Unusually rapid β-cell failure in a patient newly diagnosed with type 2 diabetes presenting acutely with unprovoked severe hyperglycaemic hyperosmolar state: a case report

Pancreatic β-cell failure on a background of insulin resistance results in the inability to compensate for fasting hyperglycaemia and eventually produces type 2 diabetes mellitus. We describe an interesting case of a patient who presented acutely with unprovoked severe hyperglycaemic hyperosmolar state and was subsequently diagnosed with type 2 diabetes mellitus on a background of only impaired first phase insulin secretion 4 months prior. Glucagon stimulation test detected significant β-cell failure necessitating long term exogenous insulin therapy which is highly unusual by virtue of the rapid apparent deterioration

Does local implantation of gentamicin impair renal function in patients undergoing surgery for chronic bone infection?

Background: The treatment of chronic bone infection often involves excision of dead bone and implantation of biomaterials which elute antibiotics. Gentamicin is a preferred drug for local delivery, but its systemic use carries a well-established risk of nephrotoxicity.  We aim to establish the risk of acute kidney injury (AKI) with local delivery in a ceramic carrier.Methods: 163 patients with Cierny-Mader type 3 or 4 chronic osteomyelitis had a single-stage operation including filling of the osseous defect with a calcium sulphate-hydroxyapatite carrier containing gentamicin. Mean gentamicin dosing was 191.3 mg (maximum 525 mg). Glomerular filtration rate (GFR) was calculated pre-operatively and during the first seven days post-operatively. Renal impairment was graded using the chronic kidney disease (CKD) staging system, and AKI was assessed using the RIFLE criteria.Results: 155 cases had adequate data to allow calculation of pre- and post-operative GFR. 7 had pre-existing renal disease. 70 patients (45.2%) had a temporary GFR drop post-operatively, with the greatest decrease occurring at a mean of 3.06 days following surgery. Twenty cases had a >10% decline in GFR, but 12 resolved within 7 days. 7 patients transiently fell into the “Risk” category according to RIFLE criteria, but no patient had a change consistent with “Injury”, “Failure” or “Loss” of renal function and none had clinical signs of new acute renal impairment post-operatively. Conclusions: Renal function is not significantly affected by local implantation of gentamicin up to 525 mg. The presence of pre-existing renal disease is not a contraindication to local gentamicin therapy.

Modulation of mitochondrial activity in HaCaT keratinocytes by the cell penetrating peptide Z-Gly-RGD(DPhe)-mitoparan.

OBJECTIVE: Biologically active cell penetrating peptides (CPPs) are an emerging class of therapeutic agent. The wasp venom peptide mastoparan is an established CPP that modulates mitochondrial activity and triggers caspase-dependent apoptosis in cancer cells, as does the mastoparan analogue mitoparan (mitP). Mitochondrial depolarisation and activation of the caspase cascade also underpins the action of dithranol, a topical agent for treatment of psoriasis. The effects of a potent mitP analogue on mitochondrial activity were therefore examined to assess its potential as a novel approach for targeting mitochondria for the treatment of psoriasis. RESULTS: In HaCaT keratinocytes treated with the mitP analogue Z-Gly-RGD(DPhe)-mitP for 24 h, a dose-dependent loss of mitochondrial activity was observed using the methyl-thiazolyl-tetrazolium (MTT) assay. At 10 μmol L-1, MTT activity was less than 30% that observed in untreated cells. Staining with the cationic dye JC-1 suggested that Z-Gly-RGD(DPhe)-mitP also dissipated the mitochondrial membrane potential, with a threefold increase in mitochondrial depolarisation levels. However, caspase activity appeared to be reduced by 24 h exposure to Z-Gly-RGD(DPhe)-mitP treatment. Furthermore, Z-Gly-RGD(DPhe)-mitP treatment had little effect on overall cell viability. Our findings suggest Z-Gly-RGD(DPhe)-mitP promotes the loss of mitochondrial activity but does not appear to evoke apoptosis in HaCaT keratinocytes

Factors influencing community case management and care hours for clients with traumatic brain injury living in the UK

Objective: To investigate the relationship between deficits associated with traumatic brain injury (TBI) and case management (CM) and care/support (CS) in two UK community samples. Research design: Prospective descriptive study. Method: Case managers across the UK and from a single UK CM service contributed client profiles to two data sets (Groups 1 and 2, respectively). Data were entered on demographics, injury severity, functional skills, functional-cognition (including executive functions), behaviour and CM and CS hours. Relationships were explored between areas of disability and service provision. Results: Clients in Group 2 were more severely injured, longer post-injury and had less family support than clients in Group 1. There were few significant differences between Groups 1 and 2 on measures of Functionalskill, Functional-cognition and Behaviour disorder. Deficits in Functionalskills were associated with CS, but not CM. Deficits in measures of executive functions (impulsivity, predictability, response to direction) were related to CM, but not to CS. Insight was related to both CM and CS. Variables related to behaviour disorder were related to CM, but were less often correlated to CS. Conclusions: The need for community support is related not only to Functionalskills (CS), but also to behaviour disorder, self-regulatory skills and impaired insight (CM)

Risk Factors of Pancreatic Cancer: A Literature Review

Objective: To identify and compare current modifiable and non-modifiable risk factors for pancreatic cancer (PaCa) that may have potential application in PaCa risk stratification, prevention, and early detection. / Material: All articles in this literature review were identified through systematic searches of PubMed, Medline, and Embase databases. All articles were published in the English language, between January 2000 to December 2021 and with an abstract. In this review study, we judge the evidence level of different PaCa risk factors through the criteria of grading evidence for cancer prevention. / Results: The modifiable risk factors identified included cigarette smoking, heavy alcohol consumption, increased Body Mass Index (BMI) and abdominal obesity, chronic pancreatitis, diabetes, hepatitis B virus (HBV) infection, periodontal disease, cholecystectomy and chemicals and asbestos exposure. The non-modifiable risk factors included age, gender, ethnicity, blood type, family history, inherited syndromes, germline mutation, and single nucleotide polymorphisms (SNPs). However, there are still some ambiguous risk factors for which the current evidence is inconclusive such as low physical activity, increased consumption of red/processed meat and dairy products, vitamin D insufficiency, and some medical-related conditions including gut microbiota such as Helicobacter Pylori infection, long-term usage of Proton-pump inhibitors (PPI), and Systemic Lupus Erythematosus (SLE) history. / Conclusions: This literature review summarizes the modifiable and non-modifiable risk factors of PaCa with strong evidence, which could be used to further establish PaCa predictive model as an application of PaCa risk stratification, raise public awareness and educate the public as a prevention program. Further studies are needed to investigate other potential risk factors

Establishing a Smartphone Ambulatory ECG Service for Patients Presenting to the Emergency Department with Pre-Syncope and Palpitations

Background and Objectives: The Investigation of Palpitations in the ED (IPED) study showed that a smartphone-based event recorder increased the number of patients in whom an electrocardiogram (ECG) was captured during symptoms over five-fold to more than 55% at 90 days compared to standard care and concluded that this safe, non-invasive and easy-to-use device should be considered part of on-going care to all patients presenting acutely with unexplained palpitations or pre-syncope. This study reports the process of establishing a smartphone palpitation and pre-syncope ambulatory care Clinic (SPACC) service. Materials and Methods: A clinical standard operating procedure (SOP) was devised, and funding was secured through a business case for the purchase of 40 AliveCor devices in the first instance. The clinic was launched on 22 July 2019. Results: Between 22 July 2019 and 31 October 2019, 68 patients seen in the emergency departments (EDs) with palpitations or pre-syncope were referred to SPACC. Of those, 30 were male and 38 were female, and the mean age was 45.8 years old (SD 15.1) with a range from 18 years old to 80 years old. A total of 50 (74%) patients underwent full investigation. On the first assessment, seven (10%) patients were deemed to have non-cardiac palpitations and were not fitted with the device. All patients who underwent full investigation achieved symptomatic rhythm correlation most with sinus rhythm, ventricular ectopics, or bigeminy. A symptomatic cardiac dysrhythmia was detected in six (8.8%) patients. Three patients had supraventricular tachycardia (4%), two had atrial fibrillation (3%), and one had atrial flutter (2%). Qualitative feedback from the SPACC team suggested several areas where improvement to the clinic could be made. Conclusion: We believe a smartphone palpitation service based on ambulatory care is simple to implement and is effective at detecting cardiac dysrhythmia in ED palpitation patients

Social and Economic Issues in Aquaculture Development for Coastal Communities of Tabasco, Mexico

Following an assessment of Mexican water resources by governmental agencies in the late 1940’s, Tabasco State was identified as a potential area for aquaculture development, as the State holds 30% of National water resources and an important share of Southeast Mexican fisheries, particularly for oyster production. However, conflicts and competition for coastal resources between the expanding oil industry and fishing communities are escalating, with consequences including severe environmental degradation. Though a number of aquaculture-linked development initiatives have been promoted, evidence suggests that issues of social benefit, integrated development and livelihood enhancement are poorly understood. This paper reports the findings of preliminary social and economic surveys of coastal communities engaged in aquaculture operations, and suggests that current approaches are unlikely to deliver benefit effectively as key issues have not been addressed. Preliminary recommendations are made based on trends and issues of particular importance to coastal communities, to improve livelihoods through better access to resources and infrastructure.Keywords: Aquaculture, socio-economics, development, Mexico, extension and researc