Aim
Insulin is the preferred treatment for the control of diabetes in hospital, but it raises the risk of hypoglycaemia, often because oral intake of carbohydrates in hospitalized persons is lower ...than planned. Our aim was to assess the effect on the incidence of hypoglycaemia of giving prandial insulin immediately after a meal depending on the amount of carbohydrate ingested.
Methods
A prospective pre–post intervention study in hospitalized persons with diabetes eating meals with stable doses of carbohydrates present in a few fixed foods. Foods were easily identifiable on the tray and contained fixed doses of carbohydrates that were easily quantifiable by nurses as multiples of 10 g (a ‘brick’). Prandial insulin was given immediately after meals in proportion to the amount of carbohydrates eaten.
Results
In 83 of the first 100 people treated with the ‘brick diet’, the oral carbohydrate intake was lower than planned on at least one occasion (median: 3 times; Q1–Q3: 2–6 times) over a median of 5 days. Compared with the last 100 people treated with standard procedures, postprandial insulin given on the basis of ingested carbohydrate significantly reduced the incidence of hypoglycaemic events per day, from 0.11 ± 0.03 to 0.04 ± 0.02 (P < 0.001) with an adjusted incidence rate ratio of 0.70 (95% confidence interval 0.54–0.92; P = 0.011).
Conclusions
In hospitalized persons with diabetes treated with subcutaneous insulin, the ‘brick diet’ offers a practical method to count the amount of carbohydrates ingested, which is often less than planned. Prandial insulin given immediately after a meal, in doses balanced with actual carbohydrate intake reduces the risk of hypoglycaemia.
What’s new?
People with diabetes who are in hospital often do not eat their whole meal.
In these cases, insulin treatment increases the risk of hypoglycaemia.
The ‘brick diet’ allows nurses to easily count carbohydrates ingested so that insulin can be given accordingly.
Postprandial insulin balanced against carbohydrate ingested reduces hypoglycaemic events.
Aim To compare the feasibility, accuracy, and effective radiation dose (ED) of multidetector computed tomography (MDCT) in the detection of coronary artery disease using a combined ED-saving strategy ...including prospective electrocardiogram (ECG) triggering with a short x-ray window and a body mass index (BMI)-adapted imaging protocol using adaptive statistical iterative reconstruction (ASIR; group 1), in comparison with a prospective ECG triggering strategy alone (group 2). Materials and methods One hundred and seventy patients scheduled for invasive coronary angiography (ICA) were evaluated. Fourteen patients were not eligible for MDCT. The remaining 156 patients were randomized to group 1 (78 patients) and group 2 (78 patients). Eight and 11 patients in groups 1 and 2, respectively, were excluded after randomization because the patients’ heart rates were >65 beats/min. MDCT images were assessed for feasibility, signal-to-noise ration (SNR), and contrast-to-noise ratio (CNR), accuracy in detection of coronary stenoses >50% versus ICA and for ED. Results The feasibility, SNR, CNR, accuracy in a segment-based and patient-based model were similar in both groups (97 versus 95%, 14.5 ± 3.9 versus 14.2 ± 4.1, 16 ± 4.6 versus 16.5 ± 4.4, 95 versus 94% and 97 versus 99%, respectively). The ED in group 1 was 72% lower than in group 2 (2.1 ± 1.2 versus 7.5 ± 1.8 mSv, respectively; p < 0.01). Conclusions The use of a multi-parametric ED saving protocol results in a significant reduction in ED without a negative impact on accuracy.
Abstract Background Cardiovascular involvement is frequent in systemic lupus erythematosus (SLE). Aortic insufficiency is a common valvular abnormality seen in patients with systemic lupus ...erythematosus (SLE), it may be caused by a primary valve pathology or by an aortitis One of the cardiac manifestations associated with SLE and antiphospholipid syndrome (APLS) is Libman–Sacks endocarditis, also known as non–bacterial thrombotic endocarditis Although rare, there are reported cases of lupus aortitis which has also been associated with dissection, aneurysm and thrombus. Case Report We present a case of a 40 –years–old lady with lupus glomerulonephritis requiring immunosuppression and dialysis, who presented to the emergency department with fever and dyspnea. She was first treated with dialysis. Blood cultures drawn from central venous catheter peripheral were positive for staphylococcus epidermidis, the cultures from peripheral blood was negative instead.Transthoracic and transesophageal Echocardiography showed severe aortic regurgitation (not present three month earlier) with doubt valvular vegetations and with a focal enlargement of the aortic root (figure 1, 2).The patient met one major criterion (blood culture) and two minor criteria (high risk and fever), implying possible infective endocarditis. The patient was then started on intravenous antibiotics (vancomycin) and immunosuppression was reduced. Given the hemodynamic instability due to the severe aortic insufficiency, an Heart CT scan was performed to planned the surgical intervention. The CT scan confirmed the presence of small, multiple vegetation attached to the aortic leaflet and an aortic dissection on the right coronary cusp (figure 3). She proceeded to urgent surgery with aortic valve and aortic root replacement, the histology revealed evidence of Libman–Sacks endocarditis and aortitis. Discussion Our patient showed two different cardiovascular complications of SLE: the more frequent Libman –Sack endocarditis and the rare lupus aortitis associated to aortic dissection.The patient had risk factors for infective endocarditis and she did fulfil the modified Duke’s criteria for infective endocarditis and was treated with antibiotics and with a reduction of immunosuppression therapy. In fact, it can be difficult to distinguish between infective endocarditis and Libman–Sacks endocarditis especially in the setting of risk factors for both. Antibiotics and immunosuppressants should be used both.
A (NOT SO) RARE CASE OF ACS IN A YOUNG WOMAN Loffreno, A; De Carlini, C; Bersano, C ...
European heart journal supplements,
05/2024, Letnik:
26, Številka:
Supplement_2
Journal Article
Recenzirano
Odprti dostop
Abstract A 39 yo Caucasian woman, former smoker, with a previous history of gestational hypertension requiring therapy for several months, presented to the ED with persistent oppressive chest pain. ...No prior ischemic, constitutional or inflammatory symptoms emerged. Physical examination revealed a left carotid bruit and a continuous murmur at the base, Killip I. The ECG showed negative T waves in the inferior leads, the echo “point of care” normal systolic function, akinesia of the inferior wall, moderate aortic insufficiency, normal dimensions of the ascending aorta. HS T troponin rose to 188 ng/L and NT–proBNP 1621 pg/mL, CPR was normal. Coronary angiography revealed a tight subocclusive stenosis of the proximal right coronary artery trated by angioplasty with drug–eluting stent placement. In the ICU diminished pedal pulses were noticed, along with a significant discrepancy in blood pressure values between the four limbs (right upper 150/60 mmHg, left 140/60 mmHg, lower right 70/40 mmHg, left 60/40 mmHg). The echocardiogram showed normalized LV kinesis, moderate aortic insufficiency, normal dimensions of the ascending aorta and arch, flow acceleration at the isthmus (Vmax 4.6 m/s, Gmax 86 mmHg). CT angiography revealed thickening of the walls of the epiaortic vessels (with a non critical stenosis of the left carotid), of the thoracic and the abdominal aorta with complete occlusion of the subrenal segment and the inferior mesenteric artery (reconstituted by the Riolano artery and distal rectal arteries); the distal iliac arteries at the carrefour were separately reconstituted. 18F–FDG PET/CT confirmed diffuse hypercaptation along the ascending aorta, isthmus and proximal descending portion indicative of active vasculitis. Elevation of ESR 110 mm/h and CRP 21 mg/L was observed. The diagnosis of Takayasu‘s arteritis (TA) was estabilished and treatment with prednisone and methotrexate was started, resulting in the normalization of acute phase markers and clinical stability at 3 months. TA is a vasculitis that primarily involves the aorta and its main branches. The diagnosis can be challenging due to the heterogeneous clinical course and lack of specific laboratory markers. Diagnostic delay and persisting inflammation can lead to catastrophic consequences. Despite its rarity, TA can account for a notable proportion of young women with documented myocardial ischemia; hence, cardiologists must be sensitive to this pathology particularly in high–risk populations.
Abstract Background Assessing the quality of care is the first step for improve the management of patients with acute myocardial infarction (AMI). The European Society of Cardiology (ESC) and the ...Acute Cardiovascular Care Association (ACCA) recently defined a set of quality indicators (QI) of care for AMI. Aim To evaluate the quality of care of patients admitted to the Cardiology ward of our first level hospital for an AMI using the ESC ACCA QI. Methods QiC project is a prospective quality improvement study in real–world practice on all patients admitted to our ward for an AMI from 1.5.2023 to 30.4.25 with six–monthly audit activities. Case record forms were filled in by doctors during admission and were attached to the patient’s discharge letter. Thirty–day mortality was assessed by telephone interviews. The ESC ACCA QI include 18 main and 8 secondary QI on centre organization, reperfusion and invasive strategy, risk assessment, antithrombotic treatment, secondary prevention discharge treatments, and patient experience. For each IQ was evaluated the percentage of QI assessable and attained. Results A total of 78 patients were admitted for AMI in our Cardiology Department in the first 3 months. No one patient denied consent, one died during hospitalization, 7 patients had to be transferred to another hospital, and 3 patients did not have their record form filled in. The median age of the 67 patients discharged alive was 66 (IQR 58–75) years, 45 (67.2%) were males, 35 (52.2%) had a ST–segment elevation myocardial infarction (STEMI) and 32 (47.8%) a non–ST–segment myocardial infarction (NSTEMI). The percentages of non–assessment, non–attainment and attainment for each QI are reported in the Figure: the degree of non–assessment of the 26 QI ranged from 0 to 22% and the degree of QI attainment from 25 to 100%. Conclusions Quality of care for acute myocardial infarction can be measured in the majority of patients admitted to our Cardiology Department using the ESC ACCA quality indicators. Although most quality indicators are met in our patients, a large room for improvement is present in the reperfusion and invasive strategy (mainly in timely reperfusion of STEMI patients) and in the patient’s satisfaction (discharge letter sent to patient).
To cite this article: Calvani M, Cardinale F, Martelli A, Muraro A, Pucci N, Savino F, Zappalà D, Panetta V, the Italian Society of Pediatric Allergy and Immunology (SIAIP) anaphylaxis’ study group. ...Risk factors for severe pediatric food anaphylaxis in Italy. Pediatr Allergy Immunol 2011: 22: 813–819.
Background: Little is known about the cause of food‐induced anaphylaxis in children or about the factors that might affect its clinical severity.
Objective: The aim of this study was to investigate the cause of food‐induced anaphylaxis in children in Italy and to identify factors that could influence the appearance of symptoms and the severity of anaphylaxis.
Methods: One hundred and sixty‐three children with anaphylaxis consecutively attending 29 outpatient allergy clinics throughout Italy were enrolled in this prospective study. Information about past anaphylaxis episodes was collected with a standardized questionnaire. Food sensitization was evaluated by skin‐prick test.
Results: A clinical history of asthma increased the risk of wheezing odds ratio (OR) 2.2; 95% confidence interval (CI) 1.1–4.5 and respiratory arrest (OR 6.9; 95% CI 1.4–34.2). A clinical history of chronic/relapsing gastrointestinal symptoms increased the risk of vomiting (OR 2.1; 95% CI 0.9–4.3), hypotension (OR 7.9; 95% CI 1.9–32.0), and bradycardia/cardiac arrest (OR 9.2; 95% CI 0.9–91.3). The severity of present and previous episodes was similar only in patients with mild or moderate anaphylaxis. Peanut and egg were the most frequent causes of severe anaphylaxis.
Conclusions: A clinical history of asthma and chronic/relapsing gastrointestinal symptoms (probably linked to food allergy) may predict the development of respiratory and gastrointestinal symptoms and the severity of anaphylaxis.
To assess the effectiveness, safety and feasibility of the revised, simplified nurse-managed version of our insulin infusion protocol, adapted to the new recommended glycaemic target of 140 to 180 ...mg/dL (Desio Diabetes Diagram i.v. 140-180).
All clinical responses to the Desio Diabetes Diagram i.v. 140-180 in use for 3 years were recorded in patients with diabetes or hyperglycaemia admitted to our intensive cardiac care unit. To assess the feasibility, we asked nurses to complete an ad hoc questionnaire anonymously when the new insulin infusion protocol had been in use for 2 years.
From December 2010 to December 2013, 276 patients (173 men, median age 75 years) were treated according to the Desio Diabetes Diagram i.v. 140-180. The median time to reach glycaemic target was 4 h (Q1-Q3 2-8) in 128 patients with blood glucose >180 mg/dL and 2 h (Q1-Q3 1-4) in 82 patients with blood glucose <140 mg/dL. Once the target had been reached, insulin infusion was maintained for a median of 38 h (Q1-Q3 24-48) with blood glucose between 140 and 180 mg/dL for 58.3% of the infusion time. Over a total of 11,863 h of infusion, seven blood glucose <70 mg/dL occurred. The Desio Diabetes Diagram i.v. 140-180 protocol was considered easy to use by 93% of nurses.
The Desio Diabetes Diagram i.v. 140-180 protocol, fully managed by nurses, with insulin and glucose intravenous infusion proved effective, safe and feasible in maintaining blood glucose between 140 and 180 mg/dL in patients with diabetes or hyperglycaemia admitted to the intensive cardiac care unit for acute cardiac events.
Injection of polymers that selectively reduce the water permeability can be used to control water production from oil or gas wells. Because this method relies on the adsorption of a polymer layer ...onto the rock surface, a deeper understanding of the relevant polymer/rock interactions is of primary importance in order to develop reliable chemical selection rules for field applications. In this paper we study the role of electrostatic interactions and wettability in the adsorption of water-soluble polymers (bearing differently charged groups) onto solid surfaces of siliceous nature. By means of static adsorption tests, we show that the adsorption is dominated by the electrostatic interactions between the polymer molecules and the solid surface. We also show that lithology, brine composition and wettability are critical parameters that can influence the adsorption behavior at a brine/rock interface.
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