Predictors and outcomes of recurrent diabetic ketoacidosis in Israeli adults.

AIMS: To identify risk factors for recurrent episodes of DKA that may allow the development of an effective prevention strategies. METHODS: Retrospective analysis of admissions for DKA in adult patients between 2004, and 2017 in a tertiary hospital. The clinical characteristics and outcomes of DKA of patients were stratified into an isolated episode of DKA (group 1) and recurrent episodes (group 2). RESULTS: 385 patients were included in the study, 281 had a single admission of DKA, and 104 had recurrent admissions. There were no statistically significant differences between the two groups in demographic or clinical variables. Patients in the recurrent DKA group had a younger age at diabetes diagnosis, 32.1 ± 17.08 vs. 36.13 ± 19.52 (p = 0.05). Patients with A1C greater than 9.0% were associated with recurrent DKA in cox regression analysis (HR 2.023; 95% Cl 1.112-3.679; p = 0.021). Recurrent DKA was a significant predictor of one-year mortality in cox regression analysis (HR 0.172; 95% CI 0.04-0.742; p = 0.018). CONCLUSION: High A1C levels, which account for poorly controlled diabetes, was identified as the strongest predictor of recurrent DKA. This patient population warrants particular attention and the development of intervention strategies in further studies.

Outcomes of diabetic ketoacidosis in a tertiary centre with restricted intensive care unit bed capacity.

BACKGROUND: Diabetic ketoacidosis (DKA) is an acute metabolic condition, sometimes requiring admission to an intensive care unit (ICU). AIMS: To investigate the outcomes of DKA patients admitted to a hospital with restricted ICU capacity. METHODS: We included all DKA patients above age 18 who were admitted to a tertiary hospital during 2004-2017. We conducted multivariate logistic regression analysis adjusted for ICU bed availability to analyse parameters associated with ICU admission, and a composite outcome of mortality, DKA recurrence and mechanical ventilation. RESULTS: Among 382 DKA patients in our cohort, 94 (24.6%) were admitted to the ICU. The in-hospital mortality was 4.7%. Low bicarbonate (<10 mmoL/L) and pH (<7) levels at presentation were associated with ICU admission (P < 0.001 for both). In multivariate models availability of beds in the ICU was not associated with ICU admission, mortality or DKA recurrence of any type. CONCLUSION: In a setting of limited ICU capacity, DKA treatment does not necessarily require admission to the ICU. When the rising rates of diabetes mellitus and the associated elevated rates of DKA are taken into account, our results highlight the importance of including step-down units when devising local protocols for care of these patients.

Clinical and Epidemiological Characteristics of Diabetic Ketoacidosis in Older Adults.

OBJECTIVES: Much of the research previously done on diabetic ketoacidosis (DKA) was based on a young population with type 1 diabetes mellitus (type 1 DM). But substantial numbers of DKA episodes occur in patients with a prior history of type 2 diabetes mellitus (type 2 DM). There is a lack of Data are lacking about DKA in older adults. The aims of this study were to analyze the clinical characteristics and outcomes of older adult patients with DKA. DESIGN: Retrospective matched cohort study of adult patients hospitalized with DKA between 2004 and 2017. SETTING: Soroka University Medical Center, Be'er Sheva, Israel. PARTICIPANTS: The clinical characteristics of DKA patients 65 years and older were compared with patients younger than 65 years. MEASUREMENTS: The primary outcome was in-hospital mortality. RESULTS: The study cohort included 385 consecutive patients for whom the admission diagnosis was DKA: 307 patients (79.7%) younger than 65 years (group 1), and 78 patients (20.3%) older than 65 years (group 2). Patients in group 2 compared with group 1 had a significantly higher Charlson index (6 [6-6] vs 6 [6-7]; P < .0001) and DM with target organ damage (24.4% vs 6.2%; P < .0001). Patients in group 2 compared with group 1 had more serious disease according to results of laboratory investigations. The total in-hospital mortality rate of patients in group 2 was 16.7% compared with 1.6% in patients in group 1 in a sex and co-morbidities matched analysis (P = .001). CONCLUSIONS: DKA in older adults is a common problem. The serious co-morbidities and precipitating factors such as infection/sepsis, myocardial infarction, and cerebrovascular accidents, may explain the severity of the problem of DKA in older adults and the high rate of mortality of these patients. DKA appears to be a lifethreatening condition in older adults. The alertness of physicians to DKA in older adults, timely diagnosis, proper treatment, and prevention are cornerstones of care. J Am Geriatr Soc 68:1256-1261, 2020.

Intraocular concentration of moxifloxacin after intracameral injection combined with presoaked intraocular lenses.

PURPOSE: To evaluate the impact of intraocular lens (IOL) moxifloxacin presoaking time on the intraocular concentration of moxifloxacin achieved after intracameral moxifloxacin injection. SETTING: Harlan Biotech Israel, Rehovot, Israel. DESIGN: Laboratory study METHODS: Sixty eyes of 30 rabbits were divided into 2 groups after crystalline lens evacuation. In Group A (30 eyes), hydrophilic acrylic IOLs presoaked for 15 minutes in 5 mg/mL moxifloxacin were implanted. In Group B (30 eyes), the same hydrophilic acrylic IOLs presoaked in the same solution for 24 hours were implanted. Intracameral injection of 100 mcg/0.1 moxifloxacin was performed at the end of surgery in both groups. Aqueous humor samples were obtained 2, 4, 6, 8, and 10 hours after IOL implantation and were analyzed by high-performance liquid chromatography to determine the antibiotic concentration. RESULTS: Group A achieved mean postoperative moxifloxacin concentrations of 18.60 mcg/mL±8.80 (SD), 4.08±6.03 mcg/mL, 1.50±0.75 mcg/mL, 0.21±0.09 mcg/mL, and 0.12±0.04 mcg/mL at 2, 4, 6, 8, and 10 hours, respectively. Group B achieved mean moxifloxacin concentrations of 17.25±6.27 mcg/mL, 9.46±2.22 mcg/mL, 6.26±1.22 mcg/mL, 4.34±0.42 mcg/mL, and 3.62±1.02 mcg/mL, respectively. Moxifloxacin concentrations at 6, 8, and 10 hours were statistically significantly higher in Group B than in Group A (all P<.0001). CONCLUSIONS: Combining intracameral moxifloxacin injection with implantation of moxifloxacin-presoaked hydrophilic acrylic IOLs yielded high intraocular concentrations of moxifloxacin. Higher concentrations were found with longer presoaking. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Hydrophilic acrylic intraocular lens as a drug delivery system: influence of the presoaking time and comparison to intracameral injection.

PURPOSE: To evaluate the influence of different intraocular lens (IOL) presoaking times in an antibiotic solution and to compare the results with intracameral antibiotic injection alone. METHODS: Part A: 45 IOLs were soaked in gatifloxacin, moxifloxacin, or prednisolone acetate for 10 min, 24 h, and 1 week and then placed in a vial with a balanced salt solution. The solutions were sampled 12 and 24 h later. Part B: 90 eyes of 45 rabbits were divided into three groups. Group A received intracameral injection of moxifloxacin after lens removal and nonpresoaked IOL implantation. Groups B and C were implanted with IOLs that were presoaked for 15 min in moxifloxacin (group B) or gatifloxacin (group C), after lens removal with no intracameral antibiotic injections. Aqueous humor samples were taken 2, 4, 6, 8, and 10 h after surgery for high-performance liquid chromatography. RESULTS: Part A: In comparison with the 24-h group, the 10-min group showed release of about 30% of the antibiotics amount; the 1-week group showed a longer release time of the antibiotics and an increase of 27% for gatifloxacin and 43% for moxifloxacin. No prednisolone acetate was found. Part B: The moxifloxacin concentrations in the intracameral injection group were higher after surgery, but with faster antibiotic decrease in comparison with both presoaked IOL groups. CONCLUSION: Intracameral antibiotic injection showed a high antibiotic concentration for a short time. Presoaked IOLs showed slower decrease rates of the antibiotic level.