July-September 2021
Page Nos. 63-97
Online since Tuesday, August 31, 2021
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High sensitivity C reactive protein level is associated with prognosis in patients with severe coronavirus disease 19 pneumonia p. 63
Lei Zhang, Bilian Yu, Lizhen Yang, Hong Zhang, Guxiang Huang, Liang Tang, Min Xu, Jienan Zhou, Le Xiao, Jianjun Tang, Xianling Liu, Chang Shu, Xin Li
DOI:10.4103/2589-9686.32192
OBJECTIVES: The objective of the study is to describe the association of high-sensitivity C-reactive protein (hsCRP) in patients with severe coronavirus disease-19 (COVID-19) pneumonia and determine the relationship between hsCRP, prognosis, and other factors. METHODS: The hsCRP level and other clinical data of patients with severe COVID-19 pneumonia in Tongji Hospital were retrospectively reviewed. Unpaired t-test and Mann–Whitney test were used to compare difference in data between groups. Spearman analysis was used to analyze the correlation. RESULTS: Fifty-seven patients (25 male [43.9%] and 32 female [56.1%]) were included, and their condition was monitored for 28 days. The baseline hsCRP level was 35.5 ± 81.9 mg/L, and the hsCRP level of 49 patients increased (86.0%). Moreover, 45 (78.9%) patients recovered to ordinary/mild COVID-19 pneumonia and 12 (21.1%) progressed to critical COVID-19 pneumonia or continued having severe pneumonia. In the recovered group, the hsCRP level decreased significantly (P = 0.0023). The hsCRP level in the deteriorated group was significantly higher than that of the recovered group (P = 0.0019 and P = 0.0004). ΔhsCRP was significantly correlated with time from onset (P = 0.0151), prognosis (P = 0.0151), ΔD-dimer level (P = 0.0320), Δwhite blood cell count (P = 0.0018), and Δneutrophil count (P = 0.0061). CONCLUSIONS: Severe COVID-19 pneumonia is crucial to patient prognosis and manifests high hsCRP levels; decreased hsCRP level is associated with improved patient prognosis, but hsCRP level may not increase in patients with deteriorating conditions. Simultaneous increase in hsCRP and D-dimer levels may indicate risk for venous thromboembolism in COVID-19 patients.
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Diabesity lipid index: A potential novel marker of 10-year cardiovascular risk p. 70
Taoreed Adegoke Azeez
DOI:10.4103/2589-9686.321923
INTRODUCTION: Diabetes mellitus is a major cardiovascular risk factor. To put appropriate preventive measures in place, there is a need to estimate the 10-year cardiovascular risk. Most of the available risk estimators are cumbersome while some are inaccurate in estimating the risk for individuals with Type 2 diabetes. This study aimed to describe the diabesity lipid index (DLI), a composite index for predicting 10-year cardiovascular risk in Type 2 diabetes. METHODS: The study design was a cross-sectional study involving 70 individuals living with Type 2 diabetes mellitus. Ethical approval and informed consent were obtained for the study. Body mass index and waist circumference were determined for each participant. Fasting plasma glucose, fasting lipid profile, and glycated hemoglobin (HbA1c) were also measured. Atherogenic index of plasma (AIP), DLI, and QRISK 3 were calculated using the appropriate formulae. Receiver operating characteristics (ROC) curve analysis was performed for DLI. DLI = HbA1c (%) x Waist circumference (cm) / HDL -- C (mg/dl) RESULTS: The mean age of the subjects was 53.34 ± 9.57 years. The median duration of diabetes was 11.50 years. Hypertension, dyslipidemia, and truncal obesity were found in 70%, 65.7%, and 64.3% of the participants, respectively. About 38.6% had sub-optimal glycemic control. There was a statistically significant positive correlation between 10-year cardiovascular risk using QRISK 3 and DLI (r = 0.317; P = 0.008). Moreover, a ROC curve analysis done showed that the area under curve was 0.72 (95% confidence interval 0.56–0.85; P = 0.032). The sensitivity and specificity of using this cut-off value to define high cardiovascular risk were 87.5% and 79.2%, respectively CONCLUSION: DLI is a simple estimator of 10-year cardiovascular risk among individuals with Type 2 diabetes mellitus. It compares favorably with AIP, a previously validated cardiovascular risk estimator.
Insulin product decreases risk of varicose vein: Evidence from a Mendelian randomization study p. 75
Kai Huang, Runnan Shen, Qinchang Chen, Zhenluan Tian, Zuqi Xia, Xi Lin, Guitao Wu, Zhenhong Chen, Chen Yao
CONTEXT: The association between insulin product treatment and risk of varicose vein (VV) is still unknown. AIMS: Our study used two-sample Mendelian randomization (MR) to investigate whether treatment of insulin product was causally associated with a lower risk of VV. SUBJECTS AND METHODS: We searched the summary data from genome-wide association study through MR-Base platform. Data included were from Neale Lab UK-Biobank (UKB)-a-153 (insulin product) and MRC integrative epidemiology unit UKB-b-15592 (VV surgery). Three MR approaches, including inverse variance weighted (IVW) method, MR-Egger, and weighted median method were used to explore the casual effect of insulin product on VV. The exposure in our study was insulin product, and the outcome was VV surgery, both measured by single nucleotide polymorphisms. RESULTS: Our results showed that insulin product decreased the risk of VV with using IVW method (odds ratio [OR] = 0.73, 95% confidence interval = 0.64–0.84, P < 0.001), which was consistent with the result of MR-Egger and weighted median method. Results of MR-Egger regression showed no evidence for the presence of directional horizontal pleiotropy. CONCLUSIONS: Our study suggested that insulin product treatment had an inverse association with risk of VV.
Prevention of venous thromboembolism in COVID-19 patients: Is there a way forward? p. 83
Andrew Nicolaides
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Patients with critical limb ischemia (CLI) not suitable for revascularization: the "dark side" of CLI p. 87
Romeo Martini, Francesca Ghirardini
Critical limb ischemia (CLI) is the most advanced stage of peripheral arterial disease (PAD). Its prognosis is poor, with high rates of limb amputation and cardiovascular mortality. The international guidelines consider limb revascularization as the first line of the treatment strategy for CLI. However, despite the progress of revascularization techniques, many patients with CLI are still considered not suitable for these procedures and treated with conservative limb treatments. We have consulted the most important guidelines on PAD and CLI published over the past two decades focusing on the epidemiology, treatment, and outcomes of CLI patients not suitable for revascularization. Our review shows that only the TASC guidelines report 25% of CLI patients conservatively treated. Regarding the treatments, all the guidelines agree that the conservative treatment is based on the best medical management of cardiovascular risk factors associated with pain drugs and wound management. Other treatments such as prostanoids, spinal cord stimulation, vasodilators, or angiogenic therapies have shown uncertain positive outcomes in reducing limb amputation and mortality. In conclusion, this work outlines the scarce consideration that the guidelines have had about these patients over the past two decades. However, this review tries to draw the main novelties and possible future treatments for the better management of this group of patients still resident in the "dark side" of the CLI.
Treatment of posttraumatic infrapopliteal pseudoaneurysm with a physician-modified covered stent p. 95
Xiang Zhou, Chen-Yang Qiu, Dong-Lin Li, Hong-Kun Zhang
Infrapopliteal pseudoaneurysms can occur after trauma. In recent years, endovascular repair has been increasingly used to treat infrapopliteal pseudoaneurysms. Nevertheless, there has been no covered stent specifically for small peripheral vessels. Here, we report a case of a 65-year-old male with a pseudoaneurysm of the anterior tibial artery which was managed with a physician-modified covered stent. 6 months after the procedure, the mass had completely disappeared and the vascular anatomy of the calf is well preserved.