Determinants of Patient's Adherence to Hypertension Medications in a Rural Population of Kancheepuram District in Tamil Nadu,South India

Context:

Non-communicable diseases, no longer a disease of the rich, impose a great threat in the developing nations due to demographic and epidemiological transition. This increasing burden of non-communicable diseases and their risk factors is worrisome. Adherence to hypertension (HT) medication is very important for improving the quality of life and preventing complications of HT.

Aim:

To study the factors determining adherence to HT medication.

Settings and Design:

A community-based cross-sectional study was conducted in a rural area of Kancheepuram district, Tamil Nadu, with a total population of around 16,005.

Materials and Methods:

This study was carried out over a period of 6 months (February-July) using a pre-structured and validated questionnaire. All eligible participants were selected by house-to-house survey and individuals not available on three consecutive visits were excluded from the study. The questionnaire included information on demographic characteristics, lifestyle habits, adherence to HT medication, blood pressure, and body mass index (BMI). Caste was classified based on Tamil Nadu Public Service commission.

Statistical Analysis:

Data were entered in MS Excel and analyzed in SPSS version 16. P value <0.05 was considered statistically significant. Ethical Consideration: Informed verbal consent was obtained prior to data collection. The patient''s adherence to HT medication was assessed using the Morisky 4-Item Self-Report Measure of Medication-taking Behavior [MMAS-4].

Results:

We studied 473 hypertensive patients of which 226 were males and 247 were females. The prevalence of adherence was 24.1% (n = 114) in the study population. Respondents with regular physical activity, non-smokers and non-alcoholics were more adherent to HT medication as compared with respondents with sedentary lifestyle, smoking and alcohol intake (P < 0.005). Based on health belief model, the respondents who perceived high susceptibility, severity, benefit had better adherence compared with moderate and low susceptibility, severity, benefit.     

Comparative evaluation of tensile-bond strength, fracture mode and microleakage of fifth, and sixth generation adhesive systems in primary dentition

Conservative procedures using dentin-bonding agents are one of the important aspects of pediatric dental practice. The objectives of this in vitro study was to comparatively evaluate the tensile-bond strength, fracture mode (under SEM) and microleakage of total etching single bottle system to self-etching adhesive system in primary dentition. The flat buccal/lingual surfaces of 20 teeth were divided into two groups and treated with Single Bond (Group 1) and Adper Prompt (Group 2) to develop a composite resin cone. Then tensile-bond strength was measured using Instron machine. Fracture mode was evaluated in three specimens from each group under SEM. Microleakage of Class V composite restorations (in 20 teeth) with the above-mentioned adhesives was assessed under stereomicroscope after Basic fuschin dye immersion. Results showed no statistically significant difference between two groups. It was concluded that concerning the single step application with similar efficacy, the self-etching adhesive is better for bonding in primary dentition.     

Exosome-mediated transmission of hepatitis C virus between human hepatoma Huh7.5 cells

Recent evidence indicates there is a role for small membrane vesicles, including exosomes, as vehicles for intercellular communication. Exosomes secreted by most cell types can mediate transfer of proteins, mRNAs, and microRNAs, but their role in the transmission of infectious agents is less established. Recent studies have shown that hepatocyte-derived exosomes containing hepatitis C virus (HCV) RNA can activate innate immune cells, but the role of exosomes in the transmission of HCV between hepatocytes remains unknown. In this study, we investigated whether exosomes transfer HCV in the presence of neutralizing antibodies. Purified exosomes isolated from HCV-infected human hepatoma Huh7.5.1 cells were shown to contain full-length viral RNA, viral protein, and particles, as determined by RT-PCR, mass spectrometry, and transmission electron microscopy. Exosomes from HCV-infected cells were capable of transmitting infection to naive human hepatoma Huh7.5.1 cells and establishing a productive infection. Even with subgenomic replicons, lacking structural viral proteins, exosome-mediated transmission of HCV RNA was observed. Treatment with patient-derived IgGs showed a variable degree of neutralization of exosome-mediated infection compared with free virus. In conclusion, this study showed that hepatic exosomes can transmit productive HCV infection in vitro and are partially resistant to antibody neutralization. This discovery sheds light on neutralizing antibodies resistant to HCV transmission by exosomes as a potential immune evasion mechanism.Most tissue and cell types produce and release exosomes, a distinct population of microvesicles ranging from about 30 to 150 nm in size. Exosomes are formed in the endocytic compartment of multivesicular bodies (1) and are secreted in various body fluids under normal and pathological conditions (2, 3). Extensive studies have now implicated exosomes in many biological processes such as tissue injury and immune responses by transfer of antigens, antigen presentation (2, 4), and the shuttling of proteins, mRNAs, and microRNAs (miRNA) between cells (5). As such, it has been postulated that exosomes play a crucial role in cell communication and in the transfer of genetic information between cells (5).The role of exosomes and other secretory vesicles in the transfer of pathogen-derived antigens and virulence factors is emerging (6, 7). Whether release of vesicles from infected cells contributes to immune control and clearance of infection by the host is still not clear. For example, the HIV Gag protein recruits the outward vesicle-budding machinery of exosomes to form free virions (8). Recently, it has been shown that exosomes released from HIV-infected cells contain negative regulatory factor, which induces apoptosis of uninfected cells (9). Epstein-Barr virus-infected B cells also secrete exosomes that contain virally encoded miRNA (10). This study further demonstrates the delivery of naturally occurring functional genetic elements to neighboring cells via exosomes, indicating that viral particles or molecules associated with viral infection can be transmitted to adjacent uninfected cells via exosomes and become functional. More recently, the hepatitis A virus has shown to be able to escape humoral immunity by cloaking itself in cellular membranes on release from host cells. These virus-containing microvesicles, resembling exosomes, were shown to protect virions from antibody-mediated neutralization (11).Hepatitis C virus (HCV) infection, a leading liver disease, has been shown to have multiple routes of transmission. Apart from classical transmission by free viral particles, an antibody-resistant cell-to-cell transmission route also has been described (12). Indeed, HCV is known to evade humoral immune responses, as indicated by a lack of resistance to HCV reinfection in i.v. drug users (13), HCV reinfection during liver transplantation (14), and an ongoing difficulty of developing effective vaccines. The role of exosomes in HCV infection is still largely unknown. One earlier paper reported the presence of viral RNA in exosomes isolated from plasma of HCV-infected patients (15) but did not show exosome-mediated transmission of infection. More recent studies suggest that HCV virus assembly and release in hepatocytes may be linked to the exosome secretory pathway (16) and that hepatocyte-derived exosomes can transfer viral RNA to plasmacytoid dendritic cells, triggering their activation and IFN-α production (17). However, the role of exosomes in the cell-to-cell transmission route of HCV between hepatocytes has not been demonstrated. The aim of our study was to investigate transmission of HCV infection by hepatocyte-derived exosomes in the presence of neutralizing antibodies (nAbs) in vitro that could explain the ineffectiveness of prophylactic nAbs and agents targeting the entry of HCV into a cell. We further observe that this route of infection can generate productive viral infection.     

The liver transplant risk score prognosticates the outcomes of liver transplant recipients at listing

BackgroundWe assessed if the risk of post-liver transplant mortality within 24 h could be stratified at the time of listing using the liver transplant risk score (LTRS). Secondary aims were to assess if the LTRS could stratify the risk of 30-day, 1-year mortality, and survival beyond the first year.MethodsMELD, BMI, age, diabetes, and the need for dialysis were the five variables used to calculate the LTRS during patients' evaluation for liver transplantation. Mortality rates at 24 h, 30 days, and 1-year were compared among groups of patients with different LTRS. Patients with ABO-incompatibility, redo, multivisceral, partial graft and malignancies except for hepatocellular carcinoma were excluded. Data of 48,616 adult liver transplant recipients were extracted from the Scientific Registry of Transplant Recipients between 2002 and 2017.Results24-h mortality was 0.9%, 1.0%, 1.1%, 1.7%, 2.3%, 2.0% and 3.5% for patients with LTRS of 0,1,2,3,4, 5 and ≥ 6, respectively (P < 0.001). 30-day mortality was 3.5%, 4.2%, 4.9%, 6.2%, 7.6%, 7.2% and 10.1% respectively (P < 0.001). 1-year mortality was 8.6%, 10.8%, 12.9%, 13.9%, 18.5%, 20.3% and 28.6% respectively (P < 0.001). 10-year survival was 61%, 56%, 57%, 54%, 47%, and 31% for patients with 0, 1, 2, 3, 4, 5 and ≥ 6 points respectively (P < 0.001).ConclusionPerioperative mortality and long-term survival of patients undergoing LT can be accurately estimated at the time of listing by the LTRS.     

Evaluation of chromosomal alteration in electrical workers occupationally exposed to low frequency of electro magnetic field (EMFs) in Coimbatore population, India

Extremely low frequency electro magnetic fields (EMFs) have been classified as possibly carcinogenic to humans by the International Agency for Research on Cancer. An increased number of chromosomal alterations in peripheral lymphocytes are correlated with elevated incidence of cancer. The aim of the present study was to assess occupationally induced chromosomal damage in EMF workers exposed to low levels of radiation. We used conventional metaphase chromosome aberration (CA) analysis and the micronucleus (MN) assay as biological indicators of non ionizing radiation exposure. In the present study totally 70 subjects were selected including 50 exposed and 20 controls. Informed written consent was obtained from all participants and the study was performed in accordance with the Declaration of Helsinki and the approval of the local ethical committee. A higher degree of CA and MN was observed in exposed subjects compared to controls, the frequency of CA being significantly enhanced with long years of exposure (P<0.05). Moreover increase in CA and MN with age was noted in both exposed subjects and controls, but was significantly greater in the former. The results of this study demonstrated that a significant induction of cytogenetic damage in peripheral lymphocytes of workers occupationally exposed to EMFs in electric transformer and distribution stations. In conclusion, our findings suggest that EMFs possess genotoxic capability, as measured by CA and MN assays; CA analysis appeared more sensitive than other cytogenetic end-points. It can be concluded that chronic occupational exposure to EMFs may lead to an increased risk of genetic damage among electrical workers.     

A novel hepatitis B virus subgenotype D10 circulating in Ethiopia

Hepatitis B virus (HBV) is genetically highly divergent and classified in ten genotypes and forty subgenotypes in distinct ethno‐geographic populations worldwide. Ethiopia is a country with high HBV prevalence; however, little is known about the genetic variability of HBV strains that circulate. Here, we characterize the complete genome of 29 HBV strains originating from five Ethiopian regions, by 454 deep sequencing and Sanger sequencing. Phylogenetically, ten strains were classified as genotype A1 and nineteen as genotype D. Fifteen genotype D strains, provisionally named subgenotype D10, showed a novel distinct cluster supported by high bootstrap value and >4% nucleotide divergence from other known subgenotypes. In addition, the novel D10 strains harboured nine unique amino acid signatures in the surface, polymerase and X genes. Seventy‐two per cent of the genotype D strains had the precore premature stop codon G1896A. In addition, 63% genotype A and 33% genotype D strains had the basal core promoter mutations, A1762T/G1764A. Furthermore, four pre‐S deletion variants and two recombinants were identified in this study. In conclusion, we identified a novel HBV subgenotype D10 circulating in Ethiopia, underlining the high genetic variability of HBV strains in Africa.     

Protective effects of Ficus carica leaves on glucose and lipids levels,carbohydrate metabolism enzymes and β-cells in type 2 diabetic rats

Context: The decoctions of Ficus carica Linn. (Moraceae) leaves are used in the folklore treatment of diabetes.

Objective: To evaluate the effect of F. carica on glucose and lipids levels, carbohydrate metabolism enzymes and β-cells protective effects in type 2 diabetes.

Material and methods: Diabetes was induced in 15 days high-fat diet (HFD)-fed Wistar rats by intraperitoneal injection of streptozotocin (STZ) (40?mg/kg). The ethyl acetate extract (250 and 500?mg/kg) of F. carica leaves was administered for 28 days. Oral glucose tolerance (OGTT) and intraperitoneal insulin tolerance tests (ITT) were evaluated on 15th and 25th days, respectively.

Results: The ethyl acetate extract (250 and 500?mg/kg) of n F. carica leaves showed significant effect (p?F. carica (250 and 500?mg/kg) significantly (p?F. carica enhanced the glucose utilization significantly (p?<?0.005) over 30 and 60?min compared to diabetic control. Further, the altered activities of key carbohydrate metabolizing enzymes such as glucose-6-phosphatase, fructose-1,6-bisphosphatase and hexokinase in the liver tissue of diabetic rats were significantly (p?F. carica. Immumohistochemical studies of islets substantiated the cytoprotective effect on pancreatic β-cells.

Discussion and conclusions: F. carica leaves exerted significant effect on carbohydrate metabolism enzymes with promising hypoglycemic and hypolipidemic activities in type 2 diabetic rats.