جستجوی مقالات مرتبط با کلیدواژه « hypoglycemia » در نشریات گروه « پزشکی »

Insulin-secreting tumors are the most common hormone-producing neoplasm of the gastrointestinal tract. Only 10 percent of overall cases of insulinoma have malignant variants, which have a poor prognosis.

Cases Report: 

The present study reports an unusual case of pancreatic neuroendocrine tumor associated with hypoglycemia and liver metastasis as the initial presentation followed a rapidly progressive clinical course. A few cases of malignant insulinoma were reported with favorable responses in the literature. This research presents a patient with resistant malignant insulinoma who could not undergo an operation and received treatment with somatostatin analogs (S.S.A.), Peptide Receptor Radionuclide Therapy (PRRT), and other supportive care that was inappropriate.

Early diagnosis and extensive treatment are auspicious for improving the prognosis of malignant insulinoma, and proper treatment with medications would increase the quality of life of patients. Nevertheless, unfortunately, late patient referrals, socioeconomic conditions, and being infected with Covid-19 disease resulted in death.

Pyruvate carboxylase catalyzes the carboxylation of pyruvate to oxaloacetate, a crucial intermediate of the tricarboxylic acid (TCA) cycle and the initial step in converting pyruvate to glucose (gluconeogenesis). Pyruvate carboxylase deficiency is a rare metabolic disorder characterized by lactic acidosis, failure to thrive, development delay, and recurrent seizures at an early age in severely affected patients. The onset and severity of pyruvate carboxylase deficiency have been classified as severe neonatal (type B), usually fatal, less severe infantile (type A), compatible with survival but with impaired neurologic development, and milder, later onset (type C) with some residual impairment. Clinical manifestations include hypotonia, mixed hypertonia, ataxia, choreoathetosis, microcephaly, and other signs of impaired white matter development.

Case Report: 

A 7-day-old baby with a birth weight of 3kg, born to related parents, presented with clinical symptoms such as lethargy, poor feeding, and grunting since birth. Additionally, he experienced a drop in O2 saturation and cyanosis during his hospitalization. Test results revealed lactic acidosis and hyperammonemia. Furthermore, serum amino acids chromatography- HPLC indicated an increase in lysine and citrulline. The patient succumbed after 16 days due to multi-organ damage. Genetic analysis identified pyruvate carboxylase enzyme deficiency.

Pyruvate carboxylase deficiency is a rare inborn error of metabolism that can lead to developmental delay and failure to thrive, typically beginning in the neonatal or early infantile period. The possibility of pyruvate carboxylase deficiency should be considered in any child presenting with lactic acidosis and neurological abnormalities, particularly if associated with hypoglycemia, hyperammonemia, or ketosis.

To describe a case of lamellar cataract in a child with a history of neonatal hypoglycemia and illustrate the importance of meticulous history-taking in children with cataracts, especially before planning surgery.

A single case report.

A 7-year-old girl with a history of neonatal hypoglycemia and ketoacidosis with high suspicion of a primary defect in ketone body utilization who presented with bilateral progressive blurred vision. Her best-corrected visual acuity (BCVA) was 20/200 in her right eye (OD) and 20/400 in her left eye (OS). Slit-lamp examination showed the presence of bilateral dense lamellar cataract. Fundus examination was unremarkable in both eyes(OU). She underwent cataract surgery with intraocular lens implantation under general anesthesia without prolonged fasting. Final BCVA was 20/82 in OD and 20/63 in OS.

Our aim through this case is to emphasize the importance to screen for episodes of hypoglycemic attacks in children with infantile cataracts.

Diagnosing hypoglycemia is a widely known challenge for anesthesiologists during the perioperative period, especially under general anesthesia, during which many signs and symptoms would be masked. On the other hand, the bispectral index, which has recently been utilized to measure the depth of anesthesia, may be influenced by other factors such as hypo and hyperglycemia.

Cases Report:

 Herein, we have presented a case of a patient who experienced an abrupt decrease in the Bispectral index following hypoglycemia.

 Although the Bispectral index is widely used to monitor anesthesia depth, it can be utilized to continuously monitor other contributing factors such as glycemic condition, hypothermia, hypovolemia, and cerebral ischemia.

Hyperinsulinism refers to improper insulin secretion in the presence of low plasma glucose, causing severe and persistent hypoglycemia in infants and children. The brain’s occipital lobe, which includes the visual and plays an essential role in visual perception is specifically sensitive to hypoglycemia-induced damage. The present study aims to investigate the visual perception in children suffering from hyperinsulinism and to compare it with the control group.

This cross-sectional control study, conducted in 2020 in Isfahan, Iran, involved 20 children aged 4-13 years with hyperinsulinism and 20 healthy children of the same age and gender for comparison. In both groups, the measuring instrument was the Test of Visual Perceptual Skills (non-motor) Third Edition.

The mean visual perceptual quotient in the case and control groups was 80.50±26.74 and 116.50±7.56 (p-value<0.001), respectively. The results overall indicated that children suffering from hyperinsulinism were weaker than healthy children in all areas of visual perception.

Based on the obtained results, it is recommended that children suffering from hyperinsulinism be screened regarding visual perceptual disorders since this screening may be helpful in initiating different rehabilitation programs among these patients.

Benzodiazepines have been highly prescribed by physicians and have attracted public attention due to their high safety. These drugs have sedative, hypnotic, anti-anxiety, and anti-seizure properties. However, these drugs are also widely used for suicide. The present study was designed and implemented to determine the distribution of patients poisoned with benzodiazepines in terms of clinical and demographic characteristics.

Investigation of poisoning with benzodiazepines in one year in the poisoning department of Loghman Medical Center in Tehran City, Iran, was carried out as a descriptive-prospective study. In this research, 458 poisoned patients were studied to collect data on their age, gender, drug dosage, type of drug, duration of hospitalization, blood analysis results, and mortality.

The majority of patients poisoned with benzodiazepines were women (62.2%). The mean age of people was 31.67 years. The most frequently used drugs were clonazepam and alprazolam. Other drugs used with benzodiazepines were propranolol, methadone, and acetaminophen. The death rate was 1.7%. The incidence of hypoglycemia and creatinine above 1.3 was 8.53% and 11.3%, respectively. Hyperglycemia was 10.6%. There were 11, 80, and 178 cases of elevated alanine transaminase, aspartate aminotransferase, and alkaline phosphatase, respectively.

Benzodiazepines have the potential to cause liver and kidney damage and changes in insulin secretion and blood sugar. This issue should be considered when dealing with a poisoned patient to prevent serious injuries.

Treatment satisfaction is one of the main factors of assessing care quality in patients with chronic diseases. Some factors may influence treatment satisfaction and improve or impair clinical outcomes. This study aimed to determine the relationship between fear of hypoglycemia and satisfaction with treatment in patients with type 2 diabetes treated with oral antidiabetic drugs.

This cross-sectional study was carried out in one of the hospitals of Qazvin Province, Iran, in 2021. The research sample was 390 patients with type 2 diabetes who used oral antidiabetic drugs, selected through convenience sampling. The data were collected using the hypoglycemic fear survey (HFS) and the diabetes medication satisfaction (DiabMedSat) questionnaire. Then, the obtained data were analyzed using the independent t-test, one-way analysis of variance, and multiple linear regression in SPSS software, version 26. Statistical significance was set at P<0.05.

Patients’ Mean±SD age was 53.4±11.49 years, and most (57.4%) were female. Treatment satisfaction score was lower in females (β=-0.12, P<0.007) and patients with diabetes complications (β=-0.138, P<0.005). Patients with college education had higher treatment satisfaction (β=0.173, P<0.001). Patients with very severe (β=-0.29, P<0.001) or severe hypoglycemia (β=-0.157, P<0.034) experienced lower treatment satisfaction than those with mild hypoglycemia. Low treatment satisfaction scores were associated with fear of hypoglycemia (β=-0.39, P<0.001).

In this study, fear of hypoglycemia was associated with a decreased level of satisfaction with treatment. As a consequence, patients with type 2 diabetes must be assessed for hypoglycemia fears and their adverse effects. Also, to prevent complications caused by not taking antihyperglycemic drugs, nursing managers and clinical nurses are recommended to prepare appropriate programs to implement psychological interventions to reduce the fear of hypoglycemia.

Hypoglycemia is a frequent complication in patients with type 2 diabetes mellitus. By providing education, awareness among diabetic patients could be increased to prevent hypoglycemia. Indonesia has yet to widely implement smartphone-based education programs for hypoglycemia prevention. This study aimed to assess the feasibility of a smartphone application-based diabetes education model, developed using the health belief model and social cognitive theory, to enhance the ability of diabetes mellitus patients to detect hypoglycemia.

This design and development research utilized a pre-test and post-test design without a control group and was done on 64 diabetics between May and September 2023. Statistical analyses were performed using the paired t-test.

The mean patient's score on the ability to prevent hypoglycemia was 45.13 before the intervention. After the intervention, the patient's ability increased by 3.21 to reach 48.34. The paired t-test yielded a p-value of 0.0001, indicating a significant difference in the ability to detect hypoglycemia before and after the intervention.

Nursing Education Diabetic Therapeutic Application (NEDTA) was declared feasible to use in detecting hypoglycemia.

 Conversion of glucose-6-phosphate to glucose is the final step in both glycogenolysis and gluconeogenesis. In glycogen storage disease type Ia (GSD type Ia), decreased activity of the enzyme glucose-6-phosphatase leads to an increased concentration of glucose-6-phosphate within the hepatocytes and shunting into alternative pathway with the following consequences: hyperlactatemia, hyperuricemia and hypertriglyceridemia. Patients develop hypoglycemia within 3 to 4 hours after a meal.

Case Report:

 We reported four patients with GSD type Ia with different clinical manifestations such as hypoglycemia, hepatomegaly, lactic acidosis, hyperchylomicronemia, and hyperuricemia and also described their prognosis.

 Previously, many children with GSD Ia died in infancy or early childhood. Recurrent severe hypoglycemia can cause brain damage, but the prognosis has improved dramatically with early diagnosis and long term maintenance of optimal metabolic control.

Neonatal hypoglycemia is the most common metabolic abnormality affecting newborns and contributes to increased morbidity and mortality. 

The present systematic review and meta-analysis aim to explore the prevalence and risk factors associated with neonatal hypoglycemia in Iran.

A systematic search was performed in Iranian and international databases, including SID, MagIran, Barakat Knowledge Network System, PubMed, Scopus, Web of Science, and the Google Scholar search engine searched for relevant articles using valid keywords. The search process was updated until September 28, 2021. Data were analyzed using STATA software, version 14, and the significance level for all tests was considered P<0.05. 

In 14 reviewed articles with a sample size of 18217, the prevalence of hypoglycemia in Iranian newborns was 29% [95%CI: 21%, 37%, P=0.0001] (64% in boys and 37% in girls). The hypoglycemia prevalence was 67% in infants born via cesarean section compared to 24% in vaginally delivered infants. The lowest and highest prevalence of neonatal hypoglycemia was observed in Mashhad (12%) and Arak (53%), respectively. The most common risk factors for neonatal hypoglycemia in Iran were infant prematurity (61%), septicemia (45%), respiratory distress syndrome (RDS) (26%), small for gestational age (SGA) (26%), maternal diabetes (21%), hypocalcemia (19%), intrauterine growth restriction (IUGR) (9%) and perinatal asphyxia (8%).

Neonatal hypoglycemia is very common in Iran, affecting nearly one-third of Iranian newborns. The prevalence of hypoglycemia in boys was almost twice as high as that in girls and 2.5 times higher in infants born by cesarean section than in infants delivered vaginally. Furthermore, prematurity was reportedly the most common risk factor for neonatal hypoglycemia in Iran.

Zingiber officinale (Ginger) is a commonly used plant for food and herbal treatment of different ailments. There is proof of ginger’s antioxidative and hypoglycemic activity, but the mechanism of action is yet to be understood, especially in a non-disease model. The present study assessed the effects of the methanolic extract of Zingiber officinale (MEZO) on blood glucose, pancreatic antioxidant levels, and histopathological changes.

Fifteen (15) female Wistar rats with an average weight of 147 g were randomly divided into three (3) groups (A-C). Group A was given no treatment and served as the control group. Groups B and C received only oral administration of 400 mg/kg and 800mg/kg of MEZO, respectively. MEZO was administered once a day for 21 days. The animals were euthanized by cervical dislocation for blood collection and retrieval of pancreatic tissue for oxidative stress and histopathological assessment.

The serum glucose level was significantly decreased in group C compared to the control (P=0.012). There were no significant changes in the levels of Superoxide dismutase (SOD), Glutathione (GSH), and Catalase (CAT) in all the MEZO groups compared to
the control (P>0.05). Pancreatic histology showed signs of acute pancreatitis, with dense aggregates of polymorphonuclear inflammatory cells infiltrating the surrounding stroma.

A high-dose ginger extract induces hypoglycemia, but a proinflammatory response is elicited in the pancreas at a lower dose. Thus, ginger extracts should be consumed with caution.

Neonatal hypoglycemia is one of the major complications in neonatal wards, requiring rapid diagnosis and treatment to prevent its complications. Dextrose gel is used as a cheap and safe choice. Thus, the present systematic review and meta-analysis study aimed to investigate the effects of oral dextrose gel in preventing and treating neonatal hypoglycemia. To find the relevant articles, the national databases, including Barekat Gostar, SID, Magiran, IranDoc, and international databases, including PubMed, Scopus, Web of Science, Cochrane, and Google Scholar were consulted with standard keywords. The data were analyzed using the STATA 14 software, while the P value < 0.05 was considered significant. In 9 articles with a sample size of 8755 neonates, the mean neonatal weight ranged from 2890 to 3669 g. The share of neonates born through normal vaginal delivery equaled 61%, while 16% had low birth weight (below 2500 g), 16% had high birth weight (above 4500 g), 51% had diabetic mothers, 20% were premature, and 88% were singleton. Oral dextrose gel reduced the risk of neonatal hypoglycemia by OR=0.83 (95% CI: 0.75-0.93). However, neonatal hypoglycemia treatment with oral dextrose gel had an OR=0.78 (95% CI: 0.57-1.07), which was not statistically significant. Oral dextrose gel was effective in preventing neonatal hypoglycemia.

 The purpose of this study was to compare the effectiveness of once-daily versus twice-daily insulin detemir injection in children with type 1 diabetes mellitus (T1DM).

 In this randomized 4-month clinical trial, 60 children aged 33 - 156 months with T1DM were randomly assigned into two groups, once-daily (group 1) and twice-daily (group 2) detemir insulin injection with pre-meal insulin Aspart. The first month of the study was devoted to educating the patients and insulin dose titration. Hemoglobin A1C (HbA1C) measured at the end of the first month and again after the fourth month was considered as the outcome. Hypoglycemia as one of the major complications was defined as blood glucose lower than 70 mg/dL with clinical symptoms or blood glucose lower than 50 mg/dL in the absence of clinical symptoms.

 Mean HbA1C in the fourth month was 8.5% ± 1% in group 1 and 8.5% ± 1.1% in group 2 (P = 0.98). Mean changes in the fourth month compared to baseline were -0.09% (95% CI: -0.47 - 0.3) in group 1, and -0.42% (95% CI: -0.94 - 0.09) in group 2 (P = 0.273). The treatment modification rate was 39% and 15% in groups 1 and 2 (P = 0.02). However, there were no statistically significant differences between the two groups in terms of insulin dose, hypoglycemia, and other complications.

 Twice-daily injections did not change HbA1c in comparison with once-daily injections. However, the lower treatment modification rate in the twice-daily group in the age group of our study was considerable.

Hyperinsulinism is the most common cause of persistent or recurrent neonatal hypoglycemia that may result in neurological deficits. The treatment goal in these patients is prevention of hypoglycemia to decrease mortality and morbidity. This study was done to determine the clinical course and outcome in children with congenital hyperinsulinism (CHI) referring to Mofid Children’s Hospital from 2011 to 2017.

This study was done on 22 children with CHI referring to Mofid Children’s Hospital from 2011 to 2017. The demographic, perinatal, clinical, laboratory, imaging, pharmacological, treatment and follow up data of these children were collected and analyzed.

Among 22 children with CHI, the mortality rate was higher among those who received hydrocortisone versus those who did not receive hydrocortisone (46% versus 40%).

According to the results of this study, hydrocortisone had a negative impact on the outcomes of these children, which is important in the management of hypoglycemia. The clinical course and outcome of children with CHI was better with medical compared to surgical treatment.

Deficiency of hepatic fructose 1,6 bisphosphatase (FBPase), a key enzyme in gluconeogenesis, impairs the formation of glucose from all gluconeogenic precursors including dietary fructose. Patients present with life threatening metabolic acidosis, fasting hypoglycemia, hepatomegaly, hyperketosis, elevated lactate and uric acid level. Glycerol and glycerol-3 phosphate have been found in the urine. The diagnosis of FBPase deficiency is confirmed via DNA molecular analysis from peripheral leukocytes. The acute life threatening episodes are treated with IV glucose at high rate and bicarbonate to control hypoglycemia and acidosis.

Here we report a girl referred with anorexia, lethargy, recurrent vomiting, progressive respiratory distress, and hepatomegaly following respiratory viral infection. She also had a history of twice similar attacks but milder than previous episodes. The test results showed hypoglycemia and severe metabolic acidosis. Despite proper treatment, the patient died of pulmonary edema following a respiratory viral infection.

Once FBPase deficiency has been diagnosed and adequate management introduced, its course is usually benign. Growth both psychomotor and intellectual development are unimpaired and tolerance to fasting improves with age.

Due to the increased prevalence of diabetes and the irreparable complications of this disease, it is important to measure and monitor the blood glucose levels of diabetic patients. The only way to treat type 1 diabetes is monitoring insulin, and in this type of diabetes, insulin should be injected into the body in order to reduce the patient’s blood glucose as prescribed by the physician at certain times. In addition, the only way to treat type 2 diabetes is through diet and exercise daily.

We aim to use an ordinary differential equation model with two-delays to control the rate of changes in blood glucose levels throughout the day, based on the amount of food that the person consumes.

In this analytical study, we extended an ODE model which is parameterized by data collected in this study to capture dynamics of glucose and insulin. We used global sensitivity analysis method to assess model robustness with respect to parameter perturbations.

Our results have shown that utilizing the dynamics of changes in blood glucose levels throughout the day can be used to prevent hypoglycemia and hyperglycemic in the diabetic patients.

Dynamic modeling can help us to prevent hypoglycemia and hyperglycemia in the diabetic patients.

Intrauterine growth restriction (IUGR) refers to fetuses with an estimated ultrasonography weight below the 10% percentile. Hypoglycemia is a major concern in neonates with IUGR.

To investigate the relationship between umbilical artery (UA) Doppler ultrasonography and neonate hypoglycemia and IUGR.

This was a longitudinal follow-up study consisting of 114 neonates (gestational age of 28-40 wk) born with IUGR in the third trimester of pregnancy at Shahid Sadoughi Hospital, Yazd, Iran between May 2016 and October 2017. The neonates were assigned into three subgroups of normal UA Doppler, absent end-diastolic flow (EDF) in UA Doppler, and reverse EDF in UA Doppler. The blood glucose of the neonates was checked one, two, three, six, 12, 24 and 48 hr after birth, and the neonates were placed in the hypoglycemia or euglycemia groups according to guidelines.

Out of the 114 neonates included in the study, 75 (65.8%) had normal UA Doppler, 29 (25.4%) had absent EDF in UA Doppler, and 10 (8.8%) had reverse EDF in UA Doppler. There was a significant difference in the mean blood glucose in the first hr between the normal UA Doppler group and the reverse EDF in UA Doppler group (p < 0.01).

Postnatal hypoglycemia in neonates with IUGR is associated with the result of UA Doppler ultrasonography during pregnancy.

Insulinoma is a rare, mostly benign and solitary neuroendocrine tumour of the β-cells of islets of langerhans of pancreas.  Clinically it presents with a classical ‘Whipple Triad’ encompassing symptomatic hypoglycemia, fasting hypoglycemia (<50 mg/dl) and immediate relief of symptoms after glucose administration. Definitive treatment is laparoscopic or open surgical excision of the tumour. We report and discuss the distinctive anaesthetic considerations and implications during perioperative period. A comprehensive approach including preoperative optimization of blood glucose levels with various drugs and dietary modifications, scrupulous hemodynamic and blood sugar monitoring with prompt initiation of dextrose infusion during surgical handling of tumour and meticulous management of rebound hyperglycemia with insulin infusion in postoperative period remains the essence for better outcome in these subset of patients.