Treatment Of Comorbid Conditions Research Articles

Metabolic syndrome and hyperuricemia: features of patient management (clinical case)

Metabolic syndrome (MS) is a group of interrelated metabolic disorders such as high blood pressure, central obesity, insulin resistance (IR), dyslipidemia. The main mechanisms that indicate a metabolic disorder and contribute to its development are IR and a large amount of circulating free fatty acids. In turn, tissue IR is often combined with other abnormalities including disorders of uric acid metabolism, changes in the hemostasis system, endothelial dysfunction, increased levels of C-reactive protein. At the same time, metabo­lic disorders are a risk factor for hyperuricemia. MS occurs in 25–60 to 90 % of all gout patients. About 50 % of patients with hyperuricemia have symptoms of MS. Hyperuricemia as a component of MS is a predictor of cardiovascular mortality, development of diabetes mellitus, hypertension and nephrolithiasis. Hyperuricemia is closely related to diabetes, obesity, coronary heart disease, hypertension. On the example of a clinical case, the main components of MS are considered, as well as the issue of the relationship between hyperuricemia, gout and the components of MS. The main idea behind the creation of the MS concept is to select a population of patients at a high cardiovascular risk in whom preventive measures such as lifestyle modification and the use of adequate drugs can significantly affect the main health indicators. The goal of managing patients with MS is to minimize cardiovascular risk and mortality as much as possible. Accordingly, the therapeutic strategy should include optimal ways to modify the lifestyle; lowering blood pressure to the target level and treating comorbid conditions; reducing low-density lipoprotein cholesterol according to the risk profile: > 50 %, and < 70 mg/dL (1.4 mmol/L) in patients at a very high cardiovascular risk; > 50 %, and < 100 mg/dL (1.8 mmol/l) in high-risk patients; reducing fasting serum glucose < 126 mg/dl (7 mmol/l) or glycated hemoglobin < 7 % (53 mmol/mol); maintaining uric acid level < 6.5 mg/dL (0.387 mmol/L), in patients with gout — below 6 mg/dL (0.357 mmol/L). Thus, according to the results of the research, a causal relationship was found between insulin resistance and serum uric acid levels in patients with metabolic syndrome. The strategy for managing patients with metabolic syndrome should include screening and correction of hypertension, carbohydrate purine metabolism, dyslipidemia, and prevention of cardiovascular events.

Converged avenues: depression and Alzheimer's disease- shared pathophysiology and novel therapeutics.

Depression, a highly prevalent disorder affecting over 280million people worldwide, is comorbid with many neurological disorders, particularly Alzheimer's disease (AD). Depression and AD share overlapping pathophysiology, and the search for accountable biological substrates made it an essential and intriguing field of research. The paper outlines the neurobiological pathways coinciding with depression and AD, including neurotrophin signalling, the hypothalamic-pituitary-adrenal axis (HPA), cellular apoptosis, neuroinflammation, and other aetiological factors. Understanding overlapping pathways is crucial in identifying common pathophysiological substrates that can be targeted for effective management of disease state. Antidepressants, particularly monoaminergic drugs (first-line therapy), are shown to have modest or no clinical benefits. Regardless of the ineffectiveness of conventional antidepressants, these drugs remain the mainstay for treating depressive symptoms in AD. To overcome the ineffectiveness of traditional pharmacological agents in treating comorbid conditions, a novel therapeutic class has been discussed in the paper. This includes neurotransmitter modulators, glutamatergic system modulators, mitochondrial modulators, antioxidant agents, HPA axis targeted therapy, inflammatory system targeted therapy, neurogenesis targeted therapy, repurposed anti-diabetic agents, and others. The primary clinical challenge is the development of therapeutic agents and the effective diagnosis of the comorbid condition for which no specific diagnosable scale is present. Hence, introducing Artificial Intelligence (AI) into the healthcare system is revolutionary. AI implemented with interdisciplinary strategies (neuroimaging, EEG, molecular biomarkers) bound to have accurate clinical interpretation of symptoms. Moreover, AI has the potential to forecast neurodegenerative and psychiatric illness much in advance before visible/observable clinical symptoms get precipitated.

Patient-reported experiences with refractory or unexplained chronic cough: a qualitative analysis.

Chronic cough, defined as a cough lasting 8 or more weeks, affects up to 10% of adults. Refractory chronic cough (RCC) is a cough that is uncontrolled despite comprehensive investigation and treatment of comorbid conditions while unexplained chronic cough (UCC) is a cough with no identifiable cause despite extensive evaluation of comorbid conditions. RCC and UCC are often poorly controlled. Understanding individuals' lived experience of the symptoms and impacts of these conditions may guide therapeutic strategies. The primary objectives of this study were to assess respondents' perceptions of the key symptoms of RCC and UCC and the impacts of RCC and UCC and their symptoms on well-being, health-related quality of life, work productivity, and social relationships. Qualitative study. This study enrolled 30 adults with physician-diagnosed RCC or UCC. Two trained qualitative researchers conducted individual, in-depth telephone interviews using a semi-structured interview guide. Interviews were audio-recorded, transcribed, coded, and systematically analyzed to identify content themes. A total of 15 respondents with RCC and 15 with UCC were included in the study. Many respondents had RCC or UCC for a long duration (median 9 years, range: 0-24). Half of the respondents reported having a coughing episode at least once daily. Only 40% of respondents reported that medication had improved their symptoms. In over half of the respondents, RCC or UCC hindered communication, caused embarrassment, frustration, and worry, and lowered quality of life. Perceptions of meaningful treatment benefits in RCC or UCC varied widely across respondents. RCC and UCC remained poorly managed in many individuals and were associated with a wide range of symptoms and cough triggers that hindered daily activities and reduced emotional well-being. Understanding individuals' lived experiences may inform the development of RCC and UCC therapeutic strategies.

Common Comorbid Condition of Patients With Autism Spectrum Disorder and Pharmacotherapy for Patients With Autism Spectrum Disorder.

This article describes common comorbid condtion of the autism spectrum disorder (ASD) and recommends treatment guidelines of pharmacotherapy for patients with ASD. More than 95% of people with ASD have at least one additional disorder and guidelines how to evaluate and treat comorbid conditions in patients with ASD and 7 recommendations for treatment with medication for ASD.

Excessive mind wandering, rumination, and mindfulness mediate the relationship between ADHD symptoms and anxiety and depression in adults with ADHD.

Persistent mind-wandering processes are associated with negative emotions; however, mindful states exhibit an anticorrelation with mind-wandering patterns. The aim of this study is to investigate the mediating role of excessive mind wandering (EMW), rumination, and trait mindfulness between attention-deficit hyperactivity disorder (ADHD) symptoms and the severity of anxiety/depression in adults with ADHD. Medication-free 159 adults diagnosed with ADHD completed a test battery that included a sociodemographic form as well as the Adult ADHD Severity Rating Scale, Hospital Anxiety Depression Scale, Mind Excessively Wandering Scale, Ruminative Response Scale, and Freiburg Mindfulness Inventory after the diagnostic examination according to the Structured Clinical Interview for DSM-5-Clinician Version (SCID-5). ADHD symptoms exhibited an indirect, but not a direct, association with the severity of anxiety and depression, mediated by increased excessive mind wandering and rumination, as well as decreased trait mindfulness. This study was carried out within a clinical population using a cross-sectional design. While diagnostic assessments were conducted using SCID-5, psychiatric symptoms were evaluated through self-report measures. Coping with EMW and rumination and promoting mindfulness ability may be promising targets in treating comorbid conditions in adults with ADHD. These findings have highlighted the effects of mentation processes on depression and anxiety, which are common comorbidities with ADHD in adults; however, longitudinal studies are needed.

Health Related Quality of Life and Associated Factors Among Adult Patients with Rheumatic Heart Disease Patients in Ethiopia.

Quality of life (QOL) is defined as "individuals" perceptions of their position in life. Rheumatic heart disease (RHD) is a consequence of severe, single, or recurrent bouts of acute rheumatic fever. To improve overall patient outcomes, there is currently a greater emphasis on assessing the QOL of these patients. The purpose of this study is to assess the QOL of adult RHD patients who had followed up at St Peter and Tikur Anbessa Hospital, Ethiopia. An institutional-based cross-sectional study done at St Peter and Tikur Anbessa Hospital, Ethiopia from March 1-June 30/2021 in adult RHD patients. The sample size was 297. Socio-demographic and clinical data were collected using a structured questionnaire. The Amharic version of Short form-36 (SF-36) was used to assess the QOL. A logistic regression model was used to identify associated factors. The study included 297 patients. The majority are female (71%), and half of them are aged between 18-30 years of age. Of the patiends, 81.1% had no comorbidity, and 15.8% had interventions. RHD affects all domains and summary scores of short form 36 QOL parameters compared to normative values. Age, marital status, place of residence, presence of comorbidity, number of medications, and whether an intervention was done are associated with the QOL of these patients. RHD patients had poor QOL assessed by SF-36. It affects all domains and summary score of short form 36 QOL parameters. Old age, divorce, living in rural areas, associated comorbid conditions, and no intervention done are associated with poor QOL. Identification and treating comorbid conditions and intervention may improve QOL.

The Burden of Comorbidities in Obstructive Sleep Apnea and the Pathophysiologic Mechanisms and Effects of CPAP

Micro-arousals and the repeated desaturation of oxyhemoglobin, which are typical in obstructive sleep apnea syndrome (OSAS), have adverse effects on the health of patients, leading to a wide range of complications such as cardiovascular (arterial hypertension, pulmonary hypertension, chronic heart failure, arrhythmias, myocardial infarction), cerebrovascular (strokes), metabolic (insulin resistance, obesity, diabetes mellitus, metabolic syndrome), gastrointestinal (non-alcoholic liver disease), urinary (chronic renal failure), and neuropsychiatric complications as well as a wide range of malignancies. These, in turn, have multilateral effects on familial, occupational, and social life, as well as increasing the risks of road traffic accidents and accidents at the workplace. Awareness, timely screening, and the prevention of complications play important roles in diagnosing and treating comorbid conditions. This review focuses on comorbidities in OSAS and the effect of Continuous Positive Airway Pressure (CPAP) therapy on their prognoses.

A case series of congenital nevus and their various manifestations

A nevus is characterized by collection of partially differentiated or well-differentiated cells normally found in the skin. Some nevi are associated with disorders such as autism, epilepsy, ophthalmogical disorders, intracranial abnormalities, and others. In this case series, we aim to analyze six cases with congenital nevus, matched our findings with case reports published and reviewed the literature, to come to a conclusion that would help the clinician to do focused clinical examination and investigations when they come across such nevi. Furthermore, as these sort of skin lesions cause psychological morbidity to both parents and patients, proper counseling is required along with dermatological therapy and treatment of comorbid conditions. As well as regular follow-up with monitoring of the lesions. The following are the cases: Case-1, is a case of congenital melanocytic nevi who presented with delayed milestone, epilepsy and neuroimaging revealed intracranial melanosis. Case-2 nevus of Ota on face with scleral nevus and glaucoma in the left eye. In Case-3: Nevus achromicus was present over the abdomen and scalp in a child who presented with status epilepticus and there was focal cortical dysplasia of left frontal cortex on imaging. Nevus sebaceous was present in case-4 who had seizure disorder but neuroimaging was normal. Case-5 child had nevus spilus over left frontal area with melanocytic satellite nevi who presented with febrile convulsion but normal neuroimaging. The sixth case is a 5-year-old male child with linear nevus without any other association.

Stage-by-stage correction of aortic coarctation in low-weight newborns (first experience)

Aortic coarctation in low-weight (less than 2.2 kg) and premature newborns with comorbid conditions is still a current problem of neonatology and cardiac surgery. The closure of the patent ductus arteriosus and the inability to maintain its functioning with prostaglandin medication leads to fatal complications due to a violation of systemic perfusion. Surgical intervention in this group of patients has extremely high risks and unsatisfactory results. In such situations, stage-by-stage correction is a promising direction. Stenting of aortic coarctation allows restoring hemodynamics at the level of the aortic isthmus with minimal risks. In the inter-stage period, it becomes possible to treat comorbid conditions and prepare a patient for radical correction.

Traumatic brain injury and relationship distress during military deployment and reunion

AbstractObjectiveThis study seeks to advance the literature by disentangling the effects of deployment‐acquired traumatic brain injury (TBI) from comorbid postconcussive symptoms and PTSD symptoms on relationship distress.BackgroundBecause TBI poses challenges to military marriages, understanding the predictors of relationship distress after TBI is important for helping service members cope with the effects of the injury.MethodSurvey data from the U.S. Army STARRS Pre–Post Deployment Study, collected from 2,585 married service members before and after a combat deployment to Afghanistan, evaluated predictors of relationship distress 9 months after homecoming.ResultsDeployment‐acquired TBI corresponded with more relationship distress controlling for predeployment brain health, but its predictive power was eclipsed by concurrent postconcussive symptoms and concurrent PTSD symptoms. Concurrent PTSD symptoms accounted for twice as much variance in relationship distress than concurrent postconcussive symptoms.ConclusionTargeting and treating comorbid conditions may be essential for supporting military marriages after TBI.Implications: Military command, policymakers, and medical professionals may find value in broadening support services for TBI to include resources addressing postconcussive symptoms, PTSD symptoms, and relationship distress.

Insomnia in primary care: Considerations for screening, assessment, and management.

Insomnia, including insomnia disorder, is a common but often overlooked complaint in primary care settings. It is a risk factor for various medical and psychiatric diagnoses and is associated with substantial health care costs. While cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment for insomnia disorder, access to CBT-I is limited. This article provides a pragmatic approach to screening, assessment, and treatment of insomnia in the primary care setting, promoting a population health approach. The authors review the role of CBT-I, treatment of comorbid conditions, and pharmacologic recommendations in working with primary care patients with insomnia. In addition, the authors highlight the potential utility of technology in improving access to insomnia care.

Amide Codrug Approach: Synthesis and Biopharmaceutical Evaluation of Nonsteroidal Anti-Inflammatory Drug and Calcium Channel Blocker Conjugates

Background and Aim Geriatric patients often suffer from osteoarthritis and hypertension comorbidity. The codrugs approach was shown to be an effective strategy for targeting diseases synergistically hence improving the quality of life of patients. The present study aimed to synthesize various Nonsteroidal Anti-inflammatory Drugs NSAIDs and Calcium channel blocker CCB Co-drugs and biopharmaceutical study to eliminate the adverse gastrointestinal effects of the NSAIDs to treat comorbid conditions in geriatric patients with significant reduction of polypharmacy.Methods Various conjugates were synthesized by a one-pot amidation reaction of Amlodipine with various NSAIDs. Further characterization by melting point TLC Fourier transform infrared nuclear magnetic resonance and mass spectroscopy followed by solubility partition coefficient and hydrolysis study in SGF and SIF.Results The synthesized codrugs satisfied the structural criteria of the proposed plan. From the biopharmaceutical and hydrolysis study it was observed that the co-drugs underwent significant hydrolysis in SIF pH 7.4 and have showed delayed onset of action with respect to the standard drugs. The delayed onset may be due to the hydrolysis of amide linkage followed by the release of the prodrug which finally releases the active drug.Conclusion The findings illuminated the codrugs pros and cons aiding optimization and development. This research advances amide-based mutual prodrugs and their use in pharmaceutical research. The outcome of this exploration confirmed that the described co-drug can offer desirable safety and therapeutic benefits. Hence these conjugates could be considered for further development.

A nationwide study of multimedicine use in people treated with cardiovascular medicines in Australia.

Multimorbidity and multimedicine use are common in people with cardiovascular disease and can lead to harms, such as prescribing errors and drug interactions. We quantified multimedicine use in people treated with cardiovascular medicines in a national sample of Australians. Cross-sectional study. Pharmaceutical dispensing claims for a 10% random sample of Australians. Australian adults dispensed any cardiovascular medicine between June and August 2019. None. We quantified the number and type of cardiovascular and non-cardiovascular medicines dispensed during the study period, and the number of unique prescribers, by age and sex. We identified 493,081 people dispensed any cardiovascular medicine (median age=67 years, 50.2% women). The population prevalence of cardiovascular medicine dispensing increased from 1.7% (n= 10,503) in people 18-34 years to 80.1% (n= 99,271) in people 75-84 years. Cardiovascular medicine dispensing varied by sex; women 18-34 years were more likely to be dispensed any cardiovascular medicine than men (male:female prevalence ratio [PR]=0.84, 95% confidence interval [CI]=0.81-0.87), whereas the prevalence of cardiovascular medicine dispensing was higher in men 35-44 years (PR=1.27, 95% CI 1.24-1.30) and 45-54 years (PR=1.24, 95% CI 1.22-1.26) and was similar between sexes in people ≥65 years. Overall, both women and men were dispensed a median of 2.0 (interquartile range [IQR]=1.0-3.0) cardiovascular medicines. Two-thirds of people ≥65 years (73.5%; n= 208,524) were dispensed ≥2 cardiovascular medicines, with 16.6% (n= 6736) of people ≥85 years dispensed five or more. Women and men were dispensed a median of 2.0 (IQR=1.0-5.0) and 2.0 (IQR=0.0-4.0) non-cardiovascular medicines, respectively, to treat comorbid conditions, commonly gastroesophageal reflux disease medicines (32.2% of women and 26.6% of men), antibiotics (28.7% of women and 22.4% of men), and antidepressants (26.3% of women and 15.9% of men). One quarter of both sexes had multiple prescribers for their cardiovascular medicines alone, whereas 54.5% (n= 134,939) of women and 49.9% (n= 122,706) of men had multiple prescribers for all medicines. Multimedicine use is common in people treated with cardiovascular medicines and presents a risk for inappropriate prescribing. Understanding the comorbid conditions commonly treated concurrently with cardiovascular disease can help improve co-prescribing guidelines and develop a person-centered approach to multimorbidity treatment.

Honey as Miracle Therapy for Covid-19: Literature Study

Due to their capacity to reduce acute inflammation by increasing the immune response, honey and its constituents are gaining attention as an efficient natural therapeutic. Studies have suggested that it may be able to treat a variety of chronic illnesses and conditions, including as bacterial and fungal infections, cardiac issues, diabetes, hypertension, and abnormalities of the lungs and heart. More significantly, honey has proven to have virucidal effects on a number of enveloped viruses, including the varicella-zoster virus, herpes simplex, influenza virus, and HIV. Honey may help patients with COVID-19, a disorder brought on by the SARS-CoV-2 enveloped virus, by boosting the host's immune system, treating comorbid conditions, and engaging in antiviral activities. Additionally, patients with COVID-19 are presently participating in a clinical trial of honey. We've attempted to condense the possible advantages of honey and its components in this review in terms of antibacterial properties, some chronic illnesses, and the host's immune system. Therefore, we have made an effort to develop a relationship with honey in order to treat COVID-19. In light of the COVID-19 epidemic, this review will be useful in reevaluating our understanding of the potential therapeutic benefits of honey. However, more in vitro and in vivo research is required to determine the effects of honey on SARS-CoV-2 replication and/or the host's immune system.

Examining Barriers to Medication Adherence and Retention in Care among Women Living with HIV in the Face of Homelessness and Unstable Housing.

Despite advances in biomedical treatments, women living with HIV (WLH) who experience homelessness and housing instability suffer suboptimal HIV outcomes, even when linked to treatment. The purpose of this study was to explore experiences of housing instability among WLH and to understand its role in their ability to adhere to antiretroviral medication and remain retained in care. Sixteen women who were linked to Ryan White Program HIV care in South Florida participated in in-depth interviews. The findings focus around four larger themes: difficulty storing medication, privacy- and stigma-related issues, inconsistent access to medication and health care disruptions, and competing and unmet physical and mental health needs. Findings underscore the importance of strategies that are responsive to the disruption of routines and are sensitive to privacy issues in shared dwelling spaces; the proactive inquiry of behavioral and environmental considerations when prescribing antiretroviral medication; and the identification and treatment of comorbid conditions. This study provides evidence for strategies to facilitate self-management and improve modifiable system realities to augment larger-level policy and funding shifts that are critically needed to end the epidemic among vulnerable populations living with HIV.

NREM Parasomnias: Retrospective Analysis of Treatment Approaches and Comorbidities.

Brief SummaryNon-rapid eye movement (NREM) parasomnias are relatively common among children and can often persist into adulthood, where they can pose as a clinical challenge:, the behaviors can result in injury or have negative impacts on functioning and quality of life, thus necessitating treatment, but the choice of treatment is complicated by the lack of evidence—based guidelines, as well as potential side effects. The aim of this retrospective analysis is to examine the most frequently used treatment strategies and pharmaceuticals for NREM parasomnias and evaluate perceived outcomes based on the patient’s subjective reports of the frequency and severity of symptoms.The aim of this retrospective analysis is to determine the most frequently prescribed medications for the treatment of NREM parasomnias and evaluate reported outcomes. We performed a retrospective chart review of all patients with NREM parasomnia diagnosed within Brigham and Women’s Hospital (BWH) clinics examining the date of diagnosis, date of starting therapy, comorbidities, type of medication prescribed, and the reported change in symptoms or side effects at follow-up visits. From 2012 to 2019, 110 patients (59 females, 51 male) at BWH clinics received a diagnosis of NREM parasomnia, including sleepwalking and night terrors. The mean age was 44. Comorbidities included obstructive sleep apnea (OSA) (46%), periodic limb movement syndrome (PLMS) (13%), insomnia (19%), Restless leg syndrome (RLS) (9%), epilepsy (4%), and REM behavior disorder (RBD) (9%). Initial treatment strategies include behavioral and safety counseling only (34%), pharmacological treatment (29%), treatment of any comorbidity (28%), and combined treatment of any of the above (9%). Improvement was reported with: treatment of OSA (n = 23 52% reported improvement), melatonin (n = 8, improvement reported by 88%.,benzodiazepine (n = 7, improvement reported by 57%). Treating comorbid conditions is a frequent treatment strategy, often associated with symptom improvement. The pharmacologic treatment most commonly included melatonin and benzodiazepines. Comprehensive management should include behavioral and safety recommendations, assessment of comorbid conditions, and individually tailored pharmaceutical treatment.

Improving the cancer survivorship journey: Developing a survivorship care transition model for rural and underserved low risk breast and gynecologic cancer patients (511)

<b>Objectives:</b> The rapid growth of cancer survivors in the United States, in combination with oncology service workforce shortage, creates an urgent need to develop effective survivorship care models. While survivorship programs are required by the Commission on Cancer and endorsed by national cancer organizations, the evidence base supporting specific components and delivery models is still lacking, and novel approaches are especially needed in rural care settings with high concentrations of underrepresented minority populations. Our team is working to create effective and innovative cancer survivorship care models for low-risk breast and gynecologic cancer patients. <b>Methods:</b> We conducted exploratory research among low-risk breast and gynecologic cancer survivors and primary care providers to inform a subsequent intervention of navigated care transitions. We convened a Patient Advisory Board (PAB) to review a structured menu of cancer survivorship issues, including access to primary care services, compliance with screening recommendations, treatment of comorbid conditions and identified the range of desired survivorship resources. We conducted five virtual PAB meetings via ZOOM, and participants completed four surveys. In parallel, we conducted semi-structured qualitative interviews with seven primary care providers (Family Physicians and OB/GYNs) to understand preferences of cancer survivor care transition timing and informational needs. Both PAB and Provider sessions/interviews were transcribed and coded for content and thematic analysis. <b>Results:</b> Participants in the PAB provided insight into survivorship experiences and processes to facilitate earlier care transitions. They emphasized the need to begin survivorship planning at an earlier stage of care and advocated for the creation of tailored documents relevant to the care needs of particular stages (e.g., diagnosis, definitive treatment, care transitions). Lastly, they identified other overlooked care needs, including adverse effects on sexual health. Primary care provider data aligned with PAB findings, including the need to initiate enhanced communication with the oncologists immediately following diagnosis. Additionally, providers expressed confidence in managing survivorship care based on responses to structured vignettes of breast and gynecological cancer patients. <b>Conclusions:</b> This formative research identified key factors with regard to the development of processes and informational resources necessary to support cancer survivorship care transitions among underserved and rural breast and gynecologic cancer patients. In alignment with findings from primary care providers, this model would focus on initiating survivorship support at an early stage of care, include a broad "menu" of potential patient care needs, and ensure provider training and awareness related to surveillance and referral pathways. Further research to test the feasibility of this model is underway.

Arterial stiffness, vascular calcification and osteoporosis — common mechanisms of interaction (literature review)

Introduction. The problem of cardiovascular morbidity and mortality remains an urgent issue of modern medicine, and arterial stiffness is its independent predictor. Lively discussions about the correct approach to the prevention and treatment of comorbid conditions – increased vascular stiffness as an influential factor of the cardiovascular events and decreased bone mineral density (osteoporosis), primarily arise against the background of the need and safety of calcium and vitamin D supplements. The purpose was to search for literature data as for possible common pathogenetic links in the progression of arterial stiffness and the development of osteoporosis in order to assess the safety of the use of drugs to prevent osteoporotic fractures. Results. Analysis of literature sourses had showed that possible osteogenic factors affecting arterial stiffness may be: secondary hyperparathyroidism, disbalance of the RANK/RANKL/OPG system, inhibition of vitamin K-dependent matrix proteins (Gla-protein), osteopontin, etc. Conclusions. Today, there are many hypotheses confirming the possible influence of osteogenic factors on vascular stiffness and arterial calcification. Therefore, the search for sensitive markers and the development of screening protocols for the patients with risk factors for both osteoporosis and vascular changes are extremely relevant. A special issue is the possibility of using monotherapy for these comorbid pathologies, which can safely and efficiently influence the prevention of complications – both low-energy osteoporotic fractures and cardiovascular catastrophes. This will be the focus of our further research.

How Are We Prescribing? a Re-Audit of Prescribing Practices for People With Personality Disorder Presented at the Local Personality Disorder Forums

AimsNICE recommends that drug treatments shouldn't be used specifically for the treatment of individual symptoms or behaviours associated with Borderline Personality Disorder but may be considered for the overall treatment of comorbid conditions. National audits have been completed by Prescribing Observatory for Mental Health UK (POMH-UK) in 2012 and 2014, with a local Trust audit in 2017. Subsequently, ‘Guidance for Prescribing in Personality Disorder’ was published and circulated across the Trust in Dec 2020.This audit aims to establish whether there has been a change in the prescribing trends in the Trust since the last audit in 2017.MethodsElectronic records of patients identified and presented at Personality Disorder forums throughout the Trust between June-December 2021 were reviewed.Two audit standards and four treatment targets derived from the POMH-UK audit were used.Results24 electronic patient records were reviewed.79% patients had a documented crisis plan, fewer than the 87% in 2017.The proportion on antipsychotics with documented clinical reasons for prescribing was 69%, compared to 43% in 2017.For those on antipsychotics in the absence of a comorbid psychotic illness, 91% were on them for &gt;4 weeks, compared to 86% in 2017.Z-hypnotics were prescribed for &gt;4weeks in 37.5%, significantly more than the 13% in 2017. Benzodiazepines were prescribed for &gt;4 weeks in 38% of patients, with 28% recorded in 2017.100% of patients eligible for medication reviews had had them, an improvement from 90%in 2017.ConclusionCompared to the previous audit, fewer patients had crisis plan documentation, but more patients had a clinical indication for antipsychotics recorded.Rates of prescribing Z-hypnotics, benzodiazepines and antipsychotics for &gt;4 weeks seems to have risen, demonstrating a lower compliance with the treatment targets.The proportion of patients having medication reviews has improved, however, the quality of these reviews remains similar to the 2017 audit.The findings will be presented within the Trust with the re-emphasis on guidelines.Prescribing in people with personality disorders can be revisited in 2 years.

Modern approaches to solving the problem of comorbidity

The article presents a model of comorbidity, which is designed to identify the general patterns of the formation of combined pathology, the features of the methodology of its detection and the general principles of therapy. In order to unify approaches to the diagnosis and treatment of comorbid conditions, the outcome of which is the formation of tissue and organ sclerosis, the concept of chronic sclerotic disease (CSD) is proposed. The proposed methodology and techniques, as well as the data obtained with their help, determine the ability to identify risk groups, plan the direction and scope of the examination, draw up a plan for the necessary point therapeutic effects in patients with CSD, which, in turn, can lead to increased effectiveness of preventive and therapeutic measures in comorbidity.