Etiology and outcome of new-onset status epilepticus in older patients / 临床神经病学杂志

Objective To investigate the etiology and outcome of elderly patients with new-onset status epilepticus(NOSE).Methods According to the electronic medical record,the keywords"Epilepsy"and"Status epilepticus"were searched for elderly patients with status epilepticus admitted to Sichuan Provincial People's Hospital between January 2018 and June 2023.Elderly patients with NOSE were strictly screened according to inclusion and exclusion criteria,and etiology were analyzed according to medical history and ancillary examinations,and factors related to prognosis of epilepsy were analyzed by Logistic regression.Results There were 63 elderly NOSE patients,including 38 males and 25 females,with an average age of(72.71±7.45)years old.Cerebrovascular disease(21%)was determined as the major cause of NOSE in elderly patients,followed by central nervous system infection(17%).Logistic regression analysis of prognostic factors showed that co-infection(OR = 11.67,95%CI:1.391-97.850,P =0.024)and renal insufficiency(OR =18.90,95%CI:3.522-101.43,P = 0.001)were associated with poor patient prognosis.Conclusions Cerebrovascular disease is the main known cause of NOSE in elderly patients.Prevention of infection and improvement of renal function may improve prognosis.

Preliminary Study on Prognostic Factors of New-onset Diabetes Mellitus After Distal Pancreatectomy for Pancreatic Cystic Tumor / 中国微创外科杂志

Objective To explore the prognostic factors of new-onset diabetes mellitus(NODM)in patients with pancreatic cystic tumor after distal pancreatectomy(DP).Methods Between January 2010 and December 2019,92 patients with cystic pancreatic tumors in our hospital underwent laparoscopic DP.According to the inclusion and exclusion criteria,a total of 74 cases were included and divided into NODM group or normal glucose metabolism group based on whether postoperative NODM occurred.A univariate analysis was used to evaluate the prognostic factors of laparoscopic DP for pancreatic cystic tumors.P<0.05 was considered statistically significant,OR>4 was considered as a potential prognostic factor of clinical significance for NODM.Results NODM was diagnosed in26 cases(35.1%),with a median diagnosis time of 9 months(range,3-56 months)after surgery.Univariate analysis showed that transecting pancreas in the neck(OR = 11.000,P = 0.000),BMI≥25.0(OR = 4.333,P = 0.007),and family history of diabetes mellitus(OR =5.000,P =0.004)were prognostic factors of postoperative NODM.Conclusions When performing DP for pancreatic cystic tumors,it is advisable to preserve as much pancreatic tissue as possible and avoid cutting off the pancreas in the neck.Precise postoperative strategy of glucose metabolism surveillance for patients with BMI≥25.0 and family history of diabetes mellitus should be promoted.

New onset refractory status epilepticus/febrile infection-related epilepsy syndrome: the new challenge in the diagnosis and treatment of status epilepticus / 中华神经科杂志

New onset refractory status epilepticus (NORSE) and its subcategory, febrile infection-related epilepsy syndrome (FIRES) are rare and devastating conditions, initial symptoms of which are often refractory status epilepticus. NORSE/FIRES is characterized by high mortality and disability, but unfortunately, due to the unclear pathogenesis, the diagnosis and treatment of NORSE/FIRES are very challenging. This editorial aims to summarize the key points and recent developments in the etiology, pathophysiology, diagnosis and management of these challenging conditions.

Health literacy of chronic diseases in newly diagnosed and prediabetes patients and its relationship with the effect of blood glucose control / 公共卫生与预防医学

Objective To explore the relationship between health literacy of chronic diseases and the effect of blood glucose control in newly diagnosed and prediabetes patients. Methods A total of 180 newly diagnosed and prediabetes patients treated in the Western Theater Command General Hospital from January 2021 to January 2023 were selected, including 94 newly diagnosed and 86 prediabetes patients. The health literacy of chronic diseases in these patients was evaluated by using the health literacy management scale (HeLMS) developed by Jordan et al. The differences of clinical general information and blood glucose control between patients with adequate and insufficient health literacy were analyzed. Results Among the 180 patients, the total score of information acquisition ability, communication and interaction ability, willingness to improve health, willingness for financial support, total score of health literacy, and adequate proportion of health literacy assessed by HeLMS were (35.54 ± 7.21), (33.02 ± 8.15), (15.54 ± 3.92), (7.10 ± 0.98), (91.87 ± 7.28), and 51.67%, respectively. The age of patients with adequate health literacy in the newly diagnosed diabetes group was (52.23 ± 7.15) years old, which was significantly lower than that of patients with insufficient health literacy (P<0.05). The proportions of patients with high school education and above, monthly income ≥ 3000 yuan, and relatives engaged in medical work were 68.09%, 68.09%, and 34.04%, respectively, which were significantly higher than those of patients with insufficient health literacy (P<0.05). The age of patients with adequate health literacy in prediabetes group was (82.23 ± 4.15) years old, which was significantly lower than that of patients with insufficient health literacy (P<0.05). The proportions of patients with high school education and above, monthly income ≥ 3000 yuan, number of children ≥ 2, and relatives engaged in medical work were 65.22%, 67.39%, 34.78%, and 41.30%, respectively, which were significantly higher than those of patients with insufficient health literacy (P<0.05). The fasting blood glucose, glycosylated hemoglobin and 2h postprandial blood glucose of patients with adequate health literacy in the newly diagnosed diabetes group after treatment were (6.43 ± 0.93) mmol/L, (6.02 ± 0.91)% and (7.71 ± 1.01) mmol/L, respectively, which were significantly lower than those of patients with insufficient health literacy (P<0.05). The fasting blood glucose, glycosylated hemoglobin and 2h postprandial blood glucose in patients with adequate health literacy in prediabetes group after treatment were (5.21 ± 0.37) mmol/L, (5.20 ± 0.40)% and (6.20 ± 0.92) mmol/L, respectively, which were significantly lower than those in patients with insufficient health literacy (P<0.05). Conclusion The chronic disease health literacy of prediabetes and new-onset patients is related to the age, education and monthly income level, number of children, relatives engaged in medical work of patients, and the level of health literacy is helpful to the control of blood glucose.

J-shaped association between dietary zinc intake and new-onset hypertension: a nationwide cohort study in China / 医学前沿

We aimed to investigate the relationship of dietary zinc intake with new-onset hypertension among Chinese adults. A total of 12,177 participants who were free of hypertension at baseline from the China Health and Nutrition Survey were included. Dietary intake was assessed by three consecutive 24-h dietary recalls combined with a household food inventory. Participants with systolic blood pressure ≽ 140 mmHg or diastolic blood pressure ≽ 90 mmHg or diagnosed by a physician or under antihypertensive treatment during the follow-up were defined as having new-onset hypertension. During a median follow-up duration of 6.1 years, 4269 participants developed new-onset hypertension. Overall, the association between dietary zinc intake and new-onset hypertension followed a J-shape (P for non-linearity < 0.001). The risk of new-onset hypertension significantly decreased with the increment of dietary zinc intake (per mg/day: hazard ratio (HR) 0.93; 95% confidence interval (CI) 0.88-0.98) in participants with zinc intake < 10.9 mg/day, and increased with the increment of zinc intake (per mg/day: HR 1.14; 95% CI 1.11-1.16) in participants with zinc intake ≽ 10.9 mg/day. In conclusion, there was a J-shaped association between dietary zinc intake and new-onset hypertension in general Chinese adults, with an inflection point at about 10.9 mg/day.

Recent Advances in Post-operatively New Onset Myasthenia Gravis in Thymoma Patients / 肿瘤防治研究

Patients with thymoma without preoperative myasthenia gravis may develop symptoms of myasthenia gravis after tumor resection. A comprehensive understanding toward this rare clinical phenomenon is lacking. Recent studies indicate that post-operatively new onset myasthenia gravis (ponoMG) is the result of multiple mechanisms and their interactions, which may be related to the thymoma-mediated production, release and long-term presence of abnormal T cells and autoimmune antibodies in the periphery, as well as the presence of ectopic thymus and late recurrence of thymoma. Preoperative antibody titer is the main predictor. The treatment strategy is based on anticholinesterase drugs and hormonal therapy. In this study, we review the incidence, pathogenesis, predictors, and prevention and treatment strategies of ponoMG.

Predictive Value of Uric Acid/Albumin Ratio for the Prediction of New-Onset Atrial Fibrillation in Patients with ST-Elevation Myocardial Infarction

ABSTRACT Background: There is a lack of studies supporting the association between the uric acid/albumin ratio (UAR) and the development of new-onset atrial fibrillation (NOAF) in ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (pPCI). Objective: The objective of the study was to assess the efficacy of the UAR for predicting the occurrence of NOAF in STEMI patients undergoing pPCI. Methods: We recruited 1484 consecutive STEMI patients in this retrospective and cross-sectional investigation. The population sample was classified based on the development of NOAF during hospitalization. NOAF was defined as an atrial fibrillation (AF) observed during hospitalization in patients without a history of AF or atrial flutter. The UAR was computed by dividing the serum uric acid (UA) level by serum albumin level. Results: After pPCI, 119 STEMI patients (8%) were diagnosed with NOAF. NOAF patients had higher serum UAR levels than individuals who did not have NOAF. According to the multivariable logistic regression model, the UAR was an independent predictor for NOAF in STEMI patients (OR: 6.951, 95% CI: 2.978-16.28, p < 0.001). The area under curve (AUC) value of the UAR in a receiver operating characteristics (ROC) evaluation was 0.758, which was greater than those of its components (albumin [AUC: 0.633] and UA [AUC: 0.647]) and C-reactive protein (AUC: 0.714). The optimal UAR value in predicting NOAF in STEMI patients was greater than 1.39, with a sensitivity of 69% and a specificity of 74.5%. Conclusion: To the best of our knowledge, this is the first study indicating that the UAR was an independent predictor of NOAF development in STEMI patients.

Application of 18F-flurodeoxyglucose positron emission tomography in patients with status epilepticus / 中华神经科杂志

Status epilepticus is a neurological emergency with unknown pathogenesis, controversial treatment options, and poor prognosis. In recent years, with the development of 18F-flurodeoxyglucose positron emission tomography ( 18F-FDG PET) imaging technology, further studies on status epilepticus have been carried out from the perspective of molecular metabolism. This article reviews the current role of 18F-FDG PET in patients with status epilepticus on etiology, disease activity, electric activity, location of epileptogenic foci, and prognosis evaluation.

Chinese Consensus for Pancreatic Cancer Screening and Surveillance in High ⁃ risk Individuals (2021, Nanjing) / 胃肠病学

Pancreatic cancer is highly malignant with low 5‑year survival rate because it is hard to be diagnosed in early stage. So far, a standardized screening strategy of early pancreatic cancer has not been achieved in China. Based on updated research evidence, a total of 26 recommendations are proposed for screening aims, high ‑ risk individuals, initial screening age, follow ‑ up interval, monitoring methods and timing of operation. Chinese consensus for early pancreatic cancer screening and surveillance is finally formulated.

Echocardiographic prognostication of new onset heart failure in a cohort of ischemic heart disease patients / Pronóstico Ecocardiográfico de un nuevo evento de insuficiencia cardíaca en una cohorte de pacientes con Cardiopatía Isquémica

Background: Echocardiographic predictors for new onset heart failure in patients with ischemic heart disease with reduced left ventricular ejection fraction (HFrEF) or with preserved left ventricular ejection fraction (HFpEF) in Ethiopian and Sub-Saharan African is not well-known.Methods: Two hundred twenty-eight patients with ischemic heart disease were retrospectively recruited and followed. Analysis on baseline clinical and echocardiographic characteristics of patients, and risk factors for new onset HFpEF and new onset HFrEF were done. The exclusion criteria were known heart failure at baseline and those who did not have echocardiography data.Results: During the follow up period, heart failure developed in 62.2% (61/98) of ischemic heart disease patients with preserved left ventricular ejection fraction and in 70.1% (92/130) of ischemic heart disease patients with reduced left ventricular ejection fraction. We did not find significant difference between HFrEF and HFpEF in time to new onset heart failure. Systolic blood pressure, diastolic blood pressure, diabetes, left atrium and diastolic left ventricular dimension had significant association with new onset HFrEF on univariate regression analysis. Whereas new onset HFpEF was significantly associated with age, sex, presence of hypertension, Systolic blood pressure and diastolic left ventricular dimension. On cox regression analysis diastolic left ventricular dimension was associated with both new onset HFpEF and HFrEF. Age, diabetes, and dimension of left atrium were also associated with HFrEF.Conclusion: This cohort study in ischemic heart disease patients suggests a key role for the diastolic left ventricular dimension, left atrium size, diabetes, sex and age as predictors of new onset HFrEF and HFpEF. Strategies directed to prevention and early treatment of diabetes, dilatation of left ventricle and left atrium may prevent a considerable proportion of HFrEF or HFpEF.

Antecedentes: Los predictores ecocardiográficos de nuevos eventos de insuficiencia cardiaca en pacientes con cardiopatía isquémica con fracción de eyección ventricular preservada (HFpEF) o con fracción de eyección ventricular reducida (HFrEF) no son bien conocidos en la Africa etíope y subsahariana.Métodos: Doscientos veintiocho pacientes con cardiopatía isquémica fueron reclutados y seguidos retrospectivamente. Se realizaron análisis sobre las características clínicas y ecocardiográficas basales de los pacientes, así como los factores de riesgo para un nuevo evento de HFpEF y un nuevo evento de HFrEF. Los criterios de exclusión fueron insuficiencia cardíaca conocida al inicio del estudio y aquellos que no tenían datos de ecocardiografía.Resultados: Durante el período de seguimiento, la insuficiencia cardíaca se desarrolló en el 62,2% (61/98) de pacientes con cardiopatía isquémica con fracción de eyección ventricular izquierda preservada y en el 70,1% (92/130) de pacientes con cardiopatía isquémica con fracción de eyección ventricular izquierda reducida. No encontramos diferencias significativas entre HFrEF y HFpEF en el tiempo hasta la nueva aparición de insuficiencia cardíaca. La presión arterial sistólica, la presión arterial diastólica, la diabetes y las dimensiones de la aurícula iquierda y del ventrículo izquierdo en diástole tuvieron una asociación significativa con nuevos eventos de HFrEF en el análisis de regresión univariada. Mientras que un nuevo evento de HFpEF se asoció significativamente con la edad, el sexo, la presencia de hipertensión, la presión arterial sistólica y la dimensión ventricular izquierda diastólica. En el análisis de regresión de cox, la dimensión ventricular izquierda diastólica se asoció con HFpEF de nuevo inicio y HFrEF. La edad, la diabetes y la dimensión de la aurícula izquierda también se asociaron con HFrEF. Conclusión: Este estudio de cohorte en pacientes con cardiopatía isquémica sugiere un papel clave para la dimensión ventricular izquierda diastólica, el tamaño de la aurícula izquierda, la diabetes, el sexo y la edad como predictores de un nuevo evento de HFrEF y HFpEF. Las estrategias dirigidas a la prevención y el tratamiento temprano de la diabetes, la dilatación del ventrículo izquierdo y la aurícula izquierda pueden prevenir una proporción considerable de HFrEF o HFpEF.

Association between pulse pressure and new-onset diabetes in overweight and obese people / 中华内分泌代谢杂志

Objective:To investigate the association between pulse pressure(PP) and new-onset diabetes in overweight and obese people.Methods:A prospective cohort study was conducted in overweight or obese participants selected from Kailuan Study who underwent 2006-2007 annual checkup and met the inclusion and exclusion criteria. PP was calculated by blood pressure and participants were divided into 4 groups according to PP quartile. The cumulative incidence of new-onset diabetes of different PP groups was calculated by Kaplan- Meier method and compare by Log- Rank test. The multivariate Cox proportional hazards model was used to analyze the association between different PP groups and new-onset diabetes. Results:During an average follow-up of 8.45 years, 8 922 diabetes was identified. The cumulative incidence rate of the Q1, Q2, Q3, and Q4 groups were 22.12%, 24.48%, 27.97%, and 33.44% respectively, which were statistically different( χ2=368.16, P<0.01). Cox proportional hazards regression analysis showed that after adjusting for multiple confounding factors, compared with Q1 group, the hazard ratio for diabetes in Q2, Q3, and Q4 groups were 1.07(1.00-1.14), 1.13(1.05-1.21), and 1.17(1.09-1.27) respectively. And the HR of diabetes event in pulse pressure(per 1 SD increase) was 1.04(1.02-1.07). Similar results were found in participants who were over-weight, obese, with normal blood pressure or hypertensive without drugs use. Conclusion:PP is positively correlated with the new-onset diabetes. High PP is one of the risk factors for developing diabetes in overweight and obese people.

A report of 5 cases of post-transplantation diabetes mellitus after kidney transplantation in children / 中华器官移植杂志

Objective:To summarize the clinical characteristics and therapeutic drug selection of post-transplantation diabetes mellitus(PTDM)after kidney transplantation in children.Methods:From May 2014 to March 2021, a total of 5 cases(5.38%)of 93 paediatric kidney transplant recipients with a median follow-up period of 34 months were diagnosed with PTDM in our centre.Retrospective data analysis was performed for these 5 paediatric recipients.The characteristics of the disease, treatment data and outcomes were summarized.Among the five paediatric recipients, one was male and four patients were female, ranging the age from 12 to 17 years.All recipients received a tacrolimus-based immunosuppressive regimen with prednisone discontinued no later than 3 months after kidney transplant.Results:The onset of PTDM ranged from 1 month to 46 months(median: 17 months)after transplantation.The blood glucose of two children returned to normal gradually after tacrolimus conversion to cyclosporine, with one of them was given insulin temporarily.Three children received oral hypoglycaemic agents, including one received acarbose, one received metformin, and one received metformin combined with acarbose.After a median follow-up of 6 months, the levels of blood glucose in five children were stable, and there was no significant change in serum creatinine and urine protein.Conclusions:The treatment of PTDM in children should be individualized with considering of age, gender and immunosuppressive regimen. Switch from tacrolimus to cyclosporine is effective. Metformin or other hypoglycemic agentsis helpful when tacrolimus is maintained.

Clinical characteristics comparation and adverse prognostic factors analysis between patients with new-onset acute heart failure and acutely decompensated chronic heart failure / 中华全科医师杂志

Objective:To analyze the clinical characteristics and prognostic factors in patients with new-onset acute heart failure (AHF) and acutely decompensated chronic heart failure (ADCHF).Methods:Patients with heart failure (HF) admitted to Beijing Hospital during January 2009 to December 2017 with follow-up records were retrospectively enrolled. According to the duration of heart failure, the patients were divided into new-onset AHF group (duration of HF<1 month) and ADCHF group (duration of HF ≥1 month). Clinical data were collected and endpoint events (all-cause death and cardiovascular death) were recorded. The Kaplan-Meier survival curve and the log-rank method was used to compare survival between different groups. The multivariate Cox regression model was used to analyze the independent risk factors for the end-point events in patients with new-onset AHF and ADCHF.Results:The study enrolled 562 patients,292 (52.0%) with new-onset AHF and 270 (48.0%) with ADCHF. Patients with new-onset AHF were more likely to have coronary heart disease, acute myocardial infarction, higher diastolic blood pressure and higher troponin I levels(χ2=12.999,15.018, t=-2.088, Z=-2.727; all P<0.05). Patients with ADCHF were more likely to have poor cardiac function, atrial fibrillation, larger left ventricle and left atrium diameter, higher proportion of patients with pulmonary hypertension(χ2=16.565, 15.688, t=2.714, 5.029, χ2=15.274; all P<0.05). There were 205 (36.5%) all-cause deaths and 132 (23.5%) cardiovascular deaths during 28 (14, 60) months of follow-up. All-cause mortality rate [33.2%(97/292) vs. 40.0%(108/270), log-rank P=0.010] and cardiovascular mortality rate [18.8%(55/292) vs. 28.5%(77/270), log-rank P=0.001]were significantly lower in patients with new-onset AHF than those in ADCHF group. Multivariate Cox regression analysis showed that low body mass index (BMI), reduced hemoglobin, reduced resting heart rate, enlarged left atrium, and segmental wall motion abnormalities were independent risk factors for poor prognosis in new-onset AHF patients. It was different with ADCHF patients. Conclusion:Patients with new-onset AHF are more likely to have coronary heart disease; and lower BMI, reduced hemoglobin, acute coronary disease are associated with poor prognosis of patients. It is necessary to identify the underlying diseases early and actively standardize treatment to avoid the deterioration of cardiac function and readmission.

Clinical features and influencing factors for new-onset atrial fibrillation early after coronary artery bypass grafting / 中国胸心血管外科临床杂志

@#To investigate the clinical features and influencing factors for new-onset atrial fibrillation (AF) early after coronary artery bypass grafting. Methods    The clinical data of 339 patients undergoing coronary artery bypass grafting in our hospital from January 2012 to January 2019 were retrospectively analyzed. There were 267 males and 72 females with an average age of 37-83 (58.03±8.90) years. The clinical features and influencing factors for new-onset AF after surgery were investigated. Results    There were 234 patients of off-pump coronary artery bypass grafting (OPCABG), with 36 (15.4%) new-onset AF patients after operation, among whom 16.1% were males and 12.5% were females. There were 105 patients of on-pump coronary artery bypass grafting (CABG), with 39 (37.1%) new-onset AF patients, among whom 40.7% were males and 25.0% were females. The incidence was higher after the CABG surgery than that after the OPCABG surgery (37.1% vs. 15.4%, P<0.05). There was no statistical difference in the incidence rate between males and females (P>0.05). The incidence of new-onset AF after surgery was higher in ≥60 years patients for both  operations (18.9% and 45.8%), which was significantly higher than that in <45 years patients (P<0.05). For both operations, the incidence of new-onset AF after surgery was high on the second day (24-48 h) after surgery, and most of the AF lasted for 1 day (P<0.05). The hypertension (OR=4.983, P=0.036), frequent premature atrial contraction or atrial tachycardia (OR=17.682, P=0.002), postoperative creatine kinase isoenzyme MB (CKMB) (OR=0.152, P=0.042), left anterior and posterior diameters (OR=17.614, P<0.001) and preoperative ejection fraction (OR=7.094, P=0.011) were influencing factors for new-onset AF after OPCABG. Diabetes (OR=11.631, P=0.020), other cardiac malformations (OR=29.023, P=0.002), frequent premature ventricular contraction or ventricular tachycardia (OR=0.047, P=0.001), and postoperative CKMB (OR=3.672, P=0.040) were influencing factors for new-onset AF after CABG. Conclusion    The incidence of new-onset AF after CABG is higher than that after OPCABG, and it increases with age increasing. There is no difference in the incidence between males and females. The influencing factors for the two operations are different.

Influence of donor and recipient CYP3A5 genotype on tacrolimus trough concentrations in the early stage after liver transplantation and its clinical significance / 中国临床药理学与治疗学

AIM: To analyze the influence of donor and recipient CYP3A5 genotype on tacrolimus trough concentrations in the early stage after liver transplantation and its clinical significance under therapeutic drug monitoring (TDM) strategy retrospectively. METHODS: A total of 125 patients undergoing liver transplantation in Shanghai General Hospital from January 2015 to March 2019 were involved in this study. Clinical pharmacology parameters and liver function indexes from 1 to 28 days after operation, the occurrence of new onset diabetes mellitus (NODM) was collected. Donor and recipient cytochrome P450, family 3, subfamily A, polypeptide 5 (CYP3A5) gene rs776746 locus were genotyped by RT-PCR technology.RESULTS: Median trough concentration (Ct

Postoperative serum triglyceride levels in predicting risk of new-onset diabetes mellitus in patients following liver transplantation / 浙江大学学报·医学版

To investigate the postoperative serum triglyceride (TG) levels in predicting the risk of new-onset diabetes mellitus (NODM) in patients following allogeneic liver transplantation. One hundred and forty three patients undergoing allogeneic liver transplantation in Shanghai General Hospital from July 2007 to July 2014 were enrolled in this study. The NODM developed in 33 patients after liver transplantation. The curve of dynamic TG levels in the early period after liver transplantation was generated. Independent risk factors of NODM were determined by univariate and multivariant logistic regression analyses. The clinical value of TG in predicting NODM was analyzed by area under the ROC curve (AUC). Serum TG levels were gradually rising in the first week and then reached the plateau phase (stable TG, sTG) in patients after surgery. The sTG in NODM group were significantly higher than that in non-NODM group (=-2.31, <0.05). Glucocorticoid therapy (=4.054, <0.01), FK506 drug concentration in the first week after operation (=3.482, <0.05) and sTG (=3.156, <0.05) were independent risk factors of NODM. ROC curve analysis showed that the AUC of sTG in predicting NODM was 0.72. TG shows a gradual recovery process in the early period after liver transplantation, and the higher TG level in stable phase may significantly increase the risk of NODM in patients.

Diabetes y COVID-19, una relación de ida y vuelta / Diabetes and COVID-19, one relation to go and comeback

Diabetic patients are at risk of developing unfavorably from SARS-COV19 disease, especially when they have poor glycemic control. On the other hand, in the case of diabetic patients with severe COVID, they evolve with severe hyperglycemia, often difficult to manage. Marked hyperglycemia has also been described in people without a known history of previous diabetes, even there have been reported cases of insulin-dependent diabetes debut in days after the disease. The aim of this review is to analyze possible mechanisms involved in the relationship between COVID-19 and DIABETES.

Evaluation of hyperglycaemic risk of atorvastatin: a dose dependent study on hyperlipidaemic rats

Background: Statins (?-hydroxy ?-methylglutaryl-CoA (HMG-CoA) reductase inhibitors) are the most prescribed medications worldwide to treat hyperlipidaemia with a proven ability to reduce major cardiovascular events. Recent data have revealed that statin therapy is associated with an increased risk for developing diabetes. The risk was most significant in patients taking atorvastatin, rosuvastatin and simvastatin.Methods: Rats were divided into 3 groups, each comprising of 6 rats. Hyperlipidaemia was induced in all the animals after feeding with high fat diet for 15 days. Rats of groups 1, 2 and 3 were given atorvastatin 1.8 mg/kg (low-dose), 3.6 mg/kg (moderate-dose) and 7.2 mg/kg (intensive-dose) respectively orally for 60 days. 12 hours fasted blood samples were collected and analyzed for serum lipid profile, fasting blood glucose and HbA1c levels.Results: The percentage increase in plasma blood glucose after 60 days of treatment in groups 1, 2, and 3 is 29.93%, 60.03% and 72.42% respectively and the variation in all the groups is statistically significant, p<0.0001. Regarding HbA1c values, the variation in low-dose group is statistically insignificant whereas the percentage increase in moderate-dose and intensive-dose groups is 19.45% (p<0.001) and 43.37% (p<0.0001) respectively.Conclusions: In conclusion, there is significant increase in blood glucose and HbA1c levels leading to new-onset diabetes in both moderate-dose and intensive-dose groups. The risk is more in intensive-dose group when compared to moderate-dose group.

Effect of statins treatment on glycemic status and development of new onset diabetes mellitus in a tertiary care teaching hospital: a cross sectional study

Background: Several observational studies, well controlled randomized trials and meta-analyses reported that patients treated with statins has high risk of new onset diabetes mellitus (NODM), but the exact incidence and mechanism is still unclear and controversy. The present study was planned to find out the incidence of prediabetes and NODM and possible mechanism of action.Methods: This was a prospective, cross‑sectional study carried out at the Department of General Medicine for a period of one and half year between August 2017 and February 2019. Normoglycemic patients whose fasting blood glucose levels below 100 mg/dL and at least one year of treatment with statins were recruited in the study. Glycaemic status, development of prediabetes and NODM and insulin resistance were the primary outcomes whereas lipid profile, adverse drug effects of statins were secondary outcomes. Collected data was analysed by suitable statistical methods.Results: A total of 146 patients were recruited and 120 completed the entire study. Mean fasting blood glucose levels before initiation of statin therapy was 89.45±10.21. After one year of statin therapy, patients were separated as prediabetics and new onset diabetics and there mean fasting blood glucose levels were 116.24±12.86 (n=10) and 152.44±20.12 (n=12) respectively. A total of 12 (10.0%) patients were developed NODM and 10 (8.2%) patients developed prediabetes at the end of statin therapy. Atorvastatin 40mg was most frequency prescribed statin followed by Atorvastatin 20mg. A total of 70 (58.3%) study participants developed mild to moderate drug related adverse effects (ADRs), statin‑induced myalgia (55.7%) was the most common ADR.Conclusions: Patients treatment with statins had developed prediabetes and NODM. Atorvastatin 40mg and greater dose significantly induced NODM. Fasting blood glucose levels should be measured periodically with prescription contains higher doses of statins

Clinical profile and evaluation of new onset seizure in adults

Background: Seizures beginning in adult life are likely to be an identifiable cause as compared to those beginning in childhood which is more likely to be idiopathic. Aim and objectives: To study the clinical profile and analyze the etiological agents of New Onset Seizures. Materials and methods: This descriptive study was done in the Government HQRS Hospital and AIMSR, Chittoor, Andhra Pradesh to know the various etiologies in patients presented with newonset seizures. In these cases history and clinical examination and special investigations like CT brain, MRI brain, EEG, Serology, CSF analysis were done to find out the etiology. Results: Out of 100 patients, 55% were males, 45%were females with male to female ratio of 1.2:1. The majority of males were in 2nd decade and females were in 4th decade. Patients' age ranged from 18 years to 80 years, with the mean of 40.11 years with 77% of the patients were in the below 50 years. Alcohol withdrawal was the leading cause of seizures which account for 34% followed by idiopathic seizures (29%), neuro infection (16%), CVA 12% and metabolic (9%). Conclusion: Alcohol withdrawal is the most common cause of seizure in new-onset seizure patients who coming to Government HQRS Hospital and AIMSR Chittoor, Andhra Pradesh