Glucose Ratio Research Articles

Method for Glucose and Fructose Quantitation in Beverages Using an Off-the-Shelf Glucose Test Strip.

A method was developed for quantifying both glucose and fructose in solutions and grape juice using commercially available glucose test strips connected to a mini-potentiostat. The first step of this sensing approach involved exposing the sample solution to an Accu Chek Aviva glucose test strip, which allowed for the direct quantitation of glucose. To quantify fructose, the solution was exposed to glucose isomerase, which led to the conversion of glucose to fructose and vice versa until an equilibrium was reached. Once equilibrium was reached, the solution was exposed to another glucose test strip; the signal obtained was shown to be related to the total amounts of glucose and fructose in solution. Finally, fructose was quantified by subtracting the glucose concentration (from the initial measurement) from the total concentration of glucose and fructose (from the second measurement after the reaction with glucose isomerase). The method yielded a limit of detection of 0.047 g L-1 for glucose and 0.49 g L-1 for fructose. Importantly, this method was shown to work well for analyzing glucose and fructose concentration in grape juice, which contains >60 g L-1 glucose and fructose. Since the ratio of glucose and fructose concentration in ripe grapes is close to 1, this method can be used to aid in the determination of grape ripeness to guide harvesting times.

Diagnostic Accuracy of CSF and Blood Glucose Ratio in Diagnosis of Bacterial Meningitis in Children Using CSF Culture as Gold Standard

Aim: To find the diagnostic accuracy of CSF and blood glucose ratio in diagnosis of bacterial meningitis in children using CSF culture as gold standard. Study design: Cross sectional study Setting and duration: The study was conducted in the department of Pediatric Emergency Medicine, The Children’s Hospital and the Institute of Child Health, Lahore, from 15 May 2021 to 15 February 2022. Methods: A total of 140 children aged 1 month up to 14 years with clinical features suggestive of meningitis was selected. The patients underwent a lumbar puncture after getting consent from parents. The emergency laboratory examinations performed for their predictive value for bacterial meningitis as follows: CSF total cell count, CSF mononuclear cell count, CSF polymorphonuclear cell count, CSF polymorphonuclear/total cell ratio, CSF glucose, CSF/blood glucose ratio. The treatment was then readily started as per protocol for the presumptive diagnosis. Results: Amongst 145 cases, 51.72%(n=75) were upto 6 years of age while 48.28%(n=70) were between 7-14 years of age, mean+sd was calculated as 6.58+3.15 years, 60% were male and 40%(n=58) were females, mean CSF/Blood glucose ratio was calculated as 0.31+0.08. The diagnostic accuracy of CSF and blood glucose ratio in diagnosis of bacterial meningitis in children using CSF culture as gold standard was recorded as 90.32%, 90.36%, 87.5%, 92.59% and 90.34% for sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate. Conclusion: Through the findings of this study, we concluded that the diagnostic accuracy of CSF and blood glucose ratio in diagnosis of bacterial meningitis in children using CSF culture as gold standard is higher but needs its validation through some other local trials in absence of previous data. Keywords: Bacterial meningitis, CSF culture, CSF/blood glucose ratio, Diagnostic accuracy

The effect of BsmI (rs1544410) single nucleotide polymorphism of vitamin D receptor (VDR) on insulin resistance in healthy children and adolescents: a cross-sectional study

The increasing prevalence of metabolic syndrome, type 2 diabetes, and insulin resistance are driven by complex interactions between genetic and environmental factors. One of the single nucleotide polymorphisms (SNPs) in the VDR gene associated with vitamin D levels is the rs1544410 SNP. This study examined the association of the rs1544410 polymorphism with insulin resistance to predict and screen for possible association with type 2 diabetes and target these individuals for appropriate treatment. This cross-sectional study examined 270 children and adolescents aged 9 to 18 years. Anthropometric and biochemical parameters were determined. Insulin resistance/sensitivity was determined using Quicki, HOMA-IR, MacAuley, Revised MacAuley, Bennetts, FIRI and insulin-to-glucose ratio. The BsmI single nucleotide polymorphism (rs1544410) was determined using the PCR-RFLP method after extracting DNA from peripheral blood collected from fasted subjects, and the resulting data were analyzed using SPSS software and statistical tests.According to linear regression analysis, a significant difference was found in Insulin to glucose ratio, FIRI and HOMA-IR indices between Bb / bb and BB genotypes and it was observed that individuals with BB genotype polymorphism of BsmI vitamin D receptor gene, after Adjustment of age, sex, BMI are at greater risk for insulin resistance and type 2 diabetes.This study demonstrated that those with the BB genotype of VDR BsmI polymorphism were at higher risk for insulin resistance and developing type 2 DM.

Evaluation of Serum Magnesium Levels in Patients with Hypertension: A Case-control Study

"There are conflicting data on the effects of magnesium on hypertension in the literature. Therefore we aim this study to investigate whether there is a relationship between serum magnesium levels and hypertension in newly diagnosed. This is a case-control study. The patients were selected from the records of patients who applied to the family medicine outpatient clinic between June 2016 and May 2017. A total of 276 patients, 68 patients with newly diagnosed hypertension in the case group and 208 patients without any disease in the control group were included in the study. Binary logistic regression analysis was performed between the case and control groups. The odds ratio for magnesium was 0.1 (0.012-0.810). When the value of the magnesium variable increases by 1mg/dl, the risk of hypertension decreases by 90%. However, in the presence of magnesium as an independent variable, the predictability rate of our model was expected to increase but decreased. The odds ratio for age was 1.14 (1.092-1.186). The odds ratio for exercise was 0.18 (0.03-0.99). The odds ratio for glucose was 1.03 (1.001-1.065). In our study that magnesium deficiency causes an increased risk of hypertension, the predictability rate of our model was expected to increase instead of decrease. These findings show that a cause-effect approach or incidental association cannot explain the relationship between magnesium and hypertension."

Assessment of the Prognostic Factors for Abnormal Neurodevelopmental Outcomes in Children with Acute Bacterial Meningitis by Using RNDA Tool

This observational follow up study was carried in the Department of Paediatrics, Institute of Child and Mother Health (ICMH), Matuail, Dhaka, during November 2016 to December 2017, to determine the prognostic factors for assessment of the prognostic factors for abnormal neurodevelopmental outcomes in children with acute bacterial meningitis by using RNDA tool. A total of 56 children with acute bacterial meningitis of age > 1month - 15 years admitted in the inpatient department were enrolled in this study. Most 34 (60.7%) of the children belonged to age <12 months and male to female ratio was almost 2:1. More than half (58.9%) children admitted >48hrs after onset of illness, 11(19.6%) children received previous treatment with antibiotics and most (85.7%) of the children had occurrence of seizures prior to admission. More than one third (39.3%) children had >100 cell count in their CSF. CSF glucose/ serum glucose ratio was found <0.2 in case of 8(14.3%) children. More than three fourth (78.6%) children had high protein in their CSF. Abnormal developmental outcome assessed by RNDA on follow ups. It was observed that gross motor development was mildly impaired in 6(12.0%), 8(16.3%) and 5 (11.6%) cases on 1st, 2nd and 3rd follow up respectively. Gross motor was moderately impaired in 4 (8.0%), 3 (6.1%) and 3 (7.0%) cases on 1st, 2nd and 3rd follow up respectively. Accordingly, fine motor was mild impaired in 5 (10.0%), 4 (8.2%) and 5 (11.6%) cases and moderately impaired in 2 (4.0%), 3 (6.1%) and 2 (4.7%) cases on 1st, 2nd and 3rd follow up respectively. Cognition was mild impaired in 11 (22.0%), 12 (24.5%) and 11 (25.6%) cases and moderately impaired in 4 (8.0%), 4 (8.2%) and 3 (7.0%) cases on 1st, 2nd and 3rd follow up respectively. Children found with any selective neurological complication or abnormal developmental outcome in at least one follow up was considered to be abnormal. Hypertonic muscle tone and exaggerated jerk was found in 2(3.8%) children. 5(9.6%) children had developmental regression on follow up. 3(5.8%) children had squint, 2 (3.8%) children had subdural effusion, 2 (3.8%) children had visual deficit, 6 (11.5%) children had hearing deficit and 4 (7.7%) children had afebrile seizures on follow up. One (11.1%) child with focal seizure and 6 (60.0%) children with hazy CSF colour had significantly (p<0.05) developed abnormal developmental outcome. Children under 12 months of age, children who received previous treatment with antibiotics, seizures prior to admission, high WBC count, hazy CSF colour and CSF glucose/ serum glucose ratio below 0.2 were significantly (p<0.05) associated with acute complications during hospital stay. Children with focal seizure and children with hazy CSF colour were significantly (p<0.05) associated to abnormal developmental outcome. Multivariate regression analysis showed no significant (p>0.05) association between acute complications and prognostic factors. Age under 12 months in adjusted OR 0.970 with 95.0% C.I 0.943 to 0.997, CSF leukocytosis in adjusted OR 0.99 with 95.0% C.I. 0.99 to 1.00) and CSF glucose/serum glucose ratio<0.2 in adjusted OR 15.23 with 95.0% C.I. 1.28 to 100.0 were significantly associated with abnormal developmental outcome in multivariate regression analysis.

Management of Patients with Hypertension at Family Medicine Practices at the Community Health Centre Ljubljana (Slovenia): A Protocol of a Cross-Sectional Study

Introduction: Hypertension is a major public health problem worldwide due to rapid urbanization, an aging population, and the global spread of unhealthy lifestyles. In 2011, model primary care practices were established in Slovenia to improve hypertension care at the primary level. Patients with hypertension undergo a standardized examination by a nurse practitioner every year. However, a proportion of patients with hypertension still do not meet the criteria for controlled disease. Therefore, there is an urgent need to identify the bottlenecks of current hypertension care in family medicine practices in Slovenia in order to improve it for the future.
 Aim: The aim of this study is to develop a research protocol to evaluate the current management (both process and outcome) of patients with hypertension in family medicine practices in Community Health Centre Ljubljana (CHCL).
 Methods: A cross-sectional study will be conducted. First, the list of patients with hypertension aged 30 years or older who were treated in primary care practices at CHCL in 2019 will be collected from the health information system. Individual clinical and demographic data will then be collected from clinical protocols of the same patient population. Descriptive statistics, logistic regression analysis, and linear regression analysis will then be performed to assess various aspects (parameters) of hypertension care.
 Results: Data from a total of 15,186 patient visits will be analyzed. (1) The process of care will be assessed by the ratio of performed hypertension-specific visits, blood pressure measurement, screening for hypertension complications (nephropathy, peripheral arterial disease, and ECG signs of heart failure), and screening for hypertension comorbidities (hypercholesterolemia, type 2 diabetes, metabolic syndrome, and depression). (2) Treatment outcomes will be assessed by the ratio of blood pressure values, fasting glucose, LDL, and depression values in the target ranges. (3) The above variables will also be stratified by patient lifestyle factors (BMI, smoking status, physical activity, eating habits, and alcohol consumption), sociodemographic factors (age, gender, education, employment, and subjective assessment of financial status), treatment adherence assessment (regularity and correctness of medication intake, and dietary errors), and treatment motivation and empowerment assessment.
 Conclusions: The proposed research protocol will provide evidence of bottlenecks in current hypertension care in family medicine practices in CHCL and identify potential opportunities for future expansion. It will also isolate the key (patient-related) determinants that lead to suboptimal management of the disease.

Glycated haemoglobin, HOMA2-B, C-peptide to glucose ratio and type 2 diabetes clusters as predictors for therapy failure in individuals with type 2 diabetes without insulin therapy: A registry analysis.

Some people with type 2 diabetes mellitus (T2D) and declining β-cell function do require insulin over time. Various laboratory parameters, indices of glucose metabolism or phenotypes of T2D (clusters) have been suggested, which might predict future therapy failure (TF), indicating the need for insulin therapy initiation. This analysis evaluated glycated haemoglobin (HbA1c), homeostatic model assessment (HOMA)2-B, C-peptide to glucose ratio (CGR) and diabetes clusters as predictive parameters for the occurrence of glycaemic TF in individuals diagnosed with T2D without previous insulin therapy. In total, 159 individuals with T2D [41% female, median age 50 (IQR: 53-69) years, diabetes duration 9 (5-15) years], without insulin therapy were prospectively evaluated for the occurrence of a composite primary endpoint, including HbA1c increasing or remaining >8.0% (64 mmol/mol) 3 months after baseline on non-insulin glucose-lowering agents, insulin initiation or hospital admissions because of acute hyperglycaemic events. Diabetes clusters were formed according to previously described characteristics. Only severe autoimmune diabetes clusters were excluded because of a small amount of glutamate decarboxylase antibody-positive participants. The other clusters were distributed as mild age-related diabetes 33%; severe insulin-deficient diabetes 31%; mild obesity-related diabetes 20%; and severe insulin-resistant diabetes 15%. During a median observation of 57 months, higher tertiles of HbA1c at baseline, HOMA2-B, as well as a lower CGR were significantly predictive for the occurrence of the primary endpoint. The probability of meeting the primary endpoint was the highest for mild obesity-related diabetes [hazard ratio 3.28 (95% confidence interval 1.75-6.2)], followed by severe insulin-deficient diabetes [hazard ratio 2.03 (95% confidence interval 1.1-3.7)], mild age-related diabetes and the lowest for severe insulin-resistant diabetes. The best performance to predict TF with an area under the curve (AUC) of 0.77 was HbA1c at baseline, followed by HOMA2-B (AUC 0.69) and CGR (AUC 0.64). HbA1c, indices of insulin secretion capacity (HOMA2-B and CGR) and T2D clusters might be applicable tools to guide practitioners in the decision of whether insulin is required in people already diagnosed with T2D. These findings need to be validated in prospective studies.

The screening and monitoring of type 2 diabetes by indirect calorimetry

An increasing amount of study is being dedicated to the identification of biomarkers associated with type 2 diabetes, with particular emphasis on the field of Metabonomics. To screen and prevent type 2 diabetes, indirect calorimetry measures real-time oxygen consumption (V_02) and carbon dioxide production (V_C02) and measures an individuals metabolic tendency which is the ratio of glucose and fat as energy substrate for a specific activity. A person with aberrant glucose metabolism after measurement may have type 2 diabetes. Adjusting food intake helps type 2 diabetics control blood glucose. Now, type 2 diabetes become personalized. In other words, type 2 diabetes needs to be analysed case by case. The population can be divided into different categories in terms of metabolic adjustment. After classification, indirect calorimetry can be used in clinical research whose purposes are to screen, prevent and treat type 2 diabetes. This paper uses literature reviews to summarize the genetic factors and environmental factors of type 2 diabetes, explain the necessity and limitations for screening, monitoring, preventing and curing type 2 diabetes, and the reasons for calorimetry can screen and monitor type 2 diabetes and how to calculate the percentage of energy substrates for a certain activity.

Efficient and Economic Utilization of Cellobiose for Glycosylation Modification by Regulating Carbon Source Supply and Metabolic Pathway In Vivo.

Glycosylation, one of the most common and significant modifications in nature, has prompted the development of a cellobiose phosphorolysis route for glycosylation in vivo. However, the process of glycosylation is hampered by the notably low conversion rate of cellobiose. In this work, regulation of the carbon source supply by changing the ratio of glucose to cellobiose improved the conversion rate of cellobiose, resulting in enhancing the efficiency of glycosylation and the production of vitexin. Moreover, three genes (pgm, agp, and ushA) involved in the degradation of UDP-glucose were knocked out to relieve the degradation and diversion of the cellobiose phosphorolysis route. Finally, through the optimization of conversion conditions, we observed a continuous enhancement in cellobiose conversion rate and vitexin production in BL21ΔushAΔagp-TcCGT-CepA, corresponding to an increased concentration of added glucose. The maximum production of vitexin reached 2228 mg/L with the addition of 2 g/L cellobiose and 6 g/L glucose, which was 312% of that in BL21-TcCGT-CepA with the addition of 2 g/L cellobiose. The conversion rate of cellobiose in BL21ΔushAΔagp-TcCGT-CepA reached 88%, which was the highest conversion rate of cellobiose to date. Therefore, this study presents a cost-effective and efficient method to enhance the conversion rate of cellobiose during the glycosylation process.

Characteristics and prognostic factors of bacterial meningitis in the intensive care unit: a prospective nationwide cohort study

BackgroundPatients with bacterial meningitis can be severely ill necessitating intensive care unit (ICU) treatment. Here, we describe clinical features and prognostic factors of adults with bacterial meningitis admitted to the ICU in a nationwide prospective cohort study.MethodsWe prospectively assessed clinical features and outcome of adults (age > 16 years) with community-acquired bacterial meningitis included in the MeninGene study between March 1, 2006 and July 1, 2022, that were initially admitted to the ICU. We identified independent predictors for initial ICU admission and for unfavourable outcome (Glasgow Outcome Scale score between 1–4) by multivariable logistic regression.ResultsA total of 2709 episodes of bacterial meningitis were included, of which 1369 (51%) were initially admitted to the ICU. We observed a decrease in proportion of patients being admitted to the ICU during the Covid-19 pandemic in 2020 (decreased to 39%, p = 0.004). Median age of the 1369 patients initially admitted to the ICU was 61 years (IQR 49–69), and the rates of unfavourable outcome (47%) and mortality (22%) were high. During the Covid-19 pandemic, we observed a trend towards an increase in unfavourable outcome. Prognostic factors predictive for initial ICU admission were younger age, immunocompromised state, male sex, factors associated with pneumococcal meningitis, and those indicative of systemic compromise. Independent predictors for unfavourable outcome in the initial ICU cohort were advanced age, admittance to an academic hospital, cranial nerve palsies or seizures on admission, low leukocyte count in blood, high C-reactive protein in blood, low CSF: blood glucose ratio, listerial meningitis, need for mechanical ventilation, circulatory shock and persistent fever. 204 of 1340 episodes (15%) that were initially not admitted to the ICU were secondarily transferred to the ICU. The rates of unfavourable outcome (66%) and mortality (30%) in this group were high.ConclusionsThe majority of patients with community-acquired bacterial meningitis are admitted to the ICU, and the unfavourable outcome and mortality rates of these patients remain high. Patients that are initially admitted to non-ICU wards but secondarily transferred to the ICU also had very high rates of unfavourable outcome.

Systemic and cerebrospinal fluid biomarkers for tuberculous meningitis identification and treatment monitoring.

Tuberculous meningitis is a life-threatening infection with high mortality and disability rates. Current diagnostic methods using cerebrospinal fluid (CSF) samples have limited sensitivity and lack predictive biomarkers for evaluating prognosis. This study's findings reveal excessive activation of the immune response during tuberculous meningitis (TBM) infection. Notably, a strong negative correlation was observed between CSF levels of monokine induced by interferon-γ (MIG) and the CSF/blood glucose ratio in TBM patients. MIG also exhibited the highest area under the curve with high sensitivity and specificity. This study suggests that MIG may serve as a novel biomarker for differentiating TBM infection in CSF or serum, potentially leading to improved diagnostic accuracy and better patient outcomes.

Machine Perfusion Deters Ischemia-Related Derangement of a Rodent Free Flap: Development of a Model

IntroductionMachine perfusion can enable isolated support of composite tissues, such as free flaps. The goal of perfusion in this setting is to preserve tissues prior to transplantation or provide transient support at the wound bed. This study aimed to establish a rodent model of machine perfusion in a fasciocutaneous-free flap to serve as an affordable testbed and determine the potential of the developed support protocol to deter ischemia-related metabolic derangement. MethodsRat epigastric-free flaps were harvested and transferred to a closed circuit that provides circulatory and respiratory support. Whole rat blood was recirculated for 8 h, while adjusting the flow rate to maintain arterial-like perfusion pressures. Blood samples were collected during support. Extracellular tissue lactate and glucose levels were characterized with a microdialysis probe and compared with warm ischemic, cold ischemic, and anastomosed-free flap controls. ResultsMaintenance of physiologic arterial pressures (85-100 mmHg) resulted in average pump flow rates of 360–430 μL/min. Blood-based measurements showed maintained glucose and oxygen consumption throughout machine perfusion. Average normalized lactate to glucose ratio for the perfused flaps was 5-32-fold lower than that for the warm ischemic flap controls during hours 2-8 (P < 0.05). ConclusionsWe developed a rat model of ex vivo machine perfusion of a fasciocutaneous-free flap with maintained stable flow and tissue metabolic activity for 8 h. This model can be used to assess critical elements of support in this setting as well as explore other novel therapies and technologies to improve free tissue transfer.

Safety of spinal anesthesia and analysis of cerebrospinal fluid in SARS-CoV-2 pregnant women undergoing cesarean section: an observational prospective study

BackgroundSystemic infection has always been considered a relative contraindication to neuraxial anesthesia, despite the fact that infectious complications are relatively uncommon. Pregnancy-related physiological changes and coronavirus disease (COVID-19) neurotropic features may facilitate the virus’ entry into the central nervous system. The principal aim of this study was to test the safety of spinal anesthesia in “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2)-positive pregnant women and to examine cerebrospinal fluid (CSF) characteristics.MethodsWe conducted a prospective observational single-center study in asymptomatic or paucisymptomatic consecutive pregnant SARS-CoV-2 patients who underwent spinal anesthesia for cesarean section. Women with severe infection were excluded because they underwent general anesthesia. At the time of spinal anesthesia, we collected CSF samples, and then we performed a chemical-physical analysis to look for signs of inflammation and for SARS-CoV-2 genome.ResultsWe included 26 women. No spinal anesthesia complications were reported in the perioperative period and after 2 months. All CSF samples were crystal clear, and all physical-chemical values were within physiological ranges: the median concentration of CSF/plasma glucose ratio was 0.66, IQR 0.5500 (0.6000–0.7100), and the average CSF protein concentration value was 23.2 mg/dl (SD 4.87). In all samples, genomes of SARS-CoV-2 and other neurotropic viruses were not detected.ConclusionsSpinal anesthesia was safe in SARS-CoV-2 pregnant women with mild disease; no clinical maternal complications were detected, and no CSF changes indicative of inflammatory or infectious diseases that would compromise the safety of the procedure were found.

HPLC for simultaneous quantification of free mannose and glucose concentrations in serum: use in detection of ovarian cancer.

Background: Abnormal levels of monosaccharides in blood have been linked to tumorigenesis. In this study, a novel high-performance liquid chromatography (HPLC) method was established for the simultaneous determination of free mannose and glucose in the serum. Methods: The serum was directly derivatized by 1-phenyl-3-methyl-5-pyrazolone under alkaline conditions using L-rhamnose as an internal standard. The chromatographic separation was then performed on a Poroshell EC-C18 chromatographic column (4.6 × 100 mm, particle size 2.7μm, Agilent) with gradient elution using NH4Ac-HAc and acetonitrile as the mobile phases. The method was thereafter validated according to international guidelines. The serum samples obtained from 200 healthy individuals and 200 ovarian cancer (OC) patients were analyzed for free mannose and glucose. Results: The method was found to be reproducible for quantification within 20min and included online sample purification. The method displayed excellent linearity in the concentration range (for mannose: 0.5-500μg/mL; glucose: 0.5-1500μg/mL). The precision, recovery, and stability met the FDA bioanalytical method validation acceptance criteria. Overall, the measurement of glucose content by HPLC correlated well with the different enzymatic methods. Ovarian cancer mannose levels in the serum were significantly higher in the advanced stage (61.22μmol/L, p < 0.0001) than those in healthy volunteers and early-stage patients (44.51μmol/L versus 50.09μmol/L, p < 0.0001). The AUC for the ratio of serum free glucose to mannose (G/M) was 0.98 (p < 0.0001), with a sensitivity of 91.46% and a specificity of 98.50%, which served as a biomarker for OC diagnosis. Conclusion: We report a simple, repeatable, and attractive analytical method by HPLC, which can be used for quantitative estimation of free mannose and glucose simultaneously in human serum. Our results indicate that the serum level of mannose could be used as a potential biomarker of ovarian cancer.

The Prognostic Nutritional Index and Mortality in Patients With Ventriculoperitoneal Shunt Infection.

The objective of this study was to investigate the relationship between mortality and the prognostic nutritional index (PNI) in the pediatric patient group with ventriculoperitoneal shunt (VPS) infection. A total of 63 pediatric patients with a VPS infection and positive cerebrospinal fluid (CSF) culture were retrospectively registered. The CSF specimens were analyzed to conduct culture and microscopic evaluation. A total of 44.4% of the cases were men and 55.6% of the cases were women. Patients were divided into 2 groups (survivor and non-survivor patients). When survivor and non-survivor patients were compared, it was found that CSF leukocytes, CSF glucose, CSF protein, CSF/blood glucose ratio, lymphocyte, albumin, and PNI levels were lower in the non-survivor patients' group. Nevertheless, blood glucose and CRP (C-reactive protein) were significantly higher in the non-survivor patients' group than in the survivor patients' group. In our investigation, we suggested that low PNI was related to high mortality in cases of VPS infection.

The Effects of Bovine Colostrum on the Stress-Hyperglycemia Ratio and the Triglyceride-Glucose Index in Exercise-Trained Healthy Subjects: A Double-Blind, Placebo-Controlled Clinical Study

Bovine colostrum (BC) is a natural substance that has been shown of benefits for exercising, and reducing the blood glucose levels in type 2 diabetes. Stress hyperglycemia is a brief rise in blood glucose levels caused by physiological stress. This placebo-controlled clinical study aimed to investigate the effects of BC on stress hyperglycemia and the triglyceride-glucose index in healthy subjects who trained in resistance exercise. This research was carried out at Al-Kut University College from April 30th to November 30th, 2022. Fifty healthy young men were randomly assigned: Group I (n = 24) received a placebo, whereas Group II (n = 26) received a 500mg single oral dosage of BC nutraceutical pill. During the treatment period, both groups of volunteers engaged in resistance exercise training. Body mass index (BMI), waist circumference (WC), stress glucose ratio (SGR), triglyceride-glucose index (TyGI), and rate pressure product (as a hemodynamic response) were all measured at the start and end of the eight-week study.‎ Stress blood glucose levels were considerably higher in Group II following resistance training (89.0±6.5 vs 102.1±11.5mg/dL, p&lt;0.001), whereas stress HbA1c% did not alter (4.70±0.25 vs 4.66±0.29, p=0.608). Bovine colostrum significantly increases the SGR from 1.01±0.03 to 1.18±0.13, p&lt;0.001. The TyGI at the stress glucose level was increased by 2.7%. We conclude that bovine colostrum significantly elevates the stress hyperglycemic ratio without inducing significant changes in the TyGI following exercise. This impact is accompanied by a stabilizing hemodynamic response.&#x0D; &#x0D;

Glycemic control and prescription profiles in internal medicine inpatients: The role of frailty

AimThis work aims to characterize the clinical profile of individuals with frailty syndrome, diabetes mellitus (DM), and hyperglycemia during hospitalization in regard to glycemic control and treatment regimen. MethodsThis cross-sectional multicentric study included patients with DM or hyperglycemia at admission. Demographic data, blood glucose values, treatment administered during hospitalization, and treatment indicated at discharge were analyzed. The sample was divided into three groups according to score on a frailty questionnaire. Generalized additive models were used to describe the relationship between either glycemic variability (GV) or minimum capillary blood glucose and hypoglycemia. Models were adjusted for age, comorbidity, and sarcopenia. ResultsA total of 1,137 patients were analyzed. Patients with frailty syndrome had more comorbidity and sarcopenia, worse renal function, and lower albumin and lymphocyte levels. A GV between 21% and 60% was related to a higher probability of hypoglycemia, especially in patients with frailty. Regarding minimum capillary blood glucose, patients with frailty had the highest probability of hypoglycemia. This probability remained significant even in the group with frailty in which, with a reference value of 200 mg/dl, the adjusted odds ratio of a minimum capillary blood glucose of 151 mg/dL was 1.08 (95% confidence interval (1.12–1.05)). Baseline treatments showed a significant predominance of insulin use in the frailest groups. ConclusionsPatients with frailty had more sarcopenia and undernourishment. These patients were managed in a similar manner during hospitalization to patients without frailty, despite their higher risk of hypoglycemia according to GV or minimum capillary blood glucose levels.

Evaluation of Biological Markers in Children's Cerebrospinal Fluid with Bacterial and Viral Meningitis

Background and Aims: Cerebrospinal fluid (CSF) and blood biomarkers are widely evaluated as diagnostic tools to distinguish between bacterial meningitis and viral meningitis in emergency laboratory tests. So, this aimed to examine the levels of diagnostic parameters in blood and CSF to discriminate between bacterial and viral meningitis in young children referred to Khoy Hospital.&#x0D; Materials and Methods: A total of 101 young children with meningitis were enrolled in this prospective study. The diagnosis of bacterial and viral meningitis was based on clinical features and laboratory findings.&#x0D; Results: Of the 101 patients with meningitis, 18 (17.82%) were bacterial, and 83 (82.17%) were viral meningitis. The levels of CSF glucose and CSF/blood glucose ratio were significantly lower in the bacterial meningitis group than in the viral meningitis group (p &lt; 0.01). In contrast, white blood cells count, CSF protein, interleukin-6, C-reactive protein, and ferritin levels were significantly higher in patients with bacterial meningitis compared to viral meningitis (p &lt; 0.01). However, there was no difference between viral and bacterial meningitis groups concerning mean serum glucose.&#x0D; Conclusion: This study suggests that decreased CSF glucose and CSF/blood glucose ratio and increased white blood cells count, CSF protein, ferritin, interleukin-6, and C-reactive protein combined with clinical symptoms can help better diagnosis of bacterial meningitis, especially in comparison with viral meningitis.

RNA-seq Analysis Reveals Potential Synergic Effects of Acetate and Cold Exposure on Interscapular Brown Adipose Tissue in Mice.

Brown adipose tissue (BAT) exhibits remarkable morphological and functional plasticity in response to environmental (e.g., cold exposure) and nutrient (e.g., high-fat diet) stimuli. Notably, a number of studies have showed that acetate, the main fermentation product of dietary fiber in gut, profoundly influences the differentiation and activity of BAT. However, the potential synergic or antagonistic effects of acetate and cold exposure on BAT have not been well examined. In the present study, the C57BL/6J mice were treated with acetate at the systemic level before a short period of cold exposure. Physiological parameters including body weight, blood glucose, and Respiratory Exchange Ratio (RER) were monitored, and thermal imaging of body surface temperature was captured. Moreover, the transcriptome profiles of interscapular BAT were also determined and analyzed afterwards. The obtained results showed that acetate treatment prior to cold exposure could alter the gene expression profile, as evidenced by significant differential clusters between the two groups. GO analysis and KEGG analysis further identified differentially expressed genes being mainly enriched for a number of biological terms and pathways related to lipid metabolism and brown adipose activity such as "G-protein-coupled receptor activity", "cAMP metabolic process", "PPAR signaling pathway", and "FoxO signaling pathway". GSEA analysis further suggested that activation status of key pathways including "PPAR signaling pathway" and "TCA cycle" were altered upon acetate treatment. Taken together, our study identified the potential synergistic effect of acetic acid with cold exposure on BAT, which highlighted the positive dietary and therapeutic aspects of acetate.

Comparative efficacy and safety of sodium–glucose cotransporter 2 inhibitors for renal outcomes in patients with type 2 diabetes mellitus: a systematic review and network meta-analysis

In this study, the summarized WMDs and RRs were calculated using a pairwise analysis and a network meta-analysis with a random effects model, to compare and rank the efficacy and safety of SGLT-2i for renal outcomes in patients with T2DM. Among 1894 identified articles, 30 trials including 50,244 patients with T2DM were evaluated. Network analysis revealed that the administration of canagliflozin was associated with a reduced risk of renal impairment (surface under the cumulative ranking: 90.8%). Further, although the administration of SGLT-2i was not associated with the risk of renal impairment (RR = 0.88, 95%CI = 0.68–1.15, p = 0.354), the administration of empagliflozin was associated with a reduced risk of renal impairment compared to that with the administration of placebo (RR = 0.74, 95%CI = 0.62–0.90, p = 0.002). Moreover, compared with the administration of a placebo, the administration of 50, 100, and 200 mg of canagliflozin was associated with lower serum creatinine levels. Furthermore, compared with the administration of a placebo, the administration of 100 mg canagliflozin, 2.5 mg dapagliflozin, and 25 mg empagliflozin was associated with a lower reduction in the estimated glomerular filtration rate. Except for 300 mg canagliflozin, all SGLT-2i were associated with greater increases in blood urea nitrogen levels (WMD = 1.39, 95%CI = 1.20–1.59, p < 0.001). Finally, the administration of all SGLT-2i significantly increased the ratio of urinary glucose to creatinine compared with the ratio upon administration of placebo (WMD = 36.21, 95%CI = 31.50–40.92, p < 0.001). Briefly, canagliflozin exerts the greatest therapeutic effect in terms of reducing the risk of renal impairment. Empagliflozin and canagliflozin may be more effective than other SGLT-2i in preventing renal impairment.