Renal biopsy in diabetic patients: clinical indicators and pathological findings / Biopsia renal en pacientes diabéticos: indicadores clínicos y hallazgos patológicos

ABSTRACT Background: In addition to diabetic nephropathies (DNP), prevalence of nondiabetic nephropathies (NDNP) is also known to be frequent in patients diagnosed with type 2 Diabetes mellitus (DM). Early diagnosis of these conditions is important for the treatment and prognosis of these patients. Aim: This study aimed to investigate the relationships between clinical and laboratory findings of type 2 diabetic patients' renal biopsies. Material and Methods: We retrospectively reviewed the medical records of 140 patients who had diagnosis of type 2 DM and underwent renal biopsy from July 2020- August 2022 at nephrology clinics of Hospital Umraniye. Renal biopsy results, presence of hypertension, diabetic retinopathy, hematuria, proteinuria; duration of the disease, biopsy indications, glycated hemoglobin (HbA1c), serum creatinine, blood urea nitrogen, albumin, and proteinuria levels in 24h urine were measured. The statistical significance level was determined as p<0,05. Results: NDNP were detected in 43,7% of the patients. Among these the most common diagnosis was interstitial nephritis (20%). The most common biopsy indication was found to be nephrotic range proteinuria (30,7%). The difference between the DNP and NDNP patients' renal biopsy indications was statistically significant (p<0,001). DNP patients had a higher retinopathy incidence (60%,11%, p<0,001). A statistically significant difference was detected between the disease duration of DNP and NDNP groups (11,23 +5,74 years, p:0,002). According to multivariate regression analysis DR and HbA1c value, more than 7% have 4, 482 and 4,591-fold increased the risk of DNP incidence (p=0,021, p:0,024). Conclusion: Early diagnosis of DNP and NDNP of diabetic patients by performing renal biopsies affects the treatment and prognosis of the patients. Therefore, when evaluating diabetic patients, its necessary not to overlook the findings suggestive of NDNP.

RESUMEN Antecedentes: Además de las nefropatías diabéticas (DNP), también se conoce la prevalencia frecuente de nefropatías no diabéticas (NDNP) en pacientes diagnosticados con Diabetes mellitus tipo 2 (DM). El diagnóstico precoz de estas condiciones es importante para el tratamiento y pronóstico de estos pacientes. Objetivo: Este estudio tuvo como objetivo investigar las relaciones entre los hallazgos clínicos y de laboratorio de las biopsias renales de pacientes diabéticos tipo 2. Material y Métodos: Revisamos retrospectivamente las historias clínicas de 140 pacientes que tenían diagnóstico de DM tipo 2, desde julio de 2020 hasta agosto de 2022, y se les realizó biopsia renal en las clínicas de nefrología del Hospital Umraniye. Se revisaron los resultados de biopsia renal, presencia de hipertensión arterial, retinopatía diabética, hematuria y proteinuria así como también la duración de la enfermedad, las indicaciones de la biopsia, la hemoglobina glucosilada (HbA1c), la creatinina sérica, el nitrógeno ureico en sangre, la albúmina y los niveles de proteinuria en orina de 24 h. El nivel de significación estadística se determinó como p<0,05. Resultados: se detectaron NDNP en el 43,7% de los pacientes. Entre estos, el diagnóstico más común fue la nefritis intersticial (20%). La indicación de biopsia más frecuente resultó ser la proteinuria en rango nefrótico (30,7%). La diferencia entre las indicaciones de biopsia renal de los pacientes DNP y NDNP fue estadísticamente significativa (p<0,001). Los pacientes con DNP tuvieron una mayor incidencia de retinopatía (60%, 11%, p<0,001). Se detectó una diferencia estadísticamente significativa entre la duración de la enfermedad de los grupos DNP y NDNP (11,23 +5,74 años, p:0,002). De acuerdo con el análisis de regresión multivariado, la presencia de DR y el valor de HbA1c en más del 7% tienen 4,482 y 4,591 veces mayor riesgo de incidencia de DNP (p = 0,021, p: 0,024). Conclusión: El diagnóstico precoz de DNP y NDNP de pacientes diabéticos mediante la realización de biopsias renales afecta el tratamiento y pronóstico de los pacientes. Por lo tanto, al evaluar pacientes diabéticos, es necesario no pasar por alto los hallazgos sugestivos de NDNP.

Analysis of blood glucose fluctuations and related influencing factors in non-diabetic patients with type A aortic dissection after surgery / 中华内分泌外科杂志

Objective:To investigate the influencing factors of blood glucose fluctuation after surgery for type A aortic dissection in non-diabetic patients.Methods:A total of 109 patients with non-diabetic type A aortic dissection who underwent surgical treatment in Ningbo Medical Center Li Huili Hospital from Dec. 2016 to Mar. 2022 were selected as the research subjects. Logistic regression analysis was used to explore the influencing factors of blood glucose fluctuation in non-diabetic patients with type A aortic dissection surgery, and a nomogram model of blood glucose fluctuation in non-diabetic patients with type A aortic dissection surgery was constructed.Results:Logistic regression analysis showed that BMI≥24 kg/m 2, poor sleep quality, depression, cardiopulmonary bypass time>5 h and intraoperative bleeding were the risk factors for postoperative blood glucose fluctuation in non-diabetic type A aortic dissection patients ( P<0.05). The C-index of the nomogram model was 0.746 (95% CI: 0.711-0.781) ; the calibration curve was in good agreement with the ideal curve; the AUC of the nomogram model was 0.804. Conclusion:BMI≥24 kg/m 2, poor sleep quality, depression, cardiopulmonary bypass time>5 h and intraoperative bleeding are risk factors for postoperative blood glucose fluctuation in non-diabetic type A aortic dissection patients.

Analysis of clinical and pathological characteristics in patients with type 2 diabetes mellitus complicated with renal damage / 中华肾脏病杂志

It was a retrospective study. The patients with type 2 diabetes mellitus (T2DM) who underwent renal biopsy in the Department of Nephrology, the First Affiliated Hospital of Xi'an Jiaotong University from 2015 to 2021 were enrolled to analyze the pathological and clinical manifestations of kidney. There were 483 patients enrolled, including 136 patients who had no history of diabetes mellitus, newly diagnosed as T2DM according to an oral glucose tolerance test. The age was (52.80±13.13) years old. There were 337 males (69.77%). Based on the renal biopsy, the patients were classified as diabetic kidney disease (DKD, 22.15%, 107/483), DKD+non-diabetic kidney disease (NDKD)(6.63%, 32/483), and NDKD (71.22%, 344/483). Membranous nephropathy was the most common pathology in patients with NDKD (40.41%, 139/344) and DKD+NDKD (34.38%, 11/32). In the 136 newly diagnosed T2DM patients, there were 3 patients (2.21%) with DKD, 2 patients (1.47%) with DKD+NDKD, and 131 patients with NDKD (96.32%). The proportions of DKD in patients with diabetes history ≤3 months, 3-12 months, 1-5 years, 5-10 years and ≥10 years were 10.53% (6/57), 25.00% (16/64), 26.53% (26/98), 41.56% (32/77) and 47.06% (24/51), respectively. The proportions of DKD+NDKD in patients with diabetes history ≤3 months, 3-12 months, 1-5 years, 5-10 years and ≥10 years were 3.51% (2/57), 3.13% (2/64), 10.20% (10/98), 9.09% (7/77) and 17.65% (9/51), respectively. Multivariate logistic regression analysis results showed that, the duration of diabetes history ( OR=1.130, 95% CI 1.057-1.208, P<0.001), diabetes retinopathy ( OR=12.185, 95% CI 5.331-27.849, P<0.001), urinary red blood cell count ( OR=0.987, 95% CI 0.974-0.999, P=0.039), glycosylated hemoglobin ( OR=1.482, 95% CI 1.119-1.961, P=0.006) as well as hemoglobin ( OR=0.973, 95% CI 0.957-0.990, P=0.001) were independently correlated with DKD. The proportions of DKD and DKD+NDKD increase with the prolongation of diabetes history. Membranous nephropathy is the most common pathology in NDKD and DKD+NDKD patients. Even in patients newly diagnosed with T2DM, it is necessary to screen for DKD. The duration of diabetes history, diabetes retinopathy, urinary red blood cell count, glycosylated hemoglobin and hemoglobin may be used to identify DKD from NDKD.

Relationships of habitual daily alcohol consumption with all-day and time-specific average glucose levels among non-diabetic population samples

BACKGROUND@#Alcohol consumption is a prevalent behavior that is bi-directionally related to the risk of type 2 diabetes. However, the effect of daily alcohol consumption on glucose levels in real-world situations in the general population has not been well elucidated. This study aimed to clarify the relationship between alcohol consumption and all-day and time-specific glucose levels among non-diabetic individuals.@*METHODS@#We investigated 913 non-diabetic males and females, aged 40-69 years, during 2018-2020 from four communities across Japan. The daily alcohol consumption was assessed using a self-report questionnaire. All-day and time-specific average glucose levels were estimated from the interstitial glucose concentrations measured using the Flash glucose monitoring system for a median duration of 13 days. Furthermore, we investigated the association between all-day and time-specific average glucose levels and habitual daily alcohol consumption levels, using never drinkers as the reference, and performed multiple linear regression analyses after adjusting for age, community, and other diabetes risk factors for males and females separately.@*RESULTS@#All-day average glucose levels did not vary according to alcohol consumption categories in both males and females. However, for males, the average glucose levels between 5:00 and 11:00 h and between 11:00 and 17:00 h were higher in moderate and heavy drinkers than in never drinkers, with the difference values of 4.6 and 4.7 mg/dL for moderate drinkers, and 5.7 and 6.8 mg/dL for heavy drinkers. Conversely, the average glucose levels between 17:00 and 24:00 h were lower in male moderate and heavy drinkers and female current drinkers than in never drinkers; the difference values of mean glucose levels were -5.8 for moderate drinkers, and -6.1 mg/dL for heavy drinkers in males and -2.7 mg/dL for female current drinkers.@*CONCLUSIONS@#Alcohol consumption was associated with glucose levels in a time-dependent biphasic pattern.

Relationship between Urinary Albumin Creatinine Ratio and Severity of Coronary Artery Disease in Non-Diabetic Patients

ackground: Coronary artery disease (CAD) is leading cause of mortality worldwide. CAD accounts for 20% of all deaths in the South Asia region. The burden of CAD is emerging as a public health concern in developing countries like Bangladesh. There are some new biomarkers for detection of CAD. The aim of this study was to find out the relationship between ACR and severity of coronary artery disease in non-diabetic.Material & Methods:This cross-sectional analytical study was conducted in the department of cardiology, National Heart Foundation Hospital and Research Institute from April, 2018 to March, 2019. Purposive sampling was done to select a total 101 study subjects. Data were collected in a predesigned data collection form through clinical history, examination, laboratory findings and coronary angiogram report. Study population was divided into two groups: Group朅: Non-diabetic patients with ACR > 30mg/g Group朆: Non-diabetic patients with ACR ? 30mg/g.Results:Participants had a mean age of 52.5 � 9.9 years with 75.24% men. Group A patients had higher ACR level (49.98�.83 vs 13.36�08; p<0.01) than group B patients. Relation between urinary ACR and severity of CAD remained significant. Conclusions:In this study, there found a significant relationship in ACR and severity of coronary artery disease in non-diabetic patients.

Corneal Endothelial Cell Density Changes In Diabetic And Non-Diabetic Eyes In Grade 2 And Grade 3 Nuclear Sclerosis Undergoing Phacoemulsification

Background:Corneal endothelial cells are susceptible to mechanical trauma from ultrasound energy during phacoemulsification. Several studies have reported various results of phacoemulsification effect on corneal endothelial cells between diabetic and non-diabetic patients due to stressful events. Present study was aimed to evaluate corneal endothelial density, hexagonality and Central Corneal Thickness (CCT) changes between diabetic and non-diabetic patients at early postoperative period and 1 month after phacoemulsification.Material And Methods:Specular microscopy examinations prior to phacoemulsification and at early postoperative period and 1 months after phacoemulsification were performed on diabetic and non-diabetic groups in grade 2 and grade 3 nuclear sclerosis. Laterthe changes in endothelial density, the percentage of hexagonality, and Central corneal thickness were evaluated.Result:Mean age of 120 study sample was 58.45 years (standard deviation –8.498 years), with the highest 74 years and lowest 43 years. Therewere 53 (44%) females and 67 (56%) males in the study. 42 (35%) samples were from 51-60 years age group followed by 37 (30.83%) subjects in 61-70 years age group. Mean corneal endothelial cell density decreases after cataract surgery in comparison with pre-operative density among study samples. Mean pre-operative corneal endothelial cell density was lower in diabetics in comparison with non-diabetics, and the difference was statistically significant. Cell density count decreases after cataract surgery inboth groups with significant difference between two groups. Mean corneal endothelial cell morphology (hexagonal cell percentage) decreases after cataract surgery in comparison with pre-operative density among study sample s. Central corneal thickness increases in early postoperative period followed by normalisation at day 30.Conclusion:Diabetic group showed greater hexagonality decrease compared to non-diabetic group at 1 month after phacoemulsification. It is suggested that diabetic corneal endothelium requires additional care and protective measures during cataract surgery to minimize surgical trauma. There were no statistically significant differences in the endothelial loss and Central corneal thickness changes between the diabetic and non-diabetic group at 1 month follow up after phacoemulsification.

Effects of different hemodialysis methods on insulin resistance, inflammatory factors and coronary artery calcification in patients with non-diabetic end-stage renal disease / 中国输血杂志

【Objective】 To compare the effects of low flux and high flux hemodialysis on insulin resistance (IR), inflammatory factors and coronary artery calcification(CAC) in patients with non-diabetic end-stage renal disease (ESRD), and analyze the related factors affecting the prognosis survival of patients. 【Methods】 A total of 217 patients with non-diabetic ESRD treated in our hospital from February 2015 to April 2017 were selected and randomly divided into control group (n=108) and observation group (n=109) according to the random number table. Low flux and high flux hemodialysis were adopted respectively. Baseline data, renal function, lipid metabolism, inflammatory factors, IR, CAC, complications, outcomes and health and economic benefits of the two groups were compared. The patients were followed up for 3 years and divided into survival group (n=130) and death group (n=75). The clinical data of the two groups were compared and related factors affecting the prognosis and survival were analyzed. 【Results】 Scr, BUN, UAER, TC, TG and LDL-C in the two groups were significantly lower than those before treatment [control group: Scr (μmol/L)349.62±37.16 vs 201.73±24.58, BUN (mmol/L) 28.43±5.39 vs20.81±3.47, UAER(μg /min)60.14±11.52 vs 55.73±9.86, TC (mmol/L)5.46±0.93 vs 4.75±0.69, TG (mmol/L)2.58±0.64 vs 2.13±0.57, LDL-C(mmol/L)3.69±0.73 vs 2.45±0.60; observation group: Scr (μmol/L) 352.14±38.29 vs 136.85±16.47, BUN (mmol/L) 27.96±5.25 vs17.56±3.68, UAER(μg /min) 60.32±12.07 vs 49.85±7.42, TC (mmol/L)5.48±0.97 vs 4.27±0.56, TG (mmol/L) 2.55±0.62 vs 1.49±0.35, LDL-C(mmol/L) 3.72±0.74 vs1.91±0.48), and eGFR and HDL-C were significantly higher than those before treatment [control group: eGFR(mL/min/1.73m)29.32±3.25 vs 72.54±7.86, HDL-C(mmol/L)1.13±0.24 vs1.28±0.31, observation group: eGFR(mL/min/1.73m)30.05±3.29 vs 121.63±13.34, HDL-C(mmol/L)1.09±0.22 vs 1.57±0.46), differences between groups were statistically significant (P<0.05); FBG, FINS, HOMA-IR, IL-6, IL-8, TNF-α and hs-CRP in the two groups were significantly lower than those before treatment [control group: FBG(mmol/L)4.99±0.95 vs 4.52±0.63, FINS(mU/L)12.93±2.54 vs10.15±2.21, HOMA-IR 2.87±0.54 vs 2.04±0.43, IL-6(pg/mL)120.16±13.54 vs 75.94±9.28, IL-8(mg/L)56.83±6.15 vs 41.52±5.38, TNF-α(ng/L)50.03±5.42 vs 45.62±4.81, hs-CRP(mg/L)26.75±2.79 vs 14.37±2.19; observation group: FBG(mmol/L)5.01±0.97 vs 4.11±0.56, FINS(mU/L)13.07±2.62 vs 8.86±1.79, HOMA-IR 2.91±0.55 vs 1.62±0.31, IL-6(pg/mL)119.85±12.91 vs 31.07±4.46, IL-8(mg/L)57.04±6.09 vs 32.65±4.27, TNF-α(ng/L)49.78±5.36 vs 40.15±4.27, hs-CRP(mg/L)23.04±2.82 vs 7.56±1.03], and the CACS score was significantly higher than that before treatment(control group: 26.75±2.79 vs 53.68±26.93, observation group: 27.04±2.82 vs 75.49±7.66), differences between groups are statistically significant (all P<0.05). Compared with the control group, the total incidence of complications during dialysis was significantly lower in the observation group (P<0.05), and has more economic advantages.Venerable age(OR=1.893, P<0.05), low HDL-C level(OR=0.575, P<0.05), high CACS score(OR=2.384, P<0.05), and high hs-CRP level(OR=3.526, P<0.05) were independent risk factors affecting the survival rate of non-diabetic ESRD patients after dialysis treatment (P<0.05). 【Conclusion】 Compared with low-flux hemodialysis, high-flux hemodialysis has significant effects in improving renal function, lipid metabolism, IR, micro-inflammatory state, and reducing CAC progression and complications, with more prominent cost-effectiveness advantages. HDL-C and Hs-CRP levels and CACS scores of patients should be closely monitored during clinical application, and active preventive measures should be taken to improve the survival rate of patients.

Proteinuria and Hypertension with and without Type 2 Diabetes Mellitus: 2021 Update

@#INTRODUCTION. This 2021 paper is an update of the 2019 version. In this current update, two new items of information added. Firstly, the 2020 Consensus statement of the Taiwan Hypertension Society and the Taiwan Society of Cardiology on HPDM, provided recommendations on additional medications to be considered in uncontrolled morning or night blood pressure (BP) are noted.9 Secondly, the nephroprotective properties of the SGLT-2 inhibitors are highlighted.19 Similar to the content of the 2019 version, four related areas are reviewed. They are (1) BP definition and classification; (2) Hypertension diagnosis; (3) Hypertension and proteinuria in non-diabetic patients; and (4) Proteinuria and hypertension in the patient with diabetes. METHODOLOGY. PubMed searches were done for papers to the above four topics published in the last five years (2014 to 2019). These were supplemented by papers from hand searches. RESULTS. For diagnosis of hypertension, the current cut off of 140/90 mmHg can be reduced to 130/80 to improve cardiovascular outcomes and all-cause mortality. Diagnosis of hypertension should not be based on office BP readings alone. Hypertension in older patients should be treated to prevent worse outcomes and should be individualised. In non-diabetic patients, both low grade and microalbuminuria needs to be treated; adequate BP control is needed to prevent cardiovascular outcomes and all-cause mortality. In the diabetic patient, a BP target of less than 140/90 mmHg applies to most patients, but individualisation of the BP goal is important. CONCLUSIONS. Much development in the management of proteinuria and hypertension has taken place in the last five years.

HbA1c as a prognostic indicator in prediabetics with acute coronary syndrome

Background: The role of HbA1C in predicting the outcomes of acute coronary syndrome remains controversial. Lesser is known about it in non-diabetic patients. Therefore authors conducted a study to seek association between the HbA1C levels and the clinical outcome in non-diabetic patients who presented with acute coronary syndrome. Objective of the study was to estimate HbA1C levels in population of prediabetics and non-diabetics and to document and correlate major adverse cardiac events in prediabetic and non-diabetics.Method: This case control study included consecutive patients (n=68) without known diabetes mellitus admitted with acute coronary syndrome (STEMI, NSTEMI, UA) at our hospital. HbA1c was measured on admission. The patients were divided into 2 groups according to their HbA1c level (group 1 HbA1c<5.7%, group 2 HbA1c>5.7%). The main outcome was MACE (major adverse cardiac events including cardiogenic shock, arrhythmia, heart failure).Results: There was no significant difference between baseline characteristics of both groups but complications were seen in higher number cases with HbA1c >5.7%. No significant difference in mortality was found. On analysis HbA1c >5.7% was found to be an independent predictor of MACE.Conclusion: HbA1C is a predictor of major adverse cardiac events. Measurement of HbA1C levels may improve risk assessment in such patients presenting with ACS.

Pathological Observation of Blood Stasis Syndrome in Non-diabetic Peripheral Neuropathies: A Retrospective Analysis Based on Nerve Biopsy / 中国结合医学杂志

OBJECTIVE@#To investigate the pathological features of blood stasis syndrome (BSS) in non-diabetic peripheral neuropathy.@*METHODS@#Clinical data of 31 patients with non-diabetic peripheral neuropathy who had undergone nerve biopsy during December 2004 and December 2010 in Xuanwu Hospital Capital Medical University were retrospectively analyzed. According to Chinese medicine (CM) syndrome differentiation and signs, 26 patients were blood stasis type and 5 patients were non-blood stasis type. Clinical and pathological data were compared in detail.@*RESULTS@#Clinically, although both groups shared similar symptoms of limb numbness, weakness and sensory disturbances, the prevalence of neuralgia was much grievous in BSS group (73.1%, 26/31) compared with the non-BSS group (0%, 0/5). As for signs, dermal nutrients disturbance (84.6%, 22/26), dark or purple tongue (100.0%, 26/26), and sublingual varices (80.7%, 21/26) were more common in the BSS group than the non-BSS group (0%, 60%, 20%, respectively). The prevalence of qi deficiency cases (19/26) in the BSS group was significantly higher compared with the non-BSS group (1/5). The unique histological manifestations of BSS were axonal degeneration (16/26 vs 2/5 in non-BSS group), which was the hallmark of ischemia. Cases with BSS had prominent microangiopathy (61.5%, 16/26), manifested as epineurium vasculitis (inflammatory cell infiltrated to the vessel wall, obliteration and recanalization, vascular proliferation, extravascular hemosiderin deposition), angiotelectasis, proliferation and hyaline degeneration of endoneurium capillary. In the BSS group, impaired blood-nerve barrier was indicated by sub-perineurial edema (46.2%, 11/26) and endoneurial edema (15.4%, 4/26). The Renaut body (15.4%, 4/26) and amyloid deposition (3.8%, 1/26) found in the BSS group were absent in the non-BSS group.@*CONCLUSIONS@#BBS was common in non-diabetic peripheral neuropathies. The nerves exhibited ischemic alteration of primary axon degeneration and secondary demyelination. The interstitial tissue revealed microcirculation impairment, blood-nerve barrier disturbance, amyloid deposition and proliferation changes. The high prevalence of qi deficiency also highlights the therapy of promotion of blood circulation and removal of blood stasis.

A Study of Lipid Profile in Non-Diabetics with Stroke

Aim: The aim is to study the serum lipid profile in non-diabetics with stroke and to determine the significant correlation betweenthem.Materials and Methods: A cross-sectional study was conducted on patients period of 12 months from May 2018–June 2019,Mahatma Gandhi Memorial Hospital for 6 months. Patients and controls were tested for fasting lipid profile 12 h after overnightfast. Participants were 60 patients of non-diabetic stroke and 60 controls. Among the 60 patients, 37 were male and 23 werefemale. In controls, there were 37 males and 23 females. Age- and sex-matched controls were selected. Stroke patients withinfarct or hemorrhage in computed tomography brain were included in the study.Results: In this study, total cholesterol (TC), low-density lipoprotein (LDL) cholesterol, and triglycerides were significantlyassociated with the risk of stroke. In this study, 56.7% of patients had high-density lipoprotein <40 mg/dl, 41.7% had TC>200 mg/dl, 65% of them had LDL cholesterol >100 mg/dl, and 43.3% of patients had very LDL >30 mg/dl.

The Study of Mortality in Hospitalized Patients with Impaired Fasting Glucose in Acute Myocardial Infarction

Introduction: Hypertension is one of most commoncardiovascular disorder in clinical practice. It is also calledhigh blood pressure. Hypertension is well known risk factorfor cardiovascular, renal and cerebrovascular disease. Evenslightly rise elevated blood pressure lead to increase risk incardiovascular disease and strokes (CVD). Hypertensiveemergency is define as recent increase in blood pressure toa very high level (> 180 mmHg systolic and > 110 mmHgdiastolic) with target organ damage. Study aimed to evaluatethe modes of presentations, clinical profile and spectrum oftarget organ damage in patients with hypertensive emergency.Material and methods: This study was hospital basedprospective study. The present study was carried out in 100patients admitted in various medical wards in R.N.T. MedicalCollege Udaipur, Rajasthan over a period of eight months.Patients fulfilling the eligible criteria were included.Result: Among the 100 patients studied, 70 were males andthe male female ratio was 2.33:1. In the age distribution, 72%patients were found age more than 50 years and rest 28% wasless than 50 years. The commonest clinical presentation foundwas neurological deficits in 50% followed by dyspnoea in34% and chest pain in 10% patients.Conclusion: The present study done over hypertensiveemergencies patients conclude that majority of patientsbelonged to the fifth and sixth decades of age and of malesex. It was commonly observed in the patients knownhypertensive. Diabetes and dyslipidemias was commonassociation observed. Commonest mode of presentation wasneuro deficit and higher level of mean blood pressure at thetime of presentation may associated with worst out come

Oxidative stress and antioxidant vitamins in cataract patients

Background: In Pakistan age related vision disturbances are mainly due to cataract. Various studies have reported relationship of ocular lesion with senile changes and diabetes mellitus resulting in reduced quality of life due to vision. Oxidative stress is an important factor in the process of cataractogenesis. The pathogenesis of the cataract may involve decreased activity of antioxidant scavenging system which includes non-enzymatic natural antioxidants as biomolecules such as carotenoids and vitamins. So, it is planned to investigate the level of serum antioxidant vitamins in diabetic cataract patients and in non-diabetic cataract patients.Methods: The study was conducted at Biochemistry department, Al-Tibri Medical College Karachi from October 2016 to October 2017. Ninety pre diagnosed cataract patients were selected from Al-Ibrahim Eye Hospital Karachi 40 normal control subjects were selected from the same population with same socioeconomic group. The demographic data was analyzed. The random blood sugar, antioxidant vitamins (C, A and E) and malondialdehyde were analyzed in the blood sample of control and cataract patients. The data was analyzed by SPSS version 20.Results: There was no significant difference in the level of vitamin C, A, E and MDA between diabetic and non-diabetic cataract patients, but the blood levels of vitamins of control are higher as compared to the cataract patients. The level of MDA is significantly high in cataract patients as compared to control. Antioxidant vitamin E was negatively correlated with serum malondialdehyde in cataract patients.Conclusions: It is concluded that in diabetic and non-diabetic cataract low level of serum antioxidant vitamins may be a contributory factor for cataractogenesis.

Proteinuria and Hypertension with and and without type 2 diabetes mellitus: An Update

@#In this update four related areas are reviewed. They are: (1) Blood Pressure (BP) definition and classification; (2) Hypertension diagnosis; (3) Hypertension and proteinuria in non-diabetic patients; and (4) Proteinuria and hypertension in the patient with diabetes. METHODOLOGY. PubMed searches were done for papers to the above four topics published in the last five years (2014 to 2019). These were supplemented by papers from hand searches. RESULTS. For diagnosis of hypertension, the current cut off of 140/90 mmHg can be reduced to 130/80 mmHg to improve cardiovascular outcomes and all-cause mortality. Diagnosis of hypertension should not be based on office BP readings alone. Hypertension in older patients should be treated to prevent worse outcomes and should be individualised. In non-diabetic patients, both low grade and microalbuminuria needs to be treated; adequate BP control is needed to prevent cardiovascular outcomes and all-cause mortality. In the diabetic patient, a BP target of less than 140/90 mmHg applies to most patients but individualisation of the BP goal is important. CONCLUSIONS. Much development in the management of proteinuria and hypertension has taken place in the last five years.

Correlation between HbA1c on admission and blood glucose fluctuations and adverse events after coronary artery bypass grafting in non-diabetic patients / 中国胸心血管外科临床杂志

@#Objective    To explore the relationship between glycated hemoglobin (HbA1c) level and blood glucose fluctuations after coronary artery bypass grafting (CABG) and adverse events in non-diabetic patients, thus providing theoretical support for intensive preoperative blood glucose management in patients undergoing CABG surgery. Methods    A total of 304 patients undergoing CABG with or without valvular surgery from October 2013 to December 2017 were enrolled in this prospective, single-center, observational cohort study. We classified them into two different groups which were a low-level group and a high-level group according to the HbA1c level. There were 102 males and 37 females, aged 36–85 (61.5±9.5) years in the low-level group, and 118 males and 47 females aged 34–85 (63.1±9.4) years in the high-level group. The main results were different in hospital mortality and perioperative complications including in-hospital death, myocardial infarction, sternal incision infection, new stroke, new-onset renal failure and multiple organ failure. To assess the effects of confounding factors, multivariate logistic regression analysis was used. Results     Postoperative blood glucose fluctuation was more pronounced in the high-level group than that in the low-level group before admission [0.8 (0.6, 1.2) mmol/L vs. 1.0 (0.8, 1.8) mmol/L, P<0.01]. This study also suggested that the  incidence of major adverse events was significantly lower in the low-level group compared with the high-level group (P=0.001). Multivariate logistic regression analyses to correct the influence of other confounding factors showed that HbA1c (OR=2.773, P=0.002) and postoperative blood glucose fluctuations (OR=3.091, P<0.001) could still predict the occurrence of postoperative adverse events. Conclusion    HbA1c on admission can effectively predict blood glucose fluctuations in 24 hours after surgery. Secondly, HbA1c on admission and postoperative blood glucose fluctuations can further predict postoperative adverse events. It is suggested that we control the patient's preoperative HbA1c at a low level, which is beneficial to control postoperative blood glucose fluctuation and postoperative adverse events.

Is elevated blood glucose a marker of occult tissue hypoperfusion in off-pump coronary artery bypass grafting?

Context: Hyperglycemia has been found to occur during myocardial infarction and cardiac surgery even in nondiabetic patients. These being essentially stressful processes associated with hypoperfusion, we decided to find a possible relationship between the occurrence of global tissue hypoperfusion (GTH) and elevated blood glucose level in adult nondiabetic patients undergoing elective off-pump coronary artery bypass grafting (CABG). Aims: This study aims to observe for the occurrence of global tissue hypoperfusion and its effect on blood glucose level and whether raised blood glucose level can be used as a marker for GTH. Design: Prospective, observational study. Settings: Cardiothoracic operation theater and intensive care unit of a tertiary care teaching hospital. Materials and Methods: The occurrence of global tissue hypoperfusion were detected with the help of combined markers of mixed venous oxygen saturation and arterial lactate level at various perioperative study points together with arterial blood glucose level. Blood glucose level compared between the patients with and without GTH. Statistical Analysis Used: Numerical variables were compared between groups by Student's t-test and categorical variables by Fisher's exact test. Two-tailed P ≤ 0.05 was considered for statistically significant. Results: The incidence of GTH was 67%. Blood glucose level was raised in patients with GTH at some study time points but with poor sensitivity and specificity values. Conclusions: Global tissue hypoperfusion is a common occurrence in even nondiabetic patients undergoing elective off-pump CABG. A relationship exists between rise in blood glucose level and global tissue hypoperfusion in such patients, although it cannot be viewed as marker of the same.

Study of awareness of diabetes mellitus among diabetics and non-diabetics and drug utilisation pattern in diabetics attending tertiary care general hospital in India

Background: Diabetes Mellitus (DM) is one of the most challenging public health problems. It is important to know about the awareness level of a disease condition in a population, which plays a vital role in future development, early detection and prevention of disease.Methods: A total of 200 subjects were interviewed and their details were noted in a specially designed data collection form. The questionnaire contained a series of questions related to demographic characteristics and awareness of DM including general knowledge, risk factors and complications of diabetic and non-diabetic patients.Results: Among 150 subjects were diabetic and 50 were non-diabetic. 60 (40%), 14(28%) of diabetics and non- diabetics were between the age of 41-50. 101 (67.3%) were male, 49 (32.6%) were female. 101 (67.3%) of the study participant had family history of diabetes in diabetic. 45 (44.5%) diabetic, 20 (40.81%) non-diabetic male knows the risk factor for diabetes mellitus and 35 (34.6%), 21 (42.8%) were aware of symptoms, 09(8.9%), 03(6.1%) awareness on complication of diabetes. 21 (20.7%), 06 (12.2%) doesn’t know about Risk factors.Conclusions: The present study conclude a current situation of knowledge and awareness of diabetes mellitus and also emphasizes the need for improvement in knowledge and awareness on diabetes mellitus among the diabetic as well as non-diabetic subjects in order to achieve prevention and better control of diabetes risk factors, complications and its management.

Nephro protection property of double blockade versus single blocked of RAAS in delaying the progression of CKD

Background: Dual renin angiotensin aldosterone system blockade using angiotensin receptor blockers in combination with angiotensin converting enzyme inhibitors is reported to improve proteinuria in non-diabetic patients.Methods: A prospective observational study was done on 810 non-diabetic chronic kidney disease patients during July 2012 to August 2014 to compare the nephro protection property of double blockade and single blocked of renin angiotensin aldosterone system in delaying the progression of chronic kidney disease.Results: At the end of 24 months urinary protein excretion rate of group I and group III were compared by using student t-test and p value (0.0001) was found significant. Similarly, on comparing group II and group III, p value (0.003) was again significant. Mean arterial blood pressure of group I and group III were statistically significant (<0.0496) while comparing group II and group III, p value (0.0419) was again significant.Conclusions: The study concludes that the use of double renin angiotensin aldosterone system blockade therapy is more effective than monotherapy at reducing albuminuria and proteinuiria, and in decreasing blood pressure at the same time not causing significant deterioration in glomerular filtration rate. Newer potassium lowering therapies can effectively and safely correct hyperkalemia and maintain normokalemia in patients receiving background treatment with renin angiotensin aldosterone system blockade. However, the use of new potassium binders for cardiovascular and renal risk reduction with combined renin angiotensin aldosterone system blockade therapy will require phase III trials.

Clinicopathological Features of Nondiabetic Renal Diseases from Different Age Groups: An Observational Cross-sectional Study / 中华医学杂志(英文版)

Background@#Diabetes mellitus (DM) has become the leading cause of chronic kidney disease (CKD). Nondiabetic renal diseases (NDRDs) have different clinicopathological features and prognosis from those of diabetic nephropathy. Our study sought to analyze the clinical and pathological features of NDRDs, in different age groups through a cross-sectional study.@*Methods@#All patients with type 2 DM at our center who underwent renal biopsy between March 1997 and March 2017 were screened and divided into three groups by age: Group 1 (youth group), 18-44 years old; Group 2 (middle-aged group), 45-59 years old; and Group 3 (elderly group), ≥60 years old. We analyzed the clinicopathological data and risk factors by univariate and multivariate logistic regression for NDRD of the patients to identify the features of NDRD in different age groups.@*Results@#We included 982 patients in the final analysis. Patients with NDRD accounted for 64.4% of all patients. IgA nephropathy (IgAN) was the most common pathological pattern in young patients with NDRD, accounting for 26.3%. In the middle-aged group, the two most common pathological patterns were IgAN and membranous nephropathy. Membranous nephropathy was the most common pathological pattern in elderly patients with NDRD, accounting for 29.3%. Consistent with pathological features, glomerular hematuria is a risk factor for NDRD in Group 1 (odds ratio [OR], 26.514; 95% confidence interval [CI], 2.503-280.910; P = 0.006). On the other hand, rapidly increasing proteinuria or nephrotic syndrome is a risk factor for NDRD in Group 2 (OR, 5.921; 95% CI, 2.061-17.013; P = 0.001) and Group 3 (OR, 90.409; 95% CI, 6.198-1318.826; P = 0.001).@*Conclusions@#This single-center study showed that the proportion and composition of NDRD differ among different age groups. Consistent with pathological features, some clinical indices such as hematuria and proteinuria showed different features among different age groups.

La cardiopatía isquémica en pacientes diabéticos y no diabéticos / Ischemic heart disease in diabetic and non-diabetic patients

Introducción: La cardiopatía isquémica tiene como uno de sus factores de riesgo más importante a la Diabetes mellitus, la cual influye en el pronóstico, tratamiento, severidad, morbilidad y mortalidad de esta enfermedad. Objetivo: Caracterizar la influencia de la Diabetes mellitus en la cardiopatía isquémica. Material y Métodos: Se realizó una revisión bibliográfica sobre la temática. Resultados: La Diabetes mellitus es un factor de riesgo de alta relevancia de la cardiopatía isquémica. Las personas con diabetes corren el mismo riesgo de tener un infarto de miocardio que las personas sin diabetes que ya han tenido uno. Las mujeres diabéticas son más propensas a cardiopatías isquémicas. Existe una mayor frecuencia de Diabetes mellitus en los pacientes portadores de la cardiopatía isquémica con edades entre 45 y 80 años. Conclusiones: La diabetes impone mayor riesgo de padecer cardiopatía isquémica, la hace más precoz, le impone dificultades diagnósticas y mayor riesgo de complicaciones. La diabetes y la cardiopatía isquémica son enfermedades con incidencias y prevalencias que se incrementan con la edad(AU)

Introduction:Ischemic heart disease has Diabetes mellitus as one of its most important factors, because affects the prognosis, treatment, severity, morbidity and mortality of the first one. Objective: To characterize the influence of diabetes mellitus on ischemic heart disease. Material and Methods: A literature review on the subject was conducted. Results: Diabetes mellitus is confirmed as a highly relevant risk factor for ischemic heart disease. People with diabetes are at the same risk of having a myocardial infarction as people without diabetes who have already had one. Diabetic women are more likely to have ischemic heart disease. There is a higher frequency of Diabetes mellitus in patients with ischemic heart disease aged between 45 and 80 years. Conclusions:Diabetes imposes an increased risk of suffering of ischemic heart disease, makes it more precocious, and imposes diagnostic difficulties and greater risk of complications. Diabetes and ischemic heart disease are illnesses with incidence and prevalence that increase with age(AU)