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1.
Sci Rep ; 10(1): 16384, 2020 10 02.
Artículo en Inglés | MEDLINE | ID: mdl-33009426

RESUMEN

The COVID-19 outbreak is becoming a public health emergency. Data are limited on the clinical characteristics and causes of death. A retrospective analysis of COVID-19 deaths were performed for patients' clinical characteristics, laboratory results, and causes of death. In total, 56 patients (72.7%) of the decedents (male-female ratio 51:26, mean age 71 ± 13, mean survival time 17.4 ± 8.4 days) had comorbidities. Acute respiratory failure (ARF) and sepsis were the main causes of death. Increases in C-reactive protein (CRP), lactate dehydrogenase (LDH), D-dimer and lactic acid and decreases in lymphocytes were common laboratory results. Intergroup analysis showed that (1) most female decedents had cough and diabetes. (2) The proportion of young- and middle-aged deaths was higher than elderly deaths for males, while elderly decedents were more prone to myocardial injury and elevated CRP. (3) CRP and LDH increased and cluster of differentiation (CD) 4+ and CD8+ cells decreased significantly in patients with hypertension. The majority of COVID-19 decedents are male, especially elderly people with comorbidities. The main causes of death are ARF and sepsis. Most female decedents have cough and diabetes. Myocardial injury is common in elderly decedents. Patients with hypertension are prone to an increased inflammatory index, tissue hypoxia and cellular immune injury.


Asunto(s)
Infecciones por Coronavirus/mortalidad , Neumonía Viral/mortalidad , Sepsis/epidemiología , Síndrome Respiratorio Agudo Grave/epidemiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Proteína C-Reactiva/análisis , Causas de Muerte , China , Comorbilidad , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/patología , Diabetes Mellitus/epidemiología , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Cardiopatías/epidemiología , Humanos , L-Lactato Deshidrogenasa/sangre , Ácido Láctico/sangre , Recuento de Linfocitos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/sangre , Neumonía Viral/complicaciones , Neumonía Viral/patología , Sepsis/etiología , Síndrome Respiratorio Agudo Grave/etiología
2.
Cardiovasc Diabetol ; 19(1): 164, 2020 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-33004045

RESUMEN

BACKGROUND: Cardiometabolic disorders may worsen Covid-19 outcomes. We investigated features and Covid-19 outcomes for patients with or without diabetes, and with or without cardiometabolic multimorbidity. METHODS: We collected and compared data retrospectively from patients hospitalized for Covid-19 with and without diabetes, and with and without cardiometabolic multimorbidity (defined as ≥ two of three risk factors of diabetes, hypertension or dyslipidaemia). Multivariate logistic regression was used to assess the risk of the primary composite outcome (any of mechanical ventilation, admission to an intensive care unit [ICU] or death) in patients with diabetes and in those with cardiometabolic multimorbidity, adjusting for confounders. RESULTS: Of 354 patients enrolled, those with diabetes (n = 81), compared with those without diabetes (n = 273), had characteristics associated with the primary composite outcome that included older age, higher prevalence of hypertension and chronic obstructive pulmonary disease (COPD), higher levels of inflammatory markers and a lower PaO2/FIO2 ratio. The risk of the primary composite outcome in the 277 patients who completed the study as of May 15th, 2020, was higher in those with diabetes (Adjusted Odds Ratio (adjOR) 2.04, 95%CI 1.12-3.73, p = 0.020), hypertension (adjOR 2.31, 95%CI: 1.37-3.92, p = 0.002) and COPD (adjOR 2.67, 95%CI 1.23-5.80, p = 0.013). Patients with cardiometabolic multimorbidity were at higher risk compared to patients with no cardiometabolic conditions (adjOR 3.19 95%CI 1.61-6.34, p = 0.001). The risk for patients with a single cardiometabolic risk factor did not differ with that for patients with no cardiometabolic risk factors (adjOR 1.66, 0.90-3.06, adjp = 0.10). CONCLUSIONS: Patients with diabetes hospitalized for Covid-19 present with high-risk features. They are at increased risk of adverse outcomes, likely because diabetes clusters with other cardiometabolic conditions.


Asunto(s)
Betacoronavirus , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiología , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/metabolismo , Infecciones por Coronavirus/metabolismo , Diabetes Mellitus/metabolismo , Femenino , Estudios de Seguimiento , Humanos , Masculino , Enfermedades Metabólicas/diagnóstico , Enfermedades Metabólicas/epidemiología , Enfermedades Metabólicas/metabolismo , Persona de Mediana Edad , Multimorbilidad/tendencias , Pandemias , Neumonía Viral/metabolismo , Pronóstico , Estudios Retrospectivos , Factores de Riesgo
3.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(8): 923-928, 2020 Aug 28.
Artículo en Inglés, Chino | MEDLINE | ID: mdl-33053533

RESUMEN

OBJECTIVES: To investigate the prevalence of primary aldosteronism (PA) in newly diagnosed diabetic patients with hypertension and to compare clinical differences between newly diagnosed diabetes mellitus with essential hypertension (EH) and PA, and to explore the relationship between plasm aldosterone concentration (PAC) and clinical biochemical variables. METHODS: A total of 270 newly diagnosed diabetic patients with hypertension were prospectively enrolled in this study. All patients were screened for PA. The positive patients in the screening test were further confirmed by captopril challenge test (CCT) to determine the prevalence of PA. Clinical biochemical indexes were detected. RESULTS: The prevalence of PA in 270 newly diagnosed diabetic patients with hypertension was 18.5%. Compared with patients in the EH group, patients in the PA group had higher systolic blood pressure (SBP), PAC, aldosterone to renin ratio (ARR), and carbondioxide binding force, but lower plasma renin activity (PRA) and serum potassium. Correlation analysis showed that the PAC was positively correlated with homeostasis model assessment-insulin resistance (HOMA-IR) in the EH group (r=0.139, P<0.05), but the correlation was not found in the PA group. Compared with patients with SBP<140 mmHg, patients with SBP≥160 mmHg had the significantly decreased PRA and potassium (P<0.05, P<0.001, respectively), but increased ARR and proportion in the PA patients (P<0.05, P<0.01, respectively). CONCLUSIONS: The prevalence of PA is relatively high in newly diagnosed diabetic patients with hypertension. Patients with hypertension above grade 2 should be actively screened for aldosterone. Newly diagnosed diabetic patients with hypertension combined with PA has a higher hypertension compared with the patients without PA.In newly diagnosed diabetic patients with hypertension, PAC may be related to insulin resistance.


Asunto(s)
Diabetes Mellitus , Hiperaldosteronismo , Hipertensión , Aldosterona , Diabetes Mellitus/epidemiología , Humanos , Hiperaldosteronismo/complicaciones , Hiperaldosteronismo/diagnóstico , Hiperaldosteronismo/epidemiología , Hipertensión/complicaciones , Hipertensión/epidemiología , Renina
4.
JAMA ; 324(14): 1429-1438, 2020 10 13.
Artículo en Inglés | MEDLINE | ID: mdl-33048153

RESUMEN

Importance: The prevalence of leading risk factors for morbidity and mortality in the US significantly varies across regions, states, and neighborhoods, but the extent these differences are associated with a person's place of residence vs the characteristics of the people who live in different places remains unclear. Objective: To estimate the degree to which geographic differences in leading risk factors are associated with a person's place of residence by comparing trends in health outcomes among individuals who moved to different areas or did not move. Design, Setting, and Participants: This retrospective cohort study estimated the association between the differences in the prevalence of uncontrolled chronic conditions across movers' destination and origin zip codes and changes in individuals' likelihood of uncontrolled chronic conditions after moving, adjusting for person-specific fixed effects, the duration of time since the move, and secular trends among movers and those who did not move. Electronic health records from the Veterans Health Administration were analyzed. The primary analysis included 5 342 207 individuals with at least 1 Veterans Health Administration outpatient encounter between 2008 and 2018 who moved zip codes exactly once or never moved. Exposures: The difference in the prevalence of uncontrolled chronic conditions between a person's origin zip code and destination zip code (excluding the individual mover's outcomes). Main Outcomes and Measures: Prevalence of uncontrolled blood pressure (systolic blood pressure level >140 mm Hg or diastolic blood pressure level >90 mm Hg), uncontrolled diabetes (hemoglobin A1c level >8%), obesity (body mass index >30), and depressive symptoms (2-item Patient Health Questionnaire score ≥2) per quarter-year during the 3 years before and the 3 years after individuals moved. Results: The study population included 5 342 207 individuals (mean age, 57.6 [SD, 17.4] years, 93.9% men, 72.5% White individuals, and 12.7% Black individuals), of whom 1 095 608 moved exactly once and 4 246 599 never moved during the study period. Among the movers, the change after moving in the prevalence of uncontrolled blood pressure was 27.5% (95% CI, 23.8%-31.3%) of the between-area difference in the prevalence of uncontrolled blood pressure. Similarly, the change after moving in the prevalence of uncontrolled diabetes was 5.0% (95% CI, 2.7%-7.2%) of the between-area difference in the prevalence of uncontrolled diabetes; the change after moving in the prevalence of obesity was 3.1% (95% CI, 2.0%-4.2%) of the between-area difference in the prevalence of obesity; and the change after moving in the prevalence of depressive symptoms was 15.2% (95% CI, 13.1%-17.2%) of the between-area difference in the prevalence of depressive symptoms. Conclusions and Relevance: In this retrospective cohort study of individuals receiving care at Veterans Health Administration facilities, geographic differences in prevalence were associated with a substantial percentage of the change in individuals' likelihood of poor blood pressure control or depressive symptoms, and a smaller percentage of the change in individuals' likelihood of poor diabetes control and obesity. Further research is needed to understand the source of these associations with a person's place of residence.


Asunto(s)
Trastorno Depresivo/epidemiología , Diabetes Mellitus/epidemiología , Migración Humana/estadística & datos numéricos , Hipertensión/epidemiología , Obesidad/epidemiología , Características de la Residencia/estadística & datos numéricos , Enfermedad Crónica/epidemiología , Enfermedad Crónica/etnología , Trastorno Depresivo/etnología , Diabetes Mellitus/etnología , Registros Electrónicos de Salud/estadística & datos numéricos , Femenino , Geografía Médica , Migración Humana/tendencias , Humanos , Hipertensión/etnología , Masculino , Persona de Mediana Edad , Obesidad/etnología , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Incertidumbre , Estados Unidos/epidemiología , Estados Unidos/etnología , Servicios de Salud para Veteranos/estadística & datos numéricos
5.
Hum Genomics ; 14(1): 35, 2020 10 02.
Artículo en Inglés | MEDLINE | ID: mdl-33008459

RESUMEN

Precision medicine aims to empower clinicians to predict the most appropriate course of action for patients with complex diseases like cancer, diabetes, cardiomyopathy, and COVID-19. With a progressive interpretation of the clinical, molecular, and genomic factors at play in diseases, more effective and personalized medical treatments are anticipated for many disorders. Understanding patient's metabolomics and genetic make-up in conjunction with clinical data will significantly lead to determining predisposition, diagnostic, prognostic, and predictive biomarkers and paths ultimately providing optimal and personalized care for diverse, and targeted chronic and acute diseases. In clinical settings, we need to timely model clinical and multi-omics data to find statistical patterns across millions of features to identify underlying biologic pathways, modifiable risk factors, and actionable information that support early detection and prevention of complex disorders, and development of new therapies for better patient care. It is important to calculate quantitative phenotype measurements, evaluate variants in unique genes and interpret using ACMG guidelines, find frequency of pathogenic and likely pathogenic variants without disease indicators, and observe autosomal recessive carriers with a phenotype manifestation in metabolome. Next, ensuring security to reconcile noise, we need to build and train machine-learning prognostic models to meaningfully process multisource heterogeneous data to identify high-risk rare variants and make medically relevant predictions. The goal, today, is to facilitate implementation of mainstream precision medicine to improve the traditional symptom-driven practice of medicine, and allow earlier interventions using predictive diagnostics and tailoring better-personalized treatments. We strongly recommend automated implementation of cutting-edge technologies, utilizing machine learning (ML) and artificial intelligence (AI) approaches for the multimodal data aggregation, multifactor examination, development of knowledgebase of clinical predictors for decision support, and best strategies for dealing with relevant ethical issues.


Asunto(s)
Infecciones por Coronavirus/genética , Diabetes Mellitus/genética , Neoplasias/genética , Neumonía Viral/genética , Medicina de Precisión/tendencias , Cardiomiopatías , Infecciones por Coronavirus/epidemiología , Análisis de Datos , Diabetes Mellitus/epidemiología , Genómica/tendencias , Humanos , Metabolómica/tendencias , Neoplasias/epidemiología , Pandemias , Neumonía Viral/epidemiología , Proteómica/tendencias
7.
BMJ Open ; 10(9): e038976, 2020 09 17.
Artículo en Inglés | MEDLINE | ID: mdl-32948572

RESUMEN

OBJECTIVE: Evaluate the risk of pre-existing comorbidities on COVID-19 mortality, and provide clinical suggestions accordingly. SETTING: A nested case-control design using confirmed case reports released from the news or the national/provincial/municipal health commissions of China between 18 December 2019 and 8 March 2020. PARTICIPANTS: Patients with confirmed SARS-CoV-2 infection, excluding asymptomatic patients, in mainland China outside of Hubei Province. OUTCOME MEASURES: Patient demographics, survival time and status, and history of comorbidities. METHOD: A total of 94 publicly reported deaths in locations outside of Hubei Province, mainland China, were included as cases. Each case was matched with up to three controls, based on gender and age ±1 year old (94 cases and 181 controls). The inverse probability-weighted Cox proportional hazard model was performed, controlling for age, gender and the early period of the outbreak. RESULTS: Of the 94 cases, the median age was 72.5 years old (IQR=16), and 59.6% were men, while in the control group the median age was 67 years old (IQR=22), and 64.6% were men. Adjusting for age, gender and the early period of the outbreak, poor health conditions were associated with a higher risk of COVID-19 mortality (HR of comorbidity score, 1.31 [95% CI 1.11 to 1.54]; p=0.001). The estimated mortality risk in patients with pre-existing coronary heart disease (CHD) was three times that of those without CHD (p<0.001). The estimated 30-day survival probability for a profile patient with pre-existing CHD (65-year-old woman with no other comorbidities) was 0.53 (95% CI 0.34 to 0.82), while it was 0.85 (95% CI 0.79 to 0.91) for those without CHD. Older age was also associated with increased mortality risk: every 1-year increase in age was associated with a 4% increased risk of mortality (p<0.001). CONCLUSION: Extra care and early medical interventions are needed for patients with pre-existing comorbidities, especially CHD.


Asunto(s)
Enfermedad Coronaria/epidemiología , Infecciones por Coronavirus/mortalidad , Neumonía Viral/mortalidad , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Betacoronavirus , Bronquitis Crónica/epidemiología , Estudios de Casos y Controles , Infarto Cerebral/epidemiología , China/epidemiología , Comorbilidad , Diabetes Mellitus/epidemiología , Femenino , Insuficiencia Cardíaca/epidemiología , Humanos , Fallo Hepático/epidemiología , Masculino , Persona de Mediana Edad , Pandemias , Modelos de Riesgos Proporcionales , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Insuficiencia Renal/epidemiología , Adulto Joven
8.
Medicine (Baltimore) ; 99(36): e21806, 2020 Sep 04.
Artículo en Inglés | MEDLINE | ID: mdl-32899010

RESUMEN

BACKGROUND: DM is a common chronic metabolic disease. COVID-19 is an infectious disease infected by enveloped single-stranded RNA coronavirus. Meanwhile, DM is a common comorbidity of SARS-CoV-2 infection. The virus can directly or indirectly damage the pancreatic islets and cause stress hyperglycemia by causing cytokine storms, acute inflammatory reactions, binding to the ACE2 receptor, etc. At the same time, hyperglycemia is a risk factor for severe infection and an independent risk factor for mild to severe disease. However, there is no evidence-based medicine to confirm the relationship between hyperglycemia and the infection of COVID-19 in diabetic patients. Therefore, we will conduct a systematic review and meta-analysis to synthesize the existing clinical evidence. METHODS AND ANALYSIS: We will retrieve each database from December 2019 to July 2020. Chinese literature comes from CNKI, Wanfang, VIP, CBM databases. English literature mainly searches Cochrane Library, PubMed, Web of Science, EMBASE. At the same time, we will look for clinical trial registration and gray literature. This study only included clinical randomized controlled trials. The reviewers independently conduct literature selection, data analysis, bias risk assessment, subgroup and sensitivity analysis. The primary outcomes include fasting blood glucose, 2-hour postprandial blood glucose, glycated hemoglobin, fasting insulin, adverse effects, etc. Finally, we will conduct a meta-analysis through Review Manager software version 5.3. RESULTS: The results will be published in peer-reviewed journals. CONCLUSION: This study will explore the relationship between hyperglycemia and COVID-19 infection in diabetic patients. It will provide evidence-based support for clinical regulation of blood glucose and combating the COVID-19 epidemic. REGISTRATION NUMBER: INPLASY202060114.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Diabetes Mellitus/epidemiología , Hiperglucemia/epidemiología , Neumonía Viral/epidemiología , Betacoronavirus , Análisis de los Gases de la Sangre , Hemoglobina A Glucada , Humanos , Pandemias , Ensayos Clínicos Controlados Aleatorios como Asunto , Proyectos de Investigación , Factores de Riesgo , Índice de Severidad de la Enfermedad
11.
Medicine (Baltimore) ; 99(39): e22413, 2020 Sep 25.
Artículo en Inglés | MEDLINE | ID: mdl-32991472

RESUMEN

Stroke is the acute onset of neurological deficits and is associated with high morbidity, mortality, and disease burden. In the present study, we aimed to develop a scientific, nomogram for non-invasive predicting risk for early ischemic stroke, in order to improve stroke prevention efforts among high-risk groups. Data were obtained from a total of 2151 patients with early ischemic stroke from October 2017 to September 2018 and from 1527 healthy controls. Risk factors were examined using logistic regression analyses. Nomogram and receiver operating characteristic (ROC) curves were drawn, cutoff values were established. Significant risk factors for early ischemic stroke included age, sex, blood pressure, history of diabetes, history of genetic, history of coronary heart disease, history of smoking. A nomogram predicting ischemic stroke for all patients had an internally validated concordance index of 0.911. The area under the ROC curve for the logistic regression model was 0.782 (95% confidence interval [CI]: 0.766-0.799, P < .001), with a cutoff value of 2.5. The nomogram developed in this study can be used as a primary non-invasive prevention tool for early ischemic stroke and is expected to provide data support for the revision of current guidelines.


Asunto(s)
Isquemia Encefálica/epidemiología , Nomogramas , Accidente Cerebrovascular/epidemiología , Adulto , Factores de Edad , Anciano , Consumo de Bebidas Alcohólicas/epidemiología , Enfermedades Cardiovasculares/epidemiología , Diabetes Mellitus/epidemiología , Femenino , Predisposición Genética a la Enfermedad , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Curva ROC , Medición de Riesgo , Factores de Riesgo , Factores Sexuales , Fumar/epidemiología
12.
Medicine (Baltimore) ; 99(35): e21723, 2020 Aug 28.
Artículo en Inglés | MEDLINE | ID: mdl-32871892

RESUMEN

BACKGROUND: Novel coronavirus pneumonia (COVID-19) has become a worldwide epidemic, causing huge loss of life and property. Because of its unique pathological mechanism, diabetes affects the prognosis of patients with COVID-19 in many aspects. At present, there are many controversies about whether angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) should be used in the treatment of patients with diabetes mellitus and COVID-19 comorbidities. There is an urgent need to provide evidence for the use of ACEI/ARB through high-quality systematic evaluation and meta-analysis. METHODS: We will search electronic databases including PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Chinese Science and Technology Periodical Database, and Wanfang database using keywords related to COVID-19, diabetes mellitus, ACEI/ARB drugs, and randomized controlled trials . We will manually search gray literature, such as conference proceedings and academic degree dissertations, and trial registries. Two independent reviewers will screen studies, extract data, and evaluate risk of bias. Data analysis will be conducted using the Review Manager software version 5.3.5 and stata 14.0 software for Mac. Statistical heterogeneity will be assessed using a standard chi-square test with a significance level of P < .10. Biases associated with study will be investigated using funnel plots. RESULTS: This study will provide a high-quality synthesis of efficacy and safety of ACEI/ARB drugs in patients with COVID-19 combined with diabetes mellitus, providing evidence for clinical treatment of diabetes mellitus combined with COVID-19. And the results will be published at a peer-reviewed journal. CONCLUSION: Our study will draw conclusions on the efficacy and safety of ACEI / ARB drugs in patients with diabetes mellitus complicated with covid-19, so as to provide theoretical guidance for clinical practice of diabetes mellitus with covid-19. INPLASY REGISTRATION NUMBER: INPLASY 202060111.


Asunto(s)
Antagonistas de Receptores de Angiotensina/farmacología , Inhibidores de la Enzima Convertidora de Angiotensina/farmacología , Infecciones por Coronavirus , Diabetes Mellitus , Administración del Tratamiento Farmacológico/normas , Pandemias , Neumonía Viral , Betacoronavirus , Comorbilidad , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Diabetes Mellitus/tratamiento farmacológico , Diabetes Mellitus/epidemiología , Humanos , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Ensayos Clínicos Controlados Aleatorios como Asunto , Proyectos de Investigación , Revisiones Sistemáticas como Asunto , Resultado del Tratamiento
15.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(8): 1256-1260, 2020 Aug 10.
Artículo en Chino | MEDLINE | ID: mdl-32867432

RESUMEN

Objective: To understand the status quo of sleep and its associations with serum hemoglobin A1c (HbA1c) among nondiabetic people of 18-79 years old in Beijing. Methods: Data was gathered from the 2017 Beijing Non-communicable and Chronic Disease Surveillance Program. Multiple classified clusters sampling method was used while the 18-79 years old were sampled from the 16 districts of Beijing. Questionnaires would include information on demographic characteristics, chronic diseases and related risk factors, sleep duration and related problems (snore/asphyxia, difficult to get to sleep, waking often during the night, waking up early or taking sleeping pills) within the last 30 days. Complex sampling logistic regression models were established to analyze the association between sleep-related problems and serum HbA1c. Results: A total of 11 608 non-diabetic participants were involved in this study, with average age, reported sleep duration and median of serum HbA1c level as (43.36±15.27) years old, (7.49±1.29) h/d and 5.30%, respectively. 47.38% of them reported having sleep problems within the last 30 days. With the increasing time of sleep, serum HbA1c level was fluctuating significantly (F=413.06, P<0.01). Significant differences appeared in serum HbA1c levels among different age groups (t=358.3, P<0.01). Among participants with several kinds of sleep problems, the serum HbA1c levels were significantly higher than those without, through the single factor analysis (U=15.11, P<0.01). After adjusting for potential confounding factors, the combination of one sleep-related problem (OR=1.21, 95%CI: 1.03-1.41) and snore/asphyxia were associated with higher serum HbA1c levels (HbA1c≥5.7%) (OR=1.37, 95%CI: 1.16-1.61). People under 60 years of age were with higher risk of having higher serum HbA1c levels. Conclusion: Duration and sleep-related problems might affect the serum HbA1c levels, especially among those younger than 60 years of age.


Asunto(s)
Hemoglobina A Glucada/análisis , Trastornos del Sueño-Vigilia/sangre , Trastornos del Sueño-Vigilia/epidemiología , Sueño , Adolescente , Adulto , Anciano , Beijing/epidemiología , Diabetes Mellitus/epidemiología , Humanos , Persona de Mediana Edad , Factores de Riesgo , Encuestas y Cuestionarios , Factores de Tiempo , Adulto Joven
16.
Medicine (Baltimore) ; 99(35): e21468, 2020 Aug 28.
Artículo en Inglés | MEDLINE | ID: mdl-32871869

RESUMEN

Saline is a commonly used intravenous solvent, however, its excessive infusion may increase drug-induced sodium intake. To investigate the effects of saline infusion on blood pressure variability (BPV) in patients with hypertension, a retrospective study was performed in 1010 patients with hypertension. The patients who received saline infusion before surgery for continuous 3 to 5 days were divided into 2 groups according to the saline infusion volume during the hospitalization, which are >500 mL per day group and <500 mL per day group. The overall incidence of abnormal BPV was 11.58%. As for the incidence of abnormal BPV in the <500 mL per day group with 698 patients was 9.17%, while that in the >500 mL per day group with 312 patients was as high as 16.99%. Additionally, >500 mL of daily saline infusion for continuous 3 to 5 days (P for trend = .004, odds ratio [OR] = 1.911, 95% confidence interval [CI] for OR 1.226-2.977), medical history of diabetes mellitus (P < .001, OR = 4.856, 95% CI for OR 3.118-7.563) and cardiovascular diseases (P < .001, OR = 2.498, 95% CI for OR 1.549-4.029) may be risk factors of abnormal BPV; while anti-hypertensive therapy with diuretics (P < .001, OR = 0.055, 95% CI for OR 0.024-0.125) may be the protective factor. Our study suggests that >500 mL of daily saline infusion for continuous 3 to 5 days may have disadvantages in the blood pressure control for hypertensive patients, especially for the patients with diabetes mellitus and cardiovascular diseases.


Asunto(s)
Variación Biológica Poblacional/fisiología , Presión Sanguínea/efectos de los fármacos , Hipertensión/epidemiología , Solución Salina/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Presión Sanguínea/fisiología , Determinación de la Presión Sanguínea/tendencias , Enfermedades Cardiovasculares/epidemiología , Estudios de Casos y Controles , China/epidemiología , Diabetes Mellitus/epidemiología , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Incidencia , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Procedimientos Ortopédicos/métodos , Procedimientos Ortopédicos/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Solución Salina/administración & dosificación
17.
Medicine (Baltimore) ; 99(38): e21786, 2020 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-32957307

RESUMEN

The present study is a retrospective cohort study. Metabolic syndrome (MetS) is a clustering of clinical findings that has been shown to increase the risk of the surgical outcomes. Our study aimed to evaluate whether MetS was a risk factor for increased perioperative outcomes in patients undergoing posterior lumbar interbody fusion (PLIF).We retrospectively analyzed patients over 18 years following elective posterior lumbar spine fusion from January 2014 to December 2018. Emergency procedures, infections, tumor, fracture, and revision surgeries were excluded. Patients were divided into 2 groups with and without MetS. The MetS was defined by having 3 of the following 4 criteria: obesity (body mass index ≥30 kg/m), dyslipidemia, hypertension, and diabetes. The follow-up period lasted up to 30 days after surgery. The outcomes of demographics, comorbidities, perioperative complications, and length of stay were compared between the 2 groups. Multivariate logistic regression analysis was used to identify perioperative outcomes that were independently associated with MetS.The overall prevalence of MetS was 12.5% (360/2880). Patients with MetS was a significantly higher risk factor for perioperative complications, and longer length of stay cmpared with patients without MetS (P < .05). The MetS group had a higher rate of cardiac complications (P = .019), pulmonary complication (P = .035), pneumonia (P = .026), cerebrovascular event (P = .023), urinary tract infection (P = .018), postoperative ICU admission (P = .02), and deep vein thrombosis (P = .029) than non-MetS group. The patients with MetS had longer hospital stays than the patients without MetS (22.16 vs 19.99 days, P < .001). Logistic regression analysis revealed that patients with MetS were more likely to experience perioperative complications (odds ratio [OR] 1.31; 95% confidence interval [CI]: 1.06-2.07; P < .001), and extend the length of stay (OR: 1.69; 95% CI: 1.25-2028; P = .001).The MetS is a significant risk factor for increased perioperative complications, and extend length of stay after PLIF. Strategies to minimize the adverse effect of MetS should be considered for these patients.


Asunto(s)
Vértebras Lumbares/cirugía , Síndrome Metabólico/epidemiología , Complicaciones Posoperatorias/epidemiología , Fusión Vertebral/efectos adversos , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Comorbilidad , Diabetes Mellitus/epidemiología , Dislipidemias/epidemiología , Procedimientos Quirúrgicos Electivos , Femenino , Humanos , Hipertensión/epidemiología , Tiempo de Internación , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Reoperación , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Fumar/epidemiología , Factores Socioeconómicos , Adulto Joven
18.
Bratisl Lek Listy ; 121(9): 628-633, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32990010

RESUMEN

AIMS: The aim of this study was to explain the demographic data, comorbidity and laboratory findings of our first cases in COVID-19 pneumonia in our country. METHODS: We gathered the data of COVID-19 pneumonia participants from our electronic medical system, including daily medical knowledge and laboratory, radiological, and microbiological results between March 10 to April 7, 2020. RESULTS: Totally, 125 patients, whose findings were compatible with COVID-19, were included in the study, 42 patients were excluded from the study. The distribution of genders was, 39 females (46.9 %), 44 males (53.01 %), the average age was 56.36 ± 16.25 (19-85). Hypertension above 60 years of age and diabetes mellitus under 60 years of age were the most common comorbidities. Neutrophils/ Lymphocyte percent(% NLR) was noted in 44 (53.01 %) patients, average: 3 (range 1.78-4.63). There was a statistically significant and positive relationship between D-dimer and C Reactive Protein (CRP) and ferritin. CONCLUSION: We detected that comorbidities, which were seen at COVID-19 disease differ according to the patients age. Besides that D-dimer, ferritin and CRP outcomes were particularly high and had a significant correlation with COVID-19 severity (Tab. 3, Fig. 2, Ref. 25). Text in PDF www.elis.sk Keywords: COVID-19, prognosis, acute phase reactan.


Asunto(s)
Proteínas de Fase Aguda/análisis , Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , Adulto , Anciano , Betacoronavirus , Comorbilidad , Infecciones por Coronavirus/epidemiología , Diabetes Mellitus/epidemiología , Femenino , Humanos , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Pronóstico , Eslovaquia/epidemiología , Adulto Joven
20.
Arch Esp Urol ; 73(7): 634-642, 2020 Sep.
Artículo en Inglés, Español | MEDLINE | ID: mdl-32886078

RESUMEN

OBJECTIVE: Ureteroscopic lithotripsy (URS) is the current standard choice of treatment for both ureteral and adequate renal stones. Although it is known to be a safe procedure, postoperative febrile urinary tract infection (UTI) is not rare. Especially in diabetic patients, rate of urinary tract infection is higher. Therefore, we aimed to describe the risk factors for UTI following URS in diabetics. MATERIALS AND METHODS: Between January 2017and April 2019, 546 patients who under went ureteroscopic lithotripsy for ureteral and/or renal stones were included. A matched-pair analysis was performed to compare postoperative UTI rates between diabetics and nondiabetics. We retrospectively reviewed the medical records including age, gender, BMI, comorbidities, UTI history, hemoglobin A1c (HbA1c), operating time, stone size and hounsfield unit (HU), preoperative hydronephrosis, ureteroscopic methods and ureteral stenting. Logistic regression analysis was done to determine the risk factors for postoperative UTI in diabetics. RESULTS: In diabetic patients rate of postoperative UTI was 29% (13/45). After matched-pair analysis within the group of non-diabetics, incidence was 11% (5/44) (p=0.04). In univariate analysis, preoperative ureteral stent, UTI history and HbA1c level were the risk factors for UTI after URS in diabetics. UTI history and HbA1clevel were the independent risk factors for developing postoperative UTI in diabetic patients. HbA1c threshold 6.9% afforded 75% sensitivity and 67% specificity for predicting postoperative UTI in diabetics. CONCLUSIONS: Diabetic patients are under greater risk to develop postoperative UTI following URS. Those patients with UTI history and HbA1c level higher than 6.9% must be followed carefully.


Asunto(s)
Diabetes Mellitus/epidemiología , Litotricia/efectos adversos , Cálculos Ureterales/cirugía , Infecciones Urinarias/etiología , Humanos , Estudios Retrospectivos , Resultado del Tratamiento , Ureteroscopía
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