Chronic Comorbid Conditions Research Articles

Mortality in Two Waves of COVID-19: A Comparative Analysis of a Tertiary Care Hospital in India.

Background COVID-19 has spread as two distinct surges of cases in many countries. Several countries have reported differences in disease severity and mortality in the two waves. Objective Compare the in-hospital mortality in the two COVID-19 waves at a tertiary care hospital in India. Methods We conducted a retrospective data collection. Distinct periods of surges in cases and admissions were defined as the first wave spanning from March 2020 to December 2020 and the second wave from April 2021 to June 21, 2021. The primary outcome of this study was to compare mortality rates in terms of total hospital mortality rate (TMR) and case fatality rate (CFR). Results Mortality rates of wave 2 were approximately 10 times that of wave 1 (TMR of 20.3% in wave 2 versus 2.4% in wave 1 and CFR of 1.5% versus 17.7% in wave 1 and 2, respectively). Mortalities in wave 2 had a larger proportion of severe disease at presentation, faster progression of symptoms to death, and more patients without any chronic comorbid condition dying due to the direct effect of COVID-19 acute respiratory distress syndrome (ARDS). Conclusion Our data matches the worldwide reported pooled hospital mortality figures and shows the comparative difference in disease severity between the two waves.

Chronic comorbid conditions and asthma exacerbation occurrence in a general population sample

Chronic comorbid conditions are common in adults with asthma, and some may influence a patient’s asthma exacerbation risk. We explored associations between eighteen chronic comorbid conditions and asthma exacerbation occurrence in adults with asthma in a cross-sectional study nested within a cohort study using data from the two-yearly US National Health and Nutrition Examination Survey (NHANES) program. Data of 2387 adults with self-reported doctor-diagnosed current asthma from the 2007 to 2018 NHANES surveys were selected. Investigated chronic comorbidities were: angina pectoris; congestive heart failure; coronary heart disease; depression; diabetes mellitus; soft and hard drug use; gastroesophageal reflux; gout; history of heart attack; history of stroke; hypercholesterolemia; hypertension; kidney failure; liver conditions; obesity; rheumatoid arthritis; and thyroid problems. Outcome was defined as asthma exacerbation category: no, moderate, or severe exacerbation(s) in the past year. Ordinal logistic regression analysis with correction for potential confounders was used to estimate odds ratios (OR) for moderate or severe exacerbations. Observed associations with increased severe asthma exacerbation occurrence were: obesity (OR = 1.67; 95% confidence interval 1.24, 2.26), and rheumatoid arthritis (OR = 1.55; 1.04, 2.30). History of stroke (OR = 1.95; 1.22, 3.11) and rheumatoid arthritis (OR = 1.33; 1.00, 1.75) showed associations with increased moderate exacerbation occurrence. Age-stratified analysis showed soft drug use, obesity, depression, thyroid problems, and rheumatoid arthritis to be associated with moderate and/or severe exacerbation occurrence in one or more 10-year age strata. In conclusion, several chronic comorbid conditions were associated with asthma exacerbation occurrence, which confirms but also complements previous studies. Our observations contribute to understanding exacerbation risk estimation and, ultimately, personalized asthma management.

Individual-level precision diagnosis for coronavirus disease 2019 related severe outcome: an early study in New York

Because of inadequate information provided by the on-going population level risk analyses for Coronavirus disease 2019 (COVID-19), this study aimed to evaluate the risk factors and develop an individual-level precision diagnostic method for COVID-19 related severe outcome in New York State (NYS) to facilitate early intervention and predict resource needs for patients with COVID-19. We analyzed COVID-19 related hospital encounter and hospitalization in NYS using Statewide Planning and Research Cooperative System hospital discharge dataset. Logistic regression was performed to evaluate the risk factors for COVID-19 related mortality. We proposed an individual-level precision diagnostic method by taking into consideration of the different weights and interactions of multiple risk factors. Age was the greatest risk factor for COVID-19 related fatal outcome. By adding other demographic variables, dyspnea or hypoxemia and multiple chronic co-morbid conditions, the model predictive accuracy was improved to 0.85 (95% CI 0.84–0.85). We selected cut-off points for predictors and provided a general recommendation to categorize the levels of risk for COVID-19 related fatal outcome, which can facilitate the individual-level diagnosis and treatment, as well as medical resource prediction. We further provided a use case of our method to evaluate the feasibility of public health policy for monoclonal antibody therapy.

Visual Functioning and Mortality of Age-Related Macular Degeneration Patients in a Colorado Cohort

To investigate the relationship between visual functioning as measured by the National Eye Institute 25-Item Visual Function Questionnaire (VFQ-25) and mortality in patients with various stages of age-related macular degeneration (AMD). Observational cohort study. Patients with AMD enrolled in the University of Colorado AMD Registry between July 9, 2014 and December 31, 2021 were included. Age-related macular degeneration cases were classified into early AMD, intermediate AMD, geographic atrophy, neovascular AMD, or both advanced types of AMD (neovasuclar and geographic atrophy both present) using multimodal imaging and the Beckman and Classification of Atrophy Meetings criteria. Visual Function Questionnaire-25 composite and subscale scores at the time of study enrollment were calculated. Cox proportional hazards modeling was used to assess time to event for mortality utilizing univariate and multivariable models, which adjusted for all variables significantly associated with mortality. The measures of association were hazard ratios (HRs) and 95% confidence intervals (CIs). All-cause mortality statistics were obtained through a collaborative agreement with the Colorado Department of Public Health and Environment. Death rates through October 19, 2022 were compared by demographics and potential confounders. Analysis was completed on a cohort of 876 patients, of which 180 (20.6%) died during the follow-up period. Average follow-up time for this cohort was 52.5 (standard deviation: 26.6) months. In univariate analysis, composite VFQ-25 score and all subscale scores aside from ocular pain were significantly associated with time to mortality. Additionally, age, AMD category, marital status, history of smoking, and multiple chronic comorbid conditions were significantly associated with time to mortality. In multivariable analysis, for each 10-point increase in a patient's VFQ-25 scores for general health and driving, the risk of death decreased with HR of 0.85 (95% CI: 0.80, 0.91; P < 0.0001) and 0.92 (95% CI: 0.87, 0.97; P= 0.005), respectively. Composite and other subscale scores were not significantly associated with mortality after adjusting for confounding variables. This cohort of AMD patients had a 20% rate of death in the 52.5-month average follow-up time. Better general health and ability to drive, as measured by the VFQ-25, were each separately associated with significantly lower risk of death among individuals with AMD. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Determinants of Medication Non-Adherence Among the Elderly with Co-Existing Hypertension and Type 2 Diabetes Mellitus in Rural Areas of Udupi District in Karnataka, India.

Medication adherence is a crucial component in the management of elderly with co-morbid chronic conditions. Hence, this study aimed to investigate the determinants of medication non-adherence among rural elderly with co-morbid chronic conditions of hypertension (HTN) and type 2 diabetes mellitus (T2DM) in India. This cross-sectional study adopted the probability proportional to size (PPS) sampling technique to find the determinants of medication non-adherence among elderly residing in rural coverage areas of five randomly selected primary health centres (PHC) in Udupi district, Karnataka, India. A total of 360 elderly (72 samples from each cluster) who met the inclusion criteria and consented were interviewed using predesigned prevalidated and standardized or reliable tools. The data were coded and entered in SPSS version 16.0 and analyzed using both descriptive and inferential statistics. The study found that 55.6% (n=200) of rural elderly with co-morbid conditions HTN and T2DM were non-adherent to their medications and established Spearman correlation coefficient rank (r) value between undesirable person-related factors (r=-0.444); good family support (including financial support) (r=0.185); poor accessibility to healthcare facility (r=-0.209); detrimental medication-related factors including high cost of medication (r=-0.237) were found to be significant at 0.05 level of confidence (p < 0.05). Further, the study depicted that the chi-square test (χ2) was identified to be significantly associated (p<0.05) with a variable such as education, knowledge, number of illnesses and impairments, vision, memory, and physical impairments. Medication adherence could be improved among rural elderly with co-morbid conditions by identifying and addressing the determinants at the earliest. Further, it is vital to identify the suitable intervention program to address these avoidable problems.

Exploring the intention and hesitancy to receive a booster dose of COVID-19 vaccine among patients with comorbid disease conditions using a health belief model

BackgroundDespite the fact that the WHO recommends that adults over the age of 18 have to receive a booster dose of the COVID-19 vaccine. The willingness and intention to accept a booster dose of the COVID-19 vaccine remain major issues among the general population, particularly patients with comorbid disease conditions. The aim of this study was to assess the patterns regarding COVID-19 infection and vaccination, along with the intention and hesitancy to receive a booster dose of the COVID-19 vaccine among patients with comorbid disease conditions in Istanbul, Türkiye. MethodsThis was a descriptive, cross-sectional study conducted among patients with comorbid disease conditions using a three-part, structured, validated questionnaire. Vaccine hesitancy from a booster dose of the COVID-19 vaccine was assessed using the Health Belief Model (HBM), based on a 5-point Likert-type scale. ResultsThe study enrolled 162 participants with a mean age of 57.2 ± 13.3 years. 97% of the respondents received the COVID-19 vaccine. Almost half of respondents (51.2%) reported receiving information about a booster dose of the COVID-19 vaccine. HBM among the participants with comorbidities showed a significant agreement regarding the perceived susceptibility (P < 0.0001), perceived severity (P < 0.0001) and perceived benefits (P < 0.0001) to receive a booster vaccine dose. There was a statistically significant correlation between the intention to receive a booster vaccine dose and education level (university education; P < 0.0001). ConclusionA vast and significant majority of patients with chronic comorbid disease conditions who received the COVID-19 vaccine reported an intention to receive a booster dose.

1017-P: Association between Early-Pandemic Primary Care Telemedicine Exposure and Ongoing HbA1c Outcomes

Objective: Telemedicine helped maintain primary care access for patients with diabetes when in-person health visits were restricted early in the COVID-19 pandemic. There is little known about the longer-term impact of pandemic telemedicine on patient outcomes. Method: In an integrated health care system that temporarily shifted all patient-initiated primary care visits to telemedicine during the early pandemic, we used EHR data to compare patients with diabetes exposed to a primary care video or telephone telemedicine visit during the first year of the pandemic (4/2020-03/2021), and examined two outcome variables in second year of the pandemic (04/2021-03/2022): any HbA1c measured, and HbA1c &amp;lt;8%. Using multivariate logistic regression to examine the association between telemedicine exposure and outcomes, we adjusted for patient age, sex, race, language, neighborhood SES and internet, video visit and patient portal history, other comorbid chronic conditions, and baseline HbA1c, then calculated multivariate adjusted outcome rates. Results: Among 242,848 patients with diabetes, 49.8% were age 65+, 59.9% were of non-White race/ethnicity. During the first year of pandemic, 42% were exposed to a primary care video visit, 32% had only telephone visits (25% had no visits). The adjusted rate of HbA1c testing in the outcome period was 91% among those with a video or telephone visit, compared to 87% for those with no visit (p&amp;lt;0.05). Similarly, an adjusted 69% of those with a video visit had HbA1c &amp;lt;8% compared to 67% among patients with no visit (p&amp;lt;0.05), with stronger associations among patients with baseline HbA1c 8+. Conclusion: In patients with diabetes, primary care telemedicine exposure during the initial pandemic period was associated with downstream higher rates of HbA1c testing and greater rates of HbA1c’s within target range. Telemedicine primary care access likely supported continuity in diabetes management during the pandemic. Disclosure M.Reed: None. J.Huang: None. A.Millman: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK085070)

Hypogonadism among Type 2 Diabetes Mellitus Patients with Male Erectile Dysfunction

Abstract Introduction Testosterone levels and erectile function are known to decline as men age, leading to hypogonadism and erectile failure. Men with type 2 diabetes mellitus (T2DM) have a high prevalence of hypogonadism and erectile dysfunction. We aimed to estimate the prevalence of hypogonadism in T2DM patients complaining of erectile dysfunction. Patients and Methods A cross-sectional study was conducted at Specialized Diabetes, Endocrine, and Metabolism Center from early September 2021 to the end of January 2022. The study included 115 fully anonymized randomly selected patients. Patients with diabetes were assessed for erectile dysfunction through a questionnaire derived from “The International Index of Erectile Function (IIEF).” Additionally, hypogonadism has been diagnosed with serum testosterone levels lower than 264 mg/dL according to the Endocrine Society 2018 criteria for the diagnosis of male hypogonadism. Results The average duration of diabetes was 6.2 years, and the mean glycated hemoglobin value was 9.3%. Dyslipidemia was the most prevalent chronic comorbid condition (84.3%) accompanying diabetes and erectile dysfunction, followed by hypertension (56.5%). An approximately similar rate of hypogonadism was observed in patients with diabetes and erectile dysfunction regardless of whether the other chronic disease was also present. From 115 patients included in this study, hypogonadism was diagnosed in 26% of patients with diabetes and erectile dysfunction. Conclusion A significant number of hypogonadisms occur in patients with diabetes and erectile dysfunction, which require particular emphasis.

#5624 REMDESIVIR IN COVID-19 PATIENTS WITH KIDNEY DISEASE: A STUDY ON THE RENAL FUNCTION AND OUTCOMES

Abstract Background and Aims The COVID-19 pandemic has created a global catastrophe with mortality rates higher in older adults and people with chronic comorbid conditions In which patients with chronic kidney disease were the most vulnerable population. Remdisivir, an antiviral nucleotide, showed promising results in individuals with COVID-19 infection. However, despite its shortened time to recovery in adults hospitalized with COVID 19, individuals with ESRD and high stage AKI were not included in clinical trials, thus when granted an emergency use authorization it was recommended to avoid use in patients with eGFR &amp;lt;30mL/min “unless benefit outweighs the risk”. In this study, in the absence of Molnupiravir, the current drug of choice, we wished to study its safety by determining its effects on renal status of individuals with known kidney dysfunction. The study aims to determine the effect of Remdesivir on renal function and outcomes among COVID19 patients with kidney disease. Method The study utilized a retrospective research design. The study included patients who were 19 years old and above, with RT-PCR confirmed COVID19 infection treated with Remdesivir and who were confirmed to have kidney disease. Results 106 patients were included; the mean age was 62.25±13.96 years old, more than half of the population were males. The majority of the population had AKI while the rest had CKD and 25% underwent renal replacement therapy. Most of them were classified with severe and critical COVID infection (Table 1). To determine effects on renal function laboratory parameters were determined at baseline and after completion of treatment. There was an overall significant improvement in egfr (&amp;lt;0.01), albuminuria (0.013) and in acid-base balance (0.003) and odds ratio showed that none of the demographic, clinical and laboratory profile significantly in-creased the chance of death in terms of overall clinical outcome (Table 2). To determine risk factors of patients that may contribute to patients outcome, odds ratio showed that none of the demographic, clinical and laboratory profile significantly increased the chance of death among patients who took Remdesivir. (Table 3). In terms of overall clinical outcome, this study had a mortality rate of 4.9% (Table 4). Conclusion Use of Remdesivir in patients with AKI, CKD and ESRD on dialysis was not associated with further renal function deterioration. Contrary to concerns there was rather an overall significant improvement in EGFR, degree of albuminuria and acid-base balance after treatment regardless of their disease severity and its use in patients on hemodialysis have not shown any detrimental impact on mortality.

Incidence and Causes of Early Hospital Readmissions After Living-Donor Renal Transplant at King Abdulaziz Medical City, Riyadh.

Living-donor organ transplant has a higher long-term survival rate compared to deceased-donor organ transplant, with kidney transplantation being the optimal treatment for most kidney failure patients. However, early hospital readmission within 30 days ofdischarge can occur due to various factors and can negatively affect long-term outcomes. Effective communication with patients pre-and post-transplant is crucial for a better quality of life and for reducing readmissions. Chronic kidney disease and co-morbid conditions must also be addressed for better long-term outcomes. The incidence and causes of early hospital readmission vary depending on local characteristics and other factors. A retrospective cohort study of outcomes in patients who underwent living-donor renal transplantation at King Abdulaziz Medical City (KAMC) between 2015 and 2022.Data were collected by chart review using the BestCare system. The data collected included patients' demographics, comorbidities, surgery-related data, and the outcome of transplantation. The categorical data were presented using percentages and frequencies, while the numerical data were presented as mean and standard deviation. The Chi-square test was used for inferential statistics to find the association between categorical variables. Regarding sociodemographic characteristics, the majority of patients were male, aged 19-50 years, and either overweight or had obesity class 1. The incidenceof complications, graft failure, and mortality after renal transplant was low, with only a small percentage of patients experiencing these outcomes within one year of transplant. There is no significant association between gender, age, BMI, and the likelihood of readmission after renal transplantation. Patients with comorbidities such as hypertension, diabetes, and coronary artery disease had a higher likelihood of readmission after renal transplantation. The study provides an association between readmission after renal transplantation and various factors such as surgical complications, previous transplant, age at transplant, graft failure, and mortality. Out of the 107 readmitted patients, 2.8% had surgical complications, and 5.6% had a previous transplant, but the association was not statistically significant. Early hospital readmission within 30 days of discharge can be a concern for patients undergoing renaltransplants. While the incidence of complications, graft failure, and mortality after renal transplant was low, patients with comorbidities such as hypertension, diabetes, and coronary artery disease had a higher likelihood of readmission after renal transplantation. Although the association between surgical complications and readmission was not statistically significant, it is important to continue monitoring this factor in future studies. Effective communication with patients pre-and post-transplant can play a crucial role in reducing readmissions and improving long-term outcomes.

EPH183 Impact of a Cancer Diagnosis on Non-Cancer Chronic Disease Medication Adherence - A Systematic Literature Review

A cancer diagnosis may affect the management of other comorbid chronic conditions. An evaluation of change in adherence to medications for these conditions after a cancer diagnosis may help in understanding the effect of cancer. This study aims to summarize existing literature assessing the impact of cancer diagnosis on adherence to medications for non-cancer chronic conditions.

Challenges and approaches when addressing dementia in the context of chronic comorbid conditions in primary care settings

AbstractBackgroundA diagnosis of dementia impacts all other comorbid conditions and areas of patient care. Yet, in primary care settings, dementia is often underdiagnosed and misdiagnosed due to competing clinical concerns. Delayed diagnosis and care of dementia can lead to more rapid cognitive decline, and increased hospitalizations, health care costs, and mortality. The objective of this work was to understand the challenges and successful approaches among primary care providers working in safety net settings when caring for patients with dementia and co‐existing chronic conditions.MethodsQualitative interviews focused on practices and challenges diagnosing and caring for patients with dementia, challenges related to comorbidities, needs for practice improvement, and successful approaches. Data was analyzed using thematic analysis.ResultsWe interviewed primary care physicians (n = 29) and primary care nurse practitioners (n = 6) based in California safety net settings in the SF Bay Area, Central Valley, and Southern California. PCPs identified the following comorbidities as most challenging to co‐manage with dementia: mental illness (depression/anxiety), hypertension, diabetes, heart disease, stroke, pain, substance use, and trauma. Most PCPs made a distinction between poorly controlled and well‐controlled chronic conditions. Challenges identified included: difficulty differentiating symptoms of dementia from other conditions, medication management and adherence; time constraints when making decisions about prioritizing acute comorbidities or dementia; need for family/caregiver involvement; and challenges controlling comorbid conditions when dementia is present. Successful approaches included: using team‐based care and targeted referrals (e.g. social work, community health workers, geriatrics); the importance of familiarity and long‐term relationships with patients; finding ways to involve family members; and simplifying visits, care plans, and communication.ConclusionPCPs face difficulties when providing care to patients with dementia and comorbid conditions, but they also identified opportunities for improvement by sharing successful approaches used in challenging healthcare settings. Findings can help shape intervention development to better support PCPs.

Association of Comorbidity With Healthcare Utilization in People Living With Dementia, 2010-2019: A Population-Based Cohort Study.

Evidence on the healthcare utilization associated with comorbidity in people with dementia is lacking in Chinese societies. This study aimed to quantify healthcare utilization associated with comorbidity that is common in people living with dementia. We conducted a cohort study using population-based data from Hong Kong public hospitals. Individuals aged 35+ with a dementia diagnosis between 2010 and 2019 were included. Among 88,151 participants, people with at least two comorbidities accounted for 81.2%. Estimates from negative binomial regressions showed that compared to those with one or no comorbid condition other than dementia, adjusted rate ratios of hospitalizations among individuals with six or seven and eight or more conditions were 1.97 [98.75% CI, 1.89-2.05] and 2.74 [2.63-2.86], respectively; adjusted rate ratios of Accident and Emergency department visits among individuals with six or seven and eight or more conditions were 1.53 [1.44-1.63] and 1.92 [1.80-2.05], respectively. Comorbid chronic kidney diseases were associated with the highest adjusted rate ratios of hospitalizations (1.81 [1.74-1.89]), whereas comorbid chronic ulcer of the skin was associated with the highest adjusted rate ratios of Accident and Emergency department visits (1.73 [1.61-1.85]). Healthcare utilization for individuals with dementia differed substantially by both the number of comorbid chronic conditions and the presence of some specific comorbid conditions. These findings further highlight the importance of taking account of multiple long-term conditions in tailoring the care approach and developing healthcare plans for people with dementia.

Chronic morbidity and health seeking behavior among post-menopausal women of Itahari Sub-Metropolitan City, Nepal

Introduction: The prevalence of morbidity increases in postmenopausal period. Usually co-morbid chronic conditions and symptoms of menopause are underestimated due to low awareness thereby affecting the health seeking behaviour. This study aims to find out the chronic morbidity and health seeking behaviour among post-menopausal women of Itahari sub metropolitan city of Nepal.&#x0D; Method: This is a community based cross-sectional study conducted in 5 wards of Itahari sub metropolitan city, of Nepal over a period of one year (February 2018 to January 2019) among 490 post-menopausal women of 45 and above age. Ethical approval was obtained. The frequency and percentage of women with chronic morbidity and their health seeking in general was calculated. Also, percentage of health seeking for the each morbidly and postmenopausal symptoms were calculated using MS-Excel.&#x0D; Result: Among the 490 participants 69.4% were having chronic diseases in which diabetes mellitus and hypertension had highest prevalence. Up to 98% of the women having chronic morbidity sought help from professionals. There was lowest professional health seeking for psychological symptoms and highest for somatic symptoms.&#x0D; Conclusion: Our study shows high chronic morbidity in post-menopausal period and good health seeking behaviour for them. There is less professional heath seeking for vasomotor and psychological symptoms of post menstrual period.

Efficacy of Videoconference Group Acceptance and Commitment Therapy (ACT) and Behavioral Activation Therapy for Depression (BATD) for Chronic Low Back Pain (CLBP) Plus Comorbid Depressive Symptoms: A Randomized Controlled Trial (IMPACT Study)

This study examined the efficacy of adding a remote, synchronous, group, videoconference-based form of acceptance and commitment therapy (ACT) or behavioral activation therapy for depression (BATD) to treatment-as-usual (TAU) in 234 patients with chronic low back pain (CLBP) plus comorbid depressive symptoms. Participants were randomly assigned to ACT, BATD, or TAU. Compared to TAU, ACT produced a significant reduction in pain interference at posttreatment (d = .64) and at follow-up (d = .73). BATD was only superior to TAU at follow-up (d = .66). A significant reduction in pain catastrophizing was reported by patients assigned to ACT and BATD at posttreatment (d = .45 and d = .59, respectively) and at follow-up (d = .59, in both) compared to TAU. Stress was significantly reduced at posttreatment by ACT in comparison to TAU (d = .69). No significant between-group differences were found in depressive or anxiety symptoms. Clinically relevant number needed to treat (NNT) values for reduction in pain interference were obtained at posttreatment (ACT vs TAU = 4) and at follow-up (ACT vs TAU = 3; BATD vs TAU = 5). In both active therapies, improvements in pain interference at follow-up were significantly related to improvements at posttreatment in psychological flexibility. These findings suggest that new forms of cognitive-behavioral therapy are clinically useful in improving pain interference and pain catastrophizing. Further research on evidence-based change processes is required to understand the therapeutic needs of patients with chronic pain and comorbid conditions. Trial numberNCT04140838. PerspectiveGroup videoconference-based ACT and BATD showed greater efficacy than TAU for reducing pain interference and pain catastrophizing in patients with CLBP plus clinically relevant depression. Psychological flexibility appeared to be the main contributor to treatment effects for both ACT and BATD.

Assessment of risk factors for thrombosis in ICU patients with COVID-19

&lt;b&gt;Introduction: &lt;/b&gt;High incidence of thrombotic events has been reported in hospitalized patients with COVID-19. Less than 50% of pulmonary embolisms (PE) are associated with signs of deep vein thrombosis (DVT) of the lower extremities.&lt;br /&gt; &lt;b&gt;Objective:&lt;/b&gt;&amp;nbsp;To assess the risk factors of deep vein thrombosis (DVT) in intensive care patients with COVID-19 by comparing the clinical features of patients in groups with thrombosis, venous stasis and without deep vein thrombosis.&lt;br /&gt; &lt;b&gt;Material and methods:&lt;/b&gt;&amp;nbsp;A prospective cross-sectional study was conducted that included all consecutive adult patients with laboratory-confirmed COVID-19 admitted to the intensive care unit. We investigated chronic comorbid conditions in patients, including arterial hypertension, diabetes mellitus, obesity, chronic kidney failure (CRF), chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF), and cancer which may be a risk factor for thrombosis.&lt;br /&gt; &lt;b&gt;Results:&amp;nbsp;&lt;/b&gt;A total of 465 patients were included in the study. Comorbidities were present in 435 of 465 patients (93.55%). Doppler ultrasound (DUS) confirmed deep vein thrombosis in 60 patients (13.8%), which was associated with older age (71.12±13.98 vs. (79.57%), chronic heart failure - 196 (42.15%), obesity - 161 (34.62%), diabetes mellitus - 144 (30.97%), chronic renal failure (CRF) -58 (12.47%) and oncological diseases - 25 (5.38%). Hypertension (p=0.02), diabetes mellitus (p=0.041) and obesity (p=0.01) were significant risk factors for DVT. D-dimer was a statistically significant predictor of DVT formation (p&amp;lt;0.001), an increase in D-dimer per unit increased the risk of DVT by 14%.&lt;br /&gt; &lt;b&gt;Conclusion:&lt;/b&gt;&amp;nbsp;The study identified risk factors for deep vein thrombosis in intensive care patients with COVID-19. These include: age, high levels of D-dimer, and comorbidities such as hypertension, obesity, and diabetes mellitus.

Association of dementia comorbidities with caregivers’ physical, psychological, social, and financial burden

BackgroundInformal caregivers of older adults with dementia may experience substantial burdens during their caregiving process, especially when caring for older adults with other comorbid conditions. This study evaluated whether and how comorbidity burden for persons with dementia (PWD) was associated with caregivers’ physical, psychological, social, and financial burden as well as caregiving gain.MethodsData were from 1,065 community-dwelling older adults living with dementia and their primary caregivers in the National Health and Aging Trends Study and the National Study of Caregiving. PWD’s comorbidity burden was measured by the count of chronic conditions and the pattern of comorbidity identified by the latent class analysis (LCA). We considered four domains of caregiving burden—physical, psychological, social, and financial burden. We used linear regressions to identify the unadjusted and adjusted associations between PWD’s comorbidity burden and caregiving burden and gain.ResultsOf 1,065 PWD, 13.5% had 0–1 and 24.9% had 5 or more number of comorbid chronic conditions, respectively. After multivariable adjustment, an additional chronic condition is associated with an 0.11- and 0.36-point increase in caregivers’ physical and psychological burden, respectively. Caregivers of PWD with 5 or more chronic conditions had a 0.64- and 2.22-point higher score of physical and psychological burden, respectively, than those caring for PWD with 0 or 1 comorbid condition. LCA divided PWD into two classes, a high comorbidity class (69.0%) and a low comorbidity class (31.0%). Caregivers of PWD in the high comorbidity burden class had a 0.46-point higher score of physical caregiving burden than those in the low comorbidity burden class. No significant association was found between care recipients’ comorbidity burden and their caregivers’ social and financial burden or caregiving gain.ConclusionsThe comorbidity burden of PWD was associated with their caregivers’ physical and psychological caregiving burden. Relevant interventions to manage the comorbid conditions of people living with dementia and support their caregivers are crucial to improving their physical health and psychological wellbeing.

Effect of remdesivir on mortality and the need for mechanical ventilation among hospitalized patients with COVID-19: real-world data from a resource-limited country

ObjectivesGeorgia introduced remdesivir for the treatment of COVID-19 in December 2020. We evaluated the real-world effect of remdesivir on mortality and the need for mechanical ventilation among inpatients with COVID-19. MethodsThe study included 346 remdesivir recipients and 346 controls not receiving remdesivir selected through propensity score matching based on age, gender, presence of any chronic comorbid condition, and oxygen saturation at admission. Factors associated with in-hospital mortality and the need for mechanical ventilation were assessed in a multivariable logistic regression model. ResultsThe groups were comparable by age, gender, comorbidities, and baseline oxygen saturation. Among 346 remdesivir recipients, 265 (76.6%) received a generic formulation of the drug. Eight (2.3%) patients died in the remdesivir group and 18 (5.2%) in the control group (P = 0.046). In the multivariable analysis, remdesivir was associated with non-statistically significant reduced odds of death (odds ratio: 0.39, 95% confidence interval: 0.14-1.04, P = 0.06). Significantly fewer patients in the remdesivir group required mechanical ventilation compared to controls: 2.9% vs 6.4% (P = 0.03). Statistically significant difference was maintained in multivariable analysis (odds ratio: 0.40, 95% confidence interval: 1.04-5.60, P = 0.04). ConclusionBorderline reduction in the odds of death and statistically significant decrease in the need for mechanical ventilation support use of remdesivir in hospitalized patients with COVID-19.

Liposaccharide-induced sustained mild inflammation fragments social behavior and alters basolateral amygdala activity.

Conditions with sustained low-grade inflammation have high comorbidity with depression and anxiety and are associated with social withdrawal. The basolateral amygdala (BLA) is critical for affective and social behaviors and is sensitive to inflammatory challenges. Large systemic doses of lipopolysaccharide (LPS) initiate peripheral inflammation, increase BLA neuronal activity, and disrupt social and affective measures in rodents. However, LPS doses commonly used in behavioral studies are high enough to evoke sickness syndrome, which can confound interpretation of amygdala-associated behaviors. The objectives of this study were to find a LPS dose that triggers mild peripheral inflammation but not observable sickness syndrome in adult male rats, to test the effects of sustained mild inflammation on BLA and social behaviors. To accomplish this, we administered single doses of LPS (0-100μg/kg, intraperitoneally) and measured open field behavior, or repeated LPS (5μg/kg, 3 consecutive days), and measured BLA neuronal firing, social interaction, and elevated plus maze behavior. Repeated low-dose LPS decreased BLA neuron firing rate but increased the total number of active BLA neurons. Repeated low-dose LPS also caused early disengagement during social bouts and less anogenital investigation and an overall pattern of heightened social caution associated with reduced gain of social familiarity over the course of a social session. These results provide evidence for parallel shifts in social interaction and amygdala activity caused by prolonged mild inflammation. This effect of inflammation may contribute to social symptoms associated with comorbid depression and chronic inflammatory conditions.

Polypharmacy among medicaid-insured children with and without documented obesity.

Polypharmacy increases the risk of drug-drug interactions and adverse drug events. As obesity and rates of obesity-associated comorbid chronic conditions continue to rise, an improved understanding of whether children with obesity experience higher risk of polypharmacy is needed. This study aimed to compare chronic medication polypharmacy prevalence among children with and without a diagnosis of obesity. We performed a cross-sectional examination of prescription data for children aged 2-18 years prescribed ≥1 chronic medication using the 2019 Marketscan Medicaid database. Children with documented obesity were identified using medical visit diagnosis codes. Chronic medications included any ≥30-day prescription with ≥2 dispensed refills. Polypharmacy was defined as the prescription of ≥2 chronic medications for ≥1 overlapping days. Chi-squared tests compared polypharmacy prevalence and the distribution of chronic medication classes between children with and without obesity. Logistic regression determined the adjusted odds ratio (aOR) of polypharmacy for children with obesity, adjusting for relevant demographic and clinical differences. Of 634,671 included children, 12.2% had documented obesity. More than one-half (52.7%) of children with obesity experienced polypharmacy compared with 47.6% of children without obesity (aOR 1.06 [95% confidence interval 1.04-1.08]). Chronic medication prescriptions, particularly for psychiatric and asthma medications, were more commonly prescribed among children with obesity than those without obesity. Children with documented obesity have higher polypharmacy prevalence than children without obesity. Clinicians must be aware of this risk and minimize inappropriate polypharmacy whenever possible. Future work should examine the consequences of polypharmacy, including drug-drug interactions and adverse drug events in children with obesity.