Quality of Sleep and Its Effect on Glycemic Control

Diabetes mellitus (DM) is a widespread illness that affects around 347 million individuals globally. DM not only has many clinical implications but also has a detrimental impact on the quality of sleep in patients. Insufficient sleep quality hinders the proper regulation of blood sugar levels, which is considered a fundamental aspect of managing diabetes. It also has other harmful repercussions that significantly affect one's overall quality of life. Increasing data suggests that sleep disturbances and sleep deprivation have an impact on glucose metabolism and insulin resistance. Simultaneously, changes in glucose metabolism can potentially affect the quality of sleep. The association between T2DM and sleep-disturbed breathing has been thoroughly investigated. Individuals diagnosed with T2DM exhibit a remarkably elevated incidence of obstructive sleep apnea, which subsequently leads to suboptimal management of blood sugar levels. Conversely, the correlation between T1DM and sleep has not been well-studied

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Thermal and Hydraulic Performances of Carbon and Metallic Oxides-Based Nanomaterials

For companies, notably in the realms of energy and power supply, the essential requirement for highly efficient thermal transport solutions has become a serious concern. Current research highlighted the use of metallic oxides and carbon-based nanofluids as heat transfer fluids. This work examined two carbon forms (PEG@GNPs & PEG@TGr) and two types of metallic oxides (Al2O3 & SiO2) in a square heated pipe in the mass fraction of 0.1 wt.%. Laboratory conditions were as follows: 6401 ≤ Re ≤ 11,907 and wall heat flux = 11,205 W/m2. The effective thermal–physical and heat transfer properties were assessed for fully developed turbulent fluid flow at 20–60 °C. The thermal and hydraulic performances of nanofluids were rated in terms of pumping power, performance index (PI), and performance evaluation criteria (PEC). The heat transfer coefficients of the nanofluids improved the most: PEG@GNPs = 44.4%, PEG@TGr = 41.2%, Al2O3 = 22.5%, and SiO2 = 24%. Meanwhile, the highest augmentation in the Nu of the nanofluids was as follows: PEG@GNPs = 35%, PEG@TGr = 30.1%, Al2O3 = 20.6%, and SiO2 = 21.9%. The pressure loss and friction factor increased the highest, by 20.8–23.7% and 3.57–3.85%, respectively. In the end, the general performance of nanofluids has shown that they would be a good alternative to the traditional working fluids in heat transfer requests

Investigation of effective parameters in the production of alumina gel through the sol-gel method

Sol-gel chemistry is currently applied as one of the most widely used methods for synthesis of nanoparticles. In this method hydrolysis and poly-condensation reactions occur when the gel precursors are mixed with water and catalyst. The further condensation of sol particles into a three-dimensional network produces a gel. There are several parameters that effect on gelation time such as the molar ratio of alkoxide to water, the rate of hydrolysis, the type and amount of catalyst used, initial concentration of precursors and the temperature of hydrolysis and drying. Encapsulated solvent can be removed from a gel by either evaporative drying or supercritical drying. Where the resulting solids are known as a xerogel and an aerogel, respectively. During the drying process due to the surface tension of the liquid, a capillary pressure gradient is built in the pore walls, which is able to collapse most part of the pore volume. The volume shrinkage may be prevented by supercritical drying. The strength, thermal stability, pore structure and morphology of aerogels are keys to success for wider applications such as catalyst supports, thermal and acoustic insulators and adsorbents. Among catalyst support materials, alumina became popular recently due to its highly thermal and chemical stability and higher porosity. In the present study, synthesis of alumina gel as a support for nano-catalysts through hydrolysis of aluminum tri-sec-butoxide (ASB) in ethanol was investigated. The gel synthesis was carried out at 32 and 60 °C with different concentrations of water and precursor and different types and amounts of acid as catalyst. Rate of gel formation, efficiency of hydrolysis and polymerization and amount of gel production were measured and discussed. Results showed that acid addition around 0.2 ml and water to ASB malar ratio of 2 at 60 °C maximized the amount of gel produced and minimized the gelation time. Then, the alumina gel that synthesized at optimum conditions was dried by two different methods, at atmospheric pressure and temperature and at supercritical conditions of carbon dioxide and the results of Scanning Electron Microscopy were compared

Nanomaterials as transmitters of non-viral gene vectors: A review

With the rapid development of nanotechnology in the recent decade, novel DNA and RNA delivery systems for gene therapy have become available that can be used instead of viral vectors. These non-viral vectors can be made of a variety of materials, including inorganic nanoparticles, carbon nanotubes, liposomes, protein and peptide-based nanoparticles, as well as nanoscale polymeric materials. They have as advantages over viral vectors a decreased immune response, and additionally offer flexibility in design, allowing them to be functionalized and targeted to specific sites in a biological system with low cytotoxicity.gene therapy keeps hopes a life for the treatment of a wide range of diseases such as cancer, nano particles are now known as promising carriers for the effective and safe vectors of genes to specific cells or tissues. This could provide alternative therapies for conventional approaches that use viruses as gene carriers. The expression of genetic material such as DNA, RNA into cells and tissues has raised considerable hopes for therapeutic and diagnostic purposes. But getting nucleic acids into the cell also faces challenges. These challenges are less for non-virus carriers as a gene and drug vectors method than for viral or free vectors and are therefore considered less risky and more appropriate. of expanding nonverbal nano carriers, we will look at a few of these nano carriers, penicillin, PEI, PLGA, silica, block copolymer, Quantum dot, gold nano particles, and common carbon nano tubes. Problems include the use of nano particles such as polymer nano particles, liposomes, solid lipid particles, in targeted gene vectors will be investigated. Gene-based therapy is the intentional modulation of gene expression in specific cells to treat pathological conditions. This modulation is accomplished by introducing exogenous nucleic acids such as DNA, mRNA, small interfering RNA (siRNA), microRNA (miRNA) or antisense oligonucleotides. Given the large size and the negative charge of these macromolecules, their delivery is typically mediated by carriers or vectors. In this Review, we introduce the biological barriers to gene delivery in vivo and discuss recent advances in material sciences, nanotechnology and nucleic acid chemistry that have yielded promising non-viral delivery systems, some of which are currently undergoing testing in clinical trials. The diversity of these systems highlights the recent progress of gene-based therapy using non-viral approaches

The Relationship between Asthma and Allergic Rhinitis in the Iraqi Population

Background: Recently, extensive research has established that epidemiologic and therapeutic links exist between allergic rhinitis and asthma. The objective of this study was to clarify this association in Iraq. Methods: The data included in this study were collected from five surveys for asthma and allergic rhinitis that were performed during the period from September 2000 to July 2008. These surveys were parts of Tikrit University College of Medicine PHC program. Results: The frequency of allergic rhinitis (AR) was 61.6% among individuals with asthma versus 6% among non-asthmatic (control) subjects (Odd Ratio [OR] = 25.5; P < 0.0001). All studies indicated a significant frequency of AR among asthmatic patients in comparison with non-asthmatic subjects, whether the patients were adults or children (OR for adults = 14.9 and 22.5, for children 34.7 and 48.4; P < 0.001 for all). Furthermore, the high frequency of AR in asthmatic patients was seen whether the study was a community based study (CBS) (OR = 14.9 and 48.4; P < 0.0001) or a hospital based study (HBS) (OR = 22.5 & 34.7; P < 0.0001). The frequency of current asthma was 51.8% among individuals with AR versus 5.4% among control subjects (OR = 23.1; P <0.0001). Conclusions: This study provided evidence that AR and asthma are strongly associated with each other and the treatment approach should consider the entire airway rather than only a part

A New Nonlinear Controller for the Maximum Power Point Tracking of Photovoltaic Systems in Micro Grid Applications Based on Modified Anti-Disturbance Compensation

In the photovoltaic system, the performance, efficiency, and generated power of the PV system are affected by changes in the environment, disturbances, and parameter variations, and this leads to a deviation from the operating maximum power point (MPP) of the PV system. Therefore, the main aim of this paper is to ensure the PV system operates at the maximum power point under the influence of exogenous disturbances and uncertainties, i.e., no matter how the irradiation, temperature, and load of the PV system change, by proposing a maximum power point tracking for the photovoltaic system (PV) based on the active disturbance rejection control (ADRC) paradigm. The proposed method provides better performance with excellent tracking for the MPP by controlling the duty cycle of the DC–DC buck converter. Moreover, comparison simulations have been performed between the proposed method and the linear ADRC (LADRC), conventional ADRC, and the improved ADRC (IADRC) to investigate the effectiveness of the proposed method. Finally, the simulation results validated the accuracy of the proposed method in tracking the desired value and disturbance/uncertainty attenuation with excellent response and minimum output performance index (OPI)

Severity of SARS-CoV-2 infection in children with inborn errors of immunity (primary immunodeficiencies): a systematic review

Abstract Background Inborn errors of immunity (IEIs) are considered significant challenges for children with IEIs, their families, and their medical providers. Infections are the most common complication of IEIs and children can acquire coronavirus disease 2019 (COVID-19) even when protective measures are taken. Objectives To estimate the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children with IEIs and analyse the demographic parameters, clinical characteristics and treatment outcomes in children with IEIs with COVID-19 illness. Methods For this systematic review, we searched ProQuest, Medline, Embase, PubMed, CINAHL, Wiley online library, Scopus and Nature through the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guideline for studies on the development of COVID-19 in children with IEIs, published from December 1, 2019 to February 28, 2023, with English language restriction. Results Of the 1095 papers that were identified, 116 articles were included in the systematic review (73 case report, 38 cohort 4 case-series and 1 case–control studies). Studies involving 710 children with IEIs with confirmed COVID-19 were analyzed. Among all 710 IEIs pediatric cases who acquired SARS-CoV-2, some children were documented to be admitted to the intensive care unit (ICU) (n = 119, 16.8%), intubated and placed on mechanical ventilation (n = 87, 12.2%), suffered acute respiratory distress syndrome (n = 98, 13.8%) or died (n = 60, 8.4%). Overall, COVID-19 in children with different IEIs patents resulted in no or low severity of disease in more than 76% of all included cases (COVID-19 severity: asymptomatic = 105, mild = 351, or moderate = 88). The majority of children with IEIs received treatment for COVID-19 (n = 579, 81.5%). Multisystem inflammatory syndrome in children (MIS-C) due to COVID-19 in children with IEIs occurred in 103 (14.5%). Fatality in children with IEIs with COVID-19 was reported in any of the included IEIs categories for cellular and humoral immunodeficiencies (n = 19, 18.6%), immune dysregulatory diseases (n = 17, 17.9%), innate immunodeficiencies (n = 5, 10%), bone marrow failure (n = 1, 14.3%), complement deficiencies (n = 1, 9.1%), combined immunodeficiencies with associated or syndromic features (n = 7, 5.5%), phagocytic diseases (n = 3, 5.5%), autoinflammatory diseases (n = 2, 3%) and predominantly antibody deficiencies (n = 5, 2.5%). Mortality was COVID-19-related in a considerable number of children with IEIs (29/60, 48.3%). The highest ICU admission and fatality rates were observed in cases belonging to cellular and humoral immunodeficiencies (26.5% and 18.6%) and immune dysregulatory diseases (35.8% and 17.9%) groups, especially in children infected with SARS-CoV-2 who suffered severe combined immunodeficiency (28.6% and 23.8%), combined immunodeficiency (25% and 15%), familial hemophagocytic lymphohistiocytosis (40% and 20%), X-linked lymphoproliferative diseases-1 (75% and 75%) and X-linked lymphoproliferative diseases-2 (50% and 50%) compared to the other IEIs cases. Conclusion Children with IEIs infected with SARS-CoV-2 may experience higher rates of ICU admission and mortality in comparison with the immunocompetent pediatric populations. Underlying immune defects does seem to be independent risk factors for severe SARS-CoV-2 infection in children with IEIs, a number of children with SCID and CID were reported to have prolonged infections–though the number of patients is small–but especially immune dysregulation diseases (XLP1 and XLP2) and innate immunodeficiencies impairing type I interferon signalling (IFNAR1, IFNAR2 and TBK1)