Chiglitazar and Thiazolidinedione in patients with type 2 diabetes: Which is better?

This published Meta-Analysis by Lin et al is an indirect comparison between two drugs Chiglitazar and Thiazolidinedione which are commonly used for glycemic control in type-II diabetes mellitus. In terms of safety and efficacy, this Meta-Analysis is inconclusive.

Analyzing the Outcomes of COVID-19 Infection on Patients With Comorbidities: Insights From Hospital-Based Study

Introduction COVID-19 exhibits a broad spectrum of clinical manifestations, ranging from asymptomatic or mild cases to severe respiratory distress and, in some instances, fatal outcomes. The pre-existing inflammatory state in the patient prior to exposure to COVID-19, which could be because of any etiology or comorbidity, has been associated with prolonged morbidity, and adverse outcomes like increased mortality have been found. This study endeavors to investigate the principal risk factors linked to the morbidity and mortality of COVID-19, such as age, gender, and co-morbidities such as hypertension, diabetes mellitus, and others. Material and methods Patient demographic data like age, gender, and co-morbidities like diabetes mellitus, hypertension, respiratory illness, and coronary artery diseases, cerebrovascular accident was observed. The patient clinical profile, hematological, inflammatory markers at the time of admission, and outcome were noticed. Patients were divided into two groups - patients with comorbidity and those without comorbidity. Results In each cohort of COVID-19 patients, comprising those with and without comorbidities, there were 145 participants. The mean age of patients without comorbidities was found to be 49.97 years, whereas the mean age of those with comorbidities was 64.35 years. Within the comorbidity group, males formed the majority, accounting for 77.2% of the cohort; in the group without comorbidity also males predominated, representing 68.3% of the participants. Hypertension was the most common co-morbidity (89.7%), followed by diabetes mellitus (39.3%), and ischemic heart disease (8.3%). The multivariate logistic regression analysis for prediction of mortality showed hypothyroidism with odds ratio (OR) of 336.26 and confidence intervals (CI) (1.19-9477.13), ischemic heart disease with OR of 320.94 (CI 3.19-3237.4) and presence greater than two co-morbidities with OR of 42.14 (CI 1.34-1325.76). Cox regression analysis showed a statistically significant hazard ratio of 0.294 in patients with greater than two co-morbidities. Conclusion Hypothyroidism, ischemic heart disease, and the presence of multiple comorbid conditions were associated with the severity of COVID-19 illness and mortality.

Assessment of Neuropathy by Temperature Threshold Testing in Type 2 Diabetes Mellitus

Introduction

Diagnosing diabetic neuropathy is a challenge at times as it is asymptomatic. Diagnosing diabetic neuropathy involves the use of quantitative sensory testing, nerve conduction study, and autonomic testing. Tempearture threshold testing (TTT) can aid in diagnosing small fiber neuropathy at early stages. This study aimed to assess the small fiber neuropathy using TTT in diabetes mellitus (DM) and correlate with age, duration of diabetes, and lipid profile.

Materials and Methods

The study was commenced after obtaining ethics approval from the institute ethics committee. The study participants included 100 patients with type 2 DM of both genders between the ages of 40 and 65 years. The glycemic status and lipid profile were noted along with physical examination. Neuropathy assessment was done using Michigan Neuropathy Screening Instrument (MNSI) and TTT.

Results

The prevalence of small fiber neuropathy based on TTT was 63%. The lipid profile was similar in both the groups. The MNSI B scale had significantly higher scores in the neuropathy group. In the neuropathy group, the thresholds for hot were significantly greater in all four limbs and cold were significantly lower. Age and years of DM were positively correlated with the neuropathy. Hot threshold in the lower limb had shown a strong positive correlation.

Conclusion

The age and duration of diabetes are independent risk factors for diabetic peripheral neuropathy. Small fiber neuropathy is a prequel to the motor neuropathy. Hot threshold testing in the lower limb is more sensitive than cold threshold testing for diagnosing small fiber neuropathy.

Association of Vitamin D with Risk Factors for Coronary Artery Disease

Introduction:Vitamin D safeguards cardiovascular health by reducing inflammation and susceptibility to atheroma. This study aimed to evaluate the association of coronary artery disease (CAD) and its risk factors like body mass index (BMI), glycated hemoglobin (HbA1c), and lipid profile with vitamin D. Methods:Patients of both genders aged over 18 years, who underwent coronary angiogram for cardiac symptoms such as chest pain, breathlessness, palpitation, or syncope, were enrolled in the present study. Demographic and anthropometric data were collected. Glycated hemoglobin, lipid profile and 25-hydroxyvitamin D were measured. The severity of CAD was analyzed along with the SYNTAX scoring. Results:The study population was divided into three groups based on vitamin D levels: Group I (vitamin D level <20 ng/mL), Group II (20-30 ng/mL) and Group III (>30 ng/mL). There was a significantly higher number of patients with diabetes mellitus and triple vessel disease in Group I. On multivariable suplogistic regression, vitamin D had a significant odds ratio (OR) of 1.21 (1.03-1.43) for single vessel disease and 0.92 (1.13-1.43) for triple vessel disease. SYNTAX score had a significant OR of 0.697 (0.557-0.873) for single vessel disease and 1.27 (1.13-1.43) for triple vessel disease. There was a significant negative correlation between HbA1c and vitamin D (r =-0.269, p= 0.008). Vitamin D levels negatively correlated with triple vessel disease (r =-0.252, p= 0.013). Conclusions:Incidence of diabetes mellitus and levels of HbA1c were both higher among patients with vitamin D deficiency. Vitamin D deficiency was a risk factor for single and triple vessel disease.

Comprehensive, continuous, and compulsory monitoring of frailty in elderly

Background

The increasing elderly population makes frailty an increasing concern in society with vulnerability to stress and functional decline. Unrecognised comorbidities are common among the elderly due to lack of mention by the patients. Physicians should be equipped with effective interviewing skills along with the use of screening tools to assess any impairments in activities of daily living, cognition and signs of depression.

Objectives

To measure the degree of independence or dependence using scales and stratify patients based on Clinical Frailty Scale (CFS) so as to recommend it as a routinely usable tool.

Materials and Methods

In total, 191 elderly subjects above the age of 65 years were recruited for geriatric assessment. Tools that assess performance in daily living activities and cognition were used. The prevalidated CFS was used to score frailty to stratify patients into frail and non-frail groups, and the parameters were compared.

Results

Mean age of the study population was 69.54 years with 53.4% males and 46.6% females. Mean Katz index and mean Lawton score were >5. The mean Global Deterioration Scale (GDS) score was 1.5, and the mean clinical frailty score was 3.55. Significantly high number of male individuals were found in the frailty group. Hypertension was significantly higher in the frail group. The mean Katz scores were significantly lower, and mean GDS scores were significantly higher in the frailty group. Multivariable logistic regression has shown gender to be an important determinant of frailty with an odds ratio of 0.05 (CI-0.01-0.20). The higher Lawton score and GDS scores were significantly associated with frailty with an odds ratio of 0.33 (CI: 0.21-0.52) and 2.62 (CI: 1.14-6.02), respectively.

Conclusion

Men are more frail than women and co-morbidities like hypertension and coronary artery disease contribute to frailty with cognitive decline and decreased autonomy. A comprehensive assessment to identify frailty will provide a holistic view of well being among the elderly.

Risk Factors Of Anaemia Among Zidovudine-Based Regimen In Patients With Hiv Infection- A Cohort Study

BACKGROUND

Anaemia in patients with HIV infection is commonly multifactorial in origin. Nutritional deficiencies and the presence of opportunistic infections as well as HIV infection itself can cause anaemia. HIV medications like zidovudine can also cause anaemia in patients with HIV infection. This study aimed to study the prevalence and risk factors of anaemia in patients with HIV infection on a zidovudine-based HAART regimen.

METHODS

This hospital-based prospective cohort study was done at the ART (anti-retroviral therapy) centre. All adult patients with HIV attending the ART centre were included in the study. After obtaining written informed consent, the patient's demographic data, risk factors, WHO staging, and body mass index (BMI) were noted. Study population was divided into two groups as patients with or without anaemia and compared using appropriate statistical tests.

RESULTS

Out of the 202 patients with HIV infection on a zidovudine-based regimen, 52 patients (25.7%) developed anaemia. Anaemia was common in stage 3 or stage 4 of WHO staging (OR-9.94, CI-3.89-25.36) and in patients with low CD4 counts (OR-0.988, CI-0. 982-0.995). Patients with anaemia had significant opportunistic infections.

CONCLUSIONS

Anaemia is common in patients with HIV on zidovudine-based HAART regimen, which is seen as early as less than 8 weeks. WHO staging, and CD4 count were the primary risk factors for anaemia, which a change of treatment regimen and supportive measures can reverse.

Takayasu arteritis, an atypical presentation as chronic kidney disease

Takayasu arteritis, also known as "pulseless disease" usually affects major vessels like aorta and its branches, pulmonary arteries, and renal arteries. Hypertension is the common presentation. Chronic kidney disease involvement is less common. Only a few chronic kidney disease cases are reported so far in Takayasu arteritis. We discuss a case of a young female who presented with accelerated hypertension with chronic kidney disease with preserved peripheral pulses. The diagnosis was confirmed by Computed tomography aortic angiogram, which showed diffuse circumferential thickening, multifocal ectasia, and aneurysmal dilatation with few saccular outpouchings of the aortic arch, descending thoracic and abdominal aorta (Type V). The patient was treated with steroids, antihypertensives, antiplatelet, and hemodialysis.

Systematic Review of the Impact on Return to Work of Return-to-Work Coordinators

Purpose We conducted a systematic review to understand the impact that return-to-work coordinators (RTWCs) have on return to work (RTW) outcomes for sick/injured workers. Methods MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, and ABI Inform were searched from January 1, 2000 to September 16, 2020. Of 2,927 retrieved and screened citations, 14 quantitative articles fulfilled the eligibility and quality criteria. Quality assessment, data extraction, and evidence synthesis followed article screening. Results We focused on the impact of RTWCs for outcomes of work absence, RTW rates, quality of life, and cost-benefit. Our final synthesis included 14 articles. We found strong evidence that work absence duration was reduced when workers had face-to-face contact with a RTWC. As well, there was strong evidence linking face-to-face RTWC interventions with higher RTW rates and moderate evidence that this reduced intervention costs. RTWC interventions involving the identification of barriers and facilitators to RTW also showed promising results. However, only limited evidence was found that RTWCs improved quality of life for workers. Conclusions Our synthesis identifies key features of RTW interventions that improve RTW outcomes. Future high-quality research should measure long-term outcomes of RTWC interventions to evaluate sustainability and consider the nature of work. They should also focus on RTWC impact on worker quality of life assessments and for older workers and workers with chronic health conditions.

Return to Work for Mental Ill-Health: A Scoping Review Exploring the Impact and Role of Return-to-Work Coordinators

Purpose This scoping review was completed to explore the role and impact of having a return-to-work (RTW) coordinator when dealing with individuals with common mental ill-health conditions. Methods Peer reviewed articles published in English between 2000 and 2018 were considered. Our research team reviewed all articles to determine if an analytic focus on RTW coordinator and mental ill-health was present; consensus on inclusion was reached for all articles. Data were extracted for all relevant articles and synthesized for outcomes of interest. Results Our search of six databases yielded 1798 unique articles; 5 articles were found to be relevant. The searched yielded only quantitative studies. Of those, we found that studies grouped mental ill-health conditions together, did not consider quality of life, and used different titles to describe RTW coordinators. Included articles described roles of RTW coordinators but did not include information on their strategies and actions. Included articles suggest that RTW interventions for mental ill-health that utilize a RTW coordinator may result in delayed time to RTW. Conclusions Our limited findings suggest that interventions for mental ill-health that employ RTW coordinators may be more time consuming than conventional approaches and may not increase RTW rate or worker's self-efficacy for RTW. Research on this topic with long-term outcomes and varied research designs (including qualitative) is needed, as well as studies that clearly define RTW coordinator roles and strategies, delineate results by mental health condition, and address the impact of RTW coordinators on workers' quality of life.

Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

We conducted a systematic review of guidelines on the management of low back pain (LBP) to assess their methodological quality and guide care. We synthesized guidelines on the management of LBP published from 2005 to 2014 following best evidence synthesis principles. We searched MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane, DARE, National Health Services Economic Evaluation Database, Health Technology Assessment Database, Index to Chiropractic Literature and grey literature. Independent reviewers critically appraised eligible guidelines using AGREE II criteria. We screened 2504 citations; 13 guidelines were eligible for critical appraisal, and 10 had a low risk of bias. According to high-quality guidelines: (1) all patients with acute or chronic LBP should receive education, reassurance and instruction on self-management options; (2) patients with acute LBP should be encouraged to return to activity and may benefit from paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), or spinal manipulation; (3) the management of chronic LBP may include exercise, paracetamol or NSAIDs, manual therapy, acupuncture, and multimodal rehabilitation (combined physical and psychological treatment); and (4) patients with lumbar disc herniation with radiculopathy may benefit from spinal manipulation. Ten guidelines were of high methodological quality, but updating and some methodological improvements are needed. Overall, most guidelines target nonspecific LBP and recommend education, staying active/exercise, manual therapy, and paracetamol or NSAIDs as first-line treatments. The recommendation to use paracetamol for acute LBP is challenged by recent evidence and needs to be revisited.

SIGNIFICANCE

Most high-quality guidelines recommend education, staying active/exercise, manual therapy and paracetamol/NSAIDs as first-line treatments for LBP. Recommendation of paracetamol for acute LBP is challenged by recent evidence and needs updating.