Evaluation of Indian Diabetes Risk Score and Random Blood Sugar Testing for Opportunistic Screening of Type 2 Diabetes Patients at a District Hospital of Gujarat.

Background: India is home to 69.2 million diabetics. For opportunistic screening of type 2 diabetes mellitus (DM), random capillary blood sugar (RBS) testing is used. Another method is Indian Diabetes Risk Score (IDRS), which is a simple and cost effective method for opportunistic screening of type 2 DM patients. The aim is to evaluate the screening test parameters of RBS testing and IDRS for opportunistic screening of undiagnosed type 2 DM patients. Materials and Methods: A cross-sectional study was done during February 2017 to August 2017 at a district hospital of Western Gujarat. A sample size of 317 patients was calculated using Buderer's formula. Systematic random sampling was used and every third patient was selected from the general Outpatient Department(OPD) attendees of 30 years or more. MS Excel and Epi Info v7.2 was used for statistical analysis. Screening parameters and accuracy of IDRS and RBS were calculated taking result of the oral glucose tolerance test as clinical reference. Results: The mean age of study participants was 50.9 (SD 12.17) years with 44.2% males and 55.8% females. Sensitivity and specificity of RBS was 72.4% and 69.1%. Sensitivity and specificity of IDRS was 93.1% and 29.0%. On simultaneous (parallel) screening by IDRS and RBS, sensitivity was 98.3% and specificity was 23.2%. In sequential screening, where IDRS was used followed by RBS, sensitivity was 67.2% and specificity was 74.9%. Conclusions: This study has found that sequential screening using a simple diabetes risk score like IDRS followed by RBS is having higher accuracy and reduced cost of opportunistic screening of type 2 diabetes. Adopting sequential screening using IDRS as first step of screening followed by RBS in those found as high risk by IDRS is recommended.

Query specific graph-based query reformulation using UMLS for clinical information access.

Biomedical document retrieval requires entity level processing instead of term level. This paper explores the usage and impact of UMLS for entity-based query reformulation in biomedical document retrieval. A novel graph-based approach for query reformulation using UMLS is described herein which queries are expanded using biomedical entities. The proposed method considers UMLS entities from a query with their related entities identified by UMLS and constructs a query-specific graph of biomedical entities for term selection. This query reformulation approach is compared with baseline, pseudo relevance feedback based query expansion approach and state-of-the-art UMLS based query reformulation approaches. The experiments on CDS 2015 and CDS 2016 datasets shows 35% and 45% improvement in retrieval performance, respectively.

Data Exchange Interoperability in IoT Ecosystem for Smart Parking and EV Charging.

Many domains are trying to integrate with the Internet of Things (IoT) ecosystem, such as public administrations starting smart city initiatives all over the world. Cities are becoming smart in many ways: smart mobility, smart buildings, smart environment and so on. However, the problem of non-interoperability in the IoT hinders the seamless communication between all kinds of IoT devices. Different domain specific IoT applications use different interoperability standards. These standards are usually not interoperable with each other. IoT applications and ecosystems therefore tend to use a vertical communication model that does not allow data sharing horizontally across different IoT ecosystems. In 2014, The Open Group published two domain-independent IoT messaging standards, O-MI and O-DF, aiming to solve the interoperability problem. In this article we describe the practical use of O-MI/O-DF standards for reaching interoperability in a mobile application for the smart city context, in particular for the Smart Mobility domain, electric vehicle (EV) charging case study. The proof-of-concept of the smart EV charging ecosystem with mobile application user interface was developed as a part of an EU (Horizon 2020) Project bIoTope.

Basic Concepts and Clinical Outcomes of Drug-Eluting Balloons for Treatment of Coronary Artery Disease: An Overview.

The technology of percutaneous coronary intervention for atherosclerotic coronary artery disease has evolved considerably since its inception. Though Drug-Eluting Stent (DES) reduces the rate of restenosis, long-term safety outcomes and persistent restenosis in complex lesion subset remain area of concern. Recently, Drug-Eluting Balloon (DEB) represents a novel treatment strategy for atherosclerotic coronary artery disease. DEB demonstrated its added value in preclinical studies. Inspired by these results, several clinical trials particularly in complex lesion subsets have been started to explore the value of this novel treatment strategy in a broader range of lesions. This review would summarise material compositions and different characteristics and clinical outcomes of currently available DEB.

A Post-Marketing Surveillance Study to Evaluate Performance of the EXIMO™ Blood Glucose Monitoring System.

INTRODUCTION: The performance of Blood Glucose Monitoring System (BGMS) is critical as the information provided by the system guide the patient or health care professional in making treatment decisions. However, besides evaluating accuracy of the BGMS in laboratory setting, it is equally important that the intended users (healthcare professionals and patients) should be able to achieve blood glucose measurements with similar level of high accuracy. AIM: To assess the performance of EXIMO™ (Meril Diagnostics Pvt. Ltd., Vapi, Gujarat, India) BGMS as per International Organization for Standardization (ISO) 15197:2013 section 8 user performance criteria. MATERIALS AND METHODS: This was a non-randomized and post-marketing study conducted at a tertiary care centre of India. A total of 1005 patients with diabetes themselves performed fingertip blood glucose measurement using EXIMO™ BGMS. Immediately after capillary blood glucose measurement using the blood glucose monitoring system, venous blood sample from each patient was obtained by a trained technician which was assessed by reference laboratory method- Cobas Integra 400 plus (Roche Instrument Centre, Rotkreuz, Switzerland). All the blood glucose measurements assessed by EXIMO™ were compared with laboratory results. Performance of the system was assessed as per ISO 15197:2013 criteria using Bland-Altman plot, Parkes-Consensus Error Grid (CEG) and Surveillance Error Grid analyses (SEG). RESULTS: A total of 1005 patients participated in the study. Average age of the patients was 44.93±14.65 years. Evaluation of capillary fingertip blood glucose measurements demonstrated that 95.82% measurements fulfilled ISO 15197:2013 section 8 user performance criteria. All the results lie within clinically non-critical zones; Zone A (99.47%; n=1000) and Zone B (0.53%; n=05) of the CEG analysis. As per SEG analysis, majority of the results fell within "no-risk" zone (risk score 0 to 0.5; 90.42%). CONCLUSION: The result of the study confirmed that intended users are able to obtain accurate glucose measurements when operating EXIMO™ BGMS, given only the instructions and training materials routinely provided with the system, in clinical practice.

Bioresorbable Scaffolds: Current Evidences in the Treatment of Coronary Artery Disease.

Percutaneous coronary revascularization strategies have gradually progressed over a period of last few decades. The advent of newer generation drug-eluting stents has significantly improved the outcomes of Percutaneous Coronary Intervention (PCI) by substantially reducing in-stent restenosis and stent thrombosis. However, vascular inflammation, restenosis, thrombosis, and neoatherosclerosis due to the permanent presence of a metallic foreign body within the artery limit their usage in complex Coronary Artery Disease (CAD). Bioresorbable Scaffolds (BRS) represent a novel approach in coronary stent technology. Complete resorption of the scaffold liberates the treated vessel from its cage and restores pulsatility, cyclical strain, physiological shear stress, and mechanotransduction. In this review article, we describe the advances in this rapidly evolving technology, present the evidence from the pre-clinical and clinical evaluation of these devices, and provide an overview of the ongoing clinical trials that were designed to examine the effectiveness of BRS in the clinical setting.

Recanalization of Chronic Total Occlusion Lesions: A Critical Appraisal of Current Devices and Techniques.

Chronic Total Occlusion (CTO) has been considered as one of the "final frontier" in interventional cardiology. Until recently, the patients with CTO are often managed surgically or medically due to lack of published evidence of clinical benefits and lower success rate of percutaneous recanalization of CTO. However, the introduction of enhanced guidewires, microcatheters combined with novel specialized devices and techniques reduce the number of unapproachable CTO. In this review article, current techniques and devices of percutaneous recanalization of CTO have been systematically summarized, which may help budding interventional cardiologists to theoretically understand these complex procedures and to deliver safe and effective percutaneous management of CTO to the patients.

Anthropometric Profiling of New Zealand Junior Elite Triathletes.

INTRODUCTION: The triathlon involves a combination of three separate disciplines-swimming, cycling and running. To date, very few studies have been conducted on the anthropometric characteristics of the New Zealand junior elite triathletes. The aim of this study was to determine the correlation between physical traits of calf girth or sum of eight skinfolds (anthropometry) and running or cycling performances in the triathlon event. METHODS: Eleven junior elite triathletes (6 females, 5 males; (Av. age: 17) who were selected for the New Zealand national squad, were examined in this cross-sectional study. All athletes were measured for the complete anthropometric profile, as per the International Society for Advancement of Kinanthropometry (ISAK) guidelines. It was then correlated with the cycling and running performances using interclass correlation (ICC) with 90% confidence interval (CI) limits. RESULTS: A non-significant positive correlation observed between eight skinfolds tests on running performance (ICC: 0.10; 90% CI: -0.68-0.77; p>0.05) and biking performance (ICC: 0.15; 90% CI: -0.65-0.79; p>0.05), suggested athletes with greater body fat may render a better athletic performance. Conversely, a significant negative correlation was observed between calf girth and running performance (ICC:-0.66; 90% CI: -0.94 - -0.12; p<0.05) and a non-significant negative correlation was observed between calf girth and cycling performance (ICC:-0.94; 90% CI: -0.97- 0.68; p>0.05). CONCLUSION: Anthropometric data can help in predicting an ideal body profile. This research indicates the similarities and differences of the New Zealand junior profile and the world junior profile.

The effect of moist air on skin blood flow and temperature in subjects with and without diabetes.

BACKGROUND: Endothelial function is known to be impaired in response to heat in people with diabetes, but little has been done to see how air humidity alters the skin blood flow response to heat. METHODS: Seventeen male and female subjects were divided in two groups, one with type 2 diabetes and the other the control subjects without diabetes, age-matched to the diabetes group. All subjects participated in a series of experiments to determine the effect of the warming of the skin by air on skin temperature and skin blood flow. On different days, skin temperature was warmed with air that was 38°C, 40°C, or 42°C for 20 min. Also, on different days, at each temperature, the air humidity was adjusted to 0%, 25%, 50%, 75%, or 100% humidity. Skin blood flow and temperature were measured throughout the exposure period. This allowed the interactions between air humidity and temperature to be assessed. RESULTS: For the control subjects, the moisture in the air had no different effect on skin blood flow at air temperatures of 38°C and 40°C (analysis of variance, P>0.05), although skin blood flow progressively increased at each air temperature that was applied. But for the warmest air temperature, 42°C, although the four lower humidities had the same effect on skin blood flow, air at 100% humidity caused the largest increase in skin blood flow. In contrast, in the subjects with diabetes, blood flow was always significantly less at any air temperature applied to the skin than was observed in the control subjects (P<0.05), and skin blood flow was significantly higher for the two higher humidities for the two higher air temperatures. Skin temperature paralleled these findings. CONCLUSION: These data show that individuals with diabetes do not tolerate moist, warm air above 50% humidity as well as controls without diabetes.

Reduced endothelial function in the skin in Southeast Asians compared to Caucasians.

BACKGROUND: The reaction of vascular endothelial cells to occlusion and heat in Southeast Asian Indians (SAI) compared to Caucasians (C) has not been studied, although genetic differences are found in endothelial cells between the races. MATERIAL/METHODS: Ten C and Ten SAI (<35 years old) male and female subjects participated. There was no difference in the demographics of the subjects except that the SAI group had been in the United States for 6 months; C was natives to the US. Endothelial function was assessed by the response of the circulation (BF) to local heating and the response to vascular occlusion. The effects of local heat on circulation in the skin on the forearm was assessed by applying heat for 6 minutes at temperatures, 38, 40 and 42°C on 3 separate days. On different days, vascular occlusion was applied for 4 minutes to the same arm and skin blood flow was measured for 2 minutes after occlusion; skin temperature was either 31°C or 42°C. RESULTS: When occlusion was applied at a skin temperature of 31°C, the BF response to occlusion was significantly lower in the SAI cohort compared to C (peak BF C = 617 ± 88.2 flux, SAE = 284 ± 73 flux). The same effect was seen at skin temperatures of 42°C. The circulatory response to heat was also significantly less in SAI compared to C at each temperature examined (p<0.05)(for temperatures of 38, 40 and 42°C, peak blood flow for C was 374.7 ± 81.2, 551.9 ± 91.3 and 725.9 ± 107 flux respectively and 248.5 ± 86.2, 361.4 ± 104.3 and 455.3 ± 109.7 flux respectively for SAI. (p<0.05). CONCLUSIONS: Thus there seems to be big differences in these 2 populations in endothelial response to these stressors. The difference may be due to genetic variations between the 2 groups of subjects.

The interrealtionship between locally applied heat, ageing and skin blood flow on heat transfer into and from the skin.

In response to a thermal stress, skin blood flow (BF) increases to protect the skin from damage. When a very warm, noxious, heat source (44 °C) is applied to the skin, the BF increases disproportionately faster than the heat stress that was applied, creating a safety mechanism for protecting the skin. In the present investigation, the rate of rise of BF in response to applied heat at temperatures between 32 °C and 40 °C was examined as well as the thermal transfer to and from the skin with and without BF in younger and older subjects to see how the skin responds to a non-noxious heat source. Twenty male and female subjects (10 - 20-35 years, 10 - 40-70 years) were examined. The arms of the subjects were passively heated for 6 min with and without vascular occlusion by a thermode at temperatures of 32, 36, 38 or 40 °C. When occlusion was not used during the 6 min exposure to heat, there was an exponential rise in skin temperature and BF in both groups of subjects over the 6-min period. However, the older subjects achieved similar skin temperatures but with the expenditure of fewer calories from the thermode than was seen for the younger subjects (p<0.05). BF was significantly less in the older group than the younger group at rest and after exposure to each of the three warmest thermode temperatures (p<0.05). As was seen for noxious temperatures, after a delay, the rate of rise of BF at the three warmest thermode temperatures was faster than the rise in skin temperature in the younger group but less in the older group of subjects. Thus, a consequence of ageing is reduced excess BF in response to thermal stress increasing susceptibility to thermal damage. This must be considered in modelling of BF.