Drug-induced hypersensitivity syndrome (DIHS) is a multi-system syndrome resulting from an idiosyncratic reaction to medication. While it commonly results in multi-organ involvement, particularly the liver, there are few reports of DIHS causing cerebral vasculitis and neurological deficits. We report the case of a 63-year old woman with DIHS secondary to allopurinol leading to multiple neurological deficits with magnetic resonance imaging findings consistent with a cerebral vasculitis.
The transition of people from paediatric to adult diabetes services is associated with worsening glycaemia and increased diabetes-related hospitalisation. This study compared the clinical characteristics of those with and without mental health conditions among attenders at a diabetes young adult clinic diabetes before and after changes in service delivery. Retrospective audit of 200 people with diabetes attending a Sydney public hospital over eight years corresponding to the period before (2012–2016) and after (2017–2018) restructuring of a clinic for young adults aged 16–25 years. Characteristics of those with and without mental health conditions (depression, anxiety, diabetes related distress, eating disorders), were compared. Among clinic attenders (type 1 diabetes n = 184, 83.2%), 40.5% (n = 89) had a mental health condition particularly, depression (n = 57, 64%), which was higher among Indigenous than non-Indigenous people (5.6% vs. 0.8%, p = 0.031) but similar between diabetes type. Over eight years, those with, compared with those without a mental health condition had higher haemoglobin A1c (HbA1c) at the last visit (9.4% (79 mmol/mol) vs. 8.7% (71 mmol/mol), p = 0.027), the proportion with diabetic ketoacidosis (DKA 60.7% vs. 42.7%, p = 0.009), smoking (38.4 vs. 13.6%, p = 0.009), retinopathy (9.0 vs. 2.3%, p = 0.025), multiple DKAs (28.4 vs. 16.0%, p = 0.031) were significantly higher. Having a mental health condition was associated with 2.02 (95% confidence intervals 1.1–3.7) fold increased risk of HbA1c ≥9.0% (75 mmol/mol). Changes to the clinic were not associated with improvements in mental health condition (39.0% vs. 32.4%, p = 0.096). In conclusion, we found that mental health conditions, particularly depression, are common in this population and are associated with diabetes complications. Diabetes type and clinic changes did not affect the reported mental health conditions. Additional strategies including having an in-house psychologist are required to reduce complication risks among those with mental health conditions.
Objective: Unplanned pregnancies among young women with diabetes are associated with hyperglycaemia related fetopathy. We have evaluated whether introducing a structured approach to contraception and pregnancy planning in the clinic was associated with greater uptake of contraception and reduced pregnancy rates. Methods: Repeat retrospective reviews before (2012-2016) and after (2017- 2018) the introduction of a proforma including documentation of contraception uptake, provision of educational materials, reserved waiting area space and early evening clinic slots in a tertiary hospital diabetes transition clinic (for those aged 17-25 years). Between clinic telephone support continued unchanged. Results: The pre-/post-change reviews included 43 and 48 women with type 1 diabetes (T1DM) respectively. Age at diagnosis (10-11 years), time between first and last clinic attendance (25-26 months), diabetes duration (10-12 years), CSII use (23%) and HbA1c (9.5-9.7%) on first attendance were similar. Number of clinic attendances dropped from 6.8±4.1 to 5.0±3.7 (p=0.01). HbA1c reduction since first attendance (0.1±1.8 vs. 1.2±3.0%, p<0.001) was greater, and episodes of diabetic ketoacidosis (55.8% vs. 14.6% p<0.001) and severe hypoglycaemia (18.6% vs. 2.1% 0.01) were less, in the ‘after’ group. Metformin use increased from 2.3% to 18.4% (p<0.05). Use of CGMS increased from 0% to 39.6% (p<0.001). Documented advice on contraception increased from 0% to 95.8% (p<0.001). Use of contraception increased from 25.6% to 43.8% (p<0.001: implants 7 to 15%, OCPs 16 to 27%). Prior/current pregnancy rates were less (18.6% vs. 8.3% respectively; p=0.03). Conclusions: Introduction of more proactive approaches to diabetes management including contraception awareness and advice were associated with improved glycaemia and a reduced risk of pregnancy in younger women with T1DM. Disclosure D. Simmons: Speaker's Bureau; Self; Sanofi-Aventis. Other Relationship; Self; Medtronic. U.L. Osuagwu: None. A. Gupta: None. M. Ratnaweera: None.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.