Circulating Antimicrobial Peptide LL-37 Status in Type 1 Diabetes Mellitus and its Relation with Glycemic Control

Antimicrobial-peptides are important molecules of constitutive innate immunity. Though patients with diabetes mellitus are generally prone to infections, there is limited information on their antimicrobialpeptide status. We assessed the circulating LL-37 antimicrobial peptide (also referred as cathelicidin) levels in patients with type 1 diabetes mellitus and its relation with their glycemic status. The LL-37 mRNA expression was assessed in the peripheral blood mononuclear cells (PBMC) by quantitative RTPCR using ß-actin and cytochrome-C1 as the reference genes in 154 subjects (Type 1 diabetes, n=111 and healthy subjects, n=43).  Serum LL-37 was quantified using sandwich-ELISA. Average HbA1c over last 2 years and current HbA1c were used to determine long-term and short-term glycemic status. LL-37 mRNA expression and serum LL-37 levels were correlated with the glycemic status. The LL-37 mRNA copies were comparable between type 1 diabetes and healthy subjects [median (IQR) = 6.7 (1.8–15.28) vs. 7.2 (2.23–21.86), respectively, P = 0.42]. There was no significant difference in serum LL-37 levels between the two groups [median (IQR) = 3.9 (2.88–7.52) vs. 5.0 (3.19–9.05) ng/ml, respectively, P = 0.52]. The LL-37 mRNA and its protein concentration showed no significant correlation with the average or current HbA1c values. The constitutive circulating antimicrobial peptide LL-37 status is not significantly altered in patients with type 1 diabetes mellitus and also not affected by their glycemic status

Role of Uroflowmetry in Children with Ano-Rectal Malformation in Anticipating Upper Urinary Tract Damage

Background: The lower urinary tract dysfunction (LUTD) has high incidence in children with ano- rectal malformation (ARM) which if left untreated leads to upper tract damage.Aim: To determine role of uroflowmetry in early diagnosis of LUTD in children with ARM.Methods: This prospective study included twenty consecutive patients of ARM and every patient underwent uroflowmetry at-least 6 weeks after definitive procedure.Results: The mean age of patients was 3.015±0.86 years. Of the twenty patients, there were 12 (60%) males and 8 (40%) females; 11 (55%) were high ARM, 4 (20%) were intermediate and 5(25%) were low ARM. Lower urinary tract symptoms (LUTS) was present in 8/20 (40%) patients but uroflowmetric abnormalities were present in 11/20 (55%) patients. Forty five percent (5/11) patients with abnormal uroflowmetry were asymptomatic and 25% (2/8) symptomatic patients had normal uroflowmetry. The incidence of uroflowmetric abnormalities was significantly higher in patients with spinal anomalies (p=0.03; χ2=4.1) and those with high ARM (p=0.004; χ2=8.1).Conclusion: Uroflowmetry is a noninvasive method that may help in early detection of neurovesical dysfunction in asymptomatic children and subsequent cystometric analysis in patients with uroflowmetric abnormalities can be done for early definitive diagnosis and prevention of upper urinary tract damage

Mechanisms of Action of Human Mesenchymal Stem Cells in Tissue Repair Regeneration and their Implications

Cell replacement therapy holds a promising future in the treatment of degenerative diseases related to neuronal, cardiac and bone tissues. In such kind of diseases, there is a progressive loss of specific types of cells. Currently the most upcoming and trusted cell candidate is Mesenchymal Stem Cells (MSCs) as these cells are easy to isolate from the tissue, easy to maintain and expand and no ethical concerns are linked. MSCs can be obtained from a number of sources like bone marrow, umbilical cord blood, umbilical cord, dental pulp, adipose tissues, etc. MSCs help in tissue repair and regeneration by various mechanisms of action like cell differentiation, immunomodulation, paracrine effect, etc. The future of regenerative medicine lies in tissue engineering and exploiting various properties to yield maximum output. In the current review article, we have targeted the repair and regeneration mechanisms of MSCs in neurodegenerative diseases, cardiac diseases and those related to bones. Yet there is a lot to understand, discover and then understand again about the molecular mechanisms of MSCs and then applying this knowledge in developing the therapy to get maximum repair and regeneration of concerned tissue and in turn the recovery of the patient

Burden of Cardiometabolic Disorders among Subjects Undergoing Preventive Health Check-up: A Follow-up Study

Objective: To study the incidence of hypertension (HTN), diabetes mellitus and coronary artery disease (CAD) in a cohort of adult subjects.Methods: A total 2159 participants (mean age: 48.6±11.6 years; 1342 males and 817 females) who attended the hospital for a comprehensive health check up were recruited and followed-up as a cohort for a mean period of 3.5 years. Their baseline and follow-up evaluation included clinical examination, biochemical investigations and cardiac check-up.Results: At baseline, 64% participants were overweight or obese, 44.3% had HTN (grade I or above), 16.7% had diabetes mellitus with additional 29.3% having impaired fasting glucose or glucose intolerance, and 46.6% had metabolic syndrome. The prevalence of CAD at baseline was 6% in males and 3% in females. The incidence (per 1000 person-years of follow-up) of HTN, diabetes mellitus and CAD was 72.2, 26.3 and 12.2, respectively.Conclusion: The burden of cardiometabolic disorders and their risk factors is high in India. Urgent remedial public health preventive measures are required to curtail the emerging epidemic of cardiometabolic disorders

Need Assessment of Consultation Liaison Psychiatry amongst the Clinical Faculty

Nearly 20-40% of patients with medico-surgical illnesses in general hospitals have a co morbid psychiatric illness or psychosocial issues, which interfere in improvement of the primary illness. It is important to assess the attitudes and awareness of non-psychiatrist clinicians about the co-existing psychiatric morbidity in their patients and their felt needs, which can help in mitigating this morbidity. The present study attempts to gauge the non-psychiatrist clinician's perception, felt needs and barriers to referral/ intervention in a tertiary care teaching hospital. A cross-sectional, descriptive, online questionnaire-based method was used. Of the 239 clinical faculty members, only 45 responded. Responses indicated that clinicians were aware of the existence and significance of psychological problems in their patients, but could do with further increased levels of awareness and more specific training in evaluation and intervention. Stigma, lack of awareness of available services, and lack of detailed understanding regarding psychological problems were the important barriers to referral/ intervention. Better teamwork, training and more manpower were the specific suggestions for improvement in the future

Restorative Therapies after Stroke: Drugs, Devices and Robotics

Restorative therapies aim to improve outcome and function by promoting plasticity within a therapeutic time window between days to weeks to years. In this article, the mechanisms by which cell-based, pharmacological and robotic treatments stimulate endogenous brain remodelling after stroke, particularly neurogenesis, axonal plasticity and white-matter integrity are described with a brief outline of the potential of neuroimaging (fMRI) techniques. Stem cells aid stroke recovery via mechanisms depending on the type of cells used. Transplanted embryonic stem cells (ESCs), induced pluripotent stem cells (iPSCs), and neural stem cells (NSCs) can replace the missing brain cells in the Infarcted area, while adult stem cells, such as mesenchymal stem cells or multipotent stromal cells (MSCs) and MNCs, provide trophic support to enhance self-repair systems such as endogenous neurogenesis. Most preclinical studies of stem cell therapy for stroke have emphasized the need to enhance self-repair systems rather than to replace lost cells, regardless of the type of cells used. Noninvasive brain stimulation (NIBS) provides a valuable tool for interventional neurophysiology by modulating brain activity in a specific distributed, cortico-subcortical network. The two most commonly used techniques for noninvasive brain stimulation are transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). The article also discusses the potential role and current evidence for the use of pharmacological therapy, robotics and specific forms of physiotherapy regimes in optimizing stroke recovery. Neurorestoration is a concept that has been proven emphatically in several experimental models and clinical studies of stroke. Elucidating the underlying mechanisms of cell-based, pharmacological and rehabilitative therapies is of primary interest and crucial for translation of treatments to clinical use. The knowledge must provide an impetus for the development of superior, advanced and cost effective neuro restorative interventions that will enhance stroke recovery. Keywords : Cerebral stroke, stroke therapy, functional neuroimaging

Neurodevelopmental Disorders: The Journey, the Dreams and their Realization

Neuro Developmental Disorders (NDDs) are associated with significant morbidity. This involves early identification of the disorder, the correct management of the disorder and associated disabilities. In India, the paucity of trained personnel and lack of knowledge about these disorders has been instrumental in inadequate management and recognition of these NDDs. The Child Neurology Division, Department of Pediatrics at All India Institute of Medical Sciences has made few noteworthy and meaningful contributions in these aspects: devising a DM curriculum for pediatric neurology, developing indigenous tools for diagnosing these NDDs and performing relevant research. These endeavors would go a long way in serving the children with NDDs.Keywords: Neurodevelopmental disorders, autism, cerebral palsy, attention deficit hyperactivity disorder

Biomedical Applications of Nanomaterials: Diagnosis and Therapy of Thrombotic Disorders

We have employed unique properties of carbon-based as well as metallic nanomaterials to develop diagnostic / therapeutic devices targeted against thrombotic disorders. We have designed a novel graphene-based biosensor that can detect individuals with high coronary risk. Further, we describe an innovative strategy to ablate pathological thrombus in situ employing near-infrared laser-irradiated gold nanorods (photothermal therapy).Keywords: Thrombus, biosensor, photothermal therapy, platelet-derived microparticles.Â