Efficacy and safety of two protocols of intravenous insulin therapy in the management of diabetic ketoacidosis.

INTRODUCTION: The correction of insulin deficiency in ketoacidosis DKA is recommended by intravenous (IV) route. Despite abundant literature, the place of the initial bolus of insulin has remained controversial. AIMS: This study was designed to compare the safety and the efficacy of two protocols of intravenous (IV) insulin therapy in the management of DKA admitted in the emergency department. Protocol (A): IV bolus of regular insulin 0.10 UI/Kg followed by a continuous IV infusion of insulin 0.10 UI/kg/H. Protocol (B): No bolus, a continuous IV infusion of regular insulin 0.14 UI/kg/H. METHODS: This was a prospective, not blinded, randomized study including patients aged more than 16 years with moderate to severe DKA. Fluid therapy and potassium replacement were standardized. Patients were randomized into two groups: Bolus-maintenance 0.10 group received protocol (A) and Maintenance 0.14 group received protocol (B). The Primary outcome data was the time to recovery defined by the time to acidosis resolution. The safety was tested by the occurrence of complications: hypoglycemia and hypokalemia. RESULTS: We enrolled 129 consecutive DKA patients. There were no differences between the two groups in clinical and biochemical data on admission, Bolus-maintenance 0.10 group versus Maintenance 0.14 group: mean age (37±18 vs. 38±17 years; p=0.810), Type 1 diabetes n (%): 34(55.7) vs. 34(50); p=0.911, pH (7.14±0.13 vs. 7.15±0.12; p=0.43). There were no differences between the two groups in the outcomes data: Bolus-maintenance 0.10 group versus Maintenance 0.14 group: Time to recovery (17 vs. 16 hours; p=0.76), complication n (%): Hypoglycemia (7(11.5) vs. 10(15.9); p=0.57) and hypokalemia (32(56.1) vs. 30(46.9); p=0.30). CONCLUSION: In the treatment of diabetic ketoacidosis, the two protocols of IV insulin were safe and had a comparable efficiency.

Role of procalcitonin and c-reactive protein levels: a diagnostic tool in lower respiratory tract infections.

BACKGROUND: Conventional biomarkers lack sensitivity and specificity for acute pulmonary Community (PAC). Procalcitonin (PCT) has been described in the literature for its usefulness in the PAC. The aim of our work was to study the contribution of the PCT in the positive diagnosis of PAC and in the initial assessment of the severity and the interest of CRP and PCT to distinguish lung infections from tuberculous origin of the PAC. METHODS: Prospective study of 100 middle-aged 45 years [16-82], admitted to our clinic for evaluation of lung opacity some of the reason for consultation. All patients with antibiotics before admission were excluded. We studied the clinical, radiological, biological and bacteriological characteristics of patients. RESULTS: The rate of PCT was significantly higher in PAC compared to TBC (p <0.001). The values of CRP and PCT were correlated to changes in the PAC. The mean values of CRP and PCT were higher for the most severe PAC and the difference was statistically significant for CRP and PCT between the two (p =0.01). The cut-off of CRP and PCT could discriminate a PAC values were 35 mg / l and 0.12 ng /ml. CONCLUSION: The PCT is a good marker for diagnosis and the prognosis of PAC. It permits  to discriminate diagnosing CAP compared to tuberculosis.

Prevalence of vitamin D deficiency in mothers and their newborns in a Tunisian population.

OBJECTIVE: To assess vitamin D status in mothers and their newborns and identify predictive factors of vitamin D deficiency. METHODS: A cross-sectional study was undertaken of healthy women and their full-term newborns delivered at the Charles Nicolle Hospital, Tunis, Tunisia, between October and November 2012. Maternal and neonatal serum 25-hydroxy vitamin D (25(OH)D) concentrations were measured. Correlations were tested. RESULTS: Overall, 87 mothers and their newborns were enrolled. No mother or neonate had an adequate vitamin D status. Mean maternal and neonatal serum 25(OH)D concentrations were 6.82±5.14ng/mL (range 3.60-23.77) and 5.92±4.15ng/mL (range 3.60-22.28), respectively. Vitamin D deficiency (serum 25(OH)D<20ng/mL) was found in 84 (97%) mothers and 85 (98%) neonates, of whom 76 (87%) and 78 (90%), respectively, had severe deficiency (serum 25(OH)D<12ng/mL). Maternal serum 25(OH)D showed a strong positive correlation with neonatal serum 25(OH)D (r=0.69, P<0.001). Maternal dietary vitamin D intake was the only factor shown to be associated with serum 25(OH)D concentrations (P<0.05). CONCLUSION: Vitamin D deficiency is prevalent among Tunisian mothers and their neonates.