High Levels Of Comorbidity Research Articles

Etiological structure, clinical and epidemiological characteristics of bloodstream infections caused by resistant microorganisms among COVID-19 patients

Infectious diseases caused by resistant pathogens are a serious public health problem. Generalized forms of resistant infections involving the vascular system in the pathological process are often associated with the irrational use of antimicrobial drugs. The pandemic of a new coronavirus infection (COVID-19) was a significant factor that determined further negative trends in the development of antibiotic resistance. The aim of the study was to investigate the spectrum of microorganisms and analyze clinical and epidemiological data in patients with COVID-19 and bloodstream infections caused by resistant bacterial pathogens in the first 10 months of the pandemic. It has been shown that resistant gram-negative microorganisms are the leading etiological cause of bloodstream infections among hospitalized patients. A. baumannii, as a mono-etiological agent or as part of microbial associations, is the predominant causative pathogen of generalized infections in COVID-19 patients. A high level of comorbidity according to the Charlson index and previous courses of antibiotic therapy can be regarded as potential out-hospital predictors of contamination by resistant pathogens. The severe course of the COVID-19 including of the phenomenon of immunosuppression and the occurrence of sepsis determine the high level of hospital mortality. The addition of generalized infections is an extremely unfavorable factor that worsens the prognosis for recovery.

Non-Alcoholic Steatohepatitis Patient Characterization and Real-World Management Approaches in Italy.

Although the estimated prevalence of non-alcoholic steatohepatitis (NASH) in Italy is 4-6%, little is known about patient characteristics and care pathways. To describe patient characteristics and management approaches for patients with NASH or suspected NASH in Italy. Data were drawn from the Adelphi Real World NASH Disease Specific Programme™, a cross-sectional survey of endocrinologists and gastroenterologists in Italy from January to March 2018. Physicians completed questionnaires for their next five consecutively consulting patients with NASH or suspected NASH. Analyses were descriptive. Seventy-six physicians provided data on 380 patients. The mean age was 58.5 ± 11.1 years and the mean body mass index was 31.8 ± 5.5 kg/m2. A total of 231 patients (61%) had no/non-advanced fibrosis as evaluated by liver biopsy or non-invasive tests. Common diagnostic assessments were cholesterol, hemoglobin A1c, absence of viral hepatitis, and alcohol assessment. At diagnosis, 87% (n=322/372) and 45% (n=169/372) of patients received an ultrasound and liver biopsy, respectively. Overall, 88% of patients were referred from primary to secondary care. Obesity (81%) and type 2 diabetes (62%) were the most commonly recorded comorbidities, with 70% of patients having ≥3 comorbidities. Vitamin E (13%) and GLP-1 receptor agonists (13%) were the most prescribed guideline-recommended treatments for all patients. Patients with NASH in Italy had high levels of obesity and comorbidities, while diagnosis and treatment frequently were not according to guidelines. Our data show an unmet need for more targeted diagnosis and treatment in Italian patients with NASH, in order to optimize outcomes.

ЭПИДЕМИОЛОГИЧЕСКИЕ АСПЕКТЫ НАРУШЕНИЙ МЕНТАЛЬНОГО ЗДОРОВЬЯ – ОТ ПРЕДИКТОРОВ К СЛЕДСТВИЮ

Introduction. Due to the high social significance of mental health disorders, the study of the spread and degree of influence of modifiable predictors of depressive psychoemotional status can contribute to the development of new approaches to active prevention. The purpose of the study. To study the epidemiological characteristics of mental health disorders and identify key predictors among students. Methods. To conduct the study, epidemiological diagnostic methods were used, such as: retrospective epidemiological analysis, descriptive and evaluative methods, as well as statistical methods, methods of epidemiological diagnostics using methods of clinical epidemiology and statistical analysis were used. Results. There was a moderate long-term epidemic trend towards an increase in the incidence of mental disorders (an increase rate of 3.68%) and a high long-term average (164.44+1.72о/оооо). The risk area is determined on the basis of the characteristic pronounced tendency to growth and an increased level of relative epidemiological risk: Minsk region, Minsk, Vitebsk and Mogilev regions (Tpr = 6.56%, 9.99%, 15.21%, and 15.57%, respectively. Consequently, the risks were: in Minsk – 0.77, in Vitebsk and Mogilev regions – 0.78 and 0.86, respectively). The result of our own original research was the identification of a depressive state in 59.25% of cases and generalized anxiety disorder – in 64.1% of cases. An aggravating circumstance is the fact of comorbidity in more than 80% of cases. When studying the epidemiological characteristics of these disorders, significant predictors were identified that increased the chance of developing a state by 2.5-11.5 times. Conclusion. The high levels of prevalence and comorbidity of depressive psychoemotional status and anxiety disorder characterize the general epidemiological situation within the mental health of students as unfavorable and require the development of preventive measures.

COMORBIDITY OF PATIENTS WITH COVID-19 (PATHOLOGICAL STUDIES)

Concomitant diseases increase the risk of hospitalization and poor prognosis in COVID-19 patients. However, in most studies devoted to prognostic value of comorbidity, only clinical manifestations were analyzed, which could lead to both under- and overdiagnosis of concomitant diseases and complications.
 The purpose of the study is to clarify the structure and prevalence of somatic diseases in patients who died in hospital from COVID-19, as well as the correlation of comorbidity with the development of vascular complications.
 Materials and Methods. A retrospective study examined the medical records of 322 patients (195 women and 127 men, mean age 71.5±12.2) with confirmed fatal COVID-19 and a post-mortem examination. Charlson comorbidity index was used to assess comorbidity. 
 Results. A high incidence of cardiovascular pathology was revealed (96%). During hospitalization, 31 patients developed acute myocardial infarction, including 9 patients with reinfarction and 14 people with previous episodes of angina pectoris. In 10 patients without previous coronary heart disease, obliterating atherosclerosis of the coronary artery was detected. Twenty-three patients developed acute cerebrovascular accident; all of them suffered from arterial hypertension. Atrial fibrillation was observed in 9 patients. Pulmonary embolism was diagnosed in 139 patients, including 17 patients with phlebothrombosis in the lower extremities.
 Conclusion. Severe fatal COVID-19 is more often observed in elderly people with a high comorbidity level, and the complications depend on the comorbidity profile.

MODERN CHONDROPROTECTORS IN THE THERAPY OF OSTEOARTHRITIS

Introduction. Osteoarthritis is a chronic progressive degenerative disease of the entire joint that affects the articular cartilage, subchondral bone, ligaments, capsule and synovial membrane. Osteoarthritis was previously considered as a mechanical wear-and-tear disease causing degeneration of cartilage, but at present it is clear that the relationship between various joint structures and local inflammation is a central aspect of the underlying pathophysiology. Over the past 20 years, significant progress has been made in osteoarthritis research; however, many questions remain unanswered due to the complexity of the pathophysiology of osteoarthritis. Osteoarthritis is a condition characterized by a high level of comorbidity, primarily due to advanced age being the most influential factor among all the risk factors associated with its development. Additionally, research indicates that individuals with osteoarthritis face a significantly elevated risk of developing comorbid conditions compared to those without this disease.
 Objectives. This study aims at summarizing the most promising therapeutic approaches using chondroprotectors (chondroitin sulfate, Alflutop) in the treatment of patients with osteoarthritis and comorbid pathologies based on the latest pharmacological achievements in the therapy of osteoarthritis.
 Materials and methods. The study was conducted at the Rheumatology Center of M.V. Sklifosovsky Poltava Regional Hospital. 150 patients with osteoarthritis in the period of exacerbation aged 41-73 were examined and received therapy. Among them there were 97 (64.67%) women and 53 (35.33%) men having comorbid diseases (arterial hypertension, coronary heart disease, diseases of the digestive, respiratory, endocrine, genitourinary systems). Radiologically, all patients showed II-III stages of joint lesions according to the Kellgren-Lawrence classification. The history of osteoarthritis lasted 5-19 years. Verification of the clinical diagnosis of osteoarthritis was carried out according to the recommendations of EULAR (2018) based on the findings of clinical, laboratory and instrumental studies. Clinical diagnoses of comorbid conditions were established in accordance with the relevant orders of the Ministry of Health of Ukraine and confirmed by specialists. The patients received standard therapy: non-steroidal anti-inflammatory drugs, chondroprotectors (chondroitin sulfate or Alflutop), gastroprotectors, local treatment according to the order of the Ministry of Health of Ukraine No. 676 dated 12.10.2006, Specialty "Rheumatology". If necessary, additional medications for the treatment of comorbid pathologies (hypotensive, anti-ischemic, anti-diabetic, hypolipidemic) were prescribed according to the recommendations of specialists.
 Prior to beginning the treatment course and following the examination of patients to establish a clinical diagnosis of osteoarthritis, we conducted a thorough assessment to rule out thrombophlebitis. This involved a coagulogram, an ultrasound examination of the lower extremity vessels, and consultation with a vascular surgeon when necessary. In cases where thrombophlebitis of the lower extremities was clinically diagnosed, patients were prescribed Alflutop in a dose of 1.0 ml intramuscularly once a day for 20 days as a chondroprotective agent. For patients without signs of lower extremity thrombophlebitis, chondroitin sulfate was administered in a dose of 2.0 ml intramuscularly once a day for 20 days. The administration of these chondroprotective agents followed a schedule of once every 6 months for the patients.
 Results. The literature regarding the complete understanding of the treatment of patients with osteoarthritis with comorbid pathology enabled us to elaborate a targeted effective therapy taking into account the appointment of the appropriate chondroprotector based on the anamnesis of the disease and the comorbid condition. This therapeutic approach contributed to prolonging the remission of the underlying disease and comorbid pathology, reducing the frequency of hospitalization and shortening the inpatient treatment by 2-3 days.
 Conclusions. The proposed approach in the treatment of patients with osteoarthritis and comorbid pathology, features of the appointment of chondroprotectors with a high prognostic value in prolonging the remission of osteoarthritis and related diseases will improve their practical application.

Risk of readmission and death after hospitalization for worsening heart failure: Role of post-discharge follow-up visits in a real-world study from the Grand Est Region of France.

Patients who experience hospitalizations due to heart failure (HF) face a significant risk of readmission and mortality. Our objective was to evaluate whether the risk of hospitalization and mortality following discharge from HF hospitalization differed based on adherence to the outpatient follow-up (FU) protocol comprising an appointment with a general practitioner (GP) within 15 days, a cardiologist within 2 months or both (termed combined FU). We studied all adults admitted for a first HF hospitalization from 2016 to 2020 in France's Grand Est region. Association between adherence to outpatient FU and outcomes were assessed with time-dependent survival analysis model. Among 67 476 admitted patients (mean age 80.3 ± 11.3 years, 53% women), 62 156 patients (92.2%) were discharged alive and followed for 723 (317-1276) days. Combined FU within 2 months was used in 21.1% of patients, with lower rates among >85 years, women, and those with higher comorbidity levels (p < 0.0001 for all). Combined FU was associated with a lower 1-year death or rehospitalization (adjusted hazard ratio [HR] 0.91, 95% confidence interval [CI] 0.88-0.94, p < 0.0001) mostly related to lower mortality (adjusted HR 0.65, 95% CI 0.62-0.68, p < 0.0001) whereas HF readmission was higher (adjusted HR 1.19, 95% CI 1.15-1.24, p < 0.0001). When analysing components of combined FU separately, 1-year mortality was more related to cardiologist FU (HR 0.65, 95% CI 0.62-0.67, p < 0.0001), than GP FU (HR 0.87, 95% CI 0.85-0.90, p < 0.0001). Combined FU is carried out in a minority of patients following HF hospitalization, yet it is linked to a substantial reduction in 1-year mortality, albeit at the expense of an increase in HF hospitalizations.

Impact of the Exercise Right for Active Ageing program on physical function in older adults: a quasi-experimental pre-post study

BackgroundThe Exercise Right for Active Ageing (ERAA) program was established to improve access to exercise classes for community-dwelling older Australians. The aims of this study were to determine whether older adults, who participated in ERAA exercise classes experienced a change in physical function, and identify factors associated with this change.MethodsParticipants included community-dwelling older adults, aged ≥ 65 years, from every state and territory of Australia. The ERAA program included 12 subsidised, weekly, low- to moderate-intensity exercise classes, delivered by accredited exercise scientists or physiologists (AESs/AEPs). Primary outcomes included the 30 s Sit-to-Stand (STS) and the 3-metre Timed Up and Go (TUG) tests. Secondary outcomes included grip strength, the Chair Sit and Reach test, and waist circumference. Linear mixed-effects regression models were used to evaluate the change in outcomes following program completion, and to determine factors associated with changes in the primary outcomes.Results3,582 older adults (77% female) with a median (IQR) age of 72 (69–77) years completed follow-up testing. For all primary and secondary outcomes, there was a statistically significant improvement after program completion (p < 0.001). The STS increased by 2.2 repetitions (95% CI: 2.1, 2.3), the TUG decreased by 0.9 s (95% CI: -1.0, -0.8), right and left grip strength increased by 1.3 kg (95% CI: 1.2, 1.5) and 1.5 kg (95% CI: 1.3, 1.6), respectively, right and left reach increased by 1.7 cm (95% CI: 1.4, 2.0), and waist circumference decreased by 1.2 cm (95% CI: -1.4, -1.1). Greater improvements in STS were observed for participants aged 65–69 years, females, and those with greater socio-economic disadvantage. For the TUG, greater improvements were observed in participants reporting 2 + comorbidities, and residing in outer regional areas and areas with greater socio-economic disadvantage.ConclusionsParticipation of older Australians in the ERAA program, led to statistically significant improvements in physical function. The program reached a large number of older Australians from every state and territory, including those from regional and remote parts of Australia, aged over 85 years, and with high levels of comorbidity, which supports the feasibility and acceptability of AES- and AEP-led exercise classes amongst community-dwelling older Australians.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN12623000483651). Registered 12 May 2023 - Retrospectively registered, https://www.anzctr.org.au/ACTRN12623000483651.aspx.

Resource utilisation and outcomes of people with heart failure in England: a descriptive analysis of linked primary and secondary care data – the PULSE study

BackgroundHeart failure (HF) is associated with high levels of resource use and mortality, but prior UK studies have not compared outcomes by HF subtype (HF with reduced ejection fraction (HFrEF)...

Real-World Treatment Patterns Among Patients with Myelodysplastic Syndromes Initiating Oral Decitabine and Cedazuridine or Intravenous/Subcutaneous Hypomethylating Agents

Introduction: Hypomethylating agents (HMAs) are recommended standard of care for patients with higher-risk myelodysplastic syndromes (HR-MDS). HMA therapies include intravenous (IV) or subcutaneous (SC) decitabine and azacitidine; however, parenteral administration of HMAs has been associated with increased patient burden. The oral HMA decitabine and cedazuridine (DEC-C) was FDA-approved in July 2020 for the treatment of MDS, and offers an alternative to IV/SC HMAs, with similar pharmacokinetic exposure and response rates compared to IV decitabine. This study examined treatment patterns among patients with MDS receiving oral DEC-C compared with IV/SC HMAs in real-world clinical practice. Methods: This was a retrospective analysis using the US Cerner Enviza claims database; medical and prescription claims data for patients were linked to mortality data from Datavant. Adults aged ≥18 years, who were diagnosed with MDS (ICD-10-CM code D46.x; all risk levels), and who had initiated a HMA (≥1 claim; August 1, 2020─August 31, 2022) were included; index date was defined as the first pharmacy or medical claim for DEC-C or IV/SC HMAs, respectively. Patients had variable follow-up after index and were followed until end of enrollment, death, or end of study. Propensity score matching (PSM; 1:1) was performed to balance for confounding factors (age, sex, acute myeloid leukemia [AML] diagnosis, Charlson Comorbidity Index [CCI] score, and red blood cell [RBC] transfusion); adjusted bivariate analysis was used to compare outcomes between treatment groups. Longitudinal persistence was assessed according to the number of cycles of therapy received during follow-up, where a cycle was defined as either 3-10 days of administration of index IV/SC HMA or 1 claim for oral DEC-C, within a 28-day cycle. Results: Of 1569 patients included, 160 (10.2%) received DEC-C and 1409 (89.8%) received IV/SC HMAs. In the DEC-C cohort, median age was 72.5 years and 66.9% were male; in the IV/SC cohort, median age was 69.0 years and 58.2% were male. Two-thirds of patients newly initiated HMAs during the study period (69.4% for DEC-C and 72.2% for IV/SC HMAs); 30.6% of the DEC-C cohort had switched from prior IV/SC HMA treatment. Both groups had high levels of comorbidity; 55.6% of patients in the DEC-C cohort and 58.4% in the IV/SC HMA cohort had CCI scores of ≥3, and 14.4% and 23.8%, respectively, had an AML diagnosis. During the 6-month pre-index period, half (55.3%) of patients in both groups received RBC transfusions, and one quarter (25.9%) received platelet transfusions. After matching, there were 158 patients in each treatment cohort and all covariates included in the PSM were balanced (standardized mean difference &amp;lt;0.2). Median age was 72.0 years and 74.0 years for the DEC-C and IV/SC HMAs matched cohorts, respectively, and 66.5% and 69.6%, respectively, were male. Mean CCI scores were 3.45 for DEC-C and 3.15 for IV/SC HMA groups and 14.6% and 15.8%, respectively, had an AML diagnosis pre index. Longitudinal persistence was comparable between the matched DEC-C and IV/SC cohorts during the first 6 months post-index, with similar proportions receiving the maximum number of treatment cycles (based on a 28-day cycle) at each month following index (73.8% vs 71.1%, 46.5% vs 48.7%, 28.6% vs 24.8%, for 2, 4, 6 months, respectively; Figure). However, a trend towards improved persistence with DEC-C versus IV/SC HMAs was observed in patients receiving treatment beyond 6 months (25.0% vs 17.0%, 18.5% vs 9.0%, 11.4% vs 7.6%, for 8, 10, 12 months, respectively). Mean time to discontinuation of treatment was also numerically higher for DEC-C compared with the IV/SC HMA group (87.7 vs 82.0 days); however, differences were not statistically significant. Conclusions: This study, which is to our knowledge the largest real-world report of oral DEC-C use to date, reveals similar but high levels of disease burden and comorbidities among patients with MDS receiving oral DEC-C and parenteral HMA therapy. Trends in treatment patterns suggest comparable persistence with oral DEC-C and IV/SC HMAs at early stages of therapy and improved persistence with oral DEC-C beyond 6 months. These data support the consideration of oral DEC-C as an alternative to chronic parenteral HMA therapy, with the potential for oral DEC-C to reduce the treatment burden associated with administration of IV/SC HMAs.

Benefits and Harms of Mammography Screening in 75 + Women to Inform Shared Decision-making: a Simulation Modeling Study.

Guidelines recommend shared decision-making (SDM) around mammography screening for women ≥ 75years old. To use microsimulation modeling to estimate the lifetime benefits and harms of screening women aged 75, 80, and 85years based on their individual risk factors (family history, breast density, prior biopsy) and comorbidity level to support SDM in clinical practice. We adapted two established Cancer Intervention and Surveillance Modeling Network (CISNET) models to evaluate the remaining lifetime benefits and harms of screening U.S. women born in 1940, at decision ages 75, 80, and 85years considering their individual risk factors and comorbidity levels. Results were summarized for average- and higher-risk women (defined as having breast cancer family history, heterogeneously dense breasts, and no prior biopsy, 5% of the population). Remaining lifetime breast cancers detected, deaths (breast cancer/other causes), false positives, and overdiagnoses for average- and higher-risk women by age and comorbidity level for screening (one or five screens) vs. no screening per 1000 women. Compared to stopping, one additional screen at 75years old resulted in six and eight more breast cancers detected (10% overdiagnoses), one and two fewer breast cancer deaths, and 52 and 59 false positives per 1000 average- and higher-risk women without comorbidities, respectively. Five additional screens over 10years led to 23 and 31 additional breast cancer cases (29-31% overdiagnoses), four and 15 breast cancer deaths avoided, and 238 and 268 false positives per 1000 average- and higher-risk screened women without comorbidities, respectively. Screening women at older ages (80 and 85years old) and high comorbidity levels led to fewer breast cancer deaths and a higher percentage of overdiagnoses. Simulation models show that continuing screening in women ≥ 75 years old results in fewer breast cancer deaths but more false positive tests and overdiagnoses. Together, clinicians and 75 + women may use model output to weigh the benefits and harms of continued screening.

39 Co-Occurring Depression and Anxiety is Associated with Greater Cognitive Variability in Persons with Multiple Sclerosis

Objective:Research examining co-occurring anxiety and depression in persons with multiple sclerosis (PwMS) is scarce, though an estimated 20% of PwMS experience clinically significant anxiety and depression (Gascoyne et al., 2019). Recent work by Hanna &amp; Strober (2020) found that PwMS with comorbid anxiety and depression reported worse outcomes in all constructs of symptomatology, disease management, psychological well-being, and quality of life. However, it is unclear how co-occurring anxiety and depression symptoms may influence or exacerbate cognitive difficulties in PwMS. Further, considering there are high levels of comorbidity between depression, anxiety, and fatigue in PwMS, this study aims to examine the unique variances of depression, anxiety, co-occurring depression and anxiety, and fatigue on cognitive functioning.Participants and Methods:86 PwMS (F=65,M=21) completed a comprehensive neuropsychological battery that included self-report measures of anxiety, depression, and fatigue. An intraindividual variability (IIV) composite score was calculated by combining standardized intraindividual standard deviation and maximum discrepancy scores on measures of attention/processing speed and memory for each participant. Lower scores indicate worse performance (i.e., greater variability). A hierarchical regression was conducted with IIV as the outcome variable and with depression, anxiety, cognitive fatigue, physical fatigue, and the interaction between depression and anxiety as predictors. Expanded Disability Status Scale (EDSS) scores were included as a covariate.Results:The only model that included a statistically significant predictor of IIV was the final model, which included EDSS, depression, anxiety, cognitive fatigue, physical fatigue, and the interaction between depression and anxiety, F(6,77)=2.97, p=.01, AR2=.08. While the main effects of depression and anxiety were not significant, the interaction between depression and anxiety was significant, F(6,77)=7.20, p=.01, n2=.09. Simple effects tests revealed that the relationship between IIV and anxiety was marginally significant for those at the cutoff for clinical depression (square root BDI-FS=2; BDI-FS=4), F(6,77)=3.52, p=.07, n2=.04. However, the effect of anxiety on IIV increased as depression increased. For example, in those with high levels of depression (1.5 SD above the mean), there was a significant relationship between anxiety and IIV, F(6,77)=4.16, p=.04, n2=.05, though this was not the case for those with low levels of depression (1.5 SD below the mean), F(6,77)=0.01, p=.92, n2=.00.Conclusions:The interaction between depression and anxiety predicted variability in performance such that those with high levels of depression and anxiety demonstrated significantly greater IIV. Since dispersion is considered a marker for neurocognitive integrity, this may suggest that co-occurring psychological disturbances are associated with poorer cognitive integrity, an important consideration for interventions and outcomes. While interventions aimed at treating co-occurring depression and anxiety have been largely overlooked within the MS literature (Butler et al., 2016), transdiagnostic interventions have been beneficial for general adult populations with co-occurring anxiety and depression (McEvoy et al., 2009). Future work should examine the efficacy of interventions aimed at addressing co-occurring depression and anxiety in PwMS, as this may help to improve cognitive functioning, as well as perception of functioning, which will likely further improve quality of life and overall well-being.

Relationship of comorbidity and platelet function in patients with unstable angina

Background. Platelets play a key role in the pathogenesis of acute coronary syndrome (ACS). In recent years, the amount of data on the advisability of using the platelet function test (PFT) in the appointment of antithrombotic therapy has been growing.Objective. To access PFT in patients with unstable angina and various comorbidities.Design and methods. The study involved 74 patients with the diagnosis of unstable angina. All patients underwent standard clinical examination, PFT (impedance aggregometry with ADP and collagen), assessment of Charlson comorbidity index.Results. The most frequent comorbidities were: hypertension (95 %), type 2 diabetes mellitus (30 %), excessive body weight (35 %), multifocal atherosclerosis (22 %), smoking (24 %). Half of the patients (n = 36) had high level of comorbidity. Patients with a comorbidity index of 5 or more had high platelet aggregation on the 3rd day of hospitalization. Elderly patients, smokers, as well as patients with diabetes mellitus type 2 and multifocal atherosclerosis also had higher values of platelet activity, which may be associated with unfavorable prognosis and risk of recurrent events.Conclusion. We revealed association between PFT and comorbidities both with risk factors or diseases alone and in its integral assessment using the Charlson comorbidity index. Among the individual risk factors, smoking, diabetes mellitus and multifocal atherosclerosis were the most important, which confirms their direct role in the pathogenesis of thrombotic complications.

Early Mortality in Paroxysmal Nocturnal Hemoglobinuria.

The elevated mortality risk among patients with paroxysmal nocturnal hemoglobinuria (PNH) has been suggested to derive from a high risk of thromboembolism (TE); however, the risks of coexisting cardiovascular risk factors are not well described. We studied mortality associated with PNH taking comorbidity and treatment into account. Patients with PNH (n=115) were identified in the1977-2016 Danish National Patient Register (DNPR). For each patient with PNH, we identified 50 age- and sex-matched general population comparators. Using the Kaplan-Meier estimator and Cox regression, we compared the overall survival of patients with comparators. Cumulative incidences were used to analyze the effects of comorbidity and the causes of death. One-year survival among patients and comparators was 92.2% and 99.4%, and after 10 years, it was 68.4% and 85.8%, respectively. Early mortality was associated with older age, higher levels of comorbidity, and solid malignancies prior to PNH diagnosis. The leading causes of death were infections and associated hematological diseases. Patients with early mortality were less likely to have received treatment with eculizumab and/or warfarin. Cardiovascular risk factors were evenly distributed between patients and comparators at diagnosis. We conclude that early mortality in PNH is associated with older age, cardiovascular comorbidity, and hematological malignancies.

Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management.

Populations with common physical diseases - such as cardiovascular diseases, cancer and neurodegenerative disorders - experience substantially higher rates of major depressive disorder (MDD) than the general population. On the other hand, people living with MDD have a greater risk for many physical diseases. This high level of comorbidity is associated with worse outcomes, reduced adherence to treatment, increased mortality, and greater health care utilization and costs. Comorbidity can also result in a range of clinical challenges, such as a more complicated therapeutic alliance, issues pertaining to adaptive health behaviors, drug-drug interactions and adverse events induced by medications used for physical and mental disorders. Potential explanations for the high prevalence of the above comorbidity involve shared genetic and biological pathways. These latter include inflammation, the gut microbiome, mitochondrial function and energy metabolism, hypothalamic-pituitary-adrenal axis dysregulation, and brain structure and function. Furthermore, MDD and physical diseases have in common several antecedents related to social factors (e.g., socioeconomic status), lifestyle variables (e.g., physical activity, diet, sleep), and stressful live events (e.g., childhood trauma). Pharmacotherapies and psychotherapies are effective treatments for comorbid MDD, and the introduction of lifestyle interventions as well as collaborative care models and digital technologies provide promising strategies for improving management. This paper aims to provide a detailed overview of the epidemiology of the comorbidity of MDD and specific physical diseases, including prevalence and bidirectional risk; of shared biological pathways potentially implicated in the pathogenesis of MDD and common physical diseases; of socio-environmental factors that serve as both shared risk and protective factors; and of management of MDD and physical diseases, including prevention and treatment. We conclude with future directions and emerging research related to optimal care of people with comorbid MDD and physical diseases.

Trichotillomania: a perspective synthesised from neuroscience and lived experience

Trichotillomania, or hair-pulling disorder, is one of a family of disorders called body-focused repetitive behaviours (BFRBs), which also include disordered skin-picking (dermotillomania) and nail-biting (onychophagia). The disorders affect 1%–2% of...

Sociodemographic factors associated with depression in people living with epilepsy in Kano, Nigeria

Background: A high level of co-morbidity exist between epilepsy and depressive disorder, and in fact it has been found to be the commonest psychiatric disorder in people with epilepsy, with consequence of huge psychosocial burden and poor quality of life. Sociodemographic factors that have been implicated in the association between depression and epilepsy include age, female gender, unemployment, low level of education amongst others.&#x0D; Objective: To determine the sociodemographic factors associated with depression in people living with epilepsy (PWE) in Kano, Nigeria.&#x0D; Materials and Methods: In this cross- sectional study, two hundred and fifty- five consecutive patients with epilepsy attending the outpatient epilepsy clinics of Kumbotso Health Centre and Neurology/Psychiatry clinics of Aminu Kano Teaching Hospital, Kano were recruited.&#x0D; Inclusion criteria were age above 18years and being seizure free for two weeks. Patients with severe neurological and cognitive deficits were excluded. Sociodemographic characteristics were obtained using a structured proforma. Diagnosis of depression was made using the M.I.N.I. International Neuropsychiatric Interview.&#x0D; Results: The age range of participants was 18-76 years with a mean of 32 years (SD=1.31). Majority of participants (57.6%) were males. Prevalence of depression was 20.4%. There was no difference in the mean age of depressed and non-depressed participants. Females had a higher frequency of depression (32%) and association between gender and depression was statistically significant (p ˂ 0.001). Being divorced/widowed and having tertiary level of education were more associated with depression.&#x0D; Conclusion: Depression is common in PWE with being female a significantly associated factor.

Impact of Comorbidities and Previous Surgery on Mid-Term Results of Revision Total Knee Arthroplasty for Periprosthetic Joint Infection.

(1) Background: In the treatment of periprosthetic joint infection (PJI), the individual host status and previous surgical procedures appear to have a relevant influence on success rates and clinical outcome of knee revision surgery. Current data about the predictive value are limited in this subgroup of patients. (2) Methods: Retrospectively, 107 patients (109 knees) undergoing two-stage exchange knee arthroplasty for PJI using a rotating-hinge design with at least two years follow-up. The cumulative incidence (CI) for different endpoints was estimated with death as competing risk. Univariate and multivariate analyses for potential predictive factors were performed. Patient-related outcome measures (PROMs) for clinical outcome were evaluated. (3) Results: At 8 years, the CI of any revision was 29.6%, and of any reoperation was 38.9%. Significant predictors for risk of re-revision were the Charlson Comorbidity Index (CCI) and the number of previous surgical procedures prior to explanation of the infected implant. The functional and clinical outcome demonstrated acceptable results in the present cohort with a high comorbidity level. (4) Conclusions: A compromised host status and multiple previous surgical procedures were identified as negative predictors for re-revision knee surgery in the treatment of PJI. Reinfection remained the major reason for re-revision. Overall mortality was high.

Cape York Kidney Care: service description and baseline characteristics of a client-centred multidisciplinary specialist kidney health service in remote Australia

BackgroundChronic Kidney disease (CKD) is over-represented amongst First Nation people with more than triple the rate of CKD in those aged 15 years and over. The impact of colonisation, including harmful experiences of health practices and research, has contributed to these health inequities. Cape York Kidney Care (CYKC) has been created as an unique service which provides specialist care that aims to centre the client within a multidisciplinary team that is integrated within the primary care setting of the remote health clinics in six communities in western Cape York, Australia. This research aims to describe the Cape York Kidney Care service delivery model, and baseline service data, including aggregated client health measures.MethodsThe model of care is described in detail. Review of the first 12 months of service provision has been undertaken with client demographic and clinical profile baseline data collected including kidney health measures. Participants are adults (> 18 years if age) with CKD grades 1–5. This data has been de-identified and aggregated.ResultsCYKC reviewed 204 individuals, with 182 not previously been reviewed by specialist kidney health services. Three quarters of clients identified as Aboriginal. The average age was 55 with a high level of comorbidity, with majority having a history of hypertension and Type 2 diabetes (average Hba1c 8.2%). Just under one third had cardiovascular disease. A large proportion of people had either Grade 2 CKD (32%) or Grade 3 CKD (~ 30%), and over half had severely increased albuminuria (A3), with Type 2 diabetes being the predominant presumed cause of CKD. Most clients did not meet evidence-based targets for diabetes, blood pressure or lipids and half were self-reported smokers. The proportion of clients reviewed represents 6.2% of the adult population in the participating First Nation communities.ConclusionThe CYKC model was able to target those clients at high risk of progression and increase the number of people with chronic kidney disease reviewed by specialist kidney services within community. Baseline data demonstrated a high burden of chronic disease that subsequently will increase risk of CKD progression and cardiovascular disease. People were seen to have more severe disease at younger ages, with a substantial number demonstrating risk factors for rapid progression of kidney disease including poorly controlled Type 2 diabetes and severely increased albuminuria. Further evaluation concerning implementation challenges, consumer and community satisfaction, and health outcomes is required.

Ayahuasca Treatment Outcome Project (ATOP): One-Year Results from Takiwasi Center and Implications for Psychedelic Science.

This article focuses on the outcomes at 1 year post-treatment of a naturalistic evaluation of services provided through the Takiwasi Centre, an accredited Peruvian therapeutic community offering an ayahuasca-assisted, integrative treatment program for addiction rehabilitation. Participants (n = 52) completed structured interviews and a battery of validated instruments. Outcome measures included the Addiction Severity Index (Version 5), the Beck Anxiety and Depression Inventories, the World Health Organization Quality of Life Brief Version (WHOQOL-BREF), and the World Health Organization Quality of Life Spiritual Religious and Personal Belief (WHOQOL-SRPB) scale. Likert rating scales were used to assess perceived importance and significance of different aspects of the program and overall participant satisfaction. The group change from baseline to the 1-year follow-up was significant and in the anticipated direction for alcohol and drug use severity, depression and anxiety, and some dimensions of quality of life. There was considerable individual variation in outcomes and treatment duration. The majority of participants rated all aspects of the program as important, including the spiritual and therapeutic significance of the ayahuasca experience, which was rated as very significant. Based on the positive 1-year outcomes, and within the limitations of an uncontrolled observational study design, the findings suggest promise for the effectiveness of the use of ayahuasca in a multifactorial treatment context for individuals with significant treatment histories, high levels of comorbidity, and treatment motivation. Results highlight considerable variation in individual experience that merit in-depth qualitative analysis. Implications for ayahuasca-assisted and other psychedelic-assisted treatment alternatives are discussed.

The Severity of Pain and Comorbidities Significantly Impact the Dependency on Activities of Daily Living among Musculoskeletal Patients in Jizan, Saudi Arabia.

Limited research has been carried out on the effects of pain, comorbidity, and impaired function in musculoskeletal patients in Jizan, Saudi Arabia. A cross-sectional study was conducted on 115 patients (aged ≥ 55 years) with physician-diagnosed musculoskeletal conditions in Jizan to investigate the association between pain severity, comorbidities, and dependence on activities of daily living (ADLs). Self-reported questionnaires were used to collect data on pain, comorbidities, and physical function measured by ADLs. In ADLs, participants were categorized as dependent (n = 36) or independent (n = 79). Logistic regression analysis was employed to determine the predictors of dependence. The results showed that higher pain severity (adjusted odds ratio (OR): 1.69, 95% confidence interval (CI): 1.21-2.38, p = 0.002) and a greater number of comorbidities (adjusted OR: 1.52, 95% CI: 1.06-2.17, p = 0.021) were independently associated with dependence in ADLs. These associations remained significant even after controlling for covariates. This study concluded that patients with musculoskeletal conditions in Jizan who experience high levels of pain and comorbidities are at risk of dependence on basic daily activities. Therefore, addressing pain and comorbidities is crucial for maintaining independence and improving quality of life. Personalized rehabilitation programs are needed to manage these conditions in this region.