Acute Metabolic Complications of Diabetes in the Oueme-Plateau Provincial Teaching Hospital: Epidemiological, Clinical, Paraclinical and Evolutionary Aspects

Introduction: Diabetes mellitus, a metabolic disease, is now an important public health problem across the world. Our aim was to study the epidemiological, clinical, paraclinical, and evolutionary aspects of acute metabolic complications (AMC) of diabetes in the endocrinology department of the Oueme-Plateau Provincial Teaching Hospital. Methods: This was a descriptive cross-sectional study with data collection based on the medical records of patients presenting with acute metabolic complications of diabetes in the endocrinology department of the Oueme-Plateau Provincial Teaching Hospital during the 3 years study period (from January 2020 to December 2022). Results: Over 788 patients hospitalized during the study period, 157 had an acute metabolic complication of diabetes, which is a hospital prevalence of 19.9%. Among these 157 cases, 140 were suitable for analysis and therefore constituted our study sample. The mean age of the patients was 49.9 ± 14.7 years, with 19 as minimum and 90 years as maximum. Most of them were women (52.4%). Hypertensive diabetics accounted for 54.9% of cases. Ketoacidosis was the most common complication (62.1%), followed by hyperosmolar hyperglycemic syndrome (23.6%) and hypoglycemia (14.3%). Infection (69.3%) and therapeutic noncompliance (22.9%) were the most common triggers. The average length period of their hospital stay was 7.1 ± 5.1 days, and the outcome was satisfactory in 87.9% of the cases. Unfortunately, there were 3.6% deaths during hospitalization. Conclusion: Acute metabolic complications of diabetes were dominated by ketoacidosis. Infection was the dominant factor in decompensation. Therapeutic education of diabetic patients as well as clinical and biological monitoring must be more stringent and rigorous.

Clinical study of recombinant human brain natriuretic peptide in patients with acute myocardial infarction complicating congestive heart failure

Objectives To observe the efficacy and safety of recombinant human brain natriuretic peptide(rh-BNP) on patients with acute myocardial infarction complicating congestive heart failure.Methods 40 patients with acute myocardial infarction complicated by congestive heart failure were randomly divided into control group and treatment group of 20 cases.The control group,15 cases of acute anterior myocardial infarction,5 cases of acute inferior wall myocardial infarction, 15 males and 5 females,aged 55-70 years,mean age 58±12 years;treated 16 cases of acute anterior myocardial infarction,4 cases of acute myocardial infarction,16 males and 4 females,aged 56-70 years,mean age 59±11 years;two groups of age,gender,severity of disease and vascular lesions no significant difference and comparable(P】0.05).Conventional group were given aspirin,clopidogrel, statins,Inotropic,diuretic and vasodilator therapy.In the con- ventional treatment group based on the use of recombinant human brain natriuretic peptide(new bios,Tibet Pharmaceutical Co.,Ltd.Chengdu Nuodikang biopharmaceutical production, usage:1.5μg/Kg intravenous injection(impact), then 0.0075μg-0.01μg/(kg·min)infusion rate).Continuous medication 72 h.The clinical symptoms observed for 3 days in patients before treatment and after treatment,heart rate,blood pressure and left ventricular ejection fraction (LVEF) and tumor necrosis factor(TNF-α),brain natriuretic peptide(BNP) levels were measured.Results In control group,8 cases markedly effect,5 cases effect and 7 cases no effect,the total effective rate was 65%;In treatment group,13 cases markedly effect,6 cases effect and 1 cases no effect,the total effective rate was 95%,compared with two groups P New bios treatment group significantly increased cardiac index(CI) in patients with heart failure and left ventricular ejection fraction(LVEF) than the control group(all P【0.05),further reduce the levels of tumor necrosis (TNF-α) and brain natriuretic peptide(BNP).Conclusions rh-BNP can improve symptoms and heart function,reduced plasma tumor necrosis factor(TNF-α) and BNP levels of acute myocardial infarction patients with congestive heart failure,the treatment safe and reliable.As small sample size observed,larger sample to be accumulated to further evaluate its efficacy and safety.

Massive retroperitoneal hematoma as an acute complication of retrograde intrarenal surgery:A case report

BACKGROUND Retrograde intrarenal surgery(RIRS)has been proven to be a safe and effective treatment modality in large-scale quantitative studies.However,although its safety profile has been established,it also has a potential risk of life-threatening complications.We here describe our experience with a patient who developed a huge periureteral hematoma after RIRS with holmium laser lithotripsy.CASE SUMMARY A 73-year-old woman visited our center with a complaint of gross hematuria.An enhanced computed tomography(CT)scan revealed a 1.5-cm left renal pelvis stone with hydronephrosis.The patient underwent RIRS.During the surgery,a 12/14-Fr ureteral access sheath was applied and a 6-Fr ureteral catheter was indwelled thereafter.On postoperative day 1,she experienced aggravated left flank pain and left lower-quadrant tenderness without rebound tenderness.A follow-up CT scan was taken,which revealed a huge hematoma in the periureteral space,not in the perirenal space,with suspicious contrast medium extravasation.Immediate angiography was performed;however,it showed no evidence of active bleeding.She was conservatively managed with hydration and antibiotic and nonsteroidal anti-inflammatory drug therapy,and was discharged on postoperative day 7.However,she visited our outpatient department with recurrent left flank pain at 5 d from discharge.Ultrasonography confirmed that the double J-stent was intact.To rule out stent malfunction,the stent was changed.Decreased size of the hematoma was observed in the imaging studies,and conservative management for candiduria was performed for 1 wk.CONCLUSION Although RIRS is an effective and safe procedure for the management of renal stones,clinicians should be aware of its potential complications.