Differences in Glycemic Control for Inpatients with Type 1 Diabetes on Insulin Pump Versus Subcutaneous Insulin Therapy.

BACKGROUND: Inpatient use of insulin pump therapy has been increasing due to greater availability of this technology, however there is a paucity of research that investigates glycemic control of inpatient insulin pump users. OBJECTIVE: To compare the glycemic control of hospitalized patients with type 1 diabetes (T1D) who used insulin pump vs. multiple daily injections (MDI). DESIGN: Retrospective chart review. PARTICIPANTS: Patients with T1D who were hospitalized between January 1, 2017, and December 31, 2019, in an academic medical center in the New York metropolitan area. MAIN MEASURES: Patients were categorized into three groups based on their method of insulin administration: "pump only" group used insulin pump exclusively, "MDI only" group used MDI only, and "intermittent pump" group used a combination of both methods. The primary endpoints are mean blood glucose, rates of hypoglycemic events (blood glucose < 70 mg/dL), and rates of hyperglycemic events (blood glucose > 250 mg/dL). Separate multivariable Poisson regressions were performed to determine the association between the type of insulin administration and rate outcomes (i.e., rate of hypoglycemic events and rate of hyperglycemic events). RESULTS: The study included 78 patients with a mean age of 51, who were mostly male (54%), and white (72%). The average proportion of glucose measurements that were hyperglycemic for the "pump only", "MDI only", and "intermittent pump" groups were 0.11 (SD = 0.11), 0.25 (SD = 0.19), and 0.24 (SD = 0.25), respectively. The "pump only" group has a significantly lower proportion of hyperglycemic events as compared to the "MDI only" group (p = 0.0227). CONCLUSIONS: In this sample, patients who exclusively used their insulin pump while inpatient had a lower rate of hyperglycemic events than patients who used MDI only; suggesting that select patients can safely continue their insulin pump therapy in the inpatient setting.

Demographic Variables Associated With Diabetes Technology Awareness or Use in Adults With Type 2 Diabetes.

Background: Studies in populations with type 1 diabetes highlight racial/ethnic disparities in the use of diabetes technology; however, little is known about disparities among those with type 2 diabetes. This project investigates the racial/ethnic and socioeconomic disparities in diabetes technology awareness and use in adults with type 2 diabetes in the ambulatory setting. Methods: Adults ≥40 years of age with type 2 diabetes in ambulatory care were invited to participate via an e-mail link to a de-identified REDCap (Research Electronic Data Capture) questionnaire. Variables, including awareness and use of continuous glucose monitoring (CGM) and insulin pumps, were summarized descriptively using frequencies and percentages and were compared across racial/ethnic groups, education level, and income using Pearson χ2 or Fisher exact tests. Results: The study included 116 participants, most of whom (62%) were White, elderly Medicare recipients. Compared with White participants, those of racially/ethnically minoritized groups were less likely to be aware of CGM (P = 0.013) or insulin pumps (P = 0.001). Participants with a high school education or less were also less likely to be aware of insulin pumps (P = 0.041). Interestingly, neither awareness nor use of CGM or insulin pumps was found to be associated with income. Conclusion: This cross-sectional analysis suggests that racially/ethnically minoritized groups and individuals with lower education have less awareness of CGM or insulin pumps.

De novo ulcerative colitis and Takotsubo cardiomyopathy following sleeve gastrectomy.

The increasing prevalence of severe obesity is a major public health concern. Bariatric surgery is an important treatment option for severe obesity due to its long-term sustained result. Multiple studies have shown that patients have an increased risk of developing inflammatory bowel disease following bariatric surgery. Takotsubo syndrome usually presents as acute left ventricular systolic dysfunction without corresponding obstructive coronary artery disease after an acute stress episode. We describe a unique case of a patient who developed de novo ulcerative colitis and takotsubo cardiomyopathy shortly after sleeve gastrectomy. The patient made a successful recovery due to prompt recognition and appropriate treatment.

Narrow Complex Tachycardia With Intermittent 2:1 Atrioventricular Relationship.

Narrow QRS complex tachycardia has a broad differential diagnosis. We present a series of rhythm strips with representative onset, transition from 2:1 AV conduction to 1:1 AV conduction, and offset of tachycardia. By analyzing these rhythm strips, we can identify the electrophysiologic mechanism and diagnosis. (Level of Difficulty: Intermediate.).

Hypertriglyceridemia-Induced Acute Pancreatitis, Euglycemic Diabetic Ketoacidosis and COVID-19 Infection in a Patient With Type 2 Diabetes Taking a Sodium-Glucose Cotransporter 2 Inhibitor.

Recent landmark trials have increased the use of sodium-glucose cotransporter 2 inhibitors (SGLT-2i) in patients with type 2 diabetes (T2D). A rare but serious side effect of SGLT-2i is euglycemic diabetic ketoacidosis (euDKA), which usually occurs in the setting of acute illness such as the coronavirus disease 2019 (COVID-19). We report a distinctive case of a patient with hyperlipidemia and T2D on SGLT-2i therapy who presented with hypertriglyceridemia-induced pancreatitis (HTGP) concurrently with euDKA and COVID-19. The patient's initial labs included venous blood gas pH of 7.27, a blood glucose level of 146 mg/dL, serum triglyceride (TG) greater than 8,300 mg/dL and lipase of 527 U/L. Viral polymerase chain reaction (PCR) result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was also positive. We suspect this patient has a primary disorder of lipoprotein metabolism which was exacerbated by stress from euDKA and COVID-19 infection. The patient was treated with intravenous fluids, fasting and intravenous insulin infusion. Resolution of euDKA and improvement of hypertriglyceridemia to less than 1,000 mg/dL occurred by day 6 and the patient was transitioned to subcutaneous basal-bolus insulin. On discharge, the SGLT-2i was discontinued and the patient was discharged on insulin, metformin, omega-3 fatty acids, and fenofibrate.

Aislamiento y caracterización estructural de un nuevo triterpeno del octocoral Plexaura Flexuosa Lamoroux. / Isolation and structural caracterization of a new triterpene from the octocoral Plexaura Flexuosa Lamoroux / Isolamento e caracterização estrutural de um novo triterpeno do octocoral Plexaura Flexuosa Lamoroux.

Estudios previos de productos naturales de origen marino han demostrado que los octocorales producen una variedad de metabolitos con diversas estructuras químicas y bioactividades. Con el objetivo de estudiar al octocoral Plexaura flexuosa Lamoroux se analizó el extracto en acetona de un ejemplar colectado en la Bahía de Mochima, estado Sucre, Venezuela. Se evaluaron las propiedades antibacteriana, antifúngica y tóxica del extracto, revelándose una marcada actividad antibacteriana contra las bacterias Gram positiva Staphylococcus aureus y Bacillus cereus, así como una letalidad significativa mediante el bioensayo de Artemia salina. La fracción soluble en hexano de dicho extracto exhibió actividad antifúngica contra Candida albicans y Trichosporum sp. A partir de dicha fracción se aisló un sólido blanquecino, usando sucesivas cromatografías de columna eluidas con mezclas de hexano:AcOEt en diferentes proporciones. El compuesto se cristalizó con AcOEt, obteniéndose cristales blancos en forma de agujas con punto de fusión de 194,8-195,0°C. Para la identificación estructural de este sólido se realizaron análisis espectroscópicos (IR, RMN¹H, RMN13C, HMQC, HMBC y COSY¹H-¹H), los cuales evidenciaron la presencia de un esqueleto triterpenoidal tetracíclico con cadena lateral, ocho metilos, un doble enlace trisustituído y un grupo epóxido exocíclico. El análisis sistemático de los datos espectrales y su posterior comparación con estructuras reportadas permitieron establecer la estructura posible del compuesto como un derivado 3,5-epoxi del dinosterol.

Previous studies of natural products of marine origin have showen that octocorals produce a variety of metabolites with diverse chemical structures and significant bioactivities. The acetone extract of the octocoral Plexaura flexuosa Lamoroux collected at Mochima Bay, Sucre state, Venezuela, was analyzed and evaluated for its antibacterial, antifungal and toxic properties, showing a significant antibacterial activity against the Gram positive bacteria Staphylococcus aureus and Bacillus cereus, and also a significant lethality in the Artemia salina bioassay. The hexane-soluble fraction of this extract exhibited antifungal activity against Candida albicans and Trichosporum sp. A white solid was isolated from this fraction by successive column chromatography with different proportions of hexane:EtOAc mixtures as eluting solvents. The compound was crystallized with EtOAc, forming needle-shaped white crystals with a melting point of 194.8-195.0°C. Subsequently, spectroscopy analyses were performed for the structural identification of this solid, employing IR, ¹HNMR, 13CNMR, HMQC, HMBC and ¹H-¹HCOSY, which revealed the presence of tetra-cyclical triterpene skeleton with a side chain, eight methyl groups, a trisubstituted double bond and an exocyclical epoxy group. Spectral data analysis and comparison with reported structures permitted the establishment of a of 3.5-epoxy dinosterol derivative as the possible structure of the compound.

Estudos prévios de produtos naturais de origem marinho têm demonstrado que os octocorais produzem uma variedade de metabolitos com diversas estruturas químicas e bioatividades. Com o objetivo de estudar ao octocoral Plexaura flexuosa Lamoroux se analisou o extrato em acetona de um exemplar recolhido na Bahia de Mochima, estado Sucre, Venezuela. Avaliaram-se as propriedades antibacteriana, antifúngica e tóxica do extrato, revelando-se uma marcada atividade antibacteriana contra as bactérias Gram positiva Staphylococcus aureus e Bacillus cereus, assim como uma letalidade significativa mediante o bioensaio de Artêmia salina. A fração solúvel em hexano de dito extrato exibiu atividade antifúngica contra Candida albicans e Trichosporum sp. A partir de dita fração se isolou um sólido branco, usando sucessivas cromatografias de coluna eluídas com misturas de hexano: AcOEt em diferentes proporções. O composto se cristalizou com AcOEt, obtendo-se cristais brancos em forma de agulhas com ponto de fusão de 194,8 - 195,0°C. Para a identificação estrutural de este sólido se realizaram análises espectroscópicas (IR, RMN¹H, RMN13C, HMQC, HMBC e COSY¹H-¹H), as quais evidenciaram a presença de um esqueleto triterpenoide tetracíclico com cadeia lateral, oito metilos, um duplo enlace trisubstituído e um grupo epóxido exocíclico. A análise sistemática dos dados espectrais e sua posterior comparação com estruturas relatadas permitiram estabelecer a estrutura possível do composto como um derivado 3,5-epóxi do dinosterol.

Evaluation of flavonoids from Bauhinia megalandra leaves as inhibitors of glucose-6-phosphatase system.

From the methanol extract of Bauhinia megalandra fresh leaves, eight flavonoids were isolated and evaluated by rat liver microsomal glucose-6-phosphatase (G-6-Pase) bioassay, which might be a useful methodology for screening antihyperglycaemic substances. All the flavonoids assayed showed an inhibitory effect on the intact microsomal G-6-Pase: quercetin and kaempferol exhibited the lowest effect; astilbin, quercetin 3-O-alpha-rhamnoside, kaempferol 3-O-alpha-rhamnoside and quercetin 3-O-alpha-arabinoside an intermediate effect. The highest inhibitory activity was shown by quercetin 3-O-alpha-(2''-galloyl)rhamnoside and kaempferol 3-O-alpha-(2''galloyl)rhamnoside. None of the flavonoids mentioned above showed an inhibitory effect on the disrupted microsomal G-6-Pase. Quercetin 3-O-alpha-(2''-galloyl)rhamnoside and kaempferol 3-O-alpha-(2''-galloyl)rhamnoside exhibited the lowest IC50 of all the flavonoids assayed. Also, the phlorizin IC50 is reported.

Valoración de un método para intubación a ciegas / Blind nasotracheal intubation

Intubación nasal a ciegas un arte en la práctica anestesiológica es sin duda un método útil y ocasionalmente el único posible este estudio está encaminado a demostrar la eficacia del uso de la sonda de succión para facilitar la introducción de la sonda de succión para facilitar la introducción de la sonda endotraqueal, utilizándola como guía. Se estudiaron 2 grupos a los cuales se designaron 30 pacientes ASA I-II ambos sexos 30 por ciento femeninos y 70 por ciento masculinos al grupo uno se le colocó una guía a través de la sonda endotraqueal (ING) al grupo 2 no se le coloco guía (INSG). La monitorización consiste en el registro continuo de presión arterial automática cada 2.5 minutos, no invasiva, frecuencia cardiaca, temperatura corporal, ECG, con un registro de trazo del monitor, oximetría de pulso y capnografo. La inducción fue con halotano y oxígeno manteniéndolos con ventilación espontánea. Los resultados fueron para evaluar el número de intensos para la realización de la técnica el grupo ING lo realizó en 2 intentos, el primero fue de 61.5 por ciento y el segundo de 38.5 por ciento. El grupo INSG lo logró en 4 intentos, el primero de 33.3 por ciento, 26.7 por ciento, 13.3 por ciento y 26.7 por ciento, respectivamente P= 0.01 y X²=12.1709. 5 pacientes del mismo grupo no se pudieron intubar por lo que se cambio de técnica, P=0.00005 FISHER, concluyendo que el uso de un cateter de succión como guía favorece notablemente la intubación nasotraqueal a ciega

Influencia de la enfermedad sobre el patrón del dormir y el sueño en una población de pacientes pediátricos

Con el objetivo de recabar datos relacionados con la relación existente entre la patología física y el proceso del dormir, se realizó un estudio en el hospital Dr. Robert Reid Cabral en una población de consulta externa. Fueron estudiados un total de 100 pacientes; de ellos obtuvimos datos sobre el patrón de dormir antes y después de enfermar y sobre el patrón de dormir antes y después de enfermar y sobre el patrón de dormir en niño sano como muestra control. Se obtuvo el 68% de los niños que dormían 6 a 9 horas antes de enfermar, despúes de perder su salud pasaron a dormir menos de 9 horas. La enteritis y el proceso gripal, con un 18%, fueron las enfermedades físicas que más modificaron el patrón de dormir. Además, antes de enfermar, el 44% de los niños tenían sueño tranquilo; después de perder su salud sólo el 19% lo conseguía. Estos datos permiten llamar la atención al médico tratante de un paciente pediátrico con una enfermedad física aguda, por cuanto debe tomar en cuenta las modificaciones que produce la enfermedad sobre el dormir