Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c

Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29–39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol—which is a marker of cardiovascular risk—changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million–4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.</p

Repositioning of the global epicentre of non-optimal cholesterol

High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol�which is a marker of cardiovascular risk�changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95 credible interval 3.7 million�4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world. © 2020, The Author(s), under exclusive licence to Springer Nature Limited

Post Transplant Erythrocytosis and the Effect of Treatment with Enalapril

Abstract: Introduction: Post transplant erythrocytosis (PTE), defined as a hematocrit level of above 51 percent, is a multifactorial condition common in renal transplant recipients. Traditional therapies include repeated phlebotomies, bilateral native nephrectomies, and anticoagulant therapy. The aim of this study was to evaluate the efficacy of ACE inhibitor on PTE. Methods: This analytic outcome study was done on all transplant patients referred to Shaid Rahnemoon hospital (Yazd, Iran). Hematocrit (HCT) and hemoglobin were assessed in two blood samples taking from the patients. Patients with HCT >51 were selected and studied for other causes of polycythemia. Not finding other causes, the patients were diagnosed as PTE and received Enalapril tab (5 mg /daily). Blood pressure, HCT and Hb of these patients were recorded during next 3 months (30, 60, 90th post-treatment days). Results: Among 126 referred patients, 47 patients had erythrocytosis [37 males (86%) and 6 females (14%)] that shows a higher prevalence in comparison with other studies. All patients responded to Enalapril treatment. Before treatment, mean hemoglobin and hematocrit were 18.35±0.59gr/l and 55.96±1.90mm respectively, while after 3 months treatment with Enalapril, hemoglobin and hematocrit decreased to 16.7±0.5mg/l and 48.73±1.42mm respectively. Conclusion: Enalapril is an effective treatment of PTE and can prevent the need for phlebotomy or nephrectomy in these patients. Keywords: Post transplant erythrocytosis, Renal Transplantation, Enalapri

Numerical investigation of transient temperature separation phenomenon in vortex tube

Ranque-Hilsch vortex tube is a simple mechanical device with no moving parts. A high pressure feed gas enters the vortex tube through the swirl nozzles causing the feed gas to split into two thermodynamically different streams. These two streams will be having not only different velocities but also distinguished temperatures that are lower and higher than the inlet feed gas temperature. This phenomenon and the associated energy separation of the feed gas through the vortex tube are strongly dependent on such parameters as geometry, position, and number of the swirl nozzles, diameter and length of the vortex tube, inlet feed gas pressure, control valves, and aperture duct size. Although the vortex tube is used for few decades across different industries, energy separation phenomenon is still neither fully explained nor agreed upon by the scientific community. This paper is an attempt at a better physical understanding of the embedded phenomenon using computational fluid dynamics via a commercial software (Fluent Software) to numerically simulate the transient flow behavior of the feed gas as well as the energy separation, resulting in distinguished gas streams in a two-dimensional and axisymmetric vortex tube. Appropriate boundary conditions are employed in the numerical simulation resembling experimental conditions from the open literature with the exception of the gas exit at the hot end which has been set to be in concert with the operation of the flow-control valve. The obtained numerical results are in good agreement with experimental data from the open literature. Further, the numerical simulation confirms the existence of free and forced vortices and indicates that the temperature of the circumferential elements towards the hot end gets hotter by receiving heat from the core flow due to the kinetic to thermal energy conversion in the presence of viscous shear stresses

Deviation pattern approach for optimizing perturbative terms of QCD renormalization group invariant observables

We first consider the idea of renormalization group-induced estimates, in the context of optimization procedures, for the Brodsky-Lepage-Mackenzie approach to generate higher-order contributions to QCD perturbative series. Secondly, we develop the deviation pattern approach (DPA) in which through a series of comparisons between lowerorder RG-induced estimates and the corresponding analytical calculations, one could modify higher-order RG-induced estimates. Finally, using the normal estimation procedure and DPA, we get estimates of αs4 corrections for the Bjorken sum rule of polarized deep-inelastic scattering and for the non-singlet contribution to the Adler function

Quality of Morning Report at Yazd Shahid Sadoughi Teaching Hospital in 1386

ackground : Morning report has been the basis of educational programs for internal residents over years. It consists of various groups including instructors, trainers, and students with varying educational objectives. Yet, there is no uniform pattern for this purpose. So, the present study was conducted to evaluate the quality of morning report at Yazd Shahid Sadoughi Teaching Hospital. Methods : This was a descriptive cross-sectional study carried out on a total of 117 subjects (37 males, and 80 females) including 39 assistant students, 39 attending students, and 39 trainees in the Internal Medicine, Pediatrics, and Obstetrics Wards. A questionnaire including 29 items was given to the students to survey the quality of morning report in different wards. The related data were collected and analyzed using Chi-square. Each questionnaire was scored on the basis of a predetermined criterion measure. The data were classified into "excellent" and "moderate" groups. Results : No statistically significant difference was found between questionnaire score and sex (P-value = 0.05) yet, there was a statistically significant difference between questionnaire scores relating to the three said wards (P-value = 0.019). The obstetrics ward (48%) was at the excellent level. 22.2% of the students presented their morning reports including a follow-up. 55.6% of the students presented their reports at the assistant level. 66.7% of the students presented their report in the form of question-and-answer, while 33.3% of them presented it as a speech. Further, 66.3% of the students maintained that the morning report has had an effective impact on the management of the patients. Conclusion : Based on the findings, it is advisable to provide evidence as films, papers, books, etc. to promote the quality of morning report