Diabetes is associated with increased risk of death in COVID-19 hospitalizations in Mexico 2020: A retrospective cohort study.

Background and Aim: The COVID-19 disease course can be thought of as a function of prior risk factors consisting of comorbidities and outcomes. Survival analysis data for diabetic patients with COVID-19 from an up to date and representative sample can increase efficiency in resource allocation. The study aimed to quantify mortality in Mexico for individuals with diabetes in the setting of COVID-19 hospitalization. Methods: This retrospective cohort study utilized publicly available data from the Mexican Federal Government, covering the period from April 14, 2020, to December 20, 2020 (last accessed). Survival analysis techniques were applied, including Kaplan-Meier curves to estimate survival probabilities, log-rank tests to compare survival between groups, Cox proportional hazard models to assess the association between diabetes and mortality risk, and restricted mean survival time (RMST) analyses to measure the average survival time. Results: A total of 402,388 adults age greater than 18 with COVID-19 were used in the analysis. Mean age = 16.16 (SD = 15.55), 214,161 males (53%). Twenty-day Kaplan-Meier estimates of mortality were 32% for COVID-19 patients with diabetes and 10.2% for those without diabetes with log-rank p < 0.01. Univariable analysis showed increased mortality in diabetic patients (hazard ratio [HR]: 3.61, 95% confidence interval [CI]: 3.54-3.67, p < 0.01) showing a 254% increase in death. After controlling for confounding variables, multivariate analysis continued to show increased mortality in diabetics (HR: 1.37, 95% CI: 1.29-1.44, p < 0.01) indicating a 37% increase in death. Multivariable RMST at Day 20 showed in Mexico, hospitalized COVID-19 patients were associated with less mean survival time by 2.01 days (p < 0.01) and a 10% increased mortality (p < 0.01). Conclusions: In the present analysis, COVID-19 patients with diabetes in Mexico had shorter survival times. Further interventions aimed at improving comorbidities in the population, particularly in individuals with diabetes, may contribute to better outcomes in COVID-19 patients.

Hospitalized COVID-19 patients with diabetes have an increased risk for pneumonia, intensive care unit requirement, intubation, and death: A cross-sectional cohort study in Mexico in 2020.

Background: Diabetes mellitus is a chronic health condition that has been linked with an increased risk of severe illness and mortality from COVID-19. In Mexico, the impact of diabetes on COVID-19 outcomes in hospitalized patients has not been fully quantified. Understanding the increased risk posed by diabetes in this patient population can help healthcare providers better allocate resources and improve patient outcomes. Objective: The objective of this study was to quantify the extent outcomes (pneumonia, intensive care unit [ICU] stay, intubation, and death) are worsened in diabetic patients with COVID-19. Methods: Between April 14, 2020 and December 20, 2020 (last accessed), data from the open-source COVID-19 database maintained by the Mexican Federal Government were examined. Utilizing hospitalized COVID-19 patients with complete outcome data, a retrospective cohort study (N = 402,388) was carried out. In relation to COVID-19, both univariate and multivariate logistic regression were used to investigate the effect of diabetes on specific outcomes. Results: The analysis included 402,388 adults (age >18) with confirmed hospitalized COVID-19 cases with mean age 46.16 (standard deviation = 15.55), 214,161 (53%) male. The outcomes delineated included pneumonia (N = 88,064; 22%), ICU requirement (N = 23,670; 6%), intubation (N = 23,670; 6%), and death (N = 55,356; 14%). After controlling for confounding variables diabetes continued to be an independent risk factor for both pneumonia (odds ratio [OR]: 1.8, confidence interval [CI]: 1.76-1.84, p < 0.01), ICU requirement (OR: 1.09, CI: 1.04-1.14, p < 0.01), intubation (OR: 1.07, CI: 1.04-1.11, p < 0.01), and death (OR: 1.88, CI: 1.84-1.93, p < 0.01) in COVID-19 patients. Conclusions: According to the study, all outcomes (pneumonia, ICU requirement, intubation, and death) were greater among hospitalized individuals with diabetes and COVID-19. Additional study is required to acquire a better understanding of how diabetes affects COVID-19 outcomes and to develop practical mitigation techniques for the risk of severe sickness and complications in this particular patient population.

Brunelleschi's mirror, Alberti's window, and Galileo's 'perspective tube'

This essay argues that the advent of linear perspective, ca. 1425, when Filippo Brunelleschi painted a small panel of the Florentine Baptistery by applying the geometric rules of optical mirror reflection, was more than just an artistic event. Indeed, it subsequently had the most profound - and quite unanticipated - influence on the rise of modern science. Surely, by 1609, Galileo would not have understood what he saw when observing the moon through his newly invented optical telescope, then called the 'perspective tube,' had it not been for his training in perspective drawing. Yet, Brunelleschi's original dependence on the mirror two centuries earlier was intended not to reveal objective 'scientific' reality, but rather to reinforce Christian spiritual 'reality.' In 1435-6, Leon Battista Alberti, when codifying Brunelleschi's perspective in his famous "Treatise on Painting," substituted a gridded window for Brunelleschi's mirror, thus redirecting the purpose of perspective art away from revealing God's divine order as reflected on earth, to a more secular physical reality viewed directly in relation to human moral order.

O presente ensaio defende que não foi somente um acontecimento artístico o advento da perspectiva linear (c. 1425), quando Filippo Brunelleschi ao pintar um pequeno painel no Batistério Florentino lançou mão das regras geométricas da reflexão em espelho ótico. Esse acontecimento veio a exercer uma profunda e inesperada influência no surgimento da ciência moderna. Com certeza, por volta de 1609, Galileu não teria compreendido o que via quando observava a lua através de seu recém-criado telescópio ótico, então chamado 'tubo de perspectiva', se não fosse sua familiaridade com o desenho em perspectiva. No entanto, a original dependência do espelho que Brunelleschi desenvolveu dois séculos antes não almejava revelar uma realidade 'científica' objetiva, mas sim reforçar a realidade espiritual cristã. Em 1435-36, Leon Battista Alberti, ao codificar a perspectiva de Brunelleschi em seu famoso "Tratado de pintura", substituiu o espelho de Brunelleschi por uma janela gradeada, assim redirecionando o propósito da arte da perspectiva, cujo intuito era não mais a revelação da ordem divina refletida na terra, mas sim de uma realidade física, mais secular, vista diretamente em sua relação com a ordem moral humana.

[Sickle cell anemia and pregnancy: review of 68 cases in Guadeloupe]. / Drépanocytose et grossesse: revue de 68 observations en Guadeloupe.

Pregnancy in women with major sickle cell syndromes is a high risk maternofetal situation. This descriptive study presents the features and the clinical course of 68 pregnancies in sickle cell women who were delivered in Guadeloupe from January 1(st) 1993 to December 31(st) 1997. Specific complications were observed in all hemoglobin types, but with a severer course in SS women. Painful vaso-occlusive crises were the main causes of hospitalisation (88% of SS pregnancies and 27% of SC pregnancies) associated most often with worsening anemia and / or infection. Acute chest syndrome was observed in all genotypes at any time throughout pregnancy and during the post partum period. One death occurred (a 16 years old SBeta(+)thal woman). Fetal mortality and morbidity were also high, intrauterine growth retardation and fetal death being the most frequent fetal complications. The rates of prematurity (21%) and caesarean section (48%) were higher than in the whole population. Three (3) neonatal deaths occurred. A multidisciplinary and specific approach, vigilance of health care providers and patient compliance are required to manage efficiently pregnancy, delivery and post partum in sickle cell women.

[Analysis of hospitalization of adult sickle-cell patients in Guadeloupe]. / Analyse des hospitalisations chez les patients drépanocytaires adultes en Guadeloupe.

PURPOSE: To determine the characteristics of acute hospitalizations in adult patient with sickle-cell disease in Guadeloupe. METHODS: We retrospectively studied clinical features of adult patients followed up by the "Centre Caribeen de la Drépanocytose" (CCD) in 1996. Data were collected from the medical records of the hospitalized patients and the longitudinal records of the CCD. RESULTS: Sixty-three (25%) of the 251 patients who were followed up by the CCD required hospitalization in 87 cases (1.38 hospitalizations/patient). Mean age of the hospitalized patients was 27.5 years (range 17 to 71 years). Most hospitalizations involved men (29 [31%] vs 34 [22%] for women, P < 0.05), and most were for homozygous patients with sickle-cell anemia: 39 (31%) SS, 19 (18.55%) SC and five (21.75%) S beta thal. A painful vaso-occlusive crisis was noted in 67 episodes. There were nine acute chest syndromes (ACS), six of them occurred following a vaso-occlusive crisis. We noted 39 infectious episodes. The increase in C-reactive protein (> 100 mg/L) was associated with ACS or urinary infection. A patient with renal failure died during septicemia. CONCLUSION: This study confirms the need for prevention of painful crises and other severe complications in patients with sickle-cell disease.

Sokolow-Lyon voltage criteria in sickle cell patients.

The electrocardiogram remains the most commonly used method of cardiac assessment in developing countries. To determine the prevalence of electrocardiographic left ventricular hypertrophy (LVH) and the clinical significance of Sokolow-Lyon voltage criteria in sickle cell patients, echocardiographic and ECG findings were studied in 112 patients (71 with haemoglobin SS disease and 41 with haemoglobin SC disease). Electrocardiographic left ventricular hypertrophy (ECGLVH) defined as Sokolow-Lyon voltage > or = 35 mm was detected in 39 (55%) SS patients and 11 (27%) SC patients. This prevalence was higher in men than in women. There were statistically significant trends for increasing prevalence of ECGLVH with height (p < 0.007 in SS, and p < 0.01 in SC, patients) and with left ventricular internal dimension (p < 0.05 in SS, and p < 0.01 in SC, patients). But no significant trend was found with increasing posterior wall (PWT) or interventricular septal thickness (IVST). Sensitivity of Sokolow-Lyon criteria for detection of echocardiographic left ventricular hypertrophy was 63% and 33% in SS and SC patients, respectively, and specificity was 51% and 74%, respectively. Sokolow-Lyon voltage correlated with left ventricular mass in SS and SC patients (r = 0.44, p < 0.01 and r = 0.32, p < 0.05) and with left ventricular internal dimension (r = 0.2, p < 0.01 and r = 0.32, p < 0.05) but not significantly with PWT and IVST. We conclude that, in sickle cell patients, the electrocardiographic LVH mainly indicates the existence of an eccentric echocardiographic LVH with increase of left ventricular internal dimension.

Sokolow-Lyon voltage criteria in sickle cell patients

The electrocardiogram remains the most commonly used method of cardiac assessment in developing countries. To determine the prevalence of electrocardiographic left ventricular hypertrophy (LVH) and the clinical significance of Sokolow-Lyon voltage criteria in sickle cell patients, echocardiographic and ECG findings were studied in 112 patients (71 with haemoglobin SS disease and 41 with haemoglobin SC disease). Electrocardiographic left ventricular hypertrophy (ECGLVH) defined as Sokolow-Lyon voltage > or = 35 mm was detected in 39 (55) SS patients and 11 (27) SC patients. This prevalence was higher in men than in women. There were statistically significant trends for increasing prevalence of ECGLVH with height (p < 0.007 in SS, and p < 0.01 in SC, patients) and with left ventricular internal dimension (p < 0.05 in SS, and p < 0.01 in SC, patients). But no significant trend was found with increasing posterior wall (PWT) or interventricular septal thickness (IVST). Sensitivity of Sokolow-Lyon criteria for detection of echocardiographic left ventricular hypertrophy was 63and 33in SS and SC patients, respectively, and specificity was 51and 74, respectively. Sokolow-Lyon voltage correlated with left ventricular mass in SS and SC patients (r = 0.44, p < 0.01 and r = 0.32, p < 0.05) and with left ventricular internal dimension (r = 0.2, p < 0.01 and r = 0.32, p < 0.05) but not significantly with PWT and IVST. We conclude that, in sickle cell patients, the electrocardiographic LVH mainly indicates the existence of an eccentric echocardiographic LVH with increase of left ventricular internal dimension.

Sokolow-Lyon voltage criteria in sickle cell patients

The electrocardiogram remains the most commonly used method of cardiac assessment in developing countries. To determine the prevalence of electrocardiographic left ventricular hypertrophy (LVH) and the clinical significance of Sokolow-Lyon voltage criteria in sickle cell patients, echocardiographic and ECG findings were studied in 112 patients (71 with haemoglobin SS disease and 41 with haemoglobin SC disease). Electrocardiographic left ventricular hypertrophy (ECGLVH) defined as Sokolow-Lyon voltage greater than or equal to 35 mm was detected in 39 (55 percent) SS patients and 11 (27 percent) SC patients. This prevalence was higher in men than in women. There were statistically significant trends for increasing prevalence of ECGLVH with height (p<0.007 in SS, and p<0.01 in SC patients). But no significant trend was found with increasing posterior wall (PWT) or interventricular septal thickness (IVST). Sensitivity of Sokolow-Lyon criteria for detection of echocardiographic left ventricular hypertrophy was 63 percent and 33 percent in SS and SC patients, respectively, and specificity was 51 percent and 74 percent, respectively. Sokolow-Lyon voltage correlated with left ventricular mass in SS and SC patients (r = 0.44, p < 0.01 and r = 0.32, p < 0.05) and with left ventricular internal dimension (r = 0.2, p < 0.01 and r = 0.32, p < 0.05) but not significantly with PWT and IVST. We conclude that, in sickle cell patients, the electrocardiographic LVH mainly indicates the existence of an eccentric echocardiographic LVH with increase of left ventricular internal dimension.(AU)

Morphological features of the human umbilical vein in normal, sickle cell trait, and sickle cell disease pregnancies.

Pathological changes often occur in the placenta of women with sickle cell disease (SCD). These alterations are caused by sickling of erythrocytes and vasoocclusion in the placental circulation, leading to regional hypoxia. However, the morphological status of the umbilical cord, which is in close physical association with the placenta, is not documented under such conditions. To explore this, the umbilical vein structure in healthy, sickle cell trait (the heterozygous state), and SCD pregnancies was studied using scanning (SEM) and transmission electron microscopy (TEM). Interestingly, the sickle cell trait umbilical vein architecture was morphologically similar to that in control veins, whereas numerous alterations were seen in the SCD umbilical vein wall. In SEM, the SCD umbilical vein endothelial cells showed atypical morphologies. TEM analysis of the tunica media showed (1) smooth muscle cell proliferation and increase in the thickness of the basement membrane underlying the cells; (2) areas of necrosis; (3) reduplication of the inner elastic lamina. Such features were often seen in sickle patients vasculature at autopsy. Our findings could have importance because tissue hypoxemia is an integral part of vasoocclusion. We conclude that the SCD umbilical vein may be an additional tool for studying vasoocclusion in sickle cell disease.

[Natural history of sickle cell anemia]. / Histoire naturelle de la drépanocytose.

Sickle-cell anaemia is characterized by three categories of clinical signs: anaemia, vaso-occlusive phenomena and infective complications, which are described here according to age. The natural history of the disease can be divided into four periods: the neonatal period which is asymptomatic but important to organize an effective protection; the first 5 years of life are characterized by a high risk of mortality, a high level of morbidity due to severe infections, episodes of acute anaemia and painful crises typical of that age-group; the life of older children and adolescents is dotted with painful crises; it is in this period that degenerative tissue pathology begins; in adulthood, the acute episodes are less frequent, but multiple complications develop. Some of them (cerebral vascular accidents or lung diseases) may be fatal, while others are the source of chronic and disabling lesions, notably ocular, orthopaedic and renal lesions, which affect the functional prognosis. Pregnancy remains a high risk. There is, therefore, a striking contrast between the basic physiopathological mechanism (polymerization of haemoglobin S) and the various clinical manifestations which depend on the type of haemoglobin, on the social and sanitary conditions in each country and on other reasons which remain to be elucidated.