Patients In Non-diabetic Group Research Articles

Assessment of fasting gastric volume using ultrasound in patients undergoing cholecystectomy and other elective surgeries: A prospective observational study

ABSTRACT Background: Prevention of pulmonary aspiration is an important aspect of anaesthesia practice. Strictly following the pre-operative fasting guidelines can pre-empt pulmonary aspiration in most patients undergoing elective surgeries. Ultrasonographic assessment of patients scheduled for laparoscopic cholecystectomy with symptomatic gall bladder disease has shown a higher incidence of a full stomach. Aim: The primary objectives of this study were to assess and compare gastric volume and contents in fasted patients undergoing elective laparoscopic cholecystectomy and other elective surgeries and to evaluate the relationship of fasting gastric volume and contents with other comorbidities and body mass index (BMI). Materials and Methods: On the day of surgery, hours of fasting were noted. Patients scheduled for laparoscopic cholecystectomy were in Group L, and patients scheduled for other surgeries were in Group O. Ultrasonography was performed before induction of anaesthesia in the pre-operative room by an experienced anaesthesiologist. The patients were classified based on the Perlas grading scale. To assess the risk of aspiration, the classification previously established by Ven de Putte and Perlas was used. Sixty patients were included in Group L and 60 patients in Group O. Results: The incidence of a full stomach was 3.33% in Group O and 20% in Group L. There was no significant association between BMI and gastric residual volume (GRV) in this study. There was no significant difference between GRV between diabetic and non-diabetic patients in Group L and Group O. Conclusion: Patients with gall bladder pathologies scheduled for cholecystectomy could have delayed gastric emptying; therefore, anaesthesiologists should be cautious, and bedside assessment tools such as ultrasound, which is easy and non-invasive, should be utilised to stratify the risk of aspiration in such patients.

Blood glucose level affects iodine-123 labeled MIBG uptake in the lung

The aim of this study was to evaluate the correlation of blood glucose and the metaiodobenzylguanidine (MIBG) uptake in lung and compare the difference between the lung uptake of MIBG in diabetic and non-diabetic patients. Patients who underwent iodine-123 MIBG whole-body scan (WBS) in the Department of Nuclear Medicine Seoul National University Hospital between January 2014 and July 2022 were recruited and analyzed. Semi-quantitative analysis of the mean value of lung-to-mediastinum ratio (LMR) was performed. Correlation was analyzed with Pearson correlation test and mean difference was analyzed with independent t-test. There were 36 patients in diabetic group and 57 patients in non-diabetic group with mean age of 56 ± 14.1 and 52 ± 14.6 years, respectively. The mean 24-h LMRs in diabetic and non-diabetic groups were 1.38 ± 0.20 and 1.17 ± 0.14, respectively. Fasting glucose showed a mean value of 136 ± 37.7 and 96 ± 8.2 mg/dL, respectively. There was a significant positive correlation in diabetic (r = 0.397; P = 0.016) and non-diabetic groups (r = 0.579; P <0.001) with significant mean difference (0.21; P <0.001). In conclusion, lung uptake of MIBG is positively correlated with blood sugar level, with diabetic patients displaying higher lung uptake of MIBG compared with non-diabetic patients. In addition, higher lung uptake of MIBG is evident in patients with higher fasting glucose level and even in non-diabetic patients. Thus, in the situations where MIBG therapy is required, the radiation dose to the lungs must be carefully adjusted for patients with high blood sugar level.

EVIDENCE AND FREQUENCY OF NEWLY DIAGNOSED DIABETES MELLITUS IN THE PATIENTS ADMITTED WITH COVID-19 INFECTION

To find out how often individuals with covid-19 infection develop new cases of diabetes mellitus. The study was conducted at Mirpur Azad Jammu and Kashmir Teaching Hospital, Divisional Headquarter of the Department of Medicine, from January 2021 to June 2021. Adult patients between 18 and 70, regardless of gender, who were diagnosed with the virus showing mild to moderate symptoms determined by RT-PCR test and were not previously reported with diabetes met the inclusion criteria. Within 24 hours of admission, 5cc of each patient's blood was drawn and sent for testing to determine the BSF, BSR, and HBA1C levels before commencing steroids. Data obtained were analyzed by using (SPSS) version 24.0. Total 130 patients of covid-19 were included who met the inclusion criteria. Mean age of patients was 39.60+ 9.76 years. There were 108 (83.1%) males and 22 (16.9%) females.Twenty-six patients (20%) were diagnosed with DM during admission. The mean age of patients in non-diabetic group was 39.75+ 9.5 years, while in diabetic group it was 51.38+ 12.74 years which was statistically significant (0.001). 24 (92.3%) patients with newly diagnosed DM had HBA1C levels of more than 6.5 which was statistically significant (0.001).We conclude that newly diagnosed DM significantly relates to covid-19 infection. Elderly patients already in pre-diabetic state with increased HBA1C levels are more prone to develop DM after this viral infection.

Correlation of Post-Operative Outcomes in patients undergoing CABG Receiving Antegradecardioplegia alone Versus Combined Antegrade Plus Retrograde Cardioplegia: A Prospective Review

Aim: To compare the mean ejection fraction and cardiac enzymes level in patients with Ischemic heart disease undergoing elective coronary artery bypass graft surgery (CABG) having antegrade blood cardioplegia versus antegrade plus retrograde Cardioplegia. Study design: Randomized Controlled Trial Place and duration: This study was performed from 7th February, 2020 to 7th August, 2020 at the Cardiac Surgery Department, PIC, Jail Road, Lahore. Methodology: After receiving informed consent, all patients undergoing CABG were enrolled in this study. In order to compare the mean ejection fraction and cardiac enzyme levels between patients who had antegrade blood cardioplegia and those who had antegrade plus retrograde cardioplegia, preoperative, intraoperative, and postoperative characteristics were recorded into the predesigned proforma. Results: The total number of patients 72 was enrolled in this study who were divided into two groups. There were 36(50%) patients of who have given Cardioplegia through antegrade route while CABG and 36(50%) patients who have given Cardioplegia through antegrade plus retrograde route while CABG in this study. According to Table 1, the mean age of the patients in Group A was 51.86±9.35 years, whereas the mean ages of the participants in Group B 52.92±7.70 years. There were 26(72%) male and 10(28%) females in Group A and 30(83%) male and 6(17%) females in Group B. The mean BMI in Group A was 25.65±5.18 and 25.02±3.97 in Group B. There were 35(97%) hypertensive and 1(3%) non hypertensive patients in Group A and B respectively. Similarly, there were 33(92%) diabetic and 3(8%) non diabetic patients in Group A and 28 (78%) diabetic and 8(22%) non diabetic patients were in Group B. There were 26(72%) smokers and 10(28%) non- smokers in Group A and 24 (67%) smokers and 12(33%) non-smokers in this Group B. Practical Implication: The comparison of CKMB(IU/L) levels in Antegrade route group and antegrade plus retrograde group baseline and after 48 hours shows insignificant p-values of 0.17 and 0.12 respectively which shows that there is no significant difference in CKMB levels regarding these two routes chosen for giving Cardioplegia to patients undergoing coronary artery bypass grafting. Conclusion: Although both required additional surgical manoeuvres, however, the antegrade and antegrade plus retrograde cardioplegia approaches were equally effective and safe. Prior research demonstrated that multiple infusions offer superior protection to either antegrade or retrograde cardioplegia alone. Keywords: Coronary artery Bypass grafting surgery, Antegrade route, Retrograde Route, Antegrade plus Retrograde route.

Diabetes or calcium channel blocker contribute to cerebral hemodynamics after bypass surgery in adult patients with moyamoya disease

Moyamoya disease (MMD) is a teratogenic and lethal disease. However, existing studies do not sufficiently indicate the impact factors. Therefore, we investigated the different impact factors on cerebral hemodynamics after revascularization in patients with MMD. We retrospectively collected the clinical data of 233 adult patients with MMD who underwent revascularization surgery in the Department of Neurosurgery, Renmin Hospital of Wuhan University, from January 2015 to June 2021 for this retrospective cohort study. We analyzed the effects on hemodynamic improvement of age, sex, stroke type, early symptoms, Suzuki stage, history of hypertension, history of diabetes, and history of hyperlipidemia in patients with MMD. We also evaluated the efficacy of different revascularization strategies and we verified the effect of computed tomography perfusion (CTP) in evaluating cerebral hemodynamics. The CTP values demonstrated that δ cerebral blood volume (CBV) values were significantly higher in the combined group [1.01 (0.87-1.75)] relative to those in the indirect group [1.34 (1.01-1.63); P=0.027]. There was no statistical significance in the improvement of clinical symptoms and clinical prognosis between the indirect and combined groups. Patients with MMD with diabetes [δ mean transit time (MTT), 0.49 (0.35-0.70) vs. 0.72 (0.52-0.87); P<0.001] or calcium channel blocker (CCB) [δCBV, 1.46 (1.10-1.83) vs. 1.12 (0.93-1.54); P=0.001] had better cerebral hemodynamics than patients in non-diabetic group or non-CCB group after revascularization. We didn't find differences in clinical outcome between indirect and combined revascularization in patients with MMD. we demonstrated that CTP values can be used as a way to detect postoperative cerebral hemodynamic changes in MMD patients. Interestingly, we found that MMD patients with diabetes or CCB showed better cerebral perfusion after revascularization.

Comparison of split skin thickness graft survival in diabetic and non-diabetic ulcer

Background: Split skin grafting is widely used surgical procedure for the treatment of ulcers. Graft survival depends on number of factors like vascularity, wound infection etc, diabetes is associated with endothelial dysfunction, neuropathy, wound infection which collectively affect the graft survival. Objective of this study was to compare the amount of graft uptake, the post-operative complications and survival of split thickness skin graft in diabetic and non-diabetic ulcer.Methods: In our prospective comparative study total 112 patients with ulcer were included of which 56 were diabetic and 56 were non-diabetic. All of t7hem underwent split skin grafting as part of their wound management. Comparison was made between two groups in terms of amount of graft uptake, post-operative wound infection, revisional surgery, donor site infection.Results: Compared with non-diabetics, diabetics have significantly less graft uptake (p&lt;0.001). out of 56 patients in diabetic group 4 (66.7%) underwent revisional surgery, out of 56 patients in non-diabetic group 2 (33.3) patients underwent revisional surgery (p value is &lt;0.68) which is statistically insignificant. 3 (60%) out of 56 in diabetic group developed post-operative graft infection, 2 (40%) out of 56 in non-diabetic group developed graft infection (p=1, not significant). One patient in the study developed donor site infection. Among 112 cases, only 1 case had donor site infection with diabetic.Conclusions: Diabetes is associated with poor graft uptake and post-operative complication rates in patients undergoing split skin grafting.

A Comparative Analysis of Spectrum and Outcome of Common bacterial Infections in Patients with and without Diabetes-a Prospective Hospital Based Study

Objective: In this prospective study we analyzed clinical spectrum of infections and there outcome in patients with diabetes mellitus and compared it with nondiabeticcontrols admitted in Endocrinology division of a tertiary care hospital.Methods: This was a prospective, longitudinal study of 242 diabetic and non-diabetic subjects. Patients were studied in terms of clinical picture, biochemical, hematological and microbiological profile, type and severity of infection, treatment received, and final outcome. There were 142 diabetic patients in group 1 and 100 nondiabetic patients in group 2 served as control. Study subjects were followed for a median period of one year (52 weeks in diabetics, 65 weeks in non-diabetics) after discharge from the ward.Results: Diabetic patients admitted because of infections were older than their non-diabetic counterparts (74% vs 51%&gt; 50 years; p&lt;0.001) and mounted a less inflammatory response in terms of fever and leucocytosis(55% vs 82%:P&lt;0.001).Urinary tract infections were the commonest infections observed among in-hospital diabetic as well as non-diabetic patients (36% vs. 30%; P&gt;0.3). Diabetics contract some specific infections exclusively, like emphysematous pyelonephritis and foot infections, while respiratory infections were more commonly seen in nondiabetic patients (31% vs. 11%; P&lt;0.001).Staphylococcus aureus was the commonest organism involved in soft tissue and diabetic foot infections (32% vs. 19%; P&lt;0.03). Though mean hospital stay was equal in either group it was significantly longer in diabetic subjects when statistically adjusted for APACHE score.Comparative mortality rates were higher in non-diabetics with in-hospital deaths, followup deaths and total deaths of11%, 6.1% and 17.2% vs 4.9%, 4% and 9.1% respectively but re-infections on follow-up occurred more in diabetics (15% vs.2.6%; P=0.005).Conclusion: Poor glycaemic control and less inflammatory response in terms of fever and leucocytosis, longer hospital stay with increased chances of reinfections are poor prognostic indicators for outcomes in diabetic patients admitted with infections. Urinary tract infections and soft tissue infections particularly foot infectionsare causes of concern in our diabetic patients. JMS 2018: 21 (2):84-90

Polymorphism in beta fibrinogen -455 g/a gene was associated with diabetic in severe ischemic stroke patients

There is a association of polymorphism in the promoter region of the beta fibrinogen gene -455 G/A with enhancement plasma fibrinogen level. Diabetes mellitus is a risk factor for early neurologic deterioration in acute ischemic stroke. The prothrombotic fibrinogen protein is frequently elevated in patients with diabetes and may be association with poorer prognosis. This study evaluated the association of beta fibrinogen gene -455 G/A promoter polymorphism on modified Ranking Scale of Ischemic Stroke patients treated with diabetic and nondiabetic group. In a Cohort study design comprises 200 consecutive patients diabetic and a nondiabetic who, three months using completed a detailed outcome stroke. Of 200 samples genotype distribution were 27.1% for GG+GA and 0% for AA with diabetic and than 4.4% for GG+GA and 0.05% diabetic patients. Fibrinogen levels were higher in diabetic than nondiabetic group patients (307.7 + 106.3 vs 278 + 84 gr/dl, p=0.002). Fibrinogen level was found to be an independent predictor for diabetic patients. On Genotype GG+GA were associated wth diabetic and nondiabetic group patients. Modified Rankin Scale on day 90 were found associated with diabetic and nondiabetic patients. Conclusion: Elevated fibrinogen level is dose-dependently associated with 90 days outcome severity stroke with diabetic following ischemic stroke

Clinical characteristics of bacterial liver abscess in patients with type 2 diabetes mellitus

Objective To compare the clinical characteristics and prognosis of bacterial liver abscess in patients with or without type 2 diabetes mellitus, in order to guide clinical diagnosis and treatment. Methods The clinical data of 110 patients with bacterial liver abscess at the First Affiliated Hospital of Anhui Medical University were retrospectively analyzed. Among them, 45 cases with type 2 diabetes mellitus and 65 cases without type 2 diabetes mellitus were included in the study. The demographic data, clinical signs and symptoms, laboratory findings, pathogenic results, imaging findings, treatment and prognosis were compared between the two groups. Differences among the quantitative data with normal distribution were compared using t test, while count data were compared with χ2 test or Fisher exact test. Multivariate Logistic regression was used to determine the prognostic risk factors of two groups. Results Fever as initial symptom in diabetic group and non-diabetic group were 37 cases and 40 cases, respectively, while abdominal pain presented in 7 cases and 22 cases of the two groups, respectively, both with statistically significant difference (χ2=5.417 and 4.582, respectively, both P<0.05). As for laboratory examination, neutrophil counts in the two groups were (12.87±8.83)×109/L and (10.24±4.86)×109/L, respectively, the percentages of neutrophils were 0.841±0.077 and 0.799±0.103, respectively, albumin levels were (28.36±4.65) g/L and (30.67±6.16) g/L, respectively, with statistically significant difference (t=2.010, 2.317 and -2.265, respectively, all P<0.05). Patients with elevated blood urea nitrogen in the two groups were 13 cases and 8 cases, respectively, patients with elevated creatinine were 9 cases and 4 cases, respectively, with statistically significant difference (χ2=4.733 and 4.892, respectively, both P<0.05). In diabetic group, pus culture was positive in 13 out of 19 cases, and blood culture was positive in 7 out of 21 cases. In non-diabetic group, pus culture was positive in 9 out of 13 cases, and blood culture was positive in 6 out of 25 cases. The positive rates of Klebsiella pneumoniae in the two groups were 37.5% (15/40) and 15.8% (6/38) , respectively, with statistically significant difference (χ2=4.669, P=0.031). The effective rates of the two groups with glycemic control were 84.4% (38/45) and 84.6% (55/65), respectively, and the mortality rates of the two groups were 2.2% (1/45) and 1.5% (1/65), respectively. Multivariate Logistic regression showed that multiple abscess (OR=34.61, 95% CI: 1.601-748.457, P=0.024) was prognostic risk factor and invasive intervention (OR=0.028, 95%CI: 0.001-0.984, P=0.049) was protective factor in the diabetes mellitus group. Hypoalbuminemia (OR=14.793, 95% CI: 1.605-136.322, P=0.017) and the history of abdominal surgery within two years (OR=7.624, 95% CI: 1.294-44.913, P=0.025) were prognostic risk factors in the non-diabetic group. Conclusions Patients with bacterial liver abscess showing symptoms of severe infection in diabetic group are more frequently than patients in non-diabetic group. Klebsiella pneumoniae infection rate is also higher in diabetic group. Patients with bacterial liver abscess and diabetes mellitus should receive antibiotic treatment combined with invasive therapy in time. Key words: Bacterial liver abscess; Diabetes mellitus; Clinical characteristics; Therapy; Prognosis

Do standard carotid artery endarterectomy and primary closure technique cause early restenosis in diabetic patients?

IntroductionWe aimed to investigate carotid restenosis in 2-year follow-up in diabetic and nondiabetic patients who underwent standard carotid endarterectomy with primary carotid closure and determine whether diabetes mellitus is a risk factor for early stenosis for this surgical procedure.Material and methodsWe retrospectively assessed the data of patients who underwent standard carotid endarterectomy with primary carotid closure from the hospital registry and outpatient clinic follow-up between January 2006 and January 2012. The study included 25 diabetics and 25 nondiabetics, in total 50 patients. The control carotid Doppler ultrasonographies and/or computed tomography angiographies of the patients at postoperative 1, 6, 12, and 24 months were examined and a stenosis rate between 70% and 99% was regarded as significant carotid restenosis.ResultsWhen the diabetic and nondiabetic group patients were compared for early carotid restenosis at 2 years, there were 3 (12%) patients in the diabetic group and 4 (16%) patients in the nondiabetic group with restenosis. A statistically significant difference in early carotid restenosis was not observed between the two groups (p > 0.05).ConclusionsStandard carotid endarterectomy and primary closure of the artery is a successfully performed surgical procedure in diabetic patients. We concluded that diabetes mellitus is not a risk factor for early restenosis in the diabetic patient population according to the results of our research.

IMPACT OF PREOPERATIVE DIABETES MELLITUS ON MORBIDITY IN PATIENTS UNDERGOING CORONARY ARTERY BYPASS GRAFT SURGERY

Objective: To determine the impact of diabetes mellitus (DM) on morbidity inpatients undergoing coronary artery bypass surgery (CABG). Methodology: This descriptive cross sectional study was conducted at Quaid-e-Azam Medical College/ Bahawal Victoria Hospital Bahawalpur from 1 May, 2014to 31 May 2015.Patients who had undergone coronary artery bypass graftingwere included. Patients operated in emergency and who underwentsimultaneous valvular and congenital heart surgery were excluded. Patients wererandomly divided into 2 groups, Group 1 : diabetics and Group 2: non-diabeticsby computer generating method. In-hospital morbidity was defined as surgicalsite infection, acute kidney injury, Stroke and arrhythmias. P-value 0.05 wastaken as significant. SPSS version 20 was used. Results: About 102 patients of both genders were included. The mean age ofpatents was 59.62±16.15 years. Hypertension was significantly morecommonly found in Diabetics compared to Non Diabetics (78.4% vs. 52.9%).Body Surface Area and pre-operative creatinine were insignificantly associatedwith DM. Acute kidney injury was found in 43.1% patients in diabetic group and in23.5% patients in non-diabetic group. Morbidity i.e. infections 9(17.6%) and thecomposite outcomes i.e. post operative stroke 1 (2%) occurred more commonlyin diabetic patients as narrated by the patient. Conclusion: Patients with DM are at significantly greater risk of seriouspostoperative complication when compared with non-diabetics after coronaryartery bypass graft surgery.

Renal Effects of Coronary Artery Bypass Graft Surgery in Diabetic and Non-Diabetic Patients: A Study with Urinary Neutrophil Gelatinase-Associated Lipocalin and Serum Cystatin C

Background/Aims: Cardiac surgery and diabetes are major causes of acute kidney injury (AKI). We aimed to investigate the value of urinary neutrophil gelatinase-associated lipocalin (NGAL) and serum cystatin C, as early biomarkers for prediction of AKI in diabetic and non-diabetic adult patients undergoing cardiac surgery. Methods: 15 non-diabetic and 15 diabetic adult patients undergoing cardiac surgery were enrolled. Peri-operative clinical and laboratory variables were recorded. Urinary NGAL, serum cystatin C, serum creatinine (Cre) and blood urea nitrogen (BUN) were evaluated. Results: AKI was detected in 4 patients in non-diabetic group and 12 patients in diabetic group. Urinary NGAL levels of diabetic and non-diabetic patients and serum cystatin C levels of diabetic patients exceed upper normal limits or cutoff values much earlier than BUN and Cre. cystatin C levels of non-diabetic patients remain unchanged. Cystatin C and NGAL levels of patients meeting AKI criteria and NGAL levels of patients not meeting AKI criteria exceeded upper normal limits or cut off values much earlier in than BUN and Cre. Conclusions: Measurement of cystatin C level in both diabetic and non-diabetic patients may reveal AKI earlier than NGAL and BUN. In diabetic patients, measurement of urinary NGAL and serum cystatin C levels may indicate AKI signs earlier than BUN and Cre.

Distribution of morbidity in diabetic and non-diabetic patients according to intraoperative blood glucose levels in coronary artery bypass greft surgery: our single-center experience of 267 patients

Background: This study aims to investigate the distribution of morbidity in diabetic and non-diabetic patients who were subjected to conservative glycemic control during coronary artery bypass graft (CABG) surgery and to determine the efficacy of this strategy according to currently recommended target intraoperative blood glucose value. Methods: Between April 2009 and April 2011, consecutive 267 CABG patients who were subjected to intraoperative conservative glycemic control with intermittent boluses of insulin during surgery were retrospectively analyzed. The patients were classified as diabetic (n=118) and non-diabetic (n=149) patients. Then, the patients were divided into three subgroups as intraoperative mean blood glucose (MBG) concentration 180 mg/dL (group 3). All recorded perioperative, intraoperative, and postoperative data were compared between diabetic and non-diabetic patients according to their intraoperative blood glucose levels. Results: Among patients enrolled in the study, 44% were diabetic and 51.7% of diabetics and 11.3% of non-diabetics were in group 3. Of all patients, 29% had an intraoperative MBG of >180 mg/dL. Non-diabetic patients in group 3 had higher lactate levels (p=0.005), renal impairment (p=0.04), and mortality rates (p=0.03), compared to other groups and with diabetic patients in same group. The incidence of infectious events was higher in diabetic patients with MBG >180 mg/dL (p=0.037). A low positive correlation between MBG and lactate levels in non-diabetic patients (r=0.20), and between MBG and the length of stay in the intensive care unit in diabetic patients (r=0.25) was found. Conclusion: Our study results demonstrate that intraoperative conservative glycemic control with intermittent boluses of insulin seems not to be sufficient in diabetic patients. Non-diabetic patients with higher lactate levels, renal impairment and mortality rates also necessitate effective glycemic control. Therefore, simple, safe and effective algorithms should be developed for intraoperative glycemic control.

The Influence of Vitrectomy of Nd:YAG Laser Posterior Capsulotomy

Purpose: This study aimed to investigate factors that cause after-cataract such as diabetes, intravitreal gas injection during vitrectomy, and other factors in relation to the vitrectomy. Methods: The relationship between the vitrectomy and the frequency of Nd:YAG laser posterior capsulotomy was investigated in a sample of 947 monitored patients’ eyes that underwent cataract surgery. The patients’ eyes were classified into Group 1, which comprised 715 patients’ eyes that underwent cataract surgery only, Group 2, which comprised 152 eyes that underwent both vitrectomy and cataract surgery at the same time, and Group 3, which comprised 80 eyes that underwent cataract surgery after vitrectomy. The age, gender, diabetes status, gases injected during the vitrectomy, and other factors were investigated. Results: It was found that 50 eyes (6.99%) in Group 1 received the posterior capsulotomy, 28 eyes (18.4%) had the procedure in Group 2, and 16 eyes (20.00%) had the procedure in Group 3, respectively. In Group 1, 21 eyes (8.86%) that received the posterior capsulotomy were from diabetic patients, 20 eyes (19.8%) were diabetic in Group 2, and 10 eyes (21.73%) were diabetic in Group 3. In Group 1, 29 eyes (6.06%) were from non-diabetics that received posterior capsulotomy, 8 eyes (15.68%) were from non-diabetic patients in Group 2, and 6 eyes (17.64%) were from non-diabetic patients in Group 3. In the group that had vitrectomy with gas injection, 6 eyes (25%) received the posterior capsulotomy in Group 2, and 10 eyes (24.39%) had the procedure in Group 3, respectively, while those in the group that had vitrectomy without gas injection included 22 eyes (17.46%) in Group 2 and 6 eyes (15.38%) in Group 3. Conclusions: The Nd:YAG laser posterior capsulotomy was more frequently applied to patients who underwent vitrectomy, younger patients, diabetes patients, and patients who had vitrectomy with gas injection. J Korean Ophthalmol Soc 2014;55(12):1787-1792

Development of Post-Lung Transplant Gastroesophageal Reflux Disease (GERD) in Diabetic Patients

Purpose: GERD is highly prevalent disease in lung transplant patients. Though there are many suggested hypotheses, clear reasons for this high prevalence are still unknown. There are no studies that have assessed the role of diabetes in development of post-lung transplant GERD. Methods: Medical records were reviewed for all patients currently established at our heart-lung transplant center who have had lung transplantation. Patients who were diagnosed with GERD before transplant were excluded from the study. As per our inclusion criteria 132 patients were enrolled in study. Patients were divided in two groups: diabetics (52%) vs. non-diabetics (48%). Incidence of post-transplant GERD was obtained for both groups. Incidence of other post-transplant GI complications such as colorectal polyp and colorectal complications (bleeding, ischemia, perforation) were also measured between both groups. Results: Among diabetics, 51.47% patients developed GERD post-lung transplant as compared to 31.25% patients in non-diabetic group (p=0.01). In the diabetic group, 17.44% of patients had established diagnosis of gastroparesis as opposed to 11.11% in the non-diabetic group (p=0.22). Colorectal polyp was detected in 48% in the diabetic group as compared to 30% in the non-diabetic group (p=0.19). Other colorectal complications were diagnosed in 32% patients from the diabetic group as compared to 18% in the non-diabetic group (p=0.16).FigureConclusion: Incidence of post-transplant GERD is significantly higher among diabetics. It may offer a risk independent of gastric motility. Though not statistically significant, incidence of colorectal polyps and complications were also higher in diabetics.

The role of diabetes mellitus as a risk factor of acute myocardial infarction

To determine the impact of elevated in-hospital glucose level on outcome of patients with acute myocardial infarction (AMI), and evaluate the role of diabetes mellitus as a risk factor of AMI. The study included a retrospective analysis of AMI patients who were admitted to No. 81 Hospital of PLA from January 2000 to May 2010. In patients without a history of diabetes, and those with fasting blood glucose (FBG)≥7.0 mmol/L at admission but returned to normal range soon after admission were defined as stress hyperglycemia of non-diabetic AMI patients. Both diabetic patients and non-diabetic patients were stratified into four mutually exclusive groups according to FBG levels: <7.0, 7.0-7.9, 8.0-11.0 and ≥11.1 mmol/L. The in-hospital mortality, incidence of complications, and treatment to lower glucose level were analyzed. Logistic regression analysis was conducted on risk factors of outcome of AMI patients. One hundred and fifty-two AMI patients were enrolled with 45 diabetic patients and 107 patients without previous diabetes. In diabetic group patients with FBG≥8.0 mmol/L and those with FBG≥11.1 mmol/L accounted for 73.3% (33 cases) and 46.7% (21 cases), respectively. In non-diabetic group patients with stress hyperglycemia accounted for 43.9% (47 cases), among which patients with FBG levels of 7.011.0 mmol/L accounted for 91.5% (43 cases). Compared with the non-diabetic group, the in-hospital mortality was significantly higher in diabetic group (35.6% vs. 15.9%, P=0.007). In both groups, the in-hospital mortality presented an elevating tendency with an increasing FBG level. Multivariate Logistic regression analysis demonstrated that in diabetic group patients with FBG≥8.0 mmol/L had 12.28-fold higher risk of death than patients with FBG<8.0 mmol/L, and that in non-diabetic group patients with FBG≥7.0 mmol/L had 4.81-fold higher risk of death than patients with FBG<7.0 mmol/L. FBG was an independent risk factor of death with relative odds ratio (OR) 1.03, with 95% confidence interval (95%CI) 1.01-1.16, P=0.012, and OR 1.56, 95%CI 1.09-2.23, P=0.015 in diabetic group and non-diabetic group, respectively. The incidence of congestive heart failure in diabetic group was significantly higher than that in non-diabetic group (40.0% vs. 22.4%, P=0.027). In non-diabetic group, the incidence of lung infection, congestive heart failure, serious arrhythmias and acute cerebrovascular events (51.1%, 34.0%, 27.7%, 14.9%, respectively) was increased significantly in patients with FBG≥7.0 mmol/L than that in patients with FBG<7.0 mmol/L (18.3%, 13.3%, 10.0%, 0, respectively, P<0.05 or P<0.01). This association was not seen in diabetic group. 80.0% of patients (36 cases) in diabetic group received anti-hyperglycemia treatments in which insulin therapy accounted for 63.9% (23 cases), while there was not even 1 patient who needed insulin therapy in non-diabetic patients with stress hyperglycemia. In-hospital mortality and complications were significantly increased in diabetic AMI patients and in non-diabetic AMI patients with stress hyperglycemia. Both a history of diabetes mellitus and stress hyperglycemia have strong influence on AMI prognosis. It seems to be more plausible to collaborate blood glucose level with history of diabetes in considering risk factors in AMI patients.

Effect of recombinant human erythropoietin on insulin resistance in hemodialysis patients

Insulin resistance is a characteristic feature of uremia. Insulin resistance and concomitant hyperinsulinemia are present irrespective of the type of renal disease. Treatment with recombinant human erythropoietin (rHuEPO) was said to be associated with improvement in insulin sensitivity in uremic patients. The aim of this study was to compare insulin resistance in adult uremic hemodialysis (HD) patients including diabetic patients treated with or without rHuEPO. A total of 59 HD patients were studied, patients were divided into 2 groups of subjects: 30 HD patients on regular rHuEPO treatment (group A), and 29 HD patients not receiving rHuEPO (group B) diabetic patients were not excluded. Full medical history and clinical examination, hematological parameters, lipid profile, serum albumin, parathyroid horomone, Kt/V, fasting glucose, and insulin levels were measured in all subjects. Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) was used to compare insulin resistance. The results of this study showed that the mean insulin level of HD patients treated with rHuEPO (group A) (17.5 +/- 10.6 microU/mL) was significantly lower than patients without rHuEPO (group B) (28.8 +/- 7.7 microU/mL), (P<0.001). Homeostasis Model Assessment of Insulin Resistance levels in group A were significantly lower than in group B (3.8 +/- 2.97, 7.98 +/- 4.9, respectively, P<0.001). Insulin resistance reflected by HOMA-IR levels among diabetic patients in group A was significantly lower than among diabetic patients in group B (3.9 +/- 3.2, 9.4 +/- 7.2, respectively, P<0.001). Also, HOMA-IR levels among nondiabetic patients in group A were significantly lower than among nondiabetic patients in group B (3.7 +/- 2.85, 6.9 +/- 1.43, respectively, P<0.01). We found a statistically significant negative correlation between duration of erythropoietin treatment, fasting blood glucose, insulin levels, and insulin resistance (r=-0.62, -0.71, and -0.57, P<0.001). Patients treated with rHuEPO showed less insulin resistance compared with patients not treated with rHuEPO in diabetic and nondiabetic patients and, duration of erythropoietin treatment is negatively correlated with insulin levels and insulin resistance in HD patients.

Comparison of effects of sevoflurane on neuromuscular blockade induced by rocuronium in patients with and without diabetes mellitus

Objective To compare the effects of sevofturane on neuromuscular block induced by rocuronium in the patients with or without diabetes mellitus. Methods Thirty diabetic and 30 non-diabetic ASA Ⅱ patients aged 45-64 yr scheduled for elective middle or lower abdominal surgery were studied. Both diabetic and non-diabetic patients were randomly assigned to one of 2 groups (n = 15 each): propofol group (group P) and sevoflurane group (group S). All patients were anesthetized with midazolam, propofol and fentanyl. After loss of consciousness tracheal intubation was performed after rocuronium 0.6 mg/kg and anesthesia was maintained with iv propofol infusion in group P. In group S tracheal intubation was performed under topical anesthesia with 1% amethacaine injected through cricotbyroid membrane. Anesthesia was maintained with sevoflurane inhalation (end-tidal concentration 1.71 %). Rocuronium 0.6 mg/kg was given iv at 10 min after inhalation of sevoflurane was started. Neuromuscular function was assessed by accelerograpby (TOF-Watch SX, Orgnnon, Holland). TOF stimulation of ulnar nerve was used. The onset time, duration of action and recovery index (for T1 to return from 25% to 75% of the control twitch) were recorded. The T1/T0 and TOF (T4/T1) ratios were recorded at 10, 20, 30, 40, 50, 60, 70, 80, 90, 100, 110 and 120 min after a single bolus of rocuronium. Results There was no significant difference in onset time and duration of action between diabetic and non-diabetic patients in both propofol and sevoflurane groups. The recovery index was significantly higher in diabetic patients than in non-diabetic patients in group S. The recovery index was significantly higher in group S than in group P in diabetic patients. The ratios of T1/T0 and TOF were significantly lower in group S than in group P in diabetic patients during 60-120 min after a single bolus of rocuronium. The TOF ratio was significantly lower in diabetic patients than in non-diabetic patients in group S during 80-120 min after a single bolus of rocuronium. Conclusion The effect of sevoflurane on rocuronium-induced neuromuscular block is enhanced in diabetic patients compared with non-diabetic patients. Key words: Androstanols; Diabetes mellitus; Neuromuscular blockade; Sevoflurane

HOSPITAL OUTCOMES OF ACUTE MYOCARDIAL INFARCTION IN PATIENTS WITH AND WITHOUT DIABETES MELLITUS

Objective: To compare hospital outcomes of acute myocardial infarction (AMI) in patients with andwithout diabetes mellitus.Methodology: This observational cohort study was carried out in the department of Cardiology,Postgraduate Medical Institute Govt. Lady Reading Hospital Peshawar. A total of 444 patients with AMIwere studied from December 2009 to December 2011. Among these half of patients were diabetic whilerests were non-diabetic. After enrolment in the study, patients were monitored for in- hospital complicationsofAMI.Results: Most of the baseline characteristics were similar between the two groups of patients. Howeverpatients in diabetic group had more hypertension, dyslipidemia, high glucose level, less smoking, high heartrate and raised blood pressure on presentation as compared to patients in non-diabetic group. Complicationrates were significantly higher in the diabetic group as compared to non-diabetic group. Complication ratesbetween diabetic and non-diabetic groups were atrial fibrillation (AF) 14.4% V 8.1%; P=0.036 respectivelywhile ventricular tachycardia (VT) 10.8% V 13.1% ;P=0.464, ventricular fibrillation (VF) 3.2% V 4.1 %;P=0.611, advanced AV blocks 12.2%V 6.3% ;P=0.033, acute heart failure (AHF) 24.8% V 17.1% ;P=0.047,cardiogenic shock(CS) 18% V 7.2%;P=0.001, recurrent MI (Re-MI) 14.4% V 7.7%; P=0.000, acute renalfailure 9%V5%; P=0.001 and death rate 13.5 % V 8.1 %; P=0.000 respectively.Conclusion: Diabetes mellitus is associated with an increase risk of in-hospital complications afterAMI.Key words: Diabetes mellitus, hospital Outcomes,Acute Myocardial Infarction