Knowledge, Attitude, and Practice of Physiotherapists about Cardiac Rehabilitation Program Adherence among Patients Discharged from the Hospital after Cardiac Surgery in India.

Background: In most settings, patients receive phase 1 cardiac rehabilitation in CTVS ICU at the hospital, but there are several barriers to follow-up after patients are discharged from the hospital. Physiotherapists play an important role in the enrolment and continuation of cardiac rehabilitation. Thus, we aim to study the knowledge, attitude, and practice of physiotherapists about CR program adherence among patients discharged from the hospital after cardiac surgery. Objectives: (i) To study the knowledge of physiotherapists about the importance of cardiac rehabilitation after discharge; (ii) to know the attitude of physiotherapists towards cardiac surgery patients after discharge; and (iii) to know what approach various centres are applying for patients after discharge to ensure adherence to cardiac rehabilitation. Methods: A questionnaire was developed with reference to the objectives of the study, which was answered by a total of 127 physiotherapists. Results: The overall response rate was 42.3%; nearly 35.4% of the participants indicated that they knew a lot about CR, while 5.5% said they knew very little. Regarding the program's content, 36.2% of participants reported having a medium degree of awareness of the diverse CR components, while 8.6% reported having very little knowledge of them. Only about one-third, 35.7% stated that CR in India is effective and 95% believed that CR will have an added value for the country. Approximately 80% of respondents thought that it would be challenging for a physiotherapist to recommend patients to a CR in the nation. Nearly 35% of respondents believed that they, "themselves as physios," needed to commence CR, and slightly less than 70% thought that doctors were required to choose and refer the patients when asked who should take the initiative to start this kind of programme in the country. A little over 40% of respondents said that insurance firms are also involved in starting a CR programme. Conclusion: Physiotherapists have good knowledge of cardiac rehabilitation. However, their attitude and practice towards adherence to exercise protocols are confounded by various clinician- and patient-level factors.

Acinetobacter baumannii in suspected bacterial infections: Association between multidrug resistance, virulence genes, & biofilm production.

BACKGROUND OBJECTIVES: Acinetobacter baumannii has emerged as a nosocomial pathogen with a tendency of high antibiotic resistance and biofilm production. This study aimed to determine the occurrence of A. baumannii from different clinical specimens of suspected bacterial infections and furthermore to see the association of biofilm production with multidrug resistance and expression of virulence factor genes in A. baumannii. METHODS: A. baumannii was confirmed in clinical specimens by the detection of the blaOXA-51-like gene. Biofilm production was tested by microtitre plate assay and virulence genes were detected by real-time PCR. RESULTS: A. baumannii was isolated from a total of 307 clinical specimens. The isolate which showed the highest number of A. baumannii was an endotracheal tube specimen (44.95%), then sputum (19.54%), followed by pus (17.26%), urine (7.49%) and blood (5.86%), and <2 per cent from body fluids, catheter-tips and urogenital specimens. A resistance rate of 70-81.43 per cent against all antibiotics tested, except colistin and tigecycline, was noted, and 242 (78.82%) isolates were multidrug-resistant (MDR). Biofilm was detected in 205 (66.78%) with a distribution of 54.1 per cent weak, 10.42 per cent medium and 2.28 per cent strong biofilms. 71.07 per cent of MDR isolates produce biofilm (P<0.05). Amongst virulence factor genes, 281 (91.53%) outer membrane protein A (OmpA) and 98 (31.92%) biofilm-associated protein (Bap) were detected. Amongst 100 carbapenem-resistant A. baumannii, the blaOXA-23-like gene was predominant (96%), the blaOXA-58-like gene (6%) and none harboured the blaOXA-24-like gene. The metallo-ß-lactamase genes blaIMP-1 (4%) and blaVIM-1(8%) were detected, and 76 per cent showed the insertion sequence ISAba1. INTERPRETATION CONCLUSIONS: The majority of isolates studied were from lower respiratory tract specimens. The high MDR rate and its positive association with biofilm formation indicate the nosocomial distribution of A. baumannii. The biofilm formation and the presence of Bap were not interrelated, indicating that biofilm formation was not regulated by a single factor. The MDR rate and the presence of OmpA and Bap showed a positive association (P<0.05). The isolates co-harbouring different carbapenem resistance genes were the predominant biofilm producers, which will seriously limit the therapeutic options suggesting the need for strict antimicrobial stewardship and molecular surveillance in hospitals.

Green synthesis of silver nanoparticles using Ocimum sanctum Linn. and its antibacterial activity against multidrug resistant Acinetobacter baumannii.

The biosynthesis of nanoparticles using the green route is an effective strategy in nanotechnology that provides a cost-effective and environmentally friendly alternative to physical and chemical methods. This study aims to prepare an aqueous extract of Ocimum sanctum (O. sanctum)-based silver nanoparticles (AgNPs) through the green route and test their antibacterial activity. The biosynthesized silver nanoparticles were characterised by colour change, UV spectrometric analysis, FTIR, and particle shape and size morphology by SEM and TEM images. The nanoparticles are almost spherical to oval or rod-shaped with smooth surfaces and have a mean particle size in the range of 55 nm with a zeta potential of -2.7 mV. The antibacterial activities of AgNPs evaluated against clinically isolated multidrug-resistant Acinetobacter baumannii (A. baumannii) showed that the AgNPs from O. sanctum are effective in inhibiting A. baumannii growth with a zone of inhibition of 15 mm in the agar well diffusion method and MIC and MBC of 32 µg/mL and 64 µg/mL, respectively. The SEM images of A. baumannii treated with AgNPs revealed damage and rupture in bacterial cells. The time-killing assay by spectrophotometry revealed the time- and dose-dependent killing action of AgNPs against A. baumannii, and the assay at various concentrations and time intervals indicated a statistically significant result in comparison with the positive control colistin at 2 µg/mL (P < 0.05). The cytotoxicity test using the MTT assay protocol showed that prepared nanoparticles of O. sanctum are less toxic against human cell A549. This study opens up a ray of hope to explore the further research in this area and to improve the antimicrobial activities against multidrug resistant bacteria.

Impact of tuberculosis disease on human gut microbiota: a systematic review.

INTRODUCTION: This systematic review evaluates the gut microbiota (GM) status in tuberculosis (TB) patients compared to healthy volunteers due to the disease or its treatment. AREAS COVERED: We conducted a systematic review of all articles published in PubMed, Web of Science, and Embase that assessed the impact of TB disease and anti-tubercular therapy (ATT) on GM from inception till January 2022 (Protocol registration number in PROSPERO: CRD42021261884). Regarding the microbial diversity indices and taxonomy, we found a significant difference in GM status between the TB and healthy control (HC) groups. We found an overabundance of Phylum Proteobacteria and depletion of some short-chain fatty acid-producing bacteria genera like Bifidobacteria, Roseburia, and Ruminococcus in the TB group. We found that ATT exacerbates the degree of dysbiosis caused by Mycobacteria tuberculosis disease. EXPERT OPINION: The modulation of GM in TB patients in clinical practice may serve as a promising target to reverse the dysbiosis caused. Moreover, this can optimistically change the TB treatment outcome. We expect that appropriate probiotic supplementation with antimycobacterial treatment during tuberculosis disease will help stabilize the GM throughout the treatment phase and protect the GM from dysbiosis.

Assessment of determining factors for severity of NeoCOVIDiabetes in India: A pan India multicentric retrospective study.

BACKGROUND AND AIMS: There is a bidirectional relationship between COVID-19 and diabetes. The primary objective of this study was to estimate the prevalence of patients newly detected to have diabetes (NDD) who recovered from COVID-19 in India whilst comparing NDD with patients without diabetes (ND) and those who have known to have diabetes (KD) in terms of glycemic status pre- and post-COVID with disease severity. MATERIALS & METHODOLOGY: There were 2212 participants enrolled from 15 sites, with 1630 active participants after the respective execution of selection criteria. Data collection was done using a specialized Case Record Form (CRF). Planned statistical analysis and descriptive statistics were concluded for significance between patient groups on various parameters. RESULT: The differences in age between the study groups were statistically significant. The average blood glucose at COVID-19 onset was significantly higher in KD than in NDD. Significantly more proportion of NDD (83%) had been hospitalized for COVID management when compared to KD (45%) and ND (55%). The NDD group received higher doses of steroids than the other two groups. On average, patients in the NDD group who received at least one vaccination (one dose or two doses) had a higher High-Resolution Computed Tomography (HRCT) score. Patients who had not been vaccinated in ND and KD groups experienced a higher HRCT score. CONCLUSION: Prospective metabolism studies in post-acute COVID-19 will be required to understand the etiology, prognosis, and treatment opportunities.

Perception of health care students towards lectures as a teaching and learning method in the COVID era - A multicentric cross-sectional study from India.

The sudden precipitation of the pandemic forced undergraduates to take refuge at home, deserting the campus. Consequently, the age-old classroom in person teaching-learning (T-L) method shifted and lessons had to be conducted online. In previous decades, archetypical classroom lectures survived a lot of criticism in the face of the quasi-passive nature of T-L  methodology. There are very few studies that reflect undergraduate students' perceptions of lectures. This study aimed to evaluate undergraduate students' perceptions of lectures using an online questionnaire with 13 items, which was circulated to undergraduate students of medical, physiotherapy, and nursing courses in three settings at different locations of private and public health schools. There was a total of 877 responses. The surveyed students were in favor of lectures and considered them indispensable for undergraduate learning. They preferred it as a kind of organized learning through the teacher's own experiences. Our study suggests that it is not the 'lecture' that requires mending but possibly teachers require better training, application of effective audio-visual aids, and innovative techniques to sustain students' interest in the class.

Phenotypic Detection of ESBL, AmpC, MBL, and Their Co-occurrence among MDR Enterobacteriaceae Isolates.

Background Emergence of extended-spectrum beta-lactamases (ESBLs), AmpC ß-lactamases, and metallo-ß lactamases (MBL), and their co-existence among members of Enterobacteriaceae pose newer diagnostic and therapeutic challenges. The present study examines the ESBL, AmpC, and MBL production by various phenotypic methods and their co-occurrence among the multidrug-resistant (MDR) Enterobacteriaceae clinical isolates. Materials and Methods Four hundred non-repetitive Enterobacteriaceae clinical isolates were collected from the Central Referral Hospital, Sikkim. The isolates were used for identification and their antibiotic susceptibility tests were performed according to the Clinical and Laboratory Standard Institute (CLSI) guidelines. ESBL was detected by double-disc synergy test (DDST) and phenotypic confirmatory disc-diffusion test (PCDDT), AmpC detection by AmpC E-test, and boronic acid disc diffusion (BD) test. MBL was detected using the imipenem-imipenem/EDTA disc and carba-NP tests. Results Around 76% were considered MDR. ESBL was seen in 58% and 50.4% based on DDST and phenotypic confirmation disc-diffusion test (PCDDT), respectively. AmpC was detected in 11.8% and 13.1% using a commercial E-test and boronic acid test, respectively. MBL were identified in 12.8% and 14.8% based on MBL imipenem-EDTA and carba-NP tests, respectively. Co-occurrence of ESBL and AmpC, ESBL and MBL, AmpC and MBL was seen in 5.2%, 11.5%, 1.3%, respectively, whereas a combination of these three ß-lactamases was observed in only 0.3% of 304 MDR isolates. Conclusion The findings highlight a high prevalence of ß-lactamases and their co-production among the Enterobacteriaceae , mainly in Klebsiella pneumoniae and Escherichia coli isolates. The study further highlights the necessity to identify the MDR ß-lactamases stains for effective therapy in severe as well as mild bacterial infections, thereby enabling to reduce the risk of MDR in hospital and community settings.

Virulence Characteristics and Emerging Therapies for Biofilm-Forming Acinetobacter baumannii: A Review.

Acinetobacter species is one of the most prevailing nosocomial pathogens with a potent ability to develop antimicrobial resistance. It commonly causes infections where there is a prolonged utilization of medical devices such as CSF shunts, catheters, endotracheal tubes, and similar. There are several strains of Acinetobacter (A) species (spp), among which the majority are pathogenic to humans, but A. baumannii are entirely resistant to several clinically available antibiotics. The crucial mechanism that renders them a multidrug-resistant strain is their potent ability to synthesize biofilms. Biofilms provide ample opportunity for the microorganisms to withstand the harsh environment and further cause chronic infections. Several studies have enumerated multiple physiological and virulence factors responsible for the production and maintenance of biofilms. To further enhance our understanding of this pathogen, in this review, we discuss its taxonomy, pathogenesis, current treatment options, global resistance rates, mechanisms of its resistance against various groups of antimicrobials, and future therapeutics.

Effect of Vitamin D Supplementation in Type 2 Diabetes Patients with Tuberculosis: A Systematic Review.

BACKGROUND: Diabetes mellitus (DM) and tuberculosis (TB) have been recognized as reemerging epidemics, especially in developing countries. Among all the risk factors, diabetes causes immunosuppression, increasing the risk of active TB three times. Vitamin D has been found as a link between DM-TB co-morbidity. OBJECTIVE: Vitamin D affects the immune response, suppresses Mycobacterium tuberculosis (Mtb) growth, and affects insulin secretion. The present systematic review determines the effect of vitamin D supplementation on clinical and therapeutic outcomes of DM-TB patients. METHOD: A comprehensive literature search was carried out in PubMed, Cochrane, Web of Science, and Scopus database to determine eligible studies from inception to January 2021. Out of the 639 articles retrieved, three randomized controlled trials (RCTs) were included in the systematic review. RESULT: The effect of vitamin D3 or oral cholecalciferol supplementation was assessed on outcomes, such as duration to sputum smear conversion, TB scores improvement, change in glycemic parameters, including HbA1c, FBS, and PLBS, and laboratory parameters, such as Hb, ESR, and CRP. Duration of sputum smear conversion was decreased by two weeks in the vitamin D3 supplemented group in two studies. TB score improvement and changes in glycemic parameters were inclined towards supplemented group; however, they were not significant. CONCLUSION: The overall effect of vitamin D3 supplementation on TB patients with DM was not significant. Further studies are required in the future examining the effect of supplementation on outcomes in this population.

Epidemiological study of snakebite cases in Sikkim: Risk modeling with regard to the habitat suitability of common venomous snakes.

BACKGROUND: Snakebite envenoming is listed as category 'A' Neglected Tropical Disease. To achieve the target of WHO (World Health Organization) 2019, it becomes necessary to understand various attributes associated with snakebite including community awareness, improvisation of medical facilities and to map the potential distribution of venomous snakes responsible for the bite. Hence this study is conducted in Sikkim, India to understand the epidemiology of snakebite in Sikkim. The potential distribution and risk mapping of five common venomous snakes are done for effective management of snakebite cases. METHODS AND FINDINGS: The snakebite cases registered in six district hospitals and four PHCs (Primary Health Centers) of Sikkim were collected from the year 2011 to 2018. Community survey was also conducted to supplement the data. Ecological Niche Modeling (ENM) was performed to predict the potential habitat of five common venomous snakes of Sikkim. The risk modeling of snakebite cases was done at the level of Gram Panchayat Unit (GPU) using Geographically Weighted Regression (GWR) and Ordinary Linear Square (OLS) model. We found higher number of male victims inflicted with snakebite envenomation. The potential distribution of the five venomous snakes showed satisfactory mean AUC (Area under Curve) value. Both the models showed significant positive association of snakebite cases with habitat suitability of the venomous snakes. Hospital data revealed no death cases whereas community data reported 24 deaths. CONCLUSIONS: Death from snakebite reflected in community data but not in hospital data strongly indicates the people's belief in traditional medicine. Though people of Sikkim have rich traditional knowledge, in case of snakebite traditional practices may be ineffective leading to loss of life. Sensitizing people and improving medical facilities along with proper transport facilities in rural areas might significantly reduce the snakebite casualties in the state.

Effect of Yoga on Blood Pressure in Prehypertension: A Systematic Review and Meta-Analysis.

INTRODUCTION: Prehypertension is a precursor for developing hypertension and is a risk factor for cardiovascular diseases. Yoga therapy may have a role in lowering the blood pressures in prehypertension and hypertension. This systematic review aims to synthesize the available literature for the same. Methodology. Databases such as PubMed, Embase, Scopus, and Web of Science were searched for randomised control trials only in the time duration of 2010-2021. The main outcome of interest was systolic and diastolic blood pressures. Articles were screened based on the inclusion criteria, and 8 articles were recruited for the review. Meta-analysis was done for suitable articles. RevMan 5.4 by Cochrane was used for meta-analysis and forest plot construction. Risk of bias was determined using the Downs and Black checklist by three independent authors. RESULTS: The meta-analysis of the articles favoured yoga intervention over the control intervention. Yoga therapy had significantly reduced the systolic pressure (-0.62 standard mean difference, at IV fixed 95% CI: -0.83, -0.41) and diastolic pressure (-0.81 standard mean difference, at IV random 95% CI: -1.39, -0.22). Secondary outcome measures studied were heart rate, weight, BMI, waist circumference, and lipid profile. The main protocol of yoga therapy included postures, breathing exercises, and different meditation techniques. A significant reduction in secondary outcomes was observed, except for HDL values in lipid profile which showed a gradual increase in yoga group in comparison with alternative therapy. CONCLUSION: Yoga therapy has shown to be significant in the reduction of systolic and diastolic pressure in prehypertensive population. Supporting evidence lacks in providing a proper structured dosage of yoga asanas and breathing techniques. Considering the existing literature and evidence, Yoga therapy can be used and recommended in prehypertensive population and can be beneficial in reducing the chances of developing hypertension or cardiovascular diseases.

Dietary Antioxidants Significantly Reduced Phorbol Myristate Acetate Induced Oxidative Stress of Peripheral Blood Mononuclear Cells of Patients with Rheumatoid Arthritis.

BACKGROUND: Rheumatoid arthritis (RA) is an autoimmune disease responsible for maximum human morbidity in modern life, whereas oxidative stress is the ultimate potential biomarker for determining disease activity in patients with RA. OBJECTIVE: The present study scientifically validated the effectiveness of antioxidants commonly present in different food supplements to neutralize the free radicals mediated oxidative stress in isolated peripheral blood mononuclear lymphocytes (PBML) of patients with RA. METHODS: The study population included patients with Rheumatoid arthritis, RA (n =15), who fulfilled the American College of Rheumatology criteria for RA. Peripheral blood was collected, and isolated mononuclear lymphocyte cells (PBML) were pretreated with phorbol myristate acetate (PMS) and furthermore, incubated with different concentrations of Naringenin, ß carotene and Nacetyl cysteine (NAC) in an ex vivo condition. The resultant cell lysate was used for further studies for the determination of other oxidative biomarkers. The increase of superoxide and nitric oxide production was observed when PBML was treated PMS. RESULTS: Importantly, the increased oxidative stress was effectively decreased by the selected plantderived compounds ß-carotene and naringenin. CONCLUSION: The study scientifically evaluated the efficacy of the molecules validated by one-way ANOVA, followed by Dunnett's post hoc test of significance. Collectively, our results indicate that both ß carotene and naringenin may be a promising non-toxic food supplement in attenuating the oxidative stress associated pathology in RA, meriting further pharmacological studies on other inflammatory cells like neutrophils.

Effect of Yoga and Exercise on Glycemic Control and Psychosocial Parameters in Type 2 Diabetes Mellitus: A Randomized Controlled Study.

CONTEXT BACKGROUND: Type 2 diabetes has been strongly associated with psychosocial factors such as stress, anxiety, depression, and quality of life (QOL). There is not much evidence whether yoga can improve these factors and motivate individuals to engage in active lifestyle. AIMS: This study aims to evaluate the effect of yoga and exercise over glycemic control, anxiety, depression, exercise self-efficacy (ESE), and QOL after 3-month program. METHODS: Two hundred and twenty-seven individuals were randomly allocated to yoga group (YG) and exercise group. YG practiced yoga for 2 weeks under supervision and then carried out practice at home for 3 months. The exercise group practiced 30 min of brisk walking for 5 days a week. RESULTS: On comparison among the groups, in YG, there was a mean change of 0.47 in glycated hemoglobin which was greater than mean reduction of 0.28 in the exercise group with P < 0.05. State anxiety reduced by 7.8 and trait anxiety reduced by 4.4 in YG (P < 0.05) in 3 months as compared to nonsignificant reductions of 3 and 1 in mean of state and trait anxiety scores in the exercise group (P > 0.05). There was a statistically significant reduction in depression score in both the groups, 8.6 in yoga and 4.0 in exercise, which was greater in YG. ESE improved by 19.2 in YG (P < 0.05), whereas it improved only 2.2 in the exercise group (P > 0.05). QOL improved by 23.7 in YG and 3.0 in the exercise group which was nonsignificant in the exercise group as compared to YG. CONCLUSIONS: Yoga is superior to exercise alone as a lifestyle modification program in improving glycemic control, anxiety, depression, and QOL as well as ESE.

Comparison of the Effectiveness of Video-assisted Teaching Program and Traditional Demonstration on Nursing Students Learning Skills of Performing Obstetrical Palpation.

BACKGROUND: Teaching methods have failed to keep up with the pace of the changing curriculum. Clinical practice, an essential part of nursing education, links theory with practice, particularly in midwifery nursing. Thus, this study aimed to compare the effects of video-assisted teaching programs and traditional demonstration on nursing students learning obstetrical palpation skills. MATERIALS AND METHODS: This is a quasi-experimental research work with pretest, posttest, control group design in which 60 third-year students of Bachelor of Science in Nursing were selected and assigned randomly, by lottery method, into an experimental group (video-assisted teaching program) and a control group (traditional demonstration) regarding obstetrical palpation. The data were collected through a self-designed rating scale. The validity of the rating scale was established by a panel of seven experts from the field of obstetrical and gynecological nursing, and the reliability was established through Cronbach's α(0.78), which showed the tool was consistent among the population. RESULTS: The results showed a significant difference between the pretest and posttest skill scores of students who were exposed to video-assisted teaching program and traditional demonstration (t = 18.35, p < 0.001). Although both the methods were equally effective in enhancing skill, traditional demonstration scored much better than the video-assisted teaching program when the posttest skills were compared (t = 36.40, p = 0.001). CONCLUSIONS: The routine educational method, i.e., demonstration, is more effective in developing skills emphasizing the reinforcement of academicians in enhancing teaching skills by adopting blended teaching technique for enhancing memory storage, retrieval, cognition, and learning.

Oxidative stress in metabolic syndrome & its association with DNA-strand break.

BACKGROUND & OBJECTIVES: Oxidative stress (OS) is associated with numerous components of metabolic syndrome (MetS). This study was aimed to investigate if hydrogen peroxide (H2O2) as the reactive oxygen species was capable of depicting OS in MetS, and If MetS patients showed DNA damage in the form of DNA strand breaks (DSB). METHODS: A total of 160 participants (90 males, 70 females) ≥20 yr of age were categorized into four groups based on the number of MetS risk parameters (n=40 in each group). Sugar and lipid profile, H2O2concentration in blood and DNA-strand breaks were measured. RESULTS: DSB was significantly more in those with MetS (n=40) than those without (n=120) whereas H2O2levels were the same in both the study groups. The number of DSB differed significantly between the control and 3 risk factor groups. DSB was also higher in groups with 2 and 1 risk factors compared to 0 risk but the difference was not significant. H2O2 level was higher in groups with 3, 2 and 1 risk factors compared to 0 risk group but the difference was not significant. The H2O2level correlated positively with triglyceride values but not with other MetS risk parameters. There was no significant correlation between DSB and MetS risk parameters. INTERPRETATION & CONCLUSIONS: Our findings showed a cumulative and synergistic effect of the risk factors of MetS on DSB. Individuals with three risk parameters had a greater effect on DNA damage than in those with two or one risk parameter. Although plasma H2O2level increased with an increase in the fat depots, use of H2O2to depict OS in MetS should be coupled with an adjunct and estimation of DSB in peripheral blood lymphocytes may be used as indicator of OS in MetS patients.

"Metabolic Syndrome and Its Risk Determinants in Sikkim": A Glimpse from a Hospital Study.

Sikkim has been reported to have the highest percentage of Diabetes Mellitus and Hypertension in the country. The study aimed to focus its precursor termed 'Metabolic Syndrome' (MetS) with special attention to its risk determinants as a measure to promote awareness in preventing the rise in number of these non communicable diseases in the state with only 6,10,577 inhabitants. Of 361 participants, 33.5% were diagnosed MetS as per the harmonized MetS criteria, 64.5% deemed non-MetS comprised of participants with "2 Risk", "1 Risk" and "0 Risk" for MetS, however not enough (3 or more) to be categorized as MetS. A "large WC + elevated BP + raised FBS"; "large WC + elevated BP" and "large WC" were the different types of risk combinations found frequently in the "3 Risk", "2 Risk" and "1 Risk" category respectively. MetS was most common among the females and highly found in 51-60 years of age. Ethnically "Bhutia/Lepcha/Tamang/Sherpa" were diagnosed with highest percentage of MetS followed by "Nepalese" and "Others". The chief contributing factor to compose MetS in the female population was a large WC. We conclude, Diabetes and Hypertension are indeed prevailing in Sikkim and that the presence of either an increased waist circumference or an elevated blood pressure mandates a check for the remaining four risk factors for MetS, rendering worthwhile to keep an account of MetS risk types by stratification to comprehend the influence of socio-cultural and ethno-geographical factors in causing MetS.

Oxidative stress in inflammatory cells of patient with rheumatoid arthritis: clinical efficacy of dietary antioxidants.

Rheumatoid arthritis (RA) is an autoimmune disease responsible for significant human morbidity in modern life. However, oxidative stress is one of the key markers for determining pathophysiology of patients with RA. The interaction between cellular immune system and body's endogenous and/or exogenous antigens produce reactive oxygen species (ROS) and reactive nitrogen species (RNS) in autoimmune disease like RA. ROS and RNS include highly toxic superoxide (O2-) and peroxynitrite (ONOO-) radicals, which activate the signaling cascades of inflammatory cells to synthesize pro-inflammatory cytokines and chemokines. Previous studies reported that Th1 cytokines could promote the development of autoimmune disorders like RA, whereas the Th2 cytokines may attenuate the same diseases. An increased awareness of the relationship between food and health led to a tremendous increase of antioxidant research in the last decade. Evaluation of the efficacy of dietary antioxidants is also becoming highly acceptable in RA research. A number of dietary phytomolecules are already established as having antioxidant activity in isolated synovial cellular infiltrate or peripheral blood neutrophils and lymphocytes. This review aims to highlight the oxidative stress in inflammatory cells of patients with RA and to summarize the clinical relevance of dietary antioxidants as a first step in assessing beneficial effect, safety and dose safety ratio in patients with RA.

Psycho-neuro-endocrine-immune mechanisms of action of yoga in type II diabetes.

Yoga has been found to benefit all the components of health viz. physical, mental, social and spiritual well being by incorporating a wide variety of practices. Pathophysiology of Type II DM and co-morbidities in Type II DM has been correlated with stress mechanisms. Stress suppresses body's immune system and neuro-humoral actions thereby aff ecting normal psychological state. It would not be wrong to state that correlation of diabetes with stress, anxiety and other psychological factors are bidirectional and lead to difficulty in understanding the interrelated mechanisms. Type II DM cannot be understood in isolation with psychological factors such as stress, anxiety and depression, neuro-endocrine and immunological factors. There is no review which tries to understand these mechanisms exclusively. The present literature review aims to understand interrelated Psycho-Neuro-Endocrine and Immunological mechanisms of action of Yoga in Type II Diabetes Mellitus. Published literature concerning mechanisms of action of Yoga in Type II DM emphasizing psycho-neuro-endocrine or immunological relations was retrieved from Pubmed using key words yoga, Type II diabetes mellitus, psychological, neural, endocrine, immune and mechanism of action. Those studies which explained the psycho-neuroendocrine and immune mechanisms of action of yoga were included and rest were excluded. Although primary aim of this study is to explain these mechanisms in Type II DM, some studies in non-diabetic population which had a similar pathway of stress mechanism was included because many insightful studies were available in that area. Search was conducted using terms yoga OR yogic AND diabetes OR diabetic IN title OR abstract for English articles. Of the 89 articles, we excluded non-English articles (22), editorials (20) and letters to editor (10). 37 studies were considered for this review. The postulated mechanism of action of yoga is through parasympathetic activation and the associated anti stress mechanism. It reduces perceived stress and HPA axis activation thereby improving overall metabolic and psychological profiles, increasing insulin sensitivity, and improving glucose tolerance and lipid metabolism. Yoga has positive effects on immune system of diabetics.- Overall, Type II DM is influenced by psycho-neuro-endocrine and immune mechanisms where Yoga has important positive role in combating stressors and improving these systems to regain health.

Fast foods and physical inactivity are risk factors for obesity and hypertension among adolescent school children in east district of Sikkim, India.

BACKGROUND: Obesity and hypertension among school children have a huge impact on public health. Hence, we estimated the prevalence and sociodemographic correlates of childhood obesity and elevated blood pressure (BP) among adolescent schoolchildren (11-19 years) in urban areas of Gangtok, Sikkim, India. MATERIALS AND METHODS: A population based cross-sectional study was conducted on 979 school children, during November 1, 2009 - April 30, 2010 in Gangtok, East Sikkim India. Anthropometric measurements and BP were recorded among the study population. Obesity and hypertension prevalent among adolescent school children and their correlates were analyzed. RESULTS AND CONCLUSION: Prevalence of obesity, overweight, and hypertension was 2.04%, 14.5% and 5.62%, respectively. The average fast food intake, screen time and limited outdoor activities were significantly associated with obesity. Increase in abdominal height positively correlated with increase in body mass index and body fat; however waist - hip ratio was not a reliable index. The burden of overweight/obesity as well as hypertension with all its associated risk was found to high among our study population, which necessitates framing of policies and actions at national level to address the risk associated with these noncommunicable diseases.

Cat's whiskers flavonoid attenuated oxidative DNA damage and acute inflammation: its importance in lymphocytes of patients with rheumatoid arthritis.

Cleome gynandra L. (Capparidaceae) is one of the vegetables commonly known as 'Hurhur' and 'Karaila' in India, 'Pe Hua Tsai' in China and "Cat's whiskers" in English. Present study was aimed to characterize previously isolated Cat's whiskers flavonoid as 5-hydroxy-3, 7, 4' -trimethoxyflavone (5HTMF) and to evaluate its effect on carrageenan-induced acute inflammation in rats and hydrogen peroxide induced DNA damage in mouse macrophages. The ex vivo effect of 5HTMF upon generation of free radicals in the mononuclear lymphocytes of patients with rheumatoid arthritis (RA) was also evaluated. 5HTMF not only reduce the swelling of hind paw in rats from 1 to 3 h of carrageenan injection but also decreased serum nitric oxide (NO) production. Toxic hydrogen peroxide induced oxidative DNA damage that was significantly decreased by 5HTMF. Though oxidative stress is a potential biomarker for determining disease activity in patients with RA, surprisingly 5HTMF inhibited the superoxide, hydroxyl and NO radicals in the isolated peripheral blood mononuclear lymphocytes of patients with RA. From the above study, it may be concluded 5HTMF attenuated acute inflammation by inhibiting NO and by protecting the oxidative DNA damage due to hydrogen peroxide scavenging property. It was also equally effective in scavenging the free radicals in lymphocytes of patients with RA. Collectively, our results indicate that 5HTMF as well as leafy vegetable of Cat's whiskers may be a promising nontoxic food alternative in attenuating the oxidative stress, meriting further studies on other human inflammatory cells.