Comorbid Conditions Research Articles

The Lived Experiences of Older Adults with Systemic Lupus Erythematosus: Patient Perspectives.

Little is known about perceptions of aging among individuals living with systemic lupus erythematosus (SLE). Gaining this knowledge could help to identify targets for future behavioral interventions aimed at successful aging with SLE. This qualitative study sought to elicit the lived experiences, and essence, of aging from older adults with SLE. We conducted semi-structured interviews with adults ≥65 years of age with SLE seen at a single tertiary center. Qualitative data were analyzed thematically using a phenomenological approach. We collected data on sociodemographic characteristics and disease features prior to each qualitative interview. Among 30 participants with mean age of 71.3 years and mean SLE duration of 26.3 years (range 5 to 62 years), four overarching themes emerged to describe the essence of aging with SLE: SLE and comorbid conditions, cumulative impact of SLE symptoms, SLE disease trajectory, and self-perceptions of aging. Older adults with SLE shared variable aging experiences, including perspectives on multimorbidity and disease trajectory and self-perceptions of aging. We identified both positive and negative self-perceptions of aging, often informed by participants' lived experiences of cumulative impact of SLE symptoms and SLE disease trajectory and underscoring the diversity of their experiences. Understanding self-perceptions of aging in this population could inform development of evidence-based strategies to empower older adults with SLE to harness their positivity and resilience and thus improve health-related outcomes, including health-related quality of life.

Tracking the relationship between accrual and comorbid conditions in clinical TRrial enrollment (TRACE)

Tracking the relationship between accrual and comorbid conditions in clinical TRrial enrollment (TRACE)

Is there a safe limit for consumption of alcohol?

In order to understand and curb the harms related to alcohol, it will be necessary to think beyond patterns of use that meet criteria for a diagnosis of alcohol use disorder, or addiction. Current research suggests that regular daily alcohol use does not confer a health benefit, and for many persons, even relatively low consumption is associated with a health risk. Determining a safe limit for alcohol consumption is challenging both for the individual person and for society. We conclude that excessive drinking is always risky. We provide a list of circumstances, such as chronic illness, driving a vehicle, or pregnancy where persons should be advised to abstain from alcohol. We recognize the need to encourage less consumption of alcohol, particularly in young adults, and in older adults with co-morbid conditions particularly when taking multiple medications. Finally, we offer the modest proposal that, for persons without the contributing negative influences described above, consumption which adheres to one drink per session, with interspersed abstinent days, does not constitute a meaningful risk to health.

Danning tablets for the treatment of multiple gallbladder polyps: Study protocol of multicentre, randomised, open-labelled, controlled trial

IntroductionGallbladder polyps (GPs) are protrusions of the gallbladder wall into the lumen, and are commonly detected during ultrasound examinations. Traditional management of multiple GPs (MGPs) has been conservative, including lifestyle interventions, regular monitoring, and surgical intervention in certain cases, but this approach poses risks of polyps enlargement and increase of number, as well as patients’ psychological burdens. Danning Tablets, a traditional Chinese medicine, have emerged as a potential non-surgical treatment for GPs, showing promise in reducing polyp size and alleviating symptoms, backed by their anti-inflammatory and antitumor properties demonstrated in preclinical studies. This suggests the need for further research into Danning Tablets as an alternative treatment for MGPs. Methods and analysisThe study is designed as a prospective, randomized, controlled, open-label trial. The study will be conducted across multiple centres specializing in gastroenterology and hepatology. Participants will be recruited from these centres, ensuring a diverse patient demographic. Adult patients diagnosed with MGPs, based on ultrasound findings, will be included. Exclusion criteria include patients with a history of gallbladder cancer, previous gallbladder surgery, or serious comorbid conditions. The control group will receive standard care, including dietary and lifestyle advice, while the intervention group will receive Danning Tablets and standard care. The dosage and administration of Danning Tablets will follow established clinical guidelines. The primary outcome will be the change in size of the largest gallbladder polyps on week 24 ​± ​1, measured by ultrasound. The secondary outcomes will include symptom improvement and recording of any adverse events. The study will span over a period of 6 months, with periodic assessments at baseline, 4, 8, 12, and 24 weeks.

Health care costs in the United States by demographic characteristics and comorbidity status

Current real-world health care cost information is needed to project future expenditures and inform policy. We estimated adults' 2019 health care costs in the United States (US) by age, sex, race/ethnicity, geographic region, and comorbidity. We aggregated and summarized health care costs in 2021 US dollars using claims data derived from Optum's de-identified Clinformatics® Data Mart database, which includes inpatient, outpatient, and prescription claims for commercial and Medicare Advantage beneficiaries nationwide. A total of 9,227,901 adults were included in the analysis. The largest group represented was 71-75 years old (13%), female (53%), White (68%), received care in the South (41%), and had commercial health insurance (56%). There was a positive relationship between health care cost and age. Females had a 1.3-fold multiplicative increase in costs compared to males (95% CI 1.33-1.34). There were 92.5% of individuals who had health claims in the Northeast, 89.6% in the Midwest, 88.9% in the South, 77.1% in the West, and 12.7% with unknown geographic region. Patients with severe renal failure, heart failure, or metastatic cancer incurred the highest mean yearly costs ($139,844, $113,031, and $85,299, respectively). Metastatic cancer and severe renal failure were associated with a 5.3-fold multiplicative increase in costs compared with not having these conditions, after adjusting for potential confounders (95% CI, 5.26-5.41 and 4.98-5.16, respectively). We identified patient characteristics and medical conditions that are associated with high health care cost burden and could benefit from tailored interventions. We provided detailed cost estimates to aid health care modeling, cost projection, and cost-minimizing interventions.

Antidepressive and cardioprotective effects of Kai-xin-san via the regulation of HPA axis dysfunction and lipid metabolism in a rat model of depressive-cardiac disease

Depressive-cardiac disease is a comorbid state in which both cardiovascular diseases and mental disorders are present. Patients with depression are more likely to develop cardiovascular disease, which increases the risk of cardiovascular events, such as acute coronary syndrome. Cardiovascular diseases also exacerbate the poor mood of patients with psychiatric disorders. Kai-xin-san (KXS), a classic antidepressant formula, has potential antidepressive and cardioprotective effects. In the present study, we first evaluated the antidepressive and cardioprotective effects of KXS in two post-myocardial ischemic depressed rat models: a) isoproterenol (ISO) via intraperitoneal injection combined with chronic unpredictable mild stress (CUMS)-induced myocardial ischemia and depression and b) left anterior descending coronary artery ligation (LAD) combined with chronic restraint stress (CRS)-induced myocardial ischemia and depression. We then induced exogenous corticosterone in a rat model of depressive-cardiac disease. Our study revealed that chronic administration of corticosterone could induce depression-like syndromes accompanied by cardiac insufficiency. The potential mechanism involves parallel onset of HPA axis dysfunction and an imbalance in lipid metabolism. KXS treatment successfully reversed corticosterone-induced depression-like behaviors and cardiac insufficiency. The present study highlights the pivotal role of the HPA axis and lipid metabolism in the development of comorbid depression and cardiovascular disease. Thus, KXS could be a promising therapeutic option for depressive-cardiac disease.

“Exploring The Nexus”: Chronic musculoskeletal pain in diabetic vs non-diabetic population

IntroductionDiabetes-mellitus (DM) has transcended the boundaries and affected populations across globe, it predisposes individual to stiffness and musculoskeletal-pain due to accumulation of glycation-end-products. Musculoskeletal-pain is a common yet frequently neglected complication. Pain mechanisms have been categorized as nociceptive, neuropathic, nociplastic, and idiopathic. Four criteria were put by Kosek-et-al to identify nociplastic pain that affects the musculoskeletal-system. Study aimed to evaluate prevalence of chronic musculoskeletal (cMSK) pain and its association with diabetes and glycaemic control and to evaluate comorbid conditions of cMSK pain. Methods and materialsA prospective case-control study was conducted at a level-1-tertiary-care-facility. Patients with type-2 DM above 30-years-age who visited outpatient department participated in the study (study group). Age-matched equal number of healthy individuals (control-cohort) were recruited in the study. We collected data from 300 participants in each group. Analysis was done based-on HbA1c-levels, random-blood-sugar (RBS),clinical-history, and comorbidities. Information regarding cMSK-pain was gathered using modified version of Nordic standard questionnaire. ResultsOverall prevalence of cMSK pain was 23.3 % (140 out of 600). Among Group-1/Diabetic group, it was 27.7 % and among group-2/Healthy Cohort it was 19 % and the odds ratio was 1.6. Most commonly reported region with cMSK among group-1 and group-2 was shoulder (32.5 %) and knee (36.8 %) respectively. We found a significant association between cMSK-pain and HbA1c levels (p < 0.005). and individuals with HbA1c levels of more than 12 reported involvements in multiple regions. We didn't find significant association between cMSK and DM, HTN, dyslipidemia, or hypothyroidism (P > 0.05). ConclusionStudy highlights higher-prevalence and significant impact of cMSK pain in diabetic patients compared to non-diabetic individuals. Addressing musculoskeletal-pain is crucial for improving overall quality-of-life in diabetic patients. Clinicians should adopt a proactive and comprehensive approach to pain management in diabetics. Using a simple Nordic questionnaire during routine check-ups helps with screening of joint and surrounding soft tissue pathology, preventing future complications that could lead to disability.

Effects of β-blockers on the Outcomes in Patients with Pulmonary Arterial Hypertension Stratified by the Presence of Comorbid Conditions: a Multicenter Prospective Cohort Study (BNP-PL)

The current guidelines do not recommend β-blockers in pulmonary arterial hypertension (PAH) unless indicated by comorbidities. However, the evidence regarding the role of β-blockers in PAH is contradictory. What are the effects of β-blockers on clinical outcomes in patients newly diagnosed with pulmonary arterial hypertension (PAH), and how do these outcomes differ based on the presence of cardiovascular comorbidities that are standard indications for β-blocker use? We analyzed data from 806 patients newly diagnosed with PAH enrolled prospectively in the Database of Pulmonary Hypertension in the Polish Population (BNP-PL). The endpoints were all-cause mortality and a composite of hospitalization due to right heart failure, syncope or death. Indications for β-blocker included hypertension, significant arrhythmia, and coronary artery disease(CAD). Propensity score matching (PSM) was used to form a control group based on age, PAH mortality risk variables and initially introduced PAH specific therapy. Out of the 806 patients, 469 (58.2%) received β-blockers at the time of PAH diagnosis. In PSM, β-blocker treatment showed a higher incidence of the composite endpoint (HR:1.44; 95% CI: 1.04-1.99; P = .03) and had neutral impact on mortality (HR, 1.22; 95% CI, 0.87-1.72; P = .25). When stratified by the presence of comorbidities, β-blockers showed adverse effects on composite endpoint in patients without comorbidities and a neutral effect in patients with at least one comorbidity INTERPRETATION: β-blockers pose significant risks in patients with PAH, especially in patients without coexisting systemic hypertension, CAD and arrhythmia.

051. Incarcerated Umbilical Hernia in A 45-Year-Old Male with Chronic Kidney Disease: A Case Report

Background: Umbilical hernias are common, but incarceration can lead to serious complications, particularly in patients with comorbidities. We present a case of an incarcerated umbilical hernia in a male patient with a history of chronic kidney disease (CKD) on hemodialysis, which required emergency surgical intervention. Case: A 45-year-old male presented with intermittent umbilical pain and a lump, which appeared during straining or coughing and spontaneously reduced upon rest. The patient also experienced nausea, absence of defecation for 3 days, and absent flatus for 1 day. There was no vomiting, but a history of chronic cough and CKD was noted. On physical examination, an umbilical lump measuring 4x3x2 cm was identified. Bloodwork revealed elevated creatinine levels (6.0 mg/dL), consistent with CKD. Imaging confirmed the diagnosis of an incarcerated paraumbilical hernia, and the patient underwent emergency herniorrhaphy. Post-operative recovery was uneventful. Conclusion: This case highlights the importance of timely intervention in patients with incarcerated umbilical hernias, especially in the presence of comorbid conditions such as CKD. Emergency herniorrhaphy remains the definitive treatment for preventing life-threatening complications.

Vitiligo is associated with an increased risk of cardiovascular diseases: a large-scale, propensity-matched, US-based retrospective study

Vitiligo is an autoimmune disease, characterized by specific destruction of melanocytes. While associations with numerous comorbid conditions, which potentially increase the risk of cardiovascular diseases have been described, data on the risk for cardiovascular disease is inconclusive. To address this relevant knowledge gap, this study aims to identify the risk of cardiovascular disease in vitiligo. The US Collaborative Network was accessed using the TriNetX platform, allowing retrospective data retrieval from electronic health records (EHRs) from 57 US based health care organizations (HCOs). Patients with vitiligo and controls were identified by their respective ICD10 codes. Risk of onset of several cardiovascular diseases was determined in patients within 15 years after diagnoses. A total of 94 diagnoses with a prevalence of ≥1% in both cohorts, which consisted of 96,581 individuals per group after propensity-score-matching, were identified. Of those, 54 displayed an increased risk in vitiligo. None of the cardiovascular diseases investigated were associated with a decreased risk in patients with vitiligo. Specifically, cerebral infarction occurred in 1.3% of patients with vitiligo, and 1.0% in controls. This difference translated into a hazard ratio (HR) of 1.21 (95% confidence interval [CI] 1.11-1.32, padj<0.001). Venous thromboembolism was recorded in 1.34% of cases and 1.02% of controls without vitiligo, resulting in an increased HR of 1.27 (95% CI 1.171-1.38, padj<0.001). Further, major adverse cardiovascular events (MACE) as a composite endpoint was evaluated. The risk for MACE was increased following a vitiligo diagnosis (HR 1.28, 95% CI 1.22-1.35, padj<0.001), which persisted in both sensitivity analyses. Patients with vitiligo display an increased risk of onset of cardiovascular diseases as compared to healthy individuals. Thus, vitiligo might require more precise monitoring and systemic treatment. This research was supported by the Schleswig-Holstein Excellence-Chair Program from the State of Schleswig Holstein, by the Excellence Cluster Precision Medicine in Chronic Inflammation (DFG, EXC 2167), and by DFG Individual Grant LU 877/25-1.

The phenotype of recovery XII: A reinforcer pathology perspective on associations between delay discounting and pain catastrophizing in substance use disorder recovery

BackgroundSubstance use disorder (SUD) and pain are highly comorbid conditions and several pain indices (e.g., pain intensity) are associated with an increased risk of relapse. However, the cognitive-emotional experience of pain (i.e., pain catastrophizing) is understudied in SUD recovery. Further, how the association between pain catastrophizing and delay discounting - a posited biomarker of addiction, impacts multidimensional aspects of SUD recovery, including remission and quality of life (QOL), has yet to be examined. MethodsIndividuals (n = 170) in SUD recovery reporting pain were asked about their chronic pain status, completed the Brief Pain Inventory, the Pain Catastrophizing Scale, an Adjusting Amount Delay Discounting Task, and the World Health Organization QOL-BREF scale. Univariate logistic and linear regressions examined associations between delay discounting and several pain indices with remission and QOL. Mediation analyses were investigated whether pain catastrophizing mediates the relationship between delay discounting and 1) sustained remission and 2) QOL. ResultsSignificant negative associations were found between delay discounting (p < .001) and pain catastrophizing (p = .001) with sustained remission. Pain catastrophizing significantly mediated the relationship between delay discounting and physical QOL (p = .044), psychological QOL (p = .009), social (p = .018), and environmental QOL (p = .014). Pain catastrophizing did not mediate the relationship between DD and sustained remission. ConclusionIndividuals with greater DD exhibited greater pain catastrophizing, contributing to poorer QOL in SUD recovery. Our findings support that a Reinforcer Pathology framework is useful to understanding the cognitive-emotional experience of pain within the context of SUD recovery. Interventions that target both delay discounting and maladaptive cognitive and emotional responses to pain may lessen the negative impact of pain on SUD recovery and improve SUD outcomes.

Assessing the impact of systemic conditions on periodontal health in Malaysian population: a retrospective study

BackgroundPeriodontal diseases, including gingivitis and periodontitis, are among the most prevalent oral health issues globally. They compromise the supportive structures of teeth and are influenced by both local and systemic factors. This study aimed to systematically assess the impact of systemic conditions on periodontal health in Malaysian population, addressing the gap in understanding these factors as potential risk factors.MethodsA retrospective, non-interventional study was conducted using medical records from Hospital Universiti Sains Malaysia, Kelantan, from September 2019 to December 2022. The study included patients with periodontitis and systemic conditions. Data were analyzed using descriptive statistics, chi-squared tests, Fisher’s exact tests, Mann-Whitney U tests, Kruskal-Wallis tests, Spearman’s correlation, and logistic regression.ResultsOut of 600 records, 274 patients were included. The cohort was 51.8% male, with a median age of 51 years. Malays accounted for 92.3% of the sample. Hypertension and diabetes mellitus were the most common comorbid conditions. Severe periodontitis was significantly associated with age (45–64 years, p = 0.018) and Malay ethnicity (p = 0.011). Logistic regression revealed that age and ethnicity were significant predictors of periodontitis severity, with Malays being 12.5 times more likely to develop severe periodontitis.ConclusionSystemic conditions significantly influence periodontitis development and progression. Age and ethnicity are crucial predictors of periodontitis severity in the Malaysian population. Comprehensive risk assessment tools are necessary to incorporate a broader spectrum of risk factors for better management and prevention.

Targeting Higher-Order Dimensions of Personality in Treatment as a Parsimonious Means to Address Co-Occurring Psychopathology

People with borderline personality disorder (BPD) commonly have co-occurring mental health conditions that may be accounted for by higher-order factors in dimensional models of psychopathology. BPD Compass is a cognitive-behavioral treatment developed to target broad personality domains (i.e., negative affectivity, antagonism, disinhibition) associated with BPD and related conditions. The purpose of the present study was to explore the extent to which BPD Compass can serve as a transdiagnostic intervention for these comorbid conditions. Participants (N = 100; Mage = 28.13, 73.7% female, 79.6% White, 66% sexual minority) were assigned to either immediately begin treatment (randomized and naturalistic) or receive treatment after an 18-week waiting period. At baseline, participants met criteria for an average of 3.28 (SD = 2.02, range: 0-8) comorbid diagnoses ranging in clinical severity from 3.30 (for substance use disorder) to 4.91 (for persistent depressive disorder). Post-treatment clinical severity ratings (CSRs) for those randomized to receive BPD Compass were below clinical thresholds for all assessed conditions except premenstrual dysphoric disorder, whereas post-waitlist CSRs remained above clinical thresholds for all disorders except bipolar II, agoraphobia, and major depressive disorder. Collapsed across all patients who received BPD Compass, pre- to post-treatment improvements in were significant and large in magnitude for most disorders assessed. These results suggest that BPD Compass may be an efficacious transdiagnostic intervention, though our small sample and high rate of dropout warrant further study.

The Impact of Socioeconomic Factors on 90-day Postoperative Readmissions and Cost in Shoulder Arthroplasty Patients

Understanding the impact of Social Drivers of Health (SDOH) on shoulder arthroplasty is pivotal for the development of equitable value-based payment models that enhance the quality of patient care. This investigation aims to understand the influence of Area Deprivation Index (ADI) on hospital admissions, readmissions, and associated costs post-shoulder arthroplasty. We conducted an analysis using US Medicare claims data from 2019 to 2021, identifying patients who received shoulder arthroplasty in either an inpatient or outpatient setting using Current Procedural Terminology (CPT) codes. Our primary outcomes were 90-day unplanned readmissions and post-procedure 90-day care costs. The ADI was our primary exposure variable, calculated at the census block level. Our analysis adjusted for multiple factors using a stepwise modeling approach including patient demographics, 29 Elixhauser comorbid conditions, Medicaid-dual eligibility, and end-stage renal disease status using logistic regression models. A total of 145,435 patients were included in our study. The average age of patients in our cohort was 74.5 years old, with 59.5% being female. Patients in the high ADI group had a higher readmission rate than the lowest ADI group (8.5% vs. 6.0%, p<0.001).When controlling for confounding factors, there was an indepdentent association between high ADI and readmission (OR: 1.28 [95% CI 1.12, 1.46]). Overall, we saw a dose-dependent relationship between ADI and readmission, with the association growing stronger as ADI increased. Conversely, we found a negative association with ADI and high-costs. (High ADI Group OR: 0.80 [95% CI 0.70, 0.91]). Patients in the high SES group had higher healthcare contact days during the 90-day follow-up period, with a median of 16 visits (IQR 8, 23), compared to 13 visits (IQR 6, 22) in the middle SES group and 10 visits (IQR 5, 20) in the low SES group (p<0.001). Socioeconomic disparities significantly influence the outcomes of primary shoulder arthroplasty, as indicated by higher readmission rates for low SES patients. Notably, our analysis shows a strong, independent association between ADI and readmission. Moreover, patients with higher SES incurred greater costs within a 90-day period potentially due to increased resource utilization.

Time trends of outcome and treatment options for disseminated intravascular coagulation from 2010 to 2021 in Japan: A nationwide observational study

IntroductionMortality and changes in treatment options for disseminated intravascular coagulation (DIC) are trending downward. This study investigated temporal trends in mortality and treatment preferences of several anticoagulants in Japan. MethodsThis retrospective observational study used the Japanese Diagnosis Procedure Combination inpatient database containing data from >1500 acute-care Japanese hospitals. All adult patients diagnosed as having DIC from July 2010 to March 2022 were sorted by predefined underlying conditions: sepsis, solid cancer, leukemia, trauma, or obstetric. We evaluated in-hospital mortality and clinical status of anticoagulant use for DIC treatment. ResultsBaseline characteristics of the 443,098 DIC patients showed increased age, worsened comorbid conditions, and higher illness severity over time. Over the 12 years, in-hospital mortality for overall DIC patients declined by 17 % from 42.0 % (95 % CI 41.4–42.5 %) to 34.7 % (95 % CI 34.1–35.3 %) (Ptrend < 0.001). This downward decrease was more evident in patients with sepsis (17 %), solid cancer (18 %), and leukemia (22 %) but was not clinically meaningful in trauma and obstetrics patients. The trend in treatment preferences of anticoagulants for DIC patients also changed. Recombinant thrombomodulin administration increased dramatically from 2011 to 2015 and remained high through 2021. Only 7 % of DIC patients were administered antithrombin and recombinant thrombomodulin concomitantly, and its use continues to decline. ConclusionsAll-cause in-hospital mortality for DIC patients clearly decrease by 17 % over the study period. Anticoagulant therapy for patients with DIC has been decreasing, possibly due to recent published clinical evidence.

AI-Guided Cancer Therapy for Patients with Coexisting Migraines.

Background: Cancer remains a leading cause of death worldwide. Progress in its effective treatment has been hampered by challenges in personalized therapy, particularly in patients with comorbid conditions. The integration of artificial intelligence (AI) into patient profiling offers a promising approach to enhancing individualized anticancer therapy. Objective: This narrative review explores the role of AI in refining anticancer therapy through personalized profiling, with a specific focus on cancer patients with comorbid migraine. Methods: A comprehensive literature search was conducted across multiple databases, including PubMed, Scopus, and Google Scholar. Studies were selected based on their relevance to AI applications in oncology and migraine management, with a focus on personalized medicine and predictive modeling. Key themes were synthesized to provide an overview of recent developments, challenges, and emerging directions. Results: AI technologies, such as machine learning (ML), deep learning (DL), and natural language processing (NLP), have become instrumental in the discovery of genetic and molecular biomarkers of cancer and migraine. These technologies also enable predictive analytics for assessing the impact of migraine on cancer therapy in comorbid cases, predicting outcomes and provide clinical decision support systems (CDSS) for real-time treatment adjustments. Conclusions: AI holds significant potential to improve the precision and effectiveness of the management and therapy of cancer patients with comorbid migraine. Nevertheless, challenges remain over data integration, clinical validation, and ethical consideration, which must be addressed to appreciate the full potential for the approach outlined herein.

Resolution of Non-Diabetic Intractable Wounds with Severe Comorbidities Using Autologous Micrografts

The wound healing process is a complex mechanism related to many factors, such as the patient’s comorbidity, blood flow, and nutritional status. This study aimed to retrospectively evaluate patients affected by various disease states and treated with Rigenera® technology, a standardized micrograft preparation system. A total of 8 patients were treated with a suspension of autologous micrografts obtained from mechanical disaggregation of small pieces of skin tissue. The micrografts suspension was applied alone to the wound or in combination with porcine collagen scaffolds directly onto the wound as described in the text. Across all cases, there was marked improvement in wound healing, with a mean healing time of 103 days and a reduction of the diameter of the wounds by 54%. Notably, the use of micrografts resulted in an overall higher quality of life for the patients. This simple and low-cost micrografting procedure that can promote wound healing of different kinds of chronic non-healing wounds and does not require postoperative rest.

Cyproheptadine Treatment in Children and Adolescents with Migraine: A Retrospective Study in Japan

Objective: Evidence on prophylactic drugs for pediatric migraine is limited, especially when comorbid conditions contribute to treatment resistance. This study evaluated the efficacy of cyproheptadine in children with migraine and explored the impact of comorbid neurodevelopmental disorders and orthostatic intolerance (OI). Methods: We retrospectively analyzed pediatric migraine patients treated with cyproheptadine. Efficacy was assessed based on the reduction in headache frequency, with responders defined as patients experiencing at least a 50% reduction in headache episodes. Fisher’s exact test analyzed the relationship between efficacy and comorbid conditions or treatment sequence. Multiple logistic regression was performed to identify factors associated with adverse events. Results: In total, 155 children (71 males, 84 females) aged 3–15 years were included. Comorbid neurodevelopmental disorders and OI were present in 27 (17.4%) and 22 (14.2%) patients, respectively. Efficacy was evaluated in 148 patients, with 68.9% classified as responders. Patients with comorbid conditions showed lower efficacy. Responders required a lower dose of cyproheptadine (p = 0.039). Multiple logistic regression identified headache frequency, cyproheptadine dose, and comorbid OI and neurodevelopmental disorders as factors influencing treatment efficacy. Conclusions: Cyproheptadine is effective in treating pediatric migraine, though patients with neurodevelopmental disorders and OI demonstrated reduced efficacy.

Disease-Modifying Treatment of Psoriasis in Children

Advances in understanding the mechanisms underlying chronic inflammatory skin diseases, such as psoriasis vulgaris, have led to implementation of new treatment options aimed at symptoms relieving. Moreover, this data may become the basis for new strategies to achieve sustained or treatment-free remission, that is disease modification with potential impact on comorbid conditions. However, achieving this goal requires further study of such crucial aspects as the terms of disease modification and disease activity indicators, deeper understanding of pathogenesis mechanisms, etiology, and systemic side effects, possible opportunities, biomarkers for successful patient stratification and intervention, as well as the adequate study design. Early intervention with genetically engineered biologic drugs such as secukinumab represents new paradigm shift in improvement of immune-mediated diseases outcomes. However, new evidence is needed to determine its efficacy in psoriasis. High level of sustained skin clearance observed on secukinumab therapy compared to standard treatment and phototherapy indicates the potential benefit of early biologic drugs treatment to achieve complete skin clearance and improvement in quality of life, education, and daily activities. It can also become a background for changing treatment strategies for patients with newly diagnosed moderate-to-severe plaque psoriasis. Keywords: psoriasis, children, secukinumab, disease-modifying treatment

Utility analysis of outpatient hypertensive patients with and without comorbidities using the EQ-5D-5L instrument: A study at UPTD Puskesmas Pagerageung, Tasikmalaya Regency, West Java

Hypertension is a chronic condition often requiring lifelong treatment, which can impact patients’ quality of life (QoL) in physical, psychological, and social domains. The presence of comorbid conditions alongside hypertension can further deteriorate QoL. Health utility measurement, particularly in hypertensive patients with comorbidities, is crucial for understanding these compounded effects. This study aims to evaluate and compare the quality of life utility in hypertensive patients with and without comorbidities using the EQ-5D-5L instrument, focusing on how comorbid conditions influence overall QoL. A descriptive observational study with a cross-sectional design was conducted among 100 hypertensive patients treated at UPTD Puskesmas Pagerageung, Tasikmalaya, from January to March 2024. Participants were selected through purposive sampling. The EQ-5D-5L questionnaire was used to assess utility scores, which were calculated using an Indonesian-specific value set. Chi-square and Post Hoc LSD analyses were applied to explore relationships between utility scores and demographic factors such as age, gender, and occupation. The average utility score for hypertensive patients without comorbidities was 0.669, higher than that of patients with comorbid conditions. Specifically, patients with diabetes mellitus, osteoarthritis, gastric conditions, heart disease, and severe comorbidities (e.g., kidney disease, cataracts, stroke) had average scores of 0.578, 0.640, 0.651, 0.537, and 0.148, respectively. Age was significantly associated with utility scores (p = 0.014), whereas gender and occupation showed no significant impact. Hypertensive patients without comorbidities had a better quality of life utility than those with additional health issues. Targeted management of comorbidities is essential to improve the quality of life among hypertensive patients, especially in those facing compounded health challenges.