Why do men have worse COVID-19-related outcomes? A systematic review and meta-analysis with sex adjusted for age

We aimed to study the mechanism behind worse coronavirus disease-19 (COVID-19) outcomes in men and whether the differences between sexes regarding mortality as well as disease severity are influenced by sex hormones. To do so, we used age as a covariate in the meta-regression and subgroup analyses. This was a systematic search and meta-analysis of observational cohorts reporting COVID-19 outcomes. The PubMed (Medline) and Cochrane Library databases were searched. The primary outcome was COVID-19-associated mortality and the secondary outcome was COVID-19 severity. The study was registered at PROSPERO: 42020182924. For mortality, men had a relative risk of 1.36 (95%CI: 1.17 to 1.59; I² 63%, P for heterogeneity <0.01) compared to women. Age was not a significant covariate in meta-analysis heterogeneity (P=0.393) or subgroup analysis. For disease severity, being male was associated with a relative risk of 1.29 (95%CI: 1.19 to 1.40; I² 48%, P for heterogeneity <0.01) compared to the relative risk of women. Again, age did not influence the outcomes of the metaregression (P=0.914) or subgroup analysis. Men had a higher risk of COVID-19 mortality and severity regardless of age, decreasing the odds of hormonal influences in the described outcomes

Coronary artery calcium score prediction of all cause mortality and cardiovascular events in people with type 2 diabetes : systematic review and meta-analysis

Objective To investigate the association of coronary artery calcium score with all cause mortality and cardiovascular events in people with type 2 diabetes. Design Systematic review and meta-analysis of observational studies. Data sources Studies were identified from Embase, PubMed, and abstracts from the 2011 and 2012 annual meetings of the American Diabetes Association, European Association for the Study of Diabetes, American College of Cardiology, and American Heart Association (2011). Eligibility criteria Prospective studies that evaluated baseline coronary artery calcium score in people with type 2 diabetes and subsequent all cause mortality or cardiovascular events (fatal and non-fatal). Data extraction Two independent reviewers extracted the data. The predictive value of the coronary artery calcium score was assessed by random effects model.Results Eight studies were included (n=6521; 802 events; mean follow-up 5.18 years). The relative risk for all cause mortality or cardiovascular events, or both comparing a total coronary artery calcium score of ≥10 with a score of <10 was 5.47 (95% confidence interval 2.59 to 11.53; I2=82.4%, P<0.001). The overall sensitivity of a total coronary artery calcium score of ≥10 for this composite outcome was 94% (95% confidence interval 89% to 96%), with a specificity of 34% (24% to 44%). The positive and negative likelihood ratios were 1.41 (95% confidence interval 1.20 to 1.66) and 0.18 (0.10 to 0.30), respectively. For people with a coronary artery calcium score of <10, the post-test probability of the composite outcome was about 1.8%, representing a 6.8-fold reduction from the pretest probability. Four studies evaluated cardiovascular events as the outcome (n=1805; 351 events). The relative risk for cardiovascular events comparing a total coronary artery calcium score of ≥10 with a score of <10 was 9.22 (2.73 to 31.07; I2=76.7%, P=0.005). The positive and negative likelihood ratios were 1.67 (1.30 to 2.17) and 0.11 (0.04 to 0.29), respectively. Conclusion In people with type 2 diabetes, a coronary artery calcium score of ≥10 predicts all cause mortality or cardiovascular events, or both, and cardiovascular events alone, with high sensitivity but low specificity. Clinically, the finding of a coronary artery calcium score of <10 may facilitate risk stratification by enabling the identification of people at low risk within this high risk population

Nefropatia Induzida por Contraste: Medidas de Prevenção

Contrast-induced nephropathy is defined as worsening in renal function after administration of intravenous contrast and ex-clusion of other causes. Contrast-induced nephropathy is usually manifested as an acute non-oliguric renal failure. Cases of con-trast-induced nephropathy are usually defined by a fixed (0.5 mg/dl) or proportionate (25-50%) rise in serum creatinine levels 24-48 hours after exposure to the contrast medium, in the absence of other causes of renal function impairment. Prevention strategies are based on the correction of factors leading to the development of contrast-induced nephropathy and are divided into choice of less nephrotoxic contrast (non-ionic); improvement in the patient’s clinical status through hydration; use of drugs that reduce renal vaso-constriction and oxidative stress; and temporary suspension of drugs with nephrotoxic potential or that are harmful in case of re-duced glomerular filtration. The development of a protocol with preventive strategies for risk patients, especially in diabetics submit-ted to potentially nephrotoxic contrast can reduce morbidity and associated costs to its development. This review aims at describing the definition and pathogenesis of contrast-induced nephropathy, focusing on the main management recommendations to prevent its occurrence.A nefropatia do contraste é definida como piora na função renal que se segue à administração de contraste intravenoso, tendo sido excluídas outras causas. A nefropatia do contraste manifesta-se, usualmente, como uma insuficiência renal aguda não oligúrica. Por definição, deve haver um aumento na creatinina basal de 25-50% ou um aumento superior a 0,5 mg/dl em 24-48 horas após o uso intravenoso de contraste, na ausência de outras causas de piora da função renal. As medidas de prevenção são baseadas na correção dos fatores que levam ao desenvolvimento da nefropatia do contraste e dividem-se em: escolha de agentes de contraste menos nefrotóxicos (não-iônicos) e utilização de doses menores; melhora no estado clínico do paciente com hidrata-ção; uso de drogas que reduzam vasoconstrição renal e estresse oxidativo; e suspensão temporária de drogas com potencial nefro-tóxico ou prejudiciais no caso de diminuição da filtração glomerular. A instituição de um protocolo com medidas preventivas em pacientes em risco e, especialmente, em diabéticos submetidos a contraste potencialmente nefrotóxico poderá reduzir a morbidade e custos associados ao seu desenvolvimento. A presente revisão tem o objetivo de descrever a definição e patogênese de nefropa-tia do contraste, enfatizando as principais recomendações de manejo para prevenir sua ocorrência

Associations between UCP1 -3826A/G, UCP2 -866G/A, Ala55Val and Ins/Del, and UCP3 -55C/T polymorphisms and susceptibility to type 2 diabetes mellitus : case-control study and meta-analysis

Background: Some studies have reported associations between five uncoupling protein (UCP) 1–3 polymorphisms and type 2 diabetes mellitus (T2DM). However, other studies have failed to confirm the associations. This paper describes a casecontrol study and a meta-analysis conducted to attempt to determine whether the following polymorphisms are associated with T2DM: -3826A/G (UCP1); -866G/A, Ala55Val and Ins/Del (UCP2) and -55C/T (UCP3). Methods: The case-control study enrolled 981 T2DM patients and 534 nondiabetic subjects, all of European ancestry. A literature search was run to identify all studies that investigated associations between UCP1–3 polymorphisms and T2DM. Pooled odds ratios (OR) were calculated for allele contrast, additive, recessive, dominant and co-dominant inheritance models. Sensitivity analyses were performed after stratification by ethnicity. Results: In the case-control study the frequencies of the UCP polymorphisms did not differ significantly between T2DM and nondiabetic groups (P.0.05). Twenty-three studies were eligible for the meta-analysis. Meta-analysis results showed that the Ala55Val polymorphism was associated with T2DM under a dominant model (OR = 1.27, 95% CI 1.03–1.57); while the - 55C/T polymorphism was associated with this disease in almost all genetic models: allele contrast (OR = 1.17, 95% CI 1.02– 1.34), additive (OR = 1.32, 95% CI 1.01–1.72) and dominant (OR = 1.18, 95% CI 1.02–1.37). However, after stratification by ethnicity, the UCP2 55Val and UCP3 -55C/T alleles remained associated with T2DM only in Asians (OR = 1.25, 95% CI 1.02– 1.51 and OR = 1.22, 95% CI 1.04–1.44, respectively; allele contrast model). No significant association of the -3826A/G, -866G/ A and Ins/Del polymorphisms with T2DM was observed. Conclusions: In our case-control study of people with European ancestry we were not able to demonstrate any association between the UCP polymorphisms and T2DM; however, our meta-analysis detected a significant association between the UCP2 Ala55Val and UCP3 -55C/T polymorphisms and increased susceptibility for T2DM in Asian

Absence of diabetic retinopathy in a patient who has had diabetes mellitus for 69 years, and inadequate glycemic control: case presentation

The main risk factors for the development and progression of diabetic retinopathy (DR) are chronic hyperglycemia, disease duration and systemic blood pressure. So far chronic hyperglycemia is the strongest evidence concerning the risk of developing DR. However there are some patients with poor metabolic control who never develop this diabetic complication. We present a case of a 73-year-old woman with type 1 diabetes mellitus, diagnosed 69 years ago. The patient is 73 years old, with no evidence of DR, despite poor glycemic control and several risk factors for DR. This case suggests the presence of a possible protection factor, which could be genetic

Human pancreatic islet transplantation : literature review and Establishment of a pancreatic islet isolation laboratory

O diabetes melito tipo 1 (DM1) está associado ao desenvolvimento de complicações crônicas de elevada morbi-mortalidade em indivíduos jovens em idade produtiva. A terapia intensiva com insulina comprovadamente diminui o aparecimento das complicações crônicas da doença. Entretanto, essa terapia ainda está associada ao aumento da incidência de hipoglicemia. Em pacientes com “DM1 lábil”, os quais apresentam hipoglicemias graves sem sintomas de alerta, o transplante de ilhotas pancreáticas humanas é uma das melhores alternativas para restaurar a secreção de insulina e a percepção da hipoglicemia. Cerca de 80% dos pacientes que receberam transplante de ilhotas de mais de um doador, submetidos ao tratamento imunossupressor do protocolo de Edmonton, adquiriram independência de insulina após 1 ano do transplante. Porém, apenas 10% destes pacientes permaneceram livres de insulina após 5 anos. Entretanto, mesmo aqueles pacientes que necessitaram utilizar novamente insulina tiveram a normalização da homeostase glicêmica e da percepção da hipoglicemia, com prevenção da hipoglicemia grave. Sendo assim, o transplante de ilhotas é capaz de diminuir os níveis de glicose plasmática e HbA1c, reduzir a ocorrência de hipoglicemias graves e melhorar a qualidade de vida dos pacientes. O objetivo deste artigo foi fazer uma breve revisão da literatura sobre o isolamento e transplante de ilhotas pancreáticas humanas e relatar a implantação de um laboratório de isolamento de ilhotas humanas no Serviço de Endocrinologia do Hospital de Clínicas de Porto Alegre.Type 1 diabetes mellitus (DM1) is associated with chronic complications of high morbidity and mortality in young adults in a productive age. Insulin therapy has proved to reduce the chronic complications of diabetes. However, this therapy is still associated to an increased incidence of hypoglycemia. In patients with “brittle DM1”, who have severe hypoglycemia without any symptoms (hypoglycemia unawareness), the pancreatic islet transplantation is one of the best alternatives for restoring insulin secretion and hypoglycemia perception. About 80% of the patients who received islet transplantation from more than one donor, on immunosuppressive treatment with the Edmonton’s protocol, maintained insulin independence 1 year after transplantation. Nevertheless, only 10% of these patients remained free of insulin after 5 years post-transplantation. However, even those patients who returned to insulin treatment had a normalization of the glucose homeostasis and hypoglycemia perception. Therefore, islet transplantation is able to diminish plasmatic glucose and HbA1c levels, to reduce the occurrence of severe hypoglycemia, and to improve the quality of life of the patients. The purpose of this paper is to briefly review islet isolation and transplantation process, and report the establishing of a human islet isolation laboratory in the Endocrine Service at Hospital de Clínicas de Porto Alegre