The metabolic syndrome in early pregnancy and risk of gestational diabetes mellitus

AimThe objective of the present study was to determine whether or not maternal metabolic syndrome in early pregnancy in women without previous diabetes is associated with the development of gestational diabetes mellitus (GDM).MethodsA total of 508 women from the Rhea study—involving a pregnant cohort in Crete, Greece (2007–2009)—with singleton pregnancies were included in the present analysis. Maternal fasting serum samples were collected and blood pressure measured before gestational week 15. The metabolic syndrome in early pregnancy was defined according to NHLBI/AHA criteria. Pregnant women were screened for GDM between weeks 24 and 28 of gestation, as defined by Carpenter and Coustan criteria. Multivariable log-binomial regression models were used to estimate the effect of the metabolic syndrome in early pregnancy on the risk of GDM, after adjusting for confounding factors.ResultsWomen with the metabolic syndrome were at high risk of GDM (RR = 3.17; 95% CI: 1.06–9.50). Among the components of the metabolic syndrome, the most significant risk factors were impaired fasting glucose (RR = 4.92; 95% CI: 1.41–17.23) and pre-pregnancy obesity (RR = 2.65; 95% CI: 1.23–5.70). A 10-mmHg rise in systolic and diastolic blood pressure increased the relative risk of GDM by 49% (RR = 1.49; 95% CI: 1.10–2.02) and 34% (RR = 1.34; 95% CI: 1.04–1.73), respectively, whereas a 1-unit increase in pre-pregnancy BMI increased the relative risk of GDM by 6% (RR = 1.06; 95% CI: 1.01–1.12).ConclusionThese findings suggest that women with the metabolic syndrome in early pregnancy have a greater risk of developing GDM.     

Reduced risk of metabolic syndrome due to regular intake of vegetables rich in antioxidants among African type 2 diabetics

BackgroundAntioxidant nutrients found in vegetables are thought to prevent chronic diseases including type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS).ObjectiveWe evaluated the prevalence of MetS and the association of antioxidants and cardiovascular risk factors with risk of MetS among patients with T2DM from General hospital of Kinshasa, DRC.MethodsThis cross-sectional study using a validated semiquantitative food frequency questionnaire. MetS was defined using criteria of IDF/Europids, IDF modified for Africa and NCEP-ATP III. Risk factors of MetS (OR and 95% CI) was estimated using logistic regression, adjusting for confounding factors.ResultsOut of 244 T2 DM patients (56.6% of females) and 48 ± 16 years, 0%, 13%, 34.4%, 20.9%, and 11.9% were defined by never consuming fruits, never consuming vegetables, MetS/IDF Europids, MetS/IDF modified for Africa, and MetS/NCEP-ATP III. Females (OR = 5 95% CI 2–10; P < 0.01), High socioeconomic status (HSES, OR = 3.5, 95% CI 1.5–8.3; P = 0.005), and regular Cassava leaves intake (OR= 0.4, 95% CI 0.2–0.9; P = 0.027) were the independent determinants of MetS/IDF Europids. HSES (OR= 2.9, 95% CI 1.2–6.9; P = 0.015), physical inactivity (OR = 2.6, 95% CI 1.6–6; P = 0.03) and regular dry red beans intake (OR = 0.4, 95% CI 0.2–0.8; P = 0.016) were the independent determinants of MetS/IDF modified for Africa. Females (OR = 5, 95% CI 2–20; P < 0.001), HSES (OR = 3.5, 95% CI 1.5–8.3; P = 0.005) and regular Cassava leaves intake (OR = 0.4, 95% CI 0.2–0.9; P < 0.0001) were the independent determinants of MetS/NCEP-ATP III.ConclusionCassava leaves and dried red beans intake, rich in antioxidants, are protective factors against MetS presence, while females, HSES, and physical inactivity are independent risk factors of MetS.     

Prevalence,incidence and risk factors for Helicobacter pylori infection in a cohort of Portuguese adolescents (EpiTeen)

BackgroundHelicobacter pylori infection is acquired mainly during childhood, but it may occur throughout life. Understanding the determinants of infection at different ages is essential to clarify dynamics of H. pylori related diseases and to design preventive strategies.AimTo estimate the prevalence of H. pylori infection at the age of 13 and the incidence after a 3-year follow-up and to identify risk factors for infection.Subjects and methodsAdolescents born in 1990 were recruited in schools from Porto. Whole-cell anti-H. pylori IgG antibodies were quantified by ELISA. Prevalence ratios (PR) and incidence rate ratios (RR) adjusted for parental education were computed at baseline (n = 1312) and at follow-up (n = 280).ResultsThe prevalence was 66.2%, lower in subjects with more educated parents (PR = 0.72, 95%CI: 0.63–0.82), and higher for those having more than one sibling (PR = 1.10, 95%CI: 1.02–1.19) and for smokers (PR = 1.11, 95%CI: 1.02–1.20). The incidence was 4.1/100 person-years. Smoking (RR = 2.35, 95%CI: 1.16–4.75) and type of school (RR = 0.38, 95%CI: 0.16–0.95) were associated with the incidence of infection.ConclusionsPrevalence and incidence of H. pylori infection were high, suggesting that gastric cancer will remain an important public health problem in this generation of Portuguese. We identified smoking as a modifiable risk factor for infection.     

Measuring change in clinical profiles between hospital admission and discharge and predicting living arrangements at discharge for aged patients presenting behavioral and psychological symptoms of dementia

BackgroundThe clinical courses of psychogeriatric inpatients presenting behavioral and psychological symptoms of dementia, between their admission and discharge, have been poorly documented. Based upon our previously elaborated profiles of psychogeriatric patients, this study aimed to describe these courses and to explore whether changing clinical profiles could predict living arrangements at discharge.MethodsRetrospective data were collected on 397 patients with dementia and hospitalized from 2011 to 2014 in French-speaking Switzerland. Patients were classified on admission and at discharge using four clinical profiles (BPSD-affective, BPSD-functional, BPSD-somatic, and BPSD-psychotic). Multinomial logistic regression analyses were used to identify predictors of living arrangements at discharge. Age, gender, marital status, living arrangements on admission, and clinical profile on admission and discharge, were used as potential predictors.ResultsOf the patients classified as BPSD-functional or BPSD-affective on admission, 70.18% and 73.48%, respectively, had the same classification at discharge. However, 45.74% of patients classified as BPSD-somatic on admission were discharged with a BPSD-functional profile, and 46.15% of inpatients classified as BPSD-psychotic on admission were discharged as BPSD-affective (χ²(9) = 128.8299; p < 0.000). At discharge, 64.99% of all patients were admitted to a nursing home. The significant predictors of return to home were: being male (OR = 0.96; 95% CI: 0.93–0.99) and BPSD-affective profile (OR = 1.95; 95% CI: 1.08–3.54. Significant predictors of transfer to acute care or death were: BPSD-somatic (OR = 12.98; 95% CI: 1.96–85.91) or BPSD-psychotic profile (OR = 13.53; 95% CI: 1.65–111.05).DiscussionThis study provides new information concerning the clinical course of older psychogeriatric inpatients using profiles derived from clinically sensitive profiles.     

Gender differences in cardiovascular risk factors among adolescents in Aseer Region,southwestern Saudi Arabia

ObjectiveThe objective of this study was to explore gender differences in the prevalence of silent and clinical apparent cardiovascular risk factors among adolescents in Aseer Region, southwestern Saudi Arabia.Materials and methodsA cross-sectional study on a stratified sample of 1869 adolescents was carried out. They were interviewed and examined for weight and height, systolic and diastolic blood pressure using standardized techniques.ResultsThe study revealed high prevalence of some potential behavioral and biological cardiovascular diseases (CVD) risk factors among adolescent males and females in the study area. Behavioral risk factors included inadequate low consumption of fruits and vegetables, physical inactivity, and smoking. Physical inactivity was significantly more prevalent among females than males (42.9% and 25.7%, respectively). Smoking was significantly more among females than males (11.8% and 1.3%, respectively). Biological risk factors found were family history of CVD, obesity and high blood pressure. Obesity was significantly prevalent among females (29.4%) compared to males (20.6%). Males had significantly more high blood pressure than females. In logistic regression analysis, being male (aOR = 2.992, 95% CI = 1.933–4.742) and obesity (aOR = 2.995, 95% CI = 2.342–3.991) were found to be significant risk factors in developing high blood pressure among adolescents in the region.ConclusionsPresence of cardiovascular risk factors among adolescents is a public health problem in the region. There is a need for a national program in the country to prevent and control cardiovascular risk factors among adolescents.     

Components of metabolic syndrome and the incidence of type 2 diabetes in an elderly Taiwanese cohort

AimsMetabolic syndrome (MetS) is at great risk of developing type 2 diabetes (T2DM). This study aimed to explore the association between the major MetS components and the T2DM incidence in an elderly Taiwanese population.Methods1738 subjects, aged 65–84 years, were enrolled from the Taiwan MJ health check-up in 2000 and 2001 and were again investigated in 2005 and 2006. Factor analysis was conducted and factor scores for the baseline of non-diabetic individuals were used as independent variables in logistic regression models to determine risk factors predicting the development of diabetes.ResultsMetS was common among the elderly residents receiving long-term health check-up in Taiwan. Sex-specific factor analyses yielded five separate factors including obesity, etc., accounting for 65.9% and 65.3% of the total variance in non-diabetic men and women, respectively. There were 56 males (6.44%) and 44 females (6.32%) without diabetic at baseline, developed diabetes during the mean 4.95 years follow-up. For non-diabetic men, blood lipids/FPG was strongly associated with diabetes incidence (RR = 2.22, 95% CI 1.69–2.92), while for women, FPG/inflammation factor had biggest RR (RR = 1.94, 95% CI 1.47–2.56). Among factor patterns, obesity was major cluster and as the common determinant of the diabetes risk for two sexes (RR = 1.33, 95% CI 1.02–1.73 and RR = 1.72, 95% CI 1.27–2.31, for men and women, respectively), but the BP was not associated with prediction of diabetes both in two genders.ConclusionsIdentification of five unique factors with different associations with incidence of diabetes suggests that the correlations among these variables reflect distinct metabolic processes rather than one single underlying entity in the elderly Taiwan cohort, and that the blood lipids/FPG and FPG/inflammation factor in both sexes predicting progression to T2DM beyond obesity alone.     

Diabetes mellitus and incidence and mortality of kidney cancer: A meta-analysis

BackgroundDiabetes is associated with increased risk of a spectrum of cancers, but there are few meta-analyses on the association between diabetes and kidney cancer. We performed a meta-analysis of case–control studies and cohort studies to address the incidence and mortality of kidney cancer in diabetes.MethodsStudies were identified by searching PubMed database and manual assessment of the cited references in the retrieved articles. Study-specific relative risks (RRs) and 95% confidence intervals (CIs) were estimated using a random-effect model. Study quality was assessed using the Newcastle–Ottawa scale.ResultsA total of 24 studies were included. We found that diabetes was significantly associated with increased risk of kidney cancer (RR = 1.40, 95% CI = 1.16 to 1.69), and the results were consistent between case–control and cohort studies. A slightly stronger positive relation was observed in women (RR = 1.47, 95% CI = 1.18 to 1.83) than in men (RR = 1.28, 95% CI = 1.10 to 1.48). Additional analyses indicated that the increased risk of kidney cancer was independent of alcohol consumption, body mass index (BMI)/obesity and smoking. However, there was no association between diabetes and mortality of kidney cancer (RR = 1.12, 95% CI = 0.99 to 1.20), without heterogeneity (P = 0.419, I² = 1.8%).ConclusionsDiabetes mellitus may increase the risk of kidney cancer in both women and men.     

Proposal of a clinical score to stratify the risk of multidrug-resistant gram-negative rods bacteremia in cancer patients

IntroductionMultidrug-resistant gram-negative rods (MDR GNR) represent a growing threat for patients with cancer. Our objective was to determine the characteristics of and risk factors for MDR GNR bacteremia in patients with cancer and to develop a clinical score to predict MDR GNR bacteremia.Material and MethodsMulticenter prospective study analyzing initial episodes of MDR GNR bacteremia. Risk factors were evaluated using a multiple logistic regression (forward-stepwise selection) analysis including variables with a p < 0.10 in univariate analysis.Results394 episodes of GNR bacteremia were included, with 168 (42.6 %) being MDR GNR. Five variables were identified as independent risk factors: recent antibiotic use (OR = 2.8, 95 % CI 1.7–4.6, p = 0.001), recent intensive care unit admission (OR = 2.9, 95 % CI 1.1–7.8, p = 0.027), hospitalization ≥ 7 days prior to the episode of bacteremia (OR = 3.5, 95 % CI 2–6.2, p = 0.005), severe mucositis (OR = 5.3, 95 % CI 1.8–15.6, p = 0.002), and recent or previous colonization/infection with MDR GNR (OR = 2.3, 95 % CI 1.2–4.3, p = 0.028). Using a cut-off value of two points, the score had a sensitivity of 66.07 % (95 % CI 58.4–73.2 %), a specificity of 77.8 % (95 % CI 71.4–82.7 %), a positive predictive value of 68 % (95 % CI 61.9–73.4 %), and a negative predictive value of 75.9 % (95 % CI 71.6–79.7 %). The overall performance of the score was satisfactory (AUROC 0.78; 95 % CI 0.73-0.82). In the cases with one or none of the risk factors identified, the negative likelihood ratio was 0.18 and the post-test probability of having MDR GNR was 11.68 %.ConclusionsWith the growing incidence of MDR GNR as etiologic agents of bacteremia in cancer patients, the development of this score could be a potential tool for clinicians.     

Prevalence and risk factors for wheezing and allergic diseases in preschool children: A perspective from the Mediterranean coast of Turkey

ObjectivesThe aim of the present study was to determine the prevalence and risk factors of allergic diseases in preschool children from one of the biggest cities in the Mediterranean Region of Turkey.MethodsThe study population included 396 preschool children attending to urban daycare centres in Mersin. In the first stage, a comprehensive standardised questionnaire modified from the International Study of Asthma and Allergies in Childhood (ISAAC) was employed. In the second stage, serum food and inhalant specific IgE, and skin tests were performed in 45 children with frequent wheezing and 28 children with no wheezing.ResultsThe prevalence of ever wheezing, current wheezing, physician-diagnosed asthma, allergic rhinitis and eczema were 53% (210), 33.3% (132), 27.3% (108), 13.4% (53) and 8.3% (33), respectively. A family history of atopy (OR = 2.5, 95% CI: 1.3–4.7, p = 0.004), dampness at home (OR = 2.4, 95% CI: 1.2–4.8, p = 0.008), a history of intestinal parasites (OR = 4.3, 95% CI: 1.7–10.9, p = 0.002), previous history of pneumonia (OR = 6.9, 95% CI: 1.9–25.9, p = 0.004), initiation of complementary foods before the age of three months (OR = 6.1, 95%CI: 1.4–26.9, p = 0.02) and presence of food allergy (OR = 3.1, 95% CI: 1.1–9.2, p = 0.03) were found to be significant risk factors for physician-diagnosed asthma. The risk factors for frequent wheezing were maternal smoking during pregnancy (OR = 5.2, 95% CI: 0.9–28.7, p = 0.05) and high serum IgE levels (OR = 2.9, 95% CI: 0.9–9.0, p = 0.05) at borderline significance.ConclusionOur study was the first epidemiological study in preschool children in the Mediterranean region of Turkey and demonstrated a high prevalence of asthma and allergic diseases, probably related to humid climatic properties in addition to other environmental and genetic factors.     

Incidence of allergic rhinitis in a cohort of young adults from 13–15 years old to 23–25 years old in Castellon (Spain)

BackgroundThe objective of this study was to estimate the incidence of Allergic Rhinitis (AR) in young adults and its risk or protective factors.MethodsA population-based prospective cohort study was carried out in 2012. The cohort participated in the International Study of Asthma and Allergy in Childhood in Castellon in 1994 and 2002. A telephone survey was conducted using the same questionnaires. A new case of AR was defined as the participants free of the disease in 2002, who self-reported suffering from AR or taking medications for AR in the period 2002–2012.ResultsOf the 1805 schoolchildren in the cohort in 2002, 1435 young adults (23–25 years old) participated (follow-up 79.1%) in 2012; 743 were female and 692 male; their mean age was 24.9 ± 0.6 years. Two hundred new cases of AR occurred in 1259 participants free of the disease with an incidence of 17.3 per 1000 person–years, and the incidence increased from 2002 (RR = 1.42; 95% CI 1.15–1.75). The risk factors of AR adjusted by age and gender were sinusitis (RR = 1.77; 95% CI 1.16–2.68), atopic dermatitis (RR = 1.51; 95% CI 1.11–2.06) and constant exposure to truck traffic (RR = 1.88; 95% CI 1.12–3.17). For male participants, the risk factors were asthma, sinusitis and atopic dermatitis, and for females bronchitis was a risk factor and presence of older siblings a protective factor.ConclusionsAn increase in AR incidence was observed. Sinusitis, atopic dermatitis and constant exposure to truck traffic were the risk factors of the AR with some differences by gender.     

Cardiothyreosis: Prevalence and risk factors

Cardiothyreosis (CT) or thyrotoxic heart disease is associated with higher morbidity and mortality than the other forms of hyperthyroidism. Its risk factors have been analyzed in a limited number of studies. The aims of our study were to investigate the prevalence of CT and its risk factors in patients with hyperthyroidism.MethodsWe identified 538 patients with a hospital discharge diagnosis of hyperthyroidism from January 2000 to December 2015. Among them, 35 patients were diagnosed as having CT. Their demographic, clinical and biological characteristics were studied and compared with those of 72 controls (patients admitted for hyperthyroidism without CT) randomly selected using univariate and multivariate analysis.ResultsThe prevalence of CT in patients hospitalized with overt hyperthyroidism was 6.5%. The cardiac complications seen were atrial fibrillation (AF) in 33 cases (6.1%) and cardiac heart failure (CHF) in 11 cases (2%). The risk factors of CT were age greater than 50 years (OR = 13.1; 95% CI [4.9–34.4]), low socioeconomic status (OR = 2.8; 95% CI [1.2–6.7]), low educational level (OR = 3.1; 95% CI [1.2–8.3]), personal history of hypertension (OR = 3.5; 95% CI [1.1–11.2]) and a multinodular toxic goiter as the etiology of hyperthyroidism (OR = 4.6; 95% CI [1.6–13.9]). After multivariate analysis, age greater than 50 years was the only independent risk factor of CT (adjusted OR = 11.6; 95% CI [2.7–49.5]). Severe biological hyperthyroidism (FT4 > 3 times normal) was associated with a lower risk of CT (adjusted OR = 0.2; 95% CI [0.1–0.9]).ConclusionsThe prevalence of CT in patients with overt hyperthyroidism was relatively low. Cardiac complications were AF and CHF with a clear predominance of AF. Advanced age was the only independent risk factor of CT. Cardiac complications may be seen even if hyperthyroidism is not biologically severe.     

The contribution of clinical and pathological predisposing factors to severe gastro-duodenal lesions in patients with long-term low-dose aspirin and proton pump inhibitor therapy

BackgroundPreventive strategies developed to avoid the complications of antiplatelet therapies recommend the evaluation of risk factors for gastrointestinal events and indicated gastroprotective strategies.AimWe aimed to assess the impact of predisposing factors - histological findings, concomitant drug consumption, comorbidities, symptoms, social habits, Helicobacter pylori infection - on severe gastro-duodenal lesions in patients with low-dose aspirin and concomitant protective therapy with proton pump inhibitors (PPI).MethodWe enrolled 237 patients with LDA and PPI therapy, referred for upper digestive endoscopy, divided into two groups according to the severity of their endoscopic lesions (172 patients with no or mild endoscopic lesions and 65 patients with severe endoscopic lesions).ResultsIn the univariate logistic regression model, the factors associated with severe gastro-duodenal lesions were gender (OR = 1.87, 95% CI: 1.04–3.41), anticoagulants (OR = 2.40, 95% CI: 1.26–4.53), gastric atrophy and/or intestinal metaplasia (OR = 1.85, 95% CI: 1.04–3.32), congestive heart failure (OR = 2.59, 95% CI: 1.16–6.62), anaemia (OR = 3.01, 95% CI: 1.67–5.47) and smoking (OR = 4.29, 95% CI: 1.57–12.32). In the final model, anticoagulants (p = 0.041 < 0.05) and anaemia (p = 0.019 < 0.05) were risk factors for severe lesions via multivariate regression analysis, while for active/inactive chronic gastritis and smoking a positive dependency with a tendency towards statistical significance (p < 0.10) was noticed for severe gastric lesions.ConclusionsIn patients treated with low-dose aspirin and gastroprotective therapy with proton pump inhibitors we have enough evidence to consider co-treatment with anticoagulants and anaemia important predictors for severe endoscopic lesions, while other factors such as inflammation in gastric biopsies, congestive heart failure, co-treatment with clopidogrel and smoking tended to have a positive influence on risk for severe gastro-duodenal lesions.     

Leisure-time physical activity and incident metabolic syndrome: a systematic review and dose-response meta-analysis of cohort studies

BackgroundLeisure-time physical activity (LTPA) has been suggested to reduce risk of metabolic syndrome (MetS). However, a quantitative comprehensive assessment of the dose–response association between LTPA and incident MetS has not been reported. We performed a meta-analysis of studies assessing the risk of MetS with LTPA.MethodMEDLINE via PubMed and EMBase databases were searched for relevant articles published up to March 13, 2017. Random-effects models were used to estimate the summary relative risk (RR) of MetS with LTPA. Restricted cubic splines were used to model the dose–response association.ResultsWe identified 16 articles (18 studies including 76,699 participants and 13,871 cases of MetS). We found a negative linear association between LTPA and incident MetS, with a reduction of 8% in MetS risk per 10 metabolic equivalent of task (MET) h/week increment. According to the restricted cubic splines model, risk of MetS was reduced 10% with LTPA performed according to the basic guideline-recommended level of 150 min of moderate PA (MPA) per week (10 MET h/week) versus inactivity (RR = 0.90, 95% CI 0.86–0.94). It was reduced 20% and 53% with LTPA at twice (20 MET h/week) and seven times (70 MET h/week) the basic recommended level (RR = 0.80, 95% CI 0.74–0.88 and 0.47, 95% CI 0.34–0.64, respectively).ConclusionOur findings provide quantitative data suggesting that any amount of LTPA is better than none and that LTPA substantially exceeding the current LTPA guidelines is associated with an additional reduction in MetS risk.     

Relative contributions of different cardiovascular risk factors to significant arterial stiffness

BackgroundAlthough arterial stiffness has been known to be related to many cardiovascular (CV) risk factors, the level of contribution of each risk factor to significant arterial stiffness is not yet clear.MethodsWe studied an out-patient cohort of 835 subjects who were without a history of CV disease. Brachial–ankle pulse wave velocity (baPWV) measurement and Framingham risk score (FRS) calculation were performed for all subjects.ResultsbaPWV was well correlated with FRS (r = 0.523, P < 0.001) and it could independently predict it (P < 0.001) after adjusting for the conventional CV risk factors. We defined a baPWV > 1710 cm/s as significant arterial stiffness on the basis of its ability to detect a high 10-year risk of coronary heart disease (FRS > 20%). Multiple logistic regression analysis revealed that the adjusted odds ratios of significant arterial stiffness for an age > 60 years, hypertension, male gender, smoking and diabetes were 6.2 (95% CI 4.4–8.7), 3.4 (95% CI 2.1–5.3), 1.9 (95% CI 1.3–2.8), 1.9 (95% CI 1.2–3.2) and 1.6 (95% CI 1.1–2.4), respectively. Hyperlipidemia and obesity were not statistically significant.ConclusionsOld age and hypertension were the strongest independent predictors of significant arterial stiffness. Male gender, smoking and diabetes followed in order of strength as independent predictors.     

An investigation of multimorbidity measures as risk factors for pneumonia in elderly frail patients admitted to hospital

ObjectivesTo investigate the association of different chronic comorbidities, considered singularly and together in Cumulative Illness Rating Scale (CIRS) indexes, with pneumonia diagnosis in a group of elderly frail hospitalized patients.Design and methodsWith a retrospective cohort design, all clinical records of frail (Rockwood ≥ 5) nonterminal patients ≥ 65 years old acutely admitted over a 8-month span in an internal medicine ward were evaluated. Pneumonia status and its categorization (community-acquired, CAP, vs healthcare-associated, HCAP) were defined according to chest radiology findings and validated criteria. Chronic comorbidities, CIRS Comorbidity Score and CIRS Severity Index were collected for each participant through a standardized methodology. Multivariate logistic regression models were applied to assess the association of each comorbid condition or scores with pneumonia.Results1199 patients (546 M, median age 81.9, IQR 72.8–87.9 years), of whom 239 with pneumonia (180 CAP, 59 HCAP) were evaluated. CIRS Comorbidity Score was significantly associated with pneumonia, both at an age- and sex-adjusted model and at a multivariate model (OR for each unitary increase 1.03, 95% CI 1.001–1.062, p = 0.04), together with provenience from nursing home (OR 1.96, 95% CI 1.41–2.73, p < 0.001). Among single comorbidities, only COPD (OR 2.7, 95% CI 1.9–3.6, p < 0.001) and dementia (OR 2.3, 95% CI 1.7–3.3, p < 0.001) were associated with pneumonia, while stroke, cancer, cardiovascular, chronic liver and kidney disease were not.ConclusionsIn a small cohort of elderly frail hospitalized patients, measures of multimorbidity, like CIRS, are significantly associated with the risk of pneumonia. COPD and dementia are the main conditions concurring to define this risk.     

Efficacy and safety of DPP-4 inhibitors in patients with type 2 diabetes: Meta-analysis of placebo-controlled randomized clinical trials

BackgroundGuidelines for type 2 diabetes (T2D) recommend reducing HbA_1c through lifestyle interventions and glucose-lowering drugs (metformin, then combination with dipeptidyl peptidase-4 inhibitors [DPP-4Is] among other glucose-lowering drugs). However, no double-blind randomized clinical trial (RCT) compared with placebo has so far demonstrated that DDP-4Is reduce micro- and macrovascular complications in T2D. Moreover, the safety of DPP-4Is (with increased heart failure and acute pancreatitis) remains controversial.MethodsA systematic review of the literature (PubMed, Cochrane Library Central Register of Controlled Trials [CENTRAL] and https://clinicaltrials.gov), including all RCTs vs placebo published up to May 2015 and the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS), published June 2015, was performed. Primary endpoints were all-cause mortality and death from cardiovascular causes; secondary endpoints were macrovascular and microvascular events. Safety endpoints were acute pancreatitis, pancreatic cancer, serious adverse events and severe hypoglycaemia.ResultsA total of 36 double-blind RCTs were included, allowing analyses of 54,664 patients. There were no significant differences in all-cause mortality (RR = 1.03, 95% confidence interval [CI] = 0.95–1.12), cardiovascular mortality (RR = 1.02, 95% CI = 0.92–1.12), myocardial infarction (RR = 0.98, 95% CI = 0.89–1.08), strokes (RR = 1.02, 95% CI = 0.88–1.17), renal failure (RR = 1.06, 95% CI = 0.88–1.27), severe hypoglycaemia (RR = 1.14, 95% CI = 0.95–1.36) and pancreatic cancer (RR = 0.54, 95% CI = 0.28–1.04) with the use of DPP-4Is. However, DDP-4Is were associated with an increased risk of heart failure (RR = 1.13, 95% CI = 1.01–1.26) and of acute pancreatitis (RR = 1.57, 95% CI = 1.03–2.39).ConclusionThere is no significant evidence of short-term efficacy of DPP-4Is on either morbidity/mortality or macro-/microvascular complications in T2D. However, there are warning signs concerning heart failure and acute pancreatitis. This suggests a great need for additional relevant studies in future.     

Factores clínicos asociados a enfermedad pulmonar por Aspergillus spp. en pacientes con enfermedad pulmonar obstructiva crónica

ObjectiveTo explore the clinical and epidemiological characteristics of chronic obstructive pulmonary disease (COPD) patients with Aspergillus spp. isolation from respiratory samples, and to identify which factors may help us to distinguish between colonisation and infection.MethodsA retrospective cohort study was performed. All patients with COPD and respiratory isolation of Aspergillus spp. over a 12-year period were included. Patients were assigned to 2 categories: colonisation and pulmonary aspergillosis (PA), which includes the different clinical forms of aspergillosis. A binary logistic regression model was performed to identify the predictive factors of PA.ResultsA total of 123 patients were included in the study: 48 (39.0%) with colonisation and 75 (61.0%) with PA: 68 with probable invasive pulmonary aspergillosis and 7 with chronic pulmonary aspergillosis. Spirometric stages of the GOLD classification were not correlated with a higher risk of PA. Four independent predictive factors of PA in COPD patients were identified: home oxygen therapy (OR: 4.39; 95% CI: 1.60-12.01; P = .004), bronchiectasis (OR: 3.61; 95% CI: 1.40-9.30; P = .008), hospital admission in the previous three months (OR: 3.12; 95% CI: 1.24-7.87; P = .016) and antifungal therapy against Candida spp. in the previous month (OR: 3.18; 95% CI: 1.16-8.73; P = .024).ConclusionsContinuous home oxygen therapy, bronchiectasis, hospital admission in the previous three months and administration of antifungal medication against Candida spp. in the previous month were associated with a higher risk of pulmonary aspergillosis in patients with COPD.     

Performance of stent thrombosis and bleeding risk scores in out-of-hospital cardiac arrest due to acute coronary syndromes

BackgroundPatients with out-of-hospital cardiac arrest (OHCA) due to acute coronary syndromes (ACS) who undergo percutaneous coronary intervention (PCI) are at high risk of bleeding and thrombosis. While predictive bleeding and stent thrombosis risk scores have been established, their performance in patients with OHCA has not been evaluated.MethodsAll consecutive patients admitted for OHCA due to ACS who underwent PCI between January 2007 and December 2019 were included. The ACTION and CRUSADE bleeding risk scores and the Dangas score for early stent thrombosis risk were calculated for each patient. A C-statistic analysis was performed to assess the performance of these scores.ResultsAmong 386 included patients, 82 patients (21.2%) experienced severe bleeding and 30 patients (7.8%) experienced stent thrombosis. The predictive performance of the ACTION and CRUSADE bleeding risk scores for major bleeding was poor, with areas under the curve (AUCs) of 0.596 and 0.548, respectively. Likewise, the predictive performance of the Dangas stent thrombosis risk score was poor (AUC 0.513). Using multivariable analysis, prolonged low-flow (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.00–1.05; P = 0.025), reduced haematocrit or fibrinogen at admission (OR 0.93, 95% CI 0.88–0.98; P = 0.010 and OR 0.61; 95% CI 0.41–0.89; P = 0.012, respectively) and the use of glycoprotein IIb/IIIa inhibitors (OR 2.10, 95% CI 1.18–3.73; P = 0.011) were independent risk factors for major bleeding.ConclusionThe classic bleeding and stent thrombosis risk scores have poor performance in a population of patients with ACS complicated by OHCA. Other predictive factors might be more pertinent to determine major bleeding and stent thrombosis risks in this specific population.