Pre-existing Comorbidities Research Articles

Prospective Observational Study of Chronic Kidney Disease, its Prescription Pattern and Risk Factors in Patients with Pre-Existing Comorbidities in Tertiary Care Hospital

Prospective Observational Study of Chronic Kidney Disease, its Prescription Pattern and Risk Factors in Patients with Pre-Existing Comorbidities in Tertiary Care Hospital

Age-Specific Outcomes of Bioprosthetic vs. Mechanical Aortic Valve Replacement: Balancing Reoperation Risk with Anticoagulation Burden.

The choice of prosthesis for aortic valve replacement (AVR) remains challenging. The risk of anticoagulation complications vs. the risk of aortic valve reintervention should be weighed. This study compared the outcomes of bioprosthetic vs. mechanical AVR in patients older and younger than 50. This retrospective study was conducted from 2009 to 2019 and involved 292 adult patients who underwent isolated AVR. The patients were divided according to their age (above 50 years or 50 years and younger) and the type of valves used in each age group. The outcomes of bioprosthetic valves (Groups 1a (>50 years) and 1b (≤50 years)) were compared with those of mechanical valves (Groups 2a (>50 years) and 2b (≤50 years)) in each age group. The groups had nearly equal rates of preexisting comorbidities except for Group 1b, in which the rate of hypertension was greater (32.6% vs. 14.7%; p = 0.025). This group also had higher rates of old stroke (8.7% vs. 0%, p = 0.011) and higher creatinine clearance (127.62 (108.82-150.23) vs. 110.02 (84.87-144.49) mL/min; p = 0.026) than Group 1b. Patients in Group 1a were significantly older than Group 2a (64 (58-71) vs. 58 (54-67) years; p = 0.002). There was no significant difference in the NYHA class between the groups. The preoperative ejection fraction and other echocardiographic parameters did not differ significantly between the groups. Re-exploration for bleeding was more common in patients older than 50 years who underwent mechanical valve replacement (p = 0.021). There was no difference in other postoperative complications between the groups. The groups had no differences in survival, stroke, or bleeding rates. Aortic valve reintervention was significantly greater in patients ≤ 50 years old with bioprosthetic valves. There were no differences between groups in the changes in left ventricular mass, ejection fraction, or peak aortic valve pressure during the 5-year follow-up. The outcomes of mechanical and bioprosthetic valve replacement were comparable in patients older than 50 years. Using bioprosthetic valves in patients younger than 50 years was associated with a greater rate of valve reintervention, with no beneficial effect on the risk of bleeding or stroke.

Pre-existing cardiovascular disease in the intensive care population: a national data study in scotland

Abstract Introduction/Background Each year, nearly 17,000 patients are admitted to Intensive Care Units (ICU) in Scotland. Forty percent of these patients suffer from one or more pre-existing co-morbidity. Pre-existing co-morbid disease is a known risk factor for readmission to ICU, increased healthcare use, protracted recovery and reduced health-related quality of life. Nonetheless, it is unknown which group of patients is most affected. Given the heterogeneity of the ICU population and in consideration of more "targeted" care, understanding the influence of co-morbidities and identification of specific patient groups is necessary. In tandem, the association between cardiovascular disease and critical illness is under researched. Yet it is known that 20% of ICU patients suffer from cardiovascular disease (CVD), with some evidence to suggest CVD is linked to increased 5-year mortality in this group of patients. Purpose To understand the prevalence of pre-existing CVD and other pre-existing co-morbidities in the critically ill population and to determine the influence of pre-existing CVD on hospital readmission rates (within one year of index hospital discharge). Methods This study is a retrospective cohort analysis using routinely collected data on ICU admissions between 2010 and 2019 in Scotland. Following public benefit and privacy panel (PBPP) approval and university integrity committee review, data was accessed via a secure National Safe Haven platform. Demographic data are presented alongside correlation analysis. Results More than 100,000 patients were admitted to ICU between 2010 and 2019. Of these patients, around 10% suffered from pre-existing CVD, with 30% suffering from any co-morbid disease, as defined by Charlson Co-morbidity index. It was identified that around 10% of ICU patients were readmitted to ICU within one year and a further 20% readmitted to hospital within one year. Of those patients readmitted to ICU, 10% suffer from pre-existing CVD. Conclusion This study identified that CVD is prevalent amongst the critically ill population with many experiencing a further admission to ICU. Despite this, little is known about the follow-up care provided to these patients with regards to managing CVD.

Renal ischemia/reperfusion induces prominent progressive kidney disease in diabetic mice.

Acute kidney injury (AKI) is a public health concern associated with high rates of mortality, even in milder cases. One of the reasons for the difficulty in managing AKI in patients is due to its association with pre-existing comorbidities, such as diabetes. In fact, diabetes increases the susceptibility to develop more severe AKI after renal ischemia. However, the long-term effects of this association are not known. Thus, an experimental model was designed to evaluate the chronic effects of renal ischemia/reperfusion (IR) in streptozotocin (STZ)-treated mice. We focused on the glomerular and tubulointerstitial damage, as well as kidney function and metabolic profile. It was found that pre-existing diabetes may potentiate progressive kidney disease after AKI, mainly by exacerbating proinflammatory and sustaining fibrotic responses and altering renal glucose metabolism. To our knowledge, this is the first report that highlights the long-term effects of renal IR on diabetes. The findings of this study can support the management of AKI in clinical practice.NEW & NOTEWORTHY This study demonstrated that early diabetes potentiates progressive kidney disease after ischemia/reperfusion (IR)-induced acute kidney injury, mainly by exacerbating pro-inflammatory and sustaining fibrotic responses and altering renal glucose metabolism. Thus, these findings will contribute to the therapeutic support of patients with type 1 diabetes with eventual renal IR intervention in clinical practice.

Preexisting Mental Disorders and Mental Distress During the Pandemic: The Roles of Stress, Risk Perception, and Loneliness.

The COVID-19 pandemic has imposed unprecedented stressors on individuals globally, leading to significant mental health challenges. This study examines the relationship between perceived adversities experienced during the pandemic-such as stress, risk perception, and loneliness-and the mental health outcomes of individuals with a specific focus on those already grappling with mental disorders. The study analyzed data from 8,259 adults who participated in surveys between waves 4 (April 2020) and 29 (June 2021) of the Understanding American Study. Participants self-reported their psychiatric diagnosis history and completed self-report measures of mental distress (PHQ-4), perceived stress, risk perception, and loneliness. Those with preexisting comorbid mental disorders reported higher levels of mental distress, COVID-19 risk perception, perceived stress as well as more days experiencing loneliness during the pandemic. Perceived adversities-stress, risk perception, and loneliness-were all positively associated with increased mental distress, indicating the risk factors for mental distress during the pandemic. Among these factors, loneliness was identified as the primary contributor, accounting for 30%-40% of the mental health gap between individuals with and without preexisting mental diagnoses. Also, the detrimental impact of these adversities was more pronounced for those with preexisting mental disorders. The research highlights that those with preexisting mental disorders, particularly those with comorbidities, face an increased risk of experiencing mental distress during the COVID-19 pandemic. These findings underscore the critical importance of providing targeted support and interventions specifically designed for this vulnerable population, with a particular focus on addressing loneliness.

Functional decline among bullous pemphigoid patients: A retrospective monocentric cohort study.

Bullous pemphigoid (BP) affects older patients with numerous comorbidities. The impact of BP on patient autonomy remains poorly understood. To assess the frequency and factors associated with functional decline (FD) in BP. In this retrospective monocentric study, we selected patients aged ≥75 years with BP diagnosed between 1 January 2015 and 31 December 2021 and followed for more than 3 months. We assessed activity limitation at diagnosis and included patients with no or mild activity limitation. We described FD and its associated factors at 6 weeks and 3 months. FD was qualified as moderate or severe. Age, comorbidities (CIRS-G score), BP characteristics at diagnosis (including palms and soles involvement) and hospitalization were collected. Factors associated with FD were investigated through univariate and multivariate logistic regression models. Worsening of previous comorbidities or new comorbidities at Week 6 were collected. One hundred and thirty-one patients were included (mean age 85 years), 75 (57.3%) had no activity limitation, and 56 (42.7%) a mild activity limitation at baseline. At Week 6, FD was observed in 44 (33.6%) patients, including 23 out of 75 (30.7%) with no activity limitation and 21 out of 56 (37.5%) with mild activity limitation at baseline. FD was moderate in 20 cases (45.5%) and severe in 24 (54.5%) and persisted at Month 3 in 37 (84%) patients. By multivariate analysis, factors associated with FD were a CIRS-G score >7, palms and soles involvement and anti-BP180 antibodies level. Fifty (38.2%) patients experienced a worsening of their pre-existing comorbidities or a new one. FD is often observed in patients with BP, especially in those with severe symptoms, palms and soles involvement and comorbidities. A comprehensive, multidisciplinary approach involving geriatric assessments should be adopted to manage these patients.

Clinical characteristics and factors associated with long COVID among post-acute COVID-19 clinic patients in Zambia, August 2020 to January 2023: A cross-sectional and longitudinal study design.

A number of seroprevalence studies in Zambia document the extent of spread of acute SARS-CoV-2 infection, yet knowledge gaps still exist on symptoms and conditions that continue or develop after acute COVID-19 (long COVID). This is an important gap given the estimated prevalence of long COVID in other African countries. We assessed factors associated with long COVID at the initial visit to a post-acute COVID-19 (PAC-19) clinic and longitudinally among a cohort of patients with ≥2 review visits. We implemented a cross-sectional and longitudinal analysis of PAC-19 clinic patients from Aug-2020 to Jan-2023. The study outcome was long COVID; defined as the presence of new, relapsing, or persistent COVID-19 symptoms that interfere with the ability to function at home or work. Explanatory variables were demographic and clinical characteristics of patients which included sex, age group, presence of new onset medical conditions, presence of pre-existing comorbidities, vaccination status and acute COVID-19 episode details. We fitted logistic and mixed effects regression models to assess for associated factors and considered statistical significance at p<0.05. Out of a total 1,359 PAC-19 clinic patients in the cross-sectional analysis, 548 (40.3%) patients with ≥2 PAC-19 clinic visits were in the longitudinal analysis. Patients' median age was 53 (interquartile range [IQR]: 41-63) years, 919 (67.6%) were hospitalized for acute COVID-19, and of whom 686 (74.6%) had severe acute COVID-19. Overall, 377 (27.7%) PAC-19 clinic patients had long COVID. Patients with hospital length of stay ≥15 days (adjusted odds ratio [aOR]: 5.37; 95% confidence interval [95% CI]: 2.99-10.0), severe acute COVID-19 (aOR: 3.22; 95% CI: 1.68-6.73), and comorbidities (aOR:1.50; 95% CI: 1.02-2.21) had significantly higher chance of long COVID. Longitudinally, long COVID prevalence significantly (p<0.001) declined from 75.4% at the initial PAC-19 visit to 26.0% by the final visit. The median follow-up time was 7 (IQR: 4-12) weeks. Factors associated with long COVID in Zambia were consistent both cross-sectionally at the initial visit to PAC-19 clinics and longitudinally across subsequent review visits. This highlights the importance of ongoing monitoring and tailored interventions for patients with comorbidities and severe COVID-19 to mitigate the long-term impacts of COVID-19.

Comparative evaluation of baseline SOFA score and CURB-65 score in predicting patient severity and outcome in COVID-19 patients admitted to a tertiary care ICU

Introduction COVID-19 is primarily a pulmonary disease, but with significant and frequent systemic manifestations. Our study aims to assess, which scoring system on admission—Confusion, Uraemia, Respiratory Rate &gt; 30/min, Blood Pressure low, Age &gt; 65 years (CURB-65) or SOFA, better correlates with COVID-19-positive patient mortality. Methodology This prospective observational study was conducted in COVID-positive adult patients. Upon admission, patient demographics, clinical condition and laboratory investigations were noted. SOFA and CURB-65 scores were calculated for each patient and the patient was followed up till the final outcome—transfer or expiry. Results Out of the 100 patients included in our study, the majority belonged to the age group of 41–60 years, with a mean age of 51 years. A significant proportion of patients (83%) had at least 1 pre-existing co-morbidity. The absence of co-morbidity showed an association with improved survival. The overall mortality rate was 46%. Baseline SOFA and CURB-65 scores showed a correlation with patient outcome, but SOFA showed a greater strength of association. It was found that at a cut-off of a total SOFA score of ≥4, it predicts patient expiry with a sensitivity of 89% and a specificity of 72%. Discussion CURB-65 is a scoring system used for severity assessment, guide therapy and prognostication of patients with lower respiratory tract infection or pneumonia. SOFA, on the other hand, is an ICU score used in multi-system diseases used for evaluating disease progression and prognostication. Many authors have found that SOFA score correlates well with patient outcome, and a high SOFA on admission usually indicates poor prognosis.

Interleukin (IL)-1/IL-6-Inhibitor–Associated Drug Reaction With Eosinophilia and Systemic Symptoms (DReSS) in Systemic Inflammatory Illnesses

After introducing interleukin(IL)-1/IL-6 inhibitors, some Still and Still-like patients developed unusual often fatal pulmonary disease. This complication was associated with scoring as DReSS (drug reaction with eosinophilia and systemic symptoms) implicating these inhibitors, although DReSS can be difficult to recognize in the setting of systemic inflammatory disease. We sought to facilitate recognition of IL-1/IL-6 inhibitor-DReSS in systemic inflammatory illnesses (Still/Still-like) by looking at timing and reaction-associated features. We evaluated outcomes of stopping or not-stopping IL-1/IL-6-inhibitors after DReSS reaction began. In an international study collaborating primarily with pediatric specialists, we characterized features of 89 drug-reaction cases versus 773 drug-exposed controls and compared outcomes of 52 cases stopping IL-1/IL-6-inhibitors to 37 cases not-stopping these drugs. Before reaction began, drug-reaction cases and controls were clinically comparable, except for younger disease onset age for reaction cases with pre-existing cardiothoracic comorbidities. After reaction began, increased rates of pulmonary complications and macrophage activation syndrome (MAS), differentiated drug-reaction cases from drug-tolerant controls (p=4.7x10-35; p=1.1x10-24, respectively). Initial DReSS feature was typically reported 2-8 weeks after initiating IL-1/IL-6-inhibition. In drug-reaction cases stopping versus not-stopping IL-1/IL-6-inhibitor treatment, reaction related features were indistinguishable, including pulmonary complication rates [75%(39/52] versus [76%(28/37)]. Those stopping subsequently required fewer medications for treatment of systemic inflammation, had decreased rates of MAS, and improved survival (p=0.005, multivariate regression). Resolution of pulmonary complications occurred in 67%(26/39) of drug-reaction cases who stopped and in none who continued inhibitors. In systemic inflammatory illnesses, recognition of IL-1/IL-6-inhibitor-associated reactions followed by avoidance of IL-1/IL-6-inhibitors significantly improved outcomes.

Navigating the COVID-19 Pandemic with DPLD: Insights from a Case Report for Healthcare Providers

The COVID-19 pandemic brought significant challenges to global healthcare systems, particularly for individuals with underlying health conditions. This article reports a case of a 65-year-old man with a medical history of diabetes mellitus, hypertension, and diffuse parenchymal lung disease (DPLD), who succumbed to severe COVID-19 infection. He presented to the Medicine inpatient of a tertiary care hospital, with fever and extreme lethargy during the second wave of the COVID-19 pandemic early in 2021. Upon presentation, his oxygen saturation (SPO2) was 31%. High-resolution computed tomography (HRCT) chest findings revealed extensive ground glass opacity, and his nasal swabs tested positive for COVID-19 via reverse transcription-polymerase chain reaction (RT-PCR). He was diagnosed with type 1 respiratory failure and was subsequently admitted to the intensive care unit (ICU), where his condition rapidly deteriorated and he passed away.This case highlights the heightened vulnerability of individuals with pre-existing comorbidities to severe COVID-19 complications and thus intensifies the importance of early recognition and intervention in such high-risk populations.

Epidemiological and Etiological Aspects of Acute Renal Failure in the Nephrology and Haemodialysis Department of the Point G University Hospital

Introduction: Acute renal failure (ARF) represents a major public health problem associated with high mortality. The incidence is increasing with the emergence of multiple risk factors. In Mali, there are currently no data on the extent and severity of this condition in either hospital or community settings. The aim of our study was to describe the epidemiological, therapeutic and prognostic aspects of ARF in adults treated at the University Hospital Centre (CHU) of Bamako. Patients and Methods: This was a retrospective and descriptive study that took place from 1 July 2021 to 30 June 2022 at the CHU du Point G in Bamako. It focused on patients hospitalised and/or followed up on an outpatient basis in the nephrology department during the study period. Results: The prevalence of acute renal failure was 11.55% with a sex ratio of 1.49. The mean age was 42.37±20.7 (range 6-88 years). Elevated plasma creatinine was the main reason for consultation. Creatinine levels were above 500µmol/l in 65.21% of cases. High blood pressure was the main presenting condition in 33.7% of cases. Acute renal failure was organic, obstructive and functional in 72.8%, 15.2% and 12% respectively. Rehydratation was used in 97.8% of cases. Dialysis was indicated in 40% of cases. Age over 60 years was a major risk factor for ARF. The outcome was favourable in 81.5% of cases. Conclusion: Mortality in dialysis patients with ARF remains high. Several factors influence the prognosis of these patients, including the severity of ARF and pre-existing comorbidity.

Navigating nephrotoxic waters: A comprehensive overview of contrast-induced acute kidney injury prevention

Contrast-induced acute kidney injury (CI-AKI) is the third leading cause of acute kidney injury deriving from the intravascular administration of contrast media in diagnostic and therapeutic procedures and leading to longer in-hospital stay and increased short and long-term mortality. Its pathophysiology, although not well-established, revolves around medullary hypoxia paired with the direct toxicity of the substance to the kidney. Critically ill patients, as well as those with pre-existing renal disease and cardiovascular comorbidities, are more susceptible to CI-AKI. Despite the continuous research in the field of CI-AKI prevention, clinical practice is based mostly on periprocedural hydration. In this review, all the investigated methods of prevention are presented, with an emphasis on the latest evidence regarding the potential of RenalGuard and contrast removal systems for CI-AKI prevention in high-risk individuals.

Impact of using a local protocol for preoperative screening exams in hip arthroplasty surgeries: cross-sectional study

Purpose: To evaluate the adoption of a protocol for patients undergoing primary total hip arthroplasty (PTA). Methods: 72 medical records of patients undergoing ATPQ were evaluated between 2016 and 2022. This is a cross-sectional retrospective study. The eligible patients were divided into two groups: group 1 – 36 arthroplasties before the adoption of the protocol; group 2 – 36 arthroplasties after the adoption of the protocol. Statistical analysis was performed using SPSS 13.0. Results: The mean age of the patients was 61 ± 11.7 years, being 42 males and 30 females. Pre-existing comorbidities were: systemic arterial hypertension (58%) and diabetes (18%) patients. The dominant side was operated on in 65% of cases. Patients were treated with cementless prosthesis (54%) of the cases and with hybrid prosthesis (40.3%). Only nine (12.5%) patients had infection. A significant difference was observed with the presence of infection in the group after the implementation of the protocol with a lower incidence. There was a lower infection rate in group 2 submitted to the application of the protocol, however, statistically the significance was not confirmed. Conclusion: It is concluded that the design of the institutional protocol has the potential to reduce postoperative infections in hip arthroplasty surgeries.

NURS-18. GERMINOMA PATIENTS – MORE PRONE TO PSYCHIATRIC DISORDERS, ALLERGIES, AND WEIGHT PROBLEMS? AN INSTITUTIONAL REVIEW

Abstract BACKGROUND Germinoma are the most frequent type of intracranial germ cell tumour. Within nursing clinical practice an increased prevalence of psychiatric manifestations, allergies, and weight gain throughout treatment and into survivorship within the germinoma population has been observed. There is only limited literature about these problems available. METHODS A retrospective review of clinical presentation, psychiatric co-morbidity, therapeutic course, and follow-up of 27 Germinoma patients (6.2-17 years) diagnosed and treated at a tertiary care center from 2008-2021 was performed. In addition, the presence and occurrence of allergies and weight changes throughout their therapy was reviewed. RESULTS Nearly half of the Germinoma patients (n=11) (suprasellar, pineal, basal ganglia) were diagnosed with pre-existing psychiatric co-morbidity (anxiety, depression, mood disorder and eating disorder) as per DSM-5 criteria, more commonly verified after their brain tumour diagnosis and persistent beyond treatment. Three of 27 (11%) patients indicated allergies (medication, food) at diagnosis. Seventeen of the 27 (63%) patients presented with allergies throughout their therapy (medication, tape, cleaning products, blood products). Six (35%) of those patients developed anaphylactic reaction to Etoposide and/or blood products. Eight of the patients (suprasellar &amp; pineal) were found to have a significant weight gain throughout their treatment and two (pineal &amp; suprasellar) were found to have significant weight loss, the rest of the cohort remained stable. The impact of tumour location (suprasellar, pineal) on the specific problems is ongoing. CONCLUSION The findings of this retrospective review could guide clinical practice. The potential higher incidence of psychiatric disorders should prompt practitioners to upfront screening and throughout therapy to ensure adequate support. Allergy prevalence in pediatrics is variable but an allergy occurrence of 35% is elevated in comparison to the general population and therefore increased awareness of allergies within this population is important for the bedside nurse. Lastly, early involvement of dieticians to aid in weight management seems crucial.

Anxiety and depression in patients with post-COVID-19 comorbities

Background: The COVID-19 pandemic has brought significant impacts on mental health, increasing conditions such as anxiety and depression. The negative impact was even bigger among the population with chronic illnesses like diabetes, hypertension, and obesity. Fear of contamination, social isolation, lack of medical follow-up, and changes in lifestyle have contributed to the worsening of these disorders. Objective: The aim of this study was to assess anxiety and depression levels and quality of life in individuals with pre-existing comorbidities post COVID-19. Methods: This is a cross-sectional study with a descriptive and analytical approach. The study included 125 individuals divided in healthy group and chronically ill group. Behavioral and clinical characteristics were evaluated, such as physical activity after COVID-19, smoking, alcohol consumption, pre-existing comorbidities, and symptoms of anxiety and depression. Results: The study highlighted that the patients with diabetes and hypertension suffered the most from anxiety and depression possibly due to the higher susceptibility to coronavirus infection and the negative impact of these pre-existing conditions on mental health. In hypertensive individuals, the complex interaction between emotional stress, anxiety, and cardiovascular system dysregulation contributed to increased levels of anxiety and depression. Obesity, besides a risk factor for severe COVID-19, it also negatively impacted the immune system and had adverse effects on mental health, with an increase in depressive and anxious symptoms. Conclusion: This study emphasizes the need of special care to at-risk groups to minimize adverse impacts on mental health and improve the quality of life of individuals with pre-existing comorbidities post COVID-19.

Impact of Age, Sex, and Cardiovascular Disease in Mortality in COVID-19 at the Medical City

INTRODUCTION: COVID-19 (coronavirus disease 2019), which is caused by the human severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), has reached a pandemic level. As a novel disease, local epidemiologic data are important to determine high-risk age groups, as well as risk factors that contribute to mortality. This study is a retrospective cohort study of 182 COVID-19–positive patients confirmed by real-time polymerase chain reaction. Baseline demographics and data on the preexisting cardiovascular comorbidities of 182 COVID-19 patients were collected by chart review and underwent statistical analysis using STATA 14 software (StataCorp, College Station, Texas). In the study, the majority of COVID-19 patients were 61 years or older (44.5%), with a higher prevalence of individuals 61 years or older among those who died (68.4%) compared with survivors (38.2%) (P = 0.005). In terms of gender, half of the patients were male (57.7%). In terms of cardiovascular disease, the most prevalent was hypertension (48.3%), followed by diabetes (28.0%). The prevalence of coronary artery disease (CAD) was significantly higher among patients who died (15.8%) compared with survivors (2.8%) (P = 0.022). In the univariate logistic regression analysis, older age was significantly associated with increased odds for mortality (odds ratio, 1.06; 95% confidence interval, 1.03–1.09). In terms of comorbidities, having CAD was significantly associated with increased odds for mortality (odds ratio, 6.6; 95% confidence interval, 1.7–24.6). Other variables were not significantly associated with mortality. In our study, advanced age and the presence of underlying CAD have been associated with an increased risk of in-hospital mortality among COVID-19 patients. KEYWORDS: age, cardiovascular disease, COVID-19, mortality, sex

Retrospective study of patient characteristics and treatment for mucormycosis in post COVID-19 population in a tertiary care hospital

ObjectivesAlong with the COVID-19 pandemic, another illness wreaking havoc in India is mucormycosis, also known as black fungus. Mucormycosis was previously known as zygomycotic infection, which is a consequential type...

Major abdominal surgery under locoregional anesthesia in a patient with primary ciliary dyskinesia: Clinical case

Laparoscopic surgery currently represents the standard approach in colorectal cancer. However, it requires general anesthesia and pneumoperitoneum, which may be contraindicated in patients with impaired lung function. We hereby present a case of tailored minimally invasive surgery for an ascending colon cancer in a patient with Primary Ciliary Dyskinesia, situs inversus totalis, and end-stage lung disease. The surgery was conducted through a 13 cm left transverse incision under locoregional anesthesia, and the patient made an uneventful recovery despite her pre-existing comorbidities. This case proves the importance of tailored surgical and anesthesiologic management to provide good oncological outcomes to all cancer patients.

Validation of a modified obstetric comorbidity index for prediction of postpartum adverse events including fetal morbidity - a retrospective cohort study from Qatar

BackgroundThe Obstetric Comorbidity Index (OBCMI) is an internationally validated scoring system for maternal risk factors intended to reliably predict the occurrence of severe maternal morbidity (SMM). This retrospective cohort study applied the OBCMI to pregnant women in Qatar to validate its performance in predicting SMM and cumulative fetal morbidity.MethodsData from 1000 women who delivered in July 2021 in a large tertiary centre was extracted from medical records. The OBCMI index included maternal demographics, pre-existing comorbidities, and various current pregnancy risk factors such as hypertension, including preeclampsia, intrauterine fetal death, prolonged rupture of membranes and unbooked pregnancies. SMM was based on the ACOG consensus definition, and the cumulative fetal morbidity (CFM) included fetal distress in labour, low APGAR and umbilical artery (UA) pH, admission to neonatal intensive care (NICU), and hypoxic-ischemic encephalopathy (HIE). A c-statistic or area under curve (AUC) was calculated to determine the ability of OBCMI to predict SMM and CFM.ResultsThe median OBCMI score for the cohort was 1 (interquartile range- 0 to 2); 50% of women scored 0, while 85% (n = 842) had a score ranging from 0 to 2. Ten women (1%) scored ≥ 7; the highest score was 10. The incidence of SMM was 13%. According to the modified scoring system, the mean OBCMI score in those who developed SMM was 2.18 (± 2.20) compared to a mean of 1.04 (± 1.40) in those who did not (median 1, IQR:1–3 versus median 0, IQR: 0–2; p < 0.001). The incidence of CFM was 11.3%. The incidence of low APGAR score, HIE and NICU admission was nearly 1 in 1000. Around 5% of the babies had fetal distress in labour and low UA pH. For every 1 unit increase in OBCMI score, the odds of SMM increased by 44% (OR 1.44 95% CI 1.30–1.59; p < 0.001; AUC 0.66), and CFM increased by 28% (OR 1.28 95% CI 1.15–1.42; p < 0.001; AUC 0.61). A cut-off score of 4 had a high specificity (> 90%); 1 in 4 and 1 in 6 women with OBCMI score ≥ 4 developed SMM and CFM, respectively.ConclusionThe OBCMI performed moderately well in predicting SMM in pregnant women of Qatar and can be effectively used as a risk assessment tool to red-flag high-risk cases so that appropriate and timely multidisciplinary care can be initiated to reduce SMM and maternal mortality. The index is also helpful in predicting fetal morbidity; however, further prospective studies are required to validate OBCMI for CFM.

Association of post-COVID phenotypic manifestations with new-onset psychiatric disease

Acute COVID-19 infection can be followed by diverse clinical manifestations referred to as Post Acute Sequelae of SARS-CoV2 Infection (PASC). Studies have shown an increased risk of being diagnosed with new-onset psychiatric disease following a diagnosis of acute COVID-19. However, it was unclear whether non-psychiatric PASC-associated manifestations (PASC-AMs) are associated with an increased risk of new-onset psychiatric disease following COVID-19. A retrospective electronic health record (EHR) cohort study of 2,391,006 individuals with acute COVID-19 was performed to evaluate whether non-psychiatric PASC-AMs are associated with new-onset psychiatric disease. Data were obtained from the National COVID Cohort Collaborative (N3C), which has EHR data from 76 clinical organizations. EHR codes were mapped to 151 non-psychiatric PASC-AMs recorded 28–120 days following SARS-CoV-2 diagnosis and before diagnosis of new-onset psychiatric disease. Association of newly diagnosed psychiatric disease with age, sex, race, pre-existing comorbidities, and PASC-AMs in seven categories was assessed by logistic regression. There were significant associations between a diagnosis of any psychiatric disease and five categories of PASC-AMs with odds ratios highest for neurological, cardiovascular, and constitutional PASC-AMs with odds ratios of 1.31, 1.29, and 1.23 respectively. Secondary analysis revealed that the proportions of 50 individual clinical features significantly differed between patients diagnosed with different psychiatric diseases. Our study provides evidence for association between non-psychiatric PASC-AMs and the incidence of newly diagnosed psychiatric disease. Significant associations were found for features related to multiple organ systems. This information could prove useful in understanding risk stratification for new-onset psychiatric disease following COVID-19. Prospective studies are needed to corroborate these findings.