Clinical Diagnosis Of Diabetes Mellitus Research Articles

Magnetic resonance imaging combined with serum endolipin and galactagoglobin-3 to diagnose cerebral infarction in the elderly with diabetes mellitus.

Magnetic resonance imaging (MRI) combined with serum endothelin and galactagoglobin-3 (Gal-3) can improve the clinical diagnosis of diabetes mellitus complicated with cerebral infarction. To analyze the clinical value of MRI combined with serum endolipin and Gal-3 for the diagnosis of cerebral infarction in the elderly with diabetes mellitus. One hundred and fifty patients with acute cerebral infarction hospitalized between January 2021 and December 2023 were divided into two groups according to comorbid diabetes mellitus, including 62 and 88 cases in the diabetic and nondiabetic cerebral infarction groups. Serum samples were collected to detect the expression of serum endolipoxins, and Gal-3, and cranial MRI was performed at admission. Differences between the two groups were compared to analyze the diagnostic value of these parameters. Serum endolipin and Gal-3 expression were higher in the diabetic cerebral infarction group (P < 0.05). The arterial wall area, vessel area, normalized wall index, and lumen stenosis rate were higher in the diabetic cerebral infarction group, while the rate of arterial lumen moderate and severe stenosis was 48.39% higher (36.36%, P < 0.05). The percentage of large (29.03%) and multiple infarcts (33.87%) in the diabetic cerebral infarction group was higher (13.64% and 20.45%), and the incidence rate of lacunar infarcts was lower (37.10% vs 65.91%) (P < 0.05). The total incidence of arterial plaque in patients in the diabetic cerebral infarction group was 96.77% higher (69.32%), while the incidence of necrotic lipid core plaque was 58.06% higher (26.14%) (P < 0.05). Receiver operating characteristic curve analysis was performed to assess the diagnosis utility of these techniques. MRI in combination with serum endoglin and Gal-3 had the highest area under the curve, the Yoden index, sensitivity and specificity (P < 0.05). The expression of serum endolipin and Gal-3 in elderly patients with diabetes mellitus with cerebral infarction showed an elevated trend, and the degree of luminal stenosis was severe. MRI predominantly revealed large and multiple infarct foci. This combined index examination can improve the clinical diagnosis of diabetes mellitus combined with cerebral infarction.

Theoretical study on the interaction between acetone and BN monolayer doped with Ni for the clinical diagnosis of diabetes mellitus

Endogenous volatile organic compounds (VOCs) in human exhaled gases can reflect human health status and be used for clinical diagnosis and health monitoring. Acetone is the sign VOC gases of diabetes mellitus. In order to find a potential material for the detection of acetone in the application of the clinical diagnosis of diabetes mellitus. The adsorption properties, including adsorption energy, adsorption distance, charge transfer, density of states, electron localization function and electrons density difference, of acetone on BN monolayer doped with Ni were comprehensively investigated based on density functional theory. The results show that there could be chemisorption between acetone and Ni-BN monolayer and Ni-BN monolayer is probably suitable gas sensitive material for the detection of acetone in the application of diabetes mellitus monitoring and clinical diagnosis.

Impact of glycated hemoglobin on 2-year clinical outcomes in elderly patients with atrial fibrillation: sub-analysis of ANAFIE Registry, a large observational study

BackgroundThis ANAFIE Registry sub-analysis investigated 2-year outcomes and oral anticoagulant (OAC) use stratified by glycated hemoglobin (HbA1c) levels among Japanese patients aged ≥ 75 years with non-valvular atrial fibrillation (NVAF) with and without clinical diagnosis of diabetes mellitus (DM).MethodsThe ANAFIE Registry was a large-scale multicenter, observational study conducted in Japan; this sub-analysis included patients with baseline HbA1c data at baseline. The main endpoints evaluated (stroke/systemic embolic events [SEE], major bleeding, intracranial hemorrhage, cardiovascular death, all-cause death, and net clinical outcome [a composite of stroke/SEE, major bleeding, and all-cause death]) were stratified by HbA1c levels (< 6.0%; 6.0% to < 7.0%; 7.0% to < 8.0%; and ≥ 8.0%).ResultsOf 17,526 patients with baseline HbA1c values, 8725 (49.8%) patients had HbA1c < 6.0%, 6700 (38.2%) had 6.0% to < 7.0%, 1548 (8.8%) had 7.0% to < 8.0%, and 553 (3.2%) had ≥ 8.0%. Compared with other subgroups, patients with HbA1c ≥ 8.0% were more likely to have lower renal function, higher CHA2DS2-VASc and HAS-BLED scores, higher prevalence of non-paroxysmal AF, and lower direct OAC (DOAC) administration, but higher warfarin administration. The HbA1c ≥ 8.0% subgroup had higher event rates for all-cause death (log-rank P = 0.003) and net clinical outcome (log-rank P = 0.007). Similar trends were observed for stroke/SEE. In multivariate analysis, risk of all-cause death (adjusted hazard ratio [aHR]: 1.46 [95% confidence interval 1.11–1.93]) and net clinical outcome (aHR 1.33 [1.05–1.68]) were significantly higher in the HbA1c ≥ 8.0% subgroup. No significant differences were observed in risks of major bleeding or other outcomes in this and other subgroups. No interaction was observed between HbA1c and OACs. Use/non-use of antidiabetic drugs was not associated with risk reduction; event risks did not differ with/without injectable antidiabetic drugs.ConclusionsAmong elderly Japanese patients with NVAF, only HbA1c ≥ 8.0% was associated with increased all-cause death and net clinical outcome risks; risks of the events did not increase in other HbA1c subgroups. Relative event risks between patients treated with DOACs and warfarin were not modified by HbA1c level.Trial registrationUMIN000024006; date of registration: September 12, 2016.

The Impact of Delayed Separation of Plasma and Serum Sample on Glucose Parameter of Apparently Healthy Students of Federal School of Medical Laboratory Technology (Science), Jos, Nigeria

Background: Estimation of glucose is very important in clinical diagnosis of diabetes mellitus, hyperglycemia and hypoglycemia. The core aim of clinical laboratory service is to produce accurate, precise and reliable test results. The ability of laboratories to do this lies in the availability of well trained personnel, equipment, electricity etc. There has been a progressive increase in the prevalence of diabetes mellitus in Nigeria and the burden is expected to increase even further and the need for proper diagnosis cannot be overemphasized.&#x0D; Aim: In this study we have tried to evaluate the impact of delayed separation of plasma and serum from cells and clot on glucose level.&#x0D; Method: A total of fifty (50) randomly selected apparently healthy students of Federal School of Medical Laboratory Technology (Science), Jos were recruited as subject into this study. Blood samples were collected from each of the subjects into plain and anticoagulant bottles for serum and plasma respectively. An aliquot was analyzed within 10 minutes to obtain a baseline value where other values after timely delays were compared. The samples were spun but not separated from the cells/clot all through the period of the analysis. Blood glucose was determined by glucose Oxidase Colourimetric assay kit obtained from Randox Laboratories Limited United Kingdom. Data were analyzed using student’s t-test and performed using the Statistical Package for Social Sciences (SPSS) version 20.0.&#x0D; Results: Result obtained shows the mean and standard deviation of all timing for plasma and serum. In plasma it shows that the means±SD of 2, 4 and 24hours (5.2±0.7, 5.1±0.4 and 5.3±0.5 respectively) were not significantly varied when compared to the baseline (0 hour) value (5.3±0.5). That of baseline and 24 hours (5.3±0.5 and5.3±0.5 respectively) were significantly higher (P&lt;0.001) than that of 48 and 74 hours (1.0±0.20 and 7±0.2 respectively). In serum, similar results were obtained.&#x0D; Conclusion: In conclusion, where possible, it is advised that the established best practices in processing and analysis of samples be adhered to. However, the results of this work shows reasonably stable results for blood glucose determination could be obtained within 24 hours. Therefore, instead of discarding the sample, it might seem more appropriate that the sample be analyzed and the result reported indicating the number of hours delayed within 24hours.

Fluorescence/electrochemiluminescence approach for instant detection of glycated hemoglobin index

The percentage of glycated hemoglobin (HbA1c) in total hemoglobin (Hb) is an important index for the diagnosis of Type II diabetes (T2D) because it reflects the long-term glucose level in blood. Herein, employing a one-pot co-reduction approach using glutathione (GSH) as structure-directing agent, a cluster-like AuAg nanoparticle (AuAg NPs) material was synthesized, therefore an electrochemiluminescence (ECL) aptamer-sensor for HbA1c detection was developed based on functionalized electrode with this material. Meanwhile, the quantitative determination of total Hb was realized based on the quenching effect of Hb on the fluorescence (FL) of luminol. Under compatible conditions, the results of both indexes can be satisfactorily acquired. This multimodal detection system has a good linear response toward Hb from 0.1 to 2.5 μM and HbA1c from 0.005 to 0.5 μM. The blood test proves this strategy is capable of accurate Hb and HbA1c detection, thus to obtain the percentage of HbA1c in total Hb (HbA1c%), which has the potential application for clinical diagnosis of diabetes mellitus.

Glycated Hemoglobin and Methods for Its Point of Care Testing.

Glycated hemoglobin (HbA1c) is a product of the spontaneous reaction between hemoglobin and elevated glucose levels in the blood. It is included among the so-called advanced glycation end products, of which is the most important for the clinical diagnosis of diabetes mellitus, and it can serve as an alternative to glycemia measurement. Compared to the diagnosis of diabetes mellitus by glycemia, the HbA1c level is less influenced by a short-term problem with diabetes compensation. Mass spectroscopy and chromatographic techniques are among the standard methods of HbA1c level measurement. Compared to glycemia measurement, there is lack of simple methods for diabetes mellitus diagnosis by means of the HbA1c assay using a point-of-care test. This review article is focused on the surveying of facts about HbA1c and its importance in diabetes mellitus diagnosis, and surveying standard methods and new methods suitable for the HbA1c assay under point-of-care conditions. Various bioassays and biosensors are mentioned and their specifications are discussed.

A formula based on autonomic test using EZSCAN and anthropometric data for diagnosis of DM in China

Clinical diagnosis of diabetes mellitus (DM) is time-consuming and invasive. This study aimed to investigate the efficacy and accuracy of EZSCAN in detecting impaired glucose tolerance (IGT) and diabetes mellitus (DM) in Chinese population, and explore a diagnosis formula based on an autonomic test using EZSCAN measurement and anthropometric data. Eligible subjects (n = 1547) had the following data collected: those of anthropometric and EZSCAN measurements and biochemical tests including FPG, OGTT, HbA1c, and serum lipid tests. The support vector machine (SVM) algorithm method was used to derive a diagnostic formula. In this study, 452 and 263 subjects were diagnosed with T2DM and IGT, respectively, while 832 had normal glucose tolerance (NGT). The sensitivity rates for the formula were 77.2% for T2DM and 80.4% for IGT. The diagnostic formula was found to correlate strongly with EZSCAN values. The diagnostic formula based on autonomic test and anthropometric data appears to be a convenient and accurate routine screening option in the Chinese population.

Development of an electrochemical enzyme-free glucose sensor based on self-assembled Pt-Pd bimetallic nanosuperlattices.

The huge demand for the clinical diagnosis of diabetes mellitus has prompted the development of great-performance sensing platforms for glucose detection. Non-enzymatic glucose sensors are getting closer to their use in realistic applications. In this work, polyvinylpyrrolidone (PVP)-conjugated bimetallic Pt-Pd nanosuperlattices were synthesized precisely through a simple synthesis procedure, leading to controllable spherical morphologies with significantly fine and precise nanostructures in a size range of ∼3-5 nm by the reduction of Pt and Pd precursors in ethylene glycol, using an ultrasonic method. High-resolution transmission electron microscopy (HRTEM) measurements evidenced the formation of Pt-Pd bimetallic nanosuperlattices (BMNSLs). The superlattice-fringe patterns (111) of bimetallic Pt-Pd NSLs were identified in the HRTEM images, clearly showing their crystalline nature. The prepared material was used in the electrochemical oxidation of glucose using voltammetry analyses. The experimental evidence indicates that the Pt-Pd BMNSL modified glassy carbon electrode is effective for the selective amperometric detection of glucose in the presence of galactose, sucrose, fructose, lactose, and ascorbic acid. Moreover, its application in the detection of glucose in real serum and urine samples was assessed and good recoveries are achieved. The results show that a Pt-Pd bimetallic nanosuperlattice with high surface area, catalytic activity, and superior selectivity could be a promising material in the generation of novel electrodes for low-cost non-enzymatic glucose sensors.

Microbiota-Related Changes in Unconjugated Fecal Bile Acids Are Associated With Naturally Occurring, Insulin-Dependent Diabetes Mellitus in Dogs.

Diabetes mellitus (DM) in humans has recently been associated with altered intestinal microbiota. The consequences of intestinal dysbiosis, such as increased intestinal permeability and altered microbial metabolites, are suspected to contribute to the host inflammatory state and peripheral insulin resistance. Human diabetics have been shown to have changes in bile acid (BA) metabolism which may be detrimental to glycemic control. The purpose of this study was to examine BA metabolism in dogs with naturally-occurring, insulin-dependent DM and to relate these findings to changes in the intestinal microbiota. A prospective observational study of adult dogs with a clinical diagnosis of DM (n = 10) and healthy controls (HC, n = 10) was performed. The fecal microbiota were analyzed by 16S rRNA gene next-generation (Illumina) sequencing. Concentrations of fecal unconjugated BA (fUBA) were measured using gas chromatography and mass spectrometry. Analysis of bacterial communities showed no significant difference for any of the alpha-diversity measures between DM vs. HC dogs. Principal coordinate analysis based on unweighted Unifrac distance metric failed to show significant clustering between dog groups (ANOSIMUnweighted: R = 0.084; p = 0.114). However, linear discriminate analysis effects size (LEfSe) detected differentially abundant bacterial taxa (α = 0.01, LDA score >2.0) on various phylogenetic levels. While Enterobacteriaceae was overrepresented in dogs with DM, the proportions of Erysipelotrichia, Mogibacteriaceae, and Anaeroplasmataceae were increased in HC dogs. Dogs with DM had increased concentration of total primary fUBA compared to HC dogs (p = 0.028). The concentrations of cholic acid and the cholic acid percentage of the total fUBA were increased (p = 0.028 and p = 0.035, respectively) in the feces of DM dogs relative to HC dogs. The levels of lithocholic acid (both absolute value and percentage of the total fUBA) were decreased (p = 0.043 and p < 0.01, respectively) in DM dogs vs. HC dogs. Results indicate that dogs with DM have both intestinal dysbiosis and associated fUBA alterations. The pattern of dysbiosis and altered BA composition is similar to that seen in humans with Type 2 DM. The dog represents a novel large animal model for advancing translational medicine research efforts (e.g., investigating pathogenesis and therapeutics) in DM affecting humans.

Decreased PGC-1α Post-Cardiopulmonary Bypass Leads to Impaired Oxidative Stress in Diabetic Patients

The mechanism of mitochondrial dysfunction after cardiopulmonary bypass (CPB) in patients with diabetes mellitus lacks understanding. We hypothesized that impaired beta-oxidation of fatty acids leads to worsened stress response in this patient population after cardiac surgery. After Institutional Review Board approval, right atrial tissue samples were collected from 35 diabetic patients and 33 nondiabetic patients before and after CPB. Patients with glycated hemoglobin of 6.0 or greater and a clinical diagnosis of diabetes mellitus were considered to be diabetic. Immunoblotting and microarray analysis were performed to assess protein and gene expression changes. Blots were quantified with ImageJ and analyzed using one-way analysis of variance with multiple Student's t test comparisons after normalization. All p values less than 0.05 were considered significant. Immunohistochemistry was performed for cellular lipid deposition assessment. Diabetic patients had significantly lower levels of PGC-1α before and after CPB (p < 0.01 for both) compared with nondiabetic patients. Several upstream regulators of PGC-1α (SIRT1 and CREB) were significantly higher in nondiabetic patients before CPB (p= 0.01 and0.0018, respectively). Antioxidant markers (NOX4 and GPX4), angiogenic factors (TGF-β, NT3, and Ang1), and the antiapoptotic factor BCL-xL were significantly lower in diabetic patients after CPB (p < 0.05). The expression of genes supporting mitochondrial energy production (CREB5 and SLC25A40) and angiogenic genes (p < 0.05) was significantly downregulated in diabetic patients after CPB. Immunohistochemistry results showed significantly increased lipid deposition in diabetic myocardial tissue. Decreased PGC-1α in diabetic patients may lead to impaired mitochondrial function and attenuated antiapoptotic and angiogenic responses after CPB. Therefore, PGC-1α and upstream regulators could serve as a target for improving beta-oxidation in diabetic patients.

Diabetes mellitus and Parkinson disease.

To investigate whether diabetes mellitus is associated with Parkinson-like pathology in people without Parkinson disease and to evaluate the effect of diabetes mellitus on markers of Parkinson pathology and clinical progression in drug-naive patients with early-stage Parkinson disease. We compared 25 patients with Parkinson disease and diabetes mellitus to 25 without diabetes mellitus, and 14 patients with diabetes mellitus and no Parkinson disease to 14 healthy controls (people with no diabetes mellitus or Parkinson disease). The clinical diagnosis of diabetes mellitus was confirmed by 2 consecutive fasting measurements of serum glucose levels >126 mL/dL. Over a 36-month follow-up period, we then investigated in the population with Parkinson disease whether the presence of diabetes mellitus was associated with faster motor progression or cognitive decline. The presence of diabetes mellitus was associated with higher motor scores (p < 0.01), lower striatal dopamine transporter binding (p < 0.05), and higher tau CSF levels (p < 0.05) in patients with Parkinson disease. In patients with diabetes but without Parkinson disease, the presence of diabetes mellitus was associated with lower striatal dopamine transporter binding (p < 0.05) and higher tau (p < 0.05) and α-synuclein (p < 0.05) CSF levels compared to healthy controls. At the Cox survival analysis in the population of patients with Parkinson disease, the presence of diabetes mellitus was associated with faster motor progression (hazard ratio = 4.521, 95% confidence interval = 1.468-13.926; p < 0.01) and cognitive decline (hazard ratio = 9.314, 95% confidence interval = 1.164-74.519; p < 0.05). Diabetes mellitus may predispose toward a Parkinson-like pathology, and when present in patients with Parkinson disease, can induce a more aggressive phenotype.

Otologic and audiologic characteristics of type 2 diabetics in a tertiary health institution in Nigeria

IntroductionThis cross-sectional comparative study was carried out at the Diabetes outpatient clinic of LAUTECH Teaching Hospital (LTH) Ogbomoso, Nigeria. ObjectiveThis study assessed patterns of otologic diseases and auditory acuity among type 2 diabetics and determinants of these findings among diabetics. MethodsNinety-seven consenting patients with clinical diagnosis of diabetes mellitus (194 ears) were matched for age and sex with ninety non-diabetic patients (180 ears). These patients were screened using otoscopy and pure tone audiometry over a 6-month period. ResultsThe study reported a crude prevalence rate of 21.6% hearing loss in T2DM patients. The most common type of otologic disease that showed significant association with T2DM patients was otitis media with effusion (p=0.027). T2DM was significantly associated with abnormal audiometric findings (p=0.022), particularly sensorineural hearing loss (p=0.022), of the moderate grade (p=0.057). There were no differences of the audilogical findings for any particular ear, and no differential affectation of frequency range was observed. Coexisting hypertension and poor glycaemic control were significantly associated with aggravation of the hearing of the T2DM patients (p< 0.001, and p=0.009 respectively). ConclusionT2DM had appreciable effects on hearing acuity. T2DM was significantly associated with the type and the degree of the hearing loss. The need for screening of hearing acuity of T2DM patients, in order to detect early changes, and promptly offer an adequate management and remedial measures was emphasized in this study.

Statin Use, Diabetes Incidence and Overall Mortality in Normoglycemic and Impaired Fasting Glucose Patients.

The association between the use of statins and the risk of diabetes and increased mortality within the same population has been a source of controversy, and may underestimate the value of statins for patients at risk. We aimed to assess whether statin use increases the risk of developing diabetes or affects overall mortality among normoglycemic patients and patients with impaired fasting glucose (IFG). Observational cohort study of 13,508 normoglycemic patients (n = 4460; 33% taking statins) and 4563 IFG patients (n = 1865; 41% taking statin) among residents of Olmsted County, Minnesota, with clinical data in the Mayo Clinic electronic medical record and at least one outpatient fasting glucose test between 1999 and 2004. Demographics, vital signs, tobacco use, laboratory results, medications and comorbidities were obtained by electronic search for the period 1999-2004. Results were analyzed by Cox proportional hazards models, and the risk of incident diabetes and mortality were analyzed by survival curves using the Kaplan-Meier method. The main endpoints were new clinical diagnosis of diabetes mellitus and total mortality. After a mean of 6 years of follow-up, statin use was found to be associated with an increased risk of incident diabetes in the normoglycemic (HR 1.19; 95% CI, 1.05 to 1.35; p = 0.007) and IFG groups (HR 1.24; 95%CI, 1.11 to 1.38; p = 0.0001). At the same time, overall mortality decreased in both normoglycemic (HR 0.70; 95% CI, 0.66 to 0.80; p < 0.0001) and IFG patients (HR 0.77, 95% CI, 0.64 to 0.91; p = 0.0029) with statin use. In general, recommendations for statin use should not be affected by concerns over an increased risk of developing diabetes, since the benefit of reduced mortality clearly outweighs this small (19-24%) risk.

2D06 プラスチック製マイクロチップ基板での血中アディポカイン測定と糖尿病診断への応用(OS1:健康工学とバイオエンジニアリング)

2D06 プラスチック製マイクロチップ基板での血中アディポカイン測定と糖尿病診断への応用(OS1:健康工学とバイオエンジニアリング)

Urinary Fatty Acid Composition and Biomarkers Discovery for Type 2 Diabetic Patients Based on Ultra-Performance Liquid Chromatography-Quadrupole/Time of Flight Mass Spectrometry and Multivariate Statistical Analysis

A strategy of high sensitive assay method of urine fatty acid profiles was established based on ultra-performance liquid chromatography-quadrupole time of flight-mass spectrometry (UPLC/Q-TOF) and applied in metabolomics research of diabetes mellitus. In this way, 19 fatty acids including two pair of hard-resolved isomers were separated well in only 13 minutes, and Q-TOF mass spectrometry reduced the matrix interference of urine samples by high resolution and accurate molecular weights. Under the optimal conditions, fatty acid profiles of 93 cases of urine samples were analyzed. Fatty acid profiles of type 2 diabetes mellitus showed large differences from health controls based on multivariate data analysis; C16:0, C18:0, C18:2, C20:5, and C22:6 were screened as potential clinical biomarkers. This work is complementary to the clinical diagnosis of diabetes mellitus; additionally, noninvasive testing of urine samples made it more convenient for examination while reducing the patient's pain and improving their living conditions.

The label free picomolar detection of insulin in blood serum

Insulin, a polypeptide hormone secreted by pancreatic cells, is a key regulator in glucose homeostasis. Its deficiency leads to insulin-dependent (type I) diabetes whereas resistance to insulin is common in type II diabetes, obesity and a range of endocrine disorders. Its determination is of considerable value, particularly in the clinical diagnosis of diabetes mellitus and the doping control of athletes. It has, additionally, been noted as a potential breast cancer marker (serum insulin levels being found to be raised in comparison to control patients). Electrochemical assays are potentially very cheap, highly sensitive, and very readily transposed to a point of care. Though there exist numerous examples of label free impedimetric or capacitative assaying of biomolecules, these are rarely demonstrated to be effective in complex biological mixtures or to be applicable to low molecular weight targets (since they operate through the interfacial displacement of water/ions and/or the steric blocking of a redox probe). We report herein an ultrasensitive electrochemical and label-free biosensor for insulin in blood serum with a clinically relevant linear range and detection limit of 1.2pM. The transducing surfaces, based on readily prepared, antibody modified, polyethylene glycol monolayer modified polycrystalline gold surfaces, respond in a highly specific and re-useable manner to the target in up to 50% blood serum.

Report of the committee on the classification and diagnostic criteria of diabetes mellitus.

Abstract Concept of Diabetes Mellitus: Diabetes mellitus is a group of diseases associated with various metabolic disorders, the main feature of which is chronic hyperglycemia due to insufficient insulin action. Its pathogenesis involves both genetic and environmental factors. The long‐term persistence of metabolic disorders can cause susceptibility to specific complications and also foster arteriosclerosis. Diabetes mellitus is associated with a broad range of clinical presentations, from being asymptomatic to ketoacidosis or coma, depending on the degree of metabolic disorder.

Acute phosphate nephropathy

Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USACASE PRESENTATIONA 60-year-old white Latino female with a clinical diagnosisof diabetes mellitus (diagnosed in 1993) and hypertensionwas referred to the chronic kidney disease clinic atBrigham and Women’s Hospital for the evaluation of acutekidney injury; serum creatinine had increased from abaseline of 0.9 to 1.5mg/dl in a 11-week period. She wasasymptomatic at the time of presentation. Her pastmedical history included a total abdominal hysterectomywith bilateral salpingo oophorectomy and uppervaginectomy for high-grade squamous intraepitheliallesion of the cervix, 11 weeks prior to presentation. Threeweeks prior to presentation (8 weeks after surgery) andwithin a week of each other, she was evaluated for twoconsecutive episodes of acute onset of chest pain withpulmonary edema in the setting of severe hypertension.Both episodes had blood pressures in excess of190–200mmHg systolic that resolved with intravenousdiuretics. Cardiovascular workup revealed no evidence ofischemic heart disease. Additionally, renal evaluationincluded magnetic resonance angiography with andwithout gadolinium, which did not reveal renal arterystenosis. However, serum creatinine peaked at 1.9 mg/dlimmediately after surgical procedure and remainedelevated at 1.5mg/dl throughout the course of her currentpresentation (corresponding to a glomerular filtration rateof 33ml/min per 1.73m

Does alfacalcidol prevent pancreatic beta cells from further destruction in children at the onset of diabetes mellitus type 1?

In recent years studies focused on prevention of type 1 diabetes mellitus (DM) and possibility of beta-cell protection at the clinical diagnosis of DM. Some recent studies have demonstrated beneficial role of vit. D3 analogue in human beta-cell activity maintenance at the early stages of DM.

Effects of Steroid Administration on Blood Glucose Concentration during Brain Surgery

Background: Steroids are normally used in neurosurgery, especially when treating brain edema and reducing the intracranial pressure. Methylprednisolone is known to increase the blood glucose concentration. However, the effect of a single methylprednisolone injection on the blood glucose concentration is unknown. Therefore, this study measured and compared the blood glucose concentration in a methylprednisolone group with that in a placebo group at the same interval. Methods: Thirty-three adult patients were enrolled in this study. The patients were scheduled to undergoing an elective craniotomy with the procedure lasting 4 hours or longer. The candidates were divided in two groups. One group was the methylprednisolone group (patients receiving methylprednisolone 125 mg, n = 18), and the other group was the placebo group (n = 15). The exclusion criteria were a clinical diagnosis of diabetes mellitus, an impaired glucose tolerance and had received steroid previously. Before injecting 125 mg of either methylprednisolone or the placebo, the blood glucose concentration was checked by glucose analyzer. After the injection, blood glucose concentration was checked every 30 minutes for more than 4 hours. Results: The blood glucose concentration increased significantly over time compared with the baseline concentration in both groups. The glucose concentration increased significantly in the methylprednisolone group than in the placebo group (P ＜ 0.05). The magnitude of this difference was greater in those who received methylprednisolone (54 mg/dl increase over 4 hours) than in the placebo group (11 mg/dl increase over 4 hours). Conclusions: In this study, compared with placebo controls, an injection of methylprednisolone (125 mg) produced a significant increase in the blood glucose concentration over a 4 hours period. Therefore, we recommend that the blood glucose level be monitored carefully in cases of brain surgery and/or when steroids are used. (Korean J Anesthesiol 2006; 50: 439~43)