Current Issue : January - March Volume : 2019 Issue Number : 1 Articles : 6 Articles
Diabetic Ketoacidosis commonly presents with hyponatremia, but hypernatremia is a rare entity. We report a unique case\nof a 50-year-old woman admitted with altered sensorium with blood glucose 979 milligrams/deciliter, serum osmolarity 363\nmOsm/kilograms, and serum sodium 144 milliequivalents/liter. Patient was given initial bolus of isotonic saline and continued\non half isotonic saline for correction of hypernatremia along with insulin infusion therapy. Patient was successfully treated with\nintravenous fluids, insulin infusion, and the altered sensorium was resolved without any sequelae. This case illustrates a teaching\npoint in the use of intravenous fluids for the treatment of Diabetic Ketoacidosis with hypernatremia....
Acting at a cell surface receptor on the extracellular domain of integrin ..., thyroid\nhormone analogues regulate downstream the expression of a large panel of genes relevant to cancer\ncell proliferation, to cancer cell survival pathways, and to tumor-linked angiogenesis. Because ... is involved in the cancer cell metastatic process, we examine here the possibility that thyroid hormone\nas L-thyroxine (T4) and the thyroid hormone antagonist, tetraiodothyroacetic acid (tetrac), may\nrespectively promote and inhibit metastasis. Actions of T4 and tetrac that are relevant to cancer\nmetastasis include the multitude of synergistic effects on molecular levels such as expression of matrix\nmetalloproteinase genes, angiogenesis support genes, receptor tyrosine kinase (EGFR/ERBB2) genes,\nspecific microRNAs, the epithelialâ??mesenchymal transition (EMT) process; and on the cellular level\nare exemplified by effects on macrophages. We conclude that the thyroid hormone .... interaction\nis mechanistically linked to cancer metastasis and that modified tetrac molecules have antimetastatic\nactivity with feasible therapeutic potential....
Introduction: Diabetic retinopathy is the retinal location of diabetic microangiopathy.\nIt is a public health problem and one of the target diseases of the\nglobal Vision 2020 initiative. The aim of our study was to determine the epidemiological\nfeatures and risk factors of diabetic retinopathy in the melanoderma\nAfrican in Abidjan. Materials and Methods: We carried out a prospective\nobservational study which took place from April to September 2016\nand which focused on the diabetic subjects received in consultation in the\nOphthalmology Department of Cocody University Hospital. All Patients had\nhad bio-microscopic examination of the fundus with Goldman three-mirror\ncontact lens and optic coherence tomography of the macula and, in some cases,\nretinal fluorescein angiography. Results: Out of a population of 448 patients,\n200 had diabetic retinopathy. That is a prevalence of 45%. The prevalence\nof macular edema was 6%. The subpopulation of subjects with retinopathy\nconsisted of 61.5% (123) of male patients versus 38.5% (77) of female\npatients. The mean age of female patients with retinopathy was 42 ± 14.08\nyears and that of male patients 58 ± 15.07 years. The majority of patients with\nretinopathy lived in urban areas (73%), and had type II diabetes. The duration\nof evolution of diabetes was 5 to 10 years in 65% of cases. Obesity, smoking,\ndyslipidemia and high blood pressure were the main factors of co-morbidity\nassociated with poor glycemic control. Discussion: Diabetic retinopathy had a\nhigh prevalence and predominated in males. Maculopathy was represented by\nmacular edema, which is the leading cause of diabetes-related blindness. Conclusion:\nThe prevention of blindness related to diabetes requires regular multidisciplinary\nfollow-up in order to treat retinal damage early....
Introduction: Diabetic neuropathy is one of the most common chronic complications\nof diabetes. Most of the studies on the subject in the sub region,\nparticularly in Burkina Faso, dealt it with the study of the complications of\ndiabetes, or one of its components. Our study was designed to study in particular\nin all its aspects, by searching for its peculiarities in our context, for\nimprovement of its support. Methodology: This is a cross-sectional descriptive\nstudy carried out in 150 diabetic patients aged at least 15 years followed\nin the Department of Internal Medicine at Yalgado Ouedraogo University\nTeaching Hospital. All patients included had agreed to participate in our survey\nafter informed consent. We collected the data during the period from\n2015 November to 2016 June. Each patient was evaluated by the DN4 questionnaire\nand clinically by a neurological examination. We determinated the\nfrequency, the sociodemographic, clinical and therapeutic characteristics of\ndiabetes neuropathy and its related factors. Results: The frequency of diabetic\nneuropathy was 80.7%. Peripheral neuropathies were seen in 81.8% of cases\nand autonomic neuropathies in 72.7% of cases. Autonomic neuropathy was\ndominated by the DAN (59.1%), and erectile dysfunction (44%). There was a\nhigh comorbidity with physical inactivity (66.9%), obesity (49.4%) and\nhypertension (38.8%). There were poorly controlled patients in 38.8%. A link\nwas found between T2DM and neuropathy (p = 0.014). Painful diabetes was\nrelated to the quality of glycemic control (p = 0.007), and hypertension (p =\n0.021). A link was also found between tobacco consumption (p < 0.001), male (p < 0.001), and urogenital autonomic neuropathy. Conclusion: Diabetic\nneuropathies are very common in our context and could be a haunting to the\npractitioner with the progression of diabetes and its corollary of degenerative\ncomplications. There was a significant association between Type 2 Diabetes\nmellitus and the presence of peripheral diabetic neuropathy....
Multiple endocrine neoplasia (MEN) type 1 syndrome is an autosomal dominant disorder caused by germline mutations in MEN1\ngene, characterized by tumours in endocrine and nonendocrine organs. Giant prolactinoma is defined as tumours larger than\n40mm with very high prolactin secretion.We report two unrelated Sri Lankan patients (8-year-old boy and a 20-year-old female)\nwho presentedwith giant prolactinomas withmass effects of the tumours.The female patient showed complete response tomedical\ntherapy, while the boy developed recurrent resistant prolactinoma needing surgery and radiotherapy. During follow-up, both\ndeveloped pancreatic neuroendocrine tumours. Genetic analysis revealed that one was heterozygous for a nonsense mutation and\nother formissensemutation inMEN1 gene. Screening confirmed familial MEN-1 syndrome in their families.High clinical suspicion\nupon unusual clinical presentation prompted genetic evaluation in these patients and detection of MEN1 gene mutation. Pituitary\nadenomas in children with MEN-1 syndrome are larger tumours with higher rates of treatment resistance. This report emphasizes\nimportance of screening young patients with giant prolactinoma for MEN-1 syndrome and arranging long-term follow-up for\nthem expecting variable treatment outcomes. Sri Lanka requires further studies to describe the genotypic-phenotypic variability of\nMEN-1 syndrome in this population....
Background: Metformin may show an antibiotic effect, but whether its use can reduce the\nrisk of tuberculosis infection has rarely been investigated in population-based studies. Methods:\nThis is a retrospective cohort analysis of the Taiwanâ??s National Health Insurance database. New-onset\ntype 2 diabetes patients, 148,468 ever users and 15,799 never users of metformin, identified during\n1999â??2005 were followed up until 31 December 2011 for the incidence of tuberculosis infection.\nHazard ratios were estimated by Cox regression incorporated with the inverse probability of treatment\nweighting using propensity score. Results: A total of 360 never users and 1976 ever users developed\na tuberculosis infection with respective incidence of 510.91 and 282.94 per 100,000 personâ??years.\nThe overall hazard ratio of presenting a tuberculosis infection among metformin ever users in\nrespect to never users was 0.552 (95% confidence interval: 0.493â??0.617). The hazard ratios for the\nfirst (<27.10 months), second (27.10â??58.27 months), and third (>58.27 months) tertile of cumulative\nduration of metformin therapy were 1.116 (0.989â??1.261), 0.543 (0.478â??0.618), and 0.200 (0.171â??0.233),\nrespectively; and were 1.037 (0.918â??1.173), 0.533 (0.469â??0.606), and 0.249 (0.215â??0.288), respectively,\nfor the first (<817,000 mg), second (817,000â??2,047,180 mg), and third (>2,047,180 mg) tertile of\ncumulative doses of metformin. The findings were consistent when analyses were restricted to\npulmonary tuberculosis. Additionally, regular users of metformin tended to have greater benefit\nthan irregular users. Conclusions: Metformin use is associated with a reduced risk of tuberculosis\ninfection in a doseâ??response pattern in type 2 diabetes patients....
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