Vitamin B12 deficiency in diabetic patients treated with metformin: A narrative review

Metformin is the most prescribed oral hypoglycemic drug and is considered by many health practitioners as the first-line treatment for non-insulin-dependent diabetes mellitus (T2DM). It is used either as a monotherapy or adjuvant to other anti-hyperglycemic agents. Most of its side effects are usually mild and self-limiting. However, several studies have shown an association between the use of metformin and low vitamin B12 levels in diabetic patients. The current review aimed to provide a literature review of the current published reports on the association, the possible mechanisms, and the related individualized risk factors that might lead to this incidence. The most accepted mechanism of the effect of metformin on vitamin B12 level is related to the absorption process where metformin antagonism of the calcium cation and interference with the calcium-dependent IF-vitamin B12 complex binding to the ileal cubilin receptor. In addition, many risk factors have been associated with the impact of metformin on vitamin B12 levels in diabetic patients such as dose and duration where longer durations showed a greater prevalence of developing vitamin B12 deficiency. Male patients showed lower levels of vitamin B12 compared to females. Black race showed a lower prevalence of vitamin B12 deficiency in metformin-treated patients. Moreover, chronic diseases including T2DM, hyperlipidemia, coronary artery disease, polycystic ovary disease (PCOD), obesity, and metformin therapy were significantly associated with increased risk of vitamin B12 deficiency. Graphical abstract: Metformin impacts vitamin B12 by (A) inhibiting calcium-dependent IF-B12 binding. (B) Prolonged use raises deficiency risk. (C) Males have lower B12 levels than females. (D) Black individuals show lower deficiency rates. (E) Conditions like T2DM, hyperlipidemia, coronary artery disease, PCOD, obesity, and metformin use heighten deficiency risk. (Figure presented.).Open Access funding provided by the Qatar National Library

ANALYSIS OF PUMPING TESTS IN A BURREN LIMESTONE AQUIFER IN THE WEST OF IRELAND

The properties of the limestoneaquifer which used asa source of water supply forAthenry,Co.Galway. Ireland, were investigated by pumping tests. Three tests were conduced, on 18th July 1994, 8th March 1995. Data from these pumping tests were analysed to determine the flow conditions during the tests. The time-drawdown curves showed that the flow regime during pumping was unsteady. The aquifer's behaviour during the tests was complex. According to the driller's report the aquifer was confined but when data from all the tests were plotted in the form of time-drawdown curves, they showed the trend qualitatively similar to the Neuman's theoretical curves for unconfined aquifers with delayed yield. The geological data from the well logs showed that the aquifer consists of weathered and dolomite below 10 m. The data was processed with four different methods starting from simplest, i.e. the Theis's curve matching. The Neuman's curves for unconfined aquifers with delayed yield were then matched with the measured data. The parameters of the Neuman's curves were also optimized by the non-linear method of least squares based on a modified version of the Rosenbrock algorithm. Inallthree cases,substantial deviationsof field data fromthe theory used were found. Finally, the Bourdet-Gringarten method for double-porosity fractured aquifers was used. In this method, the early and late time data from selected wells were matched with the classical Theis type curve. The estimated parameter values had wide range of variation in all cases except for the Bourdet-Gringarten curve matching which gave consistent values oftransmissivity, but the values of storativity are very uncertain even with this method, their average variation is between 0.0005 and 0.005. The average estimate of the aquifer transmissivity is 0.075 m2/min.The results of pumping tests show that no single classical theory of confined, unconfined, semi-confined or even fractured aquifers can fully succeed in interpreting the field data. More complex theories and their combinations should be applied in future if the aquifer behaviour is to be explained satisfactorily. In particular it appears that the flow in the fractured aquifer near the well may be non-darcian

APPLICATION OF CORMIX MODEL TO THE THERMAL DISCHARGES FROM POWER STATIONS - A CASE STUDY

The behaviour of the thermal water discharge from Shannonbridge Power Station (Co. Offaly. Ireland) into the river Shannon was investigated using the CORMIX model. The flow rate and temperature data measured at low flow conditions in summer were used in this study. The water quality standard of 3 dgree celsius rise in ambient water temperature was used for thermal plume study. The geometry of thermal plume was simulated using different angle of discharge channel and bottom slope of the river near discharge channel. The results showed that the discharge channel geometry and depth of water at discharge point are important parameters. But the most effective parameter is the horizontal discharge angle i.e. the actual angle of discharge channel with the river ban downstream.lt affects both the temperature distribution and the mixing zone length. The water quality standard was obtained at a distance of 15.75 m downstream when horizontal angle of discharge was 20 degree . While the same standard was obtained in flow establishment zone (0.25 m downstream) with cross flow (i.e. with horizontal angle of discharge of 90 drgree ). It is ' proposed for Shannonbridge Power Station that the thermal water discharge from power station be normal to the downstream bank of river (cross flow). It is also suggested that define a regulatory mixing zone length of 20 m downstream in river. Shannon to keep it environmentally safe

DESIGN OF A MULTI-LEVEL SAMPLING WELL FOR MONITORING HYDRO-SALINITY BEHAVIOR UNDER SHALLOW TUBEWELLS

Multi-level sampling wells are installed to monitor the spatial and temporal changes in hydro-salinity in fresh-saline aquifer under different pumping regimes. Sampling wells consist of 5 mm diameter high density polyethylene tubes opened at different depth is ranging from 5 to 75 m. Lower end of each tube is perforated to allow lateral entry of the water. Water samples are collected using suction bottles attached to each tube. The storage effect during sampling is minimized by disposing off the already existing water in each tube. The sampling well is cost effective, easy to install and is suitable for collecting unmixed water samples at different depths in unconfined sand aquifers

Diagnostic analysis of farmers? skimming well technologies in the Indus Basin

In Asghar, Muhammad Nadeem; Shafique, Muhammad Siddique; Yasin, Muhammad ; Alam, Muhammad Mehboob (Eds.), Root zone salinity management using fractional skimming wells with pressurized Irrigation: Proceedings of the Year-End Seminar 2001. Lahore, Pakistan: IWM

DESIGN OF A MULTI-LEVEL SAMPLING WELL FOR MONITORING HYDRO-SALINITY BEHAVIOR UNDER SHALLOW TUBEWELLS

Multi-level sampling wells are installed to monitor the spatial and temporal changes in hydro-salinity in fresh-saline aquifer under different pumping regimes. Sampling wells consist of 5 mm diameter high density polyethylene tubes opened at different depth is ranging from 5 to 75 m. Lower end of each tube is perforated to allow lateral entry of the water. Water samples are collected using suction bottles attached to each tube. The storage effect during sampling is minimized by disposing off the already existing water in each tube. The sampling well is cost effective, easy to install and is suitable for collecting unmixed water samples at different depths in unconfined sand aquifers

Preparation, Characterization, and Biological Features of Cactus Coated Bacterial Cellulose Hydrogels

The current study was aimed at developing BC-Cactus (BCC) composite hydrogels with impressive mechanical features for their potential applications in medical and environmental sectors. BCC composites hydrogels were developed through cactus gel coating on a never dried BC matrix. The FE-SEM micrographs confirmed the saturation of BC fibrils with cactus gel. Additionally, the presence of various functional groups and alteration in crystalline behavior was confirmed through FTIR and XRD analysis. Mechanical testing illustrated a three-times increase in the strain failure and an increase of 1.6 times in the tensile strength of BCC composite. Absorption capabilities of BCC were much higher than pure BC and it retained water for a longer period of time. Additionally, the rewetting and absorption potentials of composites were also higher than pure BC. The composite efficiently adsorbed Pb, Zn, Cu, and Co metals. Biocompatibility studies against human HaCat cell line indicated much better cell adhesion and proliferation of BCC compared to BC. These findings advocate that the BCC composite could find applications in medical, pharmaceutical and environmental fields

Toward developing a sea-freight supply chain for delivering pakistani mangoes to European supermarket: A private-public sector model

Exporting mangoes by sea is a commercially attractive proposition for traders throughout the world. The same is true for Pakistan, since sea-freight is 4-5 times cheaper than air freight and large volumes can be delivered, which is not possible by air. Pakistan, being the 4th largest mango producer internationally, has never had access to European supermarkets. However, with the opening up of their stores in Pakistan, and having evaluated the response of European customers to Pakistani mangoes, these supermarkets (Metro) are now trying to develop a seafreight supply chain for supplying Pakistani mangoes to their stores in Europe and other countries. This opportunity provided an impetus for changes in industry practices to improve quality and also provided an opportunity for public sector involvement to support such initiatives through capacity building of stakeholders. Since sea-freight takes extended time (24-28 days to Europe), mangoes need to undergo special pre-and postharvest/shipping protocols, so that at destination the delivered quality and shelf life meet required supermarket standards. In this internationally collaborative initiative, both simulated and physical experiments have been performed using Controlled Atmosphere (CA)-technology. Studies were performed using a mobile CA-lab, provided by the European collaborators, enabling performance evaluation of mangoes under different CA conditions. Trial shipments to Metro Germany, using a MAERSK CA-container, explored weaknesses in the overall supply chain logistics both in-country and on the European side, which had never handled Pakistani mangoes shipped by sea-under CA-conditions. This presentation provides an account of this multi-dimensional project, being funded and technically supported by several local and international organizations. While the project provides an insight into the progress made in developing mango seafreight supply chain, it also serves as model for agencies and countries targeting the development of similar fresh produce supply chains

TOWARD DEVELOPING A SEA-FREIGHT SUPPLY CHAIN FOR DELIVERING PAKISTANI MANGOES TO EUROPEAN SUPERMARKET: A PRIVATE-PUBLIC SECTOR MODEL

Exporting mangoes by sea is a commercially attractive proposition for traders throughout the world. The same is true for Pakistan, since sea-freight is 4-5 times cheaper than air freight and large volumes can be delivered, which is not possible by air. Pakistan, being the 4th largest mango producer internationally, has never had access to European supermarkets. However, with the opening up of their stores in Pakistan, and having evaluated the response of European customers to Pakistani mangoes, these supermarkets (Metro) are now trying to develop a seafreight supply chain for supplying Pakistani mangoes to their stores in Europe and other countries. This opportunity provided an impetus for changes in industry practices to improve quality and also provided an opportunity for public sector involvement to support such initiatives through capacity building of stakeholders. Since sea-freight takes extended time (24-28 days to Europe), mangoes need to undergo special pre-and postharvest/shipping protocols, so that at destination the delivered quality and shelf life meet required supermarket standards. In this internationally collaborative initiative, both simulated and physical experiments have been performed using Controlled Atmosphere (CA)-technology. Studies were performed using a mobile CA-lab, provided by the European collaborators, enabling performance evaluation of mangoes under different CA conditions. Trial shipments to Metro Germany, using a MAERSK CA-container, explored weaknesses in the overall supply chain logistics both in-country and on the European side, which had never handled Pakistani mangoes shipped by sea-under CA-conditions. This presentation provides an account of this multi-dimensional project, being funded and technically supported by several local and international organizations. While the project provides an insight into the progress made in developing mango seafreight supply chain, it also serves as model for agencies and countries targeting the development of similar fresh produce supply chains