Glypican-4 in pregnancy and its relation to glucose metabolism, insulin resistance and gestational diabetes mellitus status

Glypican-4 (GPC-4) is an adipokine that enhances insulin receptor signaling. Plasma concentrations were found to be elevated in patients with prediabetes but reduced in type 2 diabetes mellitus. No study on Glypican-4 in pregnancy and pregnancy-related insulin resistance has been published yet. GPC-4 levels were investigated in 59 overweight women throughout their pregnancy at the Medical University of Vienna. GPC-4 levels, fasting insulin, fasting glucose, estradiol, liver and renal parameters, and markers of bone development were assessed before the < 21st week of gestation (GW), and at GW 35–37. GPC-4 levels increased from < 21 GW (mean = 2.38 pg/ml, SD = 0.68 pg/ml) to GW 35–37 (mean = 2.96 pg/ml, SD = 0.77 pg/ml, p < 0.001). At the same time, GPC-4 levels correlated negatively with estimated glomerular filtration rate (eGFR), serum protein and serum albumin levels and were positively related to creatinine and uric acid levels at GW 35–37. Concerning glucose metabolism, GPC-4 levels were inversely related to ISSI-2, fasting insulin and HOMA-IR, however, not significantly different between women with normal glucose tolerance (NGT) and GDM (p = 0.239). In conclusion, GPC-4 levels rose significantly during pregnancy, correlated negatively with fasting insulin and HOMA-IR but might not be related to gestational diabetes mellitus status.

Associated Factors of the Results of Pulmonary Tuberculosis Treatment During the COVID-19 Pandemic in Makassar City

BACKGROUND: A regimen directly observed treatment-short course is recommended by the World Health Organization as a strategy for controlling tuberculosis (TB). AIM: This treatment was carried out for 6 months despite the COVID-19 pandemic situation. The purpose of the study was to determine the factors associated with the treatment outcomes of pulmonary TB undergoing treatment during the COVID-19 pandemic, with the research target was Category I pulmonary TB patients. METHOD: The type of research was observational analytic with a cohort study design. This research was conducted at the Pulmonary Center in October 2020-May 2021 involved 62 samples. RESULTS: About 75.8% (47 respondents) successfully treated and 24.2% (15 respondents) decided unsuccessful. There was a significant association between diabetes status (p = 0.014), anemia status (p = 0.035), knowledge of TB (p = 0.009), knowledge of COVID-19 (p = 0.014), and family history of COVID-19 exposure (p = 0.011) to the treatment outcomes of pulmonary TB treatment during the pandemic. CONCLUSION: Associated factors to the outcome of treatment for pulmonary TB patients undergoing TB treatment during a pandemic included diabetes mellitus status, anemia status, knowledge of TB, knowledge of COVID-19, and family history of exposure to COVID-19.

Self-Reported Diabetes Mellitus and Tooth Extraction Due to Periodontal Disease and Dental Caries in the Japanese Population

Diabetes mellitus is closely related to oral health. We aimed to determine the relationship between diabetes mellitus and tooth extraction due to periodontal disease and dental caries. Japan’s second nationwide survey data collected from 4 June to 10 June 2018 was used to identify reasons for tooth extraction among patients aged > 40 years. General dentists collected information on patients who underwent tooth extraction procedures, and the presence of diabetes mellitus was determined through interviews. Multivariable logistic regression was performed to investigate the relationship between diabetes mellitus and the reasons for tooth extraction, including periodontal disease and dental caries. In total, 2345 dentists responded to the survey (response rate 44.8%). We analyzed data on 4625 extracted teeth from 3750 patients (1815 males and 1935 females). Among patients with self-reported diabetes mellitus, 55.4% had extractions due to periodontal disease compared to 46.7% of such extractions among those without self-reported diabetes mellitus. Self-reported diabetes mellitus was significantly associated with tooth extraction due to periodontal disease. No significant differences were observed in dental caries according to self-reported diabetes mellitus status. This study provides further evidence of a significant association between diabetes mellitus and tooth extraction due to periodontal disease.

Seasonality in hyperglycemic emergencies in a Health Facility in Sub-Saharan Africa: The roles of geographic location, infection, and knowledge of diabetes mellitus status

Hyperglycemic emergencies (HEs) are acute complications of diabetes mellitus and they carry high morbidity and mortality. Studies have reported a seasonal pattern in the frequency of occurrence of both types 1 and 2 diabetes mellitus and even Gestational Diabetes Mellitus. No such association has been suggested for HEs. The study was conducted at the Asokoro District Hospital, Located in Abuja, Nigeria to examine a seasonal pattern in the frequency of hyperglycemic emergencies. The initial observation of an obvious fluctuation in the number of admitted cases of hyperglycemic emergencies motivated this prospective study which ran for a period of six years. It involved collecting the relevant information using a questionnaire from all HEs patients admitted to the medical ward from the first of January, 2008 to the 31st of December, 2013. Required investigations were done. The precipitating factors for HEs were looked for. The number of cases per month was noted for each year. The Statistical package used for analysis was STATA version 11. Round the year Abuja Climatic changes were monitored on the website of the Nigerian Meteorological station. Four hundred and fifty-one (451) patients with hyperglycemic emergency were enrolled for this study. Most of the patients, (55%), were in the middle-age bracket. Fifty-six per cent (56%), were not previously known to be living with diabetes mellitus. Infections, particularly of the respiratory and gastrointestinal tracks, were the commonest precipitating factors. Variation in the frequency of HEs was observed, with two peaks: one in April and a smaller peak in December. There is seasonal variation in the frequency of presentation of Hyperglycemic emergencies. This may have been influenced by exogenous factors such as geographic location, infection, and the fact that most of the patients never knew they had diabetes mellitus.

Number of teeth and masticatory function are associated with sarcopenia and diabetes mellitus status among community-dwelling older adults: A Shimane CoHRE study

Objectives We aimed to examine the number of teeth and masticatory function as oral health indices and clarify their roles in the pathogenesis of sarcopenia and diabetes mellitus in community-dwelling older adults. Subjects and methods This cross-sectional study was conducted with 635 older adults in Ohnan, Shimane Prefecture, in rural Japan. The number of teeth and masticatory function (measured by the number of gummy jelly pieces collected after chewing) were evaluated by dental hygienists. Sarcopenia status was assessed using handgrip strength, skeletal muscle index, calf circumference, and a possible sarcopenia diagnosis based on the Asian Working Group for Sarcopenia 2019. Diabetes mellitus status was defined as a hemoglobin A1c level ≥6.5% or self-reported diabetes. A multivariable logistic regression model was used to analyze the association between oral health, sarcopenia, and diabetes mellitus after adjusting for confounders. Results After adjusting for all confounders, logistic regression analysis showed that the number of remaining teeth was negatively associated with a low level of handgrip strength (odds ratio [OR], 0.961; 95% confidence interval [CI], 0.932–0.992) and possible sarcopenia (OR, 0.949; 95% CI, 0.907–0.992). Higher levels of masticatory function were also negatively associated with a low level of handgrip strength (OR, 0.965; 95% CI, 0.941–0.990) and possible sarcopenia (OR, 0.941; 95% CI, 0.904–0.979). Logistic regression analysis showed that the number of remaining teeth and a higher level of masticatory function were negatively associated with diabetes mellitus (OR, 0.978; 95% CI, 0.957–0.999; OR, 0.976; 95% CI, 0.960–0.992, respectively). Conclusion Our findings suggest that improvement in oral health, including the maintenance of masticatory function and remaining teeth, may contribute to the prevention of sarcopenia and diabetes mellitus in older adults.

Prediction of Hypoglycemia During Admission of Non-Critically Ill Patients: Results from the MENU Study

The objective of the work was to study admission parameters associated with an increased incidence of hypoglycemia during hospitalization of non-critically ill patients. Included in this cross-sectional study were patients admitted to internal medicine units. The Nutritional Risk Screening 2002 (NRS2002) was used for nutritional screening. Data recorded included admission serum albumin (ASA) and all glucose measurements obtained by the institutional blood glucose monitoring system. Neither of these are included in the NRS2002 metrics. Hypoalbuminemia was defined as ASA<3.5 g/dl. Patients were categorized as hypoglycemic if they had at least one documented glucose≤70 mg/dl during the hospitalization period. Included were 1342 patients [median age 75 years (IQR 61–84), 51.3% male, 52.5% with diabetes mellitus, (DM)], who were screened during three distinct periods of time from 2011–2018. The incidence of hypoglycemia was 10.8% with higher rates among DM patients (14.6 vs. 6.6%, p<0.001). Hypoglycemia incidence was negatively associated with ASA regardless of DM status. Multivariable regression showed that ASA (OR 0.550 per g/dl, 95% CI 0.387–0.781, p=0.001) and positive NRS2002 (OR 1.625, 95% CI 1.072–2.465, p=0.022) were significantly associated with hypoglycemia. The addition of hypoalbuminemia status to the NRS2002 tool improved the overall sensitivity from 0.55 to 0.71, but reduced specificity from 0.63 to 0.46. The negative predictive value was 0.93. Our data suggest that the combination of positive malnutrition screen and hypoalbuminemia upon admission are independently associated with the incidence of hypoglycemia among non-critically ill patients, regardless of diabetes mellitus status.

Identification of RAGE and OSM as new prognosis biomarkers of severe pneumonia

BackgroundPatients with severe pneumonia complicated with hypoxic respiratory failure often associated with increased morbidity and mortality rates. It is critical to discover more sensitive and specific markers for early identification of such high risk patients thus specific and timely treatment can be adjusted.MethodsThis retrospective study was performed in the respiratory intensive care unit (RICU) of Nanjing First Hospital and Jinling Hospital, Nanjing Medical University. Clinical data of patients admitted to the RICU and diagnosed with pneumonia from January 2017 to October 2019 was retrospectively reviewed. The eligible patients were classified into hypoxemia and non hypoxemia groups according to oxygenation index of 250 mmHg. In the meantime, the same cohort was separated into survival and deceased groups after 30 days post hospital admission. The related risk factors in these two classifications were examined separately.ResultsA total of 828 patients were screened for eligibility, and eventually 130 patients with pneumonia were included in our final analysis. Among the patients, 16 passed away despite exhausting standard treatments. The comparison between hypoxemia and non hypoxemia groups suggested that gender, diabetes mellitus status, count of white blood cell(WBC), neutrophils, neutrophils/Lymphocyte, lactic acid, creatinine, D-dimer, procalcitonin (PCT), C-reactive protein (CRP), PH, Lymphocyte, albumin and RAGE were significantly different.ConclusionsPrevious studies have suggested that the APACHE II score, LIS, SOFA, Nutric scores, WBC, neutrophils, lymphocyte counts and albumin levels were independent risk factors for severe pneumonia. Our study indicated that RAGE should be a new biomarker to predict poor prognosis in pneumonia. In addition, we also showed that LIS, SOFA, lactate, lymphocyte, platelet, BUN, total bilirubin, and PCT levels before treatment were independent factors that associated with 30 days survival rate. In addition, we proposed that OSM should be considered as a new prognosis marker for pneumonia patients.