Diabetes Awareness & Its Challenges- A Hammering Issue

Diabetes is one of the most common non communicable diseases affecting many people of our country. India being a diabetic capital of world is facing a major epidemic of same. After Covid -19 pandemic its become more evident that person who were having deranged blood sugar level were more at risk of getting infections. So its very important to create awareness of same. According to National Family Health Survey -5 (NFHS-5) men & women with high or very high blood sugar level (>140mg/dl) who are taking medicines were 15.6 % & 13.5% respectively. Females 15 years & above whose blood sugar levels were high or very high were 6.1 & 6.3 % and men with same were 7.3 & 7.2 %(1). These findings were added first time in NFHS survey as more and more population are getting this silent but killer disease. The main risk factors for this disease are very well known like modifiable risk factors are obesity specially central obesity, gestational diabetes, sedentary life style, a highly saturated fat diet, reduced intake of dietary fibers, malnutrition related diabetes, excessive alcohol consumption etc (2)

Effect of vegetable seed oils on methane emission and fermentation of feed in vitro

A study was conducted to assess the effect of carrot seed oil, canola seed oil and rape seed oil on rumen fermentation and methanogenesis in-vitro. The oils were supplemented to the complete feed (oat fodder and concentrate mixture in 60: 40 ratio) @ 1, 2 and 3% on DM basis, incubated for 24 h in 100 ml glass syringes. The digestibility of NDF varied significantly with highest in rapeseed and lowest in carrot seed, while OM digestibility and ME availability did not show any significant differences amongst the supplemented oils. The in-vitro methane production from complete feed supplemented with rape seed oil was observed to be the lowest. The TVFAs, acetate and propionate levels were highest in canola oil while A: P ratio was lowest. TVFA and acetate levels were highest at 1% level of supplementation, whereas propionate level was highest in control followed by at 1% supplementation. The methane production was significantly higher in oil supplemented groups as compared to control group, but amongst the oil supplemented groups it was significantly lowest when oil was supplemented at 3% level. Amongst the various oils evaluated for in vitro methane mitigation, the study conclusively revealed that the supplementation of diet with rape seed oil @ 2–3% on dry matter basis had an edge over other oils and levels

Validation of a noninvasive aMMP-8 point-of-care diagnostic methodology in COVID-19 patients with periodontal disease

Objectives: The aim of this study was to validate an active matrix metalloproteinase (MMP-8) point-of-care diagnostic tool in COVID-19 patients with periodontal disease. Subjects, Materials, and Methods: Seventy-two COVID-19-positive and 30 COVID-19-negative subjects were enrolled in the study. Demographic data were recorded, periodontal examination carried out, and chairside tests run for evaluating the expression of active MMP-8 (aMMP-8) in the site with maximum periodontal breakdown via gingival crevicular fluid sampling as well as via a mouth rinse-based kit for general disease activity. In COVID-19-positive patients, the kits were run again once the patients turned COVID-19 negative. Results: The overall (n = 102) sensitivity/specificity of the mouthrinse-based kits to detect periodontal disease was 79.41%136.76% and that of site-specific kits was 64.71%/55.88% while adjusting for age, gender, and smoking status increased the sensitivity and specificity (82.35%/76.47% and 73.53%/88.24, respectively). Receiver operating characteristic (ROC) analysis for the adjusted model revealed very good area under the ROC curve 0.746-0.869 (p < .001) and 0.740-0.872 (p < .001) (the aMMP-8 mouth rinse and site-specific kits, respectively). No statistically significant difference was observed in the distribution of results of aMMP-8 mouth rinse test (p = .302) and aMMP-8 site-specific test (p = .189) once the subjects recovered from COVID-19. Conclusions: The findings of the present study support the aMMP-8 point-of-care testing (PoCT) kits as screening tools for periodontitis in COVID-19 patients. The overall screening accuracy can be further increased by utilizing adjunctively risk factors of periodontitis. The reported noninvasive, user-friendly, and objective PoCT diagnostic methodology may provide a way of stratifying risk groups, deciding upon referrals, and in the institution of diligent oral hygiene regimens.Peer reviewe

Acute severe paediatric asthma: Study protocol for the development of a core outcome set, a Pediatric Emergency Research Networks (PERN) study

BackgroundAcute severe childhood asthma is an infrequent, but potentially life-threatening emergency condition. There is a wide range of different approaches to this condition, with very little supporting evidence, leading to significant variation in practice. To improve knowledge in this area, there must first be consensus on how to conduct clinical trials, so that valid comparisons can be made between future studies. We have formed an international working group comprising paediatricians and emergency physicians from North America, Europe, Asia, the Middle East, Africa, South America, Central America, Australasia and the United Kingdom.Methods/designA 5-stage approach will be used: (1) a comprehensive list of outcomes relevant to stakeholders will be compiled through systematic reviews and qualitative interviews with patients, families, and clinicians; (2) Delphi methodology will be applied to reduce the comprehensive list to a core outcome set; (3) we will review current clinical practice guidelines, existing clinical trials, and literature on bedside assessment of asthma severity. We will then identify practice differences in tne clinical assessment of asthma severity, and determine whether further prospective work is needed to achieve agreement on inclusion criteria for clinical trials in acute paediatric asthma in the emergency department (ED) setting; (4) a retrospective chart review in Australia and New Zealand will identify the incidence of serious clinical complications such as intubation, ICU admission, and death in children hospitalized with acute severe asthma. Understanding the incidence of such outcomes will allow us to understand how common (and therefore how feasible) particular outcomes are in asthma in the ED setting; and finally (5) a meeting of the Pediatric Emergency Research Networks (PERN) asthma working group will be held, with invitation of other clinicians interested in acute asthma research, and patients/families. The group will be asked to achieve consensus on a core set of outcomes and to make recommendations for the conduct of clinical trials in acute severe asthma. If this is not possible, the group will agree on a series of prioritized steps to achieve this aim.DiscussionThe development of an international consensus on core outcomes is an important first step towards the development of consensus guidelines and standardised protocols for randomized controlled trials (RCTs) in this population. This will enable us to better interpret and compare future studies, reduce risks of study heterogeneity and outcome reporting bias, and improve the evidence base for the management of this important condition

Analysis of guideline recommendations for treatment of asthma exacerbations in children: a Pediatric Emergency Research Networks (PERN) study

Rationale: There is significant practice variation in acute paediatric asthma, particularly severe exacerbations. It is unknown whether this is due to differences in clinical guidelines. Objectives: To describe and compare the content and quality of clinical guidelines for the management of acute exacerbations of asthma in children between geographic regions. Methods: Observational study of guidelines for the management of acute paediatric asthma from institutions across a global collaboration of six regional paediatric emergency research networks. Measurements and main results: 158 guidelines were identified. Half provided recommendations for at least two age groups, and most guidelines provided treatment recommendations according to asthma severity. There were consistent recommendations for the use of inhaled short-acting beta-agonists and systemic corticosteroids. Inhaled anticholinergic therapy was recommended in most guidelines for severe and critical asthma, but there were inconsistent recommendations for its use in mild and moderate exacerbations. Other inhaled therapies such as helium-oxygen mixture (Heliox) and nebulised magnesium were inconsistently recommended for severe and critical illness. Parenteral bronchodilator therapy and epinephrine were mostly reserved for severe and critical asthma, with intravenous magnesium most recommended. There were regional differences in the use of other parenteral bronchodilators, particularly aminophylline. Guideline quality assessment identified high ratings for clarity of presentation, scope and purpose, but low ratings for stakeholder involvement, rigour of development, applicability and editorial independence. Conclusions: Current guidelines for the management of acute paediatric asthma exacerbations have substantial deficits in important quality domains and provide limited and inconsistent guidance for severe exacerbations

Association of Serum Adiponectin Level with Dyslipidaemia in North Indian Male Population: A Case-control Study

Introduction: Adiponectin is the most abundant adipocytokines secreted from adipose tissues and circulates in considerably high concentration in human plasma. Circulating adiponectin levels are decreased in obese subjects and this decrease has been thought to play a crucial role in the early development of atherosclerosis and cardiovascular diseases. Changes in adiponectin concentration has been reported in dyslipidaemic subjects, but the evidence is controversial and no study has been conducted in north Indian population. Moreover, low molecular adiponectin seems to be linked with a worse lipid profile leading to dyslipidaemic through an association with triglyceride but the exact role of adiponectin in modulating lipid fraction is not well established. Aim: To correlate the level of serum adiponectin with lipid fractions in dyslipidaemic male subjects and also to compare them with apparently healthy individuals. Materials and Methods: This case-control study was conducted from April 2015 to November 2016 in the Biochemistry Department of Rajshree Medical Research Institute, Bareilly, Uttar Pradesh, India. A total of 70 non diabetic dyslipidaemic male subjects between the age group 35 years to 55 years were selected and all the biochemical parameters (adiponectin, fasting plasma glucose, lipid profile) were evaluated and compared with 70 apparently healthy controls. Statistical analysis was performed by licensed version of Statistical Package for Social Sciences (SPSS) 16.0 software. All the data were expressed in “mean±SD”. Student ‘t’ test was also applied to see statistical significance in adiponectin levels between dyslipidaemic subjects and healthy controls. Results: The study shows mean±SD of age in dyslipidaemic group was 43.61±4.85 years and for control group was 43.53±5.53 years. The mean±SD of BMI in dyslipidaemic group 25.72±2.43 was significantly higher than control group 23.42±1.56 with p-value <0.0001. The serum adiponectin concentration was significantly reduced in dyslipidaemic subjects 5.11±2.04 μg/mL as compared to healthy control 6.79±1.37 μg/mL with p-value <0.0001. Serum total cholesterol, triglyceride and Low Density Lipoprotein (LDL)- cholesterol were found to be negatively correlated with serum adiponectin (r= -0.89, -0.76 and -0.74) and positively correlated with High Density Lipoprotein (HDL)-cholesterol (r=0.70). Conclusion: The present study revealed that hypoadiponectinemia is associated with dyslipidaemic in men. The main observation of our present study, however, is that in dyslipidaemic subjects, lower levels of adiponectin were associated with high total cholesterol, triglyceride, LDL-cholesterol and reduced HDL cholesterol, though more extensive, multicentric, prospective research with increase sample size could obtain wider insights

Acute severe paediatric asthma: study protocol for the development of a core outcome set, a Pediatric Emergency Research Networks (PERN) study

Abstract Background Acute severe childhood asthma is an infrequent, but potentially life-threatening emergency condition. There is a wide range of different approaches to this condition, with very little supporting evidence, leading to significant variation in practice. To improve knowledge in this area, there must first be consensus on how to conduct clinical trials, so that valid comparisons can be made between future studies. We have formed an international working group comprising paediatricians and emergency physicians from North America, Europe, Asia, the Middle East, Africa, South America, Central America, Australasia and the United Kingdom. Methods/design A 5-stage approach will be used: (1) a comprehensive list of outcomes relevant to stakeholders will be compiled through systematic reviews and qualitative interviews with patients, families, and clinicians; (2) Delphi methodology will be applied to reduce the comprehensive list to a core outcome set; (3) we will review current clinical practice guidelines, existing clinical trials, and literature on bedside assessment of asthma severity. We will then identify practice differences in tne clinical assessment of asthma severity, and determine whether further prospective work is needed to achieve agreement on inclusion criteria for clinical trials in acute paediatric asthma in the emergency department (ED) setting; (4) a retrospective chart review in Australia and New Zealand will identify the incidence of serious clinical complications such as intubation, ICU admission, and death in children hospitalized with acute severe asthma. Understanding the incidence of such outcomes will allow us to understand how common (and therefore how feasible) particular outcomes are in asthma in the ED setting; and finally (5) a meeting of the Pediatric Emergency Research Networks (PERN) asthma working group will be held, with invitation of other clinicians interested in acute asthma research, and patients/families. The group will be asked to achieve consensus on a core set of outcomes and to make recommendations for the conduct of clinical trials in acute severe asthma. If this is not possible, the group will agree on a series of prioritized steps to achieve this aim. Discussion The development of an international consensus on core outcomes is an important first step towards the development of consensus guidelines and standardised protocols for randomized controlled trials (RCTs) in this population. This will enable us to better interpret and compare future studies, reduce risks of study heterogeneity and outcome reporting bias, and improve the evidence base for the management of this important condition.http://deepblue.lib.umich.edu/bitstream/2027.42/173816/1/13063_2019_Article_3785.pd

Acute severe paediatric asthma: study protocol for the development of a core outcome set, a Pediatric Emergency Reserarch Networks (PERN) study.

BACKGROUND:Acute severe childhood asthma is an infrequent, but potentially life-threatening emergency condition. There is a wide range of different approaches to this condition, with very little supporting evidence, leading to significant variation in practice. To improve knowledge in this area, there must first be consensus on how to conduct clinical trials, so that valid comparisons can be made between future studies. We have formed an international working group comprising paediatricians and emergency physicians from North America, Europe, Asia, the Middle East, Africa, South America, Central America, Australasia and the United Kingdom. METHODS/DESIGN:A 5-stage approach will be used: (1) a comprehensive list of outcomes relevant to stakeholders will be compiled through systematic reviews and qualitative interviews with patients, families, and clinicians; (2) Delphi methodology will be applied to reduce the comprehensive list to a core outcome set; (3) we will review current clinical practice guidelines, existing clinical trials, and literature on bedside assessment of asthma severity. We will then identify practice differences in tne clinical assessment of asthma severity, and determine whether further prospective work is needed to achieve agreement on inclusion criteria for clinical trials in acute paediatric asthma in the emergency department (ED) setting; (4) a retrospective chart review in Australia and New Zealand will identify the incidence of serious clinical complications such as intubation, ICU admission, and death in children hospitalized with acute severe asthma. Understanding the incidence of such outcomes will allow us to understand how common (and therefore how feasible) particular outcomes are in asthma in the ED setting; and finally (5) a meeting of the Pediatric Emergency Research Networks (PERN) asthma working group will be held, with invitation of other clinicians interested in acute asthma research, and patients/families. The group will be asked to achieve consensus on a core set of outcomes and to make recommendations for the conduct of clinical trials in acute severe asthma. If this is not possible, the group will agree on a series of prioritized steps to achieve this aim. DISCUSSION:The development of an international consensus on core outcomes is an important first step towards the development of consensus guidelines and standardised protocols for randomized controlled trials (RCTs) in this population. This will enable us to better interpret and compare future studies, reduce risks of study heterogeneity and outcome reporting bias, and improve the evidence base for the management of this important condition