Type II Diabetes Research Articles

Pattern of Thyroid Dysfunction in Type II Diabetes Mellitus Patients in a Tertiary Care Center: A Cross-Sectional Study

Background: Early identification and intervention of thyroid dysfunction which occurs in association with type-II diabetes mellitus may significantly reduce the risk of adverse cerebrovascular and cardiovascular events in such patients. Hence, this study analyzed the pattern of thyroid dysfunction in T2DM (Type 2 Diabetes mellitus) patients. Methods: The present cross-sectional study was done on 250 T2DM patients, who visited the department of General Medicine in a tertiary care teaching center. Medical history was recorded and venous blood samples were collected for investigations (HbA1C (Hemoglobin A1C), FBS (Fasting blood sugar), PPBS (Postprandial blood sugar), TSH (Thyroid stimulating hormone), T4 (Tetraiodothyronine), anti-TPO (Thyroid peroxidase), and fasting lipid profile). Thyroid dysfunction in patients with T2DM was considered as the primary outcome variable. P value <0.05 was considered statistically significant. Data were analyzed using coGuide software, V.1.03. Results: Females (55.6%) outnumbered males (44.4%) in this study. The prevalence of thyroid dysfunction in our study was 23.6% (95%CI 0.184 to 0.293). Subclinical hypothyroidism was found in 67.79% (95%CI 0.543 to 0.793) participants, overt hypothyroidism in 27.11% (95%CI 0.163 to 0.402), and hyperthyroidism in 5.10% (95%CI 0.010 to 0.141). Females (84.6%) had significantly higher prevalence of anti-TPO positivity compared to males (15.4%)(p=0.013). Conclusions: Findings of this study showed that T2DM patients have higher prevalence of thyroid dysfunction with predominance of subclinical hypothyroidism. Hence, this study emphasizes the importance of annual investigation of TSH levels in all the patients with T2DM. Keywords: Autoimmune Diseases, Hyperthyroidism, Hypothyroidism, Thyroid­Stimulating Hormone, Type II Diabetes Mellitus

Knowledge and Practices of Patients Regarding Diabetes Self-Management: A Mixed Method Approach

Diabetes Mellitus is a major source of death globally and has shaken middle-income and low-income countries including Pakistan. Objective: To determine diabetes knowledge, and explore the patient’s experiences of type-ii diabetes along with its self-management. Methods: A mixed-method design was used to carry out this study at a tertiary care hospital in KP Pakistan from April to September 2021. Information on patients’ demographic characteristics, diabetes knowledge, and diabetes self-practices, patients’ lived experiences of diabetes self-practices, and barriers to self-care activities were collected. Data were collected through a structured questionnaire and in-depth (IDIs) interviews for measuring diabetes knowledge, and its management. Results: Out of 215 recruited participants, the majority 90% had inadequate knowledge (score=0-4). 3.2% (n=07) had average knowledge (score=5-8) of diabetes, and its self-management. 60% of the participants were from the age group 50-59 years. 70% (n=151) of participants were from poor socioeconomic classes. The results showed an association between illiteracy, poverty, diabetes knowledge, and self-management (p-Value 0.001). The qualitative results expressed that the illiterate and low socioeconomic participants had inadequate diabetes self-management practices. Conclusions: The study inferred that the participants, who had inadequate knowledge about type-II diabetes and its management, were having poor self-care practices of diabetes.

Effect of Amla Powder and Turmeric Powder Consumption on Geriatric Subjects Suffering from Non-Insulin Dependent Diabetes Mellitus

Diabetes mellitus is the most challenging public health problem of 21st century. International Diabetes Federation, (2015) reported 69.1 million cases of diabetes in India. Worldwide 2011 estimation of prevalence of diabetes in the elderly population (60 years & above) is between 15% to 20% (IDF Diabetes Atlas, 2012). The present study titled “Effect of amla powder and turmeric powder consumption on geriatric subjects (60 years & above) suffering from non-insulin dependent diabetes mellitus” involved multistage random sampling technique. The study was conducted on 18 geriatric subjects residing in Kala Mahal & Pipal Mandi area of Agra city, randomly divided into 2 groups- experimental group (N1=8) and control group (N2=9). 2.5g each of amla powder and turmeric powder was consumed by experimental geriatric non-insulin dependent subjects for 45 continuous days and its effect on fasting and post prandial blood glucose level was recorded and compared with the control group. Demographic, anthropometric and dietary patterns of both groups was also recorded. Statistical tests were applied and it was found that consumption of amla powder and turmeric powder was significantly effective on geriatric subjects (60 years & above) and there was a significant drop in the fasting & post prandial blood glucose level of experimental group on 45th day of feeding trial. In the 24-hour diet recall average consumption of thiamine (mg) was significant at 95% confidence interval (p<0.05)nwhen t-test was applied while energy (kcal), protein (g), carbohydrates(g), fat(g), phosphorus (mg), iron (mg), vitamin A (mcg), riboflavin (mg), niacin (mg) and vitamin C (mg) intake were not significant (p>0.05).

Failure to repair endogenous DNA damage in β-cells causes adult-onset diabetes in mice.

Age is the greatest risk factor for the development of type 2 diabetes mellitus (T2DM). Age-related decline in organ function is attributed to the accumulation of stochastic damage, including damage to the nuclear genome. Islets of T2DM patients display increased levels of DNA damage. However, whether this is a cause or consequence of the disease has not been elucidated. Here, we asked if spontaneous, endogenous DNA damage in β-cells can drive β-cell dysfunction and diabetes, via deletion of Ercc1, a key DNA repair gene, in β-cells. Mice harboring Ercc1-deficient β-cells developed adult-onset diabetes as demonstrated by increased random and fasted blood glucose levels, impaired glucose tolerance, and reduced insulin secretion. The inability to repair endogenous DNA damage led to an increase in oxidative DNA damage and apoptosis in β-cells and a significant loss of β-cell mass. Using electron microscopy, we identified β-cells in clear distress that showed an increased cell size, enlarged nuclear size, reduced number of mature insulin granules, and decreased number of mitochondria. Some β-cells were more affected than others consistent with the stochastic nature of spontaneous DNA damage. Ercc1-deficiency in β-cells also resulted in loss of β-cell function as glucose-stimulated insulin secretion and mitochondrial function were impaired in islets isolated from mice harboring Ercc1-deficient β-cells. These data reveal that unrepaired endogenous DNA damage is sufficient to drive β-cell dysfunction and provide a mechanism by which age increases the risk of T2DM.

Exploring geomasking methods for geoprivacy: a pilot study in an environment with built features.

This study discusses the ethical use of geographical information systems (GIS) data with a focus on geomasking for upholding locational privacy. As part of a pilot study in Jeddah City, Saudi Arabia, we used open-source geomasking methods to ensure geoprivacy while examining built environment features that determine the quality of life among individuals with type-II diabetes. We employed the open-source algorithms Maskmy.XYZ and NRand-k for geomasking 329 data points. The results showed no differences between global and city-level spatial patterns, but significant variations were observed with respect to local patterns. These findings indicate the promising potential of the chosen geomasking technologies with respect to ensuring locational privacy but it was noted that further improvements are needed. We recommend developing enhanced algorithms and conducting additional studies to minimize any negative impact of geomasking in spatial analysis with the overall aim of achieving a better understanding of ethical considerations in GIS sciences. In conclusion, application of geomasking is straightforward and can lead to enhanced use for privacy protection in geospatial data analysis.

Prevalence and Incidence of Type-2 Diabetes Mellitus Among the Rural Population of Erode District of Tamil Nadu, South India

Diabetes mellitus is a group of metabolic disorders characterised by hyperglycaemia, caused by elevation of blood glucose level. A sedentary lifestyle is the most common cause of diabetes and has a wide range of long-term effects, including cardiovascular disease, kidney disease, blindness, and disability. Over the last two decades, diabetes has become more widespread in low and middle-income countries than in high-income countries. The study was aimed to determine the prevalence and incidence of type 2 diabetes mellitus among the rural population of Erode district, Tamil Nadu, India. A cross-sectional study was conducted for a period of one year. Data was collected from 870 individuals using a predesigned structured questionnaire covering the individual’s demographics, History of DM, finding, lab variables, comorbidities, problems of DM, and therapy provided. Most of the diabetic individuals were females (n= 493; 56.66%), Married (n=824; 94.71%), Un employed (n= 208; 49.06%) and Illiterate (n=238; 27.35%). Most of them aged between 56-65 years (272; 31.26%), having Past Medical History of Type-II DM (n=255; 29.31%), High blood pressure (n=486; 55.86%), and hyperlipidaemia (n=20; 2.29%). Most of the respondents were having the co morbidities of diabetes mellitus with high blood pressure (n=483; (55.51%), followed by diabetes mellitus alone 258(n= 29.65), All the individuals in this present study were diagnosed with type-2 diabetes mellitus (n=487; 100%), taking oral hypoglycaemic agents (n=755; 86.78%), 108 (12.41%) patients were treated with insulin plus Oral Hypoglycaemic agents, whereas only 7 (0.80%) patients were treated with insulin alone. Women are more likely to have diabetes, and married, obese, and overweight people are more likely to have it. Metformin was the most often used single drug therapy to treat DM, and OHA was the recommended option for antidiabetic medication. The incidence and prevalence of diabetes among this demographic increased as a result of incorrect way of living and an absence of knowledge about dm and its effects. This is a critical health issues, and it may raise the morbidity and death if not resolved right way. A well-structured health comprehensive programme must be executed in order to decrease detrimental health results and enhance quality of life for the research population.

Green Medicine for Weight Management: Medicinal Plants as promising curative agents in the treatment of Obesity

Obesity has become a global health crisis with substantial implications for public health. In the past 50 years, significant advancements have been made in the treatment of disorders like hypertension, adult-onset diabetes, and increased cholesterol that are directly related to obesity. However, the disease of obesity has proven to be mostly resistant to treatments, and anti-obesity drugs (AOMs) frequently have questionable safety and poor efficacy. Here, we give a summary of the history of AOM development with an emphasis on the lessons learned and current challenges. The search for next-generation AOMs that look capable of safely accomplishing significant and sustained body weight loss is motivated by recent developments, including improved knowledge of the molecular gut-brain communication. The exploration of medicinal plants for their anti-obesity potential has gained momentum due to their perceived safety and cultural acceptance.

Remission of Type II Diabetes Mellitus after Duodenal Switch: the Contribution of Common Channel Length

IntroductionThe role of the common channel length in duodenal switch (DS) on remission of type II diabetes mellitus (DM), when stratifying patients based on diabetes severity, is not well understood.MethodsWe retrospectively reviewed 341 consecutive patients with DM undergoing DS with one of three different common channel (CC) lengths (100 cm, 150 cm, and 200 cm), each with a fixed 300 cm alimentary limb (AL). Patients were stratified by insulin dependence (IDDM) versus non-insulin dependent diabetes (NIDDM). Data was collected at one year and at the last available follow-up.ResultsThe NIDDM group had a similar average HbA1c at last follow-up for each of the CC lengths. However, the IDDM group had lower average HbA1c with shorter CC lengths (100 cm = 5.4%, 150 cm = 6%, 200 cm = 6.4%, p < 0.05). Shorter CC lengths resulted in a greater proportion of patients achieving remission in the IDDM group (66%, 50%, 32% in the 100 cm, 150 cm, and 200 cm CC, respectively, p < 0.01). Improvements in HbA1c were independent of weight loss and average DiaRem scores were similar between CC lengths. Rates of nutritional deficiencies were higher in shorter common channel lengths. Revision for malnutrition was similar between common channel lengths (100 cm group: 3.7%; 150 cm group: 1.8%; 200 cm group: 0%, p = NS).ConclusionsWhen the AL is fixed, shortening CC lengths results in improved glycemic control and remission of DM in patients with the need for insulin preoperatively. Milder forms of DM are treated well with any of the CC lengths.Graphical

Supplementation with the Probiotic Strains Bifidobacterium longum and Lactiplantibacillus rhamnosus Alleviates Glucose Intolerance by Restoring the IL-22 Response and Pancreatic Beta Cell Dysfunction in Type 2 Diabetic Mice.

Type 2 diabetes (T2D) is known as adult-onset diabetes, but recently, T2D has increased in the number of younger people, becoming a major clinical burden in human society. The objective of this study was to determine the effects of Bifidobacterium and Lactiplantibacillus strains derived from the feces of 20 healthy humans on T2D development and to understand the mechanism underlying any positive effects of probiotics. We found that Bifidobacterium longum NBM7-1 (Chong Kun Dang strain 1; CKD1) and Lactiplantibacillus rhamnosus NBM17-4 (Chong Kun Dang strain 2; CKD2) isolated from the feces of healthy Korean adults (n = 20) have anti-diabetic effects based on the insulin sensitivity. During the oral gavage for 8weeks, T2D mice were supplemented with anti-diabetic drugs (1.0-10mg/kg body weight) to four positive and negative control groups or four probiotics (200 uL; 1 × 109CFU/mL) to groups separately or combined to the four treatment groups (n = 6 per group). While acknowledging the relatively small sample size, this study provides valuable insights into the potential benefits of B. longum NBM7-1 and L. rhamnosus NBM17-4 in mitigating T2D development. The animal gene expression was assessed using a qRT-PCR, and metabolic parameters were assessed using an ELISA assay. We demonstrated that B. longum NBM7-1 in the CKD1 group and L. rhamnosus NBM17-4 in the CKD2 group alleviate T2D development through the upregulation of IL-22, which enhances insulin sensitivity and pancreatic functions while reducing liver steatosis. These findings suggest that B. longum NBM7-1 and L. rhamnosus NBM17-4 could be the candidate probiotics for the therapeutic treatments of T2D patients as well as the prevention of type 2 diabetes.

THU387 Euglycemic Diabetic Ketoacidosis And SGLT-2 Inhibitor Use

Abstract Disclosure: N. Abrahimi: None. A. Abrahimi: None. N. Terrigno: None. Background: Diabetic ketoacidosis (DKA) is a known adverse effect of SGLT-2 inhibitors. (1) Incidences of euglycemic diabetic ketoacidosis in patients on SGLT-2 inhibitors are reported on less. Clinical Case: A 39-year-old male past medical history of uncontrolled, non-insulin dependent diabetes mellitus and pancreatitis who presented with abdominal pain, nausea and coffee ground emesis. On initial work up, basic metabolic panel showed blood glucose level of 175 mg/dL with an elevated anion gap of 22 mmol/L. Initial differentials included suspicion for euglycemic diabetic ketoacidosis or acute intraabdominal pathology. Venous blood gas showed metabolic acidosis, with a pH of 7.21 and bicarbonate of 9.7 mmol/L, beta hydroxybutyrate was elevated at 7.83 mmol/L. CT abdomen pelvis found a small hiatal hernia, gastric wall thickening, likely gastritis, and was negative for other intraabdominal pathology. Home medications of the patient included dapagliflozin, semaglutide, metformin, gabapentin, and pantoprazole. Patient was admitted with the diagnosis of suspected euglycemic diabetic ketoacidosis and was started on an insulin drip along with D5 0.45 normal saline. Patient’s anion gap was monitored with basic metabolic panel orders every two hours. The insulin drip was discontinued once the patient had two consecutive normal anion gaps and the patient was subsequently started on a subcutaneous insulin regimen. Conclusion: SGLT-2 inhibitors may cause euglycemic diabetic ketoacidosis based on the physiology of the SGLT-2 transporter and the pharmacology of the SGLT-2 inhibitors. (2) Clinical importance of this case report is to consider euglycemic diabetic ketoacidosis in patients on SGLT-2 inhibitors presenting with nausea, vomiting with normal blood glucose to not delay in the diagnosis and treatment of this life-threatening condition.

PROFILING OF CLINICAL DYNAMICS OF TYPE 2 DIABETES MELLITUS IN PATIENTS: A PERSPECTIVE REVIEW

Type 2 diabetes mellitus (T2DM), also known as Non-Insulin Dependent Diabetes Mellitus (NIDDM) is one of the common metabolic disorders in the world. T2DM accounts for around 90% of all cases of diabetes mellitus, afflicting millions worldwide. It is a significant global health burden with a steadily increasing prevalence. In T2DM, the response to insulin is diminished, and this is defined as insulin resistance. Risk factors for T2DM are diverse. Some are modifiable, and others are not. Modifiable risk factors include overweight/obesity, lack of exercise or physical inactivity, poor nutrition, etc. Non-modifiable risk factors include age, ethnicity/race, family history, history of gestational diabetes mellitus, etc. The starting points and mainstays of treatment for T2DM are diet and lifestyle modifications such as increased physical activity and stoppage of smoking. In addition to the diet and lifestyle modifications, drugs are also used in the management of T2DM. This study aimed to profile the clinical dynamics of type 2 diabetes mellitus in patients. Current literatures from different databases including MEDLINE, PubMed, EMBASE, CINAHL, Google Scholar, etc. on the topic were searched online and reviewed.

SAT092 A Case Of Mature Onset Diabetes Of The Young

Abstract Disclosure: L. Beshay: None. A. Thakkar: None. Background: Maturity onset diabetes of the young (MODY) is a disorder characterized by noninsulin-dependent diabetes diagnosed at a young age (&amp;lt;25 years) with autosomal dominant inheritance and lack of autoantibodies. It accounts for 2 to 5 percent of diabetes cases. Several different genetic abnormalities have been identified causing disruption in pancreatic beta cells development and function leading to impaired insulin secretion. Mutations in hepatocyte nuclear factor-1-alpha (HNF1A) is the most commonly identified mutation occurring in 52 to 65 of MODY cases. Case Description: A 21 year old female with a history of diabetes and recurrent skin abscesses presented to the emergency room with right lower quadrant epidermal abscess. Endocrinology was consulted for evaluation of her diabetes. She was diagnosed at age 14 when she presented with weight loss, polyuria, polydipsia, BG 406 without diabetic ketoacidosis. She reported a history of type 2 diabetes in mother. Her medications included metformin, lantus and humalog. It was noted that her diabetes was never controlled with an A1c persistently &amp;gt;10%. Patient reported skin swelling with insulin injections and working two jobs which limited her ability to take more than one injection per day. Her BMI is 23 kg/m2. Labs this admission showed HbA1c 13.7%, GAD 65 Ab and IA-2 Ab negative, c-peptide 1.1 ng/ml, with a glucose of 209 mg/dl. MODY was suspected due to her age, intact c-peptide, and lack of DM1 antibodies. The patient was discharged on Trulicity 0.75 mg weekly, Lantus 12U nightly, Glipizide 2.5mg daily. On follow up, a MODY genetic panel confirmed a HNF1A missense variant with AD inheritance. Since initiation of sulfonylurea, she has had improved control of diabetes. Glipizide dose is being titrated up with concomitant decrease in insulin dose with plan to discontinue basal insulin once her blood sugars are at goal. Conclusion: The HNF1A gene on chromosome 12 is a weak transactivator of the insulin gene in beta cells. Mutations of HNF1A can lead to abnormal insulin secretion and a low renal threshold for glucose. These patients are at risk for micro- and macrovascular complications of diabetes. In terms of treatment, they exhibit increased insulin sensitivity and marked sensitivity to the hypoglycemic effects of sulfonylureas compared with patients with type 2 diabetes. Thus, patients can be successfully treated with sulfonylurea monotherapy, and in one clinical study, approximately 70 percent of patients previously treated with insulin successfully switched to sulfonylureas. Thus, it is important to evaluate etiology of diabetes, as detection of MODY variants in which sulfonylureas are used for treatment simplifies management and improves outcomes as demonstrated in this case. Presentation: Saturday, June 17, 2023

Clinical study of add on effect of Triphaladaruadi Kwatha (Vangsenokta) along with antidiabetic drug in management of Prameha (Non-Insulin Dependent Diabetes mellitus- NIDDM)

Prameha (Diabetes mellitus) is an age long disease known from vedic period and now it is a leading lifestyle disorder. Diabetes mellitus is a group of metabolic syndromes of fat, protein and carbohydrate which is due to absolute or relative deficiency of insulin. The prevalence of diabetes in India has risen from 7.1% in 2009 to 8.9% in 2019.1 The estimates in 2019 showed that 77 million individuals had diabetes in India, which is expected to rise to over 134 million by 2045.2 In India, it is also 3rd leading cause of death (After heart disease and cancer). The number is projected to be twice by 2030. Type 2 diabetes makes up about 85-90% of all cases. Increase in the overall diabetes prevalence rates largely reflect an increase in risk factors for type 2, notably greater longevity and being overweight or obese. Hence preventive measures are essential and an ideal therapy is still obscure. It remains one of the baffling enigmas for clinical research. This is a randomized single blind standard controlled clinical trial conducted on 66 patients of Prameha (Type II DM &amp; who are on antidiabetic treatment) to rule out Add on effect of Triphaladaruadi kwath of either gender between age group of 40-60 years and grouped into Group A &amp; Group B. 33 patients in group A were on Antidiabetic drug (Metformin 500mg OD/BD and 33 patients in Group B are on same antidiabetic drug (Metformin 500mg OD/BD) with additional Triphaladaruadi kwath (Decoction) for 3 months. Results obtained in subjective and objective parameters were analyzed for the statistical significance by adapting paired ‘t’ test in the groups, Two-way ANOVA test between the groups, and Wilcoxon rank sum test. The study revealed that Group B was found to be more effective in bringing symptomatic relief and improving biochemical markers in the patients of Prameha.

TCT-168 Clinical Significance of Insulin- and Noninsulin-Dependent Diabetes in Patients Undergoing Percutaneous Revascularization of the Left Main Coronary Artery

TCT-168 Clinical Significance of Insulin- and Noninsulin-Dependent Diabetes in Patients Undergoing Percutaneous Revascularization of the Left Main Coronary Artery

Add-on effect of proprietary Ayurvedic medicine Diabrishta-21 in managing glucose variability measured through continuous glucose monitoring device: A case report

Abstract: In the scenario of modern health issues, Type 2 Diabetes Mellitus (T2DM) has gained much importance as “adult-onset diabetes” which represents a combination of genetic, environmental, and lifestyle choices. It predominantly shows hyperglycemia or increased blood glucose levels, insulin deficiency, and insulin resistance, which typically characterizes this metabolic disorder whilst manifesting life-threatening complications. This report presents the case of a 55-year-old male with T2DM whose glucose levels were monitored during a period when he was on his prescribed antidiabetic medicines, followed by the addition of an Ayurvedic preparation Diabrishta-21. His glucose summary, obtained by the Continuous Glucose Monitoring (CGM) approach depicts a change in the average value of blood sugar levels and glycated hemoglobin levels, decreasing from 167 to 108 mg/dL, and from 7.4% to 5.4%, respectively. Moreover, the percentage of time the blood glucose levels were in the desired target range increased from 29% to 79%. Thus, Diabrishta-21 in this case report appears to be beneficial in the management of T2DM by aiding in controlling the glucose variability and lowering the blood glucose levels.

Assessment of serum and salivary visfatin levels in newly diagnosed patients of type-II DM.

Type II diabetes mellitus (T2DM) is a metabolic disorder. It is thought to be an autoinflammatory disease, as inflammatory mediators are associated with the progression of the disease. Visfatin, an adipokine, is linked to insulin resistance. We aimed to study serum and salivary visfatin levels, at the time of diagnosis of T2DM, in middle-aged individuals, in the context of other diagnostic parameters like fasting blood sugar (FBS), postprandial blood sugar (PPBS), and glycated haemoglobin A1c (HbA1c). Thirty newly diagnosed T2DM (Group-I, T2DM) patients and 30 healthy nondiabetic individuals (Group-II, health controls [HC]) matched for age and sex were studied. In both the groups, we assessed serum and salivary visfatin levels, and serum high-sensitivity C-reactive protein (hs-CRP) levels. We also compared serum and salivary visfatin levels and serum hs-CRP levels between Group-I and Group-II individuals. The correlation between the groups was tested using Pearson's correlation. A P- value < 0.001 was considered to be statistically significant. The data was tabulated using software MS Excel and analysed using IBM Statistical Package for the Social Sciences (SPSS) Version 22.0. A positive correlation with a value of 0.8836 and a P value of 0.001 was noted between serum and salivary visfatin of Group-I. This is the first study in the Indian scenario to study the serum and salivary visfatin in newly diagnosed T2DM individuals. Serum visfatin and hs-CRP levels increased in T2DM, thus defining the link between visfatin, inflammation and T2DM, but we failed to notice a positive correlation.

Investigating Weekend Effect in the Management of Upper and Lower Extremity Degloving Injuries.

Weekend presentation has been associated with adverse outcomes in emergent conditions, including stroke, myocardial infarction, and critical limb ischemia. We examine whether a weekend effect exists in the management of and outcomes after extremity degloving injuries. The cohort included adults presenting with open extremity degloving injuries to a tertiary level one trauma center between June 2018 and May 2022. We collected demographics, comorbidities, injury information, interventions, and complications. Propensity score weighting was used to minimize confounding differences between those presenting on weekends (Sat-Sun) versus weekdays (Mon-Fri). Weighted regressions were used to examine differences in interventions by day of presentation. Multivariable weighted regressions accounting for differences in interventions received were used to examine whether weekend presentation was associated with amputation risk, complications, or functional deficits. Ninety-five patients with 100 open extremity degloving injuries were included. In total, 39% of injuries were weekend-presenting. There was a higher rate of noninsulin-dependent diabetes among patients presenting on weekends (P = 0.03). Weekend-presenting injuries had higher median Injury Severity Scores (P = 0.04). Propensity-weighted regression analysis revealed differences in interventions received on weekends, including lower rates of pedicled and free flaps and bone graft, and increased rates of negative-pressure wound therapy (P ≤ 0.02). Multivariable regression analysis revealed weekend presentation was a significant independent risk factor for amputation of the affected extremity [odds ratio 2.27, 95% CI (1.01-5.33), P = 0.05]. Weekend presentation may impact interventions received and amputation risk in patients presenting with open extremity degloving injuries.

Vitamin D Deficiency in the Patients of Diabetes Mellitus and Its Correlation with HbA1c

Background: Diabetes mellitus is a prevalent chronic metabolic disorder. Elevated HbA1c levels are associated with a higher risk of diabetes-related complications. Some studies have suggested a potential correlation between vitamin D levels and HbA1c, indicating that vitamin D deficiency may contribute to poor glycemic control. Objective: To evaluate the vitamin d deficiency in the patients of type-II diabetes mellitus and its correlation with HbA1c. Study Design: Cross-sectional study. Settings: Department of Medicine, PUMHS Nawabshah and MMC MirpurKhas Pakistan. Duration: 6 months of period from July 2021 to December 2021. Methods: Study included patients with type 2 diabetes mellitus, aged over 40 years and both genders. A 5ml blood sample was collected from each participant after obtaining informed consent and sent to the diagnostic laboratory to determine the HbA1c levels and vitamin D status. Data collection was carried out using a self-made study proforma, and the data were analyzed using SPSS version 26. Results: A total of 58 diabetes patients were evaluated for vitamin D deficient and its correlation with HbA1c. Overall mean age of the patients was 53.32 ± 8.54 years. Males were 28(48.3%) and females were 30(51.7%). Most of the patients 48.30% had moderately decreased vitamin D level, followed by 25.90% cases had mild deficiency, only one case had severely decreased vitamin D level. There was a significant negative correlation between vitamin d level and HbA1c (r= - 0.314) (p= 0.016). Conclusion: Among individuals with type 2 diabetes mellitus, there was a higher prevalence of vitamin D deficiency and insufficiency. Additionally, a significant inverse relationship was observed between vitamin D deficiency and HbA1c levels.

Physicochemical and Phytochemical Analysis of Siddha Polyherbal Formulation “Madhumega Nivarani Chooranam’’

Aim: The aim of the study was to assess the Physicochemical and Phytochemical analysis of Siddha herbal formulation “Madhumega Nivarana Chooranam”, used for the management of Madhumegam(Type-II Diabetes mellitus)&#x0D; Materials and Method: The Siddha Polyherbal formulation Madhumega Nivarani Chooranam was prepared in accordance with good manufacturing practises (GMP) guidelines,], Physicochemical and phytochemicalanalyses were performed at the Tamilnadu Dr. MGR Medical University, located at no. 69, Anna salai, Guindy, Chennai32.&#x0D; Results and Discussion: Physicochemical analysis shows the Loss on drying(0.08%), Total ash value (7.08%), Acid insoluble ash (1.55%), Water soluble ash (2.26% ), Water soluble extraction (31.43%), Alcohol soluble extraction(19.27%)The Phytochemical analysis shows the presence of important Phytoconstituents such as Alkaloids, Carbohydrates, Saponin, Phenols, Tannins, Flavonoids, Diterpenes, QuinSiddhaones, Gum &amp; Mucilage&#x0D; Conclusion: According to the results, it can be stated that the MNC has a comprehensive understanding of the presence of Physicochemical properties, Phytochemical components and has the ability to evaluate the quality profile of Madhumega nivarani Chooranam as the basis for the creation of a Pharmaceutical product, which has been standardised.

Identification and analysis of individuals who deviate from their genetically-predicted phenotype.

Findings from genome-wide association studies have facilitated the generation of genetic predictors for many common human phenotypes. Stratifying individuals misaligned to a genetic predictor based on common variants may be important for follow-up studies that aim to identify alternative causal factors. Using genome-wide imputed genetic data, we aimed to classify 158,951 unrelated individuals from the UK Biobank as either concordant or deviating from two well-measured phenotypes. We first applied our methods to standing height: our primary analysis classified 244 individuals (0.15%) as misaligned to their genetically predicted height. We show that these individuals are enriched for self-reporting being shorter or taller than average at age 10, diagnosed congenital malformations, and rare loss-of-function variants in genes previously catalogued as causal for growth disorders. Secondly, we apply our methods to LDL cholesterol (LDL-C). We classified 156 (0.12%) individuals as misaligned to their genetically predicted LDL-C and show that these individuals were enriched for both clinically actionable cardiovascular risk factors and rare genetic variants in genes previously shown to be involved in metabolic processes. Individuals whose LDL-C was higher than expected based on the genetic predictor were also at higher risk of developing coronary artery disease and type-two diabetes, even after adjustment for measured LDL-C, BMI and age, suggesting upward deviation from genetically predicted LDL-C is indicative of generally poor health. Our results remained broadly consistent when performing sensitivity analysis based on a variety of parametric and non-parametric methods to define individuals deviating from polygenic expectation. Our analyses demonstrate the potential importance of quantitatively identifying individuals for further follow-up based on deviation from genetic predictions.