Recruiting a New Substrate for Triacylglycerol Synthesis in Plants: The Monoacylglycerol Acyltransferase Pathway

BACKGROUND: Monoacylglycerol acyltransferases (MGATs) are predominantly associated with lipid absorption and resynthesis in the animal intestine where they catalyse the first step in the monoacylglycerol (MAG) pathway by acylating MAG to form diacylglycerol (DAG). Typical plant triacylglycerol (TAG) biosynthesis routes such as the Kennedy pathway do not include an MGAT step. Rather, DAG and TAG are synthesised de novo from glycerol-3-phosphate (G-3-P) by a series of three subsequent acylation reactions although a complex interplay with membrane lipids exists. METHODOLOGY/PRINCIPAL FINDINGS: We demonstrate that heterologous expression of a mouse MGAT acyltransferase in Nicotiana benthamiana significantly increases TAG accumulation in vegetative tissues despite the low levels of endogenous MAG substrate available. In addition, DAG produced by this acyltransferase can serve as a substrate for both native and coexpressed diacylglycerol acyltransferases (DGAT). Finally, we show that the Arabidopsis thaliana GPAT4 acyltransferase can produce MAG in Saccharomyces cerevisiae using oleoyl-CoA as the acyl-donor. CONCLUSIONS/SIGNIFICANCE: This study demonstrates the concept of a new method of increasing oil content in vegetative tissues by using MAG as a substrate for TAG biosynthesis. Based on in vitro yeast assays and expression results in N. benthamiana, we propose that co-expression of a MAG synthesising enzyme such as A. thaliana GPAT4 and a MGAT or bifunctional M/DGAT can result in DAG and TAG synthesis from G-3-P via a route that is independent and complementary to the endogenous Kennedy pathway and other TAG synthesis routes

Young, obese, and underweight patients show up inadequately at scheduled appointments: Findings from a record-based study on diabetic, hypertensive diabetic, and hypertensive patients attending a primary care clinic of Puducherry

Background: One key barrier to proper management of common cardio-metabolic conditions such as diabetes and hypertension in primary care is inadequate adherence to treatment, which, in many cases, results from inadequate follow-up at scheduled appointments. In addition to provider and health system level factors, individual patient level factors are also associated with attendance at follow-up appointments. Objective: To document the association of diabetic, hypertensive diabetic, and hypertensive patient's demographic and clinical factors with showing up inadequately at scheduled appointments. Methods: A record-based retrospective follow-up study was conducted in an urban primary health center of Puducherry from January to March 2015. Registered diabetic, hypertensive diabetic, and hypertensive patients who made at least one visit between July and December 2014 were included. Data on demographic factors, clinical factors, and dates of visits to the clinic were collected from case records of patients and were entered in EpiData entry version 3.1. Analysis was performed using R statistical package. Results: Out of 366 patients, 79% were females and 70.2% were aged >50 years. It was found that 183 (50%) were diabetic, 266 (72.7%) were hypertensive, and 115 (31.4%) were hypertensive diabetic. Out of 366 patients, all the five follow-up visits were attended by 185 (50.6%) patients, and “adequate follow-up” was found in 123 (33.6%) patients. Young, underweight, and obese patients were more likely to have inadequate follow-up. Conclusion: Family physicians should give special attention to these groups in their routine practice along with providing targeted health education and implementing full proof mechanisms to track them

Prevalence and patterns of musculoskeletal pain among school students in Puducherry and its association with sociodemographic and contextual factors

Background: Limited data exist in India regarding burden of musculoskeletal pain (MSP) in school children. Objectives: The objective of this study is to determine the prevalence and patterns of MSP, to find out the association of sociodemographic and contextual factors with MSP, and to report the association of MSP-related characteristics and bag weight with school attendance. Material and Methods: It was a cross-sectional study conducted among 7th and 8th grade students of a private school in urban Puducherry. Students who could ambulate independently and stand on the weighing scale were included in this study. Previously diagnosed self-reported pathological causes of MSP were excluded from the study. A self-administered questionnaire was used for data collection. Height and weight were measured along with weight of student's backpack. Results: A total of 327 students were enrolled, majority (67%) being boys. Mean age of participants was 12.7 (standard deviation ±0.7) years. About 86% (282 out of 327) participants had experienced MSP in the preceding 2 weeks. Shoulders, neck, and knees were the parts reported to have maximum pain, i.e., in 43.6%, 39%, and 34.8% of the participants, respectively. A high proportion, i.e., 96% of the school bags weighed more than 10% of body weight. Significant association of MSP was found with participants' grade of study (P = 0.04), perception of bag weight (P = 0.01), comfort level of carrying bag (P < 0.01), and duration of carrying bag (P < 0.01). Factors such as pain affecting daily activities (P < 0.01) and number of health-care consultations (P < 0.01) were significantly associated with school attendance (P < 0.05). Conclusion: The prevalence of MSP in school children was high. Associated sociodemographic and contextual factors should be addressed urgently

Level of tobacco dependence among tobacco users in an urban slum of Puducherry: A pilot study

Context: Successful tobacco quit by the tobacco users can avoid millions of premature death. However, the physical dependence on tobacco use results in frequent relapse most commonly due to withdrawal symptoms. Aims: The aim of this study was to study the level of tobacco dependence among tobacco users in an urban slum of Puducherry. Materials and Methods: This facility-based descriptive pilot study was conducted among patients aged 15 years or above attending an urban health and training center in an urban slum of Puducherry. A total of 90 consecutive current tobacco users were included after obtaining verbal informed consent and interviewed using a pretested questionnaire. The information on tobacco dependence was collected using Fagerstrom Addiction Scale for smokers and smokeless tobacco users separately. Results: Of the 90 current tobacco users, 95% were daily tobacco users. Of the current tobacco users, 48.8%, 45.6%, and 5.6% were smokers, smokeless tobacco users, and dual users, respectively. Majority of the smokers (61%) and most of the smokeless tobacco users (41%) had medium dependence for tobacco use. However, physical dependence was much higher among smokeless tobacco users (41.3%) than smokers (20.4%). Conclusion: Proportionately high physical dependence on tobacco is a concern in the study population. Community-based interventions are required to curb the problem; however, study with representative sample should be carried out before that

Cost-effectiveness of implementing risk-based cardiovascular disease (CVD) management using updated WHO CVD risk prediction charts in India.

IntroductionThe World Health Organization (WHO) has released the updated cardiovascular disease (CVD) risk prediction charts in 2019 for each of the 21 Global Burden of Disease regions. The WHO advocates countries to implement population-based CVD risk assessment and management using these updated charts for preventing and controlling CVDs.ObjectiveTo assess the cost-effectiveness of implementing risk-based CVD management using updated WHO CVD risk prediction charts in India.MethodsWe developed a decision tree combined with Markov Model to simulate implementing two community-based CVD risk screening strategies (interventions) compared with the current no-screening scenario. In the first strategy, the whole population is initially screened using the WHO non-lab-based CVD risk assessment method, and those with ≥10% CVD risk are subjected to WHO lab-based CVD risk assessment (two-stage screening). In the second strategy, the whole population is subjected only to the lab-based CVD risk assessment (single-stage screening). A mathematical cohort of those aged ≥40 years with no history of CVD events was simulated over a lifetime horizon with three months of cycle length. Data for the model were derived from a primary study and secondary sources. Incremental cost-effectiveness ratios (ICERs) were determined for the screening strategies and sensitivity analyses.ResultsThe discounted Incremental cost-effectiveness ratio per QALY gained for both the two-stage (US$105; ₹ 8,656) and single-stage (US$ 1073; ₹ 88,588) screening strategies were cost-effective at an implementation effect of 40% when compared with no screening scenario. Implementing CVD screening strategies are estimated to cause substantial reduction in the number of CVD events in the population compared to the no screening scenario.ConclusionIn India, both CVD screening strategies would be cost-effective, and implementing the two-staged screening would be more cost-effective. Our findings support implementing population-based CVD screening in India. Future studies shall assess the budget impact of these strategies at different implementation coverage levels

Out-of-Pocket Expenditure in Hypertension Related Care in India: Estimates from National Sample Survey 2017-18

Background: Studies estimating treatment cost associated with hypertension care in the Indian context are limited and show considerable variations. Objective: To estimate the extent of out-of-pocket expenditure (OOPE) for hypertension care at the population level and its financial impact on households in India. Methods: We analysed the data of the 75th round of the of NSSO survey (India) on the social consumption of health care conducted in 2017-18.  OOPE was assessed after deducting the amount reimbursed by insurance from the total medical expenditure per episode of hypertension-related hospitalisation and outpatient visit during the survey period. OOPE for hypertension care was considered catastrophic if exceeding 10% of the household’s monthly per capita expenditure. The determinants of catastrophic health expenditures were examined using a multivariate logistic regression analysis.   Results:  A total of 1,351 and 6,379 individuals reported hypertension-related hospitalization and outpatient care, respectively, in the survey. The overall hypertension-related hospitalization rate was 54 per 100,000 persons.  OOPE associated with hypertension-related hospitalisation were on an average INR 3,491 (SD 6,176) and INR 24,565 (SD 37,343) in public hospitals and private hospitals, respectively. The OOPE for hypertension related to outpatient visit was INR 277 (SD 571) in public facilities but was in the range of INR 457 (SD 556) – INR 695 (SD 1,431) based on the type of private hospitals/clinics. OOPE on medicines constituted on an average 43% (95% CI: 32-52%) and 66% (95% CI: 54-64%) of public sector hospitalisation and outpatient care respectively. The risk of catastrophic expenditure due to hypertension care was 41% among the poorest households. Conclusion: Direct expenses on drugs and diagnostic tests contribute significantly to OOPE. The on-going public health efforts towards controlling hypertension need to ensure better access to essential hypertensive drugs and diagnostic tests in public facilities