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1.
Journal of clinical research in pediatric endocrinology ; 14(3):368-369, 2022.
Article in English | MEDLINE | ID: covidwho-2024913
2.
Journal of clinical research in pediatric endocrinology ; 14(3):267-274, 2022.
Article in English | MEDLINE | ID: covidwho-2024911

ABSTRACT

Objective: Diabetic ketoacidosis (DKA) - a potentially preventable complication of type 1 diabetes mellitus (T1D) - is one of the most common chronic childhood diseases, and is associated with a significant risk of morbidity and mortality. The limited use of healthcare services due to fear of Coronavirus disease-2019 (COVID-19) transmission during the pandemic has raised concerns of delays in T1D diagnosis, among other diseases. This study investigated the presenting characteristics of newly diagnosed T1D patients assessed in a single clinic during the pandemic and compares them with the pre-pandemic period. Methods: For the purpose of this study, the first year of the pandemic is referred to as the "pandemic period", and the previous three years as the "pre-pandemic period". Patient files were reviewed retrospectively, the demographic and clinical characteristics and laboratory findings of the patients were recorded, and the findings from both periods were compared. Results: The number of patients diagnosed with T1D in the pandemic period was 44, and in the pre-pandemic period 39 in 2017, 22 in 2018 and 18 in 2019. The two groups had similar age, sex, pubertal stage and anthropometric characteristics (p>0.05). Regarding the type of presentation, the frequency of DKA was significantly higher in the pandemic period (68.2%) than in the pre-pandemic period (40.5%) (p=0.006), and this difference was also observed in the comparison by years (p=0.016). The duration of symptoms (16.5+/-10.7 vs. 23.5+/-17.6 days) and the length of hospital stay (10+/-3.9 vs. 15.2+/-5.5 days) were significantly shorter in the pandemic period (p=0.032, and p<0.001, respectively). There was no difference in the frequency of severe DKA between the pandemic (46.7%) and the pre-pandemic (37.5%) periods (p>0.05). However, pH (7.17+/-0.16 vs. 7.26+/-0.14) and bicarbonate (12.8+/-6.3 vs. 16.6+/-6.3) levels were significantly lower in the pandemic period (p<0.005). Additional signs of infection on admission were less frequent in the pandemic period (9.1%) than in the pre-pandemic period (27.8%) (p=0.027). The groups did not differ in terms of hemoglobin A1c, C-peptide, concurrent thyroid autoantibodies and tissue transglutaminase antibodies (p>0.05). The rate of anti-glutamic acid decarboxylase positivity was higher in the pandemic period (73.8% vs. 39.2%) (p=0.001) while the frequency of other diabetes-associated autoantibodies was similar between the groups (p>0.05). The polymerase chain reaction test for COVID-19 was negative in six patients with a history of contact. Conclusion: There was an increased frequency and severity of DKA in children with newly diagnosed T1D in the pandemic period, and these findings justify concerns related to the diagnosis of other diseases during the pandemic. Studies to raise awareness of diabetes symptoms during the pandemic should be continued regularly to reach all segments of society. Our study provides an additional contribution to the literature in its coverage of the one-year period during the pandemic and its comparison with the previous three years.

3.
Archives of Disease in Childhood ; 107(Suppl 2):A11-A12, 2022.
Article in English | ProQuest Central | ID: covidwho-2019814

ABSTRACT

AimsPaediatric emergency departments saw an unusual increased incidence and severity of disease presentation in children with new onset diabetes in the early phase of the COVID-19 pandemic. The DIMPLES study(Diabetes Mellitus in children and young people presenting to the Emergency Department during the SARS-CoV-2 pandemic) aimed to characterise the features of children presenting to Paediatric Emergency Department with new onset diabetes in the COVID-19 pandemic, exploring the incidence and severity of diabetic ketoacidosis (DKA).MethodsThe DIMPLES study is a retrospective multicentre study done across 49 paediatric emergency departments providing a unique perspective of new onset diabetes paediatric diabetes from the frontline.We compared the characteristics of children aged 6 months to 16 years presenting to the Paediatric Emergency Departments across UK and Ireland with new onset diabetes in the pandemic (March 1, 2020 to February 28, 2021) with the children presenting in the same time period over the pre pandemic period (March 1, 2019 to February 28, 2020).ResultsDuring the COVID pandemic year, there were increase from the pre-pandemic year in children with new onset diabetes presenting with DKA (pH <7.3;from 395 to 566;43% rise), severe DKA (pH <7.1;from 141 to 252;a 79% rise), and admissions to intensive care (from 38 to 72;89% rise), suggesting an increase in incidence and severity of new-onset diabetes. An increase in the incidence of new onset diabetes from 1015 to 1176 was noted in the pandemic(16% increase compared to an estimated increase of 2-4% per year).The median age of children who presented with new onset diabetes in the pandemic, the duration of symptoms before presentation and the ethnicity was similar to the pre pandemic period. Delay did not appear to be a significant factor in the pandemic compared to the pre pandemic period in the majority of cases.There was a paucity in testing for COVID-19 antibodies, 37/1176 children with new onset diabetes were tested with n=8 children testing positive for IgG/IgM COVID-19 antibodies. 12 children with new onset diabetes tested positive for SARS-CoV-2 on nasopharyngeal swabs, 7 presented with moderate to severe DKA and 3 presented with mild DKA.ConclusionThe DIMPLES study showed an increase in the number and severity of children presenting to the Paediatric Emergency Department with new onset diabetes and DKA in the COVID -19 pandemic. Proving association or causation was challenging given the small number of children tested for COVID-19 antibodies. When the incidence and severity at presentation is interpreted in the context of high levels of SARS-CoV-2 in the community and a low incidence of other viral infectious triggers it appears that COVID -19 may have a role as an accelerator or possibly even a precipitator of new onset diabetes in a genetically predisposed child.

4.
Annals of the Rheumatic Diseases ; 81:376, 2022.
Article in English | EMBASE | ID: covidwho-2008865

ABSTRACT

Background: Data on the long-term efficacy and safety of tocilizumab (TCZ) for giant cell arteritis (GCA), including incidence and timing of disease relapse after TCZ discontinuation, is limited. Objectives: We aimed to evaluate the long-term outcomes of GCA patients treated with TCZ in a real-world setting. Methods: Retrospective analysis of GCA patients treated with TCZ for >9 months at a single center between 2010-2021. Time to relapse and annualized relapse rate during and after TCZ treatment, prednisone use and safety were assessed. Relapse was defned as the re-appearance of clinical manifestations of GCA that required treatment intensifcation regardless of the erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) levels. The duration of TCZ treatment was determined as per the best clinical judgement of the treating rheumatologist. Results: A total of 57 GCA patients were followed for a mean (SD) period of 3.4 (1.7) years. Baseline characteristics and treatments received are shown in Table 1. Patients were maintained on their initial TCZ course for a mean (SD) period of 2.0 (1.3) years. The initial TCZ course lasted >12 months in 50 (88%) patients. During the initial TCZ course, 8 (14.0%) patients relapsed. Kaplan-Meier (KM) estimated relapse rates on TCZ were 10.5% and 14.9% at 12 and 18 months, respectively (Figure 1A). TCZ was discontinued due to long-term remission in 37 (64.9%) patients and after an adverse event in 6 (10.5%) patients. Of the 43 patients stopping TCZ due to remission or adverse event, 19 (44.2%) subsequently relapsed. KM estimated relapse rates after TCZ discontinuation were 30.4% and 44.0% at 12 and 18 months, respectively (Figure 1B). Overall, 12 patients received more than one TCZ course. The aggregation of all TCZ courses (mean 2.5 years) and all periods off TCZ following the initial TCZ treatment (mean 0.9 years) showed that 11 (19.3%) patients relapsed while on TCZ and 20 (35.1%) patients relapsed during time off TCZ. An analysis adjusting for age, sex, prednisone dose at initiation of frst TCZ course, and disease type (new onset vs. relapsing) at initiation of frst TCZ course showed an annualized relapse rate (95% CI) of 0.1 (0.0-0.2) during TCZ treatment and 0.4 (0.3-0.7) off TCZ (rate ratio 0.2, p<0.0001). By the end of follow up, 42 (73.7%) patients were able to wean off prednisone. During the study, 12 serious adverse events occurred in 11 (19.3%) patients. Among those 12 events, 3 (25%) were related or possibly related to TCZ exclusively (i.e., soft tissue infection, bacteremia, and COVID-19), 3 (25%) to prednisone exclusively (i.e., osteoporotic fracture, diabetic ketoacidosis and stroke), and 2 (16.7%) to either TCZ or prednisone (i.e., pneumonia and sepsis). Conclusion: Long-term TCZ treatment was efficacious in maintaining disease remission and sparing the use of prednisone in patients with GCA. Over 40% of patients stopping TCZ after long-term remission or adverse event relapsed following TCZ discontinuation.

5.
Journal of the ASEAN Federation of Endocrine Societies ; 37:46, 2022.
Article in English | EMBASE | ID: covidwho-2006560

ABSTRACT

Introduction Management of type 1 diabetes mellitus (T1 DM) patients in early adulthood is associated with unique challenges. COVID-19 pandemic had significantly impacted the quality of patient follow-up and access to care. This study assessed the characteristics of T1 DM patients under diabetes onestop clinic (DOSC) follow-up in Hospital Sultan Haji Ahmad Shah (HoSHAS), Temerloh, Pahang and the impact of the pandemic on diabetes control. METHODOLOGY In this cross-sectional study, all T1 DM patients under active follow-up were recruited. Data regarding demographics, diabetes control and COVID-19 infection status were reviewed. Further analyses were performed by dividing them into 2 groups according to COVID-19 infection status: COVID-19 positive (group 1) and COVID-19 negative (group 2). Results Thirty T1 DM patients [60% female, 63.3% Malay ethnicity, mean age 24.4 (SD7.4) years, median weight 58.35(IQR 10.3) kg, median disease duration 6.0 (IQR 8.0) years, mean duration under DOSC follow-up 4.1(SD 1.6) years] were analysed. Incident retinopathy was seen in 10.0% of patients. Within the past 12 months, 26.7% had recent hospitalisation, majority due to diabetes ketoacidosis. Within the past 3 months, 13.3% had experienced hypoglycaemia. Mean HbA1c in T1 DM increased steadily from 2019 to 2020 and 2021 (8.87% vs 8.93% vs 9.35%). Thirteen T1 DM patients (46.4%) had COVID-19 infection between 2020 and 2022. Patients with COVID-19 infection had lower HbA1c than those not infected but it was not statistically significant (8.74% vs 9.07%, p=0.82). They also tended to have more microvascular complications. Conclusion COVID-19 pandemic had negatively impacted diabetes control in our cohort. There was also a high hospitalisation rate during this period. The HbA1c level was not associated with increased risk of COVID-19 infection in our cohort.

6.
Journal of the ASEAN Federation of Endocrine Societies ; 37:43, 2022.
Article in English | EMBASE | ID: covidwho-2006559

ABSTRACT

Introduction Individuals with diabetes have similar risk of contracting COVID-19 infection compared to those without diabetes. However, COVID-19 patients with diabetes are at a higher risk for severe outcomes and death. The occurrence of hyperglycaemic emergency and diabetic ketoacidosis (DKA) may worsen the outcomes of COVID-19 infection. This study will determine the characteristics of COVID-19 patients admitted with hyperglycaemic emergency and mortality outcomes in Hospital Sultan Haji Ahmad Shah, Temerloh, Pahang. Methodology All electronic records of COVID-19 patients admitted from March 2021 until March 2022 were reviewed for occurrence of hyperglycaemic emergency. Data regarding demographics, clinical presentation, laboratory investigations and clinical outcomes were collected. Further analysis with patients subcategorised into 2 timelines: March-December 2021 (group 1) and January-March 2022 (group 2) reflecting two surges of COVID-19 admission to the hospital was done. Results Twenty-four COVID-19 patients with hyperglycaemic emergency [mean age 56.7 (SD 15.6) years, 54.2% female, 79.2% Malay ethnicity, 95.8% type 2 diabetes mellitus, 54.2% unvaccinated, 70.8% category 5 infection] were analysed. Majority of patients had DKA at 79.2% [mean pH 7.16(SD 0.12), mean HCO3 10.80 (SD 3.07), mean glucose at diagnosis 25.3 (SD 11.0) mmol/L]. The mean length of hospitalisation was 11.42 (SD 7.4) days and mortality rate was 63.2%. Nine DKA cases were detected in group 1 compared to 10 cases during the shorter timeline in group 2. All patients had resolved DKA but the majority succumbed later due to complications of COVID-19 infection. Mortality rates in both groups were 66.7%(n=6) and 60%(n=6), respectively. Conclusion Despite high occurrence of uncontrolled diabetes during COVID-19 infection in this cohort, only a small proportion had hyperglycaemic emergency. In both timeline of hospitalisation surge, COVID-19 patients with concomitant hyperglycaemic emergency had poorer prognosis.

7.
Journal of the ASEAN Federation of Endocrine Societies ; 37:39, 2022.
Article in English | EMBASE | ID: covidwho-2006558

ABSTRACT

Introduction In the era of the COVID-19 pandemic, several cases of new onset diabetes associated with COVID-19 have been reoprted. Additionally, patients with diabetes, a high-risk population, are prioritised for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. The vaccine against the (SARS-CoV-2) could represent a new environmental trigger for autoimmune disorders such as Graves' disease, immune thrombotic thrombocytopenia, autoimmune liver diseases, Guillain-Barré syndrome, systemic lupus erythematosus and type 1 diabetes. case We report a case of diabetic ketoacidosis in a new onset Type 1 diabetes in an elderly female following SARSCoV- 2 vaccination. A 69-year-old female with a history of treated TB abdomen in 2015 with no history of diabetes received her second dose of SARS-CoV-2 vaccination (COMIRNATY) on 21st August 2021. Two weeks following vaccination, she developed osmotic symptoms, reduce appetite and lethargy. Her random blood glucose (RBS) was 41 mmol/L, serum ketone 4.4 mmol/L, pH of 7.29 mmHg, bicarbonate 12.5 mmol/L and serum osmolarity of 298 mOsm/kg. She was treated for DKA with intravenous insulin infusion and hydration with resolution of DKA within 12 hours. Anti-Glutamic Acid Decarboxylase and anti-Islet Cells antibodies were positive with low fasting C-peptide of 102 pmol/L. She was discharged well with basal bolus insulin. Four months later, HbA1c reduced from 15.6% to 7.7% with a random C-peptide of 152 pmol/L. Conclusion The occurrence of hyperglycaemia crisis following SARSCoV- 2 vaccine in patients with pre-existing diabetes is known but the occurrence of new onset autoimmune diabetes following vaccination is rare. Further studies are needed to better understand the underlying pathogenesis of autoimmune diabetes following SARS-CoV-2 vaccine.

8.
Journal of the ASEAN Federation of Endocrine Societies ; 37:25-26, 2022.
Article in English | EMBASE | ID: covidwho-2006554

ABSTRACT

INTRODUCTION Fluid management is a delicate process when it involves an anuric end-stage renal disease (ESRD) patient on regular hemodialysis, who has Coronavirus Disease-19 (COVID-19) pneumonia in acute respiratory distress syndrome (ARDS). The management is made even more challenging when the condition of the patient is complicated with starvation ketoacidosis. There is limited literature with regards to this issue. CASE We report the case of a 55-year-old male patient with ESRD, who is suffering from COVID-19 pneumonia in ARDS with concomitant starvation ketoacidosis. CONCLUSION Starvation ketoacidosis is an under-recognized cause of metabolic acidosis and may occur even in a diabetic patient who has been acutely unwell with poor oral intake. While the mainstay of therapy in a patient with starvation ketoacidosis is to provide an intravenous dextrosecontaining fluid replacement, this has to be judiciously given in an anuric ESRD patient on fluid restriction. A careful balance between low-dose insulin infusion to maintain euglycemia and strict fluid management is crucial to stop gluconeogenesis and ketogenesis. The ultimate goal is to bring the patient out of starvation ketoacidosis while avoiding the deleterious effect of fluid overload in a patient who is already in ARDS.

9.
Frontiers in Endocrinology ; 13, 2022.
Article in English | EMBASE | ID: covidwho-2005860

ABSTRACT

A 39-year-old-woman with a past medical history of type 2 diabetes mellitus (T2DM) on oral hypoglycemic agents presented to the emergency room with nausea, vomiting, shortness of breath, and altered mental status. Seven days prior to presentation, she was diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Laboratory workup on presentation confirmed the diagnosis of diabetic ketoacidosis (DKA) (blood glucose 523 mg/dl, beta-hydroxybutyrate 8.91 mmol/l, pH 6.9, bicarbonate 11 mEq/l, anion gap 25 mEq/l, and HbA1c 10.8%). She was managed for DKA with hydration and insulin drip and discharged home. However, to our surprise, at the 2-week follow-up visit, she was found to have positive antibodies for zinc transporter 8 (ZnT8) (samples were collected on day of presentation). The rest of her antibodies associated with T1DM were negative. She was therefore started on a basal-bolus regimen and managed as type 1 diabetes mellitus (T1DM). Our case illustrates that there is an increased risk of T1DM following infection with SARS-CoV-2.

10.
Open Life Sciences ; 17(1):917-937, 2022.
Article in English | Web of Science | ID: covidwho-2005772

ABSTRACT

Mucormycosis (MCM) is a rare fungal disorder that has recently been increased in parallel with novel COVID-19 infection. MCM with COVID-19 is extremely lethal, particularly in immunocompromised individuals. The collection of available scientific information helps in the management of this co-infection, but still, the main question on COVID-19, whether it is occasional, participatory, concurrent, or coincidental needs to be addressed. Several case reports of these co-infections have been explained as causal associations, but the direct contribution in immunocompromised individuals remains to be explored completely. This review aims to provide an update that serves as a guide for the diagnosis and treatment of MCM patients' co-infection with COVID-19. The initial report has suggested that COVID-19 patients might be susceptible to developing invasive fungal infections by different species, including MCM as a co-infection. In spite of this, co-infection has been explored only in severe cases with common triangles: diabetes, diabetes ketoacidosis, and corticosteroids. Pathogenic mechanisms in the aggressiveness of MCM infection involves the reduction of phagocytic activity, attainable quantities of ferritin attributed with transferrin in diabetic ketoacidosis, and fungal heme oxygenase, which enhances iron absorption for its metabolism. Therefore, severe COVID-19 cases are associated with increased risk factors of invasive fungal co-infections. In addition, COVID-19 infection leads to reduction in cluster of differentiation, especially CD4+ and CD8+ T cell counts, which may be highly implicated in fungal co-infections. Thus, the progress in MCM management is dependent on a different strategy, including reduction or stopping of implicit predisposing factors, early intake of active antifungal drugs at appropriate doses, and complete elimination via surgical debridement of infected tissues.

11.
Diabetologie Und Stoffwechsel ; 17(04):265-276, 2022.
Article in English | Web of Science | ID: covidwho-2004810

ABSTRACT

The incidence and mortality of diabetic ketoacidosis (DKA) have hardly changed in recent years. Recurrent DKA in particular is characterised by a high mortality rate of about 23%. Young people with type 1 diabetes are more often hospitalised for DKA than for severe hypoglycaemia. COVID-19 probably leads to a higher incidence of DKA - especially in people with type 2 diabetes. Major risk factors for recurrent DKA include female gender, age between 13 and 25 years, higher HbA (1c) , migrant background and mental illness. Education on DKA should create awareness of the dangers of DKA and develop a concrete plan of action in case of emergency. Hypoglycaemia is the limiting factor of insulin therapy and is associated with increased diabetes-related distress and increased risk of cardiovascular events. The incidence of severe hypoglycaemia over 12 months is around 8%. The effective use of diabetes technologies should be an integral part of diabetes education. The most important technology-related education content includes alarm setting limits, the correct use of trend arrows, training in pattern recognition in the ambulatory glucose profile (AGP) and knowledge of automatic (predictive) low glucose suspend functions in automated insulin delivery (AID) systems. Hypoglycaemia unawareness occurs when the body becomes accustomed to low glucose levels and the autonomic response to low glucose levels weakens. The basis of hypoglycaemia-awareness training is systematic self-observation of one's own physical symptoms at different glucose levels.

12.
New Zealand Journal of Medical Laboratory Science ; 76(2):104-105, 2022.
Article in English | EMBASE | ID: covidwho-2003249
13.
Pediatrics ; 149, 2022.
Article in English | EMBASE | ID: covidwho-2003087

ABSTRACT

Introduction: Pulmonary artery aneurysms (PAAs) are exceedingly rare. Etiology includes congenital, idiopathic, and acquired. Bacterial and fungal infections are the most common acquired causes. Herein described is a patient with new-onset diabetes mellitus I (DM1) with COVID-19 infection complicated by PAA and mucormycosis. Case Description: A 17-year-old female with new-onset DM1 was admitted to the PICU with diabetic ketoacidosis, and COVID-19 infection complicated by multifocal necrotizing pneumonia. She was treated with remdesivir, antibiotics, systemic glucocorticoids, and discharged on inhaled glucocorticoids. Two weeks later she presented with hemoptysis. Chest computed tomography angiography (CTA) showed a resolving necrotizing pneumonia with a 16 mm aneurysmal dilatation of the proximal portion of the right inferior pulmonary artery (RIPA). Hemoptysis resolved, with no intervention required. One month later she presented again with hemoptysis. Repeat chest CTA demonstrated increasing aneurysmal dilatation, measuring 20 mm in diameter. Echocardiography showed no evidence of endocarditis, congenital heart defects, or elevated right ventricular pressures. A comprehensive infectious workup was negative (Table 1). Due to recurrent symptoms, progressive aneurysmal enlargement, and concerns for rupture, patient underwent RIPA occlusion by cardiac catheterization. Two months later hemoptysis recurred. Chest CTA revealed erosion of the occlusion device into the right inferior segmental bronchus. She underwent emergent right middle and lower lobectomy, and arterial bronchial fistula repair. Lung histology revealed non-septate hyphae with peribronchial and perivascular necrotizing granulomas concerning for mucormycosis (Figure 1). She was treated with amphotericin B and discharged on oral posaconazole. Discussion: The incidence of PAA in adults is estimated to be 1 in 14,000 patients. In adults, the upper limit of normal of an interlobar PA by CTA is 17mm. Our patient's RIPA was dilated up to 20 mm, for which she underwent occlusion of the RIPA. The proinflammatory state generated by COVID-19 can result in vascular inflammation and ultimately aneurysmal dilatation. Desnos et al. reported four cases of hemothorax secondary to PAA rupture in COVID-19 patients on ECMO for severe ARDS. The etiology for PAA formation in our patient had a complex interplay of factors including new-onset diabetes, COVID-19 vasculitis, exposure to systemic glucocorticoids, and an opportunistic infection with Mucor spp. Mucormycosis in diabetic patients with COVID-19 has a mortality of 31% in adults. We believe that the lobectomy performed for the management of PAA in our patient led to better outcomes since surgical debridement is a mainstay of mucormycosis treatment, along with antifungal therapy. Conclusion: PAA in children is uncommon. We describe a diabetic patient with COVID-19 pneumonia, complicated by PAA and mucormycosis. In patients with COVID-19 presenting with hemoptysis, it is important to have a high index of suspicion for PAA. Furthermore, diabetic patients with COVID-19 treated with systemic steroids can be at increased risk for mucormycosis. (Table Presented).

14.
Journal of General Internal Medicine ; 37:S611, 2022.
Article in English | EMBASE | ID: covidwho-1995803

ABSTRACT

SETTING AND PARTICIPANTS: AvoMD can be used in any context, including general internal medicine inpatient and outpatient settings. It can be used by clinicians at all levels of training from residents to senior attendings. DESCRIPTION: AvoMD is a platform that transforms clinical content - guidelines, algorithms, pathways, and checklists - into decision support: highly usable, interactive apps available on mobile and web, and is capable of Electronic Health Record (EHR) integration. In addition, the AvoMD platform facilitates a builder community for its users to advance clinical decision tools through peer collaboration. EVALUATION: AvoMD has been evaluated at multiple levels, including its impact on clinical decisions and learner engagement. In a randomized control trial focused on ABG interpretation, the use of AvoMD software improved diagnostic accuracy by 20% while saving clinicians 45% of their time in information retrieval (1). Initial studies also showed the potential of this software to provide just-in-time learning for obstructive sleep apnea, diabetic ketoacidosis, and COVID-19 illness (2-4). Furthermore, avoMD analytics can provide insights on how trainees engage with guidelines and inform educators with valuable feedback to precisely modify their instruction to different cohorts of learners. (1) Cha, J, et. al "Randomized control trial of avoMD clinical decision support at Samsung Medical Center for ABG" in Press (2) Park, Joongheum, and Hwan Kim. "Evidence-Based App for the Evaluation and Treatment of OSA: Development of a Mobile App by Two Medical Residents." Chest 152.4 (2017): A1079. (3) Saperstein, Yair, Joongheum Park, and Samy I. McFarlane. "Closing the Mortality Gap in Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State: Implications of a Clinical Decision Support App." International journal of clinical endocrinology and metabolism 4.1 (2018): 8. (4) Saperstein, Yair, et al. "COVID-19 Guidelines Changing Faster than the Virus: Implications of a Clinical Decision Support App." International journal of clinical research & trials 5.2 (2020). DISCUSSION / REFLECTION / LESSONS LEARNED: AvoMD is leading innovation in medical education through its dynamic platform that functions as a virtual clinical consult for any clinician, provides just-in-time learning to trainees, and empowers educators to identify gaps in knowledge of their trainees through robust analytics. Feedback through data builds a new generation of learners and educators who are technology-forward. In addition, avoMD provides a novel platform for conducting research to improve clinical decision making. AvoMD builder community fosters a space for trainees and educators to create their own algorithms (at no cost) based on the latest guidelines and share them with colleagues within or across institutions. Collaboration for just-in-time learning can transform the way medical education and healthcare are delivered.

15.
Journal of General Internal Medicine ; 37:S403-S404, 2022.
Article in English | EMBASE | ID: covidwho-1995746

ABSTRACT

CASE: A 44-year-old male with past medical history of type II insulindependent diabetes mellitus (DM) and end stage liver disease (ESLD) due to alcohol use and nonalcoholic fatty liver disease (NAFLD) presented with one week of left-sided retroorbital headache and diplopia. Two weeks prior, the patient tested positive for COVID-19 and initially his severe headache was attributed to this diagnosis. On hospital presentation the patient was found to have ophthalmoplegia, ptosis and diminished sensation in the CN V1 distribution on the left. The patient was in diabetic ketoacidosis (DKA) with glucose of 686, venous blood gas of 7.32/29/15 and serum anion gap of 17. Contrasted orbital and maxillofacial CT showed complete opacification of the left sphenoid sinus and CT angiography/venography of the head were negative for venous sinus thrombosis. MRI of the brain showed left optic nerve ischemia and left frontal lobe cerebritis without abscess. Bedside nasal endoscopy with ENT showed purulent, fuzzy white debris bilaterally concerning for fungal sinusitis. He was taken urgently to the operating room and was found to have angioinvasive fungal sinusitis with cultures growing Lichthemia corymbifera, a fungus in the Mucor family. In addition to treatment with IV insulin and fluids for DKA, the patient was given amphotericin B and posaconazole;however, surgical intervention was deemed too high risk and futile in the setting of patient's comorbidities. IMPACT/DISCUSSION: Mucormycosis is a fungal infection that typically involves the sinuses, orbits and the central nervous system (CNS). Infection of the sinuses manifests with fever, sinus congestion/pain and headache, but can rapidly progress to involve the orbits, leading to vision changes, and the CNS, leading to encephalopathy. Other structures that can be involved include the cavernous sinus, leading to palsies of cranial nerves III-VI. Known risk factors for mucormycosis include DM, especially in patients with DKA, glucocorticoid treatment, immunosuppression and deferoxamine use. Urgent histopathologic diagnosis, initiation of intravenous antifungal agents (amphotericin B) and surgical intervention with ENT, ideally prior to extension beyond the sinuses, are fundamental to decreasing mortality, which is as high as 62%. There have been numerous case reports of mucormycosis in patients with COVID-19, particularly from India. Many of these patients were prescribed glucocorticoids as part of the COVID-19 treatment pathway or had underlying DM. Additional research is needed into the association between COVID-19 and invasive mucormycosis. CONCLUSION: In patients with poorly controlled DM or immunosuppression presenting with severe headache, sinus pain, and/or neurologic changes, mucormycosis must be considered, as it is a fatal entity requiring urgent surgical intervention and initiation of antifungal agents. Patients with COVID-19 infection may be at increased risk for mucormycosis, especially in those with underlying DM or on glucocorticoids.

16.
Front Med (Lausanne) ; 9: 927099, 2022.
Article in English | MEDLINE | ID: covidwho-1993798

ABSTRACT

Several studies have investigated the correlation between the COVID-19 pandemic and the onset of type 1 diabetes (T1D) in children, reporting an increased incidence of T1D and severe diabetic ketoacidosis (DKA). This study aimed to investigate the infection by SARS-CoV-2 in children with newly-diagnosed T1D to explore a possible link between SARS-CoV-2 infection, T1D and DKA. Thirty-nine children with a T1D new onset between October 15, 2020, and April 15, 2021, were enrolled. SARS-CoV-2 infection was investigated through a polymerase chain reaction on the nasal swab, dosage of specific antibodies, and an anamnestic question form. Nine (23%) of them had antibodies directed toward SARS-CoV-2, and five (12%) had a history of recent SARS-CoV-2 infection in themselves or in their family. No molecular swabs were positive. Compared to the general pediatric population, the overall incidence of COVID-19 was 5.6 times higher in the T1D patients' group (p < 0.00001). Referring only to the cases in the metropolitan area, we find a net increase in the incidence of T1D compared to the 5 years preceding our study, by 50% compared to the same months in 2016/2017 and 2017/2018, by 69% compared to 2018/2019 and by 77% compared to 2019/2020. The same trend was observed regarding DKA cases. The attributable risk of the pandemic cohort compared to the previous year is 44%. The abnormal disproportion of SARS-CoV-2 infection between children with T1D and the pediatric reference population, with a ratio of 5.6, appears to support the causative role of SARS-CoV-2 in triggering the immune response underlying diabetes, as often described for other viral infections. The difficulty accessing care services during the pandemic, with a consequent diagnosis delay, does not justify the increase in observed T1D cases, which could to be directly linked to the pandemic. The acceleration of the immune process provoked by SARS-CoV-2 may play a suggestive role in the development of T1D with DKA. Multicenter studies are needed to deepen and fully understand the pathophysiological link between SARS-CoV-2 and the onset of T1D in children.

17.
Diabetes ; 71, 2022.
Article in English | EMBASE | ID: covidwho-1987376

ABSTRACT

KPD is classically regarded as an atypical form of diabetes caused by near-complete beta-cell failure. A 37-year-old Egyptian man (BMI: 27.7 Kg/m2) presented with hyperglycemia (362 mg/dL) and DKA (arterial pH 7.20, ketonemia 5.0 mmol/L, ketonuria 80 mg/dL) . He was afebrile, with recent polyuria, polydipsia and weight loss. HbA1c was 107 mmol/mol (11.9%) and blood tests excluded diabetes secondary to endocrinopathies. SARS-CoV-2 RT-PCR test was negative. IV insulin infusion (0.1 IU/kg/h) and IV fluid therapy were started. He was shortly transitioned to a sc basal-bolus insulin regimen (0.7 IU/kg/day) . Mixed-meal tolerance test (MMTT) revealed a peak 120-min stimulated C-peptide of 12.3 ng/mL, suggesting marked insulin resistance. Islet autoantibodies (ICA, IAA, GADA, IA-2A, ZnT8A) and insulin receptor autoantibodies (IgG/IgM) were negative. HLA genotyping detected the following haplotypes: DRB1∗01, ∗04;DQA1∗01:01P, ∗03:01P;DQB1∗03:02P, ∗05:01P. Insulin dose was gradually reduced and insulin therapy was discontinued after 4 months in favor of metformin (2550 mg/day) plus sc semaglutide (up to 1 mg/week) . After one year, MMTT revealed a peak 60-min stimulated C-peptide of 8.25 ng/mL. During the 18-month follow-up period, fasting capillary beta-hydroxybutyrate values were <0.2 mmol/L and HbA1c remained <48 mmol/mol (<6.5%) , indicating disease remission. This case suggests the existence of an autoantibody-negative KPD subtype driven by marked insulin resistance rather than by insulinopenia.

18.
Cureus ; 14(7): e26635, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1979638

ABSTRACT

Mucormycosis is an opportunistic fungal infection caused by the zygomycetes Mucor and Rhizopus. Most documented conditions and risk factors that predispose to mucormycosis are uncontrolled diabetes mellitus (DM), with or without ketoacidosis, hematological malignancies (HM), transplantation, immunosuppression, and chronic sinusitis. Pulmonary empyema secondary to Mucor in coronavirus disease 2019 (COVID-19)-infected patients is rarely documented. Here we present an extremely rare case of pulmonary empyema secondary to Mucor infection complicated by bronchocutaneous fistula in a human immunodeficiency virus (HIV)-infected patient in the setting of acute COVID-19 infection.

19.
Pakistan Journal of Medical and Health Sciences ; 16(7):41-43, 2022.
Article in English | EMBASE | ID: covidwho-1980031

ABSTRACT

Background: Diabetes is a common disease known to cause morbidity and mortality. Individuals with diabetes are at greater risk of complications from coronavirus and have recently gains attention of researchers and practitioners. Aim: To assess the effect of diabetes mellitus on clinical course and outcome of coronavirus infection. Study design: Prospective cohort study Place and duration of study: Coronavirus Disease High Dependency Unit Jinnah Hospital, Lahore from 01-01-2021 to03-04-2021. Methodology: Three hundred and seventy six patients of either genders and age range of 15-75 years were enrolled. They were divided into diabetic or non-diabetic groups. The various attributes such as demographic data, medical history, COVID-19 exposure history, symptoms and signs, laboratory findings, chest radiograph findings, the treatment measures and complications of diabetes and in hospital outcome were compared for both the groups. Result: Statistically different from each other in terms of oxygen requirement, lymphocyte %, neutrophil to lymphocyte ratio (P=0.026), alanine aminotransferase (P=0.038), C-reactive protein (P=0.048), ferritin (P=0.031), lactic acid dehydrogenase (LDH) (P=0.011), Ddimer (P=0.024), Quick sequential organ failure assessment score (qSOFA score) (P=0.001) and Chest X-ray (P=0.049), blood sugar random (P=0.000), treatment during hospital stay (P=0.000), insulin dose increase (P=0.000), complications during hospital stay (P=0.042) and shifting to the intensive care unit (P=0.002). Conclusion: Diabetic coronavirus patients have poorer prognosis due to higher risk of severe pneumonia and related complications including mortality than their non-diabetic counterparts.

20.
Journal of the ASEAN Federation of Endocrine Societies ; 37(S2):58-59, 2022.
Article in English | EMBASE | ID: covidwho-1957612
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