Comorbid Diabetes Research Articles

Association of metformin use with asthma development and adverse outcomes: A systematic review and meta-analysis.

Asthma and diabetes are prevalent chronic diseases affecting a significant population globally. Research has suggested that metformin, a commonly used medication for diabetes management, may also have beneficial effects in enhancing asthma outcomes. Considering the comorbidity of asthma and diabetes, a comprehensive analysis was performed to investigate the efficacy of metformin in reducing adverse outcomes of asthma patients with diabetes. To gather relevant data, we conducted a systematic search of the PubMed, Embase, and CENTRAL databases for observational studies published prior to September 2023. We specifically looked for studies involving individuals diagnosed with both asthma and diabetes, comparing the incidence and severity of asthma exacerbations in metformin users versus nonusers. The inclusion criteria encompassed studies that recruited participants aged 18 years and older. The primary outcome of interest was the risk of newly developing asthma, while secondary outcomes included the adjusted risk of asthma-induced exacerbations, emergency room visits, and hospitalizations. All data analyses and visualizations were performed using the R programming language. We identified and included 7 studies involving a total of 1,176,398 patients in our analysis. The pooled effect size indicated a potential reduction in the incidence of newly developed asthma among patients with type 2 diabetes who used metformin, although this finding did not reach statistical significance. Similar conclusions have also been observed in other outcomes, such as exacerbation, asthma-related emergency department visits, risk of systemic corticosteroid prescription. The only positive outcome is that the use of metformin can reduce the chance of patients being hospitalized due to asthma. In most outcome indicators, it cannot be assumed that the use of metformin can reduce asthma-related adverse events. However, the conclusion is not so certain, and longer observation and more evidence are still required. Metformin still shows some potential in the intervention of respiratory diseases.

Comorbid diseases and severity in psoriasis patients at Khartoum Dermatology and Venereology hospital, August-December 2019

Background: Psoriasis is recognized as a multisystemic disease characterized by systemic inflammation. This study explores the association between psoriasis severity and co-morbid conditions, including hypertension, diabetes, psoriatic arthritis, nail psoriasis, and symptoms such as cough and dyspnea, along with psychological factors like social isolation and sleep disturbances. Objectives were to identify co-morbid diseases associated with different severity levels of psoriasis as measured by the psoriasis area and severity index (PASI) scores at Khartoum dermatology and venereology teaching hospital (KDVTH) from August to December 2019. Methods: This prospective, observational, descriptive, cross-sectional study enrolled 150 psoriasis patients using a quantitative approach. The PASI score was used to assess disease severity. Results: Among the 150 participants (58.6% male, 41.4% female), the distribution of psoriasis severity was 18.7% severe, 30.6% moderate, and 50.6% mild. Significant co-morbidities were observed in severe cases: hypertension (46.4%), diabetes (28.6%), psoriatic arthritis (39.2%), and nail psoriasis (32.2%). Notably, 25% of patients were on lipid-lowering medications. Social isolation and sleep disturbances were prevalent in 30% of moderate and 57% of severe cases. Conclusions: Severe psoriasis is significantly associated with multiple co-morbidities, which can adversely affect patients' prognosis and quality of life. Addressing these associations may enhance management strategies for psoriasis patients.

Association of Sleep Duration and BMI with Periodontitis in Nurses Working in Day and Night Shifts and Its Impact on Co-morbidities

Background: Gender imbalances persist in high-ranking leadership roles, particularly in Aim: To evaluate the association between duration of Sleep and Body-Mass Index (BMI) as potential risk factors with Periodontitis and other co morbidities in duty nurses. Methodology: An observational study was carried out on 42 duty nurses working in hospital. Two Questionnaires (PSQI) Pittsburgh Sleep Quality Index and (ESS) Epworth-Sleepiness Scale were subjectively filled. Study was conducted in 2 phases in the same duty nurses. Phase 1 Duty nurses in morning shift underwent evaluation for periodontal health, BMI and Waist -Hip ratio was recorded. Blood Samples were drawn for analysis of C-Reactive protein, lipid profile and Fasting Blood Sugar. Participants were asked to maintain sleep diary for 6 months. Phase 2: Same Duty Nurses working in Night Shift after 6 months of sleep diary maintenance underwent evaluation of same parameters as phase 1. All-the data were tabulated and sent for statistical-analysis. Results: The result showed that, the association of duration of sleep to Periodontitis was statistically significant in the morning-shift and night-shift (p=0.001), although association of Body Mass Index to periodontitis was statistically significant in the night shift with p value=0.001 than in the morning-shift. The association of Plaque Index and Gingival-Index with duration of sleep and BMI was statistically significant. The parameters taken to study the co-morbidities showed statistical significant difference between the two shifts except WHR ratio, LDL, HDL, Triglyceride, Plaque index. Conclusion: There is an association of Duration of Sleep and Body Mass Index as a potential risk factor for periodontitis and other co-morbidities (Cardiovascular disease and Diabetes) in duty nurses, however the association is much stronger in duty nurses working in night shift than morning shift.

Interactive effect of diabetes mellitus and subclinical MRI markers of cerebrovascular disease on cognitive decline and incident dementia: a memory-clinic study

BackgroundCognitive impairment is an increasingly recognized comorbidity of diabetes, yet the mechanisms underlying this association remain poorly understood. This knowledge gap has contributed to conflicting findings regarding the impact of diabetes on long-term cognitive outcomes in older adults. The presence of cerebrovascular disease (CeVD) may potentially modify this relationship. However, interactive effect between diabetes and subclinical MRI markers of CeVD on cognitive trajectories and incident dementia remains unexplored.MethodsA total of 654 participants underwent brain MRI at baseline, from whom 614 with at least one follow-up were selected for longitudinal analysis. Cognitive tests were performed annually up to 5 years. CeVD markers of interest were lacunes, white matter hyperintensities (WMHs), cerebral microbleeds (CMBs), cortical microinfarcts (CMIs), intracranial stenosis (ICS), and cortical infarcts. Blood-based Alzheimer biomarkers, including p-tau181 and p-tau181/Aβ42 ratio, were used as indicators of Alzheimer pathology.ResultsAt baseline, diabetes was associated with lower cognitive performance and higher burden of CeVD, but not p-tau181 or p-tau181/Aβ42 ratio. Longitudinally, we found an interactive effect of diabetes and WMHs, rather than an independent effect of diabetes, on cognitive decline and dementia risk. Subgroup analyses showed association of diabetes with cognitive outcomes was stronger in participants with high WMHs load but non-significant in those with low WMHs load. Moreover, these associations remained unchanged after adjusting for blood-based Alzheimer biomarkers.ConclusionsThe effect of diabetes on cognitive decline is contingent upon the presence of WMHs and independent of Alzheimer’s pathology. This finding raises the possibility of utilizing WMHs as an imaging biomarker to identify diabetic subgroup at greater risk of developing cognitive impairment. Furthermore, therapeutic interventions targeting WMHs may prevent cognitive deterioration in older adults with diabetes.

Changes in Transient Elastography with Glucagon-Like Peptide-1 Receptor Agonist Use in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Real-World Retrospective Analysis.

Introduction: Current guidelines recommend the use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in the treatment of metabolic dysfunction-associated steatotic liver disease (MASLD), especially in patients with comorbid diabetes and obesity. This study investigated the effects of GLP-1RAs on hepatic steatosis and fibrosis in patients with MASLD, as measured by changes in vibration-controlled transient elastography (VCTE) and other clinical parameters in a real-world clinical setting. Methods: We conducted a single-center, retrospective analysis of 96 patients with MASLD from a multidisciplinary care clinic who completed VCTE at baseline and follow-up within 6-24 months to compare changes in controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), as well as other metabolic markers, between GLP-1RA users and nonusers using two-sample t-tests and Wilcoxon rank-sum tests. We also assessed whether improvements in hepatic steatosis, defined as a change in CAP >38 dB/m as previously described in the literature, were associated with improvement in fibrosis. Results: GLP-1RA use resulted in significant improvements in weight (-8.1 kg vs. -3.5 kg, P = 0.009), body mass index (BMI) (-2.9 kg/m2 vs. -1.3 kg/m2, P = 0.012), alanine aminotransferase (-15.0 IU/L vs. -4.0 IU/L, P = 0.017), aspartate aminotransferase (-5.0 IU/L vs. -1.0 IU/L, P = 0.021), glycated hemoglobin (HbA1c) (-0.7% vs. 0.1%, P = 0.019), and CAP (-59.9 dB/m vs. -29.1 dB/m, P = 0.016). Responders also had significant improvements in weight (-9.2 kg vs. -1.9 kg, P < 0.001), BMI (-3.3 kg/m2 vs. -0.7 kg/m2, P < 0.001), diastolic blood pressure (-6.1 mmHg vs. -0.7 mmHg, P = 0.028), HbA1c (-0.8% vs. 0.3%, P < 0.001), and LSM (-1.5 kPa vs. 0.1 kPa, P < 0.001). Conclusions: Patients with MASLD treated with GLP-1RAs showed significant improvements in hepatic steatosis and multiple other metabolic parameters, with weight loss as the proposed mechanism for this liver improvement. In addition, change in CAP >38 dB/m was associated with improvements in LSM and other metabolic parameters, suggesting the clinical utility of VCTE in the surveillance of MASLD.

Diverse phenotype of Ménière’s disease associated with family history, thyroid disorder, migraine and associated disorders

ObjectiveTo better understand the clinical phenotype of Ménière’s disease (MD), we examined family history, thyroid disorder, migraine, and associated disorders in complaints of people living with MD. MethodWe designed the study as a retrospective and examined data gathered from 912 participants with MD. Their data were originally collected by the Finnish Ménière Federation (FMF). The survey data included individual case histories for environmental factors, comorbidities, disease-specific complaints, impact-related questions, cognitive complaints, health-related quality of life (HRQoL), and sense of coherence (SOC). ResultsWe observed significant differences between those with and without sporadic occurrence, family history, thyroid disorder, and migraine-associated complaints. Family history explained 20% of variability in patient complaints. Patients with a family history of MD whose disease started at younger age experienced balance problems, more severe vertigo spells, more severe vestibular drop attacks (VDA), and less nausea, although they had good SOC. Thyroid disorder explained 14% of variability in patient complaints. MD patients with a thyroid disorder comorbidity suffered more often from constant dizziness, balance problems, greater impact of hearing problems, cognitive complaints, and poor HRQoL. Migraine explained 12% of variability in patients’ complaints and was associated with poor SOC and cognitive balance problems. MD patients with both thyroid disorder and migraine used antidepressants more often than other groups. Logistic regression analysis showed comorbidities of ischemic brain disorder (among 7.1%), kidney insufficiency (among 1.2%), and diabetes (among 7.3%) had statistically significant but restricted association with balance and gait problems, VDA, and reduced HRQoL. ConclusionsFamily history of MD and thyroid disorder or migraine comorbidities in MD influence the complaint pattern and partially explain complex symptom profiles, including symptoms of cognitive problems. Confounders play a minimal role in complaint profile and impact of MD whereas comorbidities influence the complaint structure and partly explain the complex symptom profile in MD.

Prior fragility fractures are associated with a higher risk of 8-year complications following total shoulder arthroplasty.

As the population ages, more patients with osteoporosis are undergoing total shoulder arthroplasty (TSA), including those who have sustained a prior fragility fracture. Sustaining a fragility fracture before TSA has been associated with increased risk of short-term revision rates, periprosthetic fracture (PPF), and secondary fragility fractures but long-term implant survivorship in this patient population is unknown. Therefore, the purpose of this study was to characterize the association of prior fragility fractures with 8-year risks of revision TSA, periprosthetic fracture, and secondary fragility fracture. Patients aged 50years and older who underwent TSA were identified in a large national database. Patients were stratified based on whether they sustained a fragility fracture within 3years prior to TSA. Patients who had a prior fragility fracture (7631) were matched 1:1 to patients who did not based on age, gender, Charlson Comorbidity Index (CCI), smoking, obesity, diabetes mellitus, and alcohol use. Kaplan-Meier and Cox Proportional Hazards analyses were used to observe the cumulative incidences of all-cause revision, periprosthetic fracture, and secondary fragility fracture within 8years of index surgery. The 8-year cumulative incidence of revision TSA (5.7% vs. 4.1%), periprosthetic fracture (3.8% vs. 1.4%), and secondary fragility fracture (46.5% vs. 10.1%) were significantly higher for those who had a prior fragility fracture when compared to those who did not. On multivariable analysis, a prior fragility fracture was associated with higher risks of revision (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.24-1.74; p < 0.001), periprosthetic fracture (HR, 2.98; 95% CI, 2.18-4.07; p < 0.001) and secondary fragility fracture (HR, 8.39; 95% CI, 7.62-9.24; p < 0.001). Prior fragility fracture was a significant risk factor for revision, periprosthetic fracture, and secondary fragility fracture within 8years of primary TSA. Identification of these high-risk patients with an emphasis on preoperative and postoperative bone health optimization may help minimize these complications. III.

Prevalence of comorbidity hypertension and diabetes mellitus in cancer patients of Madhya Pradesh, India

Prevalence of comorbidity hypertension and diabetes mellitus in cancer patients of Madhya Pradesh, India

Outcomes after endovascular revascularization for chronic limb-threatening ischemia from the only Vascular Quality Initiative (VQI) center in Asia

ObjectiveThis study compares chronic limb-threatening ischemia disease characteristics and endovascular revascularization outcomes in a multi-ethnic Asian cohort vs their North American counterparts. MethodsThe Society for Vascular Surgery Vascular Quality Initiative (VQI) registry database from the first and currently the only VQI center in Asia was reviewed to identify patients with chronic limb-threatening ischemia who underwent endovascular revascularization between July 2019 and April 2024. Standardized VQI reporting variables were compared against benchmarks derived from all participating centers in North America. ResultsA total of 2862 endovascular revascularization procedures from our center were benchmarked against 129,347 procedures from 406 North American centers. Our cohort had a higher burden of comorbidities (diabetes mellitus, end-stage renal disease, cardiac disease) and presented with more advanced Wound, Ischemia, and foot Infection stages. Our patients had more heavily calcified and longer (14.8 cm vs 6.0 cm) diseased vessels with higher prevalence of multi-level (87% vs 54.6%), infrapopliteal (52.6% vs 38.9%), and inframalleolar (9.6% vs 2.4%) disease. Rates of technical success (92.7% vs 93%) and symptom improvement (39.1% vs 40.4%) were comparable between cohorts. However, 1-year mortality rates (28.9% vs 25.1%) and major amputation rates (13.3% vs 7.8%) were significantly higher. ConclusionsShort-term outcomes of technical success and symptom relief in our center were comparable to benchmarked North American outcomes despite having a cohort with more diseased vessels, higher Wound, Ischemia, and foot Infection stages, and more comorbidities. However, this cohort fared worse in longer term outcomes of 1-year mortality and major amputation rates. Further studies are required to elucidate the causes to improve these outcomes.

Glucagon-Like Peptide-1 Receptor Agonist Use is Not Associated with Increased Complications After Total Hip Arthroplasty in Patients Who Have Type-2 Diabetes

IntroductionGlucagon-like peptide-1 (GLP-1) agonists have emerged as a powerful diabetic treatment adjunct; however, their effects on outcomes following total hip arthroplasty (THA) are not well known. This study aimed to compare the risk of complications in patients who had type-2 diabetes mellitus (DM) who were on GLP-1 agonists with those who were not on these medications. MethodsIn total, 14,065 patients who had type-2 DM undergoing primary THA between 2016 and 2021 were retrospectively reviewed utilizing a national database. Propensity score matching was employed at a 1:4 ratio to match patients who used GLP-1 agonists (n = 812) to those who did not (n = 3,248). Patients were matched on age, sex, insulin status, presence of other diabetic medications, comorbidities, and smoking status. Multivariable logistic regressions were performed to examine 90-day and 1-year THA outcomes between groups. ResultsPatients who were not on GLP-1 agonists exhibited increased rates of extended hospital stays (≥ three days) (OR [odds ratio] 1.25, P = 0.01). Patients who were on GLP-1 agonists exhibited no significant differences in surgical or medical complication rates at 90 days compared to those not on GLP-1 agonists. There were also no significant differences in rates of all-cause revision THA, aseptic revision THA, or PJI during the 1-year postoperative period. ConclusionThis study demonstrated that GLP-1 agonists were not associated with increased risks for medical or surgical complications in patients who had DM undergoing THA and were associated with lower rates of extended hospital stays after surgery. This study provides additional evidence regarding the association of GLP-1 agonist use before THA with postoperative outcomes. Given the potential for increased glycemic control and weight loss, more data is needed to delineate the role of GLP-1 agonists in the optimization of patients who have DM before THA to minimize postoperative complications.

A CASE-CONTROL STUDY OF HEMATOLOGICAL ANALYSIS ON DIABETES AND COVID-19 SEVERITY

This study investigates the relationship between diabetes comorbidity and COVID-19 severity in Muhammadiyah Palembang Hospital, focusing on hematological parameters as potential predictors of disease progression. Utilizing a case-control design with 61 respondents, demographic data, COVID-19 severity classifications, and hematological profiles were analyzed. Results reveal a prevalence rate of diabetes mellitus among COVID-19 patients at 32.8%, with diabetic individuals experiencing higher rates of moderate clinical complications. Hematological analysis demonstrates variations in parameters such as hemoglobin levels, platelet counts, and neutrophil-to-lymphocyte ratio between diabetic and non-diabetic COVID-19 patients. These findings underscore the importance of tailored interventions for diabetic individuals infected with COVID-19 and highlight the potential of hematological parameters in predicting disease severity. The study suggests the need for larger-scale, multicenter research to validate findings and inform evidence-based clinical practice in managing COVID-19 patients with comorbid diabetes mellitus.

Dapagliflozin-associated euglycemic diabetic ketoacidosis in 66-year-old with type 2 Diabetes: A clinical case report

Euglycemic diabetic ketoacidosis (EDKA) is a rare but serious complication of type 2 diabetes, often associated with the use of SGLT2 inhibitors. This case report describes an episode of EDKA in a 66-year-old male with a long history of type 2 diabetes and multiple comorbidities, who developed this complication following the introduction of dapagliflozin. Although his blood glucose levels remained within normal limits, laboratory tests revealed elevated ketonemia and severe metabolic acidosis. The patient was successfully treated with intravenous hydration and insulin therapy, leading to a rapid improvement in his clinical condition. This case underscores the importance of clinical vigilance and patient education for those treated with SGLT2 inhibitors to prevent and effectively manage this potentially life-threatening complication.

Determinants of/ factors affecting glycaemic control among type 2 diabetic patient attending a health insurance clinic in Benue, Nigeria.

Background: Diabetes mellitus is a multisystem disease that requires multifaceted management approach with the aim of maintaining good glycaemic control. Proper knowledge of factors affecting glycaemic control will provide standard operational protocols in the management of patients with resultant good glycaemic control, better quality of life, and overall reduced morbidity and mortality. Objectives: This study aimed to assess the determinants of good glycaemic control among adult patients with type 2 diabetes. Methodology: This study was a hospital based cross-sectional study conducted between December 2021 and March 2022 involving 381 adult patients with T2DM attending the National Health Insurance Authority clinic. The participants were selected by systematic random sampling. Data was collected by an interviewer administered questionnaire. Anthropometry and blood pressure measurements were also taken. Data was analyzed with the Statistical Package for Social Sciences (SPSS). Version 24 with level of confidence at 5% (p=0.005) Result: There were 194 male (50.9%). The mean age of patients was 54.94±7.21 years. The proportion of T2DM patients with good glycaemic control was 106 (27.8%). Duration of diabetes diagnosis, co-morbidities, smoking or tobacco use, frequency of vigorous intensity sports, current complementary and alternative medicine use and blood pressure had statistically significant association with good glycaemic control following bivariate analysis. Conclusion: Level of glycaemic control was por. Primary care physicians should increase efforts in identifying, educating and counselling of patients with T2DM on measures to attain optimal good glycaemic control.

HALP and PNI Score as Predictors of Nutritional Status in the Incidence of Incisional Hernia after Laparotomy in Colorectal Cancer Patients: A Case-Control Study

Background: Colorectal cancer ranks as the third most common cancer in the world. If patients can still be resected, surgical therapy is carried out. An incisional hernia is one of the complications after laparotomy surgery. Nutritional status can influence the incidence of incisional hernias after laparotomy. Colorectal cancer patients must have their nutritional status assessed using a simple scoring. This research aims to evaluate Hemoglobin, Albumin, Lymphocyte, Platelet (HALP) and Prognostic Nutritional Index (PNI) scores as a predictor of incisional hernia after laparotomy surgery in colorectal cancer patients at Dr. Sardjito General Hospital, Yogyakarta. Methods: This study uses a case-control study design which consisted of two groups, a case group of colorectal cancer patients with incisional hernias after laparotomy surgery and a control group of colorectal cancer patients without incisional hernias. The independent variable was nutritional status which was assessed by HALP and PNI score, and the dependent variable was incisional hernia. This research by taking data from laboratory patients at Dr. Sardjito General Hospital, Yogyakarta. For multivariate analysis, a logistic regression test was used with a significance value of p 0.05. Results: There is a relationship between the stage of cancer and the comorbid diabetes mellitus with the incidence of incisional hernias after laparotomy, this can be seen in the results of the chi-square test. Advanced stage has an OR of 13 (P=.001; OR=13; 95% CI 3.551-47.597), while comorbid diabetes mellitus has an OR of 6.571 (P=.002; OR=6.571; 95% CI 2.109-20.479). However, there is no correlation between the HALP and PNI score with the incidence of incisional hernia after laparotomy. The multivariate analysis results in HALP score have a significant correlation between the nutritional status and the incidence of incisional hernia with OR=17.981 (p= 0.037 OR=17; 95% CI 1.198-269.803). Conclusions: The HALP score can be used as a screening predictor in the incidence of incisional hernia after laparotomy for colorectal cancer patients.

Lower extremity amputation rates in patients with chronic kidney disease: A database study comparing patients with and without diabetes mellitus

Lower extremity amputation (LEA) is one of the most feared consequences of diabetes mellitus (DM). The purpose of this study was to evaluate the impact of DM on LEA rates in patients at various stages of chronic kidney disease (CKD).A commercially available de-identified database was searched for patients undergoing LEA and for CKD patients, from 2010 to 2023. Patients with DM and patients without DM who were followed for at least 5 years were included. LEA rates were then compared for patients at all 5 CKD stages in patients with and without diabetes.Rates of all LEA were found to be significantly higher at all CKD stages for patients with diabetes (overall, minor and major LEA). Compared to patients without DM who have CKD stage 5 (end stage renal disease), patients with DM and CKD stage 5 have a 30 fold increased likelihood of undergoing overall LEA [OR 30.2 (24.48–37.19), p < 0.001], 29 fold increased likelihood of undergoing minor LEA [28.9i (22.91–36.35), p < 0.001] and 40 times fold increased likelihood of undergoing major LEA [40.1 (26.59–60.42), p < 0.001]. For all stages of CKD, independent of diabetes status, minor LEA were performed with greater frequency than major LEA. In patients with DM, LEA rates significantly increased with CKD progression between stages 2–5 with a substantial jump between stages 4 and 5 [OR 2.6 (CI 2.49–2.74), p < 0.001]. However, CKD progression between stages 1 and 2 was not significantly associated with increased LEA rates (OR 1.1 (CI 0.92–1.21), p = 0.24) in patients with diabetes.Patients with comorbid diabetes have elevated risk for LEA at all stages of CKD compared to those without diabetes.

Sociocultural features of lifestyle modifications among TB–diabetes comorbid patients in Satara, India and its implications for planning self-management interventions for TB–diabetes comorbid patients

BackgroundLifestyle modifications (LM) are crucial in managing comorbid Tuberculosis (TB) and Diabetes Mellitus (DM) patients, significantly impacting treatment outcomes and overall health. In view of this, a study was conducted to clarify sociocultural features associated with LM among TB–diabetes comorbid patients.MethodsA cross-sectional descriptive study among randomly selected 180 adult TB–diabetes-comorbid-patients was conducted using a semi-structured interview schedule. Mann–Whitney-U-test was used to examine differences in means between patterns of distress (PDs) and perceived causes (PCs) regarding TB and Diabetes for two identified LM strategies among comorbid patients. Stepwise logistic regression was used to study factors associated with these LM strategies.ResultsTB–diabetes-comorbid-patients reporting physical symptoms as PDs preferred to follow the LM-1 strategy for TB and LM-2 for Diabetes. In contrast, patients reporting health-illness-injury-related causes follow LM-2 for TB and LM-1 for Diabetes. Further patients reporting hypertension for Diabetes (AOR = 2.916, 95% CI 0.9262–9.1788) and concerns-about-the-course-of-TB-illness (AOR = 3.746, 95% CI 1.4683–9.5593) as PDs were 3–4 times more likely to follow LM-1. While those reporting prior illnesses (AOR = 4.255, 95% CI 1.3941–12.9837) and sanitation (AOR = 5.242, 95% CI 1.2028–22.8446) as PCs for TB were 4–5 times follow LM-2. Patients who perceived consumption of alcohol as PCs of Diabetes were 10 times more likely to stop addictions (AOR = 9.680, 95% CI 2.5555–36.6639) and follow the LM-2 strategy.ConclusionGiven significant associations of sociocultural features with LM strategies, consideration of sociocultural features vis-à-vis these strategies is indispensable for managing TBDM comorbidity, emphasizing the need for developing comprehensive, patient-centred self-management interventions to enhance adherence and improve health outcomes.

Retrospective Outcome Analysis of Geriatric Traumatic Brain Injury Treated at a Tertiary Care Center in India

Abstract Background Trauma is a major cause of morbidity and mortality in elderly patients and its management is challenging. Outcome assessment in these patients is difficult because of preexisting chronic medical conditions as it may be impossible to isolate the effect of traumatic brain injury. This study aimed to examine the clinical outcomes and epidemiological and clinicoradiological characteristics of geriatric traumatic brain injury patients at a tertiary care center. Methods The clinical records of patients aged ≥60 years with head injuries treated at King George's Medical University between 2016 and 2020 were included in the study. Patients were followed up in the outpatient department or through telephone consultation. The follow-up period was updated using the Glasgow outcome score (GOS) of patients for current neurological status and relevant radiological investigations. Results The mean age of subjects was 66.16 ± 6.55 years. Road traffic accidents were the most frequent cause of brain injuries (448 [68.5%]). In total, 41% of the study patients had severe head injuries (Glasgow coma scale, GCS &lt; 9) at admission. The in-hospital mortality was 25.2%. In total, 60.7% of discharged patients showed favorable outcomes (GOS: 4 or 5). GCS at admission, best motor response, and associated comorbidity (diabetes mellitus) significantly predicted the outcome at 6 months. The majority of the patients (82.6 %) were 60 to 70 years of age. Conclusion Road traffic accidents are the most frequent cause of brain injuries in geriatrics. Most of them were managed medically, and majority were discharged (74.8%). Out of those discharged, 39.3% had unfavorable outcomes.

Bone marrow-derived mesenchymal stem cell-derived exosome-loaded miR-129-5p targets high-mobility group box 1 attenuates neurological-impairment after diabetic cerebral hemorrhage

BACKGROUND Diabetic intracerebral hemorrhage (ICH) is a serious complication of diabetes. The role and mechanism of bone marrow mesenchymal stem cell (BMSC)-derived exosomes (BMSC-exo) in neuroinflammation post-ICH in patients with diabetes are unknown. In this study, we investigated the regulation of BMSC-exo on hyperglycemia-induced neuroinflammation. AIM To study the mechanism of BMSC-exo on nerve function damage after diabetes complicated with cerebral hemorrhage. METHODS BMSC-exo were isolated from mouse BMSC media. This was followed by transfection with microRNA-129-5p (miR-129-5p). BMSC-exo or miR-129-5p-overexpressing BMSC-exo were intravitreally injected into a diabetes mouse model with ICH for in vivo analyses and were cocultured with high glucose-affected BV2 cells for in vitro analyses. The dual luciferase test and RNA immunoprecipitation test verified the targeted binding relationship between miR-129-5p and high-mobility group box 1 (HMGB1). Quantitative polymerase chain reaction, western blotting, and enzyme-linked immunosorbent assay were conducted to assess the levels of some inflammation factors, such as HMGB1, interleukin 6, interleukin 1β, toll-like receptor 4, and tumor necrosis factor α. Brain water content, neural function deficit score, and Evans blue were used to measure the neural function of mice. RESULTS Our findings indicated that BMSC-exo can promote neuroinflammation and functional recovery. MicroRNA chip analysis of BMSC-exo identified miR-129-5p as the specific microRNA with a protective role in neuroinflammation. Overexpression of miR-129-5p in BMSC-exo reduced the inflammatory response and neurological impairment in comorbid diabetes and ICH cases. Furthermore, we found that miR-129-5p had a targeted binding relationship with HMGB1 mRNA. CONCLUSION We demonstrated that BMSC-exo can reduce the inflammatory response after ICH with diabetes, thereby improving the neurological function of the brain.

Bone marrow-derived mesenchymal stem cell-derived exosome-loaded miR-129-5p targets high-mobility group box 1 attenuates neurological-impairment after diabetic cerebral hemorrhage.

Diabetic intracerebral hemorrhage (ICH) is a serious complication of diabetes. The role and mechanism of bone marrow mesenchymal stem cell (BMSC)-derived exosomes (BMSC-exo) in neuroinflammation post-ICH in patients with diabetes are unknown. In this study, we investigated the regulation of BMSC-exo on hyperglycemia-induced neuroinflammation. To study the mechanism of BMSC-exo on nerve function damage after diabetes complicated with cerebral hemorrhage. BMSC-exo were isolated from mouse BMSC media. This was followed by transfection with microRNA-129-5p (miR-129-5p). BMSC-exo or miR-129-5p-overexpressing BMSC-exo were intravitreally injected into a diabetes mouse model with ICH for in vivo analyses and were cocultured with high glucose-affected BV2 cells for in vitro analyses. The dual luciferase test and RNA immunoprecipitation test verified the targeted binding relationship between miR-129-5p and high-mobility group box 1 (HMGB1). Quantitative polymerase chain reaction, western blotting, and enzyme-linked immunosorbent assay were conducted to assess the levels of some inflammation factors, such as HMGB1, interleukin 6, interleukin 1β, toll-like receptor 4, and tumor necrosis factor α. Brain water content, neural function deficit score, and Evans blue were used to measure the neural function of mice. Our findings indicated that BMSC-exo can promote neuroinflammation and functional recovery. MicroRNA chip analysis of BMSC-exo identified miR-129-5p as the specific microRNA with a protective role in neuroinflammation. Overexpression of miR-129-5p in BMSC-exo reduced the inflammatory response and neurological impairment in comorbid diabetes and ICH cases. Furthermore, we found that miR-129-5p had a targeted binding relationship with HMGB1 mRNA. We demonstrated that BMSC-exo can reduce the inflammatory response after ICH with diabetes, thereby improving the neurological function of the brain.

Biomarkers of COVID-19 short-term worsening: a multiparameter analysis within the prospective multicenter COVIDeF cohort.

During a pandemic like COVID-19, hospital resources are constrained and accurate severity triage of the patients is required. The objective of this study is to estimate the predictive performances of candidate biomarkers for short-term worsening (STW) of COVID-19. Prospective, multicenter (20 hospitals in Paris) cohort study of consecutive COVID-19 patients with systematic biobanking at admission, during the first waves of COVID-19 in France in 2020 (COVIDeF cohort). Consecutive COVID-19 patients were screened for inclusion. They were excluded in presence of severity criteria defined by either an ICU admission, mechanical ventilation (including noninvasive ventilation), acute respiratory distress, or in-hospital death before sampling. Routine blood tests measured during usual care and centralized systematic measurement of creatine kinase, C-reactive protein (CRP), procalcitonin, soluble urokinase plasminogen activator receptor (suPAR), high-sensitive troponin T (TnT-hs), N terminal pro-B natriuretic peptide (NT-proBNP), calprotectin, platelet factor 4, mid-regional pro-adrenomedullin (MR-proADM), and proendothelin were performed. The primary outcome was STW, defined by a severity criteria within 7 days. A backward stepwise logistic regression model and a 'best subset' approach were used to identify independent association, and the area under the receiving operator characteristics (AUROC) was computed. Five hundred and eleven patients were analyzed, of whom 60 (11.7%) experienced STW. Median time to occurrence of a severity criteria was 3 days. At admission, lower values of eosinophils, lymphocytes, platelets, alanine aminotransferase, and higher values of neutrophils, creatinine, urea, CRP, TnT-hs, suPAR, NT-proBNP, calprotectin, procalcitonin, MR-proADM, and proendothelin were predictive of worsening. Stepwise logistic regression identified three biomarkers significantly associated with worsening: CRP [adjusted odds ratio (aOR): 1.10, 95% confidence interval (95% CI): 1.06-1.15 for a 10-unit increase, AUROC: 0.73 (0.66-0.79)], procalcitonin [aOR: 0.42, 95% CI: 0.22-0.81, AUROC: 0.69 (0.64-0.88)], and MR-proADM [aOR: 2.85, 95% CI: 1.74-4.69, AUROC: 0.75 (0.69-0.81)]. These biomarkers outperformed clinical variables except diabetes and cancer comorbidities. In this multicenter prospective study that assessed a large panel of biomarkers for COVID-19 patients, CRP, procalcitonin, and MR-proADM were independently associated with the risk of STW. ClinicalTrials.gov NCT04352348.