Development of a model of care based on the chronic care and collaborative care models to improve cardiometabolic health in low-to- middle income countries

Background: Non-communicable diseases (NCDs) are rising in low middle income countries (LMICs) mainly driven by cardiometabolic disease (cardiovascular disease, diabetes, and hypertension). Aim(s): To develop a model of care, based on the chronic care model and collaborative care model, to improve care, outcomes and risk factor control for adults with cardio metabolic disease in LMICs in the Covid-19 era. This will contribute to the sustainable development goals of promoting good health, well-being and reducing inequalities. Method(s): Using an iterative consultative approach with healthcare workers, clients, and community leaders in Kenya, Ghana and Mozambique, we developed a model of care, which includes core features from chronic care models: self-management support;decision support;clinical information systems;delivery system design;and community linkages. Result(s): We produced a culturally adapted self-management education programme, a training package for educators delivering the programme, as well as a training package for community and healthcare professional leaders to increase awareness and self-care for cardiometabolic disease. Given the lack of a robust health information system, we are offering a global registry to provide real world data on patient management and quality of care for people with type 2 diabetes, hypertension, heart failure and chronic kidney disease. Conclusion(s): This intervention will be tested in a mixed-methods single-arm feasibility study in five sites across three African countries: Kenya, Ghana, Mozambique.

Active rehabilitation of coronary artery disease: today and tomorrow.

In 2020, the European Association of Preventive Cardiology proposed the important role of exercise-based cardiac rehabilitation (CR) in the management of cardiovascular and metabolic diseases, and called on everyone to take action. This paper discusses the current status and future perspective of individualized active exercise-based CR for coronary artery disease (CAD) from 4 dimensions, including the basic and clinical research progress of exercise-based CR for CAD, evidence on the benefits of exercise-based CR on ameliorating CAD complications, the exercise-based CR guidelines in different countries, and the implementation of exercise-based CR under coronavirus disease 2019 pandemic, so as to provide reference for research and clinical work.Copyright © 2022, Second Military Medical University Press. All rights reserved.

Hepatocellular Carcinoma Presenting as a Clival Mass

Introduction: Hepatocellular carcinoma (HCC) comprises the majority of primary liver cancer and has a poor prognosis. Clivus metastasis is rare with only a few reported cases in the medical literature. We report a case of a patient who presented with clival mass found to have metastatic HCC. Case Description/Methods: A 63-year-old woman presented for neurosurgical evaluation after she was found to have a skull base mass on computerized tomography (CT) of the head at an outside hospital. She endorsed dysphagia for three months, however denied headaches or visual disturbances. A magnetic resonance imaging (MRI) revealed a 5.4 cm by 2.9 cm by 3.6 cm mass in the clivus, which was deemed as the cause of dysphagia (Figure 1a). The patient subsequently underwent an endoscopic transsphenoidal resection of the clival mass. Histopathology from the tissue revealed a hepatoid carcinoma, concerning for metastatic HCC (Figure 1b and 2c). Immunohistochemical strains were positive for hepatocytic marker arginase-1 (Figure 1d). Laboratory studies revealed alpha fetoprotein (AFP) of 56,344 ng/mL, CA-125 of 376 ng/mL, normal B-HCG and carcinoembryonic antigen (CEA). Thereafter, a triple phase CT of the liver revealed two LI-RADS 5 lesions suggestive of HCC as the primary malignancy. Patient's case was discussed at multidisciplinary tumor board with recommendations for systemic immunotherapy with atezolimumab plus bevacizumab and radiation therapy to the clivus. Discussion(s): The incidence of HCC has almost tripled since the 1980s making it the fastest rising cause of cancer related deaths. Metastasis to the brain comprises 0.26% to 2.2% of cases and the skull base is the most rarely affected anatomical site. Although CNS presentation is rare, we may see more neurological manifestations of metastatic HCC with the persistence of chronic hepatitis infections, the rise of metabolic diseases such as NASH, and an increase in alcohol-related liver disease during the COVID-19 pandemic. Although exceedingly rare, metastasis to the clivus should be considered in the differential diagnosis of skull base masses. Despite detection and treatment, prognosis remains poor and emphasis should be placed on consistent HCC surveillance. This case emphasizes that skull masses must be evaluated diligently as they can be the first sign of underlying liver malignancy. Given the morbidity and mortality associated with HCC, recognition of atypical manifestations of HCC can lead to a prompt diagnosis and initiation of life-saving treatment. (Figure Presented).

Factors Associated with Hospitalization with Symptomatic Coronavirus Disease 2019 among Pregnant Individuals: A Multicenter Retrospective Cohort Study

Background: Pregnant individuals are at increased risk of coronavirus disease 2019 (COVID-19) hospitalization and death, and primary and booster COVID-19 vaccination is recommended for this population. Method(s): Among a cohort of pregnant individuals who received prenatal care at 3 healthcare systems in the United States, we estimated the cumulative incidence of hospitalization with symptomatic COVID-19 illness. We also identified factors associated with COVID-19 hospitalization using a multivariable Cox proportional hazards model with pregnancy weeks as the timescale and a time-varying adjustor that accounted for severe acute respiratory syndrome coronavirus 2 circulation;model covariates included site, age, race, ethnicity, insurance status, prepregnancy weight status, and selected underlying medical conditions. Data were collected primarily through medical record extraction. Result(s): Among 19 456 pregnant individuals with an estimated due date during 1 March 2020-28 February 2021, 75 (0.4%) were hospitalized with symptomatic COVID-19. Factors associated with hospitalization for symptomatic COVID-19 were Hispanic ethnicity (adjusted hazard ratio [aHR], 2.7 [95% confidence interval {CI}, 1.3-5.5]), Native Hawaiian or Pacific Islander race (aHR, 12 [95% CI, 3.2-45.5]), age <25 years (aHR, 3.1 [95% CI, 1.3-7.6]), prepregnancy obesity (aHR, 2.1 [95% CI, 1.1-3.9]), diagnosis of a metabolic disorder (aHR, 2.2 [95% CI, 1.2-3.8]), lung disease excluding asthma (aHR, 49 [95% CI, 28-84]), and cardiovascular disease (aHR, 2.6 [95% CI, 1.5-4.7]). Conclusion(s): Although hospitalization with symptomatic COVID-19 was uncommon, pregnant individuals should be aware of risk factors associated with severe illness when considering COVID-19 vaccination. Copyright © 2022 Published by Oxford University Press on behalf of Infectious Diseases Society of America. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Pre-existing chronic liver disease is associated with poor outcome in patients with SARS-CoV2 infection

COVID-19 is characterized by predominant respiratory and gastrointestinal symptoms. Liver enzymes derangement is seen in 15-55% of the patients. Cirrhosis is characterized by immune dysregulation, leading to concerns that these patients may be at increased risk of complications following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Patients with metabolic dysfunction-associated fatty liver (MAFLD) had shown a 4-sixfold increase in severity of COVID-19, and its severity and mortality increased in patients with higher fibrosis scores. Patients with chronic liver disease had shown that cirrhosis is an independent predictor of severity of COVID-19 with increased hospitalization and mortality. An international European registry study included 756 patients with chronic liver disease from 29 countries reports high mortality in patients with cirrhosis (32%). Data of 228 patients collected from 13 Asian countries on patients with CLD, known or newly diagnosed, with confirmed COVID-19 (APCOLIS study) showed that SARSCoV- 2 infection produces acute liver injury in 43% of CLD patients without cirrhosis. Additionally, 20% of compensated cirrhosis patients develop either ACLF or acute decompensation. In decompensated cirrhotics, the liver injury was progressive in 57% of patients, with 43% mortality. Patients with CLD and associated diabetes and obesity had a worse outcome. Liver related complications were seen in nearly half of the decompensated cirrhotics, which were of greater severity and with higher mortality. Increase in Child Turcotte Pugh (CTP) score and model for end-stage liver disease (MELD) score increases the mortality in these patients. In a subsequent study of 532 patients from 17 Asian countries was obtained with 121 cases of cirrhosis. An APCOLIS risk score was developed, which included presence of comorbidity, low platelet count, AKI, HE and respiratory failure predicts poor outcome and an APCOLIS score of 34 gave a sensitivity and specificity of 79.3%, PPV of 54.8% and NPV of 92.4% and predicted higher mortality (54.8% vs 7.6%, OR = 14.3 [95 CI 5.3-41.2], p<0.001) in cirrhosis patients with Covid-19. The APCOLIS score is helpful in triaging and prognostication of cirrhotics with Coivd-19. The impact of COVID-19 on patients with cirrhosis due to non-alcoholic fatty liver disease (NASH-CLD) was separately studied in 177 NASH-CLD patients. Obese patients with diabetes and hypertension had a higher prevalence of symptomatic COVID. Presence of diabetes [HR 2.27], fraility [HR 2.68], leucocyte counts [HR 1.69] and COVID-19 were independent predictors of worsening liver functions in patients with NASH-CLD. Severity of Covid in Cirrhosis could also be assessed by measuring ICAM1 the Intercellular Adhesion Molecule, an indicator of Endothelial Injury Marker. in Cirrhosis with Covid 19 Immunosuppression should be reduced prophylactically in patients with autoimmune liver disease and post-transplantation with no COVID-19. Hydroxychloroquine and remdesivir are found to be safe in limited studies in a patient with cirrhosis and COVID-19. And is safe in cirrhosis patients. However, flare of AIH has been reported in AIH patients. For hepatologists, cirrhosis with COVID-19 is a pertinent issue as the present pandemic cause severe disease in patients with chronic liver disease leading to more hospitalization and decompensation.

ACUTE STROKE IN A PATIENTS WITH COVID-19.

COVID-19 has remained at the peak of urgent medical and social problems in all countries of the world for more than 2 years. Data on the development of new methods of treatment and prevention of infection is constantly updated, at the same time new strains of the virus appear with an increase in the number of possible complications, a more severe course of coronavirus infection, an increase in morbidity and death in young patients. It has been proven that patients with cardiovascular diseases are at increased risk of a severe course of the disease. COVID-19 is a trigger for acute cardiovascular events in patients in the setting of metabolic disorders and endocrinopathies. A high frequency of the development of multiple organ failure syndrome, often with a fatal outcome, was revealed. At the same time, stroke associated with the coronavirus infection, is one of the most severe forms of pathology. A combination of different mechanisms underlies the development of acute cerebrovascular disorders, among which disorders of the hemostasis system play a key role. This article presents an analysis of current literature data on the features of the development of acute stroke in patients with COVID-19 and also the main risk factors for severe course of both the infection itself and neurological disorders are given.Copyright © 2023 Stavropol State Medical University. All rights reserved.

Prevalence of adverse drug reactions associated with emergency department visits and risk factors for hospitalization

Objective: Adverse drug reactions increase morbidity and mortality, prolong hospital stay and increase healthcare costs. The primary objective of this study was to determine the prevalence of emergency department visits for adverse drug reactions and to describe their characteristics. The secondary objective was to determine the predictor variables of hospitalization for adverse drug reactions associated with emergency department visits. Method(s): Observational and retrospective study of adverse drug reactions registered in an emergency department, carried out from November 15th to December 15th, 2021. The demographic and clinical characteristics of the patients, the drugs involved and the adverse drug reactions were described. Logistic regression was performed to identify factors related to hospitalization for adverse drug reactions. Result(s): 10,799 patients visited the emergency department and 216 (2%) patients with adverse drug reactions were included. The mean age was 70 +/- 17.5 (18-98) years and 47.7% of the patients were male. A total of 54.6% of patients required hospitalization and 1.6% died from adverse drug reactions. The total number of drugs involved was 315 with 149 different drugs. The pharmacological group corresponding to the nervous system constituted the most representative group (n = 81). High-risk medications, such as antithrombotic agents (n = 53), were the subgroup of medications that caused the most emergency department visits and hospitalization. Acenocumarol (n = 20) was the main drug involved. Gastrointestinal (n = 62) disorders were the most common. Diarrhea (n = 16) was the most frequent adverse drug reaction, while gastrointestinal bleeding (n = 13) caused the highest number of hospitalizations. Charlson comorbidity index behaved as an independent risk factor for hospitalization (aOR 3.24, 95% CI: 1.47-7.13, p = 0.003, in Charlson comorbidity index 4-6;and aOR 20.07, 95% CI: 6.87-58.64, p = 0.000, in Charlson comorbidity index >= 10). Conclusion(s): The prevalence of emergency department visits for adverse drug reactions continues to be a non-negligible health problem. High-risk drugs such as antithrombotic agents were the main therapeutic subgroup involved. Charlson comorbidity index was an independent factor in hospitalization, while gastrointestinal bleeding was the adverse drug reaction with the highest number of hospital admissions.Copyright © 2022 Sociedad Espanola de Farmacia Hospitalaria (S.E.F.H)

Could COVID-19 be a Causative Factor for Hyperglycaemia and Cause Diabetes Mellitus.

Since the outbreak of the COVID-19 pandemic, it has been suspected that its causative agent, the SARS-CoV-2 coronavirus, may cause transient or permanent hyperglycemia. This fact has resulted in a new focus of research interest related to the study of potential mechanisms leading to damage of pancreatic insulin-producing cells, as well as the possible impact of the virus on insulin sensitivity, which may manifest as metabolic disturbances in patients with COVID-19 and cause diabetes mellitus. Evidence from the literature suggests that Corona viruses can damage pancreatic (beta-cells by direct or indirect mechanisms and cause changes in insulin secretion and sensitivity. To what extent all these changes are valid claims that SARS-CoV-2 can trigger diabetes mellitus is still not fully proven.Copyright © 2022 Medical Information Center. All rights reserved.

Silymarin: A Phytoconstituent with Significant Therapeutic Potential-A Narrative Review

Silymarin, is a phytoactive constituent isolated from the fruits and seeds of Silybum maria-num L Gaetn.), also called milk thistle belonging to the family of Asteracease. The phytoactive has been used to treat several physiological disorders. The objective of this manuscript was to review the therapeutic prospective of silymarin due to its ability to treat several physiological disorders. The da-tabases such as Pubmed, Elsevier, and Google Scholar were reviewed for the investigations or reviews published related to the title. The discussion is focused on the immunomodulatory, chemopreventive, and anti-inflammatory mechanisms of silymarin in various metabolic and dermatological disorders. In addition, the review discusses the different therapeutic potentials of silymarin such as the management of the liver disorder, skin carcinogenesis, cardiovascular disorders, diabetes mellitus, neurodegenera-tive disorders, and several dermatological disorders such as melasma, anti-aging, acne, rosacea, atopic dermatitis, and psoriasis. Silymarin is safe even with a dose higher than the therapeutic dose. Si-lymarin had good potential for the safe and effective treatment of numerous metabolic and dermatological disorders. © 2023 Bentham Science Publishers.

The association among circadian rhythm, circadian genes and chrononutrition, its effect on obesity: a review of current evidence

Circadian rhythms, also known as circadian clocks, are cyclic endogenous biological patterns of an approximately 24-hour cycle which regulate the timing of physiology, metabolism, and behavior. Recent research in the field of circadian science has suggested that the timing of food intake may also play a role in markers of health, in addition to food choice and food quantity. There is emerging evidence suggesting that the timing of dietary intake, so-called chrono-nutrition, may be influenced by an individual<apos;>s chronotype. For example, the evening type has been linked to unhealthy diet, which could indicate a higher possibility of obesity. On the other hand, the continuum of chronotype diversity is largely mediated by genes. The presence of single nucleotide polymorphisms (SNP) of clock genes have been associated with obesity, chronotype, metabolic disturbances, and dietary habits (e.g., breakfast skipping, meal timing, energy/macronutrient intake). In this review, we outline the current knowledge of the interactions between clock genes, chronotype, dietary intake and chrono-nutrition.Additionally, it is emphasized that the COVID-19 pandemichas had a significant impact on the circadian system, dietary choices and meal timing. For this reason, the current review aims to focus on how chronotype/sleep and chrono-nutrition are affected during the COVID-19 pandemic.Copyright © 2022 Informa UK Limited, trading as Taylor & Francis Group.

Placental histological findings in COVID-19 term, preterm and metabolic disorders pregnancy

Objective. In the last two years COVID-19 infection has represented a true unknown in the management of pregnancies with maternal COVID-19 positivity. However, it has not represented a serious complication, indeed it has rarely caused premature rupture of the membrane, fetal thrombosis or postnatal complications. Materials and Methods. Our retrospective cohort study included placental samples from 350 patients from San Pietro Fatebenefratelli Hospital collected in a period of 4 months. Inclusion criteria were COVID-19 positivity during childbirth or in the previous two months but also a pregnancy without previous COVID-19 infection. Anamnestic data were carried out for the histological study on each placenta. 59% of patients were COVID-19 positive (15% of these had other associated disorders like gestational diabetes, hypertension, fetal death, preterm birth) 26.5% were preterm and the 14,5% were high-risk pregnancy with COVID-19 negativity. Results. The most frequently represented lesion in a COVID-19 placenta was a mild chronic deciduitis, usually absent in placentas with normal outcome. The same deciduitis was observed in gestational diabetes placentas, although less frequently. Other rare findings were patchy fibrinoid necrosis of capsular decidua, chronic villitis, umbilical cord thrombosis. Severe lesions were rare. Conclusions. COVID-19 does not seem to have a severe impact on the health of the placenta except in rare cases in which predisposing factors coexist and determine a more serious involvement of the fetus and its appendages. COVID-19 determines a constant but mild chronic placental inflammation, that is balanced by the maternal capacity to maintain homeostasis stemming the external injuries.

Analysis of Causes of Maternal Death in East Java Province, Indonesia

BACKGROUND: The maternal mortality rate is an indicator that reflects the mother's health status, especially the risk of death for the mother during pregnancy and childbirth. Measles, Mumps, and Rubella (MMR) has a close relationship with efforts to increase human development. Therefore, efforts are needed to reduce MMR by identifying the factors that influence MMR. AIM: The aim of the study was to analyze the factors causing the incidence of Maternal Death in East Java Province. METHOD(S): The research design used in this research is a quantitative research using descriptive-analytical. The population of this research is districts/cities in East Java Province, with a sample of 38 districts/cities. The research period starts from August to September 2021. Data analysis using grouping and percentage of cases. RESULT(S): The results of the study found that cases of maternal death in East Java due to postpartum hemorrhage in 2021 were 131 cases. Cases due to hypertension as many as 115 cases. Cases due to infection as many as 25 cases. The incidence of maternal death due to abortion is 1 case. There were 13 cases of maternal death due to blood disorders. There were 6 cases of maternal death due to metabolic disorders - cases of maternal death due to Heart as many as 54 cases. Maternal deaths due to COVID-19 were 793 cases. CONCLUSION(S): Factors causing maternal death in East Java Province, namely, hypertension bleeding, infection, abortion, blood disorders, heart metabolic disorders, and COVID-19. The most influential factor in maternal mortality in 2021 is COVID-19.Copyright © 2023 Maharani Maharani, Sutrisno Sutrisno.

A study of the profile and the impact of diabetes, steroid and stress hyperglycaemia on COVID-19 outcomes

Background: Diabetes Mellitus (DM) and hyperglycaemia (HG) have been identified as risk factors for morbidity and mortality in coronavirus disease 19 (COVID-19) infection. However, a detailed study of various categories of HG and the impacts and characteristics of each of these on COVID-19 was considered important to address this metabolic disorder in COVID-19. Aim(s): This study aimed to describe the patterns of HG and its impact on the clinical outcomes in hospitalised patients with COVID-19 infection. Methodology: Data on 1000 consecutive patients with COVID-19 were analysed using Statistical Package for Social Sciences (SPSS) version 20.0 software (SPSS Inc., Chicago, IL, USA). Result(s): A total of 1000 patients were included for analysis The overall mean age of the study group was 52.77 + 19.71 with 636 (63.6%) male patients;261 had mild, 317 moderate, and 422 severe infections;and 601 had HG (New-onset DM 66, known DM 386, steroid-induced HG 133 and stress HG 16). The HG group has significantly higher levels of inflammatory markers and worse outcomes. Blood glucose levels were higher in patients with known DM. The ROC cut-off of total steroids to predict mortality in the HG group was 84 mg versus 60 mg in the normoglycaemia group. The ROC cut-off of FBS to predict mortality in the overall HG group was 165, with AUC 0.58 (95% CI 0.52, 0.63, P = 0.005), whereas that for pre-existing DM and steroid HG were 232 and 166, which were also significant. There was a wide variation in mean glucose levels against time. Conclusion(s): HG is an independent predictor of mortality, with the highest significance in the steroid-induced category. COVID-19 morbidity and mortality can be minimised by identifying the blood glucose range for best results and instituting appropriate treatment guidelines.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

With Hybrid Closed-Loop System Dblg1, the Clinical Improvement Obtained Is All the More Important as the Initial Clinical Situation Was More Deteriorated

Background and Aims: Does automatised insulin administration in closed-loop (CL) with DBLG1 system improve TIR (time in range 70-180mg/dl) and TBR (time below range <70) in all adult patients affected by Type 1 diabetes (APT1D) ? Methods: 140 APT1D, HbA1c > 8%, 43,3 +/- 13,0 years, treated with Dana insulin pump were randomised to either receive after 2 weeks in open loop (OL), CL treatment with the DBLG1 algorithm, or continue in OL, with a 4 CL/1 OL ratio. COVID health crisis prematurely terminated the study. Nonetheless, 99 patients received at least 14 days of treatment with CGM data >=75% of the time (88CL, 11 OL). Result(s): After adjusting on baseline HbA1c and centers, patients in CL versus OL, spent 12min less per 24h in hypoglycemia <70 mg/dl (p < 0.01), 3h12 more in target 70-180 (p < 0.001), 3h less in hyperglycemia >180 mg/dl (p < 0.0007). These improvements were primarily nocturnal. Significative (p < 0.0001) linear correlations were observed between: 1 - TIR baseline/ Delta-TIR: patients with the lowest TIR at T0 are the ones who increase it the most. 2 - TBR baseline/Delta-TBR: patients with the highest TIR at T0 are the ones who lower it the most. The patients who were initially the most hyperglycemic, and therefore had the least hypoglycemias, are the ones who gained the most in TIR, without deteriorating their TBR. Conclusion(s): The DBLG1 system is likely to benefit the entire spectrum of metabolic disorders in Type 1 diabetes, either by improving TIR70-180 or decreasing TBR70, depending on the situation at initiation.

FINUT 2022 Conference Abstracts

The proceedings contain 343 papers. The topics discussed include: alterations in the gut microbiota associated with obesity and metabolic disease: cause or consequence?;childhood obesity in the community context;big data and machine learning as tools for the biomedical field;thermogenesis and adipose tissue: effect of genistein;pediatric obesity and comorbidities: a question of time and genetics? the Portuguese experience;nutrigenomics of inflammation;environmental factors associated with school children's excess of weight in communities of Costa Rica;dietary consumption: guided by a focus of nutrient adequacy or selection of foodstuffs?;functional foods as key regulators of gut microbiota in the SARS-CoV-2 infection;immunomodulatory properties of human milk;vitamin d in childhood and adolescent obesity;and new sources of vitamin D and E supplementation during pregnancy.

Could COVID-19 be a Causative Factor for Hyperglycaemia and Cause Diabetes Mellitus.

Since the outbreak of the COVID-19 pandemic, it has been suspected that its causative agent, the SARS-CoV-2 coronavirus, may cause transient or permanent hyperglycemia. This fact has resulted in a new focus of research interest related to the study of potential mechanisms leading to damage of pancreatic insulin-producing cells, as well as the possible impact of the virus on insulin sensitivity, which may manifest as metabolic disturbances in patients with COVID-19 and cause diabetes mellitus. Evidence from the literature suggests that Corona viruses can damage pancreatic (beta-cells by direct or indirect mechanisms and cause changes in insulin secretion and sensitivity. To what extent all these changes are valid claims that SARS-CoV-2 can trigger diabetes mellitus is still not fully proven.Copyright © 2022 Medical Information Center. All rights reserved.

Could COVID-19 be a Causative Factor for Hyperglycaemia and Cause Diabetes Mellitus.

Since the outbreak of the COVID-19 pandemic, it has been suspected that its causative agent, the SARS-CoV-2 coronavirus, may cause transient or permanent hyperglycemia. This fact has resulted in a new focus of research interest related to the study of potential mechanisms leading to damage of pancreatic insulin-producing cells, as well as the possible impact of the virus on insulin sensitivity, which may manifest as metabolic disturbances in patients with COVID-19 and cause diabetes mellitus. Evidence from the literature suggests that Corona viruses can damage pancreatic (beta-cells by direct or indirect mechanisms and cause changes in insulin secretion and sensitivity. To what extent all these changes are valid claims that SARS-CoV-2 can trigger diabetes mellitus is still not fully proven.Copyright © 2022 Medical Information Center. All rights reserved.

Analysis of mental health and sleep problems among nursing and midwifery staff during the COVID-19 pandemic

Introduction: Nursing and midwifery staff members are at high risk of mental disorders. Depression, anxiety, and insomnia are commonly reported symptoms among healthcare professionals during the COVID-19 pandemic. Chronic insomnia leads to lower quality of life, worse professional performance and deterioration of cognitive function. Moreover, it increases the risk of metabolic and cardiovascular diseases. Material and methods: The study included 235 nurses (n =133) and midwives (n =102). The diagnostic methods included a descriptive and demographic questionnaire, The General Health Questionnaire (GHQ-28), The Pittsburgh Sleep Quality Index (PSQI), and The Insomnia Severity Index (ISI). The study was conducted using an online survey. Results: There are no statistically significant intergroup differences in terms of mental state, sleep quality and the insomnia level in the groups of nurses and midwives. 9% of subjects used psychological support and revealed lower assessment of their mental health, poorer sleep quality and the higher insomnia rate. The stable mental health of nurses and midwives positively correlated with the sleep quality and negatively with the insomnia level. 63% of study participants assessed their sleep quality as low. The symptoms of clinical insomnia were present in 35% of subjects. Conclusions: Insomnia is a serious health problem for nursing and midwifery staff during the COVID-19 pandemic. The implementation of preventive programmes focused on medical workers' mental health should be a priority in prevention of long-term consequences of sleep problems and insomnia.

Safety of and antibody response to the BNT162b2 COVID-19 vaccine in adolescents and young adults with underlying disease

Background: Data are limited regarding the safety of and antibody response to the BNT162b2 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) messenger ribonucleic acid vaccine in adolescents and young adults with underlying disease. Methods: This prospective observational study enrolled patients age 12–25 years with chronic underlying disease who received 2 doses of BNT162b2. A 18-item questionnaire was used to assess adverse events within 7 days post-vaccination, and data regarding severe adverse events were collected from electronic medical records. An antibody titer for the receptor-binding domain of the spike protein in SARS-CoV-2 was used to assess antibody response after the second vaccine dose. Results: Study participants were 429 patients (241 [56.2%] age 12–15 years;188 [43.8%] age 16–25 years). The most common underlying diseases were genetic or chromosomal abnormalities and/or congenital anomalies, followed by endocrine or metabolic diseases;32% of participants were immunocompromised. Severe adverse events were observed after the second dose in 1 (0.4%) patient age 12–15 years and in 2 (1.1%) patients age 16–25 years;all patients recovered. Seropositivity after the second vaccine dose was 99.0%. The geometric mean antibody titer was higher in patients age 12–15 years versus 16–25 years (1603.3 [1321.8–1944.7] U/mL vs. 949.4 [744.2–1211.0] U/mL). Compared with immunocompetent patients, immunocompromised patients had a lower antibody titer (2106.8 [1917.5–2314.7] U/mL vs. 467.9 [324.4–674.8] U/mL). Conclusions: Vaccination with BNT162b2 was acceptably safe and immunogenic for adolescents and young adults with underlying disease. © 2022 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases

OBESITY, HYPERTENSION, DIABETES MELLITUS, AND HYPERCHOLESTEROLEMIA OF KOREAN ADULTS

Objectives: We investigated the trends in obesity, hypertension, diabetes, and hypercholesterolemia before and during the COVID-19 outbreak in the Korean adult population. Methods: Data from 60,098 individuals of the Korean National Health and Nutritional examination Survey between 2011 and 2020 aged≥ = 19 were used. The age-standardized prevalence and annual percent changes (APC) were calculated for obesity (body mass index≥ = 25 kg/m 2), hypertension (systolic/diastolic blood pressure≥ = 140/90mmHg or under treatment), diabetes (hemoglobin A1c≥ = 6.5%, fasting glucose≥ = 126 mg/dL, physician diagnosis, or under treatment), and hypercholesterolemia (total cholesterol≥ = 240 mg/dL or under treatment). Results: Over the past decade of 2011-2020, age-standardized APCs (95% confidence interval)during 2011-2020 for obesity, hypertension, diabetes and hypercholesterolemia were 3.0% (2.1 to 3.8%), 0.1% (-1.3 to 1.5%), 1.5% (-1.0 to 4.0%) and 8.0% (5.7 to 10.3%), respectively in men;and -0.2% (-1.5 to 1.2%), -0.5% (-1.9 to 0.9%), -0.1% (-2.3 to 2.2%) and 5.9% (3.9 to 8.0%), respectively in women. In 2020 compared to the previous three years (2017-2019), obesity, hypertension, diabetes, and hypercholesterolemia increased in men (+6.0, + 1.8, + 1.9 and + 2.8 percentage points, respectively), but the increase was not apparent in women (+2.5, -1.1, + 0.8 and + 0.7 percentage points, respectively). Conclusion: An increase in major chronic diseases was observed in Korean adults, especially men, during the COVID-19 epidemic. In order to reduce the burden of cardiovascular and metabolic diseases in the future, effective intervention strategies need to be developed according to the characteristics of the target groups.