OBJECTIVE To provide a reference for the pharmaceutical care of a patient with type 2 diabetes mellitus(T2DM)and limb-girdle muscular dystrophy(LGMD)who developed euglycemic diabetic ketoacidosis(euDKA)after taking empagliflozin.METHODS Clinical pharmacists provided pharmaceutical care for a patient with T2DM and LGMD who developed euDKA after taking empagliflozin.According to the patient's recent use of medications and his conditions,clinical pharmacists assessed the correlation between euDKA and empagliflozin as"very likely".As to euDKA,clinical pharmacists suggested discontinuing empagliflozin and metformin,and giving intravenous infusion of 10％Glucose injection instead of 5％Glucose injection for fluid resuscitation.Clinical pharmacists monitored the patient's laboratory indicators such as arterial blood gas analysis,blood/urine ketones and electrolytes.They assisted physicians to decide when to stop intravenous supplements of liquid and insulin.Clinical pharmacists also assisted physicians to adjust the antidiabetic drugs and educated the patient to avoid empagliflozin or other sodium-glucose linked transporter 2 inhibitors(SGLT2i).RESULTS Physicians adopted the suggestions of clinical pharmacists.After treatment,the patient's condition improved,and he was allowed to be discharged with medication.CONCLUSIONS euDKA is a relatively rare and serious adverse reaction associated with SGLT2i,and the patients with LGMD are susceptible to euDKA.Clinical pharmacists assist physicians in developing personalized medication plans by evaluating the association between euDKA and empagliflozin,adjusting medication regimens,conducting pharmaceutical monitoring,and other pharmaceutical services.Meanwhile,they provide medication education to patients to ensure their medication safety.

Objective:To develop and verify a predictive model for hip fracture risk in the aged patients with knee osteoarthritis (KOA) on the basis of analysis of the risk factors associated with the hip fracture.Methods:A retrospective study was conducted to analyze the 701 patients who had been diagnosed with KOA (Kellgren-Lawrence grades 1 to 4) at Dongyang Hospital affiliated to Wenzhou Medical University from September 2013 to September 2023. The cohort consisted of 275 males and 426 females with an age of (76.5±8.4) years. The patients were divided into a fracture group ( n=145) and a fracture-free group ( n=556) based on whether a hip fracture occurred during the follow-up period. The 2 groups were compared in terms of age, gender, comorbidities, albumin level, absolute lymphocyte count, and Kellgren-Lawrence grade, etc. The items with P<0.05 were analyzed by a multivariate logistic regression model to identify the risk factors for hip fracture in the aged KOA patients. A clinical prediction model based on the above risk factors was constructed and validated for hip fracture risk in the aged KOA patients. Results:Multivariate logistic regression analysis identified the following as independent risk factors for hip fracture in the aged KOA patients: female ( OR=2.009, 95% CI: 1.280 to 3.154, P=0.002), age ≥75 years ( OR=2.313, 95% CI: 1.493 to 3.583, P=0.001), Kellgren-Lawrence grades of 3-4 ( OR=2.348, 95% CI: 1.533 to 3.596, P=0.001), an albumin level <35 g/L ( OR=0.316, 95% CI: 0.191 to 0.522, P=0.001), and an absolute lymphocyte count <0.8×10 9/L ( OR=0.133, 95% CI: 0.069 to 0.253, P=0.001). The area under the ROC curve (AUC) for the model developed by this study was 0.753 in the training set and 0.815 in the validation set ( P<0.05). The Hosmer-Lemeshow goodness-of-fit test showed that the consistency between the predicted risk and the actual risk was good in the training and validation sets ( P<0.05). The calibration curves for both the training and validation sets closely aligned with the ideal curve. The clinical decision curve analysis showed that the nomogram model had a good net benefit rate and a good predictive potential. Conclusions:Female, age ≥75 years, Kellgren-Lawrence grades of 3-4, an albumin level <35 g/L, and an absolute lymphocyte count <0.8×10 9/L are independent risk factors for hip fracture in the aged KOA patients. Since the nomogram prediction model based on these risk factors is satisfactory in discrimination and calibration, it shows a certain predictive ability and application value in clinic.

Objective:To develop and verify a predictive model for hip fracture risk in the aged patients with knee osteoarthritis (KOA) on the basis of analysis of the risk factors associated with the hip fracture.Methods:A retrospective study was conducted to analyze the 701 patients who had been diagnosed with KOA (Kellgren-Lawrence grades 1 to 4) at Dongyang Hospital affiliated to Wenzhou Medical University from September 2013 to September 2023. The cohort consisted of 275 males and 426 females with an age of (76.5±8.4) years. The patients were divided into a fracture group ( n=145) and a fracture-free group ( n=556) based on whether a hip fracture occurred during the follow-up period. The 2 groups were compared in terms of age, gender, comorbidities, albumin level, absolute lymphocyte count, and Kellgren-Lawrence grade, etc. The items with P<0.05 were analyzed by a multivariate logistic regression model to identify the risk factors for hip fracture in the aged KOA patients. A clinical prediction model based on the above risk factors was constructed and validated for hip fracture risk in the aged KOA patients. Results:Multivariate logistic regression analysis identified the following as independent risk factors for hip fracture in the aged KOA patients: female ( OR=2.009, 95% CI: 1.280 to 3.154, P=0.002), age ≥75 years ( OR=2.313, 95% CI: 1.493 to 3.583, P=0.001), Kellgren-Lawrence grades of 3-4 ( OR=2.348, 95% CI: 1.533 to 3.596, P=0.001), an albumin level <35 g/L ( OR=0.316, 95% CI: 0.191 to 0.522, P=0.001), and an absolute lymphocyte count <0.8×10 9/L ( OR=0.133, 95% CI: 0.069 to 0.253, P=0.001). The area under the ROC curve (AUC) for the model developed by this study was 0.753 in the training set and 0.815 in the validation set ( P<0.05). The Hosmer-Lemeshow goodness-of-fit test showed that the consistency between the predicted risk and the actual risk was good in the training and validation sets ( P<0.05). The calibration curves for both the training and validation sets closely aligned with the ideal curve. The clinical decision curve analysis showed that the nomogram model had a good net benefit rate and a good predictive potential. Conclusions:Female, age ≥75 years, Kellgren-Lawrence grades of 3-4, an albumin level <35 g/L, and an absolute lymphocyte count <0.8×10 9/L are independent risk factors for hip fracture in the aged KOA patients. Since the nomogram prediction model based on these risk factors is satisfactory in discrimination and calibration, it shows a certain predictive ability and application value in clinic.