Random Glucose Research Articles

THE CORRELATION BETWEEN TYPE 2 DIABETES MELLITUS WITH BACTERIAL INFECTION IN COVID-19 PATIENTS ADMITTED TO INTENSIVE CARE UNIT AT CENTRAL GENERAL HOSPITAL PROF. DR. I.G.N.G. NGOERAH DENPASAR IN 2021-2022

Type 2 Diabetes Mellitus (T2DM) has a detrimental impact on the immune system, resulting in a decrease in the body's immune response, making patients highly susceptible to bacterial infections. Patients with T2DM, especially those treated in the Intensive Care Unit (ICU) of a hospital, face an increased risk of infection. The emergence of COVID-19, which also infects T2DM patients, further diminishes the immune system's function in these patients. Consequently, individuals with both T2DM and COVID-19 are at a heightened risk of developing secondary infections, commonly referred to as Hospital-Acquired Infections.This research aims to explore the relationship between T2DM, assessed through blood sugar levels, and the occurrence of bacterial infections in COVID-19 patients treated in the ICU of Prof. Dr. I.G.N.G. Ngoerah Central Hospital from 2021 to 2022. The research design employed is quantitative analytical correlational study using a cross-sectional approach, with a sample size of 98 patients collected from the Medical Records and Hospital Management System of Prof. Dr. I.G.N.G. Ngoerah Central Hospital in Denpasar. This study found that there is a significant correlation between patient’s infection profile with random blood glucose levels with an Odds Ratio (OR) of 1.15 (95% CI: 1.04 – 1.27; p = 0.013). Additionally, a significant relationship was observed between the severity of COVID-19 and bacterial infections in patients, with an Odds Ratio of 1.12 (95% CI: 1.01 – 1.26; p = 0.04).
 Keywords : T2DM, ICU, Hospital-Acquired Infection

Diabetic retinopathy screening using MII Ret Cam assisted smartphone-based fundus imaging

BackgroundDiabetes Mellitus is a tremendous health implication and is proposed to be the seventh leading cause of death in 2030 by WHO. Diabetic retinopathy is one of the top complications of diabetes leading to preventable blindness. This investigation highlights the importance of timely screening and counseling using MII Ret cCam-assisted smartphone-based fundus imaging. Our study is a boon for bed-ridden and seriously ill patients who could not be evaluated on a fundus camera. MethodsThis is an observational prospective study conducted at the Ophthalmology unit, wards, and intensive care unit (ICU) of a single tertiary teaching hospital between 1 May to 31 November 2022. A total of 268 subjects with diabetes were included. The fundus of all the diabetic patients during the study period were examined by a single-trained ophthalmologist. Those diagnosed with diabetic retinopathy were taken for acquisition of fundus picture with MII Ret Cam. Images were captured using Apple iPhone 5s and 20D mounted in MII Ret Cam device. ResultsOut of 268 subjects (536 eyes) screened during the study period,86 patients (154 eyes) were found to have DR. Maleto Female ratio was 1.4:1. The mean age was 56.37 ± 15.26 years and the mean duration of diabetes was 10.60 ± 6.97 years. Grading of DR revealed proliferative diabetic retinopathy (PDR) to be the topmost (n=84 eyes, 54.5%), followed by mild non-proliferative diabetic retinopathy (NPDR) in 26 eyes (16%) and moderate NPDR in 24 eyes (15%) while severe NPDR was seen in 10 eyes (6.5%) and very severe NPDR was found in 8 eyes (5.2%) and diabetic papillopathy in 2 eyes. Grading of vitreous hemorrhage revealed Grade 1 in one eye (1.8%); Grade 2 in 19 eyes (34.54%); Grade 3 in 33 eyes (60%) and Grade 4 in 2 eyes (3.63%). Grading of macular edema according to the distribution of hard exudates as Grade 1(No Clinically significant macular edema) in 33 eyes (34.37%) and Grade 2 (Clinically significant macular edema) in 63 eyes (65.62%). The duration of diabetes had a direct association with the occurrence of DR, 13patients (15.1%) had a duration of diabetes less than five years; 31patients(36%) had a duration of diabetes between 6 years to 10 years; 28 patients (32.6%) had a duration between 11 years to 20 years. 14 patients (16.3%) had a duration of more than twenty years. The Mean duration of diabetes in Group I was 11.40+/- 7.09 years and was 9.10+/- 6.48 in Group II. The mean HbA1c in Group I is 7.44+/- 1.24 and 6.54 +/- 1.09 in Group II. The mean fasting blood sugar in Group I was 130.87 +/- 29.57 and 106.62+/- 29.85 in Group II. The mean of random blood sugar was 202.15 +/- 60.84 in Group I and 155.13 +/- 55.95 in Group II. Results are suggestive of the association of DR occurrence with fasting, random blood sugar, duration of diabetes, and HbA1c. ConclusionsDiabetic Retinopathy Screening using MII Ret Cam assisted Smartphone-based fundus imaging may be a useful device to screen for referable and vision-threatening diabetic retinopathy. MII Ret Cam is portable equipment and is easily accessible to counsel patients in resource-limited countries.

Interstitial cystitis – a diagnostic dilemma: A case report

Background: Interstitial cystitis is a debilitating condition with a rising prevalence due to increasedresearch and diagnostic criteria. Interstitial cystitis falls under the category of urologic chronic pelvic painsyndrome and is a diagnosis of exclusion. Interstitial cystitis or bladder pain syndrome (BPS) ischaracterized by chronic inflammation. Common symptoms include chronic pelvic pain, pressure, ordiscomfort perceived to be related to the urinary bladder accompanied by other urinary symptoms, suchas persistent urge to void or urinary frequency in the absence of confusable diseases (hypersensitivebladder symptoms). The true burden of interstitial cystitis is underestimated, and the economic burden ofthe disease is due to multiple office visits and an increase in direct medical costs.Case presentation: A 59-year-old para 2+0 (2 previous scars) postmenopausal with a 1-year history offrequency (up to eight episodes) nocturia with low abdominal pain. Her urinalysis profile, urea,electrolytes and creatinine, and ultrasound and computed tomography of the kidneys, ureters andbladder, pap smear, and random blood sugar tests were unremarkable. Cystoscopy was hemorrhagicwith biopsy histology showing ulcerated bladder mucosa with numerous plasma cells, eosinophils, andneutrophils in the lamina propria no atypia, with fibrosis and dilated capillaries in the lamina propria. Onfollow-up she had a recurrence of pain symptoms with a cystoscopy biopsy, seven months later showingplasma cell infiltrate with ulceration of the overlying urothelium, and congestion of the blood vessels. Shewas not neoplastic and was put on antihistamine, nonsteroidal antiinflammatory drugs, and solifen.Conclusion: Prompt diagnosis and treatment of interstitial cystitis will reduce the burden of diseaseassociated with multiple outpatient visits and unnecessary use of antibiotics. The mainstay ofmanagement is oral and intravesical treatment with surgery in refractory cases.

Arterial involvement of lower limbs in peripheral artery disease - the difference between diabetics and non-diabetics.

To detect peripheral artery disease in diabetic and non-diabetic individuals. The case-control study was conducted from October 2018 to September 2019 at Ruth K.M. Pfau Civil Hospital, Karachi, and comprised diagnosed diabetic patients with random blood sugar ≥200mg/dl in group A, and healthy non-diabetic subjects in group B. Ankle brachial pressure index was measured and mean luminal diameters of lower limb arteries were compared using colour Doppler ultrasonography. Data was analysed using SPSS 21. Of the 82 subjects, 41(50%) were in each of the 2 groups. The sample had 42(51.2%) males and 30(48.8%) females with overall mean age of 53.9±5.07 years (range 44-60 years). There was significant difference in the ankle brachial pressure index values between the groups (p=0.004). There was also a significant difference in the mean luminal diameters of distal arteries (p=0.001), while there was no significant difference in proximal arteries (p>0.05). The diabetics were more prone to developing peripheral arterial disease than nondiabetics.

Assessment of Anti-Inflammatory and Antioxidant Activities of a Proprietary Preparation of Quercetin-Rutin Blend (SophorOx™) in Exercised Rats.

Flavonoids comprise a huge class of phenolic compounds widely distributed throughout the plant kingdom. Although quercetin and rutin have been studied individually for their therapeutic value, the synergistic effect of combining the two has previously not been measured. The objective of this trial was to evaluate the anti-inflammatory and antioxidant properties of both quercetin and rutin when combined in the form of SophorOx™ (a proprietary preparation of quercetin-rutin) in exercised rats. Sprague-Dawley rats were orally administered SophorOx™ at 500 mg·kg-1·b.w. and subjected to daily exercise on a fabricated treadmill for 4 weeks. A total of 24 animals were randomly divided into four groups. All the animals were examined for body weight, feed consumption, signs of clinical abnormalities, and morbidity. In addition, serum collected on days 8, 15, 22, and 29 were measured for the liver function test (LFT), random blood sugar (RBS), inflammatory markers C-reactive protein (CRP), oxidative stress markers (8-isoprostane (8-iso-PGF2α), malondialdehyde (MDA), 8-hydroxydeoxyguanosine (8-OHdG), and cytokine levels interleukin-1β (IL-1β), interleukin 6 (IL-6), and tumor necrosis factor-α (TNF-α)) by the ELISA method. Rats that received SophorOx™ showed no signs of adverse effects, and no significant changes were observed in body weight, feed consumption, liver enzymes, and blood glucose levels. The exercise-treated rats administered with SophorOx™ exhibited a significant reduction in oxidative and inflammatory marker levels, viz., CRP (113.32 ng·mL-1) and oxidative stress markers 8-OHdG (19.32 pg·mL-1), MDA (1.06 nmol·mL-1), 8-iso-PGF2α (1.29 ng·mL-1), IL-1β (0.77 pg·mL-1), and IL-6 (317.14 pg·mL-1) in comparison to those rodents that were exercised without SophorOx™. Oral administration of SophorOx™ significantly reduced oxidative stress and inflammatory marker levels when measured in the rodents subjected to high-intensity exercise.

Type 2 diabetes, glycaemic traits and upper gastrointestinal cancer risk: a prospective cohort study

BackgroundType 2 diabetes (T2D) has been linked with site-specific upper gastrointestinal (UGI) cancers during the past decades, but associations are still inconclusive. This study aimed to determine the association between...

The correlation between the neutrophil-to-lymphocyte ratio and random blood glucose in patients with type 2 diabetes mellitus in Prof. Dr. I G. N. G. Ngoerah Hospital

Background: Diabetes mellitus and complications related to this disease have become a great problem affecting one in eleven adults. Pathophysiologically, this disease occurs due to impaired insulin secretion, resulting from systemic dysfunction in metabolic homeostasis involving inflammatory processes. One marker that can be used to measure such chronic inflammation is the neutrophil-lymphocyte ratio. Therefore, this study aims to evaluate the association between the neutrophil-to-lymphocyte ratio (NLR) with random blood glucose in patients with type 2 diabetes mellitus in Prof. Dr. I G. N. G. Ngoerah Hospital Methods: Our study is a cross-sectional study with secondary data from medical records and involved 155 type 2 diabetes mellitus patients who received inpatient or outpatient care at Prof. Dr. I G. N. G. Ngoerah Hospital in the period of 2021-2022. Results: Our analysis found a significant correlation between the neutrophil-lymphocyte ratio with random blood sugar levels (r = 0.228; p = 0.004). Additionally, the analysis also found a significant difference in random blood sugar level between the normal with the high neutrophil-lymphocyte ratio groups (p = 0.023; median difference = 39.5 mg/dL). Conclusion: It can be inferred that there is a weak and significant correlation between NLR with random blood glucose level in type 2 diabetes mellitus patients.

Self– reported oral health and oral health– related quality of life among patients with diabetes mellitus in a tertiary health facility

BackgroundConsidering the inter-relationship between Diabetes Mellitus (DM) and oral tissues, assessment of oral health status in relation to glycemic control might be informative about the disease condition, which might be pivotal to appropriate management and ultimately improve life satisfaction. This study therefore aimed to assess the pattern of self-reported diabetes related oral conditions and oral health-related quality of life (OHRQoL) among patients with DM at the University College Hospital (UCH), Ibadan, Nigeria.Materials and methodsA cross- sectional study using an interviewer administered questionnaire was conducted among in- and out- patients being managed for DM by the Endocrinology unit of the hospital. Data collected included bio-data, medical history, self-reported oral conditions and dental service utilisation. The impact of oral health related quality of life was measured using OHIP-14. Oral examination was done to assess oral mucosal lesions and their oral hygiene status. Data was analysed using SPSS 21.ResultsEighty-four patients with diabetes consisting 23 (27%) in-patients and 61 (63%) out-patients were enrolled. Males were 26(31%) and females 58(69%); their ages ranged from 22 to 88 years with a mean of 60.9 ± 12.8 years. Most (67%) of the participants had one or more self-reported oral complaints, dryness (20.4%) being the most common and bad breath (4.6%) as the least reported. Poor glycemic level was found to be higher among the in-patients (82%) with random blood glucose > 200 mg/dL during admission, compared to the out-patient participants (51%) who had fasting plasma glucose > 110 mg/dL. Their oral hygiene status was assessed using simplified oral hygiene index and documented as fair (65%), poor (25%) and good (10%). About two-thirds (61%) had ever visited a dentist, majorly due to toothache. Only the pain (21.9%) and physical disability (26.3%) components of OHIP-14 were mainly found to affect the participants’ OHRQOL.ConclusionsThis study found high rate of self- reported DM related oral conditions notably oral dryness, and periodontal diseases particularly as teeth mobility and spontaneous exfoliation. Nonetheless, most of the study participants had fair OHRQoL while its physical pain, functional limitation and psychological disability components were most reported.

Prognostic risk factors of catheter-related bloodstream infection in patients with maintenance hemodialysis

To analyze the pathogen distribution and prognostic risk factors of catheter-related bloodstream infection (CRBSI) in patients with maintenance hemodialysis (MHD) during non-hospitalization. A retrospective comparative study was conducted. Thirty-four patients of MHD with semi-permanent catheter admitted to the department of nephrology of Gansu Provincial Hospital from January 2020 to May 2023 due to CRBSI during non-hospitalization were enrolled. The distribution characteristics of pathogens causing CRBSI in MHD patients during non-hospital period were analyzed. All patients were actively given anti-infection treatment after admission. The general data, laboratory indicators and prognosis during hospitalization were collected through the electronic medical record system. Patients were divided into poor prognosis group (14 cases) and good prognosis group (20 cases) according to the treatment results during hospitalization. Univariate and binary Logistic regression were used to analyze the risk factors affecting the prognosis of patients, and receiver operator characteristic curve (ROC curve) was drawn to evaluate its predictive value for prognosis. A total of 28 pathogenic bacteria were isolated from 34 patients, of which 25 were Gram-positive, Staphylococcus was the most common pathogen, accounting for 82.15% of the total, and 16 strains of Staphylococcus aureus (57.15%), including 6 methicillin-resistant Staphylococcus aureus (MRSA, 21.43%). There were 7 strains of Staphylococcus epidermidis (25.00%), including 3 strains of methicillin-resistant Staphylococcus epidermidis (MRSE, 10.71%). There were 3 strains of Gram-negative bacteria, 1 strain each of Pseudomonas aeruginosa, Escherichia coli and Acinetobacter baumannii. Univariate analysis showed that the fever duration of MHD patients with CRBSI in the poor prognosis group was significantly longer than that in the good prognosis group [days: 8.50 (3.75, 45.00) vs. 2.50 (1.00, 4.75), P < 0.01], serum erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and random blood glucose (GLU) were significantly higher than those in the good prognosis group [ESR (mm/1 h): 82.36±24.98 vs. 56.95±35.65, CRP (mg/L): 123.45±74.10 vs. 67.35±55.22, GLU (mmol/L): 8.74±3.66 vs. 6.42±1.95, all P < 0.05]. Binary Logistic regression analysis showed that serum CRP was an independent risk factor for poor prognosis in MHD patients with CRBSI [odds ratio (OR) = 1.020, 95% confidence interval (95%CI) was 1.002-1.038, P = 0.025]. ROC curve analysis showed that the area under the curve (AUC) of serum CRP in predicting poor prognosis of MHD patients with CRBSI was 0.711; when the optimal cut-off value was 104.65 mg/L, the sensitivity was 64.3% and the specificity was 85.0%, indicating that it has good predictive value. Gram-positive bacteria are the main pathogens of CRBSI in MHD patients during non-hospital period. The poor prognosis is mainly related to the high level of serum CRP. Serum CRP level can effectively screen the high-risk group of MHD patients with CRBSI with poor prognosis.

Clinical care advice for monitoring of islet autoantibody positive individuals with presymptomatic type 1 diabetes.

Type 1 diabetes is an autoimmune disease that involves the development of autoantibodies against pancreatic islet beta-cell antigens, preceding clinical diagnosis by a period of preclinical disease activity. As screening activity to identify autoantibody-positive individuals increases, a rise in presymptomatic type 1 diabetes individuals seeking medical attention is expected. Current guidance on how to monitor these individuals in a safe but minimally invasive way is limited. This article aims to provide clinical guidance for monitoring individuals with presymptomatic type 1 diabetes to reduce the risk of diabetic ketoacidosis (DKA) at diagnosis. Expert consensus was obtained from members of the Fr1da, GPPAD, and INNODIA consortia, three European diabetes research groups. The guidance covers both specialist and primary care follow-up strategies. The guidance outlines recommended monitoring approaches based on age, disease stage and clinical setting. Individuals with presymptomatic type 1 diabetes are best followed up in specialist care. For stage 1, biannual assessments of random plasma glucose and HbA1c are suggested for children, while annual assessments are recommended for adolescents and adults. For stage 2, 3-monthly clinic visits with additional home monitoring are advised. The value of repeat OGTT in stage 1 and the use of continuous glucose monitoring in stage 2 are discussed. Primary care is encouraged to monitor individuals who decline specialist care, following the guidance presented. As type 1 diabetes screening programs become more prevalent, effective monitoring strategies are essential to mitigate the risk of complications such as DKA. This guidance serves as a valuable resource for clinicians, providing practical recommendations tailored to an individual's age and disease stage, both within specialist and primary care settings.

Diyabet Aşikar Olmasa da Komplikasyonları Aşikar Olabilir, Prediyabet Hastalarında Nefropatinin Sıklığı

BACKGROUND/AIMS: Prediabetes is considered a risk factor for diabetes mellitus (DM) and cardiovascular diseases. Complications are also detected during diagnosis in 10-40% of diabetes patients. Diabetic nephropathy is one of the critical microvascular complications of diabetes. Studies have shown that prediabetes is associated with the development of glomerular hyperfiltration and albuminuria, as in the early stages of diabetes. Identifying patients before overt DM occurs is important for early diagnosis and treatment of nephropathy and DM. The aim of our study is to investigate the presence and frequency of nephropathy in prediabetes patients. METHODS: Patients who applied to the outpatient internal medicine and endocrinology outpatient clinics and whose random fasting blood sugar was ≥100 mg/dl were evaluated. Oral glucose tolerance test (OGTT) was performed and HbA1C values were measured. 280 patients diagnosed with prediabetes and evaluated for nephropathy were included in the study. RESULTS: Nephropathy was detected in 81 (28.9%) of the patients. The average HbA1C value of the group with nephropathy was 6.28% (sd: 0.52) and the average HbA1C value of the group without nephropathy was 6.05% (sd: 0.29). The average HbA1C value was found to be significantly higher in the group with nephropathy (p=0.000). CONCLUSIONS: The fact that nephropathy was detected in 28.9% of the patients showed once again the seriousness of prediabetes. Therefore, patients with prediabetes, especially those with higher HbA1C values, need to be evaluated more carefully in terms of nephropathy and CKD.

Performance comparison of stress hyperglycemia ratio for predicting fatal outcomes in patients with thrombolyzed acute ischemic stroke.

The stress hyperglycemia ratio (SHR), a newly developed metric, is used to assess adverse outcomes in patients with acute ischemic stroke (AIS). However, the relationship between SHR and fatal outcomes (in-hospital mortality [IHM], malignant cerebral edema [MCE], symptomatic intracerebral hemorrhage [sICH], 3-month mortality, and poor functional outcome) in AIS patients receiving recombinant tissue plasminogen activator (rt-PA) treatment is unclear, and determining the optimal threshold remains incomplete. We retrospectively enrolled a total of 345 AIS patients treated with rt-PA during 2015-2022 and collected data on various glucose metrics, including different types of SHR, glycemic gap (GG), random plasma glucose (RPG), fasting plasma glucose (FPG), and hemoglobin A1c (HbA1c). SHR and GG were calculated using these equations: SHR1, [FPG]/[HbA1c]; SHR2, [admission RPG]/[HbA1c]; SHR3, FPG/[(1.59 × HbA1c)-2.59]; SHR4, [admission RPG]/[(1.59 × HbA1c)-2.59]; GG, admission RPG - [(1.59 × HbA1c)-2.59]. We used multivariable logistic regression analysis (MVLR) to identify the association between different glucose metrics and outcomes while comparing their predictive values. SHR1 had the greatest predictive power and a more significant correlation with fatal outcomes than other continuous glucose metrics. The area under the curve of the SHR1 for IHM, MCE, and sICH, 3-month mortality, and poor functional outcome were 0.75, 0.77, 0.77, 0.76, and 0.73, respectively. SHR1 (per 1-point increases) was independently associated with IHM (Odds ratios [ORs] = 5.80; 95% CI [1.96, 17.17]; p = 0.001), MCE (ORs = 4.73; 95% CI [1.71, 13.04]; p = 0.003), sICH (ORs = 4.68, 95% CI [1.48-14.82]; p = 0.009), 3-month mortality (ORs = 10.87; 95% CI [3.56, 33.21]; p<0.001), and 3-month poor functional outcome (ORs = 8.05; 95% CI [2.77, 23.39]; p<0.001) after adjustment in MVLR. In subgroup analysis, elevated SHR1 was associated with fatal outcomes in patients with non-diabetes, SBP≥ 180 mmHg, and NIHSS <16. SHR1 demonstrates an independent association with fatal outcomes in AIS patients treated with rt-PA, exhibiting superior predictive ability over other glucose metrics.

Impact of personalized diabetes care on distress and treatment satisfaction in people with breast cancer.

In patients with breast cancer (BCa) and diabetes (DM), diabetes distress (DD) and treatment satisfaction (DTS) can influence BCa management and outcomes. We assessed the impact of implementing a personalized diabetes care model in patients with BCa. Patients in active treatment or surveillance for BCa with an HbA1c > 53 mmol/mol (7%) or random blood glucose >11.1 mmol/L were included. Participants were offered continuous glucose monitoring (CGM), virtual care and a dedicated diabetes provider for 6 months. Primary outcomes included DD measured by the Diabetes Distress Survey (DDS) and DTS measured by the Diabetes Treatment Satisfaction Questionnaire (DTSQ). Questionnaires were conducted at 0, 3 and 6 months. Thirty-one women were enrolled (median age 61, IQR 49.0-69.0). Compared to baseline, the mean DDS score was lower at both 3 months (2.2 vs. 1.8 [n = 27], p = 0.004, SD = 0.70) and 6 months (2.3 vs. 1.8 [n = 23], p = 0.002, SD = 0.70). The mean DTSQ score was higher at 3 months (baseline: 20.5 vs. 3 months: 28.7 [n = 28], p < 0.001, SD = 9.2) and 6 months (baseline: 20.4 vs. 6 months: 30.0 [n = 26], p < 0.001, SD = 9.7). Personalized diabetes care models that emphasize remote management and optimize access for those with BCa may lower DD and improve DTS.

Covid-19 Pneumonia Presenting as a ‘Typical Radiological Bronchopneumonia’ Pattern in Clinical-Radiological-Pathological Phenotype with Transient Hyperglycemia

Radiological phenotypes are radiological patterns or observable characteristics of COVID19 pneumonia. Various phenotypic classifications have been reported in literature. CT severity radiological phenotypes are widely used and universally accepted radiological phenotypic methods. Radiological CT severity phenotypic differentiation has documented very crucial role in initial assessment and during triaging of these cases in indoor and outdoor setting. Typical COVID-19 lung parenchymal involvement described as predominant ground glass opacities (GGOs) and consolidations in peripheral and subpleural portion of any lobe, predominantly involving lower lobes. Atypical Radiological patterns in COVID-19 has been documented as bronchopneumonia, multifocal consolidations, necrotizing pneumonia, cavitations with GGOs with or without consolidations. In present case report, 43-year male, presented with acute febrile respiratory illness with acute hypoxic respiratory failure documented as oxygen saturation of 80% at room air with tachypnea and respiratory distress. HRCT thorax was showing Pleural based, peripheral, central, multifocal patchy, confluent &amp; ill-defined GGOs and consolidations in bilateral lung fields in upper, middle and lower lobes. These typical radiological features suggestive of bronchopneumonia like radiological pattern which was very unusual for typical COVID-19 radiology. His laboratory parameters have shown abnormally raised inflammatory markers like CRP, Ferritin, LDH, D-Dimer and IL-6. Importantly, his random blood sugars were raised with abnormally raised HbA1c levels to label as diabetes mellitus. He was diagnosed with diabetes mellitus this time with COVID-19 illness without use of steroids. He was treated with standardized COVID-19 management institutional protocol with combination of low molecular weight heparin, methylprednisolone, remdesivir, meropenem and teicoplanin. Patient required BIPAP support with higher oxygen requirement with nasals canula for one week due to advanced radiological disease with more anatomical involvement. We have documented successful treatment outcome with use of rational treatment in timely by predicting disease severity with use of composite analysis of clinical, laboratory and radiological markers of illness. Transient hyperglycemia is known to occur and reported after COVID-19 illness due to virus induced inflammatory response and pancreatopathy with beta cell dysfunction. Transient hyperglycemia can be easily managed with insulin during hospitalization and oral anti-diabetic agents after discharge for few weeks. Dietary and lifestyle modification will help in majority with complete reversal of abnormally high sugar levels with restoration of normal HbA1c levels to non-diabetic range.

Review on the screening of urine glucose for early diagnosis of type 2 diabetes mellitus in school children and adolescents with obesity in Hong Kong.

Obesity and type 2 diabetes mellitus (T2DM) are growing health concerns. Since 2005, Student Health Service (SHS) and Hong Kong Paediatric Society formulated a protocol on urine glucose screening (UGS) for early diagnosis of T2DM in students with obesity in Hong Kong. This study reviews students with T2DM captured by this screening program and compare the data with the Hong Kong Children Diabetes Registry (HKCDR) database, to see if the UGS program facilitates early diagnosis of T2DM. Students between the ages of 10-18 years old with age- and sex-specific body mass index (BMI) >97th percentile who attended SHS between the school years from 2005/06 to 2017/18 were recruited for UGS. Those tested positive for random urine glucose underwent diagnostic testing for T2DM according to ADA guidelines. Demographic data and investigatory results from UGS and HKCDR within the same time period were compared. A total of 216,526 students completed UGS in the said period; 415 (0.19 %) students were tested positive for urine glucose of which 121 students were diagnosed with T2DM. UGS picked up 23 % of the newly diagnosed T2DM cases. When compared to the HKCDR database, students diagnosed via UGS were significantly younger, less obese, and had fewer diabetic related complications. The negative predictive value of UGS is high and can effectively rule out T2DM. Urine glucose screening is an inexpensive and simple test that allows for early diagnosis of T2DM among obese school students. Other methods including POCT HbA1c can be explored to improve program effectiveness.

Hyperglycemia in hospital: an independent marker of infection, acute kidney injury & stroke for hospital inpatients.

Hyperglycemia in hospital inpatients without pre-existing diabetes is associated with increased mortality. However, the independent contribution of hyperglycemia to healthcare-associated infection (HAI), acute kidney injury (AKI), and stroke is unclear. To investigate the relationship between hyperglycemia and adverse clinical outcomes in hospital for patients with and without diabetes. Diabetes IN-hospital: Glucose and Outcomes (DINGO) was a 26-week (October 2019 - March 2020) prospective cohort study. Clinical and glucose data were collected up to the 14th day of admission. Primary stratification was by hyperglycemia, defined as ≥2 random capillary blood glucose (BG) measurements ≥11.1 mmol/L (≥200 mg/dL). Propensity weighting for nine clinical characteristics, was performed to allow interrogation of causality. To maintain the positivity assumption, patients with HbA1c > 12.0% were excluded and pre-hospital treatment not adjusted for. The Royal Melbourne Hospital, a quaternary referral hospital in Melbourne, Australia. Admissions with at least two capillary glucose values and length of stay >24 hours were eligible, with half randomly sampled. HAI, AKI, stroke, and mortality. Of 2,558 included admissions, 1,147 (45%) experienced hyperglycemia in hospital. Following propensity-weighting and adjustment, hyperglycemia in hospital was found to, independently of nine covariables, contribute an increased risk of in-hospital HAI (130 [11.3%] vs.100 [7.1%], adjusted odds ratio [aOR] 1.03, 95% confidence interval [95%CI] 1.01-1.05, p = 0.003), AKI (120 [10.5%] vs. 59 [4.2%], aOR 1.07, 95%CI 1.05-1.09, p < 0.001), and stroke (10 [0.9%] vs. 1 [0.1%], aOR 1.05, 95%CI 1.04-1.06, p < 0.001). In hospital inpatients (HbA1c ≤ 12.0%), irrespective of diabetes status and pre-hospital glycaemia, hyperglycemia increases the risk of in-hospital HAI, AKI, and stroke compared with those not experiencing hyperglycemia.

Development and validation of outcome prediction model for reperfusion therapy in acute ischemic stroke using nomogram and machine learning.

To develop logistic regression nomogram and machine learning (ML)-based models to predict 3-month unfavorable functional outcome for acute ischemic stroke (AIS) patients undergoing reperfusion therapy. Patients undergoing reperfusion therapy (intravenous thrombolysis and/or endovascular treatment) were prospectively recruited. Unfavorable outcome was defined as 3-month modified Rankin Scale (mRS) score 3-6. The independent risk factors associated with unfavorable outcome were obtained by regression analysis and included in the prediction model. The performance of nomogram was assessed by the area under the curve (AUC), calibration curve, and decision curve analysis (DCA). ML models were compared with nomogram using AUC; the generalizability of all models was ascertained in an external cohort. A total of 505 patients were enrolled, with 256 in the model construction, and 249 in the external validation. Five variables were identified as prognostic factors: baseline NIHSS, D-dimer level, random blood glucose (RBG), blood urea nitrogen (BUN), and systolic blood pressure (SBP) before reperfusion. The AUC values of nomogram were 0.865, 0.818, and 0.779 in the training set, test set, and external validation, respectively. The calibration curve and DCA indicated appreciable reliability and good net benefits. The best three ML models were extra trees (ET), CatBoost, and random forest (RF) models; all of them showed favorable discrimination in the training cohort, and confirmed in the test and external sets. Baseline NIHSS, D-dimer, RBG, BUN, and SBP before reperfusion were independent predictors for 3-month unfavorable outcome after reperfusion therapy in AIS patients. Both nomogram and ML models showed good discrimination and generalizability.

Changes in biochemical profiles of children with severe acute malnutrition on admission and after nutritional rehabilitation

Purpose: The given study was done to find out the changes in biochemical profiles before and after nutritional rehabilitation of the children admitted at the Department of Paediatrics, Assam Medical College with severe acute malnutrition (SAM). Materials and Methods: A hospital based observational study was conducted from May 2020 to April 2021 with 55 consecutive cases of SAM. Vitros System 5600 was used for analysis of 13 biochemical parameters. Results: The mean values of serum sodium, potassium, and chloride at admission were 134.59±19.37 mEq/L, 4.22±0.80 mEq/L, and 101.12±16.36 mEq/L and that after rehabilitation were 136.66±19.95 mEq/L, 4.42±0.68 mEq/L, and 103.97±4.83 mEq/L. While that for magnesium, calcium, and phosphorous on admission were 2.11±0.38 mg/dL, 8.70±1.00 mg/dL, and 4.33±1.23 mg/dL and that after rehabilitation were 2.10±0.29 mg/dL, 9.45±0.65 mg/dL, and 4.76±0.84 mg/dL, respectively. The mean values of serum total protein, albumin, globulin, and A: G on admission were 6.53±1.44 g/dL, 3.30±0.88 g/dL, 3.23±0.87 g/dL, and 1.06±0.33, respectively, and that after rehabilitation were 6.84±0.98 g/dL, 3.86±0.57 g/dL, 2.98±0.69 g/dL, and 1.34±0.28, respectively. The mean of urea and creatinine on admission were found to be 26.25±19.30 mg/dL and 0.34±0.24 mg/dL, respectively, and that after rehabilitation were 23.91±11.76 mg/dL and 0.31±0.15 mg/dL respectively. Random blood sugar (RBS) on admission was 85.20±17.88 mg/dL and that after rehabilitation was 94.18±14.82 mg/dL. After rehabilitation, the mean value of calcium, phosphorous, albumin, A: G, and RBS were significantly raised. The minimum duration required for rehabilitation was 12 days with prevalence being maximum among the Tea-tribes (80.00%). Conclusion: The biochemical derangements in a patient with SAM are associated with significant morbidity and get improved after nutritional rehabilitation.

The Association of the Neutrophil-Lymphocyte Ratio With Diabetes Mellitus and Diabetic Foot Ulcer: A Review Article

Introduction: Diabetes mellitus (DM) is inappropriately elevated blood glucose levels. Diabetic foot ulcer (DFU) is the most common complication of diabetes mellitus. Many research studies was found that neutrophil lymphocyte ratio (NLR) have positive correlation with HBA1C, blood glucose, and outcome of diabetic foot ulcer. Methods: The literature searches using online databases such as PubMed, ScienceDirect Elsevier, and Google Schoolar. Result: After doing an online search, we found 39 articles were relevant for this review topic. Analysis: Many research studies have found increased HbA1C (≥6,5) and increased blood glucose (random blood glucose ≥ 200mg/dL and/or fasting blood glucose ≥126 mg/dL) in patients with diabetes mellitus have a positive correlation with increased NLR. And there was increased NLR values in patients with diabetic foot ulcer and NLR values was higher (NLR≥6) in non-healing ulcers than in healing ulcers. Conclusion: NLR can be used as screening tool for determining evaluation of diabetes mellitus and as screening tool for determining outcome of diabetic foot ulcers.

Social isolation, loneliness, and the risk of incident type 2 diabetes mellitus by glycemic status

AimThe modifying effect of prediabetic status on the association of social isolation and loneliness with the risk of type 2 diabetes mellitus (T2DM) remains uncertain. We aimed to explore whether prediabetic status modifies the association of social isolation and loneliness with incident T2DM. Methods358,951 participants with random blood glucose < 11.1 mmol/l, hemoglobin A1c < 6.5 % and without diagnosis of diabetes from the UK Biobank were included. Prediabetes was defined by hemoglobin A1c level at 5.7–6.4 %. Social isolation and loneliness were assessed using self-reported questionnaires. The study outcome was incident T2DM. ResultsDuring a median follow-up of 12.5 years, 13,213 (3.7 %) incident T2DM cases were documented. Social isolation and loneliness in subjects with normoglycemia (adjusted HR [95 %CI]: social isolation: 1.14 [1.07;1.23]; loneliness: 1.33 [1.20;1.47]) were more strongly associated with increased risk of T2DM than in those with prediabetes (adjusted HR [95 %CI]: social isolation: 0.97 [0.91;1.03]; loneliness: 1.04 [0.95;1.13]) (Both P for interaction < 0.001). Among individuals with prediabetes, alcoholic consumption (30.9 %), household income (23.3 %), healthy sleep (17.1 %), loneliness (14.9 %), and physical activity (12.6 %) mediated most of the variance in the association between social isolation and incident T2DM, while body mass index (17.9 %) and healthy sleep (17.6 %) mediated most of the variance in the association between loneliness and incident T2DM. ConclusionSocial isolation and loneliness were independently associated with a higher risk of T2DM among individuals without prediabetes. Among those with prediabetes, the association of social isolation and loneliness with incident T2DM were mainly mediated by some socioeconomic and lifestyle factors.