‘Old Is Gold’: How Traditional Indian Dietary Practices Can Support Pediatric Diabetes Management

Nutrition is crucial for maintaining normal growth, development, and glycemic control in young people with diabetes (PwD). Undue restrictions cause nutrient deficiencies as well as poor adherence to meal plans. Widespread availability of low-cost, ultra-processed, and hyperpalatable food is further damaging. Most families struggle to find ways to provide nutritious, yet attractive, food with a low glycemic index (GI). India is one of the oldest continuous civilizations with a rich and diverse cultural and culinary heritage. Traditional dietary practices, including the centuries-old ‘Thali’ (meaning plate) concept, emphasize combinations (grains, lentils, vegetables, dairy, spices, prebiotics and probiotics, and fats) of local, seasonal, and predominantly plant-based ingredients. These practices ensure that all of the necessary food groups are provided and fit well with current evidence-based recommendations, including the International Society for Pediatric and Adolescent Diabetes (ISPAD) 2018 Guidelines. Techniques for the preparation, cooking, and preservation of food further impact the GI and nutrient availability. These practices benefit nutrient density, diet diversity, and palatability and thus improve adherence to meal plans and glycemic control. This narrative review describes the ancient wisdom, food composition, and culinary practices from across India which are still valuable today. These may be of benefit worldwide to improve glycemic control as well as quality of life, especially in PwD

Type 1 diabetes registry in developing countries: Perspective from India

India has been a prey to rising tide of non-communicable diseases. It is becoming increasingly important to evolve strategies to ensure effective prevention, diagnosis and treatment of this rising burden. Available Indian data reveal different opinions regarding type 1 diabetes (T1D). Such variation in data leads to uncertainty in healthcare planning and management. This ununiformity in data and the absence of protocol make a task challenging. Many patients consult non-specialists and even doctors from different streams. On the part of the patients, the diagnostic and screening testing are a great burden. T1D registry is of great relevance to India. It helps in ensuring good clinical practice and errors. Endocrinologists and paediatricians can audit themselves using such a registry. The overall goal is to improve population health. The objective is to reduce morbidity and mortality while maximising the cost-effectiveness. Such a registry helps in fund allocation and healthcare planning and contributes to the formulation of pragmatic management guidelines. However, healthcare professionals are reluctant to share their data. This may be due to fear of being audited by peers or regulators and record maintenance. We must work towards creating a national registry of T1D. This should involve multiple centres across the country, as it will help enhance awareness about T1D and improve standard of care. The results of which can be used to advocate for greater allocation of resources to T1D care. An effective registry will help children claim their rightful place under the sun

Burden, risk factors and outcomes associated with adequately treated hypothyroidism in a population-based cohort of pregnant women from North India.

Hypothyroidism is the commonest endocrine disorder of pregnancy, with known adverse feto-maternal outcomes. There is limited data on population-based prevalence, risk factors and outcomes associated with treatment of hypothyroidism in early pregnancy. We conducted analysis on data from an urban and peri-urban low to mid socioeconomic population-based cohort of pregnant women in North Delhi, India to ascertain the burden, risk factors and impact of treatment, on adverse pregnancy outcomes- low birth weight, prematurity, small for gestational age and stillbirth. This is an observational study embedded within the intervention group of the Women and Infants Integrated Interventions for Growth Study, an individually randomized factorial design trial. Thyroid stimulating hormone was tested in 2317 women in early (9-13 weeks) pregnancy, and thyroxin replacement started hypothyroid (TSH ≥2.5mIU/mL). Univariable and multivariable generalized linear model with binomial family and log link were performed to ascertain risk factors associated with hypothyroidism and association between hypothyroidism and adverse pregnancy outcomes. Of 2317 women, 29.2% (95% CI: 27.4 to 31.1) had hypothyroidism and were started on thyroxin replacement with close monitoring. Overweight or obesity was associated with increased risk (adjusted RR 1.29, 95% CI 1.10 to 1.51), while higher hemoglobin concentration was associated with decreased risk (adjusted RR 0.93, 95% CI 0.88 to 0.98 for each g/dL) for hypothyroidism. Hypothyroid women received appropriate treatment with no increase in adverse pregnancy outcomes. Almost a third of women from low to mid socio-economic population had hypothyroidism in early pregnancy, more so if anemic and overweight or obese. With early screening and adequate replacement, adverse pregnancy outcomes may be avoided. These findings highlight the need in early pregnancy for universal TSH screening and adequate treatment of hypothyroidism; as well as for attempts to reduce pre and peri-conception overweight, obesity and anemia. Clinical trial registration: Clinical trial registration of Women and Infants Integrated Interventions for Growth Study Clinical Trial Registry-India, #CTRI/2017/06/008908; Registered on: 23/06/2017, (http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=19339&EncHid=&userName=society%20for%20applied%20studies)

Photographs showing typical clinical signs in <i>Trypanosoma evansi</i> infection in rabbits.

<p><b>A</b>. Lacrimation <b>B</b>. Corneal opacity <b>C</b>. Swelling of external genitalia. a. <i>T</i>. <i>evansi</i> infected rabbit b. CpG C treated rabbit challenged with <i>T</i>. <i>evansi</i></p

Effects of CpG-ODN C treatment in <i>Trypanosoma evansi</i> infected and uninfected rabbits.

<p>The rabbits of group I were infected with 1x10⁵<i>T</i>. <i>evansi</i> parasites/animal. The group II rabbits were treated with CpG C formulated with 10% oil-in-water emulsion and then challenged with 1x10⁵<i>T</i>. <i>evansi</i> parasites/animal. The rabbits of group III, IV and V were inoculated with formulated CpG C, CpG C alone and PBS as negative control, respectively. Effects of CpG-ODN treatment and/or <i>T</i>. <i>evansi</i> infection. <b>A</b>. Rectal temperature (°F). <b>B</b>. The number of rabbits showing parasitemia in wet blood film during the course of the disease in both the infected groups were determined and expressed in percentage. Figure B depicts the percent of rabbits of groups I and II showing parasitemia on different days. <b>C</b>. Parasitemic scores on different days in groups I and II. D. Percent decrease in haemoglobin level in groups infected with <i>T</i>. <i>evansi</i>.</p

CpG-ODN Class C Mediated Immunostimulation in Rabbit Model of <i>Trypanosoma evansi</i> Infection

<div><p>CpG oligodeoxynucleotides (CpG-ODN) stimulate immune cells from a wide spectrum of mammalian species. Class C CpG-ODN is relatively stable and has the combined immune effects of both A and B classes of CpG-ODN. <i>Trypanosoma evansi</i> produces the state of immuno-suppression in the infected hosts. The current chemotherapeutic agents against this parasite are limited in number and usually associated with severe side effects. The present work aimed to determine the immunostimulatory effects of CpG-ODN class C in <i>T</i>. <i>evansi</i> infected rabbits. Rabbits inoculated with CpG C and challenged with <i>T</i>. <i>evansi</i> resulted in delayed onset of clinical signs with reduced severity in comparison to that of <i>T</i>. <i>evansi</i> infected rabbits. The treatment also enhanced humoral immune responses. Histopathological findings in liver and spleen revealed enhancement of mononuclear cell infiltration and secondary B cell follicles. These results demonstrate that CpG-ODN class C, has immunostimulatory properties in rabbit model of trypanosomosis. The use of booster doses or sustained delivery of CpG-ODN will further elucidate the prolonged CpG-ODN generated immune responses.</p></div

Histopathological changes in liver and spleen of <i>Trypanosoma evansi</i> infected and uninfected rabbits in response to CpG-ODN treatment.

<p><b>A</b>. Liver tissue of <i>T</i>. <i>evansi</i> infected (positive control) group I, extensive necrosis and loss of normal hepatic architecture is shown by double arrow (H&E 400X)<b>. B</b>. Liver tissue of group II (CpG C treated and challenged with <i>T</i>. <i>evansi</i>), decreased severity of necrosis (black colored arrow) (H&E 400X). <b>C</b>. Liver tissue of group III (treated with formulated CpG alone),mononuclear cell infiltration in portal triad (black colored arrow) (H&E 400X). <b>D</b>. Spleen <i>T</i>. <i>evansi</i> infected (positive control) group I, secondary follicles (white block arrows), haemorrhages and edematous fluid(H&E 100X)<b>. E</b>. Spleen of group II CpG C treated and challenged with <i>T</i>. <i>evansi</i>. Secondary follicles comparatively more in number (white block arrows) (H&E 100X)</p

Details of experimental groups and treatments.

<p>Details of experimental groups and treatments.</p

Telemedicine services for living kidney donation: A US survey of multidisciplinary providers.

Individuals considering living kidney donation face geographic, financial, and logistical challenges. Telemedicine can facilitate healthcare access/care coordination. Yet difficulties exist in telemedicine implementation and sustainability. We sought to examine centers practices and providers attitudes toward telemedicine to improve services for donors. We surveyed multidisciplinary providers from 194 active adult US living donor kidney transplant centers; 293 providers from 128 unique centers responded to the survey (center representation rate&nbsp;=&nbsp;66.0%), reflecting 83.9% of practice by donor volume and 91.5% of US states/territories. Most centers (70.3%) plan to continue using telemedicine beyond the pandemic for donor evaluation/follow-up. Video was mostly used by nephrologists, surgeons, and psychiatrists/psychologists. Telephone and video were mostly used by social workers, while video or telephone was equally used by coordinators. Half of respondent nephrologists and surgeons were willing to accept a remote completion of physical exam; 68.3% of respondent psychiatrists/psychologists and social workers were willing to accept a remote completion of mental status exam. Providers strongly agreed that telemedicine was convenient for donors and would improve the likelihood of completing donor evaluation. However, providers (65.5%) perceived out-of-state licensing as a key policy/regulatory barrier. These findings help inform practice and underscore the instigation of policies to remove barriers using telemedicine to increase living kidney donation

Descriptive epidemiology of equine influenza in India (2008-2009): temporal and spatial trends

Equine influenza is a contagious viral disease that affects all members of the family Equidae, i.e. horses, donkeys and mules. The authors describe the pattern of equine influenza outbreaks in a number of states of India from July 2008 to June 2009. The disease was first reported in June 2008 in Katra (Jammu and Kashmir) and spread to ten other states within a year. All outbreaks of equine influenza in the various states were confirmed by laboratory investigations (virus isolation and/or serological confirmation based on haemagglutination inhibition [HI] assays of paired samples) before declaring them as equine influenza virus-affected state(s). The virus (H3N8) was reported from various locations in the country including Katra, Mysore (Karnataka), Ahmedabad (Gujarat), Gopeshwar and Uttarkashi (Uttarakhand) and was isolated in 9- to 11-day-old embryonated chicken eggs. The virus was confirmed as H3N8 by HI assays with standard serum and amplification of full-length haemagglutinin and neuraminidase genes by reverse transcriptase-polymerase chain reaction. Serum samples (n = 4 740) of equines from 13 states in India screened by HI revealed 1 074 (22.65%) samples as being positive for antibodies to equine influenza virus (H3N8)