Significance of Orlistat in management of dyslipidemia, systolic blood pressure and body mass index

OBJECTIVE

The current study intends to find out the efficacy of Orlistat in the management of hyperlipidemia, Systolic Blood Pressure (SBP) and Body Mass Index (BMI).

MATERIALS AND METHODS

This retrospective study has evaluated the lipid profiles of the patients, who have been using metformin therapy for Type 2 diabetes. The study has obtained data regarding the parameters like triglyceride, Total cholesterol (TC), LDL cholesterol, HDL cholesterol and LDL/HDL ratio, systolic blood pressure and Body Mass Index (BMI). Random distribution of patients was done into placebo and Orlistat groups. The placebo group received only metformin, and patients in the Orlistat group received Orlistat along with metformin. After 24 weeks, the follow-up study was done, and statistical analysis was conducted.

RESULTS

The study found that the Orlistat group has significant improvement (p<0.05) more improvement in LDL cholesterol, HDL cholesterol, Total cholesterol, LDL/HDL Ratio and Triglycerides, while BMI and systolic blood pressure did not show a significant difference between placebo and Orlistat group.

CONCLUSIONS

This study has concluded that Orlistat can be used for significant improvement in lipid profile. The study also found that Orlistat may not have a significant effect on reducing BMI and blood pressure without adequate lifestyle modification.

Impact of left ventricular ejection fraction on hospital and long term outcomes after coronary artery bypass graft surgery

Background

Coronary artery bypass surgery is recommended for patients with extensive coronary artery disease and severely impaired left ventricular ejection fraction (LVEF). Short term clinical outcomes improved due to advanced surgical techniques and perioperative management.

Objective

To study the impact of pre-operative left ventricular ejection fraction (LV EF) on clinical outcomes during postoperative hospitalization and for 5 years follow up.

Methods

The study was a retrospective analysis of patients underwent CABG at our tertiary care hospital between January 2016 and August 2020.The primary outcome was mortality and the secondary outcomes included acute cerebrovascular stroke, length of hospitalization, subsequent revascularization, and heart failure.

Results

The study included 410 patients with a median age of 60 (55–68) years, a hospital mortality of 2.7%, postoperative stroke of 7.6%, acute kidney injury (AKI) of 25.6% and new need dialysis of 5.9%. The patients were divided into 4 groups: 75 (18.3%) patients had LV EF less than 35%, 88 (21.5%) had LV EF 35–45%, 106 (25.9%) had LV EF 45–55% and 141 (34.4%) had LV EF more than 55% with significant differences in frequencies of chronic kidney disease (29.3% vs. 40.9% vs. 23.6% vs. 24.1%, p=0.026), prior cerebral stroke (9.3% vs. 11.4% vs. 8.5% vs. 1.4%, p=0.015), Peripheral vascular disease (8% vs. 18.2% vs. 4.7% vs. 12.1%, p=0.019) respectively. The hospital mortality occurred in (6.7% vs. 0% vs. 0.9% vs. 3.5%, p=0.03), acute cerebrovascular stroke occurred in (14.7% vs. 6.8% vs. 3.8% vs. 7.1%, p=0.031), AKI occurred in (36% vs. 43.2% vs. 17.9% vs. 14.9%, p&lt;0.001), new dialysis was used in (12% vs. 5.7% vs. 1.9% vs. 5.7%, p=0.04), ICU stay was [5 (3–7) vs. 4 (3–11) vs. 4 (3–5) vs. 3 (2–5), p&lt;0.001], post ICU stay was [6 (3–10) vs. 5 (4–8) vs. 4 (3–6) vs. 4 (3–6), p=0.009] in patients with LV EF &lt;35%, LV EF 35–45%, LV EF 45–55% and LV EF &gt;55% respectively. Mortality during follow up occurred in (20% vs. 4.5% vs. 2.8% vs.4.3%, p&lt;0.001), stroke occurred in (8% vs. 4.5% vs.0.9 5% vs. 2.8%, p=0.031), revascularization was done in (2.7% vs. 23.9% vs. 18.9% vs. 12.8%, p=0.009) and readmission with heart failure occurred in (52% vs. 34.1% vs. 10.4% vs. 4.3%, p&lt;0.001) in patients with LV EF &lt;35%, LV EF 35–45%, LV EF 45–55% and LV EF &gt;55% respectively.

Conclusion

Reduced LV EF was associated with increased hospital mortality, frequent morbidities, and prolonged hospitalization after CABG with higher composite rate of death, stroke, heart failure at 5 years compared with normal or mildly reduced LV EF.

Funding Acknowledgement

Type of funding sources: None.

Impact of left ventricular ejection fraction on hospital and long term outcomes after coronary artery bypass graft surgery

Background

Coronary artery bypass surgery is recommended for patients with extensive coronary artery disease and severely impaired left ventricular ejection fraction (LVEF). Short term clinical outcomes improved due to advanced surgical techniques and perioperative management.

Objective

To study the impact of pre-operative left ventricular ejection fraction (LV EF) on clinical outcomes during postoperative hospitalization and for 5 years follow up.

Methods

The study was a retrospective analysis of patients underwent CABG at our tertiary care hospital between January 2016 and August 2020.The primary outcome was mortality and the secondary outcomes included acute cerebrovascular stroke, length of hospitalization, subsequent revascularization, and heart failure.

Results

The study included 410 patients with a median age of 60 (55–68) years, a hospital mortality of 2.7%, postoperative stroke of 7.6%, acute kidney injury (AKI) of 25.6% and new need dialysis of 5.9%. The patients were divided into 4 groups: 75 (18.3%) patients had LV EF less than 35%, 88 (21.5%) had LV EF 35–45%, 106 (25.9%) had LV EF 45–55% and 141 (34.4%) had LV EF more than 55% with significant differences in frequencies of chronic kidney disease (29.3% vs. 40.9% vs. 23.6% vs. 24.1%, p=0.026), prior cerebral stroke (9.3% vs. 11.4% vs. 8.5% vs. 1.4%, p=0.015), Peripheral vascular disease (8% vs. 18.2% vs. 4.7% vs. 12.1%, p=0.019) respectively. The hospital mortality occurred in (6.7% vs. 0% vs. 0.9% vs. 3.5%, p=0.03), acute cerebrovascular stroke occurred in (14.7% vs. 6.8% vs. 3.8% vs. 7.1%, p=0.031), AKI occurred in (36% vs. 43.2% vs. 17.9% vs. 14.9%, p&lt;0.001), new dialysis was used in (12% vs. 5.7% vs. 1.9% vs. 5.7%, p=0.04), ICU stay was [5 (3–7) vs. 4 (3–11) vs. 4 (3–5) vs. 3 (2–5), p&lt;0.001], post ICU stay was [6 (3–10) vs. 5 (4–8) vs. 4 (3–6) vs. 4 (3–6), p=0.009] in patients with LV EF &lt;35%, LV EF 35–45%, LV EF 45–55% and LV EF &gt;55% respectively. Mortality during follow up occurred in (20% vs. 4.5% vs. 2.8% vs.4.3%, p&lt;0.001), stroke occurred in (8% vs. 4.5% vs.0.9 5% vs. 2.8%, p=0.031), revascularization was done in (2.7% vs. 23.9% vs. 18.9% vs. 12.8%, p=0.009) and readmission with heart failure occurred in (52% vs. 34.1% vs. 10.4% vs. 4.3%, p&lt;0.001) in patients with LV EF &lt;35%, LV EF 35–45%, LV EF 45–55% and LV EF &gt;55% respectively.

Conclusion

Reduced LV EF was associated with increased hospital mortality, frequent morbidities, and prolonged hospitalization after CABG with higher composite rate of death, stroke, heart failure at 5 years compared with normal or mildly reduced LV EF.

Funding Acknowledgement

Type of funding sources: None.

Prevalence of cardiovascular disease and osteoarthritis in obese population of Hail region, Saudi Arabia

OBJECTIVE

The aim of the study was to analyze if there was a link between chronic diseases, like cardiovascular disease (CVD) and osteoarthritis (OA), and obesity in the population of Saudi Arabia's Hail region.

MATERIALS AND METHODS

The study was conducted over 12 months using an observational cross-sectional survey on 172 patients from five clinics in Hail, Saudi Arabia. A total of 172 individuals with obesity (BMI ≥ 30) finally participated in this research. The study evaluated sociodemographic variables via an electronic questionnaire with voluntary participation.

RESULTS

The study found a 76% prevalence of joint pain and 77.9% prevalence of cardiovascular abnormalities. Patients with CVD were older (58±23 vs. 56±12 years) than those with OA. CVD cases were found in 42 (31.3%) males and 92 (68.7%) females, whereas OA cases were recognized in 24 (18.5%) males and 106 (81.5%) females. The occurrence of various CVDs among our participants was 43 (32%) for high cholesterol, 64 (48%) for hypertension, and 27 for both high cholesterol and hypertension (20%). Definite osteophytes were found in 28 of 24 male knees (14 right and 14 left knees) and 175 of 106 female knees (88 right knees and 87 left knees).

CONCLUSIONS

The prevalence of obesity in the Hail region has continued to be a risk factor for CVD and OA in 2019 and 2020. The Saudi population has shown a higher prevalence of radiographic evidence of OA of the knee and associated symptoms than western civilizations, and preventive interventions are desperately needed in order to minimize overweight and obesity.

Comparative analysis between mono approach and multi approaches in managing T2DM: a survey-based study

OBJECTIVE

The aim of the study was to analytically compare the therapeutic effect of the addition of diet modification and regular exercise to oral agents.

MATERIALS AND METHODS

This cross-sectional study surveyed 1248 participants via online and offline modes by employing a questionnaire about an individual's management of diabetes. Group 1 patients follow Single Approach Management for Type 2 Diabetes Mellitus (T2DM), while Group 2 and Group 3 patients follow Multi-Approach Management for T2DM. Based on the answers, the participants were classified into three groups. The diagnostic criteria of Diabetes Mellitus Type-2 in this study were done by determining morning Fasting Blood Sugar (FBS) and glycated Hemoglobin (HbA1c).

RESULTS

The current study found 656 single oral agent users and 592 combination regimens users among all the study participants. The study also found that, among all participants, 511 patients were on mild to moderate diet modification while 325 patients were on moderate to severe diet modification. The study also noted that 232 males and 215 females took Complementary and Alternative Medicines (CAM). Of 447 patients, 12 showed menstrual abnormalities (2.6%), and 18 had mild diarrhoea (4%). The study also found that there is a vital significance of lowering FBS and HbA1c with the management strategies (p=0.000). The study showed a strong association between group 3 and improved FBS and HbA1c (p=0.000).

CONCLUSIONS

This study reveals that diet modification and regular exercise improve FBS and HbA1c levels significantly. Hence, diet modification and exercise can be added as adjuvants and should be incorporated into the management guidelines of T2DM.

Clinical outcomes and predictors of acute cerebrovascular strokes after coronary artery bypass graft surgery

Funding Acknowledgements

Type of funding sources: None.

Background

Coronary artery bypass graft (CABG) surgery still carries a significant risk acute cerebrovascular stroke despite advances in anesthetic, surgical and medical managements.

Objective

To study the risk factors and get the predictors of acute stroke after CABG and study the clinical outcomes during hospitalization and follow up.

Methods

This retrospective study included 410 patients who underwent CABG at our tertiary care hospital from January 2016 to August 2020. The patients were divided into two groups according to the occurrence of acute cerebrovascular stroke.

Results

The study included 410 patients with a median age of 60(55-68) years with a male predominance (82.2%). Thirty-one (7.5%) patients developed strokes after CABG. The stroke group had significantly higher initial sequential organ failure assessment (SOFA) score [ 3(2-4) vs. 2(1-3), p=0.002], SOFA after 48 hours [5(1-7) vs. 1(0-2), p&lt;0.001], higher peak blood lactate level [12.5(7.6-14.7) vs. 5.1(3.7-8.5),p&lt;0.001], longer ICU stay [11(6-42) vs. 4(3-5), p&lt;0.001], more ventilator days [10(2-32) vs. 1(1-2), p&lt;0.001], more tracheostomies (38.7 vs. 0, p&lt;0.001) ,longer post ICU ward stay [11(2-57) vs. 5(3-7), p=0.015] and greater hospital mortality (25.8 vs. 0.8, p&lt;0.001) compared to the non-stroke group respectively. Both groups showed insignificant mortality during a follow up period of 41.5(26.5-54.5) months. Multivariate regression revealed that early hospital stroke was independently predicted with carotid artery disease (OR:8.22, 95%CI:2.92-23.1, p&lt;0.001), CPB time (OR:5.64, 95%CI:1.97-16.11, p&lt;0.001), initial SOFA score (OR:1.643, 95%CI:1.194-2.26, p=0.002), prior stroke (OR:4.412, 95%CI:1.286-15.14, p=0.018), postoperative new AF (OR: 3.014, 95%CI:1.158-7.84, p=0.024) and CKD (OR:1.28,95%CI:1.05-3.75, p=0.017). Late cerebrovascular stroke was independently predicted with CAD (OR:9.38, 95%CI:3.72-23.66, p&lt;0.001), postoperative AF (OR: 2.35,95%CI:1.0125-5.41, p=0.016), prior stroke (OR:3.725,95%CI:1.179-11.768, p=0.025), CABG plus valve surgery (0R:7.44, 95%CI:2.75-20.145, p&lt;0.001), HBA1c (OR:1.431, 95%CI:1.071-1.914, p=0.016) and CKD (OR:2.33, 95%CI:1.056-5.165, p=0.036).

Conclusion

Acute cerebrovascular stroke is a serious complication after CABG and associated with increased mortality, longer hospital stays with multiple morbidities and resources consumption. Appropriate assessment and management of carotid artery disease, and post-operative atrial fibrillation should be routinely implemented to reduce the risk of early and late strokes in patients undergoing CABG.

The clinical significance of blood lactate levels in evaluation of adult patients with Veno-Arterial Extracorporeal Membrane Oxygenation

Funding Acknowledgements

Type of funding sources: None.

Background

Veno-Arterial ECMO is  a life  supporting procedure that can be done to the patients with cardiogenic shock which is associated with hyperlactatemia . The objective of this study was to detect the validity of serial measurements of arterial lactate level in differentiating hospital mortality and neurological outcome  after VA-ECMO support. Results : This retrospective study included 106 patients between 2015 and 2019 with a mean age of  40.2 ± 14.4 years and mostly males (69.8%) . The in-hospital mortality occurred in 56.6% and acute strokes occurred in 25.5% of the patients . The non-survivors and the patients with acute strokes  had significantly higher arterial  lactate levels at pre-ECMO initiation , post-ECMO peak and after 24 hours of ECMO support compared to the survivors and those without strokes respectively.  The peak arterial lactate  ≥ 14.65 mmol/L measured  after  ECMO support  had 81.7 % sensitivity and 89.1 % specificity for predicting hospital mortality  [AUROC: 0.889 , p &lt;0.001 ] while the arterial lactate level ≥ 3.25 mmol/L after 24 hours of ECMO support had  88.3% sensitivity and 97.8% specificity for predicting hospital mortality  [AUROC: 0.93 , p &lt;0.001 ]. The peak lactate  ≥ 15.15 mmol/L  measured  after  ECMO support  had 70.8 % sensitivity and 69 % specificity for predicting cerebral strokes [AUROC: 0.717 , p &lt;0.001 ] while the lactate level ≥ 3.25 mmol/L after 24 hours of ECMO support had  79.2% sensitivity and 72.4% specificity for predicting cerebral strokes [AUROC: 0.779, p &lt;0.001 ]. Progressive hyperlactatemia (OR = 1.427  , 95% CI : 1.048 – 1.944 , p = 0.024 ) and increasing  SOFA score after 48 hours  (OR = 1.819 , 95% CI : 1.374 – 2.409 , p &lt; 0.001) were significantly associated with in-hospital mortality after VA-ECMO support. Conclusion : Progressive hyperlactatemia after VA-ECMO initiation for adult patients with cardiogenic shock is a sensitive and specific predictor of hospital mortality and acute cerebrovascular strokes  . According to our results , we could recommend early VA-ECMO initiation to achieve adequate circulatory support and better outcome. Predictors of hospital mortality.Studied variablesP valueOR95% CI for ORLactate peak0.0241.4271.048 - 1.944Hemodialysis0.3154.1260.344 - 51.669Atrial fibrillation0.073.2680.786 - 31.26Cardiac surgeries0.2173.4820.480 - 25.152Δ SOFA&lt;0.0011.8191.374 - 2.409Central VA-ECMO0.123.9310.482 - 24.16Abstract Figure. ROC of lactate differentiating mortality

The validity of SOFA score to predict mortality in adult patients with cardiogenic shock on Veno-Arterial Extracorporeal Membrane Oxygenation

Funding Acknowledgements

Type of funding sources: None.

Background

veno-arterial ECMO is increasingly used in resuscitation of adults patients with cardiogenic shock  with variable mortality reports worldwide. Our objectives were to study the variables associated with hospital mortality and to determine the validity  of  the Sequential Organ Failure Assessment (SOFA) score for prediction of hospital mortality . Results : one hundred and six patients were retrospectively included in our study between 2015 and  2019 with in-hospital mortality of  56.6% . The mean age of patients was 40.2 ± 14.4 years and mostly males (69.8%) with a mean BMI of 26.5 ± 7 . Presence of CKD , chronic AF , cardiotomies were significantly more frequent in the non-survivors group . The non-survivors had more frequent AKI  , more haemodialysis , more GI bleeding , more ICH, higher peak and 24 hours blood lactate  and less ICU days as compared to the survivors group. Initial SOFA  score ≥ 13 had a 85 % sensitivity and 73.9 % specificity [AUROC = 0.862 , 95% CI: 0.791 – 0.932 ; p &lt;0.001 ] while SOFA score ≥ 13  at day 3 had 100 % sensitivity and 91.3 %  specificity for predicting mortality [AUROC =0.995 , 95% CI : 0.986 – 1 ; p &lt;0.001 ]. SOFA score ≥ 15  at day 5 had  98 % sensitivity and 100 %  specificity for predicting mortality [AUROC =0.994 , 95% CI : 0.982 – 1 ; p &lt;0.001 ].  The Δ 1 SOFA (3-1) ≥ 2 had 95% sensitivity and 93.5% specificity [AUROC = 0.958 , 95% CI: 0.913 – 1 ; p &lt;0.001 ] while  the Δ 2 SOFA (5-1) ≥ 2 had 90% sensitivity and 97.8% specificity for predicting hospital mortality [AUROC = 0.958 , 95% CI: 0.909 – 1 ; p &lt;0.001 ] .  Increasing Δ 1 SOFA score (OR = 2.506, 95% CI : 1.681 – 3.735,p &lt; 0.001) and increasing  lactate level  (OR = 1.388 , 95% CI : 1.015 – 1.898 , p = 0.04) were significantly associated with hospital mortality . Conclusion: the use of VA-ECMO in adult patients with cardiogenic shock is still associated with high mortality  . Serial evaluation with SOFA score during first few days of VA-ECMO support is a good predictor of hospital mortality . Increase of SOFA score after 48 hours and hyperlactataemia are significantly associated with increased hospital mortality. Predictors of hospital mortality.Studied variablesP valueOR95% CI for ORCentral VA-ECMO0.2483.1020.455 - 21.154lactate peak level0.0401.3881.015 - 1.898Haemodialysis0.7121.6140.127 - 20.473Δ 1 SOFA (3-1)&lt; 0.0012.5061.681 - 3.735GI bleeding0.9170.8910.102 - 7.815ICH0.42414.5850.020 - 204.51Abstract Figure. SOFA scoring of studied VA-ECMO patients

Photovoltaic Performance of Thin-Film CdTe for Solar Cell Applications

In the current investigation, we report a theoretical study to acquire the highest feasible efficiency of cadmium telluride (CdTe) thin-films. It is well recognized that CdTe crystallizes in cubic zinc-blende structure and its direct band gap of 1.5 eV turned it out as a potential candidate for photovoltaic (PV) applications. Our calculations are founded on Shockley-Queisser (SQ) limit to simulate the open-circuit voltage, current density, and filling factor versus the variation of photon energy up to 4.0 eV. These key parameters of SQ change with the variation of energy between 0.3 to 3.5 eV. This is owing to the strong optical absorption (> 104 cm−1) and direct band gap of 1.5 eV, which make CdTe thin-film suitable for single junction solar cell and ideal for PV applications. It is observed that the optical absorption enhances as the thickness of the absorbed layer increases. This will effectively provide a theoretical support to the industry of global solar energy that is anticipated to be sustainable in the future.

Characterization and cross-species amplification of microsatellite markers in African Silverbill (Lonchura cantans)

We tested the cross-amplification of eight microsatellites developed for Bengalese finch in African Silverbill (Lonchura cantans). In order to develop resources for conservation genetic studies in the species L. cantans, we tested the amplification success and polymorphism in eight previously developed microsatellite loci, in L. cantans. All eight microsatellite markers were successfully amplified, of which all were polymorphic, with 3 to 9 alleles and an expected heterozygosity (HE) ranging from 0.606 to 0.718. On average, there were 5.25 alleles/locus and a mean HE of 0.6456. These eight polymorphic markers could be of potential use in studies of genetic variability, population structure, and reproductive strategy of African Silverbills. The markers tested should be useful for population and conservation genetic studies in this genus, and, in particular, for species closely related to the source species, L. cantans.

Premature aging and cancer in nucleotide excision repair-disorders

During the past decades, the major impact of DNA damage on cancer as 'disease of the genes' has become abundantly apparent. In addition to cancer, recent years have also uncovered a very strong association of DNA damage with many features of (premature) aging. The notion that DNA repair systems protect not only against cancer but also equally against to fast aging has become evident from a systematic, integral analysis of a variety of mouse mutants carrying defects in e.g. transcription-coupled repair with or without an additional impairment of global genome nucleotide excision repair and the corresponding segmental premature aging syndromes in human. A striking correlation between the degree of the DNA repair deficiency and the acceleration of specific progeroid symptoms has been discovered for those repair systems that primarily protect from the cytotoxic and cytostatic effects of DNA damage. These observations are explained from the perspective of nucleotide excision repair mouse mutant and human syndromes. However, similar principles likely apply to other DNA repair pathways including interstrand crosslink repair and double strand break repair and genome maintenance systems in general, supporting the notion that DNA damage constitutes an important intermediate in the process of aging.

Interleukin 17A and F and asthma in Saudi Arabia: gene polymorphisms and protein levels

BACKGROUND

Asthma is a multifactorial disorder, and both genetic and environmental factors contribute to its development. We investigated the possible association between asthma and 5 single-nucleotide polymorphisms (SNPs) in the interleukin 17 (IL17) gene--rs17880588 (G/A) and rs17878530 (C/T) in IL17A and rs763780 (T/C), rs11465553 (T/C), and rs2397084 (G/A) in IL17F--and compared levels of the proteins IL17A and IL17F in asthma patients with those of controls.

PATIENTS AND METHODS

The study group included 100 asthma patients and 102 ethnically matched controls. Genotyping was performed on purified DNA using reverse transcriptase-polymerase chain reaction with specific primers and probes. Levels of IL17A and IL17F were measured in plasma using enzyme-linked immunosorbent assay.

RESULTS

Genotyping showed that AG heterozygotes of rs17880588 in IL17A were significantly more common in the control group than among the asthma patients (P < .05); no significant associations were observed for any of the other SNPs examined. Levels of IL17A and IL17F were both higher in asthma patients (IL17A, 2.242 [0.099] vs 2.752 [0.287] pg/mL; IL17F, 236.01 [38.28] vs 700 [201.078] pg/mL). The difference was statistically significant for IL17F (P = .025, t test). Levels of IL17A and IL17F were positively and significantly correlated in the asthma patients

CONCLUSION

Of all the SNPs analyzed, only rs17880588 showed a significant association with asthma in the Saudi population we studied. Levels of IL17A and IL17F were significantly upregulated in the asthma patients. The morphology of IL17F appeared to affect expression levels.