Daily Requirements Research Articles

The distinctive pharmacokinetic profile of rezafungin, a long-acting echinocandin developed in the era of modern pharmacometrics.

Echinocandin drugs are the current first-line therapy for fungal infections caused by Candida spp. Most patients require once-daily intravenous (IV) administration in a hospital or outpatient setting for treatment, which may negatively impact their quality of life and stress healthcare resources. Similar to other echinocandins, the novel FDA-, EMA-, and Medical and Healthcare Products Regulatory Agency-approved echinocandin, rezafungin (CD101), exhibited strong antifungal activity against several fungal pathogens and a low drug-drug interaction liability, which are important for medically complex patients. A pharmacometric-based approach has been adopted throughout the development of rezafungin, which contrasts with older echinocandins where dosing regimens were largely derived empirically, and only recently based on pharmacometric guidance. This state-of-the-art approach used model-based simulations incorporating pre-clinical and clinical data as it became available to optimize the dosing regimen for rezafungin. The enhanced stability of the molecular structure and the safety profile of rezafungin allow for the administration of once-weekly IV doses, compared to the daily dosing requirement for other echinocandin drugs, with this distinctive pharmacokinetic profile of rezafungin resulting in a front-loaded dosing regimen with high exposures early in therapy for enhanced fungal killing. The long shelf-life of rezafungin makes this echinocandin more flexible in terms of storage and manufacturing. Demonstrated across clinical development, rezafungin may provide patients with next-generation first-line antifungal treatment for the treatment of candidaemia and invasive candidiasis.

Biochemical diversity in Brassica leafy greens and sensory evaluation of its Saag, an Indian cuisine known for its cancer-preventive properties

Abstract Despite the wide consumption of Brassica leaves as Saag in North India during the winter season, there is a notable gap in the information regarding the nutritional profile of the available germplasm resources. This study aims to compare the nutritional value and mineral composition of eleven green leafy Brassica accessions of Indian and exotic origin. A significant variation was recorded in health-promoting compounds among the different accessions. The heat map generated through hierarchical clustering analysis (HCA) depicts three promising accessions, namely Chinese Sarson, Saag sarson, and KPT 9, which exhibit rich nutritional and antioxidant properties. Additionally, ascorbic acid and total phenols significantly correlated with the antioxidant activity of Brassica leafy greens. A significant difference in the compositional pattern of key macro-minerals (Ca, Mg, P) and micro-minerals (Zn, Fe, Cu, Mn) was noticed in the accessions. Among the eleven accession studied, GSC 7, Saag Sarson and Kangra Brown Sarson 3 exhibited richness in these elements, making them a suitable source for supplying a sizable portion of our daily mineral requirements. Subsequently, the Saag, an Indian cuisine prepared from the leaves of these accessions was subjected to sensory evaluation. The results showed that Chinese Sarson and Saag sarson received the highest consumer acceptance and were greatly appreciated. The information acquired from this study could serve as a valuable reference for the selection of high-quality leafy Brassica varieties for breeding programs aimed at enhancing nutritional value and broadening the genetic base of this important food crop.

Continuation versus Interruption of Buprenorphine/Naloxone in Adult Veterans Undergoing Surgery: Examination of Postoperative Pain and Opioid Utilization in a National Retrospective Cohort Study.

Prescription rates for buprenorphine in opioid use disorder are increasing, and recent guidelines recommend its continuation during and after surgery; however, evidence from clinical outcome studies is limited. We tested the hypotheses that 1) perioperative continuation of buprenorphine does not result in higher pain scores and 2) that this approach does not result in higher supplemental postoperative opioid requirements. The Veterans Affairs Corporate Data Warehouse was queried for patients who underwent surgery while being prescribed buprenorphine/naloxone for opioid use disorder between 2010 and 2020. Analysis of the prescription record was used to infer buprenorphine management, and a 3:1 matched control set of patients without buprenorphine prescriptions was generated. We examined patients who continued buprenorphine, patients who had buprenorphine interrupted, and control patients. The primary outcome was time-weighted average postoperative pain scores from inpatient and outpatient sources within 72 hours of surgery. The secondary outcome was postoperative average daily morphine equivalent opioid requirements within two weeks of surgery. A total of 1,881 surgical procedures in 1,673 patients taking buprenorphine for opioid use disorder were included; these procedures were matched to 5,748 control patients (5,775 procedures) without a buprenorphine prescription. Among the 1,881 procedures, 1,186 (63%) continued buprenorphine through the perioperative period while 695 (37%) interrupted buprenorphine. Pain scores were clinically similar for all three groups (4.1 ± 1.9 control [n = 3284], 4.9 ± 2.0 continued buprenorphine [n = 662], and 5.5 ± 1.7 interrupted buprenorphine [n = 419]; P < 0.001).Patients who continued buprenorphine did not require significantly more supplemental opioids as compared to controls (39.7 mg morphine equivalents/day ± 1.9 versus 36.5 ± 0.7, P = 0.23), and patients who interrupted buprenorphine received more supplemental opioids than those who continued it (74.2 ± 4.5 mg morphine equivalents/day versus 39.7 ± 1.9,respectively; P < 0.001). Continuation of buprenorphine is not associated with higher average pain scores or postoperative opioid requirements, supporting recently published guidelines.

Exploring the Potential of Spray-Dried Blackberry Powder Enriched with Zinc and Folic Acid as a Nutritional Alternative for Children and Pregnant Women

Currently, strategies to achieve the Sustainable Development Goals (SDGs) are being sought worldwide. Accordingly, this study seeks to contribute to achieving SDGs 2 (Zero Hunger) and 3 (Good Health and Well-being) by addressing nutritional deficiencies in pregnant women and children. These vulnerable populations worldwide have malnutrition problems associated with a lack of zinc and folic acid, causing them health problems. This research aimed to develop a blackberry powder fortified with zinc and folic acid obtained by spray drying as a nutritional alternative for children and pregnant women. The blackberry was characterized according to the AOAC, an optimization of the spray drying process with a central composite experimental design. The powder’s bulk and tapped density, solubility, and anthocyanin content were determined. The variation in zinc and folic acid content over a storage period was measured. The moisture content of the fresh blackberries was 89%. The solubility and anthocyanin content of blackberry powder were 86% and 0.263 mg cyanidin-3-glucose/g, respectively. The optimal spray drying conditions were: 23.6% solid content and an air inlet temperature of 167.92 °C. The bulk density of the powder did not change with storage time (p > 0.05); the zinc and folic acid content in blackberry powder was 144 and 90 (µg/100 g), respectively. A blackberry powder fortified with zinc and folic acid was obtained by spray drying, guaranteeing 30% of the daily nutritional requirement for pregnant women and children, in a 50-gram portion of powder.

How to Keep Lactose Avoiders Healthy

A large portion of the world’s population has lactose intolerance. Fundamentally, this condition occurs when the small intestine does not produce enough of the lactase enzyme, which digests the disaccharide lactose in milk. Lactose avoiders might unconsciously decide to limit or exclude milk and dairy products from their diets. This group includes people with lactose intolerance, people with an allergy to milk protein, vegans, and those expressing personal preferences. Lactose avoiders are often self-reported as being milk intolerant. In this review, specific amounts of lactose in different types of milk and milk products are presented. The amounts of micro- and macronutrients in them are compared with the daily requirements established by accepted sources. Foods are suggested that can play vital roles in permanently avoiding lactose-containing dairy products, for example, brussels sprouts, as a good source of vitamin B1; kale, as a source of vitamin K; and cereals at breakfast for vitamin B6. Attention is paid to mature cheeses as they are extremely beneficial for health due to their rich vitamin and elemental compositions, and they are also suitable for people with lactose intolerance due to their low lactose content. This information is rarely provided on packaging. In addition, the current state of labeling for the presence of lactose in food and pharmaceutical products is discussed. The term “hidden lactose” is introduced to include added lactose in unexpected foods, drinks, and even medicines.

The Utilization of Vegetable Powders for Bread Enrichment—The Effect on the Content of Selected Minerals, Total Phenolic and Flavonoid Content, and the Coverage of Daily Requirements in the Human Diet

The aim of this study was to evaluate the content of selected minerals and total phenolic and flavonoid content of wheat bread and bread enriched with varying amounts of carrot powder (CP) and pumpkin powder (PP). In addition, the coverage of daily requirements of selected minerals was evaluated after the consumption of 100 g of each type of bread. The research included seven types of bread: wheat bread (WB) and bread enriched with 10%, 20%, and 30% CP and PP. The vegetable powders were obtained by freeze-drying. The concentrations of minerals—sodium (Na), potassium (K), calcium (Ca), magnesium (Mg), iron (Fe), zinc (Zn), copper (Cu), and manganese (Mn)—were determined by atomic absorption spectroscopy (AAS) method. Coverage of daily requirements after consumption of a serving of bread was determined based on Recommended Daily Allowance (RDA) and Adequate Intake (AI) ratios for minerals, according to the nutritional standards for the Polish population. The addition of 10% PP led to a greater increase in Na, K, Mg, and Cu in the bread compared to CP, while for Ca, Fe, Zn, and Mn a greater increase was observed with the addition of 10% CP than PP. Among macronutrients, the greatest changes in content were recorded for Ca—the addition of 10 and 20% CP and PP resulted in increases of 66, 113, 51 and 59%. Among micronutrients, the addition of CP and PP to wheat bread caused the largest changes in Cu (46–150% increase) and Mn (25–99% increase) content. Additionally, there was a tenfold increase in total phenolic content (TPC) when 30% CP was added to the bread. Consuming 100 g of bread with CP and PP provided the greatest coverage of K (41–60%), Cu (8–17.5%), and Mn (6–17%). These findings suggest that fortification of bread with vegetable powders has the potential to be a useful method of enriching the mineral composition and increasing the proportion of selected minerals in the human diet.

Optimization of milling degree for maximizing nutrient retention and yield in milled rice: A study on six common Bangladeshi rice cultivars

Awareness of the nutritional value and health benefits of milled rice is crucial for its role as a staple food. This study explores the impact of different degrees of milling (DOM)—5%, 7%, and 9%—on head rice yield, proximate composition (protein, fat, fiber, and carbohydrates), and mineral content (sodium, magnesium, potassium, iron, calcium) in six rice cultivars: BRRI Dhan 28, 29, 36, 90, 51, and Bogura Katari. Our findings reveal that head rice yield decreases significantly, by 3% to 8%, when DOM is increased from 5% to 7% or 9%. Increasing the DOM also led to pronounced losses of protein (15% to 25%), fat (40% to 70%), and fiber (15% to 40%), while carbohydrate content increased. Additionally, substantial reductions in mineral content were observed at 9% DOM. Notably, consuming rice milled at 5% DOM can meet significant portions of daily nutrient requirements: 50% of protein, 10% of fiber, 20% of fat, 10% of sodium, 80% of magnesium, 35% of potassium, 100% of iron, and 30% of calcium, based on a per capita consumption of 400 g per day. This research highlights the importance of optimizing DOM between 5% and 7% to enhance head rice yield and maximize nutrient retention.

Wolf Predation on White‐tailed Deer Before, During, and After a Historically Mild Winter in Northern Minnesota

ABSTRACTIn many southern boreal ecosystems of North America, wolves are the primary predators of white‐tailed deer, and white‐tailed deer are the primary prey of wolves. Furthermore, wolf–deer systems have and will continue to become more common as white‐tailed deer range continues expanding northward in North America. Despite this, there is little information on kill rates of wolves on deer (i.e., the number of deer killed per wolf per unit of time)—a fundamental metric of wolf predation on deer—and how kill rates vary with deer density, wolf density, and environmental conditions. We estimated kill rates of wolves on deer before, during, and after a historically mild winter in the Greater Voyageurs Ecosystem, Minnesota, USA. Kill rates of wolves on deer were low (0.009–0.018 deer/wolf/day) in fall, peaked in February (0.050 deer/wolf/day), and quickly declined to 0 deer/wolf/day by April. The kill rates of wolves on deer we observed in winter were some of the lowest kill rates of wolves on deer that have been documented. Wolves in the Greater Voyageurs Ecosystem appeared unable to catch and kill a sufficient number of deer to meet their daily energetic requirements during Winter 2023–2024, and thus most wolves likely lost weight during winter, a period when wolves are typically in peak physical condition. The rates of wolf predation we observed appeared to be well below those needed to decrease deer population density in the GVE. Thus, our work, in combination with numerous other studies, indicates winter conditions are the primary driver of deer population change in northern climates.

Breakfast Protein Intake of One-third of Daily Requirement Can Maintain Lean Body Mass Post-distal Gastrectomy.

Post-gastrectomy lean body mass (LBM) decrease has a significant negative impact on postoperative survival in patients with cancer. This study investigated the effect of intake of at least one-third of the daily protein requirement at breakfast on the maintenance of LBM in patients during the first month post-gastrectomy. Among patients with gastric cancer who underwent curative distal gastrectomy between April 2011 and December 2018, without adjuvant chemotherapy, we evaluated 401 patients who had consumed more than the daily protein requirement in the first month postoperatively, using the FFQW82 nutrition intake questionnaire. Patients were divided into those who consumed more (≥1/3 intake group, n=160) and those who consumed less than one-third of the daily protein requirement at breakfast (<1/3 intake group, n=241). We compared the LBM reduction rate at one month postoperatively between groups. Univariate and multivariate analyses were performed to determine clinicopathological factors predicting LBM reduction at one month postoperatively. The LBM reduction rate at one month post-curative distal gastrectomy was significantly higher in the <1/3 intake group than in the ≥1.3 intake group (p=0.01) at breakfast. Multivariate analysis showed that morning protein intake below one-third of the daily requirement independently predicted LBM reduction (odds ratio=1.75, 95% confidence interval=1.14-2.68, p<0.01). Consuming at least one-third of the daily protein requirement at breakfast may be effective in maintaining LBM in patients undergoing curative distal gastrectomy. These results may be very important for prognosis, since maintaining LBM influences the continuation of adjuvant chemotherapy and thus survival after curative resection in patients with gastric cancer.

Ecological aspects of studying the thyroid function of the thyroid gland in women of reproductive age living in a region with iodine deficiency (Akhtynsky district, Republic of Dagestan, Russia)

Aim. To present epidemiological aspects of the study of thyroid function of the thyroid gland.The article presents the results of a clinical and laboratory examination and epidemiological aspects of studying the thyroid function of the thyroid gland in 120 women of reproductive age living in an area with iodine deficiency (Akhtynsky district, Republic of Dagestan – located at an altitude of 1.675 metres above sea level). The women were examined for thyroid diseases and for the presence of intrauterine infections: TORCH toxoplasmosis, ornithosis, rubella, cytomegalo‐ and herpesviruses.All the examined patients had thyroid diseases (the women are registered with an endocrinologist at an Endocrinological Dispensary). All women underwent correction of iodine deficiency in the form of iodine prophylaxis by taking medications containing a daily iodine requirement of up to 250 mcg to normalize thyroid function.Intrauterine infections (IUI) were found in 76 women (69 %. of the patients examined). Intrauterine infections of women registered in the women's clinic of the district hospital were also treated.

Infant Food Flours Made from Local Products to Combat Acute Malnutrition in Children Under 5 Years Old in Côte D’ivoire

In Côte d'Ivoire, recurring stock shortages and difficulties in accessing specialized food products compromise nutritional treatment. This study proposes food formulas of flours composed of locally available products capable of meeting the protein-energy needs of children aged 6 to 59 months diagnosed with moderate acute malnutrition. The methodological approach consists of formulating and determining the physicochemical, nutrient, and functional characteristics of four new formulations (1F, 2F, 3F, 4F, and 5F). The results indicate that the formulated foods have high levels of calcium (215.60-252,29 mg/100g MS), potassium (555,70-789,29 mg/100 g MS), magnesium (261,26-200,63 mg/100g MS), iron (4,86-7,03 mg/100g MS) and phosphorus (392,36 -469,36 mg/100g MS). The fat content varies from 9.66% to 23.86%. The energy value determined for all flours corresponds well to the Codex. The food formulas developed would also be able to meet more than 100% of the daily requirement of vitamins E and B1. The phytate (180.26 - 227.05 mg/100 g) and oxalate (66.00 - 88.00 mg/100 g) contents are low. The presence of phenolic compounds, including flavonoids (7.78-15.44 mg/100 g) and antioxidant activity (31.09-32.84%) would be a significant asset. The levels of deoxynivalenol (62 μg/kg) recorded in flours are below 200 μg/kg recommended for infants and young children. The proposed formulations have high-water absorption capacity (136.15 -252.94%) and high solubility index (56.84 -59.2%). The wettability time ranges from 3.66 ± 0.16 s to 33.71 ± 0.23 s. Flours (1F, 2F, 3F, 5F) have a better absorption capacity for refined palm oil (132 %, 139 %, 121 %; 115 %). The proposed new formulations have nutritional characteristics close to standard data and could therefore be recommended for children aged 6 to 59 months for complementary feeding in the context of the fight against moderate acute malnutrition.

The Effect of Dietary Approaches to Stop Hypertension (DASH) Plan on Quality of Life in Hypertensive with Acute Coronary Syndrome Patients

Objective: The aim of the study was to evaluate the effect of Dietary Approaches to Stop Hypertension (DASH) on quality of life in hypertensive patients with acute coronary syndrome (ACS). Methods: This study was designed and conducted with 34 patients using a single-group and pre-test/post-test design in two public hospitals. Descriptive characteristics of the patients were obtained through a questionnaire. The questionnaire included socio-demographic characteristics, dietary habits, physical activity levels and quality of life using the MacNew Heart Disease Health-Related Quality of Life scale. The DASH diet plan was planned individually based on the daily energy requirement and explained to the patients. Patients were requested to achieve maximum adherence to the DASH diet plan for 12 weeks. Patients’ adherence to the DASH diet and quality of life were compared at the baseline and at study completion using SPSS 25.0 paired sample t-test. Results: Patients’ adherence to the DASH diet showed a statistically significant increase compared to the baseline (p

Pollen trapping as Honeybees pollination management and identification of dominant pollinators of Guizotia abyssinica (L.f).

Pollination is one of the most fascinating aspects of insect-plant interactions. Pollen is the male reproductive element of flowering plants, gathered by foraging Honeybees from the male parts of flowering plants called the anther. Guizotia abyssinica (L.f) is an important oilseed crop cultivated in Ethiopia and India, which belongs to the family Asteraceae. Although self-incompatibility is found in Guizotia abyssinica, a higher seed set is experienced in places with an active Honeybees population. Agricultural practices usually focus on inputs such as fertilizer application to improve seed yield of Guizotia abyssinica. However, these practices have little effect on yield if the availability of insect pollination is too low. To fill this gap, an experiment was carried out at Dandi district, West Shao zone, Oromia, Ethiopia to see the effect of Honeybees pollination management as an agronomic input. Pollination management of Honeybees was tested under feeding and non-feeding of colonies management. Pollen was trapped with and without sugar syrup feeding. The results discovered that Honeybees fed sugar syrup collected much more pollen than colonies not fed sugar syrup. The proportion of Guizotia abyssinica pollen collected through sugar syrup feeding of the colony was greater (62.2%), compared to the proportion of Guizotia abyssinica pollen trapped without sugar syrup feeding (37.8%). This indicates that sugar syrup feeding enhances the collection of pollen and probably enhances the pollination efficiency of Honeybees since they visit frequently to fulfill their daily protein requirement of pollen. Therefore, Honeybees pollination services should be included as one of the agronomic inputs with sugar syrup feeding as pollination management that might increase the yield of Guizotia abyssinica since it increases visiting frequency.

Glycaemic outcomes in adults with type 2 diabetes over 34 weeks with the Omnipod® 5 automated insulin delivery system.

The aim was to evaluate the effect of extended use of the Omnipod® 5 automated insulin delivery (AID) system in adults with type 2 diabetes and suboptimal glycaemic control. Following an 8-week single-arm, multicentre, outpatient trial of AID in adults with type 2 diabetes and baseline ≥ 64 mmol/mol, participants were given the opportunity to continue use of the AID system in a 26-week (~6 month) extension phase. The primary safety endpoints were percentage of time with sensor glucose ≥ 250 mg/dL and < 54 mg/dL. Additional glycaemic measures, including percentage of time in range (TIR) (70-180 mg/dL) and HbA1c, were evaluated. The use of non-insulin anti-hyperglycaemic medications was permitted throughout the entire study. During the initial 8-week study, participants (N = 22) achieved a decrease in percentage of time ≥ 250 mg/dL from 27.4% ± 21.0% to 10.5% ± 8.8% (p < 0.0001), which further decreased to 9.7% ± 9.2% during the extension phase (p = 0.0002 vs. standard therapy). Percentage of time < 54 mg/dL remained low from standard therapy through extension (median [interquartile range] 0.00% [0.00%, 0.06%] vs. 0.02% [0.00%, 0.05%], p > 0.05). HbA1c decreased by 1.6% ± 1.2% (15.5 ± 13.1 mmol/mol, p < 0.0001) and TIR increased by 22.4% ± 19.2% (p < 0.0001) from standard therapy through extension with no significant change in body mass index and without an observed increase in total daily insulin requirements. These longer-term findings of Omnipod 5 AID system use demonstrate the potential value of AID in helping people with type 2 diabetes reach glycaemic targets.

The influence of lingonberry and sea buckthorn powder-aqua solutions on the nutritional value of sander roe

Fish roe is a rich source of polyunsaturated fatty acids, essential amino acids and several vitamins. The paper presents the possibility of using fish caviar treatment with berry solutions instead of traditional preservatives. The purpose of this study is to determine the effect of berry solutions from lingonberry powder (Vaccinium vitis-idea) and buckthorn (Hippophae rhamnoides) on the nutritional, biological value and safety of walleye caviar through the use of wild plants as preservatives. Samples of the caviar of the common walleye Sander (Sander lucioperca) were selected as research objects. The results showed that experimental caviar samples treated with berry solutions showed differences (p&gt;0.05) compared to the control sample with saline solution, this proves an increase in the nutritional value and safety of fish caviar. It is also shown that the use of berry solutions from cranberries (LS) and sea buckthorn (SBS) combined with salt is 35% more effective compared to the control sample containing only salt (S). This means that using berry solutions significantly improves the results compared to the traditional canning method. This effect may be due to the additional beneficial properties of berry extracts, such as antioxidant and antimicrobial activity, which contribute to better preservation of caviar quality and safety. It was found that using a berry solution from cranberry powder revealed the best result. Also, it was shown that the greatest value and composition was possessed by the LS sample, which more satisfied the daily requirement of vitamins A, E and B group in comparison with other samples (p&gt;0.05), the content of vitamin A (0.016±0.014); vitamin B (0.24±0.16); vitamin E (2.89±0.04); vitamin PP (2.1±0.05). This is because treating pikeperch caviar with berry solutions increases the amount of water-soluble and fat-soluble vitamins.

7255 Tirzepatide Helps Achieve Glycemic Control and Lower Triglycerides in Seven Patients with Lipodystrophy

Abstract Disclosure: R. Meral: None. E.D. Frontera: None. M. Celik Guler: None. M.C. Foss de Freitas: None. N. Nachawi: None. D.T. Broome: Consulting Fee; Self; Tayco, Inc.. Research Investigator; Self; Novo Nordisk, Fractyl Laboratories, Rhythm Pharmaceuticals. S.I. Taylor: None. E.A. Oral: Advisory Board Member; Self; Amryt, Regeneron Pharmaceuticals. Consulting Fee; Self; Regeneron Pharmaceuticals, Amryt, Third Rock Ventures. Grant Recipient; Self; Regeneron Pharmaceuticals, Amryt. Research Investigator; Self; Novo Nordisk, Fractyl, Ionis Pharmaceuticals Inc., GI Dynamics, Rhythm Pharmaceuticals. Other; Self; Amryt. Lipodystrophy encompasses a group of rare disorders associated with severe metabolic disease. These disorders are defined by abnormal distribution of fat, with near-total (generalized lipodystrophy, GL) or partial (partial lipodystrophy, PL; i.e. familial partial lipodystrophy, FPLD) absence of adipocyte mass leading to a decreased ability to store triglycerides safely. Excess triglycerides are more likely to be stored in ectopic tissues such as hepatocytes, which leads to the metabolic manifestations of the disease state. Patients with GL have near absent levels of leptin hormone and leptin replacement therapy leads to dramatic improvement, which has mainly been attributed to a reduction in caloric intake. Patients with PL are not as leptin deficient and their response to leptin replacement therapy has been variable. We hypothesized that the clinical use of tirzepatide in patients with lipodystrophy may lead to favorable outcomes through the reduction of caloric intake. We closely observed 7 patients who were prescribed tirzepatide for their diabetes with information presented respectively [Age: 44; 54; 34; 53; 44; 46; 38 years | Sex: F; F; F; F; F; M; F | Subtype: FPLD type 1; FPLD type 2; FPLD type 1; Acquired GL; FPLD type 2; FPLD type 1; FPLD type 3]. At baseline, all patients had poor control of their disease despite aggressive medical therapy (except patient #5). Follow-up durations varied due to the observational nature of the study [follow-up duration (months): 6; 12; 7; 3; 8; 9; 5]. Reductions in A1c, triglycerides, and body mass index (BMI) were observed [A1c (%): 13.4-&amp;gt;7.1; 7.1-&amp;gt;6.6; 7.6-&amp;gt;5.2; 8.7-&amp;gt;6.9; 5.4-&amp;gt;5.1; 8.9-&amp;gt;7.8; 9.7-&amp;gt;7.1 | triglycerides (mg/dL): 539-&amp;gt;339; 164-&amp;gt;109; 367-&amp;gt;NA; 151-&amp;gt;113; 388-&amp;gt;101; 459-&amp;gt;319; 4081-&amp;gt;259 | BMI (Kg/m2): 25.0-&amp;gt;24.5; 30.6-&amp;gt;28.3; 37.7-&amp;gt;33.9; 22.8-&amp;gt;20.9; 27.6-&amp;gt;23.4; 40.1-&amp;gt;37.9; 24.0-&amp;gt;24.9]. Those who were on insulin had decreased daily requirements [total daily insulin requirement (units): 160-&amp;gt;25; 82-&amp;gt;18; not on insulin; 85-&amp;gt;0; not on insulin; 280-&amp;gt;200; 124-&amp;gt;111]. All patients reported a reduction in their daily food intake. Treatment related complications were limited to known gastrointestinal issues which the patients rated as tolerable. Based on our results, a randomized controlled trial to test the efficacy of tirzepatide in patients with lipodystrophy may be warranted. Presentation: 6/3/2024

6588 Insulin Autoimmune Syndrome Presenting with Severe Insulin Resistance and Recurrent Diabetic Ketoacidosis

Abstract Disclosure: E. Looi: None. R. Rosenberg: None. S. Sugar: None. H. Stone: None. A.W. Michels: None. D. Saxon: None. Background: Insulin autoimmune syndrome (IAS) is a rare cause of severe insulin resistance and is typically associated with intermittent hypoglycemia due to insulin antibodies (IA) with high binding capacity and low insulin affinity. However, consideration should be given for atypical presentation of IAS or co-presentation of IAS with type B insulin resistance syndrome (TBIRS) in the absence of hypoglycemia, as described in this case. Case: A 78-year-old African American female (BMI 21 kg/m2) with poorly controlled type 2 diabetes (A1c 11%) experienced recurrent episodes of diabetic ketoacidosis (DKA) despite adherence to escalating insulin doses (310 units daily, 5 u/kg/day). She was referred to endocrinology and continuous glucose monitoring revealed consistently elevated glucose levels (300-400 mg/dL) without hypoglycemia. She had normal renal function, hepatic function, and lipid panel. During a subsequent hospitalization, she required insulin drip rates of 50-70 u/hr. Insulin resistance workup revealed significantly elevated IA level (8.346, normal ≤ 0.010) measured using a fluid-phase radiobinding assay with high insulin binding capacity (1040 U insulin-binding/L blood) and low insulin binding affinity (1.9x107 M), which supported the diagnosis of IAS. Rheumatologic workup for other autoimmune diseases was negative. Due to recurrent DKA episodes, severe insulin resistance without obvious alternative cause, and lack of hypoglycemic events despite low IA binding affinity, co-morbid TBIRS was considered. As there are no commercially available insulin receptor antibody (IRAb) assays, diagnosis could not be confirmed before her condition worsened, and she was admitted for another episode of DKA within a week of being discharged. Due to clinical deterioration and high suspicion for IAS ± TBIRS, treatment with a combination of immunosuppressive agents was initiated in accordance with an NIH protocol (Klubo-Gwiezdzinska J, et al. 2018). Intravenous immune globulin (0.5g/kg/day) was administered over 2 days which resulted in a brief reprieve and followed by significant relapse. Two doses of rituximab (750 mg/m2) and 2 steroid pulses (dexamethasone 40 mg PO daily for 4 days) were then administered 2 weeks apart. Cyclophosphamide 100 mg daily was also started. Her hyperglycemia and insulin requirements subsequently improved, and she was eventually discharged with good glycemic control on a total daily dose of 40 units of insulin (0.5 u/kg/day), an 87.1% reduction in daily insulin requirement. Conclusion: This case demonstrates that IAS - although classically associated with hypoglycemic episodes - may also present with severe insulin resistance and recurrent DKA without hypoglycemia. Whether characterized by high IA binding capacity and affinity or coexisting with IRAb, a combination of immunosuppressants proved effective in treating both TBIRS and IAS in this instance. Presentation: 6/3/2024

Techno-economic analysis of solar, wind and biomass hybrid renewable energy systems in Bhorha village, India

The present study investigates the potential use of Hybrid Renewable Energy Systems (Solar photovoltaic, wind, biomass, and diesel), both with and without the inclusion of battery/supercapacitor storage in the Bhorha village, Bihar, India. A comprehensive assessment of different possible system configurations is conducted using hybrid optimization model for electric renewable (HOMER) software to determine the most economically viable and efficient system for the designated place. The current analysis is focused on six distinct cases in the village community, in view of sufficing the daily energy requirement of 615.625 kWh and a peak demand of 86.47 kW, pertaining to major factors viz. system efficiency, financial viability, and ecological consequences. The primary aim of the research is to elucidate the comparative analysis of energy generation for different proposed designs of hybrid renewable energy systems. Detailed techno-commercial assessments are also carried out to examine the energy production, consumption, and financial impacts of each HRES configuration. The research outcome of this study obtained from HOMER software reveals that the optimized hybrid system comprises 86.7 kW solar photovoltaic, 30 kW wind turbine, 5 kW biogas generator, a 50 kW diesel generator, 280 kWh battery bank with nominal capacity, and 38.8 kW converter to sustain the for energy needs of the nominated place. This system has a minimum cost of energy of 0.309 $/kWh with a net present cost of $854894 along with operating cost 51847 $/year and net carbon dioxide emission of 56728 kg/yr. The research offers useful insights for designers, scholars, and policymakers on the existing design constraints and policies of biomass-based hybrid systems for a safe, sustainable and independent green future for the generations to come.

Measured Versus Predicted Total Energy Expenditure: Evaluating Methods To Approach Daily Energy Requirements Across Physical Activity Levels.

Measured Versus Predicted Total Energy Expenditure: Evaluating Methods To Approach Daily Energy Requirements Across Physical Activity Levels.

NANOENCAPSULATION OF SPIRULINA SP. LEB 18 MICROALGAE BIOMASS USING ELECTROSPRAY TECHNIQUE AND APPLICATION IN CHOCOLATE MILK

Chocolate powder is a widely consumed food, but it has a high sugar content. Spirulina microalgae contains high nutritional value and can be used to enrich foods. However, microalgae has strong sensory characteristics. To add it to food, it is necessary to hide these characteristics, such as through nanoencapsulation. Therefore, the objective of this work was to develop nanospheres with Spirulina biomass by nanoencapsulation and apply them in chocolate milk. This nanospheres were produced through the electrospraying technique, with chitosan and Spirulina. The best parameters to produce nanospheres were a polymeric solution with 0.50% chitosan, electric potential of 24kV, and capillary diameter of 0.70mm. These resulted in more uniform nanoparticles without the presence of a residual solvent. Nanospheres with Spirulina sp. LEB 18 are stable up to approximately 200 °C. Chocolate milk containing nanospheres with Spirulina was formulated to contain 5% Spirulina, which increased the protein content by 16.3%, lipids by 88.9% and ash by 33.9% in this food compared to the control. It received an average score of 6.9 in the sensory analysis and had a public acceptance rate of 76.3%. By incorporating 300mL of chocolate milk containing nanospheres with Spirulina into school meals, children up to 5 years old (weighing approximately 18kg) meet their daily protein requirement in a single serving.