Comorbid Conditions In Patients Research Articles

Topical Treatment and Aesthetic Procedures in Management of Acne Vulgaris

Acne vulgaris is a common, chronic inflammatory skin disease affecting up to 80% of young adults and adolescents. The pathogenesis of acne is multifactorial and involves the pilosebaceous units of the skin. As a result of the disease process, skin lesions such as open and closed comedones, nodules, pustules, and papules appear on the skin. In recent years, acne has been increasingly observed in younger patients, which is associated with the earlier onset of puberty. Moreover, acne is increasingly diagnosed in individuals over 20 years of age, particularly in women, which is referred to as adult female acne (AFA). Effective and rapid implementation of treatment is crucial to prevent complications such as post-inflammatory hyperpigmentation and acne scars, as well as to mitigate the negative psychological impact of the disease on patients. The article discusses both topical treatment and aesthetic medicine procedures in the management of acne vulgaris. Topical treatments include the use of retinoids, antibiotics, benzoyl peroxide, clascoterone, dapsone, azelaic acid, and combination therapies. Aesthetic procedures such as chemical peels, microdermabrasion, photodynamic therapy, blue light therapy, and laser therapies can be beneficial as adjunctive treatments. The article also addresses the issue of acne as a comorbid condition in patients seeking aesthetic medicine treatments, even if it is not the primary reason for their visit.

A Pathophysiological Approach for Selecting Medications to Treat Nociceptive and Neuropathic Pain in Servicemembers.

The prevalence of chronic pain of service members (SMs) in the U.S. is estimated to be higher (roughly 31-44%) compared to that of civilian population (26%). This higher prevalence is likely due to the high physical demands related combat and training injuries that are not immediately resolved and worsen over time. Mental Health America reports that chronic pain can lead to other mental health conditions such as severe anxiety, depression, bipolar disorder, and post-traumatic stress disorder. Such mental health conditions can negatively affect job performance, reduce readiness for military duties, and often lead to patterns of misuse of opioid after SMs entering civilian life. The primary objective of this narrative review is to present a summarized guideline for the treatment of two types of pain that likely affect SMs, namely nociceptive somatic pain and neuropathic pain. This review focused on a stepwise approach starting with nonopioid interventions prior to opioid therapy. The secondary objective of this review is to elucidate the primary mechanisms of action and pathways associated with these two types of pain. We followed the Scale for Assessment of Narrative Review Articles when transcribing this narrative review article to enhance the quality and brevity of this review. This Scale has 0.77% an intra-class coefficient of correlation, 95% confidence interval and 0.88 inter-rater reliability. We searched PubMed, Google Scholar, WorldCAT, and the Cochrane Library for the primary and secondary articles that targeted mechanisms of action, pathways, and pharmacological modalities for nociceptive somatic and neuropathic pain that were published from 2011 to 2022. We excluded articles related to pediatric, some specific pain conditions such as cancer-related pain, palliative care, end-of-life care, and articles that were not written in English language. For pharmacologic selection, we adopted the guidelines from the Policy for Implementation of a Comprehensive Policy on Pain Management by the Military Health Care system for the Fiscal Year 2021; the Clinical Practice Guidance for Opioid Therapy for Chronic Pain by the Department of Defense/Veterans Health Administration (2022); the (2021) Implementation of a Comprehensive Policy on Pain Management by the Military Health Care System; and the (2022) Guideline for Prescribing Opioids for Chronic Painby the Centers for Disease Control. From the knowledge of the mechanisms of action and pathways, we can be more likely to identify the causative origins of pain. As a result, we can correctly diagnose the type of pain, properly develop an efficient and personalized treatment plan, minimize adverse effects, and optimize clinical outcomes. The guideline, however, does not serve as a substitute for clinical judgment in patient-centered decision-making. Medication choices should be individualized judiciously based on the patient's comorbid conditions, available social and economic resources, and the patient's preferences to balance the benefits and risks associated with various pain medications and to achieve optimal pain relief and improve the patient's quality of life.

Current Considerations in the Diagnosis and Treatment of Circadian Rhythm Sleep-Wake Disorders in Children

Circadian Rhythm Sleep-Wake Disorders (CRSWDs) are important sleep disorders whose unifying feature is a mismatch between the preferred or required times for sleep and wakefulness and the endogenous circadian drives for these. Their etiology, presentation, and treatment can be different in pediatric patients as compared to adults. Evaluation of these disorders must be performed while viewed through the lens of a patient's comorbid conditions. Newer methods of assessment promise to provide greater diagnostic clarity and critical insights into how circadian physiology affects overall health and disease states. Effective clinical management of CRSWDs is multimodal, requiring an integrated approach across disciplines. Therapeutic success depends upon appropriately timed nonpharmacologic and pharmacologic interventions. A better understanding of the genetic predispositions for and causes of CRSWDs has led to novel clinical opportunities for diagnosis and improved therapeutics.

Psoriatic Arthritis Flare in a Hospitalized Patient with Schizoaffective Disorder: A Case Report

Psoriasis is a known comorbid condition in patients with schizophrenia spectrum disorders. Due to the nature of these psychiatric conditions, many experience lengthy hospitalizations and self-isolate at baseline, which can make identification and management of psoriasis difficult. We report the case of a middle-aged male with a history of schizoaffective disorder and treatment-resistant psoriatic arthritis who experienced a severe flare while hospitalized. His two-month hospital stay became complicated by combative behavior and continued medication refusal, resulting in repeated seclusion events and eventual transfer to a higher acuity unit. After treatment with ixekizumab and a course of prednisone was initiated one month after admission and symptom onset, the patient’s lesions were tremendously improved along with his mood on the unit. With the improvement in his chronic pain and discomfort, the patient was able to focus on mental health recovery and rapidly approached discharge. This report highlights the importance of appropriate management of comorbid conditions, especially psoriasis in patients with schizophrenia spectrum disorders needing long-term hospitalization. Additionally, this case demonstrates the successful use of ixekizumab in treatment-resistant psoriasis.

Justification of the expediency of using harmless analgesia in bariatric surgery: prospective randomized study

BACKGROUND: The presence of various comorbid conditions in patients with obesity increases operational risk, and high sensitivity to sedatives and opioid drugs can contribute to their aggravation.
 OBJECTIVE: To compare and evaluate two methods of perioperative analgesia, namely, multimodal without opioid and non-opioid when performing longitudinal gastric resection for patients with morbid obesity using the enhanced recovery after surgery protocol.
 MATERIALS AND METHODS: A prospective randomized study of patients with morbid obesity was conducted. Depending on the type of analgesic component of anesthesia, the patients are divided into two groups. In both groups, low-flow desflurane inhalation was used; in group 1 (n=30), the technique of non-opioid analgesia was used, which included intraoperative infusion of ketamine, dexmedetomidine, lidocaine, and magnesium sulfate. In group 2 (n=30), traditional combined anesthesia using fentanyl was administered. In the postoperative period, the infusion of the above drugs continued for 10 h in group 1. Central and peripheral hemodynamic parameters, and the depth of anesthesia were studied, and TOF-monitoring was carried out. Postoperative rehabilitation was assessed based on the time of extubation, achievement of 13 points on the PARS scale, first getting up on ones feet, appearance of overstrain, and gas discharge. Postoperative analgesia was assessed on a 10-point visual analog scale, and anesthesia-related complications were recorded.
 RESULTS: Surgical intervention under low-flow inhalation anesthesia based on desflurane in combination with multimodal opioid-free analgesia reduced the need for opioid analgesics intraoperatively (in group 1, the fentanyl dose was 0.2 [01; 0.2] mg; in group 2 0.4 [0.3; 0.5] mg; p=0.002), provided less fluctuation of intraoperative hemodynamic parameters (AvBP: stage 1: group 1 102 [100; 103]; group 2 102 [98; 105], p=0.96; stage 2: group 1 93 [90; 95]; group 2 96 [93; 99], p=0.003; stage 3: group 1 95 [95; 97]; group 2 100 [96; 102], p 0.001; stage 4: group 1 95 [92; 97]; group 2 98 [98; 101], p 0.001; CI stage 1: group 1 492.2; group 2 49.52.2, p=0.39; stage 2: group 1 44.42; group 2 44.62.1, p=0.26; stage 3: group 1 45.52.11; group 2 50.62.8, p=0.001; stage 4: group 1 44.52.1; group 2 48.82.5 p 0.001), and contributed to a lower level of pain and faster rehabilitation. In addition, anesthesia-related complications such as postoperative nausea and vomiting, hypoxemia, and dysphoria were less frequently recorded.
 CONCLUSION: The use of multimodal non-opioid analgesia contributes to a lesser fluctuation in hemodynamic parameters, a low level of postoperative pain, early activation of patients and restoration of peristalsis, and a decrease in the number of postoperative complications in patients who underwent longitudinal gastric resection for morbid obesity.

Secondary Reconstruction of Head and Neck Cancer Defects-Principles in its Practice.

Secondary reconstruction is requested by patients who have completed their head and neck cancer treatment. The reason for the request for reconstruction may be to improve the functional deficits, achieve aesthetic refinements or most commonly both.The article looks at various issues related to reconstruction in the secondary setting and suggesting the ways to approaching patients requesting secondary reconstruction. While considering secondary reconstruction, various factors need to be considered. These include issues related to the disease, the treatment received as well as the patient's comorbid conditions. Aggressive disease and multiple recurrences should deter from undertaking complex reconstructions. Lack of tissue pliability resulting in a woody neck due to radiation makes dissection difficult and wound healing poor. The reconstructive requirements include release of contractures inside the mouth, reconstruction of the missing jaws, replacement of the missing volume of the tongue and correction of the incompetent angle of mouth. Goals of reconstruction should be prioritized by the surgical team. Free soft tissue or bone containing flaps would be provided ideal tissue to meet the reconstructive requirements in secondary reconstruction. However, several impediments could exist for their safe use. Release of contractures and provision of adequate soft tissue should be given priority and must be addressed before bony reconstruction is contemplated. Bony reconstruction of both mandible and maxilla is possible, with the former being more difficult to deliver good results due to the associated soft tissue fibrosis. Virtual surgical planning with the aid of Stereo lithographic models and planning software will improve the quality of bony reconstruction. Detailed counseling sessions involving patient and the family are essential before embarking on secondary reconstruction as the patient expectations and the surgical outcome may not be easy to match. However excellent improvement in function and appearance will be possible in many patients with appropriate reconstructive procedure.

Peri-ictal headache: An underestimated prognostic finding associated with idiopathic epilepsies

ObjectiveThere are a handful of studies investigating peri-ictal headache (PIH) and its clinical associations in patients with idiopathic/genetic epilepsies (I/GE). This multi-center study aimed to investigate PIH, which is an ignored comorbid condition in patients with I/GE, by headache experts and epileptologists working together. MethodsThe data were collected from a cross-sectional large study, using two structured questionnaires for headache and epilepsy features, fulfilled by neurologists. Headaches were classified according to the International Classification of Headache Disorders, third edition, whereas seizure and syndrome types were diagnosed according to International League Against Epilepsy criteria. The patients with a headache starting 24 hours before the onset of the seizure (preictal) or within 3 hours after the seizure (postictal) were defined as patients with PIH. We compared demographic and clinical differences between two groups of patients with and without PIH statistically and used ROC curves to determine a threshold of the total number of seizure triggers associated with the occurrence of PIH. ResultsAmong 809 (531 females, 65.6%) consecutive patients with I/GE, 105 (13%) patients reported PIH (22 preictal, 82 postictal headaches, and one with both types). Peri-ictal headache was more frequently reported by females and those having a family history of migraine or epilepsy, and it was significantly associated with lower rates of seizure freedom for more than five years, drug resistance, and use of polytherapy, remarkably. Moreover, ROC curves showed that having more than 3 seizure triggers was associated with the presence of PIH. ConclusionOur findings revealed that PIH may be linked to poor outcomes in I/GEs and seems to be related to a lower ictal threshold precipitated by multiple triggers. Future prospective studies will illuminate the unknown underlying mechanisms and appropriate management strategies for PIH to improve the prognosis.

Analysis of comorbidity in rheumatoid arthritis–associated interstitial lung disease: a nested case-cohort study

ObjectivesTo describe comorbid conditions in patients with rheumatoid arthritis–associated interstitial lung disease (RA-ILD) and to analyze factors associated with multimorbidity. MethodsNested case-cohort study of 2 prospective cohorts: one with RA-ILD (cases) and another with RA but not ILD (controls). The cohorts were matched for age, sex, and time since diagnosis. Multimorbidity was defined as the co-occurrence of 2 or more chronic diseases, in addition to RA and ILD. We evaluated the comorbid conditions included in the Charlson Comorbidity Index, cardiovascular risk factors, neuropsychiatric conditions, and other frequent conditions in RA. We also recorded clinical-laboratory variables, inflammatory activity according to the 28-joint Disease Activity Score, C-reactive protein (CRP), physical function, and pulmonary function. We performed 2 multivariate analyses to identify factors associated with multimorbidity in RA and RA-ILD. ResultsThe final study population comprised 110 cases and 104 controls. Multimorbidity was more frequent among cases than controls (80 [72.7] vs 60 [57.7]; p = 0.021). In both groups, multimorbidity was associated with ILD (OR [95% CI] 1.92 [1.03–3.59]; p = 0.039), age (OR [95% CI] 1.05 [1.01–1.08]; p = 0.004), CRP (OR [95% CI] 1.16 [1.05–1.29]; p = 0.003), and erosions (OR [95% CI] 1.05 [1.01–1.08]; p = 0.004); in the cases, it was associated with CRP (OR [95% CI] 1.17 [1.01–1.35]; p = 0.027), anti–citrullinated peptide antibody (OR [95% CI] 1.23 [1.14–13.02]; p = 0.049), and forced vital capacity (OR [95% CI] 0.79 [0.96–0.99]; p = 0.036). ConclusionIn patients with RA, multimorbidity was associated with ILD, systemic inflammation, and advanced age.

Statins Have an Anti-Inflammation in CKD Patients: A Meta-Analysis of Randomized Trials.

Background Persistent inflammation has been recognized as an important comorbid condition in patients with chronic kidney disease (CKD) and is associated with many complications, mortality, and progression of CKD. Previous studies have not drawn a clear conclusion about the anti-inflammatory effects of statins in CKD. This meta-analysis is aimed at assessing the anti-inflammatory effects of statins therapy in patients with CKD. Methods A comprehensive literature search was conducted in these databases (Medline, Embase, Cochrane library, and clinical trials) to identify the randomized controlled trials that assess the anti-inflammatory effects of statins. Subgroup, sensitivity, and trim-and-fill analysis were conducted to determine the robustness of pooled results of the primary outcome. Results 25 eligible studies with 7921 participants were included in this meta-analysis. The present study showed that statins therapy was associated with a decreased C-reactive protein (CRP) (-2.06 mg/L; 95% CI: -2.85 to -1.27, p < 0.01). Subgroup, sensitivity, and trim-and-fill analysis showed that the pooled results of CPR were stable. Conclusion This meta-analysis demonstrates that statins supplementation has anti-inflammatory effects in patients with CKD. Statins exert an anti-inflammatory effect that is clinically important in improving complications, reducing mortality, and slowing progression in CKD. We believe that the benefits of statins to CKD are partly due to their anti-inflammatory effects. However, stains usually are prescribed in the CKD patients with dyslipidemia, whether statins can reduce inflammation in CKD patients with normal serum lipid needed to explore in the future. Therefore, we suggest that randomized clinical trials need to assess the effect of statins in CKD patients with normal serum lipid. Whether statins can be prescribed for aiming to inhibit inflammation in CKD also needed further study. Trial Registration. The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO); registration number: CRD42022310334.

S2658 Symptomatic Sclerosing Mesenteritis: A Flank Problem

Introduction: Sclerosing mesenteritis is a rare diagnosis consisting of fatty inflammation and necrosis of the abdominal mesentery. Patients usually present asymptomatically or with vague, generalized systemic symptoms including abdominal pain, fever, and weight loss. Here, we present a case of a 72-year-old female with an unusual presentation of right flank pain in the diagnosis of sclerosing mesenteritis. Case Description/Methods: A 72 YO female was evaluated in the hospital for acute onset, intermittent right flank pain described as a spasm sensation. Her history was significant for multiple abdominopelvic surgeries, dating back almost 50 years and including appendectomy, herniorrhaphy, pelvic reconstruction and hysterectomy, and bladder sling placement. Her most recent surgery was the appendectomy 5 months prior to admission. There was no temporal or positional association of the pain. She had no associated fevers, malaise, changes in bowel habits, nausea, vomiting, melena, or hematochezia. Prior colonoscopy history was unknown. Physical exam showed a diffusely soft, n abdomen without any masses or organomegaly. Laboratory evaluation demonstrated leukocytosis and elevated ESR and CRP. The remaining laboratory work-up was within normal limits. CT abdomen and pelvis without contrast showed hazy attenuation of the mesenteric root with hypodense halos surrounding the mesenteric lymph nodes, suggestive of sclerosing mesenteritis. Surgical intervention was deferred given the patient's comorbid conditions. Given her presentation of flank pain, retroperitoneal ultrasonography was done which was negative for any acute pathologies. Discussion: The diagnosis of sclerosing mesenteritis is often an incidental finding on abdominal imaging, as seen in our patient case. Usually, such imaging studies are performed for evaluation of an abdominal mass seen in up to 35-50% of patients, however, in our case, it was performed for initial evaluation of her flank pain. In our patient case, the only risk factor for the development of sclerosing mesenteritis was her significant history of abdominal surgery. Studies have shown up to 30% of patients diagnosed with sclerosing mesenteritis have a history of prior abdominal surgery. A wide differential should be maintained in patients presenting without obvious abdominal complaints yet having a significant abdominal surgery history.

Evaluation of infections associated with implantable cardiac electronic devices: 10 years of experience in a single center

PurposeCardiac implantable electronic device (CIED) is used increasingly in recent years. In this study, it is aimed to evaluate the frequency of CIED-associated infections in the cardiology clinic of our hospital in the last 10 years, the causative microorganisms by determining their risk factors and clinical characteristics. Materials and methods225 patients who underwent CIED implantation in our hospital's cardiology clinic between March 2009 and December 2019 were retrospectively identified. The patients were grouped as with and without CIED-associated infection. ResultsIn a period of approximately 10 years, the rate of CIED infection was determined as 4.8%. 9 of the patients (81.8%) had CIED infection after the first implantation, and 2 of the patients (18.2%) after replacement. When the groups with and without CIED infection were compared; there was no significant difference in the group with CIED infection compared to the control group in terms of age, gender, type of the device inserted and the way of placing the device (implantation/replacement). Comparing risk factors between CIED infection and control group, there is no significant difference in terms of diabetes mellitus (DM), congestive heart failure, renal failure, hypertension, dyslipidemia, malignancy, immunosuppression. The use of anticoagulation was found statistically significant. ConclusionsCIED infections occur clinically with increased morbidity and mortality due to factors related to the patient and/or the type of device implanted. Knowing the patient's comorbid conditions well and taking precautions before CIED implantation can contribute to the reduction of the CIED infections.

Frequency of Anemia in Patients Admitted with Acute Decompensated Heart Failure in Tertiary Care Cardiac Hospital

Introduction: Anemia is one of the potential comorbid condition in patients with acute decompensated heart failure (ADHF) which is linked to higher morbidity and mortality rates. Worldwide, its prevalence ranges from 4% to &gt;70% in hospitalized patients with ADHF. Unfortunately data is lacking from our region and hence we aimed to conduct this study to scientifically fill the present gap by evaluating the actual burden of anemia in patients hospitalized with ADHF in a tertiary care hospital of Karachi, Pakistan.&#x0D; Patients and Methods: This was a hospital based study conducted in the Department of Cardiology, Tabba Heart Institute, Karachi From 1st November 2019 to 30th April 2020. A total of 203 patients with ADHF with age &gt;35 years and &lt;80 years were selected. A blood sample was taken to determine the hemoglobin levels and hemoglobin (Hb) levels &lt;12.0 g/dL in women and &lt;13.0 g/dL in men were taken as cut-off for anemia.&#x0D; Results: Overall mean and SD of age was 63.70±10.53 years and among them most of were males (n = 116, 57.1%). The overall prevalence of anemia in patients with ADHF was quite high and 63.5% (n = 129). Only three condition, hypertension, diabetes mellitus, and current smoking habits had significant association with the occurrence of anemia in patients with ADHF, p value &lt;0.05.&#x0D; Conclusion: In conclusion, the results showed that anemia is an independent risk for HF. Anemia was observed in one-third of the study population. More prevalent in male gender, elderly patients of age above 60 years, and associated with other comorbids.

Getting Ready for Wound Certification: Promoting Skin Health and Preventing Injuries.

Getting Ready for Wound Certification: Promoting Skin Health and Preventing Injuries.

Characteristics of the acute myocardial infarction course in patients with type 2 diabetes mellitus before and after reperfusion therapy

Introduction. Scientific research is currently being done to diagnose and manage comorbid conditions in patients. The importance of studying the pathophysiological mechanisms of acute myocardial infarction (AMI) in patients with type 2 diabetes mellitus (DM) has been proven. The purpose of the study: to conduct a retrospective analysis before and after reperfusion therapy by evaluating the features of the AMI course in patients with type 2 DM. Material and methods. The study was conducted from January 10, 2020 to January 12, 2021. In total, 74 STEMI patients with or without type 2 DM, aged 59.42±7.66 years were examined at the Intensive Care Unit of the Government Institution “L. T. Malaya National Therapy Institute of the National Academy of Medical Sciences of Ukraine” and the Kharkiv Railway Clinical Hospital No. 1 of the branch “Center of Healthcare” of Public Joint Stock Company “Ukrainian Railway”. Serum levels of insulin, adropin, irisin, fatty acid binding protein 4 (FABP4) and C1q/TNF-related protein (CTRP3) were detected by enzyme-linked immunosorbent assay. Analysis and processing of the findings obtained after examinations were carried out using the computer program IBM SPPS software, version 27.0 (IBM Inc., USA, 2020). Results and discussion. Before the treatment, patients with AMI and type 2 DM had significantly higher values of end-systolic size (ESS) by 5.56%, left atrium (LA) by 10.53%, left ventricular myocardial mass index (LVMMI) by 6.87% and lower values of systolic blood pressure (SBP) by 11.76%, atherogenic index (AI) by 5.80%, glucose by 25.71%, insulin by 39.92%, irisin by 15.34%, FABP4 by 19.76% compared to the values of these indicators 14 days after medicamentous therapy (p&lt;0.05). Patients with AMI and type 2 DM had significantly higher values of adropin by 46.10%, irisin by 20.11%, CTRP3 by 28.78% and lower values of SBP by 17.65%, diastolic blood pressure by 12.38%, heart rate (HR) by 13.73%, pulse by 10.87%, body mass index by 5.57%, weight by 9.52%, glucose by 26.67%, insulin by 40, 75%, total cholesterol by 10.04%, very low-density lipoproteins by 24.75%, low-density lipoproteins by 8.52%, triglycerides by 27.06%, AI by 10.55%, FABP4 by 37.04% before treatment as compared to the values of these indicators 14 days after percutaneous coronary intervention (PCI) (p&lt;0.05). Comparing the studied indicators between subgroups after medicamentous treatment and PCI, a significant decrease in HR by 8.33%, ESS by 4.11%, LA by 9.52%, LVMMI by 5.53%, FABP4 by 21.53% and an increase in the levels of adropin by 36.99%, irisin by 41.88%, CTRP3 by 30.25%, high-density lipoproteins (HDL) by 10.28% were identified (p&lt;0.05). Conclusions. When compared PCI advantages due to the absence of a tendency to the left heart dilatation over the medicamentous therapy, improvements of energy and adipokine metabolism have been observed amid increased levels of adropin, irisin and CTRP3 and decreased levels of FABP4 in patients with AMI and type 2 DM. It should be noted that there has been a significant improvement in the state of energy and adipokine profiles under the conditions of performing PCI.

A PROSPECTIVE STUDY FOR PREDICTORS OF POST LAPAROTOMY ABDOMINAL WOUND DEHISCENCE

INTRODUCTION: Abdominal wound dehiscence, whether partial or complete, is a major morbidity and a leading cause of mortality in abdominal surgeries. Wound dehiscence or evisceration is the most dreaded complication faced by surgeons and of greatest concern because of risk of evisceration, the need for immediate intervention, possibility of repeat dehiscence, surgical wound infection and incisional hernia formation. In this study various predictors or risk factors are taken into account to observe the association with abdominal wound dehiscence. MATERIAL AND METHOD: The study was done on 50 patients who developed abdominal wound dehiscence post laparotomy after considering the inclusion and exclusion criteria. RESULT: During the study it was observed that Pre-operative factors like old age, male sex, anemia, malnutrition, obesity, diabetes mellitus, peritonitis, emergency surgery, high ASA score are factors leading to post-operative wound dehiscence. Intra-operative factors like contaminated wound, midline incision, poor suturing technique,improper suture material choice, inexperience surgeons are associated with the increase incidence of wound dehiscence. Post-operative factors like cough, post- operative ventilator support, hypoxia, abdominal distension, wound infection also increase the rate of wound dehiscence. CONCLUSION: Preventive measures are prophylactic optimization of patient's co-morbid conditions, improving the nutritional status of the patient, proper aseptic technique, optimizing patient lung condition, avoiding other straining conditions like cough, vomiting and by applying proper surgical technique with adequate skill acquisition. Good preoperative preparation reduces postoperative wound complications.

An Overnight Rhythmic Sleep-Wake Pattern in Stroke and Obstructive Sleep Apnea: A Case Report and Literature Review

Background and Objective: Obstructive sleep apnea (OSA) is a common sleep breathing disorder and a comorbid condition in patients with stroke. The prevalence of sleep disorders as a stroke consequence is high. Being independent of vascular risk factors, OSA is associated with increased risk of ischemic stroke. Here, we report a patient with OSA and stroke.&#x0D; Case Report: This case report presents a patient with a history of stroke and hemiparesis who underwent polysomnog-raphy (PSG) for evaluating OSA because of snoring, witnessed apnea, and excessive daytime sleepiness (EDS). Then the subject underwent continuous positive airway pressure (CPAP) titration for treating OSA. In first night of PSG, there was a repetitive cyclic pattern of sleep and arousals. After CPAP titration study and with CPAP pressure of 15 cmH2o, OSA and rhythmic changes of electroencephalography (EEG) were resolved.&#x0D; Conclusion: OSA as a risk factor for stroke can be associated with PSG cyclic wake-sleep pattern in these patients, and this pattern can be resolved by CPAP therapy.

Beneficial effect of quetiapine monotherapy in patients with bipolar depression and comorbid obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is a prevalent and clinically significant comorbid condition in patients with bipolar disorder. Treatment of bipolar disorder/OCD patients is challenging. We report the results of an open-label, short-term, prospective investigation of quetiapine monotherapy in 16 patients (three men and 13 women, aged 18-56 years) hospitalized for acute bipolar depression who in addition met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for OCD. The participants were treated with quetiapine in a dose range of 150-600 mg (mean 347 mg) for a mean duration of 4.3 ± 1.4 weeks (range 3-7 weeks). Eleven (68.8%) of the 16 study participants fulfilled the predefined criteria for response, namely a score of 'very much improved' (four patients) and 'much improved' (seven patients) on the Clinical Global Impression - Improvement scale. Treatment with quetiapine was associated with a statistically significant decrease from baseline in the relevant rating scales for the assessment of depressive, manic and OCD symptoms. Quetiapine was well tolerated. The most frequently reported side effects were sedation, orthostatic hypotension and constipation. Durability of the positive therapeutic effect of quetiapine monotherapy in patients with bipolar disorder/OCD comorbidity and the necessity for subsequent augmentation with anti-OCD agents need to be addressed in future controlled studies.

Prevalence and Impact of Comorbid Widespread Pain in Adults with Chronic Low Back Pain: A Registry-Based Study.

Widespread pain (WP) is emerging as a key comorbid condition in patients with chronic low back pain (CLBP). This study measured the prevalence of comorbid WP in adults with CLBP, WP predictors, and impact on patients. Patients with CLBP were recruited from the Pain Registry for Epidemiologic, Clinical, and Interventional Studies and Innovation from 2016 through 2019. They were followed over 12 months to measure annual WP period prevalence rates using an item from the minimum dataset recommended by the National Institutes of Health Task Force on Research Standards for Chronic Low Back Pain. Patients were classified as not having WP, having nonpersistent WP, or having persistent WP. Pain intensity, back-related disability, and quality of life were measured using a numerical rating scale, the Roland-Morris Disability Questionnaire, and the PROMIS-29 instrument, respectively. A total of 358 patients were studied, including 56 (16%) without WP, 272 (76%) with nonpersistent WP, and 30 (8%) with persistent WP. There were no significant differences among the WP groups with regard to age, sex, or CLBP duration. However, being non-White and having moderate or high levels of pain catastrophizing remained significant predictors of nonpersistent or persistent WP after adjusting for potential confounders. Patients reported greater pain intensity and back-related disability and poorer quality of life over 12 months with increasing levels of WP persistence (P < .001 for each measure). Greater efforts are needed in primary care to help close these gaps in pain intensity, back-related disability, and quality-of-life outcomes associated with WP.

Issues of personalized treatment of chronic sensorineural hearing loss in the elderly

Objectives - to analyse the age-related features of chronic sensorineural hearing loss (SNHL) in elderly patients in regards to the course of the disease and treatment. Material and methods. We reviewed the articles on the problem, published in the recent 5 years, presented in the international databases PubMed, Scopus and E-library. Results. Considering the difficulty of decision-making on the diagnosis and rehabilitation of patients with chronic SNHL, the development of automated computer programs combining the relevant information on the personification of diagnostic and treatment algorithms is relevant. According to scientific data, the rehabilitation procedure for chronic SNHL should take into account the patient's comorbid conditions, the use of pharmacological preparations with a possible ototoxic effect.

The Charlson Comorbidity Index: can it predict the outcome in acute kidney injury?

Comorbidity has a significant impact on the health status and treatment outcome of a patient. The Charlson comorbidity index (CCI) is a frequently used scoring system, which evaluates the prognosis based on the patient's comorbid conditions. The aim of this study was to evaluate the usefulness of CCI in predicting the mortality and renal recovery in non-critically ill patients with severe AKI. A total of 530 adult patients who were referred from the emergency department and underwent intermittent urgent hemodialysis (uHD) were enrolled in the study. Personal history for comorbidities were recorded and then assessed using the CCI. The mean CCI score was 3.3 ± 2.6. In our multivariate analysis, higher white blood cell count was associated with mortality (p = 0.023). The other parameters including CCI score were not found to be significantly associated with mortality excluding patients with sepsis. Moreover, the CCI was not significantly useful in the discrimination of patients with complete recovery from patients who remained dependent to dialysis. We could not find significant association between CCI and short-term hospital mortality and renal outcome. Whereas, malnutrition, inflammation and general aging may have impact on short-term mortality among patients.