Comorbidities In People Research Articles

Physical comorbidities in people with severe mental disorders: promises and future challenges

Abstract The comorbidity of mental and physical disorders is gradually becoming recognized as a major problem for health care. Its public health importance is vast and growing for a variety of reasons including the extension of life expectancy, the imperfection of currently available treatments of mental and many physical disorders and the tendency of fragmentation of medicine into ever more limited specialties. The problems related to comorbidity are also rapidly increasing in low- and middle-income countries where in addition to the issues mentioned above there is also a scarcity of means to deal with them. The presentation will remind the audience of the complexity of the problems and draw attention to action that could be taken by public health authorities and the medical profession in the areas of teaching, organization of service and research. Disclosure of Interest None Declared

Hepatitis B Vaccination in Psychiatric patients in Morocco

IntroductionSevere mental illnesses such as schizophrenia, bipolar disorder and depressive disorder are common worldwide and often have a chronic course.Due to psychiatric ( for example : substance use disorders ) and somatic ( for example : obesity, cardiovascular disease, diabetes ) comorbidities, mortality is higher in these patients than in the general population.Viral diseases are, in addition to cardiovascular diseases and metabolic alterations, among the most common somatic comorbidities in people with severe mental illness.ObjectivesThe objective of our work was to study the prevalence of vaccination against the viral hepatitis B virus in these patients.MethodsFor this purpose, we conducted a cross-sectional study of 200 patients hospitalized in the emergency department of our training center. First, we collected sociodemographic and clinical data on patients admitted to psychiatric emergencies: sex, age, diagnosis, duration of evolution, history (medical and surgical, psychiatric, suicide attempts, problematic substance use, previous incarceration). In a second step, we tested for anti-HBS antibodies.Resultsthe majority of our patients were male, the first diagnosis was schizophrenia.92% of our patients had a substance use disorder, mainly tobacco, followed by cannabis and then alcohol.Several patients reported having unprotected sex.58% of patients were vaccinated against hepatitis B, these patients were young for the most part. the majority of our patients were male, the first diagnosis was schizophrenia.92% of our patients had a substance use disorder, mainly tobacco, followed by cannabis and then alcohol.Several patients reported having unprotected sex.58% of patients were vaccinated against hepatitis B, these patients were young for the most part.Conclusions: Disclosure of InterestNone Declared

Multimorbidity prevalence and patterns in chronic kidney disease: findings from an observational multicentre UK cohort study

PurposeMultimorbidity [defined as two or more long-term conditions (LTCs)] contributes to increased treatment and medication burden, poor health-related quality of life, and worse outcomes. Management strategies need to be patient centred and tailored depending on existing comorbidities; however, little is known about the prevalence and patterns of comorbidities in people with chronic kidney disease (CKD). We investigated the prevalence of multimorbidity and comorbidity patterns across all CKD stages.MethodsMultimorbidity was assessed, using a composite of self-report and clinical data, across four CKD groups stratified by eGFR [stage 1–2, stage 3a&b, stage 4–5, and kidney transplant (KTx)]. Principal component analysis using varimax rotation was used to identify comorbidity clusters across each group.ResultsOf the 978 participants (mean 66.3 ± 14 years, 60% male), 96.0% had multimorbidity. In addition to CKD, the mean number of comorbidities was 3.0 ± 1.7. Complex multimorbidity (i.e. ≥ 4 multiple LTCs) was identified in 560 (57.3%) participants. When stratified by CKD stage, the two most prevalent comorbidities across all stages were hypertension (> 55%) and musculoskeletal disorders (> 40%). The next most prevalent comorbidity for CKD stages 1–2 was lung conditions and for CKD stages 3 and 4–5 it was heart problems. CKD stages 1–2 showed different comorbidity patterns and clustering compared to other CKD stages.ConclusionMost people across the spectrum of CKD have multimorbidity. Different patterns of multimorbidity exist at different stages of CKD, and as such, clinicians should consider patient comorbidities to integrate care and provide effective treatment strategies.

Prevalence of non-alcoholic fatty liver disease in a multicentre cohort of people living with HIV in Spain.

BackgroundNon-alcoholic fatty liver disease (NAFLD) is one of the most important liver comorbidities in people living with HIV (PLWH). Factors that could lead to a higher prevalence of NAFLD or ease the onset of fibrosis are unclear. MethodsCohort study of the Spanish HIV Research Network, which comprehends 46 hospitals and more than 15,000 PLWH. Primary objectives were to assess NAFLD prevalence and liver fibrosis according to hepatic steatosis index (HSI) and NAFLD fibrosis score, respectively. Factors associated with both were analysed. ResultsA total of 4798 PLWH were included of whom 1461 (30.5%) showed an HSI>36; these patients had higher risk for significant fibrosis (OR 1.91; 95%CI 1.11–3.28). Factors associated with NAFLD were body mass index (OR 2.05; 95%CI 1.94–2.16) and diabetes (OR 4.68; 95%CI 2.17–10.08), while exposure to integrase strand transfer inhibitors showed a lower risk (OR 0.78; 95%CI 0.62–0.97). In patients with HSI>36, being female (OR 7.33; 95%CI 1.34–40), age (OR 1.22; 95%CI 1.11–1.34), body mass index (OR 1.35; 95%CI 1.18–1.54) and exposure to thymidine analogues (OR 75.4, 95%CI 6.9–823.5) were associated with a higher risk of significant fibrosis. However, exposure to non-nucleoside reverse transcriptase inhibitors (OR 0.12, 95%CI 0.02–0.89) and time of exposure to protease inhibitors (OR 0.97, 95%CI 0.95–1) showed a lower risk. ConclusionNAFLD prevalence was high in our cohort. Patients exposed to INSTI showed a lower risk of NAFLD. In patients with hepatic steatosis, exposure to thymidine analogues had 75-fold more risk of significant fibrosis while exposure to NNRTIs reduced this risk.

Integrating substance use and mental health services

People living with HIV have an increased prevalence and frequency of medical, psychiatric, and substance-use disorders that result in increased age-matched morbidity and mortality. 1 Altice FL Kamarulzaman A Soriano VV Schechter M Friedland GH Treatment of medical, psychiatric, and substance-use comorbidities in people infected with HIV who use drugs. Lancet. 2010; 376: 367-387 Summary Full Text Full Text PDF PubMed Scopus (350) Google Scholar Alcohol, tobacco, and other substance use often co-occur with depression, anxiety, and chronic pain. This constellation of alcohol, substance, and mood-related (CASM) conditions disproportionately affects people with HIV. 2 Bershteyn A Richard E Zhou Q et al. Potential health benefits of integrated screening strategies for alcohol, tobacco, other substance use, depression, anxiety, and chronic pain among people living with HIV in the USA. Lancet HIV. 2022; 10: e118-e125 Google Scholar Integration of HIV services with other health services has been proposed as an important strategy to boost the sustainability of the global HIV response and contribute to the goal of ending AIDS by 2030. 3 Bulstra CA Hontelez JAC Otto M et al. Integrating HIV services and other health services: a systematic review and meta-analysis. PLoS Med. 2021; 18e1003836 Crossref Scopus (8) Google Scholar In The Lancet HIV, Anna Bershteyn and colleagues 2 Bershteyn A Richard E Zhou Q et al. Potential health benefits of integrated screening strategies for alcohol, tobacco, other substance use, depression, anxiety, and chronic pain among people living with HIV in the USA. Lancet HIV. 2022; 10: e118-e125 Google Scholar showed that primary care providers of people with HIV in the USA should consider comprehensive diagnostic assessment of CASM if one or more conditions screen positive, a strategy that could increase life expectancy by nearly a year, exceeding life expectancy gains from benchmark preventative care recommendations. 2 Bershteyn A Richard E Zhou Q et al. Potential health benefits of integrated screening strategies for alcohol, tobacco, other substance use, depression, anxiety, and chronic pain among people living with HIV in the USA. Lancet HIV. 2022; 10: e118-e125 Google Scholar Potential health benefits of integrated screening strategies for alcohol, tobacco, other substance use, depression, anxiety, and chronic pain among people living with HIV in the USA: a mathematical modelling studyPrimary care providers for people with HIV should consider comprehensive diagnostic assessment of CASM conditions if one or more conditions screen positive. Full-Text PDF

P822 The negative impact of mental health comorbidity in children and young adults with inflammatory bowel disease: a UK population-based cohort study

Abstract Background Whilst the high burden of mental health comorbidity in people with inflammatory bowel disease (IBD) is now being recognised, less is known about the additional impacts of having concurrent IBD and a mental health condition, especially in children and young adults. Methods We conducted a retrospective, observational study using a large UK primary care dataset (Optimum Patient Care Research Database). Children and young adults (aged 5-25 years) diagnosed with IBD prior to 2015 were identified and grouped into those with and without prevalent mental health conditions (any of depression, anxiety, eating disorders, body image disorder, attention-deficit disorder, behavioural disorders, adjustment disorder, acute stress disorder, schizophrenia, bipolar disorder or post-traumatic stress disorder). The following outcomes were compared over 5 years in the two groups; quality-of-life indicators (bowel symptoms [abdominal pain, discomfort or bloating, diarrhoea], systemic symptoms [fatigue, sleep problems, weight-loss, underweight, growth retardation], emotional function [low mood, substance abuse, deliberate self-harm, suicidal attempt or parasuicide] and social function [absence from school, absence from work, unemployment]), IBD-specific therapy interventions (diet [nutritional supplements], medications [oral and rectal 5-aminosalicylic acid and steroids, antimetabolites and tumour necrosis factor inhibitors] and surgery [abdominal and stoma formation]), and healthcare utilisation (primary care interactions and hospital admissions). Adjustment for confounders was performed using Cox regression for non-recurring outcomes (e.g. stoma formation), and negative binomial or Poisson regression for outcomes with recurring events (e.g. primary care interactions). Results 1,943 individuals with IBD were identified. 295 of these had a prevalent mental health condition. Mental health comorbidity was associated with increased bowel symptoms (adjusted Incident Rate Ratio [aIRR] 1.82; 95% Confidence Interval [CI] 1.33, 2.52), sleep disturbance (adjusted Hazard Ratio [aHR] 1.63; 95% CI 1.02, 2.62), substance abuse (aHR 3.63; 95% CI 1.69, 7.78), primary care interactions (aIRR 1.33; 95% CI 1.12, 1.58) and hospital admissions (aIRR 1.87; 95% CI 1.29, 2.75) (Figure 1). In those >18 years old, mental health comorbidity was associated with increased time off work (aHR 1.55; 95% CI 1.21, 1.99) (Figure 1). Conclusion Mental health comorbidity in children and young adults with IBD is associated with increased IBD symptoms, healthcare utilisation and time off work. Given the impact of mental health comorbidity, it is crucial those affected are monitored and receive appropriate mental health support as part of their multidisciplinary care.

Eye movement characteristics are not significantly influenced by psychiatric comorbidities in people with visual snow syndrome

Visual snow syndrome (VSS) is a neurological disorder primarily affecting the processing of visual information. Using ocular motor (OM) tasks, we previously demonstrated that participants with VSS exhibit altered saccade profiles consistent with visual attention impairments. We subsequently proposed that OM assessments may provide an objective measure of dysfunction in these individuals. However, VSS participants also frequently report significant psychiatric symptoms. Given that that these symptoms have been shown previously to influence performance on OM tasks, the objective of this study was to investigate whether psychiatric symptoms (specifically: depression, anxiety, fatigue, sleep difficulties, and depersonalization) influence the OM metrics found to differ in VSS. Sixty-one VSS participants completed a battery of four OM tasks and a series of online questionnaires assessing psychiatric symptomology. We revealed no significant relationship between psychiatric symptoms and OM metrics on any of the tasks, demonstrating that in participants with VSS, differences in OM behaviour are a feature of the disorder. This supports the utility of OM assessment in characterising deficit in VSS, whether supporting a diagnosis or monitoring future treatment efficacy.

Virtual Reality Therapy for People With Epilepsy and Related Anxiety: Protocol for a 3-Phase Pilot Clinical Trial.

Anxiety is one of the most common psychiatric comorbidities in people with epilepsy and often involves fears specifically related to the condition, such as anxiety related to the fear of having another seizure. These epilepsy- or seizure-related fears have been reported as being more disabling than the seizures themselves and significantly impact quality of life. Although research has suggested that exposure therapy (ET) is helpful in decreasing anxiety in people with epilepsy, no research to our knowledge has been conducted on ET in people with epilepsy using virtual reality (VR). The use of novel technologies such as an immersive VR head-mounted display for ET in this population offers several benefits. Indeed, using VR can increase accessibility for people with epilepsy with transportation barriers (eg, those who live outside urban centers or who have a suspended driver's license owing to their condition), among other advantages. In the present research protocol, we describe the design of an innovative VR-ET program administered in the home that focuses on decreasing anxiety in people with epilepsy, specifically anxiety related to their epilepsy or seizures. Our primary objective is to examine the feasibility of the study protocol and proposed treatment as well as identify suggestions for improvement when designing subsequent larger clinical trials. Our secondary objective is to evaluate whether VR-ET is effective in decreasing anxiety in a pilot study. We hypothesize that levels of anxiety in people with epilepsy will decrease from using VR-ET. This mixed methods study comprises 3 phases. Phase 1 involves engaging with those with lived experience through a web-based questionnaire to validate assumptions about anxiety in people with epilepsy. Phase 2 involves filming videos using a 360° camera for the VR-ET intervention (likely consisting of 3 sets of scenes, each with 3 intensity levels) based on the epilepsy- and seizure-related fears most commonly reported in the phase 1 questionnaire. Finally, phase 3 involves evaluating the at-home VR-ET intervention and study methods using a series of validated scales, as well as semistructured interviews. This pilot study was funded in November 2021. Data collection for phase 1 was completed as of August 7, 2022, and had a final sample of 18 participants. Our findings will add to the limited body of knowledge on anxiety in people with epilepsy and the use of VR in this population. We anticipate that the insights gained from this study will lay the foundation for a novel and accessible VR intervention for this underrecognized and undertreated comorbidity in people with epilepsy. ClinicalTrials.gov NCT05296057; https://clinicaltrials.gov/ct2/show/NCT05296057. DERR1-10.2196/41523.

Prevalence and incidence of vitiligo and associated comorbidities: a nationwide population-based study in Korea.

The prevalence of vitiligo shows regional variance. Recently, an association between vitiligo and extracutaneous conditions including other autoimmune, metabolic and dermatological disorders has been suggested. Despite its increasing incidence, the epidemiological trends and comorbidities in people with vitiligo have rarely been quantified in Asia. To determine the prevalence and incidence of vitiligo and the disorders associated with vitiligo using the National Health Insurance Service database. We included all patients with vitiligo, classified by the International Classification of Disease, 10th revision (ICD-10) code of L80, with ≥ 3 documented visits from 2003 to 2019. The incidence and prevalence of vitiligo were estimated for the study period. Age-, sex-, insurance type- and income level-matched controls (ratio 1 : 5) were selected to compare comorbidities. The odds ratios between comorbidities and vitiligo were calculated through conditional logistic regression. The incidence and annual prevalence of vitiligo in Korea increased from 2003 to 2019, with incidence peaking in summer. Age-specific incidence showed a bimodal distribution, with the steepest increase in the group aged < 20 years. Many comorbidities, including alopecia areata, psoriasis, rheumatoid arthritis, systemic lupus erythematosus, Crohn disease, ulcerative colitis, Sjögren syndrome, diabetes mellitus, dyslipidaemia, chronic hepatitis, anxiety disorder and mood disorder showed higher odds ratios in patients with vitiligo than controls. The incidence and prevalence of vitiligo are increasing, particularly among younger patients in Korea. In addition, various comorbidities are associated with vitiligo, therefore, if patients with vitiligo present with extracutaneous symptoms, physicians should consider the possibility of other comorbid diseases.

Histology, prevalence, and environmental sources for pulmonary silicates depositions in domestic and wild animals.

The source and significance of pulmonary silicate crystals in animals and people are poorly understood. To estimate the prevalence and characterize the pulmonary crystalline material in animals from St. Kitts, tissue samples from dogs, horses, cattle, sheep, goats, pigs, chickens, mongooses, and monkeys were examined by light microscopy, scanning electron microscopy with energy-dispersive x-ray analysis (SEM/EDXA), and x-ray diffraction. Crystalline material was seen in 201 of 259 (77.6%) lung samples as perivascular and interstitial accumulations of heterogeneous crystalline particulate material, free or within macrophages (silicate-laden macrophages [SLMs]), mostly lacking evidence of chronic inflammation or fibrosis. The crystalline material was birefringent, basophilic on acid-fast, and composed of silicas on SEM/EDXA. Mongooses (100%) and monkeys (98%) had the highest prevalence of SLM, followed by cattle and chickens. Lesions were graded on a 3-point scale based on the histologic location and extent of silicates and SLM and were significantly more severe in mongooses (median = 3) than in monkeys (median = 2), dogs (median = 2), and chickens (median = 1). On EDXA, the crystalline material from lungs, air, and topsoil was composed of silicon, oxygen, aluminum, and iron, with a particulate matter size between 2.5 and 10 µm. We hypothesize Saharan dust, volcanic ash, topsoil, and rock quarry dust are potential sources of siliceous dust inhalation and SLM accumulations lacking chronic inflammation (silicosis); dust generation may be potentiated by road vehicle or wind suspension. Future investigations are warranted on the role of silicate inhalation and respiratory comorbidities in people, with monkeys, mongooses, or chickens serving as possible sentinels for exposure.

Psychological morbidity and chronic cough: which is predominant? A comparison of clinical characteristics.

The clinical characteristics of chronic cough with pre-existing psychological co-morbidity (PCC) and chronic cough with secondary anxiety and depression (SCC) were compared to provide a basis for diagnosing and treating psychological co-morbidities in people with chronic cough. A prospective study was conducted to analyze the general clinical data between the PCC, SCC, and the chronic cough without anxiety and depression (CC) groups. A total of 203 patients with chronic cough were enrolled in the study. The final diagnosis was made in all cases using a combination of psychosomatic and respiratory diagnoses. The three groups' general clinical data, capsaicin cough sensitivity, cough symptom score, Leicester cough questionnaire (LCQ), and psychosomatic scale scores were compared among the three groups. The diagnostic value of the patient health questionnaire (PHQ)-9 and general anxiety disorder (GAD)-7 in patients with PCC and the follow-up information were analyzed. Compared with the SCC group, the duration of cough in the PCC group was shorter (H = -3.54, p = 0.001), the night cough symptoms were milder (H = -4.60, p < 0.001), the total LCQ score was lower (H = -2.97, p = 0.009), and the PHQ-9 (H = 2.90, p = 0.011) and GAD-7 scores (H = 2.71, p = 0.002) were higher. When using PHQ-9 and GAD-7 scores for the combined prediction and diagnosis of PCC, the area under the curve (AUC) was 0.88, and the sensitivity and specificity were 90.0% and 73.85%, respectively. After 8 weeks of psychosomatic treatment, cough symptoms improved in the PCC group, but the psychological improvement was not significant. The psychological status of the SCC group improved after cough symptoms were ameliorated by etiologic or empirical treatment. The clinical characteristics of patients with PCC and SCC are different. The evaluation of psychosomatic scales is of value to distinguish between the two groups. Chronic cough patients with psychological co-morbidity benefit from the combined diagnosis of psychosomatic medicine in a timely fashion. PCC requires more attention in psychological therapy, but for SCC, targeting etiological treatment of the cough is preferred. The protocol was registered in the Chinese Clinical Trials Register (http://www.chictr.org.cn/) [ChiCTR2000037429].

JS-HR-8: PROGRESS OF OBESITY/DIABETES IN AREA OF HYPERTENSION RESEARCH 2021

Obesity/diabetes is a major comorbidity in people with hypertension, and they often share the common pathological backgrounds, such as insulin resistance and vascular failure, and the risk of cardiovascular disease (CVD). Thus, obesity/diabetes is an essential culprit to hamper cardiometabolic health. One of the biggest highlights of recent years in the area or obesity/diabetes has been the remarkable benefits of newer glucose-lowering agents seen in the large-scale clinical trials on cardiorenal outcomes, followed by the relevant clinical guidelines update and the expansion of the clinical application of those agents. In addition, such agents with evidence proved to have common and incidental actions, such as body weight loss and blood pressure reduction, potentially contributing to the better management of risk factors. These evidence and insights have led to new trends in our clinical practice for obesity/diabetes and cardiometabolic syndrome. In this talk, we would like to introduce the progress of obesity/diabetes in area of Hypertension Research 2021 and their clinical perspectives.

ALZHEIMER’S DISEASE AND COMORBIDITIES: A COMPLEX INTERPLAY IN THE CONTEXT OF AGING

Abstract There is evidence on high prevalence of comorbidity in people with dementia and on associations between comorbidities and progression of Alzheimer’s disease (AD). Comorbidities accumulate with age and age is also a major risk factor for AD. Repeated measurements of comorbidity provide possibilities for gaining more knowledge about dynamic interconnection between comorbidities and AD development in the context of aging. We constructed the comorbidity index (CMI) for participants of the Health and Retirement Study aged 66+ years using data on onset of diseases from linked Medicare service use files (6,830 participants, 3,829 females, 3,001 males). We performed the joint analysis of longitudinal measurements of CMI and data on onset of AD and survival since onset of AD using the approach (the stochastic process model) that allows decomposing the overall association of trajectories of CMI with respective time-to-event outcomes into several aging-related characteristics represented by the model’s components and evaluated indirectly from the data. We found that, overall, CMI is significantly (p&amp;lt; 0.0001) associated with increased risk of onset of AD and decreased survival chances for persons with AD and that this association can be decomposed into associations of AD outcomes with different aging-related components with differentiated impact of genetic and non-genetic factors (such as APOE, polygenic scores, sex, birth cohort). In particular, age patterns and time trends in such components contribute to trends in AD prevalence so that taking into account the age dynamics and time trends in comorbidities (represented by CMI) is essential for forecasting future trends in AD prevalence.

Physical comorbidities in patients with severe mental disorders: a brief narrative review on current challenges and practical implications for professionals.

A paradox of the modern world is represented by the increasing rate of comorbidities, although the life expectancy is increasing worldwide, the number of disease-free years is not improving consequently. Physical comorbidities are often overlooked in people with severe mental disorders, although this problem needs to be adequately managed since it is associated with a worse quality of life and a poorer personal and social functioning. In this paper, we aim to: 1) carry out a narrative review of the recent literature in order to provide an update on the prevalence and incidence of the most frequent comorbid physical disorders in people with severe mental disorders; 2) highlight the most important difficulties in managing comorbidities in people with severe mental disorders in ordinary clinical care; 3) discuss possible solutions to overcome those difficulties, particularly through the role of education and scientific associations.

&lt;i&gt;Corrigendum to&lt;/i&gt;: Under-utilisation of cardioprotective glucose-lowering medication in diabetics living with HIV

Diabetes is an increasingly common co-morbidity in people living with HIV (PLWH). Given new evidence demonstrating cardiovascular benefits of sodium glucose transporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP1RA) in diabetic patients, we reviewed medical charts of 262 PLWH at Monash Health through a 1-year retrospective cohort study to determine the rates of their use. Prevalence of diabetes was 13.4% (35) and 60% (21) had microvascular and macrovascular complications. Only 4% (95% CI 0.1%&amp;#x2013;19.6%) of diabetic patients were receiving SGLT2i and 19% (95% CI 6%&amp;#x2013;39.4%) were receiving GLP1RA. Prescribers should carefully consider their choice of glucose-lowering medication when treating PLWH.

Obstructive sleep apnea and nocturnal hypoxemia in adult patients with cystic fibrosis

BackgroundObstructive sleep apnea (OSA), nocturnal hypoxemia and excessive daytime sleepiness (EDS) are common comorbidities in people with cystic fibrosis (pwCF). Most of the data showing this originates from children and adolescents. The aim of this study was to collect data on sleep parameters, EDS and pulmonary function from a large cohort of adult pwCF.MethodsFull overnight polysomnography (PSG) was performed. EDS was determined using the Epworth Sleepiness Scale (ESS). Demographic and clinical data (body mass index [BMI], pulmonary function, capillary blood gases) were collected.ResultsA total of 52 adult pwCF were included (mean age 30.7 ± 8.0 years, mean percent predicted forced expiratory volume in 1 s [ppFEV1] of 52.1 ± 14.8). Overall AHI was in the normal range (4.5 ± 4.0/h); 21/52 pwCF (40%) had an apnea-hypopnea index > 5/h. Nocturnal hypoxemia was found in 25% of participants and this was associated with ppFEV1 (p = 0.014), awake oxygen saturation (SpO2; p = 0.021) and awake partial pressure of oxygen (pO2; p = 0.003); there were no significant differences in age, lung function and BMI were found for pwCF with versus without OSA (all p > 0.05). Eight pwCF (15%) had an ESS score > 10 (indicating EDS). OSA was best predicted by awake pO2 (area under the curve [AUC] 0.66, p = 0.048), while nocturnal hypoxemia was best predicted by ppFEV1 (AUC 0.74, p = 0.009), awake pO2 (AUC 0.76, p = 0.006) and awake SpO2 (AUC 0.71; p = 0.025).ConclusionOSA, nocturnal hypoxemia and EDS were common in adult pwCF, but no strong predictors were identified. Therefore, we suggest regular PSG and ESS scoring in adult pwCF, regardless of disease severity.

Validation of a predictive model for obstructive sleep apnea in people with Down syndrome.

Detecting obstructive sleep apnea (OSA) is important to both prevent significant comorbidities in people with Down syndrome (DS) and untangle contributions to other behavioral and mental health diagnoses. However, laboratory-based polysomnograms are often poorly tolerated, unavailable, or not covered by health insurance for this population. In previous work, our team developed a prediction model that seemed to hold promise in identifying which people with DS might not have significant apnea and, consequently, might be able to forgo a diagnostic polysomnogram. In this study, we sought to validate these findings in a novel set of participants with DS. We recruited an additional 64 participants with DS, ages 3-35 years. Caregivers completed the same validated questionnaires, and our study team collected vital signs, physical exam findings, and medical histories that were previously shown to be predictive. Patients then had a laboratory-based polysomnogram. The best modeling had a validated negative predictive value of 50% for an apnea-hypopnea index (AHI) > 1/hTST and 73.7% for AHI >5/hTST. The positive predictive values were 60% and 39.1%, respectively. As such, a clinically reliable screening tool for OSA in people with DS was not achieved. Patients with DS should continue to be monitored for OSA according to current healthcare guidelines.

Diabetes mellitus tipo 2 y obesidad en el contexto de la COVID -19

La pandemia originada por coronavirus (COVID-19) ocasionada por el coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2), además de ocasionar una problemática de salud pública global ha afectado los hábitos y calidad de vida de los individuos debido al confinamiento por riesgo de contagio. En este escenario, la Diabetes Mellitus Tipo 2 (DM2) considerada una de las comorbilidades más frecuentes en personas con COVID-19 desencadenó una mayor tasa de ingreso hospitalario y mortalidad. Asimismo, la obesidad se ha vinculado con mayor riesgo de complicaciones y mortalidad en pacientes con diagnóstico de COVID-19. Los mecanismos que intentan explicar la asociación entre la COVID-19, DM2 y obesidad no se encuentran esclarecidos en su totalidad. Sin embargo, se ha identificado a la inflamación crónica como un elemento central en este contexto. En efecto, la obesidad ha incrementado su prevalencia a edades tempranas lo que implica la aparición de complicaciones como resistencia a la insulina y DM2, patologías que elevan el riesgo de infecciones y complicaciones por SARS-CoV-2. En este artículo se explora la relación entre la obesidad y DM2 en el contexto de la COVID-19 y sus repercusiones.

Mortality and life-years lost following subsequent physical comorbidity in people with pre-existing substance use disorders: a national registry-based retrospective cohort study of hospitalised individuals in Czechia

Substance use disorders constitute a major global public health problem, attributable largely to their subsequent comorbidity with other health conditions. This study aimed to investigate the risk of all-cause death and life-years lost following hospitalisation for 28 subsequent physical comorbid conditions in people with a previous hospitalisation for substance use disorder, compared with matched counterparts without substance use disorder. We did a retrospective cohort study on data from Czech nationwide registers of all-cause hospitalisations and deaths during the period from Jan 1, 1994, to Dec 31, 2017. The cohorts consisted of individuals who had initially been hospitalised between 15 and 70 years of age (index hospitalisation) and who were subsequently hospitalised with one or more of 28 comorbid physical health conditions. We included individuals with an index hospitalisation for substance use disorders and up to three counterparts without substance use disorders with a subsequent hospitalisation for the same physical health condition, with matching on sex, age (±3 years), work status, and discharge year at first hospitalisation for the subsequent condition. Data on ethnicity were not available. Risk of death due to any cause following the first hospitalisation for each physical health condition until Dec 31, 2017, and life-years lost after disease onset at ages 30, 45, and 60 years, and before 81 years of age, were examined. From a total 56 229 563 records of hospitalisations identified, we included 121 153 people with hospitalisation for substance use disorders and 6 742 134 people without hospitalisation for substance use disorders in the study. The 28 condition-specific cohorts comprised a median of 6444 individuals (IQR 2033-12 358), ranging from 444 for multiple sclerosis to 36 356 for diseases of the circulatory system. Across the cohorts, the proportion of males ranged from 31·4% for thyroid disorder to 100·0% for prostate disorders. The mean baseline age ranged from 30·0 years (SD 9·1) for chronic viral hepatitis in people with pre-existing substance use disorders to 62·2 years (9·7) for Parkinson's disease in people without pre-existing substance use disorders. After adjusting for potential confounders using stratified Cox proportional hazards models, individuals with a pre-existing substance use disorder had an increased risk of death due to any cause after the onset of 26 out of 28 physical health conditions, relative to their counterparts without substance use disorders, with adjusted hazard ratios ranging from 1·15 (1·09-1·21) for chronic liver disease to 3·86 (2·62-5·67) for thyroid disorder. For seven subsequent health conditions, the risk of death was more than doubled in the group with pre-existing substance use disorders. When compared with the general population via mortality tables, people with pre-existing substance use disorders had substantial losses in life-years after the onset of most of the subsequent physical health conditions regardless of age of onset, and, for the majority of comorbidities, lost considerably more life-years than their counterparts without substance use disorders. A history of hospitalisation for substance use disorders appears to have a significant negative effect on prognosis following the development of various subsequent physical health conditions. These findings strongly suggest that clinical vigilance and high-quality integrated treatment for people with substance use disorders could be life-saving and should be given higher priority on the public health agenda. National Institute for Health and Care Research Applied Research Collaboration East of England at Cambridge and Peterborough National Health Service Foundation Trust.

Characterization of Circulating Fibrocytes in People Living with HIV on Stable Antiretroviral Therapy.

Highly effective combination antiretroviral therapy has reduced HIV infection to a manageable chronic disease, shifting the clinical landscape toward management of noninfectious comorbidities in people living with HIV (PLWH). These comorbidities are diverse, generally associated with accelerated aging, and present within multiple organ systems. Mechanistically, immune dysregulation and chronic inflammation, both of which persist in PLWH with well-controlled virally suppressive HIV infection, are suggested to create and exacerbate noninfectious comorbidity development. Persistent inflammation often leads to fibrosis, which is the common end point pathologic feature associated with most comorbidities. Fibrocytes are bone marrow-derived fibroblast-like cells, which emerged as key effector cells in tissue repair and pathologic fibrotic diseases. Despite their relevance to fibrosis, the circulating fibrocyte concentration in PLWH remains poorly characterized, and an understanding of their functional role in chronic HIV is limited. In this study, utilizing PBMCs from a cross-sectional adult HIV cohort study with matched uninfected controls (HIV-), we aimed to identify and compare circulating fibrocytes in blood. Both the percentage and number of fibrocytes and α-smooth muscle actin+ fibrocytes in circulation did not differ between the HIV+ and HIV- groups. However, circulating fibrocyte levels were significantly associated with increasing age in both the HIV+ and HIV- groups (the percentage and number; r = 0.575, p ≤ 0.0001 and r = 0.558, p ≤ 0.0001, respectively). Our study demonstrates that circulating fibrocyte levels and their fibroblast-like phenotype defined as collagen I and α-smooth muscle actin+ expression are comparable between, and strongly associated with, age irrespective of HIV status.