Severe Comorbidities Research Articles

Has the COVID-19 pandemic negatively impacted children's development? An assessment of the neurodevelopment of premature babies born during the pandemic.

Pandemics, such as COVID-19, have the potential to adversely affect children's development due to a variety of negative factors at the level of children, families, and services. In this study the effect of the pandemic on the cognitive, language and motor development of premature babies who are among the most vulnerable group, were evaluated. The study included 236 premature infants who were followed at Hacettepe University Department of Developmental Pediatrics. The Bayley-Third Edition Developmental Assessment (Bayley III) was used to evaluate the neurodevelopment of 152 premature infants from the pre-pandemic group and 84 from the post-pandemic group at the corrected age of 18-24 months. The perinatal and sociodemographic risks were also evaluated. No difference in Bayley III scores (cognitive, language, and motor) was found between the pre- and post-pandemic groups. Furthermore, the multivariate covariance analysis displayed that regardless of the pandemic, infants with higher maternal education consistently scored higher in the cognitive, language, and motor domains; and the motor area scores of infants with moderate perinatal risk were also significantly higher than infants with high perinatal risk. It is crucial to monitor the development of vulnerable children who encounter developmental risks, such as premature babies. Fortunately, no significant effect was encountered during the COVID-19 pandemic. However, this does not underweigh the need for close supervision in extraordinary circumstances. Additionally, it should be noted that severe postnatal comorbidities, perinatal risks, and social factors, such as maternal education level, interact to influence the neurodevelopmental outcomes of preterm infants.

Acute kidney injury in subarachnoid hemorrhage: Exploring its clinical significance and prognostic implications

ObjectivesSubarachnoid hemorrhage (SAH) from spontaneous aneurysm rupture is a debilitating condition with high morbidity and mortality. Patients with SAH remain understudied, particularly concerning the evaluation of incidence and consequences of subsequent acute kidney injury (AKI). In this study, we aim to explore the risk factors and outcomes of AKI in SAH patients. Materials and MethodsInternational Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes were used to query the National Inpatient Sample (NIS) for patients with a diagnosis of SAH between 2010-2019. Subgroup analysis was stratified by AKI diagnosis during the same hospitalization. AKI and non-AKI groups were assessed for baseline clinical characteristics, interventions, complications, and outcomes. Descriptive statistics, multivariate regressions, and propensity score-matching were performed using IBM SPSS 28. ResultsOf 76,553 patients diagnosed with nontraumatic SAH between 2010-2019, 10,634 (13.89 %) had a comorbid diagnosis of AKI. SAH patients with AKI were older (p < 0.01) and more often obese (p < 0.01) compared to the non-AKI group. A multivariate regression found the diagnosis of AKI to be independently correlated with poor functional outcome (p < 0.001), above average length of stay (p < 0.001), and in-hospital mortality (p < 0.001) when controlling for age, SAH severity, and other comorbidities. ConclusionsThis study showed significant association between AKI and adverse outcomes in SAH patients, and a correlation between AKI and heightened complication rates, poor functional outcome, extended hospital stays, and elevated mortality rates. Early detection of AKI in SAH patients is vital to improve their chances of recovery.

Cytokine expression profiles in children and adolescents with tic disorders

The etiology of tic disorders (TDs) is not precisely known, although several lines of evidence suggest involvement of the immune system in pathogenesis. Here, we aimed to determine the expression levels of pro-inflammatory and anti-inflammatory cytokines in children with TD and compare them with those of healthy controls. Furthermore, we also evaluated their association with clinical variables in the TD group. Within the study period, 88 children with tic disorders and 111 healthy control children were enrolled. Most children with tic disorders were diagnosed with Tourette’s disorder (n = 47, 53.4%) or persistent motor tic disorder (n = 39, 44.3%), while the remainder (n = 2, 2.3%) were diagnosed with persistent vocal tic disorder. We found that children with tic disorders had significantly elevated levels of IL-1β, TNF-α, IL-6 and IL-4 expression, while we detected lower expression levels of IL-17 in children with tic disorders. Our findings provide a molecular landscape of cytokine expression in children with TD, which may suggest a proinflammatory state not affected by the presence of comorbidity and symptom severity. Delineating the contribution of alterations in the immune system to the pathogenesis of tic disorders may pave the way for better therapeutic interventions.

Single-Center Mid-term Experience with E-Liac Branched Device from Artivion®

IntroductionThe use of iliac branch device (IBD) is increasing due to the less invasive character and accumulated experience of physicians in this endovascular technique. Clinical data regarding the E-liac stent graft from Artivion®, however, are scarce. This study shows the mid-term outcomes of the E-liac stent graft from a large single centre. MethodsPatients treated with IBD for (aorto-)iliac aneurysms between September 2015 and December 2022 with follow-up in our centre were included. (Post)operative (technical success, reintervention, 30-day mortality) and mid-term outcomes (endoleak, reintervention, hypogastric patency, mortality) were analysed. ResultsSixty-three patients (60 male, median age 70 years (IQR 66-;76)) were treated with 82 E-liac stent grafts for aorto-iliac aneurysms with a median follow-up of 38 months (IQR 22-51). The technical success rate was 95%. 97.6% of the interal iliac arteries remained patent during follow-up. No 30-day mortality was encountered. During follow-up one patient had an endoleak type 1b of both hypogastric arteries, however the patient refused additional interventions. One other patient had a type 2 endoleak with contained rupture. Paliative treatment was chosen because of the patient's severe comorbidities. One (1.6%) IBD-related reintervention was performed with relining of the stent graft. Secondary patency of the interal iliac artery was 95.1% and the mortality was 25.4% during follow-up. ConclusionsThis study shows high technical success rates for the E-liac stent graft, with corresponding good mid-term outcomes. The E-liac stent graft is a feasible, safe and effective stent graft in the treatment of aorto-iliac aneurysms.

The number of comorbidities as an important cofactor to ASA class in predicting postoperative outcome: An international multicentre cohort study.

Multimorbidity is a growing burden in our ageing society and is associated with perioperative morbidity and mortality. Despite several modifications to the ASA physical status classification, multimorbidity as such is still not considered. Thus, the aim of this study was to quantify the burden of comorbidities in perioperative patients and to assess, independent of ASA class, its potential influence on perioperative outcome. In a subpopulation of the prospective ClassIntra® validation study from eight international centres, type and severity of anaesthesia-relevant comorbidities were additionally extracted from electronic medical records for the current study. Patients from the validation study were of all ages, undergoing any type of in-hospital surgery and were followed up until 30 days postoperatively to assess perioperative outcomes. Primary endpoint was the number of comorbidities across ASA classes. The associated postoperative length of hospital stay (pLOS) and Comprehensive Complication Index (CCI®) were secondary endpoints. On a scale from 0 (no complication) to 100 (death) the CCI® measures the severity of postoperative morbidity as a weighted sum of all postoperative complications. Of 1421 enrolled patients, the mean number of comorbidities significantly increased from 1.5 in ASA I (95% CI, 1.1-1.9) to 10.5 in ASA IV (95% CI, 8.3-12.7) patients. Furthermore, independent of ASA class, postoperative complications measured by the CCI® increased per each comorbidity by 0.81 (95% CI, 0.40-1.23) and so did pLOS (geometric mean ratio, 1.03; 95% CI, 1.01-1.06). These data quantify the high prevalence of multimorbidity in the surgical population and show that the number of comorbidities is predictive of negative postoperative outcomes, independent of ASA class.

Risk factors at admission of in-hospital dysglycemia, mortality, and readmissions in patients with type 2 diabetes and pneumonia

AimsIn-hospital dysglycemia is associated with adverse outcomes. Identifying patients at risk of in-hospital dysglycemia early on admission may improve patient outcomes. MethodsWe analysed 117 inpatients admitted with pneumonia and type 2 diabetes monitored by continuous glucose monitoring. We assessed potential risk factors for in-hospital dysglycemia and adverse clinical outcomes. ResultsTime in range (3.9–10.0 mmol/l) decreased by 2.9 %-points [95 % CI 0.7–5.0] per 5 mmol/mol [2.6 %] increase in admission haemoglobin A1c, 16.2 %-points if admission diabetes therapy included insulin therapy [95 % CI 2.9–29.5], and 2.4 %-points [95 % CI 0.3–4.6] per increase in the Charlson Comorbidity Index (CCI) (integer, as a measure of severity and amount of comorbidities). Thirty-day readmission rate increased with an IRR of 1.24 [95 % CI 1.06–1.45] per increase in CCI. In-hospital mortality risk increased with an OR of 1.41 [95 % CI 1.07–1.87] per increase in Early Warning Score (EWS) (integer, as a measure of acute illness) at admission. ConclusionsDysglycemia among hospitalised patients with pneumonia and type 2 diabetes was associated with high haemoglobin A1c, insulin treatment before admission, and the amount and severity of comorbidities (i.e., CCI). Thirty-day readmission rate increased with high CCI. The risk of in-hospital mortality increased with the degree of acute illness (i.e., high EWS) at admission. Clinical outcomes were independent of chronic glycemic status, i.e. HbA1c, and in-hospital glycemic status.

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

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

A Systematic Review of Maternal Mortality in African Countries

Introduction: The goal of this review is to investigate maternal mortality rates (MMR) in African countries. Because the MMR of Black women in the United States is 3-5x higher than in White women, this study aims to identify if a similar racial disparity is present in Africa where the majority of the birthing population identifies as Black. Methods: Four bibliographic databases were searched - PubMed, Web of Science Core Collection, Scopus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) – and a variety of search terms were identified, including “Maternal Mortality”, “Ethnic Groups”, “Minority Groups”, “Continental Population Groups”, “Medically Underserved Area”, “Race Factors” and “Racial Disparities”. Inclusion criteria were manuscripts with statistics on maternal mortality or severe maternal morbidity in African countries or regions; exclusion criteria included “wrong outcome”, “wrong study type”, and studies only discussing maternal morbidity without mention of mortality. Papers that were not written in or that did not include information about an African country or region were excluded. Results: Overwhelmingly, hypertension-related mortality was identified as a leading cause of death in nearly every study, followed closely by post-partum hemorrhage, often due to over- or underuse of anticoagulation therapy. Unsafe abortion contributed to higher rates of adolescent mortality (37% of adolescents in one study) while accounting for 9-27% of the overall mortality rate. MMR across the continent varied significantly. Countries with the highest average recorded MMRs include Tunisia (1,820/100,000), Sierra Leone (1,800/100,000), Guinea (1,600/100,000), and Somalia (1,600/100,000). The lowest average MMRs found in this study included Tanzania (120/100,000), Egypt (124.5/100,000), Algeria (160/100,000), and Libya (220/100,000). Factors contributing to higher rates of mortality included extremes in maternal age, with the highest rates being in those older than 40 and younger than 20. Educational status played a large role, with up to 68% of mortality in one study occurring in people considered to be illiterate. Low socioeconomic status and being a member of a minority religious and/or ethnic group within a population corresponded with higher mortality rates, in addition to either late or minimal access to antenatal care (up to 28x higher MMR). A common comorbidity related to maternal mortality was patients having an established HIV diagnosis. Though mortality rates were significant in both HIV-positive and HIV-negative patients, most deaths in HIV-positive patients were related to advanced disease as opposed to obstetric complications, with one study finding the MMR of HIV-infected patients to be 6.2 times higher than HIV-negative patients. Among these deaths, tuberculosis, pneumocystis jirovecii pneumonia, and meningitis were among the most common causes. One study investigated the association between antiretroviral (ART) therapy and decreased rates of HIV-positive mortality. The recorded MMR of both HIV-positive and HIV-negative women decreased over the 10 years in this study; however, the HIV-positive MMR in the third time period was still 3.2 times higher than that of HIV-negative women (4.1 times higher in the second period, 7.1 times higher in the first period) with HIV-positive patients making up 33.3% of maternal deaths. One 2021 study focused on the effects of a COVID-19 infection on maternal outcomes – identifying no statistically significant difference in MMR, except that HIV-positive patients were twice as likely to contract COVID than controls. Conclusion: According to US CDC, the 2020 US national MMR was 23.8 per 100,000 live births, compared with the lowest national MMR in this study - Tanzania at 120/100,000; 6-fold higher than the US national average. In this systematic review, multiple factors were found to contribute to higher MMR, including low socioeconomic status, poor access to trained medical professionals, and patients having untreated or severe comorbidities such as HIV or tuberculosis. Two studies used a data collection method called ‘The Sisterhood Method’ which gathered retrospective data via interviewing women about the maternal outcomes of their biological sisters. Though this method of collection is useful for countries and/or regions that have limited access to electronic medical records (EMR) or census data, it relies on the memory and the willingness of interviewees to provide information, which may create recall bias and alter the validity of those studies. Our work identifies a need for further maternal mortality research to identify differences in healthcare systems across countries (both in Africa and worldwide) leading to higher death rates in some nations. Additionally, training programs (such as “Human Resources for Health,” “Pan-African Academy of Christian Surgeons [PAACS]”, “East, Central, and Southern African Health Community [ECSA-HC]”, etc.) should be supported with funding and other resources to address this crisis, while also supporting ongoing initiatives to expand medical education and training in African countries. Efforts should also be made to increase patient education about early signs of obstetric complications. Though maternal mortality rates have trended downward in recent decades, further research is needed to highlight and address disparities across countries and populations to provide equitable care to all.

Time from injury to acute surgery for patients with traumatic cervical spinal cord injury in South-East Norway.

The recommended treatment for cervical spinal cord injury (cSCI) is surgical decompression and stabilization within 24 h after injury. The aims of the study were to estimate our institutional compliance with this recommendation and identify potential factors associated with surgical delay. Population-based retrospective database study of patients operated for cSCI in 2015-2022 within the South-East Norway Health Region (3.1 million inhabitants). Data extracted were demographics, injury description, management timeline, place of primary triage [local hospital (LH) or neurotrauma center (NTC)]. Main outcome variables were: (1) time from injury to surgery at NTC, (2) time from injury to admission NTC, and (3) time from admission NTC to surgery. We found 243 cSCI patients having acute neck surgery. Their median age was 63 years (IQR 47-74 years), 77% were male, 48% were ≥65 years old. Primary triage at an LH occurred in 150/243 (62%). The median time from injury to acute surgery was 27.8 h (IQR 15.4-61.9 h), and 47% had surgery within 24 h. The median time from injury to NTC admission was 5.6 h (IQR 1.9-19.4 h), and 67% of the patients were admitted to the NTC within 12 h. Significant factors associated with increased time from injury to NTC admission were transfer via LH, severe preinjury comorbidities, less severe cSCI, time of injury other than night, absence of multiple injuries. The median time from NTC admission to surgery was 16.7 h (IQR 9.5-31.0 h), and 70% had surgery within 24 h. Significant factors associated with increased time from NTC admission to surgery were increasing age and non-translational injury morphology. Less than half of the patients with cSCI were operated on within the recommended 24 h time frame after injury. To increase the fraction of early surgery, we suggest the following: (1) patients with clinical suspicion of cSCI should be transported directly to the NTC from the scene of the accident, (2) MRI should be performed only at the NTC, (3) at the NTC, surgery should commence on the same calendar day as arrival or as the first operation the following day.

Neurocognitive and psychiatric outcomes associated with postacute COVID-19 infection without severe medical complication: a meta-analysis

BackgroundCognitive symptoms are often reported by those with a history of COVID-19 infection. No comprehensive meta-analysis of neurocognitive outcomes related to COVID-19 exists despite the influx of studies after the...

Physical exercise as part of the rehabilitation in primary osteoporosis: insights into the signal transduction bone formation pathways

Primary osteoporosis, a geriatric bone metabolic condition affecting both the mineral density and the microarchitecture, comes with a complex burden. Bone turnover markers tidily reflect the changes of skeleton status that are part of the physiological process or theyhighlight the abnormal status including in osteoporosis in addition to other biomolecules evaluation such as hormones, inflammatory markers, myokines and adipokines. In this narrative review, we aimed to highlight several aspects regarding osteoporosis-related rehabilitation amid mitigating the role of physical exercise as bone formation booster. Bone turnover markers assays, by capturing the essence of the bone remodelling, registered a great progress during latest years, thus show-ing an enhanced index of applicability in daily practice (despite being known and studied for more than three decades). Irisin, a novel player in the muscle-bone-metabolism cross-talk, represents a muscle-derivate hormone that is expected to highlight the interplay between physical exercise and bone formation. Other concurrent signal transduction pathways include recently described biomarkers such as preptin or the spectrum associated with serotonin-LRP5-Wnt/beta catenin canonical and non-canonical loops. Current pitfalls of the topic include the personalized recommendation of physical activity due to severe co-morbidities, the lack of homogenous studies to measure the intervention and the consecutive bone health and great variations of using the bone turnover markers amid daily practice in different centers. To conclude, part of the monitoring protocol in osteoporotic patients under specific medication against osteoporosis or during bisphosphonates drug holiday, bone turnover markers assays stands for a practical insight in every day practice. The contributing role of physical exercise to boost bone formation as reflected by these biomolecules is well understood across a multitude of signal transduction pathways. However, a current gap in practical use and surveillance of the prescription of physical activity, mechanical load and rehabilitation programs in these patients is confirmed so far. Keywords: osteoporosis, bone, fracture, rehabilitation, physical exercise, bone turnover markers, osteocalcin.

Non-Muscle Invasive Bladder Cancer: Many More Patients Die With It Than Of It.

The National Cancer Institute SEER Program regularly publishes bladder-cancer specific survival statistics. However, this data is for all bladder cancers, and information for non-muscle invasive bladder cancer (NMIBC) is difficult to obtain. To quantify 5-year overall and bladder cancer-specific survival in a cohort of Department of Veterans Affairs (VA) patients diagnosed with NMIBC. We identified VA patients diagnosed with NMIBC who underwent a transurethral resection from 2003-2013. The patient demographics and Charlson Comorbidity Index were categorized. We acquired the patients' date of death from the Veterans Health Administration's Death Ascertainment File and their cause of death from the Mortality Data Repository. We calculated Kaplan Meier estimates of survival. A total of 27,008 patients were included; median age was 69 and almost all were male (99%). The median comorbidity score was 4. The most prevalent comorbidity indicators included Chronic Pulmonary Disease (48%), cancer other than Bladder (41%), and diabetes (40%). This cohort was found to have a 5-year overall survival of 68% (99% CI 67% -69%) and a 5-year bladder cancer-specific survival of 93% (99% CI 92% -94%). The 5-year bladder cancer-specific survival in patients diagnosed with non-muscle invasive bladder cancer is substantially higher than the 5-year overall survival. This difference may be related to the severity and number of comorbidities that patients in this population must manage. This warrants further research into the necessity of currently recommended high-intensity cancer surveillance for individuals with NMIBC.

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.

Some features of osteogenesis in ankylosing spondylitis and the possibilities of treatment with bisphosphonates

Despite the high efficacy of currently available targeted synthetic disease-modifying antirheumatic drugs (tsDMARDs) and biologic DMARDs (bDMARDs), approximately 40 % of patients with ankylosing spondylitis (AS) fail to achieve treatment goals according to clinical, laboratory and imaging tests. In addition, comorbidities in AS, which require an integrated approach involving different specialists, may limit the use of such therapy. In view of the above, as well as the peculiarities of bone metabolism in AS, new therapeutic approaches for this disease have recently been sought, one of which is the use of bisphosphonates. This article discusses some aspects of bone metabolism and unconventional therapeutic options – the use of bisphosphonates in AS complicated by severe comorbidities, in patients with insufficient efficacy of bDMARDs and/or DMARDs.

Therapeutic modulation of the kynurenine pathway in severe mental illness and comorbidities: A potential role for serotonergic psychedelics

Mounting evidence points towards a crucial role of the kynurenine pathway (KP) in the altered gut-brain axis (GBA) balance in severe mental illness (SMI, namely depression, bipolar disorder, and schizophrenia) and cardiometabolic comorbidities. Preliminary evidence shows that serotonergic psychedelics and their analogues may hold therapeutic potential in addressing the altered KP in the dysregulated GBA in SMI and comorbidities. In fact, aside from their effects on mood, psychedelics elicit therapeutic improvement in preclinical models of obesity, metabolic syndrome, and vascular inflammation, which are highly comorbid with SMI.Here, we review the literature on the therapeutic modulation of the KP in the dysregulated GBA in SMI and comorbidities, and the potential application of psychedelics to address the altered KP in the brain and systemic dysfunction underlying SMI and comorbidities. Psychedelics might therapeutically modulate the KP in the altered GBA in SMI and comorbidities either directly, via altering the metabolic pathway by influencing the rate-limiting enzymes of the KP and affecting the levels of available tryptophan, or indirectly, by affecting the gut microbiome, gut metabolome, metabolism, and the immune system.Despite promising preliminary evidence, the mechanisms and outcomes of the KP modulation with psychedelics in SMI and systemic comorbidities remain largely unknown and require further investigation. Several concerns are discussed surrounding the potential side effects of this approach in specific cohorts of individuals with SMI and systemic comorbidities.

Social inequity in health among patients with severe obesity and multimorbidity.

Obesity adversely affects the health of the individual and impacts society through increased healthcare costs and lost workdays. Individuals in lower socioeconomic groups are more severely affected. Here, we examined people living with severe obesity and comorbidities across educational levels. Individuals with a BMI ≥ 35 kg/m2 and aged ≥ 16 years from the Danish National Health Survey 2021 were categorised into five educational levels and according to their number of obesity-related comorbidities (0, 1, 2 and ≥ 3). A total of 5.8% had a BMI ≥ 35 kg/m2, ranging from 2.2% to 10.7% in the 98 municipalities, and from 2.6% to 8.8% according to education level. Among individuals with a BMI ≥ 35 kg/m2 and the shortest education, 13.4% had no comorbidities, and 45.6% had ≥ 3 comorbidities. In contrast, among individuals with a BMI ≥ 35 kg/m2 and the longest education, 47.4% had no comorbidities, and 14.6% had ≥ 3 comorbidities. Among those with a BMI ≥ 35 kg/m2 and ≥ 3 comorbidities, 73.6% had elementary or vocational school as their highest education level, and 3.4% had a long higher education. The prevalence of individuals living with a BMI ≥ 35 kg/m2 differs by 3-5-fold depending on municipality and between the lowest and highest educational level. Additionally, the less educated group living with a BMI ≥ 35 kg/m2 was three times more likely to have ≥ 3 comorbidities than the most educated group. Hence, more research is warranted to understand the underlying causes and reduce social inequity in health. Novo Nordisk Fonden. Not relevant.

Prevalence of functional esophageal disorders and associated clinical characteristics in patients with proton-pump-inhibitor-unresponsive reflux symptoms.

Patients with proton-pump-inhibitor (PPI)-unresponsive reflux symptoms, often caused by functional esophageal disorders (FED), are frequently encountered in clinical practice. We aimed to investigate the prevalence of FED and its associated clinical characteristics in patients with PPI-unresponsive reflux symptoms. We retrospectively identified patients who were evaluated for persistent typical reflux symptoms, despite ≥8weeks of PPI treatment, at the National Taiwan University Hospital from 2014 to 2023. All patients underwent a comprehensive evaluation comprising validated gastroesophageal reflux disease (GERD) symptom questionnaires, 5-item Brief Symptom Rating Scale (BSRS-5), Pittsburgh Sleep Quality Index (PSQI), esophagogastroduodenoscopy, high-resolution impedance manometry, and 24-h impedance-pH monitoring off PPI therapy. Diagnosis of FED and non-erosive reflux disease (NERD) was based on the Rome IV criteria. We analyzed 190 patients [46.8% male, median age 52 (interquartile range, 42-61) years], of whom 32 (16.8%) had NERD and 158 (83.2%) had FED (57.9% with functional heartburn and 25.3% with reflux hypersensitivity). Patients with FED had a lower body mass index than those with NERD and a higher prevalence of psychological comorbidities and poor sleep quality than healthy volunteers. The severity of reflux symptoms among FED patients was significantly associated with the severity of psychological comorbidities and sleep quality. A notably high prevalence (83.2%) of FED was observed among patients experiencing PPI-unresponsive reflux symptoms. Patients with FED had a higher level of psychological distress and diminished sleep quality, both of which were associated with reflux symptom severity.

Longitudinal neurofunctional changes in medication overuse headache patients after mindfulness practice in a randomized controlled trial (the MIND-CM study)

BackgroundMindfulness practice has gained interest in the management of Chronic Migraine associated with Medication Overuse Headache (CM-MOH). Mindfulness is characterized by present-moment self-awareness and relies on attention control and emotion regulation, improving headache-related pain management. Mindfulness modulates the Default Mode Network (DMN), Salience Network (SN), and Fronto-Parietal Network (FPN) functional connectivity. However, the neural mechanisms underlying headache-related pain management with mindfulness are still unclear. In this study, we tested neurofunctional changes after mindfulness practice added to pharmacological treatment as usual in CM-MOH patients.MethodsThe present study is a longitudinal phase-III single-blind Randomized Controlled Trial (MIND-CM study; NCT03671681). Patients had a diagnosis of CM-MOH, no history of neurological and severe psychiatric comorbidities, and were attending our specialty headache centre. Patients were divided in Treatment as Usual (TaU) and mindfulness added to TaU (TaU + MIND) groups. Patients underwent a neuroimaging and clinical assessment before the treatment and after one year. Longitudinal comparisons of DMN, SN, and FPN connectivity were performed between groups and correlated with clinical changes. Vertex-wise analysis was performed to assess cortical thickness changes.Results177 CM-MOH patients were randomized to either TaU group or TaU + MIND group. Thirty-four patients, divided in 17 TaU and 17 TaU + MIND, completed the neuroimaging follow-up. At the follow-up, both groups showed an improvement in most clinical variables, whereas only TaU + MIND patients showed a significant headache frequency reduction (p = 0.028). After one year, TaU + MIND patients showed greater SN functional connectivity with the left posterior insula (p-FWE = 0.007) and sensorimotor cortex (p-FWE = 0.026). In TaU + MIND patients only, greater SN-insular connectivity was associated with improved depression scores (r = -0.51, p = 0.038). A longitudinal increase in cortical thickness was observed in the insular cluster in these patients (p = 0.015). Increased anterior cingulate cortex thickness was also reported in TaU + MIND group (p-FWE = 0.02).ConclusionsIncreased SN-insular connectivity might modulate chronic pain perception and the management of negative emotions. Enhanced SN-sensorimotor connectivity could reflect improved body-awareness of painful sensations. Expanded cingulate cortex thickness might sustain improved cognitive processing of nociceptive information. Our findings unveil the therapeutic potential of mindfulness and the underlying neural mechanisms in CM-MOH patients.Trial RegistrationName of Registry; MIND-CM study; Registration Number ClinicalTrials.gov identifier: NCT0367168; Registration Date: 14/09/2018

Malignancy in systemic lupus erythematosus: relation to disease characteristics in 92 patients – a single center retrospective study

ObjectiveSystemic lupus erythematosus (SLE) is a chronic autoimmune disease with a variable clinical manifestation, potentially leading to death. Importantly, patients with SLE have an increased risk of neoplastic disorders. Thus, this study aimed to comprehensively evaluate the clinical and laboratory characteristics of patients with SLE and with or without malignancy.MethodsWe conducted a retrospective analysis of medical records of 932 adult Caucasian patients with SLE treated at the University Hospital in Kraków, Poland, from 2012 to 2022. We collected demographic, clinical, and laboratory characteristics, but also treatment modalities with disease outcomes.ResultsAmong 932 patients with SLE, malignancy was documented in 92 (9.87%), with 7 (7.61%) patients experiencing more than one such complication. Non-hematologic malignancies were more prevalent (n = 77, 83.7%) than hematologic malignancies (n = 15, 16.3%). Patients with SLE and malignancy had a higher mean age of SLE onset and a longer mean disease duration than patients without malignancy (p < 0.001 and p = 0.027, respectively). The former group also presented more frequently with weight loss (odds ratio [OR] = 2.62, 95% confidence interval [CI] 1.61–4.23, p < 0.001), fatigue/weakness (OR = 2.10, 95% CI 1.22–3.77, p = 0.005), and fever (OR = 1.68, 95% CI 1.06–2.69, p = 0.024). In the malignancy-associated group, we noticed a higher prevalence of some clinical manifestations, such as pulmonary hypertension (OR = 3.47, 95% CI 1.30–8.42, p = 0.007), lung involvement (OR = 2.64, 95% CI 1.35–4.92, p = 0.003) with pleural effusion (OR = 2.39, 95% CI 1.43–3.94, p < 0.001), and anemia (OR = 2.24, 95% CI 1.29–4.38, p = 0.006). Moreover, the patients with SLE and malignancy more frequently had internal comorbidities, including peripheral arterial obliterans disease (OR = 3.89, 95% CI 1.86–7.75, p < 0.001), myocardial infarction (OR = 3.08, 95% CI 1.41–6.30, p = 0.003), heart failure (OR = 2.94, 95% CI 1.30–6.17, p = 0.005), diabetes mellitus (OR = 2.15, 95% CI 1.14–3.91, p = 0.011), hypothyroidism (OR = 2.08, 95% CI 1.29–3.34, p = 0.002), arterial hypertension (OR = 1.97, 95% CI 1.23–3.23, p = 0.003), and hypercholesterolemia (OR = 1.87, 95% CI 1.18-3.00, p = 0.006). Patients with SLE and malignancy were treated more often with aggressive immunosuppressive therapies, including cyclophosphamide (OR = 2.07, 95% CI 1.30–3.28, p = 0.002), however median cumulative cyclophosphamide dose in malignancy-associated SLE subgroup was 0 g (0–2 g). Interestingly, over a median follow-up period of 14 years (ranges: 8–22 years) a total of 47 patients with SLE died, with 16 cases (5.28%) in the malignancy-associated SLE group and 31 cases (5.73%) in the non-malignancy SLE group (p = 0.76). The most common causes of death were infections (21.28%) and SLE exacerbation (8.51%).ConclusionThe study highlights the relatively frequent presence of malignancies in patients with SLE, a phenomenon that demands oncological vigilance, especially in patients with a severe clinical course and comorbidities, to improve long-term outcomes in these patients.

Cardiometabolic Co-morbidity Burden and Circulating Biomarkers in Patients With Chronic Coronary Disease in the ISCHEMIA Trials

Cardiometabolic co-morbidities, diabetes (DM), hypertension (HTN), and obesity contribute to cardiovascular disease. Circulating biomarkers facilitate prognostication for patients with cardiovascular disease. We explored the relation between cardiometabolic co-morbidity burden in patients with chronic coronary disease and biomarkers of myocardial stretch, injury, inflammation, and platelet activity. We analyzed participants from the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trials biorepository with plasma biomarkers (N-terminal probrain natriuretic peptide, high-sensitivity cardiac troponin T, high-sensitivity C-reactive protein, interleukin-6, soluble CD40 ligand, and growth differentiation factor-15) and clinical risk factors (hemoglobin A1c [HbA1c], systolic blood pressure [SBP], and body mass index [BMI]) at baseline. We defined cardiometabolic co-morbidities as DM, HTN, and obesity at baseline. Co-morbidity burden is characterized by the number and severity of co-morbidities. Controlled co-morbidities were defined as HbA1c <7% for those with DM, SBP <130 mm Hg for those with HTN, and BMI <30 kg/m2. Severely uncontrolled was defined as HbA1c ≥8%, SBP ≥160 mm Hg, and BMI ≥35 kg/m2. We performed linear regression analyses to examine the association between co-morbidity burden and log-transformed biomarker levels, adjusting for age, gender, estimated glomerular filtration rate controlled for hemodialysis, and left ventricular ejection fraction. A total of 752 participants (mean age 66 years, 19% women, 84% White) were included in this analysis. Self-reported Black race, current smokers, history of myocardial infarction, and heart failure had a greater cardiometabolic co-morbidity burden. The presence of ≥1 severely uncontrolled co-morbidity was associated with significantly higher baseline levels of high-sensitivity cardiac troponin T, high-sensitivity C-reactive protein, interleukin-6, and growth differentiation factor-15 than participants with no co-morbidities. In conclusion, increasing cardiometabolic co-morbidity burden in patients with chronic coronary disease is associated with higher levels of circulating biomarkers of myocardial injury and inflammation.