Influencing factors and hemodynamic study of initial and sustained orthostatic hypotension in middle‐aged and elderly patients

Orthostatic hypotension (OH) is a common autonomic disorder. This study aimed to investigate the influencing factors and hemodynamic mechanisms of initial and sustained OH in middle‐aged and elderly patients. The authors analyzed the clinical characteristics and hemodynamic variables of patients aged ≥ 50 years according to the various forms of OH, diagnosed by an active orthostatic test using the CNAP monitor. The study included 473 participants; 119 (25.2%) patients had initial (54, 45.4%) or sustained (65, 54.6%) OH. Age, comorbidities, or medications did not differ significantly between the initial OH and non‐OH groups. Sustained OH was associated with age and diabetes (p = .003 and p = .015, respectively). Hemodynamic analysis revealed higher cardiac output (CO) in the sustained OH group within 15 s than in the non‐OH and initial OH groups (both p < .001); no difference in CO was observed between the initial OH and non‐OH groups. The systemic vascular resistance (SVR) in both initial OH and sustained OH groups within 15 s was lower than that in the non‐OH group (both p < .001). No differences in SVR at 3 min were observed between the initial OH and non‐OH groups. The SVR at 3 min in the sustained OH group was significantly lower than in non‐OH and initial OH groups (both p < .001). Age and diabetes emerged as the independent risk factors associated with sustained OH. Initial OH is associated with a mismatch of increase in CO and decrease in SVR. Sustained OH is mainly associated with sustained inadequate adjustment in SVR.     

Nighttime ambulatory pulse pressure predicts cardiovascular and all‐cause mortality among middle‐aged participants in the 21‐year follow‐up

Office pulse pressure (PP) is a predictor for cardiovascular (CV) events and mortality. Our aim was to evaluate ambulatory PP as a long‐term risk factor in a random cohort of middle‐aged participants. The Opera study took place in years 1991–1993, with a 24‐h ambulatory blood pressure measurement (ABPM) performed to 900 participants. The end‐points were non‐fatal and fatal CV events, and deaths of all‐causes. Follow‐up period, until the first event or until the end of the year 2014, was 21.1 years (mean). Of 900 participants, 22.6% died (29.6% of men/15.6% of women, p<.001). A CV event was experienced by 208 participants (23.1%), 68.3% of them were male (p<.001). High nighttime ambulatory PP predicted independently CV mortality (hazard ratio [HR] 2.60; 95% confidence interval [CI 95%] 1.08–6.31, p=.034) and all‐cause mortality in the whole population (HR 1.72; Cl 95% 1.06–2.78, p=.028). In males, both 24‐h PP and nighttime PP associated with CV mortality and all‐cause mortality (24‐h PP HR for CV mortality 2.98; CI 95% 1.11–8.04, p=.031 and all‐cause mortality HR 2.40; CI 95% 1.32–4.37, p=.004). Accordingly, nighttime PP; HR for CV mortality 3.13; CI 95% 1.14–8.56, p=.026, and for all‐cause mortality HR 2.26; CI 95% 1.29–3.96, p=.004. Cox regression analyses were adjusted by sex, CV risk factors, and appropriate ambulatory mean systolic BP. In our study, high ambulatory nighttime PP was detected as a long‐term risk factor for CV and all‐cause mortality in middle‐aged individuals.     

Impact of gestational hypertension and preeclampsia on low birthweight and small‐for‐gestational‐age infants in China: A large prospective cohort study

Studies have shown that maternal blood pressure level is associated with neonatal birthweight, but the results are not exactly consistent. As the most common hypertensive disorders during pregnancy, the mechanism of gestational hypertension and pre‐eclampsia that affect fetal growth remain unclear. Our objective was to examine the association of gestational hypertension and pre‐eclampsia with the risk of low birthweight (LBW) and small‐for‐gestational‐age (SGA). Data were obtained from the China–US Collaborative Project for Neural Tube Defects Prevention, a large population‐based cohort study. We selected participants who were registered in two southern provinces, had exact information on gestational blood pressure and pregnancy outcomes, and were not affected by chronic hypertension. Logistic regression was used to adjust for the effects of the main potential confounders, including age, body mass index, education, occupation, ethnicity, folic acid use, and parity. The overall incidences of LBW and SGA were 2.25% and 5.86%, respectively. The incidences of LBW/SGA were 3.58%/7.58% and 6.02%/10.67% for gestational hypertension and pre‐eclampsia group, relative to 2.11%/5.68% and 2.16%/5.74% for normal group. The adjusted odds ratios associated with gestational hypertension/pre‐eclampsia were 1.77 (95% CI: 1.63, 1.92)/3.01 (95% CI: 2.67, 3.40) for LBW and 1.40 (95% CI: 1.32, 1.48)/2.02 (95% CI: 1.84, 2.22) for SGA, respectively. The early onset of gestational hypertension/pre‐eclampsia appeared to be a relatively more detrimental exposure window for both LBW and SGA. Our results support an association between gestational hypertension or pre‐eclampsia and the increased risk of LBW and SGA.     

Effect of positive airway pressure on cardiac troponins in patients with sleep‐disordered breathing: A meta‐analysis

BackgroundCardiac troponins are highly sensitive and specific biomarkers for cardiac injury. Previous studies evaluating the effect of positive airway pressure (PAP) on cardiac troponins in patients with sleep‐disordered breathing (SDB) have yielded conflicting results. The meta‐analysis was performed to examine the effect of PAP on cardiac troponins in SDB patients.MethodsPubMed, Web of Science, and EMBASE before September 2021 on original English language studies were searched. The data on cardiac troponins in both baseline and post‐PAP treatment were extracted from all studies. The data on the change of cardiac troponins in both PAP and control group were extracted from randomized controlled trials. Standardized mean difference (SMD) was used to synthesize quantitative results.ResultsA total of 11 studies were included. PAP treatment was not associated with a significant change in cardiac troponin T between the baseline and post‐PAP treatment (SMD = −0.163, 95% confidence interval [CI] = −0.652 to 0.326, z = 0.65, p = .514). The pooled estimate of SMD of cardiac troponin I between the pre‐ and post‐PAP treatment was 0.287, and the 95% CI was −0.586 to 1.160 (z = 0.64, p = .519). The pooled SMD of change of cardiac troponin T between the PAP group and control group was −0.473 (95% CI = −1.198 to 0.252, z = 1.28, p = .201).ConclusionsThis meta‐analysis revealed that PAP treatment was not associated with any change of cardiac troponin in SDB patients.     

The correlation between maternal serum sST2, IL‐33 and NT‐proBNP concentrations and occurrence of pre‐eclampsia in twin pregnancies: A longitudinal study

The primary objective of this study was to determine the longitudinal profile of serum sST2 (soluble suppression of tumorigenicity 2), IL‐33 (interleukin‐33) and NT‐proBNP (N‐terminal pro‐brain natriuretic peptide) concentrations in twin pregnancies with pre‐eclampsia (PE) and those normotensive twins. The secondary objective was to test whether the change of serum sST2,IL‐33 and NT‐proBNP is related to PE in twin pregnancies. This is a longitudinal nested case–control study and all 156 dichorionic (DC) pregnancies were from a prospective cohort of twin pregnancies who received antenatal care and gave two live births at Peking University Third Hospital between October 2017 and September 2020. Four to five milliliters of peripheral blood of each pregnant woman were collected during the following three intervals: (1) 6–11⁺⁶ weeks; (2) 24–27⁺⁶ weeks; (3) 28–31⁺⁶ weeks. We found that sST2 and NT‐proBNP levels increased as pregnancy progressed in normotensive twin pregnancies and further increased in PE group, while no differences were found in IL‐33 levels throughout pregnancy. Then the correlation of biomarker levels with the occurrence of PE was assessed. Our results indicated that combining maternal serum sST2 and NT‐proBNP levels yielded the highest predictive value on the occurrence of PE significantly higher than the predictive value of any markers alone. Interestingly, the predictive value of second trimester (AUC = 0.876, 95%CI 0.824–0.928, LR−0.338, LR+7.67, p < 0.001)was higher than that of early‐third trimester (AUC = 0.832, 95%CI 0.769–0.896, LR−0.29, LR+3.845, p < 0.001). Serum sST2 and NT‐proBNP concentrations during second and early‐third trimester were associated with the occurrence of PE in twin pregnancies.     

Outcomes of implantable cardioverter‐defibrillator implantation in HIV‐infected patients: A single‐center retrospective cohort study

BackgroundHIV‐infected individuals have a known increased risk of sudden cardiac death (SCD) compared to uninfected individuals. Implantable cardioverter‐defibrillators (ICDs) are standard therapy for preventing SCD; however, there is limited data on the outcomes of ICDs in HIV‐infected individuals.HypothesisHIV‐infected subjects receive a higher number of appropriate ICD therapies than uninfected controls.MethodsThis is a retrospective cohort study of 35 consecutive HIV‐Infected patients and 36 uninfected controls matched by age, race, and gender who were treated at the University of North Carolina Medical Center in the outpatient or inpatient setting from 2014 to the present and had undergone ICD implantation. For HIV‐infected subjects, a multivariate Poisson regression analysis was performed to evaluate the association between covariates and ICD therapies.ResultsAmong HIV‐infected subjects, the mean CD4 count was 582.5 cells/mm³ and 69% had an undetectable viral load. The median follow‐up was 6.4 years. HIV‐infected subjects had both a higher number of appropriate ICD shocks or antitachycardia pacing (ATP) therapy per person‐year as well as a higher number of inappropriate ICD shocks per person‐year than uninfected controls (1.512 vs. 0.590 and 0.122 vs. 0.0166, respectively, p < .001 for both comparisons). After multivariate adjustment, the presence of detectable/unsuppressed viral load at the time of ICD implantation was an independent predictor of both of the following in HIV‐infected subjects: (1) appropriate ICD discharge (p = .004), and (2) appropriate ICD discharge or appropriate ATP therapy (p < .001).ConclusionHIV‐infected subjects had a higher number of appropriate ICD discharge or ATP therapy per person‐year than matched uninfected controls.     

SARS‐CoV‐2 infections in households in a peri‐urban community of Lima,Peru: A prospective cohort study

BackgroundWe assessed the prevalence and incidence of SARS‐CoV‐2 infections in a prospective study of households in Lima, Peru.MethodsHouseholds with a child, a young adult 18–50 years, and an adult age >50 years in peri‐urban Lima were followed with twice‐a‐week household visits during a 2‐month period. Nasal swabs and saliva specimens were collected twice weekly, and nasopharyngeal swabs were collected weekly from each participant, regardless of symptoms. Laboratory‐confirmed SARS‐CoV‐2 infection was defined by two RT‐PCR tests from any of the collected specimens within a week. Blood samples collected at enrollment and end of follow‐up were tested with rapid serological tests. We calculated the prevalence and incidence of laboratory‐confirmed SARS‐CoV‐2 infections.ResultsWe enrolled 132 participants from 44 households: 44 children, 44 young adults, and 44 older adults. A total of 13 SARS‐CoV‐2 infections were detected in eight households, for an overall period prevalence of 9.85% (95% confidence interval [CI]: 5.35–16.25). Most (61.54%) infections were symptomatic. Eight of 11 (72.73%) SARS‐CoV‐2 detections corresponded to the Lambda variant. During 218.79 person‐months at risk of follow‐up, there were six new SARS‐CoV‐2 infections detected (2.74 per 100 person‐month, 95% CI: 1.25–6.04). At enrollment, 59 of 128 participants tested had positive SARS‐CoV‐2 IgG serology (46.09%, 95% CI: 37.25–55.12). Five of six new infections occurred among participants with negative baseline serology.ConclusionsWe demonstrated high incidence of SARS‐CoV‐2 infections in households, especially among subjects without evidence of prior infection, most of them not detected by the Ministry of Health system.     

T‐wave heterogeneity in standard resting 12‐lead ECGs is associated with 90‐day cardiac mortality in women following emergency department admission: A nested case–control study

BackgroundWe investigated whether T‐wave heterogeneity (TWH) can identify patients who are at risk for near‐term cardiac mortality.MethodsA nested case–control analysis was performed in the 888 patients admitted to the Emergency Department (ED) of our medical center in July through September 2018 who had ≥2 serial troponin measurement tests within 6 hr for acute coronary syndrome evaluation to rule‐in or rule‐out the presence of acute myocardial infarction. Patients who died from cardiac causes during 90 days after ED admission were considered cases (n = 20; 10 women) and were matched 1:4 on sex and age with patients who survived during this period (n = 80, 40 women). TWH, that is, interlead splay of T waves, was automatically assessed from precordial leads by second central moment analysis.ResultsTWH_V4‐6 was significantly elevated at ED admission in 12‐lead resting ECGs of female patients who died of cardiac causes during the following 90 days compared to female survivors (100 ± 14.9 vs. 40 ± 3.6 µV, p < .0001). TWH_V4‐6 generated areas under the receiver‐operating characteristic (ROC) curve (AUC) of 0.933 in women (p < .0001) and 0.573 in men (p = .4). In women, the ROC‐guided 48‐µV TWH_V4‐6 cut point for near‐term cardiac mortality produced an adjusted odds ratio of 121.37 (95% CI: 2.89–6,699.84; p = .02) with 100% sensitivity and 82.5% specificity. In Kaplan–Meier survival analysis, TWH_V4‐6 ≥ 48 µV predicted cardiac mortality in women during 90‐day follow‐up with a hazard ratio of 27.84 (95% CI: 7.29–106.36, p < .0001).ConclusionElevated TWH_V4‐6 is associated with near‐term cardiac mortality among women evaluated for acute coronary syndrome.     

Factors affecting abnormal triggering with non‐invasive ventilators: A before‐and‐after study

IntroductionAbnormal triggering of non‐invasive ventilator (NIV) is the main reason for increasing the possibility of patient intolerance and directly affecting the treatment effect.ObjectiveTo investigate factors that affect abnormal triggering of NIV.MethodsThirty health volunteers from August 2018 to August 2019 were recruited. Two kinds of NIVs, Curative Flexo ST30 and Resmed Stellar™ 150, were selected, with S/T mode, respiratory rate of 10 bpm and inspiration time of 1.0 s. Every volunteer received ventilation in two ventilators, five oxygen flows (5/10/15/20/25 L/min), five support pressures (independent inspired positive airway pressure/expired positive airway pressure [IPAP/EPAP]: 8/4; 10/4; 12/4; 16/6; 20/8 cm H₂O), two oxygen injection sites (proximal to the mask or the ventilator) and three masks (Curative: Bestfit™; Resmed: Mirage Quattro Full Face Mask™; Zhongshan: ZS‐MZ‐A™) for 60 min, respectively.ResultsAll factors mentioned above affected normal triggering. With the increase of oxygen flow and support pressure, the frequency of auto‐triggering and ineffective‐triggering increased (P < 0.05). For Curative Flexo ST30 ventilator, when the oxygen injection site was proximal to the ventilator, the frequency of auto‐triggering and ineffective‐triggering is significantly lower than when it was proximal to the mask, whereas the result in Resmed Stellar™ 150 is totally different (P < 0.05).ConclusionWhen using Curative Flexo ST30 ventilator, the oxygen injection site should be proximal to the ventilator, whereas Resmed Stellar™ 150 ventilator is just the opposite. Attention should be paid to the effectiveness of ventilators when oxygen flow and support pressure settings are high, as abnormal triggers occur more frequently. Choosing the suitable mask is also important.     

Impact of the Coming‐of‐Age Day and ceremony on the risk of SARS‐CoV‐2 transmission in Japan: A natural‐experimental study based on national surveillance data

BackgroundQuantifying the impact on COVID‐19 transmission from a single event has been difficult due to the virus transmission dynamics, such as lag from exposure to reported infection, non‐linearity arising from the person‐to‐person transmission, and the modifying effects of non‐pharmaceutical interventions over time. To address these issues, we aimed to estimate the COVID‐19 transmission risk of social events focusing on the Japanese Coming‐of‐Age Day and Coming‐of‐Age ceremony in which “new adults” practice risky behavior on that particular day.MethodsUsing national surveillance data in Japan in 2021 and 2022, we conducted difference‐in‐differences regression against COVID‐19 incidences by setting “new adults” cases as the treatment group and the cases 1 year younger or older than these “new adults” as the control group. In addition, we employed a triple differences approach to estimate the risk of holding the Coming‐Age ceremony by using a binary variable regarding the presence or absence of the ceremony in each municipality.ResultsWe estimated the relative risks (RRs) of the Coming‐of‐Age Day as 1.27 (95% confidence interval [CI] 1.02–1.57) in 2021 and 3.22 (95% CI 2.68–3.86) in 2022. The RR of the Coming‐of‐Age ceremony was also large, estimated as 2.83 (1.81–4.43) in 2022.ConclusionsWhen planning large social events, it is important to be aware of the unique risks associated with these gatherings, along with effective public health messages to best communicate these risks.     

Changes in cardiac structure and function from 3 to 12 months after hospitalization for COVID‐19

BackgroundCardiac function may be impaired during and early after hospitalization for COVID‐19, but little is known about the progression of cardiac dysfunction and the association with postacute COVID syndrome (PACS).MethodsIn a multicenter prospective cohort study, patients who had been hospitalized with COVID‐19 were enrolled and comprehensive echocardiography was performed 3 and 12 months after discharge. Twenty‐four‐hour electrocardiogram (ECG) was performed at 3 and 12 months in patients with arrhythmias at 3 months.ResultsIn total, 182 participants attended the 3 and 12 months visits (age 58 ± 14 years, 59% male, body mass index 28.2 ± 4.2 kg/m²). Of these, 35 (20%) had severe COVID‐19 (treatment in the intensive care unit) and 74 (52%) had self‐reported dyspnea at 3 months. From 3 to 12 months there were no significant overall changes in any measures of left or right ventricle (LV; RV) structure and function (p > .05 for all), including RV strain (from 26.2 ± 3.9% to 26.5 ± 3.1%, p = .29) and LV global longitudinal strain (from 19.2 ± 2.3% to 19.3 ± 2.3%, p = .64). Changes in echocardiographic parameters from 3 to 12 months did not differ by COVID‐19 severity or by the presence of persistent dyspnea (p > .05 for all). Among patients with arrhythmia at 3 months, there was no significant change in arrhythmia burden to 12 months.ConclusionFollowing COVID‐19, cardiac structure and function remained unchanged from 3 to 12 months after the index hospitalization, irrespective of COVID‐19 severity and presence of persistent dyspnea. These results suggest that progression of cardiac dysfunction after COVID‐19 is rare and unlikely to play an important role in PACS.     

The mortality for the implantable cardiac defibrillator in nonischemic cardiomyopathy: An updated systematic review and meta‐analysis

The implantable cardiac defibrillator (ICD) is common for the management of nonischemic cardiomyopathy (NICM). Mortality is a crucial issue for patients with NICM. We can understand the mortality events of ICD versus medicine treatment via a systemic review and meta‐analysis of randomized clinical trials. The comparison between ICD treatment and medicine treatment was performed to find if the ICD treatment can be associated with lower relative risk and hazard ratio of mortality than the medicine treatment. In addition, the different kinds of mortality events were analyzed for the ICD treatment. After a restricted selection, 9 studies with a total of 4001 NICM patients were enrolled. The focused outcome was the events of all‐cause mortality, sudden cardiac death, and cardiovascular death. The results showed that ICD treatment might be associated with lower relative risk and hazard ratio of all‐cause mortality and sudden cardiac death. However, the relative risk and hazard ratio of cardiovascular mortality was not significantly different between ICD treatment and medicine treatment. In the current meta‐analysis, the ICD treatment might show a lower relative risk and hazard ratio of all‐cause mortality and sudden cardiac death when compared with medicine treatment. However, no significant differences were observed in cardiovascular mortality between ICD and medicine treatment.     

Nocturnal blood pressure rather than night‐to‐day blood pressure ratio is related to arterial stiffening in untreated young and middle‐aged adults with non‐dipper hypertension

Little is known about nocturnal blood pressure (BP) or night‐to‐day BP ratio, which is a more specific determinant of arterial stiffness in subjects with non‐dipper hypertension? This study aims to investigate the correlation of nocturnal BP and brachial‐ankle pulse wave velocity (ba PWV), an index of arterial stiffness in untreated young and middle‐aged adults with non‐dipper hypertension.A cross‐sectional analysis of baseline parameters of the NARRAS trial was performed. Twenty‐four hour ambulatory BP measurements, ba PWV and routine clinical data collection were performed in all patients. The relationship of 24‐h ambulatory BP profiles, biochemical measures as well as demographic parameters and ba PWV were analyzed using Pearson''s correlation and multiple stepwise regression analysis.A total of 77 patients (mean age 47.0 ± 11.7 years) with non‐dipper hypertension were included. Age, height, weight and nocturnal systolic BP were related to ba PWV in Pearson''s correlation analysis. In stepwise regression analysis, age (β = 10.57, 95% confidence interval (CI): 6.099–15.042, p < 0.001) and weight (β = −3.835, 95% CI: −7.658‐−0.013, p = 0.049) are related to ba PWV. Nocturnal systolic BP (β = 8.662, 95% CI: 2.511–14.814, p = 0.006) was the independent predictors of ba PWV, even after night‐to‐day systolic BP ratio or 24‐h ambulatory BP profile were taken into account.Nocturnal systolic BP rather than night‐to‐day systolic BP ratio appears to be a more specific determinant for arterial stiffness, as assessed by ba PWV in young and middle‐aged adults with non‐dipper hypertension. 24‐h ambulatory BP measurements are essential for cardiovascular risk evaluation.     

Absence of association between 2019‐20 influenza vaccination and COVID‐19: Results of the European I‐MOVE‐COVID‐19 primary care project,March‐August 2020

BackgroundClaims of influenza vaccination increasing COVID‐19 risk are circulating. Within the I‐MOVE‐COVID‐19 primary care multicentre study, we measured the association between 2019‐20 influenza vaccination and COVID‐19.MethodsWe conducted a multicentre test‐negative case‐control study at primary care level, in study sites in five European countries, from March to August 2020. Patients presenting with acute respiratory infection were swabbed, with demographic, 2019‐20 influenza vaccination and clinical information documented. Using logistic regression, we measured the adjusted odds ratio (aOR), adjusting for study site and age, sex, calendar time, presence of chronic conditions. The main analysis included patients swabbed ≤7 days after onset from the three countries with <15% of missing influenza vaccination. In secondary analyses, we included five countries, using multiple imputation with chained equations to account for missing data.ResultsWe included 257 COVID‐19 cases and 1631 controls in the main analysis (three countries). The overall aOR between influenza vaccination and COVID‐19 was 0.93 (95% CI: 0.66‐1.32). The aOR was 0.92 (95% CI: 0.58‐1.46) and 0.92 (95% CI: 0.51‐1.67) among those aged 20‐59 and ≥60 years, respectively. In secondary analyses, we included 6457 cases and 69 272 controls. The imputed aOR was 0.87 (95% CI: 0.79‐0.95) among all ages and any delay between swab and symptom onset.ConclusionsThere was no evidence that COVID‐19 cases were more likely to be vaccinated against influenza than controls. Influenza vaccination should be encouraged among target groups for vaccination. I‐MOVE‐COVID‐19 will continue documenting influenza vaccination status in 2020‐21, in order to learn about effects of recent influenza vaccination.     

COVID‐19 vaccine effectiveness against hospitalization due to SARS‐CoV‐2: A test‐negative design study based on Severe Acute Respiratory Infection (SARI) sentinel surveillance in Spain

BackgroundWith the emergence of SARS‐CoV‐2, influenza surveillance systems in Spain were transformed into a new syndromic sentinel surveillance system. The Acute Respiratory Infection Surveillance System (SiVIRA in Spanish) is based on a sentinel network for acute respiratory infection (ARI) surveillance in primary care and a network of sentinel hospitals for severe ARI (SARI) surveillance in hospitals.MethodsUsing a test‐negative design and data from SARI admissions notified to SiVIRA between January 1 and October 3, 2021, we estimated COVID‐19 vaccine effectiveness (VE) against hospitalization, by age group, vaccine type, time since vaccination, and SARS‐CoV‐2 variant.ResultsVE was 89% (95% CI: 83–93) against COVID‐19 hospitalization overall in persons aged 20 years and older. VE was higher for mRNA vaccines, and lower for those aged 80 years and older, with a decrease in protection beyond 3 months of completing vaccination, and a further decrease after 5 months. We found no differences between periods with circulation of Alpha or Delta SARS‐CoV‐2 variants, although variant‐specific VE was slightly higher against Alpha.ConclusionsThe SiVIRA sentinel hospital surveillance network in Spain was able to describe clinical and epidemiological characteristics of SARI hospitalizations and provide estimates of COVID‐19 VE in the population under surveillance. Our estimates add to evidence of high effectiveness of mRNA vaccines against severe COVID‐19 and waning of protection with time since vaccination in those aged 80 or older. No substantial differences were observed between SARS‐CoV‐2 variants (Alpha vs. Delta).     

Insulin–glucagon‐like peptide‐1 receptor agonist relay and glucagon‐like peptide‐1 receptor agonist first regimens in individuals with type 2 diabetes: A randomized,open‐label trial study

Aims/IntroductionGlucagon‐like peptide‐1 receptor agonists (GLP‐1 RA) might be less effective in patients with severe hyperglycemia, because hyperglycemia downregulated the GLP‐1 receptor in an animal study. To examine this hypothesis clinically, we compared the glucose‐lowering effects of GLP‐1 receptor agonist liraglutide with and without prior glycemic control.Materials and MethodsIn an open‐label, parallel trial, participants with poorly controlled type 2 diabetes were recruited and randomized to receive once‐daily insulin therapy, degludec (Insulin–GLP‐1 RA relay group, mean 16.8 ± 11.4 IU/day), for 12 weeks and then liraglutide for 12 weeks or subcutaneous injections of GLP‐1 RA, liraglutide (GLP‐1 RA first group, 0.9 mg), for 24 weeks. The primary efficacy end‐points consisted of changes in the levels of fasting plasma glucose and glycated hemoglobin (HbA1c).ResultsThe median fasting plasma glucose and HbA1c before the study were 210.0 mg/dL and 9.8%, respectively. The levels of fasting plasma glucose and HbA1c significantly decreased in the Insulin–GLP‐1 RA relay group (P < 0.001) and GLP‐1 RA first group (P < 0.001) by week 24, although no intergroup differences were observed. The reduction of HbA1c in the Insulin–GLP‐1 RA relay group tended to be larger than that in the GLP‐1 RA first group in the lowest CPR (C‐peptide immunoreactivity) quartile (P = 0.072). The adverse events consisted of gastrointestinal problems, followed by hypoglycemia.ConclusionsThe GLP‐1 receptor agonist is overall effective without prior glycemic control with insulin in participants with poorly controlled type 2 diabetes. However, in participants with insulinopenic type 2 diabetes, prior glycemic control with insulin might overcome glucose toxicity‐induced GLP‐1 resistance.     

Prevalence and impact of diabetes in hospitalized COVID‐19 patients: A systematic review and meta‐analysis

BackgroundDiabetes is a cardiometabolic comorbidity that may predispose COVID‐19 patients to worse clinical outcomes. This study sought to determine the prevalence of diabetes in hospitalized COVID‐19 patients and investigate the association of diabetes severe COVID‐19, rate of acute respiratory distress syndrome (ARDS), mortality, and need for mechanical ventilation by performing a systematic review and meta‐analysis.MethodsIndividual studies were selected using a defined search strategy, including results up until July 2021 from PubMed, Embase, and Cochrane Central Register of Controlled Trials. A random‐effects meta‐analysis was performed to estimate the proportions and level of association of diabetes with clinical outcomes in hospitalized COVID‐19 patients. Forest plots were generated to retrieve the odds ratios (OR), and the quality and risk assessment was performed for all studies included in the meta‐analysis.ResultsThe total number of patients included in this study was 10 648, of whom 3112 had diabetes (29.23%). The overall pooled estimate of prevalence of diabetes in the meta‐analysis cohort was 31% (95% CI, 0.25‐0.38; z = 16.09, P < .0001). Diabetes significantly increased the odds of severe COVID‐19 (OR 3.39; 95% CI, 2.14‐5.37; P < .0001), ARDS (OR 2.55; 95% CI, 1.74‐3.75; P = <.0001), in‐hospital mortality (OR 2.44; 95% CI, 1.93‐3.09; P < .0001), and mechanical ventilation (OR 3.03; 95% CI, 2.17‐4.22; P < .0001).ConclusionsOur meta‐analysis demonstrates that diabetes is significantly associated with increased odds of severe COVID‐19, increased ARDS rate, mortality, and need for mechanical ventilation in hospitalized patients. We also estimated an overall pooled prevalence of diabetes of 31% in hospitalized COVID‐19 patients.     

Effect of COVID‐19 vaccine on menstrual experience among females in six Arab countries: A cross sectional study

BackgroundThere have been varying reports on the potential occurrence and severity of changes to menstruation including the median cycle length, days of bleeding, bleeding heaviness, and menstrual pain, following receipt of COVID‐19 vaccinations. We aimed to assess potential postvaccination menstrual changes in women residing in the Middle East.MethodsWe implemented a cross‐sectional online survey‐based study. Data about the participants'' demographic characteristics, menstruation experience, and vaccination status were collected and analyzed among six Arab countries.ResultsAmong 4942 menstruating females included in this study, females who had received one or more doses of COVID‐19 vaccination reported a higher frequency of back pain, nausea, tiredness, pelvic pain with periods, unprescribed analgesics use, and passage of loose stools. They also reported higher scores describing average and worst menstrual pain. Fully vaccinated females reported heavier flow and more days of bleeding.ConclusionOur findings indicate that COVID‐19 vaccine may have an effect on menstruation in terms of menstrual pain and bleeding heaviness. The evidence needs to be further investigated in longitudinal studies.