scholarly journals An Overview of Preoperative Glucose Evaluation, Management, and Perioperative Impact

2009 ◽  
Vol 3 (6) ◽  
pp. 1261-1269 ◽  
Author(s):  
Ann M. Sheehy ◽  
Robert A. Gabbay
Keyword(s):  
Glycemic Control ◽  
Practice Guidelines ◽  
Current Knowledge ◽  
Tight Glycemic Control ◽  
Prior History ◽  
Optimal Care ◽  
History Of ◽  
Glycemic Targets ◽  
Future Direction ◽  
National Practice

Perioperative hyperglycemia is a common phenomenon affecting patients both with and without a known prior history of diabetes. Despite an exponential rise in publications and studies of inpatient hyperglycemia over the last decade, many questions still exist as to what defines optimal care of these patients. Initial enthusiasm for tight glycemic control has waned as the unanticipated reality of hypoglycemia and mortality has been realized in some prospective studies. The recent dramatic modification of national practice guidelines to endorse more modest inpatient glycemic targets highlights the dynamic nature of current knowledge as the next decade approaches. This review discusses perioperative hyperglycemia and the categories of patients affected by it. It reviews current recommendations for ambulatory diabetes screening and its importance in preoperative patient care. Finally, it concludes with a review of current practice guidelines, as well as a discussion of future direction and goals for inpatient perioperative glycemic control.

Abstract WP190: Clinical Features of Sarcoid Patients With Ischemic Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Ahmed Z Obeidat ◽  
Heidi Sucharew ◽  
Charles J Moomaw ◽  
Dawn O Kleindorfer ◽  
Brett M Kissela ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Current Knowledge ◽  
Case Reports ◽  
Brain Mri ◽  
Sporadic Case ◽  
Prior History ◽  
Stroke Patients ◽  
Stroke Subtype ◽  
Stroke Event ◽  
History Of

Background: Current knowledge on ischemic stroke in sarcoid patients stems from sporadic case reports. The mechanism is thought to be related to granulomatous involvement of brain vasculature. However, clinical, demographic, and radiographic features of sarcoid patients with ischemic stroke are lacking. If sarcoid patients are at higher risk for ischemic stroke event, we hypothesized that the risk factors for ischemic stroke and stroke subtype distribution would differ between sarcoid and non-sarcoid ischemic stroke patients. Methods: Cases of ischemic stroke were identified for the years 2005 and 2010 from the population-based Greater Cincinnati/Northern Kentucky Stroke Study (population 1.3 million). Ischemic stroke cases were physician study confirmed and patients with a history of sarcoid were identified through medical chart review. Clinical variables were compared between stroke patients with history of sarcoid and those with no prior sarcoid history. Results: A total of 4258 cases of ischemic stroke were identified; of them, only 18 had prior diagnosis of sarcoid (0.04%). Brain MRI showed diffusion restriction in 14 out of 15 (93%) MRIs performed in sarcoid patients. The table presents risk factor and subtype data on sarcoid patients compared with non-sarcoid patients. Conclusions: We identified only a few cases of prior sarcoid history in our two-year ascertainment of ischemic stroke patients in our population. In comparison with stroke patients with no prior history of sarcoid, the sarcoid patients tended to be of younger age at presentation, female, have a history of diabetes and hyperlipidemia, and more likely of African descent, perhaps related to the diagnosis of sarcoid itself. We were unable to detect differences in stroke subtype distributions between sarcoid and non-sarcoid ischemic stroke patients.

scholarly journals Malignancy incidences by glycemic control among diabetic patients

2018 ◽  
Vol 7 (12) ◽  
pp. 1457-1463 ◽  
Author(s):  
Daiki Kobayashi ◽  
Nagato Kuriyama ◽  
Keita Hirano ◽  
Osamu Takahashi ◽  
Hiroshi Noto
Keyword(s):  
Longitudinal Study ◽  
Glycemic Control ◽  
Time Dependent ◽  
Prior History ◽  
Diabetic Patients ◽  
Mixed Effect ◽  
History Of ◽  
The Mean ◽  
The Difference ◽  
Hba1c Levels

Background The aim of this study was to evaluate the difference in malignancy incidence by evaluating time-dependent HbA1c levels among diabetic patients in a longitudinal study. Methods We conducted a retrospective longitudinal study at large academic hospital, Tokyo, Japan, from 2006 to 2016. We included all diabetic patients who were 50 years or older and who underwent health check-ups at the Center for Preventive Medicine. Those patients with a prior history of malignancies were excluded. We categorized patients into five groups on the basis of HbA1c measurements: <5.4, 5.5–6.4, 6.5–7.4, 7.5–8.5, >8.5%. Our primary outcome was the development of any types of malignancy. Longitudinal analyses by a mixed effect model with time-dependent HbA1c levels were applied in order to take into account fluctuations in HbA1c levels within the same patient. Results In total, 2729 participants were included in this study, where the mean age was 62.6 (standard deviation (s.d.): 7.8) and 2031 (74.4%) were male. The mean disease duration of diabetes was 7.6 (s.d.: 7.6) years, and 1688 (61.8%) were prescribed medications. Median follow-up was 1443.5 (interquartile range (IQR): 2508) days and 376 (13.8%) developed malignancies. Compared to the reference range of HbA1c (5.5–6.4%), the odds ratios for developing malignancies among the other HbA1c level groups were similar and not statistically different (OR: 0.98, 95% CI:0.31–3.15 (for HbA1c <5.4%); OR: 0.88, 95% CI: 0.69–1.12 (for HbA1c 6.5–7.4%); OR: 0.88, 95% CI: 0.64–1.22 (for HbA1c 7.5–8.4%); OR 1.07, 95% CI: 0.70–1.66 (for HbA1c >8.5%)). Conclusion In our study, there was no association between glycemic control and the development of future malignancies. Compared to very strictly controlled HbA1c levels, both excessive control and good or bad control had a statistically similar risk of developing malignancies.

Paleontology and stratigraphy of Middle Eocene rock units in the southern Green River and Uinta Basins, Wyoming and Utah

2017 ◽  
Vol 4 ◽  
pp. 1-53 ◽  
Author(s):  
Paul Murphey ◽  
K.E. Townsend ◽  
Anthony Friscia ◽  
James Westgate ◽  
Emmett Evanoff ◽  
...  
Keyword(s):  
Current Knowledge ◽  
Middle Eocene ◽  
Green River Basin ◽  
Green River ◽  
Scientific Exploration ◽  
History Of ◽  
Climatic History ◽  
Field Excursion ◽  
Land Mammal ◽  
Bridger Formation

The Bridger Formation is restricted to the Green River Basin in southwest Wyoming, and the Uinta and Duchesne River Formations are located in the Uinta Basin in Utah. These three rock units and their diverse fossil assemblages are of great scientific importance and historic interest to vertebrate paleontologists. Notably, they are also the stratotypes from oldest to youngest for the three middle Eocene North American Land Mammal Ages—the Bridgerian, Uintan, and Duchesnean. The fossils and sediments of these formations provide a critically important record of biotic, environmental, and climatic history spanning approximately 10 million years (49 to 39 Ma). This article provides a detailed field excursion through portions of the Green River and Uinta Basins that focuses on locations of geologic, paleontologic, and historical interest. In support of the field excursion, we also provide a review of current knowledge of these formations with emphasis on lithostratigraphy, biochronology, depositional, and paleoenvironmental history, and the history of scientific exploration.

High Risk of One-year Stroke Recurrence in Patients with Younger Age and Prior History of Ischemic Stroke

2019 ◽  
Vol 16 (3) ◽  
pp. 250-257 ◽  
Author(s):  
Jiann-Der Lee ◽  
Ya-Han Hu ◽  
Meng Lee ◽  
Yen-Chu Huang ◽  
Ya-Wen Kuo ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Multivariate Logistic Regression Analysis ◽  
Stroke Recurrence ◽  
Prior History ◽  
Multivariate Logistic Regression ◽  
Cart Analysis ◽  
Younger Age ◽  
History Of ◽  
One Year

Background and Purpose: Recurrent ischemic strokes increase the risk of disability and mortality. The role of conventional risk factors in recurrent strokes may change due to increased awareness of prevention strategies. The aim of this study was to explore the potential risk factors besides conventional ones which may help to affect the advances in future preventive concepts associated with one-year stroke recurrence (OSR). Methods: We analyzed 6,632 adult patients with ischemic stroke. Differences in clinical characteristics between patients with and without OSR were analyzed using multivariate logistic regression and classification and regression tree (CART) analyses. Results: Among the study population, 525 patients (7.9%) had OSR. Multivariate logistic regression analysis revealed that male sex (OR 1.243, 95% CI 1.025 – 1.506), age (OR 1.015, 95% CI 1.007 - 1.023), and a prior history of ischemic stroke (OR 1.331, 95% CI 1.096 – 1.615) were major factors associated with OSR. CART analysis further identified age and a prior history of ischemic stroke were important factors for OSR when classified the patients into three subgroups (with risks of OSR of 8.8%, 3.8%, and 12.5% for patients aged > 57.5 years, ≤ 57.5 years/with no prior history of ischemic stroke, and ≤ 57.5 years/with a prior history of ischemic stroke, respectively). Conclusions: Male sex, age, and a prior history of ischemic stroke could increase the risk of OSR by multivariate logistic regression analysis, and CART analysis further demonstrated that patients with a younger age (≤ 57.5 years) and a prior history of ischemic stroke had the highest risk of OSR.

Sign in / Sign up

Export Citation Format

Share Document