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Background: Diabetic neuropathy is one of the most common microvascular complications of diabetes mellitus (DM) and can lead to a wide array of complications, which are concerning as these are considered a leading cause of disability due to foot ulceration, amputation, gait disturbances, and injuries secondary to falls. Nerve conduction studies (NCS) enable the diagnosis of sensory and motor neuropathy even if the dysfunction is subclinical. This study was conducted to assess the correlation between glycated hemoglobin and duration of diabetes with the parameters of NCS among patients of type 2 DM. Methodology: A cross-sectional study was conducted in a tertiary care center in South India. The study was conducted from November 2022 to February 2023. Sixty patients with type 2 DM who presented to the outpatient department with symptoms of neuropathy were included in the study. Detailed clinical history was taken and clinical examination was done. NCS was conducted in them. The parameters of NCS were correlated with HbA1c and duration of diabetes. The statistical analysis was carried out using the SPSS software version 29.0. Results: Sixty patients with type 2 DM were included in the study. The mean age of type 2 DM patients was 60.92 ± 10.9 years. The mean duration of type 2 DM (in years) was 12.8 ± 6.5. Twenty-three participants (38.3%) had solely an axonal pattern of diabetic neuropathy; whereas 20 (33.3%) participants showed a combined axonal and demyelinating pattern of diabetic neuropathy. There was a significant negative correlation between HbA1c and NCS parameters such as nerve conduction velocity, amplitude, and persistence (p < 0.001); and a significant positive correlation between HbA1c and NCS parameters such as latency and F-wave latency (p < 0.001). There was a significant correlation between parameters of NCSs and duration of DM (p < 0.001). Conclusion: Glycemic control and duration of DM have a significant impact on the nerve conduction parameters. Patients with poor glycemic control have decreased NCS parameters such as velocity, amplitude, and persistence; and increased parameters such as latency and F-wave latency. Strict glycemic control can be reinforced for better management of diabetic neuropathy. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Neuromyelitis optica spectrum disorders can less commonly present with area postrema syndrome progressing to myelitis. Management involves intravenous glucocorticoids, plasma exchange, and preventive immunotherapy. Neuromyelitis optica spectrum disorders can less commonly present with area postrema syndrome progressing to myelitis. The majority of patients have positive AQP4‐Ab. Diagnosis is based on clinical and imaging findings. These patients can be treated with intravenous glucocorticoids, plasma exchange, and preventive immunotherapy. [ABSTRACT FROM AUTHOR]

Type 2 diabetes mellitus (T2DM) is a global epidemic. According to international guidelines, the management protocol of T2DM includes lowering of blood glucose, along with preventing disease-related complications and maintaining optimal quality of life. Further, the guidelines recommend the use of a patient-centric approaches for the management of T2DM; however, Asian population is underrepresented in landmark cardiovascular outcome trials (CVOTs). There are several guidelines available today for the diagnosis and management of T2DM, and hence there is much confusion among practitioners about which guidelines to follow. A group of thirty international clinical experts comprising of endocrinologists, diabetologists and cardiologist from South Asia, Middle East and Africa met at New Delhi, India on February 8 and 9, 2020 and developed an international expert opinion statements via a structured modified Delphi method on the glucodynamic properties of OADs and the glucocratic treatment approach for the management of T2DM. In this modified Delphi consensus report, we document the glucodynamic properties of Modern SUs in terms of glucoconfidence, glucosafety, and gluconomics. According to glucodynamics theory, an ideal antidiabetic drug should be efficacious, safe, and affordable. Modern SUs as a class of OADs that have demonstrated optimal glucodynamics in terms of glucoconfidence, glucosafety, and gluconomics. Hence, modern SUs are most suitable second line drug after metformin for developing countries. Based on the current evidence, we recommend a glucocratic approach for the treatment of T2DM, where an individualized treatment plan with phenotype, lifestyle, environmental, social, and cultural factors should be considered for persons with T2DM in the South Asian, Middle Eastern and African regions. [ABSTRACT FROM AUTHOR]

Background: Therapeutic drug monitoring of vancomycin is very valuable due to the good correlation between trough levels and clinical outcome. Therefore, it is important to accurately determine the concentration of vancomycin in patient plasma for adequate dose-adjustment. The objective of this study was to develop a new liquid chromatography-mass spectrometry (LC-MS) method for determination of vancomycin in patient plasma and compare the results with those obtained from enzyme-multiplied immunoassay technique (EMIT). Methods: After extraction by simple protein precipitation, vancomycin and bergenin (internal standard) were separated on a C18 column (150x4.6 mm, 5 µm) at 40°C by gradient elution with 0.1% formic acid and acetonitrile as the mobile phase and measured by electrospray ionization source in positive selective ion monitoring mode. Seventy-nine plasma samples from patients with severe infection were analyzed by enzyme-multiplied immunoassay technique and LC-MS method. MedCalc 15.2 software with Bland-Altman analysis and Passing-Bablok regression analysis was used for statistical analysis. Results: The weighted (1/x²) calibration curve of the validated LC-MS was linear within the concentration range of 0.25 - 40 µg/mL. The inter- and intra-day precisions (%RSD) were less than 10.0%. No significant matrix effect was observed in the relevant time ranges. Comparison of the two methods indicated that results of the LC-MS were close to that of EMIT with a correlation coefficient of 0.957. Upon Bland-Altman analysis, the bias amounted to 2.9 µg/mL (95% confidence intervals of -3.4 - 9.2 µg/mL). Conclusions: The established LC-MS method and EMIT were both suitable for routine TDM of vancomycin. [ABSTRACT FROM AUTHOR]

Background and Objectives: Breast carcinoma is the most common cancer and the leading cause of death in females all over the world. In most of developing countries including Pakistan the incidence is on the increase. Although a number of studies have been conducted in Pakistan, adequate statistics about demographic and epidemiologic features of breast carcinoma are not available. The present study was designed to see the frequency, age, gender and morphological features of breast carcinoma in a tertiary care hospital. Methods: It was a retrospective study of breast biopsies from all patients reported from January 2009 to December, 2011 at Department of Pathology FJMU, Lahore. All the available demographic and tumor related data was collected from the files of histopathology section and analyzed. Patients were divided into five age groups with an interval of ten years between each group. Results: Out of 727 breast biopsies, 721 specimens were from females and 6 from male patients. Breast carcinoma was diagnosed in 263 (36.17%), Sarcoma in 1 (0.14%), benign tumors in 265 (36.5%) and non-neoplastic lesions in 198 (27.23%) cases. Invasive ductal carcinoma (IDC) was the commonest subtypes seen in 251 (95.44%), followed by mucinous carcinoma (1.90%) and invasive lobular carcinoma (1.14%). All the malignant tumors were seen in female patients. Males were diagnosed to have benign lesions only. The mean age of patients with IDC was 46 years. Maximum numbers of patients with IDC were between 40 - 49 years of age. Grade II tumors were found in majority of the cases (99.5%). Axillary lymph node metastases were present in 70.96% patients. Tumor size of more than 2.5 cm was found in 75% cases. Conclusion: The breast carcinoma was quite common in our females. It occurred at a younger age as compared to western population. IDC was the commonest subtype. Most of the tumors were aggressive (grade II) and diagnosed at advanced stage with nodal metastases. [ABSTRACT FROM AUTHOR]

There are wide regional variations in the quality and provision of diabetes care. The pressure is on health care providers to deliver care of the highest quality. The Quality of Care Diabetes Assessment Tool (QUAD-CAT) was developed to benchmark the care provided in primary and secondary care, based on the American Diabetes Association (ADA) model. We studied data from a random selection of 25 diabetic patients from 10 primary care centres and 100 diabetic patients from George Eliot Hospital diabetes clinic. Data were collected based on the template of the Alphabet Strategy for managing diabetes, for various parameters, including HbA1c, blood pressure, eye and foot examination, nephropathy assessment, lipid profile and aspirin use. A patient questionnaire was included to assess the subjective quality of service. Points were allocated based on the ADA scoring system. In order for a centre to be accredited, 80 out of 110 points were required. The overall points range was 40–95, with three practices accredited. There was a wide variation in performance in the key measures assessed between the practices. In conclusion, QUAD-CAT provides an easily conducted and well-accepted tool to evaluate the quality of clinical care and patient's perception of diabetes services Copyright © 2003 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This paper presents work on the development of a thermionic diode detector for laser spectroscopy of atoms. Basically, this is a positive ion-detector that exploits the negative space charge accumulated around the cathode of a diode. In this device, a thin and straight hot cathode wire is stretched axially into a long cylindrical heat-pipe that constitutes a device similar to an electronic vacuum diode. The ions in the diode space-charge region are produced as a result of photoionization or collisional ionization of lithium atoms. The design aspects and measurement of its electrical characteristics are described. A new method based on the resonant photoionization of lithium is used to measure the gain of the ion-detector. An application is also demonstrated to measure the photoionization cross-section (σ  =  7.8  ±  1.6 Mb) of lithium near its first ionization threshold for two-photon excitation at 639.145 nm. Important features of the thermionic diode are its easy, versatile and sturdy design with high gain (104) and sensitivity that make it a valuable and cost-effective tool for spectroscopists. [ABSTRACT FROM AUTHOR]