A comparison of oral versus topical combination of glucosamine sulphate and diacerein in patients of grade 2 osteoarthritis

Background: The study aimed to compare oral versus topical combination of glucosamine sulphate and diacerein in patients of grade 2 Osteoarthritis.Methods: This was a prospective study of 70 patients with grade 2 osteoarthritis knee, randomly divided into 2 groups of 35 each. The first group was given oral 1500mg of glucosamine and 100mg of diacerein per day and second group was given topical preparation of 10% w/w glucosamine sulphate and 1% w/w diacerein to be applied twice. Both the groups were followed up at 1, 3, 6 and 12 weeks. At each follow up, Visual Analog Scale (VAS) and Lequesne et al scores were used as efficacy parameters. C-Reactive Protein (CRP) level was measured in the beginning and at the end of 12 weeks.Results: Both the groups showed improvement in pain and joint function as depicted by VAS score and Lequesne index however the difference was not statistically significant. The decrease in CRP value was significant in oral group (p value<0.001) but not in topical group (p value of 0.047). Paracetamol demand was slightly higher in topical group however the difference was not significant.Conclusions: Glucosamine sulphate and diacerein combination are effective in improving pain, stiffness and function in patients of grade 2 osteoarthritis knee. However, the efficacy of glucosamine sulphate and diacerein combination- oral as well as topical, in improving pain and stiffness is similar- there is no superiority of one over the other

Retention of mini screws in orthodontics – a comparative in vitro study on the variables

ABSTRACT Objectives: To correlate between the different lengths, angles of insertion and the mini-implant material and find out the most retentive combination. Materials and methods: 48 mini-implants (24 Titanium and 24 stainless steel) of lengths 6mm, 8mm and 1.5 mm diameter were inserted into humerus bone of goat at two different angulations, 600 and 900. To insert the mini-implant in the respective angulations, custom made template was made and the angles were confirmed with digital radiographs. Force was applied on to the mini-implants with a universal testing machine and the compressive load to failure was measured. Results: Results revealed that stability of the implant was positively correlating with the length of implant. A perpendicular angulation produced more stability. Moreover, titanium mini-implants had more resistance to compressive load than stainless steel mini-implants. Conclusion: Length of mini-implant, its angulation in the bone and the material of mini-implant were factors affecting its stability. In this study, titanium mini-implant of 8mm length angulated at 900 were stable than their counterpart

Gene prioritization in Type 2 Diabetes using domain interactions and network analysis

<p>Abstract</p> <p>Background</p> <p>Identification of disease genes for Type 2 Diabetes (T2D) by traditional methods has yielded limited success. Based on our previous observation that T2D may result from disturbed protein-protein interactions affected through disrupting modular domain interactions, here we have designed an approach to rank the candidates in the T2D linked genomic regions as plausible disease genes.</p> <p>Results</p> <p>Our approach integrates Weight value (Wv) method followed by prioritization using clustering coefficients derived from domain interaction network. Wv for each candidate is calculated based on the assumption that disease genes might be functionally related, mainly facilitated by interactions among domains of the interacting proteins. The benchmarking using a test dataset comprising of both known T2D genes and non-T2D genes revealed that Wv method had a sensitivity and specificity of 0.74 and 0.96 respectively with 9 fold enrichment. The candidate genes having a Wv > 0.5 were called High Weight Elements (HWEs). Further, we ranked HWEs by using the network property-the clustering coefficient (C_i). Each HWE with a C_i< 0.015 was prioritized as plausible disease candidates (HWEc) as previous studies indicate that disease genes tend to avoid dense clustering (with an average C_iof 0.015). This method further prioritized the identified disease genes with a sensitivity of 0.32 and a specificity of 0.98 and enriched the candidate list by 6.8 fold. Thus, from the dataset of 4052 positional candidates the method ranked 435 to be most likely disease candidates. The gene ontology sharing for the candidates showed higher representation of metabolic and signaling processes. The approach also captured genes with unknown functions which were characterized by network motif analysis.</p> <p>Conclusions</p> <p>Prioritization of positional candidates is essential for cost-effective and an expedited discovery of disease genes. Here, we demonstrate a novel approach for disease candidate prioritization from numerous loci linked to T2D.</p

Prevalence and functional significance of 25-hydroxyvitamin D deficiency and vitamin D receptor gene polymorphisms in Asian Indians

Background: Recent studies show a wide prevalence of hypovitaminosis D in Asian Indians. Objective: The objective was to assess the functional significance of 25-hydroxyvitamin D [25(OH)D] deficiency, vitamin D receptor (VDR) gene, and parathyroid hormone (PTH) gene polymorphisms in relation to bone mineral density (BMD) in urban Asian Indians. Design: Serum total calcium, inorganic phosphorus, alkaline phosphatase, 25(OH)D, intact PTH, and BMD at lumbar spine, proximal femur, and forearm were measured in 105 adult subjects. The genotyping related to VDR (BsmI, FokI, and TaqI) and PTH (BstBI and DraII) gene single-nucleotide polymorphisms was carried out by polymerase chain reaction-restriction fragment length polymorphism analysis. Results: The mean serum 25(OH)D concentration in the whole cohort was 9.8 &#177; 6.0 ng/mL, which was inversely related with serum intact PTH values (P = 0.042). Ninety-nine (94.3%) of the 105 subjects had vitamin D deficiency with 25(OH)D concentrations &lt; 20 ng/mL. The age- and body mass index (BMI)-adjusted BMD value at the hip was higher in subjects with serum 25(OH)D values &gt; 9.0 ng/mL than in those with values &#8804;9.0 ng/mL (0.893 &#177; 0.114 compared with 0.839 &#177; 0.112 g/cm2, respectively; P = 0.001). The mean forearm and spine BMD values in subjects with TT (VDR, TaqI) or bb (PTH, BstBI) genotypes were significantly higher than the values in subjects with Tt genotype and BB or Bb genotype, respectively. Conclusion: Functionally significant 25(OH)D deficiency affecting BMD at the hip region is prevalent in urban Asian Indians. However, variation in BMD at the spine and forearm is related to VDR and PTH gene polymorphisms rather than to vitamin D status, at least in this hypovitaminotic D population

Strategies for Stakeholder Engagement and Uptake of New Intervention: Experience From State-Wide Implementation of mHealth Technology for NCD Care in Tripura, India.

BACKGROUND: Appropriate strategies and key stakeholder engagement are the keys to successful implementation of new health care interventions. OBJECTIVES: The study sought to articulate the key strategies used for scaling up a research-based intervention, mPower Heart electronic Clinical Decision Support System (e-CDSS), for state-wide implementation at health facilities in Tripura. METHODS: Multiple strategies were used for statewide implementation of mPower Heart e-CDSS at noncommunicable diseases clinics across the government health facilities in Tripura: formation of a technical coordination-cum-support unit, change management, enabling environment, adapting the intervention with user focus, and strengthening the Health Information System. RESULTS: The effective delivery of a new health system intervention requires engagement at multiple levels including political leadership, health administrators, and health professionals, which can be achieved by forming a technical coordination-cum-support unit. It is important to specify the role and responsibilities of existing manpower and provide a structured training program. Enabling environment at health facilities (providing essential equipment, space and time, etc.) is also crucial. Successful implementation also requires that patients, health care providers, the health system, and leadership recognize the immediate and long-term benefits of the new intervention and have a buy-in in the intervention. With constant encouragement and nudge from administrative authorities and by using multiple strategies, 40 government health facilities adopted the mPower Heart e-CDSS. From its launch in May 2017 until November 20, 2018, a total of 100,810 eligible individuals were screened and enrolled, with 35,884 treated for hypertension, 9,698 for diabetes, and 5,527 for both hypertension and diabetes. CONCLUSIONS: Multiple strategies, based on implementation principles, are required for successful scaling up of research-based interventions

Circulating Antimicrobial Peptide LL-37 Status in Type 1 Diabetes Mellitus and its Relation with Glycemic Control

Antimicrobial-peptides are important molecules of constitutive innate immunity. Though patients with diabetes mellitus are generally prone to infections, there is limited information on their antimicrobialpeptide status. We assessed the circulating LL-37 antimicrobial peptide (also referred as cathelicidin) levels in patients with type 1 diabetes mellitus and its relation with their glycemic status. The LL-37 mRNA expression was assessed in the peripheral blood mononuclear cells (PBMC) by quantitative RTPCR using ß-actin and cytochrome-C1 as the reference genes in 154 subjects (Type 1 diabetes, n=111 and healthy subjects, n=43).  Serum LL-37 was quantified using sandwich-ELISA. Average HbA1c over last 2 years and current HbA1c were used to determine long-term and short-term glycemic status. LL-37 mRNA expression and serum LL-37 levels were correlated with the glycemic status. The LL-37 mRNA copies were comparable between type 1 diabetes and healthy subjects [median (IQR) = 6.7 (1.8–15.28) vs. 7.2 (2.23–21.86), respectively, P = 0.42]. There was no significant difference in serum LL-37 levels between the two groups [median (IQR) = 3.9 (2.88–7.52) vs. 5.0 (3.19–9.05) ng/ml, respectively, P = 0.52]. The LL-37 mRNA and its protein concentration showed no significant correlation with the average or current HbA1c values. The constitutive circulating antimicrobial peptide LL-37 status is not significantly altered in patients with type 1 diabetes mellitus and also not affected by their glycemic status

Common Variants of Homocysteine Metabolism Pathway Genes and Risk of Type 2 Diabetes and Related Traits in Indians

Hyperhomocysteinemia, a risk factor for cardiovascular disorder, obesity, and type 2 diabetes, is prevalent among Indians who are at high risk of these metabolic disorders. We evaluated association of common variants of genes involved in homocysteine metabolism or its levels with type 2 diabetes, obesity, and related traits in North Indians. We genotyped 90 variants in initial phase (2.115 subjects) and replicated top signals in an independent sample set (2.085 subjects). The variant MTHFR-rs1801133 was the top signal for association with type 2 diabetes (OR = 0.78 (95%  CI = 0.67–0.92), P = 0.003) and was also associated with 2 h postload plasma glucose (P = 0.04), high-density lipoprotein cholesterol (P = 0.004), and total cholesterol (P = 0.01) in control subjects. These associations were neither replicated nor significant after meta-analysis. Studies involving a larger study population and different ethnic groups are required before ruling out the role of these important candidate genes in type 2 diabetes, obesity, and related traits

Prevalence of vitamin B12 deficiency among individuals with type 2 diabetes mellitus in a South Indian rural community

Background: To estimate the prevalence of vitamin B12 deficiency in a rural south Indian community and to evaluate the association between metformin use and prevalent vitamin B12 deficiency in people with T2DM stratified by oral vitamin B12 supplementation.Methods: Using a cross sectional study design, a random sample of people with T2DM (N=438) was recruited from a rural community. Vitamin B12 deficiency was defined as serum B12 ≤200pg/ml. Data on metformin dose, duration of use, oral vitamin B12 supplementation, and diet were collected. Laboratory measurements included complete blood count, tests for hepatic, renal, and thyroid function, as well as serum vitamin B12 levels and HbA1c.Results: The prevalence of vitamin B12 deficiency in people with T2DM was 11.2% (95% Confidence Interval (CI) 8.2%-14.1%). The odds of vitamin B12 deficiency in patients receiving a metformin dose of 2 grams/day were 4 times higher compared to those receiving ≤1 gram/day, after adjusting for oral B12 supplementation (odds ratio 4.2;95% CI 1.5-11.8). The odds of vitamin B12 deficiency in those taking metformin and receiving oral vitamin B12 supplementation were lower compared to those on metformin and not receiving vitamin B12 supplementation (adjusted odds ratio 0.20; 95% CI 0.06-0.70).Conclusions: Vitamin B12 deficiency affects 1 in 10 people with T2DM, is associated with higher dose metformin use, and oral vitamin B12 supplementation mitigates B12 deficiency in this group

Prevalence of pulmonary tuberculosis in young adult patients with type 1 diabetes mellitus in India

Background: There is limited information on Prevalence of Pulmonary Tuberculosis (PTB) in patients with type-1-diabetes. We assessed the prevalence of PTB in patients with type-1-diabetes attending the outpatient-clinic in a tertiary-care hospital. Methods: 151 patients with type-1-diabetes were screened for PTB by clinical examination and chest-radiography. Sputum Acid-Fast Bacilli Test (AFB) and Mycobacterium tuberculosis (M. tb) culture were performed in patients with clinical and radiological features suggestive of a possibility of PTB and also in those with history of PTB in the past. Their average glycated haemoglobin (HbA1c) during preceding 2 years was assessed. Sputum culture positive patients were managed by a pulmonologist. Results: 5/151 patients had respiratory symptoms and radiographic findings suggestive of PTB. 20/151 patients were asymptomatic but had history of PTB. Four of the five symptomatic patients and 12 with past PTB were positive for sputum M. tb by culture, giving a prevalence of 10.6% sputum culture positive in type-1-diabetes. Average HbA1c was comparable in patients with and without positive sputum culture. ESR and Mantoux test were not discriminatory in these groups. Four clinically symptomatic M. tb culture positive and four asymptomatic patients with sputum culture positive for M. tb on two occasions (6 weeks apart) were put on Antitubercular Treatment (ATT). Patients who were culture positive for M. tb only on one occasion were kept on a close follow up. Conclusions: Patients with type-1-diabetes mellitus in India have high prevalence of PTB. They need to be actively screened for PTB by sputum M. tb culture in order to initiate early treatment and to prevent transmission in the community

Effect of vitamin D supplementation on insulin kinetics and cardiovascular risk factors in polycystic ovarian syndrome: a pilot study

To assess the effect of vitamin D supplementation on parameters of Insulin Sensitivity/Resistance (IS/IR) and insulin secretion in subjects with Polycystic Ovarian Syndrome (PCOS). A prospective double-blind randomized control trial was conducted to assess the effect of vitamin D on insulin kinetics in women with PCOS. The trial was conducted in a tertiary care research hospital. A total of 36 subjects with PCOS, aged 18–35 years, were included in this study. Vitamin D3 4000  IU/day versus placebo was given once a month for 6 months and both groups received metformin. IS (by whole-body IS index or Matsuda index), IR (by homeostasis model assessment IR (HOMA-IR)) and insulin secretion (by insulinogenic index; II30) were the main outcome measures. Secondary outcome included Blood Pressure (BP), lipid profile, Disposition Index (DI) and vascular stiffness. Out of 36 subjects who consented, 32 completed the study. Subjects were randomized into two groups: group A (n = 15; metformin and vitamin D 4000  IU/day) or group B (n = 17; metformin and placebo). Oral glucose tolerance tests with 75 g glucose were carried out at baseline and 6 months after supplementation. Hypovitaminosis D was observed in 93.8% of all subjects with mean serum 25 hydroxy vitamin D level of 7.30 &#177; 4.45 ng/ml. After 6 months of vitamin D supplementation, there was no significant difference in any of the parameters of IS/IR (area under curve (AUC)–glucose, AUC–insulin, insulin:glucose ratio, HOMA-IR, Matsuda index, insulinogenic index and DI), II30 and cardiovascular risk factors between the two groups. Supplementation of vitamin D, at a dose of 4000  IU/day for 6 months, did not have any significant effect on parameters of IS/IR and insulin secretion in subjects with PCOS