Assessment of a Decision Support System for Adults with Type 1 Diabetes on Multiple Daily Insulin Injections.

Introduction: DailyDose is a decision support system designed to provide real-time dosing advice and weekly insulin dose adjustments for adults living with type 1 diabetes using multiple daily insulin injections. Materials and Methods: Twenty-five adults were enrolled in this single-arm study. All participants used Dexcom G6 for continuous glucose monitoring, InPen for short-acting insulin doses, and Clipsulin to track long-acting insulin doses. Participants used DailyDose on an iPhone for 8 weeks. The primary endpoint was % time in range (TIR) comparing the 2-week baseline to the final 2-week period of DailyDose use. Results: There were no significant differences between TIR or other glycemic metrics between the baseline period compared to final 2-week period of DailyDose use. TIR significantly improved by 6.3% when more than half of recommendations were accepted and followed compared with 50% or fewer recommendations (95% CI 2.5%-10.1%, P = 0.001). Conclusions: Use of DailyDose did not improve glycemic outcomes compared to the baseline period. In a post hoc analysis, accepting and following recommendations from DailyDose was associated with improved TIR. Clinical Trial Registration Number: NCT04428645.

An artificial intelligence decision support system for the management of type 1 diabetes.

Type 1 diabetes (T1D) is characterized by pancreatic beta cell dysfunction and insulin depletion. Over 40% of people with T1D manage their glucose through multiple injections of long-acting basal and short-acting bolus insulin, so-called multiple daily injections (MDI)1,2. Errors in dosing can lead to life-threatening hypoglycaemia events (<70 mg dl-1) and hyperglycaemia (>180 mg dl-1), increasing the risk of retinopathy, neuropathy, and nephropathy. Machine learning (artificial intelligence) approaches are being harnessed to incorporate decision support into many medical specialties. Here, we report an algorithm that provides weekly insulin dosage recommendations to adults with T1D using MDI therapy. We employ a unique virtual platform3 to generate over 50,000 glucose observations to train a k-nearest neighbours4 decision support system (KNN-DSS) to identify causes of hyperglycaemia or hypoglycaemia and determine necessary insulin adjustments from a set of 12 potential recommendations. The KNN-DSS algorithm achieves an overall agreement with board-certified endocrinologists of 67.9% when validated on real-world human data, and delivers safe recommendations, per endocrinologist review. A comparison of inter-physician-recommended adjustments to insulin pump therapy indicates full agreement of 41.2% among endocrinologists, which is consistent with previous measures of inter-physician agreement (41-45%)5. In silico3,6 benchmarking using a platform accepted by the United States Food and Drug Administration for evaluation of artificial pancreas technologies indicates substantial improvement in glycaemic outcomes after 12 weeks of KNN-DSS use. Our data indicate that the KNN-DSS allows for early identification of dangerous insulin regimens and may be used to improve glycaemic outcomes and prevent life-threatening complications in people with T1D.

Participación de la Cotinina en la abstinencia nicotínica en ratas (Estudio preliminar) / Cotinine participation in chronic nicotinic withdrawal syndrome in rats (Preliminary study)

Numerosos datos clínicos y experimentales han demostrado que la nicotina del tabaco (NI) es la razón de la adicción al tabaco en los seres humanos, a través de la inducción de la tolerancia y la dependencia física. El humo del tabaco contiene otros alcaloides que pueden contribuir a la adicción, como la cotinina (COT). En este estudio se evaluaron los posibles efectos de la COT en ratas durante el síndrome de abstinencia nicotínica midiendo la actividad locomotora espontánea (ALE) utilizando el test del campo abierto. El estudio se llevó a cabo con dos grupos de ratas que recibieron NI 10 mg / kg / día en agua potable durante 120 días (grupos A y B). Luego, en el grupo A, se sustituyó NI por agua potable y en el grupo B, sustituido por COT 12 mg / kg, durante 24 horas en ambos grupos. La actividad locomotora espontánea se registró al final del día 120 (nivel basal) y al final del día 121, al final del período de abstinencia. Los resultados obtenidos se compararon con las mediciones basales. El grupo A mostró diferencias significativas en 3 de los 9 movimientos medidos y el grupo B mostró diferencias significativas en 7 de los 9 movimientos medidos. Cuando el grupo A se comparó con el grupo B sólo 1 movimiento mostró diferencia significativa. Estos resultados sugieren que en la administración crónica de nicotina y en estas condiciones experimentales, la cotinina participa en el síndrome de abstinencia nicotínica

A large amount of clinical and experimental data has shown that tobacco nicotine (NI) is the reason for tobacco addiction in humans, through the induction of tolerance and physical dependence. Tobacco smoke contains other alkaloids that may contribute to addiction, such as cotinine (COT). In this study we evaluated the possible effects of COT in rats during NI abstinence syndrome by measuring spontaneous locomotor activity (SLA) with an open field test. The study was carried out with two groups of rats receiving NI 10 mg / kg / day in drinking water for 120 days (groups A and B). Then, in group A, NI was replaced by drinking water and in group B, substituted by COT, 12 mg / kg, for 24 hours in both groups. Spontaneous locomotor activity was recorded at the end of day 120 (baseline) and at the end of day 121, the end of the abstinence period. The results obtained were compared against the baseline measurements and group A showed significant differences in 3 of the 9 movements measured and group B displayed significant differences in 7 of the 9 movements measured. When group A was compared with Group B only 1 movement showed any significant differences. These results suggest that cotinine participates in the nicotine withdrawal syndrome in chronic nicotine administration under these experimental conditions

High-performance liquid chromatography method for urinary trans,trans-muconic acid. Application to environmental exposure to benzene.

This report describes a specific and precise high-performance liquid chromatography (HPLC) method for the quantification of trans,trans-muconic acid in human urine. The procedure involved a highly efficient Bond-Elut SAX extraction with 20% acetic acid elution. The HPLC analysis used a sodium acetate/methanol mobile phase with a C18 reverse phase column and UV detection at 265 nm. The recovery, precision, linearity, and limits of detection and quantification of the method were determined. Mean absolute recoveries were between 97% and 115%. The calibration curve showed a correlation coefficient of 0.9955 and the limit of detection was determined to be 10.8 microg/L. The method is suitable for evaluation of occupational and environmental benzene exposure in humans. The study of urinary trans,trans-muconic acid of two populations of children to evaluate environmental benzene exposure is presented.

Thermotolerant Campylobacters in domestic animals in a defined population in Buenos Aires, Argentina.

We assessed the prevalence of Campylobacter jejuni in animals in a region of unsatisfied basic needs in the city of Buenos Aires and studied a few risk factors. First we conducted a census to identify all dwellings having pet animals (dogs, cats, and birds). Fecal samples were then taken for isolation and identification of strains. We observed 17% prevalence for dogs (95% CI: 13, 22), 16% for cats (95% CI: 8, 27) and 19% for birds (95% CI: 5, 42). In dogs, the highest prevalences were found in summer and in animals <1 year old; in cats, in autumn and those aged 3-5 years. Strains were identified as C. jejuni biotype II in 70% of isolates. In the population described here, dogs, cats and birds kept in households were potential sources of human Campylobacter infections.

Valores normales versus valores de referencia / Normal value vs. references values

En clínica médica es importante confrontar un resultado de laboratorio con los valores obtenidos previamente en el mismo sujeto (referencia interna), o en una poblacxión de referencia (referncia externa). Los valores obtenidos en una población de referencia se llamaron originalmente "valores normales", expresión que evolucionó a la de"valores de referencia". Para la obtención de los valores de referencia se pueden aplicar metodologías paramétricas y no param´tricas; ambas metodologías presentan fortalezas y debilidades. Es de resaltar que cuando, los valores hallados en un sujeto no coincidan con los límites de los valortes de referencia, es el médico quien debe determinar la existencia o no de álgun grado de patología.

Valores normales versus valores de referencia / Normal value vs. references values

En clínica médica es importante confrontar un resultado de laboratorio con los valores obtenidos previamente en el mismo sujeto (referencia interna), o en una poblacxión de referencia (referncia externa). Los valores obtenidos en una población de referencia se llamaron originalmente "valores normales", expresión que evolucionó a la de"valores de referencia". Para la obtención de los valores de referencia se pueden aplicar metodologías paramétricas y no param tricas; ambas metodologías presentan fortalezas y debilidades. Es de resaltar que cuando, los valores hallados en un sujeto no coincidan con los límites de los valortes de referencia, es el médico quien debe determinar la existencia o no de álgun grado de patología.(AU)

Aislamiento e identificación de diuréticos en orina por cromatografía en capa delgada / Isolation and identification of diuretics in urine by TLC

Se investgó mediante cromatografía en capa delgana la presencia de acetazolamida, ácido 4-sulfonamido benzoico, amiloride, bendroflumetiazida, bumetanida, dehídroclorotiazida, espironolactona, fuirosemida y triamtireno en muestras de orina enriquecidas. La fase fija fue silicagel 60 GF 254 y la fase móvil acetato de etilo. El revelado de las máculas fue secuencial- El sistema cromatográfico separó e identificó los nueve diuréticos ensayados con diferente sensibilidad. El amiloride, la bendroflumetiazida, la furosemida y el triamtireno pudieron ser observados a concentraciones de 0,1ug/ml; el ácido 4-sulfonamidop benzoico, la dihidroclorotiazida y la espironolactona a concentraciones de 2 ug/ml y la acetazolamida y bumetanida a concentraciones de 5 ug/ml. Este método es rápido, sencillo y económico para investigar la presencxia de diuréticos en muestras de orina, por lo que resulta adecuado para ser usado en el "screening" de diuréticos en el análisis antidopaje

Aislamiento e identificación de diuréticos en orina por cromatografía en capa delgada / Isolation and identification of diuretics in urine by TLC

Se investgó mediante cromatografía en capa delgana la presencia de acetazolamida, ácido 4-sulfonamido benzoico, amiloride, bendroflumetiazida, bumetanida, dehídroclorotiazida, espironolactona, fuirosemida y triamtireno en muestras de orina enriquecidas. La fase fija fue silicagel 60 GF 254 y la fase móvil acetato de etilo. El revelado de las máculas fue secuencial- El sistema cromatográfico separó e identificó los nueve diuréticos ensayados con diferente sensibilidad. El amiloride, la bendroflumetiazida, la furosemida y el triamtireno pudieron ser observados a concentraciones de 0,1ug/ml; el ácido 4-sulfonamidop benzoico, la dihidroclorotiazida y la espironolactona a concentraciones de 2 ug/ml y la acetazolamida y bumetanida a concentraciones de 5 ug/ml. Este método es rápido, sencillo y económico para investigar la presencxia de diuréticos en muestras de orina, por lo que resulta adecuado para ser usado en el "screening" de diuréticos en el análisis antidopaje(AU)