A study of lipid profile and glycemic status in patients with chronic kidney disease of unknown etiology in Sri Lanka

Background: Dyslipidemia and impaired glucose tolerance are common complications of chronic kidney disease (CKD) and are responsible for increased cardiovascular risk. Studies on lipid profile and glycemic status in CKD of unknown origin (CKDu) are scarce. The objective of this study was to evaluate the lipid profile and glycemic status of the patients with CKDu and to aid in preventing morbidity and mortality.Methods: The descriptive, cross sectional study was conducted in a rural CKDu endemic area, Girandurukotte.  Data was collected from February 2018 to June 2019. For the diagnosis of CKDu, history and clinical features with supportive biochemical, renal biopsy and radiological evidence were taken as criteria. Blood samples were taken for serum creatinine, lipid profile and HbA1C. Already diagnosed patients with diabetes mellitus and dyslipidemia were excluded.Results: A total of 168 patients within the age range of 32-66 years (mean 50.3±7.7) were participated. There were 106 males (63%) 46.4% were farmers. Majority of the patients (65.5%) had normal body mass index (BMI) (mean 22.9 kg/m2, normal range 18.5-23.5%) followed by overweight (23.5-30 kg/m2) in 55 (32.7%) patients. The prevalence of dyslipidemia in CKDu was found to be 55.9%.  Majority of the abnormality was seen in the HDL group with 68 (40.5%) patients having low HDL cholesterol (mean 44.7 mg/dl, SD=12.3).  There was a significant rise in the serum triglyceride concentration (>150 mg/dl) in 53 (31.5%) (mean 152.4 mg/dl, SD=73.5) and total cholesterol (>200 mg/dl) in 30 (18%) patients (mean 182 mg/dl, SD=36.9). LDL cholesterol abnormality (>130 mg/dl) was seen in only 9 patients (mean 88.7 7658mg/dl, SD=25.4). From the total, 144 (85.7%) patients had abnormal HbA1C levels; 27 (16.1%) patients had HbA1C levels between 5.7% and 6.4% (pre-diabetes), and 117 (69.6%) patients had HbA1C level more than 6.5% (diabetes mellitus). There was no statistically significant association between HbA1C levels and BMI (p=0.29) or HbA1C and lipid abnormalities (p=0.32)Conclusions: The high prevalence of dyslipidemia, pre-diabetes and diabetes mellitus in patients with CKDu may accelerate the progression of chronic kidney disease and increase the risk of cardiovascular disease. Early detection, initiation of appropriate medication and early referral to the expertise will ameliorate morbidity and mortality.

PT-symmetry breaking in complex nonlinear wave equations and their deformations

We investigate complex versions of the Korteweg-deVries equations and an Ito type nonlinear system with two coupled nonlinear fields. We systematically construct rational, trigonometric/hyperbolic, elliptic and soliton solutions for these models and focus in particular on physically feasible systems, that is those with real energies. The reality of the energy is usually attributed to different realisations of an antilinear symmetry, as for instance PT-symmetry. It is shown that the symmetry can be spontaneously broken in two alternative ways either by specific choices of the domain or by manipulating the parameters in the solutions of the model, thus leading to complex energies. Surprisingly the reality of the energies can be regained in some cases by a further breaking of the symmetry on the level of the Hamiltonian. In many examples some of the fixed points in the complex solution for the field undergo a Hopf bifurcation in the PT-symmetry breaking process. By employing several different variants of the symmetries we propose many classes of new invariant extensions of these models and study their properties. The reduction of some of these models yields complex quantum mechanical models previously studied.Comment: 50 pages, 39 figures (compressed in order to comply with arXiv policy; higher resolutions maybe obtained from the authors upon request

Can vital signs recorded in patients' homes aid decision making in emergency care? A Scoping Review

Aim: Use of tele-health programs and wearable sensors that allow patients to monitor their own vital signs have been expanded in response to COVID-19. We aimed to explore the utility of patient-held data during presentation as medical emergencies. Methods: We undertook a systematic scoping review of two groups of studies: studies using non-invasive vital sign monitoring in patients with chronic diseases aimed at preventing unscheduled reviews in primary care, hospitalization or emergency department visits and studies using vital sign measurements from wearable sensors for decision making by clinicians on presentation of these patients as emergencies. Only studies that described a comparator or control group were included. Studies limited to inpatient use of devices were excluded. Results: The initial search resulted in 896 references for screening, nine more studies were identified through searches of references. 26 studies fulfilled inclusion and exclusion criteria and were further analyzed. The majority of studies were from telehealth programs of patients with congestive heart failure or Chronic Obstructive Pulmonary Disease. There was limited evidence that patient held data is currently used to risk-stratify the admission or discharge process for medical emergencies. Studies that showed impact on mortality or hospital admission rates measured vital signs at least daily. We identified no interventional study using commercially available sensors in watches or smart phones. Conclusions: Further research is needed to determine utility of patient held monitoring devices to guide management of acute medical emergencies at the patients’ home, on presentation to hospital and after discharge back to the community

Complexified dynamical systems.

Accepted versio

Relativistic supersymmetric quantum mechanics based on Klein-Gordon equation

Witten's non-relativistic formalism of supersymmetric quantum mechanics was based on a factorization and partnership between Schroedinger equations. We show how it accommodates a transition to the partnership between relativistic Klein-Gordon equations. In such a class of models the requirement of supersymmetry is shown to lead to a certain "exceptional-point" instability of ground states.Comment: 20 page

Chaotic systems in complex phase space

This paper examines numerically the complex classical trajectories of the kicked rotor and the double pendulum. Both of these systems exhibit a transition to chaos, and this feature is studied in complex phase space. Additionally, it is shown that the short-time and long-time behaviors of these two PT-symmetric dynamical models in complex phase space exhibit strong qualitative similarities.Comment: 22 page, 16 figure

PT symmetric models in more dimensions and solvable square-well versions of their angular Schroedinger equations

For any central potential V in D dimensions, the angular Schroedinger equation remains the same and defines the so called hyperspherical harmonics. For non-central models, the situation is more complicated. We contemplate two examples in the plane: (1) the partial differential Calogero's three-body model (without centre of mass and with an impenetrable core in the two-body interaction), and (2) the Smorodinsky-Winternitz' superintegrable harmonic oscillator (with one or two impenetrable barriers). These examples are solvable due to the presence of the barriers. We contemplate a small complex shift of the angle. This creates a problem: the barriers become "translucent" and the angular potentials cease to be solvable, having the sextuple-well form for Calogero model and the quadruple or double well form otherwise. We mimic the effect of these potentials on the spectrum by the multiple, purely imaginary square wells and tabulate and discuss the result in the first nontrivial double-well case.Comment: 21 pages, 5 figures (see version 1), amendment (a single comment added on p. 7

Closing in on the sources of cosmic reionization: first results from the GLASS-JWST program

The escape fraction of Lyman-continuum (LyC) photons ($f_{esc}$) is a key parameter for determining the sources of cosmic reionization at $z\geq 6$. At these redshifts, owing to the opacity of the intergalactic medium, the LyC emission cannot be measured directly. However, LyC leakers during the epoch of reionization could be identified using indirect indicators that have been extensively tested at low and intermediate redshifts. These include a high [OIII]/[OII] flux ratio, high star-formation surface density, and compact sizes. In this work, we present observations of 29 $4.5 \leq z \leq 8$ gravitationally lensed galaxies in the Abell 2744 cluster field. From a combined analysis of JWST-NIRSpec and NIRCam data, we accurately derived their physical and spectroscopic properties: our galaxies have low masses $(\log(M_\star)\sim 8.5)$, blue UV spectral slopes ($\beta \sim -2.1$), compact sizes ($r_e \sim 0.3-0.5$ kpc), and high [OIII]/[OII] flux ratios. We confirm that these properties are similar to those characterizing low-redshift LyC leakers. Indirectly inferring the fraction of escaping ionizing photons, we find that more than 80% of our galaxies have predicted $f_{esc}$ values larger than 0.05, indicating that they would be considered leakers. The average predicted $f_{esc}$ value of our sample is 0.12, suggesting that similar galaxies at $z\geq 6$ have provided a substantial contribution to cosmic reionization.Comment: Accepted for publication in the 4. Extragalactic astronomy section of A&A, 12 pages, 8 figure

The ALMA REBELS Survey: Discovery of a massive, highly star-forming and morphologically complex ULIRG at z=7.31z =7.31

We present Atacama Large Millimeter/Submillimeter Array (ALMA) [CII] and $\sim158$ $\rm\mu m$ continuum observations of REBELS-25, a massive, morphologically complex ultra-luminous infrared galaxy (ULIRG; $L_{\rm IR}=1.5^{+0.8}_{-0.5}\times10^{12}$ L$_\odot$) at $z=7.31$, spectroscopically confirmed by the Reionization Era Bright Emission Line Survey (REBELS) ALMA Large Programme. REBELS-25 has a significant stellar mass of $M_{*}=8^{+4}_{-2}\times10^{9}$ M$_\odot$. From dust-continuum and ultraviolet observations, we determine a total obscured + unobscured star formation rate of SFR $=199^{+101}_{-63}$ M$_\odot$ yr$^{-1}$. This is about four times the SFR estimated from an extrapolated main-sequence. We also infer a [CII]-based molecular gas mass of $M_{\rm H_2}=5.1^{+5.1}_{-2.6}\times10^{10}$ $M_\odot$, implying a molecular gas depletion time of $t_{\rm depl, H_2}=0.3^{+0.3}_{-0.2}$ Gyr. We observe a [CII] velocity gradient consistent with disc rotation, but given the current resolution we cannot rule out a more complex velocity structure such as a merger. The spectrum exhibits excess [CII] emission at large positive velocities ($\sim500$ km s$^{-1}$), which we interpret as either a merging companion or an outflow. In the outflow scenario, we derive a lower limit of the mass outflow rate of 200 M$_\odot$ yr$^{-1}$, which is consistent with expectations for a star formation-driven outflow. Given its large stellar mass, SFR and molecular gas reservoir $\sim700$ Myr after the Big Bang, we explore the future evolution of REBELS-25. Considering a simple, conservative model assuming an exponentially declining star formation history, constant star formation efficiency, and no additional gas inflow, we find that REBELS-25 has the potential to evolve into a galaxy consistent with the properties of high-mass quiescent galaxies recently observed at $z\sim4$.Comment: Accepted for publication in MNRAS. 21 pages, 8 figure