Presence Of Comorbid Conditions Research Articles

Adjuvant Use and the Intensification of Pharmacologic Management for Pain in Nursing Home Residents with Cancer: Data from a US National Database.

Our objective was to describe the prevalence of adjuvants to opioid therapy and changes in these agents for pharmacologic management in nursing home residents with cancer. We included Medicare beneficiaries with cancer and documented opioid use at nursing home admission in 2011-2013 (N = 3268). The Minimum Data Set 3.0 provided information on sociodemographic and clinical characteristics. Part D claims provided information on opioid and adjuvant use during the 7days after admission and 90days later. Proportions of changes in these agents were estimated. Separate logistic models estimated associations between resident characteristics and (1) use of adjuvants at admission and (2) intensification of pharmacologic management at 90days. Nearly 20% of patients received adjuvants to opioids at admission, with gabapentin the most common adjuvant (34.4%). After 90days, approximately 25% had maintained or intensified pharmacologic management. While advanced age (≥ 85 vs. 65-74years, adjusted odds ratio [aOR] 0.80; 95% confidence interval [CI] 0.63-1.02) and comorbidities, including dementia (aOR 0.65; 95% CI 0.53-0.82) and depression (aOR 1.55; 95% CI 1.29-1.87), were associated with adjuvant use at admission, worse cognitive impairment (severe vs. no/mild, aOR 0.80; 95% CI 0.64-0.99) and presence of more severe pain (moderate/severe vs. no pain, aOR 1.60; 95% CI 1.26-2.03) were associated with intensification of drug regimen. Given aging-related changes and the presence of comorbid conditions in older adults, safety studies of these practices are warranted.

Modern pharmacotherapy of psoriatic arthritis

The lecture presents the modern principles of treatment of psoriatic arthritis (PSA), taking into account the heterogeneity of the manifestations of this disease and the presence of comorbid conditions, information on the effectiveness and tolerability of drugs that are used in the Russian Federation in PSA.

Impact of age on long term survival following transcatheter aortic valve implantation.

ObjectiveTo compare the long-term survival following transcatheter aortic valve implantation (TAVI) in an octogenarian population with that in a younger population.MethodsThis retrospective study included 274 patients that underwent TAVI for severe symptomatic aortic stenosis. The study group was divided into two age groups, as those with an age ≥ 80 years (octogenarians, n = 132), and age < 80 (younger patients, n = 142). The two groups were compared in terms of clinical outcomes and survival. In addition, significant predictors of survival were estimated.ResultsNon-cardiac mortality (during follow-up) (21.9% vs. 10.5%, P = 0.01) and in-hospital stroke (8.3% vs. 2.8%, P = 0.01) were more common among octogenarians. The two groups did not differ in terms of mean survival (41.0 ± 2.1 vs. 38.2 ± 2.2 months, respectively, P = 0.18). Multivariate analysis identified left ventricular ejection fraction < 35% (OR: 2.17, 95% CI: 1.17–4.03; P = 0.01), preoperative of moderate to severe mitral insufficiency (OR: 1.88, 95% CI: 1.15–3.06; P = 0.01), postoperative major and life-threating bleeding (OR: 2.49, 95% CI: 1.05–5.89; P = 0.03), and in-hospital stroke (OR: 2.29, 95% CI: 1.04–5.04; P = 0.03) as potential predictors of poor survival.ConclusionsIn this study, similarly favorable survival outcomes were achieved in the elderly population as in younger patients, despite the presence of comorbid conditions. A consideration should be given to non-surgical management of severe aortic stenosis with the TAVI procedure in elderly patients, in the absence of co-existent conditions associated with shortened life expectancy.

Pulmonary exacerbations as a risk factor for lung function decline-experiences of the National Cystic Fibrosis Center

Background/Aim. Pulmonary exacerbations have negative impact on clinical course of cystic fibrosis (CF) lung disease being associated with a steeper decline in the lung function, unfavorable prognosis and impaired quality of life. The aim of this study was to determine whether an increased number of exacerbations had influence on the lung function in the patients with CF, as well as to estimate the nutritional status, gender, presence of comorbid conditions and bacterial colonization of airways as predictive factors for pulmonary exacerbations. Methods. This retrospective cohort study included 83 pediatric and adult patients, treated from 2011? 2015 in the Mother and Child Health Institute of Serbia ?Dr Vukan Cupic?. The best result of forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) in each year of follow-up was taken into account to calculate the five-year trend values of these indicators. The number of exacerbations per year of follow-up and its impact on the FEV1 decline was evaluated. Results. Mean annual decline of FEV1 and FVC were 2.4% and 1.7% respectively. The malnourished patients had the lower initial values of FEV1 and FVC, and more frequent exacerbations in comparison with the normal weight and overweight patients. The frequency of exacerbations was significantly higher in the patients chronically colonized with Burkholderia cepacia (p = 0.023). The increased number of exacerbation was proved to be the most important factor in a prediction of FEV1 decline over time (p = 0.013). Conclusion. Pulmonary exacerbations lead to the more progressive lung function decline in the patients with CF. Malnourishment and chronic airway colonization with Burkholderia cepacia result in more frequent pulmonary exacerbations.

Effect of Comorbidity on Lung Cancer Diagnosis Timing and Mortality: A Nationwide Population-Based Cohort Study in Taiwan.

The effect of comorbidity on lung cancer patients' survival has been widely reported. The aim of this study was to investigate the effects of comorbidity on the establishment of the diagnosis of lung cancer and survival in lung cancer patients in Taiwan by using a nationwide population-based study design. This study collected various comorbidity patients and analyzed data regarding the lung cancer diagnosis and survival during a 16-year follow-up period (1995–2010). In total, 101,776 lung cancer patients were included, comprising 44,770 with and 57,006 without comorbidity. The Kaplan–Meier analyses were used to compare overall survival between lung cancer patients with and without comorbidity. In our cohort, chronic bronchitis patients who developed lung cancer had the lowest overall survival in one (45%), five (28.6%), and ten years (26.2%) since lung cancer diagnosis. Among lung cancer patients with nonpulmonary comorbidities, patients with hypertension had the lowest overall survival in one (47.9%), five (30.5%), and ten (28.2%) years since lung cancer diagnosis. In 2010, patients with and without comorbidity had 14.86 and 9.31 clinical visits, respectively. Lung cancer patients with preexisting comorbidity had higher frequency of physician visits. The presence of comorbid conditions was associated with early diagnosis of lung cancer.

Pharmacotherapy of obesity: what’s new?

The lifestyle change that underlies the treatment of such a prevalent chronic disease as obesity is often insufficient to successfully clinically relevant reduce body weight, especially in the presence of comorbid conditions and diseases (type 2 diabetes, atherogenic dyslipidemia, arterial hypertension, ischemic heart disease, hyperuricemia and gout, obstructive sleep apnea syndrome, polycystic ovary syndrome and other menstrual irregularities etc.). The availability in our country until recently, only two drugs for the treatment of obesity is extremely limited choice in the case of existing contraindications to this or another drug or the appearance of any side effects. The registration in Russia in 2016 of a new drug for the treatment of obese patients, including morbid or complicated concomitant diseases and conditions, an analogue of human glucagon-like peptide-1 — liraglutide in a dose of 3.0 mg, has replenished the arsenal of obesity pharmacotherapy and substantially extended capabilities of management of obesity and overweight including patients with severe comorbidities.

The Impact of Surgical Wound Dehiscence on Body Image

To identify changes in body image in patients with surgical wound dehiscence. This cross-sectional, descriptive, analytical study was conducted in a university hospital and nursing care center in Brazil. Sixty-one adult surgical patients of both genders from different inpatient wards or receiving outpatient care were selected. Forty-one participants had surgical wound dehiscence, and 20 had achieved complete wound healing (controls). The Body Dysmorphic Disorder Examination (BDDE), Body Investment Scale (BIS), and a questionnaire assessing clinical and sociodemographic characteristics of patients were used for data collection. Surgical wound dehiscence defects were 0.5 to 30 cm in length, located on the arms, legs, and chest. They were significantly associated with being white (P = .048), number of children (P = .024), and presence of comorbid conditions (P = .01). Overall, men reported higher BIS scores (positive feelings about the body) than women (P = .035). Patients with wound dehiscence had higher BDDE scores (negative body image) than controls (P = .013). The BDDE scores were associated with presence of surgical wound dehiscence (P = .013), number of children (P = .009), and wound length (P = .02). There were significant correlations between BIS scores in men with wound dehiscence (P = .042), number of children (P < .001), and BDDE scores (P < .001) and between BDDE scores and number of children (P = .031), wound length (P = .028), and BIS scores (P < .001). Surgical wound dehiscence had a negative impact on body image.

Factors Associated with Readmission of Pediatric Patients in a Developing Nation.

To determine the incidence of readmission in pediatric patients in a tertiary care hospital in a developing nation and to ascertain factors precipitating readmissions. A prospective study was conducted from February 2016 through January 2017 at a tertiary care hospital. Children between 1 mo to 15 y of age were included if they were readmitted within 60 d of discharge. The risk factors for readmission were determined on the basis of medical record review and a structured questionnaire and the ascribed cause of readmission was grouped into three categories: Patient specific factors, Hospital specific factors and Unrelated/ New illness. The readmission rate was 3%, out of which 80.66% were found to be causally related to the index admission. Several sociodemographic characteristics i.e. lack of health information like television, lower socioeconomic status, absence of adequate breastfeeding, lower age, migrants were found to be significantly associated with readmission along with other patient specific factors like presence of cardiac disease, presence of comorbid conditions like anemia, malnutrition, and global developmental delay. The most important cause for readmission was determined as patient specific (48.66%) followed by hospital specific (38%) and unknown/unrelated factors (13.33%). The progression of the primary illness and social determinants of pediatric readmissions are important contributing risk factors for readmission in developing countries in pediatric patients. Multicentric studies are needed from this region of the world to include different hospital readmissions rate and to address the issue of potential preventability of pediatric readmissions.

Chronic Myeloid Leukemia, Version 1.2019, NCCN Clinical Practice Guidelines in Oncology.

Chronic myeloid leukemia (CML) is defined by the presence of Philadelphia chromosome (Ph), resulting from a reciprocal translocation between chromosomes 9 and 22 [t(9;22] that gives rise to a BCR-ABL1 fusion gene. CML occurs in 3 different phases (chronic, accelerated, and blast phase) and is usually diagnosed in the chronic phase. Tyrosine kinase inhibitor (TKI) therapy is a highly effective first-line treatment option for all patients with newly diagnosed chronic phase CML (CP-CML). The selection TKI therapy should be based on the risk score, toxicity profile of TKI, patient's age, ability to tolerate therapy, and the presence of comorbid conditions. This manuscript discusses the recommendations outlined in the NCCN Guidelines for the diagnosis and management of patients with CP-CML.

Reducing surgical site infections through quality improvement initiative: A tertiary cardiac care facility experience in a developing country

Introduction: Amongst healthcare associated infections (HAIs), surgical site infections (SSIs) are a preventable cause of increased morbidity and mortality and are associated with substantial financial costs. SSI rates are an indicator of the quality of surgical and postoperative care, which necessitates the need for robust surveillance systems for these healthcare associated infections. Patients undergoing coronary artery bypass grafting (CABG) are at a greater risk for infection due to their relatively older age and the presence of comorbid conditions like diabetes mellitus and obesity.

Abstract IA27: Disparities in breast cancer survivorship and outcomes

Abstract In the U.S., women of European ancestry have historically had the highest incidence of breast cancer compared to other major race/ethnicity groups. In recent years, the incidence rate for black women has approached that of white women, while rates for Asian and Hispanic women are about 25% lower than for white or black women. However, once diagnosed with breast cancer, black women have poorer survival rates than white women. The most recent “Annual Report to the Nation on the Status of Cancer” using nationwide cancer-registry data from 2006-2013 (Jemal et al., JNCI, 2017) reported a higher age- and stage-adjusted relative mortality risk after breast cancer of 1.71 (95% confidence interval (CI), 1.66-1.76) for non-Hispanic blacks compared to non-Hispanic whites. Hispanic women also experienced a slightly increased relative mortality risk of 1.14 (95% CI, 1.10-1.18) compared to white women, while Asians experienced a lower relative mortality risk of 0.84 (95% CI, 0.80-0.88). The reasons for such disparities in outcomes after breast cancer are complex. One suggested contributing factor is differences in access to care, as blacks and Hispanics tend to be of lower socioeconomic status than whites or Asians. It is possible to minimize the effects of access to health care by examining outcomes after breast cancer diagnosis in an integrated health care setting such as Kaiser Permanente Northern California (KPNC), in which all patients have health insurance coverage with access to the same health care providers. We are currently conducting the Pathways Study, a prospective cohort study of 4,505 women diagnosed with breast cancer with enrollment from 2006-2013. This diverse cohort includes 557 Hispanics, 578 Asians, and 358 blacks. Preliminary analyses in the larger population of 11,176 women who were diagnosed with invasive breast cancer in KPNC and eligible for the Pathways Study found that, despite the uniform health care access, racial disparities in mortality after breast cancer were qualitatively similar to those observed nationally. With 1,738 total deaths as of September 20, 2016, and adjusted for age and stage at diagnosis, compared to white women, black women had an increased relative mortality risk of 1.59 (95% CI, 1.24-2.03). For Hispanic women, the relative risk was 0.92 (95% CI, 0.72-1.19), and for Asians it was 0.70 (95% CI, 0.51-0.97). Among the subset of women enrolled in the Pathways Study (n=538 total deaths), comparable relative risks were 1.74 (95% CI, 1.35-2.24) for black women, 0.99 (95% CI, 0.75-1.29) for Hispanic women, and 0.73 (95% CI, 0.52-1.02) for Asians. Similar black-white differences were also seen for breast cancer-specific mortality and recurrence in the Pathways Study cohort in which recurrences are being documented. These observations indicate that health care access is unlikely to explain racial/ethnic disparities in breast cancer outcomes. As the Pathways Study, we will be able to explore aspects of health care utilization, such as treatment-related factors such as treatment delay, adherence, and early discontinuation. We will also be able to explore presence of comorbid conditions or use of non-cancer medications that may influence mortality and breast cancer outcomes. In the Pathways Study, we are collecting data on lifestyle and psychosocial factors (e.g., food intake, physical activity, social support, doctor-patient communications, and quality of life); linking to geospatial databases to characterize the social and built environment of cohort members; and conducting genome-wide assays. For example, in preliminary analyses that adjusted additionally for estrogen receptor status, body mass index, educational attainment, and physical activity, black-white differences in mortality persisted even though they were somewhat attenuated (relative risk of 1.43; 95% CI, 1.09-1.86). Along with other studies that are examining breast cancer outcomes in different populations, the Pathways Study is poised to contribute to better understanding of the persistent black-white differences in mortality after breast cancer, and thus identify avenues to improve outcomes for all women with breast cancer. Citation Format: Lawrence H. Kushi, Isaac J. Ergas, Janise M. Roh, Scarlett Lin Gomez, Marilyn L. Kwan, Catherine Thomsen, Song Yao, Christine B. Ambrosone. Disparities in breast cancer survivorship and outcomes [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr IA27.

Chromosomal microarray analysis in developmental delay and intellectual disability with comorbid conditions

BackgroundDevelopmental delay (DD) and intellectual disability (ID) are frequently associated with a broad spectrum of additional phenotypes. Chromosomal microarray analysis (CMA) has been recommended as a first-tier test for DD/ID in general, whereas the diagnostic yield differs significantly among DD/ID patients with different comorbid conditions.MethodsTo investigate the genotype-phenotype correlation, we examined the characteristics of identified pathogenic copy number variations (pCNVs) and compared the diagnostic yields among patient subgroups with different co-occurring conditions.ResultsThis study is a retrospective review of CMA results generated from a mixed cohort of 710 Chinese patients with DD/ID. A total of 247 pCNVs were identified in 201 patients (28%). A large portion of these pCNVs were copy number losses, and the size of copy number losses was generally smaller than gains. The diagnostic yields were significantly higher in subgroups with co-occurring congenital heart defects (55%), facial dysmorphism (39%), microcephaly (34%) or hypotonia (35%), whereas co-occurring conditions of skeletal malformation (26%), brain malformation (24%) or epilepsy (24%) did not alter the yield. In addition, the diagnostic yield nominally correlated with ID severity.ConclusionVaried yields exist in DD/ID patients with different phenotypic presentation. The presence of comorbid conditions can be among factors to consider when planning CMA.

PIH39 - Study of Prescription Errors and Associated Factors in the Geriatric Patient Population of a Tertiary Care Hospital in India

To determine the prevalence of prescription errors( both inappropriate prescribing and prescribing omissions ) in hospitalized geriatric population and detect the association between prescribing errors and factors such as age, gender, number of medications, co-morbid conditions and length of stay in hospital. The study was a retrospective observational study conducted on 250 elderly patients of either gender ( ≥65 years) admitted to medicine ward during Nov 2014-May 2015. The patients’ data including demographics, history, diagnosis, laboratory tests and details of drug therapy during the period of hospitalization were recorded in a structured format using a case record form. The data was assessed for presence of inappropriate prescriptions according to the STOPP/START tool for detection of prescription errors. The association between prescription errors and contributing factors was studied using Chi-Square test of statistical analysis. A prevalence of 6.4% ( 16 instances in 250 patients)of inappropriate prescriptions and 9.2% (23 instances in 250 patients) of that of prescription omissions was detected in our study. The study revealed a significant association between presence of co-morbid conditions and occurrence of prescribing omissions as well as total number of medications prescribed with prescribing omissions in the elderly. Demographic factors and length of stay in the hospital did not show an association with inappropriate prescribing/omissions. Repeated sensitization and education of physicians in geriatric prescribing may contribute to lower prevalence of prescribing errors. Patients with higher co-morbid index and those on multiple drugs are at higher risk of medication errors and physicians should be more cautious while prescribing to such population.

Factors affecting morbidity and mortality in peptic ulcer perforation

Background: Peptic ulcer disease is very common disease in developing countries and so are its complications. With the introduction of H2 receptor antagonists and proton pump inhibitors, the incidence of elective surgery for peptic ulcer (PU) disease has decreased dramatically, although complications of peptic ulcer disease such as perforation and bleeding have remained fairly constant.Methods: A prospective study was conducted on43 patients presenting to KIMS Hospital, Hubli with features suggestive of hollow viscus perforation and intraoperative findings suggestive of peptic ulcer perforation from January 2015 to June 2016.Results: In this study, there were 43 cases of peptic ulcer perforation. Peptic ulcer perforation was common in third decade of life(n=12) with the mean age(SD) 39.88 years. Perforation is more common in males as compared to the female population 7.6:1. Post-operative morbidity is seen in 31 (72.1%) of patients and mortality in 4 (9.3%). Smoking, Alcohol beverage consumption, regular ingestion of NSAIDs were commonly seen in patients with peptic ulcer perforation but these factors were not significant risk factors for postoperative mortality and morbidity. Age ≥60 years (p-value 0.051), Female gender (p-value 0.012), Presence of co-morbid conditions (p-value 0.055), Shock on admission (p-value 0.029, perforation-surgery interval &gt;24 hours (p-value 0.001), preoperative higher-grade ASA, purulent intraperitoneal collection (p-value 0.002) were statistically significant predictors of mortality.Conclusions: Perforated peptic ulcer (PPU) is a life-threatening disease with historically reported high morbidity and mortality rates. Age ≥60 years, female gender, presence of co-morbidities, preoperative shock, higher ASA grade, perforation-surgery interval &gt;24 hours, Purulent intraperitoneal collection are inter-related statistically significant predictors of mortality. Therefore, proper resuscitation from shock, improving ASA grade and decreasing delay in surgery is needed to improve overall results.

Drug utilization pattern and physician adherence to treatment guidelines in inpatients with urinary tract infection

Background: Mainstay of management in urinary tract infection (UTI) is antibiotics and it is seen in recent years that antibiotic resistance is increasing. However, very few treatment guidelines exist for UTI and often treating physicians may not adhere to these guidelines. Aims: Current study was undertaken to analyze antimicrobial prescription pattern and utilization, and check for physician adherence to treatment guidelines in UTI.Methods: This retrospective, record-based study was carried out in a tertiary care hospital in inpatients with UTI. Tabulated data was analyzed using WHO core drug prescribing indicators and Anatomical Therapeutic Chemical/ Defined Daily Dose (ATC/DDD) index. Adherence to treatment guidelines was assessed using Indian Standard Treatment Guidelines for Urology. Data documented in SPSS software was analyzed using χ2-test and multinomial logistic regression.Results: Among 364 patients included in study, equal incidence of UTI was seen in both sexes (male to female ratio 1.02:1). Prolonged hospital stay (&gt;7 days) was associated with elderly age group (OR=3.09, CI95% 1.83-5.21), complicated UTI (OR=8.11, CI95% 4.62-14.24), ESBL-producing E. coli (OR=3.07, CI95% 1.58-5.94), non-adherence to treatment guidelines (OR=8.65, CI95% 4.19-17.84), and presence of comorbid conditions like diabetes mellitus (OR=4.89, CI95% 3.05-7.82), benign prostatic hypertrophy (OR=2.76, CI95% 1.36-5.59) and utero-vaginal prolapse (OR=8.33, CI95% 2.28-30.45). Average number of drugs prescribed per encounter was 1.59, while drugs prescribed by generic name and from essential drug list were 98.1% and 70.69% respectively. Majority of prescriptions (87.6%) adhered to standard treatment guidelines. Prescribed daily dose (PDD) and defined daily dose (DDD) were equal for most antibiotics prescribed.Conclusions: Majority of prescriptions were adhering to treatment guidelines but the need to prescribe using generic name and from essential drug list should be emphasised upon.

"Left to my own devices, I don't know": using theory and patient-reported barriers to move from physical activity recommendations to practice.

Physical activity recommendations exist for individuals with osteoporosis; however, to change behavior, we must address barriers and facilitators to their implementation. The purposes of this project are (1) to identify barriers to and facilitators of uptake of disease-specific physical activity recommendations (2) to use the findings to identify behavior change strategies using the Behaviour Change Wheel (BCW). Focus groups and semi-structured interviews were conducted with community-dwelling individuals attending osteoporosis-related programs or education sessions in Ontario. They were stratified by geographic area, urban/rural, and gender, and transcribed verbatim. Two researchers coded data and identified emerging themes. Using the Behaviour Change Wheel framework, themes were categorized into capability, opportunity, and motivation, and interventions were identified. Two hundred forty community-dwelling individuals across Ontario participated (mean ± SD age = 72 ± 8.28). Barriers were as follows: capability: disease-related symptoms hinder exercise and physical activity participation, lack of exercise-related knowledge, low exercise self-efficacy; opportunity: access to exercise programs that meet needs and preferences, limited resources and time, physical activity norms and preferences; motivation: incentives to exercise, fear of fracturing, trust in exercise providers. Interventions selected were training, education, and modeling. Policy categories selected were communication/marketing, guidelines, and service provision. Barriers unique to individuals with osteoporosis included the following: lack of knowledge on key exercise concepts, fear of fracturing, and trust in providers. Behavior change techniques may need tailoring to gender, age, or presence of comorbid conditions.

Awareness of Cardiovascular Risk Factors in U.S. Young Adults Aged 18–39 Years

Young adults with hyperlipidemia, hypertension, and diabetes are at increased risk of developing heart disease later in life. Despite emphasis on early screening, little is known about awareness of these risk factors in young adulthood. Data from the nationally representative cross-sectional National Health and Nutrition Examination Survey 2011-2014 were analyzed in 2017 to estimate the prevalence of self-reported awareness of hypercholesterolemia, hypertension, and diabetes in U.S. young adults aged 18-39 years (n=11,083). Prevalence estimates were weighted to population estimates using survey procedures, and predictors of awareness were identified using weighted logistic regression. Among U.S. young adults, the prevalence of hypercholesterolemia, hypertension, and diabetes was 8.8% (SE=0.4%); 7.3% (SE=0.3%); and 2.6% (SE=0.2%), respectively. The prevalence of borderline high cholesterol, blood pressure, and blood glucose were substantially higher (21.6% [SE= 0.6%]; 26.9% [SE=0.7%]; and 18.9% [SE=0.6%], respectively). Awareness was low for hypercholesterolemia (56.9% [SE=2.4%]) and moderate for hypertension and diabetes (62.7% [SE=2.4%] and 70.0% [SE=2.7%]); <25% of young adults with borderline levels of these risk factors were aware of their risk. Correlates of risk factor awareness included older age, insurance status, family income above the poverty line, U.S. origin, having a usual source of health care, and the presence of comorbid conditions. Despite the high prevalence of cardiovascular risk factors in U.S. young adults, awareness remains less than ideal. Interventions that target access may increase awareness and facilitate achieving treatment goals in young adults.

Improvement in dialysis-related adverse events with use of body composition monitoring.

This study aims to utilize body composition monitor (BCM) device to achieve euvolemic status in problematic dialysis patients and to evaluate its clinical outcome. One hundred and five hemodialysis (HD) patients were enrolled based on difficulty in achieving dry weight. The reasons for enrollment in the study were (a) recurrent intradialytic hypotension, (b) intradialytic hypertension, (c) intradialytic muscle cramps, or (d) the presence of comorbid conditions that make clinical assessment of dry weight difficult (e.g., cirrhosis of liver, heart failure, severe malnutrition, or morbid obesity). Following initial assessment of hydration status using BCM device, dry weight for each patient was adjusted accordingly (upward, downward, or unchanged). The patients were, thereafter, monitored over a 15-week period for possible resultant change in the clinical and hemodynamic parameters. Forty-two patients were monitored due to hypertension, 18 due to hypotension, 10 due to hypotension and cramps, and 35 due to comorbid conditions that make clinical assessment of dry weight difficult. At the conclusion of study period, there was improvement in the monitored parameters. Hypertension improved in 79% of the patient with hypertension, hypotension in 90%, and hypotension with cramps in 90%. In the comorbid group, BCM monitoring provided better insight to clinical problem management in 80% cases. Overall quality of BCM assessments was 96.1%. In the hypertension group, mean blood pressure decreased by 10.9 mm Hg in the whole group (P = 0.0006), the drop was 3 mm Hg in the patients dialyzing with HD (P = 0.0006) and 8.6 mm Hg in those on hemodiafiltration (HDF) (P = 0.08). In the comorbid conditions group, the mean blood pressure rose by 22.5 mm Hg in the whole group (P 0.00001), 21.5 mm Hg in the patients dialyzing with HD (P = 0.00001) and 21.5 mm Hg in those on HDF (P = 0.0004). BCM monitoring together with clinical assessment is a useful tool which when appropriately applied reduces the incidence of dialysis-related complications.

Post-cholecystectomy syndrome: A new look at an old problem.

Background:Despite being the most commonly performed operations, sometimes cholecystectomy fails to relieve symptoms; this is now a well-recognised clinical entity termed 'post-cholecystectomy syndrome' (PCS). Very few studies from India deal with PCS, and the present study was carried out to find the incidence and risk factors for PCS in patients undergoing elective laparoscopic cholecystectomy (LC).Materials and Methods:The records of 207 patients undergoing elective LC were prospectively maintained for 6 months after surgery. Persistence or appearance of new symptoms after surgery was documented and investigated only when they persisted beyond 30 days of surgery.Results:There were 185 (89.4%) female patients and 22 (10.6%) male patients with a mean age of 44.4 years (age range: 12–79 years). Conversion to open cholecystectomy was done in 18 patients (8.69%), mainly due to adhesions and unclear anatomy. The incidence of symptoms was found to be 13% at 6 months follow-up, showing a reducing trend from 58% in the 1st week after LC; the most common symptom in symptomatic patients was dyspepsia (55.56%). On investigation, a cause for symptoms could be detected in only 0.97%.Conclusion:Symptoms are common after LC, but they settle over time. Very few patients have a detectable cause for symptoms after LC, and it is difficult to predict which patients will become symptomatic after LC; in the present series, previous attacks of cholecystitis and presence of co-morbid conditions were the only consistent risk factors for symptoms after LC.

Current systemic therapies for metastatic renal cell carcinoma in older adults: A comprehensive review.

Physiological changes that occur during the aging process may impact drug metabolism and availability, consequently affecting treatment efficacy and tolerability. Despite being a disease of older adults, there is little data to guide treatment decisions for older patients with metastatic renal cell carcinoma (mRCC). The recent approval of many new agents for this disease poses a clinical challenge: how to best utilize these drugs in a population (older adults) who has been generally under-represented in clinical studies. Additionally, the presence of comorbid conditions, polypharmacy, frailty, and lack of social support place this group of patients in a very unique situation. In order to avoid under-treatment, international societies' guidelines recommend routine use of geriatric tools to assess patients' suitability for systemic treatments. Here we provide a thorough review of age-related metabolic differences, safety and efficacy data for each drug approved for mRCC, and cover specific considerations for the management of older adults with this disease.