Lower Hemoglobin Research Articles

Sex differences in genotype frequency and the risk of polycythemia associated with rs13419896 and rs2790859 among Tibetan highlanders living in Tsarang, Mustang, Nepal

BackgroundTibetan highlanders have adapted to hypoxic environments through genetic mechanisms that avoid hemoglobin concentration increases and prevent polycythemia. Recently, sex differences in hemoglobin dynamics with age have been reported among Tibetan highlanders living in Tsarang. Additionally, concerns have been raised that dietary changes associated with modernization may increase the risk of polycythemia and lifestyle-related diseases among Tibetan highlanders. However, the relationship between genetic polymorphisms and the risk of lifestyle-related diseases in Tibetan highlanders has been investigated in only a few regions. This study aims to elucidate whether polymorphisms in genes related to hypoxic adaptation are associated with the incidence of lifestyle-related diseases and polycythemia and whether these polymorphisms affect hemoglobin dynamics in the residents of Tsarang, Mustang, Nepal.MethodsHealth checkup data from individuals living in Tsarang in Mustang District, Nepal, collected in 2017, were used to determine the prevalence of obesity, hypertension, diabetes, hypoxemia, and polycythemia. DNA was extracted from whole-blood samples, and data for the single-nucleotide polymorphisms (SNPs) rs13419896 (EPAS1), rs12619696 (EPAS1), and rs2790859 (EGLN1) were obtained using real-time PCR. The health checkup data were statistically analyzed to determine the associations of these diseases with polymorphisms in genes related to hypoxic adaptation.ResultsA total of 168 participants, comprising 78 males and 90 females, were included in the final analysis. In terms of the prevalence of each disease, only the prevalence of polycythemia significantly differed between sexes (p < 0.01). Additionally, among the three analyzed SNPs, significant sex differences in genotype frequency were observed for rs13419896 and rs2790859. For rs2790859 in females, Tibetan highlanders with the adaptive genotype had a significantly lower incidence of polycythemia (p < 0.01) and significantly lower hemoglobin concentrations (p < 0.01).ConclusionsThis study revealed that there are sex differences in the genotype frequency of gene-related hypoxic adaptations among the residents of Tsarang. The findings also suggested that the rs2790859 polymorphism might be involved in the recent incidence of polycythemia among Tsarang residents. If the frequency of non-Tibetan genotypes increases due to intermixing with other populations in the Mustang District, polycythemia may emerge as a modern disease. It is essential to continue investigating the health status of Mustang residents to elucidate various aspects of hypoxic adaptation and disease susceptibility.

Elevated Plasma Atherogenic and Triglyceride-Glucose Indices: Markers of Cardiovascular Risk in Transfusion-Dependent Thalassemia

Background Transfusion-dependent thalassemia (TDT) is an autosomal recessive disorder characterized by defective hemoglobin synthesis, leading to severe complications such as iron overload and multi-organ dysfunction. This study aims to elucidate the distinctive clinical and biochemical profiles of TDT patients compared to healthy controls, with an emphasis on cardiovascular risk assessment using novel markers such as the Plasma Atherogenic Index (PAI) and Triglyceride-Glucose (TyG) index. Methods This cross-sectional study included 32 TDT patients and 36 healthy controls, matched for age and gender. Comprehensive demographic, laboratory, and imaging data were collected and analyzed. TDT patients were further stratified based on cardiac involvement and ferritin levels. Key assessments included hemoglobin levels, liver enzymes, lipid profiles, and cardiac imaging. The PAI and TyG index were calculated to evaluate cardiovascular risks. Statistical analyses were performed using SPSS 27.0, employing Student’s t-test, Mann–Whitney U test, and Pearson chi-square test as appropriate. Results No significant differences in basic demographic parameters were observed between groups; however, TDT patients exhibited significant clinical and laboratory differences. Notably, these patients had lower hemoglobin levels, higher platelet counts, elevated liver enzymes (ALT and AST), and markedly increased ferritin levels. Lipid profiles were significantly altered, with lower levels of total cholesterol, HDL, and LDL but elevated triglycerides. Importantly, the PAI was significantly higher in TDT patients, suggesting an increased atherosclerotic risk. Subgroup analysis revealed that patients with cardiac involvement had worse metabolic profiles, higher TyG indices, and prolonged QT intervals, indicating heightened cardiovascular risk. As the iron burden increases, the TyG index and PAI may lose their sensitivity in distinguishing between varying levels of iron overload, suggesting that their effectiveness plateaus beyond a certain threshold of iron accumulation. Conclusion TDT patients show significant hematological and metabolic deviations, including elevated cardiovascular risk markers like PAI and TyG index. As iron burden increases, these markers lose discriminative power, and cardiac involvement escalates rapidly once a critical iron threshold is surpassed, as supported by studies showing a non-linear relationship between iron load and cardiac complications. Comprehensive cardiovascular risk assessment and tailored management are essential for these patients. Future studies should focus on tracking cardiovascular risk progression and the effects of targeted interventions.

Diagnostic accuracy of a non-invasive spot-check hemoglobin meter, Masimo Rad-67® pulse CO-Oximeter®, in detection of anemia in antenatal care settings in Kenya.

Point of care hemoglobin meters play key roles in increasing access to anemia screening in antenatal care especially in settings with limited access to laboratories. We aimed to determine the diagnostic accuracy of a non-invasive spot-check hemoglobin (SpHb) meter, Masimo Rad-67® Pulse CO-Oximeter®, in the diagnosis of anemia in pregnant women attending antenatal care clinics in Kilifi, Kenya. This was a diagnostic accuracy study that retrospectively evaluated SpHb against a validated reference standard of laboratory assessed hemoglobin (Lab Hb) by a SYSMEX XN-330 automated hematology analyzer. The study was nested within a prospective pregnancy cohort study that recruited unselected pregnant women from antenatal care clinics in two public hospitals in Kilifi County, coastal Kenya. Records with both SpHb and Lab Hb were selected from pregnancy visits between May 2021 and December 2022. Linear regression and Bland-Altman analysis were performed to compare the two tests and diagnostic accuracy parameters obtained for the diagnosis of anemia. A total of 2,975 records (from 2,203 unique participants), with paired SpHb and Lab Hb were analyzed. Linear regression showed a significant but weak positive correlation, a proportional bias of 0.44 (95% CI 0.41-0.47) and a constant of 7.59 (95% CI 7.30-7.87, p < 0.001). The median bias was 1.70 g/dl, with limits of agreement of -0.80 to 4.20. SpHb tended to be higher than Lab Hb on the low hemoglobin range but lower than Lab Hb on the high hemoglobin range. The sensitivity of SpHb in detecting anemia was 18.66%. Prevalence, specificity, positive predictive value, and negative predictive values were 46.37%, 96.77%, 83.33%, and 57.92% respectively. Overall, SpHb by Masimo Rad-67® Pulse CO-Oximeter® did not accurately identify pregnant women with anemia and many cases would be missed. We would not recommend its use in antenatal care settings.

Correlation between staging classification of aortic stenosis based on the extent of cardiac damage and platelet indices

BackgroundPlatelets play a key role in the natural history of aortic stenosis (AS) and after transcatheter aortic valve implantation (TAVI). An echo-based staging system stratifies patients with severe AS into 5 groups according to the associated cardiac damage phenotype. We aimed to correlate these AS stages with platelet indices in post-TAVI patients.MethodsPatients with severe AS who underwent TAVI and were admitted to intensive cardiac care unit (ICCU) were prospectively identified and divided into 5 groups according to extra-valvular cardiac damage [no extravalvular cardiac damage (Stage 0), left ventricular damage (Stage 1), left atrial or mitral valve damage (Stage 2), pulmonary vasculature or tricuspid valve damage (Stage 3), or right ventricular damage (Stage 4)]. Baseline characteristics and complete blood count including mean platelet volume (MPV) and immature platelet fraction (IPF) were collected within 2 h after the procedure and analyzed in relation to aortic stenosis staging.ResultsA total of 220 patients were included. The mean age was 81 years old and 112 (50.9%) were female. Two (1%) patients were classified in stage 0; 34 (15%) in stage 1; 48 (22%) in stage 2; 49 (22%) in stage 3 and 87 (40%) in stage 4. Higher mean MPV values were correlated with higher AS staging (10.8 fL, 11 fL, 11.3 fL and 10.8 fL in stages 1, 2, 3 and 4, respectively, P = 0.02) as well as lower hemoglobin values (12 mg/dl, 11.6 mg/dl, 11 mg/dl and 11.3 mg/dl in stages 1, 2, 3 and 4, respectively P = 0.04). Mean IPF values were 5.3%, 5.58%, 5.57% and 4.83% in stage 1, 2, 3 and 4, respectively (P = 0.4). In a multivariate logistic regression model only MPV (OR = 2.6, P = 0.03) and body mass index (BMI) (OR = 1.17, P = 0.004) were correlated with higher staging (0–3) of AS.ConclusionsAlthough IPF and MPV levels increased in stages 0–3, there was a decrease in indices in stage 4, (probably due to bone marrow dysfunction) in this end-stage population. Higher levels of MPV and lower levels of hemoglobin were independently correlated with higher stages (0–3) of AS.

Tolerance of Anemia: Autologous Stem Cell Transplantation Among Bloodless Medicine Patients Can Be Safely Conducted At Lower Hemoglobin Thresholds

Tolerance of Anemia: Autologous Stem Cell Transplantation Among Bloodless Medicine Patients Can Be Safely Conducted At Lower Hemoglobin Thresholds

Racial-ethnicity group distributions of blood product use in acute trauma care transfusion.

Recent studies suggest Black patients are transfused less often and at lower hemoglobin levels than White patients. In elective surgery, Black and Non-White patients have greater estimated blood loss and transfusion frequency. We asked whether similar transfusion disparities are observable in acute trauma resuscitation. In a single-center retrospective analysis of trauma registry/blood-bank-linked data from a large US trauma center, we identified all acute trauma patients 2011-2022. Our data sources permitted distinction of Race and Ethnicity and therefor binning as Non-White-race/not Hispanic plus any-race/Hispanic or White/not Hispanic. We tallied Injury Severity Scores mild through profound (ISS 1-9, 9-15, 16-25, >25), type (blunt vs. penetrating) and mechanism (firearms, etc.), and associated blood use overall and in the first, first four, and first 24 h, comparing results with chi square, p < .01. Overall, 50,394 (68.41%) acute trauma patients were classified as White and 23,251 (31.7%) as Other than White. White patients were more likely to receive any blood products (17.8% vs. 11.9%), but, for all measures of urgency/quantity, Non-White patients were transfused more often (respectively, first 4 h, 51.9% vs. 42.1%; ≥3u/first hour, 18.5% vs. 11.0%; ≥10u/24 h, 8.1% vs. 3.8%) (all p < .001). White patients were far more likely to have blunt injury than Non-White patients, (77.2% vs. 42.6%), less likely to have penetrating injury (10.1% vs. 14%) and far less likely to be injured by firearms (30.6% vs. 56.9%) (all p < .001). At our center, blood use in acute trauma resuscitation was associated with injury severity and mechanism, not race/ethnicity.

Factors associated with acute kidney injury after on-pump coronary artery bypass grafting

BackgroundAcute kidney injury (AKI) frequently occurs as a complication of cardiac surgery and cardiopulmonary bypass (CPB). Its prevalence and severity are determined by various preoperative and intraoperative factors. The aim of this study was to examine the risk factors for AKI following on-pump coronary artery bypass grafting (CABG).MethodsA retrospective analysis of clinical records from a single medical center was performed. The primary determinant for AKI analysis was the creatinine-level changes within the first 48 h after surgery. Records of 120 patients from a prospective cohort study were examined.ResultsAn AKI incidence of 26% occurred in the study cohort. The univariate analysis revealed that patients who developed AKI had notably higher EuroSCORE II values (2.00 ± 0.98 vs. 1.49 ± 0.74, p = 0.006) and higher initial levels of urea (7.62 ± 2.94 vs. 6.12 ± 1.71, p = 0.002) and creatinine (0.108 ± 0.039 vs. 0.091 ± 0.016, p = 0.003). Additionally, they exhibited a more frequent occurrence of initial albumin levels below 40 g/l (9 (34.6%) vs. 11 (14.9%) cases, p = 0.030) and a lower initial hemoglobin level (137.8 ± 13.2 g/l vs. 146.6 ± 13.6 g/l, p = 0.005) in comparison to patients without this complication. Moreover, those with AKI had a significantly longer hospital stay duration (14.3 ± 5.45 days vs. 12.6 ± 3.05 days, p = 0.048). Logistic regression indicated one risk factor, oxygen delivery during CPB, that correlated with the onset of AKI in the early postoperative period.ConclusionThe prevalence of AKI was higher among patients with a higher EuroSCORE II, lower preoperative hemoglobin, increased preoperative levels of creatinine and urea, infrequent albumin levels below 40 g/L, diminished oxygen delivery during CPB, and greater need for RBC transfusion and furosemide, but it did not correlate with the duration of CPB.

Lysine (K)-specific methyltransferase 2A (KMT2A) rearrangements among Iraqi de novo acute myeloid leukemia

Abstract: BACKGROUND: The classification of acute myeloid leukemia (AML) has evolved extensively over the last 20 years significantly, impacting the diagnosis and prognosis of the patients. The lysine (K)-specific methyltransferase 2A (KMT2A) gene, which has more than 80 gene fusions, is present in approximately 10% of all leukemias. Most KMT2A rearrangements are associated with adverse prognosis and need heavy chemotherapy protocol upfront. OBJECTIVE: This study aims to study the prevalence of KMT2A gene fusion among Iraqi patients with AML and its association with clinical and hematological parameters and patients’ outcomes. PATIENTS, MATERIALS, AND METHODS: A prospective cohort study conducted between December 2020 and May 2022 enrolled 115 Iraqi adults newly diagnosed with AML at the Hematology Unit of Baghdad Teaching Hospital. The patients were also monitored at this facility during the study period. Genetic rearrangements were detected using the Leukemia Q-Fusion Screening Kit through Real-Time Quantitative Reverse Transcription PCR (RT-qPCR) analysis. RESULTS: KMT2A rearrangements were identified in 23 (20%) patients. The most common was t(10;11) which presented in 15 (13%) patients, followed by t(9;11) in 5 (4.3%) patients and t(11;17) in 3 (2.6%) patients. Patients with KMT2A rearrangements were significantly older and more likely to have splenomegaly. At 1-month posttreatment, they had significantly lower red blood cell counts and hemoglobin levels and higher blast percentages. Only 4.3% achieved complete remission (CR) compared to 76.1% without KMT2A rearrangements, with a significantly higher mortality rate (30.4% vs. 5.4%, P = 0.0001). Regarding the treatment response, no significant differences were observed among the different fusion types of KMT2A rearrangements. CONCLUSION: KMT2A rearrangements are more prevalent among Iraqi AML patients compared to the global trend and are associated with older age, higher rates of splenomegaly, poorer hematological recovery, and worse outcomes, regardless of the KMT2A rearrangement fusion type.

Incidence and predictors of unplanned 30-day hospital readmissions among heart failure patients in Ethiopia: a 5-year retrospective cohort study

The burden of heart failure increases over time and is a leading cause of unplanned readmissions worldwide. In addition, its impact has doubled in countries with limited health resources, including Ethiopia. Identifying and preventing the possible contributing factors is crucial to reducing unplanned hospital readmissions and improving clinical outcomes. The study aimed to assess the incidence and predictors of 30-day unplanned readmission among heart failure patients at selected South Wollo general hospitals in 2022. A hospital-based retrospective cohort study design was employed from January 1, 2016, to December 30, 2020. The data was collected from 572 randomly selected medical records using data extraction checklists. Data were entered in Epi-Data version 4.6 and analyzed with Stata version 17. The Kaplan–Meier and log-rank tests were used to estimate and compare the survival failure time. A Cox proportional hazard analysis was used to identify the predictors of readmission. The statistical significance level was declared at a p-value < 0.05 with an adjusted odds ratio and a 95% confidence interval. A total of 151 (26.40%) heart failure patients were readmitted within 30 days of discharge. Among the study participants, 302 (52.8%) were male, and 370 (64.7%) were rural residents. The mean age was 45.8 ± 14.1 SD years. In the multivariate Cox proportional hazards analysis being an age (> 65 years) (AHR: 3.172, 95% CI:.21, 4.55, P = 0.001), rural in residency (AHR: 2.47, 95%CI: 1.44, 4.24, P = 0.001), Asthma or Chronic Obstructive Pulmonary Disease (AHR: 1.62, 95% CI: 1.11, 2.35, P = 0.012), HIV/AIDS (AHR: 1.84, 95%CI: 1.24, 2.75, P = 0.003), Haemoglobin level 8–10.9 g/dL (AHR: 6.20, 95% CI: 3.74, 10.28, P = 0.001), and Mean platelet volume > 9.1 fl (AHR: 2.08, 95% CI: 1.27, 3.40, P = 0.004) were identified as independent predictors of unplanned hospital readmission. The incidence of unplanned hospital readmission was relatively high among heart failure patients. Elderly patients, rural residency, comorbidity, a higher mean platelet volume, and a low hemoglobin level were independent predictors of readmission. Working on these factors will help reduce the hazards of unplanned hospital readmission.

Incidence and predictors of common opportunistic infections among children living with HIV at Bahir Dar City, Ethiopia

Despite the dramatic decline in the incidence of common opportunistic infections (OIs) after antiretroviral therapy initiation, they remain a significant cause of morbidity and mortality among children with HIV. For better interventions, information regarding the incidence and predictors of common OIs is essential for Children living with HIV. Still, there is a lack of studies in low and middle-income countries, including Ethiopia. Therefore, this study aims to assess the incidence and predictors of common OIs among Children living with HIV on anti-retroviral therapy (ART) at public health institutions in Bahir Dar City, Northwest Ethiopia. The reasons for excluding children not on ART is we want to study the effectiveness of chronic HIV care service, ART drugs and OIs prophylaxis drugs for the prevention of common OIs because it is obvious that the occurrence of OIs in children not on ART and OIs prophylaxis drugs is high. A health institution-based retrospective cohort study was done among 403 Human Immunodeficiency Virus-infected children at public health institutions in Bahir Dar City from 2010 to 2020. Data was entered using Epi-data version 4.6 and analyzed using STATA 14.0. A bivariable Cox-proportional hazards regression model was employed to appreciate the relationship between each explanatory variable with the outcome variable. In the bivariable analysis, variables with a p-value of less than 0.25 were candidates for the multivariable proportional hazard model. The Cox proportional hazards model was used to determine predictors of common opportunistic infections at a 5% significance level. The overall incidence rate of common opportunistic infections was 7.06 with a 95% confidence interval ((CI) 5.78, 9.75) per 100 person-years of observation. Statically significant predictors were World Health Organization (WHO) clinical stage III and IV (adjusted hazard ratio (AHR) = 1.90; (95% CI 1.34, 2.75), having fair/poor adherence to anti-retroviral therapy (ART) (AHR) = 1.80; (95% CI 1.25, 2.94) and hemoglobin level < 10 g/dl (AHR) = 2.00; (95% CI 1.36, 2.89). The overall incidence rate of common OIs among children living with HIV on ART was high. Independent predictors of common OIs among children on ART were advanced-stage of HIV disease, poor ART adherence, and lower hemoglobin level. Therefore, we recommend strongly working on the prevention of advanced stages of HIV disease and improving poor ART adherence to prevent the incidence of OIs among children living with HIV on ART.

Prevalence of canine renal insufficiency: A decade-long retrospective study in and around Patna, Bihar

This retrospective study investigates the prevalence and epidemiological factors associated with renal insufficiency in dogs within Patna, Bihar, India. Out of 5,700 dogs with various illnesses, 317 were diagnosed with renal insufficiency, identified by serum creatinine levels exceeding 5 mg/dL. The study assessed the incidence of renal insufficiency across different demographics, including age, sex, breed, and season. The highest incidence was observed in dogs aged 8-10 years, with males showing a higher prevalence than females. Pomeranians (32.18%), Labrador Retrievers (25.55%), and German Shepherds (20.82%) were the most affected breeds. Seasonally, the post-monsoon period (September-November) exhibited the highest incidence (37.85%) of renal disorders. Laboratory investigations revealed significant haematological and biochemical alterations in affected dogs, including lower haemoglobin, total erythrocyte count, and packed cell volume, alongside elevated serum levels of blood urea nitrogen (BUN), creatinine, potassium, and phosphorus. Ultrasonography indicated decreased renal size and increased echogenicity in dogs with renal insufficiency. The study concludes that renal insufficiency in dogs is most prevalent in older males and certain breeds, particularly during the post-monsoon season. Regular monitoring of serum BUN and creatinine levels is recommended for early diagnosis and management of this condition.

Cytogenetic-Phenotypic Profile of Filipinos with Myelodysplastic Syndrome in Makati Medical Center: A 10-Year Review

Hematologic malignancies remained to be a significant contributor in the Global Burden of Disease. Myelodysplastic syndrome is one of the hematologic malignancies and has remained to be underestimated, underreported, and underdiagnosed. It is a group of hematologic malignancies that proves a challenge in diagnosis and is characterized by clonal hematopoiesis, with one or more cytopenias. Data on Prevalence of Myelodysplastic syndrome globally is scarce, moreso, not available in the Philippines. This is the first clinical profile study in Myelodysplastic Syndrome in the Philippines. This 10-year study has shown that 240 patients were diagnosed to have Myelodysplastic syndrome but only 35 had the MDS Fluorescent-in-Situ Hybridization test done. The most common reasons for hematologic referral, chief complaint, signs, cytogenetic test are anemia, low hemoglobin, pallor and fatigue, del7q31 which belongs to the Good risk cytogenetic category respectively. The most common CBC findings were hemoglobin of 8 and above, ANC of above 800 and Platelets of 50 and higher. There was no noted significant difference in the clinical profile of patients with MDS based on FISH study results

Modern ideas about the predictions of postpartum hemorrhage

Postpartum hemorrhage is currently a pressing problem. Its increasing incidence over time is observed not only in developing countries but also in countries with high levels of income and resources that significantly contribute to the development and functioning of the health system, which is the cause of scientific debate worldwide. The risk factors of postpartum hemorrhage include low hemoglobin level before birth, older maternal age, first birth, prolonged duration of the first and second stages of labor, high birth weight of the newborn, abnormal placentation, surgical vaginal birth, cesarean section, episiotomy, and placental defects. This review outlines the main risk factors of postpartum hemorrhage, displays new data on the relationship between types of assisted reproductive technologies and postpartum hemorrhage, and discusses prospects for research regarding the problem. A link between assisted reproductive technologies and postpartum hemorrhage elucidates the increase in the incidence of postpartum hemorrhage in developed countries. It is crucial to further research on obstetric risks following the use of assisted reproductive technologies and identify additional risk categories for complications to provide quality medical care and reduce maternal and perinatal losses.

Relationship between maternal anemia during pregnancy and the risk of preeclampsia: A multicenter case-control study.

Introduction: Anemia, defined as a low hemoglobin level, is a common condition in pregnancy that can have adverse effects on maternal and fetal outcomes. Anemia can result from various causes, such as iron deficiency, vitamin B12 deficiency, folate deficiency, hemolysis, or bleeding. The association between anemia and preeclampsia is not fully understood, but some studies have suggested that anemia may increase the risk of developing preeclampsia, especially in women with iron deficiency or chronic inflammation. Objective: To assess the association of anemia during pregnancy and the risk of developing preeclampsia. Study Design and Setting: A multicenter unmatched case-control study was conducted. The study was conducted from 2 December 2020 to 1 January 2021 in West and North Gojjam zone governmental hospitals, North West Ethiopia. A total of 337 pregnant women (113 cases and 224 controls) who consented verbally and attended antenatal or delivery services were enrolled in the study. Population: The participants of this study were mothers attending attended antenatal care and delivery services. Data Management: The analysis involved manual checking, data entry using EpiData Manager, and subsequent analysis using SPSS version 23, with logistic regression and p-values <0.05 determining statistical significance. Results: Being nonanemic, high consumption of fat related, mid-upper arm circumference ≥25.6 cm, frequent consumption of milk products, and fruits and vegetables rich in vitamin A were found to be factors associated with the risk for developing preeclampsia. Conclusion and recommendations: Being nonanemic, diets that are characterized by a high intake of vitamin A-rich fruits and vegetables and milk products were significantly associated with a low risk of preeclampsia. On the other hand, high intake of fatty foods and obesity were associated with the development of preeclampsia. Therefore, preventing anemia encouraging and promoting healthy eating habits during pregnancy by including vitamin A-rich fruits and vegetables and milk products can effectively prevent the development of preeclampsia.

Low Serum Alanine Aminotransferase Blood Activity Is Associated with Shortened Survival of Renal Cell Cancer Patients and Survivors: Retrospective Analysis of 1830 Patients

Background: Sarcopenia is characterized by a loss of muscle mass and function and is often associated with frailty, a syndrome linked to physical disability and shortened survival in various patient populations, including cancer patients. Low serum alanine aminotransferase (ALT) values, serving as a biomarker for sarcopenia, were previously associated with frailty and shortened survival in several cancers. In the current study, we aimed to test the association between low ALT and shorter survival in renal cell carcinoma (RCC) patients and survivors. Methods: This was a retrospective analysis of RCC patients and survivors, both in- and outpatients. We defined patients with sarcopenia as those presenting with ALT &lt; 17 IU/L. Results: We identified records of 3012 RCC patients. The cohort included 1830 patients (mean age 65.6 ± 13.3 years, 68% were men) of whom only 179 underwent surgical treatment. Out of the eligible cohort, 811 patients (44.3%) had ALT &lt; 17 IU/L, with a mean ALT value of patients within the low-ALT group of 11.79 IU/L, while the mean value in the higher ALT level group was 24.44 IU/L (p &lt; 0.001). Patients in the low-ALT group were older (67.9 vs. 63.7 years; p &lt; 0.001) and had lower BMIs (26.6 vs. 28; p &lt; 0.001). In addition, patients with low ALT had lower hemoglobin values (12.14 vs. 12.91 g/dL; p &lt; 0.001), higher serum creatinine (1.49 vs. 1.14; p &lt; 0.001) and higher platelet to lymphocyte ratios (178 vs. 156; p &lt; 0.001). In a univariate analysis, low ALT levels were associated with a 72% increase in mortality (95% CI 1.46–2.02, p &lt; 0.001). In a multivariate model controlled for age, gender, hemoglobin, platelets, LDH, neutrophil to lymphocyte ratios and platelet to lymphocyte ratios, low ALT levels were still associated with a 27% increase in mortality (HR = 1.27, 95% CI 1.08–1.51; p = 0.005). Conclusion. Low ALT values, associated with sarcopenia and frailty, are also associated with shortened survival in RCC patients, and survivors and could potentially be applied for optimizing individual treatment decisions.

Combined Diabetes Education/Skills Training and Social Needs Resolution Intervention for Older African Americans with Poorly Controlled Type 2 Diabetes (DM Social Needs): Study Protocol for a Randomized Controlled Trial.

Approximately 11.3% of the US population has diabetes. The burden of diabetes is higher in older adults and African Americans (AAs), such that 40% of adults aged 50 years and older have diabetes; African Americans are 60% more likely to be diagnosed with diabetes compared to non-Hispanic Whites (NHWs). Structural racism has resulted in fewer economic and educational opportunities for AAs, higher social risks, and unmet basic needs, which result in financial instability, housing instability, food insecurity, and a lack of transportation compared to NHWs. The presence of these unmet basic needs is a driver of poor adherence to diabetes self-management in older AAs. To test the preliminary efficacy of a nurse case-manager, telephone-delivered intervention that provides foundational diabetes self-management education and skills training, while also addressing and resolving the unmet social needs of older AAs with poorly controlled type 2 diabetes mellitus (T2DM). The primary hypothesis is that older AAs with T2DM randomized to the DM Social Needs intervention will have significantly lower hemoglobin A1C (HbA1C), blood pressure, and LDL levels compared to the usual care arm at 6 months post randomization. This is a three-year prospective, randomized clinical trial that will enroll 100 AAs aged 50 and older with type 2 diabetes (T2DM) and HbA1C ≥ 8% into one of the following two groups: (1) a nurse case-manager, telephone-delivered intervention that provides foundational diabetes self-management education and skills training, but also addresses and resolves unmet social needs; or (2) an enhanced usual care group that will receive mailed diabetes education materials. Participants will be followed for 6 months to determine the effect of the intervention on HbA1C, blood pressure, and low-density lipoprotein (LDL) cholesterol levels. Baseline characteristics will be presented by study group, and within- and between-group changes in primary outcomes from baseline to 6 months will be reported. The results from this study will provide insights into the efficacy of a combined diabetes education and skills training and social needs resolution intervention for older African Americans with poorly controlled type 2 diabetes and will inform strategies to improve diabetes outcomes for this vulnerable population.

8122 CGM use and its Impact on Diabetes Self-Management Behaviors: Insights from a Pilot Study Paving the Way for Targeted Interventions in Specialty Clinic

Abstract Disclosure: K.M. St. Jean: None. P. Underwood: None. R. Longo: None. J. Keels: None. J. Upadhyay: None. Introduction: Continuous glucose monitor (CGM) use is increasing. While the relationship between CGM use and improved diabetes (DM) clinical outcomes is well known (lower hemoglobin A1c (A1c), reduced hypoglycemia events), the mechanisms underlying this association are unknown. Further, the factors that contribute to successful CGM use by patients and whether CGM use influences diabetes self-management behavior (DMB) change are still undetermined. Objective: To understand the extent to which personal CGM use influences DMB versus user-blind CGM. In addition, patient satisfaction and provider perspective were evaluated during the study. Methodology: A pilot-randomized control trial (RCT) was conducted on 30 patients (15 libre-professional CGM and 15 libre 2 CGM). Adults (18-80y) with an ICD-10 diagnosis of DM within the past 12 months, A1c &amp;gt;8% measured within the past 6 months, stable weight within the past 3 months (BMI ± 2 units), able to speak, read, and write English, and a negative pregnancy test for women of childbearing age seen in the Lahey Endocrine Clinic were included.Exclusion criteria included evidence of personal CGM device use prior to the trial, addition of new oral or injectable hypoglycemic agents within 3 months of trial start, current or anticipated acute use of steroids, pregnancy, medical conditions that, per investigator determination, make it unsafe to target A1c &amp;lt;8%, severe psychiatric illness, homeless, current substance abuse, vision or hearing impairment that may affect the use of CGM. All participants were given information on how to incorporate the CGM into daily DM management and general diabetes self-management education (DSME). DMB was measured using the Diabetes Self Care Inventory-Revised scale, which was provided at visit 1 (baseline), visit 2 (2 weeks), and visit 3 (3-6 months). Additional outcome variables, including Diabetes Distress, sleep quality, exercise habits, and nutrition, were obtained. A1c was measured at baseline and at the end of visit 3. Provider satisfaction with patient CGM use was also evaluated using a newly developed provider satisfaction survey. Results: This study remains active for enrollment. Thus far, 14 patients have been recruited (7 in Libre 2 arm and 7 in Libre Pro User blind arm). Based on initial results, personal-CGM use supports improved diabetes self-care. Further, improvements in A1c, glucose time in target range, and lower rates of hypoglycemia are evident in all CGM users. Further, 100% of the providers felt that CGM use by their patients was very effective and helped their clinical decision-making during the visit. Providers did not feel that reviewing CGM data prolonged their visit. Conclusion: This pilot suggests that personal CGM use improves diabetes self-management behavior and reaffirms that CGM use in patients with poorly controlled diabetes is associated with improved DM clinical outcomes. Presentation: 6/3/2024

6680 GLP-1 Agonists in Type 1 Diabetes - Indications and Use

Abstract Disclosure: P. Panjawatanan: None. N. Radovanovic: None. R.J. Comi: None. Introduction: Insulin therapy is the mainstream treatment in patients with Type 1 diabetes. The use of insulin, though mimicking normal physiology, is associated with weight gain. Glucagon-like peptide 1 (GLP-1) agonists are a class of antidiabetic medication that lowers blood sugar levels and helps promote weight loss. We propose that GLP-1 agonists can reverse the trend of weight gain and help lower hemoglobin A1C (A1C) levels in patients with Type 1 diabetes who were gaining weight. Method: A retrospective chart review was performed at a single institution’s endocrine practice over five years. Patients with Type 1 diabetes with concomitant GLP-1 agonists used for at least one year were included. Observed outcomes were the change in A1C, weight, and basal insulin use compared at baseline, 6 months, and 12 months using mixed models repeated measures. The result was reported as estimated means (95%CI). Statistical significance was determined by a p-value less than 0.05. Results: There were 49 patients included in the study. The mean age was 44.7 years old. There were 32 females (65.3%) and 17 males (34.7%). The mean duration of diabetes was 24.6 years. Thirty-five patients (71.4%) used insulin pumps, and fourteen (28.6%) were on multiple daily injections. Overall, patients had been gaining an average of 2.0 kg per year. After the treatment with GLP-1 agonists, weight was significantly reduced at 12 months (90.0 kg (95%CI 84.9-95.1), p&amp;lt;0.001) compared to baseline (97.6 kg (95%CI 92.7-102.5)). The A1C was significantly improved at 12 months (7.6% (95%CI 7.2-7.9), p&amp;lt;0.001) compared to the baseline (8.2% (95%CI 7.9-8.6)). Total daily basal dose was significantly reduced at 12 months (35.8 units (95%CI 29.8-41.9), p&amp;lt;0.001) compared to the baseline (39.2 units (95%CI 33.3-45.1)). The improvement in the parameters was more pronounced at 6 months after treatment but persisted at 12 months. Conclusion: Weight gain is a consequence of insulin usage in both Type 1 and Type 2 diabetes, which considerably impacts treatment outcomes and the development of comorbidities. We conclude that GLP-1 agonists are helpful to reverse the trend of weight gain and help lower A1C levels in patients with Type 1 diabetes who require life-long insulin treatment. Presentation: 6/3/2024

Comparing health-related quality of life and utility scores of patients undergoing hemodialysis and continuous ambulatory peritoneal dialysis in Indonesia.

Although both hemodialysis and continuous ambulatory peritoneal dialysis (CAPD) are covered by national healthcare insurance, 98% of kidney failure disease patients are treated with hemodialysis. This study compared the health-related quality of life (HRQoL) and utility scores of patients receiving hemodialysis and CAPD in Indonesia and determined factors associated with HRQoL and utility scores. A cross-sectional study was performed using the Kidney Disease Quality of Life-36 and EQ-5D-5L instruments at six hospitals. Utility scores were presented as SF-6D and EQ-5D scores. Factors associated with the EQ-5D were evaluated using Tobit regressions due to ceiling effects, while the SF-6D and HRQoL were assessed using generalized linear models since the data were not normally distributed. Among the 613 patients, 76% were treated with hemodialysis. After adjusting for sociodemographic characteristics and clinical parameters, CAPD patients reported better HRQoL compared to hemodialysis patients in terms of the SF-6D (p = .038), mental component summary (p = .020), symptoms (p = .005), and effects of kidney disease (p<.001), but no significant differences were reported in EQ-5D (p = .083), physical component summary (p = .323), burden of kidney disease (p = .111), and kidney summary scores (p = .068). Poorer HRQoL and utility scores were likely experienced by older patients who were male, married, with diabetes, treated in Class A hospitals, and with lower education, hemoglobin, and albumin levels. In Indonesia, patients treated with CAPD had better HRQoL and utility scores compared to patients undergoing hemodialysis. Therefore, CAPD should be promoted by healthcare professionals as the first treatment option for patients who are eligible for both hemodialysis and CAPD.

Speckle-tracking echocardiography as screening tool for myocardial fibrosis and Iron overload in transfusion-dependent beta-thalassemia

BackgroundTransfusion-dependent beta thalassemia (TDT) is a genetic disorder characterized by low haemoglobin levels, often leading to myocardial iron overload (MIO) and myocardial fibrosis (MF). Cardiac Magnetic Resonance (CMR) represents the gold standard for MIO and MF assessment, although its limited availability and high costs pose challenges. Left Ventricular Global Longitudinal Strain (LV GLS) measured by Speckle Tracking Echocardiography (STE) could offer a valuable alternative. MethodsA monocentric diagnostic accuracy study was conducted to compare the performance of LV GLS with CMR using T2* for evaluating MIO and late gadolinium enhancement (LGE) for detecting MF. Between January 2022 and January 2023, 44 consecutive patients with TDT were enrolled. For each participant was performed LV GLS with STE, including CMR with T2* technique and LGE sequences. ResultsCMR identified MIO in 8 patients (18 %) and MF in 5 (11 %). LV GLS STE was normal in patients without MIO (−20.6 ± 3.1 %) or MF (−20.6 ± 2.8 %), significantly differing from those with MIO (−18.2 ± 2.1 %, p = 0.043) and MF (−16.4 ± 1.7 %, p = 0.002). ROC analysis indicated an optimal LV GLS STE cutoff of −19.8 % for MIO (AUC = 0.76, 95 % CI: 0.59–0.93, p = 0.054) with an overall diagnostic accuracy of 64 % and an optimal cutoff of −18.3 % for MF (AUC = 0.93, 95 % CI: 0.85–1.00, p = 0.009) with an accuracy of 86 %. ConclusionsThe findings of this pilot study indicate that LV GLS with STE, may be a cost-effective screening tool for the early detection of MIO and MF in TDT patients.