An evaluation of insulin therapy initiation among patients with type 2 diabetes attending a public health facility in South Africa

Background: Clinically effective interventions that could reduce diabetic patients’ risk of long-term complications are needed to contain the rising cost of diabetes care associated with the increasing prevalence of this condition. Good glycaemic control needs to be rapidly attained and maintained by the appropriate initiation and adjustment of glucoselowering therapy. In patients with insulin-requiring type 2 diabetes who are not at goal glycaemia, this translates to the initiation and intensification of insulin therapy. The aim of this study was to evaluate the appropriateness of the initiation of insulin therapy in patients with poorly controlled insulin-requiring type 2 diabetes.Method: This descriptive retrospective study evaluated treatment regimens, dose adjustments and glycated haemoglobin A1c (HbA1c) measurements extracted from records of patients with type 2 diabetes suitable for inclusion. The observation period spanned the 24 months retrospective to study start. Data collected were transcribed into a spreadsheet suitable for statistical analysis.Results: Of the overall cohort of patients with insulin-requiring type 2 diabetes (n = 131), only 45.8% (n = 60) were commenced on insulin during the observation period, of whom 51.7% had subsequent adjustment of insulin dosage. Mean HbA1c at insulin initiation was 10.29% (± 2.42), and 10.63% (± 1.93) after adjustment of insulin dose (p-value > 0.05). Of those who remained on oral glucose-lowering therapy (n = 71), 57.7% had no change in medication dosage throughout the study period. Overall, 81.35% remained ≥ 1% above goal HbA1c by the end of the study period.Conclusion: This study found a discrepancy in the appropriate use and adjustment of insulin therapy according to metabolic status

An Identification of the Risk Factors Implicated in Diabetic Ketoacidosis (DKA)

Background: Despite improvements in therapy and disease monitoring, diabetic ketoacidosis (DKA) remains a potentially fatal consequence. This retrospective study was undertaken to establish and identify those risk factors that are responsible for the onset of DKA. Methods: The medical records of 77 patients from Addington Hospital, who satisfied the criteria for inclusion into the study of DKA, were reviewed (60 type 1 diabetes mellitus (DM) patients and 17 type 2 DM patients). Results: More juveniles were admitted for multiple DKA episodes (65%) than non-juveniles (35%). DKA occurred in 23% of newly diagnosed type 1 DM on first presentation. Infection was present in 40% of type 1 DM patients with single DKA episodes and in 45% of type 1 DM patients with multiple DKA episodes. A total of 23.2% of all admissions for single DKA involved non-compliance of medication usage and was implicated in 32% of multiple DKA episodes Family and/or school problems presented in 7% of single DKA episodes and 4% in multiple DKA episodes. In the present study, the overall mortality rate was 2.5% (n=2). Conclusion: This study showed that the most important risk factors implicated in DKA were infection, non-compliance and newly diagnosed diabetes, followed by family and/or school problems, low socio-economic status and omission of insulin. South African Family Practice Vol. 49 (10) 2007: pp. 15a-15

An evaluation of postprandial glucose excursions in type 2 diabetic mellitus subjects on Monotard® HM (ge) versus Humulin N® or Humulin L® insulin, each in combination with metformin

Background There is increasing evidence that postprandial hyperglycaemia is implicated in the development of macro- and microvascular diabetic complications. Thus, control of postprandial glucose levels (PPG), in addition to control of fasting blood glucose (FBG), will ensure overall glycaemic control in diabetic patients. This study evaluated the effectiveness of a current anti-diabetic regimen on PPG in patients with type 2 diabetes mellitus. Methods A total of 31 type 2 diabetic subjects on combination treatment of either Humulin N® (HN), Monotard HM (ge)® (M) or Humulin L® (HL) insulin, with metformin, participated in a controlled, prospective, one-day visit study at a tertiary referral state diabetes clinic. The objective was to evaluate the effectiveness of the combination treatment of either M (n = 11) versus HN (n = 10) or HL (n = 10) insulin, each in combination with metformin, on PPG in this study cohort. Each subject was given a standardised meal after completing baseline procedures. Prescribed insulin doses were taken the night prior to the study day and metformin doses were taken with the standardised meal on the following morning, the study day. After completion of the meal, blood glucose levels were determined every half an hour at 0, 30, 60, 90, 120 and 150 minutes, thus providing a postprandial glucose profile for each subject. The data was analysed using ANOVA. Results The study cohort was South African, predominantly of Indian origin (54.8%), with a mean age of 59.2 ± 8 years, and 71% of the cohort was female. The subjects had a mean duration of diabetes of 11.4 ± 6.6 years, with 71% (n = 22) having a positive family history. The study cohort was obese (BMI 32.3 ± 6.2kg/m2, WHR 0.9 ± 0.1). A total of 61.3% (n = 19) of the study cohort was hypertensive, while 29% (n = 9) presented with at least one cardiovascular event and 48.3% (n = 15) had high total cholesterol. On entry to the study, the mean (± SD) FBG (10.3 ± 3.7mmol/l), fructosamine (369.9 ± 78.8￭mol/l) and glycosylated haemoglobin (9 ± 2%) were elevated. Each insulin group, HN, M and HL, was statistically matched for the above-mentioned and was therefore compared. There was no statistically significant difference in the effectiveness of HN, M and HL, each in combination with metformin, on postprandial glucose levels (AUC glucose 0-150 minutes was 2100, 2212.5 and 2362.5mmol.min.l-1, per group respectively). Each insulin group presented with mean postprandial hyperglycaemia (PPH) at all time intervals (30, 60, 90, 120 and 150 minutes). Peak glucose levels were observed at 90 (16mmol/l), 90 (16.9mmol/l) and 60 minutes (17.6mmol/l) for HN, M and HL groups respectively. Since there was no statistically significant difference in PPH between and amongst the insulin groups at 60, 90 and 120 minutes, an approximation of PPG at 60 minutes would not adversely affect the determination of PPG compared to the recommended two hours. Within the HN, M and HL groups, a statistically significant difference in blood glucose levels was observed at 0 and 120 minutes (p = 0.003, 0.009 and 0.019 respectively). Groups with a higher FBG (at 0 minutes) had higher PPG (at 120 minutes), thus showing that the extent of FBG determines the degree of postprandial glycaemia. Conclusion In this study, HN, M and HL, each in combination with metformin, were not effective in controlling postprandial hyperglycaemia. HN was most effective in lowering the postprandial profile, although this was not statistically significant. The current treatment of the study cohort was also reviewed, as both FBG and PPG were not controlled. The use of a combination of short/rapid-acting insulin with a newly- formulated basal insulin is recommended, as both FBG and PPG should be treated to achieve overall glycaemic control. South African Family Practice Vol. 49 (5) 2007: pp. 1

GePEToS : A Geant4 Monte Carlo simulation package for Positron Emission Tomography

GePEToS is a simulation framework developed over the last few years for assessing the instrumental performance of future PET scanners. It is based on Geant4, written in Object-Oriented C++ and runs on Linux platforms. The validity of GePEToS has been tested on the well-known Siemens ECAT EXACT HR+ camera. The results of two application examples are presented : the design optimization of a liquid Xe micro-PET camera dedicated to small animal imaging as well as the evaluation of the effect of a strong axial magnetic field on the image resolution of a Concorde P4 micro-PET camera.Comment: 5 pages, 12 figures, submitted to IEEE Transactions on Nuclear Scienc

Hilbert Lattice Equations

There are five known classes of lattice equations that hold in every infinite dimensional Hilbert space underlying quantum systems: generalised orthoarguesian, Mayet's E_A, Godowski, Mayet-Godowski, and Mayet's E equations. We obtain a result which opens a possibility that the first two classes coincide. We devise new algorithms to generate Mayet-Godowski equations that allow us to prove that the fourth class properly includes the third. An open problem related to the last class is answered. Finally, we show some new results on the Godowski lattices characterising the third class of equations.Comment: 24 pages, 3 figure

Measurement of the electron drift velocity for directional dark matter detectors

Three-dimensional track reconstruction is a key issue for directional Dark Matter detection. It requires a precise knowledge of the electron drift velocity. Magboltz simulations are known to give a good evaluation of this parameter. However, large TPC operated underground on long time scale may be characterized by an effective electron drift velocity that may differ from the value evaluated by simulation. In situ measurement of this key parameter is hence a way to avoid bias in the 3D track reconstruction. We present a dedicated method for the measurement of the electron drift velocity with the MIMAC detector. It is tested on two gas mixtures : $\rm CF_4$ and $\rm CF_4+CHF_3$. We also show that adding $\rm CHF_3$ allows us to lower the electron drift velocity while keeping almost the same Fluorine content of the gas mixture.Comment: Proceedings of the 4th international conference on Directional Detection of Dark Matter (CYGNUS 2013), 10-12 June 2013, Toyama, Japa

In situ measurement of the electron drift velocity for upcoming directional Dark Matter detectors

Three-dimensional track reconstruction is a key issue for directional Dark Matter detection and it requires a precise knowledge of the electron drift velocity. Magboltz simulations are known to give a good evaluation of this parameter. However, large TPC operated underground on long time scale may be characterized by an effective electron drift velocity that may differ from the value evaluated by simulation. In situ measurement of this key parameter is hence needed as it is a way to avoid bias in the 3D track reconstruction. We present a dedicated method for the measurement of the electron drift velocity with the MIMAC detector. It is tested on two gas mixtures: CF4 and CF4 + CHF3. The latter has been chosen for the MIMAC detector as we expect that adding CHF3 to pure CF4 will lower the electron drift velocity. This is a key point for directional Dark Matter as the track sampling along the drift field will be improved while keeping almost the same Fluorine content of the gas mixture. We show that the drift velocity at 50 mbar is reduced by a factor of about 5 when adding 30% of CHF3.Comment: 19 pages, 14 figures. Minor corrections, matches published version in JINS

MIMAC: MIcro-tpc MAtrix of Chambers for dark matter directional detection

Directional detection of non-baryonic Dark Matter is a promising search strategy for discriminating WIMP events from neutrons, the ultimate background for dark matter direct detection. This strategy requires both a precise measurement of the energy down to a few keV and 3D reconstruction of tracks down to a few mm. The MIMAC (MIcro-tpc MAtrix of Chambers) collaboration has developed in the last years an original prototype detector based on the direct coupling of large pixelized micromegas with a special developed fast self-triggered electronics showing the feasibility of a new generation of directional detectors. The first bi-chamber prototype has been installed at Modane, underground laboratory in June 2012. The first undergournd background events, the gain stability and calibration are shown. The first spectrum of nuclear recoils showing 3D tracks coming from the radon progeny is presented.Comment: Proceedings of the 4th International Conference on Directional Dark Matter Detection CYGNUS2013, held in Toyoma (Japan), June 201

High serum immunoglobulin g and m levels predict freedom from adverse cardiovascular events in hypertension: a nested case-control substudy of the Anglo-Scandinavian cardiac outcomes trial

Aims: We aimed to determine whether the levels of total serum IgM and IgG, together with specific antibodies against malondialdehyde-conjugated low-density lipoprotein (MDA-LDL), can improve cardiovascular risk discrimination. Methods and Results: The Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) randomized 9098 patients in the UK and Ireland into the Blood Pressure-Lowering Arm. 485 patients that had cardiovascular (CV) events over 5.5 years were age and sex matched with 1367 controls. Higher baseline total serum IgG, and to a lesser extent IgM, were associated with decreased risk of CV events (IgG odds ratio (OR) per one standard deviation (SD) 0.80 [95% confidence interval, CI 0.72,0.89], p < 0.0001; IgM 0.83[0.75,0.93], p = 0.001), and particularly events due to coronary heart disease (CHD) (IgG OR 0.66 (0.57,0.76); p < 0.0001, IgM OR 0.81 (0.71,0.93); p = 0.002). The association persisted after adjustment for a basic model with variables in the Framingham Risk Score (FRS) as well as following inclusion of C-reactive protein (CRP) and N-terminal pro-B-type natriuretic peptide (NtProBNP). IgG and IgM antibodies against MDA-LDL were also associated with CV events but their significance was lost following adjustment for total serum IgG and IgM respectively. The area under the receiver operator curve for CV events was improved from the basic risk model when adding in total serum IgG, and there was improvement in continuous and categorical net reclassification (17.6% and 7.5% respectively) as well as in the integrated discrimination index. Conclusion: High total serum IgG levels are an independent predictor of freedom from adverse cardiovascular events, particularly those attributed to CHD, in patients with hypertension