Introduction of a national program for HbA1c testing in Guyana South America and initial results

Diabetes is an increasing challenge for low- and middle-income countries (LMIC) and access to HbA1c testing is limited. HbA1c, a measure of glycaemic control averaged over 3 months, provides both clinicians and policymakers with a tool to identify the risk of long-term diabetes comorbidity. We describe the steps used to implement standardised testing in Guyana South America and the initial results according to a locally developed protocol as part of a country-wide project to improve the care of people with all forms of diabetes The steps identified include: a standardised method traceable to a recognized international reference standard, participation in a quality control cycle with an international reference laboratory, a clinical pathway for testing to reduce inappropriate use and minimize resource wastage, training of technicians in operation and maintenance of equipment, identification of a suitable space with constant power supply, a reliable procurement system, education of healthcare professionals on interpretation and follow-up of results and feedback of programme results to improve clinical practice. Some steps for implementation of the national HbA1c testing program were initiated better than others. Initial unreliability of the service undermined confidence in the system. Failure to follow the testing protocol led to some patients being tested too soon and others too late. Cost of reagents was about 5.60 USD/test. We trained 340 people in diabetes care and knowledge was improved but were unable to assess whether it was appropriately applied. Over one third of people tested in the 30-70 age group had an HbA1c over 9% (75 mmol/mol) and this did not improve over the 5 years of testing. Despite the difficulties we think our unique experience of implementation of a nationwide HbA1c testing programme has important lessons for other LMICs.

Association of body mass index and upper arm body composition with depressive symptoms in old age home and family based elderly

The following study was designed to find out the association of the mid-upper arm body composition and body mass index (BMI) with depressive symptoms among the old age home based (group 1) and family based elderly (group 2) subjects. In group 1 elderly males, 51.5% were showing mild depressive symptoms and 17% were showing moderate to severe depressive symptoms. On the other hand, among group 2 elderly males, prevalence of mild depressive symptoms was in 27% and moderate to severe depressive symptoms was in 4.5% of the subjects. Among elderly with and without depressive symptoms, BMI, waist-hip ratio (WHR), arm muscle circumference (AMC), arm muscle area (AMA), arm fat area (AFA), fat mass (FM), muscle mass and bone mass were significantly (p < 0.01) lesser among group 1 as compared to group 2. Among group 1, the AFA (R² change = 0.178), AMC (R² change = 0.035), AMA (R² change = 0.032), FM (R² change = 0.022) and muscle mass (R² change = 0.019) have highest contribution to the variance of depressive symptoms. On the other hand, BMI (R² change = 0.04) and WHR (R² change = 0.03) had the highest, though small, contribution to the variance of depressive symptoms among group 2. The upper arm body composition indices were better indicator of depressive symptoms in group 1, and BMI and WHR were better indicators of depressive symptoms in group 2. Therefore, among group 1 subjects, the upper arm body composition indices prove to be better regular health monitoring indices as compared to traditionally used BMI and WHR.

Review on titanium and titanium based alloys as biomaterials for orthopaedic applications

Variety of implant materials have been employed in various disciplines of medical science depending on the requirement of a particular application. Metals, alloys, ceramics, and polymers are the commonly used biomaterials. The main focus of this study is to review the various structural and microstructural properties of titanium and titanium based alloys used as orthopaedic implants. Orthopaedic implants need to possess certain important qualities to ensure their safe and effective use. These properties like the biocompatibility, relevant mechanical properties, high corrosion and wear resistance and osseointegration are summarized in this review. Various attempts to improve upon these properties like different processing routes, surface modifications have also been inculcated in the paper to provide an insight into the extent of research and effort that has been put into developing a highly superior titanium orthopaedic implant.

A field study of a roof bolter canopy air curtain (2nd generation) for respirable coal mine dust control

A 2nd generation roof bolter canopy air curtain (CAC) design was tested by National Institute for Occupational Safety and Health (NIOSH) at a Midwestern underground coal mine. During the study, the roof bolter never operated downwind of the continuous miner. Using a combination of personal Data Rams (pDR) and gravimetric samplers, the dust control efficiency of the roof bolter CAC was ascertained. Performance evaluation was determined using three methods: (1) comparing roof bolter operator concentrations underneath the CAC to roof bolter concentrations outside the CAC, (2) comparing roof bolter operator concentrations underneath the CAC to the concentrations at the rear of the bolter, and finally, (3) using the gravimetric data directly underneath the CAC to correct roof bolter operator concentrations underneath the CAC and comparing them to the concentrations at the rear of the bolter. Method 1 dust control efficiencies ranged from -53.9% to 60.4%. Method 2 efficiencies ranged from -150.5% to 52.2%, and Method 3 efficiencies ranged from 40.7% to 91%. Reasons for negative and low dust control efficiencies are provided in this paper and include: incorrect sampling locations, large distance between CAC and operator, and contamination of intake air from line curtain. Low dust concentrations encountered during the testing made it difficult to discern whether differences in concentrations were due to the CAC or due to variances inherent in experimental dust measurement. However, the analyses, especially the Method 3 analysis, show that the CAC can be an effective dust control device.

Field investigation to measure airflow velocities of a ram dump car using circular routing at a Midwestern underground coal mine: a case study

Due to the successful application of roof bolter canopy air curtains (CACs) to protect roof bolter operators from high levels of coal mine respirable dust, a shuttle car CAC is currently being developed. Since a shuttle car consistently trams from the continuous miner to the feeder and back at a speed up to 9.66 kph (6 mph) or 2.68 m/s (528 fpm), it is thought that the shuttle car may encounter very high air velocities (mine ventilation air velocity + max shuttle speed (2.68 m/s (528 fpm)). Past research and preliminary lab testing showed that CAC protection in high interference air velocities is difficult to achieve. Therefore, testing was conducted at a Midwestern US coal mine to determine the air velocities their shuttle car actually encounters. This mine used ram dump cars as their shuttle cars. Results showed that coal mine dust exposure is generally very low at the feeder and when tramming. Elevated concentrations are encountered at the ram dump car operator position when the car is being loaded by the continuous miner. Recorded air velocities while tramming did not reach the max air velocity of mine ventilation air velocity + 2.68 m/s (528 fpm) calculated as 3.32 m/s (653 fpm). High velocities, while encountered, were of low frequency and associated with low respirable coal mine dust concentrations. Therefore, using this new information, designing the shuttle car CAC for maximum interference air velocity may not be as important as previously thought.

Ytterbium-Doped ZnO Flowers Based Phenyl Hydrazine Chemical Sensor

Herein, we report the fabrication and characterization of phenyl hydrazine sensor based on ytterbium (Yb) doped ZnO flowers composed of nanorods prepared by simple hydrothermal process. The as-synthesized nanomaterial was characterized by X-ray diffraction (XRD), field emission scanning electron microscopy (FESEM) attached with energy dispersive spectroscopy (EDS), Fourier transformation infrared (FTIR) and Raman-scattering spectroscopy which revealed the large-quantity synthesis, well-crystallinity and wurtzite hexagonal crystal structure of Yb-doped ZnO flowers. The fabricated phenyl hydrazine chemical sensor, by employing Yb-doped ZnO flowers as an electron mediator, exhibited sensitivity of ∼34.2 µA·mM^-1 ·cm^-2, detection limit of 24 mM and linear dynamic range of 0.25-4.0 mM. The presented work demonstrates that the Yb-doped ZnO nanomaterials are promising electron mediator which can be used for the fabrication of chemical sensors to detect various hazardous and toxic chemicals as phenyl hydrazine.

Giant Warthin's Tumour of the Parotid Gland: A Rare Case Report

Warthin's tumour was first adequately described in 1929 by an American pathologist, Aldred Scott Warthin. It is synonymous with papillary cystadenoma lymphomatosum (PCL), cystadenolymphoma or adenolymphoma. Giant salivary gland tumours are usually pleomorphic adenomas. The average size of Warthin's tumour is reported to be about 2-4 cm. In the current fascinating case, an enormous disfiguring salivary gland tumour was reported which turned out to be Warthin's tumour on histopathology, which is probably the largest PCL reported till date.

Highly Sensitive Picric Acid Chemical Sensor Based on Samarium (Sm) Doped ZnO Nanorods

Herein, we report the synthesis, characterization and picric acid chemical sensing application of samarium (Sm) doped ZnO nanorods. The Sm-doped ZnO nanorods were synthesized by facile hydrothermal process and characterized using various analytical methods which confirmed the large-scale synthesis and wurtzite hexagonal crystal structure for the synthesized nanorods. The doping of Sm ions in the lattices of the synthesized nanorods was evaluated by the energy dispersive X-ray spectroscopy (EDS). The synthesized Sm-doped ZnO nanorods were used as potential scaffold to fabricate high sensitive and reproducible picric acid chemical sensor based on I-V technique. The fabricated picric acid chemical sensor based on Sm-doped ZnO nanorods exhibited a high sensitivity of 213.9 mA mM^-1 cm^-2 with the limit of detection of ∼0.228 mM and correlation coefficient of R═0.9889. The obtained results revealed that the facile grown Sm-doped ZnO nanorods can efficiently be used to fabricate high sensitive and reproducible chemical sensors.

Graphitic carbon nitride QDs impregnated biocompatible agarose cartridge for removal of heavy metals from contaminated water samples

Highly fluorescent, water-stable graphitic carbon nitride quantum dots (gCN QDs) synthesized by microwave assisted solvo-thermal technique and characterized via optical spectroscopy, XRD, HR-TEM, Fluorescence spectroscopy, FT-IR and Raman spectroscopy. Synthesized gCN were used for the removal of mercury ions from polluted water samples in a microcartridge format. Density functional theory (DFT) calculations revealed a possible interaction of mercury atoms, and embedment of mercury atom onto synthesized gCN surface lead to moderate structural distortion, reduced band gap and altered dielectric response. Experimentally, the excitation dependent fluorescence of QDs is highly compromised in presence of mercuric (Hg²⁺) and other ions, validating the theoretical findings, and establishing their use as metal sensor probes. Hg²⁺ binding ability with gCN QDs was further utilized in developing bioinspired micro-cartridge via covalent conjugation to Agarose microbeads. Micro-cartridge can remove heavy metal contamination from polluted water with a binding efficiency of 24.63 mg HgCl₂ for 10 mg of Agarose-gCN conjugate.

Cellular immunological changes in patients with LADA are a mixture of those seen in patients with type 1 and type 2 diabetes

There is currently scarce knowledge of the immunological profile of patients with latent autoimmune diabetes mellitus in the adult (LADA) when compared with healthy controls (HC) and patients with classical type 1 diabetes (T1D) and type 2 diabetes (T2D). The objective of this study was to investigate the cellular immunological profile of LADA patients and compare to HC and patients with T1D and T2D. All patients and age‐matched HC were recruited from Uppsala County. Peripheral blood mononuclear cells were isolated from freshly collected blood to determine the proportions of immune cells by flow cytometry. Plasma concentrations of the cytokine interleukin (IL)‐35 were measured by enzyme‐linked immunosorbent assay (ELISA). The proportion of CD11c⁺CD123^– antigen‐presenting cells (APCs) was lower, while the proportions of CD11c⁺CD123⁺ APCs and IL‐35⁺ tolerogenic APCs were higher in LADA patients than in T1D patients. The proportion of CD3^–CD56^highCD16⁺ natural killer (NK) cells was higher in LADA patients than in both HC and T2D patients. The frequency of IL‐35⁺ regulatory T cells and plasma IL‐35 concentrations in LADA patients were similar to those in T1D and T2D patients, but lower than in HC. The proportion of regulatory B cells in LADA patients was higher than in healthy controls, T1D and T2D patients, and the frequency of IL‐35⁺ regulatory B cells was higher than in T1D patients. LADA presents a mixed cellular immunological pattern with features overlapping with both T1D and T2D.

Abstract P3-14-04: Prevention of lymphedema in patients undergoing axillary dissection for breast cancer by benzathine penicillin: A non-inferiority randomised controlled trial

Background: Axillary lymph node dissection (ALND) is performed for axillary lymph nodal metastasis. Major complication of ALND is lymphedema. Lymphedema is a morbid condition associated with impaired activities of daily life and deterioration in quality of life (QOL). Olszewski et al (Lymphology. 2005 Jun;38(2):66–80) have shown that low-grade staphylococcal infection is a risk factor for lymphedema. Hence, we embarked upon a randomised controlled trial with non-inferiority hypothesis to evaluate efficacy of injection Benzathine penicillin in preventing breast cancer related lymphedema.

Methods: In this 2 group, open label, parallel design randomized controlled trial; patients undergoing ALND for breast cancer were included. Patients were randomized using block randomization to either injection Benzathine penicillin group or in control group. Patients in the penicillin group received injection Benzathine penicillin 1.2 million units as deep intramuscular injection after antibiotic sensitivity testing at intervals of 3 weeks. Primary endpoint was development of lymphedema at 6 months follow up. Analyses were done on an intention to treat basis. Lymphedema was defined as increase in &gt;200ml of volume on water displacement method and or increase in arm circumference of &gt;2cm from pre surgery values (Lancet Oncol. 2013 May 1;14(6):500–15).

Findings: Between July 2016 and December 2017, 83 ladies were randomly allocated, 40 in the penicillin group and 43 in control group. At 6 months follow up; a total of 15 (18.07%) patients had lymphedema. Out of them 5 patients were in penicillin group and 10 in the control group. Cellulitis was seen in 2/3rd of patients (10 out of 15) having lymphedema. The relative risk of cellulitis in penicillin group was 0.119 with 95% CI of (0.016-0.901) and prevented fraction of 0.881. Other factors like radiotherapy, type of surgery for primary tumor, extent of axillary dissection and type of chemotherapy were comparable in both groups. None of the patients receiving penicillin have any adverse effect or allergic reaction to the drug during the study period.

Comparison of lymphedema and cellulitis in two groupsOutcome Penicillin groupControl groupRR ( 95% CI)PFLymphedemaPresent05100.538 (0.201-1.437)0.462 Absent3533  CellulitisPresent01090.119 (0.016-0.901)0.881 Absent3934  RR: Relative risk, PF: Prevented fraction, CI: Confidence interval

Conclusion: Penicillin administration in patients undergoing axillary lymph node dissection is safe and significantly reduces risk of lymphedema and cellulitis.

Novelty: This is the first randomised trial demonstrating the benefit of long term administration of penicillin in reducing lymphedema and cellulitis.

Citation Format: Singh K, Dhar A, Srivastava A, Ranjan P, Kataria K, Gour KS. Prevention of lymphedema in patients undergoing axillary dissection for breast cancer by benzathine penicillin: A non-inferiority randomised controlled trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-14-04.