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BACKGROUND: Adolescence is the phase of rapid transition of the body. The requirement of all minerals and vitamins changes in this phase of life so does Vitamin D. Despite Vitamin D being abundantly available, its deficiency, which can cause innumerable side effects on the body, is extremely common among the general population.  Material and methods: The present study was a cross-sectional study carried out from January 2021 to July 2022 for two years at various government rural high schools in Kolar, Karnataka, India. All adolescents who were aged 11-18 years and studying in 9th and 10th standards were included in the study after consent and assent. Adolescent boys and girls with any pre-existing mental health illness were excluded from the study. To assess depression, Beck's Depression Inventory (BDI-II) was used. Vitamin D3 levels were assessed by using VITROS Immunodiagnostic products using a 25-OH Total reagent pack. All data were entered in a Microsoft Excel sheet (Redmond, USA) and analyzed using IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp. To check for the association between factors, Chi-square was applied with a level of significance defined as a p-value less than 0.05. RESULTS: Out of 451 students, 272 (60.3%) belonged to the 15-year age group, 224 (49.7%) were boys, 235 (52.1%) were studying in 10th standard, 323 (71.6 %) belonged to nuclear families, 379 (84%) were non-vegetarian by diet, 222 (49.2%) had sun exposure in the afternoon, and 156 (34.6%) had a sun exposure of fewer than 60 minutes, 133 (29.5%) had severe depression according to Beck's Depression Inventory-II. One hundred sixty-two (35.9%) had insufficient Vitamin D3 levels (12-20 ng/ml), and 66 (14.6%) had deficient levels of Vitamin D3 (less than 12 ng/dl). There was a statistically significant association between depression and Vitamin D3 levels. CONCLUSION: There are innumerable causes of adolescent depression. The present study shows Vitamin D levels were statistically associated with depression among adolescents. Vitamin D supplementation of at least 600 international units, which is the recommended dietary allowance (RDA), could be beneficial in tackling Vitamin D to sufficiency status (20-100 ng/ml) and also indirectly address Adolescent Depression. Better study designs, like randomized control trials showing Vitamin D intervention and its possible curative role in adolescent depression, are required to establish the causal association.

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BACKGROUND: Throughout the world, intrauterine contraceptive devices (IUDs) are a frequently used, reversible, popular contraceptive method. They are usually placed without major complications. Uterine perforation is a rarely observed complication. Migration of the IUD to the pelvic/abdominal cavity or adjacent structures can occur after perforation. We present 3 cases of uterine perforation, possibly due to scarred myometrium associated with a cesarean delivery. We describe 3 perforations with IUDs lodged in the bladder serosa, the posterior cul-de-sac, and tissue adjacent to the cardinal ligament and external iliac artery. CASES: Case 1. 26-year-old, Gravid 4, Para 2113, nonpregnant female with a history of a cesarean delivery underwent placement of an IUD one year after an elective pregnancy termination, presenting with abdominal pain requesting removal of the IUD. On speculum, although the IUD strings were visualized, the IUD could not be removed. Sonogram imaging identified an empty endometrial cavity with the IUD in posterior cul-de-sac. The IUD was removed via laparoscopy. CASE 2: 34-year-old Gravida 5, Para 4004, at 27 weeks and 3 days gestation, female with history of two previous cesarean deliveries underwent a third cesarean after spontaneous rupture of membranes with comorbid chorioamnionitis. Reproductive history was significant for placement of an IUD that had not been removed or imaged during obstetrical sonograms. The clinical evaluation revealed that the IUD had been spontaneously expelled. On the fifth operative day, the patient is febrile with CT demonstrating the IUD penetrating the anterior surface of bladder. On cystoscopy the bladder mucosa was intact. The IUD was removed via laparotomy with repair of the bladder, serosa, and muscular layer. CASE 3: 26-year-old, Gravid 4, P3013, nonpregnant female with three previous Cesarean deliveries had an IUD in place. However, with the IUD in situ, the patient conceived and had a spontaneous abortion. After the spontaneous abortion, she presented to clinic to have the IUD removed due to pain that was present since placement. Although the IUD strings were visualized, attempts to remove it were unsuccessful. Imaging identified the IUD outside the uterine cavity. Palpation with a blunt probe laparoscopically revealed a hard object within the adhesion band, close to the cardinal ligament. As per radiology evaluation, IUD was embedded 1cm from the external iliac artery on the right side outside the uterus in the adnexal region. A multidisciplinary procedure with gynecologic-oncologist was scheduled for removal due to the high risk of perioperative bleeding. CONCLUSION: Patients in whom uterine perforation and IUD migration are suspected should have appropriate evaluation that includes transvaginal or transabdominal ultrasound or radiographs to confirm the position of the IUD, regardless of whether they are asymptomatic or present with symptoms. It is particularly important in the presence of a scarred uterus that imaging is used to identify the location of a missing IUD. The uterine scar of a cesarean may facilitate migration of the IUD. Cross sectional imaging, such as CT or MRI scan, may be needed to rule out adjacent organ involvement before surgical removal.

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The purpose of this study was to explore the relationship of obesity and physical limitations with food insecurity among Georgians participating in the Older Americans Act (OAA) congregate meal-site program (N = 621, median age = 76 years, 83% female, 36% Black, and 64% White, convenience sample). Food insecurity was assessed using the modified 6-item US Household Food Security Survey Module; obesity was defined as Body Mass Index (BMI) or waist circumference (WC) class I or II obesity; and physical limitations (arthritis, joint pain, poor physical function, weight-related disability) were based on the Disablement Process. A series of multivariate logistic regression models found weight-related disability and obesity (WC class II) may be potential risk factors for food insecurity. Thus, obesity and weight-related disability may be risk factors to consider when assessing the risk of food insecurity and the need for food assistance in this vulnerable subgroup of older adults.

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OBJECTIVE: To examine the prevalence and predictors of health care professional recommendations to lose weight in Older Americans Act Nutrition Program participants in Georgia senior centers who met professional and/or governmental organization criteria for weight loss recommendation. METHODS: Demographic, health, and weight loss recommendation information obtained from community-dwelling convenience sample (n=793; 2007-2008) of older adults via interviewer administered questionnaires. RESULTS: Approximately 70% of participants met weight loss criteria, but only 36% of them received advice to lose weight in the past year. Report of weight loss recommendation was 52.0% for those 'obese with risks' and 19.8% for those 'overweight with risks'. Recommendation to lose weight was significantly (p<0.05) associated with body mass index, waist circumference risk, younger age, self-reported disability, and urban residence. When controlled for other health and demographic factors, recommendation to lose weight was significantly associated with heart disease, but not other chronic conditions including diabetes, hypertension, or joint pain. CONCLUSION: Many older adults who may benefit from weight loss are not receiving advice to do so. Health care professionals need to be aware of this problem to assist community-dwelling older adults in better managing their health to help maintain independence and improve their quality of life.

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Hydrogen sulfide (H(2)S) is emerging as a physiological neuromodulator as well as a smooth muscle relaxant. We submit the first evidence that blood H(2)S levels are significantly lower in fasting blood obtained from type 2 diabetes patients compared with age-matched healthy subjects, and in streptozotocin-treated diabetic rats compared with control Sprague-Dawley rats. We further observed that supplementation with H(2)S or an endogenous precursor of H(2)S (l-cysteine) in culture medium prevents IL-8 and MCP-1 secretion in high-glucose-treated human U937 monocytes. These first observations led to the hypothesis that lower blood H(2)S levels may contribute to the vascular inflammation seen in diabetes.

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INTRODUCTION: In Georgia, mortality from stroke is 16% higher and from cardiovascular disease is 9% higher than it is nationally. Although 75% of Georgia adults have 2 or more modifiable risk factors for cardiovascular disease, less than half recognize all major heart attack and stroke warning symptoms. To reduce disability and prevent death from cardiovascular events, high-risk population groups should be able to recognize symptoms and seek immediate medical attention. METHODS: We evaluated a 4-month education intervention in 40 senior centers in Georgia. The intervention focused on improving knowledge of heart attack and stroke symptoms and on promoting lifestyle behaviors that prevent and manage cardiovascular disease and diabetes. Participants in a convenience sample completed a pretest questionnaire, the intervention, and a posttest questionnaire (N = 693, mean age, 75 years, 84% female, 45% black). RESULTS: After the intervention, recognition of all 5 symptoms of heart attack increased from 29% at the pretest to 46% at the posttest, and recognition of all 5 symptoms of stroke increased from 42% at the pretest to 65% at the posttest (for both conditions, P < .001). In linear regression analyses, independent positive predictors of change in knowledge were younger age and higher education. Most risk factors for cardiovascular disease were not predictive. CONCLUSION: The results of this evaluation provide an evidence base for the effectiveness of this intervention in improving knowledge about heart attack and stroke symptoms, which may translate to greater preparedness in these older adults for response to cardiovascular events.

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We evaluated a community-based physical activity intervention in Georgia senior centers. Participants were a convenience sample that completed the pre-test only (n = 592), or the pre-test, the intervention, and a post-test (n = 418, 98% aged 60 and older, mean age = 75, 83% female, 56% black). The 4-month physical activity intervention, based on the Health Belief Model, included 16 sessions that focused on educator-led chair exercises, promotion of walking, using a pedometer, and recording daily steps. Pre- and post-tests assessed physical activity and physical function, categorized as poor, moderate, or good (Short Physical Performance Battery). Following the intervention, participants improved their physical function (good physical function at pre-test vs. post-test: 16.5% vs. 25.3%, P < or = 0.001), increased minutes of physical activity by 26% (P < or = 0.001) and step counts by 29% (P < or = 0.0001, sub-sample, n = 95), and decreased reports of "it's not safe" as a barrier to physical activity (P < or = 0.05). Increased physical activity (P < or = 0.01) was associated with improved physical function following the intervention. The results of this evaluation provide an evidence base for the effectiveness of this community intervention for improving physical activity and physical function in older adults.

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A community-based intervention to improve diabetes self-management (DSM) and decrease A1c in older adults with diabetes from Georgia senior centers was evaluated. Participants were a convenience sample that completed the pre-test questionnaire only (N = 351) and a subset that completed the pre-test, intervention, and post-test questionnaires and A1c measurements (n = 144, mean age = 74 years, 84% female, 42% white, 57% black). Incorporating principles of the Health Belief Model and National Standards for DSM, the 4-month intervention consisted of eight sessions focused on improving daily adherence to DSM behaviors and included physical activity. At the post-test, several DSM behaviors increased by > or = 1 day/week: following a healthy eating plan, following an eating plan prescribed by their doctor, eating five or more servings of fruits and vegetables daily, spacing carbohydrates, and inspecting the insides of shoes (P < or = 0.0001). The mean decrease in A1c for the entire sample was 0.25% (SD = 0.82, P < or = 0.001, n = 144) and those with an initial A1c > 8% had a clinically significant mean decrease of 1.15% (SD = 1.09, pre-test: 9.48% vs. 8.33%, P < or = 0.001, n = 24). Increased physical activity was the DSM behavior consistently associated with decreased A1c in regression analyses (P < or = 0.05). The results of this evaluation provide an evidence base for the effectiveness of this community intervention in decreasing A1c and improving DSM behaviors in older adults.

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The plasma levels of apoptotic DNA ladders (i.e., apoptosemia) and gamma-glutamyltranspeptidase (GGT) in diabetic outpatients and rats were investigated. Apoptotic DNA ladders were detected in plasma from 26.8% of type 1 (T1) and 18.5% of type 2 (T2) diabetic children 1-20 years of age, 25.7% of hospitalized children and 35.7% of adult RA outpatients, but in only 3.5% of adult pre-op patients. Plasma from 7.7% of young streptozotocin-induced diabetic but not control rats contained apoptotic DNA ladders. Apoptosemia was detected more often in male T1 (31%) and T2 (30.8%) diabetic outpatients than in female T1 (20.8%) and T2 (15.4%) diabetic outpatients. GGT in apoptosemic plasma was significantly higher than in nonapoptosemic plasma from T1 (P = 0.001) but not T2 diabetic children. The highest amounts of apoptotic DNA were detected most often in diabetic children > or =14 years of age. In vitro study results suggest that cell-free apoptotic DNA ladders appear prior to an increase in GGT activity in serum from human blood incubated at 37 degrees C. The results suggest that 24.7% of plasma samples from diabetic children contained apoptotic DNA ladders, the incidence and amounts of apoptotic DNA ladders were higher in the older diabetic children, and GGT was elevated in apoptosemic T1 diabetic children (P = 0.01). The results indicate that "silent" apoptosemia occurs in T1 and T2 diabetic children and suggest elevated GGT in diabetic children could be due to release from apoptotic cells.

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This study evaluated the frequency of coarrest in female victims who utilized 911 for intimate partner violence (IPV) and any patterns or circumstances that increased the likelihood of coarrest. All cases of police-documented IPV where a female IPV victim was arrested in conjunction with the perpetrator were included. Each incident report was reviewed to determine demographic characteristics of the victim, weapon and substance involvement, presence of children, and violence severity. Of IPV victims, 9% (131 of 1,489) were arrested. Having a weapon, alcohol use, not being married, and older age were associated with increased likelihood of arrest (p < .001). The presence of a child decreased the likelihood of victim arrest (p < .001). Race, prior incidents of IPV, offender restraining order, and incident severity were not significantly associated with coarrest. Although coarrest occurred in a minority of cases, it may deter victims from contacting police for future incidents of police.

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Numerous dietary and pharmacological agents have been proposed as alternative strategies for treatment and prevention of colorectal cancer. Curcumin, an active ingredient of turmeric, that inhibits growth of malignant neoplasms, has a promising role in the prevention and treatment of colorectal cancer. EGF-R related protein (ERRP), a recently identified pan-erbB inhibitor, is a potential therapeutic agent for colorectal cancer. Here we examine whether curcumin together with ERRP will cause a greater inhibition of growth of colon cancer cells than either agent alone and the mechanisms of this inhibition. Human colon cancer HCT-116 or HT-29 cells were incubated with increasing doses of curcumin (up to 10 microM) or ERRP (up to 5 microg/ml), or a combination of both for 48 h. We observed that the cell growth inhibition and stimulation of apoptosis in response to the combinatorial treatment was significantly greater than that caused by either agent alone. These changes were associated with decreased activation (tyrosine phosphorylation) of EGFR, ErbB-2, ErbB-3, and/or IGF-1R. Whereas curcumin inhibited constitutive activation of both EGFR and IGF-1R, ERRP decreased activation of EGFR, ErbB-2, and ErbB-3 but had no effect on IGF-1R. Further, the combination therapy caused a greater attenuation of downstream effectors such as NF-kappaB, Akt and BAD activation, and down-regulation of procaspase-3 than that noted with either agent alone. The superior effects of the combinatorial treatment could partly be attributed to inhibition of constitutive activation of EGFRs and IGF-1R signaling pathways.

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BACKGROUND: EGF Receptor Related Protein (ERRP), a recently identified negative regulator of EGF-receptor (EGFR), has been shown to inhibit growth of colon cancer xenograft tumors in SCID mice. However, the mechanisms by which ERRP exerts its anti-tumor properties are poorly understood The current investigation was undertaken to delineate the inhibitory mechanisms that are triggered by ERRP. MATERIALS AND METHODS: For in vivo experiments, recombinant ERRP (20 microg/mouse) or an equivalent volume of vehicle was injected (away from the tumor site) every other day for 10 days to SCID mice xenotransplanted with the colon cancer cell line HCT-116 Tumor explants were obtained for further immunohistochemical analysis. For in vitro studies, the HCT-116 cell line was incubated with recombinant ERRP and apoptosis markers and cell cycle changes were evaluated. RESULTS: Recombinant ERRP caused marked inhibition of tumor growth. This was accompanied by increased apoptosis and attenuation of ERK1/2 and Akt activities. Exposure of HCT-116 cells to recombinant ERRP for 24 hours caused apoptosis and cell cycle arrest at G0/1-phase. Induction of apoptosis was evidenced by increased levels of cleaved caspase-3, PARP proteins and acridine orange staining. CONCLUSION: Our findings reveal a pro-apoptotic property of ERRP both in vitro and in vivo. We propose that ERRP functions by inhibiting the activation of the EGF-receptor signaling and its downstream effectors such as ERK and Akt kinases, underscoring the potential of ERRP for the treatment of colorectal cancer where the EGF pathway is known to be activated.

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To understand physician practices regarding the diagnosis of acute diarrheal diseases, we conducted a survey, in 1996, of 2839 physicians in Connecticut, Georgia, Minnesota, Oregon, and California. Bacterial stool culture was requested for samples from the last patient seen for acute diarrhea by 784 (44%; 95% confidence interval, 42%-46%) of 1783 physicians. Physicians were more likely to request a culture for persons with acquired immune deficiency syndrome, bloody stools, travel to a developing country, diarrhea for >3 days, intravenous rehydration, or fever. Substantial geographic and specialty differences in culture-request practices were observed. Twenty-eight percent of physicians did not know whether stool culture included testing for Escherichia coli O157:H7; 40% did not know whether Yersinia or Vibrio species were included. These variabilities suggest a need for clinical diagnostic guidelines for diarrhea. Many physicians could benefit from education to improve their knowledge about tests included in routine stool examinations.

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Campylobacter is a common cause of gastroenteritis in the United States. We conducted a population-based case-control study to determine risk factors for sporadic Campylobacter infection. During a 12-month study, we enrolled 1316 patients with culture-confirmed Campylobacter infections from 7 states, collecting demographic, clinical, and exposure data using a standardized questionnaire. We interviewed 1 matched control subject for each case patient. Thirteen percent of patients had traveled abroad. In multivariate analysis of persons who had not traveled, the largest population attributable fraction (PAF) of 24% was related to consumption of chicken prepared at a restaurant. The PAF for consumption of nonpoultry meat that was prepared at a restaurant was also large (21%); smaller proportions of illness were associated with other food and nonfood exposures. Efforts to reduce contamination of poultry with Campylobacter should benefit public health. Restaurants should improve food-handling practices, ensure adequate cooking of meat and poultry, and consider purchasing poultry that has been treated to reduce Campylobacter contamination.

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One hundred and seventy five malnourished children aged between 1(1/2) and 12 years attending pediatric department of Regional Institute of Medical Sciences Hospital, Imphal from January 2001 to June 2002 were screened for human immunodeficiency virus (HIV) infection along with their biological mothers after pretest counselling and informed consent. The prevalence rate of HIV seropositivity among malnourished children was 21.7%. Children aged between 1(1/2) and 3 years had the highest seroprevalence (47.4%) and male to female ratio was 1.5: 1. Underweight children showed the highest seroprevalence (47.4%) and children with kwashiorkor showed least seroprevalence (10.5%). Mode of HIV transmission was vertical in 94.7%. The causative agent was HIV-I in all the cases. AIDS defining children features were seen more frequently among HIV seropositive malnourished children as compared to the seronegative children. Prolonged fever (p 0.001), oropharyngeal candidiasis (p<0.001), generalised lymphadenopathy (p<0.001) and disseminated maculopapular dermatitis (p<0.001) were significantly related to HIV infection. Among seronegative children 18.2% fulfilled the clinical criteria for AIDS and among seropositive children 94.7% had AIDS. The total mortality encountered among seropositive children was 34.2%. It is suggested to confirm findings based on larger community based data before recommending mandatory HIV testing in all malnourished children. Specific guidelines on the nutritional management of children with HIV/AIDS is needed in Manipur where HIV is spreading rapidly.

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