scholarly journals Differences between diabetic and non-diabetic patients with community-acquired pneumonia in primary care in Spain

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Loreto Arias Fernández ◽  
◽  
Jacobo Pardo Seco ◽  
Miriam Cebey-López ◽  
Ruth Gil Prieto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Descriptive Analysis ◽  
Community Acquired Pneumonia ◽  
First Episode ◽  
Diabetic Patients ◽  
High Prevalence ◽  
Patients With Diabetes ◽  
Rising Incidence ◽  
And Control

Abstract Background Diabetes is one of the underlying risk factors for developing community-acquired pneumonia (CAP). The high prevalence of diabetes among population and the rising incidence of this illness, converts it as an important disease to better control and manage, to prevent its secondary consequences as CAP. The objective of this research is to describe the characteristics of the patients with diabetes and the differences with the no diabetes who have had an episode of CAP in the context of the primary care field. Methods A retrospective, observational study in adult patients (> 18 years-old) who suffer from CAP and attended at primary care in Spain between 2009 and 2013 was developed using the Computerized Database for Pharmacoepidemiological Studies in Primary Care (BIFAP). We carried out a descriptive analysis of the first episodes of CAP, in patients with or without diabetes as comorbidity. Other morbidity (CVA, Anaemia, Arthritis, Asthma, Heart disease, Dementia, Depression, Dysphagia, Multiple sclerosis, Epilepsy, COPD, Liver disease, Arthrosis, Parkinson’s disease, Kidney disease, HIV) and life-style factors were also included in the study. Results A total of 51,185 patients were included in the study as they suffer from the first episode of CAP. Of these, 8012 had diabetes as comorbidity. There were differences between sex and age in patients with diabetes. Patients without diabetes were younger, and had less comorbidities including those related to lifestyles such as smoking, alcoholism, social and dental problems than patients with diabetes. Conclusions Patients who developed an episode of CAP with diabetes have more risk factors which could be reduced with an appropriate intervention, including vaccination to prevent successive CAP episodes and hospitalization. The burden of associated factors in these patients can produce an accumulation of risk. Health care professional should know this for treating and control these patients in order to avoid complications. Diabetes and those other risk factors associated could be reduced with an appropriate intervention, including vaccination to prevent the first and successive CAP episodes and the subsequent hospitalization in severe cases.

scholarly journals When Uncontrolled Diabetes Mellitus and Severe COVID-19 Converge: The Perfect Storm for Mucormycosis

2021 ◽  
Vol 7 (4) ◽  
pp. 298
Author(s):  
Teny M. John ◽  
Ceena N. Jacob ◽  
Dimitrios P. Kontoyiannis
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Clinical Features ◽  
The Other ◽  
Diabetic Patients ◽  
Epidemiological Factors ◽  
Uncontrolled Diabetes ◽  
Diagnostic Certainty ◽  
Patients With Diabetes ◽  
Perfect Storm

Mucormycosis (MCR) has been increasingly described in patients with coronavirus disease 2019 (COVID-19) but the epidemiological factors, presentation, diagnostic certainty, and outcome of such patients are not well described. We review the published COVID-19-associated mucormycosis (CAMCR) cases (total 41) to identify risk factors, clinical features, and outcomes. CAMCR was typically seen in patients with diabetes mellitus (DM) (94%) especially the ones with poorly controlled DM (67%) and severe or critical COVID-19 (95%). Its presentation was typical of MCR seen in diabetic patients (mostly rhino-orbital and rhino-orbital-cerebral presentation). In sharp contrast to reported COVID-associated aspergillosis (CAPA) cases, nearly all CAMCR infections were proven (93%). Treating physicians should have a high suspicion for CAMCR in patients with uncontrolled diabetes mellitus and severe COVID-19 presenting with rhino-orbital or rhino-cerebral syndromes. CAMR is the convergence of two storms, one of DM and the other of COVID-19.

Features of Stroke in Chinese Diabetes Patients: A Hospital-based Study

2007 ◽  
Vol 35 (4) ◽  
pp. 540-546 ◽  
Author(s):  
X-D Zhang ◽  
Y-R Chen ◽  
L Ge ◽  
Z-M Ge ◽  
Y-H Zhang
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Ischaemic Stroke ◽  
Cerebral Haemorrhage ◽  
Mortality Rates ◽  
Demographic Characteristics ◽  
Major Influence ◽  
Diabetic Patients ◽  
Clinical Factors ◽  
Patients With Diabetes

In this study, demographic characteristics, risk factors, stroke subtypes and outcome were compared in 2532 patients with and without diabetes hospitalized for first-ever stroke. Diabetes was present in 471 (18.6%) of the patients. Patients with diabetes presented more frequently with ischaemic stroke (92.1% versus 71.3%), especially lacunar infarction (41.2% versus 35.2%), compared with non-diabetics. Cerebral haemorrhage was less frequent in diabetics than non-diabetics (4.2% versus 18.1%). In-hospital mortality rates from ischaemic stroke were similar in the two groups (18.2% in diabetics and 16.9% in non-diabetics). Predictors of in-hospital mortality in diabetic patients included decreased consciousness, congestive heart failure and atrial fibrillation. In conclusion, stroke in diabetic patients was different to stroke in non-diabetic patients: in diabetics the frequency of cerebral haemorrhage was lower and the rate of lacunar infarct syndrome was higher, but in-hospital mortality from ischaemic stroke was not increased. Clinical factors evident at the onset of stroke have a major influence on in-hospital mortality and may help clinicians provide a more accurate prognosis.

Prevalence of Toenail Onychomycosis in Patients with Type 2 Diabetes Mellitus and Evaluation of Risk Factors

2011 ◽  
Vol 101 (1) ◽  
pp. 49-54 ◽  
Author(s):  
Aynur Gulcan ◽  
Erim Gulcan ◽  
Sukru Oksuz ◽  
Idris Sahin ◽  
Demet Kaya
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Fasting Blood Glucose ◽  
Diabetic Patients ◽  
Essential Components ◽  
Patients With Diabetes ◽  
Epidemiologic Risk

Background: We sought to determine the frequency of toenail onychomycosis in diabetic patients, to identify the causative agents, and to evaluate the epidemiologic risk factors. Methods: Data regarding patients’ diabetic characteristics were recorded by the attending internal medicine clinician. Clinical examinations of patients’ toenails were performed by a dermatologist, and specimens were collected from the nails to establish the onycomycotic abnormality. All of the specimens were analyzed by direct microscopy and culture. Results: Of 321 patients with type 2 diabetes mellitus, clinical onychomycosis was diagnosed in 162; 41 of those diagnoses were confirmed mycologically. Of the isolated fungi, 23 were yeasts and 18 were dermatophytes. Significant correlations were found between the frequency of onychomycosis and retinopathy, neuropathy, obesity, family history, and duration of diabetes. However, no correlation was found with sex, age, educational level, occupation, area of residence, levels of hemoglobin A1c and fasting blood glucose, and nephropathy. The most frequently isolated agents from clinical specimens were yeasts. Conclusions: Long-term control of glycemia to prevent chronic complications and obesity and to promote education about the importance of foot and nail care should be essential components in preventing onychomycosis and its potential complications, such as secondary foot lesions, in patients with diabetes mellitus. (J Am Podiatr Med Assoc 101(1): 49–54, 2011)

Clinical profile of acute myocardial infarction in the young

2021 ◽  
Vol 11 (2) ◽  
pp. 148-150
Author(s):  
Sapkal Harish Barsu ◽  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Epigastric Pain ◽  
Young Patients ◽  
Clinical Profile ◽  
Atypical Symptoms ◽  
Acute Mi ◽  
Rising Incidence ◽  
And Control

Background: There is a rising incidence of acute myocardial infarction (MI) in young adults. It is important to identify and control cardiovascular risk factors at an early age to prevent the incidence in cases of young MI. Aim: To study the clinical profile of acute myocardial infarction in young patients. Material and Methods: Patients aged 40 years or younger admitted to with a diagnosis of acute MI were studied for clinical presentations, risk factors and management outcome. Results: Majority of patients presented with typical chest pain. 5 patients presented with atypical symptoms, one had only sweating, two had heaviness of chest, one had epigastric pain, one had sudden collapse. The most common risk factor was smoking in 68% followed by alcoholism 40%, Obesity 38%, Metabolic syndrome 38%, HTN 28% DM 26%. Of the total 50 patients, 47 (94%) patients survived whereas 3 (6%) patients succumb to death. Conclusion: There is a need to increase awareness among the young population regarding the entity of MI in young hence stressing on modifying life style. This simple measure can make a large difference in preventing the occurrence of MI in young.

Abstract P373: Trends in Cardiovascular Risk Factors by Clinical Definitions of Prediabetes

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Caroline Liu ◽  
Kathryn Foti ◽  
Elizabeth Selvin
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Nutrition Examination Survey ◽  
Risk Factor Management ◽  
Health And Nutrition ◽  
High Prevalence ◽  
Definition Of ◽  
And Control ◽  
Over Time

Introduction: There are five different definitions of prediabetes currently used in clinical practice. How cardiovascular risk may differ by these different definitions of prediabetes and whether trends in cardiovascular risk in persons with prediabetes have changed over time is largely uncharacterized. Hypothesis: We expect the prevalence of cardiovascular risk factors will vary by prediabetes definition and will be highest among those who meet clinical definitions with higher cutoff values. We hypothesize awareness, treatment and control of hypertension and hypercholesterolemia have increased over time among those with prediabetes. Methods: We analyzed data for adults ages ≥ 20 years from the 1999-2014 National Health and Nutrition Examination Survey (NHANES). We used calibrated HbA1c and FPG values to estimate prediabetes prevalence. We examined the prevalence and trends of hypertension and hypercholesterolemia among those who met each clinical definition of prediabetes, as well as awareness, treatment, and control. Results: The prevalence of prediabetes by each definitions remained stable across survey years. The prevalence, awareness, treatment, and control of hypertension and hypercholesterolemia by clinical definition modestly increased over time. Conclusion: The prevalence of hypertension and hypercholesterolemia was higher among individuals who met HbA1c-based definitions of prediabetes than other measures and was highest when more restrictive criteria for prediabetes were used. Awareness, treatment, and control of cardiovascular risk factors increased over time by any definition, but the high prevalence of cardiovascular risk factors highlights the need for improvement in risk factor management in people with prediabetes.

scholarly journals Lifestyle and comorbid conditions as risk factors for community-acquired pneumonia in outpatient adults (NEUMO-ES-RISK project)

2019 ◽  
Vol 6 (1) ◽  
pp. e000359 ◽  
Author(s):  
Irene Rivero-Calle ◽  
Miriam Cebey-López ◽  
Jacobo Pardo-Seco ◽  
José Yuste ◽  
Esther Redondo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Dental Hygiene ◽  
Community Acquired Pneumonia ◽  
Incidence Density ◽  
Controlled Study ◽  
Chronic Obstructive ◽  
Comorbid Conditions ◽  
Obstructive Pulmonary Disease ◽  
Sampling Ratio

IntroductionInformation about community-acquired pneumonia (CAP) risk in primary care is limited. We assess different lifestyle and comorbid conditions as risk factors (RF) for CAP in adults in primary care.MethodsA retrospective-observational-controlled study was designed. Adult CAP cases diagnosed at primary care in Spain between 2009 and 2013 were retrieved using the National Surveillance System of Primary Care Data (BiFAP). Age-matched and sex-matched controls were selected by incidence density sampling (ratio 2:1). Associations are presented as percentages and OR. Binomial regression models were constructed to avoid bias effects.Results51 139 patients and 102 372 controls were compared. Mean age (SD) was 61.4 (19.9) years. RF more significantly linked to CAP were: HIV (OR [95% CI]: 5.21 [4.35 to 6.27]), chronic obstructive pulmonary disease (COPD) (2.97 [2.84 to 3.12]), asthma (2.16 [2.07,2.26]), smoking (1.96 [1.91 to 2.02]) and poor dental hygiene (1.45 [1.41 to 1.49]). Average prevalence of any RF was 82.2% in cases and 69.2% in controls (2.05 [2.00 to 2.10]). CAP rate increased with the accumulation of RF and age: risk associated with 1RF was 1.42 (1.37 to 1.47) in 18–60-year-old individuals vs 1.57 (1.49 to 1.66) in >60 years of age, with 2RF 1.88 (1.80 to 1.97) vs 2.35 (2.23, 2.48) and with ≥ 3 RF 3.11 (2.95, 3.30) vs 4.34 (4.13 to 4.57).DiscussionPrevalence of RF in adult CAP in primary care is high. Main RFs associated are HIV, COPD, asthma, smoking and poor dental hygiene. Our risk stacking results could help clinicians identify patients at higher risk of pneumonia.

scholarly journals Prevalence, treatment, and control of dyslipidemia in diabetic participants of two brazilian cohorts: a place far from heaven

2019 ◽  
Vol 65 (1) ◽  
pp. 3-8
Author(s):  
Nestor S. Martins ◽  
Daniel S.S. Mello ◽  
Joaquim Barreto ◽  
Alexandre A.S. Soares ◽  
Ikaro Breder ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Cardiovascular Health ◽  
Diastolic Pressure ◽  
Blood Glucose Control ◽  
Diabetic Patients ◽  
Heart Study ◽  
Different Populations ◽  
And Control

SUMMARY OBJECTIVE Diabetes is one of the leading causes of cardiovascular mortality. Over the last years, mortality has decreased significantly, more in individuals with diabetes than in healthy ones. That is mostly due to the control of other cardiovascular risk factors. The objective of our study was to analyze the dyslipidemia control in two diabetes cohorts. METHODS Patients from two distinct cohorts were studied, 173 patients from the BHS (Brasília Heart Study) and 222 patients from the BDS (Brazilian Diabetes Study). The data on dyslipidemia control were studied in both different populations. All patients had diabetes. RESULTS There are significant differences concerning comorbidities between the LDL-C and BDS groups. The average glycated hemoglobin is of 8.2 in the LDL-C > 100 group in comparison with 7.7 and 7.5 in the 70-100 and < 70 groups, respectively (p = 0.024). There is a higher percentage of hypertensive patients with LDL between 70-100 (63.9%), when comparing the < 70 and > 100 groups (54.3% and 54.9%, respectively; p = 0.005). Diastolic pressure is higher in the group with LDL > 100, with an average of 87 mmHg, in comparison with 82.6 mmHg and 81.9 mmHg in the 70-100 and < 70 groups, respectively (p = 0.019). The group with LDL > 100 has the greatest percentage of smokers (8.7%) in comparison with the groups with LDL between 70-100 and < 70 (5.6% and 4.3%, respectively; p = 0.015). There is also a difference in the previous incidence of coronaropathy. In the group with LDL < 70, 28.3% of patients had already experienced a previous infarction, compared with 11.1% and 10.6% in the 70-100 and > 100 groups, respectively (p < 0.001). CONCLUSIONS The data in our study have shown that the dyslipidemia control in diabetic patients is inadequate and there is a tendency of direct association between lack of blood glucose control and lack of dyslipidemia control, in addition to the association with other cardiovascular risk factors, such as diastolic hypertension and smoking. This worsened control might be related to the plateau in the descending curve of mortality, and investments in this regard can improve the cardiovascular health in diabetic patients.

Diagnosis and management of community-acquired pneumonia

2016 ◽  
Author(s):  
Antoni Torres ◽  
Adamantia Liapikou
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Community Acquired Pneumonia ◽  
Atypical Pathogens ◽  
High Prevalence ◽  
Refractory Septic Shock ◽  
Pneumococcal Bacteraemia ◽  
Severe Community Acquired Pneumonia ◽  
Reason For Admission ◽  
Selection Of

Severe community-acquired pneumonia (SCAP) remains the most common infectious reason for admission to the intensive care unit (ICU), reaching a mortality rate of 30–40%. The microbial pattern of the SCAP has changed with S. pneumoniae still the leading pathogen, but a decrease of atypical pathogens, especially Legionella and an increase of viral and polymicrobial pneumonias. IDSA/ATS issued guidelines on the management of CAP including specific criteria to identify patients for ICU admission with good predictive value. The first selection of antimicrobial therapy should be started early covering all likely pathogens, depending on the presence of the risk factors for Pseudomonas aeruginosa infection. Combination therapy may be useful in patients with non-refractory septic shock and severe sepsis pneumococcal bacteraemia as well. The challenges include the emergence of new pathogens as community-acquired methicillin-resistant Staphylococcus aureus, new influenza virus subtypes and the high prevalence of multidrug resistance, mainly from institutionalizing patients.

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