scholarly journals Clinical observation of the course of COVID-19 in patients with multiple sclerosis during ocrelizumab therapy: two clinical cases

2021 ◽  
pp. 108-111
Author(s):  
E. V. Popova ◽  
M. I. Alexandrov ◽  
I. A. Trubnikova ◽  
S. R. Zeynalova
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Multiple Sclerosis ◽  
Clinical Observation ◽  
Infectious Complications ◽  
Cytokine Storm ◽  
Population Average ◽  
Risk Patients ◽  
Dosing Intervals ◽  
Clinical Cases

The COVID-19 pandemic was announced in 2020, and many professional medical societies had to review their algorithms for the management of high-risk patients. In addition to risk factors such as overweight, age over 65 years, cardiovascular disease, diabetes mellitus, and bronchial asthma, other chronic diseases should also be emphasized, taking into account possible immunosuppressive therapy. This publication presents two clinical cases of COVID-19 infection in patients with multiple sclerosis treated with ocrelizumab. During the course of the disease, both patients developed a cytokine storm and were treated with IL-6 blockers. Both cases ended with recovery and a subsequent return to anti-B-cell therapy. Given the mechanism of action of ocrelizumab, there are higher risks of infectious complications, including with COVID-19, but mortality is not higher than the population average. The information published to date may serve as a reason to consider the use of extended dosing intervals to minimize the possible risks of COVID-19 infection, which are probably highest in the first months after infusion.

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.

scholarly journals Anticoagulation ant antiplatеlet therapy in patients with COVID-19 infection

2021 ◽  
Vol 27 (3) ◽  
pp. 24-29
Author(s):  
Zheyna Cherneva ◽  
Radostina Cherneva
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Endothelial Dysfunction ◽  
Distress Syndrome ◽  
Clinical Course ◽  
Anticoagulation Therapy ◽  
Vascular Diseases ◽  
Cytokine Storm ◽  
Thrombotic Complications ◽  
Cardio Vascular

COVID-19 infection is characterized with hyperstimulated infl ammatory response that affects lungs, cytokine storm and acute respiratory distress syndrome. Thrombotic complications are the leading reason for death in COVID-19 patients. Those of them with previous cardio-vascular diseases or risk factors – obesity, arterial hypertension, diabetes mellitus, advanced age are with higher risk for worse clinical outcome. Coagulopathy as well as thrombocytopathy and endothelial dysfunction are signifi cant pathophysiological factors for the severe clinical course of the infection. Beside anticoagulation therapy, targetеd strategies regarding thrombocytopathy and endothelial dysfunction are necessary for the treatment of patients with COVID-19 infection. 

scholarly journals SARS, MERS, COVID-19: Identification of Patients at a Higher Risk: A Narrative Review

2021 ◽  
Vol 2 (1) ◽  
pp. 57-70
Author(s):  
Hussein Noureldine ◽  
Georges Chedid ◽  
Jad Gerges Harb ◽  
Wared Nour-Eldine ◽  
Mariam Nour Eldine ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
High Risk ◽  
Pregnant Women ◽  
Early Identification ◽  
Factors Associated ◽  
High Risk Patients ◽  
Increased Risk ◽  
Risk Patients

The different presentations, comorbidities, and outcomes of COVID-19 highlight the importance of early identification and proper triage of patients. High-risk patients can be divided into patients with common comorbidities and patients with special categories. Common comorbidities include, but are not limited to, Cardiovascular Disease (CVD), Diabetes Mellitus (DM), immunosuppression, underlying respiratory disease, and obesity. Certain categories of COVID-19 patients are also at increased risk, including neonates and pregnant women.  In the present article, we delineate the reported risk factors for acquisition of infection, and for increased severity of the clinical disease. We also comparatively analyze those risk factors associated with COVID-19 and with the antecedent human acute respiratory syndrome-causing viruses, SARS-CoV-1 and MERS-CoV. We hypothesize that the structural similarities of the three viruses predict a similarity in the profile of high-risk patients. Several pathophysiological patterns have been detected to support this theory.

scholarly journals The All-Cause Mortality and a Screening Tool to Determine High-Risk Patients among Prevalent Type 2 Diabetes Mellitus Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Mohamad Adam Bujang ◽  
Pei Xuan Kuan ◽  
Xun Ting Tiong ◽  
Fatin Ellisya Saperi ◽  
Mastura Ismail ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
High Risk ◽  
Prognostic Model ◽  
Screening Tool ◽  
All Cause Mortality ◽  
Risk Patients

Aims. This study aims to determine the all-cause mortality and the associated risk factors for all-cause mortality among the prevalent type 2 diabetes mellitus (T2DM) patients within five years’ period and to develop a screening tool to determine high-risk patients. Methods. This is a cohort study of T2DM patients in the national diabetes registry, Malaysia. Patients’ particulars were derived from the database between 1st January 2009 and 31st December 2009. Their records were matched with the national death record at the end of year 2013 to determine the status after five years. The factors associated with mortality were investigated, and a prognostic model was developed based on logistic regression model. Results. There were 69,555 records analyzed. The mortality rate was 1.4 persons per 100 person-years. The major cause of death were diseases of the circulatory system (28.4%), infectious and parasitic diseases (19.7%), and respiratory system (16.0%). The risk factors of mortality within five years were age group (p<0.001), body mass index category (p<0.001), duration of diabetes (p<0.001), retinopathy (p=0.001), ischaemic heart disease (p<0.001), cerebrovascular (p=0.007), nephropathy (p=0.001), and foot problem (p=0.001). The sensitivity and specificity of the proposed model was fairly strong with 70.2% and 61.3%, respectively. Conclusions. The elderly and underweight T2DM patients with complications have higher risk for mortality within five years. The model has moderate accuracy; the prognostic model can be used as a screening tool to classify T2DM patients who are at higher risk for mortality within five years.

scholarly journals Risk factors for a delayed course of reparative processes after destructive intervention on the integumentary tissues of the foot

2021 ◽  
Author(s):  
А.А. Кубанов ◽  
Е.К. Мураховская ◽  
Р.Н. Комаров ◽  
А.Н. Дзюндзя ◽  
И.А. Винокуров
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Clinical Observation ◽  
Lower Extremities ◽  
Arterial Disease ◽  
Lower Limbs ◽  
Delayed Healing ◽  
Healing Wounds ◽  
Arterial Insufficiency

В статье обобщены сведения о заболеваниях и состояниях, оказывающих влияние на процессы нормального заживления после деструктивных вмешательств на покровных тканях стопы, представлены современные данные литературы, посвященные этим вопросам. Неадекватная оценка состояния пациента перед проведением планового деструктивного вмешательства на нижних конечностях может привести к формированию длительно незаживающего раневого дефекта и нарушению функции конечности. Проведение деструктивного вмешательства требует настороженности в отношении ряда заболеваний и состояний, влияющих на процессы нормального заживления, таких как сахарный диабет, метаболический синдром, иммунодефицит. Особое внимание в статье уделено оценке состоятельности кровотока нижних конечностей в связи с тем, что хроническая артериальная недостаточность является одной из наиболее значимых причин замедленного течения репаративных процессов в области стоп. Представлено собственное клиническое наблюдение, иллюстрирующее отсутствие нормальной регенерации в условиях гипергликемии и хронической артериальной недостаточности нижних конечностей. The article summarizes information about diseases and conditions that affect the processes of normal healing after destructive interventions on the integumentary tissues of the foot, presents modern literature data on these issues. An inadequate assessment of the patient's condition before a planned destructive intervention on the lower extremities can lead to a long-term non-healing wounds and dysfunction of the extremity. A destructive intervention requires attention to a number of diseases and conditions that affect normal healing processes, such as diabetes mellitus, metabolic syndrome, and immunodeficiency. Particular attention is paid to the assessment of the consistency of the blood flow of the lower extremities because chronic arterial insufficiency is one of the most significant reasons for the slow reparative processes in the foot area. The authors present their own clinical observation that illustrates the absence of normal regeneration in conditions of hyperglycemia and chronic arterial disease of the lower limbs. Keywords: destruction, destructive interventions, atherosclerosis, wound healing, regeneration, chronic arterial insufficiency, lower limbs, delayed healing.

scholarly journals Study of risk factors for urinary colonization in patients with the double J catheter

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Amine Saouli ◽  
Tarik Karmouni ◽  
Khalid El Khader ◽  
Abdellatif Koutani ◽  
Ahmed Iben Attya Andaloussi
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Predictive Factors ◽  
Univariate Analysis ◽  
Infectious Complications ◽  
Ureteral Stent ◽  
Continuous Variables ◽  
Qualitative Variables ◽  
Tract Infections ◽  
Jj Stent

Abstract Background The aim of this study is to evaluate the prevalence of urinary colonization in patients with the JJ stent and to define the predictive factors associated with this colonization. Methods This is a monocentric prospective study (between January 2013 and April 2017), conducted in the department of Urology B of Ibn Sina Hospital in Rabat. One hundred and forty-five double ureteral stents carried by 120 patients, 25 of which had bilateral double ureteral stent, were examined. The bacteriological profile of the urine of our patients was followed by the completion of an initial urine examination and another at the time of the removal of the JJ. The comparison of the means was made by the Student's test and the Mann–Whitney test for continuous variables and by the KHI-2 test and Fisher's test for qualitative variables. The threshold of significance is set at 0.05. Results The rate of colonization of JJ stent was 35.8% (43 out of 120). The urinary colonization rate was 31.7% (38 out of 120). Average time of indwelling of JJ stent was 90 days. On double ureteral stent culture, we identified Escherichia Coli as the most predominant colonizing pathogen (47.3% of probes) followed by Enterococcus faecalis and Klebsiella pneumoniae (18.4% and 15.8%, respectively). 11.5% of colonized patients developed infectious complications (5 out of 43) and have been treated successfully except a patient who died from septic shock. In univariate analysis, diabetes mellitus (p = 0.007, OR = 4.1, CI = 1.46–11.48), urgent establishment of JJ (p = 0.03, OR = 4.61; IC = 1.08–19.6) and time of indwelling of the JJ (p = 0.05, OR = 1.89, CI = 0.95–3.77) were the predictive factors for urinary colonization in patients with JJ. In multivariate analysis, these three factors were statistically associated with this risk: diabetes mellitus (p = 0.005, OR = 0.23, CI = 0.08–0.64), the urgent establishment of JJ (p = 0.05, OR = 0.26, CI = 0, 06–1.04) and time of indwelling of the JJ more than 30 days (p = 0.007, OR = 4.29, CI = 1.49–12.37). Conclusion The prevalence of urinary colonization in patients with the double J stent was 31.7%. Diabetes mellitus, time of indwelling of the JJ more than 30 days and urgent JJ ​​ establishment are associated with a higher risk of these urinary colonizations. Strict monitoring is therefore recommended in patients with these risk factors. These results should be confirmed by multicenter and randomized studies to analyze the development of urinary tract infections in colonized patients.

scholarly journals Prevalence of retinopathy and associated risk factors among high- and low-risk patients with type 2 diabetes mellitus

2021 ◽  
Vol 42 (6) ◽  
pp. 693-697
Author(s):  
Salem A. Alghamdi ◽  
Ayla M. Tourkmani ◽  
Turki J. Alharbi ◽  
Abdulaziz Bin Rsheed ◽  
Wedad H. Almadani
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Low Risk ◽  
Risk Patients ◽  
Associated Risk Factors

scholarly journals A Novel Enema Method Can Prevent Infectious Complications of Transrectal Ultrasound-Guided Prostate Biopsy: A Single-Center Experience

2021 ◽  
Author(s):  
Fatih Gokalp ◽  
Omer Koras ◽  
Didar GURSOY ◽  
Hakan Sigva ◽  
Sefa Burak PORGALI ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Prostate Biopsy ◽  
Protective Factor ◽  
Multivariable Analysis ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Infectious Complications ◽  
Significant Difference ◽  
Group 1

Background: Transrectal ultrasound biopsy is the preferred method for diagnosing prostate cancer, but it can cause infectious complications as a result of fluoroquinolone resistance. We aimed to explore the potential protective effect of a second rectal enema before biopsy. Methods: Between January 2015 and December 2020, 419 patients were assessed retrospectively. Patients with a history of anticoagulant use, uncontrolled diabetes, urological surgery, prostate biopsy, or recent hospitalization or overseas travel, as well as those with previous prostatitis, were excluded from the study. The patients were subsequently divided into two groups: Group 1 (n=223) had received one enema, on the morning of the biopsy, and Group 2 (n=196) had received two, with the additional enema administered half an hour before the procedure. Results: There was no significant difference between the groups in terms of age, BMI, diabetes, prostate-specific antigen (PSA) level, and prostate size (p=0.076, p=0.489, p=0.265, p=0.193, and p=0.661, respectively) or in relation to cancer detection (p=0.428). The median hospitalization date was significantly higher in Group 1 (p=0.003) as was UTI development (p=0.004). However, there was no significant difference in terms of fever and sepsis (p=0.524 and p=0.548, respectively). Additionally, subgroup analysis demonstrated that UTI was significantly lower in patients with diabetes mellitus who had received a second enema (p=0.004), though there was no significant difference in UTI between the groups in those without diabetes mellitus (p=0.215). Multivariable analysis showed that age and diabetes were significant risk factors for the development of UTI (p=0.002andp=0.003, respectively). Furthermore, the second enema was a significant protective factor for preventing UTI (p<0.001). Conclusion: Older age and the presence of diabetes mellitus are independent risk factors for UTI after prostate biopsy. A second enema procedure before biopsy may protect patients from related infectious complications and could therefore be used as an alternative preventative method.

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