Smart Rainwater Management: New Technologies and Innovation

In a smart city, the following factors are very vital such as smart grid and e-health. A smart city is one of the burning topics of research. Although there is no particular definition of a smart city, it means smart grid, e-health, e-environmental monitoring, smart home, smart water quality, smart air quality, etc. integrated into a single application. Human civilization can’t be sustained and prosper with shortage of usable water. Hence, water has a vital share in human life even for those living in smart cities. This chapter describes about the smart water quality issues in a smart city and some of the research advances in handling those issues. Among them it investigates the rainwater harvesting technologies and some of their practical applications

Effect of saroglitazar in South Indian patients with diabetic dyslipidemia uncontrolled on a moderate-intensity statin and the association of PPAR α and γ gene polymorphisms with its response

Background: Diabetic dyslipidemia is associated with atherosclerosis risk factors and cardiovascular disease. Saroglitazar is a dual PPAR α and γ agonist approved initially for diabetic dyslipidemia and later for managing non-alcoholic steatohepatitis and hyperglycemia in T2DM. This study was conducted to estimate the association of studied PPAR α and γ gene polymorphisms among patients with diabetic dyslipidemia at baseline and with triglyceride response to saroglitazar administration. Methods: A total of 54 diabetic dyslipidemia patients who are not controlled i.e., triglycerides (TG)>200 mg/dl with moderate intensity of atorvastatin (≥10 mg) were recruited to the study. All the patients were given saroglitazar 4 mg once daily for 12 weeks. PPARα single nucleotide polymorphisms (SNPs) rs1800206, rs4253778, rs135542 and those of PPARγ gene rs3856806, rs10865710, rs1805192 were genotyped by real-time PCR. Results: 54 patients (67% female) with a mean age of 48.01±6.73 years were given saroglitazar 4 mg once daily for 12 weeks. There was a significant decrease in TG (36.9%) from baseline of 292.33±83.81mg/dl (mean±SD) to 184.46±95.90 mg/dl (<0.001) and in HbA1c (0.66%) from baseline of 8.5% to 7.8% (<0.001). PPAR α and PPAR γ gene variants did not show any association with TG lowering response. Conclusions: Saroglitazar 4mg once daily effectively decreases the TG, non-HDL-C levels, and HbA1c with no major adverse events, and TG lowering response is not associated with the studied polymorphisms.

Response: Cut-off Values and Clinical Utility of Surrogate Markers for Insulin Resistance and Beta-Cell Function to Identify Metabolic Syndrome and Its Components among Southern Indian Adults (J Obes Metab Syndr 2020;29:281-91)

Insulin resistance (IR) is a defining feature of obesity, type 2 diabetes mellitus, and cardiovascular diseases and a major contributing factor in metabolic syndrome (MetS).1,2 Although researchers have made tremendous progress in understanding IR, certain elements remain unclear, especially diagnosis.3 Various types of tests are available for quantitative estimation of IR, ranging from complicated, invasive, time-consuming procedures to simple blood tests using fasting samples.4 The hyperinsulinemic-euglycemic glucose clamp is the gold standard method for determining IR but is impractical as it is both labor- and time-intensive.5 This issue has led to development of relatively simple markers for IR. In this study, we explored a variety of surrogate indices which have been currently available for estimating IR, insulin secretion, insulin sensitivity, and beta-cell function in a simplified and improved manner. We also investigated their clinical utility in and cutoff values for identifying MetS and its components. A deeper knowledge of these markers will help us better understand and manage this condition

Role of Chemerin as a Putative Biomarker of Cardiovascular Risk in Metabolic Syndrome: A Brief Review

ABSTRACT Cardiovascular disease (CVD) is one of the major alarming causes of morbidity and mortality with widespread prevalence around the world. The major risk factor for cardiovascular disease is metabolic syndrome (MetS) and is most prevalent among obesity-related comorbidities. The main causative factors linking metabolic syndrome and cardiovascular disease are assumed to involve the expansion of adipose tissue and chronic inflammation. In addition to storing surplus fat, adipose tissue also produces adipokines which act through autocrine, paracrine and endocrine functions in the body. Increasing evidence suggests that the altered secretion of adipokines may play a role in the pathogenesis of metabolic syndrome but the mechanisms underlying are not fully known. To date, only leptin and adiponectin are the best-studied adipokines among the variety of adipokines secreted by adipose tissue. However, recent studies have implicated the novel adipokine chemerin as a regulator of adipogenesis, inflammation and glucose metabolism which demonstrates its multifaceted actions. Furthermore, they also found that elevated circulating levels of chemerin in metabolic syndrome acts as a significant risk factor for cardiovascular disease. Chemerin has gained considerable interest due to its role as a pro- or anti-inflammatory mediator is still controversial and the effect of chemerin on glucose metabolism is a matter of debate. Thus, the purpose of this review is to focus primarily on chemerin expression, processing, signaling of receptors, biological actions and pathophysiological implications and the role of chemerin as a biomarker of cardiovascular disease in metabolic syndrome

Cut-off Values and Clinical Utility of Surrogate Markers for Insulin Resistance and Beta-Cell Function to Identify Metabolic Syndrome and Its Components among Southern Indian Adults

Background: Insulin resistance (IR) is a collective clinical entity that exacerbates metabolic syndrome (MetS). As the gold-standard test to quantify IR involves intravenous insulin loading and repeated blood glucose monitoring, many indices have been developed for IR assessment for convenience. This study tested the ideal cut-off values and clinical utility of IR indices in identifying MetS. Methods:We recruited 150 subjects, 75 MetS patients and 75 healthy controls, then obtained written informed consent to participate in this study. We collected fasting blood samples for glucose and lipid profiles and calculated nineteen indices of IR and insulin secretion using validated formulae. We determined the precision of these IR indices using the area under the curve (AUC) in a receiver operating characteristic analysis. Results: Subjects with MetS have significantly higher IR coupled with lower insulin sensitivity and beta-cell function than controls. Among the surrogate markers of IR tested, the homeostatic model assessment of insulin resistance (HOMA-IR), HOMA-adiponectin (HOMA-AD), triglyceride-glucose (TyG) index, HOMA-1%S (insulin sensitivity), quantitative insulin sensitivity check index (QUICKI), McAuley index, single-point insulin sensitivity estimator (SPISE), and HOMA-2%B (beta-cell function) showed the highest AUC values for detecting MetS. Conclusion: Our study results suggest that the ideal cut-off and AUC values identified for HOMA-IR, HOMA-AD, the TyG index, HOMA-1%S, QUICKI, the McAuley index, SPISE, and HOMA-2%B offer a clinical approach to the early detection and risk stratification for MetS among people in southern India

Association between metabolic syndrome components and cardiac autonomic modulation in southern Indian adults with pre-metabolic syndrome: hyperglycemia is the major contributing factor

Metabolic syndrome (MetS) involves multi-factorial conditions linked to an elevated risk of type 2 diabetes mellitus and cardiovascular disease. Pre-metabolic syndrome (pre-MetS) possesses two MetS components but does not meet the MetS diagnostic criteria. Although cardiac autonomic derangements are evident in MetS, there is little information on their status in pre-MetS subjects. In this study, we sought to examine cardiac autonomic functions in pre-MetS and to determine which MetS component is more responsible for impaired cardiac autonomic functions. A total of 182 subjects were recruited and divided into healthy controls (n=89) and pre-MetS subjects (n=93) based on inclusion and exclusion criteria. We performed biochemical profiles on fasting blood samples to detect pre-MetS. Using standardized protocols, we evaluated anthropometric data, body composition, baroreflex sensitivity (BRS), heart rate variability (HRV), and autonomic function tests (AFTs). We further examined these parameters in pre-MetS subjects for each MetS component. Compared to healthy controls, we observed a significant cardiac autonomic dysfunction (CAD) through reduced BRS, lower overall HRV, and altered AFT parameters in pre-MetS subjects, accompanied by markedly varied anthropometric, clinical and biochemical parameters. Furthermore, all examined BRS, HRV, and AFT parameters exhibited an abnormal trend and significant correlation toward hyperglycemia. This study demonstrates CAD in pre-MetS subjects with reduced BRS, lower overall HRV, and altered AFT parameters. Hyperglycemia was considered an independent determinant of alterations in all the examined BRS, HRV, and AFT parameters. Thus, hyperglycemia may contribute to CAD in pre-MetS subjects before progressing to MetS

Hypophosphatemic osteomalacia due to cadmium toxicity in silverware industry: A curious case of aches and pains

Hypophosphatemic osteomalacia in an adult often gives clinical diagnostic challenges. Usually, they are caused by either tumor-induced osteomalacia or due to genetically mediated hypophosphatemia, particularly X-linked hypophosphatemia. However, heavy metal toxicity, leading to global proximal renal tubular dysfunction, is a rare cause, and in particular, cadmium toxicity is rarely encountered in clinical practice. The presence of bony pain and neurological deficit, along with a classical exposure history, provides the diagnostic clue. In this background, here we present a middle-aged man who had severe bony pains all over his body and lower back stiffness for five years. He underwent an initial workup as a suspected spondyloarthropathy but was later on, found to have hypophosphatemic osteomalacia and severe proximal renal tubular dysfunction. Further, the workup revealed elevated FGF-23. His occupational history revealed prolonged exposure to cadmium fumes in the silverware industry. He improved moderately with treatment; however, significant renal damage is still present. This case highlights the importance of considering cadmium toxicity in proper clinical and occupational contexts in the evaluation of hypophosphatemic osteomalacia in an adult