Past History Of Diabetes Mellitus Research Articles

Poor glycemic control is associated with the prevalence of left atrial low-voltage areas in patients with atrial fibrillation ablation

Abstract Background Although glycemic control before atrial fibrillation (AF) ablation is associated with AF recurrence after the procedure, the mechanism has not been fully clarified. Left atrial low-voltage areas (LVAs) were known to be correlated with atrial scarring and AF recurrence after ablation, and a preliminary study showed that the past history of diabetes mellitus (DM) was an independent predictor of LVAs. However, the association between LVAs and glycemic control before ablation has not been elucidated. Purpose The purpose of this study was to investigate the association between glycemic control before AF ablation and the prevalence of LVAs in patients with AF ablation. Methods The study design was a single center, retrospective observational study. Between December 2014 and December 2018, 782 (age, 68 ± 10 years; female, 262 [34%]; persistent AF, 414 [53%]) consecutive patients who underwent initial AF ablation were included. Glycated hemoglobin A1c (HbA1c) levels were measured before the procedure, and HbA1c ≥ 7% was set as the cut-off value of poor glycemic control in patients with DM. The definition of LVAs was sites with a left atrial bipolar amplitude < 0.5 mV covering as ≥ 5 cm². Rhythm outcome after the procedure was followed for 24 months. Results Of 782 patients, 162 (21%) patients had LVAs, and 135 (17%) patients had past history of DM. LVAs were found more frequently in patients with poor glycemic control (Figure 1). On multivariate analysis, DM with HbA1c ≥7% was an independent predictor of LVAs (odds ratio, 3.6; 95% confidence interval: 1.8–7.0; p < 0.001). In patients with LVAs, freedom from AF recurrence during the study periods tended to be lower in patients who had DM with HbA1c ≥7% than in those with non-DM (40.3% versus 51.6%, p = 0.06) (Figure 2). Conclusions In patients with AF ablation, LVAs were found more frequently in patients with poor glycemic control. In particular, DM with HbA1c ≥7% was an independent predictor of LVAs.Prevalence of LVAs and glycemic controlAF recurrence and glycemic control

Accidental Migration of a Guide Wire During Haemodialysis Catheter Insertion Through Right Internal Jugular Vein

Introduction: Intensivist and Nephrologist generally place the dialysis catheter to obtain vascular access for immediate and short-term haemodialysis. We hereby present a case of a 54 years male with a past history of diabetes mellitus, hypertension, and chronic kidney disease stage four who was planned for immediate haemodialysis for severe hyperkalaemia and metabolic acidosis. A haemodialysis catheter was inserted under ultrasound guidance through the right internal jugular vein, but during the procedure, the guidewire was pushed into vein. The chest X-ray showed the looping of the tip of a guidewire. It was successfully surgically extracted, haemodialysis was done through the right femoral vein successfully, and the patient was discharged. From this, we want to emphasize that accidental migration is a fatal, avoidable, preventable complication. Simple measures like holding the guidewire until removal from vessels, vigilant supervision of the trainees, avoidance of vigorous force during insertion of guidewire may prevent this complication.

An observational study to correlate various factors of metabolic syndrome with coronary artery disease patients in a district of Gujarat, India

Background: Metabolic syndrome (METs) denotes to group of inter related cardiac risk factors that appear to directly encourage development of atherosclerotic cardiovascular diseases. Aims and Objectives: The aim of the study was (1) to evaluate sociodemographic profile of patients. And correlate with clinical results and (2) to compare different factors of METs with coronary artery disease (CAD) patients. Materials and Methods: A clinical and observational study was conducted in April 2021 to February 2022 among 100 patients who were diagnosed as CAD admitted under Medicine Department, GMERS medical College and civil hospital – Junagadh and at a few private hospitals of Junagadh, Gujarat. Results: Total 44% patients had METs. No sex wise significant statistical difference was observed for METs and without METs group for clinical symptomatology. Significant difference were noted regarding past history of diabetes mellitus (P = 0.004) and hypertension (P = 0.01) among patients having METs and without METs. Conclusions: Significantly higher proportion of patients with METs was having abnormal laboratory findings as compare to patients without METs.

Zanzibar Yam Poisoning - A Rare and Debilitating Condition

Background: Zanzibar Yam poisoning is not common worldwide, much less so in Singapore. This species of plant has been imported for experimental purposes but have since been propagated in the wild locally due to its efficient asexual reproduction. Toxins produced are highly alkaloid and was used in Africa as poison for fishing and cross bow hunting. We describe a case of intentional ingestion and poisoning of this high toxic plant. Case details: A 67-year-old male with past history of diabetes mellitus presented to the Emergency Department after ingestion of said plant which he harvested with vomiting and diarrhoea. Other than transaminitis and hyperlactataemia, his physical examination was unremarkable. ICU admission was warranted with worsening lactatemia upon further observation. A tumultuous 12 day ICU stay ensued during which he quickly developed severe rhabdomyolysis with hyperlactataemia resulting in acute kidney injury (AKI) and eventual anuria. This was initially treated with IV hydration as well as IV N-acetylcysteine, sodium thiosulphate and hydroxocobalamin but quickly progressed to Renal Replacement Therapy. Intubation was necessary on day 2 of ICU stay due to worsening acidosis and 2 further reintubation attempts were needed due to flash pulmonary oedema and hypercarbia induced loss of consciousness respectively. He also developed adjustment disorder which required psychiatric evaluation and treatment. He was eventually discharged after successful extubation and correction of underlying biochemical abnormalities to the community hospital for continuation of IV antibiotics and renal replacement. Conclusions: Zanzibar yam poisoning is a rare event and management is largely supportive from initial resuscitation to subsequent intensive care management. When severe, this can lead to significant end organ damage, be it temporary or permanent. More awareness needs to be raised to prevent further such incidents from happening.

Glucocorticoid-induced adrenal insufficiency: an uncommon cause of hypercalcaemia.

SummaryLong-term use of exogenous glucocorticoids leads to the suppression of the hypothalamic–pituitary–adrenal axis. Therefore, if the glucocorticoid is withdrawn abruptly, patients will develop adrenal insufficiency. Hypercalcaemia is a rare but well-known complication of adrenal insufficiency. However, hypercalcaemia is a rare presentation of glucocorticoid-induced adrenal insufficiency (GI-AI). A 62-year-old patient with a past history of diabetes mellitus, ischaemic heart disease, stroke, hypertension and dyslipidaemia presented with polyuria, loss of appetite, malaise and vomiting for a duration of 2 months. His ionized calcium level was high at 1.47 mmol/L. Intact parathyroid hormone was suppressed (4.3 pg/mL) and vitamin D was in the insufficient range (24.6 ng/mL). Extensive evaluation for solid organ or haematological malignancy including contrast-enhanced CT chest, abdomen, pelvis, multiple myeloma workup and multiple tumour markers were negative. His synacthan-stimulated cortisol was undetectable thus confirming adrenal insufficiency. His adrenocorticotrophic hormone level was 3.82 pg/mL (4.7–48.8) excluding primary adrenal insufficiency. His MRI brain and other pituitary hormones were normal. Further inquiry revealed that the patient had taken over-the-counter dexamethasone on a regular basis for allergic rhinitis for more than 2 years and had stopped 2 weeks prior to the onset of symptoms. Therefore, a diagnosis of GI-AI leading to hypercalcemia was made. The patient was resuscitated with intravenous fluids and replacement doses of oral hydrocortisone were started with a plan of prolonged tailing off to allow the endogenous adrenal function to recover. His calcium normalized and he made a complete recovery.Learning pointsLong-term use of glucocorticoids leads to the suppression of the hypothalamic–pituitary–adrenal axis.If the glucocorticoid is withdrawn abruptly, patients will develop adrenal insufficiency which is known as glucocorticoid-induced adrenal insufficiency.Adrenal insufficiency should be considered in the differential diagnosis of parathyroid hormone-independent hypercalcaemia.A thorough clinical history is of paramount importance in arriving at the correct diagnosis.

Coronavirus disease 2019 and diabetes mellitus

IntroductionIn late 2019, a new virus severe acute respiratory syndrome coronavirus-2, which causes a new serious disease called coronavirus disease 2019 (COVID-19), spread quickly all over the world. Many complications of diabetes mellitus (DM) such as microvascular and macrovascular complications increase the risk for COVID-19-related severity and mortality.ObjectiveTo assess the effect of DM on outcome and severity of COVID-19.Patients and methodsThis work was a retrospective observation that included confirmed COVID-19-infected patients (PCR positive for COVID-19) who were admitted to Shebin El-Kom Teaching Hospital, Menoufia, Egypt, from March 2021 to March 2022. Laboratory investigations such as age, sex, and sings of severity of COVID-19 were studied. In this study, patients were divided into three main groups as follows: group 1 diabetic patients had known DM, group 2 (hyperglycemic group) patients were without past history of DM but were known to have hyperglycemia with COVID-19, and group 3 (control) had normal blood glucose.ResultsA total of 300 patients were divided into diabetic and hyperglycemic groups and were compared with the control group. It was found that diabetic and hyperglycemic groups were significantly associated with severe and critical disease, long hospital stay, increased number of admissions in critical care unit, increased number of patients under mechanical ventilation, and increased mortality rate from COVID-19 compared with the control group.ConclusionsPatients with DM are more liable for severe acute respiratory syndrome coronavirus-2 infection, ICU admission, and increase in the rate of death. In addition, new hyperglycemia, even without history of DM, increased the severity of COVID-19 infection. Special care should be given for diabetic patients. Therefore, glucose monitoring and tight control of blood glucose are essential for all.

Wuchereria bancrofti Infection Causing Pleural Effusion

Presented here is a case of 46-year-old Hindu male with a complaint of progressive shortness of breath, chest discomfort, fever, generalized weakness, and malaise over 6 months. He had a past history of diabetes mellitus (on oral antihyperglycemic agents) and pulmonary tuberculosis, for which he took DOTS category-1 antitubercular treatment for 9 months about 10 years back. On examination, he was febrile with stable vitals; breath sounds diminished over the right side of chest with stony dull percussion note. A provisional diagnosis of right-sided pleural effusion was made, and chest X-ray posteroanterior (PA) view confirmed the same. Diagnostic thoracentesis was done, which showed that the fluid was exudative in nature. The microscopy of centrifuged fluid debris strikingly showed microfilariae of Wuchereria bancrofti. Eosinophils and macrophages were in plenty without any evidence of malignancy or lymphoma. The complete blood count confirmed eosinophil >30% with absolute eosinophil count to be 2400 cells. A diagnosis of filarial pleural effusion was made, and he was started on antihelminthic medication. There was a remarkable improvement in his symptoms over 14 days of starting the therapy. He was maintained on drugs for 6–8 months. There was complete resolution of his effusion and respiratory symptoms.

Prevalence and Risk Factors of Pregnancy Induced Hypertension among Pregnant Mothers Attending Antenatal Care in Wachemo University, Nigist Eleni Mohammed Memorial Comprehensive and Specialized Hospital, Hadiya Zone, Southern Ethiopia: A Cross-Sectional Study

Introduction: The leading cause of maternal and perinatal morbidity and mortality is pregnancy-induced hypertension. In developed countries, it complicates 10% of all births. Pregnancy-induced hypertension kills half a million women per year, mainly in developing countries. The aim of this study was to determine whether antenatal care attendants in Nigist Eleni Mohammed Memorial Comprehensive and Specialized Hospital in Southern Ethiopia had pregnancy-induced hypertension. Methods: A hospital-based cross-sectional study was conducted in Wachemo University Nigist Eleni Mohammed Memorial comprehensive and specialized Hospital from December 30, 2020, to February 2021. Finally, via the systematic random sampling process, the study subjects were chosen from a chart review from June 2019 to May 2020. Bivariate and multivariate analyses were used to identify factors associated with pregnancy-induced hypertension. A P-value less than 0.05 were considered statistically significant. Results: The prevalence of Pregnancy-Induced Hypertension was 23.42% with 95% CI (21.8, 30.5). Age in years 25 to 35; (AOR=6.189; 95%CI; 2.232, 7.164), urban residence (AOR=2.103; 95%CI=1.046, 4.234), primigravida (AOR=2.6; 95%CI=1.642, 2.611), gestational age 20 to 37 weeks (AOR=5.278; 95%CI=1.852, 6.038) and past history of pregnancy induced hypertension (AOR=1.358; 95%CI; 1.756, 4.351) and past history of diabetes mellitus (AOR=7.344; 95%CI=1.344, 9.372)were statistically significant with Pregnancy-Induced Hypertension. Conclusion: In this study the prevalence of pregnancy-induced hypertension was high. Age, urban residence, primigravida, gestational age in weeks, history of pregnancy-induced hypertension, and history of Diabetes Mellitus were statistically significant with Pregnancy Induced Hypertension. To enhance maternal and child health, improving screening, treatment, and prevention strategies for PIH is necessary.

Cardiovascular Disease Risk Factors among Group C Employees in a Tertiary Health Care Centre in Puducherry: A Cross-sectional Study

International Journal of Medicine and Public Health,2020,10,4,147-151.DOI:10.5530/ijmedph.2020.4.32Published:November 2020Type:Original ArticleCardiovascular Disease Risk Factors among Group C Employees in a Tertiary Health Care Centre in Puducherry: A Cross-sectional StudySantosh Kumar, and Sitanshu Sekhar Kar Santosh Kumar1, Sitanshu Sekhar Kar2,* 1Master of Public Health, Department of Preventive and Social Medicine, JIPMER, Puducherry, INDIA. 2Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, INDIA. Abstract:Background: Settings based approach for health promotion at workplaces is surveillance of employees for CVD risk factors, which will help to estimate the prevalence of CVD risk factors and monitor CVD risks among the employees. It was planned to calculate the prevalence of CVD risk factors among group C employees of tertiary care hospital in south India. Materials and Methods: A hospital based cross-sectional survey was conducted among 324 group C employees aged ≥18 years as per the WHO “STEP wise approach to surveillance of non-communicable diseases” (STEPS) methodology. Standardized international protocols were used to measure behavioural risk characteristics (smoking, alcohol consumption, fruit and vegetable consumption, physical activity) and physical characteristics (weight, waist circumference, height and blood pressure). Multivariate analysis was done to know the factors, which carry independent risk of hypertension. Risk factor profiling of the employees was done using WHO/ISH risk prediction chart to estimate the 10 year risk of a fatal or nonfatal major cardiovascular events (myocardial infarction or stroke), according to age, gender, blood pressure, smoking status and presence or absence of self-reported status of diabetes mellitus. Data entry was done using Epi-data version 4.4.2.1. Data cleaning and analysis was done using Statistical Package of Social Sciences (SPSS) version 20. Results: Mean age in years was 34.3 (±8.26) and men contributed 79.3% of study participants. Prevalence of major cardiovascular risk factors was as follows: Current smokers 25.3% men, regular alcohol intake 29.01% between men, overweight (≥23 kg/m2) 26.4%, central obesity 16%, hypertension 13.7% and a past history of diabetes mellitus 15.6%. Almost 3/4th of the participants were following unhealthy diet and living sedentary life style. The relationship between sociodemographic factors and selected risk factors of CVD (tobacco use, alcohol use, unhealthy diet and physical activity) was found significant associated with gender, age, educational status and years of work experience. Around four percent participants had a >10% risk of developing CVD in next 10 years. Conclusion: The prevalence of CVD risk factors is high in the sample population. Employee health and wellness program must be regulated and implemented in the institute, to overcome the burden of cardiovascular diseases. Keywords:cardiovascular disease, Employee, Prevalence, Risk factor profile, Tertiary Health CareView:PDF (153.55 KB)

S1556 Pancreatic Insufficiency in COVID-19

INTRODUCTION: As the 2019 coronavirus (COVID-19) pandemic reached the United States, there remained a paucity of literature on gastrointestinal (GI) manifestations. Severe acute respiratory syndrome coronavirus (SARS-CoV) 2 uses the angiotensin-converting enzyme 2 receptor (ACE2-R) to gain cellular entry into the lower respiratory tract, which is also highly expressed in GI epithelial cells. GI manifestations such as abdominal pain, nausea and diarrhea have now been well established. However, pancreatic injury due to COVID-19 has been scarcely reported. CASE DESCRIPTION/METHODS: A 72 year-old male with past history of diabetes mellitus and hypertension presented with 3 days of fever and dry cough. He was found to have COVID-19 pneumonia and was treated with IV antibiotics and hydroxychloroquine. He subsequently developed acute hypoxic respiratory failure, requiring intubation. Multiorgan failure ensued with mixed septic and cardiogenic shock, and acute renal failure. Strikingly, the patient required increasing amounts of insulin to maintain blood glucose between 140-180 mg/dL. His diabetes was well-controlled with a baseline hemoglobin A1c of 6.6% on admission. Therefore, it was unexpected that he required 70 units of insulin detemir BID (Table 1) in addition to a sliding scale to maintain goal blood glucose. Pancreatic insufficiency was suspected and lipase was trended from normal to a peak of 2,538 unit/L (Table 2). His lipase level and insulin requirement trended down to 7 units daily as he initially improved. Unfortunately, the patient expired due to fulminant viral illness and multiorgan failure. DISCUSSION: In a recent retrospective study from Zhongnan Hospital of Wuhan University in China, 17% of 52 patients with COVID-19 pneumonia had pancreatic injury defined by amylase or lipase abnormality. Only 11% of these patients had abnormal blood sugar levels. Theoretically, COVID-19 infection could cause islet damage due to the high ACE2-R expression in pancreatic islet cells, resulting in pancreatic insufficiency. This was established during the SARS-CoV of 2003 as a mechanism of pancreatic injury. Pancreatic injury in COVID-19 could be secondary to this direct cytopathic effect or due to indirect systemic inflammatory and immune-mediated cellular response to severe SARS-COV-2 infection. We urge clinicians to be aware of a potential subset of patients that may have clinical pancreatic insufficiency as a presenting or concomitant disease entity in COVID-19 infection.Table 1.: Long-acting insulin (units BID) requirement trend.Table 2.: Lipase (unit/L) trend corresponding to long-acting insulin requirement.

Effect of PM2.5 on macrosomia in China: A nationwide prospective cohort study.

Macrosomia is associated with both neonatal complications and adult diseases (obesity, diabetes mellitus, etc.). Previous studies have reported maternal exposure to PM2.5 might influence metabolism and fetal development and cause adverse pregnancy outcomes. Studies conducted in areas with low PM2.5 concentration have found relationship between gestational PM2.5 exposure and birth weight. However, the impact of air pollution on macrosomia has not been studied, especially in highly polluted areas. To evaluate the association between fine particulate matter (PM2.5) exposure during pregnancy and the risk of macrosomia. Data from preconception health examination and prenatal and postnatal records were collected from 1 January 2010 to 31 December 2012 in the National Free Preconception Health Examination Project. Monthly mean of PM2.5 concentration during pregnancy was estimated from satellite data using an ensemble machine learning model. A newborn with birth weight above 4000g was defined as macrosomia. Logistic regression models were used to examine the association between maternal exposure to PM2.5 and the risk of macrosomia, after adjusting for maternal age, pre-pregnancy body mass index, parity, neonatal sex, duration of gestation, seasonality, educational level, smoking and drinking habits, past history of diabetes mellitus and hypertension, and family history of diabetes mellitus. Restricted cubic spline models were used to evaluate the dose-response relationship between the risk of macrosomia and PM2.5 concentration. Of 177841 singleton nonlow birth weight newborns included, 14598 (8.2%) had macrosomia. The mean PM2.5 concentrations were 70.7, 71.5, and 80.9μg/m3 in the first, second, and third trimesters. In full-adjusted logistic regression models, significant associations were found between increased risk of macrosomia and every 10μg/m3 increase of PM2.5 concentration over the first (odds ratio [OR]: 1.045; 95% CI, 1.037-1.052), second (OR: 1.035; 95% CI, 1.028-1.043), and third (OR: 1.033; 95% CI, 1.026-1.039) trimesters. There was a nonlinear does-response association between PM2.5 concentration and the risk of macrosomia. Maternal exposure to PM2.5 during pregnancy was associated with an increased risk of macrosomia in China.

MASSIVE LUNG ABSCESS DUE TO STREPTOCOCCUS INTERMIDIUS IN AN IMMUNOCOMPETENT PATIENT

SESSION TITLE: Monday Fellow Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Streptococcus intermidius (SI) is a gram positive bacterium which is a part of the oral, respiratory, urogenital as well as gastrointestinal flora. We present a case of a massive lung abscess with severe acute respiratory distress syndrome (ARDS) requiring veno-venous extracorporeal membrane oxygenation (V-v ECMO) in an immunocompetent patient. CASE PRESENTATION: A 54-year-old male patient with past history of diabetes mellitus presented with shortness of breath and fever. The patient was found to have tachycardia, tachypnea and low blood pressure. A Chest radiograph showed a large dense appearing mass like lesion in the right lung (Figure 1)and a CT scan was performed. The scan showed a 14 cm lung abscess with dense necrotic material (Figure 2&3). The patient decompensated and required emergent intubation with a bedside drainage of the lung abscess and placement of a chest tube. Cultures on the aspirated material grew Streptococcus Intermidius. The patient was started on antibiotics Cefepime and Metronidazole. The patient developed severe ARDS and required the V-v ECMO. The V-v ECMO was explanted after 6 days. Over the course of his stay, the chest tube continued to drain purulent material with a continued air leak. The patient underwent a right lung decortication by a video assisted thoracoscopic surgery (VATS). Due to the prolonged intubation and a likelihood of failure of weaning a tracheostomy was performed. The patient was discharged to a rehabilitation facility with a month long course of Cefepime and Metronidazole. On a 12 month follow up the patient was doing well and the tracheostomy had been successfully decanulated. DISCUSSION: Streptococcus intermidius is a gram positive bacterium that belongs to the Streptococcus Millieri group (SMG). Streptococcus intermidius is usually associated with infections of the head, neck and respiratory tract and have a tendency to cause abscesses (1). Infections with SI a commoner in individuals with uncontrolled or undiagnosed diabetes, malignancy or intravenous drug use. Individuals with poor oral hygiene and dental caries are also at risk for getting SI infections (2). Multiple sites for infections are reported in literature including brain, lung, liver and head /neck region abscesses. A multiplex polymerase chain reaction (PCR) may aid in early detection of SI, while cultures can take over a week to grow. A study of the antibiotic sensitivities of SMG showed excellent susceptibility to Penicillin, Ampicillin and Ceftriaxone (3). However, penetration of the drugs into the abscess and necrotic material remains poor and surgical drainage and decortication is usually required. CONCLUSIONS: Streptococcus Intermidius is an important cause of empyema, early diagnosis and treatment is imperative to limit significant morbidity and mortality. Reference #1: Reddy S, Singh K, Hughes S. Liver Abscesses Caused by Streptococcus intermedius in an Immunocompromised Patient. Cureus. 2018;10(1):e2107. Published 2018 Jan 24. https://doi.org/10.7759/cureus.2107 Reference #2: Ramhmdani S, Bydon A. Streptococcus intermedius: an unusual cause of spinal epidural abscess. J Spine Surg. 2017;3(2):243-249. Reference #3: Tracy M, Wanahita A, Shuhatovich Y, Goldsmith EA, Clarridge JE, Musher DM. Antibiotic susceptibilities of genetically characterized Streptococcus milleri group strains. Antimicrob Agents Chemother. 2001;45(5):1511-4. DISCLOSURES: No relevant relationships by Yizhak Kupfer, source=Web Response No relevant relationships by Ravikaran Patti, source=Web Response No relevant relationships by Vignesh Ponnusamy, source=Web Response No relevant relationships by Chanaka Seneviratne, source=Web Response No relevant relationships by Ankur Sinha, source=Web Response No relevant relationships by Parita Soni, source=Web Response No relevant relationships by Taek Sang Yoon, source=Web Response

Higher Mortality Rate in Moderate-to-Severe Thoracoabdominal Injury Patients with Admission Hyperglycemia Than Nondiabetic Normoglycemic Patients.

Background: Hyperglycemia at admission is associated with an increase in worse outcomes in trauma patients. However, admission hyperglycemia is not only due to diabetic hyperglycemia (DH), but also stress-induced hyperglycemia (SIH). This study was designed to evaluate the mortality rates between adult moderate-to-severe thoracoabdominal injury patients with admission hyperglycemia as DH or SIH and in patients with nondiabetic normoglycemia (NDN) at a level 1 trauma center. Methods: Patients with a glucose level ≥200 mg/dL upon arrival at the hospital emergency department were diagnosed with admission hyperglycemia. Diabetes mellitus (DM) was diagnosed when patients had an admission glycohemoglobin A1c ≥6.5% or had a past history of DM. Admission hyperglycemia related to DH and SIH was diagnosed in patients with and without DM. Patients who had a thoracoabdominal Abbreviated Injury Scale score <3, a polytrauma, a burn injury and were below 20 years of age were excluded. A total of 52 patients with SIH, 79 patients with DH, and 621 patients with NDN were included from the registered trauma database between 1 January 2009, and 31 December 2018. To reduce the confounding effects of sex, age, comorbidities, and injury severity of patients in assessing the mortality rate, different 1:1 propensity score-matched patient populations were established to assess the impact of admission hyperglycemia (SIH or DH) vs. NDN, as well as SIH vs. DH, on the outcomes. Results: DH was significantly more frequent in older patients (61.4 ± 13.7 vs. 49.8 ± 17.2 years, p < 0.001) and in patients with higher incidences of preexisting hypertension (2.5% vs. 0.3%, p < 0.001) and congestive heart failure (3.8% vs. 1.9%, p = 0.014) than NDN. On the contrary, SIH had a higher injury severity score (median [Q1–Q3], 20 [15–22] vs. 13 [10–18], p < 0.001) than DH. In matched patient populations, patients with either SIH or DH had a significantly higher mortality rate than NDN patients (10.6% vs. 0.0%, p = 0.022, and 5.3% vs. 0.0%, p = 0.043, respectively). However, the mortality rate was insignificantly different between SIH and DH (11.4% vs. 8.6%, odds ratio, 1.4; 95% confidence interval, 0.29–6.66; p = 0.690). Conclusion: This study revealed that admission hyperglycemia in the patients with thoracoabdominal injuries had a higher mortality rate than NDN patients with or without adjusting the differences in patient’s age, sex, comorbidities, and injury severity.

Clinical characteristics and prognosis of polymyositis and dermatomyositis associated with malignancy: a 25-year retrospective study.

The objective of this study was to identify factors predictive of malignancy in patients with polymyositis (PM) and dermatomyositis (DM) in Japan. We conducted a retrospective study of PM and DM patients who were admitted to our hospital between January 1992 and September 2017. Among 134 patients, 29 (21.6%) were diagnosed with cancer in the 3years prior to and 3years after the initial diagnosis of PM or DM. According to multivariate analyses, male sex [odds ratio (OR) = 3.65, p = 0.03], old age (OR = 1.05, p = 0.02), and a past history of diabetes mellitus (OR = 10.4, p = 0.005) were associated with an increased risk of malignancy. The absence of interstitial lung disease (ILD) (OR = 0.25, p = 0.03) was also associated with an increased risk of malignancy. Diabetes mellitus was observed in 28.6% of PM and DM patients with malignancy, but in only 7.3% of those with malignancy. Survival was significantly lower in patients with malignancy than in those without malignancy (p < 0.001). Independent factors associated with malignancies in patients with PM or DM were male sex, old age, the absence of ILD, and, especially, a past history of diabetes mellitus.

Chest Pain Characteristics in Cardiac Syndrome X Compared to Coronary Artery Disease.

AIM:This study aimed to assess if clinical remarks gained by analysis of the present and past medical history of patients undergoing elective coronary angiography (ECA) due to typical chest pain can help to predict the outcome of ECA.MATERIAL AND METHODS:One hundred and fifty-four ECA candidates with a history of typical chest were seen on the same day intended for ECA in the cardiac centre of AlShaab Teaching Hospital, Khartoum, Sudan. The details of the present complaints, characteristics of chest pain, past medical and socioeconomic history were recorded from each subject guided by a questionnaire. ECA confirmed CAD in 112 of the studied patients and were considered as the test group. The remaining patients (N = 42) were diagnosed as CSX after exclusion of significant narrowing of the coronary vessels and were considered as the control group.RESULTS:Univariate analysis of pain characteristics among patients undergoing coronary angiography revealed that pain is less likely to radiate to the neck (OR = 0.44, 95% CI = 0.21 – 0.91, P = 0.027) and the back (OR = 0.48, 95% CI = 0.23 – 1.00, P = 0.049) in patients with CAD. Presence of shortness of breathing and/or dizziness significantly decrease the odds of having abnormal coronary angiography (OR = 0.30 and 0.48, 95% CI = 0.12 – 0.77 and 0.22 – 0.92, P = 0.013 and 0.030 respectively). Past history of diabetes mellitus significantly increases the odds of having abnormal coronary angiography (OR = 3.96, 95% CI = 1.68 – 9.30, P = 0.002). In contrast, past medical history of migraine decreases the odds of having positive finding in ECA (OR = 0.31, 95% CI = 0.13 – 0.72, P = 0.006).CONCLUSION:Characteristics of chest pain are comparable in CAD and CSX. However, pain is less likely to radiate to the neck and/or the back in the first group. Presence of dyspnea and dizziness during angina attacks as well as the history of migraine significantly decreases the odds of having abnormal coronary angiography.

Brevibacterium paucivorans bacteremia: case report and review of the literature

BackgroundBrevibacteria are obligate aerobic gram-positive rods that are associated with milk products and are also found on human skin. Brevibacterium has been reported as a rare cause of catheter related blood steam infection mainly in immunocompromised hosts such as malignancies or AIDS patients.Case presentationA 94-year old woman, which had a past history of diabetes mellitus and chronic heart failure, presented with high fever associated with decreased oral intake and appetite loss and was admitted to our institute. A physical examination at the time of presentation was unremarkable. On day 2, both blood cultures collected on admission became positive with coryneform organism within 24 h without Staphylococci and Brevibacterium species were identified by Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Subsequently, genetic investigation by 16S ribosomal RNA analysis was performed in order to identify the organism. Finally, the result identified this pathogen as Brevibacterium paucivorans with 99.5% homology on the Ez taxon database.The patient was started empirically on meropenem and teicoplanin for broad-spectrum antibiotic coverage. The patient’s fever finally abated and labs were also improved. On day 14, the antibiotic therapy was discontinued. The site of infections was unknown. We hereby report a case of Brevibacterium paicivorans bacteremia in an immunocompetent patient and review cases of Brevibacterium specises bacteremia previously reported. This is the first case of B. paucivorans bacteremia as far as we could search.ConclusionPhysicians and microbiologists should be aware that Brevibacteria are uncommon but important agents which could cause opportunistic infections in immunocompetent.

SUN-LB094 Massive Pericardial Effusion as an Initial Presentation of Hashimoto's Thyroiditis

Background: Pericardial effusion is a known complication of hypothyroidism and usually correlates with the severity and duration of the disease. However, massive pericardial effusion as the primary presenting manifestation of Hashimoto’s thyroiditis is extremely rare. Case: We present a 44-year-old female with a past history of diabetes mellitus who presented to the hospital with complaints of chest pain described as intermittent, sharp, non-radiating, 10/10 intensity ongoing for six days. On physical examination, she appeared lethargic with slow speech, cool dry puffy skin and muffled heart sounds on auscultation. EKG showed sinus rhythm and no significant ST-T wave changes and troponins trended negative. Initial lab-work was significant for a very high TSH of 86.4 (0.35-5.5 uIU/ml) and a low free T4 of 0.54 (0.61-1.12 ng/dl) with a normal free T3 and total T4. CBC, ESR and CRP were within normal limits. The patient did not endorse noticing any of the classical symptoms of hypothyroidism prior to this admission. Chest X-ray and Chest CT were concerning for a large pericardial effusion. Bedside echocardiogram revealed an ejection fraction of 30% and a massive pericardial effusion. No pericardial calcification or thickening was noted. Due to concern for tamponade physiology on echocardiogram, emergent pericardiocentesis was performed and 720 ml of straw-colored fluid was removed. Cardiac catheterization did not show any evidence of coronary artery disease and repeat echo showed trivial pericardial effusion with improvement in ejection fraction to 40-45%. The fluid analysis did not show evidence of mesothelial cells and cultures were negative. Serological markers for viral diseases (Coxsackie virus, EBV, Adenovirus), as well as immunological markers for rheumatoid arthritis (rheumatoid factor) and lupus (double-stranded DNA) were negative. Serum thyroid peroxidase (TPO) antibody was strongly positive: 877 IU/ml (<9IU/ml). Ruling out other common etiologies, pericardial effusion was attributed to severe hypothyroidism. The patient was treated with IV levothyroxine and IV hydrocortisone and her mental status improved over the course of her stay. Conclusion: Hypothyroidism should certainly be considered as a differential diagnosis in patients presenting with unexplained pericardial effusion. The mainstay of treatment for cases with mild to moderate effusions is thyroxine supplementation. Pericardiocentesis is only indicated in patients with massive effusion who are at risk of developing tamponade. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. s presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

Heart remodeling in patients with acute Q-wave myocardial infarction in the presence of left bundle branch block

The prevalence of left bundle branch block (LBBB) in the general population is 0.1–0.8 %, and in patients with ST-segment elevation Q-wave myocardial infarction (Q-MI) varies from 1 % to 15 %. The aim - to evaluate the structural and functional features of the heart in patients with acute Q-wave myocardial infarction in the presence of left bundle branch block. Materials and methods. The study involved 60 patients with Q-MI (40 men and 20 women), who were hospitalized in cardiology department for patients with myocardial infarction treatment of Zaporizhzhіa City Emergency and Urgent Care Clinic. Patients were divided into two groups: 40 patients with Q-MI and the LBBB (the mean age was 71.53 ± 1.23 years), 20 patients with Q-MI without LBBB (the mean age was 65.47 ± 2.25 years). Assessment of intracardiac hemodynamics were performed by echocardiography using a “MyLab50” (“Esaote”,Italy) ultrasound system on the recommendations of the American Society of Echocardiography. Results. Patients with acute Q-MI with LBBB were significantly older than patients who had acute Q-MI without LBBB (9.2 %, P < 0.05). Patients with anterior acute Q-MI prevailed among persons with LBBB (75 %). Thickening of the posterior wall (by 9.6 %; P < 0.05), an increase in LVMMI (by 11.2 %; P < 0.05), an increase in end-diastolic size (by 12.9 %; P < 0.05) and end-systolic size (by 18.6 %; P < 0.05); acceleration of MVE (by 18.3 %; P < 0.05); and an increase systolic pressure in the pulmonary artery (by 23.1 %; P < 0.05) were found in patients with Q-MI with LBBB compared to patients with Q-MI without LBBB. The analysis of contingency table revealed significant association between LBBB presence in patients with Q-MI and diabetes mellitus (χ 2 = 4.53; P < 0.05), female gender (χ 2 = 3.87; P < 0.05) and age over 65 years (χ 2 = 5.71; P < 0.05). In patients with acute Q-MI and LBBB a significant positive correlation between the QRS width and end-diastolic size (+0.49; P < 0.05), end-systolic size (+0.45; P < 0.05), systolic pressure in pulmonary artery (+0.31; P < 0.05) and diastolic size of right ventricle (+0.38; P < 0.05), and a negative correlation between the QRS width and ejection fraction (-0.71; P < 0.05) and IVRT (-0.37; P < 0.05) were noted. Conclusions. LBBB in patients with acute Q-MI is associated with female gender, age over 65 years and past history of diabetes mellitus. Acute Q-MI in the presence of LBBB is characterized by eccentric hypertrophy with an increase in the left ventricular size and pulmonary hypertension. QRS complex duration in patients with acute Q-MI and LBBB is associated with systolic function deterioration, left ventricular dilatation and pulmonary hypertension.

TCTAP C-118 Complications During Rotablator Atherectomy in Heavily Calcified and Tortuous Right Coronary Artery

### Patient Initials or Identifier Number S.F.L. ### Relevant Clinical History and Physical Exam The 78-year-old female with past history of diabetes mellitus and hypertension presented to our emergent department with chest pain and cold sweating. ECG revealed ST-segment depression over lateral

Cross sectional study on prevalence and medication adherence of hypertension and diabetes in a tertiary care hospital in Karimnagar, India

Background: The study aimed to assess the prevalence of Hypertension (HTN), Diabetes mellitus(DM) and other diseases along with comorbid conditions, disease complications and also to assess medication adherence in a tertiary hospital in Karimnagar, Telangana, India.Methods: A Cross sectional study is performed by analysing a total of 500 patient’s individual case safety reports (ICSR). Prevalence of Hypertension and Diabetes along with most prescribed drugs are analysed. Medication adherence is analysed by using Morisky Medication adherence questionnaire scale (MMAS-4).Results: Patients with past history of DM, HTN and other diseases which was found to be 245 (49%) patients. Patients with highest disease prevalence were found to be with HTN (56.73%), DM (31.83%) followed by other diseases like asthma (8.57%), Cerebrovascular accident (4.89%) etc., Total of 66 Patients were ruled out with comorbid diseases. Patients with HTN+DM (47) were found to be highest followed by DM+HTN+CVA (4). MMAS-4 revealed 208 patients were using medication out of 245 patients with previous history. According to MMAS-4 most of the patients were with medium adherence (76). Prevalent drug used for HTN include Amlodipine and for DM Telmisartan+Hydrochlorthiazide.Conclusions: The study revealed that almost half of the admitted patients were with HTN and DM. The patients were counselled properly to adhere strictly to the prescription. Medication adherence to HTN and DM was found to be good in this study. Since the disease complications were also ruled out, the health care professionals are recommended to spread awareness on DM and HTN and disease management in order to control disease and improve health outcomes.