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REVIEW ARTICLES
Pathophysiological status and nutritional therapy of peptic ulcer: An update
Mayank Kulshreshtha, Gunja Srivastava, Manjul Pratap Singh
July-September 2017, 2(3):76-86
DOI:10.4103/ed.ed_11_17  
Peptic ulcer (PU) is the most common disease of gastrointestinal tract (GIT) which affects the stomach and duodenum. It is characterized by an imbalance between the aggressive and defensive factors. Lifestyle and eating habits play an important role in the case of PU. According to the latest World Health Organization data published in April 2011, PU disease deaths in India reached 108,392 or 1.20% of the total deaths. The age-adjusted death rate is 12.37/100,000 of population, which leads India to 5th rank in the world. The aim of this review was to summarize the scientific data, herbal research, nutritional therapy, precautions, and pharmacological/nonpharmacological treatment regarding PU. The update conclusion regarding PU therapy was concluded with the help of published scientific data on Pub Med, Google Scholar, Med Know, Elsevier and other online resources. Natural remedies are found to be safe (minimum side effects) whereas, in allopathic treatment, antacids with the combination of proton pump inhibitors can better control PU. A balanced dietary plan should be advised by health care professionals or providers to patients suffering from PU. Following good habits and avoiding spicy food make our GIT healthy. Hence, a better lifestyle automatically cures the PU. Better knowledge with balanced lifestyle is an excellent treatment of PU.
  19,184 1,174 4
Wind turbines and adverse health effects: Applying Bradford Hill's criteria for causation
Anne Dumbrille, Robert Y McMurtry, Carmen Marie Krogh
July-September 2021, 6(3):65-87
DOI:10.4103/ed.ed_16_21  
The weight of evidence indicates occurrences of adverse health effects (AHEs) from living and working near industrial wind turbines (IWTs). Descriptions of the AHEs being reported by those living or working near the turbines are similar. While these occurrences have been associated with exposure to audible and inaudible noise annoyance, the causation of reported wind turbine-associated health effects remains controversial. Establishing an argument of causation of adverse health outcomes has important clinical, scientific, and societal implications. Bradford Hill (BH) criteria have been widely used to establish causality between an environmental agent and risk of disease or disability, but have not previously been used to evaluate the relationship between IWTs and AHEs. The objective was to apply the BH criteria to evaluate the relationship between IWTs and AHEs. The nine criteria include the strength of the association, consistency, specificity, temporal sequence, biological gradient, plausibility, coherence, experimental evidence, and analogous evidence. These nine criteria have been applied to IWT exposure and reported AHEs using peer-reviewed and other published literature that describes clinical, animal, and laboratory studies, testimony and reported experiences, and internet sources. Applying the BH criteria to the IWT-related clinical, biological, and experimental data demonstrates that the exposure to IWTs is associated with an increased risk of AHEs. This analysis concludes that living or working near IWTs can result in AHEs in both people and animals. Our findings provide compelling evidence that the risk of AHEs should be considered before the approval of wind energy projects and during the assessment of setback distances of proposed and operational projects.
  14,121 1,443 -
ORIGINAL ARTICLES
Swine barn dust stimulates CCL9 expression in mouse monocytes through protein kinase C-delta activation
David Schneberger, Jane M Devasure, Kristina L Bailey, Debra J Romberger, Todd A Wyatt
October-December 2020, 5(4):93-99
DOI:10.4103/ed.ed_16_20  
Objective: Exposure to organic barn dusts has been shown to cause numerous lung problems to chronically exposed animal barn workers. Bacterial components in these dusts trigger innate immunity in the lungs. In characterizing these responses, we examined the expression of a lesser examined chemokine believed to be a lower avidity signal for neutrophil migration, CCL9, and how its expression is controlled by dust exposure in a monocyte/macrophage cell line. Materials and Methods: CCL9 expression was assessed in the RAW267.4 macrophage cell line exposed to organic hog barn dust extracts (HDEs) or components of this dust such as lipopolysaccharide (LPS) and peptidoglycan. CCL9 expression was assessed as well as response of CXCL1 (keratinocyte-derived chemokine [KC]). Protein kinase C (PKC)-α, ζ, and δ were inhibited to assess CCL9 expression. Results: HDE was able to induce significant increase of CCL9 expression in RAW264.7 cells. The ability of HDE to induce CCL9 relied upon LPS present in HDE samples. Addition of CCL9 to RAW264.7 cells stimulated with organic dust reduced KC expression. Further, CCL9 expression was particularly sensitive to PKC-ζ inhibition by chemical or siRNA. Conclusion: CCL9 is an inducible chemokine present in mouse monocytes exposed to HDE. HDE-induced production of CCL9 appears primarily mediated by LPS in HDE samples. This induction appears to require PKC signaling, with emphasis on PKC-ζ expression.
  11,401 1,292 -
Disease comorbidities associated with chemical intolerance
Raymond F Palmer, Tatjana Walker, Roger B Perales, Rodolfo Rincon, Carlos Roberto Jaén, Claudia S Miller
October-December 2021, 6(4):134-141
DOI:10.4103/ed.ed_18_21  
Background: Chemical intolerance (CI) is characterized by multisystem symptoms initiated by a one-time high-dose or a persistent low-dose exposure to environmental toxicants. Prior studies have investigated symptom clusters rather than defined comorbid disease clusters. We use a latent class modeling approach to determine the number and type of comorbid disease clusters associated with CI. Methods: Two hundred respondents with and without CI were recruited to complete the Quick Environmental Exposure and Sensitivity Inventory (QEESI), and a 17-item comorbid disease checklist. A logistic regression model was used to predict the odds of comorbid disease conditions between groups. A latent class analysis was used to inspect the pattern of dichotomous item responses from the 17 comorbid diseases. Results: Those with the highest QEESI scores had significantly greater probability of each comorbid disease compared to the lowest scoring individuals (P < 0.0001). Three latent class disease clusters were found. Class 1 (17% of the sample) was characterized by a cluster consisting of irritable bowel syndrome (IBS), arthritis, depression, anxiety, fibromyalgia, and chronic fatigue. The second class (53% of the sample) was characterized by a low probability of any of the co-morbid diseases. The third class (30% of the sample) was characterized only by allergy. Discussion: We have demonstrated that several salient comorbid diseases form a unique statistical cluster among a subset of individuals with CI. Understanding these disease clusters may help physicians and other health care workers to gain a better understanding of individuals with CI. As such, assessing their patients for CI may help identify the salient initiators and triggers of their CI symptoms—therefore guide potential treatment efforts.
  10,913 1,407 -
Quantitative estimation of urinary ortho-cresol by high pressure liquid chromatography for biomonitoring of toluene exposed population
Anupa Yadav, Amit Chakrabarti, Geoffrey Nengzapum
July-September 2020, 5(3):78-82
DOI:10.4103/ed.ed_23_20  
Aim: Quantification of urinary ortho-cresol (OC) by high pressure liquid chromatography coupled with photodiode array detector. Materials and Methods: Includes acid hydrolysis of urine, liquid–liquid extraction, and chromatography quantification of extracted OC in urine. Results: Limit of detection, limit of quantification, and coefficient of linearity (R2) were 0.18 μg/ml, 0.62 μg/ml, and 0.9998, respectively. Recovery % of method ranged from 92%, 97%, and 100%. For intraday and interday precision coefficient of variation was 0.41%, 0.64%, and 0.89%, 0.86% for urine samples spiked with OC standards final concentration of 0.25 μg/ml and 0.7 μg/ml, respectively. Results (mean ± standard deviation) of exposed and unexposed real urine samples analyzed for OC with this method were 0.92 ± 0.76 and 0.40 ± 0.20 μg/ml, respectively. Statistical analysis of results showed significant (P ≤ 0.001) difference between urinary OC among exposed and unexposed subjects. Conclusion: The present work describes precise, easy, and less time consuming method for estimation of OC in urine of population exposed to toluene. It can be used as a promising tool for biomonitoring of population exposed to toluene.
  10,502 1,467 -
Effect of monosodium glutamate (MSG) on behavior, body and brain weights of exposed rats
Uche Stephen Akataobi
January-March 2020, 5(1):3-8
DOI:10.4103/ed.ed_31_19  
Purpose: Consumption of monosodium glutamate (MSG) in food, drink, and other consumables has been linked to different observable changes believed to be as a result of MSG's effects on the brain. Furthermore, it is believed that blood–brain barrier plays a role on how these effects are felt in different stages of life. The present study is an attempt to understand the differential effect of MSG by studying body and brain weights as well as physiological changes in the behavior of rats exposed at different stages of life (either as neonate or as adult). Materials and Methods: Pups were administered 4 mg/g MSG on postnatal days 2, 4, 6, 8, and 10, allowed to mature for 26 weeks, and afterward divided into three groups (n = 6) and administered saline, 5 mg/g, and 10 mg/g MSG for 6 weeks. Two other groups, not exposed to MSG at neonatal age (adult), were similarly administered 5 mg/g and 10 mg/g MSG for 6 weeks. During this period, weight gain and behavioral observation was made, and at the end of the 6 weeks, brain weight was measured. Results: A dose-dependent effect of MSG was recorded in both neonatal- and adult-administered rats in all the parameters studied. Conclusion: MSG affects both neonate and adult rats similarly, thus adult exposure may be used in studies involving MSG and other neurotoxic chemicals.
  10,785 986 2
REVIEW ARTICLES
Microbes: Friends or foe? An overview on the impact of COVID-19 pandemic on human health and modern eugenics for recurrence prevention
Divyanu Jain, Abha Sood, Hiroyuki Takenaka, Mitsuaki Sano, Shuhei So, Isao Tomita, Naohiro Kanayama, Ajay K Jain
January-March 2021, 6(1):4-11
DOI:10.4103/ed.ed_27_20  
Microbes are an essential component of our ecosystem which have coexisted with humans and all other life forms for millions of years. These microbes have proven beneficial in our everyday life in many ways, but the recognized pathogenic forms have also proven to be dangerous to human life. The recent pandemic caused by the severe acute respiratory syndrome coronavirus 2 is evidence for the significant impact of negative human interference with the natural ecosystem which might include but is not limited to rapid urbanization, pollution, agricultural change, food consumption, and global warming. In this context, the principle of “eugenics” proposed by Sir Galton has been discussed in the current perspective. The aim of this review is to discuss the application of ethical scientific practices to promote healthy human evolution without disturbing the ecological balance. We reviewed literature relevant to the impact of microbial systems on public health including the recent COVID-19 pandemic. We suggest that the concept of “modern eugenics” should be reconsidered in ethical scientific terms by focusing on the beneficial gene(s) and eliminating harmful gene(s) of pathogenic organisms. This might contribute to the human genetic enhancement and facilitate a safe symbiotic ecosystem. In the past, scientists have successfully developed simple and safe bioassays for the identification of mutagens and carcinogens using pathogenic microorganisms. Similarly, recently developed gene therapies using viral vectors are excellent examples of the ethical and scientific application of modern eugenics for healthy human evolution. Therefore, it is necessary to establish an “International Society for Positive Science” comprising of individuals from all fields to critically analyze the positive and ethical use of science to promote and strengthen the cohabitation of all species and prevent the recurrence of future pandemics.
  10,291 1,369 -
ORIGINAL ARTICLES
Prevalence of open defecation among households with toilets and associated factors in rural areas of district Sonepat in Haryana
Babita Rani, Anshu Yadav, Sanjay Kumar Jha, Anita Punia, Sanjeet Singh
October-December 2020, 5(4):87-92
DOI:10.4103/ed.ed_22_20  
Context: Constructing latrines and getting people to use them is one of the most effective means of improving public health and saving lives. However, building toilets alone cannot eliminate open defecation. Aims: The aim was to estimate the prevalence of open defecation and factors associated with open defecation in rural areas of a district of Haryana. Settings and Design: This community-based cross-sectional study was carried out in a rural field practice area attached to the department of community medicine of a rural medical college. Subjects and Methods: The study was carried out from July to October 2019. The data were collected from 368 randomly selected households on a pretested semi-structured proforma. Ethical approval was obtained from the institutional ethics committee. Statistical Analysis Used: The data were analyzed using the software R, version 3.6.2. Chi-square, Fisher's exact test, crude odds ratio, adjusted odds ratio with 95% confidence interval, and P value were calculated. Results: The prevalence of open defecation was 30.97% despite having a household toilet. Among the study participants practicing open defecation, the prevalence of open defecation was significantly higher among scheduled caste (64.9%), illiterates (42.7%), laborers (56.6%), and low family income (41.5%). The participants who have constructed latrine recently, i.e., <1 year before (87%), latrine constructed by government expenses (76.9%), and rarely cleaning of the latrine (76.5%) also contributed significantly. Multivariate logistic regression analysis showed that four of these predictor variables, caste, occupation of the head of the family, years since latrine constructed, and latrine cleaning remained significant predictors of open field defecation. Conclusions: Open defecation is common among latrines owners. This behavior is associated with various several structural and sociocultural factors. The present sanitation campaign should consider shifting from toilet construction to toilet use.
  10,172 1,355 -
Magnitude of fluorosis and various interventions to reduce fluorosis in Gujarat, India
Sangita V Patel, Kedar Gautambhai Mehta, Prakash V Kotecha
October-December 2020, 5(4):107-111
DOI:10.4103/ed.ed_29_20  
Background: Gujarat is one of the endemic states for the prevalence of fluorosis due to high fluoride levels in water of many villages in the state. Aim and Objectives: To determine the prevalence of dental fluorosis and skeletal fluorosis in Vadodara district, Gujarat, India, and to document various interventions conducted by Government to reduce the prevalence of fluorosis in Gujarat. Materials and Methods: A cross sectional survey was carried out in 11 villages (6 with high fluoride level and 5 with normal fluoride level) by house to house visits. Various interventions like capacity building of faculties, diagnostic, treatment and counseling for fluorosis and alternate water supply facilities were provided. Results: The prevalence of dental fluorosis and skeletal fluorosis was 59.31% and 18.65% in high fluoride areas, while it was 39.21% and 12.54% in normal fluoride areas, respectively. After estimation of this problem, and other research studies carried in Gujarat, the Government of Gujarat provided a fluorine meter to measure the fluoride level in water and urine in all government medical colleges of the state. Capacity building of faculties from various departments was done regarding the epidemiology, diagnosis, treatment, and counseling of fluorosis patients. Early diagnosis and treatment were provided to all fluorosis patients visiting tertiary care hospitals. Alternate drinking water supply was also provided by the government. Conclusion: Both dental and skeletal fluorosis was high in Gujarat and field level diagnostic facilities are inadequate. A coordinated training program helped to identify the problem and suggest remedial measures. An integrated and comprehensive approach is required to reduce the problem of fluorosis in Gujarat.
  10,034 1,308 -
ORIGINAL ARTICLE
Urinary metabolites as exposure biomarkers of benzene, toluene, ethylbenzene, and xylene in footwear workers and assessment of pulmonary function
Anupa Yadav, Asim Saha, Amit Chakrabarti, Geoffrey Nengzapum, Anirban Das, Surajit Das
July-September 2021, 6(3):91-97
DOI:10.4103/ed.ed_5_21  
Aim: This pilot cross-sectional study focused on biological monitoring of the benzene, toluene, ethylbenzene, and xylene (BTEX) urinary metabolites trans, trans-muconic acid (tt-MA), s-phenyl mercapturic acid (SPMA), hippuric acid (HA), mandelic acid (MA), and methylhippuric acid (MHA) and measured the effects of workplace BTEX exposure on pulmonary function of workers engaged in footwear manufacturing. Materials and Methods: Urinary metabolites tt-MA, SPMA, HA, MA, and MHA concentration in urine samples of study participants (N = 35) were analyzed by reverse-phase high-pressure liquid chromatography. Pulmonary function parameters were measured by spirometer and peak flow meter. Demographic information and work exposure information of study participants were collected by questionnaire interview. Results: In exposed workers, concentration of urinary SPMA, tt-MA, and HA was significantly higher (P < 0.01, in all) than the control group. Reduction in both force expiratory volume in 1 s (Forced expiratory volume in one second) and peak expiratory flow rate (PEFR) were inversely associated (P < 0.01) with growing years of age among all workers. Inverse association was measured between urinary tt-MA and decline in forced vital capacity and PEFR (P < 0.05, for each) in workers. Based on the questionnaire interview, workers were not found to be aware of workplace exposure hazards. Conclusions: Exposure biomarkers of benzene (tt-MA and SPMA) and toluene (HA) were significantly higher in workers than the control group. Study results evident the presence of occupational exposure to benzene and toluene in footwear workers. Deterioration in FEV1 and PEFR were also measured among all workers with growing years of age. The sample size was small in the present study, so further research required to confirm our results.
  9,220 1,292 -
REVIEW ARTICLES
Augmenting the public health response to ensure effective containment of the Omicron variant
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
January-March 2022, 7(1):12-15
DOI:10.4103/ed.ed_5_22  
The ongoing coronavirus disease–2019 (COVID-19) pandemic continues to disrupt human lives and almost all sectors and industries. The purpose of the current review was to explore the Omicron variant, the associated global risk, and the public health measures that need to be taken to contain the new variant. An extensive search of all materials related to the topic was carried out in the PubMed search engine and the World Health Organization website. A total of 13 articles were selected based upon their suitability with the current review objectives. Keywords used in the search include COVID-19 and Omicron in the title alone only. The World Health Organization identified a new variant of concern – Omicron on November 26, 2021, which has been reported in more than 170 nations. Depending on the evidence that has surfaced till now, the overall global risk associated with Omicron has been identified as very high. However, the variant has not been linked with serious forms of illness and complications; nevertheless, the large number of cases resulting due to high transmissibility has definitely accounted for a proportional rise in the number of hospital admissions and thus overwhelming the health-care delivery systems. To conclude, the Omicron variant of the causative virus has been associated with high transmissibility but low rates of development of serious infections. This call for the need to raise to the occasion, and all of us should adhere to the standard prevention and control measures and get immunized with the vaccine at the earliest.
  9,245 1,260 -
ORIGINAL ARTICLES
Ratios of lymphocyte and neutrophil to lymphocyte as early predictors of the severity of acute pancreatitis at different age stratifications
Peng Liu, Zhang-Dong Feng, Yu Ji, Zi-Yu Zhang, Ting-Long Zhang, Redina Bardhi, Zhi-Li Ji, Wei Han
January-March 2020, 5(1):9-15
DOI:10.4103/ed.ed_35_19  
Goal: To explore the values of lymphocyte ratio (LR) and neutrophil-to-lymphocyte ratio (NLR) in the early prediction of the severity of acute pancreatitis (AP) in patients of different ages. Background and Aims: LR and NLR, as early markers, can predict the severity of disease in patients with AP according to previous studies. However, all of the studies ignored the influence of the age factor. Study: The patients with AP from January 2012 to October 2017 were retrospectively analyzed. The patients were divided into mild acute pancreatitis (MAP) and severe acute pancreatitis (SAP) groups according to the latest Atlanta classification. In each group, the patients were further divided into the young and middle-aged group (ages ≤65), and the elderly group (ages >65). The neutrophil ratio (NR), LR and NLR were detected and collected within 24 h of disease onset. The relationship between various indicators and severity of AP was evaluated. Results: NLR (11.15±8.20 vs. 7.83±9.17 P < 0.001) significantly increased whereas LR (10.72±6.32 vs. 16.77±9.70 P < 0.001) significantly decreased in the SAP group compared to the MAP group. LR and NLR demonstrated a significant predictive value in the young- and middle-aged group. However, LR and NLR were not significant predictors in the elderly group. Conclusions: The LR reduction and NLR elevation in the early stages were closely related to the severity of AP. They were both important markers for predicting severity of AP, especially in the young and middle-aged patients.
  8,923 1,366 -
The prevalence of thyroid nodules and risk factors of thyroid nodules with metabolic disorder in Beijing: A cross-sectional study
Yuanyuan Zhang, Alexandra Wehbe, Xuhong Wang, Rong Xin Sun, Zhao Hui Zheng, Dong Zhao
January-March 2022, 7(1):22-28
DOI:10.4103/ed.ed_14_21  
Background: In recent years, the prevalence of thyroid nodules (TNs) has been increasing, but the relationship between metabolic abnormalities and the incidence of TNs is not well defined, and there is scant data evaluating this relationship stratified by gender. This study aims to analyze the prevalence of TNs and possible risk factors for TNs across gender lines and various metabolic states in Beijing, China. Patients and Methods: A total of 6001 subjects who underwent thyroid ultrasounds as part of a routine medical checkup at Luhe Hospital between 2017 and 2018 were enrolled in this study. Multivariate adjustment logic was used to analyze possible demographic and clinical risk factors of TN stratified by gender. Results: The prevalence of TNs was 44.1%, of which 45.9% were female and 40% were male. In general, the prevalence of TNs increased in parallel with advancing age. These findings were even starker among females, with TN prevalences of 37.5%, 46.5%, 52.9%, and 54.1%, among participants in <55-, 55–65-, 65–75-, and >75-year-old age groups, respectively. The prevalence of TNs was significantly higher among patients with obesity (46.8% vs. 43%, P = 0.008), central obesity (45% vs. 40.4%, P = 0.005), hypertension (47.1% vs. 42.4%, P < 0.001), metabolic syndrome (MetS) (46.1% vs. 41%, P < 0.001), and low TSH levels (46.5% vs. 37.1%, P < 0.001). MetS and obesity were independent risk factors for the prevalence of TNs (odds ratio [OR] = 1.167, [1.002–1.277] and (OR = 0.038, [1.01–1.396]), respectively). TSH had a protective effect on the prevalence of TNs (OR = 0.664, [0.585–0.75]). Conclusions: The present study supports the existing research that contends a strong correlation between older age, MetS, and other clinical risk factors and the prevalence of TNs. This relationship only persisted among women when stratified by gender. These results set the precedent for further research on how gender influences the incidence of TNs, particularly in the setting of other clinical and demographic risk factors.
  8,988 1,249 -
REVIEW ARTICLES
Genotype, environment, and evolutionary mechanism of diseases
Henry H. Q. Heng, Sarah Regan, Christine J Ye
January-March 2016, 1(1):14-23
Large-scale genomic projects have unexpectedly challenged the current approach of focusing on genes in disease studies. As common gene mutations are difficult to identify for common/complex diseases, and the diagnostic distinction of gene profile between “normal” and “patient” becomes increasingly blurry, the power of gene-focused studies in medicine is actually decreasing. More attention is now being focused on gene–environment interaction. However, such a transition is still within the framework of using molecular descriptions of specific genes for understanding diseases, which is challenging in the clinic, where nonlinear relationships are dominant. In this article, we define diseases as genotype/environment-induced variants that are not compatible with a current environment. This explains (1) why the genotype is not simply the gene mutation profile, but comprised of multiple levels of genetic/nongenetic (including epigenetic) variations, as environmental dynamics require all sorts of system modifications; (2) why many disease conditions represent a trade-off of cellular adaptation, in addition to inherited or environment-induced bio-errors; and (3) why costly variants function as the “insurance policy” for adapting to the unpredictability of environments. This leads to the general mechanism of the majority of diseases: genotype–environment interaction generates variations, which are either essential for future crises or useful for current cellular function. Unfortunately, as a trade-off, these variants also contribute to diseases. This general mechanism can unify diverse specific molecular mechanisms, and suggests that the goal of eliminating all diseases is not only impossible, but also comes with the potential negative consequence of reducing the heterogeneity essential for human survival.
  9,128 1,075 -
ORIGINAL ARTICLES
Serum ANGPTL2 and ANGPTL3 as potential biomarkers for diagnosis of non-alcoholic fatty liver disease
Yan Ma, Yan Wang, Qiang Zhang, Jia-Nan Lang, Long-Yan Yang, Dong Zhao
April-June 2020, 5(2):29-37
DOI:10.4103/ed.ed_33_19  
Purpose: Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease that has a serious effect on worldwide public health. We sought relationships among ANGPTL2, ANGPTL3, and ANGPTL6 with NAFLD metabolic and biochemical parameters, to assess their potential as diagnostic tools for NAFLD. Materials and Methods: Serum levels of ANGPTL2, ANGPTL3, and ANGPTL6 in NAFLD patients (n = 52) and non-NAFLD participants (n = 51) were quantified by ELISA. The utility of ANGPTLs as biomarkers for NAFLD prediction was assessed using receiver operating characteristic (ROC) analysis. Results: Serum ANGPTL2 levels were increased (P = 0.0102), serum ANGPTL3 levels were decreased (P < 0.0001), and ANGPTL6 levels did not change (P = 0.3174) in 52 patients with NAFLD when compared to 51 participants without NAFLD. The areas under the ROC curves for ANGPTL2 and ANGPTL3 were 0.647 and 0.746, respectively. When two factors were jointly analyzed, the area under the ROC curve for ANGPTL2 and ANGPTL3 was 0.773. Conclusion: ANGPTL2 and ANGPTL3 levels may be novel and important predictors of NAFLD severity.
  9,181 1,004 -
Secondhand smoke exposure is associated with autism spectrum disorder in US males but not in females: Results from the National Survey on Children's Health
Naila Khalil, Bhupinder Kaur, Alexandra Lawson, James Ebert, Ramzi Nahhas
January-March 2018, 3(1):8-17
DOI:10.4103/ed.ed_2_18  
Background: Secondhand smoke (SHS) exposure is linked with neurobehavioral disorders in children. This study evaluated the SHS exposure and autism spectrum disorders (ASD) in children in the United States. Materials and Methods: Parent-reported postnatal SHS exposure and ASD diagnosis were examined in children age 2 to 12 years using the 2011–2012 National Survey on Children's Health. The physician diagnosis of current ASD as reported by the parents was used as the outcome. Logistic regression analysis was used to evaluate the association of ASD with SHS after adjusting for risk factors. Results: Of the 56,710 children, 24% had SHS exposure, 2% had ASD, and the mean age was 7 years. SHS exposure was associated with 47% greater odds of ASD in male children (adjusted odds ratio [OR] = 1.47; 95% confidence interval [CI] =1.05, 2.07; P = 0.025). In contrast, SHS was not significantly associated with ASD in female children (adjusted OR = 0.72; 95% CI = 0.40, 1.29; P = 0.266). Other significant factors associated with ASD diagnosis in male children were age, income, mother's education, and mental health status. Conclusions: SHS is significantly associated with ASD in male children. Sociodemographic factors, natal and prenatal characteristics are important etiologic influences for ASD. Targeted efforts to change the smoking behavior of parents and caregivers of children could reduce ASD.
  9,291 456 4
REVIEW ARTICLES
Eplerenone–A novel Mineralocorticoid receptor antagonist for the clinical application
Nan-Nan Wu, Yuan-Yuan Zhang, Dong Zhao
January-March 2022, 7(1):1-11
DOI:10.4103/ed.ed_7_21  
Aldosterone is produced from the zona glomerulosa of the adrenal cortex in the adrenal gland, which is main mineralocorticoid hormone. Upon binding the mineralocorticoid receptor, it regulates sodium and potassium absorption, secretion, and retention, thereby maintaining stable blood pressure levels. However, abnormal aldosterone synthesis and metabolism could be pathogenic and contribute to multiple organ fibrosis and structural remodeling. For instance, hyperaldosteronemia is critically involved in the development of hypertension, heart failure (HF), and renal disease. Therefore, mineralocorticoid receptor antagonists (MRAs) that could fight against high concentrations of aldosterone play an important role in the treatment of diseases caused by hyperaldosteronism. Eplerenone, as a novel selective MRA, has better therapeutic efficiency and fewer side effects comparing to the classical drug spironolactone. In this review, first, we go through the biosynthesis and biologic properties of aldosterone and then introduce how hyperaldosteronemia facilitates certain diseases progression. Aldosterone is an important part of the renin-angiotensin-aldosterone system (RAAS), which plays a crucial role in essential hypertension, atrial tremor, and tissue fibrosis. Second, we summarize current evidence of clinical application of eplerenone in the control of primary aldosteronism, hypertension, HF, nephropathy, insulin resistance, and liver damage. It is exciting that many studies have shown that the use of eplerenone in these diseases yields good outcomes accompanied with fewer adverse effects such as hyperkalemia, metabolic acidosis, hypotension, and acute kidney failure, which indicates that eplerenone is a strong and safe MRA and inhibitor of RAAS system. This review focuses on therapeutic efficacy and disadvantages of eplerenone when treating a series of different diseases. Ultimately, we hope to shed light on future therapeutic strategies in diseases associated with hyperaldosteronemia.
  8,811 929 -
CASE REPORT
Delayed-onset high-altitude pulmonary edema: A series of 8 patients
Sanjay Singhal, Bhattachar Srinivasa Alasinga
April-June 2020, 5(2):52-55
DOI:10.4103/ed.ed_1_20  
Clinical studies were performed in eight consecutive patients who developed high-altitude pulmonary edema (HAPE) after 6 days of stay (range: 8–121 days) at the same altitude who were admitted to our hospital. The findings of this series revealed respiratory infection with exertion and cold exposure as the predominant causes of delayed-onset HAPE. HAPE in its delayed-onset form is likely to be more severe based on mortality findings in our series and requires intense monitoring and preparation of contingencies for prompt evacuation in severe or nonresponsive cases.
  8,433 1,078 -
REVIEW ARTICLES
Scope of imposing lockdown in the containment of coronavirus disease-2019 pandemic and the decision to relax
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
January-March 2021, 6(1):1-3
DOI:10.4103/ed.ed_35_20  
The ongoing coronavirus disease-2019 (COVID-19) pandemic has forced the public health authorities to implement stringent measures, with an aim to reduce the mobility of the general population and thus interrupt the chain of transmission. An extensive search of all materials related to the topic was carried out in the PubMed search engine and World Health Organization website, and a total of six articles were selected based upon the suitability with the current review objectives. Keywords used in the search include COVID-19, Lockdown, and Exit. To contain the rapid spread of the disease, some of the affected nations have imposed complete lockdown within their settings. However, it is important to consider that the strategy of lockdown cannot be there for prolonged periods of time as it interrupts the social life and negatively affects the economy of the nation immensely. Thus, it is quite essential to lift these restrictions, but of course, the decision should be not taken in haste as it will again result in the resurgence of the cases and will overwhelm the health system. In conclusion, the decision to impose a lockdown has been an effective strategy to reduce the risk of transmission. However, it is also important to plan for revoking the same, and this will obviously require strengthening of the health system and the complete support from the community.
  7,990 901 -
ORIGINAL ARTICLES
Antimicrobial potential of extract fractions of ficus vogelii Miq.
Akataobi Uche Stephen
July-September 2020, 5(3):66-71
DOI:10.4103/ed.ed_7_20  
Purpose: Microorganisms are responsible for a host of infectious disease diagnosed in human. Studies have shown that extracts of medicinal plants contain antimicrobial properties effective in the treatment of these infectious diseases. This study evaluated the antimicrobial potency of ficus vogelii Miq. extract fractions on selected microorganisms. Material and Method: The leave extract of the plant was prepared with n-hexane, crude, and methanol, serially diluted, and screened against Escherichia coli, Staphylococcus aureus, Salmonella typhimurium, and Candida albicans for zones of inhibition, minimum inhibitory concentration, resistance, and sensitivity test at a concentration of 12.5, 25, 50, and 100 mg/ml. Result: Crude and n-Hexane extract fractions inhibited E.coli and S. typhimurium effectively at different concentrations. Methanol fraction less inhibited E. coli only while all the extract fractions did not show any antimicrobial potency against S. aureus and Candida abicans. Conclusion: This study concludes that crude and n-hexane extract of ficus vogelii is a potent antimicrobial agent against E. coli and S. typhimurium at a concentration of as low as 12.5 μg/ml.
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High frequency ultrasonography of the facial nerve: Another effective method to observe the course of idiopathic facial nerve paralysis
Jing Zhu, Xiaohua Li, Yang Han, Yu Cao, Longfei Guan, Xiaokun Geng
October-December 2020, 5(4):100-106
DOI:10.4103/ed.ed_30_20  
Objective: This study was designed to investigate and compare both ultrasonographic and electrophysiological methods of examination of the facial nerve in idiopathic facial paralysis (IFP). Materials and Methods: Patients with IFP diagnosed between January 2018 and June 2019 (n = 178) underwent ultrasonographic and electrophysiological examinations of the facial nerve, within the 1st week of symptoms and every 1–3 following weeks until asymptomatic, with comparisons between the affected and unaffected sides. Results: There were significant differences in the ultrasonographic diameter and the electrophysiological results obtained from the facial nerve between the affected and unaffected sides. Ninety-one patients completed follow-up and underwent re-examination of the facial nerve by ultrasonography and/or electromyography. The difference between the affected and unaffected sides in terms of the ultrasonographic diameter of the facial nerve gradually decreased with the course of the disease. The ultrasonographic diameter of the facial nerve of the affected side was greater by 0.3 mm than that of the unaffected side for more than 3 weeks, indicative of a poor prognosis, which was consistent with the electrophysiological results. Conclusions: The combination of ultrasonographic and electrophysiological examinations of the facial nerve serves to better guide clinical treatment and assess the prognosis of IFP.
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Positive cumulative fluid balance in the first 72 h is associated with adverse outcomes following heat stroke
Xiaoxue Yin, Gang Ye
April-June 2020, 5(2):38-43
DOI:10.4103/ed.ed_3_20  
Objective: The objective of the study was to determine the association between positive cumulative fluid balance following heat stroke (HS) and its impact on patient outcomes. Methods: A retrospective chart review of HS patients admitted to the emergent intensive care unit (ICU), Beijing Lu He Hospital, Capital Medical University, from 2015 to 2018 was conducted. Results: Forty-nine surviving HS patients met the inclusion criteria. Patients were divided into two groups based on the median duration of mechanical ventilation (MV). Patients with MV for more than 6 days were placed in the longer length of the MV group. Patients with MV for <6 days were placed in the shorter MV group. There were significant differences between the two groups regarding the fluid balance on day 2 (3040 ml vs. −533 ml, P = 0.017) and persistent cumulative fluid overload in the first 72 h (6112 ml vs. −46 ml, P = 0.04). Patients with a higher cumulative fluid overload in the first 72 h were more likely to receive a longer duration of MV (10.7 days vs. 3.2 days, P < 0.001) and ICU length of stay (22.5 days vs. 6.2 days, P < 0.001). Spearman analysis of fluid overload in the first 72 h and MV time showed that the correlation coefficient was 0.662. Binary logistic regression analysis showed that the positive cumulative fluid balance in the first 72 h (odds ratio [OR] = 1, 95% confidence interval [95% CI] = 0.99–1.01] and alanine aminotransferase (OR = 0.978, 95% CI = 0.95–0.99) were both independent risk factors for prolonged MV in patients with HS (P = 0.025, P = 0.026). There were also differences between groups regarding creatine kinase-MB (P = 0.01) and Glasgow Coma Scale scores (P = 0.033). The patients with a higher cumulative fluid overload in the first 72 h had larger sequential organ failure assessment cores. Based on the receiver operating characteristic analysis, the cumulative fluid overload in the first 72 h predicted the need for invasive MV with the area under the curve of 0.869 (P < 0.0001, 95% CI: 0.779–0.958) at a cutoff value >1685 ml (sensitivity: 86%; specificity: 78%). Conclusions: Fluid overload in the first 72 h was a predictor of prolonged MV and ICU length of stay in surviving HS patients. Maintaining cautious about fluid resuscitation for HS patients may be critical for improving patient outcomes.
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SHORT COMMUNICATION
Strengthening WASH facilities for the general population to accomplish universal access by 2030
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
April-June 2020, 5(2):56-57
DOI:10.4103/ed.ed_10_20  
The provision of drinking water, sanitation, and hygiene (WASH) facilities has been identified as one of the important goals required for the attainment of universal health coverage. However, billions of people across the globe are having poor access to water, sanitation, and hygiene (WASH). It is important to note that significant progress has been observed in ensuring access to WASH facilities since the start of the current century; nevertheless, massive gaps and inequalities persist in the field with regard to access, availability, and the quality of the offered services. Another important aspect is that ensuring mere access to these facilities is not enough. The time has come wherein all the concerned stakeholders should commit themselves toward the realization of this essential and fundamental human right. In conclusion, the need of the hour is to minimize the inequality gaps in WASH facilities and that will essentially require a concerted and well-coordinated response from all the stakeholders, including the general population.
  7,162 926 -
ORIGINAL ARTICLES
Effect of parity on the serum calcium in the pregnancy: A retrospective study
Nan-Nan Wu, Bin Cao, Jia-Nan Lang, Dong Zhao
April-June 2021, 6(2):58-63
DOI:10.4103/ed.ed_6_21  
Background: Maternal hypocalcaemia has adverse outcomes on pregnant women and offspring development. The objective of this study is to test whether parity number is associated with maternal calcium level. Materials and Methods: According to parity numbers, the pregnant women were divided into never parturition group (NPG) and previous parturition group (PPG). Association between parity number and serum calcium was tested in multivariate linear regression models controlling for age, body mass index (BMI), Vitamin D, and Homeostasis model assessment for insulin resistance (HOMA-IR). The subjects were also subgrouped by recruitment in four seasons and their development of gestational hypertension (GH) and diabetes. Results: Mean serum calcium was lower in the PPG than that in the NPG (2.15 vs. 2.20 mmol/L, P < 0.001). After adjusted for albumin, adjusted serum calcium was still lower in PPG than that in NPG (2.20 vs. 2.23 mmol/L, P < 0.001). Interestingly, adjusted serum calcium level is consistently lower in the PPG in both the diabetic and hypertension subgroups compared to NPG (2.20 vs. 2.23 mmol/L, P < 0.001). In different seasons, the serum calcium level and adjusted serum calcium level in the PPG were significantly lower than the NPG (P < 0.001). Importantly, adjusted calcium correlated negatively with the parity number (r = −0.044, P < 0.001), when adjusting for age, BMI, Vitamin D, and HOMA-IR. In addition, there was a significant increase in the PPG compared to the NPG including age (29.61 vs. 33.39 years old), BMI (22.80 vs. 23.55), triglyceride (2.27 vs. 2.43 mmol/L), and fasting basal blood glucose (4.73 vs. 4.81 mmol/L), and a significant decrease regarding the albumin (38.72 vs. 37.65 g/L) and Vitamin D (20.98 vs. 18.62 ng/ml). There was no difference in the onset of GH and gestational diabetes mellitus (GDM) between the two groups. Conclusion: Parity negatively correlated with the serum calcium level. The small but significant difference in the calcium levels indicated that parity may play an intricate role in calcium homeostasis. Timely monitoring of maternal calcium could be clinically beneficial to the multiparous women.
  7,152 834 -
REVIEW ARTICLE
Principles and practices of biosafety: Expanding and extending to food safety and food supply chain
Murli Manju, Amrita Ghosh, Ranabir Pal, Gabriel Alexander Quiñones-Ossa, Rajashekar Mohan, Amit Agrawal
April-June 2021, 6(2):31-37
DOI:10.4103/ed.ed_34_20  
The perception of biosafety on food and supply chains moves around the philosophical axis of “coping and living with occupational health hazards” to upheld the sustainable development of occupational safety. COVID-19 pandemic opened the “Pandora's box” of prevailing lackadaisical attitude on the basic public health aspects principles that should apply to food safety and food supply chain. We must revamp the collaboration of food production and public health-care delivery system to save the community by containing the spread of highly infectious agent from known and unknown natural and artificial reservoirs. Equity of distribution of quality and quantity of the food and nutrition has to be ensured for the majority of the global population at this crossroads of socio-economic crisis which has pauperized en masse as the negative fallout of pandemic. Food safety should be an urgent agenda for comprehensive internalization and be supplemented with the mitigation plan to minimize psychosomatic stresses and revitalize emotional and psychosocial health by targeted interventions. There is dire need of translational research and holistic streamlining of biosafety program in the phase of the rising trend of the cases and sequels epidemiologic pandemic curve on ground. Needless to mention that apart from SARS-COV2, the holistic concept of the implementation of the biosafety programs can interrupt the transmission of innumerable infectious agents from the plant and animal resources. Biosafety models were reviewed for high laboratory standards in the real time “new normal” situation of containment and risk assessment in this unprecedented pandemic of new millennium.
  7,053 797 -