Comorbidities Hypertension Research Articles

Non-cancer-related deaths in patients with resectable locally advanced esophageal squamous cell carcinoma: A supplementary analysis of JCOG1109.

434 Background: Neoadjuvant docetaxel, cisplatin, and 5-FU (DCF) has become the standard treatment for resectable locally advanced esophageal squamous cell carcinoma (LA-ESCC) in Japan, based on the result of JCOG1109. In this study, more non-cancer-related deaths were observed in the cisplatin, and 5-FU (CF) plus radiotherapy (CF-RT) arm compared to the CF and DCF arm. However, the details of these non-cancer-related deaths remain unclear. We aimed to evaluate the influence of neoadjuvant therapies on non-cancer-related deaths using the data from JCOG1109. Methods: We analyzed patients' characteristics, classification, time of onset, risk factors associated with onset, and cumulative incidences in patients with non-cancer-related deaths. Cumulative incidences of non-cancer-related deaths in each arm were estimated, considering cancer-related deaths as a competing risk. Risk factors were explored using multivariable Fine-Gray model with Firth penalization. Results: Among 601 enrolled patients, 164 in the CF arm, 169 in the DCF arm, and 173 in the CF-RT arm were completed the surgery. Of those, non-cancer-related deaths were observed in 19 (12%), 12 (7%), and 32 (18%) patients, respectively. Patient characteristics of non-cancer-related deaths in the CF/DCF/CF-RT arm were as follows: male, 89/92/88%; median age, 69/69/69 years old; ECOG PS 0, 89/100/97%; lower thoracic esophagus, 21/25/19%; previous history of ischemic disease of heart, 5/0/0%; brain, 0/0/0%; other malignancies, 5/8/0%; comorbidity of hypertension, 26/25/47%; COPD, 0/8/3%; thoracoscopic approach, 37/42/38%. The median follow-up time was 5.7 years (range, 0.3-10.4 years). The causes of non-cancer-related deaths in the CF/DCF/CF-RT arm were pulmonary, 4 (21%)/1 (8%)/10 (31%); cardiovascular, 1 (6%)/0/2 (6%); infectious, 2 (11%)/1 (8%)/3 (9%); other malignancy, 2 (11%)/3 (25%)/5 (16%); treatment-related, 0/1 (8%)/1 (3%), and the median time from surgery to onset of non-cancer-related death was 3.3/3.8/4.3 years, respectively. Cumulative incidences of non-cancer-related deaths after 3, 6, 9 years in the CF/DCF/CF-RT arm were 4.9/3.0/7.0%, 10.7/6.1/15.6%, 12.4/8.8/26.1%, respectively. In multivariable analyses, ≥ 65 years old (hazard ratio [HR]: 3.243, 95% confidential interval [CI]: 1.797–5.852, vs. < 65 years old), ECOG PS 0 (HR: 3.579, 95% CI: 1.148–11.162, vs. PS 1), and serum CRP ≥ 1.0 mg/dl (HR: 2.238, 95% CI: 1.003–4.995, vs. <1.0 mg/dl) were significantly associated with the onset of non-cancer-related deaths. Whereas the CF-RT arm was not significantly associated (HR: 1.600, 95% CI: 0.885–2.892, P = 0.12, vs. CF). Conclusions: The incidence of non-cancer-related deaths was relatively higher in the CF-RT arm, and pulmonary-related complications tended to be a particularly common cause of death.

Clinical Characteristics Related to Complications in Abdominal Gynecological Surgery

Background: Gynecological conditions account for a significant number of surgical procedures performed worldwide, with complication rates reported between 0.2-34%. In Mexico, complication rates range from 2.15% to 15.06%. Factors such as age, obesity, comorbidities (hypertension, diabetes), and prolonged surgical time are associated with a higher risk of complications, including postoperative infections. Objective: To determine the clinical characteristics related to complications in abdominal gynecological surgery. Materials and Methods: A retrospective, descriptive, cross-sectional, and analytical study was conducted on women undergoing scheduled surgery by the Gynecology service at the Hospital de Ginecoobstetricia UMAE-CMNO IMSS during the period from January 2023 to December 2023. The study aimed to determine the frequency of postoperative complications and their relationship with clinical characteristics. The sample size calculation used the proportion formula and finite population, requiring a minimum sample of 156 patients. However, all gynecological surgeries performed during the study period were included. After obtaining approval from the Local Research Committee in Health 1310, data was collected from the hospital’s surgical productivity registry platform. Surgical data was obtained from both electronic and physical clinical records to identify postoperative complications. The data collection tool was entered into a Microsoft Excel database, and statistical analysis was performed using IBM SPSS (version 30.0). Results: A total of 392 patients were included in the study. Among them, 78 patients (19.9%) experienced complications. The most common complication was hemorrhage (9.2%), followed by wound dehiscence (3.6%), bladder injury (3.1%), surgical wound infection (2.6%), fever (1.5%), vaginal dome hematoma (1.0%), intestinal injury, and urinary tract infection (both at 0.8%), paralytic ileus (0.3%), along with other complications such as vascular injury and death (0.3%). When analyzing the groups, it was found that patients in the complication group had a higher Body Mass Index (BMI) compared to those without complications. Additionally, the surgical time, estimated bleeding, and hospital stay days were significantly higher in the complication group. Both groups showed similar characteristics in terms of age, parity, prior abdominal surgeries, comorbid conditions, smoking, ASA risk classification, and preoperative hemoglobin levels. Conclusions: The frequency of postoperative complications in this study aligns with findings reported in most international studies, with hemorrhage being the most common complication. BMI was significantly associated with a higher risk of complications, including bleeding, need for transfusions, and prolonged surgical times.

P-1912. Characteristics and Outcomes of Matched Vaccinated and Unvaccinated Patients Hospitalized for Covid-19 in 27 Hospitals During Brazil's Delta and Omicon Waves

Abstract Background Brazil faced significant challenges during the COVID-19 pandemic, emerging as one of the most affected countries globally in the number of cases and deaths. In January 2021, the country began the national vaccination campaign against COVID-19. Currently, about 80.2% of Brazilians over six months of age are fully vaccinated. Few population-based studies have compared clinical characteristics and outcomes among patients hospitalized for COVID-19 concerning vaccination status. This knowledge gap was even greater when an attempt was made to match vaccinated versus unvaccinated individuals to control for confounders. Therefore, this study aimed to compare the clinical characteristics and outcomes of matched vaccinated and unvaccinated COVID-19 in hospital patients. Flowchart of COVID-19 patients included in the study. Methods This retrospective multicenter cohort study included adult COVID-19 patients, with a laboratory-confirmed diagnosis, from 27 hospitals, admitted from March/2021 to August/2022. Clinical characteristics, vaccination status, and outcomes were collected from medical records. Vaccinated and unvaccinated patients were compared in a matched analysis, using the propensity score model that included age, sex, hospital, and comorbidities (hypertension, diabetes mellitus, obesity [body mass index > 30kg/m2], heart failure, and chronic kidney disease). Results From 3,188 patients, 1,963 (61.6%) were unvaccinated and 1,225 (38.4%) fully vaccinated. Among these, we matched 771 vaccinated with 771 unvaccinated. Vaccinated had lower rates of mortality (17.6% vs. 29.7%), invasive mechanical ventilation (IMV-17.5% vs. 33.0%), non-invasive mechanical ventilation (NIMV- 10.0% vs. 20.2%), intensive care unit admission (ICU- 29.8% vs. 44.0%) vasoactive drugs use (20.5% vs. 30.9%), dialysis (8.0% vs. 13.7%), p < 0.001 for all, and thrombosis (3.7% vs. 7.5% p=0.002). Conclusion This study suggests considerable benefits of vaccination for patients hospitalized with COVID-19. Fully vaccinated patients experienced lower mortality rates and lower severity disease with fewer ICU admissions, and shorter hospital lengths of stay. These findings confirm that prior vaccination reduces the risk of death and alters the disease trajectory in hospital settings. Disclosures All Authors: No reported disclosures

P-445. Clinical Complications and Quality of Life in People Living with HIV (PLWH) and Other Comorbidities

Abstract Background Comorbidities in PLWH tend to cluster, and may raise risk of multiple clinical complications. It is important to understand the burden of these complications and health-related quality of life (QOL) in PLWH with comorbidities. Methods This is an ongoing prospective longitudinal observational study in Hong Kong to determine the prevalence and incidence of clinical complications among PLWH with ≥1 documented comorbidities (hypertension, diabetes, obesity, liver disease, kidney disease and cardiovascular disease). The endpoints are the prevalence of each clinical complication and QOL. Clinical complications are (i) high cardiovascular risk (QRISK3 >10%), (ii) renal complication (glomerular filtrate rate < 60 mL/min/1.73m2, or urine albumin:creatinine >3 mg/mmol), (iii) liver steatosis and significant liver fibrosis (Controlled Attenuated Parameter >248 dB/m and liver stiffness >9.0 kPa, measured by transient elastography) and (iv) low bone mineral density (BMD) at lumbar spine and femoral neck (T score < -1.0 if ≥50 years or Z score < -2.0 otherwise, measured by dual energy X-ray absorptiometry). QOL was measured by EQ-5D-5L. Association between each comorbidity and the endpoints are determined by logistic or linear regression analyses, adjusted for age and gender. Results We included data from the first 279 PLWH (baseline characteristics in Table). Overall, 40.5% had high cardiovascular risk, 35.1% had renal complication, 10.8% had significant liver fibrosis, and 31.5% had low BMD at femoral neck (Figure 1A), while 14.3% had difficulty in mobility, 38.4% had pain or discomfort, and 34.1% had anxiety or depression (Figure 1B). EQ VAS was 80 (25th, 75th percentile 67, 85). PLWH with hypertension and diabetes had significantly higher cardiovascular risk and renal complication. Diabetes and obesity were significantly associated with liver fibrosis, but lower risk of low BMD (Figure 2). PLWH with diabetes had significantly greater impairment in mobility, while obesity was associated with a trend of pain or discomfort and anxiety or depression (Figure 3). Kidney disease was associated with worse EQ VAS (unstandardized B -7.032, p=0.022). Conclusion PLWH with comorbidities are vulnerable for multiple clinical complications and worse QOL. Disclosures Grace Lui, MBChB, Gilead Sciences: Grant/Research Support|MSD: Grant/Research Support

Understanding the dynamics of post-surgical recovery and its predictors in resource-limited settings: a prospective cohort study

IntroductionPost-surgical recovery time is influenced by various factors, including patient demographics, surgical details, pre-existing conditions, post-operative care, and socioeconomic status. Understanding these dynamics is crucial for improving patient outcomes. This study aims to identify significant predictors of post-surgical recovery time in a resource-limited Ethiopian hospital setting and to evaluate the variability attributable to individual patient differences and surgical team variations.MethodsA linear mixed model was employed to analyze data from 490 patients who underwent various surgical procedures. The analysis considered multiple predictors, including age, gender, BMI, type and duration of surgery, comorbidities (diabetes and hypertension), ASA scores, postoperative complications, pain management strategies, physiotherapy, smoking status, alcohol consumption, and socioeconomic status. Random effects were included to account for variability at the patient and surgical team levels.ResultsSignificant predictors of prolonged recovery time included higher BMI, longer surgery duration, the presence of diabetes and hypertension, higher ASA scores, and major post-operative complications. Opioid pain management was associated with increased recovery time, while inpatient physiotherapy reduced recovery duration. Socioeconomic status also significantly influenced recovery time. The model fit statistics indicated a robust model, with the unstructured covariance structure providing the best fit.ConclusionThe findings highlight the importance of individualized patient care and the effective management of modifiable factors such as BMI, surgery duration, and postoperative complications. Socioeconomic status emerged as a novel factor warranting further investigation. This study underscores the value of considering patient and surgical team variability in post-surgical recovery analysis, and calls for future research to explore additional predictors and alternative modeling techniques to enhance our understanding of the recovery process.

Knowledge, attitudes and practices of healthcare professionals in the management of patients with hypertension and concurrent bronchial asthma: a cross-sectional study in the Yellow River Delta region of China

ObjectiveTo assess the Knowledge, Attitudes and Practices (KAP) among healthcare professionals in managing patients with coexisting hypertension and bronchial asthma.DesignA cross-sectional survey. The reporting of this study followed the Strengthening...

A Retrospective Observational Study on Post-Pandemic Effects of Endogenous and Exogenous Factors on Prematurity in Pregnant Women Under 18 Years of Age.

Background/Objectives: This research investigates the impact of exogenous and endogenous factors on fetal health in pregnant women under the age of 18, with a special focus on the influence of educational level, adherence to vices (smoking and alcohol), comorbidities (diabetes and hypertension), and poor sanitary conditions. Methods: The study uses retrospective data collected from a medical institution in the Southeast region of Romania, including a sample of 3639 births during the post-pandemic period (2022-2023). This period was considered to be a reference period for the study because, as a result of measures to combat the spread of COVID-19 disease in the pandemic, there was an increase in the birth rate among patients under 18 years of age. The APGAR clinical score was evaluated at 5, 10, and 20 min after birth and measured on an inverted scale to reflect the increased risk to fetal health. Results: The results indicate that lack of education is a significant exogenous factor associated with an increased risk of preterm births and a lower APGAR score. Additionally, adherence to vices is more pronounced among pregnant women with low educational levels and smoking and alcohol consumption negatively impact fetal health. Regarding comorbidities, diabetes did not significantly affect the short-term APGAR score, while hypertension had a complex effect, though medical interventions mitigated the associated risks. Conclusions: The conclusions of the research emphasize the need for appropriate educational and medical interventions to reduce the risks associated with preterm births and newborn health in adolescent pregnancies, especially in disadvantaged environments. The study suggests future research directions to expand the analysis to other geographical regions and for long-term monitoring of newborn health.

A Neighborhood-Level Hispanic Paradox: the Interaction between Hispanic Density, Neighborhood Disadvantage, and Survival in Breast Cancer Patients.

To evaluate the impact of Hispanic ethnic enclaves (EE) on the relationship between neighborhood disadvantage and overall survival (OS) in breast cancer (BCa) patients. Data from BCa patients with stage I-IV disease diagnosed between 2005-2017 was used to analyze the effects of Area Deprivation Index (ADI) scores, a measure of neighborhood disadvantage, and census-tract level Hispanic density, a measure of EE, on OS using mixed-effects Cox regression models. The final model included the following individual-level factors (age, income, race, Hispanic/Latino origin, nativity, insurance status, and comorbidities (hypertension, diabetes, and body mass index) and clinical factors (National Comprehensive Cancer Network guideline-concordant treatment, stage, and receptor subtype). 5,387 patients were analyzed. 52% resided in Hispanic EE. Enclave residents were predominantly White (93%), with Cubans the predominant subgroup (37%). Overall, there were 1,040 deaths within the cohort. Patients residing in highly disadvantaged neighborhoods (ADI Tertile 3 [ADIT3]) within Hispanic EE experienced reduced HR compared to those outside of EE, evidenced by the interaction effect [EE x ADIT3 - HR (95% CI): 0.66 (0.44, 0.98)]. Hispanic EE may protect against mortality in BCa patients, suggesting positive social factors help combat negative effects of neighborhood disadvantage for patients. Understanding protective attributes of EE can help create effective cancer interventions and promote more equitable outcomes in minority populations. This study found that EE may protect against mortality in BCa patients, suggesting positive social factors may help mitigate the negative effects caused by the neighborhood.

Prevalence of Hypertension and Associated Risk Factors among Post-Menopausal Women of Boalkhali Upazila of Chattogram District: Cross Sectional Observational Study

Background: Prevalence of hypertension increases with age and postmenopausal women remain at higher risk than other population group. Various risk factors attribute to the precipitation of the postmenopausal hypertension, however definitive mechanism have not been completely explicated till date. Aims of the study: The study attempted to evaluate the prevalence of hypertension and associated risk factors among postmenopausal women of Boalkhali Upazila, Chattogram, Bangladesh. Materials and method: This cross-sectional study was conducted at Boalkhali Upazila of Chattogram District with total 400 post-menopausal women who have been included in this study with convenient sampling method. Results: The study results showed that, mean age of postmenopausal women was 58.65±7.67 years, 11.75% of them had pre-hypertension and 35.75% of them had hypertension. A logistic regression analysis showed that, age, marital status, menopausal onset, BMI, hip circumference, family history of comorbidities (hypertension, diabetes mellitus and both hypertension and diabetes mellitus), comorbidities of the respondents such as diabetes mellitus, ischemic heart disease and sedentary life style were independent risk factors of hypertensive status of the post-menopausal women when adjusted for other risk factors (p<0.05) Conclusion: This study conclude that, high prevalence of hypertension among post-menopausal women. So, its need to be more concern about post-menopausal women to reduce the prevalence of hypertension and risk factors to avoid hypertension related cardiovascular death and other dare complications. University Heart Journal 2024; 20(1): 22-30

Identifying Patients at Risk for Cardiometabolic and Chronic Diseases by Using the Exercise Vital Sign to Screen for Physical Inactivity.

Physical inactivity is a major health risk factor for multiple chronic diseases and early death. Despite evidence supporting diet and physical activity behavioral counseling interventions, physical inactivity is rarely measured or managed in primary care. A need exists to fully explore and demonstrate the value of screening patients for physical inactivity. This study aimed to 1) compare health profiles of patients screened for inactivity versus patients not screened for inactivity, and 2) compare health profiles of inactive, insufficiently active, and active patients as measured by the Exercise Vital Sign screener. The study sample comprised adult patients attending a well visit from November 1, 2017, through December 1, 2022, at a large midwestern university hospital. We extracted data from electronic medical records on exercise behavior reported by patients using the Exercise Vital Sign (EVS) questionnaire. We extracted data on demographics characteristics, resting pulse, encounters, and disease diagnoses from PCORnet Common Data Model (version 6.1). We used the Elixhauser Comorbidity Index to determine disease burden. We compared patients with complete and valid EVS values (n =7,261) with patients not screened for inactivity (n = 33,445). We conducted further comparisons between screened patients reporting 0 minutes (inactive), 1 to 149 minutes (insufficiently active), or ≥150 minutes (active) minutes per week of moderate-vigorous physical activity. Patients screened for inactivity had significantly lower rates of several comorbid conditions, including obesity (P < .001), diabetes (P < .001), and hypertension (P < .001) when compared with unscreened patients. Compared with insufficiently active and inactive patients, active patients had a lower risk of 19 inactivity-related comorbid conditions including obesity (P < .001), depression (P < .001), hypertension (P < .001), diabetes (P < .001), and valvular disease (P < .001). These findings suggest inactive and insufficiently active patients are at increased risk for multiple inactivity-related chronic conditions. These findings further support existing recommendations that inactive patients receive or be referred to evidence-based lifestyle behavioral counseling programs.

A scoping review of interventions to optimize medication adherence in hypertension comorbidity.

Patients with hypertension and other comorbidities have difficulties adhering to their medications which have negative impacts on clinical outcomes. Although some studies have identified strategies to improve medication adherence, a thorough analysis of these interventions will provide synthesized evidence for clinical decision-making and improved health outcomes for patients with hypertension comorbidities. To conduct a scoping review on interventions that have been utilised to improve medication adherence in patients with hypertension and other co-morbid conditions. A systematic literature search was conducted in the following databases: CINAHL, COCHRANE TRIALS, MEDLINE, and SCOPUS. One (1) search engine, GOOGLE SCHOLAR was included. This was done between September 2023 to February 2024. The PRISMA-SCR guidelines were followed for this review. A total of 456 unique studies were identified after duplicates were removed. Following screening and eligibility assessments, 26 papers were selected for review with a focus on the study aim and purpose, study population, interventions used and adherence measures. Most of the interventions were delivered by pharmacists, with 25 studies utilising the multimodal intervention approach. A total of 22 studies (80% of the total) found that the interventions significantly improved medication adherence. Results from 16 studies showed a significant improvement in blood pressure. Improvements in medication adherence were a common outcome of interventions that focused on patient education. Interventions such as patient education, simplified treatment regimens, and multidisciplinary care can improve medication adherence and clinical outcomes in patients with hypertension and comorbidities, but further research is needed to understand long-term effects.

RENAL HEMODYNAMICS IN PATIENTS WITH HYPERTENSION AND STAGE II–III CHRONIC OBSTRUCTIVE PULMONARY DISEASE

The purpose of the study is to assess the changes in renal blood flow during the combined course of essential hypertension and stage II-III chronic obstructive pulmonary disease. Participants and methods. The study included 60 patients, divided into three clinical groups: Group 1 involved 15 patients with stage II essential hypertension (mean age 52.87 ± 1.36 years; male-to-female ratio 73.33%/26.67%); Group 2 included 15 patients with stage II–III chronic obstructive pulmonary disease (COPD) (mean age 48.01 ± 2.75 years; male-to-female ratio 86.67%/13.33%); Group 3 included 30 patients with stage II–III COPD combined with stage II essential hypertension and stage I–III arterial hypertension (23 men and 7 women; mean age 57.49 ± 2.39 years). These patients had no other clinically significant concomitant pathologies and had not received systematic antihypertensive therapy. A control group of 20 healthy donors was also examined. Results. The study of renal blood flow dynamics at the levels of the common trunk, segmental, and interlobar branches of the renal artery revealed statistically significant changes, particularly in the presence of comorbidity. A notable increase in the parameters Vmax, Vmin, and Vaverage, as well as the resistive index (RI) and pulsatility index (PI), was observed in patients with chronic obstructive pulmonary disease (COPD) combined with essential hypertension. These changes indicate impaired renal hemodynamics, characterized by increased microvascular resistance in the interlobar branches. The severity of disturbances in key Doppler parameters of renal blood flow at the levels of the common trunk, segmental, and interlobar branches was associated with elevated RI and PI values in patients with the comorbidity of essential hypertension and COPD (p&lt;0.05), as well as in those with essential hypertension alone (p&lt;0.05). In contrast, patients with COPD alone exhibited higher values of Vmax, Vmin, and Vaverage at these levels of the renal artery. Conclusions. The evolution of linear velocity and vascular resistance indices in the renal vessels across the studied patient groups showed a consistent, proportional pattern, with more pronounced renal blood flow impairment observed in patients with the comorbidity of essential hypertension and chronic obstructive pulmonary disease, based on key Doppler criteria.

Prostatectomy outcomes for patients with benign prostatic hyperplasia and its associated factors in East and West Gojjam zones comprehensive specialized hospitals, Northwest Ethiopia

BackgroundBenign prostatic hyperplasia (BPH) is non-cancerous growth of the prostate gland which surrounds the urethra. For men with BPH who are older than 50, a prostatectomy is a common surgical procedure. Open prostatectomy is still more prevalent in regions with limited access to advanced surgical procedures like transurethral resection of the prostate and robotic-assisted laparoscopic prostatectomy. Determining prostatectomy outcomes for BPH and associated factors is essential to optimize patient care and improve awareness of this condition. However, the outcomes of prostatectomy and associated factors are not studied in Ethiopia.ObjectivesTo assess prostatectomy outcomes for patients with benign prostatic hyperplasia and its associated factors in East and West Gojjam Zones, 2021.MethodsA facility-based cross-sectional study was employed among 412 patients with prostatectomy using systematic sampling. Five-year secondary data from 2016 to 2021 data was extracted from patients’ medical records using a structured proforma. The outcomes of prostatectomy for BPH are categorized into good outcomes if significant symptom relief such as reduced urinary frequency, urgency, and nocturia and preserved sexual function using International Prostate Symptom Scores and Sexual Health Inventory for Men. A poor outcome involves minimal symptom improvement, recurrence of symptoms, severe complications like urinary incontinence or retention, and erectile dysfunction. Besides this, logistic regression models were computed to assess the relationship between variables.ResultsAmong 412 patients with prostatectomy, 68 (16.5%; 95% CI 12.9–20.1) had poor outcomes, and 344 (83.5%; 95% CI 79.9–87.1) had good outcomes. In addition, patients who took venous thromboembolism (VTE) prophylaxis were 80% less likely to develop good prostatectomy outcomes than those who did not take prophylaxis (AOR = 0.2; 95% CI 0.07–0.6). Good prostatectomy outcomes were 86% lower in those who did not obtain the proper wound care than in those who did (AOR = 0.14; 95% CI 0.03–0.6). Comparably, patients with hypertension comorbidity were 70% (AOR = 0.3; 95% CI 0.1–0.6) less likely to have good prostatectomy outcomes. On the other hand, patients who underwent transurethral resection of the prostate (TURP) had twice the odds of a good prostatectomy outcome compared to those who underwent transvesical prostatectomy (TVP) (AOR = 2; 95% CI 1.5–5.4). Moreover, patients who received preoperative oral medical therapy for benign prostatic hyperplasia (BPH) were twice as likely to experience poor prostatectomy outcomes compared to those who did not take preoperative medical therapy (AOR = 2; 95% CI 1.2–8.7). Similarly, patients with a prostate volume of 100–200 cm3 were five times more likely to develop poor prostatectomy outcomes compared to those with a prostate volume of 30–60 cm3 (AOR = 5; 95% CI 2.3–10).ConclusionsA total of 16.5% of the participants experienced poor outcomes following prostatectomy. The factors associated with these outcomes included venous thromboembolism prophylaxis intake, appropriate wound care, hypertension as a comorbidity, surgical modality, preoperative oral medication therapy for BPH, and prostate volume.

Hypertension and Cognitive Disorders.

Systemic hypertension is possibly the most important modifiable risk factor for the development of cognitive decline, both for mild cognitive impairment (MCI) and dementia. For effective blood pressure (BP) control, it requires proper assessment, using brachial, central, and ambulatory measurements, and monitoring with a focus on different BP parameters. Different BP parameters like pulse pressure, mean arterial pressure, BP variability, and circadian parameters, like nondippers and early morning surge, should be considered in the evaluation for the risk of cognitive decline due to hypertension in middle age and older adults. Chronic hypertension causes vascular remodeling in the brain and leads to brain failure or cognitive decline. Achieving specific BP goals can improve clinical outcomes and possibly slow down cognitive decline for patients with comorbid hypertension and cognitive impairment.

High Altitude is an Independent Risk Factor for Postoperative Venous Thromboembolism Following Primary Total Knee Arthroplasty: A Large Database Study.

High altitude may induce physiological changes that can predispose patients to venous thromboembolism (VTE), a relatively uncommon, but potentially fatal complication following total knee arthroplasty (TKA). The purpose of this study was to determine if high altitude is an independent risk factor for postoperative VTE following TKA. A large claims database was queried for patients who underwent TKA at high-altitude (≥ 1,219-meters) and low-altitude (≤ 30-meters) using Current Procedural Terminology codes, International Classification of Disease codes, and zip codes. High- and low-altitude cohorts were matched 1:3 by 5-year age range, sex, Charlson comorbidity index (CCI), diabetes mellitus, obesity (body mass index ≥ 30), hypertension, and tobacco use. There were 57,135 patients included in the high-altitude group and 171,322 in the low-altitude group. Outcome measures included 30- and 90-day incidence of VTE, deep venous thrombosis (DVT), and pulmonary embolism (PE). Chi-square was used to determine differences in demographics. Binomial logistic regression was used to determine postoperative rates of VTE, DVT, and PE. The incidence of VTE was significantly greater in the high-altitude versus the low-altitude group at 30-days (OR [odds ratio] 1.15 [95% CI (confidence interval) 1.02 to 1.30], P = 0.022) and 90-days (OR 1.20 [95% CI 1.08 to 1.34], P = 0.0007). The incidence of DVT was significantly higher for the high-altitude cohort at both 30- (OR 1.30 [95% CI 1.10 to 1.54], P = 0.002) and 90-days (OR 1.36 [95% CI 1.18 to 1.57], P < 0.0001). The incidence of PE within 30- and 90-days was not significantly different between groups. High altitude (> 1,219-meters) is an independent risk factor for VTE following TKA. Patients who undergo TKA at surgical centers greater than 1,219-meters in elevation are more likely to develop VTE and DVT within 30- and 90-days postoperatively. Surgeons may account for high altitude as a risk factor and determine the most suitable postoperative prophylaxis method for their patients.

Addiction to Smartphone Use in Smokers Diagnosed with Type 2 Diabetes in Jordan: Are Their Medications Involved?

The prevalence of type 2 diabetes and smoking is increasing in developing countries and is associated with deteriorated health outcomes. Also, addiction to smartphone use is an alarming behavior that can be associated with clinical factors. This study aimed to determine the prevalence and clinical correlates of smartphone addiction in smokers with T2DM in Jordan, with a particular focus on the role of medications. This cross-sectional study recruited patients from Prince Hamza Hospital, Jordan, according to pre-defined criteria. Besides demographics and clinical information, this study used the validated Arabic version of the Smartphone Addiction Scale to assess addiction to smartphones and a multivariable regression analysis to identify the correlates of smartphone addiction. Data analyzed from 346 patients revealed that 117 (33.8%) of these participants reported addiction to smartphones. Patients who had been diagnosed with T2DM for less than five years (aOR = 3.30; 95% CI = 1.43-7.60), who were "employed" (aOR = 8.85; 95% CI = 2.20-35.64), and who were "retired" (aOR = 11.46; 95% CI = 2.72-48.23) all reported a significantly (p < 0.05) higher odds of smartphone addiction. In contrast, patients on "sulfonylurea" (aOR = 0.18; 95% CI = 0.06-0.53); "metformin" (aOR = 0.19; 95% CI = 0.06-0.66), and "gabapentin" (aOR = 0.16; 95% CI = 0.04-0.67) and those with "comorbid hypertension" (aOR = 0.15; 95% CI = 0.06-0.38) had a significantly (p < 0.05) lower odds of smartphone addiction. These alarming results require adequate action from the health authorities to raise awareness of adopting positive behaviors that could improve the well-being of this high-risk population.

The efficacy of norepinephrine application in Mammotome-assisted minimally invasive resection for benign breast neoplasm: A retrospective study

ObjectiveAlthough Mammotome-assisted minimally invasive resection (MAMIR) has been widely accepted for treating breast benign nodules, the procedure remains very technical and challenging. The present study aimed to assess the efficacy of norepinephrine application in MAMIR concerning intraoperative hemorrhage, postoperative pain and postoperative hospitalization.MethodsA total of 306 patients with breast nodules admitted at the Xishan people’s Hospital of Wuxi City between June 2021 and July 2023 were included in this retrospective cohort study. The patient’s age, comorbidities (hypertension and diabetes), and characteristics of the breast nodule (number, unilateral or bilateral nature, inner quadrant volume and total volume) were all meticulously documented. Operation time, intraoperative hemorrhage, postoperative hospitalization and Visual analogue scale(VAS) score (postoperative 6-hour pain score) were recorded. Based on the application of norepinephrine, patients were categorized into non-NPP(norepinephrine) and NPP group. Univariate and multivariate analyses were performed to estimate the odds ratio (OR) and the 95% confidence intervals (CIs) for outcomes.ResultsA total of 155 who accepted MAMIR were included in this study. The NPP group exhibited reduced intraoperative bleeding, diminished postoperative pain, and a shorter duration of hospitalization (p < 0.05). Univariable analysis indicated that usage of norepinephrine during operation helped to reduce intraoperative hemorrhage (OR = 0.14, 95%CI: 0.07–0.31), alleviate postoperative pain(OR = 0.03, 95%CI: 0.01–0.09) and shorten hospital stay(OR = 0.50, 95%CI: 0.26–0.95). Furthermore, multivariate analysis identified the usage of norepinephrine during MAMIR as an independent factor associated with reducing intraoperative hemorrhage (OR = 0.11, 95%CI: 0.05–0.26) and relieving postoperative pain (OR = 0.02, 95%CI: 0.004–0.08) after adjusting for other factories.ConclusionsNorepinephrine could help to reduce postoperative hospitalization and intraoperative hemorrhage, also relieve postoperative pain for breast benign nodules resection, which was an independent protective factor for relieving postoperative pain and reducing intraoperative hemorrhage.

Impacts of hypertension and diabetes on the incidence of cardiovascular diseases and all-cause mortality: findings from the China Health and Retirement Longitudinal Study cohort.

The study aimed to examine the individual and joint effects of hypertension and diabetes on cardiovascular diseases and all-cause mortality among the middle-aged and older Chinese population. A total of 9681 individuals without preexisting CVD from the China Health and Retirement Longitudinal Study (CHARLS) were included. Participants were classified into four different groups: hypertension alone, diabetes alone, both conditions, neither condition. Multivariate Cox proportional hazards models were performed to estimate the risks of all-cause mortality and CVD. During the 7-year follow-up, 967 deaths and 1535 CVD events were documented. Compared to individuals without hypertension and diabetes, hypertension alone [adjusted hazard ratio (aHR) 1.571, 95% confidence interval (CI) 1.316-1.875, P < 0.001], diabetes alone (aHR 1.618, 95% CI 1.187-2.205, P < 0.01) and comorbid hypertension and diabetes (aHR 2.041, 95% CI 1.557-2.677, P < 0.001) increased risks of all-cause mortality. The aHRs for CVD events in individuals with both conditions, hypertension alone and diabetes only were 2.011 (95% CI 1.651-2.449, P < 0.001), 1.408 (95% CI 1.233-1.608, P < 0.001) and 1.036 (95% CI 0.808-1.327, P > 0.05), respectively. The risk of CVD among those with comorbid hypertension and diabetes exceeded the sum of the risks due to hypertension and diabetes alone (relative excess risk ratio = 0.567, 95% CI 0.136-0.999). Individuals with comorbid hypertension and diabetes had greater risks of CVD and all-cause mortality, beyond those associated with either condition alone. The synergistic interaction between hypertension and diabetes aggravated the risk of CVD.

Prevalence, risk factors, and severity of erectile dysfunction following renal transplantation.

Sexual dysfunction is common among dialysis and transplant patients. Our study evaluated the prevalence, risk factors, and severity of erectile dysfunction (ED) post-transplant in a single center. We conducted a single-centre, observational, non-interventional study of adult male renal graft recipients. Sociodemographic and clinical data were collected, and erectile function was assessed with the International Index of Erectile Function (IIEF) questionnaire. 179 patients transplanted between 1995 and 2021 were enrolled (170 answered the questionnaire). Mild, moderate, and severe ED was noted in 33.5%, 20.6% and 10.6% of cases, respectively. ED prevalence increased with age (42.6% of patients < 40, 47.4% of patients aged 40-60, 78.9% of patients > 60). The total mean IIEF score was 16.32 ± 6.93 (erectile function 19.22 ± 7.9, orgasmic function 6.8 ± 2.9, sexual desire 6.43 ± 2.1, intercourse satisfaction 8.96 ± 3.7, overall satisfaction 6.78 ± 2.6). Age, alcohol consumption, type, time on dialysis pre-transplant, and donor type were significantly associated with erectile dysfunction (p < 0.05). Most patients (93.5%) were treated for comorbidities in addition to immunosuppression. Severe ED was significantly more common among patients taking alpha blockers and non-steroidal anti-inflammatory drugs. Self-reported erectile dysfunction post renal transplantation seems influenced by age, alcohol intake, dialysis history, donor type and certain drugs, but not by comorbidities (hypertension, diabetes, heart disease).

The 30-Days readmission among hepatic encephalopathy patients and the associated factors: An experience of a tertiary care hospital in Karachi Pakistan.

Objective: To determine the 30-days readmission rate among hepatic encephalopathy patients and its associated factors among patients admitted in a tertiary care hospital. Study Design: Prospective Cohort study. Setting: Department of Gastroenterology, Liaquat National Hospital, Karachi, Pakistan. Period: July 2023 to June 2024. Methods: Patients of cirrhosis with hepatic encephalopathy discharged from hospital were followed up in out-patient and inpatient department as per the hospital protocol. Data were entered into SPSS version 26 to perform statistical analysis. Results: Total 215 patients were included into the study. Mean age of patients was 55.40 ± 11.05 years and most of the patients were males (59.3%). Incidence of 30 day readmission was 15.3%. Causes of readmission were constipation (51.5%), infection (30.3%), electrolyte imbalance (12.1%) and renal failure (6.1%). Presence of hypertension and diabetes was associated with increased risk of readmission. Increasing potassium levels at the time of discharge were also found to be associated with increased readmission rate. Conclusion: The present study analyzed that main cause of 30 days readmissions were incidence of constipation and infection after discharge. Moreover, the study also showed that patients with comorbidity of hypertension and diabetes were likely to readmit.