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   Table of Contents - Current issue
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January-March 2018
Volume 5 | Issue 1
Page Nos. 1-57

Online since Monday, May 21, 2018

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EDITORIAL  

Nuts can prevent diabetes mellitus Highly accessed article p. 1
GK Pal, Nivedita Nanda
DOI:10.4103/ijcep.ijcep_13_18  
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REVIEW ARTICLE Top

Fundamental role of warburg effect in various pathophysiological processes Highly accessed article p. 3
Vasanthakumar Natesan
DOI:10.4103/ijcep.ijcep_55_17  
In this review article, the role of Warburg effect in various pathologies is discussed using septic shock as the base model. I had proposed a slightly extended Warburg effect which I would like to call it as “Warburg common pathogenesis model or Warburg differentiation–dedifferentiation effect,” which has the potential to explain septic shock and sepsis-associated multiorgan dysfunction and many other major pathologies such as systemic hypertension, pulmonary arterial hypertension, congestive heart failure, diabetes mellitus, asthma, acute respiratory distress syndrome, and acute kidney injury, implying that most of the diseases may have a common pathogenesis as the underlying mechanism. Increased nitric oxide (NO) in sepsis via inducible nitric oxide synthase (iNOS) or any respiratory poison, in general, irreversibly inhibits the mitochondrial respiration and shifts the metabolic phenotype of the cell from oxidative phosphorylation to glycolytic phenotype, and the change in metabolic phenotype is followed by the change in cell phenotype from the normal adult dynamic differentiation state to irreversible dedifferentiation states – embryonic phenotype, synthetic/proliferative phenotype, and cancer phenotype. This dedifferentiated state switching can be seen as the cells' local survival strategy in response to injuries, but returning to their primitive forms leads to disorder and ends in global collapse of the organ systems and organism which requires order in terms of differentiation. Treatment in most of the pathologies should aim at reversing Warburg effect by the activation of mitochondrial respiration, thereby decreasing the aerobic glycolysis and changing the cell to its normal adult dynamic differentiation phenotype, i.e. all the drugs are used here as differentiation therapy. Adrenergic blockers and ascorbic acid may be the main treatment options, which are already used by some research groups. Even though high NO via iNOS was involved in most of the pathologies including sepsis, any substance that inhibits or uncouples the mitochondrial respiration can initiate this Warburg effect and irreversible dedifferentiation. A mild and reversible Warburg differentiation–dedifferentiation effect may be necessary for normal functioning, and the same effect in exaggerated and irreversible way leading to irreversible dedifferentiation states may be the underlying mechanism in most of the diseases including septic shock.
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ORIGINAL ARTICLES Top

Relationship of serum alkaline phosphatase with atherogenic indices in apparently healthy men, Makurdi, Nigeria p. 22
Ayu Agbecha, Anthony Joseph Usoro, James Saa-Aondo Gberindyer
DOI:10.4103/ijcep.ijcep_8_18  
Background and Aim: Atherosclerotic calcification marked by elevated serum alkaline phosphatase (ALP) is linked to serum lipids. However, a normal lipid profile picture does not rule out ALP-associated pathogenesis. In a bid to better characterize the atherogenic potential of the routinely measured serum lipids, our study determined a relationship between ALP and atherogenic indices. Methods: Serum ALP, aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin [ALB], lipids (total cholesterol, high-density lipoprotein-cholesterol [HDL-c], low-density lipoprotein-cholesterol [LDL-c], very LDL-c [VLDL-c], triglycerides [TGs], non-HDL-c [nHDL-c], remnant-cholesterol [remnant-c]), and atherogenic indices (Castelli's risk index [CAS-1 and CAS-2], atherogenic coefficient [AC], TG/HDL-c, atherogenic index of plasma [AIP]) were determined in 80 apparently healthy men aged 20–55 years. In addition, anthropometry, waist circumference, body mass index, and systolic and diastolic blood pressure (DBP) were determined. Results: According to ALP tertiles, a significant association (P < 0.05) of elevated ALP with increasing age, DBP, AST, ALT, VLDL-c, TGs, nHDL-c, remnant-c, CAS-1, CAS-2, AC, TG/HDL, AIP, and low HDL-c was observed in apparently healthy men. The study observed a significant negative correlation (P < 0.02) of ALP with HDL-c and ALB and positive correlation (P < 0.05) with AST, ALT, VLDL-c, TGs, nHDL-c, remnant-c, CAS-1, CAS-2, AC, TG/HDL, and AIP. Conclusion: The study has demonstrated that the atherogenic indices would be better markers than serum lipids in population studies of vascular calcification.
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Association of heart rate variability and baroreceptor sensitivity with biochemical markers in breast cancer patients p. 30
Devi R Nithiya, Pravati Pal, K Gunaseelan, Gopal Krushna Pal
DOI:10.4103/ijcep.ijcep_10_18  
Background and Aim: The global burden of breast cancer is on the rise, not sparing countries undergoing rapid urbanization. India is one among the top emerging countries to be affected by this disease. Breast cancer survivors are at increased risk of developing cardiovascular complications due to autonomic dysfunction and oxidative stress. Changes in autonomic balance can be assessed by measuring resting heart rate variability (HRV) and baroreceptor sensitivity (BRS). Serum levels of malondialdehyde and inflammatory markers give an estimate of ongoing oxidative stress. Methods: A study was conducted in two groups: (i) study group consisted of women with breast cancer who have undergone modified radical mastectomy and awaiting radiotherapy and (ii) control group consisted of normal healthy age-matched volunteers. Resting HRV and BRS were measured for participants of both the groups. Estimation of serum oxidative stress markers and inflammatory markers was also done. Results: Decrease in HRV and BRS accompanied by increase in oxidative stress markers and inflammatory markers in circulation was observed in cancer patients when compared to control group. Conclusion: Autonomic dysfunction, high oxidative stress, and decreased BRS were prominent in breast cancer patients, which could expose them to future cardiovascular events.
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Association of sleep with visceral fat in young adolescents of Gujarati Ethnicity p. 35
Archana S Nimbalkar, SK Singh, Somashekhar M Nimbalkar
DOI:10.4103/ijcep.ijcep_14_18  
Background and Aim: Habitual short sleep duration is a common practice linked to weight gain and risk of obesity. The objective of the study was to find out the association between sleep and visceral fat in young adolescents of Gujarati ethnicity. Methods: We used cross-sectional, experimental study data from students of Gujarati ethnicity from different parts of Gujarat in the same institution (n = 608). We assessed the association between sleep duration (<7.5 h and >7.5 h) and visceral obesity (visceral fat 0–9 as normal and 9 and above as visceral obese). Young healthy adolescents of Gujarati ethnicity were enrolled in the study and divided as per the areas of Gujarat. We measured visceral fat using the body composition monitor of Omron. We measured sleep by asking them the number of hours they sleep in 24 h. Data were analyzed using SPSS software. An explorative, descriptive analysis was done; univariate analysis and logistic regression were also performed. Results: Univariate analysis showed that there was a negative correlation seen with Visceral fat (-0.038), Systolic pressure (-0.044) and Diastolic pressure (-0.075); while negative correlation with sleep was seen in only female population; even though the results were not statistically significant. We found the sleep in hours in our population to be a higher mean of 7.3 h in males, while it was found to be 7.1 h in females. The range of sleep was 6 h– 9 h as the 5th and 95th percentile and 7 h as the 50th percentile in both males and females. Conclusion: The sleep is associated negatively with visceral fat in the female population. Hence, adequacy of sleep for >7.5 h, a potentially modifiable behavior to prevent obesity needs to be considered. Detailed longitudinal studies tracking other activities that contribute to obesity also need to be done.
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Increased rate pressure product is linked to sympathovagal imbalance in Indian obese postmenopausal women p. 39
R Meena, Pravati Pal, Dasari Papa, Gopal Krushna Pal
DOI:10.4103/ijcep.ijcep_15_18  
Background and Aim: Postmenopausal women experience changes in cardiovascular (CV) system and autonomic functions. Increased body mass index (BMI) alters the autonomic discharge pattern. Rate pressure product (RPP) is linked to autonomic imbalance. However, the autonomic functions status and its link to RPP in Indian obese postmenopausal women are not yet known. The present study was designed to assess sympathovagal imbalance (SVI) and its link to RPP in Indian obese postmenopausal women. Methods: In 104 postmenopausal women of 40–55 years of age, anthropometric indices such as age, height, body weight, waist-hip ratio, waist-height ratio, and CV parameters such as heart rate, systolic, and diastolic blood pressure were recorded. BMI, mean arterial pressure and RPP were calculated. Resting heart rate variability was recorded for 5 min in the supine position. Data were compared between obese (BMI >25) and nonobese (BMI 18.5–24.99) women and the link of low frequency to high frequency (LF-HF) ratio with RPP was assessed by Pearson's correlation analysis. Results: RPP was increased, sympathetic drive (low-frequency component expressed as normalized unit) was increased, vagal drive (high-frequency component expressed as normalized unit) was decreased, and LF-HF ratio, the marker of SVI was found to be increased in high BMI postmenopausal women. In addition, LF-HF ratio was significantly associated with RPP. Conclusion: There was SVI with increased sympathetic and decreased vagal function in high BMI postmenopausal women. RPP, the marker of myocardial work stress was associated with SVI.
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Interarm blood pressure difference, pulse pressure, and mean arterial pressure as predictors of cardiovascular disease risk in young adults p. 44
Manish Kumar Verma, Shambhavi Tripathi, Nitin Ashok John, Jyoti E John
DOI:10.4103/ijcep.ijcep_11_18  
Background and Aim: Most recommendations on blood pressure (BP) measurement and hypertension have stated that BP should be measured in both arms and that the hand with the highest value should be used for subsequent measurements. It has been suggested that differences in the right and left arm pressures may be caused by undiagnosed peripheral vascular disease affecting the vasculature of upper limbs and may, therefore, predict an increased risk of cardiovascular disease. Methods: Simultaneous bilateral brachial BP measurements were taken after 10 min resting period in supine position; three BP measurements were taken simultaneously and automatically using a validated automatic oscillometric device (Microlife WatchBP office) at 1 min interval. Results: There were 22, 19, and 9 participants with interarm systolic BP difference of <5 mmHg, 5–9 mmHg, and ≥10 mmHg, respectively. Out of the total 50 participants, 29 (58%) had a positive family history of HTN/diabetes mellitus (DM). There was a positive association (P < 0.05) between interarm systolic BP difference ≥10 mmHg and positive family history of HT/DM. A statistically nonsignificant correlation was observed between basal metabolic index (r = 0.04), pulse pressure (r = −0.07), and mean arterial pressure (r = 0.23) with interarm systolic BP difference of both arms. Conclusion: The presence of interarm BP difference ≥10 mmHg and positive family history of hypertension and diabetes has a prognostic value in predicting cardiovascular events. Hence, in primary care setting, BP should be measured routinely in both arms using automated oscillometric device.
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28-Homocastasterone: A dietary plant keto oxysterol positively modulating hexokinase mRNA expression and catalytic activity in diabetic male rat p. 48
Athithan Velan, Srikumar Kotteazeth
DOI:10.4103/ijcep.ijcep_12_18  
Background and Aim: 28-homocastasterone (28-HC) is a keto oxysteroid comes under the brassinosteroid family phytohormone. 28-HC exhibited structural similarity with mammalian oxysteroid such as OH-cholesterol. Humans were exposed to 28-HC through diet and herbal-based medicine. Therefore, in the present study, we investigated the influence of 28-HC on hexokinase catalytic activity and mRNA expression in liver, kidney, and testicular tissues in normal and diabetic male rat. Methods: Induction of diabetes was achieved by single peritoneal injection of streptozotocin (60 mg/kg bwt) followed by 28-HC (333.33 μg/kg b.wt) which was fed orally for 15 days. At 16th day, tissues were removed followed by hexokinase activity, and mRNA expression was analyzed. In silico, docking study was performed to 28-HC against glucokinase and hexokinase proteins carried out using docking application AutoDock 4.0 suite docking simulations. Results: 28-HC-treated rat tissues showed significantly elevated hexokinase catalytic activity and mRNA expression (P < 0.05). On the other hand, in silico molecular, docking study was performed to recognize the binding affinity of 28-HC to glucokinase and hexokinase proteins. 28-HC was bound to the drug binding pocket of glucokinase and hexokinase. The glide energy score is − 6.23 and − 6.43 for glucokinase and hexokinase. Conclusion: 28-HC has high binding affinity for both glucokinase and hexokinase equally. Upregulation of hexokinase activity resulted in cellular glycolysis. Hence, it is suggested that 28-HC supplemented diets were suitable for higher energy-related work activities in human and animals.
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LETTERS TO EDITOR Top

An account on the count of mushrooming journals! p. 54
Ruchi Kothari, Pradeep Bokariya, Saahil ML Nongrum, Ramji Singh
DOI:10.4103/ijcep.ijcep_9_18  
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Influence of wheat, maida and millets on diabetes mellitus p. 56
Mahantayya Veerabhadrayya Math, Yashoda Ravindra Kattimani, Rita Manoj Khadkikar
DOI:10.4103/ijcep.ijcep_7_18  
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NEWS AND VIEWS Top

News and Views p. 57
Nivedita Nanda
DOI:10.4103/2348-8832.232866  
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