In-Vitro Evaluation of Anti-Bacterial and Anti-Fungal Activity of Vitex nigundo (Verbenaceae)

Vitex negundo belongs to the family Verbenaceae. It is a large aromatic shrub distributed throughout the greater part of India up to an altitude of 1500 m in the outer Himalayas. It is widely planted as a hedge plant along the roads and between the roads. Traditionally it is having the flok claims like useful in treatment of rheumatism, insecticidal, antimicrobial, anticancer, tranquillizer, tonic, febrifuge, expectorant and diuretic properties. In the present study an attempt had been made to evaluate comparative antibacterial and antifungal principles from Vitex nigundo with some therapeutically used antibiotics. Different extracts of Vitex negundo leaves were investigated for its anti microbial and antifungal activity on five bacterial species and three fungal species these are Staphylococcus aureus, Proteus vulgaris, Bacillus subtilis, E.coli, Pseudomonas aerugenosa and Aspergillus niger, Aspergillus flavon, Candida albicans respectively. Among all extracts waterethanol (50:50) extract showed maximum anti microbial and water extract showed maximum antifungal activity against all tested species

Vision-Related Quality of Life in Patients with Ocular Graft-versus-Host Disease

Objective To assess the vision-related quality of life in a cohort of patients with ocular graft-versus-host disease (GVHD). Design Prospective study. Participants Eighty-four patients diagnosed with chronic ocular GVHD Methods We assessed the vision-related quality of life with the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). The symptoms of ocular GVHD were assessed using the Ocular Surface Disease Index (OSDI) and Symptom Assessment in Dry Eye (SANDE) questionnaires. Main outcome measures We assessed vision-related quality of life with NEI-VFQ-25 and compared the scores obtained from patients with ocular GVHD to those from a healthy population. In the ocular GVHD population, we also evaluated the associations between the NEI-VFQ-25 and dry eye symptoms measured by OSDI and SANDE questionnaires, age, duration of disease, best-corrected visual acuity, corneal fluorescein staining, tear break-up time, and Schirmer test. Results The mean composite NEI-VFQ-25 score in patients with ocular GVHD was 76.5 ± 17. Compared to healthy subjects, ocular GVHD patients reported reduced scores on all NEI-VFQ-25 subscales (each P < 0.001) with exception of color vision (P = 0.11). The NEI-VFQ-25 composite scores significantly correlated with OSDI (R = −0.81, P < 0.001), SANDE (R = −0.56, P < 0.001), corneal fluorescein staining (R = −0.36, P = 0.001) and best-corrected visual acuity (R = −0.30, P = 0.004). Conclusion Patients with ocular GVHD experience measurable impairment of vision-related quality of life. This study highlights the impact of ocular GVHD on the vision-related quality of life, and hence the importance of comprehensive diagnosis and treatment of this condition

Cross-sectional imaging of sinus of Valsalva aneurysms: lessons learned

Sinus of Valsalva aneurysm, dilatation of one or more of the aortic sinuses, is a rare but important aortic root defect, which can be a cause of some serious cardiac sequels. The purpose of this article is to review the etiopathogenesis, relevant anatomy, clinical manifestations, potential complications, multimodality imaging features, and management of this rare but important entity of sinus of Valsalva

The COVID-19 Pandemic Affects Seasonality, With Increasing Cases of New-Onset Type 1 Diabetes in Children, From the Worldwide SWEET Registry

Objective: To analyze whether the coronavirus disease 2019 (COVID-19) pandemic increased the number of cases or impacted seasonality of new-onset type 1 diabetes (T1D) in large pediatric diabetes centers globally. Research design and methods: We analyzed data on 17,280 cases of T1D diagnosed during 2018-2021 from 92 worldwide centers participating in the SWEET registry using hierarchic linear regression models. Results: The average number of new-onset T1D cases per center adjusted for the total number of patients treated at the center per year and stratified by age-groups increased from 11.2 (95% CI 10.1-12.2) in 2018 to 21.7 (20.6-22.8) in 2021 for the youngest age-group, <6 years; from 13.1 (12.2-14.0) in 2018 to 26.7 (25.7-27.7) in 2021 for children ages 6 to <12 years; and from 12.2 (11.5-12.9) to 24.7 (24.0-25.5) for adolescents ages 12-18 years (all P < 0.001). These increases remained within the expected increase with the 95% CI of the regression line. However, in Europe and North America following the lockdown early in 2020, the typical seasonality of more cases during winter season was delayed, with a peak during the summer and autumn months. While the seasonal pattern in Europe returned to prepandemic times in 2021, this was not the case in North America. Compared with 2018-2019 (HbA1c 7.7%), higher average HbA1c levels (2020, 8.1%; 2021, 8.6%; P < 0.001) were present within the first year of T1D during the pandemic. Conclusions: The slope of the rise in pediatric new-onset T1D in SWEET centers remained unchanged during the COVID-19 pandemic, but a change in the seasonality at onset became apparent.info:eu-repo/semantics/publishedVersio

Clinical targets for continuous glucose monitoring data interpretation : recommendations from the international consensus on time in range

Improvements in sensor accuracy, greater convenience and ease of use, and expanding reimbursement have led to growing adoption of continuous glucose monitoring (CGM). However, successful utilization of CGM technology in routine clinical practice remains relatively low. This may be due in part to the lack of clear and agreed-upon glycemic targets that both diabetes teams and people with diabetes can work toward. Although unified recommendations for use of key CGM metrics have been established in three separate peer-reviewed articles, formal adoption by diabetes professional organizations and guidance in the practical application of these metrics in clinical practice have been lacking. In February 2019, the Advanced Technologies & Treatments for Diabetes (ATTD) Congress convened an international panel of physicians, researchers, and individuals with diabetes who are expert in CGM technologies to address this issue. This article summarizes the ATTD consensus recommendations for relevant aspects of CGM data utilization and reporting among the various diabetes populations

Saroglitazar for the treatment of hypertriglyceridemia in patients with type 2 diabetes: current evidence

Aravind Sosale,1 Banshi Saboo,2 Bhavana Sosale11Diacon Hospital, Bangalore, 2Dia Care (Diabetes Care and Hormone Clinic), Ahmedabad, IndiaAbstract: Diabetes mellitus (DM) is one of the most dreaded metabolic disorders in the world today. It is the leading cause of morbidity and mortality, and plays a cardinal role in quality of life and health economics. DM is associated with a high prevalence of microvascular and macrovascular complications. DM is a very important cardiovascular (CV) risk factor. Cardiovascular disease (CVD) has been implicated as the prime cause of mortality and morbidity in patients with DM. Hence, treatment of DM goes beyond glycemic control, and demands a multidisciplinary approach that comprehensively targets risk factors inherent in CV events. Lipid abnormalities are undoubtedly common in patients with DM, and they contribute to an increased risk of CVD. A high-risk lipid profile, termed atherogenic dyslipidemia of diabetes (ADD), is known to occur in patients with DM. The use of lipid-lowering agents, a quintessential part of the multifactorial risk factor approach, is a crucial intervention to minimize diabetes-related complications. In this article, we discuss the role of peroxisome proliferator activator receptor (PPAR) alpha/gamma (&alpha;/&gamma;) agonist, saroglitazar, in the management of ADD. While statins are irrefutably the first line of drugs for dyslipidemia management in patients with residual CV risk while on a statin, PPAR&nbsp;&alpha;/&gamma; agonists have been found to be of substantial benefit. Data from the PRESS I&ndash;VI clinical trials testify to the fact that saroglitazar and fibrates have similar efficacy in reducing triglycerides and improving high-density lipoprotein. The ancillary benefit of improved glycemic control, without the weight gain of PPAR&nbsp;&gamma; agonists, is an added advantage. Reduction in ADD, improved glycemic control, efficacy at par with fibrates, and an acceptable safety profile form the grounds on which this group of PPAR &alpha;/&gamma; agonists, with their novel mechanism, holds a promising future in the management of diabetic dyslipidemia.Keywords: diabetes mellitus, dyslipidemia, cardiovascular disease, atherosclerosis, PPAR&nbsp;&alpha;/&gamma; agonist

Current Practices and Gaps in Management of Dyslipidemia in Type 2 Diabetes Mellitus (T2DM) in Accordance with American Diabetes Association (ADA) Guidelines: A Subset Analysis from a Real-World, Cross-Sectional Observational Study (LEADD Study)

Ashok Kumar Das,1 Banshi Saboo,2 Ambika G Unnikrishnan3 1Department of Endocrinology, Pondicherry Institute of Medical Sciences, Pondicherry, India; 2Department of Endocrinology, Dia Care, Ahmedabad, Gujarat, India; 3Department of Endocrinology, Chellaram Diabetes Institute, Pune, Maharashtra, IndiaCorrespondence: Ambika G UnnikrishnanDepartment of Endocrinology, Chellaram Diabetes Institute, Pune, 411021, Maharashtra, IndiaTel +91 8605011934Email [email protected]: Diabetic dyslipidemia is a risk factor for coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM). American Diabetes Association (ADA) provides internationally accepted guidelines to manage dyslipidemia in T2DM.Objective: To assess if ADA guidelines are followed for managing dyslipidemia in patients with T2DM in India.Methods: This was a subset analysis of a prospective, cross sectional, observational study (LEADD Study) conducted at 199 sites across India to evaluate dyslipidemia management practices in T2DM patients (N=4002), in a real-world setting. The data was stratified based on age and atherosclerotic cardiovascular disease (ASCVD) and ASCVD risk factors to record the percentages of T2DM patients achieving LDL-C target and treated optimally with the Guideline directed intensity of statin. Analysis was conducted using descriptive statistics.Results: As per ADA 2018 targets: LDL-C levels (&lt; 100mg/dL) were seen in 30.6% of participants. High intensity statins were prescribed to 13.4% of the participants with LDL levels &ge; 100 mg/dL. ASCVD risk assessment details were available for 89.2% of participants. Data was not available for smoking and albuminuria. In participants &lt; 40 years of age, 80% and 64.2% with ASCVD and ASCVD risk factors, respectively, did not achieve target LDL-C levels. In this age group, 15.6% and 83.3% of participants with ASCVD risk factors and ASCVD group, respectively, were not receiving statins in the recommended dose. In participants &ge; 40 years of age, 88.0% and 91.5% with ASCVD and ASCVD risk factors, respectively, did not have LDL-C levels as per ADA 2018 targets. In this age group, 87.2% and 77.9% of participants with ASCVD risk factors and ASCVD, respectively, were not receiving statins in the recommended dose.Conclusion: The sub-analysis of LEADD study shows sub-optimal adherence to ADA 2018 guidelines for management of diabetic dyslipidemia.Keywords: diabetic dyslipidemia, hyperlipidemia in diabetes, abnormal lipid profile in diabetes, dyslipidemia in diabetes, hypercholesteremia in diabete

Environmental modulators of type 1 diabetes mellitus

In genetically susceptible subjects, type 1 diabetes (T1D) appears to be a chronic immune- mediated disease with a subclinical prodromal period characterized by selective loss of insulin-releasing pancreatic beta cells. However, only a relatively small proportion of genetically susceptible subjects progress to clinical disease, which indicates that environmental factors are needed to trigger and drive the disease process in genetically predisposed subjects. In this article we provide a selective review on environmental factors involved in the pathogenesis of T1D. Accumulating evidence suggests that the proportion of subjects with high-risk human leukocyte antigen (HLA) genotypes has decreased over the last decades among patients with newly diagnosed T1D, whereas the proportion of those with low-risk or even protective HLA genotypes has increased. These findings indicate that increased environmental pressure is responsible for progression to clinical diabetes in patients with less genetic predisposition. The birth cohort studies indicate that the first signs of beta cell autoimmunity may be induced during infancy before age 3, which implies that dietary factors for beta cell autoimmunity and T1D may be active in that time period, during which early nutrition provides essential exogenous exposure. Progression to clinical T1D typically needs the combination of genetic disease susceptibility, a diabetogenic trigger, and a high exposure to a driving antigen. The triggers appear to be enteroviruses and rotaviruses as well as components of the infant diet including cows milk and gluten, while the Mediterranean diet appears protective. The only definite enterovirus responsible for T1D is congenital rubella, which may be complicated by late development of T1D. There is a temporal association between enteroviral infection and future development of antibodies resulting in T1D. Clinical studies indicate that islet cell antibodies develop 3 months after birth and seroconversion of enterovirus RNA in serum to antibodies occurs more significantly in subjects with T1D compared to controls. Omega-3 fatty acids, cocoa flavonoids, sour milk and cottage cheese have been found to be protective against autoimmunity in T1D. These foods likely promote the gut microbiome, which is deteriorated by the Western diet resulting in an increased production of lipid mediators; protectin, and resolving lipoxins, which are anti-inflammatory