Undiagnosed diabetes mellitus among residents in Taiwanese long-term care facilities: A comparison of fasting glucose, postprandial plasma glucose, and hemoglobin A1c

AbstractBackgroundThe prevalence of diabetes mellitus (DM) is escalating with an aging population, and the chances of diabetic older patients admitted to long-term care facilities (LTCFs) are increased because of DM-related complications. However, undiagnosed DM among LTCF residents is a recognized hidden problem in this setting and may result in adverse outcomes.MethodsIn May 2011, 10 private LTCFs in northern Taipei participated in this study. Trained research nurses reviewed the medical records and performed physical examinations and blood sampling for all participants. Diabetes mellitus was diagnosed, based on the levels of fasting glucose, 2-hour postprandial plasma glucose, and hemoglobin A1c (HbA1c). Patients were categorized as having DM if they met the diagnostic cut-offs of the aforementioned criteria.ResultsOne hundred and ninety-nine residents (mean age, 79.6 ± 10.5 years; 52.3% males) participated in this study. They were all moderately/severely disabled (Karnofsky Performance Scale mean score was 50 ± 13). Forty-six (23.1%) residents were diabetic, based on their medical records, or were current users of antidiabetic agents. The prevalence was 29.6% after testing with a mean HbA1c level of 6.9% ± 0.9%. The overall undiagnosed DM rate was 4%, 3.5%, and 4.5%, based on fasting glucose, 2-hour postprandial plasma glucose, and HbA1c criteria, respectively. Diabetic patients had significantly higher serum levels of prealbumin, compared to nondiabetic patients (220.8 ± 45.9 vs. 201.1 ± 62.2 mg/L; p = 0.03), but there were no differences in the levels of hemoglobin, serum albumin, or total cholesterol. Diabetic patients had a significantly higher serum triglyceride level, compared to the nondiabetic patients (1.6 ± 0.7 vs. 1.1 ± 0.5 mmol/L; p < 0.01) and a lower high-density lipoprotein level (1.0 ± 0.3 vs. 1.2 ± 0.3 mmol/L; p < 0.01). Among 43 pharmacologically treated diabetic patients, 65.1% (28/43) of patients were using oral antidiabetic agents and 41.9% (18/43) of patients had been prescribed insulin, whereas 32.6% of the patients were managed by combination therapy.ConclusionThe prevalence of DM among LTCF residents in Taipei was 29.6%, and the undiagnosed rate was no more than 5%, based on fasting glucose, 2-hour postprandial plasma glucose, or HbA1c. Further study is needed for the optimal treatment strategy of DM in LTCFs

Impact of Metallic Furniture on UWB Channel Statistical Characteristics

[[abstract]]The bit error rate (BER) performance for ultra-wide band (UWB) indoor communication with the impact of metallic furniture is investigated. The impulse responses of different indoor environments for any transmitter and receiver location are computed by shooting and bouncing ray/image and inverse fast Fourier transform (IFFT) techniques. By using the impulse responses of these multi-path channels, the BER performance for binary pulse amplitude modulation (BPAM) impulse radio UWB communication system are calculated. Numerical results have shown that the multi-path effect by the metallic cabinets is an important factor for BER performance. Also the outage probability for the UWB multi-path environment with metallic cabinets is larger than that with wooden cabinets. Finally, it is worth noting that in these cases the present work provides not only comparative information but also quantitative information on the performance reduction.[[notice]]補正完畢[[incitationindex]]EI[[booktype]]紙

Quantum Anomalous Hall Effect in Hg1−y_{1-y}Mny_{y}Te Quantum Wells

The quantum Hall effect is usually observed when the two-dimensional electron gas is subjected to an external magnetic field, so that their quantum states form Landau levels. In this work we predict that a new phenomenon, the quantum anomalous Hall effect, can be realized in Hg$_{1-y}$Mn$_{y}$Te quantum wells, without the external magnetic field and the associated Landau levels. This effect arises purely from the spin polarization of the $Mn$ atoms, and the quantized Hall conductance is predicted for a range of quantum well thickness and the concentration of the $Mn$ atoms. This effect enables dissipationless charge current in spintronics devices.Comment: 5 pages, 3 figures. For high resolution figures see final published version when availabl

Nondiabetic older adults with untreated hypertension in Taiwan: Treatment implication in elderly hypertension

AbstractBackgroundHypertension is common and often left undiagnosed in the elderly. The main purpose of this study was to evaluate the clinical characteristics of nondiabetic hypertensive older adults.MethodsCommunity-living older adults in Taipei City participating in annual health examinations were invited for study. Subjects with diabetes mellitus, whether treated or newly diagnosed, were excluded for further analysis. All participants were classified into three groups: normotension, untreated hypertension (UH), and treated hypertension (TH).ResultsIn total, 3244 subjects (mean age: 73.4±5.4 years, 56.2% males) were enrolled. The prevalence of hypertension, chronic kidney disease (CKD), and left ventricular hypertrophy (LVH) was 52.9% (36.1% TH and 16.8% UH), 20.9%, and 6.2%, respectively. Compared with the normotension group, UH subjects were older (73.8±5.5 years vs. 72.9±5.6 years, p=0.003); having higher body mass index (24.2±3.4kg/m2 vs. 23.6±3.4kg/m2, p=0.001), fasting glucose (101.7±9.1mg/dL vs. 100.5±9.0mg/dL, p=0.007), total cholesterol (TC) (205.0±37.8mg/dL vs. 196.5±36.4mg/dL, p<0.001), triglyceride (TG) (134.5±84.9mg/dL vs. 119.4±77.0mg/dL, p<0.001); and higher prevalence of overt proteinuria (19.3% vs. 13.5%, p=0.001), CKD (21.1% vs. 16.6%, p=0.025), and LVH (8.1% vs. 3.8%, p<0.001). However, the prevalence of overt proteinuria (19.3% vs. 21.1%, p=0.378) and LVH (8.1% vs. 8.5%, p=0.79) between UH and TH groups was similar. Adjusted for age, TC, TG, fasting plasma glucose, and the incidence of LVH, both UH [odds ratio (OR)=1.30, 95% confidence interval (CI)=1.01–1.66, p=0.040] and TH (OR=1.69, 95% CI=1.39–2.05, p<0.001) were significant risk factor for CKD. In addition, independent risk factors for CKD included age (OR=1.07, 95% CI=1.05–1.09, p<0.001), body mass index (OR=1.07, 95% CI=1.04–1.10, p<0.001), TC (OR=1.003, 95% CI=1.001–1.005, p=0.021), TG (OR=1.002, 95% CI=1.001–1.003, p<0.001), and hypertension (TH or UH) (OR=1.44, 95% CI=1.20–1.72, p<0.001).ConclusionIn conclusion, risk of CKD existing along with blood pressure rises among nondiabetic older hypertensive adults, and hypertension (TH or UH) carries a significant risk of CKD after adjustment of other cardiovascular risk factors. Renal protection should be highlighted in the antihypertensive treatment strategy in older hypertensive patients

Cataract surgery utilization after acute stroke: A nationwide cohort study

AbstractBackgroundCataract is a common and correctable ophthalmological condition that is associated with a poor quality of life and shortened life expectancy in older people. However, little is known regarding the use of cataract surgery in stroke patients after the incident event.MethodsA national cohort of 5462 patients who had experienced an acute stroke event without severe physical disability between 2000 and 2003, and 26,434 randomly selected age- and sex-matched controls were obtained from a random population-based sample of the National Health Insurance database in Taiwan. Multivariate Cox proportional hazard regression analysis was used to assess the association between stroke events and cataract surgery.ResultsAfter a 5-year follow-up, 482 stroke patients (8.8%) and 1897 controls (7.2%) had received cataract surgery after the index dates of their stroke. The incidence of subsequent cataract surgery following acute stroke was 27% higher than that in the comparison group (crude hazard ratio 1.27; p < 0.001). Adjusted for age, sex, co-morbid medical diseases, use of systemic steroids, exposure to radiation during computed tomography, and socioeconomic status, the incidence of cataract surgery in the stroke patients was 30% higher than that in the comparison group (adjusted hazard ratio 1.30; p < 0.001).ConclusionA 30% increase in the use of cataract surgery was noted among the survivors of acute stroke with mild-to-moderate disabilities, which may result from the increased need for better vision after stroke

Simultaneous Penile Gangrene and Testicular Infarction Secondary to Calciphylaxis in a Uremic Patient

We report here a 46-year-old man with end stage renal disease (ESRD) secondary to type 2 diabetes, who had been on hemodialysis for 5 years. He had a painful glans lesion for 1 week. Five days later, he also complained of right testicular pain. Computed tomography of the pelvis demonstrated calcification of both penile arteries. Scrotal sonography revealed right testicular infarction. He received partial penectomy and right orchiectomy because of progressive lesions and intractable pain. Pathologic examination revealed testicular and penile tissue with necrotizing inflammation accompanied by multifocal calcification in the tunica media, compatible with calciphylaxis. This is the first report to document simultaneous penile gangrene and testicular infarction secondary to calciphylaxis

A rare, highly aggressive primitive neuroectodermal tumor of the kidney: Case report and literature review

AbstractWe report a case of a 14-year-old boy who initially suffered from a sudden onset of abdominal pain for 2 weeks with a protrusive soft mass over the left upper abdomen. No obvious symptomatic symptoms or body weight loss were observed. However, early lung metastasis was detected after an initial computed tomographic examination. Even after we performed salvage en bloc resection of the huge retroperitoneal tumor after primary neoadjuvant chemotherapy, the final outcome was still poor. A diagnosis according to radiologic findings was uncharacteristic. Finally, a pathologic diagnosis based on histologic and immunohistochemical results revealed a rare renal peripheral primitive neuroectodermal tumor