Comparisons of biochemical parameters and diabetic ketoacidosis severity in adult patients with type 1 and type 2 diabetes

Objective The aim of this study was to determine the differences in biochemical parameters and diabetic ketoacidosis (DKA) severity in adult patients with type 1 and type 2 diabetes and utilization of serum BHB as a biomarker for DKA resolution was also evaluated. Materials and methods This prospective observational study of type 1 or type 2 diabetes mellitus who were diagnosed with DKA between 01 October 2018 and 30 September 2020. The correlations between serum BHB, measured by the Ranbut assay, and pH, bicarbonate, and anion gap were examined. Results A total of 99 diabetes patients were diagnosed with DKA (mean age 39.4 years, 63.4% female, 53.6% T2DM). while infection was the most common precipitating factor in T2DM (43.4%), non-compliance with treatment was the most common precipitating factor in T1DM (43.5%). T1DM patients had more severe DKA more hypokalemia during treatment. However, there was no significant difference in mortality between type1 and type2 diabetes. The initial laboratories evaluation of patients did not significant differ between type1 and type2 diabetes. Serum BHB during treatment of DKA was significantly correlated with changes in serum bicarbonate (r = − 0.64), serum anion gap (r = 0.84), and venous pH (r = − 0.6). The serum BHB levels corresponding to HCO3 levels for DKA severity were 4.5, 5.7, and 5.9 mmol/L in mild, moderate, and severe DKA, respectively. The serum BHB level of < 1 mmol/L had 73.7% sensitivity and 100% specificity to predict DKA resolution. Median time to resolution of DKA was 12 h with an optimized BHB cut-off value of < 1 mmol/L. There were no significant difference in time to resolution of DKA in the patients with type 1 and type 2 diabetes. Conclusions There are no differences in DKA-related biochemical parameters between type 1 and type 2 diabetes patients. The present findings suggest that DKA should be assessed and treated similarly, regardless of its occurrence in type 1 or type 2 diabetes patients.

A study of selfie-taking in professional college students

: Advances in technology are leading to a new way of addictive behaviour in humankind. One among them is clicking selfies. This is leading to a lot of worries in the researcher that, considering this with association with psychological changes which are being labeled as a particular disease or disorder. Even though many have concluded that excessive use is a psychological disorder. Here it's an attempt to see the selfie clicking behaviour in students. : All the students of the professional colleagues who are above 18 years of age and having smartphones were briefed about the study. And only those individuals willing to be a part of the study and gave consent were included in this study. Questionnaires were designed and validated before giving the forms to the students. Anonymities of these participants are well maintained and kept confidential.: Study participants have answered all the questionnaires and the majority of them were answering that they are clicking selfies definitely in less than a month from the last selfie. Reasons quoted for these are getting ready and send the location to other family or friends. And it also included the group who even taken these selfies to check the quality of the camera in their smartphone. Clicking selfies is a routine event for the study participants in our study.However there was no psychological precipitating factor in these individuals; taking selfies within a month fromthe previous selfie, and informing the other folks about their status was attributed to information sharing about the status. However, the participants mentioned that the quality of the smart phone camera was one of the reasons why they were clicking these selfies.

A CLINICAL STUDY TO EVALUATE RUKSHANA PURVAKA VIRECHANA KARMA IN STHOULYA WITH SPECIAL REFERENCE TO OBESITY

Sthoulya/Obesity is a medical condition in which excess body fat has accumulated to the extent that it may hurt the health and it is one of the most neglected public health issues. Sthoulya is most caused by Ati Ahara Sevana, Avyayama and Beejadosha. Sthoulya has been explained in Charaka Samhita Sutra Sthana under 21st chapter by name Astou Ninditiya Purusha as Santarpana Nimittaja Vikara1, Bahudoshavastha Vyadhi2 and included under Sleshmaja Nanatmaja Vikara. In Sushruta Samhitha also Sthoulya is narrated as rasa Nimittaja Vyadhi and con- sidered Meda vitiation as the causative factor for the manifestation. He also described Sthoulya as the physical condition of the body caused due to Dhatvagni Mandya. Acharya Charaka has also explained Swastha Purusha Laxana in terms of Sama Mamsa, Sama Pramana, Sama Samhanana and having Dridha Indriya. But Sthula Purusha is devoid of above-said qualities. Obesity contributes to many morbidities in the population, and it is known as a causative or precipitating factor for various killer ailments like hypertension, diabetes, prostate prob- lems, breast and colon cancers, respiratory problems, joint disorders, stroke, heart diseases like IHD/CAD etc. Keywords: Obesity, Sthoulya, Virechana

Emergence Delirium in a 29-Year-Old Man following an Uneventful Appendectomy

Emergence delirium (ED) is defined as the delirium that occurs during the transition from the sleep state to full consciousness. ED increases the risk for injury, self-extubation, hemorrhages, and prolonged hospitalization and occurs in patients of any age but most often in children and elderly patients. However, ED in young adults is rarely reported. We presented a case of typical ED occurring in a young healthy man following an uneventful appendectomy. The causes of ED can be classified as either predisposing or precipitating factors. In this case, the unnoticeable mental stress may be the predisposing factor and the sevoflurane maintenance of anesthesia may be the precipitating factor. ED occurs at any age of patient and in any minor surgery, and anesthesiologists should do some work to prevent it from happening.

Expression and Possible Significance of ACE2 in the Human Liver, Esophagus, Stomach, and Colon

Angiotensin-converting enzyme 2 (ACE2) has been identified as the key receptor of SARS coronavirus that plays a key role in the pathogenesis of SARS. It is known that ACE2 mRNA can be expressed in most organs. However, the protein expression of ACE2 is not clear yet. To explore the role of ACE2 as a precipitating factor in digestive organ damage under COVID-19, this study investigated the expression of ACE2 protein in the human liver, esophagus, stomach, and colon. The result showed that ACE2 can be expressed in the liver, esophagus, stomach, and colon, which suggests SARS-CoV-2 may enter the digestive system through ACE2 and cause liver and gastrointestinal damage. It is hoped that the result of the study will provide a new strategy for the prevention and treatment of digestive organ damage under COVID-19.

Meditation-Induced Psychosis: Trigger and Recurrence

Meditation is regarded as a self-regulation approach to manage emotions. Meditation has a beneficial effect on mental health. Different kinds of meditation are practiced in many religions and cultures for the general wellbeing of an individual. However, meditation-related experiences and negative effects of meditation are not uncommon. Meditation-induced psychosis has been reported in the past. Here, we present a case of a 33-year-old male patient who developed acute and transient psychosis twice after meditation and discuss the role of meditation as a precipitating factor to psychosis.

Idiopathic Chylopericardium in a Young Adult: Diagnosis and Management

Primary idiopathic chylopericardium (PIC) is an uncommon cardiologic disorder; it is defined as accumulation of lymph in the pericardial sac without any know precipitating factor. A 25-year-old presented with dyspnea and chest pain for over two months. The patient underwent a chest X-ray, which revealed an enlargement of cardiac silhouette and signs of cardiac tamponade. Chest CT was performed, revealing large pericardial effusion and small pleural effusion on the right hemithorax. The patient was referred to the ICU and underwent a pericardial window through VATS, which revealed 500 ml of a milky fluid.

A Rare Case of Rhabdomyolysis in a Patient With Pembrolizumab Induced Hypothyroidism

Introduction: Although reported in previous literature, Rhabdomyolysis due to hypothyroidism,without an obvious precipitating factor, is rare. We report a case of severe hypothyroidism leading torhabdomyolysis. Case Report: A 70-year-old man with a history of progressive weakness, myalgia x1 month, statinallergy, pancreatic adenocarcinoma, metastatic melanoma, and acquired hypothyroidism afterreceiving Pembrolizumab for 6 months. He was non-adherent to the levothyroxine, prescribed 1month before hospitalization. He presented to the ED after slipping from his bed onto the floor in aseating position and being unable to get up due to his weakness. Initially, he was afebrile, hypoxic,tachypneic, tachycardic, hypotensive, lethargic, oriented x2, and had a global muscular weakness. Labs were significant for CK of 10,180 (n &lt; 166 IU/L), TSH 136.18(n 0.34-5.6 mU/L), FT4 &lt; 0.25 (n0.6-1.10 ng/dl), FT3 1.4 (n 2.5-3.9 Pg/ml), AKI, leukocytosis, abnormal electrolytes and LFTs. IV fluidsand antibiotics failed to improve the patient’s clinical status in 48 hours. He was started on IVthyroxine and stress steroids with improved weakness and overall clinical picture. Discussion: 4.6 % of people have hypothyroidism per the United States National Health andNutrition Examination Survey. Rhabdomyolysis is defined as the rapid breakdown of skeletal muscle,which may also develop due to hypothyroidism. Most patients with hypothyroidism who developrhabdomyolysis are found to have a clear precipitating risk factor, such as the use of statins orstrenuous exercise. Still, none of these risk factors were present in this case. Our patient acquiredhypothyroidism after a few months of receiving Immunotherapy. It is reported that hypothyroidismoccurs in (9% to 18%) of patients receiving Pembrolizumab. Although the patient was prescribedthyroid replacement therapy, he was not adherent to the medication for 1 month prior topresentation. Although mechanical injury is reported to cause elevated CK levels, mostrhabdomyolysis cases are related to crush injuries. We believe that the fall was probably related tohis progressive generalized weakness due to his noncompliance with medical therapy leading tomyxedema coma and rhabdomyolysis. Conclusion: Screening for hypothyroidism in patients with elevated muscle enzymes should behighly considered since an early diagnosis. Prompt treatment of hypothyroidism is essential toprevent rhabdomyolysis and its consequence.