Effect of intensive weight-loss intervention on metabolic, ultrasound and anthropometric parameters among patients with obesity and non-alcoholic fatty liver disease: an RCT.

BACKGROUND: Lifestyle intervention is the mainstay therapy for Non-Alcoholic Fatty Liver Disease (NAFLD). We aimed to assess the efficacy of an intensive (9 contact points in 6 months) weight-loss intervention among patients with obesity (BMI 25-39.9 kg/m2) and NAFLD in north India. METHODS: A total of 140 patients (18-60 years) with obesity and NAFLD were randomized into intervention (n = 70) and control (n = 70) groups, at a tertiary-care hospital. Weight, anthropometric parameters, Controlled Attenuation Parameter (CAP), Liver Stiffness Measurement (LSM), liver enzymes, grade of fatty liver and HOMA-IR were measured at baseline (T0) and 6 months (T6). There was a high drop-out, exacerbated by the Covid-19 pandemic. Completers comprised of 59 participants (n = 30 intervention, n = 29 control). Intention to treat analysis was done. RESULTS: At T6, ALT normalized in significantly higher (p = 0.03) number of cases in the intervention arm (66.7%) versus control arm (18.2%). No significant improvement was seen in other metabolic, ultrasound or anthropometric outcomes. Weight (p < 0.001), AST (p = 0.01), ALT (p = 0.02), body fat% (p < 0.001), WC (p < 0.001) and CAP (p < 0.001) significantly improved within the intervention arm along with a trend of improvement in steatosis and HOMA-IR. Control group showed significant decrease in weight (p < 0.001), WC (p < 0.001) and CAP (p = 0.02). Twice the number of patients in intervention arm (46.7%) lost ≥5% weight, compared to control arm (24.1%) (p = 0.07). CONCLUSION: The intensive weight-loss intervention was not effective in improving the treatment outcomes among patients with obesity and NAFLD. However, given the potential of our intervention, we recommend larger trials with more intensive weight-loss interventions.

Designing and Conducting Randomized Controlled Trials: Basic Concepts for Educating Early Researchers in the Field of Clinical Nutrition.

Randomized controlled trials (RCTs) provide the best quality evidence to steer patient care in the field of clinical nutrition. However, designing and conducting an RCT, analyzing data, interpreting and reporting its findings is rather complex for young researchers working in the field of clinical nutrition. This review article attempts to educate early researchers by offering a simple step by step guide on planning the key aspects (randomization, allocation concealment, blinding, outcome measures) of a trial, and highlighting the practical considerations (ethical clearance, trial registry, patient recruitment, trial monitoring) to be kept in mind while conducting a trial contextualised to clinical nutrition settings.

Perceived barriers and facilitators for adherence to lifestyle prescription: Perspective of obese patients with non alcoholic fatty liver disease from north India.

BACKGROUND AND AIMS: This study aims to identify the barriers and facilitators faced by obese patients with NAFLD from north India, while undergoing lifestyle-modification. METHODS: 30 obese patients with NAFLD were interviewed regarding the barriers and facilitators to lifestyle change and responses were noted. Inductive thematic analysis was used. RESULTS: Eight themes under barriers (lack of family support, difficult intervention, work-related, financial, psychological, social, physical and infrastructure related) and four themes under facilitators (family support, intensive nature of intervention, psychological and physiological) were identified from the reponses. CONCLUSIONS: Personalized and socio-culturally appropriate counseling strategies may promote successful treatment outcomes among these patients.

Applications of artificial intelligence to drug design and discovery in the big data era: a comprehensive review.

Artificial intelligence (AI) renders cutting-edge applications in diverse sectors of society. Due to substantial progress in high-performance computing, the development of superior algorithms, and the accumulation of huge biological and chemical data, computer-assisted drug design technology is playing a key role in drug discovery with its advantages of high efficiency, fast speed, and low cost. Over recent years, due to continuous progress in machine learning (ML) algorithms, AI has been extensively employed in various drug discovery stages. Very recently, drug design and discovery have entered the big data era. ML algorithms have progressively developed into a deep learning technique with potent generalization capability and more effectual big data handling, which further promotes the integration of AI technology and computer-assisted drug discovery technology, hence accelerating the design and discovery of the newest drugs. This review mainly summarizes the application progression of AI technology in the drug discovery process, and explores and compares its advantages over conventional methods. The challenges and limitations of AI in drug design and discovery have also been discussed.

Variation in Lifestyle-Related Behavior Among Obese Indian Patients With Non-alcoholic Fatty Liver Disease.

Lifestyle modification is the mainstay of treatment in Non-Alcoholic Fatty Liver Disease (NAFLD). Published Indian data on the diet and lifestyle of Indian NAFLD patients is scarce. This study explored variation in lifestyle-related behavior among obese patients with NAFLD. Ultrasonography (USG) diagnosed obese NAFLD patients (n = 140) were assessed for dietary intake [1-day 24 hours recall, food-frequency questionnaire (FFQ)] and physical activity (PA) [Global Physical Activity Questionnaire (GPAQ)]. Diet quality score (0-30) and physical activity (PA) levels were used to study variation in lifestyle and assess the effect of lifestyle on the severity of NAFLD. Compared to the recommendation, calorie consumption was 25.2% higher in nearly half (53.6%) of the subjects and mean macronutrient intake was imbalanced (60.3% carbohydrates, 12.4% protein, 25.5% fats). Variation was seen in terms of diet quality-good (3%), moderate (54.3%), or poor (43.5%) and intensity of PA-high (15%), moderate (47.9%), or low (37.1%). No patient had a combination of high PA and good diet quality within all grades of NAFLD. Our study suggests wide variation in lifestyles of obese patients with NAFLD and need for a more flexible and individualized modification of their diet and PA.

Industrially produced trans fat: Usage, health implications, global and indian regulations.

Global momentum is growing for the total elimination of industrially produced trans fats from the food systems as they are known to have deleterious health effects on various body functions particularly the cardiovascular health. Many developed nations such as Denmark have completely eliminated the use of industrially produced trans fats from the food supply. India is undergoing a significant nutrition transition that has substantially increased the intake of processed and ready-to-eat foods, abundant in trans fats. The Indian regulator-Food Safety and Standards Authority of India is all set to reduce the industrially produced trans fats to <2% by the end of year 2021 in a phased manner. Multiple strategies such as reducing trans fat limit in oils and fats, mandatory labeling on food products, introduction of "Trans-fat free" claim and logo have been adopted by the Indian regulatory body, to achieve the goal of trans fat free India. This review comprehensively summarizes from a public health perspective the usage of industrially-produced trans fats in Indian food industry, its effects on health, the global strategies to limit its content, and the current Indian regulations.

Orientation and dynamics of Cu2+ based DNA labels from force field parameterized MD elucidates the relationship between EPR distance constraints and DNA backbone distances.

Pulsed electron paramagnetic resonance (EPR) based distance measurements using the recently developed Cu2+-DPA label present a promising strategy for measuring DNA backbone distance constraints. Herein we develop force field parameters for Cu2+-DPA in order to understand the features of this label at an atomic level. We perform molecular dynamics (MD) simulations using the force field parameters of Cu2+-DPA on four different DNA duplexes. The distance between the Cu2+ centers, extracted from the 2 µs MD trajectories, agrees well with the experimental distance for all the duplexes. Further analyses of the trajectory provide insight into the orientation of the Cu2+-DPA inside the duplex that leads to such agreement with experiments. The MD results also illustrate the ability of the Cu2+-DPA to report on the DNA backbone distance constraints. Furthermore, measurement of fluctuations of individual residues showed that the flexibility of Cu2+-DPA in a DNA depends on the position of the label in the duplex, and a 2 µs MD simulation is not sufficient to fully capture the experimental distribution in some cases. Finally, the MD trajectories were utilized to understand the key aspects of the double electron electron resonance (DEER) results. The lack of orientational selectivity effects of the Cu2+-DPA at Q-band frequency is rationalized in terms of fluctuations in the Cu2+ coordination environment and rotameric fluctuations of the label linker. Overall, a combination of EPR and MD simulations based on the Cu2+-DPA labelling strategy can contribute towards understanding changes in DNA backbone conformations during protein-DNA interactions.

Lifestyle Intervention Framework for Obese Patients with Non-alcoholic Fatty Liver Disease - a Tool for Health Professionals in Resource Constraint Settings.

Purpose Non-alcoholic fatty liver disease (NAFLD), is recognized as a health care burden worldwide. Lifestyle modification remains the first line of treatment. However, the real challenge is ensuring the patient's adherence to lifestyle modification measures, especially in hospitals with resource-limited settings. Methods We developed a six-month-long, dietitian-led, hospital-based, lifestyle intervention framework for obese NAFLD patients and evaluated its content. Literature review, interviews, and discussions with 10 health experts (general physicians, dietitians/nutritionists, gastroenterologists, and a clinical psychologist) and 45 NAFLD patients (35 in Phase I and 10 in Phase II) in a tertiary hospital of India were carried out. Results The lifestyle intervention framework has unique features, such as an intensive nature to ensure adherence, a comprehensive educational format with clear guidelines, the customization of a prescription as per individual patient requirements, and a holistic approach to inculcate self-monitoring and behavioral change in NAFLD patients. Conclusion Health professionals worldwide can use this lifestyle intervention framework to develop counseling interventions for better adherence among obese NAFLD patients.

Development of a self-assessment tool for resident doctors' communication skills in India

PURPOSE: Effective communication skills are essential for resident doctors to provide optimum patient care. This study was conducted to develop and validate a questionnaire for the self-assessment of resident doctors' communication skills in India. METHODS: This was a mixed-methods study conducted in 2 phases. The first phase consisted of questionnaire development, including the identification of relevant literature, focus group discussions with residents and experts from clinical specialties, and pre-testing of the questionnaire. The second phase involved administering the questionnaire survey to 95 residents from the Departments of Medicine, Emergency Medicine, Pediatrics, and Surgery at the All India Institute of Medical Sciences, New Delhi, India in April 2019. Internal consistency was tested and the factor structure was analyzed to test construct validity. RESULTS: The questionnaire consisted of 3 sections: (A) 4 items on doctor-patient conflicts and the role of communication skills in avoiding these conflicts, (B) 29 items on self-assessment of communication skills in different settings, and (C) 8 items on barriers to practicing good communication skills. Sections B and C had good internal consistency (Cronbach α: 0.885 and 0.771, respectively). Section C had a 2-factor solution, and the barriers were classified as 'training' and 'infrastructure' factors. CONCLUSION: This appears to be a valid assessment tool of resident doctors' communication skills, with potential utility for identifying gaps in communication skills and developing communication skills modules.

Questionnaire to assess adherence to diet and exercise advices for weight management in lifestyle-related diseases.

BACKGROUND: Lifestyle-related diseases have assumed significant public health problem across the globe including developing nations. High rate of nonadherence to treatment poses challenges to family physicians in its treatment. OBJECTIVE: To develop a valid and reliable questionnaire for assessment of adherence to lifestyle modification advices. MATERIALS AND METHODS: The questionnaire was developed following a systematic, scientifically accepted methodology which included literature review, focused group discussions, detailed interviews, and expert evaluation. Comprehensibility, replicability, face validity, content validity, patient acceptance, and ease of usage of the questionnaire were analyzed. Five-point Likert scale was employed as response options. Cronbach's alpha was calculated to assess internal consistency of overall questionnaire. A cross-sectional survey was then performed on 100 obese patients with nonalcoholic fatty liver disease to validate the questionnaire. RESULTS: The developed questionnaire consists of 14 questions under two domains, 12 items under diet and 2 items under the physical activity domain. Each of these questions is on a 5-point Likert scale. The tool has shown satisfactory validity. It also has adequate reliability and internal consistency with Cronbach's alpha value of 0.9. CONCLUSION: It is a valid and reliable tool which can be used in clinical practice to assess adherence to lifestyle modification advices by family physicians.

Development and Validation of a Questionnaire Assessing Knowledge, Attitude, and Practices about Obesity among Obese Individuals.

AIM: The objective of this study was to develop and validate a knowledge, attitude, and practice (KAP) questionnaire about obesity among obese individuals. MATERIALS AND METHODS: The questionnaire was developed following a standardized protocol that consisted of literature review, focused group discussions, and expert opinion. A cross-sectional survey on 100 obese individuals was carried out to validate the tool. Exploratory factor analysis was performed, using principal component with varimax rotation, to establish the construct validity of the questionnaire. Internal consistency of the questionnaire was tested using Cronbach's α coefficient. RESULTS: KAP questionnaire with 42 items categorized under three domains knowledge, attitude, and practices was developed. The KAP sections have 14, 15, and 13 items, respectively. Independent Cronbach's α for KAP domains were 0.75, 0.75, and 0.63, respectively, indicating good internal consistency. CONCLUSION: The developed questionnaire will be helpful in achieving better understanding of the patients' KAP about obesity. It has satisfactory validity and good internal consistency.

Development and Validation of Health Education Tools and Evaluation Questionnaires for Improving Patient Care in Lifestyle Related Diseases.

Lifestyle related diseases continue to be a significant burden on the health care system. Health education is a combination of educational strategies that promote voluntary adoption of healthy lifestyle choices and dietary behaviour. The use of simple and validated education and evaluation tools is now increasing in routine clinical practice to aid health status evaluation and communication between the patient, dietitian and the health care provider. Development of effective health education materials is a systematic process which starts with setting up the goals for education, followed by literature review and focus group discussion, content selection, designing the rough draft, seeking expert comments and validation. Questionnaire development should follow a logical and structured approach. Item generation should be based on extensive literature search and target group participation. Validation by the experts makes the questionnaire more meaningful, trustworthy and applicable. Considerable effort goes into designing and testing of these tools in order to ensure that they are effective. For enhancing clinical, dietetic and educational practice, it is pertinent to learn the process of developing these tools scientifically.

Utilization of Intraoperative Real-time Three-Dimensional Transoesophageal Echocardiography to Objectively Assess Improvement in Synchronization and Regional Wall Motion after Coronary Reperfusion.

It is well known that myocardial ischemia leads to Regional Wall Motion Abnormalities (RWMAs) and reversible depression of Left Ventricular (LV) systolic function. Transoesophageal Echocardiography (TEE) is an established tool for early diagnosis of new RWMAs. However, evaluation of RWMAs by echocardiography is largely qualitative and relies on visual assessment of wall segments. Evaluation of LV systolic function and Ejection Fraction (EF) is more reproducible and accurate with Real-Time 3D Echocardiography (RT3DE) as compared with two-dimensional and M-mode techniques. Primary advantages for RT3DE are fast and largely automated volumetric analysis of LV function and LV volumes, without geometric assumptions and risk of underestimating volumes in foreshortened views. This case illustrates the use of intraoperative RT3DE during coronary artery bypass surgery to objectively assess: LV systolic function with LV volumes and RWMAs and improvement in cardiac synchronization following coronary reperfusion.

Genome Sequences of Gordonia terrae Bacteriophages Phinally and Vivi2.

Bacteriophages Phinally and Vivi2 were isolated from soil from Pittsburgh, Pennsylvania, USA, using host Gordonia terrae 3612. The Phinally and Vivi2 genomes are 59,265 bp and 59,337 bp, respectively, and share sequence similarity with each other and with GTE6. Fewer than 25% of the 87 to 89 putative genes have predictable functions.

Partial Kluver-Bucy syndrome secondary to tubercular meningitis.

Tubercular meningitis (TBM) is a devastating extra pulmonary manifestation of tuberculosis and demonstrates a high neurological morbidity. A rare complication of this condition is Kluver-Bucy syndrome (KBS), which is a neurobehavioral disorder characterised by hyper-sexuality, visual agnosia, bulimia, placidity, hyperorality and memory deficits caused by lesions to the amygdala. The amygdala lesions can be due to many causes, including traumatic brain injury, systemic conditions and infections such as tuberculosis. Here, we present a case of partial KBS in a patient undergoing treatment for TBM.

Designing molecular devices by altering bond lengths.

The work focuses on a theoretical approach to investigating the electric field (EF) dependence of bond-length alternation, the geometric and electronic structures of molecular wires used in the design of molecular electronic devices, the EF dependence of SCF energy, and the spatial distribution of the frontier orbitals of the molecular wires. Just as the bond length is an important influence on the conductance of the molecular wire, the dependence of the conductance on the chain length was also studied. We have also investigated how the current-voltage (I-V) characteristics change with bond length, as the bond length plays an important role in determining the conductance of molecular wires.