Hypoglycemia, With or Without Insulin Therapy, Is Associated With Increased Mortality Among Hospitalized Patients

OBJECTIVE Hypoglycemia is associated with increased mortality in hospitalized patients. We investigated the relationship between spontaneous hypoglycemia versus insulin-associated hypoglycemia and mortality in hospitalized patients. RESEARCH DESIGN AND METHODS Data for this retrospective cohort study were obtained from electronic databases of patients admitted between 1 April 2008 and 30 November 2010. Patients with one or more blood glucose values ≤50 mg/dL on point-of-care glucose testing were considered hypoglycemic. Patients treated with insulin were assumed to have insulin-associated hypoglycemia. Age-, sex-, and race-matched patients with all blood glucose values >70 mg/dL were selected as controls. The Charlson comorbidity index (CCI) was used to control for severity of illness. RESULTS There were four groups: 1) noninsulin-treated hypoglycemia (NTH) (n = 135), 2) insulin-treated hypoglycemia (ITH) (n = 961), 3) noninsulin-treated control (NTC) (n = 1,058), and 4) insulin-treated control (ITC) (n = 736). Mortality was higher in the ITH group compared with the ITC group (20.3 vs. 4.5%, P < 0.0001), with a relatively higher CCI (1.8 vs. 1.5%, P < 0.0001), but much higher in the NTH group compared with the NTC group (34.5 vs. 1.1%, P < 0.0001), with much higher CCI (2.4 vs. 1.1%, P < 0.0001). Mortality was higher in the NTH group compared with the ITH group (P < 0.0001) but lower in the NTC group compared with the ITC group (P < 0.0001). After controlling for age, sex, CCI, and admission to the intensive care unit, insulin treatment was associated with a lower mortality among the hypoglycemic patients; hazard ratio of death in the ITH group relative to the NTH group was 0.34 (95% CI 0.25–0.47, P < 0.0001). CONCLUSIONS Insulin-associated and spontaneous hypoglycemia are associated with increased mortality among hospitalized patients

Management of immature teeth by dentin-pulp regeneration : a recent approach

Treatment of the young permanent tooth with a necrotic root canal system and an incompletely developed root is very difficult and challenging. Few acceptable results have been achieved through apexification but use of long-term calcium hydroxide might alter the mechanical properties of dentin. Thus, one alternative approach is to develop and restore a functional pulp-dentin complex. Procedures attempting to preserve the potentially remaining dental pulp stem cells and mesenchymal stem cells of the apical papilla can result in canal revascularization and the completion of root maturation. There are several advantages of promoting apexogenesis in immature teeth with open apices. It encourages a longer and thicker root to develop thus decreasing the propensity of long term root fracture. So, the present article reviews the recent approach of regeneration of pulp-dentin complex in immature permanent teeth. © Medicina Oral S. L

Andrographis paniculata transcriptome provides molecular insights into tissue-specific accumulation of medicinal diterpenes

A summary of SSRs identified in leaf and root transcriptomes. (DOCX 11 kb

Hydroxychloroquine improves insulin sensitivity in obese non-diabetic individuals

Introduction: Hydroxychloroquine (HCQ) is a common disease modifying therapy for the treatment of rheumatoid arthritis (RA). Prior research suggests that HCQ may reduce the risk of diabetes mellitus in patients with RA. To investigate the mechanism of this effect, we examined the effect of HCQ on insulin resistance, insulin sensitivity, and pancreatic β-cell secretion of insulin in non-diabetic, obese subjects. Methods We recruited 13 obese, non-diabetic subjects without systemic inflammatory conditions for an open-label longitudinal study of HCQ 6.5 mg per kilogram per day for six weeks. Subjects underwent an oral glucose tolerance test at three time points: 0 weeks (pre-treatment with HCQ), 6 weeks (at the end of the HCQ treatment), and 12 weeks (6 weeks post HCQ-treatment). The Matsuda Insulin Sensitivity Index (ISI), HOMA-IR, and HOMA-B were compared across time-points. Results: The mean age of the cohort was 49 years, 77% females and median body mass index was 36.1 kg/m2. After 6 weeks of HCQ therapy, ISI increased from a median (interquartile range) of 4.5 (2.3-7.8) to 8.9 (3.7-11.4) with a p-value of 0.040, and HOMA-IR decreased from a median of 2.1 (1.6-5.4) to 1.8 (1.02-2.1) with a p-value of 0.09. All these variables returned toward baseline at week 12. Conclusion: HCQ use for 6 weeks in non diabetic obese subjects was associated with a significant increase in ISI and trends toward reduced insulin resistance and insulin secretion. These data suggest that HCQ, a common medication used to treat RA, possesses beneficial effects upon insulin sensitization. Further study of the insulin sensitizing effects of HCQ in patients with RA is warranted

Analysis and Design of Resilient VLSI Circuits

The reliable operation of Integrated Circuits (ICs) has become increasingly difficult to achieve in the deep sub-micron (DSM) era. With continuously decreasing device feature sizes, combined with lower supply voltages and higher operating frequencies, the noise immunity of VLSI circuits is decreasing alarmingly. Thus, VLSI circuits are becoming more vulnerable to noise effects such as crosstalk, power supply variations and radiation-induced soft errors. Among these noise sources, soft errors (or error caused by radiation particle strikes) have become an increasingly troublesome issue for memory arrays as well as combinational logic circuits. Also, in the DSM era, process variations are increasing at an alarming rate, making it more difficult to design reliable VLSI circuits. Hence, it is important to efficiently design robust VLSI circuits that are resilient to radiation particle strikes and process variations. The work presented in this dissertation presents several analysis and design techniques with the goal of realizing VLSI circuits which are tolerant to radiation particle strikes and process variations. This dissertation consists of two parts. The first part proposes four analysis and two design approaches to address radiation particle strikes. The analysis techniques for the radiation particle strikes include: an approach to analytically determine the pulse width and the pulse shape of a radiation induced voltage glitch in combinational circuits, a technique to model the dynamic stability of SRAMs, and a 3D device-level analysis of the radiation tolerance of voltage scaled circuits. Experimental results demonstrate that the proposed techniques for analyzing radiation particle strikes in combinational circuits and SRAMs are fast and accurate compared to SPICE. Therefore, these analysis approaches can be easily integrated in a VLSI design flow to analyze the radiation tolerance of such circuits, and harden them early in the design flow. From 3D device-level analysis of the radiation tolerance of voltage scaled circuits, several non-intuitive observations are made and correspondingly, a set of guidelines are proposed, which are important to consider to realize radiation hardened circuits. Two circuit level hardening approaches are also presented to harden combinational circuits against a radiation particle strike. These hardening approaches significantly improve the tolerance of combinational circuits against low and very high energy radiation particle strikes respectively, with modest area and delay overheads. The second part of this dissertation addresses process variations. A technique is developed to perform sensitizable statistical timing analysis of a circuit, and thereby improve the accuracy of timing analysis under process variations. Experimental results demonstrate that this technique is able to significantly reduce the pessimism due to two sources of inaccuracy which plague current statistical static timing analysis (SSTA) tools. Two design approaches are also proposed to improve the process variation tolerance of combinational circuits and voltage level shifters (which are used in circuits with multiple interacting power supply domains), respectively. The variation tolerant design approach for combinational circuits significantly improves the resilience of these circuits to random process variations, with a reduction in the worst case delay and low area penalty. The proposed voltage level shifter is faster, requires lower dynamic power and area, has lower leakage currents, and is more tolerant to process variations, compared to the best known previous approach. In summary, this dissertation presents several analysis and design techniques which significantly augment the existing work in the area of resilient VLSI circuit design

Energy Efficient Wireless Sink Node for Monitoring of Snow Environment

Conventionally, sink node is considered to have large hardware and energy resources; however, many times sink node is working in same conditions as source nodes, especially when deployed for monitoring of the snow environment. In this paper, an effort has been made to practically realize a sink node which is energy efficient and cost effective for monitoring applications. To save energy, the Main Power Module is designed to provide controlled powers to sensors and sub-modules. The paper discusses design aspects of the sink node and its long-term field evaluation with environmental sensors, especially the Snow Depth Sensor of MaxBotix. Field performance of Snow Depth Sensor has been enhanced by Euclidean Minimum Distance filter which improved the correlation of data to 0.997. The proposed design helps to achieve energy consumption of 42.72mWh which is significantly lower than the previous work. The reliable working of the sink node in the long-term field evaluation indicates that snow environment can be monitored at less expense of energy by employing proposed sensors and the specially designed sink node

Expert opinion on challenges in the diagnosis and treatment of OCD in India

Obsessive-compulsive disorder (OCD) is considered as a significant cause of disability worldwide, ranking among the top 10 causes. The diagnosis of OCD is often delayed due to the reluctance of patients to share their symptoms. OCD is also associated with the presence of other comorbid psychological conditions like anxiety, depression, and schizophrenia among others, which adds to the challenge of accurate diagnosis. Delayed diagnosis and the presence of comorbid conditions have a poor prognosis. Hence, an increased awareness about identifying symptoms of OCD among doctors and the general public is important. Even though clinical practice guidelines outline the management for OCD, challenges in appropriate management exist. This review elaborates the challenges associated with the diagnosis and management of OCD in India and presents insights from experts which can help doctors in early diagnosis and appropriate management of this debilitating condition

Standard Infection Control Practices among Peripheral Health Care Workers: A Knowledge, Attitude and Practice Study from a Rural Haryana

Background: Globally, around 2.5% of HIV and 40% of HBV among Health Care Workers (HCWs) are attributed to occupational exposure with an overall incidence of occupational exposure to blood/body fluids among HCW as 32.3%. There exists a gap between the knowledge and practice of standard infection control practices among HCW. Failure to follow these standard protocols leads to loss of precious work hours of this skilled work force.Methods: To know the knowledge, attitude and practice regarding standard infection control protocols, a community based, cross- sectional, analytical, non –interventional study was planned among health care workers at a Rural Community Health Centre (CHC) , Dighal of district Jhajjar (Haryana). A total of 50 HCWs were included in the study. The study was conducted during the months of July –August, 2016.Results: About 56% of HCWs were having the knowledge about the correct steps of hand washing but only 20% were actually practicing hand washing before administrating injections. Only 28% of participants were correctly using hub-cutter and needle destroyers after the injection practices. It was observed that 42% of subjects were still trying to re-cap needles after the injections. 60% of subjects felt that using standard precautions was cumbersome. 74% of the subjects felt that using standard precautions was expensive. 54% of study subjects felt that it was difficult to follow stand precautions in government institutions due to logistics issues. Only 28% of the participants had received complete vaccination against Hepatitis B.Conclusion: There exists a huge gap between the knowledge and practice of standard infection control protocols. Among most of the HCWs, the attitude was not positive towards using standard precautions despite having knowledge. Lack of initiative from the higher up officials, poor training, poor monitoring further complex the issue. Regular monitoring and supervision, capacity building of HCWs along with regular logistic supply are recommended

Global Environmental Microelectromechanical Systems Sensors: Advanced Weather Observation System

The technological developments in microelectromechanical systems (MEMS) have resulted in conceptualisation of a next generation observation system called global environmental MEMS sensors (GEMS). GEMS consists of a large number of airborne probes that will remain suspended in the atmosphere for long durations and take in situ measurements of pressure, temperature, humidity, wind direction and velocity as these are carried by air currents. It is envisaged that GEMS network would provide a systematic understanding of the earths atmosphere and would improve weather forecast accuracy, well beyond the current capability. In addition to gathering meteorological data, probes could be used for environmental monitoring of particulate emissions, organic and inorganic pollutants, ozone, carbon dioxide, and chemical, biological, or nuclear contaminants. The GEMS concept requires integration of communication engineering and instrumentation with other evolving technologies. This review describes in detail the new observation system designed for environmental monitoring and its potential application in predicting cyclones and monsoon, and measurement of urban air pollution in India. The possible application of the GEMS system during military operations has also been brought out.Defence Science Journal, 2009, 59(6), pp.659-665, DOI:http://dx.doi.org/10.14429/dsj.59.157

The conformational phase diagram of neutral polymers in the presence of attractive crowders

Extensive coarse grained molecular dynamics simulations are performed to investigate the conformational phase diagram of a neutral polymer in the presence of attractive crowders. We show that, for low crowded densities, the polymer predominantly shows three phases as a function of both intra polymer and polymer-crowder interactions: (1) weak intra polymer and weak polymer-crowder attractive interactions induce extended or coil polymer conformations (phase E) (2) strong intra polymer and relatively weak polymer-crowder attractive interactions induce collapsed or globular conformations (phase CI) and (3) strong polymer-crowder attractive interactions, regardless of intra polymer interactions, induce a second collapsed or globular conformation that encloses bridging crowders (phase CB). The detailed phase diagram is obtained by determining the phase boundaries delineating the different phases based on an analysis of the radius of gyration as well as bridging crowders. The dependence of the phase diagram on strength of crowder-crowder attractive interactions and crowder density is clarified. We also show that when the crowder density is increased, a third collapsed phase of the polymer emerges for weak intra polymer attractive interactions. This crowder density induced compaction is shown to be enhanced by stronger crowder-crowder attraction and is different from the depletion induced collapse mechanism which is primarily driven by repulsive interactions. We also provide a unified explanation of the observed reentrant swollen/extended conformations of earlier simulations of weak and strongly self interacting polymers in terms of crowder-crowder attractive interactions