Stroke is a common disease that has a high rate of mortality and morbidity. The World Stroke Organization states that there are over 12.2 million strokes a year, with 1 in 4 people over the age of 25 predicted to have a stroke in their lifetime. The British data shows that there are around 150,000 stroke related admissions every year in the UK, with strokes occurring at an increasing earlier age. Strokes are generally classified as ischemic or hemorrhagic, with approximately 83% of all patients presenting with an ischemic stroke. The aim of this article is to provide an overview of the acute management of ischemic stroke in our center—a secondary care specialist hospital in the Northeast of England, with approximately 1000 stroke admissions a year.
{"title":"Hyperacute management of ischemic strokes, a British perspective","authors":"Shifan Xie, Yik Roy Hwang, Revin Thomas","doi":"10.3934/medsci.2023009","DOIUrl":"https://doi.org/10.3934/medsci.2023009","url":null,"abstract":"Stroke is a common disease that has a high rate of mortality and morbidity. The World Stroke Organization states that there are over 12.2 million strokes a year, with 1 in 4 people over the age of 25 predicted to have a stroke in their lifetime. The British data shows that there are around 150,000 stroke related admissions every year in the UK, with strokes occurring at an increasing earlier age. Strokes are generally classified as ischemic or hemorrhagic, with approximately 83% of all patients presenting with an ischemic stroke. The aim of this article is to provide an overview of the acute management of ischemic stroke in our center—a secondary care specialist hospital in the Northeast of England, with approximately 1000 stroke admissions a year.","PeriodicalId":43011,"journal":{"name":"AIMS Medical Science","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80325567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The central tenet in PCOS is predicting the development of the development of metabolic syndrome is Insulin resistance (IR). Adipocytokines are hormones produced by adipose cells that help to regulate insulin secretion and resistance in the body. This study discusses the effect of different adipocytokines and their patterns (increased or reduced) in predicting insulin resistance in obese and lean PCOS patients. A systematic review and meta-analysis were performed which identified relevant studies from 2010 to 2020. Data was analyzed using Review Manager Version (RevMan) 5.4 software. A fixed-effect model was fitted to estimate the pooled effect of adipocytokines. I2 test statistics were done to test the heterogeneity of included studies. Of 17 selected studies with 1504 participants, there is considerably lower levels of adiponectin among women with PCOS as compared with healthy controls with mean difference of −3.79 (95% CI = 3.97–3.60, I2 = 73%; P = 0.005). In comparison to their healthy counterparts, leptin levels were shown to be higher in women with PCOS with mean difference of 3.64 (95% CI = 3.20–4.08, I2 = 97%; P = 0.00001). Leptin concentration was shown to be directly related to IR and BMI. After controlling for BMI and age-related effects, adiponectin levels appear to be lower in women with PCOS compared to non-PCOS controls but leptin levels appear to be higher. In conclusion, increased in adipocytokines such as leptin, visfatin and chemerin predict IR among both obese and lean PCOS whereas decreased levels of zinc-alpha2 glycoprotein predict IR. Adipocytokines can be potential predictive serum biomarkers of insulin resistance (IR) in PCOS.
多囊卵巢综合征的中心原则是预测代谢综合征的发展是胰岛素抵抗(IR)。脂肪细胞因子是由脂肪细胞产生的激素，有助于调节体内胰岛素分泌和抵抗。本研究探讨了不同脂肪细胞因子及其模式(增加或减少)在预测肥胖和瘦弱多囊卵巢综合征患者胰岛素抵抗中的作用。对2010年至2020年的相关研究进行了系统回顾和荟萃分析。数据分析采用Review Manager Version (RevMan) 5.4软件。采用固定效应模型估计脂肪细胞因子的综合效应。采用2检验统计来检验纳入研究的异质性。在17项有1504名参与者的研究中，与健康对照组相比，PCOS女性的脂联素水平明显较低，平均差异为- 3.79 (95% CI = 3.97-3.60, I2 = 73%;P = 0.005)。与健康女性相比，PCOS女性瘦素水平较高，平均差异为3.64 (95% CI = 3.20-4.08, I2 = 97%;P = 0.00001)。瘦素浓度与IR和BMI有直接关系。在控制了BMI和年龄相关的影响后，多囊卵巢综合征女性的脂联素水平似乎比非多囊卵巢综合征女性低，但瘦素水平似乎更高。总之，脂肪细胞因子如瘦素、内脏脂肪素和趋化素的增加可以预测肥胖和瘦肉多囊卵巢综合征患者的IR，而锌- α 2糖蛋白水平的降低可以预测IR。脂肪细胞因子可能是多囊卵巢综合征胰岛素抵抗(IR)的潜在预测血清生物标志物。
{"title":"Adipocytokines in polycystic ovary syndrome (PCOS): A systematic review and meta-analysis","authors":"K. Nagandla, Ishita Banerjee, N. Ismail","doi":"10.3934/medsci.2023016","DOIUrl":"https://doi.org/10.3934/medsci.2023016","url":null,"abstract":"The central tenet in PCOS is predicting the development of the development of metabolic syndrome is Insulin resistance (IR). Adipocytokines are hormones produced by adipose cells that help to regulate insulin secretion and resistance in the body. This study discusses the effect of different adipocytokines and their patterns (increased or reduced) in predicting insulin resistance in obese and lean PCOS patients. A systematic review and meta-analysis were performed which identified relevant studies from 2010 to 2020. Data was analyzed using Review Manager Version (RevMan) 5.4 software. A fixed-effect model was fitted to estimate the pooled effect of adipocytokines. I2 test statistics were done to test the heterogeneity of included studies. Of 17 selected studies with 1504 participants, there is considerably lower levels of adiponectin among women with PCOS as compared with healthy controls with mean difference of −3.79 (95% CI = 3.97–3.60, I2 = 73%; P = 0.005). In comparison to their healthy counterparts, leptin levels were shown to be higher in women with PCOS with mean difference of 3.64 (95% CI = 3.20–4.08, I2 = 97%; P = 0.00001). Leptin concentration was shown to be directly related to IR and BMI. After controlling for BMI and age-related effects, adiponectin levels appear to be lower in women with PCOS compared to non-PCOS controls but leptin levels appear to be higher. In conclusion, increased in adipocytokines such as leptin, visfatin and chemerin predict IR among both obese and lean PCOS whereas decreased levels of zinc-alpha2 glycoprotein predict IR. Adipocytokines can be potential predictive serum biomarkers of insulin resistance (IR) in PCOS.","PeriodicalId":43011,"journal":{"name":"AIMS Medical Science","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85733801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Somayeh Boshtam, M. Shokrzadeh, Nasrin Ghassemi-Barghi
Fluoxetine is a selective serotonin reuptake inhibitor that is a commonly used drug for the treatment of depression and obsessive-compulsive disorders. Despite the positive effects of this drug, it seems to be associated with various side effects. Genotoxicity or DNA damage is an important side effect of some kinds of drugs. To date, the genotoxicity and cytotoxicity of fluoxetine are partially unknown. In the present study, some oxidative stress methods were used, such as ROS, MDA and GSH evaluation methods in HepG2 cells treated with fluoxetine (1–10 µM). A comet assay was used to evaluate the genotoxic effects of fluoxetine, and flow cytometry was used for apoptosis detection in these hepatic cells. Our data have shown that fluoxetine increased MDA and intracellular concentration of ROS significantly (P < 0.001), while the amount of GSH was reduced significantly (P < 0.001). Our results also indicated that fluoxetine increased the DNA damage of HepG2 cells. The tail percentage of DNA for control cells was 4%, but this percentage was 19%, 28% and 32% for 1, 5 and 10 µM of fluoxetine concentration, respectively (P < 0.01 and P < 0.001). The flow cytometry results have also shown increases in early and late apoptosis for fluoxetine (13.31% and 9.54%, respectively). In conclusion, the present study has shown that fluoxetine is able to induce oxidative stress-dependent DNA damage. Anyway, more studies are needed to accurately explore the molecular and cellular aspects of fluoxetine.
{"title":"Fluoxetine induces oxidative stress-dependent DNA damage in human hepatoma cells","authors":"Somayeh Boshtam, M. Shokrzadeh, Nasrin Ghassemi-Barghi","doi":"10.3934/medsci.2023007","DOIUrl":"https://doi.org/10.3934/medsci.2023007","url":null,"abstract":"Fluoxetine is a selective serotonin reuptake inhibitor that is a commonly used drug for the treatment of depression and obsessive-compulsive disorders. Despite the positive effects of this drug, it seems to be associated with various side effects. Genotoxicity or DNA damage is an important side effect of some kinds of drugs. To date, the genotoxicity and cytotoxicity of fluoxetine are partially unknown. In the present study, some oxidative stress methods were used, such as ROS, MDA and GSH evaluation methods in HepG2 cells treated with fluoxetine (1–10 µM). A comet assay was used to evaluate the genotoxic effects of fluoxetine, and flow cytometry was used for apoptosis detection in these hepatic cells. Our data have shown that fluoxetine increased MDA and intracellular concentration of ROS significantly (P < 0.001), while the amount of GSH was reduced significantly (P < 0.001). Our results also indicated that fluoxetine increased the DNA damage of HepG2 cells. The tail percentage of DNA for control cells was 4%, but this percentage was 19%, 28% and 32% for 1, 5 and 10 µM of fluoxetine concentration, respectively (P < 0.01 and P < 0.001). The flow cytometry results have also shown increases in early and late apoptosis for fluoxetine (13.31% and 9.54%, respectively). In conclusion, the present study has shown that fluoxetine is able to induce oxidative stress-dependent DNA damage. Anyway, more studies are needed to accurately explore the molecular and cellular aspects of fluoxetine.","PeriodicalId":43011,"journal":{"name":"AIMS Medical Science","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83869272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Autoimmune thyroiditis (AIT) is a chronic inflammatory that involves hyperactivation of the immune system against the thyroid gland, recognizing it as "nonself”. The aim of this research was to identify the relationships between genetic polymorphism in CTLA4, TNF-α and PTPN22 genes and the manifestation of AIT and levels of antithyroglobulin antibody (anti-TG Ab) and thyroid peroxidase antibody (anti-TPO Ab). The study was conducted during 2014–2020 and included 64 men and 106 women aged between 18 and 64 years with AIT. The control group consisted of 65 people (26 men, 39 women, aged between 20 and 65 years) without any thyroid pathologies or other autoimmune diseases. For molecular genetic analysis, real-time quantitative RT-PCR was used with fluorescently labeled FAM probes on a detection system CFX96 (BioRad). The results demonstrated that patients with the GG genotype and the G allele of the +49A/G polymorphism in the CTLA4 gene have significantly higher titers of anti-TG Ab. High titers of anti-TG Ab were detected in 22.4% of patients with the GG genotype (p = 0.005, χ2 = 7.86, OR = 0.237, 95% CI = 0.088–0.635), and in 55.6% of patients with the G allele (p = 0.0012, χ2 = 10.43, OR = 0.360, 95%, СI = 0.192–0.674). At the same time, the A allele of the +49A/G polymorphism is significantly more common in patients with normal anti-TG Ab values—in 68.1% of individuals (p = 0.0012, χ2 = 10.43, OR= 2.78, 95%, CI = 1.484–5.207). The results of the study indicate the prognostic significance of the G allele and the GG genotype of the +49A/G polymorphism of the CTLA4 gene predicting the probability of occurrence of anti-TG and anti-TPO antibodies.
{"title":"Relationship between CTLA4, TNF-α and PTPN22 gene polymorphism and the serum levels of antithyroglobulin and antiperoxidase antibodies in autoimmune thyroiditis","authors":"R. Rahimova","doi":"10.3934/medsci.2023002","DOIUrl":"https://doi.org/10.3934/medsci.2023002","url":null,"abstract":"Autoimmune thyroiditis (AIT) is a chronic inflammatory that involves hyperactivation of the immune system against the thyroid gland, recognizing it as \"nonself”. The aim of this research was to identify the relationships between genetic polymorphism in CTLA4, TNF-α and PTPN22 genes and the manifestation of AIT and levels of antithyroglobulin antibody (anti-TG Ab) and thyroid peroxidase antibody (anti-TPO Ab). The study was conducted during 2014–2020 and included 64 men and 106 women aged between 18 and 64 years with AIT. The control group consisted of 65 people (26 men, 39 women, aged between 20 and 65 years) without any thyroid pathologies or other autoimmune diseases. For molecular genetic analysis, real-time quantitative RT-PCR was used with fluorescently labeled FAM probes on a detection system CFX96 (BioRad). The results demonstrated that patients with the GG genotype and the G allele of the +49A/G polymorphism in the CTLA4 gene have significantly higher titers of anti-TG Ab. High titers of anti-TG Ab were detected in 22.4% of patients with the GG genotype (p = 0.005, χ2 = 7.86, OR = 0.237, 95% CI = 0.088–0.635), and in 55.6% of patients with the G allele (p = 0.0012, χ2 = 10.43, OR = 0.360, 95%, СI = 0.192–0.674). At the same time, the A allele of the +49A/G polymorphism is significantly more common in patients with normal anti-TG Ab values—in 68.1% of individuals (p = 0.0012, χ2 = 10.43, OR= 2.78, 95%, CI = 1.484–5.207). The results of the study indicate the prognostic significance of the G allele and the GG genotype of the +49A/G polymorphism of the CTLA4 gene predicting the probability of occurrence of anti-TG and anti-TPO antibodies.","PeriodicalId":43011,"journal":{"name":"AIMS Medical Science","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90282762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Pavone, X. Pappalardo, R. Lubrano, S. Savasta, A. Verrotti, P. Parisi, R. Falsaperla
The 4q deletion syndrome defines a disorder, which may involve patients affected by either the deletion of the interstitial region from the centromere to 4q31 or by the deletion of the terminal region from 4q31 to 4qter. Here, we describe clinical phenotypes of two unrelated children of the same age followed at the same time, with case 1 presenting with 4q interstitial and case 2 with terminal 4q deletion, and compare them each other and with those reported in the literature. Both children showed complex, heterogeneous clinical manifestations, including craniofacial features, pre-postnatal growth failure, speech and developmental delay. In case 2, thyroid and cholesterol dysfunction were also found. Analyzing these data, clinical differences between interstitial and terminal 4q deletions are scanty and no significant phenotype differences were found between the 4q regions deleted as observed in the comparison of the two children and the related cases of the literature. The term 4q deletion syndrome - inclusive for both the interstitial and terminal 4q regions deleted - seems to be appropriate. To note, the dysfunction of cholesterol metabolism and thyroid presented by case 2 may be clinically worthwhile, whether confirmed by other observations.
{"title":"4q interstitial and terminal deletion: clinical features comparison in two unrelated children","authors":"P. Pavone, X. Pappalardo, R. Lubrano, S. Savasta, A. Verrotti, P. Parisi, R. Falsaperla","doi":"10.3934/medsci.2023011","DOIUrl":"https://doi.org/10.3934/medsci.2023011","url":null,"abstract":"The 4q deletion syndrome defines a disorder, which may involve patients affected by either the deletion of the interstitial region from the centromere to 4q31 or by the deletion of the terminal region from 4q31 to 4qter. Here, we describe clinical phenotypes of two unrelated children of the same age followed at the same time, with case 1 presenting with 4q interstitial and case 2 with terminal 4q deletion, and compare them each other and with those reported in the literature. Both children showed complex, heterogeneous clinical manifestations, including craniofacial features, pre-postnatal growth failure, speech and developmental delay. In case 2, thyroid and cholesterol dysfunction were also found. Analyzing these data, clinical differences between interstitial and terminal 4q deletions are scanty and no significant phenotype differences were found between the 4q regions deleted as observed in the comparison of the two children and the related cases of the literature. The term 4q deletion syndrome - inclusive for both the interstitial and terminal 4q regions deleted - seems to be appropriate. To note, the dysfunction of cholesterol metabolism and thyroid presented by case 2 may be clinically worthwhile, whether confirmed by other observations.","PeriodicalId":43011,"journal":{"name":"AIMS Medical Science","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86714403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), a type of coronavirus that causes the condition known as coronavirus disease, was first reported in Wuhan, China in 2019. It commonly affects the respiratory system and is known to produce, in some cases, pneumonia like symptoms, and even death. However, 25 hydroxyvitamin D commonly known as vitamin D, is, when in its hormonal form, involved in many processes throughout the body, including bone health and immune function. Several studies have linked vitamin D to increased resistance to infection, but the link between vitamin D levels and COVID-19 infection, severity and mortality is yet to be fully ascertained. Several studies have linked vitamin D serum levels and deficiency to differing levels of COVID-19 outcome. This review seeks to investigate these claims made in these studies to help add to the body of knowledge and come to a greater understanding of the link between vitamin D and COVID-19 infection.
{"title":"Does vitamin D level have effect on COVID-19 outcomes?","authors":"Marcus M Martin, R. Thompson, N. Tirupathi","doi":"10.3934/medsci.2023012","DOIUrl":"https://doi.org/10.3934/medsci.2023012","url":null,"abstract":"The severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), a type of coronavirus that causes the condition known as coronavirus disease, was first reported in Wuhan, China in 2019. It commonly affects the respiratory system and is known to produce, in some cases, pneumonia like symptoms, and even death. However, 25 hydroxyvitamin D commonly known as vitamin D, is, when in its hormonal form, involved in many processes throughout the body, including bone health and immune function. Several studies have linked vitamin D to increased resistance to infection, but the link between vitamin D levels and COVID-19 infection, severity and mortality is yet to be fully ascertained. Several studies have linked vitamin D serum levels and deficiency to differing levels of COVID-19 outcome. This review seeks to investigate these claims made in these studies to help add to the body of knowledge and come to a greater understanding of the link between vitamin D and COVID-19 infection.","PeriodicalId":43011,"journal":{"name":"AIMS Medical Science","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85664631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mlyashimbi Helikumi, Paride O. Lolika, S. Mushayabasa
In this paper, we propose a fractional order Coronavirus (COVID-19) model incorporating non-pharmaceutical interventions and vaccine hesitancy. The proposed model was calibrated with data from literature and validated with reported daily cases of COVID-19 from Wuhan, China. We derived the reproduction number and demonstrated that it is an important threshold parameter for disease persistence and extinction. We examined the relationship between the reproduction number and model parameters. Our findings underscore the importance of awareness and vaccine uptake on mitigating the spread of COVID-19.
{"title":"Analysis of Caputo fractional-order model for COVID-19 with non-pharmaceuticals interventions and vaccine hesitancy","authors":"Mlyashimbi Helikumi, Paride O. Lolika, S. Mushayabasa","doi":"10.3934/medsci.2023017","DOIUrl":"https://doi.org/10.3934/medsci.2023017","url":null,"abstract":"In this paper, we propose a fractional order Coronavirus (COVID-19) model incorporating non-pharmaceutical interventions and vaccine hesitancy. The proposed model was calibrated with data from literature and validated with reported daily cases of COVID-19 from Wuhan, China. We derived the reproduction number and demonstrated that it is an important threshold parameter for disease persistence and extinction. We examined the relationship between the reproduction number and model parameters. Our findings underscore the importance of awareness and vaccine uptake on mitigating the spread of COVID-19.","PeriodicalId":43011,"journal":{"name":"AIMS Medical Science","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74866089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Burner, Lucy Liu, S. Terp, S. Arora, C. Lam, M. Menchine, D. Dworkis, S. Axeen
Aims The incidence of diabetic ketoacidosis (DKA) increased during the COVID-19 pandemic but estimates from low-resource settings are limited. We examined the odds of DKA among emergency department (ED) visits in the Los Angeles County Department of Health Services (DHS) (1) during the COVID-19 pandemic compared to the pre-COVID era, (2) without active COVID infections, and (3) stratified by effect modifiers to identify impacted sub-groups. Methods We estimated the odds of DKA from 400,187 ED visits pre-COVID era (March 2019–Feb 2020) and 320,920 ED visits during the COVID era (March 2020–Feb 2021). Our base model estimated the odds of DKA based on the COVID era. Additional specifications stratified by effect modifiers, controlled for confounders, and limited to visits without confirmed COVID-19 disease. Results After adjusting for triage acuity and interaction terms for upper respiratory infections and payor, the odds of DKA during the COVID era were 27% higher compared to the pre-COVID era (95%CI 14–41%, p < 0.001). In stratified analyses, visits with private payors had a 112% increased odds and visits with Medicaid had a 20% increased odds of DKA during the COVID era (95%CI 7–36%, p = 0.003). Conclusions We identified increased odds of DKA during the COVID pandemic, robust to a variety of specifications. We found differential effects by the payor; with increased odds during COVID for privately-insured patients.
目的:在2019冠状病毒病大流行期间，糖尿病酮症酸中毒(DKA)的发病率有所增加，但对资源匮乏地区的估计有限。我们检查了洛杉矶县卫生服务部(DHS)急诊科(ED)就诊中DKA的几率(1)在COVID-19大流行期间与前COVID时代相比，(2)没有活跃的COVID感染，(3)通过效应修饰因子分层以确定受影响的亚组。方法我们估计了COVID时代前(2019年3月- 2020年2月)400,187次ED就诊和COVID时代(2020年3月- 2021年2月)320,920次ED就诊的DKA几率。我们的基础模型基于COVID时代估计了DKA的几率。其他规格按效果调节剂分层，控制混杂因素，限制未确诊COVID-19疾病的访问。结果在调整上呼吸道感染和付款人的分诊灵敏度和相互作用条件后，与前相比，COVID时期DKA的几率高27% (95%CI 14-41%， p < 0.001)。在分层分析中，在COVID时代，私人支付者的就诊几率增加了112%，医疗补助的就诊几率增加了20% (95%CI 7-36%， p = 0.003)。结论:我们发现在COVID大流行期间，DKA的几率增加，符合各种规格。我们发现付款人的不同影响;私人保险患者在COVID期间的几率增加。
{"title":"Increased risk of diabetic ketoacidosis in an Urban, United States, safety-net emergency department in the COVID-19 era","authors":"E. Burner, Lucy Liu, S. Terp, S. Arora, C. Lam, M. Menchine, D. Dworkis, S. Axeen","doi":"10.3934/medsci.2023004","DOIUrl":"https://doi.org/10.3934/medsci.2023004","url":null,"abstract":"Aims The incidence of diabetic ketoacidosis (DKA) increased during the COVID-19 pandemic but estimates from low-resource settings are limited. We examined the odds of DKA among emergency department (ED) visits in the Los Angeles County Department of Health Services (DHS) (1) during the COVID-19 pandemic compared to the pre-COVID era, (2) without active COVID infections, and (3) stratified by effect modifiers to identify impacted sub-groups. Methods We estimated the odds of DKA from 400,187 ED visits pre-COVID era (March 2019–Feb 2020) and 320,920 ED visits during the COVID era (March 2020–Feb 2021). Our base model estimated the odds of DKA based on the COVID era. Additional specifications stratified by effect modifiers, controlled for confounders, and limited to visits without confirmed COVID-19 disease. Results After adjusting for triage acuity and interaction terms for upper respiratory infections and payor, the odds of DKA during the COVID era were 27% higher compared to the pre-COVID era (95%CI 14–41%, p < 0.001). In stratified analyses, visits with private payors had a 112% increased odds and visits with Medicaid had a 20% increased odds of DKA during the COVID era (95%CI 7–36%, p = 0.003). Conclusions We identified increased odds of DKA during the COVID pandemic, robust to a variety of specifications. We found differential effects by the payor; with increased odds during COVID for privately-insured patients.","PeriodicalId":43011,"journal":{"name":"AIMS Medical Science","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75196721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Diogo Henrique Constantino Coledam, Philippe Fanelli Ferraiol, Gustavo Aires de Arruda, Arli Ramos de Oliveira
The aim of the present study was to analyze the use of health services and associated factors among elementary school teachers. This is a cross-sectional study conducted with 505 school teachers from Londrina-PR, Brazil. The outcomes were medical consultation, emergency service, hospitalization, other consultations and laboratory and imaging exam use. Work and health characteristics were the independent variables. All variables were assessed using a self-report questionnaire and negative binomial regression was adopted to estimate rate ratios (RR). Sedentary behavior, being overweight, physical activity, alcohol consumption, tobacco use, burnout and high stress were not associated with any outcome. The presence of chronic diseases (RR = 1.27 to 4.25) and disability due to musculoskeletal disorders (RR = 1.25 to 2.52) was positively associated with all outcomes. Higher other consultations (RR = 2.13 and 1.94), laboratory (RR = 1.36 and 1.31) and imaging tests (RR = 1.50 and 1.42) were found in teachers with musculoskeletal pain and health insurance. Those with common mental disorders presented higher use of medical (RR = 1.50) or other consultations (RR = 1.41), as well as the emergency service (RR = 1.43). Length of employment was positively associated with other consultations (RR = 1.56 to 3.50) and imaging tests (RR = 1.28 to 1.39). Inadequate school infrastructure and musculoskeletal pain were associated with higher medical consultations (RR = 1.46 and 1.51), while problems related to dust and voice disorders were associated with higher use of the emergency service (RR = 1.60 to 1.99). Although the associations varied according to the outcome, the main predictors of health services were the presence of disability, chronic disease, musculoskeletal pain and common mental disorders. These variables should be considered to monitor and promote health care accessibility or reduce costs associated with health service use among elementary teachers.
{"title":"Correlates of the use of health services among elementary school teachers: A cross-sectional exploratory study","authors":"Diogo Henrique Constantino Coledam, Philippe Fanelli Ferraiol, Gustavo Aires de Arruda, Arli Ramos de Oliveira","doi":"10.3934/medsci.2023021","DOIUrl":"https://doi.org/10.3934/medsci.2023021","url":null,"abstract":"<abstract> <p>The aim of the present study was to analyze the use of health services and associated factors among elementary school teachers. This is a cross-sectional study conducted with 505 school teachers from Londrina-PR, Brazil. The outcomes were medical consultation, emergency service, hospitalization, other consultations and laboratory and imaging exam use. Work and health characteristics were the independent variables. All variables were assessed using a self-report questionnaire and negative binomial regression was adopted to estimate rate ratios (RR). Sedentary behavior, being overweight, physical activity, alcohol consumption, tobacco use, burnout and high stress were not associated with any outcome. The presence of chronic diseases (RR = 1.27 to 4.25) and disability due to musculoskeletal disorders (RR = 1.25 to 2.52) was positively associated with all outcomes. Higher other consultations (RR = 2.13 and 1.94), laboratory (RR = 1.36 and 1.31) and imaging tests (RR = 1.50 and 1.42) were found in teachers with musculoskeletal pain and health insurance. Those with common mental disorders presented higher use of medical (RR = 1.50) or other consultations (RR = 1.41), as well as the emergency service (RR = 1.43). Length of employment was positively associated with other consultations (RR = 1.56 to 3.50) and imaging tests (RR = 1.28 to 1.39). Inadequate school infrastructure and musculoskeletal pain were associated with higher medical consultations (RR = 1.46 and 1.51), while problems related to dust and voice disorders were associated with higher use of the emergency service (RR = 1.60 to 1.99). Although the associations varied according to the outcome, the main predictors of health services were the presence of disability, chronic disease, musculoskeletal pain and common mental disorders. These variables should be considered to monitor and promote health care accessibility or reduce costs associated with health service use among elementary teachers.</p> </abstract>","PeriodicalId":43011,"journal":{"name":"AIMS Medical Science","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135009368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Manasseh B. Wireko, J. Hendricks, K. Bedu-Addo, M. Van Staden, E. A. Ntim, S. Odoom, I. Owusu
Background The effect of alcohol consumption and human immunodeficiency virus (HIV) disease prognosis has been examined in several studies with inconsistent findings. We sought to determine the effect of alcohol consumption on HIV disease prognosis by examining CD4+ T cell count/µL (CD4+ count) and HIV RNA concentration [HIV viral load (VL)] independent of anti-retroviral therapy (ART). Methods A secondary analysis was performed on a cross-sectional survey data of 1120 participants between 2018 and 2020. Questionnaires were used to obtain the participants' history of alcohol consumption. Blood samples were assayed for CD4+ T cell count/µL (CD4+ count) and HIV RNA concentration (HIV viral load). The history of alcohol consumption was categorized into non-alcohol consumers, non-heavy alcohol consumers, and heavy-alcohol consumers. Age, cigarette smoking, gender, and ART use were considered potential confounders. Participants were categorized into two cohorts for the analysis and a multivariate logistic regression was used to establish relationships among virally unsuppressed participants who were ART-experienced and ART-naïve. Results A total of 1120 participants were considered for analysis. The majority were females (65.9%) between 15–39 years (72.4%). The majority were non-smokers and non-alcohol consumers (88% and 79%, respectively). ART-experienced females had an increased risk of having a higher VL (VL > 1000). This finding was statistically significant [RR, 0.425, 95% CI, (0.192–0.944), p-value, 0.036]. However, ART-experienced participants aged above 64 years had an increased risk of having a lower VL (VL < 1000 copies/mL) and a lower risk of having a higher VL (VL > 1000). However, ART-naïve participants aged between 40–64 years had a significantly lower risk of having higher CD4 count (CD4+ > 500 cells) and an increased risk of having a lower CD4 count [OR, 0.566 95% CI, (0.386–0.829), p-value, 0.004]. History of alcohol consumption did not have a significant effect on CD4+ cell count and VL in neither the ART-experienced nor the naïve cohort. Conclusions Female middle-aged people living with HIV (PLWH) are more likely to have a poorer HIV disease state, independent of alcohol consumption. Alcohol consumption may not have a direct effect on CD4+ cell count and VL in either ART-naïve or experienced patients.
{"title":"Alcohol consumption and HIV disease prognosis among virally unsuppressed in Rural KwaZulu Natal, South Africa","authors":"Manasseh B. Wireko, J. Hendricks, K. Bedu-Addo, M. Van Staden, E. A. Ntim, S. Odoom, I. Owusu","doi":"10.3934/medsci.2023018","DOIUrl":"https://doi.org/10.3934/medsci.2023018","url":null,"abstract":"Background The effect of alcohol consumption and human immunodeficiency virus (HIV) disease prognosis has been examined in several studies with inconsistent findings. We sought to determine the effect of alcohol consumption on HIV disease prognosis by examining CD4+ T cell count/µL (CD4+ count) and HIV RNA concentration [HIV viral load (VL)] independent of anti-retroviral therapy (ART). Methods A secondary analysis was performed on a cross-sectional survey data of 1120 participants between 2018 and 2020. Questionnaires were used to obtain the participants' history of alcohol consumption. Blood samples were assayed for CD4+ T cell count/µL (CD4+ count) and HIV RNA concentration (HIV viral load). The history of alcohol consumption was categorized into non-alcohol consumers, non-heavy alcohol consumers, and heavy-alcohol consumers. Age, cigarette smoking, gender, and ART use were considered potential confounders. Participants were categorized into two cohorts for the analysis and a multivariate logistic regression was used to establish relationships among virally unsuppressed participants who were ART-experienced and ART-naïve. Results A total of 1120 participants were considered for analysis. The majority were females (65.9%) between 15–39 years (72.4%). The majority were non-smokers and non-alcohol consumers (88% and 79%, respectively). ART-experienced females had an increased risk of having a higher VL (VL > 1000). This finding was statistically significant [RR, 0.425, 95% CI, (0.192–0.944), p-value, 0.036]. However, ART-experienced participants aged above 64 years had an increased risk of having a lower VL (VL < 1000 copies/mL) and a lower risk of having a higher VL (VL > 1000). However, ART-naïve participants aged between 40–64 years had a significantly lower risk of having higher CD4 count (CD4+ > 500 cells) and an increased risk of having a lower CD4 count [OR, 0.566 95% CI, (0.386–0.829), p-value, 0.004]. History of alcohol consumption did not have a significant effect on CD4+ cell count and VL in neither the ART-experienced nor the naïve cohort. Conclusions Female middle-aged people living with HIV (PLWH) are more likely to have a poorer HIV disease state, independent of alcohol consumption. Alcohol consumption may not have a direct effect on CD4+ cell count and VL in either ART-naïve or experienced patients.","PeriodicalId":43011,"journal":{"name":"AIMS Medical Science","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72644367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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