ABSTRACT
Objective Encouraged by reports of favorable outcomes following the use of corticosteroids in patients with moderate-to-severe coronavirus 2019 (COVID-19) pneumonia, we aimed to present our experience with early short-term corticosteroid use at our center in pediatric patients with COVID-19 pneumonia. Methods One hundred and twenty-nine pediatric patients were included in the study. Patients were divided into four groups according to the type and dose of corticosteroids given: Group 1 (those receiving dexamethasone 0.15 mg/kg/d);Group 2 (those receiving methylprednisolone 1 mg/kg/d);Group 3 (those receiving methylprednisolone 2 mg/kg/d);and Group 4 (those receiving pulse methylprednisolone 10-30 mg/kg/d). Results Of 129 patients, 19 (14.7%) patients were assigned to Group 1, 30 (23.3%) patients to Group 2, 30 (23.3%) patients to Group 3, and 50 (38.8%) patients to Group 4. Thirty-two (24.8%) patients were followed in the pediatric intensive care unit (PICU), of whom 13 (10%) required mechanical ventilation, and 7 (%5.4) died. In Group 4, the hospitalization length was significantly longer than in other groups (p < 0.001, p < 0.001). No significant difference was found among the groups in terms of mortality (p = 0.15). The most common comorbidity was obesity (33%). A significant association was found between the presence of comorbidity and mortality (p < 0.001). All patients who died had an underlying disease. Cerebral palsy was the most common underlying disease among the patients who died. Worsening of lymphopenia was significant in patients with severe COVID-19 pneumonia at the time of transfer to the PICU (p = 0.011). Conclusion Although children usually have a milder course of COVID-19 than adults, underlying diseases and obesity increase the severity of disease manifestations also in children. Further studies are needed to define the exact role of corticosteroids in COVID-19 patients. © 2022. Thieme. All rights reserved.
ABSTRACT
The safety of COVID-19 pharmacotherapy is a relevant issue, first of all, because of the current lack of experience with using particular medicinal products and with off-label prescribing. The aim of the study was to analyse information on potential adverse drug reactions (ADRs) and their predictors in etiology- and pathogenesis-oriented COVID-19 therapy. According to literature data, the main clinically significant risk factors for COVID-19 patients to develop an ADR are the duration of their hospital stay, combined use of antivirals, polypharmacy, and their history of drug allergies. The most common adverse reactions to antivirals, to virus-neutralising antibodies, and to human anti-COVID-19 immunoglobulin and convalescent plasma are, respectively, gastrointestinal and hepatobiliary disorders;gastrointestinal disorders, neurological disorders, and allergic reactions;and transfusion reactions (fever, chills, etc.). For pathogenesis-oriented therapy with systemic glucocorticosteroids, the most characteristic ADR is hyperglycaemia. Janus kinase inhibitors and interleukin inhibitors are most often associated with gastrointestinal disorders and hypertransaminasemia;neutropenia is also characteristic of a number of interleukin inhibitors. Haemostatic adverse reactions to anticoagulants depend on the patient's dosing regimen and condition. Drug-drug interactions are a common problem in COVID-19 treatment, with the combination of nirmatrelvir and ritonavir showing the largest number of significant interactions attributed to their pharmacokinetics. Currently, there is data on the role of pharmacogenetic biomarkers in the safety and clinical outcomes of COVID-19 therapy. Thus, to improve the safety of COVID-19 therapy, an integrated approach is needed that will take into account both the clinical, demographic, and pharmacogenetic predictors of ADRs and the risk of drug-drug interactions.
ABSTRACT
Background: Diabetes mellitus (DM) represents one of the most common metabolic diseases in the world, with rising prevalence in recent decades. Most cases are generally classified into two major pathophysiological categories: type 1 diabetes mellitus (DM1), which progresses with absolute insulin deficiency and can be identified by genetic and pancreatic islet autoimmunity markers, and type 2 diabetes mellitus (DM2), which is the most prevalent form and involves a combination of resistance to the action of insulin with an insufficient compensatory response of insulin secretion. In the last two decades, in parallel with the increase in childhood obesity, there has also been an increase in the incidence of DM2 in young people in some populations. Other forms of diabetes may affect children and adolescents, such as monogenic diabetes (neonatal diabetes, MODY – maturity onset diabetes of the young, mitochondrial diabetes, and lipoatrophic diabetes), diabetes secondary to other pancreatic diseases, endocrinopathies, infections and cytotoxic drugs, and diabetes related to certain genetic syndromes, which may involve different treatments and prognoses. DM1 is considered an immuno-mediated disease that develops as a result of gradual destruction of insulin-producing pancreatic beta cells that eventually results in their total loss and complete dependence on exogenous insulin. Clinical presentation can occur at any age, but most patients will be diagnosed before the age of 30 years
ABSTRACT
PURPOSE: Diabetes or hyperglycemia at admission are established risk factors for adverse outcomes during hospitalization for COVID-19, but the impact of prior glycemic control is not clear. METHODS: We examined the relationship between clinical predictors including acute and chronic glycemia and clinical outcomes including ICU admission, mechanical ventilation (MV), and mortality among 1,786 individuals with diabetes or hyperglycemia (glucose > 10â mmol/l twice in 24â hrs.) admitted from March 2020 through February 2021 with COVID-19 infection at 5 university hospitals in the eastern U.S. RESULTS: The cohort was 51.3% male, 53.3% White, 18.8% Black, 29.0% Hispanic, with age = 65.6 ± 14.4 yrs., BMI = 31.5 ± 7.9â kg/m2, glucose = 12.0 ± 7.5â mmol/l [216 ± 135â mg/dl], and HbA1c = 8.07 ± 2.25%. During hospitalization, 38.9% were admitted to the ICU, 22.9% received MV, and 10.6% died. Age (p < 0.001) and admission glucose (p = 0.014) but not HbA1c were associated with increased risk of mortality. Glycemic gap, defined as admission glucose minus estimated average glucose based on HbA1c, was a stronger predictor of mortality than either admission glucose or HbA1c alone (OR = 1.040 [95% CI: 1.019, 1.061] per mmol/l, p < 0.001). In an adjusted multivariable model, glycemic gap, age, BMI, and diabetic ketoacidosis on admission were associated with increased mortality, while higher eGFR and use of any diabetes medication were associated with lower mortality (p < 0.001). CONCLUSIONS: Relative hyperglycemia, as measured by the admission glycemic gap, is an important marker of mortality risk in COVID-19.
ABSTRACT
Natural extracts have been of very interest since ancient times due to their enormous medicinal use and research attention. Moringa oleifera is well known as miracle tree as it consists of high nutritive values. Originally from India is widely distributed in many tropical regions, in the pacific region, west Africa as well as central America. India is the major supplier of Moringa worldwide, accounting for around 80% of global demand. It is a multipurpose plant cultivated for medicinal applications. It contains rich sources of Vit- A, B1, B2, B3 and C, It also has calcium, potassium, iron, magnesium, zinc and phospherus. Moringa species contain various phytoconstituents such as alkaloids, saponins,tannins, steroids.phenolic acids( gallic, vanillic and p-coumaric acids) and flavanoids(catechin), tocopherol ,glucosinolates and terpenes. Investigations of ethanol extract of the leaves gives lutein, B-carotene,phytyl fatty acids, esters, poly phenols, B- sitosterols,triglycerols,fatty acids and saturated hydrocarbons. Leaves were obtained by super critical extraction with CO2 using ethanol as a cosolvent, temperature 35-80 0C.The phenolic acids( gallic, vanillic and p- coumaric acids) and flavanoids(catechin) were identified in all extracts. Extracts obtained at 35 degrees shows the highest values of total phenolic compounds. The activities of plant include Anti-oxidants, anti-cancer, anti-microbial, anti-viral,anti- hyperglycemic,anti-hyperlipidemic,anti-inflammatory,anti-hypertension, anti-spasmodic and others. Due to covid-19 pandemic, the global Moringa products market size is estimated to be worth USD 5167.2 million in 2022. Leaf powder is expected to exceed USD 6 billion by 2025 on account of increasing demand in the dietary supplement and food applications.
ABSTRACT
BACKGROUND: Diabetes mellitus (DM) is a predisposing factor for the development of many infectious complications. Numerous studies have demonstrated the association of hyperglycemia in patients having DM with a high risk of a more unfavorable course of COVID-19. However, hyperglycemia is often detected in patients with a COVID-19 not having anamnesis of DM. The following remains unclear: the etiological factors causing such disorders of carbohydrate metabolism, the persistence of these disorders and the characteristics of the course, as well as their comparative effect on the outcomes of COVID-19 and the further prognosis of patients. AIM: To study the prevalence and nature of carbohydrate metabolism disorders in patients with moderate to severe course of COVID-19, as well as 6 months after it. MATERIALS AND METHODS: Hospitalized patients with a confirmed diagnosis of COVID-19 of moderate and severe course of the disease were examined. There were no medical interventions outside recommendations of patient management. The observation was carried out during two time periods: inpatient treatment of a COVID-19 and 6 months after discharge. The following were evaluated: anamnesis data, the level of fasting plasma glucose;HbA1c, the results of computed tomography of the lungs, the drug therapy taken in all patients. Descriptive statistics methods were used to evaluate the parameters. RESULTS: The study included 280 patients with a median age of 61.5±14,2 years. During the disease, a violation of carbohydrate metabolism was detected in 188 people (67%), the remaining patients (33%) made up the normoglycemia group. Patients with hyperglycemia were stratified in a following way: a group with an established diagnosis of DM before COVID -19 included — 56 people (20%), a group with steroid-induced hyperglycemia (SIH) — 95 people (34%), a group of stress- induced hyperglycaemia — 20 people (7%), with undiagnosed diabetes — 17 people (6%). In the postcovid period (after 6 months), the normal level of glycemia in the same sample group was observed in 199 people (71.4%);8 people (3%) were diagnosed with new cases of DM. The mortality rate was 10 people (3.6%) in the group of SIH (8 people) and undiagnosed DM (2 people). CONCLUSION: The use of glucocorticoids in hospitalized patients with COVID-19 leads to high incidence of SIH, which has reversible character. About 6% among hospitalized patients with a COVID-19 had undiagnosed DM and were not receiving antihyperglycemic therapy. The highest mortality was noted in the group of SIH, which allows us to conclude that SIH worsens the prognosis of patients to the greatest extent. Patients with newly diagnosed hyperglycemia, regardless of the level of hyperglycemia, are characterized by a more unfavorable course. © Endocrinology Research Centre, 2022.
ABSTRACT
Diabetes mellitus is often treated as a uniform disease in the perioperative period. Type 2 diabetes is most commonly encountered, and only a minority of surgical patients have been diagnosed with another type of diabetes. Patients with a specific type of diabetes can be particularly prone to perioperative glycaemic dysregulation. In addition, certain type-related features and pitfalls should be taken into account in the operating theatre. In this narrative review, we discuss characteristics of types of diabetes other than type 2 diabetes relevant to the anaesthetist, based on available literature and data from our clinic.
ABSTRACT
The corona virus disease-19 (COVID-19) produced by SARS-CoV-2 has resulted in a wide spectrum of illness ranging from mild to life-threatening conditions thus enhancing the incidence of opportunistic infections among individuals harbouring comorbidities. Mucormycosis is a dreadful angio-invasive opportunistic infection produced by zygomycetes fungus in an immunocompromised host. The clinical manifestations of mucormycosis include rhino-orbital-cerebral (ROC), pulmonary, cutaneous, gastrointestinal, with ROC accounting for around 40% of cases. Diabetes, neutropenia, iron overload, cancer, and organ transplant are all major culprits. Both Aspergillus and Candida have been identified as the primary fungal pathogens causing co-infection in COVID-19 preyed individuals. The most predominant variety, Rhizopus Oryzae, is responsible for roughly 60% of mucormycosis infections in humans, as well as 90% of the Rhino-orbital-cerebral (ROCM) variant. Mucormycosis is the most widespread ailment in India. Until lately, India was declared to be the world's diabetes capital, with the second-largest number of people suffering from diabetes mellitus (DM). Diabetes has been recognised as the most common predictive marker for mucormycosis which explains the dramatic rise in Mucor cases in India lately particularly during second wave of COVID-19. The inflammatory onslaught caused by COVID 19 has debilitated patients' immune systems, making individuals vulnerable to mucormycosis outbreaks. The possible explanation that Mucorales spores appear to be expediting germination in people with COVID-19 is due to the perfect scenario of oxygen deprivation (hypoxia), hyperglycemia (steroid-induced), acidic form of media (metabolic acidosis, diabetic ketoacidosis), increased iron levels (elevated ferritin), and significantly reduced phagocytic activity of white blood cells (WBC) due to immunosuppression (SARS-CoV-2 or steroid mediated or associated comorbidities). Copyright © 2022 International Medical Sciences Academy. All rights reserved.
ABSTRACT
Background: The corona virus infects many organs of the body other than the respiratory system. It is necessary to highlight other infections caused by COVID-19 and therefore, the objective of our research is to study the relationship between the novel coronavirus and hyperglycemia, and its impact on some biochemical parameters in the serum of Iraqi patients. Material and Methods: The study, which took place in Abu Ghraib-Baghdad from September to December 2021. The findings of subjects who suffer from high blood sugar were selected from the tests that were conducted for many COVID-19 patients in our laboratory, and they were not suffering from this rise previously, and they are forty subjects (20 males and 20 females). The ages of all participants was ranged from 40 and 60 years. They were found to be infected with COVID-19 after a Real-time polymerase chain reaction test from nasopharyngeal swabs. Measured the body mass index, fasting plasma glucose, glycosylated hemoglobin, some positive acute phase reactants (C-reactive protein and D-dimer), and lactate dehydrogenase in the serum. Results: All patients studied had elevated fasting plasma glucose and glycosylated hemoglobin levels. C-reactive protein and D-dimer were also elevated but lactate dehydrogenase was high in 32.5% of the studied patients. The mean of body mass index was 28.73±4.51 kg/m2 (overweight). Conclusion: We concluded that COVID-19 caused hyperglycemia in some Iraqi patients at Baghdad, in addition to respiratory infections. © 2023, ResearchTrentz Academy Publishing Education Services. All rights reserved.
ABSTRACT
Background and aims: Sodium-glucose co-transporter-2 inhibitors (SGLT-2i) are associated with diabetic ketoacidosis (DKA), though limited real-world case series are published. The aim of this study is to examine the number and characteristics of patients admitted with SGLT2i-associated DKA to our hospital over a 4-month period. Method(s): Patients were identified retrospectively following referral to the diabetes team with SGLT2i-associated DKA between September-December 2021. Medical notes were reviewed and data related to the patients' characteristics, diabetes control, usual medications and previous medical comorbidities were collected. Result(s): Twenty-two patients with SGLT2i-associated DKA were iden tified;21 (95.5%) were hyperglycaemic and 1 (4.5%) was euglycaemic. Patients had a mean age (+/-standard deviation) 60.8+/-12.3 years and HbA1c 89.2+/-29.2 mmol/mol (10.3%). Of these patients 45.5% were diagnosed with DKA alone, though some had concurrent bacterial (27.3%) or COVID-19 (18.2%) infection. There was significant treatment heterogeneity;nine (40.9%) patients were treated with insulin and 13 (59.1%) patients with other agents. Thirteen (59.1%) patients had no significant medical co-morbidity, though nine (40.9%) patients had underlying cardiovascular, respiratory and/or malignant co-morbidity. Of the 22 patients admitted with DKA, 19 (86.4%) were discharged alive, and three patients (13.6%) died during the admission. Conclusion(s): We observed no specific characteristics which predisposed to SGLT2i-associated DKA or more severe ketoacidosis in this cohort, consistent with previous studies. Most cases were in hyperglycaemic DKA, and people with SGLT2i-associated euglycaemic DKA may have been missed. Given the number of cases observed in our hospital and the associated mortality, greater awareness of the condition is essential.
ABSTRACT
BACKGROUND: Diabetes mellitus (DM) is a predisposing factor for the development of many infectious complications. Numerous studies have demonstrated the association of hyperglycemia in patients having DM with a high risk of a more unfavorable course of COVID-19. However, hyperglycemia is often detected in patients with a COVID-19 not having anamnesis of DM. The following remains unclear: the etiological factors causing such disorders of carbohydrate metabolism, the persistence of these disorders and the characteristics of the course, as well as their comparative effect on the outcomes of COVID-19 and the further prognosis of patients. AIM: To study the prevalence and nature of carbohydrate metabolism disorders in patients with moderate to severe course of COVID-19, as well as 6 months after it. MATERIALS AND METHODS: Hospitalized patients with a confirmed diagnosis of COVID-19 of moderate and severe course of the disease were examined. There were no medical interventions outside recommendations of patient management. The observation was carried out during two time periods: inpatient treatment of a COVID-19 and 6 months after discharge. The following were evaluated: anamnesis data, the level of fasting plasma glucose;HbA1c, the results of computed tomography of the lungs, the drug therapy taken in all patients. Descriptive statistics methods were used to evaluate the parameters. RESULT(S): The study included 280 patients with a median age of 61.5+/-14,2 years. During the disease, a violation of carbohydrate metabolism was detected in 188 people (67%), the remaining patients (33%) made up the normoglycemia group. Patients with hyperglycemia were stratified in a following way: a group with an established diagnosis of DM before COVID -19 included - 56 people (20%), a group with steroid-induced hyperglycemia (SIH) - 95 people (34%), a group of stress- induced hyperglycaemia - 20 people (7%), with undiagnosed diabetes - 17 people (6%). In the postcovid period (after 6 months), the normal level of glycemia in the same sample group was observed in 199 people (71.4%);8 people (3%) were diagnosed with new cases of DM. The mortality rate was 10 people (3.6%) in the group of SIH (8 people) and undiagnosed DM (2 people). CONCLUSION(S): The use of glucocorticoids in hospitalized patients with COVID-19 leads to high incidence of SIH, which has reversible character. About 6% among hospitalized patients with a COVID-19 had undiagnosed DM and were not receiving antihyperglycemic therapy. The highest mortality was noted in the group of SIH, which allows us to conclude that SIH worsens the prognosis of patients to the greatest extent. Patients with newly diagnosed hyperglycemia, regardless of the level of hyperglycemia, are characterized by a more unfavorable course. Copyright © Endocrinology Research Centre, 2022.
ABSTRACT
Objectives There have been reports of increased new onset diabetes and severity of DKA for children with diabetes following COVID19 infection and during the pandemic worldwide. Our objective is to study whether there is a change in admission rates and severity of presentation for type 1 (T1DM) and type 2 diabetes mellitus (T2DM) in our center from 2018 to 2020. Methods This is an IRB approved retrospective chart review of children admitted to our two hospitals from 1/1/18 to 12/31/20. We included ICD9 and ICD10 codes for diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar syndrome (HHS) and hyperglycemia for those with diabetes. SAS 9.4 was used for ANOVA, T-test, Poisson regression. Results We included 132 patients with 214 hospitalizations: 158 T1DM, 40 T2DM and 16 other (14 steroid induced, 2 MODY). Overall admissions increased from 3.4% in 2018, to 4.6% in 2019, and 6.4% in 2020 (p = 0.05). Overall T1DM admissions were similar across all 3 years, however T2DM rates increased from 0.4% to 0.8% to 2% (p=0.0064). Newly diagnosed T1DM rates increased from 0.4% to 0.3% to 1.7% (p=0.002), and new-onset T2DM rates also increased from 0.2% to 0.7% to 1.1% (p=0.0026). DKA increased from 2.5% to 3.5% to 4% (p=0.028). HHS increased from 0.1% to 0.2% to 0.6% (p=0.047). There was no difference in average A1c. Severity of DKA in newly diagnosed diabetes was unaffected (p=0.833). Only 3 patients tested positive for COVID 19 while everyone else was negative by COVID 19 PCR. Conclusions Our urban academic medical center is located in central Brooklyn and serves a majority who are Black (87%). As far as we know, this is the first study investigating pediatric diabetes cases admitted in central Brooklyn during the height of the pandemic. Overall, hospitalization rates in children with T2DM and in new onset T1DM and T2DM increased, despite overall admissions declining in 2020. Whether the shutdown affected patient's perception of their symptoms or another reason leading to delayed care, or change in access to care remains to be seen. Active COVID19 infection did not appear to affect patients who had been admitted for diabetes. More studies are needed to elucidate the reason for this observed increase hospitalization rates.
ABSTRACT
Just a few years ago FreeStyle Libre (FSL) was a rarely encountered device, used only by a select few people with type 1 diabetes who could afford to self-fund it. This small disc has a small cannula under the skin which allows for interstitial glucose measurements and remains in situ for 14 days. Over the last 4 years the number of people with access to this life-changing technology on the National Health Service (NHS) has increased rapidly. Although there were barriers to implementing access and encouraging uptake of this technology, including systems, healthcare professionals and the users themselves, innovative interventions from NHS England and diabetes organisations ensured those who stood to gain the most benefit were not impeded in their access, with a particular emphasis on enabling FSL use in those who are often the hardest to reach. This article reviews the impact of FSL on type 1 diabetes care in England, the key events to date and the lessons learnt that can be applied in the future for newer diabetes technologies. Copyright © 2022 BMJ Publishing Group. All rights reserved.
ABSTRACT
Aim/Introduction: PET-CT with diagnostic CT with intravenous administration of iodinated contrast allows increasing the diagnostic efficacy of the studies by combining in a single exploration the anatomical information of CT and the metabolic information of PET. A small percentage of these patients will show incidental findings that require urgent management of the patient, taking into account that most of them are oncologic patients. Otherwise, SARSCoV-2 has caused the coronavirus disease 2019 (COVID-19) throughout the world turning into a public health emergency. PET-CT studies of some asymptomatic cancer patients showed lung involvement suggestive of COVID-19 pneumonia. Our aim is to retrospectively analyze patients who required urgent medical attention when they attended for a PET-CT scan during the years 2020 and 2021. Material(s) and Method(s): We did a retrospective review of the reports of 9057 PET-CT scans performed in our hospital during the years 2020 and 2021 (8884 with18F-FDG, 5068Ga-DOTATOC, 10618F-Fluorocholine, 1418F-DCFPyL and 318F-FDOPA). From those, 8499 (93,8%) were oncologic patients. Patients who were referred to the Emergency Department from Nuclear Medicine due to hyperglycemia or incidental findings in the PET-CT scan requiring urgent medical attention were selected. The studies were acquired after intravenous injection of radiotracer, in a PET-CT camera (multidetector CT). Most studies were performed with intravenous (i.v.) iodinated contrast, acquiring a chest sequence in inspiration and arterial phase and another full body sequence in portal phase. Each study was evaluated by an expert nuclear medicine physician and a radiologist. A single report was subsequently drawn up. Result(s): 143 patients (1.57%) with an incidental finding requiring urgent attention were identified. Twelve of these patients (8,39%) were referred to the Emergency Department for the presence of hyperglycemia greater than 350mg/dl so that PET-CT scan could not be performed. The most frequent incidental findings in PETCT images were: pulmonary thromboembolism (34 patients;23.8%), venous thrombosis (25;17.5%) and pulmonary infiltrates suggestive of COVID 19 disease (15;10.5%). The most frequent pathologies among the patients studied were lung cancer (30 patients), breast cancer (28 patients) and head and neck cancers (15 patients). Conclusion(s): PET-CT has proven to be useful in the incidental finding of medical pathologies that require urgent medical attention. Likewise, the performance of a directed chest CT with iodinated contrast within the PET-CT protocol has contributed to the diagnosis of pulmonary thromboembolism, a relatively frequent finding in oncologic patients.
ABSTRACT
Background: An increased serum glucose level is a common finding among patients admitted to hospital with acute illness, including the intensive care unit (ICU), even without a history of previous diabetes mellitus (DM]. Glycated hemoglobin (HbAlc) is not only a diagnostic tool for DM but may also has prognostic value for diabetic and non-diabetic populations. Objective(s): To assess the relationship between HbA1c level on admission and clinical outcome among patients admitted to the ICU due to cardiopulmonary disorders with hyperglycemia. Method(s): Patients consecutively admitted to the ICU due to cardiopulmonary disorders who presented with hyperglycemia at admission were evaluated during a 6-month period. HbAlc and serum glucose levels were tested on admission and during the first 24-48 hours of hospitalization. Patients were divided according to HbA1c and compared in term of demographics. We evaluated the effect of HbA1c levels at admission on the clinical outcomes. Result(s): Of patients with cardiopulmonary disorders who presented with hyperglycemia at admission to the ICU, 73 had HbA1c levels 6%, 92 had HbA1c levels < 6%: 63/165 (38.2%) known as diabetic patients. The 30-day all-cause mortality was higher in the group with high HbA1c levels;38/73 vs. 32/98 (P= 0.02). Increased length of stay in the ICU and Acute Physiology and Chronic Health Evaluation II (APACHE II) score were associated with HbA1 c 6% (P < 0.022 and P < 0.026), respectively Conclusion(s): HbAlc 6% has an important clinical prognostic value among diabetic and non-diabetic patients with cardiopulmonary disorders and hyperglycemia. Copyright © 2022 Israel Medical Association. All rights reserved.
ABSTRACT
INTRODUCTION: Glycemic control is an important component of quality improvement bundles within the ICU. Dysglycemia among intensive care unit (ICU) patients has been associated with greater morbidity and mortality. The COVID-19 pandemic has been shown to influence hypoglycemia in patients presenting to the emergency department. The purpose of this study is to evaluate risk factors for dysglycemia during the COVID-19 pandemic in critically ill ICU patients on subcutaneous insulin. METHOD(S): Single-center, retrospective quality improvement study of adult critically ill patients admitted to the ICU in 2020. Patients were included if they were on subcutaneous insulin and primarily managed by an intensive care unit multidisciplinary team. Patients were excluded with active endocrinology consultation or receiving intravenous insulin infusion. Rates of hyperglycemia (blood glucose (BG) greater than or equal to 180 mg/dL), severe hyperglycemia (BG > 300 mg/dL), hypoglycemia (less than or equal to 70 mg/dL), or severe hypoglycemia (BG < 54 mg/dL) were evaluated. Basic patient demographics, including history of diabetes, steroid use, COVID-19 diagnosis were obtained. Regression analysis was performed adjusting for age, past medical history of diabetes, use of corticosteroid medications, COVID-19 diagnosis and use of a self-adjusting insulin calculator. RESULT(S): There were 244 adult ICU patients and 2,198 patient days evaluated in this study. History of diabetes was associated with greater odds of hyperglycemia (odds ratio (OR) 2.09 (1.57-2.78), p< 0.01), severe hyperglycemia (OR 1.82 (1.02-3.24), p=0.04), and lower risk for severe hypoglycemia (OR 0.24 (0.07-0.81), p=0.02). Corticosteroid use was associated with greater risk of hyperglycemia (OR 3.04 (2.31-3.99), p< 0.01) and severe hyperglycemia (OR 4.54 (2.59-7.95), p< 0.01), with no significant difference in hypoglycemia. COVID-19 diagnosis was associated with greater hyperglycemia (OR 1.49 (1.11-2), p=0.007) and hypoglycemia (OR 3.93 (1.32-11.73), p=0.01). CONCLUSION(S): In our quality improvement analysis, dysglycemia was found to be more prevalent in patients with corticosteroid use, history of diabetes and patients with a COVID-19 diagnosis. Larger studies would be beneficial to confirm these results.
ABSTRACT
INTRODUCTION: New onset hyperglycemia is common in patients with severe Covid-19 infection. Cytokine storm due to Covid-19 infection is an important etiology for new-onset hyperglycemia, but factors like direct SARS-CoV-2 induced pancreatic beta-cell failure have also been postulated to play a role. We assessed the validity of the cytokine-induced hyperglycemia hypothesis by evaluating the association between inflammatory markers and new onset hyperglycemia in non-diabetic patients with Covid-19 infection. METHOD(S): We conducted a retrospective case-control study on adults without diabetes mellitus hospitalized for Covid-19 infection. The serum levels of glucose and inflammatory markers at presentation before initiation of corticosteroid were collected. Hyperglycemia was defined as glucose levels >=140mg/dL. CRP >=100mg/L, ferritin >=530ng/ mL, LDH>=590U/L, and D-dimer >=0.5mg/L were considered elevated. We used Chi-square test for categorical variables, Mann Whitney U test for continuous variables, and calculated the logistic regression for hyperglycemia. RESULT(S): Of the 520 patients screened, 248 met the inclusion criteria. Baseline demographics were equally distributed between the two groups. There were no statistically significant differences between serum inflammatory markers except LDH in patients with or without new-onset hyperglycemia [CRP(58.1%vs.65.6%,p-0.29), ferritin (48.4%vs.34.9%, p-0.14),D-dimer (37.1%vs.37.1%,p-0.76) & LDH (19.4%vs11.8%,p-0.02)]. However, Logistic regression analysis showed no difference in LDH levels between the two groups (OR-1.623,p-0.256). Additional analysis showed significantly higher mortality (24.2%vs.9.1%,p-0.001;OR-2.528,p-0.024) and length of stay(8.89 vs 6.69,p-0.026) in patients with hyperglycemia. CONCLUSION(S): Our pilot study showed no association between inflammatory marker levels and new-onset hyperglycemia in non-diabetic patients with Covid-19 infection, thus questioning the validity of the Covid-19 cytokine storm-induced stress hyperglycemia hypothesis. Our study also showed that new-onset hyperglycemia is an independent risk factor for higher mortality and length of stay. In light of the findings of our small single-center study, it becomes imperative to undertake a larger prospective study to understand the mechanism of SARS-CoV-2 infectioninduced hyperglycemia.
ABSTRACT
INTRODUCTION: Admissions to the intensive care unit (ICU) for children with hyperglycemic crisis (HGC, defined as diabetic ketoacidosis, hyperglycemic hyperosmolar syndrome, or hyperosmolar ketoacidosis) increased during the COVID-19 pandemic, possibly from social distancing resulting in decreased or delayed health care access. We sought to determine if severity of illness for HGC changed from pandemic year 1 to year 2 as social distancing restrictions lightened. METHOD(S): Retrospective study of children <= 18 y/o hospitalized from 3/2017 to 3/2022 in the Pediatric Health Information System for HGC. PreCOVID years (3/2017- 3/2020), COVID-19 year 1 (3/2020-3/2021), and COVID-19 year 2 (3/2021-3/2022). The primary outcome was ICU admission. Secondary outcomes included ICU length of stay (LOS) >3 days, use of therapies for neurologic compromise, and cost. RESULT(S): From 42 hospitals, 46,220 patients were admitted with HGC, of these, 19,889 patients were admitted to the ICU. There was a decrease in ICU admissions from COVID-19 year 1 (47.4%) to year 2 (44.6%) but both remained higher than PreCOVID (40.7%). Median admission cost remained elevated in year 1 ($11,134 [IQR $6,412, $13,060) and year 2 ($11,057 [IQR $7,974, $15,997]) compared to PreCovid ($9,206 [IQR $7,741, $16,069]). In multivariable analysis, when compared to PreCOVID, ICU admissions for HGC were higher in COVID-19 year 1 (OR 1.31 [95%CI 1.25-1.37], p< 0.01) and year 2 (OR 1.16 [95% CI 1.10-1.22], p< 0.01) after controlling for confounding variables. However, ICU admissions were higher in year 1 than year 2 (OR 1.13, 95% CI [1.075-1.20], p=< 0.01). ICU LOS >3days increased when compared to PreCOVID years (COVID-19 Year 1: OR 1.70, [95% CI: 1.38-2.09], p< 0.01, Year 2: OR: 1.6 [95% CI 1.3-1.97], p< 0.001) but there was no difference between year 1 and 2 (p=0.6). Therapies for neurologic compromise increased in COVID-19 year 1 (p< 0.01) and year 2 (p < 0.01) in comparison to PreCOVID years but there was no change between COVID-19 years (p=0.15). CONCLUSION(S): During the COVID-19 pandemic, children with HGC were admitted with a higher severity of illness than pre-COVID. This pattern continued during Covid-19 year 2 despite reduction in social distancing although need for ICU admission was higher in COVID-19 Year 1 than Year 2.
ABSTRACT
Background. The COVID-19 pandemic has caused an unprecedented global public health emergency. Vaccine uptake in low and middle income countries (LMICs) lags developing nations and immunity from vector-based vaccines commonly used in LMICs may be inferior to mRNA vaccines. Thus, defining clinical characteristics that can help identify and triage cases and allocate resources in LMICs of priority. Hyperglycemia has been associated with higher morbidity and mortality in numerous diseases and in critical illness. We seek to understand the relationship between COVID-19 and hyperglycemia. Methods. This is a single center retrospective review of cases with COVID-19 between January 2021 and June 2021. Adult patients >18 years of age were reviewed and those with a molecular-based laboratory confirmed SARS-CoV-2 infection were included in our study. Patients with known diabetes, elevated A1C or prior steroid use within 2 weeks of admission were excluded. Clinical characteristics, demographics, glucose levels, C-reactive protein (CRP) and ferritin were reviewed. Results. A total of 120 patients were reviewed, of which 60.8% were male. Hyperglycemia ( >140mg/dL) was present in 57.5%. Hyperglycemia was associated with elevation of inflammatory markers including CRP and Ferritin (p=0.12) (Table 1). Hyperglycemia was more common in patients requiring supplemental low flow oxygen (table 2) and was more common in patients who did not survive (Figure 1). The mortality rate was higher in the hyperglycemia group with 61.5%, a statistically significant finding. Association between hyperglycemia and inflammatory markers. Conclusion. Hyperglycemia on admission was an independent risk factor for disease progression and death. Inflammatory markers were also higher in patients with hyperglycemia. These patients had no prior steroid use or diabetes. Thus, it is possible that it reflects inflammation, stress, or endocrine end-organ damage due to SARS-CoV-2. If validated in larger studies, this simple test can help clinicians identify patients at risk of decompensation and allocate resources and therapeutics accordingly.