The Utility of Exosomes in Diagnosis and Therapy of Diabetes Mellitus and Associated Complications

Diabetes mellitus and the associated complications are metabolic diseases with high morbidity that result in poor quality of health and life. The lack of diagnostic methods for early detection results in patients losing the best treatment opportunity. Oral hypoglycemics and exogenous insulin replenishment are currently the most common therapeutic strategies, which only yield temporary glycemic control rather than curing the disease and its complications. Exosomes are nanoparticles containing bioactive molecules reflecting individual physiological status, regulating metabolism, and repairing damaged tissues. They function as biomarkers of diabetes mellitus and diabetic complications. Considering that exosomes are bioactive molecules, can be obtained from body fluid, and have cell-type specificity, in this review, we highlight the multifold effects of exosomes in the pathology and therapy of diabetes mellitus and diabetic complications.

Sexual dysfunction in women age 60 and older

Sexuality is an important aspect in women's quality of life, however, sexuality studies dedicated to women age 60 and older are scarce. The objective of this study was to determine the prevalence of female sexual dysfunction and its domains in women age 60 and older, and to identify the association between diseases and drug use with sexual dysfunction. A descriptive and cross-cutting study was conducted, in women 60 years and older, in Havana, Cuba. Two surveys participated in 112 women: The Female Sexual Function Index (IFSF) and another who collected a medical and social history. 66.1% of women had some degree of sexual dysfunction, the prevalence increased with age. The domains most affected were desire, excitement, and lubrication. A strong association between Parkinson's disease, depression and osteoarthritis was identified with the onset of sexual dysfunction in the studied population, as well as the use of antidepressants, oral hypoglycemics and diuretics. Sexual dysfunction was present in 100% of octogenary women. All women with Parkinson's disease had sexual dysfunction.

Sudden painless loss of vision following spine surgery: lessons learnt in darkness

A 26-year-old male driver presented with a history of pain in the neck for the past 1 week following trauma due to a road traffic accident. The patient had no neurological deficit. He had type 1 diabetes and was on regular oral hypoglycemics. After radiological investigations, the patient was diagnosed to have traumatic AO Spine Classification type C translational injury involving anterolisthesis of C6 over C7. After a detailed preoperative assessment, the patient was taken up for surgery. The patient underwent posterior stabilisation with instrumentation from C5 to T2. On extubation from anaesthesia, he immediately complained of complete painless loss of this vision in his left eye. Ophthalmological investigations attributed the cause to be due to central retinal artery occlusion. The patient was discharged with reassurance on the 20th postoperative day with minimal improvement in his vision and at 6-month follow-up, his vision improved to 1/60 and was advised for close follow-up.

Comparison of several survey-based algorithms to ascertain type 1 diabetes among US adults with self-reported diabetes

IntroductionDefining type of diabetes using survey data is challenging, although important, for determining national estimates of diabetes. The purpose of this study was to compare the percentage and characteristics of US adults classified as having type 1 diabetes as defined by several algorithms.Research design and methodsThis study included 6331 respondents aged ≥18 years who reported a physician diagnosis of diabetes in the 2016–2017 National Health Interview Survey. Seven algorithms classified type 1 diabetes using various combinations of self-reported diabetes type, age of diagnosis, current and continuous insulin use, and use of oral hypoglycemics.ResultsThe percentage of type 1 diabetes among those with diabetes ranged from 3.4% for those defined by age of diagnosis <30 years and continuous insulin use (algorithm 2) to 10.2% for those defined only by continuous insulin use (algorithm 1) and 10.4% for those defined as self-report of type 1 (supplementary algorithm 6). Among those defined by age of diagnosis <30 years and continuous insulin use (algorithm 2), by self-reported type 1 diabetes and continuous insulin use (algorithm 4), and by self-reported type 1 diabetes and current insulin use (algorithm 5), mean body mass index (BMI) (28.6, 27.4, and 28.5 kg/m2, respectively) and percentage using oral hypoglycemics (16.1%, 11.1%, and 19.0%, respectively) were lower than for all other algorithms assessed. Among those defined by continuous insulin use alone (algorithm 1), the estimates for mean age and age of diagnosis (54.3 and 30.9 years, respectively) and BMI (30.9 kg/m2) were higher than for other algorithms.ConclusionsEstimates of type 1 diabetes using commonly used algorithms in survey data result in varying degrees of prevalence, characteristic distributions, and potential misclassification.

Case report of bullous pemphigoid in a 65 year old woman

The unique thing about this case is that it is the first reported case of bullous pemphigoid in the elderly that has been clinically diagnosed with histologic findings highly suggestive of this blistering disorder although an immunofluorescence could not be done due to unavailability in the centre. Patient was managed successfully and discharged home with improvement on subsequent hospital visits. This case report shows how diagnosis of an immunobullous disease was made and managed in a resource poor setting. A descriptive summary of 65-year old black Nigerian woman with bullous pemphigoid covering history, physical examination and management. The main diagnosis was bullous pemphigoid in a recently diagnosed type 2 diabetic. Patient was placed on corticosteroids as well as immunosuppressive agents and diabetes was managed with subcutaneous insulin and oral hypoglycemics with appropriate wound care. Patient showed remarkable improvement after management and was discharged home with subsequent follow up in the clinics. Bullous Pemphigoid (BP) can be diagnosed clinically with a high index of suspicion with the aid of skin biopsy and histology, and can be managed successfully even in a resource poor centre where immunofluorescence facilities are lacking.

Case Report on Steroid Induced Cushing Syndrome

Glucocorticoids are the effective steroid drugs which reduce the inflammation & most commonly glucocorticoids are used in diseases such as asthma, allergic diseases such as psoriasis, eczema and rheumatoid arthritis. Long term effect of corticosteroids leads to the symptoms of moon face, buffalo hump, pink stretch marks, and weight gain. In this we are going to report a case of 30 yrs female patient with representing the long term use of corticosteroids; Prednisolone leads to cushing syndrome. Eventually she was treated with oral hypoglycemics and diuretics and the use of steroid had stopped temporarily and the dose of prednisolone was tapered. Keywords: glucocorticoids, prednisolone, Cushing syndrome

Diabetes mellitus: An adverse prognosis in cancer patients—Study of a cohort treated at Instituto Oncológico Henry Moore (IOHM).

e18212 Background: Numerous studies have evaluated the unfavorable impact of diabetes mellitus (DM) on cancer evolution. The objective of this paper is to study the coexistence of DM and cancer diagnosis; and its influence on the evolution of a cohort followed at IOHM. Methods: Between 9/26/2012 and 11/28/2018 all new patients (Pt) admitted to IOHM filled out a Past Medical History Form (PMHF) (ASCO 2013 ABST. e17539) with their preexisting clinical conditions.The database was locked and anonymized. Those with a history of DM or who were taking insulin and/ or oral antidiabetics were selected (Group A). The stage and evolution of their tumors were compared with those of non-diabetic patients (Group B). Results: Out of 15,617 Pt, 1,829 Pt (11,7%) had DM (Group A); 1,087 Pt were being treated with oral hypoglycemics (59%); 178 Pt with insulin (10%) and 564 Pt (31%) were not on antidiabetics drugs. They were compared to 13,788 Pt without DM (Group B). Oncological treatment was similar in both groups. Mortality was greaterin DM Patients adjusted by sex, age, PS, BMI, Dx and stage; Multivariate Cox Regression (p = 0.0001). The results are presented in the chart below. Conclusions: 1) In a cohort of 15,617 cancer Pt, 11,7% had DM. 2) DM Pt's tumors were more advanced. 3) Under similar treatments, DM Pt presented higher mortality. 4) Based on this, we advocate for DM in oncological Pt to be considered as an independent adverse factor.[Table: see text]