Serum Glucose Values Research Articles

Prediction of Diabetic Sensorimotor Polyneuropathy Using Machine Learning Techniques.

Diabetic sensorimotor polyneuropathy (DSPN) is a major complication in patients with diabetes mellitus (DM), and early detection or prediction of DSPN is important for preventing or managing neuropathic pain and foot ulcer. Our aim is to delineate whether machine learning techniques are more useful than traditional statistical methods for predicting DSPN in DM patients. Four hundred seventy DM patients were classified into four groups (normal, possible, probable, and confirmed) based on clinical and electrophysiological findings of suspected DSPN. Three ML methods, XGBoost (XGB), support vector machine (SVM), and random forest (RF), and their combinations were used for analysis. RF showed the best area under the receiver operator characteristic curve (AUC, 0.8250) for differentiating between two categories—criteria by clinical findings (normal, possible, and probable groups) and those by electrophysiological findings (confirmed group)—and the result was superior to that of linear regression analysis (AUC = 0.6620). Average values of serum glucose, International Federation of Clinical Chemistry (IFCC), HbA1c, and albumin levels were identified as the four most important predictors of DSPN. In conclusion, machine learning techniques, especially RF, can predict DSPN in DM patients effectively, and electrophysiological analysis is important for identifying DSPN.

Diagnostic value of pleural fluid lactate dehydrogenase/adenosine deaminase ratio in differentiating parapneumonic effusion from tuberculous pleurisy

Objective The purpose of this study was to determine the diagnostic value of pleural fluid lactate dehydrogenase (LDH)/pleural fluid adenosine deaminase (ADA) ratio in differentiating pleural effusions owing to tuberculous pleurisy (TBP) and parapneumonic effusion (PPE). Patients and methods The data of 272 patients (140 patients with TBP and 132 patients with PPE) between January 2012 and October 2018 were analyzed retrospectively. Demographic data of all patients; concurrent serum glucose, albumin, protein, and LDH values; and pleural fluid pH, glucose, albumin, protein, and ADA results have been reviewed. Results Pleural fluid ADA values were statistically significantly higher in the TBP group than PPE (P<0.001). The median values of pleural fluid LDH/ADA ratio between TBP and PPE groups were 16.10 (12.53) and 32.90 (34.45), respectively, which was found to be significantly lower in TBP group (P<0.001). Pleural fluid LDH/ADA ratio’s sensitivity, specificity, positive predictive value, and negative predictive value were 90, 59.85, 70.4, and 84.9%, respectively, in the diagnosis of TBP for values less than 28 (P<0.001). Conclusion The ratio of pleural fluid LDH/ADA determined from routine biochemical analysis predicts TBP at value of 28. Measurement of this parameter may help clinicians distinguish between TBP and PPE.

Possible predictive markers in surgical decision making in patients with degenerative or isthmic lumbar spondylolisthesis

Background: Although age, comorbidity, duration and severity of symptoms, slippage degree, and flexion-extension slipping stability during X-ray imaging are effective in making a surgical decision in patients with spondylolisthesis, these factors are rarely based on definitive evidence. The aim of this study was to determine the efficacy of clinical, radiological and biochemical findings in surgical decision making in these patients. Materials and Methods: Patients’ data including age, gender, degree and type (i.e. degenerative or isthmic) of the spondylolisthesis, urinary incontinence, neurogenic claudication were recorded. Radiological imaging studies (lumbar dynamic X-ray, computed tomography, magnetic resonance imaging), serum glucose, C-reactive protein and erythrocyte sedimentation rate values of the patients obtained during hospital admissions were evaluated. Results: Forty patients were followed conservatively and 12 patients were treated surgically. Degenerative spondylolisthesis was seen in 22 patients. Nine patients had neurogenic urinary incontinence and 19 patients had neurogenic claudication. When the patients were divided into two groups with and without surgical treatment, the presence of the pars defect, slipping distance in a neutral position and slipping distance in flexion position was significantly different between groups. A positive correlation was found between pars defect and surgical treatment. Likelihood ratio test results revealed that the presence of pars defect, neurogenic claudication and neurogenic urinary incontinence could be the best parameters in decision making the surgical treatment. Conclusion: The presence of pars defect, neurogenic claudication and urinary incontinence could be the best parameters that may help the surgeon to make the surgical treatment decision.

Reliability of continuous glucose monitoring system in the inpatient setting

Aims/HypothesisHyperglycemia and hypoglycemia are associated with increased morbidity and mortality in the inpatient setting. Standard point of care capillary glucose testing (POCT) is commonly used in hospitalized patients to monitor their glucose levels. The goal of this study was to examine the relationships between the glucose readings obtained by a continuous glucose monitoring system (CGMS) (Freestyle Libre) and the capillary blood glucose results obtained by the inpatient glucose POCT meter (Accuchek Inform II) as well as between CGMS readings and the serum glucose values obtained by the hospital laboratory. Study participants had either primary or secondary diagnosis of diabetes mellitus and were admitted to non-critical units. We hypothesized that there exists an acceptable agreement between the capillary blood glucose results obtained by the inpatient glucose POCT meter (Accuchek Inform II) and the readings obtained by the CGMS (Freestyle Libre); and that there exists an acceptable agreement between the serum glucose levels and the glucose values obtained by the CGMS. MethodsThis was an Institutional Review Board approved prospective cohort study for the non– critical inpatient setting. Fifty-two hospitalized patients with diabetes were recruited. After informed consent was obtained, patients were instructed on the application and use of the CGMS. The data were assessed using a standard regression analysis and modified Bland Altman analysis. All analyses were conducted using SAS, release 3.8 Enterprise Edition (SAS Institute Inc., Cary, NC). ResultsFifty-two subjects recruited into the study represented a sample of convenience. There were a total of 467 AccuChek-Libre pairs, The regression analysis showed a negative bias between.Libre and AccuChek, R2 = 0.83, with Libre glucose readings on average being lower than those of AccuChek. Using Bland-Altman analysis, 42% of the 467 Libre-AccuChek pairs had a difference in glucose reading more than 15%. Mean absolute relative difference (MARD) between Libre and AccuChek was 15.6%; mean relative difference (MRD) between Libre and AccuChek was −11.4%.The regression analysis showed a negative bias between Libre and serum glucose, R2 = 0.89. Using Bland Altman analysis, 36% of the 44 Libre-serum pairs had a difference in glucose reading more than 15%. Mean absolute relative difference (MARD) between Libre and serum glucose was 13.2%; mean relative difference (MRD) between Libre and serum glucose was −12.5%.A review of the data pairs showed that 71/467 Accuchek-Libre pairs had one result that was either below 70 mg/dl or above 200 mg/dl (combined American Diabetes Association-ADA-, American College of Physicians-ACP- and American College of Endocrinology-AACE- goals). Thus 85%, of these pairs would have yielded results that engendered the same intervention (e.g. treatment for hypoglycemia or hyperglycemia). Likewise 5/45 Serum-Libre pairs had one result that was either below 70 mg/dl or above 200 mg/dl; thus 89% of these pairs would have yielded results requiring the same intervention. Conclusion/InterpretationThese findings confirm the existent literature and indicate acceptable agreement between the standard POCT and the CGMS as well as between serum glucose and the CGMS values. Because of the advantages of the CGMS over capillary blood glucose testing (reduced patient discomfort and reduced staff exposure to patients in isolation) CGMS use may be preferable to the current bedside capillary blood glucose testing in hospitalized patients with diabetes mellitus. As with other laboratory measures, clinical judgement needs to be exercised when the laboratory values are used to guide patient care.

The Importance of Iron Administration in Correcting Anaemia After Major Surgery.

IntroductionPostoperative anaemia can affect more than 90% of patients undergoing major surgeries. Patients develop an absolute iron deficiency in the face of significant blood loss or preoperative anaemia and major surgery. Studies have shown the negative impact of these factors on transfusion requirements, infections, increased hospitalisation and long-term morbidities.Aim of the studyThe research was performed to determine the correlation between intravenous iron administration in the postoperative period and improved haemoglobin correction trend.Material and methodsA prospective study was conducted to screen and treat iron deficiency in patients undergoing major surgery associated with significant bleeding. For iron deficiency anaemia screening, in the postoperative period, the following bioumoral parameters were assessed: haemoglobin, serum iron, transferrin saturation (TSAT), and ferritin, direct serum total iron-binding capacity (dTIBC), mean corpuscular volume (MCV) and mean corpuscular haemoglobin (MCH). In addition, serum glucose, fibrinogen, urea, creatinine and lactate values were also collected.ResultsTwenty-one patients undergoing major surgeries (52,38% were emergency and 47,61% elective interventions) were included in the study. Iron deficiency, as defined by ferritin 100-300 μg/L along with transferrin saturation (TSAT) < 20 %, mean corpuscular volume (MVC) < 92 fL, mean corpuscular haemoglobin (MCH) < 33 g/dL, serum iron < 10 μmol/L and direct serum total iron-binding capacity (dTIBC) > 36 μmol/L, was identified in all cases. To correct the deficit and optimise the haematological status, all patients received intravenous ferric carboxymaltose (500-1000 mg, single dose). Using Quadratic statistical analysis, the trend of haemoglobin correction was found to be a favourable one.ConclusionThe administration of intravenous ferric carboxymaltose in the postoperative period showed the beneficial effect of this type of intervention on the haemoglobin correction trend in these groups of patients.

Dietary neem oil and nonylphenol accelerate somatic growth by suppressing sex steroids mediated gonadal growth in reproductively activeLabeo bata(Hamilton, 1822)

A 90-day feeding trial was conducted to study the effect of neem oil and or nonylphenol on gonadal and somatic growth performance in active reproductive phase of Labeo bata. Two hundred twenty-five L. bata (avge. wt., 48.47 ± 1.09 g) adults were randomly distributed in five treatments following completely randomized design in triplicates. Five iso-nitrogenous, iso-caloric and iso-lipidic (30% CP, 367 kcal DE/100 g, 6% EE) practical diets were prepared viz., C (no supplements), T1 (0.5% neem oil), T2 (0.5% nonylphenol), T3, 1% combined dose (0.5% neem oil + 0.5% nonylphenol) and T4, 2% combined dose (1.0% neem oil + 1.0% nonylphenol). Lowest (p < 0.05) serum glucose, plasma protein and lipid profile values were observed in T4 group. The inhibition of gonadal development was maximum (p < 0.05) in T4 group as evident from gonado-somatic index and reduced level of plasma sex steroids associated with gonadal growth. Highest (p < 0.05) somatic growth in terms of weight gain (%), SGR and PER in T4 groups and lowest in the control group. Highest (p < 0.05) AST, ALT and lowest (p < 0.05) SOD, catalase enzyme activities were recorded in T4 group. The findings suggest dietary neem oil and nonylphenol supplementation at 2% level (1:1) can inhibit gonadal development concomitant with increased somatic growth in reproductively active L. bata. This strategy may be helpful to enhance growth of L. bata during growout phases, where significant amount of energy is diverted for reproductive organ development at the cost of somatic growth.

Pulmonary Cavitary Tuberculosis in a Patient with SARS-CoV-2 Pneumonia

<strong>Background:</strong> COVID-19 disease caused by SARS-CoV-2 can lead to severe disease with pneumonia, respiratory failure, and death. Pathologic mechanisms include systemic inflammation with elevated IL-6 level. Glucocorticosteroids and Tocilizumab (TCZ), a monoclonal antibody that inhibits IL-6 receptors, are used to dampen systemic inflammation. We report a case of progressive cavitary tuberculosis during hospitalization for severe COVID-19 disease. <strong>Methods:</strong> Case report and data extraction of baseline demographic disease characteristics and longitudinal data extraction of clinical course, treatment and outcomes. <em><strong>Figure 1</strong></em> can be referred to for a timeline of important clinical events. <strong>Results:</strong> A 44-year-old male with severe COVID-19 disease was placed on invasive mechanical ventilation. He has a history of diabetes and serum glucose was 222 mg/dL at presentation. Interventions included a single dose of TCZ and high dose steroids, with a cumulative dose equivalent to 717 mg of prednisone. The Quantiferon TB (QT TB) test performed on day 2 of steroid administration and prior to TCZ use was negative. His respiratory status improved and he was subsequently extubated. One week later, he developed fever with leukocytosis. Serial, blood, urine, and fungal cultures, as well as serum galactomannan were negative. Serial chest X-rays showed persistent multifocal infiltrates. On day 29, chest CT scan showed a 6.6 × 9.4 × 9.5 cm soft tissue density consolidation within the right lower lobe with multiple internal airspaces and right hilar adenopathy with calcified subcarinal lymph nodes (<em><strong>Figure 2</strong></em>). A sputum culture grew Klebsiella pneumoniae. Despite treatment with broad-spectrum antibacterial and antifungal agents, fever and leukocytosis persisted. On day 35, a second scan revealed increased size of the infiltrate and cavities together with multifocal bronchiectasis and bronchiolectasis. Diabetes control was suboptimal with 45% (79/174) of serum glucose values &gt;180 (range, 50 to 450 mg/dL). Three acid-fast bacillus smears of sputum were found to be positive 3+ and the isolate was subsequently identified as Rifampinsusceptible Mycobacterium tuberculosis. He promptly improved after initiation of a four drug anti-TB treatment with prompt resolution of fever and leukocytosis. Upon further questioning, the patient reported that he had had a positive PPD test in the past after traveling to and from Haiti multiple times and was treated for 3 months in the last 10 years. <strong>Conclusions:</strong> This case illustrates that clinical deterioration in severe COVID-19 disease may be associated with the presence of coexisting pulmonary infections, including TB. While we cannot exclude reactivation of latent TB infection in the setting of incomplete TB infection chemoprophylaxis, it is more likely that the patient presented with unrecognized TB. COVID infiltrates may obscure the radiological features of TB. Multiple factors likely contributed to progressive cavitary disease including delated TB diagnosis, suboptimal diabetes control, immunosuppression, and Klebsiella pneumoniae. Timely use of CT scan when clinical response is slow or atypical for isolated COVID-19 disease together with complete microbiologic evaluation could lead to prompt recognition of coexisting pulmonary infections and improved outcomes.

631-P: Reliability of the Freestyle Libre Continuous Monitoring System in the Inpatient Setting: Implications for the COVID-19 Surge

Introduction: Standard point of care capillary blood glucose testing (POCT) is commonly used in hospitalized patients to monitor their glucose levels. This technique is associated with increased staff/patient contact and patient discomfort. We examined the correlation of the capillary blood glucose results obtained by the POCT device (Accuchek Inform II) with the serum glucose values obtained by the hospital laboratory and with the glucose readings obtained by the FDA-waived for in-patient use (because of COVID-19 pandemic) Freestyle Libre continuous glucose monitoring system (CGMS). Methods: For this prospective cohort study fifty-two adult participants who were diagnosed with diabetes mellitus and admitted to non-critical units were recruited. Among them, 41 (79%) were male, 50 (96%) had type 2 diabetes mellitus. CGMS sensors were placed on patients’ arms, POCT and serum glucose measurements were taken as ordered. Descriptive statistics were calculated and linear mixed models were used to determine correlation. Results: There were a total of 467 Accuchek-Libre pairs with a highly statistically significant association between pairs, p&amp;lt;0.0001. There were also 44 serum glucose -Libre pairs, with a highly statistically significant association, p&amp;lt;0.0001. On average, for each unit increase in Libre glucose level, there was a 0.92 unit increase in Accuchek glucose level as well as a 1.05 unit increase in serum glucose level. Conclusion: These findings indicate excellent correlation between the standard POCT and the CGMS as well as between serum glucose and the CGMS values. Because of the advantages of the CGMS glucose readings over blood capillary glucose testing (reduced patient discomfort and reduced staff exposure to patients during the pandemic) hospitals should consider replacing capillary blood glucose testing with CGMS. Disclosure R. Murray-bachmann: None. K. Ziskovich: None. M. Sarbanes: None. T. Leung: None. A. Myers: None. S. Murthi: None. L. Poretsky: None.

MO235EFFECT OF OMEGA-3 POLYUNSATURATED FATTY ACID SUPPLEMENTATION ON GLYSEMIC CONTROL AND RENAL FUNCTION IN TYPE 2 DIABETIC PATIENTS WITH CHRONIC KIDNEY DISEASE

Abstract Background and Aims The aim of this study was to evaluate the short-term effects of omega-3 polyunsaturated fatty acids (n-3 PUFA) supplementation on glycemic control and renal function in type 2 diabetic patients with chronic kidney disease. Method Twenty-five diabetic patients received medication containing 2 g/day n-3 PUFA orally in addition to standard treatments. Their estimated glomerular filtration rates (eGFR) were &amp;lt;80 mL/min/1.73 m2. Biochemical values were evaluated before and 3 months after treatment. Results After three months of supplementation, the changes in serum creatinine, uric acid, eGFR and urinary albumin excretion levels did not reach statistical significance. There was no difference between serum glucose, HbA1C and lipid profile values before and after the n-3 PUFA supplementation in patients. Only serum albumin significantly increased from 4.10±0.26 to 4.28±0.31 g/dL (p=0.016), and systolic blood pressure decreased from 121.4±14.5 to 116.6±14.9 mmHg (p=0.001). Conclusion Short-term n-3 PUFA supplementation did not affect renal function and glycemic control in patients with type 2 diabetes with chronic kidney disease.

A Case of Non-Islet Cell Tumor Hypoglycemia in Metastatic Solitary Fibrous Tumor

Abstract Introduction: Insulin like growth factor (IGF-2) mediated hypoglycemia secondary to solitary fibrous tumor (SFT), also known as Doege-Potter syndrome is a rare paraneoplastic syndrome. The tumor cells produce large amounts of high molecular weight IGF 2 precursor protein called “big IGF-2” which binds to insulin and IGF receptors in liver, muscle and other peripheral tissues. This causes reduced gluconeogenesis and increased uptake of glucose by the muscle and other tissues leading to hypoglycemia. Big IGF-2 also exerts central negative feedback of growth hormone causing reduction of IGF-I production. Most SFTs are benign and localized (approximately 78-88%). As a result, tumor excision alone would often lead to resolution of the hypoglycemia. We present a case of metastatic SFT with multiple metastasis managed with oral prednisone. Clinical Case: A 44-year-old man with metastatic SFT presented with bilateral humeral fractures. He has known metastatic disease to the brain, lung, liver, bony lytic lesions over a course of eleven years. It has progressed despite multiple chemotherapy and radiation therapies. Prior to admission, he had multiple syncopal episodes associated with fasting hypoglycemia. He reported capillary blood glucose values ranging between 30-50 mg/dl during these episodes which would improve after drinking juice or eating candy. There was no history of diabetes mellitus or use of oral hypoglycemic agents or insulin. On admission, he had a capillary blood glucose value of less than 20 mg/dl, which was confirmed by a serum glucose value of 18 mg/dl on basic metabolic panel. His renal, liver and thyroid function tests were normal. Significant labs include: serum glucose 17 mg/dl, C-peptide &amp;lt;0.10 ng/ml (n: 1-4 ng/ml), serum insulin &amp;lt;1.6 Uu/ml (n: &amp;lt;20 Uu/ml), beta-hydroxybutyrate &amp;lt;0.2 mmol/L (n: &amp;lt;0.3), cortisol 10.8 ug/dl(n: 5-15 ug/dl) glucagon 6 pg/ml(ref 8-57 pg/ml), insulin-like growth factor-1 (IGF 1) 20 ng/ml (n: 52-328), and IGF-2 level 380 ng/ml (267-616 ng/ml), improvement in blood glucose from 46 to 111 mg/dl after 1-gram glucagon administration. The IGF-2/IGF-1 ratio of 19 confirmed our clinical suspicion of non-islet cell tumor hypoglycemia (NICTH). He was started on prednisone 20 mg twice daily with marked improvement in hypoglycemia. Conclusion: NICTH is a rare cause of hypoglycemia and should be considered in the differential while evaluating hypoglycemia in malignancy. For diagnosing NICTH, assays for big IGF-II are not commercially available. However, the IGF-II:IGF-I ratio is considered to be a surrogate marker of big IGFII concentration. The normal ratio is 3 and ratio &amp;gt;10 is diagnostic of NICTH. In cases like ours where tumor resection is not possible, glucocorticoids are most effective in management of hypoglycemia by inhibiting big IGF2 production and stimulating gluconeogenesis.

Continuous Glucose Monitoring in the Intensive Care Unit Following Total Pancreatectomy with Islet Autotransplantation in Children: Establishing Accuracy of the Dexcom G6 Model.

Hyperglycemia is detrimental to postoperative islet cell survival in patients undergoing total pancreatectomy with islet autotransplantation (TPIAT). This makes continuous glucose monitoring (CGM) a useful management tool. We evaluated the accuracy of the Dexcom G6 CGM in pediatric intensive care unit patients following TPIAT. Twenty-five patients who underwent TPIAT had Dexcom G6 glucose values compared to paired serum glucose values. All paired glucose samples were obtained within 5 minutes of each other during the first seven days post TPIAT. Data were evaluated using mean absolute difference (MAD), mean absolute relative difference (MARD), %20/20, %15/15 accuracy, and Clarke Error Grid analysis. Exclusions included analysis during the CGM “warm-up” period and hydroxyurea administration (known drug interference). A total of 183 time-matched samples were reviewed during postoperative days 2–7. MAD was 14.7 mg/dL and MARD was 13.4%, with values of 15.2%, 14.0%, 12.1%, 11.4%, 13.2% and 14.1% at days 2, 3, 4, 5, 6 and 7, respectively. Dexcom G6 had a %20/20 accuracy of 78%, and a %15/15 accuracy of 64%. Clarke Error Grid analysis showed that 77% of time-matched values were clinically accurate, and 100% were clinically acceptable. The Dexcom G6 CGM may be an accurate tool producing clinically acceptable values to make reliable clinical decisions in the immediate post-TPIAT period.

Using dried kitchen food wastes as untraditional feed in growing rabbit's diets

BackgroundKitchen food wastes (KFW) are food lost from human especially from hotels, hospitals, cafeterias and home, could be alternative feed resources and create the attention of researchers to process these wastes and recycling it as animal feeding not only to reduce the use of expensive feed ingredients but also to decrease the environmental pollution. The main objective of this study was conducted to investigate the effect of dietary KFW inclusion on growth performance, digestibility, carcass traits, and some blood biochemical parameters of growing New Zealand White rabbits.ResultsThe results showed that rabbits fed on diets containing 30% KFW achieved significantly (P < 0.05) higher daily weight gain (22.61 g) than the control (20.79 g) and there were no difference between diets 10% and 20%, and the lowest daily gain was with diet 40%. The highest organic matter (OM) and crude protein (CP) digestibility were recorded in rabbits fed on a diet containing 30% KFW (64.08 and 64.29%, respectively), while the lowest was observed in 40% group (61.11 and 55.54%, respectively). Diets containing KFW decreased caecal ammonia nitrogen (NH3–N) and increased propionate up to 30% substitution. The addition of KFW to rabbits diets had no significant effect (P < 0.05) on serum globulin, glucose, ALT, and AST values and increased significantly (P < 0.05) serum total protein, albumin, triglycerides, cholesterol and creatinine.ConclusionIt can be concluded that the best growth performance and economical feed efficiency was observed in rabbits fed on a diet containing 30% KFW and surpassing all treated groups and achieved the best body weight gain.

Effect of Curcumin Nanoemulsions Stabilized with MAG and DAG-MCFAs in a Fructose-Induced Hepatic Steatosis Rat Model.

Current changes in diet, characterized by an increase in the intake of sweetened beverages, are heavily related to metabolic disorders such as non-alcoholic fatty liver. This condition can produce simple steatosis and, in worse cases, potentially result in steatohepatitis, fibrosis, and cirrhosis, comparable to the damage caused by the consumption of more or less 20–30 g of alcohol per day. The main objective of this research was to evaluate the effect of curcumin (Curcuma longa) nanoemulsions, using mono- and diacylglycerides medium chain fatty acids as stabilizers in an in vivo hepatic steatosis rat model. Pathology was induced by providing 30% fructose intake in the drinking water. Globule sizes under 200 nm that were stable for 4 weeks were obtained; curcumin encapsulated in the nanoemulsion was >70%. The results revealed an improvement regarding body and liver weight in the animals treated with curcumin nanoemulsions. A decrease in total cholesterol, LDL, AST/ALT, and HDL in serum was observed; however, no apparent improvement regarding serum glucose or triacylglycerides values was noted. Histological analysis showed a significant decrease in the extent of steatosis, inflammation, and brown adipose tissue in the treated animals.

Evaluation of the Bioequivalence of Acarbose in Healthy Chinese People.

The purpose of this study was to determine whether the reference formulation and test formulation of acarbose are bioequivalent among healthy Chinese subjects based on evaluation of the pharmacodynamic end point. Two clinical trials with acarbose were conducted: study A, a pilot study (n = 12; 50 and 100 mg), and study B, a pivotal study (n = 60; 50 mg). In study A, there was a dose‐dependent relationship between 50 mg acarbose and 100 mg acarbose and a significant difference compared with sucrose alone. In study B, after logarithmic conversion, a linear mixed‐effects model was used to analyze the maximum serum glucose value and area under the serum glucose‐time curve from 0 to 2 hours. The geometric mean ratios (test formulation/reference formulation) were 92.68% and 95.70%, with 90% confidence intervals of 84.08%‐102.17% and 84.21%‐108.76%, respectively, falling between 80.00% and 125.00%. According to the geometric least‐squares mean, the test formulation (or reference formulation) was statistically significantly different as a single sucrose (P < .001). The effective dose of acarbose in healthy Chinese volunteers was 50 mg. The reference and test formulations were bioequivalent.

Can Routine Blood Biochemistry Parameters be Predictive Prognostic Marker(s) in Operated Patients with Meningioma WHO Grade 1?

Abstract Background Today, there is a need for new and independent additional advanced markers that can predict the prognosis of meningioma patients, postoperatively. The present study aimed to find out postoperative short-term prognostic markers in patients with meningioma using their demographic data and routine blood biochemistry findings evaluated preoperatively. Methods The Glasgow Coma Scale (GCS), and Glasgow Outcome Scale (GOS) scores of the patients were recorded. Additionally, preoperatively obtained serum glucose, C-reactive protein (CRP), sodium, potassium, creatinine, blood urea nitrogen, aspartate aminotransferase (AST), alanine aminotransferase, and hemoglobin level values, platelet, leukocyte, neutrophil, lymphocyte, eosinophil, basophil, and monocyte count results, erythrocyte sedimentation rate (ESR), neutrophil-lymphocyte ratio, platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR) values were evaluated. Results In the present study, 23 operated patients with meningioma World Health Organization (WHO) grade 1 (17 females, 6 males) were included. Correlation test results revealed that the GCS score, platelet count, and serum potassium level values could directly predict the short-term prognosis of these patients. Additionally, these test results suggested that the lymphocyte, monocyte, and eosinophil count values, PLR, LMR, ESR, serum glucose, CRP, and AST level values could be indirect markers in predicting the short-term prognosis. However, likelihood ratio test results revealed that only monocyte count value, LMR value, and serum CRP level value could be the markers for prediction of the short-term prognosis. Conclusion At the end of the present study, it was concluded that the monocyte count value, LMR value, and serum CRP level value could be the best markers in predicting the short-term prognosis of the operated meningioma patients.

Blood chemistry and relative organ weights of rabbits fed neem leaf meal based diets

Two experiments were conducted to determine the effect of neem leaf meal (NLM) based diets on blood and relative organ weight characteristics of rabbits. In the first experiment, 36 rabbit bucks aged 7 to 8 months were distributed into four dietary groups, T1, T2, T3 and T4 of 9 rabbits using completely randomized design. Each group was replicated 3 times with 3 rabbits per replicate. Rabbits in T1 group were fed diet that contained 0% NLM while those in T2 T3 and T4 groups were fed diets that contained NLM at 5%, 10% and 15%, respectively for 112 days. In the second experiment, 36 rabbit does were used and experimental procedures were laid out as described in experiment 1. Blood samples for analysis, live weight and organ weights were collected from each replicate and data obtained analysed statistically. Higher (p&lt;0.05) kidney weight was obtained for rabbit does on diets T 2 T 3 and T4. Bucks on diet T2, recorded significantly (p&lt;0.05) higher pancreas weight than those on diet T1 diet. No significant effect (p&gt;0.05) on haematological parameters was observed among all treatments except for MCV and neutrophils which were significantly (p&lt;0.05) decreased in the groups fed diets T2 and T4 and diets T1 and T3 groups respectively than others. Rabbit bucks and does on diet I, recorded significantly (p&lt;0.05) higher serum cholesterol values than those on the other diets. Serum glucose value of rabbits on diet T, was significantly (p&lt;0.05) different from those on the other diets. Serum ALP value of rabbits on diet T4 differed significantly (p&lt;0.05) from those on the other 3 diets with the exception of bucks on diet T4 that had similar value with those on diet T1. Addition of neem leaf meal in rabbit diets increased serum AST and ALT values but the differences were not significant (p&gt;0.05). It was therefore concluded that up to 5% of neem leaf meal can be included in the diet of pubertal rabbits without any deleterious effects on their organs and blood characteristics.

Assessment of the relation between the neutrophil to lymphocyte ratio and severity of ischemic stroke in a large cohort.

The NLR is a simple and inexpensive parameter that is useful as a marker of subclinical inflammation. The purpose of this study was to investigate the clinical characteristics of patients diagnosed with acute cerebral ischemia at the time of initial evaluation in the emergency department. The study was designed as a multicentre cross-sectional study of acute ischemic stroke patients. Neurological evaluations were assessed using the NIHSS and mRS. Evaluations included the results of patients' laboratory tests performed at the time of presentation to the emergency department. Seven hundred and thirty-five ischemic stroke patients were included in the study. Stroke cases assessed by the mRS as mild or severe showed significant differences with respect to age, leukocyte counts, neutrophil counts, NLR, LDL cholesterol values, and serum glucose values (P=.001). When analysed using NIHSS, lymphocyte levels were significantly higher in very severe stroke cases compared with mild, moderate, and severe cases. NLR was also significantly higher in very severe stroke cases and severe stroke cases as compared with the mild and moderate stroke groups. Neurological evaluations assessed using the mRS showed a mild positive correlation with neutrophil and leukocyte count and a weak correlation with the NLR. The NLR exhibited a significant correlation with the results of the mRS and NIHSS. The NLR measured in the very early period was also significantly associated with clinical condition. These results suggest that high NLR values may be a marker of stroke' severity.What's known Stroke is an important disease that has a significant impact on mortality and morbidity and is closely related to the aging world population. In recent years, highly innovative approaches have been developed in the treatment of stroke. Although a long distance has been covered in the early diagnosis of stroke, the ability to predict the severity of the disease with many parameters is still up to date. What's new At the time of admission, in the absence of infection, parameters such as leukocytelymphocyte count and NLR may be telling about stroke severity. Demonstrating the utility of these simple, practical, inexpensive and naninvasive parameters to predict stroke severity can contribute to the scoring to be established at the time of initial diagnosis.

A deep learning backcasting approach to the electrolyte, metabolite, and acid-base parameters that predict risk in ICU patients.

A powerful risk model allows clinicians, at the bedside, to ensure the early identification of and decision-making for patients showing signs of developing physiological instability during treatment. The aim of this study was to enhance the identification of patients at risk for deterioration through an accurate model using electrolyte, metabolite, and acid-base parameters near the end of patients' intensive care unit (ICU) stays. This retrospective study included 5157 adult patients during the last 72 hours of their ICU stays. The patients from the MIMIC-III database who had serum lactate, pH, bicarbonate, potassium, calcium, glucose, chloride, and sodium values available, along with the times at which those data were recorded, were selected. Survivor data from the last 24 hours before discharge and four sets of nonsurvivor data from 48-72, 24-48, 8-24, and 0-8 hours before death were analyzed. Deep learning (DL), random forest (RF) and generalized linear model (GLM) analyses were applied for model construction and compared in terms of performance according to the area under the receiver operating characteristic curve (AUC). A DL backcasting approach was used to assess predictors of death vs. discharge up to 72 hours in advance. The DL, RF and GLM models achieved the highest performance for nonsurvivors 0-8 hours before death versus survivors compared with nonsurvivors 8-24, 24-48 and 48-72 hours before death versus survivors. The DL assessment outperformed the RF and GLM assessments and achieved discrimination, with an AUC of 0.982, specificity of 0.947, and sensitivity of 0.935. The DL backcasting approach achieved discrimination with an AUC of 0.898 compared with the DL native model of nonsurvivors from 8-24 hours before death versus survivors with an AUC of 0.894. The DL backcasting approach achieved discrimination with an AUC of 0.871 compared with the DL native model of nonsurvivors from 48-72 hours before death versus survivors with an AUC of 0.846. The DL backcasting approach could be used to simultaneously monitor changes in the electrolyte, metabolite, and acid-base parameters of patients who develop physiological instability during ICU treatment and predict the risk of death over a period of hours to days.

Triglyceride-Glucose Index (TyG) is associated with erectile dysfunction: A cross-sectional study.

Erectile dysfunction (ED) is often associated with endocrine metabolic diseases such as metabolic syndrome (MetS) and diabetes mellitus (DM), in which insulin resistance (IR) plays a decisive role in pathology. Triglyceride-glucose index (TyG), a simple, inexpensive and easily accessible IR marker, is calculated by fasting serum glucose and triglyceride values. We aimed to reveal the relationship between TyG index and ED. Of 152 male patients, aged between 24-80years, admitted to the urology outpatient clinic with complaining erectile insufficiency were evaluated. Liver function tests, complete blood count, fasting serum triglyceride, serum testosterone, fasting glucose, fasting insulin, and hemoglobinA1c (HbA1c) were analyzed. TyG index was calculated. All patients were requested to fill in the validated Turkish version of the 5-item International Index of Erectile Function (IIEF-5) survey. A total of 142 patients were included the study. ED was detected in 91 (64.1%) of the patients. BMI, fasting insulin level, fasting glucose level, IR, GGT, HDL, HbA1c, Triglyceride, TyG, DM, HT, and MetS status of the patients in ED group were statistically significantly higher compared to non-ED group (all P < .05). It was found that the cutoff value of TyG index for ED was 8.88 (AUC=0.739, sensitivity 67%, specificity=68.6%). In multivariate logistic regression analysis, age (OR=1.07, 95% CI=1026-1115, P=.002) and TyG index above 8.88 (OR=3.865, 95% CI=1686-8859, P=.001) were found as independent predictors of ED after accounting for BMI, serum total T and IR. TyG index might be useful in the diagnosis and follow-up of ED.

Recurrent and Treatment-Unresponsive Spontaneous Bacterial Peritonitis Worsens survival in Decompensated Liver Cirrhosis

Spontaneous bacterial peritonitis (SBP) remains a major complication of cirrhosis. However, the incidence and the real impact of SBP in determining patient survival rates remain unclear. This study aims to evaluate the incidence and risk factors for SBP development and the role of SBP in predicting transplant-free survival. Two hundred two consecutive patients underwent 492 paracenteses with biochemical and microbiological analysis of the ascitic fluid. When multiple paracenteses had been performed on a given patient, the first SBP-positive paracentesis or the first paracentesis conducted when none was diagnostic for SBP was included in the study. SBP was detected in 28 of 202 (13.9%) patients; in 26 of 28 patients, the neutrophil count in the ascitic fluid was ≥250 cells/μl, and in 15 of 28 patients, the cultures were positive. Variables independently associated with SBP were as follows: a higher model of end-stage liver disease (MELD) score, the serum glucose value, elevated CRP serum levels, and higher potassium serum levels. Overall, the median (range) transplant-free survival was 289 (54-1253) days. One hundred (49.5%) patients died, whereas 35 patients (17.3%) underwent liver transplantation. Independent predictors of death or liver transplantation were a higher MELD score and the development of SBP, especially if it was antibiotic-resistant or recurrent SBP. The occurrence of SBP is associated with more severe liver dysfunction in conjunction with the presence of inflammation. Unlike the occurrence of SBP per se, failure of first-line antibiotic treatment and SBP recurrence appear to strongly influence the mortality rate.