Lowering dietary carbohydrates to manage obesity and related disease: A systematic review and theoretical framework

This study aimed to evaluate the lowering of carbohydrates from conventionally recommended levels of ->55% of energy intake as a valid and safe treatment option for managing obesity and related disease. The study was a qualitative systematic review of fourteen randomized controlled studies, each with at least one study arm that lowered intake of carbohydrates to either ketogenic levels (->50g/) (Atkins type diet) or non-ketogenic levels including Zone type diets (>50g/d to 40-45% of energy intake). Low carbohydrate diets have generally implied increased protein intake to around 30% of energy intake. Outcomes evaluated included weight and fat loss; dyslipidemia; blood sugar control; hypertension; nutritional adequacy; hunger and satiety; adherence and safety. A synthesis of process, results and implications was used towards generating a theoretical weight maangement framework. In the short to medium term of up to six months both the ketogenic and non-ketogenic lowering of carbohydrates within the context of a calorie reduction of 300-750 kcal/day generated clinically meaningful weight loss results of 5-10% Lower-carbohydrates diet plans generated similar or better results for most of the main outcomes examined as comparted with conventional higher-carbohydrate/low-fat diet alternatives. Longer-term studies were few in number but weight loss results were in the range of 2-6% with no significant diet difference noted. Potential impact of ketogenic diets on dyslipidemia, renal and bone health needs further evaluation. When lowering carbohydrates or calories, nutritional adequacy may require maangement with the use of supplementation. Lowering carbohydrates may provide an important and useful strategy to achieve a regular daily caloriee deficit, generate clinically meaningful weight loss and improve related metabolic health markers. Recommended weight management protocols may be individualised based on a theoretical model that considers individual health risks and genetics, dietary preferences, carbohydrate sensitivity and is geared towards improved adherence

Moxifloxacin induced fatal hepatotoxicity in a 72-year-old man: a case report

Moxifloxacin is a newer-generation synthetic fluoroquinolone that is used for treatment of acute bacterial sinusitis, acute exacerbation of chronic bronchitis, community acquired pneumonia, intra-abdominal infections and skin/skin structure infections. We describe a case of fatal hepatotoxicity caused by Moxifloxacin in a 72-year-old man. He presented with jaundice and epigastric tenderness that started one week after being treated for acute exacerbation of his chronic bronchitis with Moxifloxacin by his primary care physician. He was admitted to intensive care unit for close monitoring. His labs showed marked elevation in liver enzymes and bilirubin. His condition continued to deteriorate in intensive care unit despite supportive care. Acute hepatic failure which resulted in his death was attributed to idiosyncratic reaction to Moxifloxacin

Novel Scoring Systems to Predict the Need for Oxygenation and ICU Care, and Mortality in Hospitalized COVID-19 Patients: A Risk Stratification Tool

INTRODUCTION: A rapid surge in cases during the COVID-19 pandemic can overwhelm any healthcare system. It is imperative to triage patients who would require oxygen and ICU care, and predict mortality. Specific parameters at admission may help in identifying them. METHODOLOGY: A prospective observational study was undertaken in a COVID-19 ward of a tertiary care center. All baseline clinical and laboratory data were captured. Patients were followed till death or discharge. Univariable and multivariable logistic regression was used to find predictors of the need for oxygen, need for ICU care, and mortality. Objective scoring systems were developed for the same using the predictors. RESULTS: The study included 209 patients. Disease severity was mild, moderate, and severe in 98 (46.9%), 74 (35.4%), and 37 (17.7%) patients, respectively. The neutrophil-to-lymphocyte ratio (NLR) \u3e4 was a common independent predictor of the need for oxygen (

Role of Endophytes in Apple Replant Disease

Apple replant disease (ARD) is a major problem in all the apple-growing areas of the world. It is a complex problem. The exact cause of the problem is unknown, but soil biotic factors play a major role. The repeated cultivation of same crop on same land and exhaustion of nutrients of soil, persistence of soil-borne pathogens and changes in the pH of soil. Symptoms include stunting of tree growth with short internodes, small and light green rosette leaves, development of few lateral or feeder roots, underdeveloped root systems, decayed and discolored roots, poor establishment and severe disease results in the death of young trees and, sometimes, whole orchards. The endophytes provide direct benefits to host plants as they live in close proximity. Once they enter inside the host tissue they get easily established as they feel no competition with other microorganisms. Endophytes have the capacity to produce different secondary metabolites, which saves the host plants from biotic and abiotic stresses the host plants become resistant to both biotic and abiotic stresses. An interesting facet of the interaction between endophytes and their hosts is the capacity of many microorganisms to improve the plant’s resistance by providing several bioactive metabolites. Therefore, the exploitation of soil microbial endophytes for the management of ARD is an important strategy

A Prospective Study To Evaluate Medical Management Vs Surgical Intervention In Pain Relief And Healing Of Anal Fissure

Introduction: Anal fissure is a commonly encountered problem for surgeons. It is a longitudinal tear in distal anal canal with or without an ulcer. It causes significant changes in quality of life. This study was done to compare the efficacy of medical management and surgical intervention in cases of anal fissures. Methods: 50 patients were divided into two groups of 25 each. Group A patients were treated with topical application of 2% diltiazem gel and Group B patients were treated with Lateral sphincterotomy. Both groups were examined weekly for 4 weeks for pain using VAS score and at 12 weeks for healing. Results: 21(84%) patients were pain free after 4 weeks under Group A, 24 (96%) patients were pain free after 4 weeks under Group B. 22(88%) patients were completely healed at 12 weeks under Group A, 25(100%) patients were completely healed at 12 weeks under Group B. Conclusion: Lateral sphincterotomy can be advocated as treatment of choice for anal fissures. It has better pain relief and healing rates compared to topical application of 2% diltiazem gel. Medical Management can be used in patients refusing surgery or unfit for surger

Impact of promoter region mutations of Pim-1 on c-Myc expression as well as survival in patients with breast cancer

Purpose: Breast cancer accounts for most cancer-related deaths in women with over 2.3 million new breast cancer cases diagnosed every year worldwide. Pim kinases are oncogenic proteins that play important role in various cancers. Pim-1 contains 1.7 kb promoter region without any transcriptional regulation, which is a characteristic feature of a housekeeping or constitutive promoter. This study was carried out to ascertain potential mutations in the promoter region of Pim-1 in breast cancer and also to comprehend the effect of mutations on c-Myc expression as well as on patients’ survival. Methods: Ninety-six Indian subjects with a first diagnosis of breast cancer who underwent surgery at our hospital were recruited in this study. Genomic DNA was isolated from whole blood, amplified and sequenced to identify potential mutations at the promoter region of Pim-1. FFPE sections were used to determine the c-Mycexpression in all the studied groups. Results: We observed a transversion (C>A at –502) and a deletion (–754Cdel) mutation in the promoter region with negligible association with tumor biology and c-Myc expression. Positive c-Myc expression was noted in almost 50% of the studied population with absolute nuclear staining or both cytoplasmic/nuclear staining. As per survival analysis, promoter region mutations did not modulate the patients’ survival, but patients with negative c-Myc expression had better disease-free survival compared with positive c-Myc expression. Conclusion: Our findings identified the presence of mutation in the promoter region of Pim-1 with negligible impact on c-Myc expression in patients with breast cance

Transcultural Diabetes Nutrition Therapy Algorithm: The Asian Indian Application

India and other countries in Asia are experiencing rapidly escalating epidemics of type 2 diabetes (T2D) and cardiovascular disease. The dramatic rise in the prevalence of these illnesses has been attributed to rapid changes in demographic, socioeconomic, and nutritional factors. The rapid transition in dietary patterns in India—coupled with a sedentary lifestyle and specific socioeconomic pressures—has led to an increase in obesity and other diet-related noncommunicable diseases. Studies have shown that nutritional interventions significantly enhance metabolic control and weight loss. Current clinical practice guidelines (CPGs) are not portable to diverse cultures, constraining the applicability of this type of practical educational instrument. Therefore, a transcultural Diabetes Nutrition Algorithm (tDNA) was developed and then customized per regional variations in India. The resultant India-specific tDNA reflects differences in epidemiologic, physiologic, and nutritional aspects of disease, anthropometric cutoff points, and lifestyle interventions unique to this region of the world. Specific features of this transculturalization process for India include characteristics of a transitional economy with a persistently high poverty rate in a majority of people; higher percentage of body fat and lower muscle mass for a given body mass index; higher rate of sedentary lifestyle; elements of the thrifty phenotype; impact of festivals and holidays on adherence with clinic appointments; and the role of a systems or holistic approach to the problem that must involve politics, policy, and government. This Asian Indian tDNA promises to help guide physicians in the management of prediabetes and T2D in India in a more structured, systematic, and effective way compared with previous methods and currently available CPGs

Chickpea

The narrow genetic base of cultivated chickpea warrants systematic collection, documentation and evaluation of chickpea germplasm and particularly wild Cicer species for effective and efficient use in chickpea breeding programmes. Limiting factors to crop production, possible solutions and ways to overcome them, importance of wild relatives and barriers to alien gene introgression and strategies to overcome them and traits for base broadening have been discussed. It has been clearly demonstrated that resistance to major biotic and abiotic stresses can be successfully introgressed from the primary gene pool comprising progenitor species. However, many desirable traits including high degree of resistance to multiple stresses that are present in the species belonging to secondary and tertiary gene pools can also be introgressed by using special techniques to overcome pre- and post-fertilization barriers. Besides resistance to various biotic and abiotic stresses, the yield QTLs have also been introgressed from wild Cicer species to cultivated varieties. Status and importance of molecular markers, genome mapping and genomic tools for chickpea improvement are elaborated. Because of major genes for various biotic and abiotic stresses, the transfer of agronomically important traits into elite cultivars has been made easy and practical through marker-assisted selection and marker-assisted backcross. The usefulness of molecular markers such as SSR and SNP for the construction of high-density genetic maps of chickpea and for the identification of genes/QTLs for stress resistance, quality and yield contributing traits has also been discussed

Tissue Fixatives: A Review

Fixation is the first or the foundation step of the histotechniques done  to preserve the tissues in as close a life like state as possible by preventing their autolysis and putrefaction .A number of fixatives exists, either having being in use for decades, or in the case of formaldehyde over a century. Every fixative has different properties, each indicated for a special purpose based on the type of cell component to be studied, the method of sectioning and staining employed and the type of microscopy involved. Thus, a pathologist must have a fair idea of the properties of these commonly available fixatives, so that a correct choice can be made depending upon the desired results. This review aims to give a brief overview of the commonly available fixatives with their merits and their demerits. The fixatives discussed are: a formaldehyde containing fixative-10% Formalin, a picric acid fixative-Bouin's Fluid, an alcoholic fixative- Clarke's Fluid and a mercury chloride containing fixative- Zenker's Fluid