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Vera-Delgado V, García-Rosado D, Pérez-Hernández O, Martín-Ponce E, de La Paz-Estrello AM, García-Marichal C, Pérez-Fernández S, Rodríguez-Morón V, Alemán-Valls R, González-Reimers E, Martín-González C. Mortality and COVID Infection: Predictors of Mortality 10 Months after Discharge. Diseases 2024; 12:123. [PMID: 38920555 PMCID: PMC11203287 DOI: 10.3390/diseases12060123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 05/22/2024] [Accepted: 05/27/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND The long-term survival of patients hospitalized with COVID-19 and the factors associated with poorer survival months after infection are not well understood. The aims of the present study were to analyze the overall mortality 10 months after admission. METHODS 762 patients with COVID-19 disease were included. Patients underwent a complete clinical evaluation, routine laboratory analysis and chest X-ray. Data collected included demographic and clinical data, such as vascular risk factors, tobacco or alcohol use, comorbidity, and institutionalization. RESULTS Ten-month mortality was 25.6%: 108 deaths occurred in-hospital, while 87 patients died after discharge. In-hospital mortality was independently related to NT-proBNP values > 503.5 pg/mL [OR = 4.67 (2.38-9.20)], urea > 37 mg/dL [3.21 (1.86-7.31)] and age older than 71 years [OR = 1.93 (1.05-3.54)]. NT-proBNP values > 503.5 pg/mL [OR = 5.00 (3.06-8.19)], urea > 37 mg/dL [3.51 (1.97-6.27)], cognitive impairment [OR = 1.96 (1.30-2.95), cancer [OR = 2.23 (1.36-3.68), and leukocytes > 6330/mm3 [OR = 1.64 (1.08-2.50)], were independently associated with long-term mortality. CONCLUSIONS the risk of death remains high even months after COVID-19 infection. Overall mortality of COVID-19 patients during 10 months after hospital discharge is nearly as high as that observed during hospital admission. Comorbidities such as cancer or cognitive impairment, organ dysfunction and inflammatory reaction are independent prognostic markers of long-term mortality.
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Affiliation(s)
- Víctor Vera-Delgado
- Servicio de Medicina Interna, Hospital Universitario de Canarias, 38320 San Cristóbal de La Laguna, Spain; (V.V.-D.); (D.G.-R.); (O.P.-H.); (E.M.-P.); (A.M.d.L.P.-E.); (S.P.-F.); (V.R.-M.); (R.A.-V.)
| | - Dácil García-Rosado
- Servicio de Medicina Interna, Hospital Universitario de Canarias, 38320 San Cristóbal de La Laguna, Spain; (V.V.-D.); (D.G.-R.); (O.P.-H.); (E.M.-P.); (A.M.d.L.P.-E.); (S.P.-F.); (V.R.-M.); (R.A.-V.)
| | - Onán Pérez-Hernández
- Servicio de Medicina Interna, Hospital Universitario de Canarias, 38320 San Cristóbal de La Laguna, Spain; (V.V.-D.); (D.G.-R.); (O.P.-H.); (E.M.-P.); (A.M.d.L.P.-E.); (S.P.-F.); (V.R.-M.); (R.A.-V.)
| | - Esther Martín-Ponce
- Servicio de Medicina Interna, Hospital Universitario de Canarias, 38320 San Cristóbal de La Laguna, Spain; (V.V.-D.); (D.G.-R.); (O.P.-H.); (E.M.-P.); (A.M.d.L.P.-E.); (S.P.-F.); (V.R.-M.); (R.A.-V.)
| | - Alejandro Mario de La Paz-Estrello
- Servicio de Medicina Interna, Hospital Universitario de Canarias, 38320 San Cristóbal de La Laguna, Spain; (V.V.-D.); (D.G.-R.); (O.P.-H.); (E.M.-P.); (A.M.d.L.P.-E.); (S.P.-F.); (V.R.-M.); (R.A.-V.)
| | | | - Sergio Pérez-Fernández
- Servicio de Medicina Interna, Hospital Universitario de Canarias, 38320 San Cristóbal de La Laguna, Spain; (V.V.-D.); (D.G.-R.); (O.P.-H.); (E.M.-P.); (A.M.d.L.P.-E.); (S.P.-F.); (V.R.-M.); (R.A.-V.)
| | - Valle Rodríguez-Morón
- Servicio de Medicina Interna, Hospital Universitario de Canarias, 38320 San Cristóbal de La Laguna, Spain; (V.V.-D.); (D.G.-R.); (O.P.-H.); (E.M.-P.); (A.M.d.L.P.-E.); (S.P.-F.); (V.R.-M.); (R.A.-V.)
| | - Remedios Alemán-Valls
- Servicio de Medicina Interna, Hospital Universitario de Canarias, 38320 San Cristóbal de La Laguna, Spain; (V.V.-D.); (D.G.-R.); (O.P.-H.); (E.M.-P.); (A.M.d.L.P.-E.); (S.P.-F.); (V.R.-M.); (R.A.-V.)
- Departamento de Medicina Interna, Dermatología y Psiquiatría, Universidad de La Laguna, 38320 San Cristóbal de La Laguna, Spain;
| | - Emilio González-Reimers
- Departamento de Medicina Interna, Dermatología y Psiquiatría, Universidad de La Laguna, 38320 San Cristóbal de La Laguna, Spain;
| | - Candelaria Martín-González
- Servicio de Medicina Interna, Hospital Universitario de Canarias, 38320 San Cristóbal de La Laguna, Spain; (V.V.-D.); (D.G.-R.); (O.P.-H.); (E.M.-P.); (A.M.d.L.P.-E.); (S.P.-F.); (V.R.-M.); (R.A.-V.)
- Departamento de Medicina Interna, Dermatología y Psiquiatría, Universidad de La Laguna, 38320 San Cristóbal de La Laguna, Spain;
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Uthaya Kumar A, Ahmad Zan M, Ng CL, Chieng S, Nathan S. Diabetes and Infectious Diseases with a Focus on Melioidosis. Curr Microbiol 2024; 81:208. [PMID: 38833191 DOI: 10.1007/s00284-024-03748-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/19/2024] [Indexed: 06/06/2024]
Abstract
Diabetes mellitus (DM) leads to impaired innate and adaptive immune responses. This renders individuals with DM highly susceptible to microbial infections such as COVID-19, tuberculosis and melioidosis. Melioidosis is a tropical disease caused by the bacterial pathogen Burkholderia pseudomallei, where diabetes is consistently reported as the most significant risk factor associated with the disease. Type-2 diabetes is observed in 39% of melioidosis patients where the risk of infection is 13-fold higher than non-diabetic individuals. B. pseudomallei is found in the environment and is an opportunistic pathogen in humans, often exhibiting severe clinical manifestations in immunocompromised patients. The pathophysiology of diabetes significantly affects the host immune responses that play a critical role in fighting the infection, such as leukocyte and neutrophil impairment, macrophage and monocyte inhibition and natural killer cell dysfunction. These defects result in delayed recruitment as well as activation of immune cells to target the invading B. pseudomallei. This provides an advantage for the pathogen to survive and adapt within the immunocompromised diabetic patients. Nevertheless, knowledge gaps on diabetes-infectious disease comorbidity, in particular, melioidosis-diabetes comorbidity, need to be filled to fully understand the dysfunctional host immune responses and adaptation of the pathogen under diabetic conditions to guide therapeutic options.
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Affiliation(s)
- Asqwin Uthaya Kumar
- Department of Biological Sciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Muhammad Ahmad Zan
- Department of Biological Sciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Chyan-Leong Ng
- Institute of Systems Biology, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Sylvia Chieng
- Department of Biological Sciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Sheila Nathan
- Department of Biological Sciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Malaysia.
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103
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Kordjazi M, Bazgir N, Eftekharian K, Farajpour M, Dilmaghani NA. Manifestations of Mucormycosis and Its Complications in COVID-19 Patients: A Case Series Study. EAR, NOSE & THROAT JOURNAL 2024; 103:145S-152S. [PMID: 36583239 PMCID: PMC9805989 DOI: 10.1177/01455613221143859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Mucormycosis is an opportunistic fungal disease that affects immunocompromised patients. With the advent of SARS-CoV-2, this opportunistic disease has increased. METHODS A case series of 47 patients with COVID-19 associated mucormycosis have been analyzed. Demographic information, signs, symptoms, laboratory investigations, imaging studies, and their association with ICU admission and 30-day mortality were assessed. RESULTS Total number of 47 consecutive rhino-orbital cerebral mucormycosis (ROCM) cases were analyzed. Periorbital swelling was the most common sign among patients. Majority of cases had diabetes. All patients received liposomal Amphotericin B. Debridement was performed for all cases. CONCLUSIONS SARS-CoV-2 increases the susceptibility to mucormycosis infection in various ways. Uncontrolled level of HbA1c in all patients, even non-diabetic individuals, indicates hyperglycemia over the past three months. Diabetes, orbital exenteration, ptosis, periorbital swelling, DKA, LOC, brain involvement, and mechanical ventilation all correlated with a higher rate of ICU admission and 30-day mortality. In addition, a higher white blood cell count is related to the higher probability of ICU admission. While considering all of the inflammatory laboratory data and HbA1c could help predict 30-day mortality.
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Affiliation(s)
- Mohammadsmaeil Kordjazi
- Departmentof Otorhinolaryngology,
Loghman Hakim Educational Hospital, Shahid Beheshti University of Medical
Sciences, Tehran, Iran
| | - Narges Bazgir
- School of Medicine, Shahid Beheshti University of Medical
Sciences, Tehran, Iran
| | - Kourosh Eftekharian
- Department of Otolaryngology, Head
and Neck Surgery, Loghman Hakim Educational Hospital, School of Medicine, Shahid Beheshti University of Medical
Sciences, Tehran, Iran
| | - Mostafa Farajpour
- Depatement of general surgery, Arak University of Medical
Sciences, Arak, Iran
| | - Nader Akbari Dilmaghani
- Department of Otolaryngology, Head
and Neck Surgery, Loghman Hakim Educational Hospital, School of Medicine, Shahid Beheshti University of Medical
Sciences, Tehran, Iran
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104
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Amaral LB, Carlesse F, Rossato L. Pediatric mucormycosis associated with COVID-19: A systematic review of clinical cases. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024; 42:321-326. [PMID: 38216422 DOI: 10.1016/j.eimce.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/03/2023] [Indexed: 01/14/2024]
Abstract
The occurrence of mucormycosis has been observed in individuals with COVID-19. However, there is limited information on the epidemiological factors, presentation, diagnostic certainty, and outcome of this infection in children. PubMed, MEDLINE, Scopus, Embase, Web of Science, LitCovid, and back-references of the identified manuscripts were systematically searched from December 2019 to March 2023. We have identified 14 cases of pediatric mucormycosis in patients with COVID-19. The median age of patients was 10.7 years. Among these cases, 10 were associated with active COVID-19. In 7 cases, the patients had pre-existing diabetes mellitus and concomitant diabetic ketoacidosis. Corticosteroids were administered to treat COVID-19 in 7 of the patients. The most common clinical presentation of the disease was rhino-orbital cerebral mucormycosis. Seven patients died (50%). Given the high mortality rate, clinicians should maintain a high level of clinical suspicion of mucormycosis in pediatric patients with COVID-19.
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Affiliation(s)
| | - Fabianne Carlesse
- Oncology Pediatric Institute (IOP-GRAACC), Brazil; Department of Pediatrics, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Luana Rossato
- Universidade Federal da Grande Dourados-UFGD, Brazil.
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105
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Barron E, Sharp SJ, Khunti K, Bakhai C, Wareham NJ, Valabhji J. Prediabetes, participation in the English National Health Service Diabetes Prevention Programme, and associations with COVID-19-related mortality: A whole population study. Diabetes Res Clin Pract 2024; 212:111692. [PMID: 38723673 DOI: 10.1016/j.diabres.2024.111692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 05/19/2024]
Abstract
AIMS To assess the effects of non-diabetic hyperglycaemia (NDH, also known as pre-diabetes), including the impact of the NHS Diabetes Prevention Programme (NHS DPP), on COVID-19-related mortality during the pandemic. METHODS This study included all 61,438,225 individuals registered with General Practices in England and alive on 1st March 2020. We assessed COVID-19-related mortality in the 2,290,280(3.7 %) individuals with diagnosed NDH between March 2020 and February 2022 compared to those without diagnosed NDH or diabetes using Cox regression to adjust for demographic factors and cardiovascular comorbidities. Individuals with diagnosed NDH were further sub-categorised based on their contact with the NHS DPP (N = 376,590). Analyses were stratified by age (years) (<50, 50-69 and ≥ 70). RESULTS There were 158,070 COVID-19 deaths; 17,280(11 %) for people with diagnosed NDH. The adjusted hazard ratio (HR) was 0.95(0.93-0.96),p < 0.001 for those with diagnosed NDH compared to those without diagnosed diabetes or NDH. By age (years), HRs were, 2.53(2.23-2.88),p < 0.001 for < 50, 1.29(1.24-1.35),p < 0.001 for 50-69 and 0.87(0.85-0.89),p < 0.001 for ≥ 70. NHS DPP attendance was associated with lower COVID-19 mortality with a dose-response relationship with engagement. CONCLUSIONS Younger people with diagnosed NDH were at higher relative risk of COVID-19 mortality. Attendance at the NHS DPP was associated with significantly lower COVID-19-related mortality.
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Affiliation(s)
- Emma Barron
- NHS England, Wellington House, 122-135 Waterloo Road, London SE1 8UG, UK; Department of Metabolism, Digestion and Reproduction, Imperial College London, South Kensington, London; Chelsea and Westminster hospital NHS Foundation Trust, London, UK.
| | - Stephen J Sharp
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Kamlesh Khunti
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Chirag Bakhai
- NHS England, Wellington House, 122-135 Waterloo Road, London SE1 8UG, UK
| | - Nicholas J Wareham
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Jonathan Valabhji
- NHS England, Wellington House, 122-135 Waterloo Road, London SE1 8UG, UK; Department of Metabolism, Digestion and Reproduction, Imperial College London, South Kensington, London; Chelsea and Westminster hospital NHS Foundation Trust, London, UK
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Khanal P, Dwivedi PSR, Patil VS, Shetty A, S A, Aga A, R A, Javaid A, Bhandare VV. Barosmin against postprandial hyperglycemia: outputs from computational prediction to functional responses in vitro. J Biomol Struct Dyn 2024; 42:4489-4505. [PMID: 37458811 DOI: 10.1080/07391102.2023.2233631] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/28/2023] [Indexed: 05/16/2024]
Abstract
Previously, barosmin has been demonstrated to possess anti-diabetic action. However, its effect to inhibit α-amylase and α-glucosidase, including glucose utilization efficacy, has yet to be revealed. Hence, the current study attempted to assess the efficiency of barosmin in inhibiting the α-amylase, α -glucosidase, and dipeptidyl peptidase 4 enzymes, including glucose uptake efficacy. Molecular docking and simulation were performed using AutoDock Vina and Gromacs respectively followed by gene ontology analysis using the database for annotation, visualization, and integrated discovery. Further, in vitro enzyme inhibitory activities and glucose uptake assay were performed in L6 cell lines. Density functional theory analysis detailed mechanistic insights into the crucial interaction sites of barosmin of which the electron-dense region was prone to nucleophilic attack (O-atoms) whereas hydroxyl groups (-OH) showed affinity for electrophilic attacks. Barosmin showed good binding affinity with α-amylase (-9.2 kcal/mol), α-glucosidase (-10.7 kcal/mol), and dipeptidyl peptidase 4 (-10.0 kcal/mol). Barosmin formed stable nonbonded contacts with active site residues of aforementioned enzymes throughout 200 ns molecular dynamics simulation. Further, it regulated pathway concerned with glucose homeostasis i.e. tumor necrosis factor signaling pathway. In addition, barosmin showed α-amylase (IC50= 95.77 ± 23.33 µg/mL), α-glucosidase (IC50= 68.13 ± 2.95 µg/mL), and dipeptidyl peptidase 4 (IC50= 13.27 ± 1.99 µg/mL) inhibitory activities including glucose uptake efficacy in L6 cell lines (EC50= 12.46 ± 0.90 µg/mL) in the presence of insulin. This study presents the efficacy of the barosmin to inhibit α-amylase and α-glucosidase and glucose uptake efficacy in L6 cell lines via the use of multiple system biology tools and in vitro techniques.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Pukar Khanal
- Department of Pharmacology, NGSM Institute of Pharmaceutical Sciences, Nitte Deemed to be University, Mangalore, India
| | - Prarambh S R Dwivedi
- Department of Pharmacology, NGSM Institute of Pharmaceutical Sciences, Nitte Deemed to be University, Mangalore, India
| | - Vishal S Patil
- KLE College of Pharmacy, Belagavi, KLE Academy of Higher Education and Research, India
| | - Ankith Shetty
- Department of Pharmacology, NGSM Institute of Pharmaceutical Sciences, Nitte Deemed to be University, Mangalore, India
| | - Adithya S
- Department of Pharmacology, NGSM Institute of Pharmaceutical Sciences, Nitte Deemed to be University, Mangalore, India
| | - Afra Aga
- Department of Pharmacology, NGSM Institute of Pharmaceutical Sciences, Nitte Deemed to be University, Mangalore, India
| | - Akshith R
- Department of Pharmacology, NGSM Institute of Pharmaceutical Sciences, Nitte Deemed to be University, Mangalore, India
| | - Aarif Javaid
- Department of Pharmacology, NGSM Institute of Pharmaceutical Sciences, Nitte Deemed to be University, Mangalore, India
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Sakander N, Ahmed A, Bhardwaj M, Kumari D, Nandi U, Mukherjee D. A path from synthesis to emergency use authorization of molnupiravir as a COVID-19 therapy. Bioorg Chem 2024; 147:107379. [PMID: 38643567 DOI: 10.1016/j.bioorg.2024.107379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 04/04/2024] [Accepted: 04/14/2024] [Indexed: 04/23/2024]
Abstract
Coronaviruses are a group of enveloped viruses with non-segmented, single-stranded, and positive-sense RNA genomes. It belongs to the 'Coronaviridae family', responsible for various diseases, including the common cold, SARS, and MERS. The COVID-19 pandemic, which began in March 2020, has affected 209 countries, infected over a million people, and claimed over 50,000 lives. Significant efforts have been made by repurposing several approved drugs including antiviral, to combat the COVID-19 pandemic. Molnupiravir is found to be the first orally acting efficacious drug to treat COVID-19 cases. It was approved for medical use in the UK in November 2021 and other countries, including USFDA, which granted approval an emergency use authorization (EUA) for treating adults with mild to moderate COVID-19 patients. Considering the importance of molnupiravir, the present review deals with its various synthetic strategies, pharmacokinetics, bio-efficacy, toxicity, and safety profiles. The comprehensive information along with critical analysis will be very handy for a wide range of audience including medicinal chemists in the arena of antiviral drug discovery especially anti-viral drugs against any variant of COVID-19.
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Affiliation(s)
- Norein Sakander
- Natural Product and Medicinal Chemistry Division, CSIR-Indian Institute of Integrative Medicine, Jammu 180001, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Ajaz Ahmed
- Natural Product and Medicinal Chemistry Division, CSIR-Indian Institute of Integrative Medicine, Jammu 180001, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India; Department of Chemistry and Biochemistry, University of California, Los Angeles, CA, 90095, USA
| | - Mahir Bhardwaj
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India; Pharmacology Division, CSIR-Indian Institute of Integrative Medicine, Jammu 180001, India
| | - Diksha Kumari
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India; Infectious Diseases Division, CSIR-Indian Institute of Integrative Medicine, Jammu 180001, India
| | - Utpal Nandi
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India; Pharmacology Division, CSIR-Indian Institute of Integrative Medicine, Jammu 180001, India
| | - Debaraj Mukherjee
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India; Department of Chemical Sciences, Bose Institute, EN 80, Sector V, Bidhan Nagar, Kolkata 700091, WB, India.
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Lahane V, Acharya S, Shukla S, Kumar S, Khurana K, Raut SS, Kadu A. Platelet Indices as Novel Surrogate Markers for the Prognosis of COVID-19 Infection: An Observational Study. Cureus 2024; 16:e62243. [PMID: 39006704 PMCID: PMC11244729 DOI: 10.7759/cureus.62243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/12/2024] [Indexed: 07/16/2024] Open
Abstract
Background The new severe acute respiratory syndromecoronavirus 2 (SARS-CoV-2) causes severe acute respiratory illness accountable for causing the coronavirus disease 2019 (COVID-19) illness. Thrombotic issues, acute respiratory distress syndrome (ARDS), and cytokine storm are significant contributors to morbidity and mortality in patients with COVID-19. Elevated D-dimer levels and prothrombin times are further indicators of abnormal coagulation parameters in COVID-19 patients. This study aimed to study the platelet indices as prognostic markers in COVID-19 infection. Methods In this prospective observational study, 150 real-time reverse transcription-polymerase chain reaction (RT-PCR)-positive COVID-19 patients were enrolled between October 2020 and September 2021. All the subjects were screened and explained the study procedure in their native language. Following enrolment, a detailed history and physical examination were performed. Subsequently, laboratory investigations were performed, and patients were subjected to high-resolution computed tomography (HRCT) examination to classify patients into mild, moderate, and severe according to the severity of the illness. The platelet indices taken into account were plateletcrit (PCT) in percentage, platelet count (PLT) in lakh per microlitre, mean platelet volume (MPV) in femtolitres, and platelet distribution width (PDW) in femtolitres. Results The mean PLT was significantly greater among survivors than non-survivors (2.03 ± 0.72 versus 1.76 ± 0.47; p-value = 0.018). The mean MPV (10.42 ± 0.53 versus 9.22 ± 0.64; p-value <0.0001) and PDW (17.99 ± 1.53 versus 16.54 ± 0.91 fl; p-value <0.0001) were significantly greater among non-survivors than survivors. However, the mean PCT was significantly greater among survivors than non-survivors (0.22 ± 0.03% versus 0.18 ± 0.33%; p-value <0.0001). At a cut-off of 0.213, the sensitivity and specificity of PCT in predicting death were found to be 79.2% and 74.5%, respectively. At a cut-off of 16.75, the sensitivity and specificity of PDW in predicting death were found to be 68.8% and 59.8%, respectively. The findings demonstrated a relationship between elevated MPV and PDW and mortality and severe COVID-19 infection. Increased PCT was connected to higher survival, with a specificity and sensitivity of 87.5% and 75.5%, respectively, and MPV >9.75 may predict death. PDW >16.75 exhibited a specificity and sensitivity of 68.8% and 59.8%, respectively, in predicting death. With comparable sensitivity and specificity of 79.2% and 74.5%, PCT >0.213 may predict death. Conclusion In severely sick COVID-19 patients, platelet indices should be routinely calculated and can be utilized as simple, low-cost prognostic indicators.
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Affiliation(s)
- Vivek Lahane
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sourya Acharya
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Samarth Shukla
- Department of Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sunil Kumar
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Kashish Khurana
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sarang S Raut
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ajinkya Kadu
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Liu Y, Barnet JH, Hagen EW, Peppard PE, Mignot E, Reither EN. Objectively measured daytime sleepiness predicts weight change among adults: Findings from the Wisconsin Sleep Cohort Study. Sleep Health 2024; 10:327-334. [PMID: 38688810 DOI: 10.1016/j.sleh.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE Body mass index (BMI) trajectories are associated with night-time sleep, but it is not clear how they relate to daytime sleepiness in population data. This study aimed to examine longitudinal associations between levels and changes in daytime sleepiness and BMI trajectories among men and women. METHODS We estimated growth curve models among 827 participants in the Wisconsin Sleep Cohort Study (mean [sd] age = 55.2 [8.0] years at baseline). The outcome variable was BMI (kg/m2) and the key predictor was daytime sleepiness measured by Multiple Sleep Latency Test (MSLT) scores. Covariates included demographics, health behaviors, retirement status, stimulant use, and depressive symptoms. In sensitivity analyses, we evaluated the potential effects of cardiovascular disease, shift work status, and sleep apnea on the robustness of sleepiness and BMI associations. RESULTS At the between-person level, men who were sleepier had higher BMI levels. At the within-person level, age moderated the positive association between sleepiness and BMI among women. Specifically, young women who became sleepier over time gained more BMI than older women with comparable increases in sleepiness. Furthermore, while BMI tended to increase with age among women, BMI trajectories were steeper among sleepy women than among well-rested women, who experienced less increase in BMI over time. CONCLUSION The study suggested that levels and changes in daytime sleepiness as objectively measured by MSLT scores are associated with body mass among adults.
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Affiliation(s)
- Yin Liu
- Department of Human Development and Family Studies, Utah State University, Logan, Utah, USA
| | - Jodi H Barnet
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Erika W Hagen
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Paul E Peppard
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Emmanuel Mignot
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Eric N Reither
- Department of Sociology and Anthropology, Utah State University, Logan, Utah, USA.
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Fakhruddin KS, Matsubara VH, Warnakulasuriya S, Tilakaratne WM, Ngo HC, Samaranayake LP. Mucormycosis of the Mandible and Tongue: A Systematic Scoping Review. Int Dent J 2024; 74:454-472. [PMID: 38143163 PMCID: PMC11123561 DOI: 10.1016/j.identj.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/14/2023] [Accepted: 11/14/2023] [Indexed: 12/26/2023] Open
Abstract
AIM Mucormycosis is a rare human infection associated with Mucorales, a group of filamentous moulds found in different environmental niches. Its oral manifestations may occur in the mandible and tongue despite being rare. We aimed to systematically review the data on clinical manifestations, risk factors, diagnostic approaches, treatment options, and outcomes of mandibular and tongue mucormycosis. METHODS An electronic search of articles published between January 1975 and November 2022 in PubMed, Web of Science, and EMBASE databases was performed. A total of 22 articles met the inclusion criteria and reported 27 cases of oral mucormycosis in total. RESULTS Fourteen patients had mandibular mucormycosis signs unrelated to COVID-19 infection, 6 had SARS-CoV-2-related mandibular mucormycosis, and 6 had manifestations in the tongue. All published case reports during the COVID-19 pandemic were from India. Patient ages ranged from 4 months old to 82 years, and most patients had important comorbidities, such as blood dyscrasias related to immune deficiency and uncontrolled type 2 diabetes mellitus. The signs and symptoms of mandibular and tongue mucormycosis varied from dental pain, loose teeth, and nonhealing sockets to dysphagia and paraesthesia of the lip. Some patients also reported trismus, draining sinus tract, and facial pain. The diagnosis of oral mucormycosis was based on a combination of clinical, radiographic, and histopathologic findings by demonstrating fungal hyphae in tissue specimens. In most cases, mucormycosis was managed with systemic amphotericin B, strict glycaemic control, and aggressive surgical debridement of infected tissue, minimising the progression of the fungal infection and thus improving the survival rate. In some cases, combined antifungal therapy, antibiotic therapy, and chlorhexidine mouthwashes were used successfully. CONCLUSIONS Recognition of the signs and symptoms by oral care providers is pertinent for the early diagnosis and treatment of tongue and mandibular mucormycosis, and providers should be aware of the possibility of this opportunistic fungal infection in patients with COVID-19. A multidisciplinary approach is recommended for the management of this lethal infection.
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Affiliation(s)
- Kausar Sadia Fakhruddin
- Department of Preventive and Restorative Dentistry, University of Sharjah, Sharjah, United Arab Emirates
| | | | | | | | - Hien Chi Ngo
- Dental School, University of Western Australia, Perth, Western Australia, Australia
| | - Lakshman P Samaranayake
- Faculty of Dentistry, The University of Hong Kong, Hong Kong. Special Administrative Region, China.
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Meidani M, Zahak Miandoab S, Salami A, Jadidi S, Sohrabi M, Ebrahimi Alavijeh P, Ghaderkhani S, Emadi Koochak H, Salami Khaneshan A. Secondary bacterial infections in post-COVID-19 mucormycosis cases: a retrospective study at Imam Khomeini Hospital Complex, March 2020-April 2021. IRANIAN JOURNAL OF MICROBIOLOGY 2024; 16:293-298. [PMID: 39005610 PMCID: PMC11245346 DOI: 10.18502/ijm.v16i3.15759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
Background and Objectives To explore the prevalence and characteristics of secondary bacterial infections among patients suffering from mucormycosis following COVID-19 infection. Materials and Methods We conducted a cross-sectional, retrospective analysis from March 2020 to April 2022 at Imam Khomeini Hospital Complex in Tehran. The study included patients with histopathologically confirmed mucormycosis and documented secondary bacterial infections. We extracted and analyzed data from hospital records using SPSS software, version 26. Results The study comprised 27 patients, with a predominance of females (70.4%) and an average age of 56 years. The majority of these patients (63%) had pre-existing diabetes mellitus. The severity of their COVID-19 infections varied. Treatment regimens included immunosuppressive drugs and antibiotics. Rhinocerebral mucormycosis was the most common form observed. The predominant secondary infections involved the urinary tract, respiratory system, bloodstream (bacteremia), and soft tissues, with resistant strains of Acinetobacter baumannii, Escherichia coli, and Klebsiella pneumoniae being the most frequently identified microorganisms. Notably, cases of bacteremia and pneumonia exhibited a higher mortality rate. Ultimately, 55.6% of patients were discharged, while 44.4% succumbed to their infections. Conclusion Patients recovering from COVID-19 with mucormycosis are significantly susceptible to secondary bacterial infections, particularly those with diabetes mellitus or those undergoing immunosuppressive therapy. Such infections compound the morbidity and mortality risks in this vulnerable patient cohort.
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Affiliation(s)
- Mohsen Meidani
- Department of Infectious Disease and Tropical Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepideh Zahak Miandoab
- Department of Infectious Disease and Tropical Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Salami
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sajedeh Jadidi
- Department of Urology, Shahid Beheshti University of Medical Sciences, Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Tehran, Iran
| | - Marjan Sohrabi
- Department of Infectious Disease and Tropical Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Parvaneh Ebrahimi Alavijeh
- Department of Infectious Disease and Tropical Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Ghaderkhani
- Department of Infectious Disease and Tropical Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Emadi Koochak
- Department of Infectious Disease and Tropical Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezoo Salami Khaneshan
- Department of Infectious Disease and Tropical Medicine, Tehran University of Medical Sciences, Tehran, Iran
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112
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Czaplicka A, Kaleta B. The effect of incretin-based drugs on the riks of acute pancreatitis: a review. J Diabetes Metab Disord 2024; 23:487-495. [PMID: 38932809 PMCID: PMC11196466 DOI: 10.1007/s40200-024-01430-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/27/2024] [Indexed: 06/28/2024]
Abstract
Objectives In recent years, new hypoglycaemic drugs that affect the incretin system have become increasingly popular in the treatment of type 2 diabetes mellitus (T2DM): glucagon-like receptor 1 agonists (GLP1RAs), dipeptidyl peptidase 4 inhibitors (DPP4is) and the recently developed dual glucagon-like receptor 1 agonist and glucose-dependent insulinotropic polypeptide (tirzepatide). Their main role of these drugs is to normalise blood glucose levels. In addition, GLP1RAs are approved for the treatment of excessive body weight. The efficacy of drugs affecting the incretin system is well described in the literature, however, there are still only few reports about their safety. This review aims to summarize the results of current research and meta-analyses on risk of acute pancreatitis (AP) during incretin-affecting drugs treatment. Methods A narrative review was performed using present literature in an attempt to identify the relationship between AP and incretin-affecting drugs. The following keywords were used: acute pancreatitis, glucagon-like receptor 1 agonists, dipeptidyl peptidase 4 inhibitors and tirzepatide. Results It was demonstrated that the use of DPP4is is safe for the majority of patients with T2DM, whereas a risk of AP should be noted in case of GLP1RAs therapy. To date, most studies found no significant association between tirzepatide therapy and the increased risk of AP. Conclusion The majority of studies have shown that DPP4is, GLP1RAs and tirzepatide are effective and safe in most T2DM patients. However, the follow-up time for patients treated with tirzepatide is short, therefore more studies are required to confirm the safety of this drug.
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Affiliation(s)
- Agata Czaplicka
- Department of Internal Medicine and Gastroenterology, Brodnowski Hospital of the Mazovian, Kondratowicza 8, 03-242 Warsaw, Poland
| | - Beata Kaleta
- Department of Clinical Immunology, Medical University of Warsaw, 02-006 Warsaw, Poland
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Du X, Chen F, He Y, Zou H, Pan H, Zhu X. Establishment and validation of prediction model for atherosclerotic cardiovascular disease in patients with hyperuricemia. Int J Rheum Dis 2024; 27:e15205. [PMID: 38873791 DOI: 10.1111/1756-185x.15205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVE To construct a risk prediction model for atherosclerotic cardiovascular disease (ASCVD) in patients with hyperuricemia. METHODS Data in this study were obtained from the National Health and Nutrition Examination Survey (NHANES) (2007-2010). Participants from Huashan Hospital were included as an external validation. Logistic regression analysis was used to explore the relevant factors of ASCVD in patients with hyperuricemia. The discriminability of the model was evaluated using the area under the curve (AUC) statistic of the receiver operating characteristic curve. Hosmer-Lemeshow test, correction curve and decision curve analysis (DCA) were used to evaluate the model. RESULTS A total of 389 patients collected from the NHANES were included in the final analysis. Logistic regression analysis showed that age, creatinine (Cr), glucose (Glu), serum uric acid (SUA), and history of gout were predictive factors for ASCVD in hyperuricemia (HUA) patients. These predictive factors were used to construct a nomogram. And 157 patients from NHANES were in the internal validation group and 136 patients from Huashan Hospital were in the external validation group. The AUC values of the three groups were 0.943, 0.735, and 0.664. The p values of the Hosmer-Lemeshow test were .568, .600, and .763. The calibration curve showed consistency between the nomogram and the actual observed values. The DCA curve indicated that the model has good clinical practicality. CONCLUSION This study constructed the ASCVD risk prediction model for HUA patients, which is beneficial for medical staff to detect high-risk populations of ASCVD in the early stage.
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Affiliation(s)
- Xingchen Du
- Department of Rheumatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Fangfang Chen
- Department of Rheumatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yisheng He
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Hejian Zou
- Department of Rheumatology, Huashan Hospital, Fudan University, Shanghai, China
| | - HaiFeng Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Xiaoxia Zhu
- Department of Rheumatology, Huashan Hospital, Fudan University, Shanghai, China
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Wondimkun YA, Caughey GE, Inacio MC, Hughes GA, Air T, Jorissen RN, Hogan M, Sluggett JK. National trends in utilisation of glucose lowering medicines by older people with diabetes in long-term care facilities. Diabetes Res Clin Pract 2024; 212:111701. [PMID: 38719026 DOI: 10.1016/j.diabres.2024.111701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/26/2024] [Accepted: 05/04/2024] [Indexed: 05/13/2024]
Abstract
AIMS To examine national trends in glucose lowering medicine (GLM) use among older people with diabetes in long-term care facilities (LTCFs) during 2009-2019. METHODS A repeated cross-sectional study of individuals ≥65 years with diabetes in Australian LTCFs (n = 140,322) was conducted. Annual age-sex standardised prevalence of GLM use and number of defined daily doses (DDDs)/1000 resident-days were estimated. Multivariable Poisson or Negative binomial regression models were used to estimate adjusted rate ratios (aRRs) and 95 % confidence intervals (CIs). RESULTS Prevalence of GLM use remained steady between 2009 (63.9%, 95 %CI 63.3-64.4) and 2019 (64.3%, 95 %CI 63.9-64.8) (aRR 1.00, 95 %CI 1.00-1.00). The percentage of residents receiving metformin increased from 36.0% (95 %CI 35.3-36.7) to 43.5% (95 %CI 42.9-44.1) (aRR 1.01, 95 %CI 1.01-1.01). Insulin use also increased from 21.5% (95 %CI 21.0-22.0) to 27.0% (95 %CI 26.5-27.5) (aRR 1.02, 95 %CI 1.02-1.02). Dipeptidyl peptidase-4 inhibitor use increased from 1.0% (95 %CI 0.9-1.1) to 21.1% (95 %CI 20.7-21.5) (aRR 1.24, 95 %CI 1.24-1.25), while sulfonylurea use decreased from 34.4% (95 %CI 33.8-35.1) to 19.3% (95 %CI 18.9-19.7) (aRR 0.93, 95 %CI 0.93-0.94). Similar trends were observed in DDDs/1000 resident days. CONCLUSIONS The increasing use of insulin and ongoing use of sulfonylureas suggests a need to implement evidence-based strategies to optimise diabetes care in LTCFs.
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Affiliation(s)
- Yohanes A Wondimkun
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Hawassa University, College of Medicine and Health Sciences, Hawassa, Sidama, Ethiopia.
| | - Gillian E Caughey
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Maria C Inacio
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Georgina A Hughes
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; University of South Australia, UniSA Clinical and Health Sciences, Adelaide, South Australia, Australia
| | - Tracy Air
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Robert N Jorissen
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Michelle Hogan
- Australian Government Aged Care Quality and Safety Commission, Adelaide, South Australia, Australia
| | - Janet K Sluggett
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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115
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Shahrokh S, Baradaran Ghavami S, Asadzadeh Aghdaei H, Parigi TL, Farmani M, Danese S, Ebrahimi Daryani N, Vossoughinia H, Balaii H, Alborzi F, Khoramjoo SM, Khanabadi B, Seyed Salehi A, Bastani A, Sharifi M, Safari MT, Malekpour H, Sherkat G, Saberafsharian M, Miri MB, Moosavi SH, Anaraki F, Nazemalhosseini-Mojarad E, Mohebbi SR, Shojaie S, Pourhoseingholi MA, Zali MR. High prevalence of SARS-Coronavirus-2 in patients with inflammatory bowel disease and the role of soluble angiotensin converting Enzyme2. Arch Physiol Biochem 2024; 130:325-332. [PMID: 35617972 DOI: 10.1080/13813455.2022.2080228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/07/2022] [Accepted: 05/11/2022] [Indexed: 12/15/2022]
Abstract
Context: Patients with inflammatory bowel disease (IBD) were found to have the higher intestinal expression of Angiotensin-Converting Enzyme2 (ACE2) that could consequently increase susceptibility to COVID-19 infection.Objective: This study reports the outcomes of COVID-19 infection in a large cohort of IBD patients. We compare levels of serum ACE and IFN-α between COVID19 patients with and without IBD. We performed a cross-sectional retrospective multicenter study.Methods: We enrolled patients with IBD screened for SARS-COV-2 in six medical centres in Iran from June to November 2020. The blood samples were drawn to measure COVID-19 IgM and IgG, and serum levels of sACE2, sACE1, and interferon-α, regardless of suspicious symptoms have done the molecular test.Results: A total of 534 IBD patients were included in the study. Of these, 109 (20.0%) cases had detectable IgG and IgM against SARS-CoV-2. sACE2 levels were higher in IBD patients than controls, whereas ACE1and IFN-α levels were similar among groups.
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Affiliation(s)
- Shabnam Shahrokh
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shaghayegh Baradaran Ghavami
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Asadzadeh Aghdaei
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tommaso Lorenzo Parigi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Maryam Farmani
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IBD Center, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | | | - Hassan Vossoughinia
- Department of Gastroenterology and Hepatology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hedieh Balaii
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Foroogh Alborzi
- Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mobin Khoramjoo
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Binazir Khanabadi
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Seyed Salehi
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Bastani
- Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mohsen Sharifi
- Isfahan University of Medical Science, Isfahan University of Medical Science, Isfahan, Iran
| | - Mohammad Taghi Safari
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Habib Malekpour
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ghazal Sherkat
- Medicine Faculty of Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | | | | | | | - Fakhrosadat Anaraki
- Colorectal division of surgrical ward, Taleghani hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ehsan Nazemalhosseini-Mojarad
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Reza Mohebbi
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sajad Shojaie
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohamad Amin Pourhoseingholi
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Zali
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Jang HN, Moon SJ, Jung JH, Han KD, Rhee EJ, Lee WY. Impact of Antidiabetic Drugs on Clinical Outcomes of COVID-19: A Nationwide Population-Based Study. Endocrinol Metab (Seoul) 2024; 39:479-488. [PMID: 38282452 PMCID: PMC11220209 DOI: 10.3803/enm.2023.1857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/07/2023] [Accepted: 01/03/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGRUOUND Inconsistent results have been reported regarding the association between the use of antidiabetic drugs and the clinical outcomes of coronavirus disease 2019 (COVID-19). This study aimed to investigate the effect of antidiabetic drugs on COVID-19 outcomes in patients with diabetes using data from the National Health Insurance Service (NHIS) in South Korea. METHODS We analyzed the NHIS data of patients aged ≥20 years who tested positive for COVID-19 and were taking antidiabetic drugs between December 2019 and June 2020. Multiple logistic regression analysis was performed to analyze the clinical outcomes of COVID-19 based on the use of antidiabetic drugs. RESULTS A total of 556 patients taking antidiabetic drugs tested positive for COVID-19, including 271 male (48.7%), most of whom were in their sixties. Of all patients, 433 (77.9%) were hospitalized, 119 (21.4%) received oxygen treatment, 87 (15.6%) were admitted to the intensive care unit, 31 (5.6%) required mechanical ventilation, and 61 (11.0%) died. Metformin was significantly associated with the lower risks of mechanical ventilation (odds ratio [OR], 0.281; 95% confidence interval [CI], 0.109 to 0.720; P=0.008), and death (OR, 0.395; 95% CI, 0.182 to 0.854; P=0.018). Dipeptidylpeptidase-4 inhibitor (DPP-4i) were significantly associated with the lower risks of oxygen treatment (OR, 0.565; 95% CI, 0.356 to 0.895; P=0.015) and death (OR, 0.454; 95% CI, 0.217 to 0.949; P=0.036). Sulfonylurea was significantly associated with the higher risk of mechanical ventilation (OR, 2.579; 95% CI, 1.004 to 6.626; P=0.049). CONCLUSION In patients with diabetes and COVID-19, metformin exhibited reduced risks of mechanical ventilation and death, DPP- 4i was linked with lower risks of oxygen treatment and death, while sulfonylurea was related to the increased risk of mechanical ventilation.
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Affiliation(s)
- Han Na Jang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun Joon Moon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Jin Hyung Jung
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Eun-Jung Rhee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea
| | - Won-Young Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea
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Al-Taie A, Arueyingho O, Khoshnaw J, Hafeez A. Clinical outcomes of multidimensional association of type 2 diabetes mellitus, COVID-19 and sarcopenia: an algorithm and scoping systematic evaluation. Arch Physiol Biochem 2024; 130:342-360. [PMID: 35704400 DOI: 10.1080/13813455.2022.2086265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/25/2022] [Accepted: 05/31/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND The aim of this study was to provide a scoping and comprehensive review for the clinical outcomes from the cross-link of Type 2 diabetes mellitus (T2DM), COVID-19, and sarcopenia. METHODS By using PRISMA guidelines and searching through different databases that could provide findings of evidence on the association of T2DM, COVID-19, and sarcopenia. RESULTS Thirty-three studies reported a relationship between sarcopenia with T2DM, twenty-one studies reported the prognosis COVID-19 in patients with T2DM, ten studies reported the prognosis of COVID-19 in patients with sarcopenia, five studies discussed the outcomes of sarcopenia in patients with COVID-19, and one study reported sarcopenia outcomes in the presence of T2DM and COVID-19. CONCLUSION There is an obvious multidimensional relationship between T2DM, COVID-19 and sarcopenia which can cause prejudicial effects, poor prognosis, prolonged hospitalisation, lowered quality of life and a higher mortality rate during the current COVID-19 pandemic.
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Affiliation(s)
- Anmar Al-Taie
- Clinical Pharmacy Department, Faculty of Pharmacy, Istinye University, Istanbul, Turkey
| | - Oritsetimeyin Arueyingho
- EPSRC Centre for Doctoral Training in Digital Health and Care, University of Bristol, Bristol, UK
| | - Jalal Khoshnaw
- Pharmacy Department, Faculty of Pharmacy, Girne American University, Mersin, Turkey
| | - Abdul Hafeez
- Department of Pharmaceutics, Glocal School of Pharmacy, Glocal University, Saharanpur, Uttar Pradesh, India
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118
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Gomes VMR, Pires MC, Delfino Pereira P, Schwarzbold AV, Gomes AGDR, Pessoa BP, Cimini CCR, Rios DRA, Anschau F, Nascimento FJM, Grizende GMS, Vietta GG, Batista JDL, Ruschel KB, Carneiro M, Reis MA, Bicalho MAC, Porto PF, Reis PPD, Araújo SF, Nobre V, Marcolino MS. AB 2CO risk score for in-hospital mortality of COVID-19 patients admitted to intensive care units. Respir Med 2024; 227:107635. [PMID: 38641122 DOI: 10.1016/j.rmed.2024.107635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 04/07/2024] [Accepted: 04/11/2024] [Indexed: 04/21/2024]
Abstract
PURPOSE To develop a mortality risk score for COVID-19 patients admitted to intensive care units (ICU), and to compare it with other existing scores. MATERIALS AND METHODS This retrospective observational study included consecutive adult patients with laboratory-confirmed COVID-19 admitted to ICUs of 18 hospitals from nine Brazilian cities, from September 2021 to July 2022. Potential predictors were selected based on the literature review. Generalized Additive Models were used to examine outcomes and predictors. LASSO regression was used to derive the mortality score. RESULTS From 558 patients, median age was 69 years (IQR 58-78), 56.3 % were men, 19.7 % required mechanical ventilation (MV), and 44.8 % died. The final model comprised six variables: age, pO2/FiO2, respiratory function (respiratory rate or if in MV), chronic obstructive pulmonary disease, and obesity. The AB2CO had an AUROC of 0.781 (95 % CI 0.744 to 0.819), good overall performance (Brier score = 0.191) and an excellent calibration (slope = 1.063, intercept = 0.015, p-value = 0.834). The model was compared with other scores and displayed better discrimination ability than the majority of them. CONCLUSIONS The AB2CO score is a fast and easy tool to be used upon ICU admission.
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Affiliation(s)
- Virginia Mara Reis Gomes
- Medical School and University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil.
| | - Magda Carvalho Pires
- Statistics Department, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil.
| | - Polianna Delfino Pereira
- Medical School and University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil; Institute for Health Technology Assessment (IATS), R. Ramiro Barcelos, 2359, Porto Alegre, Brazil.
| | | | | | - Bruno Porto Pessoa
- Hospital Julia Kubitschek, R. Dr. Cristiano Rezende, 2745, Belo Horizonte, Brazil.
| | | | - Danyelle Romana Alves Rios
- Hospital São João de Deus, R. Do Cobre, 800, São João de Deus, Brazil; Universidade Federal de São João del-Rei. R. Sebastião Gonçalves Coelho, 400, Divinópolis, Brazil.
| | - Fernando Anschau
- Hospital Nossa Senhora da Conceição and Hospital Cristo Redentor, Av. Francisco Trein, 326, Porto Alegre, Brazil.
| | | | | | | | - Joanna d'Arc Lyra Batista
- Institute for Health Technology Assessment (IATS), R. Ramiro Barcelos, 2359, Porto Alegre, Brazil; Medical School, Federal University of Fronteira Sul, Rod. SC 484 - Km 02, Chapecó, Brazil; Hospital Regional Do Oeste, R. Florianópolis, 1448 E, Chapecó, Brazil.
| | | | - Marcelo Carneiro
- Hospital Santa Cruz, R. Fernando Abott, 174, Santa Cruz Do Sul, Brazil.
| | - Marco Aurélio Reis
- Hospital Risoleta Tolentino Neves, R. Das Gabirobas, 01, Belo Horizonte, Brazil.
| | - Maria Aparecida Camargos Bicalho
- Medical School and University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil; Fundação Hospitalar Do Estado de Minas Gerais - FHEMIG. Cidade Administrativa de Minas Gerais, Edifício Gerais - 13° Andar, Rod. Papa João Paulo II, 3777, Belo Horizonte, Brazil.
| | - Paula Fonseca Porto
- Hospital Metropolitano Odilon Behrens, R. Formiga, 50, Belo Horizonte, Brazil.
| | | | | | - Vandack Nobre
- Medical School and University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil.
| | - Milena Soriano Marcolino
- Medical School and University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 190, Belo Horizonte, Brazil; Institute for Health Technology Assessment (IATS), R. Ramiro Barcelos, 2359, Porto Alegre, Brazil; Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, 110, Belo Horizonte, Brazil.
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Davis A, Van Eck K, Copeland-Linder N, Phuong K, Belcher HME. Hospitalization and Mortality for Insured Patients in the United States with COVID-19 with and without Autism Spectrum Disorder. J Autism Dev Disord 2024; 54:2347-2354. [PMID: 37022580 PMCID: PMC10077315 DOI: 10.1007/s10803-023-05971-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 04/07/2023]
Abstract
Autism spectrum disorder (ASD) is a neuropsychiatric condition that may be associated with negative health outcomes. This retrospective cohort study reveals the odds of hospitalization and mortality based on ASD for a population of insured patients with COVID-19. The odds of hospitalization and mortality for people with ASD were found to be greater than individuals without ASD when adjusted for sociodemographic characteristics. Hospitalization and mortality was associated with a dose-response increase to comorbidity counts (1 to 5+). Odds of mortality remained greater for those with ASD when adjusting for comorbid health conditions. ASD is a risk factor for COVID-19 mortality. Comorbid health conditions play a particular role in increasing the odds of COVID-19 related hospitalization and death for ASD patients.
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Affiliation(s)
- Amber Davis
- Department of Pediatrics, Johns Hopkins University, School of Medicine, Baltimore, USA
- Office for Health, Equity, Inclusion, and Diversity, Kennedy Krieger Institute, Baltimore, USA
| | - Kathryn Van Eck
- Office for Health, Equity, Inclusion, and Diversity, Kennedy Krieger Institute, Baltimore, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, USA
- Kennedy Krieger Institute, Center for Diversity in Public Health Leadership Training, 716 North Broadway, Baltimore, MD, 21205, USA
| | - Nikeea Copeland-Linder
- Office for Health, Equity, Inclusion, and Diversity, Kennedy Krieger Institute, Baltimore, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, USA
- Kennedy Krieger Institute, Center for Diversity in Public Health Leadership Training, 716 North Broadway, Baltimore, MD, 21205, USA
| | | | - Harolyn M E Belcher
- Department of Pediatrics, Johns Hopkins University, School of Medicine, Baltimore, USA.
- Office for Health, Equity, Inclusion, and Diversity, Kennedy Krieger Institute, Baltimore, USA.
- Kennedy Krieger Institute, Center for Diversity in Public Health Leadership Training, 716 North Broadway, Baltimore, MD, 21205, USA.
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120
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Attri B, Nagendra L, Dutta D, Shetty S, Shaikh S, Kalra S, Bhattacharya S. Prandial Insulins: A Person-Centered Choice. Curr Diab Rep 2024; 24:131-145. [PMID: 38568467 DOI: 10.1007/s11892-024-01540-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 05/12/2024]
Abstract
PURPOSE OF REVIEW Postprandial hyperglycemia, or elevated blood glucose after meals, is associated with the development and progression of various diabetes-related complications. Prandial insulins are designed to replicate the natural insulin release after meals and are highly effective in managing post-meal glucose spikes. Currently, different types of prandial insulins are available such as human regular insulin, rapid-acting analogs, ultra-rapid-acting analogs, and inhaled insulins. Knowledge about diverse landscape of prandial insulin will optimize glycemic management. RECENT FINDINGS Human regular insulin, identical to insulin produced by the human pancreas, has a slower onset and extended duration, potentially leading to post-meal hyperglycemia and later hypoglycemia. In contrast, rapid-acting analogs, such as lispro, aspart, and glulisine, are new insulin types with amino acid modifications that enhance their subcutaneous absorption, resulting in a faster onset and shorter action duration. Ultra-rapid analogs, like faster aspart and ultra-rapid lispro, offer even shorter onset of action, providing better meal-time flexibility. The Technosphere insulin offers an inhaled route for prandial insulin delivery. The prandial insulins can be incorporated into basal-bolus, basal plus, or prandial-only regimens or delivered through insulin pumps. Human regular insulin, aspart, lispro, and faster aspart are recommended for management of hyperglycemia during pregnancy. Ongoing research is focused on refining prandial insulin replacement and exploring newer delivery methods. The article provides a comprehensive overview of various prandial insulin options and their clinical applications in the management of diabetes.
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Affiliation(s)
- Bhawna Attri
- Department of Endocrinology, Sarvodaya Hospital, Faridabad, Haryana, India
| | - Lakshmi Nagendra
- Department of Endocrinology, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Deep Dutta
- Department of Endocrinology, Center for Endocrinology Diabetes Arthritis and Rheumatism (CEDAR) Super-Speciality Healthcare, Dwarka, Delhi, India
| | - Sahana Shetty
- Department of Endocrinology, Kasturba Medical College, Manipal, Karnataka, India
| | - Shehla Shaikh
- Department of Endocrinology, Saifee Hospital, Mumbai, Maharashtra, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
| | - Saptarshi Bhattacharya
- Department of Endocrinology, Indraprastha Apollo Hospitals, Sarita Vihar, Mathura Road, Delhi, 110076, India.
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Lin D, Xiao H, Yang K, Li J, Ye S, Liu Y, Jing S, Lin Y, Yang Y, Huang L, Yuan J, Li Z, Yang J, Gao H, Xie Y, Xu M, Yan L. Safety, tolerability, pharmacokinetics, and pharmacodynamics of TG103 injection in participants who are overweight or obese: a randomized, double-blind, placebo-controlled, multiple-dose phase 1b study. BMC Med 2024; 22:209. [PMID: 38807146 PMCID: PMC11134614 DOI: 10.1186/s12916-024-03394-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 04/16/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND TG103, a glucagon-like peptide-1 analog, is being investigated as an option for weight management. We aimed to determine the safety, tolerability, pharmacokinetics, and pharmacodynamics of TG103 injection in participants who are overweight or obese without diabetes. METHODS In this randomized, double-blind, placebo-controlled, multiple-dose phase 1b study, participants aged 18-75 years with a body-mass index (BMI) ≥ 26.0 kg/m2 and body weight ≥ 60 kg were enrolled from three centers in China. The study included three cohorts, and in each cohort, eligible participants were randomly assigned (3:1) to one of three once-weekly subcutaneous TG103 groups (15.0, 22.5 and 30.0 mg) or matched placebo, without lifestyle interventions. In each cohort, the doses of TG103 were escalated in 1-week intervals to the desired dose over 1 to 4 weeks. Then participants were treated at the target dose until week 12 and then followed up for 2 weeks. The primary endpoint was safety and tolerability assessed by the incidence and severity of adverse events (AEs) from baseline to the end of the follow-up period. Secondary endpoints included pharmacokinetic and pharmacodynamic profiles of TG103 and the occurrence of anti-drug antibodies to TG103. RESULTS A total of 147 participants were screened, and 48 participants were randomly assigned to TG103 (15.0, 22.5 and 30.0 mg groups, n = 12 per group) or placebo (n = 12). The mean (standard deviation, SD) age of the participants was 33.9 (10.0) years; the mean bodyweight was 81.65 (10.50) kg, and the mean BMI was 29.8 (2.5) kg/m2. A total of 466 AEs occurred in 45 of the 48 participants, with 35 (97.2%) in the TG103 group and 10 (83.3%) in the pooled placebo group. Most AEs were grade 1 or 2 in severity, and there were no serious adverse events (SAEs), AEs leading to death, or AEs leading to discontinuation of treatment. The steady-state exposure of TG103 increased with increasing dose and was proportional to Cmax,ss, AUCss, AUC0-t and AUC0-inf. The mean values of Cmax,ss ranged from 951 to 1690 ng/mL, AUC0-t ranged from 150 to 321 μg*h/mL, and AUC0-inf ranged from 159 to 340 μg*h/mL. TG103 had a half-life of 110-116 h, with a median Tmax of 36-48 h. After treatment for 12 weeks, the mean (SD) values of weight loss from baseline in the TG103 15.0 mg, 22.5 mg and 30.0 mg groups were 5.65 (3.30) kg, 5.35 (3.39) kg and 5.13 (2.56) kg, respectively, and that in the placebo group was 1.37 (2.13) kg. The least square mean percent weight loss from baseline to D85 in all the TG103 groups was more than 5% with p < 0.05 for all comparisons with placebo. CONCLUSIONS In this trial, all three doses of once-weekly TG103 were well tolerated with an acceptable safety profile. TG103 demonstrated preliminary 12-week body weight loss without lifestyle interventions, thus showing great potential for the treatment of overweight and obesity. TRIAL REGISTRATION ClinicalTrials.gov, NCT04855292. Registered on April 22, 2021.
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Affiliation(s)
- Diaozhu Lin
- Department of Endocrinology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Huisheng Xiao
- Department of Endocrinology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Kexu Yang
- Clinical Pharmacology Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Juan Li
- Phase I Clinical Trials Unit, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Suiwen Ye
- Phase I Clinical Trial Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yanqiong Liu
- Phase I Clinical Trial Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shan Jing
- Clinical Pharmacology Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yang Lin
- Clinical Pharmacology Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yuanxun Yang
- Phase I Clinical Trials Unit, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Lei Huang
- Phase I Clinical Trials Unit, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jing Yuan
- CSPC Pharmaceutical Group Co., Ltd, Shijiazhuang, China
| | - Ziyan Li
- CSPC Pharmaceutical Group Co., Ltd, Shijiazhuang, China
| | - Jinlan Yang
- CSPC Pharmaceutical Group Co., Ltd, Shijiazhuang, China
| | - Huanhuan Gao
- CSPC Pharmaceutical Group Co., Ltd, Shijiazhuang, China
| | - Ying Xie
- CSPC Pharmaceutical Group Co., Ltd, Shijiazhuang, China
| | - Mingtong Xu
- Department of Endocrinology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
| | - Li Yan
- Department of Endocrinology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
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Dallio M, Sangineto M, Romeo M, Cipullo M, Coppola A, Mammone S, Di Gioia G, Masarone M, Persico M, Serviddio G, Federico A. The influence of acute lifestyle changes on NAFLD evolution in a multicentre cohort: a matter of body composition. Nutr Diabetes 2024; 14:33. [PMID: 38802382 PMCID: PMC11130147 DOI: 10.1038/s41387-024-00294-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Unhealthy lifestyles represent a key element fueling Non-alcoholic fatty liver disease (NAFLD) onset and worsening. We aimed to evaluate the effects of forced acute lifestyle changes on NAFLD evolution. METHODS 187 NAFLD patients were followed two years pre- and two years during the lockdown social restrictions in three Italian medical centers. For each patient, biochemical, clinical, non-invasive liver fibrosis, nutritional, and body composition data were collected. RESULTS An increase in fats and carbohydrate intake associated with impaired weekly physical activity during the lockdown was demonstrated as well as an increase in body mass index and waist-hip-ratio (p < 0.0001 for all). Total cholesterol, low-density lipoprotein, high-density lipoprotein, triglycerides, glucose, insulin, homeostatic model assessment for insulin resistance, and transaminases worsened during the lockdown (glucose: p = 0.0007; p < 0.0001 for the others). Moreover, NAFLD fibrosis score, liver stiffness, and controlled attenuation parameter were also impaired during the same period (p < 0.0001 for all). The bioelectrical impedance analysis (BIA) evidenced an increase of fat mass (FM), and a reduction of free fat mass (FFM) and body cell mass (BCM) (p < 0.0001 for all). The lockdown overall hepatocellular carcinoma (HCC) and Milan-out HCC occurrence revealed Hazard Ratio (HR): 2.398, 95% Confidence Interval (CI):1.16-5, p = 0.02, and HR:5.931, CI:2-17.6, p = 0.008 respectively. A liver disease stage and comorbidities independent association between both the assessed outcomes and body composition analysis in terms of mean values and variation (T1-T2 Δ) was demonstrated. CONCLUSIONS The acute lifestyle changes impacted NAFLD evolution via body composition modifications negatively influencing the HCC occurrence.
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Affiliation(s)
- Marcello Dallio
- Hepatogastroenterology Division, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Moris Sangineto
- University Center for Research and Treatment of Liver Diseases (C.U.R.E.), Liver Unit, University of Foggia, Foggia, Italy
| | - Mario Romeo
- Hepatogastroenterology Division, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Marina Cipullo
- Hepatogastroenterology Division, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Annachiara Coppola
- Hepatogastroenterology Division, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Simone Mammone
- Hepatogastroenterology Division, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Di Gioia
- University Center for Research and Treatment of Liver Diseases (C.U.R.E.), Liver Unit, University of Foggia, Foggia, Italy
| | - Mario Masarone
- Department of Medicine and Surgery, "Scuola Medica Salernitana", Internal Medicine and Hepatology Unit, University of Salerno, Salerno, Italy
| | - Marcello Persico
- Department of Medicine and Surgery, "Scuola Medica Salernitana", Internal Medicine and Hepatology Unit, University of Salerno, Salerno, Italy
| | - Gaetano Serviddio
- University Center for Research and Treatment of Liver Diseases (C.U.R.E.), Liver Unit, University of Foggia, Foggia, Italy
| | - Alessandro Federico
- Hepatogastroenterology Division, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
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Alenzi KA, Alsuhaibani D, Batarfi B, Alshammari TM. Pancreatitis with use of new diabetic medications: a real-world data study using the post-marketing FDA adverse event reporting system (FAERS) database. Front Pharmacol 2024; 15:1364110. [PMID: 38860168 PMCID: PMC11163090 DOI: 10.3389/fphar.2024.1364110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 05/02/2024] [Indexed: 06/12/2024] Open
Abstract
Background: Pancreatitis is characterized by inflammation of the pancreas and significantly affects quality of life. Less than 5% of pancreatitis cases are drug-induced, but recent evidence suggests a substantial risk associated with glucagon-like peptide-1 receptor agonists (GLP-1 RAs). The aim of this study was to compare the risk of developing pancreatitis between those using GLP-1 RAs and those using sodium-glucose transport protein 2 (SGLT2) inhibitors and dipeptidyl peptidase 4 (DPP-4) inhibitors. Methods: This study was done using the FDA Adverse Event Reporting System (FAERS) database from 2019 to 2021. This database contains information from diverse submissions from healthcare providers, patients, and manufacturers. To ensure fairness and accuracy, the risk of pancreatitis associated with other hypoglycemic agents (SGLT2 inhibitors and DPP-4 inhibitors) was also investigated. Traditional and Bayesian statistical analysis methods were used to identify disproportionate statistics and included the reporting odds ratio (ROR), proportional reporting ratio (PRR), empirical Bayes geometric mean (EBGM), and information component (IC). A drug-adverse-event combination that met the criteria of all four indices was deemed a signal. Results: The analysis of 2,313 pancreatitis reports linked to hypoglycemic agents revealed a predominant association with GLP-1 RA (70.2%) compared to DPP-4 inhibitors (15%) and SGLT2 (14.7%). Most of these reports involved female patients (50.4%), and the highest incidence occurred in those over 50 years old (38.4%). Additionally, 17.7% of the reports were associated with serious events. The ROR was significant for the risk of pancreatitis when using DPP-4 (13.2, 95% confidence interval (CI) 11.84-14.70), while the ROR for GLP-1 was 9.65 (95% CI 9.17-10.16). The EBGM was highest with DPP-4 (12.25), followed by GLP-1 (8.64), while IC was highest with DPP-4 inhibitors (3.61). Liraglutide had the greatest association with pancreatitis among the GLP-1 RAs (ROR: 6.83, 95% CI 6.60-7.07). Conclusion: The findings show that pancreatitis has a strong link with DPP-4 inhibitors and GPL1 agonists, which pose a greater risk. Among the GLP-1 agonist medications, liraglutide has been found to have an association with pancreatitis.
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Affiliation(s)
- Khalidah A. Alenzi
- Society of Pharmacovigilance, Jeddah, Saudi Arabia
- Transformation, Planning, and Business Development Department, Tabuk Health Cluster, Tabuk, Saudi Arabia
| | - Deemah Alsuhaibani
- Pharmaceutical Care Department, Medical Services for Armed Forces, Ministry of Defense, Riyadh, Saudi Arabia
| | | | - Thamir M. Alshammari
- Society of Pharmacovigilance, Jeddah, Saudi Arabia
- Medication Safety Research Chair, King Saud University, Riyadh, Saudi Arabia
- College of Pharmacy, Almaarefa University, Riyadh, Saudi Arabia
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Huang X, Wu M, Lin J, Mou L, Zhang Y, Jiang J. Gastrointestinal safety evaluation of semaglutide for the treatment of type 2 diabetes mellitus: A meta-analysis. Medicine (Baltimore) 2024; 103:e38236. [PMID: 38787986 PMCID: PMC11124640 DOI: 10.1097/md.0000000000038236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Semaglutide, as an innovative weekly formulation, has attracted much attention. Nevertheless, the predominant occurrence of gastrointestinal adverse events (GIAEs) poses a noteworthy challenge linked to the use of this medication, substantially affecting its clinical applicability and the overall well-being of patients. Therefore, this systematic review aims to comprehensively discuss the GIAEs, providing a basis for clinical therapeutic decisions. METHODS We systematically searched 4 independent databases for randomized controlled trials investigating the application of semaglutide in managing type 2 diabetes mellitus. The search period spanned from the inception of the databases to December 2023. We conducted a comprehensive meta-analysis, employing Review Manager 5.4.1 software, to systematically analyze and evaluate potential biases. Our primary emphasis was on assessing the gastrointestinal safety profile of semaglutide. RESULTS The outcomes unveiled a noteworthy rise in the collective occurrence of GIAEs across all dosage groups of semaglutide in comparison with the control group (P < .05). Upon further analysis, it was observed that semaglutide showed a heightened occurrence of GIAEs in contrast to the placebo. However, statistically significant distinction was not observed when compared to the reduction of conventional doses or the transition to other types of glucagon-like peptide-1 receptor agonist. Additionally, an extended treatment duration with semaglutide (>30 weeks) demonstrated an association with a certain degree of decrease in the incidence of gastrointestinal events. Funnel plot assessment for publication bias demonstrated high-quality inclusion of studies with no apparent publication bias. CONCLUSION The frequency of GIAEs in using semaglutide was observed to be elevated in comparison to the control group. However, it was comparable to other glucagon-like peptide-1 receptor agonist or low-dose treatment regimens. Additionally, an extended treatment duration played a role in decreasing the frequency of GIAEs. These findings provide valuable insights for clinical practice. Nonetheless, further research is crucial to explore supplementary data indicators, informing clinical practices and better serving the interests of patients.
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Affiliation(s)
- Xiaoyan Huang
- Department of Endocrinology, Quanzhou First Hospital Affiliated to Fujian Medical University, Fujian, China
| | - Miaohui Wu
- School of Pharmacy, Fujian Medical University, Fujian, China
| | - Jiaojiao Lin
- Department of Endocrinology, Quanzhou First Hospital Affiliated to Fujian Medical University, Fujian, China
| | - Lunpan Mou
- Department of Endocrinology, Quanzhou First Hospital Affiliated to Fujian Medical University, Fujian, China
| | - Yaping Zhang
- Department of Endocrinology, Quanzhou First Hospital Affiliated to Fujian Medical University, Fujian, China
| | - Jianjia Jiang
- Department of Endocrinology, Quanzhou First Hospital Affiliated to Fujian Medical University, Fujian, China
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Gogoi M, Qureshi I, Chaloner J, Al-Oraibi A, Reilly H, Wobi F, Agbonmwandolor JO, Ekezie W, Hassan O, Lal Z, Kapilashrami A, Nellums L, Pareek M. Discrimination, disadvantage and disempowerment during COVID-19: a qualitative intrasectional analysis of the lived experiences of an ethnically diverse healthcare workforce in the United Kingdom. Int J Equity Health 2024; 23:105. [PMID: 38783292 PMCID: PMC11118759 DOI: 10.1186/s12939-024-02198-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Healthcare workers (HCWs) in the United Kingdom (UK) have faced many challenges during the COVID-19 pandemic, some of these arising out of their social positions. Existing literature explicating these challenges (e.g., lack of appropriate PPE, redeployment, understaffing) have highlighted inequities in how these have been experienced by HCWs based on ethnicity, gender or, job role. In this paper, we move a step ahead and examine how the intersection of these social positions have impacted HCWs' experiences of challenges during the pandemic. METHODS We collected qualitative data, using interviews and focus groups, from 164 HCWs from different ethnicities, gender, job roles, migration statuses, and regions in the United Kingdom (UK) between December 2020 and July 2021. Interviews and focus groups were conducted online or by telephone, and recorded with participants' permission. Recordings were transcribed and a hybrid thematic analytical approach integrating inductive data-driven codes with deductive ones informed by an intersectional framework was adopted to analyse the transcripts. RESULTS Thematic analysis of transcripts identified disempowerment, disadvantage and, discrimination as the three main themes around which HCWs' experiences of challenges were centred, based on their intersecting identities (e.g., ethnicity gender, and/or migration status). Our analysis also acknowledges that disadvantages faced by HCWs were linked to systemic and structural factors at the micro, meso and macro ecosystemic levels. This merging of analysis which is grounded in intersectionality and considers the ecosystemic levels has been termed as 'intrasectionalism'. DISCUSSION Our research demonstrates how an intrasectional lens can help better understand how different forms of mutually reinforcing inequities exist at all levels within the healthcare workforce and how these impact HCWs from certain backgrounds who face greater disadvantage, discrimination and disempowerment, particularly during times of crisis like the COVID-19 pandemic.
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Affiliation(s)
- Mayuri Gogoi
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Development Centre for Population Health, University of Leicester, Leicester, UK
| | - Irtiza Qureshi
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Development Centre for Population Health, University of Leicester, Leicester, UK
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
- The Nottingham Centre for Public Health and Epidemiology, University of Nottingham, Nottingham, UK
| | - Jonathan Chaloner
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Development Centre for Population Health, University of Leicester, Leicester, UK
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Amani Al-Oraibi
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Development Centre for Population Health, University of Leicester, Leicester, UK
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Holly Reilly
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Development Centre for Population Health, University of Leicester, Leicester, UK
| | - Fatimah Wobi
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Joy Oghogho Agbonmwandolor
- David Evans Medical Research Centre, Nottingham University Hospital NHS Trust, City Hospital, Nottingham, UK
| | - Winifred Ekezie
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Centre for Ethnic Health Research, University of Leicester, Leicester, UK
| | - Osama Hassan
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Zainab Lal
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Development Centre for Population Health, University of Leicester, Leicester, UK
| | - Anuj Kapilashrami
- School of Health and Social Care, University of Essex, Colchester, UK
- Centre for Global Health & Intersectional Equity Research, University of Essex, Colchester, UK
| | - Laura Nellums
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
- College of Population Health, Health Sciences Centre, University of New Mexico, Albuquerque, NM, USA
| | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, Leicester, UK.
- Development Centre for Population Health, University of Leicester, Leicester, UK.
- Department of Infection and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK.
- NIHR Leicester BRC, Leicester, UK.
- NIHR ARC East Midlands, Leicester, UK.
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Patel MA, Daley M, Van Nynatten LR, Slessarev M, Cepinskas G, Fraser DD. A reduced proteomic signature in critically ill Covid-19 patients determined with plasma antibody micro-array and machine learning. Clin Proteomics 2024; 21:33. [PMID: 38760690 PMCID: PMC11100131 DOI: 10.1186/s12014-024-09488-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 05/06/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND COVID-19 is a complex, multi-system disease with varying severity and symptoms. Identifying changes in critically ill COVID-19 patients' proteomes enables a better understanding of markers associated with susceptibility, symptoms, and treatment. We performed plasma antibody microarray and machine learning analyses to identify novel proteins of COVID-19. METHODS A case-control study comparing the concentration of 2000 plasma proteins in age- and sex-matched COVID-19 inpatients, non-COVID-19 sepsis controls, and healthy control subjects. Machine learning was used to identify a unique proteome signature in COVID-19 patients. Protein expression was correlated with clinically relevant variables and analyzed for temporal changes over hospitalization days 1, 3, 7, and 10. Expert-curated protein expression information was analyzed with Natural language processing (NLP) to determine organ- and cell-specific expression. RESULTS Machine learning identified a 28-protein model that accurately differentiated COVID-19 patients from ICU non-COVID-19 patients (accuracy = 0.89, AUC = 1.00, F1 = 0.89) and healthy controls (accuracy = 0.89, AUC = 1.00, F1 = 0.88). An optimal nine-protein model (PF4V1, NUCB1, CrkL, SerpinD1, Fen1, GATA-4, ProSAAS, PARK7, and NET1) maintained high classification ability. Specific proteins correlated with hemoglobin, coagulation factors, hypertension, and high-flow nasal cannula intervention (P < 0.01). Time-course analysis of the 28 leading proteins demonstrated no significant temporal changes within the COVID-19 cohort. NLP analysis identified multi-system expression of the key proteins, with the digestive and nervous systems being the leading systems. CONCLUSIONS The plasma proteome of critically ill COVID-19 patients was distinguishable from that of non-COVID-19 sepsis controls and healthy control subjects. The leading 28 proteins and their subset of 9 proteins yielded accurate classification models and are expressed in multiple organ systems. The identified COVID-19 proteomic signature helps elucidate COVID-19 pathophysiology and may guide future COVID-19 treatment development.
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Affiliation(s)
- Maitray A Patel
- Epidemiology and Biostatistics, Western University, London, ON, N6A 3K7, Canada
| | - Mark Daley
- Epidemiology and Biostatistics, Western University, London, ON, N6A 3K7, Canada
- Computer Science, Western University, London, ON, N6A 3K7, Canada
| | | | - Marat Slessarev
- Medicine, Western University, London, ON, N6A 3K7, Canada
- Lawson Health Research Institute, London, ON, N6C 2R5, Canada
| | - Gediminas Cepinskas
- Lawson Health Research Institute, London, ON, N6C 2R5, Canada
- Medical Biophysics, Western University, London, ON, N6A 3K7, Canada
| | - Douglas D Fraser
- Lawson Health Research Institute, London, ON, N6C 2R5, Canada.
- Children's Health Research Institute, London, ON, N6C 4V3, Canada.
- Pediatrics, Western University, London, ON, N6A 3K7, Canada.
- Clinical Neurological Sciences, Western University, London, ON, N6A 3K7, Canada.
- Physiology & Pharmacology, Western University, London, ON, N6A 3K7, Canada.
- London Health Sciences Centre, 800 Commissioners Road East, London, ON, N6A 5W9, Canada.
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127
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Madrid J, Agarwal P, Müller-Peltzer K, Benning L, Selig M, Rolauffs B, Diehl P, Kalbhenn J, Trummer G, Utzolino S, Wengenmayer T, Busch HJ, Stolz D, Rieg S, Panning M, Bamberg F, Schlett CL, Askani E. Cardioprotective effects of vaccination in hospitalized patients with COVID-19. Clin Exp Med 2024; 24:103. [PMID: 38758248 PMCID: PMC11101587 DOI: 10.1007/s10238-024-01367-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 04/29/2024] [Indexed: 05/18/2024]
Abstract
COVID-19 vaccination has been shown to prevent and reduce the severity of COVID-19 disease. The aim of this study was to explore the cardioprotective effect of COVID-19 vaccination in hospitalized COVID-19 patients. In this retrospective, single-center cohort study, we included hospitalized COVID-19 patients with confirmed vaccination status from July 2021 to February 2022. We assessed outcomes such as acute cardiac events and cardiac biomarker levels through clinical and laboratory data. Our analysis covered 167 patients (69% male, mean age 58 years, 42% being fully vaccinated). After adjustment for confounders, vaccinated hospitalized COVID-19 patients displayed a reduced relative risk for acute cardiac events (RR: 0.33, 95% CI [0.07; 0.75]) and showed diminished troponin T levels (Cohen's d: - 0.52, 95% CI [- 1.01; - 0.14]), compared to their non-vaccinated peers. Type 2 diabetes (OR: 2.99, 95% CI [1.22; 7.35]) and existing cardiac diseases (OR: 4.31, 95% CI [1.83; 10.74]) were identified as significant risk factors for the emergence of acute cardiac events. Our findings suggest that COVID-19 vaccination may confer both direct and indirect cardioprotective effects in hospitalized COVID-19 patients.
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Affiliation(s)
- Julian Madrid
- Department of Cardiology, Pneumology, Angiology, Acute Geriatrics and Intensive Care, Ortenau Klinikum, Klostenstraße 19, 77933, Lahr/Schwarzwald, Germany.
| | - Prerana Agarwal
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Katharina Müller-Peltzer
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Leo Benning
- University Emergency Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mischa Selig
- G.E.R.N. Research Center for Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bernd Rolauffs
- G.E.R.N. Research Center for Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philipp Diehl
- Department of Cardiology, Pneumology, Angiology, Acute Geriatrics and Intensive Care, Ortenau Klinikum, Klostenstraße 19, 77933, Lahr/Schwarzwald, Germany
| | - Johannes Kalbhenn
- Department of Anesthesiology and Intensive Care Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Georg Trummer
- Department of Cardiovascular Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stefan Utzolino
- Department of General and Visceral Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tobias Wengenmayer
- Interdisciplinary Medical Intensive Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hans-Jörg Busch
- University Emergency Center, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daiana Stolz
- Clinic of Respiratory Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, Medical Center -University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marcus Panning
- Institute of Virology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Christopher L Schlett
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Esther Askani
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
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Xu K, He W, Yu B, Zhong K, Zhou D, Wang DW. Effects of different treatments for type 2 diabetes mellitus on mortality of coronavirus disease from 2019 to 2021 in China: a multi-institutional retrospective study. MOLECULAR BIOMEDICINE 2024; 5:18. [PMID: 38755442 PMCID: PMC11099001 DOI: 10.1186/s43556-024-00183-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/12/2024] [Indexed: 05/18/2024] Open
Abstract
The coronavirus disease (COVID-19) pandemic has continued for 5 years. Sporadic cases continue to occur in different locations. Type 2 diabetes mellitus (T2DM) is associated with a high risk of a poor prognosis in patients with COVID-19. Successful control of blood glucose levels can effectively decrease the risks of severe infections and mortality. However, the effects of different treatments were reported differently and even adversely. This retrospective study included 4,922 patients who have been diagnosed as COVID-19 and T2DM from 138 Hubei hospitals. The clinical characteristics and outcomes were compared and calculated their risk for death using multivariate Cox regression and Kaplan-Meier curves. After adjustment of age, sex, comorbidities, and in-hospital medications, metformin and alpha-glucosidase inhibitor (AGI) use performed lower all-cause mortality (adjusted hazard ratio [HR], 0.41; 95% confidence interval [CI]: 0.24-0.71; p = 0.001 for metformin; 0.53, 0.35-0.80, p = 0.002 for AGIs), while insulin use was associated with increased all-cause mortality (adjusted HR, 2.07, 95% CI, 1.61-2.67, p < 0.001). After propensity score-matched (PSM) analysis, adjusted HRs for insulin, metformin, and AGIs associated with all-cause mortality were 1.32 (95% CI, 1.03-1.81; p = 0.012), 0.48 (95% CI, 0.23-0.83, p = 0.014), and 0.59 (95% CI, 0.35-0.98, p = 0.05). Therefore, metformin and AGIs might be more suitable for patients with COVID-19 and T2DM while insulin might be used with caution.
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Affiliation(s)
- Ke Xu
- Division of Cardiology, Department of Internal Medicine, Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, 1095# Jiefang Ave., Wuhan, 430030, China
| | - Wu He
- Division of Cardiology, Department of Internal Medicine, Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, 1095# Jiefang Ave., Wuhan, 430030, China
| | - Bo Yu
- Division of Cardiology, Department of Internal Medicine, Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, 1095# Jiefang Ave., Wuhan, 430030, China
| | - Kaineng Zhong
- Hubei Provincial Health Commission, Wuhan, 430079, China
| | - Da Zhou
- Hubei Provincial Health Commission, Wuhan, 430079, China
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, 1095# Jiefang Ave., Wuhan, 430030, China.
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129
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Khan AA, Ata F, Alsharkawy NAAS, Othman EMM, Hassan IM, Taha FAM, Baagar K, Ali H, Konje JC, Abou-Samra AB, Bashir M. A retrospective study comparing the results of continuous glucose monitoring to self-blood glucose monitoring for pregnant women with type 1 diabetes mellitus. Expert Rev Endocrinol Metab 2024:1-7. [PMID: 38738281 DOI: 10.1080/17446651.2024.2354471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 03/25/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Type 1 diabetes mellitus (T1DM) is associated with adverse maternal and fetal outcomes. Continuous glucose monitoring (CGM) during pregnancy is associated with better glycemic control in women with T1DM. However, no clear benefits have been demonstrated in reducing adverse feto-maternal outcomes in pregnant women with T1DM. DESIGN AND METHODS This is a retrospective, single-center study of pregnant women with T1DM to evaluate the impact of CGM use on glycemic control and feto-maternal outcomes in pregnant women with T1DM. RESULTS Of 265 women with T1DM, 92 (34.7%) used CGM, and 173 (65.3%) were managed with capillary blood glucose (CBG) monitoring. The mean (SD) age and BMI at the first visit were 29.4 (4.7) years and 27.2 (5.2) kg/m2, respectively. The mean (SD) HbA1c at the first-trimester visit was 63 (1) mmol/mol, and in the last trimester was 51 (1%). There was no difference in the mean changes in HbA1c between the two groups. Women using CGM had lower insulin requirements (1.02 + 0.37 vs. 0.87 + 0.04 units/kg, p = 0.01). The two groups had no significant differences in maternal or fetal outcomes. CONCLUSION CGM use in pregnant T1DM women is not associated with improved fetomaternal outcomes.
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Affiliation(s)
- Adeel Ahmad Khan
- Department of Endocrinology, National Diabetes Center, Hamad Medical Corporation, Doha, Qatar
| | - Fateen Ata
- Department of Endocrinology, National Diabetes Center, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Ifrah Mohamed Hassan
- National Diabetes Center, Women Wellness and Research Centre, Hamad Medical Corporation, Doha, Qatar
| | - Faten Altaher Mohd Taha
- National Diabetes Center, Women Wellness and Research Centre, Hamad Medical Corporation, Doha, Qatar
- Department of Obstetrics and Gynecology, Women Wellness and Research Centre, Hamad Medical Corporation, Doha, Qatar
| | - Khaled Baagar
- Department of Endocrinology, National Diabetes Center, Hamad Medical Corporation, Doha, Qatar
- National Diabetes Center, Women Wellness and Research Centre, Hamad Medical Corporation, Doha, Qatar
| | - Hamda Ali
- Department of Endocrinology, National Diabetes Center, Hamad Medical Corporation, Doha, Qatar
- National Diabetes Center, Women Wellness and Research Centre, Hamad Medical Corporation, Doha, Qatar
| | - Jutin C Konje
- Department of Obstetrics and Gynecology, Feto Maternal Centre, Doha, Al Markhiya, Qatar
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, Doha, Qatar
| | - Abdul Badi Abou-Samra
- Department of Endocrinology, National Diabetes Center, Hamad Medical Corporation, Doha, Qatar
- Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Bashir
- Department of Endocrinology, National Diabetes Center, Hamad Medical Corporation, Doha, Qatar
- National Diabetes Center, Women Wellness and Research Centre, Hamad Medical Corporation, Doha, Qatar
- Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar
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130
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Ciric VM, Rancic NK, Pesic MM, Radojkovic DB, Milenkovic N. Factors Associated with Length of Hospitalization in Patients with Diabetes and Mild COVID-19: Experiences from a Tertiary University Center in Serbia. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:788. [PMID: 38792970 PMCID: PMC11123358 DOI: 10.3390/medicina60050788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/06/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: During the COVID-19 pandemic, there was an increased number of hospitalized COVID-19-positive patients suffering from type 2 diabetes mellitus (T2DM). The objective of this research study was to explore factors associated with the length of hospitalization of patients with T2DM and the mild form of COVID-19. Material and Methods: This retrospective cohort study involved all patients who tested positive for COVID-19 and those who were treated in the dedicated COVID-19 department of the University Clinical Center (UCC) in Nis between 10 September 2021 and 31 December 2021. Upon admission, patients underwent blood tests for biochemical analysis, including blood count, kidney and liver function parameters (C-reactive protein (CRP), creatinine kinase, and D-dimer), and glycemia and HbA1c assessments. Additionally, all patients underwent lung radiography. Univariate and multivariate regression analyses were employed to assess the impact of specific factors on the length of hospitalization among patients with T2DM. Results: Out of a total of 549 treated COVID-19-positive patients, 124 (21.0%) had T2DM, while 470 (79.0%) did not have diabetes. Among patients with T2DM, men were significantly younger than women (60.6 ± 16.8 vs. 64.2 ± 15.3, p < 0.01). The average hospitalization length of patients with diabetes was 20.2 ± 9.6 (5 to 54 days), and it was significantly longer than for patients without diabetes, at 15.0 ± 3.4, which ranged from 3 days to 39 (t-test ≈ 5.86, p < 0.05). According to the results of the univariate regression analysis, each year of age is associated with an increase in the length of hospital stay of 0.06 days (95% CI: 0.024 to 0.128, p = 0.004). Patients who received oxygen therapy were treated for 2.8 days longer than those who did not receive oxygen treatment (95% CI: 0.687 to 4988, p = 0.010), and each one-unit increase in CRP level was associated with a 0.02-day reduction in the length of hospitalization (95% CI: 0.004 to 0.029, p = 0.008). Based on the results of the multivariate regression analysis, each year of age is associated with an increase in the length of hospitalization by 0.07 days (95% CI: 0.022 to 0.110, p = 0.003). Patients who received oxygen therapy were treated for 3.2 days longer than those who did not receive oxygen therapy (95% CI: 0.653 to 5726, p = 0.014), and each unit increase in CRP level was associated with a 0.02-day reduction in the length of hospitalization (95% CI: 0.005 to 0.028, p = 0.004). Conclusions: Based on the presented results, COVID-19-positive patients with diabetes had, on average, longer hospitalizations than COVID-19 patients without diabetes. The hospital treatment of patients with T2DM and a milder form of COVID-19 was associated with older age, the use of oxygen therapy, and elevated CRP values. Patients who received oxygen therapy were treated approximately 3 days longer than those who did not receive this therapy.
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Affiliation(s)
- Vojislav M. Ciric
- Faculty of Medicine Nis, University of Nis, 18000 Nis, Serbia; (V.M.C.); (M.M.P.); (D.B.R.)
- Universital Clinical Center Nis, Clinic for Endocrinology, Diabetes and Metabolic Diseases, 18000 Nis, Serbia;
| | - Natasa Krsto Rancic
- Faculty of Medicine Nis, University of Nis, 18000 Nis, Serbia; (V.M.C.); (M.M.P.); (D.B.R.)
- Institute for Public Health Nis, Center for Diseases Control and Prevention, 18000 Nis, Serbia
| | - Milica M. Pesic
- Faculty of Medicine Nis, University of Nis, 18000 Nis, Serbia; (V.M.C.); (M.M.P.); (D.B.R.)
- Universital Clinical Center Nis, Clinic for Endocrinology, Diabetes and Metabolic Diseases, 18000 Nis, Serbia;
| | - Danijela B. Radojkovic
- Faculty of Medicine Nis, University of Nis, 18000 Nis, Serbia; (V.M.C.); (M.M.P.); (D.B.R.)
- Universital Clinical Center Nis, Clinic for Endocrinology, Diabetes and Metabolic Diseases, 18000 Nis, Serbia;
| | - Nikola Milenkovic
- Universital Clinical Center Nis, Clinic for Endocrinology, Diabetes and Metabolic Diseases, 18000 Nis, Serbia;
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131
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Fernández D, Perez-Alvarez N, Molist G. COVID-19 patient profiles over four waves in Barcelona metropolitan area: A clustering approach. PLoS One 2024; 19:e0302461. [PMID: 38713649 DOI: 10.1371/journal.pone.0302461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/03/2024] [Indexed: 05/09/2024] Open
Abstract
OBJECTIVES Identifying profiles of hospitalized COVID-19 patients and explore their association with different degrees of severity of COVID-19 outcomes (i.e. in-hospital mortality, ICU assistance, and invasive mechanical ventilation). The findings of this study could inform the development of multiple care intervention strategies to improve patient outcomes. METHODS Prospective multicentre cohort study during four different waves of COVID-19 from March 1st, 2020 to August 31st, 2021 in four health consortiums within the southern Barcelona metropolitan region. From a starting point of over 292 demographic characteristics, comorbidities, vital signs, severity scores, and clinical analytics at hospital admission, we used both clinical judgment and supervised statistical methods to reduce to the 36 most informative completed covariates according to the disease outcomes for each wave. Patients were then grouped using an unsupervised semiparametric method (KAMILA). Results were interpreted by clinical and statistician team consensus to identify clinically-meaningful patient profiles. RESULTS The analysis included nw1 = 1657, nw2 = 697, nw3 = 677, and nw4 = 787 hospitalized-COVID-19 patients for each of the four waves. Clustering analysis identified 2 patient profiles for waves 1 and 3, while 3 profiles were determined for waves 2 and 4. Patients allocated in those groups showed a different percentage of disease outcomes (e.g., wave 1: 15.9% (Cluster 1) vs. 31.8% (Cluster 2) for in-hospital mortality rate). The main factors to determine groups were the patient's age and number of obese patients, number of comorbidities, oxygen support requirement, and various severity scores. The last wave is also influenced by the massive incorporation of COVID-19 vaccines. CONCLUSION Our study suggests that a single care model at hospital admission may not meet the needs of hospitalized-COVID-19 adults. A clustering approach appears to be appropriate for helping physicians to differentiate patients and, thus, apply multiple care intervention strategies, as another way of responding to new outbreaks of this or future diseases.
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Affiliation(s)
- Daniel Fernández
- Department of Statistics and Operations Research (DEIO), Universitat Politècnica de Catalunya BarcelonaTech (UPC), Barcelona, Spain
- Institute of Mathematics of UPC - BarcelonaTech (IMTech), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III (CIBERSAM), Madrid, Spain
| | - Nuria Perez-Alvarez
- Department of Statistics and Operations Research (DEIO), Universitat Politècnica de Catalunya BarcelonaTech (UPC), Barcelona, Spain
- Estudis d'Informàtica, Multimèdia i Telecomunicació, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Gemma Molist
- Biostatistics Unit of the Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- Faculty of Medicine, University of Vic - Central University of Catalonia (UVIC-UCC), Vic, Spain
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132
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Elgedawy GA, Elabd NS, Salem RH, Awad SM, Amer AA, Torayah MM, El-Koa AA, Abozeid M, Montaser BA, Aboshabaan HS, Abdelkreem M, Helal ML. FURIN, IFNL4, and TLR2 gene polymorphisms in relation to COVID-19 severity: a case-control study in Egyptian patients. Infection 2024:10.1007/s15010-024-02266-1. [PMID: 38703289 DOI: 10.1007/s15010-024-02266-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/12/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND AND AIM A wide range of clinical manifestations and outcomes, including liver injury, have been reported in COVID-19 patients. We investigated the association of three substantial gene polymorphisms (FURIN, IFNL4, and TLR2) with COVID-19 disease susceptibility and severity to help predict prognosis. METHODS 150 adult COVID-19-assured cases were categorized as follows: 78 patients with a non-severe presentation, 39 patients with severe disease, and 33 critically ill patients. In addition, 74 healthy controls were included. Clinical and laboratory evaluations were carried out, including complete and differential blood counts, D-dimer, lactate dehydrogenase (LDH), C-reactive protein (CRP), procalcitonin, ferritin, interleukin-6 (Il-6), and liver and kidney functions. FURIN (rs6226), IFNL4 (rs12979860), and TLR2 (rs3804099) genotyping allelic discrimination assays were conducted using real-time PCR. RESULTS The FURIN, IFNL4, and TLR2 genotypes and their alleles differed significantly between COVID-19 patients and controls, as well as between patients with severe or critical illness and those with a non-severe presentation. According to a multivariable regression analysis, FURIN (C/T + T/T) and TLR2 (T/C + C/C) mutants were associated with COVID-19 susceptibility, with odds ratios of 3.293 and 2.839, respectively. FURIN C/C and IFNL4 T/T mutants were significantly linked to severe and critical illnesses. Multivariate regression analysis showed that FURIN (G/C + C/C) genotypes and IFNL4 T/T homozygosity were independent risk factors associated with increased mortality. CONCLUSION FURIN, IFNL4, and TLR2 gene variants are associated with the risk of COVID-19 occurrence as well as increased severity and poor outcomes in Egyptian patients.
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Affiliation(s)
- Gamalat A Elgedawy
- Department of Clinical Biochemistry and Molecular Diagnostics, National Liver Institute, Menoufia University, Shebin El-Kom, Menoufia, Egypt
| | - Naglaa S Elabd
- Faculty of Medicine, Department of Tropical Medicine, Menoufia University, Shebin El-Kom, Menoufia, 32511, Egypt.
| | - Radwa H Salem
- Department of Clinical Microbiology and Immunology, National Liver Institute, Menoufia University, Shebin El-Kom, Menoufia, Egypt
| | - Samah M Awad
- Department of Clinical Microbiology and Immunology, National Liver Institute, Menoufia University, Shebin El-Kom, Menoufia, Egypt
| | - Amany A Amer
- Faculty of Medicine, Department of Tropical Medicine, Menoufia University, Shebin El-Kom, Menoufia, 32511, Egypt
| | - Mohammad M Torayah
- Faculty of Medicine, Department of Critical Care Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Amal A El-Koa
- Faculty of Medicine, Department of Chest Diseases and Tuberculosis, Menoufia University, Shebin El‑Kom, Menoufia, Egypt
| | - Mai Abozeid
- Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebin El-Kom, Menoufia, 32511, Egypt.
| | - Belal A Montaser
- Faculty of Medicine, Department of Clinical Pathology, Menoufia University, Shebin El-Kom, Menoufia, Egypt
| | - Hind S Aboshabaan
- Ph.D. of Biochemistry, National Liver Institute, Menoufia University, Shebin El-Kom, Menoufia, Egypt
| | - Mervat Abdelkreem
- Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Shebin El-Kom, Menoufia, 32511, Egypt
| | - Marwa L Helal
- Department of Clinical Biochemistry and Molecular Diagnostics, National Liver Institute, Menoufia University, Shebin El-Kom, Menoufia, Egypt
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Müllertz ALO, Sandsdal RM, Jensen SBK, Torekov SS. Potent incretin-based therapy for obesity: A systematic review and meta-analysis of the efficacy of semaglutide and tirzepatide on body weight and waist circumference, and safety. Obes Rev 2024; 25:e13717. [PMID: 38463003 DOI: 10.1111/obr.13717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/30/2023] [Accepted: 01/16/2024] [Indexed: 03/12/2024]
Abstract
Potent incretin-based therapy shows promise for the treatment of obesity along with reduced incidence of cardiovascular events in patients with preexisting cardiovascular disease and obesity. This study assessed the efficacy and safety of the incretin-based obesity treatments, once-weekly subcutaneous semaglutide 2.4 mg and tirzepatide 10 or 15 mg, in people with obesity without diabetes. Of the 744 records identified, seven randomized controlled trials (n = 5140) were included. Five studies (n = 3288) investigated semaglutide and two studies (n = 1852) investigated tirzepatide. The treatment effect, shown as placebo-subtracted difference, on body weight was -15.0% (95% CI, -17.8 to -12.2) with -12.9% (95% CI, -14.7 to -11.1) for semaglutide and -19.2% (95% CI, -22.2 to -16.2) for tirzepatide. The treatment effect on waist circumference was -11.4 cm (95% CI, -13.7 to -9.2) with -9.7 cm (95% CI, -10.8 to -8.5) for semaglutide and -14.6 cm (95% CI, -15.8 to -13.4) for tirzepatide. The adverse events related to semaglutide and tirzepatide were primarily of mild-to-moderate severity and mostly gastrointestinal, which was more frequent during the dose-titration period and leveled off during the treatment period. This emphasizes that once-weekly subcutaneous semaglutide 2.4 mg and tirzepatide 10 or 15 mg induce large reductions in body weight and waist circumference and are generally well-tolerated.
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Wong HJ, Lin NH, Teo YN, Syn NL, Teo YH, Sia CH. Evaluation of the Lifetime Benefits of Metformin and SGLT2 Inhibitors in Type 2 Diabetes Mellitus Patients with Cardiovascular Disease: A Systematic Review and Two-Stage Meta-Analysis. Am J Cardiovasc Drugs 2024; 24:371-383. [PMID: 38589722 DOI: 10.1007/s40256-024-00640-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Metformin and sodium-glucose cotransporter-2 (SGLT2) inhibitors have demonstrated cardiovascular benefits but their comparative effects on mortality in type 2 diabetes mellitus (T2DM) patients with cardiovascular disease (CVD) are unknown. Hence, we evaluated and compared lifetime benefits arising from metformin or SGLT2 inhibitors in T2DM patients with CVD. MATERIALS AND METHODS Studies published in the PubMed, EMBASE and CENTRAL databases before 28 October 2023 were retrieved. Treatment effects of metformin against US FDA-approved SGLT2 inhibitors in T2DM patients with CVD were evaluated and lifetime gains in event-free survival were estimated from our primary endpoints of all-cause and cardiovascular mortality. Risk ratios were derived to assess their impact on secondary outcomes such as major adverse cardiovascular events and hospitalizations for heart failure. RESULTS Overall, 14 studies were included. Five studies published Kaplan-Meier curves for the primary outcome of all-cause mortality. Individual participant data were reconstructed from these Kaplan-Meier curves, from which we conducted our two-stage meta-analysis. Participants receiving metformin and SGLT2 inhibitors experienced a reduction in the risk for all-cause mortality as compared with those not taking metformin and placebo. However, participants receiving SGLT2 inhibitors had a higher all-cause mortality (hazard ratio 1.308, 95% confidence interval 1.103-1.550) versus metformin. Treatment with metformin was estimated to offer an additional 23.26 months of survival free from all-cause mortality versus 23.04 months with SGLT2 inhibitors. CONCLUSIONS In patients with T2DM and CVD, metformin and SGLT2 inhibitors were associated with substantially lower all-cause mortality rates and slightly longer life expectancies than in patients without. Metformin presented an advantage over SGLT2 inhibitors in reducing all-cause mortality.
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Affiliation(s)
- Hon Jen Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Norman H Lin
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore, 119228, Singapore
| | - Yao Neng Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicholas L Syn
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore, 119228, Singapore
| | - Yao Hao Teo
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore, 119228, Singapore
| | - Ching-Hui Sia
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore, 119228, Singapore.
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135
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Vaishya R, Misra A, Vaish A, Singh SK. Diabetes and tuberculosis syndemic in India: A narrative review of facts, gaps in care and challenges. J Diabetes 2024; 16:e13427. [PMID: 37292055 PMCID: PMC11070841 DOI: 10.1111/1753-0407.13427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 06/10/2023] Open
Abstract
Both diabetes mellitus (DM) and tuberculosis (TB) are prevalent all across in India. TB-DM comorbidity has emerged as a syndemic and needs more attention in India considering gaps in screening, clinical care, and research. This paper is intended to review published literature on TB and DM in India to understand the burden of the dual epidemic and its trajectory and to obtain perspectives on the gaps, constraints, and challenges in care and treatment of this dual epidemic. A literature search was carried out on PubMed, Scopus, and Google Scholar, using the key words 'Tuberculosis' OR 'TB' AND 'Diabetes' OR 'Diabetes Mellitus' AND 'India', focusing on the research published between the year 2000 to 2022. The prevalence of DM is high in patients with TB. Quantitative data on the epidemiological situation of TB/DM in India such as incidence, prevalence, mortality, and management are lacking. During the last 2 years convergence of TB-DM syndemic with the COVID-19 pandemic has increased cases with uncontrolled DM but also made coordinated control of TB-DM operationally difficult and of low effectiveness. Research regarding TB-DM comorbidity is required in the context of epidemiology and management. Detection and bidirectional screening are aggressively warranted. Management of DM in those with TB-DM comorbidity needs more efforts, including training and supervision of frontline workers.
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Affiliation(s)
- Raju Vaishya
- Department of Orthopaedics and Joint Replacement SurgeryIndraprastha Apollo HospitalsNew DelhiIndia
| | - Anoop Misra
- Fortis‐C‐DOC Centre of Excellence for DiabetesMetabolic Diseases and EndocrinologyNew DelhiIndia
- National Diabetes, Obesity and Cholesterol Foundation (N‐DOC)New DelhiIndia
- Diabetes Foundation (India) (DFI)New DelhiIndia
| | - Abhishek Vaish
- Department of Orthopaedics and Joint Replacement SurgeryIndraprastha Apollo HospitalsNew DelhiIndia
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Pan XH, Tan B, Chin YH, Lee ECZ, Kong G, Chong B, Kueh M, Khoo CM, Mehta A, Majety P, Grandhi GR, Dimitriadis GK, Foo R, Chew NWS, Le Roux CW, Mamas MA, Chan MY. Efficacy and safety of tirzepatide, GLP-1 receptor agonists, and other weight loss drugs in overweight and obesity: a network meta-analysis. Obesity (Silver Spring) 2024; 32:840-856. [PMID: 38413012 DOI: 10.1002/oby.24002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/14/2023] [Accepted: 12/27/2023] [Indexed: 02/29/2024]
Abstract
OBJECTIVE This network meta-analysis evaluates the efficacy and safety of tirzepatide compared to glucagon-like peptide-1 receptor agonists (GLP-1 RA) and other weight loss drugs in the treatment of overweight and obesity. METHODS MEDLINE, Embase, and Cochrane CENTRAL were searched for randomized controlled trials on tirzepatide, GLP-1 RA, and weight loss drugs approved by the US Food and Drug Administration. A network meta-analysis was performed, drawing direct and indirect comparisons between treatment groups. Network diagrams and surface under the cumulative ranking curve analysis were performed for primary (≥5%, ≥10%, ≥15%, absolute weight loss) and secondary outcomes and adverse effects. RESULTS Thirty-one randomized controlled trials, involving more than 35,000 patients, were included in this study. Tirzepatide 15 mg ranked in the top three across weight-related parameters, glycemic profile (glycated hemoglobin), lipid parameters (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides), and blood pressure. Tirzepatide 15 mg had the highest efficacy compared with placebo for achieving ≥15% weight loss (risk ratio 10.24, 95% CI: 6.42-16.34). As compared to placebo, tirzepatide and GLP-1 RA across all doses had significant increases in gastrointestinal adverse effects. CONCLUSIONS The superiority of tirzepatide and GLP-1 RA in inducing weight loss and their ability to target multiple metabolic parameters render them promising candidates in the treatment of patients with overweight and obesity.
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Affiliation(s)
- Xin-Hui Pan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Bryan Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yip Han Chin
- Ministry of Health Holdings, Ministry of Health, Singapore
| | - Ethan Cheng Zhe Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Gwyneth Kong
- Ministry of Health Holdings, Ministry of Health, Singapore
| | - Bryan Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Martin Kueh
- Royal College of Surgeons in Ireland & University College Dublin Malaysia Campus, George Town, Malaysia
| | - Chin Meng Khoo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Endocrinology, National University Hospital, Singapore
| | - Anurag Mehta
- VCU Health Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Priyanka Majety
- Department of Endocrinology, Diabetes and Metabolism, Virginia Commonwealth University Health, Richmond, Virginia, USA
| | - Gowtham R Grandhi
- VCU Health Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Georgios K Dimitriadis
- Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
- Department of Endocrinology, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Roger Foo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, Singapore
| | - Nicholas W S Chew
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, Singapore
| | - Carel W Le Roux
- Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, UK
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Mark Y Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, Singapore
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Rasul HO, Thomas NV, Ghafour DD, Aziz BK, Salgado M G, Mendoza-Huizar LH, Candia LG. Searching possible SARS-CoV-2 main protease inhibitors in constituents from herbal medicines using in silico studies. J Biomol Struct Dyn 2024; 42:4234-4248. [PMID: 37349945 DOI: 10.1080/07391102.2023.2220040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 05/23/2023] [Indexed: 06/24/2023]
Abstract
The largest threat to civilization since the Second World War is the spread of the new coronavirus disease (COVID-19). Therefore, there is an urgent need for innovative therapeutic medicines to treat COVID-19. Reusing bio-actives is a workable and efficient strategy in the battle against new epidemics because the process of developing new drugs is time-consuming. This research aimed to identify which herbal remedies had the highest affinity for the receptor and assess a variety of them for potential targets to suppress the SARS-CoV-2 Mpro. The use of AutoDock Vina for structure-based virtual screening was done first due to the importance of protein interactions in the development of drugs. Molecular docking was used in the comparative study to assess 89 different chemicals from medicinal herbs. To anticipate their effectiveness against the primary protease of SARS-CoV-2, more analysis was done on the ADMET profile, drug-likeness, and Lipinski's rule of five. The next step involved three replicas of 100 ns-long molecular dynamics simulations on the potential candidates, which were preceded by calculations of the binding free energy of MM-GBSA. The outcomes showed that Achyrodimer A, Cinchonain Ib, Symphonone F, and Lupeol acetate all performed well and had the highest 6LU7 binding affinities. Using RMSD, RMSF, and protein-ligand interactions, the stability of the protein-ligand complex was assessed. The studies indicate that bioactive substances obtained from herbal medicines may function as a COVID-19 therapeutic agent, necessitating additional wet lab research to confirm their therapeutic potential, efficacy, and pharmacological capacity against the condition.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Hezha O Rasul
- Department of Pharmaceutical Chemistry, College of Science, Charmo University, Chamchamal, Sulaimani, Iraq
| | - Noel Vinay Thomas
- Department of BioMedical Science, College of Science, Komar University of Science and Technology, Sulaimani, Iraq
| | - Dlzar D Ghafour
- Department of Medical Laboratory Science, College of Science, Komar University of Science and Technology, Sulaimani, Iraq
- Department of Chemistry, College of Science, University of Sulaimani, Sulaimani, Iraq
| | - Bakhtyar K Aziz
- Department of Nanoscience and Applied Chemistry, College of Science, Charmo University, Chamchamal, Sulaimani, Iraq
| | | | - L H Mendoza-Huizar
- Academic Area of Chemistry, Mineral de la Reforma, Autonomous University of Hidalgo State, Hidalgo, México
| | - Lorena Gerli Candia
- Departamento de Química Ambiental, Facultad de Ciencias, Universidad Católica de la Santísima Concepción, Concepción, Chile
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138
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Kumar A, Pushkar K, Mathur Y, Kumar R, Patnaik U, Ahmed FHM, Yendamuri S, Dawra S. Association of socio-demographic factors with clinical outcome among hospitalized patients in first and second waves of COVID-19 pandemic: Study from the developing world. J Family Med Prim Care 2024; 13:1636-1642. [PMID: 38948593 PMCID: PMC11213441 DOI: 10.4103/jfmpc.jfmpc_57_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 05/28/2023] [Accepted: 06/15/2023] [Indexed: 07/02/2024] Open
Abstract
Background Recent disease resurgence in China indicates that corona virus infectious disease is still a pertinent public health problem. We stand at a juncture where we are still unsure about the initial dilemmas regarding its birth, therapies, and the emerging novel strains. Medical literature has focused on the clinical, laboratory, radiological, and therapeutic aspects of disease management. There is paucity of literature on the association between socio-demographic variables on disease severity and clinical outcome. Materials and Methods This retrospective observational study analyzing the socio-demographic variables was performed at a dedicated COVID care center in western Maharashtra, India. Electronic records of all individuals who were admitted to this hospital from July 29 2020, to June 14, 2021, and diagnosed COVID-19 positive by reverse transcriptase polymerase chain reaction (RT-PCR) were identified after due institutional ethical clearance. Patients admitted from July 29, 2020, to February 27, 2021, were categorized as patients presenting during the 'first wave of viral pandemic'. Those admitted from March 01, 2021, to June 14, 2021, have been included as patients admitted during 'second wave of viral pandemic'. The following outcome parameters were collected (presenting symptoms, duration of symptoms before the individual presented for diagnostic RT-PCR, total duration of symptoms, severity of disease at onset, duration of hospital stay, the final outcome (discharge/death) and Charlson's comorbidity index). The linear regression model was used to establish association between socio-demographic factors and disease severity at onset (mild/moderate/severe/critical). Results A total of 37033 patients were screened, and the positivity rate with RT-PCR was 16.99% (n = 6275) during the study period. Out of which 45% (n = 2824) of the patients had mild disease requiring home isolation and the remaining 55% of patients required admission. 1590 patients from the first wave and 910 from the second wave of COVID-19 were hospitalized and included in the study after exclusion. The mean age of patients in first wave was 49 years and that in second wave was 54 years with 77.6% and 70.6% males in two waves, respectively. The burden of critical cases was higher in second wave as computed to first wave (10% vs 8%). The second wave had more outreach in the rural population as compared to second one (17.8% vs 12.2%). The mean duration from the onset of symptoms to hospitalization was 03 and 04 days, respectively, in two waves. Mortality associated in two waves was 11.9% and 24%, respectively (P < 0.05). Higher Charlson's comorbidity index was associated with higher mortality, and the cumulative survival from urban area was more as compared to the rural population (log rank - 9.148, P = 0.0002). Conclusion The second COVID-19 wave had significantly higher case mortality. It affected elderly patients and those with rural background. The factors associated with higher mortality during COVID-19 pandemic were rural background, higher Charlson's comorbidity index and late presentation to the hospital. Ongoing vaccine campaigns, thus, should focus on rural areas and individuals with comorbidities especially in developing and least developed countries.
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Affiliation(s)
- Ankit Kumar
- Department of Medicine, Military Hospital, Shimla, Himachal Pradesh, India
| | - Kumar Pushkar
- Associate Professor, Department of Community Medicine, Command Hospital, Pune, Maharashtra, India
| | - Yashvir Mathur
- Associate Professor, Department of Radio-diagnosis, Command Hospital, Pune, Maharashtra, India
| | - Ravi Kumar
- Resident, Department of Internal Medicine, Command Hospital, Pune, Maharashtra, India
| | - Uma Patnaik
- Professor, Department of ENT, Command Hospital, Pune, Maharashtra, India
| | - F H M Ahmed
- Professor, Department of Medicine, Command Hospital, Kolkata, West Bengal, India
| | - Sushma Yendamuri
- Resident, Department of Internal Medicine, Command Hospital, Pune, Maharashtra, India
| | - Saurabh Dawra
- Associate Professor, Department of Medicine, Command Hospital, Pune, Maharashtra, India
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Chawla M, Panneerselvam D, Gundgurthy A, Sud S, Alamchandani R, Aneja P, Nair R, Korukonda KR. Retrospective Observational Study on Assessing Sitagliptin and Dapagliflozin as a Fixed-Dose Combination in the Indian Population With Type 2 Diabetes Mellitus: The SIDAXA Study. Cureus 2024; 16:e60815. [PMID: 38910691 PMCID: PMC11191412 DOI: 10.7759/cureus.60815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction Type 2 diabetes mellitus (T2DM), a prevalent chronic metabolic disorder, necessitates multifaceted treatment approaches. Emerging studies highlight the cardiovascular advantages of sodium-glucose transport protein 2 (SGLT2) and dipeptidyl peptidase 4 (DPP-4) inhibitors in T2DM. This investigation delves into the synergistic effects of the fixed-dose combination (FDC) of sitagliptin and dapagliflozin, offering insights into its safety and efficacy for the Indian population. Methods This real-world, retrospective, observational study spanned 328 cases across 111 Indian centres, evaluating the safety, efficacy, and clinical utilization of the sitagliptin and dapagliflozin FDC in T2DM patients after obtaining ethical approval. Assessments at baseline, week four, and week 12 encompassed hemoglobin A1C (HbA1C), fasting plasma glucose (FPG), postprandial blood glucose (PPBG), low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP), diastolic blood pressure (DBP), and weight change. The statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 29.0.1.0(171) (IBM Corp., Armonk, NY, USA) with a significance level p<0.05. Results Study participants [mean age: 51.14±5.55 years, 77.74% (n=255) males, 22.26% (n=73) females] exhibited prevalent risk factors like sedentary lifestyle (n=167, 50.91%) and smoking (n=147, 44.82%). Comorbidities included hypertension (n=235, 71.65%) and dyslipidaemia (n=139, 42.38%). Metformin (n=282, 85.98%) and sulfonylurea (n=134, 40.85%) were commonly prescribed concomitant oral antidiabetic agents (OADs). FDC administration significantly reduced HbA1c by 1.05 ± 0.83% (p < 0.0001) at week 12. FPG and PPBG showed significant reductions of 22.98 ± 22.23 mg/dL (p < 0.0001), 165.50 ± 37.02 mg/dL and 40.94 ± 36.04 mg/dL (p < 0.0001) at four weeks respectively. By week 12, significant reductions were noted in SBP (14.61±13.98mmHg reduction, p-value <0.0001), DBP (7.80±8.45mmHg reduction, p-value <0.0001), and LDL-C levels (18.14±23.95 mg/dL reduction, p-value <0.0001). In patients with established cardiovascular disease, there was reduction in HbA1c levels by 1.02 ± 0.63% after 12 weeks, with FPG decreasing by 54.52 ± 32.67 mg/dL and PPBG decreasing by 88.73 ± 44.90 mg/dL. Treatment-emergent adverse events included headache, changes in micturition, genital mycotic infection, and nausea and diarrhoea which were mild, transient, and necessitated no treatment discontinuation. Conclusion The FDC of sitagliptin and dapagliflozin significantly improved glycaemic control and lipid profiles in T2DM patients, particularly those with coronary artery disease. It demonstrated a favourable safety profile in the Indian population, signifying its potential as an effective and well-tolerated therapeutic option in patients with established cardiovascular disease.
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Affiliation(s)
- Manoj Chawla
- Department of Diabetes and Endocrinology, Lina Diabetes Care Centre, Mumbai, IND
| | | | - Abhay Gundgurthy
- Department of Diabetes and Endocrinology, Sanjeevani Clinic, Bangalore, IND
| | - Sanjay Sud
- Department of Diabetes and Endocrinology, Doctor Sud's Clinic, Hooghly, IND
| | | | - Pankaj Aneja
- Department of Internal Medicine, Naveda Healthcare Centre, New Delhi, IND
| | - Rathish Nair
- Medical Strategic Affairs, Torrent Pharmaceuticals Ltd., Ahmedabad, IND
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Pandey M, Xess I, Sachdev J, Sharad N, Gupta S, Singh G, Yadav RK, Rana B, Raj S, Ahmad MN, Nityadarshini N, Baitha U, Soneja M, Shalimar, Prakash B, Sikka K, Mathur P, Jyotsna VP, Kumar R, Wig N, Gourav S, Biswas A, Thakar A. Utility of an in-house real-time PCR in whole blood samples as a minimally invasive method for early and accurate diagnosis of invasive mould infections. J Infect 2024; 88:106147. [PMID: 38555035 DOI: 10.1016/j.jinf.2024.106147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 03/11/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Invasive mould infections (IMIs) are a leading cause of death in patients with compromised immune systems. Proven invasive mould infection requires detection of a fungus by histopathological analysis of a biopsied specimen, sterile culture, or fungal DNA amplification by PCR in tissue. However, the clinical performance of a PCR assay on blood samples taken from patients suspected of invasive mould disease has not been fully evaluated, particularly for the differential diagnosis of invasive aspergillosis (IA) and invasive Mucormycosis (IM). OBJECTIVES To assess the diagnostic utility of our previously validated in-house real-time PCR in blood samples for diagnosis of invasive aspergillosis and mucormycosis in patients with suspected invasive mould infection. METHODS All patients with suspected invasive mould infection were prospectively enrolled from May 2021 to July 2021. Conventional fungal diagnosis was performed using tissue and respiratory samples. In-house PCR was performed on blood samples and its diagnostic performance evaluated. RESULTS A total of 158 cases of suspected invasive mould infection were enrolled in the study. The sensitivity and specificity of in-house PCR performed on blood samples was found to be 92.5% and 81.4% respectively for diagnosis of probable IA, and 65% and 84.62% respectively for diagnosis of proven and probable IM. It was also able to detect 3 out of 5 cases of possible IM where no other microbiological evidence of IM was obtained. CONCLUSIONS This assay could be helpful in minimally invasive diagnosis of IMIs for patients in whom invasive sampling is not feasible, especially as a preliminary or screening test. It can help in early diagnosis, anticipating conventional laboratory confirmation by days or weeks. Possible correlation between fungal load and mortality can help in initiating aggressive treatment for patients with high initial fungal load.
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Affiliation(s)
- Mragnayani Pandey
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Immaculata Xess
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Janya Sachdev
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Neha Sharad
- Department of Lab medicine JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Sonakshi Gupta
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Gagandeep Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Renu Kumari Yadav
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Bhaskar Rana
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Stephen Raj
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - M Nizam Ahmad
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Neha Nityadarshini
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Upendra Baitha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Soneja
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shalimar
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Bindu Prakash
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Sikka
- Department of ENT, All India Institute of Medical Sciences, New Delhi, India
| | - Purva Mathur
- Department of Lab medicine JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Viveka P Jyotsna
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of ENT, All India Institute of Medical Sciences, New Delhi, India
| | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sudesh Gourav
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Ashutosh Biswas
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Thakar
- Department of ENT, All India Institute of Medical Sciences, New Delhi, India
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Singh AK, Singh R, Singh A, Misra A. Efficacy and safety of oral semaglutide in type 2 diabetes: A systematic review of real-world evidence. Diabetes Metab Syndr 2024; 18:103024. [PMID: 38718449 DOI: 10.1016/j.dsx.2024.103024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND AND AIMS Oral semaglutide has undergone global Phase 3 development programs named PIONEER and approved for therapeutic use in people with type 2 diabetes (T2D). We aim to systematically review the efficacy and safety of oral semaglutide in real-world settings. METHODS We systematically searched the electronic databases of PubMed, Google Scholar, and ClinicalTrials.gov from inception until March 15, 2024, using several keywords with Boolean "AND". We retrieved all the available granular details of real-world studies (RWS). RESULTS To date, results from four prospective and ten retrospective real-world studies of oral semaglutide in T2D are available. In prospective studies, the primary outcome of HbA1c reduction varied from -0.9 % to -1.6 %, weight loss varied from -4.7 kg to -8.2 kg and HbA1c target of <7 % was achieved in 30 %-64 % with oral semaglutide. In retrospective studies, HbA1c reduction varied from -0.4 % to -1.8 %, weight reduction varied from -1.4 to -9.0 kg, HbA1c target of <7 % was achieved in 32-64 %, and 30-41 % of people with T2D had ≥5 % weight loss with oral semaglutide. Gastrointestinal adverse events with oral semaglutide varied from 16 % to 50 % in prospective and 6 %-47 % in retrospective RWS. Overall, 0 %-18 % of patients had oral semaglutide discontinuation due to any cause. CONCLUSION Oral semaglutide exhibited a reasonable reduction in HbA1c and weight in people with T2D, consistent with the findings from PIONEER trials. While no new safety issues emerged, the inherent limitations of RWS underscore the necessity of long-term investigations to comprehensively assess safety.
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Affiliation(s)
- Awadhesh Kumar Singh
- G. D Hospital & Diabetes Institute, Kolkata, West Bengal, India; Horizon Multispecialty Hospital, Kolkata, West Bengal, India; Sun Valley Hospital & Diabetes Research Centre, Guwahati, Assam, India.
| | - Ritu Singh
- Horizon Multispecialty Hospital, Kolkata, West Bengal, India
| | - Akriti Singh
- College of Medicine and JNM Hospital, Kalyani, Nadia, West Bengal, India
| | - Anoop Misra
- Fortis C-DOC Hospital for Diabetes & Allied Sciences, New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India; Diabetes Foundation (India), New Delhi, India
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142
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Martínez-López YE, Neri-Rosario D, Esquivel-Hernández DA, Padron-Manrique C, Vázquez-Jiménez A, Sánchez-Castañeda JP, Girón-Villalobos D, Mendoza-Ortíz C, Reyes-Escogido MDL, Evia-Viscarra ML, Aguilar-Garcia A, Resendis-Antonio O, Guardado-Mendoza R. Effect of metformin and metformin/linagliptin on gut microbiota in patients with prediabetes. Sci Rep 2024; 14:9678. [PMID: 38678119 PMCID: PMC11055900 DOI: 10.1038/s41598-024-60081-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 04/18/2024] [Indexed: 04/29/2024] Open
Abstract
Lifestyle modifications, metformin, and linagliptin reduce the incidence of type 2 diabetes (T2D) in people with prediabetes. The gut microbiota (GM) may enhance such interventions' efficacy. We determined the effect of linagliptin/metformin (LM) vs metformin (M) on GM composition and its relationship to insulin sensitivity (IS) and pancreatic β-cell function (Pβf) in patients with prediabetes. A cross-sectional study was conducted at different times: basal, six, and twelve months in 167 Mexican adults with prediabetes. These treatments increased the abundance of GM SCFA-producing bacteria M (Fusicatenibacter and Blautia) and LM (Roseburia, Bifidobacterium, and [Eubacterium] hallii group). We performed a mediation analysis with structural equation models (SEM). In conclusion, M and LM therapies improve insulin sensitivity and Pβf in prediabetics. GM is partially associated with these improvements since the SEM models suggest a weak association between specific bacterial genera and improvements in IS and Pβf.
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Affiliation(s)
- Yoscelina Estrella Martínez-López
- Human Systems Biology Laboratory. Instituto Nacional de Medicina Genómica (INMEGEN), México City, Mexico
- Programa de Doctorado en Ciencias Médicas, Odontológicas y de la Salud, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, Mexico
- Metabolic Research Laboratory, Department of Medicine and Nutrition, University of Guanajuato, León, Guanajuato, Mexico
| | - Daniel Neri-Rosario
- Human Systems Biology Laboratory. Instituto Nacional de Medicina Genómica (INMEGEN), México City, Mexico
- Programa de Maestría en Ciencias Bioquímicas, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, Mexico
| | | | - Cristian Padron-Manrique
- Human Systems Biology Laboratory. Instituto Nacional de Medicina Genómica (INMEGEN), México City, Mexico
- Programa de Doctorado en Ciencias Biomédicas, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, Mexico
| | - Aarón Vázquez-Jiménez
- Human Systems Biology Laboratory. Instituto Nacional de Medicina Genómica (INMEGEN), México City, Mexico
| | - Jean Paul Sánchez-Castañeda
- Human Systems Biology Laboratory. Instituto Nacional de Medicina Genómica (INMEGEN), México City, Mexico
- Programa de Maestría en Ciencias Bioquímicas, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, Mexico
| | - David Girón-Villalobos
- Human Systems Biology Laboratory. Instituto Nacional de Medicina Genómica (INMEGEN), México City, Mexico
- Programa de Maestría en Ciencias Bioquímicas, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, Mexico
| | - Cristian Mendoza-Ortíz
- Human Systems Biology Laboratory. Instituto Nacional de Medicina Genómica (INMEGEN), México City, Mexico
- Programa de Maestría en Ciencias Bioquímicas, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, Mexico
| | | | | | | | - Osbaldo Resendis-Antonio
- Human Systems Biology Laboratory. Instituto Nacional de Medicina Genómica (INMEGEN), México City, Mexico.
- Coordinación de la Investigación Científica - Red de Apoyo a la Investigación - Centro de Ciencias de la Complejidad, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, Mexico.
| | - Rodolfo Guardado-Mendoza
- Metabolic Research Laboratory, Department of Medicine and Nutrition, University of Guanajuato, León, Guanajuato, Mexico.
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143
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Ndasauka Y, Twabi HS, Kainja J, Gunde AM, Makhumula-Mtimuni C. Knowledge, attitudes and demographic drivers for COVID-19 vaccine hesitancy in Malawi. Sci Rep 2024; 14:9578. [PMID: 38671014 PMCID: PMC11053073 DOI: 10.1038/s41598-024-60042-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
This study assessed the association among knowledge, attitudes and uptake of COVID-19 vaccine in Malawi, examining demographic factors influencing these variables. The study employed a quantitative research design. It thus sampled 394 participants from Malawi's three districts of Zomba, Dowa and Nkhatabay. Results showed that 163 (41.4%) participants had low levels of knowledge of COVID-19 vaccine, 231 (58.6%) had high levels of knowledge, 237 (60.2%) had a positive attitude, and 156 (39.8%) had a negative attitude towards the COVID-19 vaccine. On vaccine uptake, the study found that only 29 (17%) male and 52 (23%) female participants had received the vaccine. Further, participants with low levels of knowledge and a positive attitude towards the vaccine were 5.9 times more likely (p-value = 0.001) to be vaccinated than those with low levels of knowledge and negative attitudes towards the vaccine. On the other hand, those with high knowledge and a positive attitude towards the vaccine were 8.2 times more likely (p-value < 0.001) to be vaccinated compared to those with low knowledge and negative attitudes towards the vaccine. The findings highlight the importance of vaccine-related knowledge and attitudes in shaping uptake and reveal disparities across demographic groups. To improve vaccination coverage in Malawi, targeted interventions focusing on enhancing COVID-19 vaccine knowledge, addressing attitudinal barriers, and countering misinformation are needed. Strategies should be tailored to reach populations with lower uptake, such as males, younger adults, and those with lower education levels. Strengthening public health messaging, engaging community leaders, and building trust in healthcare systems are crucial for promoting widespread acceptance and uptake of COVID-19 vaccines in Malawi.
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Affiliation(s)
| | | | - Jimmy Kainja
- Language and Communication Skills Department, University of Malawi, Zomba, Malawi
| | - Anthony Mavuto Gunde
- Language and Communication Skills Department, University of Malawi, Zomba, Malawi
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144
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Fitero A, Negrut N, John HT, Ferician A, Marian P. Corona-Associated Mucormycosis: Case Series Reports and Review of the Literature. J Fungi (Basel) 2024; 10:305. [PMID: 38786660 PMCID: PMC11122562 DOI: 10.3390/jof10050305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
During the COVID-19 pandemic, a significant increase in cases of mucormycosis was observed in COVID-19 patients, especially in India, but not exclusively. The presented cases highlight the heterogeneous nature of mucormycosis, emphasizing the importance of recognizing predisposing factors, such as immunosuppression, due to comorbidities or medication. Diagnosing mucormycosis poses a challenge due to nonspecific clinical manifestations, requiring a multidisciplinary approach for accurate diagnosis. Treatment involves a multi-pronged approach centered around the early initiation of antifungal therapy alongside surgical intervention and the management of underlying conditions, with an emphasis on controlling immunosuppression. Understanding the relationship between COVID-19 and predisposing factors for mucormycosis is fundamental for developing prevention and treatment strategies.
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Affiliation(s)
- Andreea Fitero
- Department of Psycho-Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
- Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Nicoleta Negrut
- Department of Psycho-Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
- Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Harrie Toms John
- Department of Ear, Nose and Throat, University Hospitals of Northamptonshire, Cliftonville, Northampton NN1 5BD, UK;
| | - Anca Ferician
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (A.F.); (P.M.)
| | - Paula Marian
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (A.F.); (P.M.)
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145
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Papini C, Ullah I, Ranjan AP, Zhang S, Wu Q, Spasov KA, Zhang C, Mothes W, Crawford JM, Lindenbach BD, Uchil PD, Kumar P, Jorgensen WL, Anderson KS. Proof-of-concept studies with a computationally designed M pro inhibitor as a synergistic combination regimen alternative to Paxlovid. Proc Natl Acad Sci U S A 2024; 121:e2320713121. [PMID: 38621119 PMCID: PMC11046628 DOI: 10.1073/pnas.2320713121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/27/2024] [Indexed: 04/17/2024] Open
Abstract
As the SARS-CoV-2 virus continues to spread and mutate, it remains important to focus not only on preventing spread through vaccination but also on treating infection with direct-acting antivirals (DAA). The approval of Paxlovid, a SARS-CoV-2 main protease (Mpro) DAA, has been significant for treatment of patients. A limitation of this DAA, however, is that the antiviral component, nirmatrelvir, is rapidly metabolized and requires inclusion of a CYP450 3A4 metabolic inhibitor, ritonavir, to boost levels of the active drug. Serious drug-drug interactions can occur with Paxlovid for patients who are also taking other medications metabolized by CYP4503A4, particularly transplant or otherwise immunocompromised patients who are most at risk for SARS-CoV-2 infection and the development of severe symptoms. Developing an alternative antiviral with improved pharmacological properties is critical for treatment of these patients. By using a computational and structure-guided approach, we were able to optimize a 100 to 250 μM screening hit to a potent nanomolar inhibitor and lead compound, Mpro61. In this study, we further evaluate Mpro61 as a lead compound, starting with examination of its mode of binding to SARS-CoV-2 Mpro. In vitro pharmacological profiling established a lack of off-target effects, particularly CYP450 3A4 inhibition, as well as potential for synergy with the currently approved alternate antiviral, molnupiravir. Development and subsequent testing of a capsule formulation for oral dosing of Mpro61 in B6-K18-hACE2 mice demonstrated favorable pharmacological properties, efficacy, and synergy with molnupiravir, and complete recovery from subsequent challenge by SARS-CoV-2, establishing Mpro61 as a promising potential preclinical candidate.
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Affiliation(s)
- Christina Papini
- Department of Pharmacology, Yale University School of Medicine, New Haven, CT06520-8066
| | - Irfan Ullah
- Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT06520-8066
| | - Amalendu P. Ranjan
- Department of Microbiology, Immunology and Genetics Graduate School for Biomedical Sciences, University of North Texas Health Science Center, Fort Worth, TX76107
| | - Shuo Zhang
- Department of Microbial Pathogenesis, Yale University School of Medicine, New Haven, CT06520-8066
| | - Qihao Wu
- Department of Chemistry, Yale University, New Haven, CT06520-8107
| | - Krasimir A. Spasov
- Department of Pharmacology, Yale University School of Medicine, New Haven, CT06520-8066
| | - Chunhui Zhang
- Department of Chemistry, Yale University, New Haven, CT06520-8107
| | - Walther Mothes
- Department of Microbial Pathogenesis, Yale University School of Medicine, New Haven, CT06520-8066
| | | | - Brett D. Lindenbach
- Department of Microbial Pathogenesis, Yale University School of Medicine, New Haven, CT06520-8066
| | - Pradeep D. Uchil
- Department of Microbial Pathogenesis, Yale University School of Medicine, New Haven, CT06520-8066
| | - Priti Kumar
- Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT06520-8066
| | | | - Karen S. Anderson
- Department of Pharmacology, Yale University School of Medicine, New Haven, CT06520-8066
- Department of Molecular Biophysics and Biochemistry, Yale University School of Medicine, New Haven, CT06520-8066
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146
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Yoosuf BT, Favas Kt M, Dutta P, Bansal D. Comprehensive safety profile of dipeptidyl peptidase-4 inhibitors: a post-marketing study based on FAERS database using signal detection algorithms. Expert Opin Drug Saf 2024:1-13. [PMID: 38626310 DOI: 10.1080/14740338.2024.2343015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/26/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND Dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors) have acquired a foothold in managing type 2 diabetes mellitus, but few concerns have arisen regarding their overall safety profile. The aim of this study is to assess the potential risk of DPP-4 inhibitors by analyzing data from the FDA Adverse Event Reporting System (FAERS) database. RESEARCH DESIGN AND METHODS This is a retrospective study which explored the FAERS database till March 2023 for the collection of safety reports. The disproportionality analysis was performed using signal detection algorithms (SDAs) incorporating frequentist-based data mining approach such as relative reporting ratio (RRR), reporting odds ratio (ROR) and proportional reporting ratio (PRR) with 95% confidence interval (CI). RESULTS A total of 14,573 adverse event reports were reported in the FAERS public dashboard associated with all the included DPP-4 inhibitors. The computed PRR, ROR, and RRR indicated positive signals for DPP-4 inhibitors with cardiac failure, pancreatitis, pemphigoid, hypoglycemia, acute kidney injury and lactic acidosis. Saxagliptin showed a higher signal score for cardiac failure, while sitagliptin was more associated with pancreatitis. Moreover, alogliptin exhibited an elevated signal score associated with pancreatic carcinoma. CONCLUSION Several significant disproportionality signals were observed with DPP-4 inhibitors. However, clinicians have to consider the comorbidities and concomitant drugs while prescribing these drugs.
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Affiliation(s)
- Beema T Yoosuf
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Mohali, Punjab, India
| | - Muhammed Favas Kt
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Mohali, Punjab, India
| | - Pinaki Dutta
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dipika Bansal
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Mohali, Punjab, India
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147
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Jafarlou M. Unveiling the menace: a thorough review of potential pandemic fungal disease. FRONTIERS IN FUNGAL BIOLOGY 2024; 5:1338726. [PMID: 38711422 PMCID: PMC11071163 DOI: 10.3389/ffunb.2024.1338726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/04/2024] [Indexed: 05/08/2024]
Abstract
Fungal diseases have emerged as a significant global health threat, with the potential to cause widespread outbreaks and significant morbidity and mortality. Anticipating future pandemic fungal diseases is essential for effective preparedness and response strategies. This comprehensive literature review aims to provide a comprehensive analysis of the existing research on this topic. Through an extensive examination of scholarly articles, this review identifies potential fungal pathogens that have the potential to become pandemics in the future. It explores the factors contributing to the emergence and spread of these fungal diseases, including climate change, globalization, and antimicrobial resistance. The review also discusses the challenges in diagnosing and treating these diseases, including limited access to diagnostic tools and antifungal therapies. Furthermore, it examines the strategies and interventions that can be employed to mitigate the impact of future pandemic fungal diseases, such as improved surveillance systems, public health education, and research advancements. The findings of this literature review contribute to our understanding of the potential risks posed by fungal diseases and provide valuable insights for public health professionals and policymakers in effectively preparing for and responding to future pandemic outbreaks. Overall, this review emphasizes the importance of proactive measures and collaborative efforts to anticipate and mitigate the impact of future pandemic fungal diseases.
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148
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Iam-Arunthai K, Chamnanchanunt S, Thungthong P, Chinapha A, Nakhahes C, Suwanban T, Umemura T. COVID-19 with high-sensitivity CRP associated with worse dynamic clinical parameters and outcomes. Front Med (Lausanne) 2024; 11:1346646. [PMID: 38711780 PMCID: PMC11073493 DOI: 10.3389/fmed.2024.1346646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/26/2024] [Indexed: 05/08/2024] Open
Abstract
Objective This study aimed to evaluate the relationship between high-sensitivity C-reactive protein (hsCRP) in hospitalized COVID-19 patients and their clinical outcomes, including trajectory of hsCRP changes during hospitalization. Method and results Patients with positive COVID-19 tests between 2021 and 2023 were admitted to two hospitals. Among 184 adult patients, approximately half (47.3%) had elevated hsCRP levels upon admission, which defined as exceeding the laboratory-specific upper limit of test (> 5.0 mg/L). Clinical outcomes included critical illness, acute kidney injury, thrombotic events, intensive care unit (ICU) requirement, and death during hospitalization. Elevated hsCRP levels had a higher risk of ICU requirement than those with normal, 39.1% versus 16.5%; adjusted odds ratio (aOR), 2.3 [95% CI, 1.05-5.01]; p = 0.036. Patients with extremely high (≥2 times) hsCRP levels had aOR, 2.65 [95% CI, 1.09-6.45]; p < 0.001. On the fifth day hospitalization, patients with high hsCRP levels associated with acute kidney injury (aOR, 4.13 [95% CI, 1.30-13.08]; p = 0.016), ICU requirement (aOR, 2.67 [95%CI, 1.02-6.99]; p = 0.044), or death (aOR, 4.24 [95% CI, 1.38-12.99]; p = 0.011). The likelihood of worse clinical outcomes increased as hsCRP levels rose; patients with elevated hsCRP had lower overall survival rate than those with normal (p = 0.02). The subset of high hsCRP patients with high viral load also had a shorter half-life compared to those with normal hsCRP level (p = 0.003). Conclusion Elevated hsCRP levels were found to be a significant predictor of ICU requirement, acute kidney injury, or death within 5 days after hospitalization in COVID-19 patients. This emphasized the importance of providing more intensive care management to patients with elevated hsCRP.
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Affiliation(s)
- Kunapa Iam-Arunthai
- Division of Hematology, Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Supat Chamnanchanunt
- Division of Hematology, Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Pravinwan Thungthong
- Division of Hematology, Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Anongnart Chinapha
- Division of Infectious Diseases, Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Chajchawan Nakhahes
- Division of Hematology, Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Tawatchai Suwanban
- Division of Hematology, Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Tsukuru Umemura
- Department of Medical Technology and Sciences, International University of Health and Welfare, Okawa, Japan
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Arezoumand KS, Roberts CT, Rastegar M. Metformin Induces MeCP2 in the Hippocampus of Male Mice with Sex-Specific and Brain-Region-Dependent Molecular Impact. Biomolecules 2024; 14:505. [PMID: 38672521 PMCID: PMC11048179 DOI: 10.3390/biom14040505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/29/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Rett Syndrome (RTT) is a progressive X-linked neurodevelopmental disorder with no cure. RTT patients show disease-associated symptoms within 18 months of age that include developmental regression, progressive loss of useful hand movements, and breathing difficulties, along with neurological impairments, seizures, tremor, and mental disability. Rett Syndrome is also associated with metabolic abnormalities, and the anti-diabetic drug metformin is suggested to be a potential drug of choice with low or no side-effects. Previously, we showed that in vitro exposure of metformin in a human brain cell line induces MECP2E1 transcripts, the dominant isoform of the MECP2 gene in the brain, mutations in which causes RTT. Here, we report the molecular impact of metformin in mice. Protein analysis of specific brain regions in the male and female mice by immunoblotting indicated that metformin induces MeCP2 in the hippocampus, in a sex-dependent manner. Additional experiments confirm that the regulatory role of metformin on the MeCP2 target "BDNF" is brain region-dependent and sex-specific. Measurement of the ribosomal protein S6 (in both phosphorylated and unphosphorylated forms) confirms the sex-dependent role of metformin in the liver. Our results can help foster a better understanding of the molecular impact of metformin in different brain regions of male and female adult mice, while providing some insight towards its potential in therapeutic strategies for the treatment of Rett Syndrome.
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Affiliation(s)
| | | | - Mojgan Rastegar
- Department of Biochemistry and Medical Genetics, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
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150
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Yazdani A, Mozaffarpur SA, Ebrahimi P, Shirafkan H, Mehdinejad H. Comorbidities affecting re-admission and survival in COVID-19: Application of joint frailty model. PLoS One 2024; 19:e0301209. [PMID: 38635839 PMCID: PMC11025956 DOI: 10.1371/journal.pone.0301209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/12/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND One of the common concerns of healthcare systems is the potential for re-admission of COVID-19 patients. In addition to adding costs to the healthcare system, re-admissions also endanger patient safety. Recognizing the factors that influence re-admission, can help provide appropriate and optimal health care. The aim of this study was to assess comorbidities that affect re-admission and survival in COVID-19 patients using a joint frailty model. METHODS This historical cohort study was done using data of patients with COVID-19 who were re-hospitalized more than twice in a referral hospital in North of Iran. We used the joint frailty model to investigate prognostic factors of survival and recurrence, simultaneously using R version 3.5.1 (library "frailtypack"). P-values less than 0.05 were considered as statistically significant. RESULTS A total of 112 patients with mean (SD) age of 63.76 (14.58) years old were recruited into the study. Forty-eight (42.9%) patients died in which 53.83% of them were re-admitted for a second time. Using adjusted joint model, the hazard of re-admission increased with cancer (Hazard ratio (HR) = 1.92) and hyperlipidemia (HR = 1.22). Furthermore, the hazard of death increased with hyperlipidemia (HR = 4.05) followed by age (HR = 1.76) and cancer (HR = 1.64). It Also decreased with lung disease (HR = 0.11), hypothyroidism (HR = 0.32), and hypertension (HR = 0.97). CONCLUSION Considering the correlation between re-admission and mortality in the joint frailty model, malignancy and hyperlipidemia increased the risk of both re-admission and mortality. Moreover, lung disease probably due to the use of corticosteroids, was a protective factor against both mortality and re-admission.
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Affiliation(s)
- Akram Yazdani
- Department of Biostatistics and Epidemiology, Faculty of Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Seyyed Ali Mozaffarpur
- Traditional Medicine and History of Medical Sciences Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Pouyan Ebrahimi
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Hoda Shirafkan
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Hamed Mehdinejad
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
- Clinical Research Development Unit of Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
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