Glycemic Outcomes of Hospitalized Patients on Ambulatory Humulin-R U-500 Insulin

ObjectiveManaging hospitalized patients on ambulatory U-500 insulin is challenging because of limited guidance on how to safely adjust insulin doses during admission. We sought to evaluate glycemic outcomes in relation to inpatient insulin doses in patients receiving U-500 prior to hospitalization.MethodsRetrospective study of hospitalized patients on ambulatory U-500 seen consecutively from January 2015 to December 2019. Primary outcomes were inpatient hypoglycemia, hyperglycemia, and normoglycemia at different insulin dosages expressed as weight-based (unit/kg/d) inpatient total daily dose (TDD) and ratio of inpatient to outpatient TDD.ResultsWe identified 66 admissions of 46 unique patients. The median (interquartile range) body mass index was 41.0 kg/m² (35.1, 46.8), home TDD 212 units (120, 300), and home insulin dose 1.6 units/kg/d (1.1, 2.2). The median (interquartile range) inpatient insulin dose was 0.7 unit/kg/d (0.3, 1.0) and the ratio of inpatient to outpatient TDD was 0.4 (0.2, 0.8). Hyperglycemia persisted throughout the hospitalization. For the outcomes of hyperglycemia and normoglycemia, we found no association between increased levels of insulin dosages. For the outcome of hypoglycemia, significantly higher odds were observed when non-fasting patients received an inpatient TDD that was either > 40% of their home TDD or > 0.6 unit/kg/d of insulin.ConclusionPatients on ambulatory U-500 have significant hyperglycemia during admission. Inpatient insulin doses of 40% of home TDD or ≤ 0.6 unit/kg were not associated with increased hypoglycemia risk. Further prospective studies are needed to determine effective doses in these high-risk patients.     

Temporal priority effects on competition are not consistent among intermountain grassland species

Previous work indicates that priority effects exist, but mechanisms are not well understood. So we explored shifts in competitive outcomes and intensities as a potential general mechanism. In a standard greenhouse experiment the temporal priority effects of the target species Pseudoroegneria spicata and its competitive responses to five receptor species, i.e., Bromus ciliatus, Bromus marginatus, Coreopsis tinctoria, Senecio atratus, and Solidago canadensis were evaluated. P. spicata adults with a high root: shoot ratio had a significant inhibitory priority effect on B. ciliatus, B. marginatus, and C. tinctoria. Compared with the target species, under later and simultaneous sowing, B. ciliatus, B. marginatus, C. tinctoria, and S. atratus exhibited an increasing trend in terms of competition. However, S. canadensis did not display priority effects. In addition, the gram per gram competitive effect of P. spicata depended on the receptor species in the following order: B. marginatus > B. ciliatus > C. tinctoria > S. atratus. There were positive relationships between the relative interaction indices and the root: shoot ratios in B. ciliatus, B. marginatus, and C. tinctoria, thereby suggesting that the early germination or emergence of P. spicata may reduce the root: shoot ratios of these receptors. The results of this study indicate that priority effects occurred in early colonizers with high root: shoot ratios and greater competitive capacities.     

The contribution of longevity to population death rates

The magnitude of a population's per capita death rate depends on the maximum age at death and the intensity or schedule of mortality of its members. Knowing the maximum possible lifespan that an animal can achieve when raised under defined conditions makes it possible to calculate the component of per capita death rate due to longevity alone. This component is most important to slow-growing populations of animals with relatively short lifespans. Life-table experiments with two rotifer species and a cladoceran indicate that the short lifespans of these animals account for moderate proportions (up to 37.2%) of their population death rates. Decomposing per capita death rates into two components, one due to maximum length of life and another due to differential mortality of animals of different ages, may therefore be a useful way to examine how deleterious processes, such as predation and starvation, limit growth of zooplankton populations.     

Use of PTW-microDiamond for relative dosimetry of unflattened photon beams

PurposeThe increasing interest in SBRT treatments encourages the use of flattening filter free (FFF) beams. Aim of this work was to evaluate the performance of the PTW60019 microDiamond detector under 6 MV and 10MVFFF beams delivered with the EDGE accelerator (Varian Medical System, Palo Alto, USA). A flattened 6 MV beam was also considered for comparison.MethodsShort term stability, dose linearity and dose rate dependence were evaluated. Dose per pulse dependence was investigated in the range 0.2–2.2 mGy/pulse. MicroDiamond profiles and output factors (OFs) were compared to those obtained with other detectors for field sizes ranging from 40 × 40 cm² to 0.6 × 0.6 cm². In small fields, volume averaging effects were evaluated and the relevant correction factors were applied for each detector.ResultsMicroDiamond short term stability, dose linearity and dependence on monitor unit rate were less than 0.8% for all energies. Response variations with dose per pulse were found within 1.8%. MicroDiamond output factors (OF) values differed from those measured with the reference ion-chamber for less than 1% up to 40 × 40 cm² fields where silicon diodes overestimate the dose of ≈3%. For small fields (<3 × 3 cm²) microDiamond and the unshielded silicon diode were in good agreement.ConclusionsMicroDiamond showed optimal characteristics for relative dosimetry even under high dose rate beams. The effects due to dose per pulse dependence up to 2.2 mGy/pulse are negligible. Compared to other detectors, microDiamond provides accurate OF measurements in the whole range of field sizes. For fields <1 cm correction factors accounting for fluence perturbation and volume averaging could be required.     

A case study on Hashimoto's thyroiditis induced electrolyte imbalance

Lymphocytic thyroiditis is an autoimmune condition where auto-antibodies are produced against the thyroid gland. Initially, there might be a hyperthyroidism condition where T3 and T4 levels are high and external inflammation of thyroid gland might be seen, but over the course of time the destruction of thyroid gland can result in hypothyroidism where the complete destruction of thyroid gland. Electrolyte imbalances notably hypokalemia and hypomagnesemia with Hashimoto thyroiditis is a rare condition, in this article we will discuss about the course of treatment a 40-year-old female patient who presented with atypical symptoms of Hashimoto thyroiditis during her stay in the hospital.     

A simplified method for determination of radioactive iron in whole-blood samples

For studies on iron absorption in man radioisotopes represent an easy and simple tool However, measurement of the orbital electron emitting radioiron, 55Fe, in blood is difficult and insufficiently described in the literature. The present study describes a relatively simple method for simultaneous determination of 55Fe and 59Fe in blood, using a dry-ashing procedure and recrystallization of the remaining iron. The detection limit of the method permits measurements of 0.1 Bq/ml blood thus allowing detection of less than 1% absorption from a 40 kBq dose, which is ethically acceptable in humans. The overall recovery of radioiron from blood is more than 90%, and the coefficient of variation, as judged by the variation in the ratio 55Fe/59Fe is in the order of 4%. Combined with whole-body counting of 59Fe and direct gamma-counting of 59Fe on blood samples, this method represents a sensitive method for studying the intestinal absorption of 55Fe and 59Fe in man and at the same time allows estimation of the amount of radioiron located in the vascular compartment.     

Morphological traits of wheat (Triticum aestivum L.) associated with resistance to shoot fly,Atherigona approximata Malloch

Shoot flies (Atherigona spp.) are the members of muscidae family which have got economic importance as pest of several crops of Gramineae family mostly cereals and millets. One of the most effective management strategies for controlling shoot fly is the use of resistant wheat cultivars carrying specific resistant traits. Among thirty wheat genotypes screened at the University of Agricultural Sciences, Dharwad-Karnataka (India), two advanced germplasms UAS BW-12417 and UAS BW-11110 recorded least oviposition and dead heart due to shoot fly and found to be less preferred by Atherigona approximata Malloch. The morphological traits of different wheat genotypes revealed a significant negative correlation of shoot fly oviposition and dead heart with leaf length, leaf length to breadth ratio, seedling height, average seedling growth rate, seedling vigour, leaf glossiness and trichome density of wheat leaves, which indicated the enhanced shoot fly infestation as decrease in the values of above-mentioned morphological traits. Meanwhile, increase in leaf breadth and leaf area of wheat genotype aggrandised the oviposition and dead heart damage by shoot fly. Under the changing climate where, the minor insect pests attaining major pest status, the present investigation would pave way for breeders to tailor future breeding programmes to evolve shoot fly resistant hybrids with high yielding traits.