('Giant cell tumor,' 'osteoclastoma,' 'bone,' 'bone cement,' 'bone graft' and 'curettage'). A detailed statistical analysis of the data derived from the published literature was done.

RESULTS

The patients who underwent bone graft only exhibited significantly higher recurrence rates than those treated with polymethyl methacrylate only (risk ratio 1.90; 95% confidence interval 1.14, 3.16; overall effect Z = 2.488; P-value 0.012). The observational analysis was done in rest of the seven studies; three studies showed no recurrence rate. Only one study reported the highest recurrence rate of 42% and the remaining six had an overall recurrence rate of 20.4%.

CONCLUSION

The use of bone cement was associated with a statistically significantly lower recurrence rate than bone grafting in giant cell tumour of bones. We therefore recommend the use of bone cement with extensive intralesional curettage. Adjuvant therapy like electrocautery, phenol irrigation and the use of intravenous denosumab or bisphosphonates may help in decreasing the incidence of recurrence in giant cell tumour of bone.

Abstract 4955: Heterogeneous nuclear ribonucleoprotein C as a novel therapeutic target for acute myeloid leukemia

Acute myeloid leukemia (AML) is a highly refractory cancer despite conventional treatment. Previously, we found that blood vessels are sanctuary sites for chemo-refractory AML cells. To target AML cells sequestered in the vascular niche, we developed an in vitro co-culture assay consisting of AML cells on bone marrow- derived endothelial cells (BMECs), mimicking the chemo-protective effect of the vascular niche in the bone marrow microenvironment. Using this assay, we performed high-throughput chemical-phenotypic screening of 31 million compounds and identified a novel polyamine sulfonamide (2470-51) that selectively killed AML cells, while sparing the underlying BMECs. 2470-51 was also cytotoxic to CD34+CD38-CD123+ AML stem cells; however, the compound was non-toxic to hematopoietic stem/progenitor cells and T lymphocytes from healthy volunteers. In vivo AML patient-derived xenograft modeling further validated the efficacy of 2470-51 as a selective anti-leukemic agent compared to cytarabine (conventional control) and vehicle control. Protein target identification experiments using unbiased label-free shotgun proteomic analysis in combination with targeted selected ion monitoring revealed heterogeneous nuclear ribonucleoprotein C1/C2 (hnRNPC) as the covalent target of 2470-51. These findings were further validated by shRNA mediated knock-down of HNRNPC (HNRNPC-kd) in AML cell lines THP-1 and K562. HNRNPC-kd significantly reduced AML cell proliferation as well as AML cell viability by inducing apoptosis, compared to scramble controls. HNRNPC-kd also significantly reduced the clonogenic potential of both AML cell lines. In contrast, normal mesenchymal/fibroblastic (HS5) and endothelial cells (BMECs) were unaffected by HNRNPC-kd, indicating the selective dependence of AML cells on hnRNPC. RNA-Seq analyses revealed alternative splice events associated with HNRNPC-kd. Functional enrichment analyses followed by pathway analyses indicated the involvement of hnRNPC in key oncogenic and cell survival pathways. Depleting hnRNPC significantly altered the post-transcriptional landscape, leading to induction of apoptosis. Clinical studies using TCGA AML datasets showed significant survival advantage associated with lower HNRNPC expression. Collectively, our data indicate that hnRNPC is a critical factor in AML and that inhibiting this splicing repressor may be a new therapeutic strategy.

Citation Format: Vindhya Vijay, Amy Meacham, Jesse Terrell, Lauren Katzell, Leylah Drusbosky, Christopher Cogle. Heterogeneous nuclear ribonucleoprotein C as a novel therapeutic target for acute myeloid leukemia [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4955.

High Resolution 3D Imaging of the Human Pancreas Neuro-insular Network

Using traditional histological methods, researchers are hampered in their ability to image whole tissues or organs in large-scale 3D. Histological sections are generally limited to <20 µm as formalin fixed paraffin section on glass slides or <500 µm for free-floating fixed sections. Therefore, extensive efforts are required for serial sectioning and large-scale image reconstruction methods to recreate 3D for samples >500 µm using traditional methods. In addition, light scatters from macromolecules within tissues, particularly lipids, prevents imaging to a depth >150 µm with most confocal microscopes. To reduce light scatter and to allow for deep tissue imaging using simple confocal microscopy, various optical clearing methods have been developed that are relevant for rodent and human tissue samples fixed by immersion. Several methods are related and use protein crosslinking with acrylamide and tissue clearing with sodium dodecyl sulfate (SDS). Other optical clearing techniques used various solvents though each modification had various advantages and disadvantages. Here, an optimized passive optical clearing method is described for studies of the human pancreas innervation and specifically for interrogation of the innervation of human islets.

Abstract 5118: A novel polyamine sulfonamide with anti-leukemic activity

The greatest challenge in treating Acute Myeloid Leukemia (AML) is refractory disease. Although 60-80% of AML patients achieve complete remission after induction chemotherapy, majority of these patients relapse and die of progressive disease. New treatment options targeting the vulnerabilities of AML biology are highly critical for disease regression, in particular the chemo-resistant leukemia-initiating population, to ensure relapse-free survival in patients. Identifying novel druggable targets that are selective to AML despite their location in the vascular niche is thus highly warranted. We developed an in vitro co-culture model consisting of AML cells and Bone Marrow- derived Endothelial Cells (BMECs), mimicking the protective effect of the vascular niche in the bone marrow microenvironment. Using this unique model, and taking advantage of combinatorial chemistry, we performed high-throughput chemical-phenotypic screening of approximately 30 million novel compounds and identified a novel polyamine sulfonamide 2470-51 that can selectively kill AML cells by overcoming the protective effect of the BMECs. In addition to AML blasts, 2470-51 also exhibited highly selective activity against the leukemic stem and progenitor cell population while sparing normal hematopoietic stem and progenitor cells. In vivo studies using patient-derived xenograft models indicated significant regression in AML engraftment post 2470-51 treatment. Target identification experiments involving unbiased label-free shotgun proteomic analysis in combination with targeted Selected Ion Monitoring (SIM) revealed covalent drug binding targets of 2470-51. By performing differential protein expression analysis using ITRAQ analysis, we identified downstream mechanisms that led to mitotic cell cycle arrest and cell death. Collectively, our findings display the in vitro as well as in vivo efficacy of a novel polyamine sulfonamide in eliminating AML, including the leukemia initiating compartment. We also uncover a novel mechanism in AML that can be taken advantage of for selective toxicity. Furthermore, we establish the role of 2470-51 as a potential therapeutic agent in treating AML.

Citation Format: Vindhya Vijay, Amy Meacham, Leylah Drusbosky, Elizabeth Wise, Christopher Cogle. A novel polyamine sulfonamide with anti-leukemic activity [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5118. doi:10.1158/1538-7445.AM2017-5118

Population-based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases

Background

The aims of this prospective population-based cohort study were to identify the patient and hospital characteristics associated with emergency cholecystectomy, and the influences of these in determining variations between hospitals.

Methods

Data were collected for consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing the performance of emergency cholecystectomy were analysed by means of multilevel, multivariable logistic regression modelling using a two-level hierarchical structure with patients (level 1) nested within hospitals (level 2).

Results

Data were collected on 4744 cholecystectomies from 165 hospitals. Increasing age, lower ASA fitness grade, biliary colic, the need for further imaging (magnetic retrograde cholangiopancreatography), endoscopic interventions (endoscopic retrograde cholangiopancreatography) and admission to a non-biliary centre significantly reduced the likelihood of an emergency cholecystectomy being performed. The multilevel model was used to calculate the probability of receiving an emergency cholecystectomy for a woman aged 40 years or over with an ASA grade of I or II and a BMI of at least 25·0 kg/m2, who presented with acute cholecystitis with an ultrasound scan showing a thick-walled gallbladder and a normal common bile duct. The mean predicted probability of receiving an emergency cholecystectomy was 0·52 (95 per cent c.i. 0·45 to 0·57). The predicted probabilities ranged from 0·02 to 0·95 across the 165 hospitals, demonstrating significant variation between hospitals.

Conclusion

Patients with similar characteristics presenting to different hospitals with acute gallbladder pathology do not receive comparable care.

Painful Lytic Lesions of the Foot: A Case Report

The presence of lytic lesions in the bones of foot raises a number of diagnostic possibilities ranging from infection, inflammatory pathology to neoplastic conditions. Although the radiological picture is not pathognomonic of any pathology, clinical history and histopathological examination can help to clinch the diagnosis. We present a case of multiple lytic lesions of the foot and discuss possible differential diagnoses. The patient was diagnosed as a case of madura foot and the lesions responded to surgical debridement and anti-fungal treatment with a good functional outcome. Madura foot is an uncommon, chronic granulomatous fungal or bacterial infection with a predilection in people who walk barefoot. Although known for a specific geographical distribution, madura foot should be kept as a possible diagnosis in patients presenting with lytic lesions of the foot due to population emigration across the world.

The role of 'paraoxonase-1 activity' as an antioxidant in coronary artery diseases

BACKGROUND AND OBJECTIVES

A majority of the Coronary Artery Diseases (CAD) result from complications of atherosclerosis. There is a growing body of evidence which has revealed that the reduced activity of the HDL-associated enzyme, paraoxonase1 (PON1), is predictive of vascular disease in humans, which include the results from prospective studies. The mechanisms by which PON1 activity influences risk of vascular disease continue to be evaluated. It is generally thought that PON1 contributes to the antioxidant, and thus, to the antiatherogenic properties of High Density Lipoproteins (HDL). Depleted antioxidant levels could be a risk factor for coronary artery disease. Hence, this study was done to evaluate PON1, as antioxidant, in CAD patients.

METHODS

This study was done to determine serum levels of PON1 activity in 50 controls and in 60 clinically and ECG proven CAD cases and to compare PON1 activity with total cholesterol and triglycerides.

RESULTS

Serum levels of PON1 activity (p<0.001) were significantly lower in CAD cases than in controls. Serum total cholesterol (p< 0.001) and triglyceride (p< 0.001) levels were significantly higher in CAD cases than in controls. There was a negative correlation between PON 1 activity and total cholesterol and triglycerides. The negative correlation between PON1 activity and total cholesterol was significant (p<0.05).

INTERPRETATION AND CONCLUSION

From our present study, we can conclude that PON1 can exert a protective effect on HDL by preventing its oxidative damage. Further, a decreased PON 1 activity may be a risk factor for CAD, which is likely to be explained by derangement of PON 1 activity towards lipid peroxidation. This study suggested that serum antioxidant activity of PON1 was an important factor which provided protection from oxidative stress and lipid peroxidation in CAD. Thus, evaluating the effects of PON 1 for CAD patients may be promising in the treatment and prognosis of CAD.

Speedy orthodontics: a case report

Management of severe rotation poses a great challenge for the orthodontist, especially when cortical anchorage occurs. The conventional methods require excessive treatment time, rely on patient compliance, and can cause root resorption. A groundbreaking new procedure developed by Wilcko et al, which is actually a modification of the conventional corticotomy procedure, amalgamates the orthodontic mechanics, alveolar decortications, and augmentation procedure to make treatment time three to four times faster than conventional orthodontic techniques. This procedure uses the dynamics of bone physiology and redirects the emphasis in tooth movement to the manner in which supporting bone responds to orthodontic forces applied to the tooth. This article includes a case report in which the technique is used on a patient who has a severely rotated mandibular left canine.

Field evaluation of repellency of a polyherbal essential oil against blackflies and its dermal toxicity using rat model

In the present study we have evaluated the repellent activity of mixture of Curcuma longa, Zanthoxylum limonella and Pogostemon heyneanus essential oils in 1:1:2 ratio at 5%, 10% and 20% concentration against blackflies in northeastern India. Initially the essential oil mixture tested here has been found effective against Aedes albopictus mosquitoes. The average protection recorded in 20% concentration (170.56 ± 4.0; 95% CI = 162.09-179.02) was higher as compared to other two concentrations (F = 90.2; p<0.0001; df = 53). Percentage repellency and repellency index was found to be higher in 20% concentration (p ≤ 0.017). No appreciable clinical and behavioral signs were observed in the acute dermal toxicity using rat model. No changes were observed in biochemical profiles of treatment group animals. Similarly, no prominent lesions were observed in vital organs of treatment in both the sexes. The study concludes that tested repellent is safe for use and has multi-insects repellent property.

Pruritus ani

INTRODUCTION

Pruritus ani is a common condition with many causes, predominately anorectal pathology. There are some new insights and therapies, but the most recommendations are based on low-level evidence.

PATIENTS AND METHODS

A literature search was carried out using Medline and the internet with the keywords 'pruritus ani' from 1950 to 2007.

RESULTS

A review of the evidence is presented and a management plan based on the elimination of irritants and scratching, general control measures and active treatment measures is offered.

CONCLUSIONS

Treatment of primary and secondary pruritus ani has a good prospect of regression of symptoms and skin changes.

A solvatochromatic approach to quantifying formulation effects on dermal permeability

Dermal risk assessments are most often concerned with the occupational and environmental exposure to a single chemical and then determining solute permeability through in vitro or in vivo experimentation with various animal models and/or computational approaches. Oftentimes, the skin is exposed to more than one chemical that could potentially modulate dermal permeability of the chemical that could cause adverse health effects. The focus of this article is to demonstrate that these formulation effects on dermal permeability can occur with simple solvent formulations or complex industrial formulations and that these effects can be modeled within the context of a linear solvation energy relationship (LSER). This research demonstrated that formulation-specific strength coefficients (r p a b v) predicted (r(2) = 0.75-0.83) changes in the dermal permeability of phenolic compounds when formulated with commercial metal-working fluid (MWF) formulations or 50% ethanol. Further experimentation demonstrated that chemical-induced changes in skin permeability with 50% ethanol are strongly correlated (r(2) = 0.91) to similar changes in an inert membrane-coated fiber (MCF) array system consisting of three chemically diverse membranes. Changes in specific strength coefficients pertaining to changes in hydrogen donating ability (Deltab) and hydrophobicity (Deltav) across membrane systems were identified as important quantitative interactions associated with ethanol mixtures. This solvatochromatic approach along with the use of a MCF array system holds promise for predicting dermal permeability of complex chemical formulations in occupational exposures where performance additives can potentially modulate permeability of potential toxicants.

Parental influence on the spectrum of type 2 diabetes in the offspring among Indians

AIM

Familial aggregation of type 2 diabetes and its vascular complications is strong in Indians. In this study, we have analysed whether the age of the parent at birth of the offspring had any influence on the age at diagnosis of diabetes and age at onset of microvascular complications in the diabetic offspring.

METHODS

Families with either a type 2 diabetic father or mother and a type 2 diabetic offspring, all of whom had been tested at our centre were included in this study (n = 300, father--122, mother--178, offspring male --201, female--99). Anthropometric details, age at diagnosis of diabetes, age at onset of complications and duration of diabetes were recorded. All relevant clinical and investigatory tests were done and appropriate statistical analyses were done.

RESULTS

Age at onset of diabetes was lower in the offspring than in their parents at least by a decade. The age at diagnosis of diabetes in the offspring was determined inversely by the age of the parent at childbirth (p<0.001) and positively by the age of onset of diabetes and the presence of complications in the parents (both p<0.0001). Moreover, the age at diagnosis of complications in the offspring were determined inversely by the age of the parent at childbirth (p=0.0001) and positively by the age of onset of complications in the parents (p=0.0009).

DISCUSSION

A younger parental age at childbirth was protective to the offspring in that the offspring developed diabetes and the complications at an older age.

Metabolic syndrome does not increase the risk of conversion of impaired glucose tolerance to diabetes in Asian Indians--Result of Indian diabetes prevention programme

AIMS

In this study, we assessed for the prevalence of metabolic syndrome (MetS) in the cohort of subjects with impaired glucose tolerance (IGT) in the Indian Diabetes Prevention Programme and studied whether the syndrome enhanced the conversion to diabetes.

METHODS

Effectiveness of lifestyle modification (LSM), metformin (Met) and LSM plus Met was tested in a randomised, controlled primary prevention study in subjects with IGT n=502 (M:W 397:105) at a median follow up of 30 months. Baseline prevalence of MetS was calculated using the WHO criteria. Insulin resistance (IR) was calculated using homeostasis model assessment (HOMA) method.

RESULTS

MetS was present in 233 subjects (46.4%; 95% CI 41.9-50.9) in the total group, in men (n=168; 42.3%; 95% CI 37.4-47.3) and in women (n=65; 61.9%; 95% CI 51.9-71.2) (men versus women chi(2)=12.8, p=0.0005). Insulin resistance (HOMA-IR>or=4.1) was present in 69.1% with no gender difference. IR increased proportionately with increasing number of abnormalities, in IGT (39.8%), IGT plus one abnormality (56.5%) and IGT plus any two or more abnormalities (69.1%) (Mantel Haenszel chi(2)=22.8, p<0.0001). Incidence of diabetes was similar in subjects with (40.3%) (n=94/233) or without (40.1%) (n=108/269) MetS (p=0.97). Cox's regression analysis confirmed that MetS did not enhance the conversion rate of IGT to diabetes both in the control (HR=0.88, 95% CI 0.53-1.47, p=0.63) and in the total group (HR=1.02, 95% CI 0.78-1.35, p=0.88), after correcting for effects of intervention.

CONCLUSION

Prevalence of MetS is high in Asian Indian IGT subjects, especially in women. However, it did not influence the rate of conversion of IGT to diabetes.

Persistent impaired glucose tolerance has similar rate of risk factors as for diabetes--results of Indian diabetes prevention programme (IDPP)

OBJECTIVE

To determine the occurrence of persistent impaired glucose tolerance (IGT) (two times OGTT positive) and to compare the physical and clinical characteristics with subjects having transient IGT or diabetes.

RESEARCH DESIGN AND METHODS

Nondiabetic subjects aged 35-55 years were screened (n=10,839, M:W 8667:2172) using 2h capillary blood glucose. IGT was diagnosed in 1332 (12.3%). Among them, 1025 (77%) responded for a second OGTT and 531 subjects (51.8%) had persistent IGT. Biochemical, demographic and anthropometric characteristics were compared among the normal (NGT, 30.1%), IGT and diabetic subjects (DM, 18%) at second GTT.

RESULTS

All had similar age. BMI, waist circumference and body fat percentage were lower in NGT than in IGT and diabetes. IGT and diabetes had similar characteristics. Family history of diabetes was the highest in persistent IGT.

CONCLUSION

Among the screened subjects, 1 in 20 had persistent IGT. Subject with persistent IGT had higher rates of risk factors for diabetes, such as high BMI, waist circumference and body fat percentage.

The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1)

AIMS/HYPOTHESIS

Lifestyle modification helps in the primary prevention of diabetes in multiethnic American, Finnish and Chinese populations. In a prospective community-based study, we tested whether the progression to diabetes could be influenced by interventions in native Asian Indians with IGT who were younger, leaner and more insulin resistant than the above populations.

METHODS

We randomised 531 (421 men 110 women) subjects with IGT (mean age 45.9+/-5.7 years, BMI 25.8+/-3.5 kg/m(2)) into four groups. Group 1 was the control, Group 2 was given advice on lifestyle modification (LSM), Group 3 was treated with metformin (MET) and Group 4 was given LSM plus MET. The primary outcome measure was type 2 diabetes as diagnosed using World Health Organization criteria.

RESULTS

The median follow-up period was 30 months, and the 3-year cumulative incidences of diabetes were 55.0%, 39.3%, 40.5% and 39.5% in Groups 1-4, respectively. The relative risk reduction was 28.5% with LSM (95% CI 20.5-37.3, p=0.018), 26.4% with MET (95% CI 19.1-35.1, p=0.029) and 28.2% with LSM + MET (95% CI 20.3-37.0, p=0.022), as compared with the control group. The number needed to treat to prevent one incident case of diabetes was 6.4 for LSM, 6.9 for MET and 6.5 for LSM + MET.

CONCLUSIONS/INTERPRETATION

Progression of IGT to diabetes is high in native Asian Indians. Both LSM and MET significantly reduced the incidence of diabetes in Asian Indians with IGT; there was no added benefit from combining them.

Stress and undetected hyperglycemia in southern Indian coastal population affected by tsunami

AIM

Natural calamities are known to result in higher stress conditions and also result in adverse health outcomes including development of non-communicable diseases. The impact of tsunami on mental stress and prevalence of hyperglycemic conditions was assessed in a population affected by the calamity in coastal populations of southern India.

METHODS

Two populations similar in demography and physical characteristics, but, one affected by tsunami were selected for a comparative study. Subjects aged 20 years or above were randomly selected (control population n = 1176; tsunami population n = 1184). Details of stress were assessed using Harvard trauma questionnaire and scores were assigned. Glucose tolerance was assessed using 2h capillary blood glucose (75gms glucose load) and diagnosis was made using WHO criteria.

RESULTS

Stress score was significantly higher in tsunami population. Although the total prevalence of diabetes was similar (control - 10.0 %; tsunami population - 10.5 %) prevalence of undetected diabetes (5.7 % vs. 3.8 %; Z = 9.54, P < 0.001) and impaired glucose tolerance (9.8 % vs. 8.3 %; Z = 12.83, P < 0.001) higher in the tsunami area. Stress score was higher in women and in the young in the tsunami area.

CONCLUSION

Population affected by tsunami was under high stress and also showed a high prevalence of undetected diabetes and impaired glucose tolerance.

Derivation and validation of diabetes risk score for urban Asian Indians

OBJECTIVE

Simple risk scores for identifying people with undiagnosed diabetes have been developed, mostly in Caucasian groups. This may not be suitable for Asian Indians, therefore this study was undertaken to develop and validate a simple diabetes risk score in an urban Asian Indian population with a high prevalence of diabetes. We also tested whether this score was applicable to South Asian migrants living in a different cultural context.

RESEARCH DESIGN AND METHODS

A population based Cohort of 10,003 participants aged >or=20 years was divided into two equal halves (Cohorts 1 and 2), after excluding people with known diabetes. Cohort 1 (n=4993) was used to derive the risk score. Validation of the score was performed in the other half of the survey population (Cohort 2) (n=5010). The validation was also done in a separate survey population in Chennai, India (Cohort 3) (n=2002) (diagnosis of diabetes was based on OGTT) and in the South Asian Cohort of the 1999 Health Survey for England (n=676) (fasting glucose value>or=7 mmol/l and HbA1c>or=6.5% were used for diagnosis). A logistic regression model was used to compute the beta coefficients for risk factors. The risk score value was derived from a receiver operating characteristic curve.

RESULTS

The significant risk factors included in the risk score were age, BMI, waist circumference, family history of diabetes and sedentary physical activity. A risk score value of >21 gave a sensitivity, specificity, positive predictive value and negative predictive value of 76.6%, 59.9%, 9.4% and 97.9% in Cohort 1, 72.4%, 59%, 8.3% and 97.6% in Cohort 2 and 73.7%, 61.0%, 12.2% and 96.9% in Cohort 3, respectively. The higher distribution of risk factors in the UK Cohort means that at the same cut point the score was much more sensitive but also less specific. (sensitivity 92.2%, specificity 25.7%, positive predictive value of 21.6% and negative predictive value of 93.7%).

CONCLUSIONS

A diabetes risk score involving simple non-biochemical measurements was developed and validated in a native Asian Indian population. This easily applicable simple score could play an important role as the first step in the process of identifying individuals with an increased likelihood of having prevalent but undiagnosed diabetes. The different distribution of risk factors with the migrant Asian Indians living in England and the different relationship between sensitivity and specificity for the same score demonstrate that risk scores and cut-points developed and tested even within one ethnic group cannot be generalized to individuals of the same ethnic group living in a different cultural setting where the distribution of risk factors for diabetes is different.

Strategic Leukofiltration in Cardiac Surgery

Systemic inflammatory response syndrome (SIRS) with activation of molecular cascades, cell activation, accumulation of interstitial fluid, organ dysfunction and, occasionally, organ failure is still a commonly recognized consequence of cardiac surgery. SIRS leads to costly complications and several strategies intended to ameliorate the symptoms that have been studied, including leukocyte reduction, using filtration. Although, the body of work suggests that leukoreduction attenuates SIRS, discrepancies remain within the literature. The recent literature is reviewed highlighting the areas where concordance is lacking. In our study, on the basis of indirect indicators of SIRS, platelet function by thromboelastography biomaterial evaluation by light and scanning electron microscopy, we present our conclusions regarding clinical outcomes and the role of leukofiltration.

Development of a reliable and valid psychosocial measure of self-perception of health in type 2 diabetes

OBJECTIVES

The aim was to develop a reliable and valid psychosocial measure of self-perception of health in type 2 diabetes.

METHODS

Item analysis and factor analyses were done in order to stabilize and establish principal components of the questionnaire. Reliability (internal consistency aspect) was established using Chronbach's alpha method. Concurrent and discriminant validities were established using conventional methods.

RESULTS

Factor analysis yielded 12 significant factors (eigen value > or =1), but first six components were retained based on Scree test. These six principal varimax factors explain 49.7% of variance of psychosocial measure of self-perception of health.

CONCLUSIONS

The final version after all these psychometric procedures had 27 items with six principal components. They were appropriately named as follow: (I) Positive self-feeling; (II) Sociality; (III) Attention seeking; (IV) Feel healthy; (V) Worry about health; (VI) Dependence. Total variance explained is 49.7%.

Diffuse interstitial skeletal hyperostosis (DISH) in type 2 diabetes

A 58 years type 2 diabetic woman, school teacher by profession, presented with backache, neck pain and generalised weakness since last few months. Pain was mild with stiffness and neck pain was particularly associated with extension of the neck towards back. There was no focal neurological deficit on central nervous system examination. X-ray of lumbo- sacral spine showed prolific osteophytes and new bone formation in the body of lumbar vertebrae. Cervical X-ray showed 'Melting candle-wax' appearance at the anterior to the cervical vertebrae. In view of clinical and radiological association the case was diagnosed as DISH syndrome. It is being presented for its rarity.

Low risk threshold for acquired diabetogenic factors in Asian Indians

India is facing an epidemic of type 2 diabetes, with high prevalence in urban areas. Urbanisation and associated life style changes adversely affect the risk factors for diabetes unmasking the high genetic tendency existing in the population. Various epidemiological studies in Indians have shown that the increasing prevalence of diabetes could be attributed to a high genetic risk and lower risk thresholds for acquired risk factors such as age, obesity, abdominal adiposity and a high percentage of body fat. Diabetes occurs at a younger age in Indians compared to Whites. The risk of diabetes increases with a body mass index (BMI) of >23 kg/m(2) and waist circumference of 85 cm for men and 80 cm for women in Asian Indians. For a given BMI, Asian Indians have higher central adiposity. There is also evidence of higher insulin resistance amongst Indians, and this is partly explained by higher body fat percentage. A large proportion of urban adults has the metabolic syndrome also which predisposes them to both diabetes and cardiovascular diseases. Recognition of these conditions and institution of early preventive measures are urgently needed.

Detecting undiagnosed diabetes in urban Asian Indians--role of opportunistic screening

BACKGROUND

The aim of the study was to determine the proportion of incidental to symptomatic diagnosis of diabetes and to compare the profile of symptomatic and incidentally diagnosed diabetic subjects.

METHODS

One thousand newly diagnosed diabetic subjects (WHO criteria) were studied. Clinical, demographic, anthropometric details, blood pressure, glycaemic and lipid parameters were recorded. Reasons for medical check up were noted.

RESULTS

Among the 1000 subjects, 29% were symptomatic for diabetes and 71% were incidentally diagnosed to have diabetes. Symptomatic subjects were younger, had higher glycaemia and prevalence of hypertension.

CONCLUSION

The results show that majority of type 2 diabetic subjects remain asymptomatic and opportunistic screening for diabetes would be required for the early diagnosis of the disorder.

Use of glimepiride and insulin sensitizers in the treatment of type 2 diabetes--a study in Indians

AIM

Short-term efficacy of glimepiride, metformin and pioglitazone in newly diagnosed type 2 diabetes was compared with a group treated with diet and exercise. Effects on insulin secretion and sensitivity were also assessed.

METHODS

New type 2 diabetic subjects, aged 30-60 years with BMI < 30 kg/m2 were selected. Subjects having glycosylated haemoglobin (HbA1c) of < 8.5% were advised diet and exercise (control group). Others having HbA1c > or = 8.5 to 11.0% were randomized to receive glimepiride (group 2), metformin (group 3) and pioglitazone (group 4). At the final review between 12-14 weeks, changes in plasma glucose, HbA1c, lipid profile, HOMA insulin resistance (HOMA-IR), beta cell function (HOMA-BF) and insulinogenic index (delta I/G) were measured. Comparisons were made using appropriate statistical analyses.

RESULTS

Seventy-seven of the 97 subjects randomized equally into four groups, were available for review. Glycaemic parameters improved in all groups. Mean cholesterol decreased significantly in groups treated with metformin and pioglitazone. HDL-cholesterol increased with pioglitazone. Insulin resistance decreased significantly with metformin and pioglitazone, beta cell fuhction also showed improvement

CONCLUSIONS

Glycaemic control was seen in all study groups, the improvement was better in drug treated groups than in the control group. Glimepiride improved insulin secretion including the early phase secretion and reduced plasma triglycerides. Metformin and pioglitazone had beneficial effects on lipid levels, improved insulin sensitivity and improved insulin secretion also.

Temporal changes in prevalence of diabetes and impaired glucose tolerance associated with lifestyle transition occurring in the rural population in India

AIMS/HYPOTHESIS

The rural Indian population is undergoing lifestyle transition due to socio-economic growth. This study was done to determine the temporal changes in prevalence of diabetes and IGT that could have occurred in a rural population in India as a result of the lifestyle transition.

METHODS

A cross-sectional study of 1213 Asian-Indian subjects aged 20 years or over was done to look for the prevalence of diabetes and IGT using the 1999 WHO criteria. The temporal changes were assessed in comparison with a similar study conducted 14 years previously. The factors associated with the temporal changes were also analysed.

RESULTS

Nearly a three-fold increase in age- and sex-adjusted prevalence of diabetes (from 2.20% to 6.36%) was seen in 2003 when compared with a similar study done 14 years before. Prevalence of IGT did not change significantly (7.44% in 1989 vs 7.18% in 2003). Improvement in living conditions had occurred during the period, occupational changes were seen, the number of manual labourers had decreased and economic conditions had improved. BMI and waist circumference had increased. After correcting for age, sex and differences in time periods, waist circumference and physical inactivity showed significant associations with the increased prevalence of diabetes.

CONCLUSIONS/INTERPRETATION

Demographic transition due to improved living conditions in rural India was associated with a three-fold increase in the prevalence of diabetes. Increased upper body adiposity and physical inactivity showed significant association with this phenomenon.

Age-specific prevalence and risk associations for impaired glucose tolerance in urban southern Indian population

OBJECTIVES

A national survey of diabetes and impaired glucose tolerance (IGT) conducted in 2000 AD in six major cities of India showed a high prevalence of diabetes (12.1%) and IGT (14%). Prevalence of IGT was higher than that of diabetes in subjects with less than 40 years when compared with older subjects. This analysis was done to look for differences in the risk factors associated with IGT in the younger and older subjects.

METHODS

Associations of body mass index (BMI), waist : hip ratio, physical activity, family history of diabetes and monthly income with IGT and with diabetes were tested in the age groups of < 40 and > or = 40 years separately. Multiple logistic regression analyses were done to test the associations.

RESULTS

Prevalence of IGT was higher than diabetes in the younger group (13.1% Vs 5%, P < 0.001). Prevalence of obesity was higher in the older IGT subjects (38% Vs 30.5%, p < 0.003). Presence of positive family history of diabetes was similar in both the groups. In the > or = 40 year group age, BMI and family history of diabetes were common risk factors for diabetes and IGT. In the younger group, only BMI showed an association with IGT. The association of family history of diabetes with IGT was weaker than for diabetes even in the older subjects (Odds Ratio (OR) = 3.5 for diabetes, 1.33 for IGT).

CONCLUSIONS

Prevalence of IGT was higher than diabetes in the age group < 40 years. Only BMI showed an association with IGT in them while the risk associations were similar to diabetes in the older group. Prospective studies will throw more light on the implications of these findings.

Insulin secretion and action show differences in impaired fasting glucose and in impaired glucose tolerance in Asian Indians

BACKGROUND

The aim of the study was to compare the abnormalities in insulin secretion and insulin sensitivity in impaired fasting glucose (IFG) and in impaired glucose tolerance (IGT).

METHODS

Glucose tolerance was determined by oral glucose tolerance test in 289 non-diabetic subjects selected for this study (M : F, 160 : 129, mean age 42.2 +/- 11.0 (SD) years, mean body mass index (BMI) 24.9 +/- 4.2 kg/m(2)). Diabetic subjects were excluded from the study. The association of insulin resistance and beta-cell function (calculated by HOMA model) with IFG and IGT was studied using linear and multiple logistic regression analyses. Subjects with normoglycaemia (NGT) were used as controls.

RESULTS

Insulin resistance was significantly more in IFG and in IGT than in NGT. beta-cell dysfunction was significantly higher in IFG than in IGT. IFG was associated with both insulin resistance (OR = 9.11, p < 0.001) and beta-cell dysfunction (inverse correlation, OR = 0.103, p < 0.001), while only insulin resistance was significantly associated with IGT (OR = 1.24, p = 0.005).

CONCLUSIONS

In urban South Asian Indians, IFG differed from IGT in having combined insulin resistance and beta-cell dysfunction, while IGT was associated only with insulin resistance.

Age- and sex-specific prevalence of diabetes and impaired glucose regulation in 11 Asian cohorts

OBJECTIVE

To report the age- and sex-specific prevalence of diabetes and impaired glucose regulation (IGR) according to revised World Health Organization criteria for diabetes in Asian populations.

RESEARCH DESIGN AND METHODS

We performed 11 studies of 4 countries, comprising 24,335 subjects (10,851 men and 13,484 women) aged 30-89 years who attended the 2-h oral glucose tolerance test and met the inclusion criteria for data analysis.

RESULTS

The prevalence of diabetes increased with age and reached the peak at 70-89 years of age in Chinese and Japanese subjects but peaked at 60-69 years of age followed by a decline at the 70 years of age in Indian subjects. At 30-79 years of age, the 10-year age-specific prevalence of diabetes was higher in Indian than in Chinese and Japanese subjects. Indian subjects also had a higher prevalence of IGR in the younger age-groups (30-49 years) compared with that for Chinese and Japanese subjects. Impaired glucose tolerance was more prevalent than impaired fasting glycemia in all Asian populations studied for all age-groups.

CONCLUSIONS

Indians had the highest prevalence of diabetes among Asian countries. The age at which the peak prevalence of diabetes was reached was approximately 10 years younger in Indian compared with Chinese and Japanese subjects. Diabetes and IGR will be underestimated in Asians based on the fasting glucose testing alone.

Metabolic syndrome in urban Asian Indian adults--a population study using modified ATP III criteria

AIMS/HYPOTHESIS

To determine the prevalence of the Metabolic syndrome (MetS) using modified ATP III criteria in urban Asian Indian adults.

METHODS

475 subjects (age 20-75 years) from a population data base were studied for the MetS using ATP III criteria but with a modified waist circumference (WC) appropriate for Indians. Presence of >or=3 of the following; raised WC (Men >or=90 cm, Women >or=85 cm), triglycerides (TG) >or=1.7 mmol/l), HDL-Cholesterol (HDL-C)-<1.0 mmol/l for men, <1.3 mmol/l for women, fasting plasma glucose (FPG)>or=6.1 mmol/l and blood pressure (BP)>or=130/>or=85 mm of Hg, or using BP medication, indicated the MetS. Insulin resistance (IR) was calculated using the Homeostasis Model Assessment (HOMA) equation. Factor analysis was used to identify clusters of correlated abnormalities.

RESULTS

MetS was present in 41.1%. WC was increased in 31.4%, TG in 45.6%, low HDL-C in 65.5%, hypertension in 55.4% and raised FPG 26.7%. MetS was present in 27.9% of subjects with FPG<6.1 mmol/l and its prevalence increased to >70% with higher FPG values. MetS was more common in women than in men (46.5 vs. 36.4%, chi(2)=4.6, P=0.03) and in older people. Four distinct clusters of abnormalities were identified with some gender variations. IR was more prevalent in MetS and was a component of two clusters but it was not a core component in factor analysis.

CONCLUSIONS

MetS is common in Asian Indians. Its prevalence is age-related, and is more common in women. HOMA-IR or fasting plasma insulin was not a core component of the MetS.

Quality of life and diabetes integration among subjects with type 2 diabetes

Diabetes integration indicates that a person with diabetes makes an appropriate emotional adjustment to the requirements of diabetic way of life. Diabetes integration and a sense of well-being are expected to be correlated. The aim of diabetes treatment should be to enable a patient to adjust himself to his being a diabetic person. This should ensure a sense of well-being. Aims of this study was to assess the role of diabetes integration and psychological factors in patients with type 2 diabetes.

METHOD

A sample of 227 type 2 diabetes patients participated in the study. They were all in the upper middle class social stratum. Diabetes integration scale yields one composite score of adjustment, has 19 items applicable to both type 1 and type 2 diabetic subjects. The psychological well-being scale has 22 items, measures depression (6 items), anxiety (6 items), energy (4 items), positive well-being (6 items) and a general sense of well-being score by the whole test of 22 items.

RESULTS

The psychological well-being subscales and the whole scale scores significantly correlated with diabetes integration scale (all P values were < 0.0001). However, we found that diabetes integration and the psychological well-being subscales were not significantly correlated with metabolic and other medical indices. There were gender differences in depression (p < 0.04), anxiety (p < 0.0001), energy (p = 0.004), positive well-being. (p = 0.02) and general sense of well-being (p < 0.0001), men fared in a better than women subjects. No such gender differences were found in diabetes integration score.

CONCLUSION

Diabetic patients who integrate themselves and emotionally adjust to diabetes experience a psychological sense of well-being.