Decompensated Diabetes Mellitus Research Articles

Mucormycosis in patients admitted to a university hospital: a case series

Mucormycosis is an aggressive disease with high morbidity and mortality caused by fungi from the Mucorales order. They are fungi widely present in nature but may also be related to nosocomial infections. We present four cases of mucormycosis identified through histopathological analysis and involving the rhino-sinus region. All the cases were related to decompensated diabetes mellitus. Among these patients, two of them had lesions that affected their eyes and central nervous system (CNS). Although there were no fatalities, the two patients with ocular and CNS lesions experienced severe complications, including loss of vision and definitive chronic renal failure. 
 KEY WORDS: Mucormycosis; Covid-19; Sars-cov-2; diabetes mellitus; rhino-orbital.

CORRELATIONS OF INDICATORS OF THE IMMUNE SYSTEM, CARBOHYDRATE AND LIPID METABOLISM IN DIABETIC RETINOPATHY IN PATIENTS WITH DECOMPENSATED DIABETES DIABETES

Introduction. Pathogenetic mechanisms of the development of diabetic retinopathy are related to the toxic effect of hyperglycemia on the development of oxidative stress with subsequent activation of stress-sensitive systems
 The aim of the study. To find out the presence of correlations in patients with diabetic retinopathy against the background of decompensated diabetes
 Research methods. A clinical and laboratory examination of 70 diabetic retinopathy patients with decompensated diabetes mellitus was carried out. In order to identify correlations, the coefficient of linear correlation |r| was determined between all studied indicators
 Results and discussion. The analysis of these correlations indicates the formation of a block of strong correlations of peripheral blood leukocytes (except lymphocytes) and natural killers with indicators of lipid metabolism and pro-inflammatory cytokines.
 Strong correlations of T-lymphocyte subpopulations with indicators of carbohydrate metabolism and non-atherogenic fraction of lipoproteins were revealed.
 In the analysis of the correlations of the B-link of immunity, a positive strong correlation of the relative content of B-lymphocytes (CD19+) with CIC (r = 0.96, p < 0.05) was revealed, which indicates the dependence of the occurrence of type III hypersensitivity reactions with indicators of humoral immunity.
 Probable positive correlations of pro-inflammatory cytokines with atherogenic fractions of lipids and glucose, negative correlation of TNF-α with the acute phase marker C-peptide were revealed
 Conclusions. When analyzing the correlations of the studied indicators in patients with decompensated diabetes, 13 probable strong positive and 9 probable strong negative correlations were established).
 The increase in the pro-inflammatory component is manifested in the correlations of peripheral blood leukocytes (except lymphocytes) and natural killers with indicators of lipid metabolism and pro-inflammatory cytokines, strong correlations of T-lymphocyte subpopulations with indicators of carbohydrate metabolism and the non-atherogenic fraction of lipoproteins, type III hypersensitivity reactions with indicators of humoral immunity , pro-inflammatory cytokines with atherogenic fractions of lipids and glucose, negative relationship of TNF-α with acute phase marker C-peptide

Modern and safe treatment of type 2 diabetes mellitus. Clinical case of the use of gozogliptin in the treatment of a patient with decompensated diabetes mellitus

Modern and safe treatment of type 2 diabetes mellitus. Clinical case of the use of gozogliptin in the treatment of a patient with decompensated diabetes mellitus

Finegoldia magna and Mucorales molds co-infection in a severe case of SARS-CoV-2 disease.

Rhino-orbito-cerebral mucormycosis has been reported as a sequela after coronavirus disease in immunocompromised patients with poorly controlled diabetes mellitus. Most cases have been identified in India, with only 19 reported elsewhere. We herein report the results of clinical, imaging, microbiological, and histopathological studies in an immunocompetent 67-year-old male with rhino-orbital infection by Finegoldia magna and Mucorales molds following severe SARS-CoV-2 disease associated with new-onset decompensated diabetes mellitus. Microbiological and histological studies confirmed the presence of both Mucorales molds and Finegoldia magna, which was successfully treated with antibiotics and a specific anti-fungal agent (Posaconazole). Careful multidisciplinary follow-up of patients treated for severe SARS-CoV-2 disease is necessary for the timely diagnosis of complications such as uncontrolled diabetes mellitus and opportunistic infections.

Biomarkers of Oxidative Stress in Diabetes Mellitus with Diabetic Nephropathy Complications.

The present study aimed to investigate and compare biomarkers of oxidative stress and the activity of antioxidant enzymes in the plasma of patients with different stages of diabetic nephropathy. For this purpose, we studied (1) the levels of reactive oxygen species and reactive nitrogen species as oxidative stress parameters, (2) lipid and protein oxidation, (3) the activity of antioxidant enzymes, and (4) cytokine production. Patients with type 2 diabetes mellitus were divided into three groups according to the loss of renal function: patients with compensated diabetes mellitus with normal renal function DMT2N0 measured as an estimated glomerular filtration rate (eGFR) ≥ 90 mL/min/1.73 m2, a group with decompensated diabetes mellitus with complication diabetic nephropathy and mild-to-moderate loss of renal function DMT2N1 (eGFR < 60 mL/min/1.73 m2: 59-45 mL/min/1.73 m2), and a decompensated diabetes mellitus with diabetic nephropathy group with moderate-to-severe loss of renal function DMT2N2 (eGFR > 30 mL/min/1.73 m2: 30-44 mL/min/1.73 m2). All results were compared with healthy volunteers. The results showed that patients with diabetic nephropathy had significantly higher levels of ROS, cytokine production, and end products of lipid and protein oxidation compared to healthy volunteers. Furthermore, patients with diabetic nephropathy had depleted levels of nitric oxide (NO), an impaired NO synthase (NOS) system, and reduced antioxidant enzyme activity (p < 0.05). These findings suggest that patients with impaired renal function are unable to compensate for oxidative stress. The decreased levels of NO radicals in patients with advanced renal complications may be attributed to damage NO availability in plasma. The study highlights the compromised oxidative status as a contributing factor to impaired renal function in patients with decompensated type 2 diabetes mellitus. The findings of this study have implications for understanding the pathogenesis of diabetic nephropathy and the role of oxidative stress and chronic inflammation in its development. The assessment of oxidative stress levels and inflammatory biomarkers may aid in the early detection and prediction of diabetic complications.

(297) Evaluation of Endothelial Function and Metabolic Profile in Patients with Prostate Cancer Undergoing Androgen Deprivation Therapy

Abstract Introduction Androgen deprivation therapy (ADT) has been the cornerstone of prostate cancer treatment. ADT delays cancer progression, alleviates cancer-related symptoms, and is associated with survival gains. Despite these established benefits, the therapy comes with known side effects, such as increased cardiovascular adverse events and metabolic changes. Despite the well-established association between the level of circulating testosterone and endothelial integrity, the direct effects of ADT on endothelial function remain controversial. Objective The aim of the present study was to investigate the impact of ADT on endothelial function, through the analysis of vascular parameters of the brachial artery, and the measurement of serum inflammatory markers. It was also our goal to evaluate early impact of ADT on anthropometric and metabolic parameters Methods We prospectively evaluated men with moderate to high-risk prostate cancer treated with ADT from January to July 2022 at our institution. Patients with decompensated diabetes mellitus (HbA1c &amp;gt;9%), active smokers or smokers who have ceased for less than 5 years and those with confirmed diagnosis of peripheral artery disease, coronary artery disease, angina, congestive heart failure, myocardial infarction, coronary revascularization or stroke, were excluded. Brachial artery assessment included vascular diameter and flow-mediated (endothelium-dependent) vasodilation (FMD) using high-resolution B-mode ultrasound. Our metabolic and inflammatory profile included serum measurement of total cholesterol and fractions, triglycerides, fasting glucose, glycated hemoglobin, basal insulin, C-reactive protein, and bioimpedance assessment of body fat distribution. All measurements were performed at baseline and after 3 months of ADT initiation with goserelin acetate 10.80mg. Results A total of 14 men with mean age of 67.9 ± 6.9 years were included. The prevalence of diabetes in the present cohort was 21.4%. FMD demonstrated a slight increase following ADT, which did not reach statistical significance after 3 months (median 2.2% vs. 5.0%; p = 0.8224 – Figure 1). Baseline brachial artery diameter significantly decreased with ADT compared to baseline (median diameter 0.43cm vs 0.40cm; p = 0.006). With regard to the metabolic profile, ADT significantly increased insulin resistance: fasting insulin levels (mean 9.67 ± 6.09 vs 13.19 ± 7.47; p = 0.002), glycated hemoglobin (mean 5.79% ± 0.47 vs 6.22% ± 0.75; p = 0.009) and homeostatic model assessment insulin resistance increased significantly after 3 months (p = 0.006). Low-density lipoprotein cholesterol (mean 112.00 ± 27.35 vs 128.90 ± 29.00; p = 0.01) and triglycerides (mean 145.40 ± 78.52 vs 168.20 ± 105.80; p = 0.03) concentrations were higher after 3 months of ADT. No significant differences were found in body fat distribution. Conclusions Although the present study has not demonstrated a significant change in brachial artery FMD, we verified an important and surprisingly early worsening of the metabolic profile with ADT, especially increased insulin resistance and dyslipidemia, which represent well-established risk factors for cardiovascular events. Disclosure No

SEVERE HYPERTRIGLYCERIDEMIA IN CONGENITAL GENERALIZED LIPODYSTROPHY: A CASE REPORT

Lipodystrophic syndromes represent a heterogeneous group of very rare diseases inherited or acquired, characterized by altered body fat amount and/or repartition and metabolic alterations including marked insulin resistance and dyslipidemias. We report the case of severe hypertriglyceridemia at 96 g/L in 28-year-old Moroccan women admitted for decompensated diabetes mellitus and generalized lipodystrophy. This case illustrates the value of hypertriglyceridemia in the diagnosis and monitoring of lipodystrophic syndromes whose diagnosis is made by clinical assessment and laboratory findings.

Case report about treatment of the patient with DM Type 2 on multiple injections of insulin who with the help of continuous glucose monitoring (CGM) improved and was controlled only on anti-diabetic pills and GLP1 - RAG

We would like to describe a patient who was treated for decompensated Diabetes Mellitus Type 2(DM type 2) with Multiple Injections of Insulin per day. His HbA1c while when he visited our clinic was above 14 %. He was self-monitoring his Blood sugar at home (SMBG) 4- times a day. He was treated only with Metformin ER in the past. The CGM was started in Internal Medicine Residency Clinic. The patient start sharing his CGM data with the clinic through Dexcom G6 CGM and compatible I phone. The patient was educated on diet, how to adjust his insulin at home based on written instruction material. Moreover, the patient was called at least once a week by the Medicine Clinic professional how to adjust his insulin and to counsel him about his diet and physical activity. The patient had scheduled appointment to the clinic at least once a month. After the glucotoxicity from the initial high blood sugar was managed by using the appropriate dose of insulin, the insulin dosages started to decrease in our patient. DM type 2 was well controlled with GMI less than 7% after starting the CGM. During the clinic visits, the morning fasting C- peptide of the patient was increased which we attribute due to his morbid obesity. These gave us the opportunity to start the patients on per oral antidiabetic medications and injectable GLP-1 receptor agonists (GLP-1-RAG). The patient’s DM type 2 control was maintained 3-6 months after stopping the insulin with Glucose management index (GMI) which approximates HbA1c less than 7%. Our experience with this patient showed that introduction of CGM instead of SMBG in the General Internal Medicine Residency Clinic can help patients with DM type 2 to improve their blood sugar control with Insulin and eventually stop the Insulin and start therapy with oral antidiabetic agents and or injectable GLP-1 -RAG. Also, we showed that this can be done safely in General Internal Medicine Residency clinic and not only in specialized clinics.

Individual approach in treating patients with pulmonary and tracheobronchial tuberculosis, with a long history of tobacco smoking and decompensated diabetes mellitus

Introduction. At the end of 2020, the clinical cure rate in all registration groups of patients with pulmonary tuberculosis was 48.2 %. There is now ample evidence that additional risk factors influence the more severe course of pulmonary tuberculosis and reduce the effectiveness of standard anti-tuberculosis therapeutic programs. Diabetes mellitus and tobacco use are among the significant risk factors. Complementing standard TB therapeutic programs with nicotine addiction and diabetes mellitus treatment programs with the formation of an individual comprehensive patient treatment plan will increase the effectiveness of TB treatment. Thus, the goal of this work is to demonstrate the high effectiveness of an individualized approach to the treatment of a patient with pulmonary tuberculosis with a comorbid background.The aim of the work was to demonstrate the high effectiveness of an individualized approach to the treatment of a patient with pulmonary tuberculosis with a comorbid background.Materials and methods At the Central TB Research Institute the patient underwent a comprehensive examination, including mandatory, additional and facultative methods of investigation. Based on the findings, the patient underwent complex treatment: antituberculosis chemotherapy, correction of carbohydrate metabolism disorders using oral antidiabetic drugs, nicotine replacement therapy according to the selected scheme, taking into account the degree of nicotine addiction.Results and Discussion Against the background of complex treatment, by four months of therapy the following was achieved: knockdown of systemic inflammatory reactions, cessation of bacterial excretion, compensation of diabetes mellitus. X-ray examination revealed closure of a large decay cavity, resorption and consolidation of focal infiltrative changes. There was regression of infiltrative changes of trachea and bronchi. The patient completely stopped using tobacco due to nicotine replacement therapy.Conclusion This clinical example demonstrates the high effectiveness of an individualized approach to the treatment of tuberculosis, including the need for an individualized regimen of anti-tuberculosis therapy, adequate compensation for diabetes mellitus, and the implementation of relevant smoking cessation techniques among smokers with pulmonary tuberculosis.

SEVERE HYPERTRIGLYCERIDEMIA, THE REALITY OF A UNIVERSITY HOSPITAL

Objective: Severe hypertriglyceridemia (SHTG) is defined as a serum triglyceride (TG) level &gt; 1000 mg/dL. It is a rare condition associated with serious complications, such as acute pancreatitis (AP). A paucity of published data exists evaluating management and outcome in SHTG. So, the best treatment is still a matter of discussion. The aim of this study is to outline the demographics, management and outcome (reoccurrence and mortality) in all patients with SHTG treated at a University hospital. Design and method: A retrospective, observational and analytical study was carried out, through the collection of data from the clinical files of patients with SHTG admitted to the Internal and Intensive Medicine Department between 1 January 2009 and 31 December 2020, in a level III hospital. Data were nalysed using the IBM SPSSstatistics program. Results: The sample included 17 patients. The most common complication was AP (70.6%), followed by decompensated diabetes mellitus (DM). 84.2% required admission to the Intensive Care Unit (ICU). Concerning the metabolic profile: 94% were overweight; 52.9% had previous dyslipidemia; 47.1% arterial hypertension and 52.9% type 2 DM. Among patients with AP, the most common therapies instituted were insulin (82.4%) and fibrates (76.5%). 58.8% required plasmapheresis, and a single session allowed, on average, a reduction of 56.8% in the value of TGs. The criteria for implementation were mainly clinical and laboratory, including lactic acidosis (58.8%) and renal dysfunction (23.5%). There were no deaths, the readmission rate was 36.3%, all due to AP. Conclusions: This study shows the morbidity associated with SHTG, with a high level of admissions to the ICU and performance of plasmapheresis. This allowed a significant reduction in TG values, with the clinical severity being the main criteria for its initiation. In our population, this approach was effective, and should be highlighted, as there are no clear international guidelines on this area. Our data do not allow us to distinguish between patients with familial chylomicronemia syndrome or with multifactorial chylomicronemia. The recent appearance of specific therapy for LPL genetic deficit makes it important, and in the future the genetic study should be considered.

Endonasal Endoscopic and Transoral Approaches to the Craniovertebral Junction and the Clival Region

Introduction: The transoral approach was first described by Kanavel in 1917 to treat injuries of the craniospinal junction. In 2002, Frempong-Boaudu reported 7 adults who underwent endoscopically assisted transoral surgery, this was the first report that endoscope was used in an assisted manner for transoral surgery. In 2005, Kassam published the first report of an EEA being used to perform an odontoidectomy. Method: A descriptive, retrospective and linear study was carried out in 16 patients who underwent surgery using the microsurgical and endoscopic transoral and Extended Endoscopic Endonasal approach in the period from January 2004 to May 2021. Results: The average age of the patients was 45 years and there was a predominance of the male sex (10) with the female one (6). The tumoral pathology (9), 6 cases with histological diagnosis of clivus cordroma and 1 patient with chondrosarcoma, two cases with Meningioma and cholesterol granuloma of clival localization, achieving gross total resection in 2 of them and in the rest subtotal resection, all improved neurological symptoms. Complications, partial dehiscence of the velopalatine surgical wound 1 case, 1 lesion of the left vertebral artery and 1 case decompensated Diabetes Mellitus and hemoneumothorax during stay in the ICU, which death 7 days after surgery and 1 CSF fistula. Conclusions: Both, the transoral and endonasal endoscopic approaches have their precise indications in each particular case, having their indications well defined. To achieve this, we must have neuroimaging studies and be able to correctly define the selection of the surgical approach.

COVID-19-Associated Pulmonary Aspergillosis in Russia.

We studied the risk factors, etiology, clinical features and the effectiveness of therapy of COVID-19-associated pulmonary aspergillosis (CAPA) in adult patients. In this retrospective study, we included 45 patients with proven (7%) and probable (93%) CAPA. The ECMM/ISHAM, 2020 criteria were used to diagnose CAPA. A case-control study was conducted to study the risk factors of CAPA; the control group included 90 adult COVID-19 patients without IA. In CAPA patients, the main underlying diseases were diabetes mellitus (33%), and hematological and oncological diseases (31%). The probability of CAPA developing significantly increased with lymphocytopenia >10 days (OR = 8.156 (3.056–21.771), p = 0.001), decompensated diabetes mellitus (29% vs. 7%, (OR = 5.688 (1.991–16.246), p = 0.001)), use of glucocorticosteroids (GCS) in prednisolone-equivalent dose > 60 mg/day (OR = 4.493 (1.896–10.647), p = 0.001) and monoclonal antibodies to IL-1ß and IL-6 (OR = 2.880 (1.272–6.518), p = 0.01). The main area of localization of CAPA was the lungs (100%). The clinical features of CAPA were fever (98% vs. 85%, p = 0.007), cough (89% vs. 72%, p = 0.002) and hemoptysis (36% vs. 3%, p = 0.0001). Overall, 71% of patients were in intensive care units (ICU) (median—15.5 (5–60) days), mechanical ventilation was used in 52% of cases, and acute respiratory distress syndrome (ARDS) occurred at a rate of 31%. The lung CT scan features of CAPA were bilateral (93%) lung tissue consolidation (89% vs. 59%, p = 0.004) and destruction (47% vs. 1%, p = 0.00001), and hydrothorax (26% vs. 11%, p = 0.03). The main pathogens were A. fumigatus (44%) and A. niger (31%). The overall survival rate after 12 weeks was 47.2%.

Effect of Hemodialysis on Diabetic Retinopathy

Diabetes mellitus is a serious health problem in both developed and developing countries. It is expected that by 2040 the incidence of diabetes mellitus in the world will increase to 642 million people. With the increase in the incidence of diabetes mellitus, the incidence of diabetic vascular complications increases, which worsen the quality of life of patients and triple the risk of death. Diabetic retinopathy is one of the most common microvascular complications of diabetes mellitus, leading to progressive loss of visual function. Diabetic retinopathy occurs in conjunction with diabetic nephropathy. This fact is associated with the anatomical similarity of the blood-retinal barrier and the glomerular filtration barrier, as well as with the general pathogenetic mechanisms of the effect of hyperglycemia on peripheral microcirculation. On average, after 10–15 years, patients with decompensated diabetes mellitus develop end-stage renal failure, requiring renal replacement therapy, such as peritoneal dialysis, programmed hemodialysis, and kidney transplantation. This article highlights the latest data on the effect of programmed hemodialysis on the morphofunctional state of the retina in patients with diabetes mellitus.

Type 1 diabetes mellitus in chronic insulin deficiency conditions

Mauriac syndrome is a severe complication of type 1 diabetes mellitus, manifested by growth retardation, impaired formation of secondary sexual characteristics, lack of libido, and hepatomegaly. Currently, the presented syndrome is quite rare. This is more related to the emergence of intensive insulin therapy, which keeps the level of daily glycemia within the tolerance of type 1 for diabetes mellitus. The article describes a clinical case of the development of Mauriac syndrome in a 21-year-old patient with decompensated diabetes mellitus and multiple complications. The patient was deprived of proper control over the condition of daily glycemia and full-fledged insulin replacement therapy for a long because of unfavorable social and material conditions in the family, which contributed to the development of chronic insulin insufficiency and complications.

KETONURIAAN EARLY COVID-19 SEVERITY & PROGNOSTIC MARKER? AN OBSERVATIONAL STUDY.

Ketone bodies are insignicant in the blood and urine of normal individuals. Ketoacids become important sources of metabolic energy in circumstances in which the availability of glucose is restricted, as during prolonged fasting, or when the ability to use glucose is greatly diminished, as in decompensated diabetes mellitus or any infective illness like viral or bacterial infection1.It has been found that increased utilization of glucose for CORONA virus replication. Codo et al.1 provided conclusive evidences that glycolytic ux is indispensable for SARS-CoV-2’s impact. Increased utilization of glucose for CORONA virus replication and ux results in diminished availability of glucose and therefore increased production of ketone bodies and its appearance in urine. This study assesses the level of ketonuria and disease severity and use of ketonuria as prognostic marker of COVID infection.

Effectiveness of dietary diabetes insipidus bundle on the severity of postoperative fluid imbalance in pituitary region tumours: A randomized controlled trial

To test the effectiveness of nurse-led dietary diabetes insipidus (DI) bundle on the severity of postoperative fluid imbalance in pituitary region tumours. Blinded randomized controlled trial. Patients aged 18-65 operated for sellar-suprasellar tumours in an Indian tertiary care centre were enrolled through total enumeration sampling and underwent randomization with allocation concealment during Sep 2018-Feb 2019. Pre-operative DI, postoperative ventilation, renal failure or decompensated diabetes mellitus were excluded. Patients in the intervention group received a nurse-led DI bundle (validated by three Delphi rounds) with four dietary components: intake of only water during thirst and avoidance of the following-added salt, high-protein foods and caffeinated drinks. Treating clinicians and the investigator assessing outcome were blinded about enrolment. Urine output, serum sodium, vasopressin requirement and hospital stay were assessed as primary outcomes. The outcome measures were monitored daily till the 6th postoperative day. Analyses were performed on 'intention-to-treat' basis, irrespective of compliance. Independent t-test and Chi-square test were used. Of the initial 63 patients, 50 fulfilling criteria were randomized to two groups and assessed over six days yielding 150 patient-days per group. There were no significant baseline differences between groups. The mean daily urine output was significantly lower in the DI bundle group than in control, both overall and among endonasal operated pituitary adenomas [3000.09(462.7) vs. 4095.71(896.4)ml & 2987.14(419.5) vs. 4064.73(1051)ml], with the greatest difference on the second postoperative day. Though hypernatraemia in controls became most prominent during days 2-3 and resolved in a week, it was significantly lower in the intervention group (12.7% vs. 30.7% overall, 11.4% vs. 29.4% endonasal adenomas). The need for vasopressin analogues and hospital stay were also significantly lower with DI bundle (p<0.001). This is probably the first ever report of dietary DI bundle among operated pituitary patients, which seem to flatten the DI trend with significant benefits in polyuria, hypernatraemia, vasopressin requirement and hospital stay. CTRI/2018/07/015127 of ICMR. The nurse-led dietary DI bundle has effectively reduced the severity of DI among operated pituitary patients with significant benefits in polyuria, hypernatraemia, vasopressin requirement and hospital stay. Its implementation is simple and easy to carry out, especially in resource-constrained institutions, where continuous monitoring and repeated serum sodium estimation are difficult.

Burden of arrhythmias and associated in-hospital mortality in acute decompensated diabetes mellitus

To gain understanding of the burden of cardiac arrhythmias in patients with acutely decompensated diabetes mellitus (ADDM) on a large scale, we reviewed data on ADDM patients and subtypes of arrhythmias from the National Inpatient Sample from 2010 to 2014. The frequency and prevalence of cardiac arrhythmias were measured, as well as outcomes. Among 874,107 hospitalized ADDM patients identified, 87,970 (10.1%) developed arrhythmias. The ADDM-arrhythmia cohort showed higher all-cause mortality (1.4% vs 0.3%; adjusted odds ratio 2.58, 95% confidence interval 2.39–2.79, P < 0.001), prolonged hospital stays (4.2 ± 4.8 vs 3.3 ± 3.4 days), and higher hospital charges ($32,609 vs $23,741) compared to those without arrhythmias (P < 0.001). The prevalence of supraventricular arrhythmia (atrial fibrillation, supraventricular tachycardia, and atrial flutter) and ventricular arrhythmia (ventricular tachycardia and ventricular fibrillation) was 2965 and 446 per 100,000 ADDM-related hospitalizations, respectively. The prevalence of any arrhythmias and atrial fibrillation in ADDM patients increased by 20.4% and 38.1%, respectively. The highest increase in the prevalence of arrhythmia among ADDM patients was observed in adults aged 18 to 44 years (22.5%).

Application of the S (AD) SAD System as a Prognostic and Evaluation Tool for the Multidisciplinary Treatment of a Diabetic Foot Ulcer

Introduction: Foot ulcers combined with infection is one of the main complications of type 2 diabetes mellitus (DM2), and when not diagnosed and treated, amputation is the most frequent outcome. Thus, patients with DM2 are ten times more likely to be hospitalized for infections when compared to normal ones. For this reason, it is indisputable that diabetic foot ulcers have a major impact on health and the early approach can reduce the chances of amputations. Case Report: A 48-year-old woman, admitted with an ulcer on her right foot for 30 days, reports worsening and pain for 7 days. Previous history of DM2 diagnosed 2 years ago, using metformin irregularly. On physical examination, he had edema, flushing, impaired tibial pulses and ulcer in the calcaneus with exudate in the right lower limb. In addition, he had a BMI of 32.5, showing overweight. Having considered the hypothesis of a diabetic foot associated with hyperglycemia, the S (AD) SAD system (SEPSIS, ARTERIOPATY, DENERVATION) was applied, in order to assess the prognosis of foot ulcer (healing), setting a score of 10 due to the presence of an affected area greater than 3 cm², affected depth up to the joint capsule, presence of osteomyelitis, reduced pulses, and reduced sensitivity at the site. In this sense, the system suggested an expectation for cure in a period greater than 6 months and with a high risk for limb amputation. The exams were consistent with the hypothesis of hyperglycemia, revealing decompensated diabetes mellitus. Thus, he presented elevated glycated hemoglobin (11.8%), estimated mean glycemia (292 ml / dL), and elevated basal glucose (191 mg / dL). Treatment with antibiotic therapy was initiated for 30 days and the patient was asked to go to the health service three times a week to perform debridement with SF 0.9% and apply the ionic silver dressing to treat the ulcer. In addition, the patient received guidance related to dietary reeducation, and started treatment with empagliflozin to control DM2. The patient progressed with progressive ulcer healing and weight reduction. After 3 months of treatment, after monitoring and multidisciplinary intervention, the patient had an adequate glycated hemoglobin rate (6.9%) and the patient achieved total healing of the ulcer, with improved sensitivity and peripheral circulation of the affected limb. Conclusion: Although ulcers are a frequent problem, there are difficulties not only in choosing the most appropriate approach, but also in a system that provides a prognosis and that makes it possible to assess the risk of amputation. Therefore, the S (AD) SAD system, a reproducible tool that favored decision making, provided a prognosis for slow healing and a high risk for amputation. Thus, the multidisciplinary team was able to measure the severity of the condition, choose a treatment, and evaluate the success of the approach adopted, which configured the total healing in 3 months.

Diabetes mellitus in combination with COVID-19: modern views on therapy

Diabetic patients are in the spotlight from the early stages of a pandemic, as growing epidemiological data show they are at higher risk for severe clinical outcomes from COVID-19. As the global COVID-19 pandemic continues to evolve, it is also becoming increasingly apparent that the interactions between COVID-19 and diabetes mellitus (DM) are complex pathophysiological mechanisms. The outcome of COVID-19 is more severe in people with DM, which has the potential to accelerate the onset of acute metabolic complications of DM such as diabetic ketoacidosis and hyperglycemia. These mechanisms underlying these associations remain unclear, but they likely include the angiotensin converting enzyme receptor 2, a binding site for SARS-CoV-2, which is expressed in key metabolic organs such as in the pancreas, in particular in β-cells. The potential β-cell tropism of SARS-CoV-2 can damage cells and impair insulin secretion, causing hyperglycemia and ketoacidosis. Understanding the bidirectional interaction between DM and COVID-19 will be critical to protecting and treating people with DM. Current epidemiological data on COVID-19 do not support the hypothesis that diabetic patients are at increased risk of infection compared to the general population. To date, it has been established that decompensated DM is an independent factor that aggravates the course of coronavirus infection and significantly increases the risk of a fatal outcome of the disease. The review provides a brief summary of the evolution of pathogenetic and clinical aspects for understanding the mechanisms of this pathological tandem, as well as therapeutic strategies for treating patients with COVID-19 and DM. As the incidence of DM continues to rise globally, more than ever, diabetes prevention and control must be a priority for health systems around the world.

Эмфизематозный пиелонефрит: случай успешного консервативного лечения

Emphysematous pyelonephritis is rare form of pyelonephritis, which has mortality of nearly 80%. Conservative treatment can be successful in less than 30% of cases. Currently, in the guidelines there is no standard approach to conservative and surgical treatment of this entity. The clinical observation of successful conservative treatment of a patient with emphysematous pyelonephritis, associated with decompensated diabetes mellitus, from the diagnosis to recovery without performing nephrectomy in order to preserve kidney function, is described in the article.