Insulin resistance is a determining factor in the pathophysiology of type 2 diabetes mellitus (T2DM). Exercise is known to improve insulin resistance, but a systematic review of the literature is ...lacking.
This systematic review and meta-analysis focused on identifying evidence for the effectiveness of a structured exercise intervention program for insulin resistance in T2DM.
We searched MEDLINE via PubMed, CINHAL, Scopus and Web of Science, and the Cochrane Central Register of Controlled Trials for reports of studies on fasting insulin, homeostatic model assessment for insulin resistance (Homa-IR), fasting blood sugar, glycated hemoglobin and body mass index in patients with T2DM and healthy controls that were published between 1990 and 2017. Data are reported as the standardized mean difference or mean difference with 95% confidence intervals (CIs).
Among 2242 records retrieved, only 11 full-text articles were available for meta-analysis. Data for 846 participants were analyzed, 440 in the intervention group, and 406 in the control group. The mean difference for fasting insulin level was−1.64 (95% CI; −3.38 to 0.10), Homa-Ir 0.14 (−1.48 to 1.76), fasting blood sugar−5.12 (−7.78 to−2.45), hemoglobin A1c 0.63 (−0.82 to 2.08) and body mass index−0.36 (−1.51 to 0.79).
The evidence highlights the effectiveness of a structured exercise intervention program for insulin resistance in T2DM with a moderate level 2 of evidence.
Summary Background An increase in worldwide HPV vaccination could be facilitated if fewer than three doses of vaccine are as effective as three doses. We originally aimed to compare the ...immunogenicity and frequency of persistent infection and cervical precancerous lesions caused by vaccine-targeted HPV after vaccination with two doses of quadrivalent vaccine on days 1 and 180 or later, with three doses on days 1, 60, and 180 or later, in a cluster-randomised trial. Suspension of the recruitment and vaccination due to events unrelated to our study meant that some enrolled girls could not be vaccinated and some vaccinated girls received fewer than the planned number of vaccinations by default. As a result, we re-analysed our data as an observational cohort study. Methods Our study was designed to be done in nine locations (188 clusters) in India. Participants were unmarried girls aged 10–18 years vaccinated in four cohorts: girls who received three doses of vaccine on days 1, 60, and 180 or later, two doses on days 1 and 180 or later, two doses on days 1 and 60 by default, and one dose by default. The primary outcomes were immunogenicity in terms of L1 genotype-specific binding antibody titres, neutralising antibody titres, and antibody avidity after vaccination for the vaccine-targeted HPV types 16, 18, 6, and 11 and incident and persistent infections with these HPVs. Analysis was per actual number of vaccine doses received. This study is registered with ISRCTN, number ISRCTN98283094; and with ClinicalTrials.gov , number NCT00923702. Findings Vaccination of eligible girls was initiated on Sept 1, 2009, and continued until April 8, 2010. Of 21 258 eligible girls identified at 188 clusters, 17 729 girls were recruited from 178 clusters before suspension. 4348 (25%) girls received three doses, 4979 (28%) received two doses on days 1 and 180 or later, 3452 (19%) received two doses at days 1 and 60, and 4950 (28%) received one dose. Immune response in the two-dose HPV vaccine group was non-inferior to the three-dose group (median fluorescence intensity ratio for HPV 16 1·12 95% CI 1·02–1·23 and for HPV 18 1·04 0·92–1·19) at 7 months, but was inferior in the two-dose default (0·33 0·29–0·38 for HPV 16 and 0·51 0·43–0·59 for HPV 18) and one-dose default (0·09 0·08–0·11 for HPV 16 and 0·12 0·10–0·14 for HPV 18) groups at 18 months. The geometric mean avidity indices after fewer than three doses by design or default were non-inferior to those after three doses of vaccine. Fewer than three doses by design and default induced detectable concentrations of neutralising antibodies to all four vaccine-targeted HPV types, but at much lower concentration after one dose. Cervical samples from 2649 participants were tested and the frequency of incident HPV 16, 18, 6, and 11 infections was similar irrespective of the number of vaccine doses received. The testing of at least two samples from 838 participants showed that there was no persistent HPV 16 or 18 infections in any study group at a median follow-up of 4·7 years (IQR 4·2–5·1). Interpretation Despite the limitations imposed by the suspension of the HPV vaccination, our findings lend support to the WHO recommendation of two doses, at least 6 months apart, for routine vaccination of young girls. The short-term protection afforded by one dose of HPV vaccine against persistent infection with HPV 16, 18, 6, and 11 is similar to that afforded by two or three doses of vaccine and merits further assessment. Funding Bill & Melinda Gates Foundation.
Coronavirus disease (COVID-19) pandemic and the nationwide lockdown has increased sedentary time and physical inactivity. Physiotherapists are one of the essential health professionals who are ...actively involved in promoting physical activities. The study objectives included assessing knowledge of physical activity guidelines, physiotherapist attitude towards involvement in physical activities and practice of routine physical activity assessment, and its promotion among physiotherapists in India during COVID-19.
In this cross-sectional survey study, the study tool was prepared using Google Forms. It consisted of sixteen questions on knowledge, attitude, and practice of physical activities among physiotherapists. Study participants were physiotherapists with a minimum of a bachelor's degree qualification and practicing in India.
One hundred and eighty responses were received from sixteen states of India. The average age of respondents was 28 years, and the average work experience of five years. This study found that only 19% of physiotherapists could give the correct answer in all three domains of WHO PA guidelines. 70% of physiotherapists found with an appropriate attitude as they met the 150 min of moderate PA per week. 68% reported that they promote physical activities in routine practice.
This study suggested the majority of physiotherapists perform physical activity assessment and promotion in routine practice in India. Most of them have an appropriate attitude towards physical activity, but very few physiotherapists have adequate knowledge of WHO physical activity guidelines. Physiotherapists should actively promote physical activities in routine practice to reduce the impairment due to physical inactivity especially during the Corona virus disease pandemic in India. Efforts should be made to increase the physical activity awareness in terms of knowledge of WHO physical activity guidelines, different assessment, and promotion strategies.
•This survey is the first in the Indian context. There is a strong need to improve the knowledge of PA among the physiotherapists practicing in India.•This survey results suggest a strong need to improve the knowledge of PA among the physiotherapists practicing in India.•This study recommends future research to provide valuable insights and help bridge the gaps between the knowledge and practice components of PA promotion.
Physical activity of any amount results in substantial health benefits. However, public awareness of physical activity benefits in chronic diseases is inadequate in India. Prediabetes is a ...significant health issue on a global scale. Visceral fat (VF) is considered as an early predictor of prediabetes. Ethnicity and race have a substantial impact on VF. Hence, this study intended to evaluate the effect of a customized physical activity promotion program on VF and glycemic parameters in individuals with prediabetes.
In the current, parallel group randomized controlled trial, a total of 158 participants were recruited: 79 in intervention and 79 in control group. The study included the prediabetes individuals based on American Diabetes Association criteria. Participants from the intervention group received the customized physical activity promotion program for 24 weeks. The primary outcome measures of the study were VF level and glycemic parameters that included fasting blood sugar and glycosylated hemoglobin. Two-way mixed analysis of variance was used to study the mean difference of an outcome between 2 groups over time.
The study found a statistically significant interaction between the intervention and times on VF level, F1,136 = 23.564, fasting blood sugar levels, F1,136 = 8.762, and glycosylated hemoglobin levels, F1,136 = 64.582 at the end of 24 weeks (P < .05).
This study concluded that a customized physical activity promotion program was effective in reducing VF in individuals with prediabetes as compared with controls. It improved glycemic control by reducing fasting blood sugar and glycosylated hemoglobin levels.
"مقدمات السكري" هي طليعة لمرض السكري من النوع 2، والفحص الروتيني لمقدمات السكري أمر بالغ الأهمية. ترتبط الدهون الحشوية بمقدمات السكري ومقاومة الأنسولين. استدعت الاختلافات العرقية التي أدت إلى مستويات ...مختلفة من الدهون الحشوية في السكان الهنود دراسة خاصة بالهند. هناك ندرة في الأدبيات حول القيم الفاصلة للدهون الحشوية للتنبؤ بمقدمات السكري في السكان الهنود. ومن ثم، كان الهدف الرئيس من الدراسة الحالية هو معرفة القيمة الفاصلة لدى الجنسين للدهون الحشوية للتنبؤ بمقدمات السكري في السكان الهنود.
تم اختيار 300 فرد تتراوح أعمارهم بين 18 إلى 55 سنة من كلا الجنسين لهذه الدراسة المقطعية. تم تقييم الدهون الحشوية كجزء من تحليل تكوين الجسم باستخدام محلل المعاوقة الكهربائية الحيوية. تم فحص متغيرات تكوين الجسم للتنبؤ بمقدمات السكري باستخدام الانحدار اللوجستي العكسي. تم تحديد مستويات القيم الفاصلة للدهون الحشوية للتنبؤ بمقدمات السكري باستخدام تحليل "منحنى خصائص فعل المستقبلات".
وجد أن الدهون الحشوية، والدهون الكلية، والعمر مرتبطة إحصائيا بمقدمات السكري. كما تم تحديد القيمة الفاصلة للدهون الحشوية للتنبؤ بمقدمات السكري عند الإناث على أنها 8 مع حساسية 77.8٪ وخصوصية 69.3٪. بينما في الذكور، تم تحديد 11 مع حساسية 84٪ وخصوصية 62.9٪.
ساهمت هذه الدراسة في تحديد القيم الفاصلة بين الجنسين لمستوى الدهون الحشوية، والتي يمكن استخدامها للتنبؤ بمقدمات السكري في السكان الهنود.
Prediabetes is a precursor to type 2 diabetes mellitus and routine screening of prediabetes is crucial. Visceral fat (VF) is associated with prediabetes and insulin resistance. Ethnic and racial differences resulting in different levels of VF in the Indian population necessitates an India-specific study. There is a dearth of literature on the cut-off values of VF measured using a bioelectrical impedance analyzer (BIA) to predict prediabetes in the Indian population. Hence, the main objective of this study was to determine the sex-specific cut-off value of VF on BIA to predict prediabetes in the Indian population.
Three hundred individuals aged 18–55 years of both sexes were selected for this cross-sectional study. VF was evaluated as a part of body composition analysis using BIA. The body composition variables for the prediction of prediabetes were examined using backward logistic regression. Optimal cut-off levels of VF to predict prediabetes were identified using receiver operator characteristic curve (ROC) analysis.
VF, total fat, and age were found to be associated with prediabetes (p ≤ 0.05). In females, the cut-off value of VF for predicting prediabetes was identified as 8 with 77.8% sensitivity and 69.3% specificity; in males, it was 11 with 84% sensitivity and 62.9% specificity.
This study contributes to the sex-specific cut-off values of VF level on BIA that can be used for predicting prediabetes in the Indian population.
In context of the ongoing multi-centric HPV vaccine study in India, unvaccinated married women (N = 1484) aged 18-23 years were recruited in 2012-2015 as age-matched controls to the vaccinated women ...and followed up yearly. We assess type-specific prevalence, natural history and potential determinants of human papillomavirus (HPV) infection in these unvaccinated women. Cervical samples were collected yearly for at least four consecutive years. A Multiplex Type-Specific E7-Based polymerase chain reaction assay was used to detect 21 HPV types. HPV prevalence was 36.4% during 6 years. Most common HPV types were 16 (6.5%) and 31 (6.1%). Highest persistence were observed for HPV 35 (62.5%) and 52 (25%). New HPV acquisition rate was 5.6/1000 person-months of observation (PMO), highest for HPV 16 (1.1/1000 PMO). Type-specific clearance rates ranged between 2.9-5.5/100 PMO. HPV 16 and/or 18 infections were 41% (95% CI 4-63%) lower among women with 2-<3 years between marriage and first cervical sample collection compared to those with <2 years. HPV prevalence and acquisition rates in young Indian women were lower than their Western counterparts. HPV 16 infections being most common shows the importance and potential impact of HPV vaccination in India. Women with 2-3 years exposure had reduced risk possibly due to higher infections clearance.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
•The review is extensive coverage of advances in creatinine sensing using optical and electrochemical biosensors.•Different approaches of electrochemical biosensing for creatinine detection have been ...covered along with their advantages and limitations.•Different approaches of optical biosensing for creatinine detection have been covered along with their advantages and limitations.•A detailed comparison of electrochemical and optical biosensing approaches, their advantages, and limitations has been made in the review.•Future perspective with a focus on smartphone technology and commercial prospects of creatinine detection has been covered.
Creatinine is the by-product of creatine phosphate within the muscle, supplying energy to the muscle tissues. It is imperative to clinically assess creatinine levels in both urine and blood as it serves as an indicator of renal, muscle, and thyroid functionality. The point-of-care medical diagnostic research and development is the most innovative form of exploratory research. The determination of creatinine can be achieved through several traditional methods such as colorimetric, spectrophotometric and chromatographic techniques. Although these method offers high sensitivity and selectivity, they are accompanied by drawback such as long analysis time, the need for sample pre-treatment, expensive instruments and skilled personnel. In contrast, sensors and biosensors present a favourable solution to these limitations as they offer rapid, user-friendly, cost effective and highly sensitive alternatives. This review article describe recent trends in creatinine detection by using electrochemical and optical biosensors, advantages and disadvantages of biosensors. This review highlights the wide detection range of creatinine and explore the commercialization aspects of biosensors with in home monitoring system.
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Long-term follow-up of a cohort of unmarried girls who received one, two, or three doses of quadrivalent HPV vaccine, between 10 and 18 years of age, in an Indian multi-centric study allowed us to ...compare antibody responses between the younger and older age cohorts at 10-years post-vaccination, and study the impact of initiation of sexual activity and cervical HPV infections on antibody levels. Among the younger (10-14 years) recipients of a single dose, 97.7% and 98.2% had detectable binding antibody titers against HPV 16 and HPV 18 respectively at ten years post-vaccination. The proportions among those receiving a single dose at age 15-18 years were 92.3% and 94.2% against HPV 16 and HPV 18 respectively. Mean HPV 16 binding antibody titers were 2.1 folds (95%CI 1.4 to 3.3) higher in those vaccinated at ages 10-14 years, and 1.9 folds (95%CI 1.2 to 3.0) higher in those vaccinated at 15-18 years compared to mean titers seen in the unvaccinated women. Compared to previous timepoints of 36 or 48 months, binding antibodies against HPV 16 and neutralizing antibodies against both HPV 16 and HPV 18 were significantly higher at 10 years. This rise was more pronounced in participants vaccinated at 15-18 years. No association of marital status or cervical HPV infections was observed with the rise in titer. Durability of antibody response in single dose recipients correlated well with the high efficacy of a single dose against persistent HPV 16/18 infections irrespective of age at vaccination, as we reported earlier.
A randomised trial designed to compare three and two doses of quadrivalent human papillomavirus (HPV) vaccine in adolescent girls in India was converted to a cohort study after suspension of HPV ...vaccination in trials by the Indian Government. In this Article, the revised aim of the cohort study was to compare vaccine efficacy of single dose to that of three and two doses in protecting against persistent HPV 16 and 18 infection at 10 years post vaccination.
In the randomised trial, unmarried girls aged 10–18 years were recruited from nine centres across India and randomly assigned to either two doses or three doses of the quadrivalent HPV vaccine (Gardasil Merck Sharp & Dohme, Whitehouse Station, NJ, USA; 0·5 mL administered intramuscularly). After suspension of recruitment and vaccination, the study became a longitudinal, prospective cohort study by default, and participants were allocated to four cohorts on the basis of the number vaccine doses received per protocol: the two-dose cohort (received vaccine on days 1 and 180 or later), three-dose cohort (days 1, 60, and 180 or later), two-dose default cohort (days 1 and 60 or later), and the single-dose default cohort. Participants were followed up yearly. Cervical specimens were collected from participants 18 months after marriage or 6 months after first childbirth, whichever was earlier, to assess incident and persistent HPV infections. Married participants were screened for cervical cancer as they reached 25 years of age. Unvaccinated women age-matched to the married vaccinated participants were recruited to serve as controls. Vaccine efficacy against persistent HPV 16 and 18 infections (the primary endpoint) was analysed for single-dose recipients and compared with that in two-dose and three-dose recipients after adjusting for imbalance in the distribution of potential confounders between the unvaccinated and vaccinated cohorts. This trial is registered with ISRCTN, ISRCTN98283094, and ClinicalTrials.gov, NCT00923702.
Vaccinated participants were recruited between Sept 1, 2009, and April 8, 2010 (date of vaccination suspension), and followed up over a median duration of 9·0 years (IQR 8·2–9·6). 4348 participants had three doses, 4980 had two doses (0 and 6 months), and 4949 had a single dose. Vaccine efficacy against persistent HPV 16 and 18 infection among participants evaluable for the endpoint was 95·4% (95% CI 85·0–99·9) in the single-dose default cohort (2135 women assessed), 93·1% (77·3–99·8) in the two-dose cohort (1452 women assessed), and 93·3% (77·5–99·7) in three-dose recipients (1460 women assessed).
A single dose of HPV vaccine provides similar protection against persistent infection from HPV 16 and 18, the genotypes responsible for nearly 70% of cervical cancers, to that provided by two or three doses.
Bill & Melinda Gates Foundation.
To estimate self-reported musculoskeletal disorders among Indian population in work from home COVID-19 lockdown and its association on various socio-demographic and occupational factors among them.
...The present cross-sectional study was conducted on working Indian professionals, through an online self-reported survey during the COVID-19 work from the home situation. Details about the perceived musculoskeletal discomforts, weight gain or loss, physical activity profile, number of working hours, total sedentary time, and satisfaction perceived with working from home were recorded from the participant responses and thereafter analyzed.
A total of 281 responses were analyzed. 47.6% of respondents reported musculoskeletal disorders before lockdown, whereas 53.6% reported them during the lockdown period. 10% of respondents reported declination in physical activity. Finding of the chi-square for association and Spearman's rho correlation analysis suggested that gender, pre-existing musculoskeletal discomforts, current sedentary time, and long working hours are significantly associated with musculoskeletal discomforts during work from home COVID-19 lockdown.
This study concluded the increment in the self-reported musculoskeletal disorders among working Indian professionals during work from home COVID-19 lockdown. The study also found the significant association between MSD and gender, working hours, sedentary time and pre-existing musculoskeletal discomforts.
•Reduction of MSD depends on the “disciplined working schedule” and “short regular active breaks”.•Maintenance of physical activity profile is important.•Improving health literacy on demerits of long sitting hours among general population is paramount important.
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