Fasting salivary glucose levels is not a better measure for identifying diabetes mellitus than serum or capillary blood glucose levels: comparison in a Ghanaian population

Aims/introduction: We compared the diagnostic performance and correlation between salivary, serum and capillary blood glucose of diabetes and non-diabetes patients. Early detection of diabetes mellitus (DM) contributes to the prevention of complications and management. Materials and methods: This case-control study was conducted among a total of 138 participants comprising 79 newly diagnosed diabetes patients (cases) and 59 non-diabetes patients (controls). Fasting salivary glucose (FSLG), fasting serum glucose (FSEG) levels and fasting capillary whole blood glucose (FCWBG) level were assayed for each participant. Results: The mean FSLG, FSEG and FCWBG levels were significantly higher among the cases compared to controls (p \u3c 0.0001). There was a significant mean difference between the levels of FSLG vs. FSEG (p \u3c 0.0001) and FSLG vs. FCWBG (p \u3c 0.0001) but not levels of FSEG vs. FCWBG (p \u3e 0.05) in both cases and controls. A positive correlation was observed between FSLG and FSEG (r = 0.89; p \u3c 0.0001) and FCWBG (r = 0.87; p \u3c 0.0001). At the cut-off value \u3e6.8 mmol/l for FSEG, a sensitivity of 99%, specificity of 100.0% and area under the curve (AUC) of 98.8% was observed for predicting DM while a sensitivity of 80%, specificity of 95% and AUC of 91.0% was observed for FSLG at a cut-off value \u3e0.5 mmol/l. At the cut-off value \u3e6.9 mmol/l for FCWBG, a sensitivity of 100.0%, specificity of 100.0% and AUC of 100.0% was observed for predicting DM. Conclusion: Fasting salivary glucose (FSLG) levels increased with increasing blood glucose levels. However, it does not generate enough diagnostic and predictive accuracy compared to capillary whole blood glucose which less invasive. © 201

Chemical properties of Terminalia catappa wood

Ghana’s forest is fast depleting as a result of over-dependency on the traditionally known timber species and high demand for wood products for structural works. This study seeks to determine the chemical properties and basic density of Terminalia catappa wood and its potential for structural application. Three mature trees of Terminalia catappa were acquired based on the diameter at the breast height (dbh) greater than 40 cm. In this study 160 samples of wood were used for the chemical properties and density tests. Chemical analyses were performed by using the TAPPI standards. The study revealed that there were higher cellulose and hemicellulose contents in the sapwood than in heartwood, and in the branchwood than in stemwood. Lignin and extractives content were higher in the heartwood than in sapwood, and in the stemwood than in branchwood. The basic density of the sapwood ranged from 473 to 649 kg/m³ and in the heartwood from 444 to 579 kg/m³ being the highest in the base portion and the lowest in the branches. The difference in wood density, which is greater in the base area than the branches, emphasizes how crucial it is to take wood quality into account for the best possible use across various tree portions. The study also clarifies the wood's suitability for structural and non-structural uses. These findings have the potential to influence sustainable forest management strategies and encourage the use of alternative timber to supplement the resource base

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

Background: The EMPA KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. Methods: EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. Findings: Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5–2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62–0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16–1·59), representing a 50% (42–58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). Interpretation: In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. Funding: Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Fasting salivary glucose levels is not a better measure for identifying diabetes mellitus than serum or capillary blood glucose levels: comparison in a Ghanaian population

Aims/introduction: We compared the diagnostic performance and correlation between salivary, serum and capillary blood glucose of diabetes and non-diabetes patients. Early detection of diabetes mellitus (DM) contributes to the prevention of complications and management. Materials and methods: This case-control study was conducted among a total of 138 participants comprising 79 newly diagnosed diabetes patients (cases) and 59 non-diabetes patients (controls). Fasting salivary glucose (FSLG), fasting serum glucose (FSEG) levels and fasting capillary whole blood glucose (FCWBG) level were assayed for each participant. Results: The mean FSLG, FSEG and FCWBG levels were significantly higher among the cases compared to controls (p 0.05) in both cases and controls. A positive correlation was observed between FSLG and FSEG (r = 0.89; p 6.8 mmol/l for FSEG, a sensitivity of 99%, specificity of 100.0% and area under the curve (AUC) of 98.8% was observed for predicting DM while a sensitivity of 80%, specificity of 95% and AUC of 91.0% was observed for FSLG at a cut-off value >0.5 mmol/l. At the cut-off value >6.9 mmol/l for FCWBG, a sensitivity of 100.0%, specificity of 100.0% and AUC of 100.0% was observed for predicting DM. Conclusion: Fasting salivary glucose (FSLG) levels increased with increasing blood glucose levels. However, it does not generate enough diagnostic and predictive accuracy compared to capillary whole blood glucose which less invasive

Clinical epidemiology, determinants, and outcomes of viral encephalitis in Ghana; a cross-sectional study.

Viral encephalitis is a rare, yet severe neurological disorder. It poses a significant public health threat due to its high morbidity and mortality. Despite the disproportionate burden of the disease in impoverished African countries, the true extent of the problem remains elusive due to the scarcity of accurate diagnostic methods. The absence of timely and effective diagnostic tools, particularly Real-time Polymerase Chain Reaction, has led to misguided treatment, and an underestimation of the disease burden in Ghana. We conducted a prospective cross-sectional study to determine the viral aetiologies of encephalitis among patients presenting to a major referral hospital in Ghana from May 2019 and August 2022. The study aimed at providing a comprehensive information on the clinical epidemiology, and outcomes of viral encephalitis in Ghana. Clinical samples were collected from patients presenting with signs and symptoms of encephalitis and tested for viral agents using real-time polymerase chain reaction. We assessed the clinical epidemiology, risk factors and outcome of individuals using descriptive and logistic regression analysis. Seventy-seven (77) patients were enrolled unto the study. The participants frequently presented with fever (85.7%), seizures (80.5%), lethargy (64.9%) and headache (50.6%). Viruses were detected in 40.3% of the study participants in either cerebrospinal fluid, rectal or oral swab samples. The most frequently detected viruses were cytomegalovirus (48.4%), enteroviruses (38.7%) and HSV (29.0%). Twenty-one (27.3%) of the patients died while on hospital admission. Gender (OR = 5.70 (1.536-1.172), p = 0.01), and negative polymerase chain reaction test results were identified as significant factors associated with death. Antiviral treatment increased the chance of survival of viral encephalitis patients by 21.8%. Our results validate the crucial role of molecular tools as essential for the rapid diagnosis of viral encephalitis, enabling effective treatment and improved patient outcomes. This study contributes valuable epidemiological and clinical insight into viral encephalitis in Ghana