bluuebunny/crossref_metadata_2025 huggingface dataset:
40 días en casa, 40 mil cosas más... Mujeres en cuarentena, narrando desigualdades...
Authors: Oliva Barboza Patricia , Golen Zúñiga Backtori
Published: September 2022

Este texto sugiere el ejercicio de imaginar las situaciones que viven las mujeres desde sus contextos durante la cuarentena, y reflexionando sobre la división sexual del trabajo, el trabajo remunerado y no remunerado, a partir de preguntas como: ¿Porqué las medidas de cuarentena nos afectan de manera tan distinta a hombres y a mujeres? ¿Por qué el espacio privado no representa lo mismo para las mujeres? ¿Qué significa para las mujeres estar en la casa con sus parejas, hijos, hijas, madre, padre etc?   Este documento pretende evidenciar las implicaciones del trabajo productivo y reproductivo dentro de lo privado, cuestionando constantemente por qué este encierro está agravando aún más las múltiples jornadas de las mujeres y repensar como esta coyuntura puede ser una oportunidad para reconfigurar la organización social del cuido.
COVID-19: Encrucijadas y respuestas humanas
Authors: Pineda Sancho Andrey
Published: September 2022

Este documento, como su nombre lo indica, trata de enumerar el conjunto de problemas y encrucijadas que emergieron en nuestras sociedades a raíz de la intempestiva irrupción del COVID-19. Antes que ofrecer respuestas inequívocas a estas problemáticas, el escrito más bien trata de visibilizar las opciones y los retos que se nos empezaron a presentar ya desde una etapa muy temprana de la emergencia, así como de problematizar, de forma concomitante, nuestros posibles cursos de acción. Las encrucijadas que se plantean son de carácter societal e institucional, pero sobre todo de talante civilizatorio.
COVID-19: La urdimbre del cuido
Authors: Pérez Rodríguez Marcela
Published: September 2022

Este escrito forma parte de una serie de documentos elaborados por investigadoras e investigadores del Centro de Investigación en Cultura y Desarrollo de la UNED, donde a manera de ensayo se presentan análisis y reflexiones sobre el cómo diversos aspectos de nuestra realidad cotidiana se han visto afectados a partir de la aparición del COVID-19.
Costa Rica: Apuntes para un programa económico urgente frente la crisis del COVID-19
Authors: Vargas Solís Luis Paulino
Published: September 2022

Este artículo publicado originalmente en el blog del autor “Soñar con los pies en la tierra”el 27 de marzo de 2020, constituye una primera aproximación a la formulación depropuestas frente a la crisis económica, surgida a raíz de la aplicación de medidas sanitariasencaminadas a frenar la propagación del Covid-19. El énfasis principal (no exclusivo) estáen el corto plazo, buscando formular salidas que alivien la gravedad de la recesióneconómica y, en especial, sus impactos sociales y humanos. Con el paso de las semanas, seevidenció que las propuestas formuladas iban en el sentido correcto, pero que se quedabancortas en sus previsiones.
Migraciones en Costa Rica: aportes para la toma de decisiones en el marco del COVID-19
Authors: Gatica López Gustavo
Published: September 2022

Este escrito forma parte de una serie de documentos elaborados por investigadoras e investigadores del Centro de Investigación en Cultura y Desarrollo de la UNED, donde a manera de ensayo se presentan análisis y reflexiones sobre el cómo diversos aspectos de nuestra realidad cotidiana se han visto afectados a partir de la aparición del COVID-19.
Costa Rica y el FMI: Las ideas zombis y el camino al infierno
Authors: Vargas Solís Luis Paulino
Published: September 2022

Este escrito forma parte de una serie de documentos elaborados por investigadoras e investigadores del Centro de Investigación en Cultura y Desarrollo de la UNED, donde a manera de ensayo se presentan análisis y reflexiones sobre el cómo diversos aspectos de nuestra realidad cotidiana se han visto afectados a partir de la aparición del COVID-19.
¿Quién mató a Chico Mendes?Industria cárnica y desigualdad
Authors: Katsavavakis Giorgos
Published: September 2022

Este ensayo muestra la relación entre la industria de la carne y la desigualdad. Para lograr dicho propósito, se hace un recorrido histórico-filosófico para entender el mundo desigual en el que se vive; luego, se expone cómo el consumo de carne contribuye a reforzar dicha desigualdad y, finalmente, se reseña el crimen contra el ecosocialista Chico Mendes como un ejemplo claro de que la industria cárnica trae consigo más destrucción y menos oportunidades.
Opresiones y resistencias de las personas trabajadoras de limpieza tercerizadas en la Universidad de Costa Rica
Authors: Caamaño Morúa Carmen , Dinartes Bogantes Andrés
Published: September 2022

Este artículo, producto de la investigación del Instituto de Investigaciones Sociales de la Universidad de Costa Rica (UCR): “Entre la universidad pública y la empresa privada: el espacio vivido de trabajadoras de limpieza subcontratadas en la Universidad de Costa Rica”, se basa en 10 entrevistas realizadas durante el año 2021 con personal de la empresa Servicios de Limpieza a su medida (SELIME) en la UCR, con miembros del Sindicato de Trabajadores del Sector Privado (SITRASEP) que les representan, con funcionarias y funcionarios de la Sección de Servicios Contratados de la Oficina de Servicios Generales, situada en la Vicerrectoría de Administración de la Universidad de Costa Rica, y en el análisis de documentos oficiales relativos a la gestión de esos servicios, componente fundamental de procesos de transformación neoliberal en las universidades públicas que se sustentan en la precarización de la fuerza de trabajo en función del ahorro, la eficiencia y el control. El resultado permite conocer las implicaciones que esta organización tiene en la vida de las personas trabajadoras, los efectos a nivel laboral y psicosocial, así como las posibilidades de resistir mediante prácticas de infrapolítica y la organización colectiva frente a una empresa privada y una institución pública que se amparan en legislación vigente para desconocer los derechos laborales y necesidades del personal tercerizado y actúa de manera hostil en contra de la organización sindical.
Keep an Eye on the Eye of your Patient: An Update on the Management of Post-CABG Pituitary Apoplexy
Authors: Insler Joshua E. , Iacona Gabriele Maria
Published: September 2022

Pituitary apoplexy is a rare, potentially life-threatening complication
which has been described after both on and off-pump CABG. However, never
before has pituitary adenoma recurrence after prior resection and
subsequent apoplexy leading to severe ophthalmoplegia following on-pump
CABG been described. We present the case of a patient who previously
underwent transsphenoidal resection of a pituitary adenoma who
experienced oculomotor nerve palsy following on-pump CABG and was
ultimately found to have a recurrent pituitary adenoma and apoplexy.
The influence of metabolic syndrome in heart valve intervention. A multi-centric study.
Authors: Moscarelli Marco , Paparella Domenico , Angelini Gianni , Giannini Francesco , Contegiacomo Gaetano , Marchese Alfredo , Nasso Giuseppe , Albertini Alberto , Fattouch Khalil , Speziale Giuseppe
Published: September 2022

Background. The effect of metabolic syndrome (MetS), defined as
insulin resistance along with two or more of: obesity, atherogenic
dyslipidaemia and elevated blood pressure, on post-operative
complications after isolated heart valve intervention remains
controversial. We hypothesized that MetS may negatively influence the
post-operative course in these patients. Methods. Patients from
10 cardiac units who underwent isolated valve intervention (mitral ±
tricuspid repair/replacement (MVS) or aortic valve replacement (SAVR),
or transcatheter aortic valve replacement (TAVR) were included. MetS was
defined according to the WHO criteria. Primary outcome was in-hospital
mortality and overall post-operative length of stay. Relevant
post-operative complications were also recorded. Results. From
2010 to 2019, 17283 patients underwent valve intervention. The MVS, SVAR
and TAVR accounted for the 39.4%, 48.2% and 12.3% respectively of the
whole. MetS compared to no-MetS was associated to higher mortality in
the MVS group (6.5% vs. 2%, p<0.001), but not in the SAVR
and TAVR group. In both surgical cohorts, MetS was associated with
increased complications including red blood cells transfusion, renal
failure, mechanical ventilation time, intensive care and overall
post-operative length of stay (11 (9) vs. 10 (6), p<0.001 and
10 (6) vs. 10 (5) days, p=0.002, MVS and SAVR)). No differences were
found in the TAVR cohort, with similar mortality and complications.
Conclusion. MetS was associated to more post-operative
complications, with higher mortality in the MVS group. In the TAVR
cohort, post-operative complications and mortality rate did not differ
between patients with and without MetS, however length of stay was
longer in the MetS group.
Counting animals in aerial images with a crowd counting model
Authors: Qian Yifei , Humphries Grant , Trathan Philip , Lowther Andrew , Donovan Carl
Published: September 2022

1. Animal abundance estimation is increasingly based on drone or aerial
survey photography. Manual post-processing has been used extensively,
however volumes of such data are increasing, necessitating some level of
automation, either for complete counting, or as a labour-saving tool.
Any automated processing can be challenging when using the tools on
species that nest in close formation such as Pygoscelid penguins. 2. We
present here an adaptation of state-of-the-art crowd-counting
methodologies for counting of penguins from aerial photography. 3. The
crowd-counting model performed significantly better in terms of model
performance and computational efficiency than standard Faster RCNN
deep-learning approaches and gave an error rate of only 0.8 percent. 4.
Crowd-counting techniques as demonstrated here have the ability to
vastly improve our ability to count animals in tight aggregations, which
will demonstrably improve monitoring efforts from aerial imagery.
Impacts of drought and elevated temperature on the seeds of malting barley
Authors: Nagel Manuela , Arc Erwann , Rajjou Loïc , Cueff Gwendal , Bailly Marlene , Clément Gilles , Sanchez-Vicente Inmaculada , Bailly Christophe , Seal Charlotte , Roach Thomas , Rolletschek Hardy , Lorenzo Oscar , Börner Andreas , Kranner Ilse
Published: September 2022

High seed quality is key to agricultural production, which is
increasingly affected by climate change. We studied the effects of
drought and elevated temperature during seed production on key seed
quality traits of two genotypes of malting barley ( Hordeum
sativum L.). Plants of a “Hana-type” landrace (B1) were taller,
flowered earlier and produced heavier, larger and more vigorous seeds
that resisted ageing longer compared to a semi-dwarf breeding line (B2).
Accordingly, a NAC domain-containing transcription factor (TF)
associated with rapid response to environmental stimuli, was more
abundant in B1 seeds. Drought significantly reduced seed yield in both
genotypes, and elevated temperature reduced seed size. Genotype B2
showed partial thermodormancy that was alleviated by drought and
elevated temperature, in line with lower abundance of the TF ABI5, a key
regulator of seed dormancy and vigour. Metabolite profiling revealed
clear differences between the embryos of B1 and B2. Drought, but not
elevated temperature, affected the metabolism of amino acids, organic
acids, osmolytes and nitrogen assimilation, in the seeds of both
genotypes. Our study may support future breeding efforts to produce new
lodging and drought resistant malting barleys without trade-offs that
can occur in semi-dwarf varieties such as lower stress resistance and
higher dormancy.
A Phase I, Single-sequence, Open-label Study to Evaluate the Drug-Drug Interaction Between Hetrombopag and Cyclosporine in Healthy Chinese Subjects.
Authors: Li Fengshan , Lin Hongda , Yu Qin , Shen Kai , Zhang Lingli , Feng Sheng , Wu Yiwen , Feng Shiyin , Liu Xiaohong , Cai Linrui , Chen Zhuo , Zou Qin , Su Xu
Published: September 2022

Aims: This study aims to evaluate the drug-drug interaction（DDI）
between hetrombopag and cyclosporine in healthy Chinese subjects.
Methods: Twenty-six eligible subjects enrolled in this single-center,
single-sequence, open-label, DDI study with three treatment periods,
receiving 5 mg hetrombopag once on day 1, 100 mg cyclosporine twice
daily from day 11 to day 15, and 5 mg hetrombopag + 100 mg cyclosporine
on day 16. Serial blood samples were collected for pharmacokinetic
evaluation. Adverse events were monitored throughout the study. Results:
The plasma hetrombopag geometric mean ratios (GMRs) (90% CI) of Cmax,
AUC0-t and AUC0-∞ of co-administration of hetrombopag with cyclosporine
vs hetrombopag alone are 95.97% (70.08%, 131.43%), 105.75% (75.04%,
149.04%) and 104.19% (74.71%, 145.32%), respectively, indicating
multiple doses of cyclosporine had minimal effects on hetrombopag
exposure. The GMRs (90% CI) of Cmax and AUCss,tau for blood
cyclosporine of co-administration vs cyclosporine alone were 100.49%
(91.89%, 109.89%) and 100.81% (107.88%, 103.82%), respectively,
suggesting a single dose of hetormbopag had no impact on the exposure of
cyclosporine. Co-administration of hetormbopag with cyclosporine was
generally well tolerated. Conclusion: No clinically significant DDI was
observed when co-administration of hetrombopag with cyclosporine. No
additional dose adjustment is warranted for this combination.
Efficacy and safety of topical sirolimus for the treatment of angiofibromas in tuberous sclerosis: a systematic review and meta-analysi
Authors: Paschalidou Eleni , Tasioudis Philippos , Katsaras Georgios , Papoulakis Thomas , Kapoukranidou Dorothea , Papamitsou Theodora
Published: September 2022

Background: Facial angiofibromas (FAs) are common skin manifestations of
tuberous sclerosis complex (TSC) that occur in up to 80% of patients.
Rapamycin seems to be effective in decreasing FAs. Objective: The aim of
our study was to investigate the efficacy and safety of topically
applied rapamycin in TSC patients with FAs. Methods: The methods and the
results were carried out according to the Preferred Reporting Items for
Systematic Reviews and Meta-Analyses (PRISMA) Statement. PubMed/MEDLINE,
SCOPUS, and Cochrane database were systematically searched until April
21, 2022, using the PICO tool (Patient, Interventions, Comparisons,
Outcome). Studies regarding efficacy and/or safety of topical sirolimus
for the treatment of FAs in TSC with a published full-text in English
were included. Safety was assessed based on adverse effects and
sirolimus’ blood levels, and efficacy was documented by clinical
improvement and reduction of Facial Angiofibroma Severity Index (FASI).
For Meta-analysis, Review Manager (RevMan) 5.4.1 software was used,
using random-effects model and standardized mean difference (SMD) with
95% confidence interval (CI). Results: Twenty-one final studies were
included. Regarding safety, in the included studies the observed adverse
effects were mainly local, while the blood levels of rapamycin were
within safe limits, decreasing the likelihood of systemic
immunosuppression. The meta-analysis revealed a statistically
significant decrease in post-treatment FASI (SMD: -1.31, 95% CI:
[-1.85,-0.77], p-value <0.00001). Subgroup and sensitivity
analyses indicated similar findings. No publication bias was found to
this association. Conclusion: The application of topical sirolimus to
FAs can safely decrease their severity in patients with TSC.
INVERSE PROBLEMS FOR A BOUSSINESQ SYSTEM FOR INCOMPRESSIBLE VISCOELASTIC FLUIDS
Authors: Khompysh Khonatbek , Antontsev Stanilslav
Published: September 2022

In this paper, we study two inverse problems for the nonlinear
Boussinesq system for incompressible viscoelastic non-isothermal
Kelvin-Voigt fluids. The studying inverse problems consist of
determining an intensities of density of external forces and heat source
under given integral overdetermination conditions. Two types of boundary
conditions for the velocity v are considered: sticking and
sliding conditions on boundary. In both cases of these boundary
conditions, the local and global in time existence and uniqueness of
weak and strong solutions are established under suitable assumptions on
the data. The large time behavior of weak solutions is also studied.
Case 1: Maturity-Onset Diabetes of the Young (MODY) as a Diagnostic Possibility
Authors: Kochar Suzi , Gilden Janice
Published: September 2022

A 19-year-old man (mother: African American; father: Caucasian) was referred for evaluation of incidentally elevated A1C (HbA1c = 8.3%; normal: 4.0–6.0) and fasting blood glucose (FBG = 172 mg/dL; 9.5 mmol/L). He denied symptoms of hyperglycemia or complications suggestive of diabetes.
Case 5: Recurrent Ketoacidosis: Lessons from Multiple Clinical Presentations
Authors: Ipp Eli , Djekic Kristina
Published: September 2022

A 33-year-old Mexican American man presents to the emergency department (ED) with a history of nausea, abdominal pain, and weakness. Four months prior he was diagnosed with diabetes after complaints of polyuria, polydipsia, and anorexia. He was treated with glyburide but continued to experience symptoms. He reported a cumulative weight loss of 40 lb in the intervening months and arrived in the ED weighing 69.8 kg, with a BMI of 25 kg/m2. He is admitted to the hospital with a diagnosis of ketoacidosis.
Case 7: Reevaluation after Ketoacidosis Presentation
Authors: Cruz-Bravo Paulina , McGill Janet
Published: September 2022

A 51-year-old man presented to the emergency department with plasma glucose of 1,170 mg/dl (65 mmol/L) and in ketoacidosis. He was treated with intravenous (i.v.) insulin and transferred to the intensive care unit. Review of systems revealed he had lost 45 lb within the month before his hospitalization because of a prolonged bout of gastroenteritis. Past medical history included hypertension and hyperlipidemia but no history of diabetes. He was discharged 5 days later on 90 units of insulin glargine daily and 25 units of insulin glulisine three times a day with meals.
Case 10: Ketosis-Prone Diabetes
Authors: Saxon David , Rasouli Neda
Published: September 2022

A 64-year-old African American man presented to the endocrinology clinic for management of diabetes. His past medical history included CAD s/p STEMI (two stents), CHF (EF 50%, diastolic dysfunction), hypertension, osteoporosis, and hyperparathyroidism. Family history was significant for type 2 diabetes in both his mother and brother. He never smoked, reported drinking two beers per week, and denied use of illicit drugs. At initial outpatient consultation, his weight was 100.6 kg (BMI 31 kg/m2), blood pressure 145/84 mmHg, and pulse 72. Physical exam was unremarkable. Most recent hemoglobin A1c (HbA1c) was 6.8% while taking insulin glargine 45 units at bedtime and approximately 10 units of aspart per meal. He was experiencing rare hypoglycemia.
Case 14: What Type of Diabetes?
Authors: McCall Anthony
Published: September 2022

This patient is a 65-year-old woman who was referred to the clinic for continued treatment of her diabetes. Patient was diagnosed 5 years before her first visit (now 2 years later) with diabetes. Fasting glucose levels were elevated on routine blood work. Because her GAD-65 was positive and her C-peptide levels were low, she was uncertain about whether she had type 1 or type 2 diabetes. Her first HbA1c was 7%. Although BMI was normal, she lost 10 lb and watched her diet. Her HbA1c decreased to the 6.2–6.6% range. She was given a sliding-scale lispro and instructed to take 2 units if her blood glucose levels were >200 (11.1 mmol/L). When the patient attempted to follow this recommendation, she became hypoglycemic to ≤50 mg/dL (2.8 mmol/L) within 1–1.5 h after insulin injection. She never took oral antihyperglycemics. She had a history of gestational diabetes during her second pregnancy, which was diet controlled. Post delivery she had normal blood glucose levels.
Case 15: Type 1 Diabetes versus LADA in a Patient Misdiagnosed with Type 2 Diabetes
Authors: Low Wang Cecilia
Published: September 2022

A. is a 42-year-old African American man referred for poorly controlled diabetes. He takes metformin 1 g b.i.d. and glargine insulin; his glargine dose recently was lowered from 45 units to 40 units daily. Review of his glucose monitoring device download revealed episodes of severe hyperglycemia up to the low 300s mg/dL (16.6 mmol/L) in the mornings, with hypoglycemic episodes as low as 40 mg/dL (2.2 mmol/L) fasting and midday. He has a physically demanding job and reports never skipping a meal; he feels hypoglycemic when he delays a meal. These episodes occur approximately twice a week, but hypoglycemia was detected four times per week on his blood glucose meter download. He denied peripheral neuropathy, blurry vision, polyuria, or weight changes. His family history included a parent with hypertension and a grandparent with diabetes. His medications included glargine 40 units SC QD, metformin 1 g bi.d., aspirin 81 mg q.i.d., and lisinopril 10 mg q.i.d.. He had no other medical problems and did not smoke or drink alcohol.
Case 24: A Diagnostic Dilemma in a Patient with Elevated Glycosylated Hemoglobin
Authors: Paturi Shalini , Gilden Janice
Published: September 2022

A 19-year-old African American woman was referred to the endocrine clinic for evaluation of elevated hemoglobin A1c (A1C) of 6.5% (repeat value 6.9%) and a fasting plasma glucose (FPG) of 105 mg/dL (5.8 mmol/L). There were symptoms of mild fatigue and increased thirst. Over the past 4 months, she also experienced a 10 lb weight gain, with no changes in diet or exercise. There were no known medical problems, and she did not take any medications, alcohol, or recreational drugs. Family history was significant for diabetes in her maternal grandfather. Physical exam showed a thin female (BMI 21 kg/m2), without acanthosis nigricans, skin tags, striae, or other abnormalities.
Case 25: An Unexplained Decline in HbA1c in Spite of Persistent Hyperglycemia
Authors: Bell David
Published: September 2022

A 35-year-old white woman was diagnosed with type 1 diabetes at age 12 years, and had persistently poor glycemic control with HbA1c ranging from 10 to 13%. Some details of this case have been presented previously.1  Her historically poor glycemic control had resulted in the development of proliferative diabetic retinopathy (treated with panretinal photocoagulation), cataracts, diabetic nephropathy, recurrent pyelonephritis, distal symmetric polyneuropathy, entrapment, autonomic neuropathies, and trigger fingers. She also had euthyroid Hashimoto’s thyroiditis, lumbar and cervical disk disease, depression, and dermatitis herpetiformis.
Case 27: A “Tricky” Low HbA1c
Authors: Mazzucchelli Chiara , Bordone Caterina , Maggi David , Cordera Renzo
Published: September 2022

A 63-year-old Caucasian woman was referred to our diabetes clinic for evaluation of an unexplained drop in HbA1c in the past year without an apparent cause. She was diagnosed with type 2 diabetes (T2D) 5 years earlier upon routine laboratory screening. At the time of diagnosis, she was asymptomatic with a BMI of 29.5 kg/m2. She had had two uncomplicated pregnancies. Soon after her T2D diagnosis, she was started on therapy with a fixed combination of glyburide and metformin t.i.d. (2.5 mg + 400 mg, respectively; increased later to 5 mg + 400 mg). She also had hypertension treated with enalapril 20 mg/day. Since then, her HbA1c had been measured every 6 months and remained stable at 59 mmol/mol (7.5%) on the higher dose of glyburide. With no apparent reason, her HbA1c dropped to 42 mmol/mol (6%) during the past year. This low value, within the nondiabetic range, was confirmed 6 months later. She did not report any symptomatic hypoglycemia or a change in BMI. Blood glucose self-monitoring carried out twice weekly indicated poor glycemic control inconsistent with her HbA1c values. Her general practitioner recommended decreasing her antidiabetic therapy by half, but her HbA1c was still 42 mmol/mol (6%) 3 months later. At time of presentation, mild anemia was present. Upon obtaining further, it was discovered that she had started therapy with dapsone for pemphigus 15 months earlier.
Case 30: U-500 Insulin Pump Case
Authors: McCall Anthony
Published: September 2022

A 49-year-old man presented for follow-up of uncontrolled type 2 diabetes with moderate peripheral neuropathy, hyperlipidemia, obesity, and hypertension. His last endocrine visit was 7 years ago, when he was obese and insulin resistant. This patient was initially on multiple injections of NPH and regular insulin and then converted to injection of U-500 regular insulin twice daily with improved control. He was then placed on an insulin pump, which he still uses with U-500 insulin only.
Case 34: Adhering or Not? That Is the Question: A Case of Glucolipotoxicity and Concentrated Insulin
Authors: Deshmukh Sanaa , Buzzola Rino , Touza Mariana , Gardner Michael , Sowers James
Published: September 2022

The patient is a 57-year-old woman with past medical history significant for obesity, stage 3 chronic kidney disease (with polycystic kidney disease), hypertension, and hyperlipidemia. She presented to the clinic for follow-up of uncontrolled type 2 diabetes, diagnosed 3 years prior. Her medical regimen consisted of liraglutide 0.6 mg subcutaneously daily, insulin aspart 50 units three times a day with meals (a combination used off-label), and insulin glargine 75 units two times per day. On this regimen, she reported experiencing low blood glucose approximately two times per month, usually in the evenings before bedtime. She reported not checking her blood glucose because she had misplaced her home glucose monitoring.
Case 41: New-Onset Type 1 Diabetes, Addison’s Disease, and Hypothyroidism: A Case of Autoimmune Polyendocrine Syndrome Type 2
Authors: Golden Lauren , Goland Robin
Published: September 2022

A 49-year-old obese Caucasian woman with a 2-year history of alopecia totalis presented to the emergency department (ED) complaining of profound weakness, polyuria, polydipsia, nausea, abdominal pain, and near-syncope. She described a 2-year history of abdominal pain and weight loss of 50–70 lb. Multiple workups, including an inpatient evaluation for severe abdominal pain, had been unrevealing except for unexplained eosinophilia. She was treated for presumptive “gastritis” with antacids and histamine blockers without relief and was referred for psychiatric evaluation. The week prior to admission, she noted worsening weakness, polyuria, blurred vision, and nausea. In the ED she was found to be hypotensive (systolic blood pressure 60 mmHg) with hyperglycemia (glucose 500 mg/dL or 27.8 mmol/L), an elevated anion gap, acidosis, and elevated serum ketones. A diagnosis of new-onset diabetes with diabetic ketoacidosis (DKA) was made. She was started on intravenous insulin and fluids and admitted to the medical intensive care unit. Blood pressure was unresponsive to fluids.
Case 43: Atypical Type 2 Diabetes with Profound Dyslipidemia
Authors: Pettus Jeremy , Henry Robert
Published: September 2022

A 30-year-old otherwise-healthy African American man presented to his health care provider after recently being discharged from the military to establish care. At that time, he was complaining of rapid, unintentional weight loss (roughly 100 lb in the past 9 months) with a current BMI of 27 kg/m2, polyuria, polydipsia, blurred vision, and numbness in his extremities.
Case 47: Stiff Person Syndrome in a Patient with Multiple Autoimmune Diseases
Authors: Hughes Jing , McGill Janet
Published: September 2022

G.T. is a 56-year-old woman with an extensive past medical history of autoimmune disorders who complained of right leg stiffness at a follow-up office visit. Her first autoimmune disease was ulcerative colitis with onset during her teen years, which prompted a total colectomy at age 19 years. She was subsequently diagnosed with Graves’ disease at age 25 years, which was treated with subtotal thyroidectomy. She developed type 1 diabetes (T1D) at age 32 years, and despite insulin pump use had an HbA1c of 9.8%. Celiac disease was diagnosed at age 55 years, but it may have been present for >10 years. Her symptoms of painful spasms of her right leg began ~10 months prior to the visit and were gradually progressive. She described leg stiffness that extended from hip to ankle and felt like “general weakness with periodic spasms.” The spasms were so severe that she was not able to bend her knee or fully extend or flex her hip, causing impaired balance and several falls. She noted that these spastic episodes were exacerbated by cold weather as well as emotional stress and anxiety, as when she was being observed. On exam, she was noted to have a markedly abnormal gait, characterized by swinging of the right leg and overcompensation of the trunk. She was unable to perform tandem walk and had impaired balance with movement but negative Romberg. Thigh palpation revealed muscle tightness. No sensory deficits were identified. The symptoms had escalated and were now debilitating.
Case 51: Growth Hormone Excess-Induced Diabetic Ketoacidosis
Authors: Demidowich Andrew , Lodish Maya , Rother Kristina
Published: September 2022

A 17-year-old boy presented to a local emergency department with severe abdominal pain, nausea, and vomiting starting earlier that morning. He reported being in good health all his life, but he had not seen a physician since moving with his family from Korea 10 years prior. Upon prompting, he mentioned experiencing excessive thirst, frequent urination, and decreased energy for the preceding 6 months. On admission his glucose was 443 mg/dL (24.6 mmol/L), sodium 125 mmol/L, chloride 90 mmol/L, bicarbonate 15.0 mmol/L, urine ketones ≥150 mg/dL, and pH 7.27. The patient was diagnosed with diabetic ketoacidosis (DKA), and intravenous rehydration and insulin infusion were initiated.
Case 54: Inpatient Insulin Management for Complex Enteral Feedings
Authors: Barton Anna Beth , Evans Kathryn , Lien Lillian
Published: September 2022

A 65-year-old male patient with type 2 diabetes and longstanding achalasia refractory to myotomy was admitted for esophagectomy with cervical pharyngogastrostomy. Postoperatively, enteral tube feedings (TF) were initiated and administered on a continuous (24 h) basis. The primary team initially maintained the patient on a “sliding scale” of regular insulin alone, despite his known history of diabetes. As an outpatient, his diabetes regimen consisted of Januvia 100 mg/day, with the most recent A1C documented at 6.4% 2 months before his admission. On sliding-scale insulin alone, he was persistently hyperglycemic with blood glucose values ranging from 169 to 280 mg/dL (9.4–15.6 mmol/L). Thus, the inpatient Diabetes Management Service (DMS) was consulted for assistance with glycemic control. Of note, his postoperative course was complicated by an empyema thought to be related to aspiration resulting in sepsis requiring intravenous antibiotics, inotropic support, and chest tube placement. This led to intermittent initiation and discontinuation of tube feeds. At the time of consultation, he was afebrile with a blood pressure of 124/60 mmHg, heart rate of 100 bpm, and weight of 84 kg. He was sedated on mechanical ventilation. Physical exam was notable for a nasogastric tube in his naris and a chest tube draining purulent material. He was mildly tachycardic but without murmurs and had decreased breath sounds on bilateral lung exam. There was no upper extremity edema but he did have trace edema in his lower extremities.
Case 58: Extreme Insulin Resistance Following Heart Transplant
Authors: Gupta Suruchi , Johnson Oakes Diana , Therasse Ashley , Wallia Amisha
Published: September 2022

A 60-year-old Caucasian woman presented with 2 weeks of worsening fatigue and shortness of breath. Past medical history revealed adriamycin-induced cardiomyopathy, for which she required a left ventricular assist device (LVAD) and a subsequent heart transplant. She did not have a history of diabetes. Her blood glucose (BG) average 3 months before the transplant was 112 ± 30 mg/dL (6.2 ± 1.7 mmol/L). Her preoperative glucose was 80 mg/dL (4.4 mmol/L) and her intraoperative BG levels ranged from 95 to 342 mg/dL (5.2–19 mmol/L). There were no complications during surgery. She received a single dose of 500 mg of intravenous (i.v.) methylprednisone intraoperatively.
Case 59: Glycemic Control after Left Ventricular Assist Device Placement in a Patient with Type 2 Diabetes
Authors: Staskus Gitana
Published: September 2022

A 63-year-old man with severe coronary artery disease, ischemic cardiomyopathy, underwent a repeat coronary artery bypass grafting (CABG) with aortic valve replacement and mitral valve repair on November 1, 2012, in a regional hospital. He had difficulty weaning off of cardiopulmonary bypass despite an intraaortic balloon pump placement and inotropic support. He was transferred to the cardiothoracic surgery (CT) service at the University of Utah Hospital on November 2, 2012, in critical condition with an open chest and on extracorporeal membrane oxygenation (ECMO). His past medical history revealed poorly controlled type 2 diabetes for 13 years and CABG in 1996. His home insulin regimen was glargine 85 units once daily and glulisine 6 units with meals 3 times a day.
Case 67: Glycemic Control in a Patient with Type 1 Diabetes and Peritoneal Dialysis
Authors: Khir Nadir , Brietzke Stephen , Sowers James
Published: September 2022

A 51-year-old Caucasian woman with longstanding type 1 diabetes (T1D), with end-stage renal disease on maintenance peritoneal dialysis (PD), developed increasingly labile glycemia and frequent, severe hypoglycemia and hypoglycemia unawareness. Diabetes Service was consulted during hospitalization for severe hyperglycemia and hypoglycemia, which persisted on a basal-bolus insulin regimen of glargine and lispro. Review of her records identified a temporal association between increasing glycemic variability and the introduction of icodextrin to her dialysis protocol. Hypoglycemic episodes occurred nocturnally, before breakfast in the fasting state, or in the late morning, after breakfast. Her insulin regimen, which had been tailored toward nocturnal dialysate exchanges, consisted of glargine 10 units each morning and NPH insulin, 8 units at the start of PD exchanges each night. Mealtime aspart boluses, were administered at 2 units/15 g of carbohydrate, plus a correction dose of 1 unit per increment of 25 mg/dL (1.4 mmol/L) >150 mg/dL (8.3 mmol/L) by point-of-care testing. At home, she used a OneTouch UltraMini meter, performing at least four tests daily, and glycemia ranged from 30 to >600 mg/dL (1.7 to >33.3 mmol/L) despite frequent insulin correction dosing.
Case 68: Insulin Allergy in an Insulin-Requiring Patient
Authors: Mathioudakis Nestoras
Published: September 2022

A 60-year-old woman with a 6-year history of type 2 diabetes was referred for a second opinion regarding management of uncontrolled diabetes in the context of “an allergy to all types of insulin.” One year before her initial visit, the patient had been started on detemir injections at bedtime because of unsatisfactory glycemic control on multiple oral agents. Immediately after injecting insulin, the patient developed urticaria at the injection site, surrounded by an erythematous and pruritic rash. There was no generalized urticaria or angioedema. Neither changing needles nor taking antihistamines could prevent this reaction. Subsequently, she was given a trial of exenatide, which produced the same reaction. Glycemic control was not significantly improved by glargine or exenatide.
Case 69: Use of 3-Day Continuous Glucose Monitoring to Investigate Persistent Fasting Hyperglycemia in Type 2 Diabetes
Authors: Griffith Michelle , Korytkowski Mary
Published: September 2022

A 38-year-old woman with type 2 diabetes for 13 years, complicated by peripheral neuropathy, was seen in a university-based diabetes clinic. Additional medical history was significant for hypertension and hyperlipidemia. Her HbA1c varied from 8.1 to 8.9% over the past 2 years. Her medications included metformin 1,000 mg twice per day in combination with a basal-bolus insulin (BBI) regimen of glargine 20 units in the morning and 60 units in the evening and lispro with meals: 16 units with breakfast, 30 units with lunch, and 36 units with dinner. She reported that glargine had been increased from 50 units nightly to the current split dosing over the past 6 months.
Case 76: No Effect of Gluten-Free Diet in Prevention of Autoimmune Type 1 Diabetes and Other Autoimmune Disorders in a Child with Celiac Disease
Authors: Muntoni Sandro , Congia Mauro
Published: September 2022

An 11-month-old Sardinian female infant was brought to our clinic in March 2000 for 3 weeks of diarrhea (4–5 bowel movements daily), associated with weight loss from 9.0 kg to 7.5 kg. She was naturally born at the 39th week of gestation and breast-fed until 1 month of age when baby formula milk was introduced. At the end of the sixth month, she started the weaning until the progressive onset of the diarrhea.
Case 77: What Does It Take to Keep Glucose Normal?
Authors: Phillips Lawrence
Published: September 2022

The U.S. Diabetes Prevention Program (DPP) and other studies have shown that in patients with prediabetes, the development of diabetes could be reduced by lifestyle change programs or glucose-lowering medications. After the studies ended, the cumulative incidence of diabetes in patients who previously had received the active interventions remained lower than in the control patients,1 consistent with a change in their natural histories.
Case 80: The Case of an Older Woman with Diabetes on Insulin Pump Therapy, Struggling with Cognitive Decline, Hypoglycemia, and Loss of Autonomy
Authors: Hackel Jennifer , Douyon Liselie , Halter Jeffrey
Published: September 2022

A woman with longstanding type 2 diabetes (T2D), received an insulin pump upon enrollment in a research study at age 69 years. At age 74 years, she began receiving primary care at a geriatric clinic where a gerontological nurse practitioner (GNP), geriatrician, and social worker saw her as a team.
Case 89: Reversal of Insulin-Requiring Type 2 Diabetes and Development of Hypoglycemia in a Morbidly Obese Patient
Authors: Bell David
Published: September 2022

A 50-year-old morbidly obese African American man was in good health until age 38 years when he was diagnosed as having heart failure resulting from severe hypertension.
Case 90: Munchausen-by-Proxy: Hypoglycemia in an Islet Autotransplantation Recipient
Authors: Robertson R. Paul
Published: September 2022

An 8-year-old girl was admitted to the emergency department (ED) because of profound hypoglycemia. She had a history of unrelenting, painful chronic idiopathic pancreatitis since age 2 years that led to an inability to attain normal weight, daily narcotic use, depression, and poor school attendance. At the age of 7 years, she underwent total pancreatectomy to relieve pain followed by intrahepatic islet autotransplantation to prevent diabetes. In the post-transplant period she felt much better, improved attendance at school, and discontinued narcotics within 12 months. The entire family was pleased with this result except the girl’s mother, who initially had objected to the surgery. In her view, it made no sense to make her little girl develop diabetes and then treat the diabetes by removing islets from the pancreas and putting them in the liver. The husband understood that pancreatectomy was needed for pain relief, sided with the surgeons, and dismissed the mother’s anxieties. Post-transplant, the mother decided she would help the girl by using her blood glucose meter to monitor her glucose levels, which pleased the father.
Case 98: Severe Distal Symmetrical and Autonomic Neuropathy in a Patient with a Short Duration of Type 1 Diabetes
Authors: Bell David
Published: September 2022

17-year-old woman had had type 1 diabetes for 2 years when she developed restless legs, which was followed by paresthesias in her lower limbs, and soon after by the development of nocturnal diarrhea, fecal incontinence, early satiety, weight loss, and dizziness on standing.
Derivation and External Validation of a Clinical Model to Predict Heart Failure Onset in Patients with Incident Diabetes
Authors: Sun Louise Y. , Zghebi Salwa S. , Eddeen Anan Bader , Liu Peter , Lee Douglas S. , Tu Karen , Tobe Sheldon W. , Kontopantelis Evangelos , Mamas Mamas A.
Published: September 2022

  

Objective: Heart failure (HF) often develops in patients with diabetes and is recognized for its role in increased cardiovascular morbidity and mortality in this population. Most existing models predict risk in patients with prevalent rather than incident diabetes and fail to account for sex differences in HF risk factors. We derived sex-specific models in Ontario, Canada to predict HF at diabetes onset and externally validated these models in the UK.

Research Design and Methods: Retrospective cohort study using international population-based data. Our derivation cohort comprised all Ontario residents aged ≥18 years, who were diagnosed with diabetes between 2009-2018. Our validation cohort comprised UK patients aged ≥35 years, who were diagnosed with diabetes between 2007-2017. Primary outcome was incident HF. Sex-stratified multivariable Fine and Gray subdistribution hazard models were constructed, with death as a competing event.

Results: A total of 348,027 Ontarians (45% women) and 54,483 UK residents (45% women) were included. At 1, 5, and 9 years, respectively in the external validation cohort, the C-statistics were 0.81 (95%CI: 0.79-0.84), 0.79 (0.77-0.80), and 0.78 (0.76-0.79) for the female-specific model; 0.78 (0.75-0.80), 0.77 (0.76-0.79), and 0.77 (0.75-0.79) for the male-specific model. The models were well-calibrated. Age, rurality, hypertension duration, hemoglobin, HbA1C, and cardiovascular diseases were common predictors in both sexes. Additionally, mood disorder and alcoholism (heavy drinker) were female-specific predictors, while income and liver disease were male-specific predictors.

Conclusions: Our findings highlight the importance of developing sex-specific models and represent an important step towards personalized lifestyle and pharmacologic prevention of future HF development.
Systematic Review of Chinese Medicine for the Treatment of Dysfunctional Uterine Bleeding
Authors: Meng Wei
Published: September 2022

Objectives: To evaluate the effectiveness of Chinese medicine in treating dysfunctional uterine bleeding via a systematic review and meta-analysis. Methods: Clinical trials of Chinese medicine treating dysfunctional uterine bleeding were retrieved with specific search strategy in the following databases: CNKI (from 1994 to December 2016), Wan Fang (from 1980 to December 2016), Pro Quest Medical Database (from 1980 to December 2016), MEDLINE (from 1950 to December 2016) and PUBMED (from 1980 to December 2016). Eligible randomized controlled trials (RCTS) were selected with the inclusion and exclusion criteria. The quality of trials was accessed by the risk of bias assessment tool. Data was extracted into Excel and analyzed by Software Rev Man 5.3. Result: A total of 21 RCTs were included with 2167 patients. The meta-analysis showed that the Chinese medicine group had higher recovery rate than that of the Western medicine group [OR=2.26, 95% CI (1.86, 2.74), P<0.00001]. The effectiveness of Chinese medicine was superior to the Western medicine [OR=3.93, 95% CI (2.99, 5.169), P<0.00001]. There were no significant difference in bleeding arrest in 3 days [OR=0.90, 95% CI (0.49, 1.63), P=0.73] and in 10 days [OR=1.40, 95% CI (0.80, 2.44), P=0.24] between Chinese medicine group and Western medicine group. Few side effects were observed in the Chinese medicine group [OR=0.04, 95% CI (0.01, 0.11), P<0.0001]. The Chinese medicine group also had a lower recurrence rate than that of Western medicine group [OR=0.16, 95% CI (0.06, 0.47), P=0.0008]. Conclusion: Chinese medicine appears to have better overall clinical effect in treating dysfunctional uterine bleeding with less side effects and lower chance of recurrence. However, the quality of the included studies needs to be improved; the findings should be interpreted with caution. Further large-scale, rigorously designed trials are warranted to confirm the findings.
Aloe a Gel in a Cell
Authors: R Chandrasekar
Published: September 2022

Aloe a miracle plant obtained from many species namely aloe vera, aloe barbadensis, aloe perryi, aloe ferox and various other species. Aloe vera the Indian species cultivated in India and other species are cultivated in Africa. Aloe is a cactuslike plant that grows in hot, dry climates. Aloe plant can withstand drought conditions and can grow without rainfall. Aloe produces two substances, gel and latex. Aloe gel is a clear, jelly-like substance found in the inner part of the aloe plant leaf. Aloe latex comes from the plant's skin and is yellow in color. Some aloe products are made from the whole crushed leaf, so they contain both gel and latex. Aloe vera plant has enormous activities in treatment of various skin diseases such as acne, burns, psoriasis, etc. and used in herbal cosmetics. Aloe gel is used in many cosmetic preparations as face wash and herbal creams etc. since the potency, efficacy, safety is more toxicity and side effects are comparatively less. Aloe is used in gum diseases in, dental problems and dental plaque etc. Aloe gel has anti-diabetic activity, used in treatment of glaucoma, and can treat vision problems. It is also used in hepatitis, osteoarthritis, varicose veins, weight loss etc. aloe has tremendous other activities. This review includes various uses, medicinal properties, pharmacological actions, various extracts of these Aloe species are traditionally used and their application used to cure, arthritis, inflammation, immunity, diabetes, hyperlipidemic, antioxidant, atherosclerosis, coronary heart diseases, laxative, antibacterial, antifungal, antiviral, wound healing and antitumor effect. Since aloe has been reviewed in many journal and articles, this review is compiled from recent article of aloes. Hence aloe is an invaluable gift of nature and a miracle plant. Aloe is a medicinal plant from the past, present and future and the invaluable activities present in this plant leads us to promising activities for the research and development for finding new entities.
Low Carb Diet Outrank Low Fat Diet in Weight Loss
Authors: Ansari Shabnam
Published: September 2022

As per the study published in the Annals of Internal Medicine, a racially diverse group of 150 men and women were recruited to follow a specific diets for one year which particularly restricted them to eat wither carbohydrate or fat, but not overall calories.
Evaluation of In-vitro Antibacterial and Anthelmintic Activities of Sauropus androgynus (Phyllanthaceae) Plant Extracts
Authors: MN Palaksha
Published: September 2022

The present study was carried out to evaluate the qualitative analysis of various phytochemicals and in-vitro evaluation of antibacterial and anthelmintic activities of Ethanolic leaf extracts of Sauropus androgynus (Phyllanthaceae). The extracts were subjected to preliminary phytochemical screening for the identification of different phytoconstituents, the leaves indicated the presence of proteins, resins, steroids, tannins, glycosides, reducing sugar, carbohydrates, saponins, sterols, terpenoids, acidic compounds, cardiac glycosides, catechol, phenols, alkaloids, flavanoids. The different concentrations of Ethanolic extracts were subjected to antibacterial screening against various Gram positive and Gram negative bacteria and the results were compared with that of standard drug Gentamycin. Different concentrations of leaf extracts were tested to evaluate Anthelmintic activity using Sauropus androgynus (Indian earthworm). The extracts was found to possess vermifuge and vermicidal activity and the results were compared with standard drug Albendazole.