Asma S. A. Alneyadi, Manal AlKhanbashi, F. Alkaabi, M. Ismail
Abstract While proximal skeletal muscle myopathy is a frequently reported complication of thyrotoxicosis, acute bulbar thyrotoxic myopathy is rare especially in absence of other forms of myopathy. In this report, we present a case of 31 years old male presenting with thyrotoxicosis and aspiration pneumonia following weeks of experiencing dysphagia and hoarseness of voice. Labs confirmed Graves' disease and other causes of bulbar myopathy like Myasthenia gravis was ruled out. He was started on thyroid treatment and showed remarkable improvement of dysphagia over 15 days. Based on this, we conclude that isolated bulbar myopathy in hyperthyroidism should be considered in patients presenting with dysphagia and dysphonia in absence of other possible neurological causes.
{"title":"Thyroid Storm Presenting with Isolated Acute Bulbar Myopathy: A Case Report and Literature Review","authors":"Asma S. A. Alneyadi, Manal AlKhanbashi, F. Alkaabi, M. Ismail","doi":"10.1055/s-0042-1749074","DOIUrl":"https://doi.org/10.1055/s-0042-1749074","url":null,"abstract":"Abstract While proximal skeletal muscle myopathy is a frequently reported complication of thyrotoxicosis, acute bulbar thyrotoxic myopathy is rare especially in absence of other forms of myopathy. In this report, we present a case of 31 years old male presenting with thyrotoxicosis and aspiration pneumonia following weeks of experiencing dysphagia and hoarseness of voice. Labs confirmed Graves' disease and other causes of bulbar myopathy like Myasthenia gravis was ruled out. He was started on thyroid treatment and showed remarkable improvement of dysphagia over 15 days. Based on this, we conclude that isolated bulbar myopathy in hyperthyroidism should be considered in patients presenting with dysphagia and dysphonia in absence of other possible neurological causes.","PeriodicalId":294186,"journal":{"name":"Journal of Diabetes and Endocrine Practice","volume":"89 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115971304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Objectives The aim of this study was to compare between insulin glargine and insulin detemir on glucose profile in adolescents with type 1 diabetes mellitus (T1DM) who fast the month of Ramadan. Materials and Methods This was prospective, cross-over study. Subjects were randomized into Group G, in which insulin glargine was given once daily, and Group D, in which ⅔ of the total dose of insulin detemir was given before breaking the fast and ⅓ before starting it. Subjects were crossed-over after 1 week. We compared the mean interstitial glucose (IG), and the percentages of hypoglycemia (<70mg/dL) and severe hyperglycemia (>300mg/dL) between the groups. Results A total of 11 adolescents were enrolled. Mean (±standard deviation) age was 14±3.3 years. There was no difference in the mean IG (190±46 vs. 198±37mg/dL, p =0.1), or the percentages of severe hyperglycemia (13.5±12.9% vs. 13.6±9.2%, p =0.5) in group G and Group D, respectively. Conversely, the percentage of hypoglycemia was higher in Group G than Group D (9.1±7.0% vs. 4.4±2.7%, respectively, p =0.01). Conclusion Insulin detemir given twice daily results in less hypoglycemia than once daily insulin glargine in adolescents with T1DM during fasting in Ramadan.
摘要目的比较甘精胰岛素和地特米胰岛素对1型糖尿病(T1DM)斋月青少年血糖水平的影响。材料与方法本研究为前瞻性交叉研究。将受试者随机分为G组，每日1次给予甘精胰岛素;D组，在开斋前给予总剂量的1 / 3，在开斋前给予总剂量的1 / 3。受试者于1周后交叉。我们比较各组间质糖(IG)平均值和低血糖(300mg/dL)百分比。结果共纳入11名青少年。平均(±标准差)年龄为14±3.3岁。G组和D组的平均IG(190±46 vs 198±37mg/dL, p =0.1)和严重高血糖百分比(13.5±12.9% vs 13.6±9.2%，p =0.5)差异无统计学意义。相反，G组低血糖发生率高于D组(分别为9.1±7.0%和4.4±2.7%，p =0.01)。结论1型糖尿病青少年斋月禁食期间每日2次地特胰岛素比每日1次甘精胰岛素低血糖发生率低。
{"title":"Comparison between Insulin Glargine and Insulin Detemir in Adolescents with Type 1 Diabetes during Ramadan Fasting","authors":"W. Kaplan, B. Afandi, N. Al Hassani","doi":"10.1055/s-0042-1753496","DOIUrl":"https://doi.org/10.1055/s-0042-1753496","url":null,"abstract":"Abstract Objectives The aim of this study was to compare between insulin glargine and insulin detemir on glucose profile in adolescents with type 1 diabetes mellitus (T1DM) who fast the month of Ramadan. Materials and Methods This was prospective, cross-over study. Subjects were randomized into Group G, in which insulin glargine was given once daily, and Group D, in which ⅔ of the total dose of insulin detemir was given before breaking the fast and ⅓ before starting it. Subjects were crossed-over after 1 week. We compared the mean interstitial glucose (IG), and the percentages of hypoglycemia (<70mg/dL) and severe hyperglycemia (>300mg/dL) between the groups. Results A total of 11 adolescents were enrolled. Mean (±standard deviation) age was 14±3.3 years. There was no difference in the mean IG (190±46 vs. 198±37mg/dL, p =0.1), or the percentages of severe hyperglycemia (13.5±12.9% vs. 13.6±9.2%, p =0.5) in group G and Group D, respectively. Conversely, the percentage of hypoglycemia was higher in Group G than Group D (9.1±7.0% vs. 4.4±2.7%, respectively, p =0.01). Conclusion Insulin detemir given twice daily results in less hypoglycemia than once daily insulin glargine in adolescents with T1DM during fasting in Ramadan.","PeriodicalId":294186,"journal":{"name":"Journal of Diabetes and Endocrine Practice","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126776389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Bondugulapati, Hussam Abusahmin, Peter J. T. Drew, D. Watson, A. Dixon
A 55-year-oldman presented to his general practitioner (GP) with a 3-week history of flu-like symptoms, pruritis, weight loss, and diarrhea. Initial investigations showed eosinophilia, 32.2 10/L (normal range: 0 to 0.5 10/L) and a normal random glucose. He was seen in a general medical clinic 3 weeks after the initial referral from GP and, at this point, had polyuria and polydipsia. He was previously well and was on no medication. He is a nonsmoker, drinks alcohol occasionally, and denies illicit drug abuse. There had been no recent travel abroad. Physical examination was unremarkable. Repeat investigations showed ongoing eosinophilia (33.5 10/L), elevated randomblood glucose (15.9mmol/L), raised hemoglobin A1c (HbA1c) (89mmol/mol, i.e., 10.3%), raised creatinine (171 μmol/L; 1.93mg/dL), and normal liver function tests. There were no ova, cysts, or parasites in urine or stool. Strongyloides, hepatitis, and human immunodeficiency virus serology were negative, as were the antinuclear antibody and antineutrophil cytoplasmic autoantibody. A cytogenetic analysis test and F1P1L1-PDGFRA (to rule out eosinophilic leukemia) were also negative. Renal function normalized with intravenous fluid support. Acute kidney injury was thought to be secondary to diarrhea and osmotic diuresis. Computed tomography (CT) scan of the chest and abdomen showed a generally swollen and bulky pancreas (►Fig. 1). Management and Progress
{"title":"A Case of Diabetes Mellitus Treated with Glucocorticoids","authors":"L. Bondugulapati, Hussam Abusahmin, Peter J. T. Drew, D. Watson, A. Dixon","doi":"10.1055/s-0042-1757703","DOIUrl":"https://doi.org/10.1055/s-0042-1757703","url":null,"abstract":"A 55-year-oldman presented to his general practitioner (GP) with a 3-week history of flu-like symptoms, pruritis, weight loss, and diarrhea. Initial investigations showed eosinophilia, 32.2 10/L (normal range: 0 to 0.5 10/L) and a normal random glucose. He was seen in a general medical clinic 3 weeks after the initial referral from GP and, at this point, had polyuria and polydipsia. He was previously well and was on no medication. He is a nonsmoker, drinks alcohol occasionally, and denies illicit drug abuse. There had been no recent travel abroad. Physical examination was unremarkable. Repeat investigations showed ongoing eosinophilia (33.5 10/L), elevated randomblood glucose (15.9mmol/L), raised hemoglobin A1c (HbA1c) (89mmol/mol, i.e., 10.3%), raised creatinine (171 μmol/L; 1.93mg/dL), and normal liver function tests. There were no ova, cysts, or parasites in urine or stool. Strongyloides, hepatitis, and human immunodeficiency virus serology were negative, as were the antinuclear antibody and antineutrophil cytoplasmic autoantibody. A cytogenetic analysis test and F1P1L1-PDGFRA (to rule out eosinophilic leukemia) were also negative. Renal function normalized with intravenous fluid support. Acute kidney injury was thought to be secondary to diarrhea and osmotic diuresis. Computed tomography (CT) scan of the chest and abdomen showed a generally swollen and bulky pancreas (►Fig. 1). Management and Progress","PeriodicalId":294186,"journal":{"name":"Journal of Diabetes and Endocrine Practice","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126426950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Prolactinoma is the most common pituitary tumor. It arises from the lactotroph cells and leads to a hyperprolactinemia state. The clinical presentation of prolactinomas is either due to the high prolactin state or the adenoma mass effect. Diagnosis of prolactinomas starts with the confirmation of persistent pathologic hyperprolactinemia. Subsequently, pituitary MRI is required to characterize the prolactinoma size and extension within the sella turcica. Further investigation may include visual field assessment and laboratory investigations for hypopituitarism. Prolactinoma management is mainly medical with dopamine agonists as most of these tumors are responsive. Surgical intervention is rarely required with specific indications.
{"title":"Rational Evaluation and Treatment of Prolactinomas: A Concise Review","authors":"Moeber M. Mahzari","doi":"10.1055/s-0042-1758381","DOIUrl":"https://doi.org/10.1055/s-0042-1758381","url":null,"abstract":"Abstract Prolactinoma is the most common pituitary tumor. It arises from the lactotroph cells and leads to a hyperprolactinemia state. The clinical presentation of prolactinomas is either due to the high prolactin state or the adenoma mass effect. Diagnosis of prolactinomas starts with the confirmation of persistent pathologic hyperprolactinemia. Subsequently, pituitary MRI is required to characterize the prolactinoma size and extension within the sella turcica. Further investigation may include visual field assessment and laboratory investigations for hypopituitarism. Prolactinoma management is mainly medical with dopamine agonists as most of these tumors are responsive. Surgical intervention is rarely required with specific indications.","PeriodicalId":294186,"journal":{"name":"Journal of Diabetes and Endocrine Practice","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116715855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Beshyah, Mussa H. Almalki, S. Azzoug, M. Barake, Khaled Al Dahmani, Melika Chihaoui
Background Cushing's disease is the most prevalent cause of endogenous Cushing's syndrome. This study aimed to scope the current clinical practice pattern in managing Cushing's disease by endocrinologists in the Middle Eastern and North African (MENA) region. Methods A questionnaire dealing with diagnosis, treatment, and follow-up of patients with Cushing's disease was adopted and sent electronically to a convenience sample of endocrinologists from the MENA region. Results Out of 125 responses received, 88 were eligible for inclusion in the analysis. Most respondents selected the overnight dexamethasone suppression test (ONDST) and 24-hour urinary-free cortisol (UFC) as the best screening tests, 58 (66.7%) and 50 (57.5%) respectively, followed by midnight serum cortisol and midnight salivary cortisol. Measurement of serum adrenocorticotropic hormone (ACTH; 86.2%) and classic high-dose dexamethasone suppression test (40.2%) were selected for localization of the primary lesion. The primary choice of treatment was transsphenoidal pituitary surgery (98.8%). For the recurrence of Cushing's disease, medical therapy was the preferred modality followed by repeated pituitary surgery or bilateral adrenalectomy. In case of treatment failure following the first pituitary surgery and ketoconazole treatment, 36.9% selected pasireotide, while 32.1% chose bilateral adrenalectomy. Conclusion ONDST and UFC are the two most common tests used to screen an index case with features of hypercortisolism. Pituitary surgery is the primary choice of treatment in Cushing's disease. However, medical treatment by ketoconazole is preferred for recurrent cases. Bilateral adrenalectomy is followed by pasireotide may be chosen in case of treatment failure after pituitary surgery and ketoconazole.
{"title":"Diagnosis and Management of Cushing's Disease: A Survey of Endocrinologists from the Middle East and North Africa","authors":"S. Beshyah, Mussa H. Almalki, S. Azzoug, M. Barake, Khaled Al Dahmani, Melika Chihaoui","doi":"10.1055/s-0042-1755931","DOIUrl":"https://doi.org/10.1055/s-0042-1755931","url":null,"abstract":"\u0000 Background Cushing's disease is the most prevalent cause of endogenous Cushing's syndrome. This study aimed to scope the current clinical practice pattern in managing Cushing's disease by endocrinologists in the Middle Eastern and North African (MENA) region.\u0000 Methods A questionnaire dealing with diagnosis, treatment, and follow-up of patients with Cushing's disease was adopted and sent electronically to a convenience sample of endocrinologists from the MENA region.\u0000 Results Out of 125 responses received, 88 were eligible for inclusion in the analysis. Most respondents selected the overnight dexamethasone suppression test (ONDST) and 24-hour urinary-free cortisol (UFC) as the best screening tests, 58 (66.7%) and 50 (57.5%) respectively, followed by midnight serum cortisol and midnight salivary cortisol. Measurement of serum adrenocorticotropic hormone (ACTH; 86.2%) and classic high-dose dexamethasone suppression test (40.2%) were selected for localization of the primary lesion. The primary choice of treatment was transsphenoidal pituitary surgery (98.8%). For the recurrence of Cushing's disease, medical therapy was the preferred modality followed by repeated pituitary surgery or bilateral adrenalectomy. In case of treatment failure following the first pituitary surgery and ketoconazole treatment, 36.9% selected pasireotide, while 32.1% chose bilateral adrenalectomy.\u0000 Conclusion ONDST and UFC are the two most common tests used to screen an index case with features of hypercortisolism. Pituitary surgery is the primary choice of treatment in Cushing's disease. However, medical treatment by ketoconazole is preferred for recurrent cases. Bilateral adrenalectomy is followed by pasireotide may be chosen in case of treatment failure after pituitary surgery and ketoconazole.","PeriodicalId":294186,"journal":{"name":"Journal of Diabetes and Endocrine Practice","volume":"195 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115644455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Buthaina Alowainati, Z. Dabbous, Obada Salameh, Mohammad Hamad, Layla Al Hail, Wajeeha Abuheliqa, Ibrahim Al-Janahi, A. Jayyousi, M. Zirie
Introduction: The coronavirus disease-2019 (COVID-19) pandemic was associated with international obligations that modified lifestyles and clinical practice. These changes are worrisome for patients with diabetes, as disruption from a routine can have devastating effects on glucose control. This retrospective study aims to assess the impact of lockdown and the efficacy of the instituted changes in patient management on blood sugar control. Methods: Patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) who received management through telemedicine at the National Diabetes Center over a lockdown period of 3 months were included. The blood investigations that were done for them as part of standard care were reviewed. Results: A total of 509 patients were included. HbA1c slightly decreased in 49.5% of the patients after the lockdown (P = 0.42). Patients who were not hypertensive experienced a significant reduction in HbA1c (adjusted odds ratios [ORa]: 0.59, 95% confidence interval [CI]: 0.39–0.91, P = 0.018) during the lockdown. A significant association between body mass index (BMI) and lower HbA1c level postlockdown was also determined (ORa: 0.95, (95% CI: 0.92–0.98, P = 0.001). A significant HbA1c reduction was only noted in the BMI group of normal weight (mean: 0.46 ± 0.3, P = 0.03). Conclusion: The imposed lockdown due to COVID-19 did not adversely impact the HbA1c level and glycemic control in T1DM and T2DM patients. Inversely, HbA1c improvements were determined in patients with normal weight and blood pressure after the lockdown period.
导语:2019冠状病毒病(COVID-19)大流行与改变生活方式和临床实践的国际义务有关。这些变化对糖尿病患者来说是令人担忧的，因为日常生活的中断会对血糖控制产生毁灭性的影响。本回顾性研究旨在评估封锁的影响和制定的患者管理变化对血糖控制的效果。方法:1型糖尿病(T1DM)和2型糖尿病(T2DM)患者在国家糖尿病中心接受远程医疗管理，封锁期超过3个月。作为标准治疗的一部分，对他们进行的血液检查进行了回顾。结果:共纳入509例患者。封城后，49.5%的患者HbA1c略有下降(P = 0.42)。在封锁期间，非高血压患者的HbA1c显著降低(校正优势比[ORa]: 0.59, 95%可信区间[CI]: 0.39-0.91, P = 0.018)。还确定了身体质量指数(BMI)与封锁后较低的HbA1c水平之间的显著关联(ORa: 0.95， (95% CI: 0.92-0.98, P = 0.001)。只有体重正常的BMI组有显著的HbA1c降低(平均值:0.46±0.3,P = 0.03)。结论:新冠肺炎强制封城对T1DM和T2DM患者的HbA1c水平和血糖控制没有不利影响。相反，在封锁期后，体重和血压正常的患者的HbA1c有所改善。
{"title":"The impact of lockdown and changes in clinical practice on glycemic control during the COVID-19 pandemic: Analysis of data from the National Diabetes Center, Doha, Qatar","authors":"Buthaina Alowainati, Z. Dabbous, Obada Salameh, Mohammad Hamad, Layla Al Hail, Wajeeha Abuheliqa, Ibrahim Al-Janahi, A. Jayyousi, M. Zirie","doi":"10.4103/jdep.jdep_49_21","DOIUrl":"https://doi.org/10.4103/jdep.jdep_49_21","url":null,"abstract":"Introduction: The coronavirus disease-2019 (COVID-19) pandemic was associated with international obligations that modified lifestyles and clinical practice. These changes are worrisome for patients with diabetes, as disruption from a routine can have devastating effects on glucose control. This retrospective study aims to assess the impact of lockdown and the efficacy of the instituted changes in patient management on blood sugar control. Methods: Patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) who received management through telemedicine at the National Diabetes Center over a lockdown period of 3 months were included. The blood investigations that were done for them as part of standard care were reviewed. Results: A total of 509 patients were included. HbA1c slightly decreased in 49.5% of the patients after the lockdown (P = 0.42). Patients who were not hypertensive experienced a significant reduction in HbA1c (adjusted odds ratios [ORa]: 0.59, 95% confidence interval [CI]: 0.39–0.91, P = 0.018) during the lockdown. A significant association between body mass index (BMI) and lower HbA1c level postlockdown was also determined (ORa: 0.95, (95% CI: 0.92–0.98, P = 0.001). A significant HbA1c reduction was only noted in the BMI group of normal weight (mean: 0.46 ± 0.3, P = 0.03). Conclusion: The imposed lockdown due to COVID-19 did not adversely impact the HbA1c level and glycemic control in T1DM and T2DM patients. Inversely, HbA1c improvements were determined in patients with normal weight and blood pressure after the lockdown period.","PeriodicalId":294186,"journal":{"name":"Journal of Diabetes and Endocrine Practice","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129691547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
O. Del Foco, Antonio Bencomo-Hernández, Y. Castillo-Aleman, Pierdanilo Sanna, S. Benedetti, E. Dassen
Critical limb ischemia (CLI) is considered the end-stage of peripheral arterial disease, with a prevalence between 2% and 4% in the general population and more than 15% in older adults. One-year major amputation rate can reach 30%, and diabetic patients are five times more likely to develop CLI than nondiabetics. The vascular damage and the complexity in the anatomical extension of the lesions are also worse in people with diabetes with poorer outcomes after vascularization attempts. Following the classifications suggested by international guidelines, we can define the presence of CLI and have a precise evaluation of the amputation risk and the best revascularization procedure for the patient. Nowadays, new endovascular techniques and devices make it possible to treat tibial vessels and even arteries below the ankle with promising initial results. Nevertheless, the re-occlusions rate and the need to re-do treatments at 1 year remain between 30% and 50%. The disease progression and hyperplasia can because it. However, the damage at the microcirculatory level can also lead to a decrease in tissue runoff and an increase in peripheral resistance, which determine the revascularization failure. In the last 20 years, several trials have been designed to avoid amputation in patients with no surgical options. The aim is to find a valid cellular base therapy to create a new vessel web in the ischemic tissue based on the angiogenetic power that stem cells have already demonstrated in vitro and animal studies. Different types of cells have been tested with different concentrations and administration routes with promising results. CD34 + Mononuclear cells, Mesenchymal stem cells, growth factors have demonstrated their contribution to the neo-angiogenesis in ischemic areas. At Abu Dhabi Stem Cells Center, we created a cellular cocktail as an adjunct treatment to surgical revascularization. We think that acting at the microcirculatory and immunological level. We may reduce postsurgery hyperplasia and increase tissue perfusion, ultimately prolonging the patency of revascularization procedures.
{"title":"Surgical and cell therapy in critical limb ischemia: Current evidence and rationale for combined treatment with special focus on diabetic patients","authors":"O. Del Foco, Antonio Bencomo-Hernández, Y. Castillo-Aleman, Pierdanilo Sanna, S. Benedetti, E. Dassen","doi":"10.4103/jdep.jdep_52_21","DOIUrl":"https://doi.org/10.4103/jdep.jdep_52_21","url":null,"abstract":"Critical limb ischemia (CLI) is considered the end-stage of peripheral arterial disease, with a prevalence between 2% and 4% in the general population and more than 15% in older adults. One-year major amputation rate can reach 30%, and diabetic patients are five times more likely to develop CLI than nondiabetics. The vascular damage and the complexity in the anatomical extension of the lesions are also worse in people with diabetes with poorer outcomes after vascularization attempts. Following the classifications suggested by international guidelines, we can define the presence of CLI and have a precise evaluation of the amputation risk and the best revascularization procedure for the patient. Nowadays, new endovascular techniques and devices make it possible to treat tibial vessels and even arteries below the ankle with promising initial results. Nevertheless, the re-occlusions rate and the need to re-do treatments at 1 year remain between 30% and 50%. The disease progression and hyperplasia can because it. However, the damage at the microcirculatory level can also lead to a decrease in tissue runoff and an increase in peripheral resistance, which determine the revascularization failure. In the last 20 years, several trials have been designed to avoid amputation in patients with no surgical options. The aim is to find a valid cellular base therapy to create a new vessel web in the ischemic tissue based on the angiogenetic power that stem cells have already demonstrated in vitro and animal studies. Different types of cells have been tested with different concentrations and administration routes with promising results. CD34 + Mononuclear cells, Mesenchymal stem cells, growth factors have demonstrated their contribution to the neo-angiogenesis in ischemic areas. At Abu Dhabi Stem Cells Center, we created a cellular cocktail as an adjunct treatment to surgical revascularization. We think that acting at the microcirculatory and immunological level. We may reduce postsurgery hyperplasia and increase tissue perfusion, ultimately prolonging the patency of revascularization procedures.","PeriodicalId":294186,"journal":{"name":"Journal of Diabetes and Endocrine Practice","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131609791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Dyslipidemia is often associated with type 2 diabetes (T2D), with both having an additive effect on cardiovascular risk. The objective of the meta-analysis was to determine the prevalence of dyslipidemia in individuals living with T2D mellitus in Nigerian and to examine the pattern of their dyslipidemia. Methods: The study followed the preferred reporting items for systematic reviews and meta-analyses guidelines. Medical databases such as PubMed, Google Scholar, African Journals Online, and SCOPUS as well as the gray literature were systematically searched. MetaXL was used for statistical analysis adopting the random effect model. Heterogeneity was determined using the I 2 statistic, while publication bias was assessed with the funnel plot. Results: Twenty-two studies met the eligibility criteria for the meta-analysis. The total sample size was 3575. The prevalence of dyslipidemia among Nigerians living with diabetes ranges from 25% to 97.1%. The pooled prevalence of dyslipidemia among Nigerians living with T2D was 63% (95% confidence interval [CI]: 52%–72%). I 2 statistic was 97%. The funnel plot implied minimal publication bias. The pooled prevalence of elevated low-density lipoprotein cholesterol was 33% (95% CI: 18%–49%). The pooled prevalence of elevated hypertriglyceridemia was 88% (95% CI: 84%–91%). The pooled prevalence of low high-density lipoprotein cholesterol (HDL-C) was 47% (95% CI: 32%–62%). The pooled prevalence of elevated hypercholesterolemia was 33% (95% CI: 23%–43%). Conclusions: The prevalence of dyslipidemia among Nigerians with T2D mellitus is very high. The most common abnormalities are hypertriglyceridemia and low HDL-C.
{"title":"Lipid profiles of Nigerians living with type 2 diabetes mellitus: A systematic review and meta-analysis","authors":"T. Azeez, M. Adio, O. Bamidele","doi":"10.4103/jdep.jdep_48_21","DOIUrl":"https://doi.org/10.4103/jdep.jdep_48_21","url":null,"abstract":"Introduction: Dyslipidemia is often associated with type 2 diabetes (T2D), with both having an additive effect on cardiovascular risk. The objective of the meta-analysis was to determine the prevalence of dyslipidemia in individuals living with T2D mellitus in Nigerian and to examine the pattern of their dyslipidemia. Methods: The study followed the preferred reporting items for systematic reviews and meta-analyses guidelines. Medical databases such as PubMed, Google Scholar, African Journals Online, and SCOPUS as well as the gray literature were systematically searched. MetaXL was used for statistical analysis adopting the random effect model. Heterogeneity was determined using the I 2 statistic, while publication bias was assessed with the funnel plot. Results: Twenty-two studies met the eligibility criteria for the meta-analysis. The total sample size was 3575. The prevalence of dyslipidemia among Nigerians living with diabetes ranges from 25% to 97.1%. The pooled prevalence of dyslipidemia among Nigerians living with T2D was 63% (95% confidence interval [CI]: 52%–72%). I 2 statistic was 97%. The funnel plot implied minimal publication bias. The pooled prevalence of elevated low-density lipoprotein cholesterol was 33% (95% CI: 18%–49%). The pooled prevalence of elevated hypertriglyceridemia was 88% (95% CI: 84%–91%). The pooled prevalence of low high-density lipoprotein cholesterol (HDL-C) was 47% (95% CI: 32%–62%). The pooled prevalence of elevated hypercholesterolemia was 33% (95% CI: 23%–43%). Conclusions: The prevalence of dyslipidemia among Nigerians with T2D mellitus is very high. The most common abnormalities are hypertriglyceridemia and low HDL-C.","PeriodicalId":294186,"journal":{"name":"Journal of Diabetes and Endocrine Practice","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134125721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"JDEP 2021: Some progress, more is needed!","authors":"S. Beshyah, E. Al-Ozairi, N. Aljohani","doi":"10.4103/jdep.jdep_50_21","DOIUrl":"https://doi.org/10.4103/jdep.jdep_50_21","url":null,"abstract":"","PeriodicalId":294186,"journal":{"name":"Journal of Diabetes and Endocrine Practice","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117027430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
An increase in the incidence of subacute thyroiditis (SAT) following the COVID-19 vaccine. The aim of this report is to shed the light on different presentations of SAT postCOVID-19 vaccine while reviewing the link between the vaccine and subsequent thyroid inflammation. We present the case of a middle-aged man who presented symptoms of SAT 1-week postvaccine. He achieved euthyroidism 6 weeks later. We also present the case of a middle-aged woman with less severe symptoms of SAT 4 weeks after the vaccine. She is in the hypothyroid phase 11 weeks later. A 37-year-old male developed severe symptoms 2 weeks after the first dose and is still hyperthyroid 5 weeks later. A 36-year-old woman presented with silent SAT 3 weeks after the first dose. Cases of SAT following SARS-Cov-2 are now reported increasingly. COVID-19 can cause thyroiditis via direct cell, or alternatively though immune destruction of the thyroid in genetically susceptible individuals. Similarly, the vaccine can promote inflammation through the same mechanisms. Indeed, there is a postulated cross-reactivity between the spike protein and thyroid antigens. More-so, there is the studied vaccine adjuvant effect on the endocrine system, namely the thyroid in this case. Cases of SAT postCOVID-19 vaccines are increasingly reported. Theories are similar to COVID19-induced thyroiditis but also other mechanisms are uniquely mediated by vaccines. A low threshold should be set to diagnose SAT in patients with one or more hyperthyroid symptoms presenting 1–8 weeks postCOVID-19 vaccine.
{"title":"Subacute thyroiditis following COVID19 vaccine: Report of four cases","authors":"Sara El Ghandour, Nisrine Al Ghazal","doi":"10.4103/jdep.jdep_46_21","DOIUrl":"https://doi.org/10.4103/jdep.jdep_46_21","url":null,"abstract":"An increase in the incidence of subacute thyroiditis (SAT) following the COVID-19 vaccine. The aim of this report is to shed the light on different presentations of SAT postCOVID-19 vaccine while reviewing the link between the vaccine and subsequent thyroid inflammation. We present the case of a middle-aged man who presented symptoms of SAT 1-week postvaccine. He achieved euthyroidism 6 weeks later. We also present the case of a middle-aged woman with less severe symptoms of SAT 4 weeks after the vaccine. She is in the hypothyroid phase 11 weeks later. A 37-year-old male developed severe symptoms 2 weeks after the first dose and is still hyperthyroid 5 weeks later. A 36-year-old woman presented with silent SAT 3 weeks after the first dose. Cases of SAT following SARS-Cov-2 are now reported increasingly. COVID-19 can cause thyroiditis via direct cell, or alternatively though immune destruction of the thyroid in genetically susceptible individuals. Similarly, the vaccine can promote inflammation through the same mechanisms. Indeed, there is a postulated cross-reactivity between the spike protein and thyroid antigens. More-so, there is the studied vaccine adjuvant effect on the endocrine system, namely the thyroid in this case. Cases of SAT postCOVID-19 vaccines are increasingly reported. Theories are similar to COVID19-induced thyroiditis but also other mechanisms are uniquely mediated by vaccines. A low threshold should be set to diagnose SAT in patients with one or more hyperthyroid symptoms presenting 1–8 weeks postCOVID-19 vaccine.","PeriodicalId":294186,"journal":{"name":"Journal of Diabetes and Endocrine Practice","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129450307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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