Disease Staging: Prevalence of Cardiorespiratory Complications in Type 2 Diabetes Mellitus.

Introduction: The incidence of cardiorespiratory complications in diabetic patients is a major concern for healthcare organizations and providers in Portugal. The objectives of this study were (1) to study the prevalence of cardiorespiratory complications during hospitalization in the diabetic population and (2) to identify their associated factors.Methods: This is a cross-sectional study and included 7,347 diabetic patients admitted to all specialty services enrolled between January 1, 2018 and December 31, 2018 in 32 public hospitals in Portugal. Hospital discharge summary data and both Disease-Related Diagnosis Groups and Disease Staging were used. Descriptive statistical analysis was used where the distribution and rates of cardiorespiratory complications were calculated. Logistic regression using the risk adjustment model was used to calculate the associated risk factors for cardiorespiratory complications.Results: The total rate of cardiorespiratory complications was 18.2% cardiorespiratory complications; in women it was 21.5% and in men 15.6%. The comorbidity of congestive heart failure (98.0%) was significantly higher (P<0.001) among patients undergoing medical treatment, and the comorbidities bacterial pneumonia and coronary artery disease without prior coronary revascularization were significantly higher (63.9%, 45.1%, and 33.4%, P<0.001).Discussion: The use of different therapies to control glucose levels and the absence of antibiotic prophylaxis during medical treatment may account for these data.Conclusions: Cardiorespiratory complications were higher in women than in men and in those who received medical treatment. Comorbidities such as congestive heart failure, such as bacterial pneumonia and coronary artery disease without prior coronary revascularization were identified as risk factors.

Predictive factors for improved diagnostic accuracy with the use of radial-probe EBUS.

OBJECTIVE: To assess predictive factors for improved diagnostic accuracy with the use of radial-probe EBUS (RP-EBUS). METHODS: This was a retrospective review of consecutive patients undergoing RP-EBUS between February of 2012 and January of 2020. Parameters including the presence of a bronchus sign on CT scans, the position of the radial EBUS probe, lesion size, lesion location, and lesion type were analyzed in relation to two defined outcomes (final diagnosis or no diagnosis). Univariate analysis was used in order to explore the individual effects of each parameter on diagnostic accuracy. Multivariate logistic regression was performed to identify significant predictors of diagnostic accuracy. RESULTS: RP-EBUS was used for diagnostic purposes in 101 patients. The lesion was < 3 cm in size in 59 patients (58.4%) and predominantly solid in 60.3%. There was a positive correlation between radial EBUS probe position and diagnostic accuracy (p = 0.036), with 80.9% of the patients showing a bronchus sign on CT scans. Furthermore, 89% of the patients showed a bronchus sign on CT scans and a correlation with diagnostic accuracy (p = 0.030), with 65.8% of the lesions being located in the left/right upper lobe (p = 0.046). When the radial EBUS probe was within the target lesion, the diagnostic yield was = 80.8%. When the probe was adjacent to the lesion, the diagnostic yield was = 19.2%. A bronchus sign on CT scans was the only parameter that independently influenced diagnostic accuracy (adjusted OR, 3.20; 95% CI, 1.081-9.770; p = 0.036). CONCLUSIONS: A bronchus sign on CT scans is a powerful predictor of successful diagnosis by RP-EBUS.

Diabetic women: Inpatient mortality risk before SARS-CoV-2.

Background: Type 2 diabetes mellitus is a major driver of mortality worldwide. To assess the risk factors associated with diabetes that increase in-hospital mortality. Methods: A retrospective cohort study was conducted using the National Hospital Morbidity with a sample of 3904 diabetic women admitted (2018-2019) in public hospitals, in Portugal. The type of comorbidities and the severity of the main disease - type 2 diabetes mellitus - was assessed based on the International Classification of Diseases (ICD-9) and Disease Staging. Cox proportional hazard was used to assess mortality during hospitalization. Mortality rates and mortality risk were the main outcome measures. Results: In a total of 3904 diabetic women three hundred and eighty-nine (10.0%) died during hospitalization. Comorbidities bacterial pneumonia and coronary artery disease contributed 73% [Hazard ratio (HR) 1.73, 95% CI 1.32-2.27] and 37% [HR 1.37, 95% CI 1.03-1.81] respectively, to the risk of mortality, as did age over 65 years and severity 3 of the main disease. Conclusions: Women with advanced type 2 diabetes mellitus, advanced age, and with comorbidities such as pneumonia and coronary artery disease admitted urgently have a higher risk of mortality during hospitalization.

Influence of age on adherence to auto-CPAP: experience from a sleep center in Portugal.

INTRODUCTION: Obstructive sleep apnea (OSA) is a disorder characterized by obstructive apneas, hypopneas, and/or arousals related to respiratory effort caused by repetitive collapse of the upper airway during sleep. Left untreated, or with poor adherence to treatment, is likely to lead to negative outcomes, especially cardiac or cerebrovascular diseases. Our objective was to investigate age as a potential factor that may interfere with adherence to treatment with automatic positive airway pressure (APAP). MATERIALS AND METHODS: This is a cross-sectional study on 1151 patients with OSA and we analyzed the adherence data of all patients who had been on APAP for at least six months during the period from July 1, 2019 to December 31, 2020 at Centro de Medicina do Sono. Spearman correlation was used in the bivariate analysis and to determine the factors associated with APAP adherence, a logistic regression was performed. RESULTS: Of 1151 patients included, 780 patients were men (67.1%) and the majority was under 65 years (59.4%). APAP adherence was higher in older age groups (p<0.001) and in patients with a higher AHI (p < 0.001), no differences were observed with regards to gender. In the multivariable regression analysis, the main factors associated with adherence were age group over 65 years (OR = 2.435; 95% CI = 1.862-3.185), AHI 15-30/h (OR = 1.733; 95% CI = 1.242-2.416), and AHI > 30/h (OR = 3.406; 95% CI = 2.426-4.782). CONCLUSIONS: Patients older than 65 years have better adherence to APAP than younger ones and with moderate but especially severe AHI have better adherence than those with the milder form of the disease.

Clinical profile of patients with type 2 diabetes after COVID-19 vaccination: A prospective study.

The purpose of this study was to characterize the clinical profile of patients with type 2 diabetes after COVID-19 vaccination. This prospective study has involved 100 adult diabetic patients followed in the primary health care. SARS-CoV-2 infection after COVID-19 vaccination was the outcome indicator.

Potentially preventable urinary tract infection in patients with type 2 diabetes - A hospital-based study.

AIM: To investigate the prevalence of urinary tract infections in hospitalized patients with type 2 diabetes mellitus and identify corresponding risk factors. METHODS: We conducted a cross-sectional study on 7.347 patients with type 2 diabetes mellitus as the principal diagnosis, using hospitalization discharge summary data from January 1 to December 31, 2015. Disease stages were classified as stages 1, 2, and 3. RESULTS: Of 7.347 patients, 16.2% had urinary tract infections. The urinary tract infection prevalence was 24.4% in 428 patients in stage 1 and 4.8% in 2.840 patients in stage 2; it was higher among patients who underwent medical procedures than among those who underwent surgery (24.4% vs 4.8%). In multivariate regression analysis, age (OR = 1.031; 95% CI = 1.02-1.04), length of hospitalization (OR = 1.018; 95% CI = 1.013-1.024), sex (woman) (OR = 2.248; 95% CI = 1.778-2.842), comorbidity of stage 3 cerebrovascular disease (OR = 1.737; 95% CI = 1.111-2.714), and comorbidity of stage 1 colorectal cancer (OR = 2.417; 95% CI = 1.152-5.074) were found to be the risk factors of urinary tract infection in the ten hospitals considered. CONCLUSIONS: Our findings suggest that urinary tract infection prevalence was higher in women without evidence of organ injury and those receiving medical treatment. Comorbidities (cerebrovascular disease and colorectal cancer) were identified as risk factors.

Predictive factors for improved diagnostic accuracy with the use of radial-probe EBUS / Fatores preditivos de maior precisão diagnóstica com EBUS com sonda radial

ABSTRACT Objective: To assess predictive factors for improved diagnostic accuracy with the use of radial-probe EBUS (RP-EBUS). Methods: This was a retrospective review of consecutive patients undergoing RP-EBUS between February of 2012 and January of 2020. Parameters including the presence of a bronchus sign on CT scans, the position of the radial EBUS probe, lesion size, lesion location, and lesion type were analyzed in relation to two defined outcomes (final diagnosis or no diagnosis). Univariate analysis was used in order to explore the individual effects of each parameter on diagnostic accuracy. Multivariate logistic regression was performed to identify significant predictors of diagnostic accuracy. Results: RP-EBUS was used for diagnostic purposes in 101 patients. The lesion was < 3 cm in size in 59 patients (58.4%) and predominantly solid in 60.3%. There was a positive correlation between radial EBUS probe position and diagnostic accuracy (p = 0.036), with 80.9% of the patients showing a bronchus sign on CT scans. Furthermore, 89% of the patients showed a bronchus sign on CT scans and a correlation with diagnostic accuracy (p = 0.030), with 65.8% of the lesions being located in the left/right upper lobe (p = 0.046). When the radial EBUS probe was within the target lesion, the diagnostic yield was = 80.8%. When the probe was adjacent to the lesion, the diagnostic yield was = 19.2%. A bronchus sign on CT scans was the only parameter that independently influenced diagnostic accuracy (adjusted OR, 3.20; 95% CI, 1.081-9.770; p = 0.036). Conclusions: A bronchus sign on CT scans is a powerful predictor of successful diagnosis by RP-EBUS.

RESUMO Objetivo: Avaliar fatores preditivos de maior precisão diagnóstica com EBUS com sonda radial. Métodos: Revisão retrospectiva de pacientes consecutivos submetidos a EBUS radial entre fevereiro de 2012 e janeiro de 2020. Parâmetros como a presença do sinal brônquico na TC, a posição da sonda radial de EBUS, o tamanho da lesão, a localização da lesão e o tipo de lesão foram analisados em relação a dois desfechos definidos (diagnóstico final ou sem diagnóstico). A análise univariada foi usada para explorar os efeitos individuais de cada parâmetro na precisão do diagnóstico. A regressão logística multivariada foi realizada para identificar preditores significativos de precisão diagnóstica. Resultados: O EBUS radial foi usado para fins diagnósticos em 101 pacientes. A lesão era < 3 cm em 59 pacientes (58,4%) e predominantemente sólida em 60,3%. Houve correlação positiva entre a posição da sonda radial de EBUS e a precisão do diagnóstico (p = 0,036), sendo que 80,9% dos pacientes apresentaram o sinal brônquico na TC. Além disso, 89% dos pacientes apresentaram o sinal brônquico na TC e correlação com a precisão do diagnóstico (p = 0,030), sendo que 65,8% das lesões localizavam-se no lobo superior esquerdo/direito (p = 0,046). Com a sonda radial de EBUS dentro da lesão-alvo, o rendimento diagnóstico foi de 80,8%. Com a sonda adjacente à lesão, o rendimento diagnóstico foi de 19,2%. O sinal brônquico na TC foi o único parâmetro que influenciou de forma independente a precisão do diagnóstico (OR ajustada = 3,20; IC95%: 1,081-9,770; p = 0,036). Conclusões: O sinal brônquico na TC é um poderoso preditor de diagnóstico bem-sucedido por meio de EBUS radial.