I drank too much and now I can’t walk: a case of alcohol-induced dysautonomia

ABSTRACT Dysautonomia is a dysfunction of the autonomic nervous system, which mediates both sympathetic and parasympathetic functions of the human body. Alcohol has been established to affect the autonomic function through liver injury and accumulation of vasodilators. Alcohol can induce peripheral neurological diseases as well. This case report describes a patient who had a chronic history of alcoholism and uncontrolled diabetes mellitus presenting for orthostatic hypotension and peripheral neuropathy without underlying liver disease or other endocrinopathies. Although diabetes mellitus was controlled pharmacologically and risk factors for orthostatic hypotension were managed conservatively, his symptoms did not improve which indicated an alcohol-related autonomic dysfunction, shedding light on one of long-term complications of alcoholism.

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Risk factors associated with poor glycemic control in patients with type two Diabetes mellitus in Zakho city

Journal of Contemporary Medical Sciences ◽

10.22317/jcms.v7i3.970 ◽

2021 ◽

Vol 7 (3) ◽

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Waist Circumference ◽

Glycemic Control ◽

High Performance ◽

Poor Glycemic Control ◽

Uncontrolled Diabetes ◽

Two Factors ◽

History Of ◽

Diabetes Center

Diabetes Mellitus (DM) is a chronic condition caused by relative lack of insulin due to impaired insulin secretion or insulin resistance. The aim of this study was to investigate the prevalence of poor glycemic control in Zakho city and to explore the modifiable risk factors that may help controlling the disease. Materials and Methods We recruited patients with known history of diabetes receiving oral anti-diabetic medications. Those patients were registered in Zakho Diabetes center with regular visits. The measurement of anthropometric indices was conducted by trained personnel. Plasma glucose was determined using colorimetric enzymatic method with glucose oxidase. HbA1c concentrations were measured in whole blood samples using high performance liquid chromatography. Results In this study, 520 patients were recruited. The average age of the patients was 56.92±9.62. Among those, 190 were male. The blood sugar was controlled in 122 (23.4%) patients. We found a significant association between sex and HbA1C level (p=0.000; OR=0.4796; CI=0.3175-0.7243). In addition, waist circumference was significantly associated with HbA1C levels (p=0.018; OR=1.02; CI=1.0031-1.0373). Conclusions The vast majority of the patients had uncontrolled diabetes. We found that sex and waist circumference were risk factors for uncontrolled diabetes. Any diabetes controlling program should focus on those two factors.

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Homocysteine (Hcy) Follow-Up Study

Clinical & Investigative Medicine ◽

10.25011/cim.v30i1.445 ◽

2007 ◽

Vol 30 (1) ◽

pp. 21 ◽

Cited By ~ 3

Author(s):

Arnon Blum ◽

Ihsan Hijazi ◽

Michal Mashiach Eizenberg ◽

Nava Blum

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Natural History ◽

Beta Blockers ◽

Term Treatment ◽

Channel Blockers ◽

Long Term Treatment ◽

History Of

Background: Hyperhomocysteinemia confers an increased risk of coronary artery disease, stroke, and deep vein thrombosis, and is a strong predictor of mortality among patients with ischemic heart disease. Purpose: To determne the long term clinical outcome of patients with risk factors to atherosclerosis with high concentrations of homocysteine (Hcy). Methods: 89 patients with one or more risk factors for atherosclerosis, whose plasma total Hcy concentrations were measured, were followed for 5 years. Patients were interviewed and underwent a clinical examination in the outpatient clinic. Their medical records were reviewed in the last 5 years including smoking habits, medications, other diseases (hypertension, diabetes mellitus, hyperlipidemia) and their management. SPSS was used to describe and explore possible relationships between Hcy concentration, other diseases, medications and the clinical long term outcome. Results: All men with normal Hcy concentrations (10.76±1.71µmol/L) survived during the 5 years’ follow up, while 5 of the men with high Hcy concentrations (21.27±5.37µmol/L), died (17%) (P< 0.05). In women Hcy concentration did not affect survival. No association was found between diabetes mellitus, hypercholesterolemia, hypertension and Hcy. Long term treatment with Beta Blockers, ACE inhibitors, Calcium Channel blockers, and especially with Aspirin prevented death and changed the natural history of patients with high Hcy concentrations (P < 0.05). Conclusions – Hyperhomocysteinemia may have an effect on survival in men. Long term treatment with Beta Blockers, ACE inhibitors, Calcium Channel Blockers, and especially with Aspirin – prevented death and changed the natural history of patients with high Hcy concentrations.

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When Uncontrolled Diabetes Mellitus and Severe COVID-19 Converge: The Perfect Storm for Mucormycosis

Journal of Fungi ◽

10.3390/jof7040298 ◽

2021 ◽

Vol 7 (4) ◽

pp. 298

Author(s):

Teny M. John ◽

Ceena N. Jacob ◽

Dimitrios P. Kontoyiannis

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Clinical Features ◽

The Other ◽

Diabetic Patients ◽

Epidemiological Factors ◽

Uncontrolled Diabetes ◽

Diagnostic Certainty ◽

Patients With Diabetes ◽

Perfect Storm

Mucormycosis (MCR) has been increasingly described in patients with coronavirus disease 2019 (COVID-19) but the epidemiological factors, presentation, diagnostic certainty, and outcome of such patients are not well described. We review the published COVID-19-associated mucormycosis (CAMCR) cases (total 41) to identify risk factors, clinical features, and outcomes. CAMCR was typically seen in patients with diabetes mellitus (DM) (94%) especially the ones with poorly controlled DM (67%) and severe or critical COVID-19 (95%). Its presentation was typical of MCR seen in diabetic patients (mostly rhino-orbital and rhino-orbital-cerebral presentation). In sharp contrast to reported COVID-associated aspergillosis (CAPA) cases, nearly all CAMCR infections were proven (93%). Treating physicians should have a high suspicion for CAMCR in patients with uncontrolled diabetes mellitus and severe COVID-19 presenting with rhino-orbital or rhino-cerebral syndromes. CAMR is the convergence of two storms, one of DM and the other of COVID-19.

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Incidence of diabetes mellitus and associated risk factors in the adult population of the Basque country, Spain

Scientific Reports ◽

10.1038/s41598-021-82548-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Inés Urrutia ◽

◽

Alicia Martín-Nieto ◽

Rosa Martínez ◽

J Oriol Casanovas-Marsal ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Family History ◽

Basque Country ◽

Adult Population ◽

Tolerance Test ◽

Oral Glucose ◽

Family History Of Diabetes ◽

History Of ◽

Incident Cases

AbstractThe aim of this study was to estimate the incidence of diabetes mellitus in the Basque Country and the risk factors involved in the disease by reassessing an adult population after 7 years of follow-up. In the previous prevalence study, 847 people older than 18 years were randomly selected from all over the Basque Country and were invited to answer a medical questionnaire, followed by a physical examination and an oral glucose tolerance test. In the reassessment, the same variables were collected and the resulting cohort comprised 517 individuals of whom 43 had diabetes at baseline. The cumulative incidence of diabetes was 4.64% in 7 years and the raw incidence rate was 6.56 cases/1000 person-years (95%CI: 4.11–9.93). Among the incident cases, 59% were undiagnosed. The most strongly associated markers by univariate analyses were age > 60 years, dyslipidaemia, prediabetes and insulin resistance. We also found association with hypertension, obesity, family history of diabetes and low education level. Multivariate analysis adjusted for age and sex showed that a set of risk factors assessed together (dyslipidaemia, waist-to-hip-ratio and family history of diabetes) had great predictive value (AUC-ROC = 0.899, 95%CI: 0.846–0.953, p = 0.942), which suggests the need for early intervention before the onset of prediabetes.

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POS0727 INSULIN RESISTANCE AND LEPTIN LEVELS IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS WITHOUT DIABETES MELLITUS OR FASTING HYPERGLYCEMIA

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1307 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 613.2-614

Author(s):

L. Kondrateva ◽

T. Panafidina ◽

T. Popkova ◽

M. Cherkasova ◽

A. Lila ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Insulin Resistance ◽

Fasting Glucose ◽

Family History Of Diabetes ◽

History Of ◽

Traditional Risk Factors ◽

Risk Categories ◽

Group 1

Background:Insulin resistance (IR) is considered as initial stage of diseases continuum from development of prediabetes to eventual progression to type 2 diabetes mellitus (T2DM). Individuals with prediabetes have also elevated leptin levels, so this adipocytokine along with IR can be considered as predictive laboratory markers of higher risk of T2DM. It is not yet clear whether presence of individual or multiple SLE-related and/or known traditional risk factors of T2DM (such as unhealthy diet, physical inactivity, family history of diabetes, or being overweight) can precipitate the development of IR.Objectives:To analyze the relationship between IR and increasing leptin levels rates. To identify the presence and evaluate the potential role of traditional and disease-related risk factors for IR in SLE patients without T2DM or hyperglycemia.Methods:A total of 49 SLE pts (46 women, 3 men, 40 [33;48] years old) without established DM and with normal fasting glucose levels (<6,1 mmol/l) were enrolled in the study. Median disease duration was 3,0[0,7;8,0] years, SLEDAI-2K was 5[2;8]. SLE pts were treated with glucocorticoids (GC) (84%), hydroxychloroquine (78%), immunosuppressive drugs (20%) and biological agents (10%). Insulin levels were measured using electrochemiluminescence assay Elecsys (Roche Diagnostics), serum leptin concentrations were estimated using ELISA (DBS-Diagnostics Biochem Canada Inc.). IR was defined as Homeostasis Model Assessment of Insulin Resistance index (HOMA-IR) ≥2,77. Leptin levels were considered elevated at values ≥11,1 ng/ml for women, ≥5.6 ng/ml for men. Eight traditional T2DM risk factors from the FINDRISK (Finnish Type 2 Diabetes Risk Assessment Form) questionnaire (older age, being overweight, abdominal obesity, family history of diabetes, sedentary lifestyle, lack of regular dietary fiber intake, taking antihypertensive medications as a surrogate marker of high blood pressure, documented episodes of hyperglycemia) were evaluated. This study used 5 risk categories for developing T2DM proposed by FINDRISK questionnaire: low, slightly elevated, moderate, high or very high.Results:Median HOMA-IR levels were 1,7 [1,2;2,5]. HOMA-IR correlated with leptin levels (r=0,7, p<0,001), body mass index (BMI) (r=0,6, p<0,001), waist circumference (WC) (r=0,5, p<0,001), T2DM risk categories by FINDRISK (r=0,3, p=0,03), SLEDAI-2K (r= -0,4, p<0,01), and duration of GCs therapy (r=0,3, p=0,03). Current GC use had no influence on HOMA-IR in SLE. IR was detected in 10 (20%) SLE pts. The traditional T2DM risk factors profiles were similar in pts with (Group 1) or without IR (Group 2) except for higher anthropometric parameters in group 1 (for BMI 27,2[24,8;32,2]kg/m2 vs 23,7[20,6;26,7]kg/m2, p<0,01; for WC: 93[86;102]cm vs 83[76;93]cm, p=0,02). Leptin levels were also higher in SLE pts with IR compared to pts without IR (74,2[30,4;112,7]ng/ml vs 25,0[6,7;42,4]ng/ml, p<0,01). Increased leptin levels were found in 35 (71%) pts, more often in pts with IR (100 vs 64%, p=0,04).Conclusion:IR was found in 20% of SLE pts without T2DM having normal serum fasting glucose concentration. Emergence of IR was commonly preceded by increased leptin levels. IR values were closely associated with accumulation of adipose tissue facilitated by long-term GCs use and disease activity decrease. Contribution of other traditional risk factors of T2DM seemed insignificant.Disclosure of Interests:None declared

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Lactation Duration and Long-term Risk for Incident Type 2 Diabetes in Women With a History of Gestational Diabetes Mellitus

Diabetes Care ◽

10.2337/dc19-2237 ◽

2020 ◽

Vol 43 (4) ◽

pp. 793-798 ◽

Cited By ~ 8

Author(s):

Sylvia H. Ley ◽

Jorge E. Chavarro ◽

Mengying Li ◽

Wei Bao ◽

Stefanie N. Hinkle ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Incident Type ◽

Incident Type 2 Diabetes ◽

History Of ◽

Lactation Duration

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CLINICAL PROFILE OF PATIENTS OF YOUNG STROKE.

10.36106/ijar/3218440 ◽

2021 ◽

pp. 68-70

Author(s):

Nitin Hiraman Suryawanshi ◽

Amit Aggarwal ◽

Abhijit Kadam

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Young Patients ◽

Behavioural Pattern ◽

Long Term Outcomes ◽

Short Term ◽

Traditional Risk Factors ◽

The Individual ◽

Stroke In Young

A study of stroke in young patients has recently become a subject of interest. This is due to a lot of impact on the individual and society. Study of stroke in young patients can lead to therapeutical results affecting both short term and long-term outcomes. Our study is hospital based retrospective study for duration of 1 year. Thi Methods: Results: s study revealed stroke in young in 25.16% of all stroke cases, with cerebral infarction in 56% and followed by intracerebral haemorrhage in 25.64%, and cerebral venous thrombosis in 18%. The most common presenting symptom was hemiparesis. The most prevalent risk factor for stroke in young was hypertension followed by diabetes mellitus, alcohol consumption and smoking. Stroke in young requires a differe Conclusion: nt approach to investigate and treat. This is due to different underlying etilogy as compared to elderly. Although traditional risk factors are associated with stroke, behavioural pattern such as smoking and alcohol may cause and promote development of stroke in young.

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The influence of thrombophilia on the long-term survival of patients with a history of venous thromboembolism

Thrombosis and Haemostasis ◽

10.1160/th12-05-0361 ◽

2013 ◽

Vol 109 (01) ◽

pp. 79-84 ◽

Cited By ~ 12

Author(s):

Sylvia Reitter-Pfoertner ◽

Thomas Waldhoer ◽

Michaela Mayerhofer ◽

Ernst Eigenbauer ◽

Cihan Ay ◽

...

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Multivariable Analysis ◽

Factor V Leiden ◽

Arterial Disease ◽

Factor V ◽

Term Survival ◽

Long Term Survival ◽

History Of

SummaryData on the long-term survival following venous thromboembolism (VTE) are rare,and the influence of thrombophilia has not been evaluated thus far. Our aim was to assess thrombophilia-parameters as predictors for long-term survival of patients with VTE. Overall, 1,905 outpatients (99 with antithrombin-, protein C or protein S deficiency, 517 with factor V Leiden, 381 with elevated factor VIII and 160 with elevated homocysteine levels, of these 202 had a combination and 961 had none of these risk factors) were included in the study between September 1, 1994 and December 31, 2007. Retrospective survival analysis showed that a total of 78 patients (4.1%) had died during the analysis period, among those four of definite or possible pulmonary embolism and four of bleeding. In multivariable analysis including age and sex an association with increased mortality was found for hyperhomocysteinemia (hazard ratio 2.0 [1.1.-3.5]) whereas this was not the case for all other investigated parameters. We conclude that the classical hereditary thrombophilia risk factors did not have an impact on the long-term survival of patients with a history of VTE. Thus our study supports the current concept that thrombophilia should not be a determinant for decision on long term anticoagulation. However, hyperhomocysteinaemia, known as a risk factor for recurrent VTE and arterial disease, might impact survival.

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