Efficacy of 10%,25% and 50% dextrose in the treatment of hypoglycemia in the emergency department - A randomized controlled study.

INTRODUCTION: Documented symptomatic hypoglycemia is defined as "event during which typical symptoms of hypoglycemia are accompanied by measured blood glucose of ≤70 mg/dL. Most of the studies and recommendations for the unconscious hypoglycemic adult advocate the use of 25 g of glucose as 50 mL of 50% dextrose solution intravenous or 1 mg of intramuscular glucagon. OBJECTIVE: To compare the efficacy and safety of 5 g boluses of 10%, 25% and 50% dextrose in the treatment of hypoglycemic patients presenting to our emergency department. METHODS: This was a randomized controlled single blinded study. Hypoglycemic patients in altered mental status were randomized into three treatment arms to be administered 10%, 25% or 50% dextrose. 5 g aliquots of intravenous 10%,25% or 50% dextrose were administered over 1 min. Time taken to achieve a Glasgow Coma Scale (GCS) of 15 and median total doses (g) were the primary outcomes. RESULTS: Data of 204 patients were analysed in the study. There was no difference in the median time to achieve a GCS of 15 in all three treatment arms (6 min). Total median dose administered in the 10% and 25% groups was lower than 50% (10 g vs 15 g). Proportion of patients who received the maximum dose of 25 g was higher in the 50% group as compared to 10% and 25% groups (12%, 3%, 4%). CONCLUSION: There was no difference in 10% dextrose and 25% dextrose as compared to 50% dextrose in achieving the baseline mental status (or GCS 15) in the treatment of hypoglycemia in the ED.

Multisensory integration in Anopheles mosquito swarms: The role of visual and acoustic information in mate tracking and collision avoidance.

Male mosquitoes form aerial aggregations, known as swarms, to attract females and maximize their chances of finding a mate. Within these swarms, individuals must be able to recognize potential mates and navigate the dynamic social environment to successfully intercept a mating partner. Prior research has almost exclusively focused on the role of acoustic cues in mediating the male mosquito's ability to recognize and pursue flying females. However, the role of other sensory modalities in this behavior has not been explored. Moreover, how males avoid collisions with one another in the dense swarm while pursuing females remains poorly understood. In this study, we combined free-flight and tethered flight simulator experiments to demonstrate that swarming Anopheles coluzzii mosquitoes integrate visual and acoustic information to track conspecifics and avoid collisions. Our tethered experiments revealed that acoustic stimuli gated mosquito steering responses to visual objects simulating nearby mosquitoes, especially in males that exhibited attraction to visual objects in the presence of female flight tones. Additionally, we observed that visual cues alone could trigger changes in mosquitoes' wingbeat amplitude and frequency. These findings were corroborated by our free-flight experiments, which revealed that mosquitoes modulate their flight responses to nearby conspecifics in a similar manner to tethered animals, allowing for collision avoidance within swarms. Together, these results demonstrate that both males and females integrate multiple sensory inputs to mediate swarming behavior, and for males, the change in flight kinematics in response to multimodal cues allows them to simultaneously track females while avoiding collisions.

Tixagevimab/Cilgavimab does not prevent COVID-19 in patients with multiple sclerosis and related disorders on B-cell depleting therapies.

BACKGROUND: Patients with MS and related disorders (pwMSARD) on B-cell depleting treatments have attenuated immune responses to vaccination and were eligible to receive tixagevimab/cilgavimab. OBJECTIVES: Understand incidence and severity of COVID-19 in pwMSARD on B-cell depleting therapies who received tixagevimab/cilgavimab compared to an untreated group. METHODS: We conducted a retrospective medical records review of adult pwMSARD on B-cell depleting treatments who received tixagevimab/cilgavimab between 1/2022-1/2023. PwMSARD on B-cell depleting treatments who did not served as a control group (CG). We compared COVID-19 incidence and severity within 6 months of tixagevimab/cilgavimab or rituximab/ocrelizumab infusion for the CG. RESULTS: 210 patients were identified, 135 in the treatment group (TG) and 75 in the CG. In the TG, 24 (17.8 %) developed COVID-19 compared to 12 (16 %) in the CG. There was no difference in the odds of developing COVID-19 in an unadjusted logistic regression model (OR=1.14; 95 % CI: 0.53, 2.42; p = 0.74) or after adjusting for age and disease duration (OR=1.05; 95 % CI: 0.47, 2.37; p = 0.91). There was also no difference in COVID-19 severity between groups. CONCLUSIONS: There was no difference in COVID-19 infection rates or severity in pwMSARD on B-cell depleting treatments who received tixagevimab/cilgavimab compared to those who remained untreated.

Successful Reversal of Refractory Posttransplant Thrombotic Microangiopathy with Eculizumab.

Posttransplant thrombotic microangiopathy (PT-TMA) can be caused by calcineurin inhibitors (CNIs), ischemic injury, infections, or antibody-mediated rejection (ABMR). Delayed recognition can result in allograft loss. We describe the first reported case of successful reversal of refractory PT-TMA with eculizumab in India. It highlights the importance of prompt diagnosis and benefit from an early initiation of eculizumab therapy in refractory cases.

ChatGPT 3.5 fails to write appropriate multiple choice practice exam questions.

Artificial intelligence (AI) may have a profound impact on traditional teaching in academic settings. Multiple concerns have been raised, especially related to using ChatGPT for creating de novo essays. However, AI programs such as ChatGPT may augment teaching techniques. In this article, we used ChatGPT 3.5 to create 60 multiple choice questions. Author written text was uploaded and ChatGPT asked to create multiple choice questions with an explanation for the correct answer and explanations for the incorrect answers. Unfortunately, ChatGPT only generated correct questions and answers with explanations in 32 % of the questions (19 out of 60). In many instances, ChatGPT failed to provide an explanation for the incorrect answers. An additional 25 % of the questions had answers that were either wrong or misleading. A grade of 32 % would be considered failing in most courses. Despite these issues, instructors may still find ChatGPT useful for creating practice exams with explanations-with the caveat that extensive editing may be required.

Bridging the Mind and Gut: Uncovering the Intricacies of Neurotransmitters, Neuropeptides, and their Influence on Neuropsychiatric Disorders.

BACKGROUND: The gut-brain axis (GBA) is a bidirectional signaling channel that facilitates communication between the gastrointestinal tract and the brain. Recent research on the gut-brain axis demonstrates that this connection enables the brain to influence gut function, which in turn influences the brain and its cognitive functioning. It is well established that malfunctioning of this axis adversely affects both systems' ability to operate effectively. OBJECTIVE: Dysfunctions in the GBA have been associated with disorders of gut motility and permeability, intestinal inflammation, indigestion, constipation, diarrhea, IBS, and IBD, as well as neuropsychiatric and neurodegenerative disorders like depression, anxiety, schizophrenia, autism, Alzheimer's, and Parkinson's disease. Multiple research initiatives have shown that the gut microbiota, in particular, plays a crucial role in the GBA by participating in the regulation of a number of key neurochemicals that are known to have significant effects on the mental and physical well-being of an individual. METHODS: Several studies have investigated the relationship between neuropsychiatric disorders and imbalances or disturbances in the metabolism of neurochemicals, often leading to concomitant gastrointestinal issues and modifications in gut flora composition. The interaction between neurological diseases and gut microbiota has been a focal point within this research. The novel therapeutic interventions in neuropsychiatric conditions involving interventions such as probiotics, prebiotics, and dietary modifications are outlined in this review. RESULTS: The findings of multiple studies carried out on mice show that modulating and monitoring gut microbiota can help treat symptoms of such diseases, which raises the possibility of the use of probiotics, prebiotics, and even dietary changes as part of a new treatment strategy for neuropsychiatric disorders and their symptoms. CONCLUSION: The bidirectional communication between the gut and the brain through the gut-brain axis has revealed profound implications for both gastrointestinal and neurological health. Malfunctions in this axis have been connected to a range of disorders affecting gut function as well as cognitive and neuropsychiatric well-being. The emerging understanding of the role of gut microbiota in regulating key neurochemicals opens up possibilities for novel treatment approaches for conditions like depression, anxiety, and neurodegenerative diseases.

Foreign RNA spike-ins enable accurate allele-specific expression analysis at scale.

MOTIVATION: Analysis of allele-specific expression is strongly affected by the technical noise present in RNA-seq experiments. Previously, we showed that technical replicates can be used for precise estimates of this noise, and we provided a tool for correction of technical noise in allele-specific expression analysis. This approach is very accurate but costly due to the need for two or more replicates of each library. Here, we develop a spike-in approach which is highly accurate at only a small fraction of the cost. RESULTS: We show that a distinct RNA added as a spike-in before library preparation reflects technical noise of the whole library and can be used in large batches of samples. We experimentally demonstrate the effectiveness of this approach using combinations of RNA from species distinguishable by alignment, namely, mouse, human, and Caenorhabditis elegans. Our new approach, controlFreq, enables highly accurate and computationally efficient analysis of allele-specific expression in (and between) arbitrarily large studies at an overall cost increase of ∼5%. AVAILABILITY AND IMPLEMENTATION: Analysis pipeline for this approach is available at GitHub as R package controlFreq (github.com/gimelbrantlab/controlFreq).

Mosquito biology: Scents and selectability.

Malaria-transmitting mosquitoes are skilled human hunters, selectively choosing their prey based on a complex array of sensory cues. A new study unveils a distinct pattern of preference for human-associated olfactory cues that underlies the selective behavior of these mosquitoes.

Foreign RNA spike-ins enable accurate allele-specific expression analysis at scale.

Motivation: Analysis of allele-specific expression is strongly affected by the technical noise present in RNA-seq experiments. Previously, we showed that technical replicates can be used for precise estimates of this noise, and we provided a tool for correction of technical noise in allele-specific expression analysis. This approach is very accurate but costly due to the need for two or more replicates of each library. Here, we develop a spike-in approach that is highly accurate at only a small fraction of the cost. Results: We show that a distinct RNA added as a spike-in before library preparation reflects technical noise of the whole library and can be used in large batches of samples. We experimentally demonstrate the effectiveness of this approach using combinations of RNA from species distinguishable by alignment, namely, mouse, human, and C.elegans . Our new approach, controlFreq , enables highly accurate and computationally efficient analysis of allele-specific expression in (and between) arbitrarily large studies at an overall cost increase of ~ 5%. Availability: Analysis pipeline for this approach is available at GitHub as R package controlFreq ( github.com/gimelbrantlab/controlFreq ). Contact: agimelbrant@altius.org.

Female preferences for the spectral content of advertisement calls in Cope's gray treefrog (Hyla chrysoscelis).

Amphibians have inner ears with two sensory papillae tuned to different frequency ranges of airborne sounds. In frogs, male advertisement calls possess distinct spectral components that match the tuning of one or both sensory papillae. Female preferences for the spectral content of advertisement calls can depend on signal amplitude and can vary among closely related lineages. In this study of Cope's gray tree frog (Hyla chrysoscelis), we investigated the amplitude dependence of female preferences for the spectral content of male advertisement calls, which have a "bimodal" spectrum with separate low-frequency (1.25 kHz) and high-frequency (2.5 kHz) components. In two-alternative choice tests, females generally preferred synthetic calls with bimodal spectra over "unimodal" calls having only one of the two spectral components. They also preferred unimodal calls with a high-frequency component over one with the low-frequency component. With few exceptions, preferences were largely independent of amplitude across both a 30 dB range of overall signal amplitude and an 11 dB range in the relative amplitudes of the two spectral components. We discuss these results in the context of evolutionary lability in female preferences for the spectral content of advertisement calls in North American tree frogs in the genus Hyla.

Diabetic striatopathy in an adult with ketotic hyperglycaemia.

Diabetic striatopathy (DS) is a rare and life-threatening mani- festation of diabetes. The disease commonly affects individuals of Asian descent, women and the elderly. DS is characterized by dyskinesias with basal ganglia hyperintensities on imaging. Despite being rare, prompt recognition of a hyperglycaemia- induced hemichorea-hemiballismus is essential because the symptoms are reversible with correction of hyperglycaemia. Diagnosis is based on blood analysis and neuroimaging findings. Laboratory tests reveal raised glycosylated haemoglobin (HbA1c) levels, which indicate poorly controlled diabetes. Neuroimaging provides suggestive findings of DS. It is usually associated with non-ketotic hyperglycaemia. We report a 50-year-old woman who presented with ketotic hyperglycaemia and left-sided hemichorea and partial seizures with secondary generalization.

Managing Patients With Sympathetic Crashing Acute Pulmonary Edema (SCAPE) Using the SCAPE Treatment Protocol: A Case Series.

Pulmonary edema refers to the accumulation of excessive fluid in the alveolar walls and alveolar spaces of the lungs. It is a life-threatening condition with a high mortality rate and requires immediate assessment and management. Use of intravenous nitroglycerin has been advocated for such cases. The authors present a case series of 3 patients who presented to the emergency department with sympathetic crashing acute pulmonary edema (SCAPE) and were managed with high-dose intravenous nitroglycerin and bilevel positive airway pressure support using the SCAPE treatment protocol, leading to early correction of blood pressure, avoidance of endotracheal intubation, and no episodes of hypotension or rebound hypertension. The authors recommend emergency physicians utilize the SCAPE treatment protocol while managing patients with SCAPE.

Clinical spectrum and treatment response in patient of chronic myeloid leukemia in correlation with ABO blood group.

Background: Several studies have been conducted to evaluate and investigate the molecular mechanisms underlying alterations in ABO blood group antigens in oncogenesis. We observed that no study has been reported yet that correlate cytological, molecular and haematological responses of Imatinib therapy in chronic myeloid leukemia (CML) patients with different types of blood groups. Objective: To determine the distribution of CML in the ABO blood group, clinical spectrum of CML in different blood groups, and treatment response of CML patients in correlation with ABO and Rh blood groups. Material and Methods: All the patients included in the study were diagnosed on the basis of clinical features, peripheral smears and bone marrow aspiration findings. Real-time reverse transcriptase polymerase chain reaction (PCR) and cytogenetic analysis were done in all patients at the time of initiation of therapy. Blood grouping and Rh typing of each patient were done at the initiation of therapy. Results: Out of 100 included patients, 58 were male and 42 were female patients. It was observed that 45 (45%) patients were having a B+ blood group; 33% patients were having O+ blood group, followed by A+ (10%), AB+ (8%), A- (2%), B- (1%) and AB- (1%). Around 43.64% study subjects with O + blood groups showed complete cytogenetic response, followed by B+ (41.82%), A+ (10.91), A- (1.82) and AB+ (1.82). An equal number of patients (40% each) with O+ and B+ blood groups, followed by A+ (20%) showed undetectable Abelson-breakpoint cluster region (BCR-ABL)/ratio (%). About 75% of patients showed complete haematological response (CHR) and 25% showed PHR. Patients with B+ and O+ blood groups (41.33%) showed a CHR. It was observed that a maximum number of patients were suffering from symptoms of an abdominal mass (37%), 43.24% of patients with B+ blood group showed an abdominal mass, followed by O+ (35.13%), A+ and AB+ (8.11% each), B - and AB- (2.70% each). Conclusion: This study revealed that study subjects with B+ and O+ blood groups showed better cytogenetic, molecular and haematological responses as compared with patients with other blood groups at 6 and 12 months of treatment with Imatinib.

In Vivo Clonal Analysis Reveals Random Monoallelic Expression in Lymphocytes That Traces Back to Hematopoietic Stem Cells.

Evaluating the epigenetic landscape in the stem cell compartment at the single-cell level is essential to assess the cells' heterogeneity and predict their fate. Here, using a genome-wide transcriptomics approach in vivo, we evaluated the allelic expression imbalance in the progeny of single hematopoietic cells (HSCs) as a read-out of epigenetic marking. After 4 months of extensive proliferation and differentiation, we found that X-chromosome inactivation (XCI) is tightly maintained in all single-HSC derived hematopoietic cells. In contrast, the vast majority of the autosomal genes did not show clonal patterns of random monoallelic expression (RME). However, a persistent allele-specific autosomal transcription in HSCs and their progeny was found in a rare number of cases, none of which has been previously reported. These data show that: 1) XCI and RME in the autosomal chromosomes are driven by different mechanisms; 2) the previously reported high frequency of genes under RME in clones expanded in vitro (up to 15%) is not found in clones undergoing multiple differentiation steps in vivo; 3) prior to differentiation, HSCs have stable patterns of autosomal RME. We propose that most RME patterns in autosomal chromosomes are erased and established de novo during cell lineage differentiation.

Birth and death in terminal complement pathway.

The cytolytic activity of the membrane attack complex (MAC) is pivotal in the complement-mediated elimination of pathogens. Terminal complement pathway (TCP) genes encode the proteins that form the MAC. Although the TCP genes are well conserved within most vertebrate species, the early evolution of the TCP genes is poorly understood. Based on the comparative genomic analysis of the early evolutionary history of the TCP homologs, we evaluated four possible scenarios that could have given rise to the vertebrate TCP. Currently available genomic data support a scheme of complex sequential protein domain gains that may be responsible for the birth of the vertebrate C6 gene. The subsequent duplication and divergence of this vertebrate C6 gene formed the C7, C8α, C8ß, and C9 genes. Compared to the widespread conservation of TCP components within vertebrates, we discovered that C9 has disintegrated in the genomes of galliform birds. Publicly available genome and transcriptome sequencing datasets of chicken from Illumina short read, PacBio long read, and Optical mapping technologies support the validity of the genome assembly at the C9 locus. In this study, we have generated a > 120X coverage whole-genome Chromium 10x linked-read sequencing dataset for the chicken and used it to verify the loss of the C9 gene in the chicken. We find multiple CR1 (chicken repeat 1) element insertions within and near the remnant exons of C9 in several galliform bird genomes. The reconstructed chronology of events shows that the CR1 insertions occurred after C9 gene loss in an early galliform ancestor. Loss of C9 in galliform birds, in contrast to conservation in other vertebrates, may have implications for host-pathogen interactions. Our study of C6 gene birth in an early vertebrate ancestor and C9 gene death in galliform birds provides insights into the evolution of the TCP.

Oxytocin promotes social proximity and decreases vigilance in groups of African lions.

Oxytocin modulates mammalian social behavior; however, behavioral responses to intranasal oxytocin can vary across species and contexts. The complexity of social interactions increases with group dynamics, and the impacts of oxytocin on both within- and between-group contexts are unknown. We tested the effects of intranasal administration of oxytocin on social and non-social behaviors within in-group and out-group contexts in African lions. We hypothesized that, post intranasal oxytocin administration, lions would be in closer proximity with fellow group members, whereas out-group stimuli could either produce a heightened vigilance response or an attenuated one. Compared to control trials, post oxytocin administration, lions increased their time spent in close proximity (reducing their distance to the nearest neighbor) and decreased vigilance toward out-group intruders (reducing their vocalizations following a roar-playback). These results not only have important implications for understanding the evolution of social circuitry but may also have practical applications for conservation efforts.

RNA sequencing-based screen for reactivation of silenced alleles of autosomal genes.

In mammalian cells, maternal and paternal alleles usually have similar transcriptional activity. Epigenetic mechanisms such as X-chromosome inactivation (XCI) and imprinting were historically viewed as rare exceptions to this rule. Discovery of autosomal monoallelic autosomal expression (MAE) a decade ago revealed an additional allele-specific mode regulating thousands of mammalian genes. Despite MAE prevalence, its mechanistic basis remains unknown. Using an RNA sequencing-based screen for reactivation of silenced alleles, we identified DNA methylation as key mechanism of MAE mitotic maintenance. In contrast with the all-or-nothing allelic choice in XCI, allele-specific expression in MAE loci is tunable, with exact allelic imbalance dependent on the extent of DNA methylation. In a subset of MAE genes, allelic imbalance was insensitive to DNA demethylation, implicating additional mechanisms in MAE maintenance in these loci. Our findings identify a key mechanism of MAE maintenance and provide basis for understanding the biological role of MAE.

Unsupervised Deep Learning based Longitudinal Follicular Growth Tracking during IVF Cycle using 3D Transvaginal Ultrasound in Assisted Reproduction.

Longitudinal follicle tracking is needed in clinical practice for diagnosis and management in assisted reproduction. Follicles are tracked over the in-vitro fertilization (IVF) cycle, and this analysis is usually performed manually by a medical practitioner. It is a challenging manual analysis and is prone to error as it is largely operator dependent. In this paper we propose a two-stage framework to address the clinical need for follicular growth tracking. The first stage comprises of an unsupervised deep learning network SFR-Net to automate registration of each and every follicle across the IVF cycle. SFR-Net is composed of the standard 3DUNet [1] and Multi-Scale Residual Blocks (MSRB) [2] in order to register follicles of varying sizes. In the second stage we use the registration result to track individual follicles across the IVF cycle. The 3D Transvaginal Ultrasound (3D TVUS) volumes were acquired from 26 subjects every 2-3 days, resulting in a total of 96 volume pairs for the registration and tracking task. On the test dataset we have achieved an average DICE score of 85.84% for the follicle registration task, and we are successfully able to track follicles above 4 mm. Ours is the novel attempt towards automated tracking of follicular growth [3].Clinical Relevance- Accurate tracking of follicle count and growth is of paramount importance to increase the effectiveness of IVF procedure. Correct predictions can help doctors provide better counselling to the patients and individualize treatment for ovarian stimulation. Favorable outcome of this assisted reproductive technique depends on the estimates of the quality and quantity of the follicular pool. Therefore, automated longitudinal tracking of follicular growth is highly demanded in Assisted Reproduction clinical practice. [4].

Neural basis of acoustic species recognition in a cryptic species complex.

Sexual traits that promote species recognition are important drivers of reproductive isolation, especially among closely related species. Identifying neural processes that shape species differences in recognition is crucial for understanding the causal mechanisms of reproductive isolation. Temporal patterns are salient features of sexual signals that are widely used in species recognition by several taxa, including anurans. Recent advances in our understanding of temporal processing by the anuran auditory system provide an opportunity to investigate the neural basis of species-specific recognition. The anuran inferior colliculus consists of neurons that are selective for temporal features of calls. Of potential relevance are auditory neurons known as interval-counting neurons (ICNs) that are often selective for the pulse rate of conspecific advertisement calls. Here, we tested the hypothesis that ICNs mediate acoustic species recognition by exploiting the known differences in temporal selectivity in two cryptic species of gray treefrog (Hyla chrysoscelis and Hyla versicolor). We examined the extent to which the threshold number of pulses required to elicit behavioral responses from females and neural responses from ICNs was similar within each species but potentially different between the two species. In support of our hypothesis, we found that a species difference in behavioral pulse number thresholds closely matched the species difference in neural pulse number thresholds. However, this relationship held only for ICNs that exhibited band-pass tuning for conspecific pulse rates. Together, these findings suggest that differences in temporal processing of a subset of ICNs provide a mechanistic explanation for reproductive isolation between two cryptic treefrog species.