Objective:This review examined the co-morbidity of malaria and hypertension in Nigerian adults,with a focus on epidemiological trends,genetic and environmental risk factors,pathophysiological mechanisms,and systemic h...Objective:This review examined the co-morbidity of malaria and hypertension in Nigerian adults,with a focus on epidemiological trends,genetic and environmental risk factors,pathophysiological mechanisms,and systemic healthcare barriers.Methods:A qualitative synthesis of peer-reviewed literature,national health surveys,and institutional reports published between 2000 and 2025 was conducted using thematic analysis.While centered on Nigeria,the review incorporated comparative insights from global studies on renin angiotensin aldosterone system polymorphisms,co-infection dynamics,and health service inequalities.Results:The findings indicate overlapping risk factors including renin angiotensin aldosterone system gene polymorphisms,urbanization,and poverty.Angiotensin Ⅱ demonstrates dual functions,contributing both to malaria suppression and to hypertension pathogenesis.Clinical challenges include diagnostic overlap,adverse drug interactions,and disparities in service delivery between rural and urban populations.These challenges particularly affect older adults and highlight systemic gaps in access,workforce distribution,and policy alignment.Conclusion:The dual burden of malaria and hypertension in Nigeria requires integrated disease management strategies that address both communicable and non-communicable disease risks.Urgent priorities include multisectoral policy reforms,expanded rural health investments,and the adoption of precision medicine approaches guided by genetic profiling.The implications extend to clinical practice through co-screening and tailored treatment protocols and to public health policy,where integrated frameworks are essential to reducing inequities and improving long-term outcomes.展开更多
AIM: To investigate risk factors for severe clostridium difficile associated diarrhoea (CDAD) in hospitalised patients. METHODS: We analysed risk factors for severe CDAD (associated with systemic signs of hypovolemia)...AIM: To investigate risk factors for severe clostridium difficile associated diarrhoea (CDAD) in hospitalised patients. METHODS: We analysed risk factors for severe CDAD (associated with systemic signs of hypovolemia) in 124 hospitalised patients by retrospective chart review. RESULTS: Severe CDAD was present in 27 patients (22%). Statistical analysis showed a significant association with a higher 30-d mortality (33% vs 4%, P < 0.001) and a higher proportion of longer hospital stay exceeding 14 d (74% vs 52%, P = 0.048). Charlson co-morbidity score (OR 1.29 for 1 point increment, P < 0.05) and serum C-reactive protein at diagnosis (OR 1.15 for 10 mg/L increment, P < 0.001) were independent predictors of severe CDAD. CONCLUSION: Patients with a severe level of co- morbidity and high serum C-reactive protein levels at the time of diagnosis should receive particular attention.展开更多
Background: Differences in body composition are extensively investigated in subjects with COPD as low muscle mass was independently associated with increased morbidity and mortality. Also cardio-vascular co-morbidity ...Background: Differences in body composition are extensively investigated in subjects with COPD as low muscle mass was independently associated with increased morbidity and mortality. Also cardio-vascular co-morbidity is often reported in COPD and the contribution of fat mass in COPD related co-morbidity is gaining interest. We hypothesized that the prevalence of low muscle mass and high fat mass is higher in subjects with COPD compared to a group of current and former smokers without COPD, which result in higher reported cardiovascular co-morbidity in the COPD group. Methods: In 954 subjects with COPD and 955 subjects without COPD, body composition was assessed by bio-electrical impedance analysis and information on self-reported co-morbidity was collected. Participants were stratified for low fat free mass index and high fat mass index (resp. fat free mass index 50th percentile of the subjects without COPD). Results: Subjects with COPD were more likely to have low fat free mass index than current and former smokers without COPD. The prevalence of high fat mass index was comparable between the groups. The percentage of self-reported co-morbidity was higher in subjects with COPD, but only reports of myocardial infarction were disease specific. Conclusion: Low fat free mass index was more common in COPD, but the prevalence of high fat mass index was comparable between subjects with and without COPD. Nevertheless, subjects with COPD reported more myocardial infarction, implying that other factors than the amount of fat mass are involved in the increased co-morbidity in COPD.展开更多
The management of Hepatitis C(HCV)varies greatly due to co-morbidities.Association of Type II Diabetes Mellitus(T2DM)and HCV infection is momentous,however,only limited studies available from remote areas of Pakistan....The management of Hepatitis C(HCV)varies greatly due to co-morbidities.Association of Type II Diabetes Mellitus(T2DM)and HCV infection is momentous,however,only limited studies available from remote areas of Pakistan.This study aimed to assess the incidence of T2DM in Hepatitis C patients,and to measure the treatment outcomes of anti-HCV therapy in co-morbidity of diabetic patients in remote areas of Khyber Pakhtunkhwa Pakistan.A cross-sectional retrospective analysis of HCV patients(n=449)was conducted in the District Hospitals of Bannu and Lakki Marwat,Pakistan.Patients diagnosed of HCV infection and having T2DM as comorbidity were included in the study.The demographic information and laboratory parameters,such as viral load(VL),hemoglobin(Hb),alanine amino transferase(ALT),and platelet count were collected to measure treatment outcomes.T2DM was found in 33.18%of patients and significant association(p˂0.05)was found with HCV infection as a co-morbidity.Sofosbuvir(SOF)and Ribavirin(RBV)therapy reduced the mean(SD)VL(×10^(3))from baseline 357.1±26.23 IU/mL to 14±2.3 IU/mL and 1.3±0.3 IU/mL at 3rd and 6th months of therapy,respectively.Conventional Interferon and Ribavirin(RBV)therapy reduced VL from a baseline 234.57±13.5 IU/mL to 72±7.9 IU/mL and 62±3.7 IU/mL at 3rd and 6th months of therapy,respectively.PEG-Interferon+Ribavirin(RBV)therapy reduced baseline VL from 337±16.27 IU/mL to 18±2.8 and 4±1 at 3^(rd) and 6^(th) month of therapy,respectively.Similarly,Hb,ALT,and platelet count showed variations in all the studied groups.T2DM was highly prevalent and significantly associated with HCV in patients of 40 years or above and SOF+RBV combination therapy showed a better response,both in the diabetic and non-diabetic HCV patients compared to earlier the therapies.To further confirm the finding,a study using a larger population of HCV patients with T2DM should be conducted.展开更多
Introduction: Rural residents are at higher risk for a depressive disorder than their non-rural counterparts. Recent research has indicated that co-morbidities are also associated with depression. Health service defic...Introduction: Rural residents are at higher risk for a depressive disorder than their non-rural counterparts. Recent research has indicated that co-morbidities are also associated with depression. Health service deficits (HSDs) is an analytic concept that facilitates the examination of how a population uses health services relevant to their condition. A HSD is present when, over the preceding 12 months, an individual has had no health insurance, no specified health care provider, deferred medical care due to cost, or did not have a routine medical exam. Research has shown a high prevalence of HSDs in populations with individual chronic conditions. No study that we know of has examined if there is an association between the constellation of chronic conditions of depression and the co-morbidities of asthma, arthritis, and diabetes, with HSDs. Methods: 2011 Behavioral Risk Factor Surveillance Survey (BRFSS) data were analyzed to identify important dimensions of the epidemiology of depression by ascertaining whether there were differences in the prevalence of health service deficits in rural versus non-rural adults with depression and at least one additional chronic disease (arthritis, asthma, or diabetes). Data analyses entailed both bivariate and multivariate techniques. All analyses were performed on weighted data. Results: Logistic regression analysis performed using the presence of at least one HSD as the dependent variable yielded that for US adults with lifetime depression those who were African American, Hispanic and other/multiracial in comparison to Caucasian had higher odds of having at least one health service deficit. Low socioeconomic status (SES) and middle SES in comparison to high SES were also risk factors for US adults with lifetime depression having at least one HSD. Rural residency in comparison to non-rural residency also emerged as an independent risk factor (for US adults with lifetime depression having at least one HSD. Chronic disease, however, emerged as protective against US adults with lifetime depression having at least one health service deficit. Conclusions: This study demonstrated that race/ethnicity, SES, and rural residency are important predictors of health service deficits for individuals with a lifetime diagnosis of depression while having one or more chronic conditions for these same individuals was protective.展开更多
Background: Diabetes is a risk factor for depression, but little is known about anxiety and other psychiatric disorders and quality of life. The aim of this study was to assess the prevalence of depression, anxiety in...Background: Diabetes is a risk factor for depression, but little is known about anxiety and other psychiatric disorders and quality of life. The aim of this study was to assess the prevalence of depression, anxiety in diabetic patients in our locality and to assess the quality of life in type 2 DM. Subjects & Methods: This study was a cross-sectional study and was carried out in outpatient clinics of specialized medical hospital, Mansoura university for a period of one year. From 217 diabetes mellitus subjects, only 202 patients were matched with 247 healthy people as a control group. All subjects were examined by using socioeconomic data, clinical data, and anthropometric examinations to assess body mass index and waist circumference. All patients were interviewed by using the Mini-International Neuropsychiatric Interview (MINI) version 5, MINI, Hospital Anxiety and Depression scale (HAD) and health-related quality of life (HRQOL) scales. Laboratory investigation in the form of fasting and two-hour postprandial blood sugar (FBS & 2hpp) and HbA1C levels were done. Results: 18.3% were found to be major depressive disorder;and 2.5% panic disorder, 1% other phobia. Generalized anxiety disorder and obsessive-compulsive disorder were found in one patient, no patients were found to be diagnosed as Bipolar disorder, schizophrenia, or substance abuse. Although there was no statistically significant difference between subjects and control groups regarding height, there was statistically significant difference between weights, BMI, with more scores among DM group. Moreover our study showed that HbA1c, fasting blood sugar, two hours post prandial blood sugar were more among DM patients and control groups. Anxiety, depression, and poorer quality of life were found to be more prevalent among DM patients than control groups. Conclusion: DM is associated with depression anxiety disorder with poorer quality of life.展开更多
In this paper,a deterministic compartmental model is presented to assess the impact of vaccination and non-pharmaceutical interventions(social distance,awareness,face mask,and quarantine)on the transmission dynamics o...In this paper,a deterministic compartmental model is presented to assess the impact of vaccination and non-pharmaceutical interventions(social distance,awareness,face mask,and quarantine)on the transmission dynamics of COVID-19 with co-morbidity and reinfection.An expression for the basic reproduction number is then derived for this model.Theoretical analysis shows that the model exhibits backward bifurcation phenomenon when the basic reproduction number is less than unity.But for the case of no reinfection,the model has a globally asymptotically stable disease-free equilibrium(DFE)when the basic reproduction number is less than unity.Furthermore,it is shown that in the case of no re-infection,a unique endemic equilibrium point(EEP)of the model exists which is globally asymptotically stable whenever the reproduction number is greater than unity.From the global sensitivity and uncertainty analysis,we have identified mask coverage,mask efficacy,vaccine coverage,vaccine efficacy,and contact rate as the most influential parameters influencing the spread of COVID-19.Numerical simulation results show that the use of effective vaccines with proper implementation of non-pharmaceutical interventions could lead to the elimination of COVID-19 from the community.Numerical simulations also suggest that the control strategy that ensures a continuous and effective mass vaccination program is the most cost-effective control strategy.The study also shows that in the presence of any co-morbidity and with the occurrence of re-infection,the disease burden may increase.展开更多
A novel coronavirus(COVID-19)has emerged as a global serious public health issue from December 2019.People having a weak immune system are more susceptible to coronavirus infection.It is a double challenge for people ...A novel coronavirus(COVID-19)has emerged as a global serious public health issue from December 2019.People having a weak immune system are more susceptible to coronavirus infection.It is a double challenge for people of any age with certain underlying medical conditions including cardiovascular disease,diabetes,high blood pressure and cancer etc.Co-morbidity increases the probability of COVID-19 complication.In this paper a deterministic compartmental model is formulated to understand the transmission dynamics of COVID-19.Rigorous mathematical analysis of the model shows that it exhibits backward bifurcation phenomenon when the basic reproduction number is less than unity.For the case of no re-infection it is shown that having the reproduction number less than one is necessary and sufficient for the effective control of COVID-19,that is,the disease free equilibrium is globally asymptotically stable when the reproduction threshold is less than unity.Furthermore,in the absence of reinfection,a unique endemic equilibrium of the model exists which is globally asymptotically stable whenever the reproduction number is greater than unity.Numerical simulations of the model,using data relevant to COVID-19 transmission dynamics,show that the use of efficacious face masks publicly could lead to the elimination of COVID-19 up to a satisfactory level.The study also shows that in the presence of co-morbidity,the disease increases significantly.展开更多
Explanatory models of co-morbid traits related to dental anxiety (DA) as described in the literature were tested and relative strengths analyzed in two groups of Danish adults, one with psychiatric diagnoses (n = 108)...Explanatory models of co-morbid traits related to dental anxiety (DA) as described in the literature were tested and relative strengths analyzed in two groups of Danish adults, one with psychiatric diagnoses (n = 108) and the other healthy incoming patients at a large dental school teaching clinic (n = 151). Dental Anxiety Scale (DAS) and self-report measures representing three co-morbidity explanatory models, 1) presence of other fears;2) anxiety sensitivity and 3) feelings of vulnerability specific to dental treatment, were collected in subscales of a 53-item questionnaire. Other items identified gender, age, education, income, avoidance behavior and dental symptoms. Frequency, chi-square, odds ratio and logistic regression analyses were performed. Results: All individuals with high DA (DAS > 13) regardless of group, demonstrated significant differences in avoidance of treatment (>2 yr.) versus lower or no anxiety. Patients with psychiatric diagnoses were three times more likely to have high DA and nearly two times more likely to have avoided dental treatment >2 yr.;25.9% reported extreme DA, compared to 9.3% of controls. Models of high general fear levels, predisposing anxiety sensitivity and vulnerability all demonstrated significant and strong association with intensity of dental anxiety in bivariate analyses. Feelings of vulnerability were the strongest predictor of DAS high anxiety, according to logistic regression analyses. Conclusion: Co-morbidity explanatory models as represented in present trait measures appear not to be competitive, but rather explain different aspects of a vulnerability model in high dental anxiety. Higher incidence of DA and treatment avoidance in psychiatric patients requires special attention.展开更多
Sex differences in procedural skill learning have not been well characterized. Skill learning is an important area to explore in clinical settings that involve rehabilitation and deficit remediation, especially for re...Sex differences in procedural skill learning have not been well characterized. Skill learning is an important area to explore in clinical settings that involve rehabilitation and deficit remediation, especially for returning Veterans that have a range of co-morbid conditions (traumatic brain injury, posttraumatic stress disorder, and depression) and possess impairments in multiple domains. Sixty-five (55 males, 10 females) Veterans completed two procedural learning tasks and answered self-report questionnaires. Participants’ performance and total learning slope were analyzed to determine sex differences in learning. Our results revealed sex differences in both tasks demonstrating females tend to perform better than males with a large effect size for these mean differences. While females performed better on the procedural learning tasks compared to males, their rate of learning was equivalent. Skill learning is an important requisite for rehabilitation, as skill learning is necessary to perform daily activities in new settings. Ultimately, these results provide insight into skill learning in Veterans with a range of co-morbid conditions and provide support for further investigation of sex differences in procedural learning.展开更多
Anxiety and depressive disorders frequently coexist with gastrointestinal and hepatologic conditions.Despite their high prevalence,approach to treating these co-morbidities is not always straightforward.This paper aim...Anxiety and depressive disorders frequently coexist with gastrointestinal and hepatologic conditions.Despite their high prevalence,approach to treating these co-morbidities is not always straightforward.This paper aims to review the current literature into etiology of psychological comorbidities and their treatment in three conditions commonly encountered at gastroenterology outpatient clinics,namely inflammatory bowel disease(IBD),irritable bowel syndrome(IBS) and chronic hepatitis C(HepC).The paper demonstrates that although psychotherapy(and cognitive-behavioural therapy in particular) has been established as an effective treatment in IBS,more studies are needed in HepC and IBD.Antidepressants have been recognized as an effective treatment for psychological and somatic symptoms in IBS and for depression in HepC,but good quality studies in IBD are lacking despite the promising preliminary findings from animal models and case studies.Further studies in this area are needed.展开更多
<strong>Background:</strong> Novel corona virus (SARS-Coronavirus-2 SARS-CoV-2) which emerged in China has spread to multiple countries rapidly. Little information is known about delayed viral clearance in...<strong>Background:</strong> Novel corona virus (SARS-Coronavirus-2 SARS-CoV-2) which emerged in China has spread to multiple countries rapidly. Little information is known about delayed viral clearance in mild to moderate COVID-19 pa-tients. As it is highly contagious, health care workers including physicians are high risk of being infected in hospital care. <strong>Case Report:</strong> A 37 years old Bangladeshi physician working in a paediatric unit of a medical college hos-pital with multiple co-morbidities, hypertension, diagnosed axial spondy-loarthropathy (ankylosing spondylitis) taking disease modifying anti rheu-matic drugs— DMARDs (Salfasalazine) from 2016 till now, chronic persis-tent bronchial asthma on medication developed sore throat, increasing breathlessness and cough admitted to his own hospital on 22 April, 2020. He had a history of contact with a relapse nephrotic syndrome (glomerulone-phritis) patient admitted with severe respiratory distress later confirmed as COVID-19 following RT PCR test on 14 April, 2020. After 3 days of contact with the patient, the physician also developed the symptoms mentioned above. The RT PCR test result of the physician came positive on 18 April, 2020. The physician primarily taken only azithromycin 500 mg once daily along with other regular drugs. On 5, 12 and 18 May, 2020, his sample was taken for re-test and came positive subsequently. After that he started Iver-mectin (0.15 mg/kg) once daily for 3 days and doxycycline 100 mg BD for 7 days. He gave samples again on 27 and 29 May, 2020 which were came nega-tive after 39 days. On full recovery he was discharged from hospital on day 40. We choose the patient because presence of co-morbidities may be asso-ciated with delayed viral clearance and physicians with co-morbidities working in a hospital have high risk of being infected.展开更多
Accumulating evidence supports that psoriasis may be a potential multisystem inflammatory disease associated with a range of co-morbidities showing an overlapping pathology and an important health impact such as metab...Accumulating evidence supports that psoriasis may be a potential multisystem inflammatory disease associated with a range of co-morbidities showing an overlapping pathology and an important health impact such as metabolic diseases.Psoriasis is associated with an increased risk of obesity,metabolic syndrome(Mets)and diabetes mellitus type 2,following a"dose-response"relationship from mild to severe psoriasis.Conversely,recent evidence from large prospective studies suggests that obesity constitutes a risk factor for psoriasis and psoriatic arthritis.Also,a dyslipidemic profile may precede psoriasis onset.Both obesity,Mets and psoriasis,characterized as chronic inflammatory states,stem from a shared underlying pathophysiology exhibiting common genetic predisposition and risk factors such as high caloric intake,physical inactivity and psychological stress.Excess weight may potentiate the inflammation of psoriasis through the deregulation of adipocytokines while,at the same time,it may help the development of Mets.Interestingly,recent translational data has shown that psoriasis,through increased T-helper inflammatory cytokines in skin and sera,may exert a plethora of effects on insulin regulation and lipid metabolism.Largerpopulation-based prospective cohort and longitudinal studies are needed to unravel the association between psoriasis and metabolic co-morbidities.The recognition of the intricate complex interplay between psoriasis and metabolic co-morbidities may help dermatologists to be aware of associated metabolic co-morbidities in order to screen for metabolic diseases and manage holistically and effectively the psoriatic patient.展开更多
Introduction: Prematurity is the leading cause of neonatal death in Africa. More than a million children die each year due to co-morbidities related to prematurity. In addition to being one of the causes of neonatal d...Introduction: Prematurity is the leading cause of neonatal death in Africa. More than a million children die each year due to co-morbidities related to prematurity. In addition to being one of the causes of neonatal deaths, the health problems associated with prematurity can also lead to severe lifelong impairment in those who survive. Objectives: This paper aims to determine the epidemiology and identify co-morbidities of prematurity in the neonatology units of the Douala General Hospital (DGH) and the Laquintinie Hospital of Douala (LHD). Patients and Methodology: We conducted an analytical retrospective cohort study from January 2015 to January 2018 in the neonatology department of the GDH and the LHD, which are considered reference hospitals for the management of preterm babies in Cameroon. We included all newborns aged less than 37 weeks admitted to the neonatology units of the GDH and the LHD. The descriptive component was based on the analysis of quantitative variables using measures of central tendency. The analytical component was evaluated using Spearman correlations and the Chi-square and Fisher tests. Simple and multiple logistic regressions measured factors predictive of mortality. The Kaplan Meier survival curve used the Log Rank test and significance at p ≤ 0.05. Results: We recorded 908 preterm newborns in neonatal service and 1,124 preterm deliveries in maternity, representing an incidence of 32.5% in neonatal unit and 10.6% in maternity. 51% of whom were girls, given a sex ratio M/F of 0.9. Hypertension was the main prenatal pathology (9.1%), while premature rupture of membranes: PROM (35.5%) and eclampsia/pre-eclampsia (18.6%) were the most common obstetrical pathologies. 75.9% of deliveries were vaginal with 65.2% being performed in our referral hospitals. Gestational age ranged from 22 to 36 weeks, with a mean of 32.4 weeks. Late preterm birth rate was 53.7%, and birth weight varied between 590 and 3200 g with an average of 1747 ± 479 g. The percentage of low birth weight (1500 - 2499 g) preterm infants was predominant (65.3%), and the intrauterine growth restriction (IUGR) was estimated to be 12.4%. The majority (96.7%) had pathologies in the neonatal period, the most common being neonatal infection (86.9%). The case-fatality rate was 27.4%, compared to 72.6% live births. Factors influencing mortality are risk of premature labour, gestational age ≤ 32 SA, premature birth in hospitals other than our two referral hospitals, birth weight ≤ 1500 g, Apgar at the 10th minute, late secondary anaemia, hospital resuscitation, oxygen therapy, and duration of hospitalization Conclusion: The incidence of prematurity and the mortality rate remains high in neonatal units in Cameroon. Adequate monitoring of pregnancies and management of preterm infants remains a challenge in our context.展开更多
BACKGROUND Bilateral hip disorder is a common finding that can occur in approximately 42%of the population with osteoarthritis.It is estimated that 25%individuals with osteoarthritis requiring total hip replacement(TH...BACKGROUND Bilateral hip disorder is a common finding that can occur in approximately 42%of the population with osteoarthritis.It is estimated that 25%individuals with osteoarthritis requiring total hip replacement(THR)may require a bilateral replacement.This has resulted in the test of the greatest strategy to run single staged bilateral hip replacement while addressing the outcomes to achieve swift and cost-effective patient recovery.AIM To assess the outcomes and cost effectiveness of bilateral THR(B/L THR)at our tertiary care hospital.METHODS Retrospective observational cross-sectional study was undertaken from Jan 2018 to July 2023 to assess the clinical outcomes of patients who underwent single stage B/L THR.RESULTS Data of 75 patients were analysed.The mean age was 36 years.Our complication rate was 4.0%including acute coronary syndrome,intra-operative acetabular fracture and paralytic ileus.The re-admission rate was 4%.CONCLUSION The choice of sequential or bilateral hip replacement is controversial.While,our study showed that bilateral hip replacement is safe and cost effective.As surgeons,we were careful in patient selection(low American Society of Anesthesiologist score).Though more than 50%of our B/L THR patients were obese[body mass index(BMI)>25],our outcomes were equivalent to normal BMI patients with lower risk of complication as well as early ambulation.Systemic complication deep vein thrombosis and pulmonary embolism were handled prophylactively by close monitoring,use of mechanical and pharmacological agents along with anticoagulants.Patients who require THR,often require them bilaterally and single stage replacement thus offers early restoration of an individual into their activities of daily living with minimal complications.Our findings support the use of single-stage B/L THR as a viable option for bilateral hip disorders,having favourable outcomes.展开更多
AIM: To evaluate the aetiology, clinical outcome and factors related to mortality of acute upper gastrointestinal bleeding (AUGIB) in octogenarians. METHODS: We reviewed the records of all patients over 65 years old w...AIM: To evaluate the aetiology, clinical outcome and factors related to mortality of acute upper gastrointestinal bleeding (AUGIB) in octogenarians. METHODS: We reviewed the records of all patients over 65 years old who were hospitalised with AUGIB in two hospitals from January 2006 to December of 2006. Patients were divided into two groups: Group A (65-80 years old) and Group B (> 80 years old). RESULTS: Four hundred and sixteen patients over 65 years of age were hospitalized because of AUGIB. Group A included 269 patients and Group B 147 patients. Co-morbidity was more common in octogenarians (P = 0.04). The main cause of bleeding was peptic ulcer in both groups. Rebleeding and emergency surgery were uncommon in octogenarians and not different from those in younger patients. In-hospital complications were more common in octogenarians (P = 0.05) and more patients died in the group of octogenarians compared to the younger age group (P = 0.02). Inability to perform endoscopic examination (P = 0.002), presence of high risk for rebleeding stigmata (P = 0.004), urea on admission (P = 0.036), rebleeding (P = 0.004) and presenceof severe co-morbidity (P < 0.0001) were related to mortality. In multivariate analysis, only the presence of severe co-morbidity was independently related to mortality (P = 0.032). CONCLUSION: While rebleeding and emergency surgery rates are relatively low in octogenarians with AUGIB, the presence of severe co-morbidity is the main factor of adverse outcome.展开更多
Alcohol use disorder （AUD）, mild traumatic brain injury （mTBI）, and posttraumatic stress disorder （PTSD） commonly co-occur （AUD ＋ mTBI ＋ PTSD）. These conditions have overlapping symptoms which are, in part, ...Alcohol use disorder （AUD）, mild traumatic brain injury （mTBI）, and posttraumatic stress disorder （PTSD） commonly co-occur （AUD ＋ mTBI ＋ PTSD）. These conditions have overlapping symptoms which are, in part, reflective of overlapping neuropathology. These conditions become problematic because their co-occurrence can exacerbate symptoms. Therefore, treatments must be developed that are inclusive to all three conditions. Repetitive transcranial magnetic stimulation （rTMS） is non-invasive and may be an ideal treatment for co-occurring AUD ＋ mTBI ＋ PTSD. There is accumulating evidence on rTMS as a treatment for people with AUD, mTBI, and PTSD each alone. However, there are no published studies to date on rTMS as a treatment for co-occurring AUD ＋ mTBI ＋ PTSD. This review article advances the knowledge base for rTMS as a treatment for AUD ＋ mTBI ＋ PTSD. This review provides background information about these co-occurring conditions as well as rTMS. The existing literature on rTMS as a treatment for people with AUD, TBI, and PTSD each alone is reviewed. Finally, neurobiological findings in support of a theoretical model are discussed to inform TMS as a treatment for co-occurring AUD ＋ mTBI ＋ PTSD. The peer-reviewed literature was identified by targeted literature searches using PubMed and supplemented by cross-referencing the bibliographies of relevant review articles. The existing evidence on rTMS as a treatment for these conditions in isolation, coupled with the overlapping neuropathology and symptomology of these conditions, suggests that rTMS may be well suited for the treatment of these conditions together.展开更多
AIM: To analyze the correlation between preexisting comorbidity and other clinicopathological features, short-term surgical outcome and long-term survival in elderly patients with colorectal cancer (CRC). METHODS: Acc...AIM: To analyze the correlation between preexisting comorbidity and other clinicopathological features, short-term surgical outcome and long-term survival in elderly patients with colorectal cancer (CRC). METHODS: According to age, 403 patients operated on for CRC in our department were divided into group A (< 70 years old) and group B (≥ 70 years old) and analyzed statistically. RESULTS: Rectal localization prevailed in group A (31.6% vs 19.7%, P = 0.027), whereas the percentage of R0 resections was 77% in the two groups. Comorbidity rate was 46.2% and 69.1% for group A and B, respectively (P < 0.001), with a huge difference as regards cardiovascular diseases. Overall, postoperative morbidity was 16.9% and 20.8% in group A and B, respectively (P = 0.367), whereas mortality was limited to group B (4.5%, P = 0.001). In both groups, patients who suffered from postoperative complications had a higher overall comorbidity rate, with preexisting cardiovascular diseases prevailing in group B (P = 0.003). Overall 5-year survival rate was significantly betterfor group A (75.2% vs 55%, P = 0.006), whereas no signif icant difference was observed considering disease-specif ic survival (76.3% vs 76.9%, P = 0.674). CONCLUSION: In spite of an increase in postoperative mortality and a lower overall long-term survival for patients aged ≥ 70 years old, it should be considered that, even in the elderly group, a signif icant number of patients is alive 5 years after CRC resection.展开更多
AIM:To evaluate weight loss and surgical outcomes of Roux-en-Y gastric bypass(RYGB)and laparoscopic adjustable gastric band(LAGB).METHODS:Data relating to changes in body mass index(BMI)and procedural complications af...AIM:To evaluate weight loss and surgical outcomes of Roux-en-Y gastric bypass(RYGB)and laparoscopic adjustable gastric band(LAGB).METHODS:Data relating to changes in body mass index(BMI)and procedural complications after RYGB(1995-2009;n=609;116M:493F;42.4±0.4 years)or LAGB(2004-2009;n=686;131M:555F;37.2±0.4years)were extracted from prospective databases.RESULTS:Pre-operative BMI was higher in RYGB than LAGB patients(46.8±7.1 kg/m2vs 40.4±4.2 kg/m2,P<001);more patients with BMI<35 kg/m2underwent LAGB than RYGB(17.1%vs 4.1%,P<0.0001).BMI decrease was greater after RYGB.There were direct relationships between weight loss and pre-operative BMI(P<0.001).Although there was no difference in weight loss between genders during the first 3-year post-surgery,male LAGB patients had greater BMI reduction than females(-8.2±4.3 kg/m2vs-3.9±1.9kg/m2,P=0.02).Peri-operative complications occurred more frequently following RYGB than LAGB(8.0%vs0.5%,P<0.001);majority related to wound infection.LAGB had more long-term complications requiring corrective procedures than RYGB(8.9%vs 2.1%,P<0.001).Conversion to RYGB resulted in greater BMI reduction(-9.5±3.8 kg/m2)compared to removal and replacement of the band(-6.0±3.0 kg/m2).Twelve months post-surgery,fasting glucose,total cholesterol and low density lipoprotein levels were significantly lower with the magnitude of reduction greater in RYGB patients.CONCLUSION:RYGB produces substantially greater weight loss than LAGB.Whilst peri-operative complications are greater after RYGB,long-term complication rate is higher following LAGB.展开更多
Introduction: Hypertension is a public health problem with a high prevalence in Nigeria. The cost of prescription medications is thought to be a barrier for many patients to access the healthcare they need. This study...Introduction: Hypertension is a public health problem with a high prevalence in Nigeria. The cost of prescription medications is thought to be a barrier for many patients to access the healthcare they need. This study was aimed at identifying associated co-morbid conditions, the prescribing patterns and cost of prescription for the treatment of hypertension in an outpatient clinic at Lagos University Teaching Hospital. Materials and Methods: A cross sectional study was carried out. A total of 147 prescriptions were obtained from the case notes of patients treated at the LUTH outpatient department between February 2012 and August 2012. For each prescription, the number of drugs, the class and combinations of antihypertensives were recorded. The monthly cost of a 30-day anti-hypertensive supply based on the recommended daily dose was calculated. Results: The mean age of the patients was 54(+/-14) years and of the 147 prescriptions, 77(52.4%) was for females and 70(47.6%) was for males. The mean systolic blood pressure was 141.6 mmHg (+/-20.5SD) and mean diastolic blood pressure was 86.5 mmHg (+/-13.3SD). Of the 147 prescriptions, 112(76.2%) were for patients with co-morbidities. The frequency of prescription of the various classes of anti hypertensives are;diuretics 117(79.6%), angiotensin receptor blockers 78(53.1%), angiotensin converting enzyme inhibitors 65(44.2%), calcium channel blockers 65 (44.2%) beta blockers 54(36.7%) and centrally acting agents 12(8.2%). Average cost per month was =N=6611.47 (US$44). There was a statistically significant association between co morbid conditions and high cost of prescriptions with 73.7% of those with diabetes and 63.2% of those with renal disease having cost of prescriptions within the high cost group (p < 0.05). Conclusion: The cost per month is high and it is recommended that hypertension should be addressed as part of an integrated care program. Ingenious ways of health care financing also have to be promoted.展开更多
文摘Objective:This review examined the co-morbidity of malaria and hypertension in Nigerian adults,with a focus on epidemiological trends,genetic and environmental risk factors,pathophysiological mechanisms,and systemic healthcare barriers.Methods:A qualitative synthesis of peer-reviewed literature,national health surveys,and institutional reports published between 2000 and 2025 was conducted using thematic analysis.While centered on Nigeria,the review incorporated comparative insights from global studies on renin angiotensin aldosterone system polymorphisms,co-infection dynamics,and health service inequalities.Results:The findings indicate overlapping risk factors including renin angiotensin aldosterone system gene polymorphisms,urbanization,and poverty.Angiotensin Ⅱ demonstrates dual functions,contributing both to malaria suppression and to hypertension pathogenesis.Clinical challenges include diagnostic overlap,adverse drug interactions,and disparities in service delivery between rural and urban populations.These challenges particularly affect older adults and highlight systemic gaps in access,workforce distribution,and policy alignment.Conclusion:The dual burden of malaria and hypertension in Nigeria requires integrated disease management strategies that address both communicable and non-communicable disease risks.Urgent priorities include multisectoral policy reforms,expanded rural health investments,and the adoption of precision medicine approaches guided by genetic profiling.The implications extend to clinical practice through co-screening and tailored treatment protocols and to public health policy,where integrated frameworks are essential to reducing inequities and improving long-term outcomes.
文摘AIM: To investigate risk factors for severe clostridium difficile associated diarrhoea (CDAD) in hospitalised patients. METHODS: We analysed risk factors for severe CDAD (associated with systemic signs of hypovolemia) in 124 hospitalised patients by retrospective chart review. RESULTS: Severe CDAD was present in 27 patients (22%). Statistical analysis showed a significant association with a higher 30-d mortality (33% vs 4%, P < 0.001) and a higher proportion of longer hospital stay exceeding 14 d (74% vs 52%, P = 0.048). Charlson co-morbidity score (OR 1.29 for 1 point increment, P < 0.05) and serum C-reactive protein at diagnosis (OR 1.15 for 10 mg/L increment, P < 0.001) were independent predictors of severe CDAD. CONCLUSION: Patients with a severe level of co- morbidity and high serum C-reactive protein levels at the time of diagnosis should receive particular attention.
文摘Background: Differences in body composition are extensively investigated in subjects with COPD as low muscle mass was independently associated with increased morbidity and mortality. Also cardio-vascular co-morbidity is often reported in COPD and the contribution of fat mass in COPD related co-morbidity is gaining interest. We hypothesized that the prevalence of low muscle mass and high fat mass is higher in subjects with COPD compared to a group of current and former smokers without COPD, which result in higher reported cardiovascular co-morbidity in the COPD group. Methods: In 954 subjects with COPD and 955 subjects without COPD, body composition was assessed by bio-electrical impedance analysis and information on self-reported co-morbidity was collected. Participants were stratified for low fat free mass index and high fat mass index (resp. fat free mass index 50th percentile of the subjects without COPD). Results: Subjects with COPD were more likely to have low fat free mass index than current and former smokers without COPD. The prevalence of high fat mass index was comparable between the groups. The percentage of self-reported co-morbidity was higher in subjects with COPD, but only reports of myocardial infarction were disease specific. Conclusion: Low fat free mass index was more common in COPD, but the prevalence of high fat mass index was comparable between subjects with and without COPD. Nevertheless, subjects with COPD reported more myocardial infarction, implying that other factors than the amount of fat mass are involved in the increased co-morbidity in COPD.
文摘The management of Hepatitis C(HCV)varies greatly due to co-morbidities.Association of Type II Diabetes Mellitus(T2DM)and HCV infection is momentous,however,only limited studies available from remote areas of Pakistan.This study aimed to assess the incidence of T2DM in Hepatitis C patients,and to measure the treatment outcomes of anti-HCV therapy in co-morbidity of diabetic patients in remote areas of Khyber Pakhtunkhwa Pakistan.A cross-sectional retrospective analysis of HCV patients(n=449)was conducted in the District Hospitals of Bannu and Lakki Marwat,Pakistan.Patients diagnosed of HCV infection and having T2DM as comorbidity were included in the study.The demographic information and laboratory parameters,such as viral load(VL),hemoglobin(Hb),alanine amino transferase(ALT),and platelet count were collected to measure treatment outcomes.T2DM was found in 33.18%of patients and significant association(p˂0.05)was found with HCV infection as a co-morbidity.Sofosbuvir(SOF)and Ribavirin(RBV)therapy reduced the mean(SD)VL(×10^(3))from baseline 357.1±26.23 IU/mL to 14±2.3 IU/mL and 1.3±0.3 IU/mL at 3rd and 6th months of therapy,respectively.Conventional Interferon and Ribavirin(RBV)therapy reduced VL from a baseline 234.57±13.5 IU/mL to 72±7.9 IU/mL and 62±3.7 IU/mL at 3rd and 6th months of therapy,respectively.PEG-Interferon+Ribavirin(RBV)therapy reduced baseline VL from 337±16.27 IU/mL to 18±2.8 and 4±1 at 3^(rd) and 6^(th) month of therapy,respectively.Similarly,Hb,ALT,and platelet count showed variations in all the studied groups.T2DM was highly prevalent and significantly associated with HCV in patients of 40 years or above and SOF+RBV combination therapy showed a better response,both in the diabetic and non-diabetic HCV patients compared to earlier the therapies.To further confirm the finding,a study using a larger population of HCV patients with T2DM should be conducted.
文摘Introduction: Rural residents are at higher risk for a depressive disorder than their non-rural counterparts. Recent research has indicated that co-morbidities are also associated with depression. Health service deficits (HSDs) is an analytic concept that facilitates the examination of how a population uses health services relevant to their condition. A HSD is present when, over the preceding 12 months, an individual has had no health insurance, no specified health care provider, deferred medical care due to cost, or did not have a routine medical exam. Research has shown a high prevalence of HSDs in populations with individual chronic conditions. No study that we know of has examined if there is an association between the constellation of chronic conditions of depression and the co-morbidities of asthma, arthritis, and diabetes, with HSDs. Methods: 2011 Behavioral Risk Factor Surveillance Survey (BRFSS) data were analyzed to identify important dimensions of the epidemiology of depression by ascertaining whether there were differences in the prevalence of health service deficits in rural versus non-rural adults with depression and at least one additional chronic disease (arthritis, asthma, or diabetes). Data analyses entailed both bivariate and multivariate techniques. All analyses were performed on weighted data. Results: Logistic regression analysis performed using the presence of at least one HSD as the dependent variable yielded that for US adults with lifetime depression those who were African American, Hispanic and other/multiracial in comparison to Caucasian had higher odds of having at least one health service deficit. Low socioeconomic status (SES) and middle SES in comparison to high SES were also risk factors for US adults with lifetime depression having at least one HSD. Rural residency in comparison to non-rural residency also emerged as an independent risk factor (for US adults with lifetime depression having at least one HSD. Chronic disease, however, emerged as protective against US adults with lifetime depression having at least one health service deficit. Conclusions: This study demonstrated that race/ethnicity, SES, and rural residency are important predictors of health service deficits for individuals with a lifetime diagnosis of depression while having one or more chronic conditions for these same individuals was protective.
文摘Background: Diabetes is a risk factor for depression, but little is known about anxiety and other psychiatric disorders and quality of life. The aim of this study was to assess the prevalence of depression, anxiety in diabetic patients in our locality and to assess the quality of life in type 2 DM. Subjects & Methods: This study was a cross-sectional study and was carried out in outpatient clinics of specialized medical hospital, Mansoura university for a period of one year. From 217 diabetes mellitus subjects, only 202 patients were matched with 247 healthy people as a control group. All subjects were examined by using socioeconomic data, clinical data, and anthropometric examinations to assess body mass index and waist circumference. All patients were interviewed by using the Mini-International Neuropsychiatric Interview (MINI) version 5, MINI, Hospital Anxiety and Depression scale (HAD) and health-related quality of life (HRQOL) scales. Laboratory investigation in the form of fasting and two-hour postprandial blood sugar (FBS & 2hpp) and HbA1C levels were done. Results: 18.3% were found to be major depressive disorder;and 2.5% panic disorder, 1% other phobia. Generalized anxiety disorder and obsessive-compulsive disorder were found in one patient, no patients were found to be diagnosed as Bipolar disorder, schizophrenia, or substance abuse. Although there was no statistically significant difference between subjects and control groups regarding height, there was statistically significant difference between weights, BMI, with more scores among DM group. Moreover our study showed that HbA1c, fasting blood sugar, two hours post prandial blood sugar were more among DM patients and control groups. Anxiety, depression, and poorer quality of life were found to be more prevalent among DM patients than control groups. Conclusion: DM is associated with depression anxiety disorder with poorer quality of life.
文摘In this paper,a deterministic compartmental model is presented to assess the impact of vaccination and non-pharmaceutical interventions(social distance,awareness,face mask,and quarantine)on the transmission dynamics of COVID-19 with co-morbidity and reinfection.An expression for the basic reproduction number is then derived for this model.Theoretical analysis shows that the model exhibits backward bifurcation phenomenon when the basic reproduction number is less than unity.But for the case of no reinfection,the model has a globally asymptotically stable disease-free equilibrium(DFE)when the basic reproduction number is less than unity.Furthermore,it is shown that in the case of no re-infection,a unique endemic equilibrium point(EEP)of the model exists which is globally asymptotically stable whenever the reproduction number is greater than unity.From the global sensitivity and uncertainty analysis,we have identified mask coverage,mask efficacy,vaccine coverage,vaccine efficacy,and contact rate as the most influential parameters influencing the spread of COVID-19.Numerical simulation results show that the use of effective vaccines with proper implementation of non-pharmaceutical interventions could lead to the elimination of COVID-19 from the community.Numerical simulations also suggest that the control strategy that ensures a continuous and effective mass vaccination program is the most cost-effective control strategy.The study also shows that in the presence of any co-morbidity and with the occurrence of re-infection,the disease burden may increase.
文摘A novel coronavirus(COVID-19)has emerged as a global serious public health issue from December 2019.People having a weak immune system are more susceptible to coronavirus infection.It is a double challenge for people of any age with certain underlying medical conditions including cardiovascular disease,diabetes,high blood pressure and cancer etc.Co-morbidity increases the probability of COVID-19 complication.In this paper a deterministic compartmental model is formulated to understand the transmission dynamics of COVID-19.Rigorous mathematical analysis of the model shows that it exhibits backward bifurcation phenomenon when the basic reproduction number is less than unity.For the case of no re-infection it is shown that having the reproduction number less than one is necessary and sufficient for the effective control of COVID-19,that is,the disease free equilibrium is globally asymptotically stable when the reproduction threshold is less than unity.Furthermore,in the absence of reinfection,a unique endemic equilibrium of the model exists which is globally asymptotically stable whenever the reproduction number is greater than unity.Numerical simulations of the model,using data relevant to COVID-19 transmission dynamics,show that the use of efficacious face masks publicly could lead to the elimination of COVID-19 up to a satisfactory level.The study also shows that in the presence of co-morbidity,the disease increases significantly.
文摘Explanatory models of co-morbid traits related to dental anxiety (DA) as described in the literature were tested and relative strengths analyzed in two groups of Danish adults, one with psychiatric diagnoses (n = 108) and the other healthy incoming patients at a large dental school teaching clinic (n = 151). Dental Anxiety Scale (DAS) and self-report measures representing three co-morbidity explanatory models, 1) presence of other fears;2) anxiety sensitivity and 3) feelings of vulnerability specific to dental treatment, were collected in subscales of a 53-item questionnaire. Other items identified gender, age, education, income, avoidance behavior and dental symptoms. Frequency, chi-square, odds ratio and logistic regression analyses were performed. Results: All individuals with high DA (DAS > 13) regardless of group, demonstrated significant differences in avoidance of treatment (>2 yr.) versus lower or no anxiety. Patients with psychiatric diagnoses were three times more likely to have high DA and nearly two times more likely to have avoided dental treatment >2 yr.;25.9% reported extreme DA, compared to 9.3% of controls. Models of high general fear levels, predisposing anxiety sensitivity and vulnerability all demonstrated significant and strong association with intensity of dental anxiety in bivariate analyses. Feelings of vulnerability were the strongest predictor of DAS high anxiety, according to logistic regression analyses. Conclusion: Co-morbidity explanatory models as represented in present trait measures appear not to be competitive, but rather explain different aspects of a vulnerability model in high dental anxiety. Higher incidence of DA and treatment avoidance in psychiatric patients requires special attention.
文摘Sex differences in procedural skill learning have not been well characterized. Skill learning is an important area to explore in clinical settings that involve rehabilitation and deficit remediation, especially for returning Veterans that have a range of co-morbid conditions (traumatic brain injury, posttraumatic stress disorder, and depression) and possess impairments in multiple domains. Sixty-five (55 males, 10 females) Veterans completed two procedural learning tasks and answered self-report questionnaires. Participants’ performance and total learning slope were analyzed to determine sex differences in learning. Our results revealed sex differences in both tasks demonstrating females tend to perform better than males with a large effect size for these mean differences. While females performed better on the procedural learning tasks compared to males, their rate of learning was equivalent. Skill learning is an important requisite for rehabilitation, as skill learning is necessary to perform daily activities in new settings. Ultimately, these results provide insight into skill learning in Veterans with a range of co-morbid conditions and provide support for further investigation of sex differences in procedural learning.
文摘Anxiety and depressive disorders frequently coexist with gastrointestinal and hepatologic conditions.Despite their high prevalence,approach to treating these co-morbidities is not always straightforward.This paper aims to review the current literature into etiology of psychological comorbidities and their treatment in three conditions commonly encountered at gastroenterology outpatient clinics,namely inflammatory bowel disease(IBD),irritable bowel syndrome(IBS) and chronic hepatitis C(HepC).The paper demonstrates that although psychotherapy(and cognitive-behavioural therapy in particular) has been established as an effective treatment in IBS,more studies are needed in HepC and IBD.Antidepressants have been recognized as an effective treatment for psychological and somatic symptoms in IBS and for depression in HepC,but good quality studies in IBD are lacking despite the promising preliminary findings from animal models and case studies.Further studies in this area are needed.
文摘<strong>Background:</strong> Novel corona virus (SARS-Coronavirus-2 SARS-CoV-2) which emerged in China has spread to multiple countries rapidly. Little information is known about delayed viral clearance in mild to moderate COVID-19 pa-tients. As it is highly contagious, health care workers including physicians are high risk of being infected in hospital care. <strong>Case Report:</strong> A 37 years old Bangladeshi physician working in a paediatric unit of a medical college hos-pital with multiple co-morbidities, hypertension, diagnosed axial spondy-loarthropathy (ankylosing spondylitis) taking disease modifying anti rheu-matic drugs— DMARDs (Salfasalazine) from 2016 till now, chronic persis-tent bronchial asthma on medication developed sore throat, increasing breathlessness and cough admitted to his own hospital on 22 April, 2020. He had a history of contact with a relapse nephrotic syndrome (glomerulone-phritis) patient admitted with severe respiratory distress later confirmed as COVID-19 following RT PCR test on 14 April, 2020. After 3 days of contact with the patient, the physician also developed the symptoms mentioned above. The RT PCR test result of the physician came positive on 18 April, 2020. The physician primarily taken only azithromycin 500 mg once daily along with other regular drugs. On 5, 12 and 18 May, 2020, his sample was taken for re-test and came positive subsequently. After that he started Iver-mectin (0.15 mg/kg) once daily for 3 days and doxycycline 100 mg BD for 7 days. He gave samples again on 27 and 29 May, 2020 which were came nega-tive after 39 days. On full recovery he was discharged from hospital on day 40. We choose the patient because presence of co-morbidities may be asso-ciated with delayed viral clearance and physicians with co-morbidities working in a hospital have high risk of being infected.
文摘Accumulating evidence supports that psoriasis may be a potential multisystem inflammatory disease associated with a range of co-morbidities showing an overlapping pathology and an important health impact such as metabolic diseases.Psoriasis is associated with an increased risk of obesity,metabolic syndrome(Mets)and diabetes mellitus type 2,following a"dose-response"relationship from mild to severe psoriasis.Conversely,recent evidence from large prospective studies suggests that obesity constitutes a risk factor for psoriasis and psoriatic arthritis.Also,a dyslipidemic profile may precede psoriasis onset.Both obesity,Mets and psoriasis,characterized as chronic inflammatory states,stem from a shared underlying pathophysiology exhibiting common genetic predisposition and risk factors such as high caloric intake,physical inactivity and psychological stress.Excess weight may potentiate the inflammation of psoriasis through the deregulation of adipocytokines while,at the same time,it may help the development of Mets.Interestingly,recent translational data has shown that psoriasis,through increased T-helper inflammatory cytokines in skin and sera,may exert a plethora of effects on insulin regulation and lipid metabolism.Largerpopulation-based prospective cohort and longitudinal studies are needed to unravel the association between psoriasis and metabolic co-morbidities.The recognition of the intricate complex interplay between psoriasis and metabolic co-morbidities may help dermatologists to be aware of associated metabolic co-morbidities in order to screen for metabolic diseases and manage holistically and effectively the psoriatic patient.
文摘Introduction: Prematurity is the leading cause of neonatal death in Africa. More than a million children die each year due to co-morbidities related to prematurity. In addition to being one of the causes of neonatal deaths, the health problems associated with prematurity can also lead to severe lifelong impairment in those who survive. Objectives: This paper aims to determine the epidemiology and identify co-morbidities of prematurity in the neonatology units of the Douala General Hospital (DGH) and the Laquintinie Hospital of Douala (LHD). Patients and Methodology: We conducted an analytical retrospective cohort study from January 2015 to January 2018 in the neonatology department of the GDH and the LHD, which are considered reference hospitals for the management of preterm babies in Cameroon. We included all newborns aged less than 37 weeks admitted to the neonatology units of the GDH and the LHD. The descriptive component was based on the analysis of quantitative variables using measures of central tendency. The analytical component was evaluated using Spearman correlations and the Chi-square and Fisher tests. Simple and multiple logistic regressions measured factors predictive of mortality. The Kaplan Meier survival curve used the Log Rank test and significance at p ≤ 0.05. Results: We recorded 908 preterm newborns in neonatal service and 1,124 preterm deliveries in maternity, representing an incidence of 32.5% in neonatal unit and 10.6% in maternity. 51% of whom were girls, given a sex ratio M/F of 0.9. Hypertension was the main prenatal pathology (9.1%), while premature rupture of membranes: PROM (35.5%) and eclampsia/pre-eclampsia (18.6%) were the most common obstetrical pathologies. 75.9% of deliveries were vaginal with 65.2% being performed in our referral hospitals. Gestational age ranged from 22 to 36 weeks, with a mean of 32.4 weeks. Late preterm birth rate was 53.7%, and birth weight varied between 590 and 3200 g with an average of 1747 ± 479 g. The percentage of low birth weight (1500 - 2499 g) preterm infants was predominant (65.3%), and the intrauterine growth restriction (IUGR) was estimated to be 12.4%. The majority (96.7%) had pathologies in the neonatal period, the most common being neonatal infection (86.9%). The case-fatality rate was 27.4%, compared to 72.6% live births. Factors influencing mortality are risk of premature labour, gestational age ≤ 32 SA, premature birth in hospitals other than our two referral hospitals, birth weight ≤ 1500 g, Apgar at the 10th minute, late secondary anaemia, hospital resuscitation, oxygen therapy, and duration of hospitalization Conclusion: The incidence of prematurity and the mortality rate remains high in neonatal units in Cameroon. Adequate monitoring of pregnancies and management of preterm infants remains a challenge in our context.
文摘BACKGROUND Bilateral hip disorder is a common finding that can occur in approximately 42%of the population with osteoarthritis.It is estimated that 25%individuals with osteoarthritis requiring total hip replacement(THR)may require a bilateral replacement.This has resulted in the test of the greatest strategy to run single staged bilateral hip replacement while addressing the outcomes to achieve swift and cost-effective patient recovery.AIM To assess the outcomes and cost effectiveness of bilateral THR(B/L THR)at our tertiary care hospital.METHODS Retrospective observational cross-sectional study was undertaken from Jan 2018 to July 2023 to assess the clinical outcomes of patients who underwent single stage B/L THR.RESULTS Data of 75 patients were analysed.The mean age was 36 years.Our complication rate was 4.0%including acute coronary syndrome,intra-operative acetabular fracture and paralytic ileus.The re-admission rate was 4%.CONCLUSION The choice of sequential or bilateral hip replacement is controversial.While,our study showed that bilateral hip replacement is safe and cost effective.As surgeons,we were careful in patient selection(low American Society of Anesthesiologist score).Though more than 50%of our B/L THR patients were obese[body mass index(BMI)>25],our outcomes were equivalent to normal BMI patients with lower risk of complication as well as early ambulation.Systemic complication deep vein thrombosis and pulmonary embolism were handled prophylactively by close monitoring,use of mechanical and pharmacological agents along with anticoagulants.Patients who require THR,often require them bilaterally and single stage replacement thus offers early restoration of an individual into their activities of daily living with minimal complications.Our findings support the use of single-stage B/L THR as a viable option for bilateral hip disorders,having favourable outcomes.
文摘AIM: To evaluate the aetiology, clinical outcome and factors related to mortality of acute upper gastrointestinal bleeding (AUGIB) in octogenarians. METHODS: We reviewed the records of all patients over 65 years old who were hospitalised with AUGIB in two hospitals from January 2006 to December of 2006. Patients were divided into two groups: Group A (65-80 years old) and Group B (> 80 years old). RESULTS: Four hundred and sixteen patients over 65 years of age were hospitalized because of AUGIB. Group A included 269 patients and Group B 147 patients. Co-morbidity was more common in octogenarians (P = 0.04). The main cause of bleeding was peptic ulcer in both groups. Rebleeding and emergency surgery were uncommon in octogenarians and not different from those in younger patients. In-hospital complications were more common in octogenarians (P = 0.05) and more patients died in the group of octogenarians compared to the younger age group (P = 0.02). Inability to perform endoscopic examination (P = 0.002), presence of high risk for rebleeding stigmata (P = 0.004), urea on admission (P = 0.036), rebleeding (P = 0.004) and presenceof severe co-morbidity (P < 0.0001) were related to mortality. In multivariate analysis, only the presence of severe co-morbidity was independently related to mortality (P = 0.032). CONCLUSION: While rebleeding and emergency surgery rates are relatively low in octogenarians with AUGIB, the presence of severe co-morbidity is the main factor of adverse outcome.
基金supported with resources by Department of Veterans Affairs(VA),Health Services Research and Development Service and the Office of Academic Affiliations(TPP 42-013)at Edward Hines VA Hospitalsupported by the following:VA OAA Polytrauma Fellowship to AAH,NIDRR Merit Switzer Research Fellowship Award H133F130011to AAH and the VA RR&D CDA-II RX000949-01A2 to AAH
文摘Alcohol use disorder （AUD）, mild traumatic brain injury （mTBI）, and posttraumatic stress disorder （PTSD） commonly co-occur （AUD ＋ mTBI ＋ PTSD）. These conditions have overlapping symptoms which are, in part, reflective of overlapping neuropathology. These conditions become problematic because their co-occurrence can exacerbate symptoms. Therefore, treatments must be developed that are inclusive to all three conditions. Repetitive transcranial magnetic stimulation （rTMS） is non-invasive and may be an ideal treatment for co-occurring AUD ＋ mTBI ＋ PTSD. There is accumulating evidence on rTMS as a treatment for people with AUD, mTBI, and PTSD each alone. However, there are no published studies to date on rTMS as a treatment for co-occurring AUD ＋ mTBI ＋ PTSD. This review article advances the knowledge base for rTMS as a treatment for AUD ＋ mTBI ＋ PTSD. This review provides background information about these co-occurring conditions as well as rTMS. The existing literature on rTMS as a treatment for people with AUD, TBI, and PTSD each alone is reviewed. Finally, neurobiological findings in support of a theoretical model are discussed to inform TMS as a treatment for co-occurring AUD ＋ mTBI ＋ PTSD. The peer-reviewed literature was identified by targeted literature searches using PubMed and supplemented by cross-referencing the bibliographies of relevant review articles. The existing evidence on rTMS as a treatment for these conditions in isolation, coupled with the overlapping neuropathology and symptomology of these conditions, suggests that rTMS may be well suited for the treatment of these conditions together.
文摘AIM: To analyze the correlation between preexisting comorbidity and other clinicopathological features, short-term surgical outcome and long-term survival in elderly patients with colorectal cancer (CRC). METHODS: According to age, 403 patients operated on for CRC in our department were divided into group A (< 70 years old) and group B (≥ 70 years old) and analyzed statistically. RESULTS: Rectal localization prevailed in group A (31.6% vs 19.7%, P = 0.027), whereas the percentage of R0 resections was 77% in the two groups. Comorbidity rate was 46.2% and 69.1% for group A and B, respectively (P < 0.001), with a huge difference as regards cardiovascular diseases. Overall, postoperative morbidity was 16.9% and 20.8% in group A and B, respectively (P = 0.367), whereas mortality was limited to group B (4.5%, P = 0.001). In both groups, patients who suffered from postoperative complications had a higher overall comorbidity rate, with preexisting cardiovascular diseases prevailing in group B (P = 0.003). Overall 5-year survival rate was significantly betterfor group A (75.2% vs 55%, P = 0.006), whereas no signif icant difference was observed considering disease-specif ic survival (76.3% vs 76.9%, P = 0.674). CONCLUSION: In spite of an increase in postoperative mortality and a lower overall long-term survival for patients aged ≥ 70 years old, it should be considered that, even in the elderly group, a signif icant number of patients is alive 5 years after CRC resection.
文摘AIM:To evaluate weight loss and surgical outcomes of Roux-en-Y gastric bypass(RYGB)and laparoscopic adjustable gastric band(LAGB).METHODS:Data relating to changes in body mass index(BMI)and procedural complications after RYGB(1995-2009;n=609;116M:493F;42.4±0.4 years)or LAGB(2004-2009;n=686;131M:555F;37.2±0.4years)were extracted from prospective databases.RESULTS:Pre-operative BMI was higher in RYGB than LAGB patients(46.8±7.1 kg/m2vs 40.4±4.2 kg/m2,P<001);more patients with BMI<35 kg/m2underwent LAGB than RYGB(17.1%vs 4.1%,P<0.0001).BMI decrease was greater after RYGB.There were direct relationships between weight loss and pre-operative BMI(P<0.001).Although there was no difference in weight loss between genders during the first 3-year post-surgery,male LAGB patients had greater BMI reduction than females(-8.2±4.3 kg/m2vs-3.9±1.9kg/m2,P=0.02).Peri-operative complications occurred more frequently following RYGB than LAGB(8.0%vs0.5%,P<0.001);majority related to wound infection.LAGB had more long-term complications requiring corrective procedures than RYGB(8.9%vs 2.1%,P<0.001).Conversion to RYGB resulted in greater BMI reduction(-9.5±3.8 kg/m2)compared to removal and replacement of the band(-6.0±3.0 kg/m2).Twelve months post-surgery,fasting glucose,total cholesterol and low density lipoprotein levels were significantly lower with the magnitude of reduction greater in RYGB patients.CONCLUSION:RYGB produces substantially greater weight loss than LAGB.Whilst peri-operative complications are greater after RYGB,long-term complication rate is higher following LAGB.
文摘Introduction: Hypertension is a public health problem with a high prevalence in Nigeria. The cost of prescription medications is thought to be a barrier for many patients to access the healthcare they need. This study was aimed at identifying associated co-morbid conditions, the prescribing patterns and cost of prescription for the treatment of hypertension in an outpatient clinic at Lagos University Teaching Hospital. Materials and Methods: A cross sectional study was carried out. A total of 147 prescriptions were obtained from the case notes of patients treated at the LUTH outpatient department between February 2012 and August 2012. For each prescription, the number of drugs, the class and combinations of antihypertensives were recorded. The monthly cost of a 30-day anti-hypertensive supply based on the recommended daily dose was calculated. Results: The mean age of the patients was 54(+/-14) years and of the 147 prescriptions, 77(52.4%) was for females and 70(47.6%) was for males. The mean systolic blood pressure was 141.6 mmHg (+/-20.5SD) and mean diastolic blood pressure was 86.5 mmHg (+/-13.3SD). Of the 147 prescriptions, 112(76.2%) were for patients with co-morbidities. The frequency of prescription of the various classes of anti hypertensives are;diuretics 117(79.6%), angiotensin receptor blockers 78(53.1%), angiotensin converting enzyme inhibitors 65(44.2%), calcium channel blockers 65 (44.2%) beta blockers 54(36.7%) and centrally acting agents 12(8.2%). Average cost per month was =N=6611.47 (US$44). There was a statistically significant association between co morbid conditions and high cost of prescriptions with 73.7% of those with diabetes and 63.2% of those with renal disease having cost of prescriptions within the high cost group (p < 0.05). Conclusion: The cost per month is high and it is recommended that hypertension should be addressed as part of an integrated care program. Ingenious ways of health care financing also have to be promoted.
