bluuebunny/crossref_metadata_2025 huggingface dataset:
Short-term obstetric outcomes in obese Maltese women
Authors: Savona-Ventura C. , Gatt M.
Published: August 2024

Introduction: Obesity is associated with specific increased perinatal risks to mother and child. The study sets out to identify
and assess the risk in a high NIDDM prevalence population. Methodology: The obstetric outcomes of 1691 women with a
body weight ≥ 85 kg and a pre-pregnancy BMI >30 and their 1721 infants were statistically compared to similar parameters
in the background population of 18717 maternities and 18974 births. Results: Obese mothers were characteristically more
likely to be older than 30 years of age [p<0.0001], multiparous [p<0.0001] with a history of previous miscarriages
[p=0.003]. The antenatal period was more likely to be complicated by hypertensive disease [pre-existing and pregnancyinduced;
p<0.0001], and gestational diabetes [p<0.0001]. They were less likely to suffer from accidental haemorrhage
[p=0.0074]. These antenatal problems were not simply a determinant of maternal age. They did not appear to have a
significantly higher risk of pre-existing diabetes [p=0.3267] and did not require an increased risk of assisted reproduction
[p=0.3953]. The multiple pregnancy rates were also not statistically increased [p=0.3121]. The obese women were also more
likely to require obstetric interventions with induction of labour [p<0.0001] and Caesarean section [p<0.0001]. There was a
statistically lower rate of operative deliveries [p=0.0007]. The preterm delivery rates were not different [p=0.947] between
the two groups of women. The infants born to obese women were at a statistically higher risk for macrosomia [more than 4.0
kg; p<0.0001] and lower risk for low birth weight [under 2.5 kg; p=0.0248]. They also had a statistically higher risk for
congenital malformations. There was a slightly higher risk for respiratory distress although the differences did not reach
statistical significance [p=0.0596]. There was not any significantly increased risk for perinatal loss [p=0.8212], shoulder
dystocia [p=0.5059], and low APGAR scores at five minutes [p=0.9989]. There were no differences in the male: female
ratios [p=0.761]. Infants born to obese women were less likely to be solely breastfeed, though the differences did not reach
statistical significance [p=0.0782]. Conclusion: It appears that the obese pregnant woman and her infant are predisposed to
adverse short-term obstetric outcomes similar to those found in gestational diabetics. This relationship may reflect
determinants of the “Metabolic Syndrome”. (Int J Diabetes Metab 14: 88-91, 2006 )
Toward establishing normal waist circumference in Eastern Mediterranean and Middle East (Arab) populations. Cutoff values for waist circumference in Iraqi adults
Authors: Mansour A.A. Abbas Ali , Al-Hassan A.A. Aymen A. , Al-Jazairi M.I. Meelad Imad
Published: August 2024

Background: Determination of cutoff points for waist circumference (WC) is of paramount importance for prevention,
optimum management, and prognosis of obesity, the metabolic syndrome (MetS), type 2 diabetes mellitus, and coronary
heart disease. The aim of this project was to establish cut-off levels for waist circumference in Eastern Mediterranean and
Middle East (Arab) populations in Basrah, Iraq. Methods: This was a community-based cross-sectional survey for
establishing normal value of WC from one district in Basrah (Abu-Al-khasib). A multiple stratified sampling procedure was
used for sample selection. Results: The cutoff level yielding the maximal sensitivity plus specificity for predicting the
presence of multiple risk factors was 97cm in men and 99 cm in women. Sensitivity and specificity using these cut-off values
were 70% and 50% respectively in men and 70% and 45% respectively in women. Conclusion: We propose an optimal
cutoff point of WC for the diagnosis of MetS in the Iraqi population: 99 cm in women and 97 men. (Int J Diabetes Metab
15:14-16, 2007)
Gender: does it have role has a role in glycaemic control in Caucasians with wellcontrolled type 2 diabetes?
Authors: Barre D.E. , Mizier-Barre K.A. , Griscti O. , Hafez K.
Published: August 2024

Background: Type 2 diabetes is costly to manage and thus it is important to know if management of blood glucose and HbA1c
are meeting clinical targets in both men and women. There is conflicting published data on the gender equality of blood
glucose and HbA1c management in type 2 diabetics. Objective: The purpose of this work was to review the literature on
gender equality in blood glucose management and to test the hypothesis that management of blood glucose and HbA1c would
meet clinical targets in Cape Breton, Nova Scotia, irrespective of gender in well controlled Caucasian type 2 diabetic patients.
Design, Setting and Participants: Fasting serum insulin and insulin sensitivity levels were determined in order to assist in the
explanation of the glucose and HbA1c results in people with diabetes. Patients were asked to give a fasting blood sample on
each of two occasions three months apart. Results: There were no differences between males and females in each of fasting
serum glucose (FSG) and HbA1c levels as well as fasting serum insulin concentrations and in insulin sensitivity at visit 1 or 2.
However, each of FSG and HbA1c levels were slightly higher than clinical targets. Modestly elevated serum insulin and lower
insulin sensitivity were consistent with the FSG and HbA1c levels. This contrasts with some of the existing literature pointing
out the need for a much larger study to be done in Cape Breton. Conclusion: It is concluded that blood glucose management
among people with well controlled type 2 diabetes in Cape Breton, Nova Scotia may be close to clinical targets irrespective
of gender. A further lowering of HbA1c and FSG may be in order. However, this was only a very small study and a much
larger one would answer whether there is gender equality in FSG and HbA1c among persons with well controlled type 2
diabetes on Cape Breton Island.
Anti-diabetic and hypolipidaemic properties of garlic (Allium sativum) in streptozotocin-induced diabetic rats
Authors: Thomson Martha , Al-Amin Zainab M. , Al-Qattan Khaled K. , Shaban Lemia H. , Ali Muslim
Published: August 2024

In this study the hypoglycaemic, hypocholesterolaemic and hypotriglyceridaemic effects of garlic were studied in
streptozotocin (STZ)-induced diabetic rats. Compared to normal (non-diabetic) rats, STZ-induced diabetic rats had
approximately 200% higher serum glucose, 50% higher serum cholesterol and 30% higher serum triglyceride levels as well
as 86% higher urinary protein levels. Daily treatment of STZ-induced diabetic rats with an extract of raw garlic (500mg/kg
intraperitoneally) for seven weeks significantly lowered serum glucose, cholesterol and triglyceride levels. Compared to
control diabetic rats, garlic-treated rats had 57% less serum glucose, 40% lower serum cholesterol levels and 35% lower
triglyceride. In addition, urinary protein levels in garlic-treated diabetic animals were 50% lower compared to the diabetic
controls. In contrast, the increased urine output and water intake of diabetic rats were not affected by garlic treatment. These
results indicate that raw garlic possesses a beneficial potential in reversing proteinuria in addition to reducing blood sugar,
cholesterol and triglycerides in diabetic rats. Therefore, garlic could be of great value in managing the effects and
complications of diabetes in affected individuals.
Insulin concentration is the main predictor of leptin level: a homogenous type 2 diabetes cohort study in Taiwan
Authors: Hsu Chung-Hua , Lin Su-Ching , Hwang Kung-Chang , Chou Pesus , Liao Ying-Li
Published: August 2024

We hypothesized that there would be strong association between insulin level and leptin level, and attempted to examine factors affecting plasma leptin level among the homogeneous Type 2 diabetes subjects. The study was conducted from July 2005 through September 2005 in the Taipei Hospital, Taiwan. From 1356 registered diabetes patients, 120 subjects who met the criteria of (1) aged between 20 and 75 years, (2) being Chinese, (3) having Type 2 diabetes for more than one year, (4) having been taking gliclazide and metformin for more than 6 months, were enrolled for this study. Factors affecting plasma leptin level are determined using multiple linear regression analysis. The coefficients obtained by multiple regression analysis with stepwise method showed that gender (β=-0.49, p<0.001), insulin level (β=0.46, p<0.001) and body mass index (BMI)(β=0.21, p=0.003) were the main predictors of leptin concentrations for all type 2 diabetic subjects; insulin level (β=0.50, p<0.001), BMI (β=0.42, p<0.001) and triglyceride (β=0.17, p=0.03) were the main predictors for type 2 diabetic men; and insulin level (β=0.68, p<0.001) was the only predictor for type 2 diabetic women. These initial findings seem to indicate that insulin concentration is the main predictor of leptin level in both male and female type 2 diabetes subjects.
Higher pulse pressure, systolic arterial hypertension, duration of diabetes and family history of diabetes in Central Africans
Authors: Longo-Mbenza B. , Nkondi Mbadi A. Nsungu J. , Mbungu Fuele S.
Published: August 2024

Objective: to assess the prevalence and the risk factors of diabetic retinopathy (DR) in urban diabetics from Kinshasa, DRC. Methods: this is a community-based cross-sectional survey and a case-control study on diabetic retinopathy in Kinshasa, the capital of DRC. The medical charts of all diabetics (n=3010) ≥ 20 years were studied to estimate the prevalence of DR during November 2004. 10% (n=301) of these were randomly selected to reveal 95 diabetics with DR and 206 diabetics without DR (control). Both groups were matched for primary care centre, sex, age, body mass index, and waist circumference, attending the primary care centres between December 2004 and December 2005, and were screened for DR using stereo color photography and ophthalmoscopy. Results: the overall prevalence rate of DR in the population was 31.6% (n=950 95% confidence interval [CI]:26.3 – 36.9). Delayed diagnosis of diabetes (≥55 years) in the study sample in women, men with high socioeconomic status, and pregnancy onset after the diagnosis of DR among women, were identified as variables for Univariate analysis and for significant risk factors of DR. Logistic regression analysis showed that longer duration of diabetes (≥4years) (LDD), systolic arterial hypertension (SAH), higher pulse pressure (≥60 mmHg, clinical pre-atherosclerosis/arterial stiffness), and family history of diabetes (FHD), were the significant and independent determinants of DR in the sample study. The multivariate risk of DR conferred by these determinants is enhanced among female diabetics (y=2.679 + 1.528 SHT + 1.080 LDD + FHD; p<0.01) and patients with type 2 diabetes (y=2.725 + 1.316 SHT + LDD + 1.246 FHD; p<0.05). The adjusted odds-ratio for DR conferred by higher pulse pressure was 5 (95% CI 2 – 12.8; p<0.05. Conclusion: Longer duration of diabetes, arterial systolic hypertension, and higher pulse pressure (arterial stiffness) were the most significant independent risk factors of diabetic retinopathy. However, a population-based study is warranted to identify the risk factors, as well as the prevalence of diabetic retinopathy.
Risk factors of poor control of HBA1c and diabetic retinopathy: Paradox with insulin therapy and high values of HDL in African diabetic patients
Authors: Longo-Mbenza B. , Muaka M.M. , Mbenza G. , Mbungu-Fuele S. , Mabwa-Mbalanda L. , Nzuzi-Babeki V. , Mbadi-A-Sungu J.
Published: August 2024

Objective: To determine the risk factors of poor control of glycated haemoglobin and diabetic retinopathy. The agreement between poor control of glycated haemoglobin (HbA1c) >7% and poor control of glycemia ≥ 126 mg/dL to classify diabetic retinopathy was also assessed. Design, settings and methods: The study was a cross-sectional survey carried out on 300 African diabetic patients admitted to Lomo Medical Center, Kinshasa, Congo, between July 2005 and December 2007. Patients (150 type 1 and 151 type 2) were interviewed and underwent a complete medical assessment. HbA1c levels, anthropometry, blood pressure components, lipid profile, type of diabetes, severity and complications were determined for each patient. All patients were examined for evidence and severity of diabetic retinopathy by an ophthalmologist. Results: The rates of arterial hypertension, uncontrolled hypertension, poor control of HbA1c, poor control of glycemia, higher pulse pressure and diabetic retinopathy were 73.3%, 81.8%, 68%, 57%, 47.7% and 33.3%, respectively. Type 1 diabetes, diabetes duration ≥ 4 years, female sex, underweight, diabetic retinopathy, diabetic nephropathy, elevated total cholesterol and higher levels of HDL-cholesterol were significantly associated with poor control of HbA1c. There was a poor agreement of 52% and kappa statistic of 0.19 (P<0.0001) between poor control of HbA1c and poor glycemic control to classify diabetic retinopathy. In all diabetic patients, aged ≥60 years, female sex, diabetes duration ≥4 years, type 1 diabetes, higher pulse pressure, underweight, poor control of HbA1c, smoking, stroke, diabetic nephropathy and low HDL-cholesterol are significantly associated with the presence and the severity of diabetic retinopathy. However, in 87 diabetic patients with a history of intravenously administered insulin, duration diabetes ≥ 4 years and good control of HbA1c <7% are significantly associated with the presence of diabetic retinopathy. There was a J-shaped relationship between poor control of glycemia ≥126mg/dL and the severity of non proliferative diabetic retinopathy. Conclusion: Urgent and efficient diabetes care and diabetes monitoring are needed in sub-Saharan Africa.
Prevalence and risk factors of diabetes mellitus in Kinshasa Hinterland
Authors: Wemankoy O. , On’Kin J.B. Kasiam Lasi , Okwe Nge , Mpandamadi S.D , Longo-Mbenza B. , Kabangu N.K. , He J.
Published: August 2024

Objective: To estimate the prevalence of diabetes mellitus (DM), impaired fasting glucose (IFG), and impaired glucose tolerance (IGT), and to determine the risk factors of DM among urban and rural areas of Kinshasa Hinterland. Research, Design and Methods: Data were collected from a multistage random sample cross-sectional surveys of adult black Africans from Kinshasa region DR Congo with the help of a structured questionnaire, physical examinations and blood samples, using the WHO stepwise approach and the new criteria of WHO to define glucose intolerance. Prevalence rates were adjusted using the standard world population of Waterhouse and the standard population of Kinshasa region. Results: A total of 9770 subjects age ≥ 12 years participated (response rate of 90.3%) in this study. Age-adjusted rates to world population of IFG, IGT, DM by fasting plasma only, DM by 2h-load test only, and all cases of DM were 9.3%, 9.6%, 16.1%, 8.4% and 25.3%, respectively. Male sex, rural residence, total obesity, abdominal obesity, viral infection, milk intake, and kwashiorkor were the univariate risk factors of all cases of DM. Adjusted for confounders, advancing age, rural-urban migration, physical inactivity, smoking, abstinence of alcohol, low intake of fruits-vegetables, family history of DM, refined sugar intake, high social class, high intake of animal fat and protein, and stress, were the independents determinants of all cases of DM. Conclusions: This study observed epidemic rates of glucose intolerance. Primary prevention through lifestyle changes is needed to control DM among Africans under demographic and nutrition transition.
Obesity profile in Turkey
Authors: Bagriacik N. , Onat H. , Ilhan B. , Tarakci T. , Oşar Z. , Ozyazar M. , Hatemi H.H. , Yildiz G.
Published: August 2024

Background: Obesity is becoming a severe health problem worldwide. We evaluated the prevalence of obesity in different regions of Turkey, to study the association between BMI and regional nutritional habits and to compare the results with previous epidemiological studies. Method: 13,878 individuals (6,799 males and 7,079 females) were screened in six different regions of Turkey between 2000-2005 (Istanbul and Kastamonu from Northern part of the country, Gaziantep from South, Denizli and Kırklareli from the West and Konya from the middle part of the country). The sample was randomly selected and all participants were older than 20 years of age. Weight (kg), height (cm) and waist circumference (cm) were measured and body mass index (BMI) was calculated according to World Health Organization (WHO) methods and criteria. Results: The mean BMI was 27.52 kg/m2, 26.80 kg/m2 in men and 28.24 kg/m2 in women. The mean waist circumference was 98.5 cm in men and 79.8 cm in women. 30.9% of the subjects have normal weight, 39.6 % were overweight, and 29.5% were obese according to the WHO classification. The highest prevalence (39.9%) of obesity was observed between the ages of 50-59 years. The prevalence of obesity was highest in Gaziantep (41.6%), which is an industrialized city in the southeastern part of the country. The prevalence of overweight in men aged from 60-69 years was 49.7% and was 37.2% in women between the ages of 30-39 years. The highest frequency of obesity for men was 27.9 % in the 50-59 years age group whereas the highest frequency of obesity for women was 51.4 %) in the 50-59 years age group. A heterogenous set of results were obtained with respect to lifestyles and nutritional habits for every city when the prevalence of overweight and obesity in the age groups were evaluated according to regions. Conclusion: Obesity is a major health problem in Turkey and the increased prevalence of obesity in the young age group raises concern.
Anti-hyperglycaemic activity of IND 01 and its interaction with glyburide and pioglitazone in alloxan induced diabetic mice
Authors: Shitole Prasad P. , Badole Sachin L. , Bodhankar Subhash L. , M.V. Mohan V. , Bhaskaran Sunil
Published: August 2024

The antihyperglycaemic activity of IND 01 and its interaction with glyburide and pioglitazone on serum glucose, body weight and oral glucose tolerance test (OGTT) was determined in alloxan-induced diabetic mice. IND 01 (100 mg/kg), glyburide (10 mg/kg), pioglitzone (10 mg/kg) and their concomitant administration were administered orally in alloxan (80 mg/kg, i.v.) induced diabetic mice. The study design consisted of estimation of serum glucose after acute, subacute and glucose load administration. Administration of IND 01 (100 mg/kg) alone significantly (P<0.001) reduced serum glucose level at 6 h after administration. The antihyperglycaemic effect of glyburide and their concomitant administration of IND 01 with glyburide were similar, that is, onset was 2 h; peak effect was 6 h but the effect waned at 24 h. The onset of concomitant administration of IND 01 with pioglitazone was 4 h; peak effect was at 6 h but the effect waned at 24 h. In the subacute study, reduction in serum glucose was observed on 28th day after withdrawal for 7 days. The effects of concomitant administration were more pronounced than single drug treatment. In mice treated with either IND 01 (100 mg/kg), glyburide, pioglitazone alone or their combination, the body weight was not reduced in contrast to that in the control group. In the oral glucose tolerance test (OGTT), increased glucose utilization was observed in animals after concomitant administration of IND 01 (100 mg/kg) and glyburide (10 mg/kg) as well as IND 01 (100 mg/kg) and pioglitazone (10 mg/kg). The concomitant administration of IND 01 with glyburide as well as pioglitzone produced synergistic antihyperglycaemic effect than either drug alone.
Gender differential in apo E genotypes’ correlative tendency to dyslipidaemia responsiveness upon flaxseed oil administration in adult type 2 diabetic patients not meeting the 2008 Canadian Practice Guidelines
Authors: Barre Douglas E. , Mizier-Barre Kazimiera A. , Griscti Odette , Hafez Kevin
Published: August 2024

Fasting blood serum lipid concentrations, low density lipoprotein (LDL) oxidation, hypertension, and various anthropometric measures such as waist circumference are important measures of coronary atherosclerosis risk in type 2 diabetics. Apo E genotypes, leptin and adiponectin, modify fasting blood serum lipid levels and thus the degree of atherosclerosis as assessed in part by c-reactive protein (CRP). Hypertension, LDL oxidation and increased waist circumference promote atherosclerosis and hence the risk of myocardial infarction. It was hypothesised that there would be apo E, adiponectin, leptin and gender driven differences in myocardial infarction risk including hypertension, various anthropometric measures, CRP levels and at least some of the lipid levels including their modulating levels of leptin and adiponectin as the result of the administration of flaxseed oil (60 mg/kg bodyweight/day of alpha-linolenic acid for 90 days) and that apo E genotype would play a role in lipid responsiveness to such flaxseed oil administration. The purpose of this study was to assess this hypothesis. The only significant change seen was a statistically significant drop in cholesterol only in females consuming flaxseed oil with correlative evidence of apo E genotypic influence on other lipid parameter responsiveness in males and females. The absence of change in leptin and adiponectin levels suggests that this change did not occur due to these, lipid modulating, adipocytokines. Dietary intakes of calories, oleic acid and alpha-linolenic acid were consistent for each gender/treatment group and therefore consistent with no change in waist circumference. It is concluded that flaxseed oil consumption at an alpha-linolenic acid level of 60 mg/kg body weight/day for three months has no impact on the cardiovascular disease risk factors studied in the overall population herein except for cholesterol in female type 2 diabetics consuming flaxseed oil. However, in certain apo E genotypes there was a greater sensitivity to change in lipid parameters.
Red wine alters the glucose-insulin relationship when consumed alone after a meal
Authors: Kokavec Anna , Halloran Mark A.
Published: August 2024

The aim of this study was to assess the effect of a small-moderate dose of red wine on the level of serum insulin and plasma glucose before and after a meal. A total of 18 non-diabetic males aged between 19-22 years participated in the current investigation. In the fasting trial participants underwent a 6 hour fast before consuming 4 standard units of red wine (40g alcohol) or the equivalent amount of placebo over a period of 135-min. Food was then presented alone for 45-min. Alternatively, in the feeding trial food was consumed for 45-min prior to participants ingesting 4 standard units of red wine (40g alcohol) or the equivalent amount of placebo over a 135-min period. The serum insulin and plasma glucose level was assessed at regular 45-min intervals across the four 180-min experimental periods. The results showed a significant alcohol-induced decrease in postprandial glucose and no significant change in serum insulin concentration when red wine is consumed alone following a meal. Alternatively, the ingestion of red wine alone prior to food promoted a significant reduction in serum insulin concentration despite preprandial glucose remaining unchanged. It was concluded that red wine may promote an alteration in the feedback mechanism by which plasma glucose controls the insulin rate, which under specific conditions could potentially provide some health benefits to diabetic individuals.
Lacrimal Gland Abscess: A Case Report
Authors: Ito Mayari , Vaidya Aric , Someda Steffani Krista , Takahashi Yasuhiro
Published: August 2024

Introduction: The aim of the study was to report a rare case of lacrimal gland abscess. Case Presentation: A 47-year-old woman noticed upper eyelid swelling on the right side 1.5 months before referral to our service. Oral antibiotics were administered, based on the diagnosis of acute dacryoadenitis at another clinic. The symptom had once subsided 20 days later but recurred. On the first examination, the right upper eyelid was swollen with tenderness. The right lacrimal gland was palpable. Blood tests revealed positive proteinase 3-anti-neutrophil cytoplasmic antibody. T2-weighted magnetic resonance and diffusion-weighted images showed a high signal intensity lesion in an enlarged right lacrimal gland, while apparent diffusion coefficient map demonstrated the lesion with a low signal intensity. We started administration of intravenous antibiotics. Abscess drainage and lacrimal gland biopsy were performed 4 days after the first examination. Culture test of the abscess showed only 1 colony growth of Cutibacterium acnes. The specimen harvested from the lacrimal gland showed proliferation of fibrous connective tissue and infiltration of inflammatory cells without vasculitis. After the drainage, the swelling gradually subsided. Administration of antibiotics discontinued at 22 days of follow-up. At 4-month follow-up, the patient did not have any symptom related to the lacrimal gland abscess. Conclusion: The diffusion-weighted images and apparent diffusion coefficient map are helpful for the diagnosis of lacrimal gland abscess when the culture tests provide poor results.
Clinical Characteristics and Outcomes of Patients with Heart Failure of Hypertensive Etiology: Analysis of Colombian Heart Failure Registry (RECOLFACA)
Authors: Martínez-Carreño Erika , Echeverría Luis Eduardo , Rivera-Toquica Alex , Zarama-Márquez Mario Hernán , Ramírez-Puentes Elkin Giovanni , Bustamante Rafael Ignacio , Palacio Rolando , Ávila-Barros Luis Manuel , Campbell-Quintero Sebastián , Morales-Rodríguez Lisbeth Natalia , López-Ponce de León Juan David , Buitrago Andrés Felipe , Sandoval-Luna Jorge Alberto , Saldarriaga Clara , Gómez-Mesa Juan Esteban
Published: August 2024

Introduction: Arterial hypertension represents one of the main comorbidities observed in patients with heart failure (HF) and one of the main risk factors for its development. Despite this, studies assessing this hypertensive etiology are scarce in Latin America. Our objective was to analyze the prevalence of HF of hypertensive etiology and evaluate its prognosis in patients enrolled in the Colombian Heart Failure Registry (RECOLFACA by its Spanish acronym). Methods: RECOLFACA recruited adult patients diagnosed with HF in 60 centers in Colombia between 2017 and 2019. The primary outcome was all-cause mortality. A Cox proportional hazards regression model was used to assess factors associated with primary outcomes in patients with hypertensive HF. A p value <0.05 was considered significant. All statistical tests were two-tailed. Results: Out of the total number of patients evaluated in RECOLFACA (n = 2,514), 804 had a diagnosis of HF with hypertensive etiology (31.9%). These patients were less frequently males and had a significantly older age and lower prevalence of comorbidities than those with HF of other etiologies. Additionally, patients with hypertensive HF had a higher prevalence of HF with preserved ejection fraction (HFpEF) (34.1% vs. 28.3%; p = 0.004). Finally, type 2 diabetes mellitus, chronic obstructive pulmonary disease diagnosis, and NYHA class IV were classified as independent mortality risk factors. Conclusions: Hypertensive HF represents about one-third of the total number of patients with HF in RECOLFACA. Compared with HF of other etiologies, it presents a differential clinical profile – older age and a higher prevalence of HFpEF. RECOLFACA has become a useful tool to characterize patients with HF in Colombia, with which it has been possible to carry out a more specific search and reach the diagnosis of this pathology in our population, and it has served as an example to stimulate registries of patients with HF in other countries in the region.
Clinical Characteristics of Microcystic Macular Edema in Chronic Primary Angle-Closure Glaucoma and Primary Open-Angle Glaucoma Patients
Authors: Xiao Hui , Liu Yuan , Guo Ni , Jin Ling , Wang Zhenyu , Lin Shufen , Lin Yixiu , Zheng Shaoyang , Tan Yuheng , Luo Nachuan , Liu Xing , Zuo Chengguo
Published: August 2024

Introduction: This study investigated the clinical characteristics of and risk factors for microcystic macular edema (MME) in patients with chronic primary angle-closure glaucoma (CPACG) and primary open-angle glaucoma (POAG). Methods: This retrospective observational study included 1,588 eyes from 926 glaucoma inpatients and analyzed the patients’ basic demographic information, visual field parameters, macular scans, and peripapillary retinal nerve fiber layer thickness. Results: Our findings were that the incidence rate of MME was 3.97% (34/857) in CPACG and 5.88% (43/731) in POAG. MME was predominantly diagnosed at an advanced stage in CPACG (almost 100%) compared to POAG (93.02%). MME was most frequently involved in the inferior (83.12%) quadrant of the peri-macular region in both CPACG and POAG. Risk factors for MME occurrence in CPACG and POAG included lower visual field mean deviation (OR = 1.14, 95%: CI 1.05-1.24, p = 0.003; OR = 1.14, 95% CI: 1.06–1.21, p < 0.001) and younger age (OR = 0.92, 95% CI: 0.88-0.96, p < 0.001; OR = 0.96, 95% CI: 0.93–0.99, p = 0.003), while female sex (OR = 0.30, 95% CI: 0.11–0.84, p = 0.022) reduced the MME occurrence in POAG. Conclusion: MME could develop in both CPACG and POAG patients, occurring earlier in POAG. The inferior peri-macular region is commonly affected. Younger age and poorer visual field are risk factors for MME in glaucoma patients.
Foveal Microstructure and Visual Outcomes after Pars Plana Vitrectomy in Patients with Different Types of Epiretinal Membrane Foveoschisis
Authors: Yang Xiaohan , Wu Xijin , Qi Biying , Zhang Ke , Yu Yanping , Wang Xinbo , Feng Xiao , Jia Qinlang , Jin Zi-Bing , Liu Wu
Published: August 2024

Introduction: The aim of this study was to evaluate the clinical characteristics and surgical outcomes of the epiretinal membrane foveoschisis (ERM-FS) with different morphological types. Methods: This retrospective observational study reviewed 44 consecutive ERM-FS patients who underwent ERM surgery. According to the optical coherence tomography images, ERM-FS was classified into three groups: group A, FS crossed the fovea with the foveola elevated; group B, FS located at the foveal edges with a near-normal central foveal point thickness; and group C, FS with undermined foveal edges with a near-normal central foveal point thickness. Results: There were 10 eyes in group A, 20 eyes in group B, and 14 eyes in group C. Preoperatively, eyes in group A had the best best-corrected visual acuity (BCVA), the thickest central foveal point thickness, and the highest ellipsoid zone (EZ) intact rate among the three groups. After surgery, a resolution of foveoschisis was observed in 40.0%, 45.0%, and 50.0% of the eyes in group A, group B, and group C (p = 0.928), respectively. BCVA was significantly improved postoperatively. Although there was no significant difference in BCVA among the three groups at 1 month postoperatively, BCVA of group A was the best at 4 and 10 months. Correlation analysis indicated that the type of ERM-FS, baseline BCVA, central foveal point thickness, and postoperative EZ continuity (all p < 0.05) were important factors for the final BCVA. Conclusions: The damage to the retinal structure and visual function was milder in group A ERM-FS. Our study emphasized the necessity of OCT-based subtyping in patients with ERM-FS.
Dietary Perceptions among Patients with Crohn’s Disease in Clinical Remission: Comparison with an Era Preceding the Availability of Biologic Therapy
Authors: Tanaka Makoto , Kawakami Aki , Sakagami Kayoko , Ito Hiroaki
Published: August 2024

Introduction: Dietary temperance significantly affects the quality of life of patients with Crohn’s disease (CD) and remains a major concern. However, perceptions of diet in remission may have changed from the era when treatment options were limited. Therefore, we compared the dietary perceptions and treatment of patients with CD in remission with previously published data from the time biologic therapy was not introduced. Methods: We compared the data of 254 patients with CD in remission who completed a questionnaire survey in 2022 with those of 76 patients with CD in remission collected in 2003, when biologics were not used for maintenance therapy in Japan. Remission was defined as a CD activity index of 150 or less in both studies. Perceptions of diet (degree of eating whatever one likes) were assessed using single-item nominal scale responses. Results: The percentage of patients receiving enteral nutrition therapy had decreased (past vs. present: 43.4 vs. 12.6%), while the proportion of patients receiving biologic therapy increased (0 vs. 88.6%, respectively). The percentages of patients who responded “not at all,” “sometimes,” and “mostly” when asked if they could eat whatever they liked had changed, respectively, from 9.2%, 46.1%, and 44.7% in the past to 4.3%, 25.2%, and 70.5% in the present. Conclusion: The proportion of those who ate whatever they liked and the mean body mass index increased in comparison with the corresponding values 20 years ago. With the advent of biologic therapies, the number of patients with CD who can enjoy eating has increased.
Highly Active Relapsing-Remitting Multiple Sclerosis with Neurofibromatosis Type 1: Radiological Aspects and Therapeutic Challenges – Case Report
Authors: Lemonaris Marios , Kleopa Kleopas A.
Published: August 2024

Introduction: Multiple sclerosis (MS) is an autoimmune neurodegenerative disease which can rarely co-exist with neurofibromatosis 1 (NF1), a neurocutaneous inherited disorder that predisposes to oncogenesis. Patients who suffer from both conditions can be challenging cases for clinicians, as clinical symptoms and radiological findings may overlap, while MS immune-modifying treatments could further increase the risk of oncogenesis. Case Presentation: In this study, we describe the case of a 27-year-old woman who presented with signs and symptoms of optic neuritis and was then diagnosed with both MS and NF1. As the patient continued to experience MS relapses despite initial interferon-beta treatment, she was subsequently switched to natalizumab and responded well. Conclusion: This case illustrates how MRI lesion differentiation with the co-existence of MS and NF1 can be difficult due to overlaps in lesion characteristics, while treatment decisions can be challenging mainly due to scarce data on the oncogenic risk of MS immunomodulary therapies. Therefore, clinicians need to balance out the risk of malignancy development with the risk of progressive neurological disability when treating such patients.
TLRs1-10 Protein Expression in Circulating Human White Blood Cells during Bacterial and COVID-19 Infections
Authors: Chomel Louise , Vogt Mathieu , Demiselle Julien , Le Borgne Pierrick , Tschirhart Marine , Morandeau Valentin , Merdji Hamid , Miguet Laurent , Helms Julie , Meziani Ferhat , Mauvieux Laurent
Published: August 2024

Introduction: Toll-like receptors play crucial roles in the sepsis-induced systemic inflammatory response. Septic shock mortality correlates with overexpression of neutrophilic TLR2 and TLR9, while the role of TLR4 overexpression remains a debate. In addition, TLRs are involved in the pathogenesis of viral infections such as COVID-19, where the single-stranded RNA of SARS-CoV-2 is recognized by TLR7 and TLR8, and the spike protein activates TLR4. Methods: In this study, we conducted a comprehensive analysis of TLRs 1–10 expressions in white blood cells from 71 patients with bacterial and viral infections. Patients were divided into 4 groups based on disease type and severity (sepsis, septic shock, moderate, and severe COVID-19) and compared to 7 healthy volunteers. Results: We observed a significant reduction in the expression of TLR4 and its co-receptor CD14 in septic shock neutrophils compared to the control group (p < 0.001). Severe COVID-19 patients exhibited a significant increase in TLR3 and TLR7 levels in neutrophils compared to controls (p < 0.05). Septic shock patients also showed a similar increase in TLR7 in neutrophils along with elevated intermediate monocytes (CD14+CD16+) compared to the control group (p < 0.005 and p < 0.001, respectively). However, TLR expression remained unchanged in lymphocytes. Conclusion: This study provides further insights into the mechanisms of TLR activation in various infectious conditions. Additional analysis is needed to assess their correlation with patient outcome and to evaluate the impact of TLR-pathway modulation during septic shock and severe COVID-19.
Reversible Nyctalopia and Bilateral Optic Neuropathy due to Combined Vitamin A, Zinc, and Copper Deficiency: A Case Report
Authors: Bhatnagar Anshul , Laylani Noor , Davila-Siliezar Pamela , Beaver Hilary A. , Lee Andrew G.
Published: August 2024

Introduction: Combined nutritional deficiency is an uncommon cause of vision loss in the USA. Notably, vitamin A deficiency can produce nyctalopia but rarely causes bilateral central vision loss. The combination of these symptoms is unusual, although likely underreported. Case Presentation: We report an exceptionally rare case of bilateral central vision loss and nyctalopia caused by combined vitamin A, zinc, and copper deficiency, likely following bariatric surgery and alcohol use. Following mineral and vitamin supplementation, the patient’s vision improved significantly and returned to baseline within 1 month. Vision loss resulting from this specific multicombination of vitamin and mineral deficiency has never been reported previously in the English-language ophthalmic literature. Conclusion: Given rising rates of bariatric surgery and alcohol use in the USA and abroad, clinicians should be aware that the combination of progressive nyctalopia and bilateral central vision loss may be produced by combined nutritional deficiency. Screening and supplementation of both vitamin and mineral deficiency may result in dramatic reversal of visual loss in such cases.
Biliary Cast Syndrome and Secondary Sclerosing Cholangitis in Critically Ill Patient after Long-Term Treatment in the Intensive Care Unit
Authors: Alkurdi Adnan , Herrmann Johannes , Bikmukhametov Damir , Tschöpe Rebecca
Published: August 2024

Introduction: Secondary sclerosing cholangitis in critically ill patients (SSC-CIP) is a rare but underdiagnosed entity that occurs after life-threatening events and treatment in the intensive care unit (ICU). The etiology of SSC-CIP is not fully understood but may be caused by ischemic bile duct injury. SSC-CIP is a cholestatic liver disease that rapidly progresses to liver cirrhosis, with a high mortality rate in the first year of 50%. Endoscopic retrograde cholangiopancreatography (ERCP), which is the gold standard for diagnosing SSC-CIP, shows primary SC-like changes, usually in the intrahepatic bile ducts. Biliary cast formation is pathognomonic for SSC-CIP. No proven effective conservative treatment is available for SSC-CIP, and liver transplantation is the only curative therapy when liver cirrhosis or recurrent cholangitis occurs. Case Presentation: We report the case of a 47-year-old male patient who developed cholestasis after a long treatment in the ICU for severe pneumonia. ERCP showed characteristic findings with rarefication and multiple segmental stenosis in the intrahepatic bile ducts. We removed multiple biliary casts from the bile ducts. Conclusion: SSC-CIP should be considered for ICU patients with unclear cholestasis, especially when the cholestasis persists after recovery from the underlying disease. Early diagnosis is important to achieve better outcomes; without liver transplantation, the prognosis is generally poor.
Damage to the Descending Colon after Endoscopic Balloon Dilatation following a Minor Traffic Accident in a Patient with Crohn’s Disease: A Case Report
Authors: Seki Takaomi , Osone Katsuya , Ogawa Hiroomi , Okada Takuhisa , Shiraishi Takuya , Sohda Makoto , Shirabe Ken , Saeki Hiroshi
Published: August 2024

Introduction: Crohn’s disease (CD) is complicated by intestinal strictures and fistula formation; however, intestinal perforation is relatively rare. Case Presentation: Following a traffic accident in the evening, a 39-year-old woman experienced abdominal pain that worsened the following morning and was taken to the emergency department. She had a 17-year history of CD and eight endoscopic balloon dilations for descending colonic strictures. She presented with a high fever of 40.0°C, along with tenderness and rebound pain throughout her abdomen, with the most substantial point being in the lower left abdomen. Computed tomography showed thickening of the descending colon wall, increased fat concentration around the wall, and a slight presence of air in the mesentery near the intestinal wall. We diagnosed the patient with generalized peritonitis due to traumatic penetration of the mesentery of the descending colon and performed emergency surgery. Intraoperative observation of the abdominal cavity with a laparoscope revealed purulent ascites but no apparent perforation or edematous mesentery, with white moss and redness in the descending colon. This prompted the decision to perform peritoneal lavage drainage and a transverse colonic double colostomy. The postoperative course was favorable, and the patient was discharged from the hospital on the postoperative day 14. Four months after discharge, colostomy closure was performed. Conclusion: Relatively minor trauma in patients with CD can result in colon injury. An injured bowel is usually accompanied by active lesions due to CD; however, caution is required, as endoscopic balloon dilatation without accompaniment may be a background factor.
The Use of Coronary Imaging for Predicting Future Cardiovascular Events
Authors: Cha Jung-Joon , Hong Soon Jun , Lim Subin , Kim Ju Hyeon , Joo Hyung Joon , Park Jae Hyoung , Yu Cheol Woong , Lim Do-Sun
Published: August 2024

Background: Despite advancements in coronary artery disease (CAD) treatment with drug-eluting stent, its morbidity and mortality remain high. In context, intravascular imaging-guided percutaneous coronary intervention (PCI) is increasingly recommended for better clinical outcomes in patient with CAD. Near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS), as one of the intravascular imaging methods, is effective in detecting lipid-rich plaques, which is crucial for identifying high-risk or vulnerable plaques employing near-infrared light. High lipid core burden, as identified by NIRS-IVUS, correlates with an increased risk of adverse cardiac events and shows varying degrees of efficacy in plaque management and event prevention. Summary: This article addresses about how NIRS-IVUS can be used to predict event of CAD. The study highlights the crucial role of NIRS-IVUS in predicting future cardiovascular events. Findings indicate that the presence of high lipid core burden is related to increased risks of periprocedural myocardial infarction and reduced coronary flow during PCI. The study also outlines the predictive value of NIRS-IVUS in non-culprit lesions, where plaques with high lipid core burden significantly increase the occurrence of major adverse cardiac events as demonstrated in the PROSPECT II trial. In terms of therapeutic strategies, the study reviews the effectiveness of high-intensity lipid-lowering strategies in stabilizing vulnerable plaques, as evidenced in trials such as the YELLOW and PACMAN AMI trials. Key Messages: NIRS-IVUS emerges as a valuable diagnostic tool in treating CAD. It effectively identifies vulnerable plaques and aids in predicting and preventing future adverse cardiac events. However, to enhance its practicality and promote widespread adoption in clinical settings, further long-term outcome research of NIRS-IVUS-guided PCI is necessary. These efforts can potentially make NIRS-IVUS a more accessible and indispensable tool in cardiovascular disease management.
Place of Concordance-Discordance Model in Evaluating Next-Generation Sequencing Performance
Authors: Zhai Yue , Bardel Claire , Vallée Maxime , Iwaz Jean , Roy Pascal
Published: August 2024

Introduction: Ideally, evaluating next-generation sequencing performance requires a gold standard; in its absence, concordance between replicates is often used as substitute standard. However, the appropriateness of the concordance-discordance criterion has been rarely evaluated. This study analyses the relationship between the probability of discordance and the probability of error under different conditions. Methods: This study used a conditional probability approach under conditional dependence then conditional independence between two sequencing results and compares the probabilities of discordance and error in different theoretical conditions of sensitivity, specificity, and correlation between replicates, then on real results of sequencing genome NA12878. The study examines also covariate effects on discordance and error using generalized additive models with smooth functions. Results: With 99% sensitivity and 99.9% specificity under conditional independence, the probability of error for a positive concordant pair of calls is 0.1%. With additional hypotheses of 0.1% prevalence and 0.9 correlation between replicates, the probability of error for a positive concordant pair is 47.4%. With real data, the estimated sensitivity, specificity, and correlation between tests for variants are around 98.98%, 99.996%, and 93%, respectively, and the error rate for positive concordant calls approximates 2.5%. In covariate effect analyses, the effects’ functional form is close between discordance and error models, though the parts of deviance explained by the covariates differ between discordance and error models. Conclusion: With conditional independence of two sequencing results, the concordance-discordance criterion seems acceptable as substitute standard. However, with high correlation, the criterion becomes questionable because a high percentage of false concordant results appears among concordant results.
Lethal Immune-Related Pneumonitis after Durvalumab Therapy for Small Cell Lung Cancer: A First Case in China
Authors: Li Qian , Liu Mei , Liu Yunxia , Shi Feng , Yuan Shan , Di Guojie , Jin Haobin , Shi Yaru , Zhang Wen , Yang Zhe
Published: August 2024

Introduction: Although programmed death ligand 1 (PD-L1) inhibitor plus chemotherapy regimen is a promising strategy for malignant tumors, it can induce significant immune-related adverse events, such as immune-related pneumonitis. Here, we report the first case of lethal immune-related pneumonitis in an Asian patient receiving anti-PD-L1 treatment. Case Presentation: A 68-year-old man was diagnosed with small cell lung cancer and interstitial pneumonia. After his pulmonary infection was relieved by comprehensive treatment, the patient received first-line treatment with durvalumab plus etoposide and carboplatin. Two weeks after starting durvalumab treatment, the patient had chest pain and shortness of breath. He was diagnosed with immune-induced pneumonia and treated with methylprednisolone, cefoperazone, and sulbactam, followed by oxygen and pirfenidone. Oxygen partial pressure decreased to 58 mm Hg within next the 4 days and laboratory assessment suggested cytokine storm. The patient underwent 2 plasma exchanges, one double filtration plasmapheresis and oxygen saturation decreased continuously. The patient died 1 month after durvalumab treatment. Conclusion: Immune-related pneumonitis induced by PD-L1 inhibitors is rare but life-threatening. Infection should be ruled out before starting immunotherapy.