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Guo Y, Yonamine S, Jian Ma C, Stewart JM, Acharya N, Arnold BF, McCulloch C, Sun CQ. Developing and Validating Models to Predict Progression to Proliferative Diabetic Retinopathy. Ophthalmol Sci 2023; 3:100276. [PMID: 36950087 PMCID: PMC10025270 DOI: 10.1016/j.xops.2023.100276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 12/01/2022] [Accepted: 01/24/2023] [Indexed: 02/04/2023]
Abstract
Purpose To develop models for progression of nonproliferative diabetic retinopathy (NPDR) to proliferative diabetic retinopathy (PDR) and determine if incorporating updated information improves model performance. Design Retrospective cohort study. Participants Electronic health record (EHR) data from a tertiary academic center, University of California San Francisco (UCSF), and a safety-net hospital, Zuckerberg San Francisco General (ZSFG) Hospital were used to identify patients with a diagnosis of NPDR, age ≥ 18 years, a diagnosis of type 1 or 2 diabetes mellitus, ≥ 6 months of ophthalmology follow-up, and no prior diagnosis of PDR before the index date (date of first NPDR diagnosis in the EHR). Methods Four survival models were developed: Cox proportional hazards, Cox with backward selection, Cox with LASSO regression and Random Survival Forest. For each model, three variable sets were compared to determine the impact of including updated clinical information: Static0 (data up to the index date), Static6m (data updated 6 months after the index date), and Dynamic (data in Static0 plus data change during the 6-month period). The UCSF data were split into 80% training and 20% testing (internal validation). The ZSFG data were used for external validation. Model performance was evaluated by the Harrell's concordance index (C-Index). Main Outcome Measures Time to PDR. Results The UCSF cohort included 1130 patients and 92 (8.1%) patients progressed to PDR. The ZSFG cohort included 687 patients and 30 (4.4%) patients progressed to PDR. All models performed similarly (C-indices ∼ 0.70) in internal validation. The random survival forest with Static6m set performed best in external validation (C-index 0.76). Insurance and age were selected or ranked as highly important by all models. Other key predictors were NPDR severity, diabetic neuropathy, number of strokes, mean Hemoglobin A1c, and number of hospital admissions. Conclusions Our models for progression of NPDR to PDR achieved acceptable predictive performance and validated well in an external setting. Updating the baseline variables with new clinical information did not consistently improve the predictive performance. Financial Disclosures Proprietary or commercial disclosure may be found after the references.
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Key Words
- C-index, Harrell’s Concordance index
- Cox, Cox proportional hazards regression
- Cox-BW, Cox with backward selection
- Cox-LS, Cox with LASSO regression
- DM, diabetes mellitus
- EHR, electronic health record
- HbA1c, hemoglobin A1c
- ICD, International Classification of Diseases
- NPDR, nonproliferative diabetic retinopathy
- Nonproliferative diabetic retinopathy
- PDR, prolifterative diabetic retinopathy
- Prediction
- Proliferative diabetic retinopathy
- RSF, random survival forest
- Time-to-event models
- UCSF, University of California San Francisco
- ZSFG, Zuckerberg San Francisco General
- vs., versus
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Affiliation(s)
- Yian Guo
- Department of Ophthalmology, University of California, San Francisco, California
- F.I. Proctor Foundation, University of California, San Francisco, California
| | - Sean Yonamine
- Department of Ophthalmology, University of California, San Francisco, California
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Chu Jian Ma
- Department of Ophthalmology, University of California, San Francisco, California
| | - Jay M. Stewart
- Department of Ophthalmology, University of California, San Francisco, California
| | - Nisha Acharya
- Department of Ophthalmology, University of California, San Francisco, California
- F.I. Proctor Foundation, University of California, San Francisco, California
| | - Benjamin F. Arnold
- Department of Ophthalmology, University of California, San Francisco, California
- F.I. Proctor Foundation, University of California, San Francisco, California
| | - Charles McCulloch
- Department of Epidemiology & Biostatistics, University of California, San Francisco, California
| | - Catherine Q. Sun
- Department of Ophthalmology, University of California, San Francisco, California
- F.I. Proctor Foundation, University of California, San Francisco, California
- Correspondence: Catherine Q. Sun, MD, University of California, San Francisco, Department of Ophthalmology, San Francisco, CA 94131.
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Motawea KR, Monib FA, Abbas KS, AbdelQadir YH, Elhalag RH, Swed S, Nashwan AJ. A rare case of newly diagnosed diabetes mellitus following COVID-19 infection. J Clin Transl Endocrinol Case Rep 2023; 27:100141. [PMID: 36718471 PMCID: PMC9876009 DOI: 10.1016/j.jecr.2023.100141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 01/20/2023] [Accepted: 01/24/2023] [Indexed: 01/26/2023] Open
Abstract
Several reports showed the likelihood of a relationship between COVID-19 infection and the onset and prognosis of diabetes mellitus (DM) of all types. A 73-year-old female patient who presented to the clinic with respiratory symptoms and was tested positive for COVID-19 and treated for the next three days. Despite having neither a known history of hyperglycemia nor a family history of diabetes, she was unconscious and suffering from polyuria and polydipsia when she was brought to the emergency department. Once her condition was successfully stabilized, she was sent home with COVID-19 medications and oral anti-diabetic therapy. After subsequent viral recovery and continued anti-diabetic medication, the patient was monitored for the following seven months. DM might be linked to the SARS-CoV-2 infection. Further research is necessary to prove a relationship between COVID-19 and newly-onset diabetes.
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Affiliation(s)
- Karam R Motawea
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Fatma A Monib
- Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | | | - Rowan H Elhalag
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sarya Swed
- Faculty of Medicine, Aleppo University, Aleppo, Syria
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Torjani A, Mahmoudzadeh R, Salabati M, Cai L, Hsu J, Garg S, Ho AC, Yonekawa Y, Kuriyan AE, Starr MR. Factors Associated with Fluctuations in Central Subfield Thickness in Patients with Diabetic Macular Edema Using Diabetic Retinopathy Clinical Research Protocols T and V. Ophthalmol Sci 2023; 3:100226. [PMID: 36339948 PMCID: PMC9627096 DOI: 10.1016/j.xops.2022.100226] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/02/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE To identify baseline ocular and systemic factors associated with central subfield thickness (CST) fluctuations in patients with diabetic macular edema (DME) using data from Diabetic Retinopathy Clinical Research Protocols T and V. DESIGN Post hoc analysis of clinical trial databases. SUBJECTS Patients in Protocols T and V. METHODS The standard deviation (SD) of all recorded CSTs for each patient during each Protocol's study period was calculated. The CST SD (corresponding to CST fluctuations) for each patient was analyzed against baseline ocular and systemic factors using linear regression analyses. Each Protocol was analyzed separately. MAIN OUTCOME MEASURES Factors associated with CST fluctuations. RESULTS A total of 1197 eyes of 1197 subjects were included. In Protocol T (559 eyes, mean CST SD was 56.4 ± 35.1 microns), using multivariate linear regression analysis, baseline urine albumin/creatine ratio (for every 1000 mg/g, CST point estimate 3.50, 95% confidence interval [CI] 0.58 to 6.43, P = 0.0190), and baseline CST (for every 10 microns, 0.87, 95% CI 0.58 to 1.16, P < 0.0001) were positively associated with CST fluctuations. Baseline visual acuity (for every 10 ETDRS letters, -9.52, 95% CI -11.89 to -7.15, P < 0.0001) was negatively associated with CST fluctuations. In Protocol V (638 eyes, mean CST SD 36.6 ± 28.4 microns), gender (female, 2.18, 95% CI 0.30 to 4.06, P = 0.0227), baseline CST (for every 10 microns, 2.51, 95% CI 2.21 to 2.82, P < 0.0001), systolic blood pressure (for every 1 mm of mercury, 0.11, 95% CI 0.01 to 0.21, P = 0.0261), and observation with deferred anti-VEGF injections (5.04, 95% CI 2.51 to 7.58, P < 0.0001) were positively associated with CST fluctuations. Type 2 diabetes (-7.37, 95% CI -13.64 to -1.11, P = 0.0209) and prompt anti-VEGF injections (-6.51, 95% CI -9.07 to -3.96, P < 0.0001) were negatively associated with CST fluctuations. CONCLUSIONS Worse visual acuity at baseline, baseline renal disease, hypertension, female gender, type 1 diabetes, and delayed anti-VEGF treatment may be associated with increased CST fluctuations in patients with DME. Addressing these parameters may limit CST fluctuations and help identify patients requiring more frequent monitoring or treatment.
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Affiliation(s)
- Ava Torjani
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Raziyeh Mahmoudzadeh
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mirataollah Salabati
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Louis Cai
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jason Hsu
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sunir Garg
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Allen C. Ho
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Yoshihiro Yonekawa
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ajay E. Kuriyan
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matthew R. Starr
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
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Enzan N, Matsushima S, Kaku H, Tohyama T, Nagata T, Ide T, Tsutsui H. Beneficial Effects of Dipeptidyl Peptidase-4 Inhibitors on Heart Failure With Preserved Ejection Fraction and Diabetes. JACC Asia 2023; 3:93-104. [PMID: 36873765 PMCID: PMC9982295 DOI: 10.1016/j.jacasi.2022.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 06/12/2023]
Abstract
BACKGROUND Dipeptidyl peptidase-4 (DPP-4) inhibitors have been shown to exert pleiotropic effects on heart failure (HF) in animal experiments. OBJECTIVES This study sought to investigate the impact of DPP-4 inhibitors on HF patients with diabetes mellitus (DM). METHODS We analyzed hospitalized patients with HF and DM enrolled in the JROADHF (Japanese Registry Of Acute Decompensated Heart Failure) registry, a nationwide registry of acute decompensated HF. Primary exposure was the use of a DPP-4 inhibitor. The primary outcome was a composite of cardiovascular death or HF hospitalization during the median follow-up of 3.6 years according to left ventricular ejection fraction. RESULTS Out of 2,999 eligible patients, 1,130 had heart failure with preserved ejection fraction (HFpEF), 572 had heart failure with midrange ejection fraction (HFmrEF), and 1,297 had heart failure with reduced ejection fraction (HFrEF). In each cohort, 444, 232, and 574 patients received a DPP-4 inhibitor, respectively. A multivariable Cox regression model showed that DPP-4 inhibitor use was associated with a lower composite of cardiovascular death or HF hospitalization in HFpEF (HR: 0.69; 95% CI: 0.55-0.87; P = 0.002) but not in HFmrEF and HFrEF. Restricted cubic spline analysis demonstrated that DPP-4 inhibitors were beneficial in patients with higher left ventricular ejection fraction. In HFpEF cohort, propensity score matching yielded 263 pairs. DPP-4 inhibitor use was associated with a lower incidence rate of the composite of cardiovascular death or HF hospitalization (19.2 vs 25.9 events per 100 patient-years; rate ratio: 0.74; 95% CI: 0.57-0.97; P = 0.027) in matched patients. CONCLUSIONS DPP-4 inhibitor use was associated with better long-term outcomes in HFpEF patients with DM.
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Key Words
- BMI, body mass index
- BNP, B-type natriuretic peptide
- CV, cardiovascular
- DM, diabetes mellitus
- DPP-4, dipeptidyl peptidase-4
- HF, heart failure
- HFmrEF, heart failure with mildly reduced ejection fraction
- HFpEF, heart failure with preserved ejection fraction
- HFrEF, heart failure with reduced ejection fraction
- HbA1c, glycosylated hemoglobin
- LV, left ventricular
- LVEF, left ventricular ejection fraction
- SGLT-2, sodium-glucose cotransporter-2
- diabetes mellitus
- dipeptidyl peptidase-4 inhibitor
- heart failure with preserved ejection fraction
- long-term outcome
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Affiliation(s)
- Nobuyuki Enzan
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
- Division of Cardiovascular Medicine, Research Institute of Angiocardiology, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shouji Matsushima
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
- Division of Cardiovascular Medicine, Research Institute of Angiocardiology, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hidetaka Kaku
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Cardiology, Japan Community Healthcare Organization, Kyushu Hospital, Fukuoka, Japan
| | - Takeshi Tohyama
- Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan
| | - Takuya Nagata
- Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan
| | - Tomomi Ide
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
- Division of Cardiovascular Medicine, Research Institute of Angiocardiology, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
- Division of Cardiovascular Medicine, Research Institute of Angiocardiology, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
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Liu H, Huang Y, Zhao Y, Kang GJ, Feng F, Wang X, Liu M, Shi G, Revelo X, Bernlohr D, Dudley SC. Inflammatory Macrophage Interleukin-1β Mediates High-Fat Diet-Induced Heart Failure With Preserved Ejection Fraction. JACC Basic Transl Sci 2023; 8:174-185. [PMID: 36908663 PMCID: PMC9998610 DOI: 10.1016/j.jacbts.2022.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 08/02/2022] [Accepted: 08/02/2022] [Indexed: 12/02/2022]
Abstract
Diabetes mellitus (DM) is a main risk factor for diastolic dysfunction (DD) and heart failure with preserved ejection fraction. High-fat diet (HFD) mice presented with diabetes mellitus, DD, higher cardiac interleukin (IL)-1β levels, and proinflammatory cardiac macrophage accumulation. DD was significantly ameliorated by suppressing IL-1β signaling or depleting macrophages. Mice with macrophages unable to adopt a proinflammatory phenotype were low in cardiac IL-1β levels and were resistant to HFD-induced DD. IL-1β enhanced mitochondrial reactive oxygen species (mitoROS) in cardiomyocytes, and scavenging mitoROS improved HFD-induced DD. In conclusion, macrophage-mediated inflammation contributed to HFD-associated DD through IL-1β and mitoROS production.
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Key Words
- CCR2, C-C motif chemokine receptor 2
- CM, cardiomyocyte
- DD, diastolic dysfunction
- DM, diabetes mellitus
- EF, ejection fraction
- FABP4, fatty acid binding protein 4
- HF, heart failure
- HFD, high-fat diet
- HFpEF
- HFpEF, heart failure with preserved ejection fraction
- IL, interleukin
- IL-1β
- IL1RA, interleukin 1 receptor antagonist
- KO, knockout
- MCP, monocyte chemoattractant protein
- MyBP-C, myosin binding protein C
- TGF, transforming growth factor
- TNF, tumor necrosis factor
- Timd4, T cell immunoglobulin and mucin domain containing 4
- WT, wild-type
- diabetes
- diastolic dysfunction
- inflammation
- macrophage
- mitoROS, mitochondrial reactive oxygen species
- mitochondria
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Affiliation(s)
- Hong Liu
- Division of Cardiology, Department of Medicine, the Lillehei Heart Institute, University of Minnesota, Minneapolis, Minnesota, USA
| | - Yimao Huang
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Yang Zhao
- Division of Cardiology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu, China
| | - Gyeoung-Jin Kang
- Division of Cardiology, Department of Medicine, the Lillehei Heart Institute, University of Minnesota, Minneapolis, Minnesota, USA
| | - Feng Feng
- Division of Cardiology, Department of Medicine, the Lillehei Heart Institute, University of Minnesota, Minneapolis, Minnesota, USA
| | - Xiaodan Wang
- Division of Cardiology, Department of Medicine, the Lillehei Heart Institute, University of Minnesota, Minneapolis, Minnesota, USA
| | - Man Liu
- Division of Cardiology, Department of Medicine, the Lillehei Heart Institute, University of Minnesota, Minneapolis, Minnesota, USA
| | - Guangbin Shi
- Division of Cardiology, Cardiovascular Research Center, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Xavier Revelo
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - David Bernlohr
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Samuel C. Dudley
- Division of Cardiology, Department of Medicine, the Lillehei Heart Institute, University of Minnesota, Minneapolis, Minnesota, USA
- Address for correspondence: Dr Samuel C. Dudley, Division of Cardiology, University of Minnesota, VCRC 286 - MMC 508, 420 Delaware Street, SE, Minneapolis, Minnesota 55455, USA.
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Tagliaferri A, Melki G, Mohamed A, Cavanagh Y, Grossman M, Baddoura W. Gastric pneumatosis in immunocompromised patients: A report of 2 cases and comprehensive literature review. Radiol Case Rep 2023; 18:1152-1155. [PMID: 36660578 PMCID: PMC9842963 DOI: 10.1016/j.radcr.2022.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 01/11/2023] Open
Abstract
Gastric pneumatosis (GP) is a rare finding. It can be seen with both gastric emphysema (GE) and emphysematous gastritis (EG); however, both conditions present similarly and differentiating between the 2 is difficult radiographically. Moreover, the treatment is vastly different for both conditions, in which treatment for GE is focused on supportive care while treatment for EG may even involve gastrectomy. Making the distinction between GE and EG is crucial because GE has a benign clinical course, while EG carries significant mortality. Early endoscopy may be a useful tool in differentiating between the 2 conditions and to guide further management. Herein, we present a case series of 2 immunocompromised patients who presented with symptoms and radiographic evidence consistent with gastric pneumatosis. We found that early endoscopy assisted in risk stratification and helped guide our management strategy. We recommend consideration of endoscopic evaluation as part of ritualized evaluation of patients presenting with gastric pneumatosis.
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Dumitrascu AG, Rojas CA, Stancampiano F, Johnson EM, Harris DM, Chirila RM, Omer M, Hata DJ, Meza-Villegas DM, Heckman MG, White LJ, Alvarez S. Invasive Nocardiosis Versus Colonization at a Tertiary Care Center: Clinical and Radiological Characteristics. Mayo Clin Proc Innov Qual Outcomes 2022; 7:20-30. [PMID: 36589733 PMCID: PMC9798119 DOI: 10.1016/j.mayocpiqo.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective To describe the clinical and radiographic findings in a large cohort of patients with positive cultures for Nocardia emphasizing the differences between invasive disease and colonization. Patients and Methods We conducted a single-center, retrospective cohort study of 133 patients with a positive Nocardia isolate between August 1, 1998, and November 30, 2018, and a computed tomography (CT) of the chest within 30 days before or after the bacteria isolation date. Results Patients with colonization were older (71 vs 65 years; P=.004), frequently with chronic obstructive pulmonary disease (56.8% vs 16.9%; P<.001) and coronary artery disease (47.7% vs 27%, P=.021), and had Nocardia isolated exclusively from lung specimens (100% vs 83.1%; P=.003). On CT of the chest, they had frequent airway disease (84.1% vs 51.7%; P<.001). Patients with invasive nocardiosis had significantly (P<.05) more diabetes, chronic kidney disease, solid organ transplant, use of corticosteroids, antirejection drugs, and prophylactic sulfa. They had more fever (25.8% vs 2.3%; P<.001), cutaneous lesions (14.6% vs 0%; P=.005), fatigue (18% vs 0%; P=.001), pulmonary nodules (52.8% vs 27.3%; P=.006), and free-flowing pleural fluid (63.6% vs 29.4%; P=.024). The patterns of nodule distribution were different-diffuse for invasive nocardiosis and peribronchiolar for Nocardia colonization. Conclusion The isolation of Nocardia in sputum from a patient with respiratory symptoms does not equal active infection. Only by combining clinical and chest CT findings, one could better differentiate between invasive nocardiosis and Nocardia colonization.
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Affiliation(s)
- Adrian G. Dumitrascu
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic Florida, Jacksonville, FL,Correspondence: Address to Adrian Dumitrascu, MD, Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224.
| | - Carlos A. Rojas
- Division of Cardiothoracic Radiology, Department of Radiology, Mayo Clinic Arizona, Scottsdale, AZ
| | - Fernando Stancampiano
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic Florida, Jacksonville, FL
| | - Elizabeth M. Johnson
- Division of Cardiothoracic Radiology, Department of Radiology, Mayo Clinic Florida, Jacksonville, FL
| | - Dana M. Harris
- Division of Medallion Medicine, Department of Medicine, Mayo Clinic Florida, Jacksonville, FL
| | - Razvan M. Chirila
- Division of International and Executive Medicine, Department of Medicine, Mayo Clinic Florida, Jacksonville, FL
| | - Mohamed Omer
- Division of Internal Medicine, Department of Medicine, Harlem Hospital Center/Columbia University, New York, NY
| | - D. Jane Hata
- Department of Laboratory Medicine and Pathology, Mayo Clinic Florida, Jacksonville, FL
| | | | - Michael G. Heckman
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic Florida, Jacksonville, FL
| | - Launia J. White
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic Florida, Jacksonville, FL
| | - Salvador Alvarez
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic Florida, Jacksonville, FL
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Carrera-Escalé L, Benali A, Rathert AC, Martín-Pinardel R, Bernal-Morales C, Alé-Chilet A, Barraso M, Marín-Martinez S, Feu-Basilio S, Rosinés-Fonoll J, Hernandez T, Vilá I, Castro-Dominguez R, Oliva C, Vinagre I, Ortega E, Gimenez M, Vellido A, Romero E, Zarranz-Ventura J. Radiomics-Based Assessment of OCT Angiography Images for Diabetic Retinopathy Diagnosis. Ophthalmol Sci 2022; 3:100259. [PMID: 36578904 PMCID: PMC9791596 DOI: 10.1016/j.xops.2022.100259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/25/2022] [Accepted: 11/14/2022] [Indexed: 11/23/2022]
Abstract
Purpose To evaluate the diagnostic accuracy of machine learning (ML) techniques applied to radiomic features extracted from OCT and OCT angiography (OCTA) images for diabetes mellitus (DM), diabetic retinopathy (DR), and referable DR (R-DR) diagnosis. Design Cross-sectional analysis of a retinal image dataset from a previous prospective OCTA study (ClinicalTrials.govNCT03422965). Participants Patients with type 1 DM and controls included in the progenitor study. Methods Radiomic features were extracted from fundus retinographies, OCT, and OCTA images in each study eye. Logistic regression, linear discriminant analysis, support vector classifier (SVC)-linear, SVC-radial basis function, and random forest models were created to evaluate their diagnostic accuracy for DM, DR, and R-DR diagnosis in all image types. Main Outcome Measures Area under the receiver operating characteristic curve (AUC) mean and standard deviation for each ML model and each individual and combined image types. Results A dataset of 726 eyes (439 individuals) were included. For DM diagnosis, the greatest AUC was observed for OCT (0.82, 0.03). For DR detection, the greatest AUC was observed for OCTA (0.77, 0.03), especially in the 3 × 3 mm superficial capillary plexus OCTA scan (0.76, 0.04). For R-DR diagnosis, the greatest AUC was observed for OCTA (0.87, 0.12) and the deep capillary plexus OCTA scan (0.86, 0.08). The addition of clinical variables (age, sex, etc.) improved most models AUC for DM, DR and R-DR diagnosis. The performance of the models was similar in unilateral and bilateral eyes image datasets. Conclusions Radiomics extracted from OCT and OCTA images allow identification of patients with DM, DR, and R-DR using standard ML classifiers. OCT was the best test for DM diagnosis, OCTA for DR and R-DR diagnosis and the addition of clinical variables improved most models. This pioneer study demonstrates that radiomics-based ML techniques applied to OCT and OCTA images may be an option for DR screening in patients with type 1 DM. Financial Disclosures Proprietary or commercial disclosure may be found after the references.
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Key Words
- AI, artificial intelligence
- AUC, area under the curve
- Artificial intelligence
- DCP, deep capillary plexus
- DM, diabetes mellitus
- DR, diabetic retinopathy
- Diabetic retinopathy
- FR, fundus retinographies
- LDA, linear discriminant analysis
- LR, logistic regression
- ML, machine learning
- Machine learning
- OCT angiography
- OCTA, OCT angiography
- R-DR, referable DR
- RF, random forest
- Radiomics
- SCP, superficial capillary plexus
- SVC, support vector classifier
- rbf, radial basis function
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Affiliation(s)
- Laura Carrera-Escalé
- Intelligent Data Science and Artificial Intelligence (IDEAI) Research Center,Department of Computer Science, Facultat d’Informàtica de Barcelona (FIB), Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - Anass Benali
- Intelligent Data Science and Artificial Intelligence (IDEAI) Research Center,Department of Computer Science, Facultat d’Informàtica de Barcelona (FIB), Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - Ann-Christin Rathert
- Intelligent Data Science and Artificial Intelligence (IDEAI) Research Center,Department of Computer Science, Facultat d’Informàtica de Barcelona (FIB), Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - Ruben Martín-Pinardel
- Intelligent Data Science and Artificial Intelligence (IDEAI) Research Center,Department of Computer Science, Facultat d’Informàtica de Barcelona (FIB), Universitat Politècnica de Catalunya (UPC), Barcelona, Spain,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | - Anibal Alé-Chilet
- Institut Clínic d´Oftalmología (ICOF), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Marina Barraso
- Institut Clínic d´Oftalmología (ICOF), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Sara Marín-Martinez
- Institut Clínic d´Oftalmología (ICOF), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Silvia Feu-Basilio
- Institut Clínic d´Oftalmología (ICOF), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Josep Rosinés-Fonoll
- Institut Clínic d´Oftalmología (ICOF), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Teresa Hernandez
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain,Institut Clínic d´Oftalmología (ICOF), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Irene Vilá
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain,Institut Clínic d´Oftalmología (ICOF), Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Cristian Oliva
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain,Institut Clínic d´Oftalmología (ICOF), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Irene Vinagre
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain,Diabetes Unit, Hospital Clínic de Barcelona, Spain,Institut Clínic de Malalties Digestives i Metaboliques (ICMDM), Hospital Clínic de Barcelona, Spain
| | - Emilio Ortega
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain,Diabetes Unit, Hospital Clínic de Barcelona, Spain,Institut Clínic de Malalties Digestives i Metaboliques (ICMDM), Hospital Clínic de Barcelona, Spain
| | - Marga Gimenez
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain,Diabetes Unit, Hospital Clínic de Barcelona, Spain,Institut Clínic de Malalties Digestives i Metaboliques (ICMDM), Hospital Clínic de Barcelona, Spain
| | - Alfredo Vellido
- Intelligent Data Science and Artificial Intelligence (IDEAI) Research Center,Department of Computer Science, Facultat d’Informàtica de Barcelona (FIB), Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - Enrique Romero
- Intelligent Data Science and Artificial Intelligence (IDEAI) Research Center,Department of Computer Science, Facultat d’Informàtica de Barcelona (FIB), Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - Javier Zarranz-Ventura
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain,Institut Clínic d´Oftalmología (ICOF), Hospital Clínic de Barcelona, Barcelona, Spain,Diabetes Unit, Hospital Clínic de Barcelona, Spain,School of Medicine, Universitat de Barcelona, Spain,Correspondence: Javier Zarranz-Ventura, MD, PhD, C/ Sabino Arana 1, Barcelona 08028, Spain.
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Wish JB, Pergola P. Evolution of Mineralocorticoid Receptor Antagonists in the Treatment of Chronic Kidney Disease Associated with Type 2 Diabetes Mellitus. Mayo Clin Proc Innov Qual Outcomes 2022; 6:536-551. [PMID: 36277502 PMCID: PMC9578990 DOI: 10.1016/j.mayocpiqo.2022.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Chronic kidney disease (CKD) is one of the most frequent complications associated with type 2 diabetes mellitus (T2DM) and is also an independent risk factor for cardiovascular disease. The mineralocorticoid receptor (MR) is a nuclear receptor expressed in many tissue types, including kidney and heart. Aberrant and long-term activation of MR by aldosterone in patients with T2DM triggers detrimental effects (eg, inflammation and fibrosis) in these tissues. The suppression of aldosterone at the early stage of T2DM has been a therapeutic strategy for patients with T2DM-associated CKD. Although patients have been treated with renin-angiotensin system (RAS) blockers for decades, RAS blockers alone are not sufficient to prevent CKD progression. Steroidal MR antagonists (MRAs) have been used in combination with RAS blockers; however, undesired adverse effects have restricted their usage, prompting the development of nonsteroidal MRAs with better target specificity and safety profiles. Recently conducted studies, Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease (FIDELIO-DKD) and Finerenone in Reducing Cardiovascular Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD), have reported that finerenone, a nonsteroidal MRA, improves both renal and cardiovascular outcomes compared with placebo. In this article, we review the history of MRA development and discuss the possibility of its combination with other treatment options, such as sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide-1 receptor agonists, and potassium binders for patients with T2DM-associated CKD.
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Key Words
- ACEi, angiotensin-converting enzyme inhibitor
- ADA, American Diabetes Association
- AR, androgen receptor
- ARB, angiotensin II receptor blocker
- ARTS, minerAlocorticoid Receptor Antagonist Tolerability Study
- BP, blood pressure
- CKD, chronic kidney disease
- CV, cardiovascular
- CVD, cardiovascular disease
- DM, diabetes mellitus
- DN, diabetic nephropathy
- ESKD, end-stage kidney disease
- FIDELIO-DKD, Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease
- FIGARO-DKD, Finerenone in Reducing Cardiovascular Mortality and Morbidity in Diabetic Kidney Disease
- GLP-1 RA, glucagon-like peptide 1 receptor agonists
- GR, glucocorticoid receptor
- HF, heart failure
- HFrEF, heart failure with reduced ejection fraction
- KDIGO, Kidney Disease Improving Global Outcomes
- MR, mineralocorticoid receptor
- MRA, mineralocorticoid receptor antagonist
- PR, progesterone receptor
- RAAS, renin–angiotensin–aldosterone system
- RAS, renin–angiotensin system
- SGLT-2i, sodium-glucose cotransporter 2 inhibitor
- T2DM, type 2 diabetes mellitus
- UACR, urinary albumin-creatine ratio
- eGFR, estimated glomerular filtration rate
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Affiliation(s)
- Jay B. Wish
- Department of Medicine, Indiana University School of Medicine and Indiana University Health, Indianapolis,Correspondence: Address to Jay B. Wish, MD, Department of Medicine, Indiana University School of Medicine and Indiana University Health, 550 N, University Blvd, Suite 6100, Indianapolis IN 46202
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10
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Hurt RT, Croghan IT, Schroeder DR, Choi DS, Fischer K, Fokken S, Ebbert JO. Varenicline and Lorcaserin for Smoking Cessation and Weight Gain Prevention: A Randomized Clinical Trial. Mayo Clin Proc Innov Qual Outcomes 2022; 6:465-74. [PMID: 36160639 DOI: 10.1016/j.mayocpiqo.2022.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the safety and effectiveness of combination varenicline with lorcaserin in preventing post-cessation weight gain. Participants and Methods We conducted a randomized (varenicline for 12 weeks + lorcaserin for 24 weeks vs varenicline for 12 weeks + placebo for 24 weeks) phase II clinical study to obtain preliminary data on the safety and effectiveness of combination varenicline and lorcaserin in preventing post-cessation weight gain in overweight and obese smokers. Eighty-four overweight and obese (body mass index [BMI], 27-40 kg/m2) cigarette smokers were randomized before study termination (lorcaserin: n=40; placebo: n=44). The primary outcomes were weight and waist circumference (WC) changes at 12 and 24 weeks in smokers meeting criteria for prolonged smoking abstinence. Results Thirty-nine participants met criteria for prolonged smoking abstinence at 12 weeks (46%) and 21 at 24 weeks (25%). No significant treatment effect was observed at 12 weeks with lorcaserin compared with placebo (weight difference, −0.7 kg; 90% CI, −2.6 to 1.1 kg; P=.51; WC difference, −1.9 cm; 90% CI, −4.2 to 0.5 cm; P=.18; or BMI difference, −0.4 kg/m2; 90% CI, −1.1 to 0.3 kg/m2; P=.33). No significant treatment effect was observed between lorcaserin at 24 weeks compared with placebo (weight, 1.4 kg; 90% CI, −3.8 to 6.7 kg; P=.65; WC, −0.9 cm; 90% CI, −5.8 to 4.0 cm; P=.75; or BMI 0.29 kg/m2; 90% CI, −1.5 to 2.12 kg/m2; P=.79). Conclusion Weight gain and WC increases after prolonged smoking abstinence were not reduced using combination varenicline and lorcaserin. The results do not support further research in the obese and weight-concerned smoking population using lorcaserin or similar drugs. Trial Registration clinicaltrials.gov Identifier: NCT02412631
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Key Words
- BMI, body mass index
- CAMELLIA-TIMI 61 trial, Cardiovascular and Metabolic Effects of Lorcaserin in Overweight and Obese Patients – Thrombolysis in Myocardial Infarction 61, trial
- DM, diabetes mellitus
- FDA, Food and Drug Administration
- GLP-1 RA, glucagon like peptide-1 receptor agonist
- NRT, nicotine replacement therapy
- OR, odds ratio
- PCWG, post-cessation weight gain
- WC, waist circumference
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11
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Yusuf AP, Zhang JY, Li JQ, Muhammad A, Abubakar MB. Herbal medications and natural products for patients with covid-19 and diabetes mellitus: Potentials and challenges. Phytomed Plus 2022; 2:100280. [PMID: 35463625 PMCID: PMC9014648 DOI: 10.1016/j.phyplu.2022.100280] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/25/2022] [Accepted: 04/12/2022] [Indexed: 04/21/2023]
Abstract
BACKGROUND The presence of diabetes mellitus (DM) among COVID-19 patients is associated with increased hospitalization, morbidity, and mortality. Evidence has shown that hyperglycemia potentiates SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection and plays a central role in severe COVID-19 and diabetes comorbidity. In this review, we explore the therapeutic potentials of herbal medications and natural products in the management of COVID-19 and DM comorbidity and the challenges associated with the preexisting or concurrent use of these substances. METHODS Research papers that were published from January 2016 to December 2021 were retrieved from PubMed, ScienceDirect, and Google Scholar databases. Papers reporting clinical evidence of antidiabetic activities and any available evidence of the anti-COVID-19 potential of ten selected natural products were retrieved and analyzed for discussion in this review. RESULTS A total of 548 papers (73 clinical trials on the antidiabetic activities of the selected natural products and 475 research and review articles on their anti-COVID-19 potential) were retrieved from the literature search for further analysis. A total of 517 articles (reviews and less relevant research papers) were excluded. A cumulative sum of thirty-one (31) research papers (20 clinical trials and 10 others) met the criteria and have been discussed in this review. CONCLUSION The findings of this review suggest that phenolic compounds are the most promising phytochemicals in the management of COVID-19 and DM comorbidity. Curcumin and propolis have shown substantial evidence against COVID-19 and DM in humans and are thus, considered the best potential therapeutic options.
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Key Words
- 8-OHDG, 8-hydroxy-2’-deoxyguanosine
- ACE2
- ACE2, Angiotensin-converting enzyme 2
- ADMA, asymmetric de-methyl-arginine
- ARDS, acute respiratory distress syndrome
- COVID-19
- Comorbidity
- DM, diabetes mellitus
- Diabetes
- FBS, fasting blood sugar
- GLUT-4, glucose transporter-4
- GSK-3β, glycogen synthase kinase-3β
- HDL, high-density lipoprotein
- HOMA, homeostasis model assessment
- Herbal medication
- IAPP, islet amyloid polypeptide
- IFN, interferon
- IFNAR2, interferon-alpha receptor 2
- IL-6, interleukin-6
- LDL, low-density lipoprotein
- MDA, malondialdehyde
- Mpro, main protease
- Natural products
- PLpro, papain-like protease
- PON1, paraoxonase-1
- RBD, receptor-binding domain
- RCT, randomized control trial
- RdRp, RNA-dependent RNA polymerase
- SARS-CoV-2, severe acute respiratory syndrome coronavirus-2
- SFJDC, Shufeng Jiedu Capsule
- T1D, type 1 diabetes
- T2D, type 2 diabetes
- TAC, total antioxidant capacity
- TMPRSS2, transmembrane protease serine 2
- hs-CRP, high-sensitivity C-reactive protein
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Affiliation(s)
- Abdurrahman Pharmacy Yusuf
- Department of Biochemistry, School of Life Sciences, Federal University of Technology, P.M.B 65, Minna, Niger State, Nigeria
| | - Jian-Ye Zhang
- Guangzhou Municipal and Guangdong Provincial Key Laboratory of Molecular Target & Clinical Pharmacology, the NMPA and State Key Laboratory of Respiratory Disease, School of Pharmaceutical Sciences and the Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou 511436, P.R. China
| | - Jing-Quan Li
- The first Affiliated Hospital, Hainan Medical University, Haikou, P.R. China
| | - Aliyu Muhammad
- Department of Biochemistry, Faculty of Life Sciences, Ahmadu Bello University Zaria, 810107, Kaduna State, Nigeria
| | - Murtala Bello Abubakar
- Centre for Advanced Medical Research and Training, Usmanu Danfodiyo University, Sokoto, Nigeria
- Department of Physiology, Faculty of Basic Medical Sciences, College of Health Sciences, Usmanu Danfodiyo University, P.M.B. 2254, Sokoto, Nigeria
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12
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le Roux CW, Fils-Aimé N, Camacho F, Gould E, Barakat M. The relationship between early weight loss and weight loss maintenance with naltrexone-bupropion therapy. EClinicalMedicine 2022; 49:101436. [PMID: 35747175 PMCID: PMC9156890 DOI: 10.1016/j.eclinm.2022.101436] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 04/01/2022] [Accepted: 04/14/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Extended-release (ER) naltrexone/bupropion (NB) was associated with greater weight loss than placebo in four randomized, 56-week trials. The association of NB with longer-term maintenance of weight loss remains unknown. METHODS We conducted a post-hoc analysis of four phase III, randomized, double-blind, placebo-controlled, 56-week studies (COR-I, COR-II, COR-BMOD, and COR-DM), the placebo-controlled cardiovascular outcomes trial LIGHT (208 weeks), and the randomized, open-label trial IGNITE (78 weeks). Included subjects were treated with NB 32 mg/360 mg or placebo, with baseline, week 16, and final time point data. The primary outcome was Kaplan-Meier-estimated weight loss maintenance in each study for up to 204 weeks. FINDINGS Our analysis included data from 10,198 particpants (NB=5412; placebo=4786). Proportions of patients with ≥5% or ≥10% weight loss maintenance were numerically higher for NB vs. placebo in all studies and time points. Differences were statistically significant for ≥5% weight loss maintenance in COR-BMOD and COR-I/-II at weeks 52 and 56 and the LIGHT study at weeks 52, 104, and 208. For ≥10% weight loss maintenance, differences were statistically significant in COR-I/COR-II at weeks 52 and 56. INTERPRETATION These data suggest that NB could be used as part of long-term, comprehensive weight loss and weight loss maintenance strategies. FUNDING Orexigen Therapeutics, Inc. and Bausch Health Canada.
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Key Words
- AHEAD, Action in Health for Diabetes
- BMI, body mass index
- BMOD, behavior modification therapy
- CBT, cognitive behavioral therapy
- CI, confidence interval
- CLI, comprehensive lifestyle intervention
- COR, Contrave Obesity Research
- COR-BMOD
- COR-DM
- COR-I
- COR-II
- DM, diabetes mellitus
- ER, extended-release
- IGNITE
- LIGHT
- MACE, major adverse cardiovascular events
- Maintenance
- NAFLD, non-alcoholic fatty liver disease
- NB, naltrexone/bupropion
- NWCR, National Weight Control Registry
- Naltrexone/bupropion
- SAEs, serious adverse events
- SD, standard deviation
- SMD, standardized mean difference
- Weight loss
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Affiliation(s)
- Carel W. le Roux
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Ireland
- Corresponding author at: Diabetes Complications Research centre, UCD Conway Institute, University College Dublin, Belfield, Dublin 4, Ireland.
| | | | | | - Errol Gould
- Currax Pharmaceuticals LLC, Brentwood, TN, United States of America
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13
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Van Helm S, Krops LA, Dekker R, Vrieling AH. Effectiveness of (Active) Lifestyle Interventions in People With a Lower Limb Amputation: A Systematic Review. Arch Rehabil Res Clin Transl 2022; 4:100207. [PMID: 36545531 DOI: 10.1016/j.arrct.2022.100207] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective To explore the effectiveness of (active) lifestyle interventions for the health of people with a lower limb amputation in order to offer effective interventions during rehabilitation that may improve physical and psychosocial functioning of people with lower limb amputation. Data Sources PubMed, CINAHL and Embase were searched from inception to February 2021. Study Selection Inclusion criteria were (1) (quasi-)randomized controlled trial; (2) minimum of 10 participants with a lower limb amputation; (3) lifestyle intervention focusing on physical activity, smoking habits, alcohol use, nutrition, and/or stress management; (4) focus on health outcomes; (5) participants older than 18 years; (6) studies in Dutch, German, or English; and (7) primary research. Title, abstract, and full-text screening and quality assessment were performed by 2 independent assessors. Data Extraction Of 2460 studies identified, 13 studies were included in this review. Two studies were of moderate methodological quality, 2 studies were of medium quality, and 9 studies were of poor quality. Data Synthesis Lifestyle interventions in the included studies focused on physical activity and stress management. These interventions seemed effective for improving physical fitness, walking capacity, changes in body mass, quality of life, and intensity of physical activity. Conclusion Lifestyle interventions focusing on physical activity and stress management seem effective for improving physical and psychosocial functioning of people with a lower limb amputation. However, the findings should be interpreted with caution given the limited methodological quality of the included studies. Future research should evaluate the effectiveness of interventions on nutrition, smoking habits, and alcohol use and the effectiveness of combined interventions in people with a lower limb amputation.
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Shi S, Tang Y, Zhao Q, Yan H, Yu B, Zheng Q, Li Y, Zheng L, Yuan Y, Zhong J, Xu J, Wu Y, Xu J, Chen L, Li S, Jiang J, Wang J, Fan J, Chen M, Tang B, Li W, Wu Q, Shi B, Zhou S, Zhao X, Yin Y, Zhang Z, Zhong G, Han X, Liu F, Wu M, Gao L, Yang B, Huang H, Huang C. Prevalence and risk of atrial fibrillation in China: A national cross-sectional epidemiological study. Lancet Reg Health West Pac 2022; 23:100439. [PMID: 35800039 PMCID: PMC9252928 DOI: 10.1016/j.lanwpc.2022.100439] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common persistent cardiac arrhythmia. This study aimed to estimate its prevalence and explore associated factors in adults aged 18 years or older in China. METHODS Study data were derived from a national sample from July 2020 to September 2021. Participants were recruited using a multistage stratified sampling method from twenty-two provinces, autonomous regions, and municipalities in China. AF was determined based on a history of diagnosed AF or electrocardiogram results. FINDINGS A total of 114,039 respondents were included in the final analysis with a mean age of 55 years (standard deviation 17), 52·1% of whom were women. The crude prevalence of AF was 2·3% (95% confidence interval [CI] 1·7-2·8) and increased with age. The age-standardized AF prevalence was 1·6% (95% CI 1·6-1·7%) overall, and 1·7% (1·6-1·8%), 1·4% (1·3-1·5%), 1·6% (95% CI 1·5-1·7%), and 1·7% (1·6-1·9%) in men, women, urban areas, and rural areas, respectively. The prevalence was higher in the central regions (2·5%, 2·3-2·7%) than in the western regions (1·5%, 1·0-2·0%) and eastern regions (1·1%, 1·0-1·2%) in the overall population, either in the gender or residency subgroups. The associated factors for AF included age (per 10 years; odds ratio 1·41 [95% CI 1·38-1·46]; p < 0·001), men (1·34 [1·24-1·45]; p < 0·001), hypertension (1·22 [1·12-1·33]; p < 0·001), coronary heart disease (1·44 [1·28-1·62]; p < 0·001), chronic heart failure (3·70 [3·22-4·26]; p < 0·001), valvular heart disease (2·13 [1·72-2·63]; p < 0·001), and transient ischaemic attack/stroke (1·22 [1·04-1·43]; p = 0·013). INTERPRETATION The prevalence of AF was 1.6% in the Chinese adult population and increased with age, with significant geographic variation. Older age, male sex, and cardiovascular disease were potent factors associated with AF. It is crucial to increase the awareness of AF and disseminate standardized treatment in clinical settings to reduce the disease burden. FUNDING This research was supported the Nature Science Foundation of Hubei province (No: 2017CFB204).
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Key Words
- AF, atrial fibrillation
- Adult
- Atrial fibrillation
- BMI, body mass index
- CHD, coronary heart disease
- CHF, chronic heart failure
- CI, confidence interval
- China
- DM, diabetes mellitus
- ECG, electrocardiogram
- Factor
- HTN, hypertension
- OR, odds ratio
- Prevalence
- SD, standard deviation
- TIA, transient ischaemic attack
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Affiliation(s)
- Shaobo Shi
- Department of Cardiology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, Wuhan 430060, Hubei, China
- Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China
- Hubei Key Laboratory of Cardiology, Wuhan University, Wuhan 430060, China
| | - Yanhong Tang
- Department of Cardiology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, Wuhan 430060, Hubei, China
- Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China
- Hubei Key Laboratory of Cardiology, Wuhan University, Wuhan 430060, China
| | - Qingyan Zhao
- Department of Cardiology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, Wuhan 430060, Hubei, China
- Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China
- Hubei Key Laboratory of Cardiology, Wuhan University, Wuhan 430060, China
| | - Hong Yan
- School of Public Health,Wuhan University, Wuhan 430071, China
| | - Bin Yu
- School of Public Health,Wuhan University, Wuhan 430071, China
| | - Qiangsun Zheng
- The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China
| | - Yigang Li
- Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Liangrong Zheng
- The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Yiqiang Yuan
- Henan Provincial Chest Hospital, Zhengzhou 450008, China
| | - Jingquan Zhong
- Qilu Hospital of Shandong University, Jinan 250063, China
| | - Jian Xu
- Anhui Provincial Hospital, Hefei 230001, China
| | - Yanqing Wu
- The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Jing Xu
- Tianjin Chest Hospital, Tianjin 300222, China
| | - Lin Chen
- Fujian Provincial Hospital, Fuzhou 350013, China
| | - Shufeng Li
- The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Jian Jiang
- West China Hospital of Sichuan University, Chengdu 610044, China
| | - Jingfeng Wang
- Sun Yat-sen Memorial Hospital, Guangzhou 510120, China
| | - Jie Fan
- The First People's Hospital of Yunnan Province, Kunming 650034, China
| | | | - Baopeng Tang
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, China
| | - Wei Li
- The Affiliated Hospital of Guizhou Medical University, Guizhou 550004, China
| | - Qiang Wu
- Guizhou Provincial People's Hospital, Guizhou 550002, China
| | - Bei Shi
- Affiliated Hospital of Zunyi Medical University, Zunyi 563099, China
| | - Shenghua Zhou
- The Second Xiangya Hospital of Central South University, Changsha 430062, China
| | - Xingsheng Zhao
- Inner Mongolia Autonomous Region People's Hospital, Huhehot 010020, China
| | - Yuehui Yin
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Zheng Zhang
- The First Hospital of Lanzhou University, Lanzhou 730013, China
| | - Guoqiang Zhong
- The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Xuebin Han
- Shanxi Cardiovascular Hospital, Taiyuan 030024, China
| | - Fan Liu
- The Second Hospital of Hebei Medical University, Shijiazhuang 050004, China
| | - Ming Wu
- Hainan General Hospital, Haikou 570311, China
| | - Lianjun Gao
- The First Affiliated Hospital of Dalian Medical University, Dalian 116051, China
| | - Bo Yang
- Department of Cardiology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, Wuhan 430060, Hubei, China
- Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China
- Hubei Key Laboratory of Cardiology, Wuhan University, Wuhan 430060, China
| | - He Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, Wuhan 430060, Hubei, China
- Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China
- Hubei Key Laboratory of Cardiology, Wuhan University, Wuhan 430060, China
- Corresponding authors at: Department of Cardiology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, Wuhan, Hubei 430060, China.
| | - Congxin Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, Wuhan 430060, Hubei, China
- Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China
- Hubei Key Laboratory of Cardiology, Wuhan University, Wuhan 430060, China
- Corresponding authors at: Department of Cardiology, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, Wuhan, Hubei 430060, China.
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Asgary R, Beideck E, Naderi R. Diabetes care and its predictors among persons experiencing homelessness compared with domiciled adults with diabetes in New York City; An observational study. EClinicalMedicine 2022; 48:101418. [PMID: 35516444 PMCID: PMC9062666 DOI: 10.1016/j.eclinm.2022.101418] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/01/2022] [Accepted: 04/08/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND There is a dearth of data regarding diabetes control among patients experiencing homelessness. METHODS We retrospectively collected type 2 diabetes-related measurements, sociodemographic, and clinical indicators from medical records of all incoming adults with diabetes (n = 418; homeless: 356 and domiciled: 58) seen in shelter-clinics in New York City in 2019. The outcomes were the rates of inadequately managed diabetes and associated factors. FINDINGS Bivariate analysis showed that patients experiencing homelessness (63% Black; 32% Hispanic) 134/304 (43⋅9%) were more likely than domiciled patients 13/57 (22·8%) to have inadequately managed diabetes (OR 2⋅67, CI 1·38-5·16, p = 0⋅003). The average HbA1c among homeless (8·4%, SD± 2·6) was higher than that of domiciled persons (7·3%, SD± 1·8, p = 0·002). In logistic regression, domiciled status (OR 0⋅ 42, CI 0·21 - 0·84, p = 0·013), older age (OR 0·97, CI 0·95 - 0·99, p = 0·004), and non-Hispanic/Latino ethnicity were associated with well-managed diabetes. Among persons experiencing homelessness, non-Hispanic/Latino (OR 0·61, CI 0·37-0·99, p = 0·047) and older age (0·96, CI 0·94-0·99, p = 0·003) were associated with well-managed diabetes. In linear regression, mental illness (-0·11, p = 0·048) and older age (-0·15, p = 0·010) were associated with lower HbA1c, suggesting better support in respective shelters. There was no statistically significant association between inadequately managed diabetes with several traditional risk factors including substance or alcohol use disorder, health insurance, or other chronic diseases. INTERPRETATION Interventions at shelters or shelter-clinics should target subgroups in addition to addressing traditional risk factors to improve diabetes control. mHealth strategies could be considered to improve engagement, care delivery, and medication taking. Ultimately, homelessness itself needs to be addressed. FUNDING There are no funding sources to declare.
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Key Words
- BMI, body mass index
- BP, blood pressure
- CAD, coronary artery disease
- CKD, chronic kidney disease
- DM, diabetes mellitus
- Diabetes mellitus
- GFR, glomerular filtration rate
- HTN, hypertension
- HbA1c, hemoglobin A1c
- Health disparities
- Homeless
- LDL, low density lipoprotein
- PCP, primary care physician
- Primary care
- Quality care
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Affiliation(s)
- Ramin Asgary
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW, Washington, D.C. 20052, USA
- Weill Cornell Medical College of Cornell University, 525 East 68th Street, New York, NY 10065, USA
- Corresponding author.
| | - Elena Beideck
- Weill Cornell Medical College of Cornell University, 525 East 68th Street, New York, NY 10065, USA
| | - Rosanna Naderi
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW, Washington, D.C. 20052, USA
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16
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Zhu Y, Hu J, Zhang M, Xue Q, Liu H, Wang R, Wang X, Cheng Z, Zhao Q. Influence of Baseline HbA1c and Antiplatelet Therapy on 1-Year Vein Graft Outcome. JACC Asia 2022; 2:197-206. [PMID: 36339126 PMCID: PMC9627937 DOI: 10.1016/j.jacasi.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND The influence of baseline HbA1c levels on vein graft outcomes post coronary artery bypass grafting (CABG) remains unclear. OBJECTIVE The purpose of this study was to assess the association between baseline HbA1c and 1-year vein graft patency, and the effects of antiplatelet therapy on the 1-year vein graft patency after CABG in patients with baseline HbA1c <6.5% vs ≥6.5%. METHODS We examined the subgroups with baseline HbA1c <6.5% vs ≥6.5% from the DACAB trial (NCT02201771), in which 500 patients were randomly allocated to receive ticagrelor plus aspirin (T+A), ticagrelor alone (T), or aspirin alone (A) for 1 year after CABG. The primary outcome was the vein graft patency (FitzGibbon grade A) at 1 year. RESULTS A total of 405 patients with available baseline HbA1c data were included in this subgroup analysis. Of them, there were 233 patients (678 vein grafts) with baseline HbA1c <6.5% and 172 patients (512 vein grafts) with baseline HbA1c ≥6.5%. Compared with the HbA1c <6.5% subgroup, the HbA1c ≥6.5% subgroup showed worse 1-year vein graft patency (adjusted odds ratio [OR] for nonpatency: 1.69, 95% confidence interval [CI]: 1.08-2.64). T+A showed higher vein graft patency than A in both HbA1c <6.5% (adjusted OR for nonpatency: 0.34, 95% CI: 0.15-0.75) and HbA1c ≥6.5% subgroups (adjusted OR for nonpatency: 0.45, 95% CI: 0.19-1.09), without an interaction effect (P for interaction = 0.335), whereas T did not show more significant improvement than A in both subgroups. CONCLUSIONS In the DACAB trial, lower baseline HbA1c was associated with higher vein graft patency 1 year after CABG. T+A improved 1-year vein graft patency vs A, irrespective of baseline HbA1c.
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Affiliation(s)
- Yunpeng Zhu
- Department of Cardiovascular Surgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junlong Hu
- Department of Cardiovascular Surgery, Henan Provincial People's Hospital Heart Center, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Minlu Zhang
- Department of Cancer Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Qing Xue
- Department of Cardiovascular Surgery, Changhai Hospital of Shanghai, Shanghai, China
| | - Hao Liu
- Department of Cardiothoracic Surgery, Xinhua Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rui Wang
- Department of Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaowei Wang
- Department of Cardiovascular Surgery, Jiangsu Province Hospital, Nanjing, China
| | - Zhaoyun Cheng
- Department of Cardiovascular Surgery, Henan Provincial People's Hospital Heart Center, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Qiang Zhao
- Department of Cardiovascular Surgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
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17
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Abate HK, Ferede YM, Mekonnen CK. Adherence to physical exercise recommendations among type 2 diabetes patients during the COVID-19 pandemic. Int J Afr Nurs Sci 2022; 16:100407. [PMID: 35309376 PMCID: PMC8924031 DOI: 10.1016/j.ijans.2022.100407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 02/25/2022] [Accepted: 03/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background In the era of the COVID-19 pandemic, nonadherence to the recommended physical exercise for diabetic patients is a difficult issue. Regular physical exercise is critical for reducing further complications of diabetes mellitus and the COVID-19 pandemic. The purpose of this study was to determine the predictors of type 2 adult diabetes patients’ exercise recommendations during the COVID-19 pandemic. Methods An institution-based cross-sectional study was conducted among 576 diabetes mellitus patients from August 1, 2020, to September 28, 2020. A systematic random sampling technique was used to select the study participants. An interviewer-administered questionnaire was used to collect the data. Frequency tables and percentages were used to explain the study variables. A binary logistic regression was used to investigate the relationship between the dependent and independent variables. Result A total of 576 diabetes mellitus patients participated in the study, with a response rate of 99.3%. The overall prevalence of exercise adherence was 26.4%, whereas 73.6% were non-adherents to exercise recommendations. Rural residency (AOR = 1.95, 95% CI: 1.16–3.27) and COVID-19 related knowledge (AOR = 9.95, 95% CI: 41.14–5.24) were both strongly associated with exercise recommendations. Conclusion In this study, only one-fourth of patients had exercised adherence during the era of the COVID-19 pandemic. Knowledge about COVID-19 was one of the factors that was strongly associated with adherence to exercise recommendations for diabetes patients. During the COVID-19 pandemic, encouraging home-based exercises can improve adherence to exercise recommendations.
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Affiliation(s)
- Hailemichae Kindie Abate
- Medical Nursing Department, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Yohanes Mulu Ferede
- Medical Nursing Department, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Chilot Kassa Mekonnen
- Medical Nursing Department, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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18
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Kaur M, Verma BR, Zhou L, Lak HM, Kaur S, Sammour YM, Kapadia SR, Grimm RA, Griffin BP, Xu B. Association of pepper intake with all-cause and specific cause mortality - A systematic review and meta-analysis. Am J Prev Cardiol 2022; 9:100301. [PMID: 34977833 PMCID: PMC8688560 DOI: 10.1016/j.ajpc.2021.100301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 11/28/2021] [Accepted: 12/02/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To conduct a comprehensive systematic review and meta-analysis to compare mortality and other clinical outcomes associated with chili pepper (CP) consumption versus no/rare consumption of CP. METHODS A comprehensive search was performed using Ovid, Cochrane, Medline, EMBASE, and Scopus from inception till January 16, 2020. Observational studies and randomized controlled trials were included, while pediatric/animal studies, letters/case reports, reviews, abstracts, and book chapters were excluded. All-cause mortality was studied as the primary outcome. Cardiovascular mortality, cancer-related deaths and cerebrovascular accidents were studied as secondary outcomes. RESULTS From 4729 studies, four studies met the inclusion criteria. Random effects pooled analysis showed that all-cause mortality among CP consumers was lower, compared to rare/non-consumers, with a hazard ratio (HR) of 0.87 [95% CI: 0.85-0.90; p<0.0001; I 2=1%]. HR for cardiovascular mortality was 0.83 [95% CI: 0.74-0.95; p = 0.005, I 2=66%] and for cancer-related mortality as 0.92 [95% CI: 0.87-0.97; p = 0.001; I 2=0%]. However, the HR for CVA was 0.78 [95% CI: 0.56-1.09; p = 0.26; I2 =60%]. The mode and amount of CP consumption varied across the studies, and data were insufficient to design an optimal strategy guiding its intake. CONCLUSION Regular CP consumption was associated with significantly lower all-cause, cardiovascular, and cancer-related mortalities. However, based on current literature, it is difficult to derive a standardized approach to guide the optimal mode and amount of CP consumption. This warrants well-designed prospective studies to further investigate the potential health benefits of CP consumption.
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Affiliation(s)
- Manpreet Kaur
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195
| | - Beni R Verma
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, 44195
| | - Leon Zhou
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, 44195
| | | | - Simrat Kaur
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, 44195
| | - Yasser M Sammour
- Department of Internal Medicine, University of Missouri-Kansas City, MO, 64110
| | - Samir R Kapadia
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195
| | - Richard A Grimm
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195
| | - Brian P Griffin
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195
| | - Bo Xu
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195
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19
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Abstract
Background/Objectives Cirrhosis of liver is associated with loss of liver function, portal hypertension, and pancreatic β-cell dysfunction leading to hepatogenous diabetes (HD). Often HD is an underestimated and understudied problem, particularly in the Indian subcontinent, where the prevalence of both Chronic liver disease (CLD) and diabetes is high. Hence this study was planned to highlight the prevalence of HD and its association with the severity of cirrhosis. Methods A total of 121 cirrhotic patients without a history of diabetes were included in this prospective cross-sectional study. Seventy five g oral glucose tolerance test (OGTT) was done in all patients. Fasting serum insulin levels were done to calculate insulin resistance (IR) using homeostatic model assessment-insulin resistance (HOMA-IR). Upper gastrointestinal endoscopy was done to detect varices. Patients were divided into HD group and non-HD group for comparison of results. Results HD was seen in 52 (42.98%) patients; among them, 63.4% did not show evidence of HD by fasting plasma glucose (FPG) levels. Impaired glucose tolerance (IGT) was seen in 58 (47.93%) patients. Compared with the non-HD group, the HD group had significantly higher model for end-stage liver disease (MELD) score (P = 0.038), HOMA-IR (P < 0.001), incidence of large varices (P < 0.001) and variceal bleeding (P < 0.001). A statistically significant association was noted between HD and Hepatocellular carcinoma (HCC) (P < 0.001). Conclusion Patients with cirrhosis had a high prevalence of IGT, IR, and HD. The presence of HD is well associated with the severity of cirrhosis in the form of higher MELD score (>15), CTP score (>10), higher bilirubin levels, large varices, bleeding varices, and HCC. FPG levels and glycated hemoglobin (HbA1c) cannot be relied upon, and OGTT aids in the unmasking of HD in these patients.
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Key Words
- 120-min PG, 120 min plasma glucose
- AASLD, American association for the study of liver diseases
- ADA, American diabetic association
- CLD, chronic liver disease
- CTP score, Child-Turcotte-Pugh score
- DM, diabetes mellitus
- FPG, fasting plasma glucose
- HCC, hepatocellular carcinoma
- HD, hepatogenous diabetes
- HOMA-IR, homeostatic model assessment-insulin resistance
- HVPG, hepatic venous pressure gradient
- HbA1c, glycated hemoglobin
- IGF, insulin-like growth factor
- IGT, impaired glucose tolerance
- IR, insulin resistance
- MELD score, model for end-stage liver disease
- OGTT, oral glucose tolerance test
- SPSS, statistical software for social sciences
- T2DM, type 2 diabetes mellitus
- chronic liver disease
- hepatogenous diabetes
- impaired glucose tolerance
- insulin resistance
- variceal bleeding
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20
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Fan R, Leasure AC, Damsky W, Cohen JM. Association between atopic dermatitis and COVID-19 infection: A case-control study in the All of Us research program. JAAD Int 2021; 6:77-81. [PMID: 34977817 PMCID: PMC8712258 DOI: 10.1016/j.jdin.2021.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND There is an incomplete understanding of the risk of COVID-19 infection in atopic dermatitis (AD) patients. OBJECTIVE To evaluate the risk of COVID-19 infection in AD patients in a large, diverse cohort. METHODS A case-control study of the All of Us cohort to analyze the association between AD and COVID-19. Comorbidities and risk factors were compared between cases and controls using multivariable analyses. RESULTS In a cohort of 11,752 AD cases with 47,008 matched controls, AD patients were more likely to have a COVID-19 diagnosis (4.2% vs 2.8%, P < .001). AD remained significantly associated with COVID-19 in multivariable analysis (odds ratio, 1.29; P < .001) after adjusting for demographic factors and comorbidities. LIMITATIONS Ascertainment of AD and COVID-19 cases using electronic health records and lack of clinical data on AD severity or therapy and COVID-19 outcomes. CONCLUSION AD is associated with increased odds of COVID-19 infection even after controlling for common comorbidities.
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Affiliation(s)
- Ryan Fan
- Yale School of Medicine, New Haven, Connecticut
| | | | - William Damsky
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut,Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - Jeffrey M. Cohen
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut,Correspondence to: Jeffrey M. Cohen, MD, Department of Dermatology, 15 York St, New Haven, Connecticut 06510.
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21
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Simard T, Jung RG, Di Santo P, Harnett DT, Abdel-Razek O, Ramirez FD, Motazedian P, Parlow S, Labinaz A, Moreland R, Marbach J, Poulin A, Levi A, Majeed K, Boland P, Couture E, Sarathy K, Promislow S, Russo JJ, Chong AY, So D, Froeschl M, Dick A, Labinaz M, Le May M, Holmes DR, Hibbert B. Modifiable Risk Factors and Residual Risk Following Coronary Revascularization: Insights From a Regionalized Dedicated Follow-Up Clinic. Mayo Clin Proc Innov Qual Outcomes 2021; 5:1138-1152. [PMID: 34934904 PMCID: PMC8654638 DOI: 10.1016/j.mayocpiqo.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To ensure compliance with optimal secondary prevention strategies and document the residual risk of patients following revascularization, we established a postrevascularization clinic for risk-factor optimization at 1 year, with outcomes recorded in a web-based registry. Although coronary revascularization can reduce ischemia, medical treatment of coronary artery disease (CAD) remains the cornerstone of ongoing risk reduction. While standardized referral pathways and protocols for revascularization are prevalent and well studied, post-revascularization care is often less formalized. PATIENTS AND METHODS The University of Ottawa Heart Institute is a tertiary-care center providing coronary revascularization services. From 2015 to 2019, data were prospectively recorded in the CAPITAL revascularization registry, and patient-level procedural, clinical, and outcome data are collected in the year following revascularization. Major adverse cardiovascular event (MACE) was defined as death, myocardial infarction, unplanned revascularization, or cerebrovascular accident. Kaplan-Meier curves were generated to evaluate time-to-event data for clinical outcomes by risk-factor management, and comparisons were performed using log-rank tests and reported by hazard ratio (HR) and 95% confidence intervals (CIs). RESULTS A cohort of 4147 patients completed 1-year follow-up after revascularization procedure that included 3462 undergoing percutaneous coronary intervention (PCI), 589 undergoing coronary artery bypass graft (CABG), and 96 undergoing both PCI and CABG. In the year following revascularization (median follow-up 13.3 months-interquartile range [IQR]: 11.9-16.5) 11% of patients experienced MACE, with female patients being disproportionately at risk. Moreover, 47.7% of patients had ≥2 risk factors (diabetes, dyslipidemia, overweight, active smoker) at the time of follow-up, with 45.0% of patients with diabetes failing to achieve target hemoglobin (Hb) A1c, 54.8% of smokers continuing to smoke, and 27.1% of patients failing to achieve guideline-directed lipid targets. CONCLUSION Patients who have undergone revascularization procedures remain at elevated risk for MACE, and inadequately controlled risk factors are prevalent in follow-up. This highlights the need for aggressive secondary prevention strategies and implementation of programs to optimize postrevascularization care.
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Key Words
- ACS, acute coronary syndrome
- CABG, coronary artery bypass grafting
- CAD, coronary artery disease
- CAPITAL, Cardiovascular And Percutaneous clinical TriALs
- DM, diabetes mellitus
- HR, hazard ratio
- HbA1c, hemoglobin A1C
- MACE, major adverse cardiovascular event
- MI, myocardial infarction
- NSTEMI, non-ST elevation MI
- PCI, percutaneous coronary intervention
- STEMI, ST elevation MI
- UA, unstable angina
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Affiliation(s)
- Trevor Simard
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Richard G. Jung
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Pietro Di Santo
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - David T. Harnett
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Omar Abdel-Razek
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - F. Daniel Ramirez
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
- L’Institut de Rythmologie et Modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Pouya Motazedian
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Simon Parlow
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Alisha Labinaz
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Robert Moreland
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Jeffrey Marbach
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Anthony Poulin
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Amos Levi
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kamran Majeed
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia
- School of Medicine, University of Western Australia, Perth, Western Australia
| | - Paul Boland
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Etienne Couture
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kiran Sarathy
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Steven Promislow
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Juan J. Russo
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Aun Yeong Chong
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Derek So
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Michael Froeschl
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Alexander Dick
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marino Labinaz
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Michel Le May
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - David R. Holmes
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Benjamin Hibbert
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
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22
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Shimoda M, Tanaka Y, Kokutou H, Furuuchi K, Osawa T, Morimoto K, Yano R, Yoshimori K, Ohta K. Actinomyces meyeri pleural infection that was difficult to treat due to delayed culture: A case report and literature review of 28 cases. Respir Med Case Rep 2021; 34:101530. [PMID: 34745867 DOI: 10.1016/j.rmcr.2021.101530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/15/2021] [Accepted: 10/19/2021] [Indexed: 11/24/2022] Open
Abstract
An eighty-three-year-old man suffered from cough, right chest pain, and progressive dyspnea for sixteen days. He had hypoxemia, high white blood cells and C-reactive protein, and moderate right-sided pleural effusion on radiographic imaging. A pleural fluid examination revealed exudate. He was diagnosed with pleural infection and treated with intravenous ampicillin/sulbactam. On the second day of hospitalization, the treatment was changed to levofloxacin and clindamycin due to drug eruption. He improved gradually and was prescribed only oral levofloxacin on the eighteenth day of hospitalization. However, improvements in inflammation and imaging findings were poor. Actinomyces meyeri resistant to fluoroquinolones was cultured from a pleural effusion sample on the twenty-sixth day of hospitalization. The treatment was changed to oral clindamycin, and his medical condition subsequently improved. We reviewed twenty-eight patients with Actinomyces pleural infection and thirty-eight patients with other pleural infection phenotypes from our hospital and published case reports. Actinomyces pleural infection is a long-term process and results in a large amount of pleural effusion compared to other pleural infection phenotypes. These results might be related to the fact that Actinomyces is a slow-growing organism.
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Abd El-Raheem GOH, Mohamed DSI, Yousif MAA, Elamin HES. Characteristics and severity of COVID-19 among Sudanese patients during the waves of the pandemic. Sci Afr 2021; 14:e01033. [PMID: 34729446 PMCID: PMC8553365 DOI: 10.1016/j.sciaf.2021.e01033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 10/23/2021] [Accepted: 10/25/2021] [Indexed: 12/24/2022] Open
Abstract
COVID-19 is associated with marked morbidity and mortality. COVID-19 symptoms ranged from mild symptoms to severe pneumonia requiring admission to intensive care unit. Imperial College reported that, this second wave in Khartoum is expected to be similar to the first wave. The aim of our study was to study the characteristics and severity of COVID-19 among Sudanese patients during the waves of the pandemic. A hospital-based analytical Cross-Sectional study assessed the characteristics of COVID-19 patients who attended Imperial Hospital since November 2020, Khartoum, Sudan. Data were collected, retrospectively, from the medical records of COVID-19 patients. The characteristics of the patients were recorded. The statistical package for social sciences (SPSS-23) was used to describe and analyze the data. Descriptive statistics and chi-square test were used; tests were considered statistically significant when p < 0.05. Of the 138 participants, 75.4% were aged above 60 years. Males were 61.6%. Severe cases were 37.7%, with higher rate in the third wave (p = 0.000). Duration of hospitalization was ≤ 5 days in 60.9% of the cases, majority were from the 2nd wave (p = 0.001). Comorbidities of COVID-19 patients were more among non-severe cases (p = 0.001). COVID-19 symptoms were more prevalent in non-severe cases. Complications were more in severe cases (p = 0.000). Odds ratio of having ischemic stroke was 6.833 [95%CI: 2.092-22.321] based on COVID-19 severity. The elderly population were the majority. More males were getting admitted. Atypical symptoms were reported beside the common symptoms. Wider multi-center studies are recommended in order to complete the big picture of COVID-19 in Sudan.
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Affiliation(s)
- Ghada Omer Hamad Abd El-Raheem
- Pharmacy Department, American Board Certified Critical Care Clinical Pharmacist, Imperial Specialized Hospital, Alsharif Alhindi street, Khartoum, Sudan
| | - Doaa Salih Ibrahim Mohamed
- Emergency Department, Senior Medical Officer, Imperial Specialized Hospital, Alsharif Alhindi street, Khartoum, Sudan
| | - Maysoun Ahmed Awad Yousif
- Emergency Department, Senior Medical Officer, Imperial Specialized Hospital, Alsharif Alhindi street, Khartoum, Sudan
| | - Hind Eltayeb Salih Elamin
- Full Membership of Royal College of Physicians in London, Certificate in Research Methodology, Harvard University, Physician in Abu Dhabi Telemedicine Center, P.O. Box 147722, Abu Dhabi, United Arab Emirates
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24
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Wang Z, Fu W, Huo M, He B, Liu Y, Tian L, Li W, Zhou Z, Wang B, Xia J, Chen Y, Wei J, Abliz Z. Spatial-resolved metabolomics reveals tissue-specific metabolic reprogramming in diabetic nephropathy by using mass spectrometry imaging. Acta Pharm Sin B 2021; 11:3665-77. [PMID: 34900545 DOI: 10.1016/j.apsb.2021.05.013] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/26/2021] [Accepted: 05/05/2021] [Indexed: 12/22/2022] Open
Abstract
Detailed knowledge on tissue-specific metabolic reprogramming in diabetic nephropathy (DN) is vital for more accurate understanding the molecular pathological signature and developing novel therapeutic strategies. In the present study, a spatial-resolved metabolomics approach based on air flow-assisted desorption electrospray ionization (AFADESI) and matrix-assisted laser desorption ionization (MALDI) integrated mass spectrometry imaging (MSI) was proposed to investigate tissue-specific metabolic alterations in the kidneys of high-fat diet-fed and streptozotocin (STZ)-treated DN rats and the therapeutic effect of astragaloside IV, a potential anti-diabetic drug, against DN. As a result, a wide range of functional metabolites including sugars, amino acids, nucleotides and their derivatives, fatty acids, phospholipids, sphingolipids, glycerides, carnitine and its derivatives, vitamins, peptides, and metal ions associated with DN were identified and their unique distribution patterns in the rat kidney were visualized with high chemical specificity and high spatial resolution. These region-specific metabolic disturbances were ameliorated by repeated oral administration of astragaloside IV (100 mg/kg) for 12 weeks. This study provided more comprehensive and detailed information about the tissue-specific metabolic reprogramming and molecular pathological signature in the kidney of diabetic rats. These findings highlighted the promising potential of AFADESI and MALDI integrated MSI based metabolomics approach for application in metabolic kidney diseases.
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Key Words
- ADP, adenosine diphosphate
- AFADESI, air flow-assisted desorption electrospray ionization
- AGEs, advanced glycation end products
- AMP, adenosine monophosphate
- AMPK, adenosine monophosphate activated protein kinase
- AST, astragaloside IV
- ATP, adenosine triphosphate
- Astragaloside IV
- BUN, blood urea nitrogen
- CL, cardiolipin
- Cre, creatinine
- DAG, diacylglycerol
- DESI, desorption electrospray ionization
- DM, diabetes mellitus
- DN, diabetic nephropathy
- DPA, docosapentaenoic acid
- Diabetic nephropathy
- ESKD, end-stage kidney disease
- FBG, fasting blood glucose
- GLU, glucose
- GMP, guanosine monophosphate
- GSH, glutathione
- H&E, hematoxylin and eosin
- HPLC, high-performance liquid chromatography
- HbA1c, glycosylated hemoglobin
- LysoPC, lysophosphatidylcholine
- LysoPG, lysophosphatidylglycerol
- MALDI, matrix-assisted laser desorption ionization
- MS, mass spectrometry
- MSI, mass spectrometry imaging
- Mass spectrometry imaging
- Metabolic reprogramming
- NMR, nuclear magnetic resonance
- Na-CMC, sodium carboxymethyl cellulose
- PA, phosphatidic acid
- PC, phosphatidylcholine
- PE, phosphatidylethanolamine
- PG, phosphatidylglycerol
- PPP, pentose phosphate pathway
- PS, phosphatidylserine
- PUFA, polyunsaturated fatty acids
- ROI, regions of interest
- ROS, reactive oxygen species
- SDH, succinate dehydrogenase
- SGLTs, sodium-glucose cotransporters
- SM, sphingomyelin
- STZ, streptozotocin
- Spatial-resolved metabolomics
- TCA, tricarboxylic acid
- TCHO, total cholesterol
- TG, triglyceride
- UMP, uridine monophosphate
- VIP, variable importance in projection
- p-AMPK, phosphorylated adenosine monophosphate activated protein kinase
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Huang DC, Fricker ZP, Alqahtani S, Tamim H, Saberi B, Bonder A. The influence of equitable access policies and socioeconomic factors on post-liver transplant survival. EClinicalMedicine 2021; 41:101137. [PMID: 34585128 PMCID: PMC8452797 DOI: 10.1016/j.eclinm.2021.101137] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/27/2021] [Accepted: 09/03/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Survival following liver transplant (LT) is influenced by a variety of factors, including donor risk factors and recipient disease burden and co-morbidities. It is difficult to separate these effects from those of socioeconomic factors, such as income or insurance. The United Network for Organ Sharing (UNOS) created equitable access policies, such as Share 35, to ensure that organs are distributed to individuals with greatest medical need; however, the effect of Share 35 on disparities in post-LT survival is not clear. This study aimed to (1) characterize associations between post-transplant survival and race and ethnicity, income, insurance, and citizenship status, when adjusted for other clinical and demographic factors that may influence survival, and (2) determine if the direction of associations changed after Share 35. METHODS A retrospective, cohort study of adult LT recipients (n = 83,254) from the UNOS database from 2005 to 2019 was conducted. Kaplan-Meier survival graphs and stepwise multivariate cox-regression analyses were performed to characterize the effects of socioeconomic status on post-LT survival, adjusted for recipient and donor characteristics, across the time period and after Share 35. FINDINGS Male sex (HR: 0.93 (95% CI: 0.90-0.96)), private insurance (0.91 (0.88-0.94)), income (0.82 (0.79-0.85)), U.S. citizenship, and Asian (0.81 (0.75-0.88)) or Hispanic (0.82 (0.79-0.86)) race and ethnicity were associated with higher post-transplant survival, after adjustment for clinical and demographic factors (Table 3). These associations were found across the entire time period studied and many persisted after the implementation of Share 35 in 2013 (Table 3; male sex (0.84 (0.79-0.90)), private insurance (0.94 (0.89-1.00)), income (0.82 (0.77-0.89)), and Asian (0.87 (0.73-1.02)) or Hispanic (0.88 (0.81-0.96)) race and ethnicity). INTERPRETATION Recipients' socioeconomic factors at time of transplant may impact long-term post-transplant survival, and a single policy may not significantly alter these structural health inequalities. FUNDING None.
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Key Words
- DDLT, deceased donor living transplant
- DM, diabetes mellitus
- DRI, donor risk index
- HCC, hepatocellular carcinoma
- HCV, hepatitis c virus
- HE, hepatic encephalopathy
- Health disparities
- IQR, interquartile range
- IRB, institutional review board
- LT, liver transplant
- Liver transplant
- MELD, Model for End-Stage Liver Disease
- NAFLD, Non-alcoholic fatty liver disease
- OPTN, Organ Procurement and Transplantation Network
- STAR, Standard Transplant Analysis and Research
- Socioeconomic factors
- UNOS, United Network for Organ Sharing
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Affiliation(s)
- Dora C Huang
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, United States
| | - Zachary P Fricker
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Saleh Alqahtani
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Behnam Saberi
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Alan Bonder
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
- Corresponding author.
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Gobaru M, Sakai K, Sugiyama Y, Kohara C, Yoshimizu A, Matsui R, Sato Y, Tsukamoto T, Ashida K, Higashi H. Transient Antidiuretic Hormone Insufficiency Caused by Severe Hyperosmolar Hyperglycemic Syndrome Based on Nephrogenic Diabetes Insipidus. AACE Clin Case Rep 2021; 7:372-375. [PMID: 34765734 PMCID: PMC8573287 DOI: 10.1016/j.aace.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/29/2021] [Accepted: 06/01/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The hyperosmolar hyperglycemic state (HHS), an acute complication of diabetes mellitus with plasma hyperosmolarity, promotes the secretion of anti-diuretic hormone (ADH) and reduces the storage of ADH. Magnetic resonance T1-weighted imaging reflects ADH storage in the posterior pituitary lobe, which disappears when the storage is depleted. Whether the HHS induces ADH depletion leading to clinical manifestations has been unclear. CASE REPORT A 55-year-old Japanese woman was admitted to our center because of mental disturbance and hypotension. She had received lithium carbonate for bipolar disorder and presented with polydipsia and polyuria from 15 years of age. On admission, she had mental disturbance (Glasgow Coma Scale, E4V1M1), hypotension (systolic blood pressure, 50 mmHg), and tachycardia (pulse rate, 123/min). Plasma glucose was 697 mg/dL osmolality was 476 mOsm/kg•H2O, and bicarbonate was 23.7 mmol/L. The diagnoses of HHS and hypovolemic shock were made. During treatment with fluid replacement and insulin therapy, the urine volume continued to be approximately 3 to 4 L/day, and an endocrine examination revealed ADH insufficiency and nephrogenic diabetes insipidus. Desmopressin 10 μg/day and trichlormethiazide 2 mg/day were necessary and administered, and the endogenous ADH secretion improved gradually. The signal intensity of the pituitary posterior lobe, initially decreased on magnetic resonance T1 images, was also improved. CONCLUSION This patient had ADH insufficiency associated with ADH depletion due to hyperosmolarity and nephrogenic diabetes insipidus. Clinicians should be aware of the risk of the development of critical HHS and relative ADH insufficiency in patients being treated with lithium carbonate.
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Affiliation(s)
- Mizuki Gobaru
- Department of Nephrology, Our Lady of the Snow Social Medical Corporation, St. Mary's Hospital, Kurume, Japan
| | - Kentaro Sakai
- Department of Nephrology, Our Lady of the Snow Social Medical Corporation, St. Mary's Hospital, Kurume, Japan
| | - Yuki Sugiyama
- Department of Nephrology, Our Lady of the Snow Social Medical Corporation, St. Mary's Hospital, Kurume, Japan
| | - Chiaki Kohara
- Department of Nephrology, Our Lady of the Snow Social Medical Corporation, St. Mary's Hospital, Kurume, Japan
| | - Akiko Yoshimizu
- Department of Nephrology, Our Lady of the Snow Social Medical Corporation, St. Mary's Hospital, Kurume, Japan
| | - Rei Matsui
- Department of Nephrology, Our Lady of the Snow Social Medical Corporation, St. Mary's Hospital, Kurume, Japan
| | - Yuichi Sato
- Department of Diabetes and Endocrinology, Our Lady of the Snow Social Medical Corporation, St. Mary's Hospital, Kurume, Japan
| | - Tatsuo Tsukamoto
- Department of Psychiatry, Our Lady of the Snow Social Medical Corporation, St. Mary's Hospital, Kurume, Japan
| | - Kenji Ashida
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Harumichi Higashi
- Department of Nephrology, Our Lady of the Snow Social Medical Corporation, St. Mary's Hospital, Kurume, Japan
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Chang Y, Chi KY, Tai TW, Cheng YS, Lee PH, Huang CC, Lee JS. Risk factors for postoperative urinary retention following elective spine surgery: a meta-analysis. Spine J 2021; 21:1802-11. [PMID: 34015508 DOI: 10.1016/j.spinee.2021.05.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/18/2021] [Accepted: 05/07/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Limited studies have investigated risk factors for postoperative urinary retention (POUR) following elective spine surgery. Furthermore, some discrepancies have been found in the results of existing observational studies. PURPOSE This study aimed to review the available literature on risk factors associated with POUR following elective spine surgery. STUDY DESIGN A systematic review with meta-analysis was performed. PATIENT SAMPLE A total of 31,251 patients (POUR=2,858, no POUR=28,393) were included in the meta-analysis. OUTCOME MEASURES Demographics, type of elective spine surgery, country, definition of POUR, and potential risk factors for POUR were evaluated. METHODS The Cochrane Library, Embase, and Medline electronic databases were searched to identify relevant studies. Binary outcomes were reported as odds ratio (OR). Weighted mean differences (WMD) or standardized mean differences (SMD), with 95% confidence intervals (CI), were used for meta-analysis of continuous outcomes. RESULTS Eleven studies (2 prospective and 9 retrospective) were included in the analysis. Patients with POUR were older than those without POUR (WMD, 7.13; 95% CI, 4.50-9.76). Male patients were found to have an increased risk of POUR (OR, 1.31; 95% CI, 1.04-1.64). The following variables were also identified as significant risk factors for POUR: benign prostatic hyperplasia (BPH; OR, 3.79; 95% CI, 1.89-7.62), diabetes mellitus (DM; OR, 1.50; 95% CI, 1.17-1.93), and previous urinary tract infection (UTI; OR, 1.70; 95% CI, 1.28-2.24). Moreover, longer operative time (WMD, 19.88; 95% CI, 5.01-34.75) and increased intraoperative fluid support (SMD, 0.37; 95% CI, 0.23-0.52) were observed in patients with POUR. In contrast, spine surgical procedures involving fewer levels (OR, 0.75; 95% CI, 0.65-0.86), and ambulation on the same day as surgery (OR, 0.65; 95% CI, 0.52-0.81) were associated with a decreased risk of POUR. CONCLUSIONS Based on our meta-analysis, older age, male gender, BPH, DM, and a history of UTI are risk factors for POUR following elective spine surgery. We also found that longer operative time and increased intravenous fluid support would increase the risk of POUR. Additionally, multi-level spine surgery may have a negative effect on postoperative voiding.
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Key Words
- CAD, coronary artery disease
- CI, confidence Interval
- DM, diabetes mellitus
- Elective surgery
- IAP, intra-abdominal pressure
- IQR, interquartile range
- Meta-analysis Abbreviations: BPH, benign prostatic hyperplasia
- OR, odds ratio
- POUR, postoperative urinary retention
- PVR, post-void residual
- Postoperative urinary retention
- Risk factor
- SD, standard deviation
- SMD, standardized mean differences
- Spine surgery
- Systematic review
- UTI, urinary tract infection
- WMD, weighted mean difference
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28
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Ogunwole SM, Chen X, Mitta S, Minhas A, Sharma G, Zakaria S, Vaught AJ, Toth-Manikowski SM, Smith G. Interconception Care for Primary Care Providers: Consensus Recommendations on Preconception and Postpartum Management of Reproductive-Age Patients With Medical Comorbidities. Mayo Clin Proc Innov Qual Outcomes 2021; 5:872-890. [PMID: 34585084 PMCID: PMC8452893 DOI: 10.1016/j.mayocpiqo.2021.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Severe maternal morbidity and mortality continue to increase in the United States, largely owing to chronic and newly diagnosed medical comorbidities. Interconception care, or care and management of medical conditions between pregnancies, can improve chronic disease control before, during, and after pregnancy. It is a crucial and time-sensitive intervention that can decrease maternal morbidity and mortality and improve overall health. Despite these potential benefits, interconception care has not been well implemented by the primary care community. Furthermore, there is a lack of guidelines for optimizing preconception chronic disease, risk stratifying postpartum chronic diseases, and recommending general collaborative management principles for reproductive-age patients in the period between pregnancies. As a result, many primary care providers, especially those without obstetric training, are unclear about their specific role in interconception care and may be unsure of effective methods for collaborating with obstetric care providers. In particular, internal medicine physicians, the largest group of primary care physicians, may lack sufficient clinical exposure to medical conditions in the obstetric population during their residency training and may feel uncomfortable in caring for these patients in their subsequent practice. The objective of this article is to review concepts around interconception care, focusing specifically on preconception care for patients with chronic medical conditions (eg, chronic hypertension, chronic diabetes mellitus, chronic kidney disease, venous thromboembolism, and obesity) and postpartum care for those with medically complicated pregnancies (eg, hypertensive disorders of pregnancy, gestational diabetes mellitus, excessive gestational weight gain, peripartum cardiomyopathy, and peripartum mood disorders). We also provide a pragmatic checklist for preconception and postpartum management.
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Key Words
- ACE, angiotensin-converting enzyme
- ACOG, American College of Obstetricians and Gynecologists
- ARB, angiotensin receptor blocker
- BMI, body mass index
- CKD, chronic kidney disease
- CVD, cardiovascular disease
- DM, diabetes mellitus
- GDM, gestational diabetes mellitus
- HDP, hypertensive disorder of pregnancy
- HbA1c, hemoglobin A1c
- MFM, maternal-fetal medicine
- NTD, neural tube defect
- OB/GYN, obstetrician/gynecologist
- PCP, primary care provider
- PPCM, peripartum cardiomyopathy
- SMFM, Society for Maternal-Fetal Medicine
- VTE, venous thromboembolism
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Affiliation(s)
- S Michelle Ogunwole
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Xiaolei Chen
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI
| | - Srilakshmi Mitta
- Division of Obstetric and Consultative Medicine, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI
| | - Anum Minhas
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Garima Sharma
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.,Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sammy Zakaria
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Arthur Jason Vaught
- Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Stephanie M Toth-Manikowski
- Division of Nephrology, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago
| | - Graeme Smith
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Queens University School of Medicine, Kingston, Ontario, Canada
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Yang Y, Hyun J, Lee J, Kim JH, Lee JB, Kang DY, Lee PH, Ahn JM, Park DW, Park SJ. Effectiveness and Safety of Contemporary Drug-Eluting Stents in Patients With Diabetes Mellitus. JACC Asia 2021; 1:173-184. [PMID: 36338165 PMCID: PMC9627859 DOI: 10.1016/j.jacasi.2021.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/30/2021] [Accepted: 07/12/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND Diabetes mellitus (DM) is a well-known risk factor for adverse cardiovascular events in patients receiving percutaneous coronary intervention (PCI). Limited data are available on the relative performance of different types of contemporary drug-eluting stents (DES) for diabetic patients. OBJECTIVES The authors investigated the effectiveness and safety profiles of several contemporary DES in patients with DM in a "real-world" clinical setting. METHODS Among 24,516 patients enrolled in a multicenter, prospective registry, 7,823 patients with DM were treated with 4 contemporary DES: 2,877 with a cobalt chromium everolimus-eluting stent (EES), 789 with a biodegradable polymer biolimus-eluting stent, 2,286 with a platinum chromium-EES, and 1,871 with a Resolute zotarolimus-eluting stent. The primary outcome was target vessel failure (TVF) (a composite of cardiac death, target vessel myocardial infarction, and target vessel revascularization). RESULTS The median follow-up duration was 2.9 years. Observed 3-year rates of TVF were not significantly different according to different DES types. On multigroup propensity-score analysis, the adjusted HRs for TVF were similar in between-group comparisons: biodegradable polymer biolimus-eluting stent (HR: 0.94; 95% CI: 0.76-1.16; P = 0.57), platinum chromium-EES (HR: 0.94; 95% CI: 0.81-1.09; P = 0.41), and Resolute zotarolimus-eluting stent (HR: 1.01; 95% CI: 0.86-1.18; P = 0.93) compared with the cobalt chromium-EES (reference). This trend was maintained in patients with non-insulin- and insulin-treated DM. CONCLUSIONS In this multicenter clinical-practice PCI registry, no significant between-group differences were found for a 3-year risk of TVF in patients with DM undergoing PCI with various types of contemporary DES. (Evaluation of the First, Second, and New Drug-Eluting Stents in Routine Clinical Practice [IRIS-DES]; NCT01186133).
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Key Words
- DES, drug-eluting stent(s)
- DM, diabetes mellitus
- HbA1c, glycosylated hemoglobin
- MACE, major adverse cardiovascular event(s)
- MI, myocardial infarction
- PCI, percutaneous coronary intervention
- PES, paclitaxel-eluting stent(s)
- SES, sirolimus-eluting stent(s)
- TVF, target vessel failure
- TVR, target vessel revascularization
- coronary artery disease
- diabetes mellitus
- drug-eluting stent
- percutaneous coronary intervention
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Affiliation(s)
- Yujin Yang
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Junho Hyun
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Junghoon Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ju Hyeon Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jeong Bok Lee
- Division of Clinical Epidemiology and Biostatistics, Center for Medical Research and Information, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Do-Yoon Kang
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Pil Hyung Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jung-Min Ahn
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Duk-Woo Park
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung-Jung Park
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Tang G, Li S, Zhang C, Chen H, Wang N, Feng Y. Clinical efficacies, underlying mechanisms and molecular targets of Chinese medicines for diabetic nephropathy treatment and management. Acta Pharm Sin B 2021; 11:2749-67. [PMID: 34589395 DOI: 10.1016/j.apsb.2020.12.020] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/17/2020] [Accepted: 12/25/2020] [Indexed: 12/17/2022] Open
Abstract
Diabetic nephropathy (DN) has been recognized as a severe complication of diabetes mellitus and a dominant pathogeny of end-stage kidney disease, which causes serious health problems and great financial burden to human society worldwide. Conventional strategies, such as renin-angiotensin-aldosterone system blockade, blood glucose level control, and bodyweight reduction, may not achieve satisfactory outcomes in many clinical practices for DN management. Notably, due to the multi-target function, Chinese medicine possesses promising clinical benefits as primary or alternative therapies for DN treatment. Increasing studies have emphasized identifying bioactive compounds and molecular mechanisms of reno-protective effects of Chinese medicines. Signaling pathways involved in glucose/lipid metabolism regulation, antioxidation, anti-inflammation, anti-fibrosis, and podocyte protection have been identified as crucial mechanisms of action. Herein, we summarize the clinical efficacies of Chinese medicines and their bioactive components in treating and managing DN after reviewing the results demonstrated in clinical trials, systematic reviews, and meta-analyses, with a thorough discussion on the relative underlying mechanisms and molecular targets reported in animal and cellular experiments. We aim to provide comprehensive insights into the protective effects of Chinese medicines against DN.
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Key Words
- ACEI, angiotensin-converting enzyme inhibitor
- ADE, adverse event
- AGEs, advanced glycation end-products
- AM, mesangial area
- AMPKα, adenosine monophosphate-activated protein kinase α
- ARB, angiotensin receptor blocker
- AREs, antioxidant response elements
- ATK, protein kinase B
- BAX, BCL-2-associated X protein
- BCL-2, B-cell lymphoma 2
- BCL-XL, B-cell lymphoma-extra large
- BMP-7, bone morphogenetic protein-7
- BUN, blood urea nitrogen
- BW, body weight
- C, control group
- CCR, creatinine clearance rate
- CD2AP, CD2-associated protein
- CHOP, C/EBP homologous protein
- CI, confidence interval
- COL-I/IV, collagen I/IV
- CRP, C-reactive protein
- CTGF, connective tissue growth factor
- Chinese medicine
- D, duration
- DAG, diacylglycerol
- DG, glomerular diameter
- DKD, diabetic kidney disease
- DM, diabetes mellitus
- DN, diabetic nephropathy
- Diabetic kidney disease
- Diabetic nephropathy
- EMT, epithelial-to-mesenchymal transition
- EP, E-prostanoid receptor
- ER, endoplasmic reticulum
- ESRD, end-stage renal disease
- ET-1, endothelin-1
- ETAR, endothelium A receptor
- FBG, fasting blood glucose
- FN, fibronectin
- GCK, glucokinase
- GCLC, glutamate-cysteine ligase catalytic subunit
- GFR, glomerular filtration rate
- GLUT4, glucose transporter type 4
- GPX, glutathione peroxidase
- GRB 10, growth factor receptor-bound protein 10
- GRP78, glucose-regulated protein 78
- GSK-3, glycogen synthase kinase 3
- Gαq, Gq protein alpha subunit
- HDL-C, high density lipoprotein-cholesterol
- HO-1, heme oxygenase-1
- HbA1c, glycosylated hemoglobin
- Herbal medicine
- ICAM-1, intercellular adhesion molecule-1
- IGF-1, insulin-like growth factor 1
- IGF-1R, insulin-like growth factor 1 receptor
- IKK-β, IκB kinase β
- IL-1β/6, interleukin 1β/6
- IR, insulin receptor
- IRE-1α, inositol-requiring enzyme-1α
- IRS, insulin receptor substrate
- IκB-α, inhibitory protein α
- JAK, Janus kinase
- JNK, c-Jun N-terminal kinase
- LC3, microtubule-associated protein light chain 3
- LDL, low-density lipoprotein
- LDL-C, low density lipoprotein-cholesterol
- LOX1, lectin-like oxidized LDL receptor 1
- MAPK, mitogen-activated protein kinase
- MCP-1, monocyte chemotactic protein-1
- MD, mean difference
- MDA, malondialdehyde
- MMP-2, matrix metallopeptidase 2
- MYD88, myeloid differentiation primary response 88
- Molecular target
- N/A, not applicable
- N/O, not observed
- N/R, not reported
- NF-κB, nuclear factor kappa-light-chain-enhancer of activated B cells
- NOX-4, nicotinamide adenine dinucleotide phosphate-oxidase-4
- NQO1, NAD(P)H:quinone oxidoreductase 1
- NRF2, nuclear factor erythroid 2-related factor 2
- OCP, oxidative carbonyl protein
- ORP150, 150-kDa oxygen-regulated protein
- P70S6K, 70-kDa ribosomal protein S6 kinase
- PAI-1, plasminogen activator inhibitor-1
- PARP, poly(ADP-Ribose) polymerase
- PBG, postprandial blood glucose
- PERK, protein kinase RNA-like eukaryotic initiation factor 2A kinase
- PGC-1α, peroxisome proliferator-activated receptor gamma coactivator 1α
- PGE2, prostaglandin E2
- PI3K, phosphatidylinositol 3 kinases
- PINK1, PTEN-induced putative kinase 1
- PKC, protein kinase C
- PTEN, phosphatase and tensin homolog
- RAGE, receptors of AGE
- RASI, renin-angiotensin system inhibitor
- RCT, randomized clinical trial
- ROS, reactive oxygen species
- SCr, serum creatinine
- SD, standard deviation
- SD-rat, Sprague–Dawley rat
- SIRT1, sirtuin 1
- SMAD, small mothers against decapentaplegic
- SMD, standard mean difference
- SMURF-2, SMAD ubiquitination regulatory factor 2
- SOCS, suppressor of cytokine signaling proteins
- SOD, superoxide dismutase
- STAT, signal transducers and activators of transcription
- STZ, streptozotocin
- Signaling pathway
- T, treatment group
- TBARS, thiobarbituric acid-reactive substance
- TC, total cholesterol
- TCM, traditional Chinese medicine
- TFEB, transcription factor EB
- TG, triglyceride
- TGBM, thickness of glomerular basement membrane
- TGF-β, tumor growth factor β
- TGFβR-I/II, TGF-β receptor I/II
- TII, tubulointerstitial injury index
- TLR-2/4, toll-like receptor 2/4
- TNF-α, tumor necrosis factor α
- TRAF5, tumor-necrosis factor receptor-associated factor 5
- UACR, urinary albumin to creatinine ratio
- UAER, urinary albumin excretion rate
- UMA, urinary microalbumin
- UP, urinary protein
- VCAM-1, vascular cell adhesion molecule-1
- VEGF, vascular endothelial growth factor
- WMD, weight mean difference
- XBP-1, spliced X box-binding protein 1
- cAMP, cyclic adenosine monophosphate
- eGFR, estimated GFR
- eIF2α, eukaryotic initiation factor 2α
- mTOR, mammalian target of rapamycin
- p-IRS1, phospho-IRS1
- p62, sequestosome 1 protein
- α-SMA, α smooth muscle actin
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Kim E, Lee DW, Park HC, Kim DH. Protective effects of alpha-lipoic acid on hair cell damage in diabetic zebrafish model. Mol Genet Metab Rep 2021; 28:100783. [PMID: 34354927 PMCID: PMC8322127 DOI: 10.1016/j.ymgmr.2021.100783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 11/04/2022] Open
Abstract
Hearing impairment is one of the complications in diabetes mellitus; however, there are very few therapeutic studies on it. In this study, we investigated the protective effect of alpha-lipoic acid (ALA) on hearing loss in diabetic transgenic zebrafish and confirmed that ALA protects the loss of hair cells (HCs) caused by hyperglycemia. The data indicated that ALA has a protective effect on the damage to HCs in diabetic zebrafish.
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Affiliation(s)
- Eunmi Kim
- Department of Biomedical Sciences, College of Medicine, Korea University, Ansan 15355, Republic of Korea
| | - Dong-Won Lee
- Department of Biomedical Sciences, College of Medicine, Korea University, Ansan 15355, Republic of Korea
| | - Hae-Chul Park
- Department of Biomedical Sciences, College of Medicine, Korea University, Ansan 15355, Republic of Korea
| | - Dong Hwee Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Korea University, Ansan 15355, Republic of Korea
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Ikeda S, Sato K, Takeda M, Miki K, Aizawa K, Takada T, Fukuda K, Shiba N. Oncostatin M is a novel biomarker for coronary artery disease - A possibility as a screening tool of silent myocardial ischemia for diabetes mellitus. Int J Cardiol Heart Vasc 2021; 35:100829. [PMID: 34235245 PMCID: PMC8250159 DOI: 10.1016/j.ijcha.2021.100829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 11/30/2022]
Abstract
Objective Oncostatin M (OSM) is an inflammatory cytokine of the interleukin-6 family which plays a crucial role in the pathogenesis of atherosclerosis. Therefore, we tested our hypothesis that serum OSM levels are increased in patients with coronary artery diseases (CAD). Methods and results Serum OSM level was measured by sandwich technique immunoassay in 315 consecutive patients and who underwent coronary angiography at the International University of Health and Welfare Hospital from April 2019 to March 2021. A diagnosis of CAD was made in 169 patients. Serum OSM levels were significantly higher in patients with significant coronary stenosis compared to those without it. [123.0 ± 46.7 pg/mL (n = 169) vs. 98.3 ± 47.9 pg/mL (n = 146), p < 0.001]. A positive correlation was noted between serum OSM levels and severity and complexity of coronary stenosis. Importantly, the coronary revascularization significantly decreased the serum OSM levels. We furthermore detected a positive correlation between serum OSM levels and HbA1c levels. Finally, our data suggested that 120 pg/mL of serum OSM was the potential cutoff value for screening of silent myocardial ischemia related with diabetic mellitus (DM). Conclusion Serum OSM can be a novel biomarker for CAD and may be useful for the screening of asymptomatic CAD in patients with DM.
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Key Words
- BMI, body mass index
- BNP, brain natriuretic peptide
- Biomarker
- CACS, coronary computed tomography calcium score
- CAD, coronary artery disease
- CAG, coronary angiography
- Coronary artery diseases
- DM, diabetes mellitus
- Diabetes mellitus
- EF, ejection fraction
- FFR, fractional flow reserve
- HDL-C, high-density lipoprotein-cholesterol
- HF, heart failure
- LDL-C, low-density lipoprotein-cholesterol
- LVEF, left ventricular ejection fraction
- OSM
- OSM, oncostatin M
- PCI, percutaneous coronary intervention
- Silent myocardial ischemia
- YAP, yes-associated protein
- iFR, instantaneous wave-free ratio
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Affiliation(s)
- Shohei Ikeda
- Department of Cardiovascular Medicine, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Koichi Sato
- Department of Cardiovascular Medicine, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Morihiko Takeda
- Department of Cardiovascular Medicine, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Keita Miki
- Department of Cardiovascular Medicine, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Kentaro Aizawa
- Department of Cardiovascular Medicine, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Tsuyoshi Takada
- Department of Cardiovascular Medicine, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Koji Fukuda
- Department of Cardiovascular Medicine, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Nobuyuki Shiba
- Department of Cardiovascular Medicine, International University of Health and Welfare Hospital, Tochigi, Japan
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Yun JP, Choi EK, Han KD, Park SH, Jung JH, Park SH, Ahn HJ, Lim JH, Lee SR, Oh S. Risk of Atrial Fibrillation According to Cancer Type: A Nationwide Population-Based Study. JACC CardioOncol 2021; 3:221-232. [PMID: 34396327 PMCID: PMC8352078 DOI: 10.1016/j.jaccao.2021.03.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 02/07/2023]
Abstract
Background Patients with cancer have an increased risk of atrial fibrillation (AF). However, there is a paucity of information regarding the association between cancer type and risk of AF. Objectives This study sought to evaluate the risk of AF according to the type of cancer. Methods We enrolled 816,811 patients who were diagnosed with cancer from the Korean National Health Insurance Service database between 2009 and 2016. Age- and sex-matched noncancer control subjects (1:2; n = 1,633,663) were also selected. Newly diagnosed AF was identified based on the type of cancer. Results During a median follow-up of 4.5 years, AF was newly diagnosed in 25,356 patients with cancer (6.6 per 1,000 person-years). In multivariable Fine and Gray’s regression analysis, cancer was an independent risk factor for incident AF (adjusted subdistribution hazard ratio [aHR]: 1.63; 95% confidence interval [CI]: 1.61 to 1.66). Multiple myeloma showed a higher association with incident AF (aHR: 3.34; 95% CI: 2.98 to 3.75). Esophageal cancer showed the highest risk among solid cancers (aHR: 2.69; 95% CI: 2.45 to 2.95), and stomach cancer showed the lowest association with AF risk (aHR: 1.27; 95% CI 1.23 to 1.32). Conclusions Although patients with cancer were found to have a higher risk of AF, the impact on AF development varied by cancer type.
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Key Words
- AF, atrial fibrillation
- CI, confidence interval
- CKD, chronic kidney disease
- CNS, central nervous system
- CVD, cardiovascular disease
- DM, diabetes mellitus
- HR, hazard ratio
- ICD-10, International Classification of Diseases–10th Revision
- IQR, interquartile range
- NHIS, National Health Insurance Service
- atrial fibrillation
- cancer
- epidemiology
- type of cancer
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Affiliation(s)
- Jun Pil Yun
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Sang Hyun Park
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin-Hyung Jung
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Hyeon Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyo-Jeong Ahn
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae-Hyun Lim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Alqahtani A, Alaklabi A, Kristjansson S, Alharthi H, Aldhilan S, Alam H. Acute necrotic hemorrhagic leukoencephalitis related to COVID-19: a report of 2 cases. Radiol Case Rep 2021; 16:2393-2398. [PMID: 34104284 PMCID: PMC8173541 DOI: 10.1016/j.radcr.2021.05.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/24/2021] [Accepted: 05/28/2021] [Indexed: 01/30/2023] Open
Abstract
Acute necrotic hemorrhagic leukoencephalitis (ANHLE) is a subform of acute disseminating leukoencephalitis which is a post viral or vaccination uncommon disease with poor prognosis. Radiological findings include multiple or diffuse lesions involving the white matter and sparing the cortex with or without rim enhancement. In addition to areas of hemorrhages with possible involvement of basal ganglia and thalami. We describe the imaging findings for 2 cases of ANHLE; a 59-years-old male and a 47-years-old female. Both of them were tested positive of SARS-COVID2 with presentation of consciousness loss and respiratory failure. CT and MRI brain show global white matter changes associated with acute hemorrhagic necrosis, although uncommon, are compatible with postviral acute necrotic hemorrhagic leukoencephalitis with end point of death for the first patient and coma for the second patient.
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Key Words
- Acute hemorrhagic necrosis
- Brain
- COVID-19
- CT, computed tomography
- Coronavirus
- DM, diabetes mellitus
- DNR, do not resuscitation
- EEG, electroencephalogram
- ESRD, end stage renal disease
- GCS, Glasgow Coma Score
- HTN, hypertension
- ICU, intensive care unit
- MRI, magnetic resonance imaging
- Neuroimaging
- SARS-COVID2
- SARS-COVID2, COVID-19
- VAP, ventilator associated pneumonia
- White matter disease
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Affiliation(s)
| | - Aeed Alaklabi
- Radiology Department, Security Forces Hospital, Riyadh, Saudi Arabia
| | | | - Hanan Alharthi
- Radiology Department, King Faisal Specialist Hospital, Riyadh, Saudi Arabia
| | - Suhayb Aldhilan
- Radiology Department, Prince Sultan Military Medical Hospital, Riyadh, Saudi Arabia
| | - Hamid Alam
- Radiology Department, Brookhaven Memorial Hospital Medical Center in Patchogue, New York, NY, USA
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Stillson JE, Bunch CM, Thomas AV, Mjaess N, Dynako JA, Piscoya AS, Post JM, Ratigan BL, Goldstein ZH, Walsh MM. Pathologic fracture and hardware failure in Streptococcus anginosus femoral osteomyelitis: Case report. Ann Med Surg (Lond) 2021; 67:102478. [PMID: 34194731 DOI: 10.1016/j.amsu.2021.102478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/04/2021] [Accepted: 06/05/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Pathologic fracture of the femur due to Streptococcus anginosus osteomyelitis has rarely been described. With limited evidence for treating S. anginosus osteomyelitis, the orthopaedic surgeon is presented with a difficult treatment decision at index presentation. Presented here is a case of failed conservative management, diagnostic dilemma, failed hardware stabilization, and definitive surgical treatment resulting in good clinical outcome. Case presentation A 69-year-old male experienced acute right thigh pain, edema, and erythema after dental treatment 17 days prior. He was diagnosed with right femoral diaphyseal osteomyelitis and Brodie's abscess. Blood cultures grew S. anginosus, but all site-specific tissue cultures resulted negative. Initial management consisted of intravenous antibiotic therapy and percutaneous abscess drainage. Months later, the patient sustained a displaced pathologic fracture of the diaphyseal femur and there was concern for neoplasm, but biopsies were negative. Stabilization was attempted with a lateral plate and screws. This hardware catastrophically failed in the setting of an oligotrophic femoral nonunion. Ultimately, the patient was successfully treated with an intramedullary nail coated with antibiotic-impregnated cement. Twelve months later, the patient achieved clinical and radiographic healing with no evidence of relapse of his osteomyelitis. Clinical discussion Conservative management of S. anginosus femoral osteomyelitis was inadequate and corroborates the existing literature. S. anginosus osteomyelitis and pyomyositis may be most optimally treated aggressively with early surgical intervention. Conclusion Early surgical debridement and stabilization of the compromised bone with an antibiotic coated intramedullary nail following medullary reaming may prevent pathologic fracture, eradicate infection, and achieve predictable outcomes. S. anginosus femoral osteomyelitis is rare and difficult to diagnose and treat. Conservative measures failed, and pathologic fracture later ensued. Although sparse, existing reports suggest early surgical management is indicated. This report provides more evidence for early and aggressive surgical management. Good outcome was achieved with antibiotic coated intramedullary nailing.
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Hogg RE, Wright DM, Dolz-Marco R, Gray C, Waheed N, Teussink MM, Naskas T, Perais J, Das R, Quinn N, Bontzos G, Nicolaou C, Annam K, Young IS, Kee F, McGuiness B, Mc Kay G, MacGillivray T, Peto T, Chakravarthy U. Quantitative Parameters from OCT Angiography in Patients with Diabetic Retinopathy and in Those with Only Peripheral Retinopathy Compared with Control Participants. Ophthalmol Sci 2021; 1:100030. [PMID: 36249296 PMCID: PMC9559874 DOI: 10.1016/j.xops.2021.100030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/13/2021] [Accepted: 05/20/2021] [Indexed: 11/17/2022]
Abstract
Purpose To describe the differences in a range of quantitative OCT angiography (OCTA) metrics across early stages of diabetic retinopathy (DR), providing robust effect estimates as well as sensitivity and specificity. Design Cross-sectional study with population-based sampling. Participants Four hundred forty-one eyes from 296 individuals: 328 control eyes (no diabetes mellitus [DM] and no DR), 55 eyes with DM and no DR, and 58 eyes with early nonproliferative DR. Methods Multimodal retinal imaging included color fundus photography, color Optomap ultra-widefield imaging, and spectral-domain OCT (Spectralis OCT2; Heidelberg Engineering GmbH) with the OCTA module. All images were graded for the presence and severity of DR features. OCTA images were assessed manually for inclusion based on quality. Binary OCTA metrics were assessed after 3-dimensional projection artifact removal including from the nerve fiber layer vascular plexus, superficial vascular plexus (SVC), and deep vascular plexus (DVC) by Early Treatment Diabetic Retinopathy Study (ETDRS) grid, foveal avascular zone (FAZ) area, FAZ minimum and maximum diameter, perimeter length, and circularity. Main Outcome Measures Diabetes mellitus and DR status and presence or absence of DR in the retinal periphery. Results The reduction in vessel densities in participants with DM and manifest DR compared with control participants tended to be twice that of those with DM, but no DR, compared with control participants. Some evidence of spatial heterogeneity in vessel reductions was found in those yet to develop DR, whereas those with manifest DR had significant reductions across the ETDRS grid. The FAZ perimeter and circularity were impacted most significantly by DM, and those with DR showed decreased multispectral fractal dimensions compared with control participants. Eyes with peripheral DR had reduced vessel density compared with those with DM and no DR only in the superior outer, temporal inner, and temporal outer regions in the DVC and SVC. The area under the receiver operating characteristic curve ranged between 0.48 and 0.73. Conclusions Significant differences in OCTA metrics can be found in those with DM before manifest DR using commercially available equipment with minimal image postprocessing. Although diagnostic performance was poor, these metrics may be useful for measuring change over time in clinical trials.
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Key Words
- AUC, area under the receiver operating characteristic curve
- DM, diabetes mellitus
- DR, diabetic retinopathy
- DVC, deep vascular plexus
- Diabetes mellitus
- Diabetic retinopathy
- ETDRS, Early Treatment Diabetic Retinopathy Study
- FAZ, foveal avascular zone
- Foveal avascular zone
- NFLVP, nerve fiber layer vascular plexus
- NICOLA, Northern Ireland Cohort Study for the Longitudinal Study of Aging
- OCT angiography
- OCTA
- OCTA, OCT angiography
- Retinal periphery
- SVC, superficial vascular plexus
- Vessel density
- Vessel segmentation
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Affiliation(s)
- Ruth E. Hogg
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
- Correspondence: Ruth E. Hogg, PhD, Institute of Clinical Sciences, Block A, Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, United Kingdom.
| | - David M. Wright
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | | | - Calum Gray
- Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Nadia Waheed
- School of Medicine, Tufts University, Boston, Massachusetts
| | | | - Timos Naskas
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Jennifer Perais
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Radha Das
- Moorfields Eye Hospital, London, United Kingdom
| | - Nicola Quinn
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | | | | | - Kaushik Annam
- School of Medicine, Louisiana State University, New Orleans, Louisiana
| | - Ian S. Young
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Frank Kee
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | | | - Gareth Mc Kay
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Tom MacGillivray
- Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Tunde Peto
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Usha Chakravarthy
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
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Cardoso R, Graffunder FP, Ternes CM, Fernandes A, Rocha AV, Fernandes G, Bhatt DL. SGLT2 inhibitors decrease cardiovascular death and heart failure hospitalizations in patients with heart failure: A systematic review and meta-analysis. EClinicalMedicine 2021; 36:100933. [PMID: 34308311 PMCID: PMC8257984 DOI: 10.1016/j.eclinm.2021.100933] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce the composite of heart failure (HF) hospitalizations or cardiovascular mortality among patients with HF. However, the efficacy of SGLT2 inhibitors in secondary endpoints of randomized trials and in subgroups of HF patients is not well known. METHODS We performed a systematic review and meta-analysis of placebo-controlled, randomized trials of SGLT2 inhibitors in patients with HF. PubMed, Embase, and Cochrane databases were searched for trials published up to January 21, 2021. Data were extracted from published reports and quality assessment was performed per Cochrane recommendations. Hazard ratios (HRs) with 95% CI were pooled across trials. The primary endpoints of interest were all-cause and cardiovascular mortality. RESULTS Out of 3969 database results, 15 randomized trials and 20,241 patients were included; 10,594 (52·3%) received SGLT2 inhibitors. All-cause mortality (HR 0·86; 95% CI 0·79-0·94; p = 0·0007; I2=0%) and cardiovascular mortality (HR 0·86; 95% CI 0·78-0·96; p = 0·006; I2=0%) were significantly lower in patients treated with SGLT2 inhibitors compared with placebo. The composite of cardiovascular mortality, HF hospitalizations, or urgent visits for HF was significantly reduced with SGLT2 inhibitors in all the following subgroups: male, female, age < 65, age ≥ 65, race - Black and White, estimated glomerular filtration rate (eGFR) <60, eGFR ≥60, New York Heart Association (NYHA) class II, NYHA ≥III, and HF with preserved ejection fraction. INTERPRETATION In patients with HF, SGLT2 inhibitors significantly reduce all-cause and cardiovascular mortality compared with placebo. In addition, the composite of cardiovascular mortality or HF hospitalizations/urgent visits is reduced with SGLT2 inhibitors across subgroups of sex, age, race, eGFR, HF functional class, and ejection fraction.
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Key Words
- DM, diabetes mellitus
- HF, heart failure
- HFpEF, heart failure with preserved ejection fraction
- HR, hazard ratio
- Heart failure
- LVEF, left ventricular ejection fraction
- NYHA, New York Heart Association
- OR, odds ratio
- RCTs, randomized controlled trials
- SGLT2 inhibitors
- SGLT2, sodium-glucose cotransporter 2
- Type 2 Diabetes
- cardiovascular risk
- eGFR, estimated glomerular filtration rate
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Affiliation(s)
- Rhanderson Cardoso
- Heart and Vascular Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | | | - Caique M.P. Ternes
- Division of Medicine, Federal University of Santa Catarina, Florianopolis, Brazil
- Cardiac Arrhythmia Service, SOS Cardio Hospital, Florianopolis, Brazil
| | | | - Ana V. Rocha
- Division of Medicine, Federal University of Goias, Goiania, Brazil
| | - Gilson Fernandes
- Division of Cardiology, University of Miami, Miami, United States
| | - Deepak L. Bhatt
- Heart and Vascular Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
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Wallia A, O'Brien MJ, Liss DT, Kang RH, Cooper AJ, Gilmer A, Ackermann RT. Glycemic Outcomes of Second-Line Diabetes Drug Choice in a Real-World Population. Mayo Clin Proc Innov Qual Outcomes 2021; 5:675-81. [PMID: 34195559 DOI: 10.1016/j.mayocpiqo.2021.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Hypoglycemia and acute metabolic complications (AMCs; ketoacidosis, hyperosmolarity, and coma) are glycemic outcomes that have high cost and high morbidity; these outcomes must be taken into consideration when choosing initial second-line therapy after metformin. We conducted a retrospective cohort study analyzing national administrative data from adults with type 2 diabetes mellitus who started a second-line diabetes medication (sulfonylureas [SFUs], thiazolidinediones [TZDs], glucagon-like peptide 1 [GLP-1] agonists, dipeptidyl peptidase 4 [DPP-4] inhibitors, basal insulin, or sodium-glucose contransporter 2 [SGLT-2] inhibitors) between April 1, 2011 and September 30, 2015 (N=43,288) and compared rates of hypoglycemia and AMCs. Most patients (24,506 [56.6%]) were prescribed sulfonylurea as second-line treatment, followed by DPP-4 inhibitors (7953 [18.4%]), GLP-1 agonists (3854 [8.9%]), basal insulin (2542 [5.9%]), SGLT-2 inhibitors (2537 [5.9%), and TZDs (1896 [4.4%]). Baseline rates of hypoglycemia varied more than 5-fold across initial second-line antidiabetic medication classes, and rates of AMCs varied 7-fold. Compared with patients taking an SFU, lower adjusted rates of hypoglycemia were associated with taking a DPP-4 inhibitor (63% lower rate; incidence rate ratio [IRR], 0.37; 95% CI, 0.25 to 0.57), SGLT-2 inhibitor (54% lower; IRR, 0.46; 95% CI, 0.22 to 0.94), or TZD (79% lower; IRR, 0.21; 95% CI, 0.08 to 0.56) but not a glucagon-like peptide 1 agonist or basal insulin. For AMCs, only initiation of a DPP-4 inhibitor (43% lower rate; IRR, 0.57; 95% CI, 0.41 to 0.81) was associated with a lower adjusted rate compared with SFU. Use of SGLT-2 inhibitors was not associated with a substantially increased rate of acute metabolic complications compared with SFU. Special attention still needs to be paid to glycemic outcomes when choosing a second-line diabetes therapy following metformin.
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Key Words
- AMC, acute metabolic complication
- DM, diabetes mellitus
- DPP-4, dipeptidyl peptidase 4
- GLP-1, glucagon-like peptide 1
- ICD-9, International Classification of Diseases, Ninth Revision
- IRR, incidence rate ratio
- SFU, sulfonylurea
- SGLT-2, sodium-glucose contransporter 2
- TZD, thiazolidinedione
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Huang CF, Chen A, Lin SY, Cheng ML, Shiao MS, Mao TY. A metabolomics approach to investigate the proceedings of mitochondrial dysfunction in rats from prediabetes to diabetes. Saudi J Biol Sci 2021; 28:4762-9. [PMID: 34354464 DOI: 10.1016/j.sjbs.2021.04.091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 01/12/2023] Open
Abstract
Diabetes mellitus (DM) is a leading cause of preventable cardiovascular disease, but the metabolic changes from prediabetes to diabetes have not been fully clarified. This study implemented a metabolomics profiling platform to investigate the variations of metabolites and to elucidate their global profiling from metabolic syndrome to DM. Methods: Male Sprague-Dawley rats (n = 44) were divided into four groups. Three groups were separately fed with a normal diet, a high-fructose diet (HF), or a high-fat (HL) diet while one group was treated with streptozotocin. The HF and HL diet were meant to induce insulin resistance, obesity, and dyslipidemia, which known to induce DM. Results: The most significant metabolic variations in the DM group’s urine samples were the reduced release of citric acid cycle intermediates, the increase in acylcarnitines, and the decrease in urea excretion, all of which indicated energy metabolism abnormalities and mitochondrial dysfunction. Overall, the metabolic analysis revealed tryptophan metabolic pathway variations in the prediabetic phase, even though the mitochondrial function remains unaffected. Conclusion: This study show that widespread methylations and impaired tryptophan metabolism occur in metabolic syndrome and are then followed by a decline in citric acid cycle intermediates, indicating mitochondrial dysfunction in diabetes.
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Key Words
- CAN, acetonitrile
- DM, diabetes mellitus
- Diabetes
- GOT, glutamate oxaloacetate transaminase
- GPT, glutamate pyruvate transaminase
- HF, high-fructose
- HL, high-fat
- HMDB, human metabolome database
- KEGG, kyoto encyclopedia of genes and genomes
- LC-MS, liquid chromatography–mass spectrometry
- Metabolic syndrome
- Metabolomics
- Methylation
- Mitochondrial dysfunction
- PCA, principal component analysis
- Prediabetes
- STZ, streptozotocin
- TC, total cholesterol
- TG, triacylglycerol
- Tryptophan
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Abstract
Objective Hyperglycemia may cause acute central nervous system dysfunction manifesting as agonizing involuntary movements due to insult to the basal ganglia. We report a case of hemichorea-hemiballism (HCHB) in a patient with diabetes. Method Clinical assessment of the patient was performed, along with laboratory tests and brain imaging. Results The patient was a 50-year-old man with newly detected diabetes with persistent involuntary movement of the right upper and lower limbs for few weeks. The involuntary movement was nonrhythmic, nonpatterned, purposeless, and often jerky with variable amplitude and frequency, sometimes wild and flailing in the form of hemichorea with a ballistic component (HCHB). He had a history of poor compliance to prescribed oral antidiabetic drugs. At presentation, although he was hemodynamically stable, random capillary blood glucose level was 18 mmol/L and glycated hemoglobin A1 level was 15.1% (141.5 mmol/mol). Clinical examination did not reveal any focal deficit or positive Babinski sign. There was a hyperintensity in the left basal ganglia region in T1-weighted magnetic resonance imaging (MRI) of the brain, which was iso-to-hyperintense in T2-weighted image and fluid-attenuated inversion recovery sequence. There was no restriction of diffusion on the diffusion-weighted image or blooming on gradient echo sequences, indicating absence of infarction or hemorrhage. Control of hyperglycemia resulted in disappearance of the involuntary movement within 1 month. Conclusion While there are many differential diagnoses for HCHB, the clinical scenario suggests hyperglycemia as the underlying cause in this patient. This case reiterates that multiple central nervous system manifestations may be attributable to diabetes.
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Deng F, Zhang L, Lyu L, Lu Z, Gao D, Ma X, Guo Y, Wang R, Gong S, Jiang W. Increased levels of ferritin on admission predicts intensive care unit mortality in patients with COVID-19. ACTA ACUST UNITED AC 2021; 156:324-31. [PMID: 33824908 DOI: 10.1016/j.medcle.2020.11.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/27/2020] [Indexed: 12/27/2022]
Abstract
Background The aim of this study was to evaluate hyperferritinemia could be a predicting factor of mortality in hospitalized patients with coronavirus disease-2019 (COVID-19). Methods A total of 100 hospitalized patients with COVID-19 in intensive care unit (ICU) were enrolled and classified into moderate (n = 17), severe (n = 40) and critical groups (n = 43). Clinical information and laboratory results were collected and the concentrations of ferritin were compared among different groups. The association between ferritin and mortality was evaluated by logistic regression analysis. Moreover, the efficiency of the predicting value was assessed using receiver operating characteristic (ROC) curve. Results The amount of ferritin was significantly higher in critical group compared with moderate and severe groups. The median of ferritin concentration was about three times higher in death group than survival group (1722.25 μg/L vs. 501.90 μg/L, p < 0.01). The concentration of ferritin was positively correlated with other inflammatory cytokines, such as interleukin (IL)-8, IL-10, C-reactive protein (CRP) and tumor necrosis factor (TNF)-α. Logistic regression analysis demonstrated that ferritin was an independent predictor of in-hospital mortality. Especially, high-ferritin group was associated with higher incidence of mortality, with adjusted odds ratio of 104.97 [95% confidence interval (CI) 2.63–4185.89; p = 0.013]. Moreover, ferritin had an advantage of discriminative capacity with the area under ROC (AUC) of 0.822 (95% CI 0.737–0.907) higher than procalcitonin and CRP. Conclusion The ferritin measured at admission may serve as an independent factor for predicting in-hospital mortality in patients with COVID-19 in ICU.
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Key Words
- ALT, alanine aminotransferase
- AOSD, adult-onset Still's disease
- APTT, activated partial thromboplastin time
- ARDS, acute respiratory distress syndrome
- AST, aspartate aminotransferase
- AUC, area under the curve
- BUN, urea nitrogen
- CAPS, catastrophic anti-phospholipid syndrome
- CHD, coronary heart diseases
- CK-MB, creatine kinase-MB
- COVID-19
- COVID-19, coronavirus disease-2019
- CRP, C-reactive protein
- DBP, diastolic pressure
- DM, diabetes mellitus
- Ferritin
- FiO2, fraction of inspired oxygen
- HP, hypertension
- HR, heart rate
- Hs-TnI, high sensitive troponin I
- ICU, intensive care unit
- IL, interleukin
- INR, international normalized ratio
- IQR, interquartile range
- Inflammation markers
- MAS, macrophage activation syndrome
- MERS, Middle East respiratory syndrome
- MOF, multiple organ failure
- MV, mechanical ventilation
- Mortality
- NT-proBNP, N-terminal pro-B-type natriuretic peptide
- PCT, procalcitonin
- PT, prothrombin time
- PTA, prothrombin activity
- PaO2, partial pressure of arterial oxygen
- RBC, red blood cells
- ROC, receiver operating characteristic
- RR, respiration rate
- RT-PCR, reverse transcription-polymerase chain reaction
- SARS, severe acute respiratory syndrome
- SARS-CoV-2
- SBP, systolic blood pressure
- SpO2, percutaneous oxygen saturation
- TNF, tumor necrosis factor
- TT, plasma thrombin time
- WBC, white blood cells
- eGFR, ovulated glomerular filtration rate
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Schneider CV, Zandvakili I, Thaiss CA, Schneider KM. Physical activity is associated with reduced risk of liver disease in the prospective UK Biobank cohort. JHEP Rep 2021; 3:100263. [PMID: 33898961 PMCID: PMC8056270 DOI: 10.1016/j.jhepr.2021.100263] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/09/2021] [Accepted: 02/23/2021] [Indexed: 12/23/2022] Open
Abstract
Background & Aims Previous studies have identified physical activity as an important lifestyle factor in the pathogenesis of chronic liver diseases (CLD). However, most studies were short in follow-up, and based on self-reported activity. Moreover, it is unknown whether physical activity affects the risk of liver disease development in the general population. Herein, we aimed to clarify the association between physical activity and CLD by examining the risk of liver disease and progression in relation to accelerometer-based physical activity in a large subset of prospectively recruited participants in the UK Biobank. Methods We analysed data from 96,688 participants that recorded their physical activity through the use of a wrist accelerometer. Relative risks for development of liver diseases were calculated using multivariable-adjusted Cox regression models. In a subgroup of participants without any previously diagnosed liver disease (n = 95,974), a total of 374 liver disease cases were diagnosed during follow-up (mean = 5.5 years). Results Participants in the top compared with the bottom quartile of physical activity had a reduced risk of both overall CLD (hazard ratio [HR]: 0.41 [0.29-0.59]) and NAFLD (HR: 0.39 [0.21-0.70]). An activity increase of an additional 2,500 steps per day, was associated with a 38% reduction in CLD and a 47% reduction in NAFLD development, independent of adiposity. In the subgroup of participants with previously diagnosed liver disease (n = 714), participants in the top compared with the bottom quartile of physical activity had a striking 89% risk reduction in liver-related death (HR: 0.11 [0.02-0.86]), and 85% risk reduction in all-cause mortality (adjusted HR: 0.15 [0.05-0.44]). Walking an additional 2,500 steps per day was associated with 44% reduction in liver disease progression. Conclusions Greater physical activity is associated with a dose-dependent reduction in liver disease, which appears to be independent of adiposity. Lay summary In this study, we aimed to clarify the association between accelerometer-measured physical activity and chronic liver disease by examining risk of overall and specific liver diseases and their progression in relation to accelerometer-based physical activity in 96,688 participants in the UK Biobank. Our results show a clear, dose-dependent protective association between accelerometer-measured physical activity and liver disease development and progression. The linkage of device-measured activity could therefore create a framework for using wearables for personalised prevention of liver diseases.
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Affiliation(s)
- Carolin V Schneider
- The Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Inuk Zandvakili
- Division of Gastroenterology and Hepatology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Christoph A Thaiss
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Institute for Immunology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Institute for Diabetes, Obesity, and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kai Markus Schneider
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Institute for Immunology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Institute for Diabetes, Obesity, and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Hanff TC, Cohen JB, Zhao L, Javaheri A, Zamani P, Prenner SB, Rietzschel E, Jia Y, Walsh A, Maranville J, Wang Z, Adam L, Ramirez-Valle F, Schafer P, Seiffert D, Gordon DA, Cvijic ME, Cappola TP, Chirinos JA. Quantitative Proteomic Analysis of Diabetes Mellitus in Heart Failure With Preserved Ejection Fraction. JACC Basic Transl Sci 2021; 6:89-99. [PMID: 33665511 PMCID: PMC7907637 DOI: 10.1016/j.jacbts.2020.11.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/19/2020] [Accepted: 11/22/2020] [Indexed: 01/25/2023]
Abstract
Diabetes mellitus (DM) is associated with a higher risk of heart failure hospitalization and mortality in patients with heart failure with preserved ejection fraction (HFpEF). Using SomaScan assays and proteomics analysis of plasma from participants in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) trial and the Penn Heart Failure Study, this study identified 10 proteins with significantly different expression in patients with HFpEF and DM. Of these, apolipoprotein M was found to mediate 72% (95% CI: 36% to 100%; p < 0.001) of the association between DM and the risk of cardiovascular death, aborted cardiac arrest, and heart failure hospitalization.
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Affiliation(s)
- Thomas C. Hanff
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jordana B. Cohen
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lei Zhao
- Bristol-Myers Squibb, Princeton, New Jersey, USA
| | - Ali Javaheri
- Division of Cardiovascular Medicine, Washington University School of Medicine St. Louis, Missouri, USA
| | - Payman Zamani
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stuart B. Prenner
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ernst Rietzschel
- Department of Cardiovascular Diseases, Ghent University, Ghent, Belgium
| | - Yi Jia
- SomaLogic, Boulder, Colorado, USA
| | - Alice Walsh
- Bristol-Myers Squibb, Princeton, New Jersey, USA
| | | | | | - Leonard Adam
- Bristol-Myers Squibb, Princeton, New Jersey, USA
| | | | | | | | | | | | - Thomas P. Cappola
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Julio A. Chirinos
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Liu H, Zhao Y, Xie A, Kim TY, Terentyeva R, Liu M, Shi G, Feng F, Choi BR, Terentyev D, Hamilton S, Dudley SC. Interleukin-1β, Oxidative Stress, and Abnormal Calcium Handling Mediate Diabetic Arrhythmic Risk. ACTA ACUST UNITED AC 2021; 6:42-52. [PMID: 33532665 PMCID: PMC7838050 DOI: 10.1016/j.jacbts.2020.11.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 11/03/2020] [Accepted: 11/03/2020] [Indexed: 12/14/2022]
Abstract
Diabetes-induced arrhythmic risk involved activation of innate immunity, elevation of IL-1β, mitochondrial oxidative stress, SR calcium release channel oxidation, and QT prolongation. Diabetes-induced arrhythmic risk could be inhibited by IL-1β antagonism, mitoROS scavenging, and SR calcium release stabilization. The relationship of inflammation and arrhythmic risk may account for increased susceptibility of diabetic patients to the effects of COVID-19.
Diabetes mellitus (DM) is associated with increased arrhythmia. Type 2 DM (T2DM) mice showed prolonged QT interval and increased ventricular arrhythmic inducibility, accompanied by elevated cardiac interleukin (IL)-1β, increased mitochondrial reactive oxygen species (mitoROS), and oxidation of the sarcoplasmic reticulum (SR) Ca2+ release channel (ryanodine receptor 2 [RyR2]). Inhibiting IL-1β and mitoROS reduced RyR2 oxidation and the ventricular arrhythmia in DM. Inhibiting SR Ca2+ leak by stabilizing the oxidized RyR2 channel reversed the diabetic arrhythmic risk. In conclusion, cardiac IL-1β mediated the DM-associated arrhythmia through mitoROS generation that enhances SR Ca2+ leak. The mechanistic link between inflammation and arrhythmias provides new therapeutic options.
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Key Words
- APD, action potential duration
- DM, diabetes mellitus
- EAD, early afterdepolarization
- IL, interleukin
- IL-1RA, interleukin-1 receptor antagonist
- Ito, transient outward potassium current
- RyR2, ryanodine receptor
- SR, sarcoplasmic reticulum
- T1DM, type 1 diabetes mellitus
- T2DM, type 2 diabetes mellitus
- VT, ventricular tachycardia
- calcium handling
- inflammation
- mitoROS, mitochondrial reactive oxygen species
- mitochondria
- oxidation
- sudden cardiac death
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Affiliation(s)
- Hong Liu
- Division of Cardiology, Department of Medicine, Lillehei Heart Institute, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Yang Zhao
- Division of Cardiology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - An Xie
- Division of Cardiology, Department of Medicine, Lillehei Heart Institute, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Tae-Yun Kim
- Division of Cardiology, Cardiovascular Research Center, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Radmila Terentyeva
- Division of Cardiology, Cardiovascular Research Center, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Physiology and Cell Biology, The Ohio State University, Columbus, Ohio, USA
| | - Man Liu
- Division of Cardiology, Department of Medicine, Lillehei Heart Institute, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Guangbin Shi
- Division of Cardiology, Cardiovascular Research Center, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Feng Feng
- Division of Cardiology, Department of Medicine, Lillehei Heart Institute, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Bum-Rak Choi
- Division of Cardiology, Cardiovascular Research Center, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Dmitry Terentyev
- Division of Cardiology, Cardiovascular Research Center, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Physiology and Cell Biology, The Ohio State University, Columbus, Ohio, USA
| | - Shanna Hamilton
- Department of Physiology and Cell Biology, The Ohio State University, Columbus, Ohio, USA
| | - Samuel C Dudley
- Division of Cardiology, Department of Medicine, Lillehei Heart Institute, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
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Kohsaka S, Okami S, Kanda E, Kashihara N, Yajima T. Cardiovascular and Renal Outcomes Associated With Hyperkalemia in Chronic Kidney Disease: A Hospital-Based Cohort Study. Mayo Clin Proc Innov Qual Outcomes 2021; 5:274-285. [PMID: 33997627 PMCID: PMC8105529 DOI: 10.1016/j.mayocpiqo.2020.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective To examine the association between hyperkalemia and long-term cardiovascular and renal outcomes in patients with chronic kidney disease. Patients and Methods An observational retrospective cohort study was performed using a Japanese hospital claims registry, Medical Data Vision (April 1, 2008, to September 30, 2018). Of 1,208,894 patients with at least 1 potassium measurement, 167,465 patients with chronic kidney disease were selected based on International Classification of Diseases, Tenth Revision codes or estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2. Hyperkalemia was defined as at least 2 potassium measurements of 5.1 mmol/L or greater within 12 months. Normokalemic controls were patients without a record of potassium levels of 5.1 mmol/L or greater and 3.5 mmol/L or less. Changes in eGFRs and hazard ratios of death, hospitalization for cardiac events, heart failure, and renal replacement therapy introduction were assessed between propensity score–matched hyperkalemic patients and normokalemic controls. Results Of 16,133 hyperkalemic patients and 11,898 normokalemic controls eligible for analyses, 5859 (36.3%) patients and 5859 (49.2%) controls were selected after propensity score matching. The mean follow-up period was 3.5 years. The 3-year eGFR change in patients and controls was −5.75 and −1.79 mL/min/1.73 m2, respectively. Overall, hyperkalemic patients had higher risks for death, hospitalization for cardiac events, heart failure, and renal replacement therapy introduction than controls, with hazard ratios of 4.40 (95% CI, 3.74 to 5.18), 1.95 (95% CI, 1.59 to 2.39), 5.09 (95% CI, 4.17 to 6.21), and 7.54 (95% CI, 5.73 to 9.91), respectively. Conclusion Hyperkalemia was associated with significant risks for mortality and adverse clinical outcomes, with more rapid decline of renal function. These findings underscore the significance of hyperkalemia as a predisposition to future adverse events in patients with chronic kidney disease.
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Key Words
- ACEi, angiotensin-converting enzyme inhibitor
- ARB, angiotensin receptor blocker
- CKD, chronic kidney disease
- DM, diabetes mellitus
- HDL, high-density lipoprotein
- HF, heart failure
- ICD-10, International Classification of Diseases, Tenth Revision
- LDL, low-density lipoprotein
- MDV, Medical Data Vision
- MRA, mineralocorticoid receptor antagonist
- PS, propensity score
- RAASi, renin-angiotensin-aldosterone system inhibitor
- RRT, renal replacement therapy
- S-K, serum potassium
- eGFR, estimated glomerular filtration rate
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Affiliation(s)
- Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Suguru Okami
- Cardiovascular, Renal, and Metabolism, Medical Affairs, AstraZeneca KK, Osaka, Japan
| | - Eiichiro Kanda
- Medical Science, Kawasaki Medical School, Okayama, Japan
| | - Naoki Kashihara
- Department of Nephrology and Hypertension, Kawasaki Medical School, Okayama, Japan
| | - Toshitaka Yajima
- Cardiovascular, Renal, and Metabolism, Medical Affairs, AstraZeneca KK, Osaka, Japan
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Choudhary NS, Saraf N, Saigal S, Soin AS. Long-term Management of the Adult Liver Transplantation Recipients. J Clin Exp Hepatol 2021; 11:239-253. [PMID: 33746450 PMCID: PMC7953009 DOI: 10.1016/j.jceh.2020.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/14/2020] [Indexed: 12/12/2022] Open
Abstract
The survival of liver transplantation (LT) recipients has been improved remarkably in short-term. The major causes of mortality in long-term include nonimmunological causes such as cardiovascular, de novo malignancy, chronic kidney disease, and recurrence of primary disease. Rejection-related mortality is rare in the long-term after LT. We discuss nonrejection causes of long-term morbidity/mortality, risk factors, and management strategies in LT recipients. In addition, we discuss osteoporosis, contraception, and pregnancy in LT recipients.
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Key Words
- AIH, autoimmune hepatitis
- BMI, body mass index
- CKD, chronic kidney disease
- CNI, calcineurin inhibitors
- CVD, cardiovascular disease
- DDLT, deceased donor liver transplantation
- DM, diabetes mellitus
- DNM, de novo malignancy
- HCV, hepatitis C virus
- HR, hazard ratio
- IUCD, Intrauterine contraceptive devices
- LDLT, living donor liver transplantation
- LT, liver transplantation
- MDRD, Modification of Diet in Renal Disease
- MMF, mycophenolate
- MS, metabolic syndrome
- NAFLD, nonalcoholic fatty liver disease
- NASH, nonalcoholic steatohepatitis
- OR, odds ratio
- PBC, primary biliary cholangitis
- PSC, primary sclerosing cholangitis
- PTDM, posttransplantation diabetes mellitus
- PTMS, posttransplantation metabolic syndrome
- SVR, sustained virological response
- cardiovascular disease
- de novo malignancy
- eGFR, estimated glomerular filtration rate
- mTORi, Mammalian target of rapamycin inhibitors
- osteoporosis
- pregnancy
- recurrence
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Affiliation(s)
| | - Neeraj Saraf
- Address for correspondence: Dr Neeraj Saraf, Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity Hospital, Sector 38, Gurgaon, Delhi (NCR), India.
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Abstract
Objective Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a novel group of oral hypoglycemic agents with multiple proven beneficial effects. However, their use has been associated with euglycemic diabetic ketoacidosis (DKA), typically triggered by risk factors such as acute illness, surgery, and decreased calorie intake. Therefore, it is recommended that patients discontinue SGLT2 inhibitors at least 24 hours before surgery to minimize this risk. We report a case of a postoperative euglycemic DKA in a patient who had discontinued SGLT2 inhibitor therapy 48 hours prior to surgery. Methods We describe the clinical course of a patient with type 2 diabetes mellitus on empagliflozin therapy who was referred for coronary artery bypass graft surgery. Results A 60-year-old man with type 2 diabetes mellitus developed euglycemic DKA a few hours after coronary artery bypass graft surgery. Laboratory results showed acute postoperative elevated anion gap metabolic acidosis with normal glucose and elevated blood ketone levels. It was later revealed that the patient was treated as an outpatient with empagliflozin; the last dose was taken 48 hours prior to his procedure. Conclusion Euglycemic DKA can occur postoperatively in patients with a history of SGLT2 inhibitor use, even 48 hours after the discontinuation of therapy. This case highlights the need to revisit the recommended time to discontinue these agents, specifically prior to major surgery, because their pharmacokinetic effects may persist after 24 hours of discontinuation, putting patients at risk for postoperative euglycemic DKA.
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Affiliation(s)
| | - Ogochukwu J Okoli
- Department of Medicine, Maimonides Medical Center, Brooklyn, New York
| | - Jocelyne G Karam
- Division of Endocrinology, Department of Medicine, Maimonides Medical Center, Brooklyn, New York
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Tleyjeh IM, Kashour Z, AlDosary O, Riaz M, Tlayjeh H, Garbati MA, Tleyjeh R, Al-Mallah MH, Sohail MR, Gerberi D, Bin Abdulhak AA, Giudicessi JR, Ackerman MJ, Kashour T. Cardiac Toxicity of Chloroquine or Hydroxychloroquine in Patients With COVID-19: A Systematic Review and Meta-regression Analysis. Mayo Clin Proc Innov Qual Outcomes 2020; 5:137-150. [PMID: 33163895 PMCID: PMC7605861 DOI: 10.1016/j.mayocpiqo.2020.10.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objective To systematically review the literature and to estimate the risk of chloroquine (CQ) and hydroxychloroquine (HCQ) cardiac toxicity in patients with coronavirus disease 2019 (COVID-19). Methods We searched multiple data sources including PubMed/MEDLINE, Ovid Embase, Ovid EBM Reviews, Scopus, and Web of Science and medrxiv.org from November 2019 through May 27, 2020. We included studies that enrolled patients with COVID-19 treated with CQ or HCQ, with or without azithromycin, and reported on cardiac toxic effects. We performed a meta-analysis using the arcsine transformation of the different incidences. Results A total of 19 studies with a total of 5652 patients were included. The pooled incidence of torsades de pointes arrhythmia, ventricular tachycardia, or cardiac arrest was 3 per 1000 (95% CI, 0-21; I 2 =96%) in 18 studies with 3725 patients. Among 13 studies of 4334 patients, the pooled incidence of discontinuation of CQ or HCQ due to prolonged QTc or arrhythmias was 5% (95% CI, 1-11; I 2 =98%). The pooled incidence of change in QTc from baseline of 60 milliseconds or more or QTc of 500 milliseconds or more was 9% (95% CI, 3-17; I 2 =97%). Mean or median age, coronary artery disease, hypertension, diabetes, concomitant QT-prolonging medications, intensive care unit admission, and severity of illness in the study populations explained between-studies heterogeneity. Conclusion Treatment of patients with COVID-19 with CQ or HCQ is associated with an important risk of drug-induced QT prolongation and relatively higher incidence of torsades de pointes, ventricular tachycardia, or cardiac arrest. Therefore, these agents should not be used routinely in the management of COVID-19 disease. Patients with COVID-19 who are treated with antimalarials for other indications should be adequately monitored.
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Affiliation(s)
- Imad M Tleyjeh
- Infectious Diseases Section, Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia.,Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN.,Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, MN.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Zakariya Kashour
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Oweida AlDosary
- Infectious Diseases Section, Department of Medical Specialties, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Muhammad Riaz
- Department of Statistics, Quaid Azam University Islamabad, Pakistan
| | - Haytham Tlayjeh
- Department of Intensive Care, King Abdulaziz Medical City, King Saud bin Abdulaziz for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Musa A Garbati
- Infectious Diseases Unit, Department of Medicine, University of Maiduguri, Maiduguri, Nigeria
| | - Rana Tleyjeh
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - M Rizwan Sohail
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN.,Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Dana Gerberi
- Mayo Clinic Libraries, Mayo Clinic, Rochester, MN
| | | | - John R Giudicessi
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Michael J Ackerman
- Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN.,Department of Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN.,Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Tarek Kashour
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University Medical City, Riyadh, Saudi Arabia
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Zhang W, Ahmad MI, Soliman EZ. The role of traditional risk factors in explaining the social disparities in cardiovascular death: The national health and Nutrition Examination Survey III (NHANES III). Am J Prev Cardiol 2020; 4:100094. [PMID: 34327470 PMCID: PMC8315458 DOI: 10.1016/j.ajpc.2020.100094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 09/30/2020] [Accepted: 10/03/2020] [Indexed: 11/19/2022] Open
Abstract
Objective ─ To assess the role of traditional risk factors in explaining the association between cumulative social risk exposure and disparities in CVD death among US adults. Methods ─ The study included 15,906 participants from the Third National Health and Nutrition Examination Survey III who were CVD-free at enrollment. Baseline social risk factors (minority race, poverty-income ratio<1, education<12 grade, and living single) were used to create a cumulative social risk score (0 to ≥3). CVD death served as the primary outcome. We assessed the contribution of each major CVD risk factor to the link between cumulative social risk exposure and CVD death. Results ─ During a median follow-up of 14 years, 1309 CVD deaths occurred. Participants with elevated cumulative social risk score were at increased risk of CVD death, with hazard ratio 1.19(95%CI 1.01–1.41), 1.52(95%CI 1.28–1.79), and 1.46 (95%CI 1.23–1.74) in individuals with score 1, 2 and ≥ 3 respectively, compared with individuals with score of 0. Traditional CVD risk factors explained about one third of the disparities in CVD death in individuals with the elevated social risk exposure. Among the one third effect by combined CVD risk factors, current smoking contributed the largest proportion, accounting for approximately one half of the combined risk factors effect, followed by obesity and diabetes. Conclusions ─Among the traditional risk factors, control of smoking appears to be the greatest opportunity to attenuate the social disparities in CVD death. While these findings call for further studies to identify other pathways that explain the elevated CVD mortality in socially disadvantaged population.
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Key Words
- ACC, American College of Cardiology
- AHA, American Heart Association
- BP, blood pressure
- CI, confidence interval
- CVD, cardiovascular disease
- Cardiovascular death
- Cumulative social risk exposure
- DM, diabetes mellitus
- HLD, hyperlipidemia
- HTN, hypertension
- HbA1c, hemoglobin A1c (glycosylated hemoglobin)
- NHANES III, National Health and Nutrition Examination Survey III
- Social disparity
- Third national health and nutrition examination survey
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Affiliation(s)
- Wei Zhang
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Corresponding author. Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Medical Center Blvd, Winston Salem, NC, 27157, USA.
| | - Muhammad Imtiaz Ahmad
- Department of Internal Medicine, Section on Hospital Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Elsayed Z. Soliman
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Burra P, Becchetti C, Germani G. NAFLD and liver transplantation: Disease burden, current management and future challenges. JHEP Rep 2020; 2:100192. [PMID: 33163950 PMCID: PMC7607500 DOI: 10.1016/j.jhepr.2020.100192] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 08/06/2020] [Accepted: 08/13/2020] [Indexed: 02/07/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD), specifically its progressive form non-alcoholic steatohepatitis (NASH), represents the fastest growing indication for liver transplantation in Western countries. Diabetes mellitus, morbid obesity and cardiovascular disease are frequently present in patients with NAFLD who are candidates for liver transplantation. These factors require specific evaluation, including a detailed pre-surgical risk stratification, in order to improve outcomes after liver transplantation. Moreover, in the post-transplantation setting, the incidence of cardiovascular events and metabolic complications can be amplified by immunosuppressive therapy, which is a well-known driver of metabolic alterations. Indeed, patients with NASH are more prone to developing early post-transplant complications and, in the long-term, de novo malignancy and cardiovascular events, corresponding to higher mortality rates. Therefore, a tailored multidisciplinary approach is required for these patients, both before and after liver transplantation. Appropriate candidate selection, lifestyle modifications and specific assessment in the pre-transplant setting, as well as pharmacological strategies, adjustment of immunosuppression and a healthy lifestyle in the post-transplant setting, play a key role in correct management.
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Key Words
- CKD, chronic kidney disease
- CNI, calcineurin inhibitors
- DM, diabetes mellitus
- DPP-4, dipeptidyl peptidase-4
- ELTR, European Liver Transplant Registry
- ESLD, end-stage liver disease
- GLP1 RAs, glucagon-like peptide-1 receptor agonists
- Graft survival
- HCC, hepatocellular carcinoma
- HR, hazard ratio
- Hypertension
- IRR, incidence rate ratio
- Immunosuppressant
- LT, liver transplant
- MAFLD, metabolic dysfunction-associated fatty liver disease
- Metabolic complication
- NAFLD, non-alcoholic fatty liver disease
- NASH, non-alcoholic steatohepatitis
- New-onset diabetes after transplantation
- Non-alcoholic fatty liver disease
- Non-alcoholic steatohepatitis
- OR, odds ratio
- Obesity
- Patient survival
- SGLT2, sodium-glucose co-transporter-2
- Solid organ transplantation
- UNOS, United Network for Organ Sharing
- mTORi, mammalian target of rapamycin inhibitors
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Affiliation(s)
- Patrizia Burra
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital Padua, University of Padua, Padua, Italy
- Corresponding author. Address: Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital. Tel.: +39 0498212892; fax: + 390498217848.
| | - Chiara Becchetti
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital Padua, University of Padua, Padua, Italy
- Hepatology, Department of Visceral Surgery and Medicine, Inselspital, University Hospital Bern, Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Giacomo Germani
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital Padua, University of Padua, Padua, Italy
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