Insulin prescribing pattern in geriatric type 2 diabetic mellitus patients of different nutritional status at a tertiary level of health care: a retrospective study

Background: The world, specifically India is witnessing a steady increase in elderly population. The numbers are expected to escalate by 3 million by 2050 considering India alone. Further, the diabetic population is also increasing, and India will be home to the highest population of diabetic patients. It is thus indispensable to understand the prescribing patterns in elderly diabetics where insulin is inevitably added later in the course of diabetes, if not earlier.Methods: Data was extracted from a diabetic registry maintained of patients attending the outpatient departments of a tertiary health care between 2009 to 2012 and having completed one year of regular three-monthly follow ups. Data was entered into MS Excel, analysed using IBM SPSS software and presented in the form of percentages or averages.Results: Out of the total 180 male predominated type 2 diabetics aged 60 years and above, 142 (78.8%) elderly patients received a single type of insulin each day. 102 (56.6%) patients were on human insulins while 82 (45.5%) were receiving analogues. As for premixed insulins, 62 (34.4%) patients were receiving biphasic insulin analogues, while 83 (46.1%) patients were receiving human premixed insulin.Conclusions: The elderly population makes up for a huge proportion and is set to increase in the coming years. The insulin prescribing pattern in them needs to be tailor-made to suit their needs and preferences whilst maintaining a relaxed target of HbA1c control at 8mg% or less. However, it should not be too low so as to avoid unnecessary hypoglycaemic episodes

Os instrumentos de análise estratégica utilizados pelas empresas em Angola

A utilização de instrumentos de análise estratégica é de extrema importância para melhorar a performance da empresa. Esta dissertação avalia a disseminação destes instrumentos nas pequenas até às grandes empresas de Angola. Utilizando dados de inquéritos, encontro evidência que a análise swot, a análise da cadeira de valor e o brainstorming são os instrumentos mais utilizados, que as empresas recorrem a consultores externos e à instrução do seu staff para se familiarizarem com estes instrumentos. A sua utilização é bastante frequente. Perto de 100% das empresas reporta utilizar pelo menos um instrumento nas suas operações, contudo, a esmagadora maioria dos instrumentos ainda não são implementados sugerindo que as empresas se concentram em poucos instrumentos da panóplia disponível. Através da análise de regressão linear encontro evidência estatística de que a utilização de mais instrumentos está associada a uma melhoria importante da perceção que os indivíduos têm relativamente a três indicadores chave: o alinhamento do acionista e da gestão executiva, o retorno sobre os investimentos e a retenção e atração de talentos. Finalmente, entrevistei um diretor da Sonangol e outro da Refriango, ambas importantes players da economia Angolana. Com base nestas entrevistas, concluo que estes instrumentos permitem à firma avaliar e melhorar a sua saúde financeira, alinhar as suas estratégias de negócios ao ambiente económico que enfrentam, defender as suas propostas de investimentos junto dos acionistas e comparar-se com os seus concorrentes.The utilization of strategic tools is of paramount importance to improve firms’ performance. This dissertation accesses the spread of the usage these instruments among Angola’s small to large sized firms. Based on survey data, I find evidence that swot analysis, value chain analysis and brainstorming stand as the more standard used tools, and firms rely both on external consultants and training their own staff to get acquainted with them. The usage of these tools is also quite frequent. Close to 100% of the firms in the sample report using at least one tool in their operations, however the overwhelming majority of instruments is yet to be implemented, suggesting that firms concentrate in few instruments out of the available pool. Using regression analysis, I find statistical evidence that the usage of more tools is associated with a meaningful improvement in the perception that individuals have regarding three key indicators: the alignment of the interests of the stockholders and executive board, the return on investments and the retention and attraction of talents. Finally, I interviewed one director of Sonangol and another of Refriango, both are large players in Angola’s economy. Based on these interviews I conclude that these instruments allow the firm to access and improve its financial wealth, align their business strategies depending on the economic environment they face, support their investment proposals in front of the stockholders and compare the firm’s performance relative to its competitors

Adaptation of the Bergen Social Media Addiction Scale (BSMAS) in Spanish

The impact of social networks on people's daily lives is worrisome, particularly in adolescents and young people, who seem to exceed the limits of normal use. Constant excessive use can lead to pathological behaviors linked to social media addiction (SMA). Our objectives were to 1) adapt the Bergen Social Media Addiction Scale (BSMAS) to Spanish and 2) evaluate its psychometric properties in a young population. The BSMAS was adapted to Spanish, involving experts on social media addiction and people from the target population during the adaptation process. For the psychometric evaluation, 650 Peruvian college students responded to the Spanish version (53.5 % women aged 18 to 40, M = 21.5 SD = 2.7). The one-dimensional measurement model proposed for the original BSMAS was confirmed for our version (X2(9) = 23.9315, CFI = 0.994, TLI = 0.990, SRMR = 0.032, RMSEA = 0.061). The reliability was good (α = 0.863; 95 % CI: 0.848–0.870; ω = 0.864; 95 % CI: 0.846–0.844), and the measurement invariance was confirmed for sex and age by fitting models. The concurrent validity with external social media addiction and mental health indicators was also confirmed. This study provides new and relevant information on the BSMAS validity and allows its application to Spanish-speaker college students from Peru and similar countries.info:eu-repo/semantics/publishedVersio

Dynamic MAIT cell response with progressively enhanced innateness during acute HIV-1 infection.

Mucosa-associated invariant T (MAIT) cell loss in chronic HIV-1 infection is a significant insult to antimicrobial immune defenses. Here we investigate the response of MAIT cells during acute HIV-1 infection utilizing the RV217 cohort with paired longitudinal pre- and post-infection samples. MAIT cells are activated and expand in blood and mucosa coincident with peak HIV-1 viremia, in a manner associated with emerging microbial translocation. This is followed by a phase with elevated function as viral replication is controlled to a set-point level, and later by their functional decline at the onset of chronic infection. Interestingly, enhanced innate-like pathways and characteristics develop progressively in MAIT cells during infection, in parallel with TCR repertoire alterations. These findings delineate the dynamic MAIT cell response to acute HIV-1 infection, and show how the MAIT compartment initially responds and expands with enhanced function, followed by progressive reprogramming away from TCR-dependent antibacterial responses towards innate-like functionality

Characteristics of stable chronic obstructive pulmonary disease patients in the pulmonology clinics of seven Asian cities

Background and objectives Chronic obstructive pulmonary disease (COPD) is responsible for significant morbidity and mortality worldwide. We evaluated the characteristics of stable COPD patients in the pulmonology clinics of seven Asian cities and also evaluated whether the exposure to biomass fuels and dusty jobs were related to respiratory symptoms, airflow limitation, and quality of life in the COPD patients. Methods: This cross-sectional observational study recruited 922 COPD patients from seven cities of Asia. The patients underwent spirometry and were administered questionnaires about their exposure to cigarette smoking, biomass fuels, and dusty jobs in addition to respiratory symptoms and health related quality of life. Results: Of the patients, there appeared to be variations from city to city in the history of exposure to biomass fuels and dusty jobs and also in respiratory symptoms of cough, phlegm, wheeze, and dyspnea. These symptoms were more frequent in those COPD patients with a history of exposure to biomass fuels than without and those with a history of exposure to dusty jobs than without (P < 0.01 for all comparisons). Airflow limitation was more severe in those COPD patients with a history of exposure to biomass fuels than without (52.2% predicted versus 55.9% of post-bronchodilator forced expiratory volume in 1 second [FEV1], P = 0.009); quality of life was poorer in those with exposure to biomass fuels than without (40.4 versus 36.2 of the St George’s Respiratory Questionnaire [SGRQ] total score, P = 0.001). Airflow limitation was more severe in those COPD patients with a history of exposure to dusty jobs than without (51.2% predicted versus 57.3% of post-bronchodilator FEV1, P < 0.001); quality of life was poorer in those with dusty jobs than without (41.0 versus 34.6 of SGRQ score, P = 0.006). Conclusion: In Asian cities, the characteristics of COPD patients vary and the history of exposure to biomass fuels or dusty jobs was related to frequency of symptoms, severe airflow limitation, and poor quality of life

De Novo ZMYND8 variants result in an autosomal dominant neurodevelopmental disorder with cardiac malformations

Purpose: ZMYND8 encodes a multidomain protein that serves as a central interactive hub for coordinating critical roles in transcription regulation, chromatin remodeling, regulation of superenhancers, DNA damage response and tumor suppression. We delineate a novel neurocognitive disorder caused by variants in the ZMYND8 gene. Methods: An international collaboration, exome sequencing, molecular modeling, yeast twohybrid assays, analysis of available transcriptomic data and a knockdown Drosophila model were used to characterize the ZMYND8 variants. Results: ZMYND8 variants were identified in 11 unrelated individuals; 10 occurred de novo and one suspected de novo; 2 were truncating, 9 were missense, of which one was recurrent. The disorder is characterized by intellectual disability with variable cardiovascular, ophthalmologic and minor skeletal anomalies. Missense variants in the PWWP domain of ZMYND8 abolish the interaction with Drebrin and missense variants in the MYND domain disrupt the interaction with GATAD2A. ZMYND8 is broadly expressed across cell types in all brain regions and shows highest expression in the early stages of brain development. Neuronal knockdown of the Drosophila ZMYND8 ortholog results in decreased habituation learning, consistent with a role in cognitive function. Conclusion: We present genomic and functional evidence for disruption of ZMYND8 as a novel etiology of syndromic intellectual disability

Safety, immunogenicity, and reactogenicity of BNT162b2 and mRNA-1273 COVID-19 vaccines given as fourth-dose boosters following two doses of ChAdOx1 nCoV-19 or BNT162b2 and a third dose of BNT162b2 (COV-BOOST): a multicentre, blinded, phase 2, randomised trial

Background Some high-income countries have deployed fourth doses of COVID-19 vaccines, but the clinical need, effectiveness, timing, and dose of a fourth dose remain uncertain. We aimed to investigate the safety, reactogenicity, and immunogenicity of fourth-dose boosters against COVID-19.Methods The COV-BOOST trial is a multicentre, blinded, phase 2, randomised controlled trial of seven COVID-19 vaccines given as third-dose boosters at 18 sites in the UK. This sub-study enrolled participants who had received BNT162b2 (Pfizer-BioNTech) as their third dose in COV-BOOST and randomly assigned them (1:1) to receive a fourth dose of either BNT162b2 (30 µg in 0·30 mL; full dose) or mRNA-1273 (Moderna; 50 µg in 0·25 mL; half dose) via intramuscular injection into the upper arm. The computer-generated randomisation list was created by the study statisticians with random block sizes of two or four. Participants and all study staff not delivering the vaccines were masked to treatment allocation. The coprimary outcomes were safety and reactogenicity, and immunogenicity (antispike protein IgG titres by ELISA and cellular immune response by ELISpot). We compared immunogenicity at 28 days after the third dose versus 14 days after the fourth dose and at day 0 versus day 14 relative to the fourth dose. Safety and reactogenicity were assessed in the per-protocol population, which comprised all participants who received a fourth-dose booster regardless of their SARS-CoV-2 serostatus. Immunogenicity was primarily analysed in a modified intention-to-treat population comprising seronegative participants who had received a fourth-dose booster and had available endpoint data. This trial is registered with ISRCTN, 73765130, and is ongoing.Findings Between Jan 11 and Jan 25, 2022, 166 participants were screened, randomly assigned, and received either full-dose BNT162b2 (n=83) or half-dose mRNA-1273 (n=83) as a fourth dose. The median age of these participants was 70·1 years (IQR 51·6–77·5) and 86 (52%) of 166 participants were female and 80 (48%) were male. The median interval between the third and fourth doses was 208·5 days (IQR 203·3–214·8). Pain was the most common local solicited adverse event and fatigue was the most common systemic solicited adverse event after BNT162b2 or mRNA-1273 booster doses. None of three serious adverse events reported after a fourth dose with BNT162b2 were related to the study vaccine. In the BNT162b2 group, geometric mean anti-spike protein IgG concentration at day 28 after the third dose was 23 325 ELISA laboratory units (ELU)/mL (95% CI 20 030–27 162), which increased to 37 460 ELU/mL (31 996–43 857) at day 14 after the fourth dose, representing a significant fold change (geometric mean 1·59, 95% CI 1·41–1·78). There was a significant increase in geometric mean anti-spike protein IgG concentration from 28 days after the third dose (25 317 ELU/mL, 95% CI 20 996–30 528) to 14 days after a fourth dose of mRNA-1273 (54 936 ELU/mL, 46 826–64 452), with a geometric mean fold change of 2·19 (1·90–2·52). The fold changes in anti-spike protein IgG titres from before (day 0) to after (day 14) the fourth dose were 12·19 (95% CI 10·37–14·32) and 15·90 (12·92–19·58) in the BNT162b2 and mRNA-1273 groups, respectively. T-cell responses were also boosted after the fourth dose (eg, the fold changes for the wild-type variant from before to after the fourth dose were 7·32 [95% CI 3·24–16·54] in the BNT162b2 group and 6·22 [3·90–9·92] in the mRNA-1273 group).Interpretation Fourth-dose COVID-19 mRNA booster vaccines are well tolerated and boost cellular and humoral immunity. Peak responses after the fourth dose were similar to, and possibly better than, peak responses after the third dose