scholarly journals STUDY OF ALTERED GLUCOSE LEVELS IN CASES OF ACUTE ISCHEMIC STROKE AND ITS EFFECT ON PROGNOSIS

2019 ◽  
Vol 3 (9) ◽  
Author(s):  
Dr. Sunil I Mathew
Keyword(s):  
Blood Glucose ◽  
Medical Condition ◽  
Binary Logistic Regression ◽  
Binary Logistic Regression Analysis ◽  
Stress Hyperglycemia ◽  
Exact Test ◽  
Glucose Levels ◽  
Altered Glucose ◽  
One Year ◽  
Glucose Estimation

IntroductionGlobally about 20 million people suffer from stroke each year. Stroke is a medical condition in which poor blood flow to the brain results in cell death. The risk factors causing stroke are high blood pressure, high blood, tobacco smoking, obesity cholesterol, diabetes mellitus and previous Transient Ischemic Attack (TIA).Objectives: To determine the association of stress hyperglycemia at admission with outcome of acute ischemic strokeMaterials and Methods: A study was done at Thiruvalla, Kerala for a period of one year. All new cases of cerebral infarction admitted comprised of 70 cases, 35 each in Euglycemia and Stress hyperglycemia group who were classified at the time of admission based on random blood glucose estimation with the features of stroke. All necessary investigations for the work-up of case required were done. Glasgow Outcome Score for the assessment of recovery in patients was scored, based on National Institute of Health Stroke Scale (NIHSS) on day 1, at the time of discharge and then again on day 30 to assess the clinical outcome. Standard descriptive statistics were used to report the data. Fisher's exact test and Students t test were used to compare the two groups. Binary logistic regression analysis was done.Result: Patients with stress hyperglycemia were found to have increased NIHSS scores on admission and this was more prominent at time of discharge on compared to euglycemic group. Poor recovery was associated with small and medium infarct size in stress hyperglycemia. However, prognosis worsened if size of infarct increased in both groups.Conclusion: Adequate control of blood glucose levels should be maintained immediately during admission and during follow-up to improve prognosis.Keywords: Stroke, Glucose levels, Prognosis

scholarly journals Lack of recognition and documentation of stress hyperglycemia is a disruptor of optimal continuity of care

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Eric D. Moyer ◽  
Erik B. Lehman ◽  
Matthew D. Bolton ◽  
Jennifer Goldstein ◽  
Ariana R. Pichardo-Lowden
Keyword(s):  
Blood Glucose ◽  
Continuity Of Care ◽  
Clinical Documentation ◽  
Stress Hyperglycemia ◽  
Optimal Care ◽  
Continuity Clinic ◽  
Altered Glucose ◽  
Discharge Summaries

AbstractStress hyperglycemia (SH) is a manifestation of altered glucose metabolism in acutely ill patients which worsens outcomes and may represent a risk factor for diabetes. Continuity of care can assess this risk, which depends on quality of hospital clinical documentation. We aimed to determine the incidence of SH and documentation tendencies in hospital discharge summaries and continuity notes. We retrospectively examined diagnoses during a 12-months period. A 3-months representative sample of discharge summaries and continuity clinic notes underwent manual abstraction. Over 12-months, 495 admissions had ≥ 2 blood glucose measurements ≥ 10 mmol/L (180 mg/dL), which provided a SH incidence of 3.3%. Considering other glucose states suggestive of SH, records showing ≥ 4 blood glucose measurements ≥ 7.8 mmol/L (140 mg/dL) totaled 521 admissions. The entire 3-months subset of 124 records lacked the diagnosis SH documentation in discharge summaries. Only two (1.6%) records documented SH in the narrative of hospital summaries. Documentation or assessment of SH was absent in all ambulatory continuity notes. Lack of documentation of SH contributes to lack of follow-up after discharge, representing a disruptor of optimal care. Activities focused on improving quality of hospital documentation need to be integral to the education and competency of providers within accountable health systems.

scholarly journals Absence of Stress Hyperglycemia Indicates the Most Severe Form of Blunt Liver Trauma

Diagnostics ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. 1667
Author(s):  
Janett Kreutziger ◽  
Margot Fodor ◽  
Dagmar Morell-Hofert ◽  
Florian Primavesi ◽  
Stefan Stättner ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Liver Injury ◽  
Injury Severity ◽  
Severe Form ◽  
Liver Trauma ◽  
University Hospital ◽  
Hepatic Insulin Resistance ◽  
Trauma Patients ◽  
Stress Hyperglycemia ◽  
Glucose Levels

Background: Stress hyperglycemia is common in trauma patients. Increasing injury severity and hemorrhage trigger hepatic gluconeogenesis, glycogenolysis, peripheral and hepatic insulin resistance. Consequently, we expect glucose levels to rise with injury severity in liver, kidney and spleen injuries. In contrast, we hypothesized that in the most severe form of blunt liver injury, stress hyperglycemia may be absent despite critical injury and hemorrhage. Methods: All patients with documented liver, kidney or spleen injuries, treated at a university hospital between 2000 and 2020 were charted. Demographic, laboratory, radiological, surgical and other data were analyzed. Results: A total of 772 patients were included. In liver (n = 456), spleen (n = 375) and kidney (n = 152) trauma, an increase in injury severity past moderate to severe (according to the American Association for the Surgery of Trauma, AAST III-IV) was associated with a concomitant rise in blood glucose levels independent of the affected organ. While stress-induced hyperglycemia was even more pronounced in the most severe forms (AAST V) of spleen (median 10.7 mmol/L, p < 0.0001) and kidney injuries (median 10.6 mmol/L, p = 0.004), it was absent in AAST V liver injuries, where median blood glucose level even fell (5.6 mmol/L, p < 0.0001). Conclusions: Absence of stress hyperglycemia on hospital admission could be a sign of most severe liver injury (AAST V). Blood glucose should be considered an additional diagnostic criterion for grading liver injury.

Accuracy of Blood Glucose Estimation by Children with Diabetes: An Investigation of Repeated Practice with Growth Curve Modeling

2004 ◽  
Vol 94 (2) ◽  
pp. 371-380 ◽  
Author(s):  
Julie Ann Wagner ◽  
Laurie Ruggiero
Keyword(s):  
Blood Glucose ◽  
Growth Curve ◽  
Quadratic Function ◽  
Growth Curve Modeling ◽  
Older Children ◽  
Glucose Levels ◽  
Repeated Practice ◽  
Blood Glucose Levels ◽  
Curve Modeling ◽  
Glucose Estimation

This study used growth curve modeling to explore whether practicing the task of estimating blood glucose levels would increase accuracy in children with type 1 diabetes. It was predicted that accuracy would improve with practice and that younger, anxious, poorly adjusted children would improve most. 43 attendees at a diabetes summer camp participated. Their mean age was 13.4 yr. ( SD = 1.6). All were Euro-American, and 22 were girls. Change in accuracy was best represented by a quadratic function, and this model fit the data well. Overall, participants' accuracy improved initially and then deteriorated. Results indicate that older children were more likely to improve and then deteriorate. Younger children were more likely to improve and sustain those improvements. Results indicate that practicing the task of estimating is not an effective way to increase accuracy and may be contra-indicated. These results can help guide research and clinical use of glucose estimation in children.

scholarly journals Absence of Stress Hyperglycemia Indicates the Most Severe Form of Blunt Liver Trauma (AAST V) – A Register Analysis

2021 ◽  
Author(s):  
Janett Kreutziger ◽  
Margot Fodor ◽  
Dagmar Morell-Hofert ◽  
Florian Primavesi ◽  
Stefan Stättner ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Liver Injury ◽  
Injury Severity ◽  
Severe Form ◽  
Liver Trauma ◽  
University Hospital ◽  
Hepatic Insulin Resistance ◽  
Trauma Patients ◽  
Stress Hyperglycemia ◽  
Glucose Levels

Abstract Background: Stress hyperglycemia is common in trauma patients. Increasing injury severity and hemorrhage is known to trigger hepatic gluconeogenesis and glycogenolysis and also peripheral and hepatic insulin resistance. Consequently, we expect glucose levels to rise with injury severity in liver, kidney and spleen injuries. In contrast, we hypothesized that in the most severe form of blunt liver injury, stress hyperglycemia may be absent despite critical injury and hemorrhage.Methods: All patients with documented liver, kidney or spleen injuries, treated at a single, university hospital in Austria between 2000 and 2020 were charted in a register. Besides demographic, laboratory, radiological, surgical and other data were analyzed.Results: A total of 772 patients were included. In liver (n=456), spleen (n=375) and kidney (n=152) trauma, an increasing injury severity past moderate to severe (AAST III-IV) was associated with a concomitant rise in blood glucose levels independent of the affected organ. While this stress induced hyperglycemia was even more pronounced in the most severe forms (AAST V) of spleen (median 10.7 mmol/L, p<0.0001) and kidney injuries (median 10.6 mmol/L, p=0.004), it was absent in AAST V liver injuries, where median blood glucose level even fell (5.6 mmol/L, p<0.0001). Conclusions: Absence of stress hyperglycemia is a sign of most severe liver injury (AAST V) and should prompt fundamental diagnostic and therapeutic procedures. Blood glucose should be considered as an additional diagnostic criterion in liver injury.

scholarly journals The Effectiveness of Combination of Momordica charantia Extract and Averrhoa bilimbi on Nf-Kb Activation in Mice (Mus musculus) Balb/C Hyperglycemia Models

2020 ◽  
Vol 10 (1) ◽  
pp. 61-64
Author(s):  
Intan Sartika Risky Sampurna ◽  
◽  
Muhaimin Rifa’i ◽  
Sri Rahayu
Keyword(s):  
Blood Glucose ◽  
Medical Condition ◽  
Positive Control ◽  
Momordica Charantia ◽  
Control Treatment ◽  
Cd8 Cells ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Sugar Levels ◽  
System Disorder

Hyperglycemia is a medical condition when the blood glucose levels increase exceeds the reasonable limit. Hyperglycemia is a typical sign of diabetes mellitus (DM). Indonesia is the sixth-ranked country in the world after China, India, United States, Brazil, and Mexico. Treatment with herbs is currently being developed. Pare (Momordica charantia) and Belimbing wuluh (Averrhoa bilimbi) are plants that found around us. Some studies state that each of these plants can be anti-diabetic. The hyperglycemia can cause an immune system disorder characterized by pancreatic β cell death involving IL-1β, kappa B (NF)-κB nuclear factor, and Fas. The ability of NF-kB activation will affect the number of cytokines expressed by T cells, namely TNF-α, and IFN-γ. The purpose of this study is to determine the effect of NF-kB activation on blood glucose levels in hyperglycemia mice. The results showed that the positive control treatment showed an increase in the number of NF-kB activations in CD4 and CD8 cells. EPBW (combination of Averrhoa bilimbi extract and Momordica charantia) administration results at a dose of 10 mg.kg-1 BW showed a reduction in the amount of activated NF-kB as a substitute for the reduction. In addition, that dose can reduce blood sugar levels in mice hyperglycemia model.

scholarly journals Maximal Glycemic Difference, the Possible Strongest Glycemic Variability Parameter to Predict Mortality in ICU Patients

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Thanaphruet Issarawattana ◽  
Rungsun Bhurayanontachai
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Glucose ◽  
Standard Deviation ◽  
Coefficient Of Variation ◽  
Intensive Care Unit Mortality ◽  
Pairwise Comparison ◽  
Binary Logistic Regression ◽  
Glycemic Variability ◽  
Glucose Levels

Background. This retrospective study aimed to determine the correlation of blood glucose and glycemic variability with mortality and to identify the strongest glycemic variability parameter for predicting mortality in critically ill patients. Methods. A total of 528 patients admitted to the medical intensive care unit were included in this study. Blood glucose levels during the first 24 hours of admission were recorded and calculated to determine the glycemic variability. Significant glycemic variability parameters, including the standard deviation, coefficient of variation, maximal blood glucose difference, and J-index, were subsequently compared between intensive care unit survivors and nonsurvivors. A binary logistic regression was performed to identify independent factors associated with mortality. To determine the strongest glycemic variability parameter to predict mortality, the area under the receiver operating characteristic of each glycemic variability parameter was determined, and a pairwise comparison was performed. Results. Among the 528 patients, 17.8% (96/528) were nonsurvivors. Both survivor and nonsurvivor groups were clinically comparable. However, nonsurvivors had significantly higher median APACHE-II scores (23 [21, 27] vs. 18 [14, 22]; p < 0.01) and a higher mechanical ventilator support rate (97.4% vs. 74.9%; p < 0.01). The mean blood glucose level and significant glycemic variability parameters were higher in nonsurvivors than in survivors. The maximal blood glucose difference yielded a similar power to the coefficient of variation (p = 0.21) but was significantly stronger than the standard deviation (p = 0.005) and J-index (p = 0.006). Conclusions. Glycemic variability was independently associated with intensive care unit mortality. Higher glycemic variability was identified in the nonsurvivor group regardless of preexisting diabetes mellitus. The maximal blood glucose difference and coefficient of variation of the blood glucose were the two strongest parameters for predicting intensive care unit mortality in this study.

scholarly journals Clinical and genetic risk factors for new-onset diabetes mellitus after transplantation (NODAT) in major transplant centres in Malaysia

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Rhanye Mac Guad ◽  
Andrew W. Taylor-Robinson ◽  
Yuan Seng Wu ◽  
Siew Hua Gan ◽  
Nur Lisa Zaharan ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Blood Glucose ◽  
Renal Transplant ◽  
Fasting Blood Glucose ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Increased Risk ◽  
Daily Dose ◽  
One Year ◽  
New Onset

Abstract Background New-onset diabetes after transplantation (NODAT) is associated with reduced patient and graft survival. This study examined the clinical and selected genetic factors associated with NODAT among renal-transplanted Malaysian patients. Methods This study included 168 non-diabetic patients (58% males, 69% of Chinese ethnicity) who received renal transplantation between 1st January 1994 to 31st December 2014, and were followed up in two major renal transplant centres in Malaysia. Fasting blood glucose levels were used to diagnose NODAT in patients who received renal transplantation within 1 year. Two single nucleotide polymorphisms (SNPs), namely; rs1494558 (interleukin-7 receptor, IL-7R) and rs2232365 (mannose-binding leptin-2, MBL2) were selected and genotyped using Sequenom MassArray platform. Cox proportional hazard regression analyses were used to examine the risk of developing NODAT according to the different demographics and clinical covariates, utilizing four time-points (one-month, three-months, six-months, one-year) post-transplant. Results Seventeen per cent of patients (n = 29, 55% males, 69% Chinese) were found to have developed NODAT within one-year of renal transplantation based on their fasting blood glucose levels. NODAT patients had renal transplantation at an older age compared to non-NODAT (39.3 ± 13.4 vs 33.9 ± 11.8 years, p = 0.03). In multivariate analysis, renal-transplanted patients who received a higher daily dose of cyclosporine (mg) were associated with increased risk of NODAT (Hazard ratio (HR) =1.01 per mg increase in dose, 95% confidence interval (CI) 1.00–1.01, p = 0.002). Other demographic (gender, ethnicities, age at transplant) and clinical factors (primary kidney disease, type of donor, place of transplant, type of calcineurin inhibitors, duration of dialysis pre-transplant, BMI, creatinine levels, and daily doses of tacrolimus and prednisolone) were not found to be significantly associated with risk of NODAT. GA genotype of rs1494558 (HR = 3.15 95% CI 1.26, 7.86) and AG genotype of rs2232365 (HR = 2.57 95% CI 1.07, 6.18) were associated with increased risk of NODAT as compared to AA genotypes. Conclusion The daily dose of cyclosporine and SNPs of IL-7R (rs1494558) and MBL2 (rs2232365) genes are significantly associated with the development of NODAT in the Malaysian renal transplant population.

scholarly journals Effects of Perioperative Magnesium Sulfate Administration on Postoperative Chronic Knee Pain in Patients Undergoing Total Knee Arthroplasty: A Retrospective Evaluation

2019 ◽  
Vol 8 (12) ◽  
pp. 2231 ◽  
Author(s):  
Tak Kyu Oh ◽  
Seung Hyun Chung ◽  
Jinwoo Park ◽  
Hyunjung Shin ◽  
Chong Bum Chang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Magnesium Sulfate ◽  
Knee Arthroplasty ◽  
Binary Logistic Regression ◽  
Control Group ◽  
Binary Logistic Regression Analysis ◽  
Chronic Knee Pain ◽  
Total Knee ◽  
One Year ◽  
Propensity Score Adjustment

We aimed to investigate whether perioperative magnesium sulfate administration was associated with the incidence of chronic persistent postoperative pain (PPP) following total knee arthroplasty (TKA). This retrospective observational study was performed at a single tertiary academic hospital. We reviewed the medical records of adult patients who were admitted between August 2012 and July 2017. Patients who received magnesium sulfate during surgery were the magnesium group. The presence of PPP, one year after TKA, was evaluated using a binary logistic regression analysis. A total of 924 patients were included in the analysis, and 148 patients (16.0%) experienced PPP one year after TKA. In the multivariable model, the magnesium group had a 62% lower rate of PPP one year after TKA compared to the control group (odds ratio (OR): 0.38, 95% confidence interval (CI): 0.16 to 0.90; p = 0.027). This finding was similar in the sensitivity analysis using propensity score adjustment (OR: 0.38, 95% CI: 0.16 to 0.93; p = 0.036). We showed that perioperative magnesium sulfate administration was associated with a lower rate of PPP one year after TKA. Our results suggest that magnesium sulfate administered perioperatively is effective for the alleviation of acute and chronic pain after surgery.

scholarly journals Maintaining sinus rhythm after electrical cardioversion

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
R Menezes Fernandes ◽  
T.F Mota ◽  
H.A Costa ◽  
M Espirito Santo ◽  
D Bento ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Clinical Characteristics ◽  
Binary Logistic Regression ◽  
Left Ventricular ◽  
Electrical Cardioversion ◽  
Left Ventricular Ejection ◽  
Binary Logistic Regression Analysis ◽  
Ventricular Ejection Fraction ◽  
Electric Shocks ◽  
One Year

Abstract Introduction Atrial fibrillation (AF) and atrial flutter (AFL) are commonly terminated by electrical cardioversion (EC) when a rhythm control strategy is adopted. However, the long-term success following EC is variable. Purpose To determine the clinical characteristics and independent predictors of sinus rhythm (SR) maintenance after EC due to AF/AFL. Methods We conducted a retrospective study enrolling patients with AF/AFL referred to EC in our Cardiology Department, from September 2011 to September 2020. Clinical characteristics and echocardiographic studies were analysed. Primary endpoints were the incidence of ischemic stroke, all-cause and cardiovascular (CV) mortality. Independent predictors of SR maintenance were identified through a binary logistic regression analysis, considering p=0,05. Results A total of 719 patients with a median age of 67 years-old were included, and EC was successfully performed in 93,2%. AFL was diagnosed in 21%, 57,3% had arterial hypertension and 34,6% were obese. 62,1% had persistent AF/AFL, 19,6% presented with first diagnosed AF/AFL and 17,2% had paroxysmal episodes. Left ventricular ejection fraction (LVEF) was preserved in 66,7%. Maintenance of SR after one-year was documented in 64,7% of patients with successful EC. They had lower prevalence of chronic kidney disease (CKD) (2,6% vs 10,7%; p&lt;0,001) and received less electrical shocks during EC (1,20 vs 1,39; p=0,005). There were no differences regarding antiarrhythmic therapy between both groups. Complete LVEF recovery after EC was more frequent in patients who maintained SR (58,8% vs 31,9%; p=0,008), with a greater prevalence of preserved LVEF after EC (88,8% vs 73,6%; p&lt;0,001). During a median follow-up of 1368 days, these patients performed less additional EC (0,26 vs 0,65; p&lt;0,001) and were less referred to ablation procedures (7,1% vs 15,1%; p=0,011). No differences were found regarding stroke rate, but all-cause mortality (12,8% vs 25%; p=0,002) and CV death (3,8% vs 10,9%; p=0,005) were significantly lower in patients who maintained SR. Absence of CKD (p=0,013), applying fewer electric shocks during EC (p=0,013) and preserved LVEF after EC (p=0,004) were independent predictors of SR maintenance. Conclusion In our study, most patients maintained SR one year after EC, which was associated with a lower all-cause and CV mortality. Absence of CKD, applying fewer electric shocks during EC and preserved LVEF after EC were independent predictors of SR maintenance. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Exposure to Common Food Additive Carrageenan Alone Leads to Fasting Hyperglycemia and in Combination with High Fat Diet Exacerbates Glucose Intolerance and Hyperlipidemia without Effect on Weight

2015 ◽  
Vol 2015 ◽  
pp. 1-13 ◽  
Author(s):  
Sumit Bhattacharyya ◽  
Leo Feferman ◽  
Terry Unterman ◽  
Joanne K. Tobacman
Keyword(s):  
Blood Glucose ◽  
Glucose Tolerance ◽  
Glucose Intolerance ◽  
High Fat Diet ◽  
Fasting Blood Glucose ◽  
Food Additive ◽  
High Fat ◽  
Glucose Levels ◽  
Fat Consumption ◽  
One Year

Aims. Major aims were to determine whether exposure to the commonly used food additive carrageenan could induce fasting hyperglycemia and could increase the effects of a high fat diet on glucose intolerance and dyslipidemia.Methods. C57BL/6J mice were exposed to either carrageenan, high fat diet, or the combination of high fat diet and carrageenan, or untreated, for one year. Effects on fasting blood glucose, glucose tolerance, lipid parameters, weight, glycogen stores, and inflammation were compared.Results. Exposure to carrageenan led to glucose intolerance by six days and produced elevated fasting blood glucose by 23 weeks. Effects of carrageenan on glucose tolerance were more severe than from high fat alone. Carrageenan in combination with high fat produced earlier onset of fasting hyperglycemia and higher glucose levels in glucose tolerance tests and exacerbated dyslipidemia. In contrast to high fat, carrageenan did not lead to weight gain. In hyperinsulinemic, euglycemic clamp studies, the carrageenan-exposed mice had higher early glucose levels and lower glucose infusion rate and longer interval to achieve the steady-state.Conclusions. Carrageenan in the Western diet may contribute to the development of diabetes and the effects of high fat consumption. Carrageenan may be useful as a nonobese model of diabetes in the mouse.

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