Government Medical College, Thiruvananthapuram

Anjana R.M., Unnikrishnan R., Deepa M., Pradeepa R., Tandon N., Das A.K., Joshi S., Bajaj S., Jabbar P.K., Das H.K., Kumar A., Dhandhania V.K., Bhansali A., Rao P.V., Desai A., et. al.

BackgroundNon-communicable disease (NCD) rates are rapidly increasing in India with wide regional variations. We aimed to quantify the prevalence of metabolic NCDs in India and analyse interstate and inter-regional variations.MethodsThe Indian Council of Medical Research–India Diabetes (ICMR-INDIAB) study, a cross-sectional population-based survey, assessed a representative sample of individuals aged 20 years and older drawn from urban and rural areas of 31 states, union territories, and the National Capital Territory of India. We conducted the survey in multiple phases with a stratified multistage sampling design, using three-level stratification based on geography, population size, and socioeconomic status of each state. Diabetes and prediabetes were diagnosed using the WHO criteria, hypertension using the Eighth Joint National Committee guidelines, obesity (generalised and abdominal) using the WHO Asia Pacific guidelines, and dyslipidaemia using the National Cholesterol Education Program—Adult Treatment Panel III guidelines.FindingsA total of 113 043 individuals (79 506 from rural areas and 33 537 from urban areas) participated in the ICMR-INDIAB study between Oct 18, 2008 and Dec 17, 2020. The overall weighted prevalence of diabetes was 11·4% (95% CI 10·2–12·5; 10 151 of 107 119 individuals), prediabetes 15·3% (13·9–16·6; 15 496 of 107 119 individuals), hypertension 35·5% (33·8–37·3; 35 172 of 111 439 individuals), generalised obesity 28·6% (26·9–30·3; 29 861 of 110 368 individuals), abdominal obesity 39·5% (37·7–41·4; 40 121 of 108 665 individuals), and dyslipidaemia 81·2% (77·9–84·5; 14 895 of 18 492 of 25 647). All metabolic NCDs except prediabetes were more frequent in urban than rural areas. In many states with a lower human development index, the ratio of diabetes to prediabetes was less than 1.InterpretationThe prevalence of diabetes and other metabolic NCDs in India is considerably higher than previously estimated. While the diabetes epidemic is stabilising in the more developed states of the country, it is still increasing in most other states. Thus, there are serious implications for the nation, warranting urgent state-specific policies and interventions to arrest the rapidly rising epidemic of metabolic NCDs in India.FundingIndian Council of Medical Research and Department of Health Research, Ministry of Health and Family Welfare, Government of India.

Rosenbaum S., Morell R., Abdel-Baki A., Ahmadpanah M., Anilkumar T.V., Baie L., Bauman A., Bender S., Boyan Han J., Brand S., Bratland-Sanda S., Bueno-Antequera J., Camaz Deslandes A., Carneiro L., Carraro A., et. al.

Physical inactivity is a key contributor to the global burden of disease and disproportionately impacts the wellbeing of people experiencing mental illness. Increases in physical activity are associated with improvements in symptoms of mental illness and reduction in cardiometabolic risk. Reliable and valid clinical tools that assess physical activity would improve evaluation of intervention studies that aim to increase physical activity and reduce sedentary behaviour in people living with mental illness. The five-item Simple Physical Activity Questionnaire (SIMPAQ) was developed by a multidisciplinary, international working group as a clinical tool to assess physical activity and sedentary behaviour in people living with mental illness. Patients with a DSM or ICD mental illness diagnoses were recruited and completed the SIMPAQ on two occasions, one week apart. Participants wore an Actigraph accelerometer and completed brief cognitive and clinical assessments. Evidence of SIMPAQ validity was assessed against accelerometer-derived measures of physical activity. Data were obtained from 1010 participants. The SIMPAQ had good test-retest reliability. Correlations for moderate-vigorous physical activity was comparable to studies conducted in general population samples. Evidence of validity for the sedentary behaviour item was poor. An alternative method to calculate sedentary behaviour had stronger evidence of validity. This alternative method is recommended for use in future studies employing the SIMPAQ. The SIMPAQ is a brief measure of physical activity and sedentary behaviour that can be reliably and validly administered by health professionals.

Lee J., Meijer E., Langa K.M., Ganguli M., Varghese M., Banerjee J., Khobragade P., Angrisani M., Kurup R., Chakrabarti S.S., Gambhir I.S., Koul P.A., Goswami D., Talukdar A., Mohanty R.R., et. al.

Mulchandani R., Chandrasekaran A.M., Shivashankar R., Kondal D., Agrawal A., Panniyammakal J., Tandon N., Prabhakaran D., Sharma M., Goenka S.

Adults in urban areas spend almost 77% of their waking time being inactive at workplaces, which leaves little time for physical activity. The aim of this systematic review and meta-analysis was to synthesize evidence for the effect of workplace physical activity interventions on the cardio-metabolic health markers (body weight, waist circumference, body mass index (BMI), blood pressure, lipids and blood glucose) among working adults. All experimental studies up to March 2018, reporting cardio-metabolic worksite intervention outcomes among adult employees were identified from PUBMED, EMBASE, COCHRANE CENTRAL, CINAHL and PsycINFO. The Cochrane Risk of Bias tool was used to assess bias in studies. All studies were assessed qualitatively and meta-analysis was done where possible. Forest plots were generated for pooled estimates of each study outcome. A total of 33 studies met the eligibility criteria and 24 were included in the meta-analysis. Multi-component workplace interventions significantly reduced body weight (16 studies; mean diff: − 2.61 kg, 95% CI: − 3.89 to − 1.33) BMI (19 studies, mean diff: − 0.42 kg/m2, 95% CI: − 0.69 to − 0.15) and waist circumference (13 studies; mean diff: − 1.92 cm, 95% CI: − 3.25 to − 0.60). Reduction in blood pressure, lipids and blood glucose was not statistically significant. Workplace interventions significantly reduced body weight, BMI and waist circumference. Non-significant results for biochemical markers could be due to them being secondary outcomes in most studies. Intervention acceptability and adherence, follow-up duration and exploring non-RCT designs are factors that need attention in future research. Prospero registration number: CRD42018094436.

Duseja A., Singh S.P., De A., Madan K., Rao P.N., Shukla A., Choudhuri G., Saigal S., Shalimar, Arora A., Anand A.C., Das A., Kumar A., Eapen C.E., Devadas K., et. al.

Nonalcoholic fatty liver disease (NAFLD) is a major cause of chronic liver disease globally and in India. The already high burden of NAFLD in India is expected to further increase in the future in parallel with the ongoing epidemics of obesity and type 2 diabetes mellitus. Given the high prevalence of NAFLD in the community, it is crucial to identify those at risk of progressive liver disease to streamline referral and guide proper management. Existing guidelines on NAFLD by various international societies fail to capture the entire landscape of NAFLD in India and are often difficult to incorporate in clinical practice due to fundamental differences in sociocultural aspects and health infrastructure available in India. A lot of progress has been made in the field of NAFLD in the 7 years since the initial position paper by the Indian National Association for the Study of Liver on NAFLD in 2015. Further, the ongoing debate on the nomenclature of NAFLD is creating undue confusion among clinical practitioners. The ensuing comprehensive review provides consensus-based, guidance statements on the nomenclature, diagnosis, and treatment of NAFLD that are practically implementable in the Indian setting. Nonalcoholic fatty liver disease (NAFLD) is a major cause of chronic liver disease globally and in India. The already high burden of NAFLD in India is expected to further increase in the future in parallel with the ongoing epidemics of obesity and type 2 diabetes mellitus. Given the high prevalence of NAFLD in the community, it is crucial to identify those at risk of progressive liver disease to streamline referral and guide proper management. Existing guidelines on NAFLD by various international societies fail to capture the entire landscape of NAFLD in India and are often difficult to incorporate in clinical practice due to fundamental differences in sociocultural aspects and health infrastructure available in India. A lot of progress has been made in the field of NAFLD in the 7 years since the initial position paper by the Indian National Association for the Study of Liver on NAFLD in 2015. Further, the ongoing debate on the nomenclature of NAFLD is creating undue confusion among clinical practitioners. The ensuing comprehensive review provides consensus-based, guidance statements on the nomenclature, diagnosis, and treatment of NAFLD that are practically implementable in the Indian setting. Nonalcoholic fatty liver disease (NAFLD) has emerged as a major public health problem globally.1Lazarus J.V. Mark H.E. Anstee Q.M. et al.Advancing the global public health agenda for NAFLD: a consensus statement.Nat Rev Gastroenterol Hepatol. 2021; ([Epub ahead of print])https://doi.org/10.1038/s41575-021-00523-4Crossref Scopus (117) Google Scholar,2Younossi Z.M. Non-alcoholic fatty liver disease - a global public health perspective.J Hepatol. 2019 Mar; 70: 531-544https://doi.org/10.1016/j.jhep.2018.10.033Abstract Full Text Full Text PDF PubMed Scopus (950) Google Scholar It is predominantly related to overweight/obesity and other metabolic risk factors secondary to sedentary lifestyle and high calorie consumption.3Stefan N. Häring H.U. Cusi K. Non-alcoholic fatty liver disease: causes, diagnosis, cardiometabolic consequences, and treatment strategies.Lancet Diabetes Endocrinol. 2019; 7: 313-324https://doi.org/10.1016/S2213-8587(18)30154-2Abstract Full Text Full Text PDF PubMed Scopus (442) Google Scholar Globally and in Asia, around 25–29% of the general population has NAFLD.4Younossi Z. Anstee Q.M. Marietti M. et al.Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention.Nat Rev Gastroenterol Hepatol. 2018; 15: 11-20https://doi.org/10.1038/nrgastro.2017.109Crossref PubMed Scopus (2431) Google Scholar, 5Younossi Z.M. Koenig A.B. Abdelatif D. Fazel Y. Henry L. Wymer M. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes.Hepatology. 2016; 64: 73-84https://doi.org/10.1002/hep.28431Crossref PubMed Scopus (5385) Google Scholar, 6Li J. Zou B. Yeo Y.H. et al.Prevalence, incidence, and outcome of non-alcoholic fatty liver disease in Asia, 1999-2019: a systematic review and meta-analysis.Lancet Gastroenterol Hepatol. 2019; 4: 389-398https://doi.org/10.1016/S2468-1253(19)30039-1Abstract Full Text Full Text PDF PubMed Scopus (405) Google Scholar, 7Mitra S. De A. Chowdhury A. Epidemiology of non-alcoholic and alcoholic fatty liver diseases.Transl Gastroenterol Hepatol. 2020; 5: 16https://doi.org/10.21037/tgh.2019.09.08Crossref PubMed Google Scholar In India, the prevalence of NAFLD in the general population varies from 9 to 53% with geographical and rural–urban differences in the prevalence.8De A. Duseja A. Nonalcoholic fatty liver disease: Indian perspective.Clin Liver Dis (Hoboken). 2021; 18: 158-163https://doi.org/10.1002/cld.1141Crossref PubMed Scopus (7) Google Scholar, 9Mahajan R. Duseja A. Kumar R. et al.A community-based study to determine the prevalence of nonalcoholic fatty liver disease (NAFLD) and its metabolic risk factors in urban and rural communities of north India.J Gastroenterol Hepatol. 2019; 34: 310PubMed Google Scholar, 10Chalmers J. Ban L. Leena K.B. et al.Cohort profile: the Trivandrum non-alcoholic fatty liver disease (NAFLD) cohort.BMJ Open. 2019; 9e027244https://doi.org/10.1136/bmjopen-2018-027244Crossref Scopus (13) Google Scholar A recent meta-analysis of studies published from India reported a NAFLD prevalence of 38.6% in adults and 35.4% in children.11Shalimar Anshuman Elhence A. Bhavik Bansal B. et al.Prevalence of non-alcoholic fatty liver disease in India: a systematic review and meta-analysis.J Clin Exp Hepatol. 2021; (Epub ahead of print)https://doi.org/10.1016/j.jceh.2021.11.010Abstract Full Text Full Text PDF Scopus (6) Google Scholar The prevalence is reported to be higher in high-risk groups like those with metabolic syndrome (MetS) and its individual components.3Stefan N. Häring H.U. Cusi K. Non-alcoholic fatty liver disease: causes, diagnosis, cardiometabolic consequences, and treatment strategies.Lancet Diabetes Endocrinol. 2019; 7: 313-324https://doi.org/10.1016/S2213-8587(18)30154-2Abstract Full Text Full Text PDF PubMed Scopus (442) Google Scholar,12Kalra S. Vithalani M. Gulati G. et al.Study of prevalence of nonalcoholic fatty liver disease (NAFLD) in type 2 diabetes patients in India (SPRINT).J Assoc Phys India. 2013; 61: 448-453PubMed Google Scholar, 13Goyal A. Arora H. Arora S. Prevalence of fatty liver in metabolic syndrome.J Fam Med Prim Care. 2020; 9: 3246-3250https://doi.org/10.4103/jfmpc.jfmpc_1108_19Crossref PubMed Google Scholar, 14Srinivas M. Srinivasan V. Mohan M.B. Varghese J. Venkataraman J. A study of gender-wise risk association between fatty liver and metabolic syndrome components (Asia-Pacific criteria) in a South Indian urban cohort.Indian J Gastroenterol. 2015; 34: 38-42https://doi.org/10.1007/s12664-014-0525-4Crossref PubMed Scopus (5) Google Scholar, 15Bhargav V.Y. Jain M. Alen T. et al.Clusters and components of metabolic syndrome (MeS) as a predictor of fatty liver. A cross sectional study.J Diabetol. 2021; 12: 434-441https://doi.org/10.4103/jod.jod_17_21Crossref Google Scholar In a multicentric study conducted in 101 Indian cities, the prevalence of NAFLD among patients with type 2 diabetes mellitus (T2DM) was reported to be 56.5%.12Kalra S. Vithalani M. Gulati G. et al.Study of prevalence of nonalcoholic fatty liver disease (NAFLD) in type 2 diabetes patients in India (SPRINT).J Assoc Phys India. 2013; 61: 448-453PubMed Google Scholar Overall, the pooled prevalence of NAFLD among high-risk Indian adults who are obese or overweight or have T2DM has been estimated to be 52.8%.11Shalimar Anshuman Elhence A. Bhavik Bansal B. et al.Prevalence of non-alcoholic fatty liver disease in India: a systematic review and meta-analysis.J Clin Exp Hepatol. 2021; (Epub ahead of print)https://doi.org/10.1016/j.jceh.2021.11.010Abstract Full Text Full Text PDF Scopus (6) Google Scholar Nonalcoholic steatohepatitis (NASH) is a severe form of NAFLD which in addition to hepatic steatosis is associated with hepatic inflammation and fibrosis and has the higher propensity to progress on to cirrhosis of the liver and hepatocellular carcinoma (HCC).16Ekstedt M. Nasr P. Kechagias S. Natural history of NAFLD/NASH.Curr Hepat Rep. 2017; 16: 391-397https://doi.org/10.1007/s11901-017-0378-2Crossref PubMed Google Scholar,17De A. Duseja A. Natural history of simple steatosis or nonalcoholic fatty liver.J Clin Exp Hepatol. 2020; 10: 255-262https://doi.org/10.1016/j.jceh.2019.09.005Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar Recent data from India suggest that NAFLD is responsible for significant number of patients with advanced fibrosis or cirrhosis and HCC, and the incidence has been steadily increasing over the years.18Tohra S. Duseja A. Taneja S. et al.Experience with changing etiology and non-transplant curative treatment modalities for hepatocellular carcinoma in a real-life setting –a retrospective descriptive analysis.J Clin Exp Hepatol. 2021; 11: 682-690https://doi.org/10.1016/j.jceh.2021.02.002Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar,19Duseja A. Singh S.P. Mehta M. et al.Clinicopathological profile and outcome of a large cohort of patients with nonalcoholic fatty liver disease from South Asia: interim results of the Indian consortium on nonalcoholic fatty liver disease (ICON-D).Metab Syndr Relat Disord. 2022; 20: 166-173https://doi.org/10.1089/met.2021.0104Crossref PubMed Scopus (4) Google Scholar Management guidelines for patients with NAFLD are available from various international scientific societies. However, many of those strategies may not be applicable to Indian patients with NAFLD having altogether different socioeconomic and cultural issues.20Thakur J.S. Kathirvel S. Paika R. et al.World NCD Federation guidelines for prevention, surveillance and management of noncommunicable diseases at primary and secondary health-care for low resource settings.Int J Non-Commun Dis. 2020; 5: S43-S46Google Scholar, 21Chalasani N. Younossi Z. Lavine J.E. et al.The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the study of liver diseases.Hepatology. 2018; 67: 328-357https://doi.org/10.1002/hep.29367Crossref PubMed Scopus (3327) Google Scholar, 22European association for the study of the liver (EASL); European association for the study of diabetes (EASD); European association for the study of obesity (EASO). EASL-EASD-EASO clinical practice guidelines for the management of non-alcoholic fatty liver disease.J Hepatol. 2016; 64: 1388-1402https://doi.org/10.1016/j.jhep.2015.11.004Abstract Full Text Full Text PDF PubMed Scopus (2510) Google Scholar, 23Wong V.W. Chan W.K. Chitturi S. et al.Asia-pacific working party on non-alcoholic fatty liver disease guidelines 2017-Part 1: definition, risk factors and assessment.J Gastroenterol Hepatol. 2018; 33: 70-85https://doi.org/10.1111/jgh.13857Crossref PubMed Scopus (254) Google Scholar For instance, the dietary habits of Indians including staple dietary constituents and cooking media are quite different from Western individuals. As such, recognition of patients who have progressed on to NASH and/or significant/advanced fibrosis or patients with NAFLD who are likely to have progressive disease is an important step in reducing the liver disease burden in any country including India.1Lazarus J.V. Mark H.E. Anstee Q.M. et al.Advancing the global public health agenda for NAFLD: a consensus statement.Nat Rev Gastroenterol Hepatol. 2021; ([Epub ahead of print])https://doi.org/10.1038/s41575-021-00523-4Crossref Scopus (117) Google Scholar,24Chitturi S. Wong V.W. Chan W.K. et al.The Asia-Pacific working party on non-alcoholic fatty liver disease guidelines 2017-Part 2: management and special groups.J Gastroenterol Hepatol. 2018; 33: 86-98https://doi.org/10.1111/jgh.13856Crossref PubMed Scopus (87) Google Scholar Liver biopsy is seldom carried out in day-to-day practice in India due to lack of facilities and poor patient acceptance. Simple and practical diagnostic tools at the primary and secondary healthcare levels and clear guidelines for referral of patients to tertiary healthcare levels are required to improve the management of patients with NAFLD in a resource-constrained setting like India and optimize utilization of services of subspecialists like hepatologists and gastroenterologists who are mainly available in urban and tertiary centers. Of note, many of the proprietary noninvasive tests for detection of fibrosis are neither available in India nor have they been validated in Indian patients. As of now, India is the only country where a specific pharmacotherapy has been approved by a national regulatory agency [the drug controller general of India (DCGI)] for the management of NASH as discussed later. The last position paper by Indian National Association for Study of the Liver (INASL) on NAFLD was published in 2015, and since then, a lot of progress has occurred in the diagnosis and treatment of patients with NAFLD including the approval of saroglitazar by DCGI.25Duseja A. Singh S.P. Saraswat V.A. et al.Non-alcoholic fatty liver disease and metabolic syndrome-position paper of the Indian national association for the study of the liver, endocrine society of India, Indian College of cardiology and Indian society of gastroenterology.J Clin Exp Hepatol. 2015; 5: 51-68https://doi.org/10.1016/j.jceh.2015.02.006Abstract Full Text Full Text PDF PubMed Scopus (99) Google Scholar A group of experts recently also suggested a change in the nomenclature from NAFLD to metabolic dysfunction-associated fatty liver disease (MAFLD).26Eslam M. Newsome P.N. Sarin S.K. et al.A new definition for metabolic dysfunction-associated fatty liver disease: an international expert consensus statement.J Hepatol. 2020; 73: 202-209https://doi.org/10.1016/j.jhep.2020.03.039Abstract Full Text Full Text PDF PubMed Scopus (1283) Google Scholar Despite the astoundingly high burden of NAFLD in India, only a fraction will ever develop clinically significant liver disease. Thus, risk stratification and guidance on referral using noninvasive tests is the need of the hour for optimal utilization of limited health resources in the country. INASL-NAFLD Taskforce on NAFLD thus decided to come out with a comprehensive new guidance document on NAFLD predominantly focusing on the nomenclature, spectrum, diagnosis, and treatment of patients with NAFLD. A core committee of 11 INASL-NAFLD task force members was initially constituted which unanimously agreed upon an “INASL-NAFLD Working Party” of 31 members consisting of researchers from across the country working in the area of NAFLD. Members of the working party were divided into seven groups. Each group headed by a captain and 4–5 other members. Each group was given research questions pertaining to a specific research area. The literature was reviewed by the respective groups, and the answers to the questions were prepared as per the GRADE system. The level of evidence and grade of recommendations are depicted in Table 1. Because of the ongoing COVID-19 pandemic, multiple meetings were held virtually (December 2020 to April 2021) with each group presenting its consensus statements and supporting literature in 1–3 sessions. These presentations were made to the entire group of (31 members), which then ratified the statements after detailed discussions.Table 1Level of Evidence and Grade of Recommendations (Adapted From GRADE System).Level of evidenceaLevel was graded down if there was a poor quality, strong bias or inconsistency between studies; Level was graded up if there was a large effect size.Confidence in the evidenceHigh or IData derived from meta-analyses or systematic reviews or from (multiple) randomized trials with high quality.Further research is unlikely to change our confidence in the estimate of benefit and risk.Moderate or IIData derived from a single RCT or multiple nonrandomized studies.Further research (if performed) is likely to have an impact on our confidence in the estimate of benefit and risk and may change the estimate.Low or IIISmall studies, retrospective observational studies, registries.Any estimate of effect is uncertain.Recommendations – GradebRecommendations reached by consensus of the ‘Working Party’ and included the quality of evidence, presumed patient important outcomes and costs.Wording associated with the grade of recommendationStrong‘‘must”, ‘‘should”, or ‘‘INASL recommends”Factors influencing the strength of the recommendation included the quality of the evidence, presumed patient-important outcomes, and costWeak‘‘can”, ‘‘may”, or ‘‘INASL suggests”Variability in preferences and values, or more uncertainty. Recommendation is made with less certainty, higher cost or resource consumptionINASL: Indian National Association for Study of the Liver; MRI-PDFF: magnetic resonance imaging derived proton density fat fraction; RCT: randomised controlled trial.a Level was graded down if there was a poor quality, strong bias or inconsistency between studies; Level was graded up if there was a large effect size.b Recommendations reached by consensus of the ‘Working Party’ and included the quality of evidence, presumed patient important outcomes and costs. Open table in a new tab INASL: Indian National Association for Study of the Liver; MRI-PDFF: magnetic resonance imaging derived proton density fat fraction; RCT: randomised controlled trial. The purpose of this guidance paper is to provide a short and concise guidance document to the practicing hepatologists, gastroenterologists, and physicians. Recently, a group of experts suggested the change in name from NAFLD to MAFLD.26Eslam M. Newsome P.N. Sarin S.K. et al.A new definition for metabolic dysfunction-associated fatty liver disease: an international expert consensus statement.J Hepatol. 2020; 73: 202-209https://doi.org/10.1016/j.jhep.2020.03.039Abstract Full Text Full Text PDF PubMed Scopus (1283) Google Scholar The reasons given for this change included: the name “NAFLD” is heterogeneous, is based on negative criteria, or is a diagnosis of exclusion, metabolic risk factors which are so commonly associated with this disease are not mentioned in the name, the word “non” in the “nonalcoholic” trivializes the importance of this clinical condition and the word “alcohol” in “nonalcoholic” is stigmatizing for the patients.26Eslam M. Newsome P.N. Sarin S.K. et al.A new definition for metabolic dysfunction-associated fatty liver disease: an international expert consensus statement.J Hepatol. 2020; 73: 202-209https://doi.org/10.1016/j.jhep.2020.03.039Abstract Full Text Full Text PDF PubMed Scopus (1283) Google Scholar Based on the available literature, the members of the working party suggested that the proposed change in nomenclature from NAFLD to MAFLD is more of eminence rather than evidence based. NAFLD is a heterogeneous disease with multifactorial pathogenesis, and mere name change would not make it homogenous.27De A. Ahmad N. Mehta M. Singh P. Duseja A. NAFLD vs MAFLD - it is not the name but the disease that decides the outcome in fatty liver.J Hepatol. 2021; 76: 475-477https://doi.org/10.1016/j.jhep.2021.09.002Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar Moreover, there is no accepted definition of “metabolic dysfunction,” which is included in the new suggested name of MAFLD. Further, besides NAFLD, there are so many diseases that have prefix of “non” like non-Hodgkin's lymphoma, noncirrhotic portal fibrosis, noncommunicable diseases, and so on, and the prefix “non” does not trivialize these diseases.28Singh S.P. Anirvan P. Reddy K.R. et al.Non-alcoholic fatty liver disease: not time for an obituary just yet.J Hepatol. 2021; 74: 972-974https://doi.org/10.1016/j.jhep.2020.10.015Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar Similarly, the word “nonalcoholic” in NAFLD does not seem to be stigmatizing. In fact, patients may feel happier when they learn that their liver disease is not related to alcohol. Significant progress has been made in last 2 decades in the biomarker and drug development for NAFLD, and the change in nomenclature may have a negative impact on these efforts. The working party agreed that based on the reasons suggested by some of the experts, there was no compelling need for this change in nomenclature. In fact, the members felt that the change in nomenclature may create confusion not only among the hepatologists but also among physicians and nonhepatologists who manage these patients or do research in the area of NAFLD.29Duseja A. Taneja S. Changing nomenclature from nonalcoholic fatty liver disease to metabolic dysfunction-associated fatty liver disease - not only premature but also confusing.J Clin Exp Hepatol. 2021; 11: 278-279https://doi.org/10.1016/j.jceh.2020.08.002Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar However, the working party suggested the need for a wider consensus and collection of more evidence on this subject (see section on future research). Global, Asian and Indian data suggest that around 10–20% of patients with NAFLD may have normal body mass index as per the population-specific cut-offs (

Anjana R.M., Unnikrishnan R., Deepa M., Venkatesan U., Pradeepa R., Joshi S., Saboo B., Das A.K., Bajaj S., Bhansali A., Madhu S.V., Dhandhania V.K., Jabbar P.K., Jain S.M., Gupta A., et. al.

There is little information on comprehensive diabetes care comprising glycaemic, lipid, and blood pressure control in India; therefore, we aimed to assess the achievement of treatment targets among adults with self-reported diabetes.The Indian Council of Medical Research (ICMR)-India Diabetes (INDIAB) study is a cross-sectional, population-based survey of adults aged 20 years or older in all 30 states and union territories of India. We used a stratified multistage sampling design, sampling states in a phased manner, and selected villages in rural areas and census enumeration blocks in urban areas. We used a three-level stratification method on the basis of geography, population size, and socioeconomic status for each state. For the outcome assessment, good glycaemic control was defined as HbA1c of less than 7·0% (A), blood pressure control was defined as less than 140/90 mm Hg (B), and the LDL cholesterol target was defined as less than 100 mg/dL (C). ABC control was defined as the proportion of individuals meeting glycaemic, blood pressure, and LDL cholesterol targets together. We also performed multiple logistic regression to assess the factors influencing achievement of diabetes treatment targets.Between Oct 18, 2008, and Dec 17, 2020, 113 043 individuals (33 537 from urban areas and 79 506 from rural areas) participated in the ICMR-INDIAB study. For this analysis, 5789 adults (2633 in urban areas and 3156 in rural areas) with self-reported diabetes were included in the study population. The median age was 56·1 years (IQR 55·7-56·5). Overall, 1748 (weighted proportion 36·3%, 95% CI 34·7-37·9) of 4834 people with diabetes achieved good glycaemic control, 2819 (weighted proportion 48·8%, 47·2-50·3) of 5698 achieved blood pressure control, and 2043 (weighted proportion 41·5%, 39·9-43·1) of 4886 achieved good LDL cholesterol control. Only 419 (weighted proportion 7·7%) of 5297 individuals with self-reported diabetes achieved all three ABC targets, with significant heterogeneity between regions and states. Higher education, male sex, rural residence, and shorter duration of diabetes (

Aksu T., Padmanabhan D., Shenthar J., Yalin K., Gautam S., Valappil S.P., Banavalikar B., Guler T.E., Bozyel S., Tanboga I.H., Lakkireddy D., Olshansky R.B., Gopinathannair R.

Adequate and effective therapy for resistant vasovagal syncope patients is lacking and the benefit of cardioneuroablation (CNA) in this cohort is still debated. The aim of this study is to assess the long-term effect of CNA versus conservative therapy (CT) in a retrospectively followed cohort. A total of 2874 patients underwent head-up tilt test (HUT) and 554 (19.2 %) were reported as positive, with VASIS type 2B response or > 3 s asystole in 130 patients. After exclusion of 29 patients under 18 years and over 65 years of age, 101 patients were included final analysis. Fifty-one patients (50.4%) underwent CNA and 50 (49.6%) patients received CT. After propensity score matching, 19 pairs of patients were successfully matched. The recurrence rate of syncope was compared between groups. During a median follow-up of 22 months (IQR, 13–35), syncope was seen in 12 (11.8%) cases. In the 19 propensity-matched patients, recurrent syncope was observed in 8 patients in the CT group and in 2 patients in the CNA group, respectively. In mixed effect Cox regression analysis, CNA was associated with less syncope recurrence risk at follow-up (HR 0.23, 95% CI 0.03–0.99, p = 0.049). The 4-year Kaplan-Meier syncope free rate was 0.86 (95% CI, 0.63–1.00) for CNA group and 0.50 (95% CI, 0.30-0.82) for CT group in the matched cohort. In highly selected patients with HUT-induced cardioinhibitory response, CNA is associated with a significant reduction in syncope recurrence during follow-up when compared to CT.

Kanna R.K., Banappagoudar S.B., Menezes F.R., Sona P.S.

This paper focuses on designing a system to provide the patients with supplemental oxygen to prevent hypoxia for and covid patient. The decrease of oxygen in the tissues in patients with heart diseases, lung related diseases and elderly people result in hypoxia. During this covid-pandemic, number of the patient died due to poor monitor system and mainly due to insufficient of the oxygen. The primary objective of this article is to build a method for automatically administering oxygen supplement to patients when necessary. This technology is portable, does not restrict patients’ lifestyles, and provides patients with movement flexibility. This device can be used both on hospitals and also in houses for patients with not so critical condition to be monitored. The system is designed to read the heart rate in the body using a heartbeat sensor. As the heart-rate decreases eventually the SpO2 levels in the organs start diminishing thus leading to hypoxia. Here the Arduino Uno operates a solenoid valve using a relay to regulate the required oxygen supply automatically. It also has a temperature sensor to record the body temperature. Portable and lightweight oxygen cylinders are used in this technique to provide intranasal oxygen delivery. A liquid crystal display is used to show the collected data. For similar reasons, this system employs GSM for out-of-the-box calamity-related communication. A buzzer is included into the system to alert the user in the event of an emergency.

Latha N.R., Rajan A., Nadhan R., Achyutuni S., Sengodan S.K., Hemalatha S.K., Varghese G.R., Thankappan R., Krishnan N., Patra D., Warrier A., Srinivas P.

Breast Cancer is the most predominant female cancer in developed as well as developing countries. The treatment strategies of breast cancers depends on an array of factors like age at diagnosis, menstrual status, dietary pattern, immunological response, genetic variations of the cancer cells etc. Recent technological advancements in cancer diagnosis lead to the emergence of gene expression pattern for better understanding of the tumor behavior. It has not only bolstered the prognosis, but also the early diagnosis and therapy. The accuracy in disease prognosis can be boosted when gene expression signatures are combined with traditional clinicopathological features. This review explains how the evolution of gene expression signatures for breast cancers, its advantages and future prospects. In addition, an overview of currently available gene expression signature analysis tools and consolidated information on their current status and specific benefits, that can be availed for breast cancer diagnosis are also discussed.

Matthai J., Shanmugam N., Sobhan P.

Severe acute respiratory syndrome Coronavirus 2 (SARS-CoV2), though primarily a respiratory pathogen, also involves the gastrointestinal tract. Similar to the respiratory mucosa, angiotensin converting enzyme-2 (ACE-2) receptor and transmembrane serine protease 2 (TMPRSS2) co-express in the gastrointestinal tract, which facilitates viral entry into the tissue. Less than 10% of children with infection develop diarrhea and vomiting. Prolonged RT PCR positivity in the stool has raised the possibility of feco-oral transmission. Elevated transaminases are common, especially in those with severe coronavirus disease (COVID-19). Children with inflammatory bowel disease and post liver transplant patients do not have an increased risk of disease, and should remain on medications they are already on. Children with chronic liver disease should continue their medications as usual. All elective procedures like endoscopy should be postponed.