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| 1 | Sodium-glucose co-transporter 2 inhibitors induced euglycemic diabetic ketoacidosis within four days of initiation显示文摘Euglycemic diabetic ketoacidosis(EDKA)is a well-known complication of sodium-glucose co-transporter 2 inhibitors,and many cases with variable onset following the initiation of these agents are reported before,with a median onset of approximately 2 wk.This letter discusses a 45-year-old lady who initially presented with ischemic stroke but developed EDKA 4 d after starting empagliflozin,a rare occurrence.The patient had severe metabolic acidosis that necessitated admission into the intensive care unit.Prompt discontinuation of empagliflozin and DKA management resulted in clinical recovery. | Almurtada Razok Fateen Ata Sara Mohamed Ibrahim Ahmed Dabia Hamad S H Al Mohanadi | 2022 | World Journal of Diabetes2022，13，3： | 1 |
| 2 | Digestive system involvement and clinical outcomes among COVID-19 patients:A retrospective cohort study from Qatar显示文摘BACKGROUND Coronavirus disease 2019(COVID-19)caused by the severe acute respiratory syndrome coronavirus 2 virus most commonly presents with respiratory symptoms.While gastrointestinal(GI)manifestations either at presentation or during hospitalization are also common,their impact on clinical outcomes is controversial.Some studies have described worse outcomes in COVID-19 patients with GI symptoms,while others have shown either no association or a protective effect.There is a need for consistent standards to describe GI symptoms in COVID-19 patients and to assess their effect on clinical outcomes,including mortality and disease severity.AIM To investigate the prevalence of GI symptoms in hospitalized COVID-19 patients and their correlation with disease severity and clinical outcomes.METHODS We retrospectively reviewed 601 consecutive adult COVID-19 patients requiring hospitalization between May 1-15,2020.GI symptoms were recorded at admission and during hospitalization.Demographic,clinical,laboratory,and treatment data were retrieved.Clinical outcomes included all-cause mortality,disease severity at presentation,need for intensive care unit(ICU)admission,development of acute respiratory distress syndrome,and need for mechanical ventilation.Multivariate logistic regression model was used to identify independent predictors of the adverse outcomes.RESULTS The prevalence of any GI symptom at admission was 27.1%and during hospitalization was 19.8%.The most common symptoms were nausea(98 patients),diarrhea(76 patients),vomiting(73 patients),and epigastric pain or discomfort(69 patients).There was no difference in the mortality between the two groups(6.21%vs 5.5%,P=0.7).Patients with GI symptoms were more likely to have severe disease at presentation(33.13%vs 22.5%,P<0.001)and prolonged hospital stay(15 d vs 14 d,P=0.04).There was no difference in other clinical outcomes,including ICU admission,development of acute respiratory distress syndrome,or need for mechanical ventilation.Drugs associated with the development of GI symptoms during hospitalization were ribavirin(diarrhea 26.37%P<0.001,anorexia 17.58%,P=0.02),hydroxychloroquine(vomiting 28.52%,P=0.009)and lopinavir/ritonavir(nausea 32.65%P=0.049,vomiting 31.47%P=0.004,and epigastric pain 12.65%P=0.048).In the multivariate regression analysis,age>65 years was associated with increased mortality risk[odds ratio(OR)7.53,confidence interval(CI):3.09-18.29,P<0.001],ICU admission(OR:1.79,CI:1.13-2.83,P=0.012),and need for mechanical ventilation(OR:1.89,CI:1.94-2.99,P=0.007).Hypertension was an independent risk factor for ICU admission(OR:1.82,CI:1.17-2.84,P=0.008)and need for mechanical ventilation(OR:1.66,CI:1.05-2.62,P=0.028).CONCLUSION Patients with GI symptoms are more likely to have severe disease at presentation;however,mortality and disease progression is not different between the two groups. | Muhammad Umair Khan Kamran Mushtaq Deema Hussam Alsoub Phool Iqbal Fateen Ata Hammad Shabir Chaudhry Fatima Iqbal Girisha Balaraju Muna A Al Maslamani Betsy Varughese Rajvir Singh Khalid Al Ejji Saad Al Kaabi Yasser Medhat Kamel Adeel Ajwad Butt | 2021 | World Journal of Gastroenterology2021，27，46： | 1 |
| 3 | Migraine in physicians and final year medical students:A crosssectional insight into prevalence,self-awareness,and knowledge from Pakistan显示文摘BACKGROUND Despite its high prevalence,migraine remains underdiagnosed worldwide.A significant reason is the knowledge gap in physicians regarding diagnostic criteria,clinical features,and other clinical aspects of migraine.AIM To measure the knowledge deficit in physicians and medical students and to assess the prevalence of migraine in the same population.METHODS An online questionnaire was developed and distributed among physicians and final year medical students on duty in various medical and surgical specialties of Allied and DHQ Hospitals,Faisalabad,between October 2018 and October 2019.Inclusion criteria were public practicing physicians who experience headaches,while those who never experienced headaches were excluded.Different questions assessed respondents on their knowledge of triggers,diagnosis,management,and prophylaxis of the migraine headache.They were asked to diagnose themselves using embedded ICHD-3 diagnostic criteria for different types of migraine.Graphs,tables,and figures were made using Microsoft Office 2016 and Microsoft Visio,and data analysis was done in R Studio 1.4.RESULTS We had 213 respondents and 175 fulfilled inclusion criteria,with 99(52%),58(30%)and 12(6.3%)belonging to specialties of medicine,surgery,and others,respectively.Both genders were symmetrically represented(88 male and 87 female).Fifty-two(24.4%)of our 213 respondents were diagnosed with migraine,with 26(50%)being aware of it.Females had higher prevalence among study participants(n=28,32.2%)compared to males(n=20,22.7%,P=0.19).A majority(62%)of subjects never consulted any doctor for their headache.Similarly,a majority(62%)either never heard or did not remember the diagnostic criteria of migraine.Around 38%falsely believed that having any type of aura is essential for diagnosing migraine.The consultation rate was 37%(n=65),and migraineurs were significantly more likely to have consulted a doctor,and a neurologist in particular(P<0.001).Consulters and migraineurs fared better in the knowledge of diagnostic aspects of the disease than their counterparts.There was no significant difference in other knowledge aspects between consulters versus non-consulters and migraineurs versus nonmigraineurs.CONCLUSION Critical knowledge gaps exist between physicians and medical students,potentially contributing to misdiagnosis and mismanagement of migraine. | Hassan Choudry Fateen Ata Muhammad Naveed Naveed Alam Ruqaiya Ruqaiya Mahammed Khan Suheb Muhammad Qaiser Ikram Muhammad Muzammil Chouhdry Muaz Muaz | 2022 | World Journal of Methodology2022，12，5： | 1 |
| 4 | Clinical and biochemical predictors of intensive care unit admission among patients with diabetic ketoacidosis显示文摘BACKGROUND Diabetic ketoacidosis(DKA)contributes to 94%of diabetes-related hospital admissions,and its incidence is rising.Due to the complexity of its management and the need for rigorous monitoring,many DKA patients are managed in the intensive care unit(ICU).However,studies comparing DKA patients managed in ICU to non-ICU settings show an increase in healthcare costs without significantly affecting patient outcomes.It is,therefore,essential to identify suitable candidates for ICU care in DKA patients.AIM To evaluate factors that predict the requirement for ICU care in DKA patients.METHODS This retrospective study included consecutive patients with index DKA episodes who presented to the emergency department of four general hospitals of Hamad Medical Corporation,Doha,Qatar,between January 2015 and March 2021.All adult patients(>14 years)fulfilling the American Diabetes Association criteria for DKA diagnosis were included.RESULTS We included 922 patients with DKA in the final analysis,of which 229(25%)were managed in the ICU.Compared to non-ICU patients,patients admitted to ICU were older[mean(SD)age of 40.4±13.7 years vs 34.5±14.6 years;P<0.001],had a higher body mass index[median(IQR)of 24.6(21.5-28.4)kg/m2 vs 23.7(20.3-27.9)kg/m2;P<0.030],had T2DM(61.6%)and were predominantly males(69%vs 31%;P<0.020).ICU patients had a higher white blood cell count[median(IQR)of 15.1(10.2-21.2)×103/uL vs 11.2(7.9-15.7)×103/uL,P<0.001],urea[median(IQR)of 6.5(4.6-10.3)mmol/L vs 5.6(4.0-8.0)mmol/L;P<0.001],creatinine[median(IQR)of 99(75-144)mmol/L vs 82(63-144)mmol/L;P<0.001],C-reactive protein[median(IQR)of 27(9-83)mg/L vs 14(5-33)mg/L;P<0.001]and anion gap[median(IQR)of 24.0(19.2-29.0)mEq/L vs 22(17-27)mEq/L;P<0.001];while a lower venous pH[mean(SD)of 7.10±0.15 vs 7.20±0.13;P<0.001]and bicarbonate level[mean(SD)of 9.2±4.1 mmol/L vs 11.6±4.3 mmol/L;P<0.001]at admission than those not requiring ICU management of DKA(P<0.001).Patients in the ICU group had a longer LOS[median(IQR)of 4.2(2.7-7.1)d vs 2.0(1.0-3.9)d;P<0.001]and DKA duration[median(IQR)of 24(13-37)h vs 15(19-24)h,P<0.001]than those not requiring ICU admission.In the multivariate logistic regression analysis model,age,Asian ethnicity,concurrent coronavirus disease 2019(COVID-19)infection,DKA severity,DKA trigger,and NSTEMI were the main predicting factors for ICU admission.CONCLUSION In the largest tertiary center in Qatar,25%of all DKA patients required ICU admission.Older age,T2DM,newly onset DM,an infectious trigger of DKA,moderate-severe DKA,concurrent NSTEMI,and COVID-19 infection are some factors that predict ICU requirement in a DKA patient. | Adeel Ahmad Khan Fateen Ata Phool Iqbal Mohammed Bashir Anand Kartha | 2023 | World Journal of Diabetes2023，14，3： | 0 |
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