Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241117EnglishN2019April12HealthcareNutritional Status of Primary School Children in Different Parts of India: A Review English0104Sk Nazibar RahamanEnglish Surajit DasEnglish Sandeep Kumar DashEnglish Biplab GiriEnglish Kazi Monjur AliEnglishNutrition is a critical determinant of human health. Despite the ICDS (Integrated Child Development Services) having started as far back as 1975 to specifically address the health, nutritional and educational needs of children from the ante-natal period to six years after birth, malnutrition is still prevalent in India. In this context, this review has been done to explore the trends in the prevalence of wasting, stunting, overweight, and obesity among children both in the rural and urban areas of different states in India. EnglishMalnutrition, Underweight, Stunting, Wasting, ObesityINTRODUCTION The development of children into healthy adults is dependent on their growing, starting from their antenatal period, in a healthy environment and having balanced nutrition. Today, the majority of the avoidable infant and child mortalities results from malnutrition. The most prevalent effect of poverty on children is under nutrition. Poverty is a key determinant of under nutrition, through the unhealthy physical environment, domestic stress and fatigue-related early stopping of the mother's milk also contributes to malnutrition along with the lack of education of mothers 1, 2. WHO estimates that, in the world, 27 percent of the children fewer than five years of age have less than the normal weight-for-age, and that most of these children live in the developing countries 3. Nutrition of primary school children determines their life time health, strength and intellectual vitality. This span of life is a dynamic stage of physical growth and mental development4, 5. But still now in India, the position of health and nutritional status of the school-age children are not satisfactory level6. The national family health survey (NFHS-4) data reported that 37.5% of children were underweight in India out of which 29.1% in urban and 38.3% in rural and it varies across the states. The survey data also reported that stunting and wasting was 38.4% and 21.0% in respectively7. There are no any other efforts to supplementary feeding program for school children in age group 5-14 years except mid-day-meal programme8. Side by side, WHO health report (2006) revealed that “double burden" of disease threats in the many countries. It is noticeable that under-nutrition and obesity coexistence within the same country, community and even within the same household. Lack of inadequate nutrition may causes this double burden to the pre-natal, infant and young child due to exposure of energy-dense, high-fat, poor micronutrient and poor  physical activity 9. Based on the different study in various parts of our country, the present review work focused the nutritional status of children at a glance. DISCUSSION OF REVIEW In Karimnagar city of Telangana State a descriptive and cross sectional study was conducted among school children aged 6 to 11 years from November 2011 to October 2012. The study reported that the underweight children were 29.3% in rural areas and 22.2% in urban areas. Similarly stunted children were 21.5% in rural and 16.2% in urban areas. Major finding of the study was under nutrition. The study suggested that health education for parents, students as well as school teachers is required to improve the situation 10. In another descriptive cross sectional study which was conducted in 6 to 10 years old children in government Primary School of urban slum of Kurnool, Andhra Pradesh. In that study, 101 study subjects were selected by systematic random sampling and the prevalence of under nutrition was reported according to the Indian Academy of Pediatrics (IAP) classification. Results reflected that 38% children had normal weight for age and 63% were undernourished. The grade –I under nutrition had 35. 64%, Grade-II under nutrition had 15.84%, grade-III under nutrition had 10.89% and grade-IV under nutrition had not found. It was also reported that female children were more malnourished than male children. Malnutrition was more seen in the age of 7 to 9 years of children. Study suggested that nutrition education may be playing an important role for their health promotion11. In Bareilly district of Uttar Pradesh, across sectional study was conducted among 5 to 15 years of 512 school children. Study reported that the 46.8% children normal, 38.4%underweight, 33.3% wasted and 19.9% stunted respectively. Study also reported that maternal education positively associated with number measures of child health and nutritional status and children from joint family were more undernourished than nuclear families children. Children of non working mother have better nutritional status than children of working mother because non working mother take more time for care. In that study various recommendations were made to achieve optimal nutritional status including fortified food items, effective infection control, and training of public healthcare workers and skills-based nutrition education, etc.12. Another cross-sectional study was carried out in 484 children of 6-12 years age in Mandya district, Karnataka. The prevalence of underweight was 32.3% and 28.3% in boys and girls respectively. The prevalence of stunting was 29.1% in the boys while it was 26.5% in the girls. Study also indicated the different types of nutritional deficiencies and finally suggests the balance diet consumption13. In Mysore city of Karnataka, another cross sectional study was carried out by Ashok et al. to find out the scenario of nutritional status in private and government school. In that study, 1566 school children were studied from one private and one government school. The overall prevalence of underweight, overweight and obesity was 24.5%, 8.4% and 4.1%, respectively. The findings also indicated that prevalence of underweight was 32.5% and 18.2% in government school and private school respectively. Study reported that the prevalence of overweight and obesity emerged in increasing trend with age in private school children and also revealed that higher economic class children under private school involved sedentary life style and becoming overweight or obese and14. In a study in West Bengal, three anthropometric tools used to determine the nutritional status of 3564 primary school children aged 8 to 9 years from 183 government aided school. A high prevalence of thinness was found in boys (65.4%) and girls (65.3%). The results indicated that 26.1% boys and 22.9% girls were stunted. The prevalence of underweight in boys (39.7%) and girls (36.5%) was also reported15. In Dakshina Kannada District, Karnataka State, a descriptive cross sectional study was conducted on 424 primary schools children aged 5 to 14 years consisting 194 from 2 government schools and 230 from 2 private schools. Study reported overall prevalence of stunting was 19.2%. It was more among boys (22.4%) than girls (15.7%). The prevalence of underweight and thinness was 26.5% and 26.5% respectively. The study also reported that nutritional status of primary school children is more unsatisfactory in respect to government school16. In 2011, Izharul Hasan carried out a cross sectional study in the Azad Nagar from Urdu medium government higher primary schools and total 500 children were covered. It was reported that total malnutrition was 52% out of which boys and girls were 53.85% and 49.25% respectively. This study indicated that the boys were suffering more from stunning as compared to girls (41.47% vs 38.81%) 17. In north India (Kinnaur, Himachal Pradesh), a community based cross-sectional survey was conducted to assess nutritional status among tribal pre-school children having age group between 3 to 5 years and total sample size was 350. The overall prevalence of underweight children was found 21.4% and the prevalence of stunting and wasting was reported 27.4% and 11.1% respectively. Underweight and wasting was found more in male than female children18. In another study, nutritional status of school age children in Rural Block of Kashmir was conducted among 5-14 year old school children. Study reported that overall prevalence of 11.1%, 9.25% and 12.3% for underweight, stunting and wasting respectively19. In December 2011 and February 2012, another cross sectional study was conducted among 5-13 years old school children in urban area of Ahmedabad. Total 28,256 children were sorted out (boys-15,087 and girls-13,169) and the study was revealed that 8, 319 (29.44%) were belonged to underweight in terms of body mass index standards of children.  But 221 (0.78%) of children were either overweight or obese. Study also pointed out that the nutrition and health standards of government school children were unsatisfactory as compared to the ICMR standards20. Osei et al. (2010) was conducted a study on a hilly agrarian community in Tehri Garhwal District, Uttarakhand. Population of this area engages mainly in farming. The study was covered 499 children of 6 to 10 years. Results of the study highlighted that underweight, stunting, and wasting were present in 60.9%, 56.1%, and 12.2% of respectively21. In Odisha, acommunity based cross sectional study was carried out in an urban slum area of Berhampur city from October 2015 to September 2016. Pre-tested semi structured questionnaires were designed for data collection and measured weight, height and MUAC of the children. The study revealed that 69% of 300 children were belonged to under nutrition. The forms of under nutrition were underweight (55.3%), wasting (75%) and stunting (42%) respectively. The study also showed that maternal education, faulty feeding practice and hygienic practice are tributary factor of malnutrition22. This was another cross sectional study conducting among Santal-Munda tribal community from Amdanga block of North 24 Parganas district, West Bengal. Data was collected on the basis of pretested questionnaire and house to house visit following interview and examination. Study reported that prevalence of underweight was 38.65%, stunting 21%, and wasting 32.7% where as severe form of underweight, stunted, and wasted was 8.40%, 4.20% and 9.20% respectively. The study resulted that preschool children were more worsen condition than school going children. Study also stated that majority of families were illiterate and does not access into modernization23. A high prevalence of poor nutritional status was found in another study among tribal children from a community based cross-sectional study in ITDA Areas in nine States of India including Andhra Pradesh, Gujarat, Kerala, Karnataka, Maharashtra, Madhya Pradesh, Orissa, Tamil Nadu and West Bengal. The study covered 14,587 children aged between 0-5 years and revealed that the prevalence of under-weight, stunting and wasting was 49%, 51% and 22%, respectively. The result of this study indicates that under nutrition is still serious health problem issue. This study was also revealed that maternal literacy, morbidities pattern and socio-economic status was also most liable factor for undernutrition24. Prevalence of obesity among 6-15 years old school children in Kochi, Kerala, and South India was reported by Cherian et al. in 2012. Total 1634 children were studied and reported that obesity was 3.0% and 5.3% for boys and girls respectively. The study was also reported that obesity (7.5%) and overweight (21.9%) were highest in high economic status and lowest (1.5% and 2.5% respectively) among low economic status. A. Girls of high economic status were more documented of obesity and overweight25. There was a descriptive study conducted in Chandigarh city, Northern India during the period from January 2012 to December 2012 among 3,793 school children. In that study, underweight was found to be 73.3%, overweight was 2.3%, and obese was1.5%. Until now, under nutrition is a major public health problem in developing countries like India. This study was also revealed that prevalence of over nutrition is high in children belonging to high socio economic status in India26. CONCLUSION: Most of the surveys have showed that health status of school children are at sub optimal level. This stage of life is an intense anabolic phase when all nutritional requirements are increase. The stage also determines their life time health, strength and intellectual vitality. From literature, it is found that the health and nutritional status of school children are very poor especially in rural areas because of low socioeconomic status, pattern of father’s occupation and low education of parents. Literature also indicated that under nutrition was raised in tribal children in India. Most of research was revealed that lack of education, low socio economic status, unhygienic condition, and lack of medicare facility was liable for severe under nutrition in tribal children. Finally, to improve the condition, literature suggests the various recommendations. For primary school children, nutritional supplements should be launched as mid morning supplements through ICDS by the government especially in rural areas. Special nutritional packages for underweight, stunting and wasting children should be given in ICDS centre by the government. Nutritional seminar should be conducted to increase of nutritional knowledge in school level by nutritionist. Apart of that nutrition education must be included from pre-primary to all education system Tribal children were more under nourished, so healthcare facility and nutrition supplement should be specialized for this group of children.  ACKNOWLEDGEMENT Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Source of Funding: Nil Conflict of interest: There is no conflict of interest. Englishhttp://ijcrr.com/abstract.php?article_id=2591http://ijcrr.com/article_html.php?did=2591 World Health Organization. Infant and young child nutrition. Geneva, Switzerland: World Health Organization, 2000. URL: www.who.int/gb/ebwha/pdf_files/WHA55/ea551 5.pdf Reading R. Poverty and the health of children and adolescents. Arch Dis Child 1997; 76:463-567. World Bank. World Development Report 2003: Sustainable development in a dynamic World. World Bank, New York, 200 Bevans KB, Sanchez B, Teneralli R. Children's eating behavior: The importance of nutrition standards for foods in schools. J Sch Health 2011; 81(7): 424–429. Sharma M, Watode B, Srivastava A. Nutritional status of primary school children through anthropometric assessment in rural areas of Moradabad. Ann Int Med Dental Res 2017; 3(2): CM01-CM05. Gopalan C, Kaur H. Towards better nutrition - problems and policies. Nutrition Foundation of India, Special Publication Series 1993; 9:70-78. National Family Health Survey (NFHS 4). International Institute for Population Science, Mumbai, India, 2015-16. Patell PP, Patell PA, Chiplonkar SA, Khadilkar AV, Patel AD. Effect of mid-day meal on nutritional status of adolescents: A cross-sectional study from Gujarat. Ind J Child Health 2016; 3(3): 203-207. Rema N, Vasanthaman G. Prevalence of nutritional and lifestyle disorders among school going children in urban and rural areas of Coimbatore in Tamil Nadu, India. Ind J Sci Technol 2011; 4(2): 131-140. Shaikh MK, Kamble N, Bhawnani1 D, Bele S, Rao SR. Assessment of nutritional status among school children of Karimnagar, Telangana, India. Int J Res Med Sci 2016; 4(10):4611-4617. Cynthia Subhaprada S. Nutritional status of government primary school children in an Urban Slum, Kurnool, Andhra Pradesh. Int J Current Med Appl Sci 2015; 6(3): 167-170. Srivastava A, Mahmood SE, Srivastava PM, Shrotriya VP, Kumar B. Nutritional status of school-age children – A scenario of urban slums in India. Arch Pub Health. 2012; 70: 1-8 Shivaprakash NC, Joseph RB. Nutritional status of rural school going children (6?12 Years) in Mandya District, Karnataka. Int J Sci Study 2014; 2(2): 39-43. Ashok NC, Kavitha HS, Kulkarni P. A comparative study of nutritional status between government and private primary school children of Mysore city. Int J Health & Allied Sci 2014; 3(3):164-169. Mondal T, Mondal S, Biswas M. An assessment of nutritional status of children of government aided primary school of West Bengal. Int J Elementary Edu 2015; 4(3): 41-45. Amruth M, Kumar S, Kulkarni AG, Kamble SV, Ismail IM. A study on nutritional status and morbidity pattern among primary school children in Sullia town, South India. Ind J Basic Appl Med Res 2015; 4(4): 100-112. Hasan I, Zulkifle M, Ansari AH. An assessment of nutritional status of the children of government Urdu higher primary schools of Azad Nagar and its surrounding areas of Bangalore. Arch Appl Sci Res 2011; 3(3):167-176. Singh H,  Gupta  A, Sachdeva A, Barall D, Kumar D, Singh S. Nutritional Status of 1-5 years children in a hilly tribal district of North India. Int J Contemporary Med Res 2016; 3(11): 254-379. Fazili A, Mir AA, Pandit IM, Bhat IA, Rohul J, Shamila H. Nutritional status of school age children (5-14 years) in a rural health block of North India (Kashmir) Using WHO Z-Score System. Online J Health Allied Sci 2012; 11(2): 1-3. Patel N, Gunjana G, Patel S, Thanvi R, Sathvara P, Joshi R. Nutrition and health status of school children in urban area of Ahmedabad, India: Comparison with Indian Council of Medical Research and body mass index standards. J Nat Sci Biol Med 2015; 6(2): 372–377. Osei A, Houser R, Bulusu S, Joshi T, Hamer D. Nutritional status of primary schoolchildren in Garhwali Himalayan villages of India. Food Nut Bull 2010; 31(2): 221-223. Sethy G, Jena D, Jena P, Pradhan S, Biswas T. Prevalence of malnutrition among under five children of urban slums of Berhampur, Odisha, India: a community a community based cross-sectional study. Int J Contemp Pediatrics 2017; 4(6): 2180-2186 Ghosh J, Pati RR. Assessment of nutritional status among Santal-Munda tribal children in rural area of Amdanga block, North 24th Parganas District of West Bengal, India. Int J Curr Microbiol App Sci 2015; 4(7): 810-814. Meshram II, Arlappa N, Balakrishna N, Rao KM, Laxmaiah A, Brahmam GNV. Trends in the prevalence of under nutrition, nutrient & food intake and predictors of under nutrition among under five year tribal children in India. Asia Pacific J ClinNutr 2012; 21(4):568-576. Cherian AT, Cherian S, Subbiah S. Prevalence of obesity and overweight in urban school children in Kerala, India. Ind Pediatrics 2012; 49:475-477. Kashyap R, Kaur S. Nutritional status and morbidity profile among school children, northern India. Malaysian J Paediatrics and Child Health 2015; 21(1): 1-7.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241117EnglishN2019April12HealthcareInhibitory Action Against Alpha Glucosidase by Selected Dihydroxy Flavones English0508S. UmamaheswariEnglish K. S. Sridevi SangeethaEnglishBackground: Diabetes is one of the common metabolic disorder that occurs due to poor secretion of insulin. It is more common among aged people in India. The incidence of diabetes is increasing every day and this indicates the increasing need for the treatment for diabetes. Objective: The objective of the present study is to screen the effects of selected substituted dihydroxyflavone for its in vitro antidiabetic effect by finding the potential to inhibit the enzymes α-Glucosidase. Materials and Methods: The dihydroxy flavones used in the present study includes 2’,3’- dihydroxy flavone and 2’, 4’ dihydroxy flavones. They were synthesized using standard procedures. In vitro α-glucosidase inhibitory activity was evaluated by Li et al., 2004. The different concentration of the flavonoid ( 0.1, 0.3, 1, 3,10, 30, 100, 300, 1000 (μM/ml) were used and the experiment was done for triplicate sample. The standard antidiabetic drug used in the study was Acarbose. The inhibitory activity was calculated and tabulated. Results: The selected Dihydroxy flavones 2’,3’- dihydroxy flavone and 2’, 4’ dihydroxy flavones showed significant invitro anti diabetic activity when compared with standard drug acarbose. The IC50 value of 2’,3’- dihydroxy flavones and 2’, 4’ dihydroxy flavones was found to be 0.47μM/ml, 46.37 μM/ml respectively. EnglishDiabetes, Dihydroxy flavones, in vitro, Alpha glucosidase, Metabolic disorderIntroduction: Diabetes is often called the silent killer because people who have it are often unaware they are affected. It is one of the oldest and most prevalent chronic non-communicable disease. Diabetes Mellitus is characterized by hyperglycemia, impaired metabolism of lipids, carbohydrates and proteins with an increased risk of complication related to vascular diseases. The minimum defining feature to identify diabetes mellitus is the chronic and substantiated rise in circulating glucose concentration. The normal level of blood sugar in a fasting person is between 80-120mg percent. If the fasting level of blood sugar is more than 110mg percent or after meals more than 160mg percent, it is called high blood sugar (Diabetes Mellitus). In diabetic patients, sugar can be detected in the urine also. Patients with diabetes have a higher chance of development of coronary blockages. They also get several other diseases like kidney damages as well as damage to the nerves and eyes1-3. According to an estimation of the International Diabetes Federation, approximately 366 million people are suffering from diabetes and this may double by 2030, in India to be 40.9 million, which is expected to grow to 60.9 million by 20254. This can also be characterized by a state of chronic hyperglycemia, glucosuria, polyurea, polydipsia, polyphagia sudden weight loss, ketoacidosis and ketonuria. In type 1 diabetes, the pancreas fails to produce insulin. Because insulin transports sugar into cells, when a body lacks insulin, its cells starve for energy. In type 2 diabetes, there is plenty of insulin in the body, but sugar still cannot get inside the cells. In both types of diabetes, sugar in the blood becomes very high. Type 2 is more prevalent than type 1, with more than 90% of the total diabetic patients suffering from it. Postprandial hyperglycemia plays an important role in the development of T2D5. Number of environmental factors act on genetically susceptible individuals. They includes Sedentary life style, Diet, Malnutrition, Viral Infections, Chemical agents and Stress. Diabetes is generally accepted as a major challenging health problem all over the world  and especially in the developing countries. India has the dubious distinction of being home to one in five persons with diabetes world. The World Health Organization (WHO) predicts that the number of people with diabetes is to double in the next couple of decades and that the major burnt of this will be borne by the developing countries6. The management of Diabetes Mellitus is considered as a global problem whose successful treatment is yet to be discovered. Insulin is widely accepted as an ideal choice for treatment of diabetes mellitus but the difficulty of repeated administration led to the search for the hypoglycemic agents. Chronic hyperglycemia has been considered as one of the principal causes for several diabetic complications. In patients with Type II diabetes, postprandial blood glucose is elevated due to absorption of glucose from the gastrointestinal tract. The major enzyme involved in carbohydrates digestion is α-glucosidase (Figure-1), it is present in the brush borders of small intestine. It plays a vital role in preventing postprandial rise in blood glucose, this is because Inhibition of these enzyme systems helps to reduce the rate of digestion of carbohydrates and reduces the rate of glucose absorption from the gut and finally lowers the postprandial rise in blood glucose level7-9. Therefore, inhibition of α-glucosidase is a key in the management and treatment of Type II diabetes10,11. Alpha glucosidase inhibitors are used as oral anti diabetic drugs for treating type 2 diabetes mellitus12,13.    Flavonoids are the largest group of naturally occurring poly phenolic compounds present almost in all parts of flowering plants. Flavones have reported to have interesting pharmacological action such as anti-oxidant, anti-inflammatory, antihepatotoxic, anti-microbial, anticarcinogenic The combination of multiple pharmacological properties in a single nucleus is quite interesting. In a previous study done by the authors, it has been proven that the selected dihydroxyflavones 2’,3’- dihydroxy flavone  and  2’, 4’ dihydroxy   flavones have  potent antinociceptive14 and anti-inflammatory action 15. In the present study an attempt was done to screen the effects of selected substituted dihydroxyflavone for its in vitro antidiabetic effect by finding the potential to inhibit the enzymes α-Glucosidase. Material and Methods: α-glucosidase and 3, 5, di-nitro salicylic acid (DNS) were purchased from Sigma-Aldrich, Bangalore. P-nitro-phenyl-α-D-glucopyranoside (p-NPG), sodium carbonate (Na2 CO3), sodium dihydrogen phosphate, di-sodium hydrogen phosphate were purchased from Hi-Media, Mumbai. The dihydroxy flavones used in the present study includes 2’,3’- dihydroxy flavone  and  2’, 4’ dihydroxy    flavones, they were synthesized using standard procedures at Research Organics, Chennai, India. The authenticities of these compounds were done with melting points and UV method. In vitro α-glucosidase inhibitory activity was evaluated by Li et al., 2004. α-Glucosidase inhibitory assay is based on the breakdown of maltose to glucose.  200 μl of α -glucosidase solution was pre-incubated with the test and control samples for 5 min. The reaction was started by adding 200 μl of sucrose and it was terminated after 30 min incubation at 370C by heating at 90–1000C. The liberated glucose was determined. The enzyme activity is directly proportional to the liberated glucose and the liberated glucose is measured by GOD-POD method at 546nm using semi auto analyzer. The different concentration of the flavonoid ( 0.1, 0.3, 1, 3,10, 30, 100, 300, 1000 (μM/ml) were used and the experiment was done for triplicate sample. The standard antidiabetic drug used in the study was Acarbose. The inhibitory activity of the compounds was calculated as follows                              % Inhibition= [(control-test)/control)] X 100 Statistical Analysis: All the measurements were done in triplicate and results are expressed in terms of mean ± standard deviation and IC50 values were calculated using Graph Pad Prism version 5.01. Results and discussions: One of the therapeutic approaches for preventing diabetes mellitus is to decrease the absorption of glucose through inhibition of α-glucosidase, which is a carbohydrates digesting enzymes, located in the brush borders of the small intestine. Determining the In vitro α-glucosidase inhibitory activity was found to be one of the important tool used to examine the antidiabetic effect of any compound. The Percentage α-glucosidase inhibition was calculated for 2’,3’- dihydroxy flavone  and  2’, 4’ dihydroxy   flavone at various concentration 1, 0.3, 1, 3,10, 30, 100, 300, 1000 (μM/ml)and presented in Table 1. Standard drug used here is acarbose. The Inhibitory concentration IC50 was calculate using graph pad prism software. The selected Dihydroxy flavones 2’,3’- dihydroxy flavone  and  2’, 4’ dihydroxy   flavone showed  significant In vitro α-glucosidase inhibitory activity when compared with  standard drug acarbose. The IC50 value of 2’,3’- dihydroxy flavones and  2’, 4’ dihydroxy    flavones was found to be 0.47μM/ml, 46.37 μM/ml respectively. Table 1: In vitro α-glucosidase inhibitory activity of 2’,3’- dihydroxy flavone ,   2’, 4’ dihydroxy   flavone and the standard drug ( acarbose) The present study showed that 2’,3’- dihydroxy flavone and   2’, 4’ dihydroxy   flavones moderately inhibit α-glucosidase activity. Out of the two compounds 2’, 3’ dihydroxy   flavones have excellent invitro antidiabetic effect in α-Glucosidase inhibitory model, hence it can be used as oral antidiabetic drug. Further preclinical evaluation studies are needed to confirm its action on postprandial hypoglycemic effect. Conclusion: The study reveal that 2’, 3’ dihydroxy   flavones have excellent in vitro antidiabetic effect in α-Glucosidase inhibitory assay model. Source of Funding:   Nil Conflict of interest: Nil Authors’ Contribution: First author involved in the experimentation and analysis of work. The second author contributed in writing part of the study. Acknowledgment:  The author wish to thank the management of Sri Ramachandra Institute of Higher Education and Research for the encouragement and support. Englishhttp://ijcrr.com/abstract.php?article_id=2592http://ijcrr.com/article_html.php?did=2592 American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes—2018. Diabetes care. 2018 Jan 1;41(Supplement 1):S13-27. Zheng Y, Ley SH, Hu FB. Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nature Reviews Endocrinology. 2018 Feb;14(2):88. Ramachandran A, Snehalatha C. Current scenario of diabetes in India. Journal of diabetes. 2009 Mar;1(1):18-28. Mitra A, Dewanjee D, Dey B. Mechanistic studies of lifestyle interventions in type 2 diabetes. World journal of diabetes. 2012 Dec 15;3(12):201. Matyka KA. Type 2 diabetes in childhood: epidemiological and clinical aspects. British medical bulletin. 2008 Jun 1;86(1):59-75. Tiwari AK, Rao JM. Diabetes mellitus and multiple therapeutic approaches of phytochemicals: Present status and future prospects. Current science. 2002 Jul 10:30-8.  Matsui T, Tanaka T, Tamura S, Toshima A, Tamaya K, Miyata Y, Tanaka K, Matsumoto K. α-Glucosidase inhibitory profile of catechins and theaflavins. Journal of Agricultural and Food Chemistry. 2007 Jan 10;55(1):99-105. Kim YM, Jeong YK, Wang MH, Lee WY, Rhee HI. Inhibitory effect of pine extract on α-glucosidase activity and postprandial hyperglycemia. Nutrition. 2005 Jun 1;21(6):756-61. Chipiti T, Ibrahim MA, Singh M, Islam MS. In vitro α-amylase and α-glucosidase Inhibitory and Cytotoxic Activities of Extracts from Cissus cornifolia Planch Parts. Pharmacognosy magazine. 2017 Jul;13(Suppl 2):S329. Kumar S, Narwal S, Kumar V, Prakash O. α-glucosidase inhibitors from plants: A natural approach to treat diabetes. Pharmacognosy reviews. 2011 Jan;5(9):19. Nair SS, Kavrekar V, Mishra A. In vitro studies on alpha amylase and alpha glucosidase inhibitory activities of selected plant extracts. European Journal of Experimental Biology. 2013;3(1):128-32. Li Y, Peng G, Li Q, Wen S, Huang TH, Roufogalis BD, Yamahara J. Salacia oblonga improves cardiac fibrosis and inhibits postprandial hyperglycemia in obese Zucker rats. Life sciences. 2004 Aug 20;75(14):1735-46. Telagari M, Hullatti K. In-vitro α-amylase and α-glucosidase inhibitory activity of Adiantum caudatum Linn. and Celosia argentea Linn. extracts and fractions. Indian journal of pharmacology. 2015 Jul;47(4):425. Umamaheswari S, Viswanathan S, Sathiyasekaran BW, Parvathavarthini S, Ramaswamy S. Antinociceptive activity of certain dihydroxy flavones. Indian journal of pharmaceutical sciences. 2006;68(6):749. Umamaheswari S, Sangeetha KS. Anti-Inflammatory Effect of Selected Dihydroxyflavones. Journal of clinical and diagnostic research: JCDR. 2015 May;9(5):FF05.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241117EnglishN2019April12HealthcareRelapsing Polychondritis with Seronegative Spondyloarthritis: A Rare Case Report English0911Archana U.English Raju H. B.English Sreedhar J.English Jyoti H.English Shama B.English Abhiram M.English Rishab A.English Rajani D.EnglishThe aim of this paper is to present a case of relapsing polychondritis and response to cyclophosphamide pulse therapy. A 19 years old female patient presented with inflammatory back pain, asymmetrical oligoartheritis and acute anterior uveitis. CT thorax revealed edema in the glottis and trachea causing narrowing of lumen. Based on the investigations and clinical finding a final diagnosis of relapsing polychondritis was done and started with 5 pulse of cyclophosphamide which showed improvement. Relapsing polychondritis is a rare condition commonly affecting 40-50 years age group. But can be seen in younger age too in both the sexes. Laryngobronchial involvement occurs in approximately 50% of patients, and is among the most serious complications. Here we present the case of a 19 year old female with relapsing polychondritis presenting with stridor due to tracheal involvement. EnglishRelapsing Polychondritis, CyclophosphamideINTRODUCTION Relapsing polychondritis is an uncommon disease with an incidence of about 3.5 cases per million population per year. The peak age of onset is between the ages of 40 and 50 years. But relapsing polychondritis may affect both children and the elderly, and affects both sexes equally. Approximately 30% of patients with relapsing polychondritis will have another rheumatologic disorder, the most frequent is systemic vasculitis, followed by rheumatoid arthritis and systemic lupus erythematosus. Diagnosis is based on typical clinical features. McAdam et al. proposed a diagnostic criteria in 1976, which was further modified by Damiani and Levine in 1979. McAdam et al, proposed the following:- Recurrent chondritis of both auricles Nonerosive inflammatory arthritis Chondritis of nasal cartilage Inflammation of ocular structures, including conjunctivitis, keratitis, scleritis/episcleritis, and/or uveitis Chondritis of laryngeal and/or tracheal cartilages Cochlear and/ or vestibular damage manifested by neurosensory hearing loss, tinnitus, and/or vertigo Diagnosis is certain when 3 or more of these features are present along with a positive biopsy from the ear, nasal or respiratory cartilage1. Damiani and Levine later suggested that the diagnosis could be made when; One of the features and a positive biopsy  Two or more separate sites of cartilage involvement present that responded to glucocorticoids or dapsone Three or more of the features mentioned were present. We are reporting the case of a 19 year old female, who presented with inflammatory arthritis and uveitis, and later developed hoarseness of voice and an acute episode of choking. CASE REPORT A 19 year old female presented with symptoms suggestive of inflammatory back pain, asymmetric oligoarthritis along with acute anterior uveitis. MRI pelvis showed evidence of bilateral sacroilitis and she tested negative for Human Leukocyte Antigen B27 (HLAB27). Treatment was initiated with Non steroidal Anti-inflammatory Drugs (NSAIDs) and Sulfasalazine, further in view of lack of response to treatment, the patient was started on Infliximab therapy after a thorough work up. Following the commencement of Infliximab therapy, the joint pains subsided but, developed hoarseness of voice soon after the 1st pulse. In view of hoarseness of voice, an ENT opinion was taken, and the patient was put on steroids considering it to be Reinke’s edema, symptomatic improvement in hoarseness of voice was noted. Upon tapering steroids, the hoarseness of voice returned. In view of relapse of symptoms, an endocrinology opinion was taken to look for an endocrinologic cause for hoarseness, and following thorough evaluation, any endocrinological cause was ruled out. Three pulses of Infliximab were completed (as per protocol). Later the patient developed an acute choking episode at her college, wherein she was referred to a local hospital and subsequently intubated, and further referred to our hospital. After admission to our hospital, and stabilization of the patient, she was extubated. General physical examination at this juncture revealed a depressed nasal bridge, and tenderness over the larynx. There was no evidence of chondritis of auricles, and no history of any previous episodes of the same. No history suggestive of cochlear or vestibular involvement was elicited. No features suggestive of vasculitis were noted. With the suspicion of Relapsing Polychondritis, the patient was subjected to a CT Thorax/Neck which revealed edema in the glottis region and trachea from C6 to D5, causing luminal narrowing. A respiratory medicine opinion was taken and a bronchoscopy performed. The bronchoscopy showed severe narrowing of the tracheal lumen. A 2 Dimensional Echocardiogram (2DECHO) performed showed anterior mitral leaflet prolapse. Positron Emission Tomography- Computed Tomography (PET CT) done, showed increased uptake in the tracheal and laryngeal cartilage. Based on these clinical findings a diagnosis of Relapsing Polychondritis was made. She was started on Cyclophosphamide pulse therapy under the cover of Luperolide, to prevent gonadal toxicity. A repeat bronchoscopy was performed after 5 pulses of cyclophosphamide which showed improvement. A follow up CT scan showed narrowing at C4 level with no signs of edema. Currently the patient is on regular follow up on an outpatient basis, the cyclophosphamide pulses have been tapered, and her condition is stable, with no further episodes of acute respiratory distress. DISCUSSION Relapsing polychondritis is a systemic disease causing inflammation of cartilaginous structures in multiple organs2 Approximately one-third of patients with relapsing polychondritis suffer from another underlying autoimmune disease such as systemic vasculitis. There is genetic risk for relapsing polychondritis, as suggested by its association with Human Leukocyte Antigen- DR4 isotope (HLA-DR4), which is associated with multiple autoimmune diseases such as rheumatoid arthritis, multiple sclerosis and others. It is suggested that in RP there are circulating antibodiesagainst type II collagen, which leads to cell-mediated injury to targeted organs in the diseaseprocess3. Clinical phenotypes of relapsing polychondritis follow two patterns; either nasal cartilage/airway involvement or external ear involvement4. Typically, auricular chondritis occurs in almost 90% of the patients5. However, as demonstrated in our patient, its absence does not rule out the diagnosis of relapsing polychondritis.The respiratory tract is affected in more than 50% of the cases5. Respiratory disturbance results from airway collapse secondary to destruction of tracheal rings or narrowingof the tracheal lumen caused by fibrous or inflammatory edema. Airway manifestations are the commonest cause of morbidity and mortality in the disease6. The management of respiratory tract involvement in relapsing polychondritis is important because sudden respiratory arrest mayoccur5, as manifested by an acute episode of choking in our patient. Failure of early diagnosis of airway involvement in relapsing polychondritis can lead to irreversible cartilage damage. Steroids or other immunosuppressants are ineffective in these advanced cases, and would require airway interventions such as tracheostomy or tracheobronchial stents6. There is no current standard treatment for relapsing polychondritis, owing in part to its rarity. Corticosteroids are considered to be the first line treatment.6 Steroid sparing agents, such as cyclophosphamide, azathioprine, methotrexate and cyclosporine are also found to be helpful. Our patient achieved remission following cyclophosphamide pulse therapy. CONCLUSION Relapsing Polychondritis, is a rare condition, which can present without the classical symptom of auricle chondritis, and as involvement of the laryngotracheobronchial tree alone. In the absence of any specific diagnostic test, a high degree of clinical suspicion is required to arrive at the diagnosis. Recognition and prompt treatment of the airway symptoms of relapsing polychondritits, is beneficial so as to avoid the more invasive airway interventions at more advanced stages of the disease. Conflict of interest: None Englishhttp://ijcrr.com/abstract.php?article_id=2593http://ijcrr.com/article_html.php?did=2593 Harrison’s Principles of Internal Medicine, 20th Edition, Chapter 359, Page no 2597-600 Ferrada MA, Grayson PC, Banerjee S et al. Patient-perceptionof disease-related symptoms and complications in relapsing polychondritis. Arthritis Care Res 2017; Advance Access published 15 December 2017, doi: 10.1002/acr.23492. Maha Almackenzie, Ahmad Alharbi, Sharifa Alhassan, Eleanor Cook and Nezam Altorok, Central Nervous System Vasculitis Associated with Relapsing Polychondritis, Successful Treatment with Cyclophosphamide, The American Journal of the Medical Sciences, http://dx.doi.org/10.1016/j.amjms.2016.11.023. Shimizu J, Yamano Y, Yudoh K, Suzuki N. Organ involvementpattern suggests subgroups within relapsing polychondritis: comment on the article by Dion et al. Arthritis Rheumatol 2018;70:1489 Vito Sabato, Olivier M Vanderveken, Tim Van den Wyngaert, Carl Van Laer & Didier Ebo (2016): A patient with a severe glottic stenosis and saddle nose, Acta Clinica Belgica, DOI: 10.1080/17843286.2015.1111657 Gorard C, Kadri S. Critical airway involvement in relapsing polychondritis. BMJ Case Rep. 2014; 2014. Published 2014 Sep 11. doi:10.1136/bcr-2014-205036