The significant interaction between age and diabetes mellitus for colorectal cancer: Evidence from NHANES data 1999–2016

BackgroundDiabetes mellitus has been associated with elevated risk of colorectal cancer (CRC), although interaction between age and DM is unclear. We examined the relationship among DM, CRC and age.Methods22,580 subjects aged ≥18 years were identified from the National Health and Nutrition Examination Survey (NHANES) database collected between 1999–2016. To account for the complex, stratified, multistage probability sampling design in NHANES, SASv9.4 Procedure Survey Methodology was applied. Univariate analysis compared individual baseline characteristics between subjects with and without DM. Multivariate logistic regression model assessed association between DM and CRC, in which the model included factors with p < 0.05 in univariate analysis as covariates.ResultsUnivariate analysis showed significant differences in age (p < 0.0001), race (p < 0.0001), smoking (p = 0.0023) and body mass index (p < 0.0001) between No-DM and DM. Multivariate analysis revealed significant interaction between age and DM (p = 0.0004). Subjects with DM aged 18–65 were more likely to experience CRC (OR = 4.47, 95%CI = (1.33–15.07); p = 0.0157) compared to those without DM. Subjects with DM aged >65 were not at increased risk for CRC (OR = 0.83, 95%CI = (0.43–1.59); p = 0.5665) compared to those without DM.ConclusionsAge, DM, and interaction between age and DM are risk factors for CRC. Individuals with DM aged 18–65 years have a higher CRC risk.     

Impact of Diabetes Mellitus on Treatment Outcomes of Tuberculosis Patients in Tertiary Care Setup

BackgroundConcurrent diabetes mellitus (DM) with tuberculosis (TB) has an increased risk of treatment failure. This study was aimed to evaluate treatment outcomes in patients with TB with and without DM.MethodsA retrospective cohort study was conducted at respiratory clinic of Hospital Pulau Pinang, Malaysia. All TB-registered patients from January 2006 to December 2007 were included in the study. A validated data collection form was used for collecting data. World Health Organization’s criterion was used for categorizing treatment outcomes. Data were analyzed by using SPSS 16.ResultsOf 1267 patients, 338 patients (26.7%) had concurrent TB-DM. In multivariate analysis, TB-DM was more likely to be present in Chinese (odds ratio [OR] = 1.401, P = 0.011), patients having age of 46 to 60 years (OR = 3.168, P < 0.001) and >60 years (OR = 2.524, P < 0.001) and patients with pulmonary TB (OR = 2.079, P < 0.001). Nine hundred and eighty-five (78.8%) patients were successfully treated. No statistically significant difference was observed between 2 groups: patients with TB-DM and patients with only TB. Successful treatment outcomes were observed in patients having age of 46 to 60 (OR = 1.567, P = 0.001), whereas male gender (OR = 0.721, P = 0.049) and patients with relapse TB (OR = 0.494, P = 0.002) were less likely to have successful treatment outcome.ConclusionsHigh prevalence of TB-DM in the study signifies the fact that patients with DM are at high risk of developing TB. Treatment outcomes in both groups were comparable. The gender-based and age-based disparity in TB treatment outcomes in this study indicates the importance of gender-specific and age-specific strategies of TB management.     

Association of physical activity with metabolic syndrome in a predominantly rural Nigerian population

AimsPhysical activity is an essential determinant of health. However, there is dearth of evidence regarding prevalence of physical activity in developing countries, especially its association with metabolic syndrome risk factors. This study assessed the association of physical activity with metabolic syndrome in a Nigerian population.Materials and methodsA cross-sectional study was carried out on apparently healthy persons who are ≥18 years old. The World Health Organisation (WHO) Global Physical Activity Questionnaire (GPAQ) was used to collect five domains of physical activity. Participants were classified as physically active or inactive based on meeting the cut-off value of 600 MET-min/week. Metabolic syndrome was diagnosed using the Joint Scientific Statement on Harmonizing the Metabolic Syndrome criteria.ResultsOverall prevalence of physically active individuals was 50.1% (CI: 45.6–54.7%). Physical inactivity is significantly more in females (p < 0.01) and among participants >40 years old (p < 0.0001). Whereas individuals with metabolic syndrome appeared more likely to be physically active (OR = 1.48, CI: 0.71–3.09); physical inactivity showed to exist more among participants who were living in urban area (OR = 6.61, CI: 3.40–12.85, p < 0.001). Participants with prediabetes (OR = 1.69, CI: 0.62–4.61) and diabetes (OR = 1.91, CI: 0.65–5.63) were more likely to be physically inactive as compared to other metabolic syndrome risk factors.ConclusionThe high prevalence of physical inactivity in this study population is a clear indication that concerted efforts to improve physical activity may be required. However, it seems that metabolic syndrome is not improved by being physically active. This suggests that interventions directed at physical activity alone may not produce optimal efficacy in this study population.     

Predictors of sleep disorders among patients with type 2 diabetes mellitus

AimsThis study examined the prevalence of sleep disorders (SD) and self-reported sleep symptoms and risk factors among adult patients diagnosed with T2DM.MethodsData were obtained from the 2012 US National Health and Wellness Survey, an annual Internet-based survey. A total of 7239 participants reported a diagnosis of T2DM. Patients also provided information on diagnosis of SD (e.g., insomnia, sleep breathing disorder, other sleep conditions, etc.) and regularly experienced sleep symptoms (e.g., difficulty falling asleep, sleep apnea, daytime sleepiness, difficulty staying awake, etc.). Logistic regressions were used to examine factors associated with SD and symptoms.ResultsThe average age was 59.9 (standard deviation = 12.2), 59.5% were male, 24.4% were diagnosed with SD, 76.8% reported experiencing any sleep symptom regularly (difficulty falling asleep, 30.5%; sleep apnea, 17.4%; daytime sleepiness, 26.8%; difficulty staying awake, 10.1%). Logistic regression models showed the strongest predictors of diagnosed SD were obesity class (OC) III (OR = 2.20), White (OR = 1.92), OC II (OR = 1.57), smoking (OR = 1.57), lower income (OR = 1.49–1.19), unemployment (OR = 1.38), and comorbidities (OR = 1.35), all p < 0.05. The strongest predictors of any sleep symptom were OC III (OR = 2.22), OC II (OR = 1.78), lower income (OR = 1.74–1.24), female gender (OR = 1.72), OC I (OR = 1.60), White (OR = 1.54), and smoking (OR = 1.47), all p < 0.05.ConclusionsAlmost 25% of patients with T2DM were diagnosed with SD and over 75% reported experiencing at least one sleep symptom regularly. SD and symptoms were strongly associated with obesity, White ethnicity, gender, low income, and smoking. Interventions focusing on weight management and smoking cessation have shown to improve T2DM and may improve SD.     

Influence of apolipoprotein E gene polymorphism on development of type 2 diabetes mellitus in Chinese Han population: A meta-analysis of 29 studies

ObjectivesPublished data regarding the association between apolipoprotein E (ApoE) gene polymorphism and type 2 diabetes mellitus (T2DM) risk in Chinese Han population were inconclusive. To derive a more precise estimation of the relationship between this variant and T2DM risk in Chinese Han population, we performed this meta-analysis.Design and methodsA computerized literature search was conducted to identify the relevant studies from PubMed, EMbase, Web of Science, CBMdisc, CNKI, and Google Scholar. Additionally, hand searching of the references of identified articles was performed. All the statistical tests were performed using Stata 11.0.ResultsA total of 29 articles with 4615 T2DM cases and 2867 controls were included in the present meta-analysis. The results showed evidence for significant association between ApoE gene polymorphism and T2DM risk (for ε2/ε3 vs. ε3/ε3: OR = 1.37, 95% CI = 1.12–1.68, P < 0.01; for ε3/ε4 vs. ε3/ε3: OR = 1.53, 95% CI = 1.23–1.91, P < 0.01; for ε4/ε4 vs. ε3/ε3: OR = 1.86, 95% CI = 1.22–2.84, P < 0.01; for ε2 allele vs. ε3 allele: OR = 1.28, 95% CI = 1.08–1.52, P = 0.01; for ε4 allele vs. ε3 allele: OR = 1.43, 95% CI = 1.22–1.68, P < 0.01). In addition, significant association was also found between ApoE gene polymorphism and diabetic nephropathy (DN) risk.ConclusionsThe results of this meta-analysis suggest that the ApoE ε2 and ε4 alleles may be associated with increased risks of T2DM and DN in Chinese Han population. Additional well-designed genome-wide association studies are required to confirm these results.     

Risk factors for foot ulcers—A cross sectional survey from a primary care setting in Brazil

AimsTo identify the prevalence of higher risk of foot ulceration and associated factors among patients with diabetes mellitus (DM) at primary health care services.MethodsIndividuals with DM, registered at primary health care services in a municipality in southern Brazil, were interviewed and underwent foot examinations. Their risk of ulceration was classified in accordance with the recommendations of the International Working Group on the Diabetic Foot. Poisson bivariate and multivariate analyses were performed and adjusted prevalence ratios (PR) and 95% confidence intervals (CI) were calculated.ResultsThe prevalence of higher risk of foot ulceration among the 337 interviewees was 27.9% (95% CI 23.1–32.9). The following factors were associated with this risk: having been diagnosed with DM for more than 10 years (Adjusted-PR 1.669; 95% CI 1.175–2.373; p = 0.004); having had previous diagnoses of acute myocardial infarction (Adjusted-PR 1.873; 95% CI 1.330–2.638; p < 0.001) and stroke (Adjusted-PR 1.684; 95% CI 1.089–2.604; p = 0.019); presenting interdigital mycosis (Adjusted-PR 1.539; 95% CI 1.030–2.300; p = 0.035) and calluses (Adjusted-PR 1.654; 95% CI 1.117–2.451; p = 0.012).ConclusionsThe prevalence of higher risk of ulceration was high, which reinforces the importance of continued education for health care professionals in order to prevent complications in the feet of these patients.     

Influence of the CYP2J2 Gene Polymorphisms on Chronic Obstructive Pulmonary Disease Risk in the Chinese Han Population

IntroductionCytochrome P450 (CYP) 2J2 is a major enzyme that controls epoxyeicosatrienoic acids biosynthesis, which may play a role in chronic obstructive pulmonary disease (COPD) development. In this study, we aimed to assess the influence of CYP2J2 polymorphisms with COPD susceptibility.Material and methodsA case–control study enrolled 313 COPD cases and 508 controls was to investigate the association between CYP2J2 polymorphisms and COPD risk. Agena MassARRAY platform was used to genotype CYP2J2 polymorphisms. Odds ratios (OR) and 95% confidence intervals (CI) were calculated to evaluate the association between CYP2J2 polymorphisms and COPD risk.ResultsWe observed rs11207535 (homozygote: OR = 0.08, 95%CI = 0.01–0.96, p = 0.047; recessive: OR = 0.08, 95%CI = 0.01–0.94, p = 0.044), rs10889159 (homozygote: OR = 0.08, 95%CI = 0.01–0.92, p = 0.043; recessive: OR = 0.08, 95%CI = 0.01–0.90, p = 0.040) and rs1155002 (heterozygote: OR = 1.63, 95%CI = 1.13–2.36, p = 0.009; dominant: OR = 1.64, 95%CI = 1.15–2.35, p = 0.006; additive: OR = 1.45, 95%CI = 1.09–1.92, p = 0.011) were significantly associated with COPD risk. Allelic tests showed T allele of rs2280274 was related to a decreased risk of COPD and T allele of rs1155002 was associated with an increased COPD risk. Stratified analyses indicated the effects of CYP2J2 polymorphisms and COPD risk were dependent on gender and smoking status (p < 0.05). Additionally, two haplotypes (A_rs11207535C_rs10889159T_rs1155002 and A_rs11207535C_rs10889159C_rs1155002) significantly decreased COPD risk.ConclusionIt suggested CYP2J2 polymorphisms were associated with COPD susceptibility in the Chinese Han population.     

Determinants of glycemic control: Phase 2 analysis from nationwide diabetes report of National Program for Prevention and Control of Diabetes (NPPCD-2018)

BackgroundDiabetes is one of the leading causes of morbidity and mortality worldwide, especially among middle and low income nations. Many diabetic complications and comorbidities are attributable to poor glycemic control. The aim of this study was to update and extend the national diabetes reports on the status of comorbidities, diabetes care and complications in Iran. Moreover, we investigated the risk factors of poor glycemic control in the Iranian population.MethodsNational database of 99,651 patients with diabetes who attended university-affiliated clinics between April 1, 2017 and February 30, 2018 was used to carry out a cross-sectional study. Stepwise backward selection logistic regression model was used to examine the associated factors of glycemic control.ResultsIn this study 73.0% and 56.5% of the enrolled population with diabetes, had hypertension and hyperlipidemia, respectively. The prevalence of patients who received education for nutrition therapy or diabetes self-management was 16.3% and 23.3% respectively. Poor glycemic control was associated with male gender (OR = 1.06, p = 0.001), obesity (OR = 1.03, p = 0.05), duration of diabetes (OR = 1.018, p < 0.001), smoking (OR = 1.08, p = 0.041), hypertension (OR = 1.53, p < 0.001), hyperlipidemia (OR = 1.15, p < 0.001), insulin therapy (OR = 1.26, p < 0.001) and combination of insulin and oral anti-diabetic agents compared to oral anti-diabetic agents alone (OR = 2.36, p < 0.001).ConclusionWe demonstrated that the prevalence of diabetes comorbidities is high in Iranian population and that a great proportion of Iranian patients with diabetes had not reached the goal of glycemic control. Our findings provide a starting point from which to investigate the obstacles that prevent patients with diabetes from reaching metabolic targets.     

Epidemiologic features of a large hepatitis C cohort evaluated in a major health system in the western United States

Introduction and aimReal-world epidemiologic data to guide hepatitis C virus (HCV)-related public health initiatives are lacking. The aim of this study was to describe the prevalence and epidemiological characteristics of a large cohort of patients with an HCV diagnosis evaluated in one of the largest health systems in the United States.Materials and methodsDe-identified demographic and clinical data were extracted from the electronic health record for patients actively followed within the Providence Health & Services health care system. Rates of HCV prevalence and co-morbid illnesses among HCV-infected patients were determined.ResultsAmong 2,735,511 active patients, 23,492 (0.86%) were found to have evidence of HCV infection, the majority of which were Caucasian (78.2%) and born between the years 1945 and 1965 (68.3%). In comparison to Caucasians, higher rates of HCV infection were found among Native Americans (2.5% vs. 0.95%, p < 0.001). Compared to HCV-negative patients, a greater proportion of HCV-positive patients had diabetes mellitus (18.7 vs. 8.9%, p < 0.0001), chronic kidney disease (4.4 vs. 1.8%, p < 0.0001), end-stage renal disease necessitating hemodialysis (2.6 vs. 0.6%, p < 0.0001), and HIV co-infection (2.4 vs. 0.2, p < 0.0001). Nearly two-thirds (62.1%) of HCV patients had government-sponsored insurance, and 93.0% of treated patients resided in urban settings.ConclusionThe prevalence of HCV infection in this large health care system serving the Pacific Northwest, Alaska, and California was lower than prior population-based estimates and may reflect real-world prevalence rates among patients not selected for risk-based screening. Native Americans are disproportionately affected by HCV and may warrant targeted screening.     

Predictive Factors of Severe Behçet's disease: A Longitudinal,Prospective Cohort Followed Between 1981–2020

IntroductionBehçet's disease (BD) is a systemic vasculitis of unknown cause. The spectrum of the disease ranges from mucocutaneous manifestations to other organ diseases with relevant morbidity. Associations between disease severity and male sex, earlier age at onset, and the presence of erythema nodosum have been described.ObjectivesTo evaluate clinical factors associated with manifestations of severe disease in a single-center cohort.MethodsA longitudinal, prospective, unicentric cohort study with patients followed in a specialized outpatient clinic between 1981 and 2020. Severe BD was defined as a Krause total clinical severity score >4 points.ResultsWe included 243 patients, of whom 31% were male, with an average follow-up time of 14.6 years. Regarding organ manifestations, all patients had mucous manifestations (N = 243, 100%), 133 (55%) skin, 104 (43%) joint, 71 (29%) ocular, 48 (20%) vascular, 47 (19%) neurological, 22 (9%) gastrointestinal and 1 (0.4%) cardiac involvement by BD. One hundred fifty-six (64%) patients were classified as having severe BD. Severe BD was more frequent in men (OR = 2.004, p = 0.024), increasing with age (OR = 1.021 per year, p = 0.037), in the presence of skin manifestations (OR = 4.711, p < 0.001), specifically erythema nodosum (OR = 8.381, p < 0.001), and pseudofolliculitis (OR = 2.910, p < 0.001).In the multivariate model, variables independently associated with severe BD were male gender (Adjusted OR = 1.961, p = 0.047), erythema nodosum (Adjusted OR = 8.561, p < 0.001) and pseudofolliculitis (Adjusted OR = 2.372, p = 0.007).DiscussionMale gender, erythema nodosum, and pseudofolliculitis were independently associated with severe BD forms and therefore should serve as warning signs to the clinician.     

Hyperphagie boulimique et obésité : aspects épidémiologiques,cliniques et psychopathologiques. étude d’une population d’obèses à Sfax (Tunisie)

ObjectivesTo evaluate the prevalence of binge eating disorder (BED) in a population of obese patients, to appreciate the impact of obesity on BED through a comparison between the obese group and a control group, and to assess anxiety, depression and quality of life in obese patients with BED.Patients and methodsA cross-sectional study including 60 obese patients and 60 controls. BED was diagnosed using the Binge Eating Scale. Quality of life was assessed by the Quality Of Life, Obesity and Dietetics Scale, and depression and anxiety symptoms by the Hospital Anxiety and Depression Scale.ResultsThe obese group had a higher prevalence of BED than the control group (40% versus 8.3%; p < 0.001; OR = 3.5). The average score of BES was also higher (p < 0.001). Obese patients with BED were younger (p = 0.034). BED was correlated with an early onset of obesity (p = 0.01; OR = 1.12), depression (p = 0.002), anxiety (p = 0.008) and a poorer quality of life.ConclusionThis study confirms the relationship between obesity and BED, which is correlated with a high prevalence of anxiety and depression and with a poorer quality of life.     

Cardiometabolic phenotype and UKPDS risk in male type 2 diabetic patients with obstructive sleep apnoea

BackgroundObstructive sleep apnoea syndrome (OSAS), an obesity comorbidity, is an independent risk factor for diabetes (T2DM) and major adverse cardiovascular events (MACE). While OSAS prevalence and association with MACE are well documented in the general population, such information is not available in T2DM.MethodsWe analyzed 467 consecutive male T2DM outpatients in whom OSAS was diagnosed through Epworth's Sleepiness Scale (ESS), overnight oximetry and polysomnography. OSAS (+) (n = 43) were compared to OSAS (?) (n = 424) regarding cardiovascular (CV) risk factors and/or MACE.ResultsMean (1 SD) age was 64 (12) years, diabetes duration 13 (9) years. Metabolic syndrome prevalence was 77%, HbA_1c 7.6 (1.6) %. OSAS prevalence was 9%. There were no differences in age, diabetes duration, smoking, blood pressure and lipids between OSAS (+) and (?). There were significant differences in ESS score, ethanol intake, hypertension, BMI, waist, relative/absolute fat, conicity index, and visceral fat, all significantly higher in OSAS (+). Nasal continuous positive airway pressure was used by 37% of OSAS (+). HOMA hyperbolic product was significantly lower in OSAS (+), as a result of more severe insulin resistance. OSAS (+) were less often in primary prevention (PP) for CV disease than OSAS (?) (43% vs. 66%; p < 0.003). MACE and coronary artery disease (CAD) prevalence were 61 and 63% higher in OSAS (+) (61% vs. 38%; p < 0.01 and 44% vs. 27%; p < 0.03), who showed a higher stroke prevalence (15% vs. 8%; NS).ConclusionsOSAS is frequent in male T2DM patients. With gender and diabetes ruled out as confounders, our results indicate a strong association between OSAS and CV risk factors, such as hypertension, BMI, waist, relative/absolute/visceral fat, conicity, liver steatosis and hypoandrogenicity. Using the T2DM-specific UKPDS calculator, CVD risk estimates were high though not different between OSAS subgroups in primary CV prevention. OSAS patients with T2DM showed a marked increase in MACE/CAD, making a case for aggressive tertiary prevention.     

A study of diabetes complications in an endogamous population: An emerging public health burden

AimThe aims of this study were to determine the prevalence of diabetic complications namely neuropathy, nephropathy, and retinopathy among Qatari's DM patients; and to find associations between these complications and socio-demographic and clinical characteristics in a highly consanguineous population.DesignIt is an observational cohort study.SettingThe survey was carried out at the Hamad General Hospital and Primary Health Care (PHC) centers in the State of Qatar.SubjectsThe study was conducted from May 2011 to January 2013 among Qatari nationals above 20 years of age. Of the 2346 registered with diagnosed diabetes attending Hamad General Hospital and PHC centers, 1633 (69.3%) agreed and gave their consent to take part in this study.MethodsQuestionnaire included socio-demographic variables, body mass index (BMI), consanguinity, lifestyle habits, family history of diabetes, blood pressure and development of diabetes complications such as retinopathy, nephropathy, and neuropathy were collected at regular intervals throughout the follow-up. Univariate and multivariate statistical analysis were performed.ResultsOut of 1633 diabetic patients, 842 (51.6%) were males. The prevalence of diabetic nephropathy 12.4% and retinopathy was 12.5% followed by neuropathy 9.5% among diabetic population. The proportion of diabetic neuropathy and nephropathy were significantly higher among diabetic patients with age 60 years and above as compared to younger age groups (p = 0.010). Nephropathy was significantly higher among male diabetic (p = 0.014) and smokers (p < 0.001) while diabetic neuropathy was more common among diabetic hypertensive patients (p = 0.028). Multivariate logistic regression showed that Age (p = 0.025), being male (p = 0.045), and having high blood pressure (p = 0.006) were significant predictors of diabetic neuropathy. For diabetic retinopathy, family history of DM (p < 0.001), consanguinity (p = 0.010), having high blood pressure (p = 0.042) and physical activity (p < 0.001) were significant predictors of diabetic retinopathy. Meanwhile, for diabetic nephropathy, age (p < 0.001), smoking (p = 0.045), physical activity (p < 0.001) hypertension (p < 0.001) and gender (p = 0.012) were the significant predictors.ConclusionDiabetes exerts a significant burden in Qatar, and this is expected to increase. Many diabetic patients face significant challenges accessing diagnosis and treatment, which contributes to the high morbidity and mortality and prevalence of complications observed. The significant interactions between diabetes and associated complications highlight the need and opportunity for health planners to develop integrated responses to communicable and non-communicable diseases.     

Factors influencing the progress of mobilization in hip fracture patients during the early postsurgical period?—A prospective observational study

ObjectiveThe aim of the present study was to determine the independent factors influencing mobilization progress after geriatric hip fractures.Patients and Methods392 Hip fracture patients older than 60 years were included in this prospective, observational, cohort study. The progress of mobilization was measured with walking ability 4 days post-surgery, ability to climb stairs until discharge and the Tinetti test at discharge. Factors correlated with the progress of mobilization were determined using multivariate analyses.ResultsThe independent factors influencing walking ability 4 days post-surgery were the pre-fracture Charlson Comorbidity Index (OR = 0.834, p = 0.005), the American Society of Anesthesiologists Score (OR = 0.550, p = 0.013), pre-fracture Barthel Index ([BI], OR = 1.019, p = 0.012) and risk for depression, as measured by the Geriatric Depression Scale, (OR = 0.896, p = 0.013). The probability of climbing stairs until discharge was influenced by the patient's age (OR = 0.840, p < 0.001), pre-fracture BI (OR = 1.047, p = 0.042), cognitive impairment, as measured by the mini mental state examination (OR = 1.182 p = 0.008), pre surgical hemoglobin (OR = 1.026, p = 0.044), time until surgery (OR = 0.961, p = 0.023), duration of surgery (OR = 0.982, p = 0.014), and surgery type (prosthesis, OR = 4.545, p = 0.001). Similar variables influenced the Tinetti test ad discharge.ConclusionWhile pre-fracture co-morbidities and function cannot be changed, the treatment of patients with cognitive impairment and depressive symptoms should be optimized. Efforts should be undertaken to ensure early surgery for all hip fractures.     

Prevalence and risk factors for wheezing and allergic diseases in preschool children: A perspective from the Mediterranean coast of Turkey

ObjectivesThe aim of the present study was to determine the prevalence and risk factors of allergic diseases in preschool children from one of the biggest cities in the Mediterranean Region of Turkey.MethodsThe study population included 396 preschool children attending to urban daycare centres in Mersin. In the first stage, a comprehensive standardised questionnaire modified from the International Study of Asthma and Allergies in Childhood (ISAAC) was employed. In the second stage, serum food and inhalant specific IgE, and skin tests were performed in 45 children with frequent wheezing and 28 children with no wheezing.ResultsThe prevalence of ever wheezing, current wheezing, physician-diagnosed asthma, allergic rhinitis and eczema were 53% (210), 33.3% (132), 27.3% (108), 13.4% (53) and 8.3% (33), respectively. A family history of atopy (OR = 2.5, 95% CI: 1.3–4.7, p = 0.004), dampness at home (OR = 2.4, 95% CI: 1.2–4.8, p = 0.008), a history of intestinal parasites (OR = 4.3, 95% CI: 1.7–10.9, p = 0.002), previous history of pneumonia (OR = 6.9, 95% CI: 1.9–25.9, p = 0.004), initiation of complementary foods before the age of three months (OR = 6.1, 95%CI: 1.4–26.9, p = 0.02) and presence of food allergy (OR = 3.1, 95% CI: 1.1–9.2, p = 0.03) were found to be significant risk factors for physician-diagnosed asthma. The risk factors for frequent wheezing were maternal smoking during pregnancy (OR = 5.2, 95% CI: 0.9–28.7, p = 0.05) and high serum IgE levels (OR = 2.9, 95% CI: 0.9–9.0, p = 0.05) at borderline significance.ConclusionOur study was the first epidemiological study in preschool children in the Mediterranean region of Turkey and demonstrated a high prevalence of asthma and allergic diseases, probably related to humid climatic properties in addition to other environmental and genetic factors.     

Synergistic increase risk of death and myocardial infarction at one year in patients with concomitant diabetes mellitus and renal failure

AimsWe tested the hypothesis that in patients with acute myocardial infarction (AMI), concomitant diabetes mellitus (DM) and renal failure (RF) increases the short- and long-term risk compared to DM or RF alone.Materials and methodsThis registry included consecutive patients with AMI treated with percutaneous coronary intervention (PCI) who completed 1-year follow-up. The primary outcome included the rate of all causes of death, AMI, and target vessel revascularization (TVR).ResultsA total of 858 patients were studied in 4 groups: DM and RF, 112 (13.1%); DM alone, 145 (16.9%); RF alone, 134 (15.6%); and no DM or RF, 467 (54.4%). The DM and RF group had more cardiogenic shock, lower ejection fraction, longer hospital stay, and higher peak troponin (all p < 0.01). After multivariable adjusted analysis, the DM and RF group had higher risk of death (HR 3.35, CI 1.69–6.67; p < 0.01), AMI (HR 2.8; CI 1.15–6.83; p = 0.02), and major adverse cardiac events (HR 1.97, CI 1.23–3.13; p < 0.01) at 1-year follow-up compared to patients with no DM or RF.ConclusionThe combination of DM and RF is the strongest independent predictor of death and AMI, but not a predictor of TVR. These findings should be evaluated in large prospective studies.     

Does good clinical practice at the primary care improve the outcome care for diabetic patients? Gender differences

BackgroundThe Middle East region is predicted to have one of the highest prevalence of diabetes mellitus (DM) in the world. This is the first study in the region to assess treatment outcome of DM according to gender.ObjectiveTo assess the quality and effectiveness of diabetes care provided to patients attending primary care settings according to gender in the State of Qatar.DesignIt is an observational cohort study.SettingThe survey was carried out in primary health care (PHC) centers in the State of Qatar.Subjects and methodsThe study was conducted from January 2010 to August 2010 among diabetic patients attending (PHC) centers. Of the 2334 registered with diagnosed diabetes, 1705 agreed and gave their consent to take part in this study, thus giving a response rate of 73.1%. Face to face interviews were conducted using a structured questionnaire including socio-demographic, clinical and satisfaction score of the patients.ResultsMajority of subjects were diagnosed with type 2 DM (84.9%). A significantly larger proportion of females with DM were divorced or widowed (9.1%) in comparison to males with DM (3.4%; p < 0.001). A significantly larger proportion of females were overweight (46.5%; p = 0.009) and obese (29.5%; p = 0.003) in comparison to males. Males reported significantly greater improvements in mean values of blood glucose (mmol/l) (?2.11 vs. ?0.66; p = 0.007), HbA1c (%) (?1.44 vs. ?0.25; p = 0.006), cholesterol (mmol/l) (?0.16 vs. 0.12; p = 0.053) and systolic blood pressure (mmHg) (?9.04 vs. ?6.62; p < 0.001) in comparison to females. While there was a remarkable increase in male patients with normal range of fasting blood glucose (FBG; 51.6%) as compared to the FBG measurement 1 year before (28.5%: p < 0.001) there was only a slight increase in females normal range FBG during this period from 28.0% to 30.4% (p = 0.357).ConclusionThe present study revealed that the current form of PHC centers afforded to diabetic patients provided significantly improved outcomes for males, but only minor improved outcomes for females. This study reinforces calls for a gender-specific approach to diabetes care.     

The association between ectopic fat in the pancreas and subclinical atherosclerosis in type 2 diabetes

AimsEvidence that pancreatic fat accumulation has a role in obesity, metabolic syndrome and type 2 diabetes mellitus (DM) is emerging. However, data on the influence of pancreatic steatosis on subclinical atherosclerosis are lacking.MethodsWe examined 198 patients with type 2 DM. Pancreatic computed tomography (CT) attenuations were assessed using CT imaging. Obesity was defined as BMI ≥ 25 kg/m² according to the Asian-specific BMI cut-offs. We defined pancreatic steatosis as pancreatic attenuations below median levels.ResultsThe pancreatic attenuations was significantly correlated with age (r = −0.302, p < 0.001), visceral fat area (r = −0.194, p = 0.006) and vascular stiffness (r = −0.242, p = 0.001). In the non-obese group (BMI < 25 kg/m²), pancreatic steatosis was associated with a higher prevalence of carotid artery plaque and vascular stiffness. In the non-obese group, patients with pancreatic steatosis, compared with those without, had an odds ratio (OR) of 3.1 (95% CI 1.2–8.1) for carotid atherosclerosis, after adjusting for age, gender and BMI. However, significant associations between pancreatic steatosis and atherosclerosis were not found in the obese group.ConclusionEctopic fat in the pancreas is strongly associated with carotid atherosclerosis in non-obese subjects with type 2 DM. This finding highlights the importance of pancreatic fat deposits related to a higher risk of cardiovascular disease, especially in non-obese subjects.     

PONI and its association with oxidative stress in type I and type II diabetes mellitus

ObjectiveParaoxonase (PON) is an antioxidant enzyme linked with cardiovascular disease (CVD), diabetes as it prevents LDL oxidation. The relation of PON with the other established risk factor of diabetic complications has not been looked into.Research design and methods370 subjects were included in the study. Dividing into four group, i.e. group I included type II DM (n = 220), group II was age matched control (n = 100), group III were type I DM (n = 25) and group IV (n = 25) were age matched control group. The protocol of the study was approved by the ethical committee of the institute. SOD, GSH, PON (paraoxonase and arylesterase activity), GHb, and MDA were estimated.ResultsA highly significant decrease in paraoxonase and arylesterase activity was seen in the type II DM (p < 0.0001) while in type I DM both the activity was not significant (p > 0.05). Paraoxonase and arylesterase activity of PONI showed a negative significant correlated with MDA (r = ?0.51, p < 0.0001 and r = ?0.23, p < 0.001) in type II DM but was not correlated in type I DM. The GHb and MDA levels were significantly increased (p < 0.0001) while the levels of SOD and GSH have been decreased in type I and type II DM.ConclusionPONI is definitely associated with development of the complications of diabetes. This may be due to the role of it as an antioxidant. As it also show a negative correlation with MDA like the other antioxidants studied.