Hyperglycemia In Patients Research Articles

Pros and Cons of Inpatient SGLT2i Use for Hyperglycemia and Heart Failure.

Sodium-glucose cotransporter 2 inhibitors (SGLT2is), originally approved by the US Food and Drug Administration for glycemic control in type 2 diabetes mellitus (DM2), have shown substantial cardiovascular and renal benefits, leading to their expanded use in managing heart failure (HF) and chronic kidney disease in the outpatient setting. Despite these benefits, their use for inpatient hyperglycemia management is not universally endorsed due to safety concerns and inadequate data. However, emerging evidence suggests potential advantages of initiating SGLT2i treatment for patients during hospitalization in the setting of HF. While SGLT2is are not recommended for managing inpatient hyperglycemia, initiation during hospitalization for HF provides significant benefits. We review the current literature on the pros and cons of using SGLT2is in hospitalized DM2 and HF patients and provide guidance on careful patient selection and risk mitigation for inpatient use.

Placental expression of GLUT-1, GLUT-3, and GLUT-4 mRNA and transcriptome profiling in pregnant women with diabetes.

Placental glucose transport is regulated by glucose transporter proteins (GLUTs). The study aimed to examine placental expression of GLUT-1, GLUT-3, and GLUT-4 mRNA in patients with type 1 diabetes, early gestational diabetes (eGDM), and healthy controls, and to investigate correlations between GLUTs expression and clinical parameters. Additionally, we compared placental transcriptome profiles in recruited subgroups. We recruited 59 pregnant women: 23 with type 1 diabetes, 17 with eGDM, and 19 controls. Patients with diabetes attended follow-up visits at each trimester. Transcriptome studies were performed in 4 patients per subgroup. The mean age was similar across all subgroups. eGDM patients had significantly higher BMI and were predominantly obese. We observed a significant 2-fold (P = 0.009) decrease in placental GLUT-3 mRNA expression in the type 1 diabetes and eGDM groups. GLUT-4 mRNA expression was significantly lower in the eGDM group compared to type 1 diabetes (3-fold) and controls (6-fold) (P = 0.007). There was a significant negative correlation between GLUT-3 (R = -0.29) and GLUT-4 (R = -0.27) mRNA expression and neonatal birth weight. GLUT-4 expression was negatively correlated with 1st trimester HbA1c (R = -0.72) and OGTT 120' (R = -0.82) results in eGDM patients, and 3rd trimester glycemic variability (R = -0.49) in type 1 diabetes. Microarray analysis revealed significant transcriptomic changes, with 45 down-regulated and 365 up-regulated genes in type 1 diabetes, and 21 significant changes in eGDM. Placental samples from patients with diabetes exhibit changes in GLUTs expression, which correlates with neonatal growth and several glycemic parameters. Additionally, multiple changes in transcriptomic profiles are observed in hyperglycemic patients.

Hyperglycemia Treatment with Intravenous Insulin in Acute Stroke Patients: A Scoping Review

Introduction/Background: Hyperglycemia has been shown to lead to worse outcomes for ischemic stroke patients, including those undergoing reperfusion therapies. However current guidelines do not exclude hyperglycemic patients from reperfusion therapy. This scoping review examines what is known about the safety, feasibility, and efficacy of intravenous insulin treatment for hyperacute and acute ischemic stroke patients. Methods: PubMed, EBSCOhost, the Cochrane Database of Systemic Reviews, Embase, and Google Scholar were searched from inception to March 25, 2024. Titles, abstracts, and full texts were reviewed. Studies qualified for inclusion if they were peer-reviewed, published in English, full-text, human experimental studies using intravenous insulin for hyperglycemia treatment for hyperacute or acute stroke patients reviewing serious adverse events, feasibility, disability, or functional outcomes. Results: Ten studies were included (n=6 safety/feasibility design, n=4 efficacy design). Intravenous insulin infusion treatment targets ranged from 72-144 mg/dL, comprising of both loose and tight target controls, with symptom onset to treatment max times of 6-24 hours. Conclusions: There are limited clinical trials evaluating IV insulin for the ischemic stroke population. Of the studies found, hyperglycemia treatment with regular or GKI intravenous insulin in acute stroke patients suggest that with tight or loose control, is a safe and feasible option for at least 72 hours after symptom onset. However, it has not been demonstrated that hyperglycemia treatment alters outcomes when initiated within 6-24 hours of symptom onset.

Shock Index in Hyperglycemic Patients in the Emergency Medical and Surgical Ward of Dr. Soedono Madiun General Hospital

Uncontrolled hyperglycemia causes hyperosmolarity, stimulating osmotic diuresis and leading to excessive dehydration which can result in death. Therefore, early detection of hypovolemic shock is necessary for immediate management. The aim of the study is to assess the shock index values in hyperglycemic patients in medical and surgical emergency rooms. Using a descriptive method, this study included a population of hyperglycemic patients from January 30 to March 11, 2023, with a sample of 40 patients meeting the inclusion criteria of diabetic ketoacidosis (DKA) and Hyperosmolar Hyperglycemic State (HHS) complications. The instrument used were observation sheets and shock index assessment indicators. The results showed that 16.7% of respondents with DKA experienced moderate shock, 72.2% mild shock, and 11.1% without shock. Meanwhile, 50% of respondents with HHS experienced severe shock, and 50% moderate shock. Mild shock was most common in DKA due to sufficient body fluids preventing a drop in blood pressure and pulse rate. Conversely, HHS patient exhibited severe and moderate shock because high blood glucose levels caused osmotic diuresis, leading to excessive dehydration. It can be concluded that higher blood glucose levels result in more severe dehydration thus worsening the shock condition

Effect of Hemoglobin and Blood Glucose Levels on CT Perfusion Ischemic Core Estimation: A Post Hoc Analysis of the ESCAPE-NA1 Trial.

CT perfusion (CTP) maps can estimate the ischemic core in acute ischemic stroke based on distinctive cerebral blood flow thresholds. However, metabolic factors beyond perfusion influence the tissue tolerance to ischemia and the infarct growth rate. Underestimating the ischemic core volume (ICV) might result in overestimating the salvageable cerebral tissue and, consequently, overestimating the potential clinical benefits of reperfusion therapies. We aim to evaluate whether baseline hemoglobin and blood glucose levels influence the accuracy of baseline CTP ICV estimations. Large vessel occlusion stroke patients investigated with baseline CTP undergoing thrombectomy with near-complete reperfusion and without parenchymal hemorrhage from the ESCAPE-NA1 trial were included. Patients were subdivided into anemic (hemoglobin <130 g/L for men and <120 g/L for women) and nonanemic groups, and hyperglycemic (blood glucose level >7 mmol/L) and normoglycemic groups. Ischemic core underestimated volume (ICuV) was calculated: final infarct volume minus CTP-based ICV. The primary outcome was the presence of "perfusion scotoma" defined as ICuV ≥10 mL. Presence of "perfusion scotoma" and median ICuV were compared between anemic vs nonanemic and hyperglycemic vs normoglycemic patients using nonparametric tests and multivariable binary logistic regression with adjustment for baseline variables. One hundred sixty-two of 1,105 (15%) patients were included (median age 70.5 [interquartile range (IQR) 61-80.4], 50.6% women). The median ICuV was 7.26 mL (IQR 0-25.63). Seventy-eight (48%) patients demonstrated perfusion scotoma. Forty-two (25.7%) patients were anemic, and 65 (40.1%) were hyperglycemic. In univariable analysis, the hyperglycemic group had a higher prevalence of perfusion scotoma (65% [n = 40] vs 39% [n = 38], p = 0.006) and larger ICuV (17.79 mL [IQR 1.57-42.75] vs 6 mL [-0.31 to 12.51], p = 0.003) compared to normoglycemic patients. No significant ICuV differences between patients with and without anemia were seen. Multivariable regression analysis revealed an association between perfusion scotoma and hyperglycemia, adjusted odds ratio (OR) 2.48 (95% CI 1.25-4.92), and between perfusion scotoma and blood glucose levels, adjusted OR 1.19 (95% CI 1.03-1.39) per 1 mmol/L increase. In our study, CTP-based ischemic core underestimation was common and associated with higher baseline blood glucose levels. Individual metabolic factors beyond perfusion that critically influence the infarct growth rate should be considered when interpreting baseline CTP estimations of ischemic core.

Free Methylglyoxal as a Metabolic New Biomarker of Tumor Cell Proliferation in Cancers.

A fundamental property of cancer cells is their metabolic reprogramming, allowing them to increase glucose uptake and glycolysis. Using a rat colon adenocarcinoma model, we previously showed that blood levels of free methylglyoxal (MG), a side-product of glycolysis, remained normal in animals grafted with a non-growing tumor cell clone, while MG levels were significantly increased and positively correlated with tumor growth in animals grafted with a tumorigenic cell clone issued from the same tumor. We measured free MG in the blood of cancerous non-diabetic patients and compared the results to healthy subjects and non-cancerous diabetic patients. We also measured free MG in tumors and in the corresponding non-cancer tissues, and the peripheral blood. We show that free MG levels in the peripheral blood of cancer patients are significantly increased in comparison with free MG levels in the peripheral blood of healthy controls (p < 0.0001), and similar to those in the peripheral blood of hyperglycemic diabetic patients (p = 0.965). In addition, we show that repeated free MG level measurement could be used for the therapeutic monitoring of cancer patients. Moreover, we confirmed that free MG is produced by tumor cells at significantly higher levels than cells from their corresponding tissues (p < 0.0001), and is subsequently released in the peripheral blood. Free MG measured in the blood could be a new metabolic biomarker useful for the diagnostic, prognostic and follow-up of non-diabetic patients with cancers, such as bronchus carcinoma, pancreatic carcinoma and glioblastoma, for which there are presently no available useful biomarkers.

Impact and outcomes of hyperglycemia among post-operative children who underwent repair of congenital cardiac defects in a tertiary care setup of Pakistan.

To determine frequency of postoperative hyperglycemia in children who underwent repair of Congenital Cardiac Defects (CCDs) in a tertiary care hospital of Pakistan. The other objective was to compare outcomes in children with versus without postoperative hyperglycemia who underwent repair of CCDs in a tertiary care hospital of Pakistan. A descriptive study was conducted at the Cardiac Intensive Care Unit (CICU), Aga Khan University Hospital (AKUH), Karachi, Pakistan from October 3, 2020, to April 2, 2021. A total of 185 patients aged one month-18 years admitted to CICU underwent elective surgical repair of CCDs meeting the eligibility criteria were included. Glucose monitoring was collected at immediate, 4th and 8th postoperative hours on the first day and once daily on postoperative days Two and Three to assess hyperglycemia. Data including age, weight, gender, pre-operative diagnosis, type of surgery and variables such as CICU stay, duration of hospital stay and duration of mechanical ventilation were recorded. The mean age of the patients was 40.40±48.63 months. Out of 185 patients, 115 (62.2%) were male while 70 (37.8%) were female. Hyperglycemia was found to be in 182 (98.4%) patients. Out of 182 hyperglycemic patients, 53 (28.6%) had moderate hyperglycemia while 129 (69.7%) had severe hyperglycemia. Mean duration of hospital stays was 9.24±7.45, mean duration of pediatric CICU stays was 141.61±169.02 hours and mean duration of mechanical ventilation was 80.59±98.54 hours. Hyperglycemia is a frequent finding in children who underwent repair of CCDs, and it is not significantly associated with duration of mechanical ventilation, length of hospital and CICU stay.

B-133 Uric acid: A description of the values found in adult patients treated during 2022 in a High Complexity Hospital

Abstract Background An association between uric acid and kidney disease, glucose intolerance, high blood pressure, metabolic syndrome and cardiovascular disease has been recognized. It is the obligation of the Clinical Laboratory to have valid reference intervals (RI) for this marker. Each particular population has genetics and a diet that represents it, which cannot be extrapolated in many cases. The difficulty and high cost of using direct methods for its establishment drive us to use the existing data in our electronic archive retrospectively. Objective: to describe the range of uric acid values in adult outpatients treated at the Posadas Hospital during the year 2022. Evaluate the influence of gender and age range on the observed values. Methods A retrospective observational approach was carried out from the System database Laboratory Informatics (SIL), Roche Infinity, from the year 2022. The data corresponding to all adult outpatient patients treated in the service were processed. Analytical System: Roche Cobas 6000, Uricase-Oxidase method. Exclusion criteria: oncology patients, kidney patients, diabetics, hyperglycemic patients, obstetric patients, hormonal patients, treated in wards and referred patients. Outliers excluded by Tukey method. The statistical treatment was carried out with the SPSS 17.0 program. Results We worked with 91922 data groups. Hence 12331 of uric acid. After meeting the exclusion criteria: 3899, of which 2289 (3.96 ± 1.05 mg/dl) correspond to women &amp;lt; 50 years , 747 (4.36 ± 1.15 mg/dl at ≥ 50 years and 863 (5.59 ± 1.33 mg/dl) men, all with normal distributions. Applying ANOVA and Student's test it was possible to verify in addition to the described significant difference between sexes, a difference between the 2 age groups of women (p&amp;lt;0.01) which is not equal to that of men in women ≥ 50 years of age. Conclusions A more extensive study is necessary to define own reference ranges that enable the early alarm guidelines, especially in the group of women &amp;lt; 50 years of age. This will allow an adequate evaluation of risk and evolution of patients. The application of Indirect Methods will make it possible to exclude values corresponding to underlying pathologies not registered in the SIL.

Dengue fever in hyperglycemic patients: an emerging public health concern demanding eyes on the effective management strategies.

Hyperglycemia, also known as diabetes, is a metabolic disorder characterized by elevated levels of glucose in the bloodstream. It can lead to the prolonged dysfunction, injury, and deterioration of several organs. In addition, dengue is a viral illness transmitted by mosquitoes that has reached epidemic proportions worldwide. In this article, we focused on the severity of comorbidities, difficulties in managing them, and preventive measures meant to lessen the risks associated with comorbidities in diabetic patients with dengue infection. We explored a number of databases, including PubMed, Scopus, Embase, Web of Science, Google Scholar, and the Cochrane Library, for this review article using various related keywords. The findings of this review article indicate that elderly dengue patients with diabetes should be admitted to the hospital for close observation and early management using fluid therapy. An observed association exists between dengue hemorrhagic fever (DHF) and diabetes, indicating a possible consequence in this specific group. Additionally, patients with diabetes who contract dengue show elevated levels of inflammatory markers. Diabetes mellitus deteriorates the immune system, which exacerbates the progression of dengue fever. Cutting-edge technology and scientific research may assist in addressing the challenges that diabetes and dengue viruses pose in low- and middle-income countries. Implementing innovative diabetic care management is essential to ensuring consistency of care, improving a healthy lifestyle, and lowering patient risk factors and comorbidities. Dengue fever has spread to epidemic levels throughout the world. Inflammatory markers increase and the prevalence of DHF is greater in diabetes individuals with dengue infection. Given the continued growth of dengue in Asian nations, it is imperative that we concentrate our efforts and resources on providing more precise and effective treatment for this emerging issue.

Comparison of three artificial intelligence methods for predicting 90% quantile interval of future insulin sensitivity of intensive care patients

Insulin dosing of hyperglycemic patients in the intensive care unit (ICU) is a complex and nonlinear clinical control problem. Recent model-based glycemic control protocols predict a patient-specific and time-specific future insulin sensitivity distribution, which defines the future patient state in response to insulin and nutrition inputs. The prediction methods provide a 90% confidence interval for a future insulin sensitivity distribution for a given time horizon, making the prediction problem more specific compared to common prediction problems where the aim is to predict the expected value of the given stochastic parameter. This study proposes three alternative artificial intelligence-based insulin sensitivity prediction methods to improve the prediction accuracy and make prediction parameters better fit the clinical requirements. The proposed prediction methods use different neural network models: a classification deep neural network model, a Mixture Density Network model, and a Quantile Regression-based model. A large patient data set was used to create the neural network models, including 2357 patients and 92646 blood glucose measurements from three clinical sites (Christchurch, New Zealand, Gyula, Hungary, and Liege, Belgium). Prediction accuracy was assessed by statistical metrics expressing clinical requirements, as well as via validated in-silico virtual patient simulations comparing the clinical performance of a proven glycaemic control protocol using the alternative prediction methods to assess impact on glycemic control performance and thus the need for these alternative models.

Clinical Risk Assessment and Comparison of Bias between Laboratory Methods for Estimation of HbA1c for Glycated Hemoglobin in Hyperglycemic Patients.

Hemoglobin A1c (HbA1c), also known as glycated hemoglobin, is a blood test used to evaluate and track a patient's blood sugar levels over the previous 2-3 months. We have compared the analytical performance of the D10 hemoglobin (HPLC) testing system to that of the immunoturbidimetric technique, which is a light-scattering immunoassay. To assess the clinical risk assessment between two methods (Compare the two Immunoturbidometric methods (AU680) vs. HPLC method (D10)) in hyperglycemic patients and assess the acceptability of the respective methods in the Clinical biochemistry laboratory. The charge of the globins in Hb was used as the basis for the HPLC method used to measure HbA1c. HPLC detects and quantifies even the tiniest Hb fractions and the full spectrum of Hb variants. HbA1c was measured using the immunoturbidimetric (AU 680 Beckmann coulter analyzer) and high-performance liquid chromatography (HPLC) techniques. Experiments also made use of immunoturbidimetric techniques (using an AU 680 Beckmann coulter analyzer equipment). There is no statistically significant difference in HbA1c readings between male and female patients, as measured by either the Immunoturbidimetric or HPLC techniques. The immunoturbidimetric and high-performance liquid chromatography techniques for estimating HbA1c yielded identical results. From the results of this study, we may deduce that both techniques are valid for estimating HbA1c. As a result, it may be suggested that both approaches can be used to estimate HbA1c in diabetic individuals.

SGLT1 contributes to glucose-mediated exacerbation of ischemia-reperfusion injury in ex vivo rat heart.

Hyperglycaemia is common during acute coronary syndromes (ACS) irrespective of diabetic status and portends excess infarct size and mortality, but the mechanisms underlying this effect are poorly understood. We hypothesized that sodium/glucose linked transporter-1 (SGLT1) might contribute to the effect of high-glucose during ACS and examined this using an ex-vivo rodent heart model of ischaemia-reperfusion injury. Langendorff-perfused rat hearts were subjected to 35min ischemia and 2h reperfusion, with variable glucose and reciprocal mannitol given during reperfusion in the presence of pharmacological inhibitors of SGLT1. Myocardial SGLT1 expression was determined in rat by rtPCR, RNAscope and immunohistochemistry, as well as in human by single-cell transcriptomic analysis. High glucose in non-diabetic rat heart exacerbated reperfusion injury, significantly increasing infarct size from 45 ± 3 to 65 ± 4% at 11-22mmol/L glucose, respectively (p < 0.01), an association absent in diabetic heart (32 ± 1-37 ± 5%, p = NS). Rat heart expressed SGLT1 RNA and protein in vascular endothelium and cardiomyocytes, with similar expression found in human myocardium by single-nucleus RNA-sequencing. Rat SGLT1 expression was significantly reduced in diabetic versus non-diabetic heart (0.608 ± 0.08 compared with 1.116 ± 0.13 probe/nuclei, p < 0.01). Pharmacological inhibitors phlorizin, canagliflozin or mizagliflozoin in non-diabetic heart revealed that blockade of SGLT1 but not SGLT2, abrogated glucose-mediated excess reperfusion injury. Elevated glucose is injurious to the rat heart during reperfusion, exacerbating myocardial infarction in non-diabetic heart, whereas the diabetic heart is resistant to raised glucose, a finding which may be explained by lower myocardial SGLT1 expression. SGLT1 is expressed in vascular endothelium and cardiomyocytes and inhibiting SGLT1 abrogates excess glucose-mediated infarction. These data highlight SGLT1 as a potential clinical translational target to improve morbidity/mortality outcomes in hyperglycemic ACS patients.

Perioperative management of hyperglycemic patients undergoing surgery: an observational cross sectional study in a tertiary care hospital

Perioperative management of hyperglycemic patients undergoing surgery: an observational cross sectional study in a tertiary care hospital

Glycemia and Coagulation in Patients with Glioblastomas

Glioblastomas are among the most malignant tumors which, despite aggressive treatment, currently have an abysmal prognosis. These lesions are known to cause local and systemic perturbations in the coagulation system, leading to neoangiogenesis and a high risk of venous thromboembolism. Indeed, there have been multiple proposals of the coagulation system being a possible target for future treatment of these patients. However, nonselective anticoagulant therapy has proven suboptimal and leads to a significant increase of intracranial hemorrhage. Thus, recognizing factors that lead to hypercoagulation is considered paramount. Hyperglycemia is a well-known prothrombotic factor, a fact that has received little attention in neuro-oncology. We previously hypothesized that patients with brain tumors could be highly susceptible to iatrogenic glycemia dysregulation. Here, we analyzed the connection between glycated hemoglobin (HbA1c) and the routine coagulation markers (D-dimers, prothrombin time and activated partial thromboplastin time [aPTT]) in patients with de novo intracranial glioblastomas. Included in this study were 74 patients who were operated on in 2 hospitals: Clinical Hospital Dubrava, Zagreb, Croatia; University Hospital Center Split, Split, Croatia; and University Hospital de la Princesa, Madrid, Spain. We found a significant inverse correlation between HbA1c and aPTT (ρ=-0.379; P= 0.0009). We also found a significant inverse correlation between Ki67 immunoreactivity and aPTT (ρ=-0.211; P= 0.0082). No connection was found between HbA1c and D-dimers or prothrombin time. Our results suggest that patients with hyperglycemia, with a more proliferative glioblastoma, could in fact have their coagulation profile significantly disrupted, primarily through the intrinsic coagulation pathway. Such findings could have great clinical importance. Further research in this area could help to elucidate the vicious connection between glioblastomas and coagulation and to combat this deadly disease.

Inhibition of dynamin-related protein 1-filamin interaction improves systemic glucose metabolism.

Maintaining mitochondrial quality is attracting attention as a new strategy to treat diabetes and diabetic complications. We previously reported that mitochondrial hyperfission by forming a protein complex between dynamin-related protein (Drp) 1 and filamin, mediates chronic heart failure and cilnidipine, initially developed as an L/N-type Ca2+ channel blocker, improves heart failure by inhibiting Drp1-filamin protein complex. We investigated whether cilnidipine improves hyperglycaemia of various diabetic mice models. Retrospective analysis focusing on haemoglobin A1c (HbA1c) was performed in hypertensive and hyperglycaemic patients taking cilnidipine and amlodipine. After developing diabetic mice by streptozotocin (STZ) treatment, an osmotic pump including drug was implanted intraperitoneally, followed by weekly measurements of blood glucose levels. Mitochondrial morphology was analysed by electron microscopy. A Ca2+ channel-insensitive cilnidipine derivative (1,4-dihydropyridine [DHP]) was synthesized and its pharmacological effect was evaluated using obese (ob/ob) mice fed with high-fat diet (HFD). In patients, cilnidipine was superior to amlodipine in HbA1c lowering effect. Cilnidipine treatment improved systemic hyperglycaemia and mitochondrial morphological abnormalities in STZ-exposed mice, without lowering blood pressure. Cilnidipine failed to improve hyperglycaemia of ob/ob mice, with suppressing insulin secretion. 1,4-DHP improved hyperglycaemia and mitochondria abnormality in ob/ob mice fed HFD. 1,4-DHP and cilnidipine improved basal oxygen consumption rate of HepG2 cells cultured under 25 mM glucose. Inhibition of Drp1-filamin protein complex formation becomes a new strategy for type 2 diabetes treatment.

Additive effect of admission hyperglycemia on left ventricular stiffness in patients following acute myocardial infarction verified by CMR tissue tracking

BackgroundStress hyperglycemia occurs frequently in patients following acute myocardial infarction (AMI) and may aggravate myocardial stiffness, but relevant evidence is still lacking. Accordingly, this study aimed to examine the impact of admission stress hyperglycemia on left ventricular (LV) myocardial deformation in patients following AMI.MethodsA total of 171 patients with first AMI (96 with normoglycemia and 75 with hyperglycemia) underwent cardiac magnetic resonance (CMR) examination were included. AMI patients were classified according to admission blood glucose level (aBGL): < 7.8 mmol/L (n = 96), 7.8–11.1 mmol/L (n = 41) and ≥ 11.1 mmol/L (n = 34). LV strains, including global radial/circumferential/longitudinal peak strain (PS)/peak systolic strain rate (PSSR)/peak diastolic strain rate (PDSR), were measured and compared between groups. Further, subgroup analyses were separately conducted for AMI patients with and without diabetes. Multivariate analysis was employed to assess the independent association between aBGL and LV global PS in AMI patients.ResultsLV global PS, PSSR and PDSR were decreased in radial, circumferential and longitudinal directions in hyperglycemic AMI patients compared with normoglycemic AMI patients (all P < 0.05). These differences were more obvious in patients with diabetes than those without diabetes. AMI patients with aBGL between 7.8 and 11.1 mmol/L demonstrated significant decreased radial and longitudinal PS, radial PSSR, and radial and longitudinal PDSR than those with aBGL < 7.8 mmol/L (all P < 0.05). AMI patients with aBGL ≥ 11.1 mmol/L showed significantly decreased PS, PSSR and PDSR in all three directions than those with aBGL < 7.8 mmol/L, and decreased longitudinal PSSR than those with aBGL between 7.8 and 11.1 (all P < 0.05). Further, aBGL was significantly and independently associated with radial (β = − 0.166, P = 0.003) and longitudinal (β = 0.143, P = 0.008) PS.ConclusionsHyperglycemia may exacerbate LV myocardial stiffness in patients experienced first AMI, leading to reduction in LV strains. aBGL was an independent indicator of impaired LV global PS in AMI patients. Blood glucose monitoring is more valuable for AMI patients with diabetes.

Impact of hyperglycemia on tuberculosis treatment outcomes: a cohort study

Hyperglycemia is prevalent and closely associated with pulmonary tuberculosis (PTB). This study aimed to investigate the effects of hyperglycemia on the outcomes of PTB treatment. This study comprised 791 patients with PTB in total. Patients with fasting plasma glucose levels of ≥ 6.1 mmol/L were diagnosed with hyperglycemia. Anthropometric and baseline demographic data were also collected. The treatment response was assessed based on clinical symptoms (sputum production, cough, chest pain, fever, hemoptysis, night sweats, loss of appetite, and fatigue), sputum smear, chest computed tomography (CT), and adverse gastrointestinal responses (vomiting, nausea, abdominal distension, diarrhea, and constipation). A generalized estimating equation (GEE) was used to evaluate these relationships. Hyperglycemia affected 266 (33.6%) of the 791 patients with PTB. In GEE analyses, patients with hyperglycemia exhibited a greater incidence of elevated tuberculosis (TB) scores (odds ratio (OR) 1.569; 95% CI 1.040–2.369), cough (OR 1.332; 95% CI 1.050–1.690), and night sweats (OR 1.694; 95% CI 1.288–2.335). Hyperglycemia was linked with a higher risk of positive sputum smears (OR 1.941; 95% CI 1.382–2.727). During therapy, hyperglycemia was also associated with an increased incidence of vomiting (OR 2.738; 95% CI 1.041–7.198), abdominal distension (OR 2.230; 95% CI 1.193–4.171), and constipation (OR 2.372; 95% CI 1.442–3.902). However, the CT results indicated that hyperglycemia did not affect pulmonary lesions in patients with TB. Patients with TB and hyperglycemia are at a higher risk of severe clinical manifestations, positive sputum smears, and adverse gastrointestinal effects and, therefore, the special situation of hyperglycemic patients should be considered in the prevention and treatment of TB.

Modified Delphi RAND/UCLA Consensus on Recommendations for Preventing Surgical Site Infections in Colorectal Surgery

Abstract Surgical site infections (SSIs) are a major health care issue, with worse outcomes and higher costs in Latin America than in other countries. To reduce SSIs in colorectal surgery (CRS), we conducted a mixed-method study between May and December 2021, which included a literature review, Delphi expert consensus panel, and SSI reduction recommendations. The literature review identified 150 relevant articles, deriving 19 recommendations based on the GRADE framework. A panel of 14 experts from Argentina, Chile, and Uruguay, specializing in infection control, participated in a modified Delphi consensus process. They evaluated the recommendations using a Likert scale and assessed 13 criteria to reach consensus. After rounds of evaluation and expert discussions, 6 recommendations achieved consensus and were deemed appropriate for SSI prevention in CRS: presurgical bathing, surgical antibiotic prophylaxis, mechanical colon preparation, preincision antisepsis with alcohol and antisepsis, monitoring of hyperglycemic patients, and control of normothermia. Implementing such a multifaceted set of recommendations presents challenges, and a bundled approach has been suggested to improve the adherence to complex prevention strategies. Previous research has underscored the importance of effective implementation strategies, including engagement, education, execution, and evaluation, as well as fostering a culture of safety and readiness for change. This study offers expert recommendations for preventing SSIs in CRS, particularly in Latin America. These are crucial for regional health care organizations. Compliance with basic infection prevention measures remains a concern. A bundled approach was suggested to evaluate adherence to health care protocols in Argentina and Uruguay. Aligning guidelines and practices can increase patient safety and reduce the impact of SSIs on Latin American health care.

Current Aspects of Nanotechnology Based Healing Approaches for Diabetic Wounds

Abstract: Diabetic wounds represent a significant clinical challenge due to their chronic nature, slow healing rates, and susceptibility to infections, often leading to severe complications. Nanotechnology plays a transforming role in advancing diabetic wound repair therapies. The field of nanotechnology has shown great promise in the medical field in recent years, offering precise tools and materials at the nanoscale to address the complexities of diabetic wound management. The latest breakthroughs in nanomaterial design and fabrication showcase nanoparticles, nanofibers, and hydrogels tailored to enhance tissue regeneration, promote angiogenesis, and modulate the wound microenvironment. These engineered materials serve as versatile systems for the regulated release of cytokines and antimicrobial agents, offering a multifaceted approach to diabetic wound healing. Nanotechnology enables the growth of smart medication delivery technologies with accurate targeting and sustained delivery of medicinal substances right to the location of the wound. Prolonged injuries in hyperglycemic patients are particularly prone to infections, leading to prolonged healing times and increased morbidity. Some of the nanoscale antimicrobial agents, such as nanozyme-chitosan-derived hydrogel, silver nanoparticles, and antimicrobial peptides that exhibit potent bactericidal properties, reduce the risk of infections and associated complications. Nanosensors and advanced imaging techniques enable real-time monitoring of wound healing progress. These tools provide clinicians with valuable insights into tissue viability, inflammation levels, and treatment efficacy, facilitating timely adjustments to therapeutic regimens. This is an inclusive overview of the current state of nanotechnology for the treatment of diabetic wounds, offering insights into the promise and challenges of this innovative approach, by harnessing the unique properties of nanoscale materials and technologies.

Assessment on Inpatient Glycaemic Control in General Medical Wards, Putrajaya Hospital.

Inpatient hyperglycaemia is common and associated with poor outcomes such as increased mortality and prolonged hospital stay. This study aimed to determine the prevalence of inpatient hyperglycaemia and glycaemic control in Putrajaya Hospital, Malaysia. Secondary objectives were to compare the length of stay (LOS), 30-day readmission rate, and death between controlled and uncontrolled glycaemic groups. This cross-sectional study was conducted between 1 July and 31 December 2019 among patients in medical wards who had a blood glucose (BG) level of > 7.8 mmol/L and stayed in the wards for ≥ 24 h. We retrieved information on demographics, diabetes history and BG profiles. The definition of controlled glycaemic status is when ≥ 80% of BG readings were between 4.0 mmol/L and 10.0 mmol/L during the hospital stay. The prevalence of inpatient hyperglycaemia was 55.2%. There were 841 patients who met the eligibility criteria; their mean age was 60 (13.8) years old. Most (79.4%) of the patients were Malay and 53.9% were male. There were 452 (53.7%) patients in the uncontrolled group. They were younger and admitted with more kidney complications compared to those in the controlled group. The median LOS for both groups was 3 (2) days. The uncontrolled group showed a higher percentage of readmission within 30 days (7.5% versus 4.6 %) and death during admission (3.3% versus 1.6 %) (P = 0.100 and P = 0.082). The prevalence of inpatient hyperglycaemia was high. More than half of them had uncontrolled BG. Both groups had a similar average length of stay. The 30-day readmission rate and death during admission were higher in the uncontrolled group, although statistically not significant.