RESUMO
Objectives@#This study aimed to determine the correlation between admitting hyperglycemia and hospital outcome, on the length of hospital stay and mortality on patients who underwent PCI.@*Methodology@#A single center, retrospective observational study involving patients who underwent percutaneous coronary intervention (PCI). They were divided in four (4) groups according to presence of admission hyperglycemia (capillary blood glucose >140mg/dl) and presence of diabetes: Group 1 (patients with diabetes with admission hyperglycemia), Group 2 (patients without diabetes with admission hyperglycemia), Group 3 (patients with diabetes without admission hyperglycemia), and Group 4 (patients without diabetes without admission hyperglycemia). Length of hospital stay and mortality outcome were compared between four groups and in-hospital mortality related risk factors were analyzed by binary logistic regression analysis.@*Results@#133 patients were included in the analysis, of which 50% have admission hyperglycemia. The length of hospital stay was significantly longer in patients with admission hyperglycemia (12 vs 9 vs 7 vs 7 days, p= 0.006). The mortality rate between 4 groups were non-significant (14% vs 10% vs 9% vs 11%, p=0.272). Multiple logistic regression analysis showed the following were associated with increased mortality in patients who underwent PCI: age (odds ratio [OR] 1.1265, 95%CI 1.0497 – 1.2090, p=0.001), capillary blood glucose on admission (OR 1.0077, 95% CI 1.0015 – 1.0140, p= 0.015), presence of ST elevation on ECG (OR 16.5671, 95% CI 3.4161 – 80.344, p=<0.001).@*Conclusion@#An elevated admission capillary blood glucose, regardless of presence or absence of diabetes, was associated with longer length of hospital stay; however, it was not predictive of in-hospital mortality. Interestingly, patients with admitting hyperglycemia had earlier mortality.
Assuntos
Diabetes MellitusRESUMO
Introduction@#Thyroid carcinoma remains the most common endocrine malignancy and incidence has increased due to improved diagnosis. Most Differentiated Thyroid Cancers (DTC) are indolent and easily cured with surgery, radioactive iodine (RAI) therapy and TSH suppression. However, persistent and recurrent disease is not uncommon among Filipinos. RAI therapy is being used more frequently even for low risk patients due to this observed aggressiveness of DTC in our population. This study sought to identify factors that are associated with failure of initial RAI for DTC, leading to repeat doses.@*Methods@#This is a single-center, retrospective cohort study conducted in the Nuclear Medicine Department of a tertiary care center in the Philippines, involving 325 patients who underwent RAI from 2006-2016@*Results@#Out of 570 patients who underwent RAI therapy for DTC, only 325 were included. Majority (n=280, 86%) had PTC and the rest had FTC (n=45, 14%). Twenty four percent (n=67) of the PTC group and 31% (n=14) of the FTC had subsequent RAI therapy after initial therapy due to either persistent or recurrent disease, with a mean interval of 21-22 months. Distant metastasis at presentation (M1), uptake in distant tissues on the initial post-therapy whole body scan (WBS) and TNM stage 4 were predictive for repeat RAI for FTC. A negative post-therapy WBS was found to be associated with no need for repeat RAI. On the other hand, the initial RAI dose of 150 mCi or higher was noted to be associated with repetition of RAI for PTC. Other risk factors noted were the presence of lymph nodes and distant metastasis at presentation and loco-regional uptake on the posttherapy WBS. Conversely, a negative post-treatment scan appeared to be protective against repeat RAI, as in FTC. However, multivariate analysis of risk factors showed that only metastasis at presentation (LN or distant) was associated with repeat RAI therapy. @*Conclusion@#The only risk factor associated with failure of initial RAI for patients with PTC and FTC in this study was distant metastasis at presentation. Nodal involvement at presentation was noted to be a significant factor for among those with PTC.
Assuntos
Câncer Papilífero da Tireoide , RecidivaRESUMO
Introduction@#Hypoglycemia is a burdensome complication in the management of diabetes mellitus (DM), and has been noted to be increasing. This study evaluated the occurrence of hypoglycemia and identified its risk factors among diabetic Filipino patients. @*Methods@#Census of Filipino non-pregnant adults with type 2 DM of Chong Hua Hospital, admitted and discharged from January 2015 to June 2015 was taken. This study determined the incidence rate of hypoglycemia (capillary blood glucose <70 mg/dL), its severity, patients’ dietary status, medication, and the common hospital areas where hypoglycemia occurred. The clinical profiles of these patients were analyzed and associated risk factors of hypoglycemia were identified. Also, the incidence of congestive heart failure, myocardial infarction, cerebrovascular disease, and allcause mortality among patients with hypoglycemia were determined.@*Results@#Among 1,676 subjects, 8.9% had hypoglycemia predominantly non-severe type (blood glucose 51-69 mg/dL). The identified risk factors for the development of hypoglycemia were the following, age >65 years old (52.7% vs 36.2%, p<0.001), diabetes duration of 8.56 years (± 10.34 years), the presence of cardiovascular disease (62.7% vs 48.6%, p<0.001), congestive heart failure (8.7% vs 4.4%, p=0.009) and stage III, IV, V kidney disease (32.7% vs 25.1%, p=0.043, 12% vs 5.5%, p=0.002, 12% vs 4.1%, p<0.001, respectively), and the use of insulin whether combined with oral therapy (25.3% vs 16.5%, p<0.006) or used alone (34.7% vs 12.1%, p<0.001). Hypoglycemia occurred more frequently in the non-ICU ward (82.7%). Only one patient developed non-fatal myocardial infarction, one had nonfatal cerebrovascular disease and one had congestive heart failure. All-cause mortality rate was 4.7%@*Conclusion@#The notable incidence of in-hospital hypoglycemia of 8.9% among diabetic patients should be addressed to decrease the associated morbidity and mortality.