Uncontrolled Diabetes Mellitus Research Articles

Tsukamurella Bacteremia in a Surgical Patient: Case Report and Review of the Literature.

Background: Tsukamurella species were first isolated in 1941. Since then, 48 cases of Tsukamurella bacteremia have been reported, a majority of which were immunosuppressed patients with central venous catheters.A case is described and previous cases of Tsukamurella bacteremia are reviewed. Patients and Methods: A 70-year-old total parenteral nutrition (TPN)-dependent female with recurrent enterocutaneous fistula (ECF), developed leukocytosis one week after a challenging ECF takedown. After starting broad-spectrum antibiotic agents, undergoing percutaneous drainage of intra-abdominal abscess, and subsequent repositioning of the drain, her leukocytosis resolved. Blood and peripherally inserted central catheter (PICC) cultures grew Tsukamurella spp. The patient was discharged to home with 14 days of daily 2 g ceftriaxone, with resolution of bacteremia. Conclusions: Tsukamurella spp. are a rare opportunistic pathogen predominantly affecting immunocompromised patients, with central venous catheters present in most cases. However, there have been few reported cases in immunocompetent individuals with predisposing conditions such as end-stage renal disease and uncontrolled diabetes mellitus.

Abstract PO1-20-04: STX-478-101: A phase 1/2, first-in-human study of STX-478 monotherapy or in combination with fulvestrant in patients with breast cancer or other advanced solid tumors (trial in progress)

Abstract Background: The phosphoinositide 3-kinase-alpha (PI3Kα)/AKT/mTOR pathway is one of the major pathways in oncogenesis. PI3Kα alterations are especially prevalent in breast, gynecological, and head and neck squamous cell carcinomas. PI3Kα oncogenic mutations are highly enriched for kinase (H1047X) and helical (E542K, E545K) domain hotspots. The therapeutic potential of isoform-selective PI3Kα inhibition in PI3Kα-mutant cancers was established with alpelisib, which shows equipotent activity against both wild-type (WT) and mutant PI3Kα. However, alpelisib use is limited by toxicities induced by WT PI3Kα inhibition, e.g. hyperglycemia and mucositis. This suggests that mutant-selective PI3Kα inhibitors have the potential to improve efficacy while sparing WT-related toxicity. STX-478 is an investigational allosteric, mutant-selective PI3Kα inhibitor. Preclinical testing in human breast cancer xenografts bearing helical- or kinase-domain mutant PI3Kα demonstrated that STX-478 monotherapy and combinations with fulvestrant and/or CDK4/6 inhibitors provided robust efficacy without the metabolic dysfunction observed with alpelisib. Trial Design: This first-in-human, multicenter, phase 1/2 study (NCT05768139) evaluates the optimal dosing, safety, and preliminary efficacy of STX-478 as monotherapy in patients with locally-advanced or metastatic HR+/HER2− breast cancer or other solid tumor types with PI3Kα H1047X mutations, other kinase domain mutations, or helical domain mutations (Part 1), and STX-478 in combination with fulvestrant in patients with locally-advanced or metastatic HR+/HER2− breast cancer with PI3Kα H1047X or other kinase domain mutations (Part 2). Part 1 comprises 2 subparts (Table 1) to define the optimally biologically active dose (OBD) and maximum tolerated dose (MTD) in Part 1.1, and recommended phase 2 dose (RP2D) of STX-478 monotherapy in Part 1.2. At the conclusion of each dose-level in Part 1.1 (3 + 3 design), a backfill cohort will be initiated in patients with HR+/HER2− breast cancer with PI3Kα H1047X mutations or other kinase domain mutations, who will receive STX-478 at the determined safe dose. Part 2 comprises two subparts (Table 2) to define RP2D and assess the initial efficacy of STX-478 in combination with fulvestrant in patients with HR+/HER2− breast cancer expressing PI3Kα H1047X or other kinase domain mutations. Key Eligibility Criteria: Adults with a PI3Kα-mutant advanced or refractory solid tumor malignancy that is metastatic or locally advanced and unresectable, ECOG performance status score of 0–1, and no prior PI3K/AKT/mTOR inhibitor(s) use (except with prior intolerance) are eligible. Individuals with diabetes mellitus type 1 or uncontrolled diabetes mellitus type 2 are excluded. Cohort-specific eligibility criteria are provided in Tables 1 and 2. Endpoints: Efficacy, safety, pharmacokinetics, pharmacodynamics, patient-reported quality of life, and biomarkers (e.g., glucose metabolism, circulating tumor DNA) will be assessed. Trial Status: Recruitment opened April 2023 in the US and is ongoing, with potential for ex-US site expansion. Contact clinicaltrials@scorpiontx.com for additional information. Table 1. Part 1 Dose Escalation, RP2D Selection, and RP2D Expansion (STX-478 Monotherapy) Table 2. Part 2 RP2D Selection and Expansion (STX-478 + Fulvestrant Combination Therapy) Citation Format: Alberto Montero, Douglas Orr, Pamela Munster, Patricia LoRusso, Komal Jhaveri, Timothy Pluard, Ira Winer, Michael Streit, Monica Patterson, Simon Roberts, Stefani Corsi-Travali, Courtney Ewert, Dejan Juric. STX-478-101: A phase 1/2, first-in-human study of STX-478 monotherapy or in combination with fulvestrant in patients with breast cancer or other advanced solid tumors (trial in progress) [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-20-04.

Headache and Vision Loss as Initial Symptoms for an Acute Invasive Rhino-orbital-cerebral Mucormycosis

Background: Acute invasive rhino-orbital-cerebral mucormycosis (ROCM) is a rare fungal infection commonly caused by Rhizopus species. It occurs in immune- compromised individuals who have acquired immune deficiency syndrome (AIDS), leukemia, uncontrolled diabetes mellitus, or organ transplant patients who are on immunosuppressive therapy. Diagnosing invasive ROCM is challenging because its clinical presentation can be nonspecific, and it is not frequently observed in ophthalmic practices. Case Report: A 66-year-old Hispanic male with poorly controlled diabetes mellitus presented with the complaint of severe headache and retrobulbar pain in the right eye. An ophthalmic examination revealed normal ocular health in both eyes. Computerized tomography scan showed mild inflammatory mucosal thickening in the sinuses. Initially, he was diagnosed and treated for giant cell arteritis. The patient’s vision deteriorated to no light perception in the right eye with persistent 10 out of 10 headache and eye pain despite various treatments. Further evaluation revealed ROCM involving the sphenoid sinus. This was confirmed by a positive smear and culture of Rhizopus species from the sinus and from the patient’s symptoms improving with antifungal treatment. Conclusion: Sphenoid sinusitis is an unusual site of involvement with ROCM. The absence of nasal drainage adds to the difficulty of diagnosis without contrast imaging. Although rare, acute invasive ROCM should always be considered in any uncontrolled diabetic or immunosuppressed patient with acute headache and vision loss.

Insights on MDR Mechanism of Pseudomonas aeruginosa with Emphasis on Diabetic Foot Ulcer in the Indian Subcontinent

Diabetic foot ulcers (DFU) in patients with uncontrolled diabetes mellitus are considered a global public health menace that is highly associated with morbidity and mortality. Pathogenic microorganisms entrenched deep into diabetic foot wounds are the causative agents for delayed healing and escalation of diabetic foot wound severity. Pseudomonas aeruginosa is a common opportunistic pathogen associated with several nosocomial infections, cystic fibrosis, and one of the most critical pathogens often isolated from acute and chronic diabetic foot ulcers. The organism can exhibit resistance to a wide range of antibiotics like ciprofloxacin, cefotaxime, and meropenem, thereby causing severe damage to the host tissues, followed by amputation of the affected foot region. Due to their ability to synthesize biofilms, the wound becomes more chronic and incurable, posing a serious threat to immunocompromised diabetic patients. This review highlights on the insights of pathophysiology and microbiological profile of Diabetic foot ulcers, the resistance mechanisms, and the therapeutics available for dealing with drug-resistant Pseudomonas, which could help clinicians in treating DFUs.

The Effectiveness of Wound Dressing with Virana Sanjeevi Thailam (VST) in the Management of Madhumegha Viranam – A Case Report

Diabetic foot ulcer (DFU) is one of the most prevalent consequences for those with uncontrolled diabetes mellitus (DM). The annual incidence of DFU worldwide is between 9.1 to 26.1 million, the mortality and morbidity are the common reasons for hospitalisation of diabetes patients. The available treatment modalities are expensive and unsatisfactory in the clinical management of DFU. In Siddha system of medicine Diabetic ulcers are referred to as Madhumegha Viranam (MV). Various thailam (medicated oil) are used in the management of ulcers. Virana Sanjeevi thailam (VST) is one of the classical Siddha topical formulations indicated for the management of chronic ulcers. As this thailam is not been subjected to clinical evaluation yet, this case study is to report the effectiveness of wound dressing with VST along with adjuvant Siddha medications in 60 years old, post-menopausal, house wife who reported with complaints of ulcer in the plantar aspect of right foot for a period of 6 months, along with a past history of diabetes and systemic hypertension undergoing modern treatment for the past 10 years. The patient was diagnosed to have MV and the ulcer had features of Grade 2 in Maggit Wagner system of classification of diabetic ulcers, wound area was 12cm2, with pale granulation tissues and purulent discharges. Following treatment, ulcer healed completely in a span of 86 days and Leg Ulcer Measurement Tool score improved from 41/68 to 3/68. This may encourage the use of Siddha medicines in management of DFUs. 

IJCM_279A: Evaluation of diabetes mellitus as a risk factor for urinary tract infection in women: A case control study

Background: Diabetes mellitus (DM) disrupts insulin production and function leads to hyperglycaemia and subsequently exacerbating the risk of complications. Studies highlight hyperglycaemia’s impact on neutrophil function, predisposing diabetic patients to severe infections like pneumonia, urinary tract infections (UTIs), and skin issues. Objectives: To quantify DM’s contribution to UTI development, and to assess the risk of contracting UTI conferred by diabetes mellitus in otherwise healthy women and to characterize the UTI in the cases. Methodology: The case control study was conducted among 200 participants (100 cases with UTI and 100 controls without UTI) from 3 hospitals affiliated to Kasturba Medical College, Mangalore. The data were collected using a structured proforma. Chi – square test and students ‘t’ test was used for comparison of the results across the groups. Results: Patients with urinary tract infections (UTI) showed a higher prevalence of diabetes mellitus (DM) (27.66%) compared to controls (7.45%). The UTI patients were 4.75 times more likely to have DM. Diabetic UTI cases exhibited elevated glycated haemoglobin (HbA1C) and random blood sugar levels than controls. Complicated UTIs were more prevalent in diabetic (77%) than non-diabetic (60%) UTI cases, with E. coli being the most common infecting organism. Conclusion: The uncontrolled diabetes mellitus confers an increased risk of developing UTI and the risk of developing UTI caused by organisms which are not known to cause infections in people with normal immunity (like Candida species). Additionally, diabetics show a higher proportion of complicated UTI cases as compared to non-diabetics.

Effect of Uncontrolled Type-II Diabetes Mellitus and Its Duration on Nerve Conduction Parameters in Adult Sudanese Patients in Khartoum State

Effect of Uncontrolled Type-II Diabetes Mellitus and Its Duration on Nerve Conduction Parameters in Adult Sudanese Patients in Khartoum State

Holoprozencefalie lobară asociată diabetului zaharat matern – prezentare de caz

Holoprosencephaly is a brain abnormality resulting from an incomplete cleavage of the prosencephalon during early embryogenesis. Uncontrolled maternal diabetes mellitus is one of the strongest human teratogens and the most well-known cause of holoprosencephaly. We report a rare case of holoprosencephaly in a male fetus in a preexisting diabetic pregnancy. The diagnosis of the holoprosencephaly was established by ultrasound scan and MRI data.  

Clinical performance of 170 frictional Morse taper implants: 2 years follow-up.

This study evaluated clinical survival rates of 170 Morse taper implants through clinical and mechanical parameters in different therapeutic approaches such as single crowns, fixed partial prostheses and fixed full-arch prostheses. Patients referred to the Center on Education and Research on Dental Implants from May 2017 to July 2018 with the indication for dental implants therapy, aged >18 years, without periodontal disease, recent evidence of inflammatory activity or other oral disorders, current pregnancy, uncontrolled diabetes mellitus or heavy smoking habit were included in this study. After 12 weeks of healing since the implants were placed in the mandible and after 16 weeks following implants placed in the maxilla, patients returned to the Center for prosthetic rehabilitation. After implant therapy, all patients underwent periodical, clinical and prosthetic examinations every six months. The implant was used as a unit of evaluation for all analysis parameters. Prosthetic restorations involved 109 fixed reconstructions in function. Few prosthetic complications were reported (6.55%). Twenty implants were rehabilitated with cemented prostheses; from those, one crown suffered a loss in retention/decementation. Of the 148 implants rehabilitated with screwed-retained prostheses, 6.76% suffered prosthetic screw loosening. The cumulative implant survival rate was 98.2%. When peri-implant tissue health was evaluated, the keratinized mucosa band appeared to be related to peri-implant tissue stability. Thus, Morse taper implants represented a successful procedure for implant rehabilitation, with a high cumulative implant survival rate, low prevalence of biological and prosthetic complications and good stability of peri-implant tissues over the period assessed.

(068) The Men’s Training Cup Keep Training: A Masturbation Aid Improves Intravaginal Ejaculatory Latency Time and Erection Hardness Score in Patients who are Unable to Delay Ejaculation

Abstract Introduction Premature ejaculation (PE) has negative personal consequences, such as distress, bother, frustration, and/or the avoidance of sexual intimacy. In Japan, no oral drugs or devices are approved or used clinically to treat PE. The Men’s Training Cup Keep Training (MTCK), a masturbation aid, was developed for PE. MTCK offers 5 grades of tightness and strength. Objective We aimed to investigate the efficacy of the MTCK in patients who are unable to delay ejaculation. Methods Inclusion criteria were 20- to 60-year-old men feeling distressed and frustrated by PE and who had the same sexual partners throughout the study period. Exclusion criteria were neurologic disease and uncontrolled diabetes mellitus, as well as the use of antidepressants, α-blockers, and 5α-reductase inhibitors. The protocol comprised an 8-week training period with the MTCK from level 1 to level5, with each level used twice before moving to the next level. The main outcome measure was the extension of intravaginal ejaculation latency time (IELT). The secondary outcome measures were score improvements on the Premature Ejaculation Diagnostic Tool, Sexual Health Inventory for Men, Erection Hardness Score, and Difficulty in Performing Sexual Intercourse Questionnaire–5. Results We enrolled 37 patients, and after 19 patients withdrew, 18 concluded the study without experiencing any adverse events. The mean patient age was 39.9 years. Geometric IELT after the 8 week training with the MTCK increased significantly (mean ± SE; 232.10 ± 72.16 seconds) vs baseline (103.91 ± 50.61 seconds, P=.006). Mean scores on the Premature Ejaculation Diagnostic Tool, Difficulty in Performing Sexual Intercourse Questionnaire–5, and Erection Hardness Score after 8-week training improved significantly vs the baseline values. The mean score on the Sexual Health Inventory for Men did not improve significantly after the 8-week training, but domain 1 did significantly improve after 8 weeks of MTCK use. Conclusions The MTCK may be one possible treatment option for patients who are unable to delay ejaculation. Also, the MTCK may offer benefits for erectile function. Disclosure No.

Effect of Topical Recombinant Human Nerve Growth Factor on Corneal Epithelial Regeneration in Refractory Epithelial Keratopathy

ABSTRACT Purpose To report the effect of topical application of recombinant human nerve growth factor (rhNGF) eye drops on corneal epithelial regeneration in patients with refractory epitheliopathy. Methods A retrospective chart review was conducted on patients treated with topical rhNGF for refractory epithelial keratopathy due to stage I neurotrophic keratitis (NK). Data regarding demographics and ocular/systemic past medical history was extracted from patient charts. Visual acuity and corneal staining scores were recorded at baseline and subsequent follow-up visits at 8 weeks and 3 months. Measurements from the worse eye were used to compare before and after treatment values. Results We identified 14 patients (median age 68 years, 21% male) who received rhNGF treatment for refractory epithelial keratopathy. After an 8-week treatment with topical rhNGF, the median corneal staining score in the worse eye improved from 4 to 1 (p = 0.001). All patients showed at least one-grade improvement in corneal staining at 8 weeks, with sustained effect in seven patients at 3 months. A better response was observed in eyes with post-radiation epithelial keratopathy, LASIK, and Sjogren’s disease. Those with chronic use of other topical treatments and uncontrolled diabetes mellitus demonstrated incomplete responses. Eight patients reported mild-to-moderate ocular discomfort from drop application that fully resolved after completion of treatment. Conclusions Topical rhNGF was effective and safe for refractory epithelial keratopathy in our small cohort, but sustained effects were seen only in certain etiologies for up to 3 months. Further studies are needed for optimal dosing and duration based on underlying causes.

A Study of Relationships between the HbA1c Level and Inflammatory Markers, Neutrophil-to-Lymphocyte Ratio, and Monocyte-to-Lymphocyte Ratio in Controlled and Uncontrolled Type 2 Diabetes Mellitus.

To assess the relationship between glycated hemoglobin (HbA1c) with inflammatory markers, neutrophil-to-lymphocytes ratio (NLR), and monocyte-to-lymphocytes ratio (MLR) in controlled and uncontrolled type 2 diabetes patients. This was a hospital-based cross-sectional study conducted at the Department of Medicine, SMS Hospital, and an attached group of hospitals (Jaipur, Rajasthan, India) after informed consent from the Ethics Committee of the institute. After obtaining informed consent from patients who met the inclusion and exclusion criteria, 200 diabetic patients were included in the study using the simple randomization method. Following a detailed history and diagnosis, vital demographic information, and blood tests were collected from patients via a predesigned preliminary questionnaire. The following blood tests were collected: white blood cell (WBC), Hb, hematocrit (HCT), red cell distribution width (RDW), neutrophils, lymphocytes, HbA1c, blood glucose, NLR ratio, and MLR ratio. Data were entered and analyzed using Statistical Package for the Social Sciences version 22. The mean age of patients with controlled diabetes mellitus was 54.10 years, while that of patients with uncontrolled diabetes mellitus was 55.3 years. Glycemic control was more in the age group of 51-60 years. Around 54% of males and 46% of females were included in the present study, and no association was found between the two genders with poor and good glycemic control. Around 63.29% of participants with uncontrolled diabetes have an increased NLR, and 61.39% of participants with uncontrolled diabetes have an increased MLR. A strong association was found between the NLR and MLR with the glycemic control. Uncontrolled diabetes mellitus had a positive association with inflammatory markers, that is, NLR and MLR. Diabetes mellitus is the most common metabolic disorder in Asian countries. It leads to many acute and chronic complications in uncontrolled diabetes. Markers like the NLR ratio and MLR ratio are inexpensive and easily available for blood investigation. Hence, these markers are quite useful in differentiating controlled and uncontrolled diabetes and, therefore, useful in predicting blood sugar control in type 2 diabetes mellitus.

Factors Associated with the Development of Chronic Kidney Disease in Patients with Arterial Hypertension.

Chronic kidney disease affects a large part of the population with hypertension, diabetes mellitus as well as those over 50 years of age. Research reported that male sex and other comorbidities such as obesity and anemia are more frequent in Chronic kidney disease, as well as uncontrolled diabetes mellitus or hypertension. To determine the risk factors associated with the development of chronic kidney disease in adults with arterial hypertension. Retrospective cohort study of 455 patients with hypertension treated in a primary health care hospital. Medical records and laboratory information were reviewed for the diagnosis of chronic kidney disease and its staging. Patients aged 40 years and older, of both sexes and evaluated between the years 2015 -2017 were included. Logistic regression analysis allowed the identification of risk factors associated with the development of chronic kidney disease. 63.7% were female and 36.3% male. The average age for 2015 was 69.79 ± 9.03, more than half of participants had diabetes mellitus and controlled hypertension and the predominant nephroprotection was with Losartan (53%) that year. Male sex (OR 1.68, CI 1.03-2,76), age: 60 years or older (OR 6.38, CI 2.65-15,37) and anemia (OR 1.71, CI 1.03-2,85), were risk factors for the development of chronic kidney disease (p < 0.05), whereas nephroprotection (OR 0.39, CI 0.18-0,88) and controlled diabetes mellitus (OR: 0.18, CI 0.07-0,47) were shown to be protective factors (p < 0.05). The prevalence of chronic kidney disease between 2015 and 2017 was 19% and 45%, respectively, with predominance of category G2. The comparison group is the same cohort analyzed in each year under study. Male sex, age over 60 years, and anemia are risk factors for chronic kidney disease. Nephroprotection, controlled diabetes mellitus, and patient follow-up are factors that prevent its development.

Hyperbaric Oxygen Therapy for Diabetic Foot Ulcers Based on Wagner Grading: A Systematic Review and Meta-analysis.

Diabetic foot ulcers (DFUs) are common complications of uncontrolled diabetes mellitus that can result in infection and amputation of the lower extremities. This study compared the benefits and risks of hyperbaric oxygen therapy with those of other DFU treatments, based on the Wagner grading system. Systematic searches for randomly controlled trials using hyperbaric oxygen therapy for DFUs were performed using PubMed, the Cochrane Library, and Embase. Data regarding demographics, wound healing, minor and major amputations, operative debridement, nonhealing wounds, and adverse effects were analyzed based on Wagner grades, using RevMan 5.4.1 and Microsoft Excel. Hyperbaric oxygen therapy was significantly superior to other treatments for wound healing rates 8 or more weeks after the final treatment (RR = 2.39; 1.87-3.05; P < 0.00001) minor/distal amputations (RR = 0.58; 0.43-0.80; P < 0.007), and major/proximal amputations (RR = 0.31; 0.18-0.52; P < 0.00001) for the 14 studies analyzed. In addition, this therapy increased the rate of complete wound healing for Wagner grades II (RR = 21.11; 3.05-146.03; P = 0.002), III (RR = 19.58; 2.82-135.94, P = 0.003), and IV (RR = 17.53; 2.45-125.44; P = 0.004); decreased the minor/distal amputation rate for grade III (RR = 0.06; 0.01-0.29; P = 0.0004) and the major/proximal amputation rate on for grade IV (RR = 0.08; 0.03-0.25; P < 0.0001); and decreased the operative debridement rate for Wagner grade II (RR = 0.09; 0.01-0.60; P = 0.01). Moderate-quality evidence revealed that adjunctive hyperbaric oxygen therapy improved DFU wound healing for Wagner grades II, III, and IV; prevented minor and major amputations for grades III and IV, respectively; and prevented operative debridement in grade II wounds.

Treatment of osteoarthritis knee with bone marrow aspirate concentrate injection

To assess the clinical effectiveness and safety of bone marrow aspirate concentrate (BMAC) injections given intraarticularly as a potential treatment for knee osteoarthritis (OA). Data from 60 patients with knee osteoarthritis treated with BMAC injection at a single centre between December 2021 and December 2022 were retrospectively examined. We only included patients with idiopathic osteoarthritis. Post-traumatic osteoarthritis, prior knee surgery, ageless then 50 years or over 85 years, an active infection, uncontrolled diabetes mellitus, rheumatological or another systemic condition, cancer, or immunosuppressive medication use were all exclusion factors. A single-spin manual approach was used to aspirate and concentrate bone marrow from the iliac crest. The Numeric pain scale (NPS) and Oxford knee score (OKS) were used to evaluate patients both before and after the treatment. A 12-month follow-up period was used. The statistical analysis comprised a total of 60 patients. With a mean age of 67 years (range 50-85), there were 42 females and 18 males. At the end of the follow-up period, the mean NPS reduced from 8.12 to 4.31 (p&amp;#60; 0.001) and the mean OKS rise from 22.30 to 34.74 (p &amp;#60;0.001). There were no problems. A single BMAC intra-articular injection is a dependable and safe technique that improves the clinical condition of knee OA.

Association of Microalbuminuria with Glucose Levels, Microvascular and Macrovascular Complications in Relation with Blood Pressure in Diabetes Mellitus Type 2

Objectives: Determine the association of Microalbuminuria (MAU) with glucose markers, micro vascular and macrovascular complications in relation with blood pressure in patients with type 2 diabetes mellitus. Material and Method: This study was cross sectional study and data collected in Chemical laboratory of pathology department of Dr Akbar Niazi Teaching Hospital. It carried out during the time period of December 2021 to January 2022. Patients were divided into 2 groups which fulfill the inclusion and exclusion criteria patients having diabetes mellitus type 2 with good glucose control, HbA1c &lt; 7% (n=33) patients having diabetes mellitus type 2 with bad control HbA1c ≥7% (n=33) each group were further divided into 2 sub-groups Patients with Pre-hypertension (n) and patients with HTN (n). The sampling technique of this study was non-probability convenience sampling was done. Data/Documentation was collected by Performa and laboratory investigation. Spss version 21 used to analyze the data. Normality of data was assessed by KS test. Quantitative test was measured as mean and standard deviation. Qualitative variables were calculated as number percentage. ANCOVA test and chi square test were used for comparison of quantitative and qualitative variables respectively. Pearson correlation was applied to determine the association of MAU with glucose levels and diabetes related complications. Result: Among total 66 patients, the sample of patients were included 47 males (71.2%) and 19 females (28.8%). Patients of type 2 diabetes mellitus in HbAlc ≥7% group showed higher levels of Blood Glucose level, MAU, Systolic BP and Diastolic BP as compared to HbA1c &lt; 7% group. The comparison of the variables between 2 groups showed statistical differences in nephropathy and cardiovascular complications. In HbA1c ≥ 7% group, correlation of MAU with Systolic BP, Diastolic BP, Fasting Blood Glucose (FBG), HbA1c, Nephropathy, and Cardiovascular events were statistically significant. In Pre-HTN group, MAU was significantly correlated with Fasting blood glucose level, HbA1c, Nephropathy and cardiovascular complications. Patients of HTN showed more significant association with blood pressure (BP), Blood Glucose, HbA1c, Cardiovascular events with MAU as evident by higher r-values as compared to pre-HTN group. Regarding nephropathy, r-value was slightly higher in Prehypertensive group. Conclusion: Patients with uncontrolled diabetes mellitus have increased risk of developing HTN, MAU as well as diabetes related complication including nephropathy and cardiovascular events. More over MAU showed significant positive association with BP, blood glucose levels, nephropathy and cardiovascular events. Both pre- hypertensive and hypertensive patients showed significant positive association of MAU with blood glucose levels and diabetes related complication including nephropathy and cardiovascular events. This study suggested that Prehypertensive and hypertensive patients with altered blood glucose levels have increased risk of MAU, that why proper evaluation and treatment of MAU may lead to early diagnosis and decrease progression of HTN, diabetes mellitus type 2 and its related complications.

Sino-nasal Mucormycosis in non-compliant insulin-dependent diabetic patient: A case report with an insight on underlying psychological factors

BackgroundMucormycosis is a severe fungal infection manifested mostly in immunocompromised hosts. Underlying causes for Mucormycosis include uncontrolled diabetes mellitus (DM), malignancies, chronic corticosteroid use, and organ transplant. Case reporta 57-year-old Caucasian female, with insulin-dependent DM, presented to otolaryngology casualty complaining about a severe headache and nasal discharge. Clinical, laboratory, imaging, and histopathological investigations confirmed the diagnosis of Mucormycosis due to uncontrolled DM. Mucormycosis was managed pharmacologically, surgically, and by improving glycemic control. Psychological factors leading to non-adherence to insulin therapy were investigated and psychiatric evaluation and counseling were emphasized. Practical implicationsHealthcare providers should be aware of the signs, symptoms, and underlying causes of Mucormycosis and should manage it promptly. Mental health status should be part of the patient's evaluation and treatment plan.

A 17-year-old student with ankle sprain to leg amputation

Abstract Cutaneous mucormycosis with ischemic complications is a life-threatening condition with high mortality rates, particularly in immunocompromised individuals. The incidence of mucormycosis has increased during the COVID-19 pandemic due to reduced immunity. We present the case of a 17-year-old high school student who experienced a sprained left lower extremity, followed by worsening pain and swelling due to the topical application of unknown local herbs. Eighteen days after the injury, she was admitted to our department in a comatose state with left lower limb ischemia. The patient had a history of uncontrolled diabetes mellitus and displayed a necrotic lesion on her left ankle, suggestive of invasive infectious fungi disease. Diagnostic procedures, including tissue staining and molecular analysis, identified Rhizopus oryzae as the causative organism. Administering amphotericin B yielded marked improvement, but the patient necessitated a mid-thigh amputation to curtail the infection’s advance, culminating in her successful discharge post-treatment.

Feline Comorbidities: Hypersomatotropism-induced diabetes in cats.

Diabetes mellitus is the second-most common feline endocrinopathy, affecting an estimated 1/200 cats. While the underlying causes vary, around 15-25% of cats with diabetes mellitus develop the condition secondarily to progressive growth hormone (GH)-induced insulin resistance. This typically results in a form of diabetes that is challenging to manage, whereby the response to insulin is very variable or high doses are required to achieve even minimal diabetic control. Although uncontrolled chronic excessive GH may result in phenotypic changes that raise suspicion for acromegaly, many cats with hypersomatotropism (HST) do not have these changes. In these situations, a clinician's index of suspicion may be increased by the presence of less dramatic changes such as marked polyphagia, stertor or uncontrolled diabetes mellitus. The current diagnostic test of choice is demonstration of a markedly increased serum insulin-like growth factor 1 (IGF1) concentration, but some affected cats will have only a marginal increase; additionally, chronic insulin administration in cats results in an increase in serum IGF1, making the diagnosis less clear cut and requiring additional confirmatory tests. Over the past two decades, HST has increasingly been recognised as an underlying cause of diabetes mellitus in cats. This review, which focuses on diagnosis and treatment, utilises data from observational studies, clinical trials and case series, as well as drawing on the experience of the authors in managing this condition.

Knowledge, Attitude, and Practice of Adult Diabetics Regarding Diabetic Foot Ulcers: A Cross-Sectional Study in Saudi Arabia.

Background Diabetic foot ulcers (DFUs) are one of the most common and fatal complications of diabetic patients with uncontrolled diabetes mellitus (DM) that may end with their feet amputation. These complications can be prevented through the adherence of diabetic patients to their diabetes management plan and by educating them about risk factors, complications of diabetic foot, and proper foot care. To develop effective health education programs to educate diabetic patients and caregivers regarding diabetic foot and its effective care, we should first identify gaps in patients' knowledge and perception of diabetic foot and evaluate their practice of foot care. Objectives This study aimed to evaluate knowledge and attitude toward DFUs and the practice of foot care among adult diabetic patients attending Al-Qunfudah Diabetes Center, Saudi Arabia, from October 2022 to March 2023. Methods A total of 403 adult diabetic patients were recruited in this cross-sectional study during their attendance at the diabetes center in Al-Qunfudah district, Saudi Arabia. The study researchers conducted a physical face-to-face interview with each diabetic patient using a validated questionnaire with closed-ended questions to collect their responses regarding their knowledge and attitude toward DFUs and their behavior toward foot care. The collected data were analyzed using IBM SPSS Statistics for Windows, version 23 (released 2015; IBM Corp., Armonk, New York, United States). Results Out of 403 diabetics, 50.4% (n = 203) had inadequate knowledge (knowledge score < 80%), 46.4% (n = 187) had negative attitudes (attitude score < 80%) toward DFUs, and the majority could not practice foot care well, with 77.7% (n = 313) giving a practice score less than 80%. Seventy patients (17.4%) self-reported a history of DFUs. Predictors of good knowledge about DFUs among diabetics include age between 30 and 59 years (odds ratio (OR) = 2.942, confidence interval (CI) 95% = 1.695-2.107, p < 0.001), marriage (OR = 3.101, CI 95% = 1.893-5.079, p < 0.001), working (OR = 5.325, CI 95% = 3.019-9.389, p < 0.001), diploma education (OR = 8.205, CI 95% = 3.332-20.203, p < 0.001), managing DM with oral drugs (OR = 2.219, CI 95% = 1.399-3.519, p < 0.001), and having no DFUs (OR = 2.712, CI 95% = 1.557-4.723, p < 0.001). Males were more likely to practice foot care well (OR = 1.925, CI 95% = 1.142-3.245, p = 0.013). Primary education (OR = 3.421, CI 95% = 1.655-7.073, p < 0.001) predicted appropriate foot care. Patients with DM for one to five years (OR = 1.995, CI 95% = 1.139-3.493, p = 0.016) and those on diet and metformin (OR = 2.133, CI 95% = 1.134-4.011, p = 0.019) were expected to have better foot care than other diabetics. Conclusion Diabetic patients in the Al-Qunfudah district of Saudi Arabia had inadequate knowledge and negative attitudes toward DFUs, and their foot care behaviors were inadequate. Furthermore, DFUs were self-reported in around 17% of diabetic patients. Specialized training programs are recommended to enhance knowledge regarding DFUs among diabetics and motivate and train them and caregivers on how to conduct proper foot care. These educational programs should target all diabetics, with an emphasis on those with DFUs, females, non-working patients, individuals who have had DM for a longer time, and illiterate diabetics. To understand the factors behind patients' negative attitudes toward diabetic foot, future qualitative research is required.