Comorbid Heart Disease Research Articles

COVID-19 and Long-term Risk of Ischemic Heart Disease in Asthma.

Despite the importance of comorbid ischemic heart disease (IHD) in the prognosis of asthma, the long-term impact of coronavirus disease 2019 (COVID-19) on IHD in adults with asthma remains unclear. This study investigated the long-term effects of COVID-19 on the risk of IHD in individuals with asthma, particularly regarding COVID-19 severity. Using the Korean National Health Insurance Service claims database, we identified individuals with asthma who had recovered from COVID-19 between October 8, 2020, and December 31, 2021 (n = 8,011) and 1:1 propensity score-matched controls (n = 8,011). The incidence and risk of IHD were compared between the two groups. Overall, during a median follow-up of 95 days (interquartile range, 34-213 days; range, 1-448 days), which includes a median of 14 lag days, the COVID-19 cohort did not show a higher risk of IHD (hazard ratio [HR], 2.11; 95% confidence interval [CI], 0.99-4.48) compared to matched controls. However, when the severity of COVID-19 was considered, the severe COVID-19 cohort exhibited a higher risk of IHD (HR, 4.89; 95% CI, 1.86-12.84) than matched controls; in contrast, the non-severe COVID-19 cohort showed no significantly increased risk of IHD (HR, 1.64; 95% CI, 0.73-3.70). Severe COVID-19 is associated with an increased long-term risk of IHD in adults with asthma, emphasizing the importance of cardiovascular events monitoring to improve asthma treatment outcomes in the era of COVID-19.

Therapeutic mechanism and key active ingredients of Yinxing Mihuan Oral Solution in coronary heart disease comorbidity with anxiety: A network pharmacology and molecular docking approach.

Yinxing Mihuan Oral Solution (YMOS) is a Chinese patent medicine for treating coronary heart disease combined anxiety (CHDCA), but the molecular mechanism of its treatment is still unclear. This article aims to understand the molecular mechanism, optimize clinical drug use, and guide new drug development. Using the Swiss Target Prediction database, we obtained the main chemical composition of YMOS. Then we used network pharmacology to identify their potential targets. Network construction, coupled with protein-protein interaction and enrichment analysis was used to identify representative components and core targets. Finally, molecular docking simulation was conducted to further refine the drug-target interaction. Forty-two active chemicals were found in YMOS and 91 target genes related to CHDCA. The treatment effect was found to be associated with 1908 biological processes and 160 pathways, as revealed by the outcomes of the enrichment analysis. The potential therapeutic mechanisms of the drug are closely related to its antioxidant, anti-inflammatory, and vascular function regulation pathways, and the main core targets include albumin, tumor necrosis factor, TP53, AKT serine/threonine kinase 1, interleukin 1 beta, and vascular endothelial growth factor A. The potential molecular mechanisms of YMOS in CHDCA treatment were identified using network pharmacology and molecular docking approaches. The results reveal the systemic biological implications of YMOS. This study has systematically uncovered the molecular mechanism of YMOS for the first time, offering fresh insights for evidence-based clinical applications.

The Association Between Completion of Supervised Exercise Therapy and Long-Term Outcomes in Patients with Intermittent Claudication, Concomitant Sarcopenia, and Cardiometabolic Multimorbidity

The combination of intermittent claudication (IC), cardiometabolic multimorbidity (CMM), and sarcopenia is associated with worse outcomes than IC alone. This study aimed to identify whether the completion of supervised exercise therapy (SET) attenuates these adverse outcomes in patients with combined IC, sarcopenia, and CMM. This registry review included consecutive IC patients with concomitant CMM and sarcopenia, who were referred for SET from 2014 to 2017. CMM was defined as 2 or more comorbidities (diabetes, heart disease, stroke, or chronic kidney disease). Sarcopenia was assessed using the L3-skeletal muscle index (L3SMI) from computed tomography (CT) scans in the preceding 18months. The outcomes of interest were progression to chronic limb-threatening ischemia (CLTI), major adverse cardiovascular events (MACE), and major adverse limb events (MALE). Survival and Cox regression analyses were performed. Eighty-two patients with a combination of IC, CMM, and sarcopenia were included. Of these, 56 declined or prematurely discontinued SET and 26 completed SET. Baseline characteristics and L3SMI did not significantly differ between groups. Completion of SET was associated with slower progression to CLTI (HR: 0.23; 95% CI: 0.07-0.69; P=0.02) and a reduced risk of MALE (HR: 0.21; 95% CI: 0.057-0.775; P=0.02). However, there was no reduction in the risk of MACE (HR: 0.88; 95%CI: 0.423-1.629; P=0.73). Models demonstrated good predictive accuracy (Harrell's C-index >0.6). Completion of SET was associated with significant improvements in adverse limb outcomes in patients with IC, concomitant sarcopenia, and CMM.

Characteristics of COVID-19 patients with coronary artery disease comorbidity

Coronavirus disease 2019 (COVID-19) is an infectious respiratory disease which is caused by the SARS-CoV-2 virus. Coronary heart disease is a disease caused by plaque build-up in artery walls which supply blood to the heart and other body parts. Coronary heart disease is amongst the most severe COVID-19 comorbidities. Objective: To determine the patient profile of COVID-19 patients with coronary heart disease comorbidity Methods: Literature study with a systematic review that uses previous research as a reference to generate conclusions. Results: Based on the 24 journals used in this literature review, 11 journals discuss the topic of age, 9 journals discuss the topic of gender, and 8 journals discuss the topic of the prognosis of COVID-19 patients with coronary heart disease comorbidity. Conclusion: The mean age of COVID-19 patients with coronary heart disease comorbidity is 63,4 years old. The gender in this case is 64,7% males dan 34,3% females. The rates for prognosis are 47,6% of patients need to go to the ICU, 32,8% of patients died, 51,75% of patients recovered and 36,5% of patients need further treatment.

A Case Report of 80-Year-Old Male with Total Atrioventricular Block, Acute Decompensated Heart Failure, and Non-ST-Elevation Myocardial Infarction Very High Risk: A Complicated Case in Limited Resources Setting

Background: Cardiovascular disease is still a major problem globally, with high morbidity and mortality rates. The progression of cardiovascular disease is so dynamic that it can leave the patient in a terminal condition. Given the high mortality and morbidity accompanied by rapid disease progression, understanding the appropriate management of each patient with comorbid heart disease is very important. Case presentation: We report an 80-year-old male with TAVB (Total Atrioventricular Block), ADHF (Acute Decompensated Heart Failure), and NSTEMI (Non-ST-Elevation Myocardial Infarction). The patient was treated and stabilized intensively in our center based on protocol. Due to the rapid progression of the disease, we referred the patient to the tertiary hospital in Bali for further advanced treatment. Conclusion: The mortality rate in cases of cardiovascular diseases is relatively high, requiring rapid and adequate treatment to provide better clinical outcomes.

Exploring Endocrine Signaling between Adipose Tissues and the Heart using Transfer Learning and Induced Pluripotent Stem Cell Models

Background: Because of the amount of evidence pointed toward obesity as a co-morbidity of heart disease, our goal in this study is to use a data-driven method to discover potential cross talk signals between adipose and cardiac tissues, which may reveal a physiological reason for this association. For this study, we hypothesized that adipose-cardiac crosstalk signaling can be found by unexpected co-expression between adipose tissue genes encoding secreted proteins and cardiac tissue genes and vice versa. By discovering new crosstalk signals between these two tissues, we can find new associations between heart disease and obesity. Methods: Cross-tissue correlations of gene expression have been used to identify candidate endocrine signals that mediate tissue crosstalk, which are otherwise diffcult to detect in circulation. However, the identification of significant cross-tissue gene co-expression is hindered by immense multiple-testing burden. Our goal here is to abstract gene expression patterns of tissues into eigengenes and then test their correlation with secreted protein coding genes across tissues in a pairwise fashion. We first used the NIH Common Fund Genotype-Tissue Expression data set (GTEx v8) which contains RNA seq gene expression data from matched tissues of over 17,000 transcriptomes, to learn the latent structure of gene expression across tissues. To do so, we used PLIER (pathway level information extractor), a matrix factorization algorithm to extract the latent targets as eigengenes that map to specific biological pathways in the target tissue (e.g., pathways in the heart in the case of adipose to heart crosstalk). The learned gene expression structure is then transferred to a smaller data set with matching donor adipose and heart transcript expression data, from which a correlation matrix is constructed to find significant relationships between source tissue crosstalk signals and target tissue eigengenes and nominate novel crosstalk signals. Results: Adipose to heart tissue cross talk correlations using PLIER derived latent eigengene targets revealed many adipokines that had strong correlations with pathways found in the heart tissue through similar gene expression. Among these strong correlations were eigengene targets that were wrapped in metabolism pathways particularly those of fatty acid, phospholipid, and protein metabolism. Adipokines that showed high significant and positive correlation with cardiac latent variable expression included Adiponectin (R = 0.32, p = 4.7e−13), Glutathione Peroxidase 3 (R = 0.34, p = 5e−15) and Galectin 9 (R = 0.37, p < 2.2e−16) among others. Based on these results, we nominated new potential relationships between adipose and cardiac tissue. Work is currently under way to validate these candidate crosstalk signals using human induced pluripotent stem cell (iPSC)-derived cardiomyocytes. Future Directions In conclusion, we have found strong evidence in silico to suggest a relationship between known secreted proteins from adipose tissue (adipokine) and the expression of important pathways (such as fatty acid and protein metabolism) in the heart. Based on the findings of these correlations between adipokines and latent eigengene pathways within the heart, our future directions will involved the understanding of potential downstream functional consequences mediated by the adipose secreted proteins in iPSC derived models. This project was supported in part by NIH award R03-OD032666 and the University of Colorado Translational Research Scholar Program to E.L. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Risk factors and effect of dyspnea inappropriate treatment in adults' emergency department: a retrospective cohort study.

Dyspnea is a frequent symptom in adults' emergency departments (EDs). Misdiagnosis at initial clinical examination is common, leading to early inappropriate treatment and increased in-hospital mortality. Risk factors of inappropriate treatment assessable at early examination remain undescribed herein. The objective of this study was to identify clinical risk factors of dyspnea and inappropriate treatment in patients admitted to ED. This is an observational retrospective cohort study. Patients over the age of 15 who were admitted to adult EDs of the University Hospital of Toulouse (France) with dyspnea were included from 1 July to 31 December 2019. The primary end-point was dyspnea and inappropriate treatment was initiated at ED. Inappropriate treatment was defined by looking at the final diagnosis of dyspnea at hospital discharge and early treatment provided. Afterward, this early treatment at ED was compared to the recommended treatment defined by the International Guidelines for Acute Heart Failure, bacterial pneumonia, chronic obstructive pulmonary disease, asthma or pulmonary embolism. A total of 2123 patients were analyzed. Of these, 809 (38%) had inappropriate treatment in ED. Independent risk factors of inappropriate treatment were: age over 75 years (OR, 1.46; 95% CI, 1.18-1.81), history of heart disease (OR, 1.32; 95% CI, 1.07-1.62) and lung disease (OR, 1.47; 95% CI, 1.21-1.78), SpO 2 <90% (OR, 1.64; 95% CI, 1.37-2.02), bilateral rale (OR, 1.25; 95% CI, 1.01-1.66), focal cracklings (OR, 1.32; 95% CI, 1.05-1.66) and wheezing (OR, 1.62; 95% CI, 1.31-2.03). In multivariate analysis, under-treatment significantly increased in-hospital mortality (OR, 2.13; 95% CI, 1.29-3.52) compared to appropriate treatment. Over-treatment nonsignificantly increased in-hospital mortality (OR, 1.43; 95% CI, 0.99-2.06). Inappropriate treatment is frequent in patients admitted to ED for dyspnea. Patients older than 75 years, with comorbidities (heart or lung disease), hypoxemia (SpO 2 <90%) or abnormal pulmonary auscultation (especially wheezing) are at risk of inappropriate treatment.

Metabolomic Profiling Reveals Biomarkers in Coronary Heart Disease Comorbidity.

Background and Aims: Coronary heart disease (CHD), hypertension (HTN), depression (Dep), and Type 2 diabetes mellitus (T2DM) are often comorbid, resulting in an exacerbated patient condition and worsened prognosis. A lack of systematic metabolomic studies on comorbidities of CHD remains. Therefore, comprehensive metabolomic-based evaluation of comorbidities of CHD is necessary. Methods and Results: In the current study, 169 healthy subjects, 149 CHD subjects, 107 CHD + HTN subjects, 126 CHD + Dep subjects, and 58 CHD + T2DM subjects were recruited. Gas chromatography-mass spectrometry was used for metabolite determination, and multivariate statistical analysis was conducted to identify metabolites that are differentially expressed with the comorbidities of CHD. There were 9, 16, 14, and 10 metabolites identified in the healthy and CHD group, the CHD and CHD + HTN group, the CHD and CHD + Dep group, and the CHD and CHD + T2DM group, respectively. Six metabolic pathways were affected, involving starch and sucrose metabolism; fructose and mannose metabolism; citrate cycle; alanine, aspartate, and glutamate metabolism; fatty acid biosynthesis; and glycolysis. Conclusion: Our study has systematically elucidated the metabolic changes underlying the comorbidities of CHD, thereby providing insight into the mechanisms associated with these alterations.

PATIENT TRANSFER FROM HEMODIALYSIS TO PERITONEAL DIALYSIS: A SINGLE CENTER EXPERIENCE

INTRODUCTION Peritoneal dialysis and hemodialysis are complementary ways of treating end-stage renal failure. Changing the dialysis modality from hemodialysis to peritoneal dialysis is a rare and poorly studied phenomenon. MATERIALS AND METHODS Retrospective cohort study conducted on the population of adult patients with end-stage chronic renal failure who were treated at the Nephrology Clinic of the Clinical Center of the University of Sarajevo in the period from 2006 to 2023. A total of 109 adult patients, whose medical documentation was complete and who were in the peritoneal dialysis program at the Nephrology Clinic of the Clinical Center of the University of Sarajevo during the observed period, were included in this study. One group started the treatment with peritoneal dialysis, and the other with hemodialysis. Demographic data were collected for each patient: age, gender, underlying kidney disease, comorbidities (heart disease and diabetes), duration of treatment modality, data on modality change, complications and treatment outcomes. Data from physical and electronic patient histories were used. RESULTS Total of 109 adult patients were included in this study. They are divided into two groups. Group 1 (n=99) in which peritoneal dialysis was the first treatment modality and Group 2 (n=10) in which haemodialysis was the first treatment modality, but in which patients, after a certain time, were transferred to peritoneal dialysis. The median age of patients in Group 1 was 60 (-/-14.07) years and 54 (-/+12.23) years for Group 2. Within Group 1 the most common cause of terminal renal failure was diabetic nephropathy (n=40, 40.4%) and nephroangiosclerosis (n=24, 24.24%). The mean age of onset of peritoneal dialysis was 60 (-/-14.07) years, while the mean age of cessation of peritoneal dialysis was 63 (±13.69) years. The average duration of peritoneal dialysis treatment was 38.36(±34.14) months. During the stay at peritoneal dialysis, death was recorded in 63 patients (62.38%). The number of patients who replaced peritoneal dialysis treatment with hemodialysis was 26. The most common reason for switching to haemodialysis was insufficiency of peritoneal dialysis (n=13, 14%). After switching to haemodialysis, the average length of staying on it was 10.22 months. The reason for discontinuation of haemodialysis was death (n=17, ) or transplantation (n=1, 3.7%). Kaplan-Meier test shown worse outcome in patients with haemodialyis first than peritoneal dialysis first. CONCLUSION Changing the dialysis modality carries with it a high risk of mortality, especially in the first month. Changing the way of active treatment with dialysis speaks in favor of severe comorbidities.

Mapping Indonesia's Covid-19 Death Case with Comorbidities Using Correspondence Analysis

This research aims to map and identify COVID-19 deaths with comorbidities in Indonesia using correspondence analysis. The data collection technique involved the analysis of 6231 samples of COVID-19 death cases with comorbidities in Indonesia from the official website of the COVID‑19 Response Acceleration Task Force. The variables used were the number of COVID-19 deaths with comorbid hypertension, diabetes mellitus, cardiovascular disease, chronic obstructive pulmonary disease, kidney disease, immune disorders, liver disease, cancer, asthma, pregnancy, tuberculosis, and other respiratory disorders. The findings from this study divide four groups of provinces with characteristics: Group One with the characteristics of COVID-19 death cases with comorbid hypertension, diabetes mellitus, heart disease, kidney disease, lung disease, immune disorders, and cancer; Group Two with the characteristics of COVID-19 death cases with comorbid pregnancy, liver disease, and tuberculosis; Group Three with the characteristics of COVID-19 death cases with comorbid asthma; and Group Four with the characteristics of COVID-19 death cases with other comorbid respiratory disorders.

Exploring the relationship between vitamin D deficiency and comorbid heart disease in Americans with mood disorders: a cross-sectional nationwide study.

This study aimed to explore the relationship between vitamin D deficiency and comorbid heart disease in adult inpatients with mood disorders (depressive and bipolar disorders). A cross-sectional investigation was carried out employing the nationwide inpatient dataset, which encompassed 910,561 adult inpatients aged 18 to 50 years diagnosed with depressive and bipolar disorders. Additionally, the sample was categorized based on the presence of comorbid heart disease. We utilized a logistic regression model to assess the odds ratio (OR), pertaining to demographic features and coexisting medical conditions in relation to comorbid heart disease. Comorbid heart disease was present in 1.3% of inpatients with mood disorders; they were middle-aged (mean age 42.7 years) men and White individuals. Inpatients with depressive disorder had a higher risk of comorbid heart disease (OR 1.19, 95% CI 1.15-1.24) compared to those with bipolar disorders. Inpatients with comorbid heart disease had a higher prevalence of medical and psychiatric comorbidities. The prevalence of vitamin D deficiency was 2.3% in mood disorders but higher in those with comorbid heart disease (2.9%). Vitamin D deficiency showed a notable correlation with comorbid heart disease, resulting in a 26% increased risk in the unadjusted regression model (OR 1.26, 95% CI 1.13-1.40). However, after accounting for potential confounding factors, including comorbidities, the risk did not exhibit statistical significance (OR 1.08, 95% CI 0.97-1.21). Among psychiatric comorbidities, trauma-related (OR 1.22, 95% CI 1.17-1.28) and tobacco-related (OR 1.31, 95% CI 1.26-1.37) disorders had a higher risk of association with comorbid heart disease. Middle-aged men with depressive disorders and from low-income families had a higher risk of developing comorbid heart disease. Trauma-related and tobacco-related disorders were associated with an increased risk by 20-30% for comorbid heart disease in inpatients with mood disorders. Vitamin D deficiency was not associated with the risk of comorbid heart disease after controlling demographics and comorbid cardiovascular risk factors.

Correlated interdependences of characteristics of carbohydrate metabolism and lipid profile and batokines levels in patients with coronary heart disease and obesity

Research of comorbid coronary heart disease (CHD) and obesity in recent years often rely on the study of inflammatory mediators, among which the first and foremost are batokines, in particular on fibroblast growth factor (FGF-21) and vascular endothelial growth factor A (VEGFa). The aim of our study was to determine the correlational interdependencies of indicators of carbohydrate metabolism and lipid profile and levels of batokines in the comorbidity of CHD and obesity. 70 people aged from 25 to 85 were examined with CHD on the background of obesity. The average age was (63.6±8.8) years. The research do not violate the principles of bioethics, which is confirmed by the conclusion of the Bioethics Committee of the Kharkiv National Medical University. All patients who participated in the study signed an informed voluntary consent. Based on the results of research probable direct strong correlations of total cholesterol (TC) with low-density lipoprotein (LDL) were determined (ρ=0.889; p=0.000); triglycerides (TG) with very low-density lipoprotein (VLDL) (ρ=0.810; p=0.000). The average strength of correlation was determined: glycosylated hemoglobin (HbA1c) with vascular endothelial growth factor A (VEGFA) (ρ=0.374; p=0.001); TC and LDL and AI (respectively ρ=0.615; p=0.000, and ρ=0.648; p=0.000); VLDL with atherogenic index (AI) (ρ=0.367; p=0.002). Probable direct weak correlations of blood glucose levels with TG (ρ=0.253; p=0.034) and VLDL (ρ=0.277; p=0.020) and VEGFA (ρ=0.225; p=0.061) were found; TG and VLDL with VEGFA (ρ=0.256; p=0.032 and ρ = 0.273; p = 0.022, respectively). Inverse interdependencies were recorded: medium strength – high-density lipoprotein (HDL) and AI (ρ=-0.583; p=0.000) and weak – hemoglobin levels with HDL (ρ=-0.251; p=0.036); HbA1c with LDL (ρ=-0.241; p=0.044); HDL with VLDL (ρ=-0.293; p=0.014). Keywords: comorbidity of coronary heart disease and obesity, batokines, FGF21, VEGFA.

Predictors of outcomes in mild pulmonary hypertension according to 2022 ESC/ERS Guidelines: the EVIDENCE-PAH UK study.

Interventional studies in pulmonary arterial hypertension completed to date have shown to be effective in symptomatic patients with significantly elevated mean pulmonary artery pressure (mPAP) (≥25 mmHg) and pulmonary vascular resistance (PVR) > 3 Wood Unit (WU). However, in health the mPAP does not exceed 20 mmHg and PVR is 2 WU or lower, at rest. The ESC/ERS guidelines have recently been updated to reflect this. There is limited published data on the nature of these newly defined populations (mPAP 21-24 mmHg and PVR >2-≤3 WU) and the role of comorbidity in determining their natural history. With the change in guidelines, there is a need to understand this population and the impact of the ESC/ERS guidelines in greater detail. A retrospective nationwide evaluation of the role of pulmonary haemodynamics and comorbidity in predicting survival among patients referred to the UK pulmonary hypertension (PH) centres between 2009 and 2017. In total, 2929 patients were included in the study. Patients were stratified by mPAP (<21 mmHg, 21-24 mmHg, and ≥25 mmHg) and PVR (≤2 WU, > 2-≤3 WU, and >3 WU), with 968 (33.0%) in the mPAP <21 mmHg group, 689 (23.5%) in the mPAP 21-24 mmHg group, and 1272 (43.4%) in the mPAP ≥25 mmHg group. Survival was negatively correlated with mPAP and PVR in the population as a whole. Survival in patients with mildly elevated mPAP (21-24 mmHg) or PVR (>2-≤3WU) was lower than among those with normal pressures (mPAP <21 mmHg) and normal PVR (PVR ≤ 2WU) independent of comorbid lung and heart disease [hazard ratio (HR) 1.36, 95% confidence interval (CI) 1.14-1.61, P = .0004 for mPAP vs. HR 1.28, 95% CI 1.10-1.49, P = .0012 for PVR]. Among patients with mildly elevated mPAP, a mildly elevated PVR remained an independent predictor of survival when adjusted for comorbid lung and heart disease (HR 1.33, 95% CI 1.01-1.75, P = .042 vs. HR 1.4, 95% CI 1.06-1.86, P = .019). 68.2% of patients with a mPAP 21-24 mmHg had evidence of underlying heart or lung disease. Patients with mildly abnormal haemodynamics were not more symptomatic than patients with normal haemodynamics. Excluding patients with heart and lung disease, connective tissue disease was associated with a poorer survival among those with PH. In this subpopulation evaluating those with a mPAP of 21-24 mmHg, survival curves only diverged after 5 years. This study supports the change in diagnostic category of the ESC/ERS guidelines in a PH population. The newly included patients have an increased mortality independent of significant lung or heart disease. The majority of patients in this new category have underlying heart or lung disease rather than an isolated pulmonary vasculopathy. Mortality is higher if comorbidity is present. Rigorous phenotyping will be pivotal to determine which patients are at risk of progressive vasculopathic disease and in whom surveillance and recruitment to studies may be of benefit. This study provides an insight into the population defined by the new guidelines.

Current Perspectives of Pharmacotherapies for COPD.

Pharmacotherapies and avoidance of environmental/inhaled toxins are core to managing COPD. Compared to the drugs available 50 years ago, there has been substantial progress with COPD pharmacotherapies, but gaps in adherence and inhaler use persist. Personalizing inhaled pharmacotherapies is now possible with digital technologies by objectively documenting adherence and guiding inhaler technique. Another means to improve existing pharmacotherapies is through phenotyping and biomarkers. This is especially important considering the heterogeneity of the disease COPD. Blood eosinophils are now a recommended biomarker to guide use of inhaled corticosteroids and biologics in COPD. On the near horizon, we will see new inhaled medications as dual phosphodiesterase inhibitors, drugs to treat basic protein abnormalities as in alpha-1 antitrypsin deficiency that could have remarkable benefits, and biologic drugs targeting specific cell/mediator types in the COPD population. Characterization of COPD phenotypes, as asthma/COPD overlap and comorbid heart disease are vital to understand how to optimize pharmacotherapies. Importantly, we must determine how to optimize current medications; otherwise, we will repeat the same mistakes with new medications. But as we know so well, as we peel one layer of complexity, we encounter many more questions, all the while dedicated to limiting the burden of COPD.

Determinant Factors of Mortality in Pre-elderly and Elderly Patients With COVID-19 in Jakarta, Indonesia.

This study aimed to identify risk factors associated with coronavirus disease 2019 (COVID-19) mortality in pre-elderly and elderly individuals in Jakarta, Indonesia. We employed a case-control study design, utilizing secondary data from the Epidemiology Surveillance, Immunization Prevention, and Disease Control Sections of the DKI Jakarta Provincial Health Office, collected from December 2020 to January 2021. The study included 188 cases and an equal number of controls. Cases were COVID-19 patients confirmed to have died, as reported by hospitals and communities and subsequently verified by healthcare workers. Control subjects were patients who completed a 14-day isolation period and had been officially declared recovered by healthcare professionals. The dependent variable was the mortality of COVID-19 patients in the January 2021 period. The independent variables consisted of demographic data (age and sex), clinical symptoms (cough, runny nose, anosmia, diarrhea, headaches, abdominal pain, muscle pain, and nausea/vomiting), and comorbidities (hypertension, heart disease, and diabetes). Multivariate analysis was conducted using multiple logistic regression. The multiple logistic regression analysis revealed several factors associated with COVID-19 fatalities in Jakarta: age of 60 years or older (odds ratio [OR], 4.84; 95% CI, 3.00 to 7.80), male (OR, 2.38; 95% CI, 2.41 to 3.68), dyspnea (OR, 3.93; 95% CI, 2.04 to 7.55), anosmia (OR, 0.13; 95% CI, 0.04 to 0.46), and heart disease (OR, 4.38; 95% CI, 1.04 to 18.46). The control and prevention of COVID-19 among elderly individuals require particular vigilance. When a COVID-19 case is detected within this demographic, prompt treatment and medication administration are crucial to mitigate the presenting symptoms.

Clinical Features, Imaging, Laboratory Result, and Severity of COVID-19 Patients in Referral Hospital

BACKGROUND: COVID-19 pandemic became a global health problem due to the high number of cases and no specific treatment. Furthermore, the diagnosis was difficult due to limited publication data and diagnostic tests. AIM: The aim of this study was to determine the demographics, clinical features, laboratory results, radiological results, and factors related to the severity of COVID-19 at a referral hospital. METHODS: A descriptive analytic study of confirmed COVID-19 patients was conducted during March–October 2020. Data were collected from the medical records to determine the patient demographics, clinical symptoms, comorbidities, laboratory, chest X-ray, and first illness severity at 24 h of treatment. RESULTS: There were 79 (59%) male and 55 (41%) female patients during the study. The clinical symptoms were fever 103 (77%), cough 100 (75%), shortness of breath 88 (66%), comorbidities of diabetes mellitus 18 (13%), hypertension 24 (18%), and heart disease 20 (15%). The patient’s laboratory profiles were lymphopenia 85 (63%) and increased C-reactive protein 82 (61%). The radiology imaging of the patients was mostly atypical of COVID-19. Factors that influence the severity of COVID-19 are age, comorbid diabetes, and hypertension CONCLUSION: Most cases with severe symptoms are old age, a history of comorbid diabetes mellitus and heart disease, and abnormal laboratory results.

Determinant analysis of Length of Stay (LoS) in Covid-19 isolation room at RSUD Jend. A. Yani Metro City

Background: The increasing incidence of Coronavirus Disease 2019 (COVID-19) in Indonesia affects the need for hospital inpatient services. One of the parameters of service quality and the use of hospital resources is the length of stay (LOS). Objective: To find the determinants of COVID-19 that affect LOS in hospitals. Methods: Retrospective observational data collection using a cross-sectional study design. The sampling method used was total sampling during the January-August 2021 hospitalization period in the Isolation Room of the General Hospital of Jend. A. Yani Metro City. The data used is medical record data. Bivariate analysis uses Chi Square, while multivariate analysis uses Multiple Logistics Regression. Results: The sample consisted of 443 patients who were treated during the period January-August 2021 in the COVID-19 isolation room at RSUD Jend. A. Yani Metro City. The median LOS is 6 days. Multiple logistic regression analysis shows that the determinants of LOS include severity, diabetes mellitus, heart disease, and D-Dimer. Conclusion: Severity, comorbid diabetes mellitus, comorbid heart disease, and D-Dimer value are the determinants of LOS in confirmed COVID-19 patients in the COVID-19 isolation room at General Ahmad Yani Hospital, Lampung Province. Keywords: Determinants, Coronavirus Disease, LOS, hospital

Contribution of central sleep apnea to severe sleep apnea hypopnea syndrome

PurposeCentral sleep apnea (CSA) is usually distinguished from obstructive sleep apnea (OSA). In fact, CSA is often a component of severe sleep apnea hypopnea syndrome (SAHS), rather than occurring alone. We investigated the clinical characteristics and polysomnography (PSG) parameters of CSA components in patients with severe SAHS.MethodsThe clinical characteristics and PSG parameters were retrospectively analyzed.ResultsPure or dominant CSA was rare (5% of all patients). Of all patients with CSA, 72% also exhibited other apnea subtypes that contributed to severe SAHS. Among patients with severe SAHS, those with CSA were more likely than others to be older; thinner; exhibit higher prevalences of comorbid coronary heart disease, arrhythmia, and heart failure; a higher apnea/hypopnea index (AHI); mixed apnea index (MAI); an elevated oxygen desaturation index (ODI); and more nighttime oxygen saturation levels < 90%. Multivariate logistic regression analysis revealed that older age, comorbid arrhythmia or heart failure, and an elevated ODI were independently associated with CSA.ConclusionPatients who complain of snoring or apnea may be better evaluated by comprehensive PSG prior to treatment if they are old, show greater hypoxia, or suffer from arrhythmia and/or heart failure, because such patients are more likely than others to exhibit CSA.

Характеристика деяких показників системи гемостазу у хворих на компенсоване хронічне легеневе серце бронхо-легеневого генезу та особливості їх змін в умовах коморбідності зі стабільною ішемічною хворобою серця

The purpose of the study was to research and analyze the peculiarities of changes of some hemostasis system indices and define their possible role in the formation of a vascular lesion in the patients with compensated chronic cor pulmolale of broncho-pulmonary genesis in conditions of its comorbidity with stable coronary heart disease. Materials and methods. The retrospective study and analysis of hemostasis system indices (platelet count, thrombin time, prothrombin time, antithrombin – III, plasma tolerance to heparin, plasmin lysis, fibrinogen, soluble fibrin) in 64 patients with chronic obstructive pulmonary disease and compensated chronic cor pulmonale (29 female, 35 male, mean age – 54.6 ± 2.3) were carried out. 32 patients with the isolated pathology formed the comparative group whereas 32 patients with the comorbid coronary heart disease (exertional angina, functional class II-III, postinfarction or aterosclerotic cardiosclerosis) built the main group. The obtained research results of the patients of the main and comparative groups were compared both in groups and with the indices of practically healthy individuals (n = 15) of the same gender and age. Results and discussion. The obtained results indicated the presence of a significant increase of coagulation potential (the changes of indices of platelets, fibrinogen, plasma tolerance to heparin, antithrombin – III, and soluble fibrin) and activation of fibrinolysis system (thrombin time) and, simultaneous, its more pronounced depression (plasmin lysis) and increase of prothrombin time in case of presence of comorbid coronary heart disease in the patients with chronic cor pulmonale in conditions of chronic inflammatory process. Comorbidity promoted to the formation of disbalance of systemic correlation hemocoagulation and fibrinolysis. Our results confirm to a certain extent the following ideas of scientists: there are hypercoagulation and “exhaustion of the anticoagulant system potential” in case of combination of coronary heart disease and chronic obstructive pulmonary disease; hypercoagulation together with the oxidative stress and chronic systemic inflammation are general pathogenic mechanisms of chronic obstructive pulmonary disease and cardiovascular diseases, particularly of the coronary heart disease. Conclusion. The analysis of the changes of the hemostasis system indices in patients with compensated chronic cor pulmonale of broncho-pulmonary genesis indicates the presence of an increase of coagulation potential; the most significant changes with suppression of fibrinolytic activity are typical of the patients with comorbid coronary heart disease. The peculiarities of the hemostasis system changes in the patients with compensated chronic cor pulmonale of broncho-pulmonary genesis should be considered as a marker of the increased risk of the thrombogenic vascular complications. It should be taken into account for treatment-diagnostic strategy formation

RELATIONSHIP OF COMMORBID DISEASE TO MORTALITY EVENTS IN COVID-19 PATIENTS

Background: Covid-19 is a disease caused by acute respiratory syndrome due to corona virus 2. Patients with Covid-19 experience symptoms of severe shortness of breath resulting in death. The risk of death for Covid-19 sufferers will be greater if the patient has a history of comorbid diseases such as hypertension, diabetes mellitus, cardiovascular disease or kidney disease.Objective: The purpose of this study was to determine the relationship between comorbid diseases and the incidence of mortality in patients with Covid-19.Method: Research design using descriptive analytic. The research population was all Covid-19 sufferers who were treated at Mojowarno Christian Hospital (RSK) during 2021 totaling 450 sufferers. The research sample was 212 respondents with a sampling technique using systematic random sampling. The data was obtained from the medical records of Covid-19 patients who were treated at the Mojowarno Hospital. Statistical test using chi square and odds ratio with a significance level of P &lt;0.05. Results: The results of the study found that comorbid diabetes mellitus showed a result of P: 0.000, meaning that there was a relationship between comorbid diabetes mellitus and the incidence of mortality in patients with Covid-19. Comorbid kidney disease shows a P value: 0.003, meaning that there is a relationship between comorbid kidney disease and the occurrence of mortality in Covid-19 sufferers. Comorbid heart disease results obtained P: 0.089, meaning that there is no relationship between comorbid heart disease and mortality in patients with Covid-19. Hypertensive comorbid disease on mortality with a P value: 0.134 meaning that there is no relationship between hypertension comorbid disease and the risk of mortality in patients with Covid-19. Conclusion:Covid-19 sufferers who have comorbid diabetes mellitus cause greater mortality. This is because diabetes mellitus can cause a cytokine storm which plays a role in increasing the severity of COVID-19 sufferers so that it often causes death.