Diabetes Mellitus: An Independent Risk Factor of In-Hospital Mortality in Patients with Infective Endocarditis in a New Era of Clinical Practice

Infective endocarditis (IE) is a severe disease with a hospital mortality rate of 17%–25%. Early identification of IE patients with high risk of mortality may improve their clinical outcomes. Patients with diabetes mellitus (DM) who develop infective diseases are associated with worse outcomes. This study aimed to define the impact of DM on long-term mortality in IE patients. A total of 412 patients with definite IE from February 1999 to June 2012 were enrolled in this observational study and divided into 2 groups: group 1, patients with DM (n = 72) and group 2, patients without DM (n = 340). The overall in-hospital mortality rate for both groups combined was 20.2% and was higher in group 1 than in group 2 (41.7% vs. 16.5%, p < 0.01). Compared to patients without DM, patients with DM were older and associated with higher incidence of chronic diseases, less drug abuse, higher creatinine levels, and increased risk of Staphylococcus aureus infection (all p < 0.05). Moreover, they were more likely to have atypical clinical presentation and were associated with longer IE diagnosis time (all p < 0.05). In multivariable analysis, DM is an independent and significant predictor of mortality. The prognosis of IE patients with DM is still poor. Early identification and more aggressive treatment may be considered in IE patients with DM.

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Lipid profile and markers of vascular inflammation in patients with stable angina in the presence and absence of type 2 diabetes mellitus

Diabetes Mellitus ◽

10.14341/7959 ◽

2017 ◽

Vol 20 (3) ◽

pp. 194-200 ◽

Cited By ~ 1

Author(s):

Tatiana I. Petelina ◽

Natalia A. Musikhina ◽

Liudmila I. Gapom ◽

Irina V. Емеneva ◽

Elena A. Gorbatenko

Keyword(s):

Diabetes Mellitus ◽

Lipid Profile ◽

Stable Angina ◽

Inflammatory Markers ◽

Vascular Inflammation ◽

Increased Risk ◽

Presence And Absence ◽

Group 2 ◽

Group 1

Background. The mechanisms underlying the close relationship between diabetes mellitus (DM) and coronary artery disease (CAD) have not been fully understood. The pathophysiological processes of vascular inflammation that accelerate and enhance the development of atherosclerotic vascular lesions and their complications warrant further study. Aims. To compare lipid profiles and inflammatory markers in patients with CAD and stable angina in the presence and absence of type 2 DM. Materials and methods. A total of 169 patients were examined: Group 1 included 123 patients with CAD but without DM; Group 2 consisted of 46 patients with CAD and DM. The biochemical parameters were estimated before coronary angiography. Results. The lipid profile in both groups of patients revealed elevated levels of atherogenic markers (TС, LDL, VLDLP and TG). Patients in Group 2 had significantly increased levels of vascular inflammatory markers (hs-CRP, homocysteine, IL-1), TNF-, MMP-9 and endothelin-1 compared to those in Group 1. Conclusions. Our results indicate that the vascular inflammatory response was more pronounced in patients with CAD and DM and that they have an increased risk of developing adverse vascular complications.

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The impact of obesity to antioxidant defense parameters in adolescents with increased cardiovascular risk

Journal of Medical Biochemistry ◽

10.2478/jomb-2019-0051 ◽

2019 ◽

Vol 0 (0) ◽

Author(s):

Emina Čolak ◽

Dragana Pap ◽

Ljubinka Nikolić ◽

Sanja Vicković

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Inflammatory Markers ◽

Antioxidant Defense ◽

Hdl Cholesterol ◽

Increased Risk ◽

Group 2 ◽

The Impact ◽

Group 1

Summary Background The goal of this study was to assess the oxidative stress status through the values of antioxidant defense parameters: superoxide dismutase (SOD), glutathione peroxidase (GPx), glutathione reductase (GR) and total antioxidant status (TAS), as well as cardiovascular risk factors (total cholesterol, LDL-cholesterol, VLDL-cholesterol, non-HDL-cholesterol and triglycerides), anthropometric parameters (Body mass index-BMI, waist circumference-WC, hipp circumferemce-HC, waist-to-hipp ratio-WHR and inflammatory markers (high sensitive C-reactive protein) in a group of obese adolescents. Methods A total of 238 students of both sexes, age of 22.32 ± 1.85 yr. were included in the study. According to the values of BMI lower and higher than 25 kg/m2 and WC higher and lower than 94 cm (males)/80 cm (females) the tested group of students was divided into 2 subgroups: Group 1 (increased risk for CVD) and Group 2 (lower risk for CVD). Results Significantly reduced SOD and GPx with increased GR, TAS, inflammatory and lipoprotein parameters were obtained in Group 1 compared to Group 2. Significant positive association of hsCRP (OR:1.41; 95%CI 1.08–1.83; P=0.007), TAS (OR:827.2; 95%CI 19.27–35498; P=0.007) and GR (OR:1.13; 95%CI 1.05–1.21; P=0.002) and negative association of GPx (OR:0.97; 95%CI 0.94–1.003; P=0.043) and HDL-cholesterol (OR:0.41; 95%CI 0.176– 0.963; P=0.0014) with cardiovascular risk factors were found in obese students. According to the ROC analysis GR>44.8 U/L, TAS>1.35 mmol/L, hsCRP>1.71 mg/L and HDL-cholesterol <1.13 mmol/L have sufficient predictive ability for cardiovascular disease in obese students. Conclusions Significant association of antioxidant defense parameters with anthropometric, lipid and inflammatory markers in obese students with increased cardiovascular risk suggest that screening of these parameters is necessary and highly recommended.

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COVID-19-related outcomes in immunocompromised patients: A nationwide study in Korea

PLoS ONE ◽

10.1371/journal.pone.0257641 ◽

2021 ◽

Vol 16 (10) ◽

pp. e0257641

Author(s):

Moon Seong Baek ◽

Min-Taek Lee ◽

Won-Young Kim ◽

Jae Chol Choi ◽

Sun-Young Jung

Keyword(s):

Mortality Rate ◽

Hospital Mortality ◽

Multivariable Analysis ◽

Immunocompromised Patients ◽

Multivariable Logistic Regression Model ◽

Inverse Probability ◽

Risk Of Mortality ◽

Vulnerable Patients ◽

Increased Risk ◽

Immunocompromised Status

Background Given the rapid increased in confirmed coronavirus disease 2019 (COVID-19) and related mortality, it is important to identify vulnerable patients. Immunocompromised status is considered a risk factor for developing severe COVID-19. We aimed to determine whether immunocompromised patients with COVID-19 have an increased risk of mortality. Method The groups’ baseline characteristics were balanced using a propensity score-based inverse probability of treatment weighting approach. Odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated for the risks of in-hospital mortality and other outcomes according to immunocompromised status using a multivariable logistic regression model. We identified immunocompromised status based on a diagnosis of malignancy or HIV/AIDS, having undergone organ transplantation within 3 years, prescriptions for corticosteroids or oral immunosuppressants for ≥30 days, and at least one prescription for non-oral immunosuppressants during the last year. Results The 6,435 COVID-19 patients (≥18 years) included 871 immunocompromised (13.5%) and 5,564 non-immunocompromised (86.5%). Immunocompromised COVID-19 patients were older (60.1±16.4 years vs. 47.1±18.7 years, absolute standardized mean difference: 0.738). The immunocompromised group had more comorbidities, a higher Charlson comorbidity index, and a higher in-hospital mortality rate (9.6% vs. 2.3%; p < .001). The immunocompromised group still had a significantly higher in-hospital mortality rate after inverse probability of treatment weighting (6.4% vs. 2.0%, p < .001). Multivariable analysis adjusted for baseline imbalances revealed that immunocompromised status was independently associated with a higher risk of mortality among COVID-19 patients (adjusted odds ratio [aOR]: 2.09, 95% CI: 1.62–2.68, p < .001). Conclusions Immunocompromised status among COVID-19 patients was associated with a significantly increased risk of mortality.

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The study of cardiotoxicity of hydroxychloroquine and azithromycine combination in hospitalized patients with COVID-19

Sechenov Medical Journal ◽

10.47093/2218-7332.2020.11.2.29-39 ◽

2020 ◽

Vol 11 (2) ◽

pp. 29-39

Author(s):

Yu. N. Belenkov ◽

I. V. Menshikova ◽

I. S. Ilgisonis ◽

Yu. I. Naimann ◽

Yu. V. Pak ◽

...

Keyword(s):

Hospital Mortality ◽

Qt Interval ◽

Ministry Of Health ◽

Cardiovascular Comorbidity ◽

Corrected Qt Interval ◽

Number Of Patients ◽

Increased Risk ◽

Significant Difference ◽

Group 2 ◽

Group 1

Hydroxychloroquine (HCH) is included in guidelines for treatment of novel coronavirus infection (COVID-19). Data on increased risk of cardiovascular complications when using it have been published. Aim. To evaluate the safety and tolerability of HCH and azithromycine (AZM) combination for the treatment of the patients with COVID-19 in recommended by Russian Ministry of Health doses in real practice.Methods. 132 patients (62 men and 70 women of average age 59.2 ± 9.3 years), 59% of whom had cardiovascular comorbidities, were included in prospective сohort study. 112 patients took HCH + AZM (group 1) and 20 patients took other medications without potential cardiotoxicity (group 2). At the admission to the hospital and after 5–7 days of the treatment corrected QT interval was calculated, new rhythm and conduction disorders, other side effects and hospital mortality have been registering. Relative risk (RR) and 95% confidence interval (CI) were calculated. Results. Elongation of corrected QT-interval within the normal range was registered in 22.3% of patients in group 1 and in 15% — in group 2. An increase in the QT length to the upper limit of the norm (480 msec) was observed in 1.8% of patients in group 1. There were no statistically significant differences between the groups in the number of patients with prolonged QT interval (RR = 1.488, 95% CI: 0.496–4.466, р = 0.478). The occurrence of new arrhythmias, conduction disturbances and allergic reactions was not recorded. Tolerability of combination HCH + AZM was satisfactory in the majority of patients. The hospital mortality in group 1 was 1.8%, in group 2 — 5% without statistically significant difference (p = 0.374). Conclusion. A combination of HCL + AZM according to the scheme recommended by the Ministry of Health of the Russian Federation for the treatment of the patients with COVID-19 and cardiovascular comorbidity in inpatient conditions is safe.

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The Impact of Chemotherapy on Complications Associated with Mastectomy and Immediate Autologous Tissue Reconstruction

The American Surgeon ◽

10.1177/000313481608200830 ◽

2016 ◽

Vol 82 (8) ◽

pp. 713-717 ◽

Cited By ~ 2

Author(s):

Shoichiro Tanaka ◽

Genevieve Hayek ◽

Pravitha Jayapratap ◽

Sita Yerrasetti ◽

Hugo St. Hilaire ◽

...

Keyword(s):

Breast Cancer ◽

Preoperative Chemotherapy ◽

Wound Complications ◽

Breast Cancer Patients ◽

Autologous Tissue ◽

Increased Risk ◽

Tissue Reconstruction ◽

Group 2 ◽

The Impact ◽

Group 1

We performed this study to evaluate the impact of chemotherapy on the outcomes associated with immediate autologous tissue reconstruction (IATR) in the treatment of breast cancer. Patients were divided into two groups: Group 1 received chemotherapy before surgery and Group 2 did not receive chemotherapy. Records were reviewed to identify demographics, comorbidities, histology, and wound healing complications. Groups were compared using Kruskal-Wallis and Fisher exact tests as appropriate. A total of 128 patients were identified: 29 received chemotherapy before surgery (Group 1) and 99 did not receive chemotherapy (Group 2). Group 1 patients were more likely to have diabetes 27 per cent versus 6 per cent ( P = 0.005) despite both groups having a mean body mass index of 30. Group 2 patients had less advanced stage disease as expected because they did not receive chemotherapy; 37 per cent of Group 2 patients had stage 0 breast cancer ( P < 0.001). The incidence of wound complications was 17 per cent in Group 1 and 12 per cent in Group 2 ( P = NS). Preoperative chemotherapy for breast cancer followed by IATR was associated with no increased risk of healing complications. IATR can be offered to patients who require preoperative chemotherapy, and their healing will not be impaired as a result of the chemotherapy.

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The impact of COVID-19 on primary retinopexy in preventing retinal detachment in a tertiary eye hospital emergency department

European Journal of Ophthalmology ◽

10.1177/1120672121994727 ◽

2021 ◽

pp. 112067212199472

Author(s):

George Moussa ◽

Emma Samia-Aly ◽

Walter Andreatta ◽

Kim Son Lett ◽

Arijit Mitra ◽

...

Keyword(s):

Retinal Detachment ◽

Case Series ◽

Significant Shift ◽

Number Of Patients ◽

Increased Risk ◽

Significant Difference ◽

Male Patients ◽

Group 2 ◽

The Impact ◽

Group 1

Purpose: To review the effect of COVID-19 on rhegmatogenous retinal detachment (RRD) rate following primary retinopexy. Methods: Retrospective consecutive case series of 183 patients attending Birmingham and Midlands Eye Centre undergoing primary retinopexy (cryotherapy and laser) between March 23rd to June 30th in 2019 (Group 1) and 2020 (Group 2). Results: In total we reviewed 183 retinopexies, 122 in Group 1 and 61 in Group 2, a reduction of 50%. In Group 2 compared to Group 1, we showed a significant difference in characteristics of patients having primary retinopexy with an increase in proportion of male patients from 50 (41.0%) to 39 (63.9%) ( p = 0.005), increase in high myopes from 1 (0.8%) to 4 (6.6%) ( p = 0.043), more slit lamp laser retinopexy from 83 (68.0%) to 52 (85.2%) ( p = 0.013) and less cryopexy from 21 (17.2%) to 2 (3.3%) ( p = 0.008). In Group 2, primary retinopexy resulted in significantly more 3-month RRD rate 1 (0.8%) to 5 (8.2%) ( p = 0.016). There were no changes in number of patients requiring further retinopexy ( p = 1.000) Conclusion: This study demonstrates a reduction of primary retinopexy, an increased risk for RRD following primary retinopexy and a significant shift in type of primary retinopexy performed, demographics, operator and change in characteristics of type of retinal break observed during this pandemic. This study contributes to the growing literature of the secondary effects of the COVID-19 pandemic on other aspects of healthcare that is not just limited to the virus itself.

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A new model of diffuse brain injury in rats

Journal of Neurosurgery ◽

10.3171/jns.1994.80.2.0291 ◽

1994 ◽

Vol 80 (2) ◽

pp. 291-300 ◽

Cited By ~ 748

Author(s):

Anthony Marmarou ◽

Montasser A. Abd-Elfattah Foda ◽

Wimer van den Brink ◽

J. Campbell ◽

H. Kita ◽

...

Keyword(s):

Brain Injury ◽

Mortality Rate ◽

Cause Of Death ◽

Skull Fracture ◽

Guide Tube ◽

Diffuse Brain Injury ◽

Group 2 ◽

The Impact ◽

Diffuse Brain ◽

Group 1

✓ This report describes the development of an experimental head injury model capable of producing diffuse brain injury in the rodent. A total of 161 anesthetized adult rats were injured utilizing a simple weight-drop device consisting of a segmented brass weight free-falling through a Plexiglas guide tube. Skull fracture was prevented by cementing a small stainless-steel disc on the calvaria. Two groups of rats were tested: Group 1, consisting of 54 rats, to establish fracture threshold; and Group 2, consisting of 107 animals, to determine the primary cause of death at severe injury levels. Data from Group 1 animals showed that a 450-gm weight falling from a 2-m height (0.9 kg-m) resulted in a mortality rate of 44% with a low incidence (12.5%) of skull fracture. Impact was followed by apnea, convulsions, and moderate hypertension. The surviving rats developed decortication flexion deformity of the forelimbs, with behavioral depression and loss of muscle tone. Data from Group 2 animals suggested that the cause of death was due to central respiratory depression; the mortality rate decreased markedly in animals mechanically ventilated during the impact. Analysis of mathematical models showed that this mass-height combination resulted in a brain acceleration of 900 G and a brain compression gradient of 0.28 mm. It is concluded that this simple model is capable of producing a graded brain injury in the rodent without a massive hypertensive surge or excessive brain-stem damage.

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P6317Recipient or donor age in heart transplantation:which one fits more?

European Heart Journal ◽

10.1093/eurheartj/ehz746.0914 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

C Di Nora ◽

A Lechiancole ◽

V Ferrara ◽

S Sponga ◽

V Tursi ◽

...

Keyword(s):

Diabetes Mellitus ◽

P Value ◽

Donor Age ◽

Group 4 ◽

Surgical Data ◽

Recipient Age ◽

Group 2 ◽

The Impact ◽

Older Recipients ◽

Group 1

Abstract Increasing recipient (RA) and donor age (DA) are independently associated with mortality after Heart Transplantation (HT). The aim of this study was to analyse the impact of age-matching on HT survival. 485 recipients who underwent HT between 1990 and 2018 in our Institution were divided into four groups: RA<60-DA<50 (Group 1), RA<60-DA>50 (Group 2), RA>60-DA<50 (Group 3), RA>60-DA>50 (Group 4), and their outcomes were compared. Emergency HT, bridge with MCS and re-HT were excluded. Mean follow-up was 109±84 months. The survival of Group 1 patients was significantly higher than that of patients in other groups (p=0.001). The outcome of young recipients who received older donor grafts did not significantly differ from that of older recipients. At multivariate analysis, donor age, recipient age, Diabetes Mellitus and hypercholesterolemia correlated with long-term mortality. Demographic variables 1 (d/r) 2 (r/D) 3 (R/d) 4 (D/R) P Value Recipients data No. of patients 241 61 107 76 – Female, n (%) 50 (21) 16 (26) 17 (16) 11 (14) 0.25 Age (years), mean ± sd 49±10 54±7 64±3 65±3 <0.001* Creatinine (mg/dl), mean ± sd 1.3±0.8 1.5±0.5 1.4±0.4 1.5±0.5 0.49 Diabetes Mellitus, n (%) 33 (14) 17 (28) 38 (36) 30 (39) <0.001* Hb (g/dl), mean ± sd 12.9±2.4 11.5±2 13±1.7 12±2 0.08 Tot. Bilirubin (mg/dl), mean ± sd 1.3±1 1±0.6 1.2±0.8 1.1±0.7 0.63 sPAP (mmHg), mean ± sd 42.4±14.2 47.5±15.9 44.6±14.8 49.6±16.2 0.07 Etiology 0.003* Ischemic, n (%) 74 (30) 25 (41) 55 (51) 40 (53) Dilative, n (%) 110 (46) 24 (39) 40 (37) 29 (38) Valvular, n (%) 19 (8) 5 (8) 5 (5) 5 (6) Donors and Surgical data Age, (years) mean ± sd 31±10.5 56.5±4 36±10.5 57.5±4.5 <0.001* Female sex, n (%) 73 (30) 30 (49) 38 (35) 33 (43) 0.02* LVEF, mean ± sd 58±4 56±5 60±9 63±9 0.73 Graft ischemia time (min), mean ± sd 198±63 205±62 209±64 193±69 0.75 ECC time (min), mean ± sd 218±72 213±64 214±70 192±53 0.45 In this study, the use of hearts from older donors did not affect survival of older recipients; conversely, in young recipients it increased the risk of mortality.

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High visceral adiposity index associated with metabolic syndrome impairs erectile function in sexually active men.

10.22541/au.160765038.84087065/v1 ◽

2020 ◽

Author(s):

Mustafa Bolat ◽

Mustafa Latif Özbek ◽

Bekir Şahin ◽

Merve YILMAZ ◽

Fatih Kocamanoğlu ◽

...

Keyword(s):

Metabolic Syndrome ◽

Sexual Function ◽

Erectile Function ◽

Visceral Adiposity Index ◽

Characteristic Analysis ◽

The Metabolic Syndrome ◽

Increased Risk ◽

Group 2 ◽

The Impact ◽

Group 1

Aims:Erectile dysfunction (ED) is a common condition affected by many factors. We aimed to show the impact of the metabolic syndrome (MeTS) on male sexual function based on VAI and the impact of increased levels of the VAI was investigated in patients with ED among the patients with and without MeTS. Methods:Participants who met MeTS criteria (Group 1, n=96) and without MeTS (Group 2, n=189) were included in this cross-sectional study. The MeTS diagnosis was made in the presence of at least three of the following criteria: serum glucose level higher than 100 mg/dl, HDL cholesterol level below 40 mg/dl, triglyceride level greater than 150 mg/dl, waist circumference greater than 102 cm and blood pressure greater than 130/85 mmHg. Demographic data were recorded; biochemical and hormonal tests were measured. Erectile and other sexual function scores were recorded. The VAI was calculated using the [(WC/39.68)+(1.88xMI)]xTG/1.03x1.31/HDL formula. Results:Mean age, smoking volume, T and T/E2 ratios of the groups were similar (p>0.05). Mean VAI was two-fold higher in patients in Group 1 (p<0.001) and erectile function score was lower in Group 1 than Group 2 (p=0.001). Other sexual function scores were similar (p>0.05). The METS was associated with an increased risk of ED (p=0.001). Logistic regression analysis showed that each integer increase of the VAI was associated with a 1.4-fold increased risk of ED (p<0.001). Higher T values were associated with a better erectile function (p=0.03). For the VAI=4.33, receiver-operating characteristic analysis showed a sensitivity of 89.6 % and specificity of 57.7 %. Conclusion:Compared to non-MeTS, the presence of MeTS has emerged as a risk factor for patients with ED with high VAI levels while the other sexual functions are preserved. Management of ED patients with MeTS should cover a comprehensive metabolic and endocrinological evaluation in addition to andrological work up.

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Dyslipidemia in patients with atrial fibrillation on the background of acute coronary syndrome according to the register of the Krasnodar region

Innovative medicine of Kuban ◽

10.35401/2500-0268-2019-15-3-19-24 ◽

2019 ◽

pp. 19-24

Author(s):

Z. G. Tatarintseva ◽

E. D. Kosmacheva

Keyword(s):

Myocardial Infarction ◽

Atrial Fibrillation ◽

Acute Coronary Syndrome ◽

Mortality Rate ◽

Persistent Atrial Fibrillation ◽

Coronary Syndrome ◽

Increased Risk ◽

Group 2 ◽

General Mortality ◽

Group 1

Aim Atrial fibrillation (AF) is connected with the increased risk of stroke, mortality rate and costs for health care around the world. Earlier the predictive role of a dyslipidemia was not estimated in available literature.Material and methods This retrospective study included 13,244 patients who consistently referred to SRI-KKB #1, Krasnodar, with acute coronary syndrome from November 20, 2015 to November 20, 2017. Primary final points were defined both as mortality from all reasons and from the cardiovascular events. Secondary final points were defined as repeated myocardial infarction. Follow up period was 12 months.Results In the studied group ACS + AF we included 201 patients. This group of patients was divided into 3 subgroups: patients with originally developed AF episode accompanied with acute coronary syndrome, included 52 patients (Group 1), patients with constant AF form, included 96 patients (Group 2) and patients with paroxysmal or persistent atrial fibrillation registered before ACS episode, included 53 patients (Group 3). In Group 1 the level of the general cholesterol and low-density lipoproteins (LDL) was authentically higher. Among the survived and discharged patients after ACS episode there were 45 patients in Group 1, in Group 2 and 3 there were 81 and 47 patients, respectively. In 12 months the general mortality rate was comparable, however, the frequency of lethal and non-lethal myocardial infarction development was authentically higher in Group 1.Conclusions Higher initial levels of the general cholesterol and LDL are connected with development repeated MI that does not affect the general mortality rate. However, these data are obtained in a small selection of patients and demand a further investigation.

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