Search

The inhalation of pharmaceutic has been proven efficient and non-invasive compared to administrations via injection for various respiratory diseases. The manufacturing of microscale drug carriers with an ideal median mass aerodynamic diameter (MMAD) of 1–5 µm and sustained release profile has been challenging for decades. Current electrospray strategies adopted for drug carrier fabrication lacks control on particle morphology and size distribution. In this paper, we adopted a core–shell electrospray strategy with water-soluble cores for nanodrug encapsulation and sustained drug release from the surface nanoporous microcarriers. The results showed that both experimental parameters including voltage, tip-to-ground distance, flow rate and material properties including solution viscosity and surface tension have significant effects on microparticle morphology and size. This study presents an optimized experimental design and solution composition towards the manufacturing of desirable and controllable drug carriers. [ABSTRACT FROM AUTHOR]

Human Metapneumovirus (HMPV) is a re-emerging respiratory pathogen causing significant morbidity and mortality, particularly among young children, the elderly, and immunocompromised individuals. First identified in 2001, HMPV has since been recognised as a leading cause of acute respiratory tract infections (ARTIs) worldwide. Its transmission occurs through droplets, direct contact, and surface contamination, with crowded spaces and healthcare facilities serving as key environmental amplifiers. HMPV's clinical manifestations, ranging from mild cold-like symptoms to severe pneumonia, often overlap with those of other respiratory pathogens like RSV and COVID-19, complicating timely diagnosis and management. Despite advancements in molecular diagnostics, the limited accessibility of these tools in low-resource settings presents a challenge. Preventive measures, such as hygiene practices and physical distancing, remain critical, as no approved vaccines or targeted antiviral therapies are currently available. However, promising innovations, including AI-guided vaccine design and portable diagnostic tools, highlight the potential for future breakthroughs. This article highlights the urgent need for enhanced surveillance, scalable diagnostics, and intensified research into vaccines and therapeutic strategies. By addressing these gaps, HMPV's global burden can be significantly mitigated, improving outcomes for high-risk populations, and strengthening preparedness against respiratory virus outbreaks. [ABSTRACT FROM AUTHOR]

Osteogenesis imperfecta (OI) is a rare hereditary disease mainly resulting in reduced or altered collagen type I. Collagen type I is a major constituent of the respiratory system, and normal collagen type I is vital for pulmonary tissue function. Do patients with OI have increased admission rates resulting from pulmonary diseases compared with the general population? This was a register-based nationwide cohort study including all patients with OI in Denmark and a reference population. From January 1, 1995, through December 31, 2018, we evaluated the rates of admissions resulting from asthma, COPD, and pneumonia as well as the use of bronchodilator drugs and antibiotics comparing individuals with OI with the reference population. We included 862 individuals with OI and 4,283 people from the reference population covering 15,952 and 79,471 person-years of observation, respectively, in the two cohorts. The admissions rate (incidence rate [IR]) was highest in female patients with OI aged 65 years or older, with 56.3 admissions per 1,000 person-years and 29.4 admissions per 1,000 person-years in the reference population (amounting to an admissions incident rate ratio [IRR] of 1.91 [95% CI, 1.38-2.70]). The highest admission rate in male patients with OI was found among participants aged 0 to 18 years, with an IR of 30.4 per 1,000 person-years compared with an IR of 7.7 per 1,000 person-years in the reference population (IRR, 4.92 [95% CI, 3.79-6.38]). We found a higher proportion of long-acting and short-acting bronchodilator drug users in the OI cohort, but no increased use of antibiotics. Overall, the admission rates for respiratory diseases were low in the OI cohort, but a higher relative risk of hospitalizations resulting from respiratory disease compared with the general population. Timely diagnosis and treatment of respiratory complications in individuals with OI is warranted. [ABSTRACT FROM AUTHOR]

Mycoplasmas can cause severe chronic nasal sinusitis in tortoises and box turtles, both in captive and wild populations. The aim of this study was to compare positive and negative Mycoplasma sp. test results before and after a nasal flush protocol combined with systemic enrofloxacin and to compare positive and negative results between DNA sequencing and PCR in tortoises with nasal discharge. Fifteen mycoplasma-positive tortoises were included in the study. All were treated with the nasal flush protocol. At the end of the nasal flush protocol, 26.7% of the treated tortoises remained mycoplasma positive. One month after the end of the nasal flush protocol, 20% remained positive. The PCR and DNA sequencing tests had good agreement based on a weighted kappa of 0.64. Based on these results, we conclude that the outlined nasal flush protocol is overall successful at acutely resolving nasal discharge and leading to a PCR- or DNA sequencing–negative tortoise 1 month after treatment. [ABSTRACT FROM AUTHOR]

The article focuses on understanding and managing impaired gas exchange in critically ill patients. Topics include the underlying causes such as ventilation-perfusion mismatch and diffusion limitations, diagnostic approaches to assess the severity of gas exchange impairment, and treatment strategies like oxygen therapy, mechanical ventilation, and addressing the root causes of respiratory dysfunction.

The outbreak of respiratory diseases, such as COVID-19 and influenza, has drawn global attention. However, it remains unclear whether the risk of influenza A infection may be affected by the history of SARS-CoV-2 infection. In this study, we conducted a test-negative case-control study, and utilized a logistic regression model to analyze the relationship between SARS-CoV-2 and influenza A infections. Among 258 eligible patient samples with influenza-like illness (ILI), we did not detect a statistically significant association between the history of SARS-CoV-2 infection and the risk of influenza A infection. These findings might indicate that antibodies against COVID-19 acquired through vaccination or natural immunity have not protected against influenza. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to report otologic manifestations in a cohort of patients with aspirin exacerbated respiratory disease (AERD) to determine if severity of sinonasal inflammation is associated with presence of otologic sequalae (OS). Methods: All AERD patients treated at a tertiary care center between 2009 and 2016 were included in analysis. Demographics, history of hearing loss, Lund-Mackay (LMK) scores, number of previous sinus procedures, CT findings, and pure tone averages (PTA) were compared between patients with and without OS using chi-square test, Fisher's exact test, and Wilcoxon rank sum test. Results: Of 255 AERD patients, 58.4% were female with a mean age of 48.9 (SD: 13.4) years. The majority (52.2%) had otologic manifestations, most commonly: otitis media requiring antibiotics (n = 89, 34.9%), peripheral vertigo (n = 59, 23.1%), and middle ear effusion (n = 44, 17.3%). A total of 74 patients (29.0%) had hearing loss. PTA ranged from 13.3 to 61.7 dB for the cohort, with no significant difference between those with and without OS. There was no significant difference in LMK in both groups. Patients with OS had a significantly greater number of sinus procedures than those without OS (median = 2.4 and 1.8 respectively; P =.01). Conclusions: Otologic manifestations are common in patients with AERD. While there was an increased number of sinonasal surgeries performed in the patients with OS, there was no correlation between sinonasal inflammation, and the presence of OS as measured by LMK score or PTA. Otologic signs and symptoms should be considered in patients with AERD to help mitigate patient morbidity. Level of Evidence: III. [ABSTRACT FROM AUTHOR]

Introduction: Pasteurella multocida is a key bacterial agent involved in most respiratory disorders in rabbits. The objective of this study was to evaluate the risk of selecting Pasteurella multocida strains resistant to enrofloxacin (ENRO) in food producing rabbits treated with ENRO via drinking water, according to the standard husbandry practices. Indeed, despite the EU community guidelines recommend a prudent use of antibiotics and promote new strategies to prevent bacterial diseases, antimicrobial therapy remains the primary approach for pasteurellosis management in rabbits. Therefore, the potential risk of selecting resistant bacteria in food-producing animals requires identifying optimized dosage regimens to minimize resistance emergence and to extend the useful lifetime of the drug. Methods: In this study, we isolated Pasteurella multocida strains from bacterial colonies sampled in nasal swabs collected from 6 healthy rabbits and 12 rabbits suffering respiratory disorders. Animals were sourced from industrial farms and were randomly selected to investigate the inter-individual variability in antimicrobial exposure associated with treatment via drinking water. Sick rabbits underwent an approved ENRO treatment (10 mg/kg for 5 days) administered via drinking water, following standard husbandry practices. We investigated the minimum inhibitory concentration (MIC), the minimum bactericidal concentration (MBC), and the mutant prevention concentration (MPC) of ENRO against bacterial strains in healthy rabbits and in sick rabbits before and after treatment. We recorded plasma drug concentrations of treated animals, and we applied the mutant selection window (MSW) approach to each subject. Finally, we calculated the PK/PD indices for concentration-dependent antimicrobials to assess ENRO's clinical efficacy and it's potential for promoting resistance using published pharmacokinetic (PK) parameters and maximum drug plasma concentrations recorded in this study. Results: Here we showed that treatment with ENRO improved clinical signs in rabbits with pasteurellosis but failed to completely eradicate the pathogen, consistent with previous studies. MPC-based analysis showed acquired resistance and potential ENRO-induced shift to a lesser sensitivity in the P. multocida population. Moreover, MSW analysis revealed that 45% of treated rabbits exhibited potential for drug resistance selection. Conclusion: These findings suggest that the current ENRO dosing regimen for pasteurellosis in rabbits is inadequate and may contribute to resistance development. [ABSTRACT FROM AUTHOR]

Background: Because of their high prevalence, chronic respiratory diseases, like asthma and chronic obstructive pulmonary disease, represent main public health problems. They are mainly treated through inhaled therapy. There is low adherence to such therapy, resulting in poor control of chronic respiratory diseases. However, more research is needed on the association of several factors with low adherence. The purpose of this study was to estimate the association of age, sex, type of drug, and frequency of administration with low adherence to inhaled therapy. In order to do this, we performed a cross-sectional study. Methods: We selected all patients treated with long-acting anticholinergics (LAMA), long-acting β2-adrenergics (LABA), LAMA/LABA, or inhaled corticosteroid (ICS)/LABA in the Health Area of Lleida on 16 March 2017. For each treatment, we determined the percentage of patients showing low adherence to therapy (less than 50%), calculated as drug boxes collected from the pharmacy with respect to the prescribed ones. Then, we analysed the association of age, sex, type of drug, and frequency of administration, with low adherence to therapy through a multivariate linear model. Results: 11,128 people had electronic prescriptions for one of the inhaled therapy; of them, 24.6% (2,741) showed low adherence. The highest percentage of people with low adherence was found among young patients and women. Women 25–34 years of age included the highest percentage of patients with low adherence. As for drugs, the highest percentage of patients with low adherence was found among the ones treated with LABA and ICS/LABA. Finally, a higher percentage of patients with an administration frequency of 12 h presented low adherence, in comparison with patients treated every 24 h, in general and in the LABA and ICS/LABA groups. Conclusions: The differences that we observed in adherence to inhaled therapy according to the different factors analysed should be considered when managing chronic respiratory diseases and their impact on patients' clinical burden, quality of life, and costs for the health system. [ABSTRACT FROM AUTHOR]

As an important biomarker, serum cystatin C (Cys C) has important clinical value in the early diagnosis and long-term prognosis of cardiovascular and cerebrovascular diseases, such as acute myocardial infarction, heart failure, atherosclerosis, acute cerebral infarction, and Parkinson’s disease. This article analyzed and summarized the characteristics of serum Cys C and reviewed the application of serum Cys C in respiratory diseases based on common respiratory diseases such as chronic obstructive pulmonary disease, lung malignant tumors and novel coronavirus pneumonia. [ABSTRACT FROM AUTHOR]

Objective: To estimate the prevalence of Chronic Obstructive Pulmonary Disease (COPD) among non-smoking Sri Lanka adults as part of a larger study which assessed the burden of obstructive lung disease (BOLD) in Sri Lanka. Results: The prevalence of COPD among non-smokers was 5.3%, with mild to moderate disease. Among spirometry-diagnosed COPD patients, a higher proportion was females and above age 40. Use of biomass (Odds Ratio (OR) = 1.339, 95% Confidence Interval (CI) 1.070–1.821), exposure to passive smoking (OR = 2.376, 95% CI 1.557–3.397) and female sex (OR = 1.353, 95% CI 0.992–1.648) significantly increased the odds of developing COPD and/or related symptoms. Having a chimney, reduced the risk of COPD and/or related symptoms by 29% when cooking with biomass/kerosene. [ABSTRACT FROM AUTHOR]

The composition of the gut microbiota in patients with bronchiectasis has been proven to be distinct from that of healthy individuals, and this disrupted gut microbiota can exacerbate lung infections. However, the responsible microbes and mechanisms in the "gut-lung" axis in bronchiectasis remain unknown. Here, we report that Eggerthella lenta was enriched in the gut, and taurine ursodeoxycholic acid (TUDCA) was enriched in both the guts and sera of patients with bronchiectasis, with both being associated with disease severity. Fecal microbiota transfer from patients with bronchiectasis as well as administration of E. lenta independently exacerbated pulmonary Pseudomonas aeruginosa infections in murine models. E. lenta–associated TUDCA bound adenosine monophosphate–activated protein kinase (AMPK) within neutrophils and interfered with the interaction between liver kinase B1 and AMPK, with a consequential decrease in AMPK phosphorylation. This ultimately reduced ATP production in neutrophils, inhibited their function, and compromised P. aeruginosa elimination from the lung, aggravating tissue injury. Metformin treatment improved disease severity and outcome in the mouse models. In sum, the gut bacterium E. lenta raises the stakes of bacterial lung infection because it causes dysfunction of neutrophils circulated from serum to lung via the metabolite TUDCA. Interventions targeting E. lenta or AMPK phosphorylation may serve as adjunctive strategies to complement existing approaches for managing chronic pulmonary infection in bronchiectasis and other chronic respiratory disease states. Editor's summary: In bronchiectasis, chronic lung infection leads to permanent widening and thickening of the airways. Wang et al. show that gut microbe Eggerthella lenta can contribute to chronic airway infection and its severity. Fecal microbiota transfer from patients with bronchiectasis and direct transfer of the bacterium into mice both exacerbated lung pathology. More specifically, the E. lenta–derived metabolite TUDCA worsened neutrophil function by binding adenosine monophosphate–activated protein kinase, reducing adenosine triphosphate production and leading to diminished activity against P. aeruginosa lung infection in mice. Treatment with metformin improved disease severity and prognosis in the models, suggesting a potential therapeutic strategy in this setting. —Catherine Charneski [ABSTRACT FROM AUTHOR]

AbstractThis study assessed the impact of silica exposure on 145 mine workers in Mianwali, Punjab, Pakistan, compared to 45 non-exposed individuals. Pulmonary function tests revealed significantly reduced lung function in exposed workers (P < 0.05), with declines in Forced Expiratory Volume in one second (FEV1), Forced Vital Capacity (FVC), FEV1/FVC ratio, Peak Expiratory Flow, and Forced Expiratory Flow at 25–75% of FVC (FEF25–75). Radiological evaluations confirmed extensive lung damage (P < 0.05), including pleural effusion, reticular shadowing, and lung consolidation. Oxidative stress markers demonstrated increased lipid peroxidation, Fenton’s Oxidative Stress, and Oxidative Stress Index (P < 0.05), along with reduced antioxidant enzyme activities, including Catalase, Superoxide Dismutase, Total Antioxidant Capacity, and Glutathione Peroxidase. Hematological analysis showed elevated White Blood Cells, Lymphocyte percentage, Hemoglobin, Hematocrit, Mean Corpuscular Volume, and Mean Corpuscular Hemoglobin (P < 0.05), reflecting systemic inflammation. Silica’s piezoelectric properties contributed to oxidative stress and cellular damage, exacerbating pulmonary dysfunction. These findings highlight silica exposure as a severe occupational hazard, causing irreversible lung impairment and systemic oxidative imbalance. Implementing strict safety protocols, personal protective measures, and regular health monitoring is crucial to safeguarding workers. [ABSTRACT FROM AUTHOR]

The study of key Pseudomonas aeruginosa (PA) virulence factors, the molecular basis of pathogenicity, as well as their correlation with the immune response during exacerbations in patients with non-cystic fibrosis bronchiectasis can help to identify novel targets and biomarkers for clinical management. The objective was to compare P. aeruginosa virulence and the patient's immune response during stable phases and exacerbations of bronchiectasis. We used polymerase chain reaction (PCR) and real-time quantitative PCR (qRT-PCR) to perform molecular characterization of the genomic islands and virulence genes present in 42 P. aeruginosa strains obtained from the sputum of patients with bronchiectasis during stability and exacerbations. Immunoglobulin (Ig) and interleukin (IL) levels in 32 serum samples were analyze by ELISA and Luminex assay. A greater presence of the conjugative element pKLC102, specific virulence genes (exoS, exoY) and pyoverdine production characterize the P. aeruginosa strains obtained during exacerbations. The expression levels of type III secretion system (exoS, exoY) showed an important role in the humoral immune response during exacerbations. Exacerbations were associated with high levels of IL-6. The presence of specific genomic islands, virulence genes, and increased IL-6 levels provide an accurate characterization on bronchiectasis exacerbations. These targets could be useful in the prevention, management and treatment of these exacerbations. [ABSTRACT FROM AUTHOR]

Background: Studies of nutritional status in geriatric patients with respiratory diseases are limited. The aim of this study was to investigate the mortality risk of older patients undergoing urgent hospitalization for various respiratory diseases. Methods: This was a retrospective study of patients aged ≥ 65 years with respiratory diseases who were urgently hospitalized between April 2022 and November 2024. The Mini Nutritional Assessment Short-Form (MNA-SF) was evaluated at the time of urgent admission, and the malnutrition risk was defined by the MNA-SF score < 11. Comorbidities and frailty were assessed using the Charlson comorbidity index (CCI) and Clinical frailty scale (CFS), respectively. Biomarkers of inflammation and acute respiratory failure such as neutrophil-to-lymphocyte ratio (NLR), Glasgow Prognostic Score (GPS), Respiratory rate-oxygenation (ROX) index, and the pulse oximetric saturation (SpO2)/fraction of inspired oxygen (FiO2) [S/F] ratio were calculated and analyzed as risk factors of in-hospital mortality. Results: A total of 168 consecutive patients were enrolled in the study with median age of 77 years (interquartile range [IQR]: 72–84). Thirty-nine patients (23.2%) died during hospitalization, and the median time to death was 17 days (IQR: 10–25). Univariate analysis demonstrated that older age (> 77 years), low S/F ratio (< 315), low ROX (< 8.3), high NLR (> 6), high CFS (> 5), and low MNA-SF (< 11) were associated with in-hospital mortality, multivariate analysis revealed that low MNA-SF was an independent predictor. Conclusions: The MNA-SF is a risk factor for mortality in older patients undergoing urgent hospitalization due to various respiratory diseases. [ABSTRACT FROM AUTHOR]

Associations between long-term exposure to nitrogen oxides (NOx) and cause-specific mortality remain insufficiently explored. This study utilizes data from 502,040 participants registered in the UK Biobank. Time-varying Cox regression is used to estimate mortality risks associated with NOx. Cause-specific mortality risks, including non-accidental, accidental and 15 major disease categories across 103 subcategories, are assessed for each 10 μg/m3 increase in NOx. Positive associations are observed between NOx and mortality from all-cause (HR: 1.036; 95% CI: 1.024, 1.049) and non-accidental diseases (HR: 1.032; 95% CI: 1.019, 1.045). We further identify 20 specific diseases related to NOx, notably respiratory diseases, mental and behavioral disorders, and circulatory diseases, with generally linear exposure-response relationships. Sex and residential areas are potential modifiers of the observed associations. Our findings suggest long-term exposure to NOx may increase mortality risks from a range of diseases, emphasizing the urgent need for clean air policies to alleviate the health burden. There is a critical gap in understanding the full spectrum of health effects associated with NOx exposure. Here, the authors find using UK Biobank data that mortality from all-cause, non-accidental and other 20 specific diseases was significantly associated with NOx. [ABSTRACT FROM AUTHOR]

Buprenorphine is an agonist at the mu opioid receptor (MOR) and antagonist at the kappa (KOR) and delta (DOR) receptors and a nociceptin receptor (NOR) ligand. Buprenorphine has a relatively low intrinsic efficacy for G-proteins and a long brain and MOR dwell time. Buprenorphine ceiling on respiratory depression has theoretically been related multiple factors such as low intrinsic efficacy at MOR, binding to six-transmembrane MOR and interactions in MOR/NOR heterodimers. Buprenorphine reduces analgesic tolerance by acting as a delta opioid receptor (DOR) antagonist. As a kappa opioid receptor (KOR) antagonist, buprenorphine reduces craving associated with addiction. Buprenorphine is a model opioid for the ordinal bifunctional analogs BU10038, BU08028 which have been shown to be potent analgesics in non-human primates without reinforcing effects and little to no respiratory depression. [ABSTRACT FROM AUTHOR]

Background: The pandemic of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory disease coronavirus 2 (SARS-CoV-2), has led to millions of infected cases and deaths worldwide. Clinical practice and clinical trials in China suggested that integrated Chinese herbal medicine (CHM) and conventional Western monotherapy (ICW) have achieved significant clinical effectiveness in treating COVID-19 patients. Objectives: This article aims to systematically evaluate the effects of ICW in treating patients at distinct stages of COVID-19. The most frequently used components of the CHM formulas have been summarized to define the most promising drug candidates. Methods: In this meta-analysis, seven databases up to May 20, 2024, were systematically searched to collect relevant randomized controlled trials (RCTs) and cohort studies (CSs). Difference in mean (MD) or ratio risk (RR) with 95% confidence interval (CI) was utilized for data processing analysis. Results: A total of 46 studies, consisting of 24 RCTs and 22 CSs, and 10492 patients were included. ICW group showed significant improvement over the conventional Western monotherapy (CWM) group at all stages of COVID-19 patients. ICW therapy was effective in improving recovery rate of chest CT (RR = 1.21, 95%CI [1.13,1.29]), shortening negativity time of nucleic acid (MD = -2.14,95% CI [-3.70, -0.58]), suppressing the transition of mild/moderate patients into severe conditions (RR = 0.45, 95% CI [0.33,0.62]), and reducing mortality (RR = 0.45, 95% CI [0.37,0.55]) for severe/critical COVID-19. Furthermore, compared with severe/critical patients, mild/moderate COVID-19 patients proved more effective after being treated with ICW therapy. They had a higher recovery rate of chest CT manifestations (75.4% vs. 69.1%), shorter negativity time of nucleic acid (9.21 d vs. 14.89 d), reduced time to clinical symptom reduction (3.85d vs. 11d) and shortened days of hospital stays (15.9d vs 19.1d). As for inflammatory markers analysis, ICW regimens decreased the level of lymphocytes in mild/moderate and severe/critical patients (MD = -0.15, 95% CI [-0.18, -0.13]), but no statistical difference was observed in white blood cell count and neutrophils count (MD = 0.02, 95% CI [-0.14, -0.18]; MD = 0.22,95% CI [-0.7, 1.15], respectively). A different tendency was found in the C-reactive protein level, which significantly decreased at the early stage of COVID-19 in the ICW group (MD = 2.56, 95%CI [1.28,3.83]). Conclusion: This meta-analysis demonstrates the significant superiority of ICW over single western monotherapy in improving clinical efficacy at distinct stages of Chinese COVID-19 patients. Subgroup analysis further showed that the earlier intervention of CHM may contribute to a better therapeutic effect. Trial registration: PROSPERO ID: CRD42023401200. [ABSTRACT FROM AUTHOR]

Porcine reproductive and respiratory syndrome virus (PRRSV) is a prevalent pathogen that impacts the health of swine and is costly to the swine industry. This study utilized PRRSV test results from the University of Guelph's Animal Health Laboratory database to develop interactive, real-time dashboards and to monitor and investigate PRRSV data. The test results from Ontario swine herd samples submitted from January 2014 to July 2023 were processed in R v.4.1.1. The final optimized, aggregated, and anonymized datasets were exported to the Tableau server and were used to design dynamic real-time visualizations with Tableau Desktop v.2021.4. Constructed dashboards were: (1) monthly number of submissions and positive submissions over the last 10 years; (2) number of submissions and positive submissions over the last 3 years, interactively displayed at weekly, monthly, quarterly and yearly intervals; (3) monthly number of PRRSV restriction fragment length polymorphism pattern (RFLP) types at the submission level over the last 5 years; (4) weekly number of tested farms and positive farms over the last 6 Years; (5) monthly number of tested farms and positive farms over the last 6 Years; (6) indicators of the epidemiological data quality in each month; and (7) contextual information. Eighty different PRRSV RFLP patterns were identified with the predominant patterns being 1-8-4, 1-1-1, 1-4-2, and 2-5-2. Most farms contributed one submission per week or per month for PRRSV testing (median: 1 submission per week; IQR: 0; max: 13; median: 1 submission per month; IQR: 1, max: 31). Epidemiological data quality showed considerable improvements over the 9 years of investigation. Apparent changes in trends of submissions were visually observed when time series were stratified by reasons for submission and production class. [ABSTRACT FROM AUTHOR]

Background: The high costs associated with diabetes management, coupled with the increasing prevalence of comorbidities, present a significant challenge to China's healthcare system, with cardiovascular complications being particularly prominent. The purpose of this study was to evaluate the comorbidities of diabetic patients with stroke in Beijing from 2016 to 2018 and the impact on treatment options and associated costs. Methods: This retrospective cohort study included diabetic patients enrolled in Beijing's medical insurance with outpatient medical records. We compared comorbidities, medications, and related treatment costs between stroke and non-stroke patients. Results: A representative sample of 2,853,036 patients with diabetes was identified from the data collected from 2016 to 2018, of which an average of 21.18% of patients reported stroke. A higher percentage of diabetic patients with stroke reported other comorbidities including hypertension, coronary artery disease, dyslipidemia, chronic respiratory disease, and osteoporosis as compared to those without stroke(all p's < 0.0001). The costs increased dramatically if diabetic patients developed comorbidities, including hypertension, CAD, dyslipidemia, CRD, and osteoporosis. Annual costs of medications were higher for diabetic patients with stroke and any types of comorbidity compared to diabetic patients without stroke (p <.0001, respectively). More types of drugs were used for diabetic patients with stroke and any types of comorbidity. Conclusions: The needs of individuals with diabetes and stroke, including their comorbidity patterns and medical burdens, must be carefully taken into account. Health systems will need to address the increasing demand for diagnosing and managing comorbidities in individuals with diabetes and stroke. [ABSTRACT FROM AUTHOR]