Comorbid Group Research Articles

Reward responsivity and habit formation in the co-occurrence of restrictive eating and nonsuicidal self-injury

Dysfunctions in reward and/or habit formation have been proposed as factors contributing individually to the maintenance of restrictive eating and nonsuicidal self-injury (NSSI). However, despite the high comorbidity between these behaviors, the associations between reward and habit formation in their co-occurrence remains unclear. This study examined self-reported reward responsivity and habit strength among individuals with co-occurring restrictive eating and NSSI (Comorbid group; n = 108) and those with one behavior only (One-behavior group; n = 113). Hierarchical logistic regression analyses assessed the association between reward and habit features and the co-occurrence of restrictive eating and NSSI, accounting for the effects of impulsivity (a characteristic commonly considered to underlie co-occurring disordered eating and NSSI). Partial correlations examined the relationships between these features and the severity of eating disorder and NSSI symptoms, also controlling for impulsivity. Lower reward responsivity was associated with the co-occurrence of restrictive eating and NSSI, even after accounting for impulsivity (p = 0.017). In exploratory analyses, this relationship was no longer significant after accounting for self-reported depression. No significant associations were found regarding habit formation and restrictive eating and NSSI co-occurrence. Lower reward responsivity was linked to increased NSSI frequency and versatility in both groups and associated with severity of eating pathology in the Comorbid group (ps < 0.05). Our findings suggest that blunted reward responsivity may relate to the co-occurrence of restrictive eating, NSSI, and depressive symptoms, as well as the severity of restrictive eating and NSSI. Reward disturbances may serve as a crucial target in the treatment of multiple self-destructive behaviors.

Co-occurrence and cognitive basis of low language and low reading skills in children speaking a transparent language

AbstractWe investigated the comorbidity of low language and reading skills in 6- to 8-year-old monolingual Polish-speaking children (N = 962) using three different approaches: norming data to determine the prevalence of co-morbid difficulties, group comparisons of profiles on key cognitive-linguistic measures, and a case series analysis examining the frequency of single versus multiple deficits. We identified four groups of children based on their oral language and reading skills: children with low oral language skills alone, low reading skills alone, comorbid low language/reading skills, and typically developing chronological-age controls. We characterized the four groups (n = 38 per group) in terms of oral language and reading skills measured with normed test batteries, and in terms of the cognitive-linguistic profiles measured by the phonological awareness test (PA), rapid automatized naming test (RAN), and nonword repetition tests (NWR). We found that 24–31% of children with one type of difficulty had comorbid difficulties in the other domain. All groups differed significantly in cognitive-linguistic profiles. For each measure, the comorbid group had the lowest results. The group of children with isolated low language skills had better results than the comorbid group in (1) Sentence repetition (sub-test in an oral language test), (2) discrimination-based, blending-based, and elision-based PA sub-tests, (3) RAN (both digits and letters). The group with isolated low reading skills had better results than the comorbid group in: (1) discrimination-based PA sub-test, (2) NWR tests. The results indicate differences in cognitive-linguistic profiles between the groups with low language and/or low reading skills. They highlight the need to control for both types of difficulties in researching low language and/or reading skills, and to screen for comorbid issues while diagnosing children.

Oral bacterial insights from a comparative study between healthy and comorbid diseased human individuals

The human oral cavity is colonized by a diverse microbial community, which includes both native and transient colonizers. The microbial composition is crucial for maintaining oral homeostasis, but due to overgrowth or imbalances of these microbial communities, dysbiosis can occur. There is a lack of understanding of the research of native and transient colonizers in the oral cavity of the Indian subpopulation Therefore, in our present study, we explored the role and prevalence of transient and native colonizers between healthy and comorbid oral diseased human individuals. Culture-dependent techniques and culture-independent 16S r DNA metagenomic analyses were employed to isolate and study the interactions of native and transient colonizers from human oral samples. Among the 66 human individuals of both healthy and comorbid individuals, the most abundant isolate was found to be Bacillus amyloliquefaciens MCC 4424. In addition, the more prevalent culturable isolate from the healthy samples was Streptococcus salivarius MTCC 13009, whereas in comorbid samples Staphylococcus pasteuri MTCC 13076, Rothia dentocariosa MTCC 13010 and Pseudomonas aeruginosa MTCC 13077 were prevalent to a greater extent. 16S rDNA metagenomic analyses revealed the prevalence and abundance of genera such as Bacteroidetes and Proteobacteria in healthy individuals; consequently, Fusobacteria and Firmicutes were observed mostly in comorbid individuals. The significant differences in bacterial population density were observed in terms of the Shannon index (p = 0.5145) and Simpson index (p = 0.9061) between the healthy and comorbid groups. B. amyloliquefaciens MCC 4424 exhibits antagonistic behavior when grown as a dual-species with native and transient colonizers. This result is very consistent with the findings of antibiofilm studies using confocal laser scanning microscopy, which revealed a significant reduction in biofilm biovolume (73 %) and maximum thickness (80 %) and an increase in the rough coefficient of biofilms (30 %). Our data suggested that B. amyloliquefaciens MCC 4424 can be a native colonizer of Indian sub-populations. It may act as a novel candidate for oral healthcare applications and greatly aids in the regulation of transient species in the oral cavity.

Beyond type 2 asthma biomarkers: risk stratification for NSAID-exacerbated respiratory disease.

Type 2 (T2) asthma is often associated with chronic rhinosinusitis with nasal polyposis (CRSwNP). Additionally, nonsteroidal anti-inflammatory drug (NSAID) intolerance leads to NSAID-exacerbated respiratory disease (N-ERD). Previous transcriptomic data in non-CRSwNP T2 asthma patients showed differentially expressed genes. We focused on ALOX15, CLC, CYSLTR2, HRH4 and SMPD3 to investigate their role in T2 asthma. The study included 100 healthy controls and 103 T2 asthma patients, divided into patients with asthma (n=54), patients with asthma and CRSwNP (n=29) and patients with N-ERD (n=20). Quantitative PCR analysis was performed on blood-derived RNA samples first to validate the five differentially expressed genes. The data were further analysed to find potential associations and biomarkers. Patients, regardless of stratification, exhibited significantly higher gene expression than healthy controls. The patterns of association revealed that ALOX15 was exclusively present in the non-comorbidity group, SMPD3 and CLC in the comorbidity groups, and HRH4 in all patient groups. ALOX15, CYSLTR2 and SMPD3 expression showed potential as biomarkers to confirm the diagnosis of T2 asthma using peripheral blood eosinophils as the initial criterion. Peripheral blood eosinophils combined with gene expression, especially SMPD3, may improve the diagnosis. CLC and CYSLTR2 expression play a specific role in discriminating N-ERD. We validated the transcriptomic data of five differentially expressed genes in T2 asthma. Different patterns of association were identified in patient stratification, suggesting that different molecular mechanisms underlie the spectrum of T2 asthma. Potential biomarkers were also found and used to design an algorithm with practical diagnostic utility for T2 asthma, including risk stratification for N-ERD.

Study on the Correlation between Hcy and Hs-CRP Levels and Cognitive Function in Patients with Bipolar Disorder and Borderline Personality Disorder.

This study aims to explore the correlation and clinical significance of homocysteine and high-sensitivity C-reactive protein levels with cognitive function in patients with bipolar disorder (BD) and borderline personality disorder (BPD). Patients with BD admitted to our hospital from January 2022 to December 2022 were chosen retrospectively. BPD patients were categorized into comorbidity groups, while those without BPD were assigned to non-comorbidity groups, each consisting of 60 cases. Enzyme-linked immunosorbent assay (ELISA) was utilized to assess serum levels of homocysteine (Hcy) and high-sensitivity C-reactive protein (hs-CRP) in both patient groups. Clinical symptoms were evaluated by the Hamilton Depression Rating Scale (HAMD) and the Young Mania Rating Scale (YMRS). Cognitive function was evaluated and compared using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Pearson correlation analysis was performed on the correlation between patients' serum Hcy and hs-CRP levels and HAMD, YMRS, and RBANS scores. In the comorbidity group, patients exhibited significantly elevated serum Hcy and hs-CRP levels compared to the non-comorbidity group (p < 0.05). Patients in the comorbidity group displayed higher HAMD and YMRS scores than those in the non-comorbidity group (p < 0.05). Additionally, attention, speech, visual span, immediate memory, and delayed memory in the comorbidity group were notably lower than in the non-comorbidity group (p < 0.05). The speech, visual span, and immediate memory of RBANS in bipolar depressive patients with comorbid BPD were lower than those in bipolar depressive patients without comorbid BPD (p < 0.05), the speech of RBANS in bipolar manic patients with comorbid BPD was lower than those in bipolar manic patients without comorbid BPD (p < 0.05). Pearson correlation analysis showed that the expression of Hcy and hs-CRP in the comorbid group was positively correlated with HAMD and YMRS scores, and negatively correlated with attention, speech, visual span, immediate memory, and delayed memory, and these differences were statistically significant (p < 0.05). High serum Hcy and hs-CRP expression levels may regulate inflammatory responses, aggravating cognitive impairment in patients with BD and BPD. Serum Hcy and hs-CRP expression levels are significantly related to cognitive dysfunction. They are expected to guide the prevention and treatment of BD comorbid BPD patients.

Role of sexuality in women with chronic pain: Results from an Italian cross-sectional study on chronic headache, fibromyalgia, and vulvodynia

Background/objectivesTo compare sexual functioning, genital pain, and satisfaction among women diagnosed with various Chronic pain (CP) conditions. Additionally, it seeks to explore the role of sexual factors in predicting levels of central sensitization (indicative of CP-related mental and physical distress), physical, and mental quality of life (QoL) for each condition individually. MethodsFrom April 2023 to January 2024, 1006 women categorized into five groups (Chronic Headache - CH; Fibromyalgia - FM, Vulvodynia - VU, Comorbidity group - CO, and Healthy Controls - HC) completed an online protocol. ResultsAll groups reported sexual impairment: VU group exhibited the highest genital pain prevalence (97.93 %), followed by CO (74.29 %) and FM (55.91 %). ANCOVAs indicated lower sexual functioning scores for FM, VU, and CO compared to HC and CH. VU and CO reported lower satisfaction scores than other groups. Genital pain emerged as the primary predictor of central sensitization across all groups except controls. Regarding mental QoL, sexual satisfaction was significant for CH and CO, while genital pain and sexual satisfaction were significant for VU. ConclusionThis study emphasizes the importance of integrating genito-pelvic pain assessment and addressing related sexual difficulties in CP diagnostics and care to enhance overall well-being and QoL.

Reliability of comorbidity indices as predictive indicators for frequent severe chronic obstructive pulmonary disease exacerbations.

The relationship between comorbidities and chronic obstructive pulmonary disease (COPD) is two-sided. As the number of comorbidities increases, frequency of acute exacerbations of COPD (AECOPD) consequently increases. Comorbidity indices can be used to evaluate comorbidities while managing COPD patients. We aimed to compare comorbidity indices such as the Charlson comorbidity index (CCI), comorbidities in COPD index (COMCOLD) and COPD specific comorbidity test (COTE) regarding exacerbation frequency. Participants hospitalized for AECOPD were included in this bidirectional case-control study. Exacerbation severity, frequency, further exacerbations over a one-year follow-up period and CCI, COMCOLD, and COTE scores were recorded. High and low comorbidity groups were compared regarding AECOPD frequency, severity, and further exacerbations. Ninety-two patients were enrolled. The frequency of AECOPD was significantly higher in high-comorbidity groups (p= 0.026 for CCI; 0.015 for COTE; 0.012 for COMCOLD) than that in low-comorbidity groups. Severe AECOPD was significantly higher in all high-comorbidity groups according to the indices. Median number of exacerbations during the one-year follow-up period was significantly higher in the high-comorbidity groups defined by CCI [0 (0-4) vs. 1 (0-4), p<0.001 and COMCOLD 0 (0-4) vs. 1 (0-3), p= 0.007]. Comorbidities are among the most important risk factors for AECOPD. Managing comorbidities begins with their identification, followed by appropriate interventions. Therefore, using at least one comorbidity index during assessment ensures that comorbidities are not overlooked during diagnostic and therapeutic processes. CCI, COTE, and COMCOLD comorbidity indices can be used in predicting COPD exacerbations.

Characteristics and Management of Patients with Alopecia Areata and Selected Comorbid Conditions: Results from a Survey in Five European Countries.

Alopecia areata (AA) is an autoimmune condition that causes non-scarring hair loss and can impose a high psychosocial burden on patients. The presence of comorbid conditions may impact the management of AA in clinical practice. This analysis aims to describe disease characteristics and management of AA in patients with concomitant atopic, autoimmune, and psychiatric comorbid conditions. Data were collected from the Adelphi Disease Specific Programme™, a cross-sectional survey of physicians and their adult patients with AA conducted in France, Germany, Italy, Spain, and the UK between October 2021 and June 2022. Patients' disease severity was based on physician's definition. Physician-reported data on demographics, AA clinical characteristics, comorbid conditions, and information related to AA therapies were analyzed. Analyses were descriptive. Overall, 239 dermatologists provided data for 2083 patients, of which 558 patients (27%) had at least one atopic, autoimmune, or psychiatric comorbid conditions. The most common comorbid conditions were atopic dermatitis, autoimmune thyroid disease, and anxiety. The mean (standard deviation) patient age for the three comorbidity groups was 37.6years (12.1) and 56% of the patients were women (n = 313). In the three comorbidity groups, 51%, 50%, and 55% of patients with atopic, autoimmune, and psychiatric comorbidities had severe AA with disease progression reported as worsening in 30%, 28%, and 30%, respectively, whereas in the group with no comorbidities, 37% were described as having severe AA and 21% getting worse. Scalp hair loss was the primary sign reported across the three groups of comorbid conditions (atopic, 91%; autoimmune, 91%; psychiatric, 88%). Patients with preselected comorbidities presented more frequently AA-related signs and symptoms beyond scalp hair loss than patients without comorbid conditions. These patients were also more likely to receive topical calcineurin inhibitors, topical immunotherapy, conventional systemic immunosuppressants, and oral Janus kinase inhibitors for the treatment of their AA. This analysis provided insights into the burden and management of AA in patients presenting with atopic, autoimmune, and psychiatric comorbid conditions in five European countries.

Identifying Subgroups of Youth Suicide Decedents Based on Clinical Profiles of Psychiatric and Medical Diagnoses: A Latent Class Analysis

PurposeTo identify risk subgroups of youth suicide decedents using demographic and clinical psychiatric and medical diagnostic profiles to inform tailored youth suicide prevention efforts. MethodsThis study linked Ohio Medicaid and death certificate data for Medicaid enrolled youth aged 8–25 years who died by suicide between January 1, 2010, and December 31, 2020 (N = 511). Latent class analysis was used to identify distinct clinical risk subgroups. ResultsThree latent classes were identified. Internalizing problems were common across all classes, but especially prevalent in class 1, the High Internalizing + Multiple Comorbidities group (n = 152, 30%). A prior history of suicidal behavior was confined to class 1 decedents, who were otherwise characterized by substance misuse, and multiple psychiatric and medical comorbidities. Class 2 decedents, the Internalizing + Externalizing group (n = 176, 34%), were more often younger, male, Black, and unlikely to have a history of substance misuse. Decedents in class 3, the Internalizing + Substance Misuse group (n = 183, 36%), were more often older and likely to have a history of substance misuse, but unlikely to exhibit other externalizing problems. DiscussionInternalizing psychopathology is particularly common among youth who die by suicide, with comorbid externalizing psychopathology, substance misuse, and medical problems contributing to youth suicide risk. Because less than a third of youth who die by suicide have a prior history of recognized suicidal thinking or behavior, universal screening for youth suicide risk should be considered, particularly in younger children, and efforts to integrate suicide prevention in traditional health care settings should be prioritized.

DIABETIC POLYNEUROPATHY AND COMORBIDITY ARE DIABETIC FOOT SYNDROME FORMATION FACTORS

Background. Data from the literature indicate about the development of diabetic polyneuropathy in 5 years after the onset of type 1 diabetes and in 10-15% of patients with newly diagnosed type 2 diabetes. The purpose of the study was to find out the clinical course of diabetic polyneuropathy and to determine the frequency of the occurrence of diabetic foot syndrome in conditions of the comorbidity. Methods. We examined 121 patients, aged from 19 to 69 years, diagnosed with diabetic polyneuropathy due to type 1 and type 2 diabetes. The examined patients were divided into three groups: with diabetic polyneuropathy and cardiovascular comorbidity (group A, n=52), multimorbidity (more than 3 nosologies) (group B, n=30), without comorbidity (group C, n=39). Conclusions. Clinical manifestations of the diabetic polyneuropathy were more significant in the individuals with the cardiovascular comorbidity. The presence of stenoses and occlusions in the arterial channel in groups A and B served as a basis for the formation of ulcerative defects of the limbs in the future.

Differentiation of self as a theoretical framework to understand comorbidity of sexual dysfunction and eating disorder symptoms: an exploratory study

Although the empirical evidence supporting the comorbidity of sexual dysfunction and eating disorders is growing, the theoretical common ground of this comorbidity is not yet known. The aim of the current study was to examine the differentiation of self as a theoretical common ground of the comorbidity between sexual dysfunction and eating disorder symptoms (EDS). We used profiles of sexual dysfunction and eating disorders to examine how these profiles differed in terms of differentiation of self. The study was conducted as an online survey among a convenience sample of 985 Israeli women. Women in the comorbidity group (high levels of both sexual dysfunction and EDS) had significantly lower levels of differentiation of self than did women in the other groups: no disorder (low levels of sexual dysfunction and EDS), EDS (low levels of sexual dysfunction and high levels of EDS), and sexual dysfunction (high levels of sexual dysfunction and low levels of EDS). The current study suggests that differentiation of self may be a shared feature among both sexual dysfunction and EDS. Limitations of the study, directions for future research, and clinical implications are discussed.

Analyzing the Outcomes of COVID-19 Infection on Patients With Comorbidities: Insights From Hospital-Based Study.

Introduction COVID-19 exhibits a broad spectrum of clinical manifestations, ranging from asymptomatic or mild cases to severe respiratory distress and, in some instances, fatal outcomes. The pre-existing inflammatory state in the patient prior to exposure to COVID-19, which could be because of any etiology or comorbidity, has been associated with prolonged morbidity, and adverse outcomes like increased mortality have been found.This study endeavors to investigate the principal risk factors linked to the morbidity and mortality of COVID-19, such as age, gender, and co-morbidities such as hypertension, diabetes mellitus, and others. Material and methods Patient demographic data like age, gender, and co-morbidities like diabetes mellitus, hypertension, respiratory illness, and coronary artery diseases, cerebrovascular accident was observed. The patientclinical profile, hematological, inflammatory markers at the time of admission, and outcome were noticed.Patients were divided into two groups - patients with comorbidity and those without comorbidity. Results In each cohort of COVID-19 patients, comprising those with and without comorbidities, there were 145 participants. The mean age of patients without comorbidities was found to be 49.97 years, whereas the mean age of those with comorbidities was 64.35 years. Within the comorbidity group, males formed the majority, accounting for 77.2% of the cohort; in the group without comorbidity also males predominated, representing 68.3% of the participants. Hypertension was the most common co-morbidity (89.7%), followed by diabetes mellitus (39.3%), and ischemic heart disease (8.3%). The multivariate logistic regression analysis for prediction of mortality showed hypothyroidism with odds ratio (OR) of 336.26 and confidence intervals (CI) (1.19-9477.13), ischemic heart disease with OR of 320.94 (CI 3.19-3237.4) and presence greater than two co-morbidities with OR of 42.14 (CI 1.34-1325.76). Cox regression analysis showed a statistically significant hazard ratio of 0.294 in patients with greater than two co-morbidities. Conclusion Hypothyroidism, ischemic heart disease, and the presence of multiple comorbid conditions were associated with the severity of COVID-19 illness and mortality.

Individual Patient Comorbidities and Effect on Cochlear Implant Performance.

To examine the association between preoperative comorbidities and cochlear implant speech outcomes. Retrospective cohort. Tertiary referral center. A total of 976 patients who underwent cochlear implantation (CI) between January 2015 and May 2022. Adult patients with follow-up, preoperative audiologic data, and a standardized anesthesia preoperative note were included. Adult Comorbidity Evaluation 27 (ACE-27) based on standardized anesthesia preoperative notes. Postoperative change in consonant-nucleus-consonant (CNC) score, AzBio Sentence score in quiet, and AzBio + 10 dB signal-to-noise ratio (SNR). Sentence score of the implanted ear at 3, 6, and 12 months. A total of 560 patients met inclusion criteria; 112 patients (20%) had no comorbidity, 204 patients (36.4%) had mild comorbidities, 161 patients (28.8%) had moderate comorbidities, and 83 patients (14.8%) had severe comorbidities. Mixed model analysis revealed all comorbidity groups achieved a clinically meaningful improvement in all speech outcome measures over time. This improvement was significantly different between comorbidity groups over time for AzBio Quiet ( p = 0.045) and AzBio + 10 dB SNR ( p = 0.0096). Patients with severe comorbidities had worse outcomes. From preop to 12 months, the estimated marginal mean difference values (95% confidence interval) between the no comorbidity group and the severe comorbidity group were 52.3 (45.7-58.9) and 32.5 (24.6-40.5), respectively, for AzBio Quiet; 39.5 (33.8-45.2) and 21.2 (13.6-28.7), respectively, for AzBio + 10 dB SNR; and 43.9 (38.7-49.0) and 31.1 (24.8-37.4), respectively, for CNC. Comorbidities as assessed by ACE-27 are associated with CI performance. Patients with more severe comorbidities have clinically meaningful improvement but have worse outcome compared to patients with no comorbidities.

The Comprehension of Grammatical Structures in a Pediatric Population with ASD and Epilepsy: A Comparative Study.

Autism Spectrum Disorder (ASD) and epilepsy represent a comorbidity that negatively influences the proper development of linguistic competencies, particularly in receptive language, in the pediatric population. This group displays impairments in the auditory comprehension of both simple and complex grammatical structures, significantly limiting their performance in language-related activities, hampering their integration into social contexts, and affecting their quality of life. The main objective of this study was to assess auditory comprehension of grammatical structures in individuals with ASD and epilepsy and compare the results among the three groups. A non-experimental cross-sectional study was designed, including a total of 170 participants aged between 7 and 9 years, divided into three groups: a group with ASD, a group with epilepsy, and a comorbid group with both ASD and epilepsy (ASDEP). The comprehension of grammatical structures was assessed using the CEG and CELF-5 instruments. Statistical analyses included MANOVA and ANOVA to compare scores between groups to verify associations between study variables. The results indicate that the group with ASD and epilepsy performed worse compared to the ASD and epilepsy-only groups, respectively. Additionally, a significant and directly proportional association was observed among all variables within the measures of grammatical structure comprehension. The neurological damage caused by epilepsy in the pediatric population with ASD leads to difficulties in understanding oral language. This level of functioning significantly limits the linguistic performance of these children, negatively impacting their quality of life and the development of core language skills.

Hypoparathyroidism and mortality after total thyroidectomy: A nationwide matched cohort study.

Total thyroidectomy (TT) carries a risk of hypoparathyroidism (hypoPT). Recently, hypoPT has been associated with higher overall mortality rates. We aimed to evaluate the frequency of hypoPT and mortality in patients undergoing TT in Denmark covering 20 years. Retrospective Cohort study. Using population-based registries, we identified all Danish individuals who had undergone TT between January 1998 and December 2017. We included a comparison cohort by randomly selecting 10 citizens for each patient, matched on sex and birth year. HypoPT was defined as treatment with active vitamin D after 12 months postoperatively. We used cumulative incidence to calculate risks and Cox regression to compare the rate of mortality between patients and the comparison cohort. We evaluated patients in different comorbidity groups using the Charlson Comorbidity Index and by different indications for surgery. 7912 patients underwent TT in the period. The prevalence of hypoPT in the study period was 16.6%, 12 months postoperatively. After adjusting for potential confounders the risk of death due to any causes (hazard ratio; 95% confidence intervals) following TT was significantly increased (1.34; 1.15-1.56) for patients who developed hypoPT. However, subgroup analysis revealed mortality was only increased in malignancy cases (2.48; 1.99-3.10) whereas mortality was not increased when surgery was due to benign indications such as goitre (0.88; 0.68-1.15) or thyrotoxicosis (0.86; 0.57-1.28). The use of active vitamin D for hypoPT was prevalent one year after TT. Patients with hypoPT did not have an increased risk of mortality following TT unless the indication was due to malignancy.

Cardiovascular risk factors affecting COVID-19 outcomes at a tertiary referral hospital in northwest Iran: A prospective cohort study

Objective: To investigate cardiovascular risk factors affecting COVID-19 outcomes in a tertiary referral hospital. Methods: This prospective cohort study analyzed 269 participants with COVID-19. The primary outcomes were ICU admission, prolonged hospital stay duration, and in-hospital death. The secondary outcomes included death, chronic symptoms, and NYHA functional class during follow-up periods. Results: A total of 412 patients with COVID-19 symptoms were enrolled in the study, and out of which 269 patients had complete medical records and positive SARS-CoV-2 PCR test results, fulfilling the study criteria were analyzed. The patients were divided into two groups, with cardiovascular comorbidities (group A, n=122), such as established cardiovascular disease, diabetes mellitus, and hypertension, and without cardiovascular comorbidities (group B, n=147). Binary logistic regression analysis showed that patients with underlying hypertension, diabetes, and established cardiovascular disease had a 1.55 (95% CI: 1.28-2.26), 1.62 (95% CI: 1.34-2.13), and 1.63 (95% CI: 1.07-5.34)-fold risk of mortality, respectively in the adjusted model. Conclusions: Hospitalized COVID-19 patients with predisposing cardiovascular risk factors are more susceptible to develop worse outcomes. More attention should be paid to the management and follow-up of these patients.

Temperament Traits in Pediatric Obsessive-Compulsive Disorder in Relation to Tourette Syndrome and Attention-Deficit Hyperactivity Disorder

Introduction: Pediatric obsessive-compulsive disorder (OCD), attention-deficit hyperactivity disorder (ADHD), and Tourette syndrome (TS) are often concurrent. This study explores the temperament profile of complex OCD phenotypes. Methods: A clinical registry recorded demographic data, psychiatric diagnoses, and temperament traits, including novelty seeking (exploratory behaviors), harm avoidance (fear of uncertainty), reward dependence (sentimentality), and persistence (perseverance). Temperament data were accrued from the Junior Temperament and Character Inventory (JTCI). Participants were divided into (1) OCD only; (2) OCD+ADHD or TS; and (3) OCD+ADHD+TS to compare temperament. Results: Participants include 126 youths with OCD (61.9% male, 88.9% white) between the ages 6 and 18 years (12.7 ± 3.1). Among the three groups, the complex neurodevelopmental disorder group OCD+ADHD+TS expresses the highest novelty seeking and lowest persistence. Harm avoidance is increased in all groups compared to reference controls, irrespective of concurrent ADHD or TS. For the OCD+ADHD+TS group, contamination and washing symptoms have higher novelty seeking (p < 0.01), while counting and ordering have lower novelty seeking (p < 0.05). Harm avoidance is increased with aggressive, somatic, and checking symptoms in OCD only (p < 0.01), while persistence is increased with repeating and counting symptoms in the comorbid groups (OCD+ADHD or TS, OCD+ADHD+TS). Discussion/Conclusion: The complex subtype, OCD+ADHD+TS, is associated with high novelty seeking and low persistence, while high harm avoidance is linked to pediatric OCD irrespective of ADHD or TS co-occurrence. In sum, pediatric OCD with ADHD and TS confers a unique temperament profile, further refining complex phenotypes of pediatric OCD for future research.

Pencegahan dan Penyebaran Wabah Covid-19 di Daerah Pesisir

COVID-19 is an acute respiratory disease caused by a new type of corona virus. This disease first broke out in Wuhan, China and then spread to almost the entire world and caused a global pandemic. Main symptoms. Covid-19 includes cough, fever and shortness of breath. This disease attacks all age groups: adults, the elderly, and children. Coastal communities need to get easy-to-understand education about Covid-19 and ways to prevent it. This is the basis for the community service team for the professional study program Ners Stikes Hang Tuah Tanjungpinang to actively participate in efforts to prevent and control the Covid-19 virus by providing counseling or outreach about Covid-19 and its prevention efforts to coastal communities on the Nyirih River. The results obtained were 115 people with elementary education background 86 people (75.6%), infected with Covid-19 10 people (8.6%) positive antigen, cormobid hypertension 28 people (24.3%), cormobid DM 12 people (10 .4%) who have hyperglycemia blood glucose levels. The majority of participants have high risk factors for being infected with Covid-19 which can cause respiratory failure and death in the Comorbid group

Influence of Physiological Variables and Comorbidities on Plasma Aβ40, Aβ42, and p-tau181 Levels in Cognitively Unimpaired Individuals.

Plasma biomarkers for Alzheimer's disease (AD) are a promising tool that may help in early diagnosis. However, their levels may be influenced by physiological parameters and comorbidities that should be considered before they can be used at the population level. For this purpose, we assessed the influences of different comorbidities on AD plasma markers in 208 cognitively unimpaired subjects. We analyzed both plasma and cerebrospinal fluid levels of Aβ40, Aβ42, and p-tau181 using the fully automated Lumipulse platform. The relationships between the different plasma markers and physiological variables were studied using linear regression models. The mean differences in plasma markers according to comorbidity groups were also studied. The glomerular filtration rate showed an influence on plasma Aβ40 and Aβ42 levels but not on the Aβ42/Aβ40 ratio. The amyloid ratio was significantly lower in diabetic and hypertensive subjects, and the mean p-tau181 levels were higher in hypertensive subjects. The glomerular filtration rate may have an inverse relationship on plasma Aβ40 and Aβ42 levels but not on the amyloid ratio, suggesting that the latter is a more stable marker to use in the general population. Cardiovascular risk factors might have a long-term effect on the amyloid ratio and plasma levels of p-tau181.

Differentiating Performance on the Connors Continuous Performance Test (CPT-3) as a Function of Comorbid Internalizing Psychopathology.

Internalizing psychopathology commonly co-occurs with attention-deficit/hyperactivity disorder (ADHD). Attention concerns are present in both ADHD and internalizing disorders, yet the neuropsychological functioning of those with comorbid ADHD and internalizing psychopathology is underexamined. This study compared Conners' Continuous Performance Test-Third Edition (CPT-3) profiles across ADHD (n = 141), internalizing psychopathology (n = 78), and comorbid (ADHD/internalizing psychopathology; n = 240) groups. Compared to the internalizing psychopathology group, the comorbid group had higher mean T-scores on CPT-3 indices indicative of inattentiveness and impulsivity and more clinically elevated T-scores (T>60) on indices measuring inattentiveness and impaired sustained attention. Patients in the comorbid group were also more likely to have abnormal overall CPT-3 profiles (>2 elevated T-scores) than the ADHD and psychopathology only groups. Patients with comorbid ADHD/internalizing psychopathology may evidence a more impaired attentional performance on the CPT-3, which could aid in more tailored treatment planning.