scholarly journals Risk Factors and Bronchopulmonary Dysplasia Severity. Data From the Spanish Bronchopulmonary Dysplasia Research Network

2021 ◽  
Author(s):  
Cristina Ramos-Navarro ◽  
Elena Maderuelo-Rodriguez ◽  
Ana Concheiro-Guisan ◽  
Santiago Perez-Tarazona ◽  
Santiago Rueda-Esteban ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bronchopulmonary Dysplasia ◽  
Total Sample ◽  
Research Network ◽  
Positive Pressure ◽  
Public And Private ◽  
Postnatal Risk Factors ◽  
Type 3 ◽  
The Impact

Abstract GEIDIS is a national based research-net registry of patients with bronchopulmonary dysplasia (BPD) from public and private Spanish hospitals. It was created to provide data on the clinical characterization and follow up of infants with BPD until adulthood. The purpose of this observational study was to analyze the characteristics and the impact of perinatal risk factors on BPD severity. The study included 1,780 patients diagnosed with BPD. Of the total sample, 98.6% were premature (less than 37 weeks) and 89,4% less than 30 weeks of gestation. The median gestational age was 27.1 weeks (25.8–28.5) and median birth weight 890 g (740–1,090 g). 52.3% (n=931) were classified as mild (type 1), 25.1% (n=447) were moderate (type 2), and 22.6% (n=402) severe BPD (type 3). Most pre-and postnatal risk factors for type 2/3 BPD were associated with the length of exposure to mechanical ventilation (MV). Independent prenatal risk factors were male gender, oligohydramnios, and intrauterine growth restriction. Postnatal risk factors included the need for FiO2 of > 0.30 in the delivery room, two or more doses of surfactant administration, nosocomial pneumonia, and the length of exposure to MV. Conclusions: In this national based research-net registry of BPD patients the length of MV is the most important risk factor associated with type 2/3 BPD. Among type 3 BPD patients, those who required an FiO2 > .30 at 36 weeks’ postmenstrual age had a higher morbidity, during hospitalization and at discharge, compared to those with nasal positive pressure but FiO2 < .30.

scholarly journals Ruminant and industrial sources of trans-fat and cardiovascular and diabetic diseases

2011 ◽  
Vol 24 (1) ◽  
pp. 111-117 ◽  
Author(s):  
Anne-Laure Tardy ◽  
Béatrice Morio ◽  
Jean-Michel Chardigny ◽  
Corinne Malpuech-Brugère
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Vaccenic Acid ◽  
Biological Effects ◽  
Epidemiological Data ◽  
Cvd Risk ◽  
Industrial Sources ◽  
Ruminant Meat ◽  
The Impact

The various positional isomers of oleic acid (18 : 1Δ9c or 9c-18 : 1) may have distinct biological effects. Detrimental effects of consumption of industrial trans-fatty acids (TFA) (elaidic acid; 18 : 1Δ9t) from partially hydrogenated vegetable oils on CVD risk factors are well documented. In addition, epidemiological data suggest that chronic consumption of industrial sources of TFA could alter insulin sensitivity and predispose for type 2 diabetes. However, intervention studies on this issue have remained inconclusive. Moreover, very little information is available on the effect of natural sources of TFA (vaccenic acid; 18 : 1Δ11t) coming from dairy products and ruminant meat on the development of CVD and type 2 diabetes. The review focuses on the impact of the consumption of ruminant TFA in relation to cardiovascular risk factors, inflammation and type 2 diabetes.

scholarly journals Insulin Resistance and Atherosclerosis: Implications for Insulin-Sensitizing Agents

2019 ◽  
Vol 40 (6) ◽  
pp. 1447-1467 ◽  
Author(s):  
Antonino Di Pino ◽  
Ralph A DeFronzo
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Insulin Resistance ◽  
High Risk ◽  
Cardiometabolic Risk ◽  
Considerable Evidence ◽  
Risk Patients ◽  
Cv Disease ◽  
The Impact

Abstract Patients with type 2 diabetes mellitus (T2DM) are at high risk for macrovascular complications, which represent the major cause of mortality. Despite effective treatment of established cardiovascular (CV) risk factors (dyslipidemia, hypertension, procoagulant state), there remains a significant amount of unexplained CV risk. Insulin resistance is associated with a cluster of cardiometabolic risk factors known collectively as the insulin resistance (metabolic) syndrome (IRS). Considerable evidence, reviewed herein, suggests that insulin resistance and the IRS contribute to this unexplained CV risk in patients with T2DM. Accordingly, CV outcome trials with pioglitazone have demonstrated that this insulin-sensitizing thiazolidinedione reduces CV events in high-risk patients with T2DM. In this review the roles of insulin resistance and the IRS in the development of atherosclerotic CV disease and the impact of the insulin-sensitizing agents and of other antihyperglycemic medications on CV outcomes are discussed.

Multicenter Experience with Neurally Adjusted Ventilatory Assist in Infants with Severe Bronchopulmonary Dysplasia

2020 ◽  
Author(s):  
Robin L. McKinney ◽  
Martin Keszler ◽  
William E. Truog ◽  
Michael Norberg ◽  
Richard Sindelar ◽  
...  
Keyword(s):  
Bronchopulmonary Dysplasia ◽  
Noninvasive Positive Pressure Ventilation ◽  
Median Number ◽  
Standards Of Care ◽  
Positive Pressure ◽  
Neurally Adjusted Ventilatory Assist ◽  
Ventilatory Assist ◽  
Postmenstrual Age ◽  
The Impact

Abstract Objective The aim of this study is to determine patterns of neurally adjusted ventilatory assist (NAVA) use in ventilator-dependent preterm infants with evolving or established severe bronchopulmonary dysplasia (sBPD) among centers of the BPD Collaborative, including indications for its initiation, discontinuation, and outcomes. Study Design Retrospective review of infants with developing or established sBPD who were placed on NAVA after ≥4 weeks of mechanical ventilation and were ≥ 30 weeks of postmenstrual age (PMA). Results Among the 13 sites of the BPD collaborative, only four centers (31%) used NAVA in the management of infants with evolving or established BPD. A total of 112 patients met inclusion criteria from these four centers. PMA, weight at the start of NAVA and median number of days on NAVA, were different among the four centers. The impact of NAVA therapy was assessed as being successful in 67% of infants, as defined by the ability to achieve respiratory stability at a lower level of ventilator support, including extubation to noninvasive positive pressure ventilation or support with a home ventilator. In total 87% (range: 78–100%) of patients survived until discharge. Conclusion We conclude that NAVA can be used safely and effectively in selective infants with sBPD. Indications and current strategies for the application of NAVA in infants with evolving or established BPD, however, are highly variable between centers. Although this pilot study suggests that NAVA may be successfully used for the management of infants with BPD, sufficient experience and well-designed clinical studies are needed to establish standards of care for defining the role of NAVA in the care of infants with sBPD.

scholarly journals The Impact of COVID-19 on Diabetes Mellitus and Hypertension: A Retrospective Study

2021 ◽  
pp. 68-77
Author(s):  
S. Pavithra ◽  
S. Lavanya ◽  
P. Vaishnavi ◽  
A. Rakesh Rosario ◽  
Priyadharshini A ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Retrospective Study ◽  
Diabetic Patients ◽  
Hypertensive Patients ◽  
Study Population ◽  
The Impact

COVID-19 is a pathogenic virus that caused a pandemic outbreak in December 2019. The impact of this virus may be severe in the patients having co-morbidities like diabetes, hypertension, Chronic Kidney Disease, cardiovascular disease, etc. Aim and Objectives: This study Aims in Assessing the impact of COVID-19 on Diabetic and Hypertensive patients as well as COVID-19 patients without any co-morbidities. Objective of this is to evaluate the association between COVID-19 and its risk factors (diabetes and hypertension) and to evaluate whether the severity of the symptoms in COVID-19 patients is due to comorbidities or past medications. Methodology: A Retrospective study was conducted in SRM Hospital (Medical Records Department) for a period of 3 Months with the study population 670 at the age group of 25, known case of Diabetes and Hypertension. Cases of Pregnant women are excluded from the study. The patients were grouped into 4 categories 1) control group (patient without any co-morbidities) 2) diabetic patients 3) Hypertensive patient 4) Diabetic+Hypertension patient and studied their prescribing pattern by collecting the past medication history. Results and Discussion: There is a significant decrease in a lymphocyte in covid-19 Type 2 diabetic patients in our study. These results suggest that different mechanism exists for hypertension and diabetes mellitus as risk factors for covid-19. It is also known that these patients have impaired immune response to many infections [30]. In our retrospective study, we collected 670 covid-19 cases. It consists of 12.5% of diabetic patients and 6.6% of hypertensive patients. This study compared COVID-19 patients without any comorbidity (neither Type 2 diabetes mellitus nor hypertension) with covid- 19 patients with comorbidities (Type 2 diabetes mellitus and hypertension). COVID-19 patients with T2DM have an increased level of D-dimer compared to non-T2DM patients. Conclusion: Diabetic and hypertensive patients affected with COVID-19 are low in our study. Out of the total study population, only 12.5% are diabetic, 6.56% are hypertensive, and 9.25% were both diabetic and hypertensive. But when comparing in terms of severity, hypertensive and diabetic patients have severe effects than the control patients. In simpler terms, not every person who has diabetes and hypertension are affected with COVID-19, but those who were affected by COVID-19 showed more severity than the patients who don't have any comorbidities

scholarly journals Duodenal major papilla morphology can affect biliary cannulation and complications during ERCP, an observational study

2020 ◽  
Author(s):  
Po-Han Chen ◽  
Chun-Fang Tung ◽  
Yen-Chung Peng ◽  
Hong-Zen Yeh ◽  
Chi-Sen Chang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Risk Factor ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Biliary Cannulation ◽  
Small Papilla ◽  
Type 3

Abstract BackgroundWe investigated whether duodenal major papilla morphology could be a risk factor for failure of selective biliary cannulation (SBC) and post endoscopic retrograde cholangiography and pancreatography (ERCP) complications.MethodsA prospectively recorded database was reviewed retrospectively. Patients were included if they received therapeutic ERCP and had naïve major duodenal papilla. We used Haraldsson’s classification for papilla morphology, as follows: Regular (Type 1), Small (Type 2), Protruding or Pendulous (Type 3) and Creased or Ridged (Type 4). Risk factors for failing SBC and post-ERCP complications were analyzed by multivariate analysis.ResultsA total of 286 cases were included. Age, gender, indications and therapeutic procedures were not different among the four types of papillae. The failure rates of SBC with Type 3 papilla and Type 4 papilla were 11.11% and 6.25%, respectively. In the multivariate analysis, Type 2 papilla (odd ratio 7.18, p= 0.045) and Type 3 papilla (odd ratio 7.44, p= 0.016) were associated with greater SBC failure compared with Type 1 papilla. Malignant obstruction compared to stone (odds ratio 4.45, p=0.014) and age (odd ratio=1.06, p=0.010) were also risk factors for cannulation failure. Type 2 papilla was correlated with a higher rate of post-ERCP pancreatitis (20%, p=0.020) compared to the other types of papilla However, papilla morphology was not a significant risk factor for any complications in the multivariate analysis.ConclusionSmall papilla and protruding or pendulous papilla are more difficult to cannulate compared to regular papilla. Small papilla is associated with a higher rate of post-ERCP pancreatitis.

scholarly journals The impact of the stratification by degree of clinical severity and abandonment risk of tuberculosis treatment

2021 ◽  
pp. e20210018
Author(s):  
Pedro Daibert de Navarro1,2 ◽  
João Paulo Amaral Haddad3 ◽  
Juliana Veiga Costa Rabelo1 ◽  
Claudia Hermínia de Lima e Silva4 ◽  
Isabela Neves de Almeida2,5 ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intervention Group ◽  
Total Sample ◽  
Clinical Severity ◽  
Tuberculosis Treatment ◽  
Kaplan Meier ◽  
Belo Horizonte ◽  
Treatment Abandonment ◽  
The Impact ◽  
The City

Objective: Evaluate the impact of the instrument of the "Stratification by Degree of Clinical Severity and Abandonment Risk of Tuberculosis Treatment" (SRTB) on the tuberculosis outcome. Methods: This study was a pragmatic clinical trial involving patients with a confirmed diagnosis of tuberculosis treated at one of the 152 primary health care units in the city of Belo Horizonte, Brazil, between May of 2016 and April of 2017. Cluster areas for tuberculosis were identified, and the units and their respective patients were divided into intervention (use of SRTB) and nonintervention groups. Results: The total sample comprised 432 participants, 223 and 209 of whom being allocated to the nonintervention and intervention groups, respectively. The risk of treatment abandonment in the nonintervention group was significantly higher than was that in the intervention group (OR = 15.010; p < 0.001), regardless of the number of risk factors identified. Kaplan-Meier curves showed a hazard ratio of 0.0753 (p < 0.001). Conclusions: The SRTB instrument was effective in reducing abandonment of tuberculosis treatment, regardless of the number of risk factors for that. This instrument is rapid and easy to use, and can be adapted to different realities. Its application showed characteristics predisposing to a non-adherence to the treatment and established bases to mitigate its impact.

scholarly journals The Impact of Triglyceride-Glucose Index On Incident Cardiovascular Events in Patients With Type 2 Diabetes Mellitus

2021 ◽  
Author(s):  
Liyao Fu ◽  
Shi Tai ◽  
Jiaxing Sun ◽  
Ningjie Zhang ◽  
Ying Zhou ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Cardiovascular Risk ◽  
Tyg Index ◽  
Accord Study ◽  
The Impact ◽  
Very High

Abstract Background: Previous studies reported the prognostic value of the triglyceride-glucose (TyG) index in the course of cardiovascular (CV) diseases. Still, it remains unclear whether baseline and trajectories of TyG index are prospectively associated with incident CV events among patients with type 2 diabetes mellitus (T2DM).Methods: We performed a secondary analysis in patients with long-lasting T2DM from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study. The primary outcome was the first occurrence of adverse CV events including nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes, and the TyG index was measured at 11 visits. Cox proportional hazards regression analysis was used to observe the association between baseline and trajectories of TyG index and adverse CV outcomes.Results: During a median follow-up period of 8.8 years, 1,815 (17.8%) developed at least one primary endpoint event. After adjusting for traditional cardiovascular risk factors, each 1-SD increase in the TyG index was associated with a 19.00% higher risk of adverse CV events, similar in individuals categorized by TyG index quartiles. Four distinct trajectories of TyG indexes were identified- low (16.17%), moderate (40.01%), high (34.60%), and very high (9.30%). Among these, moderate, high, and very high TyG index trajectories had a greater risk of future incident adverse CV events than low TyG index trajectories after multivariate adjustments for traditional risk factors. Particularly, a similar association was noticed in the TyG index and the occurrence of coronary heart disease.Conclusions: The findings of this study suggest that both baseline and trajectories of TyG index have a significant association with the occurrence of adverse CV events in patients with T2DM. (Trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000620)

scholarly journals The impact of lung function on cardiovascular diseases and cardiovascular risk factors: a two sample bi-directional Mendelian randomization study

2020 ◽  
Author(s):  
SL Au Yeung ◽  
MC Borges ◽  
DA Lawlor ◽  
CM Schooling
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Lung Function ◽  
Mendelian Randomization ◽  
Sensitivity Analyses ◽  
Summary Statistics ◽  
The Impact ◽  
Genetic Instruments

AbstractBackgroundObservational studies suggested lung function is inversely associated with cardiovascular disease (CVD) although these studies could be susceptible to residual confounding. We conducted a 2 sample Mendelian randomization study using summary statistics from genome wide association studies (GWAS) to clarify the role of lung function in CVD and its risk factors, and conversely the role of CVD in lung function.MethodsWe obtained genetic instruments for forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) from publicly available UK Biobank summary statistics (n = 421,986). We applied these genetic instruments for FEV1 (260) and FVC (320) to publicly available GWAS summary statistics for coronary artery disease (CAD) (n = 184,305), stroke and its subtypes (n = 446,696), atrial fibrillation (n = 1,030,836), and heart failure (n = 977,320) and cardiovascular risk factors. Inverse variance weighting was used to assess the impact of lung function on these outcomes. Sensitivity analyses included MR-Egger, weighted median, MR-PRESSO, and multivariable Mendelian randomization. We also conducted bi-directional Mendelian randomization to assess whether CVD affects lung function.ResultsFEV1 and FVC were inversely associated with CAD (odds ratio (OR) per standard deviation (SD) increase, 0.72 (95% confidence interval (CI) 0.63 to 0.82) and 0.70 (95%CI 0.62 to 0.78)), overall stroke (0.87 (95%CI 0.77 to 0.97), 0.90 (0.82 to 1.00)), ischemic stroke (0.87 (95%CI 0.77 to 0.99), 0.90 (95%CI 0.80 to 1.00)), small vessel stroke (0.78, (95%CI 0.61 to 1.00), 0.74 (95%CI 0.61 to 0.92)), and large artery stroke (0.69 (95%CI 0.54 to 0.89), 0.72 (95%CI 0.57 to 0.91)). FEV1 and FVC were inversely associated with type 2 diabetes (0.75 (95%CI 0.62 to 0.90), 0.67 (95%CI 0.58 to 0.79)) and systolic blood pressure. Sensitivity analyses produced similar direction for most outcomes although the magnitude sometimes differed. Adjusting for height attenuated results for CAD (e.g. OR for 1SD FEV1 0.95 (0.76 to 1.20), but this may reflect weak instrument bias. This adjustment did not attenuate effects for stroke or type 2 diabetes. No strong evidence was observed for CVD affecting lung function.ConclusionHigher lung function likely protect against CAD and stroke.

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