Serum Glucose Levels In Patients Research Articles

A Determination of Salivary and Serum Glucose Levels in Patients With Type II Diabetes Mellitus.

The aim of this work was to determine and compare serum and salivary glucose levels in patients with type II diabetes mellitus (DM). This study had an overall sample size of 100, which consisted of male and female volunteers aged 30-67 years. Both in-depth interviews and physical tests were conducted. Blood and saliva were collected from the participants while fasting, which were analyzed to determine the levels of salivary alpha-amylase (α-amylase). Both the subjects and the controls were instructed to test their blood glucose levels while fasting and it was suggested that HbA1c values will be used for diagnosing diabetes following the guidelines of the American Diabetes Association, Centers for Disease Control, and World Health Organization. The average age of the control group (Category A) was noted as 47.52±6.28 years, and that of the study group (Category B) was 49.17±7.25 years. In Category A, female (n=23) were 46%, and 54% were male (n=27); and 40% of the people in Category B were female (n=20), and 60% were male (n=30). The majority of patients (54%) in Category B displayed an average level of DM control (n=27), followed by poor control (24%. n=12), well-controlled (20%, n=10), anduncontrolled DM (2%, n=1). Category A had an average salivary α-amylase concentration of 3.1±0.88 U/L, whereas that of Category B was 12.06±2.36 U/L. Thus, the mean salivary α-amylase level of Category B was found to be much higher than that of Category A, and this difference was statistically significant (p<0.001). The determination of α-amylase levels in the saliva of individuals suspected of having type II DM has been suggested as a potential diagnostic method. Screenings conducted at healthcare institutions and community health fairs, as well as epidemiological studies, might benefit from this method. We believe that normal clinical practice should include the use of saliva in a broad variety of diagnostic tests.

Sertraline and Fluoxetine in Adult Patients with Comorbid Depression and Type II Diabetes Mellitus: A Randomized Controlled Trial

Background: Depressive disorders are more common in patients with diabetes mellitus (DM) compared to the general population. Objectives: Due to heterogeneous evidence on the impact of antidepressants on serum glucose profile, this study was conducted to examine the effects of sertraline and fluoxetine on serum glucose levels in patients with comorbid depression and diabetes. Methods: In this randomized controlled trial, 40 adult patients with DM and depression were randomly allocated into two groups (n = 20 per group). The first group received 50 - 200 mg/day of sertraline, and the second group received 20 - 60 mg/day of fluoxetine. The Beck Depression Inventory (BDI-II) was used to determine depression severity, and body mass index (BMI), blood pressure, serum lipid profile, fasting blood sugar (FBS), 2-hour post-prandial blood glucose, and HbA1c were measured at the baseline and 12 weeks after the intervention. Results: Body mass index (P = 0.40), systolic blood pressure (P = 0.41), FBS (P = 0.46), 2-hour post-prandial blood glucose (P = 0.53), HbA1c (P = 0.59), serum total cholesterol (P = 0.78), and LDL cholesterol (P = 0.62) insignificantly reduced in both groups after the intervention compared to the baseline; however, the reduction in serum triglyceride level was statistically significant (P = 0.04). Also, the depression severity score was reduced in both groups; however, the difference was not statistically significant (P = 0.27). Conclusions: In adult patients diagnosed with comorbid depression and type II diabetes mellitus, three months of treatment with sertraline or fluoxetine comparably mitigated depressive symptoms and reduced HbA1c, FBS, and 2-hour post-prandial blood glucose.

The Effects of Blood Glucose Control in the Operative Spine Patient: A Systematic Review.

To our knowledge, this is the first systematic review to evaluate the available literature on the effects of perioperative serum glucose (SG) on outcomes for patients undergoing spine surgery. This review will add insight into how the perioperative management of SG affects the outcomes of patients undergoing spine surgery. Three databases were used in this review including Embase, PubMed, and Cochrane Library. The searches were from 2012 to 2022 and included the terms "spine surgery" and "glucose level" to identify studies that demonstrated a correlation between glucose level and postoperative outcomes. Pediatric studies, those that did not specify spine surgical outcomes related to glucose levels, and non-English studies were excluded. The methodological items for nonrandomized studies score was used to assess risk of bias in the included studies. This review included a total of 9 cohort studies, both prospective and retrospective, encompassing a total of 431,156 subjects. Seven of the 9 studies reported an increased overall complication rate among patients with diabetes or with higher SG levels, and 4 studies demonstrated an increased infection rate among this population. Two studies reported an association between decreased SG levels and improved neurological recovery when a deficit was present preoperatively, and 1 of the studies found that this association was statistically significant. Limitations of this review include lack of standardization regarding type of surgery, location of the spine, and level of evidence. Most of the current literature suggests that elevated SG levels in patients undergoing spine surgery likely leads to higher complication rates and may lead to increased infection rates, and this review reinforced the current evidence. Additionally, perioperative SG levels may be associated with the extent of neurological recovery after surgery, but further investigation may be warranted. This review adds to the current body of evidence regarding perioperative SG levels and its association with complications.

The effect of sulphate-sulphide mineral baths on blood glucose level in patients with knee osteoarthritis

Background/Aim: Type 2 diabetes is a common comorbidity in patients with knee osteoarthritis. Bearing in mind that obesity and insulin resistance are risk factors for the development of knee osteoarthritis, physical therapy and balneotherapy containing hydrogen sulphide (H2S) has a positive effect on the functional and metabolic status of these patients. This work was aimed to investigate the effect of sulphate-sulphide-rich mineral baths containing H2S on the level of serum glucose in patients with knee osteoarthritis. Methods: An open prospective randomised clinical trial included patients suffering from stage I and II of the knee osteoarthritis. Patients were divided into two groups of 40 subjects each: control group and experimental group. All subjects underwent inpatient physical treatment consisting of kinesitherapy and transcutaneous electrical nerve stimulation (TENS) 6 days a week. Patients from experimental group, in addition to all the mentioned treatments, also took sulphate-sulphide mineral water baths once a day for 30 minutes for 7 days, unlike the patients from control group who took tap water baths, according to the same schedule. The level of serum glucose was monitored in all patients on admission, after discharge and 6 months after the treatment. The Student t-test was used for statistical data processing and p &lt; 0.05 was considered as statistically significant. Results: Study included 80 patients of both sexes, with an average age of 67.00 ± 5.75 years. All patients had elevated serum glucose values on admission. The initial levels of glycaemia in the control and experimental groups were not significantly different (6.99 ± 1.95 and 7.88 ± 1.90 mmol/L, respectively). At discharge, patients who performed balneotherapy had a statistically significant decrease in serum glucose values compared to patients from the control group (by 1.84 vs 0.26 mmol/L, p &lt; 0.001). This effect did not persist six months after the end of the treatment (p &gt; 0.05). Conclusion: The application of balneotherapy with sulphate-sulphide mineral baths containing H2S as a potent gas transmitter significantly reduces serum glucose levels in patients with knee osteoarthritis.

Analysis of OCT1, OCT2 and OCT3 gene polymorphisms among Type 2 diabetes mellitus subjects in Indian ethnicity, Malaysia.

BackgroundType 2 Diabetes mellitus (T2DM) is a chronic metabolic disorder. It is a major non-communicable disease affecting 463 million people globally in 2019 and is expected to be double to about 700 million by 2045. The majority are Asians with Indian ethnicity in Malaysia reported as the highest prevalence of T2DM. Cardiovascular disease, renal failure, blindness and neuropathy, as well as premature death are the known morbidity and mortality resulted from T2DM. T2DM is characterized by the dysfunctional insulin physiology that causes reduction of glucose transport into the cells which lead to hyperglycaemia. Hence, one of the important treatments is an oral antidiabetic drug that lowers the serum glucose level in patients with T2DM. This drug will be transported across cell membranes by organic cation transporters (OCT). Therefore, it is important to identify the OCT candidate gene polymorphisms related to T2DM especially among the Indian ethnicity in Malaysia.MethodsBlood samples were collected from 132 T2DM patients and 133 controls. Genotyping of OCT1 (rs628031), OCT2 (rs145450955), OCT3 (rs3088442 and rs2292334) was performed using (PCR-RFLP).ResultsNo association was observed for genotypic and allelic distributions in all the gene polymorphisms of OCT genes (P > 0.05). However, a logistic regression analysis stratified by gender in a dominant model showed a significant difference for OCT3 among males with T2DM (P = 0.006). Significant association was also observed for OCT3 when stratified to subjects aged > 45 years old (P = 0.009).ConclusionBased on these findings, the association of OCT3 (rs2292334) could be considered as a possible genetic risk factor for the development of T2DM among Indian males alone.

Effects of telemedicine intervention on the management of diabetic complications in type 2 diabetes

Some studies have shown that telemedicine is effective for managing serum glucose levels in patients with type 2 diabetes (T2DM), but few studies have examined the effect of telemedicine on the management of complications in T2DM. The aim of this study was to compare the effects of telemedicine with those of outpatient care on the following parameters in T2DM patients: hemoglobin Alc (HbA1c), urinary albumin to creatinine ratio (UACR), carotid plaque, and incidence of hypoglycemia. In total, 148 adult patients with T2DM were randomized into a telemedicine group (n = 74) and a control group (n = 74). In the telemedicine group, a wireless intelligent blood-glucose meter was used to monitor blood-glucose levels, transmit data, and upload information on diet, exercise frequency, and oral medications, while the control group underwent routine outpatient follow-up. HbA1c, UACR, incidence of hypoglycemia, and carotid plaque were measured at baseline and at 3 and 6 months in the telemedicine group and the control group. There were no statistically significant differences in baselines data (p > 0.05) between the telemedicine group and the control group such as age (50.04 ± 5.76 vs. 52.21 ± 8.38, p = 0.750), diabetes course (6.24 ± 1.95 vs. 6.09 ± 1.66, p = 0.622), and gender (51/21 vs. 43/27, p = 0.236). After 6 months of follow-up, the telemedicine group, compared with the control group, showed significant decreases in incidence of hypoglycemia (25% vs. 41.4%, p = 0.038) and HbA1c (7.38 ± 1.67% vs. 8.22 ± 2.04%, p 0.05) between the telemedicine group and the control group. The telemedicine system reduced rate of hypoglycemia and indexes of HbA1c in patients with T2DM, whereas no significant differences in UACRs or carotid plaque were found.

The impact of admission blood glucose level on patients with community-acquired pneumonia

BackgroundPneumonia is one of the most common diseases with a high hospitalization rate. Many studies have suggested that there is a correlation between pre-existing diabetes and the alterations in serum glucose levels in patients with community-acquired pneumonia (CAP) and high death rate.AimTo study the impact of admission blood glucose level on patients’ outcomes with CAP.Patients and methodsSixty (30 nondiabetic and 30 diabetic patients) consecutive hospitalized adult patients with CAP were recruited over a 1-year period. Data on patients’ outcomes including duration of hospital stay, duration of antibiotic treatment, increase in oxygen requirements, increase in antibiotics coverage, ICU admission, mechanical ventilation, and in-hospital mortality were collected.ResultsAdmission blood glucose level was elevated in diabetic patients (the mean plasma glucose level was 258.86 ±116.15 mg/dl in diabetics and 151.13±51.23 mg/dl in nondiabetics). There were statistically significant increases in the duration of hospital stay (7.633±3.567 nondiabetic vs. 11.267±4.291 diabetic patients in days), duration of antibiotic treatment (7.633±3.567 nondiabetic vs. 11.267±4.291 diabetic patients in days), increase in O2 requirements (33.33 vs.70%), increase in antibiotics coverage (16.67 vs. 63.33%), and ICU admission (30 vs. 63.33%) in the diabetic group on comparing nondiabetic versus diabetic patients with CAP. Also, the previously mentioned outcomes increased significantly with increasing blood glucose levels among the entire study population.ConclusionOn admission, CAP patients with increased blood glucose level, either diabetic or nondiabetic, are expected to have poor outcomes.

Are Vaspin and Omentin-1 Related to Insulin Resistance, Blood Pressure and Inflammation in NAFLD Patients?

SummaryBackgroundNon-alcoholic fatty liver disease (NAFLD), the hepatic manifestation of insulin resistance, is the most common cause of chronic liver. The present study aimed to investigate the roles of vaspin and omentin-1 in the NAFLD-related pathology including IR, inflammation and elevated blood pressure.MethodsThis cross-sectional study was conducted among 83 NAFLD patients in Jahrom, Iran. Plasma levels of omentin-1, vaspin, hs-CRP and IL-6 were measured. Anthropometric indices, lipid profiles, liver enzymes as well as abdominal ultrasonography were assessed.ResultsPartial correlations controlling for age and sex showed significant positive correlation between vaspin and fasting blood sugar (FBS), insulin, HOMA-IR, and hs-CRP. It has been observed that omentin negatively correlated with glucose levels. Moreover, a marginally significant association has been found between omentin levels and systolic blood pressure (SBP).ConclusionsThis study shows that vaspin and omentin-1 are associated with inflammation, insulin resistance and serum glucose levels in patients with NAFLD.

Are Vaspin and Omentin-1 Related to Insulin Resistance, Blood Pressure and Inflammation in NAFLD Patients?

Summary Background: Non-alcoholic fatty liver disease (NAFLD), the hepatic manifestation of insulin resistance, is the most common cause of chronic liver. The present study aimed to investigate the roles of Vaspin and omentin-1 in the NAFLD-related pathology including IR, inflammation and elevated blood pressure. Methods: This cross-sectional study was conducted among 83 NAFLD patients in Jahrom, Iran. Plasma levels of omentin-1, Vaspin, hs-CRP and IL-6 were measured. Anthropometric indices, lipid profiles, liver enzymes as well as abdominal ultrasonography were assessed. Results: Partial correlations controlling for age and sex showed significant positive correlation between Vaspin and fasting blood sugar (FBS), insulin, HOMA-IR, and hs-CRP. It has been observed that omentin negatively correlated with glucose levels. Moreover, a marginally significant association has been found between Omentin levels and systolic blood pressure (SBP). Conclusions: This study shows that Vaspin and Omentin-1 are associated with inflammation, insulin resistance and serum glucose levels in patients with NAFLD.

Activation of μ‐opioid receptors in the rostral ventrolateral medulla blocks the sympathetic counter‐regulatory response to glucoprivation

Intensive insulin therapy is the gold standard for managing serum glucose levels in patients with insulin‐deficient diabetes mellitus. Hypoglycaemia‐associated autonomic failure (HAAF) is a clinical syndrome characterised by the absence of a glucose counter‐regulatory response to hypoglycaemia or glucoprivation. The precise physiologic mechanisms underlying HAAF remain unknown. Recent data from human studies suggests activation of the endogenous opioid system during antecedent hypoglycaemia may contribute to unawareness of hypoglycaemia.Here, we aimed to determine whether or not activation of rostral ventrolateral medullary (RVLM) μ‐opioid receptors results in downstream sympathoinhibition, resulting in attenuated glucose production, and an impaired counter‐regulatory response following glucoprivation. Experiments were performed in sodium pentobarbital anaesthetised (65 mg/kg) male Sprague‐Dawley rats (250–350g).Bilateral activation of RVLM μ‐opioid receptors with DAMGO (8 mM, 50 nl) caused depression of adrenal sympathetic nerve activity (ASNA), that lasted at least 60 minutes (Δ−56.9 ± 9.8% vs saline: Δ1.7 ± 4.4%, P&lt;0.05). In parallel, blood glucose levels were also reduced (Δ−0.8 ± 0.2 mM vs saline: Δ0.2 ± 0.3 mM, P&lt;0.05). The counter‐regulatory response to glucoprivation (measured by ASNA efferent activity) induced by 2‐deoxyglucose was completely attenuated 60 minutes following DAMGO microinjections (Δ−4.4 ± 0.7% vs saline+2‐DG: Δ59.6 ± 8.0%, P&lt;0.05). Bilateral μ‐opioid receptor activation also caused a significant decrease in mean arterial pressure (Δ−28.7 ± 6.1 mmHg vs saline: Δ−9.9 ± 7.3 mmHg, P&lt;0.05) and heart rate (Δ−40.4 ± 14.9 bpm vs saline: Δ−11.1 ± 9.7 bpm, P&lt;0.05).In conclusion, activation of RVLM μ‐opioid receptors reproduces features of HAAF (attenuated neural efferent response to glucoprivation). The mechanism underlying HAAF may include activation of RVLM μ‐opioid receptors to facilitate sympathoinhibition. Coupled with this sympathoinhibition, the reduced blood glucose levels may contribute to HAAF by increasing the threshold to elicit counter‐regulatory response.Support or Funding InformationNational Health and Medical Research Council of Australia, The University of Sydney, The Heart Research InstituteThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Preoperative Glycemic Control Predicts Perioperative Serum Glucose Levels in Patients Undergoing Total Joint Arthroplasty

BackgroundDiabetic patients undergoing total joint arthroplasty (TJA) with postoperative hyperglycemia >200 mg/dL have increased the risk of prosthetic joint infection (PJI). We investigated the correlation between preoperative hemoglobin A1c (A1c) and postoperative hyperglycemia in diabetic patients undergoing TJA. MethodsA retrospective review of 773 diabetic patients undergoing TJA was conducted. A Youden's J computational analysis determined the A1c where postoperative glucose levels >200 mg/dL were statistically more likely. Patients were then stratified into 3 groups: A1c <7%, A1c 7.0-8.0%, and A1c >8.0%. Outcomes included the highest postoperative in-hospital serum glucose level and PJI. ResultsWe determined an A1c >7.45% resulted in a greater chance of postoperative hyperglycemia >200 mg/dL. Average postoperative serum glucose increased with A1c (A1c < 7 = 167 mg/dL, A1c 7.0-8.0 = 240 mg/dL, and A1c > 8 = 276 mg/dL, P < .0001). PJI did not statistically increase with A1c (2.25%, 1.99%, and 4.55%, respectively, P = .4319). ConclusionPreoperative hemoglobin A1c levels correlate with postoperative glucose levels. We recommend using an A1c cutoff of 7.45% for patients undergoing TJA and suggest that caution should be exercised in patients with elevated A1c levels undergoing TJA.

The Eosinophil Count Tends to Be Negatively Associated with Levels of Serum Glucose in Patients with Adrenal Cushing Syndrome.

BackgroundCushing syndrome is characterized by glucose intolerance, cardiovascular disease, and an enhanced systemic inflammatory response caused by chronic exposure to excess cortisol. Eosinopenia is frequently observed in patients with adrenal Cushing syndrome, but the relationship between the eosinophil count in peripheral blood and indicators of glucose level in patients with adrenal Cushing syndrome has not been determined.MethodsA retrospective study was undertaken of the clinical and laboratory findings of 40 patients diagnosed with adrenal Cushing syndrome at Chungnam National University Hospital from January 2006 to December 2016. Clinical characteristics, complete blood cell counts with white blood cell differential, measures of their endocrine function, description of imaging studies, and pathologic findings were obtained from their medical records.ResultsEosinophil composition and count were restored by surgical treatment of all of the patients with adrenal Cushing disease. The eosinophil count was inversely correlated with serum and urine cortisol, glycated hemoglobin, and inflammatory markers in the patients with adrenal Cushing syndrome.ConclusionSmaller eosinophil populations in patients with adrenal Cushing syndrome tend to be correlated with higher levels of blood sugar and glycated hemoglobin. This study suggests that peripheral blood eosinophil composition or count may be associated with serum glucose levels in patients with adrenal Cushing syndrome.

Long-term impact of therapeutic drug monitoring on the risk of hypoglycemia in HOCM patients on cibenzoline therapy .

The purpose of this study was to evaluate the long-term impact of therapeutic drug monitoring (TDM) services on the risk of hypoglycemia in cibenzoline therapy. In addition, we evaluated the impact of changes in clinical setting or patient background on the risk of hypoglycemia in patients receiving cibenzoline. TDM services for cibenzoline have been performed at the Japan National Cerebral and Cardiovascular Center since March 1998. A case-control study was performed from September 2012 to February 2013, and the calculated risk of hypoglycemia associated with cibenzoline use was compared with data from our previous studies, which were performed ~15 years ago. A significantly increased risk for hypoglycemia was observed for users of cibenzoline (adjusted OR: 2.6; 95% CI: 1.5-4.7). In an additional analysis, the calculated risk was slightly reduced (adjusted OR; 2.1, 95% CI; 1.1-3.8) and hypertrophic obstructive cardiomyopathy (HOCM) was identified as a possible risk factor for hypoglycemia (adjusted OR: 4.7, 95% CI: 1.8-12.3). There was a significant difference in the mean level of cibenzoline between outpatients with and without HOCM (360.5±166.9 ng/mL vs. 276.4±136.3 ng/mL). An inverse relationship was observed between the percentage of outpatients whose cibenzoline serum level had been measured and their risk of hypoglycemia. Consistent TDM services for cibenzoline have contributed to a reduced risk of hypoglycemia associated with cibenzoline therapy. Patients with HOCM have a higher risk of developing hypoglycemia. Clinicians should therefore carefully monitor serum glucose levels in patients with HOCM taking cibenzoline. .

Presence of selected metabolic syndrome components in patients with psoriasis vulgaris.

IntroductionRecent studies have suggested a strong association between psoriasis and obesity, dyslipidemia, hypertension, resistance to insulin and metabolic syndrome.AimTo assess the prevalence of selected metabolic syndrome components in patients with psoriasis and the effect of the abnormalities on the disease activity.Material and methodsTwo hundred and forty-six patients diagnosed with psoriasis and 75 healthy individuals as controls were included in the study. Psoriasis activity was evaluated by the Psoriasis Area and Severity Index (PASI).ResultsThere was a statistically significant difference in triglyceride concentration between psoriasis patients and controls (p = 0.00001), which was not found for high-density lipoprotein (HDL) concentration. Mean values of serum glucose level in patients with psoriasis were significantly higher than in controls (p = 0.046). Further statistical analysis of the obtained results showed significantly higher systolic blood pressure in the psoriasis patients than in the controls (p = 0.0001), but there was no statistically significant difference in diastolic blood pressure between the investigated groups (p > 0.05).ConclusionsHigher prevalence of metabolic syndrome components was observed in patients with psoriasis than in the general population.

A mathematical model of pre-diagnostic glioma growth

Due to their location, the malignant gliomas of the brain in humans are very difficult to treat in advanced stages. Blood-based biomarkers for glioma are needed for more accurate evaluation of treatment response as well as early diagnosis. However, biomarker research in primary brain tumors is challenging given their relative rarity and genetic diversity. It is further complicated by variations in the permeability of the blood brain barrier that affects the amount of marker released into the bloodstream. Inspired by recent temporal data indicating a possible decrease in serum glucose levels in patients with gliomas yet to be diagnosed, we present an ordinary differential equation model to capture early stage glioma growth. The model contains glioma–glucose-immune interactions and poses a potential mechanism by which this glucose drop can be explained. We present numerical simulations, parameter sensitivity analysis, linear stability analysis and a numerical experiment whereby we show how a dormant glioma can become malignant.

Hyperglycemia in patients referred for cardiac catheterization is associated with preexisting diabetes rather than a stress-related phenomenon: a prospective cross-sectional study.

An increased serum glucose level in patients with acute coronary syndrome (ACS) is associated with adverse clinical outcome. This hyperglycemia has been attributed, at least in part, to acute stress reaction. Our objective was to determine whether hyperglycemia is a stress-related phenomenon or whether it represents a more sustained and possibly significant background dysglycemia. Hyperglycemia in patients undergoing coronary angiography is related to background dysglycemia. Blood samples were obtained at the time of cardiac catheterization. Patients with hemoglobin A1c >6.5% were excluded to avoid patients with chronic glucose levels above 135 mg/dL. A logistic regression model was created to assess the influence of different variables on hyperglycemia (glucose levels above 140 mg/dL). We also evaluated the effect of glucose levels above 140 mg/dL on major adverse cardiovascular events (MACEs) up to 36 months. There were 2554 consecutive patients prospectively recruited. Serum glucose levels above 140 mg/dL was a strong predictor of MACE (hazard ratio: 2.2, 95% confidence interval [CI]: 1.3-3.6, P = 0.002). Both diabetes mellitus and ACS were associated with hyperglycemia (glucose levels above 140 mg/dL). Nevertheless, the incidence of hyperglycemia was doubled in diabetic patients (odds ratio [OR]: 9.4, 95% CI: 3.9-22.4, P < 0.001) compared with patients with ACS (OR: 4.6, 95% CI: 2.3-9.0, P < 0.001). Combining both conditions was associated with a high likelihood of elevated glucose levels (OR: 15.5, 95% CI: 7.4-32.9, P < 0.001). Hyperglycemia in patients undergoing cardiac catheterization is a strong predictor of adverse outcome. It is mainly related to background dysglycemia and to a lesser extent to the acute stress accompanying ACS.

Effect of cholelithiasis and cholecystectomy on serum lipids and blood glucose parameters

Background: Association between gallstone disease (GSD) and dyslipidemia has been shown in many studies. The aim of this study was to compare the serum lipid and serum glucose levels in patients with and without gallstone and also to determine changes in same parameters in gallstone patients before and after cholecystectomy. Materials and Methods: A total of 71 patients with gallstone (Group A) and 96 without gallstone (Group B) were studied prospectively. Patients in both groups were investigated for GSD. Total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-c), low density lipoprotein cholesterol (LDL-c), atherogenic index (AI) and fasting glucose (FG) levels were estimated in both groups pre-operatively. Further, same parameters were studied in Group A post-operatively at 1 week and 1 month intervals. Results: The serum levels of TC, TGs, LDL-c, AI and FG were found to be higher and levels of serum HDL-c were lower in gallstone patients than that of the control group, though not statistically significant. In patients with gallstone, significant decrease in TC, LDL-c, TG, AI and increase in HDL-c levels were observed post-cholecystectomy at both intervals. Post-operatively, rise in serum glucose levels at 1 week interval and decrease at 1 month interval were noticed in patients with GSD.Conclusion: GSD is associated with abnormal lipid profile and serum glucose. Cholecystectomy leads to a significant decrease in these parameters except HDL-c in patients with GSD. The presence of gall stones should be perceived in the context of metabolic disorder, which may be investigated and treated. Asymptomatic gallstone patients may also be treated surgically resulting in improvement of above mentioned biochemical parameters.

Risk factors for surgical site infection following spine surgery: efficacy of intraoperative saline irrigation

The purpose of this study was to identify risk factors for surgical site infection after spine surgery, noting the amount of saline used for intraoperative irrigation to minimize wound contamination. The authors studied 223 consecutive spine operations from January 2006 through December 2006 at our institute. For a case to meet inclusion criteria as a site infection, it needed to require surgical incision and drainage and show positive intraoperative cultures. Preoperative and intraoperative data regarding each patient were collected. Patient characteristics recorded included age, sex, and body mass index (BMI). Preoperative risk factors included preoperative hospital stay, history of smoking, presence of diabetes, and an operation for a traumatized spine. Intraoperative factors that might have been risk factors for infection were collected and analyzed; these included type of procedure, estimated blood loss, duration of operation, and mean amount of saline used for irrigation per hour. Data were subjected to univariate and multivariate logistic regression analyses. The incidence of surgical site infection in this population was 6.3%. According to the univariate analysis, there was a significant difference in the mean duration of operation and intraoperative blood loss, but not in patient age, BMI, or preoperative hospital stay. The mean amount of saline used for irrigation in the infected group was less than in the noninfected group, but was not significantly different. In the multivariate analysis, sex, advanced age (> 60 years), smoking history, and obesity (BMI > 25 kg/m(2)) did not show significant differences. In the analysis of patient characteristics, only diabetes (patients receiving any medications or insulin therapy at the time of surgery) was independently associated with an increased risk of surgical site infection (OR 4.88). In the comparison of trauma and elective surgery, trauma showed a significant association with surgical site infection (OR 9.42). In the analysis of surgical factors, a sufficient amount of saline for irrigation (mean > 2000 ml/hour) showed a strong association with the prevention of surgical site infection (OR 0.08), but prolonged operation time (> 3 hours), high blood loss (> 300 g), and instrumentation were not associated with surgical site infection. Diabetes, trauma, and insufficient intraoperative irrigation of the surgical wound were independent and direct risk factors for surgical site infection following spine surgery. To prevent surgical site infection in spine surgery, it is important to control the perioperative serum glucose levels in patients with diabetes, avoid any delay of surgery in patients with trauma, and decrease intraoperative contamination by irrigating > 2000 ml/hour of saline in all patients.

The Impact of Hyperglycemia in Patients with Severe Traumatic Brain Injury

Objective: According to a recent study, strict control of serum glucose level in patients result in decreased morbidity and mortality. But the clinical relationship of hyperglycemia in patients with severe traumatic brain injury (TBI) are controversial. So the purpose of this study was to evaluate the impact of hyperglycemia in patients with severe TBI. Methods: The authors performed a retrospective 68 chart reviews of severe TBI [Glasgow Coma Scale (GCS), score ≤8] who were admitted to the department of neurosurgery from January 2007 to December 2009. The age, sex, GCS score, injury severity score (ISS), initial serum blood glucose level, abbreviated injury score (AIS) head, length of stay in intensive care unit (ICU), body mass index (BMI) infection morbidity and mortality were mesured. The patients were divided into two groups by their serum glocose level (<200 mg/dL, ≥200 mg/dL). Patients with diabetes mellitus or below age of 18 was excluded from the study. Results: Patients’ age was from 19 to 84 years with a mean age of 53.7±19.17 years. There were 44 males (64.7%) and 24 females (35.3%). The average of GCS score was 5.3±1.8, ISS was 37.2±8.3, AIS was 5.3±0.7. Length of stay in ICU was 14.6±16.8 days, BMI was 22.3±2.9 and the average of serum blood glucose level was 197.4±72.9 mg/dL. Infection rate was 25% and death rate was 48.5%. Hyperglycemic group (≥200 mg/dL) had higher infection morbidity (13.2 vs. 11.7%, p<0.01) and mortality (28.0 vs. 20.1%, p<0.01) compared to nonhyperglycemic group. Univariate analysis showed that GCS score, length of ICU stays and hyperglycemia (≥200 mg/dL) was associated with infection morbidity and mortality (p<0.01). Conculusion: Initial hyperglycemia (≥200 mg/dL) is associated higher infection morbidity and mortality in patients with severe TBI. Strict control of early blood glucose level may be an important factor to improve outcomes of severe traumatic brain injury patients. (J Kor Neurotraumatol Soc 2010;6:23-26)

Recombinant human insulin-like growth factor I (rhIGF I) reduces hyperglycaemia in patients with extreme insulin resistance

The syndrome of type A insulin resistance is encountered in young women and is characterized by glucose intolerance or frank diabetes mellitus, endogenous hyperinsulinism, insensitivity to insulin administration, acanthosis nigricans and virilization. The insulin resistance is due to reduced cellular insulin binding because of a lack of or defective binding sites and/or because the interaction with the tyrosine kinase of the beta-subunit is hindered. This study was undertaken to find out whether hyperglycaemia in these patients may be influenced by the administration of recombinant human insulin-like growth factor I which exerts insulin-like effects through the insulin receptor as well as the type 1 insulin-like growth factor I receptor. Recombinant human insulin-like growth factor I was intravenously administered in two subsequent doses of 100 micrograms/kg body weight to three women with type A insulin resistance. An immediate but slow fall of blood glucose was observed. The glucose disappearance rate was 28.0 mumol/min, i.e. considerably lower than that seen in healthy subjects. The markedly elevated insulin and C-peptide levels fell in a parallel manner to blood glucose but not to normal levels. The results show that recombinant human insulin-like growth factor I, presumably by reacting with the type 1 insulin-like growth factor receptor, can normalize serum glucose levels in patients with severe insulin resistance at least for several hours. We suggest that the potential or recombinant human insulin-like growth factor I to control hyperglycaemia in type A insulin resistant patients should be explored in more depth.