Potential Comorbidities Research Articles

Association between Obstructive Lung Disease and Cardiovascular Disease: Results from the Vermont Diabetes Information System

The association between obstructive lung disease and cardiovascular disease (CVD) has been suggested previously, but few studies have looked at this association in a diabetic cohort, a population highly susceptible to both comorbidities. A total of 1003 subjects in community practice settings were interviewed at home at the time of enrolment into the Vermont Diabetes Information System, a clinical decision support program. Patients self-reported their personal and clinical characteristics, including any obstructive lung disease. Laboratory data were obtained directly from the clinical laboratory. We performed a cross-sectional analysis of the interviewed subjects to assess a possible association between obstructive lung disease and CVD. In a multivariate logistic regression model, obstructive lung disease was significantly associated with CVD, even after correcting for potential confounders, including gender, obesity, low income, cigarette smoking, alcohol problems, and high comorbidity (odds ratio = 1.96; 95% confidence interval 1.37–2.81; p < 0.01). All components of CVD, including coronary artery disease (CAD), congestive heart failure (CHF), peripheral vascular disease (PVD), and cerebrovascular accidents (CVA), were also significantly associated with obstructive lung disease. These data suggest an association between obstructive lung disease and CVD in patients with diabetes. Future studies are needed to identify the mechanism supporting this association

Ocular Signs and Ocular Comorbidities in Monoclonal Gammopathy: Analysis of 80 Subjects.

Purpose To examine the ocular signs of monoclonal gammopathy and to evaluate ocular comorbidities in subjects with monoclonal gammopathy. Patients and Methods. We analyzed patients from two large referral hematology centers in Budapest, diagnosed and/or treated with monoclonal gammopathy between 1997 and 2020. As a control group, randomly selected individuals of the same age group, without hematological disease, have been included. There were 160 eyes of 80 patients (38.75% males; age 67.61 ± 10.48 (range: 38–85) years) with monoclonal gammopathy and 86 eyes of 43 control subjects (32.56% males; age 62.44 ± 11.89 (range 37–86) years). The hematological diagnosis was MGUS in 9 (11.25%), multiple myeloma in 61 (76.25%), smoldering myeloma in 6 (7.50%), and amyloidosis or Waldenström macroglobulinemia in 2 cases (2.50%–2.50%). Before detailed ophthalmic examination with fundoscopy, 42 subjects with gammopathy (52.50%) and all controls filled the Ocular Surface Disease Index (OSDI) questionnaire. Results The OSDI score and best-corrected visual acuity (BCVA) were significantly worse in subjects with monoclonal gammopathy than in controls (p=0.02; p=0.0005). Among gammopathy subjects, we observed potential corneal immunoglobulin deposition in 6 eyes of 4 (3.75%) patients. Ocular surface disease (p=0.0001), posterior cortical cataract (p=0.01), and cataract (p=0.0001) were significantly more common among gammopathy subjects than in controls (χ2 test). Conclusions Ocular surface disease and cataract are more common, and BCVA is worse in patients with monoclonal gammopathy than in age-matched controls. Therefore, and due to the potential ocular signs and comorbidities of monoclonal gammopathy, we suggest a regular, yearly ophthalmic checkup of these patients to improve their quality of life.

Food addiction comorbid to mental disorders in adolescents: a nationwide survey and register-based study.

Adolescence is a high-risk period for development of addictive behavior. This may also apply to addiction-like eating of highly processed foods-commonly referred to as "food addiction". Adolescents with mental disorder may be at particularly elevated risk of developing food addiction as addiction often accompanies mental disorder. However, there are only few studies in adolescents investigating this potential comorbidity. Therefore, the primary aim of this study was to examine the food addiction symptom load, as measured by the dimensional Yale Food Addiction Scale for Children-version 2.0 (dYFAS-C 2.0), among adolescents with a clinically verified mental disorder. A total of 3529 adolescents aged 13-17 were drawn from the Danish Psychiatric Central Research Register, stratified on six major diagnostic categories of mental disorders; psychotic disorders, affective disorders, anxiety disorders, eating disorders, autism spectrum disorders, and attention deficit disorders. Via their parents, these adolescents were invited to participate in a web-based survey. Data on health and socioeconomic factors from the Danish registers were linked to both respondents and non-respondents, allowing for thorough attrition analysis and estimation of weighted dYFAS-C 2.0 scores. A total of 423 adolescents participated in the survey (response rate 12.0%). The mean weighted dYFAS-C 2.0 total score was 13.9 (95% CI 12.6; 14.9) for the entire sample and varied substantially across the diagnostic categories being highest for those with psychotic disorder, mean 18.4 (95% CI 14.6; 14.9), and affective disorders, mean 19.4. (95% CI 16.3; 22.5). Furthermore, the dYFAS-C 2.0 total score was positively correlated with body mass index (BMI) (r = 0.33, p < 0.05). Food addiction symptomatology seems to be prevalent among adolescents with mental disorder, particularly affective and psychotic disorders. As obesity is a tremendous problem in individuals with mental disorder further investigation of food addiction in young people with mental disorder is called for. This could potentially aid in the identification of potential transdiagnostic targets for prevention and treatment of obesity in this group. Level IV, Observational cross-sectional descriptive study combined with retrospective register data.

Changes in subjective sleep quality in patients with type 2 diabetes who did not use Sleep agents: a cross-sectional study according to age and clinical background.

Diabetes and aging are both well-established risk factors for insomnia. Therefore, we investigated the changes in subjective sleep quality in relation to clinical backgrounds and age in patients with type 2 diabetes mellitus (T2DM). This cross-sectional study included 380 participants with T2DM who were between 18 and 79years of age from our outpatient clinics. Individuals with any symptoms and medical histories associated with obstructive sleep apnea (OSA) were excluded from the interview and analyses. Data were collected using self-administered questionnaires, namely the Pittsburgh Sleep Quality Index (PSQI) and the Morning-Evening Questionnaire (MEQ), as well as medical records and blood samples. We performed stratified analyses according to age decades. The number of patients in the age groups (in years) was as follows: < 50 (n = 69), 50-60 (n = 52), 60-70 (n = 138), and 70-80 (n = 121). PSQI score was highest in the < 50 group (4.99 ± 2.40), and significantly decreased with age (p < 0.05). Body mass index (BMI) was also highest in the < 50 group (25.5 ± 4.8kg/m2), and markedly decreased with age (p < 0.01). Interestingly, BMI was significantly correlated with the PSQI score (rs = 0.157, p < 0.05). We also found that younger patients had shorter sleep duration, stronger daytime sleepiness, and a tendency for the evening type. Younger T2DM patients had poorer sleep quality and higher BMI. Our findings suggest that insomnia should be accounted for as a potential comorbidity when examining or treating patients with T2DM and obesity even in the younger population.

Association Between Atopic Keratoconjunctivitis and the Risk of Recurrent Corneal Erosion.

Purpose: To investigate the risk of recurrent corneal erosion (RCE) in patients with atopic keratoconjunctivitis (AKC).Methods: This national, retrospective, matched cohort study enrolled 184,166 newly-diagnosed AKC patients, selected from the Taiwan National Health Insurance Research Database and identified by the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 372.05. The control group comprised 184,166 non-AKC patients matched by age, sex, and potential comorbidities and they were selected from the Taiwan Longitudinal Health Insurance Database, 2000. Information from patients was gathered from 1 January 2004 to 31 December 2011, and both groups were traced from the index date until December 2013. The incidence and risk of RCE (ICD-9-CM code 361.42) was compared between the groups. The adjusted hazard ratio (HR) for RCE was obtained by a Cox proportional hazard regression analysis. The Kaplan–Meier analysis was performed to calculate the cumulative incidence of RCE.Results: In total, 564 AKC patients and 406 non-AKC controls developed RCE during the follow-up span. The incidence of RCE was 1.45 times higher in AKC patients than in controls (95% confidence interval [CI] = 1.27–1.64; P < 0.0001). After adjusting for potential confounders, including diabetes mellitus, keratoconjunctivitis sicca, corneal transplantation, ocular blunt trauma, corneal dystrophy, and band keratopathy, AKC patients were 1.36 times more likely to develop RCE than controls (adjusted HR, 1.36; 95% CI = 1.19–1.54; p < 0.05).Conclusions: AKC Patients had an increased risk of developing RCE and should be informed of this risk.

Maximizing the Smile Symmetry in Facial Paralysis Reconstruction: An Algorithm Based on Twenty Years' Experience

Over the last two decades, the senior author (B.H.) has had an extensive experience with facial paralysis reconstruction. During this period, the techniques have evolved substantially based on the experience and after observing and analyzing the surgical outcomes. The purpose of this article is to relay the lessons learned from the 20 years' experience and suggest an algorithm. In this retrospective study, we have included 343 cases of facial paralysis cases. Complete facial paralysis cases were 285 and 58 were incomplete facial paralyses, both requiring surgical procedures. Complete facial paralyses were divided in to short term (n = 83) and long term (n = 202). In total, 58% of the patients were women and 42% were men. The age range was 6 to 82 years. The techniques employed were direct suture, nerve grafts, cross-facial nerve grafts (CFNGs), masseteric-to-facial nerve transference, hypoglossal-to-facial nerve transference, free muscle transplants, and lengthening temporal myoplasty to achieve the best symmetry after reanimation of unilateral, bilateral, complete, and incomplete facial paralysis. The type of paralysis, objective measurements, the personal patient's smile, and the gender are key concepts to be considered before scheduling a dynamic facial paralysis reconstruction. For unilateral facial paralysis, the time of onset, the type of paralysis, the patient's comorbidities, and the healthy side status are some of the determining factors when selecting the correct technique. The preferred techniques for unilateral facial paralysis are direct repair, CFNG, masseteric-to-facial transposition, and free gracilis transfer. For incomplete facial paralysis, the masseteric-to-facial nerve transference is preferred. In bilateral facial paralysis, bilateral free gracilis transfer is performed in two stages using the nerve of the masseter muscle as the source of innervation. The authors provide an algorithm which simplifies facial paralysis reconstruction to achieve the greatest facial symmetry while thinking about the potential comorbidities and developing spontaneity smile according to the gender of the patient.

Oral health-related quality of life is associated with the prevalence and development of depressive symptoms in older Japanese individuals: The Ohasama Study.

This prospective study investigated the cross-sectional association between impaired oral health-related quality of life (OHRQoL) and the prevalence of depressive symptoms, and the longitudinal association between impaired OHRQoL and development of depressive symptoms among older adults. Previous studies have shown a relationship between poor oral health and depression among older adults; however, findings are inconsistent. Participants were 669 community-dwelling older Japanese individuals aged≥55years (mean: 67.8±7.2years). Data of 296 participants were used for longitudinal analyses. OHRQoL was evaluated using the Oral Impacts on Daily Performances scale. Impaired OHRQoL was defined as the presence of at least one impact on the scale. Depressive symptoms were assessed using the Japanese version of the Zung self-rating depression scale with a cut-off score of 40. The cross-sectional logistic regression model demonstrated that impaired OHRQoL was significantly associated with depressive symptoms (odds ratio [OR], 5.17; 95% confidence interval [CI], 2.99-8.95) independent of age, sex, body mass index, hypertension, cerebrovascular/cardiovascular disease, smoking, drinking alcohol, education, cognitive function, objective oral health (dentition status) and oral health behaviour (dental visit within 1year). Similarly, impaired OHRQoL predicted the development of depressive symptoms within 4years in a fully adjusted longitudinal model (OR, 6.00; 95% CI, 1.38-26.09). Impaired OHRQoL was identified as a potential comorbidity of depressive symptoms and a predictor for depressive disorder later in life. OHRQoL may be a useful clinical outcome for elder patients with regard to their mental and oral health.

The prevalence and comorbidities of obstructive sleep apnea in middle-aged men and women: the Busselton Healthy Ageing Study.

Population surveys suggest the prevalence of obstructive sleep apnea (OSA) is high and increasing and that risk factors and outcomes differ between sexes. To explore these relationships we assessed current OSA prevalence, potential risk factors and comorbidities, and their changes relative to previous estimates in the same community. All adults on the Busselton, Australia, electoral roll born 1946-1964 were invited to participate in a general health survey. Of the 5,037 (62% response rate) respondents, 3,686 successfully completed overnight 2-channel (oximetry, airflow) sleep studies. These were scored and categorized as nil, mild, moderate, or severe OSA based on apnea-hypopnea index (< 5, ≥ 5 to < 15, ≥ 15 to < 30, and ≥ 30 events/h, respectively). Sleep scores were related to participant characteristics and health profiles. OSA prevalence was compared with previous surveys in the community. Prevalences of any and moderate-severe OSA were 57.7% and 20.2% in males and 41.7% and 10.0% in females. Matched for age group, the prevalence of moderate-severe OSA was similar to that in 2007 (males 24.6%, females 9.8%) and was higher than in 1995 (males 4.7%). OSA was associated with age, body mass index, and alcohol intake in males and age and body mass index in females. Conditions associated with OSA included hypertension and current depression in males and hypertension, skin cancer, and diabetes in females. Prevalence of OSA in a middle-aged, predominantly White population in 2010-2015 was high, has increased since 1995, and has remained stable since 2007. Sex differences exist in associated features, including potential risk factors and comorbidities. Cunningham J, Hunter M, Budgeon C, etal. The prevalence and comorbidities of obstructive sleep apnea in middle-aged men and women: the Busselton Healthy Ageing Study. J Clin Sleep Med. 2021;17(10):2029-2039.

A Case of Hypolipidemia and Hypocholesterolemia; Cause and Consequences

Background: Hypolipidemia and hypocholesterolemia are uncommon and because of the established risk of hypercholesterolemia for cardiovascular disease, reduced lipids and total cholesterol levels are often clinically desired and/or deemed clinically inconsequential. A finding of persistently low lipid levels and total cholesterol may however not be innocuous nor desirable. We describe the case of a 46 yr old man with persistently low total cholesterol levels <70mg/dl and the associated complications and comorbidities identified. Clinical Case: A 46 yr old Hispanic man with non-alcoholic fatty liver disease (NAFLD) was referred for evaluation of hyperhidrosis in the setting of persistent hypolipidemia and hypocholesterolemia. Review of the patient’s clinical and biochemical history showed persistently low total cholesterol (mean 58mg/dl), hypotriglyceridemia, and low LDL-C (mean 13.4mg/dl) over the prior 7 yrs in addition to undetectable serum lipoprotein A. Evaluation for secondary causes of hypolipidemia, such as multiple myeloma, was unremarkable. He was found to have low carotene, borderline vitamin A and low vitamin E levels while the rest of his serum fat-soluble vitamins were normal. His mother who had presumed Alzheimer’s dementia also had a history of very low cholesterol levels. The degree and persistence of his hypolipidemia and hypocholesterolemia raised the possibility of a genetic etiology of his hypolipidemia. Genetic testing confirmed that the patient was heterozygous for a pathogenic variant in the APOB gene, consistent with familial hypobetalipoproteinemia (FHBL) which is autosomal recessive linked. Subsequent close review of his clinical history revealed other potential complications and comorbidities of FHBL including NAFLD with prediabetes, hypogonadism, progressive cognitive and memory decline, peripheral neuropathy and multiple neuropsychiatric syndromes including adult ADHD, borderline personality disorder, bipolar disorder and chronic anxiety. He is presently on vitamin E and A supplementation and being followed by neurology and psychiatry in addition to ongoing endocrine and metabolic clinical surveillance. In addition, in view of his maternal history and several biologic children he has undergone formal genetic and family counselling. Conclusions: While lipid panels are ubiquitous in clinical care, clinicians need to be vigilant in settings of severe persistent hypolipidemia and/or hypocholesterolemia to evaluate for possible genetic basis for this and to also screen for possible associated complications and comorbidities.

Editorial: The Co-Occurrence of Diseases

Editorial: The Co-Occurrence of Diseases

Pediatric Psoriasis Comorbidities: Screening Recommendations for the Primary Care Provider.

Psoriasis, which affects up to 2% of children may be associated with significant comorbidity, including obesity, diabetes, cardiovascular disease, depression, and reduced quality of life. Screening and decision-making require a multidisciplinary approach with the management of potential comorbidities championed by primary care providers and supported by respective specialists and subspecialists. Research into the comorbidities and systemic manifestations has generated significant data culminating in several proposals for a consensus guideline for both pediatric and nonpediatric populations. Our aim is to provide a summary targeted to the pediatric primary care provider from the best available evidence when caring for children with psoriasis.

Cross-Cultural Adaptation, Reliability, and Validity of a Brazilian of Short Version of the Posttraumatic Diagnostic Scale.

Background: A short version of the Posttraumatic Diagnostic Scale (PDS) comprising only re-experiencing symptom items has been recently validated on Japanese adults. This short-version-PDS had good psychometric properties among Japanese adults with and without posttraumatic stress disorder (PTSD). The aim of this study was to translate and culturally validate the short-version-PDS for the Brazilian sociolinguistic context.Methods: A translation of the short-version-PDS was performed based on established guidelines. We enrolled 53 patients with PTSD as a potential comorbidity. The translation and cross-cultural adaptation of the short-version-PDS included forward and back-translation by a Japanese Brazilian researcher and a certified translator; synthesis was achieved by consensus, backward translation, pilot test, and finalization. Content validity coefficient (CVC) was used to assess quality of adaptation. Internal consistency was calculated using Cronbach's alpha coefficient. Spearman correlations were between the new short-version-PDS and the Brazilian version of the posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), and a receiver operating characteristic (ROC) curve was used to determine the best cut-off values for the short-version-PDS.Results: The short-version-PDS was well accepted by all subjects, none of the questions were experienced as inappropriate, and all questions of the 3 items were judged important. Item 1 presented CVCt = 0.92; item 2 had a CVCt = 0.87 and item 3 had a CVCt = 0.95. The internal consistency of the final version as measured by Cronbach's alpha was 0.78. The short-version-PDS scale correlated positively with the DSM-5 scale with a Spearman rho of 0.64 (95%CI [0.4-0.8], p < 0.001). The receiver operating characteristic (ROC) curve value was 0.97 (95%CI [0.9-1.0], p < 0.001). The cut-off score for a maximum Youden Index of 0.8 to distinguish moderate from severe from slight PTSD was > 31.0 with sensitivity and specificity are 86.4 and 93.5%, respectively.Conclusions: This Brazilian Portuguese version of the short-version-PDS had good psychometric properties among Brazilian adults with and without PTSD. Transferability and generalizability of the cut-off scores should be further analyzed.

Prevalence of fibrinous pericarditis in heavy pigs (170 kg) and its association with other pluck lesions at slaughter inspection

This study determined the prevalence of fibrinous pericarditis and its correlation with other pluck lesions in 658 batches of pigs from 236 intensive farms located in Northern Italy over a 12-month period. All pigs were slaughtered at 170 kg, and a total 57,943 plucks (approximately 90 pigs/batch) were individually assessed for the presence of fibrinous pericarditis, pneumonia, pleuritis, and liver milk spots.There was no seasonal variation in the prevalence of plucks with fibrinous pericarditis and annual mean prevalence was 5.6% (range, 0–26.3% at batch level; median, 4.71%). Farm of origin, evaluated as a random effect, accounted for 17.7% batch variation. Batches with a high prevalence of fibrinous pericarditis (≥7.7%) had higher prevalences of pleural, pulmonary, and liver lesions than those with low-middle prevalence of pericarditis; high prevalence of pericarditis was predictive of pluck lesions (P < 0.001). There was a highly significant association between fibrinous pericarditis and severe pleuritis, and 55% of plucks with the highest score for pleuritis also had ongoing fibrinous pericarditis, with a positive correlation at batch level (r2 = 0.52; P < 0.001). The co-existence of pericarditis and pleuritis (73.5% of all pericarditis cases) suggests that pleuritis plays a role in the pathogenesis of pericarditis. Based on the prevalence fibrinous pericarditis, and the role of pleuritis as a potential comorbidity, abattoir data on pluck lesions with accompanying farm history, could aid the interpretation and management of on-farm health problems, and inform diagnostic protocols.

EDITORIAL: MORBIDITY MANAGEMENT AND DISABILITY PREVENTION: AN AGENDA FOR DEVELOPING NATIONS INITIATED IN INDIA

Treatment of patients with lymphedema focuses on reducing limb volume with more recent recognition of the importance of quality-of-life issues. Perhaps due to the incidence of filariasis-related lymphedema compared to breast cancer-related lymphedema in the western world, the Institute of Applied Dermatology (IAD) in Kerala, India has developed a low-cost and culturally acceptable treatment with quality-of-life focus that works well in that area. Worldwide, there is also recognition of chronic edema as a potential co-morbidity and the recent advances in genetic analysis continue to shed light on lymphedema development that may be important in filariasis-related lymphedema. Although improvement in treatment outcomes by surgical means has been shown, there is often conventional treatment mixed in the therapy and no randomized controls of any therapy exist. In addition, these techniques require supermicrosurgical skill not available in many areas of the world. The WHO has documented the need in filariasis for both universal health care and innovative care for chronic conditions. The IAD has addressed these issues with its integrative model of treatment with patient quality-of-life at the forefront to incorporate traditional practice to involve the patient more fully in family and community support for an additional therapeutic tool.

Utility of preoperative labs in posterior spinal fusions for idiopathic scoliosis.

Review of 216 consecutive idiopathic scoliosis (IS) patients undergoing posterior spinal fusion (PSF) demonstrated 94.9% having abnormal lab values, but only 3.9% were referred for further evaluation. A limited set of preoperative laboratory testing costing $234/patient, and thorough, adjunct review of patient/family history could identify potentially significant comorbidities preoperatively in this study. A savings of $1556/patient from current laboratory testing was identified. The laboratory tests routinely obtained preoperatively were investigated: abnormal preoperative laboratory outcomes were identified and further documented if additional action was taken defined as a referral to another medical provider, performance of additional lab testing or counseling, or if there was alteration of the surgical plan. Overall, 94.9% (n = 205) of patients had one or more abnormal pre-operative lab values. Further actions occurred in 11.7% (n = 24) of all abnormal lab values with 3.9% (n = 8) of these being referred to other healthcare providers. Sixteen abnormal lab values underwent further testing or treatment: 11 nicotine tests, two UCx, one UA, one PT/PTT, and one bovine gelatin RAST. Eight abnormal tests prompted referral to another provider: three CBC, three platelet function tests, one UCx, and one UA. Based on these data, standard preoperative Hgb/Hct, platelet function tests, and bovine RAST (If the surgical plan involves use of bovine gelatin products) appear to be adequate to identify potential significant comorbidities in IS patients undergoing PSF for only $234/patient, a cost savings of $1556/patient from current protocol. Based on this study of 216 patients, a limited preoperative laboratory testing and thorough, adjunct review of patient/family history appears to be adequate to identify potential comorbidities preoperatively in this study. II.

The burden of chronic pain for patients with osteoarthritis in Germany: a retrospective cohort study of claims data

BackgroundOsteoarthritis (OA) is a common condition that is often associated with chronic pain. Pain often leads patients to seek healthcare advice and treatment. In this retrospective cohort analysis of German longitudinal healthcare claims data, we aimed to explore the healthcare resource utilisation (HRU) and related healthcare costs for patients with OA who develop chronic pain.MethodsPatient-level data was extracted from the German Institut für Angewandte Gesundheitsforschung (InGef) database. Insured persons (≥18 years) were indexed between January 2015 and December 2017 with a recent (none in the last 2 years) diagnosis of OA. HRU and costs were compared between patients categorised as with (identified via diagnosis or opioid prescription) and without chronic pain. Unweighted HRU (outpatient physician contacts, hospitalisations, prescriptions for physical therapy or psychotherapy, and incapacity to work) and healthcare costs (medication, medical aid/remedy, psychotherapy, inpatient and outpatient and sick pay in Euros [quartile 1, quartile 3]) were calculated per patient for the year following index. Due to potential demographic and comorbidity differences between the groups, inverse probability of treatment weighting (IPTW) was used to estimate weighted costs and rate ratio (RR; 95% confidence interval) of HRU by negative binomial regression modelling.ResultsOf 4,932,543 individuals sampled, 238,306 patients with OA were included in the analysis: 80,055 (34%) categorised as having chronic pain (24,463 via opioid prescription) and 158,251 (66%) categorised as not having chronic pain. The chronic pain cohort was slightly older, more likely to be female, and had more comorbidities. During the year following index, unweighted and IPTW-weighted HRU risk and healthcare costs were higher in patients with chronic pain vs those without for all categories. This led to a substantially higher total annual healthcare cost ─ observed mean; €6801 (1439, 8153) vs €3682 (791, 3787); estimated RR = 1.51 (1.36, 1.66).ConclusionsGerman patients with chronic pain and OA have higher healthcare costs and HRU than those with OA alone. Our findings suggest the need for better prevention and treatment of OA in order to reduce the incidence of chronic pain, and the resultant increase in disease burden experienced by patients.

Fibers in pediatric functional gastrointestinal disorders. Practical considerations from clinical cases

ABSTRACT Introduction: Functional gastrointestinal disorders (FGIDs) are common in children and incur high direct and indirect social costs. Partially hydrolyzed guar gum (PHGG) is a natural and water-soluble dietary fiber that is derived from guar gum. It has been proposed as complementary therapy in pediatric FGIDs, especially in chronic functional constipation and irritable bowel syndrome. Areas covered: By focusing on four clinical cases, this article illustrates the use of PHGG fiber as sole supplement ingredient or as a formula component in orally- and tube-fed children suffering from malnutrition due to FGIDs, with or without special medical conditions such as neurological disability. The formula used was a whey peptide-based nutritionally complete formula containing PHGG as a source of soluble dietary fiber. It was offered under medical supervision and after full consideration of all feeding options. Expert opinion: Implementing appropriate feeding behaviors, adapted to age and potential comorbidities, is an essential requisite for therapeutic management of FGIDs. The use of a PHGG supplement or a nutritionally complete formula containing PHGG as a source of soluble dietary fiber can be helpful to manage pediatric FGIDs.

Tarsal tunnel syndrome in patients with fibromyalgia.

Objectives This study aims to evaluate the frequency of tarsal tunnel syndrome (TTS) in fibromyalgia (FM) patients.Patients and methods In this prospective study, we investigated paresthesia of the foot, sensory and motor deficits, atrophy of the abductor hallucis muscle, and the presence of Tinel’s sign in 76 female FM patients (mean age 39.3±7.4 years; range, 24 to 52 years) and 60 sex-matched healthy control subjects (mean age 38.6±8.2 years; range, 28 to 49 years) without FM between July 2016 and June 2018. Bilateral electrophysiological studies of the tibial, peroneal, sural, and medial as well as lateral plantar nerves were performed.Results Paresthesia was observed in 22 FM patient extremities and four control subject extremities (p=0.002). Local tenderness at the tarsal tunnel was observed in 12 FM patient extremities and two control subject extremities (p=0.021). TTS was detected electrophysiologically in 14 FM patient extremities and two control subject extremities (p=0.009).ConclusionParesthesia of the foot and local tenderness at the tarsal tunnel were significantly more prevalent in FM patients than in healthy control subjects. TTS is statistically more frequent in patients with FM than the normal population. The potential comorbidities of TTS and paresthesia of the foot should be carefully examined in FM patients.

People-centered care for psoriasis and urticaria: Are we overlooking Internet addiction while only considering patients and physician settings?

Psoriasis and chronic urticaria (CU) are chronic skin diseases with a high impact on individuals' life and mental health. Some studies indicate a high prevalence of Internet addiction and many affected individuals seem not to utilize healthcare, but rather search for health-related information online. The aims of the study were to assess Internet addiction as a potential comorbidity in both diseases as well as identify differences in healthcare utilization between individuals with psoriasis and CU. This cross-sectional study is based on self-reported data from individuals with psoriasis and CU living throughout Germany using the framework of an online survey from 12/2018 to 01/2019. Advertisements on Google and Facebook were used to address Internet users who searched online for information on psoriasis or CU. The study questionnaire comprised questions on demographics, current contact with physicians, and disease history as well as validated screening tools for well-being and Internet addiction. Overall, 1686 participants (74.0% female, 38.5% psoriasis) with a mean age of 36.9±12.9years were analyzed. Participants with CU were more likely female (89.2% vs 49.8%, P<0.001) and not in medical care compared to participants with psoriasis (60.3% vs 45.9%, P<0.001). Sixteen percent of the participants overall were screened positive for Internet addiction. Furthermore, not utilizing medical care showed a significant association with being screened positive for Internet addiction in participants with CU (adjusted odds ratio [aOR]=1.49, 95% confidence interval [CI] 1.10-2.02), but not in those with psoriasis. The study revealed a high proportion of affected individuals not being in medical care and a high prevalence of Internet addiction, with individuals with CU not utilizing medical resources having a higher chance of being screened positive for Internet addiction. This underlines the approach of people-centered care and highlights its importance for further research.

Loneliness in Adults During a COVID-19 Lockdown

Loneliness has been frequently reported in the COVID-19 literature but rarely in the context of potential comorbidities including depression, fatigue, and sleep problems. The present study assessed the relationships between self-reported loneliness, and the potential comorbidities based on an archival database called the COVID-19 Lockdown Activities Survey (N= 260 participants). Loneliness was endorsed by 67% of the participants. Greater loneliness was related to greater depression, fatigue, and sleep problems. A regression analysis revealed that depression contributed to 47.1% of the variance in loneliness. These results highlight the multidimensionality of loneliness. The generalizability of these results is limited by the homogeneity of the sample (predominantly non-Hispanic white females). Nonetheless, they highlight the importance of designing interventional protocols that address loneliness and the associated depression, fatigue, and sleep problems rather than loneliness alone.