Comorbidity Characteristics Research Articles

Population and Co-Occurrence Characteristics of Diagnoses and Comorbidities in Coronary Artery Disease Patients: A Case Study from a Hospital in Guangxi, China

Coronary artery disease (CAD) remains a major global health concern, significantly contributing to morbidity and mortality. This study aimed to investigate the co-occurrence patterns of diagnoses and comorbidities in CAD patients using a network-based approach. A retrospective analysis was conducted on 195 hospitalized CAD patients from a single hospital in Guangxi, China, with data collected on age, sex, and comorbidities. Network analysis, supported by sensitivity analysis, revealed key diagnostic clusters and comorbidity hubs, with hypertension emerging as the central node in the co-occurrence network. Unstable angina and myocardial infarction were identified as central diagnoses, frequently co-occurring with metabolic conditions such as diabetes. The results also highlighted significant age- and sex-specific differences in CAD diagnoses and comorbidities. Sensitivity analysis confirmed the robustness of the network structure and identified clusters, despite the limitations of sample size and data source. Modularity analysis uncovered distinct clusters, illustrating the complex interplay between cardiovascular and metabolic disorders. These findings provide valuable insights into the relationships between CAD and its comorbidities, emphasizing the importance of integrated, personalized management strategies. Future studies with larger, multi-center datasets and longitudinal designs are needed to validate these results and explore the temporal dynamics of CAD progression.

Hospital readmissions following catheter ablation for atrial fibrillation with THERMOCOOL™ STSF/ THERMOCOOL™ ST catheter with CARTO™ 3 system versus TactiCath™ catheter with EnSite™ system.

Aim: Radiofrequency (RF) catheter ablation (CA) is a mainstay treatment for atrial fibrillation (AF). RF catheters with contact force (CF) sensing technology and electroanatomical mapping systems enable real-time assessment of catheter tip-tissue interface CF, facilitating individualized and precise CA. This study examined inpatient hospital readmissions in patients with AF treated with THERMOCOOL™ ST/ THERMOCOOL™ STSF catheter with the CARTO™ 3 System versus TactiCath™ catheter with the EnSite™ System. Materials & methods: Patients undergoing CA for AF between 1 July 2019 to 30 November 2021 were identified from the Premier Healthcare Database and grouped based on use of THERMOCOOL ST/STSF or TactiCath™. Study outcomes were all-cause, cardiovascular (CV)-, and AF-related inpatient readmission at 91-365-day post-CA. Inverse probability of treatment weighting of propensity scores balanced baseline patient, comorbidity and hospital characteristics. A weighted generalized estimating equation (GEE) model examined differences in readmission outcomes. Results: A total of 15,518 patients met inclusion criteria (THERMOCOOL ST/STSF, n=13,001; TactiCath™, n=2517). Patient characteristics were generally well-balanced after weighting. Patients treated with THERMOCOOL ST/STSF+CARTO 3 had a 20% lower likelihood of all-cause inpatient readmissions (7.8 vs 9.3%, chi-square p=0.041; odds ratio [OR]: 0.80, 95% confidence interval [CI]: 0.66-0.96, GEE p=0.019) and a 21% lower likelihood of CV-related inpatient readmission (5.2 vs 6.2%, chi-square p=0.133, OR: 0.79, 95% CI: 0.62-0.99, GEE p=0.043) in 91-365-days post-CA versus those treated with TactiCath™+ Ensite. No significant differences were observed for AF-related readmissions. Conclusion: Patients undergoing CA for AF treated with THERMOCOOL ST/STSF+CARTO 3 had a significantly lower risk of all-cause and CV-related inpatient hospital readmission versus those treated with TactiCath™+Ensite.

Impact of polypharmacy on patients undergoing revascularisation for peripheral arterial disease.

Background: To evaluate the impact of polypharmacy, defined as the concurrent use of five or more medications, on the clinical outcomes of patients undergoing revascularisation for symptomatic peripheral arterial disease (PAD). Patients and methods: This is a retrospective analysis of consecutive PAD patients treated by surgical, endovascular or hybrid therapy in a tertiary center between January 2017 and December 2017. The composite of amputation and/or death (amputation-free survival; AFS) was the primary endpoint. Mortality, major limb amputation, risk for Major Cardio-Cerobro-vascular Events (MACCE) and re-intervention during follow-up were additionally analyzed. Results: A total of 560 patients (369 male, 66%) were included. Mean age was 72.43 ± 38.67, while the main indication for treatment was lifestyle limiting claudication (330 patients, 59%). Most patients (434, 78%) were treated with endovascular means, and the commonest anatomical site of intervention was the femoropopliteal arterial segment (449 patients, 80%). A total of 409 (73%) met the criteria for polypharmacy. Cox regression analysis showed that polypharmacy was an independent predictor of death (exp: 4.72, p=0.008), MACCE (exp: 2.82, p=0.001), re-intervention (exp 1.51, p=0.0016) and of the composite outcome of AFS (exp: 3.46, p=0.021) but not of major amputation (exp: 1.26, p=0.686). Propensity-score matching analysis showed that even when controlling for comorbidity and procedural characteristics, polypharmacy is associated with a higher risk of cardiovascular death (p<0.001), MACCE (p<0.001), and re-intervention (p=0.001). Conclusions: In this study, polypharmacy was associated with unfavourable clinical outcomes for patients undergoing revascularisation for symptomatic PAD, without influencing the risk for major limb amputation.

Association of patient comorbidities with colorectal cancer site as detected by computed tomography scan and colonoscopy: A retrospective study

Colorectal cancer (CRC) ranks as the third most common cancer worldwide. The most prevalent site is sigmoid. Comorbidities are common in patients with CRC and may be an important prognostic factor. This study investigated the prevalence of comorbidities among patients with CRC and assessed the association between the number of comorbidities and various factors including age, tumor site, smoking status, cancer stage, and mortality. This retrospective study included patients diagnosed with cancer at our hospital between January 2018 and November 2021. The association between comorbid illnesses (diabetes mellitus and hypertension) and patient characteristics such as sex, marital status, and smoking status was evaluated. The impacts of comorbid illnesses on CRC diagnosis and outcomes (cancer stage, primary site, and patient status) were analyzed. A chi-square test was performed to assess the relationship between sex, marital status, smoking status, and the presence of comorbid conditions (diabetes mellitus and/or hypertension). The majority of patients had at least 1 comorbid illness. A higher proportion of males had comorbid conditions compared to females. The proportion of patients with an early-stage cancer was higher among those without comorbidities. The proportion of surviving patients was higher among those without comorbidities, suggesting that patients with comorbid conditions may have an increased risk of death. The sigmoid colon was the most common site for colon cancer. Hypertension was the most common comorbidity followed by diabetes mellitus. Almost 50% of patients with CRC were smokers.

The influence of Muscle Wasting on Patient Outcomes among Burn Patients: A Burn Care Quality Platform Study.

The hypermetabolism that occurs after large burns leads to muscle wasting that can result in weakness, difficulty fighting infections, and other challenges to healing. Overall, rates of muscle wasting are not well established across burn centers. The Burn Care Quality Platform (BCQP), the largest available dataset on burn patients globally, was used to explore the rate of Muscle Wasting using data collected from more than 100 burn centers. "Muscle Wasting" was defined from relevant ICD codes (sarcopenia, muscle cachexia, protein malnutrition). Binomial and logistic regression were used to analyze the role of Muscle Wasting in burn mortality and other outcomes after controlling for demographic and comorbid characteristics. In total, the BCQP provided data from 84,438 adult and pediatric burn patients injured between 2000-2018. Only 2.6% (N=2,159) of the patients in the BCQP were diagnosed with having Muscle Wasting at some point during their admission. While Muscle Wasting was not associated with a statistically significant impact on mortality, it remained an independent predictor of inability to discharge to independent living, longer inpatient days, as well as an average of 10 additional surgical procedures (P<0.001 for all) as compared to patients who did not have Muscle Wasting. Muscle Wasting is an independent risk factor for several adverse outcomes in burn patients, but not mortality in the BCQP. Confidence in these findings would be improved with more accurate data collection, as the diagnosis of Muscle Wasting is likely under-reported, under-diagnosed, or both.

Bipolar Disorder and Suicide

Suicide is a dramatic and frequent consequence of bipolar disorder. Prevention of suicidal behavior involves an assessment of suicidal vulnerability factors (history of suicidal behavior, impulsive personality, etc.), characteristics of depression (agitated depression, a subtype of bipolar disorder, etc.), psychiatric comorbidities, and stress factors. Psychosocial at the same time with the characteristics of suicidal behavior in a depressed subject (severe or repeated gestures in particular) make it possible to direct the diagnosis towards a bipolar disorder rather than a major depressive disorder. In addition to training caregivers to screen for bipolar disorder and assess suicidal behavior, the withdrawal of lethal means, networking, and treatment of depression reduce the risk of suicidal behavior. At the medicinal level, the use of lithium salts could be of particular interest in subjects at high risk of suicide.

Invasive Fungal Rhinosinusitis: The First Histopathological Study in Vietnam.

Invasive fungal rhinosinusitis (IRFS) is a rare but highly fatal disease. The two primary groups of pathogens, Mucorales and Aspergillus, require different treatments and have distinct prognoses. This study aimed to analyze the histopathological features of IFRS. We conducted a retrospective study involving 57 IFRS cases. Demographic and comorbid characteristics were obtained from clinical records. Two pathologists independently examined the histopathological features using H&E, PAS, and GMS-stained slides. Fungal groups were identified with PCR under the guidance of histopathology. The mean age of IFRS was 58.9 ± 13.4. The male-to-female ratio was 1.4:1. 100% of cases had diabetes comorbidity. Mucorales, Aspergillus, and other fungi were found in 61.4%, 33.3%, and 5.3% of cases, respectively. No Aspergillus and Mucorales co-infections were detected. Histopathology and PCR results were strongly concordant in classifying pathogens (Cohen's kappa = 84.2%, 95% CI 60.1% - 100%, p < 0.001). Mucormycosis exhibited higher rates of extensive necrosis and vascular invasion, and lower rates of pigment and spore presence than the non-Mucormycosis group (p < 0.001, p = 0.01, p = 0.02, p = 0.03, respectively). Extensive necrosis and vascular invasion were statistically significantly correlative (OR = 13.03, 95% CI 2.62-64.75, p = 0.002). IFRS predominantly affects older adults and males. Histopathology is a reliable method for differentiating between Mucorales and Aspergillus. When extensive necrosis is detected, it is critical to investigate for vascular invasion carefully. The vascular invasion, degree of necrosis, pigments, and spores are valuable factors for distinguishing fungal agents of IFRS.

Medicare Advantage Is Associated With Higher Mortality After Antibiotic Spacer Placement for Periprosthetic Joint Infection

BackgroundPrivatized Medicare Advantage (MA) plans are an alternative to traditional Medicare (TM). We sought to identify differences in 90-day postoperative mortality and nonfatal adverse events between TM and MA patients undergoing stage 1 antibiotic spacer placement for periprosthetic joint infection (PJI) of the hip or knee. MethodsA nationally representative database was queried from 2015 to 2021 for adult patients undergoing stage 1 antibiotic spacer placement for PJI. Using the International Classification of Disease, 10th Revision, and Current Procedural Terminology codes, as well as hospital charges for antibiotics, patients undergoing stage 1 exchange arthroplasty for PJI were identified. Patients were then grouped into TM and MA cohorts. The primary outcome was the odds of 90-day mortality. Multivariable logistic regressions were conducted to address possible confounding demographic, comorbidity, and hospital characteristics. ResultsOf the 40,346 patients undergoing stage 1 spacer placement for PJI, 16,637 (41.2%) had TM coverage and 9,218 (22.8%) had MA coverage. Mortality within 90 days of surgery was higher in the MA cohort (1.4% versus 1.0%, P = 0.004). Multivariable logistic regression demonstrated significantly higher adjusted odds of mortality (adjusted odds ratio = 1.42, 95% confidence interval = 1.11 to 1.81, P = 0.005) in MA patients compared to TM. ConclusionsEven after accounting for available confounders with our multivariable analyses, patients enrolled in an MA plan were more than 40% more likely to die within 90 days of surgery compared to patients who have TM coverage. Further study is necessary to better understand the underlying cause of this finding.

The frailty among suburban elderly population after one-year COVID-19 pandemic in Cirebon Regency, Indonesia

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic has had significant impacts worldwide, especially among older adults. Frailty is a determinant of susceptibility to morbidity and mortality due to COVID-19 in the elderly. This study aimed to determine frailty status and identify factors associated with the suburban elderly population in Cirebon Regency, Indonesia, after the one-year COVID-19 pandemic. Methods A cross-sectional study of community-dwelling individuals aged ≥ 60 years was conducted in Klangenan, Cirebon Regency, Indonesia, from March to June 2021. A questionnaire was used to determine the baseline characteristics of participants, healthcare access, comorbidity, and frailty status. The Ina-FRAIL scale was used to determine the frailty status (frail/non-frail). The chi-square test and logistic regression analysis were used to determine the association between independent variables and frailty. Results A total of 383 participants were recruited, with a median age of 67 (IQR 64-73) years. The prevalence of frailty in the present study was 10.2%. Multivariate analysis showed that age (OR 2.73; 95%CI 1.21-6.12), multimorbidity (OR 7.86; 95% CI 3.01-20.57) and financial dependence (OR 13.40, 95% CI 5.66-31.73) were significantly associated with frailty. Conclusion One-year COVID-19 pandemic has had a considerable burden on frailty among the suburban elderly population in Indonesia. The factors associated with frailty were age, multimorbidity, and financial dependence.

А COMPREHENSIVE STUDY OF PATIENTS WITH ISCHEMIC HEART DISEASE: AGE, GENDER, AND COMORBIDITY ASPECTS

The purpose of the study was to analyze the clinical characteristics, comorbid status, individual biochemical indicators, and systemic inflammation activity in patients with ischemic heart disease (IHD) depending on age, gender distribution, and diagnosis influence.Materials and methods. The study included 144 patients with IHD, who were divided into two groups – the main and the control. The main group comprised 120 patients with stable angina pectoris (SAP) II-III functional class (FC). The control group consisted of 24 patients with STEMI. All patients underwent a comprehensive examination: general clinical, anthropometric, laboratory (complete blood count, biochemical analysis), and instrumental (office blood pressure measurement, heart rate, and echocardiography). The comorbid profile of patients with IHD was assessed using the Charlson comorbidity index. The severity of systemic inflammation syndrome in the selected patient groups was assessed by the cellular composition of peripheral blood upon admission to the hospital, and based on the obtained data, the values of leukocyte inflammatory markers were calculated.Results. Patients in the main group were younger than those in the control group (54.78 ± 1.11 vs. 63.50 ± 1.82) (p&lt;0.001). A statistically significant predominance of men over women was found among the cohort of IHD patients (63.33% and 36.67%, respectively) (p&lt;0.001), with a tendency towards male predominance among patients with SAP II-III FC compared to those with STEMI (p = 0.074). Patients in the main group compared to those in the control group had significantly higher left ventricular ejection fraction (p&lt;0.001), systolic blood pressure (p&lt;0.001), and diastolic blood pressure (p=0.001). In the control group compared to the main group, more cases of patients with high levels of comorbidity were found (p&lt;0.001). Lower levels of creatinine, fibrinogen, prothrombin time, and glucose were observed in patients in the main group. Patients with SAP II-III FC compared to those with STEMI had lower levels of leukocyte inflammatory markers, such as neutrophil-to-lymphocyte ratio (NLR) (p&lt;0.001), systemic immune inflammation index (SII) (p=0.002), systemic inflammation response index (SIRI) (p=0.007), and aggregate index of systemic inflammation (AISI) (p=0.011).Conclusions. The study underscores the need for an individualized approach to each patient with ischemic heart disease, considering their age, gender, and comorbid characteristics, as well as laboratory peculiarities, to improve therapy outcomes and prevent complications.

Comorbidities and mortality risk in COVID-19 patients with congestive heart failure: A comprehensive analysis

The COVID-19 pandemic has posed unprecedented challenges to global healthcare systems, resulting in alarming incidence and mortality rates among patients with comorbidities, including heart failure. Understanding the characteristics of heart failure and other comorbidities during the COVID-19 pandemic is crucial for effective prevention and treatment. However, the current understanding of these characteristics among different racial groups remains incomplete. In this study, we investigated a cohort of 4711 patients, classifying them into congestive heart failure (CHF) and non-CHF groups. Biomarker analysis revealed noteworthy variations in blood urea nitrogen, aspartate aminotransferase, and white blood cell levels based on the presence or absence of CHF. Stratified by three racial groups, univariate logistic regression analysis identified significant differences in multiple variables, including CHF. Subsequent univariate Cox regression and Kaplan-Meier analysis demonstrated variations in mortality factors among distinct populations, with age and comorbidity playing prominent roles. This study utilized a large-scale database to investigate the characteristics of heart failure and related variables during the COVID-19 pandemic. The findings revealed distinctive mortality risk factors among various racial groups, emphasizing the significance of customized risk assessment and management approaches for diverse populations. These findings also provide a valuable resource for the development of targeted interventions and the promotion of equitable healthcare outcomes in the context of the COVID-19 pandemic.

Healthcare resource utilization among nursing home residents with Parkinson's disease psychosis: an analysis of Medicare beneficiaries treated with pimavanserin or other-atypical antipsychotics.

Aim: Real-world healthcare resource use (HCRU) burden among patients with Parkinson's disease psychosis (PDP) treated with pimavanserin (PIM) versus other atypical antipsychotics (other-AAPs) including quetiapine (QUE) in long term care (LTC) and nursing home (NH) settings are lacking. This analysis examines HCRU differences among residents in LTC/NH settings who initiate PIM versus QUE or other-AAPs. Methods: A retrospective analysis of LTC/NH residents with PDP from the 100% Medicare claims between 1 April 2015 and 31 December 2021 was conducted. Treatment-naive residents who initiated ≥6months continuous monotherapy with PIM or QUE or other-AAPs between 04/01/16 and06/30/2021 were propensity score matched (PSM) 1:1 using 31 variables (age, sex, race, region and 27 Elixhauser comorbidity characteristics). Post-index (i.e., 6months) HCRU outcomes included: proportion of residents with ≥1 all-cause inpatient (IP) hospitalizations and emergency room (ER) visits. HCRU differences were assessed via log binomial regression and reported as relative risk ratios (RR) and 95% confidence intervals after controlling for dementia, insomnia and index year. Results: From a total of PIM (n=1827), QUE (n=7770) or other-AAPs (n=9557), 1:1 matched sample (n=1827) in each cohort were selected. All-cause IP hospitalizations (PIM [29.8%]) versus QUE [36.7%]) and ER visits (PIM [47.3%] versus QUE [55.8%]), respectively, were significantly lower for PIM. PIM versus QUE cohort also had significantly lower RR for all-cause IP hospitalizations and ER visits, respectively, (IP hospitalizations RR: 0.82 [0.75. 0.9]; ER visits RR: 0.85 [0.8. 0.9]). PIM versus other-AAPs also had lower likelihood of HCRU outcomes. Conclusion: In this analysis, LTC/NH residents on PIM monotherapy (versus QUE) had a lower likelihood of all-cause hospitalizations (18%) and ER (15%) visits. In this setting, PIM also had lower likelihood of all-cause HCRU versus other-AAPs.

Potential profiling of self-management skills in older co-morbid patients

BackgroundUnder the general trend of global aging, geriatric comorbidity is increasingly common, which may have some impact on the quality of life of the older people. Self-management can effectively improve patient compliance, subjective initiative, and improve patient quality of life. However, the present situation of self-management in different old people is different. Therefore, this study classifies older co-morbid patients through potential profiling analysis, understands the category characteristics of self-management level of older co-morbid patients, and discusses the influencing factors of self-management level of different categories of older co-morbid patients, which can provide reference for personalized intervention programs for different comorbidity characteristics of elderly people in the future. MethodThrough a cross-sectional study, 616 cases of older co-morbid patients in three districts of Zhengzhou City, Henan Province, were selected as survey subjects by using the whole cluster sampling method. The General Information Questionnaire, Chronic Disease Self-Management Scale, Health Literacy Scale, Electronic Health Literacy Scale, Collaborative Social Support Scale, and Health Empowerment Scale were used to conduct the survey.ResultsThe result of LPA shows that the self-management characteristics of older co-morbid patients should be classified into 3 categories: good self-management (19.4%), medium self-management(27.9%), and low self-management (52.7%). The results of multivariate logistic regression analyses show that literacy, religiosity, health literacy, e-health literacy, appreciative social support, and health empowerment are influential factors for self-management among older co-morbid patients (p < 0.05).ConclusionThere is obvious heterogeneity in the self-management level of older co-morbid patients. It is recommended that healthcare professionals give targeted interventions for their weaknesses according to the self-management characteristics of different categories of patients in order to enhance the self-management level of this population and improve their quality of life.

Characteristics of COVID-19 comorbidities and severity profiles among pregnant women from a single-center cross-sectional study.

The study aimed to determine the characteristics of comorbidities, association between comorbidities and coronavirus disease 2019 (COVID-19), as well as characteristics of COVID-19 severity among pregnant women at a tertiary hospital in Bandung. We conducted a cross-sectional study by taking secondary data between January 2020 and December 2021 involving 278 pregnant women aged 16 to 45 years that confirmedly diagnosed with COVID-19 via RT-PCR. We collected information from the medical record on severity and comorbidities. The admission C-reactive protein (CRP) profiles were compared between the severe and nonsevere COVID-19 patients. This study employed bivariate analysis, t test, and multivariate analysis with logistic regression models. Of the 278 data included in this study, 120 cases had comorbidities. Most patients were asymptomatic (82%). Obesity was the most common comorbid proportion. Only hypertension as comorbid showed a significant association with symptomatic or asymptomatic COVID-19 (<0.05). Pregnant women with hypertension were 6 times more likely to show symptoms than those without hypertension (OR = 6.092; 95% CI 3.103-11.962). Pregnant women with comorbidities were at higher risk of cesarean sections and stillbirth. The CRP levels which were found to have statistically significant association with COVID-19 severity (<0.05). The domination of asymptomatic COVID-19 in pregnant women was found in this study. Hypertension comorbid has a significant association with COVID-19 symptoms. Maternal and neonatal outcomes appear to be influenced by maternal comorbidities. Moreover, the CRP levels were found to be significant risk factors for COVID-19 severity in pregnant women that might have association with comorbidities.

Increased Patient Age as a Risk Factor Following Free Flap Reconstruction after Breast Cancer: A Single Institutional Review of 2,598 Cases.

Autologous breast reconstruction (ABR) after mastectomy is increasing due to benefits over implant-based reconstruction. However, free flap reconstruction is not universally offered to patients of advanced age due to perceived increased perioperative risk. Patients undergoing free flap breast reconstruction at our institution from 2005 to 2018 were included. Risk-adjusted logistic regression models were fit while controlling for demographic and comorbid characteristics to determine the association of age with the probability of venous thromboembolism (VTE), delayed healing, skin necrosis, surgical site infection (SSI), seroma, hematoma, hernia, and flap loss. Linear predictions from risk-adjusted logistic regression models were used to create spline curves and determine the risk of outcomes associated with age. A cohort of 2,598 patients underwent free flap breast reconstruction in the period examined. The median age was 51 with approximately 9% of patients being 65 or older. Increased age was associated with a greater risk of delayed healing, skin necrosis, and hematoma after surgery. There was no increased risk of medical complications such as VTE or complications such as flap loss, seroma, or SSI. A set age cutoff for patients undergoing free flap breast reconstruction does not appear warranted. There is no difference in major surgical complications such as flap loss with increasing age. However, older age does predispose patients to specific wound complications such as hematoma, skin necrosis, and delayed wound healing, which should guide preoperative counseling. Further, medical complications do not increase with advanced age. Overall, however, the safety of ABR in older patients appears uncompromised.

J-shaped association of operation duration and blood transfusion risk in patients undergoing primary total knee arthroplasty.

Blood transfusion is a common perioperative complication of primary total knee arthroplasty (TKA) that can lead to adverse outcomes, prolonged hospital stays, and increased medical costs. The purpose of our study was to explore the risk factors for blood transfusion and to establish whether operation duration is independently related to blood transfusion risk in patients undergoing primary TKA after adjusting for other covariates. This was a secondary analysis of data from a retrospective cohort study involving patients who underwent primary TKA in Singapore. The patients' baseline data, comorbidity, and surgical characteristics were collected. The independent variable was operation duration and the dependent variable was blood transfusion events. Patients were divided into three groups according to operation durations (90 and 120min). Univariate logistic regression was used to explore the risk factors associated with blood transfusion after primary TKA. Multivariate analysis was used to assess the independent effect of operation duration on blood transfusion risk after adjusting for other covariates. Additionally, we performed subgroup analyses to identify specific groups, test the robustness of the relationships, and explore whether there were interactions between the different variables. Furthermore, restricted cubic splines (RCS) were used to identify the relationship between the two variables. A total of 2,562 patients were included in the study, of whom 136 (5.61%) had a transfusion event. Operation durations were 95.55 ± 36.93 and 83.86 ± 26.29min for blood transfused and non-transfused patients, respectively. Univariate logistic regression analysis showed that age, BMI, ASA status, Hb level, OSA, CHF, creatinine level > 2mg/dL, and anaesthesia type were risk factors for blood transfusion. After adjusting for all covariates, multivariate logistic regression models showed that operation duration was positively associated with blood transfusion risk (odds ratio [OR] = 1.87, 95% CI = 1.174-2.933, P = 0.007). Compared to patients with an operation duration of less than 90min, those with an operation duration of more than 120min had a 2.141-fold increased risk of blood transfusion (OR = 2.141, 95% CI = 1.035-4.265, P = 0.035). Stratified analysis results showed that the association persisted in patients aged > 50years, Chinese, BMI > 30kg/m 2, Hb level > 11g/dL, ASA status levels 2 and 3, general anaesthesia, and unilateral primary TKA. A non-linear (P-non-linear = 0.30) and J-shaped relationship was identified. The risk of transfusion increased as the operation duration decreased or exceeded the inflection point (73.2min). Our study demonstrated a non-linear and J-shaped relationship between operation duration and blood transfusion events in patients undergoing primary TKA. Blood transfusion risk was the lowest when the operation duration was 73.2min. A shorter operation duration implies irregular surgical procedures and incomplete intraoperative haemostasis, leading to increased perioperative blood loss and blood transfusion. These results will be useful for clinical decision-making.

Comparison of the characteristics of the population eligible for lung cancer screening under 2013 and population newly eligible under 2021 US Preventive Services Task Force recommendations

PurposeIn 2021, the United States Preventive Services Task Force (USPSTF) revised their 2013 recommendations for lung cancer screening eligibility by lowering the pack-year history from 30+ to 20+ pack-years and the recommended age from 55 to 50 years. Simulation studies suggest that Black persons and females will benefit most from these changes, but it is unclear how the revised USPSTF recommendations will impact geographic, health-related, and other sociodemographic characteristics of those eligible.MethodsThis cross-sectional study employed data from the 2017–2020 Behavioral Risk Factor Surveillance System surveys from 23 states to compare age, gender, race, marital, sexual orientation, education, employment, comorbidity, vaccination, region, and rurality characteristics of the eligible population according to the original 2013 USPSTF recommendations with the revised 2021 USPSTF recommendations using chi-squared tests. This study compared those originally eligible to those newly eligible using the BRFSS raking-dervived weighting variable.ResultsThere were 30,190 study participants. The results of this study found that eligibility increased by 62.4% due to the revised recommendations. We found that the recommendation changes increased the proportion of eligible females (50.1% vs 44.1%), Black persons (9.2% vs 6.6%), Hispanic persons (4.4% vs 2.7%), persons aged 55–64 (55.8% vs 52.6%), urban-dwellers(88.3% vs 85.9%), unmarried (3.4% vs 2.5%) and never married (10.4% vs 6.6%) persons, as well as non-retirees (76.5% vs 56.1%) Respondents without comorbidities and COPD also increased.ConclusionIt is estimated that the revision of the lung cancer screening recommendations decreased eligibility disparities in sex, race, ethnicity, marital status, respiratory comorbidities, and vaccination status. Research will be necessary to estimate whether uptake patterns subsequently follow the expanded eligibility patterns.

Survival, incidence, and predictors of diabetic neuropathy among type 2 diabetic patients in hospitals of Addis Ababa.

Diabetic neuropathy is a very common complication of diabetes mellitus. Thus, measuring the incidence of diabetic neuropathy is a key element in tracking the progress of epidemics of diabetes mellitus and an indication of early accessibility for healthcare in terms of type 2 diabetic patients. To assess survival, incidence, and predictors of diabetic neuropathy among type 2 diabetic patients in hospitals of Addis Ababa from June 25 to August 25, 2023. An institutional-based retrospective follow-up study design was used among newly diagnosed type 2 diabetic patients at hospitals of Addis Ababa. A chart review tool that contains socio-demographic, clinical, and comorbidity characteristics, biochemical characteristics, and the status of type 2 patients was used. A cleaned data was exported from Epi-data manager 4.6 version to SPSS version 25 for analysis. Bivariate Cox regression analysis was done to identify predictors of diabetic neuropathy at a 95% confidence level. A total of 414 type 2 diabetic patients were included in the study. Of these, 97 (23.4%) developed diabetic neuropathy. Variables like having hypertension (AHR 11.25, 95% CI 3.73-33.93), anemia (AHR 4.18, 95% CI 1.78-9.82), high-density lipoprotein < 40 mg/dl (AHR 5.07, 95% CI 1.38-18.67), high creatinine level (AHR 14.67, 95% CI 4.27-50.40), diabetic retinopathy (AHR 4.32, 95% CI 1.32-14.18), and diabetic nephropathy (AHR 2.50, 95% CI 1.09-6.57) were associated with the incidence of diabetic neuropathy. The mean time to develop diabetic neuropathy was 4.94 years, CI (4.50-5.38), and the mean survival time was 6.61 years. The incidence of diabetic neuropathy was high relative to other studies. Variables like having hypertension, anemia, high-density lipoprotein, high creatinine level, diabetic retinopathy, and diabetic nephropathy were predictors of diabetic neuropathy. The mean time to develop diabetic neuropathy was 5 years, with a survival mean time of 7 years.

The frailty among suburban elderly population after one-year COVID-19 pandemic in Cirebon Regency, Indonesia.

The coronavirus disease 2019 (COVID-19) pandemic has had significant impacts worldwide, especially among older adults. Frailty is a determinant of susceptibility to morbidity and mortality due to COVID-19 in the elderly. This study aimed to determine frailty status and identify factors associated with the suburban elderly population in Cirebon Regency, Indonesia, after the one-year COVID-19 pandemic. A cross-sectional study of community-dwelling individuals aged ≥ 60 years was conducted in Klangenan, Cirebon Regency, Indonesia, from March to June 2021. A questionnaire was used to determine the baseline characteristics of participants, healthcare access, comorbidity, and frailty status. The Ina-FRAIL scale was used to determine the frailty status (frail/non-frail). The chi-square test and logistic regression analysis were used to determine the association between independent variables and frailty. A total of 383 participants were recruited, with a median age of 67 (IQR 64-73) years. The prevalence of frailty in the present study was 10.2%. Multivariate analysis showed that age (OR 2.73; 95%CI 1.21-6.12), multimorbidity (OR 7.86; 95% CI 3.01-20.57) and financial dependence (OR 13.40, 95% CI 5.66-31.73) were significantly associated with frailty. One-year COVID-19 pandemic has had a considerable burden on frailty among the suburban elderly population in Indonesia. The factors associated with frailty were age, multimorbidity, and financial dependence.

Common P-glycoprotein (ABCB1) polymorphisms do not seem to be associated with the risk of rivaroxaban-related bleeding events: Preliminary data.

Considering conflicting previous reports, we aimed to evaluate whether the common ABCB1 polymorphisms (rs1128503, rs2032582, rs1045642, rs4148738) affected the risk of bleeding in rivaroxaban-treated patients. We report preliminary data from a larger nested case-control study. Consecutive adults started on rivaroxaban for any indication requiring > 6 months of treatment were followed-up to one year. Patients who experienced major or non-major clinically relevant bleeding during the initial 6 months were considered cases, whereas subjects free of bleeding over > 6 months were controls. The polymorphisms of interest (rs1128503, rs2032582, rs1045642, rs4148738) were in a strong linkage disequilibrium, hence patients were classified regarding the "load" of variant alleles: 0-2, 3-5 or 6-8. The three subsets were balanced regarding a range of demographic, comorbidity, comedication and genetic characteristics. A logistic model was fitted to probability of bleeding. There were 60 cases and 220 controls. Raw proportions of cases were similar across the subsets with increasing number of ABCB1 variant alleles (0-2, N = 85; 3-6, N = 133; 6-8, N = 62): 22.4%, 21.8%, and 19.4%, respectively. Fully adjusted probabilities of bleeding were also similar across the subsets: 22.9%, 27.5% and 17.7%, respectively. No trend was observed (linear, t = -0.63, df = 273, P = 0.529; quadratic, t = -1.10, df = 273, P = 0.272). Of the 15 identified haplotypes, the completely variant (c.1236T_c.2677T(A)_c.3435T_c.2482-2236A) (40.7%) and completely wild-type (C_G_C_G) (39.5%) haplotypes prevailed, and had a closely similar prevalence of cases: 21.1% vs. 23.1%, respectively. The evaluated common ABCB1 polymorphisms do not seem to affect the risk of early bleeding in patients started on rivaroxaban.