Background. Screening inpatients for diabetes mellitus may be a good opportunity to detect undiagnosed cases and several studies have demonstrated the feasibility and usefulness of this practice. HbA1c has been suggested as the method of choice due to the effects of acute illness on glucose. The aim of this study was to evaluate a screening protocol based on HbA1c to identify inpatients with undiagnosed diabetes mellitus in an internal medicine department. Methods. We conducted a prospective study of all admissions in the internal medicine department of a 412-bed community hospital in Greece during a 6-month period. Candidates for screening based on the American Diabetes Association’s recommendations were screened with HbA1c. Patients with very poor health status and patients with conditions that may interfere with HbA1c measurement or interpretation were excluded. Results. Of 463 patients (median age 74) only a small proportion (14.9%) were candidates for screening with HbA1c. Known diabetes mellitus, a low admission glucose, severe anemia or blood loss and poor health status were the most common reasons of exclusion. Among the 55 screened patients, 7 had diabetes (based on HbA1c ≥ 6.5%). However, in only 1 of them HbA1c was above target considering the patients’ health status. Categorical agreement (no diabetes, prediabetes, diabetes) between morning glucose and HbA1c was low. However, the concordance between a morning glucose < 125 mg/dl and HbA1c < 6.5% was > 90%. Conclusions. In settings similar to ours (very elderly patients, high rate of conditions that confound the use of HbA1c and high rate of patients with poor health status), untargeted screening of inpatients with HbA1c is unlikely to be cost-effective. A morning glucose during hospitalization may be a better first step for screening.

A high level of suspicion is required by physicians to recognize that fatigue, nausea, and vomiting may represent early signs of thiamine deficiency in patients at risk for nutritional deficiencies. Empirical thiamine supplementation may be reasonable in such cases.

Video 1 Iatrogenic colonic perforation closure with an over-the-scope clip applied with a gastroscope. ▶ Fig. 1 A defect in the sigmoid colon.▶ Fig. 2 The over-the-scope clip in place.Nicolaou Pinelopi et al. Iatrogenic colonic perforation … Endoscopy | © 2022. The Author(s).

Background IgA glomerulonephritis may present with hematuria, flank pain, and fever. This clinical presentation may be easily confused with acute pyelonephritis. Case Report We present the case of a 25-year-old female with a typical clinical presentation for acute pyelonephritis (high fever, left flank pain, left costovertebral angle tenderness, hematuria, elevated inflammatory markers, and a hypoenhancing region in the left kidney on contrast-enhanced computed tomography). However, urine and blood cultures were both negative, the serum creatinine was elevated, and the urinalysis revealed significant proteinuria and dysmorphic red blood cells. A kidney biopsy confirmed a diagnosis of IgA nephropathy. She was treated with a combination of lisinopril and methylprednisolone, with good response. Conclusion Gross hematuria, especially in the absence of pyuria or bacteriuria, should raise the suspicion for underlying IgA nephropathy, even if the rest of the clinical presentation is typical for a urinary tract infection. The presence of significant proteinuria, red blood cell casts, and dysmorphic red blood cells are useful clues suggesting glomerular disease.

Background Crohn’s disease can involve any segment of the gastrointestinal tract, with terminal ileum being the most common affected part. The wireless or video capsule endoscopy (VCE) is a valuable diagnostic tool in detecting lesions in the small bowel beyond terminal ileum. The findings of the procedure in combination with other clinical, endoscopic and laboratory factors can determine the therapeutic plan. Herein, we analyzed the findings of VCE in patients with suspicious or definite Crohn’s disease, and assessed its contribution to the therapeutic plan. Methods We evaluated these parameters in a retrospective analysis of 127 patients who underwent wireless capsule endoscopy in our department since June 2020. Results 49/127 patients (51% male) were included in the study. The mean age was 40.24 years (SD ±14.30, IQR= 73–15). The majority of them (93.9 %) presented with a newly diagnosed Crohn’s disease or terminal ileitis. The VCE examination was performed to detect any other lesions in the small bowel. 6.1% had chronic diarrhea without endoscopic findings. 57.1% had findings of Crohn’s disease across the entire small bowel, 26.6% had sparse ulcers in the terminal ileum. In 12.2% multiple aphthous ulcers and edema were found in the terminal ileum and 4.1% had no findings. After VCE examination, initiation of treatment was considered in 57.1%. Magnetic enterography (MRE) was performed in 24.5% of the patients. VCE showed more extended lesions in the small bowel compared to MRE which showed non-specific terminal ileitis up to 15 cm in all patients. Conclusion In patients with mild terminal ileitis wireless capsule endoscopy reveals extended lesions in the small bowel leading to adjustments in the therapeutic plan. In patients with newly diagnosed or suspected Crohn’s disease, VCE can contribute to the assessment of the severity and location of the lesions as well as to the therapeutic plan.