Risk Comorbidities Research Articles

“It’s what we perceive as different”: an interpretative phenomenological analysis of Nigerian women’s characterization of their health during the COVID-19 pandemic

BackgroundHealth has historically been adversely affected by social, economic, and political pandemics. In parallel with the spread of diseases, so do the risks of comorbidity and death associated with their consequences. As a result of the current pandemic, shifting resources and services in resource-poor settings without adequate preparation has intensified negative consequences, which global service interruptions have exacerbated. Pregnant women are especially vulnerable during infectious disease outbreaks, and the current pandemic has significantly impacted them.MethodsThis study used an interpretive phenomenological analysis study with a feminist lens to investigate how women obtained healthcare in Ebonyi, Ogun, and Sokoto states Nigeria during the COVID-19 pandemic. We specifically investigated whether the epidemic influenced women’s decisions to seek or avoid healthcare and whether their experiences differed from those outside of it.ResultsWe identified three superordinate themes: (1) the adoption of new personal health behaviour in response to the pandemic; (2) the pandemic as a temporal equalizer for marginalized individuals; (3) the impacts of the COVID-19 pandemic on maternal health care. In Nigeria, pregnant women were affected in a variety of ways by the COVID-19 epidemic. Women, particularly those socially identified as disabled, had to cross norms of disadvantage and discrimination to seek healthcare because of the pandemic’s impact on prescribed healthcare practices, the healthcare system, and the everyday landscapes defined by norms of disadvantage and discrimination.ConclusionIt is clear from the current pandemic that stakeholders must begin to strategize and develop plans to limit the effects of future pandemics on maternal healthcare, particularly for low-income women.

Adipose Tissue Dysfunction Related to Climate Change and Air Pollution: Understanding the Metabolic Consequences.

Obesity, a global pandemic, poses a major threat to healthcare systems worldwide. Adipose tissue, the energy-storing organ during excessive energy intake, functions as a thermoregulator, interacting with other tissues to regulate systemic metabolism. Specifically, brown adipose tissue (BAT) is positively associated with an increased resistance to obesity, due to its thermogenic function in the presence of uncoupled protein 1 (UCP1). Recently, studies on climate change and the influence of environmental pollutants on energy homeostasis and obesity have drawn increasing attention. The reciprocal relationship between increasing adiposity and increasing temperatures results in reduced adaptive thermogenesis, decreased physical activity, and increased carbon footprint production. In addition, the impact of climate change makes obese individuals more prone to developing type 2 diabetes mellitus (T2DM). An impaired response to heat stress, compromised vasodilation, and sweating increase the risk of diabetes-related comorbidities. This comprehensive review provides information about the effects of climate change on obesity and adipose tissue, the risk of T2DM development, and insights into the environmental pollutants causing adipose tissue dysfunction and obesity. The effects of altered dietary patterns on adiposity and adaptation strategies to mitigate the detrimental effects of climate change are also discussed.

Examining illness perceptions over time: an exploratory prospective analysis of causal attributions in individuals with depressive symptoms

BackgroundAccording to the Common-Sense Model of Illness Representations, illness beliefs, such as causal attributions, can influence the way people assess and cope with their illness and vice versa. To date, causal attributions in people with depressive symptoms have been studied mainly cross-sectionally, quantitatively and independently. The purpose of this study is to examine the causal attributions of people with depressive symptoms in terms of their stability over time, dependence on treatment experience, and differentiation of causal concepts.MethodsIn a population-based prospective sample, people with at least mild depressive symptoms (PHQ-9 Score ≥ 5) were interviewed via telephone at T0 and twelve months later (T1). Causal attributions were assessed using the Brief Illness Perception Questionnaire. After the open responses were qualitatively analysed using a deductive-inductive approach, stability over time was assessed for causal attributions and concepts by comparing answers between the two time points. Subsequent exploratory quantitative analyses were conducted using chi-square tests, t-tests, and logistic regression analyses.ResultsA total of 471 individuals (age M = 53.9, 53.6% female) with a mean PHQ-9 Score of 8.4 were included in the analyses. Causal attributions related to participants’ social environment, workplace, and past are the most stable over time. However, individuals with and without a time-stable causal concept showed no differences in terms of sociodemographic characteristics, severity of depressive symptoms, risk of comorbidity, and treatment experiences. Overall, the causal concepts of people with depressive symptoms appear to be very diverse. Those with treatment experience (M = 2.21, SD = 0.80) named significantly more causal attributions compared to people without treatment experience (M = 1.98, SD = 0.81, t(471) = -3.060, p < 0.01). In addition, logistic regression analyses revealed that treatment-experienced respondents were more likely to attribute “childhood/youth/parental home” and “predisposition”.ConclusionsOur study reveals that people with treatment experience tend to report treatment-congruent causal attributions, such as childhood and family environment, as well as predisposition, more frequently. Understanding how causal attributions and concepts are formed and change can be helpful for addressing causal attributions in treatment. Future studies should take into account the benefits of employing qualitative survey methods for exploring causal attributions.

Gut Mucosal Immunity in HIV-Exposed Infants: A Review

Gut mucosal immunity in infants exposed to Human Immunodeficiency Virus (HIV) presents a complex interplay of developmental processes, viral dynamics, and therapeutic interventions that significantly impact clinical outcomes. This review synthesizes current knowledge on the mechanisms, clinical implications, and therapeutic strategies concerning gut mucosal immunity in HIV-exposed infants. The gut mucosa serves as a critical site for immune maturation and defense against pathogens, but HIV infection disrupts this delicate balance, leading to compromised immune function and increased susceptibility to infections. Infants born to HIV-positive mothers experience unique challenges in gut mucosal immunity due to vertical transmission of the virus and exposure to antiretroviral therapy (ART). HIV infection disrupts gut-associated lymphoid tissue (GALT), resulting in early depletion of CD4+ T cells and compromised mucosal barrier function. These alterations contribute to microbial translocation, chronic inflammation, and immune dysregulation, impacting overall immune competence and increasing susceptibility to opportunistic infections. Despite advances in ART, persistent immune activation and residual gut mucosal damage pose ongoing challenges in achieving optimal immune reconstitution and preventing long-term complications in HIV-exposed infants. Clinical implications of compromised gut mucosal immunity in HIV-exposed infants extend beyond gastrointestinal health to encompass systemic immune dysfunction and increased risks of non-AIDS comorbidities. Impaired gut barrier function exacerbates microbial translocation, leading to systemic inflammation that may contribute to neurodevelopmental abnormalities and metabolic disorders. Keywords: Gut, Immunity, HIV, Infants

SAVA syndemic and comorbid HIV risks among youth transitioning from the U.S. juvenile legal system

To date, no studies have examined well-established associations between substance abuse, intimate partner violence, and an increased susceptibility to HIV (also known as the SAVA syndemic), among transitioning age youth in the U.S. juvenile legal system. This secondary data analysis addresses this gap using baseline and 7th wave data from the Pathways to Desistance study (N = 709). We examined the relationship between SAVA syndemic variables, mental health, and HIV testing, differentiated by gender, while controlling for neighborhood conditions, motivation to succeed, and sociodemographic variables among cisgender, youth involved in the juvenile legal system using cross-sectional logistic regression and path models. 50% endorsed intimate partner violence. In path analyses, among males and females, neighborhoods (β = 0.18, p<.01) and illegal drug use (β= −0.91, p<.05) had significant direct effects on testing. Findings underscore the need for gender-specific HIV prevention policies targeting transitioning youth in the juvenile legal system.

Palliative care considerations for the older adults with HIV/AIDS: a clinical practice review.

Human immunodeficiency virus (HIV) has historically been viewed as a terminal condition affecting younger populations, however, with advancements in antiretroviral therapy (ART) and better healthcare provisions, people with HIV are now living longer than ever before. This shift has highlighted the need to readdress the end-of-life care needs of patients aging with HIV. People aging with HIV face a double burden. Aging itself comes with an array of health challenges, including cognitive decline, frailty, and increased susceptibility to chronic illnesses. Despite effective management with ART, HIV is associated with ongoing inflammation, and may accelerate aging processes, increasing the risk of certain cancers and comorbidities, as well as an increased risk of cardiovascular disease. The stigma surrounding HIV, though diminished over the years, still lingers. People living with HIV have experienced decades of intersecting stigmatized identities in the context of social isolation, leading to potential psychological challenges like depression, anxiety, and loneliness, all of which may be amplified by aging. Addressing these emotional and social needs is as crucial as managing their physical health. The integration of primary palliative care into geriatric practice is crucial, as it improves the quality of life for older patients with chronic illnesses, life-limiting conditions. This is particularly relevant for aging individuals with HIV, who often face complex medical needs and multiple comorbidities. Primary palliative care is the basic, integrated palliative care support provided by non-specialists as part of routine care, while specialist palliative care involves more complex and specialized support from a team with specific training in palliative care. Incorporating palliative care principles enables geriatric healthcare providers to address these comprehensive needs more effectively. This approach encompasses not only physical symptom management but also the emotional well-being of patients. It aids in advanced care planning and decision-making that resonate with the patients' values and goals. Ultimately, this integrated approach leads to improved patient outcomes and a higher quality of care. This review delves into the unique considerations and challenges of providing palliative care to people aging with HIV, recognizing the interplay of age and HIV in the era of modern ART.

Once-weekly semaglutide in people with HIV-associated lipohypertrophy: a randomised, double-blind, placebo-controlled phase 2b single-centre clinical trial

HIV-associated lipohypertrophy, which is characterised by an abnormal accumulation of abdominal visceral adipose tissue, remains problematic in people with HIV. Effective interventions are lacking, despite HIV-associated lipohypertrophy carrying a substantial risk of cardiometabolic comorbidity. The primary aim of this trial was to investigate effects of the GLP-1 receptor agonist, semaglutide, on adipose tissue in HIV-associated lipohypertrophy. This randomised, double-blind, placebo-controlled phase 2b clinical trial was conducted at a single US site. Key inclusion criteria included people with HIV aged 18 years or older with controlled HIV-1, a BMI of 25 kg/m2 or more, and lipohypertrophy but without type 1 or type 2 diabetes. Participants were randomly assigned 1:1 to receive 32 weeks of once-weekly subcutaneous semaglutide (8-week dose titration and 24 weeks at 1·0 mg) or placebo; all research personnel and participants remained masked to treatment assignment. Primary outcomes were changes at 32 weeks in adipose tissue quantity by body compartment. Analyses, including safety, were performed using intention-to-treat principles. This trial was registered ClinicalTrials.gov (NCT04019197) and is complete. Between June 10, 2019, and July 28, 2022, 108 participants were randomly assigned to receive semaglutide (n=54) or placebo (n=54). Eight (15%) in each group withdrew prematurely. Significant effects of semaglutide were seen over the 32-week study period in sex-adjusted multiplicative regression analyses for the primary outcome, abdominal visceral adipose tissue (β -30·82 cm2, 95% CI -50·13 to -11·51; % change -30·6%). Decreases were also seen in other key measures, including abdominal subcutaneous adipose tissue (β -42·01 cm2, 95% CI -75·49 to -8·52; % change -11·2%) and total body fat (natural logarithmic -0·21 kg, 95% CI -0·33 to -0·08; % change -18·9%). There were no statistically significant differences in possibly related or related adverse events (absolute risk difference 0·1111, 95% CI -0·0727 to 0·2869); however, one semaglutide-related grade 4 elevated lipase and two possibly related cases of cholelithiasis (grades 1 and 2) were observed. Semaglutide holds promise as an effective treatment for HIV-associated lipohypertrophy. The potential risk of serious adverse events deserves further scrutiny in large trials in people with HIV. National Institutes of Health.

The Features of Comorbidity of Stroke in The Indonesian Population: Findings from The Indonesian Family Life Survey (IFLS-5)

Background: Comorbidities are associated with a worse stroke prognosis and more challenging clinical management. However, population-based research related to stroke comorbidities in Indonesia is still limited. Objective: This study aims to evaluate the features of important comorbidities among stroke patients in the Indonesian population. Methods: The data was taken from the 2014–2015 Indonesian Family Life Survey (IFLS-5), which represents 83% of the Indonesian population. Data were analyzed by means of logistic regression models using statistical software for data science (STATA) 13. Results: There was a statistically significant relationship between stroke history and several comorbidities risk factors. The risk of stroke increases in individuals with hypertension (odds ratio (OR): 7.97, 95% confidence interval (CI): 5.19-12.26), diabetes (OR: 1.90, 95% CI: 1.14-3.15), heart disease (OR: 2.67, 95% CI: 1.47-4.85), and hyperlipidemia (OR: 3.68, 95% CI: 2.40-5.64). Of the 309 stroke patients, 41.9% had one comorbid condition; 24.1% had two; and 10.5% had three. Comorbidities increase with age, and 80.50% of stroke patients with comorbidities are aged 50 years or more. Conclusion: This study showed that the most common comorbidities in stroke patients in Indonesia are hypertension, hyperlipidemia, and diabetes.

Pharmacokinetic Interactions Between the Fixed-Dose Combination of Ezetimibe/Rosuvastatin 10/20 Mg and the Fixed-Dose Combination of Telmisartan/Amlodipine 80/5 Mg in Healthy Subjects.

Management of hypertension and hyperlipidemia, which are common comorbid risk factors for cardiovascular diseases, require multiple medications. The development of a fixed-dose combination (FDC) containing ezetimibe, rosuvastatin, telmisartan, and amlodipine aims to enhance patient adherence and persistence, but the potential interactions among the four medications have not been studied. This study aimed to evaluate the pharmacokinetic (PK) interactions between the FDC of ezetimibe/rosuvastatin 10/20 mg (ER) and the FDC of telmisartan/amlodipine 80/5 mg (TA). An open-label, single-sequence, three-period, three-treatment crossover study was conducted in healthy male subjects. All subjects received ER for 7 days, TA for 9 days and ER combined with TA for 7 days during each treatment period. For PK analysis of total/free ezetimibe, rosuvastatin, telmisartan, and amlodipine, serial blood samples were collected for 24 hours at steady state. Safety profiles were assessed throughout the study. Thirty-eight subjects were enrolled, and 34 subjects completed the study. The systemic exposure to each active ingredient after coadministration of the two FDCs was similar to that after each FDC alone. The geometric mean ratios and 90% confidence intervals for the maximum plasma concentration (µg/L) and the area under the plasma concentration-time curve (h·µg/L) of the combination therapy to monotherapy, assessed at steady state, were as follows: total ezetimibe, 1.0264 (0.8765-1.2017) and 0.9359 (0.7847-1.1163); free ezetimibe, 1.5713 (1.2821-1.9257) and 0.9941 (0.8384-1.1788); rosuvastatin, 2.1673 (1.7807-2.6379) and 1.1714 (0.9992-1.3733); telmisartan, 1.0745 (0.8139-1.4186) and 1.1057 (0.8379-1.4591); and amlodipine, 0.9421 (0.8764-1.0126) and 0.9603 (0.8862-1.0405). Both combination therapy and monotherapy were well tolerated by the subjects. The coadministration of ezetimibe/rosuvastatin 10/20 mg and ezetimibe/rosuvastatin 10/20 mg was well tolerated in healthy subjects, and the PK interaction between those two FDCs was not clinically significant.

Activation of the α7nAChR by GTS-21 mitigates septic tubular cell injury and modulates macrophage infiltration

The most common and serious complication among hospitalized and critically ill patients is sepsis-associated acute kidney damage (S-AKI), which raises the risk of comorbidities and is linked to a high mortality rate. Cholinergic anti-inflammatory pathway (CAP), an anti-inflammatory pathway mediated by the vagus nerve, acetylcholine, and α7 nicotinic acetylcholine receptors (α7nAChRs), offers new perspectives for the treatment of S-AKI. In this study, we investigated the role of CAP and α7nAChR in kidney injury by employing an LPS-induced septic kidney injury mouse model and GTS-21 intervention. C57BL/6 mice were injected with LPS, with or without GTS-21, in different subgroups. Kidney function was assessed by plasma creatinine, histology, and markers of kidney injury 24 h after intervention. The results demonstrated that GTS-21 could inhibit the systemic inflammatory response and directly protect the tubular cell injury from LPS. To explore the novel gene involved in this response, RNA sequencing of the renal proximal tubular epithelial cell (HK-2), pretreated with LPS and GTS-21, was conducted. The results indicate that GTS-21 administration reduces LPS-induced cytokines and chemokines secretion by HK-2, including CCL20, a potent chemokine attracting monocytes/macrophages. Furthermore, a macrophage transmigration assay revealed that GTS-21 inhibits macrophage transmigration by downregulating the expression of CCL20 in HK-2 cells. In conclusion, GTS-21, as an α7nAChR agonist, emerges as a noteworthy and versatile treatment for S-AKI. Its dual function of directly protecting renal tubular cells and regulating inflammatory responses represents a major advancement in the treatment of sepsis-induced AKI. This finding might pave the way for novel approaches to improving patient outcomes and reducing death rates in sepsis-related complications.

Prediction of risks of comorbidity of type 2 diabetes mellitus and coronary heart disease taking into account plasma levels of 8-isoprostane and sirtuin-1

Prediction of risks of comorbidity of type 2 diabetes mellitus and coronary heart disease taking into account plasma levels of 8-isoprostane and sirtuin-1

Pulmonary comorbidities in people with HIV- the microbiome connection.

To report recent evidence on associations between human microbiome, particularly airway and gut, and pulmonary comorbidities in people with HIV (PWH). Furthermore, we explore how changes in the microbiome may contribute to pulmonary immune dysregulation and higher rates of pulmonary comorbidities among PWH. Finally, we propose future directions in the field. Increased risk of pulmonary comorbidities and rapid lung function decline have been reported in even well treated PWH. Altered microbiota profiles have been reported in PWH with pulmonary comorbidities and rapid lung function decline as compared to those without. The most consistent data have been the association between HIV-related pulmonary comorbidities, lung and oral microbiota dysbiosis, which has been also associated with distinct respiratory mucosal inflammatory profiles and short-term mortality. However, a possible causal link remains to be elucidated. Associations between the lung and oral microbiome, HIV-associated pulmonary comorbidities and rapid lung function decline have been reported in recent studies. Yet the underlying mechanism underpinning the observed associations is largely unknown and substantial knowledge gaps remain. Future research is warranted to unveil the role and mechanism of human microbiome from different anatomical compartments in relation to pulmonary comorbidities in PWH.

Treatment with brain specific estrogen prodrug ameliorates cognitive effects of surgical menopause in mice

Menopause is an endocrine shift leading to increased vulnerability for cognitive impairment and dementia risk factors, in part due to loss of neuroprotective circulating estrogens. Systemic replacement of estrogen post-menopause has limitations, including risk for estrogen-sensitive cancers. A promising therapeutic approach therefore might be to deliver estrogen only to the brain. We examined whether we could enhance cognitive performance by delivering estrogen exclusively to the brain in ovariectomized mice (a surgical menopause model). We treated mice with the prodrug 10β,17β-dihydroxyestra-1,4-dien-3-one (DHED), which can be administered systemically but is converted to 17β-estradiol only in the brain. Young and middle-aged C57BL/6 J mice received ovariectomy and subcutaneous implant containing vehicle or DHED and underwent cognitive testing to assess memory after 1–3.5 months of treatment. Low and medium doses of DHED did not alter metabolic status in middle-aged mice. In both age groups, DHED treatment improved spatial memory in ovariectomized mice. Additional testing in middle-aged mice showed that DHED treatment improved working and recognition memory in ovariectomized mice. These results lay the foundation for future studies determining if this intervention is as efficacious in models of dementia with comorbid risk factors.

Heart rate variability: A primer for alcohol researchers

Problem alcohol drinking remains a major cost and burden for society. Also, rates of problem drinking in women have dramatically increased in recent decades, and women are at risk for more alcohol problems and comorbidities. The purpose of this commentary is to discuss the potential utility of cardiac measures, including heart rate (HR) and HR variability (HRV), as markers of individual and sex differences in the drive to drink alcohol. We recently used cardiac telemetry in female and male adult rats to determine whether different cardiac markers, including HR and HRV, would differently predict alcohol and anxiety-like behavior across the sexes. Indeed, female behaviors related to HRV measures that indicate more parasympathetic (PNS) influence (the “rest and digest” system). In contrast, male behaviors are associated more with sympathetic (SNS) indicators (the activation system). Remarkably, similar sex differences in PNS versus SNS engagement under challenge are seen in several human studies, suggesting strong cross-species convergence in differential autonomic regulation in females and males. Here, we describe the larger challenges that alcohol addiction presents, and how HRV measures may provide new biomarkers to help enhance development of more individualized and sex-specific treatments. We briefly explain the physiological systems underlying cardiac PNS and SNS states, and how specific HRV metrics are defined and validated, especially why particular HRV measures are considered to reflect more PNS versus SNS influence. Finally, we describe hormonal influences and sex differences in brain circuits related to cardiac autonomic regulation. Together, these findings show that HR and HRV have potential for uncovering key underlying mechanisms of sex and individual differences in autonomic drivers, which could guide more personalized treatment.

Examining Age-Adjusted Associations between BMI and Comorbidities in Mongolia: Cross-Sectional Prevalence.

(1) Background: This study investigated the association between body mass index (BMI) categories and comorbidities in the context of a developing country, utilizing data from a nationwide health screening in Mongolia. (2) Methods: The study included 181,080 individuals (mean age 47.0 ± 15.3, 42.0% male) from the population-based general health screening. We counted the number of diseases from participants' medical records based on ICD-10 codes, excluding those categorized under Z00-Z99 and codes indicating acute disorders, as well as individuals classified as underweight. (3) Results: Among study participants, the prevalence of two or more comorbidities was 4.2%. The weight distribution comprised 40.4% normal weight; 37.1% overweight; and 16.9%, 4.4%, and 1.2% in the Class I, II, and III obesity categories, respectively. Comorbidities increased with BMI: normal weight (0.222); overweight (0.255); and Class I (0.290), Class II (0.302), and Class III obesity (0.303), suggesting a dose-dependent likelihood of having multiple diseases. Adjusted linear regression (beta coefficients, 95% CIs) showed increased comorbidity risks in overweight (0.017, 0.013-0.021) and obesity (0.034, 0.030-0.039). Interaction analysis with age revealed a significant effect (p < 0.001). While comorbidities tend to increase with higher BMI categories in all age-tertile groups, this association was notably stronger among younger individuals. (4) Conclusions: Obesity is associated with a twofold increase in the prevalence of multiple comorbidities compared to normal weight. Our findings also highlight the critical role of age in the development of multiple diseases, with BMI remaining a significant factor across various age groups, encompassing both younger and older adults.

Development of a machine learning-based risk model for postoperative complications of lung cancer surgery.

To develop a comorbidity risk score specifically for lung resection surgeries. We reviewed the medical records of patients who underwent lung resections for lung cancer, and developed a risk model using data from 2014 to 2017 (training dataset), validated using data from 2018 to 2019 (validation dataset). Forty variables were analyzed, including 35 factors related to the patient's overall condition and five factors related to surgical techniques and tumor-related factors. The risk model for postoperative complications was developed using an elastic net regularized generalized linear model. The performance of the risk model was evaluated using receiver operating characteristic curves and compared with the Charlson Comorbidity Index (CCI). The rate of postoperative complications was 34.7% in the training dataset and 21.9% in the validation dataset. The final model consisted of 20 variables, including age, surgical-related factors, respiratory function tests, and comorbidities, such as chronic obstructive pulmonary disease, a history of ischemic heart disease, and 12 blood test results. The area under the curve (AUC) for the developed risk model was 0.734, whereas the AUC for the CCI was 0.521 in the validation dataset. The new machine learning model could predict postoperative complications with acceptable accuracy. 2020-0375.

Testing Machine Learning Models to Predict Postoperative Ileus after Colorectal Surgery.

Background: Postoperative ileus (POI) is a common complication after colorectal surgery, leading to increased hospital stay and costs. This study aimed to explore patient comorbidities that contribute to the development of POI in the colorectal surgical population and compare machine learning (ML) model accuracy to existing risk instruments. Study Design: In a retrospective study, data were collected on 316 adult patients who underwent colorectal surgery from January 2020 to December 2021. The study excluded patients undergoing multi-visceral resections, re-operations, or combined primary and metastatic resections. Patients lacking follow-up within 90 days after surgery were also excluded. Eight different ML models were trained and cross-validated using 29 patient comorbidities and four comorbidity risk indices (ASA Status, NSQIP, CCI, and ECI). Results: The study found that 6.33% of patients experienced POI. Age, BMI, gender, kidney disease, anemia, arrhythmia, rheumatoid arthritis, and NSQIP score were identified as significant predictors of POI. The ML models with the greatest accuracy were AdaBoost tuned with grid search (94.2%) and XG Boost tuned with grid search (85.2%). Conclusions: This study suggests that ML models can predict the risk of POI with high accuracy and may offer a new frontier in early detection and intervention for postoperative outcome optimization. ML models can greatly improve the prediction and prevention of POI in colorectal surgery patients, which can lead to improved patient outcomes and reduced healthcare costs. Further research is required to validate and assess the replicability of these results.

Efficacy and underlying mechanisms of three-circle post standing qigong on insomnia in college students: a four-arm, double-blind, randomized controlled trial protocol

BackgroundInsomnia is common in college students, but its impact on health and wellbeing is often neglected. Enhancing sleep quality through targeted interventions could improve overall health and reduce the risk of consequent co-morbidities and mental health problems. Qigong exercises have been shown to significantly improve sleep quality and relieve insomnia. Three-circle Post Standing (TCPS) can help integrate body, breath, and mind, a fundamental principle of Qigong that promotes holistic wellbeing. In this clinical trial, we aim to (1) evaluate the feasibility, safety, and therapeutic efficacy of administering TCPS to improve sleep quality and quality of life in college students with insomnia; (2) explore the neurophysiological mechanisms underlying the mind adjustments mediated by TCPS in insomnia; (3) investigate body and breath pathophysiology mediated by TCPS in insomnia; and (4) assess the long-term efficacy of TCPS in terms of sleep quality and quality of life.MethodsThis will be a prospective, parallel, four-arm, double-blind randomized controlled trial to investigate the effects and underlying mechanisms of TCPS on college students with insomnia. One hundred college students meeting diagnostic criteria for insomnia will be randomly assigned to receive either 14 weeks of standardized TCPS training (two weeks of centralized training followed by 12 weeks of supervised training) or sham-control Post Standing training. Efficacy outcomes including sleep quality, quality of life, neurophysiological assessments, plantar pressure, biomechanical balance, and physical measures will be collected at baseline, eight weeks (mid-point of supervised training), and 14 weeks (end of supervised training). Sleep quality and quality of life will also be evaluated during the four- and eight-week follow-up.DiscussionThis trial will be an important milestone in the development of new therapeutic approaches for insomnia and should be easily implementable by college students with insomnia. The neuro- and pathophysiological assessments will provide new insights into the mechanisms underlying TCPS.Clinical trial registrationThis trial has been registered in the China Clinical Trials Registry (registration number: ChiCTR2400080763).

A Multi-Omics Approach to Defining Target Organ Injury in Youth with Primary Hypertension.

Primary hypertension in childhood tracks into adulthood and may be associated with increased cardiovascular risk. Studies conducted in children and adolescents provide an opportunity to explore the early cardiovascular target organ injury (CV-TOI) in a population free from many of the comorbid cardiovascular disease risk factors that confound studies in adults. Youths (n=132, mean age 15.8 years) were stratified by blood pressure (BP) as low, elevated, and high-BP and by left ventricular mass index (LVMI) as low- and high-LVMI. Systemic circulating RNA, miRNA, and methylation profiles in peripheral blood mononuclear cells and deep proteome profiles in serum were determined using high-throughput sequencing techniques. VASH1 gene expression was elevated in youths with high-BP with and without high-LVMI. VASH1 expression levels positively correlated with systolic BP (r=0.3143, p=0.0034). The expression of hsa-miR-335-5p, one of the VASH1-predicted miRNAs, was downregulated in high-BP with high-LVMI youths and was inversely correlated with systolic BP (r=-0.1891, p=0.0489). GSE1 hypermethylation, circulating PROZ upregulation (log2FC=0.61, p=0.0049 and log2FC=0.62, p=0.0064), and SOD3 downregulation (log2FC=-0.70, p=0.0042 and log2FC=-0.64, p=0.010) were observed in youths with elevated BP and high-BP with high-LVMI. Comparing the transcriptomic and proteomic profiles revealed elevated HYAL1 levels in youths displaying high-BP and high-LVMI. The findings are compatible with a novel blood pressure-associated mechanism that may occur through impaired angiogenesis and extracellular matrix degradation through dysregulation of Vasohibin-1 and Hyaluronidase1 was identified as a possible mediator of CV-TOI in youth with high-BP and suggests strategies for ameliorating TOI in adult-onset primary hypertension.

ALGORITHM FOR THE APPLICATION OF PHYSICAL THERAPY FOR CRITICALLY ILL PATIENTS IN THE CONDITIONS OF THE DEPARTMENT OF ANESTHESIA AND INTENSIVE CARE UNIT

Aim. Create and justify the algorithm of physical therapy application, which will be used at the early stage of treatment of critically ill patients treated in the transferred anesthesiology and intensive care unit. Materials and methods. The study was conducted during five months of 2023 in two medical and diagnostic centers in Kyiv, Ukraine, in the conditions of the department of anesthesiology and intensive care unit. 80 critically ill patients took part in the study, who were divided into main and control groups of 40 people each. Participants in the main group had physical therapy included in the treatment process, while the control group did not receive such treatment. The sample of patients was based on selection on the basis of indicators of critical condition and the need for treatment in the conditions of the anesthesiology and intensive care unit. Participation in the study varied from 1 to 3 weeks, with the first assessment at the meeting with the physical therapist and the last before discharge or transfer of the patient. Assessment included manual muscle testing and the Richmond Agitation/Sedation Scale, as well as observation for comorbidities. During the research, a developed algorithm for the use of physical therapy for critically ill patients was applied. Results. In the course of the study, a complex of physical therapy methods was used to influence the dynamics of the patients' state of consciousness, the functional strength of the muscles of the upper and lower limbs, as well as to study the frequency and severity of the development of accompanying complications (bedsores, contractures, swellings, deformations, wounds). Data collected from the main and control groups were subjected to comparative statistical analysis. The results of the analysis confirm that the use of the developed algorithm of physical therapy contributed to a significant improvement in the cognitive state of the participants, an increase in functional strength in the muscles of the limbs, and also effectively reduced the risk and severity of comorbidities. This indicates the importance of integrating physical therapy into a comprehensive approach to the treatment of critically ill patients. Conclusions. The proposed approach to the use of physical therapy for patients who are in critical condition and treated in the conditions of the department of anesthesiology and intensive care confirms its high efficiency in the early stages of treatment. Studies show that the use of physical therapy improves the functional state of muscles, improves the cognitive functions of patients, and also helps to prevent the development of concomitant complications that may occur during a stay in the conditions of the anesthesiology and intensive care units.