Sleep disturbances and risk of falls in an old Chinese population-Rugao Longevity and Ageing Study

BackgroundTo explore the relationship between sleep disturbances and falls in an elderly Chinese population.MethodsData from 1726 individuals aged 70–87 years from the Rugao Longevity and Ageing Study were used. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep variables. Outcomes were falls ≥1 time per year and falls ≥2 times per year.ResultsA total of 22.7% of the participants experienced ≥1 fall, and 9.8% experienced ≥2 falls per year. Poor sleep quality was associated with ≥1 fall (OR 1.08, 95% CI 1.05–1.12; OR 1.27, 95% CI 1.14–1.41) and ≥2 falls (OR 1.08, 95% CI 1.03–1.14; OR 1.28, 95% CI 1.10–1.48), with an increase per PSQI score and SD PSQI score, respectively. In addition, sleep quality, sleep latency, sleep efficiency, and sleep disturbance subcomponents were associated with an increased risk of ≥1 fall with ORs of 1.44 (95% CI, 1.21–1.72), 1.23 (95%CI,1.09–1.40), 1.12 (95%CI, 1.01–1.23) and 1.70 (95% CI,1.35–2.14), respectively, and were associated with an increased risk of ≥2 falls with ORs 1.54 (95%CI, 1.22–1.96), 1.21(95%CI, 1.02–1.44), 1.17 (95% CI 1.02–1.33), and 1.78 (95%CI, 1.31–2.44), respectively. Further, participants slept ≤5 h per night had an increased risk of ≥1 fall (OR 2.34; 95%CI, 1.59–3.46) and ≥2 falls (OR 2.19; 95%CI, 1.30–3.69).ConclusionsPoor sleep quality and several subcomponent sleep symptoms were consistently associated with increased risk of falls ≥1 time and ≥2 times in Chinese elderly. The identification of sleep disturbances may help identify high-risk Chinese elders who may benefit from fall prevention education.     

Predictors of septic shock in initially stable patients with pyogenic liver abscess

Objectives: The incidence of pyogenic liver abscess (PLA), a life-threatening condition, is increasing worldwide. This study was designed to evaluate clinical features and outcomes in initially stable patients with PLA and to determine the predictors of septic shock.

Methods: The medical records of all adult patients who were hemodynamically stable and diagnosed with PLA in the emergency department from January 2010 to December 2014, inclusive, were reviewed. The primary outcome was septic shock.

Results: A review of medical records identified 453 patients (66.7% male), of mean age 61.4 years, diagnosed with PLA. Of these patients, 73 (16.1%) had septic shock and 10 (2.2%) died in-hospital. Of the 73 patients with septic shock, nine (12.3%) died in-hospital. The most common symptom was fever (79.5%), and the most common infectious agent was Klebsiella pneumoniae. Septic shock was significantly associated with age ≥60 years [odds ratio (OR): 2.99, 95% confidence interval (CI): 1.38–6.48], malignancy (OR: 2.11, 95% CI: 1.08–4.09), systolic blood pressure <100?mmHg (OR: 3.63, 95% CI: 1.43–9.21), respiratory rate ≥24/min (OR: 3.15, 95% CI: 1.20–8.28) and lactate concentration ≥2?mmol/L (OR: 4.92, 95% CI: 2.51–9.64). Septic shock also tended to be associated with procalcitonin concentration, but this was not statistically significant (OR: 3.42, 95% CI: 0.96–12.18).

Conclusions: Septic shock was frequent in initially stable patients with PLA and was associated with older age, malignancy, low blood pressure, tachypnea and elevated lactate concentration.     

Prevalence of non-alcoholic fatty liver disease and liver fibrosis in a general population cohort from Argentina

Introduction and ObjectivesSouth America is one of the regions with the highest rates of non-alcoholic fatty liver disease (NAFLD). This study aimed to assess the prevalence and severity of NAFLD in suburban Argentina.Patients and MethodsThe study involved a general community cohort of 993 subjects evaluated sequentially with a comprehensive lifestyle questionnaire, laboratory testing, abdominal ultrasound (US) and transient elastography with XL probe. NAFLD was diagnosed according to standard criteria.ResultsThe prevalence of NAFLD by the US was 37.2% (326/875) overall, 50.3% in subjects with overweight/obesity, 58.6% with hypertriglyceridemia, 62.3% with diabetes/hyperglycemia and 72.1% with all three risk factors. Male gender (OR 1.42, 95% CI 1.03–1.47, p = 0.029), age (50–59 years: OR 1.98, 95 CI 1.16–3.39, p = 0.013 and ≥60 years: OR 1.86, 95% CI 1.13–3.09, p = 0.015), BMI (25–29: OR 2.87, 95% CI 1.86–4.51, p<0.001 and ≥30: OR 9.57, 95% CI 6.14–15.20, p<0.001), diabetes/hyperglycemia (OR 1.65, 95% CI 1.05–2.61, p = 0.029) and hypertriglyceridemia (OR 1.73, 95% CI 1.20–2.48, p = 0.002) were independent predictors of NAFLD. Among patients with steatosis, 22.2% (69/311) had ≥F2 fibrosis (overweight 25%, hypertriglyceridemia 32%, diabetes/hyperglycemia 34%). BMI (OR 5.22, 95% CI 2.64–11.74, p<0.001), diabetes/hyperglycemia (OR 2.12, 95% CI 1.05–4.29, p = 0.04) and hypertriglyceridemia (OR 1.94, 95% CI 1.03–3.68, p = 0.040) were independent predictors of liver fibrosis.ConclusionsThis general population study from Argentina showed a high prevalence of NAFLD. Significant liver fibrosis was present in 22% of subjects with NAFLD. This information adds to the existing knowledge of NAFLD epidemiology in Latin America.     

Determinants of response to the glucagon-like peptide-1 receptor agonists in a type 2 diabetes population in the real-world

AimsTo identify clinical predictors associated with a response in terms of glycemic control and weight loss in patients with type 2 diabetes treated with glucagon-like peptide-1 receptor agonists (GLP-1RAs).MethodsA retrospective observational study was performed with real-world databases in primary care. Patients with type 2 diabetes-initiated treatment with GLP-1RAs during the study period, and response to GLP-1RAs were determined six months from treatment initiation. An optimal glycated hemoglobin (HbA1c) or weight response was defined as a reduction of ≥ 1% or ≥ 3%, respectively. A “great” response was defined as both an optimal HbA1c and weight response. Bivariate and multivariate analyses with intention-to-treat were performed.ResultsA sample of 2944 patients with type 2 diabetes was recruited. Higher HbA1c at baseline was the main clinical predictor of an optimal HbA1c response (odds ratio [OR]: 2.30, 95% confidence interval [CI]: 1.96–2.71 in men and OR: 2.03, 95% CI: 1.76–2.33 in women). Treatment without insulin at baseline was associated with a greater weight reduction in men (OR: 2.50, 95% CI: 1.41–4.44). Older age and a higher weight at baseline were related with this in women (OR: 1.02, 95% CI: 1.00–1.05 and OR: 1.01, 95% CI: 1.00–1.02, respectively).ConclusionsA high HbA1c at baseline and previous non-insulin therapy were the main predictors of a greater response (optimal HbA1c and weight response) to GLP1ra in both men and women. This may aid in treatment decision-making before initiating treatment with GLP-1RAs.     

Sex-specific association of resting heart rate with type 2 diabetes mellitus

AimThis study aimed to explore the association of resting heart rate (RHR) with type 2 diabetes mellitus (T2DM) by sex, and whether the association was mediated by insulin resistance (IR).MethodsThis cross-sectional study enrolled 12,508 participants (median age 57 years), with information collection through questionnaire interview, anthropometric and laboratory measurements. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of the association between RHR and T2DM by sex, and restricted cubic splines were used to describe the dose–response association. Mediation analysis was used to explore the contribution of IR, measured by homeostasis model assessment of insulin resistance (HOMA-IR) index, to RHR-related T2DM.ResultsAmong 12,508 participants, 1413 participants (11.30%) had T2DM. RHR was positively associated with T2DM (per 10-bpm increase in RHR, OR 1.48, 95% CI: 1.34–1.64 for men and OR 1.42, 95% CI: 1.32–1.52 for women). As compared with RHR = 75 bpm, with increasing RHR, the adjusted probability of T2DM was significantly increased for both men and women. HOMA-IR partially mediated the association (indirect effect: OR = 1.17, 95% CI:1.13–1.22; direct effect: OR = 1.25, 95% CI: 1.11–1.39 in men and indirect effect: OR = 1.16, 95% CI:1.13–1.20; direct effect: OR = 1.15, 95% CI: 1.15–1.35 in women).ConclusionRHR was significantly associated with T2DM, which suggests that RHR may be a non-invasive clinical marker of early intervention to prevent T2DM, and IR may partially mediated RHR-related T2DM.     

Prevalence,correlates and outcomes of multimorbidity among the middle-aged and elderly: Findings from the China Health and Retirement Longitudinal Study

BackgroundThe multimorbidity associated with ageing has been prevalent worldwide and poses major challenges to the health care system. However, the research about multimorbidity in China is far from sufficient. Additionally, international studies on the influencing factors of multimorbidity and the impact on disability/mortality are still inconsistent. The aim of this study was to examine the prevalence, correlates and outcomes of multimorbidity among the middle-aged and elderly Chinese population.MethodsWe used data from the China Health and Retirement Longitudinal Study (CHARLS). Logistic regression was performed to analyze the influencing factors of multimorbidity. The Cox proportional hazard model was used to evaluate the impact of multimorbidity on functional disability and all-cause mortality.ResultsThe prevalence of multimorbidity was 55.12 % in the whole study population and 65.60 % among people aged ≥ 65 years. Multimorbidity was significantly associated with old age (OR: 2.76, 95 % CI: 2.31–3.30), females (OR: 1.21, 95 % CI: 1.01–1.44), ex-smoker (OR: 2.07, 95 % CI: 1.58–2.72), ex-drinker (OR: 2.18, 95 % CI: 1.66–2.87), obesity (OR: 2.87, 95 % CI: 2.30–3.57), lower education (OR:1.32, 95 % CI: 1.08–1.61), living alone (OR: 1.26, 95 % CI: 1.02–1.55) and unemployment (OR: 1.66, 95 % CI: 1.11–2.48). Moreover, multimorbidity was correlated with disability (HR: 2.27, 95 % CI: 1.93–2.66) and all-cause mortality (HR: 1.95, 95 % CI: 1.36–2.80) after multivariable adjustment.ConclusionsMultimorbidity is highly prevalent in China and possesses significantly negative effects on health outcomes. Identification of the key population and tailored interventions on their modifiable risk factors should be paid much importance.     

Osteopenia and osteoporosis among treatment-experienced people living with HIV

IntroductionLife expectancy of people living with human immunodeficiency (PLHIV) has increased mainly due to the accessibility and effectiveness of antiretroviral therapy (ART). However, adverse effects from long-term use of antiretrovirals, and the physiological changes associated with aging, may compromise the quality of life of PLHIV, in addition to causing new demands on the healthcare system.ObjectivesEstimate the frequency of osteoporosis and osteopenia in patients on prolonged ART and to verify their associated factors.MethodsA cross-sectional study was conducted in Belo Horizonte, Minas Gerais, Brazil, from August 2017 to June 2018, in a sample of PLHIV (age ≥ 18 years) who started ART between 2001 and 2005. Data were collected through face-to-face interviews, physical evaluation, laboratory tests, and Dual-Energy X-Ray Absorptiometry Screening (DEXA). The outcome of interest was presence of bone alteration, defined as presence of osteopenia or osteoporosis in DEXA. The association between the explanatory variables and the event was assessed through odds ratio (OR) estimate, with 95% confidence interval (CI). Multiple logistic regression was performed to evaluate factors independently associated with bone alteration.ResultsAmong 92 participants, 47.8% presented bone alteration (19.6% osteoporosis and 28.2% osteopenia). The variables that remained in the final logistic regression model were age ≥ 50 years (OR: 12.53; 95% CI: 4.37–35.90) and current alcohol use (OR: 2.63; 95% CI: 0.94–7.37).ConclusionsThis study showed a high frequency of bone changes, especially in PLHIV older than 50 years. This information is useful to stimulate the screening and timely intervention of this comorbidity of PLHIV on prolonged use of ART in order to prevent or minimize complications and new demands on the healthcare system.     

Prevalence of urinary system,pelvic organ,and genital tract disorders among women with type 1 diabetes in Germany

AimType 1 diabetes can lead to various long-term complications including macro- and microvascular disorders and osteoporosis. However, published data on the association between type 1 diabetes (T1D) and urinary system and genital tract disorders is limited. The aim of this work was to estimate the prevalence and incidence of urinary system- and genital tract disorders among women with T1D treated in gynecological practices in Germany.MethodsThis retrospective cohort study included women aged 16 years or older with T1D diagnosis between January 2015 and December 2018 from 268 gynecological practices in Germany (IMS Disease Analyzer database). T1D patients were matched 1:5 by age and physician with non-diabetic patients. The main outcome of the study was the prevalence of different urinary system, pelvic organ and genital tract disorders documented between the first documentation of T1D diagnosis and the last outpatient visit. All study disorders were included as dependent variables in multivariate logistic regression models, while T1D was applied as an impact variable. In each model, the effect of T1D on the defined disorder was adjusted for all other study disorders.ResultsThe present study included 1357 women with and 6785 women without T1D (mean age 45.6 years). T1D was significantly associated with acute vulvitis (OR: 2.12 (95% CI: 1.56–2.90), other specified urinary incontinence (OR: 1.64 (95% CI: 1.19–2.26), acute cystitis (OR: 1.46 (95% CI: 1.10–1.95), and absent, scanty and rare menstruation (OR: 1.37 (95% CI: 1.13–1.67).ConclusionThese findings may have implications for the future care of women with T1D. Firstly, the focus should not be on diabetes management alone, but also on identifying and handling additional associated comorbidities including urinary system and genital tract disorders. Secondly, the data suggest that patients with T1D should be asked specifically about symptoms they may be experiencing that are related to the associated disorders identified.     

Associations between hepatitis B infection and chronic kidney disease: 10-Year results from the U.S. National Inpatient Sample

IntroductionViral hepatitis infection is associated with negative impacts on renal function that may lead to nephropathy. We investigated associations between chronic hepatitis B virus (HBV) infection and chronic kidney disease (CKD) and/or end-stage renal disease (ESRD) in a large, representative sample from a nationwide U.S. database.MethodsThis population-based, retrospective observational study extracted data from the U.S. Nationwide Inpatient Sample (NIS) database, including adults ≥18 years old admitted to U.S. hospitals between 2005 and 2014 with records of chronic HBV infection in medical history. The final analytic sample included 70,674 HBV-infected patients and 282,696 matched non-HBV controls. Study endpoints were prevalent CKD and ESRD. Associations between CKD/ESRD and HBV and patients’ clinical characteristics were determined by logistic regression analysis.ResultsHBV infection was associated with slightly increased risk of prevalent CKD (OR: 1.06, 95% CI: 1.004–1.119) and an approximate 2-times risk of prevalent ESRD (OR: 1.98, 95% CI: 1.880–2.086). HBV infection in both genders was associated with slightly increased risk of CKD (males, OR: 1.09, 95% CI: 1.02–1.16; females, OR: 1.07, 95% CI: 0.98,1.17), and significantly associated with increased risk for CKD among non-diabetic patients (OR: 1.23, 95% CI: 1.15–1.32), white patients (OR: 1.14, 95% CI: 1.06–1.23) and Asian/Pacific Islanders (OR: 1.13, 95% CI: 0.98–1.30).ConclusionsChronic HBV infection is associated with slightly increased risk for CKD and greater risk for ESRD in males and females, Whites and Asian/Pacific Islanders and non-diabetic patients.     

Adiponectin predicts the antioxidant capacity and size of high-density lipoprotein (HDL) in individuals with diabetes mellitus

AimsThe relationship between adiponectin and type 2 diabetes mellitus (T2DM) is established; however the evidence on its role in high-density lipoprotein (HDL) functionality is still scant. The aim of this study was to assess the association of adiponectin with HDL functionality especially on the antioxidant capacity and HDL subfractions in individuals with T2DM.MethodsThis case-control study enrolled 356 individuals who were divided into two groups: diabetics [T2DM (n = 188)] and non-diabetic [nT2DM (n = 168)]. The association of adiponectin level on HDL functionality parameters was done in function of the cut-off point for adiponectin [percentile p < 75 = 12.9 μg/mL versus p ≥ 75 = 12.9 μg/mL] and multiple adjustments applied in the logistic regression models.ResultsBody mass index (BMI), waist circumference (WC) and body fat mass (FM) were higher in T2DM. The larger HDL particles (HDL_LARGE) were lower in T2DM group in comparison with nT2DM (28.20% versus 30.40%; p = 0.016). Individuals with T2DM and simultaneous highest adiponectin (p ≥ 75) had 2.25 OR (95% CI = 1.03–4.91) and 5.14 OR (95% CI = 2.37–11.15) to present higher HDL-C and HDL_LARGE concentrations. After adjustment for multiple confounders, high level of adiponectin was independently related with improvement of the HDL antioxidant capacity (OR = 2.78; 95% CI = 1.16–6.67).ConclusionsHigh adiponectin level associates with a lesser negative impact of T2DM on HDL functionality by increase in APO AI, particles size, and cholesterol content. On the same token, higher adiponectin was associated with greater odds to have high antioxidant capacity.     

The association between curry-rice consumption and hypertension,type 2 diabetes,and depression: The findings from KNHANES 2012–2016

Background and aimsWe aim to evaluate the association between curry-rice consumption, cardiovascular diseases (CVDs), type 2 diabetes (T2DB), arthritis, and depression.Methods17,625 participants aged ≥18 years were recruited to obtain data on sociodemographic characteristics, lifestyle, medical history, current medications, family history, and food consumption. The association between curry-rice consumption, CVDs, T2DB, arthritis, and depression was examined using multivariable-adjusted analyses.ResultsIn the logistic model, risks of elevated triglyceride (OR 0.89; 95% CI, 0.82–0.97, p = 0.006), elevated HbA1c (OR 0.81; 95% CI, 0.73–0.91, p < 0.001), and elevated glucose (OR 0.86; 95% CI, 0.79–0.94, p < 0.001) were significantly lower in the high curry-rice consumption group than in the low curry-rice consumption group. Risk of hypertension (OR 0.88; 95% CI, 0.78–0.98, p = 0.044), T2DB (OR, 0.82; 95% CI, 0.68–0.98, p < 0.001), and depression (OR 0.82; 95% CI, 0.70–0.97, p = 0.026) was significantly lower among the high curry-rice consumption group than in the low curry-rice consumption group. These findings were consistent with the results of the analysis when curry-rice consumption was treated as a continuous variable.ConclusionsThe potential health benefits resulting from the intake of curry-rice via an ordinary diet could protect the public from the burden of non-communicable diseases (NCDs) and mental health. These results highlight an ongoing need to understand the role of curry-rice in NCDs and mental health.     

Characteristics of patients with hypertension in a population with type 2 diabetes mellitus. Results from the Turkish Nationwide SurvEy of Glycemic and Other Metabolic Parameters of Patients with Diabetes Mellitus (TEMD Hypertension Study)

BackgroundThe present survey aimed to find out the demographical and clinical characteristics of patients with hypertension in a population with type 2 diabetes mellitus (T2DM) in Turkey.MethodsPatients with T2DM who were followed-up in tertiary endocrine units for at least last one year were recruited. Demographic, clinical and biochemical data of the patients were collected. Hypertension was defined as taking anti-hypertensive medications or having office arterial blood pressure (ABP) ≥140/90 mmHg or home ABP ≥ 130/80 mmHg.ResultsA total of 4756 (58.9% women) diabetic patients were evaluated. The percentage of patients with hypertension was 67.5% (n = 3212). Although 87.4% (n = 2808) of hypertensive patients were under treatment, blood pressure was on target in 52.7% (n = 1479) of patients. Hypertension proportions were higher in woman (p = 0.001), older, more obese, and those who had longer diabetes duration, lower education levels, higher frequency of hypoglycemic events (all p < 0.001) and higher triglyceride levels (p = 0.003). LDL cholesterol level and the percentage of smokers were lower in hypertensive group than in non-hypertensive group (both p < 0.001). The percentage of macro and microvascular complications was higher in the hypertensive group than in the normotensive one (both p < 0.001). In multivariate logistic regression analysis, being a woman (OR: 1.26, 95% CI: 1.04–1.51, p = 0.016), smoking (OR: 1.38, 95% CI: 1.05–1.80, p = 0.020), regular physical activity (OR: 1.24, 95% CI: 1.01–1.53, p = 0.039) and the presence of macrovascular complications (OR: 1.38 95% CI: 1.15–1.65, p = 0.001) were the significant predictors of good ABP regulation. The ratios of masked and white coat hypertension were 41.2% and 5.7%, respectively.ConclusionOur findings indicate that two-thirds (67.5%) of adult patients with T2DM have hypertension. Co-existence of hypertension increases the frequency of macro and microvascular diabetic complications in these patients. Despite the critical role of hypertension in morbidity and mortality, only half of the patients have favorable ABP levels. Masked hypertension seems to be another important issue in this population.     

Diabetes and higher HbA1c levels are independently associated with adverse renal outcomes in inpatients following multiple hospital admissions

ObjectiveTo assess the association between glycaemic status prior to the first hospital presentation with developing adverse renal outcomes overtime in patients with multiple hospital re-admissions.DesignA prospective observational cohort study.ParticipantsAll inpatients aged ≥54 years admitted between 2013 and 16 to a tertiary hospital.Main outcomesWe prospectively measured HbA1c levels in all inpatients aged ≥54 years admitted between 2013 and 16. Diabetes was defined as prior documented diagnosis of diabetes and/or HbA1c ≥6.5% (47·5 mmol/L). Included patients had ≥ two admissions (at least 90 days apart), baseline estimated glomerular filtration rate (eGFR) >30 ml/min/1·73m² and no history of renal replacement therapy. We assessed several renal outcomes: (a) 50% decline in eGFR; (b) rapid decline in renal function (eGFR decline >5 mL/min/1·73m²/year) and (c) final eGFR<30 ml/min/1·73m².ResultsOf 4126 inpatients with a median follow-up of 465 days (254, 740), 26% had diabetes. The presence of diabetes was associated with higher odds of (a) 50% decline in eGFR (OR = 1·42;95% CI:1·18–1·70;p < 0·001); (b) rapid decline in renal function (OR = 1·40;95%CI:1·20–1·63;p < 0·001), and (c) reaching eGFR<30 ml/min/1.73m² (OR = 1·25;95%CI:1·03–1·53;p < 0·05). Every 1% (11 mmol/L) increase in baseline HbA1c was associated with significantly greater odds of (a) >50% decline in eGFR (OR = 1·07;95% CI:1·01–1·4;p < 0·05) and (b) rapid decline in renal function (OR = 1·11;95% CI:1·05–1·18;p < 0·001).ConclusionsIn patients with ≥two admissions, the presence of diabetes and higher HbA1c levels were strongly and independently associated with adverse renal outcomes at follow up. Such patients are at high risk of relatively rapid deterioration in renal function and a logical target for structured preventive interventions.     

Once-weekly dulaglutide versus insulin glargine in the early control of fasting serum glucose and HbA1c

AimsTo determine the early benefit:risk balance of dulaglutide versus insulin glargine in patients with type 2 diabetes mellitus (T2DM).MethodsThis post hoc analysis used data from a randomized, open-label study (AWARD-2; modified intention-to-treat group) in which suboptimally controlled metformin + glimepiride-treated patients received dulaglutide 1.5 mg (n = 273) or insulin glargine (n = 262). Two composite endpoints were used: for weeks 2–20, fasting serum glucose (FSG) <130 mg/dL (<7.2 mmol/L) without hypoglycemia (blood glucose ≤70 mg/dL [≤3.9 mmol/L] or severe hypoglycemia); at week 26, patients with glycated hemoglobin (HbA1c) <7.0% (<53.0 mmol/mol) or reduction from baseline ≥1.0% (≥10.9 mmol/mol), no hypoglycemia (as defined above) and no weight gain. Odds ratios (ORs) were generated using logistic regression analysis.ResultsThe probability of reaching the FSG target without hypoglycemia was higher with dulaglutide than with insulin glargine at weeks 4 (OR 1.78; 95% confidence interval [CI] 1.22–2.60) and 8 (OR 1.69; 95% CI 1.15–2.48). The proportion of patients achieving the 26-week endpoint was higher with dulaglutide (37.4% vs. 10.3%; OR 5.28; 95% CI 3.28–8.48).ConclusionsDulaglutide's balanced efficacy-to-safety profile compares favorably with that of insulin glargine and is apparent soon after treatment initiation and after 6 months of therapy.     

Radiotherapy of rectal cancer in elderly patients: Real-world data assessment in a decade

Background and purposeThere is paucity of data on the efficacy and toxicity of radiotherapy in rectal cancer (RC) elderly patients. The objective was to identify management strategies and resulting outcomes in RC patients ≥70 years undergoing radiotherapy.Material and methodsA retrospective study included consecutive RC patients ≥70 years undergoing rectal radiotherapy.ResultsFrom 2004–2015, 340 RC patients underwent pre-operative (n = 238; 70%), post-operative (n = 41, 12%), or exclusive (n = 61, 18%) radiotherapy, with a median age of 78.5 years old (range: 70–96). Radiotherapy protocols were tailored, with 54 different radiotherapy programs (alteration of the total dose, and/or fractionation, and/or volume). Median follow-up was 27.1 months. Acute and late grade 3–4 radio-induced toxicities were reported in 3.5% and 0.9% of patients. Metastatic setting (OR = 6.60, CI95% 1.47–46.03, p = 0.02), exclusive radiotherapy (OR = 5.08, CI95% 1.48–18.21, p = 0.009), and intensity-modulated radiotherapy (OR = 6.42, CI95% 1.31–24.73, p = 0.01) were associated with grade ≥3 acute toxicities in univariate analysis. Exclusive radiotherapy (OR = 9.79, CI95% 2.49–43.18, p = 0.001) and intensity-modulated radiotherapy (OR = 12.62, CI95% 2.05–71.26, p = 0.003) were independent predictive factors of grade ≥3 acute toxicities in multivariate analysis. A complete pathological response was achieved in 12 out of 221 pre-operative patients (5.4%). Age, tumor stage, and surgery were independent predictive factors of survival in multivariate analysis. At end of follow-up, 7.1% of patients experienced local relapse.ConclusionRadiotherapy for RC in elderly patients appeared safe and manageable, perhaps due to the tailoring of radiotherapy protocols. Tailored management resulted in acceptable rate of local tumor control.     

Association of changes in self-reported vision and hearing impairments with depressive symptoms in middle-aged and older adults: Evidence from a nationwide longitudinal study in China

ObjectiveThis study assessed the longitudinal relationship between changes in self-reported vision impairment (VI) and hearing impairment (HI), and depressive symptoms in adults aged ≥45 years.MethodsData from the China Health and Retirement Longitudinal Study for 2015 and 2018 were used, with a sample size of 10,050. VI and HI were self-reported. The 10-item Center for Epidemiologic Studies Depression Scale (CES-D10) was used to assess depressive symptoms. Total scores and clinically significant depressive symptoms (CES-D10 scores ≥ 10) were used as outcomes and analyzed using generalized estimating equations with identity link and logit link functions.ResultsOf all changes in HI with good vision, only persistent HI was associated with higher CES-D10 scores (OR 95% CI: 1.09–3.30). Both new-onset and persistent VI with good hearing were associated with CES-D10 scores (OR 95% CI, new-onset: 1.70–3.52; persistent: 1.58–2.78) and clinically significant depressive symptoms (OR 95% CI, new-onset: 1.41–2.56; persistent: 1.36–2.27). Persistent dual sensory impairment (DSI) was associated with the highest CES-D10 scores (OR 95% CI: 3.63–5.97) and the highest risk of clinically significant depressive symptoms (OR 95% CI: 1.78–2.85). Those who self-reported improvements in vision and hearing still had higher CES-D10 scores (OR 95% CI: 1.35–2.83) and a higher risk of clinically significant depressive symptoms (OR 95% CI: 1.03–2.02) than those maintaining good vision and hearing.ConclusionSelf-reported VI and DSI are closely associated with depressive symptoms. Because VI and DSI are modifiable, interventions for them could also prevent depressive symptoms.     

Frequency of iron deficiency anemia in type 2 diabetes - Insights from tertiary diabetes care centres across India

AimTo study the frequency of iron deficiency anemia (IDA) in individuals with type 2 diabetes mellitus (T2DM) seen at tertiary diabetes care centres across India.MethodsThis is a retrospective study (January 1, 2017–December 31, 2019), which included 1137 individuals with T2DM, aged ≥18 years, for whom data on glycemic, lipid and haematological parameters were available. Anthropometric measurements were done using standardized techniques. Biochemical investigations included fasting plasma glucose[FPG], post prandial plasma glucose, HbA1c, lipids and serum ferritin and iron wherever feasible.ResultsOf the 1137 individuals included for the study, 117 (10.3%) were categorized as no ‘iron deficiency’ (ID) group [normal hemoglobin: male ≥13 g/dl, female ≥12 g/dl and normal serum ferritin ≥70 μg/L], 123 (10.8%) as ID group [normal hemoglobin and low serum ferritin <70 μg/L)], 447 (39.3%) as IDA group [low haemoglobin: male <13 g/dl, female <12 g/dl and low serum ferritin] and 450 (39.6%) as ‘anemia of chronic disease’ (ACD) group [low hemoglobin and normal serum ferritin]. The percentage of women having ID (57.7%) and IDA (65.3%) was significantly higher than their male counterparts. ID was most prevalent (61.7%) in the individuals with duration of diabetes <5 years whereas ACD was most prevalent (50.5%) in individuals with long standing diabetes (>10 years). Independent risk factors for IDA were female gender (OR 3.3,95% CI:1.75–6.23, p < 0.001), duration of diabetes (OR 1.05, 95% CI 1.01–1.11, p = 0.028) and FPG (OR 1.01, 95% CI 0.99–1.00, p = 0.018).ConclusionsThere is a need of identifying and monitoring iron status and anemia in patients with T2DM.     

Multidrug resistance 1 (MDR1/ABCB1) gene polymorphism (rs1045642 C > T) and susceptibility to multiple myeloma: a systematic review and meta-analysis

Introduction: Several studies have evaluated the association between the multidrug resistance 1 (MDR1) polymorphism (rs1045642 C?>?T) and multiple myeloma (MM). However, the results were not consistent. Therefore, to reach a comprehensive and reliable answer we determined the association of the MDR1 (rs1045642 C?>?T) polymorphism and MM in the context of meta-analysis.

Methods: All eligible studies published in EMBASE, PubMed, and Web of Science databases before July 2017 were reviewed. Subsequently, to assess the strength of association in the dominant model, recessive model, allelic model, homozygotes contrast, and heterozygotes contrast, pooled odds ratios and 95% confidence intervals (CIs) were calculated by the fixed effects model.

Results: A total of four case–control studies with 395 MM cases and 418 healthy controls were included in the meta-analysis. The overall results showed no significant association between the MDR1 (rs1045642 C?>?T) polymorphism and the risk of MM in genetic models (dominant model: OR?=?1.04, 95% CI?=?0.78–1.38; recessive model: OR?=?0.74, 95% CI?=?0.52–1.06; allelic model: OR?=?0.90, 95% CI?=?0.73–1.11; TT vs. CC: OR?=?0.80, 95% CI?=?0.51–1.25; and CT vs. CC: OR?=?1.12, 95% CI?=?0.77–1.62). No evidence of publication bias was detected except for the analysis of the recessive model.

Conclusion: This meta-analysis suggests that the MDR1 C?>?T polymorphism was not associated with the risk of MM. To confirm these findings, further comprehensive and well-designed studies are needed.     

Healthcare outcomes for patients with type 2 diabetes with and without comorbid obesity

AimsExamine the burden of comorbid obesity associated with type 2 diabetes (T2D).MethodsThe IBM® MarketScan® Explorys Claims Electronic Medical Records Data were used to identify adults with T2D, two recorded body mass index (BMI) values, and continuous insurance coverage from 1 year prior through 1 year post index date. Patients with index BMI ≥18 kg/m² and <30 kg/m² (normal/overweight) were matched to patients with index BMI ≥ 30 kg/m² (obese) using propensity score matching (PSM). Using the PSM cohort, multivariable analyses examined the association between obesity and patient comorbidities, healthcare costs, and resource utilization.ResultsIn the matched cohort (16,006 normal/overweight; 16,006 obese), multivariable analyses showed that obesity, compared to normal/overweight, was associated with increased odds of a diabetes-related comorbidity (Odds Ratio [OR] = 1.29; 95% Confidence Interval [CI] 1.21–1.38) and an obesity-related comorbidity (OR = 1.42; 95% CI 1.29–1.56). Obesity was also associated with significantly higher annual diabetes-related and all-cause total costs and resource utilization.ConclusionsThis research increases the knowledge of how patients with T2D and obesity should be of greater concern for healthcare providers compared to T2D patients without comorbid obesity, given their worse comorbidity profile, increased resource utilization, and higher healthcare costs.     

Outcomes of type 1 diabetes mellitus in pregnancy; effect of excessive gestational weight gain and hyperglycaemia on fetal growth

AimsTo study pregnancy outcomes in patients with type 1 diabetes mellitus (T1DM) and the factors associated with poor outcomes.MethodsA retrospective study of 110 patients with T2DM who attended our diabetes in pregnancy clinic at the Women's Wellness and Research centre, Doha, between March 2015 and December 2016 and 1419 normoglycaemic controls.ResultsThere was no difference in age, weight, and BMI between the two groups. The incidence of macrosomia, shoulder dystocia and stillbirth were similar in the two groups while that of pre-term labour, pre-eclampsia, Caesarean section (CS), large for gestational age (LGA), neonatal ICU (NICU) admission and neonatal hypoglycaemia were significantly higher in the T1DM than in the control group. From a multivariate regression analysis, excessive gestational weight gain was associated with increased risk of LGA (OR 4.53; 95% CI [1.42–14.25]). Last trimester HBA1c was associated with increased risk for macrosomia [OR 2.46, 95% CI [1.03–5.86)]; LGA [ OR 3.25, 95% CI [1.65–6.40)]; increased risk for C-section (OR 1.96, 95% CI [1.12–3.45]), and increased risk of NICU admission (OR 2.46, 95% CI [1.04–5.86]). The changes in HBA1C between the first and last trimester HBA1c was associated with a reduction in the risk of LGA [OR 0.46, 95% CI [(0.28–0.75)]ConclusionT1DM in pregnancy is associated with adverse pregnancy outcomes compared to the general population. Reducing gestational weight gain and improving glycaemic control might improve pregnancy outcomes.