Outcomes for adults with type 1 diabetes referred with severe hypoglycaemia and/or referred for islet transplantation to a specialist hypoglycaemia service.

Islet transplantation alone (ITA) is indicated for patients with type 1 diabetes (T1D) with disabling severe hypoglycaemia (SH) despite optimised medical therapy. We examined outcomes for patients referred to an islet transplant unit with recurrent SH. Retrospective case note audit of 45 patients with ≥1 SH per year who were referred to our ITA unit between 2009-2012; 36 patients attended follow-up appointments. The cohort was 52.8% male, mean (± SD) age 43.9 (± 11.4) years, and duration of diabetes 26.5 (± 12.9) years. Baseline HbA1c was 8.3% (± 1.7) (67.2 mmol/mol), median (IQR) frequency of SH was 6.0 (2.0-24.0) per/patient/year and 83.3% had impaired awareness of hypoglycaemia (IAH). 80.6% of patients were referred from other secondary diabetes services, 22.2% had completed structured education, and 30.6% were using continuous subcutaneous insulin infusion (CSII). Seventeen patients were optimised with conventional therapy; SH reduced from 2.0 (1.5-9.0) to 0.0 (0.0-0.5) episodes/patient/year; p<0.001, and there was concurrent improvement in HbA1c (8.1-7.7%; 65.0 vs. 60.7 mmol/mol; p=0.072). Ten patients were listed for transplantation as they were not optimised despite structured education, CSII, and continuous glucose monitoring (CGM). The remaining 9 had a reduction in SH [7.0 (4.8-40.5) to 4.0 (2.5-6.3) episodes/patient/year; p=0.058] and either left the service (n=5) or are still being optimised (n=4). In conclusion, 47.2% of patients presenting with problematic hypoglycaemia resolved with optimal medical therapy, with a further 25% achieving clinically relevant improvement, however 27.8% required transplantation despite access to all therapies. Provision of expertise in hypoglycaemia management is essential to focus limited transplant resources on those who need it most.

Inclusion levels of sweet potato root meal in the diet of broilers I. Effect on performance, organ weights, and carcass quality.

The amount of corn available for animal and poultry feed has been unpredictable in recent years due to the increased use of corn for ethanol production. As a consequence, there has been an increase in the price of feed, chicken, and chicken products. Researchers are exploring alternative feed sources to substitute for corn in poultry ration. This study evaluated the performance and carcass quality of broilers fed diets containing sweet potato root meal (SPRM). After a complete nutrient analysis of the SPRM, diets were formulated where 0, 10, 20, and 30% of corn was substituted with SPRM. The study utilized 360 1-d-old Cornish X Rock male broiler chickens randomly assigned to one of 4 treatments; 0%, 10%, 20%, and 30% SPRM. Body weights and feed intake (FI) were monitored weekly for 7 wk. Birds were slaughtered on d 50 and FI, BW gain, ADG, ADFI, abdominal fat, dressing percentage, and organ weights measured. White (breast) and dark (leg and thigh) meat were evaluated for nutrient content (protein, moisture, fat, and ash). Results showed birds fed 20% SPRM had lower (P<0.03) final BW, BW gain and ADG than those fed the 30% SPRM diet. There were no differences in FI and ADFI among treatments. Feed conversion ratio was lowest (P<0.02) in birds fed 10, 20, and 30% SPRM than the control. There were no differences in dressing percentage among treatments. Abdominal fat was highest (P<0.05) in birds fed 30% SPRM. Organ weights were similar across treatments except for gizzard which weighed highest (P<0.05) in the control. For white meat; moisture, protein, fat, and ash were similar across treatments. For dark meat, moisture (P<0.004) and fat (P<0.03) were highest in the control, while protein and ash were similar among treatments. Birds fed the SPRM diets compared well with those fed the control for both performance and nutrient content of meat.

Sirolimus-induced pneumonitis complicated by pentamidine-induced phospholipidosis in a renal transplant recipient: a case report.

The proliferation signal inhibitors (PSIs)-sirolimus, everolimus, and temsirolimus-have been associated with a noninfectious pneumonitis characterized by lymphocytic alveolitis and bronciolitis obliterans with organizing pneumonia (BOOP). This condition usually occurs within the first year. Herein we presented a case of a deceased donor renal transplant with interstitial pneumonitis developing 6 years after a switch from tacrolimus to sirolimus due to chronic graft dysfunction. After the addition of intravenous pentamidine due to the suspicion of Pneumocystis pneumonia, there was marked clinical deterioration requiring intubation. Open lung biopsy revealed sirolimus-induced pulmonary toxicity (BOOP) with the additional finding of a drug-induced phospholipidosis (DIPL) that we ascribe to pentamidine treatment. After cessation of both drugs and application of corticosteroid therapy, there was only partial improvement. Eight months later the residual interstitial fibrosis demands supplemental home oxygen. We review the literature on PSI-induced pneumonitis and discuss the pathophysiology of a potential interaction with pentamidine. We caution against its use in the setting of PSI-induced pneumonitis. It is currently unknown whether these concerns also apply to prescription of other more commonly used medications associated with DIPL, eg, amiodarone and aminoglycosides.