Next-generation hybrid technologies for the treatment of pharmaceutical industry effluents.

Water and industries are intangible units of the globe that are always set to meet the population's demand. The global population depends on one-third of freshwater increasing the demand. The increase in population along with urbanization has polluted the fresh water resources. The pharmaceutical industry is marked as an emerging contaminant of water pollution. The most common type of pharmaceutical drugs that are detected in the environment includes antibiotics, analgesics, NSAIDs, and pain-relieving drugs. These drugs alter the food chain of the organisms causing chaos mainly in the marine ecosystem. Pharmaceutical drugs are found only in shallow amounts (ng/mg) they have a huge impact on the living system. The consumption of water contaminated with pharmaceutical ingredients can disrupt reproduction, hormonal imbalance, cancer, and respiratory problems. Various methods are used to remove these chemicals from the environment. In this review, we mainly focused on the emerging hybrid technologies and their significance in the effective treatment of pharmaceutical wastewater. This review paper primarily elaborates on the merits and demerits of existing conventional technologies helpful in developing integrated technologies for the modern era of pharmaceutical effluent treatment. This review paper further in detail discusses the various strategies of eco-friendly bioremediation techniques namely biostimulation, bioaugmentation, bacterial degradation, mycoremediation, phytoremediation, and others for the ultimate removal of pharmaceutical contaminants in wastewater. The review makes clear that targeted and hybrid solutions are what the world will require in the future to get rid of these pharmacological prints.

Linear and nonlinear characterization of a broadband integrated Si-rich silicon nitride racetrack ring resonator for on-chip applications.

We demonstrate the linear and nonlinear characterization of a plasma-enhanced chemical vapor deposited silicon-rich silicon nitride (SRSN) racetrack ring resonator for on-chip applications within the telecommunication wavelength range. The SRSN waveguide parameters are optimized by employing the refractive index profile measured by ellipsometry to achieve flat dispersion in the telecom band. Furthermore, we measure the thermo-optic coefficient of the micro-resonator by analyzing the temperature-dependent transmission spectra and assess it to be 3.2825×10-5 ∘ C -1. Additionally, we study power-dependent transmission spectra to investigate the effect of local heating and nonlinear absorption. The power-dependent transmission spectra exhibit a blueshifting of the resonance peak in the visible and near-IR regions, which indicates the presence of nonlinear losses in that range. The power-dependent transmission spectra almost remain unchanged in the telecom band, revealing the absence of nonlinear losses and excellent thermal stability in that wavelength range. Our experimental results reveal that the SRSN-based structure can be employed potentially to realize linear and nonlinear applications in the telecom band.

Nonlinear spectral broadening of a dual-carrier electro-optic frequency comb in a graphene oxide cladded silicon-rich nitride hybrid waveguide.

We demonstrate a detailed theoretical analysis describing the generation of an electro-optic comb (EOC) in the near-IR range through discrete phase and amplitude modulation driven by radio frequency (RF) signal generators. Furthermore, the generated EOC spectra suffer nonlinear spectral broadening while propagating through a hybrid Si-rich nitride (SRN) waveguide structure integrated with two-dimensional (2D) layered graphene oxide (GO) films. We perform a detailed analysis to investigate the influence of GO layers, pump wavelength detuning, and other waveguide parameters on the evolution of comb spectra propagating through the hybrid waveguide structure. Owing to the strong modal overlapping between the SRN waveguides and the highly nonlinear GO films, the nonlinearity of the system is enhanced effectively, and broadband comb spectra have been achieved in the near-IR range. Furthermore, we investigate the spectral coherence of the generated comb spectra under different input conditions. The results exhibit strong potential to generate a tunable frequency comb with high spectral coherence in the near-IR range by employing the hybrid waveguide structure.

Deep learning and evolutionary intelligence with fusion-based feature extraction for detection of COVID-19 from chest X-ray images.

In recent times, COVID-19 infection gets increased exponentially with the existence of a restricted number of rapid testing kits. Several studies have reported the COVID-19 diagnosis model from chest X-ray images. But the diagnosis of COVID-19 patients from chest X-ray images is a tedious process as the bilateral modifications are considered an ill-posed problem. This paper presents a new metaheuristic-based fusion model for COVID-19 diagnosis using chest X-ray images. The proposed model comprises different preprocessing, feature extraction, and classification processes. Initially, the Weiner filtering (WF) technique is used for the preprocessing of images. Then, the fusion-based feature extraction process takes place by the incorporation of gray level co-occurrence matrix (GLCM), gray level run length matrix (GLRM), and local binary patterns (LBP). Afterward, the salp swarm algorithm (SSA) selected the optimal feature subset. Finally, an artificial neural network (ANN) is applied as a classification process to classify infected and healthy patients. The proposed model's performance has been assessed using the Chest X-ray image dataset, and the results are examined under diverse aspects. The obtained results confirmed the presented model's superior performance over the state of art methods.

Phylogeography of the wide-host range panglobal plant pathogen Phytophthora cinnamomi.

Various hypotheses have been proposed regarding the origin of the plant pathogen Phytophthora cinnamomi. P. cinnamomi is a devastating, highly invasive soilborne pathogen associated with epidemics of agricultural, horticultural and forest plantations and native ecosystems worldwide. We conducted a phylogeographic analysis of populations of this pathogen sampled in Asia, Australia, Europe, southern and northern Africa, South America, and North America. Based on genotyping-by-sequencing, we observed the highest genotypic diversity in Taiwan and Vietnam, followed by Australia and South Africa. Mating type ratios were in equal proportions in Asia as expected for a sexual population. Simulations based on the index of association suggest a partially sexual, semi-clonal mode of reproduction for the Taiwanese and Vietnamese populations while populations outside of Asia are clonal. Ancestral area reconstruction provides new evidence supporting Taiwan as the ancestral area, given our sample, indicating that this region might be near or at the centre of origin for this pathogen as speculated previously. The Australian and South African populations appear to be a secondary centre of diversity following migration from Taiwan or Vietnam. Our work also identified two panglobal, clonal lineages PcG1-A2 and PcG2-A2 of A2 mating type found on all continents. Further surveys of natural forests across Southeast Asia are needed to definitively locate the actual centre of origin of this important plant pathogen.

Groundwater Pollution and Human Health Risks in an Industrialized Region of Southern India: Impacts of the COVID-19 Lockdown and the Monsoon Seasonal Cycles.

Samples of groundwater were collected during a post-monsoon period (January) and a pre-monsoon period (May) in 2020 from 30 locations in the rapidly developing industrial and residential area of the Coimbatore region in southern India. These sampling periods coincided with times before and during the lockdown in industrial activity and reduced agricultural activity that occurred in the region due to the COVID-19 pandemic. This provided a unique opportunity to evaluate the effects of reduced anthropogenic activity on groundwater quality. Approximately 17% of the wells affected by high fluoride concentrations in the post-monsoon period returned to levels suitable for human consumption in samples collected in the pre-monsoon period. This was probably due to ion exchange processes, infiltration of rainwater during the seasonal monsoon that diluted concentrations of ions including geogenic fluoride, as well as a reduction in anthropogenic inputs during the lockdown. The total hazard index for fluoride in the post-monsoon samples calculated for children, adult women, and adult men indicated that 73%, 60%, and 50% of the groundwater samples, respectively, had fluoride levels higher than the permissible limit. In this study, nitrate pollution declined by 33.4% by the pre-monsoon period relative to the post-monsoon period. The chemical facies of groundwater reverted from the Na-HCO3-Cl and Na-Cl to the Ca-HCO3 type in pre-monsoon samples. Various geogenic indicators like molar ratios, inter-ionic relations along with graphical tools demonstrated that plagioclase mineral weathering, carbonate dissolution, reverse ion exchange, and anthropogenic inputs are influencing the groundwater chemistry of this region. These findings were further supported by the saturation index assessed for the post- and pre-monsoon samples. COVID-19 lockdown considerably reduced groundwater pollution by Na+, K+, Cl-, NO3¯, and F- ions due to shutdown of industries and reduced agricultural activities. Further groundwater quality improvement during lockdown period there is evidence that the COVID-19 lockdown by increased HCO3¯ ion concentration. Overall results illustrate the positive benefits to groundwater quality that could occur as a result of measures to control anthropogenic inputs of pollutants.

A pharmacokinetic study of morphine-6-O-sulfate in rat plasma and brain.

Morphine-6-O-sulfate (M6S), a polar, zwitterionic sulfate ester of morphine, is a powerful and safe analgesic in several rat models of pain. A sensitive liquid chromatography-tandem mass spectrometry bioanalytical method was developed and validated for the simultaneous determination of M6S and morphine (MOR) in rat plasma and brain after M6S administration. Morphine-d6 was used as internal standard. Multiple reaction monitoring was used for detection and quantitation of M6S, MOR, and morphine-d6 in the turbo ion spray positive mode. The chromatographic separation was carried out on an Alltech Altima C18 column. The analytical method was validated for linearity, precision, accuracy, specificity, and stability over a concentration range of 3-8000 ng/ml in rat plasma and 10-10,000 ng/ml in brain samples for both M6S and MOR. The validated method was applied to determine the PK profile of M6S in plasma after i.v., i.p., and oral dosing in male Sprague-Dawley rats. Rats were administered M6S by i.p. administration (5.6 and 10.0 mg/kg) or orally (10 and 30 mg/kg) and bioavailability compared to an i.v. injection (1 mg/kg) of M6S. The in vivo results indicate that M6S is not a prodrug of morphine, since M6S is not biotransformed into MOR in plasma after either i.p. or oral administration, and MOR was not detected in brain. The bioavailability of M6S was >93% and about 5% after i.p. and oral dosing, respectively. The low oral bioavailability of M6S may be due to poor permeation of the intestinal epithelial membrane. After i.p.-administration, M6S appears to reach brain tissues in low, but significant, concentrations.

An optimal cascaded recurrent neural network for intelligent COVID-19 detection using Chest X-ray images.

In recent times, COVID-19, has a great impact on the healthcare sector and results in a wide range of respiratory illnesses. It is a type of Ribonucleic acid (RNA) virus, which affects humans as well as animals. Though several artificial intelligence-based COVID-19 diagnosis models have been presented in the literature, most of the works have not focused on the hyperparameter tuning process. Therefore, this paper proposes an intelligent COVID-19 diagnosis model using a barnacle mating optimization (BMO) algorithm with a cascaded recurrent neural network (CRNN) model, named BMO-CRNN. The proposed BMO-CRNN model aims to detect and classify the existence of COVID-19 from Chest X-ray images. Initially, pre-processing is applied to enhance the quality of the image. Next, the CRNN model is used for feature extraction, followed by hyperparameter tuning of CRNN via the BMO algorithm to improve the classification performance. The BMO algorithm determines the optimal values of the CRNN hyperparameters namely learning rate, batch size, activation function, and epoch count. The application of CRNN and hyperparameter tuning using the BMO algorithm shows the novelty of this work. A comprehensive simulation analysis is carried out to ensure the better performance of the BMO-CRNN model, and the experimental outcome is investigated using several performance metrics. The simulation results portrayed that the BMO-CRNN model has showcased optimal performance with an average sensitivity of 97.01%, specificity of 98.15%, accuracy of 97.31%, and F-measure of 97.73% compared to state-of-the-art methods.

Optimal management of brain-dead organ donor.

Maintaining a brain stem-dead (BSD) donor is specialized science. It is a daunting task as they are fragile patients who need to be handled with utmost care owing to extreme haemodynamically instability and need the best of monitoring for maintenance of organs. To ensure a successful transplant, a BSD donor first needs to be identified on time. This requires scrupulous monitoring of neurologically compromised patients who tend to be the most frequent organ donors. Once the donor is identified, an all-out effort should be made to legally obtain consent for the donation. This may require numerous sessions of counselling of the relatives. It needs to be performed tactfully, displaying the best of intentions. It is important to understand the physiology of a brain-dead individual. A cascade of changes occurs in BSD donor which result in a catastrophic plummeting of the clinical condition of the donor. All organ systems are involved in this clinical chaos, and best possible clinical support of all organ systems should be available and extended to the donor. Organ support includes cardiovascular, pulmonary, temperature, glycaemic, metabolic and hormonal. This article has been written as a follow-up article of previously published article on identifying an organ donor. It intends to give the reader a concept of what the BSD donor undergoes after brain death and as to how to maintain and preserve various organs for donation for successful transplantation of maximum organs.

Comparison of peritubal infiltration and single level T10 paravertebral block in percutaneous nephrolithotomy (PCNL).

Background and Aims: In percutaneous nephrolithotomy (PCNL), distension of renal capsule, pelvicalyceal system and nephrostomy tube causes intense postoperative pain. The present study was done to compare the efficacy of peritubal infiltration of Ropivacaine with Dexmedetomidine and ultrasound guided single level T10 paravertebral block for post-operative analgesia in patients undergoing PCNL. Material and Methods: A prospective, double blind study was conducted on 60 American Society of Anesthesiologists (ASA) I and II patients of either gender between 18-65 years undergoing PCNL who were randomized into 3 groups. Group PV [n = 20] received paravertebral block at T 10 level with 20 ml of 0.25% Ropivacaine plus 0.25 mcg/kg Dexmedetomidine. Group PT [n = 20] received peritubal infiltration along nephrostomy tube with 20 ml of 0.25% Ropivacaine plus 0.25 mcg/kg Dexmedetomidine. Group C [n = 20] control group received intravenous Tramadol 1mg/kg. Postoperative pain scores, opioid consumption and side effects if any were recorded for 24 hrs. Statistical analysis was done using ANOVA test, Chi-square test. P value <0.05 was considered significant. Results: Demographic data were comparable. Reduced dynamic VAS score was noted for first 8hrs in peritubal infiltration compared to paravertebral group. Dynamic VAS scores were significantly lower in paravertebral group at 8th, 12th and 24th hr as compared to peritubal infiltration (P < 0.05). During all time intervals peritubal infiltration and paravertebral group had significantly lower VAS scores as compared to control group. Opioid requirement was more in control group compared to study groups. Conclusion: In PCNL, peritubal infiltration and single level paravertebral block produces effective postoperative analgesia without significant side effects.

Epitope mapping of the White Spot Syndrome Virus (WSSV) VP28 monoclonal antibody through combined in silico and in vitro analysis reveals the potential antibody binding site.

White Spot Syndrome Virus (WSSV) infecting shrimp is an enveloped double-stranded DNA virus. The WSSV is a member of the genus Whispovirus. The envelope protein VP28 is the most investigated protein of WSSV. In the present study, the epitope mapping of the monoclonal antibody (MAb) C-33 was carried out. Based on the epitope mapping results, an antigen-antibody interaction model was derived. Peptide scanning and confirmation of epitopes of MAb C-33 were carried out using the sequence data. The MAb was reactive to the epitope of both recombinant VP28 and the whole virus. The results of the study indicated the presence of an epitope region. The epitope region is found positioned within two peptides, covering 13 amino acids. Framework and CDR (complementarity determining regions) of heavy and light chain (VH & VL) sequences showed identity to germline immunoglobulin sequences. The Web Antibody Modelling (WAM) selected for further evaluation based on a comparative analysis of WAM and Rosetta server-generated models of the Fv region. The docking study using WAM generated model revealed that the residues from LEU98 to GLY105 are active in antibody binding. The findings of this study could form a structural basis for further research in VP28 based diagnostics and therapeutics or vaccine discovery.

Evaluation of biofilm of Vibrio anguillarum for oral vaccination of Asian seabass, Lates calcarifer (BLOCH, 1790).

The present study evaluated the biofilm (BF) of Vibrio anguillarum for oral vaccination of Asian seabass, Lates calcarifer. An 80-day experiment was carried out in circular fiber-reinforced plastic (FRP) tanks using free cell (FC) and BF of Vibrio anguillarum with triplicate in each. Heat-inactivated FC and BF cells at 107, 1010 and 1013 CFU/g fish/d were fed to fish for 20 days, agglutination antibody titer estimated at each 10 days interval up to 60-day post vaccination. As compared to FC and control there was a significant increase in agglutinating antibody titer in the biofilm vaccinated fishes. Among the 3 doses, BF at 1010 cfu/g fish/d was considered the ideal dose for vaccination. Relative percentage survival (RPS) was higher in biofilm vaccinated fish (85.4%) compared to that with free cells (27.0%). The study demonstrated the better performance of V. anguillarum biofilm oral vaccine compared that with free cell vaccine in L. calcarifer. The study further supports better performance of biofilm vaccine model with one more bacterial pathogen in a high carnivore fish.

High-fat, high-fructose, high-cholesterol feeding causes severe NASH and cecal microbiota dysbiosis in juvenile Ossabaw swine.

Pediatric obesity and nonalcoholic steatohepatitis (NASH) are on the rise in industrialized countries, yet our ability to mechanistically examine this relationship is limited by the lack of a suitable higher animal models. Here, we examined the effects of high-fat, high-fructose corn syrup, high-cholesterol Western-style diet (WD)-induced obesity on NASH and cecal microbiota dysbiosis in juvenile Ossabaw swine. Juvenile female Ossabaw swine (5 wk old) were fed WD (43.0% fat; 17.8% high-fructose corn syrup; 2% cholesterol) or low-fat diet (CON/lean; 10.5% fat) for 16 wk ( n = 6 each) or 36 wk ( n = 4 each). WD-fed pigs developed obesity, dyslipidemia, and systemic insulin resistance compared with CON pigs. In addition, obese WD-fed pigs developed severe NASH, with hepatic steatosis, hepatocyte ballooning, inflammatory cell infiltration, and fibrosis after 16 wk, with further exacerbation of histological inflammation and fibrosis after 36 wk of WD feeding. WD feeding also resulted in robust cecal microbiota changes including increased relative abundances of families and genera in Proteobacteria ( P < 0.05) (i.e., Enterobacteriaceae, Succinivibrionaceae, and Succinivibrio) and LPS-containing Desulfovibrionaceae and Desulfovibrio and a greater ( P < 0.05) predicted microbial metabolic function for LPS biosynthesis, LPS biosynthesis proteins, and peptidoglycan synthesis compared with CON-fed pigs. Overall, juvenile Ossabaw swine fed a high-fat, high-fructose, high-cholesterol diet develop obesity and severe microbiota dysbiosis with a proinflammatory signature and a NASH phenotype directly relevant to the pediatric/adolescent and young adult population.

Real-time compensation of errors in refractive index shift measurements of microring sensors using thermo-optic coefficients.

We report a method for compensation of errors caused by temperature fluctuations in refractive index measurements using Silicon photonic microring sensors. The method involves determination of resonance wavelength shifts caused by thermal fluctuations using real-time measurement of on-chip temperature variations and thermo-optic coefficient (TOC) of analyte liquids. Resistive metal lines patterned around Silicon microrings are used to track temperature variations and TOC of analyte is calculated by measuring wavelength shifts caused by controlled increments in device temperature. The TOC of de-ionized water is determined to be -1.12 × 10-4/°C, with an accuracy of ±8.26 × 10-6/°C. In our system, chip-surface temperature variations were measured with an instrument limited precision of 0.004 °C yielding a factor of 16 enhancement in tracking accuracy compared to conventional, bottom-of-chip temperature measurement. We show that refractive index detection limit of the microring sensor is also improved by the same factor.

Variation in Genetic Diversity of Phytophthora infestans Populations in Mexico from the Center of Origin Outwards.

The Toluca valley, located in central Mexico, is thought to be the center of origin of the potato late blight pathogen Phytophthora infestans. We characterized over 500 individuals of P. infestans sampled from populations with a geographical distance of more than 400 km in six regions adjacent to the Toluca valley in three states including Michoacán, Mexico, and Tlaxcala. Our sampling occurred on a predominant east to west gradient and showed significant genetic differentiation. The most western sampling location found in Michoacán was most differentiated from the other populations. Populations from San Gerónimo, Juchitepec, and Tlaxcala clustered together and appeared to be in linkage equilibrium. This work provides a finer understanding of gradients of genetic diversity in populations of P. infestans at the center of origin.

Medical Image Security Using Dual Encryption with Oppositional Based Optimization Algorithm.

Security is the most critical issue amid transmission of medical images because it contains sensitive information of patients. Medical image security is an essential method for secure the sensitive data when computerized images and their relevant patient data are transmitted across public networks. In this paper, the dual encryption procedure is utilized to encrypt the medical images. Initially Blowfish Encryption is considered and then signcryption algorithm is utilized to confirm the encryption model. After that, the Opposition based Flower Pollination (OFP) is utilized to upgrade the private and public keys. The performance of the proposed strategy is evaluated using performance measures such as Peak Signal to Noise Ratio (PSNR), entropy, Mean Square Error (MSE), and Correlation Coefficient (CC).

100-fold improvement in carrier drift mobilities in alkanephosphonate-passivated monocrystalline TiO2 nanowire arrays.

Single crystal rutile titania nanowires grown by solvothermal synthesis are actively being researched for use as electron transporting scaffolds in perovskite solar cells, in low detection limit ultraviolet photodetectors, in photoelectrochemical water-splitting, and in chemiresistive and electrochemical sensing. The electron drift mobility (µ n ) in solution-grown TiO2 nanowires is very low due to a high density of deep traps, and reduces performance in optoelectronic devices. In this study, the effects of molecular passivation of the nanowire surface by octadecylphosphonic acid (ODPA), on carrier transport in TiO2 nanowire ensembles, were investigated using transient space charge limited current measurements. Infrared spectroscopy indicated the formation of a highly ordered phosphonate monolayer with a high likelihood of bidentate binding of ODPA to the rutile surface. We report the hole drift mobility (µ p ) for the first time in unpassivated solvothermal rutile nanowires to be 8.2 × 10-5 cm2 V-1 s-1 and the use of ODPA passivation resulted in µ p improving by nearly two orders of magnitude to 7.1 × 10-3 cm2 V-1 s-1. Likewise, ODPA passivation produced between a 2 and 3 order of magnitude improvement in µ n from ∼10-5-10-6 cm2 V-1 s-1 to ∼10-3 cm2 V-1 s-1. The bias dependence of the post-transit photocurrent decays in ODPA-passivated nanowires indicated that minority carriers were lost to trapping and/or monomolecular recombination for small values of bias (<5 V). Bimolecular recombination was indicated to be the dominant recombination mechanism at higher bias values.

Evaluation of Analgesia, Tolerance, and the Mechanism of Action of Morphine-6-O-Sulfate Across Multiple Pain Modalities in Sprague-Dawley Rats.

BACKGROUND: Morphine-6-O-sulfate (M6S) is a mixed µ/δ-opioid receptor (OR) agonist and potential alternative to morphine for treatment of chronic multimodal pain. METHODS: To provide more support for this hypothesis, the antinociceptive effects of M6S and morphine were compared in tests that access a range of pain modalities, including hot plate threshold (HPT), pinprick sensitivity threshold (PST) and paw pressure threshold tests. RESULTS: Acutely, M6S was 2- to 3-fold more potent than morphine in HPT and PST tests, specifically, derived from best-fit analysis of dose-response relationships of morphine/M6S half-effective dose (ED50) ratios (lower, upper 95% confidence interval [CI]) were 2.8 (2.0-5.8) in HPT and 2.2 (2.1, 2.4) in PST tests. No differences in analgesic drug potencies were detected in the PPT test (morphine/M6S ED50 ratio 1.2 (95% CI, 0.8-1.4). After 7 to 9 days of chronic treatment, tolerance developed to the antinociceptive effects of morphine, but not to M6S, in all 3 pain tests. Morphine-tolerant rats were not crosstolerant to M6S. The antinociceptive effects of M6S were not sensitive to κ-OR antagonists. However, the δ-OR antagonist, naltrindole, blocked M6S-induced antinociception by 55% ± 4% (95% CI, 39-75) in the HPT test, 94% ± 4% (95% CI, 84-105) in the PST test, and 5% ± 17% (95% CI, -47 to 59) or 51% ± 14% (95% CI, 14-84; 6 rats per each group) in the paw pressure threshold test when examined acutely or after 7 days of chronic treatment, respectively. CONCLUSIONS: Activity via δ-ORs thus appears to be an important determinant of M6S action. M6S also exhibited favorable antinociceptive and tolerance profiles compared with morphine in 3 different antinociceptive assays, indicating that M6S may serve as a useful alternative for rotation in morphine-tolerant subjects.

Stability studies of potent opioid analgesic, morphine-6-O-sulfate in various buffers and biological matrices by HPLC-DAD analysis.

The 6-O-sulfate ester of morphine (M6S) has previously been shown to be an analgesic with greater potency and fewer side effects than morphine. However, being a sulfate ester derivative of morphine, the question exists as to whether this compound is stable in biological fluids and tissues with regard to pH- and esterase-mediated degradation. To date, no studies have focused on the stability profile of M6S across the physiologically relevant pH range of 1.2-7.4. In addition, the stability of M6S is not known in rat plasma and rat brain homogenate, or in simulated rat gastric and intestinal fluids. This study determines the stability profile of M6S (utilized as the sodium salt) and demonstrates that M6S is highly stable and resilient to either enzymatic- or pH-dependent hydrolysis in vitro.

Liraglutide as an Alternative to Insulin for Glycemic Control in Intensive Care Unit: A Randomized, Open-label, Clinical Study.

BACKGROUND: Intravenous insulin is the cornerstone in the management of hyperglycemia in the Intensive Care Unit (ICU). We studied the efficacy of liraglutide compared with insulin in the ICU. MATERIALS AND METHODS: In this prospective, open-labeled, randomized study, we included 120 patients (15-65 years, either sex) admitted to ICU with capillary blood glucose (CBG) between 181 and 300 mg/dl. We excluded patients with secondary diabetes and APACHE score >24. The patients were divided into two groups (n = 60) based on the CBG: Group 1 (181-240) and Group 2 (241-300). They were randomized further into four subgroups (n = 30) to receive insulin (Groups 1A and 2A), liraglutide (Group 1B), and insulin with liraglutide (Group 2B). The primary outcome was the ability to achieve CBG below 180 mg/dL at the end of 24 h. The secondary outcomes include mortality at 1 month and hospital stay. Data and results were analyzed using Mann-Whitney U-test, paired t- test, and Chi-square tests. RESULTS: The mean age of the patients (93M and 27F) was 57.1 ± 13.9 years, hospital stay (16.9 ± 7.5 days), and CBG was 240.5 ± 36.2 mg/dl. The primary outcome was reached in 26, 27, 25, and 28 patients of Groups 1A, 2A, 1B, and 2B, respectively. The 30-day mortality and hospital stay were similar across all the four groups. Hypoglycemia was common with insulin and gastrointestinal side effects were more common with liraglutide (P < 0.001). CONCLUSION: Liraglutide is a viable alternative to insulin for glycemic control in the ICU. Further studies with a larger number of patients are required to confirm our findings.