Type-1 diabetes and pulmonary function tests. A meta-analysis.

OBJECTIVES: To determine the association between type-1 diabetes (T1D) and pulmonary function tests. METHODS: After conducting an exhaustive literature search, we performed a meta-analysis. We employed the inverse variance method with a random effects model to calculate the effect estimate as the mean difference (MD) and 95% confidence interval (CI). We calculated the heterogeneity with the I2 statistic and performed a meta-regression analysis by age, sex, body mass index (BMI), smoking and geographical region. We also conducted a sensitivity analysis according to the studies' publication date, size of the T1D group and the study quality, excluding the study with the greatest weight in the effect. RESULTS: The meta-analysis included 39 studies, one longitudinal, 35 case-control and three cross-sectional ones, with 1274 patients with T1D and 1353 control participants. The pooled MD (95%CI) for the predicted percentage of FEV1, FVC, FEF25-75%, PEF and DLCO were -6.40 (95%CI -8.55, -4.25; p < 0.001), -6.39 (95%CI -8.46, -4.33; p < 0.001), -6.14 (95%CI -10.73, -1.56; p = 0.009), -9.32 (95%CI -14.15, -4.50; p = 0.0002) and -0.64 (95%CI -1.12, -0.16; p = 0.008), respectively. There was no difference in the ratio of FEV1/FVC (-0.33 95%CI -1.70, 1.03; p = 0.28). There was considerable heterogeneity. The meta-regression analysis showed that between studies heterogeneity was not explained by patient age, sex, BMI, smoking or geographical region. The findings were consistent in the sensitivity analysis. CONCLUSIONS: T1D is associated with impaired pulmonary function, independently of age, sex, smoking, BMI, and geographical region. Longitudinal studies are needed to investigate outcomes for patients with T1D and impaired pulmonary function.

Differences in clinical features and mortality in very old unvaccinated patients (≥ 80 years) hospitalized with COVID-19 during the first and successive waves from the multicenter SEMI-COVID-19 Registry (Spain).

BACKGROUND: Old age is one of the most important risk factors for severe COVID-19. Few studies have analyzed changes in the clinical characteristics and prognosis of COVID-19 among older adults before the availability of vaccines. This work analyzes differences in clinical features and mortality in unvaccinated very old adults during the first and successive COVID-19 waves in Spain. METHODS: This nationwide, multicenter, retrospective cohort study analyzes unvaccinated patients ≥ 80 years hospitalized for COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry). Patients were classified according to whether they were admitted in the first wave (March 1-June 30, 2020) or successive waves (July 1-December 31, 2020). The endpoint was all-cause in-hospital mortality, expressed as the case fatality rate (CFR). RESULTS: Of the 21,461 patients hospitalized with COVID-19, 5,953 (27.7%) were ≥ 80 years (mean age [IQR]: 85.6 [82.3-89.2] years). Of them, 4,545 (76.3%) were admitted during the first wave and 1,408 (23.7%) during successive waves. Patients hospitalized in successive waves were older, had a greater Charlson Comorbidity Index and dependency, less cough and fever, and met fewer severity criteria at admission (qSOFA index, PO2/FiO2 ratio, inflammatory parameters). Significant differences were observed in treatments used in the first (greater use of antimalarials, lopinavir, and macrolides) and successive waves (greater use of corticosteroids, tocilizumab and remdesivir). In-hospital complications, especially acute respiratory distress syndrome and pneumonia, were less frequent in patients hospitalized in successive waves, except for heart failure. The CFR was significantly higher in the first wave (44.1% vs. 33.3%; -10.8%; p < 0.001) and was higher among patients ≥ 95 years (54.4% vs. 38.5%; -15.9%; p < 0.001). After adjustments to the model, the probability of death was 33% lower in successive waves (OR: 0.67; 95% CI: 0.57-0.79). CONCLUSIONS: Mortality declined significantly between the first and successive waves in very old unvaccinated patients hospitalized with COVID-19 in Spain. This decline could be explained by a greater availability of hospital resources and more effective treatments as the pandemic progressed, although other factors such as changes in SARS-CoV-2 virulence cannot be ruled out.

Pacemaker-induced endocarditis by Gordonia bronchialis.

PURPOSE: Gordonia species are known to be opportunistic human pathogens causing secondary infections. We present the second case in the world of endocarditis caused by Gordonia bronchialis and a review of all the cases of endocarditis caused by Gordonia spp. METHODS: The identification was performed by matrix-assisted desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and 16S rRNA gene sequencing were performed to confirm the identification. Antimicrobial susceptibility was performed by MIC test Strip on Mueller-Hinton agar supplemented with 5% defibrinated sheep blood according to Clinical and Laboratory Standards Institute. RESULTS: Pacemaker-induced endocarditis due to Gordonia bronchialis infection was determined in an 88-year old woman. The patient was treated with ceftriaxone and ciprofloxacin until completing 6 weeks from the pacemaker explant with a good evolution. CONCLUSION: The case presented supports the pathogenic role of Gordonia bronchialis as an opportunistic pathogen and highlights the high risk of suffering infections caused by environmental bacteria.

Pulmonary function tests in type 2 diabetes: a meta-analysis.

OBJECTIVES: The aim of this study was to determine the association between type 2 diabetes (T2D) and pulmonary function tests. METHODS: After conducting an exhaustive literature search, we performed a meta-analysis. We employed the inverse variance method with a random-effects model to calculate the effect estimate as the mean difference (MD) and 95% confidence interval (CI). We calculated the heterogeneity with the I2 statistic and performed a meta-regression analysis by sex, body mass index (BMI), smoking and geographical region. We also conducted a sensitivity analysis according to the studies' publication date, size of the T2D group and the study quality, excluding the study with the greatest weight in the effect. RESULTS: The meta-analysis included 66 studies (one longitudinal, two case-control and 63 cross-sectional), with 11 134 patients with T2D and 48 377 control participants. The pooled MD (95% CI) for the predicted percentage of forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), forced expiratory flow at 25-75% of FVC, peak expiratory flow, and diffusing capacity of the lung for carbon monoxide were -7.15 (95% CI -8.27, -6.03; p<0.001), -9.21 (95% CI -11.15, -7.26; p<0.001), -9.89 (95% CI -14.42, -5.36; p<0.001), -9.79 (95% CI -13.42, -6.15; p<0.001) and -7.13 (95% CI -10.62, -3.64; p<0.001), respectively. There was no difference in the ratio of FEV1/FVC (95% CI -0.27; -1.63, 1.08; p=0.69). In all cases, there was considerable heterogeneity. The meta-regression analysis showed that between studies heterogeneity was not explained by patient sex, BMI, smoking or geographical region. The findings were consistent in the sensitivity analysis. CONCLUSIONS: T2D is associated with impaired pulmonary function, independently of sex, smoking, BMI and geographical region. Longitudinal studies are needed to investigate outcomes for patients with T2D and impaired pulmonary function.

Pacemaker-induced endocarditis by Gordonia bronchialis.

PURPOSE: Gordonia species are known to be opportunistic human pathogens causing secondary infections. We present the second case in the world of endocarditis caused by Gordonia bronchialis and a review of all the cases of endocarditis caused by Gordonia spp. METHODS: The identification was performed by matrix-assisted desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and 16S rRNA gene sequencing were performed to confirm the identification. Antimicrobial susceptibility was performed by MIC test Strip on Mueller-Hinton agar supplemented with 5% defibrinated sheep blood according to Clinical and Laboratory Standards Institute. RESULTS: Pacemaker-induced endocarditis due to Gordonia bronchialis infection was determined in an 88-year old woman. The patient was treated with ceftriaxone and ciprofloxacin until completing 6 weeks from the pacemaker explant with a good evolution. CONCLUSION: The case presented supports the pathogenic role of Gordonia bronchialis as an opportunistic pathogen and highlights the high risk of suffering infections caused by environmental bacteria.