Higher Frequency Of Comorbidities Research Articles

Cirurgia aberta e endovascular no tratamento de aneurisma de artéria poplítea: experiência de cinco anos do HCRP-FMRP-USP

Resumo Contexto Aneurismas de artéria poplítea (AAPs) correspondem a 70,00% dos aneurismas periféricos. A indicação cirúrgica é para aneurismas com diâmetros maiores que 2,0 cm ou sintomáticos. O tratamento é feito por técnicas cirúrgicas convencionais ou endovasculares. Esta última tem ganho muitos adeptos, mas ainda não há consenso estabelecido sobre sua indicação. Objetivo Apresentar a experiência da Divisão de Cirurgia Vascular e Endovascular do Hospital das Clínicas de Ribeirão Preto da Universidade de São Paulo no tratamento dos AAPs. Método Foram revisados casos de reparo convencional e endovascular de AAPs tratados nos últimos cinco anos, avaliando dados demográficos, comorbidades, indicação cirúrgica, complicações pré e pós-operatórias precoces e tardias, tempo de internação e de perviedade em até um ano. Resultados Foram realizadas no período dez cirurgias endovasculares (CE) e 21 cirurgias abertas (CA). O grupo CE teve maior frequência de comorbidades. Houve maior frequência de pacientes sintomáticos no grupo CA (85,00%) do que no grupo CE (40,00%). O Grupo CE apresentou menor número de complicações clínicas e cirúrgicas. A idade entre os grupos e o tempo de internação de cada grupo não apresentaram diferença estatística. A perviedade primária em um ano no Grupo CE foi de 80,00%, enquanto no Grupo CA foi de 75,00%. Conclusão O tratamento endovascular para AAPs apresenta bons resultados, em termos de perviedade com taxas de complicações aceitáveis, em pacientes com risco cirúrgico elevado e anatomia favorável, justificando, assim, a necessidade de mais estudos controlados para modificar a posição da técnica endovascular como uma terapia alternativa para casos selecionados.

Characterization of the Pediatric Acute-Onset Neuropsychiatric Syndrome Phenotype

Pediatric acute-onset neuropsychiatric syndrome (PANS) is a subtype of obsessive compulsive disorder (OCD) marked by an abrupt onset or exacerbation of neuropsychiatric symptoms. We aim to characterize the phenotypic presentation of youth with PANS. Forty-three youth (ages 4-14 years) meeting criteria for PANS were assessed using self-report and clinician-administered measures, medical record reviews, comprehensive clinical evaluation, and laboratory measures. Youth with PANS presented with an early age of OCD onset (mean=7.84 years) and exhibited moderate to severe obsessive compulsive symptoms upon evaluation. All had comorbid anxiety and emotional lability, and scored well below normative means on all quality of life subscales. Youth with elevated streptococcal antibody titers trended toward having higher OCD severity, and presented more frequently with dilated pupils relative to youth without elevated titers. A cluster analysis of core PANS symptoms revealed three distinct symptom clusters that included core characteristic PANS symptoms, streptococcal-related symptoms, and cytokine-driven/physiological symptoms. Youth with PANS who had comorbid tics were more likely to exhibit a decline in school performance, visuomotor impairment, food restriction symptoms, and handwriting deterioration, and they reported lower quality of life relative to youth without tics. The sudden, acute onset of neuropsychiatric symptoms, high frequency of comorbidities (i.e., anxiety, behavioral regression, depression, and suicidality), and poor quality of life capture the PANS subgroup as suddenly and severely impaired youth. Identifying clinical characteristics of youth with PANS will allow clinicians to diagnose and treat this subtype of OCD with a more strategized and effective approach.

The Year in Cardiology 2013: valvular heart disease (focus on catheter-based interventions)

2013 was the year of transcatheter heart valve interventions. Not least because of the 2012 European guidelines on the management of valvular heart disease (VHD), the multidisciplinary heart team approach became an established concept. Decision-making, when a patient is too 'sick' for surgery and too 'healthy' for catheter-based interventions, is complex, since VHD is often seen at an older age and, as a consequence, there is a higher frequency of co-morbidity and frailty. However, before TAVI and other transcatheter heart valve interventions can be expanded to intermediate-risk patients, evidence in favour of this less invasive treatment has to be provided by upcoming randomized clinical trials.

EPA-0497 – Comorbidity of adhd and personality disorders in adult out-patients

Introduction Attention-deficit/hyperactivity disorder (ADHD) is a developmental disorder that persists into adulthood. Though symptoms of inattention and hyperactivity-impulsivity are the two core symptom sets of the disorder, recent reviews argue that emotional dysregulation is an additional feature of ADHD criteria. In the DSM-5 emotional dysregulation does not appear. In a study by the Mental Health Center (MHC) of Arganda, 42 outpatients, all older than 18, we'll look for: Objectives ○ Examine the comorbidity of ADHD, in relation to Axis I and personality disorder (PD) from the DSM-IV. In addition, to see if emotional dysregulation is present in these patients. Aims ○ The proposal is that there exist comorbidity with PD, in addition to emotional dysregulation symptoms. Methods ○ Transversal descriptive study of out-patients. ○ A diagnosis of ADHD with: ASRS-V1.1, the ADHD, the CAADID and the WURS scale, reduced version. ○ Emotion dysregulation was assessed by the Impulsivity/Emotional Lability scale from the CAARS and by the DERS and PD with the SCID-II questionary. Results A high comorbidity is observed with PD and depressive symptoms. The combined type of ADHD is the most frequently found, with higher severity and frequency of PD. The association with depressive symptoms is more often found in the inattentive subtype and the combined type with substance abuse. Preliminary data is included on emotional dysregulation and ADHD. Conclusions ADHD is a disease observed in out-patient adults with a high frequency of comorbidity with PD and depression. It is necessary to look for the dimension of emotional dysregulation.

Protocolo terapéutico de las valvulopatías en el anciano

Old patients’ population requiring cardiac surgery has increased. Euro Heart Survey (HVS) and other epidemiological studies have reported a rising prevalence of valvulopathies among elderly population. Older age is associated with a higher frequency of comorbidity with important management implications.Age and associated comorbidities are the major prognostic markers for valvulopathies surgery, though populations having undergone surgical treatment may present different prognostic. In recent years, two new surgical risk markers have emerged: frailty and impairment. New risk factors and new risk scales, in addition to the former (age and comorbidities), should be taken in account to select the optimal treatment.

Metabolic syndrome, hypertension, and diabetes mellitus after gastric banding: The role of aging and of duration of obesity

BackgroundBariatric surgery leads to resolution of arterial hypertension and diabetes mellitus; isolated reports indicate that response to bariatric surgery is lower in aged patients. The aim of this study was to evaluate the role of age and of duration of obesity on the frequency of co-morbidities in morbid obesity, as well as on improvement of co-morbidities. MethodsA total of 837 consecutive patients with known duration of obesity, undergoing gastric banding, were considered for this study; they were divided into quartiles of age and of duration of obesity. Presence of co-morbidities (diabetes mellitus, arterial hypertension, metabolic syndrome), metabolic variables (cholesterol and HDL-C, triglycerides, blood glucose), anthropometric variables, and loss of weight during 24 months were considered. ResultsOlder patients had a higher frequency of co-morbidities; duration of obesity only affected frequency of co-morbidities, but not response to surgery. At logistic regression, duration of obesity had a moderate independent effect on the frequency of diabetes. Older patients lost less weight than younger patients, but diabetes mellitus and arterial hypertension improved to the same extent in patients of different ages, and metabolic syndrome disappeared more in older patients, associated with a greater decrease of blood glucose. Frequency of removal of gastric banding and loss to follow-up were not different in different quartiles of age or in different quartiles of duration of obesity. ConclusionOlder patients, despite lower weight loss, have a response to bariatric surgery that is similar to that of younger patients; age and duration of obesity should not be considered as limits to indications to bariatric surgery.

Pattern of pulmonary tuberculosis in elderly patients in Sohag Governorate: Hospital based study

BackgroundTuberculosis (TB) in elderly is a worldwide problem. ObjectiveTo evaluate differences in clinical, radiological, laboratory features, adverse antituberculosis drug reactions and TB-related mortality in elderly and young pulmonary TB patients. ResultsThe study included analysis of the medical history, chest radiographic and laboratory findings in 124 elderly and 124 young pulmonary TB patients, with mean age of 60.5±9.1 and 31.6±10.8years, respectively (p<0.0001), and comparable male predominance. There were higher frequencies of dyspnea, anorexia, weight loss, weakness and mental changes in elderly than young (p= 0.001, 0.004, <0.0001, <0.0001, 0.002, respectively) while there were higher frequencies of cough and sputum production, hemoptysis, and fever in young than elderly (p= 0.008, 0.01, 0.04, respectively) patients. Elderly had higher frequency of comorbidities (p<0.0001). Elderly had higher frequency of atypical radiological findings for pulmonary tuberculosis and initial misdiagnosis as pneumonia and lung cancer (p<0.0001, 0.001, 0.01, respectively). Elderly had a higher level of erythrocytic sedimentation rate (p=.01). Young had a higher frequency of positive sputum direct smear for acid fast bacilli (p=0.04). Elderly had a higher role for fiberoptic bronchoscope in diagnosis of pulmonary TB (p=0.001). There was a delay in the diagnosis of pulmonary TB in elderly (p<0.0001) patients. Anti-tuberculosis drug side effects and TB-related mortality were more frequent in elderly (p<0.0001, 0.03, respectively)patients. ConclusionThis study showed that elderly pulmonary TB patients had higher frequencies of atypically clinical, radiological presentations, co-morbidities, anti-tuberculosis drug adverse reactions and TB related mortality.

Stroke Subtypes and Comorbidity among Ischemic Stroke Patients in Brasilia and Cuenca: A Brazilian–Spanish Cross-cultural Study

With the increase in life expectancy worldwide, changes in stroke subtypes and burden of stroke population are expected in both developing and developed countries. Prevalence of stroke subtypes and comorbidity in ischemic stroke patients was assessed in Brasilia, Brazil, and Cuenca, Spain. This was an international (Brazilian-Spanish) cross-sectional study. Stroke subtypes were assessed by means of Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification. Modified Rankin scale was used to measure functional recovery and the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) was used to assess comorbidity. A total of 500 patients (mean age 66.2±16.4 years; 48% female; 48.2% Spanish) were included in the study. Spanish patients were significantly older than Brazilian ones (76.4±11.2 versus 56.7±14.6 years; P<.0001). Prevalence of ischemic cardiopathy (20.3% versus 6.2%) and atrial fibrillation (25.7% versus 6.6%) was significantly higher in Spanish stroke patients, whereas they less frequently used tobacco (28.3% versus 52.9%); P less than .0001. Prevalence of stroke subtypes in Spanish and Brazilian stroke patients was: stroke of undetermined etiology (58.1% versus 32.4%), cardioembolism (24.5% versus 11.6%), lacunar infarct (11.6% versus 25.5%), atherothrombotic (3.7% versus 19.7%), and other causes (2.1% versus 10.8%); P less than .0001. The Spanish sample had a significantly higher frequency of comorbidities. The CIRS-G total score and CIRS-G mean number of affected organs significantly increased with age, and correlated with the level of functional dependence as measured by Rankin scale (rS=0.50; P=.0005). Spanish stroke people had a higher frequency of comorbid conditions, atrial fibrillation, and cardioembolism and these facts were associated with age. Atherothrombotic and lacunar strokes were more common in the younger Brazilian stroke population.

Patient and Family Resources for Living With Myelodysplastic Syndromes

Primarily a disease affecting older adults, myelodysplastic syndromes (MDS) are a class of incurable myeloid malignancies with variable clinical presentation, treatment recommendations, and prognoses. Although effective communication between healthcare professionals and patients and their caregivers is a significant part of optimizing clinical outcomes, studies have shown that all three frequently have an incomplete understanding of MDS, its therapeutic options, and the fact that MDS is a malignancy. In addition, the advanced age of the patient population, high frequency of comorbidities, and variability of disease outcomes based on risk status require consistent communication across a wide number and type of healthcare providers as well as an individualized approach to patient and caregiver education. This article discusses these challenges and provides a number of resources designed to help educate healthcare professionals, patients, and caregivers.

Abstract 5514: Comorbidities are associated with breast cancer in African-American and Hispanic women

Abstract Objectives and Background: The presence of comorbidities, such as diabetes mellitus type II and hypertension may influence health outcomes from breast cancer. Women from underserved populations, particularly African-American and Hispanic women suffer from a disproportionate burden of comorbidities which may contribute to the health disparities observed in these women. The aims of the present study were to evaluate the distribution and association of comorbidities, specifically diabetes and hypertension, in African-American and Hispanic women and breast cancer. Furthermore, the present study investigated the consequence of comorbidity on survival in underserved women with breast cancer. Methods: A cross-sectional cohort of 428 African-American and Hispanic women from Los Angeles was assessed to determine the association between comorbidity and breast cancer. Clinical data were obtained by medical record abstraction. The results were assessed using logistic regression with multivariate analysis. Kaplan-Meier survival analysis was used to evaluate disease-free survival. Results: Our study identified a high frequency of comorbidity, especially hypertension and hypertension with diabetes in African-American women (38% and 14%, respectively) and Hispanic women (12% and 9%, respectively). Multivariate logistic regression analysis revealed a significant association between multiple comorbidity and breast cancer (odds ratio [OR] = 2.3; P=0.032). Furthermore, multiple comorbidity was significantly associated with obesity, especially in breast cancer patients (P &amp;lt; 0.05). There was also a trend towards significance for the association between multiple comorbidity and decreased five-year disease-free survival. Notably, the presence of comorbidity significantly modulated five-year disease-free survival based on breast cancer tumor subtype (P &amp;lt; 0.05). Implications and Next Steps: In sum, our study highlights a cohort of women who may be at a high risk for health inequalities due to the presence of comorbidity and should be considered for intervention. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 5514. doi:1538-7445.AM2012-5514

Drug Interaction in Psycho-Oncology: A Retrospective Glance over the Polymedication and Comorbidities in a Portuguese Psycho-Oncology Service

Introduction: The evaluation and prescription of psychotropic drugs in oncologic setting is of particular importance because of cancer patients susceptibility to drug interactions. Objectives: Describe the frequency and type of comorbidities and the standard prescription of pharmaceuticals in a sample of cancer patients. Secondarily, reflect on the importance of clinical pharmacological interactions in this context, particularly in the prescription of psychotropic drugs. Material/methods: Descriptive study of a sample of patients referred for the first time to the Psycho-Oncology Unit of IPOCFG, between October and December 2011. A retrospective collection of the socio-demographic and clinical variables was made by consulting the clinical processes. Results: From the sample of 60 patients included for analysis, 48,3% of the patients were on antineoplasic medication, 46,7% had prior psychiatric history and 70% were on psychotropic drugs; 75% presented other comorbidities. Only 8,3% of patients were free of medication and, from those under it, 63,6% consumed three or more distinct pharmacological classes. Conclusions: There is a high frequency of co-morbidities and co-prescription of several classes of drugs which pose cancer patients at risk of interactions. It is important that physicians are able to predict these phenomena to prevent the loss of efficiency and minimize the adverse effects, particularly of antineoplastic.

Sex Differences in Management and Mortality of Patients With ST-Elevation Myocardial Infarction (from the Korean Acute Myocardial Infarction National Registry)

There has been controversy over the disparity between men and women with regard to the management and prognosis of acute myocardial infarction. Analyzing nationwide multicenter prospective registries in Korea, the aim of this study was to determine whether female gender independently imposes a risk for mortality. Data from 14,253 patients who were hospitalized for ST-segment elevation myocardial infarction from November 2005 to September 2010 were extracted from registries. Compared to men, women were older (mean age 56 ± 12 vs 67 ± 10 years, p < 0.001), and female gender was associated with a higher frequency of co-morbidities, including hypertension, diabetes, and dyslipidemia. Women had longer pain-to-door time and more severe hemodynamic status than men. All-cause mortality rates were 13.6% in women and 7.0% in men at 1 year after the index admission (hazard ratio for women 2.01, 95% confidence interval 1.80 to 2.25, p < 0.001). The risk for death after ST-segment elevation myocardial infarction corresponded highly with age. Although the risk remained high after adjusting for age, further analyses adjusting for medical history, clinical performance, and hemodynamic status diminished the gender effect (hazard ratio 1.00, 95% confidence interval 0.86 to 1.17, p = 0.821). Propensity score matching, as a sensitivity analysis, corroborated the results. In conclusion, this study shows that women have a comparable risk for death after ST-segment elevation myocardial infarction as men. The gender effect was accounted for mostly by the women's older age, complex co-morbidities, and severe hemodynamic conditions at presentation.

Prolonged Survival in Patients with Lung Cancer with Diabetes Mellitus

Patients with lung cancer have a high frequency of comorbidity. Data on the impact of diabetes mellitus, the most frequent endocrine disorder, on the prognosis of lung cancer are conflicting. The aim was to investigate the impact of diabetes mellitus on survival in lung cancer. We analyzed data from a cohort, the Nord-Trøndelag Health Study (HUNT study) linked to the Norwegian Cancer Registry and controlled the results using two lung cancer studies, the Pemetrexed Gemcitabine study and the Norwegian Lung Cancer Biobank. Survival in lung cancer with and without diabetes mellitus was compared using the Kaplan-Meier method and Cox regression model for each study and the studies combined. One thousand six hundred seventy-seven cases of lung cancer were included, 1031 from HUNT study, 436 from the Pemetrexed Gemcitabine study, and 210 from the Norwegian Lung Cancer Biobank registry, and among these 77 patients had diabetes mellitus. In the combined analysis, patients with lung cancer with diabetes mellitus had increased survival compared with those without (p = 0.005). The 1-, 2-, and 3-year survival in patients with lung cancer with and without diabetes mellitus were 43% versus 28%, 19% versus 11%, and 3% versus 1%, respectively. Adjusting for age, gender, histology, and stage of disease in the Cox regression model, the hazard ratio for survival in patients with lung cancer with diabetes mellitus was 0.55 (95% CI, 0.41-0.75) as compared with without. Patients with lung cancer with diabetes mellitus have an increased survival compared with those without diabetes mellitus.

In‐hospital Delay Increases the Risk of Perforation in Adults with Appendicitis

The influence of in-hospital delay (time between admission and operation) on outcome after appendectomy is controversial. A total of 1,827 adult patients underwent open or laparoscopic appendectomy for suspected appendicitis in eleven Swiss hospitals between 2003 and 2006. Of these, 1,675 patients with confirmed appendicitis were included in the study. Groups were defined according in-hospital delay (≤12 vs. >12 h). Delay>12 h was associated with a significantly higher frequency of perforated appendicitis (29.7 vs. 22.7%; P=0.010) whereas a delay of 6 or 9 h was not. Size of institution, time of admission, and surgical technique (laparoscopic vs. open) were independent factors influencing in-hospital delay. Admission during regular hours was associated with higher age, higher frequency of co-morbidity, and higher perforation rate compared to admission after hours. The logistic regression identified four independent factors associated with an increased perforation rate: age (≤65 years vs. >65 years, odds ratio (OR) 4.5, P<0.001); co-morbidity (Charlson index>0 vs. Charlson index=0, OR 2.3, P<0.001); time of admission (after hours vs. regular hours, OR 0.8, P=0.040), in-hospital delay (>12 vs. ≤12 h, OR 1.5, P=0.005). Perforation was associated with an increased reintervention rate (13.4 vs. 1.6%; P<0.001) and longer length of hospital stay (9.5 vs. 4.4 days; P<0.001). In-hospital delay negatively influences outcome after appendectomy. In-hospital delay of more than 12 h, age over 65 years, time of admission during regular hours, and the presence of co-morbidity are all independent risk factors for perforation. Perforation was associated with a higher reintervention rate and increased length of hospital stay.

Epidemiology of valvular heart disease in the adult

Valvular heart disease remains common in industrialized countries, because the decrease in prevalence of rheumatic heart diseases has been accompanied by an increase in that of degenerative valve diseases. Aortic stenosis and mitral regurgitation are the two most common types of valvular disease in Europe. The prevalence of valvular disease increases sharply with age, owing to the predominance of degenerative etiologies. The burden of heart valve disease in the elderly has an important impact on patient management, given the high frequency of comorbidity and the increased risk associated with intervention in this age group. Endocarditis is an important etiology of valvular disease and is most commonly caused by Staphylococci. Rheumatic heart disease remains prevalent in developing countries.

Anorexia, fatigue, and plasma interleukin-6 levels in chronic hemodialysis patients

This study aimed at evaluating the possible relationship between anorexia and fatigue in hemodialysis (HD) patients and at measuring the plasma levels of interleukin-6 (IL-6) and C-reactive protein (CRP) in HD patients with or without anorexia and/or fatigue. The first question of the Hemodialysis Study Appetite questionnaire was used to assess the appetite of the HD patients and the vitality scale of the SF-36 to assess fatigue. The Charlson Comorbidity Index was assessed in each patient. Seventy-six HD patients were studied. Forty-four were males and 32 females. Thirty-two were classified as not-anorexic and not-fatigued, 12 as not-anorexic but fatigued, 6 as anorexic and not-fatigued, and 26 as anorexic and fatigued. Plasma IL-6 levels (pg/mL) were significantly higher in anorexic and fatigued patients (10.9 ± 11.9) than in not-anorexic and not-fatigued (1.6 ± 0.6) (p < 0.001) and in anorexic but not-fatigued patients (1.8 ± 1.7) (p < 0.01). With respect to not-anorexic but fatigued patients (3.1 ± 1.5), the difference was not statistically significant (p = 0.058). The plasma CRP levels (mg/dL) also were significantly higher in anorexic and fatigued patients (9.2 ± 6.3) than in not-anorexic and not-fatigued patients (4.1 ± 4.5), in anorexic but not-fatigued patients (2.5 ± 1.6), and in not-anorexic but fatigued patients (4.1 ± 4.4) (p = 0.001). The presence of both anorexia and fatigue in chronic HD patients is associated with significantly higher levels of plasma IL-6 and CRP and a higher frequency of comorbidities.

Effect of statins on outcomes in immunosuppressed patients with bloodstream infection

Although it has been suggested that statins have a beneficial effect on the outcome of bloodstream infection (BSI) in immunosuppressed patients, prospective studies testing this hypothesis are lacking. We performed an observational analysis of consecutive cancer patients and transplant recipients hospitalized at two tertiary hospitals in Spain (2006-2009). The first episode of BSI occurring in statin users was compared with those occurring in non-statin users. During the study period, 668 consecutive episodes of BSI in 476 immunosuppressed patients were recorded. Underlying diseases were solid tumor (46.2%), hematologic malignancy (35.1%), and transplantation (18.7%). Fifty-nine (12.4%) patients were receiving statins at the onset of BSI. Comparing with statin non-users, patients on statin treatment were older (67.3 vs. 58.7 years; p < 0.001) and had higher frequency of comorbidities (74.6% vs. 40.6%; p < 0.001). There were no significant differences in intensive care unit admission (6.8% vs. 7.7%; p = 1) and overall mortality (15.3% vs. 24%; p = 0.13) between groups. In a multivariate analysis, prior statin use was not associated with increased survival (odds ratio [OR], 0.52; 95% confidence interval [CI], 0.22-1.23; p = 0.14). In conclusion, prior statin use is not associated with increased survival in immunosuppressed patients with BSI. Caution is warranted in attributing beneficial effects to statin use in infections among immunocompromised patients.

Prevalence, characteristics and comorbidities of anxiety disorders in France: Results from the “Mental Health in General Population” Survey (MHGP)

Purpose Only a few European countries have carried out large, community-based, national surveys about psychiatric morbidity. Here is presented the first national French survey, aiming to estimate the prevalence of anxiety disorders and associated comorbidities according to sociodemographic characteristics. Materials and methods The Mental Health in General Population (MHGP) database is derived from a representative national survey of the French adult population ( n = 36,105), conducted between 1999 and 2003. Data collection was done using an anonymous face-to-face interview. The presence of anxiety disorders (generalized anxiety disorder, panic disorder, agoraphobia, social phobia and post-traumatic stress disorder) was assessed using the Mini International Neuropsychiatric Interview. Results The overall prevalence of anxiety disorders was estimated to be 21.6%, generalized anxiety disorder being the most prevalent one (12.8%). Women, young people, and people earning low income were identified as the more at risk. Major depressive episode, alcohol abuse and drug addiction frequently co-occur with anxiety disorders (28.3, 4.4 and 2.8% respectively). Conclusion The MHGP study showed that anxiety disorders are highly prevalent in France with a high frequency of comorbidities. Our results highlight the need for considering anxiety disorders as a public health priority in France as well as in other European countries.

Postoperative complications in patients with obstructive sleep apnea: a retrospective matched cohort study

Obstructive sleep apnea (OSA) is presumed to be a risk factor for postoperative morbidity and mortality, but the current evidence is incomplete. This retrospective matched cohort study tested the hypothesis that OSA is a risk factor for the development of postoperative complications. Hospital ethics approval was obtained for the conduct of this study. The patients who were selected for the study were >18 yr of age, diagnosed preoperatively with OSA, and scheduled to undergo elective surgery. A cohort of surgical patients without OSA was used as a comparator group based on a one-to-one match. Matching criteria included gender, age difference <5 yr, type of surgery, and a <5 yr difference between two surgery dates. Summary data are presented and conditional logistic regression was used to identify risk factors for postoperative complications. The 240 pairs of study subjects aged 57 +/- 13 yr included 184 (77%) males and 56 (23%) females. The OSA patients had a higher mean body mass index relative to their non-OSA counterparts (35 +/- 9 vs 28 +/- 6 kg . m-2, respectively) and a higher frequency of co-morbidities, including hypertension (48% vs 36%, respectively) and obesity (61% vs 23%, respectively). Also, the incidence of postoperative complications in the OSA patients was significantly greater (44% OSA group vs 28% non-OSA group; P < 0.05). The most commonly observed between-group difference was oxygen desaturation < 90% (17% OSA group vs 8% non-OSA group). The OSA patients who did not use home continuous positive airway pressure (CPAP) devices prior to surgery but required the use of a CPAP device after surgery had the highest rate of complications. Conditional logistic regression was used to diagnose OSA and pre-existing stroke as significant risk factors for developing postoperative complications. The hazard ratio for OSA was 2.0 (1.25-3.19). Patients with diagnosed OSA have an increased incidence of postoperative complications, the most frequent being oxygen desaturation.

Emergencies in valve disease

This review will deal with strategies for emergency management of patients with valve disease, a situation that is now rare but remains a very challenging problem: valvular patients are often elderly with a high frequency of comorbidity; furthermore, there is a growing proportion of previously operated patients who present with further problems. The main treatment is valve replacement, however, the conservative surgical approach is developing, and, more recently, percutaneous interventional techniques have been introduced. Percutaneous mitral commissurotomy is an established treatment for mitral stenosis whereas transcatheter aortic valve implantation, which is presently at the evaluation phase, shows promise. The keys to success are establishing a rapid diagnosis based mainly on echocardiography followed by early intervention. Every effort should be made to avoid performing intervention in an emergency setting, as it is always of high risk. Strategies include better patient and physician education in order to decrease the incidence of endocarditis and prosthetic-related complications such as thromboembolism and considering earlier intervention when symptoms or objective signs of ventricular dysfunction are observed in patients with known valve disease.