Impaired microvascular dilatation from any cause and impaired insulin-mediated capillary recruitment in particular result in suboptimal delivery of glucose and insulin to skeletal muscle, and subsequently impairment of glucose disposal (insulin resistance). In addition, microvascular dysfunction, through functional and/or structural arteriolar and capillary drop-out, and arteriolar constriction, increases peripheral resistance and thus blood pressure. Microvascular dysfunction may thus constitute a pathway that links insulin resistance and hypertension. Overweight and obesity may be an important cause of microvascular dysfunction. Mechanisms linking overweight and obesity to microvascular dysfunction include changes in the secretion of adipokines leading to increased levels of free fatty acids and inflammatory mediators, and decreased levels of adiponectin all of which may impair endothelial insulin signaling. Microvascular dysfunction may thus constitute a new treatment target in the prevention of type 2 diabetes mellitus and hypertension.
We have developed a semi-automatic image analysis application (CapiAna) for the assessment of skin capillary density, which agrees well with the classic manual counting procedure, is time-saving, and has a better reproducibility as compared to the classic manual counting procedure. As a result, the use of skin capillaroscopy is feasible in large-scale studies, which importantly extends the possibilities to perform microcirculation research in humans.
Purpose Data from large patient registry studies suggested an increased incidence and increased mortality in coronavirus disease-2019 (COVID-19) in patients with a history of obstructive sleep apnea (OSA). This study aimed to compare the prevalence of OSA in patients with and without COVID-19 among patients admitted to the same hospital in the same time period. In addition, the impact of OSA on clinical outcomes of COVID-19 infection was investigated. Methods Observational cohort study. Clinical data were collected retrospectively from the complete medical records for each patient individually from March 1st 2020 to May 16th 2020. Results A total of 723 patients were diagnosed with COVID-19 and 1161 with non-COVID-19 disease. The prevalence of OSA did not differ between these groups ( n = 49; 6.8% versus n = 66; 5.7%; p = 0.230). In patients with COVID-19, mortality was increased in the group of 49 patients with OSA ( n = 17; 34.7%) compared to 674 COVID-19 patients without OSA ( n = 143; 21.2%; p = 0.028). This increased risk of mortality in COVID-19 patients with OSA (OR = 2.590; 95%CI 1.218–5.507) was independent from Body Mass Index (BMI), male gender, age, diabetes, cardiovascular disease, and obstructive lung disease. Presence of OSA in COVID-19 disease was further associated with an increased length of hospital stay (12.6 ± 15.7 days versus 9.6 ± 9.9 days; p = 0.049). Conclusion The prevalence of OSA did not differ between patients with or without COVID-19, but mortality and hospital length of stay were increased in patients with OSA and comorbid COVID-19. Hence, OSA should be included in COVID-19 risk factor analyses, Clinicians should be aware of the association and the mechanism should be further explored.
Purpose The incidence, patient features, risk factors and outcomes of surgery-associated postoperative acute kidney injury (PO-AKI) across different countries and health care systems is unclear. Methods We conducted an international prospective, observational, multi-center study in 30 countries in patients undergoing major surgery (> 2-h duration and postoperative intensive care unit (ICU) or high dependency unit admission). The primary endpoint was the occurrence of PO-AKI within 72 h of surgery defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Secondary endpoints included PO-AKI severity and duration, use of renal replacement therapy (RRT), mortality, and ICU and hospital length of stay. Results We studied 10,568 patients and 1945 (18.4%) developed PO-AKI (1236 (63.5%) KDIGO stage 1500 (25.7%) KDIGO stage 2209 (10.7%) KDIGO stage 3). In 33.8% PO-AKI was persistent, and 170/1945 (8.7%) of patients with PO-AKI received RRT in the ICU. Patients with PO-AKI had greater ICU (6.3% vs. 0.7%) and hospital (8.6% vs. 1.4%) mortality, and longer ICU (median 2 (Q1-Q3, 1–3) days vs. 3 (Q1-Q3, 1–6) days) and hospital length of stay (median 14 (Q1-Q3, 9–24) days vs. 10 (Q1-Q3, 7–17) days). Risk factors for PO-AKI included older age, comorbidities (hypertension, diabetes, chronic kidney disease), type, duration and urgency of surgery as well as intraoperative vasopressors, and aminoglycosides administration. Conclusion In a comprehensive multinational study, approximately one in five patients develop PO-AKI after major surgery. Increasing severity of PO-AKI is associated with a progressive increase in adverse outcomes. Our findings indicate that PO-AKI represents a significant burden for health care worldwide. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-023-07169-7.
Objective: Cesarean sections constitute the majority of emergency gynecologic and obstetrics operations. In this study, we aimed to discuss the anesthesia methods and results of patients who underwent emergency caesarean section in our hospital retrospectively. Method: Patients who underwent emergency cesarean between January 2015, and December 2017 were retrospectively analyzed. Demographic data, cesarean indication, additional diseases, anesthesia methods, complications in mothers and their infants, 1st and 5th minute Apgar scores of newborns were examined. Patients were divided in groups of general anesthesia or regional anesthesia according to the anesthesia method used in cesarean section. Results: A total of 4874 patients were evaluated. The mean age among the groups was higher in patients undergoing regional anesthesia. ASA scores were higher in general anesthesia group (p<0.001). Our regional anesthesia and general anesthesia application rates were 78.5% and 21.5%, respectively. The most applied anesthesia method was spinal anesthesia (76.2%). The most common indications for emergency cesarean were old cesarean section (33.9%) and fetal distress (30.1%). Apgar scores at the 1 st and 5 th minutes were statistically significant in regional anesthesia group (p<0.05). Meconium aspiration was the most common complication in neonates (1.9%), and 34 (0.7%) infants died. Regional (76.8%) and general anesthesia (23.2%) were applied to respective number of migrant patients. Increase in regional anesthesia rates was observed was increased with rapid increase in the number of patients by the years. Conclusion: Since easily applied regional anesthesia provides an effective anesthesia-analgesia, and superiority in Apgar scores we think that the number of patients undergoing emergency caesarean section who will undergo regional anesthesia will increase gradually.
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