Concomitant Conditions Research Articles

Central Nervous System-related Conditions and Associated Healthcare Resource Use Among Japanese nmCRPC Patients Based on Retrospective Claims Data

Background: Japanese patients with prostate cancer are typically treated with primary androgen deprivation therapy (ADT), most commonly administered as a combination of a luteinizing hormone-releasing hormone (LHRH) agonist and an antiandrogen (AA). Since LHRH agonists and AA therapy can be maintained for several years, the long-term effects of these treatments on patients must be carefully considered, including the risk of concomitant central nervous system (CNS) conditions which could affect treatment choices. Objective: To describe CNS-related concomitant conditions during ADT and/or AA treatment and the subsequent healthcare resource utilization in Japanese nonmetastatic castration-resistant prostate cancer (nmCRPC) patients. Methods: Patients diagnosed with nmCRPC and CNS-related conditions while on ADT and/or AA therapy between April 2009 and August 2017 were retrospectively followed up for a maximum of 2 years using a claims database. Results: A total of 455 patients (average age, 78.5 years), were included. The 3 most common concomitant CNS-related conditions were pain (~60% of events), insomnia (~30%), and headache (2%-3%). The frequency of CNS-related conditions in these patients increased approximately threefold after starting AA therapy (before, 969 events; after, 2802). On average, a patient had 10 episodes of concomitant CNS-related conditions in a year. Medical costs did not significantly increase due to CNS-related conditions. Discussion: The most frequently reported CNS-related conditions were pain, insomnia, and headaches. Furthermore, more concomitant CNS-related conditions 1 year after CRPC diagnosis and 1 year after starting AA treatment were recorded. Conclusion: Patients with nmCRPC experience an increase in the frequency of concomitant CNS-related conditions, including pain, insomnia, and headaches, after CRPC diagnosis or starting AA treatment. Future research should explore the causes of this increased frequency.

Systematic Review and Meta-Analysis: Prevalence of Non-Alcoholic Fatty Liver Disease and Liver Fibrosis in Patients with Inflammatory Bowel Disease.

Non-alcoholic fatty liver disease (NAFLD) is a common concomitant condition in patients with inflammatory bowel disease (IBD). We aim to assess the magnitude of this association. We searched MEDLINE, EMBASE and Scopus libraries for the period up to February 2023 to identify studies reporting cohorts of IBD patients in which NALFLD was evaluated. Eighty-nine studies were analyzed. The overall prevalence of NAFLD was 24.4% (95%CI, 19.3-29.8) in IBD, 20.2% (18.3-22.3) in Crohn's disease and 18.5% (16.4-20.8) for ulcerative colitis. Higher prevalence was found in male compared to female patients, in full papers compared to abstracts, and in cross-sectional studies compared to prospective and retrospective ones. The prevalence of NAFLD in IBD has increased in studies published from 2015 onwards: 23.2% (21.5-24.9) vs. 17.8% (13.2-22.9). Diagnostic methods for NAFLD determined prevalence figures, being highest in patients assessed by controlled attenuation parameter (38.8%; 33.1-44.7) compared to ultrasonography (28.5%; 23.1-34.2) or other methods. The overall prevalence of fibrosis was 16.7% (12.2-21.7) but varied greatly according to the measurement method. One-quarter of patients with IBD might present with NAFLD worldwide. This proportion was higher in recent studies and in those that used current diagnostic methods.

Non-White Race and Concomitant Orthopedic Conditions Are Risk Factors for Failure to Achieve Clinically Relevant Improvement After Total Knee Arthroplasty

BackgroundData from the American Joint Replacement Registry demonstrate that 1-year minimal clinically important difference (MCID) achievement rates after total knee arthroplasty (TKA) are substantially lower when using general patient reported outcome measures, such as Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), than joint specific measures. The purpose of this study was to evaluate patient characteristics and outcomes associated with MCID achievement after TKA using the PROMIS-PF measure. MethodsA retrospective review of 263 patients undergoing TKA with preoperative and 1-year postoperative PROMIS-PF scores from March 12, 2020 to February 8, 2022 was performed. Three multivariate models were built to evaluate predictors of MCID achievement. Preoperative predictors evaluated included demographics, comorbidities, history of spine and knee surgery, and baseline PROMIS-PF. Postoperative clinical outcomes evaluated included lengths of stay, discharge statuses, complications, and utilizations of other orthopaedic services. ResultsThere were 109 patients (41%) who achieved an MCID at 1-year postoperatively. Non-white patients had 2.17 times lower odds of achieving MCID. No clinical outcomes assessed were independently predictive of MCID achievement. During the 1-year postoperative period, 63% of patients sought care for another orthopaedic condition. Patients requiring postoperative injections on another joint had a 2.27 times lower odds of achieving MCID. Those seen for spine conditions postoperatively had a 2.44 lower odds of achieving MCID. ConclusionsRace, postoperative injections, and treatment for spine conditions after TKA were independent predictors of failure to achieve MCID. These results may guide preoperative patient consultation and risk-adjustment in future studies using PROMIS-PF as an endpoint for evaluation of TKA outcomes.

Pulmonary Histoplasmosis in People Living with Human Immunodeficiency Virus in French Guiana: Clinical Epidemiology, Medical Imaging and Prognostic

BackgroundHistoplasmosis is mainly described as a disseminated disease in people living with HIV (PLHIV). Compared to historical descriptions in immunocompetent individuals, knowledge is lacking on the detailed clinical and radiological findings and outcomes of pulmonary histoplasmosis (PH). Overlooked or misdiagnosed with other AIDS-defining condition, prognostic of PLHIV may be at risk because of inappropriate care.MethodsA retrospective multicentric study was conducted in PLHIV from French Guiana between January 1988 and October 2019. Proven PH were documented through mycological direct examination, culture, or histology. Patients with concomitant respiratory infections were excluded.ResultsAmong 65 patients, sex ratio M:F was 2.4 with a median age of 39 years [IQR 25–75%: 34–44]. Median CD4 count was 24 cells/mm3 [11–71], with histoplasmosis as the AIDS-defining condition in 88% and concomitant AIDS-defining conditions in 29%. Clinical findings were fever (89%), cough (58%), dyspnea (35%), expectoration (14%), and hemoptysis (5%). Sixty-one X-rays and 24 CT-scans were performed. On X-rays, an interstitial lung disease was mainly found (77%). On CT-scans, a nodular pattern was predominant (83%): mostly miliary disease (63%), but also excavated nodules (35%). Consolidations were present in 46%, associated with miliary disease in 21%. Thoracic lymphadenopathies were found in 58%, mainly hilar and symmetric (33%). Despite antifungal treatment, case-fatality rate at one month was 22%.ConclusionWhen faced with an interstitial lung disease on X-rays or a miliary pattern on CT-scans in advanced PLHIV, physicians in endemic areas, apart from tuberculosis or pneumocystosis, should include histoplasmosis as part of their differential diagnoses.

Clinical and radiological characteristics of Covid-19 patients with acute cerebrovascular vents: A meta-analysis

The Information on the 2019 coronavirus illness (COVID-19) in Egypt's severe cerebrovascular consequences is scant. In cases of acute cerebrovascular disease (CVD), this study aimed to examine the radiological and clinical characteristics of patients with and without COVID-19. Prospective research evaluated CVD patients with and without COVID-19 who were hospitalized at Qena University Hospital (QUH) before the global epidemic. Patients diagnosed with COVID-19 and able to be treated at either assist or Aswan University Hospitals (AAUH) for cardiovascular disease were compared. The data included patient demographics, medical history, risk factors, clinical presentation, comorbidities, and imaging results from CT and MRI scans of the chest and brain. In overall 439 individuals with COVID-19, 55 (12.5%) experienced acute CVD. Of these, 13 patients (2.9%) experienced hemorrhagic CVD, whereas 42 (9.6%) suffered an ischemic stroke. 180 of the 250 non-COVID-19 individuals suffered from ischemic stroke, and 70 from hemorrhagic stroke. Many COVID-19 patients had large vascular occlusions (LVO), which is a significant portion of individuals who had ischemic stroke symptoms (40 vs. 7.2%, P <0.001) and was considerably more reciprocal than in CVD patients who were not COVID-19. Comorbidities were noted in 44 instances (80% of the total). Sufferers of ischemic stroke who had COVID-19 were much more likely to have dangerous elements such as hypertension and Ischemic Heart Disease (IHD) as well as concomitant conditions like hepatitis and kidney disease. Additionally, 6.5% of individuals with LVO had a hemorrhagic transition, and 23.5% had hemorrhagic CVD. In our research, individuals with COVID-19 often had severe CVD. The most typical LVO was. The most frequent risk factors, such as hypertension, IHD, and anemia, may make the clinical presentation worse. Patients with CVD often had comorbid conditions, but many also had high liver enzymes and creatinine levels that were partly brought on by the COVID-19 disease itself. The new findings start to describe the range of CVD linked to COVID-19 in patients from Upper Egypt.

An angiopoietin 2, FGF23, and BMP10 biomarker signature differentiates atrial fibrillation from other concomitant cardiovascular conditions

Early detection of atrial fibrillation (AF) enables initiation of anticoagulation and early rhythm control therapy to reduce stroke, cardiovascular death, and heart failure. In a cross-sectional, observational study, we aimed to identify a combination of circulating biomolecules reflecting different biological processes to detect prevalent AF in patients with cardiovascular conditions presenting to hospital. Twelve biomarkers identified by reviewing literature and patents were quantified on a high-precision, high-throughput platform in 1485 consecutive patients with cardiovascular conditions (median age 69 years [Q1, Q3 60, 78]; 60% male). Patients had either known AF (45%) or AF ruled out by 7-day ECG-monitoring. Logistic regression with backward elimination and a neural network approach considering 7 key clinical characteristics and 12 biomarker concentrations were applied to a randomly sampled discovery cohort (n = 933) and validated in the remaining patients (n = 552). In addition to age, sex, and body mass index (BMI), BMP10, ANGPT2, and FGF23 identified patients with prevalent AF (AUC 0.743 [95% CI 0.712, 0.775]). These circulating biomolecules represent distinct pathways associated with atrial cardiomyopathy and AF. Neural networks identified the same variables as the regression-based approach. The validation using regression yielded an AUC of 0.719 (95% CI 0.677, 0.762), corroborated using deep neural networks (AUC 0.784 [95% CI 0.745, 0.822]). Age, sex, BMI and three circulating biomolecules (BMP10, ANGPT2, FGF23) are associated with prevalent AF in unselected patients presenting to hospital. Findings should be externally validated. Results suggest that age and different disease processes approximated by these three biomolecules contribute to AF in patients. Our findings have the potential to improve screening programs for AF after external validation.

Clinical Manifestations and Mechanisms of Development of Eye Damage in Hemoblastosis

In the article various ophthalmic manifestations of hemoblastoses will be discussed. Detailed descriptions of the most common variants of damage to the organ of vision in the oncohematological process are presented. Here we also present the clinical symptoms and development mechanisms associated with both direct leukocyte infiltration of various structures of the eye, occurring against the background of the underlying disease, and concomitant conditions, such as violation of the hemostasis system, anemia and thrombocytopenia resulting from the progression of blood cancer. It is also considered the cases of ophthalmic manifestations of hemoblastoses developing against the background of an immunity decrease associated oncohematological disorder, or as a result of the toxic effect of chemotherapy drugs, radiotherapy and bone marrow transplantation, as well as targeted therapy.

Management of Glucose-Lowering Therapy in Older Adults with Type 2 Diabetes: Challenges and Opportunities.

The population of older adults (≥65 years) with type 2 diabetes mellitus (T2DM) is diverse, encompassing individuals with varying functional capabilities, living arrangements, concomitant medical conditions, and life expectancies. Hence, their categorization into different patient profiles (ie, good health, intermediate health, poor health) may aid in clinical decision-making when establishing glycemic goals and pharmacological treatment strategies. Further granularity in assessing each patient profile through interdisciplinary collaboration may also add precision to therapeutic and monitoring decisions. In this review, we discuss with a multidisciplinary approach how to deliver the best benefit from advanced diabetes therapies and technologies to older adults with T2DM according to each patient profile. There remain however several areas that deserve further research in older adults with T2DM, including the efficacy and safety of continuous glucose monitoring and automated insulin delivery systems, the switch to once-weekly insulin, the effectiveness of multidisciplinary care models, and the use of supported telemedicine and remote blood glucose monitoring in the oldest-old (≥85 years) who particularly require the assistance of others.

ИСХОДЫ ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТИ У ПАЦИЕНТОВ С ИШЕМИЧЕСКОЙ БОЛЕЗНЬЮ СЕРДЦА: ПРОСПЕКТИВНОЕ 5-ЛЕТНЕЕ ИССЛЕДОВАНИЕ

Introduction. Epidemiology and trends in survival of patients with chronic heart failure have changed over the past decades. As an important reason for prognostic deviations is recognized, among other things, the steady worldwide increase in the prevalence of obesity and concomitant conditions associated with it, such as diabetes mellitus, arterial hypertension, and atrial fibrillation, especially in young patients with chronic heart failure, which creates the so- called survival paradox. The aim of the study is to assess the structure of 5-year outcomes in patients with ischemic heart failure and identify some new long-term prognosis markers (mortality and cardiovascular events). Materials and Methods. 313 patients with ischemic heart failure of functional class I-IV were examined. A clinical study was conducted, and 5-year prognosis endpoints were assessed (all-cause mortality, cardiovascular mortality, and non-fatal cardiovascular events). The composite endpoint included cardiovascular mortality and nonfatal cardiovascular events. Results. All-cause 5-year mortality was 28.1%, including the cardiovascular mortality of 24.6%. In patients of functional class III-IV chronic heart failure, the 5-year risk of death from any cause and cardiovascular death was higher than in class I-II patients. All-cause death, cardiovascular mortality, and the composite endpoint risks were higher in patients with reduced ejection fraction than in those with moderately reduced or reduced left ventricular ejection fraction. The risk of death within 5 years from all causes and cardiovascular death was higher in women with a body mass index of <25 kg/m² and >30 kg/m² than in those who were moderately overweight. Mortality from all causes was lower in functional class III-IV patients with some overweight than in those with a body mass index of <25 kg/m² (p=0.03). With moderately reduced and reduced left ventricular ejection fraction, all-cause mortality and cardiovascular mortality were lower in overweight patients than in those with a body mass index of <25 kg/m² (p=0.009 and p=0.022). In patients with heart failure with reduced left ventricular ejection fraction, their overweight was a protective factor for all-cause mortality (OR=0.07, CI: 0.001-0.76) as compared to those with a body mass index of <25 kg/m²

Optical genome mapping identifies structural variants in potentially new cancer predisposition candidate genes in pediatric cancer patients.

Genetic predisposition is one of the major risk factors for pediatric cancer, with ~10% of children being carriers of a predisposing germline alteration. It is likely that this is the tip of the iceberg and many children are underdiagnosed, as most of the analysis focuses on single or short nucleotide variants, not considering the full spectrum of DNA alterations. Hence, we applied optical genome mapping (OGM) to our cohort of 34 pediatric cancer patients to perform an unbiased germline screening and analyze the frequency of structural variants (SVs) and their impact on cancer predisposition. All children were clinically highly suspicious for germline alterations (concomitant conditions or congenital anomalies, positive family cancer history, particular cancer type, synchronous or metachronous tumors), but whole exome sequencing (WES) had failed to detect pathogenic variants in cancer predisposing genes. OGM detected a median of 49 rare SVs (range 27-149) per patient. By analysis of 18 patient-parent trios, we identified three de novo SVs. Moreover, we discovered a likely pathogenic deletion of exon 3 in the known cancer predisposition gene BRCA2, and identified a duplication in RPA1, which might represent a new cancer predisposition gene. We conclude that optical genome mapping is a suitable tool for detecting potentially predisposing SVs in addition to WES in pediatric cancer patients.

Approaches to predicting life expectancy in elderly coronary artery disease patients with comorbid conditions

The aim of the study was to develop a model for predicting the probability of survival up to 80 years of age for elderly and senile patients with coronary artery disease (CAD) and concomitant conditions. Materials and methods. A retrospective data analysis of elderly and senile CAD patients who were observed in the period 1997–2019 and died from a cardiovascular event. Results. Using binary logistic regression analysis, a model of the survival probability up to 80 years in CAD patients with comorbid conditions has been developed. The overall accuracy of the model was 83.12 % (χ2 = 6.70, p < 0.05), and the predictive accuracy of the model (AUC = 0.853, 95 % CI 0.802–0.896) was sufficiently high and adequate to use in clinical practice. Odds ratio has shown a greater contribution of arterial hypertension and diabetes mellitus to reduced probabilities of surviving to the age of 80, a less significant contribution – of chronic obstructive pulmonary disease and dyslipidemia. Conclusions. The developed model for predicting the survival probability up to 80 years for older age group patients with coronary artery disease and comorbid conditions can be used to evaluate the effectiveness and correct medical and preventive measures.

Determination of genetic correlation between tobacco smoking and coronary artery disease.

Tobacco smoking is an important risk factor for coronary artery disease (CAD), but the genetic mechanisms linking smoking to CAD remain largely unknown. We analyzed summary data from the genome-wide association study (GWAS) of the UK Biobank for CAD, plasma lipid concentrations (n = 184,305), and smoking (n = 337,030) using different biostatistical methods, which included LD score regression and Mendelian randomization (MR). We identified SNPs shared by CAD and at least one smoking behavior, the genes where these SNPs are located were found to be significantly enriched in the processes related to lipoprotein metabolic, chylomicron-mediated lipid transport, lipid digestion, mobilization, and transport. The MR analysis revealed a positive correlation between smoking cessation and decreased risk for CAD when smoking cessation was considered as exposure (p = 0.001), and a negative correlation between the increased risk for CAD and smoking cessation when CAD was considered as exposure (p = 2.95E-08). This analysis further indicated that genetic liability for smoking cessation increased the risk of CAD. These findings inform the concomitant conditions of CAD and smoking and support the idea that genetic liabilities for smoking behaviors are strongly associated with the risk of CAD.

Is Surgical Treatment for Obesity Able to Cure Urinary Incontinence in Women?-A Prospective Single-Center Study.

There is enough evidence to support weight loss in order to improve urinary incontinence. Nevertheless, weight loss and maintaining a lower weight are not easy to achieve in the general population. Our study aims to evaluate whether bariatric surgery has a positive effect on the symptoms of urinary incontinence in female patients. We performed a prospective study on obese female patients before and after bariatric surgery, over a period of 9 years. Patients with a BMI ≥ 33 kg/m2 were included if they described involuntary loss of urine and no previous surgery for urinary incontinence was performed. The patients underwent laparoscopic surgery, either gastric sleeve, bypass or banding, performed by four surgeons in our hospital. The type of incontinence was not assessed at the initial visit carried out by the surgeon. All patients who declared being incontinent were referred to the urologist where they received the ICIQ-UI-SF questionnaire before their bariatric surgery and during follow -up visits. The sum of points obtained at questions 3, 4 and 5 was used to evaluate the severity of incontinence, as well as the impact on the quality of life. Our evaluation collected data on age, time since onset of symptoms, pad usage, number and type of deliveries, concomitant conditions and medications. The type of incontinence was assessed by the urologist before bariatric surgery as urge, stress or mixed incontinence. At follow-up visits, the patients were also asked to fill out a 10-point VAS questionnaire evaluating their perception on the evolution of incontinence symptoms. Data were analyzed using t-test statistical analysis. Our objective defined changes in incontinence as cure, improved, no change and worse. We included 54 women from whom initial data and at least 18 months of follow-up were available. We observed that about 50% of all women undergoing bariatric surgery have some degree of urinary incontinence. The ICIQ score improved from 13.31 ± 5.18 before surgery to 8.30 ± 4.49 points after surgery (p < 0.0001). Before surgery, 38 patients (70%) described severe incontinence compared to only 20 patients (37%) after surgery. A total of 16 women (31%) reported complete cure of urinary incontinence after bariatric surgery. Data from the VAS questionnaire show improvement in 46 cases (85%). Pad usage improved from 7.04 ± 2.79 to 3.42 ± 2.77 (p < 0.001) per day. The number of patients using more than one pad per day decreased from 35 (65%) to 9 (17%). The type of incontinence did not seem to be relevant, but our sample size was too small to lead to statistically significant results. There was no impact on the outcome of incontinence of number/type of delivery, age or BMI. Our data show that bariatric surgery is able to cure urinary incontinence in one of three obese women. A significant improvement was obtained in more than two-thirds of the patients, regardless of the type of incontinence. For an obese female with urinary incontinence, treatment for obesity should prevail and incontinence should be treated only if symptoms remain.

Timeliness of diagnostic evaluation for postmenopausal bleeding: A retrospective cohort study using claims data.

Postmenopausal bleeding (PMB) is a common gynecologic condition. Although it can be a sign of uterine cancer, most patients have benign etiology. However, research on quality of diagnostic evaluation for PMB has been limited to cancer patients. To extend this research, we examined the timeliness of diagnostic evaluation for PMB among patients with benign conditions. Using the 2008-2019 MarketScan Research Databases, we identified 499176 patients (456741 with commercial insurance and 42435 with Medicaid insurance) who presented with PMB but did not have gynecologic cancer. For each patient, we measured the time from their PMB reporting to the date of their first diagnostic procedure. The association between patient characteristics and time to first diagnostic procedure was examined using Cox proportional hazards models (for the overall sample and then stratified by insurance type). Overall, 54.3% of patients received a diagnostic procedure on the same day when they reported PMB and 86.6% received a diagnostic procedure within 12 months after reporting PMB. These percentages were 39.4% and 77.1%, respectively, for Medicaid patients, compared to 55.7% and 87.4%, respectively, for commercially insured patients (p<0.001 for both). Medicaid patients had an 18% lower rate of receiving a diagnostic procedure at any given time point than commercially insured patients (adjusted hazard ratio = 0.82, 95% CI: 0.81-0.83). Meanwhile, older age and non-gynecologic comorbidities were associated with a lower rate whereas concomitant gynecologic conditions and recent use of preventive care were associated with a higher rate of receiving diagnostic procedures. Analysis stratified by insurance type identified additional risk factors for delayed diagnostic procedures (e.g., non-metropolitan versus metropolitan location for commercially insured patients and Black versus White race for Medicaid patients). A sizable proportion of patients did not receive prompt diagnostic evaluation for PMB. Both clinical and non-clinical factors could affect timeliness of evaluation.

Analysis of the Economic-Financial Efficiency of Gout Treatment in Elderly Patients with Comorbidities in the Republic of Moldova.

The costs of treating an elderly patient with gout are largely related to the treatment of concomitant pathological conditions and complications. Determining the costs of treating the disease is made by clinical and economic analysis, the task of which is to calculate the "cost of the illness". A descriptive, selective study of 237 patients with gout. In order to study the clinical characteristics of gout in the elderly, all those included in the study was divided according to age at the time of examination: group I made up of patients with gout up to and including 59 years n=91, average age 48.1±7.4 years (from 30 years to 59 years), group II - over the age of 60 years inclusive n=146, average age 69.2±6.0 years, (60-86 years, p<0.01). For calculations, the hospitalisation rate during the year was used, which had significant differences in groups: in group I it was 0.7; in group II - 1.2 (p=0,001). The costs of clinical management of gout and each of the diseases that accompany it for 1 calendar year have been determined. The direct costs for the treatment of patients with gout, calculated taking into account National Clinical Protocol and comorbid pathology, increase significantly with the age of the patients: the average cost per year of the treatment of gout in patients of mature age was 1337 Euro without and 7320 Euro taking into account the concomitant pathology, and in the elderly 2067 Euro and, respectively, 15230 Euro.

Familial coaggregation of MASLD with hepatocellular carcinoma and adverse liver outcomes: Nationwide multigenerational cohort study

Metabolic dysfunction-associated steatotic liver disease (MASLD; formerly NAFLD) is the fastest growing cause of hepatocellular carcinoma (HCC) worldwide. However, whether family members of individuals with MASLD also share an increased risk of developing HCC is unknown. This nationwide multigenerational cohort study involved family members of all Swedish adults diagnosed with biopsy-proven MASLD (1969-2017), and matched general population comparators. Using the Swedish Multi-generation Register, we identified 38,018 first-degree relatives (FDRs: parents, siblings, offspring) and 9,381 spouses of patients with MASLD, as well as 197,303 comparator FDRs and 47,572 comparator spouses. We used Cox proportional hazards models to calculate adjusted hazard ratios (aHRs) for HCC, major adverse liver outcomes (cirrhosis, decompensated liver disease or liver transplantation), liver-related mortality, extrahepatic cancer, and non-liver-related mortality. Over a median of 17.6 years, the rate of the primary outcome HCC was higher in MASLD FDRs vs. comparator FDRs (13 vs. 8/100,000 person-years [PY]; aHR 1.80, 95% CI 1.36-2.37). The HCC risk was further increased in FDRs of individuals with liver fibrosis/cirrhosis (aHR 2.14, 95% CI 1.07-4.27; PHeterogeneity= 0.03). MASLD FDRs also had higher rates of major adverse liver outcomes (73 vs. 51/100,000 PY; aHR 1.52, 95% CI 1.36-1.69) and liver-related mortality (20 vs. 11/100,000 PY; aHR 2.14, 95% CI 1.67-2.74). MASLD FDRs with any concomitant chronic liver condition experienced accelerated progression of liver disease (aHR 1.47, 95% CI 1.29-1.67). MASLD spouses were at higher risks of major adverse liver outcomes (86 vs. 74/100,000 PY; aHR 1.23, 95% CI 1.01-1.51) and liver-related mortality (25 vs. 19/100,000 PY; aHR 1.93, 95% CI 1.15-3.23), but not of HCC (aHR 1.43, 95% CI 0.87-2.35). There is distinct familial clustering of adverse liver-related outcomes in families of individuals with biopsy-proven MASLD, with higher relative risks of HCC, progressive liver disease, and liver-related mortality, but absolute risks are low. Metabolic dysfunction-associated steatotic liver disease (MASLD; formerly termed NAFLD) clusters in families with high genetic susceptibility and shared environmental risk factors, but the risks of developing hepatocellular carcinoma and other major liver-related outcomes in family members of individuals with MASLD are largely unknown. This large nationwide multigenerational cohort study involving family members (first-degree relatives and spouses) of individuals with biopsy-proven MASLD and of matched general population comparators found slightly increased risks of hepatocellular carcinoma in first-degree relatives, and of developing cirrhosis and liver-related mortality in all family members of individuals with biopsy-proven MASLD. The findings of this study provide large-scale evidence to inform clinical practice guidelines for recommendations on the early identification of individuals at higher risk of liver-related morbidity and mortality.

Epidemic within pandemic: Alcohol-associated hepatitis and COVID-19.

An increase in alcoholic beverage sales was observed during the peak of the COVID pandemic in the US. Little is known about the impact of SARS-CoV-2 infection among hospitalized alcohol-associated hepatitis (AH) patients. In this study we analyzed the available National Inpatient Data (NIS) data from 2020 to determine mortality and healthcare utilization among hospitalized AH patients with and without COVID-19 in the United States. We observed an ~15.6% increase in cases of hospitalized AH patients from 136,620 in 2019 to 157,885 in 2020, a significant increase from an average of 5.5% per annum despite an 8.7% decline in US hospital admissions over the same time span. Men younger than 40 was the fastest growing AH group, representing a 23% increase in 2020. Approximately 1.8% of hospitalized AH patients had a SARS-CoV-2 infection. An infection with SARS-CoV-2 significantly worsened the mortality among patients with AH (11.4% vs. 4.1%, p<0.0001), especially among older AH patients with concomitant comorbidities such as clinically apparent cirrhosis, acute renal failure, upper gastrointestinal bleeding, and sepsis. AH patients with COVID-19 also had a longer length of stay (8.6 vs. 6.1 days, p <0.0001) and higher hospital charges during the stay ($93,670 vs. $66,283, p <0.0001). Our study highlighted the rise in AH cases during the COVID-19 pandemic. Screening and appropriate management of excessive alcohol use and the preventive measure such as the recommendation of COVID-19 vaccination should be considered to prevent the morbidity and mortality among patients with ALD.

Interdisciplinary Study of Health Disorders Associated with Comorbid Addictions

This study presents an interdisciplinary examination of health disorders associated with comorbid addictions. Drawing on data from medical, psychological, and sociological sources, we analyzed the interrelated impacts of multiple concurrent addictions on individuals' physical, psychological, and social health. Our findings indicate that individuals with comorbid addictions face compounded health risks and often experience exacerbated symptoms compared to those with singular addictions. Additionally, the societal perception and treatment of these individuals are often influenced by stigma, leading to decreased access to comprehensive healthcare and support. Proven that there are cause-and-effect relationships between the consumption of prohibited psychoactive substances, the formation of concomitant comorbid addictive conditions, and drug-related crime. It is noted that the comorbid addictive state depends on the classification and legal group of the psychoactive substance or drug. Common, simultaneous use of psychoactive narcotic analgesics, psychoactive psychotropic tranquilizers, cannabis, amphetamine, alcohol, other psychoactive substances, and drugs. Measures are proposed for further study of the problem to improve the quality of medical and pharmaceutical care, pharmaceutical provision, protection of the rights of patients of various contingents to medical and pharmaceutical rights.

Complexity in clinical diagnoses of acute exacerbation of chronic obstructive pulmonary disease

BackgroundAcute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a clinical syndrome with various causes. It is not uncommon that COPD patients presenting with dyspnea have multiple causes for their symptoms including AECOPD, pneumonia, or congestive heart failure occurring concurrently.MethodsTo identify clinical, radiographic, and laboratory characteristics that might help distinguish AECOPD from another dominant disease in patients with a history of COPD, we conducted a retrospective cohort study of hospitalized patients with admitting diagnosis of AECOPD who were screened for a prospective randomized controlled trial from Sep 2016 to Mar 2018. Clinical characteristics, course in hospital, and final diagnosis at discharge were reviewed and adjudicated by two authors. The final diagnosis of each patient was determined based on the synthesis of all presenting signs and symptoms, imaging, and laboratory results. We adhered to AECOPD diagnosis definitions based on the GOLD guidelines. Univariate and multivariate analyses were performed to identify any associated features of AECOPD with and without other acute processes contributing to dyspnea.ResultsThree hundred fifteen hospitalized patients with admitting diagnosis of AECOPD were included. Mean age was 72.5 (SD 10.6) years. Two thirds (65.4%) had spirometry defined COPD. The most common presenting symptom was dyspnea (96.5%), followed by cough (67.9%), and increased sputum (57.5%). One hundred and eighty (57.1%) had a final diagnosis of AECOPD alone whereas 87 (27.6%) had AECOPD with other conditions and 48 (15.2%) did not have AECOPD after adjudication. Increased sputum purulence (OR 3.35, 95%CI 1.68–6.69) and elevated venous pCO2 (OR 1.04, 95%CI 1.01 – 1.07) were associated with a diagnosis of AECOPD but these were not associated with AECOPD alone without concomitant conditions. Radiographic evidence of pleural effusion (OR 0.26, 95%CI 0.12 – 0.58) was negatively associated with AECOPD with or without other conditions while radiographic evidence of pulmonary edema (OR 0.31; 95%CI 0.11 – 0.91) and lobar pneumonia (OR 0.13, 95%CI 0.07 – 0.25) suggested against the diagnosis of AECOPD alone.ConclusionThe study highlighted the complexity and difficulty of AECOPD diagnosis. A more specific clinical tool to diagnose AECOPD is needed.

What Is the Current Best Drug Treatment for Hypertensive Heart Failure With Preserved Ejection Fraction? Review of the Totality of Evidence.

More than 90% of patients developing heart failure (HF) have an epidemiological background of hypertension. The most frequent concomitant conditions are type 2 diabetes mellitus, obesity, atrial fibrillation, and coronary disease, all disorders/diseases closely related to hypertension. HF outcome research focuses on decreasing mortality and preventing hospitalization for worsening HF syndrome. All drugs that decrease these HF endpoints lower blood pressure. Current drug treatments for HF are (i) angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or angiotensin receptor neprilysin inhibitors, (ii) selected beta-blockers, (iii) steroidal and nonsteroidal mineralocorticoid receptor antagonists, and (iv) sodium-glucose cotransporter 2 inhibitors. For various reasons, these drug treatments were first studied in HF patients with a reduced ejection fraction (HFrEF). However, subsequently, they have been investigated and, as we see it, documented as beneficial in HF patients with a preserved left ventricular ejection fraction (LVEF, HFpEF) and mostly hypertensive etiology, with effect estimates assessed partly on top of background treatment with the drugs already proven effective in HFrEF. Additionally, diuretics are given on symptomatic indications. Considering the totality of evidence and the overall need for antihypertensive treatment and/or treatment of hypertensive complications in almost all HF patients, the principal drug treatment of HF appears to be the same regardless of LVEF. Rather than LVEF-guided treatment of HF, treatment of HF should be directed by symptoms (related to the level of fluid retention), signs (tachycardia), severity (NYHA functional class), and concomitant diseases and conditions. All HF patients should be given all the drug classes mentioned above if well tolerated.