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   Table of Contents - Current issue
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April-June 2020
Volume 4 | Issue 2
Page Nos. 83-178

Online since Wednesday, June 17, 2020

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REVIEW ARTICLES  

Descriptive review of epidemiological geographic mapping of coronavirus disease 2019 (COVID-19) on the internet Highly accessed article p. 83
Brian Chanda Chiluba, Gugulethu Dube
DOI:10.4103/bbrj.bbrj_50_20  
Geoinformatics significantly enables the identification and tracking of global pandemic outbreaks such as coronavirus disease 2019 (COVID-19), from spatial mapping at various sizes to location-based alerts. This article seeks to review online attempts to geographically map COVID-19, using several established techniques such as choropleth rendering, graduated circles, graduated pie charts, buffering, overlay analysis, and animation. The import of these mapping services is primarily to educate the public (especially travelers to potentially affected areas) and empower public health authorities in mapping spatial and temporal trends and patterns in COVID-19, as well as in assessing/reviewing the efficacy of current control protocols and actions.
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Review on role of CD4 T-cells in patients with respiratory illness and human immunodeficiency virus infection p. 90
Priyanka Gaur, Sandeep Bhattacharya, Surya Kant, R A. S. Kushwaha, Sarika Pandey, Supriya Sharma
DOI:10.4103/bbrj.bbrj_5_20  
Human immunodeficiency virus (HIV) infection is now considered as a chronic disease in a population having a higher prevalence of several commodities. Infection with HIV has now emerged as the strongest risk factor for the development of active tuberculosis, asthma, chronic obstructive pulmonary disorder, and lung cancer. Several studies have investigated the presence of respiratory symptoms in the HIV-infected population. HIV infects CD4+ T-lymphocytes selectively and causes the destruction of CD4+ T-cells directly as well as indirectly, which leads to gradual loss of the CD4+ T-cell numbers in peripheral circulation. In immune response, CD4+ T-lymphocytes play a central regulatory role. The decrease in numbers of CD4+ T-cell can compromise the normal immune functions of the body. CD4+ T-cell numbers in circulation can provide important information about the immune competence of an individual since early detection and appropriate management of the disease is a priority, in order to improve patients' prognosis and to improve the quality of life.
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The associations between retinol binding protein-4 and cardiometabolic profile: Intertwined-intricate relationship p. 95
Marwa Thaier Naji, Oula Mohamed Sami, Hala Aqeel Shams, May Hassan Abdul-Hadi, Hayder Mutter Al-Kuraishy, Ali Ismail Al-Gareeb, Naseer Abdul-Amer Al-Harchan
DOI:10.4103/bbrj.bbrj_6_20  
Retinol binding protein-4 (RBP4) is a new adipokine synthesized by the liver and adipose tissue, and its secretion depends on retinol concentrations and reflects visceral fat mass. RBP4 serum levels are regarded as a new biomarker in follow-up and diagnosis of overweight and obesity and other cardiometabolic disorders, such as hypertension, ischemic stroke, and dyslipidemia. Different drugs such as statins, fibrates, glucagon-like peptide 1 (GLP-1), dipeptidyl peptidase-IV (DPPIV) inhibitors, and thiazolidinediones (TZDs) have been reported to reduce RBP4 levels. The objectives of the present study were to illustrate the role of RBP4 in different cardiometabolic disorders and to explore the conflicting about the effect of different drug groups on the circulating RBP4 levels. A multiplicity of search strategies took on and assumed which included electronic database searches of Scopus, Web of Science, Medline, Cochrane Central Register of Controlled Trials, and PubMed using MeSH terms, keywords, and title words during the search. RBP4 plasma levels are mainly correlated with visceral adiposity and less to the subcutaneous adipose tissue. Statins may reduce or increase RBP4 plasma levels. Fibrate drugs, TZDs, DPPIV inhibitors, and GLP-1 agonists reduce RBP4 plasma levels through suppression of adipose tissue RBP4 mRNA and elevation of adiponectin levels. Metformin reduces circulating RBP4 levels through the improvement of insulin sensitivity, upregulation of glucose transporter 4 (GLUT4), and activation of adipocytes PPARα.
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Tamoxifen from chemotherapy to antiviral drug: Possible activity against COVID-19 Highly accessed article p. 108
Huda Ali Salman Almosawey, Falah Hasan Obayes AL-Khikani, Raghdah Maytham Hameed, Younus Jasim Abdullah, Mohanad Kadhim Mirdan Al-Ibraheemi, Atyaf Ali Al-Asadi
DOI:10.4103/bbrj.bbrj_53_20  
Tamoxifen (TAM) is the oldest and the most-prescribed selective estrogen receptor modulator (SERM). It is a member of the triphenylethylene group. TAM has been used to treat breast cancer that spreads to other parts of the human body; it is also utilized to decreasing the chances of breast cancer developing in high-risk patients. Recently, some studies focused on the potential antimicrobial action of TAM. Coronaviruses are enveloped positive-sense RNA nucleic acid viruses that have club-like spikes, characterized by a distinctive replication strategy; they are round and sometimes pleomorphic in shape. Coronavirus disease 2019 (COVID-19) is regarding the new genera of coronaviredia that appeared for the first time in Wuhan, China, in early December 2019. Due to the continuous spread of the novel COVID-19 with the exponential rise in death numbers, new therapeutic development is urgent; in general, there are no specific antiviral drugs or vaccines for 2019-nCoV. Hence, this review will discuss the most recent information about the antiviral action of TAM against COVID-19 infection by trying to give a deep understanding of major properties, mechanisms of action, immune system responses, and antimicrobial efficiency of TAM that is regarding the promising way to treat COVID-19 novel infection. The current review may serve as an impetus for researchers working in the field of medical microbiology, vaccination, and antiviral drug design. The review also rationally reports and critically analyzes the available knowledge by focusing and mentioning future steps and strategies trying to find appropriate solutions regarding challenges in COVID-19 management by TAM utilization.
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Dermatophytosis a worldwide contiguous fungal infection: Growing challenge and few solutions p. 117
Falah Hasan Obayes AL-Khikani
DOI:10.4103/bbrj.bbrj_1_20  
Dermatophytes are filamentous fungi that survive on keratinous materials. There is a broad prevalence of dermatophytes infection among the world. Dermatophytosis is the disease that mainly caused by different species of dermatophytes within the cutaneous layer of the skin. It has contagious properties to spread from person to another and also from the animal to the human. The skin, hair, and nail of all types of mammalian, including human, are under the risk to develop dermatophytosis. A total of 2530 articles have been investigated in PubMed (n = 1525), Medline (n = 705), and Google Scholar (n = 300). From 2530 articles, just 48 studies were included in this review. This study aimed to review available data and current literature as well as information from personal experiments regarding dermatophytes infection to focus on the dermatophytes general features, dermatophytosis, pathogenesis presented by enzymes production, most common factors associated with infection, prevalence, and treatment of dermatophytes infection, and also to yield a clear vision to other researches about this worldwide predominant contiguous fungal disease.
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Pulmonary mycoses treated by topical amphotericin B p. 123
Falah Hasan Obayes AL-Khikani
DOI:10.4103/bbrj.bbrj_12_20  
Since its discovery, amphotericin B (AmB) became a key management because it is the most common antifungal drug with activity to disrupt the fungal cell wall. Furthermore, it is the first-choice treatment in pulmonary mycoses that may consider lethal infection; the difference in lipid structure between fungal and mammalian cell membranes determines the effect of AmB. However, some fungal pulmonary diseases such as aspergillomas are partially contact with the blood and narrow touch the walls of the lung cavities, thus administration of systemic antifungal agents may be ineffective to eliminate these infections. Tissue penetration of systemic antifungal agents must be evaluated to get a proper appreciation of their antifungal activity, which may differ even within the same antifungal class. So, topical administration considered necessity in these situations. AmB belongs to the polyene group has a wide-spectrum in vitro and in vivo antifungal activity. All of the known available formulas of AmB are administrated through intravenous injection to treat severe systemic fungal infections, while the development of the topical formula of AmB is still under preliminary development, including topical pulmonary AmB. Due to the revealing of antimicrobial-resistant fungi in recent years and ineffective systemic management of pulmonary fungi, this study explains the role of topical AmB in treating refractory lung fungi that not response to other drugs that may help researchers to develop an effective topical formula of AmB regarding pulmonary mycosis.
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ORIGINAL ARTICLES Top

Effect of fluoride on the uteroplacental transfer of calcium and magnesium and their role in congenital anomalies in newborns p. 127
Abhra Ghosh
DOI:10.4103/bbrj.bbrj_157_19  
Background: Calcium and magnesium are one of the most important micronutrients for fetal development. Environmental pollutants such as excess fluoride can hamper the action of calcium and magnesium, resulting in a bad outcome of pregnancy. Aim: We aimed to find out the effect of fluoride on the uteroplacental transfer of calcium and magnesium and their role of these minerals as a causative factor of congenital anomalies in newborns. Methods: Thirty newborns with congenital anomalies were included in Group I, and thirty healthy newborns were included in Group II. Cord blood fluoride was estimated by ion-selective electrode, whereas calcium and magnesium were estimated by the autoanalyzer. Unpaired “t” test and Pearson's correlation test were applied for the statistical analysis. Results: Serum fluoride levels were significantly raised, and serum calcium levels and serum magnesium levels were statistically significantly decreased in newborns with congenital anomalies as compared to newborns without congenital anomalies (P = 0.000). Serum fluoride levels showed a positive correlation with serum calcium in Group II, which got inverted in Group I. Both the results were statistically significant. Serum fluoride levels showed a positive correlation with serum magnesium levels in Group II, which got inverted in Group I. Both the results were statistically insignificant. Conclusion: Hypokalcemia and hypomagnesemia can affect fetal development. Environmental pollution due to fluorosis emerges as a factor as fluoride has a direct influence over calcium and magnesium absorption and transfer through the placenta to the developing fetus. Prophylactic measures have to be taken to counter the effect of fluorides on calcium and magnesium for the proper development of the growing fetus.
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Association between the interleukin-5 receptor alpha-subunit G-80A polymorphism and immunological parameters in asthmatic children p. 132
Raghdah Maytham Hameed, Haidar Abdul Amir Najim Abood, Mohanad Mohsin Ahmed
DOI:10.4103/bbrj.bbrj_13_20  
Introduction: The expression of human interleukin-5 (IL-5) receptor alpha (Rα)-subunit presented on eosinophils, mast cells, and basophils. Hence, a polymorphism in IL-5 Rα may be implicated in the development of asthma and effect on immunological parameters (IL-5 level, absolute eosinophil count, and total serum immunoglobulin E [IgE]) production. Methods: A total of 85 children, including 59 males and 26 females with asthma with ages between 1 and 16 years, attended the Respiratory Clinic at Karbala Pediatric Hospital, with a nonasthmatic children group who had the same age and gender. Restriction fragment length polymerase chain reaction was performed to determine IL-5 Rα G-80A genetic polymorphisms. The total IgE level was measured using the EUROIMMUN IgE ELISA kit and serum IL-5 levels using Elabscience ELISA kit. The absolute eosinophil count was measured by five differential automated hematology analyzers and confirmed by the examination of peripheral blood smear. Results: There were no statistically significant differences in GG, AG, and AA genotypes frequency of IL-5 Rα G-80A between asthmatic patients and controls (P = 0.437, 0.160, and 0.106, respectively). The results showed no statistically significant correlation between immunological parameters (IL-5 level, absolute eosinophil count, and total serum IgE) and IL-5 Rα G-80A genotypes (P = 0.649, 0.06, and 0.552 respectively). Conclusions: Asthma in children is not associated with IL-5 Rα G-80A polymorphism. IL-5 Rα G-80A polymorphism has not any impact on IL-5 levels, eosinophil count, and total serum IgE.
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Evaluation of weight and appetite of adult wistar rats supplemented with ethanolic leaf extract of Moringa oleifera p. 137
Ferdinand Uwaifo
DOI:10.4103/bbrj.bbrj_17_20  
Background: Moringa oleifera, also known as “tree of life,” has been used in the treatment of numerous diseases. Moringa has been the subject of intensive scientific research; however, there has been scanty information on its sub-acute effect on weight and appetite. This work was done to evaluate the weight and appetite of adult Wistar rats supplemented with ethanolic leaf extract of M. oleifera. Methods: Twenty-eight adult healthy rats were used for this study. The rats were divided into four groups of seven per group and fed with pellets and water ad libitum. Group A served as the controls, Group B was fed with 500 mg/kg of ethanolic extract of Moringa leaf, Group C with 1000 mg/kg, whereas Group D was fed with 1500 mg/kg body weight. Doses were administered once daily using the oral gavage for 28 days. Feed and water intake were monitored, calculated, and values recorded. The body weights of the animals were also monitored weekly, and the values were recorded. The animals were anesthetized with chloroform before the time of sacrifice. Necropsy was performed, and the tissues (liver, lungs, heart, and kidneys) weighed and values were recorded. Results: There were statistically significant increases in feed (126.26 ± 6.02 and 122.61 ± 4.26) and water (152.38 ± 4.29 and 149.96 ± 5.29) intake in the 1000 mg/kg and 1500 mg/kg treated rats, respectively. Statistical differences in the body weights (253.92 ± 4.52 and 251.76 ± 5.55) of the 1000 mg/kg and 1500 mg/kg treated rats, respectively, were noted. Conclusion: The result showed that M. oleifera may cause an increase in appetite and weight at concentrations higher than 1000 mg/kg.
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Incidence of tuberculosis among malnourished patients: A summary on epidemiological data from a rural province in indochina p. 141
Rujittika Mungmunpuntipantip, Viroj Wiwanitkit
DOI:10.4103/bbrj.bbrj_130_19  
Background: In developing countries, malnutrition is a common public health problem. In the same setting, infectious diseases including tuberculosis are also common. The interrelationship between malnutrition and tuberculosis is mentioned in literature. Malnourished patients are proposed to be a risk group prone to tuberculosis infection. Methods: In this report, the authors retrospectively analyzed the available epidemiological data regarding tuberculosis among malnourished patients in a rural province of Thailand, a tropical country in Indochina. Results: According to this study, the incidence of tuberculosis among malnourished patients is equal to 0.65% (95% confidence interval = 0.09%–4.8%). Conclusion: The incidence of tuberculosis among patients with malnutrition status is high in our setting. Screening for tuberculosis among malnourished patients is useful.
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Effectiveness of the shorter MDR regimen in the management of tuberculosis: Shortfall in the outcome of disease a multidimensional approach and evaluation for a better alternative p. 143
Prasanta Kumar Das, Somtirtha B Ganguly
DOI:10.4103/bbrj.bbrj_131_19  
Background: Shorter multidrug-resistant (MDR) regimen has proved to be very effective in some of the developing nations such as Bangladesh and several African countries. Various shortcomings in the execution of long-term MDR regimen have prompted for adapting the shorter regimen in India. The study explored the experience of the programmatic management of tuberculosis by a shorter regimen in West Bengal, India. Materials and Methods: Retrospective analysis of the data included the outcome analysis of the cured, lost to followup, treatment completed, treatment failure, treatment regimen changed and died. These attributes were analyzed. Results: Of the total 203 cases, cure rate accounted for 44.3%. Lost to follow-up was found to be 13.7%, in which alternative dispute resolution accounted for the major cause. A substantial amount of INH resistance is seen among the follow-up culture positive cases speculating the role of ethionamide in the regimen.
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Emerging carbapenemase Klebsiella oxytoca with multidrug resistance implicated in urinary tract infection p. 148
Falah Hasan Obayes AL-Khikani, Raheem Malalah Abadi, Aalae Salman Ayit
DOI:10.4103/bbrj.bbrj_165_19  
Background: At present, Klebsiella oxytoca is emerging as a crucial persisted bacterial pathogen in urinary tract infection (UTI), which causes true public health problems worldwide. This study aimed to detect the incidence of K. oxytoca in patients severe from UTI with antibiotic sensitivity tests that assist urologist doctors for appropriate empirical antimicrobial therapy for this bacterium. Methods: K. oxytoca isolated clinically from urine samples during the period from January 2018 to December 2019 at the Al-Shomally General Hospital, Babil, Iraq, and a private laboratory in Babil city. A total of 430 patients were involved in this study; urine samples were processed at the hospital laboratory during this period; and a diagnosis has been done by the routine bacteriological diagnosis as well as VITEK® 2 system. Results: Of these 430 urine samples, 122 had bacterial growth; two types of Klebsiella species have been isolated in 18 patients (14.75%) of total specimens; K. pneumonia detected in 16 patients (89%); and K. oxytoca in 2 patients (11%) of the total Klebsiella species. Escherichia coli was the most prevalent bacteria (56; 45.90%). K. oxytoca UTI isolates were sensitive to amikacin, trimethoprim, and ciprofloxacin. However, these isolates showed resistance to amoxicillin, cefotazidime, clindamycin, nitrofurantoin, and cefotaxime. Conclusion: The current study showed an increasing burden of UTI caused by K. oxytoca. Multidrug resistance is associated with K. oxytoca implicated in UTI that causes changeable sensitivity to various antimicrobial agents.
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Possible evidence of gluconeogenesis in Plasmodium- Infected children in relationship with the parasite density p. 152
Mathew Folaranmi Olaniyan, Tolulope Busayo Ojediran, Shedarck Gbenga Olayinka
DOI:10.4103/bbrj.bbrj_14_20  
Background: Gluconeogenesis is stimulated by low blood glucose to maintain the glucose level; it involves lipolysis (breaking down of triglycerides), release of cortisol, and production of glycerol which can be converted into glucose. Hypoglycemia is associated with Plasmodium infection in children. Glucose homeostasis also involves glycogenolysis. This work was designed to determine the possible evidence of gluconeogenesis in Plasmodium-infected children in relationship with the parasite density to provide the information for useful direction in the management of Plasmodium infection in children. Methods: Thirty-five (2–5 years; female – 14, male – 11) Plasmodium-infected children were recruited as test patients, while fifty (n = 50; female – 25, male – 23) age-matched children (Plasmodium-noninfected children) were recruited from the same environment as controls. Plasma cortisol and cortisol-binding globulin were measured by the ELISA; total bile acid, glycerol by spectrophotometry, glucose, and total triglycerides were measured using Cobas C111, while Plasmodium identification and density were carried out by Leishman's thin blood film technique. Results: The results obtained showed a significant increase in plasma cortisol, cortisol-binding globulin, total bile acid, and glycerol with increase in parasite density and in children with the parasite densities of 512 ± 4.0 and 1014 ± 6.0 than the control children (P < 0.05). There was also a significant decrease in plasma glucose and total triglycerides with decrease in parasite density and in children with the parasite densities of 512 ± 4.0 and 1014 ± 6.0 than the control children (P < 0.05). Conclusion: There was evidence of gluconeogenesis in Plasmodium-infected children in relationship with the parasite density, as the results showed increase in cortisol, cortisol-binding globulin, total bile acid, and glycerol and a decrease in plasma glucose and total triglycerides.
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Inflammatory responses in insulin-induced hypoglycemia among diabetic patients p. 157
Mathew Folaranmi Olaniyan, Tolulope Busayo Ojediran, Shedrack Gbenga Olayinka
DOI:10.4103/bbrj.bbrj_15_20  
Study Background: Inflammatory cytokines such as tumor necrosis factor-α (TNF-α) can induce insulin resistance. Insulin is a hormone that regulates blood glucose and can cause hypoglycemia if used inappropriately. Insulin-induced hypoglycemia is a common cause of death among diabetes patients. Aims and Objectives: This work was designed to determine the inflammatory responses in insulin-induced hypoglycemia among diabetes patients to provide information for a useful guide in the management of diabetes mellitus. Methods: The study population include insulin-induced hypoglycemia diabetes patient (n = 30; female –14; male – 16; 48–73 years), newly diagnosed diabetic patient (n = 30; female – 17; male – 13; 48–73 years), and nondiabetic individuals (n = 50; female – 25; male – 25; 48–73 years) who were negative to Giemsa thick blood film technique for plasmodium, antihepatitis C virus (HCV), hepatitis B surface antigen (HBsAg), acid-fast bacilli, and Ag-Ab HIV tests. Plasmodium identification was determined by Giemsa thick film technique, blood glucose by glucose oxidase method, acid-fast bacilli by Ziehl–Neelsen staining, whereas anti-HCV, HBsAg, TNF-α, interleukin-10 (IL-10), and Ag-Ab HIV were determined in the individual by enzyme-linked immunosorbent assay. Results: The results obtained showed a significantly higher TNF-α and lower IL-10 in insulin-induced hypoglycemia diabetic patient than the results obtained in the newly diagnosed diabetic patient and nondiabetic individuals (P < 0.05). The results obtained showed a significantly higher TNF-α and lower IL-10 in newly diagnosed diabetic patient than in nondiabetic individuals (P < 0.05). The results obtained showed a significantly higher fasting blood glucose in newly diagnosed diabetic patient than in nondiabetic individuals (P < 0.05). The results obtained showed a significantly lower fasting blood glucose in insulin-induced hypoglycemia diabetic patient than the results obtained in the newly diagnosed diabetic patient and nondiabetic individuals (P < 0.05). Conclusion: There was an evidence of inflammatory responses in insulin-induced hypoglycemia diabetes patients as indicated by significant alterations and differences in plasma TNF-α and IL-10 in the individuals studied.
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Vitamin D status among overweight and obese adolescents p. 162
Kumar Saurabh, Jyoti Bala, Hemang
DOI:10.4103/bbrj.bbrj_11_20  
Introduction: Deficiency of vitamin D is pandemic and has been associated with a wide variety of disease states such as cardiovascular disease risk factors and impaired glucose homeostasis and are more common in overweight and obese children. Both endocrine and metabolic disorders occur with obesity and it has been suggested that obesity is a risk factor for vitamin D deficiency. The inverse association between higher body fat and lower vitamin D levels has been attributed to sequestration of the fat soluble vitamins within the plentiful adipose tissue. Aim and Objective: This study aims to determine the status of vitamin D levels in overweight and obese adolescent children and to compare them with age and sex matched healthy controls. Materials and Methods: This observational study was conducted in the Department of Biochemistry in collaboration with Department of Pediatrics, Pt. B.D. Sharma, PGIMS, Rohtak. Twenty-five overweight and obese adolescents based on BMI were recruited in study group (Group II) and twenty-five age and sex matched healthy controls were included in group I (Control group). Study samples were drawn and serum vitamin D levels were analyzed by radioimmunoassay. Results: Out of 25 cases 12(48%) were overweight and 13(52%) were obese adolescents. Mean BMI in group I was 17.36±3.67 kg/m2 and in group II was 31.90±1.01 kg/m2. 14 (56%) had vitamin D levels <20 ng/mL that is in the deficiency range. 7 (28%) had in the insufficiency range (21-30 ng/mL), 4 (16%) had in the sufficient range. Mean serum vitamin D levels in group I (Controls) were 28.41±8.83 and group II (Cases) were 21.6 ±5.65. The serum vitamin D levels were significantly decreased in group II as compared to group I (p = 0.002). Conclusion: The findings of present study concluded that, vitamin D deficiency is common problem obese and overweight adolescents, this may help to explain the relationship between obesity and several chronic diseases that are associated with poor Vitamin D status. However, there is a need for more randomized controlled trials, involving larger sample sizes, focusing on obese adolescents with documented vitamin D deficiency and careful selection of the dose, dosing regimen, and achievement of vitamin D concentrations.
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Oxidative stress injury and glucolipotoxicity in type 2 diabetes mellitus: The potential role of metformin and sitagliptin p. 166
May Hassan Abdul-Hadi, Marwa Thaier Naji, Hala Akeel Shams, Oula Mohamed Sami, Naseer Abdul-Amer Al-Harchan, Hayder Mutter Al-Kuraishy, Ali Ismail Al-Gareeb
DOI:10.4103/bbrj.bbrj_7_20  
Objective: The objective of this study was to explore the potential effects of metformin and/or sitagliptin on the oxidative stress (OS) and antioxidant capacity in patients with type 2 diabetes mellitus (T2DM). Materials and Methods: In this cross-sectional study, 64 patients with T2DM compared with 32 healthy controls, they divided into three groups: Group A: 32 healthy controls, Group B: 33 patients with T2DM on metformin therapy, and Group C: 31 patients with T2DM on metformin plus sitagliptin therapy. Fasting blood glucose, glycated hemoglobin, fasting serum insulin, insulin resistance, lipid profile, cardiac indices, and anthropometric measurements were determined. As well, OS parameters which include total oxidant status (TOS), total antioxidant status (TAS), and OS index (OSI) were measured in patients with T2DM and healthy controls. Data analysis was done using SPSS; for significance testing, unpaired Student's t-test and analysis of variance were used. Pearson correlation was also used to detect the level of correlations. Results: Patients with T2DM have a high risk of diverse cardiometabolic changes compared with the controls (P = 0.0001). TOS was high in diabetic patients (36.89 ± 4.71 μmole/L) compared with the controls (12.74 ± 3.81 μmole/L) (P = 0.0001), TAS was low in diabetic patients (1145.89 ± 293.51 μmole/L) compared with the controls (1237.61 ± 383.74 μmole/L) (P = 0.0001), and OSI was high in diabetic patients (3.21 ± 1.99) compared with the controls (1.02 ± 0.92) (P = 0.0001). Patients with T2DM on metformin plus sitagliptin illustrated low OSI compared with T2DM on metformin monotherapy (P = 0.04). Conclusion: Metformin and/or sitagliptin attenuate T2DM-induced OS through potentiation of TAC and reduction of TOC and OSI. Therefore, a combination of metformin and sitagliptin is recommended to reduce glucolipotoxicity and related OS injury.
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Nebulized budesonide in the patients with acute asthma exacerbation: A randomized clinical trial p. 173
Arda Kiani, Fatemeh Razavi, Mehrdad Farahani, Javad Valizadeh, Negar Bandegani, Habib Emami, Atefeh Abedini
DOI:10.4103/bbrj.bbrj_9_20  
Background: The management of asthma currently focuses on the Global Initiative for Asthma (GINA) guideline. This randomized clinical trial aimed to find whether the addition of nebulized budesonide to basic treatment would further improve the peak expiratory flow (PEF) rates and decrease the hospitalization days in patients through asthma exacerbation. Methods: Eligible patients with a definitive diagnosis of asthma exacerbation in the emergency department of Masih Daneshvari hospital were entered into this study. Patients were divided into the intervention and the control groups based on random numbers. To follow the GINA guidelines, both the groups received hydrocortisone (3 mg/kg slow IV stat) at the arrival, oxygen and nebulizer containing salbutamol and ipratropium bromide three times every 30 min and then every 8 h during the first 24 h. Nebulized budesonide (0.5 mg/2 ml) was added to the regimen of the intervention group and nebulized saline as the placebo in the control group. PEF of all eligible cases was measured on arrival and then at 1, 6, and 24 h after the ending of the first session of inhalation. Results: Hospitalization days decreased significantly in the intervention group (P ≤ 0.001). There was no median ± standard deviation of PEF in the intervention group after 1 h (P = 0.019) and stayed higher than the control group on 6 and 24 h, respectively (P = 0.015 and P = 0.050). Conclusion: Adding nebulized budesonide to the main treatment regimen of an acute asthma attack helps the patients gaining better respiratory flow and reduces the hospitalization time.
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LETTER TO EDITOR Top

Synthetic curcumin is safe in long-term safety evaluation p. 177
Roopesh Jain
DOI:10.4103/bbrj.bbrj_129_19  
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