Search

Background and Aim Type 2 diabetes (T2D) in associated with higher prevalence and worse outcomes of nonalcoholic fatty liver disease (NAFLD). However, data regarding the prevalence of clinically relevant liver fibrosis (CRLF) in Indian individuals with T2D are scarce. We investigated the prevalence of, and factors associated with, CRLF in Indians with T2D. Methods We conducted a prospective study of 601 consecutive adults with T2D. Steatosis was diagnosed using ultrasonography. Liver stiffness measurement (LSM) by transient elastography of ≥8.0 kPa was taken as cutoff suggesting CRLF. Individuals with LSM > 13.0 kPa underwent dynamic magnetic resonance imaging (MRI) of liver for detecting changes consistent with cirrhosis. Results The prevalence of steatosis was 84.2%. Higher body mass index (BMI, P = 0.022), alanine aminotransferase (ALT; P = 0.001), and lower high‐density lipoprotein (HDL; P = 0.002) were independent factors associated with steatosis. The prevalence of CRLF was 28.2%. Higher BMI (P = 0.001), aspartate aminotransferase (AST; P 13.0 kPa. Among them, 25 individuals underwent dynamic MRI of liver, which revealed features consistent with cirrhosis in 18 patients. Conclusion CRLF, an established risk factor for cirrhosis and overall mortality, affects at least one out of four (25%) Indians with T2D. These results support screening of all patients with T2D and NAFLD for liver fibrosis., Type 2 diabetes (T2D) and nonalcoholic fatty liver disease (NAFLD) often coexist. T2D promotes the progression of NAFLD to more severe liver pathologies. We found high prevalence of clinically relevant liver fibrosis in individuals with T2D and NAFLD.

BACKGROUND AND AIM Type 2 diabetes (T2D) and low skeletal muscle mass (SMM) are associated with increased risk of nonalcoholic fatty liver disease (NAFLD). However, data regarding the association between low SMM and NAFLD-related liver fibrosis in individuals with T2D are scarce. Therefore, we aimed to investigate the association between low SMM and liver fibrosis in individuals with T2D and NAFLD. METHODS Controlled attenuation parameter (CAP) of ≥ 248 dB/m was taken as cutoff suggesting NAFLD. Clinically relevant liver fibrosis and advanced liver fibrosis were defined as liver stiffness measurement (LSM) by transient elastography (TE) of ≥ 8.0 and ≥ 9.6 kPa, respectively. SMM was measured using dual energy X-ray absorptiometry (DEXA). Low SMM was defined as appendicular SMM index of

Liraglutide, a daily injectable glucagon-like peptide-1 receptor (GLP-1r) agonist, has been shown to reduce liver fat content (LFC) in humans. Data regarding the effect of dulaglutide, a once-weekly GLP-1r agonist, on human LFC are scarce. This study examined the effect of dulaglutide on LFC in individuals with type 2 diabetes and non-alcoholic fatty liver disease (NAFLD).Effect of dulaglutide on liver fat (D-LIFT) was a 24 week, open-label, parallel-group, randomised controlled trial to determine the effect of dulaglutide on liver fat at a tertiary care centre in India. Adults (n = 64), who had type 2 diabetes and MRI-derived proton density fat fraction-assessed LFC of ≥6.0% at baseline, were randomly assigned to receive dulaglutide weekly for 24 weeks (add-on to usual care) or usual care, based on a predefined computer-generated number with a 1:1 allocation that was concealed using serially numbered, opaque, sealed envelopes. The primary endpoint was the difference of the change in LFC from 0 (baseline) to 24 weeks between groups. The secondary outcome measures included the difference of the change in pancreatic fat content (PFC), change in liver stiffness measurement (LSM in kPa) measured by vibration-controlled transient elastography, and change in liver enzymes.Eighty-eight patients were screened; 32 were randomly assigned to the dulaglutide group and 32 to the control group. Overall, 52 participants were included for per-protocol analysis: those who had MRI-PDFF data at baseline and week 24. Dulaglutide treatment resulted in a control-corrected absolute change in LFC of -3.5% (95% CI -6.6, -0.4; p = 0.025) and relative change of -26.4% (-44.2, -8.6; p = 0.004), corresponding to a 2.6-fold greater reduction. Dulaglutide-treated participants also showed a significant reduction in γ-glutamyl transpeptidase (GGT) levels (mean between-group difference -13.1 U/l [95% CI -24.4, -1.8]; p = 0.025) and non-significant reductions in aspartate aminotransferase (AST) (-9.3 U/l [-19.5, 1.0]; p = 0.075) and alanine aminotransferase (ALT) levels (-13.1 U/l [-24.4, 2.5]; p = 0.10). Absolute changes in PFC (-1.4% [-3.2, 0.3]; p = 0.106) and LSM (-1.31 kPa [-2.99, 0.37]; p = 0.123) were not significant when comparing the two groups. There were no serious drug-related adverse events.When included in the standard treatment for type 2 diabetes, dulaglutide significantly reduces LFC and improves GGT levels in participants with NAFLD. There were non-significant reductions in PFC, liver stiffness, serum AST and serum ALT levels. Dulaglutide could be considered for the early treatment of NAFLD in patients with type 2 diabetes.ClinicalTrials.gov NCT03590626 FUNDING: The current study was supported by an investigator-initiated study grant from Medanta-The Medicity's departmental research fund and a grant from the Endocrine and Diabetes Foundation (EDF), India. Graphical abstract.

Aims: To study the feasibility of diabetes education through telemedicine in patients with diabetes mellitus (DM) hospitalized for coronavirus disease 2019 (COVID-19) management. Methods: This was a prospective study of 100 patients with DM who were admitted in a COVID isolation ward for management of COVID-19. Patients managed with multiple subcutaneous insulin injections were eligible. During teleconsultation, diabetes education including insulin injection technique was given by a diabetes educator via a phone call (audio and video) during hospitalization. They were also re-assessed after 2 weeks of discharge from the hospital via teleconsultation or in-person. Results: Out of 100 patients, 72.0% had prior history of diabetes while 28.0% were newly diagnosed. The median age of our cohort was 56 years and median duration of diabetes was 7.0 years. Telemedicine as a mode of consult for diabetes education was accepted by 96.0% of patients during hospitalization. At 2 weeks’ follow-up, 77.0% patients were following insulin instructions correctly and were satisfied with this mode of consultation. Conclusion: Diabetes education using telemedicine as a technology is feasible, acceptable, and effective in the management of most patients with DM. Telemedicine appears to be an effective way to replace routine visits in special situations.

Background: Lactic acidosis is a rare but serious complication associated with metformin therapy in certain high-risk patients. NICE guidelines and the British National Formulary advise the discontinuation of metformin before surgery. The drug manufacturer's datasheet advises the withdrawal of metformin 48 h before surgery. However, the data regarding perioperative use of metformin is scarce. Aims: To evaluate the effect of continuation of metformin till night before surgery on lactate levels in patients undergoing coronary artery bypass graft (CABG) surgery. Materials and Methods: In this prospective cohort study, 1,800 consecutive patients who underwent CABG between 1st November 2015 and 31st October 2016 were enrolled. Following exclusion criteria, a total of 790 subjects were included for final analysis. Three-hundred and eight seven (48.9%) patients with diabetes received metformin till night before surgery (Met group), 239 (30.3%) patients with diabetes were non-metformin users (Non-Met group), and 164 (20.8%) patients were having no diabetes (Non-Diab group). Lactate levels and arterial pH were measured using arterial blood gas machine. Postoperative morbidity outcome data were obtained by collecting clinical data, routine biochemistry, and chest imaging. Results: The mean metformin dose was 1,124.6 mg/day (SD: 509.3; range: 500–2,500 mg/day). Mean postoperative lactate levels were 1.91 ± 0.7 in Met group, 2.04 ± 0.79 in Non-Met group, and 2.07 ± 0.78 in Non-Diab group. Lactic acidosis occurred in 41 patients and there was no difference among the groups [Met group = 18 (4.7%); Non-Met group = 14 (5.9%)]. Among secondary outcome measures, acute renal failure occurred more frequently in diabetic patients [Met group = 46 (11.9%) and Non-Met group = 32 (13.4%)] as compared with non-diabetic patients. There were no differences with regard to pneumonia, length of ICU stay, and duration of ventilatory support among the three groups. Conclusions: Continuation of metformin till night before surgery is not associated with significant changes in lactate levels in patients undergoing CABG.

Let R be a prime ring with the extended centroid C and symmetric Martindale quotient ring $$Q_s(R)$$ . In this paper we prove the following result. Let $$F: R \rightarrow R$$ be a generalized derivation associated with a non-zero derivation d on R and let h be an additive map of R such that $$F(x)x=xh(x)$$ for all $$x\in R$$ . Then either R is commutative or $$F(x)=xp$$ and $$h(x)=px$$ where $$p\in Q_{s}(R)$$ .

Let X be a real or complex Banach space, let L ( X ) be the algebra of all bounded linear operators of X and let A ( X ) ⊆ L ( X ) be a standard operator algebra. Suppose there exists a linear mapping T : A ( X ) → L ( X ) satisfying the relation T(An) = T(A)An−1 − AT(An−2)A − An−1T(A) for all A ∈ A ( X ) , where n > 2 is some fixed integer. Then T is of the form: (i)T(A) = 0 for all A ∈ F ( X ) and (ii) T(A) = BA, for all A ∈ A ( X ) and some B ∈ L ( X ) .

Aims Several studies in patients with type 2 diabetes mellitus (T2DM) from the United States and European countries have demonstrated a higher risk of morbidity and mortality than those without T2DM following coronary artery bypass grafting (CABG). The data from Indian patients are scarce. Therefore, this study was carried out to focus on immediate postoperative complications following CABG in Indian patients. Methods Eighteen hundred consecutive patients who underwent elective CABG were included. Following exclusion criteria, a total of 1017 subjects were included for final analysis. 692 (68%) patients had T2DM and 325 (32%) patients had no T2DM. Data were obtained by collecting clinical data, routine biochemistry and chest imaging. Patients were followed up to 7 days postoperatively. Results At baseline, hypertension, triple vessel coronary artery disease, chronic kidney disease and peripheral vascular disease were more common in patients with T2DM. Intraoperatively, use of blood products and intra-aortic balloon pump were more common in T2DM patients. Postoperatively, 13.2% patients with T2DM developed acute kidney injury versus 5.3% in non-T2DM group. Requirement of dialysis was not different between groups (P = 0.394). Pneumonia occurred in 2 patients in both groups (P = 0.370). Catheter-associated urinary tract infections were similar in two groups (P = 0.507). Mortality occurred only in one T2DM patient and none in non-T2DM group (P = 0.618). Conclusions A significant number of patients with T2DM developed acute kidney injury following CABG. There was no difference in infective complications such as pneumonia and catheter-associated urinary tract infection, between the two groups.

Let R be a prime ring, I a nonzero ideal of R, and a ∈ R. Suppose that σ is a nontrivial automorphism of R such that a{(σ(x ∘ y))n − (x ∘ y)m} = 0 or a{(σ([x,y]))n − ([x,y])m} = 0 for all x,y ∈ I, where n and m are fixed positive integers. We prove that if char(R) > n + 1 or char(R) = 0, then either a = 0 or R is commutative.

Let R be a prime ring with center Z, I a nonzero ideal of R, and a non- trivial automorphism of R such that {(x ◦ y) − (x ◦ y)} n ∈ Z for all x;y ∈ I. If either char(R) > n or char (R) = 0, then R satises s4, the standard identity in 4 variables.

SUMMARY Severe hypertriglyceridemia accounts for up to 7% of all cases of acute pancreatitis. Heparin and insulin activate lipoprotein lipase (LPL), thereby reducing plasma triglyceride levels. However, the safety and efficacy of heparin and insulin in the treatment of hypertriglyceridemia-associated acute pancreatitis have not been well established yet. We successfully used heparin and insulin as first-line therapy in four consecutive patients with acute pancreatitis secondary to hypertriglyceridemia. In a literature search, we revised almost all reports published to date of patients managed successfully with this combination. Heparin and insulin appear to be a safe, effective, and inexpensive first-line therapy for hypertriglyceridemia-associated acute pancreatitis.

In this paper, functional equations related to derivations on semiprime rings and standard operator algebras are investigated. We prove the following result which is related to a classical result of Chernoff. Let X be a real or complex Banach space, let \({\mathcal {L}}(X)\) be the algebra of all bounded linear operators of X into itself and let \({\mathcal {A}}(X)\subset {\mathcal {L}}(X)\) be a standard operator algebra. Suppose there exist linear mappings \(D, G:{\mathcal {A}}(X)\rightarrow {\mathcal {L}}(X)\) satisfying the relations \(D(A^{2n+1})=D(A^{2n})A+A^{2n}G(A)\) and \(G(A^{2n+1})=G(A^{2n})A+A^{2n}D(A)\) for all \(A\in {\mathcal {A}}(X)\). Then there exists \(B\in {\mathcal {L}}(X)\) such that \(D(A)=G(A)=[A,B]\) for all \(A\in {\mathcal {A}}(X)\).

In the present paper we prove that, let R be a prime ring with center Z, L a Lie ideal of R and \(\sigma \) a nontrivial automorphism of R such that (i)\(\{ \sigma (u)\}^n -(u)^{2m+1} =0\), (ii)\(\{ \sigma (u)\}^n -(u)^{2m+1} \in Z\), (iii) \(\{ \sigma (u)\}^n +(u)^{2m} =0\)\(\text{ for } \text{ all }~~u\in L\) and fixed \(n,m \ge 1\). If either char \((R)> n+1\) or char \((R) = 0\), then \(L\subseteq Z\).

The solar global ultraviolet (GUV) and broadband global (G) radiation flux obtained on a horizontal plane in Delhi, during April 2010 to March 2011 have been used to investigate the temporal variability of these radiations and their ratio, fraction of UV (FUV). For the first time the clearness index (KT) has been estimated over Delhi and its variability during different months of the year and season has been studied in detail. The impact of atmospheric aerosols on KT has also been studied. It has been found that for every unit increase in aerosol optical depth (AOD) at 340 nm, KT decreases by 0.06. A strong anti-correlation with correlation coefficient − 0.75 is observed between AOD and KT. On the basis of our field experience and observations at Delhi it is found that for highly cloudy and overcast conditions 0⩽KT⩽0.15, for partial cloudy or hazy conditions 0.15⩽KT⩽0.21 and KT > 0.21 for clear sky conditions. In addition, during foggy days in winter we have found KT values lying in the range 0.12–0.18 at Delhi. The day-time daily-averaged fluxes GUV and G varied in the range 0.15–1.23 MJ m−2 and 3.36–27.02 MJ m−2, respectively. The GUV and G showed similar pattern during the year except for the wet season when the FUV increased possibly due to an increase in water vapour concentration. Copyright © 2012 Royal Meteorological Society

The aerosol optical depth (AOD), Angstrom coefficients (α and β), and the second-order Angstrom exponent (α′) obtained by Microtops-II sun photometer have been analyzed in the spectral range 0.34–0.87 μm over the urban polluted city of Delhi, India for the period 2007–2008, aiming at investigating the physical and optical properties of aerosols. The average values of AOD at 500 nm, α and β (in the range 340–870 nm) are found to be 0.78 ± 0.32, 0.78 ± 0.28, and 0.45 ± 0.21, respectively, for the entire period of observations. The AOD data show significant curvature in the lnτ versus lnλ relationship suggesting different dominant aerosol types depending on season. In order to analyze further the curvature effect and the relative dominance of aerosol size, α has been calculated in three wavelength bands, i.e., shorter (0.34–0.50 μm), longer (0.675–0.87 μm), and broad (0.34–0.87 μm) during four seasons, summer (April–June), monsoon (July–September), winter (October–January), and spring (February–March) accomp...

Let n ⩾ 1 be a fixed integer and let R be an ( n + 1)!-torsion free ∗-ring with identity element e . If F , d : R → R are two additive mappings satisfying F ( x n +1 ) = F ( x )( x ∗ ) n + xd ( x )( x ∗ ) n −1 + x 2 d ( x )( x ∗ ) n −2 + ⋯ + x n d ( x ) for all x ∈ R , then d is a Jordan ∗-derivation and F is a generalized Jordan ∗-derivation on R .

Simultaneous measurements of aerosol absorption and scattering coefficients for the PM2.5 aerosols particles were done at Delhi during April 2008–March 2009 to estimate the aerosol single scattering albedo (SSA) and the Angstrom absorption exponents at the surface. The annual average SSA at 0.55 μm was found to be 0.70 ± 0.07 with only slight variations during the four seasons, summer (0.63 ± 0.06), monsoon (0.69 ± 0.07), winter (0.74 ± 0.03) and spring (0.72 ± 0.04). However, large variations in average absorption and scattering coefficients were seen during these four seasons. The average absorption coefficients during summer, monsoon, winter and spring were found to be 62.47 ± 21.27, 50.95 ± 43.61, 189.65 ± 85.94 and 90.65 ± 33.06 Mm−1 respectively. The corresponding scattering coefficients were 110.46 ± 36.15, 95.34 ± 49.46, 565.59 ± 274.59 and 236.56 ± 96.25 Mm−1. The Angstrom absorption exponent (ασ(abs)) remained close to unity throughout the year averaging at 1.02 ± 0.08, 1.02 ± 0.10, 1.04 ± 0.11, and 1.03 ± 0.05 during summer, monsoon, winter and spring seasons respectively, strongly indicating that the absorption at Delhi aerosol is mainly due to the abundance of black carbon of fossil fuel origin.

The concentrations of PM10, PM2.5 and their water-soluble ionic species were determined for the samples collected during January to December, 2007 at New Delhi (28.63° N, 77.18° E), India. The annual mean PM10 and PM2.5 concentrations (± standard deviation) were about 219 (± 84) and 97 (±56) µgm−3 respectively, about twice the prescribed Indian National Ambient Air Quality Standards values. The monthly average ratio of PM2.5/PM10 varied between 0.18 (June) and 0.86 (February) with an annual mean of ∼0.48 (±0.2), suggesting the dominance of coarser in summer and fine size particles in winter. The difference between the concentrations of PM10 and PM2.5, is deemed as the contribution of the coarse fraction (PM10−2.5). The analyzed coarse fractions mainly composed of secondary inorganic aerosols species (16.0 µgm−3, 13.07%), mineral matter (12.32 µgm−3, 10.06%) and salt particles (4.92 µgm−3, 4.02%). PM2.5 are mainly made up of undetermined fractions (39.46 µgm−3, 40.9%), secondary inorganic aerosols (26.15 µgm−3, 27.1%), salt aerosols (22.48 µgm−3, 23.3%) and mineral matter (8.41 µgm−3, 8.7%). The black carbon aerosols concentrations measured at a nearby (∼300 m) location to aerosol sampling site, registered an annual mean of ∼14 (±12) µgm−3, which is significantly large compared to those observed at other locations in India. The source identifications are made for the ionic species in PM10 and PM2.5. The results are discussed by way of correlations and factor analyses. The significant correlations of Cl−, SO42−, K+, Na+, Ca2+, NO3− and Mg2+ with PM2.5 on one hand and Mg2+ with PM10 on the other suggest the dominance of anthropogenic and soil origin aerosols in Delhi.