Effect of online diabetes training for hospitalists on inpatient glycaemia.

AIM: An online diabetes course for medical residents led to lower patient blood glucose, but also increased hypoglycaemia despite improved trainee confidence and knowledge. Based on these findings, we determined whether an optimized educational intervention delivered to hospitalists (corresponding to an Acute Physician or Specialist in Acute Hospital Medicine in the UK) improved inpatient glycaemia without concomitant hypoglycaemia. METHODS: All 22 hospitalists at an academic medical centre were asked to participate in an online curriculum on the management of inpatient dysglycaemia in autumn 2009 and a refresher course in spring 2010. RESULTS: All hospitalists completed the initial intervention. Median event blood glucose decreased from 9.3 mmol/l (168 mg/dl) pre-intervention to 7.8 mmol/l (141 mg/dl) post-intervention and 8.5 mmol/l (153 mg/dl) post-refresher (P < 0.001 for both). Hospitalizations categorized as hyperglycaemia decreased from 83.3 to 55.6% (P = 0.014), with a trend towards euglycaemia (10-28.9%, P = 0.08) and no change in hypoglycaemia. Hyperglycaemic patient-days decreased from 72.0 to 57.3% (P = 0.004), with greater target glycaemia (27.3-39.4%, P = 0.016) and no change in hypoglycaemia. CONCLUSIONS: An optimized online educational intervention delivered to hospitalists yielded significant improvements in inpatient glycaemia without increased hypoglycaemia.

Resolution of insulin-requiring diabetes in a liver transplant recipient after treatment of a pheochromocytoma: case report and review of literature.

The aim of this paper was to report the case of type 2 diabetes and significant insulin resistance that improved dramatically after removal of a pheochromocytoma in a liver transplant recipient , and to provide a review of the relevant literature. We describe the clinical presentation, diagnostic results and management of the patient. In addition, we performed a PubMed search for related English language articles, to provide an overview of the pertinent literature. A 53 year old woman with a history of an orthotopic liver transplantation and insulin-requiring type 2 diabetes was admitted to the hospital with fever, diaphoresis, tachycardia and hypertension. A pheochromocytoma was diagnosed and removed. The patient subsequently developed hypoglycemia and required no further insulin therapy. Pheochromocytomas have been described to lead to hyperglycemia and diabetes, due to the suppression of insulin release and increased insulin resistance. Furthermore, a review of the literature revealed only 3 other reported cases of pheochromocytomas in organ transplant recipients. None of these pheochromocytomas were believed to have occurred de novo after transplantation. This is the first report of a pheochromocytoma in a liver transplant recipient and possibly the first case of a de novo pheochromocytoma in any organ transplant recipient. Moreover, this case showcases pheochromocytomas as a rare cause of diabetes mellitus.

Assessment of endothelial function in the patient with erectile dysfunction: an opportunity for the urologist.

Although there is now ample evidence that men with manifest coronary, cerebral and peripheral vascular disease and their risk factors are at highest risk for suffering from erectile dysfunction, recent findings demonstrate a strong connection between erectile dysfunction and endothelial dysfunction. This review explores how urologists and other providers may utilize the link between these conditions in clinical practice, compares methods of assessing endothelial dysfunction and finally speculates on how this additional information might impact treatment plans.

Protection by organotellurium compounds against peroxynitrite-mediated oxidation and nitration reactions.

Diaryl tellurides effectively protect against peroxynitrite-mediated oxidation of dihydrorhodamine 123 (DHR), hydroxylation of benzoate, and nitration of 4-hydroxyphenylacetate (HPA). Bis(4-aminophenyl) telluride offered the most efficient protection against oxidation of DHR induced by peroxynitrite. Protection by this compound was approximately 3 times more effective than that afforded by its selenium analog, bis(4-aminophenyl) selenide, and 11 times more effective than selenomethionine. When peroxynitrite was infused to maintain a steady-state concentration, bis(4-aminophenyl) telluride in the presence of GSH, but neither bis(4-aminophenyl) telluride nor GSH alone, effectively inhibited the peroxynitrite-mediated hydroxylation of benzoate. The inhibition of nitration was most pronounced using bis(4-hydroxyphenyl) telluride, and this compound was ca. 3 times more effective than selenomethionine. Bis(4-aminophenyl) telluride also protected proteins in lysates from human skin fibroblasts from peroxynitrite-mediated nitration of tyrosine residues more effectively than selenomethionine. These data establish a potential biological or pharmacological role of organotellurium compounds in the defense against peroxynitrite.