Absence Of Comorbid Disease Research Articles

The peculiarities of vitamin D status and clinical characteristic in women with moderate obesity in gestational endotheliopathy

Annotation. Maternal obesity is associated with perinatal complications and increases the risk for the infant to develop cardiovascular disease later in life. The aim of present study was to assess the maternal serum 25(ОН)D levels and main clinical data in pregnancies with obese I in the presence or absence of comorbid diseases and to compare the results with healthy controls. In accordance with the purpose of our clinical study, in the first stage, we conducted a prospective analysis of the social, somatic, gynecological, and obstetric history of women with obesity and decreased serum levels of vitamin D. The main group consisted of 75 pregnant patients with grade I obesity (BMI = 30 - 34.99 kg/m2), serum 25 (OH) D content <32 ng/ml, however > 16 ng/ml and gestational endotheliopathy. The control group included 26 practically healthy pregnant women with a physiological course of gestation with a normative indicator of serum vitamin D. 85.3% of women with obese I had serum insufficiency (66.7%) and vitamin D deficiency (18.6%). Variational and statistical processing of the survey results was performed using the program “STATISTICA 10” Enterprise Portable with the definition of the main variational indicators. Moderate obesity and vitamin D insufficiency/deficiency were statistically likely to be associated with material security problems (p=0.031); unbalanced diet (p=0.03); hypodynamia (p=0.001); stressful working conditions (p=0.0045) and smoking (p=0.0045). Women with obesity and low vitamin D status had an increased risk of cardiovascular disease (p=0.029) and gastrointestinal disease (p=0.006). It was noteworthy that women with vitamin D imbalance and obese I had a significantly shorter duration of both the menstrual cycle (p=0.02) and duration of menstrual periods and blood loss during period (p=0.004 and p=0.02). For patients with obesity and decreased serum levels of 25 (OH) D, there was an increase in the number of cases of aggravated gynecological history (p=0.0001), in particular, cases of PCOS (p=0.03); frequency of miscarriage (p=0.042) and antenatal complications, in general (p=0.0012). Further research will assess the clinical effectiveness of personalized dose supplementation of vitamin D (depending on status) in obese pregnant women to prevent the development of perinatal pathology.

The infection rate in new diagnosis and relapsed/refractory multiple myeloma patients who had bortezomib-based chemotherapy and relationship between development of infection and lymphocyte/monocyte ratio

Objectives: Multiple Myeloma (MM) is a disease caused by the clonal proliferation of plasma cells. In recent years, proteozom inhibitors, immunomodulatory agents and monoclonal antibodies have been used in the treatment of MM. In this study, the relation of bortezomib, one of the proteozoma inhibitors used in the treatment of MM, with the development of infection was investigated. Methods: We retrospectively evaluated 56 patients who had MM treated with bortezomib-based regimen. We tried to determine the relationship between infection with immunoglobulin G levels at the time of diagnosis, lymphocyte absolute values at the time of diagnosis, lymphocyte absolute values at the time of chemotherapy, neutrophil absolute value at the time of chemotherapy, lymphocyte absolute values at the time of infection, monocyte absolute value at the time of infection, and the lymphocyte/monocyte (L/M) ratio at the time of infection. The effects of L/M ratio on progression free survival (PFS) and overall survival (OS) were also examined. Results: Thirty (53.6%) of the 56 patients were newly diagnosed, 26 (46.4%) of 56 patients were relapsed/refractory MM. The bortezomib-based regimen was given to all patients. Of the 56 patients included in the study, 21 (37.5%) were female, 35 were male (62.5%). The ages of the patients was 28-79 years (median: 58.5 years). No infection attack was observed in 31 (55.4%) patients. Disease stage (R-ISS) (p = 0.032), presence or absence of co-morbid disease (p = 0.035), disease status during an infection attack (p < 0.01), lymphocytopenia at the time of chemotherapy (p = 0.003), absolute value of lymphocytopenia at the time of infection attack (p < 0.01) and L/M ratio (p < 0.01) had a significant relation with development of infection. Lymphocytopenia at the time of infection attack (p < 0.01, OR<1, 94.6% CI) and L/M ratio (p < 0.01, OR<1, 91.1% CI) had been found significant in univariate logistic regression analysis. Lymphocytopenia at the time of infection attack (p = 0.002, OR<1, 95% CI) and L/M ratio (p = 0.003, OR<1, 95% CI) had been found significant in multivariate logistic regression analysis. L/M ratio had a significant effect on OS (p < 0.017) but not on PFS (p > 0.05). Conclusions: It was determined that L/M ratio has an effect on OS and it is also an independent factor on the development of infection. OS was decreasing and the risk of developing infection was increasing, when the L/M ratio was low.

Impact of socio-demographic and clinical characteristics on functional disability and health-related quality of life in patients with rheumatoid arthritis: a cross-sectional study from Palestine

BackgroundRheumatoid arthritis (RA) is a chronic autoimmune disorder, which has a significant impact on patients' health-related quality of life (HRQoL), and limits physical function as well as increases pain and fatigue. Therefore, this study aimed to evaluate the HRQoL and functional disability profile of patients with RA in Palestine to determine the socio-demographic and clinical features associated with low HRQoL and functional disability in patients with RA and to investigate the impact of drugs used on functional disability and HRQoL.MethodologyA cross-sectional, observational study conducted at rheumatology clinics in Northern West-Bank, Palestine (Alwatani Hospital—Nablus, Khalil Suleiman Hospital—Jenin, Thabet Thatbet Hospital-Tulkarem, and Darweesh Nazzal Hospital—Qalqilia). EuroQoL-5 Dimension scale (EQ-5D-5L) was used to evaluate HRQoL, Health Assessment Questionnaire, Disability Index (HAQ-DI) to evaluate the functional disability, and the Health Assessment Questionnaire pain visual analog scale (HAQ-VAS) to evaluate pain.Results300 patients were included in the study, 229(76.3%) were females, the mean ± standard deviation age was 49 ± 13.10 years, and the median RA duration (lower–upper quartiles) was 6 (4–12) years. The median EQ-5D-5L index value and Euro QOL visual analogue scale (EQ-VAS) scores were 0.56 and 60, respectively. There was a significant strong positive correlation (R = 0.773; p < 0.001) between the EQ-5D-5L index values and the reported EQ-VAS scores. The median HAQ-DI and HAQ-VAS were 0.94 and 40, respectively. The results of multiple linear regression showed that treatment with biological DMARD (Etanercept), having work, higher income, absence of night pain, and absence of comorbid diseases were significantly associated with higher EQ-5D-5L index score (better HRQoL) and lower HAQ-DI scores (less disability). On the other hand, older age and the presence of morning stiffness were significantly associated with higher HAQ-DI scores (more disability).ConclusionsThis study revealed the impact of treatment, clinical variables, and socio-demographic factors on disability and HRQoL in RA patients. Healthcare providers should be aware of the association between treatment with biological DMARD and improved HRQoL and functional status to make early interventions that reduce disability and improve HRQoL in susceptible patients.

Different Prognostic Patterns in Epilepsies and Considerations About the Denotations of Atypical Patterns.

Epilepsy is a dynamic and heterogeneous neurological disease, and in long-term studies on prognosis, classically 5 basic patterns (early remission, late remission, relapsing-remitting, worsening, and non-remitting) have been identified. The most frequent pattern was relapsing-remitting course, and factors such as the presence of genetic etiology, rare seizures at the beginning of epilepsy and the absence of psychiatric comorbid diseases were found to be related with this pattern as well as reaching 5 years of remission in the follow-ups. Anti-seizure drug resistance (ASD-R) and factors affecting the presence of this resistance (such as symptomatic etiology, abnormal electroencephalographic findings, having multiple seizure types together, status epilepticus and febrile seizure history) decrease the chance of remission, while idiopathic/genetic etiology, generalized epilepsy, and absence of comorbid diseases seem to be associated with achieving long-term remission. Apart from these basic course patterns, there are some patients with an "atypical prognosis" such as drug-resistant juvenile myoclonic epilepsy (JME), benign hippocampal sclerosis-related mesial temporal lobe epilepsy (HS-MTLE), and severe childhood epilepsy with centro-temporal spikes (CESTS), in which the pathophysiological mechanisms underlying these patterns have not been clarified despite the suggestions of various hypotheses. The presence of comorbid diseases such as hormonal factors (as in catamenial epilepsy), autoimmune processes, thyroid disorders and metabolic and psychiatric diseases may also cause an atypical prognostic pattern by affecting the course of the disease. In this review, our aim is to provide the clinician with an up-to-date and questioning perspective on the prognostic markers of epilepsy, by examining in detail some specific epilepsy syndromes that may show atypical prognosis as well as the general prognostic features of epilepsy.

Factors influencing the occurrence of electrolyte disorders in cancer patients.

Objective:The objective of this study was to determine the magnitude of electrolyte disorders and influencing factors among cancer patients in Southwest Ethiopia.Methods:Facility-based cross-sectional study was conducted in Jimma Medical Center (JMC). Eighty-four cancer patients admitted to JMC were recruited for this study. A structured questionnaire and serum electrolyte measurements were used for data collection. Bivariate and multiple logistic regression was employed to determine the association between electrolyte disorders and associated factors among admitted cancer patients. P value ⩽ 0.05 was used as a cut point to declare statistical significance.Result:The overall prevalence of electrolyte disorders was 60.7%. The presence or absence of comorbid diseases, age, body mass index (BMI), nutritional status, and current prescribed medication use were associated with electrolyte disorders. Younger patients had lower odds for electrolyte disorders (odds ratio (OR) = 0.128 (P value = 0.05) and OR = 0.08 (P value = 0.033)) for the first and the second quartile, respectively. Underweight patients had a threefold likelihood to develop electrolyte disorders (OR = 3.13 (P value = 0.043)) than having normal BMI. Compared with those in need of nutritional intervention, patients not in need of nutritional intervention had lower odds for the disorders (OR = 0.109 (P value = 0.006)). Medication had increased the likelihood of electrolyte disorders by 5.5 times than with no medication (P value = 0.023). Those who had comorbid disease had 10 times likely to develop electrolyte disorders than those who did not have comorbid diseases (P value = 0.004).Conclusion:Electrolyte disorders were prevalent in cancer patients. Age, BMI, nutritional condition, comorbid disease, and prescribed drugs were the predictors of electrolyte disorders in cancer patients. Authors recommend routine screening of electrolyte disorders in cancer patients and special emphasis on controlling and managing risk factors.

Radiological appearance of physical elder abuse.

The aim of the study was to determine the radiologic imaging characteristics of the trauma-related lesions of elderly patients determined to be abused, and to raise awareness among all types of physicians, foremost radiologists, about elder abuse. Clinical records and radiological images of 92 patients with the diagnosis of elder abuse were retrospectively evaluated in terms of age, gender, the reason for admission to the hospital, the presence or absence of comorbid disease(s), bone fracture location and number, characteristics of the fracture(s), the presence or absence of soft-tissue damage or old fracture(s), and the mortality. Of the patients, 85.9% were brought to the hospital because of a fall. Upper extremity was the most common body segment subjected to trauma (37%), followed by head and neck (30.4%) and chest (30.4%). The most commonly fractured bones were costae, and they were mostly multiple and located in the posterior segment. In long bone fractures, the lesions were located in the distal end of the bone and diaphyseal segment in 56.9% and 53.8% of the cases, respectively. The rates of concurrent joint dislocation, soft-tissue lesion(s) and old fracture(s) were 12%, 54.3% and 19.6%, respectively. The mortality rate was 9.8%. Specific fracture features and certain accompanying findings can be identified in abused elderly patients. We recommend that radiologists increase their skills in interpreting radiographs from potential victims of abuse, prioritise this work over more routine reporting and collaborate with clinicians in a multidisciplinary approach to the detection and secondary prevention of violence and neglect of older people.

Review of Radiological Parameters, Imaging Characteristics, and Their Effect on Optimal Treatment Approaches and Surgical Outcomes for Cervical Ossification of the Posterior Longitudinal Ligament.

Determining the optimal surgical method for cervical ossification of the posterior longitudinal ligament (OPLL) is challenging. The surgical indication should be made based on not only radiological findings, but also the patient’s age, preoperative neurological findings, social background, activities of daily life, and the presence or absence of comorbid diseases. Anterior resection for OPLL with or without wide corpectomy and fusion, posterior decompression with or without relatively long fusion, or anterior and posterior combined surgery may be considered. When evaluating the clinical condition of patients with cervical OPLL before surgery, various radiological parameters should be carefully considered, including the number of spinal segments involved, the cervical alignment or tilt angle, the relationship between OPLL and the C2–7 line (termed the “K-line”), the occupying ratio of OPLL, and the involvement of dural ossification. The objective of this article is to review the radiological parameters in current use for deciding upon the optimal surgical strategy and for predicting surgical outcomes, focusing on cervical OPLL.

Evaluation of Prescribing Pattern Of Antihypertensives Against The Clinical Condition

Background :The prescribing pattern of antihypertensives by different physicians is not in compliance with that of the standard guidelines given by WHO/JNC-7.The patient factors associated with hypertension like age,sex,the presence or absence of co-morbid diseases along with hypertension will also play a major role in prescribing a particular class of antihypertensive drug. If the standard guidelines and the patient factors are not taken into consideration while prescribing the drugs then the final BP control remains unsatisfactory. Objective:The purpose of this study was to evaluate the prescribing pattern,to determine the factors associated with the treatment of the disease. Methods: It is an observational,prospective,non-interventional study in which prescriptions were collected during July-2013 to January – 2014 (for a duration of 7 months) in a tertiary care hospital to comprise a study population of 400 hypertensive patients. Results: As monotherapy ACE-Inhibitors (38.25%) were the most commonly prescribed antihypertensives followed by calcium channel blockers(19.25%), Diuretics (13.25%) ranked third in the prescribing pattern.combination treatment usually consisted of 2 antihypertensive drugs as a coformulation.the most common combination was a ACE-Inh+CCB(5%), followed by Beta-blocker+CCB( 3.5%).patients gender,age and comobidities significantly influenced which treatment was prescribed. Limitations: The main limitation of this study was that all the prescriptions were collected from inpatient from a single hospital and it may not be a representative of prescribing pattern across the city. Conclusion: In this study it was observed that the ACE-Inhibitors are the most commonly prescribed monotherapy agents (38.25%) and their prescribing pattern was in consistent with the global trends.Thiazides and the combination drugs were underutilized in this study,despite robust evidence to support their use.

Applications of Nitrous Oxide for Procedural Sedation in the Pediatric Population

The objective of this review was to provide a general descriptive account of the physical properties, end-organ effects, therapeutic applications, and delivery techniques of nitrous oxide (N2O) as used in the arena of procedural sedation. A computerized bibliographic search regarding the applications of nitrous for provision of sedation and analgesia during procedures with an emphasis on the pediatric population was performed. The end-organ effects of N2O have been well described in the operating room setting. Aside from its effects on the central nervous system of sedation and analgesia, N2O may alter intracerebral dynamics and alter cerebral blood flow and intracranial pressure especially in patients with altered intracranial compliance. Effects on ventilation include a dose-related depression of ventilatory function and control of upper airway patency. These effects are generally limited in the absence of comorbid diseases and potentiated by other sedative and analgesic agents. The more clinically significant respiratory effect of N2O on ventilatory function is a dose-dependent depression of the ventilatory response to hypoxemia. Hemodynamic effects include a mild direct depressant effect on myocardial function, which in the absence of comorbid cardiac disease is generally compensated by stimulation of the sympathetic nervous system. Nitrous oxide may potentially aggravate pulmonary hypertension. Additional physiologic effects on neurologic and hematologic function may result in inactivation of the enzyme, methionine synthetase. Recent concern has also been raised regarding the potential effects of N2O on immune function and its relationship to perioperative surgical site infections. Given differences in the solubility, N2O will diffuse into and significantly expand gas-filled cavities. Chronic exposure of health care works to N2O is also a concern. Although there are limited data in the literature to clearly substantiate concerns regarding the reproductive toxicity of occupational exposure to N2O, appropriate scavenging and use of other techniques are mandatory. Nitrous oxide has been shown to be effective for a variety of minor surgical procedures such as venipuncture, intravenous cannula placement, lumbar puncture, bone marrow aspiration, laceration repair, dental care, and minor dermatologic procedures. It is generally as effective as midazolam, with several studies demonstrating it to be more effective. However, its utility is not as great in severely painful procedures such as fracture reduction. Demonstrated advantages to parenteral sedation include a more rapid onset and a shorter recovery time with the majority of patients preferring it to over other agents or agreeing to its use for subsequent procedures. The literature also suggests increased success rates with simple procedures such as intravenous cannula placement when compared with placebo. In general, life-threatening adverse events have not been reported. Most common adverse effects include dysphoria and vomiting. For more painful procedures, combination with another agent may be used, and in all cases, topical or infiltrative local anesthesia is recommended. In general, N2O is a useful adjunct for procedural sedation. Given the variety of procedures performed in the pediatric patient, ongoing research is required to identify the most appropriate and effective use of this agent. This may be particularly relevant when evaluating its use for procedures associated with significant pain. In these scenarios, the combination of N2O with other agents needs to be evaluated. Given the potential for adverse effects, strict adherence to published guidelines regarding procedural sedation and monitoring is suggested.

Ageing and the gut

The goal of this brief review is to address the role of the ageing gut in the genesis of malnutrition in the elderly. We assess the burden of malnutrition in the elderly, exploring the role of comorbid conditions and neurohumoral changes that take place to contribute towards the process of anorexia associated with ageing. Following this, the review assesses physiological changes that occur in each part of the gastrointestinal (GI) tract and what implication they may have in clinical practice. In the oropharynx and the oesophagus, changes in swallowing and oesophageal motility associated with ageing can be demonstrated using physiological testing. However, in the absence of comorbid disease, they often have little, if any, clinical significance. In the stomach, reduced fundal compliance may contribute to early satiety; however, the primary change is hypochlorhydria, which may predispose to malabsorption or bacterial overgrowth further along the GI tract. Almost uniquely, the small bowel, particularly its absorptive function, is unaffected by age and we review the literature demonstrating this. In the colon, there is evidence of a prolonged transit time related to a reduction in both neurotransmitters and receptors. Although this may cause symptoms, this aspect is unlikely to contribute to malnutrition. In addition, we assess the potential changes in the gut microbiome and how this may interact with the immune system in the process of 'inflamm-ageing'. We conclude by summarising the main changes and their impact for the clinician along with recommendations for future areas of research.

The Effect on Quality of Life and Psychiatric Symptoms of Other Comorbid Chronic Diseases on Patients with Type 2 Diabetes Mellitus

Objective: This study was intended to examine the associations between psychiatric symptoms and quality of life in patients with diabetes and other co-morbid chronic physical diseases and sociodemographic variables. Method: One hundred randomly selected consecutive patients with type 2 diabetes mellitus (DM) admitted to the Department of Endocrinology out-patient clinic at the Karadeniz Technical University were enrolled. One hundred age-, gender- and marital status-matched volunteers served as the control group. The sociodemographic data form, Hospital Anxiety and Depression Scale (HAD) and Short Form-36 (SF–36) were completed for all participants. Results: Patient group education and income levels were lower than those of the controls. When SF-36 scores were compared in terms of presence or absence of co-morbid disease in addition to diabetes, mean scores of subjects with chronic disease were lower in the patient and control groups. When HAD-A and HAD-D mean scores were compared in terms of the presence or absence of other co-morbid chronic disease, both sub-scale scores were higher in those members of the patient group with chronic diseases. Conclusions: This study establishes that diabetes causes an extreme deterioration in patients’ quality of life and gives rise to many accompanying clinical signs. Our study thus emphasizes the need for consultation and liaison between departments.

Priorities in perioperative geriatrics.

T he aging of the baby-boom population and the decreases in adult mortality seen in the last few decades will dramatically increase the age of Americans between 2010 and 2030. During that time, the population older than age 65 yr is expected to grow by 75%, whereas between 1995 and 2050, the cumulative growth of the population older than 85 yr is expected to exceed 400% (1). Furthermore, it has been reported that the increased demand for surgery in this population may exceed the rate of population growth (2). The implications of an aging population for the practice of anesthesiology are profound. Age-related changes in physiology and pharmacology can affect every aspect of perioperative care. The changes in surgical demographics will compel the anesthesiologist to become familiar with the physiology and clinical care of the aged. This review will serve as an introduction. First, some of the physiologic changes that occur with aging will be presented. Second, the preoperative assessment of the older surgical patient will be discussed. Third, some of the research related to intraoperative management of the geriatric surgical patient will be described. In the fourth section, we will discuss some geriatric-specific issues related to postoperative management.

Is redo percutaneous mitral balloon valvuloplasty (PMV) indicated in patients with post-PMV mitral restenosis?

OBJECTIVESThe purpose of this study was to assess the immediate and long-term outcome of repeat percutaneous mitral balloon valvuloplasty (PMV) for post-PMV mitral restenosis.BACKGROUNDSymptomatic mitral restenosis develop in 7% to 21% of patients after PMV. Currently, most of these patients are referred for mitral valve replacement. However, it is unknown if these patients may benefit from repeat PMV.METHODSWe report the immediate outcome and long-term clinical follow-up results of 36 patients (mean age 58 ± 13 years, 75% women) with symptomatic mitral restenosis after prior PMV, who were treated with a repeat PMV at 34.6 ± 28 months after the initial PMV. The mean follow-up period was 30 ± 33 months with a maximal follow-up of 10 years.RESULTSAn immediate procedural success was obtained in 75% patients. The overall survival rate was 74%, 72% and 71% at one, two, and three years respectively. The event-free survival rate was 61%, 54% and 47% at one, two, and three years respectively. In the presence of comorbid diseases (cardiac and noncardiac) the two-year event-free survival was reduced to 29% as compared with 86% in patients without comorbid diseases. Cox regression analysis identified the echocardiographic score (p = 0.03), post-PMV mitral valve area (p = 0.003), post-PMV mitral regurgitation grade (p = 0.02) and post-PMV pulmonary artery pressure (p = 0.0001) as independent predictors of event-free survival after repeat PMV.CONCLUSIONSRepeat PMV for post-PMV mitral restenosis results in good immediate and long-term outcome in patients with low echocardiographic scores and absence of comorbid diseases. Although the results are less favorable in patients with suboptimal characteristics, repeat PMV has a palliative role if the patients are not surgical candidates.

Illuminated near card assessment of potential acuity in eyes with cataract

Objective This study aimed to determine the accuracy and potential role of the illuminated near card (INC) for predicting visual outcome after cataract surgery in eyes with and without comorbid disease. Study design A consecutive case series. Participants A total of 101 preoperative patients with cataracts participated. Main outcome measures Accuracy of predicted postoperative distance acuity was measured. Method The preoperative acuity obtained with the INC was compared by linear regression to the postoperative INC acuity and the postoperative distance acuity for 100 consecutive eyes undergoing cataract surgery. Variables analyzed were preoperative distance acuity and the presence or absence of comorbid disease. Results The preoperative INC acuity was significantly predictive of postoperative INC ( P = 0.0005) and postoperative distance ( P = 0.0007) acuities for the 100 eyes studied. For the subgroup of 15 eyes with 20/200 or worse, the preoperative INC acuity was not predictive of postoperative INC acuity ( P = 0.8673) or postoperative distance acuity ( P = 0.8789). For the 21 eyes with comorbid disease, the predictions were more accurate for postoperative INC acuity ( P <0.0001) and postoperative distance acuities ( P <0.0001) than for 64 eyes without comorbid disease: postoperative INC acuity ( P = 0.0051), and postoperative distance acuity ( P = 0.0046). The INC predicted postoperative distance acuity to within two lines in 98% of eyes when preoperative distance acuity was 20/100 or better. When the preoperative distance acuity was 20/200 or worse, the postoperative distance vision was predicted to within two lines in only 53% of the eyes. Conclusion The INC can be a useful adjunct for predicting postoperative distance acuity in eyes with cataract that have preoperative distance acuity of 20/100 or better, particularly in eyes with comorbid disease, in which the clinical judgment of vision potential may be difficult.