High prevalence of obesity among nursing personnel working in tertiary care hospital

Aim

To find out the prevalence of obesity and glucose intolerance among nurses working in tertiary care hospital.

Beta-cell dysfunction and glucose intolerance: results from the San Antonio metabolism (SAM) study

Aims/hypothesis Both insulin resistance and beta-cell dysfunction play a role in the transition from normal glucose tolerance (NGT) to Type 2 diabetes (T2DM) through impaired glucose tolerance (IGT). The aim of the study was to define the level of glycaemia at which beta-cell dysfunction becomes evident in the context of existing insulin resistance.Methods Insulin response (OGTT) and insulin sensitivity (euglycaemic insulin clamp) were evaluated in 388 subjects in the San Antonio Metabolism (SAM) study (138 NGT, 49 IGT and 201 T2DM). In all subjects the insulin secretion/insulin resistance index (I/G÷IR) was calculated as the ratio of the increment in plasma insulin to the increment in plasma glucose during the OGTT divided by insulin resistance, as measured during the clamp.Results In lean NGTs with a 2-h plasma glucose concentration (2-h PG) between 5.6 and 6.6 and between 6.7 and 7.7 mmol/l, there was a progressive decline in I/G÷IR compared with NGTs with a 2-h PG less than 5.6 mmol/l. There was a further decline in I/G÷IR in IGTs with a 2-h PG between 7.8 and 9.3 and between 9.4 and 11.0 mmol/l, and in Type 2 diabetic patients with a 2-h PG greater than 11.1 mmol/l. Lean and obese subjects showed coincident patterns of relation of 2-h PG to I/G÷IR.Conclusion/interpreation When the plasma insulin response to oral glucose is related to the glycaemic stimulus and severity of insulin resistance, there is a progressive decline in beta-cell function that begins in normal glucose tolerant individuals.Abbreviations T2DM, Type 2 diabetes mellitus - FPG, fasting plasma glucose - 2-h PG, 2-h plasma glucose - EGP, endogenous glucose production - Ra, rate of appearance - TGD, total glucose disposal - IR, insulin resistance     

CT-Guided Percutaneous Gastrostomy without Preliminary Placement of a Nasogastric Tube

Percutaneous radiologic gastrostomy (PRG) requires preliminary gastric inflation through a nasogastric tube (NGT) to safely perform gastric puncture. However, in case of pharyngeal or esophageal obstruction, NGT placement may be impossible even with a hydrophilic angiography catheter and wire. This brief report describes percutaneous computed tomography (CT)–guided gastrostomy with a 2-stick approach without nasogastric insufflation in 13 patients. Technical success rate was 100% with a mean of 1.8 punctures ± 1.0 to access the gastric lumen. Traversal of the colon and liver with a 22-gauge needle was necessary in 4 and 1 patients, respectively. There were no major complications. Minor complications occurred in 6 patients (46%). CT-guided percutaneous gastrostomy is technically feasible with minimal morbidity.     

Validation of surrogate estimates of insulin sensitivity and insulin secretion in children and adolescents

OBJECTIVES: To compare insulin sensitivity and pancreatic beta-cell function measured by the euglycemic and the hyperglycemic clamp, with simple estimates of insulin sensitivity and pancreatic beta-cell function in youth.Study design We measured insulin sensitivity with a euglycemic clamp and first- and second-phase insulin secretion with a hyperglycemic clamp in 156 AA and white youths. Estimates of insulin sensitivity (fasting insulin level [I(F)], the ratio of fasting glucose [G(F)] to I(F) [G(F)/I(F)], homeostasis model assessment estimate of insulin sensitivity [HOMA IS], and quantitative insulin sensitivity check index [QUICKI]) and estimates of pancreatic beta-cell function (I(F), the ratio of I(F) to G(F) [I(F)/G(F)], and homeostasis model assessment estimate of pancreatic beta-cell function [HOMA %B]) were derived from fasting measurements. RESULTS: In the total group, IS(Eu) correlated strongly with I(F) (r=-0.92), G(F)/I(F) (r=0.92), HOMA IS (r=0.91), and QUICKI (r=0.91) (P<.01). First-phase and second-phase insulin secretion correlated with I(F), I(F)/G(F), and HOMA %B (first-phase insulin secretion: r=0.76, 0.79, 0.82; second-phase insulin secretion: r=0.83, 0.86, 0.86, respectively; P<.01). CONCLUSIONS: Simple estimates of insulin sensitivity and pancreatic beta-cell function using fasting insulin and glucose levels serve as surrogate measures of insulin sensitivity and secretion in nondiabetic youths. The validity of these conclusions in children with impaired glucose tolerance and type 2 diabetes mellitus remains to be determined.     

Evidence and consensus based GKJR guidelines for the treatment of juvenile idiopathic arthritis

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children and adolescents. Immunomodulatory drugs are used frequently in its treatment. Using the nominal group technique (NGT) and Delphi method, we created a multidisciplinary, evidence- and consensus-based treatment guideline for JIA based on a systematic literature analysis and three consensus conferences. Conferences were headed by a professional moderator and were attended by representatives who had been nominated by their scientific societies or organizations. 15 statements regarding drug therapy, symptomatic and surgical management were generated. It is recommended that initially JIA is treated with NSAID followed by local glucocorticoids and/or methotrexate if unresponsive. Complementing literature evidence with long-standing experience of caregivers allows creating guidelines that may potentially improve the quality of care for children and adolescents with JIA.     

PEG与NGT肠内喂养在颅脑损伤后昏迷伴吞咽困难患者中的应用

目的 探讨经皮胃镜下胃造瘘术（PEG）与经鼻胃管（NGT）肠内喂养在颅脑损伤后昏迷伴吞咽困难患者中的效果和安全性.方法 选择笔者医院神经外科2004年1月～ 2013年6月230例颅脑损伤后昏迷患者,其中148例行PEG,为观察组,82例行NGT,为对照组,观察术前和术后7天和30天患者的营养状况及并发症.结果 两组入院时两组肱三头肌皮褶厚度,血清白蛋白、血清总蛋白、血红蛋白等各项结果比较,差异无统计学意义（P＞0.05）;第7天时,各项指标均低于入院时,差异具有统计学意义（P＜0.05）;观察组第30天两组肱三头肌皮褶厚度,血清白蛋白、血清总蛋白、血红蛋白结果分别为9.76 ±0.74mm、35.82±1.96g/L、64.01±1.77g/L和123.25±9.06g/L,均高于对照组第30天各项指标,且高于观察组第7天的指标值,差异均具有统计学意义（P＜0.05）;观察组并发肺炎、反流性食管炎、消化道出血6.76％ （10/148）、12.84％ （19/148）和8.11％（12/148）,低于对照组28.05％ （23/82）、43.90％（36/82）和30.49％（25/82）,差异具有统计学意义（P＜0.05）.结论 PEG肠内喂养可明显改善患者营养状况,效果较管饲好且并发症少,是安全、可行、较好的肠内营养选择方法.