جستجوی مقالات مرتبط با کلیدواژه « هیپوگلیسمی » در نشریات گروه « پزشکی »

Hypoglycemia is one of the most important possible side effects of fasting in children who need surgery, and its prevention is very important. This study was conducted in order to investigate and compare the oral administration of 5% dextrose and intravenous infusion of 1.3, 2.3 sugar-salt serum on the blood sugar levels of 6-2-year-old children who were candidates for minor surgery under general anesthesia.

In this randomized clinical trial study, 66 children aged 2-6 years who were candidates for minor surgery under general anesthesia at Hazrat Ali Asghar Hospital in Tehran were selected as available and randomly selected in one of two The group under oral administration of 5% dextrose (intervention group) at the rate of 10 cc/kg 2 hours before the operation or continuous intravenous injection of 1.3, 2.3 sugar saline serum (control group) according to the formula 4, 2, 1 direction Calculation of the volume of venous fluids were divided while fasting, and their blood sugar levels were measured and compared on two occasions (immediately after induction of anesthesia and then half an hour later).

In this study, the average blood sugar immediately after induction of anesthesia was 88.75 in the group receiving oral dextrose and 85.77 in the group receiving saline serum, and there was no significant difference between the two groups (P=0.554), but the average blood sugar half an hour later of induction of anesthesia was 79.75 in the group receiving oral dextrose and 64.84 in the group receiving intravenous sugar-salt serum, which was significantly higher (P=0.36).

 based on the results obtained in this study, it is concluded that the oral administration of 5% dextrose has an equivalent role to the intravenous infusion of sugar-saline serum in preventing the occurrence of hypoglycemia in 2-6 year old children who are candidates for surgery. It can be used as a suitable alternative to intravenous serum in children.

Diabetic ketoacidosis and severe hypoglycemia are common and recurrent acute complications of type 1 diabetes and are associated with high mortality and morbidity. The aim of this study was to determine the frequency of diabetic ketoacidosis and hypoglycemia in children with type 1 diabetes.

In this retrospective cross-sectional study, 480 patients with type 1 diabetes admitted to the Children Hospital in Qazvin were enrolled by census method. Demographic characteristics, season of referral, place of residence, existence of type 1 diabetes in the family, kin relationship of parents, cause of hospitalization (hyperglycemia, hypoglycemia and diabetic ketoacidosis) and length of hospital stay were extracted from the files and examined.

Most patients (62.9%) were female. 46%, 44.4% and 9.6% of patients were admitted with diabetic ketoacidosis, hyperglycemia and hypoglycemia, respectively. 47.96% of patients had severe diabetic ketoacidosis. 49.3% of patients had ketoacidosis with infection and 20% of known cases were hospitalized due to poor insulin compliance. Hospitalization days were significantly higher in patients with ketoacidosis (p=0.00).

According to the results of this study, the occurrence of infection and lack of adherence to insulin use were the main cause of hospitalization in patients with diabetes, which led to an increase in hospitalization days in these patients. Adequate training to regulate blood sugar reduces the rate of hospitalizations.

Diabetes mellitus is a common disease in Iran and all around the world. A number of diabetic patients are in occupational age range and employed. Occupational health physician with the aim of decreasing both the acute and chronic complication of Diabetes mellitus in diabetic employees, play an important role in evaluation of these individuals. Decision on the appropriateness of a job for diabetic individual is a very complex and important issue. The least benefit which occupation could have for a diabetic individual is to earn money and cover the expensed associated with their illness, a point which indirectly improves their mental health including preventing depression, etc. Several factors such as diet, job-related tasks, type of work shift, history of hypoglycemia, etc. could affect the decision on the appropriateness of an occupation. However, in developing countries such as Iran because of lack of job opportunities and the probability of hiding the issue of hypoglycemia by job-seekers, job suitability assessment is difficult. Overall it seems that by making the work environment slightly suitable for diabetic patients, most of them could continue with their job. In this article, job-suitability is evaluated in regard to hypoglycemia condition in diabetic individuals.

As Iran is one of the countries in the world which its population moves toward aging rapidly, it is essential to consider older adults' needs and concerns, which might have an impact on their health-related quality of life. Quality of life is a multi-dimensional concept that has physical, mental, and social components. The present study has been conducted to determine the correlation between economic status and educational level with health-related quality of life in community-dwelling and institutionalized older adults living in Mashhad City, Iran.

 In this descriptive-analytic cross-sectional study, we recruited 135 (77 [57%] men and 58 [43%] women) community-dwelling older adults (Mean±SD =71.7 ±5.9 y), and 135 (65 [48.1%] men, 70 [51.9%] women) institutionalized older adults (Mean±SD =071.2±5.6 y). They were living in Mashhad City, Iran. Through the interview, we collected the subjects’ demographic characteristics, monthly income, and the level of education. The Persian validated version of SF-36 questionnaire was used for assessment of health-related quality of life. The questionnaire assesses 8 physical and mental health subscales. The statistical analysis was conducted by SPSS version 19. The Mann-Whitney U test was used to compare monthly income and health-related quality of life between community-dwelling and institutionalized older adults. The Chi-square test was used to compare the educational level of the two groups. Also, the effect of some independent variables on physical and mental health domains of quality of life was assessed by multiple regression models.

The education level community-dwelling older adults was lower than that in institutionalized older adults (P =0.03). In general, in terms of physical and mental dimensions of quality of life, the institutionalized older adults had a lower quality of life than community-dwelling older adults ( P<0.01). Also, the institutionalized older adults had lower monthly income than community-dwelling older people (P<0.001 (The results of multiple regression model indicate that only living place of the elderly (community, nursing home) had a significant effect on both physical and mental dimensions of quality of life (P<0.001). While the elderly’s income, education .gender, age, diseases (such as diabetes, blood pressure) and smoking didn’t have any significant effects.

 A higher level of education can promote the social class and increase the income of older people. Having enough income is a prerequisite of high quality of life, although it cannot meet all the basic needs of life. Improving health-related quality of life of old Iranian adults is achieved by considering all its dimensions, including physical, emotional and social needs, and using interventional, educational, and social support programs.

Hypoglycemia is a condition when blood glucose level is lower than 70 mg/dl in people without diabetes. The symptoms of hypoglycemia include tachycardia, sweating, pallor, pupillary dilatation. Hypoglycemia is a non-lethal and often preventable clinical problem in non-diabetic patients that can occur during fasting or after dining.

A 52 years old man referred to Shohada-e-Tajrish Hospital, Tehran, with diagnosis of kidney stones candidate for percutaneous nephrolithotomy (PCNL). The patient underwent general anesthesia and after 40 minutes, the surgeon requested injection of tranexamic acid because of bleeding, but unintentionally the patient received 100 unites of crystalline insulin by nurse anesthesia. Vital signs were stable, the patient's blood glucose was 85 mg/dl and he had no sweat. Then the therapeutic intervention consisted of administering a bolus dose of 50 cc 50% dextrose water (DW) and then infusion of 50% dextrose water over that time. The patient was monitored for 10 hours in recovery and also received 1 mg of glucagon. The blood glucose was checked frequently. Fortunately, there were not any detectable hypoglycemic attacks (blood glucose less than 70 mg/dl) during that time. Throughout the first three hours in ICU, he suffered from severe hypoglycemic episodes and treated by DW 50% (bolus stat and infusion) and after stabilization of vital signs he transferred to ward.

The mortality of iatrogenic hypoglycemia is lower than other causes of hypoglycemia. However, on time diagnosis and aggressive treatment can prevent serious complications. In addition, proper communication between health care providers and precise checking of drugs labels before injection can dramatically decrease these events.

Diabetes mellitus has many complications; hypoglycemia is one of them that is associated with severe signs and symptoms such as anxiety, psychosocial problems, and poor metabolic control. This study aimed to investigate the factors affecting hypoglycemia fear in patients with type 2 diabetes. The present descriptive-analytic study was conducted on 360 patients with type 2 diabetes referred to Velayat Hospital in Qazvin City, Iran, in 2017. The eligible samples were recruited through a convenience sampling method. The data collection instruments were a demographic checklist and the Hypoglycemia Fear Survey-II scale. The collected data were analyzed using descriptive tests, t-test, one-way ANOVA, the Pearson correlation, and regression analysis. The Mean±SD age of the patients was 58.5±14.3 years, and the majority of them were women (65.3%). The Mean±SD score of hypoglycemia fear was 22.07±8.6 which was significant in terms of gender (P=0.002), type of treatment (P<0.001), employment (P=0.05), and educational status (P=0.05). The results of single-variable regression showed that the type of treatment (P<0.001), long-term complications (P=0.002), and gender (P=0.002) were associated with hypoglycemia fear. Also, the results of simultaneous regression showed that the type of treatment was associated with hypoglycemia fear (P<0.001). The results of this study showed that the type of treatment was the most effective factor in hypoglycemia fear. Using insulin to treat diabetes strongly affect the hypoglycemia fear; therefore, it is possible to reduce the hypoglycemia fear by appropriate patients’ instructions on how to inject and monitor insulin.

Background and Hypoglycemia is an important problem in newborns which requires early diagnosis and treatment. Laboratory testing of blood glucose level and glucometer readings are used to detect hypoglycemia but sometimes the results are given late. This study aimed at evaluating the accuracy of glucometer in detection of hypoglycemia in newborns at neonate intensive care unit (NICU), 2014-2015.
A diagnostic study was performed in which 408 blood samples (glucometer capillary and venous derived samples) were obtained from 204 neonates in NICU within two hours after birth. Blood glucose concentrations were measured by glucose oxidase and photometric analysis. The mean values for blood glucose level, correlation coefficient, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined. Data analysis was performed in SPSS V.19.
The mean neonatal weight was 2915 ± 840 gr. In our study, 92 neonates were females and 112 were males. In laboratory testing the prevalence of hypoglycemia was found to be 21.6% (CI 95% 15.9-27.3%). Mean values of blood glucose level (86.4 ± 60.9 mg/dl) with glucometer was significantly higher than that of laboratory level (77.8 ± 69.1 mg/dl), (P Glucometer was found to have appropriate sensitivity and NPV in detecting neonatal hypoglycemia, therefore, it is recommended in screening of neonatal hypoglycemia without any side effects.

The aim of this study was to determine glucose, lipids and the number of hypoglycemia episodes in the patients with type2 diabetes previously treated with metformin while fasting during the month of Ramadan. Subjects and A month before Ramadan, 30 patients with type-2 diabetes eligible for inclusion who were under treatment with metformin with or without a combination of glutazone and acarbose entered the study. An individual questionnaire was completed and patients were advised to note their experience of any hypoglycemic episodes during Ramadan fasting. Blood samples were collected, 4 days before and after Ramadan for measurement of blood glucose (FBS), glycated hemoglobin (HbA1C), lipoprotein, fructosamine, low-density cholesterol (LDL), high-density(HDL) lipoprotein, and the triglycerides serum concentrations. Similarly weight, BMI, blood pressure, and diastolic and systolic blood pressure were determined. Out of a total of 30 subjects of the study group, 9 (30%) people were men and 21 (70%) women. Except for 1person, 29 people fasted the whole month. The average age was 52.6+8.2 yr (ranged 37-65yr). The average weight before and after Ramadan were 68.2+10 Kg and 67.6+10.2 Kg (P =0.04). Changes of BMI, FBS, HbA1C, total cholesterol, fructosamine, triglycerides, LDL cholesterol, HDL cholesterol and the average diastolic and systolic blood pressure were not significant. Non-severe hypoglycemia was reported in 3cases. Ramadan fasting does not have a significant effect on the lipid and glycemic control in the patients treated with metformin. Severe hypoglycemia during fasting was not seen but it should be considered as a complication.

Diabetes during pregnancy has considerable adverse effects on the mother and her fetus or neonate. Mother’s hyperglycemia may induce hyper insulinemia and pancreatic Beta cells hyperplasia in fetus. Excess Insulin secretion in fetus blood may cause macrosomia، increase basal metabolism rate، increase oxygen consumption and even fetus hypoxemia. Fetal hypoxia may fallow by erythropoietin over production، red blood cell hyperplasia and increased hematocrit level. Polycythemia may enhance blood circulation and cause hyper bilirubinemia. On the other hand hyperglycemia may cause exaggerated production of oxygen radicals in mitocondrias and produce hydroperoxides which are prostacyclin inhibitors. Erythropoietin excess and polycythemia induce catecholamine release، hypertension and myocardial hypertrophy respectively. The last may be one of the etiology of still birth in poor control diabetic pregnancies. Rigorous glycemic control before and during pregnancy may decrease the prevalence of these complications.

In the absence of sugar-containing fluids in fluid therapy during anesthesia of prolonged surgeries, the amount of blood sugar before and after the surgery has a significant difference. Regarding the lack of sugar in the fluids infused during anesthesia and the duration of NPO and the surgery, there is an increased risk of hypoglycemia during and after the surgery. The aim of this study was to evaluate the blood sugar changes before and after elective surgeries that use the usual fluid therapy (no sugar).
It was a descriptive-analytic design study. One hundred patients with an ASA class and an elective surgery with less than 2 hours duration randomly participated into the study. The patients divided into male and female groups with NPO duration of 8-10 h, 10-12 h and more than 12 h and two age groups of 15-30 and 30-45 years old. The blood sugar was measured 15 minutes prior to the onset of surgery and 15 minutes after the end of the operation. Data was analyzed by SPSS using Paired and Independent Samples T-test.
The blood sugar at the end of the surgery was significantly higher than its amount before the onset of the operation and even without using dextrose-containing fluids during anesthesia and patients NPO condition, hypoglycemia was not observed. In this study, age, gender and NPO duration did not have a significant effect on blood sugar before and after the surgery.
Using dextrose-containing fluids during fluid therapy of elective surgeries is unnecessary and only monitoring the blood sugar during prolonged surgeries is recommended in order to prevent hypoglycemia and its complications.

Objective (s): The effect of Ramadan fasting on diabetes control is not clear yet. Some lifestyle changes like changes in drug dose and time, sleep wake cycle, physical activity and diet occur in Ramadan and can lead to metabolic imbalances. As such some studies have shown increased risk of hyperglycemia and hypoglycemia. So, it is necessary to make decision based on scientific evidences about safety and allowing fasting in a wide variety of patients on different stages of metabolic control. Moreover, appropriate changes in drug prescription should be recognized and used. In this review the results of various studies regarding the effects of Ramadan fasting on metabolic control of type 1 and 2 diabetes mellitus have been summarized and provided. Keywords including "Ramadan", "Ramadan Fasting", "Islamic Fasting", Fasting in Ramadan ", Calorie Restriction, Fasting and Starvation with words Diabetes Mellitus, Hyperglycemia, Hypoglycemia, Ketoacidosis, Glucose were searched via PubMed, SID (Scientific Information Database), and some regional journals and all articles (descriptive cross - sectional, cohort, clinical trial and review articles) from 1957 to 2010. The relevant articles were reviewed. In all 86 papers were included in this review. In diabetic patients safety of Ramadan fasting is defined as blood glucose in normal range. In type 2 diabetics with no chronic complication and able to self care, with proper training, planning the time and dose of drug, controlling of diet and physical activity and regular monitoring of blood glucose, fasting is allowed. In type 1 diabetics or insulin users, fasting should be allowed with caution, because, they are more at risk of hypoglycemia. Diabetic patients who wish to fast in Ramadan need to care about time, type and dose of their medications

Neonatal macrosomia، hypoglycemia، and hypocalcemia are among the complications associated with gestational diabetes. The aim of this study was to compare the frequency of neonatal hypoglycemia and hypocalcemia in macrosomic and non macrosomic infants of diabetic mothers. This was a descriptive analytic study performed on 90 infants born to diabetic mothers in Javaheri hospital during 2005 - 2009. Blood glucose level was determined for all infants during the first 3 hour، between 3-24 hour، and 24 hours after birth. Blood calcium concentration was also measured within the first 3 hour and 24 hours after birth. Data were analyzed by chi square and Fisher exact tests. Of 90 infants، 33. 3% were macrosomic. Hypoglycemia and hypocalcemia were more common in macrosomic infants of diabetic mothers compared to non macrosomic neonates.

The role of morphine in blood glucose changes has been documented. The aim of the present study was to investigate the hormonal mechanisms involved in changes caused by morphine on blood glucose in diabetic and non-diabetic mice. Animals were divided into two, the diabetic and non-diabetic, groups. Each group was further divided into subgroups: 1. Saline+saline 2. Naloxone+morphine and 3. Control (saline+saline). Blood samples were used for determining the blood glucose as well as for hormonal (insulin, cortisol and epinephrine) analyses. In non-diabetic and diabetic mice, blood glucose was significantly decreased in the saline+morphine group, compared to controls at 3h and 1h respectively, a decrease which compensated in the naloxone+morphine group, compared to saline+morphine group. After 3h, the level of insulin in non-diabetic mice was significantly decreased compared to the controls and was compensated in the naloxone+morphine group. At this time, the level of insulin showed no changes in diabetic animals. The level of cortisol remained constant both in diabetic and non-diabetic animals at 3h. The level of epinephrine displayed a significant decrease in diabetic and non-diabetic mice at 3h when compared to the controls and was compensated in the naloxone+morphine compared to the saline+morphine group. The administration of subcutaneous morphine caused hypoglycemia in diabetic and non-diabetic mice. The hypoglycemia and the decrease of insulin level in non-diabetic mice as well as the unchanged level of this hormone in diabetic animals may suggest an insulin-independent hypoglycemia induced by morphine.

Methylmalonyl – coenzyme A deficiency is an inborn error of metabolism that can result in the formation of methylmalonic acidemia. Experience with anesthesia is limited, and recommendations are based more on theory than on clinical experience. This study demonstrated a 4 years old boy with methylmalonyl acidemia. Then the presentation of this patient we will discussed management of anesthesia.

Solitary fibrous tumors of the pleura (SFTP) are rare and often benign tumors, originating from mesenchymal (not mesothelial) cells of pleura. Depending on tumor size and its location it may present with compression effects on adjacent structures or pareneoplastic features such as hypoglycemia and clubbing of the fingers. In this presentation, we reported a 70 years old man who referred to our outpatient's clinic, showing with neurological symptoms such as dizziness, weakness, fatigue and significant weight loss. Laboratory findings showed hypoglycemia, and chest x-ray detected the first indication of the existence of a mass in the left hemi thorax, elevating the ipsilateral diaphragm. He underwent left thoracotomy and a well-encapsulated mass weighing 3 Kg was resected from the thorax. Histopathologically, it was a benign connective tissue without any evidence of malignancy as was shown by immunohistochemistry. Postoperative period was uneventful and patient was discharged from hospital with normal blood sugar.

The presence of neonatal seizures often signals an underlying ominous neurologic condition. The etiologies of neonatal seizure include; hypoxic ischemic encephalopathy, central nervous system infections, intracranial hemorrhage, central nervous system malformation, acute metabolic disorders, inborn error of metabolism and others with lower frequencies. The aim of this study was to determine the etiologic distribution of neonatal seizure and correlation of age, gender, weight and route of delivery with neonatal seizures.Subjects and Detailed questionnaires were retrospectively collected for a period of 3 years (2004-2007) on 94 infants experienced seizure at presentation in hospital, During the period of this study 94 neonate patients with convulsion were admitted. Seventy nine percent of them had seizure during the first 14 days of life. Hypoxic-ischemic encephalopathy was found to be the most common cause (34%) of neonatal seizures, followed by intracranial hemorrhage (13%), hypoglycemia (10%), meningitis (6%), hypocalcaemia (3%) and inborn error of metabolism (3%). This study showed that birth asphyxia is the most common etiology of neonatal seizures. In 31 percent of patients no pathologic factor was found.