Glycemic control is associated with lower odds of mortality and successful extubation in severe COVID-19

Context Corticosteroids, specifically dexamethasone, have become the mainstay of treatment for moderate to severe COVID-19. Although the RECOVERY trial did not report adverse effects of corticosteroids, the METCOVID (Methylprednisolone as Adjunctive Therapy for Patients Hospitalized with COVID-19) study reported a higher blood glucose level in patients receiving methylprednisolone. Objectives This study aims to analyze the association between corticosteroids and COVID-19–related outcomes in patients admitted to the medical ICU (MICU) for COVID-19 pneumonia. Methods This is an observational study of 141 patients admitted to the MICU between March 18 and June 7, 2020. Data on demographics, laboratory and imaging studies, and clinical course were obtained, including data on corticosteroid use. Bivariate analyses and logistic regression were performed between patient characteristics and mortality and successful extubation. Results Of the 141 patients, 86 required mechanical ventilation, 50 received steroids, and 71 died. Regarding demographics, patients had a median age of 58 (interquartile range [IQR] 48, 65), Hispanic (57.4%, n=81), and non-Hispanic Black (37.5%, n=53). The most prevalent comorbidities were hypertension (49.6%, n=70) and diabetes (48.2%, n=68). Lower blood glucose levels on admission (125.5 vs. 148 mg/dL, p=0.025) and lower peak blood glucose levels on corticosteroids (215.5 vs. 361 mg/dL, p=0.0021) were associated with lower prevalence of mortality. Patients who were successfully extubated had a lower admission blood glucose (126.5 vs. 149 mg/dL, p=0.0074) and lower peak blood glucose on corticosteroids (217 vs. 361 mg/dL, p=0.0023). Conclusions Lower blood glucose on admission and lower maximum blood glucose on corticosteroids were associated with lower odds of mortality and successful extubation, regardless of preexisting diabetes. Hyperglycemia may be negating any potential benefit of corticosteroid therapy. These findings suggest that glucose control could be a parameter that impacts the outcome of patients receiving corticosteroids for COVID-19 pneumonia.

PELATIHAN PEMBUATAN TEPUNG SIAP SAJI BERBAHAN DASAR UMBI PORANG (Amorphopallus oncophyllus P.) SEBAGAI PANGAN FUNGSIONAL BAGI LANSIA DI PANTI WERDHA TRESNO MUKTI TUREN

ABSTRAKPanti Werdha Tresno Mukti berada di Desa Pagedangan Kec. Turen, Kab. Malang. Perubahan aspek fisik, mental dan sosial yang terjadi pada lansia mempengaruhi kondisi kesehatan para lansia baik secara mental maupun fisik. Munculnya berbagai penyakit pada lansia akan meningkatkan resiko kekurangan nutrisi akibat kehilangan nafsu makan. Tambahan asupan makanan pendamping diperlukan sebagai pangan fungsional yang memberi manfaat kesehatan bagi para lansia. Porang (Amorphophallus oncophyllus. P) mengandung glucomannan berbentuk tepung atau serat alami yang larut di dalam air dan sering diolah menjadi produk makanan seperti mie shirataki, konnyaku, bahan campuran kue, roti, jeli, selai, es krim dan lain sebagainya. Mengkonsumsi umbi porang diketahui dapat menurunkan lipida darah, menurunkan glukosa darah, mencegah dan menghambat kanker, menurunkan obesitas dan mengatasi sembelit. Tujuan pelatihan ini untuk menambah pengetahuan dan ketrampilan para pengasuh lansia sebagai mitra dalam pemanfaatan umbi porang menjadi alternatif makanan sehat bagi lansia. Adapun metode yang digunakan adalah pelatihan secara on-line dengan pendekatan partisipatif. Kegiatan ini telah terlaksana selama bulan Juli 2021, dari 17 pengasuh lansia yang melihat video pembuatan tepung siap saji berbahan dasar umbi porang ada 14 pengasuh lansia atau 82% telah dapat membuat dengan benar. Secara keseluruhan kegiatan berjalan lancar serta antusiasme pendamping sangat baik Kata Kunci : Amorphophallus oncophyllus; glukomanan: iles-iles; lansia; porang ABSTRACTThe Tresno Mukti Nursing Home is located in Pagedangan Village, Kec. Turen , Kab. Malang. Change in physical, mental and social aspects that occur in the elderly affect the health condition of the elderly both mentally and physically. The emergence of various diseases in the elderly will increase the risk of nutritional deficiencies due to loss of appetite. Additional intake of complementary foods is needed as functional food that provides health benefits for the elderly. Porang (Amorphophallus oncophyllus. P) contains glucomannan in the form of flour or natural fiber that is soluble in water and is often processed into food products such as shirataki noodles, konnyaku, cake mix ingredients, bread, jelly, jam, ice cream and so on. Consuming porang tubers is known to lower blood glucose prevent and inhibit cancer, reduce obesity and treat constipation. The purpose of this training is to increase the knowledge and skills of elderly caregivers as partners in using porang tubers as an alternative to healthy food for th elderly. This activity has been carried out during July 2021, from 17 elderly caregivers who saw the video of making ready to eat flour made from porang tubers, 14 elderly caregivers or 82 % were able to make it correctly. Overall the activity went smoothly and the enthusiasm of the companion was very good. Keywords: Amorphophallus oncophyllus; elderly; glucomannan; iles-iles; porang

Chronic cerebral hypoperfusion in male rats results in sustained HPA activation, and hyperinsulinemia

Vascular contributions to cognitive impairment and dementia (VCID) is a spectrum of cognitive deficits caused by cerebrovascular disease, for which insulin resistance is a major risk factor. A major cause of VCID is chronic cerebral hypoperfusion (CCH). Under stress, sustained hypothalamic-pituitary-adrenal axis (HPA) activation can result in insulin resistance. Little is known about the effects of CCH on the HPA axis. We hypothesized that CCH causes sustained HPA activation and insulin resistance. Male rats were subjected to bilateral carotid artery stenosis (BCAS) for 12 weeks to induce CCH and VCID. BCAS reduced cerebral blood flow and caused memory impairment. Plasma adrenocorticotropic hormone was increased in the BCAS rats (117.2 ± 9.6 vs. 88.29 ± 9.1 pg/mL, BCAS vs. sham, p = 0.0236), as was corticosterone (220 ± 21 vs. 146 ± 18 ng/g feces, BCAS vs. sham, p = 0.0083). BCAS rats were hypoglycemic (68.1 ± 6.1 vs. 76.5± 5.9 mg/dL, BCAS vs. sham, p = 0.0072), with increased fasting insulin (481.6 ± 242.6 vs. 97.94± 40.02 pmol/L, BCAS vs. sham, p = 0.0003) indicating BCAS rats were insulin resistant (HOMA-IR:11.71 ± 6.47 vs. 2.62 ± 0.93; BCAS vs. control, p = 0.0008). Glucose tolerance tests revealed that BCAS rats had lower blood glucose AUCs than controls (250 ± 12 vs. 326 ± 20 mg/dL/h, BCAS vs. sham, p = 0.0075). These studies indicate that CCH causes sustained activation of the HPA and results in insulin resistance, a condition that is expected to worsen VCID.

Abstract 1122‐000176: Incidence and Predictors of Delayed Functional Independence in the TREVO Retriever Registry

Introduction : Chronological heterogeneity in the neurological improvement after endovascular thrombectomy (EVT) for large vessel occlusion (LVO) stroke is commonly observed in clinical practice. Understanding the temporal progression of functional independence after EVT, especially delayed functional independence in patients who do not experience early improvement, is essential for prognostication and rehabilitation. We aim to determine the incidence of early and delayed functional independence and identify associated predictors after EVT. Methods : Demographic, clinical, radiological, treatment, and procedural information were analyzed from TREVO registry (patients undergoing EVT in the setting of anterior circulation LVO using the Trevo stent‐retriever). Incidence and predictors of early functional independence (EFI, modified Rankin Scale (mRS) score 0–2 at discharge) and delayed functional independence (DFI, mRS score 0–2 at 90 days in non‐EFI patients) were analyzed. Results : A total of 1757 patients met study criteria. EFI was observed in 45% (785) of patients. Among non‐EFI patients (972), DFI was observed in 34% (332) of patients. Younger age (p<0.001), lower blood glucose (p<0.001), mTICI > = 2B (p = 0.01), and lower total number of thrombectomy passes (p = 0.004) were independent predictors of DFI. Conclusions : Approximately 45% of patients experience early functional independence. One‐third of non‐early improvers experience delayed functional independence. Younger age, lower blood glucose, better collateral grade, and lower total number of passes were independent predictors of DFI among non‐early improvers. Further studies are required to improve our understanding of DFI. No upload

Presence of Adult Companion Goats Favors the Rumen Microbial and Functional Development in Artificially Reared Kids

Newborn dairy ruminants are usually separated from their dams after birth and fed on milk replacer. This lack of contact with adult animals may hinder the rumen microbiological and physiological development. This study evaluates the effects of rearing newborn goat kids in contact with adult companions on the rumen development. Thirty-two newborn goat kids were randomly allocated to two experimental groups which were reared either in the absence (CTL) or in the presence of non-lactating adult goats (CMP) and weaned at 7 weeks of age. Blood and rumen samples were taken at 5, 7, and 9 weeks of age to evaluate blood metabolites and rumen microbial fermentation. Next-generation sequencing was carried out on rumen samples collected at 7 weeks of age. Results showed that CTL kids lacked rumen protozoa, whereas CMP kids had an abundant and complex protozoal community as well as higher methanogen abundance which positively correlated with the body weight and blood β-hydroxybutyrate as indicators of the physiological development. CMP kids also had a more diverse bacterial community (+132 ASVs) and a different structure of the bacterial and methanogen communities than CTL kids. The core rumen bacterial community in CMP animals had 53 more ASVs than that of CTL animals. Furthermore, the number of ASVs shared with the adult companions was over 4-fold higher in CMP kids than in CTL kids. Greater levels of early rumen colonizers Proteobacteria and Spirochaetes were found in CTL kids, while CMP kids had higher levels of Bacteroidetes and other less abundant taxa (Veillonellaceae, Cyanobacteria, and Selenomonas). These findings suggest that the presence of adult companions facilitated the rumen microbial development prior to weaning. This accelerated microbial development had no effect on the animal growth, but CMP animals presented higher rumen pH and butyrate (+45%) and ammonia concentrations than CTL kids, suggesting higher fibrolytic and proteolytic activities. CMP kids also had higher blood β-hydroxybutyrate (+79%) and lower blood glucose concentrations (-23%) at weaning, indicating an earlier metabolic development which could favor the transition from pre-ruminant to ruminant after the weaning process. Further research is needed to determine the effects of this intervention in more challenging farm conditions.

Binahong (Anredera cordifolia (Tenore) Steen.) Leaf Extract Modulates Fatty Acids and Amino Acids to Lower Blood Glucose in High-Fat Diet-Induced Diabetes Mellitus Rats

Patients with diabetes are 1.6 times more likely to use complementary alternative medicine than nondiabetic patients. Previous studies have shown that Anredera cordifolia (Tenore) Steen. (A. cordifolia) leaf extract has the capacity to lower blood glucose, but the actual mechanisms are unclear. Therefore, in this study, we explored the effect of A. cordifolia leaf extract on the metabolism of fatty acids and amino acids. Six-week-old male Wistar rats were randomly divided into six experimental groups (n = 5 per group). Two groups were fed with a regular diet or a high-fat diet (HFD) for six weeks. The regular diet and HFD groups were administered with 0.5% carboxymethylcellulose as a vehicle, and HFD rats were also fed with a suspension of glibenclamide (0.51 mg/kg body weight (BW)) or A. cordifolia leaf extract (25, 50, and 100 mg/kg BW). During the whole treatment, BW and food intake were recorded weekly. The rats were euthanized seven weeks after treatment. Blood glucose was evaluated by spectrophotometry, while fatty acids and amino acids were evaluated using a gas chromatography/flame ionization detector (GC/FID). All doses of A. cordifolia administration reduced blood glucose significantly, and 50 mg/kg BW was most effective in lowering blood glucose, similar to the effects of glibenclamide. A. cordifolia leaf extract affected the levels of medium-chain fatty acids, especially at 50 mg/kg BW. In contrast, glibenclamide affected long-chain fatty acids (LCFAs) to lower blood glucose. Based on the analysis conducted, we conclude that administration of A. cordifolia leaf extract can decrease blood glucose levels by regulating fatty acid metabolism and that a dose of 50 mg/kg BW in rats was the optimal dose.

Rational Use of Protein Supplements in the Elderly—Relevance of Gastrointestinal Mechanisms

Protein supplements are increasingly used by older people to maintain nutrition and prevent or treat loss of muscle function. Daily protein requirements in older people are in the range of 1.2 gm/kg/day or higher. Many older adults do not consume this much protein and are likely to benefit from higher consumption. Protein supplements are probably best taken twice daily, if possible soon after exercise, in doses that achieve protein intakes of 30 gm or more per episode. It is probably not important to give these supplements between meals, as we have shown no suppressive effects of 30 gm whey drinks, and little if any suppression of 70 gm given to older subjects at varying time intervals from meals. Many gastrointestinal mechanisms controlling food intake change with age, but their contributions to changes in responses to protein are not yet well understood. There may be benefits in giving the supplement with rather than between meals, to achieve protein intakes above the effective anabolic threshold with lower supplement doses, and have favourable effects on food-induced blood glucose increases in older people with, or at risk of developing, type 2 diabetes mellitus; combined protein and glucose drinks lower blood glucose compared with glucose alone in older people.

A Comparison of the Gluco-Regulatory Responses to High-Intensity Interval Exercise and Resistance Exercise

High-intensity interval exercise and resistance exercise both effectively lower blood glucose; however, it is not clear whether different regulatory mechanisms exist. This randomised cross-over study compared the acute gluco-regulatory and the physiological responses of high-intensity interval exercise and resistance exercise. Sixteen (eight males and eight females) recreationally active individuals, aged (mean ± SD) 22 ± 7 years, participated with a seven-day period between interventions. The high-intensity interval exercise trial consisted of twelve, 30 s cycling intervals at 80% of peak power capacity and 90 s active recovery. The resistance exercise trial consisted of four sets of 10 repetitions for three lower-limb exercises at 80% 1-RM, matched for duration of high-intensity interval exercise. Exercise was performed after an overnight fast, with blood samples collected every 30 min, for two hours after exercise. There was a significant interaction between time and intervention for glucose (p = 0.02), which was, on average (mean ± SD), 0.7 ± 0.7 mmol∙L−1 higher following high-intensity interval exercise, as compared to resistance exercise. Cortisol concentration over time was affected by intervention (p = 0.03), with cortisol 70 ± 103 ng∙mL−1 higher (p = 0.015), on average, following high-intensity interval exercise. Resistance exercise did not induce the acute rise in glucose that was induced by high-intensity interval exercise and appears to be an appropriate alternative to positively regulate blood glucose.