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Objective: Bullous pemphigoid is a rare autoimmune skin disorder characterized by blistering, urticarial lesions, which are sometimes associated with adverse drug reactions. Vildagliptin is an oral anti-diabetic agent that selectively inhibits the dipeptidyl peptidase-4 (DPP-4) enzyme. Materials and Methods: A 75-year-old female with a known case of type 2 Diabetes Mellitus, hypertension, and hypothyroidism for the last 10 years presented with pruriginous tense bullous skin lesions over her both palms and soles. There was no mucosal involvement. Further interrogation revealed that she started taking Vildagliptin 5 days ago which was prescribed due to high levels of post-prandial blood sugar level despite already intake of Glimepiride-4 mg and Metformin-3 gm. Results: Vildagliptin was immediately advised to be stopped. She was treated with antihistamines, steroids, and conservative management which led to remission of the blisters. Conclusion: Vildagliptin is the probable causative drug for developing bullous pemphigoid skin lesion which shows temporal association in this case as other concomitant drugs has no direct correlation. Therefore physicians must be aware of this rare life-threatening side effect of this medicine and advice patients to visit the hospital even the slightest cutaneous manifestation. Bullous pemphigoid can result in fatal life-threatening conditions if not treated early.

Aims: Posterior column plating through the single anterior approach reduces the morbidity in acetabular fractures that require stabilization of both the columns. The aim of this study is to assess the effectiveness of posterior column plating through the anterior intrapelvic approach (AIP) in the management of acetabular fractures. Methods: We retrospectively reviewed the data from R G Kar Medical College, Kolkata, India, from June 2018 to April 2023. Overall, there were 34 acetabulum fractures involving both columns managed by medial buttress plating of posterior column. The posterior column of the acetabular fracture was fixed through the AIP approach with buttress plate on medial surface of posterior column. Mean follow-up was 25 months (13 to 58). Accuracy of reduction and effectiveness of this technique were measured by assessing the Merle d’Aubigné score and Matta’s radiological grading at one year and at latest follow-up. Results: Immediate postoperative radiological Matta’s reduction accuracy showed anatomical reduction (0 to 1 mm) in 23 cases (67.6%), satisfactory (2 to 3 mm) in nine (26.4%), and unsatisfactory (> 3 mm) in two (6%). Merle d’Aubigné score at the end of one year was calculated to be excellent in 18 cases (52.9%), good in 11 (32.3%), fair in three (8.8%), and poor in two (5.9%). Matta’s radiological grading at the end of one year was calculated to be excellent in 16 cases (47%), good in nine (26.4%), six in fair (17.6%), and three in poor (8.8%). Merle d’Aubigné score at latest follow-up deteriorated by one point in some cases, but the grading remained the same; Matta’s radiological grading at latest follow-up also remained unchanged. Conclusion: Stabilization of posterior column through AIP by medial surface plate along the sciatic notch gives good stability to posterior column, and at the same time can avoid morbidity of the additional lateral window. Cite this article: Bone Jt Open 2024;5(2):147–153.

Menopause is the end of the menstrual cycle in a woman’s life. At menopause, a series of physiological changes occur in women’s bodies and hormonal changes are the main cause of these changes. Several metabolic changes occur in the body at that particular period, and the constellation of these changes is referred to as metabolic syndrome. Postmenopausal women have higher chances of developing these metabolic syndromes such as cardiovascular diseases (CVDs), hypertension, diabetes, and changes in the lipid profile mostly due to changes in the level of estrogen. Thus, having an overview of common metabolic disorders, their detection, and their management can improve the overall quality of life and decrease the mortality rate in the postmenopausal group. This review has discussed the commonly occurring metabolic disorders at menopause and how these disorders can be managed and treated.

Abstract Burn injuries are characterized by prolonged inflammatory phases, neurovascular damage, and hypermetabolism, eventually causing improper tissue regeneration. Insulin has gained considerable attention in normal and diabetic wound healing, yet its role in burn wounds remains poorly understood. In this study, insulin-chitosan nano-formulations (ICNP) were synthesized using a simple and robust mechanism and characterized to monitor specific interactions between insulin and chitosan, and the particles measuring approximately 30 nm in size exhibited mild alterations in the amide I, II, and III bonds of the insulin protein along with impressive insulin loading efficiency of 88.725 ± 0.295% under physiological conditions, and significantly improved burn wound healing in vitro (HEKa cells) and in vivo (murine third-degree burn model). The underlying mechanism behind superior wound closure and tissue remodeling was attributed to significant early phase reduction of pro-inflammatory cytokine IL-6 levels in ICNP-treated mice, while anti-inflammatory cytokine IL-10 levels became markedly elevated, resulting in enhanced re-epithelialization and collagen deposition. Furthermore, treatment of ICNP was associated with unregulated expression of Nrf-2, a key regulator of oxidative stress and inflammation, indicating their molecular crosstalk. These findings highlight the potential of ICNP as a promising therapeutic formulation for burn wound healing, promoting wound closure by modulating inflammatory phases, making it a valuable candidate for further clinical development in burn care. Graphical Abstract

Biochemical anomalies impairing the body’s normal metabolism are referred to as inborn errors of metabolism (IEM). Early diagnosis and management can avert the otherwise harmful situation that may occur due to inborn errors. Generally, their incidence can vary from one case in every 800 to 2500 cases. Thus, understanding the genetic defects behind the clinical presentation of the disease and their early management and treatment is the need of the hour. This review article gives an overall knowledge of the types of IEM, its pathophysiology, clinical presentation, diagnosis, and management of the disease.

Background and aims: There is limited information on the chemical nature of the edible fruits of the mangrove Sonneratia apetala, which is utilized in traditional medicine in coastal areas. The goal of the current research was to identify the biologically active substances behind their therapeutic effects, particularly blood sugar regulation. Methods: To determine the chemical fingerprint of S. apetala fruit extract, reversed phase high performance liquid chromatography (RP-HPLC) and gas chromatography–mass spectrometry (GC-MS) profiling were used. The antioxidant properties were thoroughly examined. α-Amylase and α-glucosidase enzymes were also used to evaluate the impact of S. apetala fruit extract on the regulatory mechanism for the metabolism of carbohydrates. Results: S. apetala fruit extract showed high concentrations of phenolics, flavonoids, and water-soluble vitamins (C, B2, B5, and B6). Quercetin, catechin, rutin, myricetin, p-coumaric acid, ferulic acid, gallic acid, sinapic acid, and ascorbic acid were among the recognized therapeutically active substances found in RP-HPLC. The presence of β-amyrin and lupeol in S. apetala fruit extract was determined by the GC-MS profile. The carbohydrate-slitting enzymes α-amylase and α-glucosidase were also strongly inhibited by S. apetala fruit extract. Conclusion: The fruit of S. apetala contains therapeutically useful polyphenolics, triterpenoids, phytosterols, and vitamins. It can lower blood sugar absorption by blocking enzymes that break down carbohydrates and has potent antioxidant qualities.

The COVID-19 patients experienced acute respiratory distress during their SARS-CoV-2 infections. The present observational study was undertaken to find out the possible association between vitamin D and COVID-19 clinical severity in a tertiary care hospital from November 2021 to February 2022. Patients admitted to the hospital’s Critical Care Unit (CCU) with SARS-CoV-2 illness were selected for blood vitamin D estimations. Patients’ conditions were evaluated clinically and correlated with serum vitamin D levels. Out of a total of 97 COVID-19 patients selected, 64.9% were male. Clinically, 41.3% of patients had a severe COVID-19 infection, compared to a moderate infection incidence of 58.7%. Among them, 19.6% and 42.2% were found to be vitamin D deficient and vitamin D insufficient, respectively. Serum vitamin D was significantly (p

Abstract Mechanical and corrosion properties of welded duplex stainless steel (DSS) structures are of paramount consideration in many engineering applications. The current research investigates the mechanical properties and corrosion integrity of duplex stainless-steel weldment in a simulated 3.5% NaCl environment using specially developed novel electrodes without the addition of alloying elements to the flux samples. Two different types of fluxes having basicity indexes of 2.40 and 0.40 were used to coat E1 and E2 electrodes respectively for DSS plate welding. The thermal stability of the formulated flux was evaluated using thermogravimetric analysis. The chemical composition, using optical emission spectroscopy, and the mechanical and corrosion properties of the welded joints were evaluated as per different ASTM standards. X-ray diffraction was used to find out the phases present in the DSS welded joints while a scanning electron equipped with EDS was used for microstructural examination of the weldments. The ultimate tensile strength of welded joints made using the E1 electrode was in the range of 715–732 MPa and that of the E2 electrode was found to be 606–687 MPa. The hardness was increased with increased welding current from 90 to 110 A. The welded joint with E1 electrode coated with basic flux has better mechanical properties. The steel structure in 3.5% NaCl environment possesses substantial resistance to corrosion attack. This validates the performance of the welded joints made by the newly developed electrode. The results are discussed on the basis of the depletion of alloying elements such as Cr and Mo observed from the weldments with the coated electrodes E1 and E2 as well as precipitation of the Cr2N in the welded joints made by E1 and E2 electrodes.

Capparis decidua belongs to family Capparidaceae in wastelands of India. The study aim was to determine the role of C. decidua fruits on the free fatty acids (FFA) profile in fat-rich diet (FRD) dyslipidemic rats. The methanolic extract of edible fruit of C. decidua (CD) was given orally to obese dyslipidemic rats at the dose of 125 mg/kg and 250 mg/kg for consecutive 28 days. CD treatment in FRD rats significantly restricts the body weight gains. Blood lipid profile was altered dose dependently and significantly after 4-week treatment with CD to FRD. rats. It significantly (p

Introduction: Acute Coronary Syndrome (ACS) is characterised by hypercoagulability and inflammation. In acute presentation of Ischaemic Heart Disease (IHD), like ACS, serum albumin may also play an important role. Many patients with ischaemic cerebrovascular accident, a condition similar to ACS, had low serum albumin. Aim: To estimate serum albumin levels in patient with ACS and its relation to hospital adverse outcome. Materials and Methods: The present prospective observational study was conducted in the Department of General Medicine at R.G. Kar Medical College and Hospital, West Bengal, India. The duration of the study was 18 months, from July 2019 to October 2020. Patients with ACS were included irrespective of age, sex, race and predisposing factors such as Hypertension (HTN), Diabetes Mellitus (DM), hyperthyroidism and dyslipidaemia. A total of 125 patients included and details such as relevant history, examination findings, laboratory investigation, Electrocardiography (ECG), Echocardiography (ECHO), chest X-ray Posteroanterior (PA) view were included. Chi-square test and logistic regression were applied. Results: A total of 94 (75.2%) patients were males. 49 (39.2%) study patients had DM. Total 10 (8%) patients presented with cardiac arrest at admission. In-hospital death was happened in 9 (7.2%) cases. 59 (47.2%) patients had normal serum albumin level (3.5-4.5). 61 (48.8%) had mild to moderate hypoalbuminaemia (2.5-3.5) and only 5 (4%) had severe hypoalbuminaemia (

Abstract This paper addresses the exploitation of vector based contraction theory to synchronize the motion of agents in multiagent systems. The convergence analysis of the agents using this theory provides a flexible frame as the components of a vector distance norm follow less stringent conditions than classical contraction analysis. The key feature is that it encompasses the formulation of some comparison system, as a result, the problem of convergence analysis of a complex multiagent system reduces to the convergence analysis of a much simpler comparison system. Hence, despite the nonlinearities, the methods of designing consensus controls remain simple as compared to the existing literature. We address four different cases: 1) consensus of third‐order dynamics multiagent systems subjected to acceleration and input constraints; 2) consensus of multiagent systems with heterogeneous nodes under communication imperfections; 3) synchronization of multiagent systems with connected and disconnected switching topologies; 4) synchronization in networked systems with time‐varying couplings. Moreover, an effective synchronization control scheme for a class of multiagent systems with underactuated agent dynamics is developed using the method of aggregation of comparison systems. Finally, simulation results are illustrated that show the validity of the mathematical results.

Abstract This paper proposes a distributed artificially delayed output feedback‐based leader–follower and leaderless consensus control for the uncertain general linear multiagent systems (MASs) with an arbitrary relative degree. Based on the measured relative output and their delayed information with respect to neighbours, two distributed controllers are designed, which relaxes the requirement of all relative states information of agents. Through the Lyapunov–Krasovskii functional, linear matrix inequalities (LMIs) are formulated, and these LMIs are feasible for arbitrary small delays selected by the user. Delay‐dependent sufficient conditions are provided to guarantee the asymptotic convergence of nominal error systems and ultimately uniform boundedness in the case of a perturbed error system, using the input to state stability (ISS) theory. Finally, the efficacy of the proposed method is illustrated through numerical examples.

Abstract This paper addresses a quantized feedback hands‐off control for a class of nonlinear systems. Here, [K,KL] sector is constructed with the suitable choice of control‐Lyapunov function. With adjustment policy of quantization parameters, the quantized feedback hands‐off control can force the states of the nonlinear feedback system to the interior of a continuous‐time [K,KL] sector infinite time and the Lyapunov‐candidate function decreases automatically inside the designed sector. Finally, the effectiveness of the proposed method is illustrated by numerical examples.

Objective: COVID-19 in people with diabetes is associated with a disproportionately worse prognosis. DKA is an acute complication of diabetes with a mortality rate of approximately 0.67%. Little is known about the natural history of DKA in the presence of COVID-19. This study aimed to explore the effects of COVID-19 on presentation, clinical course and outcome in patients presenting with DKA. Design: Retrospective cohort study. Methods: All patients treated for DKA between 1 March 2020 and 30 May 2020 were included. Patients were categorised as COVID-positive or COVID-negative based on the swab test. A pre-COVID group was established using data from 01 March 2019 to 30 May 2019 as external control. Data regarding demographics, diabetes type, pH, bicarbonate, lactate, glucose, DKA duration, complications and outcome were collected. Results: A total of 88 DKA episodes were included in this study. There was no significant difference in the severity or duration of DKA between the three groups. COVID-positive T1DM were more hyperglycaemic on admission compared to COVID-negative and pre- COVID patients. There was an over representation of T2DM in COVID-positive patients with DKA than in pre-COVID or COVID-negative groups. Conclusion: COVID-19 appears to influence the natural history of DKA differen tly in T1DM and T2DM. Patients with T1DM and COVID-19 presented with more hyperglycaemia (60 mmol/L (35.9–60.0) vs 31.4 mmol/L (28.0–39.1) vs 24 mmol/L (20.2–33.75), respectively). Patients with T2DM were unusually presenting in DKA when infected with COVID-19 with greater ICU need and higher mortality rates. A collaborative, multi-centre study is needed to provide more definitive results.

Abstract Efficient maximum power point tracking (MPPT) is an important problem for renewable power generation from photovoltaic systems. In this work, a current sensor based MPPT algorithm using an adaptive step‐size for a single ended primary inductance converter (SEPIC) based solar photovoltaic system is proposed. Due to lower sensitivity of power to current perturbation as compared to the voltage one, such a scheme is shown to yield better efficiency at steady‐state. A new adaptation scheme is also proposed for faster convergence of the MPPT technique. Hence, the proposed scheme yields better transient as well as steady‐state performance. A prototype converter is used along with digital implementation of the proposed MPPT technique to demonstrate the superiority of the proposed algorithm over the fixed step‐size and voltage based ones. Simulation and experimental results corroborates the same.

Abstract A novel directional inoculation technique has been designed to cast thin slab ingots containing Goss (or near Goss) oriented components in the as cast microstructure under the combined effect of oriented nucleation and oriented growth. The same has been targeted so as to retain Goss orientations and simultaneously develop γ fiber components (ranging from {111}< $$1\overline{1}0$$ 1 1 ¯ 0 > to {111}) during hot rolling. The designed scheme of directional inoculation achieved oriented nucleation by the effect of exogenously added soft magnetic inoculants under magnetic field and oriented growth by the effect of fast cooling rates prevailing in the mould. The choice of 65Fe–35Co (wt%) system as soft magnetic inoculants was made taking into account the similarity in crystal structure and lattice parameter. The chemically synthesized inoculants under the effect of external magnetic field during solidification were able to exhibit directional inoculation. Variation in the cast microstructure and microtexture by varying the extent of inoculant addition was studied by EBSD technique. The ingots cast under different conditions were subjected to a designed hot rolling schedule and the through process microstructural and microtextural evolution was assessed. It was observed that fine equiaxed grains with initial cube orientations in the as cast structure could lead to the most desirable microstructural as well as microtextural gradient in the hot band.

This article concerns the problem of stability analysis of systems with time-varying delay. Recent developments in this direction involves approximation of a second order polynomial function of time-delay. This article proposes a new Lyapunov-Krasovskii Functional that does not introduce the second-order polynomial and thereby avoid the approximation involved in obtaining the stability criterion. Two stability criterion are presented, one introduces the second-order polynomial and the other one does not. A comparison using numerical examples shows that the avoidance of second-order polynomial formulation leads to improved results.

This paper proposes new decentralised event-triggering conditions for single- and double integrator multi-agent systems. The developed conditions are based on the relative ratio of the state measurement error and norm of a state function for actuating the controller updates. With higher limits on the maximum tolerable state measurement error, the controller is shown to reduce the actuation updates and hence, the use of available resources. The network topology is assumed to be undirected and connected. The inter-event intervals are shown to be strictly positive for all agents to eliminate the zeno phenomenon. The theoretical concepts are further demonstrated through numerical comparisons and illustrative simulations.

Abstract Introduction To assess if in adults with COVID‐19, whether those with diabetes and complications (DM+C) present with a more severe clinical profile and if that relates to increased mortality, compared to those with diabetes with no complications (DM‐NC) and those without diabetes. Methods Service‐level data was used from 996 adults with laboratory confirmed COVID‐19 who presented to the Queen Elizabeth Hospital Birmingham, UK, from March to June 2020. All individuals were categorized into DM+C, DM‐NC, and non‐diabetes groups. Physiological and laboratory measurements in the first 5 days after admission were collated and compared among groups. Cox proportional hazards regression models were used to evaluate associations between diabetes status and the risk of mortality. Results Among the 996 individuals, 104 (10.4%) were DM+C, 295 (29.6%) DM‐NC and 597 (59.9%) non‐diabetes. There were 309 (31.0%) in‐hospital deaths documented, 40 (4.0% of total cohort) were DM+C, 99 (9.9%) DM‐NC and 170 (17.0%) non‐diabetes. Individuals with DM+C were more likely to present with high anion gap/metabolic acidosis, features of renal impairment, and low albumin/lymphocyte count than those with DM‐NC or those without diabetes. There was no significant difference in mortality rates among the groups: compared to individuals without diabetes, the adjusted HRs were 1.39 (95% CI 0.95–2.03, p = 0.093) and 1.18 (95% CI 0.90–1.54, p = 0.226) in DM+C and DM‐C, respectively. Conclusions Those with COVID‐19 and DM+C presented with a more severe clinical and biochemical profile, but this did not associate with increased mortality in this study.

The article analyses possible ways of using predictive controllers to perform control tasks and dynamic decoupling for dynamic systems with Multiple Inputs and Multiple Outputs (MIMO). The results of experiments on the selected reference plant are presented, showing the effectiveness of individual decoupling methods. These are also compared to those obtained in typical control systems with Proportional-Integral-Derivative (PID) controllers. Recommendations are made on how to tune model predictive controllers (MPC) for their effective use for MIMO plants. DOI: 10.5755/j01.eie.25.2.23195

Abstract Aims To establish the prevalence of admission plasma glucose in 'diabetes' and 'at risk' ranges in emergency hospital admissions with no prior diagnosis of diabetes; characteristics of people with hyperglycaemia; and factors influencing glucose measurement. Methods Electronic patient records for 113 097 hospital admissions over 1 year from 2014 to 2015 included 43 201 emergencies with glucose available for 31 927 (74%) admissions, comprising 22 045 people. Data are presented for 18 965 people with no prior diagnosis of diabetes and glucose available on first attendance. Results Three quarters (14 214) were White Europeans aged 62 (43‐78) years, median (IQ range); 12% (2241) South Asians 46 (32‐64) years; 9% (1726) Unknown/Other ethnicities 43 (29‐61) years; and 4% (784) Afro‐Caribbeans 49 (33‐63) years, P 24 hours. Conclusions Hyperglycaemia was evident in 21% of adults admitted as an emergency; various aspects related to follow‐up and initial testing, age and ethnicity need to be considered by professional bodies addressing undiagnosed diabetes in hospital admissions.

Substitutional doping is well-established in traditional semiconductors but has not been extensively explored in two-dimensional semiconductors. Here, the authors investigate the structural and electronic effects of Nb doping in MoS2 crystals.

Takayasu’s arteritis (TA) is a rare, systemic, inflammatory large-vessel vasculitis of unknown etiology resulting in a granulomatous inflammation of the aorta and its major branches. It most commonly affects the women of childbearing age. Pulmonary artery involvement is very rare. We, hereby, report a case of TA presenting with fever and hemoptysis due to pulmonary artery involvement.

Single coronary artery is a rare congenital anomaly of the coronary artery. The association ranges from predominantly asymptomatic to myocardial infarction, syncope being an uncommon presentation of Takayasu's arteritis. Given a limited literature of single coronary artery, we have made an attempt in our case report to relate an uncommon association of single coronary artery and Takayasu's arteritis.

Left ventricular systolic dysfunction in childhood can be due to many causes. It may be because of sequel of myocarditis, metabolic causes, storage disorder, congenital heart disease or idiopathic dilated cardiomyopathy. Severe left ventricular outflow obstruction can cause reversible severe left ventricular systolic dysfunction. Here we report a case of severe post-ductal coarctation of aorta presenting like dilated cardiomyopathy.

Abstract Symmetrical peripheral gangrene is an ischemic necrosis simultaneously involving the distal portions of two or more extremities without any proximal arterial obstruction or vasculitis. It may occur as a result of a large number of infectious and non-infectious causes. A few cases of symmetrical peripheral gangrene associated with cardiac disease have been described in the literature. We describe a case of symmetrical peripheral gangrene complicating ventricular pseudoaneurysm, probably a hitherto unreported occurrence. In this report, we sought to emphasize the importance of cardiac evaluation while dealing with a case of symmetrical peripheral gangrene.