Mona Boaz

Serum asymmetric dimethylarginine and arginine levels predict microvascular and macrovascular complications in type 2 diabetes mellitus

Increased oxidative stress in diabetes increases nitric oxide (NO) oxidation and low l‐arginine (Arg) could further reduce NO and impair vascular function, thereby accelerating, in the long run, vascular complications. We therefore measured Arg and asymmetric dimethylarginine (ADMA) levels in patients with type 2 diabetes mellitus (T2DM) and healthy controls. Additionally, we observed the diabetic individuals over time to see if Arg and asymmetric dimethylarginine predicted T2DM complications.

Plasma fatty acid lipidome is associated with cirrhosis prognosis and graft damage in liver transplantation

BACKGROUND Knowledge regarding the plasma fatty acid (FA) pattern in patients with liver cirrhosis is fragmentary. OBJECTIVE We evaluated plasma FA lipidome and its association with the prognosis of cirrhosis and severity of liver graft damage after transplantation. DESIGN In this observational study, plasma FA lipidome was investigated in 51 cirrhotic patients before liver transplantation and in 90 age- and sex-matched healthy control subjects. In addition, we studied ischemia-reperfusion damage in the liver of 38 patients for whom a graft biopsy was available at transplantation. With the use of logistic regression, we modeled the presence of cirrhosis, the dichotomized model for end-stage liver disease score below and above the median, and the presence of severe liver graft ischemia-reperfusion damage. RESULTS The FA pattern was markedly altered in cirrhotic patients, who showed, compared with healthy controls, higher monounsaturated FAs, lower n-6 and n-3 polyunsaturated FAs, and undetectable cerotic acid. Plasma di-homo-γ-linolenic acid was independently associated with the presence of cirrhosis (OR: 0.026; 95% CI: 0.004, 0.196; P < 0.0001), severity of its prognosis (OR: 0.041; 95% CI:0.005, 0.376; P = 0.006), postreperfusion graft hepatocellular necrosis (OR: 0.921; 95% CI: 0.851, 0.997; P = 0.043), and sinusoidal congestion (OR: 0.954; 95% CI: 0.912, 0.998; P = 0.039). Associations of di-homo-γ-linolenic acid with the presence of cirrhosis and severity of its prognosis were confirmed also after false discovery rate correction. CONCLUSIONS Cerotic and di-homo-γ-linolenic acids may serve as markers of disease and prognosis in liver cirrhosis. Dietary supplementation with di-homo-γ-linolenic acid could be a reasonable interventional strategy to delay disease progression in liver cirrhosis.

Hyperglycaemia in patients with no history of diabetes presenting to Internal Medicine Departments.

Stress hyperglycaemia during hospitalisation may be the first sign of diabetes mellitus (DM). Most hospitals routinely measure blood glucose, which may enable early diagnosis. This study measured the prevalence of hyperglycaemia in hospitalised adults with no history of diabetes, and whether the discharge summary recommended work‐up.

Serum ADMA and arginine levels predict micro- and macrovascular complications in type 2 diabetes mellitus.

Increased oxidative stress in diabetes increases nitric oxide (NO) oxidation and low l‐arginine (Arg) could further reduce NO and impair vascular function, thereby accelerating, in the long run, vascular complications. We therefore measured Arg and asymmetric dimethylarginine (ADMA) levels in patients with type 2 diabetes mellitus (T2DM) and healthy controls. Additionally, we observed the diabetic individuals over time to see if Arg and asymmetric dimethylarginine predicted T2DM complications.

Malnutrition risk is associated with hypoglycemia among general population admitted to internal medicine units. Results from the MENU study

Background/objectivesTo examine the association between increased malnutrition risk upon admission, and the incidence of hypoglycemia among adult patients admitted to internal medicine units in Israel.Subjects/methodsThis was a cross-sectional study, and included were all adult patients admitted to internal medicine units, regardless of reason for admission. The NRS2002 was used to for nutritional screening. All glucose measurements were obtained using an institutional blood glucose-monitoring system, which consisted of a point of care, automated glucometer, and an interactive database. Patients were categorized as hypoglycemic if they had at least one documented hypoglycemia (= <70 mg/dL) event during the hospitalization period. Blood chemistry measured at admission was also recorded.ResultsIncluded were 876 patients (mean age 70.0 ± 17.3, 50.6% were males). Rate of positive malnutrition screen was 39.7% of the population. A total of 5.4% of the study population had at least one hypoglycemic event during hospitalization. Rate of diabetes mellitus did not differ between patients with or without hypoglycemia. A greater proportion of patients with hypoglycemia were at increased malnutrition risk compared to patients without documented hypoglycemic events (56.8% vs. 38.9%, p = 0.018). Patients who had hypoglycemia had higher NRS2002 scores for pre-hospitalization unintentional weight loss and reduced food consumed. In logistic regression analysis, increased malnutrition risk was associated with hypoglycemia occurrence (OR 1.982, 95% confidence interval 1.056–3.718, p = 0.033). Age, sex, and diabetes mellitus status did not affect the rate of hypoglycemia.ConclusionsOur data suggest increased malnutrition risk as measured by the NRS2002 almost doubled the risk for hypoglycemia during the hospitalization.

Using a public health station for screening of undiagnosed dysglycemia and hypertension

AIM Dysglycemia, diabetes and abnormal blood pressure screening can be conducted by trained volunteers and may identify unknown cases. The aim of the study was to examine the feasibility and effectiveness of operating a screening station in pubic setting supervised by diabetes unit. METHODS A cross-sectional analysis of a program offering free screening services to non-hospitalized subjects. From 1.1.2011 through 31.12.2013 trained volunteers measured height, weight, blood glucose and blood pressure at the main entrance of the hospital. Subjects were asked whether they had diabetes or hypertension. Dysglycemia was defined as blood glucose 141-199mg/dL and probable newly-identified diabetes as ≥200mg/dL. RESULTS 13,112 adults underwent screening. Among the screened individuals (age 55.3±14.9 years) 2215 (16.9%) reported diabetes and 3037 (23.2%) hypertension. Among subjects without known hypertension, 9.6% had blood pressure ≥140/90. Among the subjects without known diabetes, 5012 (46%) had glucose ≤110mg/dL, 2873 (26.4%) ≥126mg/dL, 1553 (14.3%) >140mg/dL and 170 (1.6%) ≥200mg/dL. Compared to subjects with blood glucose ≤140mg/dL, those with dysglycemia or diabetes were older (58.9±13.4 vs. 52.7±15.2 years, P<0.001), had elevated BMI (27.5±4.6kg/m(2) vs. 26.6±4.6kg/m(2), P<0.001), higher systolic (137.5±22.2mmHg vs. 132.2±21.3mmHg, P<0.001) and diastolic blood pressure (80.3±15.6mmHg vs. 78.6±13.7mmHg, P<0.001). Compared to subjects with blood glucose<200mg/dL, those with probable newly-identified diabetes were older (58.6±10.9 vs. 53.5±15.2, P<0.001), had elevated BMI (28.4±4.8kg/m(2) vs. 26.7±4.6kg/m(2), P<0.001), higher systolic (139.4±24.0mmHg vs. 132.8±21.4mmHg, P<0.001) and diastolic blood pressure (85.4±20.7mmHg vs. 78.8±13.9mmHg, P<0.001). CONCLUSIONS Screening supervised by healthcare center can identify individuals at high-risk for dysglycemia and abnormal blood pressure, who are referred for further diagnosis and treatment and may serve as a complementary step in primary health care setting.

Prevalence of undiagnosed hyperglycaemia in patients presenting to the Department of Emergency Medicine with no known history of diabetes

Diabetes is considered a major epidemic of the 21st century. Usually, diabetes begins asymptomatically and the diagnosis takes place an average of 8–12 years after the onset of dysglycaemia. Blood check for glucose is taken at different medical setting, whether at the fasting condition or randomly. Previous studies had shown that abnormal blood glucose predicts future diabetes. Hence, medical staff should consider taking reasonable actions in patients with abnormal blood glucose.

Documented hypoglycemia is associated with poor short and long term prognosis among patients admitted to general internal medicine departments

AIM To study the association of documented hypoglycemia with length of stay, 30-day mortality, and 1-year mortality, among patients with and without diabetes admitted to internal medicine units. METHODS The electronic medical records of all patients hospitalized in internal medicine departments at E. Wolfson Medical Center, Holon, Israel, between 1/1/2010 and 31/12/2013, were reviewed. Data extracted included all glucose measurements (performed using an institutional blood glucose monitoring system). Patients were considered hypoglycemic if at least one hypoglycemic event was recorded. Regression analysis was used to assess the association between documented hypoglycemia and length of stay, 30-day and one-year mortality. Age, sex, reason for admission, and the Charlson comorbidity index were entered as covariates, and the most conservative model was developed. RESULTS The study population included 45,272 patients (mean age 68.9 ± 17.8 years, 49.4% males, 21.0% had diabetes mellitus). The rate of hypoglycemia in the total study population was 7.5% (16.8% among DM patients, 6.0% among patients without diabetes, p < 0.001). Patients with documented hypoglycemia had a longer length of hospital stay (9.3 ± 18.7 vs. 3.1 ± 6.4 days, p < 0.001), as well as higher risk for both 30-day (23.7% vs. 7.0%, p < 0.001) and 1-year mortality (41.6% vs. 15.3%, p < 0.001). Cox regression analysis showed that hypoglycemia significantly increased risk death at one year (HR 2.436, 95% CI 2.298-2.582, p < 0.001) independent of age, sex, the Charlson comorbidity index, DM status and reason for admission. CONCLUSION Documented hypoglycemia is associated with prolonged length of hospital stay and increased risk for both 30-day and 1-year mortality, regardless of diabetes mellitus status.

Association of albumin and cholesterol levels with incidence of hypoglycaemia in people admitted to general internal medicine units

To study the association between serum albumin and cholesterol levels at hospital admission and incident hypoglycaemia among people admitted to internal medicine units.

Mesalamine Enemas for Induction of Remission in Oral Mesalamine-refractory Pediatric Ulcerative Colitis: A Prospective Cohort Study

Background Paediatric ulcerative colitis [UC] is more extensive than adult disease, and more often refractory to mesalamine. However, no prospective trials have evaluated mesalamine enemas for inducing remission in children. Our goal was to evaluate the ability of mesalamine enemas to induce remission in mild to moderate paediatric UC refractory to oral mesalamine. Methods This was an open-label arm of a previously reported randomised controlled trial of once-daily mesalamine in active paediatric UC [MUPPIT trial]. Children aged 4-18 years, with a Paediatric Ulcerative Colitis Activity Index [PUCAI] score of 10-55, were enrolled after failing at least 3 weeks of full-dose oral mesalamine. Patients treated with steroids or enemas in the previous month and those with isolated proctitis were excluded. Children received Pentasa® enemas 25 mg/kg [up to 1g] daily for 3 weeks with the previous oral dose. The primary endpoint was clinical remission by Week 3. Results A total of 38 children were enrolled (mean age 14.6 ± 2.3 years; 17/38 [45%] with extensive colitis). Clinical remission was obtained in 16 [42%] and response was obtained in 27 [71%] at Week 3. Eight children deteriorated and required steroids. There were no differences in baseline parameters between those who entered or failed to enter remission, including disease extent [43% in left-sided and 41% in extensive colitis] and disease activity [44% in mild and 41% in moderate activity]. Conclusion Clinical remission can be markedly increased in children who are refractory to oral mesalamaine by adding mesalamine enemas for 3 weeks, before commencing steroids.