Burden of liver disease progression in hospitalized patients with type 2 diabetes mellitus

BACKGROUND AND AIMS: There are uncertainties on the burden of liver disease in patients with type-2 diabetes (T2D). METHODS: We measured adjusted hazard ratios of liver disease progression to hepatocellular cancer and/or decompensated cirrhosis in a 2010-2020 retrospective, bicentric, longitudinal, cohort of 52,066 hospitalized patients with T2D. RESULTS: Mean age was 64±14 years and 58% were men. Alcohol use disorders accounted for 57% of liver-related complications and were associated with all liver-related risk factors. Non-metabolic liver-related risk factors accounted for 37% of the liver burden. T2D control was not associated with liver disease progression. The incidence (95% confidence interval) of liver-related complications and of competing mortality were 3.9 (3.5-4.3) and 27.8 (26.7-28.9) per 1000 person-years at risk, respectively. The cumulative incidence of liver disease progression exceeded the cumulative incidence of competing mortality only in the presence of a well-identified risk factors of liver disease progression, including alcohol use. The incidence of hepatocellular cancer was 0.3 (95% CI, 0.1-0.5) per 1000 person-year in patients with obesity and it increased with age. The adjusted hazard ratios of liver disease progression were 55.7 (40.5-76.6), 3.5 (2.3-5.2), 8.9 (6.9-11.5), and 1.5 (1.1-2.1), for alcoholic liver disease, alcohol use disorders without alcoholic liver disease, non-metabolic liver-related risk factors, and obesity, respectively. The attributable fractions of alcohol use disorders, non-metabolic liver risk-related risk factors, and obesity to the liver burden were 55%, 14%, and 7%, respectively. CONCLUSIONS: In this analysis of data from two hospital-based cohorts of patients with T2D, alcohol use disorders, rather than obesity, contributed to most of the liver burden. These results suggest that patients with T2D should be advised to drink minimal amounts of alcohol. LAY SUMMARY: • There is uncertainty on the burden of liver-related complications in patients with type-2 diabetes • We studied the risks of liver cancer and complications of liver disease in over 50,000 patients with type-2 diabetes • We found that alcohol was the main factor associated with complications of liver disease • This finding has major implications on the alcohol advice given to patients with type-2 diabetes

Reviewing the integration of patient data: how systems are evolving in practice to meet patient needs

<p>Abstract</p> <p>Background</p> <p>The integration of Information Systems (IS) is essential to support shared care and to provide consistent care to individuals – patient-centred care. This paper identifies, appraises and summarises studies examining different approaches to integrate patient data from heterogeneous IS.</p> <p>Methods</p> <p>The literature was systematically reviewed between 1995–2005 to identify articles mentioning patient records, computers and data integration or sharing.</p> <p>Results</p> <p>Of 3124 articles, 84 were included describing 56 distinct projects. Most of the projects were on a regional scale. Integration was most commonly accomplished by messaging with pre-defined templates and middleware solutions. HL7 was the most widely used messaging standard. Direct database access and web services were the most common communication methods. The user interface for most systems was a Web browser. Regarding the type of medical data shared, 77% of projects integrated diagnosis and problems, 67% medical images and 65% lab results. More recently significantly more IS are extending to primary care and integrating referral letters.</p> <p>Conclusion</p> <p>It is clear that Information Systems are evolving to meet people's needs by implementing regional networks, allowing patient access and integration of ever more items of patient data. Many distinct technological solutions coexist to integrate patient data, using differing standards and data architectures which may difficult further interoperability.</p

Gas turbine performances improvement using steam injection in the combustion chambre under Sahara conditions

Gas turbines are generally used for large scale power generation. The basic gas turbine cycle has low thermal efficiency which decreases in the hard climatic conditions of operation, so it is important to look for improved gas turbine based cycles. Among several methods shown their success in increasing the performances, the steam injected gas turbine cycle (STIG) consists to introduce a high amount of steam at various points in the cycle. The objective of the present work is to improve the performances of gas turbine used under Sahara conditions by injecting suitable quantities of steam in the upstream of combustion chamber. The suggested method has been studied and compared with a simple cycle. Efficiency, however, is held constant when the ambient temperature increases from iso conditions to 50C. Computer program has been developed for various gas turbine processes including the effect of ambient temperature. This is achieved by studying the effect of steam injection on the gas turbine performances. Data from the performance testing of an industrial gas turbine, computer model and theoretical study are used to check the validity of the proposed model. The comparison of the prediction results to the test data is in good agreemen

Combustion chamber steam injection for gas turbine performance improvement during high ambient temperature operations

The gas turbines are generally used for large scale power generation. The basic gas turbine cycle has low thermal efficiency, which decreases in the hard climatic conditions of operation, so the cycles with thermodynamic improvement is found to be necessary. Among several methods shown their success in increasing the performances, the steam injected gas turbine cycle (STIG) consists of introducing a high amount of steam at various points in the cycle. The main purpose of the present work is to improve the principal characteristics of gas turbine used under hard condition of temperature in Algerian Sahara by injecting steam in the combustion chamber. The suggested method has been studied and compared to a simple cycle. Efficiency, however, is held constant when the ambient temperature increases from ISO conditions to 50°C. Computer program has been developed for various gas turbine processes including the effects of ambient temperature, pressure ratio, injection parameters, standard temperature, and combustion chamber temperature with and without steam injection. Data from the performance testing of an industrial gas turbine, computer model, and theoretical study are used to check the validity of the proposed model. The comparison of the predicted results to the test data is in good agreement. Starting from the advantages, we recommend the use of this method in the industry of hydrocarbons. This study can be contributed for experimental test

Gas Turbine Performances Improvement using Steam Injection in the Combustion Chamber under Sahara Conditions

Gas turbines are generally used for large scale power generation. The basic gas turbine cycle has low thermal efficiency which decreases in the hard climatic conditions of operation, so it is important to look for improved gas turbine based cycles. Among several methods shown their success in increasing the performances, the steam injected gas turbine cycle (STIG) consists to introduce a high amount of steam at various points in the cycle. The objective of the present work is to improve the performances of gas turbine used under Sahara conditions by injecting suitable quantities of steam in the upstream of combustion chamber. The suggested method has been studied and compared with a simple cycle. Efficiency, however, is held constant when the ambient temperature increases from iso conditions to 50C. Computer program has been developed for various gas turbine processes including the effect of ambient temperature. This is achieved by studying the effect of steam injection on the gas turbine performances. Data from the performance testing of an industrial gas turbine, computer model and theoretical study are used to check the validity of the proposed model. The comparison of the prediction results to the test data is in good agreement

Amélioration des performances des turbines à gaz par injection de vapeur d’eau en amont de la chambre de combustion

Le rôle des turbines à gaz, dans la production d’électricité, de l’industrie pétrolière et dans les réacteurs à neutrons rapides refroidis en utilisant l’hélium comme fluide caloporteur a pris une attention particulière ces dernières années. A cet effet, différentes méthodes (régénération, refroidissement intermédiaire, préchauffage et injection de la vapeur d’eau) ont été utilisées afin d’améliorer les performances des cycles de turbines à gaz. Dans cette optique, la méthode d’injection de la vapeur d’eau à l’amont de la chambre de combustion d’une turbine à gaz a été proposée, étudiée et comparée avec un cycle simple. L’objectif principal de ce travail consiste à la réalisation d’un programme de calcul de l’influence des conditions ambiantes sur les caractéristiques des différents composants de la turbine à gaz, telles que la compression, la combustion et la détente. Une fois que les paramètres de fonctionnement optimaux sont connus, le recalcul des performances de l’installation a été effectué en injectant des quantités convenables de vapeur d’eau à l’amont de la chambre de combustion. Les résultats obtenus de l’influence des conditions ambiantes sur les performances de la turbine à gaz sans injection de la vapeur d’eau et l’influence des conditions standards sur le début d’injection, selon ceux trouvés dans la littérature simulés par le code de calcul thermodynamique ‘Thermoptim’, sont en bonne concordance avec la variation qualitative de ces conditions, dans le cas d’un fonctionnement normal sans injection de la vapeur. Ces résultats sont représentés sous forme de courbes en deux et à trois dimensions pour une meilleure illustration des phénomènes physique

Molecular and serological detection of animal and human vector-borne pathogens in the blood of dogs from Cote d'Ivoire

In Cote d'Ivoire, limited information are available on vector-borne pathogens, their prevalence and distribution. Here, we assess the occurrence and diversity of canine vector-borne diseases (CVBDs) in Abidjan and Yamoussoukro cities. Blood from a total of 123 dogs were tested for Leishmania infantum and Ehrlichia canis antibodies and screened for Leishmania and Trypanosoma spp., Piroplasmida, Filariidae and Anaplasmataceae by PCR and sequencing. Among dogs, 39 % were positive for at least one pathogen. Seroprevalences were: 15.4 % and 12.2 % for L. infantum and E. canis, respectively. DNA of L. infantum and T. congolense (4.1 %), Baabesia vogeli (1.6 %), Filariidae (Dirofilaria immitis, D. repens and Acanthocheilonema reconditum) (10.6 %) has been detected. Anaplasmataceae were detected in (17.1 %) and E. canis was the only identified specie. Co-infections were observed in 13.8 % of dogs: E. canis-L. infantum co-infection was the most prevalent (4.9 %). Age, breed and sex of dogs do not seem to influence infections. Village dogs were more susceptible to CVBDs than kennel dogs (PV = 0.0000008). This study reports for the first time the presence of L. infantum, B. vogeli, A. reconditum, D. immitis and D. repens in dogs from Cote d'Ivoire and determines the prevalence and diversity of CVBD pathogens. The results indicate that human and animal pathogens are abundant in Ivoirian dogs which requires attention of veterinarians, physicians and authorities against these diseases, especially against major zoonosis such as visceral leishmaniasis (L. infantum)