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

Cystic fibrosis (CF) is the most common serious genetic condition in the White population groups. Thirty-three White patients (mean age 20 years, range 14-32 years) seen at an adult CF clinic at the Johannesburg Hospital between January 1980 and January 1983 are reviewed. All had elevated sweat chloride levels. There was a family history of CF in 45,5% of the cases. Most were of normal height but significantly underweight. Chronic obstructive pulmonary disease was present in 94% of the patients. Pulmonary infections played a major role in both symptomatic exacerbations and progressive lung disease. Most frequently, mucoid Pseudomonas aeruginosa and/or Staphylococcus aureus were cultured from the sputum. The management of infective exacerbations is discussed. Other respiratory complications included cor pulmonale, haemoptysis, recurrent pneumothorax and sinusitis. Chest radiographs and pulmonary function tests are also analysed. Gastro-intestinal complications included pancreatic exocrine insufficiency (94%), intestinal obstruction, cholelithiasis, and liver disease. Insulin-dependent diabetes occurred in 9%. Five pregnancies were recorded in 4 patients. By January 1983 there had been 7 deaths (mean age 19,4 years). Most of the patients are highly motivated, with few psychological problems, and appear to be well-functioning and integrated members of society.
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PMID:Experience at an adolescent and adult cystic fibrosis clinic. An analysis and overview. 671 Feb 79

During the last 4 years, 20 cases of clinical melioidosis were diagnosed in the geographical area between Tully and Thursday Island. Sixteen were diagnosed by culture of Pseudomonas pseudomallei, and four by positive serology with appropriate clinical features. Most cases occurred during or after a heavy wet season. All patients were adult, and males predominated. Farmers and stockmen represented predisposed populations due to their prolonged soil contact. Ten patients were white Australians, six were Aborigines and four were Torres Strait Islanders. Twelve cases were first diagnosed by positive blood culture and four by sputum culture. The primary site of infection was pulmonary in 14 cases, genitourinary tract in one case, subcutaneous tissues in one case, and joints in two cases. In cases of fulminating infection metastatic abscesses were commonly found in many organs; typically lungs, liver, kidneys and spleen. Six patients had acute fulminating disease and died. Fourteen patients successfully responded to appropriate therapy, but relapse occurred in three, all of whom had an alcohol problem and showed poor drug compliance. The presence of diabetes mellitus in six patients confirmed the important known association of these two diseases. In three fulminating and four subacute infections the serology was negative at the time of diagnosis by culture. Antibiotic therapy for the different forms of this disease is reviewed, and a laboratory protocol for the rapid reporting of positive culture results is included.
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PMID:Melioidosis in Far North Queensland. A clinical and epidemiological review of twenty cases. 673 79

Sera from 9,047 individuals from Northern Queensland were examined for the presence of hemagglutinating antibodies to Pseudomonas pseudomallei, the causative agent of melioidosis, and 512 (5.7%) were found to have titers of 1:40 or greater. The distribution of positive reactors in various groups was uneven, and significantly higher prevalences of positive antibody titers were found in the sera from Aborigines (7.9-10.6%), Torres Strait Islanders (7.8%), Vietnamese refugees (29%) and from persons with certain medical conditions including chronic alcoholism (15%), chronic infections (14.8%), diabetes mellitus (8.6%) and liver disease (12.9%). There were significantly fewer positive reactors (1.4%) amongst the armed forces stationed in Northern Queensland. At present, the boundaries of the major endemic region of Australia extend north from Rockhampton along the coast to Darwin and inland, west from Rockhampton to Tennant Creek in central Australia. Townsville was found to have the highest prevalence (5.2%) of positive reactors of all urban populations of Northern Queensland. The extent of the disease is such that it can no longer be considered a rare infection in Northern Queensland.
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PMID:The prevalence of human melioidosis in Northern Queensland. 673 80

A 75-yr-old diabetic woman presented with right ear tenderness and neck pain. Pseudomonas aeruginosa was cultured during surgery from an inflammatory area in the region of the cervical vertebrae. A diagnosis of malignant external otitis was made and parenteral antibiotics were given, which produced a cure. This disease has a high mortality rate, which accounts for the use of the word malignant. Our patient also manifested the jugular foramen syndrome involving multiple cranial nerves. If there is cranial nerve involvement, which is seen in at least one-half of cases, the mortality ranges as high as 80%. We describe here the first case with invasion of the cervical vertebrae.
Diabetes Care
PMID:Malignant external otitis: now a medical problem. 677 32

The number of patients admitted to hospital who harbour Pseudomonas aeruginosa, Proteus and Klebsiella, keeps rising. Of the factors predisposing to colonization, only diabetes and antibiotic therapy exert their effect equally in extrahospital and intrahospital environment. Malignant diseases, immune suppressive therapy and instrumental interventions play a predominant role in the hospital. In extrahospital environment, infancy and old age, poor general condition as well as in almost half of the cases, an inflammatory process caused by viruses or bacteria was found to create favourable conditions for the colonization of facultative pathogens. One of the main sources of the Gram-negative facultative pathogens studied was the faeces of enteric patients in the hospital. The frequency of P. aeruginosa, Klebsiella and Proteus positive cultures rose parallel in the faecal and non-faecal bacteriological samples in the period 1958 to 1977. The seasonal changes observed in the frequency of positive cultures revealed that the Gram-negative facultative pathogens had increased in number first in the enteral wards, spreading subsequently to the medical and paediatric wards, and finally they appeared in a high number in the surgical wards, originating from patients transferred there from the medical or paediatric wards.
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PMID:Extrahospital and intrahospital factors predisposing to the spread and colonization in patients of Pseudomonas aeruginosa, Proteus and Klebsiella in an infectious hospital. 679 65

Diabetics are prone to severe Pseudomonas otitis externa, but it is unknown if this is due to abnormal colonization of the external auditory canal. The bacterial and fungal flora of 26 diabetics and 29 age-matched controls was studied and found to be similar. Subjects with diabetes had more cerumen and a past history of more frequent external otitis than non-diabetics. It is concluded that diabetics probably have more frequent and severe external otitis because of undefined abnormal host defense mechanisms and not because of enhanced colonization by pathogens.
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PMID:Bacterial flora of the external canal in diabetics and non-diabetics. 708 28

In 362 cases bladder operations were performed without previous vasectomy. The incidence of postoperative epididymitis was 15.4 per cent after transvesical prostatectomy, 3.5 per cent after suprapubic section, and 1.6 per cent after transurethral prostatectomy. The incidence was twice as high in case of diabetes and previous bilateral epididymitis, as in the other cases. The incidence of postoperative epididymitis was slightly increased in patients who 1. had not been catheterized before hospitalization; 2. had residual urines over 90 ml; 3. had been free from pyuria before surgery. The prevalent pathogens in case of epididymitis included coagulase-negative staphylococci, Ps. aeruginosa and Enterobacter. Involvement of E. coli, Proteus and Pseudomonas was confined to highly resistant strains.
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PMID:Postoperative epididymitis after bladder surgery without vasectomy. 711 98

Patients with cystic fibrosis are chronically exposed to several potentially nephrotoxic factors. These include bacterial infections with their associated immune complexes and the antibiotics (aminoglycosides) used in their treatment. In addition, diabetes mellitus, liver disease, and cor pulmonale, commonly seen in these patients, may produce renal injury. To assess the extent of this injury, we performed morphologic and immunopathologic studies of the kidneys of 34 patients at autopsy. The group included 23 female and 11 male patients; their ages ranged from 4 months to 35 years and their disease was diagnosed one month to 22 years prior to death. The histological changes included glomerulomegaly, a mesangiopathic lesion, and tubulointerstitial disease frequently associated with acute and chronic tubular injury. The last was characterized by abundant tubular lysosomal proliferation and tubular atrophy suggestive of chronic amino-glycoside injury. Diagnostic diabetic lesions were not seen. Immunofluorescence studies predominantly revealed deposits of IgM or C3, or both, in glomeruli and arterioles in 18 patients. Although an anti-Pseudomonas antiserum did not show bacterial antigens in the tissues, elution studies in two specimens demonstrated antibacterial antibodies. These observations, coupled with the finding of ultrastructural glomerular deposits, suggest immune complex-mediated injury. No correlation was found between the severity or type of renal histologic lesion and patient age or duration of cystic fibrosis. Despite the occurrence of renal failure in six patients, renal involvement is currently of limited clinical concern in cystic fibrosis. Nevertheless, continued exposure to bacterial immune complexes and aminoglycosides, among other factors, can result in potentially serious renal disease.
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PMID:The nephropathy of cystic fibrosis: a human model of chronic nephrotoxicity. 712 9

Melioidosis is being diagnosed with increasing frequency in the northern part of the Northern Territory, but the mortality rate remains high in the acute septicaemic form of the disease largely because of associated chronic debilitating illnesses. This paper reviews epidemiological and clinical features of human melioidosis in 37 cases seen between 1960 and 1979. Infection with Pseudomonas pseudomallei is most often contracted during the wet season by persons who have regular contact with soil or ground water, probably through pre-existing skin lesions or penetrating wounds and, occasionally, through the genitourinary tract. The clinical features of melioidosis are protean, and definitive diagnosis can only be made by bacterial culture. Certain strongly indicative features, however, may justify vigorous early treatment with antibiotics (tetracycline or doxycycline in some combination with chloramphenicol, kanamycin or trimethoprim/sulphamethoxazole) which can be life-saving in fulminant septicaemic melioidosis. These indicative features are a severely prostrating fever with signs of respiratory tract infection in a patient with a chronic debilitating condition (particularly chronic alcoholism, diabetes mellitus, malnutrition or leprosy), with regular soil contact, and with chronic or recurrent skin lesions or a recent history of a penetrating wound. In subacute or chronic forms of melioidosis, which usually localize in an organ system, the diagnosis is commonly an unexpected bacteriological finding and the prognosis is generally good.
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PMID:Melioidosis in the Northern Territory of Australia. 723 Dec 82

The present study describes our experience with CAPD in an unselected group of patients presenting with endstage renal failure. Twenty-three consecutive patients were offered CAPD, in-center, and home hemodialysis. Twenty-two patients selected CAPD, including 14 patients more than 60 years of age, four patients with diabetes, and one with multiple myeloma. CAPD training was performed in an out-of-hospital office facility. One patient returned to hemodialysis following the development of resistant Pseudomonas peritonitis, two patients died of a myocardial infarction, and one patient died with a GI bleed. The other 18 patients are doing well. Assessment of 17 patients maintained on therapy for four months or more revealed that the patients are less depressed, less organic, and have fewer physical symptoms than previously reported for a comparable group of patients maintained on hemodialysis for a similar period of time. In conclusion, CAPD can be successfully employed, at least for the initial months of therapy, to treat the vast majority of patients with endstage renal disease. CAPD training and follow-up care can be provided in an out-of-hospital office facility.
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PMID:Continuous ambulatory peritoneal dialysis: experience with 22 unselected patients with renal failure. 726 43


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