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The Indian COVID-19 situation is and will demand more and more hospital bed capacity to manage. With diabetic foot disease (DFD) being a leading cause of hospital bed occupancy, managing these patients based on evidence-based guidelines can significantly reduce the rates of hospitalization. Every hospital bed that is not needed for a patient with DFD , gives room for occupancy by a patient suffering from COVID-19. The goal of doctors treating diabetic foot is aimed at early successful treatment of infections and preventing amputations, decreasing the hospital stay of inpatients, and effective cost reduction. Hence, changing our way of approach to managing a patient with diabetic foot and implementing new and unique ways is the need of the hour at this time of crisis. This guidance also has a section on managing diabetes in people with diabetic foot during the COVID19 pandemic.

Background: Prediction of outcome in diabetic foot infection (DFI) remains difficult due to lack of active signs of infection, and apparently normal white blood cell (WBC) count. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) have been studied previously in this regard and were not useful. Hence, we evaluated procalcitonin (PCT) as a prognostic marker in this study. Objectives: We aimed to study the role of PCT, CRP, and ESR levels in predicting clinical outcome of acute DFI. Materials and Methods: A total of 250 subjects (197 men, 53 women) with acute DFI were enrolled. WBC count, ESR, CRP, and PCT were done for all subjects at admission after obtaining informed consent. Subjects were managed according to hospital protocol and followed up for 1 month. Clinical outcome was assessed based on mobility and morbidity status of the subject. Results: Old age, anemia, hyponatremia, hypoalbuminemia, and elevated serum creatinine were risk factors for poor outcome. Presence of cardiac failure, diabetic retinopathy, peripheral vascular disease, previous amputations, and positive bone culture had negative influence on clinical outcome. Elevated WBC count, ESR, CRP, and serum PCT were significantly associated with bad outcome. Elevated PCT (>2 ng/ml) [odds ratio (OR) (95% confidence interval (CI)), 2.03 (1.13–5.19), P < 0.001], gangrene [OR (95% CI), 2.2 (1.02–4.73), P = 0.04], and sepsis [OR (95% CI), 10.101 (4.34–23.25), P < 0.001] were good predictors of clinical outcome in acute DFI. Conclusion: PCT proved to be a reliable marker of acute DFI and good predictor of clinical outcome than existing markers WBC count, ESR, and CRP. Hence it should be useful for clinicians while managing acute DFI.

Background: It is well documented in the literature that fungal infections are common in diabetic foot ulcers (DFUs). This has led to an overuse of antifungal agents, namely fluconazole, with a consequent risk of emergence of resistance to this drug. Previous studies have shown a 3.9% prevalence of fluconazole resistance in DFU, but limited data exist regarding the change in resistance pattern over the last decade. Objectives: Our aim was to study the prevalence of resistance to fluconazole in patients with DFU and culture-proven fungal infections. Materials and Methods: We retrospectively studied 1438 patients with type 2 diabetes and nonhealing foot ulcers who had fungal cultures performed during the course of their treatment. The data were collected for all patients who presented to our foot clinic over a period of 18 months. Results: The prevalence of positive fungal culture was 17.38% (250/1438). 151/200 positive cultures belonged to Candida species. Resistance to fluconazole was observed in 9.3% (17/200). The most common organism with resistance to fluconazole was Candida auris (10/17). Conclusions: High prevalence of fluconazole resistance is a potential cause of concern, and the rational use of this drug is important in the community. The above results could have an impact on public health, as fluconazole is one of the safest and effective oral antifungal agents available. The spread of resistance could have implications for its use in other situations including systemic fungal infections.

Category: Midfoot/Forefoot Introduction/Purpose: Charcot’s neuropathy is a chronic and destructive condition primarily affecting the joints of foot and ankle which can lead to severe disability sometimes even requiring amputation. Midfoot charcot’s can alter the normal biomechanics of the foot leading to point loading and ulcer formation. Different modalities with variable results have been proposed for this devastating condition. Patient reported outcome measurement information system (PROMIS) is a patient, fast and reliable validated tool with different clinical domains to assess the post-operative outcome measures in various aspects of foot and ankle surgery. The aim of the present study was to assess the Pre and post-operative PROMIS scoring of three parameters (Physical function, fatigue and social role) in diabetic patients with Charcot’s neuropathy affecting the midfoot. Methods: A prospective study was conducted at a tertiary care diabetic centre on 13 patients with Charcot’s midfoot treated with internal fixation by a single surgeon. Out of 13 patients who met the inclusion criteria, 3 patients had ulcer over the plantar aspect of the foot which was initially treated with contact cast for 6 weeks following which 2 patients were operated using internal fixation and 1 was excluded. Pre and post-operative PROMIS scores were recorded and the final outcomes were measured. The midfoot was fixed with either locking plates or long cannulated screws. Results: The mean age of the patients were 53.2±9.6 years with a mean duration of diabetes since 7.3 years. The average hospital stay was 3.7±1.5 days. Union was achieved in 13.4±2.7 weeks. The mean RAW scores for physical function, fatigue and social role measured pre-operatively were 8.33±2.53, 16.83±2.44 and 16.75±2.80 which later improved post-operatively to 16.75±2.63, 6.91±2.31 and 6.16±1.58 respectively. There was an improvement between the pre and post-operative PROMIS scores which was statistically significant (P

Aim: The aim of this study was to assess and compare the response to two forms of treatment-immobilization with zoledronic acid injection and immobilization with oral weekly Alendronate, in patients with diabetes mellitus and acute Charcot arthropathy (CA) of foot in terms of clinical and radiological parameters. Material and Methods: Patients attending the endocrinology and podiatry clinic with history of diabetes mellitus and Acute CA were taken for study. The patients were randomized into two treatment groups. Group Z-zoledronic acid injection along with total contact cast (TCC). Group A-Tab. Alendronate 70 mg. once a week till the complete clinical resolution of acute CA along with TCC. Forty-five patients were randomized and 40 of them completed the study. The primary end point was complete clinical resolution of acute CA-defined as temperature difference between normal and affected foot

Obesity hypoventilation syndrome (OHS), also known as Pickwickian syndrome, is a combination of obesity (body mass index (BMI) >30 kg/m2), daytime hypercapnia (arterial carbon dioxide tension >45 mm Hg) and sleep-disordered breathing, after exclusion of other disorders that may cause alveolar hypoventilation. Management of OHS requires a multifaceted approach in the form of weight loss, treatment of existing co-illnesses, pulmonary rehabilitation, and Bi-level positive airway pressure (Bi-PAP) therapy. A 58-year-old lady with a BMI of 50 kg/m2 with symptoms of obstructive sleep apnea (OSA) and OHS presented to the hospital with respiratory distress. She gave a history of breathlessness, snoring, and sleep disturbances for the last 7 years. She was managed by a physician with a diagnosis of obstructive airway disease without further evaluation of sleep disturbance. On admission, she was started on non-invasive ventilation during her initial management. After 72 hours of admission, the patient became stable, and overnight polysomnography was performed to confirm the diagnosis of OHS. After confirmation of the diagnosis, she was started on Bi-PAP therapy along with other supportive therapy for 7 days. She was discharged after 10 days of admission with nocturnal Bi-PAP therapy at home and was enrolled in a comprehensive pulmonary rehabilitation program. Patient is on regular follow-up and has been doing well since then.

Abstract There has been an intense surge in interest in the search for alternative sources of petroleum fuels in the modern world as a result of the inflation of fuel prices and the historic supply gap. When compared to petroleum fuels, biodiesel is becoming an increasingly valuable option due to the fact that it produces less emissions and provides the almost same amount of energy. In point of fact, the prime aim of this work is to explore the possibility of utilizing biodiesel derived from lemongrass oil and including dibutyl ether as an additive for the test diesel engine operating on varied compression ratios. The findings showed that the best operating settings are a 17.5 compression ratio with a blend of 30% biodiesel and 70% diesel fuel. At greater loads, brake thermal efficiency is lower than that of diesel engines. Lower loads result in lower specific fuel usage. Mechanical efficiency at higher loads is highest in the B30 blend, but emission metrics such as CO, CO2, HC, and NOx were reduced with the inclusion of an additive, though HC rose with higher loads of lemongrass oil biodiesel blends. When compared to the B30 biodiesel blend with various composition additives, the B30 + 4% additive has the highest efficiency at the fourth load in terms of both brake power and mechanical efficiency.

Abstract With the sustained rise in satellite deployment in Low Earth Orbits, the collision risk from untracked space debris is also increasing. Often small-sized space debris (below 10 cm) are hard to track using the existing state-of-the-art methods. However, knowing such space debris’ trajectory is crucial to avoid future collisions. We present a Physics Informed Neural Network (PINN)—based approach for estimation of the trajectory of space debris after a collision event between active satellite and space debris. In this work, we have simulated 8565 inelastic collision events between active satellites and space debris. To obtain the states of the active satellite, we use the TLE data of 1647 Starlink and 66 LEMUR satellites obtained from space-track.org. The velocity of space debris is initialized using our proposed velocity sampling method, and the coefficient of restitution is sampled from our proposed Gaussian mixture-based probability density function. Using the velocities of the colliding objects before the collision, we calculate the post-collision velocities and record the observations. The state (position and velocity), coefficient of restitution, and mass estimation of un-tracked space debris after an inelastic collision event along with the tracked active satellite can be posed as an optimization problem by observing the deviation of the active satellite from the trajectory. We have applied the classical optimization method, the Lagrange multiplier approach, for solving the above optimization problem and observed that its state estimation is not satisfactory as the system is under-determined. Subsequently, we have designed Deep Neural network-based methods and Physics Informed Neural Network (PINN) based methods for solving the above optimization problem. We have compared the performance of the models using root mean square error (RMSE) and interquartile range of the predictions. It has been observed that the PINN-based methods provide a better estimation performance for position, velocity, mass and coefficient of restitution of the space debris compared to other methods.

Background and Aims: The overexpression of glial cell-derived neurotrophic factor (GDNF) in the liver and adipose tissues offers strong protection against high-fat diet (HFD)-induced obesity in mice. We hypothesize that sustainably enhancing GDNF expression in the liver may provide a therapeutic effect that can prevent the progression of HFD-induced obesity in mice. Methods: Expression lentivector encoding mouse GDNF (GDNF(pDNA) or empty vector (pDNA, control) were encapsulated in lipid nanoparticles (LNPs) using the thin-film hydration method. Mice were fed with regular diet (RD) or HFD for 20 weeks prior to injection and the GDNF and control vector-loaded LNPs were administered by intravenous (IV) injection to mice once weekly for 5 weeks. Changes in body weight were monitored and mice tissues were collected and imaged for fluorescence using an IVIS in vivo imaging system. Post-treatment abdominal fat weight, colon length, and spleen weight were obtained. GDNF protein levels in the liver and serum were quantified by enzyme-linked immunosorbent assay, while liver AKT serine/threonine kinase and AMP-activated protein kinase phosphorylation levels were evaluated by Western blotting. Results: IV-injected GDNF(pDNA)-loaded LNPs targeted the liver and remained in there for up to 15 days postinjection. A single injection of GDNF(pDNA)-loaded LNPs significantly increased GDNF expression for 7 days and consequently increased the levels of phosphorylated AKT serine/threonine kinase and AMP-activated protein kinase. Once weekly injections of GDNF(pDNA)-loaded LNPs for 5 weeks slowed increase in body weight, reduced abdominal fat, and modulated the gut microbiota toward a healthier composition in HFD-fed mice. Conclusion: GDNF(pDNA)-loaded LNPs could potentially be developed as a therapeutic strategy to reverse weight gain in obese patients.

Abstract The potential of single date fully Polarimetric RADARSAT‐2 data in retrieving crop biophysical parameters using Machine Learning techniques was investigated. Various polarimetric parameters along with coherent and incoherent decomposition techniques were assessed for its sensitivity toward crop parameters like Wet and Dry Biomass, Crop Height, Leaf Area Index and Vegetation Water Content. A set of 39 polarimetric observables extracted from the Quad‐Pol data were used for regression analysis. In this study two Machine Learning techniques Random Forest Regression (RFR) and Multiple Linear Regression (MLR) models were assessed for the prediction of Wet Biomass (gm−2) and Height (cm). The most significant (6 out of 39) variables were applied for prediction. The results revealed that RFR algorithm performed better than MLR. The coefficient of determination (R2) and root‐mean‐square‐error of estimating wet biomass and height were 0.646, 655.65 (gm−2) and 0.71, 14.5 (cm) respectively in RFR and 0.566, 683.86 (gm−2) and 0.65, 16.14 (cm) respectively in MLR. Thus this study explored the effective application of quad‐pol data for assessing sensitivity and accurate retrieval of parameters using optimum PolSAR observables.

Abstract Enteric neuron degeneration has been observed during aging, and in individuals with metabolic dysfunction including obesity and diabetes. Honokiol, a naturally occurring compound, is an activator of Sirtuin-3 (SIRT3) that has antioxidant activity. Its role in modulating enteric neuron-specific neurodegeneration is unknown. We studied the effects of honokiol and its fluorinated analog, hexafluoro-honokiol, on enteric neuronal differentiation and survival. We used a previously established model of mouse primary enteric neuronal cells and an enteric neuronal cell line treated with palmitate (PA) and lipopolysaccharide (LPS) to induce mitochondrial dysfunction and enteric neuronal cell death. The effect of honokiol and hexafluoro-honokiol was assessed on neuronal phenotype, fiber density, differentiation, and pyroptosis. Honokiol and hexafluoro-honokiol significantly increased neuronal networks and fiber density in enteric neurons and increased levels of neuronal nitric oxide synthase and Choline acetyltransferase mRNA. Hexafluoro-honokiol and honokiol also significantly increased SIRT3 mRNA levels and suppressed palmitate and LPS-induced neuronal pyroptosis. SIRT3 knock-down prevented the hexafluoro-honokiol mediated suppression of mitochondrial superoxide release. Our data supports a neuroprotective effect of honokiol and its derivative and these could be used as prophylactic or therapeutic agents for treating enteric neurodegeneration and associated motility disorders.

Abstract Background Due to the vast socioeconomic diversity among its residents, studying health inequality in India is of particular interest. This study aimed to investigate the wealth-based inequalities in physical frailty and to quantify the contributions of potential predictors of frailty to this inequality. Methods Data were drawn from the first wave of the Longitudinal Ageing Study in India (LASI) conducted during 2017–18. Logistic regression analysis was used to examine the association between wealth status and frailty. We used the concentration index to measure the magnitude of wealth-related inequality in frailty. A decomposition analysis based on the logit model was used to assess the contribution of each predictor to the total inequality. Results The prevalence of physical frailty was significantly higher among the older adults in the poor group than in the non-poor group [Difference (poor vs. non-poor): 6.4%; p

Abstract Bacillus circulans (B. circulans) is widely used as an electrogenic bacterium in microbial fuel cell (MFC) technology. This study evaluated whether B. circulans can ferment glucose to generate electricity and mitigate the effects of human skin pathogens. The electricity production of B. circulans was examined by measuring the voltage difference and verified using a ferrozine assay in vitro. To investigate the fermentation effects of B. circulans on inhibition of human skin pathogens, Cutibacterium acnes (C. acnes) was injected intradermally into mice ears to induce an inflammatory response. The results revealed that the glucose–B. circulans co-culture enhanced electricity production and significantly supressed C. acnes growth. The addition of roseoflavin to inhibit flavin production considerably reduced the electrical energy generated by B. circulans through metabolism and, in vivo test, recovered C. acnes count and macrophage inflammatory protein 2 (MIP-2) levels. This suggests that B. circulans can generate electrons that affect the growth of C. acnes through flavin-mediated electron transfer and alleviate the resultant inflammatory response. Our findings demonstrate that probiotics separated from natural substances and antimicrobial methods of generating electrical energy through carbon source fermentation can help in the treatment of bacterial infections.

Abstract Obesity is a chief lifestyle disease globally and causes a significant increase in morbidities. Overweight/ obesity prevalence has been rising faster in India compared to the world average. Therefore, the study examined the association between overweight/ obesity and successful ageing among older population in India. We also explored the gender difference in risks posed by obesity on successful ageing and the different socio-economic correlates associated with successful ageing. This study utilized data from India’s first nationally representative longitudinal ageing survey (LASI-2017-18). The effective sample size for the present study was 31,464 older adults with a mean age of 69.2 years (SD: 7.53). Overweight/ obesity was defined as having a body mass index of 25 or above. The study carried out a bivariate analysis to observe the association between dependent and independent variables. Further, multivariable analysis was conducted to examine the associations after controlling for individual socio-demographic, lifestyle and household/community-related factors. The study included 47.5% men and 52.5% women. It was found that the prevalence of obesity/overweight was higher among older women compared to older men (23.2% vs 15.5%). Similarly, high-risk waist circumference (32.7% vs 7.9%) and high-risk waist-hip ratio (69.2% vs 66.5%) were more prevalent among older women than older men. The study found significant gender differences (men-women: 8.7%) in the prevalence rate of successful ageing (p

Abstract Nonalcoholic fatty liver disease (NAFLD) is associated with increased oxidative stress that leads to hepatocyte and mitochondrial damage. In this study we investigated the mechanisms involved in the induction of oxidative stress and impairment of mitochondrial quality control and mitophagy in hepatocytes by the saturated fatty acid palmitate and Western diet feeding in mice and if their harmful effects could be reversed by the neurotrophic factor glial cell derived neurotrophic factor (GDNF). Western diet (WD)-feeding increased hepatic lipid peroxidation in control mice and, in vitro palmitate induced oxidative stress and impaired the mitophagic clearance of damaged mitochondria in hepatocytes. This was accompanied by reductions in hepatocyte sirtuin 3 (SIRT3) deacetylase activity, gene expression and protein levels as well as in superoxide dismutase enzyme activity. These reductions were reversed in the liver of Western diet fed GDNF transgenic mice and in hepatocytes exposed to palmitate in the presence of GDNF. We demonstrate an important role for Western diet and palmitate in inducing oxidative stress and impairing mitophagy in hepatocytes and an ability of GDNF to prevent this. These findings suggest that GDNF or its agonists may be a potential therapy for the prevention or treatment of NAFLD.