Hyperosmolar hyperglycemic syndrome: A comprehensive review of clinical presentation, diagnosis, and treatment strategies in hyperglycemic crises

Introduction and Purpose Hyperosmolar Hyperglycemic State (HHS), a severe type 2 diabetes complication, presents with profound hyperglycemia, hyperosmolality, and dehydration sans ketosis, posing distinct challenges in diagnosis and treatment compared to diabetic ketoacidosis (DKA). This article aims to enhance medical community awareness by examining HHS features, prevalence, and associated risk factors, contributing to improved clinical management. Emphasizing tailored treatment strategies for dehydration, coexisting illnesses, and metabolic decompensation, it ultimately seeks to enhance outcomes for type 2 diabetes individuals. Material and methods Conducting a systematic review of medical articles from 1972 to 2023 using PubMed, this study analyzed keywords such as hyperglycemic hyperosmolar state, HHS, diabetes mellitus, hyperglycemia, and dehydration. Inclusion of pertinent articles ensured a comprehensive exploration of Hyperosmolar Hyperglycemic State (HHS) literature during the specified timeframe. Brief description of the state of knowledge. Hyperosmolar Hyperglycemic Syndrome (HHS) predominantly affects elderly type 2 diabetes individuals, often triggered by infections like pneumonia or urinary tract infections. Clinical presentation includes fatigue, weakness, polydipsia, polyuria, nausea, and altered consciousness. Diagnosis relies on criteria such as elevated blood glucose levels and increased osmolality. HHS management involves a multidisciplinary approach, addressing fluid depletion, compromised cerebral perfusion, and achieving gradual normalization of osmolality and blood glucose levels to prevent complications. Summary Hyperosmolar Hyperglycemic Syndrome (HHS), a severe metabolic disorder linked to diabetes, extends beyond hyperglycemia, necessitating a comprehensive understanding. This review sheds light on HHS etiology, clinical manifestations, diagnostic criteria, and treatment modalities, emphasizing its critical nature in diabetes care

The Genetic Characterization of the First Detected Bat Coronaviruses in Poland Revealed SARS-Related Types and Alphacoronaviruses

Bats are a major global reservoir of alphacoronaviruses (alphaCoVs) and betaCoVs. Attempts to discover the causative agents of COVID-19 and SARS have revealed horseshoe bats (Rhinolophidae) to be the most probable source of the virus. We report the first detection of bat coronaviruses (BtCoVs) in insectivorous bats in Poland and highlight SARS-related coronaviruses found in Rhinolophidae bats. The study included 503 (397 oral swabs and 106 fecal) samples collected from 20 bat species. Genetically diverse BtCoVs (n = 20) of the Alpha- and Betacoronavirus genera were found in fecal samples of two bat species. SARS-related CoVs were in 18 out of 58 lesser horseshoe bat (Rhinolophus hipposideros) samples (31%, 95% CI 20.6–43.8), and alphaCoVs were in 2 out of 55 Daubenton’s bat (Myotis daubentonii) samples (3.6%, 95% CI 0.6–12.3). The overall BtCoV prevalence was 4.0% (95% CI 2.6–6.1). High identity was determined for BtCoVs isolated from European M. daubentonii and R. hipposideros bats. The detection of SARS-related and alphaCoVs in Polish bats with high phylogenetic relatedness to reference BtCoVs isolated in different European countries but from the same species confirms their high host restriction. Our data elucidate the molecular epidemiology, prevalence, and geographic distribution of coronaviruses and particularly SARS-related types in the bat population