Objective : Zinc and copper are important to protect cells from oxidative stress and to enhance immunity. An association between low zinc levels and the severity of acute respiratory distress syndrome has been shown for patients with COVID-19. We aimed to study serum zinc and copper concentrations in severe COVID-19 patients and its supplementation in parenteral nutrition (PN). Methods : Thirty-five COVID-19 patients in need for PN were studied in a retrospective design. Serum samples were collected at three time points: at the start of PN, between three and seven days after, and at the end of PN. Results : Patients were on PN for a mean of 14 days, with a mean daily supplemental zinc of 14.8±3.7 mg/day. Serum zinc increased during PN administration from 98.8±22.8 to 114.1±23.3 µg/dL (Wilk´s λ=0.751, F=5.459, P=0.009). Conversely, serum copper did not vary from baseline (107.9±34.2 µg/dL) to the end of the study (104.5±37.4 µg/dL, Wilk´s λ=0.919, F=1.453, P=0.248). Serum zinc within the first week after starting PN and at the end of PN inversely correlated with total hospital stay (r=-0.413, P=0.014 and r=-0.386, P=0.022, respectively). Patients in critical condition presented lower serum copper (z=2.615, P=0.007). Mortality was not associated with supplemental zinc or with serum zinc or copper concentrations at any time of the study (P>0.1 for all analyses). Conclusions : Serum zinc concentrations during PN support were inversely associated with length of hospital stay but not with mortality. Serum copper concentrations were lower in patients in critical condition but not associated with prognosis.
Background: In about 16-85% of subjects with goiter, upper airway obstruction (UAO) is observed. This percentage is higher in patients affected by goiter with endothoracic enlargement. UAO is an indication for surgery. Visual analysis of flow-volume loops (FVL) are the best indicators for UAO, although various studies using clinical and radiological parameters have observed no correlation. Objective: To evaluate the presence of UAO in patients with endothoracic goiter enlargement and the relationship between the FVL with the observed symptoms and the measurements obtained by computed tomography (CT). Subjects: Subjects with endothoracic goiter enlargement participated in the study. Design: i) Symptom questionnaire (dysphagia, dyspnea, cough, oppression, dysphonia, and worsened symptoms when prone); ii) analysis: TSH and free thyroxine; iii) cervical ultrasound; iv) cervicalthoracic CT (measurements of area and diameter in the area of maximum stenosis and at 2 cm from the carina); v) chest radiography and vi) forced spirometry: visual analysis of FVL morphology and the maximum forced expiratory volume in 1 s (FEV 1 ), forced expiratory flow at 50% vital capacity/forced inspiratory flow at 50% vital capacity and FEV 1 /peak expiratory flow parameters. Results: Fifty subjects participated in the study: 11 men/39 women, median age 73.8 years (43.76-88.43). UAO was diagnosed in 13 cases (26%, confidence interval: 14.6-40.3%) and 27 subjects (54%) presented symptoms suggesting goiter compression. No clinical or radiological variables showed the presence of UAO. Conclusions: The frequency of UAO in subjects affected by goiter with endothoracic enlargement was lower than that described for goiter patients, and there were no clinical or radiological indicators to establish its presence.
We aimed to study the possible association of stress hyperglycemia in COVID-19 critically ill patients with prognosis, artificial nutrition, circulating osteocalcin, and other serum markers of inflammation and compare them with non-COVID-19 patients. Fifty-two critical patients at the intensive care unit (ICU), 26 with COVID-19 and 26 non-COVID-19, were included. Glycemic control, delivery of artificial nutrition, serum osteocalcin, total and ICU stays, and mortality were recorded. Patients with COVID-19 had higher ICU stays, were on artificial nutrition for longer (p = 0.004), and needed more frequently insulin infusion therapy (p = 0.022) to control stress hyperglycemia. The need for insulin infusion therapy was associated with higher energy (p = 0.001) and glucose delivered through artificial nutrition (p = 0.040). Those patients with stress hyperglycemia showed higher ICU stays (23 ± 17 vs. 11 ± 13 days, p = 0.007). Serum osteocalcin was a good marker for hyperglycemia, as it inversely correlated with glycemia at admission in the ICU (r = −0.476, p = 0.001) and at days 2 (r = −0.409, p = 0.007) and 3 (r = −0.351, p = 0.049). In conclusion, hyperglycemia in critically ill COVID-19 patients was associated with longer ICU stays. Low circulating osteocalcin was a good marker for stress hyperglycemia.
Introduction: There is scarce evidence demonstrating a relationship between glycemic control or glycemic variability with diabetic retinopathy (DR). Objectives: We aimed to determine the prevalence of DR and its association with time in range (TIR), and other association factors. Methods: We performed a retrospective observational study with 130 T1DM patients on continuous subcutaneous insulin infusion (CSII). Data of the three previous months were downloaded and analyzed. Results: Mean age was 37±13 years-old. 51.5% were female. Mean BMI was 24.8±4.0 Kg/m2. Duration of T1DM was 21±10 years. The mean HbA1c was 7.1±0.8%; before CSII 7.4±1.0%. Mean LDL-c was 100±26 mg/dL. The prevalence of DR was 20.8% (95%CI: 14.7 - 28.5); 19.2% non-proliferative DR and 1.5% proliferative DR. Most glycemic control and variability parameters were significantly higher in the DR+ group (Table 1). After applying the stepwise logistic regression model (p<0.001, R2 0.561), the association factors for developing DR were: LDL-c, ExpB 0.97 (95%CI 0.95-0.99); duration of DM, ExpB 1.26 (95%CI 1.12-1.41); and HbA1c before CSII, ExpB 2.24 (95%CI 1.17-4.31). Conclusions: Lower TIR and higher time in hyperglycemia were observed in patients with DR. LDL-c levels, long duration of DM and higher HbA1c before CSII were independent association factors for the development of DR. Disclosure E. Lecumberri: None. N. Bengoa: None. M. Fernández Argüeso: None. L. Nattero Chávez: None.
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