Great Equalization: Is MBBS From India Equal To M.D. In U.S.A?

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AAPI Journal • March 2009 SPECIAL ARTICLE Obesity, Acanthosis Nigricans and Type 2 Diabetes In High School Youth by Naznin M. Dixit, M.D. & Mehul P. Dixit, M.D. Naznin M. Dixit, M.D. Orlando, Florida Introduction The prevalence of type 2 diabetes has increased 4- to 6-fold in 30 years among US adolescents. We aimed to determine the prevalence of type 2 diabetes and obesity among adolescents within the border community of Douglas, Arizona. Research Design And Methods Douglas is a rural community located in Southeastern Arizona, on the Mexican-U.S.A. border. The study was approved by the Human Subjects Review Committee and the School Board. The study was conducted in 2 phases. Physical data was obtained from students (grades 9-12) during the phase 1 of the study. Parent and student health history questionnaires were sent home along with the consent forms. The school nurse was trained to identify for the presence of acanthosis nigricans (AN) around the neck. Casual capillary blood glucose (CBG) measurements were taken. During the phase 2 of the study, students with CBG ® 110mg/dl were asked to submit a fasting venous blood sample on two separate occasions for plasma glucose and insulin analysis. Statistical Analysis Data were analyzed using STATA (version 6.0,). Fisher’s Exact Chi-Square tests were used to assess correlation. A P value < 0.05 was statistically significant. 26 www.aapiusa.org Results – Of the total 1150 students in grades 9-12 aged 14-19 years, 778 entered the study, a participation rate of 68%. The male to female ratio was 1: 1.1. 93.5% were of Hispanic origin. Mean BMI ± SD was 25.01 ± 5.99 (range 15.1-54.1); BMI z- score ranged from –1.64 to 4.41. Students with BMI3 85th and
SPECIAL ARTICLE AAPI Journal • March 2009 Probiotic Theraphy by M.S. Reddy, M.D & D.R.K. Reddy, M.D. Probiotics as Therapeutic Agents: Probiotics are bacteria or microorganisms that are beneficial to the health of an individual. They are essentially the opposite of antibiotics, which are inhibitory to other bacteria (including Probiotic bacteria). The word ‘Probiotic’ is derived from two Greek words, ‘Pro’ and ‘Bios’, meaning ‘for life’. Probiotics are non-pathogenic, do not produce toxins, and are considered natural. The Probiotics organisms are believed to exhibit therapeutic effects because of their innate ability to produce lactic acid and other substances that are inhibitory to harmful bacteria. They naturally reside in the human intestinal tract at receptor sites in the ileum, where they create a mildly acidic environment that is not favorable for the growth and viability of pathogenic microorganisms, including viruses. These beneficial bacteria have an antagonistic effect on pathogenic bacteria, while antibiotics have an antagonistic effect on Probiotics. Consequently, when a person is treated with antibiotics, the Probiotics residing in the gastrointestinal tract can be inhibited, adding another layer of complexity to the illness. To counteract this problem, some physicians prescribe the use of Probiotics following use of an antibiotic, in order to restore healthy gastrointestinal flora. Considerable judgment should be exercised by the physician in prescribing a proper Probiotic by taking into account its physiological and biochemical properties. Since Probiotics are natural inhabitants of the human gastrointestinal tract, they have to be maintained in proper balance to bestow good health. Modern foods that contain preservatives and dyes, etc., are not beneficial to the gastrointestinal flora, especially Probiotics. Consequently, in order to maintain and ensure proper gastrointestinal eco-flora, continuous or periodic supplementation of Probiotics is a must. Potential Benefits of Probiotic Therapy: Before proceeding with a discussion on the benefits of Probiotic therapy, let us review the microbiological composition of the human gastrointestinal tract. The human gastrointestinal tract harbors a variety of microorganisms. The human stomach content, i.e. gastric juice, has only 10 to 100 microorganisms per milliliter (ml) or gram. In the upper portion of the small intestine, i.e. the duodenum, the bacterial population in the contents range from 1000 to 10,000 per/ml. The bacterial population increases as we go down to the distal part of the ileum to 1,000,000 to 10,000,000 per/ml of the contents. The colon has 100 billion to 1 trillion bacteria per/ml of the contents. In the entire colon, the total number of bacteria is roughly 100 trillion or more. The total number of eucaryotic cells (cells with definite nucleus) in the human being is roughly 10 trillion. Thus, the colon bacterial cell population exceeds the total host cell population by ten times or more. The bacterial population in the gut has been adapted through associative growth relationships. There are many factors that interfere with this normal dynamic balance. Various factors contribute to this eco-imbalance, including the intake of chemicals, antibiotics, etc. Under these adverse conditions, the microflora that are beneficial health promoters are replaced by pathogenic bacteria such as Clostridia, sulphate reducers, certain Bacteroides species, etc. These pathogenic bacteria predispose the host to a number of clinical disorders, and infections by transient enteropathogens. Thus, maintenance of balanced beneficial intestinal microflora, consisting of Lactobacillus and Bifidobacterium, etc. is essential. It raises a very important issue regarding the validity of antibiotic therapy. In our opinion, the microbial ecosystem of the small intestine and colon dictate the overall health and well being of the human. The following are some of the benefits of Probiotic therapy: 1. Reduction of lactose malabsorption: Half of the world population is unable to utilize lactose. Lactose malabsorption can be corrected by probiotics. Lactose is a disaccharide made of glucose and galactose. A person who lacks the enzyme lactase in the gut cannot digest lactose and thus develops clinical symptoms of typical lactose intolerance. Probiotics, especially L. acidophilus, have the B- galactosidase enzyme, which can break down the Continued on page 28 www.aapiusa.org 27
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Great Equalization: Is MBBS From India Equal To M.D. In U.S.A?

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