Is the rural population of Puducherry district healthy in terms of the burden of non-communicable diseases? Findings from a cross-sectional analytical survey.

INTRODUCTION: Epidemiological transition remains a key contributor to the rising prevalence of non-communicable diseases (NCDs) across developing nations. Population-specific NCD risk factors estimates derived using World Health Organization (WHO) 'STEP-wise approach' are crucial for devising evidence-based public health interventions to combat NCDs. OBJECTIVE: To estimate the prevalence of behavioral and biological risk factors for NCDs among the rural adult population of Puducherry district in India. METHODOLOGY: STEPS survey was conducted by following all three steps (behavioral, physical measurements and biochemical risk factors) of NCD risk factor assessment. A total of 790 participants were selected from 50 villages through multistage cluster sampling method. STEPS instrument was used to assess behavioral risk factors, physical measurements and biochemical (fasting blood glucose and total cholesterol) risk factors. RESULTS: Tobacco use and alcohol consumption were present among 11.3% (95% Confidence Interval (CI): 9-13.6%) and 19.2% (95% CI: 16.5-22.4%) of the population, respectively. Low physical activity, inadequate intake of fruits and vegetables, overweight and obesity were observed among 29.3% (95% CI: 26.2-32.7%), 89.8% (95% CI: 87.6-92%), 15.6% (95% CI: 13.1-18.3%) and 38.9% (95% CI: 35.4-42.2%), respectively. About 28.2% (95% CI: 25.2-31.6%) had hypertension and 24.4% (95% CI: 20-29%) had diabetes mellitus. Abdominal obesity was twice highly prevalent among women. Tobacco and alcohol use were more common among men, whereas low physical activity, obesity and hypercholesterolemia were higher among women. CONCLUSION: Public health interventions to promote healthy lifestyle need to be initiated especially to increase physical activity, intake for fruits and vegetables, and quitting of tobacco and alcohol consumption in the rural population of Puducherry.

Effect of metformin on thyroid function tests in patients with subclinical hypothyroidism: an open-label randomised controlled trial.

PURPOSE: Though most of the observational studies have shown that metformin can reduce serum thyroid stimulating hormone (TSH) level in patients of hypothyroidism with diabetes or polycystic ovarian disease, randomised controlled trials are sparse. The primary objective of this study was to evaluate the effect of metformin on thyroid function tests (TSH, free T4, and free T3) in patients with subclinical hypothyroidism (SCH). METHODOLOGY: In this open label, parallel arm, randomised controlled trial, 60 patients of SCH (TSH 5.5-10 mIU/L) were randomised to either metformin group (1500 mg/day) or control group. RESULT: A total of 46 patients (23 in each group) completed the study and no significant difference in serum TSH, free T4 or free T3 was found in between the 2 groups. Neither there was any significant change in serum TSH, free T4 or free T3 (pre and post 6 months) within the individual groups. However, the rate of normalisation of serum TSH in patients with negative thyroid antibody was significantly higher than patients with positive thyroid antibody (71.4% vs. 18.8%; P = 0.026) in metformin group in post hoc analysis. Fasting plasma glucose, serum high-density lipoprotein and indices of insulin sensitivity significantly improved in metformin group. Four patients (17%) had mild gastrointestinal adverse effects in the metformin group. CONCLUSION: We did not find any significant change in thyroid function test in patients with SCH with metformin therapy.

Effect of cabergoline monotherapy in Cushing's disease: an individual participant data meta-analysis.

CONTEXT: The primary treatment of choice for Cushing's disease (CD) is the removal of the pituitary adenoma by transsphenoidal surgery (TSS). The surgical failure is seen in up to 75% of cases depending on the experience of the surgeon in different studies. Medical therapy is one of the options for the treatment of recurrent or persistent CD. METHODOLOGY: The primary outcome of this meta-analysis was to find the proportion of patients achieving normalisation of 24-h urinary free cortisol (remission of CD) following cabergoline monotherapy. Literature search was conducted in January 2018 in PubMed/MEDLINE database from its date of inception to 31st December 2017. The search strategy used was "[(cushing) OR Cushing's] AND cabergoline". Individual participant data were extracted from the included studies and risk of bias was analysed by review checklist proposed by MOOSE. RESULTS: The individual participant data of 124 patients from six observational studies were included in this meta-analysis. 92 patients (74.2%) had past pituitary surgery. The proportion of patients achieving remission of Cushing's disease (CD) with cabergoline monotherapy was 34% (95% confidence interval 0.26­0.43; P = 0.001) [corrected]. The previous surgery [odds ratio (OR) 28.4], duration of cabergoline monotherapy (OR 1.31) and maximum cabergoline dose (OR 0.19) were predictors for remission of CD. Mild and severe side effects were reported in 37.3% and 5.6% of patients, respectively, during cabergoline monotherapy. CONCLUSIONS: This meta-analysis shows that cabergoline monotherapy is a reasonable alternative for subjects with persistent or recurrent CD after TSS. It can also be used in CD patients either as a bridge therapy while waiting for surgery or in those unwilling for surgery or have contraindication to it.

Comparative evaluation of hormonal protocol on the performance of crossbred cattle.

A total of 60 animals (38 cows, 22 heifers) were selected and were divided into three groups of 20 animals each (containing both anoestrus and repeat breeder) in which treatment was performed for 60 days. Group I: control (farmer practice), T1 group: group I + hormone (double synch), and T2 group: group I + hormone (Estra double synch). The growth performances were measured in terms of body weight and average daily gain (ADG). Blood collection was done at the start and end of the experiment for assessment of blood biochemical, hematological, and reproductive status of the animals. Results revealed significant improvement in growth and reproductive performances in treatment group as compared to control group. Higher percentage of conception was achieved in group III (60%) followed by group II (55%). The least percentage was in group I (15%), i.e., in control group. So it was found that the effect of treating the reproductive-disordered animals with Estra double synch gave comparatively better result than double synch hormonal application.

Public health response to the first case of Japanese encephalitis in Delhi, 2011.

Japanese Encephalitis (JE) is an acute viral zoonotic infection of the central nervous system. A confirmed case of JE was reported in the MVH, Pooth Khurd, following which the epidemiological investigation was carried out in the study area. Clinical/Syndromic surveillance started in the hospital. The local practitioners and anganwadi workers were contacted and requested to report similar cases in their areas. Serosurveillance to delineate high risk population, animal and vector survey done by taking transect walks through the colony to look for presence of amplifying hosts like pigs, ducks etc. Out of 2328 persons surveyed, 404 persons were found to have/had fever in the preceding one month. Current fever cases were 166, out of which 9 fitted into the criteria of AES. Large water body with vegetations was present within the colony. Piggeries and ducks were found in the colony. In the hospital 9 AES cases were screened. In total only 18 (9 from field, 9 from hospital) cases subjected to testing and found to be negative for IgM specific for JE. In total only 18 (9 from field, 9 from hospital) cases subjected to testing and found to be negative for IgM specific for JE. Most probably the above case of nine year child is the first case of JE indigenous to Delhi. The environmental conditions were conducive for the transmission of the viral agent. Further research is hence recommended to find the missing links and to prevent outbreaks in Delhi.

Relationship between Insulin Resistances with Autonomic Functions in Patients with Type 2 Diabetes in South Indian Population.

Cardiovascular disease (CVD) and type 2 diabetes mellitus (T2D) are major health concerns In India. Insulin resistance (IR) itself is a risk factor for CVD. Though it is associated to sympathetic activity this relation may get altered in presence of obesity. Therefore, in the present study we measured the link of IR, with their body mass index (BMI) and the corresponding degree of alteration in various autonomic function tests in T2D patients. It was an observational study conducted in a tertiary care hospital for a period of six months. Eighty-five T2D patients visiting medicine OPD were recruited out of which 17 were normal, 31 were overweight and 31 were obese as per WHO criteria of obesity. Their glucose, insulin, insulin resistance was analyzed in fasting blood samples. Conventional autonomic function tests such as isometric hand-grip test and deep breathing test was digitally recorded. Heart rate variability was recorded as LF: HF ratio. The Rate-pressure product (RPP), the marker of myocardial work stress was calculated from systolic blood pressure and basal heart rate. E: I ratio was calculated from RR interval from ECG tracing. Insulin resistance was positively associated with increased basal heart rate. It was linked to increase LF: HF ratio even after controlling for BMI. Regression analysis showed insulin resistance to be an independent factor for sympathovagal imbalance in T2D patients. The severity of insulin resistance independently predicts degree of deterioration in sympathovagal imbalance as measured in LF: HF ratio in our study which is independent of their degree of obesity.

Quality evaluation of functional chicken nuggets incorporated with ground carrot and mashed sweet potato.

This study was envisaged to evaluate the effect of ground raw carrot (0%, 5%, 10% and 15%) and mashed sweet potato (0%, 5%, 10% and 15%) as functional ingredients on the quality of chicken meat nuggets. The products were evaluated for physicochemical quality, proximate composition, nutritive value, sensory quality as well as color and texture profile analyses. Additions of either raw carrot or mashed sweet potato represent an improvement in the nutritional value and have some beneficial effects due to the presence of dietary fibers and ß-carotene. They were also found to be effective in sustaining the desired cooking yield and emulsion stability. Treated samples showed lower (p > 0.05) protein, fat and ash contents but higher (p < 0.05) moisture content than control. There were differences among the nugget samples with respect to sensory qualities, and control samples as well as samples with 10% added carrot/sweet potato had higher overall acceptability scores. Hunter color values (L*, a* and b* values) were higher (p < 0.05) for both the formulated products, while their textural parameters were nearly unchanged. In conclusion, carrot and sweet potato at 10% added level have greater potential as good source of dietary fibers and ß-carotene and may find their way in meat industry.

Efficacy of soy protein isolate as a fat replacer on physico-chemical and sensory characteristics of low-fat paneer.

The nutritional and textural properties of low fat paneer using soy protein isolate (SPI) as fat replacer was investigated. The physico-chemical and sensory characteristics of 4 types of paneer made of low-fat milk (3% milk fat (MF) and 10% solids-not-fat (SNF)) and SPI of 0 (T1), 0.1 (T2), 0.2 (T3) and 0.3% SPI (T4) were compared with high fat paneer (TC) made of high fat milk (6% MF and 9% SNF). CaCl2 (0.2%, w/v) was used as coagulant at 75 ± 1°C. Increased level of SPI in paneer increased yield, protein, ash, moisture content and decreased fat, moisture protein ratio, lactose and calorie contents. Titratable acidity and pH varied in narrow range. Instrumental firmness was higher (p ≤ 0.05) in T1-T4 than in TC. The gumminess, chewiness and firmness showed the same trend. Resilience and cohesiveness values showed no significant difference among the samples. Hunter colour L values showed a decreasing, and a and b values increasing trend with increasing levels of SPI. Sensory appearance and colour scores were lower (p ≤ 0.05) for T1-T4 than TC. More than 0.2% SPI imparted beany flavour to paneer.

Formulation of sustained-release dosage form of verapamil hydrochloride by solid dispersion technique using Eudragit RLPO or Kollidon SR.

The release of verapamil hydrochloride from tablets with Eudragit RLPO or Kollidon SR with different drug-to-polymer ratios were investigated with a view to develop twice-daily sustained-release dosage form by solid dispersion (SD) technique. The SDs containing Eudragit RLPO or Kollidon SR at drug-polymer ratios of 1:1, 1:2, and 1:3 with verapamil hydrochloride were developed using solvent evaporation technique. The physical mixtures of drug and both polymers were prepared by using simple mixing technique at the same ratio as solid dispersion. The physicochemical properties of solid dispersion were evaluated by using Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), and differential scanning calorimetry (DSC). The study of DSC, XRD, and FTIR could not show significant interaction between verapamil HCl and Kollidon SR or Eudragit RLPO. The solid dispersions or physical mixtures were compressed to tablets. The tablets were prepared with solid dispersions containing Eudragit RLPO or Kollidon SR, with all the official requirements of tablet dosage forms fulfilled. Tablets prepared were evaluated for the release of verapamil hydrochloride over a period of 12 h in pH 6.8 phosphate buffer using US Pharmacopoeia type II dissolution apparatus. The in vitro drug release study revealed that the tablet containing Eudragit has extended the release rate for 12 h whereas the tablet containing Kollidon SR at the same concentration has extended the release rate up to 8 h. The in vitro release profile and the mathematical models indicate that release of verapamil hydrochloride can be effectively controlled from a tablet containing solid dispersions of Eudragit RLPO. The reduction of size fraction of the SD system from 200-250 to 75-125 microm had a great effect on the drug release.

Comparative study of propranolol hydrochloride release from matrix tablets with KollidonSR or hydroxy propyl methyl cellulose.

The release of propranolol hydrochloride from matrix tablets with hydroxy propyl methyl cellulose (HPMC K15M) or KollidonSR at different concentrations was investigated with a view to developing twice daily sustained release dosage form. A hydrophilic matrix-based tablet using different concentrations of HPMC K15M or KollidonSR was developed using direct compression technique to contain 80 mg of propranolol hydrochloride. The resulting matrix tablets prepared with HPMC K15M or KollidonSR fulfilled all the official requirements of tablet dosage forms. Formulations were evaluated for the release of propranolol hydrochloride over a period of 12 h in pH 6.8 phosphate buffer using USP type II dissolution apparatus. Propranolol hydrochloride and pure KollidonSR or HPMC K15M compatibility interactions was investigated by using Fourier-transform infrared (FTIR) spectroscopy and differential scanning calorimetry (DSC). FTIR spectroscopic and DSC studies revealed that there was no well defined chemical interaction between propranolol hydrochloride with KollidonSR or HPMC K15M. Tablets were exposed to 40 degrees C/75% of RH in open disc for stability. The in vitro drug release study revealed that HPMC K15 at a concentration of 40% of the dosage form weight was able to control the release of propranolol hydrochloride for 12 h, exhibit non-Fickian diffusion with first-order release kinetics where as at 40% KollidonSR same dosage forms show zero-order release kinetics. In conclusion, the in vitro release profile and the mathematical models indicate that release of propranolol hydrochloride can be effectively controlled from a single tablet using HPMC K15M or KollidonSR matrix system.

Enhancement of dissolution rate of gliclazide using solid dispersions with polyethylene glycol 6000.

The aim of the present study was to enhance the dissolution rate of gliclazide using its solid dispersions (SDs) with polyethylene glycol (PEG) 6000. The phase solubility behavior of gliclazide in presence of various concentrations of PEG 6000 in 0.1 N HCl was obtained at 37 degrees C. The solubility of gliclazide increased with increasing amount of PEG 6000 in water. Gibbs free energy (deltaG(o)(tr)) values were all negative, indicating the spontaneous nature of gliclazide solubilization and they decreased with increase in the PEG 6000 concentration, demonstrating that the reaction conditions became more favorable as the concentration of PEG 6000 increased. The SDs of gliclazide with PEG 6000 were prepared at 1:1, 1:2 and 1:5 (gliclazide/PEG 6000) ratio by melting-solvent method and solvent evaporation method. Evaluation of the properties of the SDs was performed by using dissolution, Fourier-transform infrared (FTIR) spectroscopy, differential scanning calorimetry (DSC) and X-ray diffraction (XRD) studies. The SDs of gliclazide with PEG 6000 exhibited enhanced dissolution rate of gliclazide, and the rate increased with increasing concentration of PEG 6000 in SDs. Mean dissolution time (MDT)of gliclazide decreased significantly after preparation of SDs and physical mixture with PEG 6000. The FTIR spectroscopic studies showed the stability of gliclazide and absence of well-defined gliclazide-PEG 6000 interaction. The DSC and XRD studies indicated the microcrystalline or amorphous state of gliclazide in SDs of gliclazide with PEG 6000.

A comparative study of controlled release matrix tablets of diclofenac sodium, ciprofloxacin hydrochloride, and theophylline.

The need for controlled release formulations for diclofenac sodium, ciprofloxacin, and theophylline is well recognized. In our study, controlled release tablets of the three drugs were formulated by the matrix-embedding technique using ethyl cellulose as retardant. Tablets of all the drugs were of good physical quality with respect to appearance, drug content uniformity, hardness, weight variation, and friability. In vitro release rate studies showed that ethyl cellulose extended the release of the three drugs to 12 hr or more. Release patterns from formulations of the three drugs followed Higuchi's square root kinetics. At pH 6.8, the release rate was higher in all three drugs, probably due to increased solubility of the drugs and/or increased swelling of ethyl cellulose at the higher pH. The formulations were highly stable and possessed reproducible release kinetics across batches.

Quality improvement of ground buffalo meat by preblending with sodium ascorbate.

Ground buffalo meat (GBM) was preblended with sodium ascorbate (SA) at 0, 300, 400, 500 and 600 ppm level and was examined for its quality changes during refrigerated storage at 4±1 °C. It was observed that GBM containing 500 ppm SA had significantly higher pH, visual colour and odour, lovibond tintometer red colour units (LTCU 'R') and chroma; lower cooking loss, metmyoglobin content and TBARS number as compared with other levels of SA. TBARS number was highly correlated with metmyoglobin and inversely with odour score; visual colour was negatively correlated with metmyoglobin, aerobic mesophiles count and psychrotrophs plate count. SA at 500 ppm is found to be optimum level for preblending which extended the shelf life of GBM from 4 to 8 days under refrigerated storage.

Effect of natural antioxidants and vacuum packaging on the quality of buffalo meat nuggets during refrigerated storage.

Buffalo meat nuggets (BMN) were incorporated with 500 ppm sodium ascorbate, 10 ppm α-tocopherol acetate and 0.5% sodium tripolyphosphate while processing. There were three experimental groups of BMN, namely control aerobic packaged (CAP), treated aerobic packaged (TAP) and treated vacuum packaged (TVP), refrigerated and stored at 4 °C. It was observed that the treated samples (TAP and TVP) had significantly (p < 0.05) higher pH, W-B shear force, moisture and protein contents, sensory attributes and lower free fatty acids content in comparison to CAP samples. Vacuum packed nuggets (TVP) had significantly (p < 0.05) lower free fatty acid content, higher lactobacilli and total anaerobe counts and markedly higher scores for flavour and overall palatability, even at the 25th day of storage. Product quality reduced as storage time increased. Use of natural antioxidants and vacuum packaging extended the shelf life of BMN from 10 to 30 days under refrigerated storage.

Improvement in the quality of ground chevon during refrigerated storage by tocopherol acetate preblending.

A study was conducted on α-tocopherol acetate (TA) preblending at 0, 6, 8, 10, 12 and 14 ppm levels with ground chevon (GC) obtained from adult male Beetal×Black Bengal goat carcasses, to identify the optimum level of TA required for improving the quality of the meat during refrigerated storage. It was observed that the GC samples preblended with 10 ppm TA had significantly (P<0.05) higher WHC%, colour score, odour score and lower metmyoglobin (MMb) per cent, TBARS number, peroxide value, free fatty acids per cent and psychrotrophic plate count as compared to other TA levels. All the quality parameters studied showed a highly significant (P<0.01) correlation (r-value) between each other. A strong relationship was observed between TBARS number and MMb% during refrigerated storage. A regression equation (Y=0.2800+0.0055X, where Y=TBARS number, X=MMb%) was established. It was concluded that 10 ppm TA was the optimum level for preblending with ground chevon, which extends the shelf life of the meat up to 7 days as compared to 3 days in the control samples during refrigerated storage.

Antioxidant potential of curry (Murraya koenigii L.) and mint (Mentha spicata) leaf extracts and their effect on colour and oxidative stability of raw ground pork meat during refrigeration storage.

The aim of this study was to investigate the antioxidant activity of different solvent extracts of curry and mint leaf and their effect on colour and oxidative stability of raw ground pork meat stored at 4 ± 1°C. The results indicated that among the two individual leaf categories, the ethanol extract of curry leaf (EHEC) and the water extract of mint leaf (WEM) showed higher DPPH and ABTS(+) activity. EHEC also exhibited the highest total phenolic contents while these were the lowest for WEM. WEM showed the highest superoxide anionic scavenging activity (%). The pork meat samples treated with EHEC and WEM showed a decrease in the Hunter L- and a-values and a increase in b-value during storage at 4°C. However, the pH and TBARS values were higher in control samples irrespective of storage periods. In conclusion, EHEC and WEM have the potential to be used as natural antioxidants to minimise lipid oxidation of pork products.

Prospective comparison of new Japanese Association for Acute Medicine (JAAM) DIC and International Society of Thrombosis and Hemostasis (ISTH) DIC score in critically ill septic patients.

INTRODUCTION: We prospectively compared the new Japanese Association for Acute Medicine (JAAM) score with the International Society of Thrombosis and Hemostasis (ISTH) score for diagnosis of disseminated intravascular coagulation (DIC) in septic patients admitted in a general critical care intensive care unit. MATERIAL AND METHOD: Septic patients with platelet count of <150 × 10(9)/L were included. Both DIC scores were estimated from day 1 to day 4 along with APACHE II and SOFA scores. RESULTS: Out of the 148 blood samples drawn from 42 patients (28 male & 14 female) the JAAM and ISTH DIC scores had an overall significant agreement (k=0.246, p<0.001) in 83 samples. JAAM score had higher diagnostic rates on all four days. Significant (p ≤ 0.001) day wise variation existed in JAAM and ISTH DIC scores. Correlation between JAAM DIC and ISTH DIC scores on day 1 (r=0.631) & day 4 (r=0.609) was significant (p<0.001). Pneumonia was the predominant cause of sepsis. Twenty seven (64.3%) patients died during their stay in ICU. Amongst DIC patients both severity scores (SOFA/APACHE II) and DIC scores (JAAM/ISTH) did not discriminate between survivors and non-survivors. Health care associated infection (p=0.040), high lactate levels (p=0.020) on day 1 and high procalcitonin levels (p=0.036) were found to have significant discriminating ability between survivors and non-survivors. Significantly shorter length of stay was observed amongst non-survivors (p=0.002). CONCLUSIONS: In sepsis the JAAM DIC score identified most of the patients diagnosed by the overt ISTH criteria, but failed to discriminate between survivors and non-survivors amongst DIC patients.