Absence Of Comorbidities Research Articles

Influencia de la nutrición y los hábitos alimentarios en la infección por SARS-CoV-2: una revisión narrativa

The COVID-19 pandemic had a huge impact on the health of the population. The role of nutrition in the context of various infectious diseases has been widely discussed in the scientific literature. It was found that, during the pandemic, there were various changes in eating habits, highlighting the increase in vegetables, fruits, and other foods with higher nutritional value. In addition, studies suggest that nutritional status, the immune system and the presence or absence of comorbidities are factors that predispose to a greater or lesser risk of SARS-CoV-2 infection. Nutritional risk has been involved with the severity of the patient with COVID-19. In this way, the nutritional factors that influence the immune system, added to the change in eating habits during the pandemic, would determine the susceptibility to SARS-CoV-2 infection. According to the available evidence, recommendations regarding a healthy diet in susceptible people could reduce the impact of confinement.

Comorbidities Modify the Phenotype but Not the Treatment Effectiveness to Mepolizumab in Severe Eosinophilic Asthma

Comorbidities in severe asthma are common and contribute to disease burden. The severe asthma phenotype and treatment response can be impacted by comorbid conditions. Real-world data on the use of mepolizumab in severe eosinophilic asthma (SEA) in the presence of comorbidities are needed to inform clinical practice. To investigate the impact of comorbid conditions on baseline phenotype in patients with SEA and assess the mepolizumab treatment effect by comorbidity status in SEA. Patients enrolled in the Australian Mepolizumab Registry (n= 309) were classified into subgroups defined by the presence or absence of comorbidities, including nasal polyps, aspirin-exacerbated airway disease, asthma-chronic obstructive pulmonary disease overlap (ACO), fungal sensitization, and obesity. Patient baseline characteristics were compared, and the impacts of comorbidity on phenotype, identified by differences in patient age and/or baseline biomarker levels and/or asthma severity, were assessed. The mepolizumab treatment effects on clinical and biological outcomes at 12 months were assessed. Across comorbidity subgroups, mepolizumab reduced the rate of clinically significant exacerbations (range: 47%-77%), maintenance oral corticosteroid use (dose reduction: 4.2-13.3 mg/d), and improved symptom control (Asthma Control Questionnaire-5 score: 1.9-2.4 point reduction) and lung function (mean: 3.4-9.3 post-bronchodilator percent predicted forced expiratory volume in 1 second). Peripheral blood eosinophils were reduced (mean: 480-780 cells/μL). Comorbidities (nasal polyps, obesity, ACO, and fungal sensitization) modified the baseline phenotype. Mepolizumab treatment is associated with comparable clinical improvements in patients with SEA and comorbidities. Mepolizumab effectively minimizes the disease impact and corticosteroid burden in patients with SEA.

278. Long-term impact of pulmonary function among patients recovered from SARS-CoV-2 infection in Lima, Peru: a preliminary analysis of the FUNCTION cohort study

Abstract Background Longitudinal assessment and reversibility of changes in the pulmonary function tests in the post-acute phase of COVID-19 across the whole spectrum of severity of infection is needed to understand the long-term burden of the disease. Methods This was a prospective cohort of symptomatic patients with a positive SARS-CoV-2 (molecular or antigenic) test. Participants were divided based on infection severity at baseline as mildly-ill (B1), moderately-ill (B2), severely-ill (B3), critically-ill (B4) (Fig.1). Follow-up consisted of 4 visits: within 7 days from discharge (BL), and at months 1 (M1), 3 (M3), and 6(M6). We report findings up to M3 for participants enrolled August 2021- March 2022. Pulmonary function capacity was assessed with carbon monoxide diffusing capacity (DLCO), spirometry, and 6-minute walk test (6MWT). A DLCO< 80% was considered abnormal and reverted if >80% at follow-up visits. Study population divided by severity of infection Results Out of 206 eligible participants, 110 were enrolled, of which 96 (87%%), 79 (72%), and 52(47.2%) were evaluated at BL, M1, and M3, respectively (Fig.2). Most (67%) participants were male, median age was 37.5 years old (IQR: 28-46.3) and median body mass index was 26.7 (IQR:23.7-30.4). Regarding severity, 39 (41%) participants were classified as critically-ill (B4) at BL. No underlying comorbidities were reported among 63 (66%) participants, while diabetes type 2 (11%), asthma (7%) prior pulmonary tuberculosis (6%) and hypertension (5%) where the most frequent comorbidities overall; 17 (18%) reported smoking exposure. There were significant differences accross severity groups for sex, age, absence of comorbidities, and dyspnea during the acute phase of COVID-19 (Tab.1). At Of the 88 (92%) participants that underwent the pulmonary function tests at BL: 49 (56%) had DLCO < 80% with a tendency to revert across B1-B4 groups at month 3 (Fig.3). Spirometry parameters (Forced Vital Capacity, Forced Expiratory Volume 1, Peak Expiratory Flow) and distance walked on 6MWT were different across groups. Flowchart of the study population Demographics of study population stratified by groups of severity Median DLCO adjusted for hemoglobin value at baseline, month 1 and month 3 visits stratified by groups of severity of infection. Conclusion Abnormal DLCO tended to increase and revert to values greater than 80% in the 3-month follow-up period of patients recovered from SARS-CoV-2 infection across severity groups. Disclosures All Authors: No reported disclosures.

Interaction of Cardiovascular Nonmodifiable Risk Factors, Comorbidities and Comedications With Ischemia/Reperfusion Injury and Cardioprotection by Pharmacological Treatments and Ischemic Conditioning.

Preconditioning, postconditioning, and remote conditioning of the myocardium enhance the ability of the heart to withstand a prolonged ischemia/reperfusion insult and the potential to provide novel therapeutic paradigms for cardioprotection. While many signaling pathways leading to endogenous cardioprotection have been elucidated in experimental studies over the past 30 years, no cardioprotective drug is on the market yet for that indication. One likely major reason for this failure to translate cardioprotection into patient benefit is the lack of rigorous and systematic preclinical evaluation of promising cardioprotective therapies prior to their clinical evaluation, since ischemic heart disease in humans is a complex disorder caused by or associated with cardiovascular risk factors and comorbidities. These risk factors and comorbidities induce fundamental alterations in cellular signaling cascades that affect the development of ischemia/reperfusion injury and responses to cardioprotective interventions. Moreover, some of the medications used to treat these comorbidities may impact on cardioprotection by again modifying cellular signaling pathways. The aim of this article is to review the recent evidence that cardiovascular risk factors as well as comorbidities and their medications may modify the response to cardioprotective interventions. We emphasize the critical need for taking into account the presence of cardiovascular risk factors as well as comorbidities and their concomitant medications when designing preclinical studies for the identification and validation of cardioprotective drug targets and clinical studies. This will hopefully maximize the success rate of developing rational approaches to effective cardioprotective therapies for the majority of patients with multiple comorbidities. SIGNIFICANCE STATEMENT: Ischemic heart disease is a major cause of mortality; however, there are still no cardioprotective drugs on the market. Most studies on cardioprotection have been undertaken in animal models of ischemia/reperfusion in the absence of comorbidities; however, ischemic heart disease develops with other systemic disorders (e.g., hypertension, hyperlipidemia, diabetes, atherosclerosis). Here we focus on the preclinical and clinical evidence showing how these comorbidities and their routine medications affect ischemia/reperfusion injury and interfere with cardioprotective strategies.

LOW CARDIOVASCULAR RISK REDUCTION BEHAVIORS AMONG HYPERTENSIVES ATTENDING FOLLOW-UP CARE AT A TERTIARY-LEVEL HOSPITAL IN ADDIS ABABA, ETHIOPIA

Introduction: Cardiovascular disease (CVD) outcomes in hypertensives are substantially influenced by risk-reduction behaviors. Even though hypertensives in Ethiopia have a high prevalence of behavioral risks for negative CVD outcomes, little is known about risk-reduction behaviors in this population. Therefore, this study aimed to investigate the CVD risk reduction behaviors among adult hypertensives in Addis Ababa, Ethiopia. Method: A cross-sectional design was used. A sample of 384 hypertensives was selected using a systematic random sampling technique from the hypertension clinic registry. Epi data version 3.10 was used to clean the data, and SPSS version 25.0 was used for analysis. Descriptive statistic was used to determine participants’ CVD risk reduction behavioral status. Bivariate chi-square test and ordinal logistic regression analyses were run to identify variables associated with participants' ranked CVD risk reduction behavioral status at the p-value < .05 cutoff for statistical significance. Results: The mean (± standard deviation) age of participants was 53.61 (± 12.34) years, (range, 30-82 years), and 51.2% were males. The majority (56.5%) of them were at low CV risk reduction practices. Only 45.1% were at target BP control. The absence of comorbidities (p < .001), clinic visits every 3 months for hypertension (p = .041), normal body mass index (p = .008), hypertension duration of 5–9 years (p = .034), and young age adults (p = .041) were the characteristics significantly associated with the high CVD risk reduction practice. Conclusion: Hypertensives' adoption of CVD risk reduction behaviors was low, with a variety of unmanaged risk factors and a few cardioprotective behaviors. Healthcare providers may improve patients’ CV risk-reduction behavior through teaching lifestyle changes and more frequent clinic visits.

The Evolution of Hypertension Guidelines Over the Last 20+ Years: A Comprehensive Review.

Hypertension is the most common modifiable risk factor for cardiovascular and cerebrovascular diseases. In the last two decades, the guidelines have evolved tremendously from areas with no recommendations for screening or treatment to targeted recommendations for some at-risk groups. We sought to go through the literature that provided guidelines for the management of hypertension at any point in time over the last 22 years from 2000 to 2022. We searched four databases: PubMed, Embase, Google Scholar, and Cochrane, using specified search terms. The keywords used were "hypertension" and "guidelines." Wecombined them using the Boolean operators (AND, OR) and searched for articles. A total of 2461 publications were initially identified; 348 publications were excluded after screening for full-text availability. The full-text articles were further filtered based on title and abstract screening. Following this, a total of 1443 articles were excluded. The remaining 670 full-text articles were assessed for eligibility. Of the 670 full-text articles, 480 were excluded based on exclusion criteria, and following the full-text article screening, 190 articles met the final inclusion criteria. Most of these guideline evolutions concerned establishing and adjusting thresholds for the subgroups of the elderly population and patients with diabetic kidney disease, chronic kidney disease, and stroke. Furthermore, the medications of choice are now guided by the stage of disease, presence or absence of comorbidities, and other relevant information, as opposed to ethnicity, which was previously a heavy yardstick for medication choice.

Risk Role of Breast Cancer in Association with Human Papilloma Virus among Female Population in Taiwan: A Nationwide Population-Based Cohort Study.

We analyzed data from the National Health Insurance Research Database (NHIRD) in Taiwan, collected information regarding human papillomavirus (HPV) and breast cancer prevalence, and explored the association between HPV infection and the risk of breast carcinoma. We included the NHIRD data of 30,936 insured patients aged 20 years an older without breast cancer prior to the index date (date of HPV diagnosis) and matched each patient with a reference subject according to age, comorbidities, and index year (1:1 ratio). We calculated the incidence rates of breast cancer in the cohorts, age groups, and comorbidity groups, as well as the relative risk of breast cancer stratified by age and comorbidity in the HPV and non-HPV groups. The patients with and without HPV had incidence rates of 12.5 and 9.81 per 10,000 person years, respectively. The risk of breast cancer for the 50-64 and ≥65 age groups was 1.67 and 1.36 times higher than that in patients younger than 49 years, respectively, and hypertension, chronic obstructive pulmonary disease, and diabetes mellitus were significant risk factors for breast cancer. The HPV group had a higher risk of developing breast cancer than the non-HPV group, regardless of age group and the presence or absence of comorbidities. Patients with HPV in the 50-64 age group were 1.39 times more likely to develop breast cancer than patients of the same age without HPV. Patients older than 49 were more likely to develop breast cancer, and patients with HPV had a higher likelihood of developing breast cancer, regardless of age and the presence or absence of comorbidities. HPV likely plays a causal role in breast cancer.

Abstract 279: Ecpr, A New Source Of Organs

Purpose: The scarcity of renal grafts is a major public health problem. New strategies are sought to overcome the problem of organ shortage. Organ donation after brain death is a major source of renal grafts. In our center, extracorporeal cardiopulmonary resuscitation (ECPR) is used as a 2nd line of treatment for refractory cardiac arrest. Despite this treatment, some patients present brain death and become eligible to organ donation. To this day, information is scarce on the long-term outcome of renal grafts from these patients. The objective of this study was to evaluate this outcome. Methods: We conducted a monocentric retrospective observational study between 2011 and 2017. The study was validated by the local ethics committee. We included patients who were eligible to organ donation after diagnosis of brain death and from whom at least one organ graft was procured and transplanted. Among these patients we compared those who were treated by ECPR for refractory cardiac arrest (ECPR group) and those who were not (control group). Results: During the study period, 45 patients were included, respectively 23 and 22 in the control and ECPR groups. Patients from the ECPR group were younger with less comorbidities (respectively 41+/-13 vs 63+/-19 years in the ECPR and control groups, p<0,044). However, they were more severe during their ICU stay, as shown by their SAPS II score which was significantly higher (80+/-13 vs 61+/-15 in the ECPR and control groups respectively, p<0,001). A total of 68 renal grafts were procured, transplanted, and studied (34 in each group). There was no difference between the 2 groups in terms of graft survival at 1 year (94.1 vs 82.4% in the ECPR and control group respectively, p=0,52). Discussion-Conclusion: Our study outlines that kidneys harvested from patients treated with ECPR have similar long-term outcome to organs retrieved from patients developing brain death without ECPR. Younger age and absence of comorbidities seem to compensate patient severity after cardiac arrest. One could hypothesize on a protective effect of ECPR on kidney function due to continuous blood flow delivered in the descending aorta. With the increase of ECPR cases, this strategy could be an increasing source of organs to address the issue of organ shortage.

Abstract 15337: Chronic Oral Finerenone Treatment Does Not Improve Left Ventricular Diastolic Compliance in Swine With Repetitive Pressure Overload-Induced HFpEF

Introduction: The non-steroidal mineralocorticoid receptor antagonist finerenone has emerged as a potential treatment for heart failure with preserved ejection fraction (HFpEF) based, in part, on initial evidence of its anti-fibrotic properties. However, it is unclear whether chronic oral finerenone therapy can reverse established cardiac fibrosis. Accordingly, we tested the efficacy of chronic oral finerenone in a porcine model of HFpEF characterized by interstitial fibrosis and reduced left ventricular (LV) diastolic compliance in the absence of co-morbidities or anatomic LV hypertrophy. Methods: Swine (n=12) were subjected to daily (1 hr) episodes of repetitive LV pressure overload (RPO) for 2 weeks using phenylephrine (24 mg/hr) to transiently elevate LVEDP to ~30 mm Hg. After 2 weeks, RPO was discontinued and animals were followed for an additional 4 weeks, during which a subset received oral finerenone (20 mg/day; n=6). LV end-diastolic volume (EDV) and pressure (EDP) were measured at normal and elevated preload to assess LV compliance (ΔLVEDV/ΔLVEDP) and post-mortem picrosirius red staining was performed to quantify interstitial fibrosis vs. normal controls (n=8). Results: Four-weeks after cessation of RPO, untreated animals exhibited a significant increase in interstitial fibrosis vs. normal controls that was attenuated in finerenone-treated animals ( Figure A ). Despite this regression of interstitial collagen, a persistent reduction in LV diastolic compliance was observed after finerenone treatment (1.18 ± 0.33 mL/mmHg vs. 2.11 ± 0.22 mL/mmHg in normal controls; p=0.04) that was comparable to that of untreated animals after RPO (0.97 ± 0.22 mL/mmHg; p=0.61; Figure B ). Conclusion: Four weeks of chronic oral finerenone treatment does not restore LV diastolic compliance in swine with RPO-induced HFpEF despite regression of interstitial collagen content, suggesting that other factors may contribute to diastolic stiffening in this model.

Closing gaps in medication taking for secondary prevention of coronary heart disease patients among US adults

BackgroundThe secondary preventive medical remedies used in the U.S. general population, particularly those with numerous co-morbidities, are poorly understood. We aimed to assess health outcomes and the extent of their adherence to guideline-based secondary prevention medications among U.S. coronary heart disease (CHD) patients. MethodsWe analysed information from the U.S. National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018 on people in the United States aged 18 to 85 who had a personal history of coronary heart disease (CHD). Logistic regression analyses were used to identify characteristics related to healthcare access that were linked with not taking any indicated drugs among CHD and other co-morbidity patients in the U.S. ResultsWe gathered 4256 CHD patients aged 18 and above. Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs), statins, and antiplatelet medications were taken by 50.94%, 48.26%, 53.41 %, and 19.78% of the population, respectively. Surprising, not received recommended drugs was reached up to 21.12%, and taking all four drugs was only 7.64%. In conclusion, the logistic regression analysis revealed that the chance of not taking prescribed drugs increased with age (18–39), race (Hispanic and Non-Hispanic Black), low income, lack of insurance, and the absence of co-morbidities (hypertension, heart failure, and diabetes mellitus). ConclusionsThe gap between the proposed secondary preventative measures and their actual execution remains sizable. In order to achieve ‘Healthy Aging’, a systematic approach for prevention of CHD is urgently needed.

Efficacy of tocilizumab in treatment of COVID-19 pneumonia: A case-control study from a tertiary care hospital.

Coronavirus disease 2019 (COVID-19) is a viral infectious disease caused by the severe acute respiratory syndrome virus, which has affected billions of people across the globe. The pathogenesis of respiratory inflammation involves elevated concentration of interleukin-6; hence, interventions targeting interleukin-6 receptor, such as tocilizumab (TCZ), have been investigated as potential treatment amidst the dilemma of COVID-19 management. The aim of the study is to analyse the efficacy and safety of TCZ and record the outcome in COVID-19 patients. A retrospective case-control study of 80 patients in each group (N = 160) was carried out in a tertiary care hospital in Vadodara, Gujarat. Non-pregnant COVID-19-positive patients above 12 years of age were included in the study and were divided into case (those given TCZ) and control (those given standard treatment) groups after collecting their history and related data. From each group, further data was collected in the form of general and systemic examination, investigations and calculation of inflammatory and Sequential Organ Failure Assessment (SOFA) scores. Overall mortality was less in the case group compared to the control group. Patients with moderate to severe disease, age <55 years, patients having no comorbidity and patients with higher oxygen demand had lower deaths when given TCZ. Inflammatory score <3 and SOFA score <6 were associated with reduced mortality in the case group. Additionally, the study found significant results by simultaneously analysing two parameters in combination, which has not been done in any other study to the best of our knowledge. Adjuvant TCZ therapy had overall mortality benefit compared to standard treatment, with specific benefit observed in those with increasing disease severity, young to middle-age group, absence of comorbidity, higher oxygen requirements and lower inflammatory and SOFA scores.

Health related quality of life of patients undergoing in-centre hemodialysis in Rwanda: a cross sectional study

Background:There are few studies assessing the quality of life of patients with chronic and end stage kidney disease in sub-Saharan Africa. We aimed to describe the health-related quality of life (HRQOL) of patients undergoing in-centre maintenance hemodialysis in Rwanda using the KDQOL™-36 and determine sociodemographic and clinical factors associated with their quality of life.Methods:We conducted a multicenter, cross-sectional study between September 2020 and July 2021. Patients over the age of 18 receiving maintenance in-centre hemodialysis for at least three months at the Rwandan tertiary hospitals were administered the KDQOL™-36 questionnaire to assess physical and mental health functioning, the effect, burden and symptoms and problem of kidney disease. Sociodemographic and clinical information was collected for all eligible patients. Using mixed effects linear regression models, we explored factors associated with overall KDQOL and its domains, while accounting for clustering of patients within hemodialysis centres.Results:Eighty-nine eligible patients were included in the study. The majority of participants were younger than 60 years old (69.7%), male (66.3%), had comorbidities (91%), and 71.6% were categorized as level 3 on a 4 tier in-country poverty scale. All participants had health insurance coverage, with 67.4% bearing no out of pocket payments for hemodialysis. The median (IQR) quality of life score was 45.1 (29.4) for overall HRQOL, 35.0 (17.9) for PCS and 41.7 (17.7) for MCS. Symptoms and problem of kidney disease, effect of kidney disease, and burden of kidney disease scored 58.3 (43.8), 56.3 (18.8) and 18.8 (37.5), respectively. A notable difference of KDQOL scores between hemodialysis centres was observed. Overall KDQOL was associated with male sex (adjusted ß coefficient [aß]: 8.5, 95% confidence interval [CI]: 2.8, 14.3); being employed (aß: 8.2, 95% CI: 2.2, 14.3); dialysis vintage of 13–24 months (aß: 10.5, 95% CI: 3.6, 17.6), hemoglobin of 10-11 g/dl (aß: 7.3, 95% CI: 0.7, 13.7) and comorbidities (e.g., ≥ 3 comorbidities vs. none) (aß: -29.8, 95% CI: -41.5, -18.3).Conclusion:Patients on in-centre hemodialysis in Rwanda have reduced KDQOL scores, particularly in the burden of kidney disease and physical composite summary domains. Higher overall KDQOL mean score was associated with male sex, being employed, and dialysis vintage of 13–24 months, hemoglobin of 10-11 g/dl and absence of comorbidities. The majority of patients receiving in-centre hemodialysis have higher socioeconomic status reflecting the social and financial constraints to access and maintain dialysis in resource limited settings.

Clinical condition patterns of fully vaccinated brazilian patients of working age hospitalized due to severe Covid-19 according to ICU admission status

Objective: Discover patterns of clinical condition using data from patients of working age who were fully vaccinated against Covid-19, hospitalized due to the severe form of the disease, according to Intensive Care Unit (ICU) admission status in Brazil. Methods: This is a descriptive study with data extracted from the OpenDataSUS database using Association Rules Mining (ARM). Results: Information related to 3,470 individuals was described, of which 53% (n= 1,842) were male, 63% (n= 2,187) with comorbidities, 33% (n= 1,137) were admitted to the ICU and 23% (n= 796) died. ICU admission was associated with the use of invasive ventilatory support, male gender, presence of comorbidity, and death. For patients with no ICU admission, survival, absence of comorbidity, female gender, use of non-invasive ventilatory support and mild to moderate symptoms of the disease were found. Conclusion: These findings reinforce the need to administer booster doses of the Covid-19 vaccines, but also to strengthen policies to combat chronic noncommunicable diseases in Brazil.

ICU management of Traumatic Brain Injury

Traumatic brain injury (TBI) can be defined as the disruption in brain function, or other evidence of brain pathology, caused by an external physical force. Management of TBI depends on, if the injury is focal or diffuse. Focal can be epidural or intra cerebral and diffuse lesions can present as multiple contusions/DAI. A basic understanding of anatomy of central nervous system and some working knowledge of physiology of brain help in management of TBI. According to severity there are three types of TBI patients. They are: mild (GCS 13-15), moderate (GCS 9-12) and severe (GCS 3-8). TBI may be primary or secondary. Primary injuries include contusion, hematoma, subarachnoid hemorrhage, diffuse axonal injury etc. Secondary injuries can manifest as cerebral oedema, raised intra cranial pressure etc. Airway management and cervical spine immobilization are important early steps in management. Hypoxia and hypercarbia must be avoided and attention is always paid to ventilation status of patients. Mean arterial pressure (MAP) should be monitored and maintained at 80-90 mm of Hg. Intracranial pressure (ICP) should be checked whenever feasible and monitored so raised ICP can be controlled. Adequate pain control and sedation, using mannitol, hypertonic saline should be used as needed to control raised ICP. Invasive ICP monitoring and cerebrospinal fluid diversion should be used in patient who decompensate and decision to do decompressive craniectomy is often made by neurosurgeons. Body temperature in TBI patients should be maintained under 37o C. Neurologic conditions like brainstem dysfunction, intracranial hypertension, altered level of consciousness etc. and respiratory conditions like ARDS, hypoxaemia , neurogenic pulmonary oedema etc. warrants endotracheal intubation and mechanical ventilation. TBI patients requiring haemo dialysis usually need special modification in protocol to avoid pulmonary oedema and fluctuation in blood pressure. Monitoring TBI patients is done by routine assessment of GCS, pupillary size and reaction, motor responses. ICP monitoring is to be done if feasible. By aggressive monitoring secondary brain injuries can be avoided or managed. Outcome of management of TBI patients in ICU depends on severity of primary and secondary injuries of brain, status of GCS on presentation, advanced age (&gt;65yrs), presence or absence of co morbidities and severity of associated injuries. Bangladesh Crit Care J September 2022; 10(2): 135-141

IMPACT OF COMORBIDITIES ON MALE TESTOSTERONE LEVELS WITH AGE: RESULTS FROM THE BALTIMORE LONGITUDINAL AGING STUDY

To evaluate the longitudinal impact of additive comorbidity burden on testosterone levels in aging males. We hypothesized that age alone in the absence of comorbidities would not predict a significant decline in testosterone level, but development of comorbidities would lead to testosterone decline with aging.

Vaccine effectiveness against severe COVID-19 outcomes within the French overseas territories: A cohort study of 2-doses vaccinated individuals matched to unvaccinated ones followed up until September 2021 and based on the National Health Data System.

Although several observational studies on the effectiveness of SARS-CoV-2 vaccination have been published, vaccination coverage by August, 3 2021, remained low in the French overseas territories, despite Martinique and Guadeloupe experiencing an unprecedented number of COVID-19-related hospitalizations. We aimed to determine the association between COVID-19 vaccination and severe COVID-19 in the French overseas territories. The French National Health Data System was used to conduct a 1:1 matched-cohort study. For each individual receiving a first dose of BNT162b2, mRNA-1273, ChAdOx1 nCoV-19, or Ad26.COV2-S vaccine between December 27, 2020, and July 31, 2021, one unvaccinated individual was randomly selected and matched for year of birth, sex, and overseas territories on the date of vaccination. We estimated vaccine effectiveness against COVID-19-related hospitalization and in-hospital death after a full vaccination schedule, defined as ≥14 days after the second dose. Analyses were stratified according to the number of comorbidities. 276,778 vaccinated individuals had a double-dose vaccination during the follow-up period and were followed with their paired unvaccinated control. The average age was 50 years and 53% were women. During a median 77 days of follow-up from day 14 after the second injection, 96 COVID-19-related hospitalizations occurred among vaccinated individuals and 1,465 among their unvaccinated counterparts. Overall, vaccine effectiveness against hospitalization was 94% (95%CI [93-95]) and exceeded 90% in each overseas territory, except Mayotte. The results were similar looking specifically at hospitalizations between July 15 and September 30, 2021. Vaccine effectiveness against in-hospital death was similar (94% [95%CI 91-96]). The risk of COVID-19-related hospitalization increased with the number of comorbidities, especially among vaccinated individuals. In conclusion, vaccination has a major effect in reducing the risk of severe Covid-19 in the French overseas territories. The risk of COVID-19-hospitalization was very low among vaccinated individuals, especially in the absence of comorbidities. These results aim to increase confidence in vaccine effectiveness in overseas territories in hope of achieving better vaccination coverage.

Prosthesis use among individuals with lower limb amputation in Bangladesh.

This study aimed to assess factors related to prostheses use among individuals with lower limb amputation in Bangladesh. Data related to prosthesis use, functional capabilities (as measured with the Locomotor Capabilities Index [LCI]), and user satisfaction were collected using telephone interviews between January 2014 and October 2016. Descriptive and regression analyses were performed. This study involved 183 participants (89.6% male); the mean (SD) age was 49.5 (10.7) years. Most of the participants (95.6%) used prostheses daily, and the mean (SD) duration of use was 7.0 (4.1) hours per day. The mean (SD) basic LCI score, advanced LCI score, and total LCI score were 25.1 (4.9), 20.8 (8.3), and 45.9 (12.2), respectively. Among them, 36.7% were dissatisfied with the weight of the prosthesis. Having a below knee amputation (odds ratio 2.6 and confidence interval 1.3, 5.3) and absence of comorbidities (odds ratio 2.1; confidence interval 1.0, 4.4) were associated significantly with an increased use of prosthesis. Factors such as weight of the prosthesis, amputation level, and presence of comorbidities are important considerations while planning for prosthetic rehabilitation and optimize utilization of the prosthetic devices.

Thrombosis risk assessment in patients with congenital thrombophilia during COVID - 19 infection

BackgroundCoagulation dysfunction represents a serious complication in patients during the COVID-19 infection, while fulminant thrombotic complications emerge as critical issues in individuals with severe COVID-19. In addition to a severe clinical presentation, comorbidities and age significantly contribute to the development of thrombotic complications in this disease. However, there is very little data on association of congenital thrombophilia and thrombotic events in the setting of COVID-19. Our study aimed to evaluate the risk of COVID-19 associated thrombosis in patients with congenital thrombophilia. MethodsThis prospective, case-control study included patients with confirmed COVID-19 infection, followed 6 months post-confirmation. The final outcome was a symptomatic thrombotic event. In total, 90 COVID-19 patients, 30 with known congenital thrombophilia and 60 patients without thrombophilia within the period July 2020–November 2021, were included in the study. Evaluation of hemostatic parameters including FVIII activity and D-dimer was performed for all patients at 1 month, 3 months and 6 months post-COVID-19 diagnosis. ResultsSymptomatic thrombotic events were observed in 7 out of 30 (23 %) COVID-19 patients with thrombophilia, and 12 out of 60 (20 %) without thrombophilia, P = 0.715. In addition, the two patient groups had comparable localization of thrombotic events, time to thrombotic event, effect of antithrombotic treatment and changes in FVIII activity, while D-dimer level were significantly increased in patients without thrombophilia. ConclusionOur findings suggest that patients with congenital thrombophilia, irrespective of their age, a mild clinical picture and absence of comorbidities, should receive anticoagulant prophylaxis, adjusted based on the specific genetic defect.

The effect of a new coronavirus infection caused by the SARS-CoV-2 virus on microcirculation in the conjunctiva

Introduction. The availability of an objective assessment of the microcirculatory bed is possible when examining the vessels of the conjunctiva. This is especially true in individuals who have had COVID-19 and have diseases associated with endothelial dysfunction.Aim. To study the microcirculation in the conjunctiva after a new coronavirus infection caused by the SARS-CoV-2 virus.Materials and methods. 83 patients with a history of coronavirus infection were examined. Patients were divided into 2 groups depending on the presence or absence of comorbidities. Group 1 patients (n = 42) with post-COVID changes in the conjunctiva (severe injection of the eyeball, chemosis, microhemorrhagia, folliculosis of the tarsal and bulbar conjunctiva, the presence of a nodular formation (conflicts), slight edema of the corneal epithelium) and a history of concomitant diseases: arterial hypertension, diabetes, coronary heart disease, atherosclerosis. Group 2 patients (n = 41) with no history of concomitant diseases and similar post-COVID changes in the conjunctiva. The control group consisted of healthy volunteers without a history of coronavirus infection (n = 30). All subjects underwent laser Doppler flowmetry of the bulbar conjunctiva 3, 6, 12 months after the coronavirus infection.Results and discussion. In comparison with the control group of persons after 3 months, microcirculatory disorders were detected in both groups (group 1 – subcompensated, group 2 – decompensated). In group 1, after 6 months and 12 months, violations persisted in the subcompensation stage, which were accompanied by an increase in the intensity of the functioning of the regulatory systems of the microcirculation: the M index corresponded to normal values, and the values of σ and Kv were above the norm. After 6 months in group 2, compensation of microcirculatory disorders was noted (indicators M, σ, Kv were normal), which persisted even by 12 months of observation.Conclusion. The data obtained indicate that in patients with concomitant endothelial dysfunction, the processes of restoration of the microvasculature are slowed down.

Characterization of Clinical Features of Hospitalized Patients Due to the SARS-CoV-2 Infection in the Absence of Comorbidities Regarding the Sex: An Epidemiological Study of the First Year of the Pandemic in Brazil.

The male sex, due to the presence of genetic, immunological, hormonal, social, and environmental factors, is associated with higher severity and death in Coronavirus Disease (COVID)-19. We conducted an epidemiological study to characterize the COVID-19 clinical profile, severity, and outcome according to sex in patients with the severe acute respiratory syndrome (SARS) due to the fact of this disease. We carried out an epidemiological analysis using epidemiological data made available by the OpenDataSUS, which stores information about SARS in Brazil. We recorded the features of the patients admitted to the hospital for SARS treatment due to the presence of COVID-19 (in the absence of comorbidities) and associated these characteristics with sex and risk of death. The study comprised 336,463 patients, 213,151 of whom were men. Male patients presented a higher number of clinical signs, for example, fever (OR = 1.424; 95%CI = 1.399–1.448), peripheral arterial oxygen saturation (SpO2) < 95% (OR = 1.253; 95%CI = 1.232–1.274), and dyspnea (OR = 1.146; 95%CI = 1.125–1.166) as well as greater need for admission in intensive care unit (ICU, OR = 1.189; 95%CI = 1.168–1.210), and the use of invasive ventilatory support (OR = 1.306; 95%CI = 1.273–1.339) and noninvasive ventilatory support (OR = 1.238; 95%CI = 1.216–1.260) when compared with female patients. Curiously, the male sex was associated only with a small increase in the risk of death when compared with the female sex (OR = 1.041; 95%CI = 1.023–1.060). We did a secondary analysis to identify the main predictors of death. In that sense, the multivariate analysis enabled the prediction of the risk of death, and the male sex was one of the predictors (OR = 1.101; 95%CI = 1.011–1.199); however, with a small effect size. In addition, other factors also contributed to this prediction and presented a great effect size, they are listed below: older age (61–72 years old (OR = 15.778; 95%CI = 1.865–133.492), 73–85 years old (OR = 31.978; 95%CI = 3.779–270.600), and +85 years old (OR = 68.385; 95%CI = 8.164–589.705)); race (Black (OR = 1.247; 95%CI = 1.016–1.531), Pardos (multiracial background; OR = 1.585; 95%CI = 1.450–1.732), and Indigenous (OR = 3.186; 95%CI = 1.927–5.266)); clinical signs (for instance, dyspnea (OR = 1.231; 95%CI = 1.110–1.365) and SpO2 < 95% (OR = 1.367; 95%CI = 1.238–1.508)); need for admission in the ICU (OR = 3.069; 95%CI = 2.789–3.377); and for ventilatory support (invasive (OR = 10.174; 95%CI = 8.803–11.759) and noninvasive (OR = 1.609; 95%CI = 1.438–1.800)). In conclusion, in Brazil, male patients tend to present the phenotype of higher severity in COVID-19, however, with a small effect on the risk of death.