Comorbid Conditions Research Articles

Comorbidity progression analysis: patient stratification and comorbidity prediction using temporal comorbidity network.

The study aims to identify distinct population-specific comorbidity progression patterns, timely detect potential comorbidities, and gain better understanding of the progression of comorbid conditions among patients. This work presents a comorbidity progression analysis framework that utilizes temporal comorbidity networks (TCN) for patient stratification and comorbidity prediction. We propose a TCN construction approach that utilizes longitudinal, temporal diagnosis data of patients to construct their TCN. Subsequently, we employ the TCN for patient stratification by conducting preliminary analysis, and typical prescription analysis to uncover potential comorbidity progression patterns in different patient groups. Finally, we propose an innovative comorbidity prediction method by utilizing the distance-matched temporal comorbidity network (TCN-DM). This method identifies similar patients with disease prevalence and disease transition patterns and combines their diagnosis information with that of the current patient to predict potential comorbidity at the patient's next visit. This study validated the capability of the framework using a real-world dataset MIMIC-III, with heart failure (HF) as interested disease to investigate comorbidity progression in HF patients. With TCN, this study can identify four significant distinctive HF subgroups, revealing the progression of comorbidities in patients. Furthermore, compared to other methods, TCN-DM demonstrated better predictive performance with F1-Score values ranging from 0.454 to 0.612, showcasing its superiority. This study can identify comorbidity patterns for individuals and population, and offer promising prediction for future comorbidity developments in patients.

Identification of Crosstalk Genes between Lung Adenocarcinoma and Periodontitis.

Lung adenocarcinoma (LUAD) represents a significant global health issue. Smoking contributes to the development of periodontitis and LUAD. The connections between the two are still ambiguous. Based on RNA expression data from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases, differentially expressed genes (DEGs) in Periodontitis and LUAD were collected. Protein-protein interaction (PPI) networks were produced by mining genes intersecting with crossover DEGs. Genes in the subnetwork and the top 15 genes of the topology score were defined as the crosstalk gene. Feature selection and diagnostic model construction were conducted based on Recursive Feature Elimination (RFE) and support vector machines (SVM). Additionally, we analyzed the immune cells and signaling pathways influenced by the crosstalk gene. A total of 29 crossover DEGs between Periodontitis and LUAD were filtered, with 20 genes interacting with them in the PPI network. Five subnetworks with similar interaction patterns in the PPI network were detected. Based on the network topology analysis, genes ranking in the top 15 were used to take the intersection with those genes in the 5 subnetworks. Twelve intersecting genes were identified. Based on RFE and SVM algorithms, FKBP11 and MMP13 were considered as the Crosstalk genes for both Periodontitis and LUAD. The diagnostic model composed of FKBP11 and MMP13 showed excellent diagnostic potential. In addition, we found that FKBP11 and MMP13 influenced Macrophages, M1, T cells, CD8 activity, immune-related pathways, and cell cycle pathways. We identified the crosstalk genes (FKBP11 and MMP13) between periodontitis and LUAD. The two genes affected the comorbidity status between the two diseases through immune cell activity.

Family functioning mediation in tic severity and quality of life for children with Tourette syndrome

BACKGROUND Tourette syndrome (TS) is recognized as a neurodevelopmental disorder profoundly influenced by familial factors, particularly family functioning. However, the relationship among family functioning, tic severity, and quality of life in individuals with TS during childhood and adolescence remains unclear. We hypothesized that family functioning plays a role in the association between the severity of TS and quality of life in children. AIM To determine the role of family functioning in the relationship between TS severity and quality of life. METHODS This study enrolled 139 children (male/female = 113/26) with TS. We assessed tic severity using the Yale Global Tic Severity Scale, quality of life via the Tourette Syndrome Quality of Life Scale, and family functioning through the Family Assessment Device. Our analysis focused on correlating these measures and exploring the mediating role of family functioning in the relationship between tic severity and quality of life. Additionally, we examined if this mediating effect varied by gender or the presence of comorbidity. RESULTS We found that family communication dysfunction had a significant mediating effect between tic severity and both psychological symptoms (indirect effect: Β = 0.0038, 95% confidence interval: 0.0006-0.0082) as well as physical and activities of daily living impairment (indirect effect: Β = 0.0029, 95% confidence interval: 0.0004-0.0065). For vocal tic severity, this mediation was found to be even more pronounced. Additionally, in male participants and those without attention deficit hyperactivity disorder, the mediating effect of family communication dysfunction was still evident. CONCLUSION Our study highlights the impact of family functioning on the tic severity and the quality of life in children. This relationship is influenced by gender and comorbid conditions like attention deficit hyperactivity disorder.

Mitochondrial Functioning: Front and Center in Defining Psychosomatic Mechanisms of Allostasis in Health and Disease.

There is increased awareness among basic and clinical scientists that psychological and social stress can have detrimental effects on physical, cognitive, and mental health. Data have been published indicating that social, economic, psychological, and physical environmental stress can influence behavior that has biological and physiological consequences-yet there are major gaps in understanding the physiological and cellular processes that drive increased morbidity and mortality. The potential role of mitochondria has been highlighted in psychosomatic medicine, as their functionality in various biological and physiological processes has earned recognition. This review outlines the essential role of mitochondria by considering the numerous intracellular, extracellular, and physiological functions it regulates that position the organelle as a central mediator in responses to psychological stress. We then connect these functions to mitochondrial allostasis and allostatic load for further examination of the limitations of mitochondria to an adaptive psychological stress response where mitochondrial allostatic load may eventually lead to systemic pathophysiology. This review emphasizes how chronic social, economic, and psychological stress can contribute to mitochondrial dysfunction and predispose individuals to poorer health outcomes and death. Mitochondrial capacity, function, and activity may therefore serve as biomarkers for identifying individuals at high risk for developing comorbid conditions related to their psychosocial environment.

Time to Cure and Predictive Factors Among Patients with Multi-Drug Resistance Tuberculosis in Puntland, Somalia: A Retrospective Cohort Study

Background: Multi-drug-resistant tuberculosis, also known as MDR-TB, is caused by bacteria that are resistant to the most effective first-line anti-tuberculosis medications, which are rifampicin and isoniazid. MDR-TB is an increasing global concern, and its spread has varying cure times for patients affected. Thus, this study was intended to investigate the median time to cure and identify predictive factors for patients with MDR-TB in Puntland, Somalia. Methods: A retrospective cohort study was carried out at the MDR-TB center in Galkayo, Puntland, Somalia between the years of July 2017 and August 2023. The study utilized data that were collected from the inquiry form and monitoring cards of a randomly selected sample of 130 patients over a 6-year period. The data were entered into Epi-Data version 4.3 and analyzed using R Programming version 4.4.0. Non-parametric methods were used to estimate the median time to cure for patients with MDR-TB. Semi-parametric and parametric models were employed to determine predictive factors that influence the time to cure for MDR-TB patients. The Akaike Information Criteria (AIC) and Bayesian Information Criteria (BIC) of different survival models were compared to select the model that offers the best fit. Results: Out of the total of MDR-TB patients, 109(83.85%) were cured and 21(16.15%) were censored during the follow-up period. The median time to cure from MDR-TB was found to be 619 days which is approximately 20 months. In accordance with the AIC and BIC, the Log-logistic accelerated failure time model was the best fit for the data as compared to the other AFT models. The result of the Log-logistic AFT model revealed that age, sex, disease site, and comorbidities significantly affect the time to cure for MDR-TB. According to this study, older age with MDR-TB patients, male MDR-TB patients, MDR-TB patients with comorbid conditions, and extrapulmonary MDR-TB patients had a longer time to cure than their reference categories. Conclusion: Based on the findings of the study, the median time to cure for patients with MDR-TB in Puntland was found to be 20 months. Sex, disease site, comorbidities and age were predictive factors of time to cure from MDR-TB.

The prefrontal cortex, but not the medial temporal lobe, is associated with episodic memory in middle-aged persons with HIV.

Identifying persons with HIV (PWH) at increased risk for Alzheimer's disease (AD) is complicated because memory deficits are common in HIV-associated neurocognitive disorders (HAND) and a defining feature of amnestic mild cognitive impairment (aMCI; a precursor to AD). Recognition memory deficits may be useful in differentiating these etiologies. Therefore, neuroimaging correlates of different memory deficits (i.e., recall, recognition) and their longitudinal trajectories in PWH were examined. We examined 92 PWH from the CHARTER Program, ages 45-68, without severe comorbid conditions, who received baseline structural MRI and baseline and longitudinal neuropsychological testing. Linear and logistic regression examined neuroanatomical correlates (i.e., cortical thickness and volumes of regions associated with HAND and/or AD) of memory performance at baseline and multilevel modeling examined neuroanatomical correlates of memory decline (average follow-up = 6.5 years). At baseline, thinner pars opercularis cortex was associated with impaired recognition (p = 0.012; p = 0.060 after correcting for multiple comparisons). Worse delayed recall was associated with thinner pars opercularis (p = 0.001) and thinner rostral middle frontal cortex (p = 0.006) cross sectionally even after correcting for multiple comparisons. Delayed recall and recognition were not associated with medial temporal lobe (MTL), basal ganglia, or other prefrontal structures. Recognition impairment was variable over time, and there was little decline in delayed recall. Baseline MTL and prefrontal structures were not associated with delayed recall. Episodic memory was associated with prefrontal structures, and MTL and prefrontal structures did not predict memory decline. There was relative stability in memory over time. Findings suggest that episodic memory is more related to frontal structures, rather than encroaching AD pathology, in middle-aged PWH. Additional research should clarify if recognition is useful clinically to differentiate aMCI and HAND.

Association of DCI with number of preoperative comorbidities and 30-day outcomes following inguinal hernia repair: an analysis of the ACHQC database.

The Distressed Communities Index (DCI) is a stratification tool that captures socioeconomic disparities based on zip code. To date, no prior study has investigated the association of DCI score and inguinal hernia repair outcomes. This study aims to evaluate the association between DCI score and 30-day outcomes following inguinal hernia repair using the Abdominal Core Health Quality Collaborative (ACHQC) database. We hypothesize that patients with higher DCI scores will have a higher number of comorbidities and 30-day postoperative events. All patients who underwent inguinal hernia repair from 2015 to 2023 with an available DCI score and 30-day follow-up data available were included. Patients were stratified into DCI quintiles based on zip code. Primary outcomes of interest were 30-day hernia-specific postoperative outcomes. Pearson's chi-squared and Kruskal-Wallis tests were used to compare DCI scores with comorbid conditions and perioperative outcomes. 30,927 patients were included for analysis; 12,206 patients were classified as prosperous (40%), 7190 patients as comfortable (23%), 4884 patients as mid-tier (16%), 3485 patients as at-risk (11%), and 3162 as distressed (10%). Distressed patients were more likely to have ASA 3 or higher and comorbidities including hypertension, diabetes, ESRD, and COPD (p < 0.001). Patients with higher DCI scores were significantly more likely to undergo an emergency operation and have a longer OR time (p < 0.001). Distressed patients were also more likely to experience a major wound complication requiring readmission (p = 0.05) and reoperation (p < 0.001). DCI scores are strongly linked to surgical risk and outcomes following inguinal hernia repair. Special consideration should be given to DCI scores when optimizing patients prior to inguinal hernia repair.

Variation in adherence measures as a function of calculation methods

AimWe aim to compare different operational definitions of medication adherence as well as examine the within-patient variability among these measures among patients treated for multiple comorbid conditions.MethodsElectronically monitored adherence data from a study on comorbid conditions were examined using three different calculation methods. DAILY adherence calculated the number of administrations divided by the number prescribed, without considering inter-dose interval. TIMING used predefined inter-dose intervals. Measures were aggregated to six 30-day periods. A PILLCOUNT approach counted the total administrations divided by the expected number in each 30-day period. Within-patient variability was computed based on DAILY and TIMING results for each 30-day period.ResultsResults varied by adherence calculation method. PILLCOUNT demonstrated the largest adherence rates (89%–92%); DAILY rates were lower (79%–85%); and TIMING was the lowest (62%–68%) over the 6-month period. TIMING within-patient variability (29%–35%) was larger than DAILY (20%–25%).DiscussionDifferences among the three methods confirm the importance of the adherence definition. TIMING may underestimate medicinal effects because patients may take medication as instructed (e.g., with meals) rather than at fixed intervals. PILLCOUNT may overestimate adherence by not accounting for inconsistent use. DAILY may best provide daily estimates of correct administration. Higher variability for TIMING may indicate patients are more likely to vary time between doses. Adherence calculation methods are important in interpreting results. Variability measures provide a more complete picture of adherence and may raise the likelihood of effects on biological outcomes. We propose studies of adherence include calculation method in the definition of adherence.

Does High Standard Uptake Value on Positron Emission Tomography Preclude Sublobar Resection in Stage IA Non-Small Cell Lung Cancer ≤2cm?

Recent randomized trials have shown equivalent survival after sublobar resection (SLR) versus lobectomy in patients with clinical stage IA non-small cell lung cancer (NSCLC)≤2cm. High SUVmax is a known risk factor in NSCLC, yet limited data exists on whether a high SUV should preclude a SLR. This study aims to determine if there is an association between SUVmax and survival based on the extent of parenchymal resection. A retrospective review of a prospectively maintained institutional database was conducted to identify patients with clinical stage IA NSCLC≤2cm (2011-2020) treated with SLR or lobectomy. The primary outcome was cancer-specific survival (CSS). Secondary outcomes were overall survival (OS) and disease-free survival (DFS). 543 patients were identified; 36.8% had SLR and 63.2% had lobectomy. Baseline characteristics were similar. Patients who had SLR had significantly worse ECOG performance status and higher rates of comorbidities. 5-year CSS, OS, and DFS for the whole cohort were similar between SLR and lobectomy. A receiver operating characteristic curve estimated the SUVmax cutoff point to be 4.15. For the whole cohort, patients with SUVmax>4.15 had worse CSS compared to SUVmax≤4.15. However, there was no significant difference in 5-year CSS after SLR versus lobectomy in patients with SUVmax≤4.15 (98% in both groups; P=0.77) or patients with SUVmax>4.15 (90% versus 94% respectively; P=0.12). SUVmax may not be a useful clinical determinant of the extent of parenchymal resection in patients with cT1N0 NSCLC≤2cm. Patients treated by SLR had comparable survival to lobectomy, irrespective of PET avidity.

Emergency Department Visits Involving Hallucinogen Use and Risk of Schizophrenia Spectrum Disorder.

Interest in and use of hallucinogens has been increasing rapidly. While a frequently raised concern is that hallucinogens may be associated with an increased risk of psychosis, there are limited data on this association. To examine whether individuals with an emergency department (ED) visit involving hallucinogen use have an increased risk of developing a schizophrenia spectrum disorder (SSD). This population-based, retrospective cohort study (January 2008 to December 2021) included all individuals aged 14 to 65 years in Ontario, Canada, with no history of psychosis (SSD or substance induced). Data were analyzed from May to August 2024. An incident ED visit involving hallucinogen use. Diagnosis of SSD using a medical record-validated algorithm. Associations between ED visits involving hallucinogens and SSD were estimated using cause-specific adjusted hazard models. Individuals with an incident ED visit involving hallucinogens were compared with members of the general population (primary analysis) or individuals with ED visits involving alcohol or cannabis (secondary analysis). The study included 9 244 292 individuals (mean [SD] age, 40.4 [14.7] years; 50.2% female) without a history of psychosis, with a median follow-up of 5.1 years (IQR, 2.3-8.6 years); 5217 (0.1%) had an incident ED visit involving hallucinogen use. Annual rates of incident ED visits involving hallucinogens were stable between 2008 and 2012 and then increased by 86.4% between 2013 and 2021 (3.4 vs 6.4 per 100 000 individuals). Individuals with ED visits involving hallucinogens had a greater risk of being diagnosed with an SSD within 3 years compared with the general population (age- and sex-adjusted hazard ratio [HR], 21.32 [95% CI, 18.58-24.47]; absolute proportion with SSD at 3 years, 208 of 5217 with hallucinogen use [3.99%] vs 13 639 of 9 239 075 in the general population [0.15%]). After adjustment for comorbid substance use and mental health conditions, individuals with hallucinogen ED visits had a greater risk of SSD compared with the general population (HR, 3.53; 95% CI, 3.05-4.09). Emergency department visits involving hallucinogens were associated with an increased risk of SSD within 3 years compared with ED visits involving alcohol (HR, 4.66; 95% CI, 3.82-5.68) and cannabis (HR, 1.47; 95% CI, 1.21-1.80) in the fully adjusted model. In this cohort study, individuals with an ED visit involving hallucinogen use had a greater risk of developing an SSD compared with both the general population and with individuals with ED visits for other types of substances. These findings have important clinical and policy implications given the increasing use of hallucinogens and associated ED visits.

Dietary Habits, Nutritional Knowledge, and Their Impact on Thyroid Health in Women: A Cross-Sectional Study

Background: The thyroid gland plays a crucial role in regulating metabolism and various bodily functions through hormone production. Women are particularly susceptible to thyroid disorders such as hypothyroidism and Hashimoto’s disease, with associated symptoms affecting overall well-being. Prior research has inadequately addressed the influence of dietary habits and nutritional knowledge on thyroid health, especially in women. Objective: This study aimed to evaluate the dietary habits and nutritional awareness of women aged 18–45 with diagnosed thyroid disorders, emphasizing the effects of education level on knowledge and dietary practices. Material and Methods: A cross-sectional survey was conducted with 297 women diagnosed with thyroid conditions. The survey assessed demographics, comorbidities, hydration habits, and knowledge about nutrient intake critical for thyroid health. Chi-square tests, ANOVA, and correlation analyses were performed to evaluate associations. Results: Hypothyroidism and Hashimoto’s disease were most prevalent among younger women (18–25 years). A significant association was observed between higher education and knowledge of protein and carbohydrate roles in managing thyroid health (p &lt; 0.01). Women with higher educational backgrounds more frequently used healthier cooking methods and were more informed about beneficial nutrients, including vitamin D and omega-3. A chi-square test indicated that low water intake was significantly associated with comorbid conditions, including insulin resistance and cardiovascular disease (p &lt; 0.01). Conclusions: Significant gaps remain in dietary knowledge, particularly concerning protein intake and nutrient–drug interactions, indicating a need for targeted dietary education. Women with higher education demonstrated greater dietary awareness, emphasizing the importance of tailored educational interventions to enhance thyroid disorder management.

Comorbidity Pattern and Autonomic Nervous System Dysfunction in Patients with Chronic Vulvar Discomfort

This study examines novel concepts of comorbidity in patients with chronic vulvar discomfort using data from the DATRIV (Diagnostic Accuracy of Three Rings Vulvoscopy) study, which involved 328 participants categorized into four groups: asymptomatic individuals with normal or impaired vulvar skin and patients with chronic vulvar discomfort, classified as either vulvodynia or vulvar dermatosis. Clinical data were collected through a structured questionnaire and analyzed using statistical software, including StatSoft (Dell, Austin, TX, USA), Statistica 12 (TIBCO®, Palo Alto, CA, USA), and SPSS 20 (IBM, Armonk, NY, USA). The study received approval from the Institutional Review Board of Polyclinic Harni, and all participants provided written informed consent. The findings reveal significantly higher comorbidity rates in patients with chronic vulvar discomfort compared to other groups (p = 0.0000). A substantial percentage of asymptomatic participants with both normal (63.4%) and impaired (70.7%) vulvar skin also reported comorbid conditions. Analysis of comorbidity curves revealed distinct patterns of symptom progression, with a gradual increase in frequency from asymptomatic individuals to patients with vulvodynia, followed by a decline in vulvar dermatosis cases. These patterns highlight the central role of autonomic nervous system (ANS) dysfunction, where sympathetic hyperactivity and parasympathetic depression contribute to separate comorbidity chains. These dysfunctions may act independently or concurrently, leading to various health issues. The elevated comorbidity rates and overlapping symptomatology suggest complex pathophysiology driven by ANS dysregulation. Further research on comorbidity clusters may unveil new therapeutic targets and guide the development of multifaceted treatment strategies.

Abstract 4144549: Proof of Concept of a Novel Culinary Medicine Service Line to Address Diet-Related Cardiovascular Disease Risk Factors

Background: Poor diet has emerged as a top contributor to cardiovascular disease (CVD) in the United States. Evidence-based dietary strategies have been shown to decrease CVD risk by addressing comorbid conditions such as hypertension and diabetes, and there is a growing demand for practical nutrition guidance from health providers. However, implementation of nutrition support in healthcare settings remains limited due to lack of time, expertise, and reimbursement, necessitating creative interprofessional collaboration. Culinary Medicine (CM) combines medical nutrition education with culinary literacy and holds promise to address these challenges. Our study reports on the cascade implementation of a 3-prong CM service line which includes a CM eConsult, 1:1 CM specialty clinic, and shared medical appointment (group visit) in a teaching kitchen at a large, academic medical center from 2021 to 2024. Methods: A CM-specific eConsult was designed and launched on August 1 st 2021 utilizing existing eConsult workflows in the electronic health record. Next, an in-person, interprofessional CM specialty clinic launched at a community-based satellite clinic December 4 th 2022 open to referrals from physicians and patients. In April 2024, established patients in the CM clinic were invited to participate in six, biweekly cooking classes billed as shared medical appointments. A Microsoft PowerBI dashboard was developed to track patient demographics, referrals and participation, associated diagnoses, and billing data for the service line for continuous quality improvement. Results: In the first year of eConsults, 25 eConsults were completed with 19 (76%) reimbursed by insurance. In the first year from launch of the CM specialty clinic, 96 patients completed initial visits with a 100% insurance collections rate. In the recent launch of shared medical appointments, the initial cohort included 17 unique patients with 58% completing at least 4 of 6 classes. Referrals to the CM clinic included hypertension, hyperlipidemia, coronary artery disease, and type 2 diabetes as the top 4 associated diagnoses. Conclusions: We demonstrated proof-of-concept of a novel CM service line as an interprofessional, financially sustainable preventive strategy to target patients with diet-sensitive CVD risk factors such as diabetes, hypertension, and obesity. Future study will investigate the impact on biomarkers of CVD health for patients served by the CM service line.

Abstract 4118804: Use and Clinical Outcomes Associated with Urgent versus Elective Catheter Ablation of Atrial Fibrillation in the United States

Introduction: Catheter ablation of atrial fibrillation (AF) is an increasingly important evidence-based treatment option for select patients. Although typically performed as an outpatient elective procedure, the use and clinical outcomes of AF ablation pursued urgently among inpatients have not been adequately characterized. Hypothesis: Rate of urgent AF ablation, defined as an AF ablation procedure pursued among inpatients hospitalized for a non-procedural indication, has increased over time, and may be associated with worse outcomes. Aims: To describe the use and outcomes of urgent versus elective AF ablation. Methods: Using the NCDR AFib Ablation Registry, patients who underwent AF ablation from 1/1/2016 to 6/30/2023 were stratified according to whether AF ablation was urgent or elective. Logistic regression models were fitted to determine patient and hospital-level factors associated with use of urgent AF ablation. Cochrane-Armitage tests were used to test for trends over time. Unadjusted and adjusted in-hospital event rates were reported. Results: Among 140,051 patients, 2,714 (1.9%) underwent urgent inpatient AF ablation and 137,337 (98.1%) elective ablation. Compared with the elective cohort, those undergoing urgent ablation had higher rates of co-morbid conditions including: diabetes (30.6% vs. 20.4%, P&lt;0.0001), coronary artery disease (30.8% vs. 22.7%, P&lt;0.0001), and heart failure (47.1% vs 20.8%, P&lt;0.0001). Urgent AF ablation was more often used among patients of Black race (OR 1.68; 95% CI: 1.41 – 2.0) and those with AF at the time of the procedure (OR 1.73; 95% CI: 1.36 – 2.20). Higher hospital procedural volume of AF ablations ([per 100 cases] OR 1.22; 95% CI: 1.20 – 1.25) was also associated with higher odds of urgent AF ablation. The use of urgent AF ablation increased from 0.5% in 2016, to 2.0% in 2023 (P&lt;0.0001). Unadjusted event rates for AF-related complications were significantly higher for the urgent cohort (Figure). The adjusted rate of any procedure-related complication was significantly higher in the urgent cohort (urgent 4.9% vs. elective 2.4%, P&lt;0.0001). Conclusions: The rate of urgent inpatient AF ablation has increased over time. Compared with elective AF ablation, after adjustment for patient risk factors, urgent AF ablation is associated with significantly higher rates of procedural complications. Use of urgent, inpatient AF ablation should be carefully considered within clinical contexts and offered to select patients.

Abstract 4131815: The Prevalence of Normal Coronary Arteries as Determined by a Coronary Artery Calcium Score of Zero Amongst Subjects with Diabetes Mellitus

Background: The CDC reports that in 2021, 11.6% of the American population had diabetes mellitus (DM). Past literature has shown diabetes to be a significant risk factor for the development of atherosclerotic cardiovascular disease (ASCVD). Research Question/Goal: Using data obtained through Computed Tomography Angiography (CTA), we aim to distinguish the risk factors associated with a coronary artery calcium (CAC) score of zero in subjects with DM and to identify the prevalence of non-calcified plaque in individuals with this score. Methods: We performed a retrospective study of patients with DM, who underwent CAC and CTA screenings from October 2004 to January 2024 at our center in Torrance, California to examine CTA outcomes in those with CAC Score of zero and greater than zero. Results: Among the cohort of 2,763 subjects with DM, the average age was 63.8±12.2 years, 62% male. Within this cohort, 465 (17%) subjects had a CAC Score of zero compared to 2,298 subjects with a CAC Score greater than zero with a median score of 428 (Interquartile range (IQR) 91-1267). DM subjects with CAC Score of zero were significantly younger (53.0±13.9 versus 66.0±10.6: p&lt;0.001), were more likely to be female and had significantly lower rates of hypertension (57% versus 76%: p&lt;0.001), and hyperlipidemia (63% versus 76%: p&lt;0.001). In DM subjects with CAC Score of zero, 133 (29%) had a total plaque severity score of 1 or greater (median 1, IQR 1-2) while 332 (71%) had normal coronaries on CTA. Conclusions: A significant percentage of subjects with DM were determined to have a CAC score of zero. Subjects with normal coronary arteries were more likely to be younger, female, and/or absent of other chronic diseases such as hypertension and hyperlipidemia. Although age and sex are nonmodifiable risk factors of ASCVD, limiting the comorbid conditions associated with DM may be beneficial in preventing ASCVD in individuals with diabetes.

The effect of comorbidity on 28-day perioperative mortality rate among non-cardiac surgical patients in Northwest Ethiopia: a prospective cohort study using propensity score matching.

Non-communicable diseases account for nearly three-fourths of global deaths impacting public health and development. Coexisting diseases can complicate the management of surgical diseases, increasing the risk of perioperative mortality. Despite this, few studies have examined the burden of comorbidities among surgical patients and their effect on perioperative outcomes in low-income countries. In this study, we assessed the impact of comorbidity burden on 28-day perioperative mortality using a prospective data set. This was a facility-based prospective cohort study. Adult patients aged ≥ 18 who underwent non-cardiac surgery were included. Patients were followed for 28 days following surgery. Perioperative data were collected using an electronic data collection system from June 01, 2019, to June 30, 2021, at Tibebe Ghion Specialized Hospital, Northwest, Ethiopia. A propensity score-matched analysis was employed to assess the effect of comorbidity on the 28-day perioperative mortality rate. Of the 3030 patients included in this study, 715 (23.59%) had at least one comorbidity. Based on the prevalence rate, the top four comorbid conditions observed were hypertension (0.050), cancer (0.036), diabetes mellitus (0.021), and human immunodeficiency virus (0.021). The 28-day perioperative mortality rate was shown to be significantly higher among patients with comorbidity, where 45 (6.29%) of the 715 patients with comorbidity died compared to 49 (2.12%) of the 2315 patients with no comorbidity (p-value < 0.0001). After propensity score matching potential confounders, patients who have comorbidity had a 2.52% (average treatment effect on treated (ATT) = 0.0252) higher risk of perioperative death at 28 days after surgery compared with patients who did not have comorbidity. This study found a moderate prevalence of comorbid illnesses among non-cardiac surgical patients, with comorbidity increasing the risk of 28-day perioperative mortality. Preoperative screening and optimization are highly recommended for patients with comorbid illness to decrease perioperative mortality rate.

A PATIENT WITH OSTEOARTHRITIS AND HYPERTENSION IN GENERAL MEDICAL PRACTICE

Osteoarthritis is one of the most common diseases in Ukraine and worldwide, often leading to early disability in people of working age, making it both a medical and social concern. According to the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis, and Musculoskeletal Diseases, as well as the International Society for the Study of Osteoarthritis, it is known that a middle-aged patient with osteoarthritis typically has four accompanying pathologies. In elderly patients, in addition to osteoarthritis, up to eight other chronic conditions are often diagnosed. Comorbidity is frequently observed in middle-aged patients with osteoarthritis. Understanding the pathogenetic links between osteoarthritis and comorbid conditions plays an important role in the timely diagnosis and treatment of these diseases, helping to maintain a high quality of life for patients. Objevtive: the study of the pathogenesis of osteoarthritis and arterial hypertension, along with the proposed therapy for treating comorbidities in patients with both osteoarthritis and arterial hypertension, aims to enhance the treatment outcomes. Materials and methods. Analytical and bibliosemantic methods were used in this study. During the scientific search, 38 modern literature sources were reviewed and analyzed concerning the pathogenetic impact on the development of osteoarthritis and arterial hypertension, as well as their shared mechanisms in the development and progression of both conditions. The study was carried out at the Department of Family Medicine and Therapy of the Regional Rheumatology Center, M. V. Sklifosovsky Poltava Regional Hospital. A total of 50 people were examined; the main group consisted of 35 individuals with stage II hypertension, grade 2, combined with stage II knee osteoarthritis (according to the Kellgren-Lawrence scale), with joint dysfunction of stages 1-2. These patients were aged 40-65 years (mean age 51.8±2.14 years). The duration of hypertension was 10.07±1.24 years, and the duration of manifested osteoarthritis was 8.56±1.03 years. The comparison group consisted of 20 individuals with stage II, grade 2 hypertension (mean age 52.5±2.38 years), with a mean hypertension duration of 11.31±1.17 years. The clinical diagnosis of osteoarthritis was established according to the recommendations of the European Alliance of Associations for Rheumatology (2018). The diagnoses of comorbid conditions were confirmed in accordance with relevant orders from the Ministry of Health of Ukraine, with verification by specialized experts. Patients with osteoarthritis received standard treatment, and, when necessary, additional treatment for comorbid conditions was prescribed (a hypotensive combination of an ACE inhibitor and long-acting calcium. Results: The presence of osteoarthritis exerts an additional negative impact on heart rate variability in patients with hypertension. The reduction of the Low Frequency/High Frequency (LF/HF) index due to the use of this therapy (a combination of an ACE inhibitor and a long-acting calcium antagonist in doses of 4/5 mg, 4/10 mg, 8/5 mg, 8/10 mg) in the treatment of patients with comorbidity of hypertension and osteoarthritis contributes to the activation of the sympathetic nervous system, reduction of patient mortality, balancing of the nervous system by inhibiting sympathetic nervous tone, and lowering high blood pressure. Conclusions: The proposed combination therapy for patients with osteoarthritis and hypertension contributes to prolong remission of both the primary disease and comorbid conditions, reduces the frequency of hospitalizations, and shortens inpatient treatment by 3-4 days.

OSTEOARTHRITIS AND METABOLIC SYNDROME: KEY ASPECTS OF PATIENT MANAGEMENT

Introduction: Osteoarthritis is a major health concern, and along with coronary heart disease and arterial hypertension, forms a triad of the most common diseases among the adult population. Osteoarthritis significantly reduces the quality of life, leads to disability, and increases mortality rates. Globally, nearly 240 million people suffer from osteoarthritis (about 10% of men and 18% of women over the age of 60). In terms of disease burden, osteoarthritis ranks: first in complications of the musculoskeletal system, second in the number of visits to family doctors, and third in cases of disability. Patients with osteoarthritis, particularly those with comorbid conditions and metabolic syndrome, face a high prevalence of cardiovascular diseases and an increased risk of premature death. Goal: to elucidate modern insights into the pathogenetic links between osteoarthritis and metabolic syndrome, and to justify new approaches to improving treatment for patients with this pathology. Materials and Methods: A literature search was conducted using scientific databases, employing methods of analysis, comparison, and generalization of information about the relationship between osteoarthritis and metabolic syndrome. The study was carried out at the Department of Family Medicine and Therapy at Poltava State Medical University, based in the Regional Rheumatology Center of M. V. Sklifosovskiy Poltava Regional. The study involved 40 patients, both outpatients and inpatients, including 26 women (65%) and 14 men (35%), aged 54-69 years, with primary osteoarthritis of X-ray stages I-II according to the Kellgren-Lawrence scale, in combination with metabolic syndrome. The control group consisted of 20 individuals. Results. A 12-month monitoring of this group of patient was conducted, revealing mild to moderate manifestations of metabolic syndrome along with polymorbid conditions such as chronic obstructive lung diseases and genitourinary system disorders. Most frequently, one, and rarely two, comorbid conditions were detected, along with one or two diseases unrelated to osteoarthritis. The most common progressive conditions observed were arterial hypertension, ischemic heart disease, heart failure, obesity, type 2 diabetes, and digestive system diseases. The primary goal in managing patients with osteoarthritis and metabolic syndrome is to significantly reduce cardiovascular risk and mortality. This involves developing a comprehensive concept of metabolic syndrome and osteoarthritis, identifying patients at high cardiovascular risk, and implementing preventive measures, including lifestyle modifications and the use of appropriate medications. Conclusions. The study revealed a significant clinical effect from the use of therapy that included coxibs in 78% of patients in the main group with osteoarthritis combined with metabolic syndrome. A positive outcome was observed in terms of pain reduction, a reduction in inpatient treatment duration by 2-3 days, and extended remission periods. For this category of patients, primary prevention should focus on weight loss, increased physical activity, and normalization of metabolic disorders.

Influence of Injury Patterns and Management Strategies on Outcomes in Trauma Patients with Epistaxis.

Background: Epistaxis is a common emergency, particularly in the context of trauma. Understanding patterns and outcomes of epistaxis in a trauma setting can inform treatment strategies and improve patient care. Objectives: To evaluate the demographic characteristics, clinical features, and outcomes of patients treated for epistaxis following trauma. Methods: This retrospective case-control study included 1106 patients from the National Trauma Data Bank diagnosed with trauma-related epistaxis. The clinical outcomes assessed included hospital stay duration, complication rates, and mortality. Results: In comparison with younger patients, older patients were found to undergo operative intervention significantly more frequently (median age, 65 years vs 44 years; P < .001). The prevalence of cardiovascular and psychiatric comorbidities was higher in the operative group (P = .004 and P = .041, respectively). Mortality risk was not found to be independently influenced by epistaxis management approach. Conclusions: In older individuals with comorbid conditions, trauma-related epistaxis is more likely to result in operative intervention and associated complications. Nonetheless, the management of epistaxis does not appear to have a significant impact on mortality risk.

LUTS in Older Adults: Definitions, Comorbidity Impact, Patient Priorities, and Treatment Strategies for Managing Daytime and/or Nighttime Symptoms - ICI-RS 2024.

Lower urinary tract symptoms (LUTS) are prevalent among older adults, a population that faces multiple medical challenges, with frailty being a major concern. Despite the high prevalence of LUTS, current treatment strategies for older adults are often inadequate. This paper aims to address these issues by defining daytime and/or nighttime LUTS and examining the impact of comorbid conditions on these symptoms. We will identify the priorities of older patients regarding LUTS management and propose treatment strategies to improve outcomes in this vulnerable population. This review is based on discussions at the ICI-RS 2024 meeting in Bristol, UK, alongside an extensive literature review examining LUTS in older adults. The review explores distinctions between daytime and nighttime symptoms, the impact of frailty, patient priorities, treatment strategies and the role of comorbidities. LUTS in older adults present a complex and multifaceted challenge, with notable differences between daytime and nighttime manifestations, which may coexist. Clear definitions are needed. There is a lack of evidence that treating associated comorbidities will improve LUTS or urinary incontinence. Personalized care approaches, integrated into broader geriatric health strategies, are essential for addressing these symptoms. An ideal treatment strategy is proposed, focusing on daytime, nighttime or combined day- and nighttime LUTS. Further research is needed to refine treatment pathways and optimize outcomes for this population. A comprehensive, individualized approach is necessary to address LUTS in older adults. Future research should focus on refining diagnostic definitions, exploring the interplay between comorbidities and LUTS, and developing patient-centered treatment strategies that account for both daytime and nighttime (or combined) symptoms.