Diabetic ketoacidosis in adult patients: an audit of factors influencing time to normalisation of metabolic parameters

Background

Diabetic ketoacidosis (DKA) is an acute life‐threatening metabolic complication of diabetes that imposes substantial burden on our healthcare system. There is a paucity of published data in Australia assessing factors influencing time to resolution of DKA and length of stay (LOS).

Aims

To identify factors that predict a slower time to resolution of DKA in adults with diabetes.

Methods

Retrospective audit of patients admitted to St Vincent's Hospital Melbourne between 2010 to 2014 coded with a diagnosis of ‘Diabetic Ketoacidosis’. The primary outcome was time to resolution of DKA based on normalisation of biochemical markers. Episodes of DKA within the wider Victorian hospital network were also explored.

Results

Seventy‐one patients met biochemical criteria for DKA; median age 31 years (26–45 years), 59% were male and 23% had newly diagnosed diabetes. Insulin omission was the most common precipitant (42%). Median time to resolution of DKA was 11 h (6.5–16.5 h). Individual factors associated with slower resolution of DKA were lower admission pH (P < 0.001) and higher admission serum potassium level (P = 0.03). Median LOS was 3 days (2–5 days), compared to a Victorian state‐wide LOS of 2 days. Higher comorbidity scores were associated with longer LOS (P < 0.001).

Conclusions

Lower admission pH levels and higher admission serum potassium levels are independent predictors of slower time to resolution of DKA. This may assist to stratify patients with DKA using markers of severity to determine who may benefit from closer monitoring and to predict LOS.     

Matchmaking facilitates the diagnosis of an autosomal‐recessive mitochondrial disease caused by biallelic mutation of the tRNA isopentenyltransferase (TRIT1) gene

Deleterious variants in the same gene present in two or more families with overlapping clinical features provide convincing evidence of a disease–gene association; this can be a challenge in the study of ultrarare diseases. To facilitate the identification of additional families, several groups have created “matching” platforms. We describe four individuals from three unrelated families “matched” by GeneMatcher and MatchMakerExchange. Individuals had microcephaly, developmental delay, epilepsy, and recessive mutations in TRIT1. A single homozygous mutation in TRIT1 associated with similar features had previously been reported in one family. The identification of these individuals provides additional evidence to support TRIT1 as the disease‐causing gene and interprets the variants as “pathogenic.” TRIT1 functions to modify mitochondrial tRNAs and is necessary for protein translation. We show that dysfunctional TRIT1 results in decreased levels of select mitochondrial proteins. Our findings confirm the TRIT1 disease association and advance the phenotypic and molecular understanding of this disorder.     

HealthTrust: a social network approach for retrieving online health videos

Background

Social media are becoming mainstream in the health domain. Despite the large volume of accurate and trustworthy health information available on social media platforms, finding good-quality health information can be difficult. Misleading health information can often be popular (eg, antivaccination videos) and therefore highly rated by general search engines. We believe that community wisdom about the quality of health information can be harnessed to help create tools for retrieving good-quality social media content.

Objectives

To explore approaches for extracting metrics about authoritativeness in online health communities and how these metrics positively correlate with the quality of the content.

Methods

We designed a metric, called HealthTrust, that estimates the trustworthiness of social media content (eg, blog posts or videos) in a health community. The HealthTrust metric calculates reputation in an online health community based on link analysis. We used the metric to retrieve YouTube videos and channels about diabetes. In two different experiments, health consumers provided 427 ratings of 17 videos and professionals gave 162 ratings of 23 videos. In addition, two professionals reviewed 30 diabetes channels.

Results

HealthTrust may be used for retrieving online videos on diabetes, since it performed better than YouTube Search in most cases. Overall, of 20 potential channels, HealthTrust’s filtering allowed only 3 bad channels (15%) versus 8 (40%) on the YouTube list. Misleading and graphic videos (eg, featuring amputations) were more commonly found by YouTube Search than by searches based on HealthTrust. However, some videos from trusted sources had low HealthTrust scores, mostly from general health content providers, and therefore not highly connected in the diabetes community. When comparing video ratings from our reviewers, we found that HealthTrust achieved a positive and statistically significant correlation with professionals (Pearson r ₁₀ = .65, P = .02) and a trend toward significance with health consumers (r ₇ = .65, P = .06) with videos on hemoglobinA_{1 c}, but it did not perform as well with diabetic foot videos.

Conclusions

The trust-based metric HealthTrust showed promising results when used to retrieve diabetes content from YouTube. Our research indicates that social network analysis may be used to identify trustworthy social media in health communities.     

Dopamine D1 receptors and phosphorylation of dopamine- and cyclic AMP-regulated phosphoprotein-32 in the medial preoptic area are involved in experience-induced enhancement of male sexual behavior in rats

The medial preoptic area (MPOA) is an integral site for male sexual behavior. Dopamine is released in the MPOA before and during copulation and facilitates male rat sexual behavior. Repeated sexual experience and noncopulatory exposures to an estrous female facilitate subsequent copulation. However, the neurobiological mechanisms that mediate such enhancement remain unclear. Here, we examined the role of dopamine D? receptors in the MPOA in experience-induced enhancement of male sexual behavior in rats. In experiment 1, microinjections of the D? antagonist SCH-23390 into the MPOA before each of seven daily 30-min noncopulatory exposures to a receptive female impaired copulation on a drug-free test on Day 8, compared to vehicle-treated female-exposed animals. Copulatory performance in drug-treated animals was similar to that of vehicle-treated males that had not been preexposed to females. This effect was site specific. There were no group differences in locomotor activity in an open field on the copulation test day. In experiment 2, a separate cohort of animals was used to examine phosphorylation of dopamine- and cAMP-regulated phosphoprotein (DARPP-32) in the MPOA of animals with acute and/or chronic sexual experience. DARPP-32 is a downstream marker of D? receptor signaling and substrate of cAMP-dependent protein kinase (PKA). Western immunoblot analysis revealed that p-DARPP-32 expression was greatest in the MPOA of males that received both acute and chronic sexual experience, compared to all other mated conditions and na?ve controls. These data suggest that D? receptors in the MPOA contribute to experience-induced enhancement of male sexual behavior, perhaps through a PKA regulated mechanism.     

Resting state intrinsic EEG impacts on go stimulus‐response processes

Neuropsychological research and practice rely on cognitive task performance measures as indicators of brain functioning. The neural activity underlying stimulus‐response processes can be assessed with ERPs, but the relations between these cognitive processes and the brain's intrinsic resting state EEG activity are less understood. This study focused on the neurocognitive functioning of 20 healthy young adults in an equiprobable go/no‐go task to map the ERP correlates of behavioral responses and examine contributions of the resting state intrinsic EEG to task‐related outcomes. Continuous EEG was recorded during pretask eyes‐closed (EC) and eyes‐open (EO) conditions, and in the subsequent task. Delta, theta, alpha, and beta band amplitudes were assessed for the EC state and also for the reactive change to EO. Go/no‐go ERPs were submitted to temporal principal components analysis, where the P2, N2, P3, and slow wave components of interest were extracted. The performance measure of reaction time (RT) variability was positively correlated with no‐go and go errors, and also with go P2 amplitude, linking these to stimulus discrimination efforts involved in appropriate response selection. An N2c‐P3b pairing was enhanced for shorter mean RTs, supporting their involvement in the decision to execute a response. A stepwise regression model identified EC midline delta as a predictor of P3b positivity, highlighting the relevance of delta in the neural mechanisms of attentional processes. These findings clarify the electrophysiology underlying decision‐making processes in executive function, and provide a platform for further research assessing performance outcomes in larger samples and in developmental/clinical contexts.