Male Diabetes Research Articles

Linking inflammatory mediators and indicators of insulin resistance in anthropometry specified type 2 diabetic males.

Inflammation associated with insulin resistance is a risk factor in the development of complications in Type 2 diabetes mellitus (T2DM). The study was conducted to assess the relationship between inflammatory mediators and insulin resistance, independent of lipid profile in anthropometry specified male Type 2 diabetics. 180 males having T2DM for more than 5yrs and on diabetic medication were chosen for the study and categorized into obese and overweight. Patients with thyroid or other endocrine disorders, kidney, muscle, liver, systemic, and inflammatory diseases were excluded from the study. Blood glucose, glycated hemoglobin, plasma insulin, and the inflammatory biomarkers namely hs-CRP, ferritin, haptoglobin, and adiponectin were evaluated. HOMA-IR and QUICKI were computed to assess insulin resistance. The study demonstrated significant changes in adiponectin and hsCRP in obese and overweight T2DM. However, Ferritin and Haptoglobin were insignificant. The entire biochemical study was carried out to demonstrate lipid profile independent associations. The significant insulin resistance associated with a substantial increase in hs-CRP levels and a pronounced decrease in the adiponectin levels suggests impending diabetic complications in anthropometry specified male T2DM. This could promote the use of personalised medicine to regulate levels of hs-CRP or to improve the secretion of adiponectin thereby countering insulin resistance in T2DM, independent of the lipid profile which is the novelty of our study.

Cardiovascular Disease and its Risk Factors: Frequency in Patients with Chronic Obstructive Pulmonary Disease (COPD)

Chronic obstructive pulmonary disease (COPD) is one of the respiratory conditions which is indicated by persistent airflow obstruction. It is linked with various different comorbidities. Ischemic heart disease (IHD) is reported to be the most recurring in patients with COPD. Its impact in context of patient's exercise capacity, health status and manifestation of symptoms is poorly understood. The objective of my study is to ascertain the frequency of ischemic heart disease in patients with chronic obstructive pulmonary disease and to evaluate current magnitude of the problem in our local population. It a cross sectional study conducted in Department of Pulmonology, Nishtar Hospital Multan. Patients with COPD (as defined in Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria 2021) with duration of more than 3 months were taken in the study. Of these 212 study cases, 127 (59.9 %) were male patients while 85 (40.1 %) were female patients. Mean age of our study cases was 56.75 ± 6.78 years. Diabetes was present in 57 (26.9 %), Dyslipidemia in 43 (20.3%), hypertension in 98 (46.2%) our patients and 29 (13.7 %) were obese. Smoking was noted in 100 (47.2 %). Ischemic Heart disease was present in 57 (26.9%) of our study cases. High frequency of ischemic heart disease was noted in patients with chronic pulmonary obstructive disease in our study. Ischemic Heart Disease was significantly linked with male gender, increasing age, diabetes, hypertension, obesity, and family history for IHD and dyslipidemia.

Antioxidant and antidiabetic activities of a polyphenol rich extract obtained from Abelmoschus esculentus (okra) seeds using optimized conditions in microwave-assisted extraction (MAE).

Functional foods have gained popularity in recent decades. They are exploited for their bioactive compounds like polyphenols, which are highly demanded in cosmetic, pharmaceutical and nutraceutical industries. However, extractive techniques and conditions used up to recently are almost obsolete and must be optimized for higher efficiency. The current study aimed to evaluate the antidiabetic potential of an optimized extract of Abelmoschus esculentus (okra) seeds. The optimal conditions for extracting polyphenolic compounds from okra seeds were determined using Microwave Assisted Extraction (MAE). A Face Center Composite Design (FCCD) was used for optimization. Solvent/dry matter ratio, wavelength and time were considered while the response studied was the polyphenolic content. The extract obtained at optimal conditions was characterized using Thin Layer Chromatography (TLC) and Fourier Transform Infra-Red (FTIR) spectroscopy, then tested for its antioxidant, alpha amylase inhibitory and antidiabetic activities. Response Surface Methodology (RSM) permitted the determination of the optimal conditions for phenols extraction as: microwave power 330 W, with a solvent ratio of 97.04/1 mL/g for 9.5 min of extraction time. The optimized extract showed a phenolic content up to 86.37 ± 1.13 mg GAE/g containing quercetin and catechin as revealed by the TLC. Functional groups characteristic of polyphenols were identified on FTIR spectra, and the extract exhibited good in vitro antioxidant capacities with DPPH (2, 2-diphenyl-1-picrylhydrazyl) radical scavenging capacity and FRAP (Ferric Reducing Antioxidant Power Assay). An IC50 of 3.99 ± 0.15 μg/mL was obtained with the DPPH scavenging test. Alpha amylase inhibitory assay revealed that the optimized okra extract behaved as a non-competitive inhibitor of porcine pancreatic amylase with an IC50 of 484.17 ± 2.33 μg/mL. Antidiabetic activity of the extract was observed in streptozotocin-induced diabetic males Wistar rats, as shown by the fasting blood glucose levels, food intake, changes in body weight and serum lipid profile among others.

On the Natural History of Coronary Artery Disease: A Longitudinal Nationwide Serial Angiography Study.

Background The long-term course of coronary atherosclerosis has not been studied in large nationwide cohorts. Understanding the natural history of coronary atherosclerosis could help identify patients at risk for future coronary events. Methods and Results All coronary artery segments with <50% luminal stenosis in patients with a first-time coronary angiogram between 1989 and 2017 were identified (n=2 661 245 coronary artery segments in 248 736 patients) and followed until a clinically indicated angiography within 15 years was performed or until death or end of follow-up (April 2018) using SCAAR (Swedish Coronary Angiography and Angioplasty Registry). The stenosis progression and incidence rates were 2.6% and 1.45 (95% CI, 1.43-1.46) per 1000 segment-years, respectively. The greatest progression rate occurred in the proximal and middle segments of the left anterior descending artery. Male sex and diabetes were associated with a 2-fold increase in risk, and nearly 70% of new stenoses occurred in patients with baseline single-vessel disease (hazard ratio, 3.86 [95% CI, 3.69-4.04]). Coronary artery segments in patients with no baseline risk factors had a progression rate of 0.6% and incidence rate of 0.36 (95% CI, 0.34-0.39), increasing to 8.1% and 4.01 (95% CI, 3.89-4.14) per 1000 segment-years, respectively, in patients with ≥4 risk factors. The prognostic impact of risk factors on stenosis progression was greatest in younger patients and women. Conclusions Coronary atherosclerosis progressed slowly but more frequently in the left coronary artery in men and in the presence of traditional risk factors. Coronary artery segments in patients without risk factors had little or no risk of stenosis progression, and the relative impact of risk factors appears to be of greater importance in younger patients and women. These findings help in the understanding the long-term course of coronary atherosclerosis.

Serum leptin level as a cardiovascular risk factor in type 2 diabetic patients

Type 2 diabetes mellitus ( T2DM ) is a metabolic disease that is associated with an increased risk for atherosclerosis. Leptin is a hormone – like cytokine that is derived mainly from adipose tissue and has multiple functions. Recently, many vascular and atherogenic effects for leptin have been demonstrated. The aim was to study serum leptin level and its relationship with some cardiovascular risk factors in T2DM patients. Forty diabetic males with ischemic heart disease (IHD group), aged ≥ 40 years old, were compared with 40 diabetic males of similar ages who had no clinical history of IHD (DM group). Each main study group was divided into two subgroups according to the presence or absence of metabolic syndrome. The IHD group was also subdivided according to their clinical endpoints into stable angina pectoris (angina group), significant coronary artery disease on angiography (angiography group ) and myocardial infarction (MI group ). In addition to anthropometric measurements; serum lipid profile, thiobarbituric acid -reactive substances (TBARS) and leptin levels as well as plasma fibrinogen level were quantified .A highly significant increase of mean serum leptin level was observed in IHD group iin comparriison wiitth tthatt off DM grroup (11.56  10.27 vs. 7.39  3.54 ng /3ml, p&lt;0.01). IIHD pattiientts showed a hiighlly siigniiffiicantt iincrrease iin serrum llevell offTBARS iin comparriison wiitth tthatt off DM grroup ((9.00  3.61vs. 6.65  2.41 mol (MDA)/L, P&lt;0.001). The mean plasma level of fibrinogen is significantly higher in IHD group than in DM group (3.30  0.65 vs. 2.99  0.63 g/dl, p &lt; 0.05). Serum leptin level was significantly higher in (angiography group) but not in (angina group) while the level was even lower in (MI group) when compared with that of DM group. A significant increase of mean serum leptin level was observed in IHD subgroup with non-metabolic syndrome in comparison with the D.M subgroup with non-metabolic syndrome (13.06  11.01 vs. 7.06  3.08 ng/ml, P&lt;0.05). In IHD group, serum leptin level showed a positive correlation with BMI ,W/h ratio, serum TBARS, and plasma fibrinogen. In DM group, serum leptin level showed a positive correlation with BMI, W/h ratio, and plasma fibrinogen, while insignificantly correlated with TBARS. In conclusion, T2DM patients with IHD have an elevated serum leptin level that is associated with oxidative stress, inflammation and active or worsening ischemic heart disease independent of metabolic syndrome. Thus, serum leptin level could be an additional factor to assess cardiovascular risk

Spontaneous Occurrence of Various Types of Hepatocellular Adenoma in the Livers of Metabolic Syndrome-Associated Steatohepatitis Model TSOD Mice.

Male Tsumura-Suzuki Obese Diabetes (TSOD) mice, a spontaneous metabolic syndrome model, develop non-alcoholic steatohepatitis and liver tumors by feeding on a standard mouse diet. Nearly 70% of liver tumors express glutamine synthetase (GS), a marker of hepatocellular carcinoma. In contrast, approximately 30% are GS-negative without prominent nuclear or structural atypia. In this study, we examined the characteristics of the GS-negative tumors of TSOD mice. Twenty male TSOD mice were sacrificed at 40 weeks and a total of 21 tumors were analyzed by HE staining and immunostaining of GS, liver fatty acid-binding protein (L-FABP), serum amyloid A (SAA), and beta-catenin. With immunostaining for GS, six (29%) tumors were negative. Based on the histological and immunohistological characteristics, six GS-negative tumors were classified into several subtypes of human hepatocellular adenoma (HCA). One large tumor showed generally similar findings to inflammatory HCA, but contained small atypical foci with GS staining and partial nuclear beta-catenin expression suggesting malignant transformation. GS-negative tumors of TSOD mice contained features similar to various subtypes of HCA. Different HCA subtypes occurring in the same liver have been reported in humans; however, the diversity of patient backgrounds limits the ability to conduct a detailed, multifaceted analysis. TSOD mice may share similar mechanisms of HCA development as in humans. It is timely to review the pathogenesis of HCA from both genetic and environmental perspectives, and it is expected that TSOD mice will make further contributions in this regard.

An altered balance of plasma arginine metabolites is associated with increased thickness of the coronary intima-media complex in the adjacent to the culprit segment of an infarct-related artery

Abstract Background The biomarkers of atherosclerosis remain insufficiently understood. Purpose We sought to investigate whether an altered balance of arginine metabolites in patients following myocardial infarction (MI) is associated with remodeling of the adjacent to the culprit segments of an infarct-related artery (IRA) and with clinical outcomes. Methods Arginine and its metabolites including ornithine, citrulline, proline and asymmetric dimethylarginine were measured using liquid chromatography and tandem mass spectrometry in 85 consecutive ST-segment elevation MI patients upon admission and at 6-month follow-up and were compared with morphology of the adjacent to the culprit proximal and distal 10-mm segments of IRA assessed with optical coherence tomography. A composite ischemic event was defined as death, recurrent MI, stroke, or unplanned percutaneous coronary intervention. Results The ratios of citrulline/ornithine and citrulline/arginine decreased 5.22 and 2.20 times (both P&amp;lt;0.001) respectively, while the ornithine/arginine index (I_O/A) increased 2.96 times (P&amp;lt;0.001) following ischemia compared with stable follow-up, indicating the enhanced arginase activity over nitric oxide synthase (NOS) in acute phase of STEMI. Follow-up I_O/A correlated with the mean intima-media (R=0.34, P=0.003, Figure 1A) and intima (R=0.30, P=0.008) diameter of an adjacent to the culprit IRA segment. By multivariate analysis, apart from male gender (P&amp;lt;0.001) and diabetes mellitus (P=0.02), a higher follow-up I_O/A was associated with the larger mean intima-media diameter of an adjacent to the culprit IRA segments (coefficient 0.218, 95% confidence interval 0.040–0.397, P=0.017, per 0.01). Within the median follow-up of 25 (19–35) months, ischemic composite endpoint was found in 13 (15.3%) patients. The follow-up I_O/A reached the area under the ROC curve of 0.78 (95% confidence interval 0.66–0.91, P=0.005) for prediction of composite ischemic endpoint with a cut-off value of ≥0.57, and a sensitivity of 72.3% and specificity of 80.0% (Figure !B). Conclusions Our findings provide arguments that during the acute phase of MI, arginine metabolism is shifted from NOS towards arginase, as compared to 6-month stable conditions. Simultaneously, the enhanced residual arginase activity over NOS in chronic phase was correlated with a higher thickness of intima or intima-media in the adjacent to the culprit segment within the IRA, and was also associated with unfavorable clinical outcomes. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Grant of the National Science Center of Poland (Number 2016/21/B/NZ5/01378 to J.Z.)

Hearing Loss and Cardiovascular Disease Risk Profiles: Data from the Hispanic Community Health Study/Study of Latinos.

Individual cardiovascular disease (CVD) risk factors (RFs) have been associated with hearing loss (HL). The relationship to aggregate risk is poorly understood and has not been explored in the Hispanic/Latino population. The aim of this study was to characterize the association between aggregate CVD RF burden and hearing among Hispanics/Latinos. Cross-sectional examination. Participants (18-74 years; n = 12,766) in the Hispanic Community Health Study/Study of Latinos. Thresholds (0.5-8 kHz) were obtained, and HL was defined dichotomously as pure-tone average (PTA0.5,1, 2,4) > 25 dB HL. Optimal CVD risk burden was defined as follows: systolic blood pressure (SBP) < 120 mm Hg and diastolic blood pressure (DBP) < 80 mm Hg; total cholesterol < 180 mg/dL; nonsmoking; and no diabetes. Major CVD RFs were diabetes, currently smoking, SBP >160 or DBP > 100 mm Hg (or antihypertensives), and total cholesterol > 240 mg/dL (or statins). Thresholds were estimated by age (18-44 and ≥45 years) and sex using linear regression. The association between CVD risk burden and HL was assessed using multivariable logistic regression. Models were adjusted for age, sex, Hispanic/Latino background, center, education, income, alcohol use, body mass index, and noise exposure. In the target population, 53.03% were female and 18.81% and 8.52% had all RFs optimal and ≥2 major RFs, respectively. Elevated BP (SBP 120-139 mm Hg or DBP 80-89 mm Hg) was associated with HL in females < 45 years (odds ratio [OR], 2.18; 95% confidence interval [CI], 1.14-4.16). Diabetes (OR, 1.37; 95% CI, 1.01-1.84) and tobacco smoking (OR, 1.44; 95% CI, 1.03-2.01) were associated with HL in females ≥ 45 years. The odds of HL were higher for females ≥ 45 years with ≥2 RFs versus those with all RFs optimal (OR, 1.99; 95% CI, 1.12-3.53). Elevated BP (SBP 140-159 mm Hg or DBP 90-99 mm Hg), but not aggregate risk burden, was associated with HL in males ≥ 45 years (OR, 1.49; 95% CI, 1.02-2.19). No relationships with major CVD RFs were significant in males < 45 years. HL is associated with elevated BP in females < 45 years, with diabetes and hypertension in males ≥ 45 years, and with diabetes, smoking, and having ≥2 major CVD RFs in females ≥ 45 years. Future studies are needed to examine if these factors are associated with incident HL.

S1186 Mild Thrombocytopenia as a Predictor of Surgical Outcomes Following Cholecystectomy: A Tool for Perioperative Assessment in Patients With Non-Alcoholic Fatty Liver Disease?

Introduction: As evidenced by its inclusion in estimations of liver fibrosis, thrombocytopenia is a well-defined abnormality in chronic hepatic disease. Studies show that platelet counts fewer than 160 x 109/L are an independent marker for severity of hepatic fibrosis. Non-alcoholic fatty liver disease (NAFLD) is now the most prevalent liver disorder in Western countries making characterization of morbidity increasingly important. There is a paucity of information available to characterize perioperative risk for patients with NAFLD. We used a threshold of 150 x 109 as a surrogate for NAFLD in patients undergoing laparoscopic cholecystectomy to study its effect on perioperative complications and mortality. Methods: We queried the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database for cholecystectomies occurring from 2005 through 2018. Demographic differences between patients with and without thrombocytopenia were evaluated using the t-test or the chi-square test, whereas differences in outcome risk was evaluated using log-binomial regression models. Results: We identified 437,630 patients who underwent cholecystectomy, of whom 6.9% had thrombocytopenia. Patients with thrombocytopenia were more often male, older, with chronic disease. As shown in Table and Figure, patients with thrombocytopenia had higher 30-day mortality rates risk ratio (RR) 5.3 (95% CI: 4.8-5.9) and higher complication rates RR 2.4 (95% CI: 2.3-2.5). The most frequent complications included respiratory, need for transfusion, and renal. Conclusion: Peri-operatively, patients with mild thrombocytopenia undergoing cholecystectomy had higher mortality rates and complications compared to patients with normal platelet counts, and this effect continued as thrombocytopenia became more pronounced. Other etiologies of mild thrombocytopenia could not be excluded; however, aside from cancer (a small proportion) these are unlikely to affect clinical outcomes. Currently, most society guidelines including the AASLD practice guidance do not recommend NAFLD screening in the general population even among high-risk patients with diabetes or obesity. Thrombocytopenia might be a promising, cost-effective tool for NAFLD screening especially if used in high-risk populations (male gender, hypertension or diabetes, with or without high BMI). Furthermore, our study suggests that platelet counts may have utility in predicting peri-operative outcomes in this population.Figure 1.: Estimated rate of 30-day Mortality (left) and having any complication (right; infection, cardiac, respiratory, thrombotic, transfusion, renal, and/or unplanned return to the OR) across observed pre-operative platelet counts. Shaded areas represent 95% confidence intervals. The solid vertical line defines thrombocytopenia threshold at 150 x 109/L. The dashed vertical lines identify the 1st and 99th percentile of pre-operative platelet counts (92 and 480, respectively) indicating that <1% of the pre-operative platelet counts were below 92 or above 480. Table 1. - Unadjusted outcomes Thrombocytopenia p No Yes Ratio (95% CI) Sample Size 407,380 30,250 - - 30-day Mortality 0.3 1.7 5.3 (4.8-5.9) <.001 Complication 5.2 12.4 2.4 (2.3-2.5) <.001 Cardiac 0.2 0.9 3.7 (3.2-4.3) <.001 Respiratory 0.5 2.2 4.1 (3.8-4.5) <.001 Thrombotic 0.0 0.0 - - Transfusion 0.2 1.2 5.7 (5.0-6.4) <.001 Renal 0.2 1.0 4.2 (3.7-4.8) <.001 Return to OR 1.2 2.2 1.9 (1.8-2.1) <.001 Prolonged Hospitalization 0.1 0.3 2.7 (2.1-3.5) <.001 Unplanned Readmission 55.0 72.9 1.3 (1.2-1.5) <.001 Length of Stay Same-day Discharge Yes 43.4 21.5 0.5 (0.5-0.5) <.001 No (days) 3.8 5.5 1.5 (1.4-1.5) <.001 Note. Data presented as estimated percent or days. Thrombocytopenia defined as pre-operative platelet count less than 150 x 109/L. The ratios for 30-day Mortality through Unplanned Readmission are risk ratios. For all ratios, a ratio greater than 1 indicates greater unadjusted outcome for patients with thrombocytopenia.

Prognostic value of heart rate reserve in patients with suspected coronary artery disease undergoing stress myocardial perfusion imaging

BackgroundChronotropic incompetence is common in patients with cardiovascular disease and is associated with increased risk of adverse events. We assessed the incremental prognostic value of heart rate reserve (HRR) over stress myocardial perfusion single-photon emission computed tomography (MPS) findings in patients with suspected coronary artery disease (CAD). MethodsWe studied 866 patients with suspected CAD undergoing exercise stress-MPS as part of their diagnostic program. The primary study endpoint was all-cause mortality. All patients were followed for at least 5 years. HRR was calculated as the difference between peak exercise and resting HR, divided by the difference of age-predicted maximal and resting HR and expressed as percentage. ResultsDuring 7 years follow-up, 61 deaths occurred, with a 7% cumulative event rate. Patients experiencing death were older (P < .001), and had a higher prevalence of male gender (P < .001) and diabetes (P < .05). Patients with event also had lower values of HRR (65% ± 27% vs 73% ± 18%, P < .0001) and higher prevalence of stress-induced myocardial ischemia (25% vs 8%, P < .0001). Male gender, HRR and stress-induced ischemia were independent predictors of all-cause mortality (all P < .01). HRR improved the prognostic power of a model including clinical data and MPS findings, increasing the global χ2 from 66 to 82 (P < .005). ConclusionsChronotropic incompetence has independent and incremental prognostic value in predicting all-cause mortality in patients with suspected CAD undergoing exercise stress-MPS. Hence, the evaluation of HRR may further improve patients’ risk stratification.

S3214 Two Cases of Klebsiella pneumoniae Liver Abscess With Metastatic Infection

Introduction: Klebsiella pneumoniae (K. pneumoniae) is a gram-negative organism that is a known cause of pyogenic liver abscess (PLA). When K. pneumoniae causes PLA in the absence of hepatobiliary disease it is defined as invasive liver abscess syndrome (ILAS), and is commonly seen in individuals from Southeast Asia who have diabetes mellitus, cholelithiasis, or steatosis. ILAS can sometimes include metastatic spread that most commonly results in endophthalmitis or meningitis. Although K. pneumonia PLA is an endemic disease in Southeast Asia, it is now seen throughout the world and should elicit greater awareness as one of the common causes of PLA in the United States. Case Description/Methods: We present two cases of ILAS with metastatic spread causing endophthalmitis in male patients. The first case highlights known epidemiological and medical risk factors of ILAS with a 62-year-old from Southeast Asia who was diagnosed with poorly controlled type 2 diabetes mellitus (DM). The second case highlights an incidence of ILAS without any epidemiological or medical risk factors in a 36-year-old from the United States with no medical history. Both patients required interventional radiology for abscess drainage and intravenous ceftriaxone with subsequent clinical improvement and outpatient follow-ups in primary care and ophthalmology (Figure). Discussion: Liver abscesses most commonly occur with hepatobiliary disease, ILAS from K. pneumoniae is a potentially life-threatening infection and associated with significant morbidity and mortality that can occur without any hepatobiliary disease. ILAS was once commonly thought to occur typically in males and isolated in Southeast Asia, but are now seen in all sexes across the world and becoming increasingly common in the US. DM tends to be associated with K. pneumonia PLA, and the disease process also tends to be more invasive with metastatic spread to other organs, thereby leading to sepsis. Endophthalmitis is the most common infectious sequelae and is specifically associated with more virulent strains of K. pneumonia. ILAS should be part of the differential diagnosis of liver mass in the setting of sepsis, and due to K. pneumoniae metastasizing to other organ systems, early drainage and antibiotic administration is essential to decrease morbidity and mortality. A higher index of suspicion should be held for Southeast Asian diabetic males, the incidence of ILAS in all demographics is increasing, which should elicit greater awareness of risk factors, pathogenesis, and management.Figure 1.: Contrast-enhanced computed tomography scan of the abdomen in axial view demonstrating complex lesion in the left hepatic lobe (Case 1). Figure 2: Inflammation of the episclera indicative of episcleritis (Case 2).

Prevalence, clinical characteristics, and predictors of sleep disordered breathing in hospitalized heart failure patients.

Heart failure (HF) is often comorbid with sleep disordered breathing (SDB). This prospective study investigated the prevalence, clinical characteristics, and predictors of SDB in hospitalized HF patients. Sleep studies were performed on hospitalized HF patients from January 2015 to February 2019. SDB was categorized as no/mild SDB, obstructive sleep apnea (OSA), and central sleep apnea (CSA). The study included 1069 hospitalized HF patients. The prevalence rates of OSA and CSA were 16.6% and 36.9%, respectively. Patients with OSA or CSA were more likely to be male and have a higher body mass index (BMI) and more comorbidities. Multivariate logistic regression analysis showed that male sex (odds ratio [OR] = 1.803, 95% confidence interval [CI] = 1.099-2.958), BMI (per 5 kg/m2 increase: OR = 2.270, 95% CI = 1.852-2.783), hypertension (OR = 2.719, 95% CI = 1.817-4.070), diabetes (OR = 1.477, 95% CI = 1.020-2.139), and left ventricular ejection fraction (LVEF) (per 5% increase, OR = 1.126, 95% CI = 1.053-1.204) were independent predictors of OSA. Male sex (OR = 1.699, 95% CI = 1.085-1.271), age (per 10 years, OR = 1.235, 95% CI = 1.118-1.363), heart rate (per 10 bpm, OR = 1.174, 95% CI = 1.099-2.958), LVEF (per 5% increase, OR = 0.882, 95% CI = 0.835-0.932), NT-proBNP (lnNT-proBNP, OR = 1.234, 95% CI = 1.089-1.398) and hypocapnia (OR = 1.455, 95% CI = 1.105-1.915) were independent predictors of CSA. The areas under the receiver operating characteristic curves were 0.794 (95% CI = 0.758-0.830) and 0.673 (95% CI = 0.640-0.706), respectively. More than half of hospitalized HF patients had OSA or CSA, and CSA was the predominant type. OSA and CSA predictors differ. The clinical characteristics of HF patients can help make preliminary predictions for SDB patients.

Long-term exposure to PM2.5 constituents in relation to glucose levels and diabetes in middle-aged and older Chinese

BackgroundPrevious studies have indicated the associations between fine particulate matter (PM2.5) exposure and diabetes or glucose levels. However, evidence linking PM2.5 constituents and diabetes or glucose levels was extensively scarce, particularly in developing countries. This study aimed to investigate the associations of exposure to PM2.5 and its five constituents (black carbon [BC], organic matter [OM], nitrate [NO3-], sulfate [SO42-], and ammonium [NH4+]) with diabetes and glucose levels among the middle-aged and elderly Chinese populations. MethodsA national cross-sectional sample of participants aged 45+ years was enrolled from 28 provinces across China’s mainland. Health examination and questionnaire survey for each respondent were performed during 2011−2012. Diabetes was determined by alternative definitions, and the main definition (MD) was self-report diabetes or antidiabetic medicine use or HbA1c ≥6.5 or fasting glucose ≥7 mmol/L or random glucose ≥11.1 mmol/L. Monthly exposure to PM2.5 mass and its five constituents (BC, OM, NO3-, SO42-, and NH4+) for each participant at residence were estimated using satellite-based spatiotemporal prediction models. Generalized linear models and linear mixed-effects models were used to assess the effects of exposure to PM2.5 and its constituents on diabetes or glucose levels, respectively. Stratification analyses were done by sex and age. ResultsWe included a total of 17,326 adults over 45 years in this study. The 3-year mean (interquartile range [IQR]) concentrations of PM2.5, BC, OM, NO3-, SO42-, and NH4+ were 47.9 (27.4) µg/m3, 2.9 (2.2) µg/m3, 9.2 (6.6) µg/m3, 10.2 (9.4) µg/m3, 11.0 (5.2) µg/m3, and 7.1 (4.4) µg/m3, respectively. Per IQR rise in exposure to PM2.5 was significantly associated with an increase of 0.133 mmol/L (95% confidence interval, 0.048−0.219) in glucose concentrations. Similar positive associations were observed for BC (0.097 mmol/L [0.012−0.181]), OM (0.160 mmol/L [0.065−0.256]), NO3- (0.145 mmol/L [0.039−0.251]), SO42- (0.111 mmol/L [0.026−0.196]), and NH4+ (0.135 mmol/L [0.041−0.230]). Under different diabetes definitions, PM2.5 mass and selected constituents with the exception of SO42- were all associated with a higher risk of prevalent diabetes. In MD-based analysis, similar positive associations were observed for four constituents, with corresponding odds ratios of 1.180 (1.097−1.270) for PM2.5, 1.154 (1.079−1.235) for BC, 1.170 (1.079−1.270) for OM, 1.200 (1.098−1.312) for NO3-, and 1.123 (1.037−1.215) for NH4+. Stratified analyses showed a significantly higher risk of diabetes in males (1.225 [1.064−1.411]) than females (1.024 [0.923−1.136]) when exposed to PM2.5. Participants under 65 years were generally more vulnerable to diabetes hazards related to PM2.5 constituents exposure. ConclusionsExposures to PM2.5 and its constituents (i.e., BC, OM, NO3-, and NH4+) were positively associated with increased risks of prevalent diabetes and elevated glucose levels in middle-aged and older adults.

Analysis of the Factors Associated With ED in Type 2 Diabetics at the University Hospital of Libreville.

Erectile dysfunction (ED) is very common in diabetic males, especially type 2 diabetes mellitus (T2DM). Many factors and complications of diabetes such as macro- and micro-angiopathy are associated with risks leading to ED in male patients. Analysis of factors associated with ED in T2DM. The purpose of this study is to shed light on potential associations between ED, type 2 diabetes, and some risks factors. This was a prospective analytic study of T2DM over 18. The study population consisted of diabetic patients seen at the endocrinology and urology departments of the University Hospital during the study period. Evaluation of ED was made by IIEF 5 score. A total of 333 patients were selected for the study. The mean age was 56.6 ± 9.8 and the prevalence of ED was 82.6% (n=275). In univariate analysis, several associated factors were identified such as micro-angiopathic type complications including diabetic retinopathy (OR 4.88 [2.31-10.33], P < .001), diabetic nephropathy (OR 12.67 [1.71-93.66], P=.002) and macro-angiopathic type including arterial hypertension (OR 3.12 [1.69-5.75], P < .001). In multivariate analysis, duration of diabetes, micro and macroangiopathic complications, and hyperuricemia were independent risk factors for the occurrence of ED (P < .05). The presence of certain complications of diabetes such as micro or macro angiopathy or hyperuricemia should lead to a search for a ED. The presence of these associated factors identified in type 2 diabetic patients should systematically prompt an ED diagnosis which is often moderate or severe. That diagnosis would help design a protocol for the management and improvement of the life quality of these patients. The strength of this work is that it was conducted in the biggest hospital in the country which gives us a good idea of the trend of this ailment in the country. But the limitation of the study is that it only included patients who visited the hospital. This is monocentric hospital study was also transversal which does allow to establish a causal link. ED has a significant prevalence in T2DM. Several associated factors identified in uni and multivariate analyses, including duration of diabetes, micro and macro angiopathic complications, and hyperuricemia, increase ED risk. Therefore, it is essential to investigate the existence of these factors to improve the management of ED, which may allow the patient to regain a better overall health status. SNN Milama, A Mougougou, S G Olagui, et al. Analysis of the Factors Associated With ED in Type 2 Diabetics at the University Hospital of Libreville. Sex Med 2022;10:100564.

Advances in Stroke: Genetics, Genomics, Precision Medicine.

Advances in Stroke: Genetics, Genomics, Precision Medicine.

Association between Grip Strength, Obesity, and Cardiometabolic Risk Factors among the Community-Dwelling Elderly Population in Taiwan.

The aim of this study was to evaluate the association between grip strength, obesity, and cardiometabolic risk factors among elderly individuals with different grip strength statuses and weight statuses in Taiwan. We conducted a series of community-based health surveys among the elderly population in Chiayi County, Taiwan from 2017 to 2019. This is a cross-sectionally designed health check-up program that was conducted by the local public health bureau. Anthropometric characteristics, handgrip strength, diabetes, and cardiometabolic risk profiles were measured using standard methods. This study recruited 3739 subjects (1600 males and 2139 females). The non-obese subjects had lower blood glucose (BG) levels compared to the obese subjects. The BG levels of non-obese and obese subjects were 102.7 ± 25.6 mg/dL vs. 109.1 ± 34.3 mg/dL for males; and 102.8 ± 30.1 mg/dL vs. 112.5 ± 40.3 mg/dL for females (both p < 0.001). The grip strength was negatively associated with BG in both sexes (β = −0.357, p < 0.001 for males and β = −0.385, p < 0.05 for females). The relationship between the grip strength and the risk of diabetes showed that for every 1 kg increase in the grip strength, there was a 4.1% and 4.5% decrease in the risk for developing diabetes for males and females, respectively (OR = 0.959, 95% CI = 0.940–0.979 for males and OR = 0.955, 95% CI = 0.932–0.978 for females). A higher handgrip strength is associated with a lower BG level and a lower risk for diabetes mellitus in the elderly Taiwanese subjects. Additional health promotion should focus on the obese and sarcopenic population to prevent cardiometabolic comorbidities in later life.

A study to evaluate the relationship between diabetes mellitus and cognitive dysfunction

Background: Diabetes mellitus (DM) is the most common endocrine disorder. It leads to slow progressive end-organ damage (both microvascular and macrovascular). The cognitive dysfunction is a less known and less addressed complication of DM. Aims and Objectives: This study aims to evaluate the cognitive dysfunction in the patient with DM and to assess the cognitive dysfunction by Mini-Mental State Examination (MMSE) of the patients who are suffering from DM. Materials and Methods: A total of 979 diabetic patients were screened for cognitive dysfunction using MMSE score. The patients were evaluated as per the history. MMSE is a 30-point questionnaire which is mainly used to measure the cognitive impairment. Results: A total of 979 diabetic patients were included in the study out of which 44.7% of the patients were found to have cognitive dysfunction. Cognitive impairment was more prevalent in female diabetics (51%) as compared to male diabetics (39.8%). The result is significant at P&lt;0.05. Patients with longer duration of diabetes had much higher incidence of cognitive impairment (80.9%) as compare with the patients with short duration of diabetes which has lesser incidence of cognitive impairment (16.2%). P&lt;0.001 was considered statistically significant. Conclusion: Majority of the subjects suffering from DM have concomitant cognitive impairment. There is a significant cognitive impairment seen in subjects with DM. Early recognition and management of the cognitive dysfunction will help in improving quality of life.

Bacteriological aspects of bacteremia in the intensive care unit of the Mohammed V Military Hospital: 10 months prospective study.

Bacteremia is responsible for high rates of morbidity and mortality. The increasing prevalence of multidrug-resistant (MDR) bacteria in intensive care units (ICU) is a growing concern. Hence, prior knowledge of bacterial epidemiology and resistance phenotypes is required to optimize these infections' management. The objective of this study was to determine the epidemiological profile of bacteremia in ICU settings, as well as the place occupied by MDR bacteria in these infections. It is a prospective study carried out over 10 months on episodes of bacteremia in the ICU of Mohammed V Military Teaching Hospital (Rabat, Morocco). Microorganism growth was detected using fluorescent technology, species identification was based on morphological and biochemical characteristics. Antimicrobial susceptibility testing was performed following the recommendations of the Antibiogram Committee of the French Society of Microbiology (CA-SFM) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST). Among 504 hospitalized patients, sixty-one (12.1%) presented at least one episode of bacteremia. Forty patients (65.6% of bacteremic patients) presented at least one episode of bacteremia due to MDR bacteria. Male gender, cardiovascular diseases, diabetes and previous hospitalization were significant risk factors for the acquisition of MDR bacteremia. Isolated bacteria were mainly Gram-negative bacilli (GNB) (n = 62; 68.9%) dominated by Acinetobacter baumannii (n = 19; 21.1%) and Klebsiella pneumoniae (n = 16; 17.8%). MDR bacteria were represented by multi-resistant Acinetobacter baumannii (n = 19; 44.2%), extended-spectrum beta-lactamases-producing Enterobacterales (n = 9; 20.9%) and carbapenem-resistant Enterobacterales (n = 7; 16.3%). Carbapenems (n = 40; 65.6%), Aminoglycosides (n = 32; 52.5%) and Polypeptides (n = 24; 39.3%) were the most used antimicrobials. Mortality rates were 66.6% (n = 40) and 85% (n = 43) in patients with non MDR bacteremia and MDR bacteremia respectively. Limiting the spread of MDR bacteria and improving the management of bacteremic patients require continuous monitoring of bacteremia as well as adapting the therapeutic and preventive strategy.

Exemplification of ABO Blood Groups in Patients with Diabetes Mellitus

INTRODUCTION: Diabetes Mellitus and blood groups are interrelated. The relationship between ABO blood groups and disease susceptibility has generated a concern. The identification of a positive relationship between DM and blood groups could indicate higher susceptibility to diabetes and a negative relationship could indicate protection from diabetes. Therefore, the objective of the study was designed to exemplify ABO blood groups in Patients with Diabetes Mellitus. MATERIALS AND METHODS: The study was conducted at Ram Janaki Hospital and Swastika Health Care Hospital, Janakpurdham from September 2017 to March 2018.The record of the patients from the medicine OPD in both the hospitals was identified and relevant data were extracted. The data was recorded from the reports of the patients with confirmed DM patients attending Medicine department. RESULTS: The majority of the 579 diabetic patients were in the 40-60 year old age group. The most predominant blood group was B (251; 43.4 %), followed by AB (137; 23.7 %), O (125; 21.5 %), and A (66; 11.4 %) respectively. In comparison to male diabetics, less than half (44.1%) of female diabetics had blood group B. (42.7%). Similarly, males (13.0 %) were found to have more blood group A than females (9.8%). In diabetic individuals, the relationship between blood group and age (p=0.652) and sex (p=0.659) was shown to be insignificant. The majority of the patients (94.3%) had Rh positive blood groups, whereas the other had Rh negative blood types (5.7%). There was no correlation between blood group Rh factor and age group (p=0.817) or as well as with sex (p=0.333) among diabetic patients. CONCLUSIONS: Diabetic patients were more likely to have blood type B, while diabetics were less likely to have blood group A. It implies that diabetes is linked to ABO blood types, and that those with Group-B are more likely to develop the condition. Blood group could be a risk factor, and knowing it can aid with disease evaluation and screening.

The relationship between Vaspin, Nesfatin-1 plasma levels and presence of fragmented QRS with the severity of coronary atherosclerosis

PurposeDespite continuous efforts to address classical risk factors for atherosclerosis, the battle to control the disease is far from over and atherosclerosis is still a major factor in all-cause mortality. To investigate the relations between early diagnosis and severity of coronary atherosclerosis we examined vaspin and nesfatin-1 levels, and the presence of fragmented QRS (fQRS) in admission electrocardiograms. Materials and methodsWe divided 168 patients into asymptomatic control (18%), <50% coronary artery stenosis (28%), >50% stenosis (31%) and myocardial infarction (MI) (23%) groups. Patients were also evaluated in anatomically significant (>50%stenosis ​+ ​MI) and non-significant atherosclerosis (control+<50%stenosis) groups. Vaspin and nesfatin-1 levels were measured using ELISA methods. ResultsVaspin in MI and >50% stenosis groups was lower than in other groups (p ​< ​0.001). Nesfatin-1 in MI and >50% stenosis groups was lower only than in <50%stenosis group (p0.007). The presence of fQRS was higher in MI and >50% stenosis groups than other groups (p ​< ​0.001). In the anatomically significant atherosclerosis group, vaspin, nesfatin-1 and left ventricular ejection fraction (LVEF) values were lower while Gensini score and the presence of fQRS were higher (for all p ​< ​0.001). Lower vaspin levels and fQRS were related to in-hospital mortality (p ​< ​0.001 and p ​= ​0.02,respectively). Logistic regression analysis showed that male gender, diabetes mellitus, smoking, family history, lower LVEF, lower vaspin and fQRS were defined as independent risk factors for anatomically significant atherosclerosis (p ​= ​0.001). ConclusionsOur results indicate that low vaspin and fQRS were found to be novel independent risk factors for anatomically significant atherosclerosis and were predictors of mortality.