ENPP1 121Q functional variant enhances susceptibility to coronary artery disease in South Indian patients with type 2 diabetes mellitus.

Insulin resistance is associated with endothelial dysfunction and ensuing cardiovascular diseases in type 2 diabetes mellitus (T2DM) patients. ENPP1 is a key modulator of insulin signaling and its polymorphism, K121Q, increases the potency to competitively inhibit insulin receptor binding. We investigated the association of ENPP1 121Q variant with coronary artery disease (CAD) in patients with and without T2DM in South Indian population. Our study was conducted in 913 subjects: 198 patients with CAD, 284 patients in whom T2DM and CAD co-exists, 160 patients with T2DM and no CAD history, and 271 healthy volunteers. Genotyping was performed using PCR-RFLP and PCR-DNA sequencing. Genotype frequency of ENPP1 121Q was higher in disease groups compared to healthy subjects (p < 0.05). T2DM patients who carried polymorphic AC/CC genotypes were at 12.8-fold enhanced risk to CAD (95% CI 4.97-37.18, p < 0.01). Moreover we observed that 121Q, both in heterozygous and homozygous polymorphic states, was a risk factor for CAD without diabetes (OR 4.15, p < 0.01). 121Q variant was associated with T2DM patients with no CAD history too, but the risk was statistically insignificant after multivariate logistic regression analysis (OR 2.32, p > 0.05). We conclude that ENPP1 121Q variant is associated with increased risk for CAD in patients with T2DM in South Indian population. We also report that 121Q variant of ENPP1 was an independent risk factor for CAD irrespective of diabetic milieu. Factors which enhance insulin resistance increase the risk for onset and progression of coronary atherosclerosis irrespective of a diabetic background.

Risk factors for severe pneumonia in children in south Kerala: a hospital-based case-control study.

A case-control study was undertaken in 400 children under 5 years of age in South Kerala, India, to identify the risk factors for severe pneumonia. Cases were in-patients with severe pneumonia as ascertained by WHO criteria, while controls were out-patients with non-severe acute respiratory infections. Only four from many probable risk factors emerged as being significant, viz. young age, immunization, delayed weaning, and sharing of bedroom. The significant factors on univariate analysis were parental education, environmental pollution, discontinuation of breastfeeding in young infants, malnutrition, hypovitaminosis A, low birth weight, previous history of severe ARI, unresponsiveness to earlier treatment, and use of non-allopathic medicine. Correction of these factors can probably reduce mortality due to ARI.

Kerala: a unique model of development.

PIP: This article capsules health in terms of morbidity, mortality, and maternal and child health; sex ratios, and population density in Kerala state in India from a more expanded report. Kerala state is known for its highly literate and female literate, and poor income population, but its well advanced state of demographic transition. There is a declining population growth rate, a high average marriage age, a low fertility rate, and a high degree of population mobility. One of the unique features of Kerala is the high female literacy, and the favorable position of women in decision making and a matrilineal inheritance mode. The rights of the poor and underprivileged have been upheld. The largest part of government revenue is spent on education followed by health. Traditional healing systems such the ayurveda are strong in Kerala, and Christian missionaries have contributed to a caring tradition. Morbidity is high and mortality is low because medical interventions have affected morality only. The reduction of poverty and environmentally related diseases has not been accomplished inspite of land reform, mass schooling, and general egalitarian policies. Mortality declines and a decline in birth rates have lead to a more adult and aged population, which increases the prevalence of chronic degenerative diseases. Historically, the death rate in Kerala was always lower (25/1000 in 1930 and 6.4 in 1986). The gains in mortality were made in reducing infant mortality (27/1000), which is 4 times less than India as a whole and comparable to Korea, Panama, Yugoslavia, Sri Lanka, and Colombia. Lower female mortality occurs in the 0-4 years. Life expectancy which was the same as India's in 1930 is currently 12 years higher than India's. Females have a higher expectation of life. The sex ratio in 1981 was 1032 compared to India's of 935. Kerala had almost replacement level in 1985. The crude birth rate is 21 versus 32 for India. In addition to the decline in death rates of those 5 years, the 45 year population has also experienced a decline. In the 15-24 age group, the most common cause of death is suicides (53/100,000 or 25% of all deaths) and accidents. Further study is needed to examine the determinants. 76% have hospital births. Home deliveries are related to low social class. Pregnancy risk is avoided in higher groups. Child health has been improved by the rise in marriage age, the small family norm, better women's education, greater decision making for women, and health care availability: all socioeconomic factors.^ieng

Reactive Perforating Collagenosis.

A case of reactive perforating couagenosis occurring in a 23-year-old lady born of consangiunous parents is reported. No other member of the family was affected. Lesions had started appearing at the age of 12 years . with remissions and exacerbations. The lesions were mainly distributed over the exposed parts of the body. Histopathology was consistent with the clinical diagnosis. The paucity of reports regarding this entity has prompted the author to report this case.