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   Table of Contents - Current issue
January-June 2022
Volume 2 | Issue 1
Page Nos. 1-39

Online since Wednesday, June 29, 2022

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The interpretation of biochemical investigations in the management of metabolic bone disorders p. 1
Roop B Kalia, Sajid Ansari, Anil Regmi
A bone is basically a combination of the organic matrix, inorganic minerals (calcium phosphate), and vitamins that make the structural framework. The two counteracting processes, bone formation and bone resorption, make the bone a metabolically active tissue that undergoes continuous remodeling. The laboratory evaluation of serological and urinary markers is important in the diagnosis of suspected bone disease such as osteoporosis, rickets/osteomalacia, fluorosis, and primary hyperparathyroidism, which are common metabolic bone diseases (MBD), whereas a few rare MBDs include Paget’s disease, fibrous dysplasia, osteogenesis imperfecta, tumor-induced osteomalacia, etc. Calcium and phosphate level in serum and urine reflects the status of metabolism of bone. Markers of one formation include: alkaline phosphatase (ALP), osteocalcin (OCn), and procollagen I peptides: the amino (N-) terminal propeptide (PINP) and the carboxy (C-) terminal propeptide (PICP). Markers of bone resorption include hydroxyproline (OHP), hydroxylysine (HYL), deoxypyridinoline (DPD), pyridinoline (PYD), bone sialoprotein (BSP), osteopontin (OP), tartrate-resistant acid phosphatase 5b (TRAP 5b), carboxy-terminal crosslinked telopeptide of type 1 collagen (CTX-1), amino-terminal crosslinked telopeptide of type 1 collagen (NTX-1), cathepsin K (CTSK), urinary calcium, and acid phosphatase. Novel biochemical markers such as periostin, cathepsins, RANK-L, secreted frizzled-related proteins (sFRP), Wnt inhibitory factor-1 (WIF1), Dickkopfs (Dkk) 1–4, sphingosine-1-phosphate (S1P), sclerostin, fibroblast growth factor (FGF)-23, and miRNA are also the markers of bone metabolism. Biochemical markers of bone metabolism provide a potentially important clinical tool for assessing and monitoring MBD. These markers are quick to appear after any derangement in physiology. Still, we must keep in mind that the characteristics of any marker are at present primarily a function of the assay used for the assessment of the marker. That continued efforts aimed at improving the analysis and interpretation of markers that are known today must continue.
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Evaluation of diabetic neuropathies p. 9
Amit Varma, Kapil Sharma, Sumita Sharma
Diabetes mellitus is a major health problem globally that increases the economic burden of every country. According to the International Diabetes Federation (IDF) in 2021, 1 in 10 adults are living with diabetes. About 352 million adults have uncontrolled glycemic profiles worldwide. Diabetes is likely to affect 552 million people worldwide by 2030. Diabetes and its complications are emerging as the leading cause of morbidity and mortality. Diabetes neuropathies are estimated to affect approximately 50% of people suffering with diabetes. Neuropathy, the most prevalent microvascular complication of diabetes mellitus, includes distal symmetric polyneuropathy, radiculoplexus neuropathy, autonomic neuropathy, mononeuropathy, and treatment-induced neuropathy. Early diagnosis and appropriate management of diabetic neuropathy are essential to alleviate disabling symptoms and to improve the quality of life of patients. This review discusses clinical manifestations and evaluation of diabetic neuropathies as well as appropriate objective tests helpful in diagnosing diabetic neuropathies.
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Hypoglycemic and antihyperlipidemic effects of hydroalcoholic extract of maize silk on dexamethasone-induced-hyperglycemic rats p. 15
Barnabé Lucien Nkono Ya Nkono, Rouamba Ablassé, Mc Jesus Kinyok, Soumiatou Nzikoué, Léocadie Mbella Kédi, Placide Yannick Amougou Noa, Paul Désiré Djomeni Dzeufiet, Sélestin Dongmo Sokeng, Pierre Kamtchouing
Context: Maize silk (Zea mays) is used in traditional medicine to treat high blood pressure, diabetes and obesity. It is also used as an immunostimulant but few scientific studies are available to validate these properties. Aims: The aim of this study was to scientifically validate the traditional use of maize silk in the regularization of lipid profile and blood glucose level. Material and Methods: Hydroalcoholic extract of maize silk (HAEMS) was prepared by decoction (30:70 Water-Ethanol) from the dry powder of corn silk (250 g/L). Hyperglycemia was induced by repeated single daily subcutaneous injection (s.c) of dexamethasone (5 mg/kg); dexamethasone negative control group (DNC) received dexamethasone exclusively throughout 14 days while negative normal control group (NNC) received only vehicle during the same period. Positive control group (glibenclamide) and plant extract groups (50 and 100 mg/kg) received dexamethasone from the eighth day and each group consisted of six animals. All the parameters (fasting blood glucose level, TC, HDL, LDL, VLDL, atherogenic index (AI) and TG) were measured on the first, seventh and fourteenth day of the experiment. Lipid profile was performed using a BIOLABO® Kit and fasting blood glucose level was measured using a glucometer VivaCheck™ Ino. Results: Compared to the DNC group, HAEMS significantly reduced (P<0.001) on days seven and fourteen, fasting blood glucose level, TC, LDL, VLDL, artherogenic AI and TG (on day seven). In addition, only the dose of 50 mg/kg significantly increased serum HDL on the seventh (P<0.01) and fourteenth day (P<0.001). Conclusion: The results obtained in this study suggest that HAEMS have hypoglycemic and antihyperlipidemic properties.
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Spectrum of cardiac autonomic neuropathy in patients with type 2 diabetes mellitus: A North India perspective p. 23
Prativa Priyadarshani Sethi, Basavraj Jatteppanavar, Ravi Kant, Monika Pathania, Mukesh Chand Bairwa
Background: Cardiac autonomic neuropathy (CAN) is a known complication in diabetes patients but often remain underdiagnosed because of lack of proper investigation and long asymptomatic period. The study aimed to assess the spectrum of cardiac autonomic neuropathy prevailing among type 2 diabetes mellitus patients visiting a tertiary care hospital. Materials and Methods: The study was conducted as an observational cross-sectional study among the type 2 diabetes patients visiting the diabetic clinic. A total of 60 participants were included in the study, including both males and females, over one month. A cardiac autonomic neuropathy system analyser, manufactured by the Diabetik Foot Care India Pvt Limited (DFCI), Chennai (CANS 504), was used to screen for cardiac autonomic neuropathy (CAN). Results: A total of 60 patients were enrolled in the study. The mean age of the participants was 55.72 ± 12.62 (Mean ± SD). 38 (63.3%) of the participants were male, and 22 (36.7%) were Female. Early CANS dysfunction was seen among 21 (35.0%), Moderate CANS dysfunction in 9 (15.0%) and definite CANS dysfunction in 29 (48.3%) patients and only one patient had normal CAN study. Conclusion: CAN is a common microvascular complication highly prevalent among diabetes patients and may remain asymptomatic until an advanced stage, so screening of type 2 diabetes patients must be done at the time of diagnosis.
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The association between diabetic retinopathy and cardiac autonomic neuropathy in patients with type 2 diabetes p. 29
Magda Shukry Mohammad, Mona Mohamad Abdelsalam, Nesma Ali Ibrahim, Mai Mohamed Salah Eldin
Background: Cardiac autonomic neuropathy (CAN) is a serious complication of diabetes mellitus that strongly associated with increased risk of cardiovascular mortality. Aim: The aim of this study was to evaluate the association between diabetic retinopathy (DR) and early CAN in patients with type 2 diabetes (T2D). Materials and Methods: The study was conducted on 60 patients with T2D, divided into two groups; group I included 30 patients with T2D complicated with DR and group II included 30 patients with T2D not complicated with DR. All participants underwent a detailed medical history, examination and laboratory measurements including, hemoglobin A1c (HbA1c) and urinary albumin/creatinine ratio (UACR). CAN was determined based on the results of tilt-table test which was done to all study participants. Results: On comparing tilt table test positive results of group I and group II, the results showed a significant difference between both groups (P = 0.004), being higher in group I (43.33% of group I were tilt table test positive) than in group II (only 10% of the group were positive). In group I, on comparing patients with positive tilt table test (CAN) and those with negative tilt table test (without CAN) regarding fundus findings, the results showed that 69.23% of patients with positive tilt table test had proliferative diabetic retinopathy (PDR), and 30.77% had non-proliferative diabetic retinopathy (NPDR), while in patients with negative tilt table test, 17.65% had PDR, and 82.35% had NPDR, the odd‘s ratio was 10.5 (P = 0.007). Regression of determinants for the presence of cardiac autonomic neuropathy in patients with T2D showed that, the increased duration of diabetes (P = 0.010) and the increased level of UACR (P = 0.001) were significantly associated with CAN in type 2 diabetic patients. Conclusion: DR is a strong predictor for CAN. So, fundus photography may be an alternative to autonomic function testing where facilities for the latter test are unavailable.
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COVID-19 pandemic: Interaction of lockdown with liver disease and metabolic parameters p. 35
Chitranshu Vashishtha, Ankit Bhardwaj, Manoj Kumar Sharma
Background: In current COVID-19 pandemic, India had lockdown from 25th March 2020 followed by relaxation in phases from 1st June. The aim of the study was assessment of lockdown impact on metabolic and liver disease status of non-COVID patients of liver diseases. Materials and Methods: OPD data of all consecutive patients of liver disease without COVID-19 infection from 1st January 2020 to 31st December was analyzed. The primary objective was to assess lockdown impact on liver stiffness. Fibroscan, BMI and laboratory data was compared before and after implementation of lockdown in three groups (Group1-noncirrhotics, Group2- compensated cirrhotics, Group3- decompensated cirrhotics). Results: 230 patients (77% M) were analyzed. In all the three groups, there was no significant change in the liver stiffness and fat content by fibroscan, complete blood count, liver and kidney function tests. In Group1, there was significant increase in BMI (25.3 ± 6.0 vs 26.4 ± 6.1, P < 0.01), sugar (mg/dl) fasting (101.5 ± 30.1 vs110.7 ± 31.8, P < 0.01), post prandial (131 ± 31.6 vs 156.5 ± 35.5, P < 0.01), LDL (mg/dl) (111.1 ± 33.1 vs 119.1 ± 26.8, P = 0.036), total lipid/HDL ratio (4.04 ± 1.39 vs 4.58 ± 1.58, P = 0.01) and reduction in HDL (mg/dl) (45.8 ± 12.7 vs 40.4 ± 10.1, P < 0.01). In Group2, significant increase in LDL (97.3 ± 32.5 vs 114.3 ± 29.8, P = 0.01), LDL/HDL ratio (2.36 ± 1.26 vs 2.70 ± 1.03, P = 0.04) and decrease in HDL (45.6 ± 12.1 vs 40.9 ± 11.2, P < 0.01) was seen, with no significant change in BMI, and sugar fasting, post prandial, HbA1c. In Group3, there was no significant change in any of the parameters analysed. Conclusions: There was no impact of lockdown due to Covid pandemic on liver disease status. However, lockdown worsened metabolic parameters of non-cirrhotics and compensated cirrhotics.
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