Comorbid Diabetes Research Articles

Diabetes mellitus and comorbidities in elderly people from the Lugu community: A critical-reflective analysis

Ageing has a close relationship with chronic non-communicable diseases, such as diabetes mellitus and high blood pressure. These pathologies are often associated with changes in eating habits and promote crucial physiological changes which act silently in the long term in the elderly population. Due to the speed of urban development and technological advances, there has been an increase in the population's life expectancy. However, it is essential to know the socio-demographic profile and prevalent comorbidities of the elderly population, which can provide a reliable and broad database to enable the outline of strategies and the promotion of efficient health policies. In this sense, the purpose of this editorial is to contribute to the debate surrounding the article that analysed epidemiological data from the Lugu community. Diabetes mellitus, hypertension and cardiovascular pathologies and their comorbidities were the most prevalent conditions in this community. Such data could contribute to develop public policies constructively and assertively, allowing investments in the prevention and treatment of these pathologies.

Factors associated with lipid lowering therapy in the multi-ethnic study of atherosclerosis.

Lipid-lowering therapy (LLT) plays a central role in managing atherosclerotic cardiovascular disease (ASCVD) risk, but its underuse is reported in over 40% of the qualified population in the United States. Studies on factors, particularly actionable factors associated with guideline-directed LLT are limited. This study evaluated participants from the Multi-Ethnic Study of Atherosclerosis (MESA) on their qualification for LLT at exam 5 (2010-2012) according to the 2013 American College of Cardiology (ACC)/American Heart Association (AHA) guideline on cholesterol management. Participants were categorized as on-LLT or off-LLT at the following exam (2016-2018). Multi-variable relative risk (RR) models were used to analyze between LLT usage and factors prior to 2013, including age, gender, race/ethnicity, education level and medical insurance, income, smoking, body mass index (BMI), diabetes, hypertension, and presence of coronary artery calcium (CAC). Among the 2114 participants qualified for LLT at exam 5 with an average age of 70.7, 1,129 (53.4%) were on LLT while 985 (46.6%) were off LLT at exam 6. Black participants were less likely to be on LLT compared to the reference white participants (RR 0.80, 95% confidence interval CI 0.71-0.90). Higher BMI showed borderline significant association with LLT. Comorbidities of diabetes and hypertension were positively associated with LLT use (RR 1.39 and 1.23, 95% CI 1.27-1.52 and 1.10-1.36, respectively). CAC score > 0 as an indicator of subclinical ASCVD was strongly associated with LLT too, independent of other demographic or comorbidity factors (RR 1.38, 95% CI 1.21-1.56). This study identifies key factors influencing LLT use among MESA participants. Black participants were less likely to be on LLT, highlighting healthcare disparities. CAC presence was strongly associated with LLT use, suggesting that CAC measurement could be an actionable factor to improve adherence to LLT guidelines.

Antimicrobial prescribing practices and factors associated with antimicrobial prescribing in hospitalized COVID-19 patients in Oyo state: A retrospective study.

Proportion of hospitalized COVID-19 patients receiving antimicrobial drug is significantly high despite evidence of low level of actual bacterial co-infection, potentially contributing to poor health outcome and global antimicrobial resistance. A retrospective study was performed on antimicrobial agents prescribed to adult patients with confirmed COVID-19 admitted across three isolation facilities between 1 March 2020 and 30 April 2021 in Ibadan, Oyo state, Nigeria. From individual records, we evaluated patient demographics, COVID-19 risk factors, diagnostic testing, disease severity and antimicrobial utilization. The primary aim was to determine the prevalence of antimicrobial prescription as well as factors associated with antimicrobial prescribing in hospitalized patients with COVID-19 in Oyo state. In total, 271 patients were included in this study. The median age of the population was 51 years (IQR; 32-62 years). The mean duration of hospital admission was 13 days (IQR: 10-14 days). Majority of participants were symptomatic (81.5%). All participants had a COVID-19 PCR test performed and none had bacterial culture performed. All patients received antimicrobial therapy across the entire cohort. The mean DOT per LOT across cohorts was 1.2 for mild cases, 1.4 for moderate cases and 1.3 for severe cases. Factors associated with the number of antimicrobials per prescription were being single (P = 0.02), being below 60 years of age (P = 0.04), mild COVID-19 symptoms (P < 0.001) and diabetes comorbidity (P = 0.03). Given the high rate of antimicrobial prescription and absence of bacteriological culture analysis in these patients, there is risk of development and spread of antimicrobial resistant. Continuous review of antimicrobial prescription is critical in the management of hospitalized COVID-19 patients.

Abstract 4138570: The Hidden Killer in Patients with Sepsis Spectra Disorders: Systolic Heart Failure

Introduction: Sepsis and systolic heart failure (sHF) often prompt hospitalization and require near diametrically opposite treatment strategies. We, therefore, studied whether sHF would impact outcomes in patients with sepsis spectra. Methods: We examined the National Inpatient Sample 2021 for adults admitted with sepsis spectra (sepsis, severe sepsis, and septic shock). We compared patients with sHF vs those without. STATA 18 th edition was used for analyses. Age, gender, race, hypertension, diabetes, obesity, dyslipidemia, and Elixhauser comorbidity index were identified as confounders by univariate analyses and tested further with multivariate logistic regression models. The primary outcome was mortality. Secondary outcomes were the need for intubation, cardiac arrest, length of stay (LOS), and total hospital charges. Results: In 2021, nationwide, 3,030,351 adults were admitted for sepsis spectra, and 209,134 (6.9%) had concomitant sHF. Patients with sHF and sepsis spectra (as compared to those without sHF) were less likely female (35.5% vs. 48%), had a substantially higher likelihood of a prior MI, and nearly 50% were diabetic and hyperlipidemic with a higher comorbidity index. Baseline characteristics are in the Table. Sepsis and sHF resulted in substantially higher mortality (22.7%) as compared to patients with sepsis alone (14.9%) adjusted odds ratio (aOR) of 1.11 (CI 1.08-1.14; p-value &lt; 0.001). Patients with sepsis and sHF were more likely to require intubation 22.2% vs. 14.0% aOR 1.21 (CI 1.18-1.25; p-value &lt; 0.001), had more cardiac arrest 7.7% vs. 4.0% aOR 1.38 (CI 1.32-1.44; p-value &lt; 0.001), and a longer LOS (11.9 vs 9.4 days adjusted incidence rate ratio (aIRR) 1.06; CI 1.05 – 1.08; p-value &lt; 0.001). Consequently, total hospital charges were also higher, $189,415 vs $133,720, aIRR 1.15 (CI 1.13-1.18; p-value &lt; 0.001). Conclusion: In 2021, nationwide, sepsis spectra remain a major cause of in-patient mortality. We demonstrate that the coexistence of systolic heart failure and sepsis dramatically worsens complications, mortality, and total hospital costs. This study is a call to action for the in-depth analyses of this very high-risk group of patients.

Abstract 4144525: An Observation Of Racial Disparities In Patients Admitted With St Segment Elevated Myocardial Elevation

introduction: This sudy explores the multifaceted nature of racial disparities among patients admitted with STEMI, shedding light on the complex interplay of social, economic, and healthcare factors that contribute to differential outcomes among diverse populations. Methods: we examined the national inpatient sample 2017-2020 for adult admitted with st segment myocardial infarction,we compared the clincal outcome based on racial distribution.STATA 18th edition was used for analyses. Age, gender, race, hypertension, diabetes, obesity, dyslipidemia, and Elixhauser comorbidity index were identified as confounders by univariate analyses and tested further with multivariate logistic regression models. The primary outcome was mortality. Secondary outcomes were the need for intubation, cardiac arrest, length of stay (LOS), and total hospital charges. Results: There were 826315 hospitalizations with STEMI. Mean age was 64 yrs and 62% were male. Among the admitted patients, Caucasians were 593575 (72%), Blacks were 75025(9.1%),Hispanics were 69605(8.4%), Asians were 23734(2.9%). All-cause mortality in patients admitted with STEMI was 88125 where subgroup Analysis with Caucasians, Blacks ,Hispanics and Asians had 60074(10.1%) vs 9135 (12.1%) vs 7645(10.9%) and 2999(12.6%) respectively. Further subgroups analysis revealed that Blacks (13.9%, aOR 1.37 CI 1.28-1.47,P value&lt;0.001) were more likely to require intubation,followed by Asians(13.5% aOR 1.59 CI 1.43--1.76, p value &lt;0.001) ,then Hispanic (13% aOR 1.45,CI 1.35-1.56 P vale &lt;0.001)and caucasians were least likely to require intubation(9.7% ) Finally, racial subgroup showed significant primary andsecondary outcomes that are presented in Table 1. Conclusion: All obtained results revealed statistical significance and we considered Caucasian population as baseline. Mortality waa highest amongst Asians,followed by Blacks then Hispanics and least in the caucasian subgroup. Understanding these disparities is essential for improving healthcare equity and ensuring that all patients receive appropriate and equitable care regardless of their racial or ethnic background.

Nutritional status of patients with gastrointestinal cancers and analysis of factors for postoperative infections.

Patients with gastrointestinal cancer have a higher risk of malnutrition and postoperative infection. To investigate the nutritional status of patients with gastrointestinal cancers and factors for postoperative infections. Based on the nutritional risk status, 294 patients with gastrointestinal tumours were divided into a nutritional risk group and a non-nutritional risk group, and the differences between the two groups were compared. Among the included patients, 128 were at preoperative nutritional risk (43.54%); there were significant differences between the two groups in terms of age (66.25 ± 11.73 vs. 58.36 ± 10.41 years, P < 0.001), percentage of gastric cancers (39.84% vs. 28.92%, P = 0.049), percentage of stage IV tumours (60.16% vs. 45.18%, P = 0.011), total protein (64.90 ± 6.82 vs. 67.21 ± 7.41g/L, P = 0.007), albumin (38.32 ± 4.74 vs. 41.61 ± 5.10g/L, P < 0.001) and haemoglobin (112.72 ± 22.63 vs. 125.11 ± 22.79g/L, P < 0.001). Multivariate logistic regression analysis showed that risk factors for postoperative infections in patients included age ≥ 60 years (odds ratio [OR] = 2.266 95%CI = 1.357-4.134), Nutrition Risk Screening (NRS)-2002 score ≥ 3 (OR = 2.183, 95%CI = 1.218-4.102), alcohol history (OR = 2.505, 95%CI = 1.370-4.683), comorbid diabetes mellitus (OR = 2.110, 95%CI = 1.381-4.023) and surgical time ≥ 6h (OR = 2.446, 95%CI = 1.359-4.758). Patients with gastrointestinal cancers are at high incidence of preoperative nutritional risk, and those with an NRS-2002 score of > 3, history of alcohol consumption and surgical time of > 6h have a higher risk of postoperative infections.

Differentiation complex sputum microbiome in patients suspected TB pulmonary

&lt;b&gt;Purpose: &lt;/b&gt;This is the first study to attempt microbiome diversity using metagenomic full-length 16S rRNA from respiratory specimens suspected of chronic pulmonary TB patients.&lt;br /&gt; &lt;b&gt;Materials and methods:&lt;/b&gt; A 33 patients with suspected chronic pulmonary TB were included. Sputum specimens were cultured to detect &lt;i&gt;mycobacterium sp.&lt;/i&gt; and extracted using QiAmp DNA mini kit modification and 16S rRNA metagenomic sequencing by nanopore grid ion sequencer. Microbiome analysis was performed using Pavian and Krona tools.&lt;br /&gt; &lt;b&gt;Results: &lt;/b&gt;9 patients were diagnosed with TB based on GeneXpert MTB/RIF assay, and 3 patients were detected with NTM pulmonary infection.The common genera identified from TB culture positive patients were &lt;i&gt;streptococcus sp.&lt;/i&gt;, &lt;i&gt;prevotella sp., &lt;/i&gt;and &lt;i&gt;veilonella sp. &lt;/i&gt;However, less was detected in two NTM infection patients&lt;i&gt;. &lt;/i&gt;Metagenomic analysis revealed community bacteria species, including mycobacterium tuberculosis and NTM species, with the lowest number of unique reads. The abundance of &lt;i&gt;streptococcus sp.&lt;/i&gt; were less than 30% in 4 patient with comorbid diabetes mellitus.&lt;br /&gt; &lt;b&gt;Conclusions:&lt;/b&gt; Metagenomic targeted 16SrRNA full-length sequencing in the clinical respiratory specimen can provide diagnostic insight beyond standard microbiologic cultures and detailed profiling of microbial communities at the species level.

The Relationship Between Exogenous Testosterone Use and Risk for Primary Anterior Cruciate Ligament Rupture

Background: In the United States, testosterone therapy has markedly increased in recent years. Currently, there is a paucity of evidence evaluating the risk of ligamentous injuries in patients taking testosterone replacement therapy (TRT). Purpose/Hypothesis: The purpose of this study was to quantify the association between TRT and the incidence of anterior cruciate ligament (ACL) injuries and the subsequent risk of ACL reconstruction (ACLR) failure. It was hypothesized that individuals receiving TRT would demonstrate an increased risk for index ACL injury and ACL rerupture. Study Design: Cohort study; Level of evidence, 3. Methods: This is a retrospective cohort study utilizing the PearlDiver database. Records were queried between 2011 and 2020 for patients aged 18 to 59 years who filled a testosterone prescription. A matched control group based on age, sex, Charlson Comorbidity Index, tobacco use, diabetes, and hypothyroidism consisted of patients aged 18 to 59 years who had never filled a prescription for exogenous testosterone. International Classification of Diseases, 9th and 10th Revisions and Current Procedural Terminology (CPT) codes were utilized to identify patients with ACL injuries and those undergoing reconstruction. Multivariable logistic regression was used to compare rates of ACL injury at 6 months, 1 year, and 2 years after initiating TRT. ACLR failure was also examined at 1-year intervals for 5 years for individuals filling a TRT prescription. Results: A total of 851,816 patients were enrolled, with 425,908 patients in the TRT and control groups, respectively. The TRT cohort was significantly more likely to experience an ACL tear during 6-month (OR, 2.66; 95% CI, 2.17-3.26), 1-year (OR, 2.46; 95% CI, 2.11-2.86), and 2-year (OR, 2.22; 95% CI, 1.98-2.48) periods. The rate of reconstruction failure did not differ between the 2 cohorts at up to 5 years of follow-up ( P &gt; .05). Conclusion: Patients receiving TRT were significantly more likely to sustain a primary ACL rupture but were not at a statistically significant increased risk of reconstruction failure.

Surgical treatment outcomes and risk factors for post-TB lung disease.

This study aims to investigate the effectiveness and safety of surgical treatment for post-TB lung disease (PTLD) and to analyse its risk factors. Data were collected from 268 patients who underwent pulmonary resection for TB in Xi'an Chest Hospital, Xi'an, Shaanxi, China, between January 2014 and December 2023. The efficacy and safety of the three groups were compared, and the TB group was used as the control group to analyse the risk factors of PTLD. The results indicated the three groups in intraoperative blood loss, post-operative drainage volume, post-operative complications, and post-operative hospital stay also varied significantly among the three groups (all P < 0.01). Additionally, factors such as pre-operative anti-TB therapy duration (OR = 1.02, P = 0.007), age (OR = 1.03, P = 0.030), and comorbid diabetes mellitus (OR = 3.00, P = 0.046) were identified as significant contributors to PTLD. While pre-operative haemoptysis demonstrates a statistically significant correlation with both precursor PTLDs, this association likely reflects the clinical expression of the underlying disease process. The study confirms that surgery for PTLD is safe and efficacious. Patients with advanced age, an extended duration of pre-operative anti-TB therapy, comorbid diabetes mellitus and pre-operative haemoptysis should maintain vigilance regarding the potential development of PTLD.

Time in target range for systolic blood pressure and glucose with cardiovascular disease and all-cause mortality risks.

Evidence on the combined effect of time in the target range (TTR) for systolic blood pressure (SBP) and fasting blood glucose (FBG) in real-world settings was scarce. We aimed to evaluate the separate and combined effects of SBP TTR and FBG TTR on cardiovascular disease (CVD) and all-cause mortality risks among participants with comorbidity of hypertension and diabetes. The data was derived from the Kailuan study. The target ranges for SBP and FBG were set as 110-140 mmHg and 3.9-7.0 mmol/L, and linear interpolation to calculate TTR. Cox proportional hazard regression models were used to estimate the separate and combined effects of SBP TTR and FBG TTR on CVD and all-cause mortality risks. We included 11,899 participants with hypertension and diabetes comorbidity whose mean age was 54.52 ± 10.36 years, and 9,873 (83.00%) were male. After a follow-up of 6.67 years, 1,381 cases of CVD and 2,148 cases of all-cause mortality were documented. In the fully adjusted model, compared with the participants with both SBP TTR and FBG TTR lower than 25%, participants with both greater SBP TTR and FBG TTR had the lowest risks of CVD (HR: 0.53; 95%CI: 0.57-0.78) and mortality (HR: 0.59; 95%CI: 0.47-0.74). Per 1 SD increase in SBP TTR was associated with a 14% reduction in CVD risk (HR, 0.86; 95% CI, 0.80-0.92) and a 10% reduction in mortality risk (HR, 0.90; 95% CI, 0.85-0.95), all significant results were maintained in the FBG TTR analyses. Both higher SBP TTR and FBG TTR were associated with lower risks of CVD and all-cause mortality in participants with comorbidity of hypertension and diabetes. Simultaneous control of SBP and FBG within the target ranges is a beneficial strategy for CVD prevention.

The Effect of Obesity on Postoperative Analgesia Practices and Complications Following Endoscopic Sinus Surgery: A Propensity Score-Matched Cohort Study.

Despite growing concern regarding over-prescription of narcotic pain medication following ambulatory surgery, little is known about the analgesic prescribing practices following endoscopic sinus surgery (ESS) in obese patients in comparison to non-obese patients. To compare the rates of opioid versus non-opioid prescriptions, the need for steroids, and post-operative adverse events between obese and non-obese adult patients undergoing ESS. Using TriNetX Live database, we identified all patients aged ≥18 years who underwent ESS (n = 1303) between 2014 and 2022 across several healthcare institutions across the state of Tennessee. We 1:1 propensity score-matched obese (BMI ≥ 30 kg/m2) and non-obese (18.5 kg/m2 ≤ BMI < 30 kg/m2) cohorts for age, gender, race, and comorbidities including asthma, nicotine dependence, and sleep apnea. Rates of prescriptions and post-operative adverse events between cohorts were analyzed using risk ratios (RR) and confidence intervals (CI). A toal of 532 obese patients were compared to 532 propensity score-matched non-obese patients in the first 14 post-operative days following ESS. The obese cohort was significantly more likely to be prescribed analgesics generally (RR = 1.72; 95% CI = 1.20-2.47), non-opioid analgesics (RR = 1.73; 95% CI = 1.19-2.50), and opioid analgesics (RR = 1.64; 95% CI = 1.14-2.36) than non-obese patients. There was no difference in rates of antibiotic or antiemetic prescription, prednisone/methylprednisolone, dexamethasone, ED visits, critical care service, epistaxis, transfusion, anemia, revision sinus surgery, mechanical ventilation, CPAP, or inhalation airway treatments. Obese patients undergoing ESS were significantly more likely to be prescribed non-opioid and opioid analgesia in the first 14 days post-operatively compared to non-obese patients. There were no differences in post-operative adverse events or other prescriptions. Otolaryngologists should be aware that obese patients are at increased risk of opioid induced airway obstruction and steroid induced hyperglycemia, especially in patients with comorbid sleep apnea or diabetes. Emphasis on non-opioid analgesics and multimodal pain management should be advocated for this population.

Predicting diabetes prognosis using machine learning techniques in a Hungarian clinical database

Abstract Background Chronic conditions such as type 2 diabetes mellitus have great impact on patients’ quality of life. Although clinical databases provide a perfect base for research aimed at improving diabetes care, analyzing such databases requires extensive pre-processing, mainly due to the large amount of unstructured data. Our study aimed to present the steps of generating a dataset from a large clinical database, and to apply machine learning-based analytical techniques regarding. Methods Data of the Clinical Center of University of Debrecen was used. To structure the unstructured data, regular expressions and natural language processing methods were used. The main machine learning models were as follows: Gradient Boosting Machines to predict the risk of complication development; Long Short-Term Memory Networks to forecast future health outcomes. All analysis and procedures were done using Python. Results The database contains approximately 1600 tables, with a total size of 1.9 terabytes, where the largest table is 21.07 gigabytes with approximately 44.64 million rows. The final dataset consisted of 40,332 patients. Most variables originate from the unstructured data, including complications and comorbidities of diabetes, as well as physical and laboratory parameters. Related to laboratory parameters, the number of measurements and the median value for every half-year were available. The diagnosis time of the complications’ occurrence is also presented. Machine learning methods were more accurate compared with traditional statistical methods in predicting the prognosis (p &amp;lt; 0.05). Discussion Our research highlights the importance of clinical data in chronic disease management. There are challenges in pre-processing and managing datasets, but machine learning-based methods are very efficient not only in extracting useful information from unstructured data but also in predicting the prognosis and identifying potential intervention points for better care. Key messages • Natural language processing can be used to obtain useful information from unstructured clinical data. • Using machine learning techniques on clinical data could improve diabates care.

Diagnostic and prognostic evaluation of an echocardiography-based artificial intelligence algorithm for detecting HFpEF: a case-control analysis

Abstract Background Heart failure (HF) with preserved Ejection Fraction (HFpEF) is common among older adults and is associated with a high burden of morbidity and mortality. Despite its increasing prevalence, the diagnosis of HFpEF remains challenging. Recently, the FDA cleared an echocardiography-based AI HFpEF model that utilizes a 3-dimensional convolutional neural network to detect HFpEF using a single 4-chamber clip from a resting echocardiogram. However, the external validation of this algorithm against clinically adjudicated and confirmed HFpEF is limited. Purpose To evaluate the diagnostic and prognostic performance of the echocardiography-based AI HFpEF model in a cohort of HFpEF patients and matched controls. Methods The study included patients with clinically adjudicated HFpEF based on clinical history, normal ejection fraction (&amp;gt;45%), and evidence of elevated filling pressure by resting (PCWP &amp;gt; 15 mm Hg) or exercise invasive hemodynamics (PCWP &amp;gt; 25 mm Hg) or echocardiogram (E/e’ &amp;gt;14). The controls were age, sex, and BMI-matched patients without HF and a normal echocardiogram. The performance of the AI HFpEF model was evaluated using receiver operator curves. In patients with HFpEF, the association of the AI-HFpEF phenotype with elevated resting/exercise PCWP and peak exercise oxygen uptake (VO2peak) was assessed using multivariable logistic and linear regression models adjusting for age, sex, race, BMI, and comorbidities (diabetes, hypertension, kidney disease, atrial fibrillation). Results Of the 166 patients referred for evaluation of HFpEF, 82% had clinically adjudicated HFpEF, and 69.8% had elevated LV filling pressure at rest or exercise. In the matched cohorts of patients with clinically adjudicated HFpEF and matched control individuals (N = 122 each), the AI algorithm-based probability of HFpEF demonstrated good performance in identifying clinically adjudicated and hemodynamically confirmed HFpEF (AUROC: 0.75 for each) that was greater than the widely used H2FpEF score (0.69 and 0.70, Figure). In the HFpEF referral cohort, a higher probability of HFpEF based on the AI-algorithm phenotype was significantly associated with lower VO2peak (b [95% CI] per 5% higher probability: -0.11 [-0.21 to -0.01, P-value: 0.03] and greater odds of elevated PCWP (Odds ratio [95% CI] per 5% higher probability: 1.07 [1.01 – 1.15, P-value: 0.04] at rest or exercise after accounting for other confounders. Based on Youden’s index, the AI algorithm-based probability threshold of &amp;gt;0.75 was identified as the optimal cutoff for detecting HFpEF by the AI algorithm, with high sensitivity (0.85) and accuracy (0.74) and, adequate specificity (0.66). Conclusion The echocardiography-based AI HFpEF model demonstrated excellent sensitivity and discrimination in identifying patients with vs. without clinical HFpEF. Furthermore, the AI HFpEF model also had prognostic utility such that individuals with a higher probability of AI-HFpEF phenotype had more severe HFpEF.

Prediction of incident major adverse cardiac events in patients starting haemodialysis for end stage kidney disease, using clinical laboratory cardiac biomarkers - a real world analysis.

Abstract Background and Aims Despite its many advantages, haemodialysis (HD) is associated with increased cardiovascular mortality and morbidity, with some studies reporting 48% higher mortality within 2 years of starting HD. Cardiac biomarkers provide insight into cardiac structure and function, including myocyte stress, inflammation and fibrosis. We aimed to investigate the prognostic significance of routine cardiac biomarkers (troponin and natriuretic peptides) in the prediction of incident major adverse cardiac events (MACE) within 5 years if commencing HD. Methods A retrospective cohort study was performed using electronic medical records from a global federated research network from the US. The network was searched on 26th February 2023. The cohorts commenced HD post-diagnosis of end-stage kidney disease. Data censoring for MACE was invoked prior to the index event of HD. Cardiac biomarkers were the first reported result within 3 months of starting HD. Cohorts were grouped according to biomarker-specific thresholds and 1:1 propensity-score matched for age, gender and co-morbidities (hypertension, diabetes mellitus and smoking status). Logistical regression produced odds ratios with 95%CI for 5-year incident MACE. MACE was defined, a priori, as a composite of ischaemic heart disease, angina pectoris, acute myocardial infarction, heart failure, AF, stroke and all-cause mortality. All statistical analysis was performed on the online platform. Results The results are shown Tables 1(Troponin I and BNP alone) and 2 (Combined Troponin I and BNP). Results that reached statistical significance (p&amp;lt;0.05) are shown. Conclusion Routinely available cardiac biomarkers can predict MACE and cardiac outcomes in incident HD, although results differ between markers of myocyte injury (troponin) and stress (BNP). A combined approach may prove most beneficial. The results suggest the clinical need for CV mortality and morbidity risk profiling in incident dialysis using a combination of clinical and laboratory variables and the need for prospective validation.Table 1Table 2

The Impact of Poor Air Quality on Hospitalisation of Multi-morbid Patients: A Systematic Review

Abstract Background Exposure to poor air quality worsen existing health conditions, particularly amongst vulnerable patients, leading to increased healthcare utilization. We conducted a systematic review to explore the impact of exposure to poor quality on healthcare requirements in multi-morbid patients. Methods We searched six major databases (Medline via Ovid, Embase via Ovid, Web of Science, CINAHL, Global Health, and Scopus) using search terms grouped into sets relating to ‘air pollution,’ ‘multimorbidity,’ “association” and ‘hospitalisation.’ We were interested in the impact of common air pollutants (PM2.5, PM10, SO2, NO2, O3, and CO) and articles were screened independently by two researchers. The review was registered with The International Prospective Register of Systematic Reviews (CRD42022369757) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results A total of nineteen studies were included. All six air pollutants increased hospitalisation amongst multi-morbid patients, especially those with diabetes and cardiovascular comorbidity. Females and the elderly (&amp;gt;65 years old) were the most vulnerable to the effects of air pollution, with an increase in hospitalisations of 9.23% and 6.35% when exposed to PM2.5 and PM10, respectively. Patients &amp;gt;65 years had a higher likelihood of hospitalisation for ischemic and haemorrhagic stroke when exposed to PM2.5 or PM10 at warm season. Patients (≥70 years) who had cardiovascular and pulmonary comorbidity were 3.9% more likely to be hospitalised for a cardiopulmonary event with a rise in NO2 levels. We found an intersectional effect (referred to as “the CADC effect” - Climatic changes, Air pollutant, Demographics, Chronic conditions) that influenced the likelihood of hospitalisation. Conclusions Future research is required to further understand this CADC effect in other high-risk population. Key messages • Females, elderly, those with cardiovascular, and pulmonary comorbidity are at the highest risk of hospitalisation with poor air quality. • The CADC effect explains the intersectional effect between hospitalisation in multimorbid patients, patients demographics and chronic conditions, and air pollution and temperature effects.

No Difference in Postoperative Complications Between Simultaneous and Staged, Bilateral Unicompartmental Knee Arthroplasty.

Background The optimal timing of contralateral surgery following unicompartmental knee arthroplasty (UKA) remains unknown. Therefore, the objective of this study was to examine the differences in postoperative complications in patients undergoing unilateral, simultaneous and staged bilateral UKA. Methods The PearlDiver administrative claims database was queried for patients undergoing UKA between 2015-2020. Patients undergoing unilateral UKA were matched in a 1:1 fashion based on age, gender, Elixhauser Comorbidity Index (ECI), obesity, diabetes and smoking status to patients undergoing simultaneous bilateral UKA, bilateral UKA staged 1-90 days and bilateral UKA staged 91-365 days. Univariate and multivariate analyses were performed to examine the impact of timing of bilateral procedures on 90-day postoperative complications relative to patients who underwent unilateral UKA. Outcomes were considered significant at p<0.05. Results A total of 9,638 patients undergoing UKA were included in the final analysis, of which 5,672 (58.9%) were unilateral, 396 (4.1%) were simultaneous bilateral, 1,496 (15.5%) were bilateral staged between 1-90 days and 2,074 (21.5%) were bilateral staged between 91-365 days. Univariate analysis identified no significant differences in complications between matched groups except for an increased incidence of wound dehiscence amongst patients who underwent simultaneous bilateral UKA (2.1% vs. 0.0%, p=0.040) compared to unilateral UKA. However, multivariate analysis demonstrated that simultaneous or staged bilateral UKA at either time point did not increase the risk of any postoperative complication relative to unilateral surgery. Conclusion Bilateral UKA can be performed simultaneously or in a staged fashion without increasing the risk of 90-day complications relative to unilateral UKA.

Patients with Diabetes Mellitus and Comorbid Mental Disorders - Is there a Psychotherapeutic Undertreatment? - Results of the DiMPS Study

Diabetes mellitus is associated with an increased likelihood of mental disorders, especially depression. Despite a frequently postulated underprovision, the actual need for psychotherapeutic treatment in this patient group has hardly been investigated. The aim of this study is to analyze the care situation of diabetes patients with mental comorbidities in Germany. 240 consecutively treated patients with type 1 or type 2 diabetes were examined cross-sectionally and longitudinally in a tertiary diabetological center. After a screening and diagnostic examination, 94 patients with comorbid mental disorders were included in the study. Patients then decided on the treatment of their mental disorder according to a standardized shared decision-making process. At the 6-month follow-up, 77 of the 94 patients (81.9%) provided information about the realization of their treatment decision and the obstacles they encountered. 39.2% of patients with diabetes had a mental disorder. Of these, 44.2% were already receiving psychotherapy or medication. After six months, 46.8% were able to implement their treatment decision. Only 7.1% did not receive any treatment despite their efforts. The 6-month follow-up showed a significant reduction in diabetes-related distress (PAID; p<0.05) and an increase in psychological well-being in all subgroups, regardless of treatment initiation (WHO-5; p<0.05). Contrary to the widespread notion of a lack of access to psychotherapy for people with diabetes and mental disorders in Germany, this assumption could not be confirmed in this study. Equating the frequency of mental disorders with the need for psychotherapeutic and/or psychopharmacological treatment without considering the specific treatment needs and preferences of patients may lead to an overestimation of the need for care.

Factors Influencing Outcomes of Diabetic Foot Management: Retrospective Study at Mwananyamala Regional Referral Hospital

Background: Diabetic foot ulcers (DFUs) contribute to significant morbidity and mortality worldwide, with the global prevalence of diabetes expected to rise to 12.2% by 2045, an increasing number of people are at risk for complications like DFUs, which affect 19% to 34% of diabetic patients. People with DFUs carry a 20% lifetime risk of limb amputation and mortality rate of 50% to 70%. In Tanzania DFUs account for 41.9% of major limb amputations and mortality rate of 54%. Methods: A retrospective observational study aimed to investigate the clinical factors, and treatment modalities that influence the management outcomes of diabetic foot among patients attending Mwananyamala Regional Referral Hospital (MRRH). The study reviewed existing patient records. Results: A total of 143 participants were enrolled in the study, of which 94 (65.73%) were female. The participants had a mean age of 57 ± 13.9 years. And approximately half (50.35%) were married. Nearly, all patients, 140 (97.90%), underwent surgical treatment, nearly half (41.96%) had DFU Wagner Class 3 while most of participants (69.93%) had hypertension. The mean hospital stay was 9.2 days. In binary logistic regression model output, marital status, level of education, working diagnosis, surgical management, patient progress and number of readmissions were identified as determinants of the outcome (P-value &lt; 0.05). Conclusion: This study identified key factors influencing diabetic foot outcomes, including gender, marital status, co-morbidities and ulcer grade. These findings underscore the importance of early diagnosis, targeted interventions, and comprehensive management to improve patient outcomes.

Objectively measured levels of moderate to vigorous intensity physical activity are associated with cognitive impairment in diabetic hemodialysis patients: a cross-sectional study.

The purpose of this study was to observe the relationship between objectively measured levels of physical activity and cognitive impairment (CI) in the presence or absence of diabetes in middle-aged and elderly hemodialysis patients. In this multicenter cross-sectional study, 339 clinically stable hemodialysis patients (210 males; mean age: 67.38 ± 8.07 years) aged ≥55 years were included from 7 dialysis units in Shanghai, China. The Chinese version of the Modified Mini-Mental State Examination (MMSE) was used to assess the CI. The duration of physical activity at different intensities, including moderate to vigorous physical activity (MVPA) as well as light physical activity (LPA), was measured using a triaxial accelerometer (ActiGraph GT3X+, Pensacola, FL, USA). Logistic regression and multiple linear regression were used for analyses. The prevalence of CI was higher in hemodialysis patients with comorbid diabetes (24.3%). In diabetic patients, MVPA (increase per 10 min/day) was negatively associated with CI after adjusting for covariates [(OR = 0.89, 95%CI = 0.79-0.99), p = 0.042]. However, no significant association between physical activity and CI was found in non-diabetic hemodialysis patients. Further analyses revealed that MVPA was positively associated with temporal orientation, attention and calculation and recall in diabetic hemodialysis patients. Physical activity was associated with CI in diabetic hemodialysis patients rather than the non-diabetes group. This study is important for early differential diagnosis of CI and improvement of cognitive status in hemodialysis patients.

Invasive Fungal Rhinosinusitis: The First Histopathological Study in Vietnam.

Invasive fungal rhinosinusitis (IRFS) is a rare but highly fatal disease. The two primary groups of pathogens, Mucorales and Aspergillus, require different treatments and have distinct prognoses. This study aimed to analyze the histopathological features of IFRS. We conducted a retrospective study involving 57 IFRS cases. Demographic and comorbid characteristics were obtained from clinical records. Two pathologists independently examined the histopathological features using H&E, PAS, and GMS-stained slides. Fungal groups were identified with PCR under the guidance of histopathology. The mean age of IFRS was 58.9 ± 13.4. The male-to-female ratio was 1.4:1. 100% of cases had diabetes comorbidity. Mucorales, Aspergillus, and other fungi were found in 61.4%, 33.3%, and 5.3% of cases, respectively. No Aspergillus and Mucorales co-infections were detected. Histopathology and PCR results were strongly concordant in classifying pathogens (Cohen's kappa = 84.2%, 95% CI 60.1% - 100%, p < 0.001). Mucormycosis exhibited higher rates of extensive necrosis and vascular invasion, and lower rates of pigment and spore presence than the non-Mucormycosis group (p < 0.001, p = 0.01, p = 0.02, p = 0.03, respectively). Extensive necrosis and vascular invasion were statistically significantly correlative (OR = 13.03, 95% CI 2.62-64.75, p = 0.002). IFRS predominantly affects older adults and males. Histopathology is a reliable method for differentiating between Mucorales and Aspergillus. When extensive necrosis is detected, it is critical to investigate for vascular invasion carefully. The vascular invasion, degree of necrosis, pigments, and spores are valuable factors for distinguishing fungal agents of IFRS.