Ni-Catalyzed Regioselective C-5 Halogenation of 8-Aminoquinoline and Co-Catalyzed Chelation Assisted C-H Iodination of Aromatic Sulfonamides with Molecular Iodine

A Ni(II)- and Co(II)-catalyzed sequential iodination of sulfonamides using inexpensive and milder molecular iodine (I2) as an iodinating reagent is reported for the first time. The 8-amino-5-iodoquinoline moiety prepared via nickel catalysis act as a directing group for second iodination by chelation assisted cobalt catalysis resulting in ortho-iodinated arylsulfonamide products. This methodology has been elaborated to various value added products by coupling reactions.

To Study the Long Term Outcome of Endoscopic Septoplasty with Microdebrider Assisted Inferior Turbinoplasty (MAIT) Versus Medial Flap Turbinoplasty (MFT)

To study the long term outcome of endoscopic septoplasty with microdebrider assisted inferior turbinoplasty (MAIT) versus medial flap turbinoplasty (MFT). The present study was conducted in the Department of ENT, Government Medical College, Amritsar. Patients with symptomatic persistent nasal obstruction were recruited from ENT outdoor clinics. The nasal obstruction was persistent despite medical therapy that included a minimum 4 weeks. The study was primarily a double blinded prospective randomized control study including 120 patients, where all patients enrolled at odd numbers were taken for endoscopic septoplasty with microdebrider assisted inferior turbinoplasty and all patients with even numbers were taken for endoscopic septoplasty with MFT. Patient-scored nasal obstruction (1-5) along with blindly assessed nasal airway patency ratings (1-4) was done at 3 and 24 months postoperatively. A total of 120 patients were recruited in the study. The mean ages of the MAIT and MFT groups were 28.61 ± 14.8 and 30.25 ± 8.36 years, respectively. Average follow-up period was 21.9 ± 6.3 months. Nasal obstruction was improved in both techniques at 3 months, but after long term follow up, it was highly significant for MFT along with improvement in preoperative symptoms p < 0.001. No patients complained of worsening of their obstruction. Nasal patency at 24 months, a significant proportion of patients had a greater nasal assessment by a blind assessor with 97.1% in MFT and 81.9% MAIT with mild to no obstruction. In MAIT group 16.6% had pain/discomfort, 23.6% had discharge which were the major complications, but crusting (MAIT 10% and MFT 3.3%), adhesions (MAIT 13.8% and MFT 1.6%). The medial flap inferior turbinoplasty (MFT) is technically straight forward procedure that provides long term more effective and satisfactory the patient in relieving nasal obstruction, without significant risk of complications. The long term follow up of MAIT is required as there was increase in need of decongestion and they might require second procedure as MFT.

The relationship of life-course patterns of adiposity with type 2 diabetes, depression, and their comorbidity in the Northern Finland Birth Cohort 1966

OBJECTIVES

Type 2 diabetes (T2D) and comorbid depression challenges clinical management particularly in individuals with overweight. We aim to explore the shared etiology, via lifecourse adiposity, between T2D and depression.

METHODS

We used data from birth until 46years from Northern Finland Birth Cohort 1966 (n = 6,372; 53.8% females). We conducted multivariate analyses on three outcomes: T2D (4.2%), depression (19.2%) and as comorbidity (1.8%). We conducted (i) Path analysis to clarify time-dependent body mass index (BMI) related pathways, including BMI polygenic risk scores (PRS); and (ii) Cox regression models to assess whether reduction of overweight between 7years and 31years influence T2D, depression and/or comorbidity. The models were tested for covariation with sex, education, smoking, physical activity, and diet score.

RESULTS

The odd ratios (OR) of T2D in individuals with depression was 1.68 [95% confidence interval (CI): 1.34-2.11], and no change in estimate was observed when adjusted for covariates. T2D and comorbidity showed similar patterns of relationships in the path analyses (P < 0.001). The genetic risk for obesity (PRS BMI) did not show direct effect on T2D or comorbidity in adulthood but indirectly through measures of adiposity in early childhood and mid-adulthood in the path analysis (P < 0.001). Having early-onset of overweight at 7years and 31years showed highest risk of T2D (OR 3.8, 95%CI 2.4-6.1) and comorbidity (OR 5.0, 95%CI 2.7-9.5), with mild-to-moderate attenuation with adjustments. Depression showed no significant associations.

CONCLUSIONS

We found evidence for overweight since childhood as a risk factor for T2D and co-morbidity between T2D and depression, influenced moderately by lifestyle factors in later life. However, no shared early life adiposity related risk factors were observed between T2D and depression when assessed independently in this Finnish setting.

Generation of post-meal insulin correction boluses in type 1 diabetes simulation models for in-silico clinical trials: More realistic scenarios obtained using a decision tree approach

BACKGROUND AND OBJECTIVE

In type 1 diabetes (T1D) research, in-silico clinical trials (ISCTs) notably facilitate the design/testing of new therapies. Published simulation tools embed mathematical models of blood glucose (BG) and insulin dynamics, continuous glucose monitoring (CGM) sensors, and insulin treatments, but lack a realistic description of some aspects of patient lifestyle impacting on glucose control. Specifically, to effectively simulate insulin correction boluses, required to treat post-meal hyperglycemia (BG > 180 mg/dL), the timing of the bolus may be influenced by subjects' behavioral attitudes. In this work, we develop an easily interpretable model of the variability of correction bolus timing observed in real data, and embed it into a popular simulation tool for ISCTs.

METHODS

Using data collected in 196 adults with T1D monitored in free-living conditions, we trained a decision tree (DT) model to classify whether a correction bolus is injected in a future time window, based on predictors collected back in time, related to CGM data, previous insulin boluses and subject's characteristics. The performance was compared to that of a logistic regression classifier with LASSO regularization (LC), trained on the same dataset. After validation, the DT was embedded within a popular T1D simulation tool and an ISCT was performed to compare the simulated correction boluses against those observed in a subset of data not used for model training.

RESULTS

The DT provided better classification performance (accuracy: 0.792, sensitivity: 0.430, specificity: 0.878, precision: 0.455) than the LC and presented good interpretability. The most predictive features were related to CGM (and its temporal variations), time since the last insulin bolus, and time of the day. The correction boluses simulated by the DT, after implementation in the simulation tool, showed a good agreement with real-world data.

CONCLUSIONS

The DT developed in this work represents a simple set of rules to mimic the same timing of correction boluses observed on real data. The inclusion of the model in simulation tools allows investigators to perform ISCTs that more realistically represent the patient behavior in taking correction boluses and the post-prandial BG response. In the future, more complex models can be investigated.

Delivering evidence-based interventions for type 1 diabetes in the virtual world - A review of UK practice during the SARS-CoV-2 pandemic

AIMS

This review considers the impact of the SARS-CoV-2 pandemic on access to interventions for those living with type 1 diabetes and discusses the solutions which have been considered and actioned to ensure ongoing access care.

METHODS

We performed a focussed review of the published literature, and the guidelines for changes that have been effected during the pandemic. We also drew from expert recommendations and information about local practice changes for areas where formal data have not been published.

RESULTS

Evidence based interventions which support the achievement of improved glucose levels and/or reduction in hypoglycaemia include group structured education to support self-management, insulin pump therapy and continuous glucose monitoring. The SARS-CoV-2 pandemic had impacted the ability of diabetes services to deliver these intervention. Multiple adaptations have been put in place - transition to online delivery of education and care, and usage of diabetes technology.

CONCLUSIONS

Although various adaptations have been made during the pandemic that have positively influenced uptake of services, there are many areas of delivery that need immediate improvement in the UK. We recommend a proactive approach in recognising the digital divide and inequity in distribution of these changes and we recommend introducing measures to reduce them.

Recent Advances in Plasmonic Photocatalysis Based on TiO2 and Noble Metal Nanoparticles for Energy Conversion, Environmental Remediation, and Organic Synthesis

Plasmonic photocatalysis has emerged as a prominent and growing field. It enables the efficient use of sunlight as an abundant and renewable energy source to drive a myriad of chemical reactions. For instance, plasmonic photocatalysis in materials comprising TiO₂ and plasmonic nanoparticles (NPs) enables effective charge carrier separation and the tuning of optical response to longer wavelength regions (visible and near infrared). In fact, TiO₂ -based materials and plasmonic effects are at the forefront of heterogeneous photocatalysis, having applications in energy conversion, production of liquid fuels, wastewater treatment, nitrogen fixation, and organic synthesis. This review aims to comprehensively summarize the fundamentals and to provide the guidelines for future work in the field of TiO₂ -based plasmonic photocatalysis comprising the above-mentioned applications. The concepts and state-of-the-art description of important parameters including the formation of Schottky junctions, hot electron generation and transfer, near field electromagnetic enhancement, plasmon resonance energy transfer, scattering, and photothermal heating effects have been covered in this review. Synthetic approaches and the effect of various physicochemical parameters in plasmon-mediated TiO₂ -based materials on performances are discussed. It is envisioned that this review may inspire and provide insights into the rational development of the next generation of TiO₂ -based plasmonic photocatalysts with target performances and enhanced selectivities.

Association of Serum Leptin with Anthropometric Indices of Obesity, Blood Lipids, Steroidal Hormones, and Insulin Resistance in Polycystic Ovarian Syndrome

Background:

Polycystic ovarian syndrome (PCOS) is a major form of anovulatory infertility in women. It is often associated with obesity and insulin resistance (IR), both of which are linked to leptin and its receptors.

Aim:

The aim of this study was to evaluate the interrelationship between serum leptin level with anthropometric indices of obesity, lipid profile, IR, and with circulating steroidal hormones in PCOS women.

Settings and Design:

An observational case–control study was conducted in a medical college and hospital setting.

Methods:

Ninety diagnosed cases of PCOS along with ninety age-matched normal women were enrolled. Serum insulin, lipid profile, steroidal hormones, and serum leptin were estimated. IR was calculated using the Homeostatic Model Assessment-IR. Anthropometric measurements were also taken of each study participant.

Statistical Analysis:

Descriptive statistics along with independent sample t-test and Pearson (r) correlation coefficients were used.

Results:

Women with PCOS had high mean value of waist circumference (P = 0.00), hip circumference (P = 0.00), and hormonal levels than the control group (luteinizing hormone [LH] [P = 0.00], testosterone [P = 0.00], LH/follicle-stimulating hormone ratio [P = 0.00], leptin [P = 0.00], and IR [P = 0.00]). Serum insulin levels (P = 0.02), IR (P = 0.01), body mass index (BMI) (P = 0.03), and fasting blood sugar (P = 0.01) had a positive correlation with leptin. Insulin (P = 0.01), IR (P = 0.02), fasting blood sugar (P = 0.001), and leptin (P = 0.00) were more in the obese control group.

Conclusion:

Serum leptin level is raised in PCOS patients, and it is correlated positively with BMI, fasting blood sugar, insulin metabolism, and IR.

A Mathematical Formula to Determine the Minimum Continuous Glucose Monitoring Duration to Assess Time-in-ranges: Sensitivity Analysis Over the Parameters

In diabetes management, the fraction of time spent with glucose concentration within the physiological range of [70-180] mg/dL, namely time in range (TIR) is often computed by clinicians to assess glycemic control using a continuous glucose monitoring sensor. However, a sufficiently long monitoring period is required to reliably estimate this index. A mathematical equation derived by our group provides the minimum trial duration granting a desired uncertainty around the estimated TIR. The equation involves two parameters, p_r and α, related to the population under analysis, which should be set based on the clinician's experience. In this work, we evaluated the sensitivity of the formula to the parameters.Considering two independent datasets, we predicted the uncertainty of TIR estimate for a population, using the parameters of the formula estimated for a different population. We also stressed the robustness of the formula by testing wider ranges of parameters, thus assessing the impact of large errors in the parameters' estimates.Plausible errors on the α estimate impact very slightly on the prediction (relative discrepancy < 5%), thus we suggest using a fixed value for α independently on the population being analyzed. Instead, p_r should be adjusted to the TIR expected in the population, considering that errors around 20% result in a relative discrepancy of ~10%.In conclusion, the proposed formula is sufficiently robust to parameters setting and can be used by investigators to determine a suitable duration of the study.

Intrauterine immunizations trigger antigen-specific mucosal and systemic immunity in pigs and passive protection in suckling piglets

We assessed whether vaccines administered to the uterus at breeding can lead to sufficient colostral antibodies to protect suckling piglets against Porcine Endemic Diarrhea Virus (PEDV). An antigen from Lawsonia intracellularis, a disease that impacts weanling intestinal health, was also included because we have extensive knowledge on the pig immune response to this antigen. Gilts were mock-bred at 2nd estrus with killed sperm including an intrauterine (i.u.) vaccine comprised of recombinant (r) PEDV Spike protein (rPEDVS1) and L. intracellularis flagellin (rFliC) formulated with poly I:C, host defense peptide, and polyphosphazene (TriAdj). Gilts returned to estrus within 3 weeks and they were inseminated with killed sperm (3rd estrus) or live sperm (4th estrus) with rPEDVS1-TriAdj vaccine. They also received an i.m. injection of rFliC-TriAdj at 3rd and 4th estrus to establish whether i.u. vaccination primes systemic immunity without inducing mucosal tolerance. Control gilts were administered semen alone at 2nd estrus which allowed us to compare litter weights and sizes to industry standards. Colostrum from gilts challenged with low dose PEDV plus alum was used as positive reference samples for neutralizing antibodies and passive protection. Thirteen weeks later, the i.u.-vaccinated gilts showed significant PEDVS1-specific serum, colostral, and uterine antibody titers and colostral PEDVS1-neutralizing antibodies but poor cell-mediated immunity. Piglets born to i.u. vaccinated gilts received partial passive protection from PEDV infection 3 days after birth but eventually succumbed to the disease. Immunization by the i.u./i.m. route triggered significant anti-FliC cell-mediated immunity and colostral FliC antibodies that remained high in weaned piglet serum. This trial and a repeat trial wherein gilts were immunized at 1st estrus without semen and at 2nd estrus with live semen showed that intrauterine immunization did not impact fertility, number of live births or piglet growth kinetics. Further optimization is needed to promote robust passive protection in suckling offspring.

The transCampus Metabolic Training Programme Explores the Link of SARS-CoV-2 Virus to Metabolic Disease

Currently, we are experiencing a true pandemic of a communicable disease by the virus SARS-CoV-2 holding the whole world firmly in its grasp. Amazingly and unfortunately, this virus uses a metabolic and endocrine pathway via ACE2 to enter our cells causing damage and disease. Our international research training programme funded by the German Research Foundation has a clear mission to train the best students wherever they may come from to learn to tackle the enormous challenges of diabetes and its complications for our society. A modern training programme in diabetes and metabolism does not only involve a thorough understanding of classical physiology, biology and clinical diabetology but has to bring together an interdisciplinary team. With the arrival of the coronavirus pandemic, this prestigious and unique metabolic training programme is facing new challenges but also new opportunities. The consortium of the training programme has recognized early on the need for a guidance and for practical recommendations to cope with the COVID-19 pandemic for the community of patients with metabolic disease, obesity and diabetes. This involves the optimal management from surgical obesity programmes to medications and insulin replacement. We also established a global registry analyzing the dimension and role of metabolic disease including new onset diabetes potentially triggered by the virus. We have involved experts of infectious disease and virology to our faculty with this metabolic training programme to offer the full breadth and scope of expertise needed to meet these scientific challenges. We have all learned that this pandemic does not respect or heed any national borders and that we have to work together as a global community. We believe that this transCampus metabolic training programme provides a prime example how an international team of established experts in the field of metabolism can work together with students from all over the world to address a new pandemic.

Comparative morphometrical studies on the skull bones of barking deer (Muntiacus muntjak) and sambar deer (Rusa unicolor)

The present study reports data on the skull bone morphometry of barking and sambar deer. The skulls of adult barking deer (n = 6) and sambar deer (n = 6) of either sex (n = 3 males and n = 3 females) were collected from the Aizawl Zoological Park, Aizawl, Mizoram, India, with official permission from the Government of Mizoram. Anatomically, barking and sambar deer's skulls were elongated, pyramid-like, dolichocephalic and consisted of thirty-two cranial and facial bones. The cranial bones were eleven (three single and four paired), comprising of occipital, sphenoid, ethmoid, frontal, interparietal, parietal and temporal. The facial bones were twenty-one (one single and ten were paired), consisting of the maxilla, premaxilla (incisive), palatine, pterygoid, nasal, lacrimal, zygomatic (malar), vomer, turbinates, mandible and hyoid. In the present study, altogether 41 different measurements were taken morphologically and 6 different indices were applied. The obtained morphometrical parameters were significantly (p < .01, p < .05) higher in males than females of both species. Species wise, all obtained parameters were higher in sambar deer than barking deer. The obtained 41 different skull parameters and 6 indices showed statistically significant differences (p < .01 and p < .05) between both sexes of barking and sambar deer; however, practically these differences were meagre. The present morphometrical study on the skull of both species can help the wildlife professionals and zoo veterinarians determine the sex of these animals and differentiate it from other domestic and wild small ruminants for solving veterolegal cases. This study's findings will also motivate and assist other comparative studies with various domestic and wild small ruminants.

Time in range: A best practice guide for UK diabetes healthcare professionals in the context of the COVID-19 global pandemic

The emergence of continuous glucose monitoring has driven improvements in glycaemic control and quality of life for people with diabetes. Recent changes in access to continuous glucose monitoring systems within UK health services have increased the number of people able to benefit from these technologies. The COVID-19 pandemic has created an opportunity for diabetes healthcare professionals to use continuous glucose monitoring technology to remotely deliver diabetes services to support people with diabetes. This opportunity can be maximized with improved application and interpretation of continuous glucose monitoring-generated data. Amongst the diverse measures of glycaemic control, time in range is considered to be of high value in routine clinical care because it is actionable and is visibly responsive to changes in diabetes management. Importantly, it is also been linked to the risk of developing complications associated with diabetes and can be understood by people with diabetes and healthcare professionals alike. The 2019 International Consensus on Time in Range has established a series of target glucose ranges and recommendations for time spent within these ranges that is consistent with optimal glycaemic control. The recommendations cover people with type 1 or type 2 diabetes, with separate targets indicated for elderly people or those at higher risk from hypoglycaemia, as well as for women with type 1 diabetes during pregnancy. The aim of this best practice guide was to clarify the intent and purpose of these international consensus recommendations and to provide practical insights into their implementation in UK diabetes care.

Distal technology interventions in people with diabetes: an umbrella review of multiple health outcomes

AIM

To summarize and evaluate the existing evidence on the effectiveness of distal technology with regard to multiple health outcomes in people with diabetes.

METHODS

We searched PubMed, EMBASE and the Cochrane Database of Systematic Reviews from database inception to 31 August 2018 for systematic reviews and/or meta-analyses of studies that examined the impact of distal technology and reported any clinical or patient-related outcomes among people with type 1 or type 2 diabetes.

RESULTS

The umbrella review identified 95 reviews, including 162 meta-analyses with 46 unique outcomes. Evidence from meta-analyses of randomized controlled studies supports the use of distal technology, especially telehealth and mHealth (healthcare delivered by mobile technology), in people with diabetes for improving HbA_1c values by 2-4 mmol/mol (0.2-0.4%). For other health outcomes, such as changes in fasting plasma glucose levels, risk of diabetic ketoacidosis or frequency of severe hypoglycaemia, the evidence was weaker. No evidence was reported for most patient-reported outcomes including quality of life, self-efficacy and medication-taking. The evidence base was poor, with most studies rated as low to very low quality.

CONCLUSION

Distal technologies were associated with a modest improvement in glycaemic control, but it was unclear if they improved major clinical outcomes or were cost-effective in people with diabetes. More robust research to improve wider outcomes in people with diabetes is needed before such technologies can be recommended as part of routine care for any patient group.

Do-it-yourself closed-loop systems for people living with type 1 diabetes

Growing numbers of people with type 1 diabetes are using do-it-yourself closed-loop systems. While these technologies are not approved by regulatory bodies and are not commercially available, users of the technology report improvements in HbA_1c and time in range, and reduced burden of diabetes. Healthcare professionals have expressed their concern that legal or regulatory body actions could ensue if they support people who choose to use do-it-yourself closed-loop systems. Diabetes UK's position statements make recommendations that aim to provide guidance for both people with diabetes and healthcare professionals, based on the current professional and legal situation. They respect an individual's right to make their own informed decisions about their diabetes management, and recommend that they should have access to the technology they need for optimal diabetes management. People who wish to use do-it-yourself closed-loop systems should continue to receive support and care from their diabetes team. Healthcare professionals should engage in conversations around do-it-yourself closed-loop systems, if the issue is raised, to allow a balanced discussion of risks and benefits. However, healthcare professionals cannot recommend the use of do-it-yourself closed-loop systems because of a lack of regulatory body approval and robust, published research to support safety or effectiveness. People using this technology should be aware that they do so at their own risk. This position statement recognizes that the development of diabetes technology is a rapidly changing environment, and guidance around do-it-yourself systems is required from professional and regulatory bodies.

Prevalence of Menopausal Symptoms and its Effect on Quality of Life among Rural Middle Aged Women (40-60 Years) of Haryana, India

Background

Demographic and epidemiological transitions have increased the life expectancy of middle aged women, resulting in higher burden of morbidities related to menopausal symptoms and also effect the quality of life (QOL).

Objectives

To study the prevalence of menopausal symptoms and its effect on QOL among rural middle aged women (40-60 years) of Haryana, India.

Materials and Methods

A community based cross-sectional study was conducted in 400 middle aged women (40-60 years) from April 2018 to March 2019 by random sampling technique. The menopause rating scale was used to assess the prevalence of menopausal symptoms and the QOL and data were collected for sociodemographic factors, relevant menstrual history and other variables.

Results

Prevalence of menopausal symptoms was found to be 87.7%. Majority of the study subjects had anxiety (80%), followed by physical and mental exhaustion (71.5%), sleep problem (61.2%), irritability (60.7%), Joint and muscular discomfort (56%) and heart problems (54%). The most classical symptom of menopause i.e., hot flushes were reported in 36.7%. The mean age of menopause was 47.53 standard deviation 4.5 years. Statistical significant difference was seen for the mean score of few symptoms i.e., hot flushes, sweating (P < 0.003) and joint and muscular discomfort (P < 0.014) between post and peri-menopausal groups. The QOL was impaired in 70.2% of study subjects. The psychological symptoms attributed 70.8% to the poor QOL.

Conclusion

To improve the QOL and to decrease the menopausal symptoms in these women, a holistic approach in the form of lifestyle and behavioral modification are required.