Glycaemic Status in Acute Stroke in Nondiabetic Patient

Background: Elevated blood glucose is common in the early stage of stroke. Besides, blood glucose level increases during acute stroke in nondiabetic patients. Objective: Objective of the study was to assess the glycemic status during acute stroke in nondiabetic patients, find the rate of newly developed diabetes during acute stroke and rate of newly developed Impaired Fasting Glucose, Impaired Glucose Tolerance during acute stroke. Methods: The purposive sampling method was used to identify the patients and by proper history taking, documentary papers and laboratorial support evidenced by HbA1c level less than 6.5% (This means patient to be non diabetic). Data were collected from 100 patients. It was conducted from August, 2018 to February, 2019 in the Department of Medicine of Dhaka Medical College Hospital. The data were collected through questionnaire ,pre-tested earlier and data collection sheet illustrating the glycemic status during acute stroke among the nondiabetic patients. Results: While analyzing the lab investigations among the respondents, mean HbA1c level was found 5.69± 0.65 mmol/L level which was found normal among the entire patient group. Patients Fasting Blood Sugar(FBS) was tested and mean FBS level was 5.94±0.86. In 62% of the patients, IFG was found, and in 12% of patients, FBS value was found to be diabetic while 26% showed normal glycemic status. Average OGTT(2 hours after 75 gm glucose) impression was 8.53± 2.02 mmol/L. OGTT level was normal among 30%, 54% patients had IGT and 16% of the respondents were found diabetic. Conclusion: The study finds that, in patients with no history of diabetes who have acute stroke, may develop moderately elevated glucose levels which may affect short term and long term stroke related morbidity and mortality. J MEDICINE JAN 2021; 22 (1) : 22-26

Pedal Flow Hemodynamics in Patients With Chronic Limb-Threatening Ischemia

Ankle-brachial index (ABI) and duplex ultrasound (DUS) are accepted standardized tests performed on patients with suspected peripheral arterial disease. In the nondiabetic patient, ABIs can be a reliable test for disease above the level of the ankle. Toe brachial index (TBI) is also an accepted modality to test for small vessel disease. However, ABIs and TBIs fall short in providing a complete evaluation of arterial flow especially in pedal arteries in the setting of noncompressible arteries. Direct duplex ultrasonography can provide a comprehensive evaluation of arterial flow hemodynamics in the lower extremity. However, we wanted to understand the role of arterial collateral flow to the foot in the setting of tibial vessel occlusion. Using DUS, we sought to define the changes that occur in the arterial flow hemodynamics in the foot in relation to occlusions of specific tibial inflow vessels.

Diabetic Ketoacidosis on Hospitalization with COVID-19 in a Previously Nondiabetic Patient: A Review of Pathophysiology

Hyperglycaemia during inpatient admission is indicative of higher morbidity and mortality risks in critically ill patients. The severe acute respiratory distress coronavirus 2 (SARS-CoV-2) has been reported to induce ketoacidosis and diabetic ketoacidosis (DKA) even in nondiabetic patients. The pathophysiology of the SARS-CoV-2 infection that can contribute to hyperglycaemia, and the exacerbated inflammatory cytokine storm can overlap with the metabolic chronic inflammatory state attributable to the metabolic syndrome, which underlies diabetes mellitus. In this report, we explore the possible pathophysiology and metabolic mechanisms that lead to metabolic acidosis in nondiabetic patients.