Comorbid Illnesses Research Articles

Cough RIB Fracture: An Uncommon Upper Respiratory Cause.

Cough is a whole-sole dynamic housekeeper of the airways. Although a run-of-the-mill symptom, chronic cough frequently forces the patient to seek medical help. It can persist for years end on, and not only makes the patient anxious about underlying illness, but may cause vomiting, exhaustion, impaired sleep, urinary incontinence, and social embarrassment. The propulsive effort made by the patient to clear the noxious stimuli irritating the airways can at times disrupt the integrity of the chest wall and result in rib fractures. We present a case who was detected to have cough fracture during the evaluation of symptoms of chronic cough with pleuritic chest pain. He was evaluated for the aetiology of chronic cough and was diagnosed to have laryngopharyngeal reflux which even though a common aetiology for chronic cough is a very uncommon cause of cough rib fracture. The importance of small innocuous diseases causing severe debility, even in patients with no comorbid illness or contributing risk factors is emphasized by this case report.

Association of Modic Changes with Low Chronic Low Back Pain

Objective: To determine the association of Modic changes with chronic low back pain in the adult population 
 Study Design: Comparative cross-sectional study.
 Place and Duration of Study: Department of Neurosurgery, Combined Military Hospital, Lahore Pakistan, from Jan to Mar 2022.
 Methodology: All the patients who were diagnosed with chronic low back pain by Neurosurgeon were included in the study.Detailed history and physical examination were conducted on all the patients diagnosed with chronic low back pain. MRI spine was performed on all the study participants for Modic changes. Relevant socio-demographic factors were associated with different types of Modic changes in patients included in our analysis.
 Results: Out of 300 patients managed for chronic low back pain during the study period, 201(67%) were male, while 99(33%) were female. 172(57.3%) had no Modic changes, 33(11%) had Type-I changes, 80(26.7%) had Type-II changes, and 15(5%) had Type-III Modic changes. Advancing age, female gender and presence of comorbid illness had a statistically significant relationship with Modic changes in study participants (p-value<0.05).
 Conclusion: Modic changes were commonly seen in patients with low back pain. Type II Modic changes were most frequently seen in these patients. Elderly and female patients were more at risk of Modic changes than young and male patients. Comorbid medical illnesses also increase the chances of having Modic changes.

#3159 IMPACT OF MENTAL ILLNESS ON POST-TRANSPLANTATION OUTCOMES IN NEW ZEALAND: THE ASSET-MH DATA LINKAGE STUDY

Abstract Background and Aims People with severe mental illness are 6 times more likely to develop kidney disease. Mental illness is overrepresented in the kidney failure population. Up to 40% of dialysis patients are affected by depression and anxiety. There is limited understanding of the extent and impact of mental illness on transplant outcomes. We aimed to evaluate the impact mental illness has upon post-transplant outcomes, including graft failure and death in kidney transplant recipients in New Zealand. Method We included all incident kidney transplant recipients in New Zealand, 2006-2019 from the ASSET linked data platform, including Australian and New Zealand Dialysis and Transplant Registry, and national health registries (eg. hospitalisations, prescriptions and mental health services). Presence of mental illness was ascertained based on past use of medications (antipsychotics and antidepressants) and mental health services (community/residential support and inpatient) occurring at least twice over a year. Follow-up was from transplantation until death, graft failure or 31st Dec 2019. We used Cox models to evaluate risk of graft failure or death for mental health users compared to non-mental health users, adjusting for age, sex, calendar year and prior dialysis time. Results We included 1,796 kidney transplant recipients, where 457 (25%) had mental illness comorbidity. Overall, 228 (13%) used medication for mental illness (25 antipsychotics; 203 antidepressants) and 340 (19%) used mental health services (327 community/residential support; 14 inpatient). There were 111 recipients (6%) who had used medications and services for mental illness. There were 42 (9%) graft failures and 34 (7%) deaths among those with mental illness compared to 137 (10%) graft failures and 125 (9%) deaths among those without mental illness. Those with mental illness had the same risk of graft failure compared to others (p = 0.17), regardless of whether they used antidepressants (HR: 1.52, 95%CI: 0.93-2.48, p = 0.09) or received community/residential support (HR: 1.19, 95%CI: 0.78-1.81, p = 0.42). There were no graft failures among those using antipsychotics or receiving inpatient care. Risk of death increased 3-fold (HR: 3.24, 95%CI: 1.51-6.99, p < 0.01) in those using antipsychotics compared to those without mental illness, but was not increased among those using antidepressants (HR: 0.90, 95%CI: 0.47-1.72, p = 0.74). There was weak evidence for an increased risk of death among those receiving community/residential support (HR: 1.57, 95%CI: 0.99-2.49, p = 0.06) compared to those without mental illness. Risk of death was not significantly associated with those receiving inpatient care (HR: 3.00, 95%CI:0.72-12.42, p = 0.13), although event rates were low. For composite of graft failure or death, those with mental illness had the same risk as those without (p > 0.10), regardless of receiving antipsychotics (HR: 1.77, 95%CI: 0.83-3.75) or antidepressants (HR: 1.23, 95%CI: 0.84-1.82), or community/residential support (HR: 1.37, 95%CI: 1.00-1.87) or inpatient care (HR: 1.41, 95%CI: 0.35-5.71). Conclusion Mental illness comorbidity is common in this setting, with one in ten transplant recipients in New Zealand receiving psychiatric treatment. Antipsychotic use was associated with three times the risk of death. Otherwise, those with mental illness had comparable post-transplant outcomes. There is opportunity for more collaborative psychiatric and transplant services to promote better patient outcomes and reduce post-transplant mortality.

#3317 THE EFFECT OF HEMOPERFUSION ON SURVIVAL AMONG COVID-19 CRITICALLY ILL PATIENTS IN A TERTIARY HOSPITAL IN DAVAO CITY, PHILIPPINES

Abstract Background and Aims Cytokine storm in COVID-19 is an excessive immune response through the overproduction of inflammatory cytokines which significantly increases mortality. Hemoperfusion has been granted Emergency Use Authorization (EUA) by the Food and Drug Administration (FDA) in an effort to eliminate circulating inflammatory mediators among COVID-19 critical patients to improve clinical outcomes and survival. This study aims to determine the 8 – day survival of critical COVID-19 patients who received hemoperfusion. Method This is a descriptive study conducted among critically ill COVID-19 patients who completed hemoperfusion treatment admitted from October 2020 to October 2021 in a tertiary hospital in Davao City, Philippines. The inclusion criteria were adult patients greater than 18 years of age with RT-PCR confirmed SARS-CoV-2 infection who underwent and completed hemoperfusion during hospitalization for COVID-19. While those patients who did not complete the hemoperfusion treatment because of hemodynamic instability or death were excluded. All of the patients classified as COVID-19 critical received the standard treatment for COVID-19 such as steroids (dexamethasone) and antiviral (Remdesevir). Among the 1,037 COVID-19 adult patients admitted from October 2020 to October 2021, 28 of them were classified as critical and received hemoperfusion, but only 19 patients completed the treatment. Results Majority of patients in the study were males (14/19, 73.68%) with a mean age of 59 years (SD 12.90). Hypertension (n = 15, 78.95%) and Diabetes Mellitus (n = 14, 73.68%) were the most common comorbid illnesses. Cough (n = 15, 78.95%), fever (n = 11, 57.90%), and dyspnea (n = 7, 36.84%) were the frequent symptoms. The laboratory parameters (median hemoglobin, leukocytes, thrombocytes, creatinine, and ALT were within normal range except for an elevated median AST (54 U/L). Forty-two percent (8/19) of patients survived at day 8 (Figure 1). Survivors had higher baseline oxygen saturation compared to non-survivors (89% vs 78%), but in both groups, the oxygen saturation increased after hemoperfusion (Figure 2). All inflammatory markers (CRP, ferritin, LDH, and procalcitonin) decreased among survivors post-hemoperfusion. However, the ferritin, LDH, and procalcitonin remained elevated among non-survivors (Figure 3A, B, C D). The median time from symptoms onset to hemoperfusion initiation was longer in non-survivors compared to survivors (10 days vs 8 days) (Figure 4). Conclusion Close to half (42.11%) of the critical COVID-19 patients who underwent hemoperfusion survived at day 8. Therefore, hemoperfusion remains to be a beneficial adjunct treatment for critical COVID-19 patients especially if initiated early.

#3246 THE ASSOCIATION OF THE CO-OCCURRENCE OF MALNUTRITION AND SARCOPENIA WITH MORTALITY IN HEMODIALYSIS PATIENTS: A MULTICENTER PROSPECTIVE COHORT STUDY

Abstract Background and Aims Frailty is widely acknowledged as an age-related fragile state characterized by physiological vulnerability to stress, and it is prevalent among patients undergoing maintenance hemodialysis therapy. Various factors are interconnected and can be theoretically consolidated into a cycle of frailty, with malnutrition and sarcopenia at the core. These can result in numerous negative health outcomes in patients on hemodialysis and prompt identification and treatment are necessary. However, limited research has investigated the impact of the overlap between malnutrition and sarcopenia on mortality in this patient population. In this study, we examined the association of the overlap between malnutrition and sarcopenia with all-cause mortality in patients undergoing maintenance hemodialysis. Method The present prospective cohort study recruited outpatients on hemodialysis from three facilities in Japan. At the study baseline, data on patients' characteristics including age, gender, body mass index, duration of dialysis, primary kidney diseases, 11 comorbid conditions, and laboratory parameters (including serum albumin level) were collected from medical records. In addition, muscle mass (skeletal muscle index [SMI]), muscle strength (handgrip strength), and physical performance (short physical performance battery [SPPB]) were measured by physical therapists. A comorbidity index was used to quantify the severity of comorbid illnesses, which was calculated based on primary kidney diseases and the 11 comorbidities. Malnutrition was identified based on geriatric nutritional risk index <98, which was calculated using the serum albumin level and body weight. Sarcopenia was diagnosed when patients had low muscle mass (SMI <7.0 kg/m2 for males and <5.7 kg/m2 for females) and low muscle strength (handgrip strength <28.0kg for males and <18 kg for females) or low physical performance (SPPB ≤9), in accordance with the Asian Working Group for Sarcopenia 2019 criteria. After classifying the study participants into four groups based on the absence or presence of malnutrition and sarcopenia, the mortality risk was evaluated using the Kaplan-Meier method and Cox proportional hazard analysis. This study was approved by the Research Ethics Committee and conducted in accordance with the principles of the Declaration of Helsinki. Results A total of 379 patients on hemodialysis were included in the analysis. The mean age of the patients was 69.5±12.6 years, and 40.2% of the cohort being female. The mean duration of dialysis was 7.9±4.5 years. The most prevalent underlying kidney disease was diabetes mellitus. At baseline, the prevalence rates of malnutrition and sarcopenia were 32.7% and 28.2%, respectively. Over a mean follow-up period of 4.3 years, 23 patients died. The Kaplan-Meier analysis demonstrated a lower cumulative survival rate in patients with malnutrition and/or sarcopenia. After adjustment for the effect of age, gender, duration of dialysis, and comorbidity index, the hazard ratio in patients with both malnutrition and sarcopenia was significantly higher than in patients without both (hazard ratio [HR] 5.78, 95% confidence interval [CI] 1.86-17.94). However, the hazard ratios in patients suffering from either malnutrition or sarcopenia alone were not significantly different (Table 1). Conclusion The present study has demonstrated the strong association of a state of co-occurrence between malnutrition and sarcopenia, which implies starvation and muscle wasting, with a poor prognosis in patients undergoing hemodialysis. The findings of this study have accentuated the significance of addressing both malnutrition and sarcopenia in routine clinical practice for patients undergoing maintenance hemodialysis.

Prevalence of anemia and associated factors among patients with heart failure at Birat Medical College Teaching Hospital

Background and Aims: Anemia is a frequently encountered comorbid illness in heart failure and is associated with poor clinical outcomes. There are limited studies done in Nepal to evaluate its prevalence among patients diagnosed with heart failure. Hence, this study was aimed to find out the prevalence of anemia and associated factors among patients with heart failure at Birat Medical College Teaching Hospital.
 Methods: A hospital based cross sectional study was conducted from 1st July 2022 to 30 February 2023 among consecutively selected 100 patients at Birat Medical College Teaching Hospital. Socio-demography, clinical features and laboratory parameters to evaluate anemia were obtained. Ethical clearance was taken from the Institutional Review Committee of institute. Collected data was entered in Microsoft Excel and analyzed by Statistical Package for Social Sciences version 23. Frequency, mean, percentage were calculated and chi square test at 0.05% level of significance was used to find the association.
 Results: The prevalence of anemia was 65%. Out of 100 patients, majority had iron deficiency anemia (40%), followed by anemia of chronic disease (10%). Thirty three percent had iron deficiency without anemia. Female patients 36(75%) and patients with chronic obstructive pulmonary disease (COPD) 15(93.8%) had significantly higher prevalence of anemia (p value <0.05).
 Conclusions: Nearly two third of heart failure patients had anemia among which iron deficiency anemia was the commonest. Female and patients with COPD had higher prevalence of anemia.

Prevalence of unfavorable outcome in acute poisoning and associated factors at the University of Gondar comprehensive specialized hospital, Gondar, Northwest Ethiopia: a hospital-based cross-sectional study.

Acute poisoning is a medical emergency in which the toxic effects occur almost immediately, usually within hours from the time of exposure, and can result from exposure to excessive doses of any chemical. It is the common cause of emergency admission, which may result in morbidity and mortality. There are a lot of factors that are associated with an increased magnitude of mortality and complication. Therefore, this study was carried out to assess the clinical characteristics of patients, unfavorable outcomes of acute poisoning, and associated factors to improve the quality of care, resource utilization, and decrease mortality. This study aimed to assess the outcome and associated factors among acute poisoning patients at the University of Gondar Comprehensive Specialized Hospital, Gondar, Northwest Ethiopia (2021). A prospective follow-up study was conducted from January 2021 to September 2021 at the University of Gondar Comprehensive Specialized Hospital, Gondar, Northwest Ethiopia. Data were collected using a comprehensively organized and pretested interviewer-administered questionnaire. The data were entered using EPI data version 4.6.0 statistical software and then exported to Stata 14 for analysis. The data were analyzed for descriptive statistics. Statistical analysis was performed using bivariate and multivariate logistic regression models to identify factors associated with the unfavorable outcome of acute poisoning. The result is presented in the form of tables, figures, and text using frequencies and summary statistics such as mean, SD, median, IQR, and percentage. A total of 233 patients were included in the study. The prevalence of unfavorable poisoning outcomes in acute poisoning was 17.6% (95% CI: 13.2, 23.1). In the multivariate logistic regression analysis, known chronic medical comorbidities [AOR: 3.846 (1.619, 9.574); value of p: 0.014] and hospital stay of less than 48 h [AOR: 6.57 (2.03, 21.273); value of p: 0.002] were found to be independent factors associated with unfavorable outcomes in acute poisoning. The magnitude of unfavorable poisoning outcomes was high in patients with acute poisoning. Having known medical comorbid illness and short hospital stay of less than 48 h were found to be associated with unfavorable outcomes.

Correlates for the severity of suicidal risk in participants with common mental disorders with comorbid chronic medical conditions in rural primary healthcare settings in India.

Suicide is on the rise in low- and middle-income countries (LMICs), including India. There are limited studies assessing factors linked to the severity of suicidal risk in patients with depression and comorbid chronic medical disorders in primary healthcare (PHC) settings. This study examines factors linked to suicidal risk among participants in a cluster randomized controlled trial of collaborative care intervention (Healthier Options through Empowerment (HOPE Study)). The setting was at 49 PHC in the rural Ramanagara District of Karnataka State in southern India. Study eligibility criteria included being ≥30 years with at least mild depression or generalized anxiety disorder and at least one medical condition (cardiovascular disorder or type 2 diabetes mellitus). The severity of suicidal risk at baseline was assessed using the Mini International Neuropsychiatric Interview (MINI), and other measures included the severity of depression (Patient Health Questionnaire-9-items (PHQ-9)), the severity of anxiety (Generalized Anxiety Disorder Scale-7-items (GAD-7)), disability, social support, quality of life, number of comorbid chronic medical illnesses, and body mass index (BMI). Chi-square tests and independent-samples t-tests were used to compare the demographic and clinical characteristics of the no-low and mod-high suicidal risk groups. Logistic regression analysis was used to identify correlates associated with the mod-high suicidal risk group. Mod-high suicidal risk was significantly positively associated with the severity of depression and disability and significantly negatively associated with social support. The severity of depression, higher disability scores, and lower social support were found to be independent correlates of mod-high suicidal risk. Screening, managing depression, and facilitating social support for patients with chronic medical illness in PHC settings may reduce suicidal risk.

Hypoalbuminemia as a risk factor for complications in revisional/conversional bariatric surgery: an MBSAQIP analysis.

Hypoalbuminemia (HA) is a risk factor for serious complications after elective bariatric surgery. Patients undergoing revisional/conversional bariatric surgery may represent a higher-risk group who often have underlying co-morbid medical illnesses and more complex surgery. This study investigated the postoperative complications in patients with HA undergoing revisional/conversional bariatric surgery. Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), years 2015-2019. The MBSAQIP database was used to evaluate patients undergoing non-banding revisional/conversional bariatric surgery between 2015 and 2019. Patients were categorized by serum albumin (≤3.5 g/dL). Variables were assessed via bivariate analysis and multivariable regression. Propensity score matching was conducted to compare gastric bypass (RYGB) to sleeve gastrectomy (VSG). One hundred forty-seven thousand four hundred thirty patients underwent revisional/conversional procedures. After applied exclusions, 58,777 patients were available for analysis. The HA group had a significantly (P < .05) higher prevalence of being black (22.95% versus 17.76%), renal insufficiency (1.08% versus .36%), smoking history (9.47% versus 6.91%), chronic obstructive pulmonary disease (COPD) (2.54% versus 1.33%), and history of deep vein thrombosis (DVT) (4.03% versus 2.3%). Postoperative complications associated with HA included perioperative blood transfusion (3.1% versus 1.27%; P < .001), 30day readmission (10.87 versus 6.77%; P < .001), 30day reoperation (4.9% versus 3.18%; P < .001), and 30day mortality (.40% versus .14%; P < .0001). HA was a significant predictor of 30day readmission in the RYGB versus VSG matched cohort (odds ratio [OR], 1.30; 95% confidence interval [CI], [1.14, 1.48]; P < .001). HA is a risk factor requiring attention for patients undergoing revisional/conversional bariatric surgery and optimization of nutritional status or medical comorbidities associated with HA prior to bariatric surgery may help avoid postoperative complications.

Perioperative anesthesia challenges and outcomes of patients with Rhino-Orbito-Cerebral Mucormycosis during the second wave of COVID-19 pandemic: An observational study.

A rapid surge in rhino-orbito-cerebral mucormycosis (ROCM) cases was reported during the second wave of COVID, especially in India, needing extensive surgical debridement along with medical management. The present study was planned to observe perioperative anesthesia challenges and outcomes of patients with ROCM during the second wave of the COVID-19 pandemic. The primary objective was to observe intraoperative anesthesia challenges and the secondary objectives were to observe postoperative challenges and outcomes of patients. This was a single-centered, bidirectional (retrospective and prospective) observational study, conducted at a tertiary care center. We enrolled 218 adult patients scheduled for surgical debridement of ROCM under general anesthesia. Demographics, COVID status, comorbid illness, intraoperative challenges (difficult airway, hemodynamic instability, blood loss), and postoperative outcome (postoperative mechanical ventilation, and mortality rate) were noted. The majority of the patients were males (71%) and had diabetes mellitus (54%). COVID-associated mucormycosis was seen in 67% and 41% of them received steroids. Post-induction hypotension was noted in 20.6% of patients, and 14.2% had intraoperative hypotension out of which 5.5% required vasopressor support. Difficult mask ventilation and difficult intubation were reported in 7.3% and 6.4% of patients, respectively. No significant difference was found among intraoperative challenges when COVID mucormycosis was compared to non-COVID mucormycosis. Postoperative mechanical ventilation and ICU care were required in 41.3%, whereas mortality was seen in 11.5% of patients. The mortality was significantly more (P = 0.041) in patients with COVID mucormycosis (13%) compared to that with non-COVID mucormycosis (4.2%). Diabetic male patients who received steroids during COVID illness are at the highest risk of developing ROCM. Difficult airway and hemodynamic instability, are significant perioperative challenges encountered by anesthesiologists. Postoperative ICU management is crucial for decreasing postoperative morbidity and mortality.

Children with Severe Acute Malnutrition, Aged 5 to 60 Months, Admitted to Department of Pediatrics MMC Mardan, Pakistan Clinical Profile and Outcomes

Objective: The current study's goals were to ascertain the prevalence of , the clinical profile associated with , including risk factors, co-occurring diseases, and the kind of , as well as to ascertain how would fare following hospitalization and treatment. Study Design: Single Center study Place and Duration of Study: This study was conducted at the department of Pediatrics, department of pediatrics mmc mardan Pakistan from Jan 2020 to Jan 2021. Materials and Methods: Following compliance with the inclusion criteria, 100 infants between the ages of 5 and 62 months were enrolled in the research. Data from the past, the clinic, and the lab were entered into a pre-made proforma. Using the suitable statistical methodology, data were evaluated. Results: Severe acute malnutrition is present in 02.09% of the population.The study population's average age is 20.76 13.80 months.Out of the 100 kids, 69% were male and 31% were female. There were more non-edematous (57%) than edematous (43%).The age range from 0 to 26 months had the highest incidence (67%).95% of the cases (almost all) were from low SES.Mothers just attended basic school or had no education (76%). EBF was only present in 17% of instances up to the age of six months. The most common clinical symptoms were vomiting (35%), diarrhea (69%), fever (67%), anorexia (65%), ARI (57%), and eye difficulties (34%).Anemia (87%), pneumonia (41%), worm infestation (39%) were the most common comorbid illnesses, followed by UTI (33%) and TB (16%). 54% of recoveries are made. The typical hospital stay lasts 10.28 days. 2 kids (4%) died while they were hospitalized. Conclusion: The most serious kind of malnutrition, severe acute malnutrition is a medical emergency that needs immediate intervention. It is probable to disrupt the vicious cycle of undernourishment and infection with prompt diagnosis and management of many risk factors, clinical and comorbid conditions, and hence improve result. Keywords: female literacy, Severe acute malnutrition, socio-economic status, wasting

Burkholderia cepacia infections at sites other than the respiratory tract: A large case series from a tertiary hospital in Madurai

Sparsely reported extrapulmonary Burkholderia cepacia complex (Bcc) infections highlights the importance of this study. This was a retrospective chart review of 37 patients with extrapulmonary Bcc infections admitted between December 2019 and July 2022 in a tertiary hospital. Males accounted for 70% of cases. 78% had atleast one underlying comorbid illness. Among 37 isolates, 22 were from blood, others include exudates, urine and peritoneal fluid. Susceptibility rates of ceftazidime, meropenem, minocycline, cotrimoxazole and levofloxacin were 88, 88, 70, 65.7 and 56.7% respectively. Eleven died of septic shock and 24 patients (64.8%) had good outcomes, while two were lost to followup.

Validation of JRS atypical pneumonia score in patients with community-acquired Chlamydia psittaci pneumonia

IntroductionThe Japanese Respiratory Society (JRS) atypical pneumonia score is a useful tool for the rapid presumptive diagnosis of atypical pneumonia. We investigated the clinical features of community-acquired pneumonia (CAP) due to Chlamydia psittaci and validated the JRS atypical pneumonia score in patients with C. psittaci CAP. MethodsThis study was conducted at 30 institutions and assessed a total of 72 sporadic cases with C. psittaci CAP, 412 cases with Mycoplasma pneumoniae CAP, and 576 cases with Streptococcus pneumoniae CAP. ResultsSixty-two of 72 patients with C. psittaci CAP had a history of avian exposure. Among the six parameters of the JRS score, matching rates of four parameters were significantly lower in the C. psittaci CAP than the M. pneumoniae CAP in the following parameters: age <60 years, no or minor comorbid illness, stubborn or paroxysmal cough, and absence of chest adventitious sounds. The sensitivity of the diagnosis of atypical pneumonia in patients with C. psittaci CAP was significantly lower than the M. pneumoniae CAP (65.3% and 87.4%, p < 0.0001). When the diagnostic sensitivity was analyzed for different ages, the diagnostic sensitivities for the C. psittaci CAP were 90.5% for non-elderly patients and 30.0% for elderly patients. ConclusionsThe JRS atypical pneumonia score is a useful tool for distinguishing between C. psittaci CAP and bacterial CAP in patients aged <60 years, but not in patients aged ≥60 years. A history of avian exposure in middle-aged patients with normal white blood cell count may be suggestive of C. psittaci pneumonia.

Mental health and sleep quality among patients with asthma and COPD.

This quantitative cross-sectional study employed convenience sampling to enroll 200 patients with asthma and 190 patients with COPD. Data were gathered using a standardized self-administered questionnaire that contained sections on patients' characteristics, the Sleep Quality, Anxiety, and Depression. The prevalence of poor sleep quality was 17.5 and 32.6% among asthmatic and COPD patients, respectively. The incidence of anxiety and depression was 38 and 49.5% among the patients with asthma, respectively. Their prevalence in patients with COPD was 48.9 and 34.7%, respectively. The multivariate regression analysis showed that marital status (married), BMI, education level (pre-university level), presence of comorbid illness, and depression were significant predictors of PSQI in asthmatic patients. Moreover, age, gender (male), marital status (married), education level (pre-university level), depression, and anxiety were significant predictors of PSQI among COPD participants. According to this study, COPD, and asthma pose serious health risks, including reduced sleep quality, anxiety, and depression.

Challenges in Caring for Geriatric Ethnic Minorities with Co-Morbid Illness

Challenges in Caring for Geriatric Ethnic Minorities with Co-Morbid Illness

Association between chronic obstructive pulmonary disease and chronic periodontal disease: An observational study

Introduction: Chronic obstructive pulmonary disease (COPD) and chronic periodontitis share common risk factors and evidence exists showing an association between the two conditions. Aims: This retrospective study was conducted to evaluate the gingival and periodontal status of patients having COPD and their comparison with nondiseased individuals. Materials and Methods: This retrospective study recruited 60 patients (30–60 years) with COPD (Group A) and 60 healthy controls (Group B). Patients having cardiovascular diseases, diabetes, hypertension, and other comorbid illnesses except COPD were excluded from the study. A complete general physical and medical examination of all the patients was completed, case history was recorded, and investigations such as total blood count, chest X-ray, and pulmonary function tests were undertaken. Each patient’s gingival and periodontal status as evaluated by an experienced periodontist and oral hygiene simplified index, gingival index (GI) (Loe and silliness), and periodontal index (PI) (Russell’s) were recorded. Results and Discussion: Group A patients were significantly older than Group B. There was no statistically significant difference in both groups concerning gender. Group A had 45%, whereas, in Group B, 36.7% of the patients had lower socioeconomic status. In Group A, a higher body mass index &gt;30 kg/m2 was observed in 38.6% of the patients as compared to 26.9% in Group B (P &gt; 0.05). In Group A, higher values of oral hygiene simplified index (2.97 ± 0.02), mean GI (1.96 ± 0.01), and mean PI (4.85 ± 0.01) were observed as compared to Group B (P &lt; 0.001). Conclusion: The study supports an association between COPD and chronic periodontitis. Early detection and treatment of chronic periodontitis may benefit patients with COPD.

Prevalence and clinical presentation of Post-COVID syndrome in patients recovered from acute COVID infections in North Kerala

Background: Post-acute COVID symptoms have become a major health concern and one of the most important causes of morbidity throughout the world. Hence, it is important to document the pattern of presentation in post-COVID syndrome patients in India, which has been one of the countries with the largest acute COVID-19 infections. Aims and Objectives: This study was done to estimate the prevalence of post-acute COVID syndrome in patients recovered from acute COVID infection and to determine the factors influencing with its incidence. Materials and Methods: Community-based observational study in which patients who have recovered from acute COVID infection 3–6 months before the study period were selected using multistage sampling. Data were collected through house visits using a pre-validated questionnaire containing details of acute COVID-19 infection, treatment taken, vaccination status before the infection, symptoms in the period between 4 and 12 weeks, and symptoms after 12 weeks of acute COVID infection. Results: Out of the 265 patients studied, 14.34% had ongoing symptomatic COVID-19 in the first 3 months of acute illness and 9.81% had post-COVID symptoms even after 3 months. 17.74% of the patients had a history of pre-existing comorbid illnesses and 31.32% had received two doses of vaccination before acquiring COVID-19 infection. 92.83% were treated in home quarantine, 4.91% needed hospitalization without oxygen supplementation, and 2.26% required oxygen or ventilatory support. The most common post-COVID symptoms reported were tiredness, easy fatiguability, breathlessness, and body ache. Female gender, presence of comorbidities, and mode of treatment had a significant role in predicting the incidence of post-COVID symptoms. Conclusion: The study clearly showed that the severity of acute COVID infection has a significant correlation with the incidence of both ongoing symptomatic COVID and post-COVID syndrome. Other factors that increased the incidence included female gender and pre-existing comorbidities.

Prevalence of Frailty in ICU and its Impact on Patients' Outcomes.

Frailty describes a state or syndrome of reduced physical, physiologic, and cognitive reserve that increases vulnerability to acute illness. To study the prevalence of frailty in critically ill patients and find its association with resource utilization and short-term intensive care unit (ICU) outcomes. This was a prospective observational study. All adult patients ≥50 years admitted to the ICU were included and frailty was assessed by the clinical frailty score (CFS). Data were collected on demography, coexisting illness, CFS, Acute Physiology and Chronic Health Evaluation II (APACHE-II), and Sequential Organ Failure Assessment Score (SOFA) scores. Patients were followed for 30 days. Outcome data were collected on organ supports provided, duration of ICU and hospital length of stay (LOS), and ICU and 30-day mortality. 137 patients were enrolled in the study. The prevalence of frailty was 38.6%. Frail patients were older and had a more comorbid illness. APACHE-II and SOFA scores were 22.1 ± 7.0 and 7.2 ± 3.29, significantly higher in frail patients, respectively. There was a trend towards higher requirement for organ supports in frail patients. Median ICU and hospital LOS were 8 vs 6 and 20 vs 12 (frail vs nonfrail) days, respectively (p < 0.05). Intensive care unit mortality in frail and nonfrail patients was 28.3% and 23.8%, respectively (p = 0.56). Thirty-day mortality in frail patients was 49%, significantly higher compared with nonfrail patients (28.5%). The prevalence of frailty in ICU patients was high. Frail patients were quite ill on ICU admission, and they had a prolonged ICU and hospital LOS. Increasing frailty score was associated with higher mortality at 30 days. Kalaiselvan MS, Yadav A, Kaur R, Menon A, Wasnik S. Prevalence of Frailty in ICU and its Impact on Patients' Outcomes. Indian J Crit Care Med 2023;27(5):335-341.

Association between physical and mental illness comorbidity, self-harm repetition and highly lethal self-harm acts: a mixed methodsstudy among individuals with frequent self-harm episodes

Association between physical and mental illness comorbidity, self-harm repetition and highly lethal self-harm acts: a mixed methodsstudy among individuals with frequent self-harm episodes

An increasing threat in intensive care units: evaluation of multi-drug-resistant Myroides spp. infections and risk factors

Myroides spp. are Gram-negative bacilli that are commonly found in soil and water, acting as low-level opportunistic pathogens and causing a variety of infections. To assess the risk factors for multi-drug-resistant myroides infections, association with comorbid illnesses, patient care and susceptibility to antibiotics. This retrospective analytical study was conducted in Istanbul Başakşehir Çam and Sakura City Hospital, and included patients with Myroides spp. isolated in their culture samples. Total hospitalization days, first isolation day and 30-day mortality values of the patients were analysed statistically, and P<0.05 was considered to indicate significance. Myroides spp. were isolated from 437 culture samples from 228 patients. Of these cases, 210 (92.1%) were classified as having asymptomatic bacteriuria, and 18 (7.9%) as having an infection caused by Myroides spp. One hundred and seventy-four (76.3%) patients were followed up in the intensive care unit, and total hospitalization days (median 24.5 days) and first isolation day (median 9.5 days) of infected patients were shorter than those for colonized patients (P=0.023 and 0.030, respectively). No difference was found in 30-day mortality between infected and colonized patients (P=0.312). Myroides infections were seen more frequently in patients who were hospitalized for a long time, used broad-spectrum antimicrobials, underwent invasive procedures, and had co-factors such as diabetes and cerebrovascular disease. In addition, the resistance rates of Myroides odoratus were higher than those of Myroides odoratimimus, and the use of quinolones for the treatment of patients with M.odoratimimus infection led to a higher cure rate.