Precision Antiplatelet Therapy after Percutaneous Coronary Intervention (Precision PCI) Registry - Informing optimal antiplatelet strategies.

Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor (clopidogrel, prasugrel, or ticagrelor) is indicated after percutaneous coronary intervention (PCI) to reduce the risk of atherothrombotic events. Approximately 30% of the US population has a CYP2C19 no-function allele that reduces the effectiveness of clopidogrel, but not prasugrel or ticagrelor, after PCI. We have shown improved outcomes with the integration of CYP2C19 genotyping into clinical care to guide the selection of prasugrel or ticagrelor in CYP2C19 no-function allele carriers. However, the influence of patient-specific demographic, clinical, and other genetic factors on outcomes with genotype-guided DAPT has not been defined. In addition, the impact of genotype-guided de-escalation from prasugrel or ticagrelor to clopidogrel in patients without a CYP2C19 no-function allele has not been investigated in a diverse, real-world clinical setting. The Precision Antiplatelet Therapy after Percutaneous Coronary Intervention (Precision PCI) Registry is a multicenter US registry of patients who underwent PCI and clinical CYP2C19 testing. The registry is enrolling a diverse population, assessing atherothrombotic and bleeding events over 12 months, collecting DNA samples, and conducting platelet function testing in a subset of patients. The registry aims to define the influence of African ancestry and other patient-specific factors on clinical outcomes with CYP2C19-guided DAPT, evaluate the safety and effectiveness of CYP2C19-guided DAPT de-escalation following PCI in a real-world setting, and identify additional genetic influences of clopidogrel response after PCI, with the ultimate goal of establishing optimal strategies for individualized antiplatelet therapy that improves outcomes in a diverse, real-world population.

Comparative evaluation of ethylene oxide, electron beam and gamma irradiation treatments on commonly cultivated red chilli cultivars (Kunri and Hybrid) of Sindh, Pakistan.

Chillies are considered a universal ingredient for imparting flavor and pungency to foods. Pakistan stood in the top twenty countries worldwide by producing 82 thousand Tons of chillies during 2022-23. Chilli fungal contamination and aflatoxin production during drying is a common problem during post-harvest process. Gasses treatment and Ionizing radiations are efficient methods for reducing toxigenic and pathogenic microbial growth in food items. The current study was designed to compare the effects of ethylene oxide (ETO), gamma (GB) & electron beam (EB) treatments on two red chilli local cultivars (Kunri and Hybrid) of Pakistan. After treatment, the chilli samples were analyzed for aflatoxins, physicochemical, quality & safety attributes. All results were subjected to Principal Component Analysis (PCA), Hierarchical Cluster Analysis (HCA), dendrogram and ANOVA to check the correlations, grouping and level of significance within the varieties and treatments. The results showed that moisture and water activity mainly designated PC-2 directions and are slightly positively correlated. Conversely, both fat and proteins have a negative correlation with moisture, ash and water activity. Besides, carotenoids and ABTS assay mainly designated PC-2 directions and are slightly positively correlated. Color, flavonoids and TPC also possess positive correlations among them. ETO depicts effectiveness in the reduction of E. coli but is not effective in saving antioxidant potential such as total flavonoids. Similarly, gamma irradiations showed strong reduction trends in fungal and pathogenic count, however same trend was observed in ascorbic acid too. Besides, the electron beam with dosage levels of 12 and 15 kGy has shown effectiveness against Aspergillus spp., aflatoxins and pathogenic microbial load in addition to saving antioxidant potential (phenolics and flavonoids), physicochemical parameters and color values compared to other applied methods especially in Kunri variety. It was evident from the research that varietal combination in addition to applied treatment must be specially considered while designing a treatment for chillies.

Nine-fold higher risk of acute myocardial infarction in subjects with type 1 diabetes compared to controls in Norway 1973-2017.

BACKGROUND: We aimed to study the cumulative incidence and risk factors (sex, age, calendar year of diabetes onset, country of origin and educational level) of acute myocardial infarction (AMI) in subjects with type 1 diabetes and matched controls. METHODS: A nationwide cohort of subjects with type 1 diabetes diagnosed at age < 15 years in Norway during 1973-2000 was followed until the first AMI event, emigration, death or 31st of December 2017. The Norwegian Childhood Diabetes Registry was linked to five nationwide registries, and up to ten sex- and age-matched controls per case were included. RESULTS: Among 7086 subjects with type 1 diabetes, 170 (2.4%) were identified with incident AMI, compared to 193 (0.3%) of 69,356 controls. Mean age and diabetes duration at first AMI was 40.8 years and 30.6 years, respectively. The probability of AMI after 40 years of follow-up was 8.0% in subjects with type 1 diabetes and 1.1% in controls, aHR 9.05 (95% CI 7.18-11.41). In type 1 diabetes, male sex (aHR 1.45), higher age at onset of diabetes and lower education (higher compared to lower, aHR 0.38) were significantly associated with higher risk of AMI. There was no significant time trend in AMI by calendar year of diabetes onset. CONCLUSIONS: We found nine-fold excess risk of AMI in subjects with type 1 diabetes, and three-fold higher risk in subjects with low versus high education. These results highlight a strengthened focus on prevention of cardiovascular disease, and diabetes education tailored to the subjects' educational background.

End-stage renal disease: incidence and prediction by coronary heart disease, and educational level. Follow-up from diagnosis of childhood-onset type 1 diabetes throughout Norway 1973-2017.

PURPOSE: To investigate incidence of end-stage renal disease (ESRD), and the association of education and coronary heart disease (CHD) with ESRD, in subjects throughout Norway followed from the diagnosis of childhood-onset type 1 diabetes. METHODS: All new onset cases of type 1 diabetes 1973-2016 were followed for CHD and ESRD in nation-wide registries through 2017. Ten matched controls per case were selected from the National Population Register. Cox regression was used to estimate hazard ratios, and probabilities were estimated by the cumulative incidence function accounting for competing risk. RESULTS: Among 9311 patients with type 1 diabetes, 130 developed ESRD with a probability of ESRD after 40 years of 5.5%. The rate was 35-fold higher than in controls (aHR = 35.5, 95% CI 23.1 - 54.6). Higher education was associated with lower risk of ESRD compared to low education (aHR = 0.14, 95% CI 0.07 - 0.27). Diagnosed CHD was associated with 14-fold increased rate of ESRD (aHR = 14.3, 95% CI 9.2 - 22.2). CONCLUSIONS: The hazard rate of ESRD was 35-fold higher in cases compared to controls. CHD was associated with a 14-fold increased rate of subsequent ESRD, while higher education was associated with substantially lower rate of ESRD.

Evaluation of Level-Crossing ADCs for Event-Driven ECG Classification.

In this paper, a new methodology for choosing design parameters of level-crossing analog-to-digital converters (LC-ADCs) is presented that improves sampling accuracy and reduces the data stream rate. Using the MIT-BIH Arrhythmia dataset, several LC-ADC models are designed, simulated and then evaluated in terms of compression and signal-to-distortion ratio. A new one-dimensional convolutional neural network (1D-CNN) based classifier is presented. The 1D-CNN is used to evaluate the event-driven data from several LC-ADC models. With uniformly sampled data, the 1D-CNN has 99.49%, 92.4% and 94.78% overall accuracy, sensitivity and specificity, respectively. In comparison, a 7-bit LC-ADC with 2385 Hz clock frequency and 6-bit clock resolution offers 99.2%, 89.98% and 91.64% overall accuracy, sensitivity and specificity, respectively. It also offers 3x data compression while maintaining a signal-to-distortion ratio of 21.19 dB. Furthermore, it only requires 49% floating-point operations per second (FLOPS) for cardiac arrhythmia classification in comparison with the uniformly sampled ADC. Finally, an open-source event-driven arrhythmia database is presented.

Physicochemical analysis of mango flavored yogurt supplemented with moringa oleifera leaf powder.

The fermented foods are same as traditional food, in appearance and consumed as normal foods but have modified by the addition of certain pro & pre-biotics or fortification with the plant extract, which have specific physiological roles beyond just satisfying nutrition requirement. Fresh leaves of Moringa oleifera were collected from the field of Institutes of Agriculture Sciences, then dried and grounded. The proximate analysis of dried moringa leaf powder and milk was performed. In four different concentrations (0.5%, 1%, 1.5% and 2%) Moringa Oleifera leaf powder, was used for the production of fortified flavoured yogurt, while mango flavor and color was added to enhance its sensory characteristics. Physicochemical analysis (pH, acidity, ash, fat, protein, fiber, synersis, total solid content and moisture content) was done to check the yogurt nutritional profile and effect of moringa dried leaf powder on it. Sensory evaluation (body texture, appearance, color, taste, aroma, flavor and overall acceptability) is also done by expert panel of food scientist (n = 20) by using hedonic scale to check the acceptability and quality of product.To check the product shelf life stability, product is stored at 5 ± 1 ºC for 15 days and observed for its physicochemical changes and sensory attributes. The sample were analyzed for their stablity as fresh and during storage interval of 10th day and 15th day. Results shows that mango flavored yogurt supplemented with 1% Moringa Oleifera leaf powder has got the highest score in majority of the sensory attributes such as body and texture, flavor, taste and overall acceptability over the storage period of 15 days at 5 ± 1 °C. All treatment showed significantly different (p ≤ 0.05) result from each other. However, higher acidity%, total solids%, protein% and synersis value were observed, than control samples on 0 days (fresh), 10 days and 15 days storage, respectively. While all treatments have less pH and moisture content than control during fresh condition and over storage time of 15 days while fat content was nearly same in all treatments and control sample.

Patient Health Outcomes following Dialysis Facility Closures in the United States.

BACKGROUND: Ongoing changes to reimbursement of United States dialysis care may increase the risk of dialysis facility closures. Closures may be particularly detrimental to the health of patients receiving dialysis, who are medically complex and clinically tenuous. METHODS: We used two separate analytic strategies-one using facility-based matching and the other using propensity score matching-to compare health outcomes of patients receiving in-center hemodialysis at United States facilities that closed with outcomes of similar patients who were unaffected. We used negative binomial and Cox regression models to estimate associations of facility closure with hospitalization and mortality in the subsequent 180 days. RESULTS: We identified 8386 patients affected by 521 facility closures from January 2001 through April 2014. In the facility-matched model, closures were associated with 9% higher rates of hospitalization (relative rate ratio [RR], 1.09; 95% confidence interval [95% CI], 1.03 to 1.16), yielding an absolute annual rate difference of 1.69 hospital days per patient-year (95% CI, 0.45 to 2.93). Similarly, in a propensity-matched model, closures were associated with 7% higher rates of hospitalization (RR, 1.07; 95% CI, 1.00 to 1.13; P=0.04), yielding an absolute rate difference of 1.08 hospital days per year (95% CI, 0.04 to 2.12). Closures were associated with nonsignificant increases in mortality (hazard ratio [HR], 1.08; 95% CI, 1.00 to 1.18; P=0.05 for the facility-matched comparison; HR, 1.08; 95% CI, 0.99 to 1.17; P=0.08 for the propensity-matched comparison). CONCLUSIONS: Patients affected by dialysis facility closures experienced increased rates of hospitalization in the subsequent 180 days and may be at increased risk of death. This highlights the need for effective policies that continue to mitigate risk of facility closures.

Evaluation of optimum diabetes care on glycemic control of patients with gestational diabetes during Ramadan fasting.

AIMS: There is limited evidence that evaluates the impact of fasting during Ramadan in pregnant women. We explored the safety of fasting in Gestational Diabetes Mellitus (GDM) in Ramadan, while understating the glycemic variability. METHODS: 25 patients with GDM who choose to fast, were enrolled and provided optimum care that included Ramadan focused education and FreeStyle LibreFlashContinuous Glucose Monitoring(FSL-CGM) was utilized for 2-4 weeks assessment period of non-Ramadan days plus 2-3 weeks during Ramadan and medication adjustment. RESULTS: The average glucose improved significantly, while time in target and percent above target numerically improved during Ramadan compared to pre-Ramadan. There was significant increment on the number of hypoglycemic events in Ramadan. The average lowest blood glucose reading reduced significantly by 14 mg/dL with average duration of hypoglycemic events increased significantly by 38.5 min. CONCLUSION: Our study reinforces the importance of structured education before Ramadan to deliver optimal care for the management of diabetes. Strikingly FSL-CGM demonstrated that hypoglycemia is significantly increased during Ramadan Fasting. There was effective reflection of hyperglycemic spikes, immediately post Iftar. The results corroborated with the earlier studies for higher frequency of hypoglycemia during Ramadan fasting, under similar standards of care in high-risk patients with diabetes.

Serum Galectin-3 and Subsequent Risk of Coronary Heart Disease in Subjects With Childhood-Onset Type 1 Diabetes: A Cohort Study.

OBJECTIVE: To study whether serum galectin-3 and other biomarkers of inflammation predict coronary heart disease (CHD) in subjects with long-standing childhood-onset type 1 diabetes. RESEARCH DESIGN AND METHODS: A population-based nationwide cohort of 299 subjects with type 1 diabetes diagnosed in Norway at <15 years of age during 1973-1982 was examined in 2002-2003 at a mean age of 33 years (range 21-44), with mean diabetes duration of 24 years (range 19-30). Subjects were followed through 31 December 2017 for their first CHD event registered by a hospitalization or cause of death using nationwide registries. Stored serum samples were available for 296 subjects and analyzed for interleukin-6 (IL-6), IL-6 receptor, IL-18, hs-CRP, matrix metalloproteinase-9, tissue inhibitor of metalloproteinase-1 (TIMP-1), galectin-3, and high-sensitivity troponin T. Adjusted hazard ratios (aHRs) for CHD per SD increase in biomarker were estimated using Cox regression. RESULTS: Of 295 subjects, 40 (13.6%) had a documented CHD event during a mean follow-up of 14.4 years (range 0.5-16). IL-6 (aHR 1.32 [95% CI 1.07-1.63]), galectin-3 (aHR 1.44 [95% CI 1.09-1.80]), and TIMP-1 (aHR 1.37 [95% CI 1.04-1.81]) were significant predictors of CHD after adjustment for conventional risk factors. CONCLUSIONS: Galectin-3 was significantly associated with future CHD in subjects with type 1 diabetes, and if the results are replicated in larger studies, it may aid in prediction together with conventional risk factors for CHD.

Atmospheric Pressure Catalytic Vapor Deposition of Graphene on Liquid Sn and Cu-Sn Alloy Substrates.

The chemical vapor deposition (CVD) of graphene on liquid substrates produces high quality graphene films due to the defect-free and atomically flat surfaces of the liquids. Through the detailed study of graphene growth on liquid Sn using atmospheric pressure CVD (APCVD), the quality of graphene has been found to have a close relationship with hydrogen flow rate that reflects on hydrogen partial pressure inside the reactor (PH2) and hydrogen solubility of the growth substrates. The role of PH2 was found to be crucial, with a low defect density monolayer graphene being obtained in low PH2 (90.4 mbar), while partial graphene coverage occurred at high PH2 (137.3 mbar). To further understand the role of substrate's composition, binary alloy with compositions of 20, 30, 50, 60 and 80 wt.% tin in copper were made by arc-melting. Graphene quality was found to decrease with increasing the content of copper in the Cu-Sn alloys when grown using the conditions optimised for Sn substrates and this was related to the change in hydrogen solubility and the high catalytic activity of Cu compared to Sn. This shall provide a tool to help optimising CVD conditions for graphene growth based on the properties of the used catalytic substrate.

Effect of High Ammonium Salt Concentration and Temperature on the Structure, Morphology, and Ionic Conductivity of Proton-Conductor Solid Polymer Electrolytes Based PVA.

Polyvinyl alcohol (PVA) based proton-conducting solid polymer electrolyte was prepared with a high salt concentration of ammonium nitrate (NH4NO3) by the technique of solvent casting. From the X-ray diffraction studies, the semicrystalline nature of PVA with the inclusion of NH4NO3 was studied. XRD analysis indicates that the highest ion conductive sample exhibits the minimum crystalline nature. The decreasing trend of Jonscher-exponent with temperature rise reveals that the present system is insured by the correlated barrier hopping (CBH) model. The maximum room temperature conductivity was found to be 5.17 × 10-5 S/cm for PVA loaded 30 wt.% of NH4NO3. The ionic transport of the proton-conducting solid polymer electrolyte was studied at the temperature range of 303-353 K. The conductivity-temperature relationship of the systems was analyzed using both the Arrhenius and Vogel-Tammann-Fulcher (VTF) models to explain the ionic hopping mechanism for the system.

Chemical Vapour Deposition of Graphene-Synthesis, Characterisation, and Applications: A Review.

Graphene as the 2D material with extraordinary properties has attracted the interest of research communities to master the synthesis of this remarkable material at a large scale without sacrificing the quality. Although Top-Down and Bottom-Up approaches produce graphene of different quality, chemical vapour deposition (CVD) stands as the most promising technique. This review details the leading CVD methods for graphene growth, including hot-wall, cold-wall and plasma-enhanced CVD. The role of process conditions and growth substrates on the nucleation and growth of graphene film are thoroughly discussed. The essential characterisation techniques in the study of CVD-grown graphene are reported, highlighting the characteristics of a sample which can be extracted from those techniques. This review also offers a brief overview of the applications to which CVD-grown graphene is well-suited, drawing particular attention to its potential in the sectors of energy and electronic devices.

Glass-Forming Ability and Soft Magnetic Properties of (Co75Ti25)100-xFex (x; 0-20 at.%) Systems Fabricated by SPS of Mechanically Alloyed Nanopowders.

Due to their outstanding mechanical properties and soft magnetic characteristics, cobalt-based metallic glassy alloys have stimulated much interesting research. These metastable ferromagnetic materials possess very small magnetocrystalline anisotropy, and almost zero magnetostriction. They reveal low coercivity, extremely low core loss, moderate saturation polarization, and very high magnetism. Despite these attractive physical behaviors, Co-based metallic glasses are difficult to obtain by the melting/casting and conventional rapid solidification techniques due to their poor glass-forming ability. In the present study, we succeed in preparing (Co75Ti25)100-xFex (x; 0-20 at.%) metallic glassy powders, using a mechanical alloying approach. The end product of the as-prepared powders was consolidated into full dense cylinders with large-diameter and thickness (2 × 2 cm), using spark plasma sintering technique. The results have shown that the consolidation step did not lead to any undesired crystallizations or phase transformations, and the as-consolidated buttons maintained their unique short-range order structure. These bulk metallic glassy systems possessed high glass-transition and crystallization temperatures, suggesting their high thermal stability. However, they showed low values of the reduced glass-transition temperatures, indicating that this system is difficult to prepare by the conventional way of preparations.

Consolidation in dialysis Markets-Causes, consequences, and the role of policy.

The dialysis industry is one of the most highly concentrated healthcare sectors in the United States. Despite decades of growth in the number of patients with end-stage renal disease and in the size of dialysis markets, two large dialysis organizations currently care for more than two-thirds of the dialysis population. Economies of scale, bargaining leverage with suppliers and private insurers, barriers to entry, and government regulations have contributed to highly concentrated dialysis markets by conferring advantages to larger organizations. Consolidated dialysis markets have coincided with both positive and negative trends in healthcare costs and outcomes. Costs per patient receiving dialysis have grown at a slower rate than per capita Medicare costs, while access to dialysis care remains available across a wide socioeconomic range. Mortality rates have declined despite a sicker dialysis patient population. Yet, concerns remain about the cost and quality of dialysis care. Evidence suggests that chain ownership, for profit status, and less market competition may negatively impact health outcomes. Future policies and innovations involving kidney health may temporarily disrupt consolidation. However, if the underlying mechanisms that contributed to past consolidation persist, dialysis markets may remain highly concentrated over the long term.

The formation mechanism of hexagonal Mo2C defects in CVD graphene grown on liquid copper.

Thin Mo2C hexagonal defects precipitate in CVD graphene when Mo crucibles are engaged to hold the liquid copper substrate, while these defects disappear when W crucibles are present. These defects have been identified as the thin precipitates of Mo2C. The growth mechanism of the Mo2C defects is demonstrated through thermodynamic calculations. This can be beneficial in graphene defect engineering through the vapour phase transport of the volatile MoO3 phase.

Improving Residency Education on Chronic Pain and Opioid Use Disorder: Evaluation of CDC Guideline-Based Education.

Background: National surveys show that primary care physicians feel responsible for addressing the opioid epidemic. They feel their training in managing chronic pain and addiction was insufficient, and commonly endorse the need for more residency training in these areas. However, residency training in these areas remains low, with a lack of faculty expertise and time as the most commonly cited barriers for improvement. Objective: To evaluate the feasibility of an educational program for chronic pain management and addiction that does not rely on faculty expertise or additional time, and assess resident opioid-prescribing practices and confidence in managing chronic pain after its implementation. Methods: A 16-week educational curriculum was incorporated into existing residency didactics. Internal medicine residents attended six educational sessions in 2016 over a 16-week period and implemented a protocol based on CDC Guidelines for Prescribing Opioids for Chronic Pain. Surveys were completed pre- and post-intervention. Results: Implementation of this educational intervention was feasible. Surveys showed improvement in resident confidence in detecting and managing addiction and improved prescribing practices and adherence to CDC recommendations. Conclusion: This pilot study demonstrates that increasing residency education in managing chronic pain and opioid use disorder is feasible, and no longer needs to be postponed due to lack of time or faculty expertise.

Computationally efficient fully-automatic online neural spike detection and sorting in presence of multi-unit activity for implantable circuits.

BACKGROUND: Spike sorting is a basic step for implantable neural interfaces. With the growing number of channels, the process should be computationally efficient, automatic,robust and applicable on implantable circuits. NEW METHOD: The proposed method is a combination of fully-automatic offline and online processes. It introduces a novel method for automatically determining a data-aware spike detection threshold, computationally efficient spike feature extraction, automatic optimal cluster number evaluation and verification coupled with Self-Organizing Maps to accurately determine cluster centroids. The system has the ability of unsupervised online operation after initial fully-automatic offline training. The prime focus of this paper is to fully-automate the complete spike detection and sorting pipeline, while keeping the accuracy high. RESULTS: The proposed system is simulated on two well-known datasets. The automatic threshold improves detection accuracies significantly( > 15%) as compared to the most common detector. The system is able to effectively handle background multi-unit activity with improved performance. COMPARISON: Most of the existing methods are not fully-automatic; they require supervision and expert intervention at various stages of the pipeline. Secondly, existing works focus on foreground neural activity. Recent research has highlighted importance of background multi-unit activity, and this work is amongst the first efforts that proposes and verifies an automatic methodology to effectively handle them as well. CONCLUSION: This paper proposes a fully-automatic, computationally efficient system for spike sorting for both single-unit and multi-unit spikes. Although the scope of this work is design and verification through computer simulations, the system has been designed to be easily transferable into an integrated hardware form.

Use of flash glucose monitoring system in assessing safety of the SGLT2 inhibitors during Ramadan fasting in high risk insulin treated patients with type 2 diabetes.

BACKGROUND: The risks of hypoglycemia, dehydration and kidney injury may theoretically be aggravated by people with type 2 diabetes treated with Insulin and SGLT2 inhibitors during Ramadan. Data on safety and efficacy of SGLT2-I in people with type 2 diabetes treated with insulin is scanty. We aimed to assess the impact of SGLT2 inhibitors during Ramadan in high-risk patients with type 2 diabetes treated with insulin, on hypoglycemia, glycemic control and kidney function. METHODS: This is a prospective interventional study on high-risk diabetes patients who insisted on fasting. All patients were treated with insulin ±â€¯SGLT2I. All patients received a FGMS and Ramadan focused education. All patients attended clinic before and post Ramadan where they were advised on treatment modification as well as biometric and biochemical measurements. RESULTS: 95 patients enrolled in the study and 49 of them were on SGLT2i. There was a no significant change in creatinine in both groups. FGMS showed an improvement in the sensor-calculated HbA1c from 7.3 ±â€¯1.5 to 6.8 ±â€¯1.1 and from 8 ±â€¯1.6 to 7.7 ±â€¯1.5 in the SGLT2 group and the non-SGT2i groups, respectively. The hypoglycemia was predominantly reported during Ramadan between 12:00 to 18:00 h, while in pre-Ramadan readings was during 2400-0600 and 1200-1800 slots. CONCLUSIONS: This is the first study that assesses the use of SGLT2i along with insulin during Ramadan, using FGMS in high-risk patients with type 2 diabetes under optimal care. There was minimal interruption of fasting, significant improvement in glycemic control, and no significant change in the kidney function after Ramadan.

The use of Free Style Libre Continues Glucose Monitoring (FSL-CGM) to monitor the impact of Ramadan fasting on glycemic changes and kidney function in high-risk patients with diabetes and chronic kidney disease stage 3 under optimal diabetes care.

AIM: To understand the risk of hypoglycaemia during Ramadan fasting by use of CGM, as well as to observe the Glycemic control and renal functions in patients with diabetes and chronic kidney disease stage 3 (CKD-3). METHOD: A prospective interventional study conducted in the Dubai Hospital, a tertiary care centre in the United Arab Emirates, during the month of Ramadan 1437 AH (Hijri), which corresponded to June 6th till July 5th, 2016. 25 patients with type 2 diabetes and stage 3 chronic kidney disease (CKD stage 3) were included in the study, who intended to fast during Ramadan. The aim was to observe the serum glucose level through 24 h FreeStyle Libre flash continuous glucose monitor (FSL-CGM). Most patients had three sensors during the study, covering an average three weeks during Ramadan and three weeks outside Ramadan (Sha'ban and shawal). We also monitored the change in, BP, HBA1c, kidney functions and BMI before and after Ramadan. RESULTS: This study included 25 adults with a mean age of 60 (±14 years). Fasting Ramadan did not result in any significant change in biophysical and biochemical profile of these patients. Data from FSL-CGM showed significantly longer duration (101.9 ±â€¯119.1 Vs. 45.9 ±â€¯47.6 min, p < 0.033) and more frequent hypoglycemic episodes (4.4 ±â€¯4.7 Vs. 2.3 ±â€¯3.0, p < 0.047) during Ramadan compared tonon-Ramadan respectively. The mean blood glucose readings were also significantly lower (70.7 ±â€¯29.3 Vs.93.7 ±â€¯57.9 mg/dl p < 0.011) during Ramadan compared to non -fasting period. The renal function mean ±â€¯SD (serum creatinine 1.48 ±â€¯0.37, 1.44 ±â€¯0.37 and eGFR, 49.0 ±â€¯18.4, 48.9 ±â€¯17.5 p 0.9) showed no significant change due to fasting. CONCLUSION: In patients with diabetes and CKD-stage 3 Ramadan fasting under close supervision and optimal diabetes care, was not associated with worsening of HBA1c and renal function. Patients had significantly more frequent and prolonged hypoglycemic episodes during Ramadan.

Deposition of Stainless Steel Thin Films: An Electron Beam Physical Vapour Deposition Approach.

This study demonstrates an electron beam physical vapour deposition approach as an alternative stainless steel thin films fabrication method with controlled layer thickness and uniform particles distribution capability. The films were fabricated at a range of starting electron beam power percentages of 3⁻10%, and thickness of 50⁻150 nm. Surface topography and wettability analysis of the samples were investigated to observe the changes in surface microstructure and the contact angle behaviour of 20 °C to 60 °C deionised waters, of pH 4, pH 7, and pH 9, with the as-prepared surfaces. The results indicated that films fabricated at low controlled deposition rates provided uniform particles distribution and had the closest elemental percentages to stainless steel 316L and that increasing the deposition thickness caused the surface roughness to reduce by 38%. Surface wettability behaviour, in general, showed that the surface hydrophobic nature tends to weaken with the increase in temperature of the three examined fluids.