Prevalence and prognosis of fulminant type 1 diabetes mellitus in The Middle East: a comparative analysis in a 5-year nationwide cohort.

PURPOSE: To analyze the prevalence and progression of fulminant type 1 diabetes (FT1D) in Qatar. METHODS: This retrospective study analyzed consecutive index- diabetic ketoacidosis (DKA) admissions (2015-2020) among patients with new-onset T1D (NT1D) in Qatar. RESULTS: Of the 242 patients, 2.5% fulfilled the FT1D diagnostic criteria. FT1D patients were younger (median-age 4-years vs.15-years in classic-T1D). Gender distribution in FT1D was equal, whereas the classic-T1D group showed a female predominance at 57.6% (n = 136). FT1D patients had a mean C-peptide of 0.11 ± 0.09 ng/ml, compared to 0.53 ± 0.45 ng/ml in classic-T1D. FT1D patients had a median length of stay (LOS) of 1 day (1-2.2) and a DKA duration of 11.25 h (11-15). The median (length of stay) LOS and DKA duration in classic-T1D patients were 2.5 days (1-3.9) and 15.4 h (11-23), respectively. The FT1D subset primarily consisted of moderate (83.3%) and severe 916.7%) DKA, whereas classic T1D had 25.4% mild, 60.6% moderate, and 14% severe DKA cases. FT1D was associated with a higher median white cell count (22.3 × 103/uL) at admission compared to classic T1D (10.6 × 103/uL). ICU admission was needed for 66.6% of FT1D patients, compared to 38.1% of classic-T1D patients. None of the patients in the FT1D group had mortality, while two died in the classic-T1D group. CONCLUSION: This is the first study establishing the existence of FT1D in ME, which presented distinctively from classic-T1D, exhibiting earlier age onset and higher critical care requirements. However, the clinical outcomes in patients with FT1D seem similar to classic T1D.

The role of medical-grade maggots in facilitating healing of diabetic foot ulcers in Kano, northern Nigeria: a case series.

OBJECTIVE: Approximately 13% of people living with diabetes develop one or more ulcers during the course of the disease, and diabetic foot ulcer (DFU) is responsible for >60% of lower limb amputations worldwide. This case series aimed to demonstrate the effectiveness of medical-grade maggots on DFUs in promoting wound healing and reducing related hospital stays in northern Nigeria. METHOD: Maggot debridement therapy (MDT) was applied to the DFUs of patients who consented to this treatment between January-August 2021 at the Orthopaedic Unit of the Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria. Sterile first instar larvae of Lucilia sericata were obtained indigenously and applied using the confinement (free-range) method under aseptic procedure. RESULTS: A total of 15 patients with DFUs of Wagner classification grades III (33.3%) and IV (66.7%), were seen and documented. The patients included 10 (66.7%) females and five (33.3%) males, giving a female:male ratio of 2:1. The mean age (±standard deviation) of the respondents was 51.6±10.8 years. The surface area of the wounds ranged from 24-140cm2, with a median value of 75cm2. Among the patients, 60% had two cycles of MDT, with a median duration of five days. Most of the wounds (53.3%) were debrided within five days; 13.3% (two wounds) took seven days to be fully debrided. A paired sample t-test showed a statistically significant association between wound surface area and therapy duration (t=8.0; p=0.000) and between wound surface area and cycles of therapy (t=8.3; p=0.000). Before maggot application, 14 (93.3%) DFUs were completely (100%) covered with slough and only one (6.7%) was 95% covered with slough. After maggot application, 10 (66.7%) wounds were completely debrided while five (33.3%) wounds required bedside surgical debridement to achieve complete debridement. A paired sample t-test showed statistically significant difference between the pre- and post-MDT slough covering the wounds (t=45.1; p=0.000). CONCLUSION: In this case series, MDT was successfully used in the debridement of DFUs, which facilitated the healing process with an encouraging clinical outcome.

Abreast insights of harnessing microalgal lipids for producing biodiesel: A review of improving and advancing the technical aspects of cultivation.

In the pursuit of alternatives for conventional diesel, sourced from non-renewable fossil fuel, biodiesel has gained attentions for its intrinsic benefits. However, the commercial production process for biodiesel is still not sufficiently competitive. This review analyses microalgal lipid, one of the important sources of biodiesel, and its cultivation techniques with recent developments in the technical aspects. In fact, the microalgal lipids are the third generation feedstock, used for biodiesel production after its benefits outweigh that of edible vegetable oils (first generation) and non-edible oils (second generation). The critical factors influencing microalgal growth and its lipid production and accumulation are also discussed. Following that is the internal enhancement for cellular lipid production through genetic engineering. Moreover, the microalgae cultivation data modelling was also rationalized, with a specific focus on growth kinetic models that allow for the prediction and optimization of lipid production. Finally, the machine learning and environmental impact analysis are as well presented as important aspects to consider in fulfilling the prime objective of commercial sustainability to produce microalgal biodiesel.

Differential evolution of diabetic ketoacidosis in adults with pre-existent versus newly diagnosed type 1 and type 2 diabetes mellitus.

BACKGROUND: Diabetic ketoacidosis (DKA) was once known to be specific to type-1 diabetes-mellitus (T1D); however, many cases are now seen in patients with type-2 diabetes-mellitus (T2D). Little is known about how this etiology shift affects DKA's outcomes. METHODS: We studied consecutive index DKA admissions from January 2015 to March 2021. Descriptive analyses were performed based on pre-existing T1D and T2D (PT1D and PT2D, respectively) and newly diagnosed T1D and T2D (NT1D and NT2D, respectively). RESULTS: Of the 922 patients, 480 (52%) had T1D, of which 69% had PT1D and 31% NT1D, whereas 442 (48%) had T2D, of which 60% had PT2D and 40% NT2D. The mean age was highest in PT2D (47.6 ± 13.1 years) and lowest in PT1D (27.3 ± 0.5 years) (P < 0.001). Patients in all groups were predominantly male except in the PT1D group (55% females) (P < 0.001). Most patients were Arabic (76% in PT1D, 51.4% in NT1D, 46.6% in PT2D) except for NT2D, which mainly comprised Asians (53%) (P < 0.001). Patients with NT2D had the longest hospital length of stay (LOS) (6.8 ± 11.3 days) (P < 0.001), longest DKA duration (26.6 ± 21.1 h) (P < 0.001), and more intensive-care unit (ICU) admissions (31.2%) (P < 0.001). Patients with PT1D had the shortest LOS (2.5 ± 3.5 days) (P < 0.001), DKA duration (18.9 ± 4.2 h) (P < 0.001), and lowest ICU admissions (16.6%) (P < 0.001). CONCLUSIONS/INTERPRETATION: We presented the largest regional data on differences in DKA based on the type and duration of diabetes- mellitus (DM), showing that T2D is becoming an increasing cause of DKA, with worse clinical outcomes (especially newly diagnosed T2D) compared to T1D.

The impact of minimum unit pricing on traumatic brain injury in Scotland: a retrospective cohort study of routine national data.

BACKGROUND: Traumatic brain injury (TBI) is a common cause of disability and mortality and is associated with alcohol consumption. On 1st May 2018, the Scottish Government introduced Minimum Unit Pricing (MUP) legislation which set the floor price at which alcohol can be sold to 50 pence per unit. While MUP has led to a 7.6% decrease in off trade alcohol purchases, there are limited studies investigating the clinical impact of this legislation. This study aims to explore the impact of MUP on traumatic brain injury in Scotland. METHODS: Retrospective cohort study using routinely collected national data collated by the Scottish Trauma Audit Group. Data were requested for all TBI incidents from 1st May to 31st December for both 2017 and 2018. Primary outcome was alcohol-related TBI. Secondary outcomes were injury mechanism, injury severity, clinical course, and short-term mortality. Analysis was conducted using multiple regression models adjusted for age, sex, season, and deprivation. RESULTS: A total of 1166 patients (66% male, and 46% in the 60-79-year bracket) were identified. Alcohol-related TBI was evident in 184 of 509 (36%) patients before MUP and in 239 of 657 (36%) patients injured after its implementation (p = 0.638). Further, there was no change in injury mechanism, injury severity, hospital course and short-term mortality of TBI after MUP. CONCLUSIONS: MUP has not resulted in a change in alcohol-related TBI nor in the mechanism and severity of TBI. Limitations in two-point analysis mean that findings should be interpreted with caution and further studies investigating the clinical outcomes of MUP must be conducted.

Maggot debridement therapy and complementary wound care: a case series from Nigeria.

OBJECTIVE: Maggot debridement therapy (MDT) is an emerging procedure involving the application of sterile maggots of the Dipteran species (commonly Lucilia sericata) to effect debridement, disinfection and promote healing in wounds not responding to antimicrobial therapy. Data on MDT in sub-Saharan Africa (including Nigeria) are scarce. This study aimed to use medicinal grade maggots as a complementary method to debride hard-to-heal necrotic ulcers and thereby promote wound healing. METHOD: In this descriptive study, we reported on the first group of patients who had MDT at Aminu Kano Teaching Hospital (AKTH), a tertiary hospital in northern Nigeria. The first instar larvae of Lucilia sericata were applied using the confinement (free-range) maggot therapy dressing method under aseptic conditions. RESULTS: Diabetic foot ulcer (DFU) grade III-IV constituted more than half of the wounds (53.3%), followed by necrotising fasciitis (30%), and post-traumatic wound infection (10%). Others (6.7%, included pyomyositis, surgical site infection and post traumatic wound infection). The median surface area of the wounds was 56cm2. Of the 30 patients, half (50%) had two MDT cycles with a median time of four days. Of the wounds, 22 (73%) were completely debrided using maggots alone while eight (27%) achieved complete debridement together with surgical debridement. Wound culture pre-MDT yielded bacterial growth for all the patients and Staphylococcus aureus was the predominant isolate in 17 wounds (56.7%) while Pseudomonas aeruginosa and Streptococcus pyogenes were predominant in five wounds (16.7%) each. Only four (13.3%) wound cultures yielded bacterial growth after MDT, all Staphylococcus aureus. CONCLUSION: A good prognosis was achieved post-MDT for various wounds. MDT effectively debrides and significantly disinfects wounds involving different anatomical sites, thus enhancing wound healing and recovery. MDT is recommended in such wounds.

Greedy Firefly Algorithm for Optimizing Job Scheduling in IoT Grid Computing.

The Internet of Things (IoT) is defined as interconnected digital and mechanical devices with intelligent and interactive data transmission features over a defined network. The ability of the IoT to collect, analyze and mine data into information and knowledge motivates the integration of IoT with grid and cloud computing. New job scheduling techniques are crucial for the effective integration and management of IoT with grid computing as they provide optimal computational solutions. The computational grid is a modern technology that enables distributed computing to take advantage of a organization's resources in order to handle complex computational problems. However, the scheduling process is considered an NP-hard problem due to the heterogeneity of resources and management systems in the IoT grid. This paper proposed a Greedy Firefly Algorithm (GFA) for jobs scheduling in the grid environment. In the proposed greedy firefly algorithm, a greedy method is utilized as a local search mechanism to enhance the rate of convergence and efficiency of schedules produced by the standard firefly algorithm. Several experiments were conducted using the GridSim toolkit to evaluate the proposed greedy firefly algorithm's performance. The study measured several sizes of real grid computing workload traces, starting with lightweight traces with only 500 jobs, then typical with 3000 to 7000 jobs, and finally heavy load containing 8000 to 10,000 jobs. The experiment results revealed that the greedy firefly algorithm could insignificantly reduce the makespan makespan and execution times of the IoT grid scheduling process as compared to other evaluated scheduling methods. Furthermore, the proposed greedy firefly algorithm converges on large search spacefaster , making it suitable for large-scale IoT grid environments.

Design-Time Reliability Prediction Model for Component-Based Software Systems.

Software reliability is prioritised as the most critical quality attribute. Reliability prediction models participate in the prevention of software failures which can cause vital events and disastrous consequences in safety-critical applications or even in businesses. Predicting reliability during design allows software developers to avoid potential design problems, which can otherwise result in reconstructing an entire system when discovered at later stages of the software development life-cycle. Several reliability models have been built to predict reliability during software development. However, several issues still exist in these models. Current models suffer from a scalability issue referred to as the modeling of large systems. The scalability solutions usually come at a high computational cost, requiring solutions. Secondly, consideration of the nature of concurrent applications in reliability prediction is another issue. We propose a reliability prediction model that enhances scalability by introducing a system-level scenario synthesis mechanism that mitigates complexity. Additionally, the proposed model supports modeling of the nature of concurrent applications through adaption of formal statistical distribution toward scenario combination. The proposed model was evaluated using sensors-based case studies. The experimental results show the effectiveness of the proposed model from the view of computational cost reduction compared to similar models. This reduction is the main parameter for scalability enhancement. In addition, the presented work can enable system developers to know up to which load their system will be reliable via observation of the reliability value in several running scenarios.

Recent advancements in the treatment of palm oil mill effluent (POME) using anaerobic biofilm reactors: Challenges and future perspectives.

Palm oil is the most utilized vegetable globally which is mostly produced in countries such as Malaysia, Indonesia and Thailand. The great amount of POME generation from palm oil mills is now a threat to the environment and require a suitable treatment of POME to reduce the organic strength in accordance with the standard discharge limit before releasing to the environment. Currently, the technology to combine the anaerobic process and biofilm system in bioreactors have produced a fresh idea in treatments of high strength wastewater like POME. Anaerobic biofilm reactor is a convincing method for POME treatment due to its significant advantages over the conventional biological treatments consisting of anaerobic, aerobic and facultative pond systems. Overall, integrated anaerobic-aerobic bioreactor (IAAB) can remove more than 99% of chemical oxygen demand (COD), biochemical oxygen demand (BOD) and total suspended solids (TSS) with the combination of anaerobic and aerobic digestion for POME treatment. It has better performance as compared to up-flow anaerobic sludge blanket (UASB) and up-flow anaerobic filter (UAF) with 80% and 88-94% COD removal efficiency respectively. Anaerobic pond was found to perform well also by removing 97.8% of COD in POME but require long retention time and larger land. Hence, this study aims to provide intensive review of the performance of the anaerobic biofilm reactor in treating POME and the recent advancements in this technology. The limitations and future perspectives in utilization of anaerobic biofilm reactor during its operation in treating POME are discussed.

Potential use of algae for the bioremediation of different types of wastewater and contaminants: Production of bioproducts and biofuel for green circular economy.

Remediation by algae is a very effective strategy for avoiding the use of costly, environmentally harmful chemicals in wastewater treatment. Recently, industries based on biomass, especially the bioenergy sector, are getting increasing attention due to their environmental acceptability. However, their practical application is still limited due to the growing cost of raw materials such as algal biomass, harvesting and processing limitations. Potential use of algal biomass includes nutrients recovery, heavy metals removal, COD, BOD, coliforms, and other disease-causing pathogens reduction and production of bioenergy and valuable products. However, the production of algal biomass using the variable composition of different wastewater streams as a source of growing medium and the application of treated water for subsequent use in agriculture for irrigation has remained a challenging task. The present review highlights and discusses the potential role of algae in removing beneficial nutrients from different wastewater streams with complex chemical compositions as a biorefinery concept and subsequent use of produced algal biomass for bioenergy and bioactive compounds. Moreover, challenges in producing algal biomass using various wastewater streams and ways to alleviate the stress caused by the toxic and high concentrations of nutrients in the wastewater stream have been discussed in detail. The technology will be economically feasible and publicly accepted by reducing the cost of algal biomass production and reducing the loaded or attached concentration of micropollutants and pathogenic microorganisms. Algal strain improvement, consortium development, biofilm formation, building an advanced cultivation reactor system, biorefinery concept development, and life-cycle assessment are all possible options for attaining a sustainable solution for sustainable biofuel production. Furthermore, producing valuable compounds, including pharmaceutical, nutraceutical and pigment contents generated from algal biomass during biofuel production, could also help reduce the cost of wastewater management by microalgae.

Towards Secure Big Data Analysis via Fully Homomorphic Encryption Algorithms.

Privacy-preserving techniques allow private information to be used without compromising privacy. Most encryption algorithms, such as the Advanced Encryption Standard (AES) algorithm, cannot perform computational operations on encrypted data without first applying the decryption process. Homomorphic encryption algorithms provide innovative solutions to support computations on encrypted data while preserving the content of private information. However, these algorithms have some limitations, such as computational cost as well as the need for modifications for each case study. In this paper, we present a comprehensive overview of various homomorphic encryption tools for Big Data analysis and their applications. We also discuss a security framework for Big Data analysis while preserving privacy using homomorphic encryption algorithms. We highlight the fundamental features and tradeoffs that should be considered when choosing the right approach for Big Data applications in practice. We then present a comparison of popular current homomorphic encryption tools with respect to these identified characteristics. We examine the implementation results of various homomorphic encryption toolkits and compare their performances. Finally, we highlight some important issues and research opportunities. We aim to anticipate how homomorphic encryption technology will be useful for secure Big Data processing, especially to improve the utility and performance of privacy-preserving machine learning.

Bimodal distribution of thyroid dysfunction triggered by COVID-19 Infection: An experience from a single endocrine center-a case series and literature review.

BACKGROUND: COVID-19 infection has been spreading across the globe since the end of 2019, and it continues to cause chronic multi-system sequelae, of which thyroid dysfunction appears to be the major one. We have discussed here 10 cases of thyroid dysfunction after COVID-19 infection. METHODS: Case series report. From October 2020 to July 2021, a series of 10 cases of thyroid dysfunction after COVID-19 infection were recorded and managed in a single outpatient endocrine center in Doha, Qatar. CASES PRESENTATION: We have reported 5 cases of Graves's hyperthyroidism, 2 of chronic primary hypothyroidism (including one with Grave's disease [GD]) who was treated through radioactive iodine (RAI) therapy, one case of subacute thyroiditis, one case with "Sick euthyroid disease," and one case of central hypothyroidism. Presently, patients with GD are being treated with carbimazole and those with hypothyroidism are being treated with levothyroxine. The remaining patients had recovered with euthyroid. CONCLUSION: This is the largest case series reported from a single center to date. The findings of this series indicate a bimodal distribution of thyroid dysfunction in patients with COVID-19 infection. A review of the literature and discussion of potential pathophysiological mechanisms has been presented. We have emphasized the importance of screening for thyroid dysfunction in "post-COVID-19" cases, considering that the prevalence may be underestimated.

Metformin is comparable to insulin for pharmacotherapy in gestational diabetes mellitus: A network meta-analysis evaluating 6046 women.

CONTEXT: The comparative efficacy of gestational diabetes (GDM) treatments lack conclusive evidence for choice of first-line treatment. OBJECTIVES: The aim of this study was to compare the efficacy of metformin and glibenclamide to insulin using a core outcome set (COS) to unify outcomes across trials investigating the treatment of gestational diabetes mellitus. STUDY DESIGN: A network meta-analysis (NMA) was conducted. DATA-SOURCE: PubMed, Embase, and Cochrane Controlled Register of Trials were searched from inception to January 2020. STUDY SELECTION: RCTs that enrolled pregnant women who were diagnosed with GDM and that compared the efficacy of different pharmacological interventions for the treatment of GDM were included. META-ANALYSIS: A generalized pairwise modelling framework was employed. RESULTS: A total of 38 RCTs with 6046 participants were included in the network meta-analysis. Compared to insulin, the estimated effect of metformin indicated improvements for weight gain (WMD -2·39 kg; 95% CI -3·31 to -1·46), maternal hypoglycemia (OR 0.34; 95% CI 0.12 to 0·97) and LGA (OR 0.61; 95% CI 0.38 to 0·98). There were also improvements in estimated effects for neonatal hypoglycemia (OR 0.48; 95% CI 0.19 to 1·25), pregnancy induced hypertension (OR 0.63; 95% CI 0.37 to 1·06), and preeclampsia (OR 0.74; 95% CI 0.538 to 1·04), though with limited evidence against our model hypothesis of equivalence with insulin for these outcomes. CONCLUSION: Metformin is, at least, comparable to insulin for the treatment of GDM. Glibenclamide appears less favorable, in comparison to insulin, than metformin.

An Update on COVID-19 Vaccine Induced Thrombotic Thrombocytopenia Syndrome and Some Management Recommendations.

The thrombotic thrombocytopenia syndrome (TTS), a complication of COVID-19 vaccines, involves thrombosis (often cerebral venous sinus thrombosis) and thrombocytopenia with occasional pulmonary embolism and arterial ischemia. TTS appears to mostly affect females aged between 20 and 50 years old, with no predisposing risk factors conclusively identified so far. Cases are characterized by thrombocytopenia, higher levels of D-dimers than commonly observed in venous thromboembolic events, inexplicably low fibrinogen levels and worsening thrombosis. Hyper fibrinolysis associated with bleeding can also occur. Antibodies that bind platelet factor 4, similar to those associated with heparin-induced thrombocytopenia, have also been identified but in the absence of patient exposure to heparin treatment. A number of countries have now suspended the use of adenovirus-vectored vaccines for younger individuals. The prevailing opinion of most experts is that the risk of developing COVID-19 disease, including thrombosis, far exceeds the extremely low risk of TTS associated with highly efficacious vaccines. Mass vaccination should continue but with caution. Vaccines that are more likely to cause TTS (e.g., Vaxzevria manufactured by AstraZeneca) should be avoided in younger patients for whom an alternative vaccine is available.

Metabolic profiling of pre-gestational and gestational diabetes mellitus identifies novel predictors of pre-term delivery.

BACKGROUND: Pregnant women with gestational diabetes mellitus (GDM) or type 2 diabetes mellitus (T2DM) are at increased risks of pre-term labor, hypertension and preeclampsia. In this study, metabolic profiling of blood samples collected from GDM, T2DM and control pregnant women was undertaken to identify potential diagnostic biomarkers in GDM/T2DM and compared to pregnancy outcome. METHODS: Sixty-seven pregnant women (21 controls, 32 GDM, 14 T2DM) in their second trimester underwent targeted metabolomics of plasma samples using tandem mass spectrometry with the Biocrates MxP® Quant 500 Kit. Linear regression models were used to identify the metabolic signature of GDM and T2DM, followed by generalized linear model (GLMNET) and Receiver Operating Characteristic (ROC) analysis to determine best predictors of GDM, T2DM and pre-term labor. RESULTS: The gestational age at delivery was 2 weeks earlier in T2DM compared to GDM and controls and correlated negatively with maternal HbA1C and systolic blood pressure and positively with serum albumin. Linear regression models revealed elevated glutamate and branched chain amino acids in GDM + T2DM group compared to controls. Regression models also revealed association of lower levels of triacylglycerols and diacylglycerols containing oleic and linoleic fatty acids with pre-term delivery. A generalized linear model ROC analyses revealed that that glutamate is the best predictors of GDM compared to controls (area under curve; AUC = 0.81). The model also revealed that phosphatidylcholine diacyl C40:2, arachidonic acid, glycochenodeoxycholic acid, and phosphatidylcholine acyl-alkyl C34:3 are the best predictors of GDM + T2DM compared to controls (AUC = 0.90). The model also revealed that the triacylglycerols C17:2/36:4 and C18:1/34:1 are the best predictors of pre-term delivery (≤ 37 weeks) (AUC = 0.84). CONCLUSIONS: This study highlights the metabolite alterations in women in their second trimester with diabetes mellitus and identifies predictive indicators of pre-term delivery. Future studies to confirm these associations in other cohorts and investigate their functional relevance and potential utilization for targeted therapies are warranted.

Valorization of exo-microbial fermented coconut endosperm waste by black soldier fly larvae for simultaneous biodiesel and protein productions.

The conventional practice in enhancing the larvae growths is by co-digesting the low-cost organic wastes with palatable feeds for black soldier fly larvae (BSFL). In circumventing the co-digestion practice, this study focused the employment of exo-microbes in a form of bacterial consortium powder to modify coconut endosperm waste (CEW) via fermentation process in enhancing the palatability of BSFL to accumulate more larval lipid and protein. Accordingly, the optimum fermentation condition was attained by inoculating 0.5 wt% of bacterial consortium powder into CEW for 14-21 days. The peaks of BSFL biomass gained and growth rate were initially attained whilst feeding the BSFL with optimum fermented CEW. These were primarily attributed by the lowest energy loss via metabolic cost, i.e., as high as 22% of ingested optimum fermented CEW was effectively bioconverted into BSFL biomass. The harvested BSFL biomass was then found containing about 40 wt% of lipid, yielding 98% of fatty acid methyl esters of biodiesel upon transesterification. Subsequently, the protein content was also analyzed to be 0.32 mg, measured from 20 harvested BSFL with a corrected-chitin of approximately 8%. Moreover, the waste reduction index which represents the BSFL valorization potentiality was recorded at 0.31 g/day 20 BSFL. The benefit of fermenting CEW was lastly unveiled, accentuating the presence of surplus acid-producing bacteria. Thus, it was propounded the carbohydrates in CEW were rapidly hydrolysed during fermentation, releasing substantial organic acids and other nutrients to incite the BSFL assimilation into lipid for biodiesel and protein productions simultaneously.

Clinical features in primary care electronic records before diagnosis of ankylosing spondylitis: a nested case-control study.

BACKGROUND: Ankylosing spondylitis (AS) often has a long period from first symptom presentation to diagnosis. We examined the occurrence of symptoms, prescriptions and diagnostic tests in primary care electronic records over time prior to a diagnosis of AS. METHODS: Nested case-control study using anonymised primary care electronic health records from Scotland. Cases were 74 adults with a first diagnosis of AS between 2000 and 2010. Controls were matched for age, sex and GP practice: (a) 296 randomly selected adults (b) 169 adults whose records contained codes indicating spinal conditions or symptoms. We extracted clinical features (symptoms, AS-related disorders, prescriptions and diagnostic tests). Conditional logistic regression was used to examine the association between clinical features (both individually and in combinations) and diagnosis of AS. We examined the associations between clinical features and diagnosis over time prior to diagnosis. RESULTS: Several new composite pointers were predictive of AS: including distinct episodes of axial pain separated by more than 6 months (OR 12.7, 95% CI 4.7 to 34.6); the occurrence of axial pain with and tendon symptoms within the same year (OR 21.7, 95% CI 2.6 to 181.5); and the co-occurrence (within 30 days) of axial pain and a prescription for nonsteroidal anti-inflammatory drug (OR 10.4, 95%CI 4.9 to 22.1). Coded episodes of axial pain increased steadily over the 3 years before diagnosis. In contrast, large joint symptoms and enthesopathy showed little or no time trend prior to diagnosis. CONCLUSIONS: We identified novel composite pointers to a diagnosis of AS in GP records. These may represent valuable targets for diagnostic support systems.

Chromosomal aberrations in women with primary and secondary amenorrhea: A cross-sectional study.

AIM: Among women of childbearing age, about 2-5% are affected by amenorrhea that is either primary or secondary. However, there are no data regarding the frequency and type of chromosomal abnormalities associated with amenorrhea in Saudi women. The present study aims to establish the frequency and pattern of chromosomal abnormalities in primary amenorrhea (PA) and secondary amenorrhea (SA) cases in a tertiary care center, Riyadh, Saudi Arabia. METHODS: This cross-sectional study was conducted between 2013 and 2016 on women referred to the Reproductive Endocrine and Infertility Medicine Department at a tertiary care center in Riyadh. Women were divided into two groups: PA and SA. After the initial diagnosis of amenorrhea based on medical history, physical examination, hormonal profile and ultrasonography, chromosome karyotype analysis was conducted on metaphase preparations following routine cytogenetics culture and harvest methods. RESULTS: Chromosomal tests were performed for 53 patients (42 with PA and 11 with SA) out of 79 referred patients with amenorrhea. About 19% of the 42 patients with PA and 1 patient (9.1%) diagnosed as SA showed an abnormal karyotype. The most common abnormal karyotypes observed were 46, XY and 45, X. CONCLUSION: The present study indicates that the chromosomal analysis after the exclusion of nongenetic causes should be essentially considered for the precise diagnosis and the development of more successful management for females with amenorrhea. This study also revealed that the prevalence of chromosomal abnormalities in women with PA and SA is similar to that reported in the literature.

Adsorptive behaviour of palm oil mill sludge biochar pyrolyzed at low temperature for copper and cadmium removal.

In this work, the influence of pyrolysis temperature on the physicochemical properties of palm oil mill sludge biochar (POSB) and its adsorption properties towards cadmium (Cd) and copper (Cu) was investigated. Characterization experiments suggested that POSBs' surface functional groups play the major role in the adsorption process. POSB pyrolyzed at 400 °C showed the best characteristics for Cu and Cd removal. Adsorption study indicated that contact time and shaking speed enhances the adsorption capacity of POSB. It was affirmed that pH adjustment is not necessary for POSB to adsorb Cu and Cd. Mechanism studies fitted well with Langmuir and Pseudo-Second Order model. Thermodynamic parameters indicated that the adsorption was spontaneous, endothermic and correspond to chemical adsorption. The highest uptakes of Cu and Cd were recorded at 48.8 mg/g and 46.2 mg/g respectively. This work verifies that the temperature used for palm oil mill sludge (POS) pyrolysis and adsorption condition played the most prominent role in Cu and Cd removal from aqueous solutions.

Optimization of activated palm oil sludge biochar preparation for sulphur dioxide adsorption.

Palm oil sludge (POS) is an organic waste generated from the palm oil industry. POS causes environmental pollution if it is improperly disposed. In this study, the potential of activated POS biochar, as an adsorbent for the removal of SO2 gas was tested. POS biochar was physically activated using CO2 gas. The effects of activation preparation variables i.e. activation temperature (300-700 °C), activation time (30-150 min) and CO2 flow rate (100-500 ml/min) were investigated using design expert version 8.0.7.1 software. Central Composite Design (CCD) was used to develop a quadratic model to correlate the operating variables with the activated biochar adsorption capacity. Analysis of variance (ANOVA) was performed to identify the significant factors on the experimental design response. The optimum preparation conditions of activated POS biochar were found to be at activation temperature of 442 °C, activation time of 63 min and CO2 flow rate of 397 ml/min. The maximum adsorption capacity at the optimum conditions was recorded as 16.65 mg/g. The adsorption capacity increased significantly after the activation process. Characteristics of the activated POS biochar proposed that SO2 was physically adsorbed. Furthermore, it was found that the adsorption capacity can be further enhanced by increasing the reaction temperature to 100 °C or with 15% of relative humidity in the inlet gas. The prepared adsorbents can be regenerated by thermal treatment.