Correlation of Surrogate Markers of Insulin Resistance with Fasting Insulin in Type 2 Diabetes Mellitus Patients: A Study of Malwa Population in Punjab, India.

Context Insulin resistance (IR) and abnormal insulin secretion play a key role for the development of type 2 diabetes mellitus (DM). Aims We investigated the surrogate markers of IR, i.e., Homeostasis Model Assessment (HOMA), Quantitative Insulin Sensitivity Check Index (QUICKI), McAuley, and Fasting Insulin Resistance Index (FIRI) in type 2 DM patients. Also, fasting insulin (FI) levels were estimated in type 2 diabetics. Further, the correlation of FI with other surrogate markers of IR in type 2 DM was done. Settings and Design A hundred newly diagnosed patients with type 2 DM from Malwa population, Punjab, were considered for evaluation. Another 100 healthy individuals (age and sex-matched) were examined as controls. Methods and Material Fasting blood glucose, FI, and lipid profile were estimated, and IR was calculated using McAuley index (McA), HOMA, QUICKI, and FIRI. Statistical Analysis Used The statistical analysis was performed on the above-mentioned clinical interpretations. The Cohen's kappa test was used to affirm the agreement. Results FI levels in patients with type 2 diabetes were significantly higher (20.8 ± 9.05 µIU/L) than controls (7.93 ± 1.01 µIU/L). IR by surrogate markers was found significant in the study group. The 76% patients with type 2 diabetes ended up as resistant to insulin by FI measurement, almost equivalent to McA, 80%; HOMA, 88%; FIRI, 88%; and QUICKI, 90%. A notable correlation was highlighted between FI and McA manifesting IR ( p < 0.01, r = -0.85). We calculated the statistical correlation of FI with HOMA, QUICKI, and FIRI indices ( p < 0.01, r = 0.93; p < 0.01 r = -0.92; and p < 0.01, r = +0.93, respectively). The agreement visible from Cohen's kappa test also affirms the same ( k = 0.9 for McA). Conclusion We concluded that all the surrogate markers for IR were specific when compared with FI, but in terms of sensitivity McA was found to be more sensitive as it includes markers of dyslipidemia, which is the precipitating factor of metabolic derangements so as the IR in type 2 DM.

Potential role of noninvasive biomarkers during liver fibrosis.

Various types of liver disease exist, such as hepatitis and alcoholic liver disease. These liver diseases can result in scarring of liver tissue, cirrhosis, and finally liver failure. During liver fibrosis, there is an excess and disorganized accumulation of extracellular matrix (ECM) components which cause the loss of normal liver cell functions. For patients with chronic liver disease, fibrosis prediction is an essential part of the assessment and management. To diagnose liver fibrosis, several invasive and noninvasive markers have been proposed. However, the adoption of invasive markers remains limited due to their inherent characteristics and poor patient acceptance rate. In contrast, noninvasive markers can expedite the clinical decision through informed judgment about disease stage and prognosis. These noninvasive markers are classified into two types: Imaging techniques and serum biomarkers. However, the diagnostic values of biomarkers associated with liver fibrosis have also been analyzed. For example, the serum levels of ECM proteins can react to either matrix accumulation or degradation. During virus-host interactions, several regulatory steps take place to control gene expression, such as the change in cellular microRNA expression profiles. MicroRNAs are a class of non-coding RNAs (18-20 long nucleotides) that function by post-transcriptional regulation of gene expression. Although various noninvasive markers have been suggested in recent years, certain limitations have restricted their clinical applications. Understanding the potential of non-invasive biomarkers as a therapeutic option to treat liver fibrosis is still in progress.

Prevention of Parent to Child Transmission of HIV: Single Centre Experience of 14 years at Tertiary Care Hospital in Delhi, India.

INTRODUCTION: Prevention of Parent To Child Transmission (PPTCT) of HIV/AIDS is an integral component of AIDS control programme. PPTCT is an ongoing programme since last 15 years. AIM: The aim of the study was to evaluate the reduction in the burden of disease in newborn and infants by prevention of parents to child transmission of HIV/AIDS. MATERIALS AND METHODS: This retrospective study was conducted at Department of Obstetrics and Gynecology in a tertiary care hospital of Delhi from May 2002 to May 2015. The data was collected from records of maternal details registered at PPTCT clinic as well as list of infants undergoing Early Infant Diagnosis (EID) recorded in the standard format as per instructions from National AIDS Control Organization (NACO) of India. The Programme performance was assessed against performance indicators stated by NACO, India. RESULTS: Evaluation was done by dividing study period into two halves of seven years each. Out of 2,52,447 new antenatal case registration, overall, 43% received pretest of which, 91% were tested. Antenatal seropositivity rate varied from 0.1%-0.25%. Of 243 seropositive antenatal women 187 partners tested positive. While 25 women opted for MTP, 15 had still births. There were 17 neonatal deaths at 3-12 months attributable to respiratory infections and diarrheal diseases. Operative delivery rates declined from 50% to 31% over the years. Most women opted for breast feeding. The lost to follow up rate of newborns was quite high with details of only 43.5% being available at 18 months of infant's age. A total of three infants tested HIV positive at 18 months of age. CONCLUSION: The study highlights the practical aspects of policy implementation and operational issues involved in low resource country.

Degloving Injury of Bowel: An Unheard Complication of Surgical Abortion.

Unsafe abortion is one of the leading causes of maternal mortality. Various types of intestinal injury in form of haematoma, perforation, contusion and transection have been reported. Degloving injury of intestine is one of the rarest complications. We report a case of 32-year-old lady Gravida 4, para 3 admitted with history of induced surgical abortion by a quack with degloving injury to bowel. Though there was no fecal soiling of peritoneal cavity but large segment of bowel was lost. She was managed by end ileostomy and discharged in stable condition.

Forgotten Vaginal Foreign Body Presenting as Cervical Dystocia.

Generally encountered in paediatrics age group, vaginal foreign body is a rare presentation in gynaecological clinics. Inserted as a part of sexual abuse, gratification or psychiatric disorder, these foreign bodies can present with a varied symptomatology. We report a case of 22-year-old female, a victim of domestic violence, who had a foreign body inserted in the vagina which was forgotten. Later it was discovered when she presented at term with cervical dystocia.

A Comparative Evaluation of Fixation Techniques in Anterior Mandibular Fractures Using 2.0 mm Monocortical Titanium Miniplates Versus 2.4 mm Cortical Titanium Lag Screws.

OBJECTIVE: To compare the efficacy and surgical outcome of treatment of anterior mandibular fracture using either 2.0 mm titanium miniplate or 2.4 mm titanium lag screw technique. MATERIALS AND METHODS: A total of 30 patients were managed by open reduction and internal fixation utilizing the miniplate and lag screw technique for fractures of anterior mandible. The patients were randomly divided into two groups. Group I: (15 patients) were treated with Leibinger, 2.0 mm titanium mini plates system with self-tapping screws and Group II: (15 patients) were treated with 2.4 mm cortical lag screw (Synthes). Intraoperatively duration of surgery was measured from the time incision was placed till the closure of wound. Subsequent follow up was done at 3, 6, 12, 24 weeks, postoperatively. During every follow up, patients were assessed clinically for malocclusion, neurosensory deficit, biting efficiency, implant failure, mal-union/non-union. Pre and postoperative radiographs were taken to assess the gap between fracture segments. Results were evaluated using Chi square and the unpaired t test. RESULTS: In our study, the mean duration of surgery (hours) was 1.97 ± 0.52 for group I and 1.26 ± 0.55 for group II. The difference was found to be statistically significant (p value 0.001). i.e. more time was taken in case of surgery with mini-plates when compared to the lag screw. Short surgical procedure reduces the incidence of infectious complications, which significantly lowers the financial burden. The mean post-operative radiographic distance between all measuring points were considerably more in case of mini-plate group as compared to lag screw group. Lag screw group showed faster improvement in terms of biting efficiency as compared to mini-plate group which showed a tendency to masticate only medium hard food items by 24 weeks. In both groups, no postoperative malocclusion was noted. In initial weeks, neurosensory deficit was seen more in mini-plate group as compared to lag screw group but after six weeks all patients showed improvement in neurosensory function without any permanent nerve damage. CONCLUSION: According to this prospective study, rigid internal fixation provided by lag screw technique for anterior mandibular fracture offers several advantages over conventional bone plating. It is an excellent means of achieving rapid and safe fixation which is followed by primary bone healing in anterior mandibular fractures, without any major complications.

Comparative evaluation of surgical outcome after removal of impacted mandibular third molars using a Piezotome or a conventional handpiece: a prospective study.

Our aim was to compare the use of a conventional rotary handpiece and a Piezosurgical unit for extraction of lower third molars. We studied 40 patients, who were allocated alternately to have the third molar removed with either the handpiece or the Piezosurgical unit. Pain, trismus, and oedema were evaluated at baseline and then postoperatively, together with paraesthesiae, on postoperative days 1, 3, 5, 7, and 15. Damage to surrounding tissue was checked on the same day whereas dry socket was evaluated from postoperative day 3 onwards. More patients complained of pain in the conventional group, they also required more analgesics, and they developed trismus more often than in the Piezosurgery group. There was also significantly more postoperative swelling in the conventional group. Patients were also evaluated using the subjective Postoperative Symptom Severity (PoSSe) scale. Our results suggest that apart from some inherent limitations with the Piezotome, it is a valuable alternative for extraction of third molars.

Mandibular Osteosynthesis: A Comparative Evaluation of Two Different Fixation Systems Using 2.0 mm Titanium Miniplates and 3-D Locking Plates.

PURPOSE: To compare and evaluate postoperative complications and treatment outcome in mandibular fracture fixation using 2.0 mm titanium miniplates and 3-D locking plates. METHOD: Thirty patients were divided randomly into two groups of 15 each (including comminuted and malunited fractures). Group A was treated with open reduction internal fixation using 2.0 mm miniplates and group B with 3-D locking plates. RESULTS: A total of five complications were observed in four patients: implant exposure and infection in miniplate group and postoperative neurosensory deficit, implant failure and implant exposure in 3-D group. CONCLUSION: For fractures in symphysis and parasymphysis region, severely displaced angle fractures and for comminuted fractures 3-D locking plate could be a better option. In the angle and body region a single miniplate fixed according to Champy's technique is easy to place with less surgical time, less surgical trauma, is more economical and has similar clinical results.

Mandibular Osteosynthesis: A Comparative Evaluation of Two Different Fixation Systems Using 2.0 mm Titanium Miniplates & 3-D Locking Plates.

PURPOSE: To compare & evaluate postoperative complications & treatment outcome in mandibular fracture fixation using 2.0 mm titanium miniplates & 3-D locking plates. METHOD: 30 patients were divided randomly into two groups of 15 each (including comminuted & malunited fractures). GROUP A was treated with Open Reduction Internal Fixation (ORIF) using 2.0 mm miniplates & GROUP B with 3-D locking plates. RESULTS: A total of five complications were observed in four patients: Implant exposure & infection in miniplate group & postoperative neurosensory deficit, implant failure & implant exposure in 3-D group. CONCLUSION: For fractures in symphysis & parasymphysis region, severely displaced angle fractures and for comminuted fractures 3-D locking plate could be a better option. In the angle & body region a single miniplate fixed according to Champy's technique is easy to place with less surgical time, less surgical trauma, is more economical & has similar clinical results.

Impacted Canines: Our Clinical Experience.

BACKGROUND: To discuss the management of impacted canines and the various approaches used for the same. MATERIALS AND METHODS: The data of 33 cases, with 43 impacted canine teeth, seen and operated over a period of 3-year in Santosh Dental College and Hospital has been compiled. The diagnostic methods and treatment modalities undertaken are described and discussed. RESULTS: Canine impactions were more common in the maxilla as compared with mandible in our study, which was statistically significant. Impacted canine position was mostly palatal in maxilla and labial in mandible. Chi-square test yielded a p-value of 0.002 which shows that there is an association between arch and position. The treatment options used were surgical exposure and orthodontic repositioning, cyst enucleation with extraction of impacted canine and surgical removal of impacted canine. CONCLUSION: Surgical exposure and orthodontic repositioning was successfully applied as first-line treatment for correcting ectopic positioned canine. In cases where exposure and subsequent orthodontic treatment was not indicated, the impacted canine was surgically removed to prevent future problems and surgical procedure was designed according to position of impacted canine.

Postpartum feeding attitudes, maternal depression, and breastfeeding in Barbados.

Maternal feeding attitudes, maternal moods and infant feeding practices during the first 6 months postpartum were assessed in 226 healthy, well-nourished Barbadian mother-infant dyads. Factor analysis of the feeding attitudes questionnaire resulted in six independent factors. The belief that breastfeeding was better than bottle-feeding was associated with higher family income, more information seeking behavior and older maternal age at the time of her first pregnancy. Women who believed that breastfeeding was better at 7 weeks postpartum were also more likely to breastfeed at concurrent and later ages, up to 6 months postpartum. This belief was also associated with less maternal depression at 7 weeks and 6 months. The association between feeding attitudes and actual feeding practices was significant even after correcting for maternal moods and other background variables. Conversely, after controlling for feeding attitudes, maternal mood at 7 weeks was still significantly associated with infant feeding practices at 6 months. Thus, feeding attitudes and maternal moods were closely linked, but each contributed independently and uniquely to different aspects of breastfeeding, especially at 6 months. These findings suggest that early intervention addressing maternal feeding attitudes, may improve the extent of breastfeeding and the health of children in this setting.

High-performance liquid chromatography method development and validation for simultaneous determination of five model compounds, antipyrine, metoprolol, ketoprofen, furosemide and phenol red, as a tool for the standardization of rat in situ intestinal permeability studies using timed wavelength detection.

A simple, precise, accurate and rugged reversed-phase high-performance liquid chromatography (HPLC) method has been developed and validated for the simultaneous determination of five permeability model compounds, viz. antipyrine, metoprolol, ketoprofen, furosemide and phenol red. The method was intended to standardize rat in situ single-pass intestinal perfusion studies to assess the intestinal permeability of drugs in the market as well as new chemical entities. Optimum resolution was achieved by gradient elution on a Symmetry Shield C-18 analytical column with the mobile phase consisting of a mixture of aqueous potassium dihydrogen orthophosphate (pH 5.5; 0.01 m) and methanol at a flow rate of 1.5 mL/min. The retention times of antipyrine, metoprolol, ketoprofen, phenol red and furosemide were about 9, 12, 13, 16 and 17 min, respectively. Data acquisition was carried out using a photo diode array detector in the wavelength range 210-600 nm. Extraction of chromatograms was carried out by timed wavelength. Data obtained in all studies indicated that the method was suitable for the intended purpose. The validated method was found to be linear and precise in the working range. Suitability of storage under various conditions and freeze/thaw impact at cold temperature were established to ensure complete sample recovery without any stability issues. Recovery very close to the spiked amounts indicated that the method was highly accurate and suitable for use on routine basis.

Validated HPLC analytical method with programmed wavelength UV detection for simultaneous determination of DRF-4367 and Phenol red in rat in situ intestinal perfusion study.

A simple, precise and accurate isocratic reverse-phase liquid chromatography method with programmed wavelength detection has been validated to quantify DRF-4367 and Phenol red, simultaneously for application in rat in situ single pass intestinal perfusion study to assess intestinal permeability of DRF-4367, a novel cox-2 inhibitor. The method was validated on RP C-18 analytical column. Mobile phase consisted of sodium dihydrogen orthophosphate (pH 3.2, 0.01 M)-acetonitrile-methanol (30:50:20, v/v/v). The developed method has a short run time of 12 min with a flow rate of 1.0 ml/min. The injector volume was set to 20 microl and acquisition was carried out using a PDA detector while processing was done by timed wavelength extraction. The percentage R.S.D. and recovery in all studies indicated that the method was suitable for the intended purpose. The validated method was found to be linear and precise in the working range. Suitability of storage at cold temperature was ensured along with complete sample recovery.

Night and day: are siblings as different in temperament as parents say they are?

Twin studies suggest that parent ratings of temperament exaggerate differences between twins. The present study examined whether such contrast effects also operate for nontwin siblings. The activity level (AL) and shyness of 95 nontwin sibling pairs (ages 3 to 8 years) were assessed via parent ratings and objective measures (actigraph and observer ratings). Siblings showed no resemblance in either parent-rated AL or shyness; however, sibling resemblance for actigraph AL and observer-rated shyness was substantial. Thus, parents do contrast their nontwin siblings when rating these 2 temperament dimensions. Moreover, the importance of sibling differences in temperament to the sibling relationship and differential maternal treatment varied across the different measures of AL and shyness, suggesting that parent perceptions may play a role in these associations.