Efficacy of treatment for hyperglycemic crisis in elderly diabetic patients in a day hospital

The purpose of this prospective cohort study was to compare the costs of day hospital (DH) care for hyperglycemic crisis in elderly diabetic patients with those of conventional hospitalization (CH). Secondary objectives were to compare these two clinical scenarios in terms of glycemic control, number of emergency and outpatient visits, readmissions, hypoglycemic episodes, and nosocomial morbidity. The study population comprised diabetic patients aged >74 years consecutively admitted to a tertiary teaching hospital in Spain for hyperglycemic crisis (sustained hyperglycemia [>300 mg/dL] for at least 3 days with or without ketosis). The patients were assigned to DH or CH care according to time of admission and were followed for 6 months after discharge. Exclusion criteria were ketoacidosis, hyperosmolar crisis, hemodynamic instability, severe intercurrent illness, social deprivation, or Katz index >D. Sixty-four diabetic patients on DH care and 36 on CH care were included, with no differences in baseline characteristics. The average cost per patient was 1,345.1±793.6 € in the DH group and 2,212.4±982.5 € in the CH group (P <0.001). There were no differences in number of subjects with mild hypoglycemia during follow-up (45.3% DH versus 33.3% CH, P =0.24), nor in the percentage of patients achieving a glycated hemoglobin (HbA) <8% (67.2% DH versus 58.3% CH, P =0.375). Readmissions for hyperglycemic crisis and pressure ulcer rates were significantly higher in the CH group. DH care for hyperglycemic crises is more cost-effective than CH care, with a net saving of 1,418.4 € per case, lower number of readmissions and pressure ulcer rates, and similar short-term glycemic control and hypoglycemia rates

High-level production of recombinant His-tagged rhamnulose 1-phosphate aldolase in Escherichia coli

9 pages, 8 figures, 2 tables.-- Printed version published Nov 2003.An expression system based on Escherichia coli and the T5 promoter allowed the overproduction of a his-tagged rhamnulose-1-phosphate aldolase (RhuA; EC 4.1.2.19), an enzyme with applications in the production of deoxyazasugars and deoxysugars compounds. Shake flask and bioreactor cultivation with E coli M15 (pQErham) were performed under different media and inducing conditions for RhuA expression. A Defined Medium (DM) with glucose as carbon source gave a high volumetric and enzyme productivity (3460 AU dm-3 and 288 AU dm-3 h-1 respectively) compared with Luria-Bertoni (LB) medium (2292 AU dm- 3 and 255 AU dm-3 h-1). The minimum quantity of (isopropyl--D-thiogalactoside) IPTG for optimal induction was estimated in 18-20 ºmol IPTG gDCW-1. The highest volumetric production of RhuA (8333 AU dm-3) was obtained when IPTG was added in the late log-phase. No significant differences were found in specific RhuA activity for induction temperatures of 30 and 37 ºC. An effective two-step purification process comprising affinity chromatography and gel permeation has been developed (overall recovery 66.5%). These studies provide the basis for the further development of an integrated process for recombinant RhuA production suitable for biotransformation applications.Financial support from CICYT (Projects: BIO99-1219-C02-01 and PPQ 2002-04625-C02-01). The Department of Chemical Engineering is the Unit of Biochemical Engineering of the Centre de Referència en Biotecnologia de la Generalitat de Catalunya (CeRBa).Peer reviewe

Efficacy of treatment for hyperglycemic crisis in elderly diabetic patients in a day hospital

D Benaiges,1&ndash;3 JJ Chillar&oacute;n,1&ndash;3 MJ Carrera,1,3 F Cots,3,4 J Puig de Dou,1 E Corominas,1 J Pedro-Botet,1&ndash;3 JA Flores-Le Roux,1&ndash;3 C Claret,1 A Goday,1&ndash;3 JF Cano1&ndash;3 1Department of Endocrinology and Nutrition, Hospital del Mar, 2Department of Medicine, Universitat Aut&ograve;noma de Barcelona, 3Institut Hospital del Mar d&rsquo;Investigacions M&egrave;diques, 4Epidemiology and Evaluation Department, Parc de Salut Mar, Barcelona, Spain Background:&nbsp;The purpose of this prospective cohort study was to compare the costs of&nbsp;day hospital (DH) care for hyperglycemic crisis in elderly diabetic patients with those of conventional hospitalization (CH). Secondary objectives were to compare these two clinical scenarios in terms of glycemic control, number of emergency and outpatient visits, readmissions, hypoglycemic episodes, and nosocomial morbidity. Methods: The study population comprised diabetic patients aged &gt;74&nbsp;years consecutively admitted to a tertiary teaching hospital in Spain for hyperglycemic crisis (sustained hyperglycemia [&gt;300&nbsp;mg/dL] for at least&nbsp;3&nbsp;days with or without ketosis). The patients were assigned to DH or CH care according to time of admission and were followed for&nbsp;6&nbsp;months after discharge. Exclusion criteria were ketoacidosis, hyperosmolar crisis, hemodynamic instability, severe intercurrent illness, social deprivation, or Katz index &gt;D.Results: Sixty-four diabetic patients on DH care and&nbsp;36&nbsp;on CH care were included, with no differences in baseline characteristics. The average cost per patient was&nbsp;1,345.1&plusmn;793.6&nbsp;&euro; in the DH group and&nbsp;2,212.4&plusmn;982.5&nbsp;&euro; in the CH group (P&lt;0.001). There were no differences in number of subjects with mild hypoglycemia during follow-up (45.3% DH versus&nbsp;33.3% CH, P=0.24), nor in the percentage of patients achieving a glycated hemoglobin (HbA1c) &lt;8% (67.2% DH versus&nbsp;58.3% CH, P=0.375). Readmissions for hyperglycemic crisis and pressure ulcer rates were significantly higher in the CH group.Conclusion: DH care for hyperglycemic crises is more cost-effective than CH care, with a net saving of&nbsp;1,418.4&nbsp;&euro; per case, lower number of readmissions and pressure ulcer rates, and similar short-term glycemic control and hypoglycemia rates. Keywords: day hospital, conventional hospitalization, hyperglycemic crisi