128: IS UNCONTROLLED DIABETES PRIOR TO HOSPITALIZATION A RISK FACTOR FOR WORSE OUTCOMES IN COVID-19?

Hypertriglyceridaemia represents one of the most prevalent lipid abnormalities, however it is often eclipsed by focus on LDL cholesterol and is frequently overlooked by clinicians, despite it being an important cardiovascular risk factor. For most patients, hypertriglyceridaemia arises from a combination of environmental factors and multiple genetic variations with small effects. Even in cases with apparent familial clustering of hypertriglyceridaemia, a monogenetic cause is rarely identified. Common secondary causes include obesity, uncontrolled diabetes, alcohol, and various commonly used drugs. Correction of these factors, along with lifestyle optimisation, should be prioritised prior to commencing medication.The goal of drug treatment is to reduce the risk of cardiovascular disease in those with moderate hypertriglyceridaemia and the risk of pancreatitis in those with severe hypertriglyceridaemia.Recent and ongoing trials demonstrate the important role of triglycerides (TG) in determining residual risk in patients with cardiovascular disease (CVD) already established on statin therapy. Novel and emerging data on omega-3 fatty acids (high-dose icosapent ethyl) and the selective PPAR modulator pemafibrate are eagerly awaited and may provide further clarity for clinicians in determining which patients will benefit from TG lowering and help inform clinical guidelines. There are numerous novel therapies on the horizon that reduce TG by decreasing the activity of proteins that inhibit lipoprotein lipase such as apolipoprotein C-III (including Volanesorsen which was recently approved in Germany) and ANGPTL 3/4 which may offer promise for the future.

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Endogenous Fusarium Endophthalmitis in Diabetes Mellitus

Case Reports in Ophthalmological Medicine ◽

10.1155/2016/6736413 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

S. Balamurugan ◽

Ashish Khodifad

Keyword(s):

Diabetes Mellitus ◽

Risk Factor ◽

Endogenous Endophthalmitis ◽

Uncontrolled Diabetes ◽

Common Causes ◽

Masquerade Syndrome ◽

The Common ◽

Immunocompromised State ◽

Poor Outcomes ◽

High Index Of Suspicion

Endogenous endophthalmitis accounts for 2% to 8% of cases of endophthalmitis. Immunocompromised state and intravenous drug use are the 2 most common causes of endogenous endophthalmitis due to molds fungi. Aspergillus, Fusarium, and Scedosporium are the common organisms in mold endophthalmitis. We report a case of Fusarium endophthalmitis in a patient with uncontrolled diabetes. While diabetes mellitus is a well-known risk factor for endogenous endophthalmitis, we did not find any reported case of Fusarium endophthalmitis in a case of diabetes mellitus. The patient presented with granulomatous uveitis masquerading as noninfectious uveitis with a very good response to steroids. The characteristic clinical features were established late in the clinical course associated with poor outcome. This case highlights the significance of uncontrolled diabetes as a risk factor for Fusarium endophthalmitis and also the presentation of endophthalmitis as a masquerade syndrome. The clinician should have high index of suspicion as these cases have poor outcomes.

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COVID-19 Associated Rhino-Orbital-Cerebral Mucormycosis - An Institutional Series

Journal of Clinical Otorhinolaryngology ◽

10.31579/2692-9562/041 ◽

2022 ◽

Vol 4 (1) ◽

pp. 01-09

Author(s):

Nishant Rana

Keyword(s):

Risk Factor ◽

Fungal Infection ◽

Invasive Fungal Infection ◽

Diabetic Patients ◽

Transplant Recipients ◽

Host Defenses ◽

Uncontrolled Diabetes ◽

The World

Invasive fungal infection or mucormycosis is almost always confined to the patients with altered host defenses such as in transplant recipients, diabetics or patients with malignancies. Hypergycemia or uncontrolled diabetes, particularly diabetes acidosis is considered as the strongest and very well known risk factor for mucormycosis. It has spread like fire amongst the active COVID-19 and post COVID-19 diabetic patients. Many studies across the world have established the definitive severity of SARS-CoV-2 infection amongst diabetic patients.

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Increased mortality associated with uncontrolled diabetes mellitus in patients with Pulmonary Cryptococcosis — a single U.S. cohort study

10.1101/2021.01.11.21249631 ◽

2021 ◽

Author(s):

Solana Archuleta ◽

Amal A. Gharamti ◽

Stefan Sillau ◽

Paula Castellanos ◽

Sindhu Chadalawada ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factor ◽

Case Control ◽

Cox Proportional Hazard Model ◽

Proportional Hazard ◽

Proportional Hazard Model ◽

Pulmonary Cryptococcosis ◽

Cox Proportional Hazard ◽

Uncontrolled Diabetes ◽

One Year

AbstractBackgroundDiabetes mellitus is an established risk factor for bacterial infections, but its role in Cryptococcosis is unclear. The study aimed to determine whether uncontrolled diabetes (HbA1c >7%) was an independent risk factor for mortality in cryptococcosis.MethodsA retrospective case-control study partially matched by age and gender was performed in patients tested for Cryptococcus infection at the University of Colorado Hospital from 2000-2019. A multivariable logistic regression model was used to identify mortality predictors. Cox proportional hazard model was used for survival analysis.ResultsWe identified 96 cases of Cryptococcosis and 125 controls. Among cases, cryptococcal meningitis (49.0%) and pneumonia (36.5%) constituted most infections. Cases with pulmonary cryptococcosis had a higher mortality at 10 weeks (50% vs 7%, p=0.006) and one year (66.7% vs 13.8%, p=0.005). Unadjusted Cox proportional hazard model found an increased rate of death for uncontrolled diabetes at 10-weeks (hazard ratio 8.4, CI: 1.4-50.8, p=0.02), and 1-year (hazard ratio 7.0, CI: 1.7-28.4, p=0.007) among pulmonary cryptococcosis cases. Multivariable analysis showed a significantly increased odds of 10-weeks (OR=4.3, CI: 1.1-16.5, p=0.035) and one-year (OR=5.9, CI: 2.2-15.8, p=0.014) mortality for uncontrolled diabetes among pulmonary cryptococcosis cases. After adjustment for gender, age, and case/control, for every 1% increase in HbA1c levels, the odds of pulmonary cryptococcosis mortality at one-year increased by 11% (OR = 1.6, CI 95%: 1.1-2.3, p= 0.006).ConclusionUncontrolled diabetes is associated with worse outcomes in pulmonary cryptococcosis, including a 4-fold and 6-fold increased odds of death at 10-weeks and 1-year, respectively. Glucose control interventions should be explored to improve clinical outcomes in patients with pulmonary cryptococcosis.

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Uncontrolled diabetes mellitus: A risk factor for post COVID fibrosis

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2021.1607 ◽

2021 ◽

Vol 91 (1) ◽

Author(s):

Parul Mrigpuri ◽

Sonal Sonal ◽

Sonam Spalgais ◽

Nitin Goel ◽

Balakrishnan Menon ◽

...

Keyword(s):

Public Health ◽

Diabetes Mellitus ◽

Risk Factor ◽

Virus Disease ◽

Public Health Emergency ◽

World Health ◽

Uncontrolled Diabetes ◽

The World ◽

Health Organization ◽

Short Time

Dear Editor, The Corona virus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in the Wuhan province of china in December 2019. COVID-19 spread to the world in a short time and was declared as public health emergency of international concern by World Health Organization...

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Increased mortality associated with uncontrolled diabetes mellitus in patients with pulmonary cryptococcosis: a single US cohort study

Therapeutic Advances in Infectious Disease ◽

10.1177/20499361211004367 ◽

2021 ◽

Vol 8 ◽

pp. 204993612110043

Author(s):

Solana Archuleta ◽

Amal A. Gharamti ◽

Stefan Sillau ◽

Paula Castellanos ◽

Sindhu Chadalawada ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factor ◽

Hazard Model ◽

Case Control ◽

Cox Proportional Hazard Model ◽

Proportional Hazard ◽

Proportional Hazard Model ◽

Pulmonary Cryptococcosis ◽

Cox Proportional Hazard ◽

Uncontrolled Diabetes

Background: Diabetes mellitus is an established risk factor for bacterial infections, but its role in cryptococcosis is unclear. The study aimed to determine whether uncontrolled diabetes (HbA1c >7%) was an independent risk factor for mortality in cryptococcosis. Methods: A retrospective case–control study partially matched by age and gender was performed in patients tested for Cryptococcus infection at the University of Colorado Hospital from 2000 to 2019. A multivariable logistic regression model was used to identify mortality predictors. Cox proportional hazard model was used for survival analysis. Results: We identified 96 cases of cryptococcosis and 125 controls. Among cases, cryptococcal meningitis (49.0%) and pneumonia (36.5%) constituted most infections. Cases with pulmonary cryptococcosis with uncontrolled diabetes had a higher mortality at 10 weeks (50% versus 7%, p = 0.006) and 1 year (66.7% versus 13.8%, p = 0.005) compared to pulmonary cases with controlled or no diabetes. Unadjusted Cox proportional hazard model found an increased rate of death for uncontrolled diabetes at 10 weeks [hazard ratio 8.4, confidence interval (CI): 1.4–50.8, p = 0.02] and 1 year (hazard ratio 7.0, CI: 1.7–28.4, p = 0.007) among pulmonary cryptococcosis cases. Multivariable analysis showed a significantly increased odds of 10 weeks [odds ratio (OR) = 4.3, CI: 1.1–16.5, p = 0.035] and 1 year (OR = 5.0, CI: 1.4–18.3, p = 0.014) mortality for uncontrolled diabetes among pulmonary cryptococcosis cases. After adjustment for gender, age, and case/control, for every 1% increase in HbA1c levels, the odds of pulmonary cryptococcosis mortality at 1 year increased by 11% (OR = 1.6, CI 95%: 1.1–2.3, p = 0.006). Conclusion: Uncontrolled diabetes is associated with worse outcomes in pulmonary cryptococcosis, including a 4-fold and 6-fold increased odds of death at 10 weeks and 1 year, respectively. Glucose control interventions should be explored to improve clinical outcomes in patients with pulmonary cryptococcosis.

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Clinical aspects of reactive oxygen and nitrogen species

Biochemical Society Symposium ◽

10.1042/bss0710121 ◽

2004 ◽

Vol 71 ◽

pp. 121-133 ◽

Cited By ~ 25

Author(s):

Ascan Warnholtz ◽

Maria Wendt ◽

Michael August ◽

Thomas Münzel

Keyword(s):

Oxidative Stress ◽

Reactive Oxygen Species ◽

Risk Factor ◽

Endothelial Dysfunction ◽

Vascular Tissue ◽

Rapid Development ◽

Reactive Oxygen ◽

Clinical Aspects ◽

No Production ◽

Oxygen Species

Endothelial dysfunction in the setting of cardiovascular risk factors, such as hypercholesterolaemia, hypertension, diabetes mellitus and chronic smoking, as well as in the setting of heart failure, has been shown to be at least partly dependent on the production of reactive oxygen species in endothelial and/or smooth muscle cells and the adventitia, and the subsequent decrease in vascular bioavailability of NO. Superoxide-producing enzymes involved in increased oxidative stress within vascular tissue include NAD(P)H-oxidase, xanthine oxidase and endothelial nitric oxide synthase in an uncoupled state. Recent studies indicate that endothelial dysfunction of peripheral and coronary resistance and conductance vessels represents a strong and independent risk factor for future cardiovascular events. Ways to reduce endothelial dysfunction include risk-factor modification and treatment with substances that have been shown to reduce oxidative stress and, simultaneously, to stimulate endothelial NO production, such as inhibitors of angiotensin-converting enzyme or the statins. In contrast, in conditions where increased production of reactive oxygen species, such as superoxide, in vascular tissue is established, treatment with NO, e.g. via administration of nitroglycerin, results in a rapid development of endothelial dysfunction, which may worsen the prognosis in patients with established coronary artery disease.

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