Medical Comorbidities In Patients Research Articles

A Study on Suicidal Intent, Quality of Life, Medical and Psychiatric Comorbidity in Cancer Patients at a Tertiary Care Hospital in Puducherry

Background- Cancer is now widely recognised as a new epidemic globally which accounts for nearly 10 million deaths in year 2020. Aims and Objectives-The aim of the study was to estimate suicidal ideation among cancer patients and to evaluate the association between suicidal intent with the quality of life, medical and psychiatric comorbidities. Methods-The study group included 70 cancer patients who were surgically treated in the Department of Surgical Oncology in a tertiary care hospital in South India. The sample size was calculated using Open Epi Version 3.0. Sampling was done using consecutive sampling method. The study was conducted from March 2021 to September 2022. A socio-demographic information form, HADS (Hospital Anxiety Depression Scale), Beck Suicide Intent Scale and WHO-QOL BREF (WHO Quality of Life BREF) were used. Results- In our study 12.9% reported having attempted suicide in the recent past, 18.6% scored abnormal on anxiety scale and 40% scored depression level on HADS. Conclusions- Cancer patients are at increased risk of developing many psychiatric illnesses including anxiety, depression and suicidal attempts. The QOL of cancer patients are affected by these psychiatric comorbidities. Timely assessment and intervention can improve their QOL and also reduce the risks of suicide. There is a significant correlation between anxiety, depression and suicide attempt. Keywords: Suicide, Anxiety, Quality of Life, Cancer .

Medical comorbidities in patients with prolonged disorder of consciousness: A narrative review.

A few studies specifically addressed medical comorbidities (MCs) in patients with severe acquired traumatic or non-traumatic brain injury and prolonged disorders of consciousness (pDoC; i.e., patients in vegetative state/unresponsive wakefulness syndrome, VS/UWS, or in minimally conscious state, MCS). To provide an overview on incidence of MCs in patients with pDoC. Narrative review on most impacting MCs in patients with pDoC, both those directly related to brain damage (epilepsy, neurosurgical complications, spasticity, paroxysmal sympathetic hyperactivity, PSH), and those related to severe disability and prolonged immobility (respiratory comorbidities, endocrine disorders, metabolic abnormalities, heterotopic ossifications). Patients with pDoC are at high risk to develop at least one MC. Moderate or severe respiratory and musculoskeletal comorbidities are the most common MCs. Epilepsy and PSH seem to be more frequent in patients in VS/UWS compared to patients in MCS, likely because of higher severity in the brain damage in VS. Endocrine metabolic, PSH and respiratory complications are less frequent in traumatic etiology, whereas neurogenic heterotopic ossifications are more frequent in traumatic etiology. Spasticity did not significantly differ between VS/UWS and MCS and in the three etiologies. MCs are associated with higher mortality rates, worse clinical improvement and can impact accuracy in the clinical diagnosis. The frequent occurrence of several MCs requires a specialized rehabilitative setting with high level of multidisciplinary medical expertise to prevent, appropriately recognize and treat them. Comprehensive rehabilitation could avoid possible progression to more serious complications that can negatively impact clinical outcomes.

Increased Medical Comorbidities in Essential Tremor—A Wake-up Call?

I read with great interest the article by Dai et al1 and was intrigued by data that demonstrated significant increases in the prevalence of numerous medical comorbidities in patients with essential tremor (ET). The authors reported that patients with ET had a higher number of comorbidities than non-ET patients (5.3 [3.2] vs 4.0 [3.3]).

Functional (Psychogenic) Seizures are Associated with Thyroid Disorders

Objective: We investigated medical comorbidities in patients with functional seizures (FS) and those with epilepsy (idiopathic generalized epilepsies [IGEs] or temporal lobe epilepsy [TLE]). We hypothesized that the nature of medical comorbidities differs between these three groups. This might be helpful to postulate on the pathophysiology of FS. Materials and Methods: In a retrospective study, all adult patients with a diagnosis of IGE, TLE, or FS were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Iran, from 2008 until 2020. The three groups of patients were matched with regard to their age. Age, sex, and medical comorbidities were registered routinely for all patients at the time of the first visit. Results: Nine hundred and sixty-six patients were studied (254 patients with IGE, 467 persons with TLE, and 245 individuals with FS). The groups differed significantly with regard to having medical comorbidities. The most striking difference was comorbid thyroid disorders; this was more common among patients with FS. The diagnosis of FS was independently significantly associated with thyroid disorder comorbidity (odds ratio: 2.77, 95% confidence interval: 1.06–7.23; P = 0.038). Conclusion: Thyroid disorders are significantly associated with FS. We can make the following suggestions to advance the field: a. It is necessary to reproduce this observation in larger multicenter studies; b. We recommend to evaluate thyroid function in all patients with FS; c. It might be helpful to design clinical trials to investigate whether correction of any clinical or subclinical thyroid disorders changes the treatment outcome in patients with FS.

Comorbidities in Patients with Lichen Planopilaris: A Case-Control Study

Introduction: Lichen planopilaris (LPP) is a lymphocyte-mediated type of scarring alopecia and considered to have autoimmune etiology. Studies about systemic comorbid conditions are limited. Our goal is to identify the prevalence of medical comorbidities in patients with LPP. Methods: In a retrospective case-control study, the medical records of 208 LPP patients and 208 controls were reviewed for existing comorbidities such as thyroid diseases, cardiovascular disorders, hypertension, hyperlipidemia, and lupus erythematous. Results: Hyperlipidemia was found in 41.8% of all patients with LPP and in 17.3% of controls (p value <0.001, OR = 4.167). Chances of hypertension and cardiovascular disorders were lower in the LPP group in comparison to controls (p value = 0.009). Thyroid disorders were more prevalent in LPP patients, but the difference was not statistically significant (p value = 0.277). Conclusion: Our study further emphasizes that LPP patients should be screened for medical comorbidities, especially lipid profile abnormalities.

Frequency of medical comorbidities in patients attending ORM &amp; Maxillofacial Surgery Department at University College of Dentitistry, University of Lahore.

Objectives: To find the frequency and type of comorbid conditions in patients presenting with oral diseases. Study Design: Observational study. Setting: Department of Oral and Maxillofacial Surgery, University College of Dentistry, University of Lahore. Period: January 2018 to December 2019. Material &amp; Methods: After approval from the ethical committee, all cases presenting with oral diseases to the oral and maxillofacial surgery department were recruited consecutively. A thorough history and relevant examinations were made. All the previous records of the patient, including laboratory tests and the medical summary, were reviewed for the existence of any comorbid conditions. The data was entered on the spreadsheet. Descriptive statistics were used. Frequencies and percentages were calculated for comorbid conditions. Results: This study included 17155 patients who visited the oral and maxillofacial surgery department for procedures related to oral surgery. Others patients presenting to other departments of dentistry were excluded. Out of these, 4056 patients (24%) had comorbid conditions. Among these patients, 77% had single comorbid condition and 23% had multiple systemic disease. The most common comorbid condition was hypertension (77%), followed by diabetes (33%) and hepatitis (11%). Conclusion: A high prevalence of comorbidities was found in our study. Hypertension, diabetes mellitus, and hepatitis C were the common comorbidities. In addition, a significant number of patients had multiple comorbidities.

Association of Economic Well-Being With Comorbid Conditions in Patients Undergoing Carpal Tunnel Release

Medical comorbidities have been associated with the development of carpal tunnel syndrome (CTS), severity at the time of presentation, and outcomes of carpal tunnel release (CTR). Socioeconomic factors have also been associated with worse function in patients with CTS at presentation and after surgery. However, the effects of economic well-being on the prevalence of medical comorbidities in patients with CTS have not been well-described. The objective of this study was to determine whether economic well-being is associated with medical comorbidities in a cohort of patients undergoing CTR. Patients (n= 1,297) who underwent CTR at a single tertiary care referral center over a 5-year period from July 2008 to June 2013 were retrospectively identified. The exclusion criteria were acute trauma or infection, revision surgery, incomplete medical records, and neoplasm excision. Additionally, patients were excluded if they lacked documented confirmatory or normal electrodiagnostic study findings prior to CTR. Finally, this study comprised a cohort of 892 patients with electrodiagnostic study-confirmed CTS who underwent CTR. The economic well-being of patients was assessed using the Distressed Communities Index. The comorbidities of diabetes mellitus, chronic kidney disease, hypertension, hypothyroidism, cervical radiculopathy, tobacco use, and body mass index were assessed. Bivariate comparisons were used to determine the associations between the tiers of economic well-being and comorbidities. Lower economic well-being was associated with body mass index, diabetes mellitus, chronic kidney disease, and tobacco use in these patients. Although hypertension, hypothyroidism, and cervical radiculopathy were not associated with economic well-being, their comparisons were underpowered. Patients experiencing economic distress have a higher comorbidity burden, and as such, may be at an increased risk of complications or poorer outcomes. The association between economic well-being and comorbidities in this population suggests the need for a multidisciplinary care model that addresses both compressive neuropathy and the associated economic factors. Prognostic II.

Medical comorbidities and orbital implant exposure.

To investigate medical conditions and systemic therapies associated with orbital implant exposure in patients with anophthalmic sockets. Retrospective review of patients who underwent enucleation or evisceration at a single centre between January 1, 2008 and March 1, 2018. Medical comorbidities, including peripheral or coronary artery disease, rheumatologic conditions, diabetes, malignancy and history of smoking were recorded. Use of immunomodulatory and anticoagulation therapy at the time of eye removal was noted. Patients were divided into two groups-those with implant exposure and those without. Univariate and multivariate analysis was used to compare groups. Two hundred and twenty-nine patients underwent eye removal surgery over a ten-year period. Implant exposure was seen in 20 (8.7%) patients. Univariate analysis revealed a statistically significant difference between groups in rates of smoking, malignancy, and immunomodulatory therapy at the time of surgery. A history of smoking (HR = 11.72; 95% CI: 2.95, 46.53; p = 0.0001) and immunomodulatory therapy (HR = 8.02; 95% CI: 1.96, 32.87; p = 0.004) were independent predictors of exposure. The probability of exposure was 81.2% when all three risk factors were present versus 4.4% when none were present (c-index = 0.737, 95% CI: 0.608, 0.865; p < 0.001). The model was a good fit to the data (Hosmer-Lemeshow goodness-of-fit test p = 0.475). Smoking and immunomodulatory therapy were associated with orbital implant exposure in patients with anophthalmic sockets. This is the first report examining medical comorbidities in patients with orbital implant exposure. Understanding the pathophysiology of implant exposure is crucial to preoperative planning and postoperative care.

Medical comorbidities of patients presenting to an adult neurodevelopmental new case clinic in Singapore

AimsTo describe the occurrence of medical comorbity in patients with neurodevelopmental disorders presenting to the Adult Neurodevelopmental Service (ANDS) multi-disciplinary new case clinic at the Institute of Mental Health (IMH) in Singapore. We hypothesize that patients with neurodevelopmental disorders have higher rates of medical comorbidity compared to those without a diagnosis of neurodevelopmental disorder.BackgroundMedical comorbidities are common in patients with neurodevelopmental disorders. They may have difficulties managing their medical conditions which could in turn affect their well being, quality of life and life expectancy.MethodA retrospective cohort study was conducted amongst patients who presented to the clinic from January 2015 to December 2016. The electronic case records of the assessments were de-identified and the medical conditions of patients were collected and analysed.Result319 patients attended the ANDS new case clinic in the 2-year study period. 87.1% (278/319) were diagnosed with a neurodevelopmental disorder while 12.9% (41/319) did not receive any diagnosis of a neurodevelopmental disorder.58.3% (162/278) of patients with a neurodevelopmental disorder had at least 1 medical comorbidity while only 31.7% (13/41) of patients with no neurodevelopmental disorder had at least 1 medical condition.Patients with neurodevelopmental disorders had higher rates of epilepsy (12.2% vs 4.9%), cerebral palsy (3.2% vs 0%) but lower rates of having other neurological conditions (1.4% vs 7.3%) compared to those with no neurodevelopmental disorders.Patients with neurodevelopmental disorders had higher rates of diabetes (6.1% vs 2.4%), hypertension (6.1% vs 2.4%), hyperlipidaemia (7.1% vs 2.4%) and cardiovascular conditions (2.9% vs 0%) than those without a neurodevelopmental disorder.In terms of other medical comorbidities, patients with neurodevelopmental disorders had higher rates of thyroid abnormalities (4.7% vs 2.4%), respiratory problems (7.6% vs 2.4%), musculoskeletal conditions (5.8% vs 0%), eye issues (5% vs 2.4%) and hearing problems (2.9% vs 0%) but similar rates of dermatological conditions (10.1% vs 9.8%) and gastrointestinal conditions (4.7% vs 4.9%) compared to those with no neurodevelopmental disorders.ConclusionPatients with neurodevelopmental disorders have significantly highly rates of medical comorbidity than those without any neurodevelopmental disorders. This study highlights the need to raise awareness of the common medical comorbidities in patients with neurodevelopmental disorders and to ensure adequate screening and referral for follow-up medical care for them.

Scientific and Clinical Challenges within Neuro-Oncology

Both primary and metastatic brain tumors carry poor prognoses despite modern advances in medical therapy, radiation therapy, and surgical techniques. Gliomas, including glioblastoma (GBM), are particularly difficult to treat, and high-grade gliomas have poor outcomes. Treatment of brain tumors involves a unique set of scientific and clinical challenges, which are often not present in the treatment of systemic malignancies. With respect to scientific challenges, the anatomy and physiology of brain tumors (including the blood-brain barrier, blood-tumor barrier, and blood-cerebrospinal fluid barrier) prevent adequate drug delivery into the central nervous system. The unique nature of the immune system in the central nervous system as well as the immunosuppressive microenvironment of tumors such as GBM also create therapeutic roadblocks in the treatment of brain tumors. Tumor heterogeneity, particularly in GBM, has classically been believed to contribute to multitherapy resistance; however, recent data suggest that this may not be the case. Clinical challenges include neurologic and medical comorbidities of patients with brain tumor, as well as potential toxicity of tumor-directed treatment. Clinical trials investigating new treatment paradigms are needed, but several roadblocks exist to good and promising clinical trial availability.

Otorhinolaryngological manifestations of coronavirus disease 2019: a prospective review of 600 patients.

To evaluate otorhinolaryngological manifestations of coronavirus disease 2019 infection and the time required for their resolution. A prospective analysis was conducted of coronavirus disease 2019 patients presenting from 1 April 2020 to 30 July 2020. The otorhinolaryngological manifestations were evaluated based on patient history. The time required for symptom resolution was evaluated separately for intensive care unit and non-intensive care unit patients. A total of 600 patients were included in the study; 13.3 per cent required the intensive care unit and 2.2 per cent expired. The otorhinolaryngological manifestations were: sore throat (88 per cent), fever (78.8 per cent), anosmia or hyposmia (63.6 per cent), ageusia or hypogeusia (63.5 per cent), rhinorrhoea (51.3 per cent), nasal obstruction (33.5 per cent), sneezing (30.3 per cent), and breathing difficulty (18.6 per cent). The time required for symptom resolution was longest for breathing difficulty (23.6 days for intensive care unit and 8.2 days for non-intensive care unit patients). Otorhinolaryngological symptoms are one of the main presentations of coronavirus disease 2019 infection. The increased prevalence of medical co-morbidities in patients requiring intensive care unit and in deceased patients is also highlighted.

Psychosocial Syndemics and Multimorbidity in Patients with Heart Failure †.

Heart failure (HF) is a common cause of hospitalization and mortality in older adults. HF is almost always embedded within a larger pattern of multimorbidity, yet many studies exclude patients with complex psychiatric and medical comorbidities or cognitive impairment. This has left significant gaps in research on the problems and treatment of patients with HF. In addition, HF is only one of multiple challenges facing patients with multimorbidity, stressful socioeconomic circumstances, and psychosocial problems. The purpose of this study is to identify combinations of comorbidities and health disparities that may affect HF outcomes and require different mixtures of medical, psychological, and social services to address. The syndemics framework has yielded important insights into other disorders such as HIV/AIDS, but it has not been applied to the complex psychosocial problems of patients with HF. The multimorbidity framework is an alternative approach for investigating the effects of multiple comorbidities on health outcomes. The specific aims are: (1) to determine the coprevalence of psychiatric and medical comorbidities in patients with HF (n = 535); (2) to determine whether coprevalent comorbidities have synergistic effects on readmissions, mortality, self-care, and global health; (3) to identify vulnerable subpopulations of patients with HF who have high coprevalences of syndemic comorbidities; (4) to determine the extent to which syndemic comorbidities explain adverse HF outcomes in vulnerable subgroups of patients with HF; and (5) to determine the effects of multimorbidity on readmissions, mortality, self-care, and global health.

18-Year Operative Incidence and Cost Analysis of the Treatment of Adult Acquired Flatfoot Deformity.

Background:Adult acquired flatfoot (AAFD) is commonly treated by foot and ankle surgeons. Despite how commonly this disease presents, its incidence and economic impact have yet to be defined. We hypothesized that the operative incidence of AAFD and its economic burden would increase over the time period 1996 to 2014.Methods:The South Carolina database was queried for data from acute care and ambulatory surgery centers. Bivariate descriptive statistics were used to analyze the data. Operative incidence was calculated and demographics and medical comorbidities of patients who progressed to operative intervention were analyzed. Costs associated with operative care episodes were calculated to determine the economic burden.Results:A total of 1299 patients underwent AAFD corrective surgery between 1996 and 2014. Patients who underwent surgery for AAFD were most likely to be white, female, and in their fourth, fifth, and sixth decade of life. Operative incidence for AAFD rose from 0.26 per 100 000 covered lives in 1996 to 3.04 in 2014. The total health care costs associated with patients who underwent surgery for AAFD increased from $57 395.33 in 1996 to $6 859 723.60 in 2014.Conclusions:This data demonstrate that patients most commonly undergoing operative intervention for AAFD were white, female, and in their fourth, fifth, or sixth decade of life. There has been a significant increase in operative incidence, which may help direct attention to further exploration of outcome data in these patient populations, associated treatment costs, and preventative treatment options.Level of Evidence:Level III, retrospective comparative study.

The prevalence of self-reported medical comorbidities in patients with vulvar lichen sclerosus: A single-center retrospective study.

To compare the demographics and self-reported medical comorbidities of patients with vulvar lichen sclerosus (VLS) with those of women with other vulvar conditions. Intake questionnaires for patients presenting to the University of Michigan Center for Vulvar Diseases between 1996 and 2019 were entered into a de-identified database (n=1983). Responses to questions about thyroid disease, urinary symptoms and signs, gastrointestinal conditions, and pain conditions were collected. A total of 1983 women, including 865 patients with VLS and 1118 patients without VLS were enrolled. Pearson's χ2 analysis showed that age, hypertension, anorectal fissures, peptic ulcer disease/gastroesophageal reflux disease, urinary incontinence, fibromyalgia, thyroid disease, kidney problems, liver problems, and cancer were significantly associated with VLS when compared between the VLS and non-VLS groups (P<0.01). However, multiple regression analysis demonstrated that only age, thyroid disease, and anorectal fissures were strongly associated with VLS (P<0.01). Increasing age, thyroid disease, and anorectal fissures were significantly associated with VLS. The association between anorectal fissures and VLS likely represents a sequela of the disease rather than a true comorbidity.

Risk Factors for 30- and 90-Day Readmission due to Intestinal Bowel Obstruction after Posterior Lumbar Fusion.

Study DesignA retrospective analysis of data from the Healthcare Cost and Utilization Project Nationwide Readmissions Database (HCUP-NRD).PurposeTo identify the perioperative characteristics associated with 30-day and 90-day readmission due to intestinal bowel obstructions (IBOs) following posterior lumbar fusion (PLF) procedure.Overview of LiteraturePLF procedures are used to repair spinal injuries and curvature deformities. IBO is a common surgical complication and its repair often necessitates surgery that increases the readmission rates and healthcare costs. Previous studies have identified the preoperative risk factors for 30-day readmissions in PLF; however, no study has specifically investigated IBO or identified risk factors for 90-day readmissions.MethodsData on demographic characteristics and medical comorbidities of patients who underwent PLF with subsequent readmission were obtained from the HCUP-NRD. The perioperative characteristics that were significantly different between patients readmitted with and without an active diagnosis of IBO were identified with bivariate analysis for both 30-day and 90-day readmissions. The significant characteristics were then included in a multivariate analysis to identify those that were independently associated with 30-day and 90-day readmissions.ResultsDrug abuse (odds ratio [OR], 4.00), uncomplicated diabetes (OR, 2.06), having Medicare insurance (OR, 1.65), age 55–64 years (OR, 2.42), age 65–79 years (OR, 2.77), and age >80 years (OR, 3.87) were significant risk factors for 30-day readmission attributable to IBO after a PLF procedure.ConclusionsOf the several preoperative risk factors identified for readmission with IBO after PLF surgery, drug abuse had the strongest association and was likely to be the most clinically relevant factor. Physicians and care teams should understand the risks of opioid-based pain management regimens, attempt to manage pain with a multimodal approach, and minimize the opioid use.

Clinical correlates of high burden of general medical comorbidities in patients with bipolar disorder

ABSTRACT Background Bipolar disorder is associated with an increased burden of general medical conditions that might be related to a more severe illness course. Methods This is a cross-sectional study that evaluated clinical correlates of general medical comorbidities in outpatients with bipolar disorder (BD) involving 203 adult patients with a DSM-IV diagnosis of BD, consecutively recruited from the Bipolar Research Program (PROTAHBI) in Porto Alegre, Brazil. Clinical, demographic and anthropometrical variables were systematically assessed, and general medical comorbidity was measured using the Cumulative Illness Rating Scale (CIRS). Results The prevalence of one or more medical comorbidities was 90.1%. The most common were those from endocrine/metabolic/breast, neurologic and vascular categories. A high burden of general medical comorbidities (defined as CIRS total score ≥ 4) was related to increasing age and body mass index and longer duration of illness after controlling for confounding factors. Limitations The cross-sectional design limits our ability to make causal conclusions. Also, our sample consisted of patients with longer illness duration from a tertiary clinic and may not generalize to the whole spectrum of bipolar disorder. Conclusions BD was associated with a high burden of general medical conditions related to age, obesity and longer duration of illness. Medical comorbidities must be incorporated as a core feature in the development of effective treatment strategies for bipolar disorder.

Medical comorbidities in patients with chronic lymphocytic leukaemia treated with idelalisib: analysis of two large randomised clinical trials.

Comorbidities influence survival in patients with chronic lymphocytic leukaemia (CLL) treated with chemo-immunotherapy or ibrutinib. While idelalisib has been studied in patients with comorbidities, their impact has not been investigated. We analysed 481 patients treated with idelalisib on two randomised trials (NCT01659021 and NCT01539512). Comorbidities were assessed using the Cumulative Illness Risk Scale (CIRS). Patients received idelalisib+anti-CD20 (rituximab or ofatumumab; n=284) or anti-CD20 alone (n=197). The median age was 69years. We found that comorbidities did not significantly affect outcomes of idelalisib therapy. The objective response rate (ORR) was 79·3% versus 85·8%, the median progression-free survival (PFS) was 16·3 versus 19·1months, and the median overall survival (OS) was 39·8 versus 49·8months in patients treated with idelalisib who had a CIRS score of >6 versus ≤6, correspondingly. Treatment with idelalisib+anti-CD20 was associated with superior PFS and ORR when compared to anti-CD20 monotherapy in patients who had high comorbidities (CIRS score of >6) or at least one severe comorbidity (median PFS 16·3 vs. 6·9months and 16·6 vs. 6·5months; odds ratio 20·1 and 33·2; P<0·0001). Thus, comorbidities do not portend inferior outcomes in patients with CLL treated with idelalisib in combination with anti-CD20 therapy.

Severe Acute Respiratory Syndrome Coronavirus 2 is Penetrating to Dementia Research.

Severe Acute Respiratory Syndrome Coronavirus 2 is Penetrating to Dementia Research.

Investigating the impact of medical comorbidities in patients taking beta blockers and treated with immunotherapy for metastatic melanoma.

e15162 Background: Combined administration of β-adrenergic antagonist with IL-2, anti-PD-1, and/or anti-CTLA-4 immunotherapy was associated with a better overall survival in metastatic melanoma patients. This result was also reinforced by the significant reduction in tumor growth in a murine melanoma model when a β2-selective antagonist was combined with anti-PD1/IL-2 immunotherapy. Here we sought to elucidate the impact of the various comorbidities behind the indications of β-blockers, and how they might have influenced the patients’ immunotherapy treatment response. Methods: A single-institution retrospective chart review was performed to examine the medical comorbidities with indications for β-blockers in the melanoma patients who received IL-2, αPD-1 and/or αCTLA-4 immunotherapy between January 2000 and March 2015. Two groups were identified: one that took a selective β-1 blocker (N = 41), and another that took a nonselective pan β-blocker (N = 17). The primary analysis compared the distribution of different comorbidity types between two groups, using the Fisher’s exact test. A secondary analysis examined the association of overall survival and the β-blocker groups by further controlling for comorbid conditions, using the multivariate Cox Proportional-Hazard regression model. Results: Seven different comorbidities with indications for β-blocker usage were identified. Of those comorbidities, only the presence of ischemic heart disease was marginally different between the two groups (β-1 group 19.5% vs. pan-β group 47.1%, p-value = 0.0697). There was no difference for overall survival between each of the comorbidity conditions. When performing the multivariate Cox Proportional-Hazard regression model, β-blocker usage still remained statistically significant for the overall survival (HR 0.27, CI 0.0966-0.768, p = 0.0139), even after controlling for the comorbid conditions. Conclusions: Immunotherapy with pan β-adrenergic blockade was associated with a significantly improved overall survival rate for metastatic melanoma. Furthermore, having a comorbid condition that indicated for the prescription of β-blockers was not a factor in establishing this survival rate.

Challenges of facing coronavirus disease 2019: Psychiatric services for patients with mental disorders

As a public health emergency of international concern as declared by the World Health Organization (WHO), the current outbreak of coronavirus disease (COVID-19) in China has captured the world's attention.1 The global COVID-19 outbreak can now be characterized as a pandemic, and the number of confirmed cases all over the world has increased to 416 686 as of 04:34 hours, 26 March 2020, according to data released by the WHO.1 International journals for general medical and specialty fields are working closely with experts across the globe to raise comment and provide advice on measures to protect mental health in this epidemic.2, 3 We have enormous respect for those who have most recently published the latest content on this new virus; however, it is time for a change in focus. In addition to the challenges faced by medical professionals and the general public, the mental health services for patients suffering from mental disorders have several challenges to face. To this end, a guideline document was recently issued by the government of the People's Republic of China with respect to strengthening the management of treatment for patients with severe mental disorders during the outbreak of COVID-19.4 Afterwards, an expert consensus on the managing pathway and coping strategies for patients with mental disorders during prevention and control of the outbreak of a serious infectious disease (novel coronavirus pneumonia) was published by the Chinese Society of Psychiatry together with other psychiatry-related academic organizations.5 However, we are under challenging conditions to effectively deal with the realistic problems in the psychiatric domain caused by the COVID-19 outbreak. A nationwide epidemiological survey reported that the lifetime prevalence of any psychiatric disorder is 16.6% in China.6 Many patients need ongoing support in outpatient clinics, and many require repeated readmissions to inpatient wards, and vice versa. Psychiatrists assess patients, advise them and their guardian, and provide long-term treatments at hospitals. The difficulty in maintenance treatment of individual patients with mental disorders is currently increased for several reasons. First, under strict control due to the epidemic, most of the general hospitals in Hubei province and elsewhere are temporarily unable to care for psychiatric patients to lower the possibility of COVID-19 transmission. Second, because of the need to establish special wards for patients who have a fever, specialized hospitals have had to reduce the number of ordinary hospitalizations. Third, patients undergoing hospitalization and outpatients seeking help or undertaking follow up have had to discontinue their treatment due to suspended public transport in a number of areas. At present, there are few measures as to how long maintenance treatment in mental disorders should last after an episode. Failure to directly resolve these problems prevents us from achieving our goal, despite its importance in the clinical management of mental disorders. Given that many more medical comorbid factors occur in patients with mental disorders, another challenge is addressing the effects of medical comorbidity in patients; for instance, respiratory diseases are more common in schizophrenia patients than in the general population, and patients with schizophrenia and concomitant influenza or pneumonia have higher mortality rates (see Wang et al.7 for a review). There so far appears to be no attention paid to these vulnerable individuals, that is, psychiatric patients with comorbid COVID-19. Here, we would like to share response suggestions. The World Health Assembly in 2013 endorsed an action plan, the WHO's ‘Comprehensive Mental Health Action Plan 2013–2020.’8 A key recommendation is to shift services from institutions to the community, highlighting the steps required to provide appropriate psychiatric services for patients in the current COVID-19 epidemic. In addition to this, the development of artificial intelligence techniques in clinical settings, attempts to speed up constructing the framework of online consultation and Internet hospitals, and the provision of telemedicine are all valuable. As a fundamental component of mental health services, psychiatric health-care professionals based in large top-class tertiary hospitals play critical roles in the comprehensive health of the population with mental disorders. This can be leveraged through large data analyses and harnessed via updated clinical practice guidelines and algorithms to improve policy-making. The COVID-19 epidemic has now spread across China and affected the world for almost 3 months. It poses many problems not only with the provision of psychiatry care, but also public health, prevention and control, preclinical and clinical research, health policy, and even health law. We are writing to draw attention to the challenges regarding maintenance treatment and concomitant COVID-19 in patients with mental disorders. The positive response is increasingly expected to explore and address the issues that affect patients with mental disorders on the basis of available evidence. The authors declare no conflicts of interest.