Effect of glycemic control on albumin excretion in urine in diabetics

Background: Diabetes Mellitus (DM) is commonest endocrine disorder worldwide. It is associated with variety of complications such as retinopathy, neuropathy and nephropathy. The severity of the complications depends on treatment strategies, duration of diabetes and glycemic control. Microalbuminuria (MA) is an earliest predictor of nephropathy in patients of diabetic nephropathy and Diabetic Nephropathy is most common cause for End Stage Renal Disease (ESRD) worldwide. It accounts for >40% of patients with ESRD.Methods: The present study investigated effect of glycemic control on microalbuminuria. We studied 150 diabetic patients with duration of diabetes more than 3 years. Investigations like glycated hemoglobin (HbA1C) and fasting blood glucose were carried out to evaluate glycemic control and albumin in urine to evaluate early renal involvement.Results: Out of 150 patients included in the study, 107 had poor glycemic control and 33 patients had good glycemic control. The HbA1C less than 7% is taken as cut off point for control of diabetes. The mean value of albumin in urine was  34.5 mg/L in the  group of  diabetics with good glycemic control and the same was 60.7  mg/L in the group of diabetics with poor glycemic control and this change was statistically significant (p<0.05).  Conclusions: It is concluded that those patients with good glycemic control have decreased risk of developing microalbuminuria.

Effect of dietary lycopene on inflammatory marker in patients of heart failure

Background: Heart failure (HF), often referred to as chronic heart failure (CHF), occurs when the heart is unable to pump sufficiently to maintain blood flow to meet the body's needs. Patients with HF are characterized by systemic inflammation, as evident by raised circulating levels of several inflammatory cytokines with increasing levels according to the degree of disease severity. Inflammation occurs in the vasculature as a response to injury, lipid peroxidation, and perhaps infection. Inflammation can be a significant contributor in the pathophysiology of HF. Antioxidants may slow the progression of HF because of their ability to inhibit damaging inflammatory processes. The purpose of this study was to test a dietary intervention in patients with HF to assess the effect of dietary lycopene on biomarkers of inflammation.Methods: Sixty participants with HF were randomly assigned to 1 of 2 groups: lycopene intervention and non-intervention. The lycopene intervention group received 27.212 mg of lycopene intake per day by drinking 1 serving (243 gm) of tomato soup for 30 days. We obtained serum lycopene, and C-reactive protein (CRP), to determine the impact of the intervention.Results: Plasma lycopene levels increased in the intervention group compared with the usual group (0.50 µmol/L to 0.75 µmol/L, P = 0.002; 0.55 µmol/L to 0.57 µmol/L). C-reactive protein levels decreased significantly in the intervention group in both women and men. The pre-intervention and post-intervention CRP level for women was 15.37 ± 1.46 mg/dL and 8.32 ± 1.11 mg/dl respectively and for men was 15.05 ± 2.58 mg/dL and 8.14 ± 1.49 mg/dL respectively.Conclusions: These findings suggest that the antioxidants in a 30-day intervention of tomato soup significantly decreases CRP levels in a sample of female and male patients with HF.  

Systemic Anticancer Therapy and Thromboembolic Outcomes in Hospitalized Patients With Cancer and COVID-19

IMPORTANCE: Systematic data on the association between anticancer therapies and thromboembolic events (TEEs) in patients with COVID-19 are lacking. OBJECTIVE: To assess the association between anticancer therapy exposure within 3 months prior to COVID-19 and TEEs following COVID-19 diagnosis in patients with cancer. DESIGN, SETTING, AND PARTICIPANTS: This registry-based retrospective cohort study included patients who were hospitalized and had active cancer and laboratory-confirmed SARS-CoV-2 infection. Data were accrued from March 2020 to December 2021 and analyzed from December 2021 to October 2022. EXPOSURE: Treatments of interest (TOIs) (endocrine therapy, vascular endothelial growth factor inhibitors/tyrosine kinase inhibitors [VEGFis/TKIs], immunomodulators [IMiDs], immune checkpoint inhibitors [ICIs], chemotherapy) vs reference (no systemic therapy) in 3 months prior to COVID-19. MAIN OUTCOMES AND MEASURES: Main outcomes were (1) venous thromboembolism (VTE) and (2) arterial thromboembolism (ATE). Secondary outcome was severity of COVID-19 (rates of intensive care unit admission, mechanical ventilation, 30-day all-cause mortality following TEEs in TOI vs reference group) at 30-day follow-up. RESULTS: Of 4988 hospitalized patients with cancer (median [IQR] age, 69 [59-78] years; 2608 [52%] male), 1869 had received 1 or more TOIs. Incidence of VTE was higher in all TOI groups: endocrine therapy, 7%; VEGFis/TKIs, 10%; IMiDs, 8%; ICIs, 12%; and chemotherapy, 10%, compared with patients not receiving systemic therapies (6%). In multivariable log-binomial regression analyses, relative risk of VTE (adjusted risk ratio [aRR], 1.33; 95% CI, 1.04-1.69) but not ATE (aRR, 0.81; 95% CI, 0.56-1.16) was significantly higher in those exposed to all TOIs pooled together vs those with no exposure. Among individual drugs, ICIs were significantly associated with VTE (aRR, 1.45; 95% CI, 1.01-2.07). Also noted were significant associations between VTE and active and progressing cancer (aRR, 1.43; 95% CI, 1.01-2.03), history of VTE (aRR, 3.10; 95% CI, 2.38-4.04), and high-risk site of cancer (aRR, 1.42; 95% CI, 1.14-1.75). Black patients had a higher risk of TEEs (aRR, 1.24; 95% CI, 1.03-1.50) than White patients. Patients with TEEs had high intensive care unit admission (46%) and mechanical ventilation (31%) rates. Relative risk of death in patients with TEEs was higher in those exposed to TOIs vs not (aRR, 1.12; 95% CI, 0.91-1.38) and was significantly associated with poor performance status (aRR, 1.77; 95% CI, 1.30-2.40) and active/progressing cancer (aRR, 1.55; 95% CI, 1.13-2.13). CONCLUSIONS AND RELEVANCE: In this cohort study, relative risk of developing VTE was high among patients receiving TOIs and varied by the type of therapy, underlying risk factors, and demographics, such as race and ethnicity. These findings highlight the need for close monitoring and perhaps personalized thromboprophylaxis to prevent morbidity and mortality associated with COVID-19-related thromboembolism in patients with cancer

Clinical Characteristics, Racial Inequities, and Outcomes in Patients with Breast Cancer and COVID-19: A COVID-19 and Cancer Consortium (CCC19) Cohort Study

BACKGROUND: Limited information is available for patients with breast cancer (BC) and coronavirus disease 2019 (COVID-19), especially among underrepresented racial/ethnic populations. METHODS: This is a COVID-19 and Cancer Consortium (CCC19) registry-based retrospective cohort study of females with active or history of BC and laboratory-confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection diagnosed between March 2020 and June 2021 in the US. Primary outcome was COVID-19 severity measured on a five-level ordinal scale, including none of the following complications, hospitalization, intensive care unit admission, mechanical ventilation, and all-cause mortality. Multivariable ordinal logistic regression model identified characteristics associated with COVID-19 severity. RESULTS: 1383 female patient records with BC and COVID-19 were included in the analysis, the median age was 61 years, and median follow-up was 90 days. Multivariable analysis revealed higher odds of COVID-19 severity for older age (aOR per decade, 1.48 [95% CI, 1.32-1.67]); Black patients (aOR 1.74; 95 CI 1.24-2.45), Asian Americans and Pacific Islander patients (aOR 3.40; 95 CI 1.70-6.79) and Other (aOR 2.97; 95 CI 1.71-5.17) racial/ethnic groups; worse ECOG performance status (ECOG PS ≥2: aOR, 7.78 [95% CI, 4.83-12.5]); pre-existing cardiovascular (aOR, 2.26 [95% CI, 1.63-3.15])/pulmonary comorbidities (aOR, 1.65 [95% CI, 1.20-2.29]); diabetes mellitus (aOR, 2.25 [95% CI, 1.66-3.04]); and active and progressing cancer (aOR, 12.5 [95% CI, 6.89-22.6]). Hispanic ethnicity, timing, and type of anti-cancer therapy modalities were not significantly associated with worse COVID-19 outcomes. The total all-cause mortality and hospitalization rate for the entire cohort was 9% and 37%, respectively however, it varied according to the BC disease status. CONCLUSIONS: Using one of the largest registries on cancer and COVID-19, we identified patient and BC-related factors associated with worse COVID-19 outcomes. After adjusting for baseline characteristics, underrepresented racial/ethnic patients experienced worse outcomes compared to non-Hispanic White patients. FUNDING: This study was partly supported by National Cancer Institute grant number P30 CA068485 to Tianyi Sun, Sanjay Mishra, Benjamin French, Jeremy L Warner; P30-CA046592 to Christopher R Friese; P30 CA023100 for Rana R McKay; P30-CA054174 for Pankil K Shah and Dimpy P Shah; KL2 TR002646 for Pankil Shah and the American Cancer Society and Hope Foundation for Cancer Research (MRSG-16-152-01-CCE) and P30-CA054174 for Dimpy P Shah. REDCap is developed and supported by Vanderbilt Institute for Clinical and Translational Research grant support (UL1 TR000445 from NCATS/NIH). The funding sources had no role in the writing of the manuscript or the decision to submit it for publication. CLINICAL TRIAL NUMBER: CCC19 registry is registered on ClinicalTrials.gov, NCT04354701

Hepatitis B and C infections in drug using population: Viral clearance, incidence, and vaccination prevention

Drug users have high risk for acquiring hepatitis B and C infections which may progress to cirrhosis, liver failure and hepatocellular carcinoma. Lack of hepatitis C vaccine and cure for chronic hepatitis B makes it crucial to understand the relationship between virus and host. We aimed to estimate the incidence and viral clearance of hepatitis B and C infections and associated risk factors in current, not-in-treatment drug users enrolled for a hepatitis B vaccine trial in Houston, TX. We learned that HBV clearance was observed in majority of the DUs; whereas only 15% of DUs cleared HCV. In HIV negative DUs, male sex and low SES prohibited HBV clearance. African American ethnicity was associated with decreased HCV clearance. Race, daily injection drug use, and older age increase risk for acquiring HCV infection. Accelerated hepatitis B vaccination schedule is more effective than standard schedule in preventing HBV infections in DUs. Accelerated schedule should be adopted for drug using population to prevent hepatitis B and it may be studied as a vaccination model for hepatitis C vaccine, whenever it becomes available in future. Insight into these host factors affecting the incidence and viral clearance of these infections will be helpful in the successful development of vaccines, antiviral therapies, and progress in the overall knowledge of host immunity to hepatitis viral infections

Impact of obesity on vitamin D and calcium status

Introduction: Obesity is associated with metabolic syndrome. Obesity is a leading preventable cause of death worldwide, with increasing rates in adults and children. Obesity is associated with vitamin D insufficiency and hyperparathyroidism, secondary hypercalcemia. The purpose of this study is to test effect of obesity on Vitamin D and calcium level. Methods: The present study investigated effect of obesity on Vitamin D and calcium level. We studied 150 Subjects with no pre-existing disease and not taking any nutritional suppliments for vitamin D. At a baseline they were asked about their family history of obesity. Subjects are investigated for 25-hydroxyvitamin D [25(OH) D] and serum Total calcium level to study effect of obesity on vitamin D and calcium status. Results: Out of 150 subjects included in the study, 107 had obesity and 43 subjects was non-obese. The Body Mass Index less than 30 is taken as cut off point for defining obesity. The mean value of 25-hydroxyvitamin D was 13ng/ml in the group of obese people and the same was 28ng/ml in the group of non-obese individuals. This change was statistically significant (p&lt;0.05). The mean value of serum Total calcium level was 13mg/dl in the group of obese people and the same was 10mg/dl in the group of non-obese individuals. This change was statistically significant (p&lt;0.05). Conclusions: It is concluded that obese individuals are increased risk of developing Vitamin D Deficiency and secondary hypercalcemia

Impact of Lycopene intervention on serum homocysteine in patients of Myocardial Infarction

Introduction: Myocardial Infarction occurs due to any obstruction in coronary arteries leading to ischemia followed by infarction. It is characterized by systemic inflammation, elevated levels of inflammatory cytokines and atherosclerotic plaques. Plaque formation and Inflammation are significant contributor in the pathophysiology of MI. Antioxidants slow the progression of MI because of their ability to inhibit inflammatory processes. The aim of this study was to test an intervention in patients with MI to assess the effect of dietary lycopene on one of the independent risk factor for MI i. e Serum Homocysteine. Methods: Sixty participants with MI were randomly assigned to two groups: with lycopene intervention and without intervention. The intervention group received 27.212 mg of lycopene per day by drinking 1 serve (approx. 243 grams) of tomato soup for 90 days. Serum lycopene, and Serum Homocysteine were measured. Results: Plasma lycopene levels increased in the intervention group as compared with the non intervention group (0.50 µmol/L to 0.75 µmol/L, P = .002; 0.55 µmol/L to 0.57 µmol/L). Mean serum Homocysteine levels decreased significantly in the intervention group. The mean serum Homocysteine in pre intervention group was 29.77 µmol / L with S.D of 6.97 µmol / L and in post intervention subjects was 11 µmol / L with S.D of 1.96 µmol / L with a p value of 0.0001 which is statistically significant. Conclusions: These findings show that the antioxidant Lycopene in a 90-day intervention of tomato soup significantly decreases S. Hcy (Homocysteine) levels in a sample of patients with MI

COVID-19 vaccine effectiveness in patients with hematologic malignancy

COVID-19 vaccine response → HMsolid Vaccine effectiveness → Population studies urgently needed Early #COVID19CP could be lifesaving in immunocompromised HM pts This article is protected by copyright. All rights reserved

Role of Patient’s Ethnicity in Seeking Preventive Dental Services at the Community Health Centers of South-Central Texas: A Cross-Sectional Study

Background: This study was conducted to determine the impact of a patient’s ethnicity on seeking preventive dental services at the Community Health Centers (CHCs) in South-Central Texas. Methods: Primary electronic health records (EHR) data were collected regarding each patient’s medical and dental history, and comprehensive treatment planning. The researchers retrieved EHR from January 2016 to 2022. Bivariate analysis was completed to test the outcome with the predictor variable and covariates using the appropriate statistical tests. A multiple linear regression model was used to understand the association between the predictor and outcome variable while controlling for confounders. Results: The study findings revealed significantly higher dental visits (2.26 ± 2.88) for Hispanic patients. The results from the multiple regression model indicated that non-Hispanic patients had a smaller chance of visiting CHC for preventive dental services, by eight percent, compared to the Hispanic population (p-value < 0.001) when all other variables were held constant. However, the study results were not significant, as the effect size was too small to conclude the effect of ethnicity on the patients visiting the dental clinic at the CHC for preventive services. Conclusion: The study concluded that there is no difference in the preventive dental services completed by Hispanics and non-Hispanics when all other variables are controlled