Insulin and Metformin Administration: Unravelling the Multifaceted Association with Mortality across Various Clinical Settings Considering Type 2 Diabetes Mellitus and COVID-19.

Due to the molecular mechanisms of action of antidiabetic drugs, they are considered to be effective in the treatment of both COVID-19 and the post-COVID-19 syndromes. The aim of this study was to determine the effect of administering insulin and metformin on the mortality of patients with type 2 diabetes (T2DM) with symptomatic COVID-19 with the use of logistic regression models. The association between death and insulin and metformin was weak and could not be included in the multivariate model. However, the interaction of both drugs with other factors, including remdesivir and low-molecular-weight heparin (metformin), age and hsCRP (insulin), modulated the odds of death. These interactions hint at multifaceted (anti-/pro-) associations of both insulin and metformin with the odds of death, depending on the patient's characteristics. In the multivariate model, RDW-SD, adjusted with low-molecular-weight heparin treatment, age, sex and K+, was associated with mortality among patients with COVID-19 and T2DM. With a 15% increase in RDW-SD, the risk of death increased by 87.7%. This preliminary study provides the foundations for developing further, more personalized models to assess the risk of death in T2DM patients, as well as for identifying patients at an increased risk of death due to COVID-19.

Disability and emotional symptoms in women with lipedema: A comparison with overweight/obese women.

BACKGROUND: Lipedema is characterized by the painful abnormal deposition of adipose tissue in the lower limbs and is often misdiagnosed as obesity. Considering the numerous bothersome physical symptoms of lipedema, women with lipedema may have greater disability and emotional problems than women with lifestyle-induced obesity. OBJECTIVES: Our study aims to assess disability, anxiety and depression symptoms in women with lipedema compared to women with overweight/obesity. MATERIAL AND METHODS: Women with lipedema (n = 45, with a mean age of 41 years) and women who are overweight/obese (n = 43, with a mean age of 44.95 years) were asked to complete the following questionnaires: The World Health Organization Disability Assessment Schedule (WHO-DAS II), Beck's Depression Inventory - II (BDI-II), and The Hospital Anxiety and Depression Scale (HADS). RESULTS: Despite the higher BMI in the overweight/obesity group, the group with lipedema was more disabled in numerous domains of the WHO-DAS II questionnaire, including Life activities - domestic, work and school responsibilities and Participation in society When the influence of BMI was adjusted, a difference in the domain of Mobility was also present. The study groups did not differ in anxiety and depression symptoms. CONCLUSIONS: We showed that behavioral impairment was the main factor affecting functioning in women with lipedema. Emotional symptoms did not differentiate the study groups. Leg volumes and adipose tissue pain intensity were associated with greater disability in women with lipedema, and should be considered in managing women with this condition and in future research estimating the effectiveness of lipedema treatment.

Usefulness of the Veterans Health Administration COVID-19 (VACO) Index for Predicting Short-Term Mortality among Patients of the COLOS Study.

Advanced age is known to be a predictor with COVID-19 severity. Understanding of other disease progression factors may shorten the time from patient admission to applied treatment. The Veterans Health Administration COVID-19 (VACO index) was assumed to additionally anticipate clinical results of patients hospitalized with a proven infection caused by the SARS-CoV-2 virus. METHODS: The medical records of 2183 hospitalized patients were retrospectively analyzed. Patients were divided into four risk-of-death categories: low risk, medium risk, high-risk, and extreme risk depending on their VACO index calculation. RESULTS: Significant differences in the mortality at the hospital after three months of discharge and six months after discharge were noticed. For the patients in the extreme-risk group, mortality reached 37.42%, 62.81%, and 78.44% for in-hospital, three months of discharge, and six months of discharge, respectively. The mortality marked as high risk reached 20.38%, 37.19%, and 58.77%. Moreover, the secondary outcomes analysis acknowledged that patients classified as extreme risk were more likely to suffer from cardiogenic shock, myocardial infarction, myocardial injury, stroke, pneumonia, acute kidney injury, and acute liver dysfunction. Patients at moderate risk were more often admitted to ICU when compared to other patients. CONCLUSIONS: The usage of the VACO index, combined with an appropriate well-defined medical interview and past medical history, tends to be a helpful instrument in order to predict short-term mortality and disease progression based on previous medical records.

Diabetic Muscle Infarction-A Rare Diabetic Complication: Literature Review and Case Report.

We present a case of a 31-year-old patient with type 1 diabetes diagnosed at the age of 6. Diabetes is complicated with neuropathy, retinopathy, and nephropathy. He has been admitted to the diabetes ward due to inadequate diabetes control. Gastroscopy and abdominal CT were performed, and gastroparesis was confirmed as an explanation for postprandial hypoglycemia. During hospitalization, the patient reported sudden pain localized on the lateral, distal part of his right thigh. The pain occurred at rest and was aggravated by movement. Diabetic muscle infarction (DMI) is a rare complication of long-lasting, uncontrolled diabetes mellitus. It usually occurs spontaneously, without any previous infection or trauma, and is often misdiagnosed clinically as an abscess, neoplasm, or myositis. DMI patients suffer from pain and swelling of the affected muscles. Radiological examinations, including MRI, CT, and USG, are most important for the diagnosis, assessing the extent of involvement and differentiating DMI from other conditions. However, sometimes a biopsy and histopathological examination are necessary. The optimal treatment has still not been determined. There is also a potential risk of DMI recurrence.

Impact of disability in patients with diabetes on the declared quality of life.

Introduction: Diabetes mellitus is a metabolic disease that affects millions of people worldwide. The complications caused by this disease in many cases lead to a deterioration of the quality of life of patients. An additional factor that negatively affects the quality of life of respondents is disability, which in many cases is diagnosed due to diabetes. Objective: The aim of the study was to quantify the impact of disability on the declared quality of life in patients with diabetes and to compare the percentage of people with declared disability with the degree of disability among people with type 1 and type 2 diabetes. Material and methods: The study was based on an internet survey posted on social groups related to diabetes on Facebook. The shortened version of the questionnaire measuring quality of life created by the World Health Organization (WHOQOL-Bref) and some self-created questions were used. The survey was completed by 139 respondents. 113 (81.3%) of them were diagnosed with type 1 diabetes mellitus, and 26 (18.7%) with type 2 diabetes mellitus. Results: The subjective assessment of the quality of life in the entire group was moderate and totalled 3.5 ± 0.9 (on a scale from 1 to 5). The mean score of the physical domain of the WHOQOL-Bref was 48.9 ± 13.1, of the psychological domain was 55.2 ± 13.5, of the social domain was 60.8 ± 22.1, and of the environmental domain was 54.6 ± 14.5. 56.8% (79) of respondents were diagnosed with disability. 46 (58.2%) of them declared moderate disability. Disability was more frequently diagnosed in patients with type 1 diabetes compared to the group of patients with type 2 diabetes (67.3% vs. 11.5%; p<0.001). Very weak correlation was found between the duration of diabetes and particular domains of the WHOQOL-Bref questionnaire (r ranging from -0.107 to -0.017; p>0.05). The subjective quality of life and the level of satisfaction with health were moderate in the group of patients with type 1 diabetes and declared disability (3.5 ± 0.9), without disability (3.4 ± 0.9) and in the group of patients with type 2 diabetes without disability (3.7 ± 0.8). The mean scores of particular domains of the WHOQOL-Bref questionnaire were very similar in patients with type 1 diabetes, both with a disability certificate (physical domain 49.0 ± 13.6; psychological domain 55.3 ± 13.7; social domain 61.1 ± 22 .8; environmental domain 54.0 ± 14.7) and without (physical domain 48.8 ± 14.0; psychological domain 55.4 ± 13.9; social domain 63.1 ± 23.3; environmental domain 55 .4 ± 14.9), and in people with type 2 diabetes (physical domain 49.8 ± 10.4; psychological domain 56.3 ± 12.1; social domain 59.8 ± 19.1; environmental domain 57, 7 ± 11.4). Conclusions: Disability was diagnosed more often in patients with type 1 than type 2 diabetes. The disability certificate in the group of patients with type 1 diabetes does not affect the quality of life of the respondents compared to people with type 1 and type 2 diabetes without a disability certificate.

Two Doses of BNT162b2 mRNA Vaccine in Patients after Hematopoietic Stem Cell Transplantation: Humoral Response and Serological Conversion Predictors.

Vaccination against SARS-CoV-2 is currently the best tool in the fight against the COVID-19 pandemic. However, there are limited data on its efficacy and safety after hematopoietic stem cell transplantation (HCT). We present the results of a prospective analysis of the humoral response to two doses of BNT162b2 mRNA vaccine in 93 adult patients, including 29 after autologous HCT (autoHCT) and 64 after allogeneic HCT (alloHCT). Positive anti-SARS-CoV-2 antibodies were detected before vaccination in 25% of patients despite a negative medical history of COVID-19. Seroconversion after vaccination was achieved in 89% of patients after alloHCT and in 96% after autoHCT, without grade 3/4 adverse events. Post-vaccination anti-SARS-CoV-2 antibody level correlated with the time from transplant and absolute B-cell count at the vaccination. In univariate analysis restricted to the alloHCT group, short time since transplantation, low B-cell count, low intensity conditioning, GvHD, and immunosuppressive treatment at the vaccination were associated with lack of seroconversion. In the multivariate model, the only negative predictor of seroconversion remained treatment with calcineurin inhibitor (CNI). In conclusion, the BNT162b2 mRNA vaccine is highly immunogenic in patients after HCT, but treatment with CNI at the time of vaccination has a strong negative impact on the humoral response.

The COVID-19 mRNA BNT163b2 Vaccine Was Well Tolerated and Highly Immunogenic in Young Adults in Long Follow-Up after Haematopoietic Stem Cell Transplantation.

Sixty five patients (18-31 years) who had received allogeneic haematopoietic stem cell transplantation (3-27 years from HSCT) were evaluated for the tolerance and immunogenicity of the COVID-19 mRNA BNT163b2 vaccine. Methods: Patients were vaccinated with two doses at 5 weeks interval. After each dose, patients completed a survey concerning adverse events (AE) and anti-SARS-CoV-2 IgG antibodies were measured before the first vaccine dose (1stVD) and 14-21 days after the second dose (2ndVD). AE reported after 1stVD and 2ndVD, respectively were: fever 0%, 1.7%; fatigue 15.4%, 25.8%; headache 15.4%, 24.1%; chills 6.1%, 12.0%; muscle pain 15.4%, 24.1%; joint pain 3.0%, 6.9%; nausea 6.1%, 6.9%; pain at injection site 30.7%, 34.4%; swelling 3.0%, 10.3%; redness 0, 3.4%; pruritus 0, 5.2%; and axillary lymphadenopathy 3.0%, 1.7%. After 2ndVD, 96.5% patients were positive for anti-SARS-CoV-2 (GMC 3290.94 BAU/mL). No correlation presented between the antibody titer and symptoms of chronic Graft-versus-Host disease, total IgG, lymphocyte CD4+, or AE. Significantly higher titers were observed in COVID-19 convalescents, and inverse correlation (R2 = -0.0925, p = 0.02) between the time from HSCT and titers after 2ndVD was present. Conclusions: The young adults after HSCT tolerate the COVID-19 mRNA vaccine well and show immunologic response.

Diabetic autonomic neuropathy of the gastrointestinal tract.

Diabetes is a metabolic disease leading to the development of numerous health complications. In developed countries, it is the main cause of blindness, end-stage renal disease, and non-traumatic amputation of the lower limbs. Neuropathy is the most common chronic complication of diabetes. A long-term course of a metabolically unbalanced disease causing damage to the autonomic nervous system of the digestive tract results in the development of many complications, such as intensification of gastro-oesophageal reflux disease, gastroparesis, chronic diarrhoea or faecal incontinence.

Critical ischemia of the fingers in an auto mechanic as a result of occupational exposure.

Hypothenar hammer syndrome is a rare cause of ischemic fingers observed mainly in young men smoking cigarettes and it is associated with repeated trauma of the ulnar artery in the area of the hypothenar eminence of the dominant-hand arm, resulting in a deficit of blood supply with the occurrence of hand symptoms typical for chronic and sometimes critical ischemia. Artery injury in this location is most often the result of multiple repetitions of the same activity being mostly the result of occupational exposure. We present a case of a 27-year-old car mechanic admitted to the hospital with symptoms of critical ischemia of the fingers III, IV, and V of the right hand, which resolved after conservative treatment.