Do angiotensin converting enzyme inhibitors or angiotensin receptor blockers prevent diabetes mellitus? A meta-analysis

Background: The prevalence of diabetes mellitus (DM) has increased exponentially in recent years, with 100 million people expected to develop diabetes in the coming 15 years. The impact of medical therapy on the incidence of new onset DM is not clear. We performed a systematic review and meta-analysis to study the impact of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) on the incidence of new onset DM. Methods: MEDLINE, EMBASE, BIOSIS, Cochrane databases from inception until February 2009 for randomized controlled trials (RCT) that reported new incident DM with ACEI or ARB therapy. A total of 18 RCT are included in this meta-analysis. A random-effect model was used and between-studies heterogeneity was estimated with I2. Results: There were 50,451 patients randomized to ACEI or ARB and 50,397 patients randomized to other therapies. ACEI/ARB use was associated with a decrease in new onset DM (RR 0.78, 95% CI 0.70-0.88, p = 0.003 for ACEI and RR 0.8, 95% CI 0.75-0.86, p < 0.0001 for ARB). Treating 100 patients with ACEI or 50 patients with ARB prevents one case of new onset DM. Conclusions: The cumulative evidence suggests that the use of ACEI/ARB prevents diabetes mellitus. This finding may be of special clinical benefit in patients with hypertension and prediabetes or metabolic syndrome. (Cardiol J 2010; 17, 5: 448-456

Czy inhibitory konwertazy angiotensyny lub blokery receptora dla angiotensyny zapobiegają wystąpieniu cukrzycy? Metaanaliza

Wstęp: Zapadalność na cukrzycę w ciągu ostatnich lat gwałtownie wzrosła, przy czym szacuje się, że w ciągu kolejnych 15 lat choroba ta rozwinie się u 100 milionów osób. Wpływ leczenia na rozwój cukrzycy de novo nie jest jasny. Autorzy badania przeprowadzili systematyczny przegląd i metaanalizę w celu zbadania wpływu inhibitorów konwertazy angiotensyny (ACEI) i blokerów receptora dla angiotensyny (ARB) na wystąpienie cukrzycy de novo. Materiał i metody: Przeszukano bazy danych MEDLINE, EMBASE, BIOSIS, Cochrane od dnia ich powstania aż do lutego 2009 roku. Poszukiwano badań z randomizacją dotyczących świeżych zachorowań na cukrzycę w grupie pacjentów leczonych ACEI lub ARB. Do metaanalizy włączono 18 badań. Zastosowano model efektów losowych i różnice między badaniami oszacowano za pomocą I2. Wyniki: Losowo wybrano 50 451 pacjentów leczonych ACEI lub ARB i 50 397 osób poddanych terapii innymi preparatami. Stosowanie ACEI lub ARB wiązało się ze zmniejszeniem liczby nowych przypadków cukrzycy (RR 0,78, 95% CI 0,70-0,88, p = 0,003 dla ACEI i RR 0,8, 95% CI 0,75-0,86, p < 0,0001 dla ARB). Liczba osób, które należało leczyć, aby zapobiec jednemu nowemu przypadkowi cukrzycy, wyniosła 100 w przypadku ACEI i 50 w przypadku ARB. Wnioski: Zgromadzone dowody wskazują, że stosowanie ACEI/ARB zapobiega rozwojowi cukrzycy. Może to przynieść szczególne korzyści kliniczne pacjentom z nadciśnieniem tętniczym i stanem przedcukrzycowym lub zespołem metabolicznym. (Folia Cardiologica Excerpta 2010; 5, 5: 247-256

Herd immunity against severe acute respiratory syndrome coronavirus 2 infection in 10 communities, qatar

We investigated what proportion of the population acquired severe acute respiratory syndrome coronavirus 2 (SARSCoV- 2) infection and whether the herd immunity threshold has been reached in 10 communities in Qatar. The study included 4,970 participants during June 21-September 9, 2020. Antibodies against SARS-CoV-2 were detected by using an electrochemiluminescence immunoassay. Seropositivity ranged from 54.9% (95% CI 50.2%-59.4%) to 83.8% (95% CI 79.1%-87.7%) across communities and showed a pooled mean of 66.1% (95% CI 61.5%-70.6%). A range of other epidemiologic measures indicated that active infection is rare, with limited if any sustainable infection transmission for clusters to occur. Only 5 infections were ever severe and 1 was critical in these young communities; infection severity rate of 0.2% (95% CI 0.1%-0.4%). Specifi c communities in Qatar have or nearly reached herd immunity for SARS-CoV-2 infection: 65%-70% of the population has been infected.This study was supported by the Hamad Medical Corporation, Ministry of Public Health, and the Biomedical Research Program and the Biostatistics, Epidemiology, and Biomathematics Research Core, both atScopu

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Altered Responses to Cold Environment in Urocortin 1 and Corticotropin-Releasing Factor Deficient Mice

We examined core body temperature (CBT) of urocortin 1 (UCN1) and corticotropin releasing factor (CRF) knockout (KO) mice exposed to 4°C for 2 h. UCN1KO mice showed higher average CBT during cold exposure as compared to WT. The CBT of male and female WT mice dropped significantly to 34.1 ± 2.4 and 34.9 ± 3.1 C at 4°C, respectively. In contrast, the CBT of male and female UCN1KO mice dropped only slightly after 2 h at 4°C to 36.8 ± 0.7 and 38.1 ± 0.5 C, respectively. WT female and male UCN1KO mice showed significant acclimatization to cold; however, female UCN1KO mice did not show such a significant acclimatization. CRFKO mice showed a dramatic decline in CBT from 38.2 ±  0.4 at 22°C to 26.1 ± 9.8 at 4°C for 2 h. The CRF/UCN1 double KO (dKO) mice dropped their CBT to 32.5 ± 4.0 after 2 h exposure to 4°C. Dexamethasone treatment prevented the decline in CBT of the CRFKO and the dKO mice. Taken together, the data suggest a novel role for UCN1 in thermoregulation. The role of CRF is likely secondary to adrenal glucocorticoids, which have an important regulatory role on carbohydrate, fat, and protein metabolism