scholarly journals Hyperglycemic Emergencies Associated With Covid-19 Vaccination: A Case Series And Discussion

2021 ◽  
Author(s):  
Hanna J Lee ◽  
Alen Sajan ◽  
Yaron Tomer
Keyword(s):  
Case Series ◽  
Underlying Mechanism ◽  
Early Evaluation ◽  
Bidirectional Relationship ◽  
History Of ◽  
Hyperosmolar Hyperglycemic Syndrome ◽  
Insight Into ◽  
New Onset Diabetes Mellitus ◽  
Hba1c Levels

Abstract Context Hyperglycemic emergencies such as diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS) and new-onset diabetes mellitus (DM) have been reported in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. Hyperglycemia is a predictor of poor prognosis in COVID-19 disease. Objectives The objective of this work is to describe a case series of HHS and/or DKA likely triggered by the COVID-19 vaccine. The aim is to alert physicians of the potential hyperglycemic complications from the COVID-19 vaccination and to provide further insight into the underlying mechanism of the bidirectional relationship between SARS-CoV-2 and DM. Case description All 3 patients developed HHS and/or DKA within 2-10 days of the COVID-19 vaccination. PCR testing for SARS-CoV-2 was negative and other clinical precipitating factors were excluded. Two patients had a history of type 2 DM (T2DM) with pre-admission HbA1c levels of 7.0-7.5% while one patient was newly diagnosed with T2DM during the hospitalization. They were each treated with insulin infusion and were discharged on subcutaneous insulin therapy. Due to the rapid resolution of the hyperglycemia, insulin was discontinued in all patients within 8 weeks and they remain well-controlled on oral DM medications. Conclusion Severe hyperglycemia including HHS and DKA may be triggered by COVID-19 vaccination. Early evaluation and screening of patients with hyperglycemic symptoms after COVID-19 vaccination is recommended. The vaccine-induced hyperglycemia may provide further insight into the underlying pathogenesis caused by the SARS-CoV-2 infection itself. The underlying robust inflammatory response and “cytokine storm” may be the primary precipitant.

Case series: COVID-19 infection causing new-onset diabetes mellitus?

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Rujuta Katkar ◽  
Narasa Raju Madam
Keyword(s):  
Diabetes Mellitus ◽  
Severe Acute Respiratory Syndrome ◽  
Cell Damage ◽  
Small Sample Size ◽  
Case Series ◽  
Small Sample ◽  
Onset Diabetes ◽  
History Of ◽  
New Onset Diabetes Mellitus ◽  
New Onset

Objectives: This paper seeks to explore the hypothesis of the potential diabetogenic effect of SARS-COV-2 (Severe Acute respiratory syndrome coronavirus). Case series presentation: We present a case series of observation among 8 patients of age group ranging from 34 to 74 years with a BMI range of 26.61 to 53.21 Kilogram/square meters that developed new-onset diabetes after COVID-19 infection. Severe Acute Respiratory Syndrome Coronavirus (SARS-COV-2), commonly known as Coronavirus or COVID-19(Coronavirus infectious disease), gains entry into the cells by binding to the Angiotensin-converting enzyme-2(ACE-2) receptors located in essential metabolic tissues including the pancreas, adipose tissue, small intestine, and kidneys. The evidence reviewed from the scientific literature describes how ACE 2 receptors play a role in the pathogenesis of diabetes and the plausible interaction of SARS-COV-2 with ACE 2 receptors in metabolic organs and tissues. Conclusion: The 8 patients without a past medical history of diabetes admitted with COVID-19 infection developed new-onset diabetes mellitus due to plausible interaction of SARS-COV-2 with ACE 2 receptors. The resulting downregulation of ACE-2 and ACE-2 receptors expression caused islet-cell damage resulting into diabetes. The resulting observation has the potential to adversely impact significant number of the globally affected population. Screening patients with COVID-19 for diabetes routinely can help in early detection, significantly reducing morbidity and mortality associated with diabetes. Due to limitations of observational study with a small sample size will require further investigation in the form of Clinical trial.

scholarly journals Metformin Ameliorates Lipopolysaccharide-Induced Depressive-Like Behaviors and Abnormal Glutamatergic Transmission

Biology ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. 359
Author(s):  
Jiang Chen ◽  
Tian Zhou ◽  
A-Min Guo ◽  
Wen-Bing Chen ◽  
Dong Lin ◽  
...  
Keyword(s):  
Tail Suspension Test ◽  
Underlying Mechanism ◽  
Glutamatergic Transmission ◽  
Comorbid Depression ◽  
First Line ◽  
Antidepressant Effects ◽  
Swimming Test ◽  
Insight Into ◽  
Line Drug

Metformin, a first-line drug for type 2 diabetes mellitus (T2DM), has been found to reduce depressive symptoms in patients with comorbid depression and other diseases. However, it is largely unclear how metformin ameliorates depressive-like behaviors. Here, we used lipopolysaccharide (LPS) to induce depressive-like behaviors in mice and found that LPS-treated mice exhibited increased immobility in the forced swimming test (FST) and tail suspension test (TST), as well as increased glutamatergic transmission. Furthermore, metformin administration in the LPS-treated mice ameliorated depressive-like behaviors and elevated glutamatergic transmission. Our results suggest that metformin has antidepressant effects and can correct abnormal glutamatergic transmission, providing an insight into the underlying mechanism by which metformin acts against depression.

scholarly journals Impaired Inhibition by Avibactam and Resistance to the Ceftazidime-Avibactam Combination Due to the D179Y Substitution in the KPC-2 β-Lactamase

2017 ◽  
Vol 61 (7) ◽  
Author(s):  
Fabrice Compain ◽  
Michel Arthur
Keyword(s):  
Catalytic Properties ◽  
Residual Activity ◽  
Underlying Mechanism ◽  
Content Type ◽  
Y Substitution ◽  
Therapeutic Alternatives ◽  
Emergence Of Resistance ◽  
Hydrolysis Of ◽  
Insight Into

ABSTRACT The ceftazidime-avibactam antibiotic combination was recently shown to be at risk for the emergence of resistance under treatment. To gain insight into the underlying mechanism, we have analyzed the catalytic properties of a Klebsiella pneumoniae carbapenemase type 2 (KPC-2) β-lactamase harboring the D179Y substitution. We show that impaired inhibition by avibactam combined with significant residual activity for ceftazidime hydrolysis accounts for the resistance. In contrast, the D179Y substitution abolished the hydrolysis of aztreonam and imipenem, indicating that these drugs might provide therapeutic alternatives.

scholarly journals Subjects with Impaired Fasting Glucose: Evolution in a Period of 6 Years

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
E. Leiva ◽  
V. Mujica ◽  
R. Orrego ◽  
S. Wehinger ◽  
A. Soto ◽  
...  
Keyword(s):  
Impaired Fasting Glucose ◽  
Fasting Glucose ◽  
Descriptive Analysis ◽  
Hypoglycemic Agents ◽  
Oral Hypoglycemic Agents ◽  
Factors Associated ◽  
Normal Fasting Glucose ◽  
History Of ◽  
Hba1c Levels

Aim. To study the evolution of impaired fasting glucose (IFG), considering glucose and HbA1c levels and risk factors associated, in a period of 6 years.Methods. We studied 94 subjects with impaired fasting glucose (IFG) that were diagnosed in 2005 and followed up to 2012. Glucose and HbA1c levels were determined. A descriptive analysis of contingence charts was performed in order to study the evolution in the development of type-2 diabetes mellitus (T2DM).Results. Twenty-eight of ninety-four subjects became T2DM; 51/94 remained with IFG; and 20/94 presented normal fasting glucose. From the 28 diabetic subjects, 9 had already developed diabetes and were under treatment with oral hypoglycemic agents; 5 were diagnosed with plasma glucose < 126 mg/dL, but with HbA1c over 6.5%. In those who developed diabetes, 15/28 had a family history of T2DM in first relative degree. Also, diabetic subjects had a BMI significantly higher than nodiabetics (ttest:P< 0.01). The individuals that in 2005 had the highest BMI are those who currently have diabetes.Conclusion. The IFG constitutes a condition of high risk of developing T2DM in a few years, especially over 110 mg/dL and in obesity patients.

CES2 Expression in Pancreatic Adenocarcinoma Is Predictive of Response to Irinotecan and Is Associated With Type 2 Diabetes

2020 ◽  
pp. 426-436
Author(s):  
Michela Capello ◽  
Johannes F. Fahrmann ◽  
Mayrim V. Rios Perez ◽  
Jody V. Vykoukal ◽  
Ehsan Irajizad ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Overall Survival ◽  
Cox Regression ◽  
Ductal Adenocarcinoma ◽  
Saline Control ◽  
Serine Hydrolase ◽  
Meaningful Improvement ◽  
History Of ◽  
Hba1c Levels

PURPOSE The combination chemotherapy of fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) has provided clinically meaningful improvement for pancreatic ductal adenocarcinoma (PDAC). We previously uncovered a role for the serine hydrolase carboxylesterase 2 (CES2) in mediating intratumoral activation of the prodrug irinotecan, a constituent of FOLFIRINOX. We aimed to further test the predictive value of CES2 for response to irinotecan using patient-derived xenograft (PDX) models and to elucidate the determinants of CES2 expression and response to FOLFIRINOX treatment among patients with PDAC. METHODS PDXs were engrafted subcutaneously into nude mice and treated for 4 weeks with either saline control or irinotecan. CES2 and hepatocyte nuclear factor 4 alpha (HNF4A) expression in PDAC tissues was evaluated by immunohistochemical and Western blot analysis. Kaplan-Meier and Cox regression analyses were applied to assess the association between overall survival and hemoglobin A1C (HbA1C) levels in patients who underwent neoadjuvant FOLFIRINOX treatment. RESULTS High CES2 activity in PDAC PDXs was associated with increased sensitivity to irinotecan. Integrated gene expression, proteomic analyses, and in vitro genetic experiments revealed that nuclear receptor HNF4A, which is upregulated in diabetes, is the upstream transcriptional regulator of CES2 expression. Elevated CES2 protein expression in PDAC tissues was positively associated with a history of type 2 diabetes (odds ratio, 4.84; P = .02). High HbA1C levels were associated with longer overall survival in patients who received neoadjuvant FOLFIRINOX treatment ( P = .04). CONCLUSION To our knowledge, we provide, for the first time, evidence that CES2 expression is associated with a history of type 2 diabetes in PDAC and that elevated HbA1C, by predicting tumor CES2 expression, may represent a novel marker for stratifying patients most likely to respond to FOLFIRINOX therapy.

scholarly journals Dapagliflozin-Induced Acute Pancreatitis: A Case Report and Review of Literature

2020 ◽  
Vol 2020 ◽  
pp. 1-4 ◽  
Author(s):  
Sunam M. Sujanani ◽  
Mohanad M. Elfishawi ◽  
Paria Zarghamravanbaksh ◽  
Francisco J. Cuevas Castillo ◽  
David M. Reich
Keyword(s):  
Type 2 Diabetes ◽  
Acute Pancreatitis ◽  
Alcohol Intake ◽  
Case Reports ◽  
Review Of Literature ◽  
Case Presentation ◽  
Sodium Glucose Cotransporter ◽  
History Of ◽  
Hba1c Levels

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are increasingly used as add-on therapy in patients with poorly controlled type 2 diabetes mellitus (T2DM). Although pancreatitis is not a known side effect of SGLT-2 inhibitors, there have been case reports of SGLT-2 inhibitor use being associated with pancreatitis. Case Presentation. A 51-year-old male with a history of type 2 diabetes, dyslipidemia, and status-post cholecystectomy presented to the emergency room with a four-day history of periumbilical pain radiating to the back. He denied any history of recent alcohol intake or prior episodes of pancreatitis. On physical examination, his abdomen was diffusely tender to palpation without guarding or rebound. Initial labs were notable for a leukocyte count of 9.3 × 109/L, creatinine level of 0.72 mg/dL, calcium level of 9.5 mg/dL, lipase level of 262 U/L, and triglyceride level of 203 mg/dL. His last HbA1c was 8.5%. CT scan of his abdomen and pelvis showed findings consistent with acute pancreatitis with no biliary ductal dilatation. Careful review of his medications revealed the patient was recently started on dapagliflozin five days prior to admission in addition to his longstanding regimen of insulin detemir, sitagliptin, metformin, and rosuvastatin. His symptoms resolved after discontinuation of sitagliptin and dapagliflozin. A year later, due to increasing HbA1c levels, a decision was made to rechallenge the patient with dapagliflozin, after which he developed another episode of acute pancreatitis. His symptoms resolved upon cessation of dapagliflozin. Conclusion. This case highlights the possible association of SGLT-2 inhibitors and pancreatitis. Patients should be informed about the symptoms of acute pancreatitis and advised to discontinue SGLT-2 inhibitors in case such symptoms occur.

Morphological Typing of Endometrial Adenocarcinoma as the Basis of the Natural History of the Tumor.

1974 ◽  
Vol 60 (2) ◽  
pp. 163-170 ◽  
Author(s):  
Marcello Filotico ◽  
Mario Trabucco ◽  
Francesco Faggiano ◽  
Giovanni Mannarini ◽  
Silvana Grasso
Keyword(s):  
Natural History ◽  
Endometrial Adenocarcinoma ◽  
Case Series ◽  
Endocrine Treatment ◽  
Morphological Criterion ◽  
History Of ◽  
Type 3

Current ideas on Müllerian tumors of the ovary are applied to the classification of endometrial adenocarcinomas, which are divided into four main histotypes: Type 1 or homologous or endometrioid (65 % of cases); Type 2 or Fallopianlike (15.8 %); Type 3 or cervical-like (13.4%) and Type 4 or unclassifiable (5%). This classification aims to provide a useful morphological criterion for forecasting the sensitivity of endometrial adenocarcinomas to endocrine treatment with progestational agents. Type 1 accounts for about 80 % of all adenocarcinomas of the endometrium in the fifth decade of life, which is supposed to be the period most exposed to estrogenic stimulation. These adenocarcinomas represent only 14 % of all endometrial adenocarcinomas. The above results are based on a 155-case series.

Predictors of Tracheostomy Decannulation in Adult Laryngotracheal Stenosis

2020 ◽  
pp. 019459982097827
Author(s):  
Grace E. Snow ◽  
Timothy Brandon Shaver ◽  
Taylor B. Teplitzky ◽  
Elizabeth Guardiani
Keyword(s):  
Primary Outcome ◽  
Case Series ◽  
Adult Patients ◽  
Laryngotracheal Stenosis ◽  
Early Evaluation ◽  
History Of ◽  
Academic Teaching Hospital ◽  
Head And Neck Radiation ◽  
Or History

Objective Predictors of tracheostomy decannulation in patients with laryngotracheal stenosis are not fully known, making prognosis difficult. The aim was to identify predictors of tracheostomy decannulation in adult patients with acquired stenosis of the larynx and/or trachea who were tracheostomy dependent. Study Design Case series. Setting Academic teaching hospital. Methods A total of 103 consecutive adult patients with laryngotracheal stenosis who were tracheostomy dependent and seen by the otolaryngology clinic from January 1, 2013, to August 2, 2018, were included. Exclusion criteria included age <18 years, history of laryngeal cancer or head and neck radiation, or history of laryngeal fracture. The primary outcome was the presence of tracheostomy at last follow-up. The patients’ etiology of stenosis, comorbid conditions, and characteristics of the stenosis were analyzed to determine if there was a statistically significant relationship with decannulation. Results A total of 103 patients were included: 67% of patients were women and the average age was 53.5 years. Sixty-four patients (62%) were successfully decannulated. In multivariate analysis, patients who were successfully decannulated presented to the otolaryngology clinic earlier after tracheostomy was performed, were more likely to have been intubated due to trauma, and were less likely to have gastroesophageal reflux disease. In patients with subglottic or tracheal stenosis, those with granulation tissue without firm scar were more likely to be decannulated, and those who underwent rigid dilation were less likely to be decannulated. Conclusion Early evaluation by an otolaryngologist may increase the likelihood of tracheostomy decannulation in patients with laryngotracheal stenosis. Patient comorbidities may assist in predicting which patients will be successfully decannulated.

scholarly journals The Relationship between Hepatic Steatosis, inflammation and insulin Resistance in type 2 Diabetes with Metabolic Imbalance

2019 ◽  
Vol 16 (4) ◽  
pp. 13-25
Author(s):  
Elena-Daniela Grigorescu ◽  
Mariana Floria ◽  
Cristina Mihaela Lăcătușu ◽  
Bogdan Mircea-Mihai ◽  
Ioana Creţu ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Type 2 Diabetes ◽  
Hepatic Steatosis ◽  
Diabetic Patients ◽  
Alcoholic Fatty Liver ◽  
Bidirectional Relationship ◽  
Metabolic Imbalance ◽  
History Of ◽  
The Relationship

AbstractAim. Non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) are in a bidirectional relationship. This prospective study focused on associations between parameters common to the pathogenesis of insulin resistance, inflammation and hepatic steatosis in T2DM patients with metabolic imbalance.Methods. We used clinical data, insulin resistance and inflammation indices, and hepatic steatosis markers from 120 patients.Results. The patients (44% men, mean age 58) had a mean body mass index (BMI) of 32 kg/m2 and mean T2DM history of 6 years. With exceptions, significant correlations were found between metabolic, inflammatory and hepatic parameters.Conclusions. In T2DM patients with poor glycemic control, hepatic steatosis correlates significantly with insulin resistance and inflammation. Increased prevalence and poor prognosis of these diseases together justify the need for NAFLD screening of diabetic patients.

Herpetic Whitlow of the Hand in Infants

2020 ◽  
Author(s):  
Mohammad M. Al-Qattan ◽  
Nada G. AlQadri ◽  
Ghada AlHayaza
Keyword(s):  
Bacterial Infection ◽  
Case Reports ◽  
Case Series ◽  
Individual Case ◽  
Senior Author ◽  
Secondary Bacterial Infection ◽  
Clinical Appearance ◽  
History Of ◽  
Mode Of Transmission ◽  
Time Of Presentation

Abstract Introduction Herpetic whitlows in infants are rare. Previous authors only reported individual case reports. We present a case series of six infants. Materials and Methods This is a retrospective study of six cases of herpetic whitlows in infants seen by the senior author (MMA) over the past 23 years (1995–2017 inclusive). The following data were collected: age, sex, digit involved in the hand, mode of transmission, time of presentation to the author, clinical appearance, presence of secondary bacterial infection, presence of other lesions outside the hand, method of diagnosis, treatment, and outcome. Results All six infants initially presented with classic multiple vesicles of the digital pulp. In all cases, there was a history of active herpes labialis in the mother. Incision and drainage or deroofing of the vesicles (for diagnostic purposes) resulted in secondary bacterial infection. Conclusion The current report is the first series in the literature on herpetic whitlows in infants. We stress on the mode of transmission (from the mother) and establishing the diagnosis clinically. In these cases, no need for obtaining viral cultures or polymerase chain reaction; and no medications are required. Once the vesicles are disrupted, secondary bacterial infection is frequent and a combination of oral acyclovir and intravenous antibiotics will be required.

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