Role of Duration of Diabetes on Ventilatory Capacities and Expiratory Flow Rates in Type 2 Diabetes Mellitus

Diabetes mellitus is a chronic debilitating problem with increasing incidence and long term complications such as diabetic nephropathy, diabetic neuropathy, diabetic retinopathy etc. These complications are mainly a consequence of macro vascular and micro vascular damages of the target organs. The magnitude of the complications of diabetes is related to its duration. Less has been known about the after effects of diabetes on lungs. So this work was carried out to know the relation between duration of diabetes and lung volumes and capacities in Type 2 DM patients. The presence of an extensive micro vascular circulation and abundant connective tissue in the lungs raises the possibility that lung tissue may be affected by Microangiopathy process and non-enzymatic glycosylation of tissue proteins, induced by chronic hyperglycemia, there by rendering the lung a “target organ” in diabetic patients.  This is a cross-sectional study, the test group were Type 2 Diabetes Mellitus patients (n=50) with duration of 2-35 years, the control group were staff of Narayana medical college (n=50). Written consent was obtained from them. The following lung function parameters were recorded: Forced Vital Capacity (FVC), Forced Expiratory Volume in the first second (FEV1), Forced Expiratory Volume percent (FEV1/FVC %), Peak Expiratory Flow Rate (PEFR), Forced Expiratory Flow 25-75% (FEF25-75%), Maximum Voluntary Ventilation (MVV). The mean FVC, FEV1, PEFR, FEF25-75%, MVV values are low in diabetics compared to controls (p value <0.001) and the parameters showed significant negative correlation with duration of diabetes. Key words: Chronic hyperglycemia, Diabetes mellitus, Microangiopathy, Micro vascular circulation, Pulmonary function test

A temporal comparison of sex-aggregation pheromone gland content and dynamics of release in three members of the Lutzomyia longipalpis (Diptera: Psychodidae) species complex

Background: Lutzomyia longipalpis is the South American vector of Leishmania infantum, the etiologic agent of visceral leishmaniasis (VL). Male L. longipalpis produce a sex-aggregation pheromone that is critical in mating, yet very little is known about its accumulation over time or factors involved in release. This laboratory study aimed to compare accumulation of pheromone over time and determine factors that might influence release in three members of the L. longipalpis species complex. Methodology/Principal findings: We investigated male sex-aggregation pheromone gland content at different ages and the release rate of pheromone in the presence or absence of females under different light conditions by gas chromatography-mass spectrometry (GC-MS). Pheromone gland content was determined by extraction of whole males and pheromone release rate was determined by collection of headspace volatiles. Pheromone gland content appeared age-related and pheromone began to accumulate between 6 to 12 h post eclosion and gradually increased until males were 7–9 days old. The greatest amount was detected in 9-day old Campo Grande males ((S)-9-methylgermacrene-B; X ± SE: 203.5 ± 57.4 ng/male) followed by Sobral 2S males (diterpene; 199.9 ± 34.3) and Jacobina males ((1S,3S,7R)-3-methyl-α-himachalene; 128.8 ± 30.3) at 7 days old. Pheromone release was not continuous over time. During a 4-hour period, the greatest quantities of pheromone were released during the first hour, when wing beating activity was most intense. It was then substantially diminished for the remainder of the time. During a 24 h period, 4–5 day old male sand flies released approximately 63 ± 11% of the pheromone content of their glands, depending on the chemotype. The presence of females significantly increased pheromone release rate. The light regime under which the sand flies were held had little influence on pheromone release except on Sobral 2S chemotype. Conclusions/Significance: Accumulation of pheromone appears to occur at different rates in the different chemotypes examined and results in differing amounts being present in glands over time. Release of accumulated pheromone is not passive, but depends on biotic (presence of females) and abiotic (light) circumstances. There are marked differences in content and release between the members of the complex suggesting important behavioural, biosynthetic and ecological differences between them. Author summary: The Dipteran subfamily Phlebotominae includes the genera Lutzomyia and Phlebotomus among which several species are important vectors of parasitic and bacterial pathogens. The sand fly Lutzomyia longipalpis is considered the main vector of visceral leishmaniasis (VL) in the New World. Based on the main component of the male sex-aggregation pheromone gland, different sex pheromone-producing populations (chemotypes) of L. longipalpis are recognized in Brazil. Given the importance of the sex-aggregation pheromones in the biology of this species complex, we present here the first attempt to study how pheromone accumulates in the glands over time and factors that might influence its release in the three most common chemotypes from Brazil. Our results demonstrated that pheromone first starts to accumulate a few hours post-eclosion (6–12 h) and this continues over 15 days. Pheromone release is a dynamic process which varies between the 3 chemotypes depending on biotic factors, such as light regime and presence/absence of conspecific females. This work provides valuable information, critical to our understanding of the behaviour and ecology of L. longipalpis sand flies and which will contribute to investigations to improve field-based pheromone control and monitoring of L. longipalpis sand flies

Synthetic sex pheromone in a long-lasting lure attracts the visceral leishmaniasis vector, lutzomyia longipalpis, for up to 12 weeks in Brazil

Current control methodologies have not prevented the spread of visceral leishmaniasis (VL) across Brazil. Here, we describe the development of a new tool for controlling the sand fly vector of the disease: a long-lasting lure, which releases a synthetic male sex pheromone, attractive to both sexes of Lutzomyia longipalpis. This device could be used to improve the effectiveness of residual insecticide spraying as a means of sand fly control, attracting L. longipalpis to insecticide-treated animal houses, where they could be killed in potentially large numbers over a number of weeks. Different lure designs releasing the synthetic pheromone (±)-9-methylgermacrene-B (CAS 183158-38-5) were field-tested in Araçatuba, São Paulo (SP). Experiments compared numbers of sand flies caught overnight in experimental chicken sheds with pheromone lures, to numbers caught in control sheds without pheromone. Prototype lures, designed to last one night, were first used to confirm the attractiveness of the pheromone in SP, and shown to attract significantly more flies to test sheds than controls. Longer-lasting lures were tested when new, and at fortnightly intervals. Lures loaded with 1 mg of pheromone did not attract sand flies for more than two weeks. However, lures loaded with 10 mg of pheromone, with a releasing surface of 15 cm2 or 7.5 cm2, attracted female L. longipalpis for up to ten weeks, and males for up to twelve weeks. Approximately five times more sand flies were caught with 7.5 cm2 10 mg lures when first used than occurred naturally in non-experimental chicken resting sites. These results demonstrate that these lures are suitably long-lasting and attractive for use in sand fly control programmes in SP. To our knowledge, this is the first sex pheromone-based technology targeting an insect vector of a neglected human disease. Further studies should explore the general applicability of this approach for combating other insect-borne diseases

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Microstructural characterization and grain refinement of Ti-15 V-3Al-3Cr-3Sn gas tungsten arc welds by Ni- and Si-Modified fillers

In the present study, the influence of nickel (Ni) and silicon (Si) additions to the Ti-15 V-3Al-3Cr-3Sn (Ti-15-3) fillers on microstructure and mechanical properties of Ti-15-3 gas tungsten arc (GTA) weldments was investigated. Controlled amounts of Ni and Si as grain refiners were introduced into the molten pool of Ti-15-3 alloy by pre-placing the cast inserts (Ti-15-3-x wt.% Ni (x = 0.15, 0.30, 0.5) and Ti-15-3-xwt.% Si (x = 0.15, 0.30, 0.50)) by GTA welding (GTAW). Microstructural examination of welds with Ni and Si additions revealed refined grains in the fusion zone (FZ) characterized by nonlinear grain boundaries. The grain refinement that is mainly caused by Ni and Si additions develops constitutional supercooling (CS) ahead of the solid–liquid (S/L) interface in the FZ. It has been shown that welds prepared with Ti-15-3-0.5 Ni filler (yield strength (YS) of 688 ± 6 MPa, ultimate tensile strength (UTS) of 721 ± 5 MPa, and % elongation (%El) of 9 ± 0.5%) and Ti-15-3-0.5 Si filler (YS = 693 ± 6 MPa, UTS = 725 ± 5 MPa, %El = 8 ± 0.5%) exhibited higher strength compared to autogenous weld (YS = 575 ± 4 MPa, UTS = 597 ± 4 MPa, %El = 11 ± 0.5%). The increased strength observed in welds made using Ti-15-3-0.5Ni filler and Ti-15-3-0.5Si filler can be attributed to the narrower width of columnar β grains and the presence of equiaxed grains in the FZ. Post-weld heat treatment (PWHT) for all the weldments resulted in improved tensile strength and hardness of the weldments, which was attributed to the fine and uniform precipitation of the α phase in FZ

Investigations of microstructure and mechanical properties of post-weld heat-treated DP780 steel TIG welds

This study investigates the microstructure and mechanical properties of DP780 steel that has been tungsten inert gas welded and post weld heat treated. Microscopy studies revealed that the weldment’s microstructure varied from martensite in the fusion zone to a mixture of martensite and ferrite in the heat affected zone (HAZ). This heterogeneity in the microstructure resulted in the formation of hardened and softened zones in the cross section of the weldment. The DP780 as-welded joint exhibited lower strength and ductility [yield strength (YS): 492 ± 5 MPa, ultimate tensile strength (UTS): 668 ± 8 MPa, and percent elongation (%El): 8 ± 1] compared to the base metal (BM) (YS: 538 ± 2 MPa, UTS: 794 ± 5 MPa, and %El: 27 ± 2) due to strain localization in the subcritical HAZ. The weldments subjected to post weld heat treatment (PWHT) at 500°C exhibited lower strength and higher ductility (YS: 471 ± 3 MPa, UTS: 624 ± 5 MPa, and %El: 13 ± 1) than the weldments subjected to PWHT at other conditions: 300°C (YS: 501 ± 7MPa, UTS: 658 ± 6 MPa, and %El: 9 ± 1) and 400°C (YS: 492 ± 3 MPa, UTS: 649 ± 5 MPa, and %El: 11 ± 1). The decrease in strength and ductility after PWHT can be attributed to the tempering of martensite present in the weldment. Erichsen cupping tests indicated a reduction in the formability of the as-welded joint due to the presence of a softened zone. While a significant increase in formability is observed in the weldments subjected to PWHT with an increase in temperature, the formability is still inferior to that of the BM due to the inhomogeneity in the microstructures across the weldment

A Randomized Controlled Trial to Study the Effect of Yoga Therapy on Cardiac Function and N Terminal Pro BNP in Heart Failure

Aims The purpose of this study was to evaluate whether yoga training in addition to standard medical therapy can improve cardiac function and reduce N terminal pro B-type natriuretic peptide (NT pro BNP) in heart failure (HF). Methods 130 patients were recruited and randomized into two groups: Control Group (CG) ( n = 65), Yoga Group (YG). In YG, 44 patients and in CG, 48 patients completed the study. Cardiac function using left ventricular ejection fraction (LVEF), myocardial performance index (Tei index), and NT pro BNP, a biomarker of HF, was assessed at baseline and after 12 weeks. Result Improvement in LVEF, Tei index, and NT pro BNP were statistically significant in both the groups. Furthermore, when the changes in before and after 12 weeks were in percentage, LVEF increased 36.88% in the YG and 16.9% in the CG, Tei index was reduced 27.87% in the YG and 2.79% in the CG, NT pro BNP was reduced 63.75% in the YG and 10.77% in the CG. The between group comparisons from pre to post 12 weeks were significant for YG improvements (LVEF, P < 0.01, Tei index, P < 0.01, NT pro BNP, P < 0.01). Conclusion These results indicate that the addition of yoga therapy to standard medical therapy for HF patients has a markedly better effect on cardiac function and reduced myocardial stress measured using NT pro BNP in patients with stable HF

Attractiveness of lures loaded with 10<i>L. longipalpis</i> caught in test sheds with pheromone lures minus number caught in paired control sheds with no pheromone.

<p>Box and whisker plots show median (horizontal line), interquartile range (box), maximum extreme value within 1.5 of interquartile range (whiskers) and outliers (open circles). Grey boxes indicate significantly more sand flies caught in test sheds than controls (P<0.05, Wilcoxon signed rank test, data log+1 transformed prior to analysis). ‘New’ refers to fresh lures tested one week after 12 week old lures, to confirm that significant numbers of <i>L. longipalpis</i> could still be caught at the end of the sand fly season.</p

Number of male (left side) and female (right side) <i>Lutzomyia longipalpis</i> attracted per night to experimental chicken sheds with either 10 control lures (no pheromone) or 10 pheromone lures each loaded with 50 µg of synthetic sand fly pheromone.

<p>Box and whisker plots show median (horizontal line), interquartile range (box), maximum extreme value within 1.5 of interquartile range (whiskers) and outliers (open circles). Data log(+1) transformed prior to analysis (Wilcoxon signed rank test).</p