Comparing the incidence of hypoglycemia episodes in patients with type 2 diabetes and chronic kidney disease treated with insulin or glibenclamide

Introduction. Hypoglycemia is one of the side effects of glibenclamide, which is administered orally in people with diabetes. Hypoglycemia may occur easily due to the reduced metabolism of this drug in patients with chronic kidney disease. The aim of this study was to compare the incidence of hypoglycemia in patients with chronic kidney disease who were treated with glibenclamide or insulin. Material and methods. In this study, 87 patients with type 2 diabetes and in stage 3–4 of chronic kidney disease (CKD) were examined. The patients were divided into two groups of glibenclamide (N = 44) and insulin (N = 43) based on the type of blood glucose-lowering therapy. Next, demographic data, serum creatinine level, number of hypoglycemic episodes over the last year and the amount of consumed drugs were recorded in the checklist. Finally, the data analysis was performed using the SPSS Software. Results. There was no significant difference between the two groups in terms of age, estimated glomerular filtration rate (eGFR), weight, duration of diabetes and blood glucose control. In addition, it was indicated that 38% of patients in the glibenclamide group and 32% of patients in the insulin group had at least one hypoglycemic episode. Also, in those two groups, there was no significant correlation between doses of the drug and the number of hypoglycemic episodes. Conclusions. This study showed that there was no significant difference between the patients with chronic kidney disease who were treated with insulin and those patients who were treated with glibenclamide in terms of number of symptomatic hypoglycemic episodes

Analysis of the Factors Affecting the Adoption of Management Information Systems

The present study was conducted with the aim to identify and rank the factors affecting the successful adoption of management information systems in medical centers of Kerman (Iran). For this purpose, based on research literature and experts’ interview 27 criteria were identified in four dimensions and categorized. Then, considering the causal relationships between them and the importance of each indicator, the AHP and DEMATEL multi-criteria decision making approach was used in the Intuitionistic fuzzy environment. In the present study, the weight of dimensions was determined using AHP method and then the causal relationships between dimensions and degree of influence and effectiveness of each dimension were determined using DEMTEL technique. The results obtained that the dimension of senior management support is identified as the most important dimension. Then, the dimensions of information quality, system quality, and finally the user experience are important.https://dorl.net/dor/20.1001.1.20088302.2022.20.3.4.1

Porównanie częstości występowania epizodów hipoglikemii u chorych na cukrzycę typu 2 z przewlekłą chorobą nerek leczonych insuliną lub glibenklamidem

Wstęp. Hipoglikemia jest jednym z objawów ubocznych obserwowanych przy stosowaniu glibenklamidu — leku doustnego używanego w leczeniu cukrzycy. Hipoglikemia może występować częściej z powodu obniżonego metabolizmu tego leku u chorych z przewlekłą niewydolnością nerek. Celem pracy była ocena częstości występowania hipoglikemii u pacjentów z przewlekłą niewydolnością nerek leczonych glibenklamidem w porównaniu z chorymi otrzymującymi insulinę. Metody. Do badania zakwalifikowano 87 pacjentów z cukrzycą typu 2 i niewydolnością nerek w stadium 3.–4. Na podstawie zastosowanego leczenia hipoglikemizującego zostali oni podzieleni na dwie grupy: pacjentów otrzymujących glibenklamid (n = 44) oraz leczonych insuliną (n = 43). Następnie odnotowano dane demograficzne, poziom kreatyniny w surowicy krwi, liczbę epizodów hipoglikemii w ciągu ostatniego roku oraz dane dotyczące liczby zużytych leków. Analizę przeprowadzono za pomocą oprogramowania SPSS Software. Wyniki. Nie obserwowano znamiennej różnicy między badanymi grupami w odniesieniu do wieku i masy ciała pacjentów, poziomu wskaźnika filtracji kłębuszkowej (GFR), czasu trwania cukrzycy oraz jej wyrównania. Ponadto stwierdzono że u 38% pacjentów w grupie leczonych glibenklamidem oraz u 32% chorych z grupy otrzymujących insulinę wystąpił co najmniej jeden epizod hipoglikemii. W obu grupach nie było znamiennej korelacji między dawką przyjmowanego leku a liczbą incydentów hipoglikemii. Wnioski. Badanie wykazało brak istotnej różnicy w liczbie objawowych epizodów hipoglikemii między grupami pacjentów z cukrzycą i przewlekłą chorobą nerek leczonych glibenklamidem a grupą chorych z cukrzycą, i tym samym z powikłaniem, otrzymujących insulinę

Renal Cell Carcinoma with Simultaneous Bilateral Adrenal Metastasis: Ipsilateral Radical Nephrectomy with Contralateral Adrenal Preservation

Although renal cell carcinoma (RCC) can metastasize to almost every organ, the most common metastatic sites are the lungs, abdomen, bones and brain. We present a rare case of a 72-year-old male with a large left RCC with simultaneous bilateral adrenal metastasis. In the process of surgical treatment, he underwent left radical nephrectomy with ipsilateral adrenalectomy. Due to the poor general condition of the patient, and also to prevent adrenal insufficiency, the right adrenal mass was preserved, without imposing any hazard to the patient. Systemic immunotherapy was initiated and the patient is still alive 1 year after surgery

Toughening behavior of carbon/epoxy laminates interleaved by PSF/PVDF composite nanofibers

This paper presents an investigation on fracture behavior of carbon/epoxy composite laminates interleaved with electrospun nanofibers. Three different mats were manufactured and interleaved, using only polyvinylidene fluoride (PVDF), only polysulfone (PSF), and their combination. Mode-I and Mode-II fracture mechanics tests were conducted on virgin and nanomodified samples, and the results showed that PVDF and PSF nanofibers enhance the Mode-I critical energy release rate (GIC) by 66% and 51%, respectively, while using a combination of the two registered a 78% increment. The same phenomenon occurred under Mode-II loading. SEM micrographs were taken, to investigate the toughening mechanisms provided by the nanofibers

Bowel Obstruction Caused by Persimmon Phytobezoars: A Case Report

Background: The term phytobezoar refers to a trapped mass in the gastrointestinal tract caused by the agglomeration of indigestible ingested plant materials, including fibers, skins, and seeds. A persimmon phytobezoar is formed after the frequent consumption of persimmons. The clinical manifestations of persimmon phytobezoars are similar to other phytobezoars and depend on the localization and size of the trapped mass.Case Presentation: Here, we presented a 57-year-old male with persimmon phytobezoars, which finally led to small bowel obstruction. The patient was referred to the emergency room with complaints of severe abdominal pain and frequent vomiting.The patient underwent laparotomy surgery that led to the removal of a portion of his ileum.Conclusion: Overindulgence in taking persimmon can lead to formation of phytobezoar and subsequent obstruction of small intestinal. Persimmon phytobezoars are difficult to break up into pieces because of containing tannins, cellulose, hemicellulose, and lignin

Risperidone-Induced Erythema Multiforme Minor: A Case Report

Erythema Multiforme (EM) is a hypersensitivity reaction that can be triggered by an infection or particular medications. Erythema multiforme minor (EM minor) represents localized skin lesions with minimal or no mucosal involvement. Only a few case of EM associated with risperidone are found in the scientific literature. In this case report, the administration of the risperidone resulted in the rapid appearance of skin lesions. Erythematous lesions were recovered upon discontinuation of the drug and no new skin lesion was observed. A 52-year-old male patient was admitted to the psychiatry hospital because of developing schizophrenic symptoms. At the time of admission, risperidone was added to her previous drug regimen. Two weeks later, the patient returned with a complaint of progressively increasing rashes over his body. The patient was diagnosed with EM minor. The prescribed risperidone was discontinued due to its side-effect profile and the patient’s drug regimen was changed entirely to the olanzapine, haloperidol, and topical clobetasol. At one month follow up visit, his skin lesions were satisfactorily controlled

Effect of lateral laser-cladding process on the corrosion performance of Inconel 625

This study aimed to evaluate the corrosion properties of different samples coated by the laser-cladding method to find the optimal laser parameters. Thereby, potentiodynamic polarization (Tafel) and electrochemical impedance tests were performed to assess the corrosion resistance of coated samples. Consequently, the corrosion morphology of tested samples was inspected by scanning electron microscopy. The results demonstrated that the laser power directly correlates with pitting corrosion and defects on the surface of the samples. Moreover, when molybdenum and chromium ions are increased in the electrolyte solution, the passive and protective layers are more durable, as the ions are sited within the holes and defects, reducing the surface corrosion rate.Peer ReviewedPostprint (published version

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions