Nutritional Status And Its Association With Diabetes Mellitus In School Children, India

Background: Poor health and nutrition may impair both the growth and intellectual development of school children. Incidence of malnutrition related childhood diabetes mellitus has increased and continues to be on the rise.Objectives: To assess the nutritional status by anthropometry and to screen for diabetes by capillary blood examination of school children. Design: Longitudinal study Setting: The study was carried out at Sri R.L.Jalappa Central School, Kolar from August 2008 to December 2009. Methods: All the school children were interviewed with pre-designed and pre-tested proforma. Height, Weight was measured by standard procedures. The nutritional status was analysed by Body Mass Index (BMI) for age. The school children were also screened for diabetes mellitus by Finger stick capillary random plasma glucose testing. The children were followed up for any major medical problems during the study period.Participants: All the students studying in the school during study period.Results: Mean height and weight of children were found comparable to the ICMR pooled data. However, compared to NCHS standards and affluent Indian children the mean height and weight were found to be much inferior at all ages. According to BMI for age as per NCHS most of the children were undernourished (79.2%) and 3 children (0.6%) were overweight. Out of 495 children screened for diabetes 14 children had hyperglycaemia (>160mg/dl). These 14 children were further tested by oral glucose tolerance test and found to have normal blood sugars levels. During the follow up two undernourished children developed diabetes mellitus. Conclusion: The magnitude of malnutrition among school going children was found to be 79%. During the follow up two undernourished children developed diabetes mellitus, hence under nutrition was associated with diabetes mellitus

EXPEDIENCY OF MARKERS FOR EARLY DETECTION OF ACUTE KIDNEY INJURY SEQUELAE TO TYPE 2 DIABETES MELLITUS

ABSTRACTObjective: Estimation of Cystatin C (Cys C), traditional markers, inflammatory, and endothelial cell activation markers can identify subjects who areat increased risk for future acute kidney injury (AKI) after diabetes.Methods: A total of 210 subjects, having 70 subjects in each group between the age group of 45-75 years were enrolled in our study.Results: Body mass index (BMI), obesity index, waist circumference, and waist–hip ratio higher in Group III and Group II compared to Group I with asignificant p<0.001. All the biochemical parameters were significantly higher in Group III compared to Group I and Group II with a narrow differencebetween Group III and Group II. Serum Cys C was significantly correlated with creatinine and NO. Whereas serum creatinine (SCr) shows strongpositive correlation with BMI, fasting blood sugar, HbA1c, NO, and high-sensitivity C-reactive protein. Estimated glomerular filtration rate (eGFR) andtriglycerides show inverse relation to creatinine with a significant p-value. The serum Cys C showed an area under the curve (AUC) of 0.950 with acutoff value of 1.06, SCr with an AUC of 0.617, and eGFR with AUC of 0.588.Conclusion: Elevated levels of biomarker Cys C, SCr, and albumin-creatinine ratio are predictors of AKI in the setting of diabetes. Baseline inflammatoryand endothelial activation markers may also be useful for predicting future risk of AKI in diabetes mellitus. Hopefully, the advent of new biomarkerswill help defining the kidney at risk rather than relying simply on creatinine. To date, none of the new AKI biomarkers have undergone a similarrigorous assessment, but the current progress will hopefully lead to success and ultimately to improvement in patient outcome.Keywords: Type 2 diabetes mellitus, Acute kidney injury, Biomarkers, Inflammation, Endothelium

Cirrhosis of liver: Interference of serpins in quantification of SERPINA4 – A preliminary study

Background: Cirrhosis of liver is a pathological condition, wherein functions of liver are impaired by chronic liver exploitations. Due to decrease in synthetic capacity, expressions of plasma proteins tend to decrease in blood stream. Serpins (Serine protease inhibitors) are class of plasma proteins expressed from liver with structural similarities and diverse functions. SERPINA4 (Kallistatin) is a multifunctional serpin clade A protein expressed from liver and concentration in serum is the reflection of extent of liver dysfunction. Objective: To identify interference of other serpins by immunological cross reactivity with SERPINA4 in cirrhotic liver and healthy subjects. Materials and methods: Blood samples were collected from 20 subjects (10 cirrhotic liver, 10 healthy) from R.L. Jalappa Hospital and Research Centre, Kolar, Karnataka, India. Separation of proteins was carried out by SDS-PAGE. Cross reactivity study was analyzed using western blot. Results: Proteins present in cirrhotic liver and healthy subject's serum were separated by SDS PAGE. There was no band detection on both (cirrhotic liver and healthy) PVDF (polyvinylidene diflouride) membranes. However, a significant band was observed with recombinant kallistatin. Conclusion: Structurally similar serpins with minor amino acid sequence similarities did not show any immunological cross reactivity with SERPINA4 due to non identical epitope in cirrhotic liver and healthy subjects. Present study revealed that there is no interference of serpins for immunological reactions in quantitative estimation of kallistatin which needs further validation

A proteomic approach of biomarker candidate discovery for alcoholic liver cirrhosis

Alcoholic liver disease (ALD) progresses from steatosis to alcoholic hepatitis to fibrosis and cirrhosis. Liver biopsy is considered as the gold standard method for diagnosis of liver cirrhosis and provides useful information about damaging process which is an invasive procedure with complications. Existing biomarkers in clinical practice have narrow applicability due to lack of specificity and lack of sensitivity. The objective of this article is to identify proteomic biomarker candidates for alcoholic liver cirrhosis by differential expression analysis between alcoholic liver cirrhotic and healthy subjects. Blood samples were collected from 20 subjects (10 alcoholic liver cirrhosis and 10 healthy) from R. L. Jalapa Hospital and Research Centre, Kolar, Karnataka, India. Differential protein analysis was carried out by two-dimensional electrophoresis after albumin depletion, followed by liquid chromatography–mass spectrometry. The image analysis found 46 spots in cirrhotic gel and 69 spots in healthy gel, of which 14 spots were identified with significant altered expression levels. Based on the protein score and clinical significance, among 14 spots, a total of 28 protein biomarker candidates were identified: 13 with increased expression and 15 with decreased expression were categorized in alcoholic liver cirrhosis compared to healthy subjects. Protein biomarker candidates identified by “-omics” approach based on differential expression between alcoholic liver cirrhotic subjects and healthy subjects may give better insights for diagnosis of ALD. Prioritization of candidates identified is a prerequisite for validation regimen. Biomarker candidates require verification that demonstrates the differential expression will remain detectable by assay to be used for validation