Can Insulin Resistance Serve as a Potential Biomarker for the Development of Clinically Significant Macular Oedema in Patients with Type 2 Diabetes Mellitus?

Objective: To study the prevalence of insulin resistance among diabetic patients. To analyze the association between insulin resistance and clinically significant macular edema (CSME) development. Material and Methods: Single-centre, cross-sectional comparative study on a hospital-based population of diabetic patients. Patients were grouped based on the presence of CSME (group A) and the absence of CSME (group B). Simple logistic regression and multiple logistic regression analyses were performed to evaluate the association CSME with age, duration of diabetes, HbA1c, insulin resistance, body mass index, and lipid profile. Results: The study cohort comprised 86 patients with type 2 DM, with a mean age of 60+7 years. We included 43 patients in each group A and B respectively. There were 37 patients (86%) in group A, who had diabetes >10 years. In group B, 23 patients (53%) had diabetes >10 years. The mean HbA1c was found to be 8.2+1.3 mmol/ mol in group A and 7.6+0.85 mmol/mol in group B (p=0.01). Increased insulin resistance was present in 74/86 (86 %) of diabetics. Elevated IR of > 3.8 was found in 32/43 patients (74%) of group A and 17/43 (39%) of group B (p= 0.001). None of the patients in group A had normal insulin resistance. The odds ratio for the development of CSME in patients with increased HOMA-IR was found to be >4. Conclusion: We observed positive association between insulin resistance and development of clinically significant macular edema. The odds for the development of macular edema was greater in uncontrolled diabetics with elevated insulin resistance

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

EP13 A standard case of reactive arthritis? Plot twist!

Abstract Background A 49 year old male patient presented to the acute medical unit with history of acute onset high grade fever with polyarthritis involving right knee, left elbow, both ankles and small joints of right hand preceded by 2 days of diarrhoea and vomiting. He had temperature of 38°C, BP: 156/77 mmHg, Pulse rate: 98/min. Initial blood tests: CRP: 312, ESR: 51, and leucocytosis (WBC count: 17.9 with neutrophilia: 13.1). The medical team considered diagnosis of multifocal septic arthritis and initiated IV flucloxacillin empirically. He had past medical history of recently treated extra pulmonary tuberculosis three months prior to admission. Methods CT thorax abdomen and pelvis scan was organised to rule out reactivation of tuberculosis/Poncet’s arthritis. CT revealed generalised lymphadenopathy and bilateral hip effusions. At this point, a Rheumatology opinion was requested, a synovial fluid aspiration from the right knee, the most affected joint, was performed. The turbid sample had numerous pus cells, but negative gram stain and negative cultures after prolonged culture. AFB stain was negative. He was improving systemically but had intermittent fevers and CRP remained high (155mg/l). Synovial fluid sample was sent for 16S PCR testing and Streptococcus pyogenes ribosomal DNA was detected. Testing for serum ASO titres revealed elevated titres (32000 IU/mL). In conjunction with microbiology team, we augmented antibiotics to IV Gentamicin and IV Ceftriaxone. A careful history revealed transient throat infection of 6 hours duration 10 days prior to onset of arthritis. Urinary dipstick and ACR revealed proteinuria (ACR 84.8). This is under close follow-up with renal team who feel that post Streptococcal Glomerular Nephritis is likely but deferred renal biopsy. 2 DECHO study ruled out valve abnormality. A right inguinal lymph node biopsy was attempted; however, tissue sample was unsuitable. Hepatitis screen was negative and Antibody panel (ANA, ANCA were negative, RF: borderline positive (26) were unremarkable. He received total duration of 31 days of antibiotics. CRP eventually improved to 13, on follow up, in view of persisting arthritis, orals steroids (15mg OD) was prescribed for three weeks. Results Thus, we achieved a compelling diagnosis of acute rheumatic fever, with possible focus in the throat and probably bacteraemic spread to the right knee. PCR analysis of synovial fluid in context of negative culture guided antibiotic therapy choice, duration and cautious approach for immunosuppression. The patient’s story evolved with development of proteinuria suggestive of possible post streptococcal glomerulonephritis which is under follow up. Conclusion Rheumatologists are faced with challenge of reviewing ill patients with joint effusions in whom empirical antibiotics have been started. In this scenario, joint aspiration yields lower positive culture results. 16S PCR analysis can help in guiding antibiotic choice and duration with negative culture. Disclosures A. Desai None. E. Justice None. M. Rahman None. A. Johnson None. </jats:sec

Is single-port laparoscopy feasible after liver transplant?

The role of laparoscopy following liver transplant in children is debated. Herein, we report the first two cases of SIPES post-liver transplant. In both patients, SIPES access was carried out using Olympus TriPort. Patient 1 was an 11 yr old born with biliary atresia, who had four previous major laparotomies: Kasai portoenterostomy, followed by liver transplant and two laparotomies for lymph node biopsies for PTLD. The child was referred for suspected PTLD relapse due to enlarged nodes on CT scan. At SIPES, following adequate adhesiolysis, the lymph node biopsy was achieved successfully. Patient 2 was a five yr old with bilateral intra-abdominal testes who had undergone liver transplant aged twoyr. He underwent a left one-stage orchidopexy and right first-stage Fowler-Stephen procedure at fiveyr of life, followed by a second stage Fowler-Stephen surgery on the right side, ninemonths later. All procedures were successfully performed by SIPES, and both patients were discharged home on first post-operative day. We conclude that SIPES could be safely carried out in patients who have had liver transplant. In case of diffuse intraperitoneal adhesions, SIPES is beneficial to create space by blunt and sharp dissection and decreases post-operative stay.</p

A Case for Dynamic Pipeline Scaling

Energy consumption can be reduced by scaling down frequency when peak performance is not needed. A lower frequency permits slower circuits, and hence a lower supply voltage. Energy reduction comes from voltage reduction, a technique called Dynamic Voltage Scaling (DVS). This paper makes the case that the useful frequency range of DVS is limited because there is a lower bound on voltage. Lowering frequency permits voltage reduction until the lowest voltage is reached. Beyond that point, lowering frequency further does not save energy because voltage is constant. However, there is still opportunity for energy reduction outside the influence of DVS. If frequency is lowered enough, pairs of pipeline stages can be merged to form a shallower pipeline. The shallow pipeline has better instructions-per-cycle (IPC) than the deep pipeline. Since energy also depends on IPC, energy is reduced for a given frequency. Accordingly, we propose Dynamic Pipeline Scaling (DPS). A DPS-enabled deep pipeline can merge adjacent pairs of stages by making the intermediate latches transparent and disabling corresponding feedback paths. Thus, a DPS-enabled pipeline has a deep mode for higher frequencies within the influence of DVS, and a shallow mode for lower frequencies. Shallow mode extends the frequency range for which energy reduction is possible. For frequencies outside the influence of DVS, a DPS-enabled deep pipeline consumes from 23 % to 40 % less energy than a rigid deep pipeline