Retrospective, observational study to see the effect of evogliptin on continuous glucose monitoring (CGM) in T2DM Indian patients: A real-world experience

This study aimed to assess effectiveness of Evogliptin 5 mg through continues glucose monitoring (CGM) in patients with T2DM in retrospective observational real world settings. Overall 6 patients who received Evogliptin as routine clinical practice in management of T2DM were analyzed retrospectively from single center. Data collected from past medical records. FreeStyle Librepro 1.0.6 was used for CGM. CGM was done 15 days prior to adding Evogliptin and repeated immediately after that for next 15 days. Mean BG level, Percentage time in target range (80-140mg/dl), Percentage time above target and Percentage time below target were assessed prior and after adding Evogliptin in existing treatment regimen. Significant reduction in Mean blood glucose level seen after adding Evogliptin in existing treatment regimen from 215 mg/dl to 138 mg/dl (-77 mg/dl P=0.006). Significant improvement seen in Percentage time in target range (80-140mg/dl) from 17% to 44% (27% P value 0.007) and in Percentage time above target from 81% to 43% (- 38%, P valve 0.003). 13.5 % of the patients seen below target. Evogliptin was found to be effective when added to the patients who were uncontrolled on other oral anti-diabetic medications. It effectively showed improvement in continues glucose monitoring (CGM) parameters like Mean blood glucose, more number of patients were in Time in Target range i.e (80-140mg/dl) after adding Evogliptin to existing anti-diabetic medications & well tolerated. Small sample size and retrospective study

Structure of the Lysinibacillus sphaericus Tpp49Aa1 pesticidal protein elucidated from natural crystals using MHz-SFX

Tpp49Aa1 from Lysinibacillus sphaericus is a Toxin_10 family protein that must interact with Cry48Aa1, a 3-domain crystal protein, to produce potent mosquitocidal activity, specifically against Culex quinquefasciatus mosquitoes. We use Culex cell lines to demonstrate for the first time transient detrimental effects of individual toxin components and widen the known target range of the proteins. MHz serial femtosecond crystallography at a nano-focused X-ray free electron laser allowed rapid and high-quality data collection to determine the Tpp49Aa1 structure at 2.2 Å resolution from the merged X-ray diffraction data. The structure revealed the packing of Cry49Aa1 within the natural nanocrystals isolated from sporulated bacteria, as a homodimer with a large intermolecular interface. We then modelled the potential interaction between Tpp49Aa1 and Cry48Aa1. The structure sheds light on natural crystallisation and, along with cell-based assays broadens our understanding of this two-component system.

The feasibility of Telemedicine in Implementation of Therapeutic Hypothermia for Management of Neonatal Hypoxic-Ischemic Encephalopathy in Resource-Limited Areas.

Background: Telemedicine is widely used in neonatal services in developed countries. Lack of expertise and/or facilities, however, limited its use in developing countries and around areas of military conflicts. To our knowledge, no reports are demonstrating the feasibility of administering therapeutic hypothermia (TH) through telemedicine to neonates with hypoxic-ischemic encephalopathy (HIE) in resource-limited areas.Methodology: This is a retrospective study, evaluating 22 patients who received TH, guided by telemedicine, through a mobile app (Telegram®). We assessed the feasibility of utilizing Telemedicine in guiding the application of TH to infants affected with HIE in the North-West of Syria between July 2020 and July 2021.Results: Out of 5,545 newborn infants delivered during the study period, 22 patients were eligible for TH guided by Telemedicine. Patients were referred for consultation at a median (IQR) of 137 (35-165) minutes of life. A median (IQR) of 12 (3-18) minutes elapsed between the call for a consultation and the consultant response, and a median (IQR) of 30 (0-42) minutes elapsed between seeking the consultation and the initiation of cooling therapy. Eighteen patients completed cooling for 72 hours. The patients' temperatures were within the target range (33-34°C) most of the time (84.1%).Conclusion: Telemedicine is a feasible method to guide the implementation TH for HIE in resource-limited areas. The short-term success rate is relatively high; however, further studies with a larger population are needed to confirm these findings.

Glucose control after glucocorticoid administration in hospitalized patients – a retrospective analysis

Background Glucocorticoid (GC)-induced hyperglycemia is a frequent adverse effect in hospitalized patients. Guidelines recommend insulin treatment to a target range of 6–10 mmol/L (108–180 mg/dl), but efficacies of particular regimes have not been well-studied. Methods In this retrospective cohort study, hospitalized patients receiving GCs at the medical ward were analyzed by treatment (basal-bolus vs. bolus-only vs. pre-mixed insulin) and compared to a non-insulin-therapy reference group. Coefficients of glucose variation (CV), percentage of glucose readings in range (4–10 mmol/L (72–180 mg/dl)) and hypoglycemia (< 4 mmol/L (< 72 mg/dl)) were evaluated. Results Of 2424 hospitalized patients receiving systemic GCs, 875 (36%) developed GC-induced hyperglycemia. 427 patients (17%) had a previous diagnosis of diabetes. Adjusted relative risk ratios (RRR) for the top tertile of CV (> 29%) were 1.47 (95% Cl 1.01–2.15) for bolus-only insulin, 4.77 (95% CI 2.67–8.51) for basal-bolus insulin, and 4.98 (95% CI 2.02–12.31) for premixed insulin, respectively. Adjusted RRR for percentages of glucose readings in range were 0.98 (95% Cl 0.97–0.99) for basal-bolus insulin, 0.99 (95% Cl 0.98–1.00) for premixed insulin, and 1.01 (95% Cl 1.00–1.01) for bolus-only insulin, respectively. Adjusted RRR for hypoglycemia was 13.17 (95% Cl 4.35–39.90) for basal-bolus insulin, 8.92 (95% Cl 2.60–30.63) for premixed insulin, and 2.99 (95% Cl 1.01–8.87) for bolus-only insulin, respectively. Conclusions Current guidelines recommend a basal-bolus regimen for treatment of GC-induced hyperglycemia, but we found similar outcomes with pre-mixed and bolus-only insulin regimens. As GC-induced hyperglycemia is a frequent issue in hospitalized patients, it might be reasonable to prospectively study the ideal regimen.

Remote monitoring of adolescents with type 1 diabetes mellitus using a mobile application

Background: The prevalence of type 1 diabetes mellitus (T1DM) in childhood is increasing every year. Adolescence is the most challenging age for achieving optimal metabolic control of T1DM. Telemedicine has already been shown to be ­effective in children with the condition, but there are not enough studies in adolescents. The use of mobile apps may be associated with better glycemic control in patients with type 1 diabetes.Aims: To assess the effectiveness and safety of a model of medical care for adolescents with type 1 diabetes using remote counseling and a mobile application.Materials and methods: Were included adolescents aged ≥14 and 18 years with a T1DM duration> 3 months, a glycated hemoglobin level (HbA1c)> 7%. The duration of the study was 26 weeks. There were 3 face-to-face and at least 4 remote visits using a mobile application. All patients underwent standard examination and anthropometry, study of HbA1c, registration and analysis of indicators, assessment and correction of the treatment. The quality of life of adolescents was assessed at baseline and at the end of the study. Adolescents and physicians were interviewed about program evaluation.Results: 56 patients were included, 7 adolescents withdrew. HbA1c significantly decreased by the 12th week of the study (–0.3%; p = 0.005), by the end of the study the change in HbA1c was –0.5% (p <0.001). There was an increase in the percentage of glucose measurements in the target range (+5.3 pp; p = 0.016) and a decrease in blood glucose variability (-3.1 pp; p = 0.015). There was a significant improvement in both the total assessment of the quality of life by patients (+2.9 points; p = 0.008) and individual components of its indicators: attitude to diabetes (+3.0 points; p = 0.049), attitude to treatment (+4.6 points; p = 0.010) and communication with others (+4.5 points; p = 0.015). The majority of doctors and patients assessed their participation in the study positively. The incidence of adverse events did not change significantly during the study from baseline.Conclusion: Remote counseling using a mobile app is a safe and effective approach for adolescents with T1DM in terms of glycemic control and quality of life, and provides convenience and speed of interaction.

An Efficient Maritime Target Joint Detection and Imaging Method with Airborne ISAR System

In this paper, a joint maritime moving target detection and imaging approach, referred to as the fast inverse synthetic aperture radar (ISAR) imaging approach, based on the multi-resolution space−time adaptive processing (STAP), is proposed to improve the target detection performance and the target imaging efficiency in an airborne radar system. In the target detection stage, the sub-band STAP is introduced to improve the robustness of clutter suppression and to enhance the target output power with the decreased range resolution, by which the coarse estimation of target range-Doppler (R-D) location is obtained as the prior knowledge. In the following target imaging stage, the ISAR imaging is applied in the localized R-D zone surrounding with the target location. However, it is difficult to directly apply ISAR imaging with the conventional R-D algorithm because the slow-moving maritime target cannot be separated from the clutter interference in the Doppler frequency dimension. In this regard, the full-band STAP is applied in the R-D two-dimensional frequency domain for the simultaneous clutter suppression and high-resolution ISAR imaging, in which the envelope alignment and phase compensation are achieved by adaptive match filtering with the target Doppler frequency coarse estimation. Moreover, the reduced-dimension STAP applied in the target-surrounded localized Doppler frequency zone gives facilities for alleviating the computation burden. Simulation results corroborate the effectiveness of the proposed method.

Simulative Investigation of FMCW Based Optical Photonic Radar And Its Different Configurations

Intelligent transportation is becoming integral part of future smart cities where driverless operations may provide hassle free conveyance. Photonic radar technology is one such contender to deliver attractive applications in autonomous vehicle sector. In this paper we have discussed the basic principle of frequency modulated continuous wave (FMCW) photonic radar and their possible advantages. Further the basic detection schemes that is direct detection and coherent detection is explained mathematically as well as numerical simulations to understand workings is also carried out. The obtained results concludes that direct detection scheme provides minimal complexity in its architecture and is sensitive to received signal strength at the cost of thermal noise and poor sensitivity. On the other hand, coherent detection offers higher target range estimation as well as velocity measurement at the expense of increased system complexity.

Recommend-Response and Complications Comparing Radiofrequency Ablation Versus Parathyroidectomy for Secondary Hyperparathyroidism in Dialysis Patients

Introduction : To compare the efficacy and safety of ultrasound(US)-guided radiofrequency ablation (RFA) and parathyroidectomy (PTX) in the treatment of secondary hyperparathyroidism (SHPT). Methods In this retrospective study, we divided patients into PTX (n=53) and RFA (n=47) groups. The primary outcomes were the proportion of patients achieved the target range of iPTH concentrations(124-558pg/mL) and the long-term prognosis. The secondary outcomes were the differences in the changes of iPTH, calcium, and phosphorus over time and the incidence of adverse events. Results There was rarely difference in baseline characteristics between the two groups. Primary outcomes: The iPTH concentrations of 25.8% of patients in the PTX group and 51.3% of the RFA group were within the recommended range at the endpoint (P=0.031). Survival analysis revealed that the difference in all-cause mortality and cumulative response rate between the two groups was not statistically significant (P=0.902, P=0.141, respectively). Secondary outcomes: The iPTH concentrations in PTX group and RFA group dropped sharply after treatment and were 82.30±163.21pg/mL and 279.96±306.57pg/mL (P<0.001). There was no difference in the trend of iPTH, calcium, and phosphorus levels between the two groups over time(P>0.05). In addition, the incidence of infection and the hospital stay in the RFA group were significantly less. And preoperative bone-specific alkaline phosphatase concentration was a risk factor for postoperative hypocalcemia. Conclusion US-guided RFA was minimally invasive and no less than PTX in terms of cumulative response rate and complications in the treatment of severe SHPT in maintenance dialysis patients and may be used as an alternative technique to PTX, which need further studies to confirm.

Sportolás elektronikus monitorozással időskorban

Összefoglaló. Idősebb korban a testgyakorlás különösen fontos az izmok sorvadásának megelőzése, valamint a vérnyomás és a testsúly kontrollja céljából. Ma már egyre gyakoribb az időskorúak részvétele sportversenyeken is. Esettanulmányunk célja a késő felnőttkori, illetve időskori versenyszerű sportolás egészségi alkalmassági feltételeinek, kockázatainak és a teljesítőképesség változásainak bemutatása az elektronikus monitorozás és virtuális versenyzés korában. Esetünkben ez egy időskorú személy 16 év során (54–70 éves kor) teljesített maratoni futóversenyeinek, valamint virtuális evezőversenyek részvételi és felkészülési adatainak elemzésével valósul meg. Esetünk illusztrálja, hogy az észszerű túlterhelés elve alapján az izmok adaptációja akkor következik be, amikor az edzés terhelése meghaladja az addig már elért terhelési szintet. A sportóra használata az elektronikus pulzusszám és a teljesítmény monitorozásával nemcsak a versenyek és edzések alatt a pulzusszám céltartományban tartására, de hosszabb távú tendenciák felismerésére is hasznosnak bizonyult. Az egészségi állapotnak megfelelő (sportág és intenzitás) időskori testgyakorlás és sportversenyen való részvétel nemcsak az erőnlét megtartását tűzheti ki célul, hanem értékes erőnlétfejlesztést is. Orv Hetil. 2021; 162(51): 2061–2066. Summary. With advancing age, exercise becomes particularly important to prevent muscle atrophy and to control blood pressure and weight. Today, participation of aging people in athletic competitions is increasingly common. The aim of our case study is to explore and illustrate the health conditions, development and risk factors of competitive sporting activities of late adult and elderly athletes in the age of electronic monitoring and virtual racing. We processed the preparation and participation data of a total of 16 years of marathon races as well as rowing machine races of an elderly male person (age 54–70). Using a sports watch with electronic heart rate and performance monitoring has proved useful not only for keeping the heart rate in target range, but also for assessing trends in the long run. Our case underscores the value of reasonable overload with advancing age; beneficial muscle adaptation occurs when the workload of an exercise exceeds the previously reached level. Gradual exercise of older adults and participation in athletic competitions can not only maintain fitness but also develop valuable additional strength. Orv Hetil. 2021; 162(51): 2061–2066.

Preoperative Management of Diabetic Patients, an Overview

Glycemic control is critical in the perioperative setting, especially in diabetic patients. The consequences of surgical tension and anesthesia on blood sugar levels are distinct, and should be considered in order to maintain optimal glycemic control. Each stage of surgery presents its own set of challenges in terms of keeping glucose levels within the target range. Furthermore, there are some surgical conditions that necessitate specific glucose management protocols. Authors hope to highlight the most crucial factors to consider when developing a perioperative diabetic regimen, while still allowing for specific adjustments based on sound clinical judgement. Overall, by carefully managing glycemic control in perioperative patients, we may be able to reduce morbidity and mortality while improving surgical outcomes.