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Background: Hemolytic uremic syndrome (HUS) is the most common thrombotic microangiopathy (TMA) occurring in children. Objectives: To study the clinico-laboratory profile and identify the potential outcome predictors in children with hemolytic uremic syndrome. Methodology: A retrospective observational study was conducted at a tertiary center in South India. Children diagnosed with HUS during the study period of 10 years were included. The demographic, clinical, and laboratory details, complications, and outcomes were recorded. Predictors of mortality were analyzed. Results: Among 44 children with HUS, 14 (31.8 %) children were diagnosed with D + HUS while 30 had D-HUS. The median age at diagnosis was 6.3 years. Male preponderance (55.9 %) was observed. Presenting symptoms included oliguria in 36 (86.4 %), followed by fever, observed in 34 (77.3 %). 12 (27.2 %) children had anuria. Seizures and altered sensorium were present in 12 (27.35) and 16 (36.4 %) children respectively. Hypertension was observed in 33 (75 %) children. Plasmapheresis was performed in 18 (13.6 %) children. 17 (38.6 %) children underwent hemodialysis, and 7 (15.9 %) underwent peritoneal dialysis. The median duration of hospital stay was 18 (9.7, 27.7) days. Complications observed during the study were CNS involvement was seen in 16 (36.4 %) children, while coagulopathy was observed in 3 (6.8 %) children. Mortality was observed in 16 children (36.4 %). Anuria at admission was more prevalent in non-survivors (10 out of 16 children; p 0.003). The median albumin and C3 levels were significantly low in non-survivors (p-value 15,000 X 109 cells/L was independently associated with mortality even after adjustment with duration of symptoms before diagnosis >10 days and low C3 levels (adjusted OR [95 % CI]: 1.12 [1.02, 1.92] (p-value 0.03). Conclusion: Hypoalbuminemia and hypocomplementemia were observed in higher proportions among non-survivors. Elevated leucocyte count at admission was an independent predictor of mortality.

Background Boswellin® Super is a standardized extract of Boswellia serrata Roxb gum resin, standardized to contain 30% 3-acetyl-11-keto-β-boswellic acid along with other β-boswellic acids (BSE). A randomized, double-blind, placebo-controlled clinical trial was conducted at two doses of BSE to understand its safety and efficacy in supporting joint health and improving mobility and symptoms of osteoarthritis (OA) of the knee.MethodsBased on the inclusion/exclusion criteria, 105 newly diagnosed participants with degenerative hypertrophy OA were recruited and randomized into Placebo, BSE-150 mg or BSE-300 mg (n = 35 in each group) to receive either 150 mg or 300 mg BSE or a placebo tablet twice a day for 90 days. All the participants were evaluated for pain and physical function using the standard tools including the Visual Analog Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequesne Functional Index (LFI), EuroQol- 5 Dimension (EQ-5D) quality of life, 6-min walk test at day 0, days 5, 30, 60 and 90 of treatment. Additionally, the circulating levels of inflammatory biomarkers, tumor necrosis factor-α (TNFα), high-sensitive C-reactive protein (hs-CRP), and interleukin-6 (IL-6) were evaluated. Safety was evaluated by blood biochemical, hematological analysis, urinary analyses and by monitoring adverse events throughout the study.ResultsNinety-eight subjects completed the study. Improvements in pain scores were observed as early as 5 days after the start of the supplement in the BSE-150 and BSE-300 groups. By 90 days, the VAS pain score reduced by 45.3% and 61.9%, WOMAC- total score improved by 68.5% and 73.6% in the BSE-150 and BSE-300 groups respectively. WOMAC pain (70.2%, 73.9%, WOMAC stiffness (65.6%,68.9%), WOMAC function (68.8%,74.2%), LFI severity (50%,53.3%), decreased and EQ5D (56.9%, 62.9%) and distance walked in 6 minutes (21.2%, 21.9%) improved in the BSE-150 and BSE-300 groups in 90 days. Further, the levels of TNFα, hs-CRP, and IL-6 were found to decrease in the serum in BSE-supplemented participants. No significant adverse events were recorded during the study.ConclusionThe study confirms that Boswellin® Super can be used as a safe and effective supplement to support joint health and mobility in the management of osteoarthritis.Clinical Trial Registration:https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NzU2Nzc=&Enc=&userName=CTRI, identifier CTRI/2022/11/047397

Background: Hypotransferrinemia is a rare cause of anemia presenting in early childhood. The clinical scenario may mimic iron deficiency anemia at onset with no response to multiple courses of hematinics. Secondary complications may be due to iron overload in the liver and other organs. Case report: We report a rare case of congenital hypotransferrinemia in an adolescent girl who presented with microcytic hypochromic anemia refractory to iron therapy in infancy. During long-term follow-up, she developed cardiac failure due to secondary hemochromatosis, which was managed successfully with chelation therapy. Conclusion: Hypotransferrinemia should be considered as a differential diagnosis of microcytic hypochromic anemia refractory to iron therapy in infancy. Regular follow-up and monitoring are essential to look for evidence of iron overload and optimize chelation therapy to prevent complications.

Introduction The primary goal of quality improvement is to enhance patient outcomes, particularly in the emergency department (ED). Timely and effective care is crucial in these situations. By comprehending the challenges, evaluating current performance and implementing quality improvement projects, areas in need of enhancement can be pinpointed and addressed, resulting in better outcomes.Methodology This interventional study explores the implementation of quality improvement in the ED of a quaternary care teaching hospital in South India. It follows the Plan-Do-Check-Act (PDCA) cycle guided by the Donabedian model. Descriptive statistics were employed to measure changes in outcomes before and after implementation. To improve processes, Donabedian principles were applied, and a performance audit was conducted based on patient feedback and stakeholder input. Various ED indicators were measured. To address identified issues, formal root cause analysis was performed, leading to the generation of PDCA rapid change cycles. These cycles were implemented over 6 months, with two cycles executed, followed by postimplementation evaluation.Results Post implementation, improvements were observed in several aspects of ED operations. These included reduced ED average length of stay, decreased time to analgesia, shorter cross-consultation time, faster transfer time from ED and improved investigation turnaround time (TAT). Additionally, there was a reduction in revisits to ED within 72 hours and a decrease in patients who left without being seen. These positive changes demonstrate the effectiveness of the quality improvement intervention using the PDCA cycle.Conclusion A comprehensive understanding of patient profile in the ED and factors influencing care is essential for the hospital to ensure sufficient resources and skilled emergency medicine physicians are available 24/7. By enhancing services in the ED, reducing patient waiting times and improving TAT, the overall efficiency of services can be improved. This leads to provision of timely quality care to patients and ultimately improves their outcomes.

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease showing an exponential increase in its prevalence all over the world. High blood glucose level is one of the main clinical signs of the disease. Although several classes of drugs are available for treatment, their prolonged use and adverse effects behoove the use of alternative medicine. Plant-derived natural products have multifaceted beneficial roles in human pathophysiology. Plant metabolites like tannins, organic acids, polyphenols, terpenes, and flavonoids show multiple mechanisms of action against diabetes. The fruits of Emblica officinalis (EOF), also known as Indian gooseberry (amla), contain several phytochemicals, potentially having anti-diabetic activity. Hydrolyzable tannins are the major bioactive components of the amla fruit, the most abundant hydrolyzable tannin being β-glucogallin. The present review summarizes the mechanism of action and clinical evidence for the beneficial effects of EOF on T2DM and its associated complications.

ObjectivesAcute diarrhea in children is generally managed by replacing the lost fluid with oral rehydration solution (ORS). Probiotic supplementation has been reported to reduce the severity of diarrhea. In the present study, we investigated the effect of Weizmannia coagulans (Bacillus coagulans) MTCC 5856, along with ORS on acute diarrhea of all causes in non-hospitalized children.MethodsA total of 110 children of ages between 1 and 10 were enrolled in a double-blind placebo-controlled study and were randomly allocated to receive W. coagulans MTCC 5856 (4 × 108 spores, N = 54) + ORS and zinc (Zn) or a placebo (N = 56) + ORS and (Zn) for 5 days. The consistency of the stool, mean duration of diarrhea in hours, mean diarrhea frequency per day, and the dehydration status were collected as efficacy endpoints. Safety was evaluated by the occurrence of adverse events.ResultsThe mean age of the children was 5.55 ± 2.57 years (61 boys and 49 girls). The mean duration of diarrhea was 51.31 ± 20.99 h in the W. coagulans MTCC 5856 group and 62.74 ± 24.51 h in the placebo (p = 0.011) group. The frequency of diarrhea was lower in children supplemented with the probiotic, but the difference was not statistically significant. The perceived efficacy score and dehydration status improved significantly in the W. coagulans MTCC 5856 group compared with the placebo group. No adverse events were recorded.ConclusionThe results of the study suggest that W. coagulans MTCC 5856 could be supplemented along with ORS and zinc to reduce the duration of diarrhea in non-hospitalized children.Clinical Trial RegistrationClinicalTrials.gov, identifier CTRI/2022/06/043239.

BackgroundGarcinol is a naturally occurring compound from the fruit rind of the Garcinia indica, with antioxidant, anti-inflammatory, and anticancer properties. Curcuminoids are the active molecule from the rhizome of Curcuma longa, studied extensively for its health benefits as an anti-inflammatory and antioxidant activities. Non-alcoholic steatohepatitis (NASH) is the progressive form of nonalcoholic steatohepatitis characterized by liver fat and inflammation.ObjectiveTo evaluate the clinical efficacy and safety of Garcinol, Curcuminoids and piperine (GCP) combination in patients with mild to moderate NASH in a randomized, double-blind, placebo-controlled study.MethodsThe patients received one tablet (450 mg) of GCP containing garcinol-50 mg, curcuminoids −250 mg and piperine 5 mg or a placebo (450 mg of microcrystalline cellulose) twice daily for 90 days. Changes in circulating aspartate aminotransferase (AST), alanine transaminase (ALT) levels, liver stiffness measurement (LSM), and controlled attenuation parameter (CAP) using Fibroscan were compared from baseline to day 90. Anthropometric parameters, serum levels of lipids, Interleukin (IL-6), hsCRP, and adiponectin were estimated. Safety was evaluated by laboratory parameters and by monitoring adverse events.ResultsSeventy-two patients were randomized and 63 (GCP = 32, Placebo = 31) completed the study. The mean age of the patients was 48.3 ± 8.7 years (36 males and 27 females). The mean reduction in AST (U/L) was 9.53 in GCP and 3.16 in placebo (p

Muhammed Majeed,1,2 Kalyanam Nagabhushanam,2 Shaji Paulose,1 HR Rajalakshmi,1 Lakshmi Mundkur1 1Sami-Sabinsa Group Limited, Bengaluru (Bangalore), Karnataka, 560 058, India; 2Sabinsa Corporation, East Windsor, NJ, 08520, USACorrespondence: Lakshmi Mundkur, Sami-Sabinsa Group Limited, 19/1& 19/2, I Main, II Phase, Peenya Industrial Area, Bengaluru, Karnataka, 560 058, India, Fax +91 8068527706, Email lakshmi@sami-sabinsagroup.comPurpose: There has been a growing interest in the use of probiotics and their products for skin care, over the last decade. LactoSporin is the extracellular metabolite of a spore-forming probiotic Bacillus coagulans (Weizmannia coagulans) MTCC 5856, with antimicrobial and skin protecting activity.Patients and Methods: The anti-skin-aging potential of LactoSporin was evaluated in a randomized, double-blinded, placebo-controlled study in healthy female participants (70 screened and 56 randomized). The participants applied either LactoSporin or matched placebo formulation (N=28 in each group) for 10 weeks, and the effects were assessed by dermatological, and non-invasive instrument-based evaluation using Antera, Cutometer, Corneometer, and Tewameter. All the 56 participants completed the study and were included for the analysis.Results: The regular use of LactoSporin cream for 10 weeks showed a significant reduction in visibility of wrinkles around crow’s feet, nasolabial folds, frown lines, and facial fine lines compared to baseline and placebo by dermatological and Antera assessments. LactoSporin showed improvement in skin elasticity and hydration by dermatological assessments, but the effect was not significantly different from placebo when assessed by Cutometer, Corneometer, and Tewameter. No adverse events or skin irritation was observed in any participants during the study.Conclusion: These results suggest that LactoSporin could be a safe natural ingredient to reduce wrinkles and fine lines in cosmetic formulations.Keywords: LactoSporin, safety, dermatological assessments, corneometer, tewameter, cutometer

Background: Ptero stilbene is an active molecule from the bark of the Pterocarpus marsupium tree with antioxidant and anti-inflammatory properties. Objective: This study aimed to evaluate the clinical safety of a standardized P. marsupium extract (PME) containing 90% pterostilbene (200 mg per day) in healthy adults. Methods: In a randomized, double-blind, placebo-controlled study, 60 healthy adult participants (27 males and 33 females) were randomized to receive PME-100 mg or placebo capsule twice a day for two months. The primary objectives of the study were to assess any changes in laboratory parameters, vital signs, and the occurrence of adverse events from screening to the final visit. Serum antioxidant enzyme levels were evaluated as a secondary outcome. Results: The hematological, lipid, glycemic, thyroid profiles and liver and renal functions remained within the normal range in all participants, with no difference between PME and placebo. Vital signs, including blood pressure, pulse rate, body weight, body mass index and electrocardiogram, did not reveal any significant differences between the PME and placebo groups at the beginning and end of the study. No serious adverse events were observed in any participant throughout the study period. The serum antioxidant profile was not significantly different between the treatment groups, although the glutathione levels were relatively higher in the PME group. Conclusions: Scientific evaluation of clinical safety of standardized extract is mandatory for its use as a supplement for various health benefits. The results of this study convincingly establish the safety of PME (>90% Pterostilbene) at 200 mg/day (100 mg bid) for human use. The study was approved by the Institutional Ethics Committee of BGS Global Institute of Medical Sciences & Hospital, Bangalore with the registration number CTRI/2019/08/020736.

Abstract Background Financial burden is a common phenomenon, often noticed in the caregivers of children with Down syndrome. It echoes adverse effects on the caregiver’s mental and physical health. The economic burden covers direct healthcare costs, direct non-health-care costs, and indirect costs and is substantial for the family of a person with Down syndrome, as well as for society. Evidence, in this area, is necessary to reduce mental stress and promote financial well-being among caregivers. Methods In this review, quantitative studies that assess the economic burden on caregivers of children with Down syndrome will be considered. We will perform a systematic literature search conducted from the year 2000 to 2022 on electronic databases CINAHL, EBSCO, EMBASE, PubMed, Scopus, Web of Science, and EconLit. An additional gray literature search will be carried out. Two researchers will independently conduct the screening and data extraction and assess the risk of bias. Discussions The review attempts to methodically analyze the economic burden among caregivers of children with Down syndrome from the societal perspective and individual perspectives. The current study will provide an evidence base to researchers, academicians, and society in identifying need-based learning to caregivers, and the selection of appropriate therapies for children suffering from Down syndrome. Systematic review registration PROSPERO CRD42021265312

Abstract Background Undernutrition in under-five children remains a worldwide health issue and is considered one of the leading causes of increased morbidity and mortality. This study aims to assess the impact of home-based nutritional intervention on the nutritional status of preschool children living in rural areas of South India. Methods A single-blinded cluster randomized controlled trial evaluated the impact of the intervention, with weight gain as the primary outcome. A cluster of 12 villages was randomized to intervention or control arms. A total of 253 underweight preschool children from 12 clusters (villages) were randomized to intervention (n = 127) and control arm (n = 126). The intervention was composed of a health-teaching program and a demonstration of nutritious food preparation in addition to the regular services provided at the Anganwadi centers. The control arm received only standard routine care provided in the Anganwadi centre. The anthropometric assessment was carried out at the baseline and every month for a year. Result A significant increase in the mean weight kilograms was noted in the intervention group (11.9 ± 0.98 to 13.78 ± 0.89) compared to the control group (11.8 ± 1.03 to 12.96 ± 0.88). In the intervention group, at the baseline, 41.5% were moderately malnourished (> − 2SD—3SD), which decreased to 24% at the end of the year. Similarly, severe malnutrition decreased from 8.69 to 3.16%, while 20.5% of malnourished children achieved normal nutritional status. In the control group, undernourished children demonstrated minimal changes in nutritional status. Analysis of repeated measures of ANOVA results between the intervention and control groups on weight measurements (F (1, 251) = 15.42, p .001) and height measurements (F (2, 1258) = 1.540, p .001) revealed statistical significance. Conclusion The nutritional status of preschool children is found to be improved by home-based intervention, which includes training mothers or caregivers in planning and preparing healthy nutritious diets, providing timely care, and gaining an understanding and knowledge of the nutritional status along with regular home-based diet preparation. Trial registration ctri@gov.in CTRI/2017/03/008273 [Registered on: 31/03/2017].

Since 2014, highly pathogenic avian influenza (HPAI) H5 viruses of clade 2.3.4.4 have been dominating the outbreaks across Europe, causing massive deaths among poultry and wild birds. However, the factors shaping these broad‐scale outbreak patterns, especially those related to waterbird community composition, remain unclear. In particular, we do not know whether these risk factors differ from those of other H5 clades. Addressing this knowledge gap is important for predicting and preventing future HPAI outbreaks. Using extensive waterbird survey datasets from about 6883 sites, we here explored the effect of waterbird community composition on HPAI H5Nx (clade 2.3.4.4) spatial patterns in the 2016/2017 and 2020/2021 epidemics in Europe, and compared it with the 2005/2006 HPAI H5N1 (clade 2.2) epidemic. We showed that HPAI H5 occurrences in wild birds in the three epidemics were strongly associated with very similar waterbird community attributes, which suggested that, in nature, similar interspecific transmission processes operate between the HPAI H5 subtypes or clades. Importantly, community phylogenetic diversity consistently showed a negative association with H5 occurrence in all three epidemics, suggesting a dilution effect of phylogenetic diversity. In contrast, waterbird community variables showed much weaker associations with HPAI H5Nx occurrence in poultry. Our results demonstrate that models based on previous epidemics can predict future HPAI H5 patterns in wild birds, implying that it is important to include waterbird community factors in future HPAI studies to predict outbreaks and improve surveillance activities. [ABSTRACT FROM AUTHOR]

Muhammed Majeed,1,2 Kalyanam Nagabhushanam,3 Beena Bhat,4 Mohammad Ansari,4 Anjali Pandey,5 Sarang Bani,5 Lakshmi Mundkur5 1Research and Development, Sami-Sabinsa Group Limited, Bangalore, India; 2Research and Development, Sabinsa Corporation, East Windsor, NJ, USA; 3Research and Development, Natural Product Chemistry Sabinsa Corporation, East Windsor, NJ, USA; 4Research and Development, Phytochemistry, Sami-Sabinsa Group Limited, Bangalore, India; 5Research and Development, Biological Research, Sami-Sabinsa Group Limited, Bangalore, IndiaCorrespondence: Lakshmi MundkurSami-Sabinsa Group Limited, 19/1, 19/2, 1st Main, 2nd Phase, Peenya Industrial Area Bangalore, Bengaluru, Karnataka, 560058, India, Tel +80 2839 7973, Email lakshmi@sami-sabinsagroup.comPurpose: Obesity is a complex medical problem that increases the risk of other diseases like diabetes, cardiovascular diseases, and fatty liver disease. The present study evaluated the efficacy and safety of Cyperus rotundus rhizome extract (CRE), standardized to contain Piceatannol, Scirpusin A, and Scirpusin B (5% total Stilbenoids) in overweight individuals. The mechanism of activity was evaluated in a diet-induced mice model of obesity and adipocytes in vitro.Materials and Methods: The efficacy, safety, and tolerability of CRE were evaluated in 30 obese individuals with a BMI of 30 to 40 kg/m2 for 90 days in a randomized, double-blind, parallel-group, placebo-controlled study. In vitro studies were carried out in differentiated 3T3 L1 adipocytes, and the therapeutic efficacy was evaluated in high-fat diet-induced obese mice.Results: The pilot clinical study showed a reduction in body weight with a significant decrease in waist circumference and BMI. The serum lipid profile showed a significant improvement in CRE-treated individuals. The extract was well tolerated, and no adverse effects were reported at the end of the study. CRE showed a dose-dependent adipogenesis reduction in vitro with an IC50 value of 9.39 μg/mL, while oral administration of CRE reduced weight gain in diet-induced obese mice. The efficacy in mice was associated with reduced levels of leptin, corticosteroids, and serum lipid levels, with no adverse effects.Conclusion: CRE has anti-adipogenic properties, is safe for human consumption, and effectively manages weight and hypercholesterolemia in overweight individuals.Keywords: Cyperus rotundus, piceatannol, Scirpusin A, Scirpusin B, obesity, adipogenesis, lipid levels, leptin, randomized clinical trial

Fertility preservation is emerging in recent years as an important option for various indications many of which being for cancer patients and for certain benign conditions as well. In the present case report, we set out to utilise the same protocol, however, for different indications.

Maintaining peace and conserving biodiversity hinge on an international system of cooperation codified in institutions, but Russia’s invasion of Ukraine brings recent progress to a crossroads. Against this backdrop, we address some implications of Russia’s invasion of Ukraine for the governance of biodiversity conservation both within and beyond Russia. The Russian invasion of Ukraine threatens the governance system for biodiversity conservation, as it pertains to Russia and beyond, due to three interacting factors: (i) isolation of Russia from the international system, (ii) halt and delay of international cooperation, and (iii) changes in international and domestic policy priorities. We recommend making the existing international system of governance for conserving biodiversity more resilient and adaptable, while aligning security agendas with biodiversity conservation goals.

Multi-species indicators (MSIs) have been useful tools for reflecting the state of taxa and ecosystems at global, regional, and national levels. However, most indicators are from Europe and North America, and there are few from the world’s major tropical and subtropical biodiversity hotspots, often in large part because of insufficient data availability. We modelled the population trajectories of 107 regularly-occurring breeding bird species in Taiwan (100 native and seven introduced species) and developed MSIs for (i) forest, (ii) farmland, and (iii) introduced bird species based on the Taiwan Breeding Bird Survey dataset between 2011 and 2019. Individual population trajectories for 87 species did not show a significant change, those for 11 species grew significantly, and those for two species declined significantly. All MSIs show significant growth. Based on the phylogenetic generalised least squares (PGLS) results, the forest bird indicator increased somewhat more rapidly than the farmland bird indicator, perhaps reflecting very low rates of deforestation contrasting with more rapid land use change on farmlands in Taiwan. Some of the forest and farmland species, however, showed rapid declines, and most of these atypical decliners were common species or carnivores. Further, the PLGS results show that the introduced species indicator had more rapid growth than native species indicators, posing a potential risk for the integrity of native bird communities in the near future as well as compromising broader ecosystem intactness. Our study provides important information on bird population changes in subtropical Asia. The MSIs will be updated regularly and will be used to provide information to support conservation policies in Taiwan.

Background and Objectives. Skeletal muscle atrophy, a condition characterized by decreased muscle mass and contractility, is commonly observed in various pathological states, including prolonged inactivity, malnutrition, sarcopenia, and type 1 diabetes mellitus (T1DM). We aimed to investigate the potential therapeutic effects of pterostilbene (PTS), resveratrol (RSV), pulsed magnetic field (PMF), and their combinations on the streptozotocin- (STZ-) induced atrophy of slow- and fast-twitch skeletal muscles in rats. Material and Methods. Biomechanical analyses were utilized to examine the contractions of soleus and extensor digitorum longus (EDL) muscles, while muscle morphology was evaluated using hematoxylin-eosin staining. Immunohistochemical methods were employed to assess atrophy-related markers, including FBXO32, TRIM63, and FoxO3a. The levels of key proteins, such as pAkt, mTOR, FoxO3a, MSTN, CAPN3, TNF-α, NF-κB, MyHC IIb, MyLC 3, and GLUT4, in both skeletal muscle tissue and serum insulin levels were determined using ELISA. Total protein concentration was measured using the Bradford protein assay, and relative gene expressions of FBXO32, TRIM63, FoxO3a, 4E-BP1, p70S6K, TRIM72, and UbC were analyzed by real-time PCR. Results. Our findings suggest that antioxidants and PMF may alleviate impaired protein synthesis and degradation pathways in skeletal muscle atrophy. PTS showed a positive effect on the anabolic pathway, while RSV and PMF demonstrated potential for ameliorating the catabolic pathway. Notably, the combination therapy of antioxidants and PMF exhibited a stronger ameliorative effect on skeletal muscle atrophy than either intervention alone. Conclusion. The present results highlight the benefits of employing a multimodal approach, involving both antioxidant and PMF therapy, for the management of muscle-wasting conditions. These treatments may have potential therapeutic implications for skeletal muscle atrophy.

Purpose. The purpose of the study was to assess the impact of an educational intervention on the level of knowledge and adherence to the treatment regimen among hemodialysis (HD) patients as well as to describe the association between these variables. Methods. In this randomized controlled trial, 160 HD patients at an HD centre of a 2030-bed tertiary teaching hospital in Southern India were randomly assigned into intervention (N = 80, received education and a booklet) and control (N = 80, received standard care) groups. Knowledge and adherence were measured preintervention and postintervention using a validated questionnaire for knowledge and the ESRD-AQ (End-Stage Renal Disease Questionnaire) for the level of adherence. The statistical analysis of the data was performed with the help of the Statistical Program SPSS version 19.0. The statistical significance level was set at 0.05. Results. The increase in knowledge on disease management, fluid adherence, and dietary adherence in the intervention group was significantly higher compared to the control group. There was no significant correlation between knowledge and adherence. Adherence improved for all the domains, i.e., dialysis attendance, episodes of shortening, adherence to medication, fluid restriction, and dietary restriction. Adherence to fluid and dietary restriction was statistically significant. This trail is registered with https://clinicaltrials.gov/ct2/show/CTRI/2018/05/014166.

Abstract Background Type 2 diabetes mellitus (T2DM) is a major public health concern with growing prevalence with multiple debilitating complications. GlycaCare-II is a proprietary herbal formulation supplement for T2DM containing extracts of Cinnamomum cassia, Momordica charantia, Pterocarpus marsupium, Gymnema sylvestre, Salacia reticulata, Eugenia jambolana, and a bioavailability enhancer piperine from Piper nigrum. Objective The antihyperglycemic potential of GlycaCare-II was compared against metformin in a double-blind study. Design It was a randomized, two-arm design on prediabetic (N = 29; 12 in metformin and 17 in GlycaCare-II arm, respectively) and newly diagnosed diabetic (N = 40; 16 in metformin and 24 in GlycaCare-II) patients for 120 days. Outcome measures Changes in diabetic panel glycosylated hemoglobin (HbA1c), fasting blood sugar (FBS), and postprandial blood sugar (PBS) were the primary endpoints. Lipid profile, liver profile, thyroid-stimulating hormone, bilirubin and creatinine were the secondary endpoints. Result Twice a day treatment for 120 days with GlycaCare-II led to a statistically significant change in HbA1c (p

BACKGROUND: Doppler studies of uteroplacental–fetal circulation have been proven useful in diagnosing fetal growth restriction, appropriately timing delivery, and improving perinatal morbidity and mortality. There has been an extensive search for the ideal means to identify fetuses between the compensatory and acidemic phase (ie, the “preacidemic phase”), and the aortic isthmus Doppler seems to show promise. OBJECTIVE: This study aimed to investigate: (1) the prevalence of abnormal aortic isthmus Dopplers in a cohort of small-for-gestational-age fetuses and their correlation with other conventional Doppler abnormalities, and (2) the predictive ability of abnormal aortic isthmus Dopplers with regard to short-term adverse neonatal outcomes. STUDY DESIGN: Fetuses diagnosed as small-for-gestational-age at ≥24 weeks’ gestation were included. Management was as per the standard protocol. Aortic isthmus Doppler was performed within a week of delivery with other conventional Dopplers. The adverse perinatal outcomes studied were: requirement of neonatal resuscitation at birth, Apgar score at 5 minutes

The complex process of oocyte maturation involves a coordinated set of events to take place so that an adequate number of oocytes can be obtained during an oocyte pickup procedure following controlled ovarian stimulation. A weak link in any of the steps can yield a sparse number of oocytes which can be a setback in the process.

The pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is far from over as new strains are emerging all over the world. Selenium as a micronutrient is important for immunity and also has anti-viral activity. Objective: The study evaluated the activity of a Selenium enriched garlic powder (SeGP or SelenoForce®) against SARS-CoV-2 viral replication in vitro and explored its possible mechanism of action. Methods: The anti-SARS-CoV-2 activity assay was carried out in Vero E6 cells in vitro. Human lung carcinoma A549 cells were used to study the antioxidant activity, expression of angiotensin converting enzyme (ACE), transmembrane protease, serine 2 (TMPRSS2) and the activity of proprotein convertase, and furin. Anti-inflammatory activity was evaluated in lipopolysaccharide-activated RAW 264.7 cells. Results: SeGP inhibited the replication of SARS-CoV-2 in Vero E6 cells with an IC50 of 19.59 μg/ml. It exhibited significant antioxidant activity in vitro with IC50 value determined as 43.45 μg/ml. The Selenium enriched product inhibited the expression of ACE and TMPRSS2 and also showed inhibition of furin protease activity. In the presence of SeGP, the secretion of nitric oxide, interleukin −6 and TNF-α were reduced in activated RAW 264.7 macrophages. Conclusion: The results of the study suggest that Selenium enriched garlic powder could inhibit SARS-CoV-2 multiplication in vitro, reduce oxidative stress and inflammatory mediators suggesting that it could be developed as an effective supplement or adjunct therapy to combat viral infections. [ABSTRACT FROM AUTHOR]

Background: Boswellin® Super is a standardized extract of Boswellia serrata Roxb gum resin, standardized to contain 30% 3-acetyl-11-keto-ß-boswellic acid along with other ß-boswellic acids (BSE). A randomized, double-blind, placebocontrolled clinical trial was conducted at two doses of BSE to understand its safety and efficacy in supporting joint health and improving mobility and symptoms of osteoarthritis (OA) of the knee. Methods: Based on the inclusion/exclusion criteria, 105 newly diagnosed participants with degenerative hypertrophy OA were recruited and randomized into Placebo, BSE-150 mg or BSE-300 mg (n = 35 in each group) to receive either 150 mg or 300 mg BSE or a placebo tablet twice a day for 90 days. All the participants were evaluated for pain and physical function using the standard tools including the Visual Analog Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequesne Functional Index (LFI), EuroQol-5 Dimension (EQ-5D) quality of life, 6-min walk test at day 0, days 5, 30, 60 and 90 of treatment. Additionally, the circulating levels of inflammatory biomarkers, tumor necrosis factor-a (TNFa), high-sensitive C-reactive protein (hs-CRP), and interleukin-6 (IL-6) were evaluated. Safety was evaluated by blood biochemical, hematological analysis, urinary analyses and by monitoring adverse events throughout the study. Results: Ninety-eight subjects completed the study. Improvements in pain scores were observed as early as 5 days after the start of the supplement in the BSE-150 and BSE-300 groups. By 90 days, the VAS pain score reduced by 45.3% and 61.9%, WOMAC-total score improved by 68.5% and 73.6% in the BSE-150 and BSE-300 groups respectively. WOMAC pain (70.2%, 73.9%, WOMAC stiffness (65.6%,68.9%), WOMAC function (68.8%,74.2%), LFI severity (50%,53.3%), decreased and EQ5D (56.9%, 62.9%) and distance walked in 6 minutes (21.2%, 21.9%) improved in the BSE-150 and BSE-300 groups in 90 days. Further, the levels of TNFa, hs-CRP, and IL-6 were found to decrease in the serum in BSEsupplemented participants. No significant adverse events were recorded during the study. Conclusion: The study confirms that Boswellin® Super can be used as a safe and effective supplement to support joint health and mobility in the management of osteoarthritis. [ABSTRACT FROM AUTHOR]