1.Risk Factors for Recurrent Hypoglycemia in Hospitalized Diabetic Patients Admitted for Severe Hypoglycemia.
Yen Yue LIN ; Chin Wang HSU ; Wayne Huey Herng SHEU ; Shi Jye CHU ; Chin Pyng WU ; Shih Hung TSAI
Yonsei Medical Journal 2010;51(3):367-374
PURPOSE: Severe hypoglycemia can result in neural damage, impaired cognitive function, coma, seizures, or death. The decision to admit diabetic patients after initial treatment in the emergency department remains unclear. Our purpose is to identify risk factors for developing recurrent hypoglycemia in diabetic patients admitted for severe hypoglycemia. MATERIALS AND METHODS: We reviewed the records of 233 subjects (92 males, 141 females; mean age, 74.1 +/- 9.8 years) with type 2 diabetes treated at a tertiary care teaching hospital and hospitalized for severe hypoglycemia. RESULTS: Seventy-four (31.8%) patients were categorized with recurrent hypoglycemia and 159 (68.2%) with non-recurrent. Multivariate logistic regression analysis revealed that patients with loss of a recent meal, coronary artery disease, infection, and poor renal function (lower estimated glomerular filtration rate) were at risk for recurrent hypoglycemia. The use of calcium-channel blockers appeared to be a protective factor for the development of recurrent hypoglycemia. CONCLUSION: There may be a subset of patients with severe hypoglycemia and certain risk factors for recurrent hypoglycemia that should be admitted.
Aged
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Aged, 80 and over
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Calcium Channel Blockers/adverse effects/therapeutic use
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Coronary Artery Disease/complications
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Diabetes Mellitus, Type 2/complications
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Female
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Glomerular Filtration Rate
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Hospitalization
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Humans
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Hypoglycemia/*etiology/*prevention & control
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Kidney Diseases/complications
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Logistic Models
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Male
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Multivariate Analysis
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Recurrence
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Retrospective Studies
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Risk Factors
2.The Characteristics of Acute Aortic Dissection among Young Chinese Patients: A Comparison between Marfan Syndrome and Non-Marfan Syndrome Patients.
Shih Hung TSAI ; Yen Yue LIN ; Chin Wang HSU ; Yu Long CHEN ; Min Tser LIAO ; Shi Jye CHU
Yonsei Medical Journal 2009;50(2):239-244
PURPOSE: Aortic dissection (AoD) is one of the most common catastrophes involving the aorta. Nevertheless, early diagnosis remains to be a challenge in the Emergency Department (ED), particularly in young individuals. In this study, we attempted to identify the characteristics of acute AoD among young individuals, particular in patients with Marfan syndrome. MATERIALS AND METHODS: This was an retrospective chart-review study conducted in a tertiary referring hospital. The hospital database was queried for the combination of AoD and patients under age of 40 years. The medical charts were reviewed to obtain demographic data, clinical data and laboratory characteristics by using a standardized data collection sheet. A comparison between Marfan syndrome and non-Marfan syndrome patients was performed. RESULTS: During the 10-years period, 18 of 344 patients with acute AoD were younger than 40 years-old. Patients with Marfan syndrome developed acute AoD at a younger age than patients without Marfan syndrome. The mean diastolic blood pressure was significantly lower in patients with Marfan syndrome upon presenting to the ED than those without. Patients with Marfan syndrome had trends toward higher risk of development of type A AoD, increased recurrence rate and higher mortality rate than those without. However, statistical significance was not present. CONCLUSION: ED physicians should have high alert to acute AoD in young patients presenting with severe unexplained chest and back pain, particularly in those patients with a history of heart diseases, hypertension, and Marfan syndrome or featuring Marfanoid habitus. Acute coronary syndrome, unexplained abdominal symptoms, and sudden cardiac arrest could be the initial manifestation of AoD in young patients. A low threshold to perform enhanced computed tomography may facilitate early diagnosis and timely treatment in this patient population.
Adult
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Aneurysm, Dissecting/*complications/epidemiology/*pathology
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Aortic Aneurysm/complications/epidemiology/*pathology
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Asian Continental Ancestry Group
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Female
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Heart Defects, Congenital/complications/physiopathology
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Humans
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Hypertension/complications/physiopathology
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Male
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Marfan Syndrome/*complications/*physiopathology
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Middle Aged
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Retrospective Studies
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Young Adult
3.Interpretation and Use of Natriuretic Peptides in Non-Congestive Heart Failure Settings.
Shih Hung TSAI ; Yen Yue LIN ; Shi Jye CHU ; Ching Wang HSU ; Shu Meng CHENG
Yonsei Medical Journal 2010;51(2):151-163
Natriuretic peptides (NPs) have been found to be useful markers in differentiating acute dyspneic patients presenting to the emergency department (ED) and emerged as potent prognostic markers for patients with congestive heart failure (CHF). The best-established and widely used clinical application of BNP and NT-proBNP testing is for the emergent diagnosis of CHF in patients presenting with acute dyspnea. Nevertheless, elevated NPs levels can be found in many circumstances involving left ventricular (LV) dysfunction or hypertrophy; right ventricular (RV) dysfunction secondary to pulmonary diseases; cardiac inflammatory or infectious diseases; endocrinology diseases and high output status without decreased LV ejection fraction. Even in the absence of significant clinical evidence of volume overload or LV dysfunction, markedly elevated NP levels can be found in patients with multiple comorbidities with a certain degree of prognostic value. Potential clinical applications of NPs are expanded accompanied by emerging reports regarding screening the presence of secondary cardiac dysfunction; monitoring the therapeutic responses, risk stratifications and providing prognostic values in many settings. Clinicians need to have expanded knowledge regarding the interpretation of elevated NPs levels and potential clinical applications of NPs. Clinicians should recognize that currently the only reasonable application for routine practice is limited to differentiation of acute dyspnea, rule-out-diagnostic-tests, monitoring of therapeutic responses and prognosis of acute or decompensated CHF. The rationales as well the potential applications of NPs in these settings are discussed in this review article.
Acute Coronary Syndrome/metabolism
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Arrhythmias, Cardiac/metabolism
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Heart Failure/*metabolism
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Humans
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Hypertension, Pulmonary/metabolism
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Natriuretic Peptides/*metabolism
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Sepsis/metabolism