Insulin-dependent Diabetic Patients Research Articles

Synchronized Diabetes Monitoring System: Development of Smart Mobile Apparatus for Diabetes Using Insulin

Accurate and timely injection of insulin doses in accordance with the treatment protocol is very important in the follow-up of insulin-dependent diabetes patients. In this study, a new smart mobile apparatus (SMA) has been developed. The SMA can be attached to insulin pens and record and transfer data by detecting the patient's dose of insulin and the time at which it was provided. The SMA can detect the dose determined in the insulin pen through linear capacitive sensors. Electronic parts and sensor mechanism are located on the designed SMA body. The insulin pen's two-part mechanical construction of the body senses movement during dosage adjustment while also making sure the dose information is recorded in the control unit. The dose and time information recorded in the SMA internal memory are transmitted to the patient's smartphone via the developed mobile application. The developed SMA prototypes were evaluated by a team of doctors in a hospital setting for three months. As a result of the three-month study, it was observed that the insulin dose and administration times could be accurately sent to the smartphone application via SMA. The SMA was created in the laboratory environment and was prepared for pilot research with insulin-dependent diabetes patients in a hospital setting. It was observed that the SMA prototype successfully identified and recorded the dose and timing of the patient's self-administered insulin.

#1944 How the patient characteristics and the prescription can be accounted for in patient-specific predictive HD models?

Abstract Background and Aims Compartmental models in HemoDialysis (HD) allow for understanding and predicting the patient-specific response to the treatment. These models, after training with consistent clinical data, can be adapted to each single patient through the estimation of a set of parameters. This work explores the relationship between the sets of estimated parameters and the anamneses of the enrolled patients, together with the settings of the HD sessions, and their time evolution. The finding of similar relationships will help properly set the models even avoiding the training phase. Method The data acquired during the INTERREG InterACTIVE-HD 2.0 observational longitudinal study, in partnership with 5 Italian and Switzerland hospitals (ASSTs Lariana, SetteLaghi, Valtellina e Alto Lario, Regional Hospital of Lugano, and Kantonsspital Graubünden of Chur Dialysis Units), were used (576 sessions). Clinical prescription, machine settings, and blood composition at the start, end, and every hour during the HDs were monitored over 7 months. The parametric multi-compartmental, multi-solute model optimized during the study was used. The patient-specific parameters are: Their default values (literature-based) are: Patient-specific parameters have been identified for each patient, by training the model with 3 session's data. Then the model can be used to predict the patient's response by knowing the clinical data at the beginning of the HD and setting the parameters equal to the mean of the 3 identified values. A correlation analysis between the patient-dependent parameters and the anamneses of the enrolled patients, together with the settings of the HD sessions, has been performed. The optimization orders have been also considered. Results k(K+), k(Urea), and k(Crea) are the first optimized and remain generally of the same magnitude. k(Na+), k(Cl-), k(HCO3-), k(Mg2+), and k(Glu), correlate with the UF rate, the therapy technique, or the concentrations in dialysate bags. They are later optimized and characterized by wider variability in values and optimization orders. k(Ca2+) remains at the default in 98% of the sessions, being optimized last. More convective therapies seem to induce patient-specific variations in active and passive cellular transport for specific solutes. η relevant correlations refer to the dialysate bag composition and the baseline conditions of the patients. They are in general late optimized, in HDF before than in SHD. η(Urea) and η(Crea) in 99% of the cases do not move from the default, suggesting a lower interaction of the non-ionic species with the filter membrane. They are optimized only in non-hypertensive insulin-dependent diabetic patients. No correlation between η and the filter material or the initial serum albumin was instead observed. ρ is related to the therapy; in HDF sessions it is over the range boundaries ([0,10]). For females undergoing SHD, it assumes the highest values (>9). ρ seems also to be affected by the use of beta-blockers (p < 0.01) and antihyperglycemic ((p < 0.01). Ca_buff coefficients for females (higher values) and males are statistically different. Diabetics using anti-hyperglycemia drugs are characterized by lower values. Conclusion Compartmental patient-specific models, if successfully trained become a useful support tool for therapy customization, mainly for ESRD patients with multiple comorbidities. The observed correlations represent the first step to causally relate the values of the modulating parameters with the patient characteristics implying the reduction or amplification of a specific response to the treatment. The next step will be an analysis of combined effects. The final goal is to be able to correctly set up the models even before the training phase is completed.

Outcome of Percutaneous Coronary Intervention with Drug Eluting Stent in Ischemic Heart Disease with Insulin Dependent and Noninsulin Dependent Diabetic Patients

Background: Coronary artery diseases in diabetic patients are challenging because these patients represent about 25% of surgical coronary revascularization and percutaneous coronary intervention (PCI) procedures and have worse outcomes than patients without diabetes mellitus (DM) irrespective of the invasive management they receive. Patients and Methods: 53 insulin-dependent diabetic patients (ID) and non-insulin-dependent diabetic patients (NID) who underwent PCI with deployment of at least 1 drug-eluting stent (DES) in coronary arteries. Patients were divided into 2 groups: 18 ID patients & 35 NID patients. A comprehensive clinical work-up was planned one month and twelve months following the surgery, with angiographic follow-up scheduled 6-12 months thereafter. Results: Hyperlipidemia was more prevalent in the NID patients, while Coronary Artery Bypass Grafting (CABG) and multi-vessel disease were found more prevalent in the ID group than NID (p-value < 0.05). One-month follow-up showed no variations in the frequency of in-hospital mortality, Q-wave MI, or vascular sequelae. On the other hand, the rate of Target Lesions Revascularization (TRL), Non-Target Lesions Revascularization (NTLR), Nonfatal MI, and Cardiac death were high in ID patients. Conclusion: DES deployment, in comparison to coronary restenosis (ISR) following DES deployment, which remained considerably more prevalent in individuals with IDDM than in NIDDM patients, was observed to enhance angiographic and clinical results for IDDM and NIDDM patients. Long-term efficacy in those with IDDM was reduced due to an increased risk of revascularization.

Sino-nasal Mucormycosis in non-compliant insulin-dependent diabetic patient: A case report with an insight on underlying psychological factors

BackgroundMucormycosis is a severe fungal infection manifested mostly in immunocompromised hosts. Underlying causes for Mucormycosis include uncontrolled diabetes mellitus (DM), malignancies, chronic corticosteroid use, and organ transplant. Case reporta 57-year-old Caucasian female, with insulin-dependent DM, presented to otolaryngology casualty complaining about a severe headache and nasal discharge. Clinical, laboratory, imaging, and histopathological investigations confirmed the diagnosis of Mucormycosis due to uncontrolled DM. Mucormycosis was managed pharmacologically, surgically, and by improving glycemic control. Psychological factors leading to non-adherence to insulin therapy were investigated and psychiatric evaluation and counseling were emphasized. Practical implicationsHealthcare providers should be aware of the signs, symptoms, and underlying causes of Mucormycosis and should manage it promptly. Mental health status should be part of the patient's evaluation and treatment plan.

Insulin Dependence is Associated with Poor Long-Term Outcomes Following AAA Repair

While prior studies have confirmed the protective effect of diabetes on abdominal aortic aneurysm (AAA) development, much less is known about the effect of diabetes, and in particular insulin dependence, on outcomes following AAA repair. In this study, we aim to evaluate the role of insulin dependent diabetes on short- and long-term outcomes following open and endovascular AAA repair. The Vascular Implant Surveillance and Interventional Outcomes Network (VISION), a registry linking the Vascular Quality Initiative (VQI) data with Medicare claims, was queried for patients who underwent open or endovascular AAA repair from 2011 to the present. Exclusion criteria were unknown diabetes status, prior aortic intervention, maximum aneurysm diameter < 45mm at presentation and Medicare Advantage coverage due to inconsistent follow-up. Patients were stratified based on diabetes status (no diabetes vs diabetes) and insulin-dependence (no diabetes or non-insulin dependent diabetes vs insulin dependent diabetes). Of the 38,437 cases in the VISION endovascular aortic aneurysm (EVAR) and open aortic aneurysm repair (OAR) databases, 21,943 met inclusion criteria. Perioperative outcomes after OAR were comparable between diabetic and non-diabetic patients. However, diabetic patients undergoing EVAR were significantly more likely to have a post-operative myocardial infarction (1.0% vs 0.6%, p = .04) and have a 30-day readmission (10.9% vs 8.8%, p<.001). Insulin-dependent diabetic patients were more likely to require a 30-day readmission after OAR (24.5% vs 13.5%, p = .02) and EVAR (15.1% vs 9.0%, p <.001), however, only IDDM patients undergoing EVAR experienced higher rates of postoperative MI (1.9% vs 0.7%, p <.01). After propensity score matching, patients with insulin dependent diabetes undergoing EVAR were additionally at increased risk of mortality at one-, three- and five-year follow-up with the highest risk occurring at the one-year mark (HR 1.79, p <.0001), while IDDM patients undergoing OAR were only at a significantly increased risk of mortality at five-year follow-up (HR 1.90, p = .01). Patients with insulin-dependent diabetes have greater than 14% one-year mortality following open or endovascular aneurysm repair, compared to 8% for all others. Our findings raise questions about whether insulin-dependent diabetics should have a higher size threshold for prophylactic repair, although further studies are needed to address this question and consider the influence of glycemic control on these outcomes.

Wearable Insulin Biosensors for Diabetes Management: Advances and Challenges.

We present a critical review of the current progress in wearable insulin biosensors. For over 40 years, glucose biosensors have been used for diabetes management. Measurement of blood glucose is an indirect method for calculating the insulin administration dosage, which is critical for insulin-dependent diabetic patients. Research and development efforts aiming towards continuous-insulin-monitoring biosensors in combination with existing glucose biosensors are expected to offer a more accurate estimation of insulin sensitivity, regulate insulin dosage and facilitate progress towards development of a reliable artificial pancreas, as an ultimate goal in diabetes management and personalised medicine. Conventional laboratory analytical techniques for insulin detection are expensive and time-consuming and lack a real-time monitoring capability. On the other hand, biosensors offer point-of-care testing, continuous monitoring, miniaturisation, high specificity and sensitivity, rapid response time, ease of use and low costs. Current research, future developments and challenges in insulin biosensor technology are reviewed and assessed. Different insulin biosensor categories such as aptamer-based, molecularly imprinted polymer (MIP)-based, label-free and other types are presented among the latest developments in the field. This multidisciplinary field requires engagement between scientists, engineers, clinicians and industry for addressing the challenges for a commercial, reliable, real-time-monitoring wearable insulin biosensor.

Glucose-Responsive Chitosan Nanoparticle/Poly(vinyl alcohol) Hydrogels for Sustained Insulin Release In Vivo.

Stimuli-responsive hydrogels (HGs) with a controlled drug release profile are the current challenge for advanced therapeutic applications. Specifically, antidiabetic drug-loaded glucose-responsive HGs are being investigated for closed-loop insulin delivery in insulin-dependent diabetes patients. In this direction, new design principles must be exploited to create inexpensive, naturally occurring, biocompatible glucose-responsive HG materials for the future. In this work, we developed chitosan nanoparticle/poly(vinyl alcohol) (PVA) hybrid HGs (CPHGs) for controlled insulin delivery for diabetes management. In this design, PVA and chitosan nanoparticles (CNPs) are cross-linked with a glucose-responsive formylphenylboronic acid (FPBA)-based cross-linker in situ. Leveraging the structural diversity of FPBA and its pinacol ester-based cross-linkers, we fabricate six CPHGs (CPHG1-6) with more than 80% water content. Using dynamic rheological measurements, we demonstrate elastic solid-like properties of CPHG1-6, which are dramatically reduced under low-pH and high-glucose environments. An in vitro drug release assay reveals size-dependent glucose-responsive drug release from the CPHGs under physiological conditions. It is important to note that the CPHGs show appreciable self-healing and noncytotoxic properties. Promisingly, we observe a significantly slower insulin release profile from the CPHG matrix in the type-1 diabetes (T1D) rat model. We are actively pursuing scaling up of CPHGs and the in vivo safety studies for clinical trial in the near future.

Outcome Comparison Between Insulin-Dependent and Non Insulin-Dependent Patients after Open Adult Cardiac Surgery

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Insulin-dependent diabetic patients usually have poor glycemic control and higher risk of complications than non-insulin-dependent diabetic patients. However, the difference in clinical outcomes between these two groups of patients who underwent open cardiac surgery was not established. Therefore, this study compares the short-term outcome of insulin vs non-insulin-dependent diabetic patients after open cardiac surgery in a large-scale study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The study design was a retrospective cohort. All adults who underwent open cardiac surgery between January 1&lt;sup&gt;st&lt;/sup&gt; 2016-December 31&lt;sup&gt;st&lt;/sup&gt; 2020 in 4 tertiary hospitals in Indonesia were included in the study. From a total of 4.931 samples included in the study, 3.753 patients were non-diabetic (Group I) and 1.178 were diabetic (Group II). Group II was divided into subgroup IIA (930 non-insulin-dependent) and subgroup IIB (248 insulin-dependent). The main outcome was in-hospital mortality of open cardiac surgery patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Result:&lt;/strong&gt; In-hospital mortality between group I and II had no significant difference (6.8% vs 5.7%; p = 0.188), as well as IIA and IIB (5.6% vs 6%; p = 0.782). Multivariate analysis demonstrated that diabetes did not increase mortality of open cardiac surgery (OR 0.665; p = 0.021). In-hospital mortality of subgroup IIB was higher than subgroup IIA, but insulin therapy did not increase the risk of in-hospital mortality (OR 1.259; p = 0.464).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; Both insulin-dependent and non-insulin-dependent diabetes mellitus were not the predictors of poor short-term outcomes for open adult cardiac surgery patients.&lt;/p&gt;

Prevalence, Predictors and Morphological Patterns of Acanthosis Nigricans Between Obese Non-diabetic Patients on Second Generation Antipsychotics Versus Non-obese Insulin Dependent Diabetes mellitus: A Nested Case-Control Study

INTRODUCTION: There is no study in literature for analyzing acanthosis nigricans (AN) in psychotropic induced obesity or hypercholesterolemia.&#x0D; AIM: To assess the prevalence and explore the predictors and morphological patterns in AN in patients on antipsychotics induced hypercholesterolemia versus those with diabetes mellitus.&#x0D; MATERIALS AND METHODS: 491 schizophrenia patients on second generation antipsychotics were screened. 26 out of 491 patients have AN and cholesterol 200 mg/dl but non-diabetic. We used MannWhitney U-test, Pearsons 2 test, Fischer Exact and Spearmans correlation coefficient.&#x0D; RESULTS: In the group of antipsychotics induced hypercholesterolemia having developed AN in 5.29% (26 out of 491) of individuals, we observed significance of Burkes knuckle (p 0.001), knee (p = 0.002), elbow (p = 0.042) compared to patients without hypercholesterolemia. Interestingly Burkes neck severity (p 0.001), neck texture (p = 0.001) and axilla (p = 0.007) index also showed marked differences on MannWhitney U-test and Wilcoxson W-test. On Spearmans correlation coefficient antipsychotics induced hypercholesterolemia was found to affect most positively and significantly as the emergence of AN specifically for neck texture ( = 0.413, p = 0.003) compared to other bodily regions.&#x0D; CONCLUSION: About 5.29% prevalence of AN in the group having obesity secondary to psychotropic drugs which was significantly less than what even non-obese, insulin dependent diabetic patients who almost had 13.55% prevalence, close to three times. This suggests that diabetes is strongly linked with occurrence of AN lesions and might reflect the continuity in the paradigm of metabolic syndrome as its definitive predictor of severity while obesity is the initiation of phase shift in the process.

Knowledge, attitudes and practices of sharps waste disposal by diabetic patients in rural South Africa.

Sharps waste is hazardous, and it should be disposed of in a proper manner, as it can contribute to transmission of diseases and create a negative impact on the environment. The aim of this investigation was to determine the knowledge, attitudes and practices regarding sharps waste disposal of diabetic patients who inject themselves at home in uMzinyathi District Municipality, a rural area in KwaZulu-Natal, South Africa. A quantitative, descriptive cross-sectional study design was adopted using a self-administered questionnaire. Consecutive sampling with a sample size of 308 insulin-dependent diabetic patients from five selected health facilities of uMzinyathi District Municipality was used. The majority of respondents (62.3%) lacked knowledge regarding proper sharps waste disposal. The vast majority of respondents (90.6%) recognised that sharps waste should be separated from general waste. Among those who acknowledged that someone in their home had been injured by a needle, 53.3% stated that they were motivated to change their method of sharps waste disposal. The study findings indicated that the majority of the respondents lacked knowledge regarding proper disposal of sharps waste because they were not taught proper methods of sharps waste disposal. There was a general lack of awareness on proper disposal of sharps waste by diabetic patients in the home setting. The study recommended that healthcare workers must place more emphasis on the awareness of proper sharps waste disposal in order to equip diabetic patients with relevant information regarding sharps waste disposal.

PS-C01-5: RELATIONSHIP BETWEEN MICROANGIOPATHY AND MACROANGIOPATHY IN DIABETIC PATIENTS

Background: Diabetes patients are known to produce diabetic retinopathy. Pulse wave velocity (PWV) provides arterial stiffness and hemodynamic parameters. We studied the effect of diabetic retinopathy in different stages on arterial stiffness in diabetics. We measured vascular aging with a new system (pOpmètre) that measures PWV, Ankle-Brachial Index (ABI) and Central Blood pressure Methods: 83 type 1 diabetes patients attending the clinic (59% male) aged (42 ± 1.54 years). Insulin dependent diabetic patients with retinopathy (N = 61) or without retinopathy (N = 22) with abnormal albuminuria ratio (17%), mean diabetes duration 26 years. All patients underwent vascular assessment with pOpmètre (Axelife - France). The following parameters were measured in each patient, PWV, ABI and central Blood Pressure, non-invasively and without cuff compression. Results: PWV correlated with the degree of retinopathy (F = 13.80; p &lt; 10^(-4)) and with aging (r2 = 0.25; p &lt; 10^(-4)), and with diabetes duration (r2 = 0.12; p &lt; 0.002) independently of gender, HbA1c, smoking, BMI, diabetes duration or lipid profile. Aging and diabetes duration were not associated (ANOVA, p = 0.5) to the degree of retinopathy unlike PWV. Conclusions: there is a high interdependence between microvascular and macrovascular lesions in this population of well treated type I diabetic patients with or without retinopathy.

Healing of dental extraction sockets in insulin-dependent diabetic patients

Healing of dental extraction sockets in insulin-dependent diabetic patients

RF04 | PSUN233 Design of an Ultra-Stable Insulin/Glucagon Fusion Protein

Abstract Insulin replacement therapy is lifesaving for insulin-dependent diabetic patients, but it comes with an ever-present threat of hypoglycemia, which can eventually cause ischemic events, arrhythmias, neurological damage, coma, or even death. Consequently, the risk of hypoglycemia remains the most significant obstacle that prevents insulin-dependent patients from attaining adequate metabolic control. One approach to solve this issue involves the co-injection of insulin and glucagon at a fixed ratio, which has been shown to improve glycemic control with prevention of hypoglycemia. The co-administration of both hormones is based on two known physiological processes: first, insulin is a potent inhibitor of glucagon activity, especially under hyperglycemic conditions, and second, glucagon overpowers insulin and stimulates hepatic glucose production under hypoglycemic circumstances. In this work, we took this concept further into developing an insulin/glucagon fusion protein that will provide glycemic control (by the insulin portion) while preventing hypoglycemia (through the glucagon portion). Because both hormones are known to be unstable and form amyloid-like fibrils, our approach consists of using a fibrillation-resistant single-chain insulin (SCI) analog fused to a novel fibrillation-resistant glucagon analog. These molecules were independently synthesized by Solid-Phase Peptide Synthesis (SPPS) and linked together from the C-Terminus of the glucagon analog to the N-Terminus of the SCI analog by trypsin-mediated ligation. By themselves or when fused, these ultra-stable analogs didn't form fibrils after one month of agitation at 37°C in PBS (pH 7.4). By contrast, native insulin started fibrillation at 12.14 ± 3.65 hours, and native glucagon at time 0. The glucagon analog was designed to be less potent than the native molecule to allow unopposed insulin activity while in hyperglycemia but maintaining full agonism to prevent hypoglycemia. The in vitro glucagon activity was measured by cAMP production in HEK293 expressing the glucagon receptor. The glucagon analog was determined to be a full agonist with an EC50 of 125.7 nM, a ∼58-fold potency difference to the native molecule (2.175 nM). The fusion protein was tested in vitro and in vivo to determine the activities of both moieties when fused. The in vitro insulin activity of the fusion protein measured by traditional and in-cell western blot was comparable to the SCI alone. The in vitro glucagon activity of the fusion protein was also similar to the glucagon analog alone (EC50 151.2 nM), therefore validating our fusion approach. The in vivo insulin and glucagon activities are currently being tested by subcutaneous injection in diabetic (STZ) and normal rats. So far, both insulin and glucagon moieties have shown to be fully active, and hypoglycemia has not been observed in rats. Increasing doses studies are underway. We believe that this approach will allow the design of next-generation insulin treatments protected against hypoglycemia, ultra-stable, and amenable for multiplatform delivery. Presentation: Saturday, June 11, 2022 1:54 p.m. - 1:59 p.m., Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Knowledge, attitudes and practices of sharps waste disposal by diabetic patients in rural South Africa

Background: Sharps waste is hazardous, and it should be disposed of in a proper manner, as it can contribute to transmission of diseases and create a negative impact on the environment. The aim of this investigation was to determine the knowledge, attitudes and practices regarding sharps waste disposal of diabetic patients who inject themselves at home in uMzinyathi District Municipality, a rural area in KwaZulu-Natal, South Africa. Methods: A quantitative, descriptive cross-sectional study design was adopted using a self-administered questionnaire. Consecutive sampling with a sample size of 308 insulin-dependent diabetic patients from five selected health facilities of uMzinyathi District Municipality was used. Results: The majority of respondents (62.3%) lacked knowledge regarding proper sharps waste disposal. The vast majority of respondents (90.6%) recognised that sharps waste should be separated from general waste. Among those who acknowledged that someone in their home had been injured by a needle, 53.3% stated that they were motivated to change their method of sharps waste disposal. Conclusion: The study findings indicated that the majority of the respondents lacked knowledge regarding proper disposal of sharps waste because they were not taught proper methods of sharps waste disposal. There was a general lack of awareness on proper disposal of sharps waste by diabetic patients in the home setting. The study recommended that healthcare workers must place more emphasis on the awareness of proper sharps waste disposal in order to equip diabetic patients with relevant information regarding sharps waste disposal.

Comparison of Lipid Profile in Insulin Dependent Diabetic Patients and Control Groups

Background: Insulin dependent diabetes mellitus is a worldwide health problem. In diabetic patients’ high levels of cholesterol leads to atherosclerosis and coronary heart diseases. Aim and Objective: Our objective was to investigate the comparison of dyslipidemia in insulin dependent diabetic patients and control group. Methods: A cross sectional study was done on 48 people in which 24 were insulin dependent diabetic patients and 24 were normal people, sample were taken from Gulab Devi hospital, Lahore. Blood samples were collected from both the patients and the control group after an overnight fasting for lipid profile and serum was separated from the whole blood by centrifugation. Samples were analyzed and the data was entered and analyzed by using SPSS version 20. Results: In this study increased triglycerides levels 21(87.5%), cholesterol levels 10(41.66%), LDL levels 8(33%), VLDL 21(87.5%) levels and decreased HDL levels 6(25%) were found in insulin dependent diabetic patients. Conclusion: We concluded that the levels of Cholesterol, Triglyceride, LDL and VLDL were increased in insulin dependent diabetic patients while HDL levels were low. Keywords: Lipid profile, Insulin dependent diabetes.

Direct Reprogramming of Different Cell Lineages into Pancreatic β-Like Cells.

One major goal of regenerative medicine is the production of pancreatic endocrine islets to treat insulin-dependent diabetic patients. Among the different methods developed to achieve this goal, a particularly promising approach is direct lineage reprogramming, in which non-β-cells are directly converted to glucose-responsive, insulin-secreting β-like cells. Efforts by different research groups have led to critical insights in the inducing factors necessary and types of somatic tissues suitable for direct conversion to β-like cells. Nevertheless, there is limited understanding of the molecular mechanisms underlying direct cell fate conversion. Significant challenges also remain in translating discoveries into therapeutics that will eventually benefit diabetic patients. This review aims to cover the advances made in the direct reprogramming of somatic cells into β-like cells and discuss the remaining challenges.

Extent of craniofacial fungal osteomyelitis in a ketoacidotic patient may predict optic nerve involvement: A case report.

IntroductionMucormycosis is an opportunistic mycosis common in poorly-controlled insulin dependent diabetic patients particularly with ketoacidosis. Fungal osteomyelitis is a life-threatening condition affectation of the nose and paranasal sinuses within the orofacial region.Presentation of caseWe present a 63-year-old diabetic male patient with maxillary mucormycotic osteomyelitis threatening his better seeing eye and review the clinical symptoms, relevant imaging, and management.DiscussionWe highlight a rare pattern of craniofacial fungal bone infection with maxillary and orbital involvement that ultimately spared the optic nerve. This case report offers the clinician a review of important clinical and diagnostic findings that can help direct the need for orbital exenteration.ConclusionMaxillary mucormycotic osteomyelitis is an aggressive infection that needs to be addressed promptly to prevent fatal consequences.

Management of Oral Cavity Mucormycosis in a Ketoacidotic Patient with Targeted Debridement and a Palate Obturator

Mucormycosis is an opportunistic mycosis common in poorly-controlled insulin dependent diabetic patients particularly with ketoacidosis. It often begins as a nasal and paranasal sinus infection with inhalation of spores into the paranasal sinuses of a susceptible host. In this case report we review the clinical symptoms, relevant imaging.

Use of Portal Vein Extension Grafts in Pancreas Transplantation: Incidence of Vascular Thrombosis

Simultaneous Pancreas-Kidney (SPK) transplants remains the gold standard for long-term euglycemia in insulin dependent diabetic patients with renal failure. Vascular complications accounts for most graft loss in the early post-operative period. Portal Venous Extension Grafts [PVEG] are used in pancreas transplantation to salvage a short donor portal vein or to facilitate an easier anastomosis. A single center retrospective analysis of outcomes was performed to determine if PVEG were associated with comparable vascular complications.

Evaluation of psychological symptoms in patients before and after simultaneous pancreas-kidney transplantation: a single-center cross-sectional study.

ABSTRACTPurpose:Simultaneous pancreas-kidney transplantation (SPKT) brings several benefits for insulin-dependent type-1 diabetic patients associated with end-stage renal disease (ESRD). However, data on psychological outcomes for the waiting list and the transplanted patients are still lacking.Methods:Using the psychological Beck inventories of anxiety (BAI) and depression (BDI), 39 patients on the waiting list were compared to 88 post-transplanted patients who had undergone SPKT.Results:Significant differences were found regarding depression (p = 0.003) but not anxiety (p = 0.161), being the pretransplant patients more vulnerable to psychological disorders. Remarkable differences were observed relative to the feeling of punishment (p < 0.001) and suicidal thoughts (p = 0.008) between the groups. It was observed that patients who waited a longer period for the transplant showed more post-transplant anxiety symptoms due to the long treatment burden (p = 0.002).Conclusions:These results demonstrated the positive impact of SPKT on psychological aspects related to depression when comparing the groups. The high number of stressors in the pretransplant stage impacts more severely the psychosocial condition of the patient.