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1.
Diabetes Res Clin Pract ; 212: 111713, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38772502

RESUMO

AIMS: We investigated the characteristics of infection and the utility of inflammatory markers in diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS). METHODS: A multicenter, retrospective observational study in 21 acute-care hospitals was conducted in Japan. This study included adult hospitalized patients with DKA and HHS. We analyzed the diagnostic accuracy of markers including C-reactive protein (CRP) and procalcitonin (PCT) for bacteremia. Multiple regression models were created for estimating bacteremia risk factors. RESULTS: A total of 771 patients, including 545 patients with DKA and 226 patients with HHS, were analyzed. The mean age was 58.2 (SD, 19.3) years. Of these, 70 tested positive for blood culture. The mortality rates of those with and without bacteremia were 14 % and 3.3 % (P-value < 0.001). The area under the curve (AUC) of CRP and PCT for diagnosis of bacteremia was 0.85 (95 %CI, 0.81-0.89) and 0.76 (95 %CI, 0.60-0.92), respectively. Logistic regression models identified older age, altered level of consciousness, hypotension, and higher CRP as risk factors for bacteremia. CONCLUSIONS: The mortality rate was higher in patients with bacteremia than patients without it. CRP, rather than PCT, may be valid for diagnosing bacteremia in hyperglycemic emergencies. TRIAL REGISTRATION: This study is registered in the UMIN clinical trial registration system (UMIN000025393, Registered December 23, 2016).


Assuntos
Bacteriemia , Proteína C-Reativa , Cetoacidose Diabética , Coma Hiperglicêmico Hiperosmolar não Cetótico , Humanos , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Cetoacidose Diabética/diagnóstico , Cetoacidose Diabética/sangue , Cetoacidose Diabética/epidemiologia , Coma Hiperglicêmico Hiperosmolar não Cetótico/diagnóstico , Coma Hiperglicêmico Hiperosmolar não Cetótico/sangue , Coma Hiperglicêmico Hiperosmolar não Cetótico/complicações , Idoso , Adulto , Bacteriemia/diagnóstico , Bacteriemia/mortalidade , Bacteriemia/epidemiologia , Proteína C-Reativa/análise , Proteína C-Reativa/metabolismo , Japão/epidemiologia , Fatores de Risco , Pró-Calcitonina/sangue , Biomarcadores/sangue
2.
Intern Emerg Med ; 19(4): 959-970, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38488997

RESUMO

Hyperglycemic emergencies frequently lead to acute kidney injury (AKI) and require treatment with large amount of intravenous fluids. However, the effects of chloride loading on this population have not yet been investigated. We conducted a multicenter, retrospective, cohort study in 21 acute-care hospitals in Japan. The study included hospitalized adult patients with diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS) who had AKI upon arrival. The patients were classified into high and low chloride groups based on the amount of chloride administered within the first 48 h of their arrival. The primary outcome was recovery from AKI; secondary outcome was major adverse kidney events within 30 days (MAKE30), including mortality and prolonged renal failure. A total of 390 patients with AKI, including 268 (69%) with DKA and 122 (31%) with HHS, were included in the study. Using the criteria of Kidney Disease Improving Global Outcomes, the severity of AKI in the patients was Stage 1 (n = 159, 41%), Stage 2 (n = 121, 31%), and Stage 3 (n = 110, 28%). The analysis showed no significant difference between the two groups in recovery from AKI (adjusted hazard ratio, 0.96; 95% CI 0.72-1.28; P = 0.78) and in MAKE30 (adjusted odds ratio, 0.91; 95% CI 0.45-1.76; P = 0.80). Chloride loading with fluid administration had no significant impact on recovery from AKI in patients with hyperglycemic emergencies.Trial Registration This study was registered in the UMIN clinical trial registration system (UMIN000025393, registered December 23, 2016).


Assuntos
Injúria Renal Aguda , Cetoacidose Diabética , Humanos , Estudos Retrospectivos , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/terapia , Injúria Renal Aguda/fisiopatologia , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Japão/epidemiologia , Cetoacidose Diabética/complicações , Cloretos/sangue , Cloretos/análise , Estudos de Coortes , Adulto , Hiperglicemia/complicações , Coma Hiperglicêmico Hiperosmolar não Cetótico/complicações , Hidratação/métodos , Emergências
3.
BMJ Case Rep ; 17(1)2024 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-38191229

RESUMO

Subgaleal hematoma, characterised by blood accumulation between the galea aponeurosis and the periosteum, is rarely reported in adults. A man with liver cirrhosis experienced airway obstruction secondary to an extensive subgaleal hematoma due to superficial temporal artery injuries. Within 6 hours after injury, swelling of the patient's head and neck was noted, which was associating with inspiratory wheezing and paradoxical breathing, thus necessitating emergency intubation. The branches of the superficial temporal artery were identified as the bleeding source via angiography. Subsequently, endovascular embolisation was successfully performed. This case highlights a rare association between airway obstruction and subgaleal hematoma, originating from injuries of the superficial temporal artery in an adult patient with severe coagulopathy. Airway obstruction was secondary to the hematoma progression into the facial and neck regions. It is crucial to identify and address alternative bleeding sources if conservative treatments or initial interventions for subgaleal hematomas are proven ineffective.


Assuntos
Obstrução das Vias Respiratórias , Artérias Temporais , Adulto , Masculino , Humanos , Hematoma/complicações , Hematoma/diagnóstico por imagem , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/terapia , Cirrose Hepática , Angiografia
4.
Acta Diabetol ; 61(1): 117-126, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37728831

RESUMO

INTRODUCTION: Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar syndrome (HHS) are life-threatening complications of diabetes mellitus. Their clinical profiles have not been fully investigated. METHODS: A multicenter retrospective cohort study was conducted in 21 acute care hospitals in Japan. Patients included were adults aged 18 or older who had been hospitalized from January 1, 2012, to December 31, 2016 due to DKA or HHS. The data were extracted from patient medical records. A four-group comparison (mild DKA, moderate DKA, severe DKA, and HHS) was performed to evaluate outcomes. RESULTS: A total of 771 patients including 545 patients with DKA and 226 patients with HHS were identified during the study period. The major precipitating factors of disease episodes were poor medication compliance, infectious diseases, and excessive drinking of sugar-sweetened beverages. The median hospital stay was 16 days [IQR 10-26 days]. The intensive care unit (ICU) admission rate was 44.4% (mean) and the rate at each hospital ranged from 0 to 100%. The in-hospital mortality rate was 2.8% in patients with DKA and 7.1% in the HHS group. No significant difference in mortality was seen among the three DKA groups. CONCLUSIONS: The mortality rate of patients with DKA in Japan is similar to other studies, while that of HHS was lower. The ICU admission rate varied among institutions. There was no significant association between the severity of DKA and mortality in the study population. TRIAL REGISTRATION: This study is registered in the UMIN clinical Trial Registration System (UMIN000025393, Registered 23th December 2016).


Assuntos
Diabetes Mellitus , Cetoacidose Diabética , Coma Hiperglicêmico Hiperosmolar não Cetótico , Adulto , Humanos , Cetoacidose Diabética/etiologia , Cetoacidose Diabética/complicações , Coma Hiperglicêmico Hiperosmolar não Cetótico/complicações , Coma Hiperglicêmico Hiperosmolar não Cetótico/epidemiologia , Estudos Retrospectivos , Japão/epidemiologia , Hospitais
8.
Clin Case Rep ; 11(5): e7356, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-37215962

RESUMO

Key Clinical Message: Epidural pneumatosis and pneumomediastinum are rare, benign complications of diabetic ketoacidosis. As they can mimic serious conditions including esophageal rupture, diagnostic evaluation, and attentive monitoring are crucial. Abstract: Diabetic ketoacidosis can rarely present with epidural pneumatosis and pneumomediastinum, possibly due to forceful vomiting and Kussmaul breathing. Recognizing these pneumocomplications is crucial, as they can mimic severe conditions, including esophageal rupture. Consequently, diagnostic workup and vigilant monitoring are critical, even though these pneumocomplications are typically benign and self-resolving.

9.
Clin Case Rep ; 10(4): e05774, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35498349

RESUMO

This case illustrates adult-onset noncirrhotic hyperammonemic encephalopathy, which is most likely caused by splenorenal shunts and is a rare but potentially fatal cause of altered mentation in the critical care setting. Splenorenal shunts should be considered as a differential in cases of hyperammonemic encephalopathy without liver cirrhosis.

12.
Clin Case Rep ; 8(12): 3647-3648, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33364019

RESUMO

Vertebral osteomyelitis associated with concurrent emphysematous pyelonephritis and psoas abscess is rare. Coexistence of these entities is a potentially life-threatening condition, necessitating aggressive intervention.

13.
Neurocrit Care ; 33(3): 759-768, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32291575

RESUMO

BACKGROUND: Patients with Guillain-Barré syndrome (GBS) who require mechanical ventilation (MV) are regarded as candidates for early tracheostomy because of the high risk of prolonged MV; however, the association between early tracheostomy and favorable outcomes in patients with GBS remains unclear. In this study, we evaluated the association between early tracheostomy and outcomes in mechanically ventilated patients with GBS. METHODS: This retrospective observational study included adult patients with GBS identified in the Japanese Diagnosis Procedure Combination national inpatient database from July 1, 2010, to March 31, 2018, who initiated MV within the first week of admission and who received MV for more than 1 week. Early tracheostomy was defined as tracheostomy performed within 7 days of MV. The primary outcome was in-hospital mortality, and the secondary outcomes were 28-day mortality, nosocomial pneumonia, length of hospital stay, length of intensive care unit (ICU) stay, duration of MV, duration of sedation, duration of analgesia, duration of delirium, and total hospitalization costs. Propensity scores for early tracheostomy were calculated using a logistic regression model on the following variables: age; sex; body mass index; Japan Coma Scale status at admission; Charlson comorbidity index score; comorbidity of chronic pulmonary disease; complication of pneumonia at admission; complication of hyponatremia at admission; neurological presentation at admission; ambulance use; referral from other hospitals; treatment year; days from hospital admission to MV initiation; ICU admission until the day of MV initiation; and treatments until the day of MV initiation. Stabilized inverse probability of treatment weighting analyses was performed to compare the outcomes between patients with and without early tracheostomy. RESULTS: Among 919 eligible patients, 654 patients (71%) underwent tracheostomy, with 136 patients (15%) receiving early tracheostomy. Overall, the median time from initiation of MV to tracheostomy was 12 days (interquartile range 8-15 days). After stabilized inverse probability of treatment weighting, early tracheostomy was not associated with lower in-hospital mortality (risk difference 0.4%; 95% confidence interval - 5.6 to 6.7%) compared with patients without early tracheostomy. There were no significant differences in 28-day mortality (risk difference - 1.3%; 95% confidence interval - 3.5 to 0.9%) and incidence of nosocomial pneumonia (risk difference - 2.6%; 95% confidence interval - 9.1 to 4.2%) between the two groups. None of the other secondary outcomes differed significantly between the groups. CONCLUSIONS: Early tracheostomy was not significantly associated with decreased mortality or morbidity in patients with GBS requiring MV for more than 1 week.


Assuntos
Síndrome de Guillain-Barré , Mortalidade Hospitalar , Respiração Artificial , Traqueostomia , Adulto , Síndrome de Guillain-Barré/mortalidade , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Estudos Retrospectivos
14.
Clin Case Rep ; 5(3): 260-263, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28265386

RESUMO

This case highlights the probable association of significantly displaced posterior first-rib fracture and jagged edges of the fracture line following blunt chest trauma with delayed ipsilateral subclavian artery rupture. Early angiography and first-rib repair should promptly be considered under such circumstances.

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