Hyperglycemia in hospitalized patients of a tertiary care hospital: prevalence and treatment in two cross-sectional evaluations (2011-2020)

ABSTRACT Objective: A study at Centro Hospitalar Universitário do Porto in 2011 revealed suboptimal control of inpatient hyperglycemia and a similar one was carried out in 2020. This study compares the results of 2011 and 2020 regarding prevalence of hyperglycemia, metabolic control, treatment and glycemic profile by infection/non-infection diagnosis. Subjects and methods: We performed two cross-sectional studies on 13th December 2011 and 9th October 2020 that included all non-critical adults with at least 24 hours of hospitalization, with no specific intervention between them. Glycemic control evaluated by minimum and maximum capillary blood glucose (CBG) in the previous day categorized as hypoglycemia (<70 mg/dL), normoglycemia (70-179 mg/dL) and hyperglycemia (≥180 mg/dL) (SPSS v.20). Results: A total of 418 and 445 patients were respectively included in 2011 and 2020 studies and the prevalence of hyperglycemia was similar. Glycemic control improved numerically although not significantly in 2020: increase in normoglycemia, reduction in hyperglycemia and reduction in hypoglycemia. There was an increase in the use of basal-bolus regimens (19.6% vs. 7.3%, p = 0.009) and a decrease in human basal (p < 0.01) and rapid-acting insulin use (p = 0.001) with a proportional increase in long-acting (p = 0.002) and rapid-acting analogs (p < 0.001) use. There was a higher prevalence of infection (39.8% vs. 23.1%, p = 0.006) in 2020 and, in the infection subgroup, there were higher insulinization rates (37.3% vs. 10.7%, p = 0.017) and a trend to glycemic control improvement. Conclusion: Despite the higher insulinization rates, the preference for new insulin analogs and a trend to better glycemic control, we have not yet reached targets, so education still remains necessary.

Observational study of macular capillary perfusion with branch retinal vein occlusion by using DART-OCTA / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the imaging characteristics of dense automatic real time B-scan optical coherence tomography angiography(DART-OCTA)in macular-involved branch retinal vein occlusion(BRVO)and the diagnostic value of capillary perfusion imaging in the macular area.METHODS: From June 2020 to December 2020, there were 51 cases of 51 eyes with BRVO diagnosed in Eye Hospital, Wenzhou Medical University. Imaging characteristics of the BRVO macular area were observed by fluorescein angiography(FA), optical coherence tomography angiography(OCTA)and DART-OCTA examination, respectively. According to the retinal capillary perfusion status, the included patients were divided into capillary and non-imaging groups, comparing the results of capillary perfusion imaging in the BRVO macular area among the three examination methods.Furthermore, quantitative analysis of capillary perfusion density in the lesion involved area and the lesion non-involved area was performed in DART-OCTA images. RESULTS: Patients with 51 eyes were included in this study, FA identified 10 eyes of capillary perfusion imaging, OCTA identified 14 eyes of capillary perfusion imaging, DART-OCTA identified 34 eyes of the capillary perfusion imaging.Comparison of the three test methods for capillary perfusion imaging findings in the BRVO macular area showed that DART-OCTA was more sensitive compared to FA and OCTA for capillary perfusion imaging in the ischemic area. In DART-OCTA examination, retinal capillary blood flow density was lower in the lesion-involved areas in both the capillary perfusion imaging group and the non-imaging groups(0.65±0.20/mm vs 1.16±0.31/mm,0.41±0.16/mm vs 1.06±0.38/mm, all P<0.0001).CONCLUSION: DART-OCTA can provide clearer tomographic imaging of retinal capillary perfusion. And the imaging with its observation of BRVO involving the macular area is least affected by macular hemorrhage and it is an important complementary method for BRVO patients with significant retinal hemorrhage.

Correlation between admitting blood glucose levels and H=hospital outcome in patients who underwent percutaneous coronary intervention

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.

Comparison of glucose measurement on dried blood spots versus plasma samples in pregnant women with and without anemia

ABSTRACT Objective Compare the concordance degree between plasma glucose and glucose measurements on Dried Blood Spots (DBS) during pregnancy. Subjects and methods Glucose measurement was performed in pregnant women after a fast of 8-12 hours. Venous blood was collected with sodium fluoride, the plasma was separated, and glucose measured by the enzymatic oxidase glucose method. Capillary blood samples were collected and analyzed by DBS. For statistics, the paired Student's t test, interclass correlation coefficient (ICC), graphic approach of Altman and Bland, and survival - concordance plot were used. Results 307 pregnant women were evaluated, 88.6% without diabetes and 11.4% with previous diabetes. The glucose ranged from 66 to 190 mg/dL [3.66 to 10.55 mmol/L] in plasma and from 53 to 166 mg/dL [2.94 to 9.21 mmol/L] in DBS. The glucose average values were 88.1 ± 12 mg/dL [4.98 ± 0.67 mmol/L] in plasma and 89.2 ±11,5 mg/dL, [4.95 ± 0.64 mmol/L] in DBS - p-value = 0.084. The ICC value was moderate (0.510), and Pearson's correlation coefficient was r = 0.507 p < 0.001. Altman and Bland's graph showed that difference between the values obtained by both methods is -24.62 to 22.3 mg/dL [-1.37 to 1.24 mmol/L]. Significant fixed bias (-1,16 average difference) and proportional bias (r = 0.056; p = 0.33) were not observed. Anemia was associated with differences between plasma glucose and DBS measurements (p = 0.031). Conclusion Capillary glucose in DBS correlates with plasma glucose; however, the methods do not present good concordance. The presence of anemia worsens this result.

Association of Pre-Diabetes, Diabetes and BMI with family history: A Cross Sectional study in an urban area of Varanasi

Introduction: Diabetes is undoubtedly one of the most challenging health problems in the 21st century. According to The International Diabetes Federation estimation India will have risen in people living with diabetes up to 87.0 million by 2030 from 50.8 million (2010). According to the World Health Organization criteria, the prevalence of known diabetes was 5.6% and 2.7% among urban and rural areas, respectively in 2009. Family history of diabetes is not only a risk factor for the disease but is also positively associated with risk awareness and risk-reducing behaviours. It may provide a useful screening tool for detection and prevention of diabetes. Hence the study was conducted to assess the association between family history with diabetes and pre-diabetes in an urban area of Varanasi. Methodology: A Community based cross-sectional study was conducted during July 2012 to December 2012 among 706 respondents of 20-65 year age group in Sunderpur, Varanasi. Out of which 359 male and 347 females were interviewed by using pretested semi structured interview schedule. Consent was taken to all respondents. Pregnant women and known cases of diabetes respondents were excluded from this study. Fasting Capillary blood glucose level measured with the help of Glucometer. Result: In the present study prevalence of pre-diabetes was 11.8% and diabetes 7.2 %, 0.6% were known diabetic. Out of the total 700 respondents, familial risk was observed only in 10.4%. Out of which 6.7% respondents were having positive family history of one parent and 3.7% were of both parents and siblings. Positive family history was observed more among pre-diabetics 24.4% and diabetics 24% as compared to respondents with normal blood glucose level 15.4%. The association was found to be statistically significant. Significant difference was observed on diabetes, pre-diabetes with family history. Conclusion & Recommendations: Family history of diabetes mellitus was observed in 10.4% of total screened respondents. Out of which 6.7% were having either parent and 3.7% both parents and siblings. Family history of diabetes is indeed a powerful independent risk factor for the diabetes and pre-diabetes. Our efforts should now be directed toward translating this awareness for use in public health programs.

To study the effect of using ringer’s lactate with or without addition of dextrose on intra-operative blood sugar levels in Pediatric age group undergoing surgeries

Background: General anesthesia without supplemental regional anesthesia might result in elevated blood sugar levels secondary to the stress response of anesthesia and surgery. Increased levels of cortisol and catecholamines augment glucose production because of increased hepatic glycogenolysis and gluconeogenesis along with reduced peripheral utilization of glucose. Hence, there exists a high possibility that supplementing dextrose intraoperatively without regular blood sugar estimation might result in hyperglycemic episodes which can lead to osmotic diuresis, impairment of neurological outcome, and risk of hypoxic episodes under anesthesia. Aim: To compare the effect of using Ringer's lactate with or without the addition of 1% dextrose on intra-operative blood sugar levels in the pediatric age group undergoing surgeries. Methods and methods: 44 pediatric age group patients, male patients undergoing circumcision for phimosis under I.V sedation with caudal block were chosen and divided into two groups randomly into Group A and Group B. Group A received 1% dextrose RL and Group B received RL without the addition of dextrose as intra-operative maintenance fluid. Along with basic parameters like heart rate and oxygen saturation, capillary blood glucose was also measured preoperatively just before induction and after the end of procedure postoperatively. Results: Preoperative and post-operative blood sugar values were compared. No significant hypoglycemia was developed in patients who had received only RL. And patients who received 1% Dextrose RL as intra-operative fluid had not developed significant hyperglycemia. Arivuselvan K, Nalani, Naheed Azhar. To study the effect of using ringer’s lactate with or without addition of dextrose on intra-operative blood sugar levels in Pediatric age group undergoing surgeries. IAIM, 2019; 6(5): 87-91. Page 88 Conclusion: Even with patients received only RL without dextrose as intraoperative fluid there is no significant hypoglycemia. So, the addition of dextrose is not mandatory in patients undergoing short surgeries provided their preoperative sugar level is not less than 80 mg/dl.

Esferocitosis hereditaria: experiencia clínica y diagnóstica en Argentina / Hereditary spherocytosis: clinical and diagnostic experience in Argentina / Esferocitose hereditária: experiência clínica e diagnóstica na Argentina

Los objetivos del presente estudio fueron: a) Analizar las características demográficas y clínicas de nuestra población al diagnóstico; b) Evaluar si las pruebas más recientes presentan ventajas sobre las tradicionales; c) Confirmar la frecuencia de las distintas deficiencias de proteínas de membrana; d) Establecer la relación entre severidad y resultado de las pruebas o tipo de deficiencia. Se analizaron 359 individuos estudiados desde 2007, cuando se incorporaron criohemólisis hipertónica (CH), citometría de flujo con eosina-5'- maleimida (5'EMA-CF), FOE por citometría de flujo (FOE-CF) y electroforesis de proteínas de membrana (SDS-PAGE) al estudio de laboratorio clásico, fragilidad osmótica eritrocitaria (FOE) y autohemólisis (AH). Criterios diagnósticos para Esferocitosis Hereditaria (ESH): esferocitos en frotis y dos pruebas positivas. Se identificaron 174 pacientes con ESH y 22 portadores sanos. El 74,9% eran menores de 12 años. La transmisión fue dominante en el 83,1% de los casos. Tuvieron manifestaciones neonatales 89,1%. Las pruebas con mayor sensibilidad fueron CH (92,0%), FOE diferida (91,1%) y 5'EMA-CF (88,5%). En los 125 pacientes en quienes se realizaron CH, 5'EMA-CF y FOE-CF se observó que todos tenían al menos una prueba positiva; 122 (97,6%) tuvieron dos o tres positivas. Las deficiencias más frecuentes fueron ankirina y espectrina. No hubo diferencia en el resultado de las pruebas entre los subgrupos de severidad. Se concluye que las deficiencias más frecuentes en Argentina son ankirina y espectrina, coincidiendo con otras poblaciones latinoamericanas. El uso simultáneo de CH, 5'EMA-CF y FOE-CF permite diagnosticar más del 97% de los casos. La incidencia de manifestaciones neonatales es elevada.

The aims of this study were (a) to assess demographic and clinical aspects of our population at diagnosis; (b) to evaluate diagnostic accuracy of hypertonic cryohemolysis (HC), eosin-5'-maleimide flow cytometry (EMA-FC) and flow cytometric osmotic fragility (OF-FC) in relation to standard screening tests osmotic fragility (OF) and autohemolysis (AH); (c) to confirm the previously reported prevalence of membrane proteins defects; and (d) to assess the relationship between severity of anemia and results of confirmatory tests. Since 2007, the following tests were available in our laboratory: OF, AH, HC, EMA-FC, OF-FC and SDS-PAGE of membrane proteins. Diagnostic criteria for hereditary spherocytosis were spherocytes in blood smear plus ≥2 positive tests. Data from 359 individuals were analyzed: 174 HS patients and 22 silent carriers were detected; 74.9% of patients were less than 12 years old; 83.1% of them showed a dominant inheritance pattern; antecedent of neonatal jaundice/anemia was registered in 89.1%. Tests with higher sensitivity were: HC (92.0%), incubated OF (91.1%), and EMA-FC (88.5%). HC, EMA-FC and OF-FC were simultaneously performed on 125 patients: each of them had at least 1 positive test; 122 (97.6%) had 2 or 3 positive tests. Ankyrin and spectrin were the most frequently found protein deficiencies. Comparison of test results in relation to severity of anemia showed no difference between groups. It can be concluded that compared toother Latin American countries, ankyrin and spectrin were the most frequent protein deficiencies. Simultaneous performing of HC, EMA-FC and OF-FC enabled diagnosing HS in more than 97% of patients. A high incidence of neonatal jaundice/anemia was observed.

Os objetivos do presente estudo foram: a) analisar as características demográficas e clínicas de nossa população ao diagnóstico; b) Avaliar se as provas mais recentes apresentam vantagens sobre as tradicionais; c) Confirmar a frequência das diversas deficiências de proteínas de membrana; d) Establecer a relação entre severidade e resultado das provas ou tipo de deficiência. Foram analisados 359 indivíduos estudados desde 2007, quando se incorporaram crio-hemólise hipertônica (CH), citometria de fluxo com eosina-5'-maleimida (5'EMA-CF), FOE por citometria de fluxo (FOE-CF) e eletroforese de proteínas de membrana (SDS-PAGE) ao estudo de laboratório clássico - fragilidade osmótica eritrocitária (FOE) e auto-hemólise (AH). Critérios diagnósticos para ESH: esferócitos em esfregaço e duas provas positivas. Foram identificados 174 pacientes com ESH e 22 portadores sadios. 74,9% eram menores de 12 anos. A transmissão foi dominante em 83,1%. Tiveram manifestações neonatais 89,1%. As provas com maior sensibilidade foram CH (92,0%), FOE diferida (91,1%) e 5'EMA-CF (88,5%). Nos 125 pacientes aos quais lhes realizaram CH, 5'EMA-CF e FOE-CF se observou que todos tinham no mínimo uma prova positiva; 122 (97,6%) tiveram duas ou três positivas. As deficiências mais frequentes foram anquirina e espectrina. Não houve diferença no resultado das provas entre os subgrupos de severidade. Conclui-se que as deficiências mais frequentes na Argentina são anquirina e espectrina, as quais coincidem com outras populações latinoamericanas. O uso simultâneo de CH, 5'EMA-CF e FOE-CF permite diagnosticar mais de 97% dos casos. A incidência de manifestações neonatais é elevada.

Accuracy of blood glucose measurements using capillary and arterial line of extracorporeal circuit of hemodialysis among diabetic patients undergoing outpatient hemodialysis at The Medical City

Introduction@#Accurate and reliable glucose level measurements are essential for ensuring safe and effective glycemic control among diabetic patients undergoing hemodialysis (HD). Capillary blood glucose (CBG) monitoring is the standard of care of glycemic control assessment in patients with diabetes on maintenance HD. In the Philippines, glucose monitoring during HD involves either standard finger stick (CBG) or blood sample from the arterial line (AL) of extracorporeal circuit of HD machine. However, anecdotal observations noted over the years have shown discrepancies in the glucose values from the two sites. This study aimed to determine the accuracy of blood glucose measurements of capillary and AL of extracorporeal circuit of HD machine using point-of-care (POC) glucose meter in comparison to central laboratory venous plasma among diabetic patients undergoing outpatient HD in a private tertiary hospital in the Philippines. Determining the most accurate and reliable method of glucose level measurement is vital in helping patients attain glycemic control. To date, there is limited published data regarding the accuracy of blood glucose values obtained through CBG and AL of extracorporeal circuit of HD machine while patients are undergoing dialysis.@*Methods@#This is a prospective, cross-sectional, analytical study involving thirty patients. Forty blood samples from 30 patients obtained through CBG, AL and the peripheral venous plasma of the opposite arm were simultaneously analyzed. Specifically, StatStrip was utilized as the POC glucose meter. Accuracy of AL of extracorporeal circuit and CBG were determined and assessed in accordance with International Organization for Standardization (ISO) 15197:2013 minimum accuracy criteria for glucose meters. Regression analysis was used to determine whether AL and CBG significantly predict peripheral venous blood glucose levels.@*Results@#Analysis showed that there is a statistically significant difference in the glucose values obtained from AL and CBG (p-values 0.005 and <0.0001) when compared to venous plasma glucose. However, this may not pose clinical significance in routine practice. It is noteworthy that both AL (concordance rate (CR)=100%) and CBG (CR=96.5%) satisfied the revised ISO 15197:2013 accuracy criteria for glucose value greater than or equal to 100mg/dL.@*Conclusion@#Both CBG and AL blood glucose measurement significantly predict venous plasma blood glucose level. POC blood glucose value from both AL of extracorporeal circuit during HD and CBG satisfied the accuracy criteria set by ISO 15197: 2013 for glucose value greater than or equal to 100mg/dL. Thus, confirming the glucose level by CBG monitoring is not necessary in patients with arterial glucose value of greater than or equal to 100 mg/dL during HD.

Role of dental pulp in identification of the deceased individual by establishing ABO blood grouping and Rhesus factor.

Objectives: The study was conducted to emphasize the sensitivity and specificity of dental pulp in identifying the ABO Blood group, Rhesus factor and also to emphasize the role of dental pulp in forensic odontology to identify the deceased individual. Materials and Methods: The study was conducted on 60 patients. The samples obtained from finger-prick method from those 60 patients were considered as control and the samples obtained from the pulp were considered as case. The blood grouping, Rhesus typing for capillary blood drawn by finger prick was done by slide-agglutination method and the blood grouping, Rhesus typing for extracted dental pulp was done by absorption-elution method. Results: Fifty seven teeth out of sixty showed positive results. Blood group elicited from capillary blood done by slide-agglutination method matched with that of the pulpal blood group elicited by absorption-elution method. Three showed negative results. Conclusion: As the teeth are the hardest, most stable biological material, resist adverse environmental conditions and the pulpal tissue inside the teeth is well protected, the blood group antigen from pulp remains stable for long. Thus, the high potential value of dental pulp tissue is highlighted in this study.

Reduction of the Nailfold Capillary Blood Velocity in Cigarette Smokers / 가정의학회지

BACKGROUND: Cigarette smoking causes cardiovascular disease and activates markers of endothelial dysfunction or injury. We investigated the nailfold capillary blood velocity (NCV) in cigarette smokers compared to non-smokers. METHODS: Forty-eight men (eighteen non-smokers and thirty smokers) were recruited. We measured NCV using nailfold capillary microscopy and exhaled carbon monoxide (ECO) concentration three times (before smoking; NCV0min and ECO0min, and after smoking; NCV5min, ECO5min, NCV30min, and ECO30min), in a condition of fasting in the case of smokers. In non-smokers, the same measurements were taken without smoking. Additionally, personal cigarette smoking and alcohol drinking history were acquired by a self-administrated questionnaire. RESULTS: Mean age, waist circumference, ECO0min, ECO5min, and ECO30min was higher and NCV5min and NCV30min were significantly lower in smokers compared to non-smokers. Total smoking years were negatively correlated with NCV5min. Average pack of the daily smoking, total pack-years, as well as total smoking years were also negatively correlated with NCV30min by regression analysis. After adjustment of significantly different variables, NCV30min was significantly lower in smokers. In the subgroup analysis, the interleukin-6 level was significantly increased in subjects with a long period of cigarette smoking compared with non-smokers. CONCLUSION: Reduction of NCV in smokers is associated with personal smoking history, not with body composition or certain oxidative stress markers.

Cut-off points of fasting fingertip capillary blood glucose for detecting both undiagnosed diabetes and pre-diabetes / 中华流行病学杂志

Objective To determine the efficient cut-off points of fasting fingertip blood glucose test for undiagnosed diabetes mellitus(DM), impaired glucose tolerance(IGT), and impaired fasting glucose(IFG)in community-based residents aged above 45 years old. Methods A cluster-randomized study was conducted from May 2008 to January 2009. A total of 3250 subjects aged above 45 years in two communities of Baoding city received questionnaire investigation and tested for fingertip blood glucose. Those subjects whose capillary blood glucose level ≥5.1 mmol/L were subjected to 75 g oral glucose tolerance test. Undiagnosed diabetes mellitus and pre- diabetes were identified by fasting plasma glucose and OGTT. In this study, the cut-off points of fasting capillary blood glucose for detecting undiagnosed diabetes and pre-diabetes were evaluated, using receiver operator characteristic curve(ROC). Results Of 1351 subjects that having had oral glucose tolerance test, 230 cases were diagnosed as diabetes mellitus(7.3%), 166 cases(5.2%)as IFG, and 204(6.7%)as IGT under fasting capillary blood glucose as test variable and state variables according to the following criteria.(1)FPG≥7.0 mmol/L or/and 2hPG≥11.1 mmol/L(2)FPG<5.6 mmol/L (3)FPG<7.0 mmol/L and 7.8 mmol/L≤2hPG≤ 11.1 mmol/L, areas under three ROC curves were 0.905, 0.633 and 0.719, respectively. The cut-offvalues of screening for undiagnosed DM, IGT and IFG were 6.0 mmol/L, 5.7 mmol/L, and 5.7 mmol/L, respectively. When cut-off value of screening for undiagnosed DM was 6.0 mmol/L, the maximal sensitivity was 78.0% and specificity was 89.3%.But there were both lower sensitivity and specificity in screening for IFG and IGT according to the best predicting value(5.7 mmol/L)from the ROC curves(50.3% and 28.0% vs. 60.8% and 28.0%). Conclusion Fasting capillary blood glucose with the lower cut-point of 6.0 mmol/L in screening for undiagnosed diabetes mellitus alone, was relatively reliable, whereas for both IFG and IGT the fasting fingertip blood glucose tests were fallible. It was convenient and could be used in screening the DM at the community level.

Níveis glicêmicos de pacientes diabéticos segundo estudo comparativo entre duas técnicas. / Blood glucose levels of diabetic patients: comparative study of two measuring techniques

O estudo teve como objetivo identificar e comparar os resultados de glicemia de pacientes adultos com diabetes tipo 2 por meio de duas técnicas, laboratorial e capilar. Estudo comparativo foi desenvolvido no período de setembro a dezembro de 2007. A população foi constituída de 36 pacientes adultos residentes no município de Planaltina do Paraná, PR. A pesquisa foi realizada no laboratório de análises clínicas municipal. Para o exame laboratorial foi usado o sangue venoso e para o teste capilar o sangue da ponta do dedo. A maioria dos pacientes (63,9%) era do gênero feminino, idade média de 62,4 anos. Quanto à escolaridade, 41,6% dos pacientes possuíam menos de 8 anos de estudo. Em relação aos níveis glicêmicos, o p-valor do teste Kappa foi significativo em todas as categorias (p< 0,001, p=0,005 e p=0,001), mostrando concordância. Os dados indicam elevada precisão e acurácia dos resultados de glicemia obtidos por meio do glicosímetro, quando comparada ao teste padrão obtido em laboratório.

The goal of this research was to measure the blood glucose levels of type 2 diabetic adult patients and compare the results obtained by two techniques, the standard laboratory (venous) and portable glucometer (capillary) tests. A comparative longitudinal study was conducted from September to December 2007. The study population consisted of 36 resident adult patients in the town of Planaltina do Paraná in upstate Paraná, Brazil. The tests were performed in the local health authority clinical laboratory. For the lab test, venous blood from the arm was used, and for the glucometer test, capillary blood from the fingertip. Most of the patients (63.9%) were women and the average age was 62.4 years. Regarding education, 41.6% of the patients had studied for less than 8 years. Comparing the glucose measurements, the results of the Kappa test were significant in all categories (p<0.001, p=0.005 and p=0.001), showing very good agreement between the methods. The findings indicate a high level of precision and accuracy for the blood glucose readings obtained with the glucometer, compared with the standard test carried out in the laboratory.

Investigation on pulmonary diffusing capacity of the patients with diabetes mellitus / 中国综合临床

Objective To investigate pulmonary capillary changes in patients with diabetes mellitus. Meth-otis Fifty-eight patients with diabetes mellitus were enrolled and forty-seven healthy subjects were taken as control. Diffusion capacity of carbonmonoxide (DLCO) and pulmonary ventilatory function were measured. DM and Vc were measured in twenty-one patients and twelve healthy subjects among them. Results FEV1/FVC was (81.02± 6.40) % in patients with diabetes mellitus and ( 81.20±6.96 ) % in controls, and FEV 1% was ( 102.03±14.40) in patients with diabetes mellitus and 103.94±11.42 in controls ,with no significant difference between patients with DLCO% was ( 72.79±19.85 ) % in patients with diabetes mellitus and ( 90.60±13.25 ) % in controls with a sig-patients whose course of disease was less than ten years,and DLCO% was (64.69±17.49)% in patients with dia-betes mellitus whose course of disease is equal or more than ten years and (80.90±18.98)% in patients whose course of disease is less than ten years,with significant difference between these two groups (t = 4.435, -3. 381, 13.88)% in patients with diabetes mellitas and (83.58±26.79)% in controls with a significant difference (t = 4. 612, P < 0.001 ). Vc was ( 61.40±52.84 ) ml in patients with diabetes mellitus and ( 66.99±19.63 ) ml in con-trols with no significant difference (P > 0.05 ), and Vc% was (78.05±64. 40)% in patients with diabetes mellitus and (79.33±23.32) % in controls, with no significant difference ( P > 0.05 ). Conclusions Diffusing capacity is decreased in patients with diabetes mellitus, which is related to the course of disease . DM decline is the main cause of DLCO decrease in patients with diabetes mellitus.

Pulmonary membrane diffusing capacity and pulmonary capillary blood volume in patients with stable COPD / 上海第二医科大学学报

Objective To study the clinical significance of pulmonary membrane diffusing capacity(Dm) and pulmonary capillary blood volume(Vc) in patients with stable chronic obstructive pulmonary disease(COPD). Methods Spirometry was performed in 38 patients with stable COPD and 35 healthy individuals in resting condition.The changes of pulmonary parameters were obtained and compared between groups. Results Spirometry test revealed that the percent predicted forced expired volume in one second(FEV1),FEV1/forced volume capacity(FVC)and the percent predicted maximal ventilatory volume(MVV) were declined from stage Ⅰin patients with COPD in comparison with healthy individuals,while diffusing capacity for carbon monoxide of lung(DLCO),carbon monoxide diffusing capacity per liter of alveolar(DLCO/VA),Dm and Vc were declined from stage Ⅱ.Dm in patients with COPD of stageⅠwas sig-nificantly decreased compared with the controls,while Vc was increased compared with the controls(both P

Hemoglobin measured by Hemocue and a reference method in venous and capillary blood: a validation study

Objective. To assess the comparability of hemoglobin concentration (Hb) in venous and capillary blood measured by Hemocue and an automated spectrophotometer (Celldyn) and to document the influence of type of blood (capillary or venous) and analysis method on anemia prevalence estimates. Material and Methods. Between February and May 2000, capillary and venous samples were collected from 72 adults and children at Hospital del Niño Morelense (Morelos State Children's Hospital) in Cuernavaca, Morelos, Mexico, and assessed for Hb using the Hemocue and Celldyn methods. Estimated Hb levels were compared using the concordance correlation coefficient and Student's t test for paired data. The sensitivity and specificity for anemia diagnosis were estimated and compared between type of blood and method of assessment. Results. Capillary blood had higher Hb (+0.5g/dl) than venous blood in adults and children, as did samples assessed by Celldyn compared to Hemocue (+0.3g/dl). Specificity to detect anemia was adequate (>0.90) but sensitivity was low for capillary blood assessed by Hemocue (<0.80). Conclusions. The difference in Hb between venous and capillary blood is likely related to biological variability. Hemoglobin concentration in capillary blood assessed by Hemocue provides an adequate estimation of population anemia prevalence but may result in excess false negative diagnoses among individuals. The results of this study stress the importance of sample collection technique, particularly for children. Method of analysis and sampling site need to be taken into consideration in field studies.

Objetivo. Evaluar la comparabilidad de la concentración de hemoglobina (Hb) en sangre venosa y capilar medida por Hemocue y por espectrofotómetro automatizado (Celldyn), así como documentar la influencia del tipo de sangre (capilar o venosa) y del método de análisis sobre la prevalencia de anemia. Material y métodos. De febrero a mayo de 2000, se recolectaron muestras de sangre capilar y venosa en 72 adultos y niños en el Hospital del Niño Morelense, Cuernavaca, Morelos, México. Se determinaron los niveles de Hb con los métodos Hemocue y Celldyn. Las cifras de Hb estimadas se compararon con el coeficiente de concordancia y la prueba pareada de t de Student. También se comparó la sensibilidad y especificidad para el diagnóstico de anemia, utilizando sangre de los dos tipos y métodos de análisis. Resultados. La Hb fue mayor en sangre capilar comparada con sangre venosa (+0.5g/dl) en adultos y niños, y en las determinaciones por Celldyn comparadas con las de Hemocue (+0.3 g/dl). La especificidad para el diagnóstico de anemia fue adecuada (>0.90), mientras que la sensibilidad fue baja para las muestras capilares medidas por Hemocue (<0.80). Conclusiones. Es probable que la diferencia en la Hb entre sangre venosa y capilar refleje variabilidad biológica. La Hb en sangre capilar medida por Hemocue provee una estimación adecuada de la prevalencia de anemia en poblaciones, pero podría resultar en un exceso de diagnósticos falsos negativos. Los resultados de este estudio ponen énfasis en la importancia de la técnica de recolección de la muestra, particularmente en niños. Los métodos de análisis y tipos de muestra de sangre deben ser tomados en cuenta en estudios de campo.

Availability of Capillary Blood Gas Analysis in Neonate

PURPOSE: Arterial blood gas analysis is frequently performed in neonatal intensive care unit (NICU) to evaluate ventilation and the metabolic state of critically ill infants. In occasions when umbilical arterial catheterization is not available, frequent arterial puncture is mandatory. This requires some technical skill and may occasionally have side effects. So we studied the validity of capillary blood gas analysis which can be performed conveniently compared with arterial blood. METHODS: Twenty-four neonates admitted to NICU during April to Aug. 2001 were studied. They were more than two weeks old without indwelling arterial catheters. Thirty-six times, simultaneous arterial, and capillary blood gases were drawn by puncture and the pH, pCO2 and pO2 of each sample was measured. Blood pressure and body temperature was checked before sampling to rule out impaired peripheral circulation. Capillary blood was collected from warmed heels. RESULTS: There was a strong correlation between capillary and arterial pH(r=0.91, P<0.05). The absolute value of the difference between arterial and capillary pH was less than 0.05. Also capillary pCO2 showed correlation with arterial pCO2(r=0.77, P<0.05). Despite a statistically significant correlation between capillary and arterial pO2(r=0.68, P<0.05), the absolute value of the difference was more than 10 mmHg in 92% of cases. CONCLUSION: Capillary blood gases accurately reflected arterial pH and pCO2 and showed a relative correlation with pO2. Capillary blood gas analysis can be a useful alternative to arterial blood when continuation of the umbilical arterial catheter is no longer available.

Effect of severe acute respiratory syndrome on membrane diffusing capacity and Pulmonary capillary blood volume / 解放军医学杂志

Objective To study the changes in pulmonary diffusing capacity (DL), alveolar capillary membrane diffusing capacity (Dm) and pulmonary capillary blood volume (Vc) in patients with severe acute respiratory syndrome (SARS), and to elucidate the underlying pathophysiogical mechanism of reduction of pulmonary diffusing capacity. Method Spirometry was performed in 26 SARS patients and 12 healthy individuals in resting condition. DLco were measured by single breath method, estimations of Dm and Vc were done by the method of Roughton and Forster. Results DLco in SARS patients was significantly lower than that in normal control, the same was true for Dm and Vc. The severer the pulmonary lesion, the heavier the damage to the pulmonary diffusing funetion. Conclusion The changes in Dm and Vc were both found in patients with SARS. Their measurements were helpful for detecting pulmonary involvement in SARS and defining the reason of DL abnormality in SARS. Dm and Vc were important and sensitive for monitoring pulmonary diffusing function in SARS patients

The Effect of Hyperoxia on the Retinal and Optic Nerve Head Microcirculation in Smoke rs and Non-Smokers

The effect of hyperoxia and smoking on retinal and optic nerve head microcirculation, and O2 reactivity in smokers and non-smokers were investigated using HRF(Heidelberg Retinal Flowmeter). 10 eyes of 10 young healthy non-smoking volunteers and 10 eyes of 10 young healthy smoking volunteers were investigated. Blood flow measurements were performed using HRF before and after 100% oxygen was applied to the subjects. In the non-smoking group, retinal flow was reduced by 33%, retinal volume by 24%, optic nerve head flow by 16% and optic nerve head volume by 18%. In the smoking group, retinal flow was reduced by 19%, retinal volume by 16%, optic nerve head flow by 16% and optic nerve head volume by 16%. The difference of O 2 reactivity between smokers and non-smokers was statistically significant in the retinal blood flow and volume, but not significant in the optic nerve head flow and volume. These results indicate that hyperoxia leads to a decrease in capillary blood flow of the retina and optic nerve head secondary to vasoconstriction, and that smoking decreases O2 reactivity in retinal microcirculation. The findings might be based on the long term effects of nicotine on the vascular system in smokers.

Evaluation of Macular Circulation in Patient with Diabetic Maculopathy using Scanning Laser Ophthalmoscope(SLO)

In the condition of diabetic retinopathy, the vascular changes are localized primarily in the retinal capillaries and are presumed to promote angiogenesis. To investigate the change of retinal blood flow velocities and morphological parameters in diabetic retinopathy, we measured perifoveal capillary blood velocities(v) and the size of foveal avascular zones(FAZ). Thirteen patients with diabetic maculopathy and nine healthy volunteers were included in this study. The scanning laser technique in conjunction with an image analysing system were used to assess the morphological and hemodynamic changes in diabetic retinopathy. Diabetic maculopathy group showed a slower capillary blood velocity than normal group(2.44+/-0.39mm/sec vs2.75+/-0.61 mm/sec, p>0.18). The foveal avascular zone was significantly larger in diabetic maculopathy group than in normal group(313.5+/-64.6micrometervs. 238.9+/-93.8micrometer, p<0.05). This results indicate that the retinal microcirculation is altered in diabetic patients compared with healthy subjects. These alterations may be due to the change of the capillary wall and blood viscosity in diabetic patients. The determination of these parameters can be utilized in monitoring the progress of diabetic maculopathy.

Progress in the determination of blood glucose and glucose of other body fluids / 中华内分泌代谢杂志

The progresses in the determination of blood glucose and glucose of other body fluids are reviewed, including methodologies of determining glucose in venous and capillary blood, and also in interstitial fluid, including non-invasive methods. The chracteristics and error of capillary blood glucose determination are discussed in detail.