Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 9 de 9
Filtrar
1.
Medical Immunology (Russia) ; 24(2):389-394, 2022.
Artigo em Russo | EMBASE | ID: covidwho-1957613

RESUMO

Coronary artery disease (CAD) is widely considered a chronic inflammatory disorder, and dysfunction of epicardial adipose tissue could be an important source of the inflammation. Amino-terminal fragment of pro-B-type natriuretic peptide (NT-proBNP) is a known marker of cardiovascular disorders of cardiac origin. Recent studies show that inflammatory stimuli may influence its secretion. Our purpose was to evaluate NT-proBNP serum concentration in relation to immune cell ratios in epicardial adipose tissue (EAT), and cytokine levels in the patients with stable CAD. Patients with stable CAD and heart failure classified into classes II-III, according to the New York Heart Association (NYHA) scale, scheduled for the coronary artery bypass graft (CABG) surgery, were recruited into the study (n = 10;59.5 (53.0-65.0) y. o.;50% males). The EAT and subcutaneous adipose tissue (SAT) specimens were harvested in the course of CABG surgery. Immunostaining with anti-CD68, anti-CD45, anti-IL-1β and anti-TNFα monoclonal antibodies was performed to evaluate cell composition by differential counts per ten fields (400 magnification). Fasting venous blood was obtained from patients before CABG. Blood was centrifuged at 1500g, aliquots were collected and stored frozen at -40 °С until final analysis. Concentrations of NT-proBNP, IL-1β, IL-6, IL-10, TNFα were determined in serum samples by enzyme-linked immunosorbent assay (ELISA). We have found increased production of IL-1β and TNFα cytokines in EAT compared to SAT. Concentrations of NT-proBNP exceeded 125 pg/ml in 4 patients, and correlations between the CD68+ macrophage counts in both EAT and SAT samples (rs = 0.762;p = 0.010 and rs = 0.835;p = 0.003, respectively). NT-proBNP levels showed positive relations with CD45+ leukocyte counts (rs = 0.799;p = 0.006), and with IL-1β+ cell numbers (rs = 0.705;p = 0.023) in EAT samples only. As for the serum biomarkers, NT-proBNP levels showed negative correlation with fasting glucose levels (rs = -0.684;p = 0.029), and positive correlation with serum IL-6 concentrations (rs = 0.891;p = 0.001). Increased serum concentrations of NT-proBNP in CAD patients correlate with accumulation of macrophages in EAT, which is associated with increased production of IL-1β in EAT and correlates with some metabolic parameters.

2.
Neurology ; 98(18 SUPPL), 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1925270

RESUMO

Objective: To report a case of a patient who developed acute disseminated encephalomyelitis in the setting of recent COVID-19 vaccination. Background: NA Design/Methods: Data was obtained through the medical records system of Westchester Medical Center in Valhalla, New York. Results: We report on a 53-year-old female patient with a past medical history of obstructive sleep apnea who presented in the emergency room (ER) with left-sided numbness and weakness, ataxia, vertigo, and slurred speech in the context of a three month long history of headaches that started one day after she received her first dose of COVID-19 vaccine. Brain imaging studies showed findings most suggestive of acute disseminated encephalomyelitis (ADEM). Initial pretreatment cerebrospinal fluid (CSF) analysis showed markedly elevated protein with normal glucose level. Extensive workup was negative for infectious, oncologic, autoimmune, and psychiatric etiologies. Over the course of hospitalization, the patient was found to have isolated elevated liver function tests (LFTs) with transaminitis and hepatomegaly on ultrasound. The initial treatment of a five-day methylprednisolone course did not result in significant clinical improvement. The patient was then started on plasma exchange therapy (PLEX) and successfully recovered by the end of the last session. Conclusions: Our case report exemplifies a rare but severe neurologic condition observed in the setting of recent COVID-19 vaccination in a previously healthy woman.

3.
Neurology ; 98(18 SUPPL), 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1925234

RESUMO

Objective: NA Background: Acute disseminated encephalomyelitis (ADEM) is an inflammatory disease of the central nervous system thought to be caused by environmental factors to genetic susceptible individuals, where there is autoimmunity towards myelin components. Given the wide variety of symptoms, etiology and mimickers, ADEM is a diagnosis of exclusion, making difficult a prompt diagnosis. The pathogenesis associated between COVID-19 and ADEM is unknown, however, it could be secondary to immune-mediated mechanisms or molecular mimicry, creating a neuro-inflammatory response. Design/Methods: A previously healthy 22-year-old Puerto Rican male presented to the ED with altered mental status, incoherent speech, imbalance, and dizziness of 2 months progression. Neurological examination was remarkable for slow mentation, positive right Hoffman, left leg weakness and bilateral sustained clonus. Brain MRI showed innumerable foci of increased T2/FLAIR signal intensity throughout supra and infratentorial gray and white matter, none showing contrast enhancement. CSF with evidence of high protein levels, WBC of 7 (100% mononuclear) and normal glucose levels. Extensive workup for evaluation of infectious, demyelinating, inflammatory and vascular etiologies came back negative. Patient with recent history of gastrointestinal symptoms, reason why COVID-19 IgG/IgM Rapid Test was performed with positive IgG results 2 months prior to our evaluation. Patient was treated with intravenous steroids and intravenous immunoglobulin, with marked clinical improvement. Results: NA Conclusions: Here we present a case of atypical coronavirus disease 2019 (COVID-19) manifestation of a Puerto Rican male patient that 2 weeks after detecting SARS-COV-2 on his blood neurological symptoms started to develop. This is the first case of a young Puerto Rican patient without any other comorbidities where an association of COVID-19 infection and ADEM was found. Since ADEM if a diagnosis exclusion, it is vital to being able to distinguish this syndrome when it comes to a patient with history of COVID-19 infection and vaccine for prompt management.

4.
Diabetes Technology and Therapeutics ; 24(SUPPL 1):A113-A114, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1896136

RESUMO

Background and Aims: After the artificial pancreas (AP) trials performed in 2016-7 with DiAs system, during the COVID-19 pandemic the first outpatient clinical trial was carried out in Argentina. The main objective was to evaluate the feasibility of running full closed-loop (FCL) algorithms in an own and free platform developed from open-source resources. Methods: The ARG project (Automatic Regulation of Glucose) aims at developing a robust AP algorithm prioritizing patient autonomy. The evolution of the project phases is summarized in the figure. The last step towards this objective was the implementation of a FCL algorithm in our InsuMate platform and its evaluation in an outpatient setting. Five adults with DMT1 completed one week of study, consisting in 3 days of open-loop (OL) followed by 3 days of FCL (i.e., without CHO counting and without delivering meal priming insulin boluses). Accu-Chek pumps and Dexcom G6 CGMs were used. Results: When analyzing the full duration of the trial, the time in range increased in FCL control vs. OL, while the time above range decreased, as did the mean BG. On the other hand, the time below range and the time in severe hypoglycemia remain similar across methods, both achieving the ADA recommended values. The FCL showed greater improvement by the end of the trial, particularly for daytime metrics. InsuMate properly operated in FCL for an average of 95.4% of time. Conclusions: It can be concluded from this experience that the outpatient automatic regulation of glucose levels using the ARG algorithm and Insumate platform is feasible, safe, and effective. (Figure Presented).

5.
2nd International Conference on Power Electronics and IoT Applications in Renewable Energy and its Control, PARC 2022 ; 2022.
Artigo em Inglês | Scopus | ID: covidwho-1774685

RESUMO

The exponential surge in India's coronavirus infections over the past months has swamped the health care system, which limited the supply of medical oxygen cylinders. Dozens of hospitals in several Indian cities and towns have run short of oxygen cylinders and also lack continuous monitoring of patients due to labor shortage and patient admitted exponentially. This leads to the lack of attention to patients who advanced to critical complications. To overcome this, it is proposed to automatically measure the pulse rate, the oxygen level in the cylinder, and glucose level by weight with the help of a microcontroller and load cell. The real-time data send to hospital management to change or resupply. It will lead to the continuous monitoring of the patient and reduce the risk. The proposed method will ensure patient safety and also has alert the doctors if any unforeseen problems or accident occurs. © 2022 IEEE.

6.
Indian Journal of Hematology and Blood Transfusion ; 37(SUPPL 1):S75, 2021.
Artigo em Inglês | EMBASE | ID: covidwho-1632096

RESUMO

Introduction: The second wave of COVID has been devastating inIndia and many developing countries. The mortality has been reported40% higher than in the first wave overwhelming the nation's healthinfrastructure. Despite better understanding of the disease andestablished treatment protocols including steroids and heparin;thesecond wave was disastrous. Subsequent waves have the potential tofurther cripple health care deliveries affecting non COVID care alsoacross many developing economies. It is then important to identifyand triage high risk patients to best use the limited resources.Aims &Objectives: The objective of this study was to identifypotential predictors of mortality in the second wave who accessedhealth care at our academic setup.Materials &Methods: All patients admitted at our centre from 01February through June 15 2021 were included in the analysis. Areduced set of potential predictor variables was selected a priori,which included routine investigations sent on patient admission at ourcenter. These were bundled as groups namely;coagulation markers(INR, APTT, Fibrinogen, d-Dimer), Inflammatory markers (ESR,CRP, Ferritin), Hemogram, Liver function tests, Renal function tests,Arterial blood gas analytics and Glucose levels at admission (measured using the arterial blood gas analyzer).We used a two stage model building process.Result: We collected data from 790 patients. The overall mortalityrate was 10% (79 patients). The median age of patients in the cohortwas 57 years (range 1-99). Patients travelled a distance of 25 km (1-262 km) to seek care. We identified 78 candidate predictor variablesmeasured at hospital admission.n entering variables into a logisticregression model [least absolute shrinkage and selection operator] 4variables were retained within the final model. We identified 4important (Table 1) predictors of mortality by using this modelling:LDH, Oxygen Saturation in Abg (SO2), Neutrophil count and Glucose level at admission >LDH 675 U/L, Oxygen SO2 C 94%Neutrophil count C 7000/mm3 and Glucose value > 132 mg/dL].Using a ROC a 'c' measure of 0.834 corresponded to the modeldiscriminating the response.Conclusions: In our analysis, 4 variables which include LDH, Oxygen saturation, Neutrophil count and Glucose measurements atadmission are important predictors of mortality. Their role need moreresearch;possibly reflective of roles of NETs in the inflammatorycascade of severe covid.

7.
Obesity ; 29(SUPPL 2):86, 2021.
Artigo em Inglês | EMBASE | ID: covidwho-1616064

RESUMO

Background: Growing interest in very low carbohydrate diets, and in particular the ketogenic diet, has been met with some resistance. Important gaps exist regarding what diet to compare to the ketogenic diet. The objective of this study was to compare a Well Formulated Ketogenic Diet (WFKD) with a Mediterranean-Plus diet (Med-Plus;Mediterranean with emphasis on eliminating added sugars and refined grains), in a crossover study, stratified by diabetes status (T2D vs Prediabetes). Methods: The intervention involved having participants follow the WFKD and Med-Plus, for 12 weeks each, in random order. All meals were provided for the first 4 weeks of each diet phase (food delivery);then participants were responsible for purchasing and preparing their own foods (self-provided). The primary outcome was glycosylated hemoglobin (HbA1c). Secondary outcomes included weight, glucose as measured by continuous glucose monitor (CGM), and cardiometabolic risk factors, such as fasting insulin, glucose, and lipids. Results: Among participants randomized (n = 42), 33 had complete data at both diet phases (some missing data attributable to COVID disruptions). Participants were 60 ± 9 (mean ± sd) years of age, 61% men, with BMI 31 ± 5 kg/m2. Adherence for both diets was higher during the food delivery than the self-provided phase, but similar between diets for both phases. HbA1c concentrations were not significantly different between diets, but average CGM glucose levels were significantly lower during the WFKD compared to Med-Plus (p = 0.03). Additionally, WFKD induced a significantly greater decrease in triglycerides (-16% vs -5%, p = 0.02) and greater increase in LDL-C levels (10% vs -5%, p = 0.01), compared to Med-Plus. Weight change on WFKD vs Med-Plus was -8% vs -7% (p = 0.05). Sensitivity analyses largely confirmed the main findings. Conclusions: Participants improved in glucose control and weight management on both diets relative to baseline;however, glucose control was superior on the WFKD. Some caution is warranted when interpreting these results due to pandemic disruptions and a small sample size. A fair comparison of the two diets should also take into consideration non-glycemic effects.

8.
Pediatric Diabetes ; 22(SUPPL 30):143-144, 2021.
Artigo em Inglês | EMBASE | ID: covidwho-1571031

RESUMO

Introduction: Neonatal diabetes mellitus (NDM) is a rare monogenic form of diabetes occurring mainly in the first 6 months of life. Approximately 30% of transient NDM cases have an activating mutation in the KATP channel genes ABCC8 and KCNJ11. The majority of transfers from insulin to sulfonylureas in patients with KCNJ11 mutations are done inside the hospital. Objectives: To report a case of transient neonatal diabetes mellitus (TNDM) where precision medicine, defining treatment based on molecular diagnosis and technology (intermittent continuous glucose monitoring-iCGM) allowed to make treatment adjustments with the patient safely at home, in times of COVID-19 pandemic. Methods: Case report of a patient with TNDM in use of iCGM. Results: A boy with transient NDM due to the p.E227K mutation in the KCNJ11 gene. Diabetes remitted at 30 months and relapsed at 6 years of age. Insulin was initiated and soon transition to glibenclamide was proposed with the use of iCGM, which allowed the patient to safely stay at home during the transition, especially important in the context of the COVID-19 pandemic. The data was uploaded to an online platform that allowed the medical team to perform remote daily checks on glucose levels and suggest treatment changes. During insulin therapy, the device's 14-day analysis revealed a glucose management index (GMI) of 7,2% and 72% of time in range (TIR). Patient's glucose profile improved rapidly after SU was initiated so that insulin therapy was discontinued. After four months of SU treatment, GMI was 6,2% with 93% of TIR (Figure 1). Conclusions: NDM is a model of a genetic disease that can benefit from precision medicine, where treatment is defined after molecular diagnosis, and that iCGM is a valuable tool that should be considered to monitor glucose, increase safety and speed up dose adjustments in outpatient transition from insulin to glibenclamide. As far as we understand the use of iCGM was not reported in this situation previously.

9.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 51(2): 146-150, 2020 Mar.
Artigo em Chinês | MEDLINE | ID: covidwho-18395

RESUMO

Based on the higher mortality and the higher proportion of critically ill adults in coronavirus disease 2019 (COVID-19) patients with diabetes, good inpatient glycemic control is particularly important in the comprehensive treatment of COVID-19. Individualized blood glucose target goals and treatment strategies should be made according to specific circumstances of COVID-19 inpatients with diabetes. For mild patients, a strict glycemic control target (fasting plasma glucose (FPG) 4.4-6.1 mmol/L, 2-hour postprandial plasma glucose (2 h PG) 6.1-7.8 mmol/L) are recommended; a target for the glycemic control of common type patients (FPG 6.1-7.8 mmol/L, 2 h PG 7.8-10.0 mmol/L) and subcutaneous insulin deliver therapy are recommended; a target nonfasting blood glucose range of 10.0 mmol or less per liter for severe-type COVID-19 patients, a relatively Less stringent blood glucose control target (FPG 7.8-10.0 mmol/L, 2 h PG 7.8-13.9 mmol/L) for critically ill patients and intravenous insulin infusion therapy are recommended. Due to the rapid changes in the condition of some patients, the risk of diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar status (HHS) maybe occur during the treatment. Blood glucose monitoring, dynamic evaluation and timely adjustment of strategies should be strengthened to ensure patient safety and promote early recovery of patients.


Assuntos
Betacoronavirus , Glicemia , Infecções por Coronavirus/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Pneumonia Viral/complicações , Adulto , Glicemia/efeitos dos fármacos , Glicemia/metabolismo , COVID-19 , Diabetes Mellitus Tipo 2/complicações , Cetoacidose Diabética/etiologia , Cetoacidose Diabética/prevenção & controle , Humanos , Hiperglicemia/tratamento farmacológico , Coma Hiperglicêmico Hiperosmolar não Cetótico/etiologia , Coma Hiperglicêmico Hiperosmolar não Cetótico/prevenção & controle , Pandemias , SARS-CoV-2
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA