Background: Patients with chronic renal disease or failure are at a heightened risk of mortality due to cardiovascular disease (CVD), which is a predominant cause of death in this population. Hyperhomocysteinemia is prevalent in patients with end-stage renal disease (ESRD), which may increase their susceptibility to CVD. Methods: We conducted a comprehensive search of PubMed, Science Direct, and Google Scholar for articles published between 2003 and February 2023, using a combination of keywords such as "plasma homocysteine levels," "hyperhomocysteinemia," "end-stage renal disease," "renal failure," "kidney failure," "cardiovascular events," "cardiovascular disease," "myocardial infarction," "coronary artery disease," and "stroke." Our inclusion criteria were studies that investigated the association between total homocysteine (Hcy) level and CVD or total mortality, as well as the impact of vitamin supplementation on cardiovascular or mortality risk. We restricted our search to English-language studies that included ESRD patients and provided data on plasma Hcy levels and associated CVD events. Results: This systematic review includes 11 articles published between 2003 and 2023 that enrolled a total of 3,953 subjects, of whom 79.15% were male patients. All studies included in the review were either quantitative randomized trials or non-randomized studies, such as cross-sectional, cohort, or case-control studies. Of the total studies included, 10 reported either cardiovascular mortality or CVD events, including cardiovascular death, myocardial infarction (MI), angina, and stroke. One study reported the CVD risk score of the patients, and most of them had higher total homocysteine (tHcy) levels. Overall, a total of 817 CVD events were reported across the studies. Conclusion: In conclusion, the relationship between Hcy and cardiovascular events in ESRD patients is not straightforward and requires further research. However, our review suggests that Hcy could be a predictor of cardiovascular events in this population, and its nutritional characteristics as well as other associated comorbidities may contribute to its inverse association with outcomes.
Background: Numerous studies revealed mental health disorders among general population and healthcare workers during Covid-19 pandemic. However, fewer data are available on mental health status of Covid-19 infected patients. Present study was aimed to survey Covid-19 infected Saudi cohort for common mental health disorders. Objective: To determine the frequency of common mental health disorders (anxiety, depression, insomnia and post-traumatic stress disorders [PTSD]) in Covid-19 infected Saudi cohort. Design: Descriptive cross-sectional. Settings: King Fahd Armed Forces Hospital Jeddah, Kingdom of Saudi Arabia (ksa) during March to April 2021 Patients and Methods: The population of the study comprised of cohort of confirmed Covid-19 infected patients (n=310) managed at King Fahd Armed Forces Hospital Jeddah, KSA. The GAD-7 score was used to assess anxiety; Patient Health Questionnaire-9 for depression, Impact of Event Scale–revised for PTSD and Insomnia Severity Index (ISI) was used to assess insomnia. Results: The most frequent mental health disorder found in the present study was anxiety (77.1%) followed by clinically significant depression (36.1%), insomnia (33.9%), and PTSD (21.6%). Individuals with lower level of education demonstrated one and half fold higher risk of having anxiety (OR of 1.54, 95% CI: 1.006-2.343, P=0.047) and widows demonstrated 2-fold higher risk of developing insomnia (OR of 1.7, 95% CI: 1.028-2.80, P=0.039). No other significant association observed. Conclusions: A significant proportion of Covid-19 infected Saudi cohort demonstrated mental health disorders, though of mild degree in majority of the participants. Individuals with lower level of education and widows manifested higher risk of developing anxiety and insomnia, respectively. Keywords: Anxiety; Covid-19; Mental health disorders; Post traumatic stress disorder
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