Prescribing statins among patients with type 2 diabetes: The clinical gap between the guidelines and practice

The prevalence of cardiovascular diseases, chronic kidney disease, and obesity in patients with type 2 diabetes mellitus and the description of concurrent treatments: A two-center retrospective cross-sectional study in Saudi Arabia

Background

Atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), chronic kidney disease (CKD), and obesity are associated with increased morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). Nonetheless, their prevalence among patients with T2DM in Saudi Arabia (SA) remains unknown. As current guidelines recommend, these comorbidities require adding certain antidiabetic agents with cardiorenal benefits. However, the prescribers' adherence to these recommendations remains unclear.

Methods

A two-center retrospective cross-sectional study was conducted including adult patients (≥18 years) with T2DM admitted to hospital or seen at outpatient clinics between January and December 2020. Patients were classified into two groups based on the presence or absence of ASCVD. Patients with no prior ASCVD history were further classified based on the 10-year ASCVD risk estimation. Endpoints of interest included the prevalence of ASCVD, HF, CKD, and obesity in patients with T2DM. We also evaluated the characteristics of the utilized antidiabetic agents, statin, and aspirin therapies..

Results

Of the 1,218 included patients with T2DM, the majority were female (57.0 %), and aged 45-64 years (53.0 %) with a mean age of 59.3 ± 13.1 years. Hypertension and dyslipidemia were the most prevalent comorbidities (67.7 % and 69.0 %, respectively). Among all patients, 18.6 % had an established ASCVD and the prevalence of HF, CKD, and obesity were 5.1 %, 8.7 %, and 58.3 %, respectively. The most common types of ASCVD witnessed were revascularization (42.3 %), myocardial infarction (36.6 %), and stroke (33.9 %); with an increased prevalence of ASCVD as the age increases (52.8 % at age ≥ 65 years). In the non-ASCVD group, the 10-year ASCVD risk was intermediate or high in 62.7 % of these patients. The rates of utilization of guidelines-recommended therapies were 83.6 % for metformin, 9.4 % for GLP-1 RA, 10.8 % for SGLT2i, 35.2 % for aspirin alone or in combination with clopidogrel, and 79.7 % for statin therapy.

Conclusions

ASCVD, HF, CKD, and obesity are common complications in patients with T2DM in SA, with low overall utilization of the recommended guidelines-recommended medical therapies. Multimodal strategies should be utilized to assess T2DM and its complications, and to improve prescribers' adherence to guidelines-recommended therapies.

Medicinal ethnoveterinary plants used for treating livestock ailments in the omo-gibe and rift valley basins of Ethiopia

BACKGROUND

Traditional medical practices have been used to maintain animal health for millennia and have been passed down orally from generation to generation. In Ethiopia also, plants are the primary means by which the indigenous people in remote areas treat the illnesses of their animals. The present study was therefore, carried out to document the type and distribution of medicinal plants of the county.

METHODS

To collect ethnobotanical information, a total of 205 informants (133 men and 72 women) were selected. Among these 121 traditional medicine practitioners, while the remaining 84 were selected through a systematic random sampling method. Ethnobotanical data were collected between January 2023 and August 2023 through semi-structured interviews, participant observation, guided filed walks and focus group discussions. Using descriptive statistics, the ethnobotanical data were analyzed for the Informant Consensus Factor (ICF) and Fidelity Level (FL) values, preference, and direct matrix rankings. SPSS 26.0 and PAST 4.11 software were used in data analysis.

RESULTS

Totally, 78 ethnoveterinary medicinal plants distributed in 36 families were identified in the study area. Asteraceae was the dominant family with 9 species (14%), followed by Euphorbiaceae with 8 species (12%). Herbs 42(56%), wild collected 62 (66%), and leaf part (52%) made the highest share of the plant species. Hordeum vulgare L. had the highest fidelity level (FL = 98%) for treating bone fractures. Blackleg, bloat, and endoparsistes each had the highest values of the consensus factor among the informants (ICF = 1). According to preference ranking, Withania somnifera was the most potent remedy for treating blackleg. Knowledge of medicinal plants was shared through storytelling within families.

CONCLUSION

In the study area, there is broad access to traditional medicinal plants that can treat ailments in animals. Conservation efforts should be prioritized to protect medicinal plants from threats such as agricultural expansion, drought, and development. Further research should be conducted to explore the potential of different medicinal plants for treating common livestock ailments.

Repercussions and Legacy of the COVID-19 Pandemic in Manaus, Brazil: The Health Managers' Perspective

The present study aimed to know and analyze the repercussions and legacy of the COVID-19 pandemic for the Unified Health System from the perspective of health managers working in Manaus, a city considered the epicenter of the pandemic in Brazil. This qualitative research was designed as the study of a single incorporated case and conducted with 23 Health Care Network managers. The analysis was applied in two thematic coding cycles (values and focused coding methods), with the aid of the ATLAS.ti software. The categories we analyzed covered the lessons learned within the scope of the work process, change in stance, and human values, as well as the coping strategies adopted by individual or team initiatives or by the incorporation of innovations in practices. This study highlighted the importance of strengthening primary health care; of promoting team spirit in the service and establishing partnerships with public and private institutions, of being integrated with the training in complex situations, and of reflecting on human values and appreciation of life. Coping with the pandemic promoted an in-depth reflection about the functioning of the Unified Health System and the individual ways of being.

Colorectal Cancer-The Worst Enemy Is the One We Do Not Know

BACKGROUND

Colorectal cancer is one of the most common cancers in humans. It is the third most frequently diagnosed malignant neoplasm and is the second highest cause of cancer mortality in the world. Every year, more and more people die of colorectal cancer because the diagnosis is conducted too late. This shows how important a role screening tests and the awareness of the population about the symptoms play in this aspect. This article aimed to determine the knowledge of the Polish population about morbidity, symptoms, prevention, and subjective feelings about the level of availability of knowledge about colorectal cancer.

METHODS

In 2020, a study was conducted using an online questionnaire assessing the awareness of the Polish population about colorectal cancer. A self-authored questionnaire including questions about socio-demographic characteristics, and 18 questions related to substantive issues, was used. A research group was selected (n = 633). The substantive part of the questionnaire included questions examining the respondents' knowledge about morbidity, symptoms, prevention, and subjective feelings about the level of availability of knowledge about colorectal cancer.

RESULTS

The respondents' awareness level was influenced by demographic factors, such as gender: (p < 0.05) and age (p < 0.05) and social factors, such as: level of education (p < 0.05) or professional situation (p < 0.05). Compared to thematic articles from other countries, the research group was divided into smaller subgroups due to the abovementioned factors, due to which it was possible to stratify and analyze the significance of differences between them.

Diversity, distribution, and sustainability of traditional medicinal plants in Kaski district, western Nepal

Medicinal plants are the primary source of traditional healthcare systems in many rural areas mostly in developing countries. This study aimed to document and analyze the diversity, distribution, and sustainability of the traditional medicinal plants used by the Gurung people of the Sikles region in western Nepal. Ethnobotanical data were collected through focus group discussions and individual interviews, and analyzed using descriptive and inferential statistics. Prior informed consent was obtained before each interview. Quantitative ethnobotanical indices such as informant consensus factor, relative frequency of citation, and use values were also calculated. A possible association among these indices was tested using correlation analysis. A total of 115 wild medicinal plant species belonging to 106 genera and 71 families were documented. Asteraceae and Rosaceae were the dominant families whereas herbs were the most dominant life form. Roots were the most used plant part, paste was the most common method of preparation, and most of the medical formulations were taken orally. The highest number of medicinal plants were used to treat stomach disorders. The average informant consensus value of 0.79 indicates a high consensus among respondents in selecting medicinal plants. Lindera neesiana, Neopicrorhiza scrophulariiflora, Paris polyphylla, and Bergenia ciliata were found to be high-ranking medicinal plants based on the relative frequency of citation and use value. The genders did not affect medicinal plants' knowledge but age had a significant correlation. Most of the informants agreed that medicinal plants are under pressure due to overharvesting and a lack of proper forest management practices. The number of medicinal plants reported from the study area indicates that the Gurung people possess rich traditional knowledge, and the vegetation of the Sikles region constitutes rich diversity of medicinal plants.

The Effect of Statins on Clinical Outcome Among Hospitalized Patients With COVID-19: A Multi-Centric Cohort Study

The coronavirus disease-2019 (COVID-19) is caused by SARS-CoV-2, leading to acute respiratory distress syndrome (ARDS), thrombotic complications, and myocardial injury. Statins, prescribed for lipid reduction, have anti-inflammatory, anti-thrombotic, and immunomodulatory properties and are associated with reduced mortality rates in COVID-19 patients. Our goal was to investigate the beneficial effects of statins in hospitalized COVID-19 patients admitted to three multi-specialty hospitals in India from 1 June 2020, to 30 April 2021. This retrospective study included 1,626 patients, of which 524 (32.2%) were antecedent statin users among 768 patients (384 statin users, 384 non-statin users) identified with 1:1 propensity-score matching. We established a multivariable logistic regression model to identify the patients’ demographics and adjust the baseline clinical and laboratory characteristics and co-morbidities. Statin users showed a lower mean of white blood cell count (7.6 × 10³/µL vs. 8.1 × 10³/µL, p < 0.01), and C-reactive protein (100 mg/L vs. 120.7 mg/L, p < 0.001) compared to non-statin COVID-19 patients. The same positive results followed in lipid profiles for patients on statins. Cox proportional-hazards regression models evaluated the association between statin use and mortality rate. The primary endpoint involved mortality during the hospital stay. Statin use was associated with lower odds of mortality in the propensity-matched cohort (OR 0.52, 95% CI 0.33-0.64, p < 0.001). These results support the previous evidence of the beneficial effects of statins in reducing mortality in hospitalized COVID-19 patients.

Health Disparities: Statin Prescribing Patterns Among Patients with Diabetes in a Family Medicine Clinic

Purpose:

To analyze the impact of gender and race on statin prescribing patterns in patients with diabetes in a family medicine clinic.

Methods:

This study (n=192) was a single-center, cross-sectional study that examined statin prescribing patterns at a family medicine clinic. Patients were obtained from January 2015 to November 2018, who were considered eligible for statin therapy based on a documented diagnosis of diabetes. The patients were divided into four subgroups for analysis (white males, non-white males, white females, and non-white females).

Results:

Females were found to have higher rates of prescribed statin therapy and appropriate statin intensity therapy when compared to males (p>0.05). When evaluating gender and race, white females were more likely to be prescribed an appropriate statin when compared to non-white females (p<0.05).

Conclusion:

The study shows that although males had a significantly higher mean 10-year atherosclerotic cardiovascular disease risk score, they were less likely than females to receive the appropriate intensity statin. Previous studies have shown race and gender disparities exist in the prevention of cardiovascular disease. A more collective, unified approach to improve prescribing patterns for statin therapy can eliminate these disparities.

Metal Nanoparticles against Viruses: Possibilities to Fight SARS-CoV-2

In view of the current Coronavirus Disease 2019 (COVID-19) pandemic outbreak, the research community is focusing on development of diagnostics, treatment, and vaccines to halt or reverse this scenario. Although there are already various vaccines available, adaptive mutations in the SARS-CoV-2 genome can alter its pathogenic potential and, at the same time, increase the difficulty of developing drugs or immunization by vaccines. Nanotechnology carries a potential to act in all stages in fighting this viral disease, with several possibilities of strategies such as applying nanoparticles directly as antivirals in delivery systems against these viruses or incorporating them in materials, with power of achievement in therapeutics, vaccines and prevention. In this paper, we review and bring insights of recent studies using metal nanocomposites as antivirals against coronavirus and structurally similar viruses.

Clinical characteristics and treatment outcomes of severe (ICU) COVID-19 patients in Saudi Arabia: A single centre study

BACKGROUND

There is limited information describing the presenting features and treatment outcomes of intensive care unit (ICU) patients with coronavirus disease 2019 (COVID-19) in Saudi Arabia.

OBJECTIVE

To investigates the clinical, epidemiological, laboratory, radiological, vital signs and treatment characteristics/outcomes of severe (ICU) COVID-19 patients in Albaha region, Saudi Arabia.

METHODS

A retrospective cohort study was conducted from 01 April 2020 to 31 August 2020 involving files review of 171 patients admitted to the ICU of a COVID-19 treatment centre as a result of severe symptoms.

RESULTS

Around a third of the ICU patients admitted were over 66 years of age, 59.6% males, 45% diabetics, 39% hypertensive, 25.7% smokers. Patients had symptoms such as 79% fever, 78% cough, 75% headache, 59% sore throat, 57% runny nose, and 75% cough. More than half of the patients had <90% oxygen saturation. Bilateral infiltration was present in about 43% of patients. 85.4% lymphopenia, and 70.8% D-dimer (>0.5 u/ml) were the most significant laboratory results. The median stay in the hospital ranged from 4 to 15.6 days, and the ICU time ranged from 4 to 12.7 days. Approximately 29% of patients received antiviral, antimalarial, and antibiotic treatment, while 27.5% of patients received antibiotics and antimalarial therapy alone. Incorporating hydroxychloroquine in treatment protocols did not improve patients' outcomes.

CONCLUSIONS

Older age and cardio-metabolic comorbidities increase the risks of sever COVID-19. Different treatment protocols fail to improve mortality rates and urgent efforts are required to prevent the disease and reduce its severity.

Nanomedicine: A Diagnostic and Therapeutic Approach to COVID-19

The SARS-CoV-2 virus is causing devastating morbidity and mortality worldwide. Nanomedicine approaches have a high potential to enhance conventional diagnostics, drugs and vaccines. In fact, lipid nanoparticle/mRNA vaccines are already widely used to protect from COVID-19. In this review, we present an overview of the taxonomy, structure, variants of concern, epidemiology, pathophysiology and detection methods of SARS-CoV-2. The efforts of repurposing, tailoring, and adapting pre-existing medications to battle COVID-19 and the state of vaccine developments are presented. Next, we discuss the broad concepts and limitations of how nanomedicine could address the COVID-19 threat. Nanomaterials are particles in the nanometer scale (10-100 nm) which possess unique properties related to their size, polarity, structural and chemical composition. Nanoparticles can be composed of precious metals (copper, silver, gold), inorganic materials (graphene, silicon), proteins, carbohydrates, lipids, RNA/DNA, or conjugates, combinations and polymers of all of the aforementioned. The advanced biochemical features of these nanoscale particles allow them to directly interact with virions and irreversibly disrupt their structure, which can render a virus incapable of replicating within the host. Virus-neutralizing coats and surfaces impregnated with nanomaterials can enhance personal protective equipment, hand sanitizers and air filter systems. Nanoparticles can enhance drug-based therapies by optimizing uptake, stability, target cell-specific delivery, and magnetic properties. In fact, recent studies have highlighted the potential of nanoparticles in different aspects of the fight against SARS-CoV-2, such as enhancing biosensors and diagnostic tests, drug therapies, designing new delivery mechanisms, and optimizing vaccines. This article summarizes the ongoing research on diagnostic strategies, treatments, and vaccines for COVID-19, while emphasizing the potential of nanoparticle-based pharmaceuticals and vaccines.

Association Between Statin Use, Intensity and Acute Liver Injury in Human Immunodeficiency Virus, Hepatitis C Virus, and Uninfected US Veterans

OBJECTIVE

We sought to evaluate the relationship between acute liver injury (ALI) and statins utilizing the Veterans Affairs Informatics and Computing Infrastructure (VINCI) database.

METHODS

This retrospective cohort study, spanning January 2000-December 2018, compared ALI (aminotransferase > 200 U/L, severe ALI, and hospitalization with ALI) in statin users and non-users among uninfected, hepatitis C virus (HCV) mono-infected, human immunodeficiency virus (HIV)/HCV co-infected, and HIV mono-infected veterans within 18 months. We estimated adjusted Cox proportional hazards models comparing statin users and non-users and comparing statin intensity level with non-use; and estimate Cox proportional hazards models utilizing time-dependent coding of statin intensity. Adjusted models included restricted cubic splines of the propensity score as an adjustment variable.

RESULTS

From a total of 166,439 patients who met the study criteria, statin initiators were older, had higher values of body mass index, higher values of low-density lipoprotein cholesterol and triglycerides, and lower values of high-density lipoprotein cholesterol. HCV mono-infected and HIV/HCV co-infected cohorts had the highest rates of ALI, and statin users had lower rates across all outcomes of ALI compared with non-users in unadjusted analysis. Statin use is associated with a lower risk of all ALI outcomes compared with non-users. Patients on a high intensity are not associated with a statistically significant increase in risk for any ALI outcome. For each additional 30 days of treatment, there was a reduced risk of any ALI outcome across all cohorts.

CONCLUSIONS

Statin initiators had a lower risk of any ALI outcome compared with non-users within 18 months regardless of HIV and/or HCV status.

The protective role of statins in COVID-19 patients: a retrospective observational study

BACKGROUND

To evaluate and determine the protective role of statins in COVID-19 patients.

METHODS

This is a retrospective cohort study conducted across five hospitals in India. Patients diagnosed with COVID-19 and hospitalized with existing and valid medical documentation were included.

RESULTS

This study comprised 3252 COVID-19 patients, of whom 1048 (32.2%) were on statins, with 52.4% being males. The comorbidity prevalence of hypertension was 75%, followed by diabetes 62.51% and coronary artery disease being 47.5%. At the time of hospitalization, statin users had a higher incidence of dyspnea, cough, and fatigue (95.8, 93.3, and 92.7%). The laboratory results revealed a lower mean of WBC count (7.8 × 10³/μL), D-dimer (2.4 μg/mL), and C-reactive protein (103 mg/L) among statin users. They also had lower mortality rates (17.1%), a lesser requirement for mechanical ventilation (20%), and hemodialysis (5.4%).

CONCLUSION

This observation study elaborates on the beneficial effects of statins in COVID-19 patients. However, the inferences from this study should be viewed with caution due to the impending effect of confounding factors on its statistical results.

Gene interaction network approach to elucidate the multidrug resistance mechanisms in the pathogenic bacterial strain Proteus mirabilis

Proteus mirabilis is one among the most frequently identified pathogen in patients with the urinary tract infection. The multidrug resistance exhibited by P. mirabilis renders the treatment ineffective, and new progressive strategies are needed to overcome the antibiotic resistance (AR). We have analyzed the evolutionary relationship of 29 P. mirabilis strains available in the National Center for Biotechnology Information-Genome database. The antimicrobial resistance genes of P. mirabilis along with the enriched pathways and the Gene Ontology terms are analyzed using gene networks to understand the molecular basis of AR. The genes rpoB, tufB, rpsl, fusA, and rpoA could be exploited as potential drug targets as they are involved in regulating the vital functions within the bacterium. The drug targets reported in the present study will aid researchers in developing new strategies to combat multidrug-resistant P. mirabilis.

The efficacy and safety of oral paracetamol versus oral ibuprofen for patent ductus arteriosus closure in preterm neonates - A systematic review and meta-analysis

Objective

This systematic review and meta-analysis aimed to synthesize the latest evidence on the efficacy and safety of oral acetaminophen compared to oral ibuprofen for patent ductus arteriosus (PDA) in preterm infants.

Methods

We performed a systematic literature search on topics that assesses the use of oral paracetamol compared to oral ibuprofen in preterm neonates diagnosed with PDA from PubMed, EuropePMC, Cochrane Central Database, ScienceDirect, ProQuest, ClinicalTrials.gov, and hand-sampling from potential articles.

Results

There were 1547 subjects from 10 selected studies. Primary closure rate was similar in both groups. Subgroup analysis on studies enrolling neonates with ≤30 weeks gestational age showed that ibuprofen was superior (OR 0.52 [0.31, 0.90], I²: 0%). On the other hand, paracetamol was superior neonates with ≤34 weeks gestational age (OR 1.73 [1.01, 2.94], I²: 30%). Reopening rate, surgical closure rate, mortality, intraventricular hemorrhage, and necrotizing enterocolitis were similar in both groups. Rate of renal dysfunction (OR 0.27 [0.10, 0.77], I²: 0%) and gastrointestinal bleeding (OR 0.31 [0.11, 0.88], I²: 0%) were lower in paracetamol group. Subgroup analysis of randomized controlled studies (RCTs) showed similar results. Meta-regression analysis showed that the primary closure rate was not influenced by gestational age, birth weight, and gender. GRADE demonstrates a low level of certainty for primary closure and mortality. Renal dysfunction and gastrointestinal bleeding havea moderate level of certainty.

Conclusion

There was no significant difference between the efficacy of oral paracetamol and oral ibuprofen. However, the rate of renal dysfunction and gastrointestinal bleeding were higher in oral ibuprofen.

Assessment of Common Risk Factors and Lifestyle Habits Associated with Atherogenic Risk and Lipid-Lowering Therapy in Men with Type 2 Diabetes

Background and aims: Our objective was to determine common risk factors and lifestyle habits associated with atherogenic risk and with the use of lipid-lowering therapy in men with type 2 diabetes.

Material and Methods: A comparative cross-sectional study was performed in the northwestern Algeria during eleven months on adult men patients with type 2 diabetes. Anthropometric parameters, blood pressures and lipid profile were evaluated. Data of common risk factors and lifestyle habits associated to atherosclerosis were compared between two groups according to the lipid lowering therapy use based on statins.

Results: 147 adult men patients with type 2 diabetes were involved in the study, 68 (46.26%) were under statins therapy and 79 (53.74%) were not. Significant associations with statins use were observed regarding the age group of 61-70 years (OR: 0.156 [0.043-0.570]; p=0.005), a salary of less than 30000 Algerian dinars (≈250.60$) (OR: 5.758 [1.299-25.512]; p=0.021), age of diabetes of 2-3 years (OR: 0.105 [0.013-0.867]; p=0.036) as well as with lipid ratios and body mass index (BMI). However, no significant associations were noted regarding the other studied parameters (marital status, educational level, occupation, salary, and family history, smoking status, alcohol consumption and sports practices) with lipid lowering therapy.

Conclusion: Age of patients, diabetes duration, lipid ratios and the low income of patients are the strongest factors associated with the use of lipid lowering therapy (statins). However, largest longitudinal studies are needed to determine whether modifiable lifestyle habits could influence the lipid lowering therapies prescription in diabetic patients over time.