scholarly journals MON-687 Diabetic Muscle Infarction (DMI) a Rare Under-Recognised Complication of Diabetes Mellitus (DM): A Series of Three Cases

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Maheswaran Dhanasekaran ◽  
Preeti Kishore ◽  
Ulrich K Schubart
Keyword(s):  
Diabetes Mellitus ◽  
Lower Extremity ◽  
Vascular Complications ◽  
Muscle Group ◽  
Tissue Ischemia ◽  
Lower Extremity Muscle ◽  
Cell Counts ◽  
Muscle Infarction ◽  
Normal White Blood Cell

Abstract Background: Diabetic muscle infarction (DMI) also known as diabetic myonecrosis is an acute, rare, microangiopathic complication of long-standing poorly controlled Diabetes Mellitus (DM). DMI presents as severe pain and swelling of the affected muscle group, usually of the lower extremities. It generally occurs in patients with established vasculopathy from uncontrolled diabetes including retinopathy and nephropathy. However, a clear association of DMI to long term mortality has not yet been defined. Proposed pathophysiologic mechanisms for DMI are microvascular endothelial damage complicated by thromboembolic events triggering an inflammatory cascade, leading to local tissue ischemia and eventual infarction. Alterations in the coagulation-fibrinolysis system and vasculitis have also been invoked. About 50% of the cases have DMI recurrence in the setting of uncontrolled DM. Clinical Case: We report 3 cases of DMI diagnosed in patients with long-standing poorly controlled DM with at least two established micro-vascular complications. The lower extremity muscle group was affected, especially the thigh muscles and paraspinal muscle in one case. Biochemical parameters were significant for normal white blood cell counts, elevated erythrocyte sedimentation rate (112, 105, 145 mm/hr respectively; n 0–15 mm/hr) and C-reactive protein (CRP) (54.3, 260, 162 mg/L respectively; n 0–5.0 mg/L) and elevated creatine kinase in two cases (539 and 379 U/L; n 5–150 U/L). Infectious work-up including blood cultures were negative. Lower extremity doppler was negative in all three cases. Diagnosis was established with the help of MRI in two cases showing diffuse hyperintensities of the muscle groups involved and muscle biopsy in the third showing neutrophilic and eosinophilic inflammation and areas of necrosis, fibrosis and hemorrhage. Treatment involved adequate pain management and anti-platelet therapy along with tight glycemic control. No recurrence thus far was noticed in all three patients. Conclusion: DMI should be considered in the differential diagnosis of patients with the aforementioned risk factors who did not show a response to antibiotics, as administered for presumed cellulitis. Though self-limiting, studies have shown a long term temporal correlation with increased all-cause mortality in patients with DMI. Hence DMI is considered as another cardiovascular risk equivalent. Further studies are needed to explore strategies aimed at preventing DMI and its recurrence.

scholarly journals Long-term participation in community group exercise improves lower extremity muscle strength and delays age-related declines in walking speed and physical function in older adults

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Chisato Hayashi ◽  
Soshiro Ogata ◽  
Tadashi Okano ◽  
Hiromitsu Toyoda ◽  
Sonoe Mashino
Keyword(s):  
Older Adults ◽  
Muscle Strength ◽  
Physical Exercise ◽  
Lower Extremity ◽  
Physical Function ◽  
Community Dwelling ◽  
Group Exercise ◽  
Community Based ◽  
Lower Extremity Muscle

Abstract Background The effects of group exercise on the physical function of community-dwelling older adults remain unclear. The changes in lower extremity muscle strength, timed up and go (TUG) time, and the motor fitness scale (MFS), over time, among older adults who expressed a willingness to participate in community-based physical exercise groups, were determined using multilevel modelling. Methods We analyzed data of 2407 older adults between April 2010 and December 2019 from the registry of physical tests of community-based physical exercise groups. We conducted a retrospective cohort study to assess the effect of physical exercise on lower extremity muscle strength, TUG time, and MFS scores. The durations of the exercises were evaluated by frequency of physical test’s participate. Results A deterioration in lower extremity muscle strength was found in the short-term participant group only. However, in the mid-term and long-term participation groups, lower extremity muscle strength showed a trend of improvement. The TUG time and the MFS score were negatively correlated with increasing age in both groups divided by the duration of participation. However, there was a slower rate of deterioration in the long-term participation group. Discussion Lower extremity muscle strength, TUG time, and MFS scores decline with increasing age and there were differences in the slope of deterioration that depended on the duration of participation in community-based group exercise. Conclusion Participation in group exercise improved lower extremity muscle strength, TUG time, and MFS scores of older adults living in a community. The positive effects of group exercise were dependent on long-term participation.

scholarly journals Vascular Complications and Long-Term Administration of Oral Hypoglycemic Agents in Patients with Diabetes Mellitus

1978 ◽  
Vol 124 (3) ◽  
pp. 205-222 ◽  
Author(s):  
AKIRA OHNEDA ◽  
YOSHISUKE MARUHAMA ◽  
HIROSHI ITABASHI ◽  
SHIN-ICHI OIKAWA ◽  
TAKASHI KOBAYASHI ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Vascular Complications ◽  
Hypoglycemic Agents ◽  
Oral Hypoglycemic Agents ◽  
Patients With Diabetes ◽  
Term Administration

scholarly journals Neurotized latissimus dorsi flap: functional lower limb coverage in subacute trauma reconstruction

2017 ◽  
Vol 15 (1) ◽  
Author(s):  
Julie Chakriya Kvann ◽  
Stephanie Thibaudeau ◽  
Alain Joe Azzi ◽  
Teanoosh Zadeh
Keyword(s):  
Lower Extremity ◽  
Latissimus Dorsi ◽  
Soft Tissue Coverage ◽  
Muscle Flaps ◽  
Functional Reconstruction ◽  
Lower Extremity Muscle ◽  
First Case ◽  
Extremity Trauma ◽  
Latissimus Dorsi Flaps

AbstractIn the reconstruction of the mangled lower extremity, muscle flaps are well known for their reliable use in soft tissue coverage, however very few reports document their functional reconstruction potential as neurotized muscle flaps. This case illustrates that free neurotized latissimus dorsi flaps are a good option for long-term functional reconstruction in the mangled lower extremity. Our report is the first case in the literature to date describing a subacute reconstruction with a functional latissimus dorsi in lower extremity trauma. 

scholarly journals The early use of insulin in type 2 diabetes

2004 ◽  
Vol 7 (2) ◽  
pp. 10-12
Author(s):  
PHILIP LEVY
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Insulin Therapy ◽  
Vascular Complications ◽  
Acting Insulin ◽  
Oral Agents ◽  
Early Use

60?70% of all patients with Type 2 Diabetes Mellitus will ultimately require insulin therapy for the management of their diabetes. Irisulin may be used alone, or in combination with oral agents. The early use of insulin can be very important in decreasing the incidence of micro-vascular complications and in helping to delay the onset of macro-vascular complications. The United Kingdom Prospective Diabetes Study and the Kumamoto Study have shown the beneficial effects of good glucose control in type 2 diabetes mellitus. The DECODE study has related overall mortality to the level of glucose control and specifically to the postprandial glucose. The American Association of Clinical Endocrinologists has established a goal of 6.5% or less for HgbAlc. The appropriate use of insulin will allow us to achieve this goal without causing the patient any undue harm. There are many barriers to insulin therapy including psychological barriers of both the patient and the doctor, and unrealistic fears of both insulin therapy and therapy with self-administered injections. These barriers will be discussed as well as methods to overcome them. Insulin therapy is beneficial and has no long term adverse effects. The incidence of severe hypoglycemia is extremely low in type 2 diabetes. Weight gain is minimal. Insulin therapy by reducing glucose toxicity may also increase the effectiveness of oral anti-hyperglycemic agents. The physician taking care of patients with diabetes should be aggressive and should have no fears of initiating insulin therapy. Insulin dosage is flexible and good control is possible in most patients. The most common use of insulin in type 2 diabetes is as an add-on to oral agents if control with oral agents alone is unsatisfactory. Frequently this involves the use of a single dose of intermediate or long acting insulin or an insulin mixture in the evening. If control is not attained with a single dose, then the patient can be placed on an insulin mixture 2 or 3 times a day. An alternative would be a short acting insulin analogue prior to each meal with a longer acting insulin given 1 or 2 times a day. Titration schedules for insulin dosing will be presented. Insulin available in Russia will be listed along with some guidelines on using these insulins. Increasing the use of insulin and starting insulin earlier in type 2 diabetes will lead to better control of diabetes, increased patient compliance, and decreased long-term complications of diabetes mellitus.

scholarly journals EXPLORING PREVALENCE OF LONG TERM DIABETES MELLITUS VASCULAR COMPLICATIONS IN KING FAHAD GENERAL HOSPITAL.

2017 ◽  
Vol 5 (1) ◽  
pp. 2949-2959
Author(s):  
WyyedAl. Harbi. ◽  
◽  
DaniahAhmad. Faraj. ◽  
Lubna. Ismail. ◽  
Lujain. Asiri. ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
General Hospital ◽  
Vascular Complications

scholarly journals The Role of HbA1C for Diagnosis of Type-2 Diabetes Mellitus - A Review

2016 ◽  
Vol 11 (1) ◽  
pp. 30-32
Author(s):  
Shahana Zabeen ◽  
Sultana Rehana Akhter
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Large Body ◽  
Vascular Complications ◽  
Glucose Levels ◽  
Blood Glucose Levels

For many years, the diagnosis of diabetes has been made through the laboratory- based measurement of fasting or random blood glucose levels or using OGTT. In the case of diabetes, the major outcome of interest is long term micro vascular complications for which a large body of data has been accumulated leading to the endorsement of HbA1C for diagnosis in many countries worldwide, with some variations in cut-offs and testing strategies.Faridpur Med. Coll. J. Jan 2016;11(1): 30-32

scholarly journals Microvascular complications among patients with diabetes: An emerging health problem in Saudi Arabia

2019 ◽  
Vol 16 (3) ◽  
pp. 227-235 ◽  
Author(s):  
Asirvatham Alwin Robert ◽  
Mohamed Abdulaziz Al Dawish
Keyword(s):  
Diabetes Mellitus ◽  
Saudi Arabia ◽  
Microvascular Complications ◽  
Adult Population ◽  
Vascular Complications ◽  
Kingdom Of Saudi Arabia ◽  
Patients With Diabetes ◽  
The Government ◽  
Prevalence Of Diabetes Mellitus

Diabetes mellitus, besides disrupting the carbohydrate metabolism process, also induces vascular disease and impacts nearly all the types and sizes of blood vessels. In fact, vascular complications cause majority of the morbidity, hospitalizations and mortality of patients with diabetes mellitus. Retinopathy, nephropathy and neuropathy (microvascular complications) impact hundreds of millions of diabetics and normally target those having long-term or uncontrolled forms of the disease; however, these disorders can also exist at the time of diagnosis or in those yet to be diagnosed. The Kingdom of Saudi Arabia is the biggest country in the Middle East that occupies around four-fifths of the Arabian Peninsula supporting a population of more than 33.3 million people. The prevalence of diabetes mellitus is increasing at an alarming rate in Saudi Arabia. Over 25% of the adult population is suffering and that figure is projected to more than double by 2030. In fact, diabetes mellitus has approximately registered a 10-fold upsurge in the past three decades in Saudi Arabia. However, the prevalence and risk factors of microvascular complications in diabetes mellitus patients have not yet been clearly documented in Saudi Arabia. Hence, in this review, we aim to provide an overview of the microvascular complications among patients with diabetes in Saudi Arabia, utilizing data from the currently available published literature. This is an attempt to facilitate the government and healthcare systems aware of the enormous worth of prevention, early detection and appropriate management of such microvascular complications.

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