Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 58-year-old HIV-negative woman was admitted to our hospital with abdominal distension. She had a 5-year history of hypothyroidism and a 4-year history of diabetes mellitus. Physical examination revealed ascites. There was no lymphadenopathy or splenomegaly. Laboratory examination showed elevated levels of serum LDH and Al-p, polyclonal hypergammaglobulinemia, and was positive for anti-nuclear antibody, several autoantibodies and HCV-RNA. A computed tomographic scan of the abdomen and chest showed massive ascites, but there was no evidence of tumor masses or lymph node enlargement. Cytologic examination of the ascitic fluid revealed numerous abnormal lymphocytes which by flow cytometry demonstrated expression of CD5, CD19, CD20, and CD4. Cytogenetical analysis demonstrated a hyperdiploid karyotype, with numerical abnormalities. Southern blot analysis demonstrated rearranged monoclonal bands in JH and c-mycgenes. Polymerase chain reaction (PCR) analysis failed to detect the genomes of EBV and HHV-8 in the abnormal lymphocytes. A diagnosis of primary effusion lymphoma of B cell lineage was made. Following abdominal paracentesis, the patient remained in complete clinical remission for 7 months and died of an unrelated cause (cerebral bleeding). The present case demonstrated an HIV-, HHV-8-, and EBV-negative, and HCV-positive primary effusion lymphoma of B cell lineage, with a unique clinical course.
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PMID:[Human herpesvirus-8 negative primary effusion lymphoma with complete clinical remission after removal of ascites]. 1222 24

An update on clinical aspects of HIV in africa highlights new proposed clinical definitions of adult AIDS and of tuberculosis in HIV+ adults, and staging of adult HIV infection. The 1986 WHO clinical definition of AIDS has been widely used in Africa, but now research suggests that this definition has several limitations: the definition will pick up several unrelated diseases such as diabetes mellitus and renal failure. It does not ascertain cases of AIDS marked by nonopportunistic infections. Most persons with pulmonary tuberculosis may be wrongly diagnosed with AIDS by this definition. The study showed that the WHO clinical definition has good specificity and positive predictive value for HIV+ people, but its positive predictive value fell to 30% in identifying people with AIDS in Africa. New definitions should take into account any serious morbidity, tuberculosis, neurological disease, both endemic localized Kaposi's, and aggressive typical Kaposi's sarcoma, and HIV serological testing. Tuberculosis is a problem because few HIV+ people suspected of having pulmonary TB (sputum-negative TB) actually have it based on bronchoscopy, while HIV+ persons with TB experience high mortality, often from pyogenic bacteremia. HIV+ persons with TB suffer high rates of relapse, possibly related to insufficient drug treatment or reinfection. 1 study showed that 6 months of isoniazid significantly improved incidence of TB over 30 months of follow-up. Staging of AIDS in Africa based on degree of immunosuppression was proposed as: 1) clinically inapparent HIV infection marked by pulmonary TB, soft tissue infections, and community acquired pneumonia; 2) lymphadenopathy, oral thrush, widespread pruritic maculopapular rash, herpes zoster, enteric illness, dysentery, and Kaposi's sarcoma; and 3) HIV wasting syndrome, chronic pulmonary disease, meningitis, and fever of unknown origin.
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PMID:Some clinical aspects of HIV infection in Africa. 1231 68

Various therapeutic strategies have been developed to tolerize autoreactive T cells and prevent autoimmune pathology in type 1 diabetes. 4-1BB, a member of the tumor necrosis factor receptor (TNFR) superfamily, is a costimulatory receptor primarily expressed on activated T cells. The administration of an agonistic anti-4-1BB antibody (2A) dramatically reduced the incidence and severity of experimental autoimmune encephalomyelitis (EAE). Treatment with the same antibody in Fas-deficient MRL/lpr mice blocked lymphadenopathy and lupus-like autoimmune processes. Paradoxically, transgenic non-obese diabetic (NOD) mice overexpressing membrane-bound agonistic single-chain anti-4-1BB Fv in pancreatic beta cells developed more severe diabetes than their non-transgenic littermates, with earlier onset, faster diabetic processes, and higher mortality. Forty percent of transgenic mice developed diabetes by 4 weeks of age, compared with their control littermates, which first exhibited diabetes at 14 weeks. The frequency of diabetes in female transgenics reached 70% by 8 weeks of age. Most female transgenic mice died around 12 weeks. Consistent with this, transgenic mice developed earlier and more severe insulitis and showed stronger GAD-specific T-cell responses, compared with age-matched control littermates. Our results indicate an adverse effect of transgenic anti-4-1BB scFv in NOD mice and suggest a potential risk of this anti-4-1BB-based immunotherapy for autoimmune diseases.
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PMID:Anti-4-1BB-based immunotherapy for autoimmune diabetes: lessons from a transgenic non-obese diabetic (NOD) model. 1459 49

A case of middle aged female with acute arthritis, mediastinal lymphadenopathy and diabetes mellitus is described. The patient underwent mediastinal lymph node biopsy and was diagnosed as having acute sarcoidosis (Lofgrens syndrome). She was treated with systemic steroids and responded well.
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PMID:Acute sarcoid arthropathy. 1592 45

Rubella, also known as German measles, is usually a very mild infection that can have devastating effects in certain instances. It is a pleomorphic RNA virus in the Togaviridae family of the genus Rubivirus. It typically causes a scarletiniform rash, cervical lymphadenopathy, and mild constitutional symptoms, but in older children and adults, especially women, it may be more severe, with joint involvement and purpuric rash. Infection during the first 12 weeks of pregnancy results in congenital infection and/or miscarriage in 80-90% of cases. The congenital rubella syndrome (CRS) involves multiple organ systems and has a long period of active infection and virus shedding in the postnatal period. For these reasons, the rubella vaccine program was instituted in 1969, and the incidence of rubella infection in the United States has since declined by 99%. Rubella has been recognized as a disease for approximately 200 years, and it has since been found that humans are the only natural reservoir for the rubella virus. Virus is present in nasopharyngeal secretions, blood, feces, and urine during the clinical illness, although patients with subclinical disease are also infectious. The virus is spread via oral droplets and is shed in the nasopharynx for approximately 7 days before and after the rash is visible. CRS includes a configuration of anomalies, including nerve deafness, cataracts, cardiac anomalies (usually pulmonary artery and valvular stenosis, and patent ductus arteriosis), and mental retardation, with late complications including diabetes, thyroid disease, growth hormone deficiency, and progressive panencephalitis. In 1969, the first rubella vaccine was licensed for use, and the Centers for Disease Control and Prevention (CDC) began its National Congenital Rubella Syndrome Registry. As required under the National Childhood Injury Act, all healthcare providers in the United States who administer any vaccine shall, prior to administration of the vaccine, provide a copy of the Vaccine Information Statements (VIS) produced by the CDC to the parent or legal representative of any child to whom the provider intends to administer such vaccine, or to any adult to whom the provider intends to administer such vaccine. Despite efforts to vaccinate children, CRS continues to occur in the United States. Hispanic infants have an increased risk of CRS. HIV-1infected children with a preserved immune system and MMR immunization had a good response to rubella vaccine. In contrast, those in more advanced categories for HIV infection responded poorly. Issues of risk, choice, and chance are central to the controversy over the MMR vaccine that erupted in the UK in 1998, and has continued into the new millennium. An important contribution to the MMR controversy has come from the parents of autistic children, some of whom reject the notion that this disorder is a random genetic misfortune and insist that it is, at least in part, the result of some environmental insult, such as MMR vaccinations.
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PMID:Rubella and congenital rubella (German measles). 1602 42

The object of this paper was to investigate lipoplastic lymphadenopathy in superficial locations with ultrasound. We selected 110 patients with a total number of 247 nodes with a central hyperechoic area extended for more than one third of the transverse diameter. We considered gender, age, body mass index (BMI), and associated disease such as thyroid disorders and diabetes. For each lymph node, we measured the long:short axis ratio and the parenchyma:fat (P:F) ratio. Differences between mean P:F ratio in diabetic and nondiabetic patients were significant (p=0.045). Mean P:F ratio was negatively related to BMI (r=0.62, p=0.015) and age (r=0.54, p=0.024). All of the nodes examined with a mean P:F ratio <or= 1.2 (58) were found in patients older than 72 y and with a BMI higher than 27.8. Fatty involution may mimic a macrometastasis at palpation and may cause difficulties in US detection.
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PMID:Fatty changes as a misleading factor in the evaluation with ultrasound of superficial lymph nodes. 1608 92

A 40-year-old male agricultural laborer presented to our clinic with asymptomatic swellings on his left hand and left leg of 2 years' duration. A pea-sized swelling was first noticed on the back of the left hand, which was gradual in onset and slowly progressed to its present size. The patient later noticed multiple swellings over his left leg and thigh, with a similar progression. There was no history suggestive of inflammatory changes or discharge from the lesions. There was no previous history of trauma. The patient was an asthmatic and was on long-term oral steroid therapy (10-20 mg/day prednisolone). None of his family members had similar complaints. On physical examination, the patient was febrile. Cutaneous examination showed multiple, circumscribed, lobulated, non-tender, mobile, cystic swellings of various sizes, ranging from less than 2 cm over the left shin to more than 8 cm over the dorsum of the left hand and ankle (Fig. 1a,b). The surface over these swellings was shiny, smooth, and intact. The skin over the swellings was pliable and normal in color. There was no regional lymphadenopathy. The rest of the clinical examination was normal, except for decreased breath sounds over the left mid and lower pulmonary lobes. Routine laboratory tests, including complete blood count and liver and renal function tests, were within normal limits. Random blood glucose was greater than 400 mg%. Histopathologic examination of one of the cysts (from the hand) showed pheohyphomycotic cysts lined by dense fibrous tissue with chronic inflammatory infiltrate admixed with scattered giant cells in the dermis (Fig. 2). No fungal elements were visualized in the hematoxylin and eosin-stained sections. The fungal elements were found within the cystic cavity on special staining with Gomori's methenamine silver (GMS) and Masson-Fontana stains. The hyphae had irregularly placed branches and showed constrictions around their septae, thus resembling pseudohyphae and yeast forms (Fig. 3). Fine needle aspiration cytology from one of the swellings showed the presence of filamentous fungi on KOH examination and brown-pigmented distorted filaments and yeast-like cells on Masson-Fontana staining (Fig. 4a,b). The positive Masson-Fontana stain was indicative of the presence of melanin in the fungal hyphae, even when the fungal hyphae were not pigmented in the hematoxylin and eosin-stained section. Periodic acid-Schiff reagent also stained the fungal elements, thus confirming our diagnosis of pheohyphomycosis and ruling out the possibility of hyalohyphomycosis. The culture for fungus from the swelling aspirate grew contaminants. The chest X-ray showed dense nodular shadows in the left lower and mid pulmonary lobes. Sputum for acid-fast bacilli and Mantoux test were negative. During the hospital stay, the patient developed high fever and showed altered behavior, for which a computed tomography scan of the brain was performed; this showed evidence of multiple ring enhancing lesions in both frontal lobes. Ultrasound of the abdomen was normal. On the basis of the above findings, a diagnosis of disseminated subcutaneous pheohyphomycosis was made. The patient was given itraconazole, 100 mg twice daily, and his diabetes was managed with insulin. The fever stopped within a week and the altered behavior also started to show an improvement. There was obvious improvement in neurologic signs and symptoms. His skin lesions, however, responded slowly to the treatment. The patient did not report for further follow-up after 1 month.
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PMID:Disseminated pheohyphomycosis. 1734 84

A novel pigmented dermatosis was observed in four unrelated boys, three of whom had insulin-dependent diabetes. Three patients were the offspring of consanguineous parents. All four boys had pigmented hypertrichotic patches or induration on the upper inner thighs, with variable involvement of the genitalia, trunk, and limbs. Two boys had episcleritis and orbital proptosis with similar facies and musculoskeletal abnormalities including clinodactyly, flat feet, and short stature. One child had paraaortic and inguinal lymphadenopathy and three patients had an enlarged liver and spleen. A large, swollen pancreas was observed on ultrasound imaging in one patient with insulin dependent diabetes who also had echocardiographic evidence of pericardial inflammation. Three boys had elevated laboratory markers of inflammation. Biopsy specimens from the skin and orbit showed a chronic inflammatory cell infiltrate composed of polyclonal lymphocytes, histiocytes, and plasma cells; fibrosis was observed in two patients, one of whom had previously received radiation therapy to the orbit. Two boys responded to treatment with subcutaneous interferon-alpha, combined with a short course of oral prednisone in the child without diabetes. We believe these inflammatory pigmented skin lesions represent a unique dermatosis associated with diabetes mellitus and systemic disease. The pathogenesis is unknown. The presence of consanguinity in three of four families, and similar dysmorphic features in two boys, suggest a genetic disorder, possibly with autosomal recessive inheritance.
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PMID:Pigmented hypertrichotic dermatosis and insulin dependent diabetes: manifestations of a unique genetic disorder? 1746 1

A total of 136 patients, 67 HIV, 69 diabetes mellitus (DM) with or without (+/-) end-stage renal disease (ESRD), were registered for tuberculosis treatment at the National Tuberculosis Center (NTBC) from May to December, 2003. Ages ranged from 21-78 years (median 57.7 years) in TB/DM patients, and 21-62 (mean 37.6 +/- 8.3 years) in TB/HIV patients. TB was significantly found in younger and single HIV patients, but in older and married DM patients (p<0.05). Male patients in both groups were strongly associated with TB, while females more commonly had TB with DM (p<0.05). The majority of these patients were Malays, unemployed, and resided in Kuala Lumpur territory; however, no statistically significant difference was found between the 2 groups. Smoking, IVDUs and hepatitis C virus (HCV) infection were more significantly found in TB/HIV patients and further analysis showed that pulmonary TB was strongly associated with HCV infection in these patients (p<0.05). Pulmonary TB (62; 89.9%) was the most common type found in both groups and was a markedly more common disease location in TB/DM patients, while extrapulmonary TB (21; 31.3%) and miliary TB (14; 21%) were significantly higher in TB/HIV patients. Cough with or without sputum, fever and loss of appetite and/or weight were common clinical presentations in both groups. Nevertheless, fever (54; 80.6%) and lymphadenopathy (17; 25.4%) were significantly related to TB/HIV patients (p<0.05). Interestingly, the presence of BCG vaccination and positive tuberculin skin test were stronger in TB/HIV (27; 40.3%) and TB/DM (20; 29%) patients, respectively (p<0.05). Overall, regular 6-, 9- and 12-months' anti-tubercular therapy (ATT) were routine practice, and EHRZ+B6 was the most common regimen used. The highest percentage of patients with treatment success were in both groups with 6 months' ATT; however, a significantly higher percentage was found in TB/DM (24; 34.8%) than TB/HIV (13; 19.4%) (p<0.05). A success rate of 15 (21.7%) was noted for TB/DM patients with 9 months' ATT, which was similar to both groups with the 12-month regimen. A higher percentage failure rate (lost to follow-up) was seen in TB/HIV (19; 28.4%) patients. Nine patients were reported to have anti-tubercular-drug side-effects, such as drug-induced hepatitis, blurred vision, and skin rash. No cases of drug resistance or death were notified among these patients.
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PMID:Tuberculosis: a resurgent disease in immunosuppressed patients. 1754 73

A 65-year-old woman with a medical history of diabetes mellitus type 2, hypertension, an old cerebrovascular accident, and seizure disorder presented to the emergency room with lower abdominal pain of 4 weeks duration. Upon physical examination, her abdomen was soft and bowel sounds were present, but there was diffuse tenderness in her lower abdomen with some guarding. A computed tomography scan of her abdomen with oral and intravenous contrast showed significantly thickened small bowel loops with subjacent lymphadenopathy. Biopsies obtained during esophagogastroduodenoscopy and colonoscopy showed acute and chronic inflammation. A double balloon enteroscopy (DBE) was then performed, which showed stricture in the jejunum from which the biopsy was obtained. The biopsy showed marginal cell lymphoma. The patient is presently undergoing chemotherapy. Double balloon enteroscopy is a new elegant endoscopical technique that seems promising, as the endoscopist can reach undiscovered small bowel segments. It seems to be well tolerated and safe. For the first time, it provides the means to endoscopically investigate and treat disorders of the small intestine that have previously been inaccessible to conventional endoscopy.
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PMID:Diagnosis of marginal cell lymphoma of small intestine by double balloon enteroscopy. 1841 78


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