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  • Klitgaard Greenberg posted an update 10 months, 2 weeks ago

    We discuss how exceptional characteristics may mislead clinicians, including misperception about lower risk due to gender, East Asian predisposition to intracranial more than coronary atherosclerosis, high levels of high density lipoprotein cholesterol (HDL-C), and CACS = 0.

    To evaluate the non-alcoholic fatty liver disease (NAFLD) fibrosis score (NFS) and Fibrosis-4 score (FIB4) as predictors of complications development and mortality in a cohort of type 2 diabetes.

    554 type 2 diabetic subjects had NFS and FIB4 calculated at baseline. Multivariate Cox and Poisson analyses evaluated the associations between fibrosis scores and the occurrence of microvascular and cardiovascular complications, and all-cause mortality.

    According to recommended cut-offs of NFS, 12.8% had advanced fibrosis and 45.9% had absence of advanced fibrosis and of FIB4, 3.8% and 86.1%, respectively. During a median follow-up of 11 years, 217subjects died, 172 had cardiovascular events (CVEs), 184 had renal events, and 139 had retinopathy and 185 neuropathy events. As continuous variables, both scores predicted all-cause mortality NFS, HR 1.30 (p = 0.032) and FIB4, HR 1.24 (p = 0.021); an increased NFS implied in a significant 90% excess risk of mortality, whereas a higher FIB4 in a borderline 69% higher risk. The scores were mainly predictors of mortality in women and for non-cardiovascular deaths. The NFS was a predictor of renal events, mainly for renal function deterioration.

    The NFS and FIB4 predicted all-cause mortality, particularly in women and for non-cardiovascular causes. The NFS predicted adverse renal outcomes. These liver fibrosis scores may improve stratification risk in individuals with diabetes and NAFLD.

    The NFS and FIB4 predicted all-cause mortality, particularly in women and for non-cardiovascular causes. The NFS predicted adverse renal outcomes. These liver fibrosis scores may improve stratification risk in individuals with diabetes and NAFLD.

    To analyze trajectories of psychosocial health among people with diabetes during the first three months of lockdowns and reopenings of the COVID-19 pandemic in Denmark.

    An online longitudinal survey of 2430 people with diabetes consisting of six questionnaire waves (Q1-Q6) was conducted between March 19 and June 25, 2020. Psychosocial outcomes assessed were COVID-19 worries, quality of life, feelings of social isolation, psychological distress, diabetes distress, anxiety, and general and diabetes-specific loneliness. Trajectories in psychosocial health were analyzed with linear multilevel mixed-effects models. Subgroup analyses were conducted.

    In total, 1366 (56%) people with diabetes responded to the first questionnaire. Cyclopamine solubility dmso COVID-19 worries, feelings of social isolation, psychological distress, anxiety and general loneliness had all improved at Q6 compared to Q1 (p < 0.001). In general, improvements in psychosocial health started after the first reopening phase (April 15); however, general loneliness increased up to the first reopening phase (p ≤  0.001) before decreasing, and quality of life decreased up to the first reopening phase (p = 0.002), with no improvements to follow. Subgroup analyses revealed that women had larger decreases in feelings of social isolation (p < 0.001) and in psychological distress (p = 0.035) and increases in quality of life (p < 0.001), between Q1 and Q6, compared to men.

    Psychosocial health in people with diabetes improved following reopening of society. However, increases in loneliness and decreases in quality of life during lockdown indicates a potential need to mitigate the acute effects of such policies.

    Psychosocial health in people with diabetes improved following reopening of society. However, increases in loneliness and decreases in quality of life during lockdown indicates a potential need to mitigate the acute effects of such policies.

    Determining early and reliable prognosis in comatose subjects after cardiac arrest is a central component of post-cardiac arrest care both for developing realistic prognostic expectations for families, and for better determining which resources are mobilized or withheld for individual patients. The aim of the study was to evaluate the prognostic accuracy of EEG and SEP patterns during the very early period (within the first 6 h) after cardiac arrest.

    We retrospectively analysed comatose patients after CA, either inside or outside the hospital, in which prognostic evaluation was made during the first 6 h from CA. Prognostic evaluation comprised clinical evaluation (GCS and pupillary light reflex) and neurophysiological (electroencephalography (EEG) and somatosensory evoked potentials (SEP)) studies. Prognosis was evaluated with regards to likelihood of recovery of consciousness and also likelihood of failure to regain consciousness.

    Forty-one comatose patients after cardiac arrest were included. All patiam allows identification of patients with very high probability of a good outcome, allowing rapid use of the most appropriate therapeutic procedures.In this retrospective cohort study, we analysed treatment and outcomes among ≥65-year-old patients who experienced a traumatic pretibial laceration in the province of Kymenlaakso, Finland, between 2015 and 2019. We reviewed computerised medical records for 116 patients with a pretibial laceration, 107 of whom we analysed in further detail. Patients were traced from injury to healing, including rehabilitation periods in health care centres. As expected, the majority of patients were elderly women (67%). Most lacerations were superficial and small, explaining why treatment was mostly conservative. Only 11 (9.48%) patients were treated operatively with surgical debridement or a split-thickness skin graft. The number of overall complications in wounds was high, with a complication rate of 30.2%. Most complications were local wound infections. We found that wound healing took more than 3 months in 32% of patients. Thorough patient tracing revealed numerous follow-up visits and long rehabilitative hospitalisation periods, indicating a significant decline in patient independence and the excessive use of resources. Successful wound healing was eventually observed in 89.66% patients. Furthermore, no terminology regarding pretibial lacerations was found in patient records. This study indicates that pretibial lacerations remain poorly recognised and understood in Finland.