Unconventional Organ Damage In Diabetes Ecab

Cell health depends on a steady supply of fuel from glucose and free fatty acids. Both these major fuels are regulated by insulin. Cells in the muscle, liver, and fat need insulin to receive glucose, and hence do not become exposed to high blood glucose levels when the blood sugars are high and insulin levels are low. The lack of insulin slows the movement of glucose into these cells, and probably spares them from damage when blood sugars are high. However, other cells such as those in the brain, nervous system, heart, blood vessels and kidneys pick up glucose directly from the blood without using insulin. These cells, except the brain, are more prone to damage from high blood sugars because they become exposed to high internal levels of glucose. This to quite an extent explains why damage tends to occur in specific organs such as in nerve and kidney cells, and in small blood vessels like those in the eyes. This project on the organ damage in diabetes is an attempt to elaborate on the various factors to be considered in managing these patients, the pointers for early diagnosis and prevention of the same.

Critical Issues and Diabetes - ECAB - E-Book

The insulin resistance syndrome can be defined as insulin resistance, compensatory hyperinsulinemia, and their associated co-morbidities. Clinically, the term insulin resistance syndrome describes a constellation of abnormalities such as obesity, hypertension, dyslipidemia, type 2 diabetes/hyperglycemia, and coronary artery disease. Insulin is responsible for glucose uptake into the body cells and tissues. The response of the cells to insulin varies from individual to individual. In some individuals, the tissue response to insulin may be diminished. This means that even with adequate levels of insulin, the glucose uptake into the cells and tissues is not optimal. This results in a compensatory over-secretion of insulin from the pancreas. The persistence of high levels of insulin in the blood or hyperinsulinemia is thought to be responsible for some of the abnormalities associated with this condition. However, the exact causal association of the condition with these disorders and the pathophysiology of their evolution are unclear. The most common underlying mechanism proposed is increased free fatty acids from abdominal fat in individuals with central obesity. This leads to deranged insulin signaling, reduced muscular glucose uptake, increased triglyceride synthesis, and hepatic gluconeogenesis. A genetic basis of the disease as well as several other factors such as tumor necrosis factor-α, adiponectin, leptin, Interleukin-6, and some adipokines have also been implicated. Insulin resistance syndrome is of clinical significance because of its association with potentially debilitating conditions that contribute to long-term morbidity and even mortality of the individual. People with insulin resistance syndrome are at an increased risk of developing type 2 diabetes, hypertension, dyslipidemia, myocardial infarction, polycystic ovarian disease, and fatty liver. In this book, we have tried to collate the experiences of the pioneers of this field on the subject and provide the reader a comprehensive view on the topic along with practical management points, which we are sure will benefit the physicians in their clinical practice. The contributors have focused on the condition as is prevalent in our subcontinent and have tried to give an insight on the issues pertaining to the same with a topical flavor.

Patients with diabetes are predisposed to infections. The risk ratio for infectious disease-related hospitalization for diabetic versus nondiabetic persons is more than 2, and almost 2 for death attributable to infection. Infections in diabetes may precipitate metabolic derangements and, conversely, the metabolic derangements of diabetes may facilitate infection. Abnormalities in the microvascular circulation of individuals with diabetes may result in decreased tissue perfusion, which facilitates the acquisition of infection and impairs response to therapy. The incidence of TB among diabetic patients is 2–5 times higher when compared to the general population, which recently has raised the concern that a combination of DM and HIV infection might lead to a further increased incidence of TB in India and in other developing nations. However, it is unclear whether diabetes is an independent risk for common upper and lower respiratory tract infections. Urinary tract is also reported to be the most prevalent site of infection in patients with diabetes. These infections are known to account for a relatively smaller percentage of reported patients probably due to the fact that most patients, including diabetics, with urinary tract infection are treated as outpatients. A number of long-term effects of diabetes mellitus on the genitourinary system predispose diabetic patients to bacterial urinary tract infections. In addition, complications of urinary tract infection (e.g., bacteremia, renal abscesses, and renal papillary necrosis) are more common in patients with than without diabetes. Rhinocerebral mucormycosis and emphysematous pyelonephritis are some of the less commonly reported conditions seen in diabetics though being important pathologies. The primary goal of this book is to provide a high-quality, evidence-based text on the various aspects of the associations of various infections in diabetics with prime focus on TB and diabetes, rare conditions such as rhinocerebral mucormycosis and emphysematous pyelonephritis and also the various acute infections commonly reported in the condition. The book includes in-depth analysis of the diagnostic and management issues considering the same.

Type 2 diabetes mellitus is associated with a greater risk of developing atherosclerotic macrovascular diseases like myocardial infarction, stroke, and peripheral vascular disease. There is 2- to 4-fold increased risk of atherosclerotic heart disease and stroke in diabetic patients compared to non-diabetic patients. As the prevalence of type 2 diabetes is increasing rapidly, this diabetes related atherosclerotic disease is predicted to be a major public health problem. Atherosclerosis is a complex process and in diabetic patients, it behaves differently with increased lesion progression and severity. This accelerated atherosclerotic process in diabetics is explained on the basis of several risk factors like hyperglycemia, dyslipidemia, accelerated formation of advanced glycation end products, increased oxidative stress, and genetic factors. It is difficult to establish precisely the elements responsible for this atherosclerosis in diabetics, but by epidemiological, clinical, and by animal studies, it has been possible to get an idea of this problem in diabetics. Of the several risk factors for atherosclerosis in diabetes, dyslipidemia is the leading one, and an insight into the pathophysiologic relation of isolated triglyceridemia in Indian diabetics with the identification of the targets for control of lipids in diabetes (practical vs. ideal) needs to be well understood by the treating physician. This book is designed to address such issues with supportive typical clinical scenarios, with which the readers will be able to identify. Thus, it provides an excellent opportunity to widen one’s perspective in this area.

Chronic rhinosinusitis is a widely prevalent condition globally as well as in India. The chronicity of the condition and its multifactorial origin makes the detection of the underlying mechanism of the disease difficult to detect and renders the management challenging. This clinical update handbook put together by the eminent exponents of otolaryngology in India aims to simplify this elusive condition for the benefit of all practitioners involved in the management of this disease. The first chapter highlights socio-economic burden and the impact of this disease on the health related quality of life. The second chapter describes the underlying mechanisms involved in development of the disease. The third chapter showcases the various diagnostic modalities used to detect the disease, differentiate it from other similar conditions and assess its severity. The fourth chapter gives a very succinent overview of the various management modalities. The fifth chapter encapsulates the medical treatment and the sixth offers a lucid description of the latest surgical techniques for this disease. The seventh chapter deals with the other associated conditions that can confuse, complicate or impact the management of the disease as well as affect its prognosis. The eighth chapter describes fungal rhinosinusitis, which is of special importance because of its high prevalence in India.

ECAB Deceased Donor Transplantation: Lessons to Learn - E-Book

Acute pancreatitis is defined as an acute inflammatory process of the pancreas that may also involve peripancreatic tissues and/or remote organ systems. It typically presents with sudden deep, boring pain that starts in the epigastrium and radiates to the back, which usually worsens on intake of food. It may be of varying severity ranging from mild to severe. Mild disease, if managed promptly and adequately resolves with minimal or no sequelae and seldom leads to extended morbidity or mortality. However Severe Acute Pancreatitis has a longer course of resolution, usually requires hospitalization and has a greater propensity to lead to adverse outcomes. As a thumb rule, it has greater morbidity and mortality rates as compared to Mild Acute Pancreatitis. Understandably, the management protocol for the severe acute pancreatitis is more invasive and emergent, and may require intensive care management. Hence understanding and assessment of the condition in the first 48 hours is a critical step in deciding the outcome. The various assessment criteria that are used to prognosticate and plan the management for this disease have been discussed in this clinical update. Previously, the condition was thought to be caused by infection, but now it is an established fact that it is an acute inflammation of the pancreatic gland with activation of the pancreatic enzymes within the gland leading to its autodigestion. Previously, acute pancreatitis was considered to be mostly associated with chronic alcohol abuse or acute bouts of binge drinking. With the availability of data from recent studies in India and the Asian subcontinent, Biliary disease is emerging as the commonest etiological agent. Extensive genetic analysis and mapping have helped put a cause to the erstwhile "idiopathic" cases. Newer diagnostic modalities and minimal invasive procedures have made the conventional surgeries nearly obsolete now. The rationale and use of antimicrobial treatment in the medical management of the condition has also undergone a change. This clinical update has been designed to update the readers on the important aspects of Acute Pancreatitis. The book has stressed upon various aspects of the condition like the etiology, pathogenesis, diagnosis and evaluation along with an insight into the management approach of the patient including the supportive and nutritional management. Overall, the book presents to the readers an excellent compilation of clinically applicable literature sourced from the most acclaimed physicians in the country.