Higher Rates Of Diabetes Research Articles

Functional dependency and COVID-19 in elderly patients with mild to moderate disease. Experience of tertiary geriatric hospital.

Clinical course of COVID-19 may be associated with functional dependency of geriatric patients. Data from the records of patients admitted to the COVID-19 Geriatric Unit were gathered during three months, including background, clinical aspects, time to resolution of infection and functional status.Functionally dependent patients had higher rates of diabetes (p = 0.03) and stroke (p = 0.004), as well as longer time to resolution of infection (p < 0.001), but less respiratory COVID-19 symptoms (p = 0.007), compared to independent patients. Time to resolution of infection was longer in women (p = 0.01) and positively associated with WBC level (p < 0.01) and age (p < 0.001). An adjusted analysis which controlled these variables confirmed the significant effect of functional status on the time to resolution of infection (p = 0.015).Functionally dependent geriatric patients with mild to moderate infection had less respiratory COVID-19 symptoms but showed longer time to resolution of infection compared to independent. Assessment of functional status in the elderly population may contribute to decision making for care of geriatric inpatients with COVID-19.

Cardiac Risk Factors in Black Women With Breast Cancer Undergoing Proton Therapy (PBT): Potential for Increased Therapeutic Gain

Proton therapy remains a scarce resource in the United States, especially for minority citizens who reside in low socioeconomic areas. Breast cancer (BC) often requires adjuvant radiation therapy (RT) and adjuvant RT is associated with increased cardiac events. PBT results in decreased cardiac exposure for BC. Black patients are more likely to present with advanced breast cancer and are at higher risk for additional cardiac comorbidities when compared to other races. Here we report a single institutional experience of BC patients receiving adjuvant proton therapy in an urban environment. We hypothesize that our black BC population undergoing PBT will carry higher rates of cardiac risk factors than other races and thus would be more likely to benefit from the cardiac-sparing dosimetry of PBT.Consecutive BC patients who received proton therapy were retrospectively analyzed under an IRB approval. A variety of demographic and tumor related variables were analyzed using descriptive statistics. Chi-square tests were used to assess associations of categorical variables. Mann-Whitney U test was used to assess significant differences between populations.From February 2016 - December 2020, 343 BC patients received adjuvant proton therapy. With a median follow-up of 13 months (range:0.7-60), black patients comprised 30% of the population (white: 61.8%; other: 8.2%) and were more likely to have triple negative (35.3% vs.16.2%; P = 0.001) and more advanced disease (stage III: 36% vs.24%) when compared to white patients. Black patients had higher rates of diabetes (P = 0.043), hypertension (P < 0.001), hyperlipidemia (P-0.028) and obesity (BMI) (P < 0.001) at time of consultation. Median income was lower for black patients when compared to white patients (P < 0.001) yet there was no difference in insurance coverage between the cohorts. At time of last follow up, 86% of patients had no evidence of recurrence.We report a high percentage of black patients with increased cardiac comorbidities treated with proton therapy as part of their treatment paradigm for BC. Protons have the potential to decrease the risk of long-term cardiovascular events in BC patients, particularly in women who have an increased risk of heart disease, and thus may be particularly beneficial in the black population. Improvements in access to care continues to be important for black and minority populations with BC.

HEALTH RISK FACTORS: BODY MASS INDEX, BLOOD PRESSURE AND BLOOD GLUCOSE AMONG ROMA IN BULGARIA

Roma communities suffer from higher rates of diabetes, cardiovascular disease, hypertension and related impairments and limitations in daily activities. Purpose of the article is to study and analyze health risk factors: body mass index, blood pressure and blood glucose among the Roma population in small cities in Bulgaria. Material/Methods: In May 2015, a community-based approach was applied, and all adult residents of the Roma neighborhood of the town of Knezha, district of Pleven, were invited to participate. Only the persons who agreed to participate (59) or about 9% of the adult residents of Roma origin are included. By measuring BMI, blood pressure and blood glucose, the collection of primary data was done. The statistical processing of the data with Microsoft Office Excel 2010 and STATGRAPHICS-19 centurion software packages was performed. The significance of the results and conclusions was determined at p&lt;0.05. Results: The Roma population is characterized by an unfavorable risk constellation and a health profile. Over two thirds (77.1%) of the participants in the study have BMI values above the normal. There is a high relative share of people with hypertension – 42.3% of Roma people covered. Elevated levels of blood sugar were found in almost 40% of the people observed: in equal relative shares are presented the persons with impaired glucose tolerance (prediabetic) and diabetes mellitus – respectively 18.7%. Conclusions: The study found a wide distribution of unhealthy factors of lifestyle among Roma population, and particularly alarming results are established regarding to the health of the Roma women.

Sex-Based Difference in Clinical Presentation and Outcomes—A Single-Center Experience

Abstract Background and Aim The aim of this study was to compare the gender-based differences in baseline characteristics, clinical presentation, and outcomes among patients who underwent percutaneous coronary intervention (PCI) in our institute. Methods This is a single-center, retrospective observational study. A total of 1,595 patients underwent PCI from a period of January 2019 to December 2019, in which 1,293 were males and 302 were females. Demographic characteristics, clinical and procedural details, and their in-hospital outcomes were all collected and analyzed. Results Females presenting with symptoms were older than males (58 vs. 60.8 years, p &lt; 0.001) and had higher body mass index (26.2 ± 6.7 vs. 27.2 ± 4, p &lt; 0.001). Risk factors like diabetes mellitus (57.8 vs. 69.5%, p &lt; 0.001) and systemic hypertension (50.2 vs. 65%, p &lt; 0.001) were more common in females. Women were more likely to present with unstable angina (16.2 vs. 22.7%, p-0.009) and the rate of thrombolysis is low in women who presented with ST-elevation myocardial infarction (13.5 vs. 6.3%, p &lt; 0.001). There was no significant difference in in-hospital mortality between both groups, but bleeding complications were higher in females (1.3 vs. 4%, p-0.006). Conclusion Women who underwent PCI tend to be older and had higher rates of diabetes, hypertension, and obesity. Although mortality rates did not differ between groups, bleeding risk is higher in women.

Perioperative outcomes of carotid endarterectomy and transfemoral and transcervical carotid artery stenting in radiation-induced carotid lesions

ObjectiveLimited data are available to guide the choice of intervention for patients with radiation-induced carotid stenosis (RICS), either transcarotid artery revascularization (TCAR), transfemoral carotid artery stenting (TFCAS), or carotid endarterectomy (CEA). The purpose of the present study was to evaluate patients who had undergone these carotid artery interventions for RICS and the associated outcomes. MethodsPatients in the Society for Vascular Surgery (SVS) Vascular Quality Initiative (VQI) carotid artery stenting surveillance project registry and the SVS VQI CEA modules who had undergone carotid artery intervention (TCAR, TFCAS, or CEA) for RICS were included. Those aged >90 years and those with concomitant interventions (eg, coronary bypass) were excluded. A composite of death, myocardial infarction (MI), and stroke was the primary outcome. The secondary outcomes included death, MI, stroke, cranial nerve injury (CNI), and other local and systemic complications. Multivariable logistic regression controlling for presenting symptomatic status and comorbid medical conditions was conducted for the outcome variables, except for death, which was analyzed using Cox regression modeling. ResultsA total of 1927 patients with RICS had undergone CEA (n = 1172), TCAR (n = 253), or TFCAS (n = 502). The CEA group had a higher rate of diabetes (31% vs 25% for TCAR and 25% for TFCAS; P = .01), hypertension (85% vs 82% for TCAR and 79% for TFCAS; P < .01), and peripheral vascular disease (8% vs 4% for TCAR and 4% for TFCAS; P < .01). The TCAR and TFCAS groups had higher rates of coronary artery disease (21% for CEA vs 30% for TCAR and 29% for TFCAS; P < .01). The patients who had undergone TFCAS were more likely to have had symptomatic lesions (57% for TFCAS vs 47% for CEA and 41% for TCAR; P < .01) and prior stroke (55% for TFCAS vs 47% for CEA and 40% for TCAR; P < .001). The composite outcome occurred in 3.2% of TCAR patients, 11.2% of TFCAS patients, and 11.1% of CEA patients (P < .01) with an odds ratio of 0.27 for TCAR, 0.91 for TFCAS, and 1.00 for CEA. However, no differences in the individual outcomes were noted for any procedure. TCAR exhibited the lowest odds ratio for CNI (0.15) compared with TFCAS at 0.9, both relative to CEA (P = .03). ConclusionsRICS patients treated by TCAR in the SVS VQI had the lowest risk of the composite of stroke, death, and MI and CNI. Therefore, TCAR might be the preferred treatment modality. Further comparative studies are needed to evaluate the long-term outcomes in this population and to elucidate the relationship of these procedures to the individual outcomes of stroke, MI, and death.

Use of the PROMIS-10 global health in patients with chronic low back pain in outpatient physical therapy: a retrospective cohort study

BackgroundAlthough evidence-based guidelines for physical therapy for patients with chronic low back pain (cLBP) are available, selecting patient-reported outcome measures to capture complexity of health status and quality of life remains a challenge. PROMIS-10 Global Health (GH) may be used to screen for impactful health risks and enable patient-centered care. The purpose of this study was to investigate the interrelationships between PROMIS-10 GH scores and patient demographics, health status, and healthcare utilization in patients with cLBP who received physical therapy.MethodsA retrospective review of de-identified electronic health records of patients with cLBP was performed. Data were collected for 328 patients seen from 2017 to 2020 in three physical therapy clinics. Patients were grouped into HIGH and LOW initial assessment scores on the PROMIS-10 Global Physical Health (PH) and Global Mental Health (MH) measures. Outcomes of interest were patient demographics, health status, and healthcare utilization. Mann–Whitney U and chi-square tests were used to determine differences between groups, and binary logistic regression was used to calculate odds ratios (OR) to determine predictors of PH-LOW and MH-LOW group assignments.ResultsThe PH-LOW and MH-LOW groups contained larger proportions of patients who were African American, non-Hispanic, and non-commercially insured compared to PH-HIGH and MH-HIGH groups (p < .05). The PH-LOW and MH-LOW groups also had a higher Charlson comorbidity index (CCI), higher rates of diabetes and depression, and more appointment cancellations or no-shows (p < .05). African American race (OR 2.54), other race (2.01), having Medi-Cal insurance (OR 3.37), and higher CCI scores (OR 1.55) increased the likelihood of being in the PH-LOW group. African American race (OR 3.54), having Medi-Cal insurance (OR 2.19), depression (OR 3.15), kidney disease (OR 2.66), and chronic obstructive pulmonary disease (OR 1.92) all increased the likeihood of being in the MH-LOW group.ConclusionsOur study identified groups of patients with cLBP who are more likely to have lower PH and MH scores. PROMIS-10 GH provides an opportunity to capture and identify quality of life and global health risks in patients with cLBP. Using PROMIS-10 in physical therapy practice could help identify psychosocial factors and quality of life in the population with cLBP.

Abstract MP66: Social Determinants And Co-morbid Conditions In Women Of Child-bearing Age With Hypertension From 2001-2018

Introduction: Hypertension (HTN) is the most important modifiable risk factor of serious maternal mortality and morbidity. Social determinants, including economic stability and access to healthcare, influence HTN outcomes and are critical to understanding and addressing racial and ethnic differences in HTN control. Objective: To assess social determinants and co-morbidities in US women of child-bearing age with HTN by race/ethnicity Methods: We studied women (age 20-50) with HTN in the National Health and Nutrition Examination Surveys 2001-2018. Social determinants and co-morbid conditions were examined in groups categorized by race/ethnicity - Non-Hispanic White (White), Non-Hispanic Black (Black), and Hispanic. Demographics, anthropometric measures, and co-morbid conditions were compared with White women as reference. Results: In all women with HTN, the mean (SE) age was 36.0 (0.3) years and 63% were on BP medication. Compared to white women, Black and Hispanic women had lower food security, poverty income ratio, smoking use, and private insurance (all p&lt;0.0001, Table ). Black women had higher BP medication use, BMI, and BP compared to White women (all p&lt;0.0001). Hispanic women had higher rates of diabetes (p=0.009) and no place to go for healthcare (p=0.005) compared to White women. Food insecurity was present in 34% of Hispanic women. Conclusions: Despite effective diagnostics and therapy, health inequity is common in women of child-bearing age with HTN, with differences by race/ethnicity in social determinants and co-morbid conditions. Each racial/ethnic group with HTN brings social determinants and comorbid conditions important for providers to recognize.

Gene-environmental research in Indigenous communities: sovereignty, data sharing, and community-relevant research

BACKGROUND AND AIM: American Indians suffer from higher rates of diabetes, chronic kidney disease, cardiovascular disease and disproportionate exposures to metals and/or other hazards. Indigenous people in the rest of the Americas and Polynesia show remarkable similarities. Gene-environmental studies are key to creating interventions for these groups. Increased Indigenous participation is also key. However, trust to participate can only be manifested when research relevance and respect for Indigenous sovereignty are included in community education METHODS: Due to the limited publication of qualitative research on this type of engagement, a Scoping Review was not feasible. Instead, we conducted a narrative literature review of articles studying genomics using a participatory approach with Indigenous communities between 2012 and the present. We evaluated whether these studies have considered environmental exposures. We also evaluated if environmental studies in Indigenous communities have considered genomics their engagements. Search terms such as environment, genomic and Indigenous were used. RESULTS:In 2009, the American Reinvestment and Recovery Act (2009) funded a large number of genomic projects. Consequently, databases showed a substantial rise of genomic manuscripts by 2012. The Ethical, Legal and Social Implications (ELSI) of genomics publications showed a similar pattern. Since, many such publications have engaged Indigenous communities about genomic data but few have paired the exposome in their community education or attitude surveys. Moreover, none assessed research participation likelihood if the paired topics could demonstrate the usefulness of combined inquiry. CONCLUSIONS:Few studies have explained the impact of multifactorial research to communities. Many reasons obligate the genomic environmental researchers to look at Human Health holistically. The Exposome provides the opportunity to jointly study human genomics & systemically biased socio-economic realities that negatively impact Indigenous communities. Successful research recruitment must account for the historic mistrust of Indigenous communities and could be reversed by an explication of interactions that lead to disparity KEYWORDS: American Indian, Environmental Exposure, Exposome, Amerindigenous, Community Engagement, ELSI

Study The Anti –Inflammatory Effect Of Stevia Rebaudiana Sweetnessin Vitro

Because of the high rates of diabetes, overweight disorders and fatness, the need and interest in finding alternatives to sugar has increased, especially in the industrial sector in parallel with reducing the daily intake of sugar by human. The idea of this research was developed to identify the active ingredients which include in the plant aqueous extract of Stevia rebaudiana. Chemical examination showed the glycosides and phenolic compounds presence of in the Stevia rebaudiana plant. The effect of Stevia rebaudiana leaves products aqueous extract as anti-inflammation measured in vitro with two procedures , The repression of protein denaturation and hemolysis stimulated by heating and results showed Stevia rebaudiana efficiency with compared to typical medicine (Aspirin) and negative control groups.

P74. Cost impact of intravenous drug use on the treatment of spine infections

<h3>BACKGROUND CONTEXT</h3> Intravenous drug use (IVDU) is the most common cause of spinal infections in otherwise healthy young patients without medical risk factors or significant comorbidities. IVDU is also associated with significant medical and psychological morbidity and mortality, resulting in a large financial burden to the entire health care system. Psychosocial issues and noncompliance are common, plaguing and complicating the logistics of standard of care. <h3>PURPOSE</h3> The purpose of this study is to identify the cost of treating spinal infections in patients with IVDU history and compare it to the cost of treating similar infections in medical patients without IVDU history. <h3>METHODS</h3> A retrospective chart review was performed to identify all adult patients admitted in 2018 to a single tertiary referral center with a diagnosis of discitis, vertebral osteomyelitis, or spinal epidural abscess. Information on demographics, treatment, comorbidities, costs of treatment, and payment were collected for each patient. Data was compared between the group with IVDU history and the group without. <h3>RESULTS</h3> A total of 130 patients met inclusion criteria; 42 had IVDU history and 88 did not. The non-IVDU group was found to be older (age of 63.7 years vs 41.3 years, p<0.0001) with higher rates of diabetes, end stage renal disease, and cancer, and lower rates of infective endocarditis and liver disease. The average length of stay in the hospital was 28.1 days for the IVDU group, and 13.5 for the non-IVDU group (p<0.0001). Nine (21.4%) of the IVDU group were able to be discharged to rehab or long-term care facility for treatment, while 38 (43.2%) of the non-IVDU were discharged to another facility (p=0.0001). Forty (95.2%) of the IVDU group and 75 (85.2%) of the non-IVDU group had either Medicare or Medicaid as their insurance (p=0.06). Average total charge per hospitalization for the patients in the IVDU group was $141,070 and $125,283 in the non-IVDU group (p=0.41). Insurance payment per day was significantly lower in the IVDU group compared to the non-IVDU group, with the values being $1,231.47 and $3,549.61, respectively (p=0.0008). Total cost per day to the hospital was also significantly lower in the IVDU group, who had a per day cost of $3,374.16 compared to $6,788.19 in the non-IVDU group (p=0.0049). Total charges per day were lower in the IVDU group at $6,192 compared to $10,151.20 in the non-IVDU group (p=0.0009). <h3>CONCLUSIONS</h3> While those who use IV drugs do not cost the hospital as much per day as others being treated for spinal infections, the length of stay for these patients is more than double that of non-IV drug users. This is likely due to the practice in many hospitals, where active IVDU history is a contraindication to discharge with long-term intravenous access (such as peripheral intravenous central catheters). This population is also often self-pay or Medicaid, thereby often not accepted by short-term rehabilitation or long-term care facilities to finish their medical treatment. Tertiary care centers are often left to treat these patients until completion of intravenous course. This constellation of situational consequences results in a significant loss of revenue and tieing-up of resources that could otherwise be utilized on other patients. This study quantifies the significant cost burden created by IVDU-associated spine infections in one tertiary academic hospital center and offers insight on specific areas where policy and public health can help in minimizing the cost of this epidemic. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Clinical outcomes for intracoronary imaging strategies at different medical facilities in Japanese patients with coronary artery disease: the SAKURA imaging PCI Registry.

The relationships between intracoronary imaging modalities and outcomes among Japanese patients with coronary artery disease (CAD) based on the type of medical facility providing outpatient care remain unclear. In this multicenter prospective study (SAKURA PCI Registry), we aimed to investigate the clinical outcomes of patients with CAD who underwent percutaneous coronary intervention (PCI) between April 2015 and December 2018. In this registry, we investigated differences in patient characteristics, intracoronary imaging modalities, and clinical outcomes between two types of medical facilities. Of the 414 patients enrolled in this registry, 196 were treated at two university hospitals, and 218 were treated at five community hospitals (median follow-up 11.0months). The primary endpoint was clinically relevant events (CREs), including a composite of all-cause death, non-fatal myocardial infarction, clinically driven target lesion revascularization, stent thrombosis, stroke, and major bleeding. Patients treated at university hospitals had higher rates of diabetes (50% vs. 38%, p = 0.015) and malignant tumors (12% vs. 6%, p = 0.015) and more frequent use of multiple intracoronary imaging modalities than patients treated at community hospitals (21% vs. 0.5%, p < 0.001). The Kaplan-Meier incidence of CREs at 1year was comparable between university hospitals and community hospitals (8.8% vs. 7.3%, p = 0.527, log-rank test). Despite the relatively higher risk among patients in university hospitals with frequent use of multi-intracoronary imaging modalities, adverse clinical events appeared to be comparable between patients with CAD treated at university and community hospitals in Japan.

“Over-preoccupation with healthy food is perceived as worship of the body”: Food, culture and beliefs in Ultra-Orthodox Jewish families

BackgroundEating behaviours vary by culture and religion, and an understanding of attitudes and practices are essential for providing culturally competent nutritional guidance. The Ultra-orthodox Jewish community is characterized by poor diet, high rates of obesity, anemia and diabetes. This study aimed to acquire insights that could influence the promotion of healthier eating in the Ultra-orthodox and other closed religious communities, particularly regarding children's eating habits and the food they consume. MethodsIn depth face-to-face recorded interviews were conducted with 20 information-rich participants: religious leaders, opinion leaders and education/health professionals from Gur and Chabad, two Ultra-orthodox Jewish religious communities in Israel. The focus was on exploring young family eating behaviours and perceived challenges to encouraging healthier nutrition in the community. Interviews were transcribed and thematic analysis employed using grounded theory. ResultsSeven themes were identified with findings that had clear implications for the promotion of health at both the community and individual level. These included spiritual aspects of eating, deficits in knowledge and awareness, less relevance of kashrut than previously thought, the centrality of motherhood and family meals, the quality of food in educational institutions, the significance and sensitivity of Sabbath and festive meals and pragmatic considerations. Discussion and conclusionsBy illuminating attitudes and behaviors, the study broadens and enhances our understanding of the Ultra-orthodox communities' perspectives on eating behaviours in the family. The findings have the potential to contribute to strengths-based health promotion for children's nutrition. Recommendations regarding culturally competent guidance and implications for other secluded religious communities are discussed.

Analysis of clinical characteristics and prognostic risk factors in patients with Stanford type B aortic dissection complicated with hypertension

To investigate the clinical characteristics as well as short-term and long-term prognostic factors of patients with Stanford type B aortic dissection (TBAD) with hypertension. Patients with TBAD who received thoracic endovascular aortic repair (TEVAR) admitted to Xiangyang Central Hospital from January 2014 to December 2018 were enrolled. The baseline data of patients admitted to the hospital were collected through the case management system, including gender, age, underlying diseases (hypertension, diabetes, coronary heart disease), smoking history, drinking history, duration of pain, vital signs at admission [heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP)], laboratory results [white blood cell count (WBC), platelet count (PLT), neutrophil/lymphocyte ratio (NLR), serum creatinine (SCr), C-reactive protein (CRP), D-dimer, ascending aorta diameter], etc. The clinical characteristics of TBAD patients with hypertension were analyzed. Logistic regression model and Cox proportional risk model were used to analyze the impact of hypertension on the short-term and long-term all-cause deaths after TEVAR in TBAD patients. Among 227 TBAD patients, 160 cases (70.5%) were complicated with hypertension, while 67 cases (29.5%) were not. The average age, the proportion of diabetes and coronary heart disease, and the level of SBP, DBP and SCr at admission of TBAD patients with hypertension were higher than those of TBAD without hypertension [age (years old): 53.1±11.9 vs. 42.8±14.1, combined with diabetes: 8.8% vs. 1.5%, combined with coronary heart disease: 6.3% vs. 0%, SBP (mmHg, 1 mmHg = 0.133 kPa): 147.9±18.1 vs. 136.9±15.2, DBP (mmHg): 93.9±11.9 vs. 89.1±13.8, SCr (μmol/L): 97.8±25.4 vs. 89.8±23.6, all P < 0.05]. The short-term mortality of TBAD with hypertension group was significantly higher than that of TBAD without hypertension group [6.3% (10/160) vs. 0% (0/67), χ2 = 4.386, P = 0.036]. 227 patients with TBAD were followed up for 3-66 months, with a median follow-up time of 25 months. There was no significant difference in long-term mortality between TBAD patients with and without hypertensive during discharge follow-up [13.1% (21/160) vs. 9.0% (6/67), χ2 = 0.784, P = 0.376]. Further multivariate Logistic regression analysis and Cox regression analysis did not indicate that hypertension was an independent risk factor for short-term and long-term death in TBAD patients [odds ratio (OR) and 95% confidence interval (95%CI) were 13.477 (0.541-330.215), 1.012 (0.990-1.035), both P > 0.05]. Age and HR were independent risk factors for the short-term mortality of TBAD patients [OR and 95%CI were 15.287 (1.051-226.415), 0.026 (0.002-0.840), both P < 0.05]. Age, PLT and D-dimer were independent risk factors for the long-term mortality of TBAD patients [OR and 95%CI were 1.808 (1.205-2.711), 0.555 (0.333-0.924), 1.482 (1.035-2.122), respectively, all P < 0.05]. The TBAD patients with hypertension have older age, high rates of diabetes or coronary heart disease. However, hypertension is not an independent risk factor for short-term and long-term mortality in TBAD patients.

Gender-Based Disparities in Rural Versus Urban Patients Undergoing Cardiac Procedures.

IntroductionRural populations have higher rates of diabetes and hypertension (HTN) with disparities in outcomes among patients presenting to the emergency room with heart attack and stroke. However, it is unclear whether there are any sex differences among patients presenting for cardiac procedures from rural versus urban areas. Our study aimed to investigate gender-based differences in baseline characteristics and procedural outcomes among rural and urban residents presenting for cardiac catheterization and percutaneous interventional procedures.MethodsWe assessed baseline conditions and outcomes in 1775 patients who underwent cardiac catheterization and or Percutaneous Coronary Intervention at the University of Tennessee Medical Center between July 2018 to October 2019 from rural as well as urban areas. Baseline conditions assessed were diabetes, HTN, stroke, peripheral vascular disease, heart failure, and prior bypass surgery. Outcomes assessed were vascular/bleeding complications, duration of the procedure, and mortality.ResultsThere were significant gender-based inter-group differences in outcomes between rural versus urban residents. In general, both rural and urban males had significantly longer procedure times and higher mortality than rural or urban females (P=0.01). Among females, rural women had longer procedure times than urban women. Bleeding complications were greater among rural residents than urban residents (p≤0.001), with rural females having the highest bleeding complication rate. Mortality was also higher among rural females compared to their urban counterparts (p=0.01).Significant gender-based inter-group differences were noted between rural versus urban residents. While the incidence of stroke was higher among rural and urban females compared to males, the peripheral vascular disease was more common among males. The history of coronary artery bypass graft (CABG) was more commonly seen among rural males than females. Rural and urban males had significantly longer procedure times than females, particularly urban females (P=0.01). Among women, rural females had longer procedure times, higher vascular/bleeding complications, and greater mortality than urban females. Mortality was higher among rural men and women compared to urban men or women (p=0.01). Rural women had the highest bleeding/vascular complications.ConclusionsWe found significant gender-based differences between rural versus urban patients. While rural females had a higher incidence of stroke, peripheral vascular disease and a history of CABG were more commonly seen among rural males. Overall, rural males had higher mortality than females (P=0.01). Among women, rural females had longer procedure times, higher bleeding complications, and greater mortality than urban females. Being aware of such gender-based differences may help physicians take steps to improve outcomes. Information derived from our study may also be useful for policymakers in directing healthcare funding to lower gaps in the care of patients such as those with peripheral vascular disease, ultimately leading to better health outcomes.

Direct and indirect effects of COVID-19 on perinatal outcomes in low- and middle-income countries.

Similar to previous outbreaks, the coronavirus disease 2019 (COVID-19) pandemic will have both direct and indirect effects on perinatal outcomes, especially in low- and middle-income countries. Limited data on the direct impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy shows women who are Black, obese and with co-morbidities are at higher risk of hospitalisation due to COVID-19. Younger age groups in Africa and South Asia have shown increased COVID-19 mortality. Indigenous pregnant women in Pacific Island countries are likely to be high risk for severe outcomes from COVID-19 due to high rates of diabetes and obesity. It is important to involve pregnant women in research, especially with regards to vaccine development and therapeutics.

Clinically significant depressive symptoms and high diabetes distress in adults with type 1 and type 2 diabetes in Appalachian Ohio.

In rural southeastern Ohio, the prevalence of diabetes is 19.9%, nearly double the national average of 10.5%. Despite the high rate of diabetes, its impact on the region is understudied; one such understudied topic is psychosocial difficulties. People with diabetes experience disproportionately higher rates of major depressive disorder (MDD), clinically significant depressive symptoms, and diabetes distress. Diabetes distress refers to the negative emotional experience of living with diabetes. It reflects an individual's worries, concerns, and fears about living a chronic and progressive disease. To assess the prevalence of diabetes distress as well as comorbid, clinically significant depressive symptoms and diabetes distress among patients in southeastern Ohio; and to assess impact of depressive symptoms and diabetes distress on A1C levels, diabetes self care behaviors, and diabetes quality of life (DQOL). In this cross sectional survey study, individuals aged 18years and older, diagnosed with type 1 (T1D) or type 2 (T2D) diabetes, who were able to read and speak English, and living in southeastern Ohio were invited to participate. Participants completed the Diabetes Distress Scale for T2D or T1D, the Patient Health Questionnaire-9, the Self Care Inventory-Revised, and the DQOL Scale as part of the study survey. Participants completed the survey via an online questionnaire service or mailed packets. Chi square tests determined the comorbidity of clinically significant depressive symptoms and high diabetes distress levels by type of diabetes. Multiple regression models examined the relationships among clinically significant depressive symptoms, diabetes distress scores, A1C levels, self care behaviors, and DQOL scores. Statistical significance was defined as a p<0.05. A total of 325 adults participated (mean±standard deviation [SD] age, 41.6±19.2years; 131 (40.7%) with T1D; 194 (59.7%) with T2D; mean±SD A1C, 7.5±1.6%; mean±SD duration, 12.4±9.6years). Of the 325 participants, 70 (21.5%) indicated clinically significant depressive symptoms, with 29 (22.3%) T1D participants and 41 (21.0%) T2D participants reporting clinically significant depressive symptoms. A total of 92 (28.3%) participants reported high diabetes distress (39 (30.5%) T1D participants and 53 (27.5%) T2D participants). Forty-eight participants (15.0%) screened positive for both clinically significant depressive symptoms and high diabetes distress. Regression models showed that higher diabetes distress scores were associated with fewer self care behaviors (T1D, b=-0.268, p=0.030; T2D, b=-0.312, p<0.001) and lower DQOL (T1D, b=0.726, p<0.001; T2D, b=0.501, p<0.001). Further, more depressive symptoms were associated with lower DQOL in participants with T2D (b=0.363, p<0.001). Higher diabetes distress scores were not associated with higher A1C levels in participants with T1D or T2D; however, increased depressive symptoms were associated with higher A1C levels in participants with T2D (b=0.390, p<0.001). Findings showed that adults in southeastern Ohio experienced high levels of diabetes distress and co-occurring clinically significant depressive symptoms that were within range of data from previous studies. These findings highlight the importance of routine screening for both clinically significant depressive symptoms and diabetes distress. Future longitudinal research is needed to confirm these findings and examine the evolution of these relationships over time.

Quality gap in venous thromboembolism prophylaxis practices in inpatients: Assessment of prophylaxis practices in a University Hospital.

Venous thromboembolism (VTE) is a prevalent complication of inpatient care, causing high burden of morbidity and mortality. Prophylaxis reduces the events; thus, these practices are promoted. We aimed to assess the VTE prophylaxis practices in the general internal medicine wards of a tertiary-care university hospital and utilize these data to propose quality improvement projects. Assess the pharmacological venous thromboembolism prophylaxis utilization by using the Padua Prediction Score and demonstrate the main determinants of inappropriate prophylaxis use. Electronic medical records were used to collect data cross-sectionally from 1 January 2019 to 30 June 2019. Padua Prediction Score was used to assess the appropriateness of VTE prophylaxis. Underlying health conditions, hospitalization causes, anti-platelets and use of glucocorticoids were also assessed as confounding factors. A total of 295 patients were included. Higher proportion of patients who received VTE prophylaxis were obese and had higher rates of diabetes and coronary artery disease. Prophylaxis was more commonly utilized among patients who were elderly, obese, having an acute infection and/or rheumatologic disorder and prolonged bed rest (P ≤ 0.001, P = 0.01, P = 0.22 and P ≤ 0.001, respectively). Thirty-five patients (11.8%) received VTE prophylaxis, despite 89 patients (30.2%) were high-risk patients. In the high-risk group (n = 89), 27 patients (30.3%) received appropriate pharmacological prophylaxis, while 8 patients (3.9%) received VTE prophylaxis in the low-risk group (total n = 206). A considerable percentage of the high-risk population (69.6%) did not receive VTE prophylaxis. Underuse constitutes a major challenge in our hospital but differing from other institutions, overuse is not a significant issue. Further studies are needed whether VTE prophylaxis improvement implementations uniformly increase appropriate VTE use.

Severe SARS-CoV-2 infection: Mortality and comorbidities in a third level hospital in San Luis Potosi, Mexico

The high rates of hypertension, obesity and diabetes in San Luis Potosí are worrying, since it has been shown that the existence of comorbidities associated with SARS-CoV-2 infection increases the risk of mortality, however most of the evidence comes from of other populations in the world for which it is necessary other investigations that focus on the Mexican population, in this case potosine. The objective of this study is to describe the clinical and respiratory characteristics of seriously ill and deceased patients with COVID-19, in a state in northeastern Mexico. And determine comorbidities, in order to apply better measures aimed at safeguarding the population at risk. Design: prospective and observational in the same medical center. Methods: Different types of variables, such as demographic data, severity, laboratory variables, ventilatory assistance received (high-flow oxygen therapy [HFO] and invasive mechanical ventilation [IMV]), oxygenation (PaO2 , PaO2 /FiO2 ), comorbidities and complications were automatically obtained. In order to analyze the difference between medians, the Fisher test (categorical variables) and the Mann-Whitney U test were used. A value of p &lt;0.001 was considered significant. Results: 163 patients were included (G1 = 51 [31.2%]; G2 = 92 [56.44%] and G3 = 20 [31.74%]); age 65 (52-72) years; 68% men, APACHE II 18 (15 -24); SOFA 6 (4-7); arterial hypertension (25.11%) and obesity (16.82%) were the most frequent comorbidities. HFO was used in 62.7% of the patients, 85% failed. 95% of the patients required IMV and 85% ventilation in the prone position. In the population, baseline PaO2 /FiO2 improved at the 7th day (165 [125-210] vs 194 [153-285]; p = 0.02), as in G1 (164 [125-197] vs 207 [160-294]; p = 0.07), but not in G2 (163 [95-197] vs. 135 [85-177]). The development of pneumonia associated with IMV was high. The amount of D-dimer and IL-6 was also significantly increased in patients who died on the 7th day of the study. Conclusions: The lack of improvement in PaO2 /FiO2 at the 7th day could be a prognostic marker for deterioration, as well as D-dimer and IL-6 secretion. Special attention needs to be paid to managing hypertension and diabetes in adults over 60 years of age. Which was the age group with the highest mortality.

Impact of Obesity on Atrial Fibrillation Recurrence Following Stand-Alone Cox Maze IV Procedure

Obesity is a strong and independent factor for the development of atrial fibrillation (AF), and adversely impacts the success of catheter ablation procedures for AF. This study evaluated the impact of body mass index (BMI) on the outcomes following surgical ablation of AF. Between 2003 and 2019, 236 patients underwent a stand-alone biatrial Cox maze IV procedure (CMP-IV) for refractory AF. Obesity was defined as BMI ≥30 kg/m2. Patients were divided into two groups: BMI <30 kg/m2 (n = 100) and BMI ≥30 kg/m2 (n = 136). Freedom from atrial tachyarrhythmia (ATA) was determined using electrocardiography, Holter, or pacemaker interrogation at 1 year and annually thereafter. Recurrence was defined as any documented ATA lasting ≥30 s. Predictors of recurrence were determined using multivariable logistic regression. Preoperative and procedural outcomes were compared between groups. Obese patients had a higher rate of diabetes (16% vs 7%, P = 0.044) and larger left atrial diameter (4.9 ± 1.1 cm vs 4.6 ± 1.0 cm, P = 0.021) when compared to non-obese patients. There was no difference in major complication rate between the groups (4% vs 7%, P = 0.389). There was no operative mortality in either group. During 4.1 ± 2.4 years of follow-up, there was no significant difference in freedom from ATA with or without antiarrhythmic drugs in obese patients when compared to the non-obese group (P > 0.05). Absence of sinus rhythm at discharge predicted AF recurrence up to 7 years postoperatively. As opposed to catheter ablation, obesity did not adversely impact the short and long-term outcomes of stand-alone surgical ablation with CMP-IV, and BMI was not a predictor of AF recurrence. Additionally, there was no significant increase in major complications in obese patients.

Clinical and Economic Burden of Transfusion-Dependent β-Thalassemia in Adult Patients in the United States

Introduction: β-thalassemia is a genetic blood disorder in which defective β-globin synthesis leads to ineffective erythropoiesis. Patients with transfusion-dependent β-thalassemia require lifelong management with blood transfusions and iron chelation therapy. Complications related to iron overload can cause significant morbidity and mortality, and it is well understood that the chronic management of this disease presents a substantial burden to patients in terms of healthcare visits and costs. However, the specific clinical and economic burden has not been well characterized in the USA.Objectives: The objectives of this study were to analyze the clinical and economic burden of current disease management for patients with transfusion-dependent (TD) β-thalassemia in the USA over a 1-year time period.Methods: This retrospective matched cohort study was conducted using the Truven Health MarketScan® Research Databases (Truven Health Analytics, Ann Arbor, MI). The MarketScan® Databases provide detailed utilization, outcomes, and cost data for healthcare services performed in inpatient and outpatient settings, and contains de-identified data from > 110 million patient lives. Adult patients with TD β-thalassemia and matched controls were identified between Jan 1, 2011 and Sep 30, 2015. Patients were required to be ≥ 18 years old at the index date with ≥ 12 months of continuous enrollment post index date. TD β-thalassemia patients were required to have ≥ 2 claims with a β-thalassemia (ICD-9-CM 282.44, ICD-10-CM D56.1) or hemoglobin E-β thalassemia (ICD-9-CM 282.47, ICD-10-CM D56.5) diagnosis, and ≥ 8 transfusion events to be defined as TD. Patients were excluded if they had ≥ 2 claims with any sickle cell diagnosis. Controls were required to have ≥ 1 medical claim and were excluded if they had a diagnosis of any thalassemia or sickle cell condition. Patients with TD β-thalassemia were matched to controls in a 1:5 ratio using exact matching based on age, sex, index year, payer type, and census division. Comorbidities were not used in matching because patients with TD β-thalassemia have a high burden of disease-associated comorbidities. Index date was the first claim for a β-thalassemia diagnosis in patients with TD β-thalassemia or the first medical claim for controls. Outcomes examined were disease burden such as comorbid conditions, healthcare utilization and costs specific to the management of TD β-thalassemia, as well as general healthcare utilization and costs during the 12 months post index date. Chi-squared tests and Fisher's exact test were used for categorical variables and the Wilcoxon-Mann-Whitney test was used for continuous outcomes.Results: Fifty patients with TD β-thalassemia met selection criteria and were matched to 250 controls. Mean age was 34.7 ± 9.1 years for both patients and controls. Patients with TD β-thalassemia had higher rates of diabetes (18% vs 6%, P = 0.009), cardiac disease (30% vs 2%, P < 0.001), hypogonadism (22% vs 7%, P = 0.002), osteoporosis (16% vs 1%, P < 0.001), and hypothyroidism (12% vs 4%, P = 0.045) compared with controls. On average, patients with TD β-thalassemia required 17 transfusions per year, 23 days apart. Mean number of outpatient visits was significantly higher in the TD β-thalassemia cohort compared with matched controls; however, inpatient and ER visits were not significantly different (Table 1). Mean total healthcare costs among the TD β-thalassemia cohort were USD 128,062 ± 62,260, compared with USD 5,438 ± 11,855 in controls (P < 0.001). Medical and medication costs were significantly higher in the TD β-thalassemia cohort compared with matched controls (Table 2). Among patients with TD β-thalassemia, total costs were primarily driven by chelation and transfusion costs, with other costs displayed in the figure. The majority of patients with TD β-thalassemia received oral chelators (72%), whereas 30% of patients received injectable chelators; 14% of patients received both oral and injectable chelators.Conclusions: Ongoing comprehensive treatment for TD β-thalassemia poses a substantial clinical and economic burden as compared with matched controls. Patients with TD β-thalassemia had significantly higher healthcare resource utilization, medication costs, and total costs compared with matched controls, and required frequent visits to their healthcare provider, which poses a burden to their quality of life and work productivity. [Display omitted] DisclosuresSheth:Novartis, Celgene, ApoPharma, Bluebird Bio: Consultancy. Weiss:Celgene: Employment; Zocdoc: Other: Equity ownership (options have not vested yet); Zocdoc: Other: Husband's employment. Parisi:Celgene: Employment, Equity Ownership. Ni:Celgene: Employment.