Long term management challenges in diabetic patients with rhino-orbito-cerebral mucormycosis

There has been a recent upsurge in prevalence of diabetes mellitus in developing world. This has resulted in exponential increase in the incidence of both communicable and non-communicable diseases. Some of the infections increase morbidity and mortality associated with diabetes. Rhino-orbital-cerebral mucormycosis (ROCM) is one of the fatal opportunistic infections in diabetes. There is little data published regarding the short and long term management of patients suffering from this invasive fungal infection. Hereby, we report few cases of ROCM with varied presentations and their short and long term follow up. These patients were initially treated with injectable amphotericin B and later followed up with oral posaconazole

Genome-wide association study for type 2 diabetes in Indians identifies a new susceptibility locus at 2q21.

Indians undergoing socioeconomic and lifestyle transitions will be maximally affected by epidemic of type 2 diabetes (T2D). We conducted a two-stage genome-wide association study of T2D in 12,535 Indians, a less explored but high-risk group. We identified a new type 2 diabetes-associated locus at 2q21, with the lead signal being rs6723108 (odds ratio 1.31; P = 3.32 × 10⁻⁹). Imputation analysis refined the signal to rs998451 (odds ratio 1.56; P = 6.3 × 10⁻¹²) within TMEM163 that encodes a probable vesicular transporter in nerve terminals. TMEM163 variants also showed association with decreased fasting plasma insulin and homeostatic model assessment of insulin resistance, indicating a plausible effect through impaired insulin secretion. The 2q21 region also harbors RAB3GAP1 and ACMSD; those are involved in neurologic disorders. Forty-nine of 56 previously reported signals showed consistency in direction with similar effect sizes in Indians and previous studies, and 25 of them were also associated (P < 0.05). Known loci and the newly identified 2q21 locus altogether explained 7.65% variance in the risk of T2D in Indians. Our study suggests that common susceptibility variants for T2D are largely the same across populations, but also reveals a population-specific locus and provides further insights into genetic architecture and etiology of T2D

Finite element modelling of LV transformer winding to simulate dynamic events occurring under short circuit : In Ansys Mechanical

The ability to withstand a short circuit is the most essential feature of a power transformer. The most important reason to design short-circuits proof transformers is to ensure the reliability of the power grid (avoiding black outs etc.) and safety (fire and explosion in case of failure). During short circuit, the most effected winding is the LV winding due to the flow high currents even during the normal working condition. So during a short circuit large forces are generated which act on the winding and these forces can reach hundreds of tons in fraction of a second, so the transformer must be properly designed in order to withstand these forces or the transformer can fail in different ways. One of the possible failure modes called “Spiraling” is discussed and analyzed in this thesis. Spiraling Occurs when the LV winding twists tangentially in the opposite direction at the ends due to radial short circuit forces. From literature study the transient forces acting on the winding during a 3-phase short circuit was determined and these transient forces were used to perform simulations on the model. The axial and radial forces applied on the model were such that it has a uniform magnitude per each turn. Various analysis was performed on the model which includes the Static, Modal and Transient Structural analysis in Ansys Workbench and each analysis involved parametric analysis where the deformations and the torsional mode shapes were determine

Długoterminowe wyzwania terapeutyczne u chorych z cukrzycą i mukormykozą nosa, oczodołu i mózgu

W krajach rozwijających się obserwuje się ostatnio wzrost częstości występowania cukrzycy. Spowodowało to wykładniczy wzrost zapadalności na choroby zarówno zakaźne, jak i niezakaźne. Niektóre zakażenia zwiększają chorobowość i umieralność związane z cukrzycą. Mukormykoza nosa, oczodołu i mózgu (ROCM) stanowi jedno ze śmiertelnych zakażeń oportunistycznych wikłających cukrzycę. Dostępnych jest niewiele danych na temat krótko- i długoterminowego postępowania u chorych z tym inwazyjnym zakażeniem grzybiczym. W niniejszej pracy przedstawiono kilka przypadków ROCM o różnym obrazie klinicznym oraz dane z ich krótko- i długoterminowej obserwacji. Opisywani pacjenci byli początkowo leczeni amfoterycyną B we wstrzyknięciach, a następnie posokonazolem doustnie

Finite element modelling of LV transformer winding to simulate dynamic events occurring under short circuit : In Ansys Mechanical

The ability to withstand a short circuit is the most essential feature of a power transformer. The most important reason to design short-circuits proof transformers is to ensure the reliability of the power grid (avoiding black outs etc.) and safety (fire and explosion in case of failure). During short circuit, the most effected winding is the LV winding due to the flow high currents even during the normal working condition. So during a short circuit large forces are generated which act on the winding and these forces can reach hundreds of tons in fraction of a second, so the transformer must be properly designed in order to withstand these forces or the transformer can fail in different ways. One of the possible failure modes called “Spiraling” is discussed and analyzed in this thesis. Spiraling Occurs when the LV winding twists tangentially in the opposite direction at the ends due to radial short circuit forces. From literature study the transient forces acting on the winding during a 3-phase short circuit was determined and these transient forces were used to perform simulations on the model. The axial and radial forces applied on the model were such that it has a uniform magnitude per each turn. Various analysis was performed on the model which includes the Static, Modal and Transient Structural analysis in Ansys Workbench and each analysis involved parametric analysis where the deformations and the torsional mode shapes were determine

Genetic Polymorphism in Patients with Diabetic Nephropathy and Retinopathy: A Cross-sectional Study

Introduction: The chronic persistence of diabetes leads to microvascular complications, such as Diabetic Nephropathy (DN) and Diabetic Retinopathy (DR). Both of these are progressive disorders involving pathological changes in capillaries. A few biochemical pathways have been suggested to link hyperglycaemia and microvascular complications. The probability of developing and progressing DN and DR is associated with the duration of diabetes. These complex disorders are strongly influenced by both genetics and environmental factors. Several candidate genes have been reported to be associated with DN and DR in different populations. Aim: To determine the co-existence of DN and DR in relation to gene polymorphisms of Angiotensin-Converting Enzyme (ACE), Angiotensinogen (AGT), Receptor for Advanced Glycation End-products (RAGE), Aldose reductase (ALR2), and Vascular Endothelial Growth Factor (VEGF). Materials and Methods: The present DN and DR cross-sectional study was conducted at the Department of Endocrinology, University College of Medical Sciences, University of Delhi and GTB, New Delhi, India, and the Discipline of Biochemistry, Indira Gandhi National Open University, New Delhi, India. The study was conducted from October 2019 to August 2022. All the participants under uniform diabetes management were divided into two groups (100 in each group): Group 1 included Type-II diabetic patients with DN and DR, and Group 2 comprised Type-II diabetic patients with DN only. Polymorphisms in all genes were determined using Polymerase Chain Reaction (PCR), followed by digestion with restriction enzymes and visualisation through an ultraviolet transilluminator. The analysis of biochemical parameters and association of gene polymorphisms was performed using Statistical Package for Social Sciences (SPSS) version 26.0 software. Results: There were 57 males and 43 females in the DN+DR group, and 51 males and 49 females in the DN-DR group. The mean age of study subjects in the DN+DR group was 52.60±9.08 years, compared to the DN-DR group (47.33±10.68 years). The DN+DR group had a significantly higher mean duration of diabetes (11.78±6.86 vs. 5.13±4.78, p≤0.001) and a significantly lower mean waist circumference (91.30±13.99 vs. 95.11±9.95 cm, p≤0.02). The DN+DR group also had significantly higher urea (34.34±16.32 vs. 26.43±12.34 cm, p≤0.001), creatinine (1.34±0.90 vs. 0.89±0.25 cm, p≤0.03) and significantly lower estimated Glomerular Filtration Rate (eGFR) levels compared to the DN-DR group. The distribution of genotypes of ALR2 (p≤0.04) and VEGF genes (p≤0.001) showed a significant difference between both DN+DR and DN-DR groups. The frequency of the D allele of the VEGF gene (p≤0.02) (OR=1.94, 95% Confidence Interval (CI)=1.10-3.40) was higher in the DN+DR group. The DN+DR group also had a significantly lower frequency of the CT+TT dominant model of the ALR2 gene (p≤0.04) as well as an increased frequency of the ID+DD dominant model of the VEGF gene (p≤0.002). No significant differences were found in genotypic as well as allelic frequencies of ACE, AGT, and RAGE gene polymorphisms between the two groups. Conclusion: The D allele of the VEGF (I/D) gene polymorphism is significantly associated with DR in patients with DN. It can be concluded that the VEGF gene plays an important role in the development of retinopathy in DN patients

Postprandial Hypertriglyceridemia Predicts Development of Insulin Resistance Glucose Intolerance and Type 2 Diabetes.

Insulin resistance (IR) and type 2 diabetes mellitus (T2DM) have been found to be associated with postprandial hypertriglyceridemia (PPHTg). However, whether PPHTg can cause IR and diabetes is not clear. We therefore investigated the role of PPHTg in development of T2DM in rat model of T2DM. 96 male Wistar rats were randomized into four groups (24 rats each). Control Group A, high sucrose diet (HSD) Group B, HSD+Pioglitazone (10 mg/kg/day) Group C and HSD+Atorvastatin (20 mg/kg/day) Group D. Fat and glucose tolerance tests were done at regular intervals in all groups besides insulin and body weight measurement. At 26 weeks, low dose streptozotocin (15 mg/kg, i.p.) was given to half of the rats. All rats were followed up till 48 weeks. PPHTg developed as early as week 2 in Group B and stabilized by week 14. Group B displayed highest PPHTg compared to other groups. Atorvastatin treatment (Group D) abolished PPHTg which became comparable to controls, pioglitazone treatment partially blunted PPHTg resulting in intermediate PPHTg. Group B with highest PPHTg showed highest subsequent IR, glucose intolerance (GI) and highest incidence of prediabetes at week 26 and diabetes at week 34 and 46 compared to other groups. Group D rats displayed lower IR, GI, low incidence of prediabetes and diabetes at these time points compared to Groups B and C. ROC analysis showed that triglyceride area under the curve of each time point significantly predicts the risk of diabetes. Present study provides the evidence that PPHTg predicts the development of IR, GI and T2DM in rat model of diet induced T2DM

Body weight in all the four groups at different time points.

<p>Body weight in all the four groups at different time points.</p

HOMA-IR in all the four groups at various time points.

<p>HOMA-IR in all the four groups at various time points.</p