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Cancer is a disease characterized by the uncontrolled multiplication of cells in human body with the inability to be controlled or stopped, consequently forming tumors of malignant cells with the potential to be metastatic. Around one third of deaths due to cancer are due to five leading behavioral and dietary risks: high body mass index, low fruit and vegetable intake, lack of physical activity, tobacco use and alcohol use. According to the World Health Organization, cancer is the second leading cause of death globally and about one in 6 deaths is due to cancer. The economic impact of cancer is significant and is increasing. The total annual economic cost of cancer in 2010 was estimated at approximately US 1.16 trillion. The economic burden on low- and middle-income countries is profound since approximately 70% of deaths due to cancer occur in these countries. To combat the growing challenge, development in cures and preventative therapies has emerged through rapid research in this area. Current treatments include chemotherapy, radiotherapy and chemically derived drugs which have severe side effects. Therefore, there is an increasing impetus on development and use of natural alternative therapies against cancer. Plants sources have been exploited in medicine for their natural antiseptic properties. Thus, research has developed into investigating the potential properties and uses of terrestrial plant extracts for the preparation of potential nanomaterial-based drugs for diseases including cancer. This article aims to take an overview of naturally derived compounds that have anticancer therapeutic properties and their current status in this field.

Conscious perception of the emotional valence of faces has been proposed to involve top-down and bottom-up information processing. Yet, the underlying neuronal mechanisms of these two processes and the implementation of their cooperation is still unclear. According to the global workspace model, higher level cognitive processing of visual emotional stimuli relies on both bottom-up and top-down processing. Using masking stimuli in a visual backward masking paradigm with delays at the perceptual threshold, at which stimuli can only partly be detected, suggests that only top-down processing differs between correctly and incorrectly perceived stimuli, while bottom-up visual processing is not compromised and comparable for both conditions. Providing visual stimulation near the perceptual threshold in the backward masking paradigm thus enabled us to compare differences in top-down modulation of the visual information of correctly and incorrectly recognized facial emotions in 12 healthy individuals using magnetoencephalography (MEG). For correctly recognized facial emotions, we found a right-hemispheric fronto-parietal network oscillating in the high-beta and low-gamma band and exerting top-down control as determined by the causality measure of phase slope index (PSI). In contrast, incorrect recognition was associated with enhanced coupling in the gamma band between left frontal and right parietal regions. Our results indicate that the perception of emotional face stimuli relies on the right-hemispheric dominance of synchronized fronto-parietal gamma-band activity.

Bimanual movements involve the interactions between both primary motor cortices. These interactions are assumed to involve phase-locked oscillatory brain activity referred to as inter-hemispheric functional coupling. So far, inter-hemispheric functional coupling has been investigated as a function of motor performance. These studies report mostly a negative correlation between the performance in motor tasks and the strength of functional coupling. However, correlation might not reflect a causal relationship. To overcome this limitation, we opted for an alternative approach by manipulating the strength of inter-hemispheric functional coupling and assessing bimanual motor performance as a dependent variable. We hypothesize that an increase/decrease of functional coupling deteriorates/facilitates motor performance in an out-of-phase bimanual finger-tapping task. Healthy individuals were trained to volitionally regulate functional coupling in an operant conditioning paradigm using real-time magnetoencephalography neurofeedback. During operant conditioning, two discriminative stimuli were associated with upregulation and downregulation of functional coupling. Effects of training were assessed by comparing motor performance prior to (pre-test) and after the training (post-test). Participants receiving contingent feedback learned to upregulate and downregulate functional coupling. Comparing motor performance, as indexed by the ratio of tapping speed for upregulation versus downregulation trials, no change was found in the control group between pre- and post-test. In contrast, the group receiving contingent feedback evidenced a significant decrease of the ratio implicating lower tapping speed with stronger functional coupling. Results point toward a causal role of inter-hemispheric functional coupling for the performance in bimanual tasks. Hum Brain Mapp 38:4353-4369, 2017. © 2017 Wiley Periodicals, Inc.

Introduction: Hypertension and atherosclerosis though separate entities, are interrelated as hypertension plays an important role in the pathogenesis of atherosclerosis. This study was undertaken to study the association of carotid intimal medial thickness with left ventricular hypertrophy (LVH) in hypertensive patients. Materials and Methods: Hundred hypertensives (JNC-7, Stage 1 and 2) between 30 and 55 years were enrolled in this prospective observational study conducted at a tertiary care teaching institute of Punjab, India. Electrocardiogram, Carotid Doppler, and Echocardiography were carried out in addition to routine biochemical investigations. Results: Increased carotid intimal medial thickness (CIMT) had statistically significant association with age, duration of hypertension, high systolic and diastolic blood pressure (BP), left ventricular hypertrophy and left ventricular mass index but was not associated with body mass index, low-density lipoproteins, and total cholesterol. Conclusions: LVH and arterial wall changes occur concurrently, and therefore, management of hypertension should not be limited just to control of BP but should also include therapy for carotid plaques and increased CIMT.

Background There is need to assess left ventricular diastolic dysfunction (LVDD) in metabolic syndrome to effectively implicate and strengthen population-based prevention strategies. Objectives To assess the prevalence of LVDD in metabolic syndrome. Methods This study was conducted in the Department of Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot on 100 cases (with metabolic syndrome diagnosed on International Diabetic Federation criteria) and 100 age- and sex-matched controls (without metabolic syndrome) between 30 and 60 years of age by echocardiography to assess LVDD. Results Overall prevalence of diastolic dysfunction was 73% in the cases and 14% in controls with an increasing trend with increasing age in both groups showing age an important determinant of diastolic dysfunction; gender-wise difference was not significant in any group. However, increasing trend with increasing body mass index, elevated blood pressure, elevated fasting blood sugar, elevated serum triglyceride, and deceased serum high density lipoprotein was noted showing their risk correlation in the outcome of diastolic dysfunction; participants without metabolic syndrome had lesser diastolic dysfunction (14%). Conclusions The diastolic dysfunction in metabolic syndrome was found to be higher that supports the assumption that metabolic syndrome could be correlated to risk of development of LVDD. Holistic prevention of metabolic syndrome has an important role to prevent development of diastolic dysfunction.

The central nervous system exerts control over the activation of muscles via a dense network of nerve fibers targeting each individual muscle. There are numerous clinical situations where a detailed assessment of the nerve-innervation pattern is required for diagnosis and treatment. Especially, deep muscles are hard to examine and are as yet only accessible by uncomfortable and painful needle EMG techniques. Just recently, a new and flexible method and device became available to measure the small magnetic fields generated by the contraction of the muscles: optically pumped magnetometers (OPMs). OPMs are small devices that measure the zero-field level crossing resonance of spin-polarized rubidium atoms. The resonance is dependent on the local magnetic field strength, and therefore, these devices are able to measure small magnetic fields in the range of a few hundred femtoteslas. In this paper, we demonstrate as a proof of principle that OPMs can be used to measure the low magnetic fields generated by small hand muscles after electric stimulation of the ulnar or median nerve. We show that using this technique, we are able to record differential innervation pattern of small palmar hand muscles and are capable of distinguishing between areas innervated by the median or ulnar nerve. We expect that the new approach will have an important impact on the diagnosis of nerve entrapment syndromes, spinal cord lesions, and neuromuscular diseases.

Conscious perception of emotional valence of faces has been proposed to involve top-down and bottom-up information processing. Yet, the underlying neuronal mechanisms of these two processes and the implementation of their cooperation is still unclear. We hypothesized that the networks activated during the interaction of top-down and bottom-up processes are the key substrates responsible for perception. We assessed the participation of neural networks involved in conscious perception of emotional stimuli near the perceptual threshold using a visual-backward-masking paradigm in 12 healthy individuals using magnetoencephalography. Providing visual stimulation near the perceptual threshold enabled us to compare correctly and incorrectly recognized facial emotions and assess differences in top-down modulation for these stimuli using coherence analysis. We found a fronto-parietal network oscillating in the lower gamma band and exerting top-down control as determined by the causality measure of phase slope index. We demonstrated that correct recognition of facial emotions involved high-beta and low-gamma activity in parietal networks, Incorrect recognition was associated with enhanced coupling in the gamma band between left frontal and right parietal regions. Our results indicate that fronto-parietal control of the perception of emotional face stimuli relies on the right-hemispheric dominance of synchronized gamma band activity.

Background: The emergency department of every tertiary care teaching hospital is the backbone of community health care service. Aims: This study was undertaken to identify the pattern of emergencies in the hospital, and to identify the risk factors associated with these emergencies. Materials and Methods: This was a retrospective record analysis of the emergency department from Jan 2010 to Dec 2010. The data were analyzed for various types of medical emergencies presented at the hospital at Guru Gobind Singh Medical College and Hospital, Faridkot. Results: A total of 2310 patients presented in the emergency department of which nearly half were males; a great majority were in the age group of 15-40 years. The diseases related to the cardiovascular system, 367 (15.89%), topped the list of which hypertension was noted in 267 (11.56%) cases. This was followed by morbidities related to the neurological system, diabetes, hepatobiliary, respiratory, renal 168 (7.27%), poisoning, pyrexia of unknown origin, and multi-organ involvement. With regard to the specific diseases, the majority were contributed by coronary artery disease 217 (9.39%), stroke 178 (7.71%), alcoholic liver disease 160 (6.93%), and chronic obstructive lung diseases 90 (3.90%). In our series, we noted that a great majority of cases were in the 41-60 age groups except poisoning (majority less than 40 years). The age groups were significantly related with selected morbidities. Conclusions: There are transparent evidence that we need an organized emergency care system in India as relatively the younger age group (15-40 years) comprised nearly half cases.

Electrolyte imbalance always poses challenging situations to the attending intensivists, particularly if it is associated with endocrinopathies and other comorbidities. One such rare clinical scenario is hypokalemic periodic paralysis (HPP) due to hyperthyroidism. The epidemiology of such a condition is slightly higher among males of Asian origin as compared to its universal occurrence. The diagnostic challenges in this clinical situation can lead to higher morbidity if timeliness is compromised from the presentation to active management. Moreover, atypical presentation of this pathologic condition further compounds the problem if it is associated with overt hyperthyroidism. Here, we report a unique case that presented to the emergency medicine department of our institute with weakness of all the four limbs and in which we faced all the diagnostic and management challenges as the clinical condition of hypokalemia was somehow dominated by overt hyperthyroidism.

Cerebral information processing involves the activation of brain regions and the exchange of information between them. As metric for intra-cortical communication, coherence, a frequency specific measure quantifying the correlation of the amplitudes across trials of two phase-locked signals, has been suggested. A value of 0 indicates that both signals are unrelated, a value of 1 that both signals are fully synchronized. It is evidenced by the plethora of findings that the functional connectivity between brain regions is modulated by brain states, mental processing and the planning and execution of actions. Thus, it might be hypothesized that volitionally modulating the functional connectivity between two interacting brain regions should have an impact either on behavior or cognition. The purpose of the study was to test whether subjects can learn to volitionally modulate brain functional connectivity between left and right motor cortices employing a neurofeedback training and whether the neurofeedback training induces specific effects on motor function. Thirty right-handed subjects participated in the study. The subject group was partitioned into two sub-groups, namely contingent feedback group and sham feedback group, consisting of fifteen subjects. During the neurofeedback training the magnetic brain activity originating from left and right primary motor cortices was recorded using magnetoencephalography (MEG) and a feedback signal representing the coherence between the primary motor cortices of both hemispheres was presented to the subjects on a screen. Subjects receiving contingent feedback were trained to increase coherence while the discriminative stimulus S D+ was presented and to decrease coherence while the S D− was presented. A pretest and posttest examination served to examine whether acquired control on functional connectivity evidences any behavioral effects. During pre- and posttest subjects had to perform a complex bimanual finger tapping task while the discriminative stimulus either for up- or down-training was presented. Our findings suggest that it is possible to modulate the functional connectivity between the primary motor cortices of both hemispheres and that changes in functional connectivity do have a strong behavioral impact. Modulating the functional connectivity between brain regions can be used to study the functional role of cortico-cortical connections and will offer therapeutic interventions in brain diseases originating from impaired intra-cortical connections.

Background: Diabetes mellitus (DM), being a long-term condition, requires consistent blood glucose monitoring and adjustment of doses of the antidiabetic drugs and insulin. Telehealth is an emerging field that can have a positive impact on the management of this disease. Aim: The aim was to study the impact of the frequency of consultation and follow-up on telephone of diagnosed follow-up patients of DM on glycemic and metabolic profiles, the patients' compliance, and their quality of life (QoL), and to compare the effectiveness of different modes of follow-up. Materials and Methods: One hundred twenty patients were enrolled from the outpatient department (OPD) including both type 1 and type 2 DM patients who had already been diagnosed and were on treatment. They were randomly assigned to one of three groups, each consisting of 40 subjects, according to the mode of follow-up: A (rare, i.e., less frequent outpatient visits), B (moderate, i.e., more frequent outpatient visits), and C (frequent, i.e., more frequent outpatient visits with weekly telephonic consultation). Metabolic profiles and the QoL were monitored. The patients' compliance with and adherence to the treatment, and dietary and exercise advice were assessed. Results: The patients' compliance with and adherence to the treatment was higher in group C, followed by groups B and A. There was a net decrease in adverse events, with an increase in the frequency of follow-up. Changes in glycated hemoglobin (HbA1c) suggested a positive impact of weekly telephonic consultation. The lipid profile was also positively affected, with maximum improvement being in high-density lipoproteins (HDLs) and triglycerides. There was an improvement in the QoL domains pertaining to physical health and endurance in patients with higher frequency of follow-ups. There was no effect on emotional or mental health. There was an overall deterioration of the financial domain, being most marked in group B. The treatment satisfaction questionnaire showed better results in the telephone intervention group. Conclusion: Telephonic consultation can be a useful measure to improve the follow-up and management of patients with DM.