Diabetes Mellitus OR Research Articles

Sleep Disordered Breathing in Patient with Type 2 Diabetes Mellitus and its Association with Diabetic Retinopathy: Single Center Study

Introduction: Sleep-disordered breathing comprises of obstructive sleep apnea, central sleep apnea, and periodic breathing. There is a link between obesity diabetes and sleep apnea with its association with retinopathy. Therefore this study was done to find out the association of sleep-disordered breathing in uncontrolled diabetes mellitus and association with retinopathy.Materials and Methods: This study was done from 2015 September to 2018 September in Sleep center, Nepal. Patients diagnosed with Type 2 diabetes mellitus were included. Diabetes mellitus was diagnosed as blood sugar fasting ≥ 126mg/dl, or blood sugar postprandial ≥200mg/dl and glycosylated hemoglobin above 6.5%. Obstructive sleep apnea risk was determined using the STOP-BANG questionnaire. Relationships between the risk of Obstructive sleep apnea and clinical variables along with its association with diabetic retinopathy were evaluated using bivariate analyses and covariate-adjusted logistic regression models.Results: A total of 150 diabetic patients were analyzed. Among them 30 (20.0%) patients had mild Obstructive sleep apnea, 14 (9.3%) patients had moderate Obstructive sleep apnea and 15 (10.0%) patients had severe sleep apnea. Among patients with diabetes mellitus on multivariate regression analysis Obstructive sleep apnea was associated with diabetes mellitus OR 2.05, 95% CI (1.69- 8.83) and diabetic retinopathy OR 1.20 (0.67-5.89).Conclusions: This study concludes that those individuals having diabetes may be suffering from obstructive sleep apnea and association with retinopathy these individuals can be considered for the screening of sleep-disordered breathing by polysomnography.

CPET and cardioesophagectomy: A single centre 10-year experience

IntroductionCPET is a routine investigation prior to cardioesophagectomy. Over a 10-year period 200 patients had CPET before elective cardioesophagectomy. We examine the relationship between CPET and outcomes in these patients. Materials and methodsComplication data were prospectively collected using the Clavien-Dindo system. Logistic regression analysis was used to determine whether 90-day mortality and morbidity were significantly different between fitter and less fit patients. Results90-day mortality was 5.5%. In univariate analysis the following factors were associated with a significantly increased risk of death at 90 days: anaerobic threshold <11 ml kg−1 min−1 OR (95% CI) = 4.38 (1.23,15.6), p = 0.023; V̇O2 peak <15 ml kg−1 min−1 O2 OR (95% CI) = 5.0 (1.42,15.55), p = 0.012; V̇E/V̇CO2 > 34 OR (95% CI) = 4.07 (1.19,14.0), p = 0.026; diabetes mellitus OR (95% CI) = 5.76 (1.55,21.35) p = 0.009. In multivariate logistic regression analysis both diabetes (OR = 5.76 [1.55,21.4] p = 0.009) and presence of ≥ 1 subthreshold CPET value (OR = 6.72 [1.32,29.8] p = 0.021) were significantly associated with increased risk of death at 90 days. Median (95% CI) survival for patients who had a CPET with ‘normal’ parameters was 1176 (565, 1787) days, compared with 642 (336, 948) days for patients with ≥ one subthreshold parameter. 15.5% of patients had ECG ischaemia; there were no deaths in this group. ConclusionPresence of at least one sub-threshold CPET value at pre-operative testing is associated with increased risk of 90-day mortality and shorter long term survival. These results allow us to better define risks during shared decision-making with patients.

Do T90 and SaO2 nadir identify a different phenotype in obstructive sleep apnea?

Severity of obstructive sleep apnea (OSA) is commonly based upon the apnea-hypopnea index (AHI). However, patients with similar AHIs may demonstrate widely varying comorbidities and risk for cardiovascular disease. These varying manifestations of disease may be related to nocturnal hypoxia and not AHI. We hypothesize that parameters of oxygenation may identify a different phenotype in OSA. To explore potential associations between lowest SaO2 (SaO2 nadir) and total sleep time spent with arterial oxygen saturation (SaO2) < 90% (T90) with comorbidities and mortality in patients with moderate and severe OSA. This was a retrospective study of patients between 2009 and 2014, with a new diagnosis of moderate-to-severe OSA without a concomitant respiratory disease. Data collection included demography, comorbidities, sleep study parameters, and mortality over a 5-year interval. Patients were categorized into two groups for analysis, group 1: SaO2 nadir < 75%, and group 2: T90 > 20%. Of the 365 patients, 163 (45%) recorded SaO2 nadir < 75% and 127 (35%) recorded T90 > 20%. These oxygenation parameters were associated with more severe OSA by AHI (p < 0.001). T90 > 20% was associated with an increased risk of hypertension (HT) OR 2.95 (CI 1.87-4.76, p < 0.001) in patients with both moderate and severe OSA. T90 > 20% was also associated with an increased risk of type 2 diabetes mellitus (T2DM) OR 2.14 (CI 1.35-3.38, p = 0.001) and mortality 2.70 (CI 1.37-5.22, p = 0.0048). The findings demonstrate a correlation between SaO2 nadir < 75% and T90 > 20% and increased severity of OSA. The findings also show a strong association between SaO2 nadir < 75% and T90 > 20% and increased risk for comorbidities of HT and T2DM as well as mortality at 5years. This analysis suggests that parameters of oxygenation should be used to describe a high-risk phenotype of OSA.

Metabolic Syndrome and Subclinical Hypothyroidism: A Type 2 Diabetes-Dependent Association.

Introduction Subclinical hypothyroidism (ScH) is an endocrine alteration that is related to cardiovascular risk factors, including those categorized as components of the Metabolic Syndrome (MS). However, findings in prior reports regarding an association between these alterations are inconsistent. The purpose of this study was to determine the relationship between both entities in adult subjects from Maracaibo City, Venezuela. Materials and Methods The Maracaibo City Metabolic Syndrome Prevalence Study is a descriptive, cross-sectional study with random and multistage sampling. In this substudy, 391 individuals of both genders were selected and TSH, free T3, and free T4 tests were performed as well as a complete lipid profile, fasting glycaemia, and insulin blood values. ScH was defined according to the National Health and Nutrition Examination Survey (NHANES) criteria: high TSH (≥4.12mUI/L) and normal free T4 (0.9-1,9 ng/dL) in subjects without personal history of thyroid disease. MS components were defined according to IDF/AHA/NHLBI/WHF/IAS/IASO-2009 criteria. A multiple logistic regression analysis was used to assess the relationship between MS components and ScH diagnosis. Results Of the evaluated population, 10.5% (n=41) was diagnosed with ScH, with a higher prevalence in women (female: 13.6% versus male: 7.7%; χ2=3.56, p=0.05). Likewise, 56.1% (n=23) of the subjects with ScH were diagnosed with MS (χ2=4.85; p=0.03), being hyperglycemia the main associated criterion (χ2=11.7; p=0.001). In multivariable analysis, it was observed that the relationship was exclusive with the presence of type 2 diabetes mellitus (T2DM) OR: 3.22 (1.14-9.14); p=0.03. Conclusion The relationship between ScH and MS in our population is dependent on the presence of hyperglycemia, specifically T2DM diagnosis, findings that vary from those previously reported in Latin American subjects.

Efficacy of Magnesium Supplementation on Glycemic Control in Type 2 Diabetes Patients: A Meta-analysis.

ObjectiveTo evaluate if magnesium supplementation, in addition to standard therapy, improves fasting blood sugar (FBS) and/or glycosylated hemoglobin (HbA1c) in patients with type 2 diabetes mellitus (T2DM) compared to placebo or other comparator.MethodologyWe searched MEDLINE/PubMed, Cochrane Library, Acta Medica Philippina, Health Research and Development Information Network (HERDIN) and references of reviewed journals from 1966 to July 2015 using the following search terms: “magnesium” OR “magnesium supplementation” OR “magnesium replacement”, AND randomized controlled trial AND diabetes OR diabetes mellitus OR non-insulin dependent diabetes mellitus OR diabetic OR diab* (with MeSH, where available). Studies were retrieved and rated independently using the standards provided by The Cochrane Collaboration. High quality trials were included in a systematic review and meta-analysis.ResultsOf the 689 records screened, 10 studies were included in the qualitative synthesis and 7 studies in the meta-analysis. Pooled data showed a non-significant trend towards improvement in glycemic control in the magnesium-treated group (mean difference -0.19, CI -0.58 to 0.21). There was a stronger but still non-significant trend in T2DM patients with hypomagnesemia (mean difference -1.16, CI -2.92 to 0.6).ConclusionRoutine magnesium supplementation for improvement in glycemic control in T2DM patients cannot be recommended based on data from included studies in this meta-analysis.

CHRONIC KIDNEY DISEASE

Diabetes Mellitus and Hypertension are leading causes of chronic kidneydisease (CKD). There is limited data on frequency of retinopathy attributed to diabetes mellitusor hypertension in CKD patients in local population. Objective: to determine the frequency ofdiabetic and hypertensive retinopathy in patients with CKD not on hemodialysis or peritonealdialysis. Study Design: Cross Sectional. Setting: Nephorology ward at Sharif Medical CityHospital. Period: 6 Month. Methods: All patients between ages of 20-80 years with CKD notpreviously on renal replacement therapy (hemodialysis or peritoneal dialysis) who were admittedto nephrology ward at tertiary care facility over a 6 month period were included. Fundoscopicexamination was performed by a qualified ophthalmologist after dilating pupils. Results: A totalof 124 patients were included in the study. Stage V CKD was present in 85.7%. Diabetes Mellituswas present in 84 patients (67.7%). Of these patients, 39 (46.4%) had diabetic retinopathy. Nonproliferativediabetic retinopathy, proliferative diabetic retinopathy and macular edema werefound in 27 (69.1%), 4 (10.2%) and 9 (23.1%) patients respectively. Hypertensive retinopathywas present in 51 (49.5%) out of 103 (83%) hypertensive patients. Of these patients, 16 (31.3%)had grade I, 21 (41.2%) had grade II, 11 (21.6%) had grade III and 3 (5.8%) had grade IVhypertensive retinopathy. Conclusion: A significant proportion of patients with advanced CKDhave retinopathy. Patients with CKD and diabetes or hypertension should be encouraged toundergo a complete eye examination

English

Diabetes Mellitus and Hypertension are leading causes of chronic kidneydisease (CKD). There is limited data on frequency of retinopathy attributed to diabetes mellitusor hypertension in CKD patients in local population. Objective: to determine the frequency ofdiabetic and hypertensive retinopathy in patients with CKD not on hemodialysis or peritonealdialysis. Study Design: Cross Sectional. Setting: Nephorology ward at Sharif Medical CityHospital. Period: 6 Month. Methods: All patients between ages of 20-80 years with CKD notpreviously on renal replacement therapy (hemodialysis or peritoneal dialysis) who were admittedto nephrology ward at tertiary care facility over a 6 month period were included. Fundoscopicexamination was performed by a qualified ophthalmologist after dilating pupils. Results: A totalof 124 patients were included in the study. Stage V CKD was present in 85.7%. Diabetes Mellituswas present in 84 patients (67.7%). Of these patients, 39 (46.4%) had diabetic retinopathy. Nonproliferativediabetic retinopathy, proliferative diabetic retinopathy and macular edema werefound in 27 (69.1%), 4 (10.2%) and 9 (23.1%) patients respectively. Hypertensive retinopathywas present in 51 (49.5%) out of 103 (83%) hypertensive patients. Of these patients, 16 (31.3%)had grade I, 21 (41.2%) had grade II, 11 (21.6%) had grade III and 3 (5.8%) had grade IVhypertensive retinopathy. Conclusion: A significant proportion of patients with advanced CKDhave retinopathy. Patients with CKD and diabetes or hypertension should be encouraged toundergo a complete eye examination

Association between diabetes and the prevalence of radiolucent periapical lesions in root-filled teeth: systematic review and meta-analysis.

The question of whether diabetes mellitus can influence the outcome of root canal treatment (RCT) remains unclear. The aim of this systematic review and meta-analysis was to analyze scientific available evidence on the association between diabetes and the presence of radiolucent periapical lesions (RPLs) in root-filled teeth (RFT). The review question was as follows: in adult patients who had endodontically treated teeth, does the absence or presence of diabetes result in an increase in the prevalence of RPL associated to RFT? A systematic MEDLINE/PubMed, Wiley Online Database, Web of Science, and Scopus search was conducted using the following MeSH and keywords: Diabetes Mellitus OR Diabetes OR Diabetic OR Hyperglycemia, AND Endodontics, Periapical Periodontitis, Periapical Diseases, Apical Periodontitis, Periradicular Lesion, Periapical Radiolucency, Radiolucent Periapical Lesion, Root Canal Treatment, Root Canal Preparation, Root Canal Therapy, Root Filled Teeth, Endodontically Treated Teeth. Seven studies reporting data on the prevalence of RPL associated to RFT both in diabetic and control subjects were included. After the study selection, seven epidemiological studies fulfilled the inclusion criteria, representing data from 1593 root canal treatments, 1011 in non-diabetic control subjects, and 582 in diabetic patients. The calculated pooled odds ratio (OR=1.42; 95% CL=1.11-1.80; p=0.0058) indicates that diabetic patients have higher prevalence of RFT with RPLs than controls. Available scientific evidence indicates that diabetes is significantly associated to higher prevalence of periapical radiolucencies in endodontically treated teeth, being an important putative pre-operative prognostic factor in RCT. Taking into account that diabetes is the third most prevalent chronic medical condition among dental patients, endodontic providers should be aware of the relationship between the outcome of endodontic treatment and diabetes.

The impact of poor glycaemic control on the prevalence of erectile dysfunction in men with type 2 diabetes mellitus: a systematic review.

ObjectiveTo determine the impact of poor glycaemic control on the prevalence of erectile dysfunction among men with type 2 Diabetics aged 27 to 85 years.DesignThe databases Embase classic+Embase, Global health, Ovid Medline and PsychINFO, were searched for relevant studies in June 2014 using the keywords: (Diabetes Mellitus OR diabetes mellitus type2 OR DM2 OR T2DM OR insulin resistance) AND (erectile dysfunction OR sexual dysfunction OR impotence) AND glycaemic control.SettingAll study settings were considered (primary care, secondary care and tertiary care setting).ParticipantsType 2 Diabetic Patients with erectile dysfunction.Main outcome measuresIncluded studies must include one of the following outcomes: (1) HBA1c for assess the level of glycaemic control; (2) Erectile dysfunction (any stage: IIEF-5 = 21 or less).ResultsFive cross-sectional studies involving 3299 patients were included. The findings pointed to a positive association between erectile dysfunction and glycaemic control. Three studies showed a significant positive association, while one study showed only a weak correlation and one study showed borderline significance. Patients’ age, diabetes mellitus duration, peripheral neuropathy and body mass index had positive association with erectile dysfunction. However, smoking and hypertension were not associated with erectile dysfunction in most included studies. Physical activity had a protective effect against erectile dysfunction.ConclusionWe may conclude that the risk of erectile dysfunction is higher in type 2 diabetic men with poor glycaemic control than those with good control.

Distal Sensory Polyneuropathy among HIV Patients in Libreville in Gabon

Distal sensory polyneuropathy (DSP) was more frequent among Human Immunodeficiency Virus (HIV) patients. The reliable tool for its diagnosis is not available everywhere in sub-Saharan Africa. We aimed to estimate the frequency of DSP among HIV patients in Libreville. We’ve conducted a cross-sectional study including all consecutives HIV-patients admitted to the HIV clinic in the University Teaching Hospital of Libreville (Gabon) between 1 May and 31 July 2014. All patients underwent a full neurological examination doing by two neurologists. The diagnosis of DSP was based on Brief Peripheral Neuropathy Screen (BPNS). We also collected the data concerning past medical history, the use of neurotoxic drug, history of disease and data of High Active Antiretroviral Therapy (HAART). The logistic regression was used to study the factors associated with DSP. They were 620 patients aged from 17 to 74 years with the mean age of 42.1 years ± 11.0 years and 570 (91.9%) were on HAART. The mean duration of disease was 57.6 ± 42.5 months. Among the 620 patients 170 fulfilled criteria for DSP, and the overall frequency of DSP was 27.4%. The associated factors in univariate analysis were the age, the occupation, the use of HAART, the HAART option, the stage of the disease, opportunistic disease, alcohol consumption, exposure to isoniazid, diabetes mellitus and the modes of contamination. But in multivariate analysis the associated factors were the stage of disease OR 2.7 [1.2 - 3.7], diabetes mellitus OR 2.4 [1.4 - 5.8] and the use of D4T in HAART OR 1.9 [1.1 - 4.9]. The main symptoms among the patients were burning feet (47.6%), the tingling (40.0%), numbness (27.6%), alteration of ankle reflex (87.6%) and alteration of vibration sensation (27.6%). The DSP was more frequent among HIV patients and could be explained by the duration of the disease, the association with metabolic disease and the use of D4T.

Factores asociados a la aparición de mediastinitis en 2.073 revascularizaciones miocárdicas

IntroductionMediastinitis is a multifactorial entity which occurs in up to 4% of patients undergoing coronary artery bypass graft (CABG). It has a hospital mortality of 14% to 47%, which generates increased costs of care and deterioration of the quality of life and patient survival in the long term. ObjectiveTo determine which clinical antecedents and factors related to the surgical procedure are associated with the occurrence of mediastinitis. Materials and methodsA nested case control study in a historical cohort of patients undergoing CABG in the period January 2005 to July 2011. Patients with mediastinitis were compared with a control group without mediastinitis taken from the same risk group in a 1:4 ratio and matched for date of surgery. The diagnosis of mediastinitis was made on clinical and laboratory criteria and surgical findings. ResultsThirty cases were identified in the related period. Factors associated with the occurrence of the event were: diabetes mellitus OR 2.3 (1.1 to 4.9), use of extracorporeal circulation OR 2.4 (1.1–5.5), OR 1 perfusion time, 1 (1.1 to 1.3) and patients older than 70 years OR 1.1 (1.2–1.4). ConclusionsMediastinitis remains complications of low prevalence with devastating consequences. The clinical and economic impact of this complication should compel surgical groups to create prevention strategies based on knowledge of the risk factors of the population.

Randomized Clinical Stroke Trials in 2009

Problem statement: Stroke ranks as the leading cause of serious, long-term disability and death world-wide. It is estimated direct and indirect cost of stroke for 2009 was $68.9 billion. Approach: The objective of this review was to examine the effectiveness of emerging pharmacotherapy’s in patients with acute (≤2 weeks), sub-acute (2-12 weeks) and chronic (≥12 weeks) stroke studied in Randomized Control Trials (RCT’s) published in 2009. Medline search was performed to identify all RCT’s in acute, sub-acute and chronic stroke treatment in the year 2008. The search strategy used for Pub Med included key words such as Randomized Controlled Trials (RCT), Stroke OR cerebrovascular disorders OR CVA, Ischemic stroke OR ischemia, Hemorrhage OR intraparenchymal hemorrhage OR subarachnoid hemorrhage, Thrombolytics OR tissue plasminogen activator OR alteplase OR t-PA, Diabetes mellitus OR hyperglycemia, Hypertension OR raised blood pressure, Aspirin OR anti-platelets, Warfare OR anticoagulant, Antidepressants , Neuroprotectants and Coiling OR stents OR endovascular. Search limits included Human, Adult (age>19 years), English language and Publication date: 1/1/2009-12/31/2009. Results: Eleven categories of 27 RCT’s were found and analyzed. Conclusion: There was sufficient evidence to suggest that: (1) extending the time-window for administration of desmoteplase between 3-9 h after ischemic stroke onset did not improve clinical outcome; (2) at present neither lidocaine, erythropoietin or ropinotan had been effective neuroprotective agents in ischemic stroke; (3) treatment with dabigatran was associated with lower rate of stroke and systemic embolism in patients with non-valvular aerial fibrillation; (4) memantine and constraint-induced aphasia therapy were able to reduce the severity of aphasia in chronic post-stroke aphasia and (5) percutaneous closure of the left aerial appendage can be an effective alternative to chronic warfare treatment.

Randomized Clinical Stroke Trials In 2008

Problem statement: Stroke ranks as the third leading cause of death and the leading cause of serious, long-term disability; estimated direct and indirect cost of stroke for 2009 was $68.9 billion. Approach: The objective of this review was to examine the effectiveness of emerging pharmacotherapies in patients with acute (≤2 weeks), sub-acute (2-12 weeks) and chronic (≥12 weeks) stroke studied in Randomized Control Trials (RCT's) published in 2008. Medline search was performed to identify all RCT’s in acute, sub-acute and chronic stroke treatment in the year 2008. The search strategy used for PubMed included key words such as Randomized Controlled Trials (RCT), Stroke OR cerebrovascular disorders OR CVA, Ischemic stroke OR ischemia, Hemorrhage OR intraparenchymal hemorrhage OR subarachnoid hemorrhage, Thrombolytics OR tissue plasminogen activator OR alteplase OR t-PA, Diabetes mellitus OR hyperglycaemia, Hypertension OR raised blood pressure, Aspirin OR anti-platelets, Warfarin OR anticoagulant, Antidepressants, Neuroprotectants and Coiling OR stents OR endovascular. Search limits included Human, Adult (age >19 years), English language and Publication date: 1/1/2008 to 12/31/2008. Results: Eleven categories of 21 RCT’s were found and analyzed. Conclusion/Recommendations: There is sufficient evidence to suggest that: (1) extending the time-window for administration of alteplase from 3-4.5 h after stroke onset does improve clinical outcome; (2) treatment of hypertension in the elderly does reduce rate of stroke, cardiac failure and death from stroke and (3) at present there are no neuroprotectants on the horizon.

A Case-Control Study of Effect of Opium Addiction on Myocardial Infarction

Ischemic Heart Disease (IHD) and Myocardial Infarction (MI) are one of the most important disease which cause mortality and morbidity. Opioid peptides and exogenous opioid such as morphine are known to exert an important cardiovascular effect. To study effect of opium addiction to incidence of MI. A Case-Control study was designed in Kerman university. 150 patients with MI was admitted to CCU and 150 matched patients admitted in surgical wards evaluate from cardiovascular risk factor and opium addiction. Analysis of data suggested no difference between two groups (P>0.05). But smoking OR = 2.45, hypertension OR = 2.65, Diabetes mellitus OR = 1.82 and Hypercholesterolemia OR = 3.16 were a risk factor for MI. Effect of opium in IHD has controversial. But recent of study defined that opioid peptides have a cardioprotective effect. Many exact and longitudinal studies should design for this purpose.