Clearing hepatitis C virus with direct antiviral agents reduces cardiovascular events in patients with prediabetes. Commentary to Sasso and colleagues

Liver health is a key determinant of cardiovascular risk (CVR). Hepatic fibrosis is the shared common result of chronic hepatitis, irrespective of aetiology. Fibrosis profoundly distorts liver tissue architecture and perturbs hepatic physiology, dictates the course of chronic liver disease and is increasingly recognized as a CVR factor. The relative weights of pre-diabetes and hepatic fibrosis as risk factors for major adverse cardiac events (MACE) in patients with HCV remain an open issue. Sasso and Colleagues answered this research question by treating approximately half of 770 HCV positive pre-diabetic patients with direct antiviral agents (DAAs), while the rest served as historical controls. Data have shown that achieving HCV clearance with DAAs was associated with a 60% reduced risk of MACE, thereby implying that this antiviral strategy is recommended in HCV positive pre-diabetic patients, regardless of the severity of liver disease and concurrent CVR factors. This study paves the way for additional studies addressing the molecular patho-mechanisms and changes in the clinical spectrum involved in cardio-metabolic protection following HCV eradication in patients with pre-diabetes.     

Syndemics at play: chronic kidney disease,diabetes and COVID-19 in Pakistan

Although coronavirus disease 2019 (COVID-19) is a pandemic, it has several specificities influencing its outcomes due to the entwinement of several factors, which anthropologists have called "syndemics". Drawing upon Singer and Clair’s syndemics model, I focus on synergistic interaction among chronic kidney disease (CKD), diabetes, and COVID-19 in Pakistan. I argue that over 36 million people in Pakistan are standing at a higher risk of contracting COVID-19, developing severe complications, and losing their lives. These two diseases, but several other socio-cultural, economic, and political factors contributing to structured vulnerabilities, would function as confounders. To deal with the critical effects of these syndemics the government needs appropriate policies and their implementation during the pandemic and post-pandemic. To eliminate or at least minimize various vulnerabilities, Pakistan needs drastic changes, especially to overcome (formal) illiteracy, unemployment, poverty, gender difference, and rural and urban difference.     

医院-社区-家庭闭环式模式在老年糖尿病周围神经病变患者中的应用价值

【摘要】目的 探讨“医院-社区-家庭”闭环式管理模式在老年糖尿病周围神经病变（DPN）患者中的应用价值。方法 选取2017年6月～2019年6月我院收治的老年DPN患者96例，随机分为观察组与对照组，每组各48例。对照组采用常规护理，观察组采用医院-社区-家庭闭环式管理模式。比较两组患者治疗依从性、血糖控制、心理健康状况、周围神经病变情况以及神经传导速率。结果 干预后，观察组患者用药、饮食、血糖测量、健康行为等方面依从率均高于对照组（P＜0.05）；观察组空腹血糖、饭后2 h血糖、糖化血红蛋白均低于对照组（P＜0.05）；观察组SCL-90症状自评量表躯体化、人际关系敏感、抑郁、焦虑、敌对以及睡眠饮食情况得分均低于对照组（P＜0.05）；观察组密西根糖尿病周围神经病变量表（MDNS）和多伦多临床神经病变评分量表（TCSS）评分均低于对照组（P＜0.05）；观察组正中神经、腓总神经神经传导速度（SNCV）和运动神经传导速度（MNCV）均高于对照组（P＜0.05）。结论 对老年DPN患者应用医院-社区-家庭闭环式管理模式能有效提高患者自我管理效能，维持血糖平稳，缓解不良情绪以改善DPN病情。     

妊娠期糖尿病患者血糖控制与妊娠结局的关系

目的探究妊娠期糖尿病(GDM)患者血糖控制与妊娠结局的关系。方法2017年12月—2019年12月间对该院65例GDM患者的病历资料做回顾性分析,并随机选取30名正常妊娠的孕妇作为健康对照组,GDM患者均给予常规治疗,依据血糖控制情况分为达标组及未达标组,血糖达标以美国糖尿病协会制定的血糖控制目标为标准,分别比较3组对象及围产儿并发症发生情况。结果3组对象分娩前FBG、2 hPG、HbAlc水平比较差异有统计学意义(F=36.100、37.634、48.209,P<0.05);达标组羊水过多、胎膜早破、妊娠期高血压、酮症酸中毒发生率分别为(5.45%、7.27%、5.45%、9.09%)均较未达标组的(60.00%、50.00%、60.00%、70.00%)更低,差异有统计学意义(χ²=21.104、12.950、19.059、20.854,P<0.05),与健康对照组比较差异无统计学意义(P>0.05),3组产后感染、产后出血、剖宫产发生率比较差异无统计学意义(P>0.05);达标组巨大儿、新生儿窒息、新生儿低血糖、胎儿窘迫发生率分别为(7.27%、5.45%、3.64%、1.82%)均较未达标组的(60.00%、50.00%、40.00%、40.00%)更低,差异有统计学意义(χ²=18.071、15.557、9.366、12.412,P<0.05),与健康对照组比较差异无统计学意义(P>0.05),3组早产儿发生率比较差异无统计学意义(P>0.05)。结论GDM患者血糖水平控制情况与其妊娠结局及围产儿并发症具有密切关系。     

高血压及高血压合并糖尿病的患者血浆可溶性NRP-1与SOD浓度的变化

探讨高血压和高血压合并糖尿病患者血浆可溶性神经纤毛蛋白-1（NRP-1）的浓度与超氧化物歧化酶（SOD）活性的变化。     

2型糖尿病患者使用胰岛素治疗期间的药师指导

目的探讨药师参与2型糖尿病患者在使用胰岛素治疗过程中对患者治疗效果的影响。方法选择该院在2019年5月—2020年5月门诊收治的200例2型糖尿病患者为研究对象,随机分为实验组和观察组,每组100例,实验组患者在治疗期间药师参与患者治疗全过程;观察组按照常规治疗方案进行治疗;观察患者各项指标变化情况。结果实验组在经过药师指导后,糖化血红蛋白、空腹血糖、患者用药依从性明显优于观察组,差异有统计学意义(P<0.05)。结论药师参与2型糖尿病患者使用胰岛素治疗期间,能够明显提高患者的治疗效果和生活质量,实现了医药护理共同协作,值得被医护人员在临床中广泛应用,并进行大力推广及宣传。     

Automated Computational Detection of Interstitial Fibrosis,Tubular Atrophy,and Glomerulosclerosis

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雾化吸入布地奈德治疗AECOPD合并2型糖尿病患者疗效及对肺通气功能和糖代谢的影响

目的分析雾化吸入布地奈德治疗慢性阻塞性肺疾病急性加重(AECOPD)合并2型糖尿病(T2DM)患者疗效及对肺通气功能和糖代谢指标的影响。 方法选择四川大学华西医院2019年1月至2020年5月诊治的120例AECOPD合并T2DM患者作为对象，根据非随机临床同期对照研究及患者自愿原则分为对照组58例和观察组62例，其中对照组给予低剂量布地奈德治疗，观察组给予高剂量布地奈德治疗。比较两组患者治疗前后肺通气功能、糖代谢指标和炎性因子水平变化，并评估疗效和安全性。 结果两组患者治疗有效率比较无显著差异(P>0.05)；与治疗前比，两组患者治疗后肺通气功能指标均显著升高，但观察组较对照组升高更为显著(P<0.05)；两组患者之间及其治疗前后糖代谢指标均无显著差异(P>0.05)；与治疗前比，两组患者治疗后炎症因子水平均显著降低，但观察组较对照组降低更为显著(P<0.05)；两组不良反应发生率比较无统计学意义(P>0.05)。 结论布地奈德雾化吸入治疗AECOPD合并T2DM安全有效，对糖代谢指标无明显影响，但高剂量的布地奈德对于患者肺通气功能和炎症水平改善效果更好。     

Physical activity as a proxy to ameliorate inflammation in patients with type 2 diabetes and periodontal disease at high cardiovascular risk

While the beneficial impact of physical activity has been ascertained in a variety of pathological scenarios, including diabetes and low-grade systemic inflammation, its potential remains still putative for periodontal health. Periodontal disease has been associated with inflammatory systemic alterations, which share a common denominator with type 2 diabetes mellitus and cardiovascular disease. Physical exercise, along with nutritional counseling, is a cornerstone in the treatment and prevention of type 2 diabetes, also able to reduce the prevalence of periodontal disease and cardiovascular risk. In addition, considering the higher incidence of periodontitis in patients with type 2 diabetes compared to healthy controls, the fascinating research question would be whether physical activity could relieve the inflammatory pressure exerted by the combination of these two diseases. This multi-disciplinary viewpoint discusses available literature in order to argument the hypothesis of a “three–way relationship” linking diabetes, periodontitis, and physical activity.     

2型糖尿病患者病耻感调查及其影响因素分析

目的探讨2型糖尿病患者病耻感现状,并分析病耻感的影响因素。方法2018年8月—2020年3月期间,采用便利抽样法,对该院就诊的135例2型糖尿病患者进行问卷调查。调查工具为一般情况调查表、2型糖尿病病耻感评估表。对病耻感的影响因素进行单因素分析和多因素分析。结果所有患者平均病耻感得分为(54.22±10.65)分。不同年龄、文化水平、是否接受胰岛素治疗、是否合并并发症等4个因素的单因素亚组分析显示,组间病耻感得分差异有统计学意义(P<0.05);采用逐步多元线性回归分析显示,只有年龄、是否合并并发症、文化水平是影响病耻感的独立因素。结论该次调查显示2型糖尿病患者普遍存在病耻感,年龄低、具有糖尿病并发症和文化水平较高的患者具有更明显的病耻感,应引起医务人员的重视,并及时给予治疗干预。