Prevalence Of Chronic Conditions Research Articles

An Analysis of the Connection between Type 2 Diabetes and Heart Failure

Type 2 diabetes (T2D) and heart failure (HF) are two of the most prevalent chronic conditions worldwide, both of which contribute significantly to global morbidity and mortality rates. Individuals with T2D are at a 2-5 times higher risk of developing HF. At the same time, a substantial proportion of patients with HF also suffer from diabetes, introducing complex clinical challenges that complicate the management of both conditions. This article explores the links between T2D and HF, with a particular focus on shared pathophysiological mechanisms, risk factors, and clinical implications. Through a systematic literature review of peer-reviewed studies, this research identifies and critically evaluates the common pathways that contribute to the development and progression of both conditions, such as insulin resistance, chronic inflammation, and obesity-induced lipotoxicity. Additionally, the study discusses the impact of these mechanisms on the heart. It explores the potential for integrated therapeutic strategies aimed at simultaneously managing the metabolic and cardiovascular risks associated with T2D and HF. The findings underscore the importance of a holistic approach to patient care, emphasizing the need for early intervention and targeted treatments that address the dual burden of these interrelated conditions.

Biomarkers and potential therapeutic targets driving progression of non-alcoholic steatohepatitis to hepatocellular carcinoma predicted through transcriptomic analysis

BackgroundNon-alcoholic steatohepatitis (NASH) is the most prevalent chronic liver condition globally, with potential progression to cirrhosis, and even hepatocellular carcinoma (HCC). The increasing prevalence of NASH underscores the urgent need for advanced diagnostic and therapeutic strategies. Despite its widespread impact, effective treatments to prevent the progression of NASH remain elusive, highlighting the critical importance of innovative molecular techniques in both the diagnosis and management of this disease.MethodsSix microarray datasets available in GEO were used to perform Robust Rank Aggregation (RRA) to identify differentially expressed genes (DEGs).We identified 62 robust upregulated genes and 24 robust downregulated genes. These genes were undergone Gene Ontology enrichment analysis and further examination for expression correlation with NAS score. Molecular subtypes were generated using “ConsensusClusterPlus” on identified genes, which were further assessed for tumor stage relevance, expression differences in adjacent and tumor tissues, and impact on survival in TCGA liver cancer patients. Single-cell analysis was then used to explore the genes across different cell types and subgroups as well as cell-type interactions. The clinical utility of predicted core genes was highlighted through decision curve analysis, with emphasis on HCC prognosis. The GDSC database was used to evaluate the relationship between the predicted core genes and drug sensitivity, while the TIDE database was used to evaluate their relationship with immunotherapy.ResultsFour core genes, TREM2, GDF15, TTC39A, and ANXA2, were identified as key to influencing HCC prognosis and therapy responsiveness, especially immune treatment efficacy in NASH-associated HCC.ConclusionThe core genes may act as critical biomarkers driving the progression of NASH to HCC. They are potential novel targets for the diagnosis and treatment of NASH progression, offering innovative perspectives for its clinical management.

Mental Health Implications of Acne Vulgaris

Acne vulgaris, a prevalent chronic inflammatory skin condition, affects approximately 9.4% of the global population, with implications that extend beyond physical appearance to significantly impact mental health. While acne primarily manifests through visible skin lesions, such as comedones, papules, and pustules, the condition’s psychological toll can be profound. Many individuals with acne experience elevated levels of anxiety, depression, and reduced self-esteem, especially adolescents, for whom acne can disrupt self-identity formation. These mental health challenges are often exacerbated by the social stigma associated with visible skin conditions, leading to issues like social withdrawal, body image concerns, and, in severe cases, even suicidal thoughts. Effectively managing acne requires a holistic approach that addresses both physical symptoms and psychological well-being. Dermatological treatments, including topical retinoids, benzoyl peroxide, and oral isotretinoin, are commonly used to control acne symptoms. Dietary modifications, such as reducing high-glycemic foods and dairy, and the use of probiotics, have shown promise as supportive measures. However, addressing the psychological component is equally critical; integrating psychological interventions, such as counseling, cognitive-behavioral therapy, and patient education, can help alleviate the mental strain associated with acne, improve adherence to treatment, and enhance quality of life. Further research is essential to explore the long-term benefits of combined dermatological and psychological treatments and to develop personalized approaches that consider individual psychological profiles. A comprehensive treatment model that incorporates both physical and mental health support offers the potential for improved outcomes, fostering both dermatological recovery and mental resilience in individuals affected by acne vulgaris.

Health utility attributable to oral conditions in Japanese adults.

Utility values enable relative comparisons across various health conditions, providing information for efficient allocation of healthcare resources. This study aimed to (1) quantify the utility values attributable to oral health-related quality of life (OHRQoL) in Japanese adults and (2) develop models for converting the 14-item Oral Health Impact Profile (OHIP-14) scores into EuroQoL 5-dimension 5-level (EQ-5D-5L)-based utility values. This was a cross-sectional study. Data from a large-scale Internet survey of Japanese adults conducted in 2022 (n = 28 405; mean age 48.2 years) were analysed. Multiple linear regression models were fitted to investigate the association between OHIP-14 scores and EQ-5D-5L-based utility values, adjusting for confounders. Conversion models were developed using a random half of the participants, and the observed and predicted utility values in the other half were compared to evaluate the model performance. Among the participants, 55.2% scored 0, 20.9% scored 1-5 and 23.9% scored 6-56 on the OHIP-14, corresponding mean utility values of 0.93, 0.90 and 0.84, respectively. A one-point increase in the OHIP-14 score was associated with a lower utility value (coefficient: -0.0053; 95% confidence interval:health-related quality of life -0.0056, -0.0051). The estimated utility value attributable to OHIP-14 was -23.3 per 1000 individuals, greater than that for other prevalent chronic conditions, including hypertension and diabetes (-2.9 and -7.1 per 1000 individuals, respectively). The conversion model incorporated the OHIP-14 total score, age, sex and self-rated health, predicted utility scores on average and captured differences according to the number of teeth lost. However, there was a discrepancy between predicted and observed utility values in the lower utility value groups. OHRQoL substantially impacted utility values at the population level. The OHIP-14 holds the potential as a valuable tool for predicting average utility values based on oral health conditions; however, the prediction performance was relatively low for individuals with a lower health-related quality of life.

Classification of Drug Usage Patterns and Identification of Diseases in the Provision of Drug Types Using the K-Nearest Neighbors Method

The increasing complexity of healthcare systems highlights the need for data-driven approaches to optimize drug usage patterns and improve disease management. This study employs the K-Nearest Neighbors (KNN) algorithm to analyze correlations between prescribed medications and associated diseases, utilizing a dataset comprising attributes such as patient demographics, drug types, dosages, and treatment frequencies. The results reveal significant trends, including the predominance of "Drug_D" due to its versatility across multiple conditions such as hypertension, diabetes, and cardiovascular diseases. The study also highlights the prevalence of chronic conditions like hypertension and respiratory disorders, underscoring the importance of preventive healthcare and resource allocation. Simplified dosage regimens, predominantly "Once_Daily," were found to enhance patient adherence, aligning with global best practices in chronic disease management. The analysis further emphasizes targeted prescribing practices, with specific drugs strongly correlated to particular diseases, such as "Drug_A" for hypertension and "Drug_B" for respiratory disorders. However, the broad usage of certain medications raises concerns about potential over-reliance, necessitating regular monitoring. These findings demonstrate the value of machine learning in improving healthcare decision-making, enhancing operational efficiency, and supporting evidence-based practices. Future research should expand the dataset to include genetic and lifestyle factors to further refine predictive accuracy and contribute to the advancement of personalized medicine. This study underscores the transformative potential of integrating data mining techniques into healthcare systems to achieve better patient outcomes and more effective resource management.

Human Nasal Turbinate-Derived Stem Cells for Tissue Engineering and Regenerative Medicine

Mesenchymal stem cells (MSCs) are multipotent progenitor cells present in adult tissues that are recognized as promising candidates for cell therapy due to their ease of access, straightforward isolation, and capacity for bio-preservation with minimal loss of potency. However, the clinical application of MSCs faces significant challenges, such as donor site morbidity, underscoring the need for alternative sources. Recent studies have suggested that inferior turbinate tissues, which are commonly removed during turbinate surgery, may be a viable donor site for MSCs. Turbinate surgery is a safe and effective procedure frequently performed to alleviate nasal obstruction, a prevalent chronic condition treated by otolaryngologists. This implies that harvesting MSCs from turbinate tissue for tissue engineering and regenerative medicine could serve as a simple, minimally invasive method with faster healing and minimal risk of morbidity or scarring at the donor site. This review highlights previous research indicating that MSCs derived from human turbinate tissues maintain their stability and demonstrate multi-differentiation potential. Therefore, the turbinate could be an alternative to traditional MSC sources for producing functionally competent cells for future clinical applications.

Breaking barriers: enhancing solubility and dissolution of efonidipine using co-amorphous formulations.

The study aims to enhance the solubility and dissolution characteristics of efonidipine hydrochloride ethanolate (EFD), an antihypertensive drug, through the co-amorphous approach. Hypertension is a prevalent chronic condition characterized by consistently elevated blood pressure. Efonidipine, a BCS class II drug, has high permeability but low solubility, limiting its therapeutic effectiveness. Amorphization, which disrupts the crystal lattice of crystalline medications, can significantly enhance drug solubility and dissolution rates. Co-amorphous systems of EFD were prepared using solvent evaporation, ball milling, and liquid-assisted grinding methods. The drug and co-former were used in a different ratio, a stoichiometric proportion known for forming stable amorphous phases. The in vitro dissolution of the co-amorphous form was evaluated and compared with the pure crystalline form of EFD. The co-amorphous system of EFD with benzoic acid demonstrated significantly higher dissolution rates in vitro compared to the pure drug. PXRD analysis confirmed the transformation from a crystalline to an amorphous state, indicated by the disappearance of sharp peaks characteristic of the crystalline form. The resultant co-amorphous system exhibited dissolution properties. The co-amorphous approach effectively improved the solubility and dissolution of efonidipine hydrochloride ethanolate. Benzoic acid, as a co-former, facilitated the formation of a stable amorphous phase, thereby enhancing the drug's dissolution rate. The developed a co-amorphous system of EFD with benzoic acid, significantly enhancing its dissolution characteristics. PXRD analysis confirmed the amorphous nature and improved stability of the co-amorphous form, indicating its potential for better therapeutic efficacy in hypertension management.

Challenges in oral health practice in Somalia: a call for regulatory strengthening and inclusion into primary healthcare services

BackgroundOral diseases remain a significant public health problem worldwide despite being largely preventable. Oral disorders such as dental caries, periodontal diseases, and oral cancers are highly prevalent chronic conditions that negatively impact quality of life. The oral health practice in Somalia has been evolving over the years, we therefore explored the challenges of oral health practice in a security-constrained poorly regulated environment to guide policy development.MethodsWe conducted a descriptive cross-sectional study among 15 oral health practitioners in Somalia. Using in-depth interviews, we gathered data on challenges working in private dental clinics and governmental institutions. Additionally, we gathered data on gender, age, marital status, profession, country of graduation, current location of practice, and years of clinical experience. Because the participants worked in different cities, we conducted interviews over the phone and recorded them. The data were analyzed via thematic analysis.ResultsIn this study, 9 of the participants were men and the median age was 29 years. Most of the participants (10) were dentists and remaining were dental specialists. The findings on challenges fall under four broad thematic areas: (1) Patient-related challenges; low patient literacy, preference for dental quacks, delay in seeking oral care, and dental phobia. (2) Institutional-related challenges: limited access to basic oral health services, oral health not an integral part of primary health care, and unregulated private dental clinics resulting in unqualified quacks practising as private caregivers. (3) Societal-related challenges, the absence of community-oriented preventive oral health services and low prioritization of oral health. (4) Personal-related challenges: female dentists in this study faced challenges related to the preference of male dentists and the shortage of oral health specialists in the country.ConclusionThis study reveals the need for the establishment and strengthening of regulation of oral services and its inclusion into the basic primary service package provided to the populace. It also calls for community enlightenment and more investment in dental health care in Somalia.Clinical trial numberNot applicable.

<b>Editorial: The Future of Family Medicine as a Specialty in Pakistan</b>

Globally, family medicine is considered the foundation of primary healthcare systems, and its significance is becoming more widely acknowledged in Pakistan. Pakistan's healthcare system is under a lot of strain due to the country's fast expanding population, diverse healthcare system, and new public health issues. Given this, family medicine is a profession with great potential to address numerous systemic problems, increase access to healthcare, and promote the patient-centered care movement. But there are many obstacles facing family medicine in Pakistan, and lawmakers, educators, and medical professionals must work together to overcome them. Family medicine as a specialty focuses on the continuous, comprehensive care of patients of all ages and genders, incorporating social, mental, and physical health into treatment regimens. (1) Family medicine stresses the full range of healthcare, including preventive, curative, and rehabilitative treatments, in contrast to specialty medicine, which sometimes concentrates on a limited field. Better patient outcomes and increased satisfaction with healthcare services are the results of fostering long-term connections between patients and healthcare providers. Family medicine is more important than ever in Pakistan. Alongside the persistent problems caused by infectious diseases, the nation is seeing a rise in the prevalence of chronic conditions like diabetes, high blood pressure, and cardiovascular disorders. (2) Because of this dual burden of disease, family medicine may offer a comprehensive approach to healthcare. Family doctors are qualified to treat both acute and chronic illnesses, providing the continuity of care required to manage diseases over the long term, lowering hospitalization rates, and relieving the burden on specialized care.

The comparative research of aspirin-ethanol induced acute gastric mucosal injury in sprague dawley rats and hypertensive rats

Hypertension is a prevalent chronic health condition that complicates the understanding of gastric injury mechanisms. The aim of this research was to investigate the impact of hypertension on acute gastric mucosal injury induced by aspirin-ethanol in spontaneously hypertensive rats (SHR) and normotensive Sprague Dawley (SD) rats. Both groups were gavaged with 120 mg/ml aspirin and 70 % ethanol, followed by evaluation of gastric injury using gross pathology and histological analysis. SHR rats exhibited significantly less severe gastric mucosal damage compared to SD rats, with lower ulcer index and injury grade scores. Histopathological examination revealed milder edema and hemorrhage in SHR rats. Additionally, gastric tissue from SHR rats showed localized lesions with less epithelial tissue damage compared to SD rats, which exhibited more widespread damage and severe hemorrhagic erosions. These findings suggest that hypertension may reduce the extent of aspirin-ethanol-induced gastric injury, potentially due to thicker vascular walls, enhanced coagulation, and altered vascular responses in hypertensive animals. The study highlights the complex interplay between hypertension and gastric injury, demonstrating that hypertensive conditions may offer some protection against aspirin-induced gastric damage. These insights call for further research to better understand the underlying mechanisms and explore potential therapeutic strategies for gastric injury in hypertensive individuals.

Contrast-induced nephropathy - prevention and treatment

Introduction and purpose: Contrast-induced nephropathy (CIN) is kidney damage that can occur after the administration of contrast agents used in medical imaging procedures like angiography and CT scans. The exact mechanism is not fully understood but is believed to involve direct toxic effects, changes in kidney blood flow, and inflammation. Diagnosis is based on increased serum creatinine levels after contrast exposure. CIN poses challenges due to the rising use of contrast imaging, an aging population, and the increasing prevalence of chronic conditions like diabetes and hypertension. The Aim of this article is to summarize information on how to prevent contrast-induced nephropathy. Review of medications and pre-procedural screening and monitoring helpful to lower risk of CIN. State of knowledge: Contrast-induced nephropathy (CIN) is a form of kidney damage that may occur following the administration of contrast agents used in medical imaging procedures. The exact mechanism of contrast-induced nephropathy is not fully understood, but it is believed to involve a combination of factors, including the direct toxic effects of the contrast agent on kidney cells, changes in blood flow to the kidneys, and the body's inflammatory response, direct effect of oxygen free radicals. The diagnosis of CIN is typically based on an increase in serum creatinine levels within a certain time frame after the administration of the contrast agent. According to European guidelines, the definition of CIN is increased creatinine level in serum by 25% from baseline or creatinine total level in serum increased by 0.5 mg/dL (44 µmol/L) 48-72h after contrast media administration. Material and methods. A review of the available literature of PubMed database from 1992 – 2024.

Trajectory of Multiple Chronic Conditions and Associated Factors Among Noninstitutionalized Adults Aged 60 Years or Older in Southern Brazil.

The prevalence of chronic conditions is increasing worldwide. The objective of this study was to describe the trajectory of the occurrence of multiple chronic conditions during 6 years of follow-up and investigate their association with demographic, socioeconomic, and behavioral health characteristics of older adults in Southern Brazil. We used data from a longitudinal study (the Como Vai? study) of noninstitutionalized adults aged 60 or older living in the urban area of Pelotas, Rio Grande do Sul. We assessed the number of chronic conditions based on a list of 24 conditions in 3 interviews, conducted in 2014, 2016-2017, and 2019-2020. We used group-based semiparametric modeling to identify groups of participants based on the number of chronic conditions. For associations with participant characteristics, we performed multinomial logistic regression and considered a low, moderate, and high burden of chronic conditions. Of the 1,451 older adults in the cohort, 1,098 (75.7%) were included in analysis. Almost one-third (30.9%) had a low burden (2.3 conditions), more than half (52.0%) had a moderate burden (5.6 conditions), and 17.1% had a high burden (9.7 conditions). Men (relative risk [RR] = 6.10; 95% CI, 3.64-10.22), those aged 80 years or older (RR = 2.33; 95% CI, 1.15-4.72), those with no education (RR= 4.78; 95% CI, 2.19-10.45), and former smokers (RR = 1.53; 95% CI, 0.96-2.44) had a higher risk of being classified in the high-burden group than in the low-burden group. Most older adults belonged to the group with a moderate number of chronic conditions. Several sociodemographic characteristics were associated with belonging to the trajectory with a greater number of conditions.

Dihydromyricetin Alleviates Non-Alcoholic Fatty Liver Disease by Modulating Gut Microbiota and Inflammatory Signaling Pathways.

Non-alcoholic fatty liver disease (NAFLD) is a prevalent chronic liver condition that is strongly linked to gut microbiota imbalance and chronic inflammation. This study aims to explore the preventive effects of dihydromyricetin (DHM) on NAFLD by modulating the intestinal flora and the TLR4/NF-κB signaling pathway. Fifty male C57BL/6J mice were randomly assigned to five groups: a normal control group, a model group, and three DHM treatment groups receiving low (500 mg/kg), medium (750 mg/kg), and high doses (1,000 mg/kg). NAFLD was induced using a high-fat diet, and DHM was administered for 8 weeks. ELISA measured serum levels of LPS, IL-1β, and TNF-α, while Western Blot assessed liver expression of TLR4 and NF-κB p65. Changes in intestinal flora composition were analyzed using high-throughput 16S rRNA sequencing. The results showed that DHM treatment significantly reduced serum levels of LPS, IL-1β, and TNF-α, decreasing the liver expression of TLR4 and NF-κB p65. Intestinal flora analysis indicated a notable increase in beneficial bacteria, especially in the medium and high-dose groups. DHM treatment also significantly improved liver pathology, reducing fat deposition and inflammatory cell infiltration. In conclusion, DHM effectively prevents the progression of NAFLD by improving gut microbiota balance and suppressing inflammatory signaling pathways.

Prediction models for treatment success after an interdisciplinary multimodal pain treatment program

Chronic musculoskeletal pain (CMP) poses a widespread health and socioeconomic problem, being the most prevalent chronic pain condition. Interdisciplinary multimodal pain treatment (IMPT) is considered the gold standard, offering cost-effective long-term care. Unfortunately, only a subset of patients experiences clinically relevant improvements in pain, fatigue, and disability post-IMPT. Establishing a prediction model encompassing various outcome measures could enhance rehabilitation and personalized healthcare. Thus, the aim was to develop and validate a prediction model for IMPT success in patients with CMP. A prospective cohort study within routine care was performed, including patients with CMP undergoing a 10-week IMPT. Success across four outcome measures was determined: patients' recovery perspective, quality of life (physical and mental), and disability. Sixty-five demographic and candidate predictors (mainly patient reported outcome measures) were examined. Finally, 2309 patients participated, with IMPT success rates ranging from 30% to 57%. Four models incorporating 33 predictors were developed, with treatment control being the sole consistent predictor across all models. Additionally, predictors effects varied in direction in the models. All models demonstrated strong calibration, fair to good discrimination, and were internally validated (optimism-corrected AUC range 0.69–0.80). Our findings show that treatment success can be predicted using standardized patient-reported measures, exhibiting strong discriminatory power. However, predictors vary depending on the outcome, underscoring the importance of selecting the appropriate measure upfront. Clinically, these results suggest potential for patient-centered care and may contribute to the development of a scientifically sound decision tool.

Determining the Knowledge and Attitude of Medical Intern Students about the Effect of Periodontal Diseases on Systemic Diseases

Background: Periodontal diseases are prevalent chronic multifactorial conditions that significantly affect individuals' quality of life across various dimensions. Additionally, the association and impact of periodontal disease on systemic health have been a focus of medical attention for many years. This influence is particularly recognized as a risk factor in several conditions, notably coronary artery disease. Consequently, enhancing awareness and improving the attitudes of healthcare professionals toward this association is of great importance. Numerous studies have been conducted to evaluate the level of awareness and attitudes regarding this impact. This study has investigated the knowledge and attitude of medical intern students of Kashan University of Medical Sciences. Methods: In this descriptive study, a knowledge of the effect of periodontal disease on systemic diseases and their attitude towards periodontal in medical interns of Kashan University of Medical Sciences, a total of 160 people who were selected by census method, were investigated using a questionnaire based on the study by Thomas and Pralhad in 2011. The obtained data was analyzed by SPSS software with independent t-tests, one-way analysis of variance, and Pearson's correlation coefficient. Results: A total of 160 medical interns were surveyed. There was a significant positive correlation between the age of students and their attitude toward periodontal health (p=0.024). Additionally, the student's knowledge and attitudes toward periodontal health were not significantly associated with the level of information abo ut periodontal disease or the predominant source of oral health information (p>0.05). Moreover, knowledge of the impact of systemic diseases or conditions on periodontal disease was significantly correlated with awareness of the impact of systemic diseases on periodontal health (p<0.001). Furthermore, attitudes toward periodontal health showed a significant positive correlation with knowledge of the systemic impact on periodontal disease (p<0.01). Conclusion: The results of the study indicated that the participant's knowledge regarding the impact of periodontal disease on systemic health is moderate. While the majority of participants assess their knowledge about periodontal issues as insufficient, they believe that clinical and theoretical education related to this topic should be included in the curriculum of their studies. Furthermore, they express a positive attitude toward acquiring more information and education on this matter.

Supply and Geographic Distribution of Geriatric Physicians and Geriatric Nurse Practitioners

The rapidly growing population of older adults and their concomitant high prevalence of chronic health conditions require an increased supply in the specialized geriatric workforce to meet increasing health care demands. Understanding trends and geographic disparities in the supply of the geriatric workforce is essential for developing effective policies. To examine temporal and geographic trends in the supply of geriatric physicians (GMDs) and geriatric nurse practitioners (GNPs) from 2010 to 2020 and to assess potential disparities between metropolitan and nonmetropolitan counties. This repeated cross-sectional study used annual county-level data from 2010 to 2020, encompassing all counties in the 50 US states and Washington, DC. Statistical analysis was performed from June 2023 to March 2024. The primary outcomes were the numbers of GMDs, GNPs, and the combined number of GMDs and GNPs per 100 000 older adults. The secondary outcome included the proportion of counties with or without any GMDs or GNPs. From 2010 to 2020, the national per capita supply of GMDs decreased by 12.7%, from 13.4 per 100 000 older adults in 2010 to 11.7 per 100 000 older adults in 2020, while GNPs increased by 125.0%, from 4.4 per 100 000 older adults in 2010 to 9.9 per 100 000 older adults in 2020. The combined GMD and GNP workforce increased by 21.3%, from 17.8 per 100 000 older adults in 2010 to 21.6 per 100 000 older adults in 2020. The distributions of older adults, GMDs, and GNPs closely resembled the distribution of metropolitan and nonmetropolitan counties, with GMDs and GNPs highly concentrated in metropolitan counties where the number of older adults was greatest. Throughout the study period, 63.9% of counties (2008 of 3142 in 2010-2019; 2009 of 3143 in 2020), predominantly small and nonmetropolitan counties, had no GMDs or GNPs, which was associated with the disparities between metropolitan and nonmetropolitan counties. This repeated cross-sectional study found that from 2010 to 2020, the overall national supply of GMDs and GNPs kept pace with the growth of the older population, largely due to the rapid growth in the number of GNPs. However, significant geographic disparities persisted, particularly in small and nonmetropolitan counties. Future efforts should focus on increasing the availability of GMDs and GNPs in underserved small and nonmetropolitan counties to ensure equitable access to geriatric care.

The correlation between metabolic dysfunction-associated steatotic liver disease (MASLD) grades and hemodynamic alterations of the portal, hepatic, and splenic vein and spleen size.

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), is the most prevalent chronic liver condition worldwide, affecting over 25% of the population. Fatty infiltration in MASLD leads to hemodynamic changes in hepatic circulation, which can be quantitatively assessed using Color Doppler Ultrasonography (US). In this study, we aimed to investigate the correlation of Color Doppler US findings of the portal, hepatic, and splenic venous system within various degrees of MASLD. Between 2021 and 2024, 104 patients referred to Mousavi Hospital at Zanjan University of Medical Sciences were enrolled. Participants were divided into four groups based on the degree of hepatic fatty infiltration on biopsy results: normal, grade 1, grade 2, and grade 3, with 26 subjects in each group (13 men and 13 women). All patients were biopsy proved. Gray-scale and Color Doppler US were used to assess portal and splenic vein peak systolic velocity (PSV), portal and splenic vein diameter, hepatic vein waveform, and spleen size. The Spearman rank correlation was employed to evaluate the relationship between these variables under non-parametric conditions. A significant negative correlation was found between portal vein PSV and MASLD grade (r = - 0.499, p = 0.000). A significant difference was also observed in hepatic venous waveform abnormality between different grades of MASLD (p = 0.043). Accordingly, portal vein PSV and splenic vein PSV had a significantly positive correlation (r = 0.209, p = 0.033). We also observed a positive correlation between the portal vein and splenic diameter (r = 0.210, p = 0.032). Increasing MASLD severity is associated with reduced portal vein PSV and more pronounced abnormalities in hepatic vein flow. Routine assessment of portal and hepatic vein flow using Color Doppler US is recommended to accurately diagnose and monitor the effects of MASLD on hepatic circulation, potentially improving disease management and patient outcomes.

Comparing the Antibacterial Efficacy of Nanosilver vs Traditional Fluoride Varnishes in Caries Prevention

ABSTRACT Background: Dental caries remains a prevalent chronic condition affecting individuals worldwide, particularly children. Traditional fluoride varnishes have long been employed in caries prevention due to their ability to enhance enamel remineralization and reduce demineralization. Materials and Methods: A randomized controlled trial was conducted involving 120 participants aged 6–12 years with a high risk of dental caries. The participants were divided into two groups: one receiving nanosilver varnish and the other receiving traditional fluoride varnish. Each varnish was applied bi-weekly for six months. Salivary samples were collected at baseline, three months, and six months to measure bacterial counts, focusing on Streptococcus mutans. The data were analyzed using ANOVA to assess differences between the groups over time. Results: At baseline, both groups exhibited similar levels of Streptococcus mutans (P > 0.05). After three months, the nanosilver group showed a significant reduction in bacterial counts (mean reduction of 45%, P < 0.01), compared to a 30% reduction in the fluoride varnish group (P < 0.05). At six months, the nanosilver group maintained a 55% reduction, whereas the fluoride group showed a 40% reduction. The difference between the groups at six months was statistically significant (P < 0.01). Conclusion: Nanosilver varnish demonstrated superior antibacterial efficacy compared to traditional fluoride varnish in reducing Streptococcus mutans levels over six months. These findings suggest that nanosilver could serve as a valuable alternative or adjunct to fluoride varnish in caries prevention strategies.

Virtual Healthcare for Older Adults With Preventable Chronic Conditions: A Meta-synthesis of Quality Aspects.

Our study employed a six-step meta-synthesis approach to understand quality aspects of virtual healthcare trajectories and identify effective strategies for older adults with preventable chronic conditions across the world. Review of twenty-one articles revealed four key themes: functionality of virtual healthcare, equity in service delivery, satisfaction with care, and cost-effectiveness. Despite the challenges posed by technological and clinical complexities, virtual healthcare initiatives have significantly improved accessibility and availability of health services, thereby reducing disparities. Notably, telehealth saved an average of 166-minutes of travel time, demonstrating a clear benefit of virtual healthcare. While all parties expressed satisfaction with virtual healthcare, several challenges were reported, including a digital divide, limited access to digital devices, absence of a multidisciplinary approach, and lack of rural-specific programs.

Abstract 4132657: Age-related Differences in Peak Oxygen Uptake in Patients with Multimorbidity Undergoing Cardiac Rehabilitation

Background: Cardiac rehabilitation (CR) patients demonstrate a high burden of chronic conditions (CC). Both multimorbidity (MM; ≥2 coexisting CC) and aging negatively impact functional capacity, whereas CR improves performance. Age-related difference in cardiorespiratory fitness (CRF, peak oxygen uptake (VO 2 )) in CR patients with MM has not been studied. Hypothesis: We hypothesized improvement in CRF will be attenuated by MM with increasing age in CR patients. Aims: We aimed to identify age-related differences in CRF improvement in CR patients with MM. Methods: Patients ≥18 yrs old who attended ≥1 CR sessions from 1999-2017 and completed cardiopulmonary exercise stress test before and after CR were included. The prevalence of CC was assessed using Rochester Epidemiology Project records-linkage system. Age categories included: Younger (18-49 yrs), Midlife (50-64 yrs) and Older (≥65 yrs). CRF categories included: <0%, 0-8% and >8%. Analysis included Kruskal-Wallis and Chi-squared. Results: Of 622 patients, 75.4% were male. Mean age: 62.9±11.2 yrs; Younger (n=70) age: 42.7±6.8 yrs, 67.1% male; Midlife (n=283) age: 58.3±4.3 yrs, 78.8% male; Older (n=269) age: 73.0±5.2 yrs, 74.0% male. BMI was 29.9±5.4 kg/m 2 (Younger: 30.0±6.7, Midlife: 30.4±5.6, Older: 29.3±4.7; p<.05). Median (Q1, Q3) no. of CR sessions attended was 33(22, 35), with lower attendance in the Younger group: 25(16,34) vs Midlife: 33(20,35) and Older: 34 (29,35), p<.05. Overall, percent change in peak VO 2 was 11.5±21.6% (Younger: 18.8±22.8%, Midlife: 11.6±19.5%, Older: 9.4±23.1%; p<.01). The median number of CC was 7(5,8) with significant differences across groups: Younger: 5(3,7), Midlife: 6(5,8), Older: 7(6,9), p<.01. Number of CC increased with age across all CRF categories (p<.01, Fig. 1). However, there was no difference in number of CC within age groups across categories of CRF, Table 1. Conclusions: Our results suggest that MM increases with age in patients attending CR; however, within a given age group, improvement in CRF does not appear dependent on MM. The impact of age appears to have a greater impact than MM on CRF improvement. Individualized treatment plans should focus on the impact of age-related disparities on CRF improvement among CR patients with MM.