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Background: Severe progression of coronavirus disease 2019 (COVID-19) causes respiratory failure and critical illness. Recently, COVID-19 has been associated with heparanase (HPSE)-induced endothelial barrier dysfunction and inflammation, so called endothelitis, and therapeutic treatment with heparin or low-molecular-weight heparin (LMWH) targeting HPSE has been postulated. Because, up to this date, clinicians are unable to measure the severity of endothelitis, which can lead to multiorgan failure and concomitant death, we investigated plasma levels of HPSE and heparin-binding protein (HBP) in COVID-19 intensive care patients to render a possible link between endothelitis and these plasma parameters. Therefore, a prospective prolonged cohort study was conducted, including 47 COVID-19 patients from the intensive care unit. Plasma levels of HPSE, and HBP were measured daily by enzyme-linked immunosorbent assay in survivors (n = 35) and nonsurvivors (n = 12) of COVID-19 from admission until discharge or death. All patients were either treated with heparin or LMWH, aiming for an activated partial thromboplastin time of ≥60 seconds or an anti-Xa level of >0.8 IU/mL using enoxaparin, depending on the clinical status of the patient (patients with extracorporeal membrane oxygenation or >0.1 μg/kg/min noradrenaline received heparin, all others enoxaparin). Results: We found significantly higher plasma levels of HPSE and HBP in survivors and nonsurvivors of COVID-19, compared with healthy controls. Still, interestingly, plasma HPSE levels were significantly higher (P < 0.001) in survivors compared with nonsurvivors of COVID-19. In contrast, plasma HBP levels were significantly reduced (P < 0.001) in survivors compared with nonsurvivors of COVID-19. Furthermore, when patients received heparin, they had significantly lower HPSE (P = 2.22e - 16) and significantly higher HBP (P = 0.00013) plasma levels as when they received LMWH. Conclusion: Our results demonstrated that patients, who recover from COVID-19-induced vascular and pulmonary damage and were discharged from the intensive care unit, have significantly higher plasma HPSE level than patients who succumb to COVID-19. Therefore, HPSE is not suitable as marker for disease severity in COVID-19 but maybe as marker for patient's recovery. In addition, patients receiving therapeutic heparin treatment displayed significantly lower heparanse plasma level than upon therapeutic treatment with LMWH.

Acute gastroenteritis is an important cause of preventable acute kidney injury (AKI). Inadequate or delayed restoration of diarrheal losses results in a very high incidence of AKI. Diarrheal illness is a major reason for hospitalization, but data on consequent acute kidney injury are sparse. The objective of the study is to determine the incidence of AKI in infectious and noninfectious diarrheal illness requiring hospitalization and to identify correlates and outcomes of diarrhea-associated AKI. None of the patients had any organism isolated in stool, probably due to prompt initiation of antibiotics/inadequate culture growth. Three out of our 6 cases did not require hemodialysis (HD) and AKI resolved on conservative management alone (fluids, electrolyte management, and antibiotics). Three out of 6 cases had nonresolving AKI and were dependent on renal replacement therapy (RRT) even at 1 month after discharge as they remained oliguric. One recent paper has reported the recovery of renal function after a period of dialysis. Frequent electrolyte abnormalities, risk of (catheter-related/bloodstream) infections, and severity of the primary disease are the chief reasons for the persistently high morbidity. Although, there was no mortality in our study.

Background Patients with cancer have an increased risk of atrial fibrillation (AF). However, there is a paucity of information regarding the association between cancer type and risk of AF. Objectives This study sought to evaluate the risk of AF according to the type of cancer. Methods We enrolled 816,811 patients who were diagnosed with cancer from the Korean National Health Insurance Service database between 2009 and 2016. Age- and sex-matched noncancer control subjects (1:2; n = 1,633,663) were also selected. Newly diagnosed AF was identified based on the type of cancer. Results During a median follow-up of 4.5 years, AF was newly diagnosed in 25,356 patients with cancer (6.6 per 1,000 person-years). In multivariable Fine and Gray’s regression analysis, cancer was an independent risk factor for incident AF (adjusted subdistribution hazard ratio [aHR]: 1.63; 95% confidence interval [CI]: 1.61 to 1.66). Multiple myeloma showed a higher association with incident AF (aHR: 3.34; 95% CI: 2.98 to 3.75). Esophageal cancer showed the highest risk among solid cancers (aHR: 2.69; 95% CI: 2.45 to 2.95), and stomach cancer showed the lowest association with AF risk (aHR: 1.27; 95% CI 1.23 to 1.32). Conclusions Although patients with cancer were found to have a higher risk of AF, the impact on AF development varied by cancer type., Central Illustration

Hearing impairment is one of the complications in diabetes mellitus; however, there are very few therapeutic studies on it. In this study, we investigated the protective effect of alpha-lipoic acid (ALA) on hearing loss in diabetic transgenic zebrafish and confirmed that ALA protects the loss of hair cells (HCs) caused by hyperglycemia. The data indicated that ALA has a protective effect on the damage to HCs in diabetic zebrafish.

Irrespective of the definition and diagnostic criteria used, the term prediabetes denotes a state of dysmetabolism with a high risk of progression to diabetes mellitus. Although diabetes-related complications may already be evident among individuals with prediabetes, interventions at this stage primarily aim to hinder the development of overt hyperglycemia rather than to prevent complications. Current recommendations for prediabetes testing are common across all adult age categories. Recent evidence arising from the prospective investigation of the natural course of prediabetes among elderly individuals pose questions regarding the benefits of meticulous prediabetes screening in this age group. In view of this and due to the lack of sufficient data to concretely support a positive impact of further preventive strategies among older individuals, screening recommendations should be reevaluated to target selected elderly individuals who are most likely to benefit in terms of quality of life and prognosis. Further therapeutic measures should be tailored to the inherent features of this frail age group, in order to exert a meaningful effect on overall health status.

Aims: To identify factors predicting HbA1c reduction in patients with diabetes mellitus (DM) using FreeStyle Libre Flash Glucose Monitoring (FSL-FGM).Methods: Data from a 12-month prospective nation-wide FSL registry were used and analysed with multivariable regression. For the present study we included patients with hypoglycaemia unawareness or unexpected hypoglycaemias (n = 566) and persons who did not reach acceptable glycaemic control (HbA1c > 70 mmol/mol (8.5%)) (n = 294). People with other indications for use, such as sensation loss of the fingers or individuals already using FSL-FGM or rtCGM, were excluded (37%).Results: Eight hundred and sixty persons (55% male with a mean age of 46.7 (+/- 16.4) years) were included. Baseline HbA1c was 65.1 (+/- 14.5) mmol/mol (8.1 +/- 1.3%), 75% of the patients had type 1 DM and 37% had microvascular complications. Data concerning HbA1c was present for 482 (56.0%) at 6 months and 423 (49.2%) persons at 12 months. A significant reduction in HbA1c (>= 5 mmol/mol (0.5%)) was present in 187 (22%) persons. For these persons, median HbA1c reduction was -9.0 [-13.0, -4.0] mmol/mol (-0.82 [-1.19, -0.37]%) at 6 months and -9.0 [-15.0, -7.0] mmol/mol (-0.82 [-1.37, -0.64]%) at 12 months. In multi-variable regression analysis with age, gender and SF-12 physical and mental component scores as covariates, only baseline HbA1c was significant: -0.319 (SE 0.025; p Conclusions: Among the variables we analysed in the present study, only high HbA1c at baseline predicts significant HbA1c reduction during FSL-CGM use.

Objective To evaluate surgical outcome, complications, and patients satisfaction with the Tube® (Promedon, Cordoba, Argentina) malleable penile prosthesis in diabetic and non-diabetic patients with refractory erectile dysfunction (ED). Patients and methods The records of 128 eligible patients who received Tube malleable penile prostheses at our institute between September 2008 and October 2015 were reviewed. Results Of the 128 patients, who received Tube penile prostheses at our institute, 53 were diabetics and 75 were non-diabetics. Both groups of patients were comparable for mean age, education level, marital status, hospital stay, time to commencing sexual intercourse, and median follow-up. Complications included: inter-corporeal septal perforation (2.3%), glanular urethral injury (1.5%), acute urinary retention (3.9%), superficial wound infection (7%), penile discomfort (9.4%), and penile prostheses infection (5.5%). Moreover, 3.9% developed atrophy of the cavernosal tissue, 5.5% experienced bad cosmesis, 6.3% experienced ejaculatory disorders, and 2.3% developed bladder calculi. In all, 13 prostheses (9.4%) were removed, seven of them due to infection, three on the patients’ demand and three due to mechanical failure. The satisfaction rates with the prostheses were 77.3% and 79.4% in the diabetic and non-diabetic patients, respectively; with an overall satisfaction rate of 78.5%. There was no significant difference in the complication rate or prostheses infection between diabetic and non-diabetic patients. Conclusion Tube malleable penile prostheses are associated with low complication and high satisfaction rates. There was no significant difference in the complication rate or prostheses infection between diabetic and non-diabetic patients. A prospective comparative study with a large number of patients is recommended.

Background Vanadium (V) is an element with a wide range of effects on the mammalian organism. The ability of this metal to form organometallic compounds has contributed to the increase in the number of studies on the multidirectional biological activity of its various organic complexes in view of their application in medicine. Objective This review aims at summarizing the current state of knowledge of the pharmacological potential of V and the mechanisms underlying its anti-viral, anti-bacterial, anti-parasitic, anti-fungal, anti-cancer, anti-diabetic, anti-hypercholesterolemic, cardioprotective, and neuroprotective activity as well as the mechanisms of appetite regulation related to the possibility of using this element in the treatment of obesity. The toxicological potential of V and the mechanisms of its toxic action, which have not been sufficiently recognized yet, as well as key information about the essentiality of this metal, its physiological role, and metabolism with certain aspects on the timeline is collected as well. The report also aims to review the use of V in the implantology and industrial sectors emphasizing the human health hazard as well as collect data on the directions of further research on V and its interactions with Mg along with their character. Results and Conclusions Multidirectional studies on V have shown that further analyses are still required for this element to be used as a metallodrug in the fight against certain life-threatening diseases. Studies on interactions of V with Mg, which showed that both elements are able to modulate the response in an interactive manner are needed as well, as the results of such investigations may help not only in recognizing new markers of V toxicity and clarify the underlying interactive mechanism between them, thus improving the medical application of the metals against modern-age diseases, but also they may help in development of principles of effective protection of humans against environmental/occupational V exposure.

Background: Few studies have examined whether there was an independent association between multiple medication use and risk of chronic kidney disease (CKD), with adjustment for cardiometabolic factors. In the study, we aimed to examine this association using a nationally representative sample in CKD patients aged 60 and older. Methods: In the study, subjects aged ⩾60 years ( n = 1306) who participated in the 2011–2012 National Health and Nutrition Examination Survey were analyzed cross-sectionally. CKD was defined using the CKD Epidemiology Collaboration (CKD-EPI) equation i.e. estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2. Patients with multiple medications were classified as those having five or more prescription medications per day. All data analysis was performed using SAS 9.3 version. Results: The prevalence of CKD among age group ⩾80 years, age group 70–79 years and age group 60–69 years were 73.26%, 55.76% and 27.03% respectively ( p < 0.001). About half of hypertension (HTN) and diabetic patients aged ⩾60 years had CKD. The prevalence of CKD in patients with cardiovascular disease (CVD) was 60.57%. The logistic regression model without adjustment reflects that those on multiple medications (⩾5 medications/day) had 1.53 (1.02–2.31) times as likely (53% increase) to have CKD compared with those on Conclusion: We did not find significant independent association between use of multiple medications and CKD. The switchover of odds for multiple medication suggested a confounding effect of covariates; further prospective studies are required to find the individualized effect of multiple medications on CKD.

OBJECTIVEIntracerebral hemorrhage (ICH) is associated with a poor prognosis and high mortality, but no study has elucidated the association between glycemic variability (GV) and functional outcome in ICH. The authors of this study aimed to determine whether GV is a predictor of 30-day functional outcome in ICH patients.METHODSThe study recruited 366 patients with first-ever acute-onset ICH in the period during 2014 and 2015. Fasting blood glucose was assessed on admission and with 7-day continuous monitoring. Glycemic variability was calculated and expressed by the standard deviation (GluSD) and coefficient of variation (GluCV). Patients were divided into groups of those with diabetes mellitus (DM), stress hyperglycemia (SHG), and normal glucose (NG). Functional outcome was measured using the modified Rankin Scale.RESULTSThe numbers of patients with DM, SHG, and NG were 108 (29.5%), 127 (34.7%), and 131 (35.8%), respectively. As compared with the DM patients, those with SHG had higher mortality (29.9% vs 15.7%, p < 0.05) and a poorer prognosis (64.6% vs 52.8%, p < 0.05). Poor prognosis was associated with both high GluSD (OR 1.54, 95% CI 1.19–1.99) and high GluCV (1.05, 1.02–1.09), especially in the DM group. The area under the receiver operating characteristic curve was greater for the GluSD (OR 0.929, 95% CI 0.902–0.956) and the GluCV (0.932, 0.906–0.958) model than the original model (0.860, 0.823–0.898) in predicting a poor outcome.CONCLUSIONSStress hyperglycemia may be associated with increased mortality and a poor outcome in ICH, and increased GV may be independently associated with a poor outcome, particularly in ICH patients with DM.

Objective To review the contemporary knowledge of the pathophysiology of Peyronie’s disease (PD). Methods Medline was searched for papers published in English from 2000 to March 2013, using the keywords ‘Peyronie’s disease’ and ‘pathophysiology’. Results More than 300 relevant articles were identified for the purpose of this review. Unfortunately only a few studies had a high level of evidence, and the remaining studies were not controlled in their design. Many theories have been proposed to explain the cause of PD, but the true pathogenesis of PD remains an enigma. Identifying particular growth factors and the specific genes responsible for the induction of PD have been the ultimate goal of research over the past several decades. This would provide the means to devise a possible gene therapy for this devastating condition. We discuss present controversies and new discoveries related to the pathophysiology of this condition. Conclusion PD is one of the most puzzling diseases in urology. The pathogenesis remains uncertain and there is still controversy about the best management. The pathogenesis of PD has been explored in animal models, cell cultures and clinical trials, but the results have led to further questions. New research on the aetiology and pathogenesis of PD is needed, and which will hopefully improve the understanding and management for patients with this frustrating disease.

Objective To review local published data on the diagnosis and treatment of erectile dysfunction (ED) in Arab countries. Methods MEDLINE was searched for English-language articles published from 2000 to 2011, using the search terms ‘Arab countries’, ‘sexual dysfunction’, ‘diagnosis’ and ‘treatment’. Results In all, 86 articles were found to be relevant to this review; only a few had a high level of evidence and the remaining studies used an uncontrolled design. Several local studies were consistent with previous reports showing that a customised diagnostic pathway, with full consideration of the patient’s goals, is adopted by most clinicians to treat ED. For an effective treatment, the evaluation methods should answer important questions about the aetiology and severity of ED, as well as the patient’s and partner’s goals and expectations. As ED is known to be associated with many common medical comorbidities and medications, careful questioning can yield information about peripheral vascular disease, coronary artery disease, diabetes, hypertension, dyslipidaemia, and tobacco and alcohol use. The presence of psychological, neurological or chronic debilitating diseases can direct further evaluation. Conclusion The methods used for the diagnosis and treatment of ED need more investigation, especially in Arab countries. Only a few studies addressed the results of different methods of investigating and treating ED among Arab men.

Background Increasing the living-donor pool by accepting donors with an isolated medical abnormality (IMA) can significantly decrease the huge gap between limited supply and rising demand for organs. There is a wide range of variation among different centres in dealing with these categories of donors. We reviewed studies discussing living kidney donors with IMA, including greater age, obesity, hypertension, microscopic haematuria and nephrolithiasis, to highlight the effect of these abnormalities on both donor and recipient sides from medical and surgical perspectives. Methods We systematically searched MEDLINE, ISI Science Citation Index expanded, and Google scholar, from the inception of each source to January 2011, using the terms ‘kidney transplant’, ‘renal’, ‘graft’, ‘living donor’, ‘old’, ‘obesity’, ‘nephrolithiasis’, ‘haematuria’ and ‘hypertension’. In all, 58 studies were found to be relevant and were reviewed comprehensively. Results Most of the reviewed studies confirmed the safety of using elderly, moderately obese and well-controlled hypertensive donors. Also, under specific circumstances, donors with nephrolithiasis can be accepted. However, persistent microscopic haematuria should be considered seriously and renal biopsy is indicated to exclude underlying renal disease. Conclusion Extensive examination and cautious selection with tailored immunosuppressive protocols for these groups can provide a satisfactory short- and medium-term outcome. Highly motivated elderly, obese, controlled hypertensive and the donor with a unilateral small stone (

Introduction Emphysematous pyelonephritis (EPN) is a life-threatening necrotising kidney infection, but there is no consensus on the best management. Methods We systematically reviewed previous articles published from 1980 to 2013 that included studies reporting on EPN, and applying the Cochrane guidelines, we conducted a meta-analysis of the results. Results In all, 32 studies were included, with results for 628 patients (mean age 56.6 years, range 33.8–79.9). There were 462 women, outnumbering men by 3:1. Diabetes was present in 85% of the cases. Fevers and rigor (74.7%), pyuria (78.2%) and pain (70.4%) were the most common symptoms. Shock was associated with 54.4% of deaths while obstructive uropathy was associated with 15.1% of deaths. Computed tomography was diagnostic in all the cases. Percutaneous drainage (PCD) and medical management (MM) alone were associated with a significantly lower mortality rate than was emergency nephrectomy (EN), with an odds ratio (95% confidence interval) for PCD vs. EN of 3.13 (1.89–5.16; P

New-onset diabetes mellitus (DM) may herald pancreatic cancer (PaC). We determined whether changes in body weight distinguished PaC-associated DM (PaCDM) from type 2 DM.Among Olmsted County residents, we identified 29 PaCDM and 43 type 2 DM subjects who had serial fasting blood glucose measurements, new-onset DM, and no cancer-specific symptoms at DM onset. We compared body weight (kg) and fasting blood glucose (mg/dL) at DM onset, 1 to 2 years before and at index date in the 2 groups.Fasting blood glucose values were similar before and at the onset of DM. Before onset of DM, PaCDM and type 2 DM subjects had similar body weight (P = 0.80). However, at onset of DM, 59% of PaCDM subjects lost weight versus 30% of type 2 DM subjects (P = 0.02). At onset of DM, 56% of type 2 DM subjects gained weight versus 31% of PaCDM subjects (P = 0.04). By index date, PaCDM subjects lost more weight than type 2 DM subjects did (8.3 ± 8.3 vs 0.8 ± 4.8 kg, P0.01).Although new-onset primary type 2 DM is typically associated with weight gain, weight loss frequently precedes onset of PaCDM. The paradoxical development of diabetes in the face of ongoing weight loss may be an important clue to understanding the pathogenesis of PaCDM.

Key words: CKD (Chronic Kidney Disease); DM (Diabetes mellitus); HTN (Hypertension); BMI (Body Mass Index); C-G (Cockcroft-Gault) formula; MDRD (Modification of Diet in Renal Disease) equationDOI: 10.3329/jcmcta.v21i2.7733 Journal of Chittagong Medical College Teachers' Association 2010: 21(2):25-29