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1.
Anaesthesia and Intensive Care Medicine ; 23(8):415-422, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2031577

RESUMO

Failed intubation in obstetrics remains a topical issue, a rare but potentially devastating complication of obstetric general anaesthesia. The 2015 guidelines produced following several years of collaborative work between the Difficult Airway Society (DAS) and Obstetric Anaesthetists' Association (OAA) remain the definitive text. While deaths from failed intubation have declined significantly over 30 years, the incidence of failed intubation remains fairly constant at 1:300, with the latest studies showing a rate of 1:224. This reflects the significant decline in the use of general anaesthesia for caesarean section over the last three decades;however, it also highlights a decreased exposure for trainees to tracheal intubation in the obstetric population.

2.
Virology Journal ; 19(1):148, 2022.
Artigo em Inglês | MEDLINE | ID: covidwho-2029723

RESUMO

BACKGROUND: Omicron variant (B.1.1.529) is a dominant variant worldwide. However, the risk factors for Omicron variant clearance are yet unknown. The present study aimed to investigate the risk factors for early viral clearance of Omicron variant in patients with a history of inactivated vaccine injection. METHODS: Demographic, clinical, and epidemiological data from 187 patients were collected retrospectively during the Omicron variant wave. RESULTS: 73/187 and 114/187 patients were administered two and three doses of vaccine, respectively. The median duration of SARS-CoV-2 RNA positivity was 9 days, and the difference between patients with two and three vaccine injections was insignificant (P = 0.722). Fever was the most common symptom (125/187), and most patients (98.4%) had a fever for < 7 days. The RNA was undetectable in 65/187 patients on day 7. Univariable logistic analysis showed that baseline glucose, uric acid, lymphocytes count, platelet count, and CD4+ T lymphocyte count were associated with SARS-CoV-2 RNA-positivity on day 7. Multivariable analysis showed that glucose >= 6.1 mmol/L and CD4+T lymphocytes count were independent risk factors for RNA positivity on day 7. 163/187 patients had an undetectable RNA test on day 14, and uric acid was the only independent risk factor for RNA positivity. Moreover, baseline glucose was negatively correlated with uric acid and CD4+ and CD8+ T cell count, while uric acid was positively correlated with CD4+ and CD8+ T cell count. CONCLUSIONS: Omicron variant clearance was delayed in breakthrough cases with elevated fasting blood glucose, irrespective of the doses of inactivated vaccine.

3.
Journal of Advanced Biotechnology and Experimental Therapeutics ; 5(3):445-455, 2022.
Artigo em Inglês | Scopus | ID: covidwho-2025149

RESUMO

Compared to other pandemic diseases, COVID-19 had the highest transmission rate and high fatality risk. Diabetes is the hand was also one of the most frequent diseases among individuals. This study aimed to evaluate the relationship between diabetic patients infected by COVID-19 and some hematological parameters associated with diabetes and COVID-19.ICLE Patients with COVID-19 were diagnosed by PCR and/or chest computer topography (CT) scan, eight parameters were detected by AFIAS-6. The results of eight parameters for patients with diabetes mellitus infected with COVID-19 and patients with COVID-19 only showed that the Mean of Fasting Blood Glucose (FBG), glycated haemoglobin HbA1c, Insulin Sensitivity (INS) and ferritin show significant differences at (0.000, 0.000, 0.017, 0.000) respectively for the two groups, while insulin resistance (INR), insulin (IN), C-reactive protein (CRP) and D-dimer don’t show any significant differences for two groups, the statistical analysis performed at P-value ≤ 0.01 and 0.05. Infection duration results showed that the mean Insulin level (IN) and D-dimer show significant differences at (0.033 and 0.011) respectively for all infection duration categories, while FBG, HbA1c, INR, INS, CRP, and ferritin don’t show any significant differences for all day’s category. The Correlation Coefficients Between diabetes mellitus patients infected with COVID-19 and blood parameters highly correlated between FBG with INR at (0.647), HbA1c with IN at (0.078), INR with IN at (0.791), INS with CT-Scan at (0.058), CRP with D-dimer at (0.287), D-dimer with ferritin at (0.331), Ferritin with infection duration at (0.098). In conclusion, we find that the diabetes mellitus patients infected with COVID-19 suffer from a high increase of inflammatory proteins and parameters associated with diabetes compared to other patients infected with COVID-19 only, making them more susceptible to disease and more deaths compared to other people. © 2022, Bangladesh Society for Microbiology, Immunology and Advanced Biotechnology. All rights reserved.

4.
Journal of the ASEAN Federation of Endocrine Societies ; 37:55, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2006563

RESUMO

Introduction Teleconsultation has become an increasingly important service in managing T2DM especially with the ongoing COVID-19 pandemic and is assumed to be less costly to patients compared to physical visits. This study aimed to compare patients' cost for a teleconsultation session vs physical clinic visit. Methodology This was a cross-sectional study from June 2020 to December 2021 in UMMC which included patients who had successfully participated in teleconsultation sessions. Patient interviews were conducted to collect demographics, detailed cost items (direct/ indirect cost) and a self-administered Patient Satisfaction Questionnaire Short Form (PSQ-18). HbA1c and average self-monitoring blood glucose (SMBG) records at baseline and 3-months after teleconsultation were obtained from electronic medical records (EMR). Results A total of 36 patients were recruited. The median cost of attending a physical visit was significantly higher compared to teleconsultation (RM 123.41 [54.29, 219.51] vs RM 41.41 [30.55, 49.66];p<0.001) with a median cost difference of RM 81.24 [20.20,171.69]. Indirect costs (income loss from absence) made up the majority of the cost saving with teleconsultation (teleconsultation RM 10.71 [0.00,18.45], physical visit RM95.24 [0.00,182.74];p<0.001). There was a reduction in HbA1c (9.45% [7.98, 11.38] to 8.25% [7.42, 9.49];p<0.001) and average fasting SMBG (8.11 mmol/L [6.75, 9.70] to 7.20 mmol/L [6.22, 8.71];p=0.03) after 3 months of teleconsultation. Patients reported high satisfaction levels with teleconsultation, with an overall PSQ-18 score of 78%. Conclusion Teleconsultation service in UMMC Diabetes outpatient clinic was cost saving to patients compared to physical visits without compromising blood glucose control. Teleconsultation may be a viable option of healthcare provision for many patients and may be considered as part of routine care.

5.
Journal of the ASEAN Federation of Endocrine Societies ; 37:39, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2006558

RESUMO

Introduction In the era of the COVID-19 pandemic, several cases of new onset diabetes associated with COVID-19 have been reoprted. Additionally, patients with diabetes, a high-risk population, are prioritised for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. The vaccine against the (SARS-CoV-2) could represent a new environmental trigger for autoimmune disorders such as Graves' disease, immune thrombotic thrombocytopenia, autoimmune liver diseases, Guillain-Barré syndrome, systemic lupus erythematosus and type 1 diabetes. case We report a case of diabetic ketoacidosis in a new onset Type 1 diabetes in an elderly female following SARSCoV- 2 vaccination. A 69-year-old female with a history of treated TB abdomen in 2015 with no history of diabetes received her second dose of SARS-CoV-2 vaccination (COMIRNATY) on 21st August 2021. Two weeks following vaccination, she developed osmotic symptoms, reduce appetite and lethargy. Her random blood glucose (RBS) was 41 mmol/L, serum ketone 4.4 mmol/L, pH of 7.29 mmHg, bicarbonate 12.5 mmol/L and serum osmolarity of 298 mOsm/kg. She was treated for DKA with intravenous insulin infusion and hydration with resolution of DKA within 12 hours. Anti-Glutamic Acid Decarboxylase and anti-Islet Cells antibodies were positive with low fasting C-peptide of 102 pmol/L. She was discharged well with basal bolus insulin. Four months later, HbA1c reduced from 15.6% to 7.7% with a random C-peptide of 152 pmol/L. Conclusion The occurrence of hyperglycaemia crisis following SARSCoV- 2 vaccine in patients with pre-existing diabetes is known but the occurrence of new onset autoimmune diabetes following vaccination is rare. Further studies are needed to better understand the underlying pathogenesis of autoimmune diabetes following SARS-CoV-2 vaccine.

6.
Clinical Nutrition ESPEN ; 48:505, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2003960

RESUMO

Adequate protein and energy provision in critical care is associated with better clinical outcomes. The aim of this audit was to evaluate compliance with achieving recommended protein and energy targets in our Intensive Care Unit (ICU) and to explore the reasons for any deficits identified. Nutrition parameters were collected on patients admitted to our ICU between March and May 2021. Inclusion criteria were requirement for nutritional support and mechanical ventilation with an ICU length of stay ≥ 4 days. Patients with COVID19 were excluded. Protein and energy intakes were compared to best practice guidelines1. 51 patients met the inclusion criteria: 53% male, 47% female. Mean age was 59.6 years and mean length of stay was 19.9 days (range 5-61 days). Protein and energy intakes achieved as follows: [Formula presented] Of the patients who received < 80% of their nutritional requirements, the main barriers to achieving targets identified were fasting and constipation in this cohort. Cumulative deficit ranged from 0 - 903g protein and 0 - 12717kcal over duration of ICU stay. Mean deficit was 315g protein and 2945kcal. Of concern, 12 patients had a deficit of > 500g protein and 7 patients had > 5000kcal deficit. While 69% of patients met ≥ 80% protein requirements and 77% of patients met ≥ 80% energy requirements, we have identified areas to consider to improve nutritional adequacy including increasing awareness of minimising fasting times and the introduction of a bowel management protocol. References 1. Singer P, Blaser AR, Berger MM. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019 1;38(1):48-79. Disclosure of Interest: None Declared

7.
Pediatrics ; 149, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2003410

RESUMO

Background: The COVID-19 pandemic has raised concerns for worsening cardiometabolic health in children. Methods: Retrospective chart review to analyze patients who had visits to a pediatric lipid clinic in both the year prior to (3/18/2019- 3/17/2020) and during (3/18/2020-3/17/2021) the COVID-19 pandemic. Laboratory markers of cardiometabolic health (lipid panel, insulin resistance, and transaminases), physical exam findings (BMI, waist circumference (WC), and blood pressure), self-reported exercise time, and lipid-lowering medications (LLM) were compared via paired t-tests. Results: 303 patients met inclusion criteria. Among patients prescribed no LLM (metformin, statin, omega-3 fatty acids, fenofibrate) or on stable doses of LLM (n=244), there was a significant increase in BMI and WC (see Table). All changes in lipid panels were statistically, but likely not clinically, significant. Among patients with changes in prescribed LLM between pre-pandemic and pandemic intervals (n=62), there was an increase in HgbA1c and TG, a trend towards increased fasting insulin and ALT, and no changes in LDL-C or HDL-C. During the pandemic, patients showed increased BMI and trended towards increased WC (see Table). Neither group had a statistically significant change in exercise time. The incidence of newly prescribed LLM increased during the pandemic. This included statistically significant increases in prescriptions for statins (P= 0.003), metformin (P= 0.001), and omega-3 fatty acids (P= 0.001). Conclusion: Pediatric patients in a lipid clinic demonstrated increases in BMI and WC in the year of the COVID-19 pandemic compared to the year prior, despite few clinically significant changes in their lipid panels. In patients who required changes in LLM, increases in HgbA1c, TG, ALT and fasting insulin are consistent with reports of higher rates of pediatric type 2 diabetes during the pandemic. The increase in medication prescriptions further supports this, and indicates the need to diagnose and treat new onset dyslipidemia, insulin resistance, and diabetes in children.

8.
Journal of Hepatology ; 77:S366-S367, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1996636

RESUMO

Background and aims: Malnutrition is a common comorbidity in cirrhotic patients and confers a poorer prognosis. Vitamin C (VC) is a micronutrient essential for human health. Vitamin C deficiency (VCD) can lead to scurvy and may impair immune and liver functions. Although previously thought to be rare in developed countries, VCD is now well described in patients with pneumonia, COVID19 and upper gastrointestinal bleeding (UGIB). The prevalence and clinical significance of VCD in cirrhosis remains poorly studied. Method: Patients with cirrhosis admitted to 3 metropolitan tertiary centres in Australia were prospectively included over a 10-month period in 2021. Fasting VC levels were collected on admission and we recorded demographic data and clinical outcomes. The primary outcomes were the prevalence of VCD (defined as VC level <23 mcmol/L) and severe VCD (SVCD), defined as <11 mcmol/L. Secondary outcomes included mortality, intensive care admission, length of stay (LOS) and rate of infection. Results: 117 patients were included. Mean age was 57.1 ± 13.9 years, 59.0% were male and 23.9% belonged to the lowest socioeconomic decile. The most common aetiologies of cirrhosis were alcohol (62.4%), viral hepatitis (24.0%) and non-alcoholic fatty liver disease (18.8%). Median MELD scorewas 29 (IQR 22–36) and Child Pugh (CP) grades were 12.8% A, 46.2% B and 41.0% C. Most patients (74.4%) were hospitalised with complications of decompensated cirrhosis, including ascites (59.0%), encephalopathy (31.6%) and variceal bleeding (11.1%). Median VC level was 34mcmol/L (IQR 16–55) and did not differ with age, gender, or aetiology of cirrhosis. Increasing CP grade correlated with significantly lower median VC levels (CP-A 46.0 mcmol/L vs. CPB 36.5 mcmol/L and CP-C 20.5 mcmol/L, p = 0.026). The prevalence of VCD and SVCD were 39.3% and 17.1% respectively. SVCD was more prevalent in patients with a body mass index <25 (28.3% vs 13.0%, p = 0.036). In-hospital mortality was 12.8% and did not differ by VCD status, however in the subgroup of patients presenting with UGIB, SVCD correlated with significantly higher mortality (50% vs 4.1%, p = 0.045). Bacteraemia was more frequent in patients with VCD (13.3% vs. 1.4%, p = 0.014) and SVCD (26.3% vs 2.1%, p < 0.001), which remained significant at multivariate analysis (OR for every 1mcmol/L increase in VC, 0.91 (95% CI: 0.83–0.99), p = 0.037). Overall infection rateswere higher in patients with SVCD (40.0% vs. 27.8%) although thiswas nonsignificant (p = 0.279). Median hospital LOS was 10 (IQR 6–18) days and did not differ by VCD status. (Figure Presented) Conclusion: VCD is common in hospitalised cirrhotic patients and prevalence increases with severity of liver disease. VCD increases the risk of infective complications and higher mortality was observed in patients with UGIB and SVCD. Further studies are required to assess the significance of VCD in cirrhosis and the impacts of VC replacement.

9.
Journal of Clinical Lipidology ; 16(3):e41-e42, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1996301

RESUMO

Lead Author's Financial Disclosures: Nothing to disclose. Study Funding: None. Background/Synopsis: Extensive evidence exists in support of a causal association of elevated triglyceride-rich lipoprotein (TRL) levels with the risk of atherosclerosis progression. Hypertriglyceridemia has been established as a risk factor for venous thrombosis, including a 2- fold increase in the risk of venous thrombosis in postmenopausal women. However, there is limited data on the role of hypertriglyceridemia in the arterial thrombosis. Objective/Purpose: Not Applicable. Methods: Case description: A 51-year-old white female with hypertension and type 2 diabetes (hemoglobin A1C, 7.4%) was transferred for further management of newly diagnosed bilateral renal and splenic infarcts. No risky habits were elicited except for the use of combined hormonal contraceptives over the past two years to control menorrhagia. Family history was significant for hypertriglyceridemia. Her physical exam was unremarkable. Testing for COVID-19 was negative. An extensive hypercoagulable and autoimmune work-up was unremarkable. Fasting lipid profile was significant for elevated levels of triglycerides, 1,274 mg/dL (replicated on two separate occasions), very low-density lipoprotein-cholesterol, 255 mg/dL, and non-high-density lipoprotein-cholesterol, 214 mg/dL, directly measured low-density lipoprotein cholesterol, 39 mg/dL and lipoprotein(a), 6 mg/dL. There was no structural pathology on the echocardiogram, including no interatrial shunt or intracardiac thrombus. Her whole-body computed tomography angiography revealed a focal calcified protruding thrombus in the distal thoracic aorta. No significant plaque was seen elsewhere in the aorta. Results: Decision-making. The posterior thrombus in the distal thoracic and proximal abdominal aorta was determined as a culprit for the visceral organ infarcts. Over the course of the hospital stay her abdominal pain gradually resolved. Treatment with low dose aspirin and therapeutic dose of low-molecular weight heparin was initiated followed by apixaban and aspirin on discharge. She was started on atorvastatin 40 mg, fenofibrate 145 mg, icosapent ethyl 4 g, resulting in a 70% reduction in the triglycerides levels (306 mg/dL). In 3 months, her repeat CT angiography showed significant resolution of the aortic atherothrombosis with no signs of aortic wall inflammation. At the 6-month follow-up visit she was switched to dual antiplatelet therapy with a plan to repeat imaging in 6 months. Conclusions: This case illustrates challenges in managing patients with arterial thrombosis in the setting of familial hypertriglyceridemia. Apart from severely elevated triglycerides no other etiology was evident. We propose further investigation of the prothrombotic properties of TRL and the role of targeted triglyceride-lowering therapies on atherothrombotic outcomes.

10.
Diabetes ; 71, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1987376

RESUMO

KPD is classically regarded as an atypical form of diabetes caused by near-complete beta-cell failure. A 37-year-old Egyptian man (BMI: 27.7 Kg/m2) presented with hyperglycemia (362 mg/dL) and DKA (arterial pH 7.20, ketonemia 5.0 mmol/L, ketonuria 80 mg/dL) . He was afebrile, with recent polyuria, polydipsia and weight loss. HbA1c was 107 mmol/mol (11.9%) and blood tests excluded diabetes secondary to endocrinopathies. SARS-CoV-2 RT-PCR test was negative. IV insulin infusion (0.1 IU/kg/h) and IV fluid therapy were started. He was shortly transitioned to a sc basal-bolus insulin regimen (0.7 IU/kg/day) . Mixed-meal tolerance test (MMTT) revealed a peak 120-min stimulated C-peptide of 12.3 ng/mL, suggesting marked insulin resistance. Islet autoantibodies (ICA, IAA, GADA, IA-2A, ZnT8A) and insulin receptor autoantibodies (IgG/IgM) were negative. HLA genotyping detected the following haplotypes: DRB1∗01, ∗04;DQA1∗01:01P, ∗03:01P;DQB1∗03:02P, ∗05:01P. Insulin dose was gradually reduced and insulin therapy was discontinued after 4 months in favor of metformin (2550 mg/day) plus sc semaglutide (up to 1 mg/week) . After one year, MMTT revealed a peak 60-min stimulated C-peptide of 8.25 ng/mL. During the 18-month follow-up period, fasting capillary beta-hydroxybutyrate values were <0.2 mmol/L and HbA1c remained <48 mmol/mol (<6.5%) , indicating disease remission. This case suggests the existence of an autoantibody-negative KPD subtype driven by marked insulin resistance rather than by insulinopenia.

11.
BMJ Nutrition, Prevention and Health ; 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1968290

RESUMO

Objectives: Intermittent fasting boosts some host defence mechanisms while modulating the inflammatory response. Lower-frequency fasting is associated with greater survival and lower risk from COVID-19-related comorbidities. This study evaluated associations of periodic fasting with COVID-19 severity and, secondarily, initial infection by SARS-CoV-2. Design: Prospective longitudinal observational cohort study. Setting: Single-centre secondary care facility in Salt Lake City, Utah, USA with follow-up across a 24-hospital integrated healthcare system. Participants: Patients enrolled in the INSPIRE registry in 2013-2020 were studied for the primary outcome if they tested positive for SARS-CoV-2 during March 2020 to February 2021 (n=205) or, for the secondary outcome, if they had any SARS-CoV-2 test result (n=1524). Interventions: No treatment assignments were made;individuals reported their personal history of routine periodic fasting across their life span. Main outcome measures: A composite of mortality or hospitalisation was the primary outcome and evaluated by Cox regression through February 2021 with multivariable analyses considering 36 covariables. The secondary outcome was whether a patient tested positive for SARS-CoV-2. Results: Subjects engaging in periodic fasting (n=73, 35.6%) did so for 40.4±20.6 years (max: 81.9 years) prior to COVID-19 diagnosis. The composite outcome occurred in 11.0% of periodic fasters and 28.8% of non-fasters (p=0.013), with HR=0.61 (95% CI 0.42 to 0.90) favouring fasting. Multivariable analyses confirmed this association. Other predictors of hospitalisation/mortality were age, Hispanic ethnicity, prior MI, prior TIA and renal failure, with trends for race, smoking, hyperlipidaemia, coronary disease, diabetes, heart failure and anxiety, but not alcohol use. In secondary analysis, COVID-19 was diagnosed in 14.3% of fasters and 13.0% of non-fasters (p=0.51). Conclusions: Routine periodic fasting was associated with a lower risk of hospitalisation or mortality in patients with COVID-19. Fasting may be a complementary therapy to vaccination that could provide immune support and hyperinflammation control during and beyond the pandemic. Trial registration: Clinicaltrials.gov, NCT02450006 (the INSPIRE registry).

12.
Al-Zahra: Journal for Islamic and Arabic Studies ; 18(2), 2021.
Artigo em Árabe | ProQuest Central | ID: covidwho-1964771

RESUMO

This research aims to know the ruling on the validity of fasting by receiving a vaccine for the Coronavirus or not, through the fatwa of the Indonesian Council of Scholars, compared to the fatwas of the fatwa councils in the Islamic world, using the analytical and comparative methodology. Fasting is obligatory for Muslims in the month of Ramadan in particular, and it may be required in other months. On the other hand, the Coronavirus may spread in the world at the end of the year 2019. As of February 28, 2021, it has recorded one million and 335 thousand infections and 36 thousand and 166 deaths, and in Indonesia, which leads the government to take preventive measures, including positively receiving the Coronavirus vaccine for the people. And when Ramadan came, people were wondering about the ruling on taking it while fasting, and the Fatwa Committee of the Indonesian Council of Scholars issued a fatwa that fasting is not invalidated by receiving the vaccine, and it became clear that this fatwa agrees with the fatwas of the fatwa councils in the Islamic world.

13.
Journal of Chinese Medicine ; 2022(129):9-14, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1955736

RESUMO

More than half of the human body consists of non-human microbes such as bacteria and viruses. Microbes can cause infection, inflammation, immune system disorders, obesity, diabetes, respiratory and cardiovascular illnesses, even heart failure. Microbes are governed by the cycles of nature, including the cycles of day and night, and are influenced by what and when we eat. Research has shown intermittent fasting to be a promising approach for reducing inflammation, improving metabolic health and reducing risk factors for cardiovascular disease, possibly through influencing gut microbial composition. This article explores the role of the microbiome and intermittent fasting on human health from the perspective of traditional Chinese medicine (TCM).

14.
Front Nutr ; 9: 925092, 2022.
Artigo em Inglês | MEDLINE | ID: covidwho-1952482

RESUMO

Objective: Disrupted sleep and training behaviors in athletes have been reported during the COVID-19 pandemic. We aimed at investigating the combined effects of Ramadan observance and COVID-19 related lockdown in Muslim athletes. Methods: From an international sample of athletes (n = 3,911), 1,681 Muslim athletes (from 44 countries; 25.1 ± 8.7 years, 38% females, 41% elite, 51% team sport athletes) answered a retrospective, cross-sectional questionnaire relating to their behavioral habits pre- and during- COVID-19 lockdown, including: (i) Pittsburgh sleep quality index (PSQI); (ii) insomnia severity index (ISI); (iii) bespoke questions about training, napping, and eating behaviors, and (iv) questions related to training and sleep behaviors during-lockdown and Ramadan compared to lockdown outside of Ramadan. The survey was disseminated predominately through social media, opening 8 July and closing 30 September 2020. Results: The lockdown reduced sleep quality and increased insomnia severity (both p < 0.001). Compared to non-Muslim (n = 2,230), Muslim athletes reported higher PSQI and ISI scores during-lockdown (both p < 0.001), but not pre-lockdown (p > 0.05). Muslim athletes reported longer (p < 0.001; d = 0.29) and later (p < 0.001; d = 0.14) daytime naps, and an increase in late-night meals (p < 0.001; d = 0.49) during- compared to pre-lockdown, associated with lower sleep quality (all p < 0.001). Both sleep quality (χ2 = 222.6; p < 0.001) and training volume (χ2 = 342.4; p < 0.001) were lower during-lockdown and Ramadan compared to lockdown outside of Ramadan in the Muslims athletes. Conclusion: Muslim athletes reported lower sleep quality and higher insomnia severity during- compared to pre-lockdown, and this was exacerbated by Ramadan observance. Therefore, further attention to Muslim athletes is warranted when a circadian disrupter (e.g., lockdown) occurs during Ramadan.

15.
Diabetes Metab Syndr ; 16(8): 102567, 2022 Jul 20.
Artigo em Inglês | MEDLINE | ID: covidwho-1936311

RESUMO

OBJECTIVE: People with type 1 diabetes (T1D) are advised to have a "pre-Ramadan" visit to receive the assessment and education needed to safely fast during the holy month of Ramadan. The COVID-19 lockdown has interrupted this standard of care in Muslim-majority countries where telemedicine is not well-established. Here, we examined the impact of virtual"pre-Ramadan" visits, as an alternative option to the traditional (in-person) visits, on fasting experience and glycemic control during Ramadan in people with T1D. METHOD: 151 individuals with T1D were categorized into 3 groups according to the type of"pre-Ramadan" visit that they attended in 2020: virtual (n = 50), in-person (n = 56), and no visit (n = 45). Number of days fast was broken and CGM metrics were retrospectively compared across the groups. RESULT: Patients who had a virtual"pre-Ramadan" visit were more likely to use continuous glucose monitors (CGM) than those who had no visit (61.7% and 38.6%, respectively, p < 0.05). Attending a virtual"pre-Ramadan" visit was associated with the least number of days fast was broken compared to those who had no visit (p < 0.01) or in-person visit (p = 0.02). CGM time in range (TIR) during Ramadan was the highest in those who had virtual "Pre-Ramadan" visits compared to those who had no visit or in-person visits (59%, 44%, and 47%,respectively). After adjusting for age, gender, pre-Ramadan A1c, and CGM use, the odds of fasting most days of Ramadan were highest in the virtual group [OR (CI): 9.13 (1.43, 58.22)] followed by the in-person group [3.02 (0.54,16.68)] compared to the no visit group. CONCLUSION: Virtual"pre-Ramadan" visits are effective alternative to in-person visits when managing people with T1D who plan to fast during Ramadan.

16.
Nutrients ; 14(14)2022 Jul 17.
Artigo em Inglês | MEDLINE | ID: covidwho-1938927

RESUMO

BACKGROUND: SARS-CoV-2 infection was analyzed according to previous metabolic status and its association with mortality and post-acute COVID-19. METHODS: A population-based observational retrospective study was conducted on a cohort of 110,726 patients aged 12 years or more who were diagnosed with COVID-19 infection between June 1st, 2021, and 28 February 2022 on the island of Gran Canaria, Spain. RESULTS: In the 347 patients who died, the combination of advanced age, male sex, cancer, immunosuppressive therapy, coronary heart disease, elevated total cholesterol and reduced high-density lipoprotein cholesterol (HDL-C) was strongly predictive of mortality (p < 0.05). In the 555 patients who developed post-acute COVID-19, the persistence of symptoms was most frequent in women, older subjects and patients with obstructive sleep apnea syndrome, asthma, elevated fasting glucose levels or elevated total cholesterol (p < 0.05). A complete vaccination schedule was associated with lower mortality (incidence rate ratio (IRR) 0.5, 95%CI 0.39-0.64; p < 0.05) and post-acute COVID-19 (IRR 0.37, 95%CI 0.31-0.44; p < 0.05). CONCLUSIONS: Elevated HDL-C and elevated total cholesterol were significantly associated with COVID-19 mortality. Elevated fasting glucose levels and elevated total cholesterol were risk factors for the development of post-acute COVID-19.


Assuntos
COVID-19 , Colesterol , HDL-Colesterol , Feminino , Glucose , Humanos , Masculino , Estudos Retrospectivos , SARS-CoV-2
17.
Journal of Clinical and Diagnostic Research ; 16(6):BC28-BC32, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1928863

RESUMO

Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic has spread rapidly, infecting more than 194 million and killing more than 4 million people worldwide. Algeria has not escaped this scourge;according to World Health Organization (WHO), 162,155 confirmed cases and 4,063 deaths have been recorded from 3rdJanuary 2020 to 26thJuly 2021. Recent studies have indicated the critical role of an altered immune system, and oxidative stress in the pathological process contributing to several complications during COVID-19 disease. Aim: To determine blood markers, oxidant/antioxidant status and biochemical parameters in patients highly recovered from COVID-19 and compare with those who have never contracted COVID-19;considered as controls. Materials and Methods: The present case-control study was conducted in Tiaret, Algeria, between May 2021 and June 2021. Thirty healthy volunteers who had never contracted COVID-19 and 16 volunteers who recovered from COVID-19 in the last six months were included in the study. Blood samples were taken after 8 to 12 hours of fasting, the blood markers and biochemical parameters were evaluated. The participant with chronic diseases (diabetes, hypertension, cardiovascular diseases, kidney disease) was excluded. Student's t-test was performed for statistical comparison between the two groups. Statistical analysis was performed using Excel Microsoft 2010 software. Results. The control group consisted of 46.7% male (n=14) and 53.3% females (n=16). While, the case group consisted of 62.5% males (n=10) and 37.5% females (n=6). The plasma levels of Low Density Lipoprotein-Cholesterol (LDL-C), p-value=0.004∗∗and creatinine increased very significantly in the cases compared to the controls. While, total cholesterol, p-value=0.04∗and Glutamate Pyruvate Transaminase (GPT), p-value=0.03∗ increased significantly in the case group on comparision to the control group. On the other hand, erythrocyte Malondialdehyde (MDA) levels, p-value=0.009∗∗increased very significantly in the case group compared to controls. The erythrocyte activity catalase decreased highly significantly in the case group compared to the controls. But erythrocyte Reduced glutathione (GSH) decreased very significantly in group cases compared to controls. Conclusion: The findings in the present study confirmed the persistence of metabolic alterations and oxidative stress in COVID-19 patients after recovery. Antioxidant supplementation is recommended to improve redox status and reduce oxidative stress after recovery.

18.
Diabetes ; 71, 2022.
Artigo em Inglês | ProQuest Central | ID: covidwho-1923919

RESUMO

The use of telehealth for Diabetes Self-Management Education and Support (DSMES) is expanding. There is a need among people with diabetes (PWD) to manage their diabetes, as they represent 20% of ICU admissions, 30% of hospitalized cases and have an increased risk of COVID-related mortality. While people at risk for diabetes or prediabetes may join a 1-year CDC accredited diabetes prevention program to make lifestyle changes to reduce their diabetes risk, PWD are often offered short-term DSMES programs that do not necessarily incorporate long-term goals. We developed a year-long intensive Diabetes Self-Management Education and Support (iDSMES) program combining Virtual Diabetes Conversation Map® and selected modified modules from the PreventT2® curriculum to suit PWD. The curriculum included 18 maps/modules. Our team of certified lifestyle coaches/diabetes educators/Conversation Map® Trainers used shared decision-making and problem-solving approaches to improve glycemic control and diabetes self-management. We hypothesized that iDSMES would improve diabetes outcomes in PWD. Fourteen PWD (12F/2M) with a BMI of 25 or above underwent the iDSMES in a group with their lifestyle coaches using the Zoom® platform. We collected their fasting blood glucose, weight, blood pressure, and physical activity minutes at each session (every three weeks) and assessed their Hemoglobin A1c quarterly. Nine PWD completed the iDSMES and lost an average of 8.8% of their initial body weight (a total of 203lbs) . We observed a 1% decrease in their A1c, 10mg/dL decrease in fasting blood glucose, and mm Hg decrease in systolic and diastolic blood pressure, respectively. There was also a 110-minute increase in their physical activity. A year-long iDSMES distance learning program effectively enhances lasting lifestyle changes to improve diabetes self-management in PWD. A 5-year follow-up is warranted to assess factors affecting the maintenance of accomplished lifestyle changes.

19.
Diabetes ; 71, 2022.
Artigo em Inglês | ProQuest Central | ID: covidwho-1923918

RESUMO

Background: The lockdown due to the COVID-pandemic in April 2020 led to the suspension of face-to-face diabetes care and education. In this period, management of diabetes emergency was a challenge because it needed rapid recognition, diagnosis and treatment. Despite adverse situations, many DAFNE graduates had chosen to fast during Ramadan. This was supported virtually to DAFNE graduates through intermittently scanned continuous glucose monitoring (isCGM) . Aims: This study aimed to compare the isCGM glucose metrics of people with T1D who fasted during Ramadan. Methods: Baseline and fasting period isCGM data were collected. The primary outcome measures HbA1c, time in range [ (TIR) 3.9- mmol/L], time below range [ (TBR) <3.9 mmol/L], coefficient of variation (CV) , and self-reported adverse events. Results: A total of 35 people with T1D fasted with a median of 20 days. Mean HbA1c was 7.5 (0.93) % and 7.4 (0.91) % before and after fasting periods, respectively. No significant change in TIR (pre 61.1 ± 17.9% vs. during 61.9 ± 14.9%) and TAR (pre 32.1 ± 19.0% vs. during 33.1 ± 15.6%) were found. However, TBR (pre 6.8 ± 5.4% vs. during 5.0 ± 4.6%) was significantly decreased (p= 0.045) . The CV (-2.3%) and low glucose events (-5.0) also decreased during the fasting period (p≤ 0.010) . No episodes of severe hypoglycemia, DKA, or hospitalization occurred during the fasting period. Conclusions: DAFNE graduates can fast safely without the fear of hypoglycemia, and safe metrics of glycemia using diabetes self-management skills, including disaster situations like the COVID-pandemic.

20.
Internal Medicine Journal ; 52(SUPPL 1):7, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1916177

RESUMO

Background: Upper gastrointestinal bleeding (UGIB) is a common gastrointestinal emergency and carries a high morbidity and mortality. There are multiple risk factors for poorer outcomes, including malnutrition. Ascorbic acid is a water-soluble vitamin present in most plant foods. Dietary deficiency leads to scurvy, which may alter the natural history of UGIB through impaired tissue and mucosal integrity. Traditionally thought to be rare in developed countries, Vitamin C deficiency (VCD) is now well described in patients with pneumonia, sepsis and COVID-191, 2. There is a paucity of literature investigating the prevalence and clinical significance of VCD in UGIB;interim findings reported by our group suggested a prevalence of >30%. Aim: The aim of this study was to establish the prevalence of VCD in patients presenting with UGIB and its association with clinical outcomes. Methods: We conducted a prospective cohort study of adult patients presenting with UGIB to two metropolitan tertiary hospitals in Melbourne, Australia over a 12-month period (March 2020 to March 2021). Fasting Vitamin C levels were obtained on admission. Patients were risk stratified using the AIMS65 score and baseline demographic data and outcomes were recorded. The primary outcome was the prevalence of VCD (serum Vitamin C level <23mcmol/L) and severe VCD (<12mcmol/L). Secondary outcomes included a composite endpoint of adverse events (AE), comprising inpatient death, intensive care unit (ICU) admission, rebleeding, surgery, angioembolisation or massive transfusion (≥4 units of red cells). Multivariate logistic regression was used to determine the association between Vitamin C levels and the secondary endpoints. Subgroup analyses were performed in variceal and non-variceal UGIB and high- (AIMS65≥2) and low-risk (AIMS65 0-2) UGIB. Results: 227 patients were included. The mean age was 65±17 years, 145 (63.9%) were male and median AIMS65 score was 1 (IQR 1-2). The aetiology of UGIB was variceal bleeding in 20.3%, peptic ulcer disease (PUD) in 44.1% and other causes in 35.7%. The mean Vitamin C level was 40±26mcmol/L. In terms of patient outcomes, inpatient mortality was 4%, ICU admission occurred in 11.9% and mean length of stay (LOS) was 7.7±9.7 days. Red cell transfusion was required in 63.4% of patients with a mean requirement of 2.2±2.8 units. VCD was identified in 74 patients (32.6%) with severe deficiency in 32 (14.1%). VCD was associated with significantly higher in-hospital mortality (9.5% vs. 1.3%, p=0.01), prolonged LOS (10.8 vs. 6.2 days, p<0.01), rebleeding (17.6% vs. 7.88%, p=0.05) and a higher composite endpoint of AE (77% vs. 54.9%, p<0.01). At multivariate logistic regression, high-risk UGIB (OR 3.24, CI 1.42-7.42), VCD (OR 2.28, CI1.11-4.71) and chronic liver disease (OR 11.66, CI 2.92-46.64) were all independently associated with the composite endpoint of AE. At subgroup analysis, VCD was associated with a significantly increased composite endpoint of AE in patients with non-variceal (74% vs. 51%, p<0.01) and low-risk UGIB (66% vs. 44%, p=0.04). Conclusion: VCD is highly prevalent in patients with UGIB and associated with poorer outcomes, including higher mortality, rebleeding and LOS. Interventional studies are required to determine the impact of early Vitamin C supplementation on clinical outcomes.

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