Course Of Chronic Disorders Research Articles

Changes in the clinical course of psoriasis post-COVID-19: a clinical case series

During COVID-19 pandemic, researchers and clinicians worldwide have noted changes in the course of chronic disorders of various organs and systems, which are likely to be related to systemic effects of the pathogen. Specific heterogeneous skin lesions have been identified in SARS-CoV-2 infection, including those in the patients without any history of skin disorders and exacerbation of chronic dermatoses and/or changes in their clinical manifestation. Post-COVID-19 manifestation and exacerbation of psoriasis have been also described in the literature.
 We retrospectively analyzed medical files of 22 in-patients with exacerbation of psoriasis after mild or moderate SARS-CoV-2 infection in the Department of Dermatovenereology from April 2020 to April 2021. There were 7 male patients aged 42 to 74 (meanSD 57.714.1) years and 15 female patients aged 40 to 78 (59.210.3) years. The duration of psoriasis ranged from 1 to 15 (8.74.7) years. Their mean PASI before the coronavirus infection had been 10.25.2. In the majority of the patients the psoriasis exacerbation after COVID-19 was associated with a significant increase of PASI to 18.594.82 (n=12, p 0.05), 32.221.71 (n=5, p 0.01), and to 596 (n=2, p 0.01). In 3 patients, in addition to the increase of the rash area (PASI 10 to 17, mean 13.42.63), psoriatic arthritis was newly diagnosed after COVID-19.
 We present a clinical case of a 33-year old male patient with a 15-year history of psoriasis, dramatic worsening of his benign psoriasis vulgaris with its transformation to the Zumbusch type of generalized pustular psoriasis after SARS-CoV-2 infection and rapid clinical improvement after the initiation of treatment with an interleukin-17A inhibitor secukinumab.
 This clinical case series may contribute to the knowledge on the new coronavirus infection and its effects on the course of psoriasis.

Human variation in response to food and nutrients.

The application of science to human nutrition over the centuries has served societies well. One example is the identification of key nutrients to overcome nutritional deficiencies, which has enhanced life expectancy. Enhanced life expectancy, however, is associated with an increased prevalence of chronic disorders related to food and nutrition. Findings of studies indicating that individual responses to nutrients differ substantially between individuals make it necessary to re-examine the relationship between nutrition and human health. The emergence of new genomic-based technologies illustrates the complexity and scale of the interactions between nutrition and genetic factors. Epigenetic modifications resulting from interactions of the genetic profile, aging, and lifestyle can influence the time course of chronic disorders and contribute to human variability in response to nutritional interventions. Developing a better understanding of human variability as it applies to human nutrition will involve embracing the approaches and principles of complex science.

Prevalence of anemia in hospitalized internal medicine patients: Correlations with comorbidities and length of hospital stay

BackgroundSeveral studies have documented a linear growth of the prevalence of anemia with aging. Especially in hospitalized elderly patients, anemia can aggravate the course of chronic disorders, and ultimately get worse the clinical outcomes. MethodsTo evaluate the distribution, the main causes, and the possible correlations of anemia with comorbidities and length of hospitalization in a population of internal medicine inpatients, we carried out an observational study on a cohort of 923 consecutive admissions relative to 856 subjects. ResultsAnemia was observed in 58.4% of patients, with an increase of the prevalence with increasing age regardless gender difference. In more than one-half of anemic patients, anemia was mild. Chronic inflammation and chronic renal failure were the most frequent causes of anemia in our population, and in >35% of patients a multifactorial anemia was diagnosed.Age, chronic renal failure, chronic liver disease, hematological malignancies, solid tumors, and antiplatelet therapy showed a significantly independent association with the presence of anemia.Hemoglobin levels were influenced by the presence of chronic lung disease, chronic renal failure, hematological malignancies, solid tumors, and antiplatelet therapy.The presence and the degree of anemia also correlated with a significantly longer hospital stay. ConclusionsOur data confirm the high prevalence of anemia in patients hospitalized in an Internal Medicine Department, with a remarkable burden of mild forms, and of chronic inflammation's pathogenic mechanism. Correlations with comorbidities and duration of hospital stay highlight the crucial part played by anemia in determining the clinical complexity of such patients.

P03-31 Alexithymia and suicide risk among patients with obsessive-compulsive disorder

Objective:The aim of our study was to evaluate relationships between alexithymia and suicidal ideation a sample of adult outpatients with obsessive-compulsive disorder (OCD).Methods:A sample of 86 adult outpatients with OCD (44 females and 42 males), was evaluated with a series of rating scales such as the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Toronto Alexithymia Scale (TAS-20), the Scale for Suicide Ideation (SSI) and Montgomery-Åsberg Depression Rating Scale (MADRS). the score of item #11 on the Y-BOCS was considered as a measure of insight.Results:Alexithymics showed a more early onset, a longer duration of illness and were more suitable to have a chronic course than nonalexithymics; they also reported higher MADRS and SSI scores. Alexithymics without insight (n=21) reported higher SSI scores than alexithymics with insight, nonalexythimics without insight and nonalexithymics with insight. A linear regression showed that chronic OCD course together with DIF dimension of TAS-20 and higher MADRS scores were significantly associated with higher suicide risk.Conclusions:Alexithymia and depressive symptoms were highly correlated in OCD patients and were significantly associated with higher suicide risk. DIF dimension of TAS-20 seems to be significantly associated with presence of suicidal ideation as well as chronic course of disorder. However, further longitudinal studies on larger samples are needed to definitely clarify this topic.

The relationship between trait vulnerability and anxiety and depressive diagnoses at long-term follow-up of Generalized Anxiety Disorder

The current study examined the relationship between measures of trait vulnerability and long-term outcome in 83 patients diagnosed and treated for Generalized Anxiety Disorder (GAD) 8–14 years previously. Diagnostic status was assessed by structured interview, and trait affect, trait anxiety and trait depression were measured by the Positive and Negative Affect Scale (PANAS), the State–Trait Anxiety Inventory (STAI-T) and the Personal Style Inventory (PSI), respectively. Trait measures were all highly inter-correlated, and patients with diagnoses of GAD, social phobia and depressive disorders at long-term follow-up recorded very poor scores on all three scales. Trait anxiety recorded pre-treatment was also related to both anxiety and depression at long-term follow-up. However, trait depression showed no significant association with panic disorder. Increased numbers of comorbid diagnoses were strongly related to high levels of both trait anxiety and negative affect (NA). The findings suggest that patients reporting high trait anxiety or NA may suffer from a chronic course of disorder and higher levels of comorbidity over the longer term.

Personality disorders over time: precursors, course and outcome.

Personality disorders cause dysfunction over the course of adult life. A chronic course of disorder tends to be associated with an early onset, and personality disorders are preceded by precursor symptoms in childhood. Long-term outcome varies by personality disorder category: antisocial and borderline personality tend to remit with age, an improvement that is not seen in other diagnoses. The chronicity of personality disorders can usefully guide treatment planning, and psychotherapy for personality disorders can focus on rehabilitation.