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   Table of Contents - Current issue
Coverpage
October-December 2022
Volume 12 | Issue 4
Page Nos. 221-328

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REVIEW ARTICLES  

Dietary Approaches and Nutritional Complexities of Autism Spectrum Disorder Highly accessed article p. 221
Abdul Momin Rizwan Ahmad, Anosh Intikhab, Juweria Abid, Sehar Iqbal
DOI:10.4103/ijnpnd.ijnpnd_65_22  
Background: Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by poor social interaction, repetitive behavior, learning difficulties, cognitive issues, and unusual eating patterns. Different factors including genetic and environmental variables have been identified to increase the risk of developing ASD. Objective: The main objective of the present review is to investigate the dietary approaches and modifications to reduce the intricacies related to ASD. Results: Studies included in this review suggested that abnormalities in the gut microbiota are involved in the pathogenesis and severity of the disease. Medical nutrition therapy for ASD consists of excluding harmful food components such as gluten, casein, processed foods, and excessive sugars and increasing the consumption of omega-3 fats, vitamins and minerals, probiotics, and antioxidants. Furthermore, awareness regarding food labels might help to avoid food allergens in diet. Conclusion: Active dietary treatments including the use of dietary supplements and elimination of processed foods appear to reduce the complexities of ASD. Furthermore, support of health care professionals and adopting public health approaches might help to prevent adverse outcomes related to ASD. Future research is required to determine the prevalence of ASD and related outcomes in low/middle income countries as this area is highly neglected.
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Whom to Blame for Brain Health and Appetite Slump in Toddlers? A Narrative Review p. 242
Vidya Seshan, Blessy Prabha Valsaraj, Divya Raghavan, Judie Arulappan, Gerald Amandu Matua, Sofia Cyril, Emi John Prince
DOI:10.4103/ijnpnd.ijnpnd_66_22  
Food preference in children depends on the interplay between genetic and environmental factors. Exposure to flavors during prenatal and postnatal period through amniotic fluid, breast milk, and weaning foods have been identified as possible influences on food preference and acceptance in children. Therefore, maternal nutrition has a strong influence on the child’s food preference early in life. Aim: The authors carried out a narrative review to understand the contribution of maternal nutrition on the food preferences in children in later life. Methods: The authors retrieved the articles from SCOPUS, Medline, Science Direct, CINAHL, EBSCO, and PubMed central databases. The key words including food preferences, food choice, and acceptance of food, pregnant women, toddlers, and food culture were used to identify the appropriate articles. The authors included in the review, full-text articles, published in English language between 1995 and 2018. In total, six articles, which met the inclusion criteria, were included in the final review. Results: The results revealed that there is a very strong connection between the exposure to flavors during prenatal and postnatal period and food preference and acceptance in children in later life. The olfactory and gustatory exposures to flavors during prenatal period through maternal diet, and during postnatal period through breast milk and weaning foods determines the food preferences in childhood. Conclusion: We conclude that maternal nutrition has a strong influence on the child’s food preference early in the life, therefore effective strategies should be designed to increase healthy feeding choices during the prenatal and postnatal periods.
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ORIGINAL ARTICLES Top

Evaluation of Neurocognitive Disorder in Patients with Type 2 Diabetes Mellitus p. 247
K Preetam, Nagesh Kumar Talkad Chandrashekar, Rashmi Krishnappa
DOI:10.4103/ijnpnd.ijnpnd_44_22  
Background: Diabetes mellitus (DM) is a syndrome characterized by hyperglycemia due to absolute or relative deficiency of insulin or both. In India, an estimated 40 million people suffered from diabetes in 2007 and are expected to rise to 70 million by 2025 as per the Indian Diabetes Study 2011. Individuals with type 2 diabetes are at 60% greater risk for development of dementia compared to those without diabetes. For vascular dementia, but not for nonvascular dementia, the additional risk is that it is greater in women. Aim and Objective: To assess cognitive impairment among type 2 DM patients. Methods: In this cross-sectional study, 67 patients with type 2 DM and 66 control attending Put patient department (OPD) services between October 2018 and September 2020 were included. Both these groups were scored on the Montreal Cognitive Assessment (MoCA). The scores ranged from zero to 30. The scores of ≥26 were considered normal. A score of ≤22.1 in these people was considered as mild cognitive. Categorical data were represented in the form of frequencies and proportions. Chi-square test or Fischer exact test were used as test of significance for qualitative data. Correlations were performed with Pearson correlation coefficient. The P-value < 0.05 was considered as statistically significant after assuming all the rules of statistical tests. Results: Age and duration of diabetes had positive correlation with MoCA score which was not statistically significant. The body mass index (BMI) and waist circumference had negative correlation with MoCA score which was not statistically significant. Hemoglobin A1C (HbA1c) had negative correlation with MoCA score which was statistically significant. Conclusion: Older individuals with longer duration of DM and higher HbA1c levels showed higher cognitive impairment with MoCA score correlation. This study also highlights the early screening for all DM patients with easily available MoCA scores. Thus, helping in early recognition of mild cognitive impairment and preventing it from proceeding to dementia.
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Impact of Nurse-Led Stroke Education Program (NSEP) on ADL and SS-QOL among Patients with Stroke and Burden among Caregivers p. 253
Bamini Devi
DOI:10.4103/ijnpnd.ijnpnd_47_22  
Aim: To determine the effectiveness of Nurse-Led Stroke Education Program (NSEP) on Activities of Daily Living (ADL) and Stroke-Specific Quality of Life (SS-QOL) among patients with stroke and elicit burden among caregivers. Method: A quantitative research method was adopted. Stroke victims and their caregivers who fulfill eligibility criteria were chosen. The sample size was 170 dyads, 85 dyads in the study and 85 dyads in the control groups were recruited by lottery method. NSEP was implemented in the study group dyads. The posttest assessments were taken on days 30, 90, and 180 for both groups. Results: The mean scores of ADL in the study and control group during posttest-I, II, and III were significant at P < 0.05. The mean scores of PCS during posttest-I, II, and III showed significance at P < 0.05. MCS mean score during posttest-I, II, and III was significant at P < 0.05. Overall mean scores of SS-QOL in the study group were found to be higher than that in the control group during posttest-I, II, and III at P < 0.01 between groups. The burden mean scores were higher in the control group caregiver than in the study group caregiver during the posttest-I and II at P < 0.01. Conclusion: Findings concluded that the combination of interventions like structured teaching, an information booklet on “Life after stroke,” and telephonic reminder and reinforcement has a positive impact on ADL and SS-QOL of patients with stroke and minimized caregiver burden.
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Effect of Lockdown in the COVID-19 Pandemic on Dietary Habits and Self-Medication Practice in People Living in Jordan p. 263
Malak M Angor, Areen O Nawasreh
DOI:10.4103/ijnpnd.ijnpnd_50_22  
Background: The pandemic of the coronavirus disease 2019 (COVID-19) has impacted Jordanian society, particularly on health. Aims: This study examined the effect of the COVID-19 pandemic lockdown on Jordanian society’s dietary habits and self-medication practices. Methods: We surveyed 1252 Jordanians of both genders between the ages of 18 and 65 years by questionnaire. Three questions were asked to evaluate the frequency of foods/drinks consumption, general eating habits, and self-medication practice of individuals of both genders during the lockdown. Results: Dietary habits and food quality affected weight (increase or decrease) by 69.5% during the lockdown. The highest percentages of “very high” consumption per week for fruits, processed juices, and fried foods were 37.6 %, 36.7%, and 29.4%, respectively. The highest percentage of “very little” consumption per week for drinking water, milk, and soft drinks were 12.5%, 8.5%, and 7.4%, respectively. The percentage of respondents who had taken medicine without a doctor’s prescription was 84.7%. The highest percentage (74%) was in using self-medication as a preventive measure against the coronavirus, followed by treating a cold/flu (61.4%), in both genders and age groups. The largest percentage (78.5%) was for using paracetamol, followed by ibuprofen and azithromycin (78.1% and 77.1%), respectively. Conclusion: Dietary habits and the quality of the foods consumed during lockdown affected participants’ weight (increase or decrease) by 69.5%. The percentage of participants who self-medicated was 84.7%.
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The purpose of the text is the effectiveness/benefits of dragon fruit and guava fruit that can lower blood glucose levels in type 2 Diabetes Mellitus patients p. 269
Listrianah , Muzakar , Susyani , Novellyna Mulyaningsih, Eliza , Sriwiyanti
DOI:10.4103/ijnpnd.ijnpnd_31_22  
Introduction: Diabetes mellitus (DM) is a serious chronic degenerative disease caused by insufficient insulin hormone, or the body’s ineffective use of the insulin produced, with clinical symptoms such as polyphagia, polydipsia, polyuria, weight loss, and weakness accompanied by blood sugar levels ≥ 200 mg/dL and fasting blood sugar ≥ 126 mg/dL. Material and Method: This was a quantitative study with a quasi-experimental design. Results: Most of the respondents were female (70%) either in the treatment group or (60%) in the comparison group and had an average age between 45 and 59 years (50%). The average decrease in blood sugar level was 69.40 mg/dL. Red guava (NAMBUIRA) showed an effect on the blood sugar levels in type 2 DM patients at Talang Ratu Palembang Public Health Center (P = 0.000). Conclusion: NAMBUIRA pudding contains antioxidants and is rich in fiber and had an effect on reducing blood sugar levels in patients with type 2 DM at Talang Ratu Public Health Center of Palembang.
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Actions of Caffeic Acid Loaded-Silver Nanoparticles on Blood Pressure, Oxidative Stress, and Antioxidants in Nitric Oxide Deficient Hypertensive Rats p. 275
Kanagaraj Kalaiarasi, Boobalan Raja, Dhanasekaran Saranya, Ravi Dhakshinamoorthi
DOI:10.4103/ijnpnd.ijnpnd_41_22  
Objectives: This study aimed to evaluate the antihypertensive and antioxidant potential of caffeic acid-loaded silver nanoparticles (CA-AgNPs) in Nω −Nitro-L-arginine methyl ester hydrochloride (L-NAME) induced hypertension in male albino Wistar rats. Materials and methods: The rats have randomly divided into four groups, that is, Group I Control rats, Group II rats injected with CA-AgNPs, Group III L-NAME rats, and Group IV −L-NAME+ CA-AgNPs. Hypertension was induced in rats by oral administration of L-NAME (40 mg/kg body weight) dissolved in drinking water daily for 4 weeks. Rats were given intraperitoneal injection of CA-AgNPs (0.5 mg/kg/ml). Results: The results showed that L-NAME administration caused a sustained increase in blood pressure, levels of thiobarbituric acid reactive substances (TBARS), lipid hydroperoxides (LOOH), and a significant decrease in the activities of enzymatic antioxidants such as superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (Gpx), and levels of non-enzymatic antioxidants such as vitamin C and vitamin E in the tissues such as heart, aorta, liver, and kidney. Above pathological changes were considerably restored with the treatment of CA-AgNPs. Conclusions: The result confirms CA-AgNPs have enough potential to narrow down hypertension and oxidative stress in L-NAME hypertensive rats.
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Perceived Wellness Measured by the National Wellness Institute’s Wellness Focus Survey Tool among Women in Al Ain, UAE: A Sentinel Study p. 282
Shamsa Al Awar, Howaida Khair, Nawal Osman, Teodora-Elena Ucenic, Gehan Sallam, Sara Maki, Aishwarya Ganesh
DOI:10.4103/ijnpnd.ijnpnd_64_22  
Objectives: While there is a plethora of women’s studies conducted on psychosocial variables such as mental health, quality of life, and burden of care, there is a dearth of studies on the dimension of “wellness,” particularly from the Arabian Gulf population. This study was designed to investigate perceptions of personal wellness among women residing in the United Arab Emirates (UAE) using six dimensions of wellness, namely; Spiritual, Emotional, Intellectual, Occupational, Physical, and Social. The related aim was to examine the relationship between perceived wellness and socio-demographic characteristics. Methods: This online cross-sectional study was carried out from August 2021 to October 2021 among women residing in the UAE. The outcome measure included the National Wellness Institute’s Wellness Focus Survey Tool, which was adapted to suit local dialect and social modesty. The newly adapted questionnaire was translated into Arabic. The study also included pertinent socio-demographic variables. Results: A total of 325 women living in Al Ain, UAE participated in the study. Out of the participants, 60.8% were Emiratis, aged between 31 and 40 years (37.3%) and married (57.8%). The participants were mainly employed (59.7%) and most of them lived in private (61.5%) accommodation. The analysis reveals the following ranking order of the six dimensions of wellness; Spiritual (mean = 4.30, SD = 0.84), followed by Social (mean = 4.05, SD = 0.85), Occupational (mean = 3.93, SD = 1.05), Emotional (mean = 3.76, SD = 0.91), Intellectual (mean = 3.73, SD = 1.01), and Physical (mean = 2.41, SD = 1.04). Among the women’s characteristics, age and marital status were found to be significantly associated with the Emotional Dimension. Moreover, nationality and accommodation were significantly associated with the Intellectual Dimension. Overall, using factor analysis of the instrument, we found that only one component was sufficient to adequately explain either the Occupational or Spiritual Dimensions, while two components were needed to explain each of the following; Intellectual, Emotional, Social, and Physical dimensions of wellness. Conclusion: Wellness is of great importance to UAE women, with significant associations with some socio-demographic characteristics. The Spiritual Dimension, in particular, was perceived to be of highest importance, closely followed by Social, Occupational, Emotional, Intellectual, and Physical dimensions. In particular, age and marital status had significant association with the Emotional Dimension, while nationality and accommodation were significantly associated with the Intellectual Dimension. These findings are of importance to future endeavors that are aimed towards the betterment of the quality of life of women in the UAE, by indicating which spheres of wellness are prioritized and which ones require further scrutiny.
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Mental and Physical Performance of Adult during the COVID-19 Pandemic and Use of Dietary Supplements p. 291
Abhilasha Tomer, Amlan Kanti Sarkar, Havagiray R Chitme
DOI:10.4103/ijnpnd.ijnpnd_49_22  
Background: Life during the COVID-19 pandemic was miserable, most of the people were in a panic situation either because of being affected by COVID-19 or losing their near and dear ones. Majority of Indian population was in the trauma condition impacting physical and mental health directly or indirectly either due to the infection or repeated lockdowns. Aim: The present study was carried out to gain knowledge of people’s physical and mental health such as anxiety, depression, and stress during the period of the pandemic in the year 2021. Material and methods: The standard questionnaires were used to conduct the online survey using google form. The questionnaire contains five sections and collects the information on anxiety, stress, depression, and physical activities. The survey started on May 23, 2021, and ended on June 2, 2021 by circulating the link through emails, WhatsApp, and messages. Result: A total of 291 people participated in this survey process and all responses were analyzed, out of which 165 were men and 126 were women. It was calculated that 59.4% of men and 40.6% of women were affected by COVID-19. Total 49.5% of people affected by COVID-19 were in favor of improvement in physical and mental performance while taking dietary supplements. Whereas 19.8% denied the statement and 28.7% of people saw slight changes in their health status. Conclusions: During the pandemic people were mostly affected by anxiety, depression, stress, and physical health and to cope with these situations dietary supplements surely be the utilitarian for the society. Through this study, it was found that if a person includes both exercise and nutraceutical products in their lifestyle, there will be a chance of living a sustainable and healthy life.
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Modified Technology for a New Generation Stroke Rehabilitation Module by Transcutaneous Vagal Nerve Stimulation Therapy − A Critical Analysis p. 300
Leena Chacko, Janseya Delani, Rajaram Prabhu, Uma Maheshwari Raman, Hanan Fahad Alharbi, Yoga Rajamani, Mullaicharam Bhupathyraaj
DOI:10.4103/ijnpnd.ijnpnd_63_22  
An important goal of stroke rehabilitation is to improve the quality of life, enhancing functional independence, and active participation in daily routine activities. Stroke is a cerebral vascular event with rapidly developing clinical signs of global disturbances with no apparent cause other than a vascular origin. A stroke occurs when the blood vessels in the brain are blocked or burst, which prevents the blood and oxygen from reaching brain tissues. Symptoms of stroke in body parts are controlled by damaged areas of the brain and the main symptoms show involuntary muscle tightening, paralysis, and restricted physical abilities. Other complications depend upon the damage to part of the brain. Enhancing plasticity by triggering neuromodulators with paired motor training provides the basis for transcutaneous vagal nerve stimulation (TVNS) therapy. TVNS to activate the neuromodulatory networks of cortical neurons shall be achieved by the battery-powered device with electrodes and adhesive backing which can be positioned on the skin in specific areas. The device delivers electrical impulses which activate the vagal nerve and enhance the plasticity of cortical neurons. This article emphasizes vagal nerve stimulation paired with rehabilitation therapy, which combines a device that stimulates vagal function which promotes motor function, and rehabilitation training to facilitate a speedy recovery. This technology is precise and consistent in developing pro plasticity neuromodulators and improves the daily performance of the affected individual.
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Prevalence and Risk Factors of Cognitive Impairment and its Effect on Quality of Life: A Cross-Sectional Analysis of the TILDA Cohort p. 305
Ahmed Al-Hindawi, Louai Wael Al Tabaa, Ahmed Ali Gebril Ali, Yousef Waly, Mohamed Shelig, Muhammed Hussain, Ali Al-Sabti
DOI:10.4103/ijnpnd.ijnpnd_59_22  
Objectives: Examine the prevalence of cognitive impairment within Wave 1 of the Irish Longitudinal Study on Aging (TILDA) cohort and its relationship with comorbidities and lifestyle factors. The effect of cognitive impairment on quality-of-life scores was also investigated. Methods: A secondary cross-sectional analysis of data from Wave 1 of the TILDA cohort was undertaken. Results: Prevalence of cognitive impairment ranged between 5.8% and 51.2%, depending on the instrument used (Mini-Mental State Examination [MMSE] and Montreal Cognitive Assessment [MoCA], respectively). Having hypertension (odds ratio [OR] 1.68; 95% confidence interval [CI] 1.36–2.08), being a past or current smoker (OR 1.25; 95% CI 1.01–1.55) and having low physical activity (OR 2.04; 95% CI 1.64–2.53) increased the odds of being classified as cognitively impaired (MMSE <25). Similarly, being obese (OR 1.31; 95% CI 1.17–1.47), having hypertension (OR 1.42; 95% CI 1.27–1.57), and having diabetes (OR 1.71; 95% CI 1.40–2.09) increased the odds of cognitive impairment (MoCA <26). High cholesterol was associated with a protective effect (OR 0.79; 95% CI 0.63–0.98) under MMSE <25 classification while, problematic alcohol behavior reduced the odds of being classified as cognitively impaired using MoCA <26 by 35% (OR 0.65; 95% CI 0.55–0.76). Depression was not associated with increased odds of cognitive decline. Lastly, mean quality of life (QoL) scores decreases as severity of cognitive impairment increases from normal to moderate cognitive impairment (P < 0.001). Conclusions: Several modifiable risk factors for cognitive decline were identified, including smoking, low physical activity, hypertension, diabetes, and obesity. Policies aimed at reducing the prevalence of these risk factors in the population might reduce the impact of cognitive decline on public health.
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Evaluation of the Antibacterial Efficacy of Vitex negundo Leaf Extract against Antibiotic Resistant Klebsiella pneumoniae: An In Vitro Pharmacological Study p. 319
Preetha Srinivasan Palaninathan, Arul Salomee Kamalabai Raveendran, Jayachandran Swaminathan Kesavan
DOI:10.4103/ijnpnd.ijnpnd_77_22  
Vitex negundo is an aromatic shrub distributed worldwide with several medicinal properties. The alarming and rapid increase in the antimicrobial drug resistance globally has led to the development of alternative therapeutic strategies to overcome drug resistance. Hence, the present study was carried out to evaluate the antibacterial efficacy of the acetone, benzene, ethyl acetate, chloroform, and methanolic leaf extracts of V. negundo against Klebsiella pneumonia (K. pneumonia) using in vitro studies. The sensitivity test against the standard antibiotics showed that the tested K. pneumoniae was multi drug resistant (MDR) bacteria. Based on the results of the Thin Layer Chromatography (TLC) bioassay, ethyl acetate was selected as the suitable solvent for extraction of V. negundo leaves. The zone of inhibition (ZoI) was observed starting from the concentration of 50 μg/mL for the V. negundo ethyl acetate leaf extract for the selected MDR bacteria K. pneumoniae. The highest ZoI was observed as 18 mm at the concentration of 200 mg/mL. Ethyl acetate leaf extract of V. negundo also expressed MIC value of 1.5 μg/mL against the test pathogen MDR K. pneumoniae. The inhibitory effect of the ethyl acetate leaf extract of V. negundo leaves was apparent from 40 minutes indicating time dependant inhibition or killing of the MDR K. pneumoniae. The results of the present study demonstrate the antibacterial activity of the ethyl acetate leaf extract of V. negundo, which may be attributed to the presence of several secondary metabolites in the extract.
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BOOK REVIEW Top

Book Review: Food as Medicine p. 327
Sawsan Mohammed, M. Walid Qoronfleh
DOI:10.4103/ijnpnd.ijnpnd_51_22  
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