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Abstract The large-scale convection during the Asian summer monsoon plays an important role in the rapid transport of boundary layer aerosols into the Asian summer monsoon anticyclone. Here, using the state-of-the-art ECHAM6–HAMMOZ aerosol-chemistry-climate model, we show that these aerosols are further transported to the Arctic along isentropic surfaces by the Brewer-Dobson-Circulation (BDC) during the monsoon season. Our model simulations show that East and South Asian anthropogenic emissions contribute significantly to the aerosol transported to the Arctic, which causes a higher negative net aerosol radiative forcing at the surface (dimming) of −0.09 ± 0.02 Wm−2 and −0.07 ± 0.02 Wm−2, respectively. Over the Arctic, the East Asian anthropogenic aerosols that include large amounts of sulfate cause a seasonal mean net radiative forcing at the top of the atmosphere (TOA) of −0.003 ± 0.001Wm−2 and a surface cooling of −0.56 K while the black carbon dominated aerosol from South Asia shows a positive TOA forcing of +0.004 ± 0.001Wm−2 with an only minor surface cooling of −0.043 K. Overall, the long-range transport of South Asian aerosols results in a notably warming throughout the atmospheric column but minimal temperature response at the Arctic surface. Conversely, East Asian aerosols cool the troposphere and heat the lower stratosphere in the Arctic. The Asian aerosol thus plays an ambivalent role, with the East Asian sources in particular having the potential to counteract the rapid rise in Arctic temperatures and the associated melting of snow and ice.

Abstract Acute kidney injury (AKI) causes distant organ dysfunction through yet unknown mechanisms, leading to multiorgan failure and death. The lungs are one of the most common extrarenal organs affected by AKI, and combined lung and kidney injury has a mortality as high as 60%–80%. One mechanism that has been implicated in lung injury after AKI involves molecules released from injured kidney cells (DAMPs, or damage‐associated molecular patterns) that promote a noninfectious inflammatory response by binding to pattern recognition receptors (PRRs) constitutively expressed on the pulmonary endothelium. To date there are limited data investigating the role of PRRs and DAMPs in the pulmonary endothelial response to AKI. Understanding these mechanisms holds great promise for therapeutics aimed at ameliorating the devastating effects of AKI. In this study, we stimulate primary human microvascular endothelial cells with DAMPs derived from injured primary renal tubular epithelial cells (RTECs) as an ex‐vivo model of lung injury following AKI. We show that DAMPs derived from injured RTECs cause activation of Toll‐Like Receptor and NOD‐Like Receptor signaling pathways as well as increase human primary pulmonary microvascular endothelial cell (HMVEC) cytokine production, cell signaling activation, and permeability. We further show that cytokine production in HMVECs in response to DAMPs derived from RTECs is reduced by the inhibition of NOD1 and NOD2, which may have implications for future therapeutics. This paper adds to our understanding of PRR expression and function in pulmonary HMVECs and provides a foundation for future work aimed at developing therapeutic strategies to prevent lung injury following AKI.

Abstract Long‐term survival of transplant recipients is significantly impacted by malignancy. We aimed to determine whether calcineurin inhibitor (CNI)‐treated recipients converted to and weaned off molecular target of rapamycin inhibitor (mTOR‐I) therapy have favorable changes in their molecular profiles in regard to malignancy risk. We performed gene expression profiling from liver biopsy and blood (PBMC) specimens followed by network analysis of key dysregulated genes, associated diseases and disorders, molecular and cellular functions using IPA software. Twenty non‐immune, non‐viremic patients were included, and 8 of them achieved tolerance. Two comparisons were performed: (1) tolerance time point vs tacrolimus monotherapy and (2) tolerance time point vs sirolimus monotherapy. Upon achieving tolerance, IPA predicted significant activation of DNA damage response (p = 5.40e‐04) and inhibition of DNA replication (p = 7.56e‐03). Conversion from sirolimus to tolerance showed decrease in HCC (p = 1.30e‐02), hepatic steatosis (p = 5.60e‐02) and liver fibrosis (p = 2.91e‐02) associated genes. In conclusion, this longitudinal study of patients eventually achieving tolerance reveals an evolving molecular profile associated with decreased cancer risk and improved hepatic steatosis and liver fibrosis. This provides a biological rationale for attempting conversion to mTOR‐I therapy and tolerance following liver transplantation particularly in patients at higher risk of cancer incidence and progression post‐transplant.

Aim: The present study was conducted to evaluate differences in Oral Health-Related Quality of Life (OHRQoL) in denture wearers based on psychological classification and patient satisfaction. Settings and Design: A prospective study. Materials and Methods: 284 patients, aged 30 years and above who fulfilled the eligibility criteria were recruited. Participants answered the OHIP – EDENT questionnaire at the time of denture insertion and 6 months later. Psychological categorization was based on MM House classification. Patient satisfaction was graded from totally satisfied to not very satisfied. Statistical Analysis Used: SPSS 23 version was used for analyzing descriptive and inferential statistics. ANOVA was used to find significant differences for OHRQoL based on psychological classification and patient satisfaction. Before and after intervention analysis was assessed using student 't' test. Results: Philosophical and exacting patients had better adaptation to dentures than the hysterical and indifferent class of denture wearers. Totally satisfied and very satisfied patients with dentures had lesser mean scores as against the other categories which was significant in all domains suggesting better. Overall, OHIP – EDENT score decreased from 20.253 ± 12.466 to 17.168 ± 14.143, which were significant at P =0.043, thus showing an improvement after a 6 month follow up. Conclusions: Psychological attitude of denture wearers must be considered by the prosthetic specialist for effective adaptation and acceptance by the edentulous patient.

Chemical composition of aerosols is of great concern in the Arctic because of its great influence on climate. In this communication, we report the physico-chemical properties of size-separated aerosol data archived at Gruvebadet lab in Ny-Ålesund (78.55°S, 11.55°E) as a part of the Indian Arctic Mission over the station ''Himadri'' in 2010. The results reveal that the mass-size distribution (MSD) of aerosol composition exhibits tri-modal distribution with coarse-mode (62%), fine-mode (32%) and weak nucleation-mode (6%) indicating dominance of natural sources over the study region. MSD of chemical components showed a significant contribution to coarse-mode particles for Ca2+, Mg2+, Na+ and Cl−; fine-mode particles for SO42−, NO3−, NH4+ and K+. The marine sources contributed maximum for SO42− (89%) and Mg2+ (44%) in the coarse fraction, and in the fine fraction, 31% to SO42− and 86% to Mg2+. Non-marine sources were major contributors (80 to 95%) in both mode fractions for Ca2+and K+. The estimated aerosol radiative forcing in the atmosphere of ∼3.21 W/m2 could be attributed to the loading of black carbon aerosols (62%) over the site. The backward trajectories show air masses from Canada and Greenland travelling from 6000 m elevation, bringing the pollutants to Ny-Ålesund and lower altitudes; the oceanic region within Arctic circle contributes more.

Background. Delayed graft function (DGF) after kidney transplantation is associated with higher rates of acute rejection and poor graft survival and outcomes. Current DGF definitions based on posttransplant need for dialysis are not standardized and there are no objective methodologies for quantifying DGF severity. Methods. Using Organ Procurement and Transplantation Network data, we examined DGF, and used recipient serum creatinine at discharge as a correlate of renal function and DGF severity (mild:

Introduction: Skin grafting is one of the most indispensable techniques in surgery these days. In low resource settings, skin grafting using mesh, still forms the important technique of wound coverage. Aim: To evaluate the factors affecting graft uptake of large wound surface covered by mesh split skin grafting on day 5, day 10 and day 21 of postoperative days. Materials and Methods: This prospective longitudinal study was conducted at Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India, from June 2017 to December 2019, among patients with large wound surface. After baseline evaluation and wound preparation; patients were posted for mesh skin grafting. Postoperatively, the graft uptake percentage was assessed on the day 5, day 10 and day 21. Other parameters that were assessed were demographic details, mean stay of the patients during the preoperative and postoperative period, effect of various factors (age, gender, co-morbidities, addictions, site and aetiology of raw area, preoperative cultures) influencing graft uptake and postoperative complications. Statistical Package for Social Sciences (SPSS) version 20.0 was used for statistical analysis. Results: A total of 117 patients were enrolled in the study, out of which, 97 (82.9%) of the patients were males. The most common raw area was seen in lower limbs and accounted for 98 patients and the most common cause of raw area was cellulitis (n=91). Out of 117 patients, 105 (89.7%) had successful graft uptake on postoperative day 5, 102 patients (87.2%) on day 10 and 100 patients (85.4%) on day 21. Whereas, 17 (14.5%) patients had failed uptake of graft on postoperative day 21. It was observed that age (p-value=0.04) and preoperative cultures (p-value=0.01) were statistically significant factors influencing graft uptake. Conclusion: The present study concluded that mesh split skin grafting is a reliable and useful technique with successful graft uptake. Hence, it can be considered for the management of large raw areas.

This review describes the Story of the Human Hand. It traces the functional needs that led to evolution of the human hand as well as its embryological development. The various in utero stages of formation of the human hand are covered along with a description of the various molecular and genetic factors that control this process.

Abstract Precision medicine is associated with favorable outcomes in selected patients with cancer. Herein, we report an interim analysis of IMPACT2, an ongoing randomized study evaluating genomic profiling and targeted agents in metastatic cancer. Patients with metastatic cancer underwent tumor genomic profiling (ClinialTrials.gov: NCT02152254), and 69 patients met the criteria for randomization. Tumor board and multidisciplinary review of molecular alterations optimized treatment selection. From 5/2014 to 4/2017, 320 patients (median age, 63 years; men, 47%) had tumor molecular aberrations, and 213 (66.56%) received anticancer therapy. The most frequently mutated genes were TP53 (42%), KRAS (16%), PIK3CA (12%), and CDKN2A (11%). The median OS was 10.9 months (95% CI, 8.8–12.9). OS was shorter in patients with higher tumor mutational burden. Independent factors associated with shorter OS were age ≥60 years, liver metastases, low albumin levels, high LDH levels, and KRAS and TP53 mutations. Outcomes for randomized patients will be reported after completion of the study.

In this study, we investigate the temporal variations in columnar aerosol pollutants and their possible association with the simultaneously measured black carbon (BC) aerosol mass concentration and associated biomass burning (BB) over urban (Delhi) and rural (Panchgaon) sites during the lockdown phases of the COVID-19 pandemic. We also show the impact of lockdown measures on boundary layer ozone and its primary precursors, NO2, and water vapor (H2O), potent greenhouse gases that destroy protective ozone. For this purpose, we used multiple datasets, namely, black carbon (BC) aerosol mass concentration and biomass burning (BB) aerosols using an aethalometer at Amity University Haryana (AUH), Panchgaon, India, and satellite retrievals from NASA’s MODIS and OMI at both the stations. The analysis was conducted during the pre-lockdown period (1–25 March), lockdown 1st phase (25 March–14 April), lockdown 2nd phase (15 April–3 May), lockdown 3rd phase (4–17 May), lockdown 4th phase (18–31 May), and post-lockdown (1–30 June) period in 2020. Our diagnostic analysis shows a substantial reduction in AOD (Delhi: −20% to −80%, Panchgaon: −20% to −80%) and NO2 (Delhi: −10% to −42.03%, Panchgaon −10% to −46.54%) in comparison with climatology (2010–2019) during all four phases of lockdown. The reduction in AOD is attributed to lockdown measures and less transport of dust from west Asia than climatology. Despite a reduction in NO2, there is an increase in the ozone amount (Delhi: 1% to 8% and Panchgaon: 1% to 10%) during lockdown I, II, and III phases. The observed enhancement in ozone may be resultant from the complex photochemical processes that involve the presence of NO2, CO, volatile organic compounds (VOCs), and water vapor. The reduction in AOD and NO2 and enhancement in ozone are stronger at the rural site, Panchgaon than that at the urban site, Delhi.

Background. Focal segmental glomerulosclerosis (FSGS) is a common recurrent glomerulopathy associated with graft loss and patient survival after kidney transplantation (KT). However, its natural history, clinical predictors, and treatment response are still poorly understood. Steroid withdrawal regimens in KT have been associated with improvements in cardiovascular risk and patient outcomes. The Scripps Center for Organ Transplantation (SCOT) uses a rapid low-dose steroid withdrawal immunosuppression (IS) protocol for KT maintenance. Methods. We assessed the impact of our protocol on FSGS disease recurrence over a 10-y period to reassess our steroid and IS protocols and to evaluate if our patient outcomes diverge from published data. We compared 4 groups: steroids always, steroid free, steroid switch on, and steroid weaned off. We used IS and induction-matched retrospective data from United Network for Organ Sharing (UNOS) to investigate patient and graft survival for FSGS at SCOT. Results. Our analysis results differ from earlier studies showing that FSGS was associated with a higher risk of graft loss, perhaps because of selection of a UNOS data set filtered to match the SCOT IS protocol for making direct comparisons. Overall outcomes of graft failure and recipient death did not differ between SCOT patients and steroid-free transplant patient data from the UNOS data for FSGS. SCOT recurrence rate for FSGS was 7.5%, which was lower than in most published single-center studies. Conclusions. Based on our results, we believe that it is safe to continue the steroid avoidance protocols at SCOT and the steroid-free protocol may not be detrimental when the adverse effects and toxicities associated with steroid use are considered.

Introduction: With significant advances in the area of interventional radiology, angioplasty and stenting have become preferred first-line treatment in patients with significant renal artery stenosis. However, not all patients have favorable anatomy to undergo minimally invasive treatments, and reconstruction of the renal artery is an option. In select cases, either improved renal function or maintenance of existing function and sometimes resolution of hypertension can follow surgical treatment. Material and Methods: This was a prospective observational study conducted from August 2010 to June 2016. Patients

Immunoglobulin A (IgA) Nephropathy (IgAN) is one of the most common recurrent glomerulopathies associated with graft loss and patient survival after kidney transplantation (KT). Steroid withdrawal regimens in KT have been associated with improvements of patient outcomes. The Scripps Center for Organ Transplantation (SCOT) utilizes a rapid low-dose steroid withdrawal immunosuppression (IS) protocol for KT maintenance. We assessed the impact of our protocol on IgAN recurrence over a 10-year period to reassess our steroid withdrawal and IS protocols to see if outcomes diverged from available UNOS data. Therefore, we used IS and induction matched retrospective data from UNOS to investigate patient and graft survival for IgAN. SCOT recurrence rates for IgAN was 13.6%. Overall outcomes of graft failure and recipient death did not differ between SCOT patients and data obtained from steroid free transplants from UNOS. Our results differ from earlier studies showing IgAN was associated with a higher risk of graft loss, perhaps due to selection of a SCOT IS matched dataset. Based on our analysis, we believe that it is safe to continue the steroid avoidance protocols at SCOT and think that it may be beneficial, given the adverse effects and toxicities associated with steroid use.

Objective: To assess the real-world management practices of subjects with type 2 diabetes mellitus (T2DM) and type 1 diabetes mellitus (T1DM) in India. Methods: This cross-sectional study was conducted between 7 March 2016 and 15 May 2016 in India as part of the seventh wave (2016) of the International Diabetes Management Practices Study (IDMPS). Adult subjects with T1DM or T2DM visiting physicians during a 2-week recruitment period were included. Results: A total of 55 physicians included 539 subjects who met eligibility criteria. Of 495 subjects with T2DM, 303 were treated with oral glucose lowering drugs (OGLDs) only, 158 were treated with OGLD + insulin, and 27 received insulin only. Among 44 subjects with T1DM receiving insulin, 13 (29.5%) were also treated with OGLD therapy. The most commonly used insulin regimens were basal alone (69/184; 37.5%) and premixed alone (63/184; 34.2%) in subjects with T2DM, and basal + prandial insulin (24/44; 54.5%) in subjects with T1DM. Proportions of subjects achieving glycemic targets were low [glycated haemoglobin (HbA1c)

Objective Anterior cervical discectomy with fusion [ACDF] has been considered gold standard for cervical disc herniation over period of time. Anterior percutaneous endoscopic cervical discectomy [PECD] is minimally invasive technique without need for implant or bone graft in properly selected cases. In this study we present clinical and radiological results of anterior PECD. Methods We retrospectively studied 31 patients treated with anterior PECD in our institute from January 2014 to December 2016. Patients’ clinical data, visual analogue score [VAS], neck disability index [NDI] and radiographs were collected. Cervical lordosis angle, focal angle and disc height of involved segment were measured using Medsynapse software. Statistical analysis was performed using paired T test, chi square test. Results There were 18 males, 13 females in this study. Mean follow up period was 28.5 months. VAS for neck pain reduced from 6.2±0.72 to 1.67±0.59; VAS for arm pain reduced from 7.25±0.71 to 1.5±0.61 at final follow up. NDI reduced from 64.7±7.62 to 13.48±5.42 at final follow up. Mean disc height of involved segment was 6.15 mm pre-operatively which reduced to 5.24 mm at final follow up showing reduction of 0.91 mm. This reduction is disc space is not clinically significant as VAS and NDI show significant fall. Cervical lordosis was well maintained which changed from 13.93°±3.7° to 15.58°±6.66°; [p-value is 0.060]. Pre-operative focal cervical angle of involved segment was 0.86°±1.66° which increased to 1.7°±1.81° at final follow up [p-value 0.0067]. Twenty out of 31 patients resumed their previous employment within 2 weeks. Conclusion Anterior PECD is excellent minimally invasive technique for cervical disc herniation in properly selected cases. Patients have good functional and clinical recovery after this procedure.

Mitochondrial dehydrogenases are differentially stimulated by Ca2+. Ca2+ has also diverse regulatory effects on mitochondrial transporters and other enzymes. However, the consequences of these regulatory effects on mitochondrial oxidative phosphorylation (OxPhos) and ATP production, and the dependencies of these consequences on respiratory substrates, have not been investigated between the kidney and heart despite the fact that kidney energy requirements are second only to those of the heart. Our objective was, therefore, to elucidate these relationships in isolated mitochondria from the kidney outer medulla (OM) and heart. ADP-induced mitochondrial respiration was measured at different CaCl2 concentrations in the presence of various respiratory substrates, including pyruvate + malate (PM), glutamate + malate (GM), alpha-ketoglutarate + malate (AM), palmitoyl-carnitine + malate (PCM), and succinate + rotenone (SUC + ROT). The results showed that, in both heart and OM mitochondria, and for most complex I substrates, Ca2+ effects are biphasic: small increases in Ca2+ concentration stimulated, while large increases inhibited mitochondrial respiration. Furthermore, significant differences in substrate- and Ca2+-dependent O2 utilization towards ATP production between heart and OM mitochondria were observed. With PM and PCM substrates, Ca2+ showed more prominent stimulatory effects in OM than in heart mitochondria, while with GM and AM substrates, Ca2+ had similar biphasic regulatory effects in both OM and heart mitochondria. In contrast, with complex II substrate SUC + ROT, only inhibitory effects on mitochondrial respiration was observed in both the heart and the OM. We conclude that the regulatory effects of Ca2+ on mitochondrial OxPhos and ATP synthesis are biphasic, substrate-dependent, and tissue-specific.

Purpose: Pulmonary tuberculosis is associated with increased oxidative stress, enhanced lipid peroxidation, and decreased glutathione (GSH) levels. N-acetylcysteine (NAC) effectively increases GSH levels, improves lipid peroxidation, and decreases reactive oxygen species levels as reported by earlier studies. Hence, we planned to clinically evaluate the effect of NAC as add-on to Directly Observed Therapy Short-I (DOTS-I) regimen on treatment outcome in PTB with the objectives to study the effect of NAC as an add-on to intensive phase of DOTS-I (2 months) on sputum conversion, radiological improvement, GSH peroxidase (GPx) level, and weight and immunological response compared to placebo add-on at the end of 2 and 6 months. Materials and Methods: This was a design-prospective, randomized, parallel group, add-on design, placebo-controlled, double-blinded, 24-week study. Parameters studied were sputum acid-fast bacillus examination, radiological improvements, GPx level, weight, and Mantoux response. NAC/placebo was added to DOTS Category I in intensive phase. Results: Totally 48 patients completed the study. In NAC group, 23 patients achieved sputum negativity in 3 weeks while 14 patients in PLACEBO group. There was a significant clearing of infiltration and reduction in cavity size in NAC group compared to placebo at 2 months. At 2 and 6 months, NAC significantly raised GPx level and body weight. In 2 months, the patients with Mix ≤5 became Mx positive (100%) in NAC group while none in placebo group. Conclusion: NAC addition to DOTS-I significantly brings about faster sputum negativity, improves radiological response, weight, raises serum GPx level, and rectifies the deregulated immune response. Thus, NAC may be a useful adjuvant to DOTS in PTB.

Background: The Indian aged population is the second largest in the world. A high prevalence of mental disorders is a major public health problem with a global prevalence of 322 million; with India contributing to 31 million. The prevalence in elderly population var- ies from 13 to 25%. Early diagnosis and treatment are the key step towards curbing this mental health problem. We screened the el- derly population for depression to determine the prevalence and to identify the risk factors of depression in elderly urban population in Pune city. Material and Methods: A cross sectional study was conducted on 242 elderly subjects >60 years by administering the WHO (five) wellbeing index and the major International Classification of Dis- eases 10th Revision. Results: The prevalence of depression was 21.07%. On analysis, age more than 80 years (p value 0.004, Odds ratio- 2.84,95% CI; 1.38- 5.68), female gender (p value 0.03, Odds ratio- 1.94,95% CI; 1.03- 3.64), loneliness (p value 0.001, Odds ratio- 2.56,95% CI; 1.50-5.27) and financial dependence (p value 0.001, Odds ratio- 3.17,95% CI; 1.53- 6.55) were statistically significantly associated with depres- sion. Conclusion: The prevalence of depression was 21.07%. The major risk factors identified were age more than 80 years, loneliness and financial dependence.

The present communication highlights the significant records of tettigoniids from Radhanagari Wildlife Sanctuary, Kolhapur, Maharashtra State. A total of 11 species belonging to five subfamilies distributed over 11 genera are discussed. Out of these 11 species nine are known from Maharashtra and two are new locality records. Each subfamily is represented by only one species of which Phyllozelus (Phyllozelus) siccus siccus and Hexacentrus unicolor are new records to Maharashtra.

Diabetes insipidus (DI) is a hereditary or acquired condition which disrupts normal life of persons with the condition; disruption is due to increased thirst and passing of large volumes of urine, even at night. A systematic search of literature for DI was carried out using the PubMed database for the purpose of this review. Central DI due to impaired secretion of arginine vasopressin (AVP) could result from traumatic brain injury, surgery, or tumors whereas nephrogenic DI due to failure of the kidney to respond to AVP is usually inherited. The earliest treatment was posterior pituitary extracts containing vasopressin and oxytocin. The synthetic analog of vasopressin, desmopressin has several benefi ts over vasopressin. Desmopressin was initially available as intranasal preparation, but now the oral tablet and melt formulations have gained significance, with benefits such as ease of administration and stability at room temperature. Other molecules used for treatment include chlorpropamide, carbamazepine, thiazide diuretics, indapamide, clofibrate, indomethacin, and amiloride. However, desmopressin remains the most widely used drug for the treatment of DI. This review covers the physiology of water balance, causes of DI and various treatment modalities available, with a special focus on desmopressin.

There is growing evidence that transplantation of cadaveric human islets is an effective therapy for type 1 diabetes. However, gauging the suitability of islet samples for clinical use remains a challenge. We hypothesized that islet quality is reflected in the expression of specific genes. Therefore, gene expression in 59 human islet preparations was analyzed and correlated with diabetes reversal after transplantation in diabetic mice. Analysis yielded 262 differentially expressed probesets, which together predict islet quality with 83% accuracy. Pathway analysis revealed that failing islet preparations activated inflammatory pathways, while functional islets showed increased regeneration pathway gene expression. Gene expression associated with apoptosis and oxygen consumption showed little overlap with each other or with the 262 probeset classifier, indicating that the three tests are measuring different aspects of islet cell biology. A subset of 36 probesets surpassed the predictive accuracy of the entire set for reversal of diabetes, and was further reduced by logistic regression to sets of 14 and 5 without losing accuracy. These genes were further validated with an independent cohort of 16 samples. We believe this limited number of gene classifiers in combination with other tests may provide complementary verification of islet quality prior to their clinical use.

Type 1 diabetes mellitus (T1DM) has a wide presence in children and has a high mortality rates. The disease, if left unmanaged, poses various challenges to the patient and healthcare providers, including development of diabetic complications and thus decreasing the life expectancy of the affected child. The challenges of T1DM include awareness of the disease that is very poor among the general public and also in parents of T1DM children along with the health care professionals. The challenge of lack of awareness of T1DM can be met by increasing public awareness programs, conducting workshops for diabetes educators regarding T1DM in children, newsletters, CMEs, online courses, and by structured teaching modules for diabetes educators. Diagnosis of T1DM was a challenge a few decades ago but the situation has improved today with diagnostic tests and facilities, made available even in villages. Investigation facilities and infrastructure, however, are very poor at the primary care level, especially in rural areas. Insulin availability, acceptability, and affordability are also major problems, compounded by the various types of insulin that are available in the market with a varied price range. But effective use of insulin remains a matter of utmost importance.

Background: The A 1 chieve, a multicentric (28 countries), 24-week, non-interventional study evaluated the safety and effectiveness of insulin detemir, biphasic insulin aspart and insulin aspart in people with T2DM (n = 66,726) in routine clinical care across four continents. Materials and Methods: Data was collected at baseline, at 12 weeks and at 24 weeks. This short communication presents the results for patients enrolled from West India. Results: A total of 4192 patients were enrolled in the study. Four different insulin analogue regimens were used in the study. Patients had started on or were switched to biphasic insulin aspart (n = 2846), insulin detemir (n = 596), insulin aspart (n = 517), basal insulin plus insulin aspart (n = 140) and other insulin combinations (n = 83). At baseline glycaemic control was poor for both insulin naïve (mean HbA 1 c: 8.8%) and insulin user (mean HbA 1 c: 9.1%) groups. After 24 weeks of treatment, both the groups showed improvement in HbA 1 c (insulin naïve: −1.6%, insulin users: −1.7%). SADRs including major hypoglycaemic events or episodes did not occur in any of the study patients. Conclusion: Starting or switching to insulin analogues was associated with improvement in glycaemic control with a low rate of hypoglycaemia.

Context: Skin thickness of type-2 diabetic insulin naïve adult patients. Background: We have limited data on skin and subcutaneous tissue thickness of Indian type-2 diabetic population. Objective of this study was to assess skin and subcutaneous tissue thickness in insulin naïve type-2 diabetic patients as this information may be useful for insulin injection technique. Aims: To assess the skin and subcutaneous tissue thickness at insulin injection sites in insulin naïve, type-2 diabetic adult population across different body mass index (BMI). Settings and Design: Observational study carried out at our institute. Materials and Methods: One hundred and one insulin naïve type-2 diabetic subjects underwent skin thickness measurement using ultrasound at insulin administration sites. Skin and subcutaneous tissue thickness were measured and prints taken. Though, the sample size to be taken for the study was not calculated, the results obtained clearly show that the power of the study was 80%. Results: At arm and thigh, the mean skin thickness was more in males as compared to females in the BMI range 25 kg/m 2 where thickness in males was comparable. At thigh, the skin plus subcutaneous tissue thickness was more in females (P < 0.05), across all BMI ranges. At abdomen, thickness was more in females for the BMI ranges 17-19 kg/m 2 and 23-25 kg/m 2 , while it was comparable across all other BMI ranges (P > 0.05). Conclusions: Skin and subcutaneous tissue thickness can be estimated by BMI. In general it is higher in females.

An adrenal incidentaloma (AI) is a puzzle for clinician. In the era of widespread use of CT and MRI, it is becoming an increasingly frequent diagnosis. A detailed list of investigations is ordered to diagnose pathology responsible for AI. Most likely etiology of AI is pathology of AI is benign non-functional adenoma. But looking to the need of specific preoperative preparation for functional adrenal adenoma and importance of early diagnosis in adrenal carcinoma, a complete workup is essential. CT scan of adrenals with contrast gives maximum information about nature of lesion. In general, a lesion more than 6cm or a functioning AI or tumor signal intensity of more than 10HU on unenhanced image, significant enhancement on contrast and deenhancement in signal intensity of less than 50% is suggestive of carcinoma and must be removed. Those AI which are left for observation, also needs regular testing and if found functional on subsequent follow-up or if their size enlarge, they must be removed.

India, with one of the largest and most diverse populations of people living with diabetes, experiences significant barriers in successful diabetes care. Limitations in appropriate and timely use of insulin impede the achievement of good glycemic control. The current article aims to identify solutions to barriers in the effective use of insulin therapy viz. its efficacy and safety, impact on convenience and life-style and lack of awareness and education. Therapeutic modalities, which avoid placing an undue burden on patients′ life-style, must be built. These should incorporate patient-centric paradigms of diabetes care, team-based approach for life-style modification and monitoring of patients′ adherence to therapy. To address the issues in efficacy and safety, long-acting, flat profile basal insulin, which mimics physiological insulin and show fewer hypoglycemic events is needed. In addition, therapy must be linked to monitoring of blood glucose to enable effective use of insulin therapy. In conjunction, wide-ranging efforts must be made to remove negative perception of insulin therapy in the community. Patient- and physician - targeted programs to enhance awareness in various aspects of diabetes care must be initiated across all levels of health-care ensuring uniformity of information. To successfully address the challenges in facing diabetes care, partnerships between various stakeholders in the care process must be explored.

The study was designed to isolate and characterize bacterial endophytes from root and stem of Lycopersicon esculentum plant which was collected form different region of Gujarat. Total 18 isolates of endophytic bacteria were selected in which, all the endophytic bacteria produced one or the other different characteristics involved in plant growth promotion. They either produced phytohormones like indole acetic acid, siderophore, protease, pectinase, organic acid showed antifungal activity, chromium tolerance and solubilized phosphate. Four of the strains among the 18 showed maximum positive results of plant growth promoting regulators (PGPR) test and among them best probable isolate was selected and thus its 16SrDNA was amplified and sequenced. Only HR7 endophyte of tomato turned out to be Pseudomonas aeruginosa. It’s a gram negative coccobacili, sporeforming motile bacilli and show maximum PGPR activity. The results of our present studies indicated that above strains might be endophytic and therefore, were associated with the plant growth.