]. Absence of patient stratification and statistical adjustment for imbalances in risk factors such as obesity, commonly encountered in diabetic patients, or age, diet, physical activity, alcohol, smoking, co-morbidities and drug use could have impacted on observed associations and shifted relationships. Finally, lack of clear definition or consistency of the clinical criteria used for diagnosing diabetes and several outcomes, e.g.
Several randomised controlled trials have investigated the effect of anti-diabetic lifestyle, dietary or drug interventions on a number of these outcomes. This umbrella review includes 117 meta-analyses of observational cohort studies and 200 meta-analyses of randomised clinical trials that evaluated 317 outcomes and provides the most comprehensive appraisal of the literature to date exploring the strength and validity of the published associations between diabetes and anti-diabetic interventions on obstetric and gynaecological morbidity.
High-quality evidence supported an association between gestational diabetes treatment and reduced rates of large for gestational age babies and macrosomia.
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Myocardial injury defined as elevated high-sensitivity cardiac troponin T is associated with higher mortality in patients seeking care at emergency departments with acute dyspnea - BMC Emergency MedicineBackground Elevated levels of cardiac troponin T has been observed in patients seeking care at the emergency department (ED) presenting with chest pain but without myocardial infarction (MI). The clinical importance of this observation remains, however, still unclear. Our main aim was to study the role of cardiac troponin T in patients admitted to the emergency department with acute dyspnea, a group of patients with a high cardiovascular comorbidity, but no primary acute MI. Population and methods Patients from the age of 18 seeking care at the ED for dyspnea, without an acute cardiac syndrome, and with a recorded assessment of high-sensitivity cardiac troponin T (hs-cTnT), were included (n = 1001). Patients were categorized into 3 groups by hs-cTnT level, i.e. 100 µg/l. Cox regression with Hazard Ratios (HRs) and 95% Confidence Intervals (CI) for 3-months mortality was performed, with adjustment for sex, age, respiratory frequency, saturation, CHF, renal disease, and BMI. Results Fully adjusted HRs (95% CI) for 3-month mortality, with hs-cTnT 100 a HR of 10.523 (4.465–24.803). Conclusion Elevated hs-cTnT seems to be a relevant marker of poor prognosis in patients with acute dyspnea without MI and warrants further validation and clinical testing.
Source: BioMedCentral - 🏆 22. / 71 Read more »
Increased interleukin-6 is associated with long COVID-19: a systematic review and meta-analysis - Infectious Diseases of PovertyBackground Coronavirus disease 2019 (COVID-19) can involve persistence, sequelae, and other clinical complications that last weeks to months to evolve into long COVID-19. Exploratory studies have suggested that interleukin-6 (IL-6) is related to COVID-19; however, the correlation between IL-6 and long COVID-19 is unknown. We designed a systematic review and meta-analysis to assess the relationship between IL-6 levels and long COVID-19. Methods Databases were systematically searched for articles with data on long COVID-19 and IL-6 levels published before September 2022. A total of 22 published studies were eligible for inclusion following the PRISMA guidelines. Analysis of data was undertaken by using Cochran's Q test and the Higgins I-squared (I2) statistic for heterogeneity. Random-effect meta-analyses were conducted to pool the IL-6 levels of long COVID-19 patients and to compare the differences in IL-6 levels among the long COVID-19, healthy, non-postacute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (non-PASC), and acute COVID-19 populations. The funnel plot and Egger's test were used to assess potential publication bias. Sensitivity analysis was used to test the stability of the results. Results An increase in IL-6 levels was observed after SARS-CoV-2 infection. The pooled estimate of IL-6 revealed a mean value of 20.92 pg/ml (95% CI = 9.30–32.54 pg/ml, I2 = 100%, P | 0.01) for long COVID-19 patients. The forest plot showed high levels of IL-6 for long COVID-19 compared with healthy controls (mean difference = 9.75 pg/ml, 95% CI = 5.75–13.75 pg/ml, I2 = 100%, P | 0.00001) and PASC category (mean difference = 3.32 pg/ml, 95% CI = 0.22–6.42 pg/ml, I2 = 88%, P = 0.04). The symmetry of the funnel plots was not obvious, and Egger’s test showed that there was no significant small study effect in all groups. Conclusions This study showed that increased IL-6 correlates with long COVID-19. Such an informative revelation suggests IL-
Source: BioMedCentral - 🏆 22. / 71 Read more »
Associations between Avocado Intake and Lower Rates of Incident Type 2 Diabetes in US Adults with Hispanic/Latino AncestryBackground/Purpose: Hispanic/Latinos in the US are at increased risk for type 2 diabetes (T2D). Data suggest that avocado intake is associated with better glycemic control, but whether this translates to protection from T2D has not been studied. The goal of the current analyses was to examine whether consuming avocados at baseline is associated with lower incident T2D over a six-year period, compared to not consuming avocados at baseline. Subjects/Methods: Using data from a large population of US adults with Hispanic ancestry, without known or unknown T2D at baseline (N=6159), participants were classified as avocado consumers (N=983) or non-consumers (N=5176) based on the mean of two 24-hour dietary recalls. Cox proportional hazard models estimated the association of avocado consumption with incident T2D (N=656 cases) over a six-year follow-up period, in the population as a whole, and separately in those with normoglycemia vs. prediabetes at baseline. A set of three sequential models were run: the first controlling only for sociodemographic factors (“minimally adjusted” models), the second for these and health behaviors (“fully adjusted” models), and a third for both sets of covariates and also body mass index (BMI; “fully adjusted + BMI” models). Results: In the population as a whole, avocado intake at baseline was associated with reduced incident T2D in both the minimally adjusted (hazard ratio [HR] (±95% confidence intervals [CIs]): 0.70 (0.52 - 0.94), P=0.04) and the fully adjusted models (HR: 0.72 (0.54 - 0.97), P=0.03). This association was observed in both those with prediabetes and with normoglycemia at baseline, but only reached significance in those with prediabetes (minimally adjusted model: HR: 0.68 (0.48 - 0.97), P=0.03; fully adjusted model: HR: 0.69 (0.48 - 0.98), P=0.04), not in those with normoglycemia (minimally adjusted model: HR: 0.86 (0.45 - 1.65), P=0.65; fully adjusted model: HR: 0.80 (0.41 - 1.55), P=0.50). In models which additionally contro
Source: medical_xpress - 🏆 101. / 51 Read more »
Myocardial injury defined as elevated high-sensitivity cardiac troponin T is associated with higher mortality in patients seeking care at emergency departments with acute dyspnea - BMC Emergency MedicineBackground Elevated levels of cardiac troponin T has been observed in patients seeking care at the emergency department (ED) presenting with chest pain but without myocardial infarction (MI). The clinical importance of this observation remains, however, still unclear. Our main aim was to study the role of cardiac troponin T in patients admitted to the emergency department with acute dyspnea, a group of patients with a high cardiovascular comorbidity, but no primary acute MI. Population and methods Patients from the age of 18 seeking care at the ED for dyspnea, without an acute cardiac syndrome, and with a recorded assessment of high-sensitivity cardiac troponin T (hs-cTnT), were included (n = 1001). Patients were categorized into 3 groups by hs-cTnT level, i.e. 100 µg/l. Cox regression with Hazard Ratios (HRs) and 95% Confidence Intervals (CI) for 3-months mortality was performed, with adjustment for sex, age, respiratory frequency, saturation, CHF, renal disease, and BMI. Results Fully adjusted HRs (95% CI) for 3-month mortality, with hs-cTnT 100 a HR of 10.523 (4.465–24.803). Conclusion Elevated hs-cTnT seems to be a relevant marker of poor prognosis in patients with acute dyspnea without MI and warrants further validation and clinical testing.
Source: BioMedCentral - 🏆 22. / 71 Read more »