Aortic stiffness and microalbuminuria in patients with chronic obstructive pulmonary disease

AbstractBackgroundCardiovascular diseases (CVDs) remain a major leading cause of morbidity and mortality in patients with chronic obstructive pulmonary disease (COPD). Increased aortic stiffness is an independent predictor of cardiovascular disease. Microalbuminuria (MAU) reflects increased permeability of the glomerulus, usually due to microvascular damage and suggested as an early prognostic cardiovascular marker. So this study was done to determine the prevalence of aortic stiffness in patients with COPD and to evaluate the relationship of MAU levels with the degree of aortic stiffness.Subjects and methodsThis study was done at Respirology, Cardiology, Internal Medicine, and Clinical Pathology Departments, Farwaniya Hospital, Ministry of Health, State of Kuwait in the period between July 2013 and October 2014. A total 60 patients was distributed into 38 patients with COPD (group 1) and 22 control subjects (group 2). Patients with COPD and controls underwent spirometry, blood pressure, aortic stiffness assessment using aortic pulse wave velocity (aPWV) study and provided a spot urine sample for MAU measurement.ResultsPatients with COPD (group 1) had increased aortic stiffness compared with matched controls (group 2) 11.2±2.3 vs. 7.8±1.5m/s, P<0.05. Patients with GOLD III and IV had significant higher aPWV values as compared to patients with GOLD I and II (P<0.05). Multiple logistic regression analyses revealed that the adjusted odds ratios of having MAU for aPWV quartile III and IV were 6.38 (95% confidence interval: 2.37–13.2) and 6.58 (95% confidence interval: 1.59–22.0) respectively, P<0.05.ConclusionsCOPD is associated with increased aortic stiffness. MAU is independently related to aortic stiffness in patients with COPD. Further studies are necessary to investigate whether MAU could be an effective biomarker of aortic stiffness and potential cardiovascular compromise in patients with COPD

The impact of smoking on inflammatory biomarkers in patients with chronic obstructive pulmonary disease

AbstractBackgroundChronic obstructive pulmonary disease (COPD) is a chronic progressive inflammatory disease characterized by airflow limitation that is not fully reversible (Nillawar et al., 2012). The pathophysiology of COPD is not completely understood. Cigarette smoking is a major risk factor for chronic obstructive pulmonary disease (COPD). Elevated CRP has been increasingly used as a surrogate marker of systemic inflammation in diverse conditions. TNF-α, a powerful pro-inflammatory cytokine primarily produced by activated macrophages, is thought to play a critical role in the pathogenesis of COPD (Higashimoto et al., 2008; Churg et al., 2002).The aim of the workTo evaluate the impact of smoking on inflammatory biomarkers and relations between these biomarkers and the decline of lung function in COPD patients.MethodsThis case–control observational prospective study was conducted on fifty-eight clinically stable COPD patients (26 non-smokers and 32 current smokers; at different stages ranged from mild to very severe), their mean age 53.1±14.25 and 53.9±5.95years respectively), recruited from Chest Department, Assiut University Hospitals. All patients met the Global Initiative for Obstructive Lung Disease (GOLD) (Battaglia et al., 2007). All participants were subjected to thorough history taking, full clinical examination, anthropometric measurements with spirometry and chest X-ray. Peripheral hemogram, liver function tests, kidney function tests, high sensitivity C-reactive protein (hs CRP) and serum level of TNF-α were measured for both patients and controls.ResultsThe concentrations of circulating hs-CRP and TNF-α, were highly significantly elevated in patients with COPD in comparison to the control group (3.74±0.2 vs. 1.30±0.14 for hs-CRP; 33.88±5.97 vs. 8.79±0. 57 for TNF-α with p<0.0001 for each) and the levels of measured TNF-α were significantly increased with the increased degree and severity of COPD and increased severity of smoking status. Regarding the smoking status of COPD patients, there was a highly significant difference for the measured TNF-α (53. 74±9.52 versus 12.73±1.20 with p<0.0001) with no significant difference for the measured hs-CRP (3.87±0.29 versus 3.58±0.27 with p>0.05). Interestingly, there were significant negative correlations between the levels of TNF-α and hs-CRP, and FEV1 in stages II, III, and IV of COPD.ConclusionsThe circulating levels of the inflammatory markers hs-CRP and TNF-alpha are significantly elevated in patients with stable COPD and these biomarkers could be used as predictor factors for severity of inflammation in COPD patients. Longitudinal studies evaluating the effects of smoking cessation on bronchial and systemic inflammation are needed to allow better understanding of these relationships and their consequences

Immunohistochemistry of Janus Kinase 1 (JAK1) Expression in Vitiligo

Background Vitiligo is a chronic autoimmune disease in which the destruction of melanocytes causes white spots on the affected skin. Janus kinase (JAK) is a family of intracellular, non-receptor tyrosine kinases that transduce cytokine-mediated signals via the JAK–signal transducer and activator of transcription pathway. The aim of the present study is to explore the possible role of JAK1 in the pathogenesis of vitiligo using immunohistochemical methods. Methods The current study was conducted in a sample of 39 patients who presented with vitiligo and 22 healthy individuals who were age and sex matched as a control group. We used immunohistochemistry to evaluate JAK1 status (intensity and distribution) and assess the percentage of residual melanocytes using human melanoma black 45 (HMB45). Results Intense and diffuse JAK1 expression was significantly more likely to indicate vitiliginous skin compared to normal skin (p < .001). Strong and diffuse JAK1 expression was associated with short disease duration, female sex, and lower percentage of melanocytes (detected by HMB45) (p < .05). Conclusions JAK1 may be involved in the pathogenesis of vitiligo, as indicated by intense and diffuse expression compared to control and association with lower percentage of melanocytes detected by HMB45 immunostaining

The Impact of Multi-Layer Governance on Bank Risk Disclosure in Emerging Markets: The Case of Middle East and North Africa

This study examines the impact of multi-layer governance mechanisms on the level of bank risk disclosure. Using a large dataset from 14 Middle East and North Africa (MENA) countries over a period of 8 years, our findings are three-fold. First, our results suggest that the presence of a Sharia supervisory board is positively associated with the level of risk disclosure. Second and at the bank-level, we find that ownership structures have a positive effect on the level of risk disclosure. At the country-level, our evidence suggests that control of corruption has a positive effect on the level of bank risk disclosure. Our study is, therefore, a major departure from much of the existing accounting literature that offers new crucial insights that show that firms’ disclosure choices are not mainly shaped by firm-level (internal) governance arrangements, but also country-level (external) governance and religious factors. Our findings have important implications for corporate boards, investors, regulatory authorities, standards-setters and governments relating to the development, implementation and enforcement of corporate and national governance standards

Factors Affecting Outcomes of COVID-19 Infection among Older Adults with Type 2 Diabetes: A Single Center, Cross-Sectional Study

Objective: COVID-19 infection and the factors affecting it are major concerns worldwide. This retrospective study aimed to investigate clinical, laboratory and radiological characteristics associated with disease severity and hospitalization among older adults with type 2 diabetes mellitus (T2D) with COVID-19. Materials and methods: A retrospective case series study was conducted to review the records of older adults with T2D infected with COVID-19. Sociodemographic, COVID-19-related data, laboratory tests at the time of COVID-19 diagnosis and CT findings were collected. Bivariate and multivariate regression analysis were done to determine the predictors of the studied outcome, either hospitalization or complete recovery. Results: A total of 343 patients’ records were reviewed, with a mean age of 73.6 ± 6.4 years. Most of patients had fever and cough at the time of diagnosis and ground glass opacities was found on CT in 62.1% of patients. Hospitalized patients had higher duration of diabetes, suffered more from dyspnea, body aches and chest pain, had higher HbA1c, CRP and ferritin and lower lymphocytes and hemoglobin. Fasting plasma glucose and HbA1c positively affected the duration from onset of symptoms till resolution, while hemoglobin level negatively affected it. Logistic regression analysis revealed that duration of diabetes, HbA1c, ferritin and dyspnea were significant predictors of hospitalization. Conclusions: Among older adults with T2D infected with COVID-19, poor glycemic control is associated with higher risk of hospitalization and longer duration till recovery of symptoms. Longer duration of diabetes, high serum ferritin and the presence of dyspnea are associated with higher risk for hospitalization among these patients

A prospective multicentre study evaluating the outcomes of the abdominal wall dehiscence repair using posterior component separation with transversus abdominis muscle release reinforced by a retro-muscular mesh: filling a step

Background This study aimed to evaluate the results of posterior component separation (CS) and transversus abdominis muscle release (TAR) with retro-muscular mesh reinforcement in patients with primary abdominal wall dehiscence (AWD). The secondary aims were to detect the incidence of postoperative surgical site occurrence and risk factors of incisional hernia (IH) development following AWD repair with posterior CS with TAR reinforced by retromuscular mesh. Methods Between June 2014 and April 2018, 202 patients with grade IA primary AWD (Björck’s first classification) following midline laparotomies were treated using posterior CS with TAR release reinforced by a retro-muscular mesh in a prospective multicenter cohort study. Results The mean age was 42 ± 10 years, with female predominance (59.9%). The mean time from index surgery (midline laparotomy) to primary AWD was 7 ± 3 days. The mean vertical length of primary AWD was 16 ± 2 cm. The median time from primary AWD occurrence to posterior CS + TAR surgery was 3 ± 1 days. The mean operative time of posterior CS + TAR was 95 ± 12 min. No recurrent AWD occurred. Surgical site infections (SSI), seroma, hematoma, IH, and infected mesh occurred in 7.9%, 12.4%, 2%, 8.9%, and 3%, respectively. Mortality was reported in 2.5%. Old age, male gender, smoking, albumin level &lt; 3.5 gm%, time from AWD to posterior CS + TAR surgery, SSI, ileus, and infected mesh were significantly higher in IH. IH rate was 0.5% and 8.9% at two and three years, respectively. In multivariate logistic regression analyses, the predictors of IH were time from AWD till posterior CS + TAR surgical intervention, ileus, SSI, and infected mesh. Conclusion Posterior CS with TAR reinforced by retro-muscular mesh insertion resulted in no AWD recurrence, low IH rates, and low mortality of 2.5%. Trial registration Clinical trial: NCT05278117

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries