Background: Denosumab is a monoclonal antibody approved for the treat-ment of postmenopausal osteoporosis. The withdrawal of denosumab produc-es an abrupt loss of bone mineral density and may cause multiple vertebral fractures (MVF). Objective: To study the clinical, biochemical and densitometric characteristics in a large series of postmenopausal women who suffered MVF after deno-sumab withdrawal. Likewise, we try to identify those factors related to the presence of a greater number of vertebral fractures (VF). Patients and Methods: 56 patients (54 women) who suffered MVF after re-ceiving denosumab at least for 3 consecutive years and abruptly suspended it. A clinical examination was carried out. Biochemical bone remodeling markers (BBRM) and bone densitometry at the lumbar spine and proximal femur were measured. VF were diagnosed by MRI, X-ray or both at dorsal and lumbar spine. Results: 56 patients presented a total of 192 VF. 41 patients (73.2%) had not previously suffered VF. After discontinuation of the drug, a statistically signifi-cant increase in the BBRM was observed. In the multivariate analysis, only the time that denosumab was previously received was associated with the pres-ence of a greater number of VF (p = 0.04). Conclusions: We present the series with the largest number of patients col-lected to date. 56 patients accumulated 192 new VF. After the suspension of denosumab and the production of MVF, an increase in the serum values of the BBRM. The time of denosumab use was the only parameter associated with a greater number of fractures.
Background: Overweight, obesity and lack of sleep quality as inflammatory states are the common problems among college students and the Association of Dietary Inflammatory Index (DII) with these problems among this population is unknown. We aimed to evaluate the relationship of the DII with obesity and sleep quality among Iranian female students. Methods: The present cross-sectional study was conducted in 249 female college students. The Dietary Inflammatory Index (DII) was calculated using a valid and reliable 147-item food frequency questionnaire (FFQ). To assess sleep quality, Pittsburgh Sleep Quality Index (PSQI) was used. Odds Ratio (OR) and 95% Confidence Intervals (CIs) were estimated for anthropometric indices and sleep quality according to DII score. Linear regression was used to estimate the relationship between DII score with sleep and anthropometric indices. Results: There was a significant association evident between DII and sleep quality(> 5 is considered as poor quality of sleep); i.e., the odds ratios between DII quartile 2 vs 1 (unadjusted model: OR= 0.33 (CI: 0.14-0.74), P for trend =0.002; model 1: the fully adjusted OR= 0.31(CI: 0.12-0.78), P for trend = 0.005; model 2:OR=0.30 (CI:0.12-0.78), P for trend = 0.005) to quartile 4(unadjusted model: OR= 1.13(CI: 0.45-2.80); model 1: OR= 1.11(CI: 0.44-2.79); model 2:OR=1.13(CI:0.44-2.87), P for trend = 0.005). Also, odds ratios increased significantly from quartile 2 to quartile 4 in all models for DII and sleep quality. According to the continuous score of DII, there was a significant positive association between DII and sleep quality in all 3 models: unadjusted, model 1, and model 2 (OR= 1.21 (CI: 1.05-1.40), OR= 1.21 (CI: 1.03-1.43), and OR= 1.22 (CI: 1.03-1.44), respectively. Conclusions: In this study, after removing the effect of confounding factors, participants in the highest quartile of DII score had significantly higher PSQI global score.
Background: We investigated the interaction between PPAR-γ Pro12Ala polymorphism and Healthy Eating Index (HEI), Dietary Quality Index-International (DQI-I) and Dietary Phytochemical Index (DPI) on Cardiovascular Disease (CVD) risk factors in patients with type 2 diabetes mellitus (T2DM). Methods: This cross-sectional study was conducted on 393 diabetic patients. PPAR-γ Pro12Ala was genotyped by PCR-RFLP method. Biochemical markers including total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride (TG), superoxide dismutase (SOD), C-reactive protein (CRP), total antioxidant capacity (TAC), pentraxin-3 (PTX3), isoprostaneF2α (PGF2α) were measured by standard protocol. FFQ was used for dietary indices (DQI, DPI, HEI) calculation. Results: There was no significant relationship between PPAR-γ Pro12Ala polymorphism and CVD risk factors. The rs1801282-DQI interactions were significant on WC (P= 0.01). Thus, C-allele carriers in the higher tertile of DQI had higher WC compared to GG homozygous. Further, an interaction was observed between PPAR rs1801282 polymorphism and DQI on serum IL-18 level (P = 0.03). Besides, a significant rs1801282-DPI interaction was shown on HDL concentration (P Interaction= 0.04), G allele carriers who were in the highest tertile of DPI, had lower HDL. Moreover, there were significant rs1801282-HEI interactions on ghrelin (P= 0.04) in the crude model and serum leptin (P = 0.02) in the adjusted model. Individuals with (CC, CG) genotypes in the higher tertile of HEI, had lower leptin and ghrelin concentration. Conclusions: Higher dietary indices (DQI, DPI, HEI) may affect the relationship between PPAR-γ Pro12Ala polymorphism and waist circumference and ghrelin, leptin, HDL-c, IL-18 concentration in patients with T2DM. To date, studies on this polymorphism have been shown that this gene can interact with diabetes and different nutritional factors. For the first time, this study provides information on the interaction of dietary indices (DQI, DPI, HEI) and PPAR-γ gene which is functionally effective in nutrient metabolism.
Aims: Non-small-cell lung cancer (NSCLC) is the most common clinical lung cancer. Polymorphonuclear-myeloid derived suppressor cells (PMN-MDSCs), which are the major population of MDSCs, are involved in NSCLC progression. Recently, it was found that lectin-type oxidized LDL receptor 1 (LOX-1) could identify humsn PMN-MDSCs. However, the role of CD15+LOX-1+ PMN-MDSCs in NSCLC early diagnosis has not been revealed. Here, we tried to confirm the application of the newly-identified CD15+LOX-1+ PMN-MDSCs in the early diagnosis of NSCLC. Methods: Flow cytometry (FCM) was used to detect the proportion of CD15+LOX-1+ PMN-MDSCs in the peripheral blood (PB) of healthy controls (HC) and NSCLC patients. The correlation of CD15+LOX-1+ PMN-MDSC frequency with levels of cytokeratin 19-fragments (CYFRA21-1), carcinoembryonic antigen (CEA), and carbohydrate antigen 125 (CA125) was analyzed. Receiver operating characteristic (ROC) curve was used to estimate the diagnostic efficacy of CD15+LOX-1+ PMN-MDSCs for NSCLC. Additionally, the association of CD15+LOX-1+ PMN-MDSC frequency with NSCLC prognosis/recurrence after surgery was explored. Results: The proportion of CD15+LOX-1+ PMN-MDSCs increased in PB of NSCLC patients. CD15+LOX-1+ PMN-MDSC proportion was positively correlated with levels of CEA and CYFRA21-1. The area under the ROC curve (AUC) of PMN-MDSC percentage was higher than CYFRA21-1, CEA and CA125. The proportion of CD15+LOX-1+ PMN-MDSCs decreased in patients after surgery. The frequency of CD15+LOX-1+ PMN-MDSCs was lower in NSCLC patients without recurrence compared to those with recurrence after surgery. Conclusions: Circulating CD15+LOX-1+ PMN-MDSCs are a potential diagnostic marker for NSCLC, and are associated with NSCLC prognosis and recurrence after surgery.
Aim Extracorporeal shockwave therapy (ESWT) is known as one of the most effective treatment methods in plantar fasciitis (PF). Low-dye taping, which is the most preferred method of banding treatments, provides an analgesic effect by correcting biomechanics. It was aimed to compare the efficacy of adjuvant low-dye kinesio-taping (KT), sham-taping, or extracorporeal shockwave therapy (ESWT) alone in plantar fasciitis (PF). Methods In this double-blind, sham-controlled study, forty-five patients with PF were randomized to 3-group (Group 1: ESWT plus low-dye KT, n=15; Group 2: ESWT plus Sham-taping, n=15; and Group 3: ESWT only, n=15) five-session ESWT were administrated. KT was performed and changed every 1-week for the ESWT sessions in Groups 1 and 2. The main outcome measures were the visual analog scale (VAS) change, the heel tenderness index (HTI), foot function index (FFI). The patients were evaluated at the beginning and end of the treatment and the 4-week follow-up. Results The demographic characteristics and baseline outcomes between groups were similar (p>0.05). VAS and HTI changes were observed in all three groups, there was no difference between groups. Repeated-measures ANOVA showed a significant interaction between the time and the groups in FFI-total (F3.919= 2.607; p=.043). At the 4-week follow-up, when Groups 1 and 2 were evaluated, the lower FFI-total, FFI-disability, and FFI-activity limitation were statistically significant in Group 1 (p=0.027; p=0.026; p=0.029, respectively). When Group 1 and 3 were compared, the decrease in FFI-pain and FFI-activity limitation were significant in Group 1 (p=0.042; p=0.035, respectively). Conclusions Low-dye KT, in addition to ESWT, is more effective than sham-taping and ESWT in pain relief and foot function improvement due to PF at a 4-week follow-up.
Purpose: To investigate the prediction values of the preoperative NLR, LMR, PLR, MPV, RDW for recurrence and progression of patients with non-muscle invasive bladder cancer (NMIBC). Methods: In this prospective study, 94 consecutive patients, newly diagnosed with NMIBC between July 2017 - August 2018 were included. The blood samples were collected from patients before transurethral resection of bladder tumor (TURB) and NLR, LMR, PLR, RDW, MPV values were calculated. The effect of these preoperative inflammatory parameters and other clinicopathological parameters on recurrence and progression rates were evaluated. Kaplan-Meier and multivariate Cox regression analyses were performed to identify significant prognostic variables. Results: The mean follow-up was 11 ± 6.4 months. Recurrence was observed in 35.1% and progression was detected in 7.4% of the patients. Neutrophil-lymphocyte ratio was statistically significantly associated with both recurrence (p = 0.01) and progression (p = 0.035) whereas lymphocyte-monocyte ratio was only associated with recurrence (p = 0.038). In the survival analyses, the relationship between recurrence and LMR was confirmed in both univariate (p = 0.021) and multivariate (p = 0.022) analyses. The relationship between NLR and recurrence was confirmed in univariate analysis (p = 0.019), however in multivariate analysis was found to be statistically insignificant (p = 0.051). Conclusions: Lymphocyte-monocyte ratio might be an easy obtainable, non-invasive and cost-effective method for predicting recurrence of disease in patients with non-muscle invasive bladder cancer.
Background: The global cases of Covid-19 increasing day by day. On Nov. 25, 2020, a total of 59,850,910 cases reported globally with a 1,411,216 global death. In India, total cases in the country now stand at 91,77,841 including 86,04,955 recoveries and 4,38,667 active cases as of Nov. 24, 2020, as per data issued by ICMR. A new generation of voice/audio analysis application which can tell whether the person is suffering from COVID-19 or not. Aims: To describe how to establish a new generation of voice/audio analysis applications to identify the suspected covid-19 hidden cases in hotspot areas with the help of an audio sample of the general public. Materials & Methods: The different patents and data available as literature on the internet are evaluated to make a new generation of voice/audio analysis application with the help of an audio sample of the general public. Results: The collection of the audio sample will be done from the already suffered covid-19 patients in (.Wave files) personally or through phone calls. The audio samples like the sound of the cough, the pattern of breathing, respiration rate, and way of speech will be recorded. The parameters will be evaluated for loudness, articulation, tempo, rhythm, melody, and timbre. The analysis and interpretation of the parameters can be made through machine learning and artificial intelligence to detect corona cases with an audio sample. Discussion: The voice/audio application current project can be merged with a mobile App called “Aarogya Setu” by Govt. of India. The project can be implemented in the high-risk area of Covid-19 in the country. Conclusion: This new method of detecting cases will decrease the workload in the covid-19 laboratory.
Introduction: The coexistence of diabetes mellitus (DM) and hypertension (HTN) worsen clinical outcomes and contribute to increased morbidity and mortality. Objective: This study aims to analyze the length of stay and healthcare costs by calculating the direct and indirect costs of diabetes with co-existing hypertension in North India. Methods: A prospective observational study was conducted at the medicine department of the three different hospitals. Results: The patients’ mean age was found to be (M=53.8, SD=11.5) years. Out of 1914 patients, 53.65% were found female. Our study revealed that the median cost of medical supplies and equipment was found to be 21.2 $. The median cost of dialysis was found at 47.5 $; the median cost of hospitalization was found to be 142.6 $. The treatment’s median direct cost was 188.5 $, followed by the overall median cost of 295.6 $. The maximum overall cost of treatment was observed at 603.9 $. It was observed that that maximum LOS was found to be 14 days for patients having BPS between 140 to 159 mmHg and BPD between 110- 119 mmHg, and minimum LOS was found to be 3.5 days. Conclusion: The present study highlighted that diabetes co-existing hypertension poses a high economic burden on patients. This study explored that highly significant result for BPS, BPD, FBS, and HbA1c, whereas the significant results were obtained when RBS is compared with LOS and treatment costs. Our study concluded that a mean difference of 9.24 $ in patients having FBS: 261-290 mg/dl and > 290 mg/dL. The LOS increases 6.57 days for patients with BPS between 140-159 mmHg compared to BPS between 180 -above 209 mmHg, which lower treatment costs by -21.31$. Keywords: Diabetes, Hypertension, length of stay, cost of treatment, direct medical cost, indirect medical cost
Objective: It was aimed to compare the breastfeeding status and healthy life style changes, eating behaviors, attitudes, and orthorectic tendencies of mothers. Materials and Methods: All volunteered mothers who have a child between the ages of 0 and 2 were included in this cross-sectional study. 514 individuals were included. Five parted questionnaire and “ORTO-11” test and “Eating Attitude Test” was used. Results: A statistically significant relationship was found between breastfeeding status and working status and professions of mothers. Mothers who did not breastfeed, skipped main meal more frequently, and smoking and occasional alcohol consumption was higher. The mean score of the participants on the ORTO-11 scale was 25.09 ± 4.80, EAT-40 scale mean score was 18.80 ± 10.42. High risk in eating attitudes was found in 12.0% of all participants. It was observed that mothers who did not breastfeed were mostly in high risk group in terms of eating attitude. Conclusion: Mothers who did not breastfeed were mostly in high risk group in terms of eating attitude compared to breastfeeding mothers. It is of great importance that healthcare professionals organize trainings for increasing the general level of knowledge of mothers and provide healthy living and breastfeeding counseling.
Background: Although mostly common adverse events associated to dry needling can be considered minor, serious adverse events including induced pneumothorax cannot be excluded, and safety instructions for reducing the risk of pleura puncture are needed. Objective: To investigate if anthropometric features can predict the rhomboid major muscle and pleura depth in a sample of healthy subjects to avoid the risk of pneumothorax during dry needling. Methods: A diagnostic study was conducted on 59 healthy subjects (52.5 % male) involving a total of 236 measurements (both sides in maximum inspiration and expiration), to calculate the accuracy of a prediction model for both pleura and rhomboid depth, as assessed with ultrasound imaging, based on sex, age, height, weight, body mass index (BMI), breathing and chest circumference. A correlation matrix and a multiple linear regression analyses were used to detect those variables contributing significantly to the variance in both locations. Results: Men showed greater height, weight, BMI, thorax circumference and skin-to-rhomboid, rhomboid-to-pleura y skin-to-pleura distances (p<0.001). Sex, BMI, and thorax circumference explained 51.5% of the variance of the rhomboid (p<0.001) and 69.7% of pleura (p<0.001) depth limit. In general, inserting a maximum length of 19 mm is recommended to reach the deep limit of rhomboid major decreasing the risk of passing through the pleura. Conclusion: This study identified that gender, BMI and thorax circumference can predict both rhomboid and pleura depth, as assessed with ultrasonography, in healthy subjects. Our findings could assist clinicians in the needle length election for avoiding the risk of induced pneumothorax during dry needling.
Objective: The main objective of this prospective and observational study is to investigate the effect of preoperative hospitalization period on early postoperative cognitive dysfunction (POCD) development in patients undergoing total hip replacement surgery under regional anesthesia. Materials and Methods: Between November 2013 to September 2014, 64 patients were enrolled the study. Test scores were obtained on the initial admission day (MMT1), 24 hours prior to surgery (MMT2) and 24 hours after the surgery (MMT3). Patients were divided into two groups according to MMT scores as “no cognitive dysfunction” (Group 1) and “cognitive dysfunction” (Group 2). Differences between groups were evaluated statistically. Statistical significance level was set as p<0.05 in a 95% confidential interval. Results: POCD incidence rate was calculated as 43.8% in all patients. Preoperative hospitalization duration was significantly higher in patients with POCD when compared to patients without POCD (p<0,001). The factors which affect POCD development were found to be advanced age (p<0,001), high ASA scores (p=0,004), presence of comorbid disease (p=0,025), duration of operation (p=0,018) and decreased postoperative hematocrit levels (p=0,014). Conclusion: In this study, we observed patients with early POCD had a relatively longer pre-operative hospitalization period when compared to patients without POCD. We consider that the prolonged preoperative hospitalization periods may contribute to increased POCD incidence rates in patients with risk factors.
Background: Patient safety represents a global issue which leads to potentially avoidable morbidity and mortality. This study aimed to determine the inter-professional differences in patient safety culture in a tertiary university hospital. Method: A cross-sectional study using the Safety Attitude Questionnaire (SAQ) self-administered electronically in the English and Malay languages to evaluate safety culture domains. A positive percentage agreement score of 60% was considered satisfactory. Comparisons were made between clinicians, nurses, allied health professionals, ward attendants and support staff. Results: Of 6562 potential respondents, 5724 (80.4%) completed the questionnaire; 3930 (74.5%) women, 2263 (42.9%) nurses, and 1812 (34.2%) had 6-10 years of working experience. The mean overall positive percentage agreement scores were 66.2 (range=31.1 to 84.7%), with job satisfaction (72.3±21.9%) and stress recognition (58.3±25.6%) representing the highest and lowest mean domain scores respectively. Discussion: Differences were observed between all five job categories. Linear regression analyses revealed that the other four job categories scored lower in teamwork, safety culture, job satisfaction, and working conditions compared to nurses. Conclusions: The overall mean SAQ score was above the satisfactory level, with unsatisfactory percentage agreement scores in the stress recognition domain. Interventions to improve patient safety culture should be developed, focusing on stress management.
Aim: This study evaluated the effect of intracavitary levobupivacaine infusion diluted with locally applied isotonic solution for pain control in cystoscopy. Methods: Included in this study are 100 patients who had previously undergone transurethral tumor resection for bladder tumor and were followed up by cystoscopy. The patients were randomized into five groups (n = 20). In the first, second, third, and fourth groups, 4, 6, 8, and 10 mL of levobupivacaine HCl (5.0 mg/mL) were mixed with 26, 24, 22, and 20 mL of isotonic solution, respectively. Hence, the total mixture was 30 mL for each group. The fifth group was the control group. In this group, the standard method commonly used in most clinics was utilized. That is, a gel containing Cathejell-2% lidocaine (25 mg lidocaine) was applied. Cystoscopic interventions were performed with a 17.5 Fr rigid cystoscope and 0°, 30°, and 70° lens. During cystoscopy and 30 min later, the pain status of patients was assessed using the Visual Analogue Scale (VAS), and patient satisfaction was questioned. Results: The mean VAS score during and after the cystoscopy procedure was significantly lower in the levobupivacaine groups compared to the lidocaine group. In addition, patient satisfaction in the levobupivacaine groups was significantly higher than in the lidocaine group. No drug-related side-effects were observed in all groups. Conclusion: Thus, levobupivacaine is a more effective drug than lidocaine alone to control pain during cystoscopy. The use of levobupivacaine is recommended to prevent possible complications of general anesthesia by eliminating the need for the aforementioned as well as its cost-saving advantage.
Background: Mast cells play a critical role in tumor-associated immune pathways. We aimed to determine whether the urinary mast cell mediators predict the immune response in patients with non-muscle invasive bladder cancer (NMIBC) treated with Bacillus Calmette-Guérin (BCG) immunotherapy. Methods: Nineteen patients who have received immunotherapy due to NMIBC and 19 healthy participants were enrolled. Urine samples were collected to assay N-methylhistamine, histamine, and tryptase levels immediately before the first BCG instillation, immediately after the third and sixth instillations, and four weeks after the sixth instillation in patients with NMIBC and at a single visit in healthy participants. Cystoscopic examinations were performed on the patient with NMIBC at three-month intervals for two years. The changes in urinary markers due to BCC response, BCG instillation, and the presence of NMIBC were assessed. Results: The average age was 56.1 ± 10.5 years in patients with NMIBC. Fourteen patients had high-grade Ta tumors, and 5 had high-grade T1 tumors. While 12 patients responded, 6 presented with recurrence and 1 with progression. There was no correlation between the levels of mast cell mediators and BCG response. The N-methylhistamine and histamine levels were increased significantly with the onset of immunotherapy, and N-methylhistamine levels were significantly decreased when immunotherapy was terminated. Pre-BCG estimated marginal means of N-methylhistamine were significantly higher in patients with NMIBC than healthy participants. Conclusions: Our study is the first study to identify the changes in mast cell mediators with the onset of immunotherapy and with the presence of bladder cancer. However, these mediators were not found to predict the patients’ response to immunotherapy.
Objectives: To compare pain, quality of life(QoL), sexual function and lower urinary tract symptoms(LUTS) between rigid(RC) and flexible cystoscopy(FC). Methods: Forty-one patients who were planned control cystoscopies were enrolled the study. At the first cystoscopy, 20 patients(Group 1) and other 21 patients(Group 2) were performed by using flexible(15,5Fr) and rigid cystoscope(15,5Fr), respectively. At the second cystoscopies, the patients in group 1 and group 2 were performed by using rigid and flexible cystosacope, respectively. In all the patients, pain was measured with visual pain scale(VPS) shortly after cystoscopy. Also SF, QoL and LUTS were assessed by using IIEF, SF-36 and MLUTS forms, respectively. Results: While 22 of the patients preferred FC, the other 19 preferred RC(p>0,05). There were no statistically differences between VPS, IIEF, SF-36 and MLUTS scores of the two groups. In multivariate analysis regarding quality of life, although sexual function, pain and cystoscopy type did not affect QoL, voiding symptoms affected independently QoL. After the both cystoscopy type, IIEF, SF-36 and MLUTS scores did not change statistically. Conclusion: The results showed that the effects on pain, sexual function, QoL and LUTS of RC and FC were similar. In general, cystoscopy did not affect negatively on QoL, sexual function and LUTS of the patients.
Background: Telehealth is delivering health care services remote from health-care facilities using telecommunications. Egypt is aiming for Universal Health Coverage; this increases the demand of telehealth in routine health services. Objective: to measure the awareness of telehealth health care workers of primary health care units and to evaluate the effect of an orientation program on primary health care workers’ awareness and acceptance of application of telehealth. Methodology: This was an intervention study among health care workers. A self-administrated valid questionnaire for health care workers was designed, the questionnaire consists of different domains of knowledge in addition to advantages, disadvantages, security and necessity perceptions. Each domain consists of Likert scale questions of 5 points. The questions were scored as the worst answer (1) and the best (5). A total of 109 questionnaires were filled by participants who spent at least 6 months in primary health care units. Then the health care workers were attended an orientation program and the questionnaire was re-filled once more. A total of 104 was recollected. Ethical issues were considered. Results: 50.5% of health care workers were aware of telehealth; 66.7% of health care workers with master’s degree were aware of telehealth in comparison to 31.8% among those with a diploma, 64.3% of physicians were aware of telehealth while 9.6% of nurses were aware. The score of knowledge and attitude increased from 130±23.538 to 156.49±18.456 after the educational program. Conclusion: Half of health care workers were aware of telehealth; the orientation improved the Healthcare Workers’ knowledge and attitude.
Background: Levofloxacin and ciprofloxacin are more commonly used among fluoroquinolone class and the question of cardiac safety and glucose hemostasis of this class has been raised. Objective: To compare intravenous levofloxacin and ciprofloxacin regarding their risk on QTc prolongation and dysglycemia in diabetic and non-diabetic patients. Methods: A randomized prospective study at Beni-Suef university hospital was conducted on 200 adult patients over 6 months. The patients received intravenous levofloxacin 750mg once daily or ciprofloxacin 400mg twice daily. Electrocardiogram and fasting blood glucose were obtained from each patient before starting antibiotic, 24 hours, 72 hours after the first dose and 72 hours after antibiotics cessation. Results: The results of the current study showed the relative risk for QTc prolongation with levofloxacin was more than ciprofloxacin by about 4 and 1.5 in diabetic and non-diabetic patients, respectively. The relative risk for dysglycemia with levofloxacin was 2.28 and 1.39 times more than ciprofloxacin in diabetic and non-diabetic patients, respectively. Conclusion: The present study showed that the risk for QTc prolongation and hyperglycemia was greater with levofloxacin than ciprofloxacin in diabetic and non-diabetic patients. In addition, the risk for hypoglycemia was greater with levofloxacin than ciprofloxacin in non-diabetic patients.