Hyperglycémie de stress: prévalence et impact sur la mortalité intra hospitalière au cours des accidents vasculaires cérébraux ischémiques à la phase aigue au Centre Hospitalier Universitaire Yalgado Ouédraogo, Burkina Faso / Stress hyperglycemia: Prevalence and impact on intra-hospital mortality during ischemic strokes in the acute phase at the Yalgado Ouédraogo University Hospital, Burkina Faso

Contexte et objectif. L'hyperglycémie de stress est fréquente et délétère à la phase aigüe de l'accident vasculaire cérébral ischémique. L'objectif de la présente étude était de déterminer la prévalence de l'hyperglycémie de stress à la phase aigüe de l'AVCI et d'analyser son impact sur la mortalité intra hospitalière Méthodes. Il s'est agi d'une série retrospective de cas qui s'est déroulée du 1er janvier 2021 au 31 Décembre 2022 dans les services des urgences médicales et de Neurologie du Centre hospitalier Yalgado Ouédraogo. Les patients non diabétiques de plus de 15 ans hospitalisés pour un AVCI confirmé par une imagerie cérébrale et ayant une hyperglycémie avec une hémoglobine glyquée normale ont été inclus. Résultats. La prévalence de l'hyperglycémie de stress était de 37,8 %. L'âge moyen était de 59,98 ± 15,9 ans avec des extrêmes de 20 et 98 ans. Le sex-ratio M/F était de 1,12/1. Les facteurs de risque vasculaire les plus fréquents étaient l'hypertension artérielle (54,1 %), la sédentarité (20,3 %) et l'antécédent personnel d'AVC (11 %). Le taux moyen de l'hyperglycémie était de 8,8 ± 2,2mmol/l avec des extrêmes de 7,0 à 15,3 mmol/l. La mortalité intra hospitalière était de 13,37 %. L'hyperglycémie à l'admission ≥ 7mmol/l (p= 0,0027) la température ≥ 38,5° à l'admission (p= 0,0107) et l'insuffisance cardiaque (p= 0,0045) ont émergé comme prédicteurs indépendants de la mortalité intra-hospitalière. Conclusion. L'hyperglycémie de stress est associée à un mauvais pronostic au cours de la phase aigüe des AVCI d'où la nécessité d'un monitorage de la glycémie et d'une prise en charge adaptée

Context and objective. Neonatal jaundice is a common symptom. The objective of the present study was to update the epidemiological profile and identify the factors associated with neonatal jaundice in sick newborns. Methods. A descriptive cross-sectional study was conducted from June 2022 to April 2023 at the Kinshasa University Hospital. The study included sick newborns who presented with mucocutaneous jaundice. Sociodemographic, perinatal, clinical and paraclinical variables were sought. Results. Out of 152 sick newborns, 102 (67.1 %) cases of jaundice were identified. Fullterm newborns (72.5 %), born vaginally (67.6 %) and whose mothers had presented with urogenital infections (98 %) and blood group O (53 %) rhesus positive (97.1 %) were the most represented. Jaundice appeared in the first week of life (85.3 %). Baseline total serum bilirubin was between 10 and 15 mmol/L (57.8 %). The infectious origin was noted in 85 % of cases (Klebsiella pneumoniae in 50 % of cases). Conventional phototherapy was used in 74.5 %. Vaginal delivery was the only associated factor (p=0.001). Conclusion. Neonatal jaundice is common in sick newborns. The infectious etiology must be systematically sought. Appropriate management helps reduce the occurrence of neurosensory after effects.

Mucormycosis in a Typhoid Treated Patient: A Case Report with Review of Literature

Introduction: Mucormycosis is an opportunistic fungal infection which is a rapidly progressing disease, and often fatal. Various predisposing factors including uncontrolled diabetes mellitus, immunosuppression, and prolonged use of steroids influence the disease pathology. Case Presentation: In this article, we present a case of mucormycosis of the palate in a patient treated with prolonged dose of steroids for typhoid fever which led to the appearance of exposed maxillary bone, and subsequent histopathological examination showed mucor hyphae. The treatment included antifungal therapy of Amphoterecine B. Management: Treatment of typhoid fever with corticosteroids, leading to immunosuppression, may result in patients harbouring opportunistic infections. An insight into the changes of oral cavity caused by corticosteroids is necessary for better diagnosis of the disease and improved patient care. In addition, early diagnosis is critical in the treatment of patients with mucormycosis

The Role of Oxidative Stress and Inflammation in Prediabetes: A Review

@#Prediabetes is a condition in which blood glucose level is above the normal but below the diagnostic value of diabetes mellitus. Hyperglycaemia can upregulate markers of chronic inflammation and contribute to the overproduction of reactive oxygen species (ROS), which ultimately causes increased oxidative stress. This leads to beta-cell dysfunction and insulin resistance, which are involved in the pathogenesis of prediabetes status. Proper treatment of hyperglycaemia, inhibition of ROS overproduction, and suppression of inflammation are crucial for delaying the onset of diabetes. Therefore, it is essential to determine and understand the mechanisms involved in prediabetes. This review discusses the relationship between oxidative stress and prediabetes, along with the inflammation’s role in prediabetes. Additionally, the effects of some biomarkers of oxidative stress in prediabetes, inflammatory markers, and their influence on chronic inflammation are also briefly reviewed. Finally, the role of antioxidant and anti-inflammatory markers are discussed.

Effect of Nyctanthes arbor-tristis on cardiovascular parameters and metabolic syndrome in fructose-induced hypertensive rats

Objectives: We investigated the effects of methanolic extract of Nyctanthes arbor-tristis (MNAT) 100, 200 and 400 mg/kg/day post-operative for 6 weeks on ECG, basal mean arterial blood pressure (MABP), heart rate, respiratory rate, vascular reactivity, antioxidant activities of enzyme superoxide dismutase (SOD) and catalase (CAT), levels of thiobarbituric acid reactive substances (TBARS), serum levels of leptin, adiponectin, glucose, triglycerides, cholesterol, uric acid, insulin, sodium and potassium in fructose-fed rats. Materials and Methods: A high-fructose-diet (fructose 10%, w/v) ad libitum for 6 weeks was used to induce hypertension in male Wistar rats (150–200 g). Sixty albino Wistar rats were randomly divided into a group of six, each group containing 10 animals. Group I was considered as normal control which received chow pellets and normal drinking water ad libitum for 6 weeks. Group II received fructose (10%) solution instead of normal drinking water for 6 weeks. Group III received fructose (10%) solution instead of drinking water ad libitum and MNAT at a dose of 100 mg/kg post-operative for 6 weeks. Group IV received fructose (10%) solution instead of drinking water ad libitum and MNAT at a dose of 200 mg/kg post-operative for 6 weeks. Group V received fructose (10%) solution instead of drinking water ad libitum and MNAT at a dose of 400 mg/kg post-operative for 6 weeks. Group VI received fructose (10%) solution instead of drinking water ad libitum and enalapril at a dose of 10 mg/kg post-operative for 6 weeks. Physiological parameters, ECG, heart rate, respiratory rate and blood pressure vascular reactivity to various drugs were measured and recorded by the invasive method. The antioxidant activities of enzyme SOD and CAT, levels of TBARS, along with serum levels of leptin, adiponectin, glucose, triglycerides, cholesterol, uric acid, insulin, sodium and potassium were measured. Cumulative concentrationresponse curve (CCRC) of Ang II and acetylcholine (Ach) was recorded. Results: MNAT treatment decreased MABP and altered vascular reactivity to various catecholamines. The activities of SOD and CAT enzymes exhibited a considerable increase and the levels of TBARS in the liver were reduced by MNAT treatment. MNAT has shown decrease in the plasma level of triglycerides, cholesterol, insulin and sodium while increase in plasma adiponectin and potassium levels. The CCRC of Ang II was shifted towards the right by MNAT treatment using an isolated strip of rat ascending colon. MNAT treatment increased the contractile characteristics of the rat ascending colon in the CCRC of ACh as compared to the fructose-treated group. MNAT treatment reduced fructose-induced tissue damage due to the consequence of metabolic syndrome (MetS). MNAT is rich in flavonoids and, therefore, has powerful antioxidant properties. The findings show that by battling oxidative stress caused by fructose (10%) and reducing Ang II activity, MNAT may be able to prevent the development of high blood pressure caused by fructose. Conclusion: MNAT has antihypertensive action and reverses MetS in the fructose-induced hypertensive rat model.

Cyperus esculentus L. protects testis and sperm morphology of hyperglycaemic rats / Cyperus esculentus L. protege la morfología de los testículos y los espermatozoides de ratas hiperglicémicas

Cyperus esculentus L. (tiger nut) is a tuberous plant that promotes and protects reproductive functions, which are usually hampered in diabetics. The present study investigated the effect of Cyperus esculentus tuber extract (CETE) on testicular histology and sperm viability of alloxan-induced hyperglycaemic Wistar rats. Twenty-five adult male Wistar rats weighing 150-200g and grouped into five (n=5): Group 1, the control, administered tap water (20mL/kg), while groups 2-5 were administered a single intraperitoneal dose (120mg/kg b.w.) of alloxan, and each further received orally tap water (20mL/kg), CETE (100mg/kg), CETE (500 mg/kg) and metformin (500 mg/kg), respectively for 21 days. The animals were sacrificed, their sperm collected for analysis, while the testes were harvested, and processed for histology. Results showed significantly increased (p<0.05) blood glucose and testosterone, and significantly decreased (p<0.05) sperm pH, motility, count, morphology and density, as well as disruptions and hypertrophy of the spermatogenic and Sertoli cells of the hyperglycaemic group. There were significant (p<0.05) blood glucose decline, while the sperm parameters and testicular weight improved with normal testicular histology in the 100 mg/kg CETE, 500 mg/kg CETE, and metformin-treated groups compared to the control and hyperglycaemic group. Treatment with CETE showed blood glucose amelioration and improved sperm quality, as well as testicular damage attenuation.

Cyperus esculentus L. es una planta tuberosa que promueve y protege las funciones reproductivas, que generalmente se ven afectadas en los diabéticos. El presente estudio investigó el efecto del extracto de tubérculo de Cyperus esculentus (CETE) sobre la histología testicular y la viabilidad de los espermatozoides de ratas wistar con hiperglicemia inducida por alloxan. Veinticinco ratas Wistar macho adultas que pesaban 150-200 g y se agruparon en cinco (n = 5): el grupo 1, el control, administró agua del grifo (20ml / kg), mientras que los grupos 2-5 se les administró una dosis intraperitoneal única (120 mg / kg p.v.) de alloxan, y agua del grifo por vía oral (20ml/kg), CETE (100 mg/kg), CETE (500 mg/kg) y metformina (500 mg/kg), respectivamente durante 21 días. Los animales fueron sacrificados, su esperma recolectada para su análisis, mientras que los testículos fueron retirados y procesados para histología. Los resultados mostraron un aumento significativo (p<0,05) de la glucosa en sangre y la testosterona, y una disminución significativa (p<0,05) del pH, la motilidad, el recuento, la morfología y la densidad de los espermatozoides, así como interrupciones e hipertrofia de las células espermatogénicas y sertoli del grupo hiperglucémico. Hubo una disminución significativa (p<0,05) de la glucosa en sangre, mientras que los parámetros espermáticos y el peso testicular mejoraron con la histología testicular normal en los grupos de 100 mg / kg de CETE, 500 mg / kg de CETE y tratados con metformina en comparación con el grupo de control e hiperglucémico. El tratamiento con CETE mostró una mejora de la glucosa en sangre y una mejora de la calidad de los espermatozoides, así como atenuación del daño testicular.

A Prospective Observation Study to know the Prevalence of Thyroid Disorders in Patients with Type 2 Diabetes Mellitus

Background: Diabetes mellitus and thyroid diseases are the two common endocrinopathies seen in the adult population. Insulin and thyroid hormones are intimately involved in cellular metabolism. Excess or deficit of either of these hormones could result in the functional derangement of the other. Methods: This study was conducted on the Type 2 diabetic patients to know the prevalence of thyroid abnormalities. The duration of study over a period of one year. Results: T he result of this study revealed that thyroid profile in patients with type 2 diabetes mellitus 20% of patients with type 2 diabetes mellitus had abnormal thyroid profile. Conclusion: This study concludes that Routine screening for thyroid dysfunction in type 2 diabetes mellitus patients may be justified especially in females

Association of hyperglycaemia at-admission & diabetes mellitus with 28 day mortality in patients admitted with moderate-severe SARS-CoV-2 infection: A retrospective study

Background & objectives: The association between hyperglycaemia at admission, diabetes mellitus (DM) status and mortality in hospitalized SARS-CoV-2 infected patients is not clear. The purpose of this study was to determine the relationship between DM, at-admission hyperglycaemia and 28 day mortality in patients admitted with moderate-severe SARS-CoV-2 infection requiring intensive care. Methods: All consecutive moderate-to-severe patients with SARS-CoV-2 infection admitted to the intensive care units (ICUs) over six months were enrolled in this single-centre, retrospective study. The predicators for 28 day mortality were analysed from the independent variables including DM status and hyperglycaemia at-admission. Results: Four hundred and fifty two patients with SARS-CoV-2 were admitted to the ICU, with a mean age of 58.5±13.4 yr, 78.5 per cent being male, HbA1c of 7.2 per cent (6.3-8.8) and 63.7 per cent having DM. Overall, 28 day mortality was 48.9 per cent. In univariate analysis, mortality in diabetes patients was comparable with non-diabetes (47.9 vs. 50.6%, P=0.58), while it was significantly higher in hyperglycaemic group (60.4 vs. 35.8%, P<0.001). In multivariate Cox regression analysis, after adjusting for age, sex and comorbidities, hyperglycaemia at-admission was an independent risk factor of mortality [hazard ratio (HR) 1.45, 95% confidence interval (CI) (1.06-1.99), P<0.05]. Interpretation & conclusions: This study showed that the presence of hyperglycaemia at-admission in critically ill SARS-CoV-2 patients was an independent predictor of 28 day mortality. However, the findings may be susceptible to unmeasured confounding, and more research from prospective studies is required.

Association of serum lactate levels among patients with Type 2 diabetes mellitus of a tertiary care hospital, Uttar Pradesh

Background: Serum lactate levels are a direct quantification of gap in between energy-expenditure and oxidative capacity. Variation in the lactate levels among the resting individuals could be exigent, requiring attention often and raised lactate levels can be observed among the individuals with mitochondrial impairments in the oxidative phosphorylation pathways. Aim and Objectives: Aim and objectives of the study was to evaluate the association of serum lactate levels among Type 2 diabetes mellitus patients. Materials and Methods: This present observational cross-sectional study involved 300 diabetic patients who presented to the tertiary care hospital of Uttar Pradesh. The patients were stratified according to their random blood sugar, Glycated hemoglobin and lactate levels. Student t-test was used for assessing the significance, a probability of <0.05 is considered significant. Results: A total of 300 patients have been included in this study, of which 150 are males and 150 are females, the median age was 48 years. The highest age of patient included was 84 years, and the lowest of patient included in the study was 34 years. The patients with high lactate levels are found to have poor glycaemic control, which may further proceed to worst outcome of the disease. Conclusion: Serum lactate levels could be the potential predictor and reliable indicator of poor glycemic control/status of diabetic patients.

Effects of Different Dietary Approaches on Type 2 Diabetes Mellitus: A Review

Type 2 diabetes (T2D) is a metabolic disorder that occurs due to various etiologies including lifestyle. One of the significant contributors in causing Type-2 diabetes is diet. For high-risk individuals, diet is way more significant in causing Type-2 diabetes. This present study discussed several published papers comprising of various food categories and their effects on type-2 diabetes or its role in causing the disorder. The study revealed the advantages of functional foods and their role in the prevention of T2D. The study has elaborated the outcome of T2D due to consumption of fats, carbohydrates, protein, dietary fibres, red meat, fried food, common beverages like carbonated drinks, and a few other foods. The authors also reviewed T2D from the aspect of religion, region, specific lifestyles, smoking and drinking habit and body weight. Overall, the study has successfully drawn a map of the spectrum of dietary role in T2D including its prevention, increasing the risk of T2D, its causation and affecting the outcome of the disorder.

Soy flour snack bars lower glycaemic response in type 2 diabetes mellitus subjects: A randomised cross-over design

@#Introduction: Low glycaemic snacks may help to improve blood glucose control. However, data on the effect of soybean snack bars on postprandial glucose levels of the diabetic population is scarce. Therefore, the current study aimed to examine the effect of consuming soy flour snack bars on glycaemic response (GR) over a 180-minute period in individuals with diabetes by estimating postprandial glucose levels variation and total area under the curve (AUC). Methods: Nine subjects (age: 54.6±4.0 years; BMI: 25.0±2.5 kg/m2) with type 2 diabetes mellitus (T2DM) diagnoses without complication enrolled in this randomised, open-label, cross-over trial. On three separate sessions, they consumed glucose standard solution, soy flour snack bar (SF), and wheat flour snack bar (WF) containing 25 g of available carbohydrate, respectively. Finger prick capillary method was executed to measure blood glucose levels at 30, 60, 90, 120, 150, 180 minutes after test product ingestion. Results: Overall, significantly lower postprandial glucose levels were observed at 30, 60, 90, and 120 minutes (122.3±17.6, 136.3±24.9, 125.7±25.3, and 107.2±24.1 mg/dL; p<0.001) in those who consumed SF snack bars than WF snack bars (147.9±41.3, 168.0±43.6, 152.6±30.0, and 140.6±33.4 mg/dL). The AUC level after the ingestion of SF snack bar was 2044.8±503.1 mg.min/dL, >20% lower compared to ingestion of WF snack bar (4735.0±666.8 mg.min/dL), p<0.001. These glycaemic control benefits can be explained due to the high fibre and protein content linked to the physicochemical properties of SF. Conclusion: With high nutritional properties, SF snack bar has a low GR and might help control blood glucose in T2DM subjects.

Angiotensin-converting enzyme inhibitors from plants: A review of their diversity, modes of action, prospects, and concerns in the management of diabetes-centric complications / 中西医结合学报

Angiotensin-converting enzyme (ACE) inhibitors are antihypertensive medications often used in the treatment of diabetes-related complications. Synthetic ACE inhibitors are known to cause serious side effects like hypotension, renal insufficiency, and hyperkalaemia. Therefore, there has been an intensifying search for natural ACE inhibitors. Many plants or plant-based extracts are known to possess ACE-inhibitory activity. In this review, articles focusing on the natural ACE inhibitors extracted from plants were retrieved from databases like Google Scholar, PubMed, Scopus, and Web of Science. We have found more than 50 plant species with ACE-inhibitory activity. Among them, Angelica keiskei, Momordica charantia, Muntingia calabura, Prunus domestica, and Peperomia pellucida were the most potent, showing comparatively lower half-maximal inhibitory concentration values. Among the bioactive metabolites, peptides (e.g., Tyr-Glu-Pro, Met-Arg-Trp, and Gln-Phe-Tyr-Ala-Val), phenolics (e.g., cyanidin-3-O-sambubioside and delphinidin-3-O-sambubioside), flavonoids ([-]-epicatechin, astilbin, and eupatorin), terpenoids (ursolic acid and oleanolic acid) and alkaloids (berberine and harmaline) isolated from several plant and fungus species were found to possess significant ACE-inhibitory activity. These were also known to possess promising antioxidant, antidiabetic, antihyperlipidemic and anti-inflammatory activities. Considering the minimal side effects and lower toxicity of herbal compounds, development of antihypertensive drugs from these plant extracts or phytocompounds for the treatment of diabetes-associated complications is an important endeavour. This review, therefore, focuses on the ACE inhibitors extracted from different plant sources, their possible mechanisms of action, present status, and any safety concerns.

Diabetic Hyperglycaemia Protects Smooth Muscle Arterial Cells but Not Macrophages and Endothelial Cells from the Cytotoxic Effects of 7-Ketocholesterol: An In Vitro Study

ABSTRACT Plasmatic hyperglycaemia is responsible for positive and negative stimuli. Among responsive cells, smooth muscle cells respond actively, increasing their growth. Diabetes hyperglycaemia and lipidic disorders are frequently associated, resulting in the highest probability of cardiovascular disease, especially atherosclerosis. Endothelial dysfunction and initiation of inflammatory process mediated by macrophages cause the formation of atherosclerotic plaques, rich in oxidized cholesterol, mostly 7-ketocholesterol. In this study, we evaluated the effect of 7-ketocholesterol in rabbit aorta endothelial cells, murine macrophages (J774) and smooth muscle cells (A7R5) maintained in normoglycemic and hyperglycaemic cultures. The 7-ketocholesterol-induced-cell death was observed in the normoglycemic medium three times more than the hyperglycaemic medium in all cells. High glucose medium had a protective effect on arterial smooth muscle cell death.

Assessment of Capillary Blood Glucose Levels as a Prognostic Indicator in Acute Ischemic Stroke

Acute Stroke is an abrupt onset of a neurological deficit attributable to a focal vascular cause. The diagnosis of stroke is based on clinical examination, and brain imaging. Cerebral ischemia is caused by a reduction in blood flow lasting longer than several seconds with manifestation of neurologic symptoms due to infarction or death of brain tissue because neurons utilise only glucose and lack glycogen stores, so energy failure is rapid. Neurologic signs and symptoms lasting for >24 hours or brain infarction demonstrated on brain imaging is known as Acute Stroke.[1] Abnormal blood glucose at the time of acute stroke is associated with poor clinical outcomes, longer in-hospital stay and mortality. We wanted to evaluate the influence of abnormal capillary glucose levels on functional outcomes by grading the Acute Ischemic Stroke patient on modified Rankin scale.METHODSThis cross sectional study was conducted for a period of 6 months in the medicine and neurology wards, ICU in a tertiary care rural hospital in central India and included a total of 35 patients after obtaining institutional ethical committee clearance. The capillary blood glucose samples were taken using a standard glucometer. Capillary blood glucose was determined at the time of admission, each day within the first 72 hrs. Two values of blood glucose were considered; admission value and max. value within the 1st 72 hrs. Functional prognosis was assessed on Modified Rankin scale at the time of discharge or 1 month. The categorical variables were assessed using chi-square test and odd’s ratio and p-value were calculated and assessed. The association of altered capillary glucose levels with functional outcomes on modified Rankin scale were analysed. The data were entered in excel spreadsheet and all the statistical analysis was conducted using STATA version 14.2 software.RESULTSA significant correlation between the higher admission capillary blood glucose levels with the outcomes on modified Rankin scale after 1 month or after discharge was found (p-0.0032). Hyperglycaemia at the time of admission with poor prognosis on mRS (p-value 0.007) was also found.CONCLUSIONSThe results of the study reveal that the patients with admission hyperglycaemia have poor prognosis as compared to the normoglycemic patients. There is a significantly positive correlation between the altered capillary blood glucose levels at the onset of stroke and functional prognosis of the patients with stroke after treatment.

A prospective study to assess glycemic status as a possible prognostic marker in non diabetic acute organophosphate poisoning patients

Background: Organophosphates (OP) are a diverse group of insecticides used for pest control. Due to easy availability of these compounds over the counter, organophosphate poisoning continues to be a major cause of deliberate self-harm. Although choline esterase inhibition plays a key role in OP poisoning, other metabolic factors like dysglycemia contribute to the severity of poisoning. The present study attempts to assess glycaemic variability as a probable prognostic factor in acute OP poisoning. Aim of the study was to correlate the blood glucose levels with the severity and treatment outcome of acute organophosphate poisoning.Methods: 100 patients of acute organophosphate poisoning admitted in the hospitals affiliated to Bangalore Medical College and Research Institute during the study period from August 2018 to July 2019, were enrolled into the study as per the inclusion criteria and graded into mild, moderate & severe, based on Peradeniya organophosphorus poisoning (POP) scale. Random blood sugar (RBS) was estimated at the time of admission and patients were followed up till recovery/death.Results: The patients in this study were categorized into hypoglycemics (10%), euglycemics (75%) and hyperglycemic (15%). 16% of euglycemics, 30% of hypoglycemics and 60% of hyperglycemics had severe grade of poisoning. The ventilator requirements in hypoglycaemics, euglycemics and hyperglycemics were 40%,48% and 80% respectively. The outcome in terms of mortality was 8% in euglycemics group and 20% in hyperglycemics group. Hence hyperglycemia was found to be a poor prognostic marker in acute organophosphate poisoning.Conclusions: RBS at admission in acute organophosphate poisoning patients is a simple, inexpensive tool that may help to predict the clinical outcome. Early identification of the poor prognostic indicators may help in timely intervention, to reduce morbidity and mortality, especially in a resource limited country like India.

Clinical effects of a blood glycaemic control optimization programme in patients with stress hyperglycaemia after thoracic surgery / 中国医师进修杂志

Objective To investigate the clinical effects of a blood glycaemic control optimization programme in patients with stress hyperglycaemia after thoracic surgery.Methods One hundred and sixty patients with postoperative stress hyperglycaemia in the First Affiliated Hospital of Nanjing Medical University form July 2016 to July 2018 were randomly divided into control group and experimental group,with 80 patients in each group.Participants in the control group underwent conventional intensive insulin therapy,while participants in the experimental group underwent blood glycaemic control optimization programme.The blood glycaemic control validity index,glycemic variability index and prognostic index were compared between two groups.Results The total-dose insulin,time to reach the target range,high glycaemic index (HGI),72 h average blood glycaemic (GluAve),standard deviation of blood glycaemic (GluSD),mean amplitude of glycaemic excursions (MAGE),glycaemic instability index (GLI),variable coefficient of glycaemic (GluCv) were (69.34 ± 13.97) U,(4.14 ± 1.27) h,0.94 ± 0.30,(8.20 ± 1.06) mmol/L,(1.95 ± 0.35) mmol/L,(0.74 ± 0.27) mmol/L,35.10 ± 13.03,(22.49 ± 6.92) ％ in the experimental group.However,those index were (78.99 ± 11.46) U,(5.80 ± 2.05) h,2.27 ± 0.62,(8.30 ± 1.18) mmol/L,(2.32 ± 0.52) mmol/L,(1.15 ± 0.59) mmol/L,42.06 ± 17.09,(26.54 ± 5.14) ％ in the control group.The total-dose insulin,time to reach the target range,high glycaemic index,GluSD,MAGE,GLI,GluCv were significantly lower in the experimental group than those in control group (P ＜ 0.05).In addition,the incidence of hypoglycaemia,50％ glucose rescue and nosocomial infection were significantly decreased in the experimental group compared to the control group (P＜0.05).Conclusions Blood glycaemic control optimization programme can reduce the incidence of hypoglycemia and infection and achieve blood sugar control goal faster,safer and more effectively in patients with stress hyperglycaemia after thoracic surgery.

Clinical effects of a blood glycaemic control optimization programme in patients with stress hyperglycaemia after thoracic surgery / 中国医师进修杂志

Objective@#To investigate the clinical effects of a blood glycaemic control optimization programme in patients with stress hyperglycaemia after thoracic surgery.@*Methods@#One hundred and sixty patients with postoperative stress hyperglycaemia in the First Affiliated Hospital of Nanjing Medical University form July 2016 to July 2018 were randomly divided into control group and experimental group, with 80 patients in each group. Participants in the control group underwent conventional intensive insulin therapy, while participants in the experimental group underwent blood glycaemic control optimization programme. The blood glycaemic control validity index, glycemic variability index and prognostic index were compared between two groups.@*Results@#The total-dose insulin, time to reach the target range, high glycaemic index (HGI), 72 h average blood glycaemic (GluAve), standard deviation of blood glycaemic (GluSD), mean amplitude of glycaemic excursions (MAGE), glycaemic instability index (GLI), variable coefficient of glycaemic (GluCV) were (69.34 ± 13.97) U, (4.14 ± 1.27) h, 0.94 ± 0.30, (8.20 ± 1.06) mmol/L, (1.95 ± 0.35) mmol/L, (0.74 ± 0.27) mmol/L, 35.10 ± 13.03, (22.49 ± 6.92)% in the experimental group. However, those index were (78.99 ± 11.46) U, (5.80 ± 2.05) h, 2.27 ± 0.62, (8.30 ± 1.18) mmol/L, (2.32 ± 0.52) mmol/L, (1.15 ± 0.59) mmol/L, 42.06 ± 17.09, (26.54 ± 5.14)% in the control group. The total-dose insulin, time to reach the target range, high glycaemic index, GluSD, MAGE, GLI, GluCV were significantly lower in the experimental group than those in control group (P<0.05). In addition, the incidence of hypoglycaemia, 50% glucose rescue and nosocomial infection were significantly decreased in the experimental group compared to the control group (P<0.05).@*Conclusions@#Blood glycaemic control optimization programme can reduce the incidence of hypoglycemia and infection and achieve blood sugar control goal faster, safer and more effectively in patients with stress hyperglycaemia after thoracic surgery.

Determination of individual type 2 diabetes risk profile in the North East Indian population & its association with anthropometric parameters

Background & objectives: Diabetes genomics research has illuminated single nucleotide polymorphism (SNP) in several genes including, fat mass and obesity associated (FTO) (rs9939609 and rs9926289), potassium voltage-gated channel subfamily J member 11 (rs5219), SLC30A 8 (rs13266634) and peroxisome proliferator-activated receptor gamma 2 (rs1805192). The present study was conducted to investigate the involvement of these polymorphisms in conferring susceptibility to type 2 diabetes (T2D) in the North East Indian population, and also to establish their association with anthropometric parameters. Methods: DNA was extracted from blood samples of 155 patients with T2D and 100 controls. Genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism and DNA sequencing. To confirm the association between the inheritance of SNP and T2D development, logistic regression analysis was performed. Results: For the rs9939609 variant (FTO), the dominant model AA/(AT+TT) revealed significant association with T2D [odds ratio (OR)=2.03, P=0.021], but was non-significant post correction for multiple testing (P=0.002). For the rs13266634 variant (SLC30A 8), there was considerable but non-significant difference in the distribution pattern of genotypic polymorphisms between the patients and the controls (P=0.004). Significant association was observed in case of the recessive model (CC+CT)/TT (OR=4.56 P=0.001), after adjusting for age, gender and body mass index. In addition, a significant association (P=0.001) of low-density lipoprotein (mg/dl) could be established with the FTO (rs9926289) polymorphism assuming dominant model. Interpretation & conclusions: The current study demonstrated a modest but significant effect of SLC30A8 (rs13266634) polymorphisms on T2D predisposition. Considering the burgeoning prevalence of T2D in the Indian population, the contribution of these genetic variants studied, to the ever-increasing number of T2D cases, appears to be relatively low. This study may serve as a foundation for performing future genome-wide association studies (GWAS) involving larger populations.

Estudio descriptivo de las cetoacidosis atendidas en urgencias de un hospital de la Comunidad de Madrid mediante la herramienta Savana Manager / Diabetic ketoacidosis in a emergency department of a hospital in Madrid (Spain) using the Savana Manager tool

Objetivo: El objetivo del estudio fue describir las características y evolución de los pacientes que acudieron a las urgencias de nuestro hospital y fueron diagnosticados de cetoacidosis diabética (CAD) utilizando la novedosa herramienta de Big Data Savana. Método: Estudio retrospectivo descriptivo de los pacientes atendidos en urgencias del Hospital Universitario Infanta Leonor durante los años 2011 al 2016 con diagnóstico de CAD. La búsqueda se realizó con Savana Manager. Resultados: Se diagnosticaron 95 episodios de CAD en 68 pacientes. Del total de episodios de CAD, 57 fueron en diabéticos tipo 1 (de ellos 4 LADA), 25 en diabéticos tipo 2, 2 en diabéticos postpancreatectomía y 12 fueron debuts diabéticos. Del total, 61 (64,2%) requirieron ingreso hospitalario, de ellos 23 (24,2%) ingresaron en UCI. La media de HbA1c fue de 10,6 ± 2,1%. Tres pacientes requirieron reingreso tras el alta. La mortalidad fue muy baja con el fallecimiento en 1 paciente diagnosticado simultáneamente de cáncer pulmonar. Los desencadenantes de la CAD fueron: 35 casos (36,8%) falta de adherencia al tratamiento, 31 (32,6%) infecciones, 12 (12,6%) debuts, 8 (8,4%) varias causas y 9 (9,5%) no se pudo determinar la causa. Se clasificaron como CAD de gravedad leve un 28%, un 38% como de gravedad moderada y 34% como graves. La duración del ingreso no se relacionó con la severidad de la cetoacidosis. Conclusiones: La CAD es una complicación grave que afecta tanto a diabéticos tipo 1 como a tipo 2 con elevado porcentaje de ingresos hospitalarios y en UCI, aunque con baja mortalidad en nuestro medio. La duración de los ingresos no se relaciona con la severidad del cuadro.

Objective: the study was designed to describe the clinical features and evolution of the diabetic patients attended in our hospital emergency department with diabetic ketoacidosis (DKA) using the novel Big Data tool Savana. Method: Retrospective descriptive study of the patients attended in the emergency room of the Infanta Leonor University Hospital during the years 2011 to 2016 with diagnosis of CAD. The search was made with Savana. Results: 95 episodes of DKA were diagnosed in 68 patients. Of the total episodes of CAD 57 were in type 1 diabetics (of which 4 were LADA), 25 in type 2 diabetics, 2 in diabetics postpancreatectomy and 12 were new onset of diabetes. Of the total, 61 (64.2%) required hospital admission, of which 23 (24.2%) were admitted to the intensive care unit (ICU). The mean HbA1c was 10.6 ± 2.1%. Three patients required readmission after discharge. Mortality was very low with death in 1 patient simultaneously diagnosed of lung cancer. The triggers of CAD were: 35 cases (36,8%) lack of adherence to treatment, 31 (32.6%) infections, 12 (12.6%) new onset, 8 (8,4%) various causes and 9 (9.5%) the cause could not be determined. They were classified as mild DKA 28%, 38% as moderate and 34% as severe. The duration of admission was not related to the severity of ketoacidosis. Conclusions: DKA is a serious complication that affects both, type 1 and type 2 diabetics patients, with a high percentage of hospital and ICU admissions, although with low mortality in our environment. The lenght of the stay in hospital is not related to the severity of the DKA.

Epidemiology of preoperative hyperglycaemia among patients undergoing surgery at a tertiary health care facility of Eastern India

Background: With about 425 million patients globally and 72.9 million patients in India, diabetes mellitus (DM) is one of the global health emergency of 21st century. Perioperative hyperglycaemia is reported in 20-40% of patients undergoing general surgery. A substantial body of literature demonstrates a clear association between perioperative hyperglycaemia and adverse clinical outcomes. This study aims to find out the frequency of preoperative hyperglycaemia and factors influencing it among patients undergoing surgery at a tertiary health care hospital of Eastern India.Methods: This Institution based, cross-sectional, observational study was conducted among study subjects who were operated at IQ City Medical College and Multispecialty Hospital, Durgapur, India during January-February 2019. Relevant medical records were reviewed to collect data regarding clinic-social data. Estimation of fasting plasma glucose (FPG) has been done as per World Health Organization (WHO) guidelines. Hyperglycaemia was defined and classified as per American Diabetes Association (ADA). Anthropometric measurements were taken as per standard WHO protocols.Results: A total 158 study subjects participated in study. The mean age and mean FPG of the study subjects was 42.63±12.95 years and 103.3±17.37 mg/dl respectively. As per the ADA criteria, 58.9% had normal FPG, 24.0% had impaired fasting glucose (IFG) and 17.1% had diabetes. Out of total 27 T2DM patients, 22 (13.9%) were known cases of T2DM and 5 (3.2%) were undiagnosed. The frequency of preoperative hyperglycaemia i.e. sums of IFG and diabetes was found to be 41.1%. Increasing age, male gender and overweight and obesity significantly influenced the occurrence of preoperative hyperglycaemia.Conclusions: The prevalence of preoperative hyperglycaemia among patients undergoing surgery is higher than the prevalence of hyperglycaemia among non surgical patients. Routine HbA1C should be done in all surgical patients to differentiate between chronic undiagnosed hyperglycaemia and stress hyperglycaemia.

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