32 research outputs found
Clinical Signs and Laboratory Parameters as Predictors of Mortality among Hospitalized Human Immunodeficiency Virus-Infected Adult Patients at Tertiary Hospital in Surabaya
BACKGROUND: The morbidity and mortality rates due to human immunodeficiency virus (HIV) infection are still high despite various and advanced efforts in the management given for HIV/AIDS patients.
AIM: This study proposed that clinical signs and laboratory parameters could be expected to predict the patientβs mortality.
METHODS: This retrospective study was done by collecting 408 medical records of adult HIV/AIDS inpatients at a tertiary hospital in Surabaya from January 1, 2017, to December 31, 2019. Bivariate analysis using Chi-square test was carried out on nine variables, which were Glasgow Coma Scale (GCS) <15, hypotension, PaO2/FiO2 <400 mmHg, elevated liver enzymes, hemoglobin levels <10 mg/dl, platelet count <150,000/mm, albumin levels <3.5 mg/dl, and body mass index (BMI) <18.5 kg/m, eGFR <60 ml/min/1.73 m. Variables which met the criteria would be included in the multivariate analysis using logistic regression.
RESULTS: Based on bivariate analysis, mortality was found to be significantly associated with GCS <15, hypotension, PaO2/FiO2, elevated liver enzymes, platelet count <100,000 mm, albumin levels <3.5 mgdl, and BMI <18.5 kg/m, eGFR <60 ml/1.73kg/m. However, based on multivariate analysis, there were five variables which were found to be able to independently predict the patientsβ mortality, those were GCS <15 (OR 11.625), hypotension (OR 6.062), PaO2 /FiO2 < 400 mmHg (OR 7.794), eGFR <60 ml/min/1.73 m (OR 2.646), and albumin levels <3.5 mg/dl (OR 4.091).
CONCLUSION: GCS <15, hypotension, PaO2 /FiO2 <400 mmHg, eGFR <60 ml/1.73g/m , and albumin levels <3.5 mg/dl were found as the independent risk factors which could predict the hospitalized HIV/AIDS patientsβ mortality
B-Complex Vitamins
This book provides the most current information on the effects of vitamin B deficiency as well as the roles of niacin (vitamin B3), pyridoxine (vitamin B6), folate (vitamin B9), and vitamin B12 in numerous disorders. Chapters discuss novel applications of B-complex vitamins, such as thiamin in patients with critical conditions, dietary supplements in the prevention of renal stones, and treatment of COVID-19. Throughout, the authors discuss the effects of vitamin B deficiency from retrospective, perspective, and prospective points of view
Maternal Diabetes, Related Biomarkers and Genes, and Risk of Orofacial Clefts
Orofacial clefts (OFCs) are among the most common congenital birth defects and are characterized by incomplete development of the lip or the palate or both. The lip and palate develop separately at different times during the first trimester of pregnancy. The etiology of OFCs is multifactorial and includes a combination of genetic and environmental factors. This project aims to examine role of maternal diabetes mellitus in orofacial clefts through studies of medical histories, biomarkers, and genes.
In a study of Utah birth certificates, mothers with pre-existing diabetes and gestational diabetes mellitus (GDM) had an increased risk of OFCs, and obese mothers also had an increased risk. Mothers of children with OFCs were more likely than mothers of unaffected children to develop obesity, metabolic syndrome and gestational diabetes mellitus later in life. These result were more strongly related to cleft palate than cleft lip. Many genes related to GDM were associated with OFCs through genetic effects alone and gene-environment interaction effects with periconceptional maternal multivitamin use, maternal smoking, and environmental tobacco smoke. These results support the hypothesis that GDM may be causally related to OFCs via multiple GDM susceptibility genes and interactions with environmental factors.
Individuals with OFCs face both physical and mental health problem, which require multi-specialty team care. OFC prevention and prediction are important to public health. This dissertation reported that maternal diabetes mellitus, maternal pre-pregnancy weight and genes related to GDM had an association with the risk of OFCs. Mothers having an OFC child had an increased risk of developing metabolic abnormalities later in life. Potential risk factors were reported in this dissertation that may be useful for OFC prevention. This dissertation also reported potential biomarkers for predicting OFCs. Moreover, mothers having an OFC child may require regular monitoring of metabolic abnormalities later in life
Side Effects of Drugs in Patients with Nasopharyngeal Carcinoma Receiving Neoadjuvant Chemotherapy
Background: Nasopharyngeal carcinoma (NPC) therapy includes radiation, chemotherapy, or a combination of both. The purpose of this study was to determine the incidence of drug side effects in NPC patients receiving neoadjuvant chemotherapy. Methods: This was a retrospective descriptive study using secondary data in the form of medical records at Dr. Soetomo Hospital, Surabaya, from January 1 to December 31, 2018. Results: Comparison of the number of patients with the incidence of side effects of chemotherapy drugs was 1:3.8. Anemia was the most side effect of chemotherapy drugs with 85 cases (24.85%), followed by hypocalcemia with 78 cases (22.81%), and hyponatremia with 60 cases (17.54%). Leukopenia was the rarest type of side effect of chemotherapy drugs, with only one in 342 cases (0.29%). Based on the degree, it was found that the most side effects of chemotherapy drugs were first degree with 253 cases (73.98%), followed by second degree with 78 cases (22.81%), third degree with 9 cases (2.63%), and degree IV with 2 cases (0.58%). There were no side effects of grade V drugs in the samples. Conclusion: The incidence of side effects of neoadjuvant chemotherapy drugs was 77.24% with the most side effects of anemia
Establishing the association of type 2 diabetes and insulin resistance with Tuberculosis and Coronary Heart Diseases among euglycaemic and diabetic patients in Saudi Arabia
Background: Patients with Coronary Heart Disease (CHD) or Tuberculosis (TB) are more likely to have Type 2 Diabetes Mellitus (T2DM). Insulin Resistance (IR) in patients with normal glucose may also be a risk factor for these conditions. Methods: This thesis explored whether T2DM and IR are risk factors for TB enrolled patients receiving TB treatment in the previous year and controls. In addition, the thesis explores whether T2DM and IR are risk factors for CHD among patients with stable CHD and controls. The studies were based in Saudi Arabia and used cross sectional surveys and case controls design. Controls were asymptomatic adults attending the TB clinics for labour reasons. All participants were screened for fasting plasma glucose (FPG), insulin, glycated haemoglobin (HbA1c) and lipids. We assessed the severity of the clinical presentation of TB among patients with T2DM, IR and normal glucose. Finally, we described the quality of life of patients with CHD among patients with T2DM, IR and normal glucose. Results: One hundred seventy-five adults with pulmonary TB and 140 controls were recruited (36.6% and 40.7% female and 63.4% and 59.3% male, respectively). Twenty-nine per cent of TB cases had T2DM and 22% normoglycemic IR. 3.3% of patients were unaware of their T2DM diagnosis. TB was associated with prediabetes (AOR 5.112, p = 0.032), low level of risky HDL Cholesterol (AOR 0.316, p = 0.001) and non-Saudi nationalities (AOR 4.018, p Λ 0.001). Former TB cases were more likely to eat fast foods (1 β 2 times/week, AOR 2.857 and 2 β 3 times/month, AOR 3.126, p = 0.026, respectively) and to have a fair or poor diet (AOR 13.518, and AOR 37.766, respectively) (p Λ 0.001). Three hundred twenty-five patients with stable CHD and were recruited (29.2% and 39.9% female and 70.8% and 60.1% male, respectively). Of these 65% had T2DM and 31.3% normoglycemic IR. Almost 6% of patients were unaware of their T2DM status. CHD were more likely to have T2DM (AOR 4.974, p = 0.034), high FPG (AOR 5.034, p = 0.021), to be male (AOR 9.950, p Λ 0.001), aged above 50 years old (p Λ 0.015), Saudi (AOR 6.879, p = 0.002), to have primary education (AOR 20.315, p = 0.004), hypertension (AOR 5.920, p = 0.003) and to take lipid lowering medications (AOR 24.516, p Λ 0.001) than controls. Cases were more likely to have high WHR (AOR 33.997, p Λ 0.001) and diastolic BP (AOR 1.080, p = 0.004) than controls. CHD-IR cases had lower quality of life and satisfaction scores with bodily appearance (p = 0.003), overall perception of satisfaction with themselves (p = 0.041) and score in the psychological domains (p = 0.006) than controls. Patients with CHD and T2DM had lower overall scores for quality of life (p = 0.002), satisfaction with bodily appearance (p = 0.012), overall perception of satisfaction with themselves (p = 0.015), with access to health services (p = 0.049) and satisfaction score with transport (p = 0.027) than controls. Conclusion: TB was more prevalent among non-Saudi nationals and males. Patients with TB were more likely to have T2DM, and to be prediabetic, but not more likely to have IR than controls. More efforts are required to upscale the detection of T2DM among TB patients. Patients with CHD were more likely to be male and to have T2DM and IR than controls. Patients with CHD and IR had a lower quality of life than controls. More efforts are required to upscale the management of T2DM and IR among CHD patients
Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective
This Report has a number of inter-related general purposes. One is to explore the extent to which food, nutrition, physical activity, and body composition modify the risk of cancer, and to specify which factors are most important. To the extent that environmental factors such as food, nutrition, and physical activity influence the risk of cancer, it is a preventable disease. The Report specifies recommendations based on solid evidence which, when followed, will be expected to reduce the incidence of cancer
Patterns of injury and violence in YaoundΓ© Cameroon: an analysis of hospital data.
BackgroundInjuries are quickly becoming a leading cause of death globally, disproportionately affecting sub-Saharan Africa, where reports on the epidemiology of injuries are extremely limited. Reports on the patterns and frequency of injuries are available from Cameroon are also scarce. This study explores the patterns of trauma seen at the emergency ward of the busiest trauma center in Cameroon's capital city.Materials and methodsAdministrative records from January 1, 2007, through December 31, 2007, were retrospectively reviewed; information on age, gender, mechanism of injury, and outcome was abstracted for all trauma patients presenting to the emergency ward. Univariate analysis was performed to assess patterns of injuries in terms of mechanism, date, age, and gender. Bivariate analysis was used to explore potential relationships between demographic variables and mechanism of injury.ResultsA total of 6,234 injured people were seen at the Central Hospital of YaoundΓ©'s emergency ward during the year 2007. Males comprised 71% of those injured, and the mean age of injured patients was 29 years (SDΒ =Β 14.9). Nearly 60% of the injuries were due to road traffic accidents, 46% of which involved a pedestrian. Intentional injuries were the second most common mechanism of injury (22.5%), 55% of which involved unarmed assault. Patients injured in falls were more likely to be admitted to the hospital (pΒ <Β 0.001), whereas patients suffering intentional injuries and bites were less likely to be hospitalized (pΒ <Β 0.001). Males were significantly more likely to be admitted than females (pΒ <Β 0.001)DiscussionPatterns in terms of age, gender, and mechanism of injury are similar to reports from other countries from the same geographic region, but the magnitude of cases reported is high for a single institution in an African city the size of YaoundΓ©. As the burden of disease is predicted to increase dramatically in sub-Saharan Africa, immediate efforts in prevention and treatment in Cameroon are strongly warranted
Polycystic ovary syndrome β burden and adverse outcomes
Background
Polycystic ovary syndrome (PCOS) is the most common, yet underdiagnosed, endocrine disorder in women of reproductive age, posing lifelong threats to their health with limited therapeutic options. Within UK primary care, there is a lack of evidence exploring the extent of missed PCOS diagnosis and possible ethnic variation in the incidence of PCOS. Furthermore, there is lack of (conclusive) evidence on the burden of PCOS including trends in the incidence of impaired glucose regulation outcomes, risk of adverse obstetric outcomes and susceptibility to COVID-19. Finally, the effectiveness of combined oral contraceptive pills (COCP), commonly prescribed for the management of PCOS symptoms, for longer term benefits such as prevention of impaired glucose regulation has not been explored. In this doctoral thesis, I undertook a series of retrospective studies using UK primary and secondary care data to address these research gaps.
Methods
A retrospective cohort of all eligible patients registered within the Clinical Practice Research Datalink (CPRD) Gold database between 1995 and 2019 was used to explore the incidence and prevalence trends of confirmed and possible PCOS diagnosis (based on relevant symptom codes) to estimate the extent of missed diagnosis, and the incidence estimates were stratified by ethnic subgroups. In subgroups of women with confirmed and possible PCOS diagnosis, incidence trends of type 2 diabetes, impaired glucose regulation (IGR) and gestational diabetes mellitus (GDM) were estimated. Using CPRD Gold Pregnancy Register and linked Hospital Episode Statistics data, pregnancies of women with PCOS between 1997 and 2020 were age matched to pregnancies of women without PCOS to observe the odds of four primary outcomes among the two groups of pregnancies: (1) preterm delivery, (2) mode of delivery, (3) high and low birthweight, and (4) stillbirth. Using contemporaneous data from The Health Improvement Network (THIN) provided by Cegedim (January-July 2020), the hazard of confirmed or suspected COVID-19 was estimated among women with PCOS compared to an age matched cohort of women without PCOS. Finally, using a nested case-control design of a base cohort of women with PCOS identified from THIN, women with and without incident development of impaired glucose regulation were matched, and the odds of COCP prescription within a predefined exposure window was estimated.
Results
The incidence and prevalence of PCOS rose sharply in the year 2004, followed by stabilisation of the incidence rate. In addition to confirmed diagnosis, inclusion of symptom codes representing Rotterdam criteria resulted in 299 (95% CI, 198β299) missed PCOS diagnoses per 100,000 person-years. The prevalence of PCOS was highest among South Asians followed by Afro-Caribbeans. The incidence of type 2 diabetes, IGR and GDM has been rising in women with PCOS. Pregnancies of women with PCOS were at an increased risk of preterm and operative (emergency caesarean, elective caesarean and instrumental vaginal) delivery [adjusted OR: 1.11 (95% CI, 1.06-1.17), 1.10 (1.05-1.15), 1.07 (1.03-1.12), 1.04 (1.00-1.09), respectively]. Women with PCOS had a 28% increased risk of COVID-19 [adjusted HR: 1.28 (95% CI, 1.05-1.561)]. Women with PCOS and COCP use had a reduced risk of impaired glucose regulation [adjusted OR: 0.72, (95% CI, 0.59β0.87)].
Conclusion
There is a high level of missed PCOS diagnosis in primary care and an increasing ethnic disparity in the incidence of PCOS. The increased risk of adverse obstetric outcomes and susceptibility to COVID-19 should be clearly conveyed to women with PCOS. Future investigations should explore barriers to care and management of women with PCOS, especially from ethnic minority communities, and should examine the efficacy of COCP in prevention of impaired glucose regulation in a randomized controlled trial setting
Smoking and Second Hand Smoking in Adolescents with Chronic Kidney Disease: A Report from the Chronic Kidney Disease in Children (CKiD) Cohort Study
The goal of this study was to determine the prevalence of smoking and second hand smoking [SHS] in adolescents with CKD and their relationship to baseline parameters at enrollment in the CKiD, observational cohort study of 600 children (aged 1-16 yrs) with Schwartz estimated GFR of 30-90 ml/min/1.73m2. 239 adolescents had self-report survey data on smoking and SHS exposure: 21 [9%] subjects had βeverβ smoked a cigarette. Among them, 4 were current and 17 were former smokers. Hypertension was more prevalent in those that had βeverβ smoked a cigarette (42%) compared to non-smokers (9%),