Publications by authors named "A H Abdelhafiz"

95 Publications

Dexamethasone and oxygen therapy in care home residents with diabetes: a management guide and algorithm for treatment: a rapid response action statement from the European Diabetes Working Party for Older People (EDWPOP) and European Geriatric Medicine Society (EuGMS).

Aging Clin Exp Res 2021 Apr 15. Epub 2021 Apr 15.

European Geriatric Medicine Society (EuGMS), Vienna, Austria.

This statement addresses the need to provide clinically relevant and practical guidance for long-term care staff working in care homes and other stakeholders engaged in the care of residents who require consideration for dexamethasone and oxygen therapy. It had been provided following a series of consensus discussions between the EDWPOP and the EuGMS in January and February 2021. Its main aim is to minimise morbidity and mortality from serious acute illnesses including COVID-19 requiring these treatments within the long-term care sector.
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http://dx.doi.org/10.1007/s40520-021-01822-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046642PMC
April 2021

Knowledge, perceptions and attitude of Egyptian physicians towards biobanking issues.

PLoS One 2021 26;16(3):e0248401. Epub 2021 Mar 26.

Department of Community Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt.

Objectives: Collection and storage of biospecimens and data for biobanking raise many ethical concerns. Stakeholders' opinions about these ethical issues are important since they can help in the development of ethical guidelines to govern biobanking activities. Physicians are among the important stakeholders since they contact potential participants and could be biobank users. The goal of this study is to evaluate the perceptions and attitude of Egyptian physicians towards ethical issues in biobanking.

Methods: A cross-sectional online survey was designed and distributed with the target group between November 2019 and January 2020.

Results: The questionnaire was completed by 223 physicians. While 65.5% reported hearing the term "Biobanking" before, 45.7% knew that there are biobanks in Egypt. Participants had a general positive attitude towards the value of biobanks in research. About 73% agreed that biobanks can share biospecimens with international research organizations, but only 42.6% supported collaboration with pharmaceutical companies, and 44% agreed to the use of user fees by biobanks. About 48% supported the use of broad consent in biobanks, and 73.1% believed that donors of biospecimens should be informed about results of research performed on their biospecimens.

Conclusion: Although many Egyptian physicians heard about biobanking, they had limited knowledge about the existence of biobanks in Egypt. They had concerns about commercialization, use of broad consent and user fees. A knowledge gap exists among these stakeholders, which should be covered by different educational activities. Community discussions should start to reach consensus about the issues of commercialization and return of research results.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0248401PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7996976PMC
March 2021

Newer anti-diabetic therapies with low hypoglycemic risk-potential advantages for frail older people.

Hosp Pract (1995) 2021 Apr 5:1-13. Epub 2021 Apr 5.

Department of Geriatric Medicine, Rotherham General Hospital, Rotherham, United Kingdom of Great Britain and Northern Ireland.

Background: The prevalence of diabetes is increasing due to increasing aging of the population. Hypoglycemia is a common diabetes-related complication in old age especially in patients with multiple comorbidities and frailty. Hypoglycemia and frailty appear to have a bidirectional relationship reenforcing each other in a negative downhill spiral that leads to an increased risk of adverse events including disability and mortality.

Objectives: To review risk of hypoglycaemia in frail older people with diabetes mellitus and safety of the new anti-diabetic therapy of sodium-glucose co-transprter-2 (SGLT-2) inhibitors and glucagon like peptide-1 receptor agonist (GLP-1 RA) in this group of patients.

Results: The incidence of hypoglycemia in this age group is usually underestimated due to its atypical clinical presentation and difficult recognition by health-care professionals. Guidelines generally recommend a relaxed glycemic control in frail older people with diabetes mainly due to the fear of anti-diabetic medications-induced hypoglycemia. The new anti-diabetic therapies of SGLT-2 inhibitors and GLP-1RA have consistently shown a cardio-renal protective effect independent of their glycemic control. Contrary to the traditional hypoglycemic agents that either increase insulin stimulation or insulin sensitization with a potential hypoglycemic risk especially sulfonylureas, the new therapies have a novel anti-diabetic mechanisms of action that have a negligible risk of hypoglycemia. The new therapies appear to be both effective and well tolerated in old age. With appropriate patients' selection, most older people will be eligible for the new therapies if well tolerated and no contraindications.

Conclusion: In frail older people, we suggest a pragmatic approach of the use of the new therapies based on the concept of the weight status rather than the frailty status. Frail patients with normal or excess weight are likely to gain most from the new therapies due to its favorable metabolic properties in this group, while the use in the underweight frail patients should be largely avoided especially in those with persistent anorexia and weight loss.
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http://dx.doi.org/10.1080/21548331.2021.1905414DOI Listing
April 2021

Factors Influencing Participation in COVID-19 Clinical Trials: A Multi-National Study.

Front Med (Lausanne) 2021 23;8:608959. Epub 2021 Feb 23.

Department of Physiology and Biochemistry, The University of Jordan, Amman, Jordan.

In 2020, the World Health Organization has characterized COVID-19, a disease caused by infection with the SARS-CoV-2 virus, as a pandemic. Although a few vaccines and drugs have been approved to, respectively, prevent or treat the disease, several clinical trials are still ongoing to test new vaccines or drugs to mitigate the burden of the pandemic. Few studies have shown the role of host genetics in disease prognosis and drug response highlighting the importance of diverse participation in COVID-19 clinical trials. The goal of this study is to assess public attitudes in Egypt, Saudi Arabia, and Jordan toward participating in COVID-19 clinical trials and to identify the factors that may influence their attitude. An online questionnaire was developed and distributed among the target group through social media platforms. The number of responses was 1,576. Three quarters (74.9%) of participants heard about clinical trials before, 57.6% of them had a positive attitude toward participation in COVID-19 clinical trials. The conduct of clinical trials in accordance with the scientific, research, and ethical guidelines was a strong predictor of willingness to participate in clinical trials. Other positive factors also included protection of family from COVID-19 and contributing to the return to normal community life as well as receiving additional healthcare benefit was the fourth significant predictor. On the other hand, the thought that clinical trials can have a negative impact on the health of participants strongly predicted the unwillingness of individuals to participate in such trials. This was followed by having limited information about the novel coronavirus and COVID-19 and the lack of trust in physicians and hospitals. In general, Arab citizens are accepting the concept and have a positive attitude toward COVID-19 clinical trials. Increasing awareness of COVID-19 and clinical trials, enforcing the concept of altruism, and placing clear policies in conducting clinical trials are needed to increase participation in clinical trials among Arabs.
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http://dx.doi.org/10.3389/fmed.2021.608959DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7940528PMC
February 2021

Diabetes in COVID-19 pandemic-prevalence, patient characteristics and adverse outcomes.

Int J Clin Pract 2021 Feb 25:e14112. Epub 2021 Feb 25.

Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Droitwich Spa, UK.

Background: Current literature on COVID-19 pandemic has identified diabetes as a common comorbidity in patients affected. However, the evidence that diabetes increases the risk of infection, effect of diabetes on outcomes and characteristics of patients at risk is not clear.

Objectives: To explore the prevalence of diabetes in COVID-19 pandemic, effect of diabetes on clinical outcomes and to characterise the patients with diabetes affected by COVID-19.

Methods: A literature review of articles published in English language and reported outcomes on prevalence and effect of diabetes on outcomes and patients' characteristics.

Results: The prevalence of diabetes in COVID-19 patients appears similar to that in the general population. The evidence of diabetes increasing the risk of severe infection and adverse outcomes is substantial. The progression of the disease into acute respiratory distress syndrome, the requirement for intensive care admission or mechanical ventilation and mortality all have been increased by the presence of diabetes. Patients with diabetes at risk of COVID-19 appear to be obese, of older age, have uncontrolled glycaemia and have coexisting comorbidities especially cardiovascular disease and hypertension. Tight glycaemic control on admission to hospital using insulin infusion has shown some beneficial effects; however, the role of hypoglycaemic medications in the management of these patients is not yet clear.

Conclusion: High risk group should be identified and prioritised in future vaccination programmes. Future research is required to optimise management of patients with diabetes and develop new ways to manage them via technological developments such as telecare.
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http://dx.doi.org/10.1111/ijcp.14112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7995213PMC
February 2021

Care for Older People with Dementia During COVID-19 Pandemic.

SN Compr Clin Med 2021 Jan 27:1-7. Epub 2021 Jan 27.

Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham, S60 2UD UK.

Older people living with dementia, who are likely frail with multiple comorbidities, appear particularly vulnerable to COVID-19. Care for older people with comorbid dementia and COVID-19 is a challenge to health care professionals due to their complex needs. COVID-19 is a respiratory disease which typically presents with respiratory symptoms; however, in older people with dementia, it may present atypically with delirium. Delirium may precede respiratory symptoms, and in some cases, it may be the only symptom, leading to a delay in the diagnosis. Therefore, screening for delirium should be part of the routine clinical practice for older people with dementia and suspected COVID-19 infection. Due to the complexity of care required for older people with dementia affected by COVID-19, a holistic and individualised approach that includes acute, transitional and long-term care is required. Advanced decision-making, for example, ceiling of care and resuscitation decisions, should be made early on admission to hospital. Screening for frailty with clinical frailty scale may help to aid decision-making. Palliative care and relief of suffering should be considered from the outset. Early and regular involvement of patients and their families in care plans and periodic updates regarding any changes in the clinical condition are good clinical practice. The introduction of telehealth programmes that are suitable for older people with poor cognitive function and also cover diverse cultural backgrounds are urgently required for the future support of this vulnerable group of patients.
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http://dx.doi.org/10.1007/s42399-020-00715-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7837877PMC
January 2021

Prevalence, Associated Factors, and Consequences of Burnout Among Egyptian Physicians During COVID-19 Pandemic.

Front Public Health 2020;8:590190. Epub 2020 Dec 3.

Department of Community Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt.

COVID-19 has been recognized as a pandemic by the World Health Organization, and physicians are at the frontline to confront the disease. Burnout syndrome (BOS) is a syndrome resulting from chronic workplace stress that has not been successfully managed. The objective of this study is to evaluate the frequency and associated risk factors of BOS among a sample of Egyptian physicians during the COVID-19 pandemic. Using Maslach Burnout Inventory Human Services Survey, a cross-sectional electronic survey was conducted to assess BOS among the target group. Two hundred and twenty physicians participated in the study. The frequency of BOS among the research group was 36.36%. The possibility of development of BOS increased two times with the need to buy personal protective equipment (PPE) from participants' own money, with harassment by patients' families, and was less likely to develop in doctors with older age. While male gender was a predictor of depersonalization (DP), female gender showed a significant association with higher emotional exhaustion (EE). Infection or death from COVID-19 among colleagues or relatives showed significant association with elevated EE and lowered personal achievement (PA), respectively. COVID-19 pandemic added new factors to the development of BOS in our research group. Several measures should be taken to support physicians at this stage. These measures include psychological support, organizing work hours, adjusting salaries, and providing personal protective equipment and training on safety measures.
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http://dx.doi.org/10.3389/fpubh.2020.590190DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7744472PMC
January 2021

Acute lymphoblastic leukemia-like treatment regimen provides better response in mixed phenotype acute leukemia: a comparative study between adults and pediatric MPAL patients.

Ann Hematol 2021 Mar 23;100(3):699-707. Epub 2020 Nov 23.

Clinical Pathology Department, National Cancer Institute, Cairo University, Foum elkhalig Sq., Cairo, Egypt.

Mixed phenotype acute leukemia (MPAL) is a rare type of leukemia with a limited number of studies conducted to characterize its clinical spectrum and most importantly the best treatment modality. MPAL blasts show more than one phenotype either myeloid/monocytic with T- or B-lymphoid or extremely rare triple lineage associated phenotypic markers. This study aimed to characterize MPAL cases with special emphasis on comparing adult and pediatric age groups, exploring treatment regimens, and clinical outcome. Among 2571 acute leukemia patients, 102 MPAL cases fulfilling the 2008/2016 WHO diagnostic criteria of MPAL were recruited in the study. The incidence of MPAL was 4% of acute leukemia patients. Pediatric cases were 54 (53%) while adults were 48/102 (47%). Myeloid/B-lymphoid phenotype was found in 86/102 (84%), with BCR-ABL fusion gene transcript detected in 14/102(13.7%) patients. ALL-like treatment showed better response rates as compared with the myeloid based regimen (p = 0.001). MPAL behaves in a manner that resembles in clinical features, their lymphoid progenitor counterpart leukemias both in adults and pediatric patients with superior treatment response to ALL-like regimen, especially in adults.
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http://dx.doi.org/10.1007/s00277-020-04354-2DOI Listing
March 2021

Clinical characteristics and progression of COVID-19 confirmed cases admitted to a single British clinical centre-A brief case series report.

Int J Clin Pract 2020 Oct 31:e13807. Epub 2020 Oct 31.

Department of Geriatric Medicine, Rotherham General Hospital, Rotherham, UK.

Objectives: In December 2019, a pneumonia-like illness was first reported in Wuhan-China caused by a new coronavirus named corona virus disease-2019 (COVID-19) which then spread to cause a global pandemic. Most of the available data in the literature is derived from Chinese cohorts and we aim to contribute the clinical experience of a single British clinical centre with the characteristics of a British cohort.

Design: A prospective case series.

Setting: A single clinical centre in the UK.

Methods: We have collected the demographics and medical characteristics of all COVID-19-positive cases admitted over 2-week period. All cases were diagnosed by PCR.

Results: Total of 71 COVID-19 patients were included in this case series. Majority of patients (75%) were ≥75 years old and 58% were men. Pre-existing comorbidities was common (85% of patients). Most patients presented with respiratory symptoms such as fever (59%), shortness of breath (56%) and cough (55%). Gastrointestinal symptoms were second-most common presenting compliant such as diarrhoea (10%) and abdominal pain (7%). Opacification in chest X-rays was demonstrated in 45% of patients. All patients received supportive treatment and no specific antiviral therapy was administered in this cohort. So far, 18 (25%) patients have fully recovered, 9 patients (13%) escalated to a higher level of care and 10 (14%) have died. Patients who died were non-significantly older than those who have recovered (78.0 vs 69.2 years, P = .15) but they had a significantly higher clinical frailty scores (5.75 vs 3.36, P = .005).

Conclusion: This case series demonstrated that the characteristics of British COVID-19 patients were generally similar to what is published in literature, although we report more gastrointestinal symptoms at presentation. We have identified frailty as a risk factor for adverse outcome in COVID-19 patients and suggest that it should be included in the future vaccination recommendations.
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http://dx.doi.org/10.1111/ijcp.13807DOI Listing
October 2020

Social Stigma: The Hidden Threat of COVID-19.

Front Public Health 2020 28;8:429. Epub 2020 Aug 28.

Department of Clinical Oncology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

COVID-19 infection has been recognized as a pandemic by the World Health Organization. Efforts to prevent the spread of the disease are threatened by the appearance of disease-associated social stigma in society. In Egypt, a small wave of stigma directed at different groups started to appear. Here we report the features of COVID-19-associated stigma in Egypt and suggest recommendations to overcome this stigma before it grows and have physical and psychological impacts on society.
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http://dx.doi.org/10.3389/fpubh.2020.00429DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7484807PMC
August 2020

Characteristics of patients with diabetes hospitalised for COVID-19 infection-a brief case series report.

Diabetes Res Clin Pract 2020 Nov 21;169:108460. Epub 2020 Sep 21.

Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Droitwich Spa WR9 0QH, UK; Kings College, London SE1 9NH, UK.

Objectives: Diabetes has been shown to be a risk factor for corona virus disease-2019 (COVID-19) infection. The characteristics of patients with diabetes vulnerable to this infection are less specified. We aim to present the characteristics of patients with diabetes admitted to hospital with COVID-19.

Design: A retrospective case series.

Setting: A single clinical centre in the UK.

Methods: We have retrospectively collected the demographics, medical characteristics and outcome of all patients with diabetes admitted to hospital over two-week period with COVID-19 infection. All cases were diagnosed by a reverse transcription polymerase chain reaction (RT-PCR) of pharyngeal and nasal swabs.

Results: A total of 71 COVID-19 patients were admitted during the study period of whom 16 (22.5%) patients had diabetes and were included in this case series. There was no significant difference between patients with compared to those without diabetes regarding age, gender or clinical presentation. However, comorbidities were more common in patients with diabetes specially hypertension {75% v 36.4%, a difference of 38.6%, 95% confidence interval (CI) 6.5-58.3} and chronic kidney disease (37.5 v 5.5, a difference of 32% (1.6-51.6). Patients with diabetes were significantly more obese than those without diabetes (56.2% v 21.8% a difference of 34.4%, 95% CI 7.7-61.1). About one third (31.3%) of patients with diabetes were frail. Mean {standard deviation (SD)} duration of diabetes was 10 (2.8) years and mean (SD) HbA1c was 60.3 (15.6) mmol/mol. The use of angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and non-steroidal anti-inflammatory drugs (NSAIDs) was common (37.5%, 25% and 18.8% respectively). There was no significant difference in the outcomes between patients with compared to those without diabetes.

Conclusion: Patients with diabetes hospitalised for COVID-19 were significantly more obese and had high prevalence of comorbidities than those without diabetes. Other features of patients with diabetes and COVID-19 infection included long duration of diabetes, less tight glycaemic control and common use of ACE inhibitors, ARBs and NSAIDs.
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http://dx.doi.org/10.1016/j.diabres.2020.108460DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7505129PMC
November 2020

New hypoglycaemic therapy in frail older people with diabetes mellitus-phenotypic status likely to be more important than functional status.

Diabetes Res Clin Pract 2020 Nov 10;169:108438. Epub 2020 Sep 10.

Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Droitwich Spa WR9 0QH, UK.

Frail older people are largely excluded from clinical trials and therefore glycaemic targets and optimum hypoglycaemic therapy in this group has not been fully investigated. Guidelines generally recommend tight glycaemic control in functionally fit individuals and relaxed targets in frail ones mainly due to the fear of hypoglycaemia. The newly introduced sodium glucose cotransporter-2 inhibitors and the glucagon like peptide-1 receptor agonists have shown benefit that is independent of glycaemic control and a minimal risk of hypoglycaemia. However, guidelines still express caution about its use in frail older people due to fear of other side effects such as weight loss, hypotension and falls. Some frail older people will miss out on the benefits of this new therapy if frailty is considered as a one entity with a blanket application of guidelines. We propose that frailty should be viewed as two distinct metabolically different phenotypes, the sarcopenic-obese, in which new therapy will improve their metabolic profile and should be liberally used if no contraindications, and the anorexic-malnourished phenotype in which the new therapy should be cautiously considered. In other words, glycaemic targets should be driven by individual's overall function but the use of new therapy should be driven by frailty phenotype.
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http://dx.doi.org/10.1016/j.diabres.2020.108438DOI Listing
November 2020

CRISPR-mediated gene modification of hematopoietic stem cells with beta-thalassemia IVS-1-110 mutation.

Stem Cell Res Ther 2020 09 10;11(1):390. Epub 2020 Sep 10.

Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt.

Background: β-Thalassemias represent a group of genetic disorders caused by human hemoglobin beta (HBB) gene mutations. The radical curative approach is to correct the mutations causing the disease. CRISPR-CAS9 is a novel gene-editing technology that can be used auspiciously for the treatment of these disorders. The study aimed to investigate the utility of CRISPR-CAS9 for gene modification of hematopoietic stem cells in β-thalassemia with IVS-1-110 mutation.

Methods And Results: We successfully isolated CD34 cells from peripheral blood of β-thalassemia patients with IVS-1-110 mutation. The cells were transfected with Cas9 endonuclease together with guide RNA to create double-strand breaks and knock out the mutation. The mutation-corrected CD34 cells were subjected to erythroid differentiation by culturing in complete media containing erythropoietin.

Conclusion: CRISPR/Cas-9 is an effective tool for gene therapy that will broaden the spectrum of therapy and potentially improve the outcomes of β-thalassemia.
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http://dx.doi.org/10.1186/s13287-020-01876-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7488347PMC
September 2020

Delirium in Older People with COVID-19: Clinical Scenario and Literature Review.

SN Compr Clin Med 2020 Aug 29:1-8. Epub 2020 Aug 29.

Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham, S60 2UD UK.

Delirium is a potentially fatal acute brain dysfunction that is characterised by inattention and fluctuating mental changes. It is indicative of an acute serious organ failure or acute infection. Delirium is also associated with undesirable health outcomes that include prolonged hospital stay, long-term cognitive decline and increased mortality. The new SARS-CoV-2 shows, not only pulmonary tropism but also, neurotropism which results in delirium in the acute phase illness particularly in the older age groups. The current assessment for COVID-19 in older people does not routinely include screening for delirium. Implementation of a rapid delirium screening tool is necessary because, without screening, up to 75% of cases can be missed. Delirium can also be exaggerated by health care policies that recommend social isolation and wearing personal protective equipment in addition to less interaction with patients. Non-pharmacological intervention for delirium prevention and management may be helpful if implemented as early and as often as possible in hospitalised older people with COVID-19. A holistic approach that includes psychological support in addition to medical care is needed for older people admitted to hospital with COVID-19.
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http://dx.doi.org/10.1007/s42399-020-00474-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7455775PMC
August 2020

Facile Room-Temperature Synthesis of a Highly Active and Robust Single-Crystal Pt Multipod Catalyst for Oxygen Reduction Reaction.

ACS Appl Mater Interfaces 2020 Nov 23;12(44):49510-49518. Epub 2020 Oct 23.

School of Materials Science and Engineering, Georgia Institute of Technology, 771 Ferst Drive, Atlanta, Georgia 30332-0245, United States.

Economical production of highly active and robust Pt catalysts on a large scale is vital to the broad commercialization of polymer electrolyte membrane fuel cells. Here, we report a low-cost, one-pot process for large-scale synthesis of single-crystal Pt multipods with abundant high-index facets, in an aqueous solution without any template or surfactant. A composite consisting of the Pt multipods (40 wt %) and carbon displays a specific activity of 0.242 mA/cm and a mass activity of 0.109 A/mg at 0.9 V (versus a reversible hydrogen electrode) for oxygen reduction reaction, corresponding to ∼124% and ∼100% enhancement compared with those of the state-of-the-art commercial Pt/C catalyst (0.108 mA/cm and 0.054 A/mg). The single-crystal Pt multipods also show excellent stability when tested for 4500 cycles in a potential range of 0.6-1.1 V and another 2000 cycles in 0-1.2 V. More importantly, the superior performance of the Pt multipods/C catalyst is also demonstrated in a membrane electrode assembly (MEA), achieving a power density of 774 mW/cm (1.29 A/cm) at 0.6 V and a peak power density of ∼1 W/cm, representing 34% and 20% enhancement compared with those of a MEA based on the state-of-the-art commercial Pt/C catalyst (576 and 834 mW/cm).
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http://dx.doi.org/10.1021/acsami.0c06652DOI Listing
November 2020

Challenges and Strategies for Diabetes Management in Community-Living Older Adults.

Diabetes Spectr 2020 Aug;33(3):217-227

Department of Geriatric Medicine, Rotherham General Hospital, Rotherham, UK.

The prevalence of diabetes is increasing, especially in older people, mainly because of an increase in life expectancy. The number of comorbidities also increases with increasing age, leading to a unique diabetes phenotype in old age that includes vascular disease, physical and neuropathic complications, and mental dysfunction. These three categories of complications appear to have a synergistic effect that can lead to a vicious cycle of deterioration into disability. Early assessment and appropriate, timely interventions may delay adverse outcomes. However, this complex phenotype constitutes a great challenge for health care professionals. This article reviews the complex diabetes phenotype in old age and explores management strategies that are predominantly based on the overall functional status of patients within this heterogeneous age-group.
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http://dx.doi.org/10.2337/ds20-0013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7428661PMC
August 2020

Chinese and British Hospitalised Patients with COVID-19-a Comparative Case Series Analysis.

SN Compr Clin Med 2020 Jul 18:1-5. Epub 2020 Jul 18.

Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham, S60 2UD UK.

The COVID-19 pandemic initially started in China then spread to Europe. It is not known whether COVID-19 affects patients differently across the two continents. We aimed to describe our cohort of patients admitted to a single British centre with COVID-19 in comparison to a Chinese cohort of similar size and admitted over a similar time period to Chinese centres. We present a comparison of 62 Chinese and 71 British cases hospitalised for COVID-19. Cases in both sites were confirmed by a positive RT-PCR of nasopharyngeal swabs. Comparison analysis highlighted some differences between both populations. The most striking difference is the significantly older age of the British population (72% of the British ≥ 66 years compared to only 3% of the Chinese patients, difference of 69%, 95% confidence interval (CI) 68.3% to 69.7%, respectively) and the associated significant premorbid conditions (85% of patients vs 32%, difference of 53%, 95% CI 52 to 54%, respectively). Gastrointestinal and general symptoms were more common clinical presentation in the British while respiratory symptoms were more prominent in the Chinese cohort. Mortality was significantly higher in the British cohort 14% compared to none in the Chinese cohort (difference of 14%, 95% CI 13.7 to 14.3%). We conclude that COVID-19 does present differently in these two cohorts, but the apparent differences in the clinical presentations could be explained by the inherent differences in the demographics and case mix between both countries.
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http://dx.doi.org/10.1007/s42399-020-00414-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7368627PMC
July 2020

Cardiometabolic disease in the older person: prediction and prevention for the generalist physician.

Cardiovasc Endocrinol Metab 2020 Sep 22;9(3):90-95. Epub 2020 Feb 22.

Department of Geriatric Medicine, Rotherham General Hospital, Rotherham, UK.

Ageing is associated with chronic inflammation and oxidative stress that increase the risk of cardiovascular disease. Frailty and sarcopenia, which are associated with increased visceral obesity and muscle mass loss, are now emerging as new potential risk factors for cardiovascular disease. Increased muscle visceral fat leads to increased secretion of harmful proinflammatory adipokines and reduced muscle mass leads to reduced secretion of the protective myokines creating an abnormal cardiometabolic state increasing the risk of cardiovascular disease. This review: (1) explore traditional and newly emerging cardiometabolic risk factors in older people; (2) investigate methods of prediction and prevention of cardiovascular disease in those with diabetes; and (3) concludes that the development of a subspeciality of Cardiometabolic Medicine should be considered.
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http://dx.doi.org/10.1097/XCE.0000000000000193DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7410030PMC
September 2020

Cardio-renal protection in older people with diabetes with frailty and medical comorbidities - A focus on the new hypoglycaemic therapy.

J Diabetes Complications 2020 09 26;34(9):107639. Epub 2020 May 26.

Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Droitwich Spa WR9 0QH, UK; Kings College, London SE1 9NH, UK.

The prevalence of diabetes is increasing particularly in the older age group due to the increased life expectancy. Ageing is associated with vascular and renal changes that predispose older people with diabetes to an increased risk of cardio-renal complications. This manuscript is set to review the use of the sodium glucose transporter-2 (SGLT-2) inhibitors and the glucagon like peptide-1 receptor agonists (GLP1-RA) in older population with diabetes especially in those with comorbidities and frailty. The recently introduced (SGLT-2) inhibitors and the GLP1-RA have shown promising cardio-renal protective outcomes. In addition to the favourable effect of glycaemic control on cardio-renal complications, these new agents seem to add additional benefits independent of their hypoglycaemic properties. The favourable outcomes have been shown in the older age group (>65 years) who were reasonably represented in the randomised controlled clinical trials. However, the evidence for those ≥75 years old is limited due to the small number of the included participants and the few clinical events. Data from both real world and post-hoc analyses of clinical trials is assuring about the use of these new agents in older people. However, it remains reasonable to express caution in using these agents in frail older people with diabetes due to high risk of adverse events in this group.
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http://dx.doi.org/10.1016/j.jdiacomp.2020.107639DOI Listing
September 2020

Cognitive Dysfunction in Older Adults with Type 2 Diabetes: Links, Risks, and Clinical Implications.

Clin Geriatr Med 2020 08 17;36(3):407-417. Epub 2020 Apr 17.

Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham S60 2UD, UK.

The prevalence of comorbid diabetes and cognitive dysfunction increases as the population ages. Diabetes increases the risk of progression of cognitive dysfunction through a spectrum of cognitive decline to mild cognitive impairment then to dementia. Cognitive dysfunction, especially impairment in the executive domain, has a negative impact on patients' self-care tasks. With further progression of dementia and the development of behavioral problems, the challenge to carers and health care professionals looking after these patients is significant. Therefore, clinical trials are needed to explore the impact of novel hypoglycemic therapy on cognitive function as an important outcome in this population.
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http://dx.doi.org/10.1016/j.cger.2020.04.002DOI Listing
August 2020

Diabetic Kidney Disease in Older People with Type 2 Diabetes Mellitus: Improving Prevention and Treatment Options.

Drugs Aging 2020 08;37(8):567-584

Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham, S60 2UD, UK.

Age-related metabolic and renal changes predispose older people to an increased risk of diabetes mellitus and diabetic kidney disease, respectively. As the prevalence of the ageing population is increasing, because of increased life expectancy, the prevalence of older people with diabetic kidney disease is likely to increase. Diabetic kidney disease is associated with an increased risk of adverse outcomes and increased costs to healthcare systems. The management includes promotion of a healthy lifestyle and control of cardiovascular risk factors such as hyperglycaemia, hypertension and dyslipidaemia. Older people are a heterogeneous group of people from a community-living fit and independent person to a fully dependent individual residing in a care home. Therefore, management in this age group should be based on a patient's functional level adopting tight metabolic control in the fit individual and relaxed targets in the frail person. However, despite the maximum available therapy, a significant number of patients with diabetic kidney disease still progress to renal failure and experience adverse cardiac outcomes. Therefore, future research is required to explore methods of early detection of diabetic kidney disease and to investigate novel therapeutic interventions to further improve the outcomes.
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http://dx.doi.org/10.1007/s40266-020-00773-yDOI Listing
August 2020

Guidelines for the management of diabetes in care homes during the Covid-19 pandemic.

Diabet Med 2020 07 15;37(7):1090-1093. Epub 2020 Jun 15.

Diabetes UK.

The National Diabetes Stakeholders Covid-19 Response Group was formed in early April 2020 as a rapid action by the Joint British Diabetes Societies for Inpatient Care, Diabetes UK, the Association of British Clinical Diabetologists, and Diabetes Frail to address and support the special needs of residents with diabetes in UK care homes during Covid-19. It was obvious that the care home sector was becoming a second wave of Covid-19 infection and that those with diabetes residing in care homes were at increased risk not only of susceptibility to infection but also to poorer outcomes. Its key purposes included minimising the morbidity and mortality associated with Covid-19 and assisting care staff to identify those residents with diabetes at highest risk of Covid-19 infection. The guidance was particularly created for care home managers, other care home staff, and specialist and non-specialist community nursing teams. The guidance covers the management of hyperglycaemia by discussion of various clinical scenarios that could arise, the management of hypoglycaemia, foot care and end of life care. In addition, it outlines the conditions where hospital admission is required. The guidance should be regarded as interim and will be updated as further medical and scientific evidence becomes available.
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http://dx.doi.org/10.1111/dme.14317DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7267536PMC
July 2020

Age, frailty and diabetes - triple jeopardy for vulnerability to COVID-19 infection.

EClinicalMedicine 2020 May 23;22:100343. Epub 2020 Apr 23.

Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham S60 2UD, United Kingdom.

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http://dx.doi.org/10.1016/j.eclinm.2020.100343DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7177130PMC
May 2020

Knowledge, Perceptions, and Attitude of Egyptians Towards the Novel Coronavirus Disease (COVID-19).

J Community Health 2020 10;45(5):881-890

Department of Community Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt.

Coronavirus disease 2019 (COVID-19) has been recognized as a pandemic by the World Health Organization. Global efforts have been exerted to prevent the spreading of the disease through political decisions together with personal behaviors, which depend on awareness of the public. The goal of this study is to assess the knowledge, perceptions and attitude of the Egyptian public towards the COVID-19 disease. We conducted a cross-sectional survey about these points, which was distributed among adult Egyptians. Five hundred and fifty nine persons completed the survey. The mean knowledge score was 16.39 out of 23, gained mainly though social media (66.9%), and the internet (58.3%). Knowledge was significantly lower among older, less educated, lower income participants, and rural residents. Most participants (86.9%) were concerned about the risk of infection. While 37.6% thought that their salary will be continued if they become isolated, 68.5% believed that it should be continued during this period. About 73.0% were looking forward to get the vaccine when available. In general, participants had a good knowledge about the disease and a positive attitude towards protective measures. This knowledge is gained mainly through novel media channels, which have pros and cons. Although the government has taken major steps to educate the public and limit the spread of the disease, more effort is needed to educate and support the lower economic strata. If a vaccine or a treatment is approved, we recommend a government control over its use to preserve the rights of the vulnerable and needy groups.
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http://dx.doi.org/10.1007/s10900-020-00827-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7173684PMC
October 2020

Low expression of miR-204 is associated with expression of CD34 and poor performance status in denovo AML.

Int J Lab Hematol 2020 Jun 12;42(3):263-269. Epub 2020 Feb 12.

Department of Clinical pathology, National Cancer Institute, Cairo University, Cairo, Egypt.

Introduction: Acute myeloid leukemia (AML) is the most common acute leukemia in adults. There is growing evidence that microRNAs (miRNAs) provide prognostic information in AML. MiR-204 has a tumor suppressor function, and several studies have proven its role in solid cancers. The aim of this work is to evaluate the level of expression of miR-204 in adults newly diagnosed with AML with normal karyotype and to correlate its level of expression with disease outcome and different prognostic factors.

Patients And Methods: The study included 87 adult patients newly diagnosed with AML. Detection of miR-204 was done using RT-PCR in patients and seven age-matched controls.

Results: Acute myeloid leukemia patients showed significantly lower miR-204 expression, compared to control group (P = .029). Low miR-204 expression was significantly associated with positive CD34 (P = .017), with poor performance status (PS) (P = .009), and with the presence of diabetes mellitus (DM) (P = .014). Low expression of miR-204 was also significantly associated with shorter overall survival (OS) (P = .020) and disease-free survival (DFS) (P = .013). Low miR-204 expression was identified as an independent prognostic factor for prediction of shorter OS (P = .034) and DFS (P = .027) in AML.

Conclusion: To the best of our knowledge; this is the first time to prove the correlation between miR-204 expression and CD34 expression. Further study of this correlation is needed to confirm the role of miR-204 in CD34-positive cells, including leukemic stem cells. This correlation may have therapeutic implications. MiR-204 can be used as a biomarker for PS in AML patients.
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http://dx.doi.org/10.1111/ijlh.13161DOI Listing
June 2020

Triad of impairment in older people with diabetes-reciprocal relations and clinical implications.

Diabetes Res Clin Pract 2020 Mar 7;161:108065. Epub 2020 Feb 7.

Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Droitwich Spa WR9 0QH, UK; Kings College, London SE1 9NH, UK.

Frailty is emerging as a new category complication of diabetes in older people. Clinically, frailty is still not well defined and mostly viewed as a decline in solely the physical domain. However, frailty is a multidimensional syndrome and the newly introduced concept of "triad of impairment" (physical, cognitive and emotional) may be a more representative of the broad nature of frailty. The components of the triad of impairment (TOI) commonly coexist and demonstrate a reciprocal relation. Diabetes in old age appears to increase the risk of the triad of impairment, which may eventually progress to disability. Therefore, older people with diabetes should be regularly assessed for the presence of these three key components. Adequate nutrition and regular resistance exercise training have been shown to have a positive impact on the long-term outcome in this population. However, the role of good glycaemic control and the use of current hypoglycaemic medications in reducing the incidence of this triad are less clear. Future research is needed to develop novel hypoglycaemic medications that not only focus on glycaemic control and cardiovascular safety but also on reducing the risk of the triad of impairment.
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http://dx.doi.org/10.1016/j.diabres.2020.108065DOI Listing
March 2020

Patient-controlled variable dosing of levodopa for Parkinson's disease.

Age Ageing 2020 02;49(2):305-306

The Rotherham NHS Foundation Trust, Rotherham, UK.

Medication for idiopathic Parkinson's disease (PD) is for symptomatic relief, and typically, patients are advised to take their medication at agreed regular times. Here, we present a lady with moderate PD and superimposed anxiety for whom this management strategy did not work well as it increased her anxiety significantly around dosing times. She was switched to an PRN regime and although taking the same total dose of levodopa with similar symptom control was overall much happier. Although there are sound reasons behind regular dosing of levodopa (its short duration of action and relationship of clinical response to plasma concentration), a holistic co-created management plan against classical advice but taking into account the psychological burden of disease and medication may in many cases be more appropriate.
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http://dx.doi.org/10.1093/ageing/afz167DOI Listing
February 2020

Atomic Structure and Dynamics of Epitaxial Platinum Bilayers on Graphene.

ACS Nano 2019 Oct 26;13(10):12162-12170. Epub 2019 Sep 26.

School of Materials Science and Engineering , Georgia Institute of Technology , Atlanta , Georgia 30332 , United States.

Platinum atomic layers grown on graphene were investigated by atomic resolution transmission electron microscopy (TEM). These TEM images reveal the epitaxial relationship between the atomically thin platinum layers and graphene, with two optimal epitaxies observed. The energetics of these epitaxies influences the grain structure of the platinum film, facilitating grain growth in-plane rotation and assimilation of neighbor grains, rather than grain coarsening from the movement of grain boundaries. This growth process was enabled due to the availability of several possible low-energy intermediate states for the rotating grains, the Pt-Gr epitaxies, which are minima in surface energy, and coincident site lattice grain boundaries, which are minima in grain boundary energy. Density functional theory calculations reveal a complex interplay of considerations for minimizing the platinum grain energy, with free platinum edges also having an effect on the relative energetics. We thus find that the platinum atomic layer grains undergo significant reorientation to minimize interface energy ( epitaxy), grain boundary energy ( low-energy orientations), and free edge energy. These results will be important for the design of two-dimensional graphene-supported platinum catalysts and obtaining large-area uniform platinum atomic layer films and also provide fundamental experimental insight into the growth of heteroepitaxial thin films.
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http://dx.doi.org/10.1021/acsnano.9b06701DOI Listing
October 2019

What Egyptians think. Knowledge, attitude, and opinions of Egyptian patients towards biobanking issues.

BMC Med Ethics 2019 08 9;20(1):57. Epub 2019 Aug 9.

Research Department, Children's Cancer Hospital Egypt, 57357, Cairo, Egypt.

Background: Biobanking is a relatively new concept in Egypt. Building a good relationship with different stakeholders is essential for the social sustainability of biobanks. To establish this relationship, it is necessary to assess the attitude of different groups towards this concept. The objective of this work is to assess the knowledge, attitude, and opinions of Egyptian patients towards biobanking issues.

Methods: We designed a structured survey to be administered to patients coming to the outpatient clinics in 3 university hospitals in Egypt. The survey included questions estimating the level of knowledge about the term "Biobank", together with questions about the attitudes and opinions about related issues.

Results: Two hundred and fifty-nine patients participated in the survey. Eighty-one percent of participants reported that they never heard about the term before. About 85% expressed that they would be willing to donate their samples for research and about 87% thought that sample donation did not contradict their religious beliefs. Fifty eight percent were willing to participate in a genetic research project, 27.8% supported sharing their sample with pharmaceutical companies, and 32.4% agreed to share their samples with institutions abroad.

Conclusion: Although there is limited knowledge about biobanking among Egyptian patients, many had a positive attitude towards sample donation and didn't show religious concerns against it. However, they showed concerns regarding participation in genetic research and with sharing their samples across borders or with pharmaceutical companies. Public education about biobanking is possible, taking into consideration the specific cultural and legal framework in Egypt.
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http://dx.doi.org/10.1186/s12910-019-0394-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6689171PMC
August 2019

Cognitive Frailty in Older People with Type 2 Diabetes Mellitus: the Central Role of Hypoglycaemia and the Need for Prevention.

Curr Diab Rep 2019 02 26;19(4):15. Epub 2019 Feb 26.

Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Droitwich Spa, WR9 0QH, UK.

Purpose Of Review: To highlight the central role of hypoglycaemia in the causation of cognitive frailty and explore ways of recognition and prevention of hypoglycaemia.

Recent Findings: Cognitive frailty is an emerging new concept defined as the concomitant presence of physical frailty and cognitive impairment. In older people with diabetes, cognitive frailty is associated with an increased risk of mortality greater than from either physical frailty or cognitive impairment alone. Hypoglycaemia is directly associated with increased risk of cognitive impairment and physical frailty which are the two components of cognitive frailty. The incidence of hypoglycaemia in older people with diabetes is rising and hypoglycaemia-related hospitalisation has overtaken that of hyperglycaemia. Recognition of hypoglycaemic episodes in old age remains challenging which leads to misdiagnoses and under-reporting. Therefore, hypoglycaemia prevention strategies are needed. Research is still required to investigate whether prevention of hypoglycaemia would lead to a reduction in the incidence of cognitive frailty.
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http://dx.doi.org/10.1007/s11892-019-1135-4DOI Listing
February 2019