Search

IntroductionWithin 5 years of having acute pancreatitis (AP), approximately 20% of patients develop diabetes mellitus (DM), which later increases to approximately 40%. Some studies suggest that the prevalence of prediabetes (PD) and/or DM can grow as high as 59% over time. However, information on risk factors is limited. We aimed to identify risk factors for developing PD or DM following AP.MethodsWe systematically searched three databases up to 4 September 2023 extracting direct, within-study comparisons of risk factors on the rate of new-onset PD and DM in AP patients. When PD and DM event rates could not be separated, we reported results for this composite outcome as PD/DM. Meta-analysis was performed using the random-effects model to calculate pooled odds ratios (OR) with 95% confidence intervals (CI).ResultsOf the 61 studies identified, 50 were included in the meta-analysis, covering 76,797 participants. The studies reported on 79 risk factors, and meta-analysis was feasible for 34 risk factor and outcome pairs. The odds of developing PD/DM was significantly higher after severe and moderately severe AP (OR: 4.32; CI: 1.76–10.60) than mild AP. Hypertriglyceridemic AP etiology (OR: 3.27; CI: 0.17–63.91) and pancreatic necrosis (OR: 5.53; CI: 1.59–19.21) were associated with a higher risk of developing PD/DM. Alcoholic AP etiology (OR: 1.82; CI: 1.09–3.04), organ failure (OR: 3.19; CI: 0.55–18.64), recurrent AP (OR: 1.89; CI: 0.95–3.77), obesity (OR: 1.85; CI: 1.43–2.38), chronic kidney disease (OR: 2.10; CI: 1.85–2.38), liver cirrhosis (OR: 2.48; CI: 0.18–34.25), and dyslipidemia (OR: 1.82; CI: 0.68–4.84) were associated with a higher risk of developing DM.DiscussionSevere and moderately severe AP, alcoholic and hypertriglyceridemic etiologies, pancreatic necrosis, organ failure, recurrent acute pancreatitis and comorbidities of obesity, chronic kidney disease liver disease, and dyslipidemia are associated with a higher risk of developing PD or DM.Systematic review registration:https://www.crd.york.ac.uk/prospero/, identifier CRD42021281983.

ObjectiveThis study aimed to determine whether sarcopenia affects the all-cause mortality rate of patients with diabetic foot ulcers (DFUs).Research design and methodsThe clinic-based observational study included 217 patients treated at the Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University during a 4-year period. All subjects underwent dual-energy X-ray absorptiometry to determine their body composition during hospitalization. Diagnosis of sarcopenia was based on the Baumgartner diagnostic criteria. Patients were followed up regularly by phone calls until April 1, 2019, and their survival status was recorded.Univariate and multivariate Cox risk ratio regression models were used to analyze factors influencing the all-cause mortality rate of patients with DFUs.ResultsOf the 217 patients, 158 people survived (82.7%), 33 died (17.3%), and 26 were lost to follow-up. The median follow-up time was 23 (Range 11–34) months. The majority of patients were male (68.6%), with a mean age of 67.29 ± 11.14 years. The 5-year survival rate was 68.3% and 45.9% for all study patients (n = 217) and sarcopenia patients (n = 81), respectively. Multivariate Cox risk regression model showed that age (HR 1.042[95%CI:1.006, 1.078], P = 0.021), sarcopenia (HR 5.051[95%CI:1.968, 12.961], P = 0.001), and serum creatinine (HR 1.007[95%CI: 1.003, 1.010], P < 0.001) were independent risk factors for all-cause mortality rate of patients with DFUs. Kaplan-Meier survival curve indicated that the survival rate of patients with sarcopenia was significantly lower than non-sarcopenia patients (P < 0.001).ConclusionsSarcopenia is an independent risk factor for all-cause mortality of patients with DFUs and hence an important prognostic factor for patients with DFUs. Active prevention and improvement of sarcopenia can potentially improve the survival outcomes of this patient population.

Background: Tigecycline was recently found to cause coagulation disorders, especially hypofibrinogenemia, which may interfere with the administration of antimicrobial therapy. This study aimed to investigate the incidence and clinical characteristics of and risk factors for tigecycline-associated hypofibrinogenemia. Methods: In this multicenter retrospective study, patients receiving tigecycline or imipenem-cilastatin to treat Gram-negative bacterial infections in nine Chinese tertiary hospitals between January 2020 and December 2020 were enrolled. Baseline data and coagulation variables were compared using cohort and case-control studies. Results: Totals of 485 patients treated with tigecycline and 490 patients treated with imipenem-cilastatin were included in this study. Compared with imipenem-cilastatin, tigecycline was associated with reduced fibrinogen and prolonged activated partial thromboplastin time and prothrombin time (all p < 0.001), with the most remarkable change in fibrinogen (down by 48.0%). The incidence of hypofibrinogenemia in patients treated with tigecycline was >50%, with propensity score-matched analysis or not. The relative risk of hypofibrinogenemia with tigecycline versus imipenem-cilastatin was 2.947 (95% CI: 2.151-4.039) at baseline balance. Tigecycline-associated hypofibrinogenemia led to a higher incidence (12.1%) of bleeding events. However, none of supplemental therapies after withdrawal had an effect on the normalization of fibrinogen levels. The risk factors for tigecyclineassociated hypofibrinogenemia were treatment duration =6 days (odds ratio [OR] 5.214, 95% confidence interval [CI] 2.957-9.191, p < 0.001), baseline fibrinogen <4 g/L (OR 4.625, 95% CI 2.911-7.346, p < 0.001), cumulative dose =1,000 mg (OR 2.637, 95% CI 1.439-4.832, p = 0.002), receiving CRRT (OR 2.436, 95% CI 1.179-5.031, p = 0.016), baseline PT > 14 s (OR 2.110, 95% CI 1.317-3.380, p = 0.002) and baseline total bilirubin >21 µmol/L (OR 1.867, 95% CI 1.107-3.147, p = 0.019), while the protective factor was skin and soft tissue infection (OR 0.110, 95% CI 0.026-0.473, p = 0.003). Conclusion: The clinical characteristics of and risk factors for tigecyclineassociated hypofibrinogenemia identified in this study can offer practical reference for the clinical management of patients. [ABSTRACT FROM AUTHOR]

BackgroundLow birth weight (LBW) is one of the most common adverse pregnancy outcomes. Previous studies have consistently shown that maternal body mass index (BMI) status before and during pregnancy is associated with LBW. However, previous studies lacked an association between paternal BMI and the conjunction effect of a couple's BMI and LBW in the offspring. Therefore, we established a cohort of pre-pregnancy couples to prospectively assess the relationship between maternal and paternal pre-pregnancy BMI and offspring LBW, very low birth weight (VLBW), and extremely low birth weight (ELBW).MethodsA prospective cohort study was established in Central China. A total of 34,104 pregnant women with singleton pregnancies at 8–14 gestational weeks and their husbands were finally enrolled and followed to 3 months postpartum. The multivariate logistic regression and restrictive cubic spline model were used to explore the relationship between parental pre-pregnancy BMI and the risk of LBW, VLBW, and ELBW in offspring.ResultsOf the 34,104 participants, maternal pre-pregnancy overweight and obesity were associated with a higher risk of LBW (overweight: OR = 1.720, 95% CI = 1.533 ~ 1.930; obesity: OR = 1.710, 95% CI = 1.360 ~ 2.151), VLBW (overweight: OR = 2.283, 95% CI = 1.839 ~ 2.834; obesity: OR = 4.023, 95% CI = 2.855 ~ 5.670), and ELBW (overweight: OR = 3.292, 95% CI = 2.151 ~ 5.036; obesity: OR = 3.467, 95% CI = 1.481 ~ 8.115), while underweight was associated with a higher risk of LBW (OR = 1.438, 95% CI = 1.294 ~ 1.599) and a lower risk of ELBW (OR = 0.473, 95% CI = 0.236 ~ 0.946). Paternal pre-pregnancy overweight and obesity were associated with a higher risk of LBW (overweight: OR = 1.637, 95% CI = 1.501 ~ 1.784; obesity: OR = 1.454, 95% CI = 1.289 ~ 1.641) and VLBW (overweight: OR = 1.310, 95% CI = 1.097 ~ 1.564; obesity: OR = 1.320, 95% CI = 1.037 ~ 1.681), while underweight was associated with a lower risk of LBW (OR = 0.660, 95% CI = 0.519 ~ 0.839). Parents who were both excessive-weights in pre-pregnancy BMI, as well as overweight mothers and normal-weight fathers before pre-pregnancy, were more likely to have offspring with LBW, VLBW, and ELBW. Dose-response relationship existed between parental pre-pregnancy and LBW, VLBW, and ELBW, except for paternal BMI and ELBW.ConclusionsParental pre-pregnancy BMI was associated with the risk of LBW in offspring. Management of weight before pregnancy for couples might help reduce their adverse pregnancy outcomes in future intervention studies.

Purpose: The need to elucidate risk factors for adolescent suicide is urgent, as suicide consistently ranks among the top causes of death globally. Understanding suicide risk factors could inform more effective interventions. Previous studies have identified certain risk factors associated with suicide, but there is a paucity of research among adolescent and multi-ethnic Asian populations. Materials and methods: This case-control study sampled 13-to-19-yearold Asian adolescents who had attempted suicide (N = 60) and controls (N = 58) matched by age, ethnicity and gender at group-level (73.7% female). Life stressors, temperament, parenting style, mental health conditions and help-seeking behavior were examined. Results: All domains of life stress apart from emerging adult responsibility were higher among cases than controls, especially home life, peer pressure and romantic relationships. Suicide attempters tended to avoid new situations, be less adaptable to changes, have a negative outlook and irregular sleepwake cycle. Additionally, they perceived their parents to be significantly more aggressive, neglecting, rejecting and cold, while parents' perceptions of their own parenting were only significantly different in the domain of parental neglect. Cases were more likely to exhibit disorders of disruptive behavior, eating, mood, anxiety, symptoms of schizophrenia and experience of disturbing events. Significant differences were also found for 10 out of 12 Axis II disorders, particularly borderline, depressive, and avoidant personality disorder traits. No significant case-control differences were found regarding overall rates of help-seeking. Conclusion: Findings from this study may help in suicide prevention efforts through more tailored interventions. [ABSTRACT FROM AUTHOR]

BackgroundCardio-oncology is a rapidly growing field that requires a novel service design to deal with the increasing number of patients. It is reported that the volume of patients at the cardio-oncology clinic in the United Kingdom is 535 patients/5 years and in Canada is 779 patients/7 years. The pharmacist has a role in reducing the consultation time of physicians.ObjectiveTo identify the role of a qualified cardiology pharmacist at the cardio-oncology clinic using a new paradigm based on complementary interventions with the cardiologist for the management of patients with cancer and cardiovascular risk factors and/or cardiovascular diseases (CVRF/CVD).MethodsA prospective observational study was conducted at the cardio-oncology clinic in the Medical City in Baghdad, Iraq between December 2020 and December 2021. Patients with CVRF/CVD were registered. The Iraqi Cardio-Oncology Program-Pharmacist (ICOP-Pharm) paradigm was designed to involve a qualified cardiology pharmacist for initial cardiovascular (CV) drug interventions.ResultsAmong 333 patients who attended our clinic over the 1-year interval, 200 (60%) CVRF/CVD cases were enrolled in the study, and of them 79 (40%) patients had CV drug interventions. A total of 196 interventions were done, including 147 (75%) cases performed by the cardiology pharmacist, and 92 (63%) of the latter were CV drug initiations. Among the total CVRF/CVD treated initially by the cardiology pharmacist, hypertension 32 (26%) and cancer therapy-related cardiac dysfunction 29 (24%) were the main types.ConclusionThe qualified cardiology pharmacist was responsible for three-quarters of the initial CV drug interventions at the cardio-oncology clinic in a complementary approach to the cardiologist. The role of the cardiology pharmacist in the ICOP-Pharm paradigm may be one of the reasons for the ability of the heart team to manage 3-fold of the patient volume when compared with those in the United Kingdom or Canada.

PurposeThe need to elucidate risk factors for adolescent suicide is urgent, as suicide consistently ranks among the top causes of death globally. Understanding suicide risk factors could inform more effective interventions. Previous studies have identified certain risk factors associated with suicide, but there is a paucity of research among adolescent and multi-ethnic Asian populations.Materials and methodsThis case-control study sampled 13-to-19-year-old Asian adolescents who had attempted suicide (N = 60) and controls (N = 58) matched by age, ethnicity and gender at group-level (73.7% female). Life stressors, temperament, parenting style, mental health conditions and help-seeking behavior were examined.ResultsAll domains of life stress apart from emerging adult responsibility were higher among cases than controls, especially home life, peer pressure and romantic relationships. Suicide attempters tended to avoid new situations, be less adaptable to changes, have a negative outlook and irregular sleep-wake cycle. Additionally, they perceived their parents to be significantly more aggressive, neglecting, rejecting and cold, while parents’ perceptions of their own parenting were only significantly different in the domain of parental neglect. Cases were more likely to exhibit disorders of disruptive behavior, eating, mood, anxiety, symptoms of schizophrenia and experience of disturbing events. Significant differences were also found for 10 out of 12 Axis II disorders, particularly borderline, depressive, and avoidant personality disorder traits. No significant case-control differences were found regarding overall rates of help-seeking.ConclusionFindings from this study may help in suicide prevention efforts through more tailored interventions.

ObjectiveTo evaluate risk factors for severe disease in children under 59 months of age hospitalized with respiratory syncytial virus (RSV) infection.Study designWe prospectively enrolled 1,096 cases of laboratory confirmed RSV infection during three consecutive RSV seasons in 2015–2018. Potential risk factors for severe disease were retrieved through patient questionnaires and linkage to national health registries. Need for respiratory support (invasive ventilation, bi-level positive airway pressure, or continuous positive airway pressure), and length of stay exceeding 72 h were used as measures of disease severity. Associations were investigated using multivariable logistic regression analyses. Multiple imputation was used to avoid bias and inference induced by missing data.ResultsRisk factors associated with a need for respiratory support included age younger than 3 months of age [aOR: 6.73 (95% CI 2.71–16.7)], having siblings [aOR: 1.65 (95% CI 1.05–2.59)] and comorbidity [aOR: 2.40 (95% CI 1.35–4.24)]. The length of hospital stay >72 h was significantly associated with being younger than 3 months of age [aOR: 3.52 (95% CI 1.65–7.54)], having siblings [aOR: 1.45 (95% CI 1.01–2.08)], and comorbidity [aOR: 2.18 (95% CI 1.31–3.61)]. Sub-group analysis of children younger than 6 months of age confirmed the association between both young age and having siblings and the need for respiratory support.ConclusionIn a large cohort of children

Background: Physical activity (PA) has a significant health impact worldwide and has been linked to a lower risk of the common cold. Objective: The aim of this study was to estimate the form of PA among Chinese adults and the correlation between PA and number of the common cold in China's eastern, central, and western areas. Design: A cross-sectional study. Setting: China's eastern, central, and western regions from 30 November 2020 to 30 March 2021. Patients: A total of 1,920 healthy participants, who aged over 18 years old, with Internet access, were enrolled, and then self-reported PA behaviors and number of the common cold were collected. Measurements: The authors calculated preference, intensity, frequency, and duration of PA in Chinese based on gender, age, and broad occupational categories and explored the potential effect between these factors and the common cold. Results: Approximately 20.4% of participants reported not participating in sports regularly. Except for gender, there were significant differences in PA preference and intensity among the remaining individuals (P <0.05). Sixteen common exercises were divided into three intensity levels by the Borg CR10 Scale: low- (5), moderate- (8), and high-intensity exercises (3), and the corresponding intensity, frequency, and duration were computed with significant differences (P <0.05). The most popular workouts are "Brisk walking" and "Running." Age, sex, and occupation had no significant effect on colds (P > 0.05). However, intensity shows a U-shaped dose-response relationship with colds, whereas the frequency and duration have an inverse dose-response relationship (P <0.05). High intensity combined with high frequency increased colds the most. Nevertheless, non-exercise groups always have the most colds in each comparison. Limitations: The result may be vulnerable to recall bias. Conclusion: Intensity showed that U-shape, frequency, and duration showed inverse response to the number of colds last year, but age, sex, and occupation had no significant effects. High intensity and high frequency mixed increased colds the most, regardless of duration. [ABSTRACT FROM AUTHOR]

Background: Sepsis-associated encephalopathy (SAE) is a common complication in septic patients with a higher ICU and hospital mortality in adults and poorer long-term outcomes. Clinical presentation may range from mild confusion to convulsions and deep coma; however, little is known about SAE in children. We aimed to retrospectively analyze the data for children with sepsis, to illustrate the epidemiology, performance, and adverse outcome, and to evaluate the association between risk factors and SAE in children. Methods: All children with sepsis who were admitted to the Department of Pediatrics, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China from January 2010 to December 2020 were retrospectively analyzed. Results: A total of 210 patients with sepsis were retrospectively assigned to the SAE and non-SAE groups, of which 91 (43.33%) were diagnosed with SAE with a mortality of 6.70% (14/210). Significant differences were observed in the level of white blood platelet, platelets, international normalized ratio, prothrombin time, activated partial thromboplastin time, total protein, Ccr, UREA, blood urea nitrogen, alanine transaminase, aspartate transaminase, creatine kinase, creatine kinase isoenzymes, lactate dehydrogenase, procalcitonin, and lactic acid (p < 0.05). In the risk assessment scales, significant differences were observed in the modified Glasgow Coma score, PCIS, Pediatric Logistic Organ Dysfunction Score 2 (PELOD-2), Pediatric Sequential Organ Failure Assessment Score, and Pediatric Risk of Mortality III (p < 0.05). The incidence of septic shock, acute kidney disease, liver dysfunction, and coagulation disorder were higher in the SAE group (p < 0.05). The mechanical ventilation time ([6.57 d ± 16.86 d] vs. [2.05 d ± 5.79 d]; p < 0.001), CRRT time ([1.74 d ± 6.77 d] vs. [0.11 d ± 0.63 d]; p < 0.001), ICU stay time ([299.90 h ± 449.50 h] vs. [177.67 h ± 245.36 h]); p < 0.001 was longer than that of non-SAE. Both the PCT, Ca2+, septic shock, PELOD-2, and midazolam were identified as independent risk factors, and fentanyl was a protective factor for SAE in pediatric patients (p < 0.05). The main clinical neurological symptoms consisted of agitation, hypnosia, hypnosis alternates agitated, anterior fontanelle full/bulging/high tension, coma, muscle hypertonia, muscle hypotonia, hyperreflexia, focal seizure, and generalized seizure. Conclusions: The incidence of SAE in children was found high and the prognosis poor. In this retrospective study, the identified patients were more susceptible to SAE, with an inflammatory storm with hypocalcemia or septic shock. The use of midazolam will increase the occurrence of SAE, whereas fentanyl will reduce the incidence of SAE, and PELOD-2 may predict the occurrence of SAE. [ABSTRACT FROM AUTHOR]

Rift Valley fever (RVF) is an important emerging zoonoses causing abortion and neonatal deaths in livestock and hemorrhagic fever in humans. It is typically characterized by acute epidemics with abortion storms often preceding human disease and these events have been associated with the El Niño weather cycles. Outside of areas that experience epidemics, little is known about its epidemiology. Here, we present results from a serological study using biobank samples from a study of cattle conducted in 2013 at two sites in Cameroon. A total of 1,458 cattle from 100 herds were bled and sera screened using a commercially available RVF ELISA. The overall design-adjusted animal-level apparent seroprevalence of RVF exposure for the Northwest Region (NWR) of Cameroon was 6.5% (95% CI: 3.9–11.0) and for the Vina Division (VIN) of the Adamawa Region was 8.2% (95% CI: 6.2–11.0). The age-stratified serological results were also used to estimate the force of infection, and the age-independent estimates were 0.029 for the VIN and 0.024 for the NWR. The effective reproductive number was ~1.08. Increasing age and contact with wild antelope species were associated with an increased risk of seropositivity, while high altitudes and contact with buffalo were associated with a reduced risk of seropositivity. The serological patterns are more consistent with an endemical stability rather than the more typical epidemic patterns seen in East Africa. However, there is little surveillance in livestock for abortion storms or in humans with fevers in Cameroon, and it is, therefore, difficult to interpret these observations. There is an urgent need for an integrated One Health approach to understand the levels of human- and livestock-related clinical and asymptomatic disease and whether there is a need to implement interventions such as vaccination.

BackgroundPhysical activity (PA) has a significant health impact worldwide and has been linked to a lower risk of the common cold.ObjectiveThe aim of this study was to estimate the form of PA among Chinese adults and the correlation between PA and number of the common cold in China's eastern, central, and western areas.DesignA cross-sectional study.SettingChina's eastern, central, and western regions from 30 November 2020 to 30 March 2021.PatientsA total of 1,920 healthy participants, who aged over 18 years old, with Internet access, were enrolled, and then self-reported PA behaviors and number of the common cold were collected.MeasurementsThe authors calculated preference, intensity, frequency, and duration of PA in Chinese based on gender, age, and broad occupational categories and explored the potential effect between these factors and the common cold.ResultsApproximately 20.4% of participants reported not participating in sports regularly. Except for gender, there were significant differences in PA preference and intensity among the remaining individuals (P 0.05). However, intensity shows a U-shaped dose-response relationship with colds, whereas the frequency and duration have an inverse dose-response relationship (P

BackgroundSepsis-associated encephalopathy (SAE) is a common complication in septic patients with a higher ICU and hospital mortality in adults and poorer long-term outcomes. Clinical presentation may range from mild confusion to convulsions and deep coma; however, little is known about SAE in children. We aimed to retrospectively analyze the data for children with sepsis, to illustrate the epidemiology, performance, and adverse outcome, and to evaluate the association between risk factors and SAE in children.MethodsAll children with sepsis who were admitted to the Department of Pediatrics, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China from January 2010 to December 2020 were retrospectively analyzed.ResultsA total of 210 patients with sepsis were retrospectively assigned to the SAE and non-SAE groups, of which 91 (43.33%) were diagnosed with SAE with a mortality of 6.70% (14/210). Significant differences were observed in the level of white blood platelet, platelets, international normalized ratio, prothrombin time, activated partial thromboplastin time, total protein, Ccr, UREA, blood urea nitrogen, alanine transaminase, aspartate transaminase, creatine kinase, creatine kinase isoenzymes, lactate dehydrogenase, procalcitonin, and lactic acid (p < 0.05). In the risk assessment scales, significant differences were observed in the modified Glasgow Coma score, PCIS, Pediatric Logistic Organ Dysfunction Score 2 (PELOD-2), Pediatric Sequential Organ Failure Assessment Score, and Pediatric Risk of Mortality III (p < 0.05). The incidence of septic shock, acute kidney disease, liver dysfunction, and coagulation disorder were higher in the SAE group (p < 0.05). The mechanical ventilation time ([6.57 d ± 16.86 d] vs. [2.05 d ± 5.79 d]; p < 0.001), CRRT time ([1.74 d ± 6.77 d] vs. [0.11 d ± 0.63 d]; p < 0.001), ICU stay time ([299.90 h ± 449.50 h] vs. [177.67 h ± 245.36 h]); p < 0.001 was longer than that of non-SAE. Both the PCT, Ca2+, septic shock, PELOD-2, and midazolam were identified as independent risk factors, and fentanyl was a protective factor for SAE in pediatric patients (p < 0.05). The main clinical neurological symptoms consisted of agitation, hypnosia, hypnosis alternates agitated, anterior fontanelle full/bulging/high tension, coma, muscle hypertonia, muscle hypotonia, hyperreflexia, focal seizure, and generalized seizure.ConclusionsThe incidence of SAE in children was found high and the prognosis poor. In this retrospective study, the identified patients were more susceptible to SAE, with an inflammatory storm with hypocalcemia or septic shock. The use of midazolam will increase the occurrence of SAE, whereas fentanyl will reduce the incidence of SAE, and PELOD-2 may predict the occurrence of SAE.