Coexisting Diabetes Mellitus Research Articles

Glycemic control and survival of patients with coexisting diabetes mellitus and gastric or esophageal cancer.

Aim:To examine effects of diabetes mellitus (DM) on survival in gastric or esophageal (GE) cancer and the cancers’ effects on glycemic control.Materials & methods:Patients with GE cancer with and without DM were matched 1 to 1 (2006–2016). Characteristics were compared and survival assessed with Kaplan–Meier method and Cox regression. Mixed models compared hemoglobin A1c and glucose over time.Results:Among DM cases, mean hemoglobin A1c was 6.8% in the year after cancer diagnosis. Three-year overall survival was 46% with DM versus 52% without DM (hazard ratio [95% CI]: 1.95 [1.14–3.34]; p = 0.02).Conclusion:GE cancer and its treatment did not affect glycemic control. Risks of death and progression were greater for patients with DM than patients without DM.

Delay in diagnosis and treatment among adult multidrug resistant tuberculosis patients in Yangon Regional Tuberculosis Center, Myanmar: a cross-sectional study

BackgroundDelays in diagnosis and treatment initiation may allow the emergence of new cases by transmission to the community, and is one of the challenges facing programme management of drug resistance in Myanmar. This study aimed to explore delays in diagnosis and treatment initiation, and associated factors among patients with multidrug-resistant tuberculosis.MethodsA cross-sectional study was conducted at Yangon Regional Tuberculosis Centre, Myanmar. Data were collected by face-to-face interviews and treatment-card reviews of all adult patients who had registered and started treatment with the standard regimen from May to November, 2017. Delay time was categorized by using median cut-off and analyzed using SPSS version 23.0. Logistic regression analysis was performed to assess the relative impact of predictor variables on diagnosis and treatment delays.ResultsA total of 210 patients participated in this study. The median diagnosis delay was 9 days, IQR 3 (8–11) and 58.6% of the patients experienced a long diagnosis delay. Below middle school education (adjusted odds ratio [AOR] = 2.75, 95% CI = 1.22–6.21), non-permanent salaried employment (AOR = 3.03, 95% CI = 1.32–6.95), co-existing diabetes mellitus (AOR = 5.06, 95% CI = 1.97–13.01) and poor awareness (AOR = 2.99, 95% CI = 1.29–6.92) were independent predictors of long diagnosis delay. The median treatment delay was 13 days, IQR 9 (8–17) and 51% of the patients experienced long treatment delay. Age 31–50 years (AOR = 4.50, 95% CI = 1.47–13.97) and age > 50 years (AOR = 9.40, 95% CI = 2.55–34.83), history with MDR-TB patient (AOR = 3.16, 95% CI = 1.29–7.69), > 20 km away from a Regional TB Centre (AOR = 14.33, 95% CI = 1.91–107.64) and poor awareness (AOR = 4.62, 95% CI = 1.56–13.67) were independent predictors of long treatment delay.ConclusionsStrengthening comprehensive health education, enhancing treatment adherence counseling, providing more Xpert MTB/RIF machines, expanding decentralized MDR-TB treatment centers, ensuring timely sputum transportation, provision of a patient support package immediately after confirmation, and strengthening contact-tracing for all household contacts with MDR-TB patients and active tuberculosis screening were the most effective ways to shorten delays in MDR-TB diagnosis and treatment initiation.

Population-based cohort study of diabetes mellitus and mortality in gastric adenocarcinoma.

Gastric adenocarcinoma is a common cause of cancer death globally. It remains unclear whether coexisting diabetes mellitus influences survival in patients with this tumour. A cohort study was conducted to determine whether coexisting diabetes increases mortality in gastric adenocarcinoma. This nationwide population-based cohort study included all patients diagnosed with gastric adenocarcinoma in Sweden between 1990 and 2014. Cox proportional hazards regression and competing risks regression were used to assess the influence of coexisting diabetes on disease-specific mortality in gastric adenocarcinoma with adjustment for sex, age, calendar year and co-morbidity (Charlson Co-morbidity Index score excluding diabetes). Among 23 591 patients with gastric adenocarcinoma, 2806 (11·9 per cent) had coexisting diabetes. Overall, patients with diabetes had a moderately increased risk of disease-specific mortality after diagnosis of gastric adenocarcinoma compared with those without diabetes, as shown by both Cox regression (hazard ratio (HR) 1·17, 95 per cent c.i. 1·11 to 1·22) and competing risks regression (sub-HR 1·08, 1·02 to 1·13). The HRs for disease-specific mortality were notably increased in diabetic patients without other co-morbidity (HR 1·23, 1·15 to 1·32) and in diabetic patients who had surgery with curative intent (HR 1·27, 1·16 to 1·38). These findings indicate a worse prognosis in patients with gastric adenocarcinoma and coexisting diabetes compared with those without diabetes.

Cardiorenal prognosis by residual proteinuria level in diabetic chronic kidney disease: pooled analysis of four cohort studies.

No study has assessed whether the prognosis of coexisting diabetes mellitus and chronic kidney disease (DM-CKD) is dictated by DM per se or by the extent of proteinuria. In this pooled analysis of four prospective studies in CKD patients treated with drugs inhibiting the renin-angiotensin system, we compared the risk of all-cause mortality, fatal and non-fatal cardiovascular (CV) events and end-stage renal disease (ESRD) between patients with (n = 693) and without diabetes (n = 1481) stratified by proteinuria level (<0.15, 0.15-0.49, 0.5-1 and >1 g/day). The group with DM-CKD was older (69 ± 11 versus 65 ± 15 years), had a higher body mass index (29.6 ± 5.4 versus 27.5 ± 4.8 kg/m2) and systolic blood pressure (143 ± 19 versus 136 ± 18 mmHg), prevalent CV disease (48% versus 29%) and lower estimated glomerular filtration rate (34.5 ± 17.9 versus 36.6 ± 19.0 mL/min/1.73m2). During 4.07 years of follow-up, there were 466 patients with ESRD, 334 deaths and 401 CV events occurred. In the subgroup with urine protein <0.15 g/day (N = 662), the risks of ESRD, CV events and mortality were similar in diabetic and non-diabetic patients. Conversely, in DM-CKD patients, the mortality risk was higher in proteinuric patients {hazard ratio 1.92 [95% confidence interval (CI) 1.25-2.95); 1.99 (1.26-3.15) and 1.98 (1.28-3.06) for proteinuria 0.15-0.49, 0.5-1 and >1 g/day, respectively}, whereas in non-diabetics the mortality risk increased only for proteinuria 0.5-1 g/day [HR 1.60 (95% CI 1.07-2.40)] and >1 g/day [HR 1.69 (95% CI1.20-2.55)]. In both groups, CV risk had a trend similar to that of mortality. ESRD risk increased progressively across strata >0.5 g/day independent of diabetic status. We provide evidence that patients with non-proteinuric DM-CKD are not exposed to higher cardiorenal risk. In contrast, in the presence of moderate proteinuria and diabetes per se is associated with a higher risk of mortality and CV events, whereas the entity of abnormal proteinuria modulates ESRD risk independent of diabetes.

Factors that affect the duration of antimicrobial therapy for cellulitis.

The recommended duration of antibiotic therapy for patients hospitalized with cellulitis is 5-14 days. However, factors that affect the duration of treatment have rarely been examined. We conducted an observation study in a regional hospital in Japan to examine factors that affect the duration of antibiotic therapy for cellulitis. Our study included 102 patients with cellulitis of the lower extremities who were treated with intravenous cefazolin alone. Intravenous cefazolin was terminated when redness, swelling, and tenderness of the lower extremities disappeared, and subsequently the patients were discharged. The relationship between the duration (days) of treatment with intravenous cefazolin (DIVC) and clinical factors were analyzed. The median DIVC was 8 days (interquartile range, 7-10 days). On univariate analysis, DIVC correlated significantly with patient age (P=0.0071) and with C-reactive protein levels before treatment (P=0.0053). DIVC in patients with diabetes mellitus was significantly longer than that in patients without diabetes mellitus (P=0.0033). DIVC in patients with blood stream infection was significantly longer than that in patients without blood stream infection (P=0.029). On multivariate analysis, variables independently associated with longer DIVC included patient age (P=0.044), C-reactive protein levels before treatment (P=0.017), presence of diabetes mellitus (P=0.0021), and presence of blood stream infection (P=0.028). Duration of treatment with intravenous antibiotics for cellulitis is associated with patient age, C-reactive protein levels, coexisting diabetes mellitus, and coexisting blood stream infection. These findings should be considered when treatment plans for cellulitis are devised.

Co-Existing Prostate Cancer and Diabetes Mellitus: Implications for Patient Outcomes and Care

To investigate how diabetes mellitus (DM) impacts short-term overall survival (OS) for patients with prostate cancer and to examine how prostate cancer impacts glycemic control in DM. Patients with DM and prostate cancer newly diagnosed from 2007 to 2014 were identified from the institutional cancer registry and matched to patients with prostate cancer but no DM according to age and year of prostate cancer diagnosis. The study included 276 cases and 276 controls; the mean age was 72 years, most (93%) were white, the most common Gleason score (52%) was 7, and the majority (56%) were tumor stage II. Patients with DM had a higher mean body mass index (P = .03). Alcohol use and performance status differed by group (P<.001), but the 2 groups otherwise were not significantly different. Among those with DM, the mean hemoglobin A1c (HbA1c) was 6.7%. In Kaplan-Meier survival analysis (median follow-up time, 43.7 months), the 5-year OS rates were estimated at 88% and 93% for patients with and without DM, respectively (hazard ratio, 1.64; 95% confidence interval, 0.77-3.46; P = .20). Mean glucose among patients with DM was significantly higher (P<.001) compared with non-DM patients, but mean HbA1c and glucose values did not change significantly over 1 year (P≥.13). DM did not adversely impact survival in patients with prostate cancer. In addition, prostate cancer and its treatment did not affect glycemic control. Patients and their providers can be reassured that the concurrent diagnoses do not adversely interact to worsen short-term outcomes. DM = diabetes mellitus; HbA1c = hemoglobin A1c; OS = overall survival.

Abstract 111: Health Status Implications for Comorbid Diabetes in Patients with Symptomatic Peripheral Arterial Disease: Insights from PORTRAIT Registry

Introduction: Patients with peripheral arterial disease (PAD) and coexisting diabetes mellitus (DM) have an increased rate of PAD progression and reduced walking performance as compared with non-diabetic PAD patients. It is unknown, however, whether patients with PAD and comorbid diabetes also experience worse PAD-specific health status (symptoms, functioning, quality of life) and what factors might mediate such a difference. Methods: PORTRAIT is a 16-center international registry that includes patients with exacerbated or new-onset symptomatic PAD presenting to specialty clinics. We measured PAD-specific health status at the time of PAD evaluation, 3, 6 and 12 months using the Peripheral Artery Questionnaire (PAQ). Hierarchical, multivariable, repeated measures analysis was used to assess the association between DM and health status at baseline and over time. Sequential adjustments for demographics, socioeconomic factors, PAD severity, comorbidities, psychosocial characteristics, primary treatment strategy and quality of care were made. Results: Of 1,204 patients, 398 patients had diabetes (33%, of whom 94% had Type II). Patients with PAD and DM had lower unadjusted PAQ summary scores at 0, 3, 6 and 12 months respectively (46.1 vs. 50.8, p &lt; 0.001; 63.6 vs. 68.2, p &lt; 0.01; 65.7 vs. 71.7, p &lt; 0.001; 65.4 vs. 72.6, p &lt;0.001). Patients with PAD and DM were more likely to be unemployed, depressed, of non-White race and to have more cardiovascular comorbidities, bilateral disease, non-healing ulcers and prior peripheral vascular interventions. When sequentially adjusting for relevant confounders, the effect for diabetes was mostly explained by comorbidities and psychosocial factors (Figure 1). Conclusion: Patients with PAD and co-existing DM have poorer health status upon PAD diagnosis and the year thereafter as compared with those who do not have DM, potentially explained by a higher burden of clinical comorbidities and psychosocial factors. Future work will need to further evaluate whether more emphasis on psychosocial aspects of care in these patients can improve their PAD-specific health status.

Prevalence and determinants of anxiety and depression in end stage renal disease (ESRD). A comparison between ESRD patients with and without coexisting diabetes mellitus

ObjectiveTo compare anxiety and/or depressive symptoms between patients with end-stage renal disease with and without comorbid diabetes and identify factors associated with symptoms of distress in this population. MethodsData from two studies (conducted between 2010 and 2014) were pooled. A total of 526 patients on hemodialysis (68.8% with diabetes) completed the Hospital Anxiety and Depression Scale (HADS). Elevated symptoms were defined as HADS-Anxiety or HADS-Depression≥8. Univariate and multivariate logistic regressions were used to estimate associations between diabetic status, and other socio-demographic and clinical factors with baseline clinical anxiety and depression. ResultsA total of 233 (45.4%) reported elevated anxiety symptoms and 256 (49.9%) reported elevated depressive symptoms sufficient for caseness. Rates were not different between patients with and without diabetes. Risk for clinical depression was higher in patients who were single/unpartnered (OR=1.828), Chinese vs. Malay (OR=2.05), or had lower albumin levels (OR=0.932). None of the parameters were associated with anxiety caseness. ConclusionSociocultural factors rather than comorbid burden may help identify patients at risk for depression. The high rates of anxiety and depression underlie the importance for monitoring and intervention in dialysis care.

Serum bilirubin: a simple routine surrogate marker of the progression of chronic kidney disease

Background: Studies suggest that Chronic Kidney Disease (CKD) is a global burden health associated with significant comorbid conditions. Few biochemical parameters have gained significance in predicting the disease progression. The present work aimed to study the association of the simple biochemical parameter of serum bilirubin level with the estimated glomerular filtration rate (eGFR), and to assess their association with the co-morbid conditions in CKD.Methods: We recruited 188 patients with CKD who attended a Nephrology out-patient department. eGFR values were calculated based on the serum creatinine levels using CKD-EPI formula. Various biochemical parameters including glucose, creatinine, uric acid, total and direct bilirubin were assayed in all study subjects. Study subjects were categorized into subgroups based on their eGFR values and their diabetic status and the parameters were compared among the different subgroups.Results: We observed a significantly decreased serum bilirubin levels (p < 0.001) in patients with lower eGFR values, compared to those with higher eGFR levels. There was a significant positive correlation between the eGFR levels and the total bilirubin levels (r = 0.92). We also observed a significant positive correlation between the eGFR levels and the direct bilirubin levels (r = 0.76). On multivariate linear regression analysis, we found that total and direct bilirubin independently predict eGFR, after adjusting for potential confounders (p < 0.001).Conclusions: Our results suggest that there is significant hypobilirubinemia in CKD, especially with increasing severity and co-existing diabetes mellitus. This finding has importance in the clinical setting, as assay of simple routine biochemical parameters such as serum bilirubin may help in predicting the early progression of CKD and more so in diabetic CKD.

A Comparison of Clinical, Radiological, and Bacteriological Characteristics of Pulmonary Tuberculosis in Diabetic and Non-Diabetic Patients

SESSION TITLE: Chest Infections SESSION TYPE: Original Investigation Poster PRESENTED ON: Saturday, April 16, 2016 at 11:45 AM - 12:45 PM PURPOSE: Diabetes Mellitus (DM) may influence the clinical features, radiological involvement and sputum smear positivity rate of pulmonary tuberculosis (PTB). The aim of this study was to see the clinical, radiological and bacteriological features of PTB in DM patients compared to non-diabetic (non-DM) patients. METHODS: This cross-sectional study was performed from July 2013 to June 2015 in the Department of Internal Medicine and Pulmonology of BIRDEM General Hospital as part of BADAS-USAID TB Care-II project, Bangladesh. Out of 7165 TB suspects, 1014 (14.2%) were confirmed as TB cases; of them 694 (68.4%) were diagnosed as PTB and were included in the study. RESULTS: Out of 694 PTB patients, 606 (87.3%) were diabetic and 88 (12.7%) were non-diabetic. Most of the patients in both groups (71.1% DM vs 63.6% non-DM) were male. Compared to non-DM patients, patients with DM were older (Mean age 48.7±12.4 vs 36.4±17.0; p=0.015] and had increased body mass index (BMI) (Mean BMI 20.0±3.7 vs 18.4±3.3; p=0.003). There was no significant difference in the clinical features of PTB (fever 96.4% vs 94.3%, cough 92.0% vs 95.5%, weight loss 87.8% vs 85.2% respectively) between DM and non-DM patients. Compared to non-DM patients, cavitary lesion (26.7% in DM vs 8.0% in non-DM) and lower-lobe opacity (28.3% in DM vs 14.9% in non-DM) in chest x-ray were more in diabetics whereas apical opacity (1.7% in DM vs 5.7% in non-DM) and pleural effusion (9.3% in DM vs 12.6% in non-DM) was more in non-DM [p=0.000]. Most of the DM patients (60.1%) had sputum smear positive PTB while non-DM patients (66.7%) had smear negative PTB. Gene x-pert MTB/RIF was positive more in DM patients (93.7% vs 88.6%) [p=0.05]. CONCLUSIONS: Diabetic patients with PTB are comparatively older, have increased body weight, are more sputum smear positive and have atypical radiological involvement. CLINICAL IMPLICATIONS: Atypical chest x-ray in a pulmonary tuberculosis patient can hint to co-existing diabetes mellitus. DISCLOSURE: The following authors have nothing to disclose: Mohammad Hossain, Jamal Ahmed, Farhana Afroz No Product/Research Disclosure Information

Evaluation of LRINEC Scale Feasibility for Predicting Outcomes of Fournier Gangrene

Fournier gangrene (FG) is a fulminant necrotizing infection of the perineal, perianal, and periurethral tissues. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scale is used for diagnosis of necrotizing fasciitis. However, data on its relevance and usefulness in FG are lacking. The aim of this study was to evaluate the utility of the LRINEC scale in predicting the outcome of FG. This retrospective case study included 41 patents with FG treated at our institution from 2000 to 2013. The patients were divided into survivors and non-survivors. The mortality rate was 22%. The median age (75 vs. 62.5 y; p = 0.013), rate of co-existing diabetes mellitus (66.7% vs. 3.1%; p < 0.001), and median affected skin surface (4% vs. 1%; p < 0.001) were greater in the non-survivors. Seven of nine patients (77.8%) who did not survive (compared with 37.5% who survived) had a polymicrobial infection (p = 0.032). Of all the causative pathogens isolated, Proteus mirabilis was more common in non-survivors (55.6% vs. 6.3%; p = 0.001). The median calculated LRINEC score for survivors was 5 compared with 10 for the non-survivors (p < 0.001). Regression analysis showed that all the aforementioned variables, except for polymicrobial culture, were significant risk factors for predicting death. The area under the receiver operating characteristic curve for the LRINEC score was the highest, 0.976 (95% confidence interval 0.872-0.999; p < 0.0001), and the cut-off value was ≥9 with 93.7% specificity and 100% susceptibility for the prediction of a lethal outcome. The LRINEC score could be used for prediction of disease severity and outcomes. A threshold of 9 could be a high-value predictor of death during the initial evaluation of patients with FG.

Effect of coexisting diabetes mellitus and chronic kidney disease on mortality of cirrhotic patients with esophageal variceal bleeding.

BackgroundEsophageal variceal bleeding (EVB) is a serious and common complication of cirrhosis. Diabetes mellitus (DM) and chronic kidney disease (CKD) increase mortality in patients with cirrhosis. However, whether coexisting DM and CKD increase mortality in cirrhotic patients with EVB remains unclear.MethodsWe enrolled cirrhotic patients hospitalized with the first presentation of EVB from 2005 through 2010 using Longitudinal Health Insurance Database 2005. The hazard ratios (HRs) of 42-day and one-year EVB mortality were calculated using Cox regression model.ResultsWe identified 888 patients hospitalized with the first presentation of EVB. Among the cirrhotic patients with EVB, all-cause mortality at 42-day and one-year were 21.3 and 45.0 %, respectively. The respective HRs for the 42-day and one-year mortality were 1.80 (95 % confidence interval [CI], 1.10–2.97) and 1.52 (95 % CI, 1.06–2.17) for patients with CKD and 0.79 (95 % CI, 0.57–1.10) and 0.88 (95 % CI, 0.71–1.09) for patients with DM. Specifically, coexisting CKD and DM increased the 42-day and one-year mortality with respective HRs of 1.99 (95%CI, 1.03–3.84) and 1.84 (95%CI, 1.14–2.98) compared with those without CKD and DM. The HRs for 42-day and 1-year mortality in female patients with DM and CKD were 4.03 (95%CI, 1.40–11.59) and 2.84 (95%CI, 1.31–6.14) respectively, and were 2.93 (95%CI, 1.14–7.57) and 2.42 (95%CI, 1.28–4.57) in male patients with DM and CKD.ConclusionWe identified that coexisting DM and CKD increased risk of mortality at 42 days and 1 year following EVB.

Myopic choroidal neovascular membrane: A retrospective study

Purpose: The purpose of the study was to analyse the fundus fluorescein angiographic (FFA) and Spectral domain Optical coherence tomographic (SD- OCT) patterns of myopic CNVM and to evaluate their response to anti-VEGF. Materials and Methods: This is a retrospective analysis of 24 treatment naive eyes diagnosed with myopic CNVM. Eyes with age related macular degeneration, coexisting diabetes mellitus, inflammatory CNVM, idiopathic CNVM and Pseudophakia were excluded.Analysis of degree of myopia, the best corrected visual acuity (BCVA) at presentation and one year after treatment, FFA features, SD-OCT images and the response to intravitreal anti VEGF injections were carried out. Results: 24 eyes of 21patients ( 6 males, 15 females) were included in the study Mean age of the patients was 44.78 ± 17.40 years.Degree of myopia ranged from -2.5D to -22 D. Fundus fluorescein angiography showed classic CNVM in all eyes with subfoveal location in 19 eyes and juxtafoveal in 5 eyes. SD-OCT imaging showed subretinal hyperreflective material with intraretinal oedema in all eyes. Intravitreal bevacizumab (1.25mg in 0.5ml) was given in 18 eyes and ranibizumab (0.5 mg in 0.5ml) in 6 eyes. Mean number of injections taken was 1.83 (range 1 to 5). At 1 year follow up,13 eyes showed improvement in BCVA (54.16%), 6 worsened (25%), 5 remained stable (20.83%). Conclusion: Myopic CNVM responds to finite number of anti-VEGF injections anatomically and visually with no associated complications. The worsening is due to degenerative changes rather than recurrence of CNVM.

Clinical and Surgical Predictors of Complications Following Surgery for the Treatment of Cervical Spondylotic Myelopathy: Results From the Multicenter, Prospective AOSpine International Study of 479 Patients.

Surgery for cervical spondylotic myelopathy (CSM) is generally safe and effective. Nonetheless, complications occur in 11% to 38% of patients. Knowledge of important predictors of complications will help clinicians identify high-risk patients and institute prevention and management strategies. To identify clinical and surgical predictors of perioperative complications in CSM patients. Four hundred seventy-nine surgical CSM patients were enrolled in the prospective CSM-International study at 16 sites. A panel of physicians reviewed all adverse events and classified each as related or unrelated to surgery. Univariate analyses were performed to determine differences between patients who experienced a perioperative complication and those who did not. A complication prediction rule was developed using multiple logistic regression. Seventy-eight patients experienced 89 perioperative complications (16.25%). On univariate analysis, the major clinical risk factors were ossification of the posterior longitudinal ligament (OPLL) (P = .055), number of comorbidities (P = .002), comorbidity score (P = .006), diabetes mellitus (P = .001), and coexisting gastrointestinal (P = .039) and cardiovascular (P = .046) disorders. Patients undergoing a 2-stage surgery (P = .002) and those with a longer operative duration (P = .001) were at greater risk of perioperative complications. A final prediction model consisted of diabetes mellitus (odds ratio [OR] = 1.96, P = .060), number of comorbidities (OR = 1.20, P = .069), operative duration (OR = 1.07, P = .002), and OPLL (OR = 1.75, P = .040). Surgical CSM patients have a higher risk of perioperative complications if they have a greater number of comorbidities, coexisting diabetes mellitus, OPLL, and a longer operative duration. Surgeons can use this information to discuss the risks and benefits of surgery with patients, to plan case-specific preventive strategies, and to ensure appropriate management in the perioperative period. BMI, body mass indexCSM, cervical spondylotic myelopathymJOA, modified Japanese Orthopaedic AssociationOPLL, ossification of the posterior longitudinal ligament.

Hyperglycemia among hospitalized cancer patients with coexisting diabetes mellitus

Aims: The objective was to study the care of hospitalized patients with diabetes mellitus and coexisting cancer. Patients & methods: Hospitalized patients with a new solid organ malignancy and diabetes were retrospectively analyzed. Multivariable generalized estimating equation models evaluated associations between cancer type and hyperglycemia (glucose >180 mg/dl). Results: Among 443 patients with 914 hospitalizations, cancer types included prostatic, liver, lung, kidney, pancreatic, bladder, breast, colorectal and gynecologic. Increased hemoglobin A1c (β = 2.72; p < 0.01), mean glucose within 24 h after admission (β = 0.27; p < 0.01) and insulin administration (β = 10.16; p < 0.01) were significantly associated with hyperglycemia. No association existed between cancer type and hyperglycemia frequency (p = 0.79). Conclusion: Inpatient hyperglycemia management is not associated with type of solid organ malignancy.

Hyperglycemia among hospitalized cancer patients with co-existing diabetes mellitus.

Hyperglycemia among hospitalized cancer patients with co-existing diabetes mellitus.

English

PURPOSE: To estimate the prevalence of fundus changes in Pregnancy Induced Hypertension (PIH) and to find the correlation of the findings with the levels of hypertension and with the severity of the disease. METHODS: This was a hospital based cross sectional study conducted over a period of one year from July 2012 to June 2013. 150 patients with diagnosed PIH and admission into wards at King George Hospital, Visakhapatnam, with 36 weeks period of gestation and above, were included in the study. Those with pre-existing hypertension, coexisting diabetes mellitus, severe anaemia, renal disease and ocular diseases like cataract or corneal opacities were excluded from the study. After taking consent and ocular history, anterior segment was evaluated. Pupils were dilated with 0.5% tropicamide eye drops and fundus examination was done with direct ophthalmoscope. Information like age, para, BP etc., was noted down from case sheets. RESULTS: Total number of patients studied was 150.Mean age was 23.06+ 3.03years. 105 (70%) were primigravidae and 45(30%) were multigravidae. Fundus findings were seen in 35 cases (23.33%). 26 (17.33%) had Grade I changes, 1 (0.66%) had grade II changes, 6 (3.9%) had grade III changes 2 (1.3%) had serous retinal detachment/grade -IV. The degree of retinopathy was correlating with the severity of the disease and levels of hypertension. CONCLUSION: The prevalence of fundus changes in PIH is 23.33%. Most of the fundus changes in PIH are underdiagnosed. Timely ophthalmoscopy should be called for in all cases of PIH as it would affect the decision of induction of delivery, thereby preventing other complications.

Gas in the Kidneys? Emphysematous Pyelonephritis: A Case Series

We examine three cases of emphysematous pyelonephritis that presented to our intensive care unit over a three-year period. The three patients were all female, had co-existing diabetes mellitus, and developed acute kidney injury (AKI), hyponatraemia and thrombocytopenia during the course of their illness. All three were managed by radiological intervention along with medical management. Two of the three patients also had surgical management (nephrectomy), which was carried out at different stages of the acute illness. All three patients survived to hospital discharge. There was an inconsistent approach to the management of this rare condition, both in our cases and in similar cases reported in the medical literature. These cases underline the importance of maintaining open dialogue between the intensive care and the specialist teams to aid the decision-making required in these patients, who have a potentially high mortality.

Effect of type 2 diabetes on the left ventricular diastolic dysfunction in patients with chronic kidney disease, 3 and 4 stages

Patients with chronic kidney disease (CKD) and coexisting diabetes mellitus (DM) are likely to have cardiological complications. We assessed whether patients with moderate kidney dysfunction, with coexisting type 2 DM and preserved left ventricular (LV) systolic function, demonstrate a more advanced LV diastolic dysfunction. The study group consisted of 58 ambulatory patients with CKD, stages 3 and 4. The patients were assigned to groups based on the presence of type 2 DM. The first group (DM+) consisted of 21 patients with type 2 DM while second one (DM−) consisted of 37 patients without type 2 DM. Standard echocardiography was performed in all patients with tissue Doppler echocardiography for evaluation of the systolic velocity and both diastolic velocities of LV. The following laboratory parameters were measured: serum creatinine concentration, estimated glomerular filtration rate, and the levels of urea, phosphorus, calcium, parathormone, platelets count, hemoglobin level and N-terminal pro-B-type natriuretic peptide levels. LV diastolic dysfunction was defined as EmLV less than 8 cm/s. Patients in DM+ group, as compared to patients in DM− group, were characterized by higher values of left and right ventricular end-diastolic dimension, left atrial diastolic dimension, interventricular septal diastolic diameter, LV posterior wall dimension at diastole and of LV mass index, smaller LV ejection fraction and LV fractional shortening. In tissue Doppler echocardiography patients of DM+ group, as compared to patients of DM− group, did not differ in value of EmLV (7.4 ± 2.4 cm/s vs. 7.6 ± 2.1 cm/s, P = .723), respectively, and were characterized by similar estimated LV diastolic filling pressure as indicated by E /EmLV (10.1 ± 3.7 vs. 8.8 ± 2.6, P = .119). CKD patients in the moderate stage, with coexisting type 2 DM were not characterized by higher risk of developing LV diastolic dysfunction.

Safety and effectiveness of adalimumab in Japanese rheumatoid arthritis patients: Postmarketing surveillance report of 7740 patients

Objectives. To confirm the safety and effectiveness of adalimumab and to evaluate the influence of the concomitant use of methotrexate (MTX).Methods. Postmarketing surveillance of 7740 Japanese rheumatoid arthritis (RA) patients was performed. All patients who received adalimumab in the registration period were followed for 28 weeks after starting treatment for safety and 24 weeks for effectiveness. Effectiveness was measured by duration of morning stiffness, swollen and tender joint counts (28 joints), patient global assessment of disease activity, erythrocyte sedimentation rate and serum C-reactive protein.Results. Comparable rates of adverse drug reactions (ADRs) were reported in this study and in the interim analysis. Age, pulmonary disease history or comorbidity, co-existing diabetes mellitus, concomitant MTX at doses of > 8 mg/week and concomitant glucocorticoids at doses of > 5 mg/day were risk factors for infections. All mean values of effectiveness measurements improved. Relatively lower disease activity at baseline, biologic-naïve, concomitant MTX use and early RA stage/low functional class were background factors contributing to the effectiveness. The combination of adalimumab with MTX improved the response to adalimumab treatment.Conclusion. Adalimumab, especially with concomitant use of MTX, provided significant improvement in disease activity, without any unexpected ADRs in Japanese RA patients.