Evaluation of liver function in acute complications of type 2 diabetes mellitus

Background: Diabetic ketoacidosis (DKA) and Hyperosmolar Hyperglycaemic state (HHS) are the acute complications of Type 2 Diabetes Mellitus (T2DM). The aim was to evaluate the role of liver function parameters in T2DM patients with DKA and HHS.Methods: This descriptive study included 50 subjects in each of the following four groups: non-T2DM, T2DM without acute complications, T2DM with DKA, T2DM with HHS. Data on demography, clinical and lab diagnosis, as well as liver function parameters were collected from May 2017 to October 2017. The baseline data and liver function parameters were compared across the study groups.Results: There was significant hyperglycemia and associated baseline electrolyte, Arterial Blood Gas (ABG) analysis changes in acute complications of T2DM. Besides GGT, the serum total and direct bilirubin levels were also higher in T2DM cases with DKA. Significant levels of hypoalbuminemia and hyperglobulinemia along with raised SGPT and ALP levels were seen in acute complications of T2DM, especially in HHS complicating T2DM.Conclusions: Decreased serum albumin levels, along with elevated liver enzymes-SGPT, ALP, and GGT characterized the acute complications of T2DM, with specific alterations of liver function parameters seen in DKA and HHS cases.

Acute diabetic complications and rhabdomyolysis / 中国糖尿病杂志

It is important to test creatine kinase in patients with acute diabetic complications in order to detect rhabdomyolysis,especially subclinical rhabdomyolysis.The prognosis of rhabdomyolysis can be improved when it is treated once diagnosed.However,endocrinologists sometimes neglect the diagnosis of rhabdomyolysis.Here,we reviewed the pathogenesis of rhabdomyolysis caused by acute diabetic complications,and also the clinical features,diagnosis,treatment and prognosis of rhabdomyolysis.

Decúbito prono en pacientes con síndrome de distrés respiratorio agudo / Prone position in patients with acute respiratory distress syndrome

RESUMEN El síndrome de distrés respiratorio agudo ocupa gran atención en la unidad de cuidados intensivos. A pesar del amplio conocimiento alcanzado sobre la fisiopatología de éste síndrome, el enfoque en la unidad de cuidados intensivos consiste, en gran parte, en un tratamiento de soporte vital y en evitar los efectos secundarios de las terapéuticas invasivas. Si bien, durante los últimos 20 años, se generaron grandes avances en ventilación mecánica con un impacto importante sobre la mortalidad, ésta continúa siendo elevada. Una característica de los pacientes con síndrome de distrés respiratorio agudo, sobre todo los más severos, es la presencia de hipoxemia refractaria debido a la existencia de shunt, pudiendo requerir tratamientos adicionales a la ventilación mecánica, entre ellos la ventilación mecánica en decúbito prono. Este método, recomendado para mejorar la oxigenación por primera vez en 1974, puede ser implementado fácilmente en cualquier unidad de cuidados intensivos con personal entrenado. El decúbito prono tiene un sustento bibliográfico sumamente robusto. Varios ensayos clínicos randomizados han demostrado el efecto del decúbito prono sobre la oxigenación en pacientes con síndrome de distrés respiratorio agudo medida a través de la relación PaO2/FiO2 e incluso su impacto en el aumento de la sobrevida de estos pacientes. Los integrantes del Comité de Kinesiología Intensivista de la Sociedad Argentina de Terapia Intensiva realizaron una revisión narrativa con el objetivo de exponer la evidencia disponible en relación a la implementación del decúbito prono, los cambios producidos en el sistema respiratorio por la aplicación de la maniobra y su impacto sobre la mortalidad. Por último, se sugerirán lineamientos para la toma de decisiones.

ABSTRACT Acute respiratory distress syndrome occupies a great deal of attention in intensive care units. Despite ample knowledge of the physiopathology of this syndrome, the focus in intensive care units consists mostly of life-supporting treatment and avoidance of the side effects of invasive treatments. Although great advances in mechanical ventilation have occurred in the past 20 years, with a significant impact on mortality, the incidence continues to be high. Patients with acute respiratory distress syndrome, especially the most severe cases, often present with refractory hypoxemia due to shunt, which can require additional treatments beyond mechanical ventilation, among which is mechanical ventilation in the prone position. This method, first recommended to improve oxygenation in 1974, can be easily implemented in any intensive care unit with trained personnel. Prone position has extremely robust bibliographic support. Various randomized clinical studies have demonstrated the effect of prone decubitus on the oxygenation of patients with acute respiratory distress syndrome measured in terms of the PaO2/FiO2 ratio, including its effects on increasing patient survival. The members of the Respiratory Therapists Committee of the Sociedad Argentina de Terapia Intensiva performed a narrative review with the objective of discovering the available evidence related to the implementation of prone position, changes produced in the respiratory system due to the application of this maneuver, and its impact on mortality. Finally, guidelines are suggested for decision-making.

Study on the risk factors of the occurrence of hepato renal syndrome for patients with acute on chronic hepatitis B liver failure / 中国医师杂志

Objective To investigate and analyze the risk factors of the occurrence of hepato renal syndrome (Hepatorenal syndrome,HRS) for patients with acute on chronic hepatitis B liver failure.Methods Sixty cases of patients with acute on chronic hepatitis B liver failure from January 2009 to December 2013 in our hospital were selected as the research objects.The single factor and multi-factor regression analyses were in patients with the basic clinical data,and the complications and the baseline clinical testing index of patients.The independent risk factors of the occurrence of HRS for patients with acute on chronic hepatitis B liver failure were screened.Results The cases of the occurrence of HRS for patients with acute on chronic hepatitis B liver failure was 17 among 60 cases with a incidence of 28.3 ％ ; The results of multivariable logistic regression analysis showed that serum albumin,serum sodium,liver function grade (Child-Pugh score),model for end-stage liver disease (MELD) index,primary bacterial peritonitis,upper gastrointestinal hemorrhage,ascites,and hepatic encephalopathy were the risk factors of the occurrence of HRS for patients with acute on chronic hepatitis B liver failure (P ＜ 0.05).Conclusions The occurrence of HRS for patients with acute on chronic hepatitis B liver failure is higher.The various sensitive indicators should be monitored dynanically,and the relevant prevention and treatment measures should be taken in time.It has a significantly scientific merit to improve the prognosis of patients.

Características clínico epidemiológicas de las complicaciones agudas de la diabetes en el servicio de urgencias del Hospital General de Atizapán / Clinical-epidemiological features of diabetes acute complications in the emergency ward at Atizapan General Hospital

Antecedentes: La epidemia de la diabetes mellitus es reconocida por la Organización Mundial de la Salud (OMS) como una creciente amenaza mundial. Se calcula que en el mundo existen más de 180 millones de personas con diabetes y es probable que esta cifra aumente a más del doble para 2030. En México la diabetes ocupa el primer lugar en número de defunciones por encima de otros padecimientos crónicos, enfermedades infectocontagiosas o accidentes. Las complicaciones agudas de diabetes representan casi el 30% de las hospitalizaciones en la sala de urgencias y de ellos hasta el 10% de la mortalidad en dicho servicio. Objetivo: Identificar las características clínicas y epidemiológicas de los pacientes ingresados por complicaciones agudas de la diabetes mellitus al servicio de urgencias del Hospital General de Atizapán, un suburbio de la ciudad de México. Materiales y métodos: Se realizó un estudio prospectivo, transversal, descriptivo y observacional. El universo estuvo conformado por 1417 pacientes diabéticos que ingresaron al servicio de urgencias del Hospital General de Atizapán del 1 de julio de 2010 al 31 de junio del 2011. Resultados: Cien pacientes (7% del total) ingresaron con diagnóstico de complicaciones agudas de diabetes. La más frecuente fue la hipoglucemia, que se observó en 48% de los pacientes. En menor cantidad, 33% con cetoacidosis diabética, 17% con estado hiperosmolar y 2% con acidosis láctica. Presentando principalmente manifestaciones neurológicas y digestivas, la mayoría de ellos provenientes de nivel socioeconómico bajo. Conclusiones: La identificación oportuna de las características clínicas de las complicaciones agudas de la diabetes nos permite brindar atención rápida y eficaz, con lo que se evita mayor gravedad. Los factores sociales, culturales o educacionales pueden favorecer su aparición por lo que la educación para la salud será esencial en materia de prevención.

Background: The epidemic of diabetes mellitus is recognized by the World Health Organization as an increasing world menace. It has been estimated that there are more than 180 million diabetic patients in the world. This amount can double by the year 2030. In Mexico, diabetes is the first cause of mortality over other problems such as chronic or infectious diseases or accidents. Acute complications of diabetes account for almost 30% of the hospitalized patients in the emergency room, from which the mortality rate reaches 10%. Objective: To identify clinical and epidemiological features of the patients presenting acute complications of diabetes mellitus admitted to the emergency ward at Atizapan General Hospital, a suburb of Mexico City. Material and Methods: Prospective, transversal, descriptive, observational study with 1417 diabetic patients admitted to the emergency ward at Atizapan General Hospital from July the first, 2010 until June 31, 2011. Results: A hundred patients (7%) were admitted with a diagnosis of acute complications of diabetes. Hypoglycemia (48%) was the most frequent complication followed by diabetic ketoacidosis (33%), hyperosmolar hyperglycemic state (17%) and finally lactic acidosis (2%). Neurological and digestive were the main symptoms and most patients came from low socioeconomic level. Conclusions: Timely identification of the clinical manifestations of acute complications of diabetes allows better and faster attention avoiding severe complications. Social, economic and cultural and/or educational factors may foster complications; therefore, health education is essential to prevent such conditions.

Tumores primarios del estroma gastrointestinal (GIST) localizados en yeyuno e íleon: reporte de un caso / Primary gastrointestinal stromal tumors (GIST) presenting in jejunum and ileum: a case report

Introduction. Multiple primary gastrointestinal stromal tumors (GIST) are an infrequent finding in patients without known risk factors for this condition, such as type I neurofibromatosis or Carney’s triad. Benign and malignant tumors might coexist in the same patient. We discuss one case of a benign jejunal GIST and a malignant ileal GIST coexisting in the same patient. Case Report. A 46-years-old male patient presented with a distal ileum perforated GIST and a small non-complicated proximal jejunum GIST diagnosed by computerized tomography. The patient was submitted to surgery and both tumors were managed without incidents. Discussion. Radiological and pathological characteristics of GIST are clearly established, this clinical case highlights those characteristics and illustrates an uncommon clinical scenario in patients without known risk factors for multiple GIST.

Introducción: Los tumores múltiples del estroma gastrointestinal (GIST), son un hallazgo infrecuente en pacientes sin factores de riesgo como neurofibromatosis tipo I o tríada de Carney. En estos casos pueden coexistir GIST benignos y malignos en un mismo paciente. El presente reporte discute el caso de un paciente que se presenta con un GIST maligno perforado de íleon distal y con un GIST benigno de yeyuno proximal. Reporte de caso: Paciente masculino de 46 años de edad que se presentó con un GIST de íleon distal perforado y un pequeño GIST no complicado de yeyuno proximal diagnosticados mediante tomografía abdominal. Ambos tumores se resolvieron quirúrgicamente sin incidentes. Discusión: Las características anatomopatológicas y radiológicas de los GIST se encuentran actualmente claramente establecidas, el presente caso remarca estas características e ilustra una situación clínica poco habitual en pacientes sin factores de riesgo para GIST múltiples.

Effects of Acute Hemorrhage Complicated with Cyanide Poisoning on the Hemodynamics in the Dog / 第三军医大学学报

The effects of acute hemorrhage complicated with cyanide posisoning on the hemodynamics were studied and compared with those simple cyanide poisoning in 24 dogs.Cyanide poisoning was induced by intravenous injection a lethal dose of NaCN of 2.5mg/kg,Acute hemorrhage was created by bleeding the dogs to an arterial pressure of 9.33 kPa(70mm Hg)within 2 minutes through a cannulated femoral artery.HR,CO,MAP,LVP,LVP (?)dp/bt max,and ECG were recorded.It was found that the excitatory response of cardiovascular functions was observed within 1 minute after cyanide poisoning,then a significant failure of the cardiavascular functions resulted in the rapid death of the animal 7~10 minutes after cyanide administration.In case when cyanide poisoning was complicated with acute hemorrhage,no excitatory response of the cardiovascular functions could be observed.An early cardiovascular collapse occurred which was characterized by a rapid fall of CO,MAP,LVP,LVP(?)dp/dt max as well as arrhythmia.All the dogs in this group died of acute failure of cardiovascular functions 4- 6 minutes after cyanide poisoning.The results of this study suggest that the failure of the cardiovascular functions is the main cause of death in case of acute hemorrhage complicated with cyanide poisoning.