Search

Background: Striae are a disfiguring cutaneous condition characterized by linear smooth bands of atrophic-appearing skin that occur in areas of dermal damage produced by stretching. They occur about twice as frequently in women as in men. They commonly occur during pregnancy, puberty, and obesity. Aims of the Study: The aim was to study the clinical profile and co-morbidities associated with striae and to study the correlation between striae and obesity with grading of obesity based on BMI. Methods: A complete evaluation of 107 patients with striae attending the Department of Dermatology of Rajarajeswari Medical College and Hospital was done over a period of one year. The data was collected by history taking and clinical examination. Results: This study comprised 107 patients, with a female preponderance. The majority of the patients (38.3%) belonged to the age group of 20-29 years. Striae alba was present in 66.4% of the patients. Striae because of pregnancy was present in 31.8%, followed by 22.4% who gave a history of steroid use. In adult female patients, the sites commonly involved were the abdomen (42.1%), thigh (30.8%), and breast (12.1%), whereas the thigh (50%) and buttocks (22.7%) were sites more commonly involved in adolescent female patients. In adult male patients, the sites commonly involved were the thigh (12.1%) and abdomen (8.4%), whereas in adolescent male patients, the sites most involved were the lower back (31.8%), thigh (9.1%), knee (9.1%), and buttocks (9.1%). Obesity was the major co-morbidity associated with striae, present in 39 (36.4.%) patients. Most of these obese patients belonged to obesity class I. Conclusion: Pregnancy is the most common cause of striae in females. Steroid abuse is the most common cause of developing striae in males in the present era, which is a multi-faceted problem that needs multi-dimensional interventions. Obesity is the major comorbidity associated with striae, followed by diabetes mellitus. In obese individuals, it is most often seen in obesity class I. Hence, a modification of lifestyle is the key to preventing obesity, which may, to a certain extent, prevent the development of striae. [ABSTRACT FROM AUTHOR]

Background: Microalbuminuria (MAB) in chronic obstructive pulmonary disease (COPD) reflects generalised endothelial dysfunction as well as systemic inflammation. It is considered a vital marker of early cardiovascular involvement and other systemic involvement in COPD. MAB can serve as a surrogate marker to predict the severity of the disease and other systemic co-morbidities amongst COPD patients. This study was carried out to study the association between MAB with COPD severity and to compare the presence of MAB in COPD patients with and without co-morbidities. Methods: The study included 106 COPD patients diagnosed as per the Global Initiative for Obstructive Lung Disease (GOLD) criteria. Severity was assessed with the help of GOLD staging and modified Medical Research Council Dyspnoea Scale. MAB was assessed by urine albumin–creatinine ratio (UACR) of the spot urinary sample. The presence of comorbidities assessed by history, physical examination, laboratory investigations. Results: MAB was evident in n/N (70.8%) patients. MAB was found in 80.6%, 79.1%, 38.1% and 0% of the patients with GOLD Stage 4, Stage 3, Stage 2 and Stage 1 COPD patients, respectively (P = 0.0001). The mean UACR was significantly higher in severe stages of COPD. A significant association of MAB with co-morbidities such as hypertension, ishaemic heart disease, dyslipidaemia and diabetes mellitus (P < 0.05) was evident. Conclusions: MAB could be a promising biomarker to identify COPD patients with severe disease and who are at risk of developing cardiovascular and other systemic co-morbidities.

Background: Obesity has emerged as an epidemic and is known to be associated with multiple co-morbidities, contributing to increased morbidity and mortality. Body-mass index (BMI) has been traditionally used to assess obesity in an individual but abdominal obesity markers are being claimed to have a stronger association with adverse cardiovascular outcome as compared to BMI. However, there are only a few studies that have evaluated these indices in Asian Indians. Aims and Objectives: The study was conducted to compare BMI and waist measurement based indices among hypertensive adults and their association with adverse cardiovascular outcomes. The secondary objectives were to determine any gender-based differences among anthropometric indices and improved predictability on adding waist-based indices to BMI. Materials and Methods: An observational study was conducted to analyse association of anthropometric indices such as BMI, A body shape index (ABSI), Waist–hip ratio (WHR), Waist-to-height ratio (WHtR), Lean body mass-to-weight ratio, and Waist circumference (WC), with risk of cerebrovascular accidents (CVA) and coronary artery disease (CAD) in Indian hypertensive adults. Results: In total, 400 participants were included and female subjects were noted to have higher prevalence of obesity in our study population. Only 33.25% patients had BMI in recommended range and the numbers were even lower for WHtR and WHR. BMI and ABSI were found to have a weak association with development of co-morbidities while measures of abdominal obesity such as WHR, WC, and WHtR were found to have consistently strong association with CVA and CAD with high sensitivity and negative predictive values. Conclusion: More accurate markers of abdominal obesity can help in better assessment of cardiovascular risk among high-risk population to improve the overall outcome. Easy to use, outpatient-based markers such as WC, WHR, and WHtR appear to be better than BMI in risk assessment.

The human microbiota, a diverse community of microorganisms living on or within their hosts, play an irreplaceable role in maintaining human health. Dysbiosis of the microbiota is associated with the pathogenesis of diverse human diseases. In recent years, growing evidence has been presented to support the substantial effect of human microbiota on the progression of infectious diseases. In this review, we describe the functional role of human microbiota in infectious diseases by highlighting their Janus-faced effects in the regulation of acute and chronic infections as well as their related co-morbidities. Thereafter, we review the latest advances elucidating the mechanisms underlying tri-directional interactions between the microbiota, hosts, and invading pathogens, with a further discussion on external environmental factors that shape this interconnected regulatory network. A better understanding of the regulatory functions and mechanisms of human microbiota in infectious diseases will facilitate the development of new diagnostic, preventive, and therapeutic approaches for infectious diseases.

Improving preoperative care for elderly patients with hip fractures is crucial for achieving the best outcomes. A multidisciplinary team that can improve overall care quality by addressing patient's medical conditions, analgesia, timely surgery, and early postoperative mobilization is required. This narrative review provides insights regarding the extent of preoperative optimization needed for hip fracture surgery. [ABSTRACT FROM AUTHOR]

Background: The incidence of chronic disease is increasing worldwide which, in turn, increases the demand for healthcare services. To meet these demands, healthcare systems are adapting their services in order to reduce treatment costs and ensure coherence for patients with multiple diseases. One form of adaptation is shared outpatient consultations between internal medical specialties. However, little is known about how patients interact with multiple clinicians in shared consultations. Aim: This project aimed to explore how patients with diabetes and chronic kidney disease interact with multiple clinicians in a shared outpatient setting. Research Methods: We performed a qualitative ethnographic study, combining focused participant observations with informal field interviews. We included 17 participants, nine males and eight females with a mean age of 67.3 in the project. The data analysis was guided by Braun and Clarke's reflexive thematic analysis and Arthur Kleinman's theory of illness and disease. Results: We found one over‐arching theme: 'A consultation which encompassed both illness and disease' and four subthemes: (1) 'The medical focal point' pertained to the focus on physiological measurements in dialogue between patients and clinicians. (2) 'The possibility of negotiations' illustrated how decisions about dialysis and pharmacological treatment were based on negotiations. (3) 'Speaking different languages' displayed how patients used alternative illness‐based explanations whereas clinicians tended to use biomedical language. (4) 'Perceptions of everyday life' concerned what patients considered was best for them when managing their illness and everyday lives. Conclusion: Patients present information on how they balance life with physiological and psychosocial challenges. When clinicians employ a biomedical perspective, opportunities to gain information on patients' illness behaviours or cues to negotiate are missed. Patients prioritise functioning on a daily level over following treatment regimes. These findings are tenuous and require verification in similar studies in similar settings. Short Phrases: Shared Outpatient Clinic, Patient–clinician interactions. [ABSTRACT FROM AUTHOR]

This study aims to estimate the prevalence of cardiovascular disease, kidney disease, and other selected diseases including hypertension, atrial fibrillation, asthma, chronic obstructive lung disease, osteoarthritis, osteoporosis, psoriasis and depression among Greenlanders living in Nuuk with and without type 2 diabetes (T2D). The study was designed as a cross-sectional case-control study based on data from the electronic medical record (EMR) in Greenland. Persons with a registered T2D diagnosis in EMR and residence in Nuuk (N = 435) were included. The prevalence of cardiovascular disease was 17.9% among persons with T2D and significantly higher compared to the control group (10.1%). In addition, our results showed a significantly higher prevalence of ischaemic heart disease, hypertension, heart failure, atrial fibrillation, osteoarthritis and psoriasis among persons with T2D compared to the control group.Our study found a higher prevalence in five out of 10 selected diseases in regularly followed persons with T2D in Nuuk compared to unselected controls. This enlightens the importance of a broad multifaceted approach in combination of changing primary health care to focus on early detection of controllable risk factors and chronic conditions care in Artic Greenland. [ABSTRACT FROM AUTHOR]

Background: Obesity has emerged as an epidemic and is known to be associated with multiple co-morbidities, contributing to increased morbidity and mortality. Body-mass index (BMI) has been traditionally used to assess obesity in an individual but abdominal obesity markers are being claimed to have a stronger association with adverse cardiovascular outcome as compared to BMI. However, there are only a few studies that have evaluated these indices in Asian Indians. Aims and Objectives: The study was conducted to compare BMI and waist measurement based indices among hypertensive adults and their association with adverse cardiovascular outcomes. The secondary objectives were to determine any gender-based differences among anthropometric indices and improved predictability on adding waistbased indices to BMI. Materials and Methods: An observational study was conducted to analyse association of anthropometric indices such as BMI, A body shape index (ABSI), Waist--hip ratio (WHR), Waist-to-height ratio (WHtR), Lean body mass-to-weight ratio, and Waist circumference (WC), with risk of cerebrovascular accidents (CVA) and coronary artery disease (CAD) in Indian hypertensive adults. Results: In total, 400 participants were included and female subjects were noted to have higher prevalence of obesity in our study population. Only 33.25% patients had BMI in recommended range and the numbers were even lower for WHtR and WHR. BMI and ABSI were found to have a weak association with development of co-morbidities while measures of abdominal obesity such as WHR, WC, and WHtR were found to have consistently strong association with CVA and CAD with high sensitivity and negative predictive values. Conclusion: More accurate markers of abdominal obesity can help in better assessment of cardiovascular risk among high-risk population to improve the overall outcome. Easy to use, outpatient-based markers such as WC, WHR, and WHtR appear to be better than BMI in risk assessment. [ABSTRACT FROM AUTHOR]

Background: Outpatient follow-up after a hospital discharge may reduce the risk of readmissions, but existing evidence has methodological limitations. Objectives: To assess effect of outpatient follow-up within 7, 14, 21 and 30 days of a hospital discharge on 30-day unplanned readmissions or mortality among heart failure (HF) patients; and whether this varies for patients with different clinical complexities. Design: We analyzed medical records between January 2016 and December 2021 from a prospective cohort study. Using time varying mixed effects parametric survival models, we examined the association between not having an outpatient follow-up and risk of adverse events. We used interaction models to assess if the effect of outpatient follow-up visit on outcomes varies with patients' clinical complexity (comorbidities, grip strength, cognitive impairment and length of inpatient stay). Participants: Two hundred and forty-one patients with advanced HF. Main Measures: 30-day all-cause (or cardiac) adverse event defined as all cause (or cardiac) unplanned readmissions or death within 30 days of an unplanned all-cause (or cardiac) admission or emergency department visit. Key Results: We analyzed 1595 all-cause admissions, inclusive of 1266 cardiac admissions. Not having an outpatient follow-up (vs having an outpatient follow-up) significantly increased the risk of 30-day all-cause adverse event. (risk [95% CI] – 14 days: 35.1 [84.5,-1.1]; 21 days: 43.9 [48.2,6.7]; 30 days: 31.1 [48.5, 7.9]) The risk (at 21 days) was higher for those with one co-morbidity (0.25 [0.11,0.58]), mild (0.67 [0.45, 1.00]) and moderate cognitive impairment (0.38 [0.17, 0.84]), normal grip strength (0.57 [0.34, 0.96]) and length of inpatient stay 7–13 days (0.45 [0.23, 0.89]). Conclusion: Outpatient follow-up within 30 days after a hospital discharge reduced risk of 30-day adverse events among HF patients, the benefit varying according to clinical complexity. Results suggest the need to prioritize patients who benefit from outpatient follow-up for these visits. [ABSTRACT FROM AUTHOR]

Introduction: Chronic kidney disease (CKD) significantly elevates the risk of cardiovascular disease (CVD), which is the leading cause of morbidity and mortality in CKD patients. Understanding the cardiovascular outcomes in this population is crucial for developing effective prevention and management strategies. Objective: This study aims to evaluate the incidence and determinants of cardiovascular events in patients with CKD at the Department of Cardiology, Hi-Tech Medical College & Hospital, Bhubaneswar, India, over a period from June 2018 to December 2023. Method: An observational cohort study was conducted with a sample size of 68 CKD patients. Data were collected on traditional and non-traditional cardiovascular risk factors, and patients were followed to document major cardiovascular events such as myocardial infarction, stroke, and heart failure. Statistical analyses included the calculation of incidence rates and multivariate regression to identify independent predictors of cardiovascular outcomes. Results: During the study period, 23.5% of the patients experienced a major cardiovascular event. The incidence rates of myocardial infarction, stroke, and heart failure were 10.3%, 5.9%, and 7.3%, respectively. Significant predictors of cardiovascular events included hypertension (p < 0.01), dyslipidemia (p < 0.05), and elevated levels of inflammatory markers (p < 0.01). CKD progression was also strongly associated with increased cardiovascular risk (p < 0.01). Conclusions: The findings highlight a high incidence of cardiovascular events among CKD patients and underscore the importance of comprehensive cardiovascular risk management in this population. Early identification and intervention for modifiable risk factors are essential to improve cardiovascular outcomes in CKD patients. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 pandemic, triggered by SARS-CoV-2, has significantly impacted global health, with varying effects across different regions. In India, Tezpur Medical College & Hospital (TMCH) in Assam has been a crucial site for managing COVID-19 patients. Understanding the clinical-epidemiological characteristics in this setting can enhance regional and national healthcare strategies. Objective: This study aims to analyze the demographic profile, clinical features, co-morbidities, treatment modalities, and outcomes of COVID-19 patients admitted to TMCH from January 2020 to December 2020. Method: A retrospective analysis was conducted on data from 1710 COVID-19 patients admitted to TMCH during the study period. Clinical records were reviewed to assess demographic details, clinical manifestations, co-morbidities, treatment approaches, and outcomes. Descriptive statistics were used to summarize the findings. Result: Among the 1710 patients, 117 (6.8%) died. The most frequently reported symptoms were fever (85.4%), cough (77.8%), and shortness of breath (71.5%). Comorbidities were present in 60.2% of patients, with hypertension in 35.2%, diabetes in 30.4%, and cardiovascular diseases in 15.8%. Of the patients with co-morbidities, 18.4% died compared to 2.7% of those without co-morbidities. The average age of deceased patients was 68 years, significantly higher than the average age of survivors (52 years). Treatment included supportive care for 90.1% of patients, oxygen therapy for 58.7%, and antiviral medications for 22.3%. Conclusion: The study highlights significant clinical and demographic characteristics of COVID-19 patients at TMCH. High mortality was associated with co-morbidities and older age. These findings underscore the need for targeted interventions and resource allocation in similar settings to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Bullous pemphigoid (BP) and atopic dermatitis (AD) are currently thought to be tightly related, yet studies of the mechanisms of co‐morbidities are lacking. Methods: We obtained GWAS data for BP (N = 376,274) and AD (N = 796,661) from the Finnish Genetic Research Program dataset and the UK Biobank, separately. Then, the following four analyses were performed: (1) cross‐trait linkage disequilibrium score regression (LDSC) to assess the genetic correlation between BP and AD, (2) cross‐phenotype association analysis (CPASSOC) to identify multiple effector loci shared by BP and AD, (3) transcriptome‐wide association study (TWAS) to determine whether their cross‐organizational expression patterns share genes with a common biological mechanism of relevance, and (4) bidirectional Mendelian randomization (MR) analysis to assess bidirectional causal effects of BP and AD. Results: We found a positive genetic association between BP and AD (rg = 0.5476, p = 0.0495) as well as identified four pleiotropic loci and 59 common genes affecting BP and AD. Bidirectional MR analysis suggested that BP promotes the risk of AD. Conclusions: We revealed a genetic link between BP and AD, which is associated with biological pleiotropy and causality. Awareness of the association between BP and AD helps dermatologists manage patients with these illnesses. [ABSTRACT FROM AUTHOR]

Biological and clinical heterogeneity is a major challenge in research for developing new treatments for Alzheimer's disease (AD). AD may be defined by its amyloid beta and tau pathologies, but we recognize that mixed pathologies are common, and that diverse genetics, central nervous system (CNS) and systemic pathophysiological processes, and environmental/experiential factors contribute to AD's diverse clinical and neuropathological features. All these factors are rational targets for therapeutic development; indeed, there are hundreds of candidate pharmacological, dietary, neurostimulation, and lifestyle interventions that show benefits in homogeneous laboratory models. Conventional clinical trial designs accommodate heterogeneity poorly, and this may be one reason that progress in translating candidate interventions has been so difficult. We review the challenges of AD's heterogeneity for the clinical trials enterprise. We then discuss how advances in repeatable biomarkers and digital phenotyping enable novel "single‐case" and adaptive trial designs to accelerate therapeutics development, moving us closer to personalized research and medicine for AD. Highlights: Alzheimer's disease is diverse in its clinical features, course, risks, and biology.Typical randomized controlled trials are exclusive and necessarily large to attain arm comparability with broad outcomes.Repeated blood biomarkers and digital tracking can improve outcome measure precision and sensitivity.This enables the use of novel "single‐case" and adaptive trial designs for inclusivity, rigor, and efficiency. [ABSTRACT FROM AUTHOR]

COVID-19 causes cytokine storm which results in altered iron homeostasis within the system. The negative consequences of this include poor iron metabolism, ROS-induced oxidative damage, ferroptosis, and increased severity of COVID-19 along with illnesses like anemia, thalassemia, diabetes, cancer, neurological disorders, and long COVID. Therefore, managing iron overload with natural or synthetic iron chelators and alternative therapeutics can help to reduce the severity of COVID-19. This review analyzes the intricate molecular mechanism of iron dynamics during SARS-CoV-2 infection and disease progression in COVID-19 patients along with related clinical consequences. Also, the review explores a comprehensive understanding of the reciprocal mechanism between iron overload and COVID-19 and their adverse effects, thereby facilitating the development of potential therapeutic interventions. Plain Language Summary Iron is one of the most important elements of our body. Any disturbance in iron metabolism can lead to disease and can also exacerbate infections, such as COVID-19. The SARS-CoV-2 virus also affects the red blood cells and iron-related metabolic dysfunction is observed even after patients recover from infection. The free iron content in the body rises as a result, this is known as iron overload. High levels of iron cause tissue and cell damage and can lead to many problems. Many natural and artificial compounds that bind free iron are given to patients for treatment to remove excess iron from the body. They may also help to treat COVID-19 and prevent worsening of the disease. GRAPHICAL ABSTRACT [ABSTRACT FROM AUTHOR]

Background: The second wave of the COVID-19 pandemic led to a very dreaded complication of mucormycosis. Immunosuppressive action of the COVID-19 virus, co-morbidities, for example, diabetes mellitus (DM), hypertension, use of steroids, and humidified oxygen, are among the important factors that make the patients susceptible to developing mucormycosis. Objective: The present study was conducted to identify and understand all the significant histological changes including the type and extent of tissue involvement, the pattern of inflammation, the volume of fungal hyphae, hemorrhage, etc., in patients with COVID-19 associated mucormycosis (CAM) and correlate with clinical outcome. Method: It was a retrospective cross-sectional observational study involving all the patients of CAM, who underwent debridement or biopsy over a period of 5 months, from April 01, 2021, to August 31, 2021. CAM was classified based on the radiological evaluation, clinical features, and organs involved. Different demographic, clinical, laboratory, and histologic parameters were recorded. The variables were assessed for their association with poor clinical outcomes using multiple logistic regression. P < 0.05 was considered statistically significant. Results: A total of 146 patients were included in the study with a mean age of 49.4 years and 71.2% were male. Sino-naso-palatal was the most common type of CAM (32.9%), while sino-naso-cerebral was the least common (14.3%). DM was present in 54.1% of patients, out of which 26.6% were recently diagnosed. The death occurred in 21.9% of patients. Maximum mortality was observed in CAM of sino-naso-cerebral involvement (42.9%). Total leucocyte count (TLC) [OR = 0.87; 95%CI: 0.76-0.97; P = 0.02] and C-reactive protein (CRP) [OR = 0.97; 95%CI: 0.96-0.99; P = 0.008] were significantly associated with poor outcomes. Other factors, that is, high prothrombin time, DM, ferritin, and the involvement of muscle, skin, and cartilage, were also associated with poor clinical outcomes but were not statistically significant. Similarly, high fungal volume and the presence of thrombosis were also associated with poor outcomes but were not statistically significant. Conclusion: CAM more commonly affects males with co-morbidities. TLC and CRP were significantly associated with poor outcomes. Histologically, the involvement of skin, muscle, and cartilage and the presence of excessive fungal hyphae and thrombosis were also associated with poor outcomes.

Background: COVID-19 an infectious disease caused by the SARS-CoV-2 virus, started in late 2019 and became a pandemic within a short period. To respond to the pandemic vaccines like Covishield, Covaxin, Sputnik V, Covovax, etc., were developed rapidly. However, there were raising concerns about the development of immunity as well as adverse events following vaccination. Objectives: To compare anti-SARS-CoV-2 IgG antibody titres at different time-points post-vaccination between baseline seropositive and seronegative groups and to assess the adverse events following the 1st dose of Covishield vaccine among adult beneficiaries attending vaccination centre in a tertiary care hospital of Upper Assam. Materials and Methods: Prospective Cohort study was conducted from July 2021 to June 2022 among adult beneficiaries receiving the Covishield vaccine. The oral questionnaire was used incorporating socio-demographic variables, and clinical profiles including co-morbidities and adverse events following vaccination. Data analysis was done by Microsoft Excel and SPSS Results: Out of a total of 146 study participants, IgG estimation showed 61% as seropositive and the rest as seronegative. A total of 55.40% had minor adverse events, majority of them were females (53.08%) and 88.80% belonged to 18–59 years compared to 11.11% above 60 years of age. The majority (71.60%) did not have any co-morbidities and the major AEFI was NIL among the study participants. The study group had 61% seropositive previously infected. Conclusion: Covishield vaccination induces an immune response and 90% seroconversion is achieved after 1st dose (booster dose). Antibody titres of the seropositive group by natural infection of SARS-CoV-2 were higher than seronegative cohort seroconverted by vaccination. The AEFI observed were minor and can be commented as safer.

INTRODUCTION: Alzheimers disease (AD) incidence is thought to be higher among Black than White individuals. METHODS: We studied the US Medicare population from 2000 to 2018. Cox regression was used to determine the roles of race and co-morbidities for AD incidence. RESULTS: We studied 11,880,906 Medicare beneficiaries, with 774,548 AD cases. Hazard ratios (HRs) by increasing numbers of co-morbidities (1-7) were 1.51, 2.00, 2.55, 3.16, 2.89, 4.77, and 5.65. Among those with no co-morbidities, Black individuals had a lower rate than those who are White (HR = 0.69), while among those with one more co-morbidities, Black individuals had a higher rate (HR = 1.19). The presence of hypertension increased AD rates by 14% for White individuals, but 69% for those who are Black. DISCUSSION: More co-morbidities was strongly associated with higher AD rates. The higher rates for Black versus White individuals was apparent only for those with co-morbidities and appears driven both by more co-morbidities, and the greater effect of hypertension. HIGHLIGHTS: Black individuals have been shown to have higher Alzheimers disease (AD) rates than those who are White. Some co-morbidities are known to increase AD risk. Among those In Medicare data with no co-morbidities, Black individuals have less risk than those who are White. Among those with co-morbidities, Black individuals have higher rates than those who are White. Hypertension results in a much stronger increase in AD risk for Black versus White individuals.

Self-administered pre-participation screening for physical activity (PA) requires an instrument that should be easily used and identify individuals at high risk. The Physical Activity Readiness Questionnaire (PAR-Q+) has been used for many years. Its ease of use and ability to identify those not fit to undergo PA has not been assessed. This study was to determine the rates of the PAR-Q+ in identifying adults who may not be fit for moderate or intense PA and obtain feedback on the use of this tool. A randomized, cross-sectional study involving a wide spectrum of members of the public was carried out. Participants were asked to provide their bio-characteristics, complete the PARQ+, and provide feedback on the questionnaire. With 1019 participants, about 33.1% of the participants using the PARQ+ would have required further medical evaluation. Except for those patients with respiratory illness, there was no difference in levels of PA in those who answered yes or no to the seven PARQ+ questions. Only 4 of the 7 main PAR-Q+ questions were perceived by the public as easily understood. Difficulties were encountered with 21 of the 45 follow-up questions, especially amongst those with co-morbidities. The wordiness of the questions and the large number of technical terms were also sources of concern. Suggestions were provided by participants on areas where improvements may be made to the wording of the questions. The study suggests that the PAR-Q+ probably over-identified those who require further medical evaluation. In addition, the wordiness of the questions and frequent use of medical jargon made the PARQ+ challenging to understand and use. The suggestions provide opportunities to review areas for possible improvements. [ABSTRACT FROM AUTHOR]

COVID-19 pandemic has presented as a major health problem worldwide. There has been wide range of presentation of COVID-19 ranging from mild (flu-like symptoms) to severe life-threatening pneumonia with multi-organ involvement. Steroids have shown some ray of hope in its management. Although, systemic steroids have shown to have survival benefits but rampant use of glucocorticoids have resulted in secondary bacterial and fungal infections. Invasive fungal infections have been found in large number of COVID19 treated patients during the second wave. Mucormycosis is a life-threatening fungal infection that is commonly encountered in immunocompromised patients. Despite aggressive therapy, which includes disfiguring surgical debridement and frequently adjunctive toxic antifungal therapy, the overall mortality rate is high. We studied nearly 40 post COVID patients that were posted for mucormycosis endoscopic debridement in our hospital over a period of 2 months. We hereby present the anaesthesia challenges and mortality in these patients. Demographics, hemodynamic parameters, invasive monitoring methods, surgical procedures, hospital records, and mortality rates of these patients were studied. We concluded that an aggressive postoperative ICU care is important for recovery and for improving the survival in these patients. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: COVID-19 an infectious disease caused by the SARS-CoV-2 virus, started in late 2019 and became a pandemic within a short period. To respond to the pandemic vaccines like Covishield, Covaxin, Sputnik V, Covovax, etc., were developed rapidly. However, there were raising concerns about the development of immunity as well as adverse events following vaccination. Objectives: To compare anti-SARS-CoV-2 IgG antibody titres at different time-points post-vaccination between baseline seropositive and seronegative groups and to assess the adverse events following the 1st dose of Covishield vaccine among adult beneficiaries attending vaccination centre in a tertiary care hospital of Upper Assam. Materials and Methods: Prospective Cohort study was conducted from July 2021 to June 2022 among adult beneficiaries receiving the Covishield vaccine. The oral questionnaire was used incorporating socio-demographic variables, and clinical profiles including co-morbidities and adverse events following vaccination. Data analysis was done by Microsoft Excel and SPSS Results: Out of a total of 146 study participants, IgG estimation showed 61% as seropositive and the rest as seronegative. A total of 55.40% had minor adverse events, majority of them were females (53.08%) and 88.80% belonged to 18–59 years compared to 11.11% above 60 years of age. The majority (71.60%) did not have any co-morbidities and the major AEFI was NIL among the study participants. The study group had 61% seropositive previously infected. Conclusion: Covishield vaccination induces an immune response and 90% seroconversion is achieved after 1st dose (booster dose). Antibody titres of the seropositive group by natural infection of SARS-CoV-2 were higher than seronegative cohort seroconverted by vaccination. The AEFI observed were minor and can be commented as safer. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: The second wave of the COVID-19 pandemic led to a very dreaded complication of mucormycosis. Immunosuppressive action of the COVID-19 virus, co-morbidities, for example, diabetes mellitus (DM), hypertension, use of steroids, and humidified oxygen, are among the important factors that make the patients susceptible to developing mucormycosis. Objective: The present study was conducted to identify and understand all the significant histological changes including the type and extent of tissue involvement, the pattern of inflammation, the volume of fungal hyphae, hemorrhage, etc., in patients with COVID-19 associated mucormycosis (CAM) and correlate with clinical outcome. Method: It was a retrospective cross-sectional observational study involving all the patients of CAM, who underwent debridement or biopsy over a period of 5 months, from April 01, 2021, to August 31, 2021. CAM was classified based on the radiological evaluation, clinical features, and organs involved. Different demographic, clinical, laboratory, and histologic parameters were recorded. The variables were assessed for their association with poor clinical outcomes using multiple logistic regression. P < 0.05 was considered statistically significant. Results: A total of 146 patients were included in the study with a mean age of 49.4 years and 71.2% were male. Sino-naso-palatal was the most common type of CAM (32.9%), while sino-naso-cerebral was the least common (14.3%). DM was present in 54.1% of patients, out of which 26.6% were recently diagnosed. The death occurred in 21.9% of patients. Maximum mortality was observed in CAM of sino-naso-cerebral involvement (42.9%). Total leucocyte count (TLC) [OR = 0.87; 95%CI: 0.76-0.97; P = 0.02] and C-reactive protein (CRP) [OR = 0.97; 95%CI: 0.96-0.99; P = 0.008] were significantly associated with poor outcomes. Other factors, that is, high prothrombin time, DM, ferritin, and the involvement of muscle, skin, and cartilage, were also associated with poor clinical outcomes but were not statistically significant. Similarly, high fungal volume and the presence of thrombosis were also associated with poor outcomes but were not statistically significant. Conclusion: CAM more commonly affects males with co-morbidities. TLC and CRP were significantly associated with poor outcomes. Histologically, the involvement of skin, muscle, and cartilage and the presence of excessive fungal hyphae and thrombosis were also associated with poor outcomes. [ABSTRACT FROM AUTHOR]

Background: Microalbuminuria (MAB) in chronic obstructive pulmonary disease (COPD) reflects generalised endothelial dysfunction as well as systemic inflammation. It is considered a vital marker of early cardiovascular involvement and other systemic involvement in COPD. MAB can serve as a surrogate marker to predict the severity of the disease and other systemic co-morbidities amongst COPD patients. This study was carried out to study the association between MAB with COPD severity and to compare the presence of MAB in COPD patients with and without co-morbidities. Methods: The study included 106 COPD patients diagnosed as per the Global Initiative for Obstructive Lung Disease (GOLD) criteria. Severity was assessed with the help of GOLD staging and modified Medical Research Council Dyspnoea Scale. MAB was assessed by urine albumin–creatinine ratio (UACR) of the spot urinary sample. The presence of comorbidities assessed by history, physical examination, laboratory investigations. Results: MAB was evident in n/N (70.8%) patients. MAB was found in 80.6%, 79.1%, 38.1% and 0% of the patients with GOLD Stage 4, Stage 3, Stage 2 and Stage 1 COPD patients, respectively (P = 0.0001). The mean UACR was significantly higher in severe stages of COPD. A significant association of MAB with co-morbidities such as hypertension, ishaemic heart disease, dyslipidaemia and diabetes mellitus (P < 0.05) was evident. Conclusions: MAB could be a promising biomarker to identify COPD patients with severe disease and who are at risk of developing cardiovascular and other systemic co-morbidities. [ABSTRACT FROM AUTHOR]

Background: In the ongoing battle against both drug-susceptible and drug- resistant tuberculosis (DR-TB), multi-morbidity is becoming more and more acknowledged as a severe public health hazard. Co-morbidities should be adequately handled while treating MDR tuberculosis by enlisting the help of specialists from other fields. Objective: To analyze various co-morbidities and its effect on final outcome of multi- drug-resistant tuberculosis patients. Methodology: This prospective descriptive study was carried at department of pulmonology, Lady Reading Hospital, Peshawar, from 1st June 2021 till 30th May 2022. Sampling: A total of 157 participants with multi-drug resistant tuberculosis were registered which was confirmed based on PCR reporting resistance of the pathogen towards isoniazid and rifampicin. Co-morbidities were assessed in terms of diabetes mellitus, COPD, HIV and CKD. Analysis: Data analysis was performed using SPSS version 24. Results: Male to female ratio was 1.7: 1. Age of the patients ranged from 20 to 60 years with mean age of 39. 37 ± 6.143 years. Mean BMI of the patients was 23.285 ± 2.5843 kg/m². Diabetes mellitus was the most frequent comorbidity observed in 48 patients (30.6%), followed by COPD in 33 patients (21.0%). This study showed that successful outcome of the study cases was 112 (71.4%) and unsuccessful outcome was 45 (28.6). Crosstabulation between comorbidities and final outcome showed that positive significant association was found among comorbidities and unsuccessful outcome (P-value <0.005). Conclusion: Comorbidity is common among multidrug-resistant tuberculosis individuals in our local population. The most common concurrent illnesses is diabetes mellitus. Authorities must explore the involvement of additional professions, particularly endocrinologists. [ABSTRACT FROM AUTHOR]

Introduction: The present study is an epidemiological study of the fatal cases of COVID-19 positive by Reverse Transcriptase Polymerase Chain Reaction in a tertiary care centre in West Bengal. The trace, track and treat mode of investigation has helped in the control and timely intervention in the disease pathogenesis. Objective: to analyse the epidemiological characteristics of COVID-19 related deaths in tertiary centre in Eastern India and comprehended the pattern of deaths due to COVID-19. This will help in understanding the gaps between infection and deaths. Methods: It was a cross sectional analytical study. The Medical certification of cause of death was studied and data was tabulated. We collected deaths due to COVID-19 in a tertiary set up in Eastern India from March'2020 to September'2020. Results: A total of sixty-one deaths were studied. Among the deaths with COVID-19, mild type accounted for the most followed by the severe type. The median age was 65 years50% of the deaths were distributed in 60-80 years age group. Additionally, the male to female ratio was 3:1. % of patients had underlying comorbidities. It was noted more amongst males. Most of the underlying diseases were hypertension, Diabetes Mellitus, cardiovascular diseases. Conclusion: COVID-19 posed a greater threat to the elderly people and men with fatal consequences. [ABSTRACT FROM AUTHOR]

This study aims to estimate the prevalence of cardiovascular disease, kidney disease, and other selected diseases including hypertension, atrial fibrillation, asthma, chronic obstructive lung disease, osteoarthritis, osteoporosis, psoriasis and depression among Greenlanders living in Nuuk with and without type 2 diabetes (T2D). The study was designed as a cross-sectional case-control study based on data from the electronic medical record (EMR) in Greenland. Persons with a registered T2D diagnosis in EMR and residence in Nuuk (N = 435) were included. The prevalence of cardiovascular disease was 17.9% among persons with T2D and significantly higher compared to the control group (10.1%). In addition, our results showed a significantly higher prevalence of ischaemic heart disease, hypertension, heart failure, atrial fibrillation, osteoarthritis and psoriasis among persons with T2D compared to the control group.Our study found a higher prevalence in five out of 10 selected diseases in regularly followed persons with T2D in Nuuk compared to unselected controls. This enlightens the importance of a broad multifaceted approach in combination of changing primary health care to focus on early detection of controllable risk factors and chronic conditions care in Artic Greenland.

Here we describe the use of a synthetic polyurethane matrix in the setting of burns and other complex wounds in the largest United States case series to date. A retrospective review was conducted at a verified, regional burn center. All patients greater than 18 years of age who received this matrix between January 2019 and July 2023 were included. A total of 182 patients with 250 wounds were included in this study. Thirty-seven percent were smokers, 23.6 % had diabetes and 5.5 % had peripheral vascular disease. The majority were acute burn wounds (60 %), followed by trauma (24.4 %), chronic wounds (5.6 %), infection (4 %) and donor sites (2 %). Exposed structures included fat (54 %), muscle (30 %), bone (16 %) and tendon (14.4 %). Microbial colonization was present in 143 (57.2 %) of cases: 98 (39.2 %) pre-application and 89 (35.6 %) post application. The incidence of new microbial colonisation post-application was 25.6 %. Infection was present in 117 (46.8 %) cases, 49 (19.6 %) pre-matrix application, 44 (17.6 %) post-matrix application and 24 (9.6 %) pre and post application. Eighteen patients (10 %) died. Median length of stay was 27 days. Median time to matrix implantation was 10 days. Median time from matrix placement to skin grafting was 35 days. Where documented, there were 162 wounds (83.5 %) with > 95 % matrix survival and 136 wounds (82.4 %) with > 95 % skin graft survival even in the setting of adverse factors such as infection, diabetes, or nicotine use. This study demonstrates the robustness of this skin substitute to achieve successful reconstruction even in the setting of adverse patient or wound characteristics.

Abstract Background Few studies have assessed the burden of mental disorders among children and adolescents considering the impact of co-morbidities and suicide on disability adjusted life years (DALYs). Methods This was a multicenter cross-sectional study. Our survey data in Liaoning Province (LN) were used to estimate the burden of six mental disorders, supplemented with data from other investigative studies conducted in China to assess four other disorders. DALYs were derived from the sum of years lived with a disability (YLDs) adjusted for co-morbidities, and the years of life lost (YLLs) adjusted for suicide. The changes in DALYs, YLDs, and YLLs were compared with and without adjustment for co-morbidities and suicide. Results The DALYs rate of mental disorders among children and adolescents in LN decreased from 1579.6/105 to 1391.4/105, after adjusting for both co-morbidities and suicide (-11.9%). The DALYs rate for major depression, anxiety disorder, and conduct disorder (-80.8/105, -75.0/105 and -30.2/105, respectively) were the top three contributors to the DALYs reduction (-188.2/105). The YLDs decreased from 72724.8 to 62478.5 after co-morbidity adjustment (-17.8%), mainly due to the reduction by major depression (-35.3%) and attention deficit/hyperactivity disorder [ADHD] (-34.2%). The YLLs increased from 130 to 1697.8 after adjusting for suicides (+ 56.9% of all suicide YLLs), mainly due to the contribution of major depression (+ 32.4%) and anxiety disorder (+ 10.4%). Compared to GBD 2010, the estimated DALY rate for mental disorders in LN was to be about 80%, with the proportion of DALYs and DALY rates explained by major depressive disorder accounted for only approximately one-third (14.6% vs. 41.9% and 202.6 vs. 759.9, respectively). But the proportion and absolute level of DALY rates explained by anxiety disorders were approximately 2-fold higher (39.7% vs. 19.6% and 552.2 vs. 323.3, respectively). Conclusions The DALYs of mental disorders among Chinese children and adolescents were approximately 80% of the global level, with anxiety disorders imposing about 2 times the global level. Co-morbidity and suicide must be adjusted when calculating DALYs.

Background: Chronic kidney disease (CKD) poses a well-documented burden, necessitating patient awareness of the importance of healthy lifestyle modifications to mitigate co-morbidities and mortality risks. Objective: This study aimed to assess the effectiveness of education-based conservative management in mitigating disease progression among CKD patients in the eastern region of India. Materials and Methods: A total of 248 CKD patients receiving outpatient department and inpatient department care at the nephrology and dialysis department of Belle Vue Clinic, Kolkata, West Bengal, India, were included in the study. Comprehensive data encompassing demographic details, socioeconomic status, clinical co-morbidities, and conservative management interventions via patient education were examined. The study compared the rise in creatinine levels with adherence to five key factors: dietary restrictions, medication compliance, follow-up appointments with physicians, management of co-morbidities, and adherence to lifestyle modifications. Each strategy was graded on a scale of 0, 1, or 2 based on compliance, with 0 indicating minimal or no compliance, 1 indicating moderate compliance, and 2 indicating strong compliance. Results: In this study, several factors were linked to elevated creatinine levels among CKD patients, including being in the middle-age range, male gender, living predominantly in urban areas, and working in business or service occupations. Additionally, a higher prevalence of co-existing conditions such as diabetes mellitus and hypertension was noted among CKD patients, along with documented instances of polycystic kidney disease, obstructive uropathy, and renal cell carcinoma. After educating CKD patients, those who scored 8–10 on compliance exhibited a decrease in creatinine elevation (0.35 mg/dL) among 120 cases from January 2022 to June 2023. Conversely, those with scores ranging from 5 to 7 (81 cases) showed moderate creatinine elevation (1.24 mg/dL), while those with scores of 0–4 (47 cases) demonstrated higher levels of creatinine elevation (5.48 mg/dL). Conclusion: This study concludes that the conservative management of CKD patients educates individuals about primary prevention of the disorder and provides a comprehensive understanding of secondary and tertiary prevention strategies. This cost-effective approach significantly impacts physical, mental, social, and psychological adjustment behaviors.

Aim: Frailty is defined as extreme vulnerability, a syndrome that exposes the individual to a higher risk of disability. While risk factors for frailty have been gradually uncovered, the full identification of biochemical factors and co‐morbidities influencing frailty remains incomplete. Methods: Cross‐sectional and longitudinal analyses were performed to elucidate the risk factors for the prevalence and progression of frailty. The study included 1035 Japanese female outpatients. At baseline, biochemical markers were measured. Co‐morbidities included diabetes mellitus, dyslipidemia, hypertension, vertebral osteoarthritis, and osteoporosis. Frailty levels were assessed using frailty scores ranging from 0 to 5. Prevalence of frailty was judged by a score of 3 or above, and progression was judged by an increase in the frailty score during the observation period. Multiple regression analysis was used for the cross‐sectional analysis, and the Cox hazard model was used for the longitudinal analysis. Results: Of the 1035 selected participants, 212 were diagnosed with frailty. Advanced age and log IL‐6 and branched‐chain amino acids (BCAA) levels were significant independent risk factors for frailty. Subjects were followed for 7.7 ± 5.9 years and progression was observed in 130 subjects. Older age, the absence of hyperlipidemia, the presence of osteoporosis, and lower frailty scores were identified as significant risk factors for frailty progression. Conclusions: Inflammatory and nutritional markers exhibited significant associations with the current frailty status, whereas co‐morbidities such as osteoporosis or hyperlipidemia emerged as independent risk or protective factors of future frailty progression. Geriatr Gerontol Int 2024; 24: 523–528. [ABSTRACT FROM AUTHOR]

Background: Few studies have assessed the burden of mental disorders among children and adolescents considering the impact of co-morbidities and suicide on disability adjusted life years (DALYs). Methods: This was a multicenter cross-sectional study. Our survey data in Liaoning Province (LN) were used to estimate the burden of six mental disorders, supplemented with data from other investigative studies conducted in China to assess four other disorders. DALYs were derived from the sum of years lived with a disability (YLDs) adjusted for co-morbidities, and the years of life lost (YLLs) adjusted for suicide. The changes in DALYs, YLDs, and YLLs were compared with and without adjustment for co-morbidities and suicide. Results: The DALYs rate of mental disorders among children and adolescents in LN decreased from 1579.6/105 to 1391.4/105, after adjusting for both co-morbidities and suicide (-11.9%). The DALYs rate for major depression, anxiety disorder, and conduct disorder (-80.8/105, -75.0/105 and -30.2/105, respectively) were the top three contributors to the DALYs reduction (-188.2/105). The YLDs decreased from 72724.8 to 62478.5 after co-morbidity adjustment (-17.8%), mainly due to the reduction by major depression (-35.3%) and attention deficit/hyperactivity disorder [ADHD] (-34.2%). The YLLs increased from 130 to 1697.8 after adjusting for suicides (+ 56.9% of all suicide YLLs), mainly due to the contribution of major depression (+ 32.4%) and anxiety disorder (+ 10.4%). Compared to GBD 2010, the estimated DALY rate for mental disorders in LN was to be about 80%, with the proportion of DALYs and DALY rates explained by major depressive disorder accounted for only approximately one-third (14.6% vs. 41.9% and 202.6 vs. 759.9, respectively). But the proportion and absolute level of DALY rates explained by anxiety disorders were approximately 2-fold higher (39.7% vs. 19.6% and 552.2 vs. 323.3, respectively). Conclusions: The DALYs of mental disorders among Chinese children and adolescents were approximately 80% of the global level, with anxiety disorders imposing about 2 times the global level. Co-morbidity and suicide must be adjusted when calculating DALYs. [ABSTRACT FROM AUTHOR]

This study aims to establish the significance of social determinants of health and prevalent co-morbidities on multiple indicators for quality of care in patients admitted to the Burn and Surgical Intensive Care Unit (ICU). We performed a retrospective analysis of population group data for patients admitted at the Burn and Surgical ICU from January 1, 2016, to November 18, 2019. The primary outcomes were length of hospital stay (LOS), mortality, 30-day readmission, and hospital charges. Pearson's chi-square test for categorical variables and t-test for continuous variables were used to compare population health groups. We analyzed a total of 487 burn and 510 surgical patients. When comparing ICU patients, we observed significantly higher mean hospital charges and length of stay (LOS) in BICU v. SICU patients with a history of mental health ($93,259.40 v. $50,503.36, p = 0.013 and 16.28 v. 9.16 days, p = 0.0085), end-stage-renal-disease (ESRD) ($653,871.05 v. $75,746.35, p = 0.0047 and 96.15 v. 17.53 days, p = 0.0104), sepsis ($267,979.60 v. $99,154.41, p = <0.001 and 39.1 v. 18.42 days, p = 0.0043), and venous thromboembolism (VTE) ($757,740.50 v. $117,816.40, p = <0.001 and 93.11 v. 20.21 days, p = 0.002). Also, higher mortality was observed in burn patients with ESRD, ST-Elevation Myocardial Infarction (STEMI), sepsis, VTE, and diabetes mellitus. 30-day-readmissions were greater among burn patients with a history of mental health, drug dependence, heart failure, and diabetes mellitus. Our study provides new insights into the variability of outcomes between burn patients treated in different critical care settings, underlining the influence of comorbidities on these outcomes. By comparing burn patients in the BICU with those in the SICU, we aim to highlight how differences in patient backgrounds, including the quality of care received, contribute to these outcomes. This comparison underscores the need for tailored healthcare strategies that consider the unique challenges faced by each patient group, aiming to mitigate disparities in health outcomes and healthcare spending. Further research to develop relevant and timely interventions that can improve these outcomes. • Social factors affect BICU and SICU patients differently. • BICU patients with mental health, renal disease, sepsis, and thrombosis face higher costs and LOS. • BICU patients with renal disease, heart attack, sepsis, thrombosis, and diabetes see higher death rates. • BICU patients with mental health, addiction, heart failure, and diabetes face more readmissions. [ABSTRACT FROM AUTHOR]

Background: Hypertension is a chronic long-stay disease that requires proper treatment management and regular medication assessment, which ensure that the disease does not progress into a disorder. Medication Adherence is an easy access and assessable tool that provides insights about patient compliance to medications and effectiveness of therapy. This helps the physicians to improve patient treatment outcomes and quality of life by addressing the factors that influence medication adherence. Objectives: To assess patient compliance to antihypertensive medications and factors that influence medication adherence. Materials and Methods: A prospective Observational study was conducted in a tertiary care teaching hospital in Hubli among 200 hypertensive patients, the study subjects were selected based on inclusion and exclusion criteria, data was collected and sorted from patient data collection forms. Medication adherence rating scale was used to assess medication adherence among patients. The association between variables such as age, social status, co-morbidities and polypharmacy with medication adherence was determined using Pearson chi-square in SPSS version 25. Results: Our study included 200 hypertensive patients, most of them were males 64%. On assessing Medication adherence rating scale, we found that majority 62.8% of the study subjects adhere to their antihypertensive medication. The association between various factors that influence medication adherence was determined by Pearson Chi-square, we observed that age, social status, co-morbidities and polypharmacy were statistically significant at p=<0.05 with medication adherence. Conclusion: Medication adherence plays a significant role in assessing the patient's response to a treatment and improving their quality of life. Similarly, our study highlights the importance of assessing medication adherence, especially in study subjects with existing co-morbidities and polypharmacy, thus reducing hospital stays and unnecessary side effects. [ABSTRACT FROM AUTHOR]

This study aimed to determine the incidence and prevalence of multiple myeloma (MM) in Finland in 2015–2019, to characterize adult patients newly diagnosed with MM, and to follow-up their overall survival (OS) and treatment patterns until the end of 2020. We sourced the data on inpatient and outpatient diagnoses, outpatient medication use, and date of death from comprehensive, nationwide registers. We identified 2037 incident patients with MM in 2015–2019. On average, the annual crude incidence was 8.8 and the age-standardized incidence (World Standard Population) was 3.3 per 100,000. The crude prevalence at the end of 2019 was 32.7 cases per 100,000 inhabitants ≥ 18 years of age. Median age of the patients at first diagnosis (index date) was 71 years, and 48% were female, the median follow-up being 2.4 years. The median OS was estimated at 4.5 years. The proportion of the patients receiving autologous stem cell transplantation (ASCT) within one year since the index date was 24%, with little variation across study years. Conversely, the proportion of all patients receiving lenalidomide within one year since the index date increased from 27 to 48% overall, and from 39 to 81% among ASCT recipients. The estimated median relapse-free survival after ASCT was 2.9 years. Information on in-hospital MM medication administrations was available for a subset of the study cohort. In this subset, 85.8% of the patients received immunomodulatory drugs and/or proteasome inhibitors within the first year after the index date. [ABSTRACT FROM AUTHOR]

Background: The presence of urinary incontinence (UI) in acute stroke patients indicates poor outcomes in men and women. However, there is a paucity and inconsistency of data on UI risk factors in this group and hence we conducted a sex‐specific analysis to identify risk factors. Methods: Data were collected prospectively (2014–2016) from the Sentinel Stroke National Audit Program for patients admitted to four UK hyperacute stroke units. Relevant risk factors for UI were determined by stepwise multivariable logistic regression, presented as odds ratios (OR) and 95% confidence intervals (CI). Results: The mean (±SD) age of UI onset in men (73.9 year ± 13.1; n = 1593) was significantly earlier than for women (79.8 year ± 12.9; n = 1591: p < 0.001). Older age between 70 and 79 year in men (OR = 1.61: CI = 1.24–2.10) and women (OR = 1.55: CI = 1.12–2.15), or ≥80 year in men (OR = 2.19: CI = 1.71–2.81), and women (OR = 2.07: CI = 1.57–2.74)–reference: <70 year–both predicted UI. In addition, intracranial hemorrhage (reference: acute ischemic stroke) in men (OR = 1.64: CI = 1.22–2.20) and women (OR = 1.75: CI = 1.30–2.34); and prestroke disability (mRS scores ≥ 4) in men (OR = 1.90: CI = 1.02–3.5) and women (OR = 1.62: CI = 1.05–2.49) (reference: mRS scores < 4); and stroke severity at admission: NIHSS scores = 5–15 in men (OR = 1.50: CI = 1.20–1.88) and women (OR = 1.72: CI = 1.37–2.16), and NIHSS scores = 16–42 in men (OR = 4.68: CI = 3.20–6.85) and women (OR = 3.89: CI = 2.82–5.37) (reference: NIHSS scores = 0–4) were also significant. Factors not selected were: a history of congestive heart failure, hypertension, atrial fibrillation, diabetes and previous stroke. Conclusions: We have identified similar risk factors for UI after stroke in men and women including age >70 year, intracranial hemorrhage, prestroke disability and stroke severity. [ABSTRACT FROM AUTHOR]

Background: The roll-out of antiretroviral medicines has improved life expectancy in people living with HIV (PLHIV). This has resulted in more patients being hospitalised for non-communicable diseases, increasing risk for medication errors (MEs). Pharmacists, through medication reconciliation, may identify and reduce MEs in this population. Objectives: To describe the importance of a pharmacist’s involvement in identifying and quantifying types of MEs. Method: A quantitative, prospective observational study was conducted over 14 weeks. A pharmacist reviewed HIV-positive, hospitalised patients’ files, using a data collection instrument, to determine the prevalence of MEs in PLHIV. The study pharmacist recommended appropriate actions to the prescriber to resolve MEs and documented resolution of the MEs. Results: The study population of n = 180 patient files were reviewed 453 times, identifying 466 MEs. Medication errors included incorrect medication reconciliation from history (19; 4.1%), prescription omission (17; 3.7%), duplication of therapy (10; 2.2%), missed doses (265; 57.1%), incorrect dosing (103; 22.2%), incorrect administration frequency (2; 0.4%), incorrect duration of therapy (15; 3.2%) and drug-drug interactions (18; 3.9%). More than half (58.2%) of the MEs were resolved in less than 24 h, with involvement of the pharmacist. Conclusion: This study demonstrates the magnitude of MEs experienced in hospitalised PLHIV and highlights the role clinical pharmacists play in identifying and resolving MEs to improve patient outcomes.

Introduction: COVID-19, a novel disease, appeared in December 2019 in China and rapidly spread across the world. Till the second week of April 2020, high incidence (2.9/100,000) and cases fatality rates (1.7%) were observed in Pakistan. This study was conducted to determine the temporal and spatial distribution of the first 100 deaths attributed to COVID-19 in Pakistan and their associated demographic factors. Method: A record review of the first 100 deaths reported among RT-PCR confirmed COVID-19 cases was conducted. Demographic, epidemiological, and risk factors information was obtained associated comorbidities and clinical signs and symptoms were recorded and frequencies were determined. Results: A total of 100 mortalities with an overall case fatality rate of 1.67% (CFR) were analyzed. The median age of patients was 64.5 years (IQR: 54-70) with 75% (n=75) males. Among all deaths reported, 71 (71%) cases had one or more documented comorbidities at the time of diagnosis. The most frequently reported co-morbidities were: hypertension (67%), followed by Diabetes Mellitus (45%) and Ischemic Heart Diseases (27%). The most frequent presenting symptoms were shortness of breath (87%) and fever (79%). The median duration of illness was eight days (IQR: 4-11 days), the median delay reaching hospital to seek health care was three days (IQR: 0-6 days) while the median duration of hospital stay was also three days (IQR: 1-7 days). Among all, 62% had no history of international travel. The most affected age group was 60-69 years while no death reported in the age group below 20 years.

Abstract Background People with psoriasis live with other long‐term conditions (co‐morbidities) that affect their use of healthcare, but the scale of this is not well characterised. Objectives Estimate the concurrent prevalence of co‐morbidities known to affect the use of healthcare in people living with psoriasis in England. Methods A retrospective cohort study using linked data from the UK's Clinical Practice Research Datalink with Hospital Episode Statistics, Office for National Statistics mortality records, and Index of Multiple Deprivation 2010. A cohort of adults (≥18 years) with psoriasis was matched with a comparator cohort of individuals based on age, sex and registered general practice between April 2007 and December 2017. A predefined list of 21 co‐morbidities was selected from a published measure: the Cambridge Multimorbidity Index (CMI). Descriptive analysis describes prevalence with statistical tests (t tests; two‐sample proportions test) of difference for selected variables. Results The study cohort comprised 372,949 individuals (54,817 psoriasis; and 318,132 matched‐comparator). The calculated CMI general score was statistically higher at 0.54 (standard deviation: 0.9) for psoriasis compared with 0.39 (standard deviation: 0.75) for the matched comparator (t test; p

Introduction: Three years into the Coronavirus Disease-2019 (COVID-19) pandemic, questions linger regarding long-term vaccine efficacy, potential side effects, and the risk of future viral waves. Despite vaccinations, no existing vaccine offers complete protection, contributing to ongoing fears and vaccine hesitancy. Asymptomatic carriers and unattained herd immunity add layers of complexity. This study seeks to examine the status of immunity in vaccinated and unvaccinated individuals amidst the shifting landscape of different Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) variants. Aim: To determine the percentage of unvaccinated individuals who have developed COVID-19 specific antibodies and to compare the factors influencing immunity in both unvaccinated and vaccinated individuals. Materials and Methods: This prospective cohort study was conducted at Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India, from March 2021 to May 2023. Participants, aged 18-82 of both sexes, were divided into two groups. Group-1 comprised our college and hospital staff who were vaccinated, and Group-2 consisted of members from the local community in the Chromepet, Chennai area who remained unvaccinated. Blood samples were collected from both groups to assess immunity status. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS, version 22.0). The tests used included the Chi-square test, p-value, mean, and standard deviation. Results: Blood group “B” was more commonly observed in Group-2. The prevalence of co-morbidities was higher in Group-2. Immunological markers CD4 and CD8 were below normal in some individuals in Group-2. By April 2022, 53 (95%) out of 56 persons in Group-1 and by December 2022, 24 (96%) out of 25 persons in Group-2 tested positive for COVID-specific IgG antibodies. By May 2023, 100% of the volunteers in both groups were found to be positive. Conclusion: This study suggests that natural immunity may be effective in protecting against COVID-19. Whether vaccinated or not, by the end of the two-year study, all individuals in the study group had developed COVID antibodies.

Background: The immune system declines with age, but the impact of chronological age may be affected by sex, co-morbidities, and sociodemographic factors. Objective: The article aims to study infections associated with hospital admission in the elderly in their last year of life and the impact of age, sex, co-morbidities, and sociodemographic factors. Method: A retrospective study based on registry data covering all care visits in Stockholm Region, Sweden, for 7 years was conducted. All deceased subjects with at least one hospital admission with infection as the main diagnosis in the last year of life were compared with subjects with no such admission. Subjects were categorized into three different age-groups 65–79, 80–89, and 90 years and above. Co-morbidity was measured by the Charlson Comorbidity Index (CCI) and sociodemographic factors were assessed using the ‘Mosaic-system’. Subjects living in nursing homes were analyzed separately. Uni- and multivariable logistic regressions were conducted. Results: Of the 55,238 subjects in the study population, 14,192 (26%) had at least one hospital admission due to infection in the last year of life. The risk of having a severe infection increased with age, adjusted odds ratio (OR): 1.30 (1.25–1.36), and 1.60 (1.52–1.69) for the age-groups 80–89 and ≥ 90 compared to the age-group 65–79. The most important factor for infection was a high co-morbidity score; adjusted OR: 1.75 (1.68–1.82). Male sex and living in a less affluent area were weaker risk factors for infections. Conclusion: Chronological age and co-morbidities are independent risk factors of infections associated with hospital admission in the last year in life while male sex and sociodemographic factors have less impact.