Search

Author(s): Aparna Padmanabhan (corresponding author) [1]; Jayakrishnan Thayyil [2]; G Alan [3]; Siju Kumar [4] INTRODUCTION The metabolic syndrome refers to the co-occurrence of several known cardiovascular risk factors, including [...], Context: Police personnel constitute a special occupational group with exposure to stressful work environment indirectly resulting in a high prevalence of cardiovascular risk factors, including metabolic syndrome (MS), hypertension, hyperlipidemia, cigarette smoking, and a sedentary lifestyle is reported among policemen. Surveillance activities are limited in the present scenario. Aims: The present study was designed to measure the prevalence of metabolic syndrome and other cardiovascular risk factors among police officers in Kozhikode district and observe the trend over the last 10 years. Settings and Design: The design was cross-sectional and spanned 630 policemen of Kozhikode Corporation in Kerala Methods and Material: Data collection was done using a pre-tested questionnaire. Anthropometric and biochemical measurements were carried out using standard techniques. MS was diagnosed using the National Cholesterol Education Program--Adult Treatment Panel III criteria. Statistical Analysis Used: Statistical analysis was performed using the SPSS 20.0 software. Prevalence of MS and cardiovascular risk factors were expressed as percentages (95 CI). Associated factors with MS were identified using Chi square test. Results: MS was observed in 45.1 of the study population. Obesity and lack of physical activity were the commonest abnormalities. Cardiovascular risk factors identified were high body mass index (67.3), lack of physical activity (47.1), hypertension (16.7), alcohol use (24.2), smoking (17.3) and diabetes (8.8). Conclusions: There is a rising prevalence (16.8 in 2012 to 45.1 in 2021) of Metabolic Syndrome among policemen in Calicut Corporation. All the cardio vascular risk factors are also highly prevalent among the policemen. Policy makers might seriously take up the issue and introduce effective policies that might help reduce the incidence of MS and other cardio vascular risk factors in the newly recruited young policemen. Keywords: Metabolic Syndrome, Physical Inactivity, Obesity, Police, Kerala

Author(s): Alexander Zarbock [sup.1] [sup.20], Raphael Weiss [sup.1], Felix Albert [sup.2], Kristen Rutledge [sup.3], John A. Kellum [sup.4], Rinaldo Bellomo [sup.5] [sup.6] [sup.7] [sup.8], Evgeny Grigoryev [sup.9], Angel M. Candela-Toha [...], Purpose The incidence, patient features, risk factors and outcomes of surgery-associated postoperative acute kidney injury (PO-AKI) across different countries and health care systems is unclear. Methods We conducted an international prospective, observational, multi-center study in 30 countries in patients undergoing major surgery (> 2-h duration and postoperative intensive care unit (ICU) or high dependency unit admission). The primary endpoint was the occurrence of PO-AKI within 72 h of surgery defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Secondary endpoints included PO-AKI severity and duration, use of renal replacement therapy (RRT), mortality, and ICU and hospital length of stay. Results We studied 10,568 patients and 1945 (18.4%) developed PO-AKI (1236 (63.5%) KDIGO stage 1500 (25.7%) KDIGO stage 2209 (10.7%) KDIGO stage 3). In 33.8% PO-AKI was persistent, and 170/1945 (8.7%) of patients with PO-AKI received RRT in the ICU. Patients with PO-AKI had greater ICU (6.3% vs. 0.7%) and hospital (8.6% vs. 1.4%) mortality, and longer ICU (median 2 (Q1-Q3, 1-3) days vs. 3 (Q1-Q3, 1-6) days) and hospital length of stay (median 14 (Q1-Q3, 9-24) days vs. 10 (Q1-Q3, 7-17) days). Risk factors for PO-AKI included older age, comorbidities (hypertension, diabetes, chronic kidney disease), type, duration and urgency of surgery as well as intraoperative vasopressors, and aminoglycosides administration. Conclusion In a comprehensive multinational study, approximately one in five patients develop PO-AKI after major surgery. Increasing severity of PO-AKI is associated with a progressive increase in adverse outcomes. Our findings indicate that PO-AKI represents a significant burden for health care worldwide.

Author(s): Jake R. Lehman [sup.1] , Matthew Schuchman [sup.2] , Elizabeth Mitchell [sup.3] [sup.4] , Christine A. Capone [sup.3] [sup.4] , Christine B. Sethna [sup.2] [sup.3] [sup.5] Author Affiliations: (1) [...], Background Multisystem inflammatory syndrome in children (MIS-C) is associated with SARS-CoV-2. Long-term consequences of MIS-C remain unknown. The objective was to describe the prevalence and clinical predictors of hypertension (HTN) and elevated blood pressure (BP) following MIS-C. Methods A retrospective study of children [less than or equal to] 18 years admitted to a tertiary center with MIS-C was performed. HTN and elevated BP were classified as per the 2017 American Academy of Pediatrics Clinical Practice Guidelines and indexed to the 95th percentile. Data included demographics, inpatient clinical measures, and echocardiograms over 1-year follow-up. Data were analyzed using Kruskal-Wallis, chi-square, and logistic regression. Results Among 63 children hospitalized with MIS-C (mean age 9.7 ± 4.2 years, 58.7% male, body mass index (BMI) z-score 0.59 ± 1.9), 14% had HTN, and 4% had elevated BP > 30 days post-hospitalization. Multivariate linear regression analysis showed that BMI z-score was significantly associated with higher mean systolic ([beta] = 2.664, CI = 1.307-3.980, p < 0.001) and diastolic ([beta] = 2.547, CI = 0.605-4.489, p = 0.012) BP index > 30 days post-hospitalization. Acute kidney injury (AKI) (23.8%) (OR = 2.977, CI = 1.778-4.987, p < 0.001), peak inpatient serum creatinine (OR = 2.524, CI = 1.344-4.740, p = 0.004), and maximum CRP (OR = 1.009, CI = 1.002-1.016, p = 0.014) were all associated with increased odds of post-hospitalization HTN. Left ventricular hypertrophy was present in 46% while hospitalized, compared to 10% at last follow-up. All had return of normal systolic function. Conclusions Post-hospitalization HTN and elevated BP may be associated with MIS-C. Children with greater BMI or AKI may be at greater risk for developing HTN after MIS-C. MIS-C follow-up requires careful BP monitoring and antihypertensive medication consideration. Graphical abstract

Author(s): Szymon Czajka [sup.1], Zbigniew Putowski [sup.2], Lukasz J. Krzych [sup.1] Author Affiliations: (1) grid.411728.9, 0000 0001 2198 0923, Department of Anaesthesiology and Intensive Care, School of Medicine in Katowice, [...], Purpose Intraoperative hypotension (IOH) is associated with organ hypoperfusion. There are different underlying causes of IOH depending on the phase of surgery. Post-induction hypotension (PIH) and early-intraoperative hypotension tend to be frequently differentiated. We aimed to explore further different phases of IOH and verify whether they are differently associated with postoperative complications. Methods Patients undergoing abdominal surgery between October 2018 and July 2019 in a university hospital were screened. Post-induction hypotension was defined as MAP [less than or equal to] 65 mmHg between the induction of anaesthesia and the onset of surgery. Hypotension during surgery (IOH) was defined as MAP [less than or equal to] 65 mmHg occurring between the onset of surgery and its completion. Acute kidney injury, stroke or transient ischaemic attack, delirium, and myocardial infarction were considered as the outcome. Results We enrolled 508 patients (219 males, median age 62 years). 158 subjects (31.1%) met PIH, 171 (33.7%) met IOH criteria, and 67 (13.2%) patients experienced both. PIH time accounted for 22.8% of the total hypotension time and 29.7% of the IOH time. The IOH time accounted for 5.17% of the total intraoperative time, while PIH for 8.91% of the pre-incision time. Female sex, lower height, body mass and lower pre-induction BP (SBP and MAP) were found to be associated with the incidence of PIH. The negative outcome was observed in 38 (7.5%) patients. Intraoperative MAP [less than or equal to] 65 mmHg, longer duration of the procedure ([greater than or equal to] 230 min), chronic arterial hypertension and age were associated with the presence of the outcome (p < 0.01 each). Conclusions The presence of IOH defined as MAP [less than or equal to] 65 mmHg is relevant to post-operative organ complications, the presence of PIH does not appear to be of such significance. Because cumulative duration of PIH and IOH differs significantly, especially in long-lasting procedures, direct comparison of the influence of PIH and IOH on outcome separately may be biased and should be taken into account in data interpretation. Further research is needed to deeply investigate this phenomenon.

INTRODUCTION With the expanded coverage of antiretroviral treatment (ART), AIDS‐related mortality among persons living with HIV (PLHIV) has substantially decreased, resulting in a growing burden of non‐AIDS comorbidities, including liver [...], : Introduction: Liver disease is a leading cause of morbidity and mortality among persons living with HIV (PLHIV). While chronic viral hepatitis has been extensively studied in low‐ and middle‐income countries (LMICs), there is limited information about the burden of metabolic disorders on liver disease in PLHIV. Methods: We conducted a cross‐sectional analysis of baseline data collected between October 2020 and July 2022 from the IeDEA‐Sentinel Research Network, a prospective cohort enrolling PLHIV ≥40 years on antiretroviral treatment (ART) for ≥6 months from eight clinics in Asia, Americas, and central, East, southern and West Africa. Clinical assessments, laboratory testing on fasting blood samples and liver stiffness measurement (LSM)/controlled attenuation parameter (CAP) by vibration‐controlled transient elastography were performed. Multivariable logistic regression models assessed factors associated with liver fibrosis (LSM ≥7.1 kPa) and steatosis (CAP ≥248 dB/m). Population attributable fraction (PAF) of each variable associated with significant liver fibrosis was estimated using Levin's formula. Results: Overall, 2120 PLHIV (56% female, median age 50 [interquartile range: 45−56] years) were included. The prevalence of obesity was 19%, 12% had type 2 diabetes mellitus (T2DM), 29% had hypertension and 53% had dyslipidaemia. The overall prevalence of liver fibrosis and steatosis was 7.6% (95% confidence interval [CI] 6.1−8.4) and 28.4% (95% CI 26.5−30.7), respectively, with regional variability. Male sex at birth (odds ratio [OR] 1.62, CI 1.10−2.40), overweight/obesity (OR = 2.50, 95% CI 1.69−3.75), T2DM (OR 2.26, 95% CI 1.46−3.47) and prolonged exposure to didanosine (OR 3.13, 95% CI 1.46−6.49) were associated with liver fibrosis. Overweight/obesity and T2DM accounted for 42% and 11% of the PAF for liver fibrosis, while HBsAg and anti‐HCV accounted for 3% and 1%, respectively. Factors associated with steatosis included overweight/obesity (OR 4.25, 95% CI 3.29−5.51), T2DM (OR 2.06, 95% CI 1.47−2.88), prolonged exposure to stavudine (OR 1.69, 95% CI 1.27−2.26) and dyslipidaemia (OR 1.68, 95% CI 1.31−2.16). Conclusions: Metabolic disorders were significant risk factors for liver disease among PLHIV in LMICs. Early recognition of metabolic disorders risk factors might be helpful to guide clinical and lifestyle interventions. Further prospective studies are needed to determine the causative natures of these findings.