High Levels Of Comorbidity Research Articles

Alcohol-induced psychotic disorder: a study of hospitalized patients in Lisbon

IntroductionWhile alcohol-induced psychotic disorder (AIPD) is a well-recognised clinical disorder, relativery little is known about aspects such as epidemiology, course and treatment of the condition. Current evidence suggests AIPD can be clinically distinguised from alcohol-withdrawal delirium and schizophrenia. AIPD is associated with high comorbidity with other psychiatric disorders, high re-hospitalization and mortality rate, namely suicidal behaviour.ObjectivesThe objetive of the study was to examine the correlates, clinical features, psycopathology, and short-term response in an inpatient sample with alcohol-induced psychotic disorder, predominant hallucinations (ICD-10 F10.52) admitted to Centro Hospitalar Psiquiátrico de Lisboa.MethodsWe collected retrospectively data from all admitted patients to our Alcohol Unit between January 2010 and January 2020 with the diagnosis of AIPD. The exclusion criteria were: presence of preexisting psychotic disorder, delirium, or other substance use disorders. We characterized our sample in Demographic categories, Clinical categories, Treatment and Short-term course.Results A total of 113 subjects were included in the study. The prevalance of alcoholic hallucinosis was found to be 1.3% of all patients who received inpatient treatment. Most individuals reported auditory hallucinations, that iniciated when they decrease their alcohol intake, and 1 in 4 had past episodes of AIPD.ConclusionsThere are specific challenges in studiyng AIPD, such as the relatively rarity of the disorder, its often transient nature and high levels of comorbidity. A high degree of recurrence and morbidity indicates a need to prevent, and intervene early with an abstinent-oriented management goal.DisclosureNo significant relationships.

Adolescent borderline personality disorder: Does early intervention 'bend the curve'?

The Global Alliance for Prevention and Early Intervention for Borderline Personality Disorder (BPD) proposed a major change for youth mental health services. The Alliance recommended that early detection and specialised treatment for youth BPD becomes a major focus of their clinical activities. Since structured psychotherapies for BPD are complex and lengthy, this proposal has significant implications for youth policy, planning and resource allocation. Our commentary addresses whether BPD is diagnosable and treatable in youth, and whether early intervention results in longer-term benefits. People diagnosed with BPD are highly heterogeneous and experience high levels of comorbidity. The low quality of the evidence for the treatment of BPD in adolescence limits our ability to develop evidence-based guidelines. Accordingly, there is no clear case for BPD early intervention as a major component of youth mental health services. The introduction of ICD-11 classification system may facilitate further empirical studies of personality disorders in adolescence and emerging adulthood.

Comorbidities, Rather Than Older Age, Are Strongly Associated With Higher Utilization of Healthcare in Colorectal Cancer Survivors.

Colorectal cancer (CRC) survivors generally have a higher healthcare utilization (HCU) than the general population due to cancer burden. However, it is unclear which factors are associated with this increased uptake. Our study aimed to (1) compare CRC-related and non-CRC visits to general practitioners (GPs) and medical specialists (MSs) by comorbidities, and (2) assess whether HCU differs by demographic, clinical, and psychological factors. We used data from a German population-based cohort of 1,718 survivors of stage I-III CRC diagnosed in 2003 through 2010 who provided information on HCU at 5-year follow-up. Multivariable linear regression was used to calculate least-square means of CRC-related and non-CRC HCU according to the Charlson comorbidity index and comorbidity cluster, adjusting for relevant demographic, clinical, and psychological characteristics. A higher comorbidity level was associated with more CRC-related MS visits and non-CRC GP visits. In addition to being strongly associated with non-CRC GP visits, comorbidity clusters were associated with CRC-related GP and MS visits, but their association varied by specific cardiometabolic comorbidities. HCU was less dependent on prognostic factors for CRC, such as age and tumor stage, but was strongly associated with disease recurrence, depression, and emotional functioning. Comorbidities, rather than age or tumor stage, were related to HCU, suggesting that CRC survivors use healthcare mainly for reasons other than cancer 5 years postdiagnosis. Improved communication between primary and tertiary healthcare providers could enhance the medical care of cancer survivors with complex health needs and thereby also reduce healthcare costs.

P286. Functional Limitations in Patients With Single and Multiple Psychiatric Disorders

Psychiatric disorders are characterized by high levels of comorbidity. Both the severity of the psychiatric symptoms and the level of functional limitations (disability) are an indication of the impact of psychiatric disorders. In this study we aim to assess: 1) the impact of the number of psychiatric disorders on the level of functional limitations, 2) the association between various types of psychiatric comorbidity and functional limitations, and 3) whether the severity of psychiatric symptoms is an explanatory factor of the association between psychiatric comorbidity and functional limitations.

Rewarding and Antidepressant Properties of Ketamine and Ethanol: Effects on the Brain-Derived Neurotrophic Factor and TrkB and p75NTR Receptors

There is a high level of comorbidity between depression and alcohol use disorder. Subanesthetic doses of ketamine induce short-acting and enduring antidepressant effects after a single or a few administrations. Considering such comorbidity, we assessed, in Swiss male mice, if ketamine-induced antidepressant-like effects would alter ethanol’s rewarding effects; and, if ethanol pretreatment would alter the rewarding and antidepressant effects of ketamine. The role of the brain-derived neurotrophic factor (BDNF) and its high and low affinity receptors TrkB and p75NTR, respectively, in both reward and depression-related behaviors is well established. The present study assessed, in outbred Swiss male mice, the expression of these proteins in the prefrontal cortex and hippocampus. Ketamine did not alter the development of ethanol-induced conditioned place preference (CPP), yet ethanol inhibited the expression of CPP induced by 50 mg/kg ketamine. The antidepressant action of 50 mg/kg ketamine was attenuated after repeated treatment (i.e., developed tolerance), an effect blocked by ethanol preexposure; ethanol also inhibited the antidepressant effect of 30 mg/kg ketamine. Ketamine (50 mg/kg) and Ethanol–Ketamine (50 mg/kg) groups showed lower levels of 145 kDa TrkB in the hippocampus than Saline-treated group. Ethanol–Ketamine (50 mg/kg) decreased the hippocampal expression of p75NTR compared to Saline–Saline and Saline–Ethanol groups. Ketamine (50 mg/kg) induced hippocampal downregulation of 145 kDa TrkB may contribute to ketamine-induced antidepressant tolerance. Likewise, a relationship between low hippocampal levels of p75NTR in the Ethanol–Ketamine (50 mg/kg) and ketamine-induced CPP blockade may be considered. The findings underscore potential ethanol–ketamine interactions likely to undermine ketamine putative antidepressant effects.

Self‐reported wellbeing and health‐related quality of life of Aboriginal and Torres Strait Islander people pre and post the first wave of the COVID‐19 2020 pandemic

ObjectiveQuantify change in wellbeing and health‐related quality‐of‐life (HRQoL) in Aboriginal and Torres Strait Islander adults pre and post Australia's initial COVID‐19 lockdown. MethodsAboriginal and Torres Strait Islander adults completed an online survey at Time 1 (October–November 2019; before the initial Australian COVID‐19 outbreak) and Time 2 (August–September 2020; after the first Australian lockdown). We assessed wellbeing using a visual analogue scale (VAS) and HRQoL using the Assessment of Quality of Life (AQoL‐4D) instrument. Participants who completed both surveys (n=42) were included to quantify change in outcomes over time and by comorbidity and demographic factors. ResultsMean reduction in wellbeing over time was 6.4 points (95%CI −14.2 to 1.4) and was associated with age (18–54yo), financial instability and mental health comorbidity. Mean reduction in HRQoL over time was 0.06 (95%CI −0.12 to 0.01) and was associated with financial instability, high physical comorbidity level and mental health comorbidity. ConclusionsAboriginal and Torres Strait Islanders aged 18–54yo, who were financially unstable or had elevated comorbidity during COVID lockdowns experienced greater reductions in wellbeing and HRQoL. Implications for public healthAs the COVID‐19 pandemic continues in Australia, both urgent and forward planning is needed, especially for the priority groups identified.

Functional Outcome After Spinal Meningioma Surgery. A Nationwide Population-Based Study.

ObjectiveTo describe and analysed the functional outcome (FO) after spinal meningioma (SM) surgery. MethodsWe processed the système national des données de santé (SNDS) i.e. , the French national administrative medical database to retrieve appropriate cases. We analysed the International Classification of Diseases 10 codes to assess the FO. Logistic models were implemented to search for variables associated with a favourable FO i.e. , a patient being independent at home without disabling symptom. ResultsA total of 2,844 patients were identified of which 79.1% were female. Median age at surgery was 66 years, interquartile range (IQR) (56–75). Ninety-five point nine percent of the SMs were removed through a posterior ± lateral approach and 0.7% need an associated stabilisation. Benign meningioma represented 92.9% and malignant 2.1%. Median follow-up was 5.5 years, IQR (2.1–8), and at data collection 9% had died. The FO was good and increased along the follow-up: 84.3% of the patients were alive and had not associated symptoms at one year, 85.9% at 2 and 86.8% at 3 years. Nonetheless, 3 years after the surgery 9.8% of the alive patients still presented at least one disabling symptom of which 2.7% motor deficit, 3.3% bladder control problem, and 2.5% gait disturbance. One point seven percent were care-provider dependent and 2.1% chair or bedfast. In the multivariable logistic regression an older age at surgery (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.29–0.47, p<0.001), a high level of comorbidities (OR, 0.71; 95% CI, 0.66–0.75, p<0.001), and an aggressive tumor (OR, 0.49; 95% CI, 0.33–0.73; p<0.001) were associated with a worse FO. ConclusionFO after meningioma surgery is favourable but, may be impaired for older patients with a high level of comorbidities and aggressive tumor.

Protocol for a randomised controlled feasibility study examining the efficacy of brief cognitive therapy for the treatment of panic disorder in adolescents (PANDA)

BackgroundPanic disorder occurs in between 1 and 3% of adolescents, is associated with high levels of co-morbidity, and without treatment, appears to have a chronic course. To improve access to effective psychological interventions, briefer versions of cognitive behaviour therapy (CBT) have been developed and evaluated for preadolescent children with anxiety disorders. However, there are currently no brief evidence-based CBT interventions for adolescents with anxiety disorders that can be delivered in less than eight sessions. Given that a brief version of cognitive therapy has been shown to be effective in adults with panic disorder, it is possible that an adapted version could be effective for adolescents with panic disorder.MethodsThe study will examine whether a definitive trial can be conducted, based on a single-centre feasibility randomised controlled trial using several well-defined criteria. Between 30 and 48 young people (age 11–18 years) who meet diagnostic criteria for panic disorder, attending a routine clinical service will be randomly allocated to receive either (i) brief cognitive therapy or (ii) a general form of CBT treatment that is more commonly used for adolescents with anxiety disorders. Both will be delivered 1:1 by a therapist and involve five treatment sessions and two booster sessions. Young people’s outcomes will be assessed at the end of treatment and at 3-month follow-up, and qualitative interviews will be conducted to examine acceptability. We will also explore outcomes 1 year after the completion of treatment.DiscussionThis study will test the feasibility of a randomised controlled trial to compare brief cognitive therapy to a general form of CBT for adolescents with panic disorder in the UK. The outputs from the study will provide a clear indication of the feasibility of a future definitive trial and, if indicated, the critical resources that will be required and key information to inform the design and maximise the successful completion of the trial. This has the potential to bring direct benefits to young people and their families, as well as services and society more broadly.Trial registrationThis trial is registered on the ISRCTN Registry, registration number ISRCTN14884288, registered retrospectively on 05/12/2019.

A Population Health Perspective on Racism and Racial Microaggressions.

Racism, one of the social determinants of health, often goes unnoticed by those less affected by its pernicious effects. The lived social experience of race has been linked to significant physical and mental health disparities. Individually or together, we know that racism and discrimination are associated with poorer health of persons from racial minority groups as evidenced in higher rates of mortality, earlier onset of disease, greater severity and progression of disease and higher levels of comorbidity and impairment. These disparities are persistent over time and, although may lessen in degree, are evident at every level of income and education. This article provides a glimpse of the impact of racism on individuals and groups, with a focus on microaggressions as a subtle but pervasive form of racism, and how it is an underlying causative factor for health disparities.

Epidemiology and Survival after Spinal Meningioma Surgery: A Nationwide Population-Based Study.

This is a cross-sectional nationwide descriptive observational and analytic retrospective study. This study aims to describe and assess survival after spinal meningioma (SM) surgery. A few studies report a reduced survival after SM surgery. The current study processed the Système National des Données de Santé (SNDS), the French national administrative medical database, to retrieve appropriate cases. This study identified 2,844 patients (79.1% females) between 2008 and 2017. The median age at surgery was 66 years (interquartile range [IQR], 56-75 years). Moreover, 95.9% of SMs were removed through posterior or posterolateral approaches, and 6.9% were epidural and 0.7% needed an associated spine stabilization. Benign meningioma represented 92.9%, with 5% and 2.1% atypical and malignant, respectively. The median follow-up was 3.3 years (IQR, 3.1-3.5 years). Of the patients, 0.25% and 1.2% expired within a month and a year of surgery, respectively. At data collection, 225 patients (7.9%) expired. The 5-year overall survival (OS) probability was 90.1% (95% CI, 88.6%-91.7%). However, absolute excess risk of mortality after SM surgery was null, and the related standardized mortality ratio was 1 (95% CI, 0.9-1.2; p =0.565). In the adjusted regression, age at surgery (hazard ratio [HR], 1.06; 95% CI, 1.04-1.07; p <0.001), level of comorbidities (HR, 1.44; 95% CI, 1.34-1.54; p <0.001), neurofibromatosis type 2 (NF2; HR, 3.65; 95% CI, 1.28-10.39; p =0.0152), epidural SM (HR, 1.73; 95% CI, 1.09-2.75; p =0.0206), and malignant meningioma (HR, 2.64; 95% CI, 1.51-4.61; p <0.001) remained significantly associated to a reduced OS. The SNDS is of great value in assessing SM incidence, associated mortality, and its predictors. OS after meningioma surgery is favorable but may be impaired for NF2 or older patients with a high level of comorbidities, epidural tumor, and malignant histopathology. SM surgery is not associated with an increased absolute excess mortality risk despite being performed on even more senior patients compared with intracranial meningioma.

Assessing the Impact of Changes to the Rome IV Criteria for Clinical Practice in Irritable Bowel Syndrome

Modifications to the Rome IV criteria for clinical practice have been proposed.1 For irritable bowel syndrome (IBS), these include relaxing the minimum symptom frequency threshold, provided the cardinal symptoms are present and impact on quality of life by being bothersome (eg, leading to consultation with a physician), and removing the 6-month minimum symptom duration. We have shown that the Rome IV criteria for IBS select a group of patients with severe symptoms and high levels of psychological comorbidity.

Implementing an Eye Movement and Desensitization Reprocessing Treatment-Program for Women With Posttraumatic Stress Disorder After Childbirth.

PurposeThe purpose of this study is to describe the implementation and outcomes of an Eye Movement and Desensitization Reprocessing (EMDR) treatment-program for women with posttraumatic stress disorder (PTSD) after childbirth.MethodsA prospective cohort-study with pre- and post-measurements was carried out in the setting of an academic hospital in the Netherland. Included were women who gave birth to a living child at least 4 weeks ago, with a diagnosis of PTSD, or severe symptoms of PTSD combined with another psychiatric diagnosis. All received up to 8 sessions of EMDR-therapy. The posttraumatic stress disorder Checklist for DSM-5 was administered before and after treatment. Trauma history was assessed before treatment with the Life Events Checklist for the DSM-5, the Childhood Trauma Questionnaire and the Childbirth Perception Scale. Descriptive statistics were used.ResultsForty-four women were referred, 26 met the inclusion criteria. After treatment, none of the women met the criteria for diagnosis of PTSD after on average 5 weekly sessions of EMDR- therapy. These outcomes are promising, as they were achieved in women with relatively high levels of psychiatric comorbidity (64%) and high rates of previous mental health treatment (80%).ConclusionImplementing an EMDR-treatment program for women with PTSD after childbirth in the setting of an academic hospital is feasible and effective. Key factors for success include a close collaboration between the relevant hospital departments and a thorough case conceptualization addressing the etiology of the PTSD.

Investigating the salmon bias effect among international immigrants in Sweden: a register-based open cohort study.

BackgroundStudies of migration and health have hypothesized that immigrants may emigrate when they develop poor health (salmon bias effect), which may partially explain the mortality advantage observed among immigrants in high-income countries. We evaluated the salmon bias effect by comparing the health of immigrants in Sweden who emigrated with those who remained, while also exploring potential variation by macro-economic conditions, duration of residence and region of origin.MethodsA longitudinal, open cohort study design was used to assess risk of emigration between 1992 and 2016 among all adult (18+ years) foreign-born persons who immigrated to Sweden between 1965 and 2012 (n = 1 765 459). The Charlson Comorbidity Index was used to measure health status, using information on hospitalizations from the Swedish National Patient Register. Poisson regression models were used to estimate incidence rate ratios (RRs) with 95% confidence intervals (CIs) for emigrating from Sweden.ResultsImmigrants with low (RR = 0.83; 95% CI: 0.76–0.90) moderate (RR = 0.70; 95% CI: 0.62–0.80) and high (RR = 0.62; 95% CI: 0.48–0.82) levels of comorbidities had decreased risk of emigration relative to those with no comorbidities. There was no evidence of variation by health status in emigration during periods of economic recession or by duration of residence. Individuals with low to moderate levels of comorbidities from some regions of origin had an increased risk of emigration relative to those with no comorbidities.ConclusionsThe study results do not support the existence of a salmon bias effect as a universal phenomenon among international immigrants in Sweden.

Engaging Older Veterans With Serious Mental Illness in Physical Activity: In-Person, Remote, and Hybrid Models

Older adults with serious mental illness (SMI) have complex care needs across medical, psychiatric, cognitive, and social domains. This growing population exhibits high levels of medical comorbidity and sedentariness. Innovative interventions that promote holistic recovery for this group are needed, especially in the context of the COVID-19 pandemic. Peer Education on Exercise for Recovery (PEER) is a peer coaching intervention, delivered by VA Peer Specialists (Veterans with lived experience of mental illness), to promote exercise and physical activity among older adults with SMI. This paper will present on three different models of PEER: fully in-person, fully remote, and a hybrid model with both in-person and remote elements. Preliminary data indicates that PEER is (1) engaging and well-liked, (2) associated with greater sustained increases in physical activity compared to an active control, and (3) can lead to sustained physical activity increases that are resilient to situational constraints such as physical distancing.

Эффективность применения кверцетина у пациентов с ишемическим инсультом и коморбидной патологией

Актуальность. На сегодняшний день существует необходимость внедрения эффективного и безопасного патогенетического лечения мозгового инсульта, направленного на защиту нейронов от ишемического повреждения. Коморбидная патология у пациентов с ишемическим инсультом может оказывать существенное воздействие на течение заболевания и влиять на эффективность восстановления нарушенных функций. Целью исследования было изучение влияния кверцетина на функциональный исход острого периода ишемического инсульта, возникшего у больных на фоне соматической патологии. Материалы и методы. Представлены результаты анализа 639 случаев острого мозгового ишемического инсульта в зависимости от применявшейся схемы лечения и уровня коморбидности. Результаты. Исследуемые группы пациентов были сопоставимы по показателям исходного неврологического дефицита. 98 % из них имели коморбидную патологию с диапазоном значений от 1 до 8 баллов по шкале Чарльсона (среднее значение 3,75 ± ± 1,40 балла). Пациенты с высоким уровнем коморбидности продемонстрировали худшие показатели функционального восстановления в остром периоде ишемического инсульта по шкале инвалидизации (3,3 ± 1,6 балла) по сравнению с пациентами с низким уровнем коморбидности (2,2 ± 1,4 балла) (p &lt; 0,01, U). Изучение эффективности разных схем лечения на фоне коморбидной патологии показало достоверную эффективность назначения кверцетина у пациентов с высокой коморбидностью. Среди пациентов с низкой коморбидностью не было отмечено статистически значимых различий по показателю инвалидизации и выживаемости больных в остром периоде ишемического инсульта. Выводы. У 98 % больных с ишемическим инсультом выявляется коморбидная патология, которая негативно влияет на показатели выживания и функционального восстановления у больных в остром периоде ишемического инсульта. Худшие показатели функционального восстановления продемонстрировали пациенты с высоким уровнем коморбидности по индексу Чарльсона. Применение кверцетина в остром периоде ишемического инсульта продемонстрировало высокую эффективность у больных с высоким уровнем коморбидности, что подтвердило мультимодальный спектр его терапевтических эффектов. Индивидуальный подбор лечебных мероприятий у больных с ишемическим инсультом с учетом сопутствующей патологии повышает эффективность лечения.

Bipolar Disorder: Comorbidity with Other Mental Disorders

Failure to diagnose bipolar disorder (BD) in time leads to an increase in suicide risk, worse prognosis of the disease, and an increase in the socioeconomic burden.Aim: to assess the incidence of comorbidity of bipolar disorder (BD) and other mental and behavioral disorders, as well as the sequence of formation of this multimorbidity.Patients and methods: in the Affective States Department of the Mental Health Research Institute TNRMC, 121 patients with a diagnosis of bipolar disorder were selected for the study group according to the ICD-10 diagnostic criteria. The predominance of women in the study group was revealed (n = 83; 68.6%; p &lt; 0.01). Median age of male patients was 36 [30; 54] years, for females — 47 [34; 55] years.Results: data were obtained on a high level of comorbidity in the study group: in 46.3% of patients, BD was combined with another mental disorder. It was found that personality disorders as a comorbid disorder in type I bipolar disorder are less common than in type II bipolar disorder. Gender differences were found in the incidence of anxiety-phobic spectrum and substance use disorders in bipolar disorder. The features of the chronology of the development of bipolar disorder and associated mental disorders have been revealed.Conclusion: in the case of bipolar disorder, there is a high likelihood of comorbidity with other mental disorders. Certain patterns in the chronology of the formation of comorbid relationships between BD and concomitant mental and behavioral disorders were revealed.

Course of labor and condition of the newborn in women affected by benign ovarian tumors

Annotation. According to various estimations, the incidence of adnexal neoplasms during pregnancy makes up from 0.19% to 8.8%. Most of cases are diagnosed in the first trimester and their incidence gradually decreases as the period of pregnancy grows. Depending on their size and location, ovarian tumors may be related to an adverse obstetrical result caused by mechanical influence. They increase the risk of abortion (from 0 to 6%), preterm labor (from 5.8% to 10.4%) and mechanical impediment to labor. Aim – studying the peculiarities of the course of labor and the condition of the newborn of women affected by benign ovarian tumors. We have conducted a complex examination of 67 pregnant women with benign ovarian tumors and tumor-like growths found before pregnancy or in the first trimester of gestation (basic group) and 50 women presenting no ovarian neoplasms or any other severe gynecological or somatic pathology (reference group). To identify the risk factors, the basic group was divided into 2 subgroups. The condition of fetuses was assessed with the use of automated cardiotocography analysis based on the Dawes/Redman criteria, with the calculation of the short-term variability (STV). The mean and standard deviation (M ± m) were evaluated at a significance level of p &lt;0.05. Categorical variables are presented as the absolute number of cases in the group and the frequency in percent – n (%). Tests for differences between independent samples in the case of quantitative variables were performed using Student’s t test, the Mann-Whitney rank test, and in the case of categorical variables using Fisher’s exact test. The obtained results suggest that the course of labor in women affected by benign ovarian neoplasms is characterized by an increased incidence of complications. A significant difference has been established in the incidence of cesarean sections (35.8% vs 8.0% in the reference group, р&lt;0.05), preterm labor (28.4% vs. 6.0%, р&lt;0.05), fetal distress (19.4% vs. 8.0%, р&lt;0.05) and preterm rupture of membranes (17.9% vs. 6.0%, р&lt;0.05). The incidence of almost all complications of labor in Subgroup 1 significantly exceeds the figures from the reference group and the incidence of preterm labor and fetal distress is also higher in comparison with Subgroup 2. The presence of extragenital pathology is a well-known risk factor for perinatal complications, which is also confirmed by our research. A high level of comorbidity of benign ovarian neoplasms with various extragenital diseases also accounts to a certain degree for gestational complications. Thus, pregnancy in women affected by ovarian tumors implies an increased risk of obstetrical and perinatal complications, in particular, threats of miscarriage and preterm labor. The studies of this issue lack systematization, are often controversial and fragmentary. There has been practically no research on the risk factors for such complications and the ways of their prognostication and prevention.

Рання діагностика гіпотиреозу як фактора прогресування остеоартрозу та коморбідних процесів, особливості фітокорекції

Мета: вивчити поширеність і форми гіпотиреозу у хворих на остеоартроз (ОА) та дослідити вплив фітозасобу зобофіт на функціонально-морфологічний стан щитоподібної залози, прояви коморбідних захворювань, оксидантний статус, фібринолітичну і протеолітичну активність крові. Матеріал і методи. У 312 хворих на ОА досліджено прояви коморбідних процесів і серед них — явища гіпотиреозу. Використовували клінічні, біохімічні, радіоімунологічні, ультразвукові методи. Результати. У всіх хворих на ОА після 50 років відзначаються зростаюча кількість і вираженість коморбідних процесів. Серед них у 4,48 % виявлено маніфестний і у 13,78 % — субклінічний гіпотиреоз. Ознаки гіпотиреозу спостерігаються в осіб після 55, особливо 60 років. Субклінічний гіпотиреоз незначно погіршував клінічну симптоматику ОА та коморбідних процесів, але посилював явища оксидативного стресу, зниження фібринолітичної і підвищення протеолітичної активності крові, погіршення швидкості клубочкової фільтрації нирок. Зазначене розглядається як неспецифічна патофізіологічна основа прогресування виявлених хвороб. Тримісячне застосування фітозасобу зобофіт у більшості пацієнтів нормалізувало тиреоїдний гомеостаз, покращило загальні результати лікування основного і коморбідних захворювань, зменшило вираженість метаболічних порушень. Висновки. У хворих на ОА у віці старше 50 років і з високим рівнем коморбідності необхідно здійснювати скринінг на гіпотиреоз. При виявленні ознак субклінічного гіпотиреозу в такого контингенту хворих доцільно застосування полікомпонентних фітозасобів із різноплановою тиреоїдотропною дією.

Особливості клініки, перебігу та результатів лікування хворих на остеоартроз на тлі гіпотиреозу: вікові та гендерні аспекти

Мета дослідження — вивчити поширеність субклінічного та маніфестного гіпотиреозу серед когорти хворих на остеоартроз (ОА) та його вплив на клінічні прояви, перебіг ОА й коморбідних процесів та результати їх лікування. Матеріал та методи. Обстежено 312 хворих на ОА віком 37–76 років. З урахуванням рівнів тиреотропного гормона (ТТГ) у сироватці крові хворі розподілені на групи: із проявами субклінічного (43 особи), маніфестного (14 пацієнтів) гіпотиреозу, із високонормальним (114 хворих) та низьконормальним рівнем ТТГ (141 пацієнт). Методи дослідження: антропометричні, біохімічні, визначення гормонів щитоподібної залози (ЩЗ), антитіл до тиреоїдної пероксидази, швидкості клубочкової фільтрації, проведення електрокардіографії, вимірювання офісного артеріального тиску, ультразвукове дослі­дження ЩЗ. Результати. Установлено, що зі збільшенням віку пацієнтів відмічається помітна тенденція до підвищення високонормальних рівнів ТТГ, кількості випадків проявів поліостеоартрозу, збільшення поширеності та вираженості вікових коморбідних процесів. Хворим на ОА на тлі субклінічного гіпотиреозу притаманні вищі рівні коморбідності, особливо складові метаболічного синдрому, торпідний перебіг ОА з ознаками прискорення прогресування, вищі ступені ураження суглобів, глибші порушення ліпідного обміну, помірне зниження швидкості клубочкової фільтрації, зниження результатів лікування ОА та коморбідних процесів. Найбільш вираженими зазначені особливості були в пацієнтів із маніфестним гіпотиреозом. Корекція гіпотиреозу сприяла покращанню результатів лікування ОА та коморбідних процесів. Висновки. У хворих на ОА віком понад 50 років із системним ураженням суглобів, торпідним чи прогресуючим перебігом, появою знижених результатів лікування ОА та коморбідних процесів доцільні ультразвукове дослі­дження ЩЗ, визначення рівнів ТТГ, вільного тироксину, антитіл до тиреоїдної пероксидази з метою ранньої діагностики субклінічної форми гіпотиреозу та своєчасної медикаментозної корекції функції ЩЗ, що сприятиме покращанню загальних результатів лікування ОА та вікових коморбідних процесів.

Патоморфоз метаболічного фенотипу остеоартрозу: роль ожиріння, цукрового діабету та гіпотиреозу (вікові та гендерні аспекти)

Актуальність. Остеоартроз (ОА) — одне із найпоширеніших захворювань опорно-рухового апарату, якому притаманний високий рівень коморбідності. Серед коморбідних явищ заслуговують на увагу зростаюча частота ожиріння, цукрового діабету (ЦД) та гіпотиреозу як складових частин метаболічного фенотипу ОА. Мета дослідження: дослідити вікові та гендерні особливості патоморфозу метаболічного фенотипу ОА з коморбідними явищами ожиріння, ЦД 2-го типу та гіпотиреозу. Матеріали та методи. Обстеженням охоплено 312 хворих на первинний ОА віком від 37 до 76 років. Методи дослідження: клінічні, рентгенологічні, ультрасонографічні, біохімічні, радіоімунологічні, статистичні. Результати. Серед обраної вибірки хворих метаболічний фенотип ОА був домінуючим (62,9 %), основною його складовою було ожиріння, але у 19 % випадків цього фенотипу згодом нашаровувався ЦД 2-го типу, а у 18 % інших випадків виявляли гіпотиреоз (субклінічна форма становить 13,78 %), переважно у жінок. Відзначається суттєва різниця у вікових періодах виникнення ожиріння, ЦД та гіпотиреозу. Верифіковані ендокринні недуги вагомо погіршували прояви, перебіг, ступінь дисліпідемії та результати лікування ОА й коморбідних захворювань серцево-судинної і травної систем. За клінічних, прогностичних і лікувально-профілактичних особливостей із метаболічного фенотипу ОА пропонується виділення підтипу А — ожиріння та цукровий діабет та підтипу Б — ожиріння та гіпотиреоз. Висновки. Метаболічний фенотип ОА є домінуючим в його структурі, а виділення підтипів А (ОА, ожиріння та ЦД) і Б (ОА, ожиріння та гіпотиреоз) сприятиме обґрунтованим вдосконаленням в лікувально-профілактичній стратегії в аспекті персоніфікованого лікування.