Prevalence and Assessment of Excessive Daytime Sleepiness in Diabetic and Obese Patients.

Objective: To study the prevalence of Excessive Day time Sleepiness [ EDS] in diabetes and obese patients by assessing the quality and quantity of sleep by Epworth[ ESS] and Pittsburgh Sleep Quality Index [PSQI] Scale and also to provide patient education to improve quality and quantity of sleep. Study Design: It is a prospective observational study. Study Site: The study was conducted in the department of Diabetology, Kovai Medical Center and Hospital, a multispecialty hospital in Coimbatore, Tamilnadu. Study Period: The study was conducted over a period of five months from September2011 to January 2012. Study Population: Both male and female patients diagnosed with Type II Diabetes Mellitus & Obesity within the age group of 20-65 were included in the study. CONCLUSION: The study findings observed that excessive day time sleepiness is more prevalent in diabetic obese population. Sleep loss varies considerably by gender in diabetic patients. It was more observed in diabetic females than males. Obesity was also more common in diabetic women than in men while physical activity was less in women compared to men. A sedentary lifestyle has shown to enhance excessive day time sleepiness in diabetic patients. Difference was observed in the ESS scores between both genders. Sleep disturbances were seen more common in older age group of 55-65. Most of the patients observed with EDS had hypertension as a comorbid disease. Sleep exerts marked modulatory effects on glucose metabolism by influencing the balance and levels of hormones, including leptin, ghrelin, insulin and cortisol, in addition to the activity of the sympathetic nervous system(SNS). These physiological defence mechanisms alter glucose tolerance and sensitivity to insulin and leptin, impairing appetite regulation. Therefore, when chronically activated, these stress responses favour the development of obesity and T2DM. In addition, shorter sleepers have more opportunity for food consumption and tend to be more fatigued and less active during the day, which favour obesity. On the other hand, obesity itself, especially when central, leads to OSA, to inflammatory processes, and to the development of T2DM. Thus, we may conclude that it is difficult to isolate a cause and an effect from this neuroendocrine- metabolic misbalance, since sleep characteristics (disorders or duration) may impact neurological and endocrine systems to promote obesity and T2DM, while obesity and T2DM may impact sleep as well. Therefore, while obesity and T2DM are favoured and aggravated by short sleep duration or sleep disorders, sleep may be impaired by these two widespread metabolic conditions. Thus sleep quality is seen poor in diabetic patients. To improve sleep quality, a clinical pharmacist can help patients to follow good sleep habits. The pharmacist encourages patients to engage in good sleep hygiene to reduce daytime sleepiness and instruct patients that adequate high-quality sleep is important to improve daytime function. Good sleep hygiene includes ensuring adequate sleep duration, developing sleep promoting bedtime rituals, avoiding staying in bed if unable to sleep, and avoiding caffeine if it disturbs the patient’s ability to fall asleep. There are many effective treatments for sleep disorders, and the deleterious health effects of insufficient sleep or a coexisting sleep disorder warrant greater attention. Pharmacist can be instrumental in encouraging adherence to treatment for sleep disorders. Although persons with diabetes are instructed to restrict calories and to increase physical activity, the presence of less than optimal sleep may undermine these important treatment goals. Thus, educating patients with type 2 diabetes about the importance of sleep and regular screening for sleep disorders has the potential for a positive clinical outcome

Tuberculous Aortic Root Abscess in a child: A case report

Although tuberculous aortitis is fairly common in adults, tuberculous mycotic aneurysm of aorta is rare withinvolvement of aortic root being very uncommon. The diagnosis depends on a combination of clinical criteria,including persistent fever and bacteraemia and echocardiographic confirmation. Because of the rarity of aorticroot abscess in children, there is no consensus on a treatment strategy. We describe a 10-year-old male whopresented with fever, abdominal pain and headache, and was found to have disseminated tuberculosis and aorticroot abscess with mycotic aneurysm. Due to the presence of evidence of tuberculosis elsewhere in the body(multiple tuberculomas in brain, granulomas in liver, lichen scrofulosorum over abdomen), therapy with antituberculousdrugs was started to which the patient responded partially, but later died suddenly at home

Stark verbesserte Empfindlichkeit von CMOS-kompatiblen plasmonischen Titannitrid-Nanoloch-Arrays für die Brechungsindex-Messungen unter nicht-senkrechtem Lichteinfall

Titanium nitride (TiN) is a complementary metal-oxide-semiconductor (CMOS) compatible material with large potential for the fabrication of plasmonic structures suited for device integration. However, the comparatively large optical losses can be detrimental for application. This work reports a CMOS compatible TiN nanohole array (NHA) on top of a multilayer stack for potential use in integrated refractive index sensing with high sensitivities at wavelengths between 800 and 1500 nm. The stack, consisting of the TiN NHA on a silicon dioxide (SiO2) layer with Si as substrate (TiN NHA/SiO2/Si), is prepared using an industrial CMOS compatible process. The TiN NHA/SiO2/Si shows Fano resonances in reflectance spectra under oblique excitation, which are well reproduced by simulation using both finite difference time domain (FDTD) and rigorous coupled-wave analysis (RCWA) methods. The sensitivities derived from spectroscopic characterizations increase with the increasing incident angle and match well with the simulated sensitivities. Our systematic simulation-based investigation of the sensitivity of the TiN NHA/SiO2/Si stack under varied conditions reveals that very large sensitivities up to 2305 nm per refractive index unit (nm RIU−1) are predicted when the refractive index of superstrate is similar to that of the SiO2 layer. We analyze in detail how the interplay between plasmonic and photonic resonances such as surface plasmon polaritons (SPPs), localized surface plasmon resonances (LSPRs), Rayleigh Anomalies (RAs), and photonic microcavity modes (Fabry-Pérot resonances) contributes to this result. This work not only reveals the tunability of TiN nanostructures for plasmonic applications but also paves the way to explore efficient devices for sensing in broad conditions.Titannitrid (TiN) ist ein CMOS-kompatibles Material mit großem Potenzial für die Herstellung plasmonischer Strukturen, die sich für die Bauelementintegration eignen. Die vergleichsweise großen optischen Verluste können sich jedoch nachteilig auf die Anwendung auswirken. In dieser Arbeit wird ein CMOS-kompatibles TiN-Nanoloch-Array (NHA) auf einem Mehrschichtstapel vorgestellt, das für die integrierte Brechungsindexmessung mit hoher Empfindlichkeit bei Wellenlängen zwischen 800 und 1500 nm eingesetzt werden kann. Der Stapel, bestehend aus dem TiN NHA auf einer Siliziumdioxid (SiO2)-Schicht mit Si als Substrat (TiN NHA/SiO2/Si), wurde in einem industriellen CMOS-kompatiblen Prozess hergestellt. Das TiN NHA/SiO2/Si zeigt Fano-Resonanzen in den Reflexionsspektren bei schrägem Einfallswinkel, die durch Simulationen sowohl mit Finite-Differenzen-Zeitbereichsmethoden (FDTD) als auch Rigorous Coupled Wave Analysis (RCWA) gut reproduziert werden. Die aus den spektroskopischen Charakterisierungen abgeleiteten Empfindlichkeiten nehmen mit zunehmendem Einfallswinkel zu und stimmen gut mit den simulierten Empfindlichkeiten überein. Unsere systematische simulationsbasierte Untersuchung der Empfindlichkeit des TiN NHA/SiO2/Si-Stapels unter verschiedenen Bedingungen zeigt, dass sehr große Empfindlichkeiten bis zu 2305 nm RIU-1 vorhergesagt werden, wenn der Brechungsindex des Dielektrikums oberhalb des NHAs ähnlich dem der SiO2-Schicht ist. Wir analysieren im Detail, wie das Zusammenspiel zwischen plasmonischen und photonischen Resonanzen wie Oberflächenplasmonpolaritonen (SPPs), lokalisierten Oberflächenplasmonenresonanzen (LSPRs), Rayleigh-Anomalien (RAs) und photonischen Mikrokavitätsmoden (Fabry-Pérot-Resonanzen) zu diesem Ergebnis beiträgt. Diese Arbeit zeigt nicht nur die Abstimmbarkeit von TiN-Nanostrukturen für plasmonische Anwendungen, sondern ebnet auch den Weg für die Erforschung effizienter Geräte für die Erkennung unter verschiedensten Bedingungen