IntroductionExtracellular vesicles (EVs) are known to have a significant role in the central nervous system (CNS) and neurodegenerative disease.MethodsPubMed, Scopus, ISI Web of Science, EMBASE, and Google Scholar were used to identify published articles about EV modifications (2012 to Feb 2022).ResultsIn total, 1,435 published papers were identified among the searched articles, with 1,128 non-duplicate publications being identified. Following the screening of titles and abstracts, 214 publications were excluded; following the full-text screening of 93 published articles, another 33 publications were excluded. The remaining 60 studies were considered. The kappa statistic of 0.868 indicated that the raters were highly reliable. Furthermore, the inter-reliability and intra-reliability coefficients were found to be 0.931 and 0.908, respectively, indicating strong reliability and consistency between the eligible studies identified by the raters. A total of 27 relevant studies demonstrated the role of EVs as therapeutic and diagnostic biomarkers in neurodegenerative diseases. Of note, 19 and 14 studies, respectively, found EVs to be pioneering in diagnostic and therapeutic roles.DiscussionEVs play an important role in the central nervous system (CNS), aiding in cell-to-cell communication and serving as a diagnostic marker and therapeutic target in a variety of neurodegenerative diseases. EVs are the home of several proteins [including-synuclein (-syn) and tau proteins], lipids, and genetic materials such as DNA and RNA. The presence of novel miRNAs in EVs suggests biomarkers for the diagnosis and screening of neurodegenerative disorders. Furthermore, EVs play an important role in the pathogenesis of such disorders. This systematic review discussed the current state of EVs’ role in neurological diseases, as well as some preclinical studies on the therapeutic and diagnostic potential of EVs.

Background: About half the patients with cirrhosis develop ascites during 10 years of observation. The present study was designed to study the relation between spontaneous bacterial peritonitis and serum ascites albumin gradient in chronic liver disease patients.Methods: This prospective observational study was done in 55 patients with chronic liver disease attending IPD of tertiary hospital. Based on investigation findings, patients were divided into two groups: Group A-Patients with sterile cirrhotic ascites, Group B- Patients with spontaneous bacterial peritonitis. Detailed history, examination and relevant investigation were done. Data was collected, recorded and statistical calculation was done using in Microsoft excel 2007.Results: Most common presenting symptoms of SBP patients were increasing ascites refractory to treatment (90%), followed by peripheral edema (80%). Jaundice and hepatic encephalopathy was found in 75% and 65% respectively. Serum and ascites albumin levels were lower in Group B (2.54±0.33 and 0.43±0.23 g/dl respectively) as compared to Group A (2.85±0.36 and 0.91±0.31 g/dl respectively) and it was statistically significant. The Mean±SD of SAAG for group A and group B was (1.94±0.36) and (2.09±0.47 g/dl) respectively. This difference was statistically not significant.Conclusions:Study conclude that the development of spontaneous bacterial peritonitis in chronic liver disease patients with sterile ascites is directly proportional to ascitic fluid albumin and serum albumin concentration whereas occurrence of SBP is not affected by variation in SAAG ratio if it is already higher than 1.1 g/dl.

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INTRODUCTIONDiabetes and vitamin D deficiency are global epidemics. Presently, around 285 million people have diabetes and this number is expected to reach 438 million by the year 2030.1 Given the burden of diabetes and its complications, researchers have long been exploring the role of potentially modifiable factors to identify at-risk individuals prior to diagnosis. Our focus has now shifted to prediabetes, which is an intermediate form of dysglycemia on a spectrum ranging from normal to overt diabetes.2 As per American Diabetes Association, a fasting glucose of 100 -<126 mg/dL, a 2-hour plasma glucose of 140 -<200 mg/dL after a 75-g OGT test, or HbA1c 5.7% (39mmol/mol) to <6.5% (48mmol/mol) defines prediabetes. Diabetes mellitus is diagnosed when fasting glucose >126mg/dL, 2-hour plasma glucose ≥200 mg/dL or HbA1c ≥6.5% (48mmol/mol). Despite the advances in the diagnosis and management of diabetes, achieving normoglycemia or optimal glycemic control is still considered challenging.4 This is because care of prediabetes and type 2 diabetes warrants intense life-style adaptations, polypharmacy and insulin centered regimens. ABSTRACT Background:The growing incidence of diabetes, consequent devastating morbidity, increasing mortality highlight the need for innovative approaches for prevention and management of disease. Pleiotropic hormonal effect of vitamin D3 has speculated its role in pathogenesis of diabetes. This study aims to assess vitamin D3 levels in study and control group and co-relate its level with HbA1c. Methods: This is a cross-sectional observational study done on randomly selected patients from January 2015 to September 2016. Patients were divided into 2 groups: control group and study group including pre-diabetics and diabetics. Venous sample for serum 25-OH vitamin D and HbA1c were collected. Results: 109 subjects were included in the study: 37 controls, 41 pre-diabetics, 31 diabetics. Out of the 37 healthy subjects, 14 (37.9%) had sufficient levels, 11 (29.7%) had insufficient levels whereas 12 (32.4%) were deficient in Serum vitamin D3 levels. Vitamin D3 deficiency was prevalent in 46.3% pre-diabetics, 41.7% diabetics with good glycaemic control and 84.2% diabetics with poor glycaemic control. Conclusions: Using Pearson Chi square, inverse co-relation was found between glycated haemoglobin and vitamin D3 levels (p<0.003).

Background: Citicoline has emerged as a potential neuroprotectant in experimental models in stroke patients. Citicoline has shown some beneficial effects in human ischaemic stroke and with an excellent safety profile while in haemorrhagic stroke data is limited. Authors conducted this study to test role of citicoline in stroke patients in terms of cognition, memory and post stroke disability.Methods: In this prospective study, patients had to be previously independent, aged >18 years of age, presented within 24 hours of onset of symptoms of stroke diagnosed by neuroimaging (CT or MRI). Patients received either a placebo or 500 mg/12 h citicoline for 12 weeks (orally or intravenously). The primary aim was to evaluate improvement in cognition, memory and post stroke disability after 12 weeks. The efficacy endpoint was the percentage of subjects with MMSE and DRS at 12 weeks.Results: Total 75 stroke patients were enrolled, 40 in control group and 35 in citicoline group were allotted randomly. Patients in citicoline group were given intravenous citicoline 500 mg/12 hour during hospital stay and orally 500 mg/12 hour after discharge for up to 12 weeks. Control Group was given Placebo. cognition, memory and post stroke disability show positive improvement in citicoline group.Conclusions: Citicoline shows beneficial effects in stroke in terms of cognition, memory and post stroke disability.

Quercetin (QCT) is a naturally occurring phenolic flavonoid compound with inbuilt characteristics of antioxidant, anti-inflammatory, and immune protection. Several recent studies have shown that QCT and QCTits nanoparticles have therapeutic potential against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Novel therapeutics also include the implication of extracellular vesicles (EVs) to protect from SARS-CoV-2 viral infection. This article highlighted the therapeutic/prophylactic potential of engineered EVs loaded with QCT against SARS-CoV-2 infection. Several biotechnological engineering approaches are available to deliver EVs loaded with QCT nanoparticles. Among these biotechnological advances, a specific approach with significantly higher efficiency and yield has to be opted to fabricate such drug delivery of nano molecules, especially to combat SARS-CoV-2 infection. The current treatment regime protects the human body from virus infection but has some limitations including drugs and long-term steroid side effects. However, the vaccine strategy is somehow effective in inhibiting the spread of coronavirus disease-19 (COVID-19) infection. Moreover, the proposed exosomal therapy met the current need to repair the damaged tissue along with inhibition of COVID-19-associated complications at the tissue level. These scientific findings expand the possibilities and predictability of developing a novel and cost-effective therapeutic approach that combines the dual molecule, EVs and QCT nanoparticles, to treat SARS-CoV-2 infection. Therefore, the most suitable engineering method to fabricate such a drug delivery system should be better understood before developing novel therapeutics for clinical purposes.

Altered calcium homeostasis, including vitamin D deficiency, was found to be associated with subclinical atherosclerosis and low bone mineral density. 6 Vitamin D insufficiency has been linked to cardiovascular diseases, infections, and even cancer in recent large epidemiological studies. 7 Low serum levels of 25-ABSTRACT Background: This study aimed to investigate the relationship between serum vitamin D level and carotid artery intima-media thickness in ischemic stroke patients. The correlation of vitamin D and carotid artery intima media thickness in ischemic stroke patients had conflicting results in different parts of the world. Methods: 217 patients with CVA infarct were selected for analysis between ages 45 and 80 years admitted at our hospital from January 2014 to December 2015. Measurements of serum vitamin D concentration and Carotid-IMT were made by electrochemiluminescence immunoassay and B-mode ultrasound, respectively. Confounding variables like diabetes, hypertension, smoking, alcohol, tobacco, dyslipidemia, BMI, CRP, Serum uric acid, duration of sunlight exposure, prior history of drug intake or fracture and Serum calcium were considered. 200 age and sex matched controls were taken. Questionnaires were used for data collection and multiple linear regression analysis and correlation analysis were used. Results: The mean serum level of vitamin D was 19.14±9.45 SD ng/mL and average IMT was 0.78±0.09 SD mm with pearson coefficient of (-0.36) significant at 0.01 level. The R 2 value was 0.13. Conclusions: Correlation analysis found an inverse relationship between serum vitamin D level and carotid-IMT in ischemic stroke patients.

INTRODUCTIONExposure to sunlight and taking food rich in vitamin D can meet our daily requirements.1,2 Low serum levels of 25-hydroxyvitamin D (25(OH)D) is also shown to be associated with insulin resistance. 3,4 Vitamin D insufficiency has been linked to cardiovascular diseases, infections and even cancer in recent large epidemiological studies.5 Rise in serum cholesterol is associated with increase in cardiovascular diseases. 6,7 Studies have also demonstrated that 25-hydroxyvitamin D deficiency is a novel CV risk factor, predicting both CV events and mortality.8 Vitamin-D deficiency is associated with changes in PTH, calcium, phosphorus, and 1,25-dihydroxyvitamin D levels (1,25[OH]2D). 9 METHODSA case control study where all cases of ischemic stroke admitted from neurology clinic , OPD and medicine wards of LLR and associated hospitals, Kanpur, India from January 2014 to December 2015 and age and sex matched controls not having ischemic stroke were taken after informed consent.Age group >30 years irrespective of sex with diagnosis of ischemic stroke by CT scan or MRI brain were included in the study and patients with valvular heart disease, cardiomyopathy, congenital heart disease and connective tissue disorders were excluded. ABSTRACTBackground: This study aimed to investigate the relationship between serum vitamin D level and lipid profile in ischemic stroke patients. Methods: 217 patients with ischemic stroke were selected for analysis between ages 45 and 80 years admitted at our hospital from January 2014 to December 2015. Measurement of serum vitamin-D concentration was made by electrochemiluminescence immunoassay. Confounding variables like diabetes, hypertension, smoking, alcohol, tobacco, BMI, CRP, S. uric acid, duration of sunlight exposure, prior history of drug intake or fracture and S. calcium were considered. 200 age and sex matched controls were taken. The source of data was questionnaires and multiple linear regression analysis and correlation analysis were used. Results: A positive correlation was seen between vitamin D and serum cholesterol, VLDL, LDL, triglycerides, cholesterol/HDL ratio and LDL/HDL ratio but inverse correlation between vitamin D and HDL. Conclusions: In ischemic stroke patients increase in vitamin D is associated with increase in atherogenic lipids.