Ashwini Mallad - Academia.edu (original) (raw)

Papers by Ashwini Mallad

ABSTRACT Background / Purpose: Rabies is an important public health problem worldwide, and more t... more ABSTRACT Background / Purpose: Rabies is an important public health problem worldwide, and more than 55,000 people die annually of the disease. The King Edward Memorial Hospital, Mumbai, is a tertiary referral centre where a rabies clinic runs 24 hours. In view of lack of information about the demographics of the disease in an urban environment the present study was carried out. Main conclusion: Our findings showed that the use of human rabies immunoglobulin (HRIG) was low, with less than 2% of the Category III patients being prescribed it. As vaccination and HRIG continue to remain expensive, the intradermal vaccine shorter regimes, like the Zagreb regime and monoclonal antibodies may offer safer and cost-effective options in the future. Further studies need to be done in different parts of the country.

1 Postprandial Glucose Fluxes and Insulin Sensitivity during Exercise: 1 A Study in Healthy Indiv... more 1 Postprandial Glucose Fluxes and Insulin Sensitivity during Exercise: 1 A Study in Healthy Individuals 2 3 Michele Schiavon * 4 Ling Hinshaw 5 Ashwini Mallad 6 Chiara Dalla Man* 7 Giovanni Sparacino* 8 Matthew Johnson 9 Rickey Carter 10 Rita Basu 11 Yogish Kudva 12 Claudio Cobelli* 13 Ananda Basu. 14 15 16 Running Title: Insulin sensitivity during exercise 17

Marshall Journal of Medicine, 2018

Background: Kawasaki disease is one of the leading causes of acquired heart disease in children. ... more Background: Kawasaki disease is one of the leading causes of acquired heart disease in children. It is an acute self-limited vasculitis that predominantly affects infants and children younger than 5 years of age. These patients present with nonspecific symptoms, such as fever and lymphadenopathy, making the diagnosis challenging. This disease can have serious and potentially fatal outcomes, and prompt recognition of this disease is vital to the patient's outcome. We present a complete review of the disease, including the epidemiology, pathophysiology, diagnosis and management of acute Kawasaki disease, the natural history of this disease, and follow up of these patients as they transition into the adult cardiology practice. Methods: Our systematic review information was collected from articles retrieved from PubMed library. Keywords that were used included; Kawasaki disease, coronary artery disease, coronary artery aneurysm, pediatric coronary artery disease, epidemiology of Kawasaki disease and treatment of Kawasaki disease. We included only relevant to the topic articles. No exclusion criteria were applied. Conclusions: Kawasaki disease incidence tends to be increasing over the last decade in the United States. Seasonality of the disease has been described in Japan. It is a mysterious disease with unknown etiology, however, multiple hypotheses have been proposed and tested to explain the pathophysiology. As this disease has an associated high morbidity and mortality, prompt recognition and management are important to the patient's overall prognosis and survival.

Marshall Journal of Medicine, 2016

Isolated left ventricular noncompaction cardiomyopathy (LVNC) is a rare congenital condition occu... more Isolated left ventricular noncompaction cardiomyopathy (LVNC) is a rare congenital condition occurring due to arrest of myocardial compaction in the first trimester, resulting in a thin layer of compacted epicardium and thick hypertrabeculated myocardium containing deep recesses. This article presents a 44-year-old female with progressive dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and pleuritic chest pain. Examination revealed elevated jugular venous distention, lower extremity edema, and bibasilar crackles on lung auscultation, while the electrocardiogram (EKG) exhibited left bundle branch block. Two-dimensional echocardiography (2D-Echo) showed a dilated left ventricle (LV) with ejection fraction (EF) of 25% and severe diffuse hypokinesia. Cardiac magnetic resonance imaging (MRI) confirmed the diagnosis of LVNC. Thereafter, she developed atrial fibrillation with rapid ventricular rate. Conservative treatment was initiated with Tikosyn, Xarelto, Lasix, Toprol XL, Lisinopril, statin and life vest. Eventually, a cardiac resynchronization therapy defibrillator (CRT-D) was implanted to prevent sudden cardiac death and reduce heart failure complications.

The Journal of Clinical Endocrinology & Metabolism, 2016

Context: Early postprandial hyperglycemia and delayed hypoglycemia remain major problems in curre... more Context: Early postprandial hyperglycemia and delayed hypoglycemia remain major problems in current management of type 1 diabetes (T1D). Objective: Our objective was to investigate the effects of pramlintide, known to suppress glucagon and delay gastric emptying, on postprandial glucose fluxes in T1D. Design: This was a single-center, inpatient, randomized, crossover study. Patients: Twelve patients with T1D who completed the study were analyzed. Interventions: Subjects were studied on two occasions with or without pramlintide. Triple tracer mixed-meal method and oral minimal model were used to estimate postprandial glucose turnover and insulin sensitivity (SI). Integrated liver insulin sensitivity was calculated based on glucose turnover. Plasma glucagon and insulin were measured. Main Outcome Measure: Glucose turnover and SI were the main outcome measures. Results: With pramlintide, 2-hour postprandial glucose, insulin, glucagon, glucose turnover, and SI indices showed: plasma glu...

The Indian Journal of Medical Research

Background & objectives: Rabies is an important public health problem worldwide and more than 55,... more Background & objectives: Rabies is an important public health problem worldwide and more than 55,000 people die annually of the disease. The King Edward Memorial Hospital, Mumbai, is a tertiary referral centre where a rabies clinic runs 24 hours. In view of lack of information about the demographics of the disease in an urban environment the present study was carried out. Methods: Data on 1000 consecutive animal bite victims presenting to the institute in 2010 were collected over a 15 wk period. An electronic database was specially created for capturing information and was modelled on the information available from the WHO expert consultation on rabies, 2005. Economic burden from the patients’ perspective was calculated using both direct and indirect costs. Results: The victims were largely males (771 subjects). The dog was the major biting animal (891, 89.1%). Bites were mainly of Category III (783, 78.3%). One twenty three subjects used indigenous treatments only for local wound c...

American journal of physiology. Endocrinology and metabolism, Jan 7, 2015

Glucagon use in artificial pancreas for type 1 diabetes (T1D) is being explored for prevention an... more Glucagon use in artificial pancreas for type 1 diabetes (T1D) is being explored for prevention and rescue from hypoglycemia. However, the relationship between glucagon stimulation of endogenous glucose production (EGP) viz., hepatic glucagon sensitivity, and prevailing glucose concentrations has not been examined. To test the hypothesis that glucagon sensitivity is increased at hypoglycemia vs. euglycemia, we studied 29 subjects with T1D randomized to a hypoglycemia or euglycemia clamp. Each subject was studied at 3 glucagon doses either at euglycemia or hypoglycemia with EGP measured by isotope dilution technique. The peak EGP increments and the integrated EGP response increased with increasing glucagon dose during euglycemia and hypoglycemia. However, the difference in dose response based on glycemia was not significant despite higher catecholamine concentrations in the hypoglycemia group. Knowledge on glucagon effects on EGP was used to develop an in silico glucagon action model....

The Journal of Clinical Endocrinology & Metabolism, 2015

Closed-loop control (CLC) relies on an individual&amp... more Closed-loop control (CLC) relies on an individual's open-loop insulin pump settings to initialize the system. Optimizing open-loop settings prior to use of CLC usually requires significant time and effort. To investigate the effects of a one-time algorithmic adjustment of basal rate and insulin to carbohydrate ratio (CR) open-loop settings on the performance of CLC. Multicenter, outpatient, randomized, crossover clinical trial. 37 adults with type 1 diabetes were enrolled at 3 clinical sites. Each subject'ss insulin pump settings were subject to a one-time algorithmic adjustment based on one week of open-loop (i.e., home care) data collection. Subjects then underwent two 27-hr periods of CLC in random order with either unchanged (control) or algorithmic adjusted basal rate and CR settings (adjusted) used to initialize the zone-MPC artificial pancreas controller. Subject'ss followed their usual meal-plan and had an unannounced exercise session. Time in glucose range 80-140 mg/dL, compared between both arms. 32 subjects completed the protocol. Median time in CLC was 25.3 hrs. Median time in range 80-140 mg/dL was similar in both groups (39.7% control, 44.2% adjusted). Subjects in both arms of CLC showed minimal time spent <70 mg/dL (median 1.34% and 1.37% respectively). There were no significant differences time >140 mg/dL. A one-time algorithmic adjustment of open-loop settings did not alter glucose control in a relatively short duration outpatient closed-loop study. The CLC system proved very robust and adaptable, with minimal…

Diabetes technology & therapeutics, Jan 29, 2015

Understanding the effect size, variability, and underlying physiology of the dawn phenomenon is i... more Understanding the effect size, variability, and underlying physiology of the dawn phenomenon is important for next-generation closed-loop control algorithms for type 1 diabetes (T1D). We used an iterative protocol design to study 16 subjects with T1D on individualized insulin pump therapy for two successive nights. Endogenous glucose production (EGP) rates at 3 a.m. and 7 a.m. were measured with [6,6-(2)H2]glucose as a single tracer, infused from midnight to 7 a.m. in all subjects. To explore possibility of tracer recycling due to prolonged [6,6-(2)H2]glucose infusion, which was highly probable after preplanned interim data analyses, we infused a second tracer, [6-(3)H]glucose, from 4 a.m. to 7 a.m. in the last seven subjects to measure EGP at 7 a.m. Cortisol concentrations increased during both nights, but changes in glucagon and insulin concentration were inconsistent. Although the plasma glucose concentrations rose from midnight to 7 a.m. during both nights, EGP measured with [6,...

The Indian journal of medical research, 2014

Rabies is an important public health problem worldwide and more than 55,000 people die annually o... more Rabies is an important public health problem worldwide and more than 55,000 people die annually of the disease. The King Edward Memorial Hospital, Mumbai, is a tertiary referral centre where a rabies clinic runs 24 hours. In view of lack of information about the demographics of the disease in an urban environment the present study was carried out. Data on 1000 consecutive animal bite victims presenting to the institute in 2010 were collected over a 15 wk period. An electronic database was specially created for capturing information and was modelled on the information available from the WHO expert consultation on rabies, 2005. Economic burden from the patients' perspective was calculated using both direct and indirect costs. The victims were largely males (771 subjects). The dog was the major biting animal (891, 89.1%).Bites were mainly of Category III (783, 78.3%). One twenty three subjects used indigenous treatments only for local wound care. Of the Category III bites, only 21 ...

The International journal of risk & safety in medicine, 2014

Off-label use of drugs is widely prevalent in children mainly due to a limited data generated in ... more Off-label use of drugs is widely prevalent in children mainly due to a limited data generated in children during drug development process. Parents play a critical role in giving consent for their child to participate in clinical trials. Very few studies have assessed the opinion of the parents regarding such use and permitting their child to participate in clinical trials. In view of lack of information about the awareness among parents regarding both off-label drug use in children as well as about allowing their child to participate in clinical research especially from a developing country, this study was conducted. Adults accompanying patients in a tertiary care hospital were administered a validated, structured questionnaire following written informed consent. The questionnaire consisted of 18 items broadly divided into 5 themes - parental views on safety and labelled use of drugs in children, awareness of off-label drug use in children, communication from healthcare worker about...

American Journal of Physiology-Endocrinology and Metabolism, 2013

Quantifying the effect size of acute exercise on insulin sensitivity (SIexercise) and simultaneou... more Quantifying the effect size of acute exercise on insulin sensitivity (SIexercise) and simultaneous measurement of glucose disappearance (Rd), endogenous glucose production (EGP), and meal glucose appearance in the postprandial state has not been developed in humans. To do so, we studied 12 healthy subjects [5 men, age 37.1 ± 3.1 yr, body mass index 24.1 ± 1.1 kg/m2, fat-free mass (FFM) 50.9 ± 3.9 kg] during moderate exercise at 50% V̇o2max for 75 min, 120–195 min after a triple-tracer mixed meal consumed at time 0. Tracer infusion rates were adjusted to achieve constant tracer-to-tracee ratio and minimize non-steady-state errors. Glucose turnover was estimated by accounting for the nonstationary kinetics introduced by exercise. Insulin sensitivity index was calculated in each subject both in the absence [time ( t) = 0–120 min, SIrest] and presence ( t = 0–360 min, SIexercise) of physical activity. EGP at t = 0 min (13.4 ± 1.1 μM·kg FFM−1·min−1) fell at t = 120 min (2.4 ± 0.4 μM·kg F...

American Journal of Infection Control, 2012

American Journal of Infection Control, 1993

American Journal of Infection Control, 2012

Risk factors were assessed using a case-control study. Seventy-seven patients (23.1%) were found ... more Risk factors were assessed using a case-control study. Seventy-seven patients (23.1%) were found to be colonised with vanC VRE and only one patient (0.3%) was colonised with vanA VRE. Independent risk factors for VRE colonisation included nephropathy [odds ratio (OR) = 13.6, p < 0.001], prior antibiotic use (OR = 5.5, p < 0.03) and carbapenem use (OR = 17.3, p < 0.001). Our results showed a higher frequency (23.1%) of Enterococcus gallinarum and Enterococcus casseliflavus, species that are intrinsically resistant to low levels of vancomycin (vanC), without an associated infection, associated with prior antibiotic use, carbapenem use and nephropathy as comorbidity. This study is the first to demonstrate the risk factors associated with vanC VRE colonisation in ICU hospitalised patients. Although vanA and vanB enterococci are of great importance, the epidemiology of vanC VRE needs to be better understood. Even though the clinical relevance of vanC VRE is uncertain, these species are opportunistic pathogens and vanC VREcolonised patients are a potential epidemiologic reservoir of resistance genes.

ABSTRACT Background / Purpose: Rabies is an important public health problem worldwide, and more t... more ABSTRACT Background / Purpose: Rabies is an important public health problem worldwide, and more than 55,000 people die annually of the disease. The King Edward Memorial Hospital, Mumbai, is a tertiary referral centre where a rabies clinic runs 24 hours. In view of lack of information about the demographics of the disease in an urban environment the present study was carried out. Main conclusion: Our findings showed that the use of human rabies immunoglobulin (HRIG) was low, with less than 2% of the Category III patients being prescribed it. As vaccination and HRIG continue to remain expensive, the intradermal vaccine shorter regimes, like the Zagreb regime and monoclonal antibodies may offer safer and cost-effective options in the future. Further studies need to be done in different parts of the country.

1 Postprandial Glucose Fluxes and Insulin Sensitivity during Exercise: 1 A Study in Healthy Indiv... more 1 Postprandial Glucose Fluxes and Insulin Sensitivity during Exercise: 1 A Study in Healthy Individuals 2 3 Michele Schiavon * 4 Ling Hinshaw 5 Ashwini Mallad 6 Chiara Dalla Man* 7 Giovanni Sparacino* 8 Matthew Johnson 9 Rickey Carter 10 Rita Basu 11 Yogish Kudva 12 Claudio Cobelli* 13 Ananda Basu. 14 15 16 Running Title: Insulin sensitivity during exercise 17

Marshall Journal of Medicine, 2018

Background: Kawasaki disease is one of the leading causes of acquired heart disease in children. ... more Background: Kawasaki disease is one of the leading causes of acquired heart disease in children. It is an acute self-limited vasculitis that predominantly affects infants and children younger than 5 years of age. These patients present with nonspecific symptoms, such as fever and lymphadenopathy, making the diagnosis challenging. This disease can have serious and potentially fatal outcomes, and prompt recognition of this disease is vital to the patient's outcome. We present a complete review of the disease, including the epidemiology, pathophysiology, diagnosis and management of acute Kawasaki disease, the natural history of this disease, and follow up of these patients as they transition into the adult cardiology practice. Methods: Our systematic review information was collected from articles retrieved from PubMed library. Keywords that were used included; Kawasaki disease, coronary artery disease, coronary artery aneurysm, pediatric coronary artery disease, epidemiology of Kawasaki disease and treatment of Kawasaki disease. We included only relevant to the topic articles. No exclusion criteria were applied. Conclusions: Kawasaki disease incidence tends to be increasing over the last decade in the United States. Seasonality of the disease has been described in Japan. It is a mysterious disease with unknown etiology, however, multiple hypotheses have been proposed and tested to explain the pathophysiology. As this disease has an associated high morbidity and mortality, prompt recognition and management are important to the patient's overall prognosis and survival.

Marshall Journal of Medicine, 2016

Isolated left ventricular noncompaction cardiomyopathy (LVNC) is a rare congenital condition occu... more Isolated left ventricular noncompaction cardiomyopathy (LVNC) is a rare congenital condition occurring due to arrest of myocardial compaction in the first trimester, resulting in a thin layer of compacted epicardium and thick hypertrabeculated myocardium containing deep recesses. This article presents a 44-year-old female with progressive dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and pleuritic chest pain. Examination revealed elevated jugular venous distention, lower extremity edema, and bibasilar crackles on lung auscultation, while the electrocardiogram (EKG) exhibited left bundle branch block. Two-dimensional echocardiography (2D-Echo) showed a dilated left ventricle (LV) with ejection fraction (EF) of 25% and severe diffuse hypokinesia. Cardiac magnetic resonance imaging (MRI) confirmed the diagnosis of LVNC. Thereafter, she developed atrial fibrillation with rapid ventricular rate. Conservative treatment was initiated with Tikosyn, Xarelto, Lasix, Toprol XL, Lisinopril, statin and life vest. Eventually, a cardiac resynchronization therapy defibrillator (CRT-D) was implanted to prevent sudden cardiac death and reduce heart failure complications.

The Journal of Clinical Endocrinology & Metabolism, 2016

Context: Early postprandial hyperglycemia and delayed hypoglycemia remain major problems in curre... more Context: Early postprandial hyperglycemia and delayed hypoglycemia remain major problems in current management of type 1 diabetes (T1D). Objective: Our objective was to investigate the effects of pramlintide, known to suppress glucagon and delay gastric emptying, on postprandial glucose fluxes in T1D. Design: This was a single-center, inpatient, randomized, crossover study. Patients: Twelve patients with T1D who completed the study were analyzed. Interventions: Subjects were studied on two occasions with or without pramlintide. Triple tracer mixed-meal method and oral minimal model were used to estimate postprandial glucose turnover and insulin sensitivity (SI). Integrated liver insulin sensitivity was calculated based on glucose turnover. Plasma glucagon and insulin were measured. Main Outcome Measure: Glucose turnover and SI were the main outcome measures. Results: With pramlintide, 2-hour postprandial glucose, insulin, glucagon, glucose turnover, and SI indices showed: plasma glu...

The Indian Journal of Medical Research

Background & objectives: Rabies is an important public health problem worldwide and more than 55,... more Background & objectives: Rabies is an important public health problem worldwide and more than 55,000 people die annually of the disease. The King Edward Memorial Hospital, Mumbai, is a tertiary referral centre where a rabies clinic runs 24 hours. In view of lack of information about the demographics of the disease in an urban environment the present study was carried out. Methods: Data on 1000 consecutive animal bite victims presenting to the institute in 2010 were collected over a 15 wk period. An electronic database was specially created for capturing information and was modelled on the information available from the WHO expert consultation on rabies, 2005. Economic burden from the patients’ perspective was calculated using both direct and indirect costs. Results: The victims were largely males (771 subjects). The dog was the major biting animal (891, 89.1%). Bites were mainly of Category III (783, 78.3%). One twenty three subjects used indigenous treatments only for local wound c...

American journal of physiology. Endocrinology and metabolism, Jan 7, 2015

Glucagon use in artificial pancreas for type 1 diabetes (T1D) is being explored for prevention an... more Glucagon use in artificial pancreas for type 1 diabetes (T1D) is being explored for prevention and rescue from hypoglycemia. However, the relationship between glucagon stimulation of endogenous glucose production (EGP) viz., hepatic glucagon sensitivity, and prevailing glucose concentrations has not been examined. To test the hypothesis that glucagon sensitivity is increased at hypoglycemia vs. euglycemia, we studied 29 subjects with T1D randomized to a hypoglycemia or euglycemia clamp. Each subject was studied at 3 glucagon doses either at euglycemia or hypoglycemia with EGP measured by isotope dilution technique. The peak EGP increments and the integrated EGP response increased with increasing glucagon dose during euglycemia and hypoglycemia. However, the difference in dose response based on glycemia was not significant despite higher catecholamine concentrations in the hypoglycemia group. Knowledge on glucagon effects on EGP was used to develop an in silico glucagon action model....

The Journal of Clinical Endocrinology & Metabolism, 2015

Closed-loop control (CLC) relies on an individual&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp... more Closed-loop control (CLC) relies on an individual&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s open-loop insulin pump settings to initialize the system. Optimizing open-loop settings prior to use of CLC usually requires significant time and effort. To investigate the effects of a one-time algorithmic adjustment of basal rate and insulin to carbohydrate ratio (CR) open-loop settings on the performance of CLC. Multicenter, outpatient, randomized, crossover clinical trial. 37 adults with type 1 diabetes were enrolled at 3 clinical sites. Each subject&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;ss insulin pump settings were subject to a one-time algorithmic adjustment based on one week of open-loop (i.e., home care) data collection. Subjects then underwent two 27-hr periods of CLC in random order with either unchanged (control) or algorithmic adjusted basal rate and CR settings (adjusted) used to initialize the zone-MPC artificial pancreas controller. Subject&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;ss followed their usual meal-plan and had an unannounced exercise session. Time in glucose range 80-140 mg/dL, compared between both arms. 32 subjects completed the protocol. Median time in CLC was 25.3 hrs. Median time in range 80-140 mg/dL was similar in both groups (39.7% control, 44.2% adjusted). Subjects in both arms of CLC showed minimal time spent &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;70 mg/dL (median 1.34% and 1.37% respectively). There were no significant differences time &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;140 mg/dL. A one-time algorithmic adjustment of open-loop settings did not alter glucose control in a relatively short duration outpatient closed-loop study. The CLC system proved very robust and adaptable, with minimal…

Diabetes technology & therapeutics, Jan 29, 2015

Understanding the effect size, variability, and underlying physiology of the dawn phenomenon is i... more Understanding the effect size, variability, and underlying physiology of the dawn phenomenon is important for next-generation closed-loop control algorithms for type 1 diabetes (T1D). We used an iterative protocol design to study 16 subjects with T1D on individualized insulin pump therapy for two successive nights. Endogenous glucose production (EGP) rates at 3 a.m. and 7 a.m. were measured with [6,6-(2)H2]glucose as a single tracer, infused from midnight to 7 a.m. in all subjects. To explore possibility of tracer recycling due to prolonged [6,6-(2)H2]glucose infusion, which was highly probable after preplanned interim data analyses, we infused a second tracer, [6-(3)H]glucose, from 4 a.m. to 7 a.m. in the last seven subjects to measure EGP at 7 a.m. Cortisol concentrations increased during both nights, but changes in glucagon and insulin concentration were inconsistent. Although the plasma glucose concentrations rose from midnight to 7 a.m. during both nights, EGP measured with [6,...

The Indian journal of medical research, 2014

Rabies is an important public health problem worldwide and more than 55,000 people die annually o... more Rabies is an important public health problem worldwide and more than 55,000 people die annually of the disease. The King Edward Memorial Hospital, Mumbai, is a tertiary referral centre where a rabies clinic runs 24 hours. In view of lack of information about the demographics of the disease in an urban environment the present study was carried out. Data on 1000 consecutive animal bite victims presenting to the institute in 2010 were collected over a 15 wk period. An electronic database was specially created for capturing information and was modelled on the information available from the WHO expert consultation on rabies, 2005. Economic burden from the patients' perspective was calculated using both direct and indirect costs. The victims were largely males (771 subjects). The dog was the major biting animal (891, 89.1%).Bites were mainly of Category III (783, 78.3%). One twenty three subjects used indigenous treatments only for local wound care. Of the Category III bites, only 21 ...

The International journal of risk & safety in medicine, 2014

Off-label use of drugs is widely prevalent in children mainly due to a limited data generated in ... more Off-label use of drugs is widely prevalent in children mainly due to a limited data generated in children during drug development process. Parents play a critical role in giving consent for their child to participate in clinical trials. Very few studies have assessed the opinion of the parents regarding such use and permitting their child to participate in clinical trials. In view of lack of information about the awareness among parents regarding both off-label drug use in children as well as about allowing their child to participate in clinical research especially from a developing country, this study was conducted. Adults accompanying patients in a tertiary care hospital were administered a validated, structured questionnaire following written informed consent. The questionnaire consisted of 18 items broadly divided into 5 themes - parental views on safety and labelled use of drugs in children, awareness of off-label drug use in children, communication from healthcare worker about...

American Journal of Physiology-Endocrinology and Metabolism, 2013

Quantifying the effect size of acute exercise on insulin sensitivity (SIexercise) and simultaneou... more Quantifying the effect size of acute exercise on insulin sensitivity (SIexercise) and simultaneous measurement of glucose disappearance (Rd), endogenous glucose production (EGP), and meal glucose appearance in the postprandial state has not been developed in humans. To do so, we studied 12 healthy subjects [5 men, age 37.1 ± 3.1 yr, body mass index 24.1 ± 1.1 kg/m2, fat-free mass (FFM) 50.9 ± 3.9 kg] during moderate exercise at 50% V̇o2max for 75 min, 120–195 min after a triple-tracer mixed meal consumed at time 0. Tracer infusion rates were adjusted to achieve constant tracer-to-tracee ratio and minimize non-steady-state errors. Glucose turnover was estimated by accounting for the nonstationary kinetics introduced by exercise. Insulin sensitivity index was calculated in each subject both in the absence [time ( t) = 0–120 min, SIrest] and presence ( t = 0–360 min, SIexercise) of physical activity. EGP at t = 0 min (13.4 ± 1.1 μM·kg FFM−1·min−1) fell at t = 120 min (2.4 ± 0.4 μM·kg F...

American Journal of Infection Control, 2012

American Journal of Infection Control, 1993

American Journal of Infection Control, 2012

Risk factors were assessed using a case-control study. Seventy-seven patients (23.1%) were found ... more Risk factors were assessed using a case-control study. Seventy-seven patients (23.1%) were found to be colonised with vanC VRE and only one patient (0.3%) was colonised with vanA VRE. Independent risk factors for VRE colonisation included nephropathy [odds ratio (OR) = 13.6, p < 0.001], prior antibiotic use (OR = 5.5, p < 0.03) and carbapenem use (OR = 17.3, p < 0.001). Our results showed a higher frequency (23.1%) of Enterococcus gallinarum and Enterococcus casseliflavus, species that are intrinsically resistant to low levels of vancomycin (vanC), without an associated infection, associated with prior antibiotic use, carbapenem use and nephropathy as comorbidity. This study is the first to demonstrate the risk factors associated with vanC VRE colonisation in ICU hospitalised patients. Although vanA and vanB enterococci are of great importance, the epidemiology of vanC VRE needs to be better understood. Even though the clinical relevance of vanC VRE is uncertain, these species are opportunistic pathogens and vanC VREcolonised patients are a potential epidemiologic reservoir of resistance genes.