Diabetes and COVID-19 Outcomes: An Analysis of Freeman Health System Patients.

BACKGROUND: As COVID-19 continues to affect millions of people around the world, it has become vital to understand how comorbidities such as diabetes affect the health outcomes of these patients. While earlier studies have focused on major metropolitan areas, rural settings have been comparatively understudied. The goal of this study is to understand the effect on mortality that these two diseases have in the inpatient setting of a rural population. METHODS: The electronic medical records of all adult patients admitted to Freeman Health System, Joplin, Missouri, United States, between April 1, 2020, and December 31, 2021, were reviewed for the presence of COVID-19 infection and/or diabetes (type I and type II). Freeman Health is a major health system headquartered in Southwest Missouri. Diagnoses were obtained through the use of standard International Classification of Disease, 10th edition (ICD-10) codes. The initial data set consisted of 19,323 admissions. After excluding duplicate admissions and those who had already been infected with COVID-19, 1,729 patients with COVID-19, 172 patients with type I diabetes, and 3,992 patients with type II diabetes were included in the analysis of inpatient all-cause mortality. We hypothesized that patients with type I and type II diabetes would both show an increased risk of all-cause mortality. Mortality in the context of our study results refers to all-cause mortality. RESULTS: The all-cause mortality rate was 19.94% (137/687, with a 95% confidence interval (CI) of 16.95%-22.93%) in patients admitted with both diabetes (the combined type I and type II subsets) and COVID-19 (P1). The mortality rate was 16.03% (167/1042, with 95% CI of 13.80%-18.25%) in patients admitted with COVID-19 who did not have diabetes (P2). Patients admitted with a comorbid diagnosis of diabetes but without COVID-19 (P5) had a much lower mortality rate of 5.98% (249/4164, with a 95% CI of 5.26%-6.70%). The combination of both COVID-19 and diabetes together was associated with a higher mortality rate than either of the two separately. The mortality rate was additionally elevated in patients with both type II diabetes and COVID-19 (P4) (134/663, mortality rate of 20.21% with 95% CI of 17.15%-23.27%) versus those with COVID-19 without diabetes (P2) (167/1042, 16.03% with 95% CI of 13.80%-18.25%), an overall difference of 4.18% (95% CI of 0.40%-7.94%). The subset of patients with type I diabetes with COVID-19 (P3) and type I diabetes without COVID-19 (P6) were too small to accurately power individual analysis. The subset of patients with diabetes (type I and type II) and without COVID-19 (P5) had the lowest mortality rate of any subset adequately powered for analysis at 5.98% (249/41464, CI of 5.26%-6.70%).  Conclusions: The results of this study show that type II diabetes is a significant risk factor for mortality in admitted COVID-19 patients. P4 had the highest overall mortality of any subset studied. The study was underpowered to show if type I diabetes patients, with and without COVID-19, had an increased mortality when analyzed separately. COVID-19 significantly increased mortality in all subsets adequately powered for full analysis.

Exploring the Influence of a Pandemic on Medical Education.

A shift occurred in medical school education due to the novel coronavirus disease-19 (COVID-19) pandemic. It has been more than a year since the start of the pandemic, and many medical schools have had to adapt quickly. The medical school curriculum had to be changed in order to accommodate the risk of the virus, which has caused an interruption in clinical education for both preclinical and clinical medical students. Limited hands-on labs, remote standardized patient encounters, telemedicine education and other substitutes have been used to bridge this gap within in-person learning. This review discusses the changes in curricula that some schools have taken, and the benefits and disadvantages of these selected methods.

Patient perspectives of an individualized diabetes care management plan.

PURPOSE: This cross sectional study examines patients' knowledge, attitudes and beliefs about a diabetic care management plan (DCMP) that was developed to provide patient education on diabetes guidelines and display individual diabetic core measures. Secondary objectives included a comparison of diabetic core measures [hemoglobin A1C (HbA1C), systolic and diastolic blood pressure (SBP, DBP), low-density lipoprotein (LDL) and urine microalbumin (Um)] before and after DCMP implementation. We hypothesize this tool will contribute to patients' awareness of current disease status, diabetes knowledge and diabetic core value improvement over time. METHODS: A consecutive sample of 102 adult patients with diabetes mellitus type 2 in a primary care setting participated. Patients' perspectives on the care plan and knowledge about diabetes was collected via survey after care plan implementation. A comparison of selected diabetic core measures was conducted at baseline and post-DCMP. Descriptive statistics summarized survey response and diabetic core measures. A repeated measures ANOVA was used to assess change in diabetic core measures over time. RESULTS: Participants understood the DCMP (96%), found it important because it explained their laboratory results and medications (89%) and believed it would help them to have better diabetic control (99%). There was a significant interaction between time and being at goal pre-DCMP for HbA1c, SBP and LDL. Patients not at goal pre-DCMP for the above measures decreased significantly over time (P = <0.01 for HbA1c, SBP and LDL). Participants at goal for all diabetic core measures increased pre- to post-DCMP from 13% to 20% (P = 0.28). CONCLUSION: Patients perceived the diabetic care management plan favorably and their diabetic core measurements improved over time. This simple and reproducible self-management intervention can enhance self-management in a patient population with diabetes mellitus type 2.

Diagnosis and Management of Hepatitis C.

Hepatitis C virus (HCV) infection, a major cause of chronic liver disease and cirrhosis, is predominantly transmitted by exposure to blood or body fluids. The infection progresses to a chronic state in 80% of patients, whereas the virus clears completely after the acute infection in 20% of patients. Screening for HCV with an anti-HCV antibody test is recommended for all adults at high risk of infection, and one-time screening is recommended in adults born between 1945 and 1965. If the anti-HCV antibody test result is positive, current infection should be confirmed with a qualitative HCV RNA test. In patients with confirmed HCV infection, quantitative HCV RNA testing and testing for HCV genotype is recommended. An assessment of the degree of liver fibrosis with liver biopsy or noninvasive testing is necessary to determine the urgency of treatment. Treatment of patients with chronic HCV infection should be considered based on genotype, extent of fibrosis or cirrhosis, prior treatment, comorbidities, and potential adverse effects. The goal of therapy is to reduce all-cause mortality and liver-associated complications. Although interferon-based regimens have been the mainstay of treatment for HCV infection, the U.S. Food and Drug Administration recently approved two combination-pill interferon-free treatments (ledipasvir plus sofosbuvir, and ombitasvir/paritaprevir/ritonavir plus dasabuvir) for chronic HCV genotype 1.

Emerging roles for PAX8 in ovarian cancer and endosalpingeal development.

OBJECTIVES: Epithelial ovarian carcinomas develop from ovarian surface epithelia that undergo complex differentiation to form distinguishable phenotypes resembling those of the epithelia of the female urogenital regions. While previous studies have implicated regulatory developmental homeobox (HOX) genes in this process, other factors responsible for this differentiation are largely unknown. Aberrant transcriptional expression of PAX8 has been reported in epithelial ovarian cancer, prompting us to initiate the molecular characterization of this master regulatory gene in ovarian cancer development. METHODS: Immunohistochemistry, immunoblotting and RT-PCR were used to investigate the presence of PAX8 and its protein products in epithelial ovarian cancer subtypes, normal ovarian surface epithelia, ovarian inclusion cysts and normal endosalpingeal epithelia. RESULTS: In this report, we confirm microarray results indicating that the transcription factor, PAX8, is highly expressed in epithelial ovarian cancer but absent from the precursor ovarian surface epithelia of healthy individuals. Furthermore, we report that PAX8 is localized to the nucleus of non-ciliated epithelia in simple ovarian epithelial inclusion cysts and in three epithelial ovarian cancer subtypes (serous, endometrioid and clear cell). We also determined that PAX8 is expressed in the non-ciliated, secretory cells of healthy fallopian tube mucosal linings but not in the adjacent ciliated epithelia. CONCLUSION: These findings support the hypothesis that PAX8 plays parallel roles in the development of epithelial ovarian cancer and in the developmental differentiation of coelomic epithelia into endosalpingeal epithelia.