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   Table of Contents - Current issue
Coverpage
July-September 2020
Volume 10 | Issue 3
Page Nos. 75-169

Online since Thursday, August 20, 2020

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REVIEW ARTICLES  

Health Benefits of Substituting Added Sugars with Fruits in Developing Value-Added Food Products: A Review Highly accessed article p. 75
Chandini Shantha Kumar, Amanat Ali, Annamalai Manickavasagan
DOI:10.4103/ijnpnd.ijnpnd_34_20  
Increased intake of added sugar is associated with nutrient deficiencies and higher risk of several non-communicable diseases such as obesity, type 2 diabetes, heart diseases, dental caries, and certain type of cancers. The current consumption of added sugar is much higher than the dietary recommendations in many parts of the world. To minimize the intake of added sugar, and enjoy the delicious sweet taste, the natural sugars from fruits can provide an excellent transition to replace white sugar in everyday diet. Fruits, in its various forms, have the potential to blend with ingredients of many food products and add sweet taste along with several healthy bioactive compounds. This article provides the health consequences of increased intake of added sugars and the health benefits of fruit-based value-added products. The scope of using fruit extracts, concentrates, dried fruits, and fruit powders in the preparation of various food products to replace the added sugar has been discussed.
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A Systematic Review on Urinary Biomarkers for Early Diagnosis of Alzheimer’s Disease (AD) p. 91
P. Rani, S. Vivek, S. Maheswar Ram
DOI:10.4103/ijnpnd.ijnpnd_10_20  
Alzheimer’s disease (AD) is a neurodegenerative disease that commonly affects the older population whose symptoms are only visible during the later stage which renders the available treatment ineffective. Our study attempts to provide a solution to this problem by identifying urinary biomarkers that could be used in the first-line screening of a larger population for AD before analysing with more sophisticated blood and CSF based biomarkers, which provide high sensitivity on comparison. A systematic review was performed using the keywords “Alzheimer”, “urine”, “biomarkers” and “metabolomics” following the PRISMA criteria, to identify urinary biomarkers for the early diagnosis of Alzheimer’s disease. From the performed study, three metabolites were identified namely 5-hydroxy indole acetic acid, L-arginine and allantoin as biomarkers whose level was altered in AD samples compared to controls. In AD, 5-hydroxy indole acetic acid level was downregulated in urine probably because of the extensive serotonergic denervation that has been observed in the AD brain. Increased levels of L-arginine in the brain which act as a precursor to nitric oxide due to the action of NO synthase might potentially lead to neurotoxicity when present in excess, and is also known to be in synergy with ROS. Increased levels of allantoin in urine is due to the action of increased ROS in the system reacting with uric acid. Here, we provide an overview of all the reported metabolites obtained from the search, by discussing their influence in AD pathology. This study identified three metabolites in urine that could function as potential biomarkers for AD based on significant changes observed between disease and control samples, along with its recurrence and commonality in different models namely mice and human. However, longitudinal and cross-sectional follow-up studies are required for the validation of these biomarkers.
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The Effect of Bariatric Surgery on the Composition of the Gut Microbiota Community: an Imbalance Associated with Severe Disorders p. 99
Elham El Darazi, Yonna Sacre, Elias El-Khoury, Afif M Abdel Nour
DOI:10.4103/ijnpnd.ijnpnd_84_19  
Obesity has become an imminently serious public health problem as nearly 40% of the adult population worldwide is obese. Bariatric surgery is considered the most efficient weight loss treatment by mechanically restricting caloric intake. However, evidence proposes a strong association between weight loss and the alteration of the gut microbial composition after bariatric surgery. Modifications in the concentration of gut microbial bacteria affect human health by either increasing or reducing the likelihood of diseases associated with specific bacteria. In this review, we discuss the effect of bariatric surgery on the gut microbial composition in patients. Additionally, we detail the modifications in the abundance of specific phylum and species in the intestinal microbiota after bariatric surgery. Different disorders associated with the increase or decrease of a particular bacterium are mentioned in order to evaluate the impact of the alteration of post-surgery intestinal microbial structure on individuals’ health.
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ORIGINAL ARTICLES Top

Factors Associated with Treatment Adherence in Children with Malnutrition in Turkey p. 105
Fatih Ozdener, Feza Kirbiyik, Ali Evrim Dogan, Arzu Baygul, Study Group Factrem
DOI:10.4103/ijnpnd.ijnpnd_18_20  
Aims: Malnutrition (MN) is associated with an increased mortality rate in infants and children and is an important comorbidity. Adherence to MN treatment is critical for a successful outcome, as are early diagnosis and administration of an appropriate treatment regimen. This study aimed to identify the factors pediatricians perceive to be associated with adherence to MN treatment in children. Materials and Methods: This mixed-methods study employed both qualitative and quantitative methods. The study included 136 pediatricians from various geographical regions of Turkey. Data were obtained via face-to-face interview, questionnaire, and group discussion. Results: Physicians perceived that among the patients that were diagnosed with MN, 66% underwent enteral nutrition therapy and that the treatment adherence rate was 59%. Patient-related factors associated with adherence to MN treatment were treatment tolerability, the severity of MN, and comorbidities. Nutritional product-related factors associated with treatment adherence were cost and flavor. Family-related factors associated with treatment adherence were parental level of education, economic status, and the level of confidence in the treatment modality. Use of an unflavored pediatric oral nutritional product increased the treatment adherence in patients aged 18–24 months (60% vs. 40%), whereas flavored varieties increased the treatment adherence rate after 2 years of age. Conclusion: The prevalence of MN is high in Turkey and non-adherence to MN treatment is common. Increasing awareness of the factors that contribute to adherence to MN treatment among physicians, the general public, and government are important for improving the rate of adherence to MN treatment.
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Characterization of Whole Wheat Bread Reformulated with Pea and Soy Protein Isolates p. 112
Manickavasagan Shivaani
DOI:10.4103/ijnpnd.ijnpnd_78_19  
Aims: At present, there is an increasing demand for plant-based proteins due to their nutritional values and beneficial effect to the environment. Improving the availability of plant protein enriched foods would be highly beneficial for the consumers to follow a healthy diet. Reformulating a commonly consumed product, such as bread, with plant-based protein will be a convenient option for the people to improve their protein intake. Therefore, the objective of this study was to determine the effect of protein isolate (pea and soy) on color, microscopic structure, sensory properties, and protein content in whole wheat bread. Methods: The experiments were conducted at the University of Guelph, ON, Canada. Seven whole wheat bread samples (control, P20, P30, P40, S20, S30 and S40) were prepared (n = 3 loaves for each treatment). Results: The RGB and L*a*b*values of loaf (crust) and slice (crumb) of the control bread was higher than that of all protein enriched bread samples. The control bread had larger pores than the protein enriched samples. The pores in the pea protein isolate enriched bread were tightly packed while compared to soy protein. There was no difference in most of the sensory attributes between control and S20 breads. In terms of softness, all protein blended breads scored lower than the control. Fifty percentage of the panelists chose S20 as their first choice, whereas only thirty percent selected control as their first choice. The protein content of the bread samples was 8.9, 15.4, 18.1, 20.7, 15.9, 18.6 and 20.9%, for control, P20, P30, P40, S20, S30 and S40, respectively. Conclusion: Soy protein isolate has more opportunities than pea protein isolate to incorporate with whole wheat flour, and produce acceptable bread.
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Therapeutic Evaluation of Thymoquinone in the Intracerebroventricular Injection of L-Cysteine Induced Vascular Dementia in Rats p. 120
Narahari Rishitha, Arunachalam Muthuraman, Chidambaram Saravanababu
DOI:10.4103/ijnpnd.ijnpnd_1_20  
Introduction: Worldwide, dementia is one of the leading causes of death. The major type of dementia disorders is Alzheimer disease (AD) and vascular dementia (VaD). The progress of VaD is due to the lack of blood flow; and the accumulation of metabolic neurotoxin in the nervous system. In the present study, VaD was induced by intracerebroventricular injection of L-Cysteine (L-Cys) in rats. Methods: Thymoquinone (TQ; 5 and 10 mg/kg; p.o.) was administered for 5 consecutive days. Donepezil (10 mg/kg; p.o. 5 consecutive days) was used as a reference control. Neurocognitive functions were tested at different time intervals. Furthermore, L-Cys induced biochemical changes were also estimated in plasma and hippocampus tissue samples. Results: Treatment of TQ ameliorates the L-Cys induced cognitive impairments along with biochemical changes as similar to donepezil treatment. Conclusion: Hence, the TQ may be a newer medicine for dementia disorder due to its anti-oxidant, anti-lipid peroxidative, anti-inflammatory actions; regulation of cholinergic neurotransmission; and reduction of metabolic accumulation of neurotoxin.
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Whole Grain Food Products: Knowledge, Availability and Consumption in Oman p. 128
Annamalai Manickavasagan, Ihsan Abbas, Amanat Ali, Lorna Cork, Mohib Ahmed Khan, Michel Claereboudt, Malik Al-Wardy, Sawsana Al-Rahbi, Marla Reicks
DOI:10.4103/ijnpnd.ijnpnd_23_20  
Aims: To assess the consumption, willingness to consume, availability and knowledge of people about the whole grain food products across the Sultanate of Oman. Methods: A self-administered survey was conducted among a convenience sample of adults to assess the consumption, willingness to consume, availability and knowledge about whole grain products across all the nine Governorates of Oman. Results: Almost all respondents (99%, n = 1891) reported that they consume rice and bread at least 4 days per week. Less than 5% of adults indicated that they consume brown rice, whereas 20% to 90% consume whole grain bread. Forty percent of the respondents indicated that they did not know, which type of bread or rice either white or brown, is healthier. Only 20% to 30% of the respondents reported that brown rice or whole wheat bread was available in the market all the time. The various indexes (0 to 1, where 0 as nil and 1 as maximum) developed based on the survey results for the availability, knowledge and willingness to consume whole grain products were 0.36 to 0.87, 0.35 to 0.64 and 0.51 to 0.57 respectively, in different Governorates of Oman. Conclusion: The results indicated that there is an urgent need to educate the Omani people about the nutritional and health benefits of consuming whole grain products and to improve the availability of whole grain food products across Oman.
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Physical Activity Pattern Among Female College Students at Taibah University p. 137
Rola Adnan Jalloun, Amal Mohammed Surrati
DOI:10.4103/ijnpnd.ijnpnd_13_20  
Introduction: Physical activity simply is any movement of the body that sustains and empowers physical fitness and overall health and wellness. Physical inactivity became a concern in the Kingdom of Saudi Arabia especially in females during the last few decades. The purpose of this study was to assess the physical activity patterns among female college students. Methods: A cross-sectional study was conducted among 658 female college students at Taibah University. The short form of the Arabic version of the International Physical Activity Questionnaire (IPAQ) was used to assess physical activity pattern. Additional data were collected on body mass index (BMI), body composition, including body fat percentage (BF%), visceral fat level (VFL), and skeletal muscle percent (SM%). Results: Overall, 37.5% of the students performed vigorous-intensity, and 44.9% performed moderate-intensity physical activity. Both BMI and BF% were significantly inversely associated with vigorous and moderate physical activity. These associations appeared to be stronger among students who performed vigorous physical activity for ≥75 min/week for BMI (aOR = 0.559, 95% CI 0.318–0.687) and BF% (aOR = 0.389, 95% CI 0.044–0.507) and moderate physical activity for ≥ 150 min/week for BMI (aOR = 0.580, 95% CI 0.205–0.812) and BF% (aOR = 0.320, 95% CI 0.124–0.402). Conclusion: Although both vigorous and moderate physical activity appeared to affect BMI and BF%, among college students who performed physical activity, our findings suggest the need for strategies to increase awareness among female students to be physically active to promote healthy lifestyles and substantial health benefits.
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Prevalence and Severity of Adverse Drug Reactions Among Patients Receiving Antipsychotic Drugs in a Tertiary Care Hospital p. 144
Netravathi Basavaraj Angadi, Chhavi Mathur
DOI:10.4103/ijnpnd.ijnpnd_9_20  
Aims: Adverse drug reactions are usually dose dependent and can be influenced by patient characteristics including age and gender and these confounding factors should be considered in clinical practice and in the interpretation of research data. This study was planned to evaluate the profile of adverse drug reactions among patients receiving antipsychotic drugs in a tertiary care hospital and to assess the severity of adverse drug reactions. Methods: It was a hospital-based cross-sectional study, conducted in Department of Psychiatry in a tertiary care hospital. An assessment of severity was done using modified Hartwig and Siegel scale. Categorical variables were summarized as percentages. Chi-square test was used to test for independence of two categorical variables. P < 0.05 was considered as statistically significant. Results: The overall prevalence of ADRs in the study population was found to be 51.9%. When the percentage of individual ADRs was taken into consideration, the most common ADR was increase in weight (15.7%) followed by sedation (9.6%), increased appetite (7.8%), Rigidity (6.8%) and akathesia (5.1%) As per modified Hartwig and Siegel scale for assessing the severity of ADRs, 34(63.0%) ADRs were mild in severity and 20 (37.0%) ADRs were moderate in severity. Conclusion: ADRs occur quite frequently in these patients receiving antipsychotic drugs, which are often mild in nature Thus, the recognition of these side-effects and their management can ensure optimal care for the patient.
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The Dosage of the Avocado Leaf Extract (Persea americana Mill.) on Regeneration of Diabetic White Rats (Rattus norvegicus) Renal Cell p. 149
Nurdin Rahman, Sri Mulyani Sabang, Nikmah Utami Dewi, Bohari , St. Ika Fitrasyah
DOI:10.4103/ijnpnd.ijnpnd_6_20  
Context: Antioxidant activity in avocado leaves plays a role in improving insulin work in controlling blood glucose levels. Aim: To analyse the effect of doses of avocado leaf extract on the regeneration of diabetic rat renal cells. Methods: Experimental method was used with 18 male white rats as subjects. White rats were divided into six groups: Treatment G1: Feed + STZ (Streptozotocin) + Sucrose 10% + Avocado leaf extract dose of 100 mg/kg body weight + NaCMC 0.5%, G2: Feed + STZ + Sucrose 10% + Avocado leaf extract 150 mg/kg body weight + NaCMC 0.5%, G3: Feed + STZ + Sucrose 10% + Avocado leaf extract dose 200 mg/kg body weight + Na-CMC 0.5%, G4: Feed + STZ + 10% sucrose + Na-CMC 0.5%, G5: Feed + STZ + 10% sucrose + Glibenclamid + Na-CMC 0.5%, and P6: Feed. Results: The average renal damage of rats in the rat group was G1 = 1.66; G2 = 1.33; G3 = 0; G4 = 3; P5 = 0; P6 = 0. Score 0 = no damage. Score 1 = mild renal cell damage (1/3 cell part); score 2 = moderate renal cell damage (2/3 cell parts); score 3 = severe renal cell damage (>2/3 cell parts). Conclusion: The treatment of G3 with a dose of 200 mg/kg body weight avocado leaf extract gives a relatively effective influence on regenerating STZ induced renal cell rats, compared to other doses.
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CASE REPORT Top

Copper deficiency myeloneuropathy with bicytopenia − a rare case report p. 154
Sourya Acharya, Swapnil Lahole, Samarth Shukla, Preeti Mishra, Parag Aradhey
DOI:10.4103/ijnpnd.ijnpnd_17_20  
Copper is a trace element required for various enzymatic activities in the body. Copper deficiency myeloneuropathy (CDM) is an entity which presents with spastic paraparesis, sensory ataxia and peripheral neuropathy resembling subacute combined degeneration of spinal cord seen in vitamin B 12 deficiency. Hematologic manifestations of copper deficiency may present as cytopenias resembling myelodysplastic syndrome. We present a case of a 48 year old female who presented with myeloneuropathy and bicytopenia because of copper deficiency.
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LETTERS TO EDITOR Top

Can Fruits and Vegetables be Infected or Contaminated by COVID-19? p. 157
M. S. Shahid, A. M. Al-Sadi
DOI:10.4103/ijnpnd.ijnpnd_40_20  
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COVID-19 Impact on Health, Social & Economy p. 159
Subrahmanian Muthuraman, Mohammed Al Haziazi
DOI:10.4103/ijnpnd.ijnpnd_64_20  
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COVID-19 Impact − A Physician’s Perspective p. 161
Preeja Prabhakar, Sivaprasad Punnaveetil
DOI:10.4103/ijnpnd.ijnpnd_62_20  
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The Impact of COVID-19 on Children − Parent’s Perspective Highly accessed article p. 164
Buthaina Al-Balushi, Musthafa Mohamed Essa
DOI:10.4103/ijnpnd.ijnpnd_55_20  
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The Coronavirus’ Impact on Education − School Students’ Perspective p. 166
Sanjay Subramanian, Saeefh Mohamed, Tahir Khanzadah
DOI:10.4103/ijnpnd.ijnpnd_59_20  
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Impact of COVID-19: University Students’ Perspective p. 168
Amanda Jane Fernandes
DOI:10.4103/ijnpnd.ijnpnd_60_20  
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