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Non-traumatic neurological conditions in medico-legal work
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
Hypoglycaemic brain damage will be produced in the adult when blood glucose levels fall below about 1.5 mmol/L. Hypoglycaemia produces a pattern of selective neuronal necrosis which, in its pure form, differs from that seen with ischaemia (Auer 2004). However, hypoglycaemic coma is often accompanied by seizures or cardiorespiratory depression such that ischaemic features may coexist with the pathology associated with hypoglycaemia.
Fever In Endocrinologic Disorders
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
Ygal Gilboa, Elisabeth Horer, B. Isaac
Molnar et al.27 described cases of insulin induced hypoglycemic coma accompanied by hyperthermia. The coma was usually severe and prolonged, lasting between 2 to 14 days. The outcome was fatal and at autopsy, cerebral hyperemia and edema were present. Similar findings were reported by Ramos et al.28 and in one case mannitol administration, which reduces the cerebral edema, was life saving.
Management of Diabetes and Hyperlipidaemia by Natural Medicines
Published in Dilip Ghosh, Pulok K. Mukherjee, Natural Medicines, 2019
Kalpana Bhaskaran, Ong Jing Ting, Tan Tengli
Bitter melon can be used as a dietary supplement herbal medicine for the management of diabetes and/or metabolic syndromes (Cefalu et al. 2008). Some of the adverse effects that have been reported are hypoglycemic coma, convulsions in children, a favism-like syndrome and headaches. Bitter melon may also have an additive effect with other glucose-lowering agents (Basch et al. 2018).
Impact of a clinical pathway on cardiovascular risk in patients with diabetes
Published in Postgraduate Medicine, 2022
María Concepción Fernández-Planelles, Antonio Palazón-Bru, Miriam Calvo-Pérez, Antonio Miguel Picó-Alfonso, Vicente Francisco Gil-Guillén
Table 3 displays the total number of patients for whom information was obtained for the different outcomes, both in the pre- and post-intervention period. Through these numbers, the different percentages were calculated, as well as the difference between both periods and their statistical significance. An improvement in all outcomes was found, with reductions in events and increases in the control of the various cardiovascular parameters, although significance was not reached (p > 0.05) in hyperglycemic decompensation (0.43% vs 0.32%, p = 0.126), stroke (0.95% vs 0.77%, p = 0.124), STEMI (0.51% vs 0.36%, p = 0.076), non-STEMI (0.42% vs 0.41%, p = 0.989), diabetic ketoacidosis (0.03% vs 0.01%, p = 0.362), or hyperglycemic (0.06% vs 0.05%, p = 0.968) and hypoglycemic coma (0.03% vs 0.01%, p = 0.666). When we analyzed the magnitude of the differences, we observed that this was most notable in the improvement in metabolic control of diabetes (69.6%-32.5% = 37.1% in the youngest patients and 62.9%-28.8% = 34.0% in the oldest, p < 0.001), in screening (75.7%-70.3% = 5.4%, p < 0.001), and in the reduction in obesity (22.1%-26.2% = 4.1%, p < 0.001). An improvement was also seen in the control of dyslipidemia (42.0%-39.5% = 2.5%, p < 0.001). The absolute figures had variability, as different sources were used; therefore, only the relative data were interpreted.
Guidelines for the management of paediatric cholera infection: a systematic review of the evidence
Published in Paediatrics and International Child Health, 2018
Phoebe C. M. Williams, James A. Berkley
The infectious dose of V. cholerae required to cause infection is relatively high (over 108 V. cholerae), although human-shed organisms are more infectious and require a lower inoculum [10]. Once infected, V. cholerae causes a spectrum of illness — from asymptomatic disease to life-threatening dehydration — depending on bacterial load, degree of background immunity and presence or absence of malnutrition [11]. The incubation period varies between hosts and inoculum size, from 1 to 5 days. Mild cases may be indistinguishable from other causes of diarrhoeal illness, while profound infection causes rapid loss of fluid and electrolytes in ‘rice water’ stool (containing large amounts of sodium, potassium and bicarbonate) at rates of 10–20 ml/kg/h [3]. Severe hypovolaemia may occur within hours of symptom onset, resulting in hypovolaemic shock, hypokalaemia, lactic acidosis (owing to bicarbonate loss), acute renal failure and hypoglycaemic coma. The mortality of untreated cholera is 50–70%, and children have a 10 times greater risk of death than adults [5].
Patient and family expectations of beta-cell replacement therapies in type 1 diabetes
Published in Islets, 2018
Akitsu Kawabe, Shinichi Matsumoto, Masayuki Shimoda
In this questionnaire, we adopted a subjective assessment method for the respondents because we thought each patient had their own way to judge their condition and they should be responsible for setting each goal. In our previous survey we examined detailed information about hypoglycemia and pointed out that the experience of a hypoglycemic coma could increase the acceptance of new therapies.5 Thus, objective glycemic control needs to be examined so we can understand the influence of the quality of glycemic control on patients’ willingness to accept new therapies. On the basis of these points, further research should focus on the relationship between the acceptance of new therapies and respondents’ education level, occupation, and objective indicators of glycemic control such as HbA1c.