Uncomplicated Diabetes Research Articles

Determinants of quality of life of patients with uncomplicated diabetes mellitus attending endocrinology clinic, UNIOSUN Teaching Hospital, Osogbo, Osun State

Introduction: Diabetes Mellitus (DM) is a chronic metabolic disorder that poses significant problems to individuals living with it. The emotional anguish and psychological impact of DM on patients' quality of life (QoL) contribute to poor prognosis of the condition. Therefore, the goal of this study is to examine how psychological experiences and satisfaction with diabetic care affect patients' QoL.Methods: A descriptive research survey conducted among one hundred and ten (110) diabetes patients attending the UNIOSUN Teaching Hospital's endocrinology clinic in Osun State, Nigeria between June and December, 2020. Modified Kessler psychological distress scale and World Health Organization Quality of Life Instrument (WHOQOL-BREF) were used to collect data. Data were analyzed using descriptive statistics of frequencies, percentages and tables, while inferential statistics of chi-square was used to test the stated hypothesis at 0.05 level of significance.Results: The results showed that more than three-fourth of the patients had negative social 83(75.5%) and psychological 79 (71.8%) experiences with diabetic care, though majority 68(61.8%) demonstrated good quality of life. The result also showed a positive relationship between psychological experience and quality of life (x2=9.766; df=1; p-value=0.001) as well as social experiences and quality of life (x2=4.576; df=1; p-value=0.032). More so, socio-demographic characteristics of age, gender, marital status, level of education, occupation and income were significantly associated with quality of life of diabetes patients.Conclusion: Overall quality of life of diabetes patients was observed to be good, although majority of diabetes patient had negative social and psychological experiences. Therefore, efforts to improve diabetic care must be intensified in clinical settings to promote good health outcomes and prevent negative social and psychological impact of diabetes mellitus.

Diabetes associated with higher health care utilization and poor outcomes after COPD-related hospitalizations.

Readmissions after hospitalizations for acute exacerbation of chronic obstructive pulmonary disease (COPD) have a high socioeconomic burden. Comorbidities such as diabetes increase the risk for hospital readmissions, but the impact of diabetes on hospital outcomes remains unknown. The aim of this study was to evaluate the effect of complicated or uncomplicated diabetes on outcomes and health care costs related to admissions and readmissions in patients 35 years and older with an index admission for COPD. This was a retrospective longitudinal data analysis. We analyzed data from the Healthcare Cost and Utilization Project (HCUP) Nationwide Readmissions Database. We analyzed the 2012-2015 HCUP Nationwide Readmissions Database and used multivariable weighted regression analyses to adjust for confounding factors. Individuals with any chronic pulmonary disease other than COPD were excluded. Of 1,728,931 patients hospitalized for COPD, 522,020 (30.2%) had a diagnosis of diabetes. Risk of all-cause 30-day readmission was higher among patients with complicated diabetes (adjusted odds ratio [OR], 1.15; 95% CI, 1.11-1.18) and uncomplicated diabetes (adjusted OR, 1.10; 95% CI, 1.08-1.12) compared with patients without diabetes. Diabetes was associated with longer length of stay, higher rates of hospital complications during index hospitalizations and 30-day readmissions, and a higher health care cost. Although diabetes was not associated with higher hospital mortality, routine hospital discharges were less common and the need for home health care upon discharge was higher among those with diabetes. Patients hospitalized for COPD and coexisting diabetes have worse clinical outcomes and higher 30-day readmissions compared with patients hospitalized for COPD without diabetes. Optimizing medical therapies and targeted interventions for both diseases is needed to alleviate disease burden to individuals and to society.

Perioperative Ischemic Optic Neuropathy after Cardiac Surgery: Development and Validation of a Preoperative Risk Prediction Model

ObjectivePrevious studies identified risk factors for ischemic optic neuropathy (ION) after cardiac surgery; however, there is no easy-to-use risk calculator for the physician to identify high-risk patients for ION before cardiac surgery. The authors sought to develop and validate a simple-to-use predictive model and calculator to assist with preoperative identification of risk and informed consent for this rare but serious complication. DesignRetrospective case-control study. SettingHospital discharge records. PatientsA total of 5,561,177 discharges in the National Inpatient Sample >18 years of age, with procedure codes for coronary artery bypass grafting, heart valve repair/replacement, or left ventricular assist device insertion. InterventionsAll patients had undergone cardiac surgery. Measurements and Main ResultsKnown preoperative risk factors for ION after cardiac surgery were assessed to develop a risk score and prediction model. This model was validated internally using the split-sample method. There were 771 cases of ION among 5,561,177 patients in the National Inpatient Sample. The risk factors for ION used in the model were carotid artery stenosis, cataract, diabetic retinopathy, macular degeneration, glaucoma, male sex, and prior stroke; whereas uncomplicated diabetes decreased risk. With the internal validation, the predictive model had an area under the receiver operating characteristic curve of 0.66. A risk score cutoff ≥3 had 98.4% specificity. ConclusionsThis predictive model, based on previously identified preoperative factors, predicted risk of perioperative ION with a fair area under the receiver operating characteristic curve. This predictive model could enable screening to provide a more accurate risk assessment for ION, and consent process for cardiac surgery.

Possibilities of Multilayer Perceptron in Complexing Risk Factors of Diabetic Foot Syndrome.

The levels of markers of endothelial dysfunction, MMP9, and polymorphisms of genes of vascular tone regulation factors, platelet receptors, vascular wall remodeling and prothrombotic factors, and markers of endothelial dysfunction were studied in patients with complicated and uncomplicated diabetes mellitus. It was found that the neural network analysis of these data makes it possible to predict the development of diabetic foot syndrome with an accuracy of 92.9%. The high accuracy of neural network analysis is due to the multifactorial nature of the diabetic foot syndrome.

Multimorbidity Profile of COVID-19 Deaths in Portugal during 2020.

Background: COVID-19 is caused by SARS-CoV-2 infection and has reached pandemic proportions. Since then, several clinical characteristics have been associated with poor outcomes. This study aimed to describe the morbidity profile of COVID-19 deaths in Portugal. Methods: A study was performed including deaths certificated in Portugal with “COVID-19” (ICD-10: U07.1 or U07.2) coded as the underlying cause of death from the National e-Death Certificates Information System between 16 March and 31 December 2020. Comorbidities were derived from ICD-10 codes using the Charlson and Elixhauser indexes. The resident Portuguese population estimates for 2020 were used. Results: The study included 6701 deaths (death rate: 65.1 deaths/100,000 inhabitants), predominantly males (72.1). The male-to-female mortality ratio was 1.1. The male-to-female mortality rate ratio was 1.2; however, within age groups, it varied 5.0–11.4-fold. COVID-19 deaths in Portugal during 2020 occurred mainly in individuals aged 80 years or older, predominantly in public healthcare institutions. Uncomplicated hypertension, uncomplicated diabetes mellitus, congestive heart failure, renal failure, cardiac arrhythmias, dementia, and cerebrovascular disease were observed among COVID-19 deceased patients, with prevalences higher than 10%. A high prevalence of zero morbidities was registered using both the Elixhauser and Charlson comorbidities lists (above 40.2%). Nevertheless, high multimorbidity was also identified at the time of COVID-19 death (about 36.5%). Higher multimorbidity levels were observed in men, increasing with age up to 80 years old. Zero-morbidity prevalence and high multimorbidity prevalences varied throughout the year 2020, seemingly more elevated in the mortality waves’ peaks, suggesting variation according to the degree of disease incidence at a given period. Conclusions: This study provides detailed sociodemographic and clinical information on all certificated deaths from COVID-19 in Portugal during 2020, showing complex and extreme levels of morbidity (zero-morbidity vs. high multimorbidity) dynamics during the first year of the pandemic in Portugal.

Comparison in Macular Thickness between Non diabetic and Uncomplicated Diabetics after Uncomplicated Phacoemulsification

Comparison in Macular Thickness between Non diabetic and Uncomplicated Diabetics after Uncomplicated Phacoemulsification

A study of behaviour for fractional order diabetes model via the nonsingular kernel

<abstract><p>A susceptible diabetes comorbidity model was used in the mathematical treatment to explain the predominance of mellitus. In the susceptible diabetes comorbidity model, diabetic patients were divided into three groups: susceptible diabetes, uncomplicated diabetics, and complicated diabetics. In this research, we investigate the susceptible diabetes comorbidity model and its intricacy via the Atangana-Baleanu fractional derivative operator in the Caputo sense (ABC). The analysis backs up the idea that the aforesaid fractional order technique plays an important role in predicting whether or not a person will develop diabetes after a substantial immunological assault. Using the fixed point postulates, several theoretic outcomes of existence and Ulam's stability are proposed for the susceptible diabetes comorbidity model. Meanwhile, a mathematical approach is provided for determining the numerical solution of the developed framework employing the Adams type predictor–corrector algorithm for the ABC-fractional integral operator. Numerous mathematical representations correlating to multiple fractional orders are shown. It brings up the prospect of employing this structure to generate framework regulators for glucose metabolism in type 2 diabetes mellitus patients.</p></abstract>

Oxidative Status and Insulin Resistance in Diabetic Retinopathy: Effect of Natural Antioxidants

The homeostatic model assessment (HOMA) Index was found to be increased both in uncomplicated diabetes mellitus and in diabetic retinopathy indicating the degrees of insulin resistance. Malondialdehyde as a biomarker for oxidative stress has also been found in these groups with a decreased tolerance to glucose load. When these groups were further analyzed and compared according to their insulin status, it was observed that hyperinsulinemia in diabetic retinopathy enhanced the level of oxidative stress with a decrease in plasma ascorbic acid and an increase of plasma dehydroascorbic acid level, paralleling the levels of malondialdehyde in these patients. The role of natural antioxidants e.g. ascorbic acid, Vitamin E and mixed carotenoids in lessening insulin has been discussed. It seems that ascorbic acid is a better antioxidant in comparison to other antioxidants in normalization of insulin resistance and glucose utilization. A persistent long-standing insulin resistance has been suggested as one of the responsible factors for vascular complications in diabetic retinopathy. Dehydroascorbic acid seems to be a better sensitive biomarker for oxidative stress.

Urine proteomics identifies biomarkers for diabetic kidney disease at different stages

BackgroundType 2 diabetic kidney disease is the most common cause of chronic kidney diseases (CKD) and end-stage renal diseases (ESRD). Although kidney biopsy is considered as the ‘gold standard’ for diabetic kidney disease (DKD) diagnosis, it is an invasive procedure, and the diagnosis can be influenced by sampling bias and personal judgement. It is desirable to establish a non-invasive procedure that can complement kidney biopsy in diagnosis and tracking the DKD progress.MethodsIn this cross-sectional study, we collected 252 urine samples, including 134 uncomplicated diabetes, 65 DKD, 40 CKD without diabetes and 13 follow-up diabetic samples, and analyzed the urine proteomes with liquid chromatography coupled with tandem mass spectrometry (LC–MS/MS). We built logistic regression models to distinguish uncomplicated diabetes, DKD and other CKDs.ResultsWe quantified 559 ± 202 gene products (GPs) (Mean ± SD) on a single sample and 2946 GPs in total. Based on logistic regression models, DKD patients could be differentiated from the uncomplicated diabetic patients with 2 urinary proteins (AUC = 0.928), and the stage 3 (DKD3) and stage 4 (DKD4) DKD patients with 3 urinary proteins (AUC = 0.949). These results were validated in an independent dataset. Finally, a 4-protein classifier identified putative pre-DKD3 patients, who showed DKD3 proteomic features but were not diagnosed by clinical standards. Follow-up studies on 11 patients indicated that 2 putative pre-DKD patients have progressed to DKD3.ConclusionsOur study demonstrated the potential for urinary proteomics as a noninvasive method for DKD diagnosis and identifying high-risk patients for progression monitoring.

Abstract 10416: Rising Trends in the Burden of Cardiovascular Comorbidities and Major Adverse Cardiovascular Events in Young Female Smokers Across Two Nationwide Cohorts Studied a Decade Apart (2017 vs. 2007)

Background: Ample evidence has suggested that female smokers are at a higher risk of smoking-related health problems compared to men. With the increasing number of young smokers in the US, there is limited data on the impact of smoking in young female smokers in the last decade. Methods: The National Inpatient Sample datasets (2007 and 2017) were utilized to identify hospitalizations among young (18-44 years) female tobacco smokers. We compared differences in frequency of admissions, comorbidity burden, and in-hospital outcomes (all-cause mortality and MACE) and resource utilization across two young cohorts 10-years apart. Results: A total of 1,224,479 (median age 32) admissions among young female smokers were identified in 2017 vs. 665,901 (median age 35) in 2007. Both cohorts showed the majority of admissions among white female smokers, followed by African Americans (Table 1) . Compared to the 2007 cohort, the rate of alcohol abuse, hyperlipidemia, uncomplicated diabetes and chronic pulmonary disease decreased inn 2017, whereas a rising trend was observed for deficiency and chronic blood loss anemias, diabetes with complications, drug abuse, hypertension, congestive heart failure, depression, liver disease, and obesity (p<0.001). On adjusted multivariable analysis, the 2017 cohort showed significantly higher odds of all-cause mortality [aOR 1.25 (95%CI: 1.16-1.35)] with a higher risk of MACE [aOR 1.17 (95%CI:1.14-1.20)] (p<0.001). There were fewer routine discharges and higher requirements of home health care in the 2017 cohort vs. 2007. Conclusion: The study reveals escalating trends in the burden of comorbidities, MACE and healthcare resource utilization in admissions (irrespective of primary cause) among young female smokers in this decade apart analysis. It is essential to raise awareness among young female smokers about the adverse impact of tobacco and associated polysubstance abuse on cardiovascular outcomes.

Cost-effectiveness of population-based screening for diabetes and hypertension in India: an economic modelling study

India faces a high burden of diabetes and hypertension. Currently, there is a dearth of economic evidence about screening programmes, affected age groups, and frequency of screening for these diseases in Indian settings. We assessed the cost effectiveness of population-based screening for diabetes and hypertension compared with current practice in India for different scenarios, according to type of screening test, population age group, and pattern of health-care use. We used a hybrid decision model (decision tree and Markov model) to estimate the lifetime costs and consequences from a societal perspective. A meta-analysis was done to assess the effectiveness of population-based screening. Primary data were collected from two Indian states (Haryana and Tamil Nadu) to assess the cost of screening. The data from the National Health System Cost Database and the Costing of Health Services in India study were used to determine the health system cost of diagnostic tests and cost of treating diabetes or hypertension and their complications. A total of 962 patients were recruited to assess out-of-pocket expenditure and quality of life. Parameter uncertainty was evaluated using univariate and multivariable probabilistic sensitivity analyses. Finally, we estimated the incremental cost per quality-adjusted life-year (QALY) gained with alternative scenarios of scaling up primary health care through a health and wellness centre programme for the treatment of diabetes and hypertension. The incremental cost per QALY gained across various strategies for population-based screening for diabetes and hypertension ranged from US$0·02 million to $0·03 million. At the current pattern of health services use, none of the screening strategies of annual screening, screening every 3 years, and screening every 5 years was cost-effective at a threshold of 1-time per capita gross domestic product in India. In the scenario in which health and wellness centres provided primary care to 20% of patients who were newly diagnosed with uncomplicated diabetes or hypertension, screening the group aged between 30 and 65 years every 5 years or 3 years for either diabetes, hypertension, or a comorbid state (both diabetes and hypertension) became cost-effective. If the share of treatment for patients with newly diagnosed uncomplicated diabetes or hypertension at health and wellness centres increases to 70%, from the existing 4% at subcentres and primary health centres, annual population-based screening becomes a cost saving strategy. Population-based screening for diabetes and hypertension in India could potentially reduce time to diagnosis and treatment and be cost-effective if it is linked to comprehensive primary health care through health and wellness centres for provision of treatment to patients who screen positive. Department of Health Research, Government of India.

Direct medical cost of nephropathy in patients with type 2 diabetes.

Although it is known in the literature that the medical cost due to the complications of diabetes mellitus (DM) is high, data about the effect of diabetic kidney disease (DKD) on medical cost are limited. The aim of this study is to investigate the cost of hospitalized patients with nephropathy due to type 2 DM, the parameters closely related to this cost and the effect of diabetic nephropathy stage on medical hospitalization costs. The study group consisted of 141 patients with DKD, and the control group consisted of 111 patients with DM without chronic complications in this retrospective study. The demographic characteristics, duration of diabetes and HbA1c values of the patients were recorded at the time of their first hospitalization, medical hospitalization costs, and the length of stay in hospital were recorded for a year from the date of hospitalization. The total medical hospitalization costs of the patients were divided into two groups as cost of medications and supplies and service cost. Patients with DKD were compared according to their dialysis status and nephropathy stages. While the average cost of a patient with DKD was 603 (283-1267) United States Dollars (USD), the average cost of a DM patient without complications was 222 (141-292) USD (p < 0.05). It was observed that the patients with DKD had higher medical hospitalization costs and length of stay in hospital compared to patients with diabetes without complications. In addition, it was observed that the medical hospitalization costs and the length of stay in hospital were significantly higher in patients undergoing dialysis than patients who did not undergo dialysis (p < 0.05 for each). An independent relation was found between average cost and duration of diabetes in patients with DKD (p < 0.05). No relation was found between diabetic nephropathy stage and medical hospitalization costs (p > 0.05 for each). The estimated cost of treatment of DKD is higher than patients with uncomplicated diabetes. If preventive measures are not taken for DKD, it will continue to be a heavy economic burden.

Analysis of the association of polymorphisms of genes markers functions of endothelium and vascular-plate hemostasis with development of diabetic foot syndrome

The aim. To study the prevalence of various combinations of polymorphic variants of genes markers of endothelial function and vascular-platelet hemostasis in the development of diabetic foot syndrome.Materials and methods. In 198 patients with uncomplicated diabetes mellitus and 199 patients with diabetic foot syndrome, the frequency of polymorphic variants of the NOS 786C&gt;T, END1 Lys198Asn, ITGB3 1565T&gt;C (Leu33Pro), F5 1691G&gt;A, F2 20210G&gt;A, MMP9 8202A&gt;G, MTHFR 1298A&gt;C, VEGFA-634C&gt;G genes was studied. Using binary logistic regression analysis, the relationship of various combinations of polymorphisms of the studied genes with the development of diabetic foot was assessed.Results. In diabetic foot syndrome, the most significant contribution is made by the combination of polymorphic variants of the ITGB3 1565T&gt;C (Leu33Pro) and MTHFR 1298A&gt;C genes. With the development of this complication of diabetes mellitus, a combination of the 1565 TC polymorphism of gene ITGB3 and the 1298AA polymorphism of gene MTHFR is 2.1 times more common. The association of the 1565TT polymorphism of gene ITGB3 and the 1298AC polymorphism of gene MTHFR is 2 times more common in diabetes mellitus without complications.Conclusion. The combination of the 1565TС polymorphism of gene ITGB3 and the 1298АА polymorphism of gene MTHFR is associated with the risk of developing a diabetic foot and increases the risk of developing this complication by 2.4 times. The presence of a combination of the 1565TT polymorphisms of gene ITGB3 and the 1298AC polymorphism of gene MTHFR is more common in uncomplicated diabetes mellitus, which suggests its protective effect against the development of diabetic foot syndrome.

Review article: Diagnosing acute pancreatitis in diabetes mellitus.

Acute pancreatitis is a common reason for presentation to EDs. The criteria for diagnosis of acute pancreatitis are defined by the revised Atlanta classification. Patients with diabetes mellitus are at increased risk of acute pancreatitis. Uncomplicated diabetes mellitus, complications such as ketoacidosis and newer medications used in the treatment of hyperglycaemia may all be associated with elevated serum lipase and amylase in the absence of acute pancreatitis. Checkpoint inhibitors may also precipitate acute type 1 diabetes mellitus and be associated with elevated lipase and amylase. Finally, individuals with diabetes mellitus are at increased risk of hypertriglyceridaemic pancreatitis, which may be associated with falsely normal lipase and amylase because of laboratory interference. Awareness of these factors in individuals with diabetes mellitus presenting to EDs with symptoms suggestive of acute pancreatitis is important for accurate diagnosis.

РАСПРОСТРАНЕННОСТЬ ПОЛИМОРФИЗМОВ ГЕНОВ ФАКТОРОВ РЕГУЛЯЦИИ СОСУДИСТОГО ТОНУСА, РЕЦЕПТОРОВ ТРОМБОЦИТОВ, РЕМОДЕЛИРОВАНИЯ СОСУДИСТОЙ СТЕНКИ И ПРОТРОМБОТИЧЕСКИХ ФАКТОРОВ ПРИ СИНДРОМЕ ДИАБЕТИЧЕСКОЙ СТОПЫ

Objective. To analyze the frequency of occurrence of eNOS 786C&gt;T, END1 Lys198Ash, ITGB3 1565T&gt;C (Leu33Pro), F5 1691G&gt;A, F2 20210G&gt;A, MMP9 8202A&gt;G, MTHFRA 1298 C,VEGFA 634C&gt;G gene polymorphisms in diabetic foot syndrome. Methods. The study included patients (n=198) with uncomplicated diabetes mellitus and patients (n=199) with the development of diabetic foot syndrome. Genotyping of the studied gene polymorphisms was performed by the polymerase chain reaction method. Results. In patients with uncomplicated diabetes mellitus and in patients with diabetic foot, no significant differences were found in the frequency of occurrence of polymorphisms 786C&gt;T of the eNOS3 gene, Lys198Ash of the END1 gene, 1691G&gt;A of the F5 gene, 20210G&gt;A of the F2 gene, 8202A&gt;G of the MMP9 gene, 634C&gt; G of the VEGFA gene and their allelic variants. Associative relationship between the polymorphisms of the NOS 786C&gt;T, END1 Lys198Ash, F5 1691G&gt;A, F2 20210G&gt;A, MMP9 8202A&gt;G, VEGFA 634C&gt;G genes and the development of diabetic foot syndrome was not found. With the development of a diabetic foot, a heterozygous variant of the 1565TС polymorphism of the ITGB3 gene was more common than in uncomplicated diabetes mellitus (37.7% and 28.3%, respectively (χ²=6.243, p=0.045)). The risk of developing a diabetic foot with the carriage of this polymorphism is 1.5 times higher than with other variants of gene polymorphism ((OR=1.534 (95% Cl 1.006 - 2.338), p&lt;0.05). Polymorphism 1298 AS of the MTHFR gene was more often detected in the group of patients with uncomplicated diabetes mellitus than in the group with the development of diabetic foot (45.4% and 29.1%), (χ²=11.55, p=0.004). Conclusion. The development of diabetic foot syndrome is associated with the carriage of the heterozygous 1565TС polymorphism of the ITGB3 gene, in which the likelihood of developing this complication increases 1.5 fold. In diabetes mellitus without complications, a more frequent carriage of the heterozygous polymorphism 1298 AC of the MTHFR gene was revealed, which may have a protective effect against the development of diabetic foot syndrome. What this paper adds The frequency of occurrence of genetic polymorphisms for regulating vascular tone, platelet receptors, vascular wall remodeling and prothrombotic factors and their allelic variants in diabetic foot syndrome was studied. It was found that the frequency of heterozygous 1565TС polymorphism of the ITGB3 gene in the development of diabetic foot is 1.3 fold higher than in the uncomplicated course of the disease. It was revealed that the fregnency of this variant of the ITGB3 gene polymorphism is associated with the risk of developing this complication of diabetes mellitus. In the presence of the heterozygous 1565TС polymorphism of the ITGB3 gene, the risk of developing diabetic foot syndrome increases by 1.5 fold than with the carriage of other variants of the T1565С polymorphism of the ITGB3 gene. It was found that in the uncomplicated course of the disease, the heterozygous genotype 1298 AC of the MTHFR gene occurs 1.6 fold more often than in the development of diabetic foot syndrome.

Hospital outcomes in pediatric patients with Prader–Willi syndrome (PWS) undergoing orthopedic surgery: A 12-year analysis of national trends in surgical management and inpatient hospital outcomes

BackgroundThe incidence of orthopedic disorders amongst patients with Prader–Willi Syndrome (PWS) is high when compared to the general pediatric population. The purpose of this retrospective study was to define the most commonly performed orthopedic procedures in pediatric patients with PWS and to characterize the peri-operative outcomes of these patients. MethodsThe Kids Inpatient Database (KID) was queried to collect data and identify all pediatric patients with PWS who underwent orthopedic procedures from 2001 to 2012. A total of 3684 patients with PWS were identified, 334 of who underwent an orthopedic procedure. Population demographics, comorbidities, and specific procedures undergone were defined. The incidences of postoperative complications and length of associated hospital stay were additionally evaluated. ResultsMean age of patients in this sample was 10.33 years (SD 4.5). The most common comorbidities included obesity (18.1%), chronic pulmonary disease (14.1%), hypothyroidism (5.1%), hypertension (5.1%), and uncomplicated diabetes (4%). Common procedures were spinal fusion (165/334, 49%) and lower extremity procedures (50/334, 15%). Complications included acute blood loss anemia, device related complications, pneumonia, sepsis, and urinary tract infections. The overall complication rate was 35.6%. Average hospital lengths of stay for patients undergoing spinal fusion was 6.68 days (SD 4.13), lower extremity orthopedic procedure was 5.65 days (SD 7.4), and all other orthopedic procedures was 7.74 days (SD 16.3). ConclusionsOrthopedic disorders are common in patients with PWS. Consequently, spinal fusions and lower extremity procedures are commonly performed in this patient population. Associated comorbid conditions may negatively impact surgical outcomes in these patients. This information should prove useful in the peri-operative management of patients with PWS undergoing orthopedic surgery and for shared decision making with families.

Arrhythmias and diabetes: heart block, ventricular arrhythmias, and death

Arrhythmias and diabetes: heart block, ventricular arrhythmias, and death

42. Do no harm: a retrospective analysis of the initial risk of complications in robotic spine surgery

<h3>BACKGROUND CONTEXT</h3> Incorporation of open and MIS robotic techniques in spine surgery has been growing over the past decade, resulting in altered surgical techniques and the need for newly developed skills. With the initial learning curve involved in using this new technology, the upfront risk of complications and poor outcomes during the learning process has been understudied in the literature. <h3>PURPOSE</h3> To evaluate the initial risk of complications with the incorporation of robotic assisted spine surgery. <h3>STUDY DESIGN/SETTING</h3> Retrospective review of a national patient database between 2007-2016. <h3>PATIENT SAMPLE</h3> A total of 3,759,824 elective spine surgery patients. <h3>OUTCOME MEASURES</h3> Comorbidity burden, perioperative complication rates, year-to-year complications, mechanical complications. <h3>METHODS</h3> Inclusion criteria: elective spine surgery procedures from 2007-2016 as defined by ICD-9-CM and ICD-10-CM codes. Exclusion criteria: emergency, trauma or nonelective surgery. Descriptive statistics assessed demographic information. Rates of open and MIS robot-assisted procedures were assessed, as well as trends in postoperative complications and length of stay. Logistic regressions were performed to see if robotic use was independently predictive of a postoperative complication. <h3>RESULTS</h3> The study included 3,759,824 elective spine surgery patients. Overall, 4,185 patients underwent robotic spine surgery (0.1%). There was a significant increase from in robotic surgery cases from 2010 to 2016 with 11 patients in 2010 to 1,535 patients in 2016 (p<0.001). During this time, 93% of robotic spine cases were open compared to 7% MIS (p<0.001). Relative to nonrobotic patients, robotic-spine patients presented with higher rates of anemia, rheumatoid arthritis, uncomplicated diabetes, hypertension, hypothyroidism, fluid and electrolyte disorders (all p<0.001). Overall, robotic-spine patients had higher overall perioperative complication rates, including cardiac, urinary and anemia (all p<0.001). Postoperatively, year-to-year overall complications in robotic surgery patients increased from 25% in 2011 to 29.6% in 2016 (p <0.001), with a high of 31.8% in 2015. Robotic-open cases compared to robotic-MIS cases were shown to have significantly higher overall complications (28.2 vs 13.6%, p<0.001), including complications associated with anemia and mechanical complications (both p<0.001). <h3>CONCLUSIONS</h3> The rise of robotic assisted spine surgery has yielded a concurrent rise in perioperative complications as surgeons adjust to this new technology. Until the learning curve lessens for incorporation of robotic techniques in spine surgery, providers should weigh MIS or open robotic procedures with an eye towards perioperative complications. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Impact of Vitamin C as an Adjuvant Agent on Glycemic Indices in Type 2 Diabetes Mellitus: Randomized Clinical Trial

Objectives: To evaluate the effects of adjuvant vitamin C therapy with oral hypoglycemic on FBS, RBS and HbA1c and to find out the correlation of Vitamin C with glycemic indices. Study Design &amp; Settings: This randomized open label clinical trial was conducted at Bahria University Medical &amp; Dental College (BUMDC) in collaboration with NMC, Karachi from October 2018 to April 2019. Methodology: A total of 160 known type -2 males and females, uncomplicated diabetics, aged 40-65 years with FBS= 200 mg/dl, HbA1c = 8.5% and diabetes duration &gt; 5years were enrolled from diabetic clinic of NMC after written informed consent. They were divided into control group and treatment group by sealed envelope technique. Control group received oral hypoglycemic drugs while treatment group received vitamin C 500 mg per orally BD with oral hypoglycemic drugs with advice of diet control and daily exercise. Patients were subjected to FBS, RBS and HbA1c at baseline and at the end of 90 days. SPSS version 23.0 was used for data analysis. The results were expressed as mean ± standard deviation (SD). P value&lt;0.05 was considered as statistically significant. Results: In control group FBS and RBS reduced by1mg /dl and 7mg/dl from day-0 to 90. In treatment group FBS reduced by 14mg/dl and RBS reduced by 21mg/dl from day-0 to 90. HbA1c increased by 0.7% in control group and decreased by 0.4 % in treatment group at the end of 90 days. Negative correlation is observed between Vitamin C and glycemic indices. Conclusion: Adjuvant vitamin C therapy with oral hypoglycemic drugs in type-2 diabetics reduced FBS, RBS and HbA1c and exhibited negative correlation with glycemic parameters.

Effects of Momordica Charantia (Karela/bitterguord) in Type 2 Diabetic Patients Taking Allopathic Drugs: A pilot study

Background Momordica charantia is evolving as supplementary therapy in type 2 diabetes mellitus. Animal studies reveal its anti-diabetic and lipid lowering property. However, clinical studies with human subjects are very few.&#x0D; Objective To find out the effects of Momordica charantia supplements on glycemic and lipid profile among type 2 diabetes mellitus patients taking allopathic drugs.&#x0D; Method A comparative study was conducted in internal medicine department of B P Koirala Institute of Health Sciences, Dharan from July 2015 to May 2016 after ethical clearance. Twenty two uncomplicated type-2 diabetes mellitus patients were enrolled. Group A patients were supplemented with allopathic drug (oral anti-diabetic agents) only and Group B with add on treatment of 200 ml juice of Momordica charantia along with allopathic drug daily for ninety days. Fasting, post prandial blood sugar and lipid profile levels were compared between baseline and ninety days post supplementation. Data was collected and entry was done in Statistical Packages for Social Services version 20.0, using independent t test with p &lt; 0.05.&#x0D; Result Add on treatment with 200 ml of Momordica charantia along with anti-diabetic drug daily significantly reduced fasting (p= &lt; 0.0001) and post prandial blood sugar (p=&lt; 0.0001). Treatment with anti-diabetic drugs only reduced fasting (p = 0.0008) and post-prandial blood sugar but the reduction was not significant ((p =0.0001). There was improvement in lipid profile by both anti-diabetic drugs alone and Momordica charantia along with anti-diabetic drug, but it was not significant.&#x0D; Conclusion Add on treatment with 200 ml/day juice of Momordica charantia is effective in glycaemic control in type-2 diabetes mellitus patients as compared to the allopathic treatment alone.