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Management of critically ill patients with diabetes 预览
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作者 Livier Josefina Silva-Perez Mario Alberto Benitez-Lopez +1 位作者 Joseph Varon Salim Surani 《世界糖尿病杂志:英文版(电子版)》 2017年第3期89-96,共8页
Disorders of glucose homeostasis, such as stress-induced hypoglycemia and hyperglycemia, are common complications in patients in the intensive care unit. Patients with preexisting diabetes mellitus(DM) are more suscep... Disorders of glucose homeostasis, such as stress-induced hypoglycemia and hyperglycemia, are common complications in patients in the intensive care unit. Patients with preexisting diabetes mellitus(DM) are more susceptible to hyperglycemia, as well as a higher risk from glucose overcorrection, that may results in severe hypoglycemia. In critically ill patients with DM, it is recommended to maintain a blood glucose range between 140-180 mg/d L. In neurological patients and surgical patients, tighter glycemic control(i.e., 110-140 mg/d) is recommended if hypoglycemia can be properly avoided. There is limited evidence that shows that critically ill diabetic patients with a glycosylated hemoglobin levels above 7% may benefit from looser glycemic control, in order to reduce the risk of hypoglycemia and significant glycemic variability. 展开更多
关键词 糖尿病 mellitus 批评照顾 强调多糖症 低血糖症 Glycemic 控制 特别护理联合起来
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Critically ill patients and gut motility: Are we addressing it? 预览
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作者 Alfredo Vazquez-Sandoval Shekhar Ghamande Salim Surani 《世界胃肠药理与治疗学杂志:英文版(电子版)》 2017年第3期174-179,共6页
Gastrointestinal(GI) dysmotility is a common problemin the critically ill population. It can be a reflection and an early sign of patient deterioration or it can be an independent cause of morbidity and mortality. GI ... Gastrointestinal(GI) dysmotility is a common problemin the critically ill population. It can be a reflection and an early sign of patient deterioration or it can be an independent cause of morbidity and mortality. GI dysmotility can be divided for clinical purposes on upper GI dysmotility and lower GI dysmotility. Upper GI dysmotility manifests by nausea, feeding intolerance and vomiting; its implications include aspiration into the airway of abdominal contents and underfeeding. Several strategies to prevent and treat this condition can be tried and they include prokinetics and post-pyloric feeds. It is important to note that upper GI dysmotility should be treated only when there are clinical signs of intolerance(nausea, vomiting) and not based on measurement of gastric residual volumes. Lower GI dysmotility manifests throughout the spectrum of ileus and diarrhea. Ileus can present in the small bowel and the large bowel as well. In both scenarios the initial treatment is correction of electrolyte abnormalities, avoiding drugs that can decrease motility and patient mobilization. When this fails, in the case of small bowel ileus, lactulose and polyethylene glycol solutions can be useful. In the case of colonic pseudo obstruction, neostigmine, endoscopic decompression and cecostomy can be tried when the situation reaches the risk of rupture. Diarrhea is also a common manifestation of GI dysmotility and the most important step is to differentiate between infectious sources and non-infectious sources. 展开更多
关键词 毁坏活动性 内脏 dysmotility 特别护理联合起来 在特别护理联合起来的胃肠的问题 肠塞痛
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Diabetic ketoacidosis: Treatment in the intensive care unit or general medical/surgical ward? 预览
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作者 Yamely Mendez Salim Surani Joseph Varon 《世界糖尿病杂志:英文版(电子版)》 2017年第2期40-44,共5页
Diabetic ketoacidosis(DKA) is defined as an acute metabolic disorder, which is characterized by an increased presence of circulating ketones, and the development of ketoacidosis in the presence of hyperglycemia. This ... Diabetic ketoacidosis(DKA) is defined as an acute metabolic disorder, which is characterized by an increased presence of circulating ketones, and the development of ketoacidosis in the presence of hyperglycemia. This syndrome occurs as a result of insulin deficiency. Patients can be dramatically ill, however, with aggressive treatment, most patients recover rapidly. Despite being a low-risk condition, the development of acidosis, is one of the admission criteria to the intensive care unit(ICU) for these patients, in order to provide close monitoring, and recognize complications that could result from the use of aggressive therapy, such as continuous infusions if insulin. In some institutions, DKA is treated in the emergency department and general medical/surgical wards to avoid ICU overcrowding. 展开更多
关键词 糖尿病的 ketoacidosis 糖尿病 Hyperosmolar non-ketotic 状态 临床的结果 浆液酉同类
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When a liver transplant recipient goes back to alcohol abuse: Should we be more selective? 预览
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作者 Monica Leon Joseph Varon Salim Surani 《世界胃肠病学杂志:英文版》 SCIE CAS 2016年第20期4789-4793,共5页
Alcoholic liver disease(ALD) is one of the most common indications for liver transplantation(LT). However, it has always remained as a complicated topic from both medical and ethical grounds, as it is seen for many a ... Alcoholic liver disease(ALD) is one of the most common indications for liver transplantation(LT). However, it has always remained as a complicated topic from both medical and ethical grounds, as it is seen for many a 'self-inflicted disease'. Over the years, the survival rate of transplanted patients has significantly improved. The allocation system and the inclusion criteria for LT has also undergone some modifications. Early LT for acute alcoholic hepatitis has been subject to recent clinical studies with encouraging results in highly selected patients. We have learned from studies the importance of a multidisciplinary evaluation of candidates for LT. Complete abstinence should be attempted to overcome addiction issues and to allow spontaneous liver recovery. Risk factors for relapse include the presence of anxiety or depressive disorder, short duration of sobriety pre-LT and lack of social support. The identification of risk factors and the strengthen of social support system may decrease relapse among these patients. Family counseling of candidates is highly encouraged to prevent relapse to alcohol. Relapse has been associated with different histopathological changes, graft damage, graft loss and even decrease in survival among some studies. Therefore, each patient should be carefully selected and priority is to continue to lean on patients with high probability of success. The ethical issue remains as to the patient returning to drinking after the LT, hindering the way for other patients who could have received the same organ. 展开更多
关键词 LIVER transplantation ALCOHOLIC LIVER disease ALCOHOLIC CIRRHOSIS Selection criteria RELAPSES
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Are diabetic patients being screened for sleep related breathing disorder? 预览
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作者 Salim Surani 《世界糖尿病杂志:英文版(电子版)》 SCIE 2013年第5期162-164,共3页
Prevalence of both diabetes mellitus and obstructive sleep apnea(OSA)is high among general population.Both of these conditions are associated with significant morbidity.OSA affects approximately 25%of men and 9%of wo... Prevalence of both diabetes mellitus and obstructive sleep apnea(OSA)is high among general population.Both of these conditions are associated with significant morbidity.OSA affects approximately 25%of men and 9%of women,and its prevalence is even higher among obese,Hispanics,African American and diabetic patients.Diabetes on the other hand besides having high prevalence in general population has even higher prevalence among ethnic populations as Hispanics and African American.Despite the availability of several simple screening tools for OSA,as Berlin questionnaire,STOP-BANG questionnaire,NAMES Criteria,the utility for screening of OSA among the diabetic population remains marginal.This in turn can lead to significant morbidity and complications related to OSA as well as worsening of diabetes mellitus and increase in diabetic complications due to untreated sleep related breathing disorder.It is therefore imperative for the primary care giver to screen for OSA among the diabetic population as a part of their routine evaluation to prevent worsening of diabetes,and its cardiovascular,renal,ophthalmologic and neurological complications. 展开更多
关键词 OBSTRUCTIVE SLEEP APNEA and diabetes MELLITUS OBSTRUCTIVE SLEEP APNEA screening OBSTRUCTIVE SLEEP APNEA and metabolic syndrome
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类型 2 糖尿病 mellitus 上的妨碍的睡觉呼吸暂停的效果: 全面文学评论 预览 被引量:3
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作者 Srikant Nannapaneni Kannan Ramar Salim Surani 《世界糖尿病杂志:英文版(电子版)》 SCIE 2013年第6期238-244,共7页
Obstructive sleep apnea(OSA)is frequently associated with obesity and metabolic syndrome.Also frequently associated with metabolic syndrome is type 2 diabetes mellitus(T2DM).Therefore,it is common to find OSA and T2D... Obstructive sleep apnea(OSA)is frequently associated with obesity and metabolic syndrome.Also frequently associated with metabolic syndrome is type 2 diabetes mellitus(T2DM).Therefore,it is common to find OSA and T2DM together in individuals with metabolic syndrome.Additionally,both OSA and T2DM have a common pathophysiological link with development of insulin resistance.Individuals with severe insulin resistance are likely to have inadequate glycemic control.Long standing poorly controlled T2DM is associated with debilitating microvascular complications such as retinopathy,nephropathy,neuropathy and macrovascular complications such as coronary artery and cerebrovascular disease.There is extensively published literature exploring the cause-effect relationship between OSA and T2DM.In this article we provide an in-depth review of the complex pathophysiological mechanisms linking OSA to T2DM.Specifically,this review focusses on the effect of OSA on the microvascular complications of T2DM such as retinopathy,nephropathy and neuropathy.Additionally,we review the current literature on the effect of continuous positive airway pressure use in individuals with T2DM and OSA. 展开更多
关键词 SLEEP APNEA and DIABETES OBSTRUCTIVE SLEEP APNEA and DIABETIC COMPLICATIONS OBSTRUCTIVE SLEEP APNEA DIABETIC COMPLICATIONS SLEEP related breathing disorder DIABETES
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葡萄糖控制上的连续积极航线压力治疗的效果 预览 被引量:4
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作者 Salim Surani Shyam Subramanian 《世界糖尿病杂志:英文版(电子版)》 SCIE 2012年第4期65-70,共6页
Obstructive sleep apnea (OSA) and diabetes mellitus are both highly prevalent disorders.There has been a recent recognition of an association between insulin resistance and sleep apnea.Continuous positive airway pres... Obstructive sleep apnea (OSA) and diabetes mellitus are both highly prevalent disorders.There has been a recent recognition of an association between insulin resistance and sleep apnea.Continuous positive airway pressure (CPAP) has emerged as an effective therapy for treatment of OSA and has been shown to positively influence numerous pathophysiological factors that con-tribute to cardiovascular risk.There is emerging data that explores the influence of CPAP therapy,insulin sensitivity and glycemic control.In the current review,we examine this literature critically and formulate a synopsis that summarizes the current knowledge in this field. 展开更多
关键词 OBSTRUCTIVE SLEEP APNEA Continuous positive AIRWAY pressure DIABETES METABOLIC syndrome
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Pulmonary complications of hepatic diseases 预览
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作者 Salim R Surani Yamely Mendez +1 位作者 Humayun Anjum Joseph Varon 《世界胃肠病学杂志:英文版》 SCIE CAS 2016年第26期6008-6015,共8页
Severe chronic liver disease(CLD) may result from portal hypertension, hepatocellular failure or the combination of both. Some of these patients may develop pulmonary complications independent from any pulmonary patho... Severe chronic liver disease(CLD) may result from portal hypertension, hepatocellular failure or the combination of both. Some of these patients may develop pulmonary complications independent from any pulmonary pathology that they may have. Among them the hepatopulmonary syndrome(HPS), portopulmonary hypertension(PPH) and hepatic hydrothorax(HH) are described in detail in this literature review. HPS is encountered in approximately 15% to 30% of the patients and its presence is associated with increase in mortality and also requires liver transplantation in many cases. PPH has been reported among 4%-8% of the patient with CLD who have undergone liver transplantation. The HH is another entity, which has the prevalence rate of 5% to 6% and is associated in the absence of cardiopulmonary disease. These clinical syndromes occur in similar pathophysiologic environments. Most treatment modalities work as temporizing measures. The ultimate treatment of choice is liver transplant. This clinical review provides basic concepts; pathophysiology and clinical presentation that will allow the clinician to better understand these potentially life-threatening complications. This article will review up-to-date information on the pathophysiology, clinical features and the treatment of the pulmonary complications among liver disease patients. 展开更多
关键词 Portopulmonary HYPERTENSION Hepato PULMONARY syndrome CIRRHOSIS HEPATOCELLULAR failure HEPATIC HYDRO
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糖尿病,睡觉呼吸暂停,肥胖和心血管的疾病: 为什么不一起跟他们讲话? 预览
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作者 Salim R Surani 《世界糖尿病杂志:英文版(电子版)》 SCIE 2014年第3期381-384,共4页
Obesity, sleep apnea, diabetes and cardiovascular diseases are some of the most common diseases encountered by the worldwide population, with high social and economic burdens. Significant emphasis has been placed on ... Obesity, sleep apnea, diabetes and cardiovascular diseases are some of the most common diseases encountered by the worldwide population, with high social and economic burdens. Significant emphasis has been placed on obtaining blood pressure, body mass index, and placing importance on screening for signs and symptoms pointing towards cardiovascular disease. Symptoms related to sleep, or screening for sleep apnea has been overlooked by cardiac, diabetic, pulmonary and general medicine clinics despite recommendations for screening by several societies. In recent years, there is mounting data where obesity and obstructive sleep apnea sit at the epicenter and its control can lead to improvement and prevention of diabetes and cardiovascular complications. This editorial raises questions as to why obstructive sleep apnea screening should be included as yet another vital sign during patient initial inpatient or outpatient visit. 展开更多
关键词 OBSTRUCTIVE SLEEP APNEA DIABETES OBSTRUCTIVE SLEEP APNEA screening CARDIOVASCULAR COMPLICATIONS
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有静脉内的铬在的严重胰岛素抵抗治疗腐败吃惊病人 预览
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作者 Salim R Surani Iqbal Ratnani +1 位作者 Bharath Guntupalli Swetha Bopparaju 《世界糖尿病杂志:英文版(电子版)》 SCIE 2012年第9期170-173,共4页
Insulin resistance has been well documented in critically ill patients.Adequate blood sugar control has been associated with better wound healing,and better outcomes in selected patient populations.Chromium is an ess... Insulin resistance has been well documented in critically ill patients.Adequate blood sugar control has been associated with better wound healing,and better outcomes in selected patient populations.Chromium is an essential component of human diet.It is believed to affect changes in glucose uptake.Several studies have shown beneficial effects of oral chromium in diabetic patients with insulin resistance,but role of intravenous chromium infusion has not been completely evaluated.We present a case of extreme insulin resistance in a 62-year-old woman with history of diabetes who suffered a cardiac arrest and respiratory failure,leading to aspiration pneumonia and septic shock requiring greater than 7000 units of insulin over a period of 12 h which was successfully treated with intravenous chromium replacement. 展开更多
关键词 INSULIN resistance Chromium SEPTIC shock SEPSIS NUTRITION
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