Interleukin-6 Levels in Patients With Diabetic Polyneuropathy.

Introduction Diabetic polyneuropathy (DPN) is a common chronic complication of type 2 diabetes. The pathogenesis of DPN is still debated, but proinflammatory cytokine mediators like interleukin-6 (IL-6) are possibly involved. We conducted this cross-sectional observational study to assess whether IL-6 levels increase in patients with DPN. Materials and methods This study was conducted at the Institute of Post Graduate Medical Education and Research Hospital in Kolkata, India, from 2016 to 2017. The study included 57 patients aged 30 to 60 years diagnosed with type 2 diabetes with neuropathy on clinical examination and nerve conduction study. Patients with neuropathy due to other causes were excluded. The study participants were assigned into one of four groups. Group 1 (n=15) served as healthy control patients, Group 2 (n=12) contained patients with type 2 diabetes without neuropathy, Group 3 (n=20) contained patients with type 2 diabetes with painful neuropathy, and Group 4 (n=10) contained patients with type 2 diabetes with painless neuropathy. We compared IL-6 levels between each group.  Results There was no significant difference in serum IL-6 levels between healthy controls (Group 1) and patients with type 2 diabetes without neuropathy (Group 2). However, we noted a significant increase in serum IL-6 levels among patients with painful DPN (Group 3) compared to control groups. Interestingly, serum IL-6 levels were higher in patients with painful DPN (Group 3) than patients with painless DPN (Group 4). Conclusions IL-6 increases significantly in painful diabetic neuropathy patients compared to patients with diabetes with painless neuropathy and thus may have a role in the pathogenesis of pain in DPN. Serum IL6 level can be a potential noninvasive marker of painful DPN, and it can help distinguish painful DPN from other causes of pain in patients with diabetes.

Hydraulic performance, consolidation characteristics and shear strength analysis of bentonites in the presence of fly-ash, sewage sludge and paper-mill leachates for landfill application.

A rapid upsurge in urban and industrial developments leads to increased generations of solid wastes. The most accepted technique of waste discarding around the world is landfilling. Leaching chemicals from municipal dumping grounds can pollute the groundwater source and the surrounding environment without appropriate precautionary measures. Bentonite is a low-cost constituent used as a liner material in landfills due to its low permeability, high sealing ability, high specific surface area, and the ability to hold up the impurity migration through adsorption. However, leachate interaction with bentonite may alter its properties and reduce its usefulness as a barrier material in the long term. Also, bentonite having different chemical and mineralogical compositions will behave differently due to the leachate interaction. Therefore, it is necessary to compare the performance of various bentonites in the presence of leachates. In the present investigation, two Indian bentonites of different mineralogical compositions were studied for their change in the index properties, swelling, swelling potential, swelling pressure, hydraulic conductivity, consolidation parameters and shear strength properties in the presence of fly ash, sewage sludge and paper mill leachates. The outcomes showed that in the presence of all the leachates, liquid limit, free swell, compression index, swelling potential, swelling pressure, time to complete 90% of consolidation and shear strength dropped; whereas, hydraulic conductivity and coefficient of consolidation increased. Besides, the quality of bentonite prominently influenced the hydraulic, strength and swelling behaviour. The bentonite having a higher cation exchange capacity, liquid limit, specific surface area, and swelling capability undergoes a higher variability in the free swell (80.0, 73.8 and 76.9% decline), liquid limit (73.5, 61.7 and 69.2% decline), swelling potential (61.3, 55.7 and 51.0% decline), swelling pressure (53.3 and 56.4% decrease), and hydraulic conductivity (57.5, 8.6 and 41.1 times increase at a void ratio of 1.2) values when infused with fly ash, sewage sludge and paper mill leachates, respectively. The study also showed that the fly ash leachate interaction causes a higher variation in bentonite behaviour than sewage sludge and paper mill leachates. The study's findings would prove beneficial to design engineers for selecting bentonite types for landfill liners.

Impact of real and simulated municipal solid waste leachates on the hydraulic and swelling behaviour of bentonites for landfill application.

For the efficient functioning of a landfill, compacted bentonite is an acclaimed liner element due to its excellent adsorption capability, minimal hydraulic conductivity, and superior specific surface area (SSA). However, the leachate generation within the landfill worsens the liner material's quality, causing migration of the leachates, contaminating groundwater, and causing pollution of surrounding environment. With this perspective, a comparative assessment of the influence of real and simulated municipal solid waste (MSW) leachate on two different bentonites has been carried out in the present investigation. The two bentonites, differing precisely by their cation exchange capacity (CEC), liquid limit (LL), and swelling capability, were examined for variation in their LL, free swell (FS), and hydraulic behaviour concerning their interaction with both leachates. Results depicted that in both the leachates, LL and FS, swelling potential (SP) and pressure declined, whereas hydraulic conductivity (HC) rose. Furthermore, the bentonite quality greatly influenced the LL, FS, SP, swelling pressure, and hydraulic behaviour. Bentonite having higher CEC, SSA, and swelling ability experienced a higher variability in the LL (55.5 and 65.2% decrease), free swelling (76.9 and 83.1% decrease), SP, swelling pressure (53.3 and 56.4% decrease), and HC (13.1 and 49.4 times increase) values when permeated with simulated and real MSW leachates, respectively. The study also showed that the real MSW leachate interaction causes a higher variation in bentonite behaviour than its simulated counterpart. The study's findings would prove beneficial to design engineers for selecting bentonite types for landfill liners.

Influence of real and synthetic municipal solid waste leachates on consolidation and shear strength behaviour of bentonites.

For safe disposal of wastes in landfills, compacted bentonite is recommended as bottom liners due to their significant cation exchange (CEC) and swelling capacity, low permeability and large specific surface area (SSA). The present investigation carried out various experimental studies determining the compressibility behaviour and unconfined compressive strength (UCS) of two different compacted bentonites in the presence of municipal solid waste (MSW) and synthetic MSW leachates. Various examinations were conducted determining alterations in consolidation parameters like the coefficient of consolidation (cv), time taken for 90% consolidation (t90) and compression index (Cc) with both leachates. The outcomes reveal that Cc and t90 values of both bentonites declined; however, cv value rose. Results also indicated that under any given consolidation pressure, a lesser void ratio was achieved for leachates. UCS of both bentonites reduced with leachates' interaction yet, lying within the recommended a value higher than 200 kPa. A comparative assessment of the two bentonites displayed that bentonite having higher CEC and swelling capacity, and SSA unveiled more excellent Cc and t90 values and a reduction in the UCS. A higher variation in behaviour of bentonites was perceived in the existence of MSW leachate in comparison to synthetic MSW leachate.

High-Titre ANA Positivity in NAFLD: An Uncommon Presentation of a Common Disease.

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease and has emerged as a serious public health challenge. About 20% of NAFLD patients may have low titres (<1:320) of antinuclear antibodies (ANA). However, we describe a patient with NAFLD whose ANA titre was high (>1:320) on presentation. After 3 months of diet, exercise and vitamin E supplementation, the patient was symptomatically better but her ANA titre had increased (>1:640). Her liver biopsy showed features of NAFLD with minimal fibrosis. High-titre ANA (>1:320) positivity is rare. Our patient showed a progressive rise in ANA titre from >1:320 to >1:640 within 3 months even though she was improving and histology showed minimal fibrosis. LEARNING POINTS: Up to 30% of patients with non-alcoholic fatty liver disease (NAFLD) may have antinuclear antibodies (ANA).Low titre (<1:320) ANA positivity is not uncommon, but a high titre is rare.The ANA titre does not correlate with the histological grade of NAFLD.

Evaluation of the Safety and Efficacy of Teneligliptin at a Higher Dose in Indian Type 2 Diabetes Patients: A Retrospective Analysis.

Background and aim While diabetes mellitus (DM) is occupying the topmost global epidemic position, India is harboring a challenging number of type 2 DM patients in the world. This devastating picture of the health sector in India requires the availability of more cost-effective, context-specific, and safer drugs for DM management. This study aimed to evaluate the safety and efficacy of teneligliptin in Indian patients with type 2 DM inadequately controlled with diet, exercise, and a maximal dose of metformin treatment. Materials and methods This was a retrospective, observational, and single-center study conducted at a diabetic clinic in India in type 2 DM patients who have been treated with teneligliptin 40 mg once daily as add-on therapy with diet, exercise, and the maximal tolerable dose of metformin for three months. The study was observational, where the data collection was through self-reporting and an observational study conducted over one year (September 2018 to August 2019). A total of 100 patients were enrolled in the study (male 69% and female 31%). Patients with available data for fasting plasma glucose (FPG), postprandial plasma glucose (2h PPG), glycated hemoglobin (HbA1c), renal function parameters, such as urinary albumin to creatinine ratio (UACR), and electrocardiogram (ECG) at baseline and three months after treatment were enrolled in the study. Results There was a significant reduction in fasting blood sugar (P=<0.001), postprandial blood sugar (P=<0.001), and HbA1c (P=<0.001) at the end of the three months treatment in comparison to the baseline level and in the primary outcomes of this study as compared to baseline. The teneligliptin treatment did not cause any significant reduction in body mass index (BMI) before and after treatment. When we compared the secondary outcomes, the indicator of renal function as expressed through the albumin-to-creatinine ratio (ACR; P=0.052), there was a borderline change in ACR from baseline to three months. The mean corrected QT interval at screening baseline was 429.7 ± 8.89 milliseconds while after three months, it was 429.1 ± 8.68 milliseconds, which was statistically insignificant. Conclusion The current results demonstrated a high level of efficacy as an add-on therapy of teneligliptin at a high dose with inadequately controlled type 2 DM subjects in India. The study results also indicate the good tolerance of this drug with no critical adverse event in this study design.

Detecting linkages between human illness and Salmonella isolates in food using a new tool for spatio-temporal analysis of multi-stream data.

We present a prototype tool designed to enable computationally efficient visualization of data and its spatio-temporal analysis by food safety and public health investigators. Its utility is evaluated in the following contexts: (1) Investigation of relationships between cases of Salmonella related human illness and Salmonella positives in meat and poultry products at USDA regulated establishments; (2) Identification and detection of patterns in food safety data which may impact public health.

T-Cube Web Interface: a tool for immediate visualization, interactive manipulation and analysis of large sets of multivariate time series.

The T-Cube Web Interface is a generic tool to visualize and manipulate large scale multivariate time series datasets. The interface allows the user to execute complex queries quickly and to run various types of statistical tests on the loaded dataset. The web interface can be used on a variety of platforms using Java-enabled browser.