It has been suggested that diabetes mellitus is associated with an increased susceptibility to infections, the risk of using more aggressive therapeutic agents and increased mortality and morbidity; however, current evidence supporting these events in the field of pneumonia is scarce. Aim: The aim of the present study is to evaluate the clinical features and microbiological characteristics and outcome of bacterial pneumonia in patients with type-2 diabetes mellitus, and to compare them with non-diabetics. Materials and Methods: A prospective study conducted in Santhiram medical college and general hospital, Nandyal, which included 60 patients of pneumonia with diabetes and 60 patients of pneumonia in non-diabetics. The clinical and radiological characteristics, the spectrum of causative agents, microbiological data and the outcome of diabeticpatients were analysed and compared with data obtained from nondiabeticpatients. Results: Patients with diabetes were significantly associated with multilobar involvement (P = 0.039), prolonged duration of hospital stay (P = 0.018), more severe at presentation in form of increased PSI score (P = 0.038) and more ICU admissions. By contrast, there was no significant difference in age, sex, concomitant underlying illness, complications, mortality. In the sub group of patients with diabetes, mortality was associated with multilobar infiltrate, concomitant illness, high PSI score (P < 0.001) more complications (P < 0.001). Conclusions: In patients with pneumonia, diabetes is associated with poor prognosis, increased duration of hospital stay and poor outcome compared to non-diabetics. This study suggests that this outcome is more attributable to underlying circumstances of patients than to uncommon microbiological finding.
76%, with a value of only 13% for the left main coronary artery, while specificity and accuracy were 90% and 87%, respectively. Thus, all parameters were significantly lower in the DM Group than those found in the non-diabetic Group because the former had a lower prevalence of false negative (21 segments) and showed mainly false positive (37 segments). Similarly, in a patient-based model the diagnostic performance of MDCT in the DM Group was less than satisfactory, mainly because 9 patients were diag- nosed with MDCT as affected by significant CAD that was not confirmed by ICA. This explains the significantly lower specificity, NPV and accuracy found in DM patients as compared to their non-diabetic counterparts. The worse diagnostic accuracy found in DM patients is likely due to several factors. First, DM is associated with more prevalent and extensive coronary calcifications that impede the correct visualization of the coronary lumen. Indeed, accumulation of calcium in the arterial wall of patients affected by DM is not limited to the subintimal space, but often extends in the medial layer . A very recent study of Maffei et al. confirmed that coronary pla- que burden and coronary calcium score are higher in dia- betic vs. non-diabeticpatients . The calcium burden affects not only MDCT feasibility but also the quantifica- tion of the coronary stenosis, sometimes leading to an overestimation of the lesion severity . Second, com- pared to non-diabetic individuals, DM patients have a more extensive plaque burden, as shown in several pre- vious studies [6,21] and confirmed by our results, which has a strong influence on MDCT diagnostic accuracy . Third, the small coronary size and lumen area, typical of DM patients [10,23] and confirmed in our study, cause dif- ficulties detecting focal lesions and differentiating between significant and non-significant stenoses, since the small coronary lumen dimension is proximal to the imaging technique resolution.
levels of improvements after 3 months. Same results seen with HGMT and LGMT, however the short duration period of our study . This study was in agreement with finding of Vermeulen et al.,  in which 16 patients with diabetes were participated for mobilization treatment for 12 months. They found that patient treated with HGMTs had clinically significant improvement in shoulder mobility and pain reduction. However they found no evidence that these patients with diabetes showed poorer results than non- diabeticpatients. The common explanation for limited joint mobility has been that weakness of collagen leads to its accumulation. Evidence suggested that the increased cross-linking of collagen is due to increase of non enzymatic glycosylatetion, and these become 13 times higher in patients with diabetic mellitus than in normal subjects. More over patients with diabetes who use insulin treatment for long period are most susceptible to shoulder calcifications. . The limitation to our study may be that we do not have the long-term follow up data for our treatment in both groups. Randomized controlled studies of large study populations are needed to clearly define the efficacy of physical therapy in patients with different stages of frozen shoulder with diabetic and nondiabetic.
Final clinical outcomes in DI, DII, and DIII groups are shown in Figures 1 and 2. In diabetic and non-diabetic groups, there was a reverse correlation between the du- ration of CTS and the outcome in both diabetic and non- diabeticpatients. The clinical outcome worsens as the duration of symptoms increase. In this regard, the differ- ence between DI and DII groups was statistically signifi- cant (P = 0.007) as well as the difference between DII and DIII groups (P = 0.00). When the duration of symptoms was more than 10 years before the operation, all the non- diabetics and 60% of the diabetics had fair results. Among 38 hands that underwent CTR, 27 were dominant and 11 were nondominant. There was no significant correlation between the dominancy of hand and the outcome of sur- gery (P = 0.237).
Knowledge of Diabetes Mellitus Among Diabetic and Non Diabetic Patients in Klinik Kesihatan Seremban ORIGINAL ARTICLE Knowledge of Diabetes Mellitus Among Diabetic and Non Diabetic Patients in Klinik[.]
Our study resulted that out of 100 individuals with stroke, ischemic or infarct stroke had more number of patients compared to hemorrhage stroke. The study conducted by Ali showed that there was a higher incidence of ischemic stroke in diabeticpatients than the non-diabeticpatients. Our study showed higher incidence of infarct and the incidence of large sized infarcts were more in diabeticpatients and small and medium sized infarcts were more in non-diabeticpatients. Our study findings were similar with many other study findings by Kissela et al, Air et al, Jorgensen et al which suggested that diabetes are more prone to have ischemic stroke and less to have
Abstract Background and objectives: Hypoglycemia in the body is controlled by counter regulatory hormones. Serum cortisol is one among them not subjected to extensive study, in Type 2 diabetes mellitus cases. Cortisol responses among non diabetics and type 1 diabetics have been studied to a certain extent. The primary objective of our study was to identify the serum cortisol levels in hypoglycemic patients with or without type 2 diabetes and to find out the correlation between the mean cortisol responses in the two groups. Methodology: A total population of 51 symptomatic hypoglycemic patients meeting Whipple’s criteria were studied in the ER of a medical college hospital at Kochi. Forty patients were diabetic and 11 nondiabetic. Previous history, present illness, comorbidities, medical history and reasons for hypoglycemia were considered. Laboratory investigations on RFT, 7 AM serum cortisol and RBS were made and the results analysed applying standard statistical methods and SPSS II software. Results and discussion: Male female ratio in the diabetic and nondiabetic groups was 3:1 and 10:1 respectively. Hypoglycemia was more among males, especially in the diabetic group due to decreased food intake(49%) or concurrent illness(51%), the mean age being 65.7 years in these cases. Hypoglycemia was more frequent in those on sulfonylurea (61.9%), and in habitual insulin users (42.5%). In nondiabeticpatients, hypoglycemia was caused by renal failure(27.27%), insulinoma(27.27%) or sepsis(18.18%). The mean serum cortisol among the diabetic group was subnormal(17.47), and in the nondiabetic group it was 28.56. Age, sex, serum creatinine, GCS, period of stay and condition at discharge showed no correlation with serum cortisol levels. RBS, period of stay and condition at discharge showed no correlation with diabetic status. Conclusion: Diabeticpatients with acute symptomatic hypoglycemia demonstrated a subnormal serum cortisol response as compared to nondiabetic hypoglycemic patients.
8. Sensory: Sensation or grimace to pinprick when tested, or withdrawal from noxious stimulus in the obtunded or aphasic patient. Only sensory loss attributed to stroke is scored as abnormal and the examiner should test as many body areas (arms [not hands], legs, trunk, face) as needed to accurately check for hemisensory loss. A score of 2, “severe or total sensory loss,” should only be given when a severe or total loss of sensation can be clearly demonstrated. Stuporous and aphasic patients will, therefore, probably score 1 or 0. The patient with brainstem stroke who has bilateral loss of sensation is scored 2. If the patient does not respond and is quadriplegic, score2. Patients in a coma (item 1a=3) are automatically given a 2 on thisitem.
control groups. The study protocol was approved by the ethical committee of the hospital. The data for this study was collected from 50 patients with diabetes mellitus and 50 matched controls (non- diabetics) by detailed history taking, clinical examination, anthropometric measurements and relevant investigations. The data collected in this study was analyzed statistically. Inclusion Criteria: Type-2 diabetes mellitus patients with duration greater than 6 months and matched non-diabetics. Exclusion Criteria: Patients who are on insulin therapy and gestational diabetes patients. A detailed clinical history, physical examination and relevant investigations were undertaken. Routine physical examination was done and anthropometric measurements like body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR) were calculated in all patients. Vital parameters like pulse, BP etc..of each patient wererecorded. Clinical examination was done for the evidence of complications of diabetes, hypertension, & dyslipidemia. Investigationsincludes: Fasting plasma glucose,Post prandial
plasma glucose levels were 41–60 mg/dL, the levels were not low enough to cause severe neurogenous symptoms and the GCS scores did not correlate with the plasma glucose levels. Conversely, when the plasma glucose levels were below 40 mg/dL, the levels were low enough to cause severe neurogenous symptoms in almost all of the patients and the GCS scores were significantly corre- lated with the plasma glucose levels. The cause of the declined plasma glucose levels at the onset of neuroglyco- penic symptoms might be different between the diabetic and non‐diabeticpatients; however, the high frequency of moderate or extreme hypoglycemia had contributed to the high value of Spearman's rank sum test in the diabetic and non-diabeticpatients. In the future, even when a patient has a high GCS score, a careful assessment of dif- ferential diagnosis should be made, and the treating physi- cians should consider the possibility of hypoglycemia in light of the patient's various neurogenous symptoms.
Results: Of 763 subjects enrolled at 12 international centers, 219 (29%) had diabetes. The two groups were well- balanced for age, clinical presentation (stable or unstable), coronary vessel studied, volume and type of intracoronary contrast, and volume of intracoronary adenosine. A binary threshold of cFFR ≤ 0.83 produced an accuracy superior to both Pd/Pa and iFR when compared with FFR ≤ 0.80 in the absence of significant interaction with diabetes status; indeed, accuracy in subgroups of patients with or without diabetes was similar for cFFR (86.7 vs 85.4% respectively; p = 0.76), iFR (84.2 vs 80.0%, p = 0.29) and Pd/Pa (81.3 vs 78.9%, p = 0.55). There was no significant heterogene- ity between patients with or without diabetes in terms of sensitivity and specificity of all metrics. The area under the receiver operating characteristic (ROC) curve was largest for cFFR compared with Pd/Pa and iFR which were equivalent (cFFR 0.961 and 0.928; Pd/Pa 0.916 and 0.870; iFR 0.911 and 0.861 in diabetic and non-diabeticpatients respectively).
Newer studies are in favour of lens implantation in diabetic eyes, as correction of aphakia with spectacle causes further image distortion and constriction of peripheral visual fields . The need for this study is to establish the influence of glycaemic control on visual control to better advice patients before surgery. The aim of this study was evaluation and comparison of visual outcomes after cataract surgery in diabetic and non-diabeticpatients: patients with and without diabetic retinopathy; assessment of post-operative complications after cataract surgery in diabetics compared to non- diabetics; and analysis of increment in central foveal thickness using optical coherence tomography, after cataract surgery. Also, through this study, we wanted to determine whether uneventful SICS/phacoemulsification cataract surgery led to adverse visual outcomes in diabetics.
The impact of acute hyperglycemia on clinical out- comes of diabetic and non-diabeticpatients admitted with ST-elevation myocardial infarction (STEMI) has been extensively studied. High admission blood glucose among STEMI patients is associated with higher short- term incidences of failed reperfusion, acute kidney injury, stent thrombosis, myocardial damage and death among [1–12]. In addition, hyperglycemia during STEMI hospi- talizations in diabetics predicted left ventricular remod- eling and survival during long-term follow-up [13–18]. However, large-scale outcomes data of STEMI patients with acutely decompensated diabetes manifesting as dia- betic ketoacidosis (DKA) or hyperglycemic hyperosmo- lar state (HHS) are scarce . We utilized a nationwide representative sample to assess the contemporary trends in the incidence and in-hospital morbidity and mortality and cost of decompensated diabetes (defined as DKA or HSS) among diabeticpatients admitted with STEMI.
In terms of sleep quality, analysis of data on the quality of sleep in diabeticpatients showed that the majority of them are at a low level. In a study by Hemmati et al. to assess the quality of sleep in diabetic and non-diabeticpatients, the results represented an increase in sleep problems in diabeticpatients (22).The results of a review study also revealed that the prevalence of sleep disorders increases with the onset of diabetes and poor blood glucose control (self-care) (14).According to the results of Tsai's research, in which the relationship between sleep quality and blood sugar levels was examined, a significant difference was shown between glucose levels and low sleep quality as well as inadequate sleep in patients and this is consistent with the outcomes of this study (23) as one of the self-care goals for diabetics is maintaining blood glucose at the normal level and subsequently
of PAOD. Adiponectin exhibits anti-inflammatory and atheroprotective actions and osteoprotegerin protects vascular endothelial cells and inhibits atherosclerosis. Lower plasma levels of adiponectin and higher osteopro- tegerin were found in diabeticpatients with PAOD [9-11]. In fact, the incidence of atherosclerosis in dia- betes was significantly higher than that in non-diabeticpatients, and the lesion in diabetes was more serious and diffuse. For diabetes, atherosclerosis usually involved the below-knee arteries; the severe vascular lesions and their wide range often lead to less effective intervention; on the other hand, initial hyperplasia or smooth muscle cell proliferation and the progression of atherosclerosis was more serious in diabetes than that in non-diabetes after revascularization.
Diabeticpatients with AMI hold poorer clinical out- comes than non-diabeticpatients . Our findings supported the observation that patients with diabetes have more composite MACE at 1 year of follow-up than those without diabetes, regardless of renal insufficiency. Multiple mechanisms have been implicated in the increased number of adverse outcomes in diabetes patients. These mechanisms include an abnormal meta- bolic response to ischemia with inefficient energy use and accumulation of deleterious oxygen-free radicals , greater endothelial dysfunction , and abnormal- ities of thrombosis and fibrinolysis . Recently, Yan et al .  demonstrated a significant association between plasma osteopontin levels and the presence and severity of coronary artery disease in diabeticpatients, indicating that osteopontin may be critically involved in the inflammatory processes resulting in accelerated athero- sclerosis. Patients with diabetes are known to have a
Furthermore, the dynamic response was evaluated in non-diabeticpatients and in diabeticpatients without pharmacological treatment according to the different groups of baseline insulin resistance: liver-IR, muscle- IR, liver and muscle-IR, non-liver and non-muscle-IR. Patients with liver insulin resistance (liver-IR) showed higher postprandial response of TG compared with those patients with muscle-IR or without any insulin-resistance respectively (p < 0.001). No differences were observed according to the magnitude of postprandial response in group of patients with liver-IR group compared with those patients with liver-IR and muscle-IR (p > 0.05) (Fig. 3). Pearson’s correlation and linear regression were used to associate postprandial response of TG and insu- lin resistance indices variables: HIRI and MISI. Multi- ple regression analysis using the AUC-TG as dependent variable showed a significant association with HIRI (R: 0.309; CI 95 % (15327.162–24080.365); p < 0001). It has not been observed association between postprandial response and muscle-IR index. (p > 0.05) (Fig. 4a, b). Similar results were obtained using iAUC-TG as depend- ent variable. The analysis showed a significant association with HIRI (R: 0.2; IC 95 %: (4437.52–9238.68); p < 0.001). No significant association was observed between post- prandial response and MIRI index (R: −0.012; IC 95 %: (−2047.05 to 1439.18); p = 0.732) (Fig. 4c). Finally, we explored the influence of pharmacological treatments Table 1 Baseline characteristics according to diabetic status
- 483 - long lesion and total occlusion more in diabeticpatients than nondiabeticpatients, there were significant increase of Syntax score, Gensini score and type C lesion of American heart association angiographic classification in diabeticpatients than nondiabeticpatients, there was significant increase of usage of balloon dilation (PTCA) before PCI, double stent, drug eluting stent, peri procedure myocardial injury more in diabetic patient than in nondiabeticpatients, there were significant higher incidences of myocardial injury in diabeticpatients than nondiabeticpatients but there were significant higher incidences myocardial injury in diabetic patient with intermediate syntax score (23-33) than in nondiabetic patient intermediate syntax score (23-33)., LAD and RCA lesion were more frequently present in diabeticpatients than nondiabeticpatients. There were no significant difference regard LCX, D1 and OM1 lesion in diabeticpatients and nondiabeticpatients, the occurrence of myocardial injury was more frequently present with proximal LAD lesion and distal LCX lesion than in RCA, OM1 and D1 lesion.Although the SXscore was originally developed to evaluate patients with triple vessel and/or left main coronary artery, we have demonstrated its predictive power in patients undergoing single or double vessel PCI. In our study, the positive predictive value of a SXscore ≥ 15 for PPI was 95.5% compared with a positive predictive value of 73.3% for an AHA/ACC type B lesion.
In the study we found in conformity with the literature among our diabeticpatients that 33% of them had a hypertriglyceridemia, 37% of them had a high LDL cholesterol and 40% of them had a HDL hypocholesterolemia .However, among our non-diabeticpatients we found out respectively 10%, 30%, 20%. This difference could be due to the fact the association of diabetes with obesity is the bench of metabolic complications. Charfi  found in his study a dyslipidemia in 60.1% of the cases (associating a hypertriglyceridemia with a high LDL cho- lesterol and a HDL hypocholesterolemia).
Infections are a major cause of morbidity and mortality in the elderly. Improvements in health care prevention including vaccinations and treatment have led to an increase in the birth life ex- pectancy. The vaccines that are now recommended for people over 60 are influenza, herpes zoster and a vaccine combining tetanus toxoid, reduced diphtheria toxoid, and pneumococcal vaccine. Our aim was to estimate the prevelance of vaccination among diabeticpatients attending in Tepe- cik Training Hospital and in Ege University Faculty of Medicine. Patients and Methods: Individuals at or over the age of 60 who were attending to Tepecik Training Hospital and at Ege University Faculty of Medicine. Department of Internal Medicine was targeted from February to May 2014. Our data are collected from the patients face to face by questionnaire. Results: A total of 274 el- derly patients with a mean ± SD (range) age of 72 ± 6 (62 - 93) years were questioned. The vacci- nation ratios were determined as 34% (93) for influenza, 9.5% (26) for pneumococcal, 10.6% (27) for tetanus vaccine. The patients were divided in two groups as diabetics and non-diabetics. The influenza vaccination rate is 38.1% in diabeticpatients, rate of 31.8% in non-diabeticpatients, the pneumococcal vaccine rate is 13.4% in diabeticpatients, rate of 7.39% in non-diabeticpatients. The tetanus vaccination rate is 9.28% in diabeticpatients, rate of 11.36% in non-diabeticpatients. No statistically significant difference between two groups was determined.