Multiple Systemic Comorbidities Research Articles

Combination of intravenous immunoglobulin, oral prednisone, and methotrexate for managing scleromyxedema: case report and literature discussion.

The generalized and sclerodermic form of lichen myxedematosus, known as scleromyxedema (SMX), is a chronic mucinosis that manifests cutaneously and has multiple systemic comorbidities. There are few available treatment options and no established therapeutic guidelines. We describe a 48-year-old man who had intravenous immunoglobulins (IVIg), oral corticosteroids, and methotrexate (MTX) for the treatment of SMX, monoclonal gammopathy, and arthritis. Because of its effectiveness and high level of tolerance, IVIg is the most often used first-line therapy for SMX and has been used for an increasing range of skin conditions. In our instance, better control of skin disease and extracutaneous manifestations was made possible by combining IVIg with oral prednisone and MTX. To the best of our knowledge, this is the first instance of SMX treatment that has combined therapeutic approaches with a favorable safety profile.

Study of P-wave dispersion in patients of psoriasis: An observational study

: Psoriasis being a multisystemic disorder has multiple systemic comorbidities apart from cutaneous manifestations including metabolic syndrome and cardiovascular diseases. To study P-wave dispersion in patients of psoriasis.A total of 71 patients who presented in the dermatology OPD with chronic plaque psoriasis were assessed for disease severity and their ECG was evaluated.In this study of 71 patients aged 15-60 years, a strong positive correlation was found between PASI score and P-wave dispersion (r=0.703, p=0.000) indicating a strong association between disease severity of psoriasis and development of cardiovascular diseases.The P-wave dispersion was significantly higher in patients with high PASI scores. This indicates that the patients of psoriasis are at a higher risk of developing cardiovascular diseases like atrial fibrillation.

Characteristics of posterior zone I retinopathy of prematurity.

To report the demographic profile and clinical characteristics of retinopathy of prematurity (ROP) in posterior Zone I. In a partly retrospective (ten years) and partly prospective (one year) study, we analysed the demographic profile and clinical characteristics of babies with ROP in posterior Zone I. The study included 130 eyes of 67 infants with a mean gestational age and birth weight of 29.3 (±2.2) weeks and 1217.3 (±381.9) grams, respectively. All babies had received unblended oxygen. In 47 of 51 (91.1%) babies, the weekly weight gain was <100 g (details were not available in 16 babies). The ROP subtypes included aggressive, threshold, hybrid, stage 4, and atypical types in 78 (60%), 20 (15.4%), 11 (8.5%), 15 (11.5%), and 6 (4.6%) eyes, respectively. Fibrovascular proliferation, when present, was prominent nasally, occasionally overriding the disc margin. Extensive arteriovenous tortuosity was more prominent than vascular dilatation. Atypical observations included bleb-like detachment (6 eyes; 4.6%) and candle wax-like preretinal deposits (23 eyes; 17.7%). Retinopathy of Prematurity in posterior Zone I in this cohort was strongly associated with 100% unblended oxygen supplementation, poor weight gain, and multiple systemic co-morbidities. ROP in posterior zone 1 has a distinct profile with several atypical characteristics different from ROP in other zones.

Clinical impact of severe acute kidney injury on post-operative and brain injury outcomes in preterm infants following surgical necrotizing enterocolitis

Background To evaluate post-operative outcomes and white matter injury (WMI) using brain MRI at term equivalent in neonates with and without severe acute kidney injury (AKI) following surgical necrotizing enterocolitis (NEC). Methods A retrospective cohort study comparing neonates with severe (Stage 2/3) vs. other (no AKI/Stage 1) AKI using KDIGO classification with multivariable models assessing this association in the context of multiple systemic comorbidities. Results Of 103 neonates with surgical NEC, 60 (58%) had severe AKI. Those with severe AKI had lower birth weight (BW; 715 vs. 950 g; p = .023), more frequently treated with indomethacin (18.3 vs. 2.4%); p = .014), higher CRP levels at 24 h after NEC onset (14.4 [6.4–19.8] vs. 4.8 [1.6–13.4]; p = .005), higher presence of cholestasis (73.3 vs. 51.2%); p = .023), later age of NEC onset (14 vs. 7 d); p = .004), longer length of bowel resected (14.9 vs. 4.3 cm); p = .011), longer post-operative ileus days (14 vs. 9 d); p < .001), longer post-operative days at starting enteral feedings (15 vs. 10 d; p < .001), longer days of attainment of full enteral feedings (75 vs. 44.5 d; p = .008) and longer length of stay (140.5 vs. 94 d; p = .028) compared to those without severe AKI. Compared to infants without AKI by serum creatinine, those with AKI had significantly more cases of white matter abnormality (WMA; 90 vs. 36.6%; p < .001) and retinopathy of prematurity (63.9 vs. 35.3%; p = .017). In addition, the presence of AKI Stage 2 and 3 by serum creatinine was independently associated with higher odds of sustaining severe WMI level on an ordinal scale (OR = 6.2; 95% CI = (1.1–35.5); p = .041). Conclusions Neonates with severe AKI following surgical NEC were more likely to experience longer post-operative morbidity and higher WMI by MRI at term.

Surgical and Nonsurgical Factors Associated with Salvaging Exposed Vertical Expandable Prosthetic Titanium Rib Hardware.

Vertical expandable prosthetic titanium rib (VEPTR) devices were designed to treat childhood scoliosis and thoracic insufficiency syndrome. Although they have drastically reduced patient mortality, they present a profound subcutaneous hardware burden. The authors examined the surgical and nonsurgical factors associated with salvage of VEPTR hardware exposures. Between 2014 and 2020, a prospective institutional database was queried for patients with VEPTR hardware complications who required soft-tissue reconstruction. Hardware salvage was considered successful if reconstruction allowed the hardware to be retained until the next VEPTR expansion. Fifty-eight patients required VEPTR hardware salvage. Hardware complications were successfully salvaged in 62.1 percent of patients at 60.0 percent of operative sites. Neuromuscular scoliosis (p = 0.041) and nonambulatory status (p = 0.018) were factors associated with VEPTR hardware salvage failure, whereas congenital scoliosis was associated with successful hardware salvage (p = 0.012) and preventing need for immediate hardware removal (p = 0.049). Exposed hardware, as compared to threatened exposure, was more likely to require immediate removal (p = 0.045) and result in unsuccessful hardware salvage (p = 0.015). Local and regional muscle flaps were able to prevent VEPTR hardware removal in the majority of patients, even in the setting of infection, immobility, incontinence, and multiple systemic comorbidities. Patients with neuromuscular scoliosis and nonambulatory status were at increased risk for failure, whereas those with incontinence and low body mass index trended toward increased risk of failure. Threatened exposure was associated with higher rates of salvage than exposed hardware, and thus earlier referral to plastic surgeons for soft-tissue salvage may be advised. Risk, III.

Number of teeth is associated with all-cause and disease-specific mortality

BackgroundTooth loss has been shown to correlate with multiple systemic comorbidities. However, the associations between the number of remaining natural teeth (NoT) and all-cause mortality have not been explored extensively. We aimed to investigate whether having fewer NoT imposes a higher risk in mortality. We tested such hypotheses using three groups of NoT (20–28,10–19, and 0–9), edentulism and without functional dentition (NoT < 19).MethodsThe National Health and Nutrition Examination Survey in the United States (NHANES) (1999–2014) conducted dental examinations and provided linkage of mortality data. NHANES participants aged 20 years and older, without missing information of dental examination, age, gender, race, education, income, body-mass-index, smoking, physical activities, and existing systemic conditions [hypertension, total cardiovascular disease, diabetes, and stroke (N = 33,071; death = 3978), or with femoral neck bone mineral density measurement (N = 13,131; death = 1091)] were analyzed. Cox proportional hazard survival analyses were used to investigate risks of all-cause, heart disease, diabetes and cancer mortality associated with NoT in 3 groups, edentulism, or without functional dentition.ResultsParticipants having fewer number of teeth had higher all-cause and disease-specific mortality. In fully-adjusted models, participants with NoT0-9 had the highest hazard ratio (HR) for all-cause mortality [HR(95%CI) = 1.46(1.25–1.71); p < .001], mortality from heart diseases [HR(95%CI) = 1.92(1.33–2.77); p < .001], from diabetes [HR(95%CI) = 1.67(1.05–2.66); p = 0.03], or cancer-related mortality [HR(95%CI) = 1.80(1.34–2.43); p < .001]. Risks for all-cause mortality were also higher among the edentulous [HR(95%CI) = 1.35(1.17–1.57); p < .001] or those without functional dentition [HR(95%CI) = 1.34(1.17–1.55); p < .001].ConclusionsHaving fewer NoT were associated with higher risks for all-cause mortality. More research is needed to explore possible biological implications and validate our findings.

Systemic comorbidities of rosacea: practice gaps among dermatologists.

Rosacea is a chronic inflammatory skin condition that is associated with multiple systemic comorbidities, with the strongest evidence linking rosacea to hypertension, dyslipidemia, inflammatory bowel disease, and anxiety and depression. To assess dermatologists' awareness of and screening practices for rosacea comorbidities, we developed a survey that was distributed to attendings and residents across four academic dermatology departments in Massachusetts. A total of 73 dermatologists with varying experience participated in the study. Findings demonstrated significant knowledge and practice gaps among academic dermatologists in managing systemic comorbidities in rosacea. In addition, dermatologists' awareness of rosacea comorbidities was negatively correlated with number of years out of residency training, highlighting the need to address this knowledge gap through increased continuing medical education. Importantly, we observed a low screening frequency despite a high awareness of the association between rosacea and ocular comorbidities, suggesting that additional financial, institutional, or practice barriers likely contribute to the low screening rate.

Analysis of periodontitis-associated miRNAs in gingival tissue, gingival crevicular fluid, saliva and blood plasma

ObjectivePeriodontitis (PD) is a chronic inflammatory disease which is associated with multiple systemic comorbidities, including rheumatoid arthritis (RA), meanwhile the etiopathology of PD may be modulated by various factors including microRNA (miRNA). The present study aimed to reveal miRNAs associated with PD in gingival tissue, gingival crevicular fluid (GCF), saliva, plasma and to assess the possible influence of RA. DesignThe cross-sectional study included 30 patients with PD and 31 periodontally healthy participants. A total of 25 participants were additionally diagnosed with RA. Microarray analysis of eight gingival tissue samples was performed and four PD-associated miRNAs were selected: miR-199a-5p, miR-483-5p, miR-3198 and miR-4299. Target miRNAs were further assessed by means of RT-qPCR in 61 gingival tissue samples and corresponding bodily fluids – GCF, saliva and plasma. ResultsThe upregulation of miR-199a-5p and downregulation of miR-4299 in gingival tissue was associated with the presence of PD and RA (P < 0.05). GCF level of miR-3198 was higher amongst participants with PD (P = 0.019) and showed a good diagnostic ability (AUC = 0.72, P = 0.008). Increased miR-199a-5p salivary level and decreased miR-199a-5p plasma level were observed amongst patients with worse clinical status of PD (P < 0.05). MiR-3198 and miR-4299 combination in GCF demonstrated AUC value of 0.86 and reached sensitivity of 68 % and specificity of 96 %. ConclusionsAberrant expression of miR-199a-5p, miR-483-5p, miR-3198, miR-4299 in gingival tissues is associated with the presence and/or severity of PD. MiR-3198, miR-4299 level in GCF and miR-199a-5p level in plasma strongly correlated with PD, demonstrating significant diagnostic performance.

Current perspectives on the impact of clinical disease and biochemical control on comorbidities and quality of life in acromegaly.

Acromegaly is a rare chronic, systemic disorder caused by excessive growth hormone (GH) secretion from a somatotroph pituitary adenoma. GH hypersecretion leads to overproduction of insulin-like growth factor-1 (IGF-1), which contributes to the somatic overgrowth, physical disfigurement, onset of multiple systemic comorbidities, reduced quality of life (QoL) and premature mortality of uncontrolled patients. Somatostatin receptor ligands, dopamine agonists and a GH receptor antagonist are currently available for medical therapy of acromegaly. The main aim of treatment is biochemical normalisation, defined as age-normalised serum IGF-1 values and random GH levels <1.0μg/L. However, there is an increasing evidence suggesting that achieving biochemical control does not always decrease the burden of disease-related comorbidities and/or improve patients' QoL. This lack of correlation between biochemical and clinical control can be due to both disease duration (late diagnosis) or to the peculiarity of a given comorbidity. Herein we conducted ad hoc literature searches in order to find the most recent and relevant reports on biochemical and clinical disease control during medical treatment of acromegaly. Particularly, we analyse and describe the relationship between biochemical, as well as clinical disease control in patients with acromegaly receiving medical therapy, with a focus on comorbidities and QoL. In conclusion, we found that current literature data seem to indicate that clinical disease control (besides biochemical control), encompassing clinical signs and symptoms, comorbidities and QoL, emerge as a primary focus of acromegaly patient management.

Systemic comorbidities are associated with medication-related osteonecrosis of the jaws: Case-control study.

Medication-related osteonecrosis of the jaws (MRONJ) is a serious condition developed in up to 15% of patients who take antiresorptive medications. Its underlying pathogenesis remains unclear. The association between systemic comorbidities and MRONJ was investigated. A case-control study was conducted in Brisbane, Australia. Hospital records were used to identify 68 cases of MRONJ between January 2003 and March 2017. Each case was individually matched to three controls (204 in total) according to sex, age, primary disease, and type and duration of antiresorptive therapy. Data on patient demographic, social and clinical characteristics were collected. Systemic comorbidities and medications were quantified as a comorbidity-polypharmacy score (CPS). Associations were investigated using conditional logistic regression. The CPS calculated for patients who developed MRONJ (mean±SD=20.2±5.1) was significantly higher than for controls (12.9±4.6). Multivariable analysis determined a significant relationship between CPS and the presence of MRONJ (OR=1.5; 95% CI=1.3, 1.8, p<0.001). Patients with multiple systemic comorbidities and high levels of polypharmacy were more likely to develop MRONJ. The CPS is a simple and effective tool to quantify the risk of MRONJ attributed to a patient's systemic condition and should be considered in conjunction with the patient's oral health to assess the overall risk of MRONJ.

Combined branch retinal vein and branch retinal artery occlusion - clinical features, systemic associations, and outcomes.

Purpose:Retinal vascular occlusions affecting both the arterial and venous systems are rare events. Combined branch retinal artery (BRAO) and vein (BRVO) occlusion are exceedingly rare and not well characterized.Methods:Six patients with combined BRAO and BRVO underwent a comprehensive eye examination, fundus fluorescein angiography, optical coherence tomography, and cardiovascular evaluation.Results:Mean age at presentation was 54 ± 7.8 years (range: 39–60), and five of the six were men. Patients had a combination of systemic comorbidities such as diabetes (5), hypertension (4), dyslipidemia (5), and hyperhomocysteinemia (1). All had unilateral combined occlusion characterized by narrowing and cattle tracking of blood in arteries and dilated tortuous veins in the involved quadrant. Fluorescein angiography demonstrated complete capillary drop out and a clear demarcation between the perfused and nonperfused retina. Presenting vision ranged from 6/9 to 1/60 Snellen's, and final vision depended on the macular perfusion status. All eyes were treated with angiography-guided sectoral laser photocoagulation, and three eyes required intravitreal bevacizumab due to macular edema or retinal neovascularization.Conclusions:Combined BRAO and BRVO is rare, may have unique underlying pathogenetic mechanisms, is associated with multiple systemic comorbidities and can yield good visual outcome if macula remains well perfused.

Pathway Network Analyses for Autism Reveal Multisystem Involvement, Major Overlaps with Other Diseases and Convergence upon MAPK and Calcium Signaling.

We used established databases in standard ways to systematically characterize gene ontologies, pathways and functional linkages in the large set of genes now associated with autism spectrum disorders (ASDs). These conditions are particularly challenging—they lack clear pathognomonic biological markers, they involve great heterogeneity across multiple levels (genes, systemic biological and brain characteristics, and nuances of behavioral manifestations)—and yet everyone with this diagnosis meets the same defining behavioral criteria. Using the human gene list from Simons Foundation Autism Research Initiative (SFARI) we performed gene set enrichment analysis with the Kyoto Encyclopedia of Genes and Genomes (KEGG) Pathway Database, and then derived a pathway network from pathway-pathway functional interactions again in reference to KEGG. Through identifying the GO (Gene Ontology) groups in which SFARI genes were enriched, mapping the coherence between pathways and GO groups, and ranking the relative strengths of representation of pathway network components, we 1) identified 10 disease-associated and 30 function-associated pathways 2) revealed calcium signaling pathway and neuroactive ligand-receptor interaction as the most enriched, statistically significant pathways from the enrichment analysis, 3) showed calcium signaling pathways and MAPK signaling pathway to be interactive hubs with other pathways and also to be involved with pervasively present biological processes, 4) found convergent indications that the process “calcium-PRC (protein kinase C)-Ras-Raf-MAPK/ERK” is likely a major contributor to ASD pathophysiology, and 5) noted that perturbations associated with KEGG’s category of environmental information processing were common. These findings support the idea that ASD-associated genes may contribute not only to core features of ASD themselves but also to vulnerability to other chronic and systemic problems potentially including cancer, metabolic conditions and heart diseases. ASDs may thus arise, or emerge, from underlying vulnerabilities related to pleiotropic genes associated with pervasively important molecular mechanisms, vulnerability to environmental input and multiple systemic co-morbidities.

A Sporadic Case of Darier Disease with Acrokeratosis Verruciformis like Lesions: Treated Effectively with Oral and Topical Retinoid

Darier disease (DD) is a type of autosomal dominant genodermatosis with calcium pump defect. We are reporting a case of Darier disease because of its rarity. A 24 year old man presented with multiple pruritic dark warty lesions over the seborrheic areas since 5 years of age. We treated him with retinoids, with which he had considerable improvement. It is necessary to diagnose this condition early as it can adversely affects the quality of life and can be associated with multiple systemic co-morbidities.

Aggressive posterior retinopathy of prematurity in infants ≥1500 g birth weight

In this retrospective case series, we report the spectrum and outcomes of aggressive posterior retinopathy of prematurity (APROP) in infants ≥1500 g birth weight. Twenty-nine eyes of 15 infants are included. All infants were referred from level I or II nurseries, received supplemental unmonitored oxygen for prolonged duration (>1 week) and had multiple systemic co-morbidities. Of the 29 eyes, 10 (34.5%) had zone 1 and 19 (65.5%) had posterior zone 2 disease. Twenty-five (86.2%) eyes had flat neovascularization and 4 (13.8%) eyes had brush like proliferation. We noticed large vascular loops in 10 (34.5%) eyes. After confluent laser photocoagulation, 22 (75.9%) eyes had a favorable outcome. The study concludes that APROP in heavier (≥1500 g birth weight) premature infants occurs mostly in posterior zone 2 with flat neovascularization and atypical features like large vascular loops. Supplemental unmonitored oxygen for prolonged duration and multiple systemic co-morbidities could be a contributing factor.

Population‐Based Estimates of Medical Comorbidities in Erectile Dysfunction in a Taiwanese Population

Erectile dysfunction (ED) is usually associated with systemic disorders. This population-based study supports and expands on previous research. It also presents data in a Taiwanese male population where existing data on this topic remain sparse. The aim of this study is to analyze the prevalence and risk of 36 medical comorbidities in patients with ED compared with the general population. A total of 2,213 patients with ED and 11,065 matching controls were selected from the Taiwan National Health Insurance Research Dataset. We chose 22 comorbidities from the Elixhauser comorbidity index, 10 highly prevalent medical conditions in an Asian population, and four male gender-specific comorbidities for analysis. Conditional logistic regression analyses conditioned on age group and monthly income were performed to investigate the risk of various comorbidities for patients with and without ED, after adjusting for the geographic region and level of urbanization of the patient's community. Patients with ED were at an increased risk for multiple systemic comorbidities. Conditional regression analyses showed that patients with ED were at a higher risk for hypertrophy of the prostate (odds ratio [OR] = 12.87), chronic prostatitis (OR = 9.36), alcohol abuse (OR = 3.60), drug abuse (OR = 2.62), urinary incontinence (OR = 2.58), ankylosing spondylitis (OR = 2.19), peripheral vascular disorder (OR = 1.98), ischemic heart disease (OR = 1.94), psychoses (OR = 1.97), depression (OR = 1.88), uncomplicated diabetes (OR = 1.91), complicated diabetes (OR = 1.84), hepatitis B or C (OR = 1.71), hyperlipidemia (OR = 1.69), and chronic pulmonary disease (OR = 1.55) than patients without ED. The results show that patients with ED have a higher prevalence of multiple noncardiovascular comorbidities than the general population in Taiwan.

Comorbidity profiles among patients with ankylosing spondylitis: a nationwide population-based study

ObjectiveAnkylosing spondylitis (AS) is a systemic inflammatory disease that can result in chronic pain and disability. This study aimed to analyse the prevalence and risk of medical comorbidities in patients...

Effect of statin drugs and aspirin on progression in open‐angle glaucoma suspects using confocal scanning laser ophthalmoscopy

To determine the effect of statins and aspirin on the rate of progression of optic nerve parameters in open-angle glaucoma (OAG) suspects, as defined by confocal scanning laser ophthalmoscopy (CSLO). Data of OAG suspects who had undergone at least two CSLO tests at the Beckman Vision Center at UCSF from January 2001 to June 2006 was collected. We conducted a retrospective chart review of 149 eyes from 76 patients considered suspect for glaucoma based on a cup-to-disc ratio >0.5, but with normal intraocular pressures (IOP) and visual fields. Subjects included glaucoma suspects who took statin drugs or aspirin for greater than 23 months. The control group consisted of suspects who never used statins or aspirin. The data were analysed using mixed effects regression. When comparing controls with the statin group there were significant differences in the progression of multiple CSLO parameters per year, including rim volume (-13.7% controls, +26.7% statin only; P = 0.0156), retinal nerve fibre layer cross-sectional area (-12.2% controls, +24.3% statin only; P = 0.0051), and mean global retinal nerve fibre layer thickness (-10.3% controls, +26.6% statin only; P = 0.0114), with adjustment for age, gender, race, IOP, central corneal thickness, refractive error and multiple systemic comorbidities. No significant differences were found when comparing subjects taking a statin plus aspirin or aspirin alone with the controls. Statin drugs may be associated with slowed progression of optic nerve parameters in glaucoma suspects as measured by CSLO.