Clinical features, predictive factors and outcome of hyperglycaemic emergencies in a developing country

<p>Abstract</p> <p>Background</p> <p>Hyperglycaemic emergencies are common acute complications of diabetes mellitus (DM) but unfortunately, there is a dearth of published data on this entity from Nigeria. This study attempts to describe the clinical and laboratory scenario associated with this complication of DM.</p> <p>Methods</p> <p>This study was carried out in DM patients who presented to an urban hospital in Nigeria with hyperglycaemic emergencies (HEs). The information extracted included biodata, laboratory data and hospitalization outcome. Outcome measures included mortality rates, case fatality rates and predictive factors for HEs mortality. Statistical tests used are <it>χ</it>², Student's t test and logistic regression.</p> <p>Results</p> <p>A total of 111 subjects with HEs were recruited for the study. Diabetes ketoacidosis (DKA) and hyperosomolar hyperglycaemic state (HHS) accounted for 94 (85%) and 17 (15%) respectively of the HEs. The mean age (SD) of the subjects was 53.9 (14.4) years and their ages ranged from 22 to 86 years. DKA occurred in all subjects with type 1 DM and 73 (81%) of subjects with type 2 DM. The presence of HSS was noted in 17 (19%) of the subjects with type 2 DM.</p> <p>Hypokalaemia (HK) was documented in 41 (37%) of the study subjects. Elevated urea levels and hyponatraemia were noted more in subjects with DKA than in those subjects with HHS (57.5%,19% vs 53%,18%). The mortality rate for HEs in this report is 20% and the case fatality rates for DKA and HHS are 18% and 35% respectively.</p> <p>The predictive factors for HEs mortality include, sepsis, foot ulceration, previously undetected DM, hypokalaemia and being elderly.</p> <p>Conclusion</p> <p>HHS carry a higher case fatality rate than DKA and the predictive factors for hyperglycaemic emergencies' mortality in the Nigerian with DM include foot ulcers, hypokalaemia and being elderly.</p

Depressive Symptoms in Children with Chronic Kidney Disease

To assess depression in children with chronic kidney disease (CKD) and to determine associations with patient characteristics, intellectual and educational levels, and health related quality of life (HRQoL)

US International Trade and the Global Economic Crisis

World trade volume is in retreat for the first time in more than two decades and the contraction is on a scale not seen since the global recession following the second oil shock of 1979–1980. The United States (US) is at the epicenter of the crisis and is a major source of external demand for developing Asia and Pacific economies. US import and export data are examined to understand the repercussions of the crisis for international trade, particularly for export-oriented economies in East and Southeast Asia. US trade with preferential trade partners is found to be contracting significantly faster than trade with the rest of the world. Moreover, US imports that avail of preferential tariff treatment are also contracting more sharply than imports from non-preferential partners. Developing Asian non-preferential suppliers appear to be performing better in the US market than free trade agreement partners. If preferential trade is faltering and trade disputes are on the rise, the question becomes whether the multilateral trading system can ride to the rescue before protectionist forces begin to strangle world trade. The failure of bilateral free trade agreements to act as a shock absorber suggests that a new global trade deal may be the way forward. The outcome is crucial as the US will need to expand net exports to restore growth and unwind its global debt obligations