Longitudinally Extensive Transverse Myelitis (LETM) in COVID-19 Infection, A Case-Report

IntroductionSince the COVID-19 pandemic, a growing number of central nervous system (CNS) complications in patients with COVID-19 have been reported. Isolated, longitudinally extensive transverse myelitis (LETM), is a unique presentation of CNS involvement. The limited reports, its diverse clinical manifestations and the possible long-term consequences make the reporting crucial to further our understanding of those syndromes occurring in COVID-19 positive patients.Case PresentationA 63-year old male consulted the emergency department after a sudden onset of gait ataxia, a one-week history of paresthesia progressing from the feet to the midsternal area and urinary. He tested positive on a SARS-CoV-2 RNA RT-PCR nasopharyngeal swab two days prior to the onset of his symptoms. Neurological examination showed a sensory level at T7 with symmetrically reduced fine touch, vibration, proprioception and furthermore an ataxic gait was observed. Cerebrospinal fluid on day one of admission showed pleocytosis, predominantly neutrophils, elevated protein count and normal glucose level and IgG. MRI of the spinal cord revealed a diffusely increased signal intensity involving the near-complete spinal cord, from the brainstem to level T12, fitting the diagnosis of LETM. ConclusionThe few cases of transverse myelitis in association with COVID-infection are believed to have an immune-mediated postinfectious mechanism. In this case however, parainfectious direct viral invasion of the spinal cord is far more likely because of a neutrophilic predominance in CSF and a short timespan between infection and symptoms. It could provide more clues that the SARS-CoV-2 is acutally capable of causing direct neurotoxic effects.

A Child with Primary Leptomeningeal Melanoma

Primary malignant melanoma of the meninges is an exceedingly rare neoplasm. Usually its symptoms include raised intracraneal pressure resulting from hydrocephalus seconday to tumoral obliteration of cisternal basal cisterns, but the passage of time from initial symptomalogy to diagnosis is frequently delayed. A 12-year-old male with primary letomeningeal melanoma is reported. At the beginning, he presented with vomiting, headache, complex seizures, fever four months before the admission in the hospital where progressive loss of consciouness after admission. Lumbar puncture reveled high protein level, normal glucose level and 50 leucocytes/mm3 with 86% polymorphic cells. Magnetic ressonance imaging of the brain was referred and in T1-weighted images revealed a diffuse enhancement of the leptomeninges on right frontal cortical. An open brain biopsy trough was performed, after exclusion of the infectious nervous system disease. Histological examination revealed massive infiltration of meninges with brown tumor cells. These cells stained positive for HMB-45, S-100 protein and vimentin. The patient received post operative radiation therapy, but died after three months of the diagnosis with septic shock and epileptical status

Ketoacidosis associated with ketogenic diet in a non-diabetic lactating woman

A 37-year-old woman who had 8 weeks post partum, breast feeding and on a low carbohydrate and high protein (ketogenic) diet, was admitted to the hospital with acute onset of nausea, vomiting and abdominal pain of 1-day duration. On admission, she was found to have high anion gap metabolic acidosis, elevated beta-hydroxybutyric acid level, normal glucose level and evidence of ketoacidosis. She was treated with lactated Ringer solution, along with dextrose 5% solution with the resolution of symptoms and metabolic derangement.

ANALYSIS OF THE INCIDENT RATE OF PEOPLE WITH A POTENTIAL RISK FOR HYPERTENTION AND DIABETES IN KENJERAN SUB-DISTRICT, SURABAYA

Background: The number of people with diabetes mellitus in Indonesia is increasing every year. The data in 2016 showed that 1 of 11 adults could have diabetes mellitus. Uncontrolled and untreated diabetes mellitus can cause complications. Objectives: This activity aimed to determine the group of age that have a potential risk of hypertension and diabetes so that it could minimize the prevalence of disease and optimize human productivity. Methods: (1) Counseling about hypertension and diabetes, (2) Screening the people with a potential risk of hypertension using tensimeter and diabetes prediction using point-of-care testing (POCT) and urine dipstick. Results: The data were collected from 75 respondents with characteristics about 85,33% female and 14,67% male. About 25 respondents (33,33%) were suspected of hypertension. Based on age group, it showed that the highest incident rate of hypertension was found in the age group of 41-60 years (41,86%), followed by the age group of 61-80 years (20%), 21-40 years (13,33%), and age under 20 years and above 80 years (0%). The majority of respondents had a normal glucose level(90,67%). Based on gender, there was 1 male respondent (9,09%)and5female respondents (7,81%) having a glucose level higher than normal value (hyperglycemia). Conclusion: The age group with the highest potential risk for hypertension was 41-60 years, while for diabetes was 61-80 years. This activity provided information to prevent the potential risk leading to hypertension and diabetes.

Is there any Effect of Blood Glucose Level on Finger Biting?

To interact glucose level of blood with finger biting was the goal of present research. 130 subjects took part in present research, where their glucose level of blood calculated. The normal glucose level in blood is in between 100 to 140mg/dl. The hyperglycemia is known as high glucose level while hypoglycemia is known as low glucose level. The biting of fingers in the mouth with teeth is known as finger biting. It also refer as onychophagia. There were 130 students take part in this research and they measured their sugar level by using glucose meter. Then they correlate the glucose level with finger biting. It was concluded from the present study that glucose level of blood has no impact on finger biting.

Treatment Compliance in Diabetics: Physician-Patient Relationship

Diabetes is a chronic disease and non-compliance attitude of patients poses a great challenge to the success of therapy. Multiple factors influence compliance among diabetics and other chronic diseases and non-compliance results in avoidable consequences and complications. In order to determine the magnitudeand factors of non-compliance to physicians’ advice in diabetics attending outpatients, a cross-sectional analytical study was conducted in outpatient diabetic clinics of Shaikh Zayed and Services Hospitals in Lahore. Results presented in this study are based on 177 patients investigated for 3 months (April 2014-June2014). Subjects were conveniently enrolled after taking written informed consent using a self-constructed and structured questionnaire. Out of 177 participants, 55.36% were females and 51.41% participants were in the range of 52-75 years of age. Among 79 males, majority (45.6%) were employees, whereas 91.8% werehousewives among females’ participants,. Out of 177 diabetic patients, 42 patients (23.7%) were non-compliant and 135 patients (62.5%) were found to be compliant. The normal glucose level was observed in 120/177 (67.8%) of participants. Interestingly, 97.2% subjects revealed agood attitude as the main trait of apractitioner whereas 2.8% claimed good practice and competency. Conversely, 94.4% blamed bad attitude as a trait of bad doctor whereas 4.6% reported that the bad practice and incompetency is responsible for the negative trait. Taken together, compliance to physician’s advice is better among diabetics attending tertiarycare hospitals in current study. The study encourages our health care system to provide more awareness and obtain a deeper understanding of factors causing non-compliance. A positive relationship between patient and practitioners would positively impact on the clinical outcome of the ailments and their therapies.

Selection of the Best Thermal Massage Treatment for Diabetes by using Fuzzy Analytical Hierarchy Process

Diabetes is a condition in which the human blood glucose (sugar) level is abnormally high due to the lack of insulin produced by the pancreas. As diabetes has been claimed to be a disease that is incurable, researchers have come out with numerous alternati ves in making it curable and one of them is thermal massage treatment. This treatment refers to the application of chiropractic where it focuses on realigning the spine where diabetes is claimed to be related to the misalignment of thoracic 7 (T7). The obj ective of this study is to identify and select the best and most effective thermal massage treatment session(s) required for both T1D and T2D patients of different high glucose level in the blood to be reduced to the normal glucose level by using thermal m assager. This study is conducted for the diabetic patients who receive treatments from Ceragem Healthcare Centre on how to optimise their thermal massage treatments to normalise their glucose level. Fuzzy Analytical Hierarchy Process (AHP) is utilised in t his type of selection problem mainly due to the reliable results produced for the imprecise and uncertain preferences of the users in which able to be expressed as a fuzzy set (triangular fuzzy number). The findings indicated that the most significant crit eria for effective thermal massage is determined by the “number of treatment session (per day)” where the best thermal massage treatment is derived from the normalised fuzzy weight of both criteria and sub - criteria.

Diabetic Foot Complications Despite Successful Pancreas Transplantation

Background: It is known that successful pancreas transplantation enables patients with diabetes to maintain a normal glucose level without insulin and reduces diabetes-related complications. However, we have little information about the foot-specific morbidity in patients who have undergone successful pancreas transplantation. The purpose of this study was to investigate the prevalence and predisposing factors for foot complications after successful pancreas transplantation. Methods: This retrospective study included 218 patients (91 males, 127 females) who had undergone pancreas transplantation for diabetes. The mean age was 40.7 (range, 15-76) years. Diabetes type, transplantation type, body mass index, and diabetes duration before transplantation were confirmed. After pancreas transplantation, the occurrence and duration of foot and ankle complications were assessed. Results: Twenty-two patients (10.1%) had diabetic foot complications. Fifteen patients (6.9%) had diabetic foot ulcer and 7 patients (3.2%) had Charcot arthropathy. Three patients had both diabetic foot ulcer and Charcot arthropathy. Three insufficiency fractures (1.4%) were included. Mean time of complications after transplantation was 18.5 (range, 2-77) months. Creatinine level 1 year after surgery was higher in the complication group rather than the noncomplication group ( P = .02). Conclusion: Complications of the foot and ankle still occurred following pancreas transplantation in patients with diabetes. Level of Evidence: Level III, comparative study

Dual effects of fructose on ChREBP and FoxO1/3α are responsible for AldoB up-regulation and vascular remodelling

Increased production of methylglyoxal (MG) in vascular tissues is one of the causative factors for vascular remodelling in different subtypes of metabolic syndrome, including hypertension and insulin resistance. Fructose-induced up-regulation of aldolase B (AldoB) contributes to increased vascular MG production but the underlying mechanisms are unclear. Serum levels of MG and fructose were determined in diabetic patients with hypertension. MG level had significant positive correlations with blood pressure and fructose level respectively. C57BL/6 mice were fed with control or fructose-enriched diet for 3 months and ultrasonographic and histologic analyses were performed to evaluate arterial structural changes. Fructose-fed mice exhibited hypertension and high levels of serum MG with normal glucose level. Fructose intake increased blood vessel wall thickness and vascular smooth muscle cell (VSMC) proliferation. Western blotting and real-time PCR analysis revealed that AldoB level was significantly increased in both the aorta of fructose-fed mice and the fructose-treated VSMCs, whereas aldolase A (AldoA) expression was not changed. The knockdown of AldoB expression prevented fructose-induced MG overproduction and VSMC proliferation. Moreover, fructose significantly increased carbohydrate-responsive element-binding protein (ChREBP), phosphorylated FoxO1/3α and Akt1 levels. Fructose induced translocation of ChREBP from the cytosol to nucleus and activated AldoB gene expression, which was inhibited by the knockdown of ChREBP. Meanwhile, fructose caused FoxO1/3α shuttling from the nucleus to cytosol and inhibited its binding to AldoB promoter region. Fructose-induced AldoB up-regulation was suppressed by Akt1 inhibitor but enhanced by FoxO1/3α siRNA. Collectively, fructose activates ChREBP and inactivates FoxO1/3α pathways to up-regulate AldoB expression and MG production, leading to vascular remodelling.