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Takahashi K, Uenishi N, Sanui M, Uchino S, Yonezawa N, Takei T, Nishioka N, Kobayashi H, Otaka S, Yamamoto K, Yasuda H, Kosaka S, Tokunaga H, Fujiwara N, Kondo T, Ishida T, Komatsu T, Endo K, Moriyama T, Oyasu T, Hayakawa M, Hoshino A, Matsuyama T, Miyamoto Y, Yanagisawa A, Wakabayashi T, Ueda T, Komuro T, Sugimoto T, Sasabuchi Y. Epidemiology, microbiology, and diagnosis of infection in diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: A multicenter retrospective observational study. Diabetes Res Clin Pract 2024; 212:111713. [PMID: 38772502 DOI: 10.1016/j.diabres.2024.111713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/04/2024] [Accepted: 05/16/2024] [Indexed: 05/23/2024]
Abstract
AIMS We investigated the characteristics of infection and the utility of inflammatory markers in diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS). METHODS A multicenter, retrospective observational study in 21 acute-care hospitals was conducted in Japan. This study included adult hospitalized patients with DKA and HHS. We analyzed the diagnostic accuracy of markers including C-reactive protein (CRP) and procalcitonin (PCT) for bacteremia. Multiple regression models were created for estimating bacteremia risk factors. RESULTS A total of 771 patients, including 545 patients with DKA and 226 patients with HHS, were analyzed. The mean age was 58.2 (SD, 19.3) years. Of these, 70 tested positive for blood culture. The mortality rates of those with and without bacteremia were 14 % and 3.3 % (P-value < 0.001). The area under the curve (AUC) of CRP and PCT for diagnosis of bacteremia was 0.85 (95 %CI, 0.81-0.89) and 0.76 (95 %CI, 0.60-0.92), respectively. Logistic regression models identified older age, altered level of consciousness, hypotension, and higher CRP as risk factors for bacteremia. CONCLUSIONS The mortality rate was higher in patients with bacteremia than patients without it. CRP, rather than PCT, may be valid for diagnosing bacteremia in hyperglycemic emergencies. TRIAL REGISTRATION This study is registered in the UMIN clinical trial registration system (UMIN000025393, Registered December 23, 2016).
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Affiliation(s)
- Kyosuke Takahashi
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiya-ku, Saitama-city, Saitama 330-0834, Japan; Department of Anesthesiology and Critical Care Medicine, Kawasaki Municipal Hospital, 12-1 Shinkawadori, Kawasaki-ku, Kawasaki, Kanagawa 210-0013, Japan.
| | - Norimichi Uenishi
- Department of Emergency and General Internal Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
| | - Masamitsu Sanui
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiya-ku, Saitama-city, Saitama 330-0834, Japan
| | - Shigehiko Uchino
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiya-ku, Saitama-city, Saitama 330-0834, Japan
| | - Naoki Yonezawa
- Department of Emergency and Critical Care Medicine, Yokohama City Minato Red Cross Hospital, 3-12-1 Shinyamashita, Naka-ku, Yokohama, Kanagawa 231-8682, Japan
| | - Tetsuhiro Takei
- Department of Emergency and Critical Care Medicine, Yokohama City Minato Red Cross Hospital, 3-12-1 Shinyamashita, Naka-ku, Yokohama, Kanagawa 231-8682, Japan
| | - Norihiro Nishioka
- Department of Preventive Services, Kyoto University Graduate School of Medicine, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan; Division of Nephrology, Department of Internal Medicine, Okinawa Prefectural Chubu Hospital, 281 Miyazato, Uruma, Okinawa 904-2293, Japan
| | - Hirotada Kobayashi
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, 27 King's College Cir, Toronto, ON M5S, Canada; Department of Intensive Care Medicine, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba 296-8602, Japan
| | - Shunichi Otaka
- Department of Emergency Medicine, International University of Health and Welfare Narita Hospital, 852 Hatakeda Narita, Chiba 286-0124, Japan; Department of Emergency Medicine, Kumamoto Red Cross Hospital, Higashi, 2-1-1, Nagamineminami, Higashi-ku, Kumamoto 861-8520, Japan
| | - Kotaro Yamamoto
- Department of Emergency Medicine, Musashino Red Cross Hospital, 1-26-1 Kyonancho, Musashino, Tokyo 180-8610, Japan
| | - Hideto Yasuda
- Department of Emergency Medicine, Musashino Red Cross Hospital, 1-26-1 Kyonancho, Musashino, Tokyo 180-8610, Japan; Department of Emergency Medicine, Jichi Medical University Saitama Medical Center, 847 Amanumacho, Omiya-ku, Saitama-city, Saitama 330-0834, Japan
| | - Shintaro Kosaka
- Department of Medicine, Nerima Hikarigaoka Hospital, 2-5-1 Hikarigaoka, Nerima-ku, Tokyo 179-0072, Japan
| | - Hidehiko Tokunaga
- Department of Medicine, Nerima Hikarigaoka Hospital, 2-5-1 Hikarigaoka, Nerima-ku, Tokyo 179-0072, Japan
| | - Naoki Fujiwara
- Department of Medicine, Nerima Hikarigaoka Hospital, 2-5-1 Hikarigaoka, Nerima-ku, Tokyo 179-0072, Japan; Department of Medicine, Taito Municipal Taito Hospital, 3-20-5 Senzoku, Taito-ku, Tokyo 111-0031, Japan
| | - Takashiro Kondo
- Department of Emergency and Critical Care Medicine, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, Aichi 460-0001, Japan
| | - Tomoki Ishida
- Nanohana Clinic, 2-11-22 Katsuyamakita, Ikuno-ku, Osaka 544-0033, Japan; Department of Emergency Medicine, Yodogawa Christian Hospital, 1-7-50, Kunijima, Higashi Yodogawa-Ku, Osaka 533-0024, Japan
| | - Takayuki Komatsu
- Department of Sports Medicine, Faculty of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan; Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Koji Endo
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan; Department of General Internal Medicine, Tottori Prefectural Central Hospital, 730 Ezu, Tottori 680-0901, Japan
| | - Taiki Moriyama
- Department of Emergency Medicine, Hyogo Emergency Medical Center, 1-3 Wakinohamakaigandori, Chuo-ku, Kobe, Hyogo 651-0073, Japan; Department of Emergency Medicine, Saiseikai Senri Hospital, 1-1-6 Tsukumodai, Suita, Osaka 565-0862, Japan
| | - Takayoshi Oyasu
- Department of Emergency Medicine, Hokkaido University Hospital, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido 060-8648, Japan
| | - Mineji Hayakawa
- Department of Emergency Medicine, Hokkaido University Hospital, Kita14, Nishi5, Kita-Ku, Sapporo, Hokkaido 060-8648, Japan
| | - Atsumi Hoshino
- Department of Intensive Care Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan; Department of Emergency and Critical Care Medicine, Toyooka Public Hospital, 1094 Tobera, Toyooka, Hyogo 668-8501, Japan
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Yuki Miyamoto
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Akihiro Yanagisawa
- Department of Anesthesia, Gyoda General Hospital, 376 Mochida, Gyoda, Saitama, 361-0056, Japan; Department of Anesthesiology and Intensive Care, Gunma University Hospital, 3-39-15 Showamachi, Maebashi, Gunma, Japan
| | - Tadamasa Wakabayashi
- Department of Medicine, Suwa Central Hospital, 4300 Tamagawa, Chino, Nagano, 391-0011, Japan; Department of Cardiology, Suwa Central Hospital, 4300 Tamagawa, Chino, Nagano 391-0011, Japan
| | - Takeshi Ueda
- Department of Emergency and General Internal Medicine, Rakuwakai Marutamachi Hospital, Agaru, Marutamachi, Shichihonmatus-dori, Nakagyo-ku, Kyoto 604-8401, Japan
| | - Tetsuya Komuro
- Department of Medicine, TMG Muneoka Central Hospital, 5-14-50 Kamimuneoka, Shiki, Saitama 353-0001, Japan; Department of Critical Care, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa 247-8533, Japan
| | - Toshiro Sugimoto
- Department of Medicine, Shiga University of Medical Science, Setatsukinowacho, Otsu, Shiga 520-2192, Japan; Department of Medicine, National Hospital Organization Higashiohmi General Medical Center, 255 Gochicho, Higashiohmi, Shiga 527-8505, Japan
| | - Yusuke Sasabuchi
- Department of Real-World Evidence, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
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Meseret F, Muluken S, Gebru Gebi T, Embiale Yigrem T. Treatment Outcome and Associated Factors among Type 1 Diabetic Children Admitted with DKA in Bahir Dar City Public Referral Hospital, Northwest, Ethiopia: A Cross-sectional Study. Glob Pediatr Health 2024; 11:2333794X241248320. [PMID: 38660690 PMCID: PMC11041539 DOI: 10.1177/2333794x241248320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 03/01/2024] [Accepted: 04/03/2024] [Indexed: 04/26/2024] Open
Abstract
Background. Outcomes that should be measured during diabetic ketoacidosis management is crucial. However, data associated to this was limited in Ethiopia. Methods. A cross-sectional study was conducted among children with diabetic keto acidosis between 2016 and 2021.Data were stored in Epi-data version 4.6 and exported into STATA 14.0 software for analysis. The association between independent variables and length of hospital stay was assessed using binary logistic regression. Finally, variables with P-value <.05 were considered statistically significant. Result. Median length of hospital stay was 8 ± 6.2 days. Majority of patients (97.5%) improved and discharged. Factors that affected longer hospital stay were Residence(aOR = 4.31;95% CI = 1.25-14.80),family history of diabetes (aOR = 0.12; 95% CI = 0.02-0.64), glycemia at admission (aOR = 1.01; 95% CI = 1.00-1.02),insulin skipping (aOR = 0.08; 95% CI = 0.01-0.98), abdominal pain (aOR = 4.28; 95% CI = 1.11-15.52) and time in which the patient get out of diabetic ketoacidosis(aOR = 6.39; 95% CI = 1.09-37.50). Conclusion. Majority of patients showed improvement and discharged to homes after a long hospital stay. Majority of patients resolved from diabetic ketoacidosis between 24 and 48 hours.
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Vidanapathirana M. Sodium bicarbonate and intubation in severe diabetic ketoacidosis: are we too quick to dismiss them? Clin Diabetes Endocrinol 2024; 10:13. [PMID: 38616273 PMCID: PMC11017618 DOI: 10.1186/s40842-024-00171-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/24/2024] [Indexed: 04/16/2024] Open
Abstract
Management of diabetic ketoacidosis (DKA) has internationally established guidelines. However, management of severe, refractory DKA with multiple contributors to acidosis, and management of DKA in patients with altered mentation, remain ambiguous. Use of sodium bicarbonate and intubation in DKA are unpopular treatment practices, but warrant consideration in these unique clinical scenarios. This paper describes a 61-year-old Sri Lankan female who presented with severe DKA, seizures and altered level of consciousness. In her case, the acidosis was secondary to DKA, hyperlactatemia, hyperchloraemic acidosis and acute kidney injury (AKI). Intravenous sodium bicarbonate was used in the management of acidosis. She was intubated due to altered level of consciousness with inadequate respiratory drive to compensate for metabolic acidosis. The outcome in her case was favorable. Intravenous sodium bicarbonate in DKA should be considered for patients with severe, refractory acidosis with hemodynamic instability, hyperkalemia and compounding acidosis due to normal anion gap acidosis or AKI. Intubation should be considered for patients with obtunded mentation unable to achieve respiratory compensation and obtunded mentation where reversal of DKA is unlikely to improve consciousness. Both strategies should be personalized with consideration of individual risk vs benefit.
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Flores-Franco RA, González-Ponce CM, Irigoyen-Monroy V. High-flow Nasal Oxygen Therapy Yields a Favorable Outcome in Patient Presenting With Kussmaul Breathing. OPEN RESPIRATORY ARCHIVES 2024; 6:100316. [PMID: 38628811 PMCID: PMC11019267 DOI: 10.1016/j.opresp.2024.100316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
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Hsu CH, Hsu NC. Elderly Man With Fall Incident. Ann Emerg Med 2024; 83:168-169. [PMID: 38245231 DOI: 10.1016/j.annemergmed.2023.08.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 01/22/2024]
Affiliation(s)
- Chia-Hao Hsu
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Nin-Chieh Hsu
- Division of Hospital Medicine, Department of Internal Medicine, Taipei City Hospital, Zhongxing Branch, Taipei, Taiwan Taipei, Taiwan; Division of Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Millner S, Devlin C. Adolescent with Diabetic Ketoacidosis, Hypothermia and Pneumomediastinum. JOURNAL OF EDUCATION & TEACHING IN EMERGENCY MEDICINE 2023; 8:S1-S24. [PMID: 37969160 PMCID: PMC10631814 DOI: 10.21980/j8fp8j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/12/2023] [Indexed: 11/17/2023]
Abstract
Audience The target audience of this simulation is emergency medicine residents and medical students. The simulation is based on a real case of a 12-year-old male who presented obtunded with shortness of breath and hypothermia who was ultimately diagnosed with diabetic ketoacidosis (DKA) and pneumomediastinum. This case highlights the diagnosis and management of an adolescent with new onset diabetic ketoacidosis and pneumomediastinum with deterioration of status, as well as important ventilator settings if intubation is required in the setting of diabetic ketoacidosis. Background Type 1 diabetes is a common disease in the pediatric population with the prevalence being approximately 2.15 per 1000 youths and diabetic ketoacidosis being the presenting status in 30-40% of the patients.1 Physicians who evaluate a child with altered mental status must have diabetic ketoacidosis in their differential. In the setting of mechanical ventilation in patients with diabetic ketoacidosis (DKA), special care must be taken. Mechanical ventilation in these patients comes with increased risk, morbidity, and mortality. Risk factors for pneumomediastinum include lung disease such as asthma, chronic obstructive pulmonary disease (COPD), and malignancy, but also can occur in the acute setting of vomiting or trauma.2. Educational Objectives By the end of the simulation, learners will be able to: 1) develop a differential diagnosis for an adolescent who presents obtunded with shortness of breath; 2) discuss the management of diabetic ketoacidosis; 3) discuss management of hypothermia in a pediatric patient; 4) discuss appropriate ventilator settings in a patient with diabetic ketoacidosis; and 5) demonstrate interpersonal communication with family, nursing, and consultants during high stress situations. Educational Methods This is a high-fidelity simulation that allows learners to manage the diagnosis and treatment of diabetic ketoacidosis and hypothermia in an adolescent patient. Participants participated in a debriefing after the simulation. There should be approximately 4-5 learners per case. This simulation was performed in 3 sessions. Each learner performed this simulation one time. Research Methods The effectiveness of this case was evaluated by surveys given to learners after debriefing. Learners gave quantitative and qualitative results of their feedback using a 1-5 rating scale and open-ended written questions. This case was trialed with residents in their first through third years of training as well as fourth year medical students. Results Feedback was very positive, with 19 residents completing the post-simulation survey. They enjoyed the case and reported they would feel more comfortable in a comparable situation in the future. Four survey questions were asked of the participants. On average, learners stated they felt the simulation improved their ability to manage a pediatric DKA patient, and their knowledge of complications and appropriate ventilator settings improved (modes of 5, 4 and 5, respectively). Discussion Diabetic ketoacidosis is a common and critical diagnosis for emergency medicine physicians to consider in the setting of altered mental status in a pediatric patient. This simulation has multiple steps and is based on a real case of an obtunded and hypothermic pediatric patient who was ultimately diagnosed with diabetic ketoacidosis complicated by pneumomediastinum. Topics Diabetic ketoacidosis, pneumomediastinum, hypothermia, altered mental status, pediatrics, adolescent, intubation, hypoxia, ventilator settings, cardiac arrest, emergency medicine, medical simulation.
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Affiliation(s)
- Steven Millner
- University of Pittsburgh Medical Center Harrisburg, Department of Emergency Medicine, Harrisburg, PA
| | - Courtney Devlin
- University of Pittsburgh Medical Center Harrisburg, Department of Emergency Medicine, Harrisburg, PA
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Goldman M, Lucke-Wold B, Katz J, Dawoud B, Dagra A. Respiratory Patterns in Neurological Injury, Pathophysiology, Ventilation Management, and Future Innovations: A Systematic Review. EXPLORATORY RESEARCH AND HYPOTHESIS IN MEDICINE 2023; 8:338-349. [PMID: 38130817 PMCID: PMC10735242 DOI: 10.14218/erhm.2022.00081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Traumatic brain injuries (TBI), ischemic stroke, hemorrhagic stroke, brain tumors, and seizures have diverse and sometimes overlapping associated breathing patterns. Homeostatic mechanisms for respiratory control are intertwined with complex neurocircuitry, both centrally and peripherally. This paper summarizes the neurorespiratory control and pathophysiology of its disruption. It also reviews the clinical presentation, ventilatory management, and emerging therapeutics. This review additionally serves to update all recent preclinical and clinical research regarding the spectrum of respiratory dysfunction. Having a solid pathophysiological foundation of disruptive mechanisms would permit further therapeutic development. This novel review bridges experimental/physiological data with bedside management, thus allowing neurosurgeons and intensivists alike to rapidly diagnose and treat respiratory sequelae of acute brain injury.
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Affiliation(s)
| | | | | | - Bavly Dawoud
- Neurosurgical Resident, University of Illinois, Peoria Illinois, United States
| | - Abeer Dagra
- Research Assistant, University of Florida, Gainesville, United States
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Chiarello N, Leger B, De Riedmatten M, Rossier MF, Vuistiner P, Duc M, Rapillard A, Allet L. Effect of a four-week isocaloric ketogenic diet on physical performance at very high-altitude: a pilot study. BMC Sports Sci Med Rehabil 2023; 15:37. [PMID: 36941621 PMCID: PMC10029223 DOI: 10.1186/s13102-023-00649-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 03/13/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND A ketogenic diet (KD) reduces daily carbohydrates (CHOs) ingestion by replacing most calories with fat. KD is of increasing interest among athletes because it may increase their maximal oxygen uptake (VO2max), the principal performance limitation at high-altitudes (1500-3500 m). We examined the tolerance of a 4-week isocaloric KD (ICKD) under simulated hypoxia and the possibility of evaluating ICKD performance benefits with a maximal graded exercise bike test under hypoxia and collected data on the effect of the diet on performance markers and arterial blood gases. METHODS In a randomised single-blind cross-over model, 6 recreational mountaineers (age 24-44 years) completed a 4-week ICKD followed or preceded by a 4-week usual mixed Western-style diet (UD). Performance parameters (VO2max, lactate threshold [LT], peak power [Ppeak]) and arterial blood gases (PaO2, PaCO2, pH, HCO3-) were measured at baseline under two conditions (normoxia and hypoxia) as well as after a 4-week UD and 4-week ICKD under the hypoxic condition. RESULTS We analysed data for all 6 participants (BMI 19.9-24.6 kg m-2). Mean VO2max in the normoxic condition was 44.6 ml kg-1 min-1. Hypoxia led to decreased performance in all participants. With the ICKD diet, median values for PaO2 decreased by - 14.5% and VO2max by + 7.3% and Ppeak by + 4.7%. CONCLUSION All participants except one could complete the ICKD. VO2max improved with the ICKD under the hypoxia condition. Therefore, an ICKD is an interesting alternative to CHOs dependency for endurance performance at high-altitudes, including high-altitude training and high-altitude races. Nevertheless, decreased PaO2 with ICKD remains a significant limitation in very-high to extreme altitudes (> 3500 m). Trial registration Clinical trial registration Nr. NCT05603689 (Clinicaltrials.gov). Ethics approval CER-VD, trial Nr. 2020-00427, registered 18.08.2020-prospectively registered.
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Affiliation(s)
- Nicolas Chiarello
- Department of Medicine, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland.
| | | | | | - Michel F Rossier
- Service of Clinical Chemistry and Toxicology, Central Institute of the Hospitals - HVS, Sion, Switzerland
- Department of Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Philippe Vuistiner
- Institute for Research in Rehabilitation, Clinique romande de réadaptation, Sion, Switzerland
| | - Michael Duc
- Swiss Olympic Medical Center, Clinique romande de réadaptation, Sion, Switzerland
| | - Arnaud Rapillard
- Swiss Olympic Medical Center, Clinique romande de réadaptation, Sion, Switzerland
| | - Lara Allet
- Department of Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Valais-Wallis School of Health Sciences, HES-SO, University of Applied Sciences and Arts Western Switzerland, Valais, Switzerland
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Roy B, Runa SA. SARS-CoV-2 infection and diabetes: Pathophysiological mechanism of multi-system organ failure. World J Virol 2022; 11:252-274. [PMID: 36188734 PMCID: PMC9523319 DOI: 10.5501/wjv.v11.i5.252] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/25/2022] [Accepted: 07/31/2022] [Indexed: 02/05/2023] Open
Abstract
Since the discovery of the coronavirus disease 2019 outbreak, a vast majority of studies have been carried out that confirmed the worst outcome of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in people with preexisting health conditions, including diabetes, obesity, hypertension, cancer, and cardiovascular diseases. Likewise, diabetes itself is one of the leading causes of global public health concerns that impose a heavy global burden on public health as well as socio-economic development. Both diabetes and SARS-CoV-2 infection have their independent ability to induce the pathogenesis and severity of multi-system organ failure, while the co-existence of these two culprits can accelerate the rate of disease progression and magnify the severity of the disease. However, the exact pathophysiology of multi-system organ failure in diabetic patients after SARS-CoV-2 infection is still obscure. This review summarized the organ-specific possible molecular mechanisms of SARS-CoV-2 and diabetes-induced pathophysiology of several diseases of multiple organs, including the lungs, heart, kidneys, brain, eyes, gastrointestinal system, and bones, and sub-sequent manifestation of multi-system organ failure.
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Affiliation(s)
- Bipradas Roy
- Department of Physiology, Wayne State University, Detroit, MI 48201, United States
- Division of Hypertension and Vascular Research, Department of Internal Medicine, Henry Ford Health System, Detroit, MI 48202, United States
| | - Sadia Afrin Runa
- Department of Biotechnology and Genetic Engineering, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj 8100, Bangladesh
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Yee J, Park T, Park M. Identification of the associations between genes and quantitative traits using entropy-based kernel density estimation. Genomics Inform 2022; 20:e17. [PMID: 35794697 PMCID: PMC9299569 DOI: 10.5808/gi.22033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/15/2022] [Indexed: 11/20/2022] Open
Abstract
Genetic associations have been quantified using a number of statistical measures. Entropy-based mutual information may be one of the more direct ways of estimating the association, in the sense that it does not depend on the parametrization. For this purpose, both the entropy and conditional entropy of the phenotype distribution should be obtained. Quantitative traits, however, do not usually allow an exact evaluation of entropy. The estimation of entropy needs a probability density function, which can be approximated by kernel density estimation. We have investigated the proper sequence of procedures for combining the kernel density estimation and entropy estimation with a probability density function in order to calculate mutual information. Genotypes and their interactions were constructed to set the conditions for conditional entropy. Extensive simulation data created using three types of generating functions were analyzed using two different kernels as well as two types of multifactor dimensionality reduction and another probability density approximation method called m-spacing. The statistical power in terms of correct detection rates was compared. Using kernels was found to be most useful when the trait distributions were more complex than simple normal or gamma distributions. A full-scale genomic dataset was explored to identify associations using the 2-h oral glucose tolerance test results and γ-glutamyl transpeptidase levels as phenotypes. Clearly distinguishable single-nucleotide polymorphisms (SNPs) and interacting SNP pairs associated with these phenotypes were found and listed with empirical p-values.
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Affiliation(s)
- Jaeyong Yee
- Department of Physiology and Biophysics, Eulji University, Daejeon 34824, Korea
| | - Taesung Park
- Department of Statistics, Seoul National University, Seoul 08826, Korea
| | - Mira Park
- Department of Preventive Medicine, Eulji University, Daejeon 34824, Korea
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Lah Tomulić K, Matko L, Verbić A, Milardović A, Severinski S, Kolić I, Baraba Dekanić K, Šerifi S, Butorac Ahel I. Epidemiologic Characteristics of Children with Diabetic Ketoacidosis Treated in a Pediatric Intensive Care Unit in a 10-Year-Period: Single Centre Experience in Croatia. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:638. [PMID: 35630055 PMCID: PMC9143855 DOI: 10.3390/medicina58050638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The incidence of severe and moderate forms of DKA as the initial presentation of type 1 diabetes mellitus (T1D) is increasing, especially during the COVID-19 pandemic. This poses a higher risk of developing cerebral edema as a complication of diabetic ketoacidosis (DKA), as well as morbidity and mortality rates. The aim of this study was to determine the trend and clinical features of children treated in the last 10 years in the Pediatric Intensive Care Unit (PICU) due to the development of DKA. Materials and Methods: This retrospective study was performed in the PICU, Clinical Hospital Centre Rijeka, in Croatia. All children diagnosed with DKA from 2011-2020 were included in this study. Data were received from hospital medical documentation and patient paper history. The number of new cases and severity of DKA were identified and classified using recent International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines. Results: In this investigation period, 194 children with newly diagnosed T1D were admitted to our hospital: 58 of them were treated in the PICU due to DKA; 48 had newly diagnosed T1D (48/58); and ten previously diagnosed T1D (10/58). DKA as the initial presentation of T1D was diagnosed in 24.7% (48/194). Moderate or severe dehydration was present in 76% of the children at hospital admission. Polyuria, polydipsia, and Kussmaul breathing were the most common signs. Three patients (5.2%) developed cerebral edema, of whom one died. Conclusions: During the investigation period a rising trend in T1D was noted, especially in 2020. About one quarter of children with T1D presented with DKA at initial diagnosis in western Croatia, most of them with a severe form. Good education of the general population, along with the patients and families of children with diabetes, is crucial to prevent the development of DKA and thus reduce severe complications.
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Affiliation(s)
- Kristina Lah Tomulić
- Pediatric Intensive Care Unit, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia; (A.V.); (A.M.)
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (L.M.); (S.S.); (K.B.D.); (S.Š.); (I.B.A.)
| | - Lucija Matko
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (L.M.); (S.S.); (K.B.D.); (S.Š.); (I.B.A.)
| | - Arijan Verbić
- Pediatric Intensive Care Unit, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia; (A.V.); (A.M.)
| | - Ana Milardović
- Pediatric Intensive Care Unit, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia; (A.V.); (A.M.)
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (L.M.); (S.S.); (K.B.D.); (S.Š.); (I.B.A.)
| | - Srećko Severinski
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (L.M.); (S.S.); (K.B.D.); (S.Š.); (I.B.A.)
- Department of Pediatrics, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia;
| | - Ivana Kolić
- Department of Pediatrics, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia;
| | - Kristina Baraba Dekanić
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (L.M.); (S.S.); (K.B.D.); (S.Š.); (I.B.A.)
- Department of Pediatrics, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia;
| | - Senada Šerifi
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (L.M.); (S.S.); (K.B.D.); (S.Š.); (I.B.A.)
- Department of Pediatrics, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia;
| | - Ivona Butorac Ahel
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia; (L.M.); (S.S.); (K.B.D.); (S.Š.); (I.B.A.)
- Department of Pediatrics, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia;
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Check L, Figueroa G, Galindo L, Pham J, Sherertz R. Severe Trichotillomania: An Unusual Trigger of Recurrent Diabetic Ketoacidosis. Cureus 2022; 14:e21384. [PMID: 35198295 PMCID: PMC8853716 DOI: 10.7759/cureus.21384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2022] [Indexed: 11/05/2022] Open
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Lam C, Thapa R, Maharjan J, Rahmani K, Tso CF, Singh NP, Casie Chetty S, Mao Q. Multi-Task Learning with Recurrent Neural Networks for ARDS Prediction using only EHR Data: Model Development and Validation Study (Preprint). JMIR Med Inform 2022; 10:e36202. [PMID: 35704370 PMCID: PMC9244659 DOI: 10.2196/36202] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/07/2022] [Accepted: 05/02/2022] [Indexed: 11/24/2022] Open
Abstract
Background Acute respiratory distress syndrome (ARDS) is a condition that is often considered to have broad and subjective diagnostic criteria and is associated with significant mortality and morbidity. Early and accurate prediction of ARDS and related conditions such as hypoxemia and sepsis could allow timely administration of therapies, leading to improved patient outcomes. Objective The aim of this study is to perform an exploration of how multilabel classification in the clinical setting can take advantage of the underlying dependencies between ARDS and related conditions to improve early prediction of ARDS in patients. Methods The electronic health record data set included 40,703 patient encounters from 7 hospitals from April 20, 2018, to March 17, 2021. A recurrent neural network (RNN) was trained using data from 5 hospitals, and external validation was conducted on data from 2 hospitals. In addition to ARDS, 12 target labels for related conditions such as sepsis, hypoxemia, and COVID-19 were used to train the model to classify a total of 13 outputs. As a comparator, XGBoost models were developed for each of the 13 target labels. Model performance was assessed using the area under the receiver operating characteristic curve. Heat maps to visualize attention scores were generated to provide interpretability to the neural networks. Finally, cluster analysis was performed to identify potential phenotypic subgroups of patients with ARDS. Results The single RNN model trained to classify 13 outputs outperformed the individual XGBoost models for ARDS prediction, achieving an area under the receiver operating characteristic curve of 0.842 on the external test sets. Models trained on an increasing number of tasks resulted in improved performance. Earlier prediction of ARDS nearly doubled the rate of in-hospital survival. Cluster analysis revealed distinct ARDS subgroups, some of which had similar mortality rates but different clinical presentations. Conclusions The RNN model presented in this paper can be used as an early warning system to stratify patients who are at risk of developing one of the multiple risk outcomes, hence providing practitioners with the means to take early action.
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Affiliation(s)
- Carson Lam
- Dascena, Inc, Houston, TX, United States
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Abdou M, Hassan MM, Hassanein SA, Elsebaie EH, Shamma RA. Presentations, Complications, and Challenges Encountered During Management of Type 1 Diabetes in Egyptian Children During COVID-19 Pandemic: A Single-Center Experience. Front Endocrinol (Lausanne) 2022; 13:814991. [PMID: 35360079 PMCID: PMC8963467 DOI: 10.3389/fendo.2022.814991] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 01/27/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has been associated with significant challenges pertaining to the management of children and adolescents with type 1 diabetes (T1D). Issues such as fear of infection and lockdown measures have resulted in delayed and more severe clinical presentations of this disease. OBJECTIVES This study aimed at reporting the frequency and severity of diabetic ketoacidosis (DKA) and the rate of DKA complications in children with diabetes who presented to the emergency unit during COVID-19 pandemic. Furthermore, the purpose of this study was to compare the data collected from the first and second COVID-19 waves with that of the pre-COVID-19 period and describe the challenges encountered during disease management. METHODS This cross-sectional study included all children and adolescents with T1D who presented to the emergency department at Abo El Rish Children's Hospital, Cairo University, during the first and second COVID-19 waves. It also included data collected from the pre-COVID-19 period. Demographic and clinical data, investigations, and management details were collected from the patients' medical records. RESULTS Three hundred twenty-four Egyptian children and adolescents diagnosed with T1D were recruited. One hundred forty patients (43.2%) presented with severe DKA, and approximately 66% were newly diagnosed with T1D. The participants presented with manifestations suggestive of COVID-19, such as fever (29.5%), respiratory manifestations (7.2%), and gastrointestinal symptoms (14.7%). Thirty-seven patients were tested for severe acute respiratory syndrome coronavirus 2 infection using nasopharyngeal swabs, and four patients tested positive. Around 18% of patients developed hypokalemia during disease management. A comparison between these data and the data from previous years revealed that there was a significant increase in the number of newly diagnosed cases with more severe DKA at presentation and a higher frequency of development of hypokalemia during both COVID-19 waves. CONCLUSION An increase in the frequency of newly diagnosed cases was identified during the first and the second COVID-19 waves compared with the pre-COVID-19 period. The patients presented with more severe DKA, probably due to a more delayed presentation. The frequency of hypokalemia development was also significantly higher, and the severity of DKA was associated with a longer ICU admission. Further studies are required to establish a definitive link between the COVID-19 pandemic and the severity of presentation.
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Affiliation(s)
- Marise Abdou
- The Diabetes, Endocrine and Metabolism Pediatric Unit, Pediatric Department, Cairo University, Cairo, Egypt
- *Correspondence: Marise Abdou,
| | - Mona M. Hassan
- The Diabetes, Endocrine and Metabolism Pediatric Unit, Pediatric Department, Cairo University, Cairo, Egypt
| | - Samah A. Hassanein
- The Diabetes, Endocrine and Metabolism Pediatric Unit, Pediatric Department, Cairo University, Cairo, Egypt
| | - Eman H. Elsebaie
- Public Health and Community Medicine Department, Cairo University, Cairo, Egypt
| | - Radwa A. Shamma
- The Diabetes, Endocrine and Metabolism Pediatric Unit, Pediatric Department, Cairo University, Cairo, Egypt
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15
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Mohammad Ashraf H, Sunderajan T, Pierre L, Kondamudi N, Adeyinka A. Aversion to Hospital Admission Due to Fear of COVID Infection Leading to Fatality From Diabetic Ketoacidosis. Cureus 2021; 13:e20251. [PMID: 35018256 PMCID: PMC8738863 DOI: 10.7759/cureus.20251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 11/10/2022] Open
Abstract
Diabetic ketoacidosis (DKA) is a potentially life-threatening condition that occurs in patients with diabetes mellitus (DM) where the decrease in the insulin level leads to a state of metabolic acidosis and hyperglycemia. Based on the literature review, the risk of severity of DKA in children was significantly associated with coronavirus disease-2019 (COVID-19) cases during the first wave of the pandemic. This could be attributed to social distancing restrictions which delayed hospital presentation and timely treatment and interventions. We present the case of a 15-year-old female, with non-insulin-dependent diabetes (type 2), who presented during the COVID-19 pandemic with severe DKA from another hospital. She had elevated glucose level at home for three days that was worsening but her parents continue to manage the patient at home out of fear of the patient contracting COVID-19 if she was brought to the hospital. After she deteriorated, the parents took her to the nearest hospital which did not have a pediatric intensive care unit (PICU). She was immediately transferred to our facility. The patient was intubated immediately on arrival because of altered mental status possibly due to cerebral edema from severe metabolic acidosis and elevated glucose level. The patient rapidly progressed into shock, acute respiratory distress syndrome (ARDS), and multiple organ dysfunction syndrome (MODS). She was managed aggressively with vasopressors, fluid resuscitation, and insulin drip. She had four cardiac arrests for which she was resuscitated. Despite all efforts, she subsequently expired less than 24 hours after admission. We intend on shedding light on an emerging phenomenon due to the ongoing COVID-19 pandemic, wherein due to the fear of contracting COVID-19, many parents opt to keep and manage sick children at home. This report highlights the important role that the aversion of presenting to medical establishments out of fear of contracting COVID-19 may have led to the untimely and preventable death of our patient. It also outlines the importance of future educational reforms toward changing the patient and family’s perception of hospitals and medical institutions, especially in children with pre-existing chronic medical conditions.
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Marchand A, Ménard J, Brochu P, Haddad S. Impact of heat on biological concentrations of toluene and acetone resulting from exposure by inhalation: A pilot study. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2021; 88:103737. [PMID: 34481063 DOI: 10.1016/j.etap.2021.103737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 06/13/2023]
Abstract
Climatic conditions raise new concerns about the potential impact of heat on the absorption and kinetics of certain chemicals. The impact of 3 temperatures (21, 25 and 30 °C WBGT) on the toxicokinetics of toluene and acetone was therefore evaluated in five human subjects during controlled exposures in an inhalation chamber. Biological samples were collected and analyzed by GC-MS/MS. Increases between 4 and 85 % were observed for solvents concentrations in blood (30 vs 21 °C) while decreases in urine samples for acetone and o-cresol were measured at the end of the exposure period (4 h). Mean blood concentrations at 4 h are well correlated with temperature. Results suggest an increased absorption and/or a decreased elimination of volatile chemicals in the presence of heat. Higher increases of blood chemical concentrations were observed in heavier individuals. Further studies should include physiologically based toxicokinetic models to help in better understanding the mechanisms involved and their respective contribution.
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Affiliation(s)
- Axelle Marchand
- Centre for Public Health Research (CReSP), 7101 Parc Avenue, Montreal, Quebec, H3N 1X9, Canada; Department of Environmental and Occupational Health, ESPUM, Université de Montréal, P.O. Box 6128, Downtown Branch, Montreal, Quebec, H3C 3J7, Canada
| | - Jessie Ménard
- Centre for Public Health Research (CReSP), 7101 Parc Avenue, Montreal, Quebec, H3N 1X9, Canada; Department of Environmental and Occupational Health, ESPUM, Université de Montréal, P.O. Box 6128, Downtown Branch, Montreal, Quebec, H3C 3J7, Canada
| | - Pierre Brochu
- Department of Environmental and Occupational Health, ESPUM, Université de Montréal, P.O. Box 6128, Downtown Branch, Montreal, Quebec, H3C 3J7, Canada
| | - Sami Haddad
- Centre for Public Health Research (CReSP), 7101 Parc Avenue, Montreal, Quebec, H3N 1X9, Canada; Department of Environmental and Occupational Health, ESPUM, Université de Montréal, P.O. Box 6128, Downtown Branch, Montreal, Quebec, H3C 3J7, Canada.
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Sridharan B, Lee MJ. Ketogenic diet: A promising neuroprotective composition for managing Alzheimer's diseases and its pathological mechanisms. Curr Mol Med 2021; 22:640-656. [PMID: 34607541 DOI: 10.2174/1566524021666211004104703] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 11/22/2022]
Abstract
Ketogenic diet and ketone bodies gained significant attention in recent years due to their ability to influence the specific energy metabolism and restoration of mitochondrial homeostasis that can help in hindering the progression of many metabolic diseases including diabetes and neurodegenerative diseases. Ketogenic diet consists of high fat and low carbohydrate contents which makes the body glucose deprived and rely on alternative sources (ketone bodies) for energy. It has been initially designed and supplemented for the treatment of epilepsy and later its influence on many energy-deriving biochemical pathways made it a highly sorted food supplement for many metabolic diseases and even by healthy individuals for body building and calorie restriction. Among the reported therapeutic action over a range of diseases, neurodegenerative disorders especially Alzheimer's disease gained the attention of many researchers and clinicians because of its potency and its easier supplementation as a food additive. Complex pathology and multiple influencing factors of Alzheimer's disease make exploration of its therapeutic strategies a demanding task. It was a common phenomenon that energy deprivation in neurological disorders including Alzheimer's disease, to progress rapidly. The ability of ketone bodies to stabilize the mitochondrial energy metabolism makes it a suitable intervening agent. In this review, we will discuss various research progress made with regards to ketone bodies/ketogenic diet for management of Alzheimer's disease and elaborate in detail about the mechanisms that are influenced during their therapeutic action.
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Affiliation(s)
- Badrinathan Sridharan
- Department of Applied Chemistry, Chaoyang University of Technology, 168 Jifeng East Road, Taichung. Taiwan
| | - Meng-Jen Lee
- Department of Applied Chemistry, Chaoyang University of Technology, 168 Jifeng East Road, Taichung. Taiwan
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Development and validation of a deep learning model to screen hypokalemia from electrocardiogram in emergency patients. Chin Med J (Engl) 2021; 134:2333-2339. [PMID: 34483253 PMCID: PMC8509898 DOI: 10.1097/cm9.0000000000001650] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: A deep learning model (DLM) that enables non-invasive hypokalemia screening from an electrocardiogram (ECG) may improve the detection of this life-threatening condition. This study aimed to develop and evaluate the performance of a DLM for the detection of hypokalemia from the ECGs of emergency patients. Methods: We used a total of 9908 ECG data from emergency patients who were admitted at the Second Affiliated Hospital of Nanchang University, Jiangxi, China, from September 2017 to October 2020. The DLM was trained using 12 ECG leads (lead I, II, III, aVR, aVL, aVF, and V1–6) to detect patients with serum potassium concentrations <3.5 mmol/L and was validated using retrospective data from the Jiangling branch of the Second Affiliated Hospital of Nanchang University. The blood draw was completed within 10 min before and after the ECG examination, and there was no new or ongoing infusion during this period. Results: We used 6904 ECGs and 1726 ECGs as development and internal validation data sets, respectively. In addition, 1278 ECGs from the Jiangling branch of the Second Affiliated Hospital of Nanchang University were used as external validation data sets. Using 12 ECG leads (leads I, II, III, aVR, aVL, aVF, and V1–6), the area under the receiver operating characteristic curve (AUC) of the DLM was 0.80 (95% confidence interval [CI]: 0.77–0.82) for the internal validation data set. Using an optimal operating point yielded a sensitivity of 71.4% and a specificity of 77.1%. Using the same 12 ECG leads, the external validation data set resulted in an AUC for the DLM of 0.77 (95% CI: 0.75–0.79). Using an optimal operating point yielded a sensitivity of 70.0% and a specificity of 69.1%. Conclusions: In this study, using 12 ECG leads, a DLM detected hypokalemia in emergency patients with an AUC of 0.77 to 0.80. Artificial intelligence could be used to analyze an ECG to quickly screen for hypokalemia.
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Fan T, Wang H, Wang J, Wang W, Guan H, Zhang C. Nomogram to predict the risk of acute kidney injury in patients with diabetic ketoacidosis: an analysis of the MIMIC-III database. BMC Endocr Disord 2021; 21:37. [PMID: 33663489 PMCID: PMC7931351 DOI: 10.1186/s12902-021-00696-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/10/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND This study aimed to develop and validate a nomogram for predicting acute kidney injury (AKI) during the Intensive Care Unit (ICU) stay of patients with diabetic ketoacidosis (DKA). METHODS A total of 760 patients diagnosed with DKA from the Medical Information Mart for Intensive Care III (MIMIC-III) database were included and randomly divided into a training set (70%, n = 532) and a validation set (30%, n = 228). Clinical characteristics of the data set were utilized to establish a nomogram for the prediction of AKI during ICU stay. The least absolute shrinkage and selection operator (LASSO) regression was utilized to identified candidate predictors. Meanwhile, a multivariate logistic regression analysis was performed based on variables derived from LASSO regression, in which variables with P < 0.1 were included in the final model. Then, a nomogram was constructed applying these significant risk predictors based on a multivariate logistic regression model. The discriminatory ability of the model was determined by illustrating a receiver operating curve (ROC) and calculating the area under the curve (AUC). Moreover, the calibration plot and Hosmer-Lemeshow goodness-of-fit test (HL test) were conducted to evaluate the performance of our newly bullied nomogram. Decision curve analysis (DCA) was performed to evaluate the clinical net benefit. RESULTS A multivariable model that included type 2 diabetes mellitus (T2DM), microangiopathy, history of congestive heart failure (CHF), history of hypertension, diastolic blood pressure (DBP), urine output, Glasgow coma scale (GCS), and respiratory rate (RR) was represented as the nomogram. The predictive model demonstrated satisfied discrimination with an AUC of 0.747 (95% CI, 0.706-0.789) in the training dataset, and 0.712 (95% CI, 0.642-0.782) in the validation set. The nomogram showed well-calibrated according to the calibration plot and HL test (P > 0.05). DCA showed that our model was clinically useful. CONCLUSION The nomogram predicted model for predicting AKI in patients with DKA was constructed. This predicted model can help clinical physicians to identify the patients with high risk earlier and prevent the occurrence of AKI and intervene timely to improve prognosis.
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Affiliation(s)
- Tingting Fan
- Department of Endocrinology, Second Affiliated Hospital of Jilin University, Ziqiang Street 218, Changchun, 130041, Jilin, China
| | - Haosheng Wang
- Department of Orthopedics, Second Affiliated Hospital of Jilin University, Changchun, China
| | - Jiaxin Wang
- Department of Endocrinology, Second Affiliated Hospital of Jilin University, Ziqiang Street 218, Changchun, 130041, Jilin, China
| | - Wenrui Wang
- Department of Endocrinology, Second Affiliated Hospital of Jilin University, Ziqiang Street 218, Changchun, 130041, Jilin, China
| | - Haifei Guan
- Department of Endocrinology, Second Affiliated Hospital of Jilin University, Ziqiang Street 218, Changchun, 130041, Jilin, China
| | - Chuan Zhang
- Department of Endocrinology, Second Affiliated Hospital of Jilin University, Ziqiang Street 218, Changchun, 130041, Jilin, China.
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Großmann S, Hoffmann U, Girlich C. [Confusion, tachypnea, and tachycardia in a 71-year-old man with type 2 diabetes mellitus]. Internist (Berl) 2021; 62:672-678. [PMID: 33411015 PMCID: PMC7788531 DOI: 10.1007/s00108-020-00930-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2020] [Indexed: 11/14/2022]
Abstract
Bei Patienten mit Diabetes mellitus Typ 2 muss im Falle einer unklaren Bewusstseinsstörung und/oder Bauchschmerzen eine Natrium/Glukose-Kotransporter-2(SGLT-2)-Inhibitor-induzierte diabetische Ketoazidose in die Differenzialdiagnose einbezogen werden. Dabei können die Blutzuckerspiegel trotz ausgeprägter Azidose nur moderat erhöht sein. Bei Nachweis ist eine umgehende intensivmedizinische Therapie unerlässlich.
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Affiliation(s)
- S Großmann
- Klinik für Pneumologie und konservative Intensivmedizin, Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049, Regensburg, Deutschland.
| | - U Hoffmann
- Klinik für Allgemeine Innere Medizin und Geriatrie, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Deutschland
| | - C Girlich
- Klinik für Allgemeine Innere Medizin und Geriatrie, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Deutschland
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21
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Johnston L, Leister E, Singer L. Severe metabolic acidosis due to acetazolamide intoxication in a dog. Aust Vet J 2020; 99:11-14. [PMID: 33025586 DOI: 10.1111/avj.13027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/22/2020] [Accepted: 09/22/2020] [Indexed: 12/01/2022]
Abstract
CASE REPORT This case report describes the clinical signs and case management of a 1-year-old neutered male Siberian Husky that accidentally ingested 635 mg/kg of oral acetazolamide (a carbonic anhydrase inhibitor). The dog presented with severe tachypnoea due to the development of hyperchloraemic metabolic acidosis and associated hypokalaemia that persisted for 7 days. Clinical and biochemical changes resolved with intravenous and subsequent oral supplementation of sodium bicarbonate and potassium. Complete recovery occurred within 9 days of presentation. CONCLUSION To the authors' knowledge, this is the first case that reports overdosage of an oral carbonic anhydrase inhibitor in a dog and subsequent recovery with adequate supplementation and supportive care.
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Affiliation(s)
- L Johnston
- Internal Medicine, Veterinary Specialist Services, Eastlake Street, Carrara, Queensland, 4211, Australia
| | - E Leister
- Emergency and Critical care, Pet ICU, Lexington Road, Underwood, Queensland, 4119, Australia
| | - L Singer
- Internal Medicine, Veterinary Specialist Services, Eastlake Street, Carrara, Queensland, 4211, Australia
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Respiratory Emergencies. Vet Clin North Am Small Anim Pract 2020; 50:1237-1259. [PMID: 32891440 DOI: 10.1016/j.cvsm.2020.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Respiratory distress is commonly seen in dogs and cats presenting to the emergency room. Rapid identification of respiratory difficulty with strategic stabilization and diagnostic efforts are warranted to maximize patient outcome. This article focuses on the relevant anatomy and physiology of the respiratory system and the clinical recognition, stabilization, and initial diagnostic planning for small animal patients that present for respiratory emergencies.
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Castellanos L, Tuffaha M, Koren D, Levitsky LL. Management of Diabetic Ketoacidosis in Children and Adolescents with Type 1 Diabetes Mellitus. Paediatr Drugs 2020; 22:357-367. [PMID: 32449138 DOI: 10.1007/s40272-020-00397-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Diabetic ketoacidosis (DKA) is the end result of insulin deficiency in type 1 diabetes mellitus (T1D). Loss of insulin production leads to profound catabolism with increased gluconeogenesis, glycogenolysis, lipolysis, and muscle proteolysis causing hyperglycemia and osmotic diuresis. High levels of counter-regulatory hormones lead to enhanced ketogenesis and the release of 'ketone bodies' into the circulation, which dissociate to release hydrogen ions and cause an overwhelming acidosis. Dehydration, hyperglycemia, and ketoacidosis are the hallmarks of this condition. Treatment is effective repletion of insulin, fluids and electrolytes. Newer approaches to early diagnosis, treatment, and prevention may diminish the risk of DKA and its childhood complications including cerebral edema. However, the potential for some technical and pharmacologic advances in the management of T1D to increase DKA events must be recognized.
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Affiliation(s)
- Luz Castellanos
- Division of Pediatric Endocrinology and Pediatric Diabetes Center, Massachusetts General Hospital, 175 Cambridge Street, 5th Floor, Boston, MA, 02114, USA
| | - Marwa Tuffaha
- Division of Pediatric Endocrinology and Pediatric Diabetes Center, Massachusetts General Hospital, 175 Cambridge Street, 5th Floor, Boston, MA, 02114, USA
| | - Dorit Koren
- Division of Pediatric Endocrinology and Pediatric Diabetes Center, Massachusetts General Hospital, 175 Cambridge Street, 5th Floor, Boston, MA, 02114, USA
| | - Lynne L Levitsky
- Division of Pediatric Endocrinology and Pediatric Diabetes Center, Massachusetts General Hospital, 175 Cambridge Street, 5th Floor, Boston, MA, 02114, USA.
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Ahmed AM, Khabour OF, Ahmed SM, Alebaid IA, Ibrahim AM. Frequency and severity of ketoacidosis at diagnosis among childhood type 1 diabetes in Khartoum state, Sudan. Afr Health Sci 2020; 20:841-848. [PMID: 33163051 PMCID: PMC7609092 DOI: 10.4314/ahs.v20i2.38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Diabetic ketoacidosis (DKA) is a potentially life threatening acute complication of Type I diabetes mellitus (T1DM). This study aimed to determine the frequency and clinical characteristics of pediatric DKA at diagnosis of new-onset T1DM in Khartoum during 2000-2017 period. METHODS The study was retrospective and involved review of medical files of children (<15 years) with T1DM in the city hospitals and diabetes centers. RESULTS The overall frequency of DKA among T1DM children at onset of disease diagnosis was 17.6% (173/982). The episodes of DKA increased from 26% in first 6- year period (2000-2005) to 46.3% in the last 6-year period (2011-2012; p<0.001). No significant difference in the frequency of DKA was observed according to gender (p=0.9) and age (p=0.24). Compared to other age groups, the severity of DKA (pH<7.1) was higher in pre-school children (p<0.01). Approximately, 5% of patients were complicated with cerebral edema with a mortality rate of 1.7%. CONCLUSION The DKA frequency at diagnosis of childhood T1DM in Khartoum was lower than previous reports. In addition, the severity of DKA was high among pre-school age children with a relatively high mortality rate when compared to the global rate.
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Affiliation(s)
- Ahmed M Ahmed
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Taibah University, AL-Madinah, Saudi Arabia
| | - Omar F Khabour
- Department of Medical Laboratory Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Samia M Ahmed
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Taibah University, AL-Madinah, Saudi Arabia
| | | | - Amna M Ibrahim
- Faculty of Medicine, Omdurman Islamic University, Khartoum, Sudan
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Dialysis-associated hyperglycemia: manifestations and treatment. Int Urol Nephrol 2020; 52:505-517. [PMID: 31955362 DOI: 10.1007/s11255-019-02373-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 12/23/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE Dialysis-associated hyperglycemia (DAH), is associated with a distinct fluid and electrolyte pathophysiology. The purpose of this report was to review the pathophysiology and provide treatment guidelines for DAH. METHODS Review of published reports on DAH. Synthesis of guidelines based on these reports. RESULTS The following fluid and solute abnormalities have been identified in DAH: (a) hypoglycemia: this is a frequent complication of insulin treatment and its prevention requires special attention. (b) Elevated serum tonicity. The degree of hypertonicity in DAH is lower than in similar levels of hyperglycemia in patients with preserved renal function. Typically, correction of hyperglycemia with insulin corrects the hypertonicity of DAH. (c) Extracellular volume abnormalities ranging from pulmonary edema associated with osmotic fluid shift from the intracellular into the extracellular compartment as a consequence of gain in extracellular solute (glucose) to hypovolemia from osmotic diuresis in patients with residual renal function or from fluid losses through extrarenal routes. Correction of DAH by insulin infusion reverses the osmotic fluid transfer between the intracellular and extracellular compartments and corrects the pulmonary edema, but can worsen the manifestations of hypovolemia, which require saline infusion. (d) A variety of acid-base disorders including ketoacidosis correctable with insulin infusion and no other interventions. (e) Hyperkalemia, which is frequent in DAH and is more severe when ketoacidosis is also present. Insulin infusion corrects the hyperkalemia. Extreme hyperkalemia at presentation or hypokalemia developing during insulin infusion require additional measures. CONCLUSIONS In DAH, insulin infusion is the primary management strategy and corrects the fluid and electrolyte abnormalities. Patients treated for DAH should be monitored for the development of hypoglycemia or fluid and electrolyte abnormalities that may require additional treatments.
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Zhou Q, Wang Q, Chen B, Han Y, Cheng L, Shen Y, Hao P, Zhang Z. Factors influencing breath analysis results in patients with diabetes mellitus. J Breath Res 2019; 13:046012. [PMID: 31489846 DOI: 10.1088/1752-7163/ab285a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Breath analysis is used to detect the composition of exhaled gas. As a quick and non-invasive detection method, breath analysis provides deep insights into the progression of various kinds of diseases, especially those with metabolism disorders. Abundant information on volatile compounds in diabetic patients has been studied in numerous articles in the literature. However, exhaled gas in diabetic patients can be altered by various complications. So far, little attention has been paid to this alteration. In our paper, we found that under air pollution conditions, diabetic patients exhale more nitric oxide. Diabetic patients with heart failure exhale more acetone than those without heart failure. After 13C-labeled glucose intake, patients infected with Helicobacter pylori exhaled more 13C and less 18O than those without infection. Exhalation with chronic kidney disease changes volatile organic compounds on a large scale. Diabetic patients with ketoacidosis exhale more acetone than those without ketoacidosis. Some specific volatile organic compounds also emanate from diabetic feet. By monitoring breath frequency, diabetic patients with obstructive sleep apnea syndrome exhibit a unique breath pattern and rhythm as compared with other diabetic patients, and sleep apnea is prevalent among diabetic patients. In addition to clinical findings, we analyzed the underlying mechanisms at the levels of molecules, cells and whole bodies, and provided suggestions for further studies.
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Affiliation(s)
- Qing Zhou
- Department of Endocrinology, Shandong Provincial Qianfoshan Hospital, the First Hospital Affiliated with Shandong First Medical University, Department of Cardiology, Shandong University Qilu Hospital, and School of Medicine of Shandong University, Jinan, 250012, Shandong, People's Republic of China
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