Background: In most patients with diabetes, guidelines recommend discontinuation of oral anti-diabetic agents. Preliminary data suggest that pre-admission metformin use may have a mortality benefit in patients with coronavirus disease (COVID)-19 admitted to the hospital. Objective: The objective of the study was to review the impact of metformin on morbidity and mortality among hospitalized patients with COVID-19. Methods: Review of English literature by PUBMED search until November 10, 2020. Search terms included diabetes, COVID-19, metformin, retrospective studies, meta-analyses, pertinent reviews, pre-print articles, and consensus guidelines are reviewed.
A study on prescription pattern and rational use of statins in tertiary care ...SriramNagarajan16
Objectives
Our objectives are to evaluate prescription pattern and rational use of statins in a tertiary care corporate hospital.
Methodology
It was a prospective observational study conducted for a period of 6 months and included various departments of 300
bedded multi specialty tertiary care corporate hospital. A total of 200 patients were included and the study criteria
was inpatients and induvial more than 18 years of either gender who are prescribed with HMG-CoA reductase
inhibitors.
Results
In the present study 200 patients belonged to the age group of above 18 years, out of which about 65% were male
and 35% were female. Atorvastatin (67%) was prescribed mostly and Rosuvastatin (29.5%) was also used.
Conclusion
It is finally concluded that Rational and prophylactic use of statins can reduce further complications of Diabetes
Mellitus (DM) and cardiac events.
Statins treatment is favourable in long term treatment of diseases, it is most effectively used in treatment of serious
disease conditions which has shown its immense therapeutic role in treatment
A study on prescription pattern and rational use of statins in tertiary care ...SriramNagarajan16
Objectives
Our objectives are to evaluate prescription pattern and rational use of statins in a tertiary care corporate hospital.
Methodology
It was a prospective observational study conducted for a period of 6 months and included various departments of 300
bedded multi specialty tertiary care corporate hospital. A total of 200 patients were included and the study criteria
was inpatients and induvial more than 18 years of either gender who are prescribed with HMG-CoA reductase
inhibitors.
Results
In the present study 200 patients belonged to the age group of above 18 years, out of which about 65% were male
and 35% were female. Atorvastatin (67%) was prescribed mostly and Rosuvastatin (29.5%) was also used.
Conclusion
It is finally concluded that Rational and prophylactic use of statins can reduce further complications of Diabetes
Mellitus (DM) and cardiac events.
Statins treatment is favourable in long term treatment of diseases, it is most effectively used in treatment of serious
disease conditions which has shown its immense therapeutic role in treatment
INTRODUCTION: This research aims at enlightens and emphasizing the most prevailing disease conditions and disorders which are most common in mahabubnagar locality ,were category A(augmented) type ADR are more followed by type C(continous).
METHODS: A retrospective research study was conducted using Naronji's and WHO standard scales have been used to categorise the ADR into category A, category B, category C and category D for the given cases.
Epidemological data like age, ADR, and disease condition prevailing in hospitalised patients are noted and categorised department wise.
The Effect of Obesity on Pulmonary Function among Healthy Non-smoking AdultsBRNSS Publication Hub
Background: Obesity is a chronic disease characterized by the excessive accumulation of body fat which is associated with comorbidities. It is a growing health issue worldwide. Obesity is known to have significant effects on respiratory function and obese patients commonly report respiratory complaints requiring pulmonary function tests. Objectives: The objectives of the study were to determine the effects of obesity on pulmonary function in overweight and obese adults who were non-smokers and did not have any respiratory diseases. Materials and Methods: This cross-sectional study was carried out among 181 healthy adults of both sexes between 20 and 60 years, those attended master health check-up and medicine outpatient department. The study participants were divided into three body mass index (BMI) groups according to the WHO BMI classification. Forced vital capacity in liters (FVC), forced expiratory volume in the first second in liters (FEV1), FVC/FEV1, peak expiratory flow rate in liter/min (PEFR), and forced expiratory flow (FEF)25–75% were recorded. These three BMI groups were compared using one-way ANOVA, correlation was assessed by Pearson’s “r.” Linear regression analysis was applied. Results: Significant differences in lung volumes were found in three BMI groups. Obese and overweight subjects had significantly lower FVC, FEV1, FEF25%–75%, and PEFR (P < 0.0001) as compared to normal weight subjects. However, there was no statistically significant difference found in FEV1/FVC ratio. There were significant linear relationships between obesity and pulmonary function. BMI had significant negative linear association at the level of P < 0.001 with FVC% (r = −0.355), FEV1% (r = −0.361), FEF25%–75% (−0.432), and PEFR (r = −0.501). FEV1/FVC ratio was negatively correlated, but statistically not significant. Conclusion: BMI has a detrimental effect on pulmonary functions in overweight and obese subjects. Reduction in FVC and FEV1 was the most representative findings among the overweight and obese subjects, suggesting the presence of a restrictive respiratory pattern associated with obesity. It might be due to decrease in lung and chest wall compliance and increase in work of breathing.
Diabetic is a well known public health problem of today. There are many risk factors of it, which can be identified in pre-diabetic state. So the present study was conducted with the aim to know the status of anthropometric and haematological parameters in pre-diabetic states. For this hospital based study pre-diabetic subjects were identified from first degree relatives of type 2 DM Patients, enrolled in diabetic research centre P.B.M. hospital Bikaner. Relevant investigations were done. Data thus collected on semi-structured questionnaire and analysed using content analysis. Data analysis revealed that although mean Body Mass Index (BMI) was within normal range but Waist circumference (WC), West Hip (W/H) Ratio, Systolic blood pressure were higher than the normal range accepted for that parameter. But mean value of all the studied haematological parameter were within the normal range accepted for that parameter. So it can be conclude that anthropology of an individual may be associated with the pre-diabetic state. Hypertension was found in 25.35% of pre-diabetics. Further researches are necessary to find out this possible association of anthropologic parameter and pre-diabetic state.
A DIRECT MEDICAL COST ANALYSIS OF PATIENTS WITH T2DM AND ITS MACROVASCULAR CO...Abith Baburaj
A DIRECT MEDICAL COST ANALYSIS OF PATIENTS WITH T2DM AND ITS MACROVASCULAR COMPLICATIONS
-A PHARMACOECONOMIC STUDY
-assessment of cost of treatment of diabetis with its macrovascular complication patients
A Possible Role of Rosmarinic Acid against CD2 Associated Protein for the Tre...YogeshIJTSRD
Multiple sclerosis is a chronic inflammatory neurodegenerative disorder which directly affects Central Nervous System CNS . People with MS suffer with an episodic reversible memory loss during the initial stages and later it leads to the neurological deterioration. Number of research and studies has been done on the natural compounds and phytochemical compounds in order to develop the particular drug for the treatment of MS in vivo andin vitro. The present study focuses on the inhibitory effect of Rosmarinic acid against the effect of CD2 Associated protein with the help of Molecular Docking. Molecular Docking basically screens the ligand and the target protein and shows the interaction between them on the basis of the minimum binding affinities and drug likeliness properties. In our research, docking was performed between CD2 Associated protein and selected ligands with the help of docking software. Ligands were selected on the basis of their minimum Binding affinities and finally by their drug likeliness properties. Rosmarinic acid BA 5.6 was the resultant ligand of our recent study. It showed the perfect interaction with CD2 Associated protein. Therefore, we may conclude that Rosmarinic acid may act as a compound which may be used as a drug for the treatment of multiple sclerosis fromfurther in vitro and in vivostudies in future. Jitin Kumar | Tejaswee Anand | Ritika Sharma | Noopur Khare | Abhimanyu Kumar Jha | Yamini Dixit "A Possible Role of Rosmarinic Acid against CD2-Associated Protein for the Treatment of Multiple Sclerosis through in Silico Approach" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-5 , August 2021, URL: https://www.ijtsrd.com/papers/ijtsrd44979.pdf Paper URL: https://www.ijtsrd.com/biological-science/biotechnology/44979/a-possible-role-of-rosmarinic-acid-against-cd2associated-protein-for-the-treatment-of-multiple-sclerosis-through-in-silico-approach/jitin-kumar
Inappropriate drug use in hospitalized elderly patients of medicine and cardi...Apollo Hospitals
National committee on quality assurance, USA convened an expert consensus panel and identified the list of drugs which should be avoided in the elderly people. This resulting list of drugs after 2003 beers criteria were added to the 2006 Health Plan Employer Data and Information Set (HEDIS) to assess the drug prescribing in elderly people.
Dr. ihsan edan abdulkareem alsaimary
PROFESSOR IN MEDICAL MICROBIOLOGY AND MOLECULAR IMMUNOLOGY
ihsanalsaimary@gmail.com
mobile : 009647801410838
university of basrah - college of medicine - basrah -IRAQ
ABSTRACT- In today’s modern lifestyle high blood cholesterol is one of the most dreaded causes of heart diseases among the global population. Fast lifestyle, lack of exercise, obesity and improper food intake all sum up to deranged lipid profile as well as diabetes. Diabetes and high blood cholesterol goes hand in hand which leads to an increased incidence of coronary artery and cardiovascular disorders which still remains as one of the leading causes of mortality overall. In the present study there has been an effort put to draw a correlation between glycosylated hemoglobin which is a marker for level of blood glucose in diabetic patients as well as deranged lipid profile. Blood samples collected in sterile vials were first centrifuged and then put into analyzer for the computation of the lipid profile and the glycosylated hemoglobin. Results computed were made a note of and then prepared for statistical analysis. Results thus obtained showed that females showed significantly higher levels of total serum cholesterol and Non-HDL compared to males other than that their lipid parameters were a little higher than males in general. Diabetic female patients showed a significantly higher level of glycosylated hemoglobin. There was a significant difference in the HDL values of patients in pre diabetic state and worst control of glycemic hemoglobin. There were also significant differences observed in the TGL, TGL/HDL and VLDL values between Diabetic and control patients. In general there were increased correlation of HbA1c with TSC and LDL and the respective ratios as HbA1c increases while LDL/HDL showed a significant increase with HbA1c.
Key-words- Cholesterol, Diabetes mellitus, Lipid profile, HDL, LDL, Lipid ratios
INTRODUCTION: This research aims at enlightens and emphasizing the most prevailing disease conditions and disorders which are most common in mahabubnagar locality ,were category A(augmented) type ADR are more followed by type C(continous).
METHODS: A retrospective research study was conducted using Naronji's and WHO standard scales have been used to categorise the ADR into category A, category B, category C and category D for the given cases.
Epidemological data like age, ADR, and disease condition prevailing in hospitalised patients are noted and categorised department wise.
The Effect of Obesity on Pulmonary Function among Healthy Non-smoking AdultsBRNSS Publication Hub
Background: Obesity is a chronic disease characterized by the excessive accumulation of body fat which is associated with comorbidities. It is a growing health issue worldwide. Obesity is known to have significant effects on respiratory function and obese patients commonly report respiratory complaints requiring pulmonary function tests. Objectives: The objectives of the study were to determine the effects of obesity on pulmonary function in overweight and obese adults who were non-smokers and did not have any respiratory diseases. Materials and Methods: This cross-sectional study was carried out among 181 healthy adults of both sexes between 20 and 60 years, those attended master health check-up and medicine outpatient department. The study participants were divided into three body mass index (BMI) groups according to the WHO BMI classification. Forced vital capacity in liters (FVC), forced expiratory volume in the first second in liters (FEV1), FVC/FEV1, peak expiratory flow rate in liter/min (PEFR), and forced expiratory flow (FEF)25–75% were recorded. These three BMI groups were compared using one-way ANOVA, correlation was assessed by Pearson’s “r.” Linear regression analysis was applied. Results: Significant differences in lung volumes were found in three BMI groups. Obese and overweight subjects had significantly lower FVC, FEV1, FEF25%–75%, and PEFR (P < 0.0001) as compared to normal weight subjects. However, there was no statistically significant difference found in FEV1/FVC ratio. There were significant linear relationships between obesity and pulmonary function. BMI had significant negative linear association at the level of P < 0.001 with FVC% (r = −0.355), FEV1% (r = −0.361), FEF25%–75% (−0.432), and PEFR (r = −0.501). FEV1/FVC ratio was negatively correlated, but statistically not significant. Conclusion: BMI has a detrimental effect on pulmonary functions in overweight and obese subjects. Reduction in FVC and FEV1 was the most representative findings among the overweight and obese subjects, suggesting the presence of a restrictive respiratory pattern associated with obesity. It might be due to decrease in lung and chest wall compliance and increase in work of breathing.
Diabetic is a well known public health problem of today. There are many risk factors of it, which can be identified in pre-diabetic state. So the present study was conducted with the aim to know the status of anthropometric and haematological parameters in pre-diabetic states. For this hospital based study pre-diabetic subjects were identified from first degree relatives of type 2 DM Patients, enrolled in diabetic research centre P.B.M. hospital Bikaner. Relevant investigations were done. Data thus collected on semi-structured questionnaire and analysed using content analysis. Data analysis revealed that although mean Body Mass Index (BMI) was within normal range but Waist circumference (WC), West Hip (W/H) Ratio, Systolic blood pressure were higher than the normal range accepted for that parameter. But mean value of all the studied haematological parameter were within the normal range accepted for that parameter. So it can be conclude that anthropology of an individual may be associated with the pre-diabetic state. Hypertension was found in 25.35% of pre-diabetics. Further researches are necessary to find out this possible association of anthropologic parameter and pre-diabetic state.
A DIRECT MEDICAL COST ANALYSIS OF PATIENTS WITH T2DM AND ITS MACROVASCULAR CO...Abith Baburaj
A DIRECT MEDICAL COST ANALYSIS OF PATIENTS WITH T2DM AND ITS MACROVASCULAR COMPLICATIONS
-A PHARMACOECONOMIC STUDY
-assessment of cost of treatment of diabetis with its macrovascular complication patients
A Possible Role of Rosmarinic Acid against CD2 Associated Protein for the Tre...YogeshIJTSRD
Multiple sclerosis is a chronic inflammatory neurodegenerative disorder which directly affects Central Nervous System CNS . People with MS suffer with an episodic reversible memory loss during the initial stages and later it leads to the neurological deterioration. Number of research and studies has been done on the natural compounds and phytochemical compounds in order to develop the particular drug for the treatment of MS in vivo andin vitro. The present study focuses on the inhibitory effect of Rosmarinic acid against the effect of CD2 Associated protein with the help of Molecular Docking. Molecular Docking basically screens the ligand and the target protein and shows the interaction between them on the basis of the minimum binding affinities and drug likeliness properties. In our research, docking was performed between CD2 Associated protein and selected ligands with the help of docking software. Ligands were selected on the basis of their minimum Binding affinities and finally by their drug likeliness properties. Rosmarinic acid BA 5.6 was the resultant ligand of our recent study. It showed the perfect interaction with CD2 Associated protein. Therefore, we may conclude that Rosmarinic acid may act as a compound which may be used as a drug for the treatment of multiple sclerosis fromfurther in vitro and in vivostudies in future. Jitin Kumar | Tejaswee Anand | Ritika Sharma | Noopur Khare | Abhimanyu Kumar Jha | Yamini Dixit "A Possible Role of Rosmarinic Acid against CD2-Associated Protein for the Treatment of Multiple Sclerosis through in Silico Approach" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-5 , August 2021, URL: https://www.ijtsrd.com/papers/ijtsrd44979.pdf Paper URL: https://www.ijtsrd.com/biological-science/biotechnology/44979/a-possible-role-of-rosmarinic-acid-against-cd2associated-protein-for-the-treatment-of-multiple-sclerosis-through-in-silico-approach/jitin-kumar
Inappropriate drug use in hospitalized elderly patients of medicine and cardi...Apollo Hospitals
National committee on quality assurance, USA convened an expert consensus panel and identified the list of drugs which should be avoided in the elderly people. This resulting list of drugs after 2003 beers criteria were added to the 2006 Health Plan Employer Data and Information Set (HEDIS) to assess the drug prescribing in elderly people.
Dr. ihsan edan abdulkareem alsaimary
PROFESSOR IN MEDICAL MICROBIOLOGY AND MOLECULAR IMMUNOLOGY
ihsanalsaimary@gmail.com
mobile : 009647801410838
university of basrah - college of medicine - basrah -IRAQ
ABSTRACT- In today’s modern lifestyle high blood cholesterol is one of the most dreaded causes of heart diseases among the global population. Fast lifestyle, lack of exercise, obesity and improper food intake all sum up to deranged lipid profile as well as diabetes. Diabetes and high blood cholesterol goes hand in hand which leads to an increased incidence of coronary artery and cardiovascular disorders which still remains as one of the leading causes of mortality overall. In the present study there has been an effort put to draw a correlation between glycosylated hemoglobin which is a marker for level of blood glucose in diabetic patients as well as deranged lipid profile. Blood samples collected in sterile vials were first centrifuged and then put into analyzer for the computation of the lipid profile and the glycosylated hemoglobin. Results computed were made a note of and then prepared for statistical analysis. Results thus obtained showed that females showed significantly higher levels of total serum cholesterol and Non-HDL compared to males other than that their lipid parameters were a little higher than males in general. Diabetic female patients showed a significantly higher level of glycosylated hemoglobin. There was a significant difference in the HDL values of patients in pre diabetic state and worst control of glycemic hemoglobin. There were also significant differences observed in the TGL, TGL/HDL and VLDL values between Diabetic and control patients. In general there were increased correlation of HbA1c with TSC and LDL and the respective ratios as HbA1c increases while LDL/HDL showed a significant increase with HbA1c.
Key-words- Cholesterol, Diabetes mellitus, Lipid profile, HDL, LDL, Lipid ratios
Evaluation Of Adverse Effects Of Antituberculosis In El-Idrissi Hospital, Ken...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
ADVERSE DRUG REACTION | PHARMACY PRACTICE | PDF | SHIVAM DUBEY B PHARMA | PHA...MrHotmaster1
PHARMACY PRACTICE
SHIVAM DUBEY
BPYN1PY18041
ADVERSE DRUG REACTION Abstract
We define an adverse drug reaction as "an appreciably harmful or
unpleasant reaction
Microalbuminuria in Saudi Adults with Type 1 Diabetes Mellitus_Crimson Publis...CrimsonPublishersIOD
Background: Diabetes mellitus is among the most common chronic non-communicable diseases. The development of microalbuminuria in type 1 diabetes increases the risk for renal and cardiovascular disease.
Methods: A cross sectional study was conducted at the Primary Health Care Clinics at King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia. A total of 334 Saudi with type 1 diabetes were randomly selected.
Results: Total of 334 patients with T2DM included in this study; 102 (30.5%) male and 232 (69.5%) female with mean age 25.8±3.4. MA was present in 99 (29.6%). MA was not significantly more prevalent in female (69.4%) with female predominance (sex ratio male: female) 1:2.3. HTN with MA was significantly more prevalent in 51(51.5%) of MA group with odd ratio 1.7 (1.2-2.4), p=0.001 with no siginificant difference between both gender. Patients with MA have significant higher HbA1c than patients with normal buminuria and there was a significant difference between gender (p< 0.0001) and when compared to HbA1c groups (p=0.002).
Conclusion: The frequency of microalbuminuria in patients with type 1 diabetes in this study is high. It is mandatory to have adequate diagnostic, therapeutic and educational resources in addition to competent physicians who can manage microalbuminuria in diabetic patients by using a continuing, comprehensive and coordinated approach.
To Assess the Severity and Mortality among Covid 19 Patients after Having Vac...YogeshIJTSRD
The severity and mortality of COVID 19 cases has been associated with the Three category such as vaccination status, severity of disease and outcome. Objective presently study was aimed to assess the severity and mortality among covid 19 patients. Methods Using simple lottery random method 100 samples were selected. From these 100 patients, 50 patients were randomly assigned to case group and 50 patients in control group after informed consents of relative obtained. Patients in the case group who being died after got COVID 19 whereas 50 patients in the control group participated who were survive after got infected from COVID 19 patients. Result It has three categories such as a Vaccination status For the vaccination status we have seen 59 patients were not vaccinated and 41 patients was vaccinated out of 100. b Incidence There were 41 patients were vaccinated whereas 59 patients were not vaccinated. c Severity In the case of mortality we selected 50 patients who were died from the Corona and I got to know that out of 50 patients there were 12 24 patients were vaccinated whereas 38 76 patients were non vaccinated. Although for the 50 control survival group total 29 58 patients were vaccinated and 21 42 patients was not vaccinated all graph start. Conclusion we have find out that those people who got vaccinated were less infected and mortality rate very low. Prof. (Dr) Binod Kumar Singh | Dr. Saroj Kumar | Ms. Anuradha Sharma "To Assess the Severity and Mortality among Covid-19 Patients after Having Vaccinated: A Retrospective Study" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-5 , August 2021, URL: https://www.ijtsrd.com/papers/ijtsrd45065.pdf Paper URL: https://www.ijtsrd.com/other-scientific-research-area/other/45065/to-assess-the-severity-and-mortality-among-covid19-patients-after-having-vaccinated-a-retrospective-study/prof-dr-binod-kumar-singh
Convalescent Plasma and COVID-19: Ancient Therapy Re-emergedasclepiuspdfs
Convalescent plasma has again re-emerged as a therapy during coronavirus disease (COVID-19) outbreaks currently use as a prophylactic or an interventional treatment in infected patients. Convalescent plasma has been used in the 20th century confronting different infectious diseases where there was no other therapy available. Conceivably, this convalescent plasma therapy tends to be proving a game-changing treatment in some COVID-19 patients and could support treatment, in addition to the current interventions before other developed therapies are available for the population.
The Negative Clinical Consequences Due to the Lack of the Elaboration of a Sc...asclepiuspdfs
Until a few years ago, the immune system was considered as responsible for the only defense against microbial infections and other external agents. On the contrary, the immune cells have been proven to be linked not only through cell-cell contact but also by releasing proteins capable of influencing the immune-inflammatory response, the so-called cytokines or interleukins. Moreover, the cytokines have appeared to play not only immune activities but also metabolic and systemic effects influencing the overall biological systems, including the nervous, the endocrine, and the cardiovascular systems, by representing the main endogenous molecules responsible for the maintenance of the unity of the biological life. Therefore, only the systematic clinical consideration of cytokine effects may allow the generation of real future holistic medicine.
The great benefit of blood/blood constitutes therapy is the ability to provide transfusion support for patients with many unique hematologic conditions. For some patients, such as patients with sickle cell disease, thalassemia major, immune hemolytic anemia, anemia of kidney disease, and aplastic anemia may need for this consolidation extends throughout their life. By knowing the alteration mechanisms of these conditions, we can appreciate the stationary, urgency, and the value of the transfused red blood cell (RBC).
Decreasing or Increasing Role of Autologous Stem Cell Transplantation in Mult...asclepiuspdfs
During the past four decades, autologous stem cell transplantation (ASCT) has been the first choice and the standard option for the treatment of newly diagnosed patients with multiple myeloma. The introduction of new agents such as thalidomide, lenalidomide, and bortezomib has led to a clear improvement in basic approach and those agents became the standard of care in the induction phase; however, they were not able to play the role of ASCT in term of progression-free survival and overall survival. Debate continues about the best induction, consolidation, and maintenance taking into account the toxicities of these new agents. The new monoclonal antibody (anti CD38) starts to take its place in the induction setting and it seems to be a promising agent in the high-risk group. Until recently, ASCT is the standard treatment for newly diagnosed patients.
Comparison of the Hypocalcemic Effects of Erythropoietin and U-74389Gasclepiuspdfs
Aim: This study calculated the effects on serum calcium (Ca) levels, after treatment with either of two drugs: The erythropoietin (Epo) and the antioxidant lazaroid (L) drug U-74389G. The calculation was based on the results of two preliminary studies, each one of which estimated the certain influence, after the respective drug usage in an induced ischemia-reperfusion animal experiment. Materials and Methods: The two main experimental endpoints at which the serum Ca levels were evaluated were the 60th reperfusion min (for the Groups A, C, and E) and the 120th reperfusion min (for the Groups B, D, and F). Especially, the Groups A and B were processed without drugs, Groups C and D after Epo administration, whereas Groups E and F after the L administration. Results: The first preliminary study of Epo presented a non-significant hypocalcemic effect by 0.34% ± 0.68% (P = 0.6095). However, the second preliminary study of U-74389G presented a non-significant hypercalcemic effect by 0.14% ± 0.66% (P = 0.8245). These two studies were coevaluated since they came from the same experimental setting. The outcome of the coevaluation was that L is 2.3623042-fold (2.3482723–2.3764196) more hypercalcemic than Epo (P = 0.0000). Conclusions: The antioxidant capacities of U-74389G ascribe 2.3623042-fold more hypercalcemic effects than Epo (P = 0.0000).
The term refractory anemia (RA) may be confusing to those who are not hematologists. RA should be well defined because it means more than what it says. RA is defined as anemia that is not responsive to therapy except transfusion.[1] The term RA is used to rule out those types of anemia with a known cause such as anemia of systemic diseases (liver and kidney) and anemia of inflammation even though they are considered refractory to therapy.[2] RA with cellular or hypercellular bone marrow was formerly used to exclude aplastic anemia.
Management of Immunogenic Heparin-induced Thrombocytopeniaasclepiuspdfs
Immunogenic heparin-induced thrombocytopenia (HIT) is an immune response to heparin associated with significant morbidity and mortality in hospitalized patients if unidentified as soon as possible, due to thromboembolic complications involving both arterial and venous systems. Early diagnoses based on a comprehensive interpretation of clinical and laboratory information improve clinical outcomes. Management principles of strongly suspected HIT should not be delayed for laboratory result confirmation. Treatment strategies have been introduced including new, safe, and effective agents. This review summarizes the clinical therapeutic options for HIT addressing the use of parenteral direct thrombin inhibitors and indirect factor Xa inhibitors as well as the potential non-Vitamin K antagonist oral anticoagulants.
73-year-old woman without any pertinent history was admitted to the hospital due to remittent fever with erythema. She showed itching and linearly arranged erythema on the chest, back, and abdomen [Figure 1a and b]. As she had been taking daily cefditoren pivoxil for the 4 days before her admission, she was diagnosed as having drug-related scratch dermatitis, and the antibiotic treatment was stopped. Her fever remained. Laboratory data showed elevated levels of white blood cells (14,800/μl, normal range 4000–7000) and liver enzymes such as aspartate aminotransferase (AST) 138 IU/L (normal range 5–40), alanine aminotransferase 97 IU/L (normal range 5–35), and ferritin (17469.5 ng/mL, normal range 5–152).
Bone Marrow Histology is a Pathognomonic Clue to Each of the JAK2V617F, MPL,5...asclepiuspdfs
According to the World Health Organization and Clinical Laboratory Molecular and Pathological criteria bone marrow pathology in JAK2V617F mutated trilinear myeloproliferative neoplasm (MPN) patients essential thrombocythemia (ET) and polycythemia vera are indistinguishably featured by clustered medium to large pleomorphic megakaryocytes and increased cellularity (60–90%) due to increased erythropoiesis and megakaryopoiesis. MPL515 mutated ET is the second distinct clonal MPN characterized by thrombocythemia in a normocellular bone marrow showing clustered increased large to giant mature megakaryocytes with staghorn-like hyperlobulated nuclei. Calreticulin (CALR) mutated hypercellular thrombocythemia associated with prefibrotic megakaryocytic, granulocytic myeloproliferation (MGM) recently became the third distinct MPN featured by dense clusters of immature megakaryocytes with cloud-like nuclei. Bone marrow pathology in newly diagnosed MPN patients appears to be a pathognomonic clue for diagnostic differentiation between JAK2V617F mutated trilinear MPN, MPL515 normocellular thrombocythemia, and CALR thrombocythemia with MGM characteristics followed by secondary reticulin fibrosis. Their natural histories clearly differ featured by an increase of erythro/granulopoiesis and cellularity in JAK2V617F, decrease of erythropoiesis and cellularity in MPL515 and increase of dual megakaryo/granulopoiesis and cellularity in CALR mutated MPN.
Helicobacter pylori Frequency in Polycythemia Vera Patients without Dyspeptic...asclepiuspdfs
Introduction: In polycythemia vera (PV) patients, peptic ulcer and gastroduodenal erosions are more common than the general population, but there are insufficient data on the frequency of Helicobacter pylori (HP) and its role in etiopathogenesis. In this study, we aimed to compare the prevalence of HP infection in PV patients without dyspeptic complaints with a healthy control group without dyspeptic complaints. Materials and Methods: Fifty patients with PV without dyspeptic complaints and 50 controls without dyspeptic complaints were enrolled in this study after informed consent obtained. Stool samples of selected patients were analyzed using HP stool antigen test (True Line®). Results: There was surprisingly striking difference between HP prevalence in PV patients without dyspeptic complaints and asymptomatic healthy controls (64% vs. 2%) (P < 0.05). There was no significant relationship found between HP presence and age, gender, treatment modalities, complete blood count, positivity of JAK2 V617F, serum erythropoietin level, and splenomegaly in PV patients (P > 0.05). Conclusion: As the susceptibility of HP infections in PV patients are higher, it is recommended to have close surveillance of these patients by screening HP presence. In addition, when HP positivity is determined, the eradication of HP is essential to prevent possible future gastrointestinal lesions in patients with PV.
Lymphoma of the Tonsil in a Developing Communityasclepiuspdfs
The lymphoma of the tonsil is a rarity. Single case reports have appeared in countries as disparate as China, Greece, India, Japan, and Turkey. Therefore, this paper presents cases found in Nigeria among the Ibo ethnic group. The epidemiological comparisons are deemed to be worthy of documentation such as age ranges and sides of involvement.
Clinical Significance of Hypocalcemia in COVID-19asclepiuspdfs
Background: Preliminary data suggest that hypocalcemia is common among patients with COVID-19 admitted to the hospital. Objective: The objective of the study was to examine the clinical significance of hypocalcemia in the setting of COVID-19. Methods: Literature search (PubMed) until August 5, 2020. Search terms include hypocalcemia, COVID-19, mortality, and complications. Retrospective studies are reviewed due to a lack of randomized trials. Results: Prevalence of hypocalcemia among hospitalized patients with COVID-19 ranges from 62% to 78%, depending on the definition of hypocalcemia and patients’ characteristics. In most cases, hypocalcemia is mild to moderate biochemically. Hypocalcemia is a risk factor for hospitalization of patients with COVID-19. In already hospitalized patients, hypocalcemia is significantly associated with increase severity of COVID-19 and its complications, including multiorgan failure, acute respiratory distress syndrome, and death. Hypocalcemia is significantly correlated with inflammatory markers of COVID-19. Causes of hypocalcemia in COVID-19 patients are unclear, but Vitamin D deficiency may be a contributing factor. Conclusion: Hypocalcemia is common in hospitalized patients with COVID-19 and carries unfavorable outcomes. Further studies are needed to examine the causes of hypocalcemia in COVID-19 and to see whether normalization of circulating calcium levels improves prognosis.
Excess of Maternal Transmission of Type 2 Diabetes: Is there a Role of Bioche...asclepiuspdfs
Objective: An excess of maternal transmission of Type 2 diabetes (T2D) has been reported in some populations but not confirmed in other studies. Mitochondrial inheritance has been proposed to explain such excess. In the present paper, we have considered the presence of T2D in the mother and/or in the father in relation to the risk of T2D and to age at onset of the disease in the offspring. The distribution of two genetic polymorphisms involved in glucose metabolism in relation to the presence of T2D in the mother has been also considered. Materials and Methods: Two hundred and seventy-nine participants with T2D were studied in the population of Penne, a small rural town in the eastern side of central Italy. Adenosine deaminase locus 1 (ADA1) and phosphoglucomutase locus 1 (PGM1) phenotypes were determined by starch gel electrophoresis. Statistical analyses were carried out using commercial software (SPSS). Results: The proportion of patients from T2D mothers is much greater as compared to the proportion of the patients from T2D fathers (P < 0.0001). Age at onset of the disease in patients in whom one or both parents are T2D is lower as compared to other patients. The distribution of ADA1 and PGM1 phenotypes in participants with T2D depends on the presence of diabetes in the mother. Conclusions: About the transmission of T2D, our data confirm the high proportion of maternal T2D and show the role of two common biochemical polymorphisms involved in glucose metabolism.
The Effect of Demographic Data and Hemoglobin A 1c on Treatment Outcomes in P...asclepiuspdfs
Objective: Diabetes mellitus, the most common cause of non-traumatic foot amputations, is a life-threatening condition due to its high mortality and morbidity. In our study, we retrospectively evaluated our patients with diabetic foot syndrome in our clinic. Materials and Methods: The demographic data, duration of diabetes, Wagner classification, haemoglobin A 1c (HbA1c) levels, white blood cell, C-reactive protein sedimentation levels, hospital stay, and treatment results were evaluated retrospectively in 14 patients with diabetic foot between January 2017 and December 2018. Results: The mean age of the patients was 62.43 ± 7.7 years. Of the 14 patients, 3 were females and 11 were males. All 14 patients were type 2 diabetes mellitus. When diabetic foot Wagner classification was performed, 6 patients were evaluated as Wagner 2, five patients were Wagner 3, and three patients were evaluated as Wagner 4. Nine patients had complete amputation and 3 had vascular surgery. Conclusion: Although the level of HbA1c is below the target level, the risk of diabetic foot is increased when there is no adequate diabetes mellitus foot training. Inadequate diabetic patient education and hospitalization of patients after infection progress the amputation rate.
Self-efficacy Impact Adherence in Diabetes Mellitusasclepiuspdfs
The aim of the paper is to explore how self-efficacy (SE) is associated with adherence among adults with diabetes mellitus (DM). Methods: The search of electronic databases identified 564 records from 2007 to 2017 on SE and adherence from different perspectives and its effect on adults with DM. Discussions: SE increases the confidence in adults in their self-care behaviors. Non-adherence continues to be a significant barrier to SE. SE and adherence should be informed by an understanding of theoretical frameworks and the individual characteristics. Conclusion: Adherence is likely among adults with better SE to empower them to make valid decisions about their health. Interventions to improve SE should be tailored based on different types of non-adherence such as intentional and unintentional non-adherence. Implications: An intercollaborative professional practice approach is crucial to improve SE and adherence for sound judgment and valid decision-making.
Uncoiling the Tightening Obesity Spiralasclepiuspdfs
While an underweight prevalence was once more than twice that of obesity, now more people are obese than underweight. Obesity is one of the leading causes of preventable death in the world. There are an estimated 2,100,000,000 obese people worldwide and that number is forecast to grow to 51% of the world’s population by 2030. Escalating obesity-related disease costs threaten to bankrupt the world’s health-care systems.
Prevalence of Chronic Kidney disease in Patients with Metabolic Syndrome in S...asclepiuspdfs
Background and Objective: Chronic kidney disease (CKD) which is an increasingly important clinical and public health issue is associated with cardiovascular disease. Epidemiologic studies have also linked metabolic syndrome (MetS) with an increased risk of incident CKD. Therefore, the present study was designed retrospectively to find the prevalence and potential risk factors of CKD in patients with MetS in Saudi Arabia.
Management Of Hypoglycemia In Patients With Type 2 Diabetesasclepiuspdfs
Hypoglycemia is the rate-limiting step of intensive management in patients with diabetes. Lowering one’s A1C to a prescribed target is expected to mitigate one’s risk of developing long- and short-term diabetes-related complications. Several of the less expensive and commonly prescribed glucose lowering agents favored by practitioners result in weight gain, hypoglycemia, and even an increased risk of cardiovascular (CV) mortality. Although achieving a targeted A1C of <7 % is the standard of care, clinicians often fail to evaluate patients for glycemic variability which can increase oxidative stress driving long-term diabetes-related complications including CV death. The use of concentrated insulins and glucagon-like peptide-1 receptor agonists separately or in combination with each other reduces glycemic variability and one’s risk of hypoglycemia. Pharmaceutical agents which allow patients to safely achieve their targeted A1C without weight gain and hypoglycemia should be preferred in patients with type 2 diabetes.
Predictive and Preventive Care: Metabolic Diseasesasclepiuspdfs
South Asians have a very high incidence of ischemic heart disease and stroke. In addition, they also have a very high incidence of metabolic diseases such as prehypertension, hypertension, visceral obesity, metabolic syndrome, prediabetes, type-2 diabetes, and its clinical complications. Currently, there are over 75 million diabetic subjects in India and an equal number of prediabetics. Republic of China has taken over India as the diabetes capital of the world, with over 115 million diabetics. Modern medicine is disease focused and has failed to address the prevention of these chronic diseases. According to the reports from the United Nations (Millennium Development Goals [MDGs], the World Health Organization, Global Health Initiatives, and the non-communicable disease risk task force), obesity has increased by 2-fold and type-2 diabetes by 4-fold worldwide. Experts in this field predict that chances of meeting the MDGs set by the UN members of reducing the incidence of these diseases at 2025 to the level of 2020 are very little. Western medicine has failed to reduce or reverse the trend in the incidence of these diseases. We feel that an integrated approach to health care may be a better option, to reduce the disease burden in developing and resource-poor countries. Having said that, one cannot prevent something that one is not aware of, as such it is the need of the hour for us, to develop a robust predictive and preventive health-care platform. In an earlier article, we presented our views on reducing or reversing cardiometabolic diseases. There is great enthusiasm among the health-care providers and professional bodies that integration of emerging technologies will help develop personalized, precision medicine, as well as reduce the cost of health-care worldwide.
It is known that the cancer development process is multifactorial nowadays. The relationship between insulin and cancer has recently been gaining in importance. The number of studies between insulin resistance and thyroid cancer is very small, although the association between obesity, type 2 diabetes, and insulin resistance, particularly breast, colon, and pancreatic cancer development, is long. There are studies advocating increased growth factors with insulin resistance as well as triode cancer after thyroid angiogenesis. Insulin and insulin-like growth factors may be the primary causes of pathophysiology in many cancers, especially thyroid cancer, with mitogenic activity.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
2. Mikhail and Wali: Metformin in COVID-19
6 Clinical Research in Diabetes and Endocrinology • Vol 3 • Issue 2 • 2020
patients after hospital admission admitted to the hospital due
to due to lack of efficacy data, presence of adverse effects,
and limited efficacy.[5]
The ADA recommends insulin as the
standard therapy for hyperglycemia in hospital.[5]
However,
one possible exception is metformin due to emerging data
showing several clinical benefits in patients with COVID-19.
This review discusses the impact of metformin on mortality
and morbidity in patients with type 2 diabetes and COVID-19
when metformin was used before and after hospitalization.
Specifically, the authors attempt to determine whether
metformin should be continued or not in patients with
COVID-19 and diabetes after admission to the hospital.
EFFECT OF METFORMIN ON
MORTALITY AND MORBIDITY IN
HOSPITALIZED PATIENTS WITH
COVID-19
Effect of pre-admission use of etformin on
mortality
The most comprehensive data in this respect may be
derived from the recent meta-analysis conducted by Kow
and Hassan.[6]
In this study, the authors analyzed data (up
to August 8, 2020) of 5 studies, including 8121 patients
with diabetes and COVID-19 who were using metformin
before hospital admission. Their pooled analysis revealed
a significantly reduced risk for mortality with the use of
metformin before admission, pooled odds ratio (OR) being
0.62 (95% CI, 0.43–0.89) compared to patients with diabetes
who were non-users of metformin.[6]
Interestingly, the largest
study included in this meta-analysis by Bramante et al.[7]
that
contributed to 48.7% of the meta-analysis weight showed
that pre-admission metformin use was associated with
decreased in-hospital mortality in women only; OR 0.79
(95% CI 0.64–0.98), but not in men. Another retrospective
study from the University of Alabama included in the
previous meta-analysis[6]
provided information on mortality
in a diverse population of 604 patients (55% women, 51%
African-American) with COVID-19 and diabetes admitted
to the hospital.[8]
In the latter study, Crouse et al.[8]
reported
that metformin treatment was independently associated
with a significant reduction in mortality; OR = 0.33 (95%
CI, 0.13–0.84; P = 0.02). Moreover, the absolute reduction
in mortality was substantial.[8]
Thus, whereas the mortality
rate in patients with COVID-19 and diabetes who were not
taking metformin was 23%, this rate dropped to 11% in
patients who were using metformin.[8]
Contrary to the study
of Bramante et al.,[7]
who found that metformin mortality
reduction was limited to women, Crouse et al.[8]
did not
observe a significant differential effect of metformin on
mortality based on gender.
It should be emphasized that while the results of the
previous studies are encouraging, they should be considered
preliminary due to the following limitations. First, all
included studies were retrospective prone for confounding
factors. Second, it was not possible to know to what extent
patients were adherent to metformin intake prior to hospital
admission. Third, the duration and dosage of metformin were
not known. Fourth, it was not clear in any of these studies,
whether patients continued to take metformin or discontinued
it after admission to the hospital.
Effect of continuing metformin intake during
hospitalization
To the best of authors’knowledge, there are two retrospective
Chinese studies that evaluated the effects of continuing
metformin after admission on mortality and severity of
COVID-19 in patients with type 2 diabetes.[9,10]
In the first
larger study (n = 1213), Cheng et al.[9]
have shown that
metformin administration during hospitalization was not
associated with an increase in 28-day all-cause mortality
compared with metformin non-users; adjusted hazard ratio
(HR) 0.87 (95% CI 0.36–2.12); P = 0.75. In the second
smaller study (n = 110), Gao et al.[10]
found that risk of
life-threatening complications was significantly higher in
patients with COVID-19 receiving metformin compared with
patients not taking metformin; OR 3.96 (95% CI 1.03–15.09;
P = 0.045). Furthermore, 28.6% (16 of 56) of metformin
users developed life-threatening complications of COVID-
19, mostly admission to the intensive care unit, compared
with 7.4% (4 of 54) of non-users of metformin, P = 0.004.[10]
ADVERSE EFFECTS OF
METFORMIN USE DURING
HOSPITALIZATION OF PATIENTS
WITH COVID-19
Effect of metformin on lactic acidosis
Lactic acidosis is a rare but potentially lethal adverse effect
of metformin.[11]
The large study of Cheng et al.[9]
allowed
the evaluation of metformin safety in different subgroups of
patients. Thus, they found that lactic acidosis was increased in
patientswithCOVID-19comparedwithmetforminnon-users,
adjusted HR 4.66, 95% 1.45–14.99; P = 0.01.[9]
However,
this increased risk of lactic acidosis was limited to the
following subgroups of patients: Those with severe COVID-
19, patients using metformin in doses of 2 g/d or higher, and
in the presence of kidney dysfunction defined as estimated
glomerular filtration rate (eGFR) 60 ml/min/1.73 kg/m2
.[9]
It
should be emphasized that metformin should not be used in
the presence of hypoxia, decreased tissue perfusion, sepsis,
acute or chronic kidney disease, and acute heart and liver
failure to avoid the risk of lactic acidosis.[11]
Effect of metformin on heart failure and ARDS
In the study of Cheng et al.,[9]
metformin in-hospital use was
shown to be associated with decreased risk of heart failure
3. Mikhail and Wali: Metformin in COVID-19
Clinical Research in Diabetes and Endocrinology • Vol 3 • Issue 2 • 2020 7
adjusted HR 0.61 (95% CI 0.43–0.87; P = 0.006) and ARDS,
adjusted HR 0.66 (95% CI 0.46–0.96; P = 0.03). There was
no significant effect of metformin on acute kidney injury or
disseminated intravascular coagulation.[9]
POTENTIAL MECHANISMS
UNDERLYING METFORMIN
CLINICAL BENEFITS AND HARMS
There are some potential mechanisms whereby metformin
could decrease mortality before hospitalization of patients
withCOVID-19.Thus,metforminhasbeenshowntoimprove
the immune response and reduce inflammation.[12]
Indeed,
Cheng et al.[9]
found that serum levels of pro-inflammatory
cytokines known to mediate cytokine storm in COVID-19
were increased to a lesser extent among metformin-users
versus metformin non-users. Such pro-inflammatory
cytokines included: Interleukin-6, interleukin-2, and
tumor necrosis-alpha (TNF-α).[9]
Likewise, Cheng et al.[9]
found that levels of IL-6 were lower in metformin users
than non-users. Moreover, Cheng et al.[9]
recorded lower
neutrophil count among metformin users compared with
non-users. On the other hand, when metformin use was
continued after hospital admission, no mortality benefit
was demonstrated.[9]
On the contrary, in-hospital metformin
use was associated with increased severity of COVID-19
and lactic acidosis.[9,10]
CONCLUSIONS AND FUTURE
NEEDS
Preliminary data suggest that metformin use before
hospitalization of patients with diabetes and COVID-19
might reduce mortality. Meanwhile, continuing metformin
after hospitalization did not affect mortality but was
associated with an increased risk of lactic acidosis in patients
admitted with diabetes and COVID-19. The risk of lactic
acidosis was evident in patients with severe symptoms of
COVID-19, those with kidney dysfunction, and in patients
taking 2 g of metformin or more daily.[9]
In addition, Gao
et al.[10]
reported increase admissions to the intensive care
unit and the occurrence of life-threatening complications in
association with in-hospital use of metformin. Accordingly,
metformin should be discontinued in patients with COVID-19
and diabetes upon admission to the hospital. Unfortunately,
all current data related to COVID-19 and metformin are
based on retrospective studies prone for multiple biases and
confounding factors. Randomized trials are urgently needed
to determine safety and efficacy of metformin in hospitalized
COVID-19 patients.
REFERENCES
1. SinghAK, Gupta R, GhoshA, MisraA. Diabetes in COVID-19:
Prevalence, pathophysiology, prognosis and practical
considerations. Diabetes Metab Syndr 2020;14:303-10.
2. Guan W, Ni Z, Hu Y, Liang WH, Ou CQ, He JH, et al. Clinical
characteristics of coronavirus disease 2019 in China. N Engl J
Med 2020;382:1708-20.
3. Huang I, Lim MA, Pranata R. Diabetes mellitus is associated
with increased mortality and severity of disease in COVID-19
pneumonia-a systematic review, meta-analysis, and meta-
regression. Diabetes Metab Syndr 2020;14:395-403.
4. American Diabetes Association. Pharmacologic approaches to
glycemictreatment:Standardsofmedicalcareindiabetes-2020.
Diabetes Care 2020;43 Suppl 1:S98-110.
5. American Diabetes Association. Diabetes care in the hospital:
Standards of medical care in diabetes-2020. Diabetes Care
2020;43 Suppl 1:S193-201.
6. Kow CS, Hasan SS. Mortality of COVID-19 with preadmission
metformin use in patients with diabetes: A meta-analysis. J
Med Virol 2020.
7. Bramante C, Ingraham N, Murray T, Marmor S, Hoversten S,
Gronski J, et al. Observational Study of Metformin and Risk of
Mortality in Patients Hospitalized with COVID-19, medRxiv;
2020.
8. Crouse A, Grimes T, Li P, Might M, Ovalle F, Shalev A.
Metformin Use is Associated with Reduced Mortality in a
Diverse Population with COVID-19 and Diabetes, medRxiv;
2020.
9. Cheng X, Liu YM, Li H, Zhang X, Lei F, Qin JJ, et al.
Metformin is associated with higher incidence of acidosis, but
not mortality, in individuals with COVID-19 and pre-existing
Type 2 diabetes. Cell Metab 2020;32:537-47.e3.
10. Gao Y, Liu T, Zhong W, Liu R, Zhou H, Huang W, et al. Risk
of metformin in patients with Type 2 diabetes with COVID-19:
A preliminary retrospective report. Clin Transl Sci 2020;1:1-5.
11. DeFronzo R, Fleming A, Chen K, Bicsak TA. Metformin-
associated lactic acidosis: Current perspectives on causes and
risk. Metabolism 2016;65:20-9.
12. Cameron AR, Morrison VL, Levin D, Mohan M, Forteath C,
Beall C, et al. Anti-inflammatory effects of metformin
irrespective of diabetes status. Circ Res 2016;119:652-65.
How to cite this article: Mikhail N, Wali S. Should
Metformin Be Continued after Hospital Admission
in Patients with Coronavirus Disease 2019? Clin Res
Diabetes Endocrinol 2020;3(2):5-7.