Single Comorbidity Research Articles

The role of simultaneous stereotactic biopsy and radiofrequency ablation in the management of brain neoplasms in countries with limited financial resources

Abstract Background Heat can help control the progression of intra-axial cerebral neoplasms in selected cases. RF (Radiofrequency) is available and cost effective in resource-limited settings. RF stereotactic heat was delivered simultaneously with the biopsy in brain tumors. Objective We evaluated the safety and feasibility of stereotactic RF ablation of intra-axial brain neoplasms during stereotactic brain biopsy procedure. Methods Twenty-two adult patients were treated with interstitial hyperthermia by RF plus stereotactic brain tumor biopsy in Ain shams University Hospitals from 2022 to 2024. Follow-up for tumor progression was done over a period of 12 months. Results A total of 22 participants have been enrolled; follow-up period was 12 months. There were 12 (54.5%) females and 10 (45.5%) males. The mean and median ages were 53.6 years (range 25–72) and 54 years, respectively. 72.6% had at least a single baseline comorbidity. From the ablated tumors, 17 were primary, 4 were metastatic, and 1 was in-field necrosis. Median tumor volume was 6 cm3 and mean was 10.2 cm3 (range, 0.5–40 cm3). The one-year estimated survival rate was 86.6%, and this was impacted by disease etiology. Conclusions Results from this study demonstrate that RF ablation is a safe technique that it can be used simultaneously with stereotactic biopsy in selected cases of intra-axial brain neoplasms. A potential trend of longer progression-free interval of tumor is presumed in the cases. In resource-limited settings, RF ablation can be a safe and available alternative to LITT (Laser Interstitial Thermocoagulative Therapy) that can deliver heat to intracranial tumors.

Comorbidities, drug-resistance and length of hospital stay among tuberculosis inpatients in Northeastern China: a retrospective observational study from 2013 to 2021

BackgroundTuberculosis (TB) remains a significant global health issue. Drug-resistant TB and comorbidities exacerbate its burden, influencing treatment outcomes and healthcare utilization. Despite the growing prevalence of TB comorbidities, research often focuses on single comorbidities rather than comorbidity patterns. This study aims to evaluate comorbidity patterns among TB inpatients in Northeastern China from 2013 to 2021 and investigate the association between comorbidities and drug-resistance with length of hospital stay (LOS). Our findings could enhance the understanding of TB comorbidity interactions and provide evidence for targeted morbidity management strategies.MethodsNetwork analysis was used to evaluate comorbidity patterns, estimating centrality indices to understand the structural importance of each comorbidity. The Walktrap algorithm was used to identify clusters of highly connected comorbidities. Networks of drug-susceptible and drug-resistant TB inpatients were compared. Multivariable linear regression models were used to assess the associations between LOS with comorbidities and drug resistance.ResultsA total of 2,352 TB inpatients were included, with a median LOS of 31 (IQR: 16–51) days. Inpatients with multidrug-resistant TB (β = 12.88, 95%CI = 8.03–17.73), chronic hepatitis C (β = 31.89, 95%CI: 4.41–59.37), pneumonia (β = 37.14, 95%CI: 12.53 – 61.76), pneumoconiosis (β = 28.40, 95%CI: 11.92 – 44.87), pneumothorax (β = 19.88, 95%CI: 4.97 – 34.80), and dermatitis/eczema (β = 56.54, 95%CI: 8.18 – 104.89) were significantly associated with longer LOS. Frequent comorbidities included liver dysfunction(15.2%), hypoproteinemia (14.4%), diabetes (14.2%), pleural effusion (11.3%), and emphysema (10.2%). Hypoproteinemia showed high structural importance in the network, ranking second in strength and highest in betweenness. Nine clusters of comorbidities were detected. No significant differences were found between the networks of drug-sensitive and drug-resistant TB inpatients, except for the greater strength of cholecystitis among drug-resistant inpatients.ConclusionsEarly detection and management of drug-resistant TB and comorbidities that prolong LOS, as well as those with structural importance or within the same cluster in the comorbidity network, are crucial for improving patient outcomes.

Bone Health in Patients with Rheumatoid Arthritis in Bahrain.

Background and Objectives: Compared to the general population, rheumatoid arthritis (RA) patients have additional disease-specific risk factors for osteoporosis that include chronic exposure to systemic inflammation. The current study aimed to investigate the prevalence of osteoporosis and its associated risk factors, such as age, sex, body mass index (BMI), uric acid (UA), and vitamin D status, but also the coexistence of type 2 diabetes mellitus (DMT2) and breast cancer (Ca breast) in patients with RA in Bahrain. Material and Methods: Data from DEXA scans were collected retrospectively from the patient's electronic health records. All patients who had BMD data and at least one single comorbidity, including RA, were included in the current study. The collected data were analyzed by using SPSS, version 28. Results: A total of 4396 patients were included in the current study. The comorbidities among this cohort were as follows: 3434 patients had endocrinological diseases, among them 63.6% had DMT2; 1870 patients had rheumatological diseases, among them 15.1% had rheumatoid arthritis; and 941 patients had malignancies, among them 75.6% had breast cancer. Our results indicated that patients with RA had a high prevalence of low BMD (72.30%, p < 0.001) and low vitamin D levels (63.10%, p < 0.001) but high serum UA (20.85%). Comparing RA with non-RA patients, our results showed a statistically significant association between RA and each of BMD and UA (p = 0.017 and p = 0.004, respectively), but also between RA and each of age (p = 0.001) and Ca breast (p < 0.001). However, no association was found between RA and BMI, DMT2, or vitamin D status. Conclusions: RA patients had a high prevalence of low BMD (72.3%) and low vitamin D (63.10%) but high serum UA (20.85%). The risk of osteoporosis, hypovitaminosis, and gout must be kept in mind during the evaluation of any case with RA.

Longitudinal Trends of Comorbidities and Survival Among Kidney Cancer Patients in Asian Population.

Comorbidity could influence cancer diagnosis, treatment, prognosis, or survival. Although comorbidity burden in kidney cancer patients is high, limited evidence exists on the longitudinal patterns of individual comorbidity prevalence and its impact on overall survival among kidney cancer patients, particularly in Asian populations. We included adults diagnosed with kidney cancer between 2010 and 2021 using the Korean nationwide health insurance database. Comorbidities assessed were any 1 of 19 specific medical conditions, diagnosed within 1 year prior to cancer diagnosis. We calculated the incidence and age-standardized incidence rate of kidney cancer, prevalence of individual medical conditions as single or multiple comorbidities, and overall survival probability of kidney cancer patients over a 12-year period. We estimated the odds ratio (OR) of having individual and multiple comorbidities with age and sex as independent covariates and adjusted for other comorbidities. Kaplan-Meier curves were used for overall survival at different time frames up to 5 years of follow-up. Among kidney cancer patients (N = 42,740), 68.7% were men, and median (interquartile range) age was 59 (49-68) years. Approximately 76% of patients had at least one comorbidity at the time of cancer diagnosis. Overall, hypertension (51.3%), dyslipidemia (40.2%), mild liver disease (27.4%), diabetes (25.1%), and peptic ulcer disease (18.9%) were the most prevalent comorbidities. The proportion of patients having three or more comorbidities continuously increased from 2010 (29.4%) to 2021 (44.9%). Having more comorbidities was associated with a lower probability of overall survival. Comorbidities were prevalent in kidney cancer patients, and the proportions of patients with multiple conditions increased over time. Although survival probability increased over time, it was attenuated by having more comorbidities. Our data emphasizes the importance of comprehensive management for both cancer and comorbid conditions in kidney cancer patients.

Unlocking the Potential of the Elderly Population in Serbia: A Modeling Study on Musculoskeletal Disorders and Associated Factors.

Background/Objectives: A properly functioning musculoskeletal system is imperative for human well-being at every stage of life, including at an older age. This study's aim was to assess the relationship between sociodemographic and physical functioning variables and the presence of individual musculoskeletal disorders (MSDs), MSD comorbidity, and multimorbidity, as well as to determine factors that are independent predictors of the presence of MSDs in people over 65 years old. Methods: This population-based study included 3701 participants aged 65 years and older. Data on individual MSDs addressed cervical and lumbosacral spine regions and degenerative joint disease (arthrosis). The subjects were categorized into four groups: those without any diseases; those with one MSD; those with two MSDs (comorbidities); and those with three MSDs (multimorbidities). The sociodemographic and physical functioning variables were analyzed. Results: Females were more likely to have MSDs (two: OR 1.95 and three: OR 2.25) than men. Elderly people aged 75 and above were 1.49 times more likely to have three MSDs. Elderly people with elementary school education were more likely to have MSDs (two: OR 1.34 and three: OR 2.06) than those with high school/university education. The low-income population was 2.47 times more likely to have three MSDs. Individuals with partial activity limitations because of health problems had greater chances of having one, two, or three MSDs (OR 1.60, 1.59, and 1.94, respectively), and elderly individuals with severe limitations had an OR of 1.43, 2.17, and 4.12, respectively. Individuals with some/many difficulties in walking up or down 12 steps were more likely to have MSDs (two: OR 2.26 and three: OR 2.28). Conclusions: The significant predictors of experiencing a single MSD, MSD comorbidity, or MSD multimorbidity include residing in the Serbian capital city and having limitations in activities due to health problems. A significant predictor of having a single MSD or MSD comorbidity is residing in the northern region of Serbia. A significant predictor of MSD comorbidity is residing in the southeastern region of Serbia. Significant predictors of MSD comorbidity or MSD multimorbidity include female gender, an elementary school educational level, and experiencing difficulty in walking up or down 12 steps. Significant predictors of MSD multimorbidity are being 75 years of age and above and having a lower income.

Lipitension – myth or reality? Opinion of a practicing cardiologist (letter to the editor)

The article (letter to the editor) presents current data on the prevalence of arterial hypertension and dyslipidemia according to domestic and foreign epidemiological studies. It is advisable for a clinical practitioner to consider these two leading cardiovascular pathologies (they are also the most common risk factors for the development and progression of atherosclerosis) together for further active correction with drug and non-drug methods of treatment. According to the studies presented in the article, the association of high blood pressure with the risk of myocardial infarction, stroke, heart failure, sudden cardiac death, atherosclerosis of peripheral arteries, chronic kidney disease, regardless of the age of patients with hypertension, is shown. There is no doubt about the positive effect of long-term maintenance of target blood pressure values in patients with an established diagnosis of arterial hypertension in relation to the prevention of cardiovascular complications.At the same time, up to 40 % of patients with arterial hypertension are characterized by the presence of one or another type of dyslipidemia. The opinion was expressed about the legality of using the term "lipitension" in connection with the convenience of designating these two pathologies in the form of a single pro-atherogenic comorbidity. The article presents the opinion of a practicing cardiologist, which is the advisability of distinguishing the term "lipitension" (as a pathological-nosological combination (comorbidity) of two leading risk factors in the population of developed countries – arterial hypertension and dyslipidemia. Understanding the commonality of two key factors limiting the prognosis of patients with cardiovascular diseases allows the practitioner to more confidently, with pathogenetic justification, apply the polytablet strategy (containing lipid-lowering and antihypertensive components), which allows not only to achieve more effective control of blood pressure and lipid profile indicators, but also to improve the prognosis and quality of life of patients in the framework of primary and secondary prevention.

Epidemiology of Infections, Readmissions, and Reoperations after 1434 Foot and Ankle Surgeries at an Academic Medical Center

Category: Other Introduction/Purpose: Foot and ankle orthopaedic procedures account for approximately 10% of all orthopaedic procedures annually, however, limited data exists on the rates of infection, readmissions and reoperations after surgery. Current literature in other fields of orthopaedic surgery suggests that patient characteristics, including body mass index (BMI), age, gender, race/ethnicity, smoking status, and comorbidities, may impact these rates. The variety of foot and ankle procedures performed presents a challenge when counseling patients on post-operative complications and mitigating risk. Methods: In this retrospective study of 1434 foot and ankle surgeries performed at a large, urban medical center by a single surgeon, patient demographics, pre-operative comorbidities, and post-operative complications within 90 days, including superficial wound infection, readmission, and reoperation, were analyzed using Chi-square test of independence. Preoperative demographics analyzed included age, diabetes mellitus (DM) status, smoking status, race/ethnicity, body mass index (BMI), and perioperative opioid use. Results: The overall rate of superficial wound infection was 2.3% (n=33); readmission and reoperation rates were 3.3% (n=47) and 3.6% (n=51), respectively. Patients who had DM, were 70 years or older, smoke tobacco products, had no perioperative opioid use, and had BMI &gt;25 were all independently associated with higher rates of readmissions by 90 days (p &lt; 0.05). Smoking tobacco products and perioperative opioid use were associated with higher rates of reoperation within 90 days (p &lt; 0.001). Patients with perioperative opioid use also had higher rates of infection (p=0.0002). Age, DM, smoking status, race/ethnicity, BMI, and procedure type were not associated with differences in rate of infections. Conclusion: In elective and non-elective foot and ankle orthopaedic surgery, older age, DM, smoking and BMI&gt;25 were associated with increased postoperative complications. The association of opioid use perioperatively and lower complication rates represents an area of future investigation. The conclusions of this study should be used to counsel patients on their anticipated risks of surgery and help identify areas risk mitigation to prevent and avoid complications.

A Prospective and Observational Study on the Impact of Patient Counselling on Medication Adherence and Quality of Life in Stroke Patients

PURPOSE: The study goals are to improve medication adherence and high-quality lifestyles in stroke patients through effective patient counselling. BACKGROUND: Stroke is one of the most common neurological disorders and the second most common purpose of dying worldwide. Stroke is likewise called cerebral infarction or cerebrovascular twist of fate. It occurs when blood flow to the brain is reduced due to permanent or temporary blockage of an artery that carries blood to the brain, or rupture of an artery in the brain because of high blood pressure The primary danger elements of Stroke encountered are high blood pressure, age, diabetes mellitus, obesity, smoking, and alcohol. the burden of stroke is gigantic and recurrence of stroke is a first-rate risk issue for growing the weight of stroke. medications play an crucial position in stopping stroke recurrence. Adherence can be summarized as ‘The extent to which someone’s behaviour taking medicinal drug, following a diet, and/or executing life-style modifications – corresponds with agreed tips from a health care provider”. current estimates are that only one-sixth of all sufferers come close to perfect adherence to their medicine regimen. the issue is gaining importance because of an increase in the prevalence of chronic diseases and an ageing population. common reasons of medicine nonadherence include complicated remedy regimens and patients’ lack of belief within the treatment. Healthcare specialists play an crucial position in remedy adherence amongst stroke survivors. They should deal with the boundaries and facilitate remedy adherence behaviours. METHODOLOGY: It is a prospective observational study conducted in Lalitha Super specialities Hospital, Guntur over 6 months duration study in the neurology department, a total of 200 patients of age groups between 25-85 of both genders with comorbidities like hypertension, diabetes, and affected with stroke were enrolled in the study. RESULTS &amp; DISCUSSIONS: The outcomes were obtained after 6 months duration observe within the neurology branch of tertiary care hospital a total of 200 patients enrolled in the study. The study of the effect of patient counselling on medication adherence and quality of life in stroke patients is a prospective observational take a look at in which facts is amassed in Lalitha super speciality hospital with a random representative sampling method explaining the qualitative &amp; quantitative evaluation. We accrued 200 instances of these tormented by ischemic, hemorrhagic, and transient ischemic stroke, and affected person counselling was given and followed up after discharge. Out of 2 hundred samples, 67% of patients are suffering from ischemic stroke, 22.5% from hemorrhagic &amp; 10.5% from TIA. males (60.5%) are greater stricken by stroke than females (39.5%) and the age group between 46-55 is more affected by stroke (32%). The patients who are with both hypertension and diabetes were extra affected by stroke (45.5%) than the ones having single co-morbidities, high blood pressure (28%) and DM (13.5%). in the collected samples males are more effecting by hypertension (33.88%) and females with diabetes (15.18%) and both high blood pressure &amp; diabetes (49.36%). medication adherence in stroke patients is the primary goal of the observe, figure no 5 indicates that out of 200 sufferers, 129 (sixty four.5%) have highly adhered to medicine, 61 patients (30.5%) are mild, and, 10 patients (5.0%) low adherence to remedy after counselling to the patients. quality of lifestyles is the main objective of this study. figure no 6 suggests the quality of life of 200 stroke patients earlier than and after patient counselling. The exceptional of lifestyles had been measured using a modified ranking SCALE (mRS). After the 6-month observe up the quality of life had improved in patients. A quantitative analysis was done using the chi-square test the end result of x squared value is 35.1 with Df 6 at a significance level of 0.05, and the P value is &lt;0.05. CONCLUSION: The main aim of this study is to provide better patient counselling to improve medication adherence and the quality of life in stroke patients was achieved successfully. In this study 200 stroke patients were enrolled and patient counseling was provided and followed up through face-to-face interviews and phone calls. Among 200 patients, 129 patients (64.5%) were highly adherence to the medication and 61 patients (30.50%) were moderately. 10 patients (5%) were low adherence to medication. The quality of life of stroke patients increased after the counselling compared to before counselling. The medication adherence and quality of life were measured using MMAS-8 QUESTIONS and a modified ranking scale (mRS) respectively. It is also evident from the study that pharmacist intervention is effective in improving medication adherence and its associated effect on the management of patients receiving stroke therapy.

Differences in networks of alexithymia and cognitive emotion regulation strategies among older adults with different health statuses in eastern China—A network analysis and network comparison

To identify core and bridge nodes in the network structure of alexithymia and cognitive emotion regulation strategies in community-dwelling older adults, and compare network differences among older adults with different health statuses, we recruited 677 participants and network analysis was performed in R 4.2.0. After including the covariates, the nodes Catastrophizing, Difficulty Identifying feelings, and Refocusing on Planning ranked as the top three. The nodes Externally Oriented Thoughts and Difficulty Identifying Feelings were identified as bridge nodes based on bridge strength values. Significant differences were observed between the healthy and comorbidity groups, and also between the single chronic disease and comorbidity groups (p < 0.05). Catastrophizing, Difficulty Identifying Feelings, and Refocusing on Planning were the core nodes, and Externally Oriented Thoughts and Difficulty Identifying Feelings were the key bridge nodes. The network structure of comorbidity in older adults was characterized by stronger ties to non-adaptive cognitive emotion regulation strategies.

Psychiatric Comorbidity in Children and Youth with Epilepsy

Introduction: Psychiatric comorbidities of epilepsy are common. Yet psychiatric disorders are often under-prevented, under-diagnosed, and under-treated. Objectives: to assess the prevalence of different psychiatric disorders in children and adolescents with epilepsy and to determine associated risk factors. Methods: This is a descriptive and analytical cross-sectional study of patients treated for a psychiatric disorder comorbid with epilepsy, conducted in the Child Psychiatry Department at Ar-Razi Hospital in Salé, Morocco, from January 1st to December 31st, 2022.Data were collected using a questionnaire concerning the socio-demographic and clinical characteristics of our patients. Psychiatric disorders were assessed using the diagnostic criteria of the DSM-5 psychiatric manual. Results: Our study included 70 patients followed for epilepsy comorbid with a psychiatric disorder. The most common psychiatric comorbidities were intellectual development disorder, autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). 72.9% suffered from a single psychiatric comorbidity, while 27.1% had two or more. Several sociodemographic and clinical factors were associated with different psychiatric disorders. Gender was associated with conduct and behavior disorders, with males predominating (p=0.043), while age was significantly associated with psychosis (p=0.047). Mood disorders were associated with the type of epilepsy. Seizure recurrence was associated with behavioral and anxiety disorders. Conclusion: The co-morbidity of psychiatric disorders and epilepsy in children and adolescents is common, underscoring the importance of early detection for improved management.

Risk Factors Associated With Anastomotic Stricture in Patients Undergoing Minimally Invasive Esophagectomy: Experience From a High-Volume Center.

Esophageal cancer is aprevalent cancer, with a high incidence in low socioeconomic category countries. Minimally invasive esophagectomy is increasingly being used to treat this malignant condition. However, anastomotic stricture is a serious complication post esophagectomy. The study aims to enhance diagnostic consistency, improve treatment methods, guide patient management, stratify outcomes, and offer evidence-based preventive interventions. A retrospective analysis of 550 patients who had minimally invasive esophagus surgery was carried out at Shaukat Khanum Memorial Cancer Hospital and Research Centre in Lahore between 2015 and 2020. All patients were treated with radical resection. For tumors of the lower esophagus and gastroesophageal junction, transhiatal esophagectomy was used; for tumors of the middle and upper thoracic esophagus, right video-assisted thoracoscopic surgery (VATS) was used in a three-stage procedure. Patients were routinely followed up two weeks after discharge, then every three, six, and 12 months. The mean age and BMI were 46.7 years and 19.4 kg/m2, respectively. Anastomotic leaks were rare, with only 13 patients experiencing them. The grade of tumor differentiation was poor, moderate, and well-differentiated. The study found that older age, high Eastern Cooperative Oncology Group (ECOG) performance status, and malignancies located in the upper and middle one-third of the esophagus had significant associations with anastomotic stricture. However, some variables, like sex, did not show significant associations in either analysis. The study reveals that factors such as older patient age, high ECOG performance status, single comorbidity, and malignancies located in the upper and middle one-third of the esophagus significantly influence anastomotic stricture. The study suggests that measures against anastomotic stricture such as endoscopic procedures and minimally invasive esophagectomy should be implemented to minimize the complications.

Association between maternal multimorbidity and neurodevelopment of offspring: a prospective birth cohort study from the Japan Environment and Children’s Study

ObjectivesTo investigate the association between multimorbidity during pregnancy and neurodevelopmental delay in offspring using data from a Japanese nationwide birth cohort study.DesignThis study was a prospective birth cohort study.SettingThis study...

The Impact of Comorbidities and Motor Impairment on the Quality of Life of Patients with Spinal Muscular Atrophy: A Case-Control Study.

Introduction: Spinal muscular atrophy (SMA) is a genetically determined disease primarily leading to muscle weakness, but now, it is considered a systemic disease with changes in various tissues and organs. In our study, we aimed to compare quality of life (QoL) outcomes in patients with SMA in relation to the degree of motor limitation and comorbidities, mainly internal medicine diseases. Methods: We included 35 adult patients with SMA and 36 healthy volunteers. Thorough medical histories were taken focusing on comorbidities, and neurological examinations incorporating assessments using functional motor scales were performed. QoL was assessed based on the World Health Organization Quality of Life Brief Version (WHOQOL-BREF) questionnaire. Results: SMA patients and controls were comparable in terms of scores in the questionnaire's main domains. SMA patients presented significantly higher levels of satisfaction with their medical care than controls. Patients with more advanced SMA had significantly better scores on certain questions, e.g., those related to health satisfaction or leisure activities. A total of 71.4% of SMA patients had comorbidities, ranging from one to three in individual patients. SMA patients with comorbidities did not show worse QoL. Negative correlations were found between the number of comorbidities in SMA patients and individual questions on the WHOQOL-BREF questionnaire. Conclusions: Patients with SMA were satisfied with their medical care. Better scores on some questions in more advanced SMA may have been due to better adaptation to disease-related limitations. The presence of single comorbidities did not affect QoL, but a higher number of comorbidities negatively correlated with QoL.

Is a high preoperative HbA1c level a risk factor for postoperative complications in patients with non-small-cell lung cancer?

PurposeDiabetes mellitus (DM) is a common comorbidity of lung cancer. We hypothesized that severe DM is associated with increased complications after surgical resection of non-small-cell lung cancer (NSCLC).MethodsA review of our retrospective thoracic database identified 1139 consecutive surgical resections for NSCLC from 2002 to 2021. Our analysis included the exploration of clinicopathological features, perioperative variables, and surgical outcomes.ResultsIn addition to lung cancer, 170 patients (14.9%) had DM. The patients included 132 (77.6%) men and 38 (22.4%) women, with a median age of 72 (range, 51–93) years old. The median preoperative fasting blood glucose and HbA1c levels were 135 mg/dL (range, 57–303) and 6.9% (range, 5.1–14.8), respectively. Eighty-one patients had DM as a single comorbidity, and 89 patients had other comorbidities or a relevant medical history. A total of 144 patients were prescribed these drugs. There were 107 patients (62.9%) who consulted a specialist diabetes endocrinology department preoperatively and 118 patients (69.4%) who required sliding-scale insulin during the perioperative period. Forty-seven patients (27.6%) developed post-operative complications. No cases of bronchopleural fistula were noted. A univariate analysis showed that the sex (p = 0.017), body mass index (BMI) (p = 0.0032), surgical procedure (p = 0.017), surgical time (p = 0.002), and lymphatic invasion (p = 0.011) were significantly different among patients stratified by postoperative complications. A multivariate analysis showed that a low BMI (odds ratio [OR]: 0.413, 95% confidence interval [CI]: 0.196–0.870, p = 0.018), long surgical time (OR: 2.690, 95% CI: 1.190–6.082, p = 0.015), and presence of lymphatic invasion (OR: 2.849, 95% CI: 1.319–6.135, p = 0.007) were risk factors for postoperative complications. In contrast, severe preoperative DM did not have a significant negative effect on the incidence of postoperative complications.ConclusionIn modern respiratory surgery, severe DM does not affect the short-term outcomes under strict preoperative treatment.

Number of comorbidities and the risk of delay in seeking treatment for coronary heart disease: a longitudinal study in Bogor City, Indonesia.

The aim of this study was to investigate the relationship between the number of patient comorbidities and the delays in seeking treatment for coronary heart disease (CHD). This longitudinal study utilized secondary data from the Non-Communicable Disease Risk Factor (NCDRF) cohort study conducted in Bogor City. Individuals who participated in the NCDRF cohort study and were diagnosed with CHD within the 6-year study period met the inclusion criteria. Respondents who were not continuously monitored up to the 6th year were excluded. The final sample included data from respondents with CHD who participated in the NCDRF cohort study and were monitored for the full 6-year duration. The final logistic regression analysis was conducted on data collected from 812 participants. Among the participants with CHD, 702 out of 812 exhibited a delay in seeking treatment. The risk of a delay in seeking treatment was significantly higher among individuals without comorbidities, with an odds ratio (OR) of 3.5 (95% confidence interval [CI], 1.735-7.036; p<0.001). Among those with a single comorbidity, the risk of delay in seeking treatment was still notable (OR, 2.6; 95% CI, 1.259-5.418; p=0.010) when compared to those with 2 or more comorbidities. These odds were adjusted for age, sex, education level, and health insurance status. The proportion of patients with CHD who delayed seeking treatment was high, particularly among individuals with no comorbidities. Low levels of comorbidity also appeared to correlate with a greater tendency to delay in seeking treatment.

Drug-resistant epilepsy in Morocco: description, prevalence and predictive factors in Casablanca-Settat region

Drug-resistant epilepsy (DRE) affects about one-third of people with epilepsy (PWE). Our study aims to estimate the DRE prevalence and its predictive factors in Morocco. A cross-sectional study was conducted over 18 months. PWE with clinical diagnosis of epilepsy, and with an antiseizure treatment duration >12 months were examined in the neurology, neurosurgery, psychiatry, and pediatrics departments, of different sampled clinical sectors for the Casablanca-Settat region. Sociodemographic and clinical data were collected using a questionnaire during consultations. Antiseizure multi-therapy, a seizure freedom duration <12 months, compliance, and adequate posology were the determining factors for classifying DRE. Data were analyzed using Statistical Package for Social Sciences (SPSS) software, version 21.0. Statistical significance was set at p < 0.05 and logistic regression was performed to determine the predictive factors. In our sample of 446 PWE, the median age is 25 years (IQR: 11.75–44.00). The DRE estimated prevalence was 29.4 %. Pseudo-resistant epilepsy (PRE) was 18.0 %. Multivariate logistic regression analysis reports that single marital status (ORa = 1.94; CI95%: 1.02–3.71), comorbidities and concomitant affections (ORa = 2.14; CI95%: 1.27–3.59), structural etiology (ORa = 1.96; CI95%: 1.16–3.30), pre-ictal aura (ORa = 1.90; CI95%: 1.09–3.29), inter-ictal EEG abnormalities (ORa = 2.45; CI95%: 1.24–4.84) and allopathic treatment use (ORa = 2.10; CI95%: 1.30–3.39) are the predictive factors for DRE. We report an alarming DRE prevalence. Associated factors found may contribute to the prognosis and early management. PWE awareness, facilitating healthcare access and the development of epilepsy surgery are the key points to limit DRE in Morocco and prevent its various complications, especially for the pediatric population.

The Role of Tranexamic Acid (TXA) In Spine Surgery for Patients with Comorbidities in Basra/Iraq

Background: Blood loss occurs frequently and remains a challenge in spinal surgery. As significant intra and postoperative hemorrhage negatively affects patient outcomes by increasing coagulopathy, postoperative hematoma, and anemia. The need for allogenic blood transfusions can lead to potential transfusion reactions and infections, in addition to increasing long-term mortality rates. Although there are many randomized control trials and meta-analysis investigating the role of tranexamic acid (TXA), we could not find any study that investigated the role of TXA in patients with medical comorbidities. Therefore, tackling the role of TXA in patients with single or multiple comorbidities is of valuable outcome to our locality as most of the patients have indeed associated comorbidities. Objectives: to investigate the role of tranexamic acid in decreasing perioperative blood loss in patients with multiple comorbidities as compared to otherwise healthy individuals. Patients and methods: A single center randomized control trial. We included patients that were about to undergo simple decompressive surgeries for lumbar canal stenosis and fixation with decompression for spondylolisthesis. Patients were randomly categorized into cases (who received TXA) and controls who received NS. Patients then were subcategorized according to comorbidities and types of surgeries. Intraoperative blood loss was calculated using the suction drain and the gauze while the post operative bleeding was calculated using the drain output. Results: There was 441.84 ml (49.6 %) decrease in intraoperative bleeding for patients who received TXA as compared to controls regardless the type of surgery and regardless the presence or absence of comorbidities. Hypertensive patients had 52.7 % reduction in intraoperative bleeding when received TXA, Diabetic patients showed 44.4 % reduction in bleeding, Obese patients showed 51.1% reduction and patients with multiple comorbidities showed 51% reduction in intraoperative bleeding while healthy individuals showed 38.9% reduction in intraoperative bleeding. Conclusion: TXA was even more effective in decreasing intraoperative bleeding in patients with multiple comorbidities as compared to healthy individuals.

Multicomorbidity in Psoriasis Vulgaris: A Retrospective Analysis.

The frequencies of comorbidities in patients with psoriasis have been compared to that in the general population in many studies. Moreover, several studies have investigated the risk factors influencing the number of comorbidities in patients with psoriasis. However, a few studies have examined clusters of patients with psoriasis according to their comorbidities. In this study, we aimed to explore the multicomorbidities of psoriasis vulgaris in terms of risk factors and clusters. All diagnoses of 452 patients with psoriasis vulgaris were extracted from electronic medical records of a tertiary hospital. Binary association coefficients were calculated for all pairs of comorbidities. Subsequently, a hierarchical cluster analysis was performed. Among the patients, 30.5% had no comorbidities, 28.8% had a single comorbidity, and 40.7% had multiple comorbidities. The number of comorbidities was positively associated with age and follow-up duration but not with sex. The most striking cluster of comorbidities was composed of diabetes, hepatosteatosis, hyperlipidemia, hypertension, cancer, and cardiovascular disease. This cluster could be explained by cardiometabolic multimorbidity. Exploring such clusters may provide a more forward-looking perspective for the management of psoriasis patients.

Clinical Profile and Outcome of Critically-ill Hospitalized COVID-19 Patients Aged 18-50 Years: A Limited Resource Setting Perspective.

The coronavirus disease of 2019 (COVID-19) pandemic started by affecting the older age groups with comorbidities but gradually advanced to severely affect even young adults. This study attempts to clinically evaluate critically ill young and middle-aged adults hospitalized with COVID-19 and study the association of risk factors and the markers of inflammation and coagulation with their outcome. A prospective observational study on 146 patients was conducted in a tertiary care hospital in Western India. History taking, clinical examination, laboratory investigations, and chest X-rays were done for all patients, and investigations were repeated after 3 days. Treatment, including ventilation, was given according to standard guidelines. Difficulty in breathing was the most common chief complaint, and the majority of patients had a normal body temperature on admission. Involvement of >2 lung zones on chest X-ray, a high neutrophil to lymphocyte (N/L) ratio, the presence of complications, raised D-dimer and serum ferritin, and invasive ventilation were all associated with higher mortality. While the presence of a single comorbidity did not affect the outcome, a combination of multiple comorbidities increased the mortality. The presence of multiple comorbidities and complications along with radiological abnormalities and raised D-dimer and serum ferritin are associated with critically ill COVID-19 patients and may indicate a higher risk of mortality. Administration of remdesivir has no significant influence on the outcome, but tocilizumab decreases the mortality. The inflammatory markers scoring system has utility in the prognosis of patients, especially in limited-resource settings.

Development of a comorbidity index for patients undergoing abdominal aortic aneurysm repair

BackgroundEndovascular aneurysm repair (EVAR) and open surgical repair (OSR) are two modalities to treat patients with abdominal aortic aneurysm (AAA). Alternative to individual comorbidity adjustment, a summary comorbidity index is a weighted composite score of all comorbidities that can be used as standard metric to control for comorbidity burden in clinical studies. This study aimed to develop summary comorbidity indices for patients who underwent AAA repair. MethodsPatients who went under EVAR or OSR were identified in National Inpatient Sample (NIS) between the last quarter of 2015 to 2020. In each group, patients were randomly sampled into experimental (2/3) and validation (1/3) groups. The weights of Elixhauser comorbidities were determined from a multivariable logistic regression and single comorbidity indices were developed for EVAR and OAR groups, respectively. ResultsThere were 34,668 patients underwent EVAR (2.19% mortality) and 4792 underwent OSR (10.98% mortality). Both comorbidity indices had moderate discriminative power (EVAR c-statistic, 0.641; 95% confidence interval [CI], 0.616-0.665; OSR c-statistic, 0.600; 95% CI, 0.563-0.630) and good calibration (EVAR Brier score, 0.021; OSR Brier score, 0.096). The indices had significantly better discriminative power (DeLong P <.001) than the Elixhauser Comorbidity Index (ECI) (EVAR c-statistic, 0.572; 95% CI, 0.546-0.597; OSR c-statistic, 0.502; 95% CI, 0.472-0.533). For internal validation, both indices had similar performance compared with individual comorbidity adjustment (EVAR DeLong P = .650; OSR DeLong P = .431). These indices demonstrated good external validation, exhibiting comparable performance to their respective validation groups (EVAR DeLong P = .891; OSR DeLong P = .757). ConclusionsECI, the comorbidity index formulated for the general population, exhibited suboptimal performance in patients who underwent AAA repair. In response, we developed summary comorbidity indices for both EVAR and OSR for AAA repair, which were internally and externally validated. The EVAR and OSR comorbidity indices outperformed the ECI in discriminating in-hospital mortality rates. They can standardize comorbidity measurement for clinical studies in AAA repair, especially for studies with small samples such as single-institute data sources to facilitate replication and comparison of results across studies.