Elevated beta-hydroxybutyric acid with no ketoacidosis in type 2 diabetic patients using sodium-glucose cotransporter-2 inhibitors

SGLT2 inhibitor (SGLT2i) class of medications are known to cause to euglycemic diabetic ketoacidosis (euDKA) as reported in the article by Lin et al. in your esteemed publication about this entity being reported for the first time in Taiwanese population.We wish to share the findings from our center to further expand the spectrum of findings associated with SGLT2i therapy

Alternative treatment modality for periocular infantile hemangioma

Background: Capillary hemangiomas are the most common tumors of the eyelids and orbit in children. They typically appear at or shortly after birth, with approximately 90% being clinically obvious by 2 months of age. Complications include functional sequelae like anisometropia, amblyopia, visual axis impairment; cosmetic sequelae like scarring, ulceration, bleeding, displacement of the globe, proptosis and even optic nerve compression. Therapeutic options include corticosteroids, beta-blockers, pulse dye laser, topical imiquimod, interferon-α, vincristine, cyclophosphamide and surgery. Aim: The aim of our study is to investigate the efficacy of intralesional triamcinolone and combination of intralesional triamcinolone with topical timolol in treatment of periocular infantile hemangioma & its recurrence. Method: This prospective study was performed in 24 patients with periocular hemangiomas requiring intervention. Patients were arranged in two groups: Triamcinolone acetonide intralesional injection alone & combination of triamcinolone acetonide intralesional injection with timolol maleate local application. Patients were followed up for three months. The size of the hemangioma was measured in mm2. Result: In Group 1, 66.66% of patients showed good response while in group 2, 88.89% of patients showed good response. Group 2 showed less recurrence rate than group 1. None of the patients developed local side effects during or after injection. Conclusion: Beta blocker and intralesional steroid both are relatively safe and effective for the periocular capillary hemangioma. Beta blocker with intralesional steroid has less chances of recurrence than beta blocker and steroid alone

Tuberculosis of the Adrenal Gland: A Case Report and Review of the Literature of Infections of the Adrenal Gland

Infections of the adrenal glands remain an important cause of adrenal insufficiency, especially in the developing world. Indeed, when Thomas Addison first described the condition that now bears his name over 150 years ago, the vast majority of cases were attributable to tuberculosis. Here we describe a classic, but relatively uncommon, presentation in the United States of adrenal insufficiency followed by a review of the current literature pertaining to adrenal infections

Tuberculosis of the Adrenal Gland: A Case Report and Review of the Literature of Infections of the Adrenal Gland

Infections of the adrenal glands remain an important cause of adrenal insufficiency, especially in the developing world. Indeed, when Thomas Addison first described the condition that now bears his name over 150 years ago, the vast majority of cases were attributable to tuberculosis. Here we describe a classic, but relatively uncommon, presentation in the United States of adrenal insufficiency followed by a review of the current literature pertaining to adrenal infections

Optimal Blood Glucose Monitoring Interval for Insulin Infusion in Critically Ill Non-Cardiothoracic Patients: A Pilot Study

OBJECTIVE: The American Diabetes Association and the Society of Critical Care Medicine recommend monitoring blood glucose (BG) every 1-2 hours in patients receiving insulin infusion to guide titration of insulin infusion to maintain serum glucose in the target range; however, this is based on weak evidence. We evaluated the compliance of hourly BG monitoring and relation of less frequent BG monitoring to glycemic status. MATERIALS AND METHODS: Retrospective chart review performed on 56 consecutive adult patients who received intravenous insulin infusion for persistent hyperglycemia in the ICU at Saint Vincent Hospital, a tertiary care community hospital an urban setting in Northeast region of USA. The frequency of fingerstick blood glucose (FSBG) readings was reviewed for compliance with hourly FSBG monitoring per protocol and the impact of FSBG testing at different time intervals on the glycemic status. Depending on time interval of FSBG monitoring, the data was divided into three groups: Group A ( \u3c 90 min), Group B (91-179 min) and Group C ( \u3e /=180 min). RESULTS: The mean age was 69 years (48% were males), 77% patients had preexisting type 2 diabetes mellitus (T2DM). The mean MPM II score was 41. Of the 1411 readings for BG monitoring on insulin infusion, 467 (33%) were in group A, 806 (57%) in group B and 138 (10%) in group C; hourly BG monitoring compliance was 12.6%. The overall glycemic status was similar among all groups. There were 14 (0.99%) hypoglycemic episodes observed. The rate of hypoglycemic episodes was similar in all three groups (p=0.55). CONCLUSION: In patients requiring insulin infusion for sustained hyperglycemia in ICU, the risk of hypoglycemic episodes was not significantly different with less frequent BG monitoring. The compliance to hourly blood glucose monitoring and ICU was variable, and hypoglycemic episodes were similar across the groups despite the variation in monitoring

HiRel: Hybrid Automated Reliability Predictor (HARP) integrated reliability tool system, (version 7.0). Volume 2: HARP tutorial

The Hybrid Automated Reliability Predictor (HARP) integrated Reliability (HiRel) tool system for reliability/availability prediction offers a toolbox of integrated reliability/availability programs that can be used to customize the user's application in a workstation or nonworkstation environment. The Hybrid Automated Reliability Predictor (HARP) tutorial provides insight into HARP modeling techniques and the interactive textual prompting input language via a step-by-step explanation and demonstration of HARP's fault occurrence/repair model and the fault/error handling models. Example applications are worked in their entirety and the HARP tabular output data are presented for each. Simple models are presented at first with each succeeding example demonstrating greater modeling power and complexity. This document is not intended to present the theoretical and mathematical basis for HARP

HiRel: Hybrid Automated Reliability Predictor (HARP) integrated reliability tool system, (version 7.0). Volume 1: HARP introduction and user's guide

The Hybrid Automated Reliability Predictor (HARP) integrated Reliability (HiRel) tool system for reliability/availability prediction offers a toolbox of integrated reliability/availability programs that can be used to customize the user's application in a workstation or nonworkstation environment. HiRel consists of interactive graphical input/output programs and four reliability/availability modeling engines that provide analytical and simulative solutions to a wide host of reliable fault-tolerant system architectures and is also applicable to electronic systems in general. The tool system was designed to be compatible with most computing platforms and operating systems, and some programs have been beta tested, within the aerospace community for over 8 years. Volume 1 provides an introduction to the HARP program. Comprehensive information on HARP mathematical models can be found in the references

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

Complex limbal choristoma in linear nevus sebaceous syndrome managed with scleral grafting

Linear nevus sebaceous syndrome (LNSS) is characterized by nevus sebaceous, mental retardation, seizures, and ocular abnormalities such as complex limbal choistoma. A young male with history of mass in right eye and blackish discoloration of skin over right and left side of forehead since birth presented with foreign body sensation and diminished vision in right eye. Ocular examination showed mass over epibulbar region with chorioretinal coloboma and posterior staphyloma in right eye and megalocornea in left eye. Histopathology report revealed complex limbal choristoma with compound melanocytic nevus. The case was managed by surgical excision of the limbal mass and filling the gap with scleral graft