scholarly journals Safety of renal biopsy bleeding prophylaxis with desmopressin

2021 ◽  
Vol 49 (9) ◽  
pp. 030006052110407
Author(s):  
R. Haridian Sosa Barrios ◽  
Víctor Burguera Vion ◽  
Marta Álvarez Nadal ◽  
Melissa Cintra Cabrera ◽  
Sandra Elías Triviño ◽  
...  
Keyword(s):  
Risk Factor ◽  
Single Dose ◽  
Renal Biopsy ◽  
Cardiovascular Events ◽  
Receptor Agonist ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Percutaneous Renal Biopsy ◽  
Bleeding Prophylaxis

Background Percutaneous renal biopsy (PRB) is invasive, and bleeding-related complications are a concern. Desmopressin (DDAVP) is a selective type 2 vasopressin receptor-agonist also used for haemostasis. Aim To evaluate the side effects of intravenous (IV) weight-adjusted desmopressin preceding PRB. Methods This was a retrospective study of renal biopsies performed by nephrologists from 2013 to 2017 in patients who received single-dose DDAVP pre-PRB. Results Of 482 PRBs, 65 (13.5%) received DDAVP (0.3 µg/kg); 55.4% of the PRBs were native kidneys. Desmopressin indications were altered platelet function analyser (PFA)-100 results (75.3% of the patients), urea >24.9 mmol/L (15.5%), antiplatelet drugs (6.1%) and thrombocytopaenia (3%). Of the 65 patients, 30.7% had minor asymptomatic complications, and 3 patients had major complications. Pre-PRB haemoglobin (Hb) <100 g/L was a risk factor for Hb decrease >10 g/L, and altered collagen-epinephrine (Col-Epi) time was a significant risk factor for overall complications. Mean sodium decrease was 0.6 ± 3 mmol/L. Hyponatraemia without neurological symptoms was diagnosed in two patients; no cardiovascular events occurred. Conclusion Hyponatraemia after single-dose DDAVP is rare. A single IV dose of desmopressin adjusted to the patient’s weight is safe as pre-PRB bleeding prophylaxis.

scholarly journals Type-2 Diabetes as a Risk Factor for Severe COVID-19 Infection

2021 ◽  
Vol 9 (6) ◽  
pp. 1211
Author(s):  
Mahnaz Norouzi ◽  
Shaghayegh Norouzi ◽  
Alistaire Ruggiero ◽  
Mohammad S. Khan ◽  
Stephen Myers ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Risk Factor ◽  
Inflammatory Responses ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Diabetic Patients ◽  
Angiotensin Converting Enzyme 2 ◽  
Immune System Dysfunction ◽  
Current Outbreak

The current outbreak caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), termed coronavirus disease 2019 (COVID-19), has generated a notable challenge for diabetic patients. Overall, people with diabetes have a higher risk of developing different infectious diseases and demonstrate increased mortality. Type 2 diabetes mellitus (T2DM) is a significant risk factor for COVID-19 progression and its severity, poor prognosis, and increased mortality. How diabetes contributes to COVID-19 severity is unclear; however, it may be correlated with the effects of hyperglycemia on systemic inflammatory responses and immune system dysfunction. Using the envelope spike glycoprotein SARS-CoV-2, COVID-19 binds to angiotensin-converting enzyme 2 (ACE2) receptors, a key protein expressed in metabolic organs and tissues such as pancreatic islets. Therefore, it has been suggested that diabetic patients are more susceptible to severe SARS-CoV-2 infections, as glucose metabolism impairments complicate the pathophysiology of COVID-19 disease in these patients. In this review, we provide insight into the COVID-19 disease complications relevant to diabetes and try to focus on the present data and growing concepts surrounding SARS-CoV-2 infections in T2DM patients.

scholarly journals Duodenal major papilla morphology can affect biliary cannulation and complications during ERCP, an observational study

2020 ◽  
Author(s):  
Po-Han Chen ◽  
Chun-Fang Tung ◽  
Yen-Chung Peng ◽  
Hong-Zen Yeh ◽  
Chi-Sen Chang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Risk Factor ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Biliary Cannulation ◽  
Small Papilla ◽  
Type 3

Abstract BackgroundWe investigated whether duodenal major papilla morphology could be a risk factor for failure of selective biliary cannulation (SBC) and post endoscopic retrograde cholangiography and pancreatography (ERCP) complications.MethodsA prospectively recorded database was reviewed retrospectively. Patients were included if they received therapeutic ERCP and had naïve major duodenal papilla. We used Haraldsson’s classification for papilla morphology, as follows: Regular (Type 1), Small (Type 2), Protruding or Pendulous (Type 3) and Creased or Ridged (Type 4). Risk factors for failing SBC and post-ERCP complications were analyzed by multivariate analysis.ResultsA total of 286 cases were included. Age, gender, indications and therapeutic procedures were not different among the four types of papillae. The failure rates of SBC with Type 3 papilla and Type 4 papilla were 11.11% and 6.25%, respectively. In the multivariate analysis, Type 2 papilla (odd ratio 7.18, p= 0.045) and Type 3 papilla (odd ratio 7.44, p= 0.016) were associated with greater SBC failure compared with Type 1 papilla. Malignant obstruction compared to stone (odds ratio 4.45, p=0.014) and age (odd ratio=1.06, p=0.010) were also risk factors for cannulation failure. Type 2 papilla was correlated with a higher rate of post-ERCP pancreatitis (20%, p=0.020) compared to the other types of papilla However, papilla morphology was not a significant risk factor for any complications in the multivariate analysis.ConclusionSmall papilla and protruding or pendulous papilla are more difficult to cannulate compared to regular papilla. Small papilla is associated with a higher rate of post-ERCP pancreatitis.

scholarly journals Elevation of PTPN1 promoter methylation is a significant risk factor of type 2 diabetes in the Chinese population

2017 ◽  
Vol 14 (4) ◽  
pp. 2976-2982 ◽  
Author(s):  
Qing Huang ◽  
Liyuan Han ◽  
Yanfen Liu ◽  
Changyi Wang ◽  
Donghui Duan ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Risk Factor ◽  
Promoter Methylation ◽  
Chinese Population ◽  
Significant Risk ◽  
Significant Risk Factor

scholarly journals Duodenal major papilla morphology can affect biliary cannulation and complications during ERCP, an observational study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Po-Han Chen ◽  
Chun-Fang Tung ◽  
Yen-Chung Peng ◽  
Hong-Zen Yeh ◽  
Chi-Sen Chang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Risk Factor ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Biliary Cannulation ◽  
Small Papilla ◽  
Type 3

Abstract Background We investigated whether duodenal major papilla morphology could be a risk factor for failure of selective biliary cannulation (SBC) and post endoscopic retrograde cholangiography and pancreatography (ERCP) complications. Methods A prospectively recorded database was reviewed retrospectively. Patients were included if they received therapeutic ERCP and had naïve major duodenal papilla. We used Haraldsson’s classification for papilla morphology, as follows: Regular (Type 1), Small (Type 2), Protruding or Pendulous (Type 3) and Creased or Ridged (Type 4). Risk factors for failing SBC and post-ERCP complications were analyzed by multivariate analysis. Results A total of 286 cases were included. Age, gender, indications and therapeutic procedures were not different among the four types of papillae. The failure rates of SBC with Type 3 papilla and Type 4 papilla were 11.11% and 6.25%, respectively. In the multivariate analysis, Type 2 papilla (odd ratio 7.18, p = 0.045) and Type 3 papilla (odd ratio 7.44, p = 0.016) were associated with greater SBC failure compared with Type 1 papilla. Malignant obstruction compared to stone (odds ratio 4.45, p = 0.014) and age (odd ratio = 1.06, p = 0.010) were also risk factors for cannulation failure. Type 2 papilla was correlated with a higher rate of post-ERCP pancreatitis (20%, p = 0.020) compared to the other types of papilla However, papilla morphology was not a significant risk factor for any complications in the multivariate analysis. Conclusion Small papilla and protruding or pendulous papilla are more difficult to cannulate compared to regular papilla. Small papilla is associated with a higher rate of post-ERCP pancreatitis.

scholarly journals Urinary Tract Infection due to Extended-Spectrum Beta-Lactamase Producing Organisms is a Risk Factor for Acute Kidney Injury among Patients with Type 2 Diabetes Mellitus

2017 ◽  
Vol 19 (1) ◽  
pp. 40-43 ◽  
Author(s):  
Muhammad Abdur Rahim ◽  
Palash Mitra ◽  
Ariful Haque ◽  
Shahana Zaman ◽  
Tabassum Samad ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Urinary Tract Infection ◽  
Risk Factor ◽  
Urinary Tract ◽  
Significant Risk ◽  
Kidney Injury ◽  
Significant Risk Factor ◽  
Beta Lactamase ◽  
Type 2 Diabetic

Background: Urinary tract infection (UTI) is common and diabetic patients are at increased risk for UTI. UTI may be complicated by acute kidney injury (AKI). This study was designed to evaluate whether UTI due to extend ed-spectrum beta-lactamase (ESBL) producing organisms should be considered as a risk factor for AKI in type 2 diabetic subjects.Methods: This case-control study was done in a tertiary care hospital in Dhaka, Bangladesh from April to June 2016. Type 2 diabetic subjects with culture proven UTI were evaluated. Patients with UTI complicated by AKI were cases and those without AKI were taken as controls. ESBL-positivity of the isolated organisms was evaluated as risk factor for AKI.Results: During the study period, a total of 131 (male to female ratio 1:2.6) type 2 diabetic subjects with culture proven UTI were enrolled. Mean age and mean duration of diabetes were 56.1±13.3 and 8.7±5.4 years respectively. Escherichia coli (82, 62.6%) was the commonest aetiological agent followed by Klebsiella pneumoniae(14, 10.7%). Two-thirds (55/82, 67.1%) of E. coli and two-fifths (6/14, 42.9%) of Klebsiellae were ESBL-positive. UTI in 64 (48.9%) patients were due to ESBL-positive organisms. Out of 131 UTI patients, 62 (47.3%) had AKI; 40 (40/64, 62.5%) among ESBL-positive and 22 (22/67, 32.8%) among non-ESBL organisms. There were no significant difference in relation to age (p=0.71), sex (p=0.26), duration of diabetes (p=0.37) and glycated haemoglobin (HbA1c) (p=0.69) between cases and controls. ESBL-positivity appeared as a significant risk factor for AKI among the study subjects (OR=3.4, 95% CI=1.66-6.99, p=0.008).Conclusions: Almost half of the type 2 diabetic subjects with UTI had ESBL-positive organisms as aetiological agents in this study. UTI due to ESBL-positive organisms was a significant risk factor for AKI.J MEDICINE Jan 2018; 19 (1) : 40-43

scholarly journals Urinary Tract Infection due to Extended-spectrum Beta-lactamase Producing Organisms is a Risk Factor for Bacteraemia Among Patients with Type 2 Diabetes Mellitus

2019 ◽  
Vol 31 (1) ◽  
pp. 9-12
Author(s):  
Muhammad Abdur Rahim ◽  
Shahana Zaman ◽  
Ishrat Jahan ◽  
Samira Humaira Habib ◽  
Tabassum Samad ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Urinary Tract Infection ◽  
Risk Factor ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Beta Lactamase ◽  
Extended Spectrum Beta Lactamase ◽  
Type 2 Diabetic

Introduction: Urinary tract infection (UTI) is common among patients with diabetes mellitus and the aetiological agents are often extended-spectrum beta-lactamase (ESBL) producing bacteria. Diabetic patients with UTI are sometimes complicated by bacteraemia. This study was designed to evaluate whether UTI due to ESBL-positive organisms is a risk factor for bacteraemia among patients with type 2 diabetes mellitus. Methods: This was a cross-sectional analytical study, done in BIRDEM General Hospital, Dhaka, Bangladesh from January to April 2016. Adult (e”18 years) type 2 diabetic subjects of either sex with culture proven UTI were included in this study. All study participants were subjected to undergo blood cultures as well. ESBL-positivity of the infective organisms for UTI was evaluated as possible risk factor for bacteraemia. Results: Total patients were 145 including 119 (82%) females. Eshcerichia coli (112, 77.2%) was the most common aetiological agents followed by Klebsiella pneumoniae (28, 19.3%). In 54 (37.2%) patients UTI was due to ESBL-positive organisms. Ten (6.9%) patients were complicated by bacteraemia [7 (7/ 54, 13%) among patients with UTI due to ESBL-positive organisms and 3 (3/91, 3.3%) among patients with UTI due to non-ESBL organisms]. UTI due to ESBL-positive organisms appeared as a significant risk factor for bacteraemia (OR 4.37, 95% CI 1.08-17.38, p 0.03). Conclusion: Nearly two-fifths of UTI cases were due to ESBL-positive organisms in this study. ESBLpositivity of the causative organisms was a significant risk factor for bacteraemia among type 2 diabetic subjects. Bangladesh J Medicine Jan 2020; 31(1) : 9-12

scholarly journals Past Obesity as well as Present Body Weight Status Is a Risk Factor for Diabetic Nephropathy

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Shu Meguro ◽  
Yusuke Kabeya ◽  
Karin Tanaka ◽  
Toshihide Kawai ◽  
Masuomi Tomita ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Body Weight ◽  
Risk Factor ◽  
Diabetic Nephropathy ◽  
Weight Status ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
The Past ◽  
Body Weight Status

Aims. We analyzed the prevalence of nephropathy according to past body weight status in Japanese subjects with type 2 diabetes because the influence of past obesity on diabetic complications is not certain.Methods. We examined the prevalence of nephropathy in 2927 subjects with type 2 diabetes mellitus according to current BMI and maximum BMI in the past. We defined “current obesity” as BMI on hospitalization of 25 or more, “previous obesity” as BMI on hospitalization of less than 25 and self-reported maximum BMI in the past of 25 or more, and “continuously lean” as maximum BMI of less than 25.Results. The prevalence of nephropathy was significantly higher in subjects with current obesity (40.6%) or previous obesity (35.6%) than in those who were continuously lean (24.3%) (P<0.017). In logistic regression analysis, previous obesity, as well as current obesity, was a significant risk factor for nephropathy, independent of sex, age, disease duration, hypertension, dyslipidemia, HbA1c, and diabetic retinopathy.Conclusions. Obesity in the past, as well as the present body weight status, was a risk factor for diabetic nephropathy.

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