not-yet-known not-yet-known not-yet-known unknown Abstract Few studies have investigated blood glucose levels and complication management in elderly patients with type 2 diabetes (T2D) at community hospitals in China. The objective of this study was to investigate the factors influencing blood glucose control in elderly patients with T2D and assess the adherence of doctors in community hospitals to the latest diabetes guidelines regarding the use of glucose-lowering medications. This study involved 1150 elderly patients (age≥65 years) with diabetes to assess blood glucose control, complications management, and adherence of medication according to the guidelines of American Diabetes Association. To evaluate blood glucose control, different glycated haemoglobin targets were assigned according to patient characteristics and health status (including comorbidities and cognitive status). Univariate and multivariate logistic regression analyses were used to investigate the factors affecting glucose control. Among the 1150 participants, 351 (30.52%) had poor glucose control. Frailty (odds ratio [OR]:0.393; 95% confidence interval [CI]:0.195-0.789; P=0.009), male sex (OR:1.472; 95% CI:1.131-1.915, P=0.004), and insulin treatment (OR:4.364; 95% CI:3.151-6.042; P<0.001) were significantly associated with poor blood glucose control in patients treated with glucose-lowering medications. The proportion of patients without frailty with poor control was higher than those with frailty (31.28% vs. 17.46%, respectively). In conclusion, blood glucose control in elderly Chinese patients with T2D is poor and influenced by frailty, sex, and insulin treatment. Hence, it is crucial to enhance the implementation of sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists in Chinese community hospitals and strengthen the differentiation of updated guidelines within these healthcare settings.

Objective: To assess the effectiveness and safety of nirmatrelvir-ritonavir in the treatment of mild-to-moderate COVID-19 caused by the omicron BA. 2. 2 variant. Methods: An observational study was conducted retrospectively to review the outcomes of mild-to-moderate COVID-19 patients admitted between 26 April and 30 June, 2022. Patients’ baseline characteristics were collected and assessed. Participants in the intervention group were administered nirmatrelvir-ritonavir in addition to standard care, whereas those in the control group only received standard care. The primary outcome was the duration between symptoms onset or the initial positive RT-PCR test and the subsequent conversion to a negative result. Results: The analysis included 324 patients who were administered nirmatrelvir-ritonavir and an equal number of control patients. The patient characteristics in both groups were evenly matched. The average duration from symptoms onset or the initial positive RT-PCR to negative conversion was similar in both groups (16.2±5.0 vs. 16.1±6.3 days, P=0.83). Control patients exhibited slower conversion in comparison to patients who received nirmatrelvir-ritonavir treatment within 10 days of symptom onset. Conclusion: These findings suggest that administering nirmatrelvir-ritonavir within 10 days of symptom onset could potentially reduce the time it takes for SARS-CoV-2-infected patients to negative RT-PCR results, thereby expanding the current usage guidelines for nirmatrelvir-ritonavir.

Abstract: Minor hepatic impairment might already exist before meeting the diagnostic criteria for tigecycline-induced liver injury. To clarify the process, we performed a retrospective study among 1054 adult inpatients treated with tigecycline to evaluate characteristics of each indicator for liver function tests (LFTs) during the course. Indicators of LFTs contained serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyltransferase (GGT), and total bilirubin (TB). Incidence of each indicator abnormality and dynamic changes of severity grading during the course were evaluated respectively. Multiple logistic analysis was applied to identify independent risk factors associated with abnormal LFTs. 798 patients were finally included. Values of first and peak abnormalities were significantly increased compared with those at baseline. Gender was considered an independent factor for abnormal ALT (OR=0.544, P=0.001), AST (OR=0.652, P=0.012) and GGT (OR=0.582, P=0.006). High maintenance dosage (100mg twice daily) and prolonged duration (>14 days) were independent risk factors for abnormal ALT, AST, ALP, and GGT (P=0.000 for all parameters). Furthermore, surgery (OR=1.513, P=0.005) and abnormal baseline LFTs (OR=1.372, P=0.037) were independent risk factors for abnormal TB. The current study first depicted characteristics of abnormal LFTs during tigecycline therapy, facilitating early detection of liver injury.

Aim: Many concerns still existed about the safety of hydroxychloroquine (HCQ) in the treatment of Corona Virus Disease 2019 (COVID-19). The purpose of this study was to evaluate the safety of HCQ by performing a systematic review and meta-analysis. Methods: Randomized controlled trials reporting the safety of HCQ in PubMed, Embase, and Cochrane Library were retrieved from the establishment of the database to February 27, 2020. Literature screening, data extraction, and assessment of risk bias were performed independently by two reviewers. Results: We identified 34 eligible studies that involved 3,639 patients. The difference in the cumulative number of AEs between the HCQ and control group was statistically significant (P<0.0001). The pooled incidence of gastrointestinal AEs, which occurred most frequently in the HCQ group was higher than that in the control group (P<0.0001) according to the system organ class. In addition, the risks of skin and subcutaneous tissue AEs (P = 0.011), renal and urinary disorders (P=0.011), ear and labyrinth AEs (P = 0.045) and surgical and medical procedures AEs (P = 0.020) in HCQ group are also significantly increased compared with the control group. Meanwhile, the cumulative number of SAEs was similar between the two groups (P=0.222). Meta-analysis results indicated that the pooled incidences of all the AEs reported by two or more studies were similar except for the treatment discontinuation caused by AEs (RD 0.02, 95% CI: 0.00 to 0.06). Conclusion: HCQ was well tolerated and might be safe for clinical application under the outbreak of COVID-19.