ABSTRACT
BACKGROUND: Type 2 diabetes mellitus (T2DM) is usually accompanied by a low-grade inflammatory phenomenon, which participates in the pathogenesis of different complications of this condition. The inflammatory response is under the regulation of different mechanisms, including T regulatory (Treg) lymphocytes. However, the possible role of type 1 T regulatory (Tr1) cells in T2DM has not been explored so far. AIM: To carry out a quantitative analysis of Tr1 lymphocytes and other immune cell subsets in patients with T2DM and correlate these results with clinical findings and treatments. MATERIALS AND METHODS: Sixty patients with T2DM and twenty-three healthy controls were included in the study. Biochemical and anthropometric variables were evaluated, and Tr1 lymphocytes (CD4+CD49+LAG-3+IL-10+) and other cell subsets (Th17, Th22 and Foxp3 + Treg cells) were analyzed in peripheral blood samples by multiparametric flow cytometry. RESULTS: Significant increased levels of Tr1 cells were detected in patients with severe and mild disease, compared to healthy controls. In addition, CD4+IL-10+ lymphocytes were also increased in patients with T2DM. In contrast, similar levels of Foxp3+ Treg cells, Th17 and Th22 lymphocytes were observed in patients and controls. Likewise, no significant associations were detected between Tr1 cell levels and different clinical and laboratory parameters. However, those patients receiving glucagon-like peptide-1 receptor agonists (GLP-1-RA) showed similar levels of Tr1 cells than healthy controls, and significant lower numbers than untreated patients. CONCLUSION: We observed an increase in Tr1 and CD4+IL10+ lymphocyte levels in T2DM. Moreover, GLP1-RA treatment was significantly associated with normalization of the Tr1 levels. This highlights another potential immune dysfunction in patients with T2DM, which could participate in the pathogenesis of this condition.
Subject(s)
Diabetes Mellitus, Type 2 , T-Lymphocytes, Regulatory , Humans , Diabetes Mellitus, Type 2/immunology , Diabetes Mellitus, Type 2/blood , Male , Female , Middle Aged , T-Lymphocytes, Regulatory/immunology , Case-Control Studies , Adult , Aged , Flow Cytometry/methodsABSTRACT
INTRODUCTION: A small percentage of patients will develop a severe form of COVID-19 caused by SARS-CoV-2 infection. Thus, it is important to predict the potential outcomes identifying early markers of poor prognosis. In this context, we evaluated the association of SARS-CoV-2 infection with lipid abnormalities and their role in prognosis. METHODS: Single-center, retrospective, observational study of COVID-19 patients admitted from March to October 2020. Clinical and laboratory data, comorbidities, and treatments for COVID-19 were evaluated. Main outcomes including intensive care unit (ICU) admission and mortality were analyzed with a multivariable Cox proportional hazards regression model. RESULTS: We selected 1489 from a total of 2038 consecutive patients with confirmed COVID-19, who had a complete lipid profile before ICU admission. During the follow-up performed in 1109 patients, we observed a decrease in T-c, HDL-c, and LDL-c in 28.6%, 42.9%, and 30.4% of patients, respectively, and an increase in TG in 76.8%. The decrease of both T-c and HDL- c was correlated with a decrease in albumin levels (r = 0.39 and r = 0.37, respectively). Kaplan-Meier survival curves found an increased ICU admission in patients with lower T-c (HR 0.55, CI 0.36-0.86), HDL-c (HR 0.61, CI 0.45-0.84), and LDL-c (HR 0.85, CI 0.74-0.97). Higher values of T-c (HR 0.45, CI 0.36-0.57), HDL-c (HR 0.66, CI 0.54-0.81), and LDL-c (HR 0.86, CI 0.78-0.94) showed a protective effect on mortality. CONCLUSIONS: Abnormalities in lipid profile are a frequent complication of SARS-CoV-2 infection and might be related to morbidity and mortality. FUNDING: Proyectos de Investigación en Salud (FIS) and cofinanced by FEDER.
Subject(s)
COVID-19 , Humans , Intensive Care Units , Lipids , Retrospective Studies , Risk Factors , SARS-CoV-2Subject(s)
COVID-19/complications , Graves Disease/virology , SARS-CoV-2 , Female , Humans , Middle Aged , RecurrenceABSTRACT
Objetivo. Analizar el nivel de desgaste profesional o burnout que presentaban los médicos de atención primaria de Ávila y la influencia de factores sociales, laborales y de salud en la aparición del mismo. Material y métodos. Se realizó un estudio epidemiológico transversal y descriptivo dirigido a todo el personal médico de atención primaria de Ávila durante el primer semestre de 2011, mediante 2 cuestionarios: el Maslach Burnout Inventory y otro de variables sociodemográficas, laborales y de salud. Resultados. Se obtuvo una tasa de respuesta del 51,8%. La edad media fue de 48,55 ± 8,16. El 52% eran varones, casados el 77%, con plaza en propiedad el 45%, trabajando en centros rurales el 78% y realizando guardias más consulta el 82%. La prevalencia en nuestro estudio resultó ser baja, 16% en su grado grave. Constatamos una alta prevalencia de la enfermedad, 68%, en su grado grave o moderado/grave. Estar casado (p = 0,012), no hacer guardias (p < 0,0001), trabajar en zona rural (p = 0,008) y ser médico de área (p = 0,03) predispone a padecer burnout en grado grave o moderado/grave. Conclusiones. Encontramos un nivel moderado de burnout. Al contrario de lo que pensaban muchos facultativos, la prevalencia de la enfermedad en su forma grave fue baja, pero sí fue elevada al considerar en conjunto los grados grave y moderado/grave. Por tanto, se deberían extender medidas para reducir el estrés laboral de los médicos con el fin de una mejor práctica laboral y eficiencia profesional (AU)
Objective. To determine the level of burnout in general practitioners of Avila and the influence of social, occupational and health factors. Material and methods. A descriptive cross-sectional epidemiological study was conducted and aimed at all Primary Care medical staff of Avila during the first half of 2011, using two questionnaires: the Maslach Burnout Inventory and other sociodemographic, health and occupational variables. Results. A response rate of 51.8% was obtained. The mean age was 48.55 ± 8.16, and 52% were male, 77% married, 45% with tenure, 78% worked in rural centres, and, 82% performed out of hours home visits plus clinics. The prevalence of severe burn out was low (16%) in our study was low. A high prevalence (68%) of moderate/severe level of the condition was found. Being married (P = .012), do not guards (P < .0001), working in rural areas (P = .008), and to be an area doctor (p=.03), predisposes to suffer burnout in severe or moderate/severe burnout. Conclusions. A moderate level of burnout was found. Contrary to what many doctors thought, the prevalence of the condition in its severe form was low, but was high when taking the severe and moderate/severe forms together. Therefore, measures should be extended to reduce occupational stress of doctors, in order to improve working practices and professional efficiency (AU)
Subject(s)
Humans , Male , Female , Burnout, Professional/epidemiology , Burnout, Professional/prevention & control , Health Personnel/organization & administration , Health Personnel/standards , Primary Health Care/methods , Primary Health Care/standards , Primary Health Care , Stress, Psychological/epidemiology , Stress, Psychological/prevention & control , Health Personnel , Surveys and Questionnaires , Stress, Psychological/physiopathology , Stress, Psychological/psychology , Family Practice/methods , Family Practice/organization & administration , Cross-Sectional Studies/methods , Cross-Sectional Studies , 28599ABSTRACT
OBJECTIVE: To determine the level of burnout in general practitioners of Avila and the influence of social, occupational and health factors. MATERIAL AND METHODS: A descriptive cross-sectional epidemiological study was conducted and aimed at all Primary Care medical staff of Avila during the first half of 2011, using two questionnaires: the Maslach Burnout Inventory and other sociodemographic, health and occupational variables. RESULTS: A response rate of 51.8% was obtained. The mean age was 48.55±8.16, and 52% were male, 77% married, 45% with tenure, 78% worked in rural centres, and, 82% performed out of hours home visits plus clinics. The prevalence of severe burn out was low (16%) in our study was low. A high prevalence (68%) of moderate/severe level of the condition was found. Being married (P=.012), do not guards (P<.0001), working in rural areas (P=.008), and to be an area doctor (p=.03), predisposes to suffer burnout in severe or moderate/severe burnout. CONCLUSIONS: A moderate level of burnout was found. Contrary to what many doctors thought, the prevalence of the condition in its severe form was low, but was high when taking the severe and moderate/severe forms together. Therefore, measures should be extended to reduce occupational stress of doctors, in order to improve working practices and professional efficiency.
