Comorbid Conditions Research Articles

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.

Momentary Associations Between Positive Coping and Nonsuicidal Self-Injury Risk Among Individuals With Problematic Alcohol Use.

Background: The use of positive coping skills has demonstrated protective effects with regard to Nonsuicidal Self-Injury (NSSI) engagement; however, cross-sectional evidence suggests that the presence of comorbid conditions, such as alcohol use disorders, may negate these benefits. Aims: The current study leverages ecological momentary assessment (EMA) to examine the between-person and within-person relationships between positive coping strategies and NSSI risk among individuals with problematic alcohol use. Method: Undergraduate students (n = 56) completed a 21-day EMA protocol, in which they completed four surveys per day asking about their use of several positive coping strategies and NSSI risk. Results: Socializing was the only coping strategy to demonstrate a protective effect on NSSI risk. Alternatively, the coping strategies of finding perspective, positive thinking, and sitting with feelings until they pass all increased risk for NSSI. Limitations: The current study was underpowered to disentangle relationships with urges to engage in NSSI and NSSI behaviors. Conclusion: The results suggest that using coping skills that may present physical barriers to engaging in NSSI may be effective for reducing momentary NSSI risk.

WP5.13 - National Emergency Laparotomy (NELA) critical care admissions: A cohort study

Abstract Aims NELA is committed to enhancing quality of peri-operative care of patients undergoing emergency laparotomy. NELA emphasizes importance of identifying high risk patients, who are associated with significant morbidity & mortality. Critical care allows close monitoring, organ (basic/advanced) support. Aim of study is to review the NELA critical care patients. Methods Cohort study of NELA patients that received post-operative ITU care (direct/indirect admission) at single centre. Descriptive demography, and outcomes were evaluated. NELA parsimonious risk & CCMDS ITU scores used. NELA patient that did not require ITU care were controls. Results NELA critical care (n = 400) NELA non critical care (n = 466) Mann Whitney U (p value) Deaths (n) - (n) Age(yrs) 71.8 64.0 < 0.0001 Sex(M:F) 173 : 227 220 : 246 NS ASA 3 2 < 0.0001 BMI(kg/m2) 26.3 25.0 NS Lap(n) 67 168 Open(n) 333 293 Op time(mins) 131.0 109.4 < 0.0001 LOS(days) 18 9.5 < 0.0001 Deaths 30 day 50 25 60 day 66 37 90 day 73 40 Lactate(mmol/L) 2.4 1.8 <0.01 WCC(x109/L) 13.0 11.8 <0.05 CRP(mg/L) 90.1 56.6 <0.0001 Physiological-score 25.6 19.8 <0.0001 Operative-severity-score 17.9 15.9 <0.0001 Prepossum-score 21.6 7.5 <0.0001 PPmortality-score 11.9 4.9 <0.0001 PPmorbidity-score 77.3 55.7 <0.0001 Survival Rate (%) 1styear 75.4 86.2 5thyear 53.8 70.8 Logrank 10thyear 41.1 58.7 p<0.0001 Conclusion NELA critical care patients had poorer survival rates in our study. Theatre return or indirect critical care transfers can adversely affect survival. These patients were older, frail, multiple co-morbid status. NELA parsimonious mortality risk score >5% should encourage consultant level supervision, mortality risk score >10% should encourage direct critical care involvement.

The psychosocial and educational burden of obsessive-compulsive disorder in youth

BackgroundPediatric OCD is associated with functional impairment in multiple environments. However, relatively little is known about the impact of comorbid conditions, as well as OCD severity on psychosocial functioning in this population. Furthermore, most studies did not include a control sample, nor examined differences between children and adolescents. The goal of this investigation was to assess psychosocial functioning and its associations with age, symptom severity, and comorbid conditions in a large well characterized sample of pediatric OCD probands, and controls. MethodsParticipants included 117 pediatric OCD probands and 147 controls, that underwent a careful diagnostic process, and completed several questionnaires and interviews. ResultsResults revealed significant psychosocial impairments across multiple domains/settings, some of which were affected by symptom severity as well as by conduct related comorbidities and to a lesser extent affective disorders. In addition, different aspects of psychosocial impairments were found between children and adolescents. ConclusionThis study provides high resolution information regarding the types and extent of psychosocial dysfunction in youth with OCD, as well as its relationship with clinical and diagnostic correlates. It is recommended that evaluation and management of OCD in youth in research and clinical settings regularly include qualitative and semi-quantitative assessment of function across these domains.

Systematic Review on Mortality in the Elderly on Methadone Maintenance Treatment.

Opioid dependence is a serious public health concern, particularly for older individuals who have a high prevalence of comorbid conditions. To effectively manage opioid use disorder (OUD), methadone maintenance treatment (MMT) is crucial; however, the MMT poses certain challenges for the aging population. The purpose of this review is to evaluate the impact of MMT on health outcomes, identify predictive factors for mortality, and assess mortality rates among older individuals receiving MMT. A systematic search was performed across databases, including PubMed, Scopus, Web of Science, and Google Scholar, adhering to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Studies included were published between January 2000 and December 2023, focused on elderly patients (60 years of age and older) receiving MMTand provided information on death rates. A total of 15 studies were examined. The main causes of death for older MMT patients were overdose, respiratory issues, and cardiovascular diseases. The annual mortality rates for these patients ranged from 2% to 10%. Treatment outcomes and mortality were significantly impacted by comorbid conditions. Greater treatment adherence and longer care periods were observed in older individuals, which correlated with better health outcomes and lower mortality. This review makes clear how elderly MMT patients with addiction and chronic health issues require integrated care models. Treatment effectiveness may be further increased by gender-specific interventions. For this aging population, policy reforms and enhanced healthcare support are essential. To enhance clinical results and lower mortality rates among older individuals enrolled in MMT programs, comprehensive age-appropriate care models are crucial. Long-term health outcomes should be investigated further and evidence-based treatments for older individuals with OUD should be developed.

Comparative analysis of treatment results of craniotomy and external closed drain in patients with chronic subdural hematomas

Aim. To conduct a comparative analysis of the treatment results of the patients with chronic subdural hematoma using two methods: closed external drainage and craniotomy.Materials and methods. The data of 55 patients with chronic subdural hematoma operated in the I.I. Dzhanelidze St. Petersburg Research Institute of Emergency Medicine from 2019 to mid-2023 was analyses retrospectively. Depending on the treatment method, patients were divided into 2 groups: external subdural drains (n = 30, 55.5 %) and evacuation of hematoma via craniotomy (n = 25, 45.5 %). The patients in the groups were comparable in clinical features, radiological characteristics and the Charlson comorbidity index. In the postoperative period, the following were assessed: hematoma thickness and displacement of median structures, occurrence of surgical complications, and mortality.Results. There were no differences between the groupsin the midline shift, the frequency of postoperative complications, reoperation and deaths. The thickness of the hematomas according to the control computed tomography scans of the brain was lower in the craniotomy group, but this did not determine the outcome of treatment. Patients with a Charlson Comorbidity Index value of 4 points or higher were significantly more likely to have an unfavorable outcome. The sensitivity and specificity of the index in predicting an unfavorable outcome was 71.4 and 69.7 %, respectively.Conclusion. There were no differencesin the effectiveness of craniotomy and externalsubdural drains of chronic subdural hematoma. In this regard, it is necessary to give preference to minimally invasive methods of treatment. Assessment of the comorbid status allows predicting an unfavorable outcome of treatment.

Integrated telehealth intervention to reduce chronic pain and unhealthy drinking among people living with HIV: protocol for a randomized controlled trial

BackgroundUnhealthy alcohol use represents a significant risk for morbidity and mortality among people living with HIV (PLWH), in part through its impact on HIV management. Chronic pain, a common comorbidity, exacerbates suboptimal engagement in the HIV care continuum and has reciprocal detrimental effects on alcohol outcomes. There are no integrated, accessible approaches that address these comorbid conditions among PLWH to date. This paper describes a research study protocol of an integrated telehealth intervention to reduce unhealthy drinking and chronic pain among PLWH (Motivational and Cognitive-Behavioral Management for Alcohol and Pain [INTV]).MethodsTwo-hundred and fifty PLWH with unhealthy drinking and chronic pain will be recruited nationally via online advertisement. Informed consent and baseline assessments occur remotely, followed by 15 days of ecological momentary assessment to assess alcohol use, chronic pain, functioning, and mechanisms of behavior change. Next, participants will be randomized to either the INTV or Control (CTL) condition. Individuals in both conditions will meet with a health counselor through videoconferencing following randomization, and those in the INTV condition will receive 6 additional sessions. At 3- and 6-months post-baseline, participants will complete outcome assessments. It is hypothesized that the INTV condition will result in reduced unhealthy alcohol use and pain ratings compared to the CTL condition.ConclusionThis protocol paper describes a randomized controlled trial which tests the efficacy of a novel, integrated telehealth approach to reduce unhealthy alcohol use and chronic pain for PLWH, two common comorbid conditions that influence the HIV treatment cascade.ClinicalTrials.gov identifierNCT05503173.

Prevalence and associated factors of non-adherence to antihyperlipidemic medication: a nationwide cross sectional survey in Pakistan

Hyperlipidemia significantly contributes to the risk of developing cardiovascular diseases. However, about half of the patients do not adhere to their antihyperlipidemic medications, leading to healthcare costs and premature mortality. This study's objective was to determine the prevalence and associated factors of non-adherence to antihyperlipidemic medications. The study covered hypertensive patients (21,451) aged 21–75 years, presenting to the primary and secondary healthcare facilities across Pakistan (covering 21 divisions) from January 2022 to April 2023. The outcome intended was non-adherence to antihyperlipidemic medication, which was assessed by SEAMS and pill-counting methods (non-adherence < 80%). The study found overall non-adherence to antihyperlipidemic medication of 60.6% across Pakistan, with the highest non-adherence rates found in Azad Jammu and Kashmir (71.9%) and the lowest in Islamabad (47.7%). Multivariable logistic regression analysis revealed that female, no health card (Sehat Sahulat Program government insurance), < 5 years of illness, < 5 daily medications, and dose frequency of twice daily revealed a positively significant association with non-adherence. While monthly income 51,000–100,000, graduation level of education, Muhajir, and hyperlipidemia with one comorbid condition had a significant negative association with the non-adherence. Antihyperlipidemic non-adherence is a multifaceted, multifactorial, profound problem requiring a multipronged approach.

Evaluation of platelet indices in chronic kidney disease

Objective: Chronic kidney disease (CKD) is characterized by an irreversible decrease in kidney functions and accumulation of uremic toxins in the body. Platelet indices have the potential to predict the inflammatory status and disease progression in patients with CKD. In this study it was aimed to investigate platelet indices and their relations with renal function and comorbid conditions in CKD patients. Method: In this study it was included 411 CKD patients. We looked for associations between platelet indices and estimated glomerular filtration rate (eGFR). We generated linear regression models for platelet indices that may be associated with eGFR. We evaluated CKD patients for possible associations between platelet indices and comorbid conditions such as diabetes, hypertension, and cardiovascular diseases. Results: The mean age of CKD patients was 60.5 and the GFR value was 40.1+24.8 mL/min/1.73m2. While the mean platelet count, MPV, PCT, PDW, P-LCR values were lower in the advanced CKD group, hematocrit adjusted platelet count (HAPC), MPV/Lymphocyte ratio and SII parameters were higher in the advanced CKD group (p

Evaluation of Sociomedical Factors on Corneal Donor Recovery Using Machine Learning

ABSTRACT Purpose To evaluate co-morbid sociomedical conditions affecting corneal donor endothelial cell density and transplant suitability. Method(s) Corneal donor transplant information was collected from the CorneaGen eye bank between June 1, 2012 and June 30, 2016. A natural language processing algorithm was applied to generate co-morbid sociomedical conditions for each donor. Variables of importance were identified using four machine learning models (random forest, Glmnet, Earth, nnet), for the outcomes of transplant suitability and endothelial cell density. SHAP (SHapley Additive exPlanations) values were generated, with beeswarm and box plots to visualize the contribution of each feature to the models. Results With a total of 23,522 unique donors, natural language processing generated 30,573 indices, which were reduced to 41 most common co-morbid sociomedical conditions. For transplant suitability, hypertension ranked the top overall variable of importance in two models. Hypertension, chronic obstructive pulmonary disease, history of smoking, and alcohol use appeared consistently in the top variables of importance. By SHAP feature importance, hypertension (0.042), alcohol use (0.017), ventilation of donor (0.011), and history of smoking (0.010) contributed the most to the transplant suitability model. For endothelial cell density, hypertension was the sociomedical condition of highest importance in three models. SHAP scores were highest among the sociomedical conditions of hypertension (0.037), alcohol use (0.013), myocardial infarction (0.012), and history of smoking (0.011). Conclusion In a large cohort of corneal donor eyes, hypertension was identified as the most common contributor to machine learning models examining sociomedical conditions for corneal donor transplant suitability and endothelial cell density.

Visual field loss and falls requiring hospitalisation: results from the eFOVID study.

Visual fields are important for postural stability and ability to manoeuvre around objects. Examine the association between visual field loss and falls requiring hospitalisation in adults aged 50 +. Older adults aged 50+ with and without visual field loss were identified using a fields database obtained from a cross-section of ophthalmologists' practices in Western Australia (WA). Data were linked to the Hospital Morbidity Data Collection and WA Hospital Mortality System to identify participants who experienced falls-related hospitalisations between 1990 and 2019. A generalised linear negative binomial regression model examined the association between falls requiring hospitalisation for those with and without field loss, based on the better eye mean deviation (mild: -2 to -6dB, moderate: -6.01dB to -12dB, severe < -12.01dB) in the most contemporaneous visual field test (3years prior or if not available, 2years after the fall), after adjusting for potential confounders. A total of 31 021 unique individuals of whom 6054 (19.5%) experienced 11 818 falls requiring hospitalisation during a median observation time of 14.1years. Only mean deviation index of <-12.01dB (severe) was significantly associated with an increased rate of falls requiring hospitalisations by 14% (adjusted IRR 1.14, 95% CI 1.0-1.25) compared with no field loss, after adjusting for potential confounders. Other factors included age, with those aged 80+ having an increased rate (IRR 29.16, 95% CI 21.39-39.84), other comorbid conditions (IRR 1.49, 95% CI 1.38-1.60) and diabetes (IRR 1.25, 95% CI 1.14-1.37). Previous cataract surgery was associated with a decreased rate of falls that required hospitalisations by 13% (IRR 0.87, 95% CI 0.81-0.95) compared with those who did not have cataract surgery. The findings highlight the importance of continuous clinical monitoring of visual field loss and injury prevention strategies for older adults with visual field loss.

Exploring the Renoprotective Potential of Bioactive Nutraceuticals in Chronic Kidney Disease Progression: A Narrative Review.

Chronic kidney disease (CKD) is a condition that is characterized by progressive loss of kidney function over time. A substantial increase in the burden of CKD is evident globally, attributed to multifactorial conditions like an expanding aging population, rising diabetes and hypertension rates, and more significant exposures to risk factors associated with the environment and lifestyle. Nutraceuticals are substances that are usually considered a food or an active part of a food that provides medical or health benefits, including the prevention and treatment of a disease. The aim is to review the positive role of nutraceuticals in managing CKD. A narrative review is generated, extracting the papers from databases like Web of Science, Scopus, ScienceDirect, ResearchGate, and PubMed. Animal and human trials focusing on the effect of different nutraceuticals on the initial stage of kidney disease, i.e., stages 1, 2, and 3 of CKD, were included. The review's outcome is understanding the effectiveness of nutraceuticals that have shown positive results in CKD conditions. Active compounds include ubiquinone, curcumin, nitrates, nitrites, lycopene, and resveratrol. These bioactive components are also beneficial for other comorbid conditions like diabetes, hypertension, and cardiovascular conditions that have an eminent adverse effect on CKD. Lycopene, coenzyme Q10 (CoQ10), resveratrol, curcumin, and flavonoids have positively impacted CKD complications. Nutraceuticals hold great promise for individuals with CKD in the coming years, offering diverse potential benefits. These include delivering vital antioxidant and anti-inflammatory support to alleviate oxidative stress and inflammation, helping to regulate blood pressure and lipid levels for improved cardiovascular health, promoting optimal renal function to sustain kidney health, assisting in maintaining electrolyte balance, warding off complications, influencing gut microbiota for enhanced digestive well-being, and ultimately elevating the overall quality of life, for those managing CKD.

A Comparative Study in the Treatment of Fracture Neck of Femur with Cemented and Non Cemented Bipolar Prosthetic Replacement in Rural Hospitals of Bangladesh

Background: The treatment of fracture neck of femur with bipolar prosthetic replacement is commonly performed using cemented and non-cemented implants. This study compares the clinical outcomes, complications, and patient satisfaction between these two methods in rural hospitals of Bangladesh. Methods: This comparative study was conducted in rural hospitals of the Kishorganj district, Bangladesh, from January 2023 to December 2023, to evaluate the outcomes of cemented versus non-cemented bipolar prosthetic replacement in patients with femoral neck fractures. Results: The age range of participants was 48 to 68 years. Regarding gender distribution, 44.4% of patients in the Cemented group were male, compared to 37.0% in the Non-Cemented group. The cemented group had a mean hospital stay of 8.3 ± 2.1 days, while the non-cemented group had a slightly longer stay of 9.0 ± 2.3 days. Postoperative infection rates were higher in the cemented group (11.1%) compared to the non-cemented group (3.7%), with diabetic patients showing a higher infection risk in both groups. Patient satisfaction was 78% in the cemented group and 74% in the non-cemented group, with no significant difference between the two groups (p &gt; 0.05). Conclusion: Cemented bipolar prosthetic replacement offers the advantage of shorter hospital stays and slightly higher patient satisfaction, but at the cost of a higher infection rate, particularly among diabetic patients. Non-cemented prostheses provide comparable long-term outcomes with a lower infection risk, making them a viable option for patients with comorbid conditions

P218 MAY MEASUREMENT MONTH 2019: BLOOD PRESSURE VARIABILITY AND ITS RELATIONSHIP WITH HYPERTENSION AND COMORBIDITIES

Background and Objective: Within-visit blood pressure variability (BPV) is a predictor of cardiovascular events, independent of mean blood pressure (BP) levels. This study explored the associations of BPV with hypertension status and comorbidities in May Measurement Month (MMM) 2019 global survey participants. Methods: Adults (≥18 years) were surveyed via convenience sampling from 92 countries in May 2019. Each participant had up to three standardized seated BP readings. Participants with incomplete data on age or sex, or any missing BP readings were excluded. Hypertension was defined as having a BP ≥140 and/or 90 mmHg or being treated with BP-lowering medication. Participants were stratified into three groups: normotensive, untreated hypertensives, treated hypertensives, and normotensives. BPV was calculated as the variation independent of the mean (VIM) of the three BP readings. Associations between BPV and each of three conditions (previous stroke, previous myocardial infarction, or diabetes) were modelled using linear regression. Each model was adjusted for mean BP, age, sex, and an interaction term between age and sex. Results: Data from 1,128,889 participants were included. The mean age was 45.2 (SD 16.6) years and 51.4% were female. A third (33.6%) of participants were hypertensive, of whom 200,370 (53.2%) were treated. Of non-hypertensive and untreated hypertensive participants, those with a history of stroke, myocardial infarction, or diabetes had lower BPV relative to those without a history of these conditions (Figure). A stronger association was observed for diabetes within untreated hypertensive than non-hypertensive participants. However, amongst treated hypertensive participants, differences in BPV between those with comorbid conditions and those without were smaller than in the other two groups. Conclusions: Contrary to expectation, BPV was significantly lower in those with diabetes, or a history of stroke or myocardial infarction, amongst both untreated hypertensives and normotensives. However, among treated hypertensives, BPV was similar between those with or without each comorbidity, suggesting a modifying effect of BP-lowering medication.

Preliminary validation of the virtual bariatric endoscopic simulator

Background and AimsObesity is a global health concern. Bariatric surgery offers reliably effective and durable weight loss and improvements of other comorbid conditions. However, the accessibility of bariatric surgery remains limited. Minimally invasive techniques, including endoscopic sleeve gastroplasty (ESG), have emerged to bridge this gap. To effectively complete the ESG procedure, one requires skill in multiple complex interventional endoscopic maneuvers. This requisite expertise poses challenges for training in this burgeoning field. MethodsWe designed the Virtual Bariatric Endoscopic (ViBE) simulator software to mimic the ESG procedure accurately. It features a detailed simulation of an endoscope equipped with an endoscopic suturing system and a high-resolution stomach, enhancing the visualization of the procedural details. Furthermore, it incorporates performance metrics utilizing a reverse scoring system to evaluate users’ proficiency in tasks such as argon plasma coagulation (APC) marking, suturing, and cinching. To validate the simulator, we conducted a study involving experts and novices at the Indiana University School of Medicine, where participants engaged with the simulation environment in a series of training tasks. ResultsTwelve participants, comprising five experts and seven novices, participated in the study. They were asked to complete a post-questionnaire featuring seven items, rating each on a Likert scale. The APC task realism received the highest score, averaging 3.83. The usefulness of improving endoscopic technical skills averaged 3.08, with the realism of cinching the knot and suturing tasks receiving scores of 3.17 and 3.25, respectively, suggesting a generally positive reception. Automated performance metrics indicated that, on average, experts outperformed novices by 10.83 points. ConclusionThe ViBE simulation strives to replicate the steps of the ESG within a virtual environment. Our primary objective in developing this simulator is to enhance the learning curve for endoscopic suturing and ESG techniques, thereby safely extending these skills to a broader patient base.

Population-Based Estimates of the Prevalence of Children With Congenital Heart Disease and Associated Comorbidities in the United States.

Congenital heart defects (CHD) are the most common birth defects and previous estimates report the disease affects 1% of births annually in the United States. To date, CHD prevalence estimates are inconsistent due to varied definitions, data reliant on birth registries, and are geographically limited. These data sources may not be representative of the total prevalence of the CHD population. It is therefore important to derive high-quality, population-based estimates of the prevalence of CHD to help care for this vulnerable population. We performed a descriptive, retrospective 8-year analysis using all-payer claims data from Colorado from 2012 to 2019. Children with CHD were identified by applying International Classification of Diseases-Ninth Revision (ICD-9) and International Classification of Diseases-Tenth Revision (ICD-10) diagnosis codes from the American Heart Association-American College of Cardiology harmonized cardiac codes. We included children with CHD <18 years of age who resided in Colorado, had a documented zip code, and had at least 1 health care claim. CHD type was categorized as simple, moderate, and severe disease. Association with comorbid conditions and genetic diagnoses were analyzed using χ2 test. We used direct standardization to calculate adjusted prevalence rates, controlling for age, sex, primary insurance provider, and urban-rural residence. We identified 1 566 328 children receiving care in Colorado from 2012 to 2019. Of those, 30 512 children had at least 1 CHD diagnosis, comprising 1.95% (95% CI, 1.93-1.97) of the pediatric population. Over half of the children with CHD also had at least 1 complex chronic condition. After direct standardization, the adjusted prevalence rates show a small increase in simple severity diagnoses across the study period (adjusted rate of 11.5 [2012]-14.4 [2019]; P<0.001). The current study is the first population-level analysis of pediatric CHD in the United States. Using administrative claims data, our study found a higher CHD prevalence and comorbidity burden compared with previous estimates.

Association between race, post operative outcomes and costs for inpatient and outpatient total joint arthroplasty

Background: While factors like readmissions and costs have been compared between care settings for total joint arthroplasty, little research has analyzed readmission and cost differentials stratified by patient characteristics within each care setting. This study will unveil such differences with regard to race and co-morbidity status. Methods: Retrospective binary-logistic-regression and OLS regression were employed on de-identified inpatient and outpatient orthopedic surgical data gathered from an academic medical center from 2016-2020. Data elements included surgical setting, covariates (age, gender, race, obesity, smoking status), Elixhauser comorbidity indices, surgical times, and cost. Results: African American (AA) inpatients had significantly greater odds of return to hospital (7 day, 30 day, 90 day) when compared to Caucasian inpatients (P&lt;0.01-0.05). AA inpatients less than 65 yr old had significantly increased odds of returning to the hospital and getting readmitted (7 day, 30 day) when compared to AA inpatients older than 65 and all Caucasian inpatients (P&lt;0.05). Asian inpatients had significantly greater odds of 90 day return (P&lt;0.05). AA outpatients had significantly greater odds of 30 day return when compared to Caucasian outpatients. Age and time spent in the OR directly correlated with increased costs (P&lt;0.05, P&lt;0.01). Increased comorbidities correlated with increased costs only for inpatients (P&lt;0.05). Conclusion: All AA patients, but specifically those less than 65 yr of age, experience increased readmissions and returns to hospital following the same procedure when compared to their Caucasian counterparts. Medicaid patients experience greater costs, Medicare-Managed patients experienced decreased costs. Co-morbidites were directly related to costs in the inpatient setting.

The Impact of Bariatric Surgery on Weight Reduction and the Resolution of Comorbidities in Older Geriatric Populations of Saudi Arabia: A Retrospective Study.

Background Obesity is a significant health concern among older adults, leading to various comorbidities and reduced quality of life. Bariatric surgery (BS) has emerged as a potential intervention, but its efficacy in geriatric populations, particularly in Saudi Arabia, is not well-established. Aims This retrospective study aims to evaluate the impact of BS on weight reduction and comorbidity resolution in Saudi Arabian geriatric populations. Methods A retrospective cohort study was conducted at King Khalid Hospital, Saudi Arabia, involving geriatric patients aged 60 and above who underwent BS between January 2018 and December 2022. Data were collected from medical records and analyzed using descriptive statistics, chi-square tests, t-tests, and multivariate regression analysis. Results The study included a total of 26 patients with a mean age of 64 years. Of these, 18 (69.3%) were females, while eight (30.7%) were males, and 23 (87%) underwent sleeve gastrectomy (SG), while three (13%) hadRoux-en-Y gastric bypass (RYGB). Preoperative comorbidities majorly included diabetes (17, 35.42%), hypertension (11, 22.92%), and anemia (four, 8.33%). The average body mass index (BMI) of the patients decreased significantly from 45.12 to 37.29 at three months and further to 31.36 at six months post surgery. Total weight loss (TWL) was 19.92% at three months and 35.15% at six months, while the percentage of excess weight loss (%EWL) was 33.42% at three months and 57.85% at six months. Results also showed a significant reduction in the number of comorbidities postoperatively. A significant association with gender, preoperative weight, and preoperative height at three and six months and a significant association with preoperative BMI and comorbidity status at six months were recorded. Conclusion The study suggests that bariatric surgery is effective in achieving significant weight loss and improving comorbidities in geriatric patients. Few demographic and clinical features affect the outcome of the weight loss.

Multisystem Inflammatory Syndrome of the Adults (MIS-A) - The undercover threat for young adults. A systematic review and meta-analysis of medical cases.

COVID-19 related syndromes are not yet well described and understood. Multisystem inflammatory syndrome of the adults (MIS-A) is a recently characterized syndrome affecting multiple organs of young adults, causing serious complications, even shock and death. To determine the clinical characteristics, course, and complications of MIS-A in a systematic way and summarize currently used treatments. Literature search in March 2023 in PubMed and Scopus databases. Case reports and case-series that fulfilled the CDC criteria for MIS-A were eligible for inclusion. A total of 71 patients from 60 reports were included. 66% of the patients were male and the mean age of the synthetic cohort was 32.9 years old. The majority (70.4%) of the enrolled cases had no significant medical history. MIS-A was diagnosed after a median of 4 weeks period. All but two patients presented with cardiac symptoms, while the most common secondary diagnostic criterion was abdominal pain, vomiting or diarrhea followed by shock or hypotension. Heart failure therapy and immunomodulation were used as therapeutic options. Although more than half of the cohort was admitted to the Intensive Care Unit (ICU) (n=39) only 4 deaths were reported. MIS-A can affect patients independently of age, sex, and co-morbidity status, resulting in serious complications, often including severe cardiac disease, shock, acute kidney injury and sometimes death. It can occur immediately after SARS-CoV-2 acute infection until two months later, usually manifesting four weeks after acute disease.

P035 SOCIAL DETERMINANTS OF HEALTH AND CONTROL OF HYPERTENSION

Background and Objectives: Recent national blood pressure (BP) survey data of adults in Canada and United States show a troubling decline in the control of hypertension, particularly in women, the elderly and those with low income, less education and under-using health services. Social determinants of health (SDH) can be important barriers to controlling hypertension. Studies assessing associations of BP control and SDH have focused on one or a few domains. Objectives of this study are to screen treated hypertensive patients for a wide range of SDH, test for correlations and assess the effects of high-quality treatment on SDH and BP control relationship. Method: We created and applied a screening tool to gather personal information on 14 SDH from consecutive consenting eligible patients attending a complex hypertension care clinic. Logistic regression was used to assess association of each SDH domain with BP control. Results: Of 90 patients enrolled, 88 completed the 6-month study. At baseline, mean age (standard deviation) was 64 (14) years, 64% male, 69% white, 25% experiencing financial hardship, mean BMI 30.4 kg/m2 (5.9), mean automated office BP 138/78 (23/14), mean number of co-morbid conditions 4.2 (2.0) and 55% had treatment-resistant hypertension. From baseline to exit, BP fell to 127/73 (17/12), p&lt;0.001, mean number of antihypertensive drug classes increased from 3.06 (1.43) to 3.23 (1.30), p=0.049 but BMI remained unchanged. There were no associations between uncontrolled hypertension and any of the 14 SDOH domains at baseline. However, at exit financial status was associated with uncontrolled hypertension on univariate analysis (p=0.022) and on multivariate analysis. Stress (p=0.063) and optimism status (p=0.085] showed a similar trend. These analyzes indicated better BP control among those with poorer financial status, higher stress levels or more pessimistic outlook. Conclusion: None of the SDOH were associated with uncontrolled hypertension at baseline. However good medical care and follow-up appeared to have improved BP control, noticeably in those experiencing financial hardship. Explanation of findings requires further study.