Glycemic Control in Diabetic Foot Ulcers: A Comparative Analysis of Wound and Wound-free Periods in Adults With Type 1 and Type 2 Diabetes.

OBJECTIVE: Our aim in this study was to determine whether there are differences in glycemia during wound and wound-free states among individuals with diabetes at a multidisciplinary diabetic foot and wound clinic from 2012 to 2019. METHODS: We conducted a retrospective analysis of prospectively collected data over 7.4 years from the Johns Hopkins Multidisciplinary Diabetic Foot and Wound Clinic. Participants with diabetic foot ulcers were observed during at least one wound period and one wound-free period and had at least one glycated hemoglobin (A1C) measurement in both a wound and wound-free period. The A1C measurements were aggregated and summarized across wound and wound-free periods, and compared using the Wilcoxon matched-pairs signed rank test. RESULTS: Two hundred six eligible participants with a total of 623 wounds were included in this analysis. Participants were followed for a median period of 2.4 years (876 days). There were no significant differences in mean, minimum, and maximum A1C between the aggregate wound and wound-free periods, with median values of 7.6% (interquartile range [IQR] 6.6% to 9.1%) and 7.5% (IQR 6.6% to 9.1%) for mean A1C (p=0.43), 6.9% (IQR 6.0% to 8.0%) and 6.8% (6.0% to 8.1%) for minimum A1C (p=0.78), and 8.6% (IQR 7.1% to 10.9%) and 8.5% (IQR 7.0% to 10.7%) for maximum A1C (p=0.06) in the wound and wound-free periods, respectively. CONCLUSIONS: This retrospective study shows similar levels of A1C during wound and wound-free periods; however, given the limitations of missing A1C and small sample size, further studies leveraging continuous glucose monitoring are needed to determine whether glycemia worsens in the setting of a DFU.

Higher serum uric acid is associated with poorer cognitive performance in healthy middle-aged people: a cross-sectional study.

Age-related cognitive impairment can occur many years before the onset of the clinical symptoms of dementia. Uric acid (UA), a metabolite of purine-rich foods, has been shown to be positively associated with improved cognitive function, but such association remains controversial. Moreover, most of the previous studies investigating the association included elderly participants with memory-related diseases. Therefore, the present study aimed at investigating whether serum UA (sUA) is associated with cognitive performance in healthy middle-aged individuals. We conducted a cross-sectional study on a cohort of middle-aged individuals (40-60 years old) who participated in the Qatar Biobank. The participants had no memory-related diseases, schizophrenia, stroke, or brain damage. They were divided according to sUA level into a normal group (< 360 µmol/L) and a high group (≥ 360 µmol/L), and underwent an assessment of cognitive function using the Cambridge Neuropsychological Test Automated Battery. Two cognitive function domains were assessed: (a) speed of reaction/reaction time and (b) short-term visual memory. The median age of the 931 participants included in the study was 48.0 years (IQR: 44.0, 53.0), of which 47.6% were male. Adjusted multivariable linear regression analyses showed that higher sUA is associated with poorer performance on the visual memory domain of cognitive function (ß = - 6.87, 95% CI - 11.65 to - 2.10, P = 0.005), but not on the speed of reaction domain (ß = - 55.16, 95% CI - 190.63 to 80.30, P = 0.424). Our findings support previous studies suggesting an inverse association between high sUA levels and cognitive function in elderly and extend the evidence for such a role to middle-aged participants. Further prospective studies are warranted to investigate the relationship between UA and cognition.

Dynamics of Anti-S IgG Antibodies Titers after the Second Dose of COVID-19 Vaccines in the Manual and Craft Worker Population of Qatar.

There is limited seroepidemiological evidence on the magnitude and long-term durability of antibody titers of mRNA and non-mRNA vaccines in the Qatari population. This study was conducted to generate evidence on long-term anti-S IgG antibody titers and their dynamics in individuals who have completed a primary COVID-19 vaccination schedule. A total of 300 male participants who received any of the following vaccines BNT162b2/Comirnaty, mRNA-1273, ChAdOx1-S/Covishield, COVID-19 Vaccine Janssen/Johnson, or BBIBP-CorV or Covaxin were enrolled in our study. All sera samples were tested by chemiluminescent microparticle immunoassay (CMIA) for the quantitative determination of IgG antibodies to SARS-CoV-2, receptor-binding domain (RBD) of the S1 subunit of the spike protein of SARS-CoV-2. Antibodies against SARS-CoV-2 nucleocapsid (SARS-CoV-2 N-protein IgG) were also determined. Kaplan-Meier survival curves were used to compare the time from the last dose of the primary vaccination schedule to the time by which anti-S IgG antibody titers fell into the lowest quartile (range of values collected) for the mRNA and non-mRNA vaccines. Participants vaccinated with mRNA vaccines had higher median anti-S IgG antibody titers. Participants vaccinated with the mRNA-1273 vaccine had the highest median anti-S-antibody level of 13,720.9 AU/mL (IQR 6426.5 to 30,185.6 AU/mL) followed by BNT162b2 (median, 7570.9 AU/mL; IQR, 3757.9 to 16,577.4 AU/mL); while the median anti-S antibody titer for non-mRNA vaccinated participants was 3759.7 AU/mL (IQR, 2059.7-5693.5 AU/mL). The median time to reach the lowest quartile was 3.53 months (IQR, 2.2-4.5 months) and 7.63 months (IQR, 6.3-8.4 months) for the non-mRNA vaccine recipients and Pfizer vaccine recipients, respectively. However, more than 50% of the Moderna vaccine recipients did not reach the lowest quartile by the end of the follow-up period. This evidence on anti-S IgG antibody titers should be considered for informing decisions on the durability of the neutralizing activity and thus protection against infection after the full course of primary vaccination in individuals receiving different type (mRNA verus non-mRNA) vaccines and those with natural infection.

Knowledge and Perception of and Attitude toward a Premarital Screening Program in Qatar: A Cross-Sectional Study.

Premarital screening (PMS) is a primary preventive measure to decrease the incidence of certain genetic disorders and sexually transmitted diseases. This study aimed to explore the knowledge and perception of and the attitude toward PMS and predictors of knowledge and attitude. A cross-sectional study was conducted among Qatar University students using an online survey. Multivariable regression analyses were used to identify factors associated with PMS knowledge and attitude. A total of 476 students participated in the study; 424 (89.1%) were females; two-thirds were 18-21 years old. Only 100 participants had heard about PMS. Knowledge of PMS was significantly associated with females, students enrolled in a health-related college, and non-consanguineous marriage of a participant's parents. The majority of the participants agreed that genetic diseases are psychological and economic burdens. For attitude, only 178 participants were willing to cancel marriages, given incompatible PMS results. The following factors were positively associated with attitude: PMS knowledge, enrollment in a health-related college, and the belief that PMS does not interfere with destiny. Our study findings revealed that despite the mandatory PMS in Qatar, the study participants, future couples, had low knowledge about the program. Therefore, strategies to increase awareness of PMS should be considered toward improving its outcomes.

Glycemic control and diabetic foot ulcer outcomes: A systematic review and meta-analysis of observational studies.

OBJECTIVE: To evaluate the association between glycemic control (hemoglobin A1C, fasting glucose, and random glucose) and the outcomes of wound healing and lower extremity amputation (LEA) among patients with diabetic foot ulcers (DFUs). RESEARCH DESIGN AND METHODS: Medline, EMBASE, Cochrane Library, and Scopus were searched for observational studies published up to March 2019. Five independent reviewers assessed in duplicate the eligibility of each study based on predefined eligibility criteria and two independent reviewers assessed risk of bias. Ameta-analysis was performed to calculate a pooled odds ratio (OR) or hazard ratio (HR) using random effects for glycemic measures in relation to the outcomes of wound healing and LEA. Subgroup analyses were conducted to explore potential source of heterogeneity between studies. The study protocol is registered with PROSPERO (CRD42018096842). RESULTS: Of 4572 study records screened, 60 observational studies met the study eligibility criteria of which 47 studies had appropriate data for inclusion in one or more meta-analyses(n = 12,604 DFUs). For cohort studies comparing A1C >7.0 to 7.5% vs. lower A1C levels, the pooled OR for LEA was 2.04 (95% CI, 0.91, 4.57) and for studies comparing A1C ≥ 8% vs. <8%, the pooled OR for LEA was 4.80 (95% CI 2.83, 8.13). For cohort studies comparing fasting glucose ≥126 vs. <126 mg/dl, the pooled OR for LEA was 1.46 (95% CI, 1.02, 2.09). There was no association with A1C category and wound healing (OR or HR). There was high risk of bias with respect to comparability of cohorts as many studies did not adjust for potential confounders in the association between glycemic control and DFU outcomes. CONCLUSIONS: Our findings suggest that A1C levels ≥8% and fasting glucose levels ≥126 mg/dl are associated with increased likelihood of LEA in patients with DFUs. A purposively designed prospective study is needed to better understand the mechanisms underlying the association between hyperglycemia and LEA.

Glucagon-like Peptide-1 Receptor Agonists Cardio-protective Effects: An Umbrella Review.

BACKGROUND: We thought to delve deeper into seven meta-analyses of major clinical trials focusing on Glucagon-Like Peptide-One Receptor Agonist (GLP-1 RA) cardioprotective effect. AIM: We explored the role of GLP-1 RA in cardiovascular risk protection as the primary outcome in subjects with type 2 diabetes mellitus. METHODOLOGY: The current review has explored and critically appraised seven meta-analyses of placebo- controlled randomized clinical trials (RCT-s) involving GLP-1 RA used in diabetes that has exhibited major cardiovascular events as the primary outcome. RESULTS: Based on the participants-intervention-comparison and outcomes (PICO), the total number of the participants in this review were (138750), the intervention was conducted with GLP-1 RA, the comparator was a placebo and the outcome was major cardiovascular events. The overall evidence for the cardioprotective effect of GLP-1 RA in diabetes was very clear in subjects with the cardiovascular risk of varying degrees. Most of the currently reviewed meta-analyses have not shown cardioprotection with GLP-1 RA in subjects with diabetes exhibiting high cardiovascular risk or medical history of cardiovascular diseases. Patient variability, in addition to potency parameters, will be the key to a successful member of the class. There will be avenues for selection of a candidate based on the suitability to patient preferences and characteristics. CONCLUSION: The RCT-s for GLP-1 RA should characterize cardiovascular risk in subjects with diabetes such that disparities between established cardiovascular risk (high, moderate and low) or medical history of cardiovascular disease have been accounted for in subgroup analysis.