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1.
Healthcare (Basel) ; 10(8)2022 Jul 27.
Article in English | MEDLINE | ID: covidwho-2023362

ABSTRACT

BACKGROUND: Investigate the effectiveness of the scientific 4 Phases Method, a methodology developed by EMAGRECENTRO, which is based on a ketogenic approach (total carbohydrate intake <40 g/day; including fibers) associated with health coach assistance, in promoting reductions in body weight, body mass index (BMI), and waist circumference after 5 weeks of methodology application. METHODS: Record files from 354 individuals, both sexes, aged between 18 and 67, who took part in the 4 Phases Method were used to develop this study. Age, sex, weight, height, BMI, waist circumference measurement, and the presence of ketone bodies in the urine were evaluated before (baseline) and after 5 weeks of the 4 Phases application. RESULTS: In general, a significant reduction in body weight (-7.8 ± 1.2 kg, p < 0.0001), BMI (-2.8 ± 0.4 kg/m2, p < 0.0001), and waist circumference measurement (-7.6 ± 0.4 cm, p < 0.0001) was found after the application of the 4 Phases Method, regardless of age, gender, and BMI. CONCLUSIONS: Taken together, our results demonstrated that the 4 Phases Method was able to promote significant body weight, BMI, and waist circumference reductions in the short term, particularly by associating a ketogenic intake strategy with a regular close follow-up weekly consultation with a health coach assistance.

2.
Food Research ; 6(3):178-186, 2022.
Article in English | EMBASE | ID: covidwho-2010592

ABSTRACT

Metabolic syndrome is not a disease but is a set of several disorders and causes an increased risk of cardiovascular disease and diabetes mellitus complications. Several studies have shown that non-invasive approaches such as anthropometric measurements can be used for the early detection of metabolic syndrome. This study aimed to analyse the anthropometric indicators related to metabolic syndrome in female college students. The design of this research was cross sectional, with the number of subjects involved were as many as 163 female college students aged 19 to 24 years old. Purposive sampling was used in the sampling of this research. The independent variables in this study were the Waist-to-Height Ratio (WHtR), Waist-Hip Ratio (WHR), Body Mass Index (BMI), Sagittal Abdominal Diameter (SAD), and hip circumference. The dependent variable in this study is the metabolic syndrome component that has been converted into a metabolic syndrome score (cMetS). The analysis results showed that all anthropometric indicators, namely WHtR, BMI, SAD, waist circumference, hip circumference and WHR have a strong positive relationship with the metabolic syndrome score (p<0.001). BMI was the anthropometric indicator that is most associated with the metabolic profiles, such as systolic blood pressure (p<0.001), blood sugar (p<0.05), and HDL (p<0.001). Waist circumference was the anthropometric indicator that is most associated with triglycerides and metabolic syndrome score (p<0.001). Metabolic syndrome in female college students can be identified using anthropometric measurements, one of which is BMI and WHR which are very easy to measure and efficient. BMI and WHR have the strongest relationship and can be used to detect early risk of metabolic syndrome in female college students.

3.
Pediatrics ; 149, 2022.
Article in English | EMBASE | ID: covidwho-2003410

ABSTRACT

Background: The COVID-19 pandemic has raised concerns for worsening cardiometabolic health in children. Methods: Retrospective chart review to analyze patients who had visits to a pediatric lipid clinic in both the year prior to (3/18/2019- 3/17/2020) and during (3/18/2020-3/17/2021) the COVID-19 pandemic. Laboratory markers of cardiometabolic health (lipid panel, insulin resistance, and transaminases), physical exam findings (BMI, waist circumference (WC), and blood pressure), self-reported exercise time, and lipid-lowering medications (LLM) were compared via paired t-tests. Results: 303 patients met inclusion criteria. Among patients prescribed no LLM (metformin, statin, omega-3 fatty acids, fenofibrate) or on stable doses of LLM (n=244), there was a significant increase in BMI and WC (see Table). All changes in lipid panels were statistically, but likely not clinically, significant. Among patients with changes in prescribed LLM between pre-pandemic and pandemic intervals (n=62), there was an increase in HgbA1c and TG, a trend towards increased fasting insulin and ALT, and no changes in LDL-C or HDL-C. During the pandemic, patients showed increased BMI and trended towards increased WC (see Table). Neither group had a statistically significant change in exercise time. The incidence of newly prescribed LLM increased during the pandemic. This included statistically significant increases in prescriptions for statins (P= 0.003), metformin (P= 0.001), and omega-3 fatty acids (P= 0.001). Conclusion: Pediatric patients in a lipid clinic demonstrated increases in BMI and WC in the year of the COVID-19 pandemic compared to the year prior, despite few clinically significant changes in their lipid panels. In patients who required changes in LLM, increases in HgbA1c, TG, ALT and fasting insulin are consistent with reports of higher rates of pediatric type 2 diabetes during the pandemic. The increase in medication prescriptions further supports this, and indicates the need to diagnose and treat new onset dyslipidemia, insulin resistance, and diabetes in children.

4.
Medical Immunology (Russia) ; 24(2):389-394, 2022.
Article in Russian | EMBASE | ID: covidwho-1957613

ABSTRACT

Coronary artery disease (CAD) is widely considered a chronic inflammatory disorder, and dysfunction of epicardial adipose tissue could be an important source of the inflammation. Amino-terminal fragment of pro-B-type natriuretic peptide (NT-proBNP) is a known marker of cardiovascular disorders of cardiac origin. Recent studies show that inflammatory stimuli may influence its secretion. Our purpose was to evaluate NT-proBNP serum concentration in relation to immune cell ratios in epicardial adipose tissue (EAT), and cytokine levels in the patients with stable CAD. Patients with stable CAD and heart failure classified into classes II-III, according to the New York Heart Association (NYHA) scale, scheduled for the coronary artery bypass graft (CABG) surgery, were recruited into the study (n = 10;59.5 (53.0-65.0) y. o.;50% males). The EAT and subcutaneous adipose tissue (SAT) specimens were harvested in the course of CABG surgery. Immunostaining with anti-CD68, anti-CD45, anti-IL-1β and anti-TNFα monoclonal antibodies was performed to evaluate cell composition by differential counts per ten fields (400 magnification). Fasting venous blood was obtained from patients before CABG. Blood was centrifuged at 1500g, aliquots were collected and stored frozen at -40 °С until final analysis. Concentrations of NT-proBNP, IL-1β, IL-6, IL-10, TNFα were determined in serum samples by enzyme-linked immunosorbent assay (ELISA). We have found increased production of IL-1β and TNFα cytokines in EAT compared to SAT. Concentrations of NT-proBNP exceeded 125 pg/ml in 4 patients, and correlations between the CD68+ macrophage counts in both EAT and SAT samples (rs = 0.762;p = 0.010 and rs = 0.835;p = 0.003, respectively). NT-proBNP levels showed positive relations with CD45+ leukocyte counts (rs = 0.799;p = 0.006), and with IL-1β+ cell numbers (rs = 0.705;p = 0.023) in EAT samples only. As for the serum biomarkers, NT-proBNP levels showed negative correlation with fasting glucose levels (rs = -0.684;p = 0.029), and positive correlation with serum IL-6 concentrations (rs = 0.891;p = 0.001). Increased serum concentrations of NT-proBNP in CAD patients correlate with accumulation of macrophages in EAT, which is associated with increased production of IL-1β in EAT and correlates with some metabolic parameters.

5.
Clinical Nutrition ESPEN ; 2022.
Article in English | ScienceDirect | ID: covidwho-1936181

ABSTRACT

Summary Background & aims Obesity has been described as a predisposing risk factor to severe forms of COVID-19, but conflicting results are emerging on its real impact on the mortality of COVID-19. We aimed to compare clinical outcomes and mortality among COVID-19 patients according to obesity, metabolic syndrome and adiposity distribution. Methods We conducted a prospective observational study of all consecutive adult patients with a confirmed diagnosis of SARS-CoV-2 infection admitted to the Infectious Diseases Clinic at Udine Hospital, Italy, from January 2021 to February 2021. At admission, the study population was submitted to specific anthropometric, laboratory and bioimpedance analysis (BIA) measurements and divided into five groups according to: 1) BMI < or > 30 kg/m2;2) waist circumference (WC) < or > 98 cm for women, < or > 102 cm for men;3) presence or absence of metabolic syndrome (MS);4) visceral adipose tissue (VAT) distribution;and 5) presence or absence of sarcopenia (SP) both based on BIA. We then compared clinical outcomes (ventilatory support, intensive care unit (ICU) admission, ICU length of stay, total hospital length of stay and mortality), immune and inflammatory makers and infectious and non-infectious acute complications within the five groups. Results A total of 195 patients were enrolled in the study. The mean age of patients was 71 years (IQR 61-80) and 64.6% (126) were male. The most common comorbidities were hypertension (55.9%) and MS (55.4%). Overall mortality was 19.5%. Abdominal adiposity, measured both with WC and with BIA, and SP were significantly associated with need for increased ventilator support (p = 0.013 for WC;p = 0.037, 0.027 and 0.009 for VAT;p = 0.004 and 0.036 for FMI;and p = 0.051 for SP), but not with ICU admission (WC p = 0.627, VAT p = 0.153, FMI p = 0.519 and SP p = 0.938), length of stay (WC p =0.345, VAT p = 0.650, FMI p = 0.159 and SP p = 0.992) and mortality (WC p = 0.277, VAT p = 0.533, FMI p = 0.957 and SP p = 0.211). Obesity and MS did not discriminate for the intensity of ventilatory outcome (p = 0.142 and p = 0.198, respectively), ICU admission (p = 0.802 and p = 0.947, respectively), length of stay (p = 0.471 and p = 0.768, respectively) and mortality (p = 0.495 and p = 0.268, respectively). We did not find significant differences in inflammatory markers and secondary complications within the five groups. Conclusions In patients admitted with COVID-19, increased WC, visceral abdominal fat and SP are associated with higher need for ventilatory support. However, obesity, MS, SP and abdominal adiposity are not sensitive predictive factors for mortality.

6.
NeuroQuantology ; 20(6):6698-6705, 2022.
Article in English | EMBASE | ID: covidwho-1939460

ABSTRACT

Ischemic heart disease is the most common cardiovascular disease and causeof death in both males and females. Our study, conducted in Babylon governorate, aim of study To determine association between diabetic millets with risk factors among patients with ischemic heart disease in shaheedAlmuhrab center of cath& cardiac surgery in Hilla city. The method of study A cross-sectional study was conducted in center shaheedAlmuhrab center of cath& cardiac surgery The apparent association of diabetic Miletus with age, gender, and socioeconomic status is highly significant (0.019,0.047 and 0.045) respectively. And family history is not significant with diabetic Miletus p-value 0.142. While diabetes mellitus with hypertension, chronic kidney disease, and COVID-19 are highly significant (0.0001,0.029 and 0.01) respectively, whereas diabetic Miletus, smoking and exercise are significantp-value (0.013 and 0.005) respectively, but drinking alcohol is not significant p-value 0.410. Even though waist circumference and body mass index are linked to diabetes, they are very importantp-value (0.002 and 0.006) respectively. conclusion show result risk factor diabetic highly association between age,gender, socioeconomic status, hypertension and chronic kidney disease and covid-19 can cause ischemic heart disease. Also sedentary exercise smoking and anthropometric measurement.

7.
Journal of Hypertension ; 40:e173, 2022.
Article in English | EMBASE | ID: covidwho-1937719

ABSTRACT

Objective: Up to date the possibility of a vascular damage due to COVID-19 pneumonia is a not clarified. We searched for relationships between the carotidfemoral pulse wave velocity (cfPWV) and clinical and biochemical markers of severity of the infectious disease, after hospital discharge, in a group of patients who had been admitted in care units. Design and method: In 69 subjects (age 58 ± 13 years, 36 males), previously admitted in hospital because of COVID-19 pneumonia, we evaluated at the time of hospital admission anthropometric parameters, blood pressure, history of arterial hypertension or other diseases, drugs, smoking and alcohol habit, physical activity level, and indexes of infectious disease severity, such as the SIMEU score, need for invasive oxygen delivery, PaO2, PaCo2, inflammatory markers such as white blood cells count, levels of proadrenomedulline (proADM), reactive C protein, procalcitonin, IL- 6, glomerular filtration rate (GFR), troponin, mioglobin, B natriuretic peptide. After an average 2 months follow-up the cf- PWV was measured. Results: At univariate analysis the cfPWV was significantly and positively related to age (r = 0.454, P < 0.001), body mass index (r = 0.436, P = 0.016), waist circumference (r = 0.345, P = 0.004), levels of plasma glucose (r = 0.430, P = 0.001), proADM (r = 0.456, P = 0.006), IL-6 (r = 0.280, P = 0.037), mioglobin (r = 0.443, P = 0.001) and inversely related to GFR (r = -0.289, P = 0.023). The cfPWV was higher in diabetics subjects than in non-diabetics (P = 0.011), and in patients who had needed invasive oxygen support (P = 0.044). There was no difference in cfPWV in patients with or without history of arterial hypertension or with different blood pressure levels at admission. At multivariate analysis the cfPWV was independently associated with invasive oxygen support (B = 0.168, P = 0.012), body mass index (B = 0.180, P = 0.001), waist circumference (B = 0.162, P = 0.002), GFR (B = 0.078, P = 0.008), and proADM levels (B = 0.161, P = 0.003). Conclusions: In patients who recovered from COVID-19 pneumonia the aortic stiffness is associated with severity of disease and levels of proADM, but not with history of hypertension. Patients with more higher proADM levels in acute phase of the infectious disease could need a longer follow-up evaluation of the CFPWV after the recovering from disease to search for long time vascular damage.

8.
Revista Medica del Instituto Mexicano del Seguro Social ; 60(4):418-424, 2022.
Article in Spanish | MEDLINE | ID: covidwho-1929414

ABSTRACT

Background: During the COVID-19 containment, a decrease in physical activity, vigorous physical exercise and an increase in sedentary lifestyle were documented. Objective: To describe the physical activity, biochemical and somatometric profile of Rehabilitacion resident physicians during the COVID-19 pandemic and to determine the correlations between these variables. Material and methods: A cross-sectional, analytical study of medical residents was carried out. Clinical, somatometric and biochemical data were taken. The average number of steps for one day was recorded. Correlations between these variables were sought. A p < 0.05 was considered significant. Results: 57 residents were recruited. The median number of steps was 3,187 (36 - 6,338) in men and 4,935 (2,139 - 7,731) in women. The median waist circumference was normal in women and men (77.5 (67.4 - 87.6) cm and 90 (74.5 - 105) cm);the waist/hip ratio remained within normal limits (0.84 (0.77 - 0.91) and 0.91 (0.78 - 1.04)) and the percentage of fat was high in both sexes (35.42 +/- 7.41% and 29.82 +/- 8.67). Significant correlations were found between the number of steps and serum triglycerides (-0.34), BMI (-0.49), waist circumference (-0.44), and fat percentage (-0.55). Conclusions: The physical activity of medical residents in the COVID-19 contingency was low. The percentage of fat was found to be increased in both sexes. Total cholesterol was found in the upper limits of normality. Significant correlations were found between the number of steps and serum triglycerides, BMI, waist circumference, and body fat percentage.

9.
Diabetes Metab Syndr ; 16(7): 102564, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1914306

ABSTRACT

BACKGROUND AND AIMS: Implementation of COVID restrictions following lockdown led to changes in routines of subjects with type 1 diabetes due to closure of schools and outdoor activities. The aim of this study was to assess the impact of decreased physical activity due to COVID restrictions on cardio-metabolic risk parameters (waist circumference, laboratory and body composition parameters) in Indian children and youth with T1D. METHODS: This observational study included 312 participants (2-21 years) with T1DM having disease duration of ≥6 months. Demographic, anthropometric, body composition data and investigations were recorded at two time points (during COVID restrictions when children came for follow up, pre COVID restriction data from medical and electronic records). RESULTS: Glycemic control improved during COVID restrictions (Hba1c: 9.8 ± 2.0%) as compared to pre COVID restrictions (Hba1C: 10.0 ± 1.9%) (p < 0.05). However, due to significant reduction in physical activity (p < 0.05) there was significant increase in waist circumference z-scores (-0.9 ± 1.1 vs -1.6 ± 1.1), body fat percentage z-scores (-0.2 ± 1.0 vs -0.3 ± 0.9) and lipid parameters like cholesterol, low density lipid cholesterol and triglyceride concentrations (p < 0.05) without any significant change in body mass index z-scores (p > 0.05). CONCLUSIONS: Prolonged COVID restrictions, although led to modest improvement in glycemic control, there was worsening of cardio-metabolic risk factors or indices of adiposity like waist circumference, body fat percentage and lipid parameters which could be attributed to decreased time spent in physical activity.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 1 , Adolescent , Body Mass Index , COVID-19/epidemiology , COVID-19/prevention & control , Child , Child, Preschool , Cholesterol , Communicable Disease Control , Cross-Sectional Studies , Exercise , Glycated Hemoglobin A , Humans , Risk Factors , Triglycerides , Waist Circumference , Young Adult
10.
Clinical Pediatric Endocrinology ; 31(2):81-86, 2022.
Article in English | EMBASE | ID: covidwho-1883580

ABSTRACT

Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are diabetic emergencies. Some patients with a hyperglycemic crisis can present with an overlap of DKA and HHS. The coexistence of DKA and HHS is associated with higher mortality than in isolated DKA and HHS. In addition, electrolyte derangements caused by global electrolyte imbalance are associated with potentially life-threatening complications. Here, we describe three cases of mixed DKA and HHS with severe hypernatremia at the onset of type 2 diabetes mellitus. All patients had extreme hyperglycemia and hyperosmolarity with acidosis at the onset of diabetes mellitus. They consumed 2 to 3 L/d of high-carbohydrate drinks prior to admission to relieve thirst. They showed severe hypernatremia with renal impairment. Two patients recovered completely without any complications, while one died. Severe hypernatremia with mixed DKA and HHS is rare. However, it may be associated with excess carbohydrate beverage consumption. Reduced physical activity during the COVID19 pandemic and unhealthy eating behaviors worsened the initial presentation of diabetes mellitus. We highlight the impact of lifestyle factors on mixed DKA and HHS.

11.
The Journal of the Association of Physicians of India ; 70(4):11-12, 2022.
Article in English | Scopus | ID: covidwho-1823949

ABSTRACT

Chronic liver disease (CLD) patients develop portal hypertension which lead to complications like splenomegaly, ascites and esophageal varices. Portal hypertension is defined as hepatic venous pressure gradient more than 5mmHg, being invasive it is difficult to measure. Some studies show that increased portal vein diameter (PVD) on ultrasonography correlate with oesophageal varices and can indicate portal hypertension. Studies correlating PVD with other complications of portal hypertension like ascites and spleen size are lacking. Aim of this study was to correlate portal vein diameter with ascites, spleen size, thrombocytopenia and prognostic markers like Child-Turcotte Pugh (CTP) score and Model for End stage Liver Disease (MELD) score in Chronic liver disease patients. MATERIAL: This was a cross-sectional observational study of patients with Chronic liver disease conducted at tertiary care teaching hospital. All patient underwent clinical history, examination, blood testing and ultrasonography. Data collected was analysed by using statistical tests. OBSERVATION: Out of 97 CLD patients taken in study, the mean age of patients was 47.39 ± 12.64 year and majority were male (75.3%). Most common etiological factor was alcohol (in 53.7%). On clinical examination, 55.7% patients had pallor, 54.6% had icterus. Chest radiograph shows pleural effusion in 14.4% patients. Mean portal vein diameter was found to be 12.31 ± 2.71mm. Correlation coefficient of portal vein diameter with spleen size was 0.3 with p value of 0.004 suggesting a positive correlation. Parameters like thrombocytopenia, CTP score and MELD score correlation coefficient was -0.2(p-value: 0.066), 0.1(p value: 0.463) and 0.0(p-value: 0.725) respectively. The mean of PVD(mm) in ascites group was 12.43 and non ascites group was 11.92. Strength of association was 0.08 (Point Biserial correlation) indicating no association. CONCLUSION: Portal vein diameter had positive correlation with spleen size which is statistically significant in our study. No significant correlation was observed between PVD with ascites, thrombocytopenia, CTP score and MELD score. © Journal of the Association of Physicians of India 2011.

12.
Progress in Nutrition ; 24(1), 2022.
Article in English | EMBASE | ID: covidwho-1819020

ABSTRACT

Objective: Body dissatisfaction is an increasing problem in adolescents, and it is thought that mindful eating and body image are related. These problems have become more serious during the pandemic period. This current study was carried out to examine the relationship between adolescents’ mindful eating, body image, and anthropometric measurements during COVID-19 pandemic. Methods: A total of 200 adolescents (100 boys and 100 girls) aged 11-17 years, were involved in the study. The data were collected by the researcher using the face-to-face interview method through a questionnaire. The Mindful Eating Questionnaire was used to determine mindful eating. The Stunkard body image scale was employed to evaluate the body image of individuals, and all anthropometric measurements were made by the researcher in accordance with technique. Results: The mean age of the individuals was 14.2±2.04 years, and more than half (52%) attended high school. 60.0% of obese boys and 38.0% of obese girls considered themselves obese. A statistically significant difference was found depending on gender in terms of body perception (p<0.05). No significant difference was found between the mindful eating scores of participants according to their body perception (p>0.05). A negative statistically significant correlation was determined between the total mindful eating score of those who described themselves as underweight, overweight, and obese, and BMI (kg/m2), waist circumference (cm), hip circumference (cm), and body fat (%) (p<0.05). It was also found there were negative significant relationships between mindful eating subscales, anthropometric measurements, and BMI (p<0.05). Conclusion: It was concluded that body image in adolescents was affected by gender and BMI, and anthropometric measurements were associated with mindful eating.

13.
Journal of the Hong Kong College of Cardiology ; 28(2):103, 2020.
Article in English | EMBASE | ID: covidwho-1743907

ABSTRACT

Introduction: Tele-cardiac rehabilitation has demonstrated safety and efficacy in several clinical studies. With the outbreak of COVID-19, the centered-based CR service was totally suspended. To facilitate patients to exercise at home while being monitored. A pilot home-based cardiac tele-rehabilitation program was developed with a structured protocol at Princess Margaret Hospital (PMH) and rolled out from October 2020. Objectives: 1. To minimize the impact of suspension of in-hospital CR service due to outbreak of COVID-19. 2. To evaluate the effects and develop a home-based CR program for remote rehabilitation, based on advanced technological infrastructure and complementary clinical protocols. Methodology: Target patients: Low risk cardiac patients who fulfil the intake criteria, able and willing to use digital monitoring devices including blood pressure machine, smart watch and smart phone. Program design: The program will last for 12 weeks and consists of education, exercise training and relaxation training. Each consenting patient will be given a training kit containing a training log-book, informative educational leaflets and a set of QR codes to access our home-made education, exercise training & relaxation practice videos. Individual phone consultation by multidisciplinary will be scheduled once a week at the first five weeks. Patients can view the video at their own convenience, and then discuss or ask questions during phone follow-up. Individualized exercise will be prescribed according to patients' age, mobility and cardio fitness level. Patients can follow the designated video to do exercise at home. They will be instructed to measure and record their blood pressure, heart rate, and rate perceived exertion (RPE) before and after exercise. Physiotherapist will phone call patient to monitor and coach patients. Evaluation: All patients will undergo a detailed face-to-face assessment at baseline and at 12-week. They are including 6-minute walk test, body mass index (BMI), waist circumference, blood test for lipid profile, etc. In addition, patients will also request to fill in a set of questionnaires to measure the physical activity level, functional performance and psychological fitness. Conclusion: It believes that tele-rehabilitation is a more cost-effective model compared to center-based CR. It enables a new direction for the CR program.

14.
European Journal of General Practice ; 27(1):358-359, 2021.
Article in English | EMBASE | ID: covidwho-1612359

ABSTRACT

Background: Antipsychotics are associated with metabolic disturbances adversely affecting cardiometabolic health. Routine cardiometabolic monitoring is subsequently an important component of care in patients on antipsychotics. During the Covid-19 pandemic, there has been a transition towards remote consulting. Understanding the effect of the pandemic on routine primary care activity may help avoid potential adverse health outcomes. Research question: This study aimed to identify the local impact of the Covid-19 pandemic on cardiometabolic monitoring in patients on antipsychotics. Methods: A cross-sectional analysis was performed of patients on antipsychotic medications at a suburban South-West London practice. Patients were identified through a search via EMIS Web. Inclusion criteria included those registered permanently and commenced on medication prior to 17 December 2018. Primary outcomes included the difference in the yearly incidence of recorded weight, waist circumference, pulse, blood pressure, fasting blood glucose, HbA1c and lipids. Statistical significance was defined by p<0.050. Results: Fifty-three patients met the inclusion criteria. The mean patient age was 52.2 (±17.4). A total of 64 antipsychotics were on repeat prescriptions, with quetiapine (N=18;28.1%) and olanzapine (n=18;28.1%) being the most commonly prescribed. Comparing 2019 against 2020, there was no statistically significant difference in incidence of recorded weight (2019: 49.2%;2020: 49.2%;p=0.698), waist circumference (2019: 10.2%;2020: 6.8%;p=0.486), pulse (2019: 20.3%;2020: 11.9%;p=0.672), blood pressure (2019: 59.3%;2020: 44.1%;p=0.821), fasting blood glucose (2019: 5.1%;2020: 0.0%;p=1.000), HbA1c (2019: 72.9%;2020: 49.2%;p=0.613), lipids (2019: 55.9%;2020: 39.0%;p=0.251). Conclusion: A reduction in cardiometabolic monitoring was observed in this studied population locally in 2020. This was not statistically significant but may be clinically significant for longterm health outcomes on an individual patient basis. It is important that any potential adverse effects on different populations of increased remote consulting during and beyond the Covid-19 pandemic are identified. Health systems may be reconfigured to ensure robust follow-up and reduce excess mortality.

15.
Vaccines (Basel) ; 10(1)2022 Jan 05.
Article in English | MEDLINE | ID: covidwho-1614029

ABSTRACT

Obesity is associated with a poor COVID-19 prognosis, and it seems associated with reduced humoral response to vaccination. Public health campaigns have advocated for weight loss in subjects with obesity, hoping to eliminate this risk. However, no evidence proves that weight loss leads to a better prognosis or a stronger immune response to vaccination. We aimed to investigate the impact of rapid weight loss on the adaptive immune response in subjects with morbid obesity. Twenty-one patients followed a hypocaloric, very-low-carbohydrate diet one week before to one week after the two mRNA vaccine doses. The diet's safety and efficacy were assessed, and the adaptive humoral (anti-SARS CoV-2 S antibodies, Abs) and cell-mediated responses (IFNγ secretion on stimulation with two different SARS CoV-2 peptide mixes, IFNγ-1 and IFNγ-2) were evaluated. The patients lost ~10% of their body weight with metabolic improvement. A high baseline BMI correlated with a poor immune response (R -0.558, p = 0.013 for IFNγ-1; R -0.581, p = 0.009 for IFNγ-2; R -0.512, p = 0.018 for Abs). Furthermore, there was a correlation between weight loss and higher IFNγ-2 (R 0.471, p = 0.042), and between blood glucose reduction and higher IFNγ-1 (R 0.534, p = 0.019), maintained after weight loss and waist circumference reduction adjustment. Urate reduction correlated with higher Abs (R 0.552, p = 0.033). In conclusion, obesity is associated with a reduced adaptive response to a COVID-19 mRNA vaccine, and weight loss and metabolic improvement may reverse the effect.

16.
Pediatric Diabetes ; 22(SUPPL 30):52, 2021.
Article in English | EMBASE | ID: covidwho-1571012

ABSTRACT

Introduction: Since the beginning of the SARS-CoV-2 infection, concerns for consequences on auxological and glycemic control data in patients with type 1 diabetes (T1D) were raised. Objectives: To investigate 1-year effects of the COVID-19 pandemic on auxological parameters and metabolic control in youths with T1D. Methods: Anthropometric (height [Ht], weight, waist circumference [W]) and glycemic control data of patients with T1D were collected during the annual routine outpatient visit between Dec20-Feb21 (1-year after the pandemic) and were compared with the ones of the same period in 2019-20 (before the closure of schools and organized sport activities). Results: Seventy-eight children and adolescents with T1D (61.5% male;median age 13.7 [5.7-17.8] years;T1D duration 5.96 [2.1-15.4] years) were enrolled. Patients affected by SARS-CoV-2 infection were 15.4% (second wave). In Dec20-Feb21, BMI SDS and WHt ratio remained comparable to the year before lockdown. CGM use increased during the pandemic period (67.9 vs 71.8%, p<0.0001). Annual number of outpatient visits decreased (4 vs 3, p<0.0001), while telemedicine increased because 56.4% of patients had at least one telemedicine visit during pandemic (none before). Rate of DKA remained comparable (1.82 vs 2.56%) and no severe hypoglycemic event was recorder during pandemic (2.56 vs. 0%). Physical activity decreased (2 vs 0 h/week, p<0.001) and insulin TDD increased (0.84 vs 0.94 IU/kg/day, p=0.029). Average annual HbA1c values were comparable (62 vs 60 mmol/mol) and prevalence of patients with the last HbA1c value ≤53 mmol/mol increased (24 vs 28%, p<0.0001). Conclusions: In our patients with T1D, BMI SDS and glycemic control were maintained during the 1-year pandemic period despite the decrease of physical activity. Our data may be possibly related to the increase of telemedicine visits that allowed us to adjust patients' insulin TDD, to avoid acute complications, and also to continue educational training to start CGM, complying with safety rules to avoid COVID-19 spread.

17.
British Journal of Surgery ; 108(SUPPL 6):vi205-vi206, 2021.
Article in English | EMBASE | ID: covidwho-1569623

ABSTRACT

Introduction: 'Phonation' is the physical process by which the vocal folds produce certain sounds. According to laryngology, there are different factors that can affect our larynx (voice box) negatively, such as: Obesity, benign vocal cord lesions, sex hormones, head and neck surgeries and patients who are suffering from health complications recovered from COVID-19 after a prolonged intubation. These factors could show difficulties in voice, airway, and swallowing. Aim: This study aimed to investigate the relationship between obesity and chronic laryngitis in which this inflammation hinders phonation and voice/sound output. This investigation in South Korea using data from Korea National Health and Nutrition Examination Survey (KNHANES) collected during 2008 - 2010. Method: (KNHANES) was a cross-sectional survey of the civilian, noninstitutionalized population of South Korea (n=13,819) aged 19 years or older. Obesity status was measured by using BMI and waist circumference. Conclusions: Obese women in Korea have an elevated risk for developing chronic laryngitis. Chronic laryngitis itself is a misfortune. Chronic laryngitis (CL) causes excess mucus, a sore throat, a persistent dry cough, loss of voice and phonation and difficulty swallowing. Moreover, obese women will suffer from hormonal imbalances that show changes in their voice tones. Elevated estrogen levels cause gastric acid secretion and GERD in women. To help those patients, it is better to shift into a healthy lifestyle, manage their weight by healthy diet and exercises. In this way, a lot of complications will be lessened such as: GERD that is responsible for benign vocal cord lesions possibility. Some women who suffer from chronic laryngitis and turns into cancer decide to do neck surgery. Otolaryngologists stated common side effects from head and neck surgery include temporary or permanent loss of normal voice, impaired speech, and hearing loss.

18.
European Heart Journal ; 42(SUPPL 1):3083, 2021.
Article in English | EMBASE | ID: covidwho-1554206

ABSTRACT

Background: Acute coronary syndrome (ACS) and heart failure (HF) are frequent causes of hospitalisation and readmissions. A novel smartphone app-based model of care (TeleClinical Care-TCC) was developed to support patients after ACS or HF admission. Purpose: This randomised control trial aimed to characterise both the intervention and clinical outcomes. The primary endpoint was the incidence of 30-day readmissions. Secondary endpoints included six-month cardiac and all-cause readmissions, mortality, major adverse cardiovascular events (MACE), cardiac rehabilitation (CR) completion, medication adherence, serum low-density lipoprotein (LDL-C), quality of life, blood pressure, body mass index, waist circumference and six-minute walk distance. Additionally, cost-effectiveness and user satisfaction were evaluated. Methods: Patients were randomised 1:1 to either TCC plus usual care or usual care alone and were followed-up at six months. Intervention arm participants received the TCC app and were asked to use Bluetooth-enabled devices for measuring weight, heart rate, blood pressure and physical activity daily. Readings were automatically transmitted to the patient's smartphone and a secure web-server (KIOLA). Customisable thresholds for each parameter were defined at discharge. Abnormal readings were flagged by email to a monitoring team, who discussed management with the patient's usual healthcare providers. The app also provided educational push notifications. Results: 164 patients from two hospitals in Sydney, Australia were enrolled between February 2019 and March 2020 (TCC n=81, control n=83). Recruitment ceased during the COVID-19 pandemic. The mean age was 61.5 years. 79% of patients were male. The per-patient mean percentage of days with data transmission was 64.2±27.5%. 565 alerts were received, 16% of which resulted in additional investigations, healthcare consultation or a change in management. There was no difference in 30-day readmission rate (11 readmissions in each arm). There was a significant difference in six-month readmissions, favouring the intervention (21 vs. 41 readmissions, HR=0.40, 95% CI 0.16-0.95, P=0.03), driven by a reduction in cardiac readmissions (11 vs. 25, HR=0.51, 95% CI 0.27-0.94, P=0.03). Use of TCC was associated with improved CR completion (39% vs. 18%, P=0.025) and medication adherence (75% vs. 50%, P=0.002). There was no significant difference in mortality, MACE, LDL-C, quality of life or any of the physical parameters. The average user rating was 4.56 out of 5. The study cost EUR 4015 per readmission saved. Upon modelling, it was calculated that if the number of enrolled patients exceeds 243, total expenditure will be overcome by cost savings from reducing readmissions. Conclusion: The TCC model of care was feasible and safe. In this study, clinical benefits were demonstrated including a reduction in six-month readmissions, improved CR completion and improved medication adherence.

19.
European Heart Journal ; 42(SUPPL 1):2688, 2021.
Article in English | EMBASE | ID: covidwho-1554011

ABSTRACT

Background/Introduction: Cardiaovascular prevention/rehabilitation programmes continue to reduce cardiovascular mortality even with contemporary treatment. During covid the majority of face-to-face programmes were suspended but these services have never been more crucial as control of cardiovascular risk factors can mitigate the morbidity/mortality risk from covid. Programmes must now however be delivered in a way that reduces patient exposure. Here we describe how we rapidly transitioned our previously fully face to face cardiovascular prevention/programme to a completely virtual platform adopting Fitbit as wearable technology. Methods: The previously face-to-face initial assessment (IA) conducted by the multidisciplinary team (MDT) - nurse, dietician and physiotherapist is now delivered via video/phone as per patient preference. Patients are provided with equipment kits (tape measures, blood pressure monitors (BP), Fitbit smartwatches and Fibricheck app as required. The virtual IA includes assessment of: Smoking habit, blood pressure (BP), heart rate, lipid profile and HbA1c (taken in community phlebotomy hub), cardioprotective medications, weight, BMI, waist circumference, Mediterranean Diet Score, functional capacity via the Duke Activity Status Index, habitual activity levels, risk stratification for exercise, hospital anxiety and depression scores (HADS) and quality of life (QOL). Patients receive education and tailored advice with SMART goals as well as a written care plan. The subsequent 12 programme is comprised of • Weekly virtual meeting with cardiologist to optimise BP/lipids and medications • Alternate weekly virtual coaching consultation by MDT for monitoring/ goal resetting • Alternate weekly video group education sessions on key cardiovascular health topics • Online educational videos filmed by the MDT Monitoring of physical activity (step count, active minutes) in real time via Fibit dashboard with personalised messages sent to patients via the Fitbit app • Provision of Fibricheck app via Fibit for rhythm assessment • End of programme (EOP) assessments are then also conducted virtually Results: Between April and November 2020 n=262 had a virtual IA (94% of those offered and n=114 (95% of those offered) attended an end of programme assessment. 64% were male and the mean age was 64.1 years. Acceptance of the Fitbit device was 72% of those offered. Table 1 below shows the main clinical and patient-reported outcomes in those attending both an IA and EOP with the data for the same 6 months the year prior (face to face programme) also for comparison. Programme satisfaction ratings were high with 85% rating the programme as excellent or very good. Conclusions: Transitioning a previously fully face to face cardiac rehabilitation programme to a wholly virtual platform was feasible and acceptable to patients. Early data analysis would suggest that the virtual programme achieves similar clinical and patient reported outcomes. (Figure Presented).

20.
Exp Biol Med (Maywood) ; 247(3): 200-206, 2022 02.
Article in English | MEDLINE | ID: covidwho-1477209

ABSTRACT

An observational study was conducted in Ukraine to determine the independent mortality risks among adult inpatients with COVID-19. The results of treatment of COVID-19 inpatients (n = 367) are presented, and waist circumference (WC) was measured. Logistic regression analysis was applied to evaluate the effects of factors on the risk of mortality. Odds ratios and 95% CIs for the association were calculated. One hundred and three of 367 subjects had fasting plasma glucose level that met the diabetes mellitus criteria (≥7.0 mmol/L), in 53 patients, diabetes mellitus was previously known. Two hundred and eleven patients did not have diabetes or hyperglycemia. Diabetes mellitus/hyperglycemia odds ratio 2.5 (CI 1.0-6.1), p = 0.045 loses statistical significance after standardization by age, waist circumference or fasting plasma glucose. No effect on gender, body mass index-determined obesity, or hypertension was found. The fasting plasma glucose (>8.5 mmol/L), age (≥61 years), and waist circumference (>105 cm) categories were associated with ORs 6.34 (CI 2.60-15.4); 4.12 (CI 1.37-12.4); 8.93 (CI 3.26-24.5), respectively. The optimal model of mortality risk with AUC 0.86 (CI 0.81-0.91) included the diabetes/heperglycemia and age categories as well as waist circumference as a continued variable. Waist circumference is an independent risk factor for mortality of inpatients with COVID-19.


Subject(s)
COVID-19/etiology , COVID-19/mortality , Hyperglycemia , Waist Circumference , Aged , Body Mass Index , COVID-19/epidemiology , COVID-19/therapy , Comorbidity , Diabetes Mellitus/epidemiology , Female , Humans , Hyperglycemia/complications , Hyperglycemia/epidemiology , Length of Stay , Leukocyte Count , Male , Middle Aged , Obesity, Abdominal/epidemiology , Risk Assessment , Treatment Outcome , Ukraine/epidemiology
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