Role of eNOS and TGFβ1 gene polymorphisms in the development of diabetic nephropathy in type 2 diabetic patients in South Indian population

Background Diabetic nephropathy is known to be a leading complication of diabetes mellitus, characterized by diverse aspects such as high urinary albumin level, elevated blood pressure, and genetic susceptibility leading to end-stage renal disease. The current study was carried out to investigate the association of eNOS and TGFβ1 gene polymorphisms in the progression of diabetic nephropathy among type 2 diabetic patients in the South Indian population. The eNOS and TGFβ1 genetic variants were genotyped in 280 T2DM patients, 140 with DN, 140 without DN, and 140 controls. Genotyping was performed using ARMS PCR and the genomic variants were confirmed by the Sanger sequencing method. Results A significant (p < 0.05) association was observed in the genotypic frequencies of eNOS (G > T) polymorphism in the T2DM patients with diabetic nephropathy when compared to controls. The frequency of TT (heterozygous) genotype was observed to increase in patients with type 2 diabetes and DN when compared to the diabetic patients without DN and controls. This indicates that diabetic patients with TT genotype are at an increased risk to develop DN. However, TGFβ1 (G > C) polymorphism did not show any association in the allele and genotypic frequencies with DN when compared with T2DM and controls. Conclusion The results of the study propose a strong influence of TT genotype of eNOS gene be significantly linked with diabetic nephropathy in T2DM patients. Whereas no association was examined concerning TGFβ1 gene polymorphism and DN. Nevertheless, large sample size studies are required to confirm the part of these genetic variants in the development of DN.

Effectiveness of Educative Session on Knowledge, Attitude and Practice, on Diabetes and Dyslipidemia, of Patients Attending a Private Medical College Hospital in South-India

Introduction Diabetes mellitus and dyslipidemia are non-communicable diseases that can be prevented and controlled by maintaining a healthy lifestyle. Knowledge, attitude, and practice (KAP) in patients will provide information of much importance in Advocacy (to set guidelines by the Healthcare providers), Communication (increase awareness in subpopulation), and Social mobilization (improve services and expand community support). The study aimed to assess the effectiveness of an educative session on Knowledge, attitude, and practice (KAP) in patients attending a private medical college hospital on diabetes and dyslipidemia in the South-Indian population. Methodology The study was cross-sectional which included 100 patients (41 female and 59 male) of 18-50 years of age attending the hospital and the Central clinical laboratory for various disease conditions. A self-administered questionnaire on personal aspects and diabetes and dyslipidemia was collected. Result Among the study participants, 18% completed school education, 74% completed under-graduation, and 8% completed post-graduation. The frequency of livelihood showed 84% from rural and 16% from an urban background. Nearly 71% were active and 29% were sedentary performing self-activity. The source of information regarding the treatment of patients was also obtained from the patients to implement the same in advocacy. The knowledge of the study group on various aspects including the causes, symptoms, tests, complications of diabetes mellitus, lipid profile, dietary fiber, and exercises was analyzed. We found clarity of explanation about diabetes improved well after the educative session. Around 80% of responders believed that both fiber and routine exercises would contribute to preventing diabetes. Analysis of the attitude and practice revealed a significant knowledge of practicing proper diet, exercises, and routine health care after the educative session. Conclusion We conclude that healthcare providers shall focus on educating the patients according to their needs with the knowledge to have positive attitudes on healthy lifestyle practices in addition to the appropriate treatment.

Morphometry of Corpus Callosum in South Indian Population

Background: The corpus callosum (CC) is a connecting bridge between two cerebral hemispheres and helps in interhemispheric integration of information. Purpose: The primary objective of the study is to explain the topographical position of CC in relation to the brain in the South Indian population, contributing to the reference values of measurements of CC, which helps in planning surgical interventions. Also, the reference values help in cross-referencing with other populations and ethnic group. Methods and Material: In the study, 40 formalin fixed, full brain specimens were cut in midsagittal plane and CC was measured along with its relation to the brain. The major diameters considered were longitudinal dimension of corpus callosum (LC), distance of CC from frontal pole to genu (AS), distance of CC occipital pole to splenium (PS), and longitudinal dimension of brain (LB) from frontal pole to occipital pole. Statistical Analysis Used: The statistical analysis was carried with the mean, standard deviation, 95% CI, and the range measured for each measurement. The Pearson coefficient was evaluated between dimensions of brain and CC. Multivariate linear regression analysis was done to correlate between LB as a dependent variable, and LC, vertical dimension of brain (CD), and PS as independent variables. Results: Pearson’s ratio showed a positive correlation between LB and PS (0.61), and also between LB and LC (0.59). The ratio of LC/LB was 0.45 and LC/CD was 0.69, which are stable in all brains studied. Conclusions: The study concludes that CC maintains a stable proportion with its parts (genu, rostrum, body, and splenium) and with the horizontal dimension of the brain. Further, measured values help in cross-referencing with other population.

Are blood groups related to the distribution and severity of COVID-19? A cross-sectional study in a tertiary care hospital in South India

Background: Blood groups are inherited traits that affect the susceptibility/severity of a disease. A clear relationship between coronavirus disease 2019 (COVID-19) and ABO blood groups is yet to be established in the Indian population. This study aimed to demonstrate an association of the distribution and severity of COVID-19 with ABO blood groups. Methods: A cross-sectional study was conducted after obtaining ethics approval (IEC 207/20) among hospitalized patients using in-patient records and analyzed on SPSS-25. Chi-square tests were used for the analysis of categorical data and independent sample t-test/Mann–Whitney U tests were used for continuous data. Results: The B blood group had the highest prevalence among COVID-19-positive patients. The AB blood group was significantly associated with acute respiratory distress syndrome (ARDS) (p = 0.03), sepsis (p = 0.02), and septic shock (p = 0.02). The O blood group was associated with significantly lower rates of lymphopenia and leucocytosis. However, no significant clinical association was seen in the O blood group. Conclusion: This study has demonstrated that blood groups have a similar distribution among patients hospitalized with COVID-19 in the South Indian population. Additionally, it preludes to a possible association between the AB blood group and ARDS, sepsis, and septic shock. Further studies having a larger representation of AB blood groups, especially in patients hospitalized for critical COVID-19, with adjustment for possible covariates, are warranted to provide a reliable estimate of the risk in the South Indian population.

Magnetic Resonance Morphometry of Normal Cerebral Aqueduct in South Indian Population

Introduction Cerebral aqueduct (of Sylvius) connects the third and fourth ventricles of the brain, and the shape of the aqueduct varies. The aim of the study is to assess the morphometry of the cerebral aqueduct in normal south Indian adult population and to look for pattern by shape, if any. Materials and Methods One hundred and fifty normal brain MR images (75 males and 75 females) using 3D heavily T2-weighted sequence were analyzed for various normal parameters of cerebral aqueduct. Mean and standard deviation were calculated. Based on the shape of the aqueduct, an attempt was made to classify them. Unpaired t-test was used to assess any significant difference between age groups and gender. The intraclass coefficient correlation was used to analyze the interobserver variability. Results The mean value of the length of the cranial and caudal part of aqueduct in males were 0.69 cm and 0.86 cm and in females 0.65 cm and 0.80 cm, respectively. The length was more in males, and it was statistically significant (p = 0.006 and 0.02). There are four types of cerebral aqueduct based on shape. Conclusion MRI is considered as the investigation of choice for preoperative planning of brain operative procedures. The MR morphometric evaluation of cerebral aqueduct provides precise knowledge about the anatomy and may be of help in the diagnosis and treatment by endoscopic neurosurgery.

Influence of CYP2C9 Polymorphisms on Plasma Concentration of Warfarin and 7-Hydroxy Warfarin in South Indian Patients

Background: Warfarin is primarily metabolized by cytochrome P450 2C9 (CYP2C9), which is encoded by the CYP2C9 gene. CYP2C9*2 and CYP2C9*3 variants significantly influence warfarin metabolism and subsequently the required dose of warfarin. Objective: The current retrospective study was aimed to determine the influence of CYP2C9 variants on warfarin metabolic ratio (MR, warfarin/7-hydroxy warfarin) and warfarin maintenance therapy in 210 patients (mean age 44.6±11.6 (SD) years; male to female ratio 81:129). Method: High-performance liquid chromatography (HPLC) with UV detector was used to measure plasma concentrations of warfarin and 7-hydroxy warfarin. Plasma samples were collected 12 h after the previous dose of warfarin was administered. CYP2C9 variants (rs1799853 and rs1057910) were identified using real-time polymerase chain reaction allele-discrimination method. Results: The mean daily maintenance dose of warfarin was 4.6±1.8 (SD) mg. The mean plasma warfarin and 7-hydroxy warfarin concentrations were 3.7±1.6 (SD) µg/mL and 1.1±0.54 (SD) µg/mL, respectively. Patients carrying other CYP2C9 variants required 39% lower warfarin maintenance dose (3.3±1.2 mg) than CYP2C9*1*1 carrier (4.9±1.8 mg), (p<0.0001). MRs differed significantly between CYP2C9 variant carriers (8.1±5.1) and normal genotype carriers (4.8±3.9) (p<0.0001). Probit analysis identified an MR value of 7.6 as the anti-mode (sensitivity of 55% and specificity of 84%) to differentiate poor and intermediate metabolizers (carriers of any *2 or *3 variant allele) from normal metabolizers (CYP2C9*1*1 genotype). Conclusion : The present study results provide, insights on effect of CYP2C9 genetic polymorphisms on inter-individual variability in warfarin metabolism and emphasizes utility of phenotyping in a setting of genotype-guided dosing of warfarin in the South Indian population.