J-curve relationship between long term glycemic control and mortality in diabetic patients with acute myocardial infarction undergoing percutaneous coronary intervention

Background Intensive glycemic control is generally recommended for diabetic patients to reduce complications. However, the role of glycemic control in the mortality in diabetic patients with acute myocardial infarction (AMI) remained unclear. Methods We selected diabetic patients who measured HbA1c more than 3 times after AMI among 10,719 patients enrolled in the multicenter AMI registry. Patients (n = 1384) were categorized into five groups: according to mean HbA1c level: ≤ 6.5%, > 6.5 to ≤ 7.0%, > 7.0 to ≤ 7.5%, > 7.5 to ≤ 8.0% and > 8.0%. The primary endpoint was all-cause mortality. Results During a median follow-up of 6.2 years, the patients with a mean HbA1c of 6.5 to 7.0% had the lowest all-cause mortality. Compared to patients with mean HbA1c of 6.5 to 7.0%, the risk of all-cause mortality increased in subjects with mean HbA1c ≤ 6.5% (adjusted hazard ratio [HR] 2.00, 95% confidence interval [CI] 1.02–3.95) and in those with mean HbA1c > 8.0% (adjusted HR 3.35, 95% CI 1.78–6.29). In the subgroup analysis by age, the J-curve relationship between mean HbA1c and all-cause mortality was accentuated in elderly patients (age ≥ 65 years), while there was no difference in all-cause mortality across the HbA1c groups in younger patients (age < 65 years). Conclusions The less strict glycemic control in diabetic patients with AMI would be optimal for preventing mortality, especially in elderly patients.

Tucked and treated- a case series on outcome of meshplasty with abdominoplasty for incisional hernia

Incisional hernia is the second most common type of hernia. Incisional hernia occurs in 10-20% of patients who were subjected to abdominal surgery in India. Here we are presenting a case series of 20 patients with incisional hernia and obesity. Body mass index (BMI) ranges from 28 to 35 in all cases. Females outnumbered the male in the ratio of 4:1 and 40% of cases had a previous history of caesarean section. All cases were operated by combining open polypropylene meshplasty and abdominoplasty techniques and follow up consultations were done for 1 year. 10% of cases had post-op wound infections, who were known to be diabetic. They were managed with appropriate antibiotics and maintained strict glycemic control. 90% of patients were satisfied from the procedure performed which improved their quality of life, significant cosmetic outcome and no recurrence. 10% of cases had recurrence after heavy weight lifting following surgery (BMI was 36). By incorporating the above mentioned techniques in hernia repair, recurrence rate and complications were reduced, quality of life and aesthetic outcome are enhanced.

Wagner’s Classification for Management and Evaluation of Diabetic Foot: A Prospective Study

Background: In our community diabetes is one of the most common co-morbid illnesses. Out of its several complications in long course diabetic foot is one of them. Morbidity and mortality due to this complication is a major health issue. Objective: This study is undertaken for management and evaluation of foot ulceration to avoid amputation of lower extremities due to diabetic foot disease. Methods: This prospective observational study conducted between July 2019 and September 2020, 40 patients with diabetic foot admitted to Department of General Surgery, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar (TS) were subjected to surgical treatment depending upon the Wagner’s classification. Data was collected and analyzed by statistical software SPSS V 25. Results: Majority of the patients presented with higher grade and with poor glycemic control at the time of presentation. Conservative management with antibiotics was useful in a small subset of the patients. Majority of the patients needed surgical treatment in the form of debridement to amputations. Conclusion: Patient education and strict glycemic control can reduce the burden of diabetic foot. Early diagnosis and hospitalization, appropriate treatment including medical and surgical treatment according to the grade can reduce the morbidity mortality and improve the outcome of the disease. Keywords: Antibiotics; Amputation; Wagner classification; Complications; Glycemic control.

AN APPROACH TO DIAGNOSIS AND MANAGEMENT OF DIABETIC FOOT

INTRODUCTION India has the dubious distinction of becoming the diabetic capital of the world within the next few years; with its attendant complications it is going to burden the resources of the country. In the past, the diabetics succumbed to the metabolic complications like ketoacidosis, but now they survive long enough to develop and succumb to the diabetic nephropathy and diabetic foot complications. AIMS AND OBJECTIVES The various predisposing factors for diabetic foot with respect to North Bihar population. To analyse the different ways of clinical presentation of diabetic foot in our hospital. To evaluate the usefulness of surgical management available with special emphasis on strict glycemic control. To determine commonest microorganism/s infecting the diabetic foot patients in the North Bihar Population. MATERIALS AND METHODS Department of General Surgery, DARBHANGA MEDICAL COLLEGE AND HOSPITAL, LAHERIASARAI. Diabetic patients with foot ulcers admitted in this hospital, according to the WHO criteria, were selected for this study for 1 Year 8 month (April 2019 to December 2020). RESULTS AND ANALYSIS We found peripheral Pulse of 37.9% of the patients was absent. Infection was present in 86.2% of the cases which was signicantly higher (Z=10.23;p<0.0001). Ulcers were mostly at dorsum (22.4%) (Z=1.58;p=0.11) followed by fore foot (13.8%) and great toe (13.8%). Ulcers were mostly right sided (67.2%) followed by left sided (31.0%) (Z=5.12;p<0.001). Only 1(1.7%) patients had bilateral infection. CONCLUSION The prevalence of risk factors for foot ulcer and infections, viz., neuropathy and vasculopathy, are different from the Western literature. Studies from India, suggest predominantly neuropathic ulcers unlike the West where neuroischemia is the most important predisposing factor.As compared to the West, which have predominant Gram-positive infections, centers throughout India have reported a consistent Gramnegative bacterial preponderance in DFI.

Hepatic abscess by klebsiella pneumoniae in a type 2 diabetic

Klebsiella Pneumoniae is a potentially lethal superbug whose likelihood of causing pyogenic liver abscess is already known. The following report describes the clinical case of a 65 years old diabetic, who had dark fever, abdominal pain and nausea. The patient had been diagnosed with a pyogenic liver abscess caused by the microorganism Klebsiella Pneumoniae. The study aims to emphasize to the public the importance of strict glycemic control to potentially reduce the predisposition to infections. It details the adopted diagnostic approach, therapeutic conduct composed mainly of antibiotic therapy, its clinical evolution and its outcome.

Diabetes and Cardiovascular Risk in Renal Transplant Patients

End-stage kidney disease (ESKD) is a main public health problem, the prevalence of which is continuously increasing worldwide. Due to adverse effects of renal replacement therapies, kidney transplantation seems to be the optimal form of therapy with significantly improved survival, quality of life and diminished overall costs compared with dialysis. However, post-transplant patients frequently suffer from post-transplant diabetes mellitus (PTDM) which an important risk factor for cardiovascular and cardiovascular-related deaths after transplantation. The management of post-transplant diabetes resembles that of diabetes in the general population as it is based on strict glycemic control as well as screening and treatment of common complications. Lifestyle interventions accompanied by the tailoring of immunosuppressive regimen may be of key importance to mitigate PTDM-associated complications in kidney transplant patients. More transplant-specific approach can include the exchange of tacrolimus with an alternative immunosuppressant (cyclosporine or mammalian target of rapamycin (mTOR) inhibitor), the decrease or cessation of corticosteroid therapy and caution in the prescribing of diuretics since they are independently connected with post-transplant diabetes. Early identification of high-risk patients for cardiovascular diseases enables timely introduction of appropriate therapeutic strategy and results in higher survival rates for patients with a transplanted kidney.

Klebsiella pneumoniae-related invasive liver abscess syndrome complicated by purulent meningitis: a review of the literature and description of three cases

Background Klebsiella pneumoniae (K. pneumoniae) invasive liver abscess syndrome (ILAS) with purulent meningitis was rarely identified the mainland of China. Last winter, we received 3 cases of K. pneumoniae meningitis and all of them died in a short time. We report these cases in order to find the reason of high mortality and discuss effective effort to improve these patients’ prognosis. Case presentation Three patients with uncontrolled diabetes developed live abscess and purulent meningitis. Upon admission, the clinical manifestations, laboratory result of blood and cerebrospinal fluid (CSF) and imaging examinations were compatible with K. pneumoniae ILAS which had metastasis infection of meningitis. Even with timely adequate antibiotic therapy and strict glycemic control, all of the patients’ condition deteriorated rapidly and died in a short time. Conclusion The reason of patients’ poor prognosis might be the absence of liver abscess drainage, high level of CSF protein which indicates severe inflammation and unknown special but stronger virulence factors of K. pneumoniae the patients’ living place Zhangjiakou. Strict glycemic control, early drainage of liver abscess and appropriate antibiotic application are recommended for treating this condition, further progress on the pathogenesis and treatment of K. pneumoniae meningitis may help patients gain a better prognosis.

Pregnancy outcome among gestational diabetes mellitus patients

Background and Aim: Though not all babies have birth defects there is still a high probability ofcongenital defects if the glucose level is not under control during pregnancy and also increasedmorbidity in terms of hypoglycemia, hyperbilirubinemia, and respiratory distress syndromewarranting NICU admissions. The objective of this study was to find out the maternal and perinataloutcome in patients with gestational diabetes mellitus. Material and Methods: An observationalstudy was conducted among 400 pregnant women who came for antenatal checkups attending theOPD of the department of obstetrics and gynecology, the tertiary care institute of Gujarat, from June2012 to November 2013. A detailed history including maternal age, parity, BMI, and clinicalexamination along with antenatal checkup was done. Results: Out of 400 antenatal women testedfor OGTT using 75 grams of glucose, about 12.75% (51) of antenatal women developed GDM. Out of51 GDM mothers, about 10% ie.,5 antenatal women had pregnancy-induced hypertension and only2 developed polyhydramnios and preterm delivery in 11.76% of antenatal women with GDM Out of51 babies, 19.6% of them had respiratory distress syndrome, 7.8% of the babies requiring NICUadmissions because of hypoglycemia, hyperbilirubinemia, and hypocalcemia. Conclusion:Gestational diabetes mellitus was once thought to be a mild condition but now it carries significantshort-term and long-term implications for the women and their offspring. Screening for diabetes ismandatory in preventing complications as strict glycemic control is necessary for preventingmacrosomia and unexplained stillbirths.