Group Of Chronic Patients Research Articles

Scent of relief: Mastic resin scent recovers salivation in chronic dry mouth patients

BackgroundOlfactory stimulation with mastic resin, derived from the Pistacia lentiscus tree, demonstrated a bona fide sialagogic effect in healthy volunteers [1]. Its main volatile compound, α-pinene, also showed this effect. The current study aimed to validate the effect of mastic resin volatiles in chronic dry mouth patients with confirmed decreased saliva secretion. Methods41 chronic dry mouth patients with decreased unstimulated saliva secretion (<0.25 mL/min) were exposed to mastic resin volatiles as part of the diagnostic routine at the Saliva Clinic of Academic Centre for Dentistry Amsterdam. During their visit, dry-mouth questionnaires were conducted and samples of unstimulated whole saliva, chew-stimulated saliva, acid-stimulated saliva and mastic resin stimulated saliva were collected. Saliva flow rate, spinnbarkeit, pH, ion composition, MUC5B and MUC7 levels in all samples were analyzed. ResultsSalivary flow rates increased by all stimuli when compared to the baseline unstimulated saliva (P<0.001). During olfactory mastic resin stimulation, the salivary spinnbarkeit (P<0.001) and sodium concentration (P<0.01) were increased compared to unstimulated saliva. MUC5B and MUC7 levels were increased during olfactory mastic resin stimulation compared to chew-stimulated saliva (P=0.016 and P<0.001, respectively). Spinnbarkeit correlated positively with MUC5B (R=0.399, P=0.002) and MUC7 levels (R=0.375, P=0.004). Results of dry-mouth questionnaires indicated reduced posterior palate dryness shortly after olfactory mastic resin stimulation (P=0.04). ConclusionsOlfactory mastic resin stimulation increased mucous saliva secretion and reduced posterior palate dryness in a group of chronic dry mouth patients. These findings, validated in patients, underscore mastic resin scent as a beneficial and non-invasive sialagogic treatment for clinical applications.

Periostin as a marker of eosinophilic inflammation in patients with asthma and chronic obstructive pulmonary disease

BACKGROUND: Asthma and chronic obstructive pulmonary disease are common chronic respiratory diseases. Given their heterogeneity, the study of periostin is a relevant area for establishing the endotypes of airway inflammation and determining further therapy tactics. AIM: To evaluate periostin levels and determine its significance as a marker of eosinophilic inflammation in patients with asthma and chronic obstructive pulmonary disease. MATERIALS AND METHODS: The study included 59 patients with asthma and 33 patients with chronic obstructive pulmonary disease. The control group consisted of 37 apparently healthy people, comparable in age and sex, without allergic and bronchial obstructive diseases in anamnesis. The anamnesis data, the number of peripheral blood eosinophils and induced sputum, indices of external respiratory function were evaluated. Levels of specific immunoglobulin E to allergens, periostin level were determined in blood serum by immunoenzyme method. The obtained data were processed using STATISTICA 13 and SPSS Statistic 27 software systems. RESULTS: The maximum serum periostin concentration 22.5 (17–38) ng/ml was recorded in the patients with asthma, which was significantly higher than in the chronic obstructive pulmonary disease group [16 (12–21) ng/ml; p = 0.006] and control group [20.1 (14.6–24.8) ng/ml; p = 0.044]. The level of periostin in induced sputum in the patients with asthma was significantly higher than in the chronic obstructive pulmonary disease group — 0.05 (0.03–0.6) ng/ml vs 0.03 (0.02–0.04) ng/ml (p = 0.008). The study revealed the correlation between serum periostin level and eosinophil level (r = 0.406; p 0.05) and with forced expiratory volume in the first second after bronchodilator test (r = 0.366; p 0.05) as well as with forced expiratory volume in the first second divided by forced vital capacity after bronchodilator test (r = 0.572; p 0.05). CONCLUSIONS: Periostin is a promising marker of eosinophilic inflammation in patients with asthma, which can be considered as an indicator of fixed bronchial obstruction and a molecule linking T2-inflammation and airway remodelling. In a group of chronic obstructive pulmonary disease patients, the use of periostin for diagnostic and prognostic purposes requires further investigation and larger studies.

Immunological Assessment of Interleukin-6 in Patients with Gastric (Stomach) Ulceration of Acute and Chronic Types in Babylon Province

Stomach ulcers have emerged as a serious public health concern. Serum interleukin-6 (IL-6) levels in individuals with chronic and acute gastric ulcers will be examined in this study. Sixty blood samples were obtained from participants in the research. The Marjan Teaching Hospital, Al-Sadiq Hospital in Babylon Province, Iraq, treated forty patients having stomach ulcer surgery between March and November 2023; the control group consisted of twenty individuals. A high mean value for IL-6 concentration was seen in both the chronic and acute patient groups compared to the control group (44.1 ± 28.6 pg/ml) for chronic patient and (30.2 ± 15.4 pg/ml) for acute patients with significant differences(P&lt;0.05). The results conducted a noteworthy rise in the level of interleukin-6 in the age group of 71–80 years, with a mean value of 10.9±9.02 pg/ml, compared to other age groups. Additionally, when considering gender, it was observed that males had a higher mean value of 73.4±30.60 pg/ml, while females had a similar mean value of 73.4±30.60 pg/ml. These findings were found to be statistically significant (P&lt;0.05).

Innovations in use of registry data (INOREG)

Abstract: In recent years there have been several political initiatives in Norway, requiring more research into how multimorbidity and health care pathways in the municipality affect outcomes such as work participation, hospital admissions, disability and quality of life for patients with chronic diseases. Most of the care is provided outside hospitals and has been difficult to capture in large, registry-based studies. Focusing on two important groups, patients with chronic obstructive pulmonary disease (COPD) and musculoskeletal disorders (MSD), the INOREG project aims to reduce these knowledge gaps. In the paper we present 1) the data that are used in the project, 2) the construction of samples, variables and possible methods for analysis and 3) an example on how the data and methods will be applied. The project database is constructed from a novel linkage of national health and welfare registries. The data cover social, primary and specialized care for all COPD and MSD patients in Norway, long-term care data from Oslo and Trondheim municipalities and functioning and quality of life for ca. 2,700 patients treated at physiotherapy clinics in the FYSIOPRIM project. This enables construction of care pathways and outcomes at the individual level from 2008 through 2019. The project will fill knowledge gaps regarding the patterns of care at different levels in the health care system, and the association to outcomes for chronic patient groups. If the project is successful, it will provide improved insight on how to further develop provision and coordination of services to the decision makers, and ideally reduce inequalities in health.

PREDICTION OF CHRONIC KIDNEY DISEASE

Chronic Kidney Disease is a prevalent and weakening medical condition with a substantial impact on public health. Early detection and prediction reduces its adverse effects and improve patient outcomes. In this project, wepropose a comprehensive predictive analysis framework utilizing advanced machine learning algorithms to forecast the onset and progression of the disease. The dataset comprises a diverse range of clinical, population, and laboratory features collected from a group of chronic kidney disease patients over a defined period. Preprocessing techniques are employed to handle missing values and normalize data. Subsequently, various machine learning algorithms, including Random Forest, Support Vector Machine, and Gradient Boosting , are trained on the processed dataset to learn complex patterns and relationships within the data. Additionally, feature importance analysis is undertaken to identify the most influential variables contributing to prediction accuracy. The machine learning algorithms can effectively aid clinicians in predicting chronic kidney diseases, enabling timely interventions and personalized treatment plans. This research contributes to the growing knowledge on the application of machine learning in healthcare, particularly in chronic disease prediction.

Graph analysis of cortical reorganization after virtual reality-based rehabilitation following stroke: a pilot randomized study.

Stroke is the leading cause of functional disability worldwide. With the increase of the global population, motor rehabilitation of stroke survivors is of ever-increasing importance. In the last decade, virtual reality (VR) technologies for rehabilitation have been extensively studied, to be used instead of or together with conventional treatments such as physiotherapy or occupational therapy. The aim of this work was to evaluate the GestureCollection VR-based rehabilitation tool in terms of the brain changes and clinical outcomes of the patients. Two groups of chronic patients underwent a rehabilitation treatment with (experimental) or without (control) complementation with GestureCollection. Functional magnetic resonance imaging exams and clinical assessments were performed before and after the treatment. A functional connectivity graph-based analysis was used to assess differences between the connections and in the network parameters strength and clustering coefficient. Patients in both groups showed improvement in clinical scales, but there were more increases in functional connectivity in the experimental group than in the control group. The experimental group presented changes in the connections between the frontoparietal and the somatomotor networks, associative cerebellum and basal ganglia, which are regions associated with reward-based motor learning. On the other hand, the control group also had results in the somatomotor network, in its ipsilateral connections with the thalamus and with the motor cerebellum, which are regions more related to a purely mechanical activity. Thus, the use of the GestureCollection system was successfully shown to promote neuroplasticity in several motor-related areas.

Behavioral modeling and neuroimaging of impaired risky decision making in patients with chronic musculoskeletal pain.

Performance during risky decision making is one of the essential cognitive functions that is impaired in several psychiatric disorders including addiction. However, the cognitive mechanism and neural correlates underlying risky decision making in chronic pain patients are unclear. To our knowledge, this study is among the first to construct computational models to detect the underlying cognitive process of chronic pain patients during risky decision making. This study aimed at inspecting the significantly abnormal risky decision-making patterns of chronic pain patients and its neuro-cognitive correlates. In this case-control study, 19 chronic pain patients and 32 healthy controls (HCs) were included to measure the risky decision making in a balloon analogue risk task (BART). Optical neuroimaging using functional near-infrared spectroscopy, together with computational modeling, was carried out to systematically characterize the specific impairments based on BART. Computational modeling findings on behavioral performance demonstrated that the chronic pain patient group exhibited significant deficits in learning during BART (), tending to make decisions more randomly without deliberation (). In addition, significant brain deactivation alternation in the prefrontal cortex (PFC) during the task was detected for the patient group compared with that from the control group (). Long-term aberrant pain responses significantly disrupted the PFC function and behavioral performance in chronic pain patients. The joint behavioral modeling and neuroimaging techniques open a new avenue for fully understanding the cognitive impairment and brain dysfunction of risky decision making associated with chronic pain.

An investigation of effects of a non-repetitive preferred music on physiological responses amongst a group of chronic tinnitus patients

A kind of specific music, which was non-repetitive and fulfilled the individualized preferences of tinnitus patients, has been shown to be effective in relieving tinnitus in short term. Currently, the effects of the specific music on physiological responses of tinnitus patients were unknown, which was the main objective of this study. Thirty patients suffering from chronic tinnitus were involved in this study for a three-week specific music intervention. During this period, tinnitus patients received four measurements, each of which simultaneously collected electrocardiogram (ECG), photoplethysmogram (PPG), respiration (RSP), and surface electromyogram (EMG) signals to measure physiological responses, such as activities of autonomic nervous system (ANS) and mental stress. The effects of the specific music were evaluated by differences of physiological responses in different stages (before, during, and after specific music intervention). Significant differences (p ≤ 0.001) of physiological parameters among the three stages were observed. Results indicated that the specific music might be helpful to increase HRV, enhance activities of parasympathetic nervous system, and mitigate the mental stress of tinnitus patients.

Disorder of consciousness: Structural integrity of brain networks for the clinical assessment.

When studying brain networks in patients with Disorders of Consciousness (DoC), it is important to evaluate the structural integrity of networks in addition to their functional activity. Here, we investigated whether structural MRI, together with clinical variables, can be useful for diagnostic purposes and whether a quantitative analysis is feasible in a group of chronic DoC patients. We studied 109 chronic patients with DoC and emerged from DoC with structural MRI: 65 in vegetative state/unresponsive wakefulness state (VS/UWS), 34 in minimally conscious state (MCS), and 10 with severe disability. MRI data were analyzed through qualitative and quantitative approaches. The qualitative MRI analysis outperformed the quantitative one, which resulted to be hardly feasible in chronic DoC patients. The results of the qualitative approach showed that the structural integrity of HighOrder networks, altogether, had better diagnostic accuracy than LowOrder networks, particularly when the model included clinical variables (AUC=0.83). Diagnostic differences between VS/UWS and MCS were stronger in anoxic etiology than vascular and traumatic etiology. MRI data of all LowOrder and HighOrder networks correlated with the clinical score. The integrity of the left hemisphere was associated with a better clinical status. Structural integrity of brain networks is sensitive to clinical severity. When patients are chronic, the qualitative analysis of MRI data is indicated.

Barriers and solutions for the integrated care of diabetic patients from the point of view of general practitioners in Latvia.

Ambulatory care sensitive indicators for chronic care patients, such as avoidable hospitalizations and preventable mortality, show worse results in Latvia in comparison with the EU average. Previous studies reveal the situation is not far behind in terms of the quantity of diagnostics and consultations, but it is possible to prevent at least 14% of hospitalizations in the chronic patient group. The aim of this study is to find out the opinions of GPs on the barriers and solutions for better care results for diabetic patients in the context of applying an integrated care approach. A qualitative study was conducted in the form of semi-strucured in-depth interviews (5 themes, 18 questions), and analyzed using an inductive thematic analysis. The online interviews were conducted in May and April 2021. The respondents were GPs representing different rural regions (n=26). The results of the study reveal that the main barriers to integrated care are: the workload of GPs, especially in COVID conditions; the limited visit time; the lack of focused informational handouts; long queues for secondary care; and the lack of electronic patient health records (EHRs). GPs point to the need to set up patient EHRs, to develop diabetes training rooms in regional hospitals, and to expand GP practice with a third nurse. Special attention should be paid to developing integrated care tools at the healthcare system level and patient data digitization and care of socially isolated and sedentary patients by developing home care services, communication tools and integrating primary, secondary and social care at the regional level.

An Assessment of Cardiovascular Functional Capacity of a Group of Chronic Heart Failure Patients Using the 6-Minute Walk Test in a Cameroonian Urban Setting

An Assessment of Cardiovascular Functional Capacity of a Group of Chronic Heart Failure Patients Using the 6-Minute Walk Test in a Cameroonian Urban Setting

Quantitative Evaluation of late Gadolinium Enhancement to the Differential Diagnosis of Prostate Cancer and Prostatitis in mpMRI.

To evaluate the late gadolinium enhancement ratio (LGER) quantitatively in late post-contrast images in multiparametric prostate MRI (mpMRI) for the differential diagnosis of chronic prostatitis and prostate cancer (PCa). Descriptive study. Department of Radiology, Suleyman Demirel University, Isparta, Turkey, from January 2018 to October 2021. The data of 111 patients with a diagnosis of PCa and chronic prostatitis, were retrospectively analysed who underwent mpMRI of the prostate were retrospectively analysed. Histopathological verification was available in 57 of 57 prostate carcinoma patients and 20 of 54 chronic prostatitis cases. The detection of lesions from the images and the correlation of the detected lesions with their histopathological diagnoses were made by the joint decision of two radiologists. The LGER measurements were made independently by both radiologists. Signal intensity (SI) values of the lesions were obtained by placing a hand-drawn ROI on pre-contrast and late post-contrast images. Late enhancement ratio was calculated from the ratio of the difference between the pre- and post-contrast SI values to the pre-contrast SI values. The LGER values obtained were statistically compared between the pathologically proven PCa and chronic prostatitis patient groups. The prostatitis LGER values (103.40 ± 31.54%) were significantly higher than the PCa values (79.71±27.39, p<0.001). The LGER values of lesions with a Gleason score <7 were lower than those of lesions scoring ≥7 (p = 0.004). The LGER values of PI-RADS-3 PCa lesions were lower than those of PI-RADS-4 and PI-RADS-5 (p = 0.002). In the late post-contrast phase, low signal measurements in PI-RADS-3 lesions excluded the presence of prostatitis. Late contrast enhancement quantitative SI measurements performed in the late contrast phase of mpMRI may enable the differential diagnosis of PCa/prostatitis and a more accurate evaluation of PI-RADS scores in terms of malignancy. Prostate cancer, Prostatitis, Gadolinium, Dynamic contrast-enhanced magnetic resonance imaging.

Adenoviral VEGF-DΔN ΔC gene therapy for myocardial ischemia.

Background: Cardiovascular diseases are the leading cause of death globally. In spite of the availability of improved treatments, there is still a large group of chronic ischemia patients who suffer from significant symptoms and disability. Thus, there is a clear need to develop new treatment strategies for these patients. Therapeutic angiogenesis is a novel therapy method which has shown promising results in preclinical studies. In this study, we evaluated safety and efficacy of adenoviral (Ad) VEGF-DΔNΔC gene transfer for the treatment of myocardial ischemia in a pig model. Methods: Adenoviral VEGF-DΔNΔC gene transfer was given to pigs (n = 26) via intramyocardial injections using an electromechanical injection catheter. Angiogenic effects were evaluated in an acute myocardial infarction model (n = 18) and functionality of the lymphatic vessels were tested in healthy porcine myocardium (n = 8). AdLacZ was used as a control. Results: AdVEGF-DΔNΔC induced safe and effective myocardial angiogenesis by inducing a four-fold increase in mean capillary area at the edge of the myocardial infarct six days after the gene transfer relative to the control AdLacZ group. The effect was sustained over 21 days after the gene transfer, and there were no signs of vessels regression. AdVEGF-DΔNΔC also increased perfusion 3.4-fold near the infarct border zone relative to the control as measured by fluorescent microspheres. Ejection fraction was 8.7% higher in the AdVEGF-DΔNΔC treated group 21days after the gene transfer relative to the AdLacZ control group. Modified Miles assay detected a transient increase in plasma protein extravasation after the AdVEGF-DΔNΔC treatment and a mild accumulation of pericardial effusate was observed at d6. However, AdVEGF-DΔNΔC also induced the growth of functional lymphatic vasculature, and the amount of pericardial fluid and level of vascular permeability had returned to normal by d21. Conclusion: Endovascular intramyocardial AdVEGF-DΔNΔC gene therapy proved to be safe and effective in the acute porcine myocardial infarction model and provides a new potential treatment option for patients with severe coronary heart disease.

Low Serum Testosterone Level and Its Relationship with Hypogonadism in Patients with Chronic Liver Disease

Objective: Loss of libido, low serum testosterone levels, and other symptoms of hypogonadism like subfertility, gynecomastia, and immature testes, is a prevalent medical condition amongst males with advanced chronic liver disease. The purpose of this investigation was to evaluate the low serum testosterone levels association with hypogonadism in people with chronic liver disease. Study Duration: This study was carried out at Outpatient Department (OPD) of Medicine Ayub Teaching Hospital, Abbottabad from 1st January 2022 to 30th June 2022. Material and Methods: The retrospective study was completed on two hundred confirmed patients of hypogonadism with liver cirrhosis. In the repository, the available data was divided into two groups. The first group of chronic liver disease patients was diagnosed due to non-alcoholic fatty liver disease (NAFLD) and second patient group due to alcoholic liver disease (ALD). The patient in NAFLD group were in the age group between 15-30 years whereas the patients from ALD group were 30-60 years of age. The diagnostic values of total testosterone and Sex hormone binding globulin (SHBG) were collected from patient’s record. The independent t test was used for statistical analysis by using SPSS version 22. The frequency distribution of testosterone was also calculated between two types of chronic liver disease patients. Results: The retrospective research was performed. The data were dispersed across two age groups. The youth had no alcohol-related data, while the elderly had. According to hospital data, distribution was based on age between 15 and 30 years (NAFLD) and between 30 and 60 years (ALD). When T-test was applied it showed that there was no statistically significant difference found in means of SHBG between two age groups amongst chronic liver disease patients. In the case of serum testosterone, there was a statistically significant (p 0.05) difference between age groups (Table 1). Figures 1 and 2 illustrate the frequency distribution of total testosterone and its comparison within the liver cirrhosis group, respectively. Practical Implication: Our study predicted that low testosterone can raise the risk of mortality, the necessity for liver transplantation, and the likelihood of severe infection in men with cirrhosis given the mechanisms of action of testosterone. Conclusion: On the basis of two groups of liver cirrhosis, there is a significant age-related change in total serum testosterone, its control by the pituitary and it’s binding to SHBG in males over the age of forty. However, no substantial data was discovered in sex hormone binding globulin. Low testosterone levels are associated with hypogonadism in patients with cirrhosis of the liver. The effect of testosterone replacement treatment on increasing muscle quality in male cirrhotic patients remains to be determined. Safety and effectiveness of the treatment requires additional prospective research. Keywords: Sex Hormone Binding Globulin, Serum Testosterone, Hypogonadism, Chronic Liver Disease

Periodic limb movements among dialysis and non-dialysis chronic kidney disease patients: a comparative study

BackgroundPeriodic leg movement disorder is defined as periodic episodes of repetitive limb movements during sleep that mainly occurs in the lower limb, including the hips, knees, and toes, and sometimes affects the upper limb. It may be accompanied by frequent nocturnal arousals, and if so, this sleep disturbance may cause excessive daytime sleepiness. Chronic kidney disease patients are at risk of periodic leg movements and common causes are iron deficiency, anemia, raised serum calcium, and central and peripheral nervous system disorders. This study aimed to screen the prevalence of periodic limb movements among chronic kidney disease patients using full-night attended polysomnography, compare dialysis with non-dialysis CKD patients, and correlate PLM prevalence with the HGB level and degree of renal impairment.ResultsThis cross-sectional study was carried out on one hundred chronic kidney disease patients during the period between May 2017 and March 2020. The patients were subdivided into two groups: group I included patients on regular hemodialysis (n = 50), and group II included patients not on dialysis. All patients were screened for periodic limb movement using full-night attended polysomnography. Our study revealed a high prevalence of periodic limb movements in both groups of chronic kidney disease patients (60% in dialysis and 66% in non-dialysis patients) with mean PLM indices insignificantly higher in group I than group II (29.90 ± 19.19/h vs. 17.54 ± 13.56/h, P-value = 0.748). Moreover, there was a significant positive correlation between periodic leg movements and serum urea level (r-value = 0.38 and 0.33 and P-value = 0.04 and 0.030 in group I and group II consequently). Also, we reported a significant negative correlation between periodic leg movements and hemoglobin level (r = −0.251 and −0.291 and P-value = 0.037 and 0.010 in group I and group II consequently).ConclusionPeriodic leg movement disorder is highly prevalent among CKD patients either on dialysis or not, and good management of renal dysfunction and anemia in those patients can help in the management of PLM.

Implication of High Body Fat Percentage on Migraine Chronification in Premenopausal Females

Background Chronic migraine, being a debilitating headache disorder, needs assessment of the risk factors implicated in its occurrence. We investigated the potential role of obesity as a risk for chronic migraine in premenopausal females with episodic migraine. Methods In this analytical study, body fat% was compared between episodic and chronic migraine patient groups. The standard criteria of the international classification of headache disorder were used for the diagnosis. Demographic data, clinical details of migraine, and anthropometric measurements were collected using structured questions and standardized techniques. Pearson's correlation (r) was estimated to assess the concordance between body fat% and migraine frequency. High body fat%'s implication on chronic migraine which was adjusted for body mass index (BMI), and the use of oral contraceptives was determined using logistic regression analysis. Results A total of 168 premenopausal female migraineurs, with a mean (Standard deviation) age of 33.0 (±9.0) years, were enrolled in the study. BMI and high body fat% were significantly associated with chronic migraine (p < 0.05). There was a weak positive, but significant, correlation between body fat% and migraine frequency (r = 0.185, p < 0.017). The presence of high body fat was found to increase the risk of chronic migraine by 2.8 times (confidence interval 1.4–5.6; p < 0.003). Conclusion The amount of fat mass in the body relates to the clinical characteristics of migraine. There is an increased risk of developing chronic migraine in patients having high body fat. Weight control measures can be targeted for the prevention of migraine worsening.

EPIDEMIOLOGY OF COVID -19 HEMODIALYSIS PATIENTS AT THE MILITARY HOSPITAL OF RABAT

Introduction:Sars Cov2 infection is a risk factor for mortality in chronic hemodialysis (HD) patients and those with chronic kidney disease. In addition, it can be responsible for acute kidney injury (AKI) with a poor prognosis in patients requiring renal replacement therapy.The objective of our study is to determine the epidemiological and evolutionary profile of Covid 19 patients undergoing hemodialysis sessions. Method:This is a monocentric retrospective study including patients with the severe form of Covid-19 referred to the Mohammed V military instruction hospital and undergoing one or more dialysis sessions between March 2020 and April 2021. Results:Of 30 dialysis patients, 63.3% (n=19) were on chronic hemodialysis, 20% (n=6) presented an acutization of their chronic renal failure, and 16.7% (n=5) developed acute kidney injury. The average age was 64.4 years with a male predominance (70%). Type 2 diabetes was the most common comorbidity (50%), followed by hypertension (33.3%) and cardiovascular disease (13.3%). About two-thirds of the patients presented with severe lesions on the chest CT classified as Co-RADS 5. The overall mortality rate was 51.7%. This rate was 100% (n=5) in the AKI group, 66% (n=4) in the case of pre-existing renal failure and 33% (n=7) in the group of chronic hemodialysis patients. There is a statistically significant difference in mortality between the group of hemodialysis patients and that of patients with AKI (p=0.034). The hospitalization departmentalso seems to be statistically associated with patient mortality (p=0.014). Among the comorbidities, only diabetes was statistically associated with patient mortality (p=0.05). In our study, the levels of C reactive protein (CRP), ferritin, Lactate Dehydrogenase (LDH), white blood cells were lower in the chronic hemodialysis group compared to the other groups. Conclusion:Our results underline the vulnerability of chronic hemodialysis patients to Covid 19 infection. They also confirm the poor prognosis of patients who develop AKI requiring hemodialysis, as well as those with diabetes.

Bowel Management in Patients With Chronic Spinal Cord Injury: A Cross-Sectional Survey.

IntroductionSpinal cord injury (SCI) impairs colorectal movement, transit time, and complete evacuation at defecation. Incontinence has been documented to affect quality of life across the globe in different proportions. Bowel management has been recognized as a key factor in SCI patients’ participation in the society and leading a satisfactory life. Limited information on bowel management in SCI patients drove us to study the demographic profile and bowel management in a group of chronic SCI patients at a tertiary care rehabilitation center.MethodsA total of 42 adults (age: 18-60 years) with SCI and duration > 12 months were enrolled. Patients were evaluated with a semi-structured questionnaire containing both open and closed questions. Data were collected and analyzed using Statistical Package for Social Sciences (SPSS) Version 10.ResultsMost (52.4%) of the patients were manual laborers (85.7% males). Mean age was 37.6 ± 11 years. The injury level was predominantly thoracic level (69%). Only eight (19%) patients had fecal incontinence; 21(50%) patients used suppository and only six patients were using laxatives. Impacted stool was the most common complication followed by hemorrhoids.ConclusionYoung paraplegics is the most common age group affected by SCI. Most of the patients managed their bowel well conservatively with good adherence to bowel rehabilitation program. The study findings emphasize on patient-centric bowel management in SCI patients to reduce the impact on quality of life and minimize complications.

Association between lead poising and chronic kidney disease in a sample of Iraqi population

High environmental exposure to lead is associated with kidney failure, but the effect of low-level environmental exposure has not been well studied .Objective : The aim of the study was to evaluate the blood lead levels in the serum of patients with renal failure and compare it with those in the control group, as well as to verify its relationship with kidney function. Subjects and Method : The study included 87 people, their ages ranged (17-72 years), 45 of them were diagnosed with chronic kidney disease, while 32 of them were diagnosed with good health. Samples were collected from December 2022 to May 2022 and blood lead levels were estimated using atomic absorption Shimadzu in China, biochemical parameters were measured weight calculated for body mass index divided by height squared in meters, serum creatinine and blood urea by colorimetric methods using Spectrophotometer from Genway company . Results : The average levels of lead in the blood in the group of chronic kidney patients were much higher than it was in the control group (p≤ 0.01).

Profiles of Resilience and Risk in Chronic Pain: Loneliness, Mindfulness, and Optimism Coming Out of the Pandemic

Individuals experience variable degrees of severity and interference from chronic pain. While clinical diagnosis and pain symptomology may importantly inform treatment options, person-level characteristics may also impact treatment efficacy. The biopsychosocial model of pain includes several pain-modulatory factors which may inform meaningful categorization, or clustering, of individuals with chronic pain, and help predict pain outcomes. In this observational, longitudinal study conducted approximately shortly after the onset of social distancing, patients with chronic pain (N=94) completed validated assessments of known psychosocial (depression, stress, sleep, catastrophizing) pain modulators and pain intensity, which were used to empirically cluster patients into 3 groups using a two-step hierarchical approach. Subsequently, at 1 year later, degree of pain interference, loneliness, social support, mindfulness, and optimism were compared between these 3 groups using ANOVAs. Participants clustered empirically into three groups: 1) Global Elevation Symptoms (GES), characterized by high psychological distress and moderate pain intensity; 2) Pain Intensity Predominant (PIP), characterized by high pain intensity, but average psychological distress; and 3) Less Elevated Symptoms (LES), characterized by low pain intensity and psychological distress. At the 1-year follow-up, patients in the GES cluster reported significantly greater pain interference than the other two clusters, as well as greater feelings of loneliness and lower mindfulness and optimism compared to the LES cluster. This study supports prior research suggesting that psychosocial-based clustering of patients can be used to identify distinct groups of chronic pain patients. In particular, patients identified as belonging to the GES cluster (high psychological distress, high pain intensity early after onset of social distancing) were at greater risk of suffering from pain a year later, as well as loneliness and less mindfulness and optimism. Patient clustering techniques may help identify high risk patients and suggest behavioral interventions to improve pain by addressing psychosocial modulators of pain. Grant support from 5R35GM128691-02.