Mesenteric infarction due to combined protein C deficiency and prothrombin 20210 defects

The prothrombin gene mutation, 20210A, a guanine to adenine substitution at nucleotide position 20210, has recently been described as an additional risk factor for venous thromboembolic disease. We describe the case of a patient with combined heterozygous prothrombin 20210A mutation and type 1 protein C deficiency who presented with massive mesenteric venous infarction of his small bowel and survived following the use of protein C concentrate and extensive small bowel resection.     

Impaired Glucose Metabolism and the Exaggerated Blood Pressure Response to Exercise Treadmill Testing in Normotensive Patients

The authors aimed to investigate the association between glucose metabolism measures and the exaggerated blood pressure response (EXBPR) to exercise testing in normotensive nondiabetic patients. One hundred and forty-two consecutive patients underwent office blood pressure (BP) measurements, 24-hour BP monitoring, echocardiography, and treadmill exercise test according to the Bruce protocol. The population was divided into 2 groups according to EXBPR at a submaximal workload level. Furthermore, blood samples were obtained for fasting glucose (FG), fasting insulin (FI), and lipid profile assessment. Measures of insulin resistance (homeostasis model assessment of insulin resistance [HOMA-IR], quantitative insulin sensitivity check index [QUICKI], and McAuley index) were also estimated, and a standardized oral glucose tolerance test was performed to evaluate glucose levels at 120 minutes (G120). Patients with EXBPR (n=40; 27 men) compared with those without EXBPR (n=102; 66 men) were older by 4±6 years (P<.001). FG, FI, G120, HOMA-IR, QUICKI, and McAuley index differed in patients with EXBPR compared with those without EXBPR (P<.001 for all). Logistic multivariable regression models revealed that the studied glucose metabolism measures, duration of exercise, and 24-hour systolic BP remained determinants of EXBPR (P<.05 for all) after adjustment. Impaired glucose measures are significant determinants of EXBPR to exercise testing in normotensive nondiabetic patients, suggesting that impaired glucose metabolism may contribute to adverse cardiovascular prognosis including new-onset hypertension.     

Relationship between mean blood glucose and glycated haemoglobin in Type 2 diabetic patients

Aims To correlate the values of MBG to HbA_1c in Greek patients with Type 2 diabetes and/or metabolic syndrome. Methods We followed up 140 Greek adult patients: 92 patients with Type 2 diabetes treated with insulin or oral glucose‐lowering medication, and 48 patients with newly diagnosed Type 2 diabetes or metabolic syndrome not receiving any treatment. MBG was calculated for each patient from self‐measurements of blood glucose using a portable glucometer, made six times a day (before eating and 2 h after a meal), three times a week for 1 month. HbA_1c was determined by HPLC at 0 and 12 weeks. Results HbA_1c at 0 (x) and 12 weeks (y) correlated strongly (y = 0.790x + 1.115, r = 0.92), confirming that the patient's glycaemic status remained stable during the whole period of follow‐up. Linear regression was performed on MBG values; HbA_1c at 12 weeks, sex, age, body mass index (BMI) and patient status (Type 2 diabetes treated or not) were used as independent variables. None of the independent variables reached statistical significance in the model, with the exception of HbA_1c at 12 weeks. The final model was: MBG (mg/dl) = (34.74 × HbA_1c) – 79.21, r = 0.93; or MBG (mmol/l) = 1.91 × HbA_1c – 4.36, r = 0.93. Conclusions Our results establish for the first time a strong correlation between MBG and HbA_1c in Type 2 diabetic patients and support the idea of expressing HbA_1c results as MBG. This will help patients to gain a clearer interpretation of the result, with less confusion. This simplification will allow every person with diabetes using home glucose‐monitoring to understand his or her own target level.     

Evans'' syndrome associated with dermatomyositis.

Autoimmune haematological complications in dermatomyositis are very uncommon. This case report describes autoimmune haemolytic anaemia and thrombocytopenia in a patient with dermatomyositis and pulmonary fibrosis.     

Measurement of glycated hemoglobin (HbA1c) with an automated POCT instrument in comparison with HPLC and automated immunochemistry method: evaluation of the influence of hemoglobin variants.

Our study evaluates a fast and easy way to perform point-of-care testing (POCT) measurements of glycated hemoglobin HbA1c in comparison with an immunoassay on an automated biochemistry analyzer and cation exchange chromatography, the two methods routinely used in clinical laboratories for the measurement of HbA1c. A significant finding of our study is that although the POCT instrument insert claims that the method is not affected by the presence of HbS in the heterozygous state or in combination with beta-thalassemia, discrepant results were found in some cases with such hemoglobinopathies. In these cases, the two POCT and laboratory immunoassay methods showed clinically significant positive interferences with samples containing the HbS trait. We conclude that samples with the HbS trait should be interpreted with caution when tested using the POCT instrument.     

Self-Monitoring of Mistakes Among Subjects High and Low in Perfectionistic Concern over Mistakes

Subjects high and low in perfectionistic concern over mistakes (CM; Frost, Marten, Lahart, & Rosenblate, 1990) monitored their mistakes daily to test several hypotheses about the nature of mistakes among perfectionists. High-CM subjects did not report a greater number of mistakes, nor were the mistakes reported by high- and low-CM subjects different in quality, based on ratings by independent judges. However, there were differences in personal reactions to mistakes, perceptions of the seriousness of mistakes, beliefs about other peoples' reactions to mistakes, and rumination about mistakes. High-CM subjects reacted more strongly and more negatively to their mistakes. The specific nature of these findings and implications for cognitive-behavioral treatment of perfectionism are discussed.