Random Plasma Glucose Levels Research Articles

PROGNOSTIC SIGNIFICANCE OF GLYCAEMIC STATUS AND ELECTROCARDIOGRAPHIC CHANGES IN ORGANOPHOSPHOROUS POISONING AND ITS SEVERITY USING PERADENIYA SCORE

OBJECTIVE: To correlate the documented Random Plasma glucose level and ECG ndings with the severity in Acute Organophosphorus poisoning. METHOD: A prospective observational study of 80 patients with alleged history of OP poisoning within 24 hours and fullling inclusion and exclusion criteria in MLN Medical College, Prayagraj from Jan 2019 to March 2020 irrespective of age and sex were included. The glycemic status, ECG ndings at the time of presentation was documented and same was correlated with severity using Peradeniya score and relevant statistics. RESULT:In present study, 16.7% of hypoglycemics and 10.3% of hyperglycemics had severe grade of poisoning based on POP scoring while none of the euglycemic had severe grade of poisoning and this was statistically signicant. Prolonged QT interval was the most common nding seen in 59 (73.8%) subjects. CONCLUSION: ECG can be used as a simple and effective method in predicting mortality and morbidity. RPG at admission in acute OPpoisoning patients is a simple, inexpensive tool that may help to predict the clinical outcome.

Hyperglycemia in Childhood Acute Lymphoblastic Leukemia during Induction Chemotherapy

Introduction: Hyperglycemia is a well-known adverse effect of the corticosteroids and asparaginase given during induction chemotherapy for pediatric acute lymphoblastic leukemia (ALL). ALL is a type of hematologic malignancy with high incidence in the childhood. The aim of this study is to investigate the impact of hyperglycemia during induction chemotherapy in childhood ALL. Methods: This prospective study was done in Dr. Soetomo hospital from January to April 2018. The subject was newly diagnosed as ALL under the age of 18 years, treated with Indonesian childhood ALL 2013 protocol (standard risk (SR) group and high risk (HR) group). Hyperglycemia was defined as at least two separate random plasma glucose levels >200 mg/dL, which was evaluated before and during induction chemotherapy. Statistical analysis using Paired T-test for parametric and Wilcoxon test for nonparametric. Results: Thirty-three children were enrolled, 18/33 boys with mean age 5.8 (SD 3.78) years, compromised as ALL-L1 30/33. They were treated with ALL-HR 19/33 and ALL-SR 14/33. In overall groups, the mean random blood glucose level significantly increased from 108 (SD 21.3) mg/dl to 147 (SD 48.1) mg/dl, (mean difference 38.67 mg/dl; 95% CI 18.08 to 59.26 mg/dl, p=0.008). In SR group, there was a significant increase of mean random blood glucose level from 102 (SD 13.5) mg/dl to 133 (SD 37.3) mg/dl, (mean difference 31.8 mg/dl; 95% CI 8.78 to 54.8 mg/dl; p=0.01). In HR group, the mean random blood glucose level increased from 113 (SD 51.9) mg/dl to 165 (SD 25.4) mg/dl, (mean difference 51.9 mg/dl; 95% CI 18.6 to 85.2 mg/dl, p=0.004). Conclusion: Blood glucose level is significantly increase during induction chemotherapy in both SR and HR Indonesian childhood ALL 2013 protocol.

Predicting 72-h mortality in patients with extremely high random plasma glucose levels: A case-controlled cross-sectional study.

The risk factors associated with 72-hours mortality in patients with extremely high levels of random plasma glucose (RPG) remain unclear.To explore the risk factors predictive of 72-hours mortality in patients with extremely high RPG under heterogenos pathophysiological conditions.Retrospective, single-center, case-controlled cross-sectional study.University teaching hospital.Adults over age 18 were selected from the medical records of patients at the Saitama Medical Center, Japan, from 2004 to 2013.Extremely high RPG (≥500 mg/dl).Mortality at 72 hours following the RPG test, regardless of hospitalization or in an outpatient setting. Multivariate logistic regression analysis was performed with adjustment for age, sex, body mass index (BMI), and RPG level. The final prediction model was built using the logistic regression model with a higher C-statistic, specificity, and sensitivity.A total of 351 patients with RPG ≥500 mg/dl were identified within the 10-year period. The 72-hours mortality rate was 16/351 (4.6%). The C-statistics of the 72-hours mortality prediction model with serum albumin (ALB) and creatine kinase (CK) was 0.856. The probability of 72-hours mortality was calculated as follows: 1/[1 + exp (−5.142 + 0.901log (CK) −1.087 (ALB) + 0.293 (presence (1) or absence (0) of metastatic solid tumor)]. The sensitivity and specificity of this model was 75.5%.The independent risk factors associated with 72-hours mortality in patients with RPG ≥500 mg/dl are hypoalbuminemia, elevated CK, and presence of a metastatic solid tumour. Further research is needed to understand the mechanisms and possible interventions to prevent mortality associated with extremely high RPG.

Hyperglicemia in Childhood Acute Lymphoblastic Leukemia During Induction Chemotherapy

Background: Hyperglycemia is a recognized side effect of the corticosteroids and asparaginase givenduring induction chemotherapy for pediatric acute lymphoblastic leukemia (ALL). The ALL is the malignanttumor with the highest incidence in the childhood. The aim of this study is to investigate the impact ofhyperglycemia during induction chemoteraphy in childhood ALL.Methods: This prospective study was done in Dr. Soetomo hospital from January to April 2018. The subjectwas newly diagnosed as ALL under the age of 18 years, treated with Indonesian childhood ALL 2013protocol (Standard Risk (SR) group and High Risk (HR) group). Hyperglycemia was defined as at leasttwo separate random plasma glucose levels > 200 mg/dL, which was evaluated before and during inductionchemotherapy. Statistical analysis using Paired T-test for parametric and Wilcoxon Test for nonparametric.Results: Thirty-three children were enrolled, 18/33 boys with mean age 5.8 (SD 3.78) years, compromisedas ALL-L1 30/33. They were treated with ALL-HR 19/33 and ALL-SR 14/33. In overall groups, the meanrandom blood glucose level significantly increased from 108 (SD 21.3) mg/dL to 147 (SD 48.1) mg/dL,(mean difference 38.67 mg/dL; 95% CI 18.08 to 59.26 mg/dL, P=0.008). In SR group, there was a significantincreased of mean random blood glucose level from 102 (SD 13.5) mg/dL to 133 (SD 37.3) mg/dL, (meandifference 31.8 mg/dL; 95% CI 8.78 to 54.8 mg/dL; P=0.01). In HR group, the mean random blood glucoselevel increased from 113 (SD 51.9) mg/dL to 165 (SD 25.4) mg/dL, (mean difference 51.9 mg/dL; 95% CI18.6 to 85.2 mg/dL, P=0.004).Conclusion: Blood glucose level is significantly increase during induction chemotherapy in both SR and HR Indonesian childhood ALL 2013 protocol.

Menopausal status and metabolic syndrome among women with cardiovascular diseases

Background: There are currently no reports showing the relationship between metabolic syndrome (MetS) and menopause among Bangladeshi women with cardiovascular disease (CVD). Aim: The present study aims to examine the prevalence of MetS and evaluate the impact of menopausal status on the MetS among women with CVD in Bangladesh. Materials and Methods: Data for the present analysis were collected from a cross-sectional study of 355 cardiovascular patients seeking care at five tertiary care hospitals in Bangladesh. A total of 146 women were included for this secondary analysis. The MetS was identified based on the definition of the Adult Treatment Panel (ATP) III of the National Cholesterol Education Program (NCEP). Results: About 45.83% pre-menopausal and 59.02% post-menopausal women were noticed to have MetS. The mean waist circumference, systolic, and diastolic blood pressure, total cholesterol, LDL cholesterol, triglyceride, and random plasma glucose levels were higher in post-menopausal women whereas HDL cholesterol value was higher in pre-menopausal women. The multivariate-adjusted odds ratio showed that post-menopausal status (Adjusted odds ratio [AOR]: 1.72; 95% confidence interval [CI]: 1.04-4.94) and obesity (AOR: 8.20; 95% CI: 1.15-58.77) were significantly associated with the presence of the MetS among women with CVD. Conclusion: The high prevalence of MetS among women with CVD is evident, particularly post-menopausal women. Hence, the present findings can alert women from the earlier stages of the menopausal transition to prevent the appearance of MetS.

RISK FACTORS OF PULMONARY TUBERCULOSIS AMONG DIABETES MELLITUS PATIENTS: A CASE-CONTROL STUDY IN DR. KARIADI GENERAL HOSPITAL, SEMARANG, INDONESIA

Diabetes mellitus (DM) is a well-known risk factor for tuberculosis (TB). Prevalence of TB among DM patients ranged from 1.7 % to 36 %. Limited information has been reported regarding TB among DM patients in Indonesia. This case-control study aimed to investigate prevalence and related factors of pulmonary TB among DM patients in Dr. Kariadi General Hospital. Cases of pulmonary TB were defined by a positive acid-fast bacilli smear or molecular rapid test and thorax x-ray. Data were presented as frequency and percentage comparing the case and control group. Chi-square continued by Binary logistic regression analyses were done to determine the relationship between the parameters and TB status performed by the SPSS 16. Prevalence of 8.02% or 72 patients were diagnosed as having pulmonary TB from 898 registered patients with DM. Of the 72 TB patients, 30 completed the data as case group, and 45 DM patients without TB determined as a control group. Comparison between the case and control group study found differences in household contact (63.3 % and 4.4 %, respectively), random plasma glucose (76.7 % and 33.3 %), duration of DM (40 % and 71 %), and treatment compliance (30 % and 68.9 %). The final model in Binary logistic regression involved household contact, random plasma glucose level, and treatment compliance. The prevalence of pulmonary TB among DM patients in Dr. Kariadi General Hospital was 8.02%. Risk factors that were associated with this occurrence were: household contact, high random plasma glucose level, and poor treatment compliance.

PROFILE OF DIABETIC KETOACIDOSIS PATIENTS AT REGIONAL PUBLIC HOSPITAL DR. SOETOMO IN 2017

Background: Diabetic ketoacidosis (DKA) is one of many life-threatening complications of diabetes mellitus (DM), which is characterized by severe hyperglycemia, metabolic acidosis and ketonemia. This complication can eventually lead to coma and death if not treated properly. Purpose: The aim of this study is to describe the profile of the DKA patients who were at Regional Public Hospital (RSUD) Dr. Soetomo in 2017. Methods: This study was a descriptive study that used the medical record data of DKA patients who were at RSUD Dr. Soetomo in 2017. The study’s total sample size was 63 patients. The study’s variables were gender, age, type of DM, severity of DKA, precipitating factors, main complaints, vital signs, random plasma glucose level, electrolyte level, and blood gas analysis. The frequency, mean, and standard deviation were analyzed. Results: Most of the 63 DKA patients were female (66.67%), aged from 50–59 years (38.10%). The DKA cases being handled by the Dr. Soetomo Hospital were overwhelmingly of type 2 DM patients (88.89%). More than half the patients (58.73%) experienced severe DKA. Altered states of consciousness (46.03%) and shortness of breath (26.98%) were the most common main complains made by the DKA patients. Almost all patients experienced infection (88.89%) as the precipitating factor; the most common infections were sepsis (92.86%), pneumonia (30.36%), and urinary tract infections (23.21%). Two thirds of the patients (66.67%) had a length of stay of 0–7 days. About 57.14% of the DKA patients died while undergoing treatment. Conclusion: The number of severe DKA patients and the mortality rate in our study were higher than in other studies. Females and the elderly were more prone to DKA, and the most common precipitating factor was infection.

Acute leukoencephalopathy in an adult

A 35-year-old unmarried man living alone was brought to the emergency department with acute abdominal pain mainly in the epigastric region. He could not provide any detailed history regarding his...

1447-P: Random Glucose May Be an Effective Tool to Screen for Undiagnosed Diabetes: The Africans in America Study

The high prevalence of undiagnosed diabetes (DM) in Africa calls for the identification of effective, efficient, and feasible screening tests. Emerging data suggests that random plasma glucose≥100 mg/dL (RPG≥100) may be a valuable screening tool and equivalent to or better than standard ADA criteria, which requires fasting blood samples, knowledge of family history, anthropometrics and blood pressure. Since RPG≥100 as a screening tool for DM has not been tested in Africans, our goals were twofold: first, to compare the diagnostic performance of RPG≥100 to ADA criteria; second, to determine for RPG≥100 the number needed to screen to find a single case of DM. Hence, African-born blacks who self-identified as healthy and were living in America (n=469, 66% male, age: 38±10y (mean±SD), BMI: 27.6±4.5 kg/m2) had random plasma glucose levels measured. One week later, an OGTT was performed. Glucose criteria for the OGTT was used to diagnose DM. Area under the receiver operating characteristic curve (AROC) was used to assess the performance of RPG≥100 and ADA criteria (age≥45y, BMI≥25 kg/m2, HDL<35mg/dL, TG>250mg/dL, SBP≥140mmHg, DBP≥90mmHg, and family history of DM). The number of people needed to screen to correctly identify one case of undiagnosed DM was calculated by the formula: 1/(proportion correctly diagnosed - proportion incorrectly diagnosed). DM was identified in 7% (31/469) of the participants; whereas RPG≥100 occurred in 15% (68/469). For the prediction of DM, RPG≥100 tended to be superior to the ADA criteria (AROC 0.80 vs. 0.68, P=0.09). RPG≥100 was 71% sensitive and 89% specific. ADA criteria was 90% sensitive and 37% specific. For RPG≥100, the number needed to screen to correctly identify a single case of DM was two. Overall, RPG≥100 as a screening tool for DM is effective, more cost-efficient, and less time-consuming than ADA criteria. In short, RPG≥100 may be an important way forward for the detection of DM in Africans and further study is warranted. Disclosure E.M. Shoup: None. N.H. Osei-Tutu: None. T. Hormenu: None. A.F. Hobabagabo: None. C. DuBose: None. L. Mabundo: None. S.T. Chung: None. M.F. Horlyck-Romanovsky: None. A.E. Sumner: None.

MON-062 46 XX DSD Due to POR Deficiency

BackgroundPORD (P450 oxidoreductase deficiency) is a rare form of CAH with marked phenotypic variations due to differences in the degree of steroid hormone excess/deficiency. PORD results in17αhydroxylase/17,20lyase- CYP17, 21αhydroxylase- CYP21, and aromatase- CYP19A1 inhibition. In the absence of characteristic skeletal features of Antley Bixler phenotype, differentiating PORD from other types of CAH is challenging.Case details04 day child, second of the non-identical twins, product of 2nd degree consanguinity, third in birth order was brought with abnormal genitalia. The other male twin had no genital ambiguity but had pigmented scrotum. There was no adrenal crisis in index case or maternal virilization. First child is normal female. Child was hemodynamically stable weighed 02 kgs and measured 51 cms, had no hyperpigmentation, skeletal deformities or dysmorphic features. Phallus was 10mm, clitoral index 40mm2 with single urogenital opening and posteriorly fused labia (anogenital ratio 0.6).Gonads were not palpable. Karyotype was 46XX with normal Mullerian structures and non-visualized gonads on ultrasonography. Biochemical workup showed random plasma glucose level of 99mg/dl and normal electrolytes. Baseline serum 8am Cortisol was 1.15 mcg/dl (normal 5-18 mcg/dl) and 17OHP was 20 ng/ml (normal < 02 ng/ml). Serum Androstenedione level was 0.39 nmol/L (normal 0.5-3.4 nmol/L).In view of clinical, laboratory and imaging findings, presumptive diagnosis of 46 XX DSD due to 21 alpha hydroxylase deficiency CAH was made. Oral Hydrocortisone 15mg/m2 and Fludrocortisone 0.05 mg were initiated. Therapy was monitored with serum 17(OH)P levels and Androstenedione. Genetic testing for 21 alpha hydroxylase gene however came negative.This led to further genetic mutational analysis, and there was a homozygous R457H POR gene mutation at exon 12 leading to protein change p.Arg457His (nucleotide change c.1370G>A), confirming PORD. Retrospectively, maternal triple test done during the candidate pregnancy showed low serum estriol, suggestive of placental aromatase deficiency. Mineralocorticoid supplements were stopped thereafter. Conclusions PORD needs to be considered and differentiated from garden variety of CAH in 46 XX DSD when elevation of 17(OH)P is modest with isolated cortisol deficiency and aromatase deficiency (evidenced by low maternal estriol levels and/or virilization), as its course and follow up are different.

MEAN PLASMA GLUCOSE LEVEL - A SURROGATE MARKER TO GLYCATED HAEMOGLOBIN LEVEL FOR ASSESSMENT OF GLYCAEMIC CONTROL

The purpose of present study was to find out a suitable alternative to glycated haemoglobin (HbA1c) for the assessment of glycaemic control in diabetic individuals. For the purpose of the study (HbA1c), fasting plasma glucose (FPG), postprandial plasma glucose (PPG) and random plasma glucose (RPG) levels of 500 individuals were assessed. Mean plasma glucose (MPG) was calculated by using the equation (FPG + PPG)/2. On correlation analyses, it was found that correlation of MPG with HbA1c was better than that of FPG, PPG or RPG with HbA1c. Thus MPG seems to be a suitable alternative to HbA1c in the situations where high cost, medical conditions or standardization issues preclude the use of HbA1c assays. We suggest using a cut-off of 145.8 mg/dl for MPG to predict HbA1c ≥6.5%. For those centers that are estimating HbA1c levels, we suggest eMPG-I (Estimated Mean Plasma Glucose-Indian) study equation (28.455 x HbA1c) - 46.78 for predicting the estimated mean plasma glucose of a patient in mg/dl, as it is easier to converse with the patients in terms of glucose levels.&#x0D; Key words: Diabetes, Plasma glucose, HbA1c, Glycaemic control

1905-P: Artificial Decline in HbA1c Level during Treatment of Hepatitis C with Interferon-Free, Direct-Acting Antiviral Regimen Combined with Ribavirin

HbA1c is an important marker for glycemic control; however, not only plasma glucose levels but also RBCs' lifespan determines the value. Some of interferon-free, direct-acting antiviral regimens for hepatitis C are combined with ribavirin, which causes hemolytic anemia. Hemolytic anemia shortens the RBCs' lifespan and lowers HbA1c levels. We monitored HbA1c levels in 28 patients during and after antiviral therapy with daily sofosbuvir (400 mg) plus weight-based ribavirin for hepatitis C. Five cases (18%) had antidiabetic medication. The hemoglobin concentration, 13.9 ± 1.4 g/dl at the baseline, significantly fell to 12.0 ± 1.3 g/dl at the 4th week of treatment (P &amp;lt; 0.001). It hardly declined further during the treatment and immediately recovered after the end of treatment. Although there was no significant change in the random plasma glucose levels, the HbA1c level, 5.8% ± 0.7% at the baseline, gradually declined to 4.3% ± 0.7% (- 1.5% ± 0.7%, P &amp;lt; 0.001) at the end of treatment. It partly recovered to 4.8% ± 0.6% at the 4th week after treatment, then further increased to 6.2% ± 0.9% at the 12th week, and eventually returned to 5.7% ± 0.7%, which was similar to the value at baseline. Conclusions: interferon-free, direct-acting antiviral regimen combined with ribavirin temporally causes artificial declines in HbA1c levels. Disclosure A. Moriya: None. Y. Iwasaki: None. M. Ando: None.

Hypoglycemia Contributes to Increased CVD Mortality with HbA1c &amp;lt;6.0%

Better diabetes control generally reduces development of complications, but those with HbA1c &amp;lt;6.0% have increased cardiovascular (CVD) mortality. Since the cause is unknown, we studied the potential contributions of hypoglycemia, using VA and Medicare databases. 297,263 Veterans with diabetes (ICD-9 codes and diabetes Rx) had ≥4 primary care provider (PCP) visits in 2002-2003, baseline data including age, sex, race, ethnicity, BMI, non-HDL cholesterol, systolic blood pressure (sBP), smoking, ≥1 HbA1c, ≥3 outpatient random plasma glucose (RPG) levels, follow-up through 2012, and survived at least 1 year after A1c measurement. The 40,429 with A1c &amp;lt;6.0% (A1c&amp;lt;6) had mean age 66 year, were 98% male, 16% black and 6.5% Hispanic, had BMI 31, eGFR 71, sBP 139, 81% ever smoked, 51% had CVD at baseline, 48% used sulfonylureas and 13% insulin, with mean HbA1c 5.5%, and RPG 125 mg/dl, while 90,574 with HbA1c 6.0-6.9% (A1c6-6.9) had HbA1c 6.5% and RPG 141 (both p&amp;lt;0.001), but were otherwise clinically comparable. In fully adjusted Cox proportional hazard models, A1c&amp;lt;6 had increased CVD mortality compared to A1c6-6.9 (HR 1.07, p&amp;lt;0.001). However, within 1 year after baseline, A1c&amp;lt;6 also had increased frequency of both outpatient RPG &amp;lt;70 (8.4% vs. 6.0%, p&amp;lt;0.001), outpatient point of care glucose (POCG) &amp;lt;70 (0.34% vs. 0.29%, p=ns), and emergency visits with hypoglycemia (EDHYPO, 0.28% vs. 0.24%, p=ns). Moreover, in Cox models including HbA1c (&amp;lt;6.0 -6.9, -7.9, -8.9, ≥9.0%), hypoglycemia measured by (i) outpatient RPG or POCG levels &amp;lt;70 or (ii) EDHYPO, was independently associated with increased CVD mortality, fully adjusted HR 1.18 and 1.49, both p&amp;lt;0.001. At all HbA1c levels, RPG or POCG &amp;lt;70 predicted CVD mortality more consistently than EDHYPO. Conclusion: Hypoglycemia-associated CVD mortality occurs in general clinical practice-especially with outpatient glucose &amp;lt;70 mg/dl-and increased mortality with HbA1c &amp;lt;6.0% may be due in part to hypoglycemia. Management should be aimed to optimize control but limit the risk of hypoglycemia. Disclosure M. Rhee: None. K.E. Kurgansky: None. Y. Ho: None. D.R. Gagnon: None. S. Raghavan: None. J.L. Vassy: None. K. Cho: None. A. Gonzalez: None. F.N. Khan: None. L.R. Staimez: None. C.N. Ford: None. P.W. Wilson: None. L.S. Phillips: Other Relationship; Self; DIASYST Inc.. Research Support; Self; Amylin Pharmaceuticals, Eli Lilly and Company, Novo Nordisk Inc., Sanofi-Aventis, PhaseBio Pharmaceuticals, Inc., Roche Diabetes Care Health and Digital Solutions, AbbVie Inc., Vascular Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc., GlaxoSmithKline plc., Pfizer Inc.. Other Relationship; Self; Novartis Pharmaceuticals Corporation, Merck &amp; Co., Inc..

Effects of Vitamin D Supplementation on Lipid Profile and Plasma Glucose of Preeclamptic Women in Ibadan, Nigeria

Biochemical metabolites are implicated in preeclampsia, which include elevated plasma concentration of Triglycerides (TG), Low Density Lipoprotein Cholesterol (LDLC), total lipids and reduced High Density Lipoprotein Cholesterol (HDLC) concentrations and significant reductions in fasting plasma glucose, and serum insulin homeostasis model of assessment. Vitamin D supplementation seems to be a possible target for intervention and possible improved pregnancy outcomes in preeclampsia. Therefore, this study aimed at determining the effects of Vitamin D supplementation on the Lipid Profile, and random plasma glucose levels of preeclamptic women in Ibadan, Nigeria. This interventional study was carried out at the Antenatal clinic of Obstetrics and Gynecology Departments of University College Hospital Ibadan and Adeoyo Maternity Clinic, Yemetu, Ibadan, Nigeria. 120 pregnant women aged 18 to 35 were recruited; 40 normotensive pregnant women served as control; 40 randomly chosen preeclamptic women were placed on oral vitamin D supplement of 1000 IU/day for 8 weeks and 40 preeclamptic women were given no supplement. Blood samples were taken at study baseline (22 weeks), after 8 weeks of supplementation (3rd trimester) and 3 to 5 days postpartum in all groups to quantify serum vitamin D, random glucose and Lipid profile. Vitamin D was quantified by Enzyme Linked Immunosorbent Assay (ELISA), glucose status by glucose oxidase method and lipid profile by standard methods. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) soft version 17.0 and subjected to One way analysis of Variance (ANOVA) and Student’s t test. Results showed a significant increase (p p p p p > 0.05). Vitamin D supplementation is important in ameliorating dyslipidemia associated with preeclampsia.

Laboratory Patterns in Hypoglycin A Toxicity

The unripe fruit of the ackee tree (Blighia Sapida), contains significantly high concentrations of the hypoglycin (L-α - amino-β -[methylene cyclopropyl] propionic acid) a toxin implicated in over 5000 deaths worldwide. Methylenecyclopropane acetyl CoA (MCPA-CoA) a metabolite of hypoglycin A, inhibits several coenzyme A dehydrogenases which are essential for gluconeogenesis resulting in depletion of glucose reserves and the inability of cells to regenerate glucose; eventually leading to hypoglycaemia. This study aimed at reviewing literature on the hypoglycin A toxicity, add to the body of tests already established by the WHO in detecting hypoglycin toxicity based on the patterns we have observed and to provide physicians with a simple panel of tests that will aid in the speedy detection of hypoglycin A toxicity for more timing therapeutic intervention. This review covers the description, pathophysiology, epidemiology, and clinical presentation. In addition, data on patients diagnosed with hypoglycin A toxicity was collected and analysed for significant trends. Analysis of data determined that 86%, 97% and 79% of patients demonstrated significant increase in phosphorous (95% CI of 1.74-2.73), anion gap (95% CI 24.26-29.05) and AST (95% CI 37.97-73.06) respectively. On the other hand, 95%, and 92% of patients demonstrated significant decrease in bicarbonate (95% CI of 13.02-16.56) and Lymphocytes count 95% CI of 7.49-12.81 respectively. Significantly low random plasma glucose levels, in conjunction with elevated levels of Phosphorus, Anion gap, and AST, as well as decreased levels of bicarbonate, and an absolute lymphocyte count could prove an effective screening for Hypoglcyin A toxicity in affected regions.

Prevalence and Correlates of Prediabetes and Diabetes Results-I: A Screening Plan in a Selected Military Community in Central Saudi Arabia

Background: Diabetes is a chronic disease of a genetic and environmental background. If it is not diagnosed and controlled early, it can have devastating complications. Aim: Measure and analyze the prevalence and risks of prediabetes and diabetes among recruits enlisted in the Wadi Al-Dawasir (WD) military zone, central Saudi Arabia. The influence of some demographic criteria, weight, and blood pressure upon blood glucose level would be evaluated. Methods: A cross sectional design was utilized, whereas predesigned questionnaire and clinical interview were used to screen the study population. Results: The participants’ median age was 33.7 (IQR 11.9), mean body mass index (BMI) was 27.6 ± 5.4 kg/m2. Out of 531 recruits screened, almost two-thirds were either overweight (34.7%) or obese (29.9%). The mean waist circumference (WC) was 94.7 ± 13.3 cm; and 27.9% had central obesity (WC ≥102 cm). Random plasma glucose (RPG) median accounted 106 mg/dl (IQR 21). The participants’ RPG levels significantly increased by age (U = 19697.0), by BMI [H(df 5) = 59.6], and by WC (U = 25,670.5), (p rho(df 503) = 0.241, p U 3515, p 25 to ≥40 kg/m2) more than normal subjects [46 (87%) vs. 5 (0.9%)], [χ2(df 5) = 18.8, p < 0.0001]. Conclusions: Prediabetes and uncontrolled diabetes are relatively prevalent among Saudi recruits’ community. An insufficient influence of obesity for developing diabetes symptoms in the study population may well be attributed to time factor separating the two variables. A preventive approach to revert the predisposition of prediabetes in WD recruits population is quite promising.

Identification and Verification of Potential Therapeutic Target Genes in Berberine-Treated Zucker Diabetic Fatty Rats through Bioinformatics Analysis.

BackgroundBerberine is used to treat diabetes and dyslipidemia. However, the effect of berberine on specific diabetes treatment targets is unknown. In the current study, we investigated the effect of berberine on the random plasma glucose, glycated hemoglobin (HbA1C), AST, ALT, BUN and CREA levels of Zucker diabetic fatty (ZDF) rats, and we identified and verified the importance of potential therapeutic target genes to provide molecular information for further investigation of the mechanisms underlying the anti-diabetic effects of berberine.MethodsZDF rats were randomly divided into control (Con), diabetic (DM) and berberine-treated (300 mg⋅kg−1, BBR) groups. After the ZDF rats were treated with BBR for 12 weeks, its effect on the random plasma glucose and HbA1C levels was evaluated. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen (BUN), CREA and OGTT were measured from blood, respectively. The levels of gene expression in liver samples were analyzed using an Agilent rat gene expression 4x44K microarray. The differentially expressed genes (DEGs) were screened as those with log2 (Con vs DM) ≥ 1 and log2 (BBR vs DM) ≥ 1 expression levels, which were the genes with up-regulated expression, and those with log2 (Con vs DM) ≤ -1 and log2 (BBR vs DM) ≤ -1 expression levels, which were the genes with down-regulated expression; the changes in gene expression were considered significant at P<0.05. The functions of the DEGs were determined using gene ontology (GO) and pathway analysis. Furthermore, a protein-protein interaction (PPI) network was constructed using STRING and Cytoscape software. The expression levels of the key node genes in the livers of the ZDF rats were also analyzed using qRT-PCR.ResultsWe found that 12 weeks of berberine treatment significantly decreased the random plasma glucose, HbA1C levels and improved glucose tolerance. There was a tendency for berberine to reduce AST, ALT, BUN except increase CREA levels. In the livers of the BBR group, we found 154 DEGs, including 91 genes with up-regulated expression and 63 genes with down-regulated expression. In addition, GO enrichment analysis showed significant enrichment of the DEGs in the following categories: metabolic process, localization, cellular process, biological regulation and response to stimulus process. After the gene screening, KEGG pathway analysis showed that the target genes are involved in multiple pathways, including the lysine degradation, glycosaminoglycan biosynthesis-chondroitin sulfate/dermatan sulfate and pyruvate metabolism pathways. By combining the results of PPI network and KEGG pathway analyses, we identified seven key node genes. The qRT-PCR results confirmed that the expression of the RHOA, MAPK4 and DLAT genes was significantly down-regulated compared with the levels in DM group, whereas the expression of the SgK494, DOT1L, SETD2 and ME3 genes was significantly up-regulated in the BBR group.ConclusionBerberine can significantly improve glucose metabolism and has a protective effects of liver and kidney function in ZDF rats. The qRT-PCR results for the crucial DEGs validated the microarray results. These results suggested that the RHOA, MAPK4, SGK494, DOT1L, SETD2, ME3 and DLAT genes are potential therapeutic target genes for the treatment of diabetes.

Association of Random Plasma Glucose Levels With the Risk for Cardiovascular Disease Among Chinese Adults Without Known Diabetes.

Diabetes is a known risk factor for cardiovascular disease (CVD). Substantial uncertainty remains, however, about the relevance to CVD risk for blood glucose levels below the diabetes threshold. To examine the association of random plasma glucose (RPG) levels with the risk for major CVD in Chinese adults without known diabetes. This prospective cohort study included 467 508 men and women aged 30 to 79 years with no history of diabetes, ischemic heart disease (IHD), stroke, or transient ischemic attack. Participants were recruited from 5 urban and 5 rural diverse locations across China from June 25, 2004, to July 15, 2008, and followed up to January 1, 2014. Baseline and usual (longer-term average) RPG level. Cardiovascular deaths, major coronary events (MCE) (including fatal IHD and nonfatal myocardial infarction), ischemic stroke (IS), major occlusive vascular disease (MOVD) (including MCE or IS), and intracerebral hemorrhage. Preliminary validation of stroke and IHD events demonstrated positive predictive values of approximately 90% and 85%, respectively. Cox regression yielded adjusted hazard ratios (aHRs) for CVD associated with RPG levels. Among the 467 508 participants (41.0% men; 59.0% women; mean [SD] age, 51 [11] years), a significant positive association of baseline RPG levels with CVD risks continued to 4.0 mmol/L (72 mg/dL). After adjusting for regression dilution bias, each 1-mmol/L (18-mg/dL) higher usual RPG level above 5.9 mmol/L (106 mg/dL) was associated with an 11% higher risk for cardiovascular death (6645 deaths; aHR, 1.11; 95% CI, 1.10-1.13). Similarly strong positive associations were seen for MCE (3270 events; aHR, 1.10; 95% CI, 1.08-1.13), IS (19 153 events; aHR, 1.08; 95% CI, 1.07-1.09), and MOVD (22 023 events; aHR, 1.08; 95% CI, 1.07-1.09). For intracerebral hemorrhage, the association was weaker, but also significant (4326 events; aHR, 1.05; 95% CI, 1.02-1.07). These associations persisted after excluding participants who developed diabetes during follow-up. Among adult Chinese without diabetes, lower RPG levels are associated with lower risks for major CVDs, even within a normal range of blood glucose levels.

Clinical significance of second-trimester 50-g glucose challenge test among Japanese women diagnosed as normoglycemic after first-trimester 75-g glucose tolerance test

ObjectiveThis study was performed to determine how often Japanese women diagnosed as normoglycemic on first-trimester 75-g glucose tolerance test (75gGTT) later develop gestational diabetes mellitus (GDM). Material and methodsSixty-two women with random plasma glucose (PG) level ≥ 105 mg/dL during the first trimester and subsequent first-trimester diagnosis of normoglycemia with 75gGTT underwent 50-g glucose challenge test (50gGCT) during the second trimester. Twenty-one with a positive 50gGCT result (60-m PG ≥ 140 mg/dL) underwent second-trimester 75gGTT. First-trimester random PG levels and 75gGTT results were compared between 21 and 41 women with positive and negative 50gGCT results, respectively. Changes in immunoreactive insulin (IRI) associated with 75gGTT were determined simultaneously. ResultsAll 21 women with a positive 50gGCT result showed normoglycemia on second-trimester 75gGTT. Thus, none of the 62 women developed GDM. Insulin resistance increased significantly in the 21 women with 75gGTT during the first and second trimesters, as indicated by increases in homeostasis model assessment for insulin resistance (HOMA-IR) and homeostasis model assessment for β-cell function (HOMA-β) with no significant changes in preload or afterload PG levels. Neither random PG levels (116 ± 12 vs. 116 ± 12 mg/dL, respectively) nor 75gGTT results (86 ± 6 vs. 84 ± 5 mg/dL for 0-minute [0-m] PG level, 130 ± 28 vs. 131 ± 25 mg/dL for 60-m PG, and 111 ± 19 vs. 118 ± 18 mg/dL for 120-m PG, respectively) during the first trimester differed significantly between the 41 and 21 women with negative and positive second-trimester 50gGCT results, respectively. ConclusionAlthough insulin resistance increased in the second trimester, risk of developing GDM was < 1/62 among Japanese women in whom hyperglycemia was excluded with first-trimester GTT.

Neutrophil/Lymphocyte Ratio as a Predictor of In-Hospital Major Adverse Cardiac Events, New-Onset Atrial Fibrillation, and No-Reflow Phenomenon in Patients with ST Elevation Myocardial Infarction.

BACKGROUNDNeutrophil/lymphocyte (N/L) ratio represents the balance between neutrophil and lymphocyte counts in the body and can be utilized as an index for systemic inflammatory status. The no-reflow phenomenon is defined as inadequate myocardial perfusion through a given segment of the coronary circulation without angiographic evidence of mechanical vessel obstruction. Systemic inflammatory status has been associated with new-onset atrial fibrillation (NOAF) as well as no-reflow.AIMTo evaluate the predictive value of N/L ratio for in-hospital major adverse events, NOAF, and no-reflow in patients with ST elevation myocardial infarction (STEMI).PATIENTSTwo hundred consecutive patients with STEMI presenting to Alexandria Main University Hospital and International Cardiac Center Hospital, Alexandria, Egypt, from April 2013 to October 2013 were included in this study.METHODSLaboratory investigation upon admission included complete blood count with mean platelet volume (MPV) and N/L ratio, and random plasma glucose (RPG) level. The results of coronary angiography indicating the infarct-related artery (IRA), initial thrombolysis in myocardial infarction (TIMI) flow in the IRA, and the TIMI flow after stenting were recorded. The patients were studied according to the presence of various clinical and laboratory variables, such as age, gender, pain-to-balloon time, location of the infarction, RPG level and complete blood count including N/L ratio and MPV on admission, and initial TIMI flow in the IRA. They were also evaluated for the final TIMI flow after the primary percutaneous coronary intervention, incidence of NOAF, and the incidence of in-hospital major adverse cardiac events (MACE).RESULTSThe incidence rate of no-reflow, NOAF, and in-hospital MACE was 13.2%, 8%, and 5%, respectively, with cardiac death as the predominant form of in-hospital MACE. The group of no-reflow, NOAF, and/or MACE showed significantly older age (62.29 ± 7.90 vs 56.30 ± 10.34, P = 0.014), longer pain-to-balloon time (15.90 ± 7.87 vs 6.08 ± 3.82 hours, P < 0.001), higher levels of RPG, N/L ratio (8.19 ± 3.05 vs 5.44 ± 3.53, P, 0.001), and MPV (11.90 ± 2.09 vs 8.58 ± 1.84 fL, P < 0.001) on admission. After adjustment of confounding factors, the independent predictors of NOAF, no-reflow, and in-hospital MACE were higher N/L ratio (odds ratio [OR] = 3.5, P = 0.02) and older age (OR = 3.1, P = 0.04).CONCLUSIONSOlder patient age, longer pain-to-balloon time, hyperglycemia, higher N/L ratio, and MPV on admission are useful predictive factors for the occurrence of no-reflow postprimary percutaneous coronary intervention, NOAF, and/or in-hospital MACE. N/L ratio is a new strong independent predictor of no-reflow, NOAF, and/or in-hospital MACE in patients with STEMI. The use of this simple routine biomarker may have a potential therapeutic implication in preventing NOAF and improving prognosis in STEMI revascularized patients.