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1.
Annals of Medicine and Surgery ; 81, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2031101

RESUMO

Introduction: Chronic extrahepatic non-tumoral thrombotic portal vein occlusion in non-cirrhotic patients is a rare condition, affecting 5–10% of patients with portal hypertension. Presentation of case: The present study reports the case of a young patient without previous comorbidities who presented with portal hypertension secondary to chronic extrahepatic non-tumoral thrombotic occlusion of the portal vein. He underwent portal recanalization with a 12 × 80 mm nitinol self-expandable stent and embolization of esophagogastric varices with fibrous springs and cyanoacrylate via transparieto-hepatic access. Immediate resolution of the trans-lesion pressure gradient was obtained transoperatively, while complete remission of esophagogastric varices was verified by endoscopic control during outpatient follow-up. Discussion: Chronic portal vein occlusion is associated or not with liver cirrhosis. The chronic phase is characterized by cavernomatous transformation of the portal vein, which consists of the formation of multiple collaterals that bypass the lesion. This phase usually courses with portal hypertension and consequent variceal gastrointestinal bleeding. Decompression of the portal system through direct recanalization (angioplasty with stenting) is one therapeutic options. Conclusion: We conclude that, in the present case, resolving portal hypertension by direct portal recanalization was a good therapeutic option, as it decompressed the portal system while maintaining the hepatopetal flow.

2.
Journal of the ASEAN Federation of Endocrine Societies ; 37:8, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2006564

RESUMO

Introduction The management of teenagers with diabetes during the COVID-19 pandemic has become more challenging with the negative psychosocial impact brought upon by the pandemic. Methodology We embarked on a cross-sectional study to identify the factors influencing glycaemic control (HbA1c) among teenagers with diabetes during the COVID-19 pandemic. Interviews regarding lifestyle changes were conducted among teenagers with type 1 (T1DM) and type 2 diabetes mellitus (T2DM), followed by the administration of the Depression, Anxiety, and Stress Scale (DASS-21). Results A total of 59 adolescents with T1DM (32 males, 54.2%) and 31 patients with T2DM (10 males, 32.3%) were recruited. Overall, the HbA1c worsened from 9.13% before the COVID-19 pandemic to 9.33% during the pandemic (p-value 0.039). Significant factors which negatively influenced glycaemic control were male sex, puberty, prolonged screen time, presence of symptoms of anxiety/stress, and T2DM. However, skipping breakfast, sleep adequacy and physical activity did not directly influence the HbA1c. About one-third of the participants suffered from some form of mental disturbance (31.1% of patients had depressive symptoms, 38.9% of patients had anxiety symptoms, and 23.3% of patients experienced stress). The incidence of depression was higher among participants with T2DM, while anxiety and stress were higher among those with T1DM. Male gender, good glycaemic control pre-pandemic, and prepubertal status were associated with depressive symptoms during the pandemic. Conclusion Besides the disruption of daily routine, glycaemic control worsened among diabetic adolescents during the COVID-19 pandemic. A holistic management plan is needed to address the psychosocial concerns of this group to ensure optimal mental well-being and appropriate glycaemic control.

3.
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.

4.
Journal of the ASEAN Federation of Endocrine Societies ; 37:46, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2006560

RESUMO

Introduction Management of type 1 diabetes mellitus (T1 DM) patients in early adulthood is associated with unique challenges. COVID-19 pandemic had significantly impacted the quality of patient follow-up and access to care. This study assessed the characteristics of T1 DM patients under diabetes onestop clinic (DOSC) follow-up in Hospital Sultan Haji Ahmad Shah (HoSHAS), Temerloh, Pahang and the impact of the pandemic on diabetes control. METHODOLOGY In this cross-sectional study, all T1 DM patients under active follow-up were recruited. Data regarding demographics, diabetes control and COVID-19 infection status were reviewed. Further analyses were performed by dividing them into 2 groups according to COVID-19 infection status: COVID-19 positive (group 1) and COVID-19 negative (group 2). Results Thirty T1 DM patients [60% female, 63.3% Malay ethnicity, mean age 24.4 (SD7.4) years, median weight 58.35(IQR 10.3) kg, median disease duration 6.0 (IQR 8.0) years, mean duration under DOSC follow-up 4.1(SD 1.6) years] were analysed. Incident retinopathy was seen in 10.0% of patients. Within the past 12 months, 26.7% had recent hospitalisation, majority due to diabetes ketoacidosis. Within the past 3 months, 13.3% had experienced hypoglycaemia. Mean HbA1c in T1 DM increased steadily from 2019 to 2020 and 2021 (8.87% vs 8.93% vs 9.35%). Thirteen T1 DM patients (46.4%) had COVID-19 infection between 2020 and 2022. Patients with COVID-19 infection had lower HbA1c than those not infected but it was not statistically significant (8.74% vs 9.07%, p=0.82). They also tended to have more microvascular complications. Conclusion COVID-19 pandemic had negatively impacted diabetes control in our cohort. There was also a high hospitalisation rate during this period. The HbA1c level was not associated with increased risk of COVID-19 infection in our cohort.

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.
Frontiers in Endocrinology ; 13, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2005860

RESUMO

A 39-year-old-woman with a past medical history of type 2 diabetes mellitus (T2DM) on oral hypoglycemic agents presented to the emergency room with nausea, vomiting, shortness of breath, and altered mental status. Seven days prior to presentation, she was diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Laboratory workup on presentation confirmed the diagnosis of diabetic ketoacidosis (DKA) (blood glucose 523 mg/dl, beta-hydroxybutyrate 8.91 mmol/l, pH 6.9, bicarbonate 11 mEq/l, anion gap 25 mEq/l, and HbA1c 10.8%). She was managed for DKA with hydration and insulin drip and discharged home. However, to our surprise, at the 2-week follow-up visit, she was found to have positive antibodies for zinc transporter 8 (ZnT8) (samples were collected on day of presentation). The rest of her antibodies associated with T1DM were negative. She was therefore started on a basal-bolus regimen and managed as type 1 diabetes mellitus (T1DM). Our case illustrates that there is an increased risk of T1DM following infection with SARS-CoV-2.

7.
Diabetes Research and Clinical Practice ; 186, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2004012

RESUMO

Background: Diabetes and its association with poor outcomes in patients with COVID-19 is a well established fact. In this study, we are focusing on gender differences in age of occurrence of COVID 19, gender differences in patients with newly diagnosed diabetes vs established diabetes. Through this study, we are trying to focus on gender specific diabetes care in the background of the current pandemic. Aim: 1. To compare the gender differences in age of occurrence of Covid 19. 2. To find out the gender difference in patients with newly diagnosed diabetes vs established diabetes. Method: All patients admitted to the Voluntary Health Services (VHS) hospital with confirmed COVID-19 from May 2020 - May 2021 were included. Established diabetes was determined using patients’ history and patients were considered to have newly diagnosed diabetes if the HbA1c level at admission was ≥6.5% and no known history of diabetes. Age was categorised into five groups: Group 1: Those below 25, Group 2 :25–40, Group 3: 41–60, Group 4: 61–80, Group 5: Above 80. The data was retrieved from our hospital medical records. Results: Of 497 patients who had Covid with diabetes, we could include 411 patients for the analysis of newly diagnosed vs established diabetes. The results were as follows: (See Table 1 and 2) This study has revealed that the incidence of newly diagnosed diabetes is higher in men. As for clinical outcome, mortality rate was higher in men than women. More men got admitted with COVID 19 than women in all age groups. Discussion: Our study has revealed that overall 42.8% were under the age of 60. More men had Covid at all ages and their outcomes were poorer. More men had new onset diabetes than women. Nearly 25% of the men and 15% of the women had new onset diabetes which has serious implications for future burden of diabetes. Follow up is the need of the hour especially for women who already have an increased lifetime risk of diabetes.

8.
Diabetes Research and Clinical Practice ; 186, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2004011

RESUMO

Background: Covid-19 and its association with comorbidities especially diabetes has been a global public health challenge. While more men have developed Covid 19, there is limited data on gender differences in glycemic status on admission need to be understood. Aim: To study the gender differences on admission HbA1c in patients hospitalized with Covid-19 and diabetes. Method: All patients admitted to Voluntary Health Services (VHS) with confirmed COVID-19 from May 2020 - May 2021 were included. Diabetes was determined using patients’ past history (diagnosed) or was newly diagnosed if the haemoglobin A1C (HbA1c) level at admission was ≥6.5%. Based on the HbA1c level, the patients were divided into five groups. Group 1: Those below 7%, Group 2:7–8%, Group 3: 8.1–10%, Group 4: 10.1–12%, Group 5: above 12%. Patients with HbA1c more than 8 were categorised as having poorly controlled diabetes. The data was retrieved from our institution's medical records and recorded in excel files for further statistical analysis. Results: Of 497 patients who had Covid with diabetes, 342 patients with admission A1c were included for the analysis. Out of 342, 120 (35.1%) were women and 222 (64.9%) were men respectively. The results: Women with HbA1c below 7% n = 22 (22.2%), between 7–12% n = 21(17.1%), above 12% n = 15 (12.8%). Men with A1c value below 7% n = 61 (26.8%), between 7–8% n = 54 (24.5%), 8.1–10% n = 55 (25.0%), 10.1–12% n = 32 (14.5%), above 12% n = 20 (9.1%). This study has revealed that women have poorer baseline glycemic control than men on admission. (See Table 1) Discussion: The gender difference in patients with Covid 19 and DM is not well documented. With this present study, we observed that women have poorly controlled diabetes than men in all subgroups with A1c > 8. This study shows the gender centric impact of the pandemic and given the socioeconomic impact the pandemic is likely to have on the long-term care of women with diabetes, there is an urgent need to create effective communication, policies and interventions to promote optimal care in this vulnerable group.

9.
Diabetes Research and Clinical Practice ; 186, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2004010

RESUMO

Background: Patients with diabetes mellitus (DM) are at increased risk for intubation, death, and other complications from COVID-19. However, the importance of a patient’s glycemic control preceding the COVID-19 infection is less well understood. Method: From March to November 2020, data from adult patients with confirmed COVID-19 admitted to Rush University System for Health (RUSH) was studied. Patients with both a pre-existing history of diabetes mellitus (DM) and a hemoglobin A1c (HbA1c) measurement during their hospitalization were included. Based on their HbA1c, patients were then divided into 4 groups: adequate glycemic control (≤ 6.5), mild elevation (6.5 – 7.4), intermediate elevation (7.5 – 8.4), and severe elevation (≥ 8.5). Multivariable logistic regression, adjusted for age, body mass index, and pre-existing history of atrial fibrillation, coronary artery disease, hypertension, and chronic obstructive pulmonary disorder, was performed with glycemic control group as a predictor for 60-day mortality and severe COVID-19, which was a composite of 60-day mortality or requiring the intensive care unit, non-invasive positive pressure ventilation, or mechanical ventilation. Major adverse cardiac events (MACE) were defined as nonfatal myocardial injury, nonfatal stroke, or cardiovascular death. Results: Of the 1682 patients admitted, 774 had pre-existing DM, and 534 had HbA1c measurement during their hospitalization. The median HbA1c value was 8.0% (interquartile range 6.6% – 9.9%). In our entire cohort, 75 (14.0%) and 280 (52.4%) patients suffered 60-day mortality and severe COVID-19 infection, respectively. When adjusting for baseline characteristics and comorbidities, patients with mild (adjusted odds ratio [aOR] 2.39 [CI 1.04 – 5.83];p < 0.05) and intermediate (aOR 3.59 [CI 1.49 – 9.12];p < 0.01) HbA1c elevation were at increased risk of 60-day mortality compared to those with adequate glycemic control;no statistically significant difference was present in those with severe elevation (aOR 2.19 [CI 0.95 – 5.44];p = 0.08). Furthermore, only the mild HbA1c elevation group was at increased risk for severe COVID-19 infection (aOR 1.88 [CI 1.06 – 3.38];p < 0.05). Those with intermediate (aOR 1.77 [CI 0.94 – 3.33];p = 0.08) or severe (aOR 1.57 [CI 0.92 – 2.70];p = 0.10) HbA1c elevation were not at higher risk for severe COVID-19 infection. When comparing other 60-day outcomes, there was no difference between the glycemic groups in MACE, life-threatening arrhythmia, deep venous thrombosis, acute renal failure requiring renal replacement therapy, and pulmonary embolism (Table 1). Discussion: In our cohort, patients with DM with an HbA1c of 6.5 – 8.4 were at increased risk of 60-day mortality, while those with an HbA1c of 6.5 – 7.4 were at an increased risk of severe COVID-19 infection.

10.
Diabetes Research and Clinical Practice ; 186, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2004008

RESUMO

Background: Glycemic imbalance has long been recognized as a major vascular risk factor, and in the can be considered an authentic vascular condition that accelerates the development of chronic complications and major cardiovascular events in diabetics. Aim: The main aim of this study is to determine the correlation between the deferential glycemic profile parameters in order to assess the linkage of these parameters with cardiovascular risk score and chronic complications. Method: During this Covid pandemic, a cross-sectional descriptive and analytical study was included 384 Algerian diabetic patients (189 men, 205 women) with a 9-month follow-up. The diagnostic criteria for diabetes have been defined according to FID and WHO guidelines. Fasting blood sugar levels, GPP and HbA1c, prevalence of chronic complications and cardiovascular risk score were evaluated. Multifactor statistical analysis was performed by Software R studio (Package for Social science software), significance was set at p < 0,05. Results: The mean ± SD age of the patients was 61.28 ± 10.04 with mean fasting blood sugar (61.28 ± 10.04), PPG (3.59 ± 1.02) and HbA1c (8.67 ± 1.64%). PPG and FPG are positively and significantly correlated with HbA1c (regression curves;Figure 1) with a stronger correlation between FPG and HbA1c (r = 0.698). A significant association between Hb1Ac and cardiovascular risk score was noted in patients at very high risk and those at high risk (p-value <10-3). This clinical adherence was the object of studying the multifactorial relationship between Hb1Ac, dyslipidemia and BMI, the correlation of which was significantly positive with r = 0.852. In view of these results and the emergence of significant links, the correlational study by the application of the Pearson test between the variabilities studied, the risk score and the chronic complications shows that there is a very strong association between PPG, Hb1Ac, cardiovascular risk score and macroangiopathy complication. Likewise, the correlation was also positive but moderately significant between FPG, Hb1Ac, and microangiopathy complications. (Correlation matrix in Figure 2). Discussion: The HbA1c is the essential tool for monitoring diabetic patients, its level reflecting glycemic equilibration. It is widely accepted that the glycemic balance of diabetic patients is a complex “alchemy” involving both changes in fasting blood sugar and changes in postprandial blood glucose. The study demonstrated the link between these three parameters and determined its relationship to chronic complications. In this way, glycemic balancing reduces the micro-vascular complications of diabetic patients.

11.
Diabetes Research and Clinical Practice ; 186, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2004007

RESUMO

Background: Diabetes is one of the main non-communicable diseases with alarming prevalence in the world, including in Algeria. Diabetes is characterized by chronic hyperglycemia accompanied by a metabolic disorder of carbohydrates, lipids and proteins. A level of glycated hemoglobin (HbA1c) ≥ 6.5% was included as a diagnostic criterion for diabetes. The altered lipid profile is commonly present in type 2 diabetes. Patients with type 2 diabetes (T2DM) have an increased prevalence of dyslipidemia, which contributes to their high risk of cardiovascular disease (CVD). Aim: This study is an attempt to determine the correlation between the serum lipid profile and blood glucose and to assess the importance of HbA1c as an indicator of dyslipidemia. Method: This descriptive and analytical cross-sectional study was carried out during this Covid pandemic, at the level of the diabetic house and the Khemis Meliana hospital (North Algerian) over a period of 9 months. A total of 384 patients with T2DM aged 30 to 89 years were selected for this purpose. Dyslipidemia was defined according to the guidelines of the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III). Diabetes has been defined according to the criteria of the American Diabetes Association. The levels of fasting blood sugar, total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglycerides (TG) and glycated hemoglobin (HbA1c) were evaluated. Statistical analysis was performed by R studio software (Package for Social science software). The significance test was calculated by the unpaired Student “t” test. Correlation studies (Pearson correlation) have been performed between glycated hemoglobin (HbA1c) and lipid ratios and individual lipid indices. Significance was set at p <0.05. Results: The mean age ± standard deviation of the patients was 61.28 ± 10.04 years with a mean duration of diabetes was 14.32 ± 6.24 years. Significant positive correlations were observed between HbA1c and serum total cholesterol (p-value <10-6), triglyceride (p-value <10-3) and LDL-C (p-value = 0.002). In contrast, the correlation between HbA1c and HDL-C was negative and insignificant. Thus, the association between HbA1c and the atherogenicity index, especially the LDL-C / HDL-C ratio has been well established. Discussion: The study concluded that the HbA1c value correlated well with the lipid profile of diabetic patients. Thus, HbA1c can also be used as a predictor of dyslipidemia and therefore early diagnosis of dyslipidemia can be used as a preventive measure for the development of CVD in patients with T2DM.

12.
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.

13.
Pediatrics ; 149, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2003168

RESUMO

Background: In the United States, obesity impacts the health of over 20% of adolescents. As more data emerges on obesity and the associated adipose tissue dysfunction, updated screening and treatment guidelines for obesity and its related comorbidities have been published. (See Table 1). However, it is unclear if providers are adhering to these guidelines. Methods: We leveraged the TriNetX Research Network platform, a global federated network of electronic medical record data, to identify current national practice patterns for screening for lipid dysfunction, liver function abnormalities, and insulin resistance, and prescribing of anti-obesity medications. Additionally, we reviewed the prescription patterns of FDA approved and offlabel anti-obesity medications. Our cohort was defined as patients 14-18 years old, with three outpatient encounters between Jan 1, 2017 and March 1, 2020, and obesity, defined as BMI>30 or greater than the 95th percentile recorded on 3 separate outpatient encounters. The date cutoff was set in order to avoid the potential confounding effects of COVID-19 global pandemic. Exclusion criteria included a diagnostic code for lipid dysfunction, fatty liver, or insulin resistance prior to Jan 1, 2017 as well as any diagnosis of type 1 Diabetes. Screening for comorbidity of lipid dysfunction, fatty liver, and insulin resistance were defined by the presence of a total cholesterol, ALT, and Hgb A1C respectively. Results: The cohort included 31,017 patients that met all inclusion and exclusion criteria. The mean age of patients was 16. 56% of patient had an ICD-10 code of obesity in the chart. Screening rates for lipid dysfunction (Total Cholesterol), insulin resistance (Hgb A1c), and fatty liver (ALT) were 44%, 54%, and 41% respectively. Only 31% of patients were screened for all 3. When screened, 28% of patients had a Hgb A1C >5.7%, 22% had an ALT >45, and 13% had a total cholesterol >200. 9% of patients had prescriptions of anti-obesity medication including (Orlistat, Phentermine, Topiramate, Metformin, Liraglutide). The two most used medication were Metformin and Topiramate. However, when excluding individuals with ICD-10 codes for migraines (G40, G43, G44), prevalence of topiramate prescription decreased from 4% to 1%. Conclusion: Screening for obesity comorbidities continues to fall short of recommendations. Screening rates in our study occurred at about the same rates as previously reported in the literature (50- 60% for diabetes, 38-40% for lipid dysfunction, and 2-56% for liver disease). There is evidence to support the use of antiobesity medications in pediatric patients;however, we found that anti-obesity medication prescriptions remain limited nationally. To our knowledge, this is one of the largest studies to evaluate this issue in children. Further studies are warranted to explore the causes of low screening and treatment rates in adolescents with obesity and inform interventions.

14.
Archives of Razi Institute ; 77(3):1303-1310, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1998136

RESUMO

This case-control study aimed to assess pathologic alteration in the serum levels of the atherogenic index, cholesterol to high-density lipoprotein (HDL) ratio, HDL cholesterol, total cholesterol, triglyceride, HbA1c, and glucose in 158 COVID-19 patients who were hospitalized in Erbil international hospital, Erbil, Iraq, between January and May 2020, in the early stage of infection. The patients were confirmed for SARS-CoV-2 on admission. The laboratory test results were compared between this group and a group of healthy individuals (n=158). A statistically significant difference was found between the studied factors in healthy controls and COVID-19 patients, except for low-density lipoprotein (LDL) cholesterol (P=0.13). In the case of COVID-19 patients, total levels of cholesterol and HDL cholesterol were significantly lower than controls (P<0.003). Triglyceride, VLDL cholesterol, atherogenic index, and total cholesterol to HDL ratio were found to be significantly higher in COVID-19 patients, compared to controls (P<0.005). Atherogenic index were found to be positively correlated with triglyceride (r=0.88, P=0.00), HbA1C (r=0.6, P=0.05), and glucose index (r= 0.62, P= 0.05), and the ratio of cholesterol to HDL (r=0.64, P=0.04). In contrast, no correlation was found between atherogenic index and cholesterol to HDL ratio in controls. The results of the current study indicated that risk factors for the cardiovascular disease increased in patients with COVID-19 infection, which included atherogenic index, cholesterol to HDL ratio, as well as the association between atherogenic index, and all were organized in one cluster. Therefore, lipids can perform a vital physiological function in patients infected with COVID-19.

15.
Canadian Journal of Diabetes ; 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1996319

RESUMO

Objectives: Our aim in this study was to compare rates of anthropometric, blood pressure (BP) and glycated hemoglobin (A1C) measurements and laboratory screening for hypothyroidism, nephropathy and dyslipidemia in children and youth with type 1 diabetes (T1D), 1 year before and after the onset of COVID-19. Methods: Clinical data were analyzed from a voluntary registry of children and youth with T1D followed at the BC Children's Hospital between March 2019 and 2021. Logistic and Poisson mixed-effect models were used. Results: Four hundred forty patients, with median (interquartile range) age and time since diagnosis 12.7 (9.5 to 15.4) and 4.7 (2.6 to 7.9) years, respectively, were included. Clinic visits were all in-person before March 2020, and 99% via telemedicine afterward. The number of visits per patient was 2 (2 to 3), with a 6% increase during the pandemic (relative risk [RR], 1.06;95% confidence interval [CI], 1.01 to 1.10). There was a substantial decrease in height, weight and BP measurements (RR, 0.32;95% CI, 0.28 to 0.36;RR, 0.34, 95% CI, 0.31 to 0.38;RR, 0.005, 95% CI, 0.002 to 0.014, respectively);only 49% of patients had anthropometric and 1% BP data during the pandemic year, compared with >97% before the pandemic. A1C measurements dropped from 3 (2 to 4) to 1 (1 to 2) per patient per year (RR, 0.53;95% CI, 0.48 to 0.57). Rates of screening investigations were suboptimal before the pandemic, and these rates continued to decline. Conclusions: Shifting to telemedicine allowed ongoing care during the pandemic, but the frequency of anthropometric, BP and A1C measurements decreased dramatically. A combined telemedicine/in-person model may be needed to ensure adequate care for this population.

16.
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.

17.
Journal of General Internal Medicine ; 37:S468, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1995805

RESUMO

CASE: A 59-year-old Mexican-American man with hypertension and type II diabetes (Hemoglobin A1c 11.5) was admitted for sepsis and Acute Respiratory Distress Syndrome secondary to COVID-19 pneumonia. He was ventilator- dependent for 66 days. His clinical course was complicated by acute renal failure requiring hemodialysis, pulmonary embolism, and recurrent ventilator-associated bacterial pneumonia. He was discharged to a long-term acute care center four months after his initial presentation, but was readmitted two weeks later for abdominal pain and fever. CT abdomen revealed diffuse mesenteric nodular stranding and pelvic ascites concerning for peritoneal carcinomatosis. Biopsy of an omental nodule, however, showed necrotizing granulomatous inflammation and no malignant cells. No cultures were sent from the initial biopsy, so repeat sampling was performed and culture was positive for Mycobacterium tuberculosis complex. Treatment for active tuberculosis was initiated with subsequent recovery. IMPACT/DISCUSSION: Initial infection by tuberculosis occurs in the lungs, where alveolar macrophages encounter and phagocytose the bacteria. The macrophages initiate a cytokine response and recruit lymphocytes to form a granuloma, which segregates the infection within the host. The granuloma is then perpetually maintained by an ongoing immune response that is driven by monocytes and CD-4 T cells. Reactivation of tuberculosis occurs when the ongoing immune response is disrupted. Sepsis has profound and complex effects on the immune system, including marked inhibition of lymphocyte proliferation that leads to reduced levels of B cells, CD-4 T cells, and follicular dendritic cells. Signaling pathways are disrupted without these lymphocytes, which then leads to the dysfunction of the remaining leukocytes. Further, critically ill patients often suffer from post-intensive care unit syndrome. This syndrome is marked by persistent inflammation, which prompts an immunosuppressive response that suppresses T-cell function and leads to T-cell apoptosis. Both sepsis and post-intensive care unit syndrome predispose patients to opportunistic infection by attenuation of the usual immune response. In this particular case, the specific loss of T-cell function in both syndromes allowed this patient's latent tuberculosis to reactivate several months after his initial presentation with sepsis from COVID-19 pneumonia. This case highlights the importance of maintaining a high index of suspicion for opportunistic infection after critical illness. CONCLUSION: Sepsis and post-intensive care unit syndrome disrupted this patient's ability to maintain the immune responses that prevent the progression of latent tuberculosis infection. The diagnosis was delayed due to a lack of awareness of the profound immunosuppression that accompanies and follows critical illness. Providers must recognize these syndromes and the impact they have on immunity in order to diagnose and treat opportunistic infections in a timely manner.

18.
Journal of General Internal Medicine ; 37:S142, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1995770

RESUMO

BACKGROUND: Drops in chronic disease performance metric occurred during the COVID-19 pandemic in 2020. We evaluated changes in diabetes and hypertension disease control and disease non-assessment during the year prior and the initial year of COVID in a large group of Chicago-area primary care practices and evaluated factors associated with non-assessment. METHODS: Design: Retrospective observational studies of two cohorts, one with diabetes mellitus, and one with hypertension. Participants: Patients in the denominator for the medical group's performance measures for diabetes control or hypertension control on March 31, 2020 who also had continued contact with the health system (telephone, visit, medication refill, patient portal message) between April 1, 2020 and March 31, 2021. Main Measures: Diabetes not poorly controlled (HbA1C done in the past year and ≤9.0), diabetes cohort;Controlling High Blood Pressure (office blood pressure measured in the past 12 months and the most recent blood pressure was <140/90mmHg), hypertension cohort. Weexamined rates of poor control due to uncontrolled disease or lack of assessment. For patients with measurements in both the year preceding and the year following March 31, 2020, we calculated changes in HbA1C and weight (diabetes cohort) and systolic blood pressure and weight (hypertension cohort). RESULTS: In the diabetes cohort of 16,015, control was 78.0% in the year prior to March 31, 2020 and fell to 69.4% the following year. For the 57,346 patients in the hypertension cohort, the corresponding rates were 64.0% and 52.1%. For diabetes, 10.5% of the cohort had no HbA1C in the pre-COVID year and 22.0% had no HbA1C in the subsequent year. For hypertension, rates of non-assessment were 6.3% and 22.9%, respectively. Significant predictors of non-assessment in the first COVID year for diabetes and hypertension included younger age (18-49 year old, ORs 1.42, 1.11), having ≥ 1 telehealth visit (ORs 2.29, 7.82), and having ≥ 1 office visit (ORs 0.02, 0.005). Among diabetes patients who had HbA1C and weight measurements in both years, both declined?mean difference for HbA1C was -0.08 (95%CI -0.05 to -0.10) and weight -0.77 kg (CI -0.34 to -0.88). Among hypertension patients with blood pressure and weight measurements in both years, mean difference systolic blood pressure increased by 0.77 mmHg (CI 0.60 to 0.94) and weight decreased -0.30 kg (CI -0.25 to -0.35). CONCLUSIONS: During the first year of the COVID, many more patients with diabetes and hypertension did not have basic assessments of their disease control compared to the prior year, and type of visits (telehealth and office) was strongly associated with non-assessment. Among diabetes patients who were assessed there was no evidence of worsening disease HbA1C or weight. Systolic blood pressure increased slightly among hypertensive patients.

19.
Journal of General Internal Medicine ; 37:S447-S448, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1995714

RESUMO

CASE: A 52-year-old male with a past medical history of asthma and uncontrolled OSA presented to the ED ten days after diagnosis of COVID-19 with worsening dyspnea. He had a history of fluticasone propionate and fluticasone salmeterol use for asthma exacerbations. He endorsed cough, fever, chills, and diarrhea, and denied chest pain, leg edema, and anosmia.Vitals showed oxygen saturation of 65%. CBC demonstrated leukopenia consistent with COVID- 19 infection. Blood labs showed hyperglycemia (blood sugar 182 mg/dL, hemoglobin A1c 9.6%). Bilateral crackles were noted on exam. He was placed on high-flow nasal cannula (HFNC) immediately due to critical hypoxemia. CT PE was negative;CXR revealed bilateral opacities consistent with COVID-19 pneumonia. He started on dexamethasone and remdesivir and was admitted to the MICU for acute hypoxemic respiratory failure. Notably, the patient had no known diagnosis of diabetes mellitus and was started on sliding scale insulin and Lantus. Barcitinib was added in the MICU in addition to linezolid and cefepime for fear of bacterial superinfection but were discontinued after receiving negative cultures. He was transferred out of the MICU four days later after successful weaning of oxygen but soon returned due to worsening oxygen needs. New leukocytosis prompted a repeat respiratory culture, which grew mold on the preliminary read. Voriconazole was initiated due to concern for Aspergillus infection and was continued with confirmation on the final read. Repeat CT showed left pneumomediastinum, right apical pneumothorax, and worsening bilateral opacities. Despite ongoing treatment, the patient required NC at rest and HFNC with minimal exertion. He was discharged home with HFNC. IMPACT/DISCUSSION: CAPA is a result of opportunistic fungal infection, causing devastating disease in the immunocompromised. A crucial risk factor is the use of high-dose corticosteroids for a prolonged period. The diagnosis of CAPA is based on a combination of imaging, microbiology, and clinical presentation. Peripheral nodules, air crescent, reverse halo sign, nodular consolidation, ground-glass opacities, crazy paving pattern, pleural effusion, and pulmonary cysts have been reported among CAPA patients. A fungal culture and galactomannan test from respiratory specimens can aid in early diagnosis. The usual presenting symptoms of CAPA include refractory fever, pleuritic chest pain, or dyspnea. Voriconazole is a first-line anti-Aspergillus agent. CONCLUSION: Clinical presentation of CAPA is often subtle but associated with high morbidity and mortality. Multiple reports add support to our observation that CAPA can be a result of worsening COVID-19 pneumonia. Early diagnosis and treatment are vital to prevent worse clinical outcomes. Physicians should demonstrate a heightened awareness of the risk of developing CAPA in critically ill COVID-19 patients. Clinicians should exercise low thresholds to identify and treat CAPA, especially in patients on high-dose steroids long-term.

20.
Journal of General Internal Medicine ; 37:S294, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1995705

RESUMO

BACKGROUND: The rapid conversion to telehealth services as an alternative to in-person ambulatory care in response to COVID-19 required abrupt adaptations by patients with diabetes and their providers, that may have resulted in poorer outcomes for subgroups of the population. METHODS: We conducted a longitudinal population study from a diabetes registry with clinical and administrative data maintained for all patients with diabetes seen at an academic medical center. From this registry, we identified all patients seen at least once in the year before and after 03/20/20 at any of the 16 ambulatory care clinics at this site (n=9760) who also had ≧ 1 HbA1c value in both periods (n=4710), and those with ≧ 2 visits and ≧ 2 HbA1c values in the same periods (n=1553). We compared patient characteristics (age, gender, race/ethnicity, Charlson comorbidity score), clinic site [Federally Qualified Health Centers (FQHCs) vs. other ambulatory care sites], total number of ambulatory visits and number of telehealth visits, mean HbA1c mean value and % in poor control (HbA1c ≧ 9%) for both groups of patients. We used odds ratios for bivariate comparisons and logistic regression for multivariable analyses. RESULTS: The mean age of patients with ≧ 1 visit in the pre-post periods was 62.5 [SD 14.0], 47% were female, 40% were Hispanic, 28% had a Charlson score greater than the median, 37% were seen at an FQHC, and 18.9% had poor glycemic control (HbA1c ≧9%). Characteristics for patients with ≧ 2 visits were comparable. Poor control was more likely among those seen at FQHC sites (OR=3.17, p<.0002), those ≧65 years (OR=3.53, p<.0001), those with substantial comorbidity (Charlson ≧ median value, OR=1.40, p=.0011), Hispanic patients (OR=3.08, p<.0001) and those seen by telehealth (OR=1.59, p<.0001). Results for patients with ≧ 2 visits and corresponding HbA1c values were comparable. Parameter estimates from the logistic regression model predicting HbA1c ≧ 9% were all statistically significant and in the expected direction for the variables considered. CONCLUSIONS: Telemedicine is currently being considered for continuation as an accepted, efficient and safe mode of healthcare delivery. However, it may not be effective for specific subgroups of patients with chronic diseases such as diabetes in which patient partnership and the provider patient relationship are key to optimizing outcomes. Further, advances in the delivery of telehealth care, including easily accessed high quality technologies are needed to ensure that remote healthcare delivery does not further increase disparities in health outcomes, particularly for the poor, underserved, minorities, elderly and those with complex diseases.

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