Diabetes Hypertension Research Articles

The association between index-year, average, and variability of the triglyceride-glucose index with health outcomes: more than a decade of follow-up in Tehran lipid and glucose study

BackgroundThe association between baseline triglyceride glucose index (TyG index) and incident non-communicable diseases, mainly in Asian populations, has been reported. In the current study, we aimed to evaluate the association between index-year, average, and visit-to-visit variability (VVV) of the TyG index with incident type 2 diabetes mellitus (T2DM), hypertension, cardiovascular disease (CVD), and all-cause mortality among the Iranian population.MethodsThe study population included 5220 participants (2195 men) aged ≥ 30 years. TyG index was calculated as Ln (fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2). Average values of the TyG index and also VVV (assessed by the standard deviation (SD) and variability independent of mean) were derived during the exposure period from 2002 to 2011 (index-year). Multivariable Cox proportional hazards regression models were used to estimate the hazard ratio (HR) and 95% confidence interval (CI) of the TyG index for incident different health outcomes.ResultsDuring more than 6 years of follow-up after the index year, 290, 560, 361, and 280 events of T2DM, hypertension, CVD, and all-cause mortality occurred. 1-SD increase in the TyG index values at the index-year was independently associated with the incident T2DM [HR (95% CI) 2.50 (2.13–2.93)]; the corresponding values for the average of TyG index were 2.37 (2.03–2.76), 1.12 (0.99–1.26, pvalue = 0.05), 1.18 (1.01–1.36), and 1.29 (1.08–1.53) for incident T2DM, hypertension, CVD, and all-cause mortality, respectively. Compared to the first tertile, tertile 3 of VVV of the TyG index was independently associated with incident hypertension [1.33 (1.07–1.64), Ptrend <0.01]. Likewise, a 1-SD increase in VVV of the TyG index was associated with an 11% excess risk of incident hypertension [1.11 (1.02–1.21)]. However, no association was found between the VVV of the TyG index and other outcomes. Moreover, the impact of index-year and average values of the TyG index was more prominent among women regarding incident CVD (P for interactions < 0.05).ConclusionAlthough the higher TyG index at index-year and its VVV were only associated with the incident T2DM and hypertension, respectively, its average value was capable of capturing the risk for all of the health outcomes.

Maternal Death Due to Lymphocytic Hypophysitis: A Case Report

Lymphocytic hypophysitis is a rare condition characterized by lymphocyte and plasma cell infiltration, leading to fibrosis and functional impairment of the pituitary gland. Although lymphocytic hypophysitis is associated with pregnancy, its diagnosis may be challenging in pregnant women owing to unclear symptoms of pituitary dysfunction. Lymphocytic hypophysitis can lead to serious complications, including a sudden death; however, no case of maternal death has been reported in Korea. This study presents a case of maternal death after childbirth. The deceased had a history of hypertension, obesity, hypothyroidism, and gestational diabetes and died suddenly the day after the emergency cesarean section. Notably, no other pregnancy-related complications were observed. Histopathological examination of the pituitary gland confirmed lymphocytic hypophysitis. This case report emphasizes the requirement of clinical awareness and underscores the significance of examining the pituitary gland during autopsy investigations of maternal deaths.

The Relationship Between Platelet Indices, Hormonal Status, and Insulin Resistance in Adolescents with Polycystic Ovary Syndrome: A Retrospective Case-Control Study

Aim: This study aimed to investigate the relationship between polycystic ovary syndrome in adolescents, a disease caused by inflammation and insulin resistance that is associated with metabolic disorders, and platelet indices, which provide information about platelet activity. Materials and methods: Patients with oligoovulation, hyperandrogenemia, or clinical signs of hyperandrogenism (hirsutism, acne, etc.) and polycystic appearance with ≥ 20 small follicles ≥ 2∼ 9 mm in diameter in both ovaries on ultrasound according to the newly updated Rotterdam criteria were included in the study with a diagnosis of polycystic ovary syndrome and formed PCOS group. Patients with similar age groups and body mass index (BMI) values who presented to the clinic for non-PCOS symptoms (vaginitis, dysmenorrhea, cystitis), whose complete blood count was checked during hormone testing, and who did not meet the Rotterdam criteria were selected as the control group. Platelet indices found in routine blood count parameters (platelet large cell ratio (P-LCR), platelet distribution width (PDW) and mean platelet volume (MPV)) were analyzed between the two groups. In addition, the relationship between these indices and hormone status and insulin resistance in PCOS patients was analyzed. Patients with diabetes mellitus, hypertension, malignant diseases, cardiovascular diseases, essential thrombocytopenia or other blood diseases and patients taking medication were excluded. Results: In the study of 123 patients, there was no statistically significant difference between the groups in terms of age and body mass index (p:&gt;0.05). When hemogram parameters were compared between the groups, hemogram parameters such as P-LCR (p: 0.002), PDW (p: 0.011) and MPV (p: 0.007), which indicate platelet activity, were statistically significantly higher in the PCOS group. When the data of PCOS patients were analyzed, platelet indices were found to be higher in the group with high insulin resistance (p:

Screening for Diabetes Mellitus and Hypertension in Duhok Governorate, Kurdistan Region of Iraq

Objective: To determine the prevalence and significant correlates of prediabetes (pre-DM), diabetes mellitus (DM), prehypertension (pre-HT), and hypertension (HT) among adults in all districts of Duhok Governorate through a community-based screening study. Methods: This is a cross-sectional community-based screening study involving 3,000 non-fasting adults not diagnosed as prediabetes or DM and prehypertension or HT conducted in all districts of Duhok Governorate. Random glucose and blood pressure reading according to American Diabetes Association and American Heart Association Guidelines in 2023 will be used in a community-based screening. BMI will be also calculated in the present study as a screening tool. Results: Findings reveal that 18.2% had DM, 14.7% had pre-DM and 41.3% had HT and 11.5% had pre-HT. The study also revealed that nearly two third had increased BMI in which 40.1% were overweight and 24.5% were obese. Among screened subjects 32% were smokers. Around half of screened subjects reported having family history of DM and HT, DM alone (10.8%), HT alone (12.1%) and 28.9% had family history of both DM and HT together. The study also shows that screened male subjects reported higher prevalence of pre-DM, DM, pre-HT and HT than screened female subjects. Older age group of screened subjects tend to have more abnormal blood sugar and blood pressure levels than younger age group. Conclusion: This study has shown a high prevalence of pre-DM, DM, pre-HT and HT among adults in all districts of Duhok Governorate. Significant correlates of pre-DM, DM, pre-HT and HT in this study were age, gender, BMI, smoking and family history.

Artificial Intelligence-Based Chronic Disease Detection Application Among Hypertension and Diabetes Mellitus Risk Group in Indonesian Primary Healthcare: A Usability and User Experience Evaluation

This study aims to considering the assessment of the usability and user experience of applications based on artificial intelligence (AI) for early detection of chronic diseases. Health data is recorded and chronic disease risk is classified using an AI-based early detection of chronic disease application. The study was conducted in Semarang city/regency health service facilities, using quantitative research methodology. The study's inclusion criteria were individuals with a history of diabetes mellitus and hypertension. Using the System Usability Scale (SUS) and User Experience Question (UEQ) surveys, 131 respondents were studied in May–July 2023. The study's findings showed that respondents who were older than 60, female, had not completed their education, worked for a living or were self-employed, did not use a mobile phone, and had never used health applications scored poorly for usability and user experience. The system satisfation aspect receives the lowest grade in terms of system usability, while the memorability aspect has the best score. The efficiency aspect of the system receives the greatest score in terms of user experience, while the novelty aspect receives the lowest. It is known that the AI-based early detection of chronic disease application has a reasonably acceptable usability and user experience based on the findings of the SUS and UEQ questionnaires for patients at risk of hypertension and diabetes mellitus. It is necessary to design an AI-based chronic disease detection application that is easier to learn and more innovative so that it can be used by the wider community.

Other Diagnostic Tests for Young-Onset Type 2 Diabetes Mellitus

We have read with interest the article entitled “A Cross-sectional Study to Evaluate Beta Cell Function in Individuals with Newly Diagnosed Young-Onset Type 2 Diabetes Mellitus and its Complications,”1 elevated C-peptide levels are indicative of both insulin resistance and beta cell malfunction. These factors are directly linked to the development of complications associated with young-onset Type 2 Diabetes Mellitus (YO-T2DM), including obesity, hypertension, and diabetic kidney disease. The present letter aims to expand the current diagnostic testing options for early detection of YO-T2DM.

Comorbid Diseases and Outcomes of Critically Ill COVID-19 Patients Admitted to an Indonesian Intensive Care Unit from May to October 2021

Background: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2). The spread of COVID-19 has become a worldwide health threat, with 583,038,110 cases and a death toll of 6,416,023. This study attempted to determine the relationship of age, sex, and comorbid diseases with the outcomes of critically ill COVID-19 patients at Prof. Dr. IGNG Ngoerah Central General Hospital, Denpasar, Indonesia. Methods: This analytic study employed a retrospective approach, analyzing secondary data from medical records using a purposive sampling method. The research included univariate analysis, bivariate analysis using the chi-square test, and multivariate analysis using a general linear model performed with the assistance of IBM SPSS Statistics for Windows, version 23.0 (IBM Corp., Armonk, N.Y., USA). A statistical analysis result with a p-value of less than 0.05 was deemed significant. Results: A total of 264 critically ill COVID-19 patients were hospitalized in the Intensive Care Unit of Prof. Dr. IGNG Ngoerah Central General Hospital from May to October 2021. Comorbid diseases were present in 215 patients. The comorbid diseases that had the greatest impact on increasing mortality were diabetes mellitus, hypertension, kidney disease, and cardiovascular disease (p=0.000–0.006, 95% CI). Conclusion: Age and sex do not have any significant relationship with the outcomes of critically ill COVID-19 patients. Meanwhile, comorbid diseases, such as diabetes mellitus, hypertension, and renal and cardiovascular diseases, pose a significant impact on the mortality rate of critically ill COVID-19 patients. Highlights: This study investigated patients who were critically ill with COVID-19 to determine the relationship between age, sex, comorbidities, and patient outcomes. The findings of this study may provide additional data on the impact of comorbidities on the severity of COVID-19, which can be valuable to prevent mortality due to the infection.

Correlation between non-alcoholic fatty liver disease and metabolic parameters in persons with newly diagnosed type 2 diabetes mellitus.

There are limited studies investigating the association between type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD) in the region of Bihar, India. To estimate the prevalence of NAFLD in persons with newly diagnosed T2DM in the population of North Bihar, India. This single centre cross-sectional study was undertaken in the Research Centre for Diabetes Hypertension and Obesity, Samastipur, Bihar, India. Data were collected from persons newly diagnosed with T2DM or those diagnosed within 6 months of when the study was conducted between December 2022 to May 2023. A total of 148 people with newly diagnosed T2DM were included (median age 47 years, 46.6% female) and 109 patients with liver disease on ultrasound evaluation. The persons with liver disease consumed more fats and oils (88.1% vs 74.4%, P = 0.042) and they had significantly greater body mass index (27.4 vs 23.0, P < 0.001), waist circumference (37 vs 33, P < 0.001), and waist-to-hip ratio (1.00 vs 0.70, P = 0.025). Females were associated with greater liver disease [odds ratio (OR): 3.09, 95% confidence interval (CI): 1.09-8.80, P = 0.32]. Waist circumference (OR: 1.42, 95%CI: 1.22-1.66, P < 0.001) and low-density lipoprotein cholesterol (OR: 1.01, 95%CI: 1.01-1.02, P = 0.048) were associated with any liver disease. The factors most associated with grade 2/3 liver disease was right upper quadrant pain or heaviness (OR: 5.22, 95%CI: 1.40-19.41, P = 0.14), greater income (OR: 3.58, 95%CI: 1.28-10.04, P = 0.015) and waist circumference (OR: 1.31, 95%CI: 1.02-1.69, P = 0.036). NAFLD is common in new/recently diagnosed T2DM and disease burden is high and common among patients who are either high consumers of fats and oils or have obesity-associated markers.

Association of cardiovascular risk factors and intraplaque neovascularization in symptomatic carotid plaque.

Cardiovascular risk factors are known to contribute to the formation of atherosclerotic plaques, which can result in carotid stenosis. However, the extent to which these factors are associated with intraplaque neovascularization, a key indicator of plaque vulnerability, remains unclear. To investigate this relationship, a study was conducted utilizing contrast-enhanced ultrasound (CEUS) to assess intraplaque neovascularization in symptomatic patients. A cohort of 157 symptomatic patients underwent evaluation using Contrast-Enhanced Ultrasound (CEUS) imaging to assess carotid intraplaque neovascularization, which was quantified based on the degree of plaque enhancement. The collected data encompassed baseline patient characteristics, results from biochemical examinations, cardiovascular risk factors, and medication usage history. Regression analyses were conducted to elucidate the relationship between carotid plaque neovascularization and various cardiovascular risk factors. Patients with intraplaque neovascularization were more prone to have diabetes mellitus (OR 3.81, 95% CI 1.94-7.46, p < 0.001), dyslipidemia (OR 2.36, 95% CI 1.22-4.55, p = 0.011) and hypertension (OR 2.92, 95% CI 1.50-5.71, p = 0.002). Smoking increased the risk of having intraplaque neovascularization (OR 2.25, 95% CI 1.12-4.54, p = 0.023). Treatment with statins was significantly lower in patients with intraplaque neovascularization (OR 0.37, 95% CI 0.19-0.72, p = 0.003). In the multivariate analysis, diabetes mellitus (OR 3.27, 95% CI 1.10-9.78, p = 0.034) was independently related to the presence of intraplaque neovascularization. Meanwhile, compared to the patients in the first tertile of serum glucose (< 6.20 mmol/L), the patients in the third tertile (> 13.35 mmol/L) had the most significance of intraplaque neovascularization (OR 5.55, 95% CI 1.85-16.66, p = 0.002). The findings indicated that diabetes mellitus is a significant cardiovascular risk factor that is strongly associated with carotid intraplaque neovascularization.

Impact of cigarette smoking on the outcomes of ST-elevation myocardial infarction after primary percutaneous coronary intervention in metropolitan Tehran

Objective: Although the adverse effects of smoking are well-established, evidence shows a longer survival rate following an acute myocardial infarction (MI) among smokers or the so-called “smoker's paradox”. This study aimed to determine the impact of smoking on the one-year clinical outcomes of ST-elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI) in a large registry of the Iranian population. Methods: A total of 3087 patients diagnosed with acute STEMI who underwent PPCI between 2013 and 2018 were enrolled in the study. Patients' smoking status was determined based on self-reported history and categorized into two groups: current smokers and non-smokers. Clinical and angiographic data were collected from the Tehran Heart Center (THC) registry. The primary outcome was one-year of major adverse cardiac and cerebrovascular events (MACCE). The effect of smoking on MACCE was evaluated using a Cox model. Results: From the study population, 1967 (63.7%) were non-smokers, and 1120 (36.3%) were current smokers. Non-smokers had higher rates of prior CABG (5.3%) as well as a higher history of co-morbidities, including a history of diabetes mellitus (46.0%), hypertension (52.7%) and hyperlipidemia (55.4%) than smokers (2.3%, 30.4%, 35.7%, and 49.8% respectively). Smokers had a higher reference vessel diameter than non-smokers (P=0.005). The unadjusted hazard ratios (HRs) for MACCE within one year were significantly lower in smokers than non-smokers (0.73, 95% CI: [0.58,0.92]; P=0.009); however, after adjustment for confounders, the HRs for MACCE in smokers were similar to non-smokers (HR: 1.00, 95% CI: [0.73,1.38]). Conclusion: The study found that smoking had no significant impact on the one-year clinical outcomes of STEMI patients after PPCI in the Iranian population. This study is the first of its kind to assess the effect of smoking on STEMI patients in Iran and highlights the need for further research in this area.

A IMPORTÂNCIA NA MUDANÇA NO ESTILO DE VIDA PARA PACIENTES COM DIABETES MELLITUS TIPO 2 E HIPERTENSÃO ARTERIAL SISTÊMICA: UM RELATO DE CASO

Introduction: Inadequate lifestyle habits, such as poor diet, physical inactivity, and visceral obesity, are directly related to chronic non-communicable diseases like diabetes and systemic arterial hypertension, as well as cardiovascular outcomes. Objective: To report the case of a patient with hypertension and diabetes with poor adherence to non-pharmacological treatment. Methodology: Case report developed in the PIESC Axis of the 7th semester of the Medical Course, involving a 58-year-old male patient with systemic arterial hypertension and diabetes for 20 years. Results: The patient, with a history of stroke and family history of diabetes, has a diet high in salt, fat, and carbohydrates, and does not regularly consume fruits and vegetables. He does not engage in physical activities and is a smoker. During the physical examination, he presented with blood pressure of 135/85 mmHg, heart rate of 88 bpm, body mass index of 30.8, and fasting blood glucose of 200 mg/dl. The importance of lifestyle changes was reinforced, and medication doses were adjusted. Conclusion: The patient has high-risk factors, such as hypertension, age over 55, and a history of smoking. Adherence to non-pharmacological treatment is essential to control modifiable risk factors and improve long-term adherence. Reducing body mass index and abdominal circumference, along with a healthy diet, is crucial. Regular physical activity and diet play an essential role in controlling diabetes. It is crucial for health professionals to emphasize the importance of treatment adherence and the quality of life of patients.

Assessing Stroke Recurrence Risk by Using a Lipoprotein-Associated Phospholipase A2 and Platelet Count-Based Nomogram.

Stroke recurrence remains a critical challenge in clinical neurology, necessitating the identification of reliable predictive markers for better management and treatment strategies. This study investigates the interaction between lipoprotein-associated phospholipase A2 (Lp-PLA2) and platelets as a potential predictor for stroke recurrence, aiming to refine risk assessment and therapeutic approaches. In a retrospective cohort of 580 ischemic stroke patients, we analyzed clinical data with a focus on Lp-PLA2 and platelet levels. By using multivariable logistic regression, we identified independent predictors of stroke recurrence. These predictors were then used to develop a comprehensive nomogram. The study established diabetes mellitus, hypertension, low-density lipoprotein (LDL), Lp-PLA2 levels, and platelet counts as independent predictors of stroke recurrence. Crucially, the interaction parameter Lp-PLA2 * platelet (multiplication of Lp-PLA2 and platelet count) exhibited superior predictive power over each factor considered separately. Our nomogram incorporated diabetes mellitus, cerebral infarction causes, hypertension, LDL, and the Lp-PLA2 * platelet count interaction and demonstrated enhanced accuracy in predicting stroke recurrence compared to traditional risk models. The interaction between Lp-PLA2 and platelets emerged as a significant predictor for stroke recurrence when integrated with traditional risk factors. The developed nomogram offers a novel and practical tool in molecular neurobiology for assessing individual risks, facilitating personalized treatment strategies. This approach underscores the importance of multifactorial assessment in stroke management and opens avenues for targeted interventions to mitigate recurrence risks.

The effect of educational interventions by nurses through Orem's self-care theory on the ability of self-care in myocardial Infarction patients in public sector hospital: A quasi-experimental study.

To assess the impact of educational intervention by nurses guided by Orem's theory to reinforce the self-care abilities of patients experiencing myocardial infarction. The prospective, quasi-experimental case-control study was conducted from September 2020 to April 2021 at Dr. Ruth K.M. Pfau Civil Hospital, Karachi, and comprised myocardial infarction and heart failure patients with comorbidities diabetes mellitus and hypertension. The patients were randomised into experiment group A and control group B. Group A received educational intervention one day before and one day after discharge in line with the American Heart Association guidelines. Two 30-45-minute sessions of seven modules were conducted. Group B received routine information from ward staff. Assessment was done at baseline and first month and second month post-intervention using the Heart Failure Self-Care Index version 6.2. Data was analysed using SPSS 21. Of the 80 patients, 40(50%) were in group A; 27(76.5%) males and 13(32.5%) females. The remaining 40(50%) patients were in group B; 20(50%) males and 20(50%) females. The overall age of the sample ranged 36-65 years and 48(60%) had a previous history of heart failure. The mean score of maintenance, management, confidence and overall self-care were significantly higher in group A compared to group B (p<0.05). Nursing self-care educational intervention based on Orem's theory was found to be highly effective among patients of myocardial infarction and heart failure with respect to their self-efficacy ability.

Trimethylamine N-oxide: A new target for the prevention and treatment of ischemic stroke

At present, ischemic stroke (IS) is the main contributor to mortality and disability. As a major chronic non-communicable disease, it poses a major threat to public health. Adding to the already substantial burden of stroke in China is the rapidly aging population and the rising incidence of diabetes mellitus, hypertension, and hyperlipidemia. As a Chinese proverb goes, &amp;ldquo;diseases invade the body through the mouth,&amp;rdquo; which is, coincidentally, consistent with a claim by Hippocrates, the father of modern medicine, that the source of all diseases begins in the intestines. These ancient wisdom underscore the importance of dissecting the relationship between IS and diet. Food is the primary source of trimethylamine N-oxide (TMAO), an intestinal metabolite, which has drawn a lot of attention because it plays a key role in a number of pathways linked to the development and progression of atherosclerosis. These pathways include lipid metabolism, vascular endothelial injury, and the induction of inflammation. Given its potential as a therapeutic target for IS, conducting in-depth research on TMAO has become particularly crucial. With varied involvement in atherosclerosis, TMAO stands out as a viable target for innovative treatment techniques targeted at decreasing the risk and severity of IS. It is evident that practicing a specific diet can reduce the risk for IS, underscoring the necessity to investigate the role of controlling dietary TMAO intake in mitigating the risk of IS. At present, a growing body of research has explored the role of TMAO in vascular diseases, uncovering numerous interventions to reduce TMAO levels, which serve dual benefits of addressing both atherosclerosis and the associated risk of IS. This paper reviews the relationship between TMAO and IS, along with the progress in research on the clinical value of TMAO, offering new perspectives on IS prevention and treatment.

Knowledge and willingness to donate kidney for transplantation among general population in Saudi Arabia

IntroductionKidney transplantation is the preferred treatment for end-stage renal disease (ESRD), offering a superior quality of life and extended survival compared to other renal replacement therapies. As the number of ESRD patients grows, so does the demand for organ transplants. The prevalence of ESRD is anticipated to escalate further due to the rising rates of diabetes mellitus (DM), hypertension (HTN), and obesity. Organ donation, particularly from living donors, remains the main source of transplants in the region, despite the notable underutilization of potential deceased donors’ organs. The objective of this research is to assess the level of knowledge, attitudes, and willingness to donate kidneys among the general population, a pivotal step in addressing the organ shortage crisis.MethodsThis cross-sectional study was conducted in the Aseer region of Saudi Arabia using a previously validated questionnaire. The questionnaire collected demographic data and insights into general attitudes, knowledge, and beliefs about organ donation. Logistic regression was used to identify predictors of knowledge and willingness to donate.ResultsThe study involved 705 participants, predominantly young adults with a high level of education. Awareness of kidney donation was high, and knowledge about donation was broad, especially regarding religious permissibility and awareness of the donor registry. However, only 25% expressed willingness to donate their kidneys, and a 4% were already registered as donors. Furthermore, higher educational level was not associated with higher odds of knowledge or willingness to donate.ConclusionDespite the considerable awareness, actual donor registration rates were low, highlighting the necessity for targeted educational interventions and a deeper understanding of the cultural and socioeconomic barriers that exist.

Pregnancy Outcomes in Patients With Hepatitis C Virus Infection.

To evaluate the risks of adverse maternal and neonatal outcomes associated with pregnancies complicated by hepatitis C virus (HCV) infection. This is a secondary analysis of a multicenter prospective cohort study of HCV infection in pregnancy. Participants were screened for HCV infection with serum antibody tests, and each participant with a positive HCV result (case group) was matched with up to two individuals with negative HCV results (control group) prospectively by gestational age (±2 weeks) at enrollment. Maternal outcomes included gestational diabetes, abruption, preeclampsia or gestational hypertension, cholestasis, and preterm delivery. Neonatal outcomes included hyperbilirubinemia, admission to neonatal intensive care (NICU); small-for-gestational-age (SGA) birth weight; and neonatal infection, defined as sepsis or pneumonia. Models were adjusted for maternal age, body mass index, injection drug use, and maternal medical comorbidities. The 249 individuals in the case group were prospectively matched to 486 individuals in the control group who met eligibility criteria. There were significant differences in demographic characteristics between the groups, including race, socioeconomic markers, education, insurance status, and drug and tobacco use. The frequencies of maternal outcomes of gestational diabetes, preeclampsia, and abruption were similar between the case and control groups. Preterm birth was similar between groups, but neonates born to individuals in the case group were more likely to be admitted to the NICU (45.1% vs 19.0%, adjusted odds ratio [aOR] 2.6, 95% CI, 1.8-3.8) and to have SGA birth weights below the 5th percentile (10.6% vs 3.1%, aOR 2.9, 95% CI, 1.4-6.0). There were no increased odds of hyperbilirubinemia or neonatal infection. Despite no increased odds of preterm birth or other adverse maternal outcomes in adjusted analyses, maternal HCV infection was associated with twofold increased odds of NICU admission and nearly threefold increased odds of SGA birth weight below the 5th percentile.

Correlation of geriatric assessment and outcomes of acute myeloid leukemia in elderly patients

Abstract Background Frailty is a vulnerable susceptibility to stressors during aging. Assessment of frailty could help make appropriate management plans and early interventions. Geriatric 8 (G8) is a screening tool designed to identify those at risk for frailty who need a more detailed assessment, while Geriatric Assessment in Hematology (GAH) is a multidimensional assessment similar to the comprehensive assessment designed specifically for patients with hematological malignancies. Methods Thirty-two newly diagnosed elderly acute myeloid leukemia (AML) patients, with a mean age of 64.9 years, were assessed by G8 and GAH scores to be reclassified into 16 frail patients and 16 non-frail patients. The disease progression, hospital stay, complications, overall survival, and mortality rates in both groups were followed for 6 months. Results Comorbidities with diabetes mellitus (DM) and hypertension (HTN) were significantly higher in frail patients compared to non-frail patients; also, the ECOG performance score was significantly higher in frail patients compared to the non-frail patients. At 6 months of evaluation, non-frail patients had better overall response compared to frail patients, on using both G8 and GAH scores. At 1, 3, and 6 months of evaluation, the frail patients group exhibited a significantly higher mortality rate than the non-frail group. In our study, median hospitalization of non-frail group was significantly higher than that of frail group and total incidence of complications did not reveal a significant correlation with patient's frailty status. Conclusion Based on G8 and GAH scores, frail AML patients were more likely to have a higher incidence of early mortality and lower overall survival compared to non-frail patients.

Outcomes of different steroid dosing regimens in critical Covid-19 pneumonia at a Kenyan hospital: A retrospective cohort study.

Among therapeutic options for severe and critical COVID- 19 infection, dexamethasone six milligrams once daily for ten days has demonstrated mortality benefit and is guideline recommended at this dose. In practice, variable doses of steroids have been used, especially in critical care settings. Our study aimed to determine the pattern of steroid dosing and outcomes in terms of critical care mortality, occurrence of dysglycaemias, and occurrence of superadded infections in patients with critical COVID-19. A retrospective cohort study was carried out on all eligible patients admitted to the Aga Khan University Hospital, Nairobi, with critical COVID-19 between 1st March 2020 and 31st December 2021. The intervention of interest was corticosteroids quantified as the average daily dose in milligrams of dexamethasone. A steroid dose of six milligrams once a day was compared to high dose steroid dosing, which was defined as any dose greater than this. The primary outcome measure was ICU mortality and secondary outcomes included occurrence of dysglycaemias, superadded infections and duration of critical care admission. The study included 288 patients. The median age was 61.2 years (IQR: 49.7, 72.5), with 71.2% of patients being male. The most common comorbidities were diabetes mellitus (60.7%), hypertension (58%), and heart disease (12.2%). The average oxygen saturation and C-reactive protein at admission were 82% [IQR: 70.0-89.0]and 113.0 [IQR: 54.0-186.0], respectively. Fifty-eight percent of patients received a standard dose (6mg) of steroids. The mortality rate was higher in the high-dose group compared to the standard-dose group; however, the difference was not statistically significant (47.9% vs 43.7% p = 0.549). The two most common steroid associated adverse effects were uncomplicated hyperglycemia (62.2%) and superimposed bacterial pneumonia (20.1%). The high-dose group had a higher incidence of uncomplicated hyperglycemia compared to the standard-dose group (63.6% vs 61.1%). However, the incidence of diabetic ketoacidosis was lower in the high dose group (0.6% vs 6.6%). Oxygen saturation at admission was associated with survival where it was lower among non-survivor patients with critical COVID-19. The study found that high-dose steroids in the treatment of critically ill patients with COVID-19 pneumonia did not confer any mortality benefit and were associated with an increased risk of dysglycemia and superimposed infections.

A customised fetal growth and birthweight standard for Qatar: a population-based cohort study.

Customized birthweight centiles have improved the detection of small for gestational age (SGA) and large for gestational age (LGA) babies compared to existing population standards. This study used perinatal registry data to derive coefficients for developing customized growth charts for Qatar. The PEARL registry data on women delivering inQatar (2017-2018) was used to develop a multivariable linear regression model predicting optimal birthweight. Physiological variables included gestational age, maternal height, weight, ethnicity, parity, and sex of the baby. Pathological variables such as hypertension, preexisting and gestational diabetes and smoking were calculated and excluded to derive the optimal weight at term. The regression model found a term optimal birthweight of 3,235 g for a Qatari nationality mother with median height (159 cm), booking weight (72 kg), parity (1) and gestation at birth (276days) at the end of an uncomplicated pregnancy. Constitutional coefficients significantly affecting birthweight were gestational age, height, weight, and parity. The main pathological factors were preexisting diabetes (increase by +175.7 g) and smoking (decrease by-190.9 g). The SGA and LGA rates in the entire cohort after applying the population-specific customized centiles were 11.1 and 12.2 %, respectively (contrasting with the Hadlock standard: SGA-26.3 % and LGA-1.8 %, and Fenton standard: SGA-12.9 % and LGA-4.0 %). Constitutional and pathological variations infetal growth and birthweight apply in the maternity population in Qatar and have been quantified to allow the generation of customised charts for better identification ofpregnancies with abnormal growth. Currently in-use population standards may misdiagnose many SGA and LGAbabies.

The Relationship Between Pre-Pandemic Comorbidities With SARS-CoV-2 Infections and Hospitalizations in Black Versus White Military Service Members: A Retrospective Study.

Comorbidities such as hypertension, diabetes mellitus, asthma, and cardiovascular conditions have been reported to worsen the clinical progression of coronavirus disease 2019 (COVID-19) and related hospitalizations. Furthermore, the COVID-19 pandemic has disproportionately affected the historically marginalized groups, i.e., Black, Hispanic, and Asian individuals have substantially higher rates of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection, COVID-19 hospitalization, and death compared to White individuals. Despite these findings in civilian populations, the impact of comorbidities and race in SARS-CoV-2 infection and COVID-19 hospitalizations in military populations is unknown. We evaluated the relationship of pre-selected pre-pandemic comorbidities and race with SARS-CoV-2 infections and COVID-19 hospitalizations in U.S. military service members (SMs). We conducted a systematic review of Military Health System beneficiaries' records by accessing the Defense Medical Epidemiological Database. Our inclusion criteria were being an active duty SM and having at least one pre-COVID-19 pandemic comorbidity. Retired as well as uninfected healthy active duty SMs and beneficiaries were excluded from the study. A total population of 1.334 million active duty SM records was drawn from Defense Medical Epidemiological Database. The data were stratified, by race (primary outcome), as well as gender, age, and military service branches (secondary outcomes). We found higher trends in SARS-CoV-2 infection and COVID-19 hospitalization rates in Black compared to White SMs. This seamless inequality was also seen in other viral infections affecting SMs including human immunodeficiency virus and viral hepatitis. We hypothesized this disparity to some extent be associated with the presence of pre-pandemic comorbidities that is affecting this military subpopulation. Supporting our hypothesis, we found trends toward the higher pre-pandemic prevalence of diabetes mellitus, asthma, hypertension, and ischemic heart disease, in Black compared to White military SMs, especially in Black older male adults. Our results highlight the role of pre-pandemic comorbidities and race likely enhancing the frequency of SARS-CoV-2 infections and COVID-19 hospitalizations in military SMs. These preliminary findings underscore the need for future retrospective studies using additional Military Health System data bases reporting data on this military subpopulation, especially in the setting of future pathogens outbreaks or pandemics affecting military populations.