Emphysematous cystitis in an elderly Japanese patient with type 2 diabetes mellitus.
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ABSTRACT:
SUBMITTER: Yashima H
PROVIDER: S-EPMC6406141 | biostudies-literature | 2019 Mar
REPOSITORIES: biostudies-literature
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Emphysematous cystitis in an elderly Japanese patient with type 2 diabetes mellitus.
Yashima Hironori H Terasaki Michishige M Kushima Hideki H Hirano Tsutomu T
Clinical case reports 20190206 3
We report a rare but fatal case of emphysematous cystitis (EC) that presented as a typical image of gas bubbles within the urinary bladder wall on computed tomography (CT). This disease has a high mortality rate more than that reported previously based on recent literature review in Japan. ...[more]
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Project description:The prevalence of type 2 diabetes is expected to increase gradually with the prolongation of population aging and life expectancy. In addition to macrovascular and microvascular complications of elderly patients of diabetes mellitus, geriatric syndromes such as cognitive impairment, depression, urinary incontinence, falling and polypharmacy are also accompanied by aging. Individual functional status in the elderly shows heterogeneity so that in these patients, there are many unanswered questions about the management of diabetes treatment. The goals of diabetes treatment in elderly patients include hyperglycemia and risk factors, as in younger patients. comorbid diseases and functional limitations of individuals should be taken into consideration when setting treatment targets. Thus, treatment should be individualized. In the treatment of diabetes in vulnerable elderly patients, hypoglycemia, hypotension, and drug interactions due to multiple drug use should be avoided. Since it also affects the ability to self-care in these patients, management of other concurrent medical conditions is also important.
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Project description:Chronic obstructive pulmonary disease (COPD) has been classically divided into blue bloaters and pink puffers. The utility of these clinical subtypes is unclear. However, the broader distinction between airway-predominant and emphysema-predominant COPD may be clinically relevant. The objective was to define clinical features of emphysema-predominant and non-emphysematous COPD patients.Current and former smokers from the Genetic Epidemiology of COPD Study (COPDGene) had chest computed tomography (CT) scans with quantitative image analysis. Emphysema-predominant COPD was defined by low attenuation area at -950 Hounsfield Units (LAA-950) ?10%. Non-emphysematous COPD was defined by airflow obstruction with minimal to no emphysema (LAA-950?<?5%).Out of 4197 COPD subjects, 1687 were classified as emphysema-predominant and 1817 as non-emphysematous; 693 had LAA-950 between 5-10% and were not categorized. Subjects with emphysema-predominant COPD were older (65.6 vs 60.6 years, p?<?0.0001) with more severe COPD based on airflow obstruction (FEV1 44.5 vs 68.4%, p?<?0.0001), greater exercise limitation (6-minute walk distance 1138 vs 1331 ft, p?<?0.0001) and reduced quality of life (St. George's Respiratory Questionnaire score 43 vs 31, p?<?0.0001). Self-reported diabetes was more frequent in non-emphysematous COPD (OR 2.13, p?<?0.001), which was also confirmed using a strict definition of diabetes based on medication use. The association between diabetes and non-emphysematous COPD was replicated in the ECLIPSE study.Non-emphysematous COPD, defined by airflow obstruction with a paucity of emphysema on chest CT scan, is associated with an increased risk of diabetes. COPD patients without emphysema may warrant closer monitoring for diabetes, hypertension, and hyperlipidemia and vice versa.Clinicaltrials.gov identifiers: COPDGene NCT00608764, ECLIPSE NCT00292552.
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2015-02-28 | GSE62003 | GEO
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Project description:Diabetes mellitus is a risk factor for mild cognitive impairment (MCI) and dementia. However, how the clinical characteristics of MCI patients with type 2 diabetes mellitus are linked to sarcopenia and/or its criteria remain to be elucidated. Japanese patients with type 2 diabetes mellitus were categorized into the MCI group for MoCA-J (the Japanese version of the Montreal cognitive assessment) score <26, and into the non-MCI group for MoCA-J ?26. Sarcopenia was defined by a low skeletal mass index along with low muscle strength (handgrip strength) or low physical performance (walking speed <1.0 m/s). Univariate and multivariate-adjusted odds ratio models were used to determine the independent contributors for MoCA-J <26. Among 438 participants, 221 (50.5%) and 217 (49.5%) comprised the non-MCI and MCI groups, respectively. In the MCI group, age (61 ± 12 vs. 71 ± 10 years, p < 0.01) and duration of diabetes mellitus (14 ± 9 vs. 17 ± 9 years, p < 0.01) were higher than those in the non-MCI group. Patients in the MCI group exhibited lower hand grip strength, walking speed, and skeletal mass index, but higher prevalence of sarcopenia. Only walking speed (rather than muscle loss or muscle weakness) was found to be an independent determinant of MCI after adjusting for multiple factors, such as age, gender, body mass index (BMI), duration of diabetes mellitus, hypertension, dyslipidemia, smoking, drinking, estimated glomerular filtration rate (eGFR), HbA1c, and history of coronary heart diseases and stroke. In subgroup analysis, a group consisting of male patients aged ?65 years, with BMI <25, showed a significant OR for walking speed. This study showed that slow walking speed is a sole determinant criterion of sarcopenia of MCI in patients with type 2 diabetes mellitus. It was suggested that walking speed is an important factor in the prediction and prevention of MCI development in patients with diabetes mellitus.
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Project description:ObjectiveResting energy expenditure (REE) is an important tool in nutrition management, especially in type 2 diabetes mellitus (T2DM). The predicted REE (pREE) was reported to be inaccurate, compared with measured REE (mREE) in Japanese T2DM patients. Despite the accuracy of REE, measured via indirect calorimetry (mREE), the technique is demanding. This study evaluated the associated clinical factors of the difference between pREE and mREE in Japanese patients with T2DM.MethodsForty-nine Japanese patients with T2DM but no severe complications (32 men and 17 women) were enrolled. mREE was determined via indirect calorimetry.ResultsParticipants average age was 56.3 ± 11.0 years, body mass index was 25.2 ± 3.6 kg/m2, and HbA1c was 9.6 ± 1.6%. The mean mREE was 1099 ± 212 kcal/day. Age, body mass index, hemoglobin, and uric acid levels were all associated with mREE by simple regression; of these, body weight was the significant factor in the multiple regression analysis. When the patients were divided into tertiles, the average mREE values were lower than the pREE values for each group. The difference between mREE and pREE was largest in the lowest value group, whose subjects were mostly women aged over 50 years. This group of women showed significantly lower mREE (904 ± 121 kcal) in comparison with men in the same age group, with 26% overestimation of pREE, even when the equation that yielded the closest mREE value was used.ConclusionThe previously reported pREE overestimates mREE in Japanese patients with T2DM, especially in postmenopausal women.
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Project description:BACKGROUND:Sleep disturbances are a common problem among patients with Type 2 diabetes mellitus (T2DM). The aim of the study was to identify the phenotype of T2DM patients with poor sleep quality. METHODS:An observational, cross-sectional study was conducted between May 2013 and August 2015. One hundred and sixty consecutive patients with T2DM: 74 women and 86 men, with a median age of 69.50 years (59.00; 79.50 years) were enrolled in the study. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. RESULTS:Poor sleep quality was noted in 85 (53%) patients. Sleep disorders were associated with older age, as well as female gender, longer duration of diabetes, lower level of fasting plasma glucose, glycated hemoglobin A1c, estimated glomerular filtration rate, triglycerides, waist-to-hip ratio, and the presence of nephropathy. A multivariate logistic regression revealed that sleep disorders were associated with older age (Odd Ratio (OR) = 1.11, 95% Confidence Interval (CI) 1.07-1.15). Fifty-one patients (31.87%) were treated with sleeping pills. We found that older age, female gender, longer duration of diabetes, lower level of fasting plasma glucose, glycated hemoglobin A1c, estimated glomerular filtration rate, triglycerides, and the presence of nephropathy were linked with more frequent usage of hypnotics. A multivariate logistic regression demonstrated that older age (OR = 1.09, 95% CI 1.05-1.14) and nephropathy (OR = 2.79, 95% CI 1.24-6.28) were associated with a more frequent receiving the hypnotics, whereas male gender (OR = 0.30, 95% CI 0.13-0.71) has less frequent hypnotics usage. CONCLUSION:Although, we assessed a wide range of patients' characteristics, age had the most negative impact on the quality of sleep in patients with T2DM. We detected more frequent use of hypnotics in older females, with coexisting nephropathy.
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Project description:Due to an aging population, the incidence of dementia is steadily rising. The ability to identify early markers in blood, which appear before the onset of clinical symptoms is of considerable interest to allow early intervention, particularly in "high risk" groups such as those with type 2 diabetes. Here, we present a longitudinal study of genome-wide DNA methylation in whole blood from 18 elderly individuals with type 2 diabetes who developed presymptomatic dementia within an 18-month period following baseline assessment and 18 age-, sex-, and education-matched controls who maintained normal cognitive function. We identified a significant overlap in methylomic differences between groups at baseline and follow-up, with 8 CpG sites being consistently differentially methylated above our nominal significance threshold before symptoms at baseline and at 18 months follow up, after a diagnosis of presymptomatic dementia. Finally, we report a significant overlap between DNA methylation differences identified in converters, only after they develop symptoms of dementia, with differences at the same loci in blood samples from patients with clinically diagnosed Alzheimer's disease compared with unaffected control subjects.
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