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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Neuropathic arthritis is a destructive arthropathy frequently associated with loss of proprioception. A third of patients, however, may have no demonstrable neurological deficit. Patients with diabetes, syphilis, syringomyelia and other neuropathies are particularly prone to developing this joint disease. The diagnosis of Charcot's joints should be considered in anyone who develops what appears to be a severe osteoarthritis or a transverse fracture of the tibia or fibula after minor trauma. Scoliosis with particularly destructive changes on radiography should prompt a search for syringomyelia or syphilis. The most common radiographic abnormalities are those of distension in 3D (Dislocation, Destruction and Degeneration). An atrophic form with resorption of the proximal humerus, most frequently described in syringomyelia, has been observed in diabetes. Loss of the distal end of the clavicle has not been described before in the neuropathies. These changes coupled with speckled calcification or shards of bone in the periarticular soft tissue confirm the diagnosis. Infection and CPPD crystal disease can be difficult to exclude. The joint fluid may be inflammatory and infection may be a complication. Treatment includes anti-inflammatories and splinting. Indications for surgery are limited.
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PMID:The neuropathic joint. 807 Jan 70

In an attempt to identify causes of perinatal mortality and thence devise preventative strategies on the island of Jamaica, a study was made of the 1847 singleton perinatal deaths occurring over the 12-month period between 1 September 1986 and 31 August 1987. Complications of the pregnancy were elicited by questioning the mother as well abstracting data from the antenatal and clinical obstetric records. The deaths were classified using the Wigglesworth categorisation and the three largest groups were chosen for special study: antepartum fetal deaths, deaths of live birth from immaturity and deaths from intrapartum asphyxia. The medical features of the pregnancies were compared with data similarly obtained from 9919 women delivering singletons in the 2 months of September and October 1986 and who survived the first week of life. Unadjusted statistically significant associations were found with maternal syphilis, vaginal infection or discharge, bleeding in the first two trimesters, bleeding in the third trimester, lowest haemoglobin, highest diastolic and first diastolic blood pressures, highest level of proteinuria, diabetes and antenatal eclampsia. Logistic regression taking account of social, environmental and health behaviour variables showed the following significant relationships. Antepartum fetal death was associated with adjusted odds ratio (AOR) for syphilis 2.88 [95% confidence interval (CI): 1.91, 4.32], bleeding in third trimester 3.86 [2.73, 5.44], highest diastolic blood pressure (P < 0.0001), highest level of proteinuria (P < 0.0001), lowest Hb (P < 0.0001) and antenatal eclamptic fits AOR 4.62 [1.47, 14.50]. Deaths from immaturity were independently associated with bleeding < 28 weeks AOR 3.50 [2.39, 5.13], bleeding 28 + weeks AOR 1.93 [1.16, 3.22], highest diastolic blood pressure (P < 0.01) and highest level of proteinuria (P < 0.0001). Infection featured in deaths associated with intrapartum asphyxia, with syphilis AOR 2.17 [1.44, 3.26] and vaginal infection/discharge (P < 0.01) independently associated; other strong associations were bleeding < 28 weeks AOR 2.10 [1.57, 2.81], bleeding 28 + weeks AOR 2.32 [1.62, 3.33], highest diastolic blood pressure (P < 0.0001), first diastolic blood pressure (P < 0.0001) and antenatal eclampsia AOR 6.70 [2.63, 17.13]. For all perinatal deaths combined, independent features were syphilis AOR 2.06 [1.49, 2.85], vaginal infection/discharge (P < 0.001), bleeding < 28 weeks AOR 2.01 [1.60, 2.53], bleeding 28 + weeks AOR 2.65 [2.02, 3.48], highest diastolic blood pressure (P < 0.0001), first diastolic blood pressure (P < 0.0001), proteinuria (P < 0.0001) and antenatal eclampsia AOR 4.22 [1.76, 10.14]. The results help identify areas for monitoring and identifying pregnancies at highest risk.
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PMID:Medical conditions present during pregnancy and risk of perinatal death in Jamaica. 807 3

Data comparing peritoneal dialysis (PD)-related infection rates between diabetic and nondiabetic patients on chronic peritoneal dialysis are conflicting. We carried out a prospective study comparing PD-related infection rates between diabetic and nondiabetic patients treated with continuous ambulatory peritoneal dialysis (CAPD) in our center. All patients commencing CAPD between January 1989 and June 1992 were enrolled into the study. Patients were followed up until death, CAPD dropout, or until December 1992. Data on diabetes mellitus status, Staphylococcus aureus nasal carriage, and PD-related infections were gathered. Infection rates were analyzed using life tables and the negative binomial test. One hundred and seven diabetic patients and 72 nondiabetic patients were studied. Patients with diabetes mellitus were not at increased risk of being S. aureus nasal carriers. The peritonitis rate was significantly higher in the diabetic group (1.2 vs 0.8 episodes/patient/year, p < 0.05). The exit-site and tunnel infection, catheter loss, and patient dropout rates were not significantly different between the two groups. Life-table analysis did not show a significant difference in the time to first episode of peritonitis and catheter-related infection.
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PMID:A prospective study of peritoneal dialysis-related infections in CAPD patients with diabetes mellitus. 810 22

Infections complicating diabetes mellitus are often severe and persist, becoming intractable. As the mechanism of the intractability, cell function involved in the defense against infection was evaluated. The function of peripheral blood neutrophils in diabetes mellitus was markedly decreased compared with the control group. In the bronchoalveolar lavage fluid (BALF) in diabetes mellitus, alveolar macrophages (AM) were increased, and especially, the appearance of foamy AM was characteristic. Among the functions of AM, chemotactic ability and bactericidal ability were significantly decreased, and the decreases were more marked in IDDM than in the NIDDM. The function of AM did not recover even after improvement in the blood glucose level. Thus, the effects of metabolic abnormalities in diabetes mellitus extended to the cellular level in the lungs.
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PMID:[Diabetes mellitus with intractable bacterial infections]. 812 91

Group B beta-hemolytic streptococcus (Streptococcus agalactiae) vertebral osteomyelitis was diagnosed in a 65-year-old man. The patient received a 3-week course of in-hospital intravenous ampicillin followed by ceftriaxone and continued to receive ceftriaxone therapy on an ambulatory basis for 3 more weeks. Hospitalization and follow-up were uncomplicated with no neurological sequelae. Review of the medical literature documented only 15 cases of group B streptococcal osteomyelitis in adults and only three cases of vertebral osteomyelitis due to this pathogen. As in most adult patients with group B streptococcal infections, the patient had coexisting chronic conditions (chronic obstructive lung disease, diabetes mellitus) but bacteremia was not present. Although uncommon, group B streptococcus should be considered as an opportunistic pathogen in patients with debilitating conditions, but vertebral osteomyelitis is even rarer.
Infection
PMID:Group B streptococcal vertebral osteomyelitis in an adult. 813 71

Twenty-six patients presenting with 33 episodes of Diabetic Ketoacidosis (DKA) and managed on a protocol oriented system were analysed. Diabetes mellitus was newly diagnosed at presentation in 18% of the 33 episodes. The presenting symptoms were polyuria and polydipsia (58%), nausea and vomiting (52%), change in sensorium (24%), hyperventilation (24%), and abdominal pain (18%). The main clinical findings at admission were dehydration (97%), acidotic respiration (67%), coma and confusion (61%), a clinically detectable source of sepsis (49%), fever (33%) and hypotension (9%). Blood sugar levels at admission ranged between 351 mg/dl and 1200 mg/dl (mean = 633 mg/dl). The mean serum potassium at diagnosis was 5.1 mmol/l and the mean calculated serum osmolality was 320 mOsm/kg. The mean serum osmolality was higher in those with disturbed conscious level. Infections, particularly those of the urogenital tract, were the main precipitating cause for the DKA. Only 12 of the 19 patients with sepsis had fever. Eight of the episodes were attributed to patients' non-compliance with insulin. Four patients died during the 33 hospitalisations, giving a mortality rate of 10%. Death occurred despite glucose control and stabilisation of the ketoacidotic state and was due to uncontrolled septicaemia. The mean duration of hospitalisation was 11 days. The ketoacidosis state was reversed after a mean duration of 9.5 hours, with an average soluble insulin requirement per patient of 52.4 units.
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PMID:Diabetic ketoacidosis--a study of 33 episodes. 815 79

Infections resulting from puncture wounds to the foot in diabetics appear not to have been previously reported in the medical literature. The purpose of this report is to describe bacterial pathogens identified from bone and soft tissue infections precipitated by a puncture injury in patients with diabetes. In a 7-year retrospective study, the authors evaluated 22 patients with osteomyelitis and 44 patients with soft tissue infections. Medical records and operative culture and sensitivity reports were reviewed. Staphylococcus aureus (68%), Streptococcus species (44%), and Enterococcus species (27%) were the most common pathogens identified. Pseudomonas was more common in cases of osteomyelitis (36%) than in soft tissue infections (18%) (p < 0.001). Pseudomonas was more common in patients that had worn tennis shoes at the time of the puncture injury compared to patients that were barefoot or who wore some other type of footwear (p < 0.001). Seventy-four percent of patients had polymicrobial infections. Anaerobes were identified in only seven patients (11%). This study suggests that polymicrobial infections with few anaerobes are common in infected puncture wounds in diabetics. Pseudomonas is more common in bone infections and is associated with wearing tennis shoes at the time of injury.
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PMID:Bacterial pathogens in infected puncture wounds in adults with diabetes. 816 1

Meningitis is rarely caused by Klebsiella ozaenae, a colonizer of the oral and nasopharyngeal mucosa. We describe two patients with K. ozaenae meningitis. Both patients suffered from a primary disease of the nasopharyngeal pathway; one had nasopharyngeal carcinoma and the other ozena. Review of the English-language literature from 1966 to the present revealed only two cases of K. ozaenae meningitis; pneumonia and hyperglycemia were noted in one patient and otitis media, sinusitis and diabetes mellitus in the other. All these four patients were over 50 years old. Of the four patients, two treated with third-generation cephalosporins recovered whereas one of the two treated with chloramphenicol died. One patient who died had a positive blood culture for K. ozaenae. Blood culture was positive in only one of the three survivors. Whether chloramphenicol should be replaced by a third-generation cephalosporin and whether blood culture indicates a poor prognosis in K. ozaenae meningitis remain to be determined.
Infection
PMID:Klebsiella ozaenae meningitis: report of two cases and review of the literature. 818 46

Sixty-two consecutive episodes of diabetic ketoacidosis (DKA) were studied at Aga Khan University Hospital, Karachi. Forty-four (71%) were type I and 18 (29%) type II diabetics. Mean age was 28.1 years and mean duration of diabetes 4.1 years. Infections were the most common precipitating factor accounting for 28 episodes (45.2%). Twenty-two patients (35.5%) had hyperosmolality (serum osmolality > 320 mosmol/L). Mean serum Na+ was 131.7 mmol/L and K+ 4.6 mmol/L. Twenty-three (37.1%) were hyperkalemic at presentation with seven patients (11.3%) being comatosed and 35 (56.5%) alert. Mean random blood glucose (RBG) was 624 mg/dl, mean pN 7.09, osmolality 316 mosmol/L and the neurological status correlated statistically significantly with mean RBG, pH and osmolality. A leukemoid response was seen in 83.9% episodes. Mortality rate was 8.0% in patients with DKA managed in this hospital.
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PMID:Diabetic ketoacidosis in a hospital based population in Pakistan. 823 Jun 67

Only little is known about soft tissue, bone or joint infections caused by Moraxella spp. A case of panaritium ossale et articulare caused by Moraxella nonliquefaciens in an 80-year-old patient immunocompromised by diabetes mellitus and liver insufficiency is reported here. Surgery, local antiseptic treatment, and therapy with aminopenicillins plus beta-lactamase-inhibitors led to complete cure of the infection within 10 days.
Infection
PMID:Panaritium ossale et articulare caused by Moraxella nonliquefaciens. 830 Feb 55


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