Role of adjuvant metformin therapy on HA1C in type 1 diabetes

BackgroundAdequate glycaemic control ‎is a protective strategy against ‎diabetic complication that achieved manly with insulin therapy, ‎‎studies have shown that type 1 diabetic patients had ‎a reduced insulin sensitivity, on view of this fact, ‎‎metformin as an insulin sensitizing agent was used in ‎trials as an adjuvant medication to the insulin. AimsCurrent study aimed to summarize the benefit of adjuvant metformin on HA1C in type 1 diabetes on glycaemic control.Methods A systematic electronic search was conducted including ‎the Pub Med, Google ‎Scholar, and EBSCO using the ‎‎following terms in different combinations: metformin, diabetes, ‎HA1c, and C- peptide. Out of two hundred and four articles, only ‎six were included.Results Six randomized control trials were identified, aimed to investigate the role of adjuvant metformin on glycaemic control in type 1 diabetes patients. Metformin in dose ranging between 1–2g per day were used for at least three months. Significant HA1c reduction was shown in two out of six trials.ConclusionAdministering adjunctive metformin therapy in type ‎‎1 ‎diabetic patients ‎associated with modest reduction in ‎HA1c, improve insulin resistance as indicated ‎by reduce ‎daily insulin ‎requirement.

Left Main Coronary Artery Revascularization in Patients with Impaired Renal Function: Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting

Introduction: The evidence about the optimal revascularization strategy in patients with left main coronary artery (LMCA) disease and impaired renal function is limited. Thus, we aimed to compare the outcomes of LMCA disease revascularization (percutaneous coronary intervention [PCI] vs. coronary artery bypass grafting [CABG]) in patients with and without impaired renal function. Methods: This retrospective cohort study included 2,138 patients recruited from 14 centers between 2015 and 2,019. We compared patients with impaired renal function who had PCI (n= 316) to those who had CABG (n = 121) and compared patients with normal renal function who had PCI (n = 906) to those who had CABG (n = 795). The study outcomes were in-hospital and follow-up major adverse cardiovascular and cerebrovascular events (MACCE). Results: Multivariable logistic regression analysis showed that the risk of in-hospital MACCE was significantly higher in CABG compared to PCI in patients with impaired renal function (odds ratio [OR]: 8.13 [95% CI: 4.19–15.76], p < 0.001) and normal renal function (OR: 2.59 [95% CI: 1.79–3.73]; p < 0.001). There were no differences in follow-up MACCE between CABG and PCI in patients with impaired renal function (HR: 1.14 [95% CI: 0.71–1.81], p = 0.585) and normal renal function (HR: 1.12 [0.90–1.39], p = 0.312). Conclusions: PCI could have an advantage over CABG in revascularization of LMCA disease in patients with impaired renal function regarding in-hospital MACCE. The follow-up MACCE was comparable between PCI and CABG in patients with impaired and normal renal function

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Development of a Laboratory-Scale Thermal-Arc-Plasma Reactor and its Application in the Pyrolysis of Petroleum Oily Sludge

Waste treatment using thermal arc plasma is well established and laboratory/pilot scale plasma reactors were developed and their performances for the destruction of different hazardous wastes, other than petroleum oily sludge, were studied. This work aims to extend the plasma technology to the pyrolysis of hazardous petroleum oily sludge. A 4.7 kW thermal arc plasma reactor was developed using a standard TIG arc welding torch. The transferred arc plasma reactor was used to treat 20 g/batch of petroleum oily sludge. The prevailing temperature inside the reactor ranges between 356 – 1694 oC. The plasma arc temperature increased with increasing plasma arc current and also with increasing plasma gas flow-rate. A vitreous slag and a flue gas were generated as products. A mass reduction of between 36.87 – 91.40% and a TOC reduction of 21.47 – 93.76% were achieved in the treatment time of 2 – 5 min. The mass reduction was observed to increase with treatment time. However, the increase was more rapid between the 3rd and the 4th min of the treatment. The flue gas produced contains H2 (43.79 – 50.97 mol%), H2O (26.60 – 30.22 mol%), CO (8.45 – 11.18 mol%), CO2 (5.12 – 10.35 mol%), CH4 (2.17 – 3.38 mol%), C2H2 (0.86 – 2.69 mol%) and C2H4 (0.76 – 2.17 mol%). Thus, the thermal plasma reactor provides a suitable method of treating petroleum oily sludge

Relaxed Inertial Tseng’s Type Method for Solving the Inclusion Problem with Application to Image Restoration

The relaxed inertial Tseng-type method for solving the inclusion problem involving a maximally monotone mapping and a monotone mapping is proposed in this article. The study modifies the Tseng forward-backward forward splitting method by using both the relaxation parameter, as well as the inertial extrapolation step. The proposed method follows from time explicit discretization of a dynamical system. A weak convergence of the iterates generated by the method involving monotone operators is given. Moreover, the iterative scheme uses a variable step size, which does not depend on the Lipschitz constant of the underlying operator given by a simple updating rule. Furthermore, the proposed algorithm is modified and used to derive a scheme for solving a split feasibility problem. The proposed schemes are used in solving the image deblurring problem to illustrate the applicability of the proposed methods in comparison with the existing state-of-the-art methods

A Weak Convergence Self-Adaptive Method for Solving Pseudomonotone Equilibrium Problems in a Real Hilbert Space

In this paper, we presented a modification of the extragradient method to solve pseudomonotone equilibrium problems involving the Lipschitz-type condition in a real Hilbert space. The method uses an inertial effect and a formula for stepsize evaluation, that is updated for each iteration based on some previous iterations. The key advantage of the algorithm is that it is achieved without previous knowledge of the Lipschitz-type constants and also without any line search procedure. A weak convergence theorem for the proposed method is well established by assuming mild cost bifunction conditions. Many numerical experiments are presented to explain the computational performance of the method and to equate them with others

A Dai-Liao-type projection method for monotone nonlinear equations and signal processing

In this article, inspired by the projection technique of Solodov and Svaiter, we exploit the simple structure, low memory requirement, and good convergence properties of the mixed conjugate gradient method of Stanimirović et al. [New hybrid conjugate gradient and broyden-fletcher-goldfarbshanno conjugate gradient methods, J. Optim. Theory Appl. 178 (2018), no. 3, 860–884] for unconstrained optimization problems to solve convex constrained monotone nonlinear equations. The proposed method does not require Jacobian information. Under monotonicity and Lipschitz continuity assumptions, the global convergence properties of the proposed method are established. Computational experiments indicate that the proposed method is computationally efficient. Furthermore, the proposed method is applied to solve the ℓ1{\ell }_{1}-norm regularized problems to decode sparse signals and images in compressive sensing

On the Direct and Skew Sums of Γ1−Non Deranged Permutations

Direct and skew sum operations are invaluable techniques for linking permutations while retaining their original structure in the resulting concatenation. In this work we apply the direct and skew sum operations on the elements of the Γ1−non deranged permutation group (G Γ1 p ), and present relations and schemes on the structures and fixed points of the permutations obtained from these operations. Furthermore, if π is the direct sum of these Γ1− non deranged permutations, then the collection of permutations in the form of π is an abelian group under composition, denoted as G m⊕ p . We present an expression relating the direct and skew sum operations, and we establish an isomorphism between G Γ1 p × GΓ1 p and G m⊕ p

Sources of some heavy minerals and their association with gold-bearing stream sediments in the Gagare Drainage Basin, Wonaka Schist belt northwestern Nigeria

No Abstract