Depression is a possible influence factor for the increased risk of incident atrial fibrillation (AF). Although several investigations have assessed their association, the results are still controversial. Therefore, we conducted a meta-analysis to evaluate the association between depression or using antidepressants and AF.

We systemically performed the literature retrieval from two electronic databases PubMed and EMBASE until March 2022 to extract relevant data. The hazard ratios (HRs) and odds ratios (OR) from included studies with 95% confidence intervals (CIs) were adjusted into the risk ratio (RR) and pooled by using the random-effects model.

Totally 9 studies about the associations between depression or antidepressants and incident AF risk were included in this meta-analysis. Among them, 5 studies specifically analyzed the impact of antidepressants on the risk of AF. The outcomes of our analysis indicated that depression or depressive symptoms could increase AF risk (RR = 1.15, 95% CI, 1.03-1.27, P < 0.01). In addition, the use of antidepressants can also increase AF risk (RR = 1.16, 95% CI, 1.07-1.25, P < 0.001). These results remained unchanged when we remove the source of heterogeneity or adjust the analysis model into the fixed-effects model.

Based on existing investigations, both depression and the use of antidepressants are closely related to the increase of incident AF risk.

Anorexia nervosa is an eating disorder characterized by restrictive eating and an intense fear of gaining weight. It is a disease with an increasing incidence during the last few decades, and represents a complex psychiatric condition which includes secondary amenorrhea, nutritional and metabolic damage, and impaired endocrine panel up to bone loss as well as cardiac, gastrointestinal and hematological complications. This is a narrative review which includes an update on this eating disorder from the perspective of an endocrine panel of anomalies, especially of the skeleton, considering the pressure of the recent global COVID-19 pandemic changes. Practically affecting every organ, anorexia nervosa needs to be taken into consideration during the pandemic period because of the higher risk of relapse due to new living conditions, social distancing, self-isolation, changes in food access, more intense use of social media platforms, disruption of daily habits, and more difficult access to healthcare practitioners. The lack of physical activity in addition to vitamin D deficiency related to low sun exposure or to the use of facial masks may also be connected to further bone damage related to this disease.

Brain-derived neurotrophic factor (BDNF) rs6265 polymorphism has been previously suggested to be associated with the susceptibility of type 2 diabetes mellitus (T2DM), but results remained controversial. We aim to provide a more reliable conclusion about the association between BDNF rs6265 polymorphism and T2DM risk by using a meta-analysis.

Electronic databases such as Pubmed, Embase, CNKI, and Wanfang were searched for relevant articles published up to May 06, 2020. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were used to evaluate the strength of the associations. Subgroup analysis was carried out according to source of controls and quality score of included studies. A trial sequential analysis was conducted to reduce the risk of type I error.

A total of 8 case-control studies (7 conducted in China) with 1576 T2DM patients and 1866 controls were included. Overall, our results indicated no significant association between BDNF rs6265 polymorphism and T2DM risk with the random-effects model (allele model: pooled OR = 1.14, 95% CI = 0.79-1.65, homozygote model: pooled OR = 1.13, 95% CI = 0.57-2.21, heterozygote model: pooled OR = 1.07, 95% CI = 0.78-1.48, dominant model: pooled OR = 1.14, 95% CI = 0.74-1.75 and recessive model: pooled OR = 1.10, 95% CI = 0.67-1.80). Subgroup analysis by source of controls and quality score also showed no significant association between BDNF rs6265 polymorphism and T2DM risk. Trial sequential analysis results confirmed the null association and further studies were unnecessary.

This meta-analysis study indicated that no significant association between BDNF rs6265 polymorphism and T2DM risk.

As life expectancy increases, a rise in the number of chronically ill patients is observed due to the aging population. Among the various diseases, chronic kidney disease is at present one of the main causes of morbidity and, due to its typical complications, it is also one of the most important causes of mortality in the general population. For these reasons, the understanding of the kidney aging process, its consequences and its adequate management are essential. The judicious use of certain types of drugs, the prevention of episodes of renal injury either by toxic mechanisms or by dehydration are important aspects and are part of the apropriate approach for elderly patients. The most effective treatment of various types of conditions with a negative impact on renal function and for which an increased incidence is known as we age should also be considered. Thus, in the case of elderly patients, in order to protect the kidneys, an integrative approach is recommended, one that includes both elements of prevention and the appropriate treatment of existing diseases.

Although obesity is an established risk factor of primary stroke, the association between obesity and post-stroke mortality remains unclear. The aim of this study was to investigate the association between dynamic obesity status and mortality in survivors of their first stroke in China.Of 775 patients with first-ever ischemic stroke included in a longitudinal study, 754 patients were included in this study and categorized into 4 categories of body mass index (BMI) (underweight, normal weight, overweight, and obese) and 2 categories of waist circumference (WC) (normal WC and abdominal obesity) according to standard Chinese criteria. The mortality information and obesity status were obtained via telephone follow-up every 3 months, beginning in 2010 through 2016. Time-dependent Cox proportional hazards models were used to estimate the unadjusted and adjusted hazard ratios (HRs) for the relationship between all-cause mortality and dynamic obesity status.Of 754 patients, 60.87% were male, and the overall mean age was 61.45 years. After adjusting for possible confounders, significant inverse associations were identified between BMI and WC and all-cause mortality. Compared with those with normal BMI or WC, those with abdominal obesity or overweight had a significantly lower risk of all-cause mortality (HR and 95% confidence intervals [CIs]: .521 [.303-.897] and 0.545 [.352-.845], respectively), whereas patients with underweight had the highest risk and those with obesity had lower risk of mortality, though it was not statistically significant (1.241 [.691-2.226] and .486 [.192-1.231], respectively).Overweight and abdominal obesity were paradoxically associated with reduced risk of mortality in patients who survived their first-ever ischemic stroke in China. Future prospective studies must look at evaluating the role of obesity in different stroke subtypes and devise appropriate weight-management strategies for optimal prognoses in secondary prevention in these survivors.

We evaluated the statewide burden of obesity and its complications among government and state funded programs (Medicare and Medicaid) and commercial insurance.We calculated the prevalence of obesity and the prevalence of relevant comorbidities among different demographic groups and based on health insurance, among adults (18-65 years old) who visited a statewide health network in the state of Rhode Island, in 2017.The overall prevalence of obesity among 74,089 individuals was 38.88% [Asians 16.77%, Whites 37.49%, Hispanics 44.23%, and Blacks 48.44%]. Medicare or Medicaid beneficiaries were 26% and 27%, respectively, more likely to have obesity than those who had commercial insurance (Odds Ratio:1.26, 95% confidence interval [CI]:1.20-1.32; Odds Ratio:1.27, 95%CI:1.22-1.32). Moreover, Medicaid and Medicare beneficiaries with obesity had a higher prevalence of diabetes compared with privately insured with obesity (10.58% and 10.44% vs 4.45%). Medicare beneficiaries with obesity had a statistically higher prevalence of ischemic heart disease (4.34%, 95%CI: 3.77-4.91) than privately insured (3.21%, 95%CI: 2.94-3.47).Based on statewide data among 18 to 65 years old adults, Medicare and Medicaid provide health coverage to 40% of individuals with obesity and 46% of those with the obesity-related comorbidities and complications. State and federal health care programs need to support and expand obesity-related services and coverage.

The monitoring and care of patients with chronic kidney disease (CKD) before the dialysis initiation contribute to a better survival rate and an improvement in quality of life. The patients who do not benefit from a good predialysis management have a worse short and long-term prognosis. A retrospective, unicentric study was performed to evaluate the status of patients with stage 5 CKD at the time of initiation of renal replacement treatment. A total of 109 patients were included in the study. The evaluation of the patients included the clinical manifestations leading to hemodialysis initiation, the clinical and laboratory data of the patients when the hemodialysis was started. Based on the obtained data, a statistical analysis was performed using the Chi-square test, Fisher's exact test, ANOVA, and Kruskal-Wallis H test. The mean age of the patients was 64.61±13.59 years. Of the patients 51.38% were women. Vascular nephropathies and diabetes mellitus dominated the etiology of CKD. The comorbidities were high blood pressure, ischemic heart disease, history of myocardial infarction, heart failure, history of stroke, peripheral artery disease or atrial fibrillation. Only 43 (39.45%) of our patients were monitored before the hemodialysis initiation. Hemodialysis was initiated on central venous catheter (in most cases non-tunneled) in 78.90% of the patients. Most of the patients had an altered general status, fatigue/tiredness with poor exercise capacity when hemodialysis was initiated. Most of the patients (98.17%) had anemia, the average level of hemoglobin being 8.69±1.85 g/dl. In conclusion, careful monitoring of patients in the early stages of CKD would result in lower morbidity and mortality. These objectives can be achieved by implementing screening programs and early interventions.

Reducing cardiovascular risk (CVR) is the main focus of diabetes mellitus (DM) management nowadays. Complex pathogenic mechanisms that are the subject of this review lead to early and severe atherosclerosis in DM patients. Although it is not a cardiovascular disease equivalent at the moment of diagnosis, DM subjects are affected by numerous cardiovascular complications, such as acute coronary syndrome, stroke, or peripheral artery disease, as the disease duration increases. Therefore, early therapeutic intervention is mandatory and recent guidelines focus on intensive CVR factor management: hyperglycaemia, hypertension, and dyslipidaemia. Most important, the appearance of oral or injectable antidiabetic medication such as SGLT-2 inhibitors or GLP-1 agonists has proven that an antidiabetic drug not only reduces glycaemia, but also reduces CVR by complex mechanisms. A profound understanding of intimate mechanisms that generate atherosclerosis in DM and ways to inhibit or delay them are of the utmost importance in a society where cardiovascular morbidity and mortality are predominant.

Obesity and diabetes are associated with high levels of oxidative stress. In Romanian patients with obesity and (or) diabetes, this association has not been sufficiently explored.

To evaluate oxidative stress in obese and (or) diabetic subjects and to investigate the possible correlations between oxidative stress and anthropometric/biochemical parameters.

Oxidative stress was evaluated from a single drop of capillary blood. Reactive oxygen species (ROS) were evaluated using the free oxygen radical test (FORT). The free oxygen radical defence (FORD) assay was used to measure antioxidant levels.

FORT levels were higher in obese subjects (3.04 ± 0.36 mmol/L H2O2) vs controls (2.03 ± 0.14 mmol/L H2O2) (P < 0.0001). FORD levels were lower in obese subjects (1.27 ± 0.13 mmol/L Trolox) vs controls (1.87 ± 1.20 mmol/L Trolox) (P = 0.0072). Obese diabetic subjects had higher FORT values (3.16 ± 0.39 mmol/L H2O2) vs non-diabetic counterparts (2.99 ± 0.33 mmol/L H2O2) (P = 0.0233). In obese subjects, FORT values correlated positively with body mass index (BMI) (r = 0.48, P = 0.0000), waist circumference (WC) (r = 0.31, P = 0.0018), fasting plasma glucose (FPG) (r = 0.31, P = 0.0017), total cholesterol (TC) (r = 0.27, P = 0.0068) and uric acid (r = 0.36, P = 0.0001). FORD values correlated negatively with BMI (r = -0.43, P = 0.00001), WC (r = -0.28, P = 0.0049), FPG (r = -0.25, P = 0.0130), TC (r = -0.23, P = 0.0198) and uric acid (r = -0.35, P = 0.0002). In obese diabetic subjects, FORT values correlated positively with BMI (r = 0.49, P = 0.0034) and TC (r = 0.54, P = 0.0217). FORD values were negatively associated with BMI (r = -0.54, P = 0.0217) and TC (r = -0.58, P = 0.0121).

Oxidative stress levels, as measured by the FORT and FORD assays, were higher in obese subjects vs controls. ROS levels were elevated in diabetic obese patients vs obese non-diabetic patients and controls.

Although several studies have investigated the role of psychological factors in atrial fibrillation (AF), the results are still under debate. Therefore, we performed a meta-analysis to examine the relationship between psychological factors and the risk of incident AF.

We systematically searched the PubMed and EMBASE databases from inception to December 2019 to identify eligible studies. The hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled by using a random-effects model.

A total of 11 cohort studies were included in this meta-analysis. There were 5, 2, 4, and 5 studies examining the association of anxiety, anger, depression, and psychological stress with AF, respectively. In the pooled analysis by a random-effects model, anxiety (HR = 1.10, 95%CI 0.97-1.24; P = .14), anger (HR = 1.08, 95%CI 0.95-1.23; P = .21), depression (HR = 1.15, 95%CI 0.98-1.35; P = .08), and work stress (HR = 1.14, 95%CI 0.98-1.34; P = .09) were not associated with the risk of AF. These results were not changed when we re-performed the analysis using a fixed-effects model.

Based on current evidence, no associations were observed for anger, anxiety, and work stress with the risk of AF.

Background and Objectives: This study evaluated the clinical characteristics of the acute coronary syndromes (ACS) in chronic kidney disease (CKD) patients and established prognostic values of the biomarkers and echocardiography. Materials and Methods: 273 patients admitted to the cardiology department of the Clinical County Emergency Hospital of Oradea, Romania, with ACS diagnosis were studied. Two study groups were formed according to the presence of CKD (137 patients with ACS + CKD and 136 with ACS without CKD). Kidney Disease: Improving Global Outcomes (KDIGO) threshold was used to assess the stages of CKD. Results: Data regarding the medical history, laboratory findings, biomarkers, echocardiography, and coronary angiography were analysed for both groups. ACS parameters were represented by ST-segment elevation myocardial infarction (STEMI), which revealed a greater incidence in subjects without CKD (43.88%); non-ST-segment elevation myocardial infarction (NSTEMI), characteristic for the CKD group (28.47%, with statistically significance p = 0.04); unstable angina and myocardial infarction with nonobstructive coronary arteries (MINOCA). Diabetes mellitus, chronic heart failure, previous stroke, and chronic coronary syndrome were more prevalent in the ACS + CKD group (56.93%, p < 0.01; 41.61%, p < 0.01; 18.25%, p < 0.01; 45.26%, p < 0.01). N-terminal pro b-type natriuretic peptide (NT-proBNP) was statistically higher (p < 0.01) in patients with CKD; Killip class 3 was evidenced more frequently in the same group (p < 0.01). Single-vessel coronary artery disease (CAD) was statistically more frequent in the ACS without CKD group (29.41%, p < 0.01) and three-vessel CAD or left main coronary artery disease (LMCA) were found more often in the ACS + CKD group (27.01%, 14.6%). Conclusions: Extension of the CAD in CKD subjects revealed an increased prevalence of the proximal CAD, and the involvement of various coronary arteries is characteristic in these patients. Biomarkers and echocardiographic elements can outline the evolution and outcomes of ACS in CKD patients.

Cardiovascular disease (CVD) is one of the leading causes of death worldwide. CVD is associated with increased levels of reactive oxygen species which are pro-inflammatory and can damage the endothelium. The pomegranate fruit is a rich source of phytochemicals with a high antioxidant and anti-inflammatory activity, possessing thus health benefits. This systematic review and meta-analysis aims to evaluate the effect of pomegranate juice on the biomarkers of inflammation and vascular dysfunction.

Studies were identified using the PubMed/Medline and SCOPUS databases. Screening of relevant articles and references was carried out from inception until May 2019. This systematic review and meta-analysis was performed using the Preferred Items for Reporting of Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Overall, 16 randomized controlled trials (RCTs) involving 572 subjects were included in this study. Combining effect sizes from 16 studies, we recorded that pomegranate supplementation significantly reduced hs-CRP, IL-6 and TNF-α (Weighted Mean Diff ;erences (WMD): -6.57 mg/L, 95 % CI: -10.04 to -3.10, P = 0.000; WMD: -1.68 pg/mL, 95 % CI: -3.52, 0.157, P = 0.000; WMD: -2.37 pg/mL, 95 % CI: -3.67, -1.07, P = 0.00, respectively) levels, when compared to placebo. No significant reduction was found in CRP (WMD: 2.19 mg/dL, 95 % CI: -3.28, 7.67, P = 0.61), E-selectin (WMD: 8.42 ng/mL, 95 % CI: -22.9, 39.8, P = 0.599), ICAM (WMD= -17.38 ng/mL, 95 % CI: -53.43, 18.66, P = 0.107), VCAM (WMD: -69.32 ng/mL, 95 % CI: -229.26, 90.61, P = 0.396) or MDA (WMD: 0.031 μmol/L, 95 % CI: -1.56, 0.218, P = 0.746) comparing pomegranate supplementation to placebo.

We found a significant effect of pomegranate supplementation on hs-CRP, IL-6 and TNF-α in adults. However, the effects of pomegranate supplementation on CRP, E-selectin, ICAM, VCAM or MDA were not significant in this meta-analysis.

Polypharmacy heavily impacts the quality of life of patients worldwide. It is a necessary evil in many disorders, and especially in type 2 diabetes mellitus, as patients require treatment both for this condition and its related or unrelated comorbidities. Thus, we aimed to evaluate the use of polypharmacy in type 2 diabetes mellitus vs. non-diabetes patients.

A cross-sectional retrospective observational study was conducted. We collected the medical records of patients hospitalized in the Internal Medicine Clinic of the Clinical Emergency Hospital of Bucharest, Romania, for a period of two months (01/01/2018-28/02/2018). Patients diagnosed with type 2 diabetes mellitus were included in the study group, whereas patients who were not diabetic were used as controls.

The study group consisted of 63 patients with type 2 diabetes mellitus (mean age 69.19 ± 9.67 years, range 46-89 years; 52.38% males). The control group included 63 non-diabetes patients (mean age 67.05 ± 14.40 years, range 42-93 years, 39.68% males). Diabetic patients had more comorbidities (10.35 ± 3.09 vs. 7.48 ± 3.59, p = 0.0001) and received more drugs (7.81 ± 2.23 vs. 5.33 ± 2.63, p = 0.0001) vs. non-diabetic counterparts. The mean number of drug-drug and food-drug interactions was higher in type 2 diabetes mellitus patients vs. controls: 8.86 ± 5.76 vs. 4.98 ± 5.04, p = 0.0003 (minor: 1.22 ± 1.42 vs. 1.27 ± 1.89; moderate: 7.08 ± 4.08 vs. 3.54 ± 3.77; major: 0.56 ± 0.74 vs. 0.37 ± 0.77) and 2.63 ± 1.08 vs. 2.19 ± 1.42 (p = 0.0457), respectively.

Polypharmacy should be an area of serious concern also in type 2 diabetes mellitus, especially in the elderly. In our study, type 2 diabetes mellitus patients received more drugs than their non-diabetes counterparts and were exposed to more drug-drug and food-drug interactions.