CLINICAL CHARACTERISTICS OF NON-PROTEINURIC KIDNEY DISEASE IN PATIENTS WITH TYPE 2 DIABETIC IN INDIA: A COHORT STUDY.

Background The study aims to examine the clinical profile and progression of non-proteinuric diabetic kidney disease (NP-DKD) in type 2 diabetic patients in India and compare it with proteinuric diabetic kidney disease. Methods A cohort study of 120 patients over 18 years old was carried out. Individuals were divided into proteinuric (n=68) and non-proteinuric (n=52) groups based on uPCR or 24-hour urine protein levels. Data on demographics, clinical parameters, and biochemical investigations were gathered at baseline and during follow-ups at six months and one year. Renal function was assessed using eGFR, and proteinuria was monitored. Statistical analyses were performed. Results The study comprised 70 males (58.3%) and 50 females (41.7%). The participants had a mean age of 55.3 ± 10.2 years and an average diabetes duration of 12.5 ± 6.4 years. The proteinuric group exhibited a significantly lower baseline eGFR (45.8 ± 12.6 ml/min/1.73 m²) compared to the nonproteinuric group (62.4 ± 8.7 ml/min/1.73 m², p < 0.001). Over one year, the proteinuric group had a larger mean decline in eGFR (8.5 ± 3.4 ml/min/1.73 m²) than the nonproteinuric group (4.2 ± 2.1 ml/min/1.73 m², p < 0.001). ACEi/ARB therapy substantially reduced proteinuria in the proteinuric group (p < 0.01). Hyperkalemia was more prevalent in the proteinuric group (22.1%) compared to the nonproteinuric group (7.7%, p = 0.03). Conclusion NP-DKD poses a significant risk for renal function decline, similar to proteinuric DKD. ACEi/ARB therapy effectively reduces proteinuria but needs careful monitoring for hyperkalemia. Early detection and tailored management are crucial for improving NP-DKD patient outcomes. Recommendations Regular monitoring of renal function and proteinuria, along with the use of ACEi/ARB therapy, should be considered for all diabetic patients, with particular attention to those with NP-DKD. Further research is ought to explore additional therapeutic options and improve diagnostic techniques for NP-DKD

Cardiovascular changes in newly detected hypothyroid patients in Eastern India

Background: Present study was carried out with an objective to study all the cardiovascular changes associated with newly detected hypothyroidism, and to know the cardiovascular involvement in sub-clinical hypothyroidism.Methods: A total number of 60 newly detected hypothyroid patients, diagnosed by clinical evaluation and confirmed by thyroid hormone assay by chemiluminescence immunoassay (CLIA) method, were subjected to cardiovascular examination, electrocardiograph, echocardiography and Tread mill test. It was cross sectional study design based on random sampling method which was conducted for 2 years in the department of General Medicine, MKCG Medical College Hospital, Berhampur, Odisha, India. The work was carried out after approval from the Institutional Ethics Committee of MKCG Medical College Hospital, Berhampur, Odisha. Patients were investigated before thyroid hormone replacement therapy. Statistical data analysis was made on basis of deviation, standard error, t-test and the proportion test. P value of < 0.05 was considered statistically significant.Results: Out of 60 patients studied 14 were males and 46 were females. Hypothyroidism was newly diagnosed more in females and maximum in age group of 17-47 years (69.9%). Out of 60 patients, 63.3% had symptoms less than 3 months duration. Cardiovascular symptoms were present in 12 (20%) patients. Bradycardia was observed in 7% patients. Stage 1 hypertension was noticed in 13.3% (diastolic high blood pressure). Low voltage complexes in electrocardiogram was present in 40% study group. Pericardial effusion was present in 26.7% patients. Tread mill test was positive for inducible ischaemia in 2 patients. Diastolic dysfunction was noticed in 26.6% study group. Altered lipid profile was present in 16.7% (S. cholesterol) and 53.4% (S. Triglycerides).Conclusions: Hypothyroidism is common in female, maximum between 17-47 years age group. Majority of the patients did not have any cardiovascular changes. Observed cardiovascular changes were ECG abnormalities, pericardial effusion, diastolic hypertension and diastolic dysfunction. Systematic study was done to know the early effects of hypothyroidism on cardiovascular system. The identification of patients with hypothyroidism is an important individual as well as public health issue. Hence, early detection and initiation of hormone replacement therapy can minimize associated cardiovascular changes

Geo-distributed Multi-tier Workload Migration Over Multi-timescale Electricity Markets

Virtual machine (VM) migration enables cloud service providers (CSPs) to balance workload, perform zero-downtime maintenance, and reduce applications\u27 power consumption and response time. Migrating a VM consumes energy at the source, destination, and backbone networks, i.e., intermediate routers and switches, especially in a Geo-distributed setting. In this context, we propose a VM migration model called Low Energy Application Workload Migration (LEAWM) aimed at reducing the per-bit migration cost in migrating VMs over Geo-distributed clouds. With a Geo-distributed cloud connected through multiple Internet Service Providers (ISPs), we develop an approach to find out the migration path across ISPs leading to the most feasible destination. For this, we use the variation in the electricity price at the ISPs to decide the migration paths. However, reduced power consumption at the expense of higher migration time is intolerable for real-time applications. As finding an optimal relocation is $\mathcal {NP}$-Hard, we propose an Ant Colony Optimization (ACO) based bi-objective optimization technique to strike a balance between migration delay and migration power. A thorough simulation analysis of the proposed approach shows that the proposed model can reduce the migration time by $25\%$–$30\%$ and electricity cost by approximately $25\%$ compared to the baseline

GAMap : A Genetic Algorithm based Effective Virtual Data Center Re-Embedding Strategy

Network virtualization allows the service providers (SPs) to divide the substrate resources into isolated entities called virtual data centers (VDCs). Typically, a VDC comprises multiple cooperative virtual machines (VMs) and virtual links (VLs) capturing their communication relationships. The SPs often re-embed VDCs entirely or partially to meet dynamic resource demands, balance the load, and perform routine maintenance activities. This paper proposes a genetic algorithm (GA)-based effective VDC re-embedding (GAMap) framework that focuses on a use case where the SPs relocate the VDCs to meet their excess resource demands, introducing the following challenges. Firstly, it encompasses the re-embedding of VMs. Secondly, VL re-embedding follows the re-embedding of the VMs, which adds to the complexity. Thirdly, VM and VL re-embedding are computationally intractable problems and are proven to be NP-Hard. Given these challenges, we adopt the GA-based solution that generates an efficient re-embedding plan with minimum costs. Experimental evaluations confirm that the proposed scheme shows promising performance by achieving an 11.94% reduction in the re-embedding cost compared to the baselines

Plasma rich in growth factors (PRGF) in non-surgical periodontal therapy: a randomized clinical trial

Abstract The aim of this split mouth, double blinded, randomized clinical trial was to evaluate the clinical efficacy of use of Plasma rich in growth factors (PRGF) as an adjunct to scaling and root planing (SRP) in the treatment of periodontal pockets. Twenty six patients (15 males, 11 females) diagnosed with generalized periodontitis with Pocket Depth > 5mm and plaque index score 4mm necessitating further treatment after 6-month follow-up were significantly lesser for SRP+PRGF group. The use of PRGF technology in non-surgical periodontal therapy, by single intra-pocket application in to periodontal pockets as an adjunct to SRP, in chronic periodontitis patients, was found to be effective in reduction of pocket depth and gain in clinical attachment level

Proteogenomic landscape of breast cancer tumorigenesis and targeted therapy

The integration of mass spectrometry-based proteomics with next-generation DNA and RNA sequencing profiles tumors more comprehensively. Here this "proteogenomics" approach was applied to 122 treatment-naive primary breast cancers accrued to preserve post-translational modifications, including protein phosphorylation and acetylation. Proteogenomics challenged standard breast cancer diagnoses, provided detailed analysis of the ERBB2 amplicon, defined tumor subsets that could benefit from immune checkpoint therapy, and allowed more accurate assessment of Rb status for prediction of CDK4/6 inhibitor responsiveness. Phosphoproteomics profiles uncovered novel associations between tumor suppressor loss and targetable kinases. Acetylproteome analysis highlighted acetylation on key nuclear proteins involved in the DNA damage response and revealed cross-talk between cytoplasmic and mitochondrial acetylation and metabolism. Our results underscore the potential of proteogenomics for clinical investigation of breast cancer through more accurate annotation of targetable pathways and biological features of this remarkably heterogeneous malignancy

Prevalence and attributable health burden of chronic respiratory diseases, 1990–2017: A systematic analysis for the global burden of disease study 2017

© 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Background: Previous attempts to characterise the burden of chronic respiratory diseases have focused only on specific disease conditions, such as chronic obstructive pulmonary disease (COPD) or asthma. In this study, we aimed to characterise the burden of chronic respiratory diseases globally, providing a comprehensive and up-to-date analysis on geographical and time trends from 1990 to 2017. Methods: Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, we estimated the prevalence, morbidity, and mortality attributable to chronic respiratory diseases through an analysis of deaths, disability-adjusted life-years (DALYs), and years of life lost (YLL) by GBD super-region, from 1990 to 2017, stratified by age and sex. Specific diseases analysed included asthma, COPD, interstitial lung disease and pulmonary sarcoidosis, pneumoconiosis, and other chronic respiratory diseases. We also assessed the contribution of risk factors (smoking, second-hand smoke, ambient particulate matter and ozone pollution, household air pollution from solid fuels, and occupational risks) to chronic respiratory disease-attributable DALYs. Findings: In 2017, 544·9 million people (95% uncertainty interval [UI] 506·9–584·8) worldwide had a chronic respiratory disease, representing an increase of 39·8% compared with 1990. Chronic respiratory disease prevalence showed wide variability across GBD super-regions, with the highest prevalence among both males and females in high-income regions, and the lowest prevalence in sub-Saharan Africa and south Asia. The age-sex-specific prevalence of each chronic respiratory disease in 2017 was also highly variable geographically. Chronic respiratory diseases were the third leading cause of death in 2017 (7·0% [95% UI 6·8–7·2] of all deaths), behind cardiovascular diseases and neoplasms. Deaths due to chronic respiratory diseases numbered 3 914 196 (95% UI 3 790 578–4 044 819) in 2017, an increase of 18·0% since 1990, while total DALYs increased by 13·3%. However, when accounting for ageing and population growth, declines were observed in age-standardised prevalence (14·3% decrease), age-standardised death rates (42·6%), and age-standardised DALY rates (38·2%). In males and females, most chronic respiratory disease-attributable deaths and DALYs were due to COPD. In regional analyses, mortality rates from chronic respiratory diseases were greatest in south Asia and lowest in sub-Saharan Africa, also across both sexes. Notably, although absolute prevalence was lower in south Asia than in most other super-regions, YLLs due to chronic respiratory diseases across the subcontinent were the highest in the world. Death rates due to interstitial lung disease and pulmonary sarcoidosis were greater than those due to pneumoconiosis in all super-regions. Smoking was the leading risk factor for chronic respiratory disease-related disability across all regions for men. Among women, household air pollution from solid fuels was the predominant risk factor for chronic respiratory diseases in south Asia and sub-Saharan Africa, while ambient particulate matter represented the leading risk factor in southeast Asia, east Asia, and Oceania, and in the Middle East and north Africa super-region. Interpretation: Our study shows that chronic respiratory diseases remain a leading cause of death and disability worldwide, with growth in absolute numbers but sharp declines in several age-standardised estimators since 1990. Premature mortality from chronic respiratory diseases seems to be highest in regions with less-resourced health systems on a per-capita basis. Funding: Bill & Melinda Gates Foundation

Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016

The UN’s Sustainable Development Goals (SDGs) are grounded in the global ambition of “leaving no one behind”. Understanding today’s gains and gaps for the health-related SDGs is essential for decision makers as they aim to improve the health of populations. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016), we measured 37 of the 50 health-related SDG indicators over the period 1990–2016 for 188 countries, and then on the basis of these past trends, we projected indicators to 2030

Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016

Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970–2016: a systematic analysis for the Global Burden of Disease Study 2016

BACKGROUND: Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016. METHODS: We have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15-60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, to estimate age-specific and sex-specific death rates for each location-year. Using various international databases, we identified fatal discontinuities, which we defined as increases in the death rate of more than one death per million, resulting from conflict and terrorism, natural disasters, major transport or technological accidents, and a subset of epidemic infectious diseases; these were added to estimates in the relevant years. In 47 countries with an identified peak adult prevalence for HIV/AIDS of more than 0·5% and where VR systems were less than 65% complete, we informed our estimates of age-sex-specific mortality using the Estimation and Projection Package (EPP)-Spectrum model fitted to national HIV/AIDS prevalence surveys and antenatal clinic serosurveillance systems. We estimated stillbirths, early neonatal, late neonatal, and childhood mortality using both survey and VR data in spatiotemporal Gaussian process regression models. We estimated abridged life tables for all location-years using age-specific death rates. We grouped locations into development quintiles based on the Socio-demographic Index (SDI) and analysed mortality trends by quintile. Using spline regression, we estimated the expected mortality rate for each age-sex group as a function of SDI. We identified countries with higher life expectancy than expected by comparing observed life expectancy to anticipated life expectancy on the basis of development status alone. FINDINGS: Completeness in the registration of deaths increased from 28% in 1970 to a peak of 45% in 2013; completeness was lower after 2013 because of lags in reporting. Total deaths in children younger than 5 years decreased from 1970 to 2016, and slower decreases occurred at ages 5-24 years. By contrast, numbers of adult deaths increased in each 5-year age bracket above the age of 25 years. The distribution of annualised rates of change in age-specific mortality rate differed over the period 2000 to 2016 compared with earlier decades: increasing annualised rates of change were less frequent, although rising annualised rates of change still occurred in some locations, particularly for adolescent and younger adult age groups. Rates of stillbirths and under-5 mortality both decreased globally from 1970. Evidence for global convergence of death rates was mixed; although the absolute difference between age-standardised death rates narrowed between countries at the lowest and highest levels of SDI, the ratio of these death rates-a measure of relative inequality-increased slightly. There was a strong shift between 1970 and 2016 toward higher life expectancy, most noticeably at higher levels of SDI. Among countries with populations greater than 1 million in 2016, life expectancy at birth was highest for women in Japan, at 86·9 years (95% UI 86·7-87·2), and for men in Singapore, at 81·3 years (78·8-83·7) in 2016. Male life expectancy was generally lower than female life expectancy between 1970 and 2016, an