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Case Report: A Severe Hypernatremia with Multiple Organ Failure, about a Clinical Observation

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Open Journal of Nephrology 2017年第1期7卷 19-23页

作者： Alpha Oumar Bah Mamadou Cellou Balde Amadou Bah Alpha Oumar Barry departement of Nephrology Donka National Hospital Conakry Guinea departement of Nephrology-Hemodialysis Chiva Hospital Foix Cedex France departement of diabetology Donka National Hospital Conakry Guinea departement of Reanimation Donka National Hospital Conakry Guinea

A hypernatremia severity is often associated with a poor prognosis, especially if it is associated with multiple organ failure. In a country with very limited resources, the prognosis may be favorable in the absence of renal replacement. We report the case of a 63 years old woman, hypertensive and diabetic, admitted to the ICU for unconsciousness. Clinically, neurological examination notes a Glasgow of 8/15 (Y2, V2, M4) and a left hemiplegia. Temperature was 39°C. Diuresis was 100 ml during the first 24 hours. Blood pressure was 90/60 mmHg, tachycardia at 133/min. Cardiac auscultation is normal. Vascular axes were weakly perceptible. Oxygen saturation was 95%. The skin examination notes a dry skin and mucous membranes, a flattening of the superficial veins, sunken eyes and a persistent skin fold. There is no hepatomegaly or splenomegaly, or jaundice. Biological point of view note natremia: 176 mmol/L;osmolarity: 390 mosmol/kg;creatinin: 300 μmol/L;glycemia > 6 g/L;transaminases 217 UI. Diagnostics: malignant hypernatremia with a high plasma osmolarity associated with an acute anuric renal failure, hydro electrolytic disorders, an abnormal liver function, a fever of central origin and a stroke. The treatment consisted of a correction of the electrolyte disorders by infusion of isotonic and hypotonic fluids with insulin. In a country with very limited resources, the severe hypernatremia prognosis associated with anuric acute renal failure may be favorable in the absence of renal replacement.

关键词： Hypernatremia Hyperosmolar Coma Multiple Organ Failure Acute Renal Failure Diabetes

Corticosteroid-Induced Adrenal Insufficiency in Africa: Report of Nine Cases at the Internal Medicine/Endocrinology-diabetology Department of Pikine NHC

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Open Journal of Endocrine and Metabolic Diseases 2020年第12期10卷 155-163页

作者： Nafy Ndiaye Ngone Diaba Diack Yakham Mohamed Leye Abdou Dieng Mamadou Ba Abdoulaye Leye Internal Medicine/Endocrinology-diabetology Department Teaching Hospital of Pikine Dakar Senegal

Introduction: Prolonged corticosteroid therapy is labeled as the main cause of corticotropic adrenal insufficiency. However, the current frequency of this complication remains unknown. The objective of our study was to assess its epidemiologic, diagnostic, therapeutic, and evolutionary aspects of our practice. Methodology: A 60-month retrospective study was performed from May 2014 to April 2020 in the Pikine National Hospital Centre. Data were obtained from the medical records of patients with corticosteroid-induced adrenal insufficiency. Epidemiologic, diagnostic, therapeutic, and evolutionary parameters, and data related to corticotherapy were recorded. Patients with basal plasma cortisol levels Results: Medical records were obtained from nine patients, comprising six women and three men. The mean age of the patients was 48 years. Long-term corticosteroid therapy was used for self-medication in six patients and artificial bleaching in the remaining three patients. Betamethasone was the most commonly used drug in four patients, followed by clobetasol in three patients. Corticotropic insufficiency was revealed as a result of acute decompensation in five patients. All patients presented with a pseudo-cushingoid pattern. Diagnosis of corticotropic adrenal insufficiency was confirmed by measuring basal plasma cortisol levels of <50 ng/ml in seven patients. A standard Synachtene test was performed on two patients. All patients benefited from hydrocortisone supplementation. In the short-term, the outcome was unremarkable for all patients. Medium and long-term progression could be assessed in only three patients. Two patients showed persistent suppression with a 6- and 9-month follow-up. One patient was readmitted after one month due to an adrenal cris

关键词： Adrenal Insufficiency Corticotherapy Artificial Depigmentation Self-Medication

Optimized health care for subjects with type 1 diabetes in a resource constraint society: A three-year follow-up study from Pakistan

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World Journal of Diabetes 2019年第3期10卷 224-233页

作者： Muhammad Yakoob Ahmedani Asher Fawwad Fariha Shaheen Bilal Tahir Nazish Waris Abdul Basit Department of Medicine Baqai Institute of Diabetology and Endocrinology Baqai Medical University Karachi 74600 Pakistan Department of Biochemistry Baqai Medical University Research Department Baqai Institute of Diabetology and Endocrinology Baqai Medical University Karachi 74600 Pakistan Research Department Baqai Institute of Diabetology and Endocrinology Baqai Medical University Karachi 74600 Pakistan

BACKGROUND Inadequate health infrastructure and poverty especially in rural areas are the main hindrance in the optimal management of subjects with type 1 diabetes (T1D) in Pakistan. AIM To observe effectiveness of diabetes care through development of model clinics for subjects with T1D in the province of Sindh Pakistan. METHODS A welfare project with name of “Insulin My Life”, was started in province of Sindh, Pakistan. This was collaborative work of Baqai Institute of diabetology and Endocrinology, World Diabetes Foundation and Baqai Medical University between February 2010 to February 2013. Under this project thirty-four T1D clinics were established. Electronic database was designed for demographic, biochemical, anthropometric and medical examination. Monthly consultation was part of the standardized diabetes care. All the recruited subjects with T1D were provided free insulins and related materials. RESULTS Out of 1428 subjects, 795 (55.7%) were males and 633 (44.3%) were females. Subjects were categorized into ≤ 5 years of age 103 (7.2%), between 6-12 years 323 (22.6%), between 13–18 years 428 (29.7%) and ≥ 19 years of age 574 (40.2%) groups. Glycemic control as assessed by HbA1c was significantly improved (P 0.05). CONCLUSION This study gives us long-term longitudinal data of people with T1D in a resource constraint society. With provision of standardized and comprehensive care significant improvement in glycemic control without any change in the frequency of microvascular complications was observed over 3 years.

关键词： Insulin My Life Type 1 diabetes Insulin Care Pakistan

Rapid correction of hyperglycemia:A necessity but at what price?A brief report of a patient living with type 1 diabetes

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World Journal of Diabetes 2023年第11期14卷 1710-1716页

作者： Priscille Huret Philippe Lopes Randa Dardari Alfred Penfornis Claire Thomas Dured Dardari LBEPS University EvryIRBAUniversitéParis SaclayEvry 91000France diabetology Al FourkanAleppo 90000Syria diabetology Centre Hospitalier Sud FrancilienCorbeil Essonne 91100France

BACKGROUND The correction and control of chronic hyperglycemia are the management goals of patients living with *** hyperglycemia is the main factor inducing diabetes-related ***,in certain situations,the rapid and intense correction of chronic hyperglycemia can paradoxically favor the onset of microvascular *** SUMMARY In this case report,we describe the case of a 25-year-old woman living with type 1 diabetes since the age of 9 *** diabetes was chronic and unstable but without *** an unplanned pregnancy,her diabetes was intensely managed with the rapid correction of her ***,over the following 2 years,she developed numerous degenerative microvascular complications:Charcot neuroarthropathy with multiple joint involvement,severe proliferative diabetic retinopathy,gastroparesis,bladder voiding disorders,and end-stage renal failure requiring *** In the literature to date,the occurrence of multiple microvascular complications following the rapid correction of chronic hyperglycemia has been rarely described in the same individual.

关键词： Unstable diabetes Chronic hyperglycemia Microvascular complication Type 1 diabetes Case report

Intact fish skin graft a new hope for the treatment of diabetic foot ulcers:A case report

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World Journal of Diabetes 2024年第12期15卷 2353-2359页

作者： Anne Christine Jugnet Tatiana Benard Corinne Lequint Elise Bobony Anna-Rosiana Pieheiro Thomas Winther Alfred Penfornis Dured Dardari Department of diabetology Centre Hospitalier Sud FrancilienCorbeil Essonne 91100France

BACKGROUND Diabetic foot ulcers(DFUs)are a real public health problem which carry a high risk of *** treatment of DFUs is based on general management such as the treatment of infection,arterial disease,and offloading,but recent studies have shown that the quality of the local covering can impact the healing *** SUMMARY We report the case of a 39-year-old man,living with diabetes since the age of 15,who developed DFU on the dorsum of his left foot,with muscle and tendon *** management with intensive diabetes control,surgery,treatment of infection and negative pressure therapy gave only limited *** patient benefited from the application of an intact fish skin graft with com-plete epithelialisation of the ulcer after 10 weeks of *** The use of intact fish skin graft appears to be a promising option for deep DFUs.

关键词： Intact fish skin graft Diabetic foot ulcer Foot amputation Case report

Utility of different serum fibrosis markers in diagnosing patients with chronic pancreatitis and pancreatic adenocarcinoma

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World Journal of Gastrointestinal Oncology 2016年第8期8卷 635-641页

作者： Anna Kozak Renata Talar-Wojnarowska Aleksandra Kaczka Anna Borkowska Leszek Czupryniak Ewa Malecka-Panas Anita Gasiorowska Department of Digestive Tract Diseases Medical University of Lodz Department of diabetology and Metabolic Diseases Medical University of Lodz

AIM: To estimate the levels of serum cytokines in chronic pancreatitis(CP) and pancreatic ductal adenocarcinoma(PDAC) patients in order to evaluate their usefulness as possible ***: The study included 167 Caucasian patients: 74 with PDAC(28 men and 42 women, aged 30-88 years), 78 with CP(50 men and 21 women, aged 20-79 years) and 15 age-matched healthy controls hospitalized in the Department of Digestive Tract Diseases, Medical University of Lodz, Poland between 2006 and 2013. Serum MCP-1, transforming growth factor(TGF)-β1, HA and s-Fr were measured in patients with CP(n = 78), PDAC(n = 74) and healthy controls(n = 15) using ELISA(Corgenix United Kingdom Ltd R and D Systems). The severity of CP was assessed according to the Cambridge ***: Both patients with CP and PDAC had a significantly higher mean TGF-β1 serum level(1066 ± 582and 888 ± 356 vs 264 ± 93, P < 0.0001), mean s-Fr(2.42 ± 1.385 and 2.41 ± 1.275 vs 0.6 ± 0.370, P < 0.0001) and mean HA(199 ± 254 and 270 ± 358 vs 40 ± 26, P < 0.0001) compared to controls. There was no difference in mean MCP-1 between all the groups. There were no significant differences in any cytokine levels between the PC and PDAC groups. No significant differences between serum cytokines depending on age, gender or smoking status were found in CP patients. Mean s-Fr concentration was significantly higher in CP, lasting longer than 5 years compared to those with a shorter disease clinical course(2.639 ± 1.125 vs 1.870 ± 0.970, P < 0.03). There was no correlation between tumor size, localization or TNM classification and serum TGF-β1, MCP-1, s-Fr and HA levels in patients with PDAC. No significant differences between cytokines depending on diabetes presence in CP were found. Nevertheless, mean serum TGF-β1 concentration in PDAC patients was higher in those with diabetes compared to the remaining group(986 vs 839, P = 0.043). CONCLUSION: Serum TGF-β1, s-Fr and HA may be considered additional diagnostic ma

关键词： Fibrosis Chronic pancreatitis Soluble type fractalkine Pancreatic adenocarcinoma Transforming growth factor beta-1 Hyaluronic acid Monocyte chemoattractant protein-1

Decreased b-Cell Function is Associated with Cardiovascular Autonomic Neuropathy in Chinese Patients Newly Diagnosed with Type 2 Diabetes

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Neuroscience Bulletin 2019年第1期35卷 25-33页

作者： Xubin Yang Wen Xu Yanhua Zhu Hongrong Deng Ying Tan Longyi Zeng Jianping Weng Department of Endocrinology and Metabolism Guangdong Provincial Key Laboratory of DiabetologyThird Affiliated Hospital of Sun Yat-sen UniversityGuangzhou 510630China

The influence of b-cell function on cardiovascular autonomic neuropathy(CAN), an important diabetesrelated complication, is still unclear. In this study, we aimed to investigate the association between residual b-cell function and CAN in patients newly diagnosed with type 2 diabetes. We enrolled 90 newly-diagnosed type 2 diabetic patients and 37 participants with normal glucose tolerance as controls. The patients were divided into a CAN? group(diabetic patients with CAN, n = 20) and a CAN-group(diabetic patients without CAN, n = 70) according to the standard Ewing battery of tests. Fasting and postprandial plasma glucose, insulin, and C-peptide were *** model assessment-beta cells(HOMA-B) and HOMA-insulin resistance(IR) were calculated. The prevalence of CAN in this population was 22.2%. Compared with the CAN-group, the CAN? group had significantly lower fasting plasma insulin(6.60 ± 4.39 vs 10.45 ± 7.82 l/L, P = 0.029), fasting C-peptide(0.51 ± 0.20 vs0.82 ± 0.51 nmol/L, P = 0.004), and HOMA-B(21.44 ± 17.06 vs 44.17 ± 38.49, P = 0.002). Fasting C-peptide was correlated with the Valsalva ratio(r = 0.24, P = 0.043) and the 30:15 test(r = 0.26,P = 0.023). Further analysis showed that fasting C-peptide(OR: 0.041, 95% CI 0.003–0.501, P = 0.012) and HOMAB(OR: 0.965, 95% CI 0.934–0.996, P = 0.028) were independently associated with cardiovascular autonomic nerve function in this population. The patients with fasting C-peptide values \ 0.67 nmol/L were more likely to have CAN than those with C-peptide levels C0.67 nmol/L(OR:6.00, 95% CI 1.815–19.830, P = 0.003). A high prevalence of CAN was found in patients with newly-diagnosed type 2 diabetes. Decreased b-cell function was closely associated with CAN in this population.

关键词： Cardiovascular autonomic neuropathy b-cell function Type 2 diabetes mellitus

Effects of oncological treatments on semen quality in patients with testicular neoplasia or lymphoproliferative disorders

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Asian Journal of Andrology 2013年第3期15卷 425-429页

作者： Cataldo Di Bisceglie Angela Bertagna Emanuela R Composto Fabio Lanfranco Matteo Baldi Giovanna Motta Anna M Barberis Emanuela Napolitano Elena Castellano Chiara Manieri Division of Endocrinology Diabetology and Metabolism Unit of Andrology Seminology and Cryopreservation GJ. D. Department of Medical Sciences University of Turin Turin 10126 Italy

Pretherapy sperm cryopreservation in young men is currently included in good clinical practice guidelines for cancer patients. The aim of this paper is to outline the effects of different oncological treatments on semen quality in patients with testicular neoplasia or lymphoprol iferative disorders, based on an 8-year experience of the Cryopreservation Centre of a large public hospital. Two hundred and sixty-one patients with testicular neoplasia and 219 patients with lymphoproliferative disorders who underwent chemotherapy and/or radiotherapy and pretherapy semen cryopreservation were evaluated. Sperm and hormonal parameters （follicle-stimulating hormone （FSH）, luteinizing hormone （LH）, testosterone, inhibin B levels） were assessed prior to and 6, 12, 18, 24 and 36 months after the end of cancer treatment. At the time of sperm collection, baseline FSH level and sperm concentration were impaired to a greater extent in patients with malignant testicular neoplasias than in patients with lymphoproliferative disorders. Toxic effects on spermatogenesis were still evident at 6 and 12 months after the end of cancer therapies, while an improvement of seminal parameters was observed after 18 months. In conclusion, an overall increase in sperm concentration was recorded about 18 months after the end of cancer treatments in the majority of patients, even if it was not possible to predict the evolution of each single case ＇a priori＇. For this reason, pretherapy semen cryopreservation should be considered in all young cancer patients.

关键词： chemoradiotherapy lymphoproliferative disorders semen analysis semen cryopreservation testicular neoplasia

A thorough analysis of diabetes research in China from 1995 to 2015: current scenario and future scope

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Science China(Life Sciences) 2019年第1期62卷 46-62页

作者： Zekai Wu Tianru Jin Jianping Weng Department of Endocrinology and Metabolism Guangdong Provincial Key Laboratory of Diabetology The Third Affiliated Hospital of Sun Yat-Sen University Department of Physiology University of Toronto

The prevalence of diabetes has increased dramatically over the past three decades, and currently, China has the largest number of diabetics worldwide; this number continues to grow and puts ongoing strains on the medical resources. In this review, we reviewed the diabetes research conducted in China from 1995 to 2015 with the aim of providing new insights regarding the current status and future perspectives for researchers, diabetes health providers, and respective policy-makers. Remarkable progress has been made in diabetes research in China during the past two decades in terms of both the quantity and publication influence. The progress, however, struggles to adequately manage diabetes in China. Here we addressed opportunities to strengthen researches, including new drug development, high quality studies on health economics, and healthcare quality improvement studies. As the expected wave of diabetic complications is upcoming and overwhelming, we therefore recommend that immediate improvements are required to implement the researches regarding their prevention and treatment.

关键词： diabetes publication number publication influence clinical research basic research traditional Chinese medicine