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   Table of Contents - Current issue
Coverpage
July-September 2021
Volume 11 | Issue 3
Page Nos. 181-253

Online since Wednesday, July 28, 2021

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NUTRITION - REVIEW ARTICLE  

Impact of the Drying Techniques on the Functional Properties of Citrus sinensis (Sweet Orange) Fruit − A Review p. 181
J. Shiny Derose, G. Nagamaniammai, Ghazi Daradkeh, Walid M Qoronfleh, Marwa Al-Mahrizi
DOI:10.4103/ijnpnd.ijnpnd_14_21  
Citrus sinensis, commonly known as sweet orange, is rich in antioxidants and widely produced worldwide. Sweet orange consists of the water-soluble vitamins C, B1, B2, essential oils, and phenolic components. This fruit is known for its health benefits such as immune booster, digestive aid, anticancer activity, and cardioprotective activity. Its shelf life is low and also it contains high moisture content and so drying of oranges can be done. This review compared the following drying methods: sun drying, spray drying, freeze-drying, microwave drying, inert fluidized bed drying, ultrasonic drying, and infrared drying. Both thermal and nonthermal drying techniques had an influence on the functional properties of the dried orange powder. The comparison of the drying techniques determined relationship between the temperature of the drying process and its subsequent changes on the orange components. At higher drying temperature, it was reported to have a lower color, higher browning effect, lower total phenol content, lower total flavonoid content, and lowered antioxidant activity in dried orange samples. Further studies should be done to determine a method for drying oranges which provides high yield with low power consumption, temperature, and cost.
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NUTRITION - ORIGINAL ARTICLES Top

Assessment of Knowledge, Practice and Treatment Adherence of Patients with Hypothyroidism in Endocrinology Department p. 189
Abinaya Nagendiran, Kavitha Kalaimani, K Anantharani
DOI:10.4103/ijnpnd.ijnpnd_7_21  
Assess the knowledge, practice, and treatment adherence of patients with hypothyroidism attending in endocrinology department in Chennai. The research design adopted for this study was descriptive. Using convenience sampling technique, a total of 120 patients both male and female who had diagnosed with hypothyroidism, Sri Ramachandra Hospital who met the inclusion criteria were recruited. The data related to background variables and assessment of knowledge, practice and treatment adherence on patients with hypothyroidism were obtained using questionnaires through interview method. The data were analyzed using descriptive and inferential statistics. The study findings showed that 61.7% of patients had moderately adequate level of knowledge on hypothyroidism, 76.7% of them had adequate level of practice and 49.2% of them had low adherence. The mean score of knowledge on hypothyroidism was 16.69, practice was 8.28, and treatment adherence was 2.09. The study showed that the knowledge, practice, and treatment adherence with hypothyroidism were moderately adequate among patients with hypothyroidism.
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Soy – Sorghum Milk as a Functional Drink Source of Antioxidants p. 194
Dzul Fadly, Fadila Tulaseket, Rahmawati Rahmawati, M Sakriawati, Armenia Eka Putriana, Septiyanti Septiyanti, Fatimah Fitriani Mujahidah, Ika Wirya Wirawanti, Nicen Suherlin, Anisa Febristi, Yuges Saputri Muttalib
DOI:10.4103/ijnpnd.ijnpnd_15_21  
Background: With the increasing need for antioxidants as a support for health, this study was conducted to determine the functional potential of drinks made from soybeans and sorghum by determining organoleptic, proximate, and antioxidant activity properties. Methods: In this study, the formulations of soy milk (Glycine max (L.) Merill) added with sorghum (Sorghum bicolor (L.) Moench) were including F1 (100% soy milk), F2 (90% soy milk: 10% sorghum), F2 (80% soy milk: 20% sorghum), and F3 (70% soy milk: 30% sorghum). The organoleptic test consisted of a hedonic test and a hedonic quality test involving 25 semitrained panelists measured using an analogue visual scale (0–10). Antioxidant activity identification was determined through the 2,2-diphenyl-1-picrylhydrazyl (DPPH) method. Results: This study found that sorghum’s addition to soy milk significantly affected the hedonic quality value of aroma and texture (P<0.05). Meanwhile, it also significantly affected the protein, fat, and ash content (P<0.05). The addition of 20% sorghum in F2 showed the best characteristics of organoleptic values, with carbohydrate 4.02±2.07%, protein 1.91±0.35%, fat 1.07±1.07%, water 92.74±2.13%, and ash 0.26±0.001%. The addition of sorghum tends to increase the antioxidant capacity of soy-sorghum milk functional drinks. The soy milk products with 20% sorghum possessed antioxidant capability in Half-maximal inhibitory concentration (IC50) about 28.45 ppm and categorized as strong antioxidants. Conclusion: Thus, this soy-sorghum milk product potentially being a functional drink source of antioxidants.
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Association Between Nutritional Status and Neutrophil Lymphocyte Ratio in Patients with Lung Cancer at Persahabatan Hospital, Indonesia p. 199
Lidya Anissa, Yohannessa Wulandari, Fariz Nurwidya
DOI:10.4103/ijnpnd.ijnpnd_16_21  
Context: Systemic inflammation in patients with lung cancer can be seen by the increase of neutrophil lymphocyte ratio (NLR) where these examinations are common in hospitals. Systemic inflammation can cause anorexia resulting in decreased nutrition intake of patients with lung cancer and affecting their nutritional status. One of the diagnostics of nutritional status for patients with lung cancer is using the American Society for Parenteral and Enteral Nutrition (ASPEN) criteria that consist of decreased nutritional intake, weight loss, decreased muscle mass and subcutaneous fat mass, general or local fluid accumulation, and functional capacity. Malnutrition can be diagnosed if there are two of the six criteria. Aims: The study aims to determine the relationship between nutritional status and NLR in patients with lung cancer at Persahabatan Hospital in East Jakarta, Indonesia. Settings and Design: This cross-sectional study included 52 patients with lung cancer in oncology outpatient clinic of Persahabatan Hospital. Methods and Material: Data of characteristics subject were taken from interviews, physical examinations, laboratory analysis, and patients medical records in the oncology outpatient clinic of Persahabatan Hospital. Statistical analysis used chi-square or Fisher exact test to assess relationship between nutritional status and NLR (P < 0.05). Results: Based on nutrient intake, more than 50% of the subjects had low energy and protein intake. Based on patient generated subjective global assessment, 38.5% of subjects were at risk of malnutrition or moderate malnutrition, while 67.3% of them were malnutrition based on ASPEN. There was no statistically significant association between nutritional status and NLR (P = 0.35). Conclusions: There was no association between nutritional status and NLR, and so further research with larger samples is needed.
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PHARMACOLOGY - ORIGINAL ARTICLES Top

Impact of Osteoprotegerin and RANKL on Non-ST-segment Elevation Myocardial Infarction p. 206
Feryal Hashim Rada
DOI:10.4103/ijnpnd.ijnpnd_30_21  
Objective: Osteoprotogerin and receptor activator of nuclear factor kappa-B ligand (RANKL) formed an alliance that joining between bone remaking and vascular reforming. The aim of this study is to quantify the blood concentrations of osteoprotogerin and of RANKL in diabetic patients with myocardial infarction and to evaluate their relationship with other perilous factors in reference to healthy subjects. Methods: A total of 76 diabetic patients with myocardial infarction of non-ST-segment raising aged 50 to 60 years and their matched 60 healthy control aged 45 to 55 years were randomly selected from Al-yarmook Hospital and evaluated for inclusion in this case–control study. Blood levels of osteoprotogerin and RANKL were assessed using high-sensitive enzyme-linked immunosorbent assay. Results: The outcomes of this study elucidated increment in the blood concentrations of osteoprotogerin and RANKL in those patients. Apparently, significant positive correlation directed between osteoprotogerin level with age and onset of diabetes. Otherwise, lipid profile, and inflammatory markers exhibited no significant correlation with osteoprotogerin level. Conclusion: Upraised blood levels of osteoprotogerin and RANKL in diabetic patients with non-ST-segment raising myocardial infarction may be of a consequence of diabetic complication on vascular cell.
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To Evaluate the Implementation and Impact of an Antimicrobial Stewardship at a Tertiary Care Teaching Hospital in India p. 211
Sweta Kumari, Kavita Dhar Bagati, Bala Krishnan Sadasivam, Gudise Chitti Babu
DOI:10.4103/ijnpnd.ijnpnd_4_21  
Background: Antimicrobial stewardship programs refer to antibiotic policies, antibiotic management programs, and antibiotic control programs. According to the Centers for Disease Control and Prevention (CDC) Project ICARE, all hospitals reported having an antibiotic formulary, and 91% used at least one other antimicrobial control strategy. Materials and Methods: The present study is a retrospective and observational study. All information was noted and surveyed sporadically. Any deviations from the agreed criteria were communicated, discussed, and documented. Antibiotic stewardship started from an inpatient setting. In the first phase, the patient pool from inpatient was addressed. For the prospective audit, two components had been recognized to have an evidence level 1. These were multidisciplinary rounds of infectious diseases patients and the use of antimicrobials. Result: In Medicine ward, the most common class of drugs was beta-lactam; in beta-lactam, a combination of piperacillin/tazobactam, amoxicillin/clavulanic acid, and macrolides was used with a mean dose of 1408.18 g. While in orthopedics, most common drugs for prophylaxis use were found to be cephalosporins (cefazolin first generation) with a mean dose of 937.07 ± 741.81 g to reduce surgical site infections. Prophylactic use of beta-lactam (amoxicillin/clavulanic acid) was prescribed for the most of the cases of Ears, Nose and Throat (ENT) surgery with mean dose of 1019.63 g as well as in pediatrics with mean dose of 579.47 g. Conclusions: Antimicrobial stewardships have a significant impact on the reduction of targeted and empiric antibiotic use, healthcare costs, and antimicrobial resistance in inpatient settings.
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Estimation of Demographic Parameters of COVID-19 Patients Admitted in a Tertiary Care Hospital, Jaipur p. 220
Gudise Chitti Babu, Bhagwati Chundawat, Rajeev Pareek, Ramana Murty Kadali, Ajit Thakur
DOI:10.4103/ijnpnd.ijnpnd_5_21  
Background: COVID-19 is a pandemic disorder spreading rapidly worldwide. Most of the countries were affected by the COVID-19 during the year 2020. Demographic data are important to understand the impact of COVID-19 across the country and also provide information on an appropriate response, planning, and allocation of resources. This study aims to assess the demographic data of COVID-19 patients admitted and treated in a tertiary care hospital, Jaipur. Materials and Methods: This is a retrospective study conducted in a tertiary care hospital in Jaipur. A total of 1149 patients’ data like age, gender, area they belong to, duration of the treatment, etc., were collected from the medical records department (MRD) department between July 1, 2020 and September 30, 2020. The data were expressed as counts, number, and percentage (%). The data were analyzed using Excel software. Results: Out of 1149 patients, 70% were males and 30% were females, respectively, and mean ± SD (standard deviation) of age was 44.23 ± 3.57. Most of the cases were obtained from Jaipur 63%, Bikaner 5.4%, Ajmer 4.4%, Alwar 2.6%, Sawai Madhopur 2.6%, Dausa 2.3%, Nagaur 2.3%, Bharatpur 2.1%, and Karauli 1.7%, respectively, and remaining places reported <1.5% cases. Also 40 to 80 years age groups were most affected. About 32.4% mild, 55.7% moderate, and 11.8% severe cases were reported. Conclusions: More male patients were affected when compared with female patients. Age and other disease conditions have a positive correlation with COVID-19. Older people should take extra precautions and avoid going to markets, parties, etc., unless it is essential. Early identification and detection of COVID-19 helps in better treatment and preventing the conversion of mild cases into moderate or severe cases and prevents the transmission from one to another.
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Antihyperglycemic and Antioxidant Potential of Plant Extract of Litchi chinensis and Glycine max p. 225
Samrat Chauhan, Sumeet Gupta, Sabina Yasmin, Monika Saini
DOI:10.4103/ijnpnd.ijnpnd_13_21  
Background: Diabetes mellitus, an endocrine disease, is a major health concern all over the world. Litchi chinensis Gaertn. and Glycine max (L.) Merr have been traditionally used in Chinese medicines for the treatment of various disorders. The present study was carried out to explore the antioxidant and antihyperglycemic potential of ethyl acetate and hydroethanolic extracts of L. chinensis fruit pericarp and G. max seed coats. Methods: Phytoconstituents of ethyl acetate and hydroethanolic extracts of L. chinensis fruit pericarp and G. max seed coat were investigated using preliminary qualitative techniques. In vitro and in vivo antioxidant potential of ethyl acetate and hydroethanolic extracts was assessed using 2,2-diphenyl-1-picrylhydrazyl (DPPH), hydrogen peroxide (H2O2) free radical scavenging, reducing power assays, total phenol content, glutathione (GSH), superoxide dismutase (SOD), and thiobarbituric acid reactive substances (TBARS). In vivo antihyperglycemic activity was assessed using alloxan-induced diabetic rats. Blood glucose levels were evaluated on 0, 7th, 14th, and 28th day of the study. Results: Hydroethanolic extracts of both plants exhibited superior antioxidant activity to ethyl acetate extract. A marked increase in levels of serum glucose was observed in diabetic rats. Ethyl acetate and hydroalcoholic extract treatment for 28 days accounted for decreased blood glucose levels in hyperglycemic rats. Conclusions: The present study suggests that ethyl acetate and hydroethanolic extracts of L. chinensis fruit pericarp and G. max seed coats possess potent antioxidant antihyperglycemic activities and have potential as a therapeutic agent in diabetes.
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NEUROLOGICAL DISEASES - ORGINAL ARTICLES Top

Cost-Effectiveness Analysis of Head Computed Tomography in Children with Mild Traumatic Brain Injury: A Retrospective Study p. 234
Thara Tunthanathip, Nakornchai Phuenpathom, Sakchai Sae-heng, Thakul Oearsakul, Ittichai Sakarunchai, Anukoon Krewborisutsakul, Chin Taweesomboonyat
DOI:10.4103/ijnpnd.ijnpnd_8_21  
Background: Head computed tomography (CT) is used as a diagnostic tool for intracranial injury following traumatic brain injury (TBI). However, the long-term effects of radiation exposure should be of concern in children. This study compared the cost-effectiveness of the early head CT (ECT) strategy with that of initial conservative treatment with parent education of the nonearly CT (NECT) in pediatric TBI with a Glasgow Coma Scale (GCS) score of 15. Methods: A retrospective study was conducted with TBI children with a GCS of 15, who were treated at an emergency department (ED). The costs and outcomes of the children were recorded. The authors used a decision tree model (Plant-A-Tree, International Decision Support Initiative, United Kingdom) to compare the cost-effectiveness analysis of two strategies. The incremental cost-effectiveness ratio (ICER) was also calculated. Results: For the ECT group, the rate of the positive results following head CT was 17.6%, and the common intracranial injuries were epidural hematoma, skull fracture, and subdural hematoma in 11.5%, 9.8%, and 6.6%, respectively. The children in the ECT group who underwent surgery were 3.2%. For the NECT group, revisions were observed in 5.3%, and all patients with revision underwent CT. Therefore, the frontal contusion was observed in 10% following CT, and none underwent surgery in the NECT group. From a healthcare provider’s perspective, the expected cost of the ECT group was US $597.49, whereas the expected cost of the NECT group that included overall costs at ED was US $115.27. The expected outcome of the ECT group was less than the NECT group that caused the base-case ICER to be negative (−US $30,715.28 per outcome gained). A sensitivity analysis revealed that an early CT strategy became a dominant strategy that needed a low revision rate but a high rate of positive findings after head CT. Conclusion: The initial conservative treatment was the dominant strategy. This strategy was safe and effective and could diminish the unnecessary exposure to radiation in children.
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Effect of Centella asiatica L. Extract on Apoptosis and Bcl-2 Immunoexpression of Pyramidal Cells in Traumatic Brain Injury Rat Model p. 242
Nafiisah, MM Rudi Prihatno, Dody Novrial
DOI:10.4103/ijnpnd.ijnpnd_3_21  
Background: Traumatic brain injury therapy still has many shortcomings. The slow repair of post-traumatic pyramidal cells causes the need to find new alternatives to deal with the consequences of traumatic brain injury. This study aims to determine the effect of Centella asiatica L. extract in increasing pyramidal cells repair, assessed from the apoptosis and B-cell lymphoma 2 (Bcl-2) immunoexpression of pyramidal cells in traumatic brain injury rat model. Methods: This research was conducted during July 3–17, 2020 and used a true experimental research design with a posttest-only controlled group design. Rats were divided into five groups, that is, normal group, group treated with traumatic brain injury, and groups treated with traumatic brain injuries and given extracts of C. asiatica (L.) dose of 150, 300, and 600 mg/kg bw/day. Brains from each group were taken to examine the apoptosis and Bcl-2 immunoexpression of pyramidal cells at day 7. This study used Kruskal–Wallis test and post hoc Mann–Whitney test. Results: Based on the statistical analysis results, there was a significant correlation between the Bcl-2 immunoexpression and apoptosis of pyramidal cells in traumatic brain injury rat model with different doses of C. asiatica (L.) extract (P < 0.05). Dose of 600 mg/kgBW was the most effective in decreasing apoptosis and increasing Bcl-2 immunoexpression of pyramidal cells in traumatic brain injury rat model. Conclusion: This study proved that C. asiatica (L.) extract can decrease apoptosis and increase Bcl-2 immunoexpression of pyramidal cells in traumatic brain injury rat model.
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Relationship of Serum Cytokine Profile to Steroid Resistance in Demyelinating Neurologic Illnesses p. 249
Devaprasad Markandeyan, Mabalirajan Ulaganathan, Surajit Pathak, Ramesh Ganesan Vengalathur
DOI:10.4103/ijnpnd.ijnpnd_23_21  
Background and Purpose: Corticosteroids form main stay of treatment of autoimmune neurological diseases. Immunotherapy with Intravenous Immunoglobulin, Plasmapheresis, biological agents like Rituximab, Infliximab, etanarcept are also used for treatment of patients who are resistant to steroid treatment and in severe cases. This study was aimed to elicit the relationship between serum cytokine levels and steroid resistance which is important for early commencement of other medications. Methods: The serum samples of patients who presented with autoimmune neurological diseases were collected and cytokine levels were estimated. The cytokine profile of patients who responded well to steroid treatment was compared with that of steroid nonresponders. Results: The steroid unresponsive group had significantly higher serum Interferon gamma and IL-13 levels than steroid unresponsive group. Conclusion: when patients present with high serum levels of IL-13 and Interferon Gamma they should be considered for prompt escalation of immunomodulatory therapy.
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