scholarly journals Capecitabine-Induced Hyperosmolar Hyperglycemic State

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A370-A371
Author(s):  
Carly Yim ◽  
Terra G Arnason ◽  
Nassrein Hussein
Keyword(s):  
Breast Cancer ◽  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Case Reports ◽  
Family Doctor ◽  
Metastatic Breast ◽  
Insulin Regimen ◽  
Her Family ◽  
Hyperglycemic Hyperosmolar State ◽  
History Of

Abstract Capecitabine is an orally administered prodrug of 5-fluorouracil (5-FU) which is often used for treatment of solid tumour cancers such as breast cancer and gastrointestinal tumours. Common adverse effects include nausea, diarrhea, anorexia and erythrodysthesia (hand-foot syndrome). However, there have been case reports of metabolic disturbances linked to capecitabine including hyperlipidemia, and less commonly, hyperglycemia. We report a case of a new diagnosis of persistent diabetes mellitus following an acute presentation of hyperosmolar hyperglycemic syndrome (HHS) subsequent to treatment with the chemotherapy agent, capecitabine. A 72 year old female with a history of metastatic breast cancer was admitted to hospital for management of hyperglycemic hyperosmolar state (HHS) after bloodwork from her family doctor revealed an elevated random blood glucose (40.2 mmol/L). Leading up to her presentation, the patient had completed 7 cycles of capecitabine treatment for her breast cancer. Prior to her capecitabine treatment, the patient did not have a history of diabetes mellitus. However, on admission, her hemoglobin A1C (HbA1C) was found to elevated into the diabetic range. Offending medications were considered and given the temporal dysglycemia following the patient’s chemotherapy regimen, capecitabine was thought to be a probable offending agent. The patient was acutely treated for HHS, and eventually transitioned to a basal-bolus insulin regimen at discharge. Her capecitabine was held pending review with her oncology team and she was closely followed up by her family doctor. The patient’s insulin regimen was ultimately titrated down to basal insulin only. Given the increasing use of capecitabine therapy in breast cancer, it is important to recognize the risk of hyperglycemia and hyperglycemic emergencies as a potential adverse effect of this treatment. It highlights the need to ensure that blood glucose is monitored throughout treatment to prevent hyperglycemic emergencies.

Capecitabine-induced hyperosmolar hyperglycaemic state

2021 ◽  
Vol 14 (3) ◽  
pp. e241109
Author(s):  
Carly Yim ◽  
Nassrein Hussein ◽  
Terra Arnason
Keyword(s):  
Breast Cancer ◽  
Family Doctor ◽  
Metastatic Breast ◽  
Haemoglobin A1c ◽  
Insulin Regimen ◽  
Her Family ◽  
History Of ◽  
The Common ◽  
Bolus Insulin ◽  
Basal Bolus

An elderly woman with metastatic breast cancer was admitted with hyperglycaemic hyperosmolar state (HHS) and an elevated haemoglobin A1C. For 1 week, she had experienced confusion, nausea and frequent urination. Preceding this, she had completed seven cycles of capecitabine chemotherapy for her breast cancer. She did not have a history of diabetes prior to chemotherapy. Given the temporal dysglycaemia following the patient’s chemotherapy regimen, capecitabine was thought to be a probable offending agent. The patient was acutely treated for HHS, and was discharged on a basal-bolus insulin regimen. Her capecitabine was held pending review with her oncology team. The patient was ultimately titrated down to basal insulin only by her family doctor. Given the common use of capecitabine, it is important to recognise the risk of hyperglycaemic and hyperglycaemic emergencies as potential adverse effects. This highlights the need to monitor blood glucose throughout treatment to prevent hyperglycaemic emergencies.

scholarly journals Diabetic Ketoacidosis With Alpelisib

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A376-A377
Author(s):  
Rebecca Jeun ◽  
Victor Ralph Lavis ◽  
Sonali Thosani
Keyword(s):  
Breast Cancer ◽  
Diabetes Mellitus ◽  
Metastatic Breast Cancer ◽  
Diabetic Ketoacidosis ◽  
Hormone Receptor ◽  
Previous History ◽  
Metastatic Breast ◽  
Laboratory Evaluation ◽  
Hormone Receptor Positive ◽  
History Of

Abstract Background: Hyperglycemia is a frequently reported adverse effect of alpelisib, an isoform specific phosphoinositide 3 kinase inhibitor, which is recently approved for use in hormone receptor positive advanced or metastatic breast cancer. Though two patients in clinical trials with alpelisib developed diabetic ketoacidosis (DKA), there have been no case reports to date characterizing this complication after drug approval. We present the first case of DKA in patients on alpelisib therapy. Clinical Case: A 55-year-old woman with a history of hormone-receptor positive metastatic breast cancer was started on treatment with fulvestrant and alpelisib. The patient did not have any previous history of diabetes nor gestational diabetes, though she had evidence of prediabetes prior to starting treatment. Patient was non-obese and had a family history of type 2 diabetes. Baseline hemoglobin A1c was 5.6% (n <5.7%) with impaired fasting glucose of 108 mg/dl (n<105 mg/dL) immediately prior to starting therapy. One week after starting alpelisib, she presented to the emergency center in diabetic ketoacidosis. Initial laboratory evaluation showed serum glucose 690 mg/dl, anion gap metabolic acidosis, with undetectable serum bicarbonate and ketonuria. C-peptide on hospital day 1 was found to be 2.8 ng/ml (n 0.5 - 3.4 ng/ml) with a concurrent glucose of 479 mg/dl. GAD65 and Islet Antigen 2 antibodies were negative. Diabetic ketoacidosis quickly resolved with continuous insulin infusion and stopping alpelisib. The patient was able to come off all insulin therapy prior to discharge and was discharged on metformin with adequate glycemic control. Conclusions: Current manufacturer guidelines for alpelisib recommend screening for diabetes mellitus at baseline and monitoring blood glucose and/or fasting plasma glucose weekly for the first two weeks of treatment and monthly thereafter. However, patients with no pre-existing history of diabetes mellitus may be at risk for life-threatening hyperglycemic crises which may develop within a week of initiation of alpelisib and more frequent monitoring may be indicated. The hyperglycemic effect of alpelisib appears to be reversible upon stopping the drug.

Glucose Levels and Outcome After Primary Intraventricular Hemorrhage

2019 ◽  
Vol 16 (1) ◽  
pp. 40-46
Author(s):  
Rui Guo ◽  
Ruiqi Chen ◽  
Chao You ◽  
Lu Ma ◽  
Hao Li ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Blood Glucose Level ◽  
Incidence Rate ◽  
Glucose Level ◽  
Intraventricular Hemorrhage ◽  
Laboratory Data ◽  
History Of ◽  
Poor Outcomes ◽  
The Impact

Background and Purpose: Hyperglycemia is reported to be associated with poor outcome in patients with spontaneous Intracerebral Hemorrhage (ICH), but the association between blood glucose level and outcomes in Primary Intraventricular Hemorrhage (PIVH) remains unclear. We sought to identify the parameters associated with admission hyperglycemia and analyze the impact of hyperglycemia on clinical outcome in patients with PIVH. Methods: Patients admitted to Department of Neurosurgery, West China Hospital with PIVH between 2010 and 2016 were retrospectively included in our study. Clinical, radiographic, and laboratory data were collected. Univariate and multivariate logistic regression analyses were used to identify independent predictors of poor outcomes. Results: One hundred and seventy patients were included in the analysis. Mean admission blood glucose level was 7.78±2.73 mmol/L and 10 patients (5.9%) had a history of diabetes mellitus. History of diabetes mellitus (P = 0.01; Odds Ratio [OR], 9.10; 95% Confidence Interval [CI], 1.64 to 50.54) was independent predictor of admission critical hyperglycemia defined at 8.17 mmol/L. Patients with admission critical hyperglycemia poorer outcome at discharge (P < 0.001) and 90 days (P < 0.001). After adjustment, admission blood glucose was significantly associated with discharge (P = 0.01; OR, 1.30; 95% CI, 1.06 to 1.59) and 90-day poor outcomes (P = 0.03; OR, 1.27; 95% CI, 1.03 to 1.58), as well as mortality at 90 days (P = 0.005; OR, 1.41; 95% CI, 1.11 to 1.78). In addition, admission critical hyperglycemia showed significantly increased the incidence rate of pneumonia in PIVH (P = 0.02; OR, 6.04; 95% CI 1.27 to 28.80) even after adjusting for the confounders. Conclusion: Admission blood glucose after PIVH is associated with discharge and 90-day poor outcomes, as well as mortality at 90 days. Admission hyperglycemia significantly increases the incidence rate of pneumonia in PIVH.

scholarly journals Sirenomelia: two case reports

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Asiyeh Shojaee ◽  
Firooze Ronnasian ◽  
Mahdiyeh Behnam ◽  
Mansoor Salehi
Keyword(s):  
Case Reports ◽  
Three Dimensional ◽  
First Trimester ◽  
Mendelian Inheritance ◽  
Lower Limbs ◽  
Congenital Deformity ◽  
White Family ◽  
Her Family ◽  
Caudal Regression ◽  
History Of

AbstractBackgroundSirenomelia, also called mermaid syndrome, is a rare lethal multi-system congenital deformity with an incidence of one in 60,000–70,000 pregnancies. Sirenomelia is mainly characterized by the fusion of lower limbs and is widely associated with severe urogenital and gastrointestinal malformations. The presence of a single umbilical artery derived from the vitelline artery is the main anatomical feature distinguishing sirenomelia from caudal regression syndrome. First-trimester diagnosis of this disorder and induced abortion may be the safest medical option. In this report, two cases of sirenomelia that occurred in an white family will be discussed.Case presentationWe report two white cases of sirenomelia occurring in a 31-year-old multigravid pregnant woman. In the first pregnancy (18 weeks of gestation) abortion was performed, but in the third pregnancy (32 weeks) the stillborn baby was delivered by spontaneous vaginal birth. In the second and fourth pregnancies, however, she gave birth to normal babies. Three-dimensional ultrasound imaging showed fusion of the lower limbs. Neither she nor any member of her family had a history of diabetes. In terms of other risk factors, she had no history of exposure to teratogenic agents during her pregnancy. Also, her marriage was non-consanguineous.ConclusionThis report suggests the existence of a genetic background in this mother with a Mendelian inheritance pattern of 50% second-generation incidence in her offspring.

TMJ pain as a presentation of metastatic breast cancer to the right mandibular condyle

2021 ◽  
Vol 14 (3) ◽  
pp. e241601
Author(s):  
Victor Ken On Chang ◽  
Samuel Thambar
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Head And Neck ◽  
Cancer Metastasis ◽  
Mandibular Condyle ◽  
Metastatic Breast ◽  
Neck Region ◽  
Head And Neck Region ◽  
History Of ◽  
The Right

Cancer metastasis to the oral and maxillofacial region is uncommon, and metastasis to the mandibular condyle is considered rare. We present a case of a 56-year-old woman with a history of invasive ductal cell carcinoma of the right breast, 10 years in remission, presenting with a 6-month history of symptoms typical of temporomandibular joint (TMJ) dysfunction. Imaging revealed an osteolytic lesion of her right TMJ and subsequent open biopsy confirmed the diagnosis of metastatic breast cancer. Despite the rarity of metastatic cancer to the head and neck region, it is still important for clinicians from both medical and dental backgrounds to consider this differential diagnosis, particularly in patients with a history of hormonal positive subtype of breast cancer. Given that bony metastasis can manifest even 10 years after initial diagnosis, surveillance which includes examination of the head and neck region is important, and may include routine plain-film imaging surveillance with an orthopantomogram (OPG).

Knowledge, Attitude, practice, and their associated factor towards Diabetes Mellitus among peoples live in Debre Markos Town, North West Ethiopia, Amhara Regional State, Ethiopia 2020 GC

2022 ◽  
Author(s):  
Addisu Simachew ◽  
Habtamu Temesgen
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Family History ◽  
Blood Glucose Level ◽  
Glucose Level ◽  
Educational Level ◽  
Good Practice ◽  
Favorable Attitude ◽  
Family History Of Diabetes ◽  
History Of

Abstract Background: Diabetes mellitus is a group of metabolic disease in which there is high blood glucose level over a prolonged period of time, chronic multi system disease related to abnormal insulin production, impaired insulin utilization and both. Risk of diabetes are obesity, being young or old age, family history of diabetes, history gestational diabetes, impaired, glucose metabolism, physical inactivity and ethnicity/race respectively. In type one diabetes mellitus insulin injection is needed to control the blood glucose level where as in type two diabetes mellitus the first line treatment is life style modification like diet management, exercise, and weight reduction then if uncontrolled use oral hypoglycemic agent.Objective: The main aim of the study was to assess Knowledge, Attitude, practice and their associated factor towards diabetes mellitus in Debre Markos town, northwest , Amhara Regional state, Ethiopia 2020 GC.Methodology: a community based cross-sectional study was conduct from June to July for 403 respondents using systematic random sampling technique to select the household after select the first household by lottery method. Data collected through self administered questions, the collected data process and analysis manually using pen, pencil, tally sheet and present in tables, graphs and charts respectively.Result: based on our study 138 (34.6%) of the respondents were classified as having inadequate knowledge, whereas 261(65.4%) of the respondents were deemed to be knowledgeable. from the participant 186(46.6%) had unfavorable attitude while 213(53.4%) had favorable attitude towards diabetes mellitus. Overall practice of the participant was 37.8% good practice and 62.2% poor practice. Single individuals 5.133 times (AOR=5.133, CI=1.737, 15.051) more likely knowledgeable than those divorced. Family history of diabetes mellitus 5.019 times (AOR=5.02- CI=1.59-15.76) more likely had favorable attitude than those who had no family history of DM. secondary educational level were 2.34 times (AOR=2.34, CI=1.14- 0.78) more likely good practice than those with able to read and write and persons in primary educational level. DM patients 2.811 times (AOR=2.81-95%, CI=0.99- 7.97) more likely good practice than non-diabetic.Conclusion: majority of the participant’s relatively knowledgeable. The overall attitude of the participant was more than half was favorable attitude. Majority of the study participants were poor practice regarding to DM controlling and management. Knowledge of the participant highly significant association with marital status, income and practice, practice also strong association with level of education and attitude significantly associated with family history of DM

scholarly journals Prediction of the risk of developing diabetes mellitus among Bangladeshi adults by using risk assessment score

2019 ◽  
Vol 10 (1) ◽  
pp. 40-47
Author(s):  
Nazma Akter
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Risk Assessment ◽  
Blood Glucose ◽  
High Risk ◽  
Risk Score ◽  
Diabetes Risk ◽  
High Blood Glucose ◽  
History Of ◽  
Diabetes Risk Score

Background: Diabetes mellitus (DM) is considered as one of the major health problems worldwide. The rising prevalence of type 2 diabetes mellitus (T2DM) in Bangladesh is primarily attributed to rapid urbanization and associated changes in lifestyle, such as sedentary lifestyle, higher calorie food intake and stressful life. Studies support the utilization of riskassessment scoring systems in quantifying individual’s risk for developing T2DM. Thus, a simple risk-assessment scoring system for early screening of T2DM among Bangladeshi adults will be beneficial to identify the high-risk adults and thus taking adequate preventive measures in combating DM.The purpose of the study was to calculate the risk assessment score of developing T2DM within 10 years among Bangladeshi adults. Methods: The cross-sectional observational study was carried out in the outpatient department (OPD) of Medicine, MARKS Medical College & Hospital, a tertiary care hospital in Dhaka, Bangladesh from February 2018 to July 2018 among randomly sampled 205 adult subjects. Subjects undiagnosed with diabetes mellitus and had previous history of high blood glucose during pregnancy or other health examination (i.e. impaired fasting glucose, impaired glucose tolerance or gestational diabetes mellitus) were included. From a review of literature regarding risk factors of developing DM in Bangladesh, the Finnish Diabetes Risk Score (FINDRISC) system was found to be more useful for the Bangladeshi adults. The Finnish Diabetes Risk Score (FINDRISC) questionnaire was used to collect the data including demographic characteristics and different risk factors and to calculate total risk score for predicting the risk of developing T2DM within 10 years. Results: Among 205 subjects, male and female were 57.1% and 42.9% respectively. The Mean (±SD) age of the study subjects was 37.64±1.07 years. In this study, both non-modifiable and modifiable risk factors showed statistically significant association with the FINDRISC among Bangladeshi adults (p<0.05). There was a significant association among FINDRISC with history of previous high blood glucose, and treated hypertensive Bangladeshi adults.33.65% of the Bangladeshi adults had slightly elevated diabetes risk score (DRS). This study predicts that 17.55% of the Bangladeshi adults may have moderate to high risk to develop T2DM within the consecutive 10 years. Conclusion: This study provides a simple, feasible, non-invasive and convenient screening FINDRISC tool that identifies individuals at risk of having T2DM. People with high risk of DM should be referred for early intervention and changes to a healthy lifestyle and primary prevention to prevent or delay the onset of T2DM. Birdem Med J 2020; 10(1): 40-47

scholarly journals Evaluation of the association of HER family members with efficacy of trastuzumab therapy in metastatic breast cancer

2016 ◽  
Vol 27 ◽  
pp. vi32 ◽  
Author(s):  
A. Koutras ◽  
V. Kotoula ◽  
G. Kouvatseas ◽  
C. Christodoulou ◽  
D. Pectasides ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Family Members ◽  
Metastatic Breast ◽  
Her Family ◽  
Trastuzumab Therapy

scholarly journals Acute Liver Failure with Diffuse Liver Metastasis from Breast Cancer, Not Detected by Computed Tomography: 2 Case Reports

2018 ◽  
Vol 11 (3) ◽  
pp. 699-704 ◽  
Author(s):  
Takatsugu Ogata ◽  
Yuichiro Kikawa ◽  
Misato Ogata ◽  
Hironaga Satake ◽  
Yukimasa Hatachi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Computed Tomography ◽  
Liver Metastasis ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Hepatic Failure ◽  
Poor Prognosis ◽  
Alcoholic Hepatitis ◽  
Case Reports ◽  
History Of

Diffuse liver metastasis is a rare pattern of liver metastasis that is associated with hepatic failure and poor prognosis. We experienced 2 cases of acute liver failure due to diffuse metastasis that could not be detected using computed tomography. In case 1, it was difficult to differentiate diffuse metastasis from alcoholic hepatitis. In case 2, it was difficult to diagnose diffuse liver metastasis because the patient had no history of malignancy. When liver enzyme levels are elevated, it is necessary to consider liver metastasis as a potential cause, regardless of computed tomography findings.

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