Comorbid Illnesses Research Articles

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.

Quasi-Experimental Study: Evaluating the Effectiveness of Jacobson Relaxation Techniques on Pain Among Post-COVID Geriatrics with Co-morbid Illness

Introduction: Jacobson's progressive muscle has been widely recognized for its potential benefits in pain management, particularly in populations experiencing high levels of stress and anxiety, which are common in post-COVID patients. Objectives: This study aimed to evaluate the effectiveness of Jacobson Relaxation Techniques on pain among post-COVID geriatrics who had co-morbid illness. Methods: Quantitative study was selected for the study. A total of 82 participants were selected using purposive methods allocated to either the intervention group (n=41) or the control group (n=41). Pain levels were assessed using the Numeric Pain Rating Scale (NPRS) at baseline and after a week of intervention. Descriptive statistics and inferential analysis were employed to analyze the data. Results: The study finding revealed that the intervention group had a pre-intervention pain score of 7.2 ± 1.5, which reduced to 4.5 ± 1.2 post-intervention, indicating a noticeable reduction in pain levels following the intervention. In contrast, the control group had a pre-intervention pain score of 7.0 ± 1.4, which showed a minimal reduction to 6.8 ± 1.3 post-intervention, suggesting that the control condition had little to no impact on pain levels. The intervention group demonstrated a significant reduction in pain scores compared to the control group post-intervention (p &lt; 0.05), indicating the efficacy of Jacobson Relaxation Techniques in pain management among post-COVID geriatrics with co-morbid illness. Conclusions: Jacobson Relaxation Techniques offer a valuable non-pharmacological approach for alleviating pain in post-COVID geriatrics with co-morbid illness. Further study recommended on the integration of these techniques into clinical practice can improve the quality of life for this vulnerable population, addressing a critical aspect of post-COVID care.

Autonomic and Immune Stress Response Networks in Patients Living With HIV.

Stress response systems are frequently dysregulated in patients with chronic inflammatory disorders. Pre-clinical studies have demonstrated direct influences of the sympathetic and vagal/parasympathetic branches of the autonomic nervous system (ANS) on the immune system. However, these connections have not been examined in humans. We hypothesized that the subtype and severity of autonomic neuropathy (AN) would predict immune phenotypes with distinct clinical and demographic characteristics in people living with HIV. This is a cross-sectional study of 79 adult people with a history of well-controlled HIV on stable combination antiretroviral treatment (CART) recruited from a primary care clinic network within the Mount Sinai Health System in New York City. All participants underwent a standardized battery of autonomic function tests summarized as the Composite Autonomic Severity Score (CASS) and vagal and adrenergic baroreflex sensitivity (BRS-V and BRS-A). Immune profiling included: 1) measurement of interleukin-6 (IL-6) as part of the Olink assay Target 96 Inflammation Panel, 2) non-negative matrix factorization (NMF) clustering analyses on Olink immune biomarkers, and 3) mass cytometry (CyTOF) on a subset of participants with and without autonomic neuropathy (N = 10). Reduced activity of caudal vagal circuitry involved in the cholinergic anti-inflammatory pathway (CAP) predicted higher levels of IL-6 (Spearman's rho = -0.352, p=0.002). The comprehensive assessment of the ANS-immune network showed four immunotypes defined by NMF analyses. A pro-inflammatory immunotype defined by elevations in type 1 cytokines (IL-6, IL-17) and increased numbers of CD8+ T-cells was associated with autonomic neuropathy (AN). This association was driven by deficits in the cardiovascular sympathetic nervous system and remained strongly significant after controlling for the older age and greater burden of co-morbid illness among participants with this immunotype (aOR=4.7, p=0.017). Our results provide novel support for the clinical relevance of the CAP in patients with chronic inflammatory AN. These data also provide insight regarding the role of the sympathetic nervous system and aging in the progression and development of co-morbidities in patients with chronic HIV and support future research aimed at developing therapies focused on modulation of the sympathetic and parasympathetic/vagal nervous system.

Hypertension guideline implementation and blood pressure control in Matlosana, South Africa.

High systolic blood pressure remains a leading modifiable risk factor for cardiovascular diseases worldwide and in South Africa (SA). Information about the extent of guideline implementation and blood pressure (BP) control is lacking in Matlosana Sub-district, North West province, SA. The study aimed to assess the implementation of the South African Hypertension Practice Guideline (SAHPG) and BP control in adults attending primary care facilities in Matlosana. Cross-sectional study was conducted, using 523 randomly sampled medical records. Data collected included demographic information, recorded BP readings, anthropometry, screening for target organ damage (TOD), hypertension complications, comorbidities, lifestyle advice and drug therapy. According to the reviewed records the mean age of the participants was 56.77 years with a standard deviation of 12.4 years and 376 (71.9%) records belonged to females. Blood pressure control was documented in 229 (43.8%) of the medical records, with better control recorded in a group with comorbid human immunodeficiency virus (HIV) than in groups with other comorbidities. The study found poor documentation of the SAHPG recommendations among patients with hypertension. According to the patient records BP control was suboptimal, the most common documented comorbid illness was HIV, and screening for TOD was generally poorly documented.Contribution:Programmes that audit and improve the quality of hypertension guideline implementation and BP control in primary care require ongoing support and research.

Hypothermia and Influence of Rewarming Rates on Survival Among Patients Admitted to Intensive Care with Bloodstream Infection: A Multicenter Cohort Study.

Although critically ill patients with bloodstream infections (BSIs) who present with hypothermia are at the highest risk for death, it is not known how rewarming rates may influence the outcomes. The objective of this study was to identify the occurrence and determinants of hypothermia among patients admitted to intensive care units (ICUs) with BSI and assess how the rate of temperature correction may influence 90-day all-cause case-fatality. A cohort of 3951 ICU admissions associated with BSI was assembled. The lowest temperature measured within the first 24 hours of admission was identified, and among those who were hypothermic (<36°C), the rewarming rate [(time difference between lowest and subsequent first temperature ≥36°C) divided by hypothermia severity (difference between lowest measured and 36°C)] was determined. Within the first 24 hours of admission to the ICU, 329 (8.4%) and 897 (22.7%) subjects had the lowest temperature measurements ranging <34.9°C and 35-35.9°C, respectively. Patients with lower temperatures were more likely to be admitted to tertiary care ICUs, have more comorbid illnesses, have greater severity of illness, and have a higher need for organ-supportive therapies. The 90-day all-cause case-fatality rate was 22.9% overall and was 45.3%, 24.8%, and 19.6% for those with the lowest 24 hours temperatures of <35°C, 35-35.9°C, and ≥36°C, respectively (p < 0.001). Among 1133 hypothermic patients with documented temperatures corrected to the normal range while admitted to the ICU, the median rate of temperature increase was 0.24 (interquartile range, 0.13-0.45)oC/hour. After controlling for the severity of illness and comorbidity, a faster rewarming rate was associated with significantly lower 90-day case-fatality. Hypothermia is a significant risk factor associated with death among critically ill patients with BSI that faster rates of rewarming may modify.

Autism diagnostic aid (ADA) tool for use in adults with intellectual disability: development, face and content validation

Purpose Individuals with intellectual disability have an increased predisposition to other co-morbid physical health conditions, mental illness and neurodevelopmental conditions including autism spectrum condition. There are challenges in diagnosing autism in adults with intellectual disability, and these are often attributes to the complexities in symptoms. The purpose of this paper is to describe the development of the autism diagnostic aid (ADA) tool and face and content validation of its properties. Design/methodology/approach The ADA tool was developed following a detailed scoping exercise which included literature reviews, observations and discussion with wider multi-disciplinary team members. A face and content validation after consultation with eight experts who are trained and routinely perform assessments for autism spectrum disorders. The experts also have expertise in working with individuals with intellectual disability. Findings The experts agreed that the ADA tool is appropriate to the targeted construct and assessment objectives as a diagnostic aid in the assessment of autism in adults with intellectual disability. They also determined that the content of ADA tool was valid for its use as a diagnostic aid in the diagnosis of adults with intellectual disability. Research limitations/implications The ADA tool was considered a valid tool from the expert’s perspective. It was identified to have a good face and content validity. To the best of the authors’ knowledge, the ADA is first of its kind tool, developed specifically to aid clinicians with autism assessments in adults with intellectual disability. Practical implications This tool could potentially help with timely assessment and help with providing appropriate intervention but would require further exploration. Originality/value To the best of the authors’ knowledge, this is the first of its kind tool for the assessment of autism in adults with intellectual disability.

COVID-19 Deaths in Transnational Settings: Disrupted Bereavement and Pandemic-Related Prolonged Grief Disorder in the Latinx Immigrant Population.

The Latinx immigrant population experienced one of the highest COVID-19 death rates. Those left behind have exhibited rising rates of mental illness, particularly, pandemic-related prolonged grief disorder. The Latinx immigrant population is uniquely vulnerable to this disorder as a result of disrupted culturally appropriate bereavement practices, constrained social support, and concurrent COVID-19 stressors and immigration-related trauma. Despite a rising call for research on pandemic-related prolonged grief disorder, little is known about the true prevalence, cause, and appropriate treatment protocol behind this disorder in the Latinx immigrant population. Four areas of research critical to the identification and understanding of pandemic-related prolonged grief disorder in this population are recommended: 1) death and bereavement in transnational settings, 2) immigrant social networks and disrupted bereavement, 3) COVID-19 stressors and grieving, and 4) prolonged grief disorder and mental illness comorbidities. An understanding of these four contributing areas to Latinx immigrants' vulnerability to prolonged grief disorder is imperative to providers' development of assessments and treatment protocols needed to identify and treat prolonged grief disorder in this population.

8113 Thyroid Storm in a Patient with Thyroid Nodule on Anticoagulation

Abstract Disclosure: R. Kulkarni: None. S.S. Krishnasamy: None. N. Mon: None. R. Downs: None. Background: There are very few case reports related to hyperthyroidism due to anticoagulation use. We describe a case, of a less common cause of hyperthyroidism due to hemorrhagic thyroiditis in a patient on anticoagulation and history of metastatic colon cancer. Clinical case: A 67-year-old white male with PMH significant for colon cancer with liver metastasis s/p exploratory laparotomy with sigmoid colectomy, end-colostomy with Hartman's pouch creation, pre-diabetes, recent left IJ &amp; axillary vein thrombus on Eliquis, and thyroid nodule; presented with complaints of shortness of breath, difficulty swallowing and dizziness. Other symptoms included weight loss, complaints of heart racing and generalized body aches. The patient had a recent admission for similar complaints and was newly diagnosed with left IJ/axillary vein thrombus and expanding hemorrhagic thyroid nodule on imaging. He was discharged on anticoagulation for the DVT with 2 week follow up for elective thyroidectomy for goiter. The patient was admitted to the ICU for worsened respiratory status needing ventilatory support and pressor support. Physical findings on admission included jaundice, sinus tachycardia, lethargy with agitation. Initial labs showed TSH 0.02 uIU/mL, FT4 4.85 ng/dL and FT3 6.8 pg/mL, LFTs &amp;gt;500 U/L. Burch-Wartofsky Point Scale score was &amp;gt;60 suggestive of thyroid storm. Imaging with PET CT was concerning for thyroid enlargement with multiple nodules with increased uptake. Thyroid US was consistent with heterogenous gland with hemorrhagic nodules. Based on clinical history, physical findings, diagnostic labs, and imaging the patient was diagnosed with severe hyperthyroidism with thyroid storm secondary to hemorrhagic thyroid nodules in the setting of anticoagulation. The patient underwent thyroid artery angiogram with particle embolization of left inferior and right superior thyroid arteries. Endocrinology started the patient on methylprednisolone, cholestyramine and propranolol. Thionamide was held since the patient had abnormal liver function tests in the setting of shock liver. The patient’s thyroid function slowly improved on current regimen to TSH 0.05 uIU/mL, FT4 1.7 ng/Dl and FT3 4.1 pg/mL on day 3. At the family interdisciplinary meeting, due to guarded prognosis, family opted for comfort care, and the patient finally succumbed to multiple co-morbidities. Conclusion: The case presented discusses diagnosis and management of less common causes of hyperthyroidism and management of thyroid storm in liver dysfunction. The patient would have needed a thyroid biopsy at a later date to rule out colonic metastasis as a cause of hemorrhage if he had survived the thyroid storm and comorbid illnesses. Presentation: 6/3/2024

Ovothiol-A Mitigates High-Fat Diet-Induced Non-alcoholic Fatty Liver Disease in Rats

Background: Obesity is frequently linked to multiple comorbid and chronic illnesses, including non-alcoholic fatty liver disease, type 2 diabetes, cancer, and heart disease. Ovothiol-A is one of the most powerful natural antioxidants found in marine invertebrates like sea urchins. Objective: The current study aimed to investigate ovothiol-A's hypolipidemic and hypoglycemic potential in obese rats. Methods: All groups get a high-fat diet (HFD) for four weeks except for the control group. The control and HFD groups received distilled water, while the Ovothiol-A groups received two doses of Ovothiol-A (200 and 400 mg/kg orally) concurrent with HFD. Results: Weight gain, glucose, insulin, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, alkaline phosphatase, total cholesterol, triglycerides, low-density lipoprotein, malondialdehyde, and nitric oxide were all decreased after oral administration of Ovo at either the 200 or 400 mg/kg dose, while levels of high-density lipoprotein (HDL), glutathionereduced, catalase and glutathione-S-transferase increased. Histopathological alterations were less noticeable in the liver tissue of Ovothiol-A groups, with only a few vacuolated or pyknotic nuclei amongst a few dispersed hepatocytes. Conclusion: The current findings indicate that ovothiol-A protects against high-fat diet-induced fatty liver in rats. The anti-obesity mechanism of Ovothiol-A is associated with its hypolipidemic, hypoglycemic, and antioxidant properties.

Length of Stay, Readmission Rates, and Mortality Are Similar Between Hospitalized Individuals With Sickle Cell Disease With and Without COVID-19.

Background We sought to clarify the impact of COVID-19 on clinical outcomes in sickle cell disease patients, given their baseline hypercoagulable state in combination with COVID-19-related coagulopathies and other complications. Methods Retrospective chart review of two groups of sickle cell disease patients hospitalized between March 2020 to December 2021: Group 1 did not have COVID-19 (n = 95) and Group 2 did (n = 73). Results Groups 1 and 2 were similar in terms of age, race, sex, comorbid illnesses, genotype, hydroxyurea use, and opioid use. Group 1 and 2 patients had a mean hospital length of stay of 7.05 and 7.64 days, respectively (p = 0.981). ICU-level care was required for six (6.3%) Group 1 patients and four (5.5%) Group 2 patients (p = 1.000). Readmissions within 30 days occurred for 25 (26.3%) Group 1 patients, and 18 (24.7%) Group 2 patients (p = 0.807). Death occurred for one (1.05%) Group 1 patient and one (1.4%) Group 2 patient (p = 1.000). There were no significant differences in commonly ordered initial laboratory values (total bilirubin, hemoglobin, hematocrit, creatinine, lactate dehydrogenase, and D-dimer) between Group 1 and Group 2 patients. Conclusions We observed no significant differences in clinical outcomes among sickle cell disease patients hospitalized due to COVID-19 compared to those without COVID-19.

Opportunistic infections changed before and after SARS-CoV-2 infection in inflammatory bowel disease patients: a retrospective single-center study in China.

SARS-CoV-2 transmission has become a serious worldwide public health concern. However, there is currently insufficient data to determine whether SARS-CoV-2 infection would affect opportunistic infections in inflammatory bowel disease (IBD) patients. A retrospective study included 451 IBD patients (294 UC and 157 CD). The IBD patients were divided into two groups: before SARS-CoV-2 infection and after SARS-CoV-2 infection, and outcomes were measured for these groups. The primary outcome was the presence and distribution of opportunistic infections. The secondary outcomes included factors associated with opportunistic infections, based on which a nomogram prediction model was developed and validated. After SARS-CoV-2 infection, the proportion of IBD patients with opportunistic infections by Clostridium difficile (21.31% vs. 14.01%, p = 0.044) and Epstein-Barr virus (13.93% vs. 4.35%, p = 0.001) was significantly higher compared to that before. Conversely, the proportion of patients with hepatitis B virus (3.69% vs. 10.14%, p = 0.006) and herpes simplex virus type I (1.23% vs. 4.35%, p = 0.04) infections was significantly lower after the infection. Additionally, pre-SARS-CoV-2 infection factors associated with opportunistic infections in IBD include duration of illness, red blood cell count, the presence of comorbid chronic illnesses, and alcohol consumption, while post-SARS-CoV-2 infection, the primary risk factors involve corticosteroid use, red blood cell count, protein level, and high-sensitivity C-reactive protein. After the SARS-CoV-2 infection, there has been a shift in the occurrence of opportunistic infections among IBD patients. It might be attributed to the use of corticosteroids and also the strengthening of containment measures, heightened public health awareness, and widespread vaccination.

DIAGNOSTIC ACCURACY OF BOEY SCORE TO PREDICT 30 DAYS MORTALITY IN PERFORATED PEPTIC ULCER PATIENTS

Perforated peptic ulcers remain a life-threatening condition despite advancements in surgical and medical treatments. Accurate risk stratification of patients can improve outcomes by guiding clinical decision-making. The Boey scoring system is widely used for predicting mortality in patients with perforated peptic ulcers, yet its diagnostic accuracy warrants further evaluation. Objective: This study aimed to evaluate the diagnostic accuracy of the Boey score in predicting 30-day mortality among patients with perforated peptic ulcers. Methods: This cross-sectional study was conducted at the Department of Surgical Unit VI, Civil Hospital Karachi, over a six-month period from December 7, 2020, to June 7, 2021. A total of 149 patients diagnosed with perforated peptic ulcers were included using non-probability consecutive sampling. The Boey score was calculated for each patient based on preoperative shock, comorbid illness, and duration of perforation &gt;24 hours. The primary outcome measure was 30-day mortality. Descriptive statistics were used to assess the frequency distribution of mortality, and the association between Boey score and mortality was analysed using appropriate statistical methods, with significance set at p &lt; 0.05. Results: The study included 149 patients, with a minimum age of 21 and a maximum age of 50. Of the total, 32 patients (21.5%) experienced 30-day mortality. Among patients with a Boey score of 1, 2.68% had 30-day mortality, and 0.67% of patients with a Boey score of 2 died. Patients with a Boey score of 3 had the highest mortality rate, with 18.1% of this group experiencing 30-day mortality. In contrast, 81.9% of patients with a Boey score of 1 to 3 survived beyond 30 days. Conclusion: The Boey scoring system demonstrated vital predictive accuracy for 30-day mortality in patients with perforated peptic ulcers. This scoring tool effectively identifies high-risk patients, allowing for timely and appropriate management. Despite modern treatment advances, perforated peptic ulcer remains associated with significant mortality, particularly in high-risk patients, as identified by the Boey score.

Oxa-Iboga alkaloids lack cardiac risk and disrupt opioid use in animal models

Ibogaine and its main metabolite noribogaine provide important molecular prototypes for markedly different treatment of substance use disorders and co-morbid mental health illnesses. However, these compounds present a cardiac safety risk and a highly complex molecular mechanism. We introduce a class of iboga alkaloids – termed oxa-iboga – defined as benzofuran-containing iboga analogs and created via structural editing of the iboga skeleton. The oxa-iboga compounds lack the proarrhythmic adverse effects of ibogaine and noribogaine in primary human cardiomyocytes and show superior efficacy in animal models of opioid use disorder in male rats. They act as potent kappa opioid receptor agonists in vitro and in vivo, but exhibit atypical behavioral features compared to standard kappa opioid agonists. Oxa-noribogaine induces long-lasting suppression of morphine, heroin, and fentanyl intake after a single dose or a short treatment regimen, reversal of persistent opioid-induced hyperalgesia, and suppression of opioid drug seeking in rodent relapse models. As such, oxa-iboga compounds represent mechanistically distinct iboga analogs with therapeutic potential.

Clinical characteristics and risk factors for lupus flares in sub-Saharan Africa-retrospective cross-sectional study.

Systemic lupus erythematosus (SLE) is an autoimmune disease with a variable course with unpredictable flares. Identifying predictors of these flares is essential for monitoring and timely hospital care. To characterize the prevalence of flares within the first five years of SLE diagnosis and determine the clinical and immunological characteristics associated with flare development among patients attending the Rheumatology Clinic at Tikur Anbesa Specialized Hospital (TASH) and Lancet General Hospital. A multicenter, cross-sectional study was conducted from May 2023 to November 2023 at TASH and Lancet General Hospital. The data was collected from electronic medical records and analyzed using SPSS version 26. Logistic regressions were used to determine factors associated with lupus flare. Most patients with SLE were female (95.4%). The most common clinical presentations were musculoskeletal (71.8%), cutaneous (55%), and constitutional (22%). Almost half (44.3%) of the patients had comorbidity illness. Positive ANA test was found in 96.5% of the patients, whereas only 55% had positive anti-dsDNA test. The prevalence of SLE flare in the first five years of SLE diagnosis was 38.9%, and most flares occurred within the first year of diagnosis. Patients with the following characteristics were more likely to have flare-ups: younger age at diagnosis (less than 25years old), initial presentation with vasculitis, renal flare, and being on low-dose prednisolone. The most common clinical presentations were musculoskeletal, dermatologic, and constitutional manifestations. Age < 25years at diagnosis, initial clinical presentation with renal manifestation, and being on low-dose prednisolone were predictors of SLE flare. Key Points • This study found a significant gender disparity, with 95% female. • Nearly 39% of patients experienced an SLE flare within the first five years of diagnosis. • Over three-quarters (77%) of flares occurred within the first year of diagnosis. • Age less than 25years, initial presentation with vasculitis, renal involvement, and being on low-dose prednisolone were identified as predictors of flares.

Early Outcome of Percutaneous Cooled Radiofrequency Ablation in Degenerative Lumbar Facet Arthropathy and Sacroiliac Dysfunction with Associated Comorbid Illness: A Prospective Observational Study

Abstract Study Design: This was a prospective observational study. Objectives: We report clinical outcomes in a clinical study of patients treated with cooled radiofrequency ablation for chronic back pain associated with lumbar facet arthropathy with sacroiliac dysfunction (unilateral as well as bilateral) associated with multiple medical comorbidities. Summary of Background Data: A clinical study was conducted on patients with lumbar facet arthropathy with sacroiliac dysfunction. A significant difference was observed postprocedure during periodical follow-ups. Materials and Methods: A prospective observational study of 56 patients suffering from lumbar facet arthropathy with sacroiliac joint dysfunctions was conducted at Apollo Multi-Speciality Hospital, Kolkata, from July 2022 to July 2023 over 1 year. Inclusion criteria are chronic low back pain with degenerative lumbar facet arthropathy with sacroiliac dysfunction with sacroiliitis and patients with failed back syndrome which fails on conservative management for at least 3 months in more than 30-year-old patients. The outcome assessment of all patients was done by the Visual Analog Scale (VAS) scores and Oswestry Disability Index (ODI) scores and followed up for 0, 1, 3, and 6 months and 1 year. Results: We found significant relief in pain with a significant statistical difference on subsequent follow-up over 6 months to 1 year using VAS and ODI scores. We did not get any major complications in our study despite elderly patients with multiple medical comorbidities. Conclusion: Cooled radiofrequency significantly improves the pain associated with lumbar facet arthropathy with sacroiliac dysfunction with promising results.

Efficacy of Platelet-Rich Plasma Versus Steroids In Patients of Tennis Elbow

Objective: To compare the efficacy of Platelet Rich Plasma versus Steroids among patients managed for Tennis elbow at our Orthopaedic unit. Study Design: Quasi-experimental study. Place and Duration of Study: Orthopaedic Department, Combined Military Hospital, Rawalpindi Pakistan, from Jan 2021 to Jul 2022. Methodology: Patients with Tennis Elbow diagnosed by a consultant orthopaedic surgeon were included in the study. They were randomly allocated treatment with platelet-rich plasma and steroid injections. The team assessed them after three months of treatment using the Disabilities of Arm, Shoulder, and Hand score. Different factors, including mode of treatment, were associated with significant improvement in these patients at the end of three months. Results: Out of 250 patients with tennis elbow included in the final analysis, 193(77.2%) were male, and 57(22.3%) were female. Patients were divided into two groups for comparison, and Group-1 had significant improvement, while Group-2 had no improvement. Out of the total, 117(46.8%) patients received platelet-rich plasma, while 133(53.2%) patients were managed with corticosteroids. The presence of comorbid illnesses and the use of platelet-rich plasma was statistically significantly found in a group with significant improvement in Disabilities of Arm, Shoulder, and Hand score (p-value&lt;0.05) as compared to a group of patients without significant improvement. Conclusion: Most patients had significant improvement in symptoms at the end of three months. In our study, patients who were managed with platelet-rich plasma and had no comorbid illness had more chances of significant improvement at the end of three months.

Adult sickle cell disease and SARS-CoV-2: an increasingly common comorbidity for a rare disease

Sickle cell disease (SCD) is a collection of genetic lesions that manifest in the diminished effectiveness of hemoglobin. We collected and reviewed the recent and extant literature on SARS-CoV-2 (COVID-19) and SCD. We posit an answer to the question associated with any adaptive responses to COVID-19 in individuals with SCD. We collected papers from MEDLINE and all available published papers on COVID-19 and SCD. Unlike a formal meta-analysis, given the early phase of this review in the pandemic, we did not seek unpublished papers. We found an emerging literature where case studies dominated, and traditional large N epidemiological studies were absent. Patients with SCD share many comorbid illnesses with an increased risk of mortality associated with contracting COVID-19. There is sufficient empirical justification to accelerate research on the impact of a viral pathogen like COVID-19 on individuals with SCD. *************************************************************** List of all authors: Michaela Boggan,1,2,3 Christopher L. Edwards,1,2,3 Jordan Meek,1,2,3 Mary Wood,4 W. Jeff Bryson,5 John J. Sollers,1,2,3 Debra O. Parker,1,2,3 Camela S. Barker,2,5 Jessica Miller,2,6 Brianna Downey,2,5 Asha Lockett,2,5 Jazmin Rosales,1,2,3 Courtney Munroe, Jr.,2 Noa Wax,2,5 Sharena Scott,1,2,3 Bridget Pittman,1,2,3 Merell Turner,1,2,3 Hillary T. Dietahin,1,2,3 Eric Smith,1,2,3 Alexandria McDougald,1,2,3 Samantha Beavers,1,2,3 Lakaiya Meadows,1,2,3 Maya Walker,1,2,3 Andrea Richardson,1,2,3 John J. Sollers, IV,2,8 Grace D. Donahue,2,8 Goldie Byrd,7 Malik Muhammad,1,2 Alvin Kidd,9 Walter Charles,1,2 Jonathan Livingston,1,2,3 Shiv Sudhakar10 1North Carolina Central University; 2NCCU Psychoneuroendocrine and Rare Diseases Laboratory; 3NCCU Debra O. Parker Research Incubator; 4Duke University Medical Center; 5Fielding Graduate University; 6Bridges Point Sickle Cell Foundation; 7Wake Forest Medical Center; 8Thomas Moore University; 9Livingston College; 10California Northstate University, United States

Causal Inference of the Effect of Vaccination on COVID-19 Disease Severity and Need for Intensive Care Unit Admission Among Hospitalized Patients in an African Setting.

Background Coronavirus disease 2019 (COVID-19) is a novel, primarily respiratory, coronavirus that became a pandemic when it spread to over 210 countries and led to the death of over six million people. There is no definitive treatment for COVID-19, but vaccines have been developed that can help prevent severe illness and death. Studies have investigated the effect of vaccination on disease severity and outcome, and the findings indicate that vaccination is linked to a significant reduction in the risk of hospitalization, intensive care unit (ICU) admission, and disease mortality. However, there is a scarcity of evidence in Africa in general, and no similar study has been conducted in Ethiopia yet. Therefore, the study aimed to assess the effect of vaccination on COVID-19 disease severity and the need for ICU admission among hospitalized patients at a private specialty clinic in Ethiopia. Methods A retrospective cohort study was conducted among 126 patients with COVID-19, 41 vaccinated and 85 unvaccinated, who were hospitalized between September 2021 and May 2022. Data were summarized using frequency (percentage) and median (interquartile range (IQR)). To compare the characteristics of the two groups, Chi-square/Fisher's exact and Mann-Whitney U tests at p-values of ≤ 0.05 were used. To identify the effect of vaccination on COVID-19 disease severity, a marginal structural model (MSM) with an inverse probability weighting (IPW) approach using a robust Poisson regression model was fitted. Adjusted relative risk (ARR) and 95% confidence interval (CI) for ARR were used for interpreting the result. Results The cohort included groups that were comparable in terms of their sociodemographic and clinical characteristics. More than half of the participants were older than 60 years (n = 66, 52.4%), were males (n = 71, 56.3%), and had one or more comorbid illnesses (n = 66, 52.4%). At admission, 85 (67.5%) had severe disease, and 11 (8.7%) progressed after hospitalization and required ICU admission, of which three unvaccinated cases died. From the final model, vaccination was found to be associated with a 62% decreased risk of developing severe COVID-19 disease if infected, compared to not getting vaccinated (ARR = 0.38, 95% CI = 0.23-0.65, p < 0.0001). Conclusions The study's findings support previous reports that vaccinated people are less likely to develop severe COVID-19 disease if later infected with the virus, emphasizing the importance of continuing efforts to promote COVID-19 vaccination not only to safeguard individuals but also to confer community-level immunity.

Stenotrophomonas Maltophilia Infection in Cancer Patients Undergoing Major Surgery in A Tertiary Cancer Centre

Background: We aim to study the impact of postoperative Stenotrophomonas maltophilia infections among cancer patients undergoing major surgery. Methods: Ambispective, observational study. Study period from 1st November 2019 to 31st March 2024. The study population included patients with a definite diagnosis of cancer who underwent a major surgical procedure in a single, dedicated surgical unit and developed postoperative infection which showed a documented growth of Stenotrophomonas maltophilia. Clinical and laboratory parameters were collected and data represented as median values, percentages and range. Results: Nine patients were identified to have Stenotrophomonas maltophilia infection in the postoperative period among a total of 2506 patients. Co-morbid illnesses were noted in 33.3% patients; all were nosocomial infections. Fever was a manifestation in 77.8% patients, 44.4% had leukocytosis. Of all samples, 33.3% were respiratory ones. Co-infection was noted in 44.4% patients. Sensitivity to trimethoprim-sulphamethoxazole was seen in 44.4% and to levofloxacin in 66.7% isolates. Mortality rate was 11.1%. Conclusion: Stenotrophomonas maltophilia causes uncommon but clinically significant infections among cancer patients in the postoperative period.

Worsening of medication non-adherence among patients with chronic diseases during times of armed conflict in the war-torn region of Ethiopia

BackgroundArmed conflict is a complex global phenomenon resulting in numerous injuries and significant health risks, particularly for individuals with chronic illness. This study aims to highlight the degree of medication non-adherence during armed conflict in northwest Ethiopia. MethodAn institution-based cross-sectional study was conducted at comprehensive specialized hospitals in northwest Ethiopia. Proportional allocation was used to assign patients in each setting. Proportions and means were compared using the chi-square test and the t-test, respectively. Binary logistic regression was employed to identify significant factors. ResultsThe degree of medication non-adherence was 68.1 %, and 88.3 % of participants reported that the armed conflict had a negative impact on their treatment. Additionally, 69.1 % of participants claimed that they did not use strategies to cope with the challenges they faced. Significant factors associated with medication non-adherence included the absence of health insurance (AOR = 3.43 (95 % CI 2.04–5.76)), the presence of comorbid illness (AOR (95 % CI): 5.19 (2.91–9.24)), medication unavailability (AOR = 1.84 (95 % CI 1.02–3.30)), and routine follow-up disturbances (AOR = 2.03 (95 % CI 1.08–3.79)). ConclusionPatients with chronic diseases exhibited a high rate of medication non-adherence during times of conflict. Particular attention should be given to patients with no social insurance, those with comorbid diseases, those experiencing follow-up disturbances, and those facing medication unavailability. Relevant entities are expected to develop initiatives that minimize constraints on medication adherence during armed conflicts.