Browsing by Author "Surya Kumar Singh"

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Alterations in Bone Turnover during Chemotherapy in Children with Acute Lymphoblastic Leukemia
(Georg Thieme Verlag, 2021) Vineeta Gupta; Shalini Dash; Priyanka Aggarwal; Surya Kumar Singh
Background Disturbances of bone metabolism frequently occur in children with acute lymphoblastic leukemia (ALL), leading to increased risk of osteopenia and osteoporosis at diagnosis, during and after completion of chemotherapy. The present study was performed to evaluate alteration in bone mineral metabolism in children with ALL during chemotherapy. Method Fifty newly diagnosed patients with ALL in the age group of 2 to 14 years were included. Relapsed and refractory cases were excluded. Enrolled children were stratified into standard and high risk according to National Cancer Institute criteria. Quantitative analysis of bone resorptive marker carboxyl-terminal telopeptide of human type 1 collagen (ICTP) was assessed at baseline and 3 months after chemotherapy by the sandwich enzyme-linked immunosorbent assay technique. Results Of 50 patients enrolled, 21 were standard and 29 were high risk. The mean age was 7.75 ± 4.0 years and the male-to-female ratio was 3.5:1. ICTP levels were analyzed in 44 patients, of which 37 (84%) showed significantly increased levels. The mean ICTP level in patients at diagnosis and controls was 1.78 ± 1.39 and 0.96 ± 0.32 μg/L, respectively (p = 0.001). The mean ICTP level at 3 months after chemotherapy increased to 3.55 ± 1.40 μg/L (p = 0.000). It was significantly increased in males (p = 0.000) and in B cell ALL group (p = 0.000) in comparison to females and T cell group. Both standard and high risk groups were equally affected (p = 0.000). On multivariate analysis, no single risk factor could be identified. Conclusion The marker of bone resorption (ICTP) in children with ALL was increased at diagnosis, which further increased during chemotherapy. The disease itself and the intensive chemotherapy both contributed to the increased levels. © 2021 Wolters Kluwer Medknow Publications. All rights reserved.
Anti-oxidant, anti-apoptotic, anti-hypoxic and anti-inflammatory conditions induced by PTY-2 against STZ-induced stress in islets
(International Advancement Center for Medicine and Health Research Co., Ltd., 2019) Shivani Srivastava; Harsh Pandey; Surya Kumar Singh; Yamini Bhusan Tripathi
The earlier assessment of Pueraria tuberosa (PT) has shown anti-diabetic effects through enhancing incretin action and DPP-IV (Dipeptidyl peptidase-IV) inhibition. The aim of this work was to further explore the protective role of aqueous extract of Pueraria tuberosa tuber (PTY-2) against streptozotocin (STZ) induced islet stress in rats. Diabetes was induced by STZ (65 mg/kg body weight) in charles foster male rats. After 60 days of STZ administration, animals with blood glucose levels > 200 g/dL were considered as diabetic. All the rats were later divided into three groups: Group-1 (STZ untreated normal rats), Group-2 (Diabetic control), and Group-3 (PTY-2 [50 mg/100 g bw treatment for next 10 days to diabetic rats). The rats were then sacrificed after the 10th day of treatment accordingly. STZ treatment led to an increase in expression of Matrix metalloproteinases-9 (MMP-9), Tumour necrosis factor-α (Tnf-α), Hypoxia inducible factor-α (HIF-1α), Vascular endothelial growth factor (VEGF), Interleukin-6 (IL-6), Protein kinase C-ε (PKC-ε), Nuclear factor kappa-light-chainenhancer of activated B-cells (NFkB), and Caspase-3. Reverse Transcriptase-PCR (RT-PCR), Immunohistochemistry and Western-Blot analysis showed an increase in the expressions of Superoxide Dismutase (SOD) and Nephrin, and a decrease in the expressions of NFkB, PKC-ε, TNF-α, MMP-9, HIF-1α, VEGF, Caspase-3 and IL-6 after 10 days of PTY-2 treatment. The results showed that PTY-2 favorably changed all the expressions via anti-oxidant, antiapoptotic, anti-hypoxic and anti-inflammatory pathways, making itself as a protective agent against STZ induced islet stress. Further evaluation of PTY-2 might be helpful in establishing its role in the management of diabetes mellitus. © 2019, International Advancement Center for Medicine and Health Research Co., Ltd.
Antitubercular drug resistance in four healthcare facilities in north India
(2011) Anamika Gupta; Jitendra Prasad Mathuria; Surya Kumar Singh; Anil Kumar Gulati; Shampa Anupurba
Tuberculosis (TB) is a major public-health problem in India, having the highest number of incident and multidrug-resistant (MDR) TB cases. The study was carried out to appraise the prevalence of first-line anti-TB drug resistance in Mycobacterium tuberculosis (MTB) and its patterns among different types of TB patients from different settings in a province of North India. Of 3,704 clinical specimens, 345 (9.3%) were culturepositive, and drug-susceptibility testing was carried out for 301 MTB strains. A high level of primary and acquired drug resistance of MTB was observed in the region studied, with weighted mean of 10.5% and 28.08%, 12.81% and 29.72%, 17.12% and 29.94%, 11.97% and 27.84%, and 10.74% and 23.54% for rifampicin, isoniazid, streptomycin, ethambutol-resistant and MDR cases respectively. Drug resistance was significantly higher in pulmonary (p=0.014) and acquired drug-resistant TB cases (p<0.001). Any drug resistance (p=0.002) and MDR TB were significantly (p=0.009) associated with HIV-seropositive cases. An urgent plan is needed to continuously monitor the transmission trends of drug-resistant strains, especially MDR-TB strains, in the region. © International Centre for Diarrhoeal Disease Research, Bangladesh.
Carotid intima media as predictor of liver fibrosis in type 2 diabetes mellitus with NAFLD
(Elsevier Ltd, 2022) Bharmal Vahid Shabbirhussain; Saurabh Singh; Vinod Kumar Dixit; Ashish Verma; Surya Kumar Singh
Background and aims: Non Alcoholic Fatty Liver Disease (NAFLD) is common in type 2 Diabetes Mellitus (DM) that might progress to advance liver fibrosis. Early recognition of liver fibrosis may have clinical implication. Non invasive assessment tool for severity of liver fibrosis in NAFLD is expensive fibroscan. An alternate method of diagnosis will be very useful innovation. We aimed to evaluate Carotid Intima Media Thickness (CIMT) and its association with severity of liver fibrosis in patients with type 2 DM and NAFLD. Methods: Treatment naïve patients with type 2 DM were enrolled. Measurement of CIMT, hepatic ultrasound and fibroscan were done. Liver function tests included hepatic transaminases. The data obtained was subjected to statistical analysis using IBM SPSS version 20.0 software. Result: Prevalence of NAFLD was 76% including 12% with moderate to advance liver fibrosis in patients with type 2 DM. CIMT was significantly higher in patients with NAFLD than with normal liver. CIMT positively correlated with severity of liver fibrosis measured by fibroscan. ROC curve analysis showed right CIMT value of 0.575 mm predicting liver fibrosis with sensitivity of 91.7% and specificity of 78.9%. Conclusion: Three fourth of patients with type 2 DM had NAFLD but small proportion had moderate to advance liver fibrosis. CIMT increased more in patients with NAFLD than with normal liver in T2DM. CIMT value of 0.575 mm has a good sensitivity to predict liver fibrosis and therefore, it can be a reliable marker of severity of Non Alcoholic Steato Hepatitis (NASH) in diabetes with NAFLD. © 2022
Clinical profile of patients of turner syndrome (TS) with karyotype-phenotype corelation from a tertiary care hospital in Eastern Uttar Pradesh (UP), India
(IP Innovative Publication Pvt. Ltd., 2023) Asha Ranjan; Neeraj Kumar Agrawal; Surya Kumar Singh; Saurabh Arora; Dhananjya Melkunte Shanthaiah; Rujul Jain; Vahid Bharmal
Objective: The present study was done to study the clinical profile and karyotype-phenotype corelation of turner syndrome patients in eastern UP, India. Materials and Methods: The present study was a retrospective observational study conducted from January 2018 to December 2020 on newly diagnosed TS patients. All patients were screened for thyroid dysfunction, celiac disease, diabetes mellitus (DM), dyslipidaemia, liver dysfunction, hearing loss, cardiovascular anomalies and renal anomalies. Data was tabulated in Microsoft excel sheet and averages and means were calculated. Fischer exact test was used to assess the corelation of karyotype with clinical phenotypic features. Results: Total 16 patients were diagnosed with TS and 37.5% were classic 45 XO, 18.5% were mosaic 45X/46XX and rest 43.75% were of rarer TS variants. One patient had mosaicism for X chromosome with reciprocal autosomal translocation-45X, t(12,20)(q24.1p13), 46X, t(12,20)(q24.1p13) *marker karyotype which is the first case reported so far. The average age of presentations was 16.8years ± 3.4years (range 8 to 23 years). One patient with karyotype 46,X, del(Xq22-28) had DM with negative anti-GAD antibodies and one patient with karyotype 46XX/46,X+marker had systemic lupus erythematosus (SLE). No significant karyotype and phenotype corelation was found in our study. Conclusion: We report rare association of SLE with TS and a novel karyotype in TS involving mosaicism for X with autosomal translocation t(12,20). No significant karyotype-phenotype corelation was found in our study. More focused studies are needed to study the genes responsible for various manifestations in TS, pathogenic mechanisms of DM and SLE in TS and the effect of autosomal translocations in TS phenotype. © 2023 Innovative Publication. All rights reserved.
Detection of anaerobic infection in diabetic foot ulcer using PCR technique and the status of metronidazole therapy on treatment outcome
(2012) Nitin Aherrao; Shailesh K. Shahi; Awanindra Dwivedi; Ashok Kumar; Sanjeev Gupta; Surya Kumar Singh
Metronidazole is the drug of choice for anaerobic infection in diabetic foot ulcers (DFU) for a majority of clinicians. The present study was conducted to determine if Metronidazole is really making a difference in the healing of DFU. Methods. Deep tissue samples from the wound area of 61 diabetic foot patients were tested for anaerobic bacterial infection (Peptostreptococcus productus, Bacteroides, and Clostridium) by polymerase chain reaction (PCR). PCR-positive patients were randomized into 2 groups: Metronidazole and non-Metronidazole. Antibiotics for the control of infection were given in both groups as per clinical condition of patients. Treatment outcome was assessed by complete healing of the wound. Results. Out of 61 patients, PCR detected evidence of anaerobic infection in 32 (52%), while culture methods detected only 5 (8%) (Clostridium spp.), hence emphasizing the significance of the PCR technique over culture methods in detection of microbes. In this study, Clostridium was found with maximum prevalence of n (75%), followed by Bacteroides with n (53.1%), and Peptostreptococcus productus with n (40.6 %). Across all Wagner Ulcer Classification grades, Clostridium was the most prevalent anaerobe, and significantly associated with wound age and total leukocyte count. No difference was noted in wound healing in both groups at the end of 16 weeks. Conclusions. The authors propose that it is not mandatory to supplement Metronidazole in antibiotic regime for treatment of DFU.
Effects of Azardirachta indica on Vascular Endothelial Growth Factor and Cytokines in Diabetic Deep Wound
(Georg Thieme Verlag, 2015) Manish Kumar Gautam; Mayank Gangwar; Surya Kumar Singh; Raj Kumar Goel
A chronic, unhealed diabetic wound is one of the severe complications of diabetes mellitus. Azadirachta indica has been reported to have antidiabetic and antiapoptotic properties. The present work incorporates the healing potential of 50% ethanol A. indica leaves extract against deep surgical wounds in streptozotocin-induced mild diabetic rats. A. indica leaves extract (500 mg/kg) was administered orally, once daily for ten days. Serum glucose, cholesterol, and triglycerides as well as body weight, food, and water intake, and tissue antioxidants (catalase, superoxide dismutase and reduced glutathione), free radicals (lipid peroxidation and nitric oxide), myeloperoxidase, total collagens (hydroxyproline, hexuronic acid and hexosamine), protein, vascular endothelial growth factor, and cytokines (tumor necrotic factor-α and interleukin-1β) were estimated. Histology was done for connective tissue formation and inflammatory and healing in deep granulation tissue after A. indica leaves extract treatment. Diabetic rats showed an increase in serum glucose, cholesterol, and triglycerides levels, food and water intake, and granular tissue free radicals, myeloperoxidase, and cytokines, but a decrease in body weight, total collagen, and vascular endothelial growth factor levels. A. indica leaves extract reversed the increased serum glucose, cholesterol, and triglycerides, food and water intake, and tissue free radicals, myeloperoxidase and, cytokines, but increased body weight, tissue antioxidants, total collagen, and vascular endothelial growth factor contents. The results thus indicated an improvement in wound healing by A. indica leaves extract in diabetic rats through enhanced angiogenesis mediated through the inhibition of hyperglycemia, oxidative stress, and down- and upregulation of inflammatory mediators and growth factor expression. © Georg Thieme Verlag KG Stuttgart. New York.
Evidence-based recommendations for insulin intensification strategies after basal insulin in type 2 diabetes
(Elsevier Ltd, 2017) Sujoy Ghosh; A.G. Unnikrishnan; Banshi Saboo; Jothydev Kesavadev; S.R. Aravind; Sarita Bajaj; Rajesh Rajput; Krishna Seshadri; Narsingh Verma; Arvind Gupta; Brij Mohan Makkar; Mihir Saikia; Shailaja Kale; Suresh Damodaran; Ashish Dengra; T.K.M. Eashwar; Anuj Maheshwari; Sharad Pendsey; Sanjeev R. Phatak; Surendra Kumar Sharma; Surya Kumar Singh; A. Ramachandran; Abdul H. Zargar; Shashank R. Joshi; Shaukat M. Sadikot
Over the time due to progressive nature of diabetes, proactive intensification of the existing insulin therapy becomes imminent as it minimizes patients’ exposure to chronic hypo/hyperglycaemia and reduces weight gain while achieving individualized glycaemic targets. This review focuses on the strength of evidence behind various options for intensification, primarily the insulins as also the GLP-1 analogues. The recommendations presented here are meant to serve as a guide for the physician managing type 2 diabetes patients requiring insulin intensification upon failing of basal insulin therapy. © 2017 Diabetes India
GLP 1 regulated intestinal cell’s insulin expression and self-adaptation before the onset of type 2 diabetes
(Tabriz University of Medical Sciences, 2019) Shivani Srivastava; Harsh Pandey; Surya Kumar Singh; Yamini Bhusan Tripathi
Purpose: Basically insulin is known to be secreted by β cells of the pancreas. Recently, it has also been found to be produced and expressed by intestinal epithelial cells with the help of L cells secreting glucagon like peptide 1 (GLP 1). Here, we have studied the same intestinal insulin expression property in T2D rats. Methods: Following 2 weeks of high fat diet (HFD) consumption, we have been given a single dose of streptozotocin (STZ) (35 mg/kg bw). Rats were then sacrificed after 1, 7 and 21 days. The GLP 1 analogue, liraglutide was also given to one group of diabetic rats, upto their respective durations. Intestinal cells apoptosis were checked by tunnel assay, Incretin hormones secretion and dipeptidyl peptidase 4 (DPP-IV) activity were analyzed through ELISA and immunohistochemistry was used to determine the insulin expression of intestine at different time interval during diabetes progression. Results: As compared to 1 and 21 days, we have found minor cells apoptosis in 7 days group along with high level of GLP 1 in diabetic model. Further, these effects were enhanced by liraglutide. In response to these we have found, decreased insulin expression after 21 days and with no significant effect upto 7 days in diabetic control groups. In contrast to this, GLP-1 level and insulin expression enhances prominently after 7 days of liraglutide treatment. Conclusion: These results explain the self-adapting approach of intestinal cells against diabetes onset and insulin expression enhancing property of liraglutide under stressful conditions. This study should be continued in future for the development of intestinal insulin producing drugs, to control diabetes under irreversible β cells damage. © 2019 The Author (s).
High Frequency of Recessive WFS1 Mutations Among Indian Children With Islet Antibody-negative Type 1 Diabetes
(Endocrine Society, 2024) Jayakrishnan C Menon; Pratibha Singh; Archana Archana; Preeti Singh; Medha Mittal; Uma Kanga; Kausik Mandal; Anju Seth; Vijayalakshmi Bhatia; Preeti Dabadghao; Siddhnath Sudhanshu; Atul Garg; Ruchira Vishwakarma; Aditya Narayan Sarangi; Shivendra Verma; Surya Kumar Singh; Eesh Bhatia
Background: While the frequency of islet antibody-negative (idiopathic) type 1 diabetes mellitus (T1DM) is reported to be increased in Indian children, its aetiology has not been studied. We investigated the role of monogenic diabetes in the causation of islet antibody-negative T1DM. Methods: We conducted a multicenter, prospective, observational study of 169 Indian children (age 1-18 years) with recent-onset T1DM. All were tested for antibodies against GAD65, islet antigen-2, and zinc transporter 8 using validated ELISA. Thirty-four islet antibody-negative children underwent targeted next-generation sequencing for 31 genes implicated in monogenic diabetes using the Illumina platform. All mutations were confirmed by Sanger sequencing. Results: Thirty-five (21%) children were negative for all islet antibodies. Twelve patients (7% of entire cohort, 34% of patients with islet antibody-negative T1DM) were detected to have pathogenic or likely pathogenic genetic variants. The most frequently affected locus was WFS1, with 9 patients (5% of entire cohort, 26% of islet antibody-negative). These included 7 children with homozygous and 1 patient each with a compound heterozygous and heterozygous mutation. Children with Wolfram syndrome 1 (WS) presented with severe insulin-requiring diabetes (including 3 patients with ketoacidosis), but other syndromic manifestations were not detected. In 3 patients, heterozygous mutations in HNF4A, ABCC8, and PTF1A loci were detected. Conclusion: Nearly one-quarter of Indian children with islet antibody-negative T1DM had recessive mutations in the WFS1 gene. These patients did not exhibit other features of WS at the time of diagnosis. Testing for monogenic diabetes, especially WS, should be considered in Indian children with antibody-negative T1DM. © 2023 The Author(s). Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved.
Parenteral vitamin D supplementation is superior to oral in vitamin D insufficient patients with type 2 diabetes mellitus
(Elsevier Ltd, 2017) Awanindra Dwivedi; Balram Gupta; Shalbha Tiwari; Daliparthy D. Pratyush; Saurabh Singh; Surya Kumar Singh
Background/objectives Oral vitamin D supplementation is better than parenteral in improving vitamin D deficiency in individuals with no systemic illness. Our aim was to compare the efficacy of oral and parenteral routes of vitamin D supplementation on circulating serum 25(OH) vitamin D level in patients with type 2 diabetes mellitus. Methods Total 85 cases of with type 2 diabetes mellitus were screened for vitamin D status of which 71 patients were vitamin D insufficient/deficient. They were randomized into two intent to treat groups with different vitamin D supplementation protocols (a) Oral-60000 IU per day for 5 days (group I; n = 40) and (b) injectable-300000 IU intramuscularly once (group II; n = 31). Baseline and one month post supplementation 25(OH) vitamin D levels were measured in both the groups. Results Baseline clinical characteristics and 25(OH) vitamin D levels were comparable in both the groups. Post treatment 25(OH) vitamin D level in group I was 26.06 ± 9.06 ng/ml and in group II was 49.69 ± 18.92 ng/ml. After one month of vitamin D supplementation, increment in 25(OH) vitamin D level from baseline was significantly higher in group II than group I (p < 0.001). Interpretation & conclusions Injectable method of supplementation was better than oral route in improving serum 25 (OH) vitamin D status in patients with type 2 diabetes. The study suggested impaired absorption of vitamin D from the gastrointestinal tract in patients with type 2 diabetes mellitus and a need for parenteral route of vitamin D supplementation in deficient patients with type 2 diabetes mellitus. © 2017 Diabetes India
Prevalence and severity of vitamin D deficiency in patients with diabetic foot infection
(2013) Shalbha Tiwari; Daliparthy D. Pratyush; Balram Gupta; Awanindra Dwivedi; Sandeep Chaudhary; Rammohan K. Rayicherla; Sanjeev K. Gupta; Surya Kumar Singh
The aim of the present research was to study the prevalence and severity of vitamin D deficiency in patients with diabetic foot infection. Patients were enrolled in two groups: diabetic patients with foot infection (n 125) as cases and diabetic patients without the infection as controls (n 164). Serum 25-hydroxyvitamin D (25(OH)D) was measured by RIA. Data were presented as means and standard deviations unless otherwise indicated and were analysed by SPSS. Results revealed that 25(OH)D (nmol/l) was significantly lower (40·25 (sd 38·35) v. 50·75 (sd 33·00); P < 0·001) in cases than in controls. Vitamin D inadequacy (25(OH)D < 75 nmol/l) was equally common in cases and controls (OR 1·45, 95% CI 0·8, 3·0; P = 0·32), but cases had a greater risk of vitamin D deficiency (25(OH)D < 50 nmol/l) than controls (OR 1·8, 95% CI 1·1, 3·0; P = 0·02). Risk of severe vitamin D deficiency (25(OH)D < 25 nmol/l) was significantly higher in cases than in controls (OR 4·0, 95% CI 2·4, 6·9; P < 0·0001). Age, duration of diabetes and HbA1c were significantly higher in cases than in controls and therefore adjusted to nullify the effect of these variables, if any, on study outcome. The study concluded that vitamin D deficiency was more prevalent and severe in patients with diabetic foot infection. This study opens up the issue of recognising severe vitamin D deficiency ( < 25 nmol/l) as a possible risk factor for diabetic foot infections and the need for vitamin D supplementation in such patients for a better clinical outcome. This could be substantiated by similar data from future studies. © 2012 The Authors.
Pueraria tuberosa as dipeptidyl-peptidase-iv inhibitor prevents streptozotocin-induced intestinal stress
(Open Access Macedonian Journal of Medical Sciences, 2021) Shivani Srivastava; Harsh Pandey; Surya Kumar Singh; Yamini Bhusan Tripathi
BACKGROUND: Enhanced expression of dipeptidyl-peptidase-IV (DPP-IV) has been found in various intestinal diseases. Pueraria tuberosa tuber water extract (PTY-2) is already known to have DPP-IV inhibitory potential. At the mRNA level, this inhibition has not yet been investigated. Increased incretin secretion due to inhibition of DPP-IV could lead to the suppression of stress and apoptosis of intestinal cells. AIM: In this research, we tried to study the antioxidant, anti-apoptotic, and DPP-IV inhibitory effect of PTY 2 against intestinal damage induced by STZ. METHODS: We found morphological damage to the intestine following streptozotocin (STZ) injection (65 mg/kg bw) in male Charles foster rats through histological examination. Superoxide dismutase (SOD) and DPP-IV mRNA expressions were analyzed by polymerase chain reaction and cell apoptosis was examined by tunnel assay and Bcl 2 immunoexpression. RESULTS: In STZ-induced diabetic control, the number and length of villi were decreased, but these damages were reversed by 10 days of PTY-2 treatment. SOD expression was found to be decreased whereas DPP-IV expression was enhanced with significant intestinal cell apoptosis in the diabetic control group. Treatment with PTY-2 decreases stress by upregulating SOD expression and by downregulating the expression of DPP-IV. These PTY-2 recoveries contribute to the suppression of apoptosis in the intestinal cells. CONCLUSION: The protective action of PTY-2 against STZ mediated intestinal damage is demonstrated by these short studies. Therefore, PTY-2 may be taken as a herbal remedy for diabetes-induced intestinal damages. © 2021 Shivani Srivastava, Harsh Pandey, Surya Kumar Singh, Yamini Bhusan Tripathi.
Role of anti mullerian hormone (AMH) in diagnosis of polycystic ovarian syndrome (PCOS) in Indian women
(IP Innovative Publication Pvt. Ltd., 2023) Uma Pandey; Neha Gupta; Shivi Jain; Surya Kumar Singh
Background: Transvaginal ultrasound is an important part of the Rotterdam criteria, which are commonly used to diagnose polycystic ovary syndrome (PCOS). Specifically, the presence of polycystic ovarian morphology (PCOM) is a key factor in the criteria. Another useful indicator of PCOM is the Anti-Mullerian hormone (AMH) level. Aim: The objective is to evaluate the diagnostic accuracy of serum Anti-Mullerian hormone (AMH) in identifying polycystic ovary syndrome (PCOS) and determine whether it can be used as a substitute for polycystic ovarian morphology (PCOM) in the Rotterdam criteria. Additionally, we aim to investigate the relationship between AMH levels and hyperandrogenism in PCOS patients. Materials and Methods: A study was out in SSH BHU various parameters will be used in diagnosis. Serum AMH Radiology: By Transvaginal Sonography single observer obtained dimensions for ovarian volume and the maximum number of follicles in one section. AMH levels will be estimated using commercially available Gen-II ELISA assay. Result: Biochemical evaluation will be done in the Department of Bio-Chemistry IMS BHU. The Anti-Mullerian hormone (AMH) serum levels will be measured using a commercially available ultra-sensitive Gen-II enzyme-linked immunosorbent assay (ELISA) kit from Beckman Coulter, CA. The ELISA has a lower limit of detectability (LoD) of 0.08 ng/ml, a lower limit of quantification (LoQ) of 0.17 mg/ml, and an intra-assay coefficient of variation of 5.8%. The unit of measurement is ng/mL (1ng/mL=7.14 pmol/L). Conclusion: The study showed that Anti-Mullerian hormone (AMH) levels were markedly higher in individuals with polycystic ovary syndrome (PCOS) than in controls. While AMH alone was not a reliable diagnostic marker for PCOS, the findings suggested that incorporating AMH levels as an additional factor in the existing Rotterdam criteria could improve the accuracy of PCOS diagnosis. Therefore, AMH levels have the potential as a useful adjunct marker for the diagnosis of PCOS. © 2023 Innovative Publication, All rights reserved.
Significance of Surgical Intervention in the Management of Diabetic Foot Infections
(Elsevier Inc., 2014) Shalbha Tiwari; Daliparthy Devi Pratyush; Sanjeev Kumar Gupta; Surya Kumar Singh
The incidence of diabetes is increasing at an alarming rate. Diabetic foot is a major cause of frequent hospital visits and extended stays. Both micro and macro-vascular abnormality play a role in its pathogenesis; i.e., it can be neuropathic or ischemic. Other factors such as impaired immunity, poor tissue reparative process and altered foot anatomy further deteriorate wound condition. Infection complicates the wound, delays healing and is a major cause of amputations. Infection control is the primary target for effective wound healing. This can be achieved by appropriate antibiotic selection and surgical intervention. Incision, drainage, debridement, revascularization and wound closure are the key surgical procedures for the management of diabetic foot infection. Careful evaluation of clinical and laboratory findings helps to determine the associated risk of organ involvement, complexity of the wound and severity of infection, as well as the timing of surgical interventions. This chapter provides an overview of diabetic foot infection and its management, with emphasis on surgical intervention. © 2014 Elsevier Inc. All rights reserved.
Sitagliptin: Anti-platelet effect in diabetes and healthy volunteers
(2012) Ashish Kumar Gupta; Akhilesh Kumar Verma; Jyotsna Kailashiya; Surya Kumar Singh; Narender Kumar
Sitagliptin, a selective dipeptidyl peptidase-4 inhibitor drug is used to treat type-2 diabetes (T2DM). We investigated the anti-platelet activity of sitagliptin in patients with T2DM and in in vitro samples obtained from healthy humans. Patients with T2DM (27 male 23 female) were selected and followed up before (control) and after treatment with sitagliptin for up to 3 months. Platelets were isolated from the blood of sitagliptin treated patients and controls. Patients with T2DM treated with sitagliptin for 1and 3 months, showed 10±2 and 30±5 inhibition of platelet aggregation, respectively. For the in vitro study, platelets from 10 normal humans (n10) were isolated. Platelet aggregation, intracellular free calcium and tyrosine phosphorylation of multiple proteins were measured by aggregometer, spectrofluorometer and western blotting, respectively. Platelets pre-treated with 5 and 10g/ml of sitagliptin, showed 25±4 and 40±6 inhibition of thrombin-induced platelet aggregation, respectively. Sitagliptin decreased intracellular free calcium (2.5-fold) and tyrosine phosphorylation of multiple proteins in thrombin-induced platelet activation. Sitagliptin inhibited platelet aggregation in T2DM as well as in healthy humans. Sitagliptin has significant concentration-dependent anti-platelet activity. This activity was due to its inhibitory effect on intracellular free calcium and tyrosine phosphorylation. Copyright © 2012 Informa UK Ltd.
Study of Epalrestat in diabetic distal symmetric polyneuropathy and correlation of its therapeutic efficacy with erythrocyte sorbitol levels: A step towards precision medicine
(Via Medica, 2021) Rujul Jain; Surya Kumar Singh
Background. Diabetic Distal Symmetric Polyneuropathy (DSPn), despite being the most common and a disabling diabetic complication, remains difficult to treat. It has led to rekindle our interest in Epalrestat which has the potential to alter the natural history of the disease. The present study was designed to evaluate the efficacy of Epalrestat in DSPn and to correlate its therapeutic efficacy with baseline erythrocyte sorbitol levels. Methods. One hundred patients with duration of diabetes more than five years and Diabetic Neuropathy Symptom Score (DnSS) ≥ 1 were included. They were divided into two groups of 50 patients each: group 1 (received Epalrestat 150 mg Tablet once a day), group 2 (received placebo). baseline Diabetic neuropathy Symptom Score (score out of 4), numeric Pain Intensity Scale (NPIS; score out of 10), monofilament score (score out of 10), Vibration Perception Threshold (VPT) by Sensitometer and erythrocyte sorbitol levels (by ElISA) were recorded. Same parameters were repeated at three months follow up visit. Results. The mean improvement in DnSS score was 2.39 ± 1.1 in group 1 vs 0.57 ± 1.04 in group 2; P < 0.01. Similarly there was a significant difference in improvement in monofilament score in the two groups (2.82 ± 1.41 in group 1 vs 0.12 ± 0.93 in group 2; p< 0.01), in nPIS score (2.61 ± 1.26 in group 1 vs 0.41 ± 0.81 in group 2; P < 0.01). Average VPT score improved by 3.48 ± 2 in group 1 vs 0.34 ± 1.14 V in group 2; P < 0.01). Improvement in VPT score with Epalrestat was correlated with baseline erythrocyte sorbitol levels (correlation coefficient of 0.911; P < 0.0001). Conclusions. Epalrestat was overall more effective than placebo in improving the symptoms as well as in improving the quantitative sensory nerve function measured by sensitometer. The improvement in all the parameters positively correlated with baseline erythrocyte sorbitol levels. Sorbitol levels can be a useful tool in predicting the response to drug. (Clin Diabetol 2021; 10; 4: 354–358) © 2021 Via Medica. All rights reserved.
Summer and winter prevalence of vitamin D deficiency of young resident doctors in North India
(2011) Surya Kumar Singh; Ved Prakash; Shalbha Tiwari; Devi Pratyush Daliparthy; Saurabh Singh; Pankaj Jain
Aim: Vitamin D deficiency is common both in children and adults all over the world. Long indoor working hours may contribute to deficiency in adult populations particularly in those not receiving vitamin D supplementation in any form. The study aimed to evaluate vitamin D status of young resident doctors working in a university hospital in North India. Methods: Serum 25(OH)D, calcium and alkaline phosphatase were measured in a cross-sectional sample of young resident doctors living in Varanasi, India (latitude 25 degrees North). A total of 80 resident doctors were recruited to participate in the present study with 40 participants enrolled at the end of summer in September 2005, and the remainders were enrolled at the end of winter in March 2006. Results: There was a significant decrease (P < 0.001) in mean 25(OH) vitamin D concentration of the study groups from summer (29 (±21.7) nmol/L) to winter (16.5 (±11.0) nmol/L). In summer, 33 residents had 25 (OH) vitamin D < 50nmol/L, five had between 50 and 75nmol/L and only two had >75nmol/L, but in winter the corresponding numbers were 38, two and none had a concentration >75nmol/L. No difference in serum calcium and phosphorus was observed; however, alkaline phosphatase was significantly higher in participants sampled in the winter (P < 0.001). Conclusions: Hypovitaminosis D was common among apparently normal young resident doctors engaged in indoor work in both seasons. This may have negative short- and long-term health implications. Provision of vitamin D supplementation (oral cholecalciferol) to young resident doctors and other indoor professionals should be considered. © 2011 The Authors. Nutrition & Dietetics © 2011 Dietitians Association of Australia.
The etiopathogenesis of the diabetic foot: An unrelenting epidemic
(2010) Sanjeev Kumar Gupta; Satyajit Panda; Surya Kumar Singh
Diabetes mellitus is a metabolic disease that is associated with hyperglycemia affecting various organ systems of the body. One of the most dreaded complications of this disease is the diabetic foot. The diabetic foot is the end result of multiple causal pathways, which include peripheral neuropathy and vascular disease. The problem is compounded by the increased incidence of infection. This article deals with the various pathogenic pathways associated with the development of the diabetic foot. © The Author(s) 2010.
The tuber extract of pueraria tuberosa Linn. competitively inhibits DPP-IV activity in normoglycemic rats
(International Journal of Pharmacy and Pharmaceutical Science, 2015) Shivani Srivastava; Tanmay Kumar Koley; Surya Kumar Singh; Yamini Bhusan Tripathi
Objective: The main objective of this research was to explore the effect of the polar fraction of tubers of Pueraria tuberosa (PTWE) on DPP-IV activity. Methods: The comparison of in vitro inhibitory potential between commercially available Galvus (Vildagliptin) and PTWE was determined by measuring percent inhibition and IC50. The enzyme kinetics were also done to reveal the nature of inhibition. In vivo study was done via the glucose tolerance test and by the measurement of increased plasma GLP-1 concentration and DPP-IV activity after glucose load. Results: PTWE has given the IC50 value of 17.4 mg/ml and was found to be a competitive inhibitor having the Ki value of 13.11 mg/ml. Plasma GLP-1 concentration was increased and DPP-IV activity was decreased after 60 minutes of glucose load in PTWE treated rats as compared to control rats. Overall PTWE was found to be less potential DPP-IV inhibitor than Galvus. Conclusion: These findings suggest that antidiabetic effect of PTWE could be because of its role in DPP-IV inhibition. © 2015, International Journal of Pharmacy and Pharmaceutical Science. All rights reserved.