scholarly journals Onychomycosis in patients with diabetes mellitus: Etiology, clinical features, and treatment response

2021 ◽  
Vol 12 (4) ◽  
pp. 359-366
Author(s):  
Alma Ileana Molina-Hernandez ◽  
Hassiel Aurelio Ramírez-Marín ◽  
Alexandro Bonifaz
Keyword(s):  
Diabetes Mellitus ◽  
Treatment Response ◽  
Correct Diagnosis ◽  
Response To Therapy ◽  
Histopathological Study ◽  
Direct Examination ◽  
Calcofluor White ◽  
Nail Diseases ◽  
Pharmacological Interactions ◽  
Patients With Diabetes

Background: Onychomycosis accounts for 30% of all superficial mycoses and 50% of all nail diseases. One of the most studied predisposing factors is diabetes mellitus, with a frequency of onychomycosis of 31.5% in these patients. Many show resistance to standard therapeutics and have “polypharmacy”, which represents a risk for pharmacological interactions. Objective: The objective was to assess the clinical response to therapy, evaluate with histopathology, direct examination with KOH and white-calcofluor, and culture the most frequent etiologic agents associated with the development of onychomycosis in patients with diabetes mellitus. Materials and Methods: A non-randomized, uncontrolled, open-ended, prospective cohort study was conducted on 46 patients with onychomycosis and diabetes mellitus. Treatment was assigned according to clinical findings and specific indications for treatment. Results: From the samples taken for direct examination with KOH and calcofluor-white, culture, and histopathological study, positive results were: 39 (84.1%) patients to the direct examination, 32 (69.6%) to the culture, 27 (65.2%) with a positive histopathological study, and 17 (54.86%) to the calcofluor-white. On clinical evaluation, we found no treatment response in 8 patients (20%), a partial response in 14 patients (25%), and a complete response in 18 patients (45%). Out of the 46 patients evaluated initially, 25 persisted with onychomycosis after six months of follow-up. Conclusion: The prevalence of onychomycosis is increasing and requires correct diagnosis since there are other non-fungal diseases of the nails that resemble onychomycosis. Presumably, the immunosuppression of diabetes, its systemic affection, and the foot abnormalities of a diabetic patient cause more nail dystrophy, an increased fungal load, and treatment resistance.

scholarly journals Frequency of diabetes and other comorbidities in chronic inflammatory demyelinating polyradiculoneuropathy and their impact on clinical presentation and response to therapy

2020 ◽  
Vol 91 (10) ◽  
pp. 1092-1099 ◽  
Author(s):  
Pietro Emiliano Doneddu ◽  
Dario Cocito ◽  
Fiore Manganelli ◽  
Raffaella Fazio ◽  
Chiara Briani ◽  
...  
Keyword(s):  
Treatment Response ◽  
Age At Onset ◽  
European Population ◽  
Chronic Inflammatory Demyelinating Polyradiculoneuropathy ◽  
Treatment Choice ◽  
Response To Therapy ◽  
Response To Treatment ◽  
European Federation ◽  
Immune Disorders ◽  
Patients With Diabetes

ObjectivesTo determine the prevalence of different comorbidities in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), and their impact on outcome, treatment choice and response.MethodsUsing a structured questionnaire, we collected information on comorbidities from 393 patients with CIDP fulfilling the European Federation of Neurological Societies and Peripheral Nerve Society criteria included in the Italian CIDP database.ResultsOne or more comorbidities were reported by 294 patients (75%) and potentially influenced treatment choice in 192 (49%) leading to a less frequent use of corticosteroids. Response to treatment did not differ, however, from that in patients without comorbidities. Diabetes (14%), monoclonal gammopathy of undetermined significance (MGUS) (12%) and other immune disorders (16%) were significantly more frequent in patients with CIDP than expected in the general European population. Patients with diabetes had higher disability scores, worse quality of life and a less frequent treatment response compared with patients without diabetes. Patients with IgG-IgA or IgM MGUS had an older age at CIDP onset while patients with other immune disorders had a younger age at onset and were more frequently females. IgM MGUS was more frequent in patients with motor CIDP than in patients with typical CIDP.ConclusionsComorbidities are frequent in patients with CIDP and in almost 50% of them have an impact on treatment choice. Diabetes, MGUS and other immune diseases are more frequent in patients with CIDP than in the general population. Only diabetes seems, however, to have an impact on disease severity and treatment response possibly reflecting in some patients a coexisting diabetic neuropathy.

scholarly journals Sequential C-reactive protein: a cheap and a valuable biomarker in patients with sepsis

2019 ◽  
Vol 7 (5) ◽  
pp. 1837
Author(s):  
Vinod Dhakad ◽  
Sushma Trikha ◽  
Neelima Singh ◽  
Archana Kansal
Keyword(s):  
Diabetes Mellitus ◽  
Protein A ◽  
Response To Therapy ◽  
Age Group ◽  
C Reactive Protein ◽  
Protein Levels ◽  
Reactive Protein ◽  
Patients With Diabetes ◽  
Observational Cohort ◽  
Time Of Admission

Background: C-reactive protein (CRP) is a valuable biomarker of sepsis. Levels of CRP increase very rapidly in response to infection, and decrease just as rapidly with the resolution of the condition. The aim of the research was to study, C-reactive protein levels in patients of sepsis and to study the pattern of CRP levels in patients of Sepsis with hypertension, diabetes, smokers and alcoholics.Methods: This prospective observational cohort study was conducted from December 2016 to September 2018 in 100 cases of sepsis. Patients presenting in emergency with sepsis were included as subjects. C- reactive protein was measured in every patient at the time of admission and after 72 hours.  Facts related to history, clinical examination and biochemical parameters were recorded in a pretyped proforma. Data were analyzed using SPSS software.Results: Males outnumbered females. Most of the patients40(40%)  were in the age group of  less than 30 years  age group. CRP levels were markedly elevated in patients with diabetes mellitus (92.2±102.63) as compared to patients with hypertension (36.66±26.97) or both (24.20±12.87). CRP levels were higher in alcoholics (60.59±44.20) as compared to smokers (13.37±10.96).  CRP levels decreased significantly after 72 hours compared to CRP levels at the time of admission (p <0.001) across all patients suggestive of acute infection.Conclusions: Serial CRP measurement, rather than a single determination at the time of admission, is cheap and valuable in the diagnosis of sepsis and in monitoring the response to therapy.  CRP levels shows exaggerated response in diabetes mellitus and alcoholics with sepsis in this study.

Intramuscular Nerve and Neuromuscular Junction Alteration In Extraocular Muscles of Diabetic Mice

1985 ◽  
Vol 43 ◽  
pp. 682-683
Author(s):  
Bruce R. Pachter
Keyword(s):  
Diabetes Mellitus ◽  
Peripheral Nerves ◽  
Sudden Onset ◽  
Extraocular Muscles ◽  
Diabetic Patients ◽  
Oculomotor Palsy ◽  
Third Nerve Palsy ◽  
Patients With Diabetes ◽  
Intramuscular Nerve ◽  
Oculomotor Nerves

Diabetes mellitus is one of the commonest causes of neuropathy. Diabetic neuropathy is a heterogeneous group of neuropathic disorders to which patients with diabetes mellitus are susceptible; more than one kind of neuropathy can frequently occur in the same individual. Abnormalities are also known to occur in nearly every anatomic subdivision of the eye in diabetic patients. Oculomotor palsy appears to be common in diabetes mellitus for their occurrence in isolation to suggest diabetes. Nerves to the external ocular muscles are most commonly affected, particularly the oculomotor or third cranial nerve. The third nerve palsy of diabetes is characteristic, being of sudden onset, accompanied by orbital and retro-orbital pain, often associated with complete involvement of the external ocular muscles innervated by the nerve. While the human and experimental animal literature is replete with studies on the peripheral nerves in diabetes mellitus, there is but a paucity of reported studies dealing with the oculomotor nerves and their associated extraocular muscles (EOMs).

Desmopressin Stimulates Parallel Norepinephrine and Tissue Plasminogen Activator Release in Normal Subjects and Patients with Diabetes Mellitus

1988 ◽  
Vol 59 (02) ◽  
pp. 269-272 ◽  
Author(s):  
M B Grant ◽  
C Guay ◽  
R Lottenberg
Keyword(s):  
Diabetes Mellitus ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Time Course ◽  
Vascular Endothelial Cells ◽  
Normal Subjects ◽  
Plasma Norepinephrine ◽  
Endogenous Catecholamine ◽  
Tissue Plasminogen ◽  
Patients With Diabetes

SummaryDesmopressin acetate administration markedly stimulates release of tissue plasminogen activator (t-PA) from vascular endothelial cells. The mechanism for this effect is unknown. Because infusion of epinephrine has been shown to increase t-PA levels, we examined the role of endogenous catecholamine mediation of t-PA release by desmopressin. Intravenous desmopressin acetate (0.3 μg/kg) was infused over 30 min in 9 controls and 11 subjects with diabetes mellitus, a condition associated with abnormalities of the fibrinolytic system. Plasma was collected in the supine, overnight fasted state at 15 min intervals (0-60 min) for measurement of t-PA activity, t-PA antigen and fractionated catecholamines. t-PA activity peaked at 30-45 min and subsequently decreased. The norepinephrine levels paralleled the t-PA activity. t-PA activity increased 10-fold from 0.14 ± .12 to 1.49 ± 0.79 IU/ml (Mean ± SD) and plasma norepinephrine increased 2- fold from 426 ± 90 to 780 ± 292 pg/ml. However, epinephrine and dopamine levels did not change significantly. The response to desmopressin of control and diabetic subjects was not shown to differ and their data were combined. We conclude that desmopressin increases plasma norepinephrine in addition to t-PA and that the parallel time course of change suggests a possible role for norepinephrine in mediating endothelial cell t-PA release.

Soluble Fibrin Complexes and Fibrinogen Heterogeneity in Diabetes mellitus

1980 ◽  
Vol 44 (03) ◽  
pp. 130-134 ◽  
Author(s):  
E B Tsianos ◽  
N E Stathakis
Keyword(s):  
Diabetes Mellitus ◽  
Molecular Weight ◽  
Plasma Proteins ◽  
Polyacrylamide Gel Electrophoresis ◽  
Gel Filtration ◽  
Lower Molecular Weight ◽  
Polyacrylamide Gels ◽  
Soluble Fibrin ◽  
Α2 Macroglobulin ◽  
Patients With Diabetes

SummaryThe presence of soluble fibrin complexes (SFC) measured by gel filtration of plasma on 4% agarose columns, fibrinogen heterogeneity on 3.5% SDS-polyacrylamide gels and the concentrations of several plasma proteins were evaluated in 39 patients with diabetes mellitus (DM) and 19 matched control subjects. A small but significant increase of SFC was found in DM (p<0.01). On individual basis 51.2% of the patients had increased SFC (>M + 2 SD of the controls). Polyacrylamide gel electrophoresis of the SFC showed no evidence of cross-linking or proteolysis. Plasma clots formed in the presence of EDTA and trasylol were analysed in SDS-polyacrylamide gels in a normal and two lower molecular weight fibrin bands (band I, II, III). The percentage of band I fibrinogen was in diabetics (65.3 ± 4.7%) lower than that of the controls (71.8 ± 4.5%) (p < 0.01). Fibrinogen levels, antithrombin III, α1-antitrypsin, α2-macroglobulin and plasminogen were significantly increased in DM. We suggest that in DM there is an enhancement of intravascular fibrin formation and accelerated fibrinogen degradation to lower molecular weight forms.

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