Monday 30 August 2021

Lupine Publishers| Insight Virtual Humanoid Robotics Modeling: the Ultimate Level 0f Artificial Intelligence

 Lupine Publishers| Advances in Robotics & Mechanical Engineering (ARME)


I have no doubt to state Virtual Humanoid Robots (VHRs) are the ultimate level of Artificial Intelligence which change the scenario of world and human technologies, it would be applicable in all domains of technology with common factor Ultra Artificial Intelligence (UAI) with disappear and appear ability by any means which boost to our civilization from Type-0 to type-1 civilization at least and would be first step to compete with Aliens technology, if exist (hypothesis only). I would like to define term Virtual Humanoid Robotics (VHR) as “it’s Humanoid Robotics with UAI and has ability to transform from Physical to Virtual by any Internal (Humanoid Self-Control) or External (Human-Control) mode activation mechanism”. VHR is future technology which will use energy from Sun (or Space), Internet of Things (IoT) with RFID USN, Bigdata and Self-learning and healing mechanism. Now I would like to generate future utopia front of your eyes with initial modeling to coined term VHR in this short communication.

Keywords: Humanoid Robotics; Bionic Brain; UAI; Virtual Humanoid Robotics; Robotics Teleportation

Modeling to VHR

a) VHR-Basic Engineering Model

Figure 1:


I depicted in my first model “VHR-Basic Engineering” that there we need to extent our fundamental engineering aspect of Humanoid to Virtual Humanoid robotics domain. Hence model divided into two broad chambers as Humanoid Chamber and to give virtual ability Virtualization chamber. As we can analyze from model for successful humanoid building we need advanced Humanoid robotics hardware’s which link to Bionic Brain as similar to human brain mimic in the form of UAI which further cascade to Advanced Humanoid Operating System and Communication Interfaces. After successful engineering of first segment successful physical humanoid can build but to next level i.e. to convert physical humanoid into virtual and back from virtual to physical we doesn’t need to modify hardware but to strongly need to give extension to existed. Hence Virtualization chamber exhibits this regard in model. The virtualization chamber has two functional blocks to engineer Advanced Physical to Virtual Mode transfer Units and Light/Projection/Optical/Teleport interfaces Engineering (Figure 1).

b) Physical-to-Virtual Modes Switch Model

Figure 2:


My second purposed model “Physical-to-Virtual Mode Switch” model one of the essential VHR engineering models, in another word can say expansion and detail discussion on Virtualization Chamber second part of my first model. Its lucid and clear representation of concept in model diagram I considered three different possible modes viz. M1, M2 and M3 which may be increase in future with technological advancement and new methods of virtualization. The mode M1 has highest priority to implement VHR where Humanoid hardware itself has ability to appear and disappear itself with selfcontrol (Internal Control) which is only hypothesis right now. The second mode M2 has possible and second priority Teleportation and lot research going on this Mode M2 by several premium university and institutions scholars. The last mode M3 is easiest one but not satisfactory where virtualization engineer using virtual and augmented reality [1-10] (Figure 2).


I have discussed two models and with the help of them try to learn one of the promising and world change future technology “Virtual Humanoid Robotics” where Humanoid not only seems to be like human in near future but also will have ability to Avatar itself. This would be very helpful to send humanoid virtually in deepspace, on stars and planets to understand universe closely with teleportation or internal humanoid mechanism. VHR also ultimate level of AI hence might be shift mankind race on planet earth from Type-0 civilization to Type-1 civilization as shown in sci-fi movies.

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Lupine Publishers| Incidence of Patella Alta in Anterior Knee Pain- Assessment with Patellar Height Ratio's

 Lupine Publishers| Orthopedics and Sports Medicine Open Access Journal (OSMOAJ)


Background: Altered patellar alignment is associated with anterior knee pain and multitude of conditions that affect the patellofemoral joint. The study aim was to report the incidence of patella altaand patella baja in indian population with anterior knee pain and to investigate whether the normal limits of the patellar height ratios are applicable in indian population.

Methods: Lateral radiographs of 528 knees with anterior knee pain were performed. Patellar heights were measured to calculate the Insall-Salvati (IS), Insall-Salvati Modified (MIS), Blackburne-Peel (BP), Caton Deschamps (CD) ratios.

Results: The overall mean LT/LP ratio was 1.03 (SD 0.37) with incidence of 16.2% (86/528) for patella alta with Insall-Salvati. Mean MIS was found to be 1.68 (SD 0.018) and incidence of patella alta as per MIS ratio was 14.3% (76/528). Blackburne-Peel and Caton-Deschamps ratios revealed mean ratios of 0.88 (SD 0.15) and .99 (SD 0.16) and the incidence of patella alta 17.8% with BP ratio and 10.2% with CD ratio respectively.

Conclusion: Incidence of patella alta was found to be 17.8% with BP ratio, 16.2% with IS ratio, 14.3% with MIS ratio and 10.2% with CD ratio. The BP and IS ratio were the most sensitive with MIS ratio being the more specific one and CD ratio the least sensitive.

Keywords: Insall-salvati ratio; Modified insall-salvati; Blackburne-peel; Caton deschamps; Patellar alignment


Anterior knee pain remains one of the commonest musculoskeletal complaint with patients, and evaluation of patellar height is done commonly as many conditions are associated with abnormal patellofemoral relationship. The lever arm function of the patella plays an important role in knee extensor mechanism and improves the quadriceps strength by 30-50% [1]. The joint reaction force of the patellofemoral joint varies with the patellar height. A high riding patella or patella alta is associated with patellofemoral malalignment and a reduced patellofemoral contact often leading to patellofemoral pain or instability [2-3]. A low riding patella or patella baja is often associated with limited knee range of motion, patellofemoral arthritis and Osgood Schlatter disease [4]. Numerous methods of patellar height have been described in the literature: Blumensaat [5] Insal-Salvati [6], modified Insal-Salvati [7], Blackburne-peel [8], Caton-Deschamps [9], DeCarvalho [7] and Koshino [10]. These ratios are based on the ratio of the patellar length to the reference point from the tibia. A very few studies have compared the different indices for the patellar height analysis regarding their reproducibility and reliability.

The study objective was to analyse the commonest methods for measuring the patellar height in patients with anterior knee pain and the aim of this study was to report the incidence of patella alta and patella baja and investigate whether the patellar height ratios have significant variations in adult indian population in which sitting on the ground, kneeling, and squatting is common.

Materials and methods

528 lateral x-rays of the knee (212 male and178 females) were collected between the time period August 2017 to February 2018 from patients with anterior knee pain, with difficulty or pain on squatting or sitting. Patients with underlying knee pathologies, knee deformities and knee surgery were excluded. Institutional review board approval was obtained prior to conducting the study. Lateral radiographs of the knee set in 30° of flexion were taken with assistance of a goniometer. 30° of flexion of knee results in better visualization of the tibial insertion. Radiographs were perpendicular to the film and centered on the joint at a distance of 100cm.

Figure 1: IS.

Figure 2: CD.

The measurements were made with the digital imaging software (Radiant diacom viewer) by a single experienced physician. The patella length was measured from the superior articular pole to the inferior non articular pole (Figure 1). The distance from the origin of the patellar tendon at the inferior pole of patella to its insertion on the tibial tubercle was taken as the patellar tendon length. The Insall-Salvati index is calculated as ratio of LT/LP, where LT is the length of the patellar tendon and LP is the patella length (Figure 1). The Blackburne-Peel index (Figure 2) is calculated as PP/PG where PP is the perpendicular height of the distal part of the joint surface of the patella to a line projected anteriorly to the surface of the tibial plateau and PG is the length of the articular surface of patella. The ratio PTG/PG, in which PTG is the distance from the lower edge of the articular surface of the patella to the anterosuperior angle of the tibia, and PG is the length of the articular surface of the patella is calculated as Caton-Deschamps index (Figure 3). The Modified Insall-Salvati index consists of the ratio PT/PG, wherein PT is the distance from the lower edge of the joint surface of the patella to the insertion of the posterior or deep surface of the patellar tendon in the tibial tubercle, and PG is the length of the joint surface of the patella (Figure 4).

Figure 3: BP.

Figure 4: MIS.


Table 1.

The overall mean LT/LP ratio was 1.02 (SD 0.37). Comparison between genders revealed that the mean LT/LP ratio was higher in males than females with a mean of 1.04 (SD 0.29) and 1.01 (SD 0.46), respectively (Table 1 & 2). Using criteria of defining abnormal patellar position (1.00±20%) based on Insall's study, the overall incidence was 16.2% (86/528) for patella alta (Tables 3 & 4). The mean PT/PG ratio was 1.68 (SD 0.018). The MIS ratio was higher in males with mean of 1.70(SD 0.29) than females with a mean of 1.66 (SD 0.29). The incidences of patella alta as per MIS ratio were 14.3% (76/528). Blackburne -Peel and Caton- Deschamps ratios revealed mean ratios of 0.88 (SD 0.15) and .99 (SD 0.16). Males were found to have a higher mean in both the ratios compared to the females (BP ratio: 0.89, SD 0.12 and CD ratio: 1.0, SD 0.18 in males and BP ratio: 0.88, SD 0.05 and CD ratio: 0.98, SD 0.06 in females). The incidence of patella alta were 17.8% and 36% with BP ratio and CD ratio respectively.

Table 2.

Table 3.

Table 4.


Vast majority of the studies in literature are often quoted with the data obtained from the Caucasian population. There are none, if at all few studies of patellar height being done in Asian population. There are morphological changes in patella of the Caucasian and the Asian population which make the patellar height ratios even more significant. The present study is an observational study done with aim of assessing the patellar alignment in anterior knee pain patients.

The position of the patella has an important role on patellofemoral function. Abnormalities in patella position have thus been associated with anterior knee pain and many extensor mechanism disorders. While many techniques have been developed to measure patellar position such as the Blacburne's ratio, the Insall Salvati ratio still remains one of the most popular, largely because it is easy to use and remember [7,8] .Despite its popularity, recent studies have suggested that the current normal ranges should be extended, as the ratios may not be applied to ethnicities outside western regions [11,12].

The Insall-Salvati (IS) method uses the length of the patellar ligament in relation to the length of the patella6. The patellar morphology and morphological differences in the anterior tuberosity of the tibia (ATT) directly affect the measurements made using this method. Grelsamer and Meadows [7] developed the modified Insall-Salvati (ISM) method based on the length of the joint surface. Difficulty in identifying this parameter is considered to be the main measurement bias. The Modified Insall -Salvati ratio has its advantages over the IS ratio that it can efficiently find out the patella alta in patients with small patellar articular surface which is not taken into account in IS ratio (Figure 5). Digital radiography seems not to present greater details for this anatomical reference. The Blackburne-Peel (BP) method exchanges the reference point of the ATT for the joint surface of the tibial plateau, while keeping the joint surface of the patella. Although Berg et al. [13] found that this was the most accurate and reproducible method in conjunction with the IS index, and Seil et al. [13] ranked it as the second most reproducible method in conjunction with the IS index, we did not obtain similar results in our analysis, such that it was only better than the ISM index. Lack of definition of the reference line of the tibial plateau, such as which condyle to use as the reference, or whether this line runs parallel to the joint surface or perpendicular to the long axis of the tibia, contributes towards lower concordance with this method. The method of Caton et al. [2], which uses the joint surface of the patella and the angle of the tibial plateau as references, also presents difficulty regarding identification of the joint surface, as well as presenting a certain amount of variability in defining the angle of the tibial plateau. Despite these factors, this method was the one that showed greatest concordance in the study by Seil et al. [13].

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Saturday 28 August 2021

Lupine Publishers | Inadvertent Sulfonylurea Overdose and Treatment with Octreotide: A Case Report

 Lupine Publishers | Journal of Immunology & Infectious Diseases


Suicide attempts using hypoglycemic agents are uncommon but are associated with a high level of morbidity and mortality. A fifty-eight-year-old-gentleman with no history of diabetes was presented in a state of shock to the emergency room with the ingestion of 12 tablets of 2 mg glimepiride. The patient was in persistent state of hypoglycemia. In such cases of sulfonylurea toxicity, goal of therapy depends on the adequate glucose supplementation to maintain normal blood glucose level. Octreotide is an effective drug in preventing rebound hypoglycemia after sulfonylurea ingestion. Octreotide in combination with dextrose should be considered for first-line therapy in the treatment of sulfonylurea-induced hypoglycemia.


The most common complication of sulfonylurea overdose is hypoglycemia [1]. The toxicity is caused secondary to the exertion of the sulfonylurea pharmacological properties. It reduces the glucose level by release of insulin from beta cells of the pancreas [2]. Early symptoms of hypoglycemia from sulfonylureas are characterized by weakness, hunger, diaphoresis, pallor, palpitations, sinus tachycardia, headache, irritability, and tremor. If hypoglycemia remains untreated, neuroglycopenia may develop resulting in impaired concentration and judgment, confusion, blurred vision, drowsiness, and amnesia. Further progression can result in seizures or coma, and possibly death [3]. Conventional therapy of hypoglycemia with intravenous dextrose infusions may only temporarily correct blood sugar levels as sulfonylurea and active metabolite levels may remain high for a prolonged period of time resulting in persistent hypoglycemia [4]. Although octreotide use has been advocated as a first line therapy, indications and dosing are not firmly established. It has also been identified that the use of octreotide may reduce the incidence of recurrent hypoglycemia that is seen with dextrose-alone therapy. Our case report discusses a patient with severe hypoglycemia resulting from suicide attempt by ingesting 24 mg of glimepiride and highlights the response to treatment with octreotide after failed attempts to correct the patient’s hypoglycemia with dextrose.

Case Report

A fifty-eight-old male with no previous co-morbidities was presented to was presented to the emergency room of Northwest General Hospital, Peshawar in the month of January 2019. The son reported that the patient is a non-diabetic. He ingested his spouse’s 12 tablets of 2 mg glimepiride as a suicide attempt.In the emergency room, the patient was tachycardic, tachypneic and diaphoretic. Initial glucose meter reading was found to be 36 mg/dL and a blood glucose level on the metabolic panel was 49 mg/dL. Patient serum creatinine was 2.1 mg/dL. While in the emergency room, the patient received 50% dextrose intravenously eventually requiring an intravenous infusion of 10% dextrose. Despite this treatment, the patient remained persistently hypoglycemic with blood sugars less than 80 mg/dL. He was admitted to the medical intensive care unit for close monitoring. Despite giving high dose of dextrose infusion, his blood sugars remained low. A decision was made at this point to administer 50 micrograms of octreotide subcutaneously. Two hours later, the patient’s blood sugar started to improve and the intravenous 10% dextrose was discontinued. Eight hours later, the patient received another dose of 50 micrograms of octreotide and his blood sugars started improving. The dose was continued for two days and he remained consistently euglycemia. Once stable, his insulin levels and C-peptide levels were done which were normal. Other parameters including complete blood picture, U&Es, liver function tests and urine analysis were within normal limit. Following initial correction of his low blood sugar, the patient was encouraged orally. Once stable he was discharged on normal blood sugars with advise to see a psychiatrist.


Glimepiride is a second-generation sulfonylurea indicated for diabetes mellitus type 2. After the intake, the drug is completely absorbed and the maximum concentration is reached in 0.7-2.8 h. It is primarily metabolized in the liver, first to its active metabolite via the cytochrome P450 and then to its dehydrogenated inactive metabolite [5]. Glimepiride was generally associated with lower risk of hypoglycemia compared to other sulfonylureas and it should be used in caution with hepatic and renal disease. It has a narrow therapeutic index. Glimepiride overdose is associated with hypoglycemia [1]. Onset of hypoglycemia may be delayed up to 12 h, and duration may be prolonged for days after overdoses. Patients who are hypoglycemic experience dizziness, weakness, headache, confusion, lethargy, slurred speech, coma, and seizures. Other clinical effects include tachycardia, palpitations, nausea, and diaphoresis. Protracted hypoglycemia can result in death [2]. Several case reports are published on sulfonylurea overdose in adults. Potential for hypoglycemia associated with dosage increases is well described, especially in older patients, sometimes with fatal outcomes. Review of national poison center data found 14 sulfonylurea-associated fatalities reported between 1992 and 1996 in adults aged 18 to 79 years. Eleven cases were the result of suicides and involved contestants [6]. A potential complication of treatment of sulfonylurea-induced hypoglycemia with intravenous dextrose is recurrent hypoglycemia. Dextrose administration results in hyperglycemia which in turn potentiates insulin release from the pancreas leading to recurrent hypoglycemia. Re-administration of dextrose perpetuates this cycle, resulting in high dextrose requirements and the need for frequent monitoring of blood glucose levels.By contrast, octreotide, a synthetic octapeptide analogue of somatostatin, effectively suppresses insulin secretion and has a very benign adverse effect profile. The long-acting, synthetic somatostatin analog, octreotide, is FDA-approved for the treatment of acromegaly, metastatic carcinoid symptoms, and vasoactive intestinal secreting tumors. It has also been used for the cessation of upper gastrointestinal bleeding and to correct refractory hypoglycemia caused by sulfonylurea overdoses. Octreotide can be administered either intravenously or subcutaneously, with both routes having equivalent bioavailability. It appears to abolish the need for hypertonic dextrose infusion, thus avoiding the need for a central line, close observation, and complications relating to fluid and electrolyte disturbances. This obviates the need for prolonged ICU admission. Octreotide is now regarded as a first line antidote for sulfonylurea poisoning with the role of dextrose confined to rapid restoration of euglycemia in the already hypoglycemic patient and maintenance of euglycemia until such time as octreotide can be sourced and administered [7].

Patients who developed hypoglycemia with therapeutic doses of sulfonylureas have been given supplemental dextrose and octreotide, with subsequent correction of the hypoglycemia. There are numerous case reports describing treatment of sulfonylurea overdoses with octreotide. In 2002, Carr and Zed described glyburide overdoses in two patients with refractory hypoglycemia despite dextrose 50% boluses and 10% infusions who demonstrated fewer hypoglycemic episodes and lower dextrose requirements with octreotide 50 μg every 8 h for three doses. These authors provide a summary of six previously reported cases that demonstrate the benefits of octreotide therapy [8]. Subsequent to Carr and Zed’s report, there have been 13 case reports on the treatment of sulfonylurea-induced hypoglycemia with octreotide, including two cases in young children [9]. As octreotide represents the definitive management of sulfonylurea induced hypoglycemia, efforts should be made to administer it as soon as possible. If available in the remote area, it can be safely commenced according the administration regime described above. If not immediately available, efforts should be made to move the antidote to the patient as part of the management plan.

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Friday 27 August 2021

Lupine Publishers | Smoking Cessation: Review Article

 Lupine Publishers | Journal of Respiratory & Skin Diseases



Globally, including the United States, cigarette smoking is the single most important cause of premature death, even though it is preventable. The prevalence of smoking is high, although some resources have been dedicated to this problem. A variety of interventions have been tried on smoking prevention. From the public health perspective, it is the biggest concern. As there are numerous health benefits of smoking cessation, most individuals who smoke express a desire to quit. Studies show that most smokers in the United States and the United Kingdom report that they want to stop or intend to leave smoking at some point in life Hyland [1]. A multitude of non-pharmacological and pharmacological interventions now exist to aid smokers in cessation.


To bring awareness among public and policy makers. To provide evidence and recommendations required for effective cessation interventions. To be carried out in public health globally.


Articles published from 2000 to 2016 were identified through electronic databases such as Medline, Pub Med, and EBSCO host.


This research paper suggests the trends of smoking habits and smoking cessation intervention strategies differ from region to region when viewed from an international perspective. This highlights the necessity for the improvement of new methods that prevent people from starting to smoke, motivate smokers to quit and enable them to sustain long-term cessation. Future research should examine whether increasing the rate of quit attempts would be key to improving the population smoking cessation rate.

Keywords: Smoking Prevention; Tobacco Use; Smoking Cessation; International.


This article is a retrospective review of research articles on smoking cessation obtained through a search of selected databases from 1 Aug 2017 back to 31 Dec 2000. The purpose and goal of this report is to bring awareness to the population. Additionally, to provide data for professionals in public health and policymakers, to help make recommendations based on effective cessation intervention evidence. Also, to provide information to youth who indulge in tobacco smoking of the trends, prevalence, consequences and to inspire engaging in programs for smoking cessation.


The articles published from 2000 to 2017 were identified retrospectively through electronic databases such as Medline, Pub Med, and EBSCO host. Peer review articles relevant to smoking cessation were chosen. Statistical information was gathered and further analyzed. Besides web-based resources, other important resources such as the Center for Disease Control (CDC) and the World Health Organization (WHO) were also utilized for research.


Even though several preventive measures have been taken by the governments and several organizations, smoking remains a constant and severe problem in communities all over the world. Smoking-related diseases claim an estimated six million lives each year out of which 600,000 deaths were from exposure to second-hand smoke, though it is entirely preventable (WHO, 2014). An estimated 126 million Americans are regularly exposed to secondhand smoke each year National Institute on Drug Abuse [2]. More than 43 million adults are current smokers in the USA. Eighty- eight percent of those adults who started smoking at their youth (age 11-12 years) almost became an addict when they turned 14. Globally, as well as in, tobacco smoking has been the leading cause of preventable death. The prevalence of youth smoking is high, although some resources have been dedicated to this problem and the variety of interventions that have been tried to prevent smoking is a big concern from a public health perspective. As there are numerous health benefits of smoking cessation, most individuals who smoke express a desire to quit smoking. Studies show that the majority of smokers in the United States and the United Kingdom report that they want to stop or intend to quit smoking at some point in life.

In India, tobacco's associated mortality is the highest in the world, an estimated 700,000 annual deaths attributable to tobacco use Murthy [3]. Whereas, the lowest smoking rates for men can be found in Nigeria, Barbuda, and Antigua. For women, smoking rates are lowest in Eritrea, Cameroon, and Morocco (UW TODAY, 2014). A multitude of non-pharmacological and pharmacological interventions now exist to aid smokers in cessation. The financial burden imposed by cigarette smoking is enormous. Smoking- related illness in the United States costs $96 billion each year in medical expenses and $97 billion in lost productivity due to premature mortality. Cigarette industries are spending billions of dollars on advertising tobacco products, attracting specifically adolescents and young adults who fuel the existing burden. The primary cause of chronic obstructive pulmonary disease (COPD) and lung cancer in adults has been cigarette smoking. There is an association between smoking and periodontal disease in children and adolescents. Smoking is responsible for 87% of the lung cancer deaths in the United States. It is responsible for 30% of all cancer deaths universally. Cigarette smokers have a lower level of lung function than those persons who have never smoked. Smoking hurts young people's physical fitness regarding both performance and endurance, even among young people trained in competitive running. On average, a person smoking a pack or more of cigarettes per day lives seven years less than the person who never smoked (Department of Health & CDC, 2008). In 2007, 1,800 Hispanic women and almost 3,000 Hispanic men died of lung cancer. Cigarette smokers are also known to possess a greater risk than nonsmokers for heart attack (in the same year, about 3,000 Hispanic women and nearly 3,800 men died from heart attack.Smokers have a 70% greater chance of dying from coronary heart disease than non-smokers (Department of Health & CDC, 2011).

Overall, lung cancer is known to be the leading cause of cancer deaths among African Americans. Multiple factors are associated with tobacco use such as social, physical and environmental. Young people are more likely to use tobacco if their peers use tobacco. Perceived smoking is acceptable or normative among their peers. They expect positive outcomes from smoking, such as surviving with stress, anxiety, and depression. Parental and sibling smoking may also promote smoking among children and youth in a household where perceived parental approval plays a significant role in adolescent smoking. In Hispanic and Asian communities, families live intimately with each other. Parents have control over their children and watch their activities, and vice versa offspring also respect parents and elders. Hispanic youth are more likely than other young people to be protected from second-hand smoke by smoking bans at home. Seventy-one percent of Hispanic households do not allow smoking in their homes. Parenteral perceived disapproval of smoking is a protective factor against adolescent smoking McCausland [4]. Other factors like low socioeconomic status, lack of parental support or involvement, accessibility, availability, low level of academic achievement, low self-image and aggressive behavior have been associated with youth smoking Miller [5]. Peer pressure is a significant factor in their decisionmaking process. There are many studies showing that the influence of peers is especially powerful in determining when and how young people first try a cigarette. Even if someone thinks that their child is too smart, all children and adolescents are vulnerable either for negative or positive influence. Kids feel that they are pulled in two directions-on the one hand they do not want to use tobacco but the other side they afraid of losing friends. The smoking rate among children and young adults who have three or more friends who smoke are ten times higher than those who report that none of their friends' smoke Nicotine & Tobacco Research [6].

According to a study concerning accessibility of cigarettes, it is seen that among the 12.9 percent of students nationwide who tried to buy cigarettes 30 days before the study, 48.5 percent them were not asked to show proof of age. The prevalence of students, not having been ID'd to show evidence of age was higher among ninth graders at 70.4% than tenth graders at 55.6%, eleventh graders at 59.2%, and least for twelfth graders at 32.7%. For females, it was higher among eleventh graders at 57.7% compared to twelfth grader females at 29.3%. Among males, ninth-graders were at 65.7%, tenth graders were at 55.6%, eleventh graders were at 59.6% and finally twelfth graders at 34.9%. Illiteracy is another factor in youth smoking. According to Census Bureau report from 2007, 61% of Hispanics in comparison to 85% of non-Hispanics have a high school diploma. While only 12.5% of Hispanics compared to 30.5% of non-Hispanic, have a bachelor’s degree (NSDUH 2010) [7]. Currently, there is an increasing trend of smoking prevalence among young women, low socio-economic, racial/ethnic minorities, and vulnerable populations such as the LGBT community (lesbian, gay bisexual, and transgendered) (USDHS, 2004). As regards quitting smoking, a study shows that Hispanic smokers are less likely than white smokers to be prescribed or to attempt quitting (CDC, 2016) (Table 1, 2).

Table 1: Countries that had the highest and lowest smoking prevalence for men in 2012.


Table 2: Countries that had the highest and lowest smoking prevalence for women in 2012.


Health impact

Secondhand smoke exposure puts family members of smokers at an increased risk. The following table illustrates the various health impacts in children and adults:

Other benefits of quitting smoking are reduced chances of impotence, having difficulty getting pregnant, having premature births, babies with low birth weight and miscarriage. In children, the risk factors of many second hand smoking such as asthma and other respiratory diseases decrease Stead [8]. After quitting smoking, there are numerous physical and emotional effects the body experiences. These effects consist of are both short-term and long-term benefits. The short term benefits, which can commence as soon as 20 minutes past quitting, include heart rate and blood pressure decrease. Carbon monoxide level drops to normal after 12 hours. There is an improvement in blood circulation and lung function after two to twelve weeks of quitting. Shortness of breath and coughing decrease after one to nine months of stopping. Subsequently, two to three weeks following cessation, several regenerative processes begin to take place in the body. The long-term benefits of quitting reduce the risk of coronary heart disease after one year to one and a half. Five years past quitting, the probability of stroke is reduced to that of a nonsmoker. The potential for lung cancer, cancer of mouth, throat, esophagus, bladder, cervix and pancreas reduces to about half of that for a smoker. Within 15 years of cessation, almost all of the recuperative processes are completed. The risk of heart disease is no greater than someone who has never smoked a cigarette CDC [9]. The advantages of quitting smoking compared to those who continued to smoke are huge. Life expectancy is increased compared to those who continued to smoke. The probability of suffering from another heart attack is reduced by 50% for people who quit smoking after having a heart attack or following the onset of life-threatening disease (Table 3).

Table 3: WHO, 2011.


Dependence and Relapse

The addictive effect of nicotine once smoked, makes hard to quit smoking. Early initiation increases the likely-hood of habituation, and continuous tobacco smoking eventually ends up in addiction. People who begin to smoke at a very young age are more likely to develop severe levels of smoking than those who start a later age. Tobacco addictions should be treated as a chronic disease with a constant risk of relapse Fiore [10]. Based on literature review, many studies have proved that tobacco is apparently more addictive than any other substance abuse. According to one study high rates of relapse among smoking quitters occurs due to the addiction potential of tobacco. It is reported that brief counseling has resulted in a quit rate of 55% the relapse rate among quitters was 23% Warner [11]. The current improved knowledge of the neurobiology of nicotine addiction has significant implications for the management of its dependency Joy [12].

Challenges for quitting

There are many challenges and barriers to quitting. There are three critical challenges that one should be acquainted with before planning to assist smokers to quit or attempt to quit. All people do not have the same reasons why they smoke and why they could not quit. The reasons have been classified into three categories. Physiological addiction; behavioral and environmental social; emotional or psychological connections WHO [14].

Smoking Cessation, Smoking Prevention and Methods to Quit

The Treating Tobacco Use and Dependence-Clinical Practice Guideline, issued by the United States Department of Health and Human Services, recommends the 5A’s and 5 R’s approach that should be addressed in a motivational counseling intervention to help those who are not ready to quit (HHS, 2012). The below figure illustrates the motivational counseling interventions:

There are seven first-line medications available that are known to increase long-term smoking abstinence: Nicotine inhaler, Nicotine gum, Bupropion SR Nicotine lozenge, Nicotine patch, Nicotine nasal spray, and Varenicline. Current information on adolescence tobacco use prevention has proposed that macro-level approaches can be effective in reducing the prevalence of tobacco use among adolescents. The stronger tobacco control policy that increased tobacco taxation and counter-marketing campaigns has all proven to be successful strategies for reducing youth tobacco use Backinger [14]. The use of counseling and pharmacotherapy together has been reported as the most effective strategy to achieve tobacco abstinence. The time spent on counseling is very effective since it has got a significant association between the time devoted to counseling a person quitting smoking and their chances of quitting. According to WHO guidelines, more than one type of pharmacotherapy should be offered in combination, if appropriate, for a prolonged period.

After identifying and understanding different sub-groups, various communication strategies should be developed for specific focus groups that enhance the impact of health information. The Community Preventive Services recommends the use of "mass- reach health communication interventions" e.g. television and radio broadcasts, newspapers, billboards, built on solid evidence for their advantageousness in preventing or reducing cigarette smoking and increasing use of cessation services like quit lines. Regarding the use of media, studies suggest that the success of different types of smoking cessation messages may vary by socioeconomic status, predominantly income and education status. Cessation programs must be custom-made to focus on the envisioned audience rather than just providing information Strickland [15] (Table 3).

Nicotine replacement therapy

Among the currently available smoking-cessation treatments, including nicotine replacement therapy (NRT), bupropion and varenicline are well-known pharmacological interventions to raise the chances of quitting tobacco smoking, mainly when combined with health education and counseling programs. Various studies have shown that tobacco cessation assistance provided by health professionals (physicians, nurses, dentists, pharmacists and other health care workers) enhances the quit rate among their patients Gorin [16]. Almost all forms of NRT gum, transversal patches, nasal sprays, inhalers and sublingual tablets can help persons who make a quit attempt and increases their chance of successfully quitting smoking by 50% to 70% irrespective of any setting. The purpose of NRT is to briefly replace considerable nicotine from cigarettes and to decrease the stimulus to smoke and avoid nicotine withdrawal symptoms consequently to ease the transition from smoking to complete abstinence.


Quit-line is a tobacco cessation program which is a phone based service that helps tobacco users quit smoking. Today, residents of all 50 states in U.S. and Canada, have access to quit lines services. In the recent years, Quit-lines have been able to become a critical part of the tobacco control efforts that are ongoing in the United States. The universal access, demonstrated efficacy and the convenience of remote counseling via telephone have all led to the quick and widespread adoption of Quit lines in the North American region Cummins [17]. Currently over 53 countries have at least one national toll-free quit line with a person available to provide quit line cessation services, with access to its population. All the 50 states of USA and Canada are having multiple quit lines operated by Federal government, state government and non-governmental organizations. Out of 53 countries, 32 (60%) of them are wealthy countries and four countries (8%) are of low income and 17 of them are middle-income countries which made up only18% of all middle- income countries in the world, have at least one national toll-free quit line. There is the noticeable difference in reach as well as type, quality, quantity, volume and of services provided by different quit lines. The counselors and supervisors working in quit lines are well trained by the psychiatrists for operational purpose of smoking cessation assistance. Quit-lines are established in collaboration with health care system, health care providers, nongovernmental organizations, and governments both local and national. Among the primary methods used by countries to promote quit line services are media advertisements (newspapers, television, radio or flyers). Some countries, including Brazil, New Zealand, South Africa, and all the European Union (EU), have printed the quit line number on cigarette packets together with health warnings. In spite of their widespread presence, information including international data on how Quit-lines services operate in practice and their outcome is not readily available Gollust.

Complementary and alternative medicine

Very few studies have been confirmed that the complementary and alternative medicine (CAM) for tobacco cessation, like, yoga, hypnosis, herbal products, acupuncture, relaxation, and massage therapy have been tried and were successful. However, use of complementary and alternative medicine treatments and a higher level of education were significantly associated. Yoga and mindfulness meditation as promising complementary therapies for treating and preventing addictive behaviors. The hypothetical models propose that the skills, perceptions, and self-awareness adapted through the practice of yoga and mindfulness can target multiple psychological, physiological, neural, and behavioral processes that maybe associated with relapse due to addiction.

Electronic cigarettes:

Also, electronic cigarettes are becoming popular and being debated concerning their role in smoking cessation. The electronic cigarettes are similarly known as e-cigarette, which is electronic nicotine delivery system a mechanical device designed to mimic regular cigarettes, looks conventional alike cigarette, and delivers nicotine through inhaling vapors without burning tobacco. These devices are supposed to deliver nicotine without any toxins considered to be a safer alternative to regular tobacco cigarettes. However, there are no sufficient studies to determine the vapors generates from e-cigarettes don't contain any toxic substances harmful to health in contrast to the natural tobacco smoking which has been proved to be carcinogenic. These electronic devices sold as a tobacco delivery device needs to be regulated. Currently, there are no uniform regulations, either no regulations or at some places complete ban on sale. Countries like Canada, Mexico, Israel, Brazil, Hong Kong, Panama, Singapore and the United Arab Emirates have completely banned e-cigarettes. Subsequently, more practical approaches are needed to reduce the burden of cigarette smoking.

E-cigarettes were used much by former smokers to avoid relapse or as an aid to cut down or quit smoking as the second option to nicotine replacement medications. Based one-cigarette literature review, it was found that electronic devices sold as a nicotine delivery device, need further research to gather scientific evidence of their safety, efficacy of device in delivering nicotine and other substances, patterns of use, effectiveness for smoking cessation or quitting, prevention of relapse, and issues associated regulations with the use of e-cigarettes. Many studies have shown that smoking e-cigarette is harmless compared to smoking traditional cigarettes. Most of the devices contain nicotine and inhaling their vapors exposes users to toxic substances, including lead, cadmium, and nickel, heavy metals that linked with significant health problems Grana.

The electronic cigarette which resembles a conventional cigarette is a battery-operated electronic device that is designed to vaporize a liquid solution. The solution is known to contain propylene glycol and or vegetable glycerin in which nicotine or other fragrances may be dissolved. During puffing activates the lithium-ion rechargeable battery that is designed to vaporize nicotine to be inhaled. The modern e-cigarette was invented in the year 2003 by a Chinese scientist Hon Like (Figure1, 2).

Figure 1.


Figure 2.


Even though e-cigarette bears a resemblance exactly as the traditional conventional tobacco cigarettes has a perceptible sensation. An e-cigarette consists of a plastic tube, electronic heating element, and liquid nicotine cartridge. The conventional cigarette is soft and light in weight whereas e-cigarette is hard and heavy to feel. The e-cigarette is designed to mimic conventional cigarette provide a flavor and physical sensation like that of tobacco smoke during inhalation, but no smoke is involved in maneuvering.During the inhalation process in e-cigarette device, an electronic sensor senses airflow and automatically activates the heating element that heats the liquid in the cartridge which vaporizes. Also at the same time during puffs, the electronic sensor lights up a LED indicator. The cartridges may be containing nicotine suspended in propylene glycol, glycerol plus water and sometimes contains flavors of different fruits and mint or without nicotine. The nicotine vapors absorb through the mucous membrane of mouth may even enter into the blood stream, but with low concentration comparing to conventional tobacco cigarettes. Since e-cigarettes don’t burn tobacco, may be considered a lower risk substitute for conventional paper and tobacco cigarette Eissenberg [18]. Toxic components, including low levels of carcinogens have been identified in some e-cigarette cartridges during laboratory testing Food and Drug Administration [19].

Many scientific research studies have identified hundreds of toxic chemicals used in the liquids in the canister of e-cigarettes were detected in the bloodstream of some persons which inhaled by smoking were known to cause health effects (may even cause cancer). Even persons have affected second-hand smoke from e-cigarette have detected toxins in the blood stream. The following chemicals are identified in e-cigarettes: Nicotine, butanone, Formaldehyde, Acetaldehyde, Acetic Acid, Acetone, Acrolein, Aluminum, Barium Benzene, Butyl hydroxyl toluene, Cadmium, Chromium, Copper Croton Aldehyde Diethylene Glycol, Glyoxal Iron Isoprene, Lead, Limonene m, p-Xylene, Magnesium, Manganese, Nickel, N-Nitrosonornicotine, Methyl benzaldehyde, Phenol, Polycyclic Aromatic Hydrocarbons, Potassium Propanol, Propylene Glycol, Sulfur, Tin, Toluene, Vale Aldehyde, Zinc Zirconium.

There are numerous unreciprocated questions about their comprehensive influence. For example; are e-cigarette used by young new non-smokers; would e-cigarettes be a gateway to tobacco use or nicotine dependency; is there any tendency for addiction to e-cigarettes or could its use in public places challenge smoke-free laws. The nicotine and other chemicals found in e-cigarettes might harm brain development in young persons and younger persons who start smoking are more likely to develop a habit and are more prone to addiction. Young persons who have never smoked or never tried smoking, when starts to use e-cigarette might get an addiction to nicotine and decide to switch to regular cigarettes is the biggest worry and public health concern, if the government does not ban e-cigarette sale to underage (Jean-Fran^ois Etter, 2011).

Smoking cessation policies and interventions

Smoking cessation is vital to any tobacco control program. It is also one of the important modules of a widespread tobacco policy that strongly contributes to decreasing the smoking prevalence and thereby reduces tobacco-related morbidity and mortality. Numerous policies influence smokers' inspiration to quit smoking. The tobacco control measures such as increased taxation on tobacco and tobacco products, ban on advertising and promotion by global communications media, smoke-free areas and educational campaigns increase smokers’ motivation to stop. These policies also help in creating a climate that makes it easier for former smokers to remain abstained World Health Organization [20]. An international body of research indicates smoking cessation policies and interventions are cost-effective that include two comprehensive types of activities:

    a) Mass population policies and actions aimed to motivate smokers to quit smoking, such as higher prices through taxation, restrictions on smoking in public places and mass media educational campaigns.

    b) 2) Policies and activities designed to help dependent smokers who are already motivated to quit Fronczak [21].

In May 2010, a committee of 20 experts from 12 countries on tobacco control, economics, epidemiology, and public health policy met at the International Agency for Research on Cancer Frank [22]. They discussed the series of evidence gathered after conducting studies on the tobacco pricing and tax related lobbying; tax, price and collective demand for tobacco; tax, price and adult tobacco use, use among adolescents and among poor; and impact of tobacco taxation on health. All the studies were conducted in both the developed and underdeveloped countries including high, medium and low income. From eighteen total studies, twelve study’s conclusions were showing strength of the effectiveness on tax reduction and price increase. A small number of high-income group countries report that higher prices increased smoking cessation rate. Studies from countries of low, medium and high income report that smoking among young people decreases as price increases. After consensus, the expert scientists’ committee concluded that there is sufficient evidence of effectiveness of increased tobacco excise taxes and prices in reducing the prevalence of tobacco use and improvement of public health.

Uruguay, a middle-income country in South America, implemented a comprehensive continued program of multiple tobacco control procedures consisting of a ban on publicity and promotion. Additionally, the ban on smoking in enclosed public spaces and workplaces, the policy for healthcare providers to treat nicotine dependence. Furthermore, a rule, that signs with warnings cover eighty percent of the front and back of every cigarette pack in addition to the ban on using misleading terms such as light and mild, besides a considerable increase in tobacco taxes. The results reported over during six years' period from 2005 to 2011 was about a 23% decrease in tobacco use Abascal [23]. According to a Global Youth Survey (GYT) from Bangladesh, a low-income country in Asia, report between 2007 and 2013, the use of tobacco and its products has not decreased. The rationale being no good smoking cessation programs and lack of resources and insufficient policies on tobacco control. This is despite many students (59.9%) expressing the desire to quit smoking if they have proper guidance and tools World Health Organization [24].

Brazil, an upper middle-income country, being a third largest tobacco producing country in the world, has a comprehensive tobacco control policy including restrictions on publicity, ban on smoking in indoor public areas, mandatory pictorial warning labels on cigarette packs and total ban on menthol cigarettes, increase tax and pricing policies. One study showed that increase taxes and price rise have great potential to stimulate cessation and reduces prevalence among the vulnerable population Gigliotti [25-75].


This review suggests the trends of smoking habits and smoking cessation intervention strategies differ from region to region when viewed from an international perspective. This highlights the necessity for the improvement of new methods that prevent people from starting to smoke, motivate to quit smoking and sustain longterm cessation. Further, we suggest exploring how to change more smokers to try quit and to choose the most appropriate evidence- based practical approach and to try more frequently. If appropriate and applicable, poly pharmacotherapy should be offered for a prolonged period since relapse is more common. Cessation programs must be custom-made to focus on the envisioned audience rather than just providing information. It is observed by many that e-cigarette to be harmless than traditional cigarettes, still a lot of the devices contain nicotine and inhaling their vapors exposes users to toxic substances, including lead, cadmium, and nickel, heavy metals that linked with significant health problems (Grana, 2014).In developing countries due to lack of infrastructure, and funds are the major drawback towards the success of smoking control and smoking cessation, rich countries should extend help in the implementation of intervention programs. Additionally, countries can also contribute by strictly implementing taxation on cigarettes and also increase the price of tobacco and tobacco products in general. Future research should be directed to assess whether increasing the number of quitting attempts would positively impact smoking cessation.

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Thursday 26 August 2021

Lupine Publishers | A present and global threat called Extended-Spectrum Beta-lactamases (ESBLs)

 Lupine Publishers | Journal of Biotechnology & Microbiology


The urinary tract infection (UTI) is a common cause of antibiotic prescription in general medicine. The main etiological agents of UTIs are the Enterobacteria, that account for about 70 to 80% of the isolated microorganisms in the laboratory routine. In most cases, the empirical treatment is initiated, without the request of the urine culture, which can result in therapeutic failures and worsening of the disease due to the development of microbial resistance [1]. Consequently, the indiscriminate use of antimicrobials can often impose barriers in the control of infections by decreasing the therapeutic options. In this epidemiological context, it is important to note that the susceptibility profile as well as the etiologic agent may also vary according to the environment in which the infection was acquired. In the last few years, the resistance of the most used antibiotics in clinical practice for treatment of Gram-negative bacteria has increased worldwide. The treatment of infections caused by these pathogens is usually performed with beta-lactam antibiotics, drugs of first choice due to their efficiency and low toxicity. Their inappropriate and excessive favored the emergence of microorganisms with different mechanisms of resistance, being the main of these, the production of beta-lactamase enzymes that have the ability to hydrolyze the structure of the beta-lactam ring, which decrease the drug effectiveness [2]. Among the different types of beta-lactamase enzymes, Extended-Spectrum Beta-lactamases (ESBL) confer resistance to third generation cephalosporins [3]. As an example, ESBL-producing Escherichia coli (E. coli) and Klebsiella pneumoniae are among the bacteria that few potentially effective drugs are available [4]. High prevalence of ESBL and carbapenemase producing Gram-negative bacteria had already been reported from different countries [3-6]. Only in the United States, it is estimated that ESBL-carrying Enterobacteriaceae is responsible for more than 1700 deaths per year [7]. In Brazil, a high rate of antimicrobial resistance of ESBL-producing isolated from urine showed that among 3,418 urine cultures evaluated, Enterobacteriaceae were responsible for 584 (86.9%) cases among the 672 samples positive for UTI. ESBL-producing was detected in 29 (4.8%) of the 584 Enterobacteriaceae, of which 16 (55.2%) corresponded to the E. coli species and 13 (44.8%) species of Klebsiella. Additionally, a high proportion of the isolates presented resistance to monobactams, cephalosporins, fluoroquinolones and sulfonamides [8]. Resistance to sulfamethoxazole/trimethoprim among bacteria that causes UTIs are also on the rise (34.4% to 56.4%) [9,10]. Numbers as high as 88.9% of resistance to sulfamethoxazole/trimethoprim as well as 44.4% to gentamicin were also detected in microorganisms causing UTI in the city of São Luís, in Northeast of Brazil. In addition, except for E. coli, other microorganisms showed 100% of resistance to ciprofloxacin, levofloxacin and nitrofurantoin [11]. In pediatric patients, a rapid increase in the prevalence of ESBL-producing Enterobacteriaceae recovered from UTI in Qatar was described. The values ranged from 18% in 2010 to 24% in 2014 and reached 31.7% (n=201 of 635 positive cultures) in 2017. The prevalence varied among patients with different ethnic backgrounds, being more prevalent among Qataris when compared to Egyptians, Indians, and Pakistani. As an increase in the prevalence of ESBL-producing Enterobacteriaceae is being more frequently described, the use of carbapenems and amikacin are becoming the recommended therapeutic choice for the treatment of severe infections [12]. Taking all these into account, it is important to consider that the emergence and spread of ESBL-producing Enterobacteriaceae is an important public health problem with serious implications, especially in lowincome countries where the time to identify these pathogens are too high and second-line treatment is often unavailable. An effort to improve the time of diagnosis and to acquire knowledge in the local prevalence ESBL-producing Enterobacteriaceae is critical to define appropriate empirical therapeutic strategies for multidrugresistant organisms and to monitor their spread.

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Wednesday 25 August 2021

Lupine Publishers| Diet, Obesity and Diabetes

 Lupine Publishers| Archives of Diabetes & Obesity (ADO)


Obesity and diabetes have become a very important global problem. In developed countries the incidence of both seems to have stabilised probably due to greater awareness and better education. Weight reduction in obese subjects with diabetes can be achieved by bariatric surgery and often results in remission of diabetes, hypertension and dyslipidaemia but at a cost of mortality and morbidity. Dietary intervention until recently has been relatively unsuccessful. Recently however, structured, low calorie diet with nurse/dietician support in a general practice setting has shown promise. Successful drug therapy to aid weight reduction remains elusive.


There is a national awareness of the increasing prevalence of obesity and type 2 diabetes. The good news is that the rising trends in children’s BMI has plateaued in high income countries such as ours but it is sad that they have accelerated in parts of Asia and other regions [1]. Early development of obesity has been shown to predict obesity in adulthood especially for children who are severely obese [2]. An interesting recent article [3] examined overweight children at the age of 7, at 13, and early adulthood. The authors found that at any of these 3 stages overweight was positively associated with risk of type 2 diabetes. Men who had had remission of overweight before the age of 13 years, had a risk of having type 2 diabetes diagnosed at 30 to 60 years of age that was similar to that of men who had never been overweight. Thus there would seem to have been a window of opportunity for diabetes prevention between the age of 7 and 13. Type 2 Diabetes, hypertension and dyslipidaemia, can of course be reversed in many cases by weight reduction. The most impressive results have been obtained through Bariatric Surgery. Weight and metabolic outcomes 12 years after gastric bypass was reported by Adams et al. [4]. This was an observational prospective study of roux en y gastric bypass. Mean percentage body weight reduction in the surgery group was 45kg (mean % change in body weight was minus 35%) as compared to a reduction of minus 2% in the non surgery group. Diabetes remitted in 75% of the patients at 2 years and in 55% at 12 years. Hypertension and dyslipidaemia also remitted significantly more in the surgery group than in the non surgery group. The 12 year incidence of diabetes was 3% in the surgery group and 26% in the non surgery group. Alas there were 7 deaths by suicide, 5 in the surgery group and 2 in the non-surgery group who went on later to have bariatric surgery. This study and many others demonstrate the success of surgery in causing important weight loss and in reversing important cardiovascular risk factors such as hypertension, diabetes and dyslipidaemia. The morbidity and mortality make physicians and patients wary of the procedure and opt instead for calorie restriction, sometimes with drug therapy such as GLP1 agonists or appetite suppressants. Unfortunately the results only rarely match those of bariatric surgery.

In 2011 Lim et al. [5] published their seminal paper supporting the hypothesis that type 2 diabetes is caused specifically by fat in the liver and pancreas. They showed that on a negative energy balance with a 600-700 kcal/day diet. Liver insulin resistance and fat content normalised within 7 days with first phase insulin response and pancreatic fat content, normalising over 8 weeks. The underlying changes were shown to remain stable over the next 6 months of isocaloric eating. Unfortunately the popularity of this wonderfully successful treatment had not gained widespread acceptance even though it is virtually free from serious adverse events and mortality. However, it seems as if acceptance will dramatically increase in the next few years following the next important paper from Roy Taylors group [6]. The aim of their study was to assess whether intensive weight management in primary care would achieve remission of type 2 diabetes. Forty nine primary care practices in Scotland and the Tyneside region in England were involved. The patients recruited were between 25 and 60 years of age, who had been diagnosed with type 2 diabetes within the past 6 years, had a BMI of 27-45kg/m2 and were not receiving insulin. The intervention comprised with drawl of antihypertensive and anti diabetic drugs. Total diet replacement 825-853kcal/day formula diet for 3-5 months, stepped up food reintroduction (2-8 weeks) and structured support for long term weight loss maintenance. The study was run by local nurses or dieticians rather than by specialist staff. Fifteen hundred patients were invited by mail. 800 did not reply and more than 200 refused and 306 individuals agreed to take part in the trial. Only 8% lost to follow up in the 12 months. 86% in the intervention group and 99% in the control group attended the 12 month assessment. At 12 months weight loss of 15kg (24%) or more was found in 24% of participants. Diabetes remission was achieved in 68 (46%) of the participants and in the intervention group and 6 (4%) in the control group. 86% the 36 participant who lost 15kg or more achieved diabetes remission. 2 serious adverse events were seen in one patient (biliary colic and abdominal pain). They were deemed potentially related to the intervention. This trial demonstrates a feasible method of treating obesity at very little cost in a community setting.

There are of course many other methods that have some success in achieving weight reduction through calorie restriction but they are either poorly researched and/or have only very limited success. Intermittent food deprivation is a method which has had some popularity. Intermittent energy restriction is a potent stimulus for ketosis. In mice alternate day food deprivation has been shown to modulate molecular pathways involved in mitochondrial biogenesis, metabolism and cellular plasticity. These results lead to increased metabolic efficiency and indurance capacity [7]. Intermittent fasting in short term studies has been shown to reduce LDL cholesterol and increase HDL. These studies however are observational and lack detailed information about diet [8]. A recent review of weight loss strategies in people with and without diabetes came to the conclusion that intermittent fasting has a benefit beyond the weight loss produced and does not spare lean mass compared with daily energy restriction [9]. Another recent review also came to the conclusion that intermittent energy restriction was no better than continuous energy restriction for short term weight loss in obese adults. The authors suggest that although intermittent energy restriction was shown to be more effective than no treatment, this should be interpreted cautiously due to the small number of studies [10].

A recent study examined bariatric surgery vs. medical treatment with long-term medical complications and obesity related co-morbidities. The surgically treated patients had a greater likelihood of remission of hypertension and other co-morbidities including diabetes but a greater risk of new onset depression and other medical complications. The authors conclude that there should be careful consideration of the medical complications of surgery in their decision making [11]. The difficulties involved in treating obesity cannot be underestimated. Drug treatment with drugs such as GLP1 agonists have not been impressive A useful review on treatment options available for obesity has recently been published [12].

Many studies have suggested that different methods of monitoring of weight loss programmes are important for the limited success of these programmes. In a 12 month programme Jospe et al. [13] examined in 250 patients to see whether there would be a difference in our come between brief monthly individual consults, daily monitoring of weight, self monitoring of diet using My Fitness Pal, self monitoring of hunger or control. 68.4% of the study group of 250 adults with BMI 27 or greater completed the study. The study concluded that adding a monitoring strategy to diet and exercise advice did not further increase weight loss. Bupropion is a drug used in addiction. It stimulates hypothalamic pro-opiomelanocortin (POMC) neurones and reduces food intake and increases energy expenditure. Naloxone blocks POMC auto inhibition. The combination has been used to treat obesity. Aprovian et al [14] examined the effect of this combination and found that the combination reduced weight by 6, 4% as compared to a weight loss of 1.2% in the placebo arm. To date drug therapy for obesity treatment has been very disappointing. GLP1 agonists which delay gastric emptying as well as having a central effect on apatite. Three years of lira glutide versus placebo in patients with pre-diabetes and BMI of at least 30 has been reported [15-17]. More than 2000 patients were recruited. Only 50% of the patients completed the study. The subjects on Lira glutide lost 6.1% of body weight compared to the controls that lost 1.9%. A not very impressive treatment alas for obese patients.

In conclusion prevention of obesity, rather than treatment when present, would seem the way forward. The recent evidence is that the rising prevalence of obesity has been curbed in developed countries as has the rising prevalence of diabetes. It is likely that Government intervention with strategies to improve education curb advertising of unhealthy foods and tax reforms to decrease the cost of ‘Healthy food’ will succeed. Once obesity occurs bariatric surgery is the only very effective treatment but the mortality and morbidity means that patients have to be very carefully chosen. Very low calorie diets with supervision in a General Practice environment with minimal but regular support has been shown to be feasible.

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Tuesday 24 August 2021

Lupine Publishers| Correlative Variation of The Essential Amino Acids

 Lupine Publishers| Current Trends on Biostatistics & Biometrics (CTBB)


On the example of the table of contents of eight essential amino acids in 22 products, the methodology of factor analysis and determination of the coefficient of correlation variation, calculated as the ratio of the sum of the correlation coefficients of stable laws and laws of binary relations between amino acids to the product of the number of amino acids as influencing variables and as dependent indicators. It is shown that this evaluation criterion depends on the composition of the products and the set of amino acids considered. Therefore, it is proposed to make a more complete table considering the set of objects, which considers the content of all 20 amino acids. The law of binary relations between amino acids is the sum of the exponential law and the biotechnical law of stress excitation in the product. By correlation coefficients of individual binary relations, the ratings of amino acids as influencing variables and as dependent indicators are performed. The correlation matrix of super strong bonds of essential amino acids with correlation coefficients of more than 0.99 is considered, in part of which the graphs are given. By the nature of behavior, it is proposed to classify the binary relationships between amino acids into positive, neutral and negative. Separately, the method of rating products. The equations and graphs of rank distributions of the content of essential amino acids in products are given. The rating of essential amino acids by dispersion of residues from the equations of binary relations and rank distributions is given.

Keywords: Amino Acids; Products; Factor Analysis; Regularities; Correlation Coefficients; Coefficient of A Correlative Variation


Under the expression correlative variation Charles Darwin understands that the whole organization is internally connected during growth and development, and when weak variations occur in one part and are cumulated by natural selection, the other parts are modified. Modifications in the structure recognized by taxonomists for a very important, can depend solely on the laws of variation and correlation [1]. For example, Phyto enosis [2] has at least three fundamental properties: first, the correlative variation in the values of parameters in time and space; second, the correlation depends on the genotypic properties of the plant species; third, the variation is due to phenotypic properties, as well as the cycles of solar activity [3], the rotation of the moon around the Earth and our planet around itself [4].

In accordance with the correlative variation of Charles Darwin, during the growth and development of the body, significant changes in the initial age will lead to changes in the structure and in the adult creature. Therefore, people, taking, and thereby enhancing some feature of, almost, probably, unintentionally modifying other parts of the body based on the mysterious laws of correlation [1]. Any non-investigative variation is insignificant for us. But the number and variety of hereditary deviations in the structure, both minor and very important in physiological terms, is infinite. All things are things, properties and relations [5], and in the bios relations control things and change their structures. The purpose of the article is to show the laws and regularities of the correlative variation of the content of eight essential amino acids in a set of 22 products.

The Concept of Correlative Variation

Variability [1] is usually associated with the living conditions that the species has been subjected to for several successive generations. In General, according to Darwin, there are two factors: the nature of the body (most important factor) and the properties of existing conditions [1]. Thus, we adopted the basic hypothesis that typing, and the classification has no effect on biotech based on mastery of life laws. Therefore, the variation (the set of deviations from the Darwin correlation) depends on the human factor, i.e. on the quality of measurements of soil properties and plants [4,6]. Soil according to V.V. Dokuchaev [7] is a living organism. Therefore, the principle of Darwin’s correlative variation should provide high adequacy of the revealed regularities [6]. Similarly, a priori we will consider experiments with essential amino acids [8] to measure their concentration in different types of products for humans and animals highly correlative.

From the concept of correlative variation of Charles Darwin, which was not understood by mathematicians and was not developed by biologists, it clearly follows that in other conditions of the habitat other combinations of values of factors may be stronger (Darwin calls factors hereditary deviations). Therefore, weak factor connections may be stronger for other combinations of the studied objects. As a result, there is a mathematical tool [9- 12] (identification method) for comparison of different natural and artificial (technical) objects [13]. The coefficient of correlative variation is considered for many factors of the physical object of study, that is, biological, chemical, technological, socio-economic, etc. It is equal to the ratio of the total sum of the correlation coefficients to the square of the number of factors for the complete table model (or to the product of the number of factors and). The type of the system under study does not affect this criterion, and the correlation variation depends entirely on the internal properties of the system under study. The coefficient of correlative variation is calculated by the formula



K – the coefficient of correlative variation of the set of factors or parameters characterizing the system under study,

ΣΣr – the total sum of the correlation coefficients for the rows and columns of the correlation matrix of the relationships between the factors,

N – number of factors to consider in the symmetric table,

Nx, Ny – the number of factors on the axes x and y .

Functional connectivity is a universal property of matter. For example, internal correlation variation is observed in the results of agrochemical analysis of soil samples [6], as all agrochemical parameters are measured on the same sample. Sampling sites do not affect the internal connectivity of biochemical and other reactions, that is, the same interactions between chemical elements and their compounds are observed on Earth. Such a community is called an ecosystem [2] or a biosphere superposition. The strongest correlative variation over 0.999 is observed in the set of genes [13- 15]. Slightly less, but more than 0.99, as will be shown in this article, such a variation exists in the group of essential amino acids.

Essential Amino Acids

These are essential amino acids for animals that cannot be synthesized in the body, in particular, human. Therefore, their intake from food is necessary (Table 1).

Table 1: The content of essential amino acids in products [1] (grams per 100 grams of product), We have included in the list of products №22 «Shiitake mushrooms».


Rating of Influencing and Dependent Factors

To determine the coefficient of correlative variation of nine amino acids among 22 types of products it is necessary to conduct a factor analysis [9]. Due to the absence of a measured value of glycine content in one cell of Table 1 in the row Shiitaki mushrooms, factor analysis was first carried out [9, pp. 82-83, table. 3.30] nine factors and 21 products. The coefficient of correlative variation was equal to 0.9985. All binary 92– 9 = 72 relations are characterized by the exponential law. Table 2 shows the correlation matrix of binary relationships and the rating of eight factors excluding glycine for 22 products according to Table 1.

Table 2: Correlation matrix of factor analysis without glycine and rating of factors in identification by the exponential law.


Table 3: Correlation matrix of factor analysis without glycine and rating of factors in identification by exponential and biotechnical law.


Table 3.1:


The coefficient of correlative variation is 0.9727, which is significantly less than 0.9985. In the future, it turned out that in addition to the indicative law, the biotechnical law [4,6,9-15] of the stress excitation of amino acids depending on each other is additionally considered (Table 3). With the coefficient of correlative variation 0.9890 in the first place among the influencing variables was lysine, and among the indicators -phenylalanine. Thus, the correlative variation is very sensitive to the composition of amino acids and products. This fact in the future will reveal the rational compositions, structures and functions of amino acids in different systems under study.

The Law of the Relationship Between Amino Acids

It is expressed by an equation of the form


where y- amino acid content in the product as an indicator (g per 100 g of product),

x- amino acid content of the product as an influencing variable (g per 100 g of product),

a1..... a6 - the parameters of the model (2) taking the numerical values in the course of structural-parametric identification in the software environment CurveExpert-1.40. Formula (2) shows three types of stress-induced amino acids under the influence of each other: positive, neutral and negative. Neutral type appears only without shiitake mushrooms, that is, when the amino acid content changes from 0 to 2 (maximum 2.009 for beef). The maximum concentrations of nine amino acids without shiitaki mushrooms are in two products-beef and chicken meat. In the amino acid content range from 2 to 7 in Table 1 there are no types of products (except mushrooms). Therefore, it is necessary to add new products to the list and Table 1.

In the concentration range from 0 to 7, two types of behavior appear:

  1. positive behavior, with a positive sign in front of the second component of the formula (2), when with increasing content of the influencing amino acid, the content of the dependent amino acid increases according to the biotechnical law of stress excitation;
  2. negative behavior, with a negative sign, when the content of the dependent amino acid is inhibited from the action of the wagging amino acid. These two types provide optima for the interaction of essential amino acids.


We have extended the principle of correlative variation not only to Charles Darwin organisms, but also to populations (in the article population of eight amino acids) and even to any biological, biotechnical and technical systems [13]. This principle allows to compare heterogeneous systems on one or some set of factors by functional connectivity. The coefficient of correlative variation, as a generalized criterion for comparing different sets of homogeneous biological objects, gets a very high value. For example, populations of genes [14,15] obtained the correlative coefficient of variation not less than 0.9999. In the example of this article, the level of adequacy for the set of eight essential amino acids is not less than 0.99. This makes it possible in the future to create the most complete table of contents and other indicators for a system of 20 amino acids and hundreds of objects, including products. Functional connectivity between essential amino acids was super strong and it is subject to a simple formula of two-term trend containing exponential and biotechnical laws. The absence of the second term determines the neutral type of behavior, and signs in the presence of the second member characterize the positive (+) or negative (-) type of behavior of amino acids in the studied system of products. To identify the effect of oscillatory adaptation of essential amino acids to each other in some sets of products need more accurate (with measurement error, less than an order of magnitude) data.

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