BACKGROUND Mild cognitive impairment(MCI)is common in atrial fibrillation(AF)patients and may develop earlier in those with multiple cardiovascular comorbidities,potentially impairing self-management and treatment adh...BACKGROUND Mild cognitive impairment(MCI)is common in atrial fibrillation(AF)patients and may develop earlier in those with multiple cardiovascular comorbidities,potentially impairing self-management and treatment adherence.This study aimed to characterize the prevalence and profile of MCI in AF patients,examine its associations with cardiovascular comorbidities,and assess how these comorbidities influence specific cognitive domains.METHODS This cross-sectional study analyzed data from AF patients who underwent cognitive assessment between 2017 and 2021.Cognitive status was categorized as MCI or non-MCI based on the Montreal Cognitive Assessment.Associations between comorbidities and MCI were assessed by logistic regression,and cognitive domains were compared using the Mann-Whitney U test.RESULTS Of 4136 AF patients(mean age:64.7±9.4 years,64.7%male),33.5%of patients had MCI.Among the AF patients,31.2%of patients had coronary artery disease,20.1%of patients had heart failure,and 18.1%of patients had hypertension.88.7%of patients had left atrial enlargement,and 11.0%of patients had reduced left ventricular ejection fraction.Independent factors associated with higher MCI prevalence included older age(OR=1.04,95%CI:1.03-1.05,P<0.001),lower education level(OR=1.51,95%CI:1.31-1.73,P<0.001),hypertension(OR=1.28,95%CI:1.07-1.52,P=0.001),heart failure(OR=1.24,95%CI:1.04-1.48,P=0.020),and lower left ventricular ejection fraction(OR=1.43,95%CI:1.04-1.98,P=0.028).A higher CHA_(2)DS_(2)-VASc score(OR=1.27,95%CI:1.22-1.33,P<0.001;≥2 points vs.<2 points),and greater atherosclerotic cardiovascular disease burden(OR=1.45,95%CI:1.02-2.08,P=0.040;2 types vs.0 type)were linked to increased MCI risk.These above factors influenced various cognitive domains.CONCLUSIONS MCI is common in AF and closely associated with cardiovascular multimorbidity.Patients with multiple comorbidities are at higher risk,highlighting the importance of routine cognitive assessment to support self-management and integrated care.展开更多
BACKGROUND With an increase in the elderly population,the frequency of hospitalizations in recent years has also risen at a rapid pace.This,in turn,has resulted in poor outcomes and costly treatments.Hospitalization r...BACKGROUND With an increase in the elderly population,the frequency of hospitalizations in recent years has also risen at a rapid pace.This,in turn,has resulted in poor outcomes and costly treatments.Hospitalization rates increase in elderly patients due to a decline in glomerular filtration rate(GFR).AIM To investigate the connection between GFR and comorbidity and reasons for hospitalization in elderly patients.METHODS We analyzed patients aged 75 years and over who were admitted to the internal medicine clinic of a tertiary hospital in Eskisehir.At admission,we calculated GFR values using the Modification of Diet in Renal Disease study formula and classified them into six categories:G1,G2,G3a,G3b,G4,and G5.We analyzed associations with hospitalization diagnoses and comorbidity factors.RESULTS The average age of the patients was 80.8 years(±4.5 years).GFR was 57.287±29.5 mL/kg/1.73 m2 in women and 61.3±31.5 mL/kg/1.73 m2 in men(P=0.106).Most patients were admitted to the hospital at G2 stage(32.8%).The main reasons for hospitalization were anemia(34.4%and 28.6%)and malnutrition(20.9%and 20.8%)in women and men,respectively(P=0.078).The most frequent comor-bidity leading to hospitalization was arterial hypertension(n=168,28%),fo-llowed by diabetes(n=166,27.7%)(P=0.001).CONCLUSION When evaluating geriatric patients,low GFR alone does not provide sufficient information.Patients’comorbid factors should also be taken into account.There is no association between low GFR during hospitalization and hospitalization-Hamarat H.Aging and GFR related diagnoses.Knowing the GFR value before hospitalization will be more informative in such studies.展开更多
Pain is often comorbid with emotional disorders such as anxiety and depression.Hyperexcitability of the anterior cingulate cortex has been implicated in pain and pain-related negative emotions that arise from impairme...Pain is often comorbid with emotional disorders such as anxiety and depression.Hyperexcitability of the anterior cingulate cortex has been implicated in pain and pain-related negative emotions that arise from impairments in inhibitory gamma-aminobutyric acid neurotransmission.This review primarily aims to outline the main circuitry(including the input and output connectivity)of the anterior cingulate cortex and classification and functions of different gamma-aminobutyric acidergic neurons;it also describes the neurotransmitters/neuromodulators affecting these neurons,their intercommunication with other neurons,and their importance in mental comorbidities associated with chronic pain disorders.Improving understanding on their role in pain-related mental comorbidities may facilitate the development of more effective treatments for these conditions.However,the mechanisms that regulate gamma-aminobutyric acidergic systems remain elusive.It is also unclear as to whether the mechanisms are presynaptic or postsynaptic.Further exploration of the complexities of this system may reveal new pathways for research and drug development.展开更多
There is growing evidence that interleukin(IL)-6 plays an important role in neurological and psychiatric disorders.This editorial comments on the study published in the recent issue of the World Journal of Psychiatry,...There is growing evidence that interleukin(IL)-6 plays an important role in neurological and psychiatric disorders.This editorial comments on the study published in the recent issue of the World Journal of Psychiatry,which employed Mendelian randomization to identify a causal relationship between IL-6 receptor blockade and decreased epilepsy incidence.The purpose of this editorial is to highlight the dual effects of IL-6 in epilepsy and its related neuropsychiatric comorbidities.IL-6 plays a critical role in the facilitation of epileptogenesis and maintenance of epileptic seizures and is implicated in neuroinflammatory proce-sses associated with epilepsy.Furthermore,IL-6 significantly influences mood regulation and cognitive dysfunction in patients with epilepsy,highlighting its involvement in neuropsychiatric comorbidities.In summary,IL-6 is not only a pivotal factor in the pathogenesis of epilepsy but also significantly contributes to the emergence of epilepsy-related neuropsychiatric complications.Future resear-ch should prioritize elucidating the specific mechanisms by which IL-6 operates across different subtypes,stages and neuropsychiatric comorbidities of epilepsy,with the aim of developing more precise and effective interventions.Furthermore,the potential of IL-6 as a biomarker for the early diagnosis and prognosis of epile-psy warrants further investigation.展开更多
The novel coronavirus disease 2019(COVID-19)causes serious respiratory illness and related disorders.Vulnerable populations,including those with chronic obstructive pulmonary disease,heart disease,diabetes,chronic kid...The novel coronavirus disease 2019(COVID-19)causes serious respiratory illness and related disorders.Vulnerable populations,including those with chronic obstructive pulmonary disease,heart disease,diabetes,chronic kidney disease,obesity,and the elderly,face an increased risk of severe complications.As the pandemic evolves,various diagnostic techniques are available to detect severe acute respiratory distress syndrome(SARS-CoV-2),including clinical presentation,rapid antigen/antibody testing,molecular testing,supplemental laboratory analysis,and imaging.Based on peer-reviewed data,treatment options include convalescent plasma transfusion,corticosteroids,antivirals,and immunomodulatory medications.Convalescent plasma therapy,historically used in outbreaks like Middle East respiratory syndrome,Ebola,and SARS,is suggested by the World Health Organization for critically ill COVID-19 patients when vaccines or antiviral drugs are unavailable.Neutralizing antibodies in convalescent plasma help control viral load and improve patient outcomes,especially when administered early,though effectiveness varies.The United States Food and Drug Administration has authorized its emergency use for severe COVID-19 cases,but potential risks such as transfusion reactions and transfusion-related acute lung injury require further investigation to establish definitive efficacy.Antiviral agents like Remdesivir,an adenosine nucleotide analog,inhibit viral RNA polymerase and have shown efficacy in reducing COVID-19 severity,leading to its emergency use authorization for hospitalized patients.Other antivirals like ritonavir,lopinavir,and umifenovir disrupt viral replication and entry,but their effectiveness against SARS-CoV-2 remains under investigation.Dexamethasone,a corticosteroid,has been used in critically ill COVID-19 patients to reduce inflammation and prevent respiratory failure,as shown in the RECOVERY trial.Other immunosuppressants like ruxolitinib,baricitinib,and colchicine help modulate the immune response,reducing cytokine storms and inflammation-related complications.However,corticosteroids carry risks such as hyperglycemia,immunosuppression,and delayed viral clearance,requiring careful administration.Systematic reviews of clinical studies revealed that hydroxychloroquine with or without azithromycin did not decrease viral load nor reduce the severity of symptoms,but increased mortality among acutely hospitalized patients.There was no improvement in patients’clinical conditions after 15 days compared to standard treatment.The United States Food and Drug Administration has revoked the authorization for the use of hydroxychloroquine in COVID-19 patients due to the null benefit-risk balance.Monoclonal antibodies like itolizumab,gimsilumab,sarilumab,and tocilizumab are being studied for their ability to reduce the severe inflammatory response in COVID-19 patients,particularly cytokine release syndrome and acute respiratory distress syndrome.These antibodies target specific immune pathways to decrease pro-inflammatory cytokines,with some showing promising results in clinical trials,though their use remains under investigation.The Clustered Regularly Interspaced Short Palindromic Repeats/Cas13 family of enzymes,sequenced from many COVID-19-positive patients,can potentially inhibit SARS-CoV-2 replication,cleave the RNA genome,and aid in the amplification of the genome assay.Cas13 can also target emerging pathogens via an adeno-associated virus vector when delivered to the infected lungs.In addition to pharmacological agents,vaccines effectively prevent symptomatic infection,reduce hospitalizations,minimize mortality rates,and ultimately reduce the severity of the disease.This paper aims to explore the management of patients with underlying conditions who present with COVID-19 to lessen the burden on healthcare systems.展开更多
BACKGROUND A significant association between increased age and an increased risk of metachronous gastric cancer(MGC)following curative endoscopic submucosal dissection(ESD)has previously been reported.AIM To determine...BACKGROUND A significant association between increased age and an increased risk of metachronous gastric cancer(MGC)following curative endoscopic submucosal dissection(ESD)has previously been reported.AIM To determine risk factors for the metachronous occurrence of early gastric cancer(EGC)in elderly individuals.METHODS This retrospective cohort study comprised 653 elderly patients(aged≥65 years)who underwent curative ESD for EGC between January 2014 and June 2020 at Nanjing Drum Tower Hospital.Comprehensive analyses were conducted to compare lifestyle habits,comorbidities,and Helicobacter pylori(H.pylori)infections as potential indicators.RESULTS During a median follow-up of 38 months,46 patients(7.0%,20.46/1000 person-years)developed MGC in the elderly cohort.The cumulative incidences of MGC at 2,3,and 5 years were 3.3%,5.3%,and 11.5%,respectively.In multivariate Cox regression analyses,the independent risk factors for MGC included metabolic dysfunctionassociated steatotic liver disease(MASLD)[hazard ratio(HR)=2.44,95%confidence interval(CI):1.15-5.17],persistent H.pylori infection(HR=10.38,95%CI:3.36-32.07),severe mucosal atrophy(HR=2.71,95%CI:1.45-5.08),and pathological differentiation of EGC(well/moderately differentiated vs poorly differentiated:HR=10.18,95%CI:1.30-79.65).Based on these risk factors,a risk stratification system was developed to categorize individuals into low(0-1 point),intermediate(2-3 points),and high(4-8 points)risk categories for MGC,with cumulative incidence rates of 12.3%,21.6%,and 45%,respectively.CONCLUSION Among elderly individuals,MASLD,persistent H.pylori infection,severe mucosal atrophy,and well/moderately differentiated EGC were associated with an increased risk of MGC.Elderly patients are recommended to adopt healthy lifestyle practices,and undergo regular endoscopic screening and H.pylori testing after curative ESD for EGC.展开更多
In recent years,with the rapid development of digital technology,mobile health technology has been widely used in the medical field.This article reviews the application forms,application effects,and existing problems ...In recent years,with the rapid development of digital technology,mobile health technology has been widely used in the medical field.This article reviews the application forms,application effects,and existing problems of mobile health technology in patients with comorbid coronary heart disease,aiming to provide a reference for the future development of mobile health technology services for patients with comorbid coronary heart disease in China.展开更多
BACKGROUND Patients with inflammatory bowel disease(IBD)are at an increased risk of bacterial pneumonia,contributing to significant morbidity and mortality.While previous studies have identified various risk factors,i...BACKGROUND Patients with inflammatory bowel disease(IBD)are at an increased risk of bacterial pneumonia,contributing to significant morbidity and mortality.While previous studies have identified various risk factors,including medications and comorbidities,the independent contribution of IBD to pneumonia risk remains unclear.We hypothesized that the increased pneumonia risk is primarily driven by factors other than IBD itself.AIM To investigate the relative contributions of IBD,comorbidities,and medications to pneumonia risk in patients with IBD.METHODS We conducted a retrospective cohort study using the All of Us Research Program database(2010-2022).We matched 2810 participants with IBD 1:1 with controls using four propensity score models:(1)Demographics/Lifestyle only;(2)Plus comorbidities;(3)Plus medications;and(4)All factors combined.Then we used Cox proportional hazards models to assess pneumonia risk and logistic regression to evaluate risk factors.RESULTS In the primary analysis of 5620 matched participants,IBD was not independently associated with increased pneumonia risk[hazard ratio(HR)=1.07,95%CI:0.84-1.35]when matched for all factors.However,participants with IBD had significantly higher risk(HR=2.08,95%CI:1.56-2.78)when matched only for demographics and lifestyle factors.Within the IBD cohort,a high comorbidity burden(Charlson Comorbidity Index≥10)[odds ratio(OR)=12.20,95%CI:6.69-23.00]and systemic steroid use(OR=2.26,95%CI:1.21-4.64)were independently associated with increased pneumonia risk.CONCLUSION Comorbidities and systemic steroids,rather than IBD itself,drive pneumonia risk.Management should focus on these factors and prioritize vaccination in high-risk patients.展开更多
Background Based on the China-VHD database,this study sought to develop and validate a Valvular Heart Disease-specific Age-adjusted Comorbidity Index(VHD-ACI)for predicting mortality risk in patients with VHD.Methods&...Background Based on the China-VHD database,this study sought to develop and validate a Valvular Heart Disease-specific Age-adjusted Comorbidity Index(VHD-ACI)for predicting mortality risk in patients with VHD.Methods&Results The China-VHD study was a nationwide,multi-centre multi-centre cohort study enrolling 13,917 patients with moderate or severe VHD across 46 medical centres in China between April-June 2018.After excluding cases with missing key variables,11,459 patients were retained for final analysis.The primary endpoint was 2-year all-cause mortality,with 941 deaths(10.0%)observed during follow-up.The VHD-ACI was derived after identifying 13 independent mortality predictors:cardiomyopathy,myocardial infarction,chronic obstructive pulmonary disease,pulmonary artery hypertension,low body weight,anaemia,hypoalbuminaemia,renal insufficiency,moderate/severe hepatic dysfunction,heart failure,cancer,NYHA functional class and age.The index exhibited good discrimination(AUC,0.79)and calibration(Brier score,0.062)in the total cohort,outperforming both EuroSCORE II and ACCI(P<0.001 for comparison).Internal validation through 100 bootstrap iterations yielded a C statistic of 0.694(95%CI:0.665−0.723)for 2-year mortality prediction.VHD-ACI scores,as a continuous variable(VHD-ACI score:adjusted HR(95%CI):1.263(1.245-1.282),P<0.001)or categorized using thresholds determined by the Yoden index(VHDACI≥9 vs.<9,adjusted HR(95%CI):6.216(5.378-7.184),P<0.001),were independently associated with mortality.The prognostic performance remained consistent across all VHD subtypes(aortic stenosis,aortic regurgitation,mitral stenosis,mitral regurgitation,tricuspid valve disease,mixed aortic/mitral valve disease and multiple VHD),and clinical subgroups stratified by therapeutic strategy,LVEF status(preserved vs.reduced),disease severity and etiology.Conclusion The VHD-ACI is a simple 13-comorbidity algorithm for the prediction of mortality in VHD patients and providing a simple and rapid tool for risk stratification.展开更多
Obese individuals who subsequently sustain a traumatic brain injury(TBI)exhibit worsened outcomes including longer periods of rehabilitation(Eagle et al.,2023).In obese individuals,prolonged symptomology is associated...Obese individuals who subsequently sustain a traumatic brain injury(TBI)exhibit worsened outcomes including longer periods of rehabilitation(Eagle et al.,2023).In obese individuals,prolonged symptomology is associated with increased levels of circulato ry pro-inflammatory marke rs up to 1 year postTBI(Eagle et al.,2023).展开更多
Tuberculosis(TB)remains a leading cause of death among infectious diseases,particularly in poor countries.Viral infections,multidrug-resistant and ex-tensively drug-resistant TB strains,as well as the coexistence of c...Tuberculosis(TB)remains a leading cause of death among infectious diseases,particularly in poor countries.Viral infections,multidrug-resistant and ex-tensively drug-resistant TB strains,as well as the coexistence of chronic illnesses such as diabetes mellitus(DM)greatly aggravate TB morbidity and mortality.DM[particularly type 2 DM(T2DM)]and TB have converged making their control even more challenging.Two contemporary global epidemics,TB-DM behaves like a syndemic,a synergistic confluence of two highly prevalent diseases.T2DM is a risk factor for developing more severe forms of multi-drug resistant-TB and TB recurrence after preventive treatment.Since a bidirectional relationship exists between TB and DM,it is necessary to concurrently treat both,and promote recommendations for the joint management of both diseases.There are also some drug-drug interactions resulting in adverse treatment outcomes in TB-DM patients including treatment failure,and reinfection.In addition,autophagy may play a role in these comorbidities.Therefore,the TB-DM comorbidities present several health challenges,requiring a focus on multidisciplinary collaboration and integrated strategies,to effectively deal with this double burden.To effectively manage the comorbidity,further screening in affected countries,more suitable drugs,and better treatment strategies are required.展开更多
Background:Chitinase-3-like protein-1(CHI3L1),also known as human cartilage glycoprotein-39(HC-gp39),plays a role in several biological processes,including oxidative damage,apoptosis,inflammatory vesicle activation,ma...Background:Chitinase-3-like protein-1(CHI3L1),also known as human cartilage glycoprotein-39(HC-gp39),plays a role in several biological processes,including oxidative damage,apoptosis,inflammatory vesicle activation,macrophage formation,and fibroblast proliferation.Purpose:The potential of CHI3L1 as a biomarker and therapeutic target in allergic disorders and respiratory comorbidities.It also discusses CHI3L1-specific inhibitors and highlights the need for further research on their safety,efficacy,and interactions with other medications.Recent findings:The crucial roles of CHI3L1 in antigen-induced helper T cell 2(Th2)response,antigen sensitization,and IgE production highlight its importance in allergic diseases.Elevated CHI3L1 expression has been noted in various allergic conditions,including asthma,allergic rhinitis,and allergic dermatitis.Plasma CHI3L1 levels are strongly correlated with disease incidence and progression,making it valuable for predicting disease onset and prognosis.Consequently,CHI3L1 has been studied as a potential therapeutic target and diagnostic marker.Conclusion:This review highlights the growing importance of CHI3L1 as a biomarker for allergic diseases,with particular emphasis on its potential in asthma,where it correlates with disease severity.展开更多
The first pandemic wave of coronavirus disease 2019(COVID-19)induced a considerable increase in several antivirals and antibiotics in surface water.The common symptoms of COVID-19 are viral and bacterial infections,wh...The first pandemic wave of coronavirus disease 2019(COVID-19)induced a considerable increase in several antivirals and antibiotics in surface water.The common symptoms of COVID-19 are viral and bacterial infections,while comorbidities(e.g.,hypertension and diabetes)and mental shock(e.g.,insomnia and anxiety)are nonnegligible.Nevertheless,little is known about the long-term impacts of comorbidities and mental shock on organic micropollutants(OMPs)in surface waters.Herein,we monitored 114 OMPs in surface water and wastewater treatment plants(WWTPs)in Wuhan,China,between 2019 and 2021.The pandemic-induced OMP pollution in surface water was confirmed by significant increases in 26 OMP concentrations.Significant increases in four antihypertensives and one diabetic drug suggest that the treatment of comorbidities may induce OMP pollution.Notably,cotinine(a metabolite of nicotine)increased 155 times to 187 ngL1,which might be associated with increased smoking.Additionally,the increases in zolpidem and sulpiride might be the result of worsened insomnia and depression.Hence,it is reasonable to note that mental-health protecting drugs/behavior also contributed to OMP pollution.Among the observed OMPs,telmisartan,lopinavir,and ritonavir were associated with significantly higher ecological risks because of their limited WWTP-removal rate and high ecotoxicity.This study provides new insights into the effects of comorbidities and mental shock on OMPs in surface water during a pandemic and highlights the need to monitor the fate of related pharmaceuticals in the aquatic environment and to improve their removal efficiencies in WWTPs。展开更多
Ageing has a close relationship with chronic non-communicable diseases,such as diabetes mellitus and high blood pressure.These pathologies are often associated with changes in eating habits and promote crucial physiol...Ageing has a close relationship with chronic non-communicable diseases,such as diabetes mellitus and high blood pressure.These pathologies are often associated with changes in eating habits and promote crucial physiological changes which act silently in the long term in the elderly population.Due to the speed of urban development and technological advances,there has been an increase in the population's life expectancy.However,it is essential to know the socio-demographic profile and prevalent comorbidities of the elderly population,which can provide a reliable and broad database to enable the outline of strategies and the promotion of efficient health policies.In this sense,the purpose of this editorial is to contribute to the debate surrounding the article that analysed epidemiological data from the Lugu community.Diabetes mellitus,hypertension and cardiovascular pathologies and their comorbidities were the most prevalent conditions in this community.Such data could contribute to develop public policies constructively and assertively,allowing investments in the prevention and treatment of these pathologies.展开更多
Cytokines like interleukins(ILs)play important roles in inflammation and innate immune.Yang and Zhang carried out an interesting study related to ILs and hepatic diseases.They described the role of ILs in the pathogen...Cytokines like interleukins(ILs)play important roles in inflammation and innate immune.Yang and Zhang carried out an interesting study related to ILs and hepatic diseases.They described the role of ILs in the pathogenesis and resolution of hepatic disorders.The authors summarized alcohol-related liver disease and virus-induced hepatitis,as far as clinical studies a fortiori carried out on ILmediated treatments pertaining to these dysfunctions.This editorial contributes to the review by Yang and Zhang titled,"Interleukins in liver disease treatment",and focuses on therapies mediated by ILs in comorbid liver diseases.The documentary search was conducted on recent pertinent literature,primarily using the Google Scholar and PubMed databases.展开更多
Context: Antiretroviral therapy (ART) helps restore the health status of people living with HIV (PLHIV). Likewise, it increases the risk of overweight/obesity and related comorbidities among the recipients. In countri...Context: Antiretroviral therapy (ART) helps restore the health status of people living with HIV (PLHIV). Likewise, it increases the risk of overweight/obesity and related comorbidities among the recipients. In countries like Botswana where ±84% of PLHIV is on ART, the paucity of data comparing overweight/obesity between HIV-positive on ART and HIV-negative patients may impede clinical and policy decision-making. This study sought to estimate and compare: i) the prevalence of overweight/obesity between HIV-positive on ART and HIV-negative patients;ii) the prevalence of hypertension (HTN), diabetes mellitus (DM)/coronary heart disease (CHD) between HIV-positive patients on ART and HIV-negative patients attending same outpatient departments of general clinics in Gaborone, Botswana. Patients and Methods: Five hundred eighty-one (581) outpatients were recruited in four major clinics of Gaborone, Botswana, between June and July 2019;294 or 51% of them were HIV-negative and 287 or 49% were HIV-positive on ART. The prevalence of overweight/obesity and of HTN and DM/CHD were calculated and examined using stratified analysis. Subgroups were compared using Chi-square analysis with Yates correction or Fisher exact test and t-student test for continuous data. Results: Major findings after stratification of the study population by HIV status were: i) the prevalence of all categories of (BMI), including overweight/obesity, were comparable between HIV-negative-patients and HIV-positive. In fact, there were 24 (8.0%) cases of underweight among HIV-negative-Patients and 15(5%) cases among HIV-positive patients, p = 0.2;145 (49%) HIV-negative-patients and 128 (45%) HIV-positive, p = 0.07 cases of normal weight;72 (25%) HIV-negative-patients and 87 (30%) HIV-positive, p = 0.08, were overweight;53 (18%) HIV-negative-patients and 57 (20%) HIV-positive, p = 0.12, were obese;125 (43%) HIV-negative patients and 144 (50%) HIV-positive, p=0.06 were overweight/obese;ii) the prevalence of HTN and DM/CHD among HIV-positive-patients were significantly lower (p < 0.05) compared to HIV-negative patients: There were 32 (10.9%) cases of HTN among HIV-negative patients compared to 18 (6.3%) cases of HTN among HIV-positive patients, p = 0.001;32 (11%) cases of DM/CHD HIV-negative patients compared to 4 (1.4%) cases of DM/CHD among HIV-positive patients, p = 0.001. Conclusion: the prevalence of overweight/obesity observed between HIV-negative and HIV-positive patients may suggest that the two groups shared the same exposure factors. That HTN and DM/CHD prevalence was lower among HIV-positive compared to HIV-negative patients, is possibly due to interplay factors of ART, HIV or the host population. Further studies are, however, recommended for clarifications.展开更多
Background:With the rapid aging of China’s population and the increasing prevalence of comorbidities in the elderly,psychological crises have become more common.This study aims to investigate the present status of ps...Background:With the rapid aging of China’s population and the increasing prevalence of comorbidities in the elderly,psychological crises have become more common.This study aims to investigate the present status of psychological vulnerability,aging attitudes,and life meaning in elderly patients with comorbidities.Methods:A total of 685 elderly inpatients and outpatients at Renmin Hospital of Wuhan University between July and December 2022 were selected using the simple random sampling method.Social demographic data were collected,and the Attitudes to aging Questionnaire(AAQ),the Chinese Life Meaning Questionnaire(C-MLQ),and the Psychological Vulnerability Scale(C-PVS)were used for the analysis.A total of 685 questionnaires were received,and 602 valid questionnaires were collected,with an effective rate of 87.88%.Data analysis was performed using SPSS V25.0 and AMOS V24.0.Results:The total scores of psychological vulnerability,aging attitudes,and life meaning were 69.4±12.8,80.2±13.5 and 39.2±8.3,respectively.The psychological vulnerability was significantly negatively correlated with life meaning and aging attitudes(r=-0.351,-0.264;p<0.01).There was a significant positive correlation between aging attitudes and life meaning(r=0.515;p<0.01).Life meaning played a partial mediating role between psychological vulnerability and aging attitudes(β=3.070,p<0.05).Conclusion:This study found that the psychological vulnerability in elderly patients with comorbidities was at the lower level,which was related to the elderly patients’aging attitudes and their current status of life meaning.The level of psychological vulnerability in elderly patients with senile-related comorbidities needs to be further improved.Medical workers should pay attention to the psychological vulnerability of elderly patients and improve the identification of psychological crises of such patients.展开更多
Introduction: 2019 coronavirus disease, also known as COVID-19, is a highly contagious respiratory disease, rapidly expanding, caused by a new human coronavirus (SARS-COV-2). COVID-19, the main public health problem i...Introduction: 2019 coronavirus disease, also known as COVID-19, is a highly contagious respiratory disease, rapidly expanding, caused by a new human coronavirus (SARS-COV-2). COVID-19, the main public health problem in Benin since March 2020, is marked by its impact on morbidity and mortality, and its significant socio-economic consequences worldwide. When associated with comorbidity, it can be fatal for the patient. The aim of this work is to study the profile of patients infected with the new coronavirus and presenting one or more associated comorbidities in Benin’s CTEs. Method: This study was carried out in the three (03) CTEs of Benin. It was a retrospective and descriptive study on patients infected with the new coronavirus and presenting at least one associated comorbidity over 11-month period from August 2020 to June 2021. We carried out a thorough recruitment of all patients who tested positive by PCR and were admitted to these centers, presenting at least one comorbidity and whose records were more or less complete during the study period. Results: Out of 819 hospitalized patients during the study period, 516 patients had at least one comorbidity. The hospital prevalence of COVID cases associated with comorbidities in the care centers was 63%. The male gender predominated (57.75%), with a sex ratio (M/F) of 1.37. The over-60 age group was the most represented (49.80%). Comorbidities were dominated respectively by arterial hypertension (68.60%), diabetes (40.31%), obesity (11.05%) and chronic renal failure (7.75%). The symptomatology was polymorphous, but respectively dominated by asthenia (57.56%), fever (51.55%), dyspnea (45.93%) and cough (45.16%). Patient treatment was based on two protocols: one using chloroquine and the other using antiretrovirals (ARVs). The progression was favorable for 76.74% of patients. Conclusion: It is therefore important to reinforce the means of combating comorbidities, in particular hypertension, diabetes, obesity, HIV and chronic renal failure. A particular attention must be paid to the old individuals.展开更多
Introduction: Graves’ disease associated with comorbidities can increase morbidity and mortality. Our objective was to describe the epidemiological, clinical, therapeutic and evolutionary aspects of comorbidities ass...Introduction: Graves’ disease associated with comorbidities can increase morbidity and mortality. Our objective was to describe the epidemiological, clinical, therapeutic and evolutionary aspects of comorbidities associated with Graves’ disease at the Abass hospital center, Ndao. Methods: This was a cross-sectional and descriptive study conducted from January 2020 to December 2020. It focused on patients followed for Graves’ disease at Abass hospital, Ndao de Dakar. Epidemiological, clinical, therapeutic and evolutionary data were evaluated. Results: Three hundred and three eighteen (318) cases were collected, 70 of which had comorbidities (51.15%). The average age was 38.45 years with extremes ranging from 15 to 71 years. Women represented 91.42% of patients. A consultation delay of more than one year was noted in 24.29%. Cardiovascular comorbidities were dominated by hypertension with 30%. Graves’ disease was associated with an evolving pregnancy in 10 women. Endocrine comorbidities were dominated by type 1 diabetes noted in 8.57% each. Biermer’s disease was noted in 2 patients. Female gender was the most common etiological factor of Graves’ disease noted in 64 patients (91.42%). A hereditary predisposition existed in 4 patients (5.71%), stress was noted in 7 patients (10%). 43 patients were under thyrozol (61.42%), 41 patients were on propranolol (58.57%), 14 patients were on carbimazole (20%). A good balance was noted in 44 cases (68.75%) after 9 months of treatment. Conclusion: Graves’ disease is a public health problem with nonspecific signs. It requires screening and treating comorbidities to reduce morbidity and mortality.展开更多
Goal: To determine the type of comorbidity and highlight the complications of adenomectomy and comorbidities. Material and Methods: This is a prospective, descriptive, cross-sectional study lasting six (6) months, fro...Goal: To determine the type of comorbidity and highlight the complications of adenomectomy and comorbidities. Material and Methods: This is a prospective, descriptive, cross-sectional study lasting six (6) months, from July 1, 2022 to December 31, 2022. Patients with BPH on comorbidity condition taken care of during the study period AND have agreed to participate in the study. Results: During our study, 49 cases of benign prostatic hypertrophy with comorbidities were collected, representing a frequency of 29%. The average age ranges for the patients were 43 - 70 years. The age group most affected was 70 to 79 years old (38.80%). Nocturnal urinary frequency was the main reason for consultation present in all our patients. The most frequent comorbidity was hypertension, i.e. 83.70%. The PSA rate between 4 and 10 was the most represented, i.e. 42.86%. The prostate volume was between 61 and 100 ml in 40.82% of patients. Histology showed that it was a benign adenomatous hypertrophy of the prostate in 85.70% and a prostatic adenomyoma in 14.29%. Trans-bladder adenomectomy alone was the most performed technique, i.e. 49%, followed by trans urethral resection of the prostate, i.e. 38.80%. Retention of urine after removal of the catheter was the most observed complication, i.e. 12.20%. Conclusion: Benign prostatic hypertrophy with comorbidities constitutes a frequent association. Because their presence can affect effectiveness and lead to complications.展开更多
基金supported by the National Natural Science Foundation of China(No.82270316)the Beijing Municipal Commission of Science and Technology(Z24-1100007724008).
文摘BACKGROUND Mild cognitive impairment(MCI)is common in atrial fibrillation(AF)patients and may develop earlier in those with multiple cardiovascular comorbidities,potentially impairing self-management and treatment adherence.This study aimed to characterize the prevalence and profile of MCI in AF patients,examine its associations with cardiovascular comorbidities,and assess how these comorbidities influence specific cognitive domains.METHODS This cross-sectional study analyzed data from AF patients who underwent cognitive assessment between 2017 and 2021.Cognitive status was categorized as MCI or non-MCI based on the Montreal Cognitive Assessment.Associations between comorbidities and MCI were assessed by logistic regression,and cognitive domains were compared using the Mann-Whitney U test.RESULTS Of 4136 AF patients(mean age:64.7±9.4 years,64.7%male),33.5%of patients had MCI.Among the AF patients,31.2%of patients had coronary artery disease,20.1%of patients had heart failure,and 18.1%of patients had hypertension.88.7%of patients had left atrial enlargement,and 11.0%of patients had reduced left ventricular ejection fraction.Independent factors associated with higher MCI prevalence included older age(OR=1.04,95%CI:1.03-1.05,P<0.001),lower education level(OR=1.51,95%CI:1.31-1.73,P<0.001),hypertension(OR=1.28,95%CI:1.07-1.52,P=0.001),heart failure(OR=1.24,95%CI:1.04-1.48,P=0.020),and lower left ventricular ejection fraction(OR=1.43,95%CI:1.04-1.98,P=0.028).A higher CHA_(2)DS_(2)-VASc score(OR=1.27,95%CI:1.22-1.33,P<0.001;≥2 points vs.<2 points),and greater atherosclerotic cardiovascular disease burden(OR=1.45,95%CI:1.02-2.08,P=0.040;2 types vs.0 type)were linked to increased MCI risk.These above factors influenced various cognitive domains.CONCLUSIONS MCI is common in AF and closely associated with cardiovascular multimorbidity.Patients with multiple comorbidities are at higher risk,highlighting the importance of routine cognitive assessment to support self-management and integrated care.
文摘BACKGROUND With an increase in the elderly population,the frequency of hospitalizations in recent years has also risen at a rapid pace.This,in turn,has resulted in poor outcomes and costly treatments.Hospitalization rates increase in elderly patients due to a decline in glomerular filtration rate(GFR).AIM To investigate the connection between GFR and comorbidity and reasons for hospitalization in elderly patients.METHODS We analyzed patients aged 75 years and over who were admitted to the internal medicine clinic of a tertiary hospital in Eskisehir.At admission,we calculated GFR values using the Modification of Diet in Renal Disease study formula and classified them into six categories:G1,G2,G3a,G3b,G4,and G5.We analyzed associations with hospitalization diagnoses and comorbidity factors.RESULTS The average age of the patients was 80.8 years(±4.5 years).GFR was 57.287±29.5 mL/kg/1.73 m2 in women and 61.3±31.5 mL/kg/1.73 m2 in men(P=0.106).Most patients were admitted to the hospital at G2 stage(32.8%).The main reasons for hospitalization were anemia(34.4%and 28.6%)and malnutrition(20.9%and 20.8%)in women and men,respectively(P=0.078).The most frequent comor-bidity leading to hospitalization was arterial hypertension(n=168,28%),fo-llowed by diabetes(n=166,27.7%)(P=0.001).CONCLUSION When evaluating geriatric patients,low GFR alone does not provide sufficient information.Patients’comorbid factors should also be taken into account.There is no association between low GFR during hospitalization and hospitalization-Hamarat H.Aging and GFR related diagnoses.Knowing the GFR value before hospitalization will be more informative in such studies.
基金supported by the National Natural Science Foundation of China,Nos.82374561(to JD),82174490(to JF)the Medical and Health Science and Technology Program of Zhejiang Province,No.2021RC098(to JD)the Research Project of Zhejiang Chinese Medical University,Nos.2022JKZKTS44(to JD),2022FSYYZZ07(to JF).
文摘Pain is often comorbid with emotional disorders such as anxiety and depression.Hyperexcitability of the anterior cingulate cortex has been implicated in pain and pain-related negative emotions that arise from impairments in inhibitory gamma-aminobutyric acid neurotransmission.This review primarily aims to outline the main circuitry(including the input and output connectivity)of the anterior cingulate cortex and classification and functions of different gamma-aminobutyric acidergic neurons;it also describes the neurotransmitters/neuromodulators affecting these neurons,their intercommunication with other neurons,and their importance in mental comorbidities associated with chronic pain disorders.Improving understanding on their role in pain-related mental comorbidities may facilitate the development of more effective treatments for these conditions.However,the mechanisms that regulate gamma-aminobutyric acidergic systems remain elusive.It is also unclear as to whether the mechanisms are presynaptic or postsynaptic.Further exploration of the complexities of this system may reveal new pathways for research and drug development.
文摘There is growing evidence that interleukin(IL)-6 plays an important role in neurological and psychiatric disorders.This editorial comments on the study published in the recent issue of the World Journal of Psychiatry,which employed Mendelian randomization to identify a causal relationship between IL-6 receptor blockade and decreased epilepsy incidence.The purpose of this editorial is to highlight the dual effects of IL-6 in epilepsy and its related neuropsychiatric comorbidities.IL-6 plays a critical role in the facilitation of epileptogenesis and maintenance of epileptic seizures and is implicated in neuroinflammatory proce-sses associated with epilepsy.Furthermore,IL-6 significantly influences mood regulation and cognitive dysfunction in patients with epilepsy,highlighting its involvement in neuropsychiatric comorbidities.In summary,IL-6 is not only a pivotal factor in the pathogenesis of epilepsy but also significantly contributes to the emergence of epilepsy-related neuropsychiatric complications.Future resear-ch should prioritize elucidating the specific mechanisms by which IL-6 operates across different subtypes,stages and neuropsychiatric comorbidities of epilepsy,with the aim of developing more precise and effective interventions.Furthermore,the potential of IL-6 as a biomarker for the early diagnosis and prognosis of epile-psy warrants further investigation.
文摘The novel coronavirus disease 2019(COVID-19)causes serious respiratory illness and related disorders.Vulnerable populations,including those with chronic obstructive pulmonary disease,heart disease,diabetes,chronic kidney disease,obesity,and the elderly,face an increased risk of severe complications.As the pandemic evolves,various diagnostic techniques are available to detect severe acute respiratory distress syndrome(SARS-CoV-2),including clinical presentation,rapid antigen/antibody testing,molecular testing,supplemental laboratory analysis,and imaging.Based on peer-reviewed data,treatment options include convalescent plasma transfusion,corticosteroids,antivirals,and immunomodulatory medications.Convalescent plasma therapy,historically used in outbreaks like Middle East respiratory syndrome,Ebola,and SARS,is suggested by the World Health Organization for critically ill COVID-19 patients when vaccines or antiviral drugs are unavailable.Neutralizing antibodies in convalescent plasma help control viral load and improve patient outcomes,especially when administered early,though effectiveness varies.The United States Food and Drug Administration has authorized its emergency use for severe COVID-19 cases,but potential risks such as transfusion reactions and transfusion-related acute lung injury require further investigation to establish definitive efficacy.Antiviral agents like Remdesivir,an adenosine nucleotide analog,inhibit viral RNA polymerase and have shown efficacy in reducing COVID-19 severity,leading to its emergency use authorization for hospitalized patients.Other antivirals like ritonavir,lopinavir,and umifenovir disrupt viral replication and entry,but their effectiveness against SARS-CoV-2 remains under investigation.Dexamethasone,a corticosteroid,has been used in critically ill COVID-19 patients to reduce inflammation and prevent respiratory failure,as shown in the RECOVERY trial.Other immunosuppressants like ruxolitinib,baricitinib,and colchicine help modulate the immune response,reducing cytokine storms and inflammation-related complications.However,corticosteroids carry risks such as hyperglycemia,immunosuppression,and delayed viral clearance,requiring careful administration.Systematic reviews of clinical studies revealed that hydroxychloroquine with or without azithromycin did not decrease viral load nor reduce the severity of symptoms,but increased mortality among acutely hospitalized patients.There was no improvement in patients’clinical conditions after 15 days compared to standard treatment.The United States Food and Drug Administration has revoked the authorization for the use of hydroxychloroquine in COVID-19 patients due to the null benefit-risk balance.Monoclonal antibodies like itolizumab,gimsilumab,sarilumab,and tocilizumab are being studied for their ability to reduce the severe inflammatory response in COVID-19 patients,particularly cytokine release syndrome and acute respiratory distress syndrome.These antibodies target specific immune pathways to decrease pro-inflammatory cytokines,with some showing promising results in clinical trials,though their use remains under investigation.The Clustered Regularly Interspaced Short Palindromic Repeats/Cas13 family of enzymes,sequenced from many COVID-19-positive patients,can potentially inhibit SARS-CoV-2 replication,cleave the RNA genome,and aid in the amplification of the genome assay.Cas13 can also target emerging pathogens via an adeno-associated virus vector when delivered to the infected lungs.In addition to pharmacological agents,vaccines effectively prevent symptomatic infection,reduce hospitalizations,minimize mortality rates,and ultimately reduce the severity of the disease.This paper aims to explore the management of patients with underlying conditions who present with COVID-19 to lessen the burden on healthcare systems.
基金Supported by the National Natural Science Foundation of China,No.81572338 and No.82170548C-class-sponsored research project of the Jiangsu Provincial Six Talent Peaks,No.WSN-078+2 种基金Jiangsu Province“333 High-level Talents Training Project”,No.2016-III-0126the Jiangsu Provincial Key Research and Development Program,No.BE2021601the Postgraduate Research and Practice Innovation Program of Jiangsu Province,No.SJCX24_1037.
文摘BACKGROUND A significant association between increased age and an increased risk of metachronous gastric cancer(MGC)following curative endoscopic submucosal dissection(ESD)has previously been reported.AIM To determine risk factors for the metachronous occurrence of early gastric cancer(EGC)in elderly individuals.METHODS This retrospective cohort study comprised 653 elderly patients(aged≥65 years)who underwent curative ESD for EGC between January 2014 and June 2020 at Nanjing Drum Tower Hospital.Comprehensive analyses were conducted to compare lifestyle habits,comorbidities,and Helicobacter pylori(H.pylori)infections as potential indicators.RESULTS During a median follow-up of 38 months,46 patients(7.0%,20.46/1000 person-years)developed MGC in the elderly cohort.The cumulative incidences of MGC at 2,3,and 5 years were 3.3%,5.3%,and 11.5%,respectively.In multivariate Cox regression analyses,the independent risk factors for MGC included metabolic dysfunctionassociated steatotic liver disease(MASLD)[hazard ratio(HR)=2.44,95%confidence interval(CI):1.15-5.17],persistent H.pylori infection(HR=10.38,95%CI:3.36-32.07),severe mucosal atrophy(HR=2.71,95%CI:1.45-5.08),and pathological differentiation of EGC(well/moderately differentiated vs poorly differentiated:HR=10.18,95%CI:1.30-79.65).Based on these risk factors,a risk stratification system was developed to categorize individuals into low(0-1 point),intermediate(2-3 points),and high(4-8 points)risk categories for MGC,with cumulative incidence rates of 12.3%,21.6%,and 45%,respectively.CONCLUSION Among elderly individuals,MASLD,persistent H.pylori infection,severe mucosal atrophy,and well/moderately differentiated EGC were associated with an increased risk of MGC.Elderly patients are recommended to adopt healthy lifestyle practices,and undergo regular endoscopic screening and H.pylori testing after curative ESD for EGC.
文摘In recent years,with the rapid development of digital technology,mobile health technology has been widely used in the medical field.This article reviews the application forms,application effects,and existing problems of mobile health technology in patients with comorbid coronary heart disease,aiming to provide a reference for the future development of mobile health technology services for patients with comorbid coronary heart disease in China.
基金Supported by The Interdisciplinary Guided Network for Investigation,Translation and Equity for the All of Us Research Program,No.OT2 OD031915.
文摘BACKGROUND Patients with inflammatory bowel disease(IBD)are at an increased risk of bacterial pneumonia,contributing to significant morbidity and mortality.While previous studies have identified various risk factors,including medications and comorbidities,the independent contribution of IBD to pneumonia risk remains unclear.We hypothesized that the increased pneumonia risk is primarily driven by factors other than IBD itself.AIM To investigate the relative contributions of IBD,comorbidities,and medications to pneumonia risk in patients with IBD.METHODS We conducted a retrospective cohort study using the All of Us Research Program database(2010-2022).We matched 2810 participants with IBD 1:1 with controls using four propensity score models:(1)Demographics/Lifestyle only;(2)Plus comorbidities;(3)Plus medications;and(4)All factors combined.Then we used Cox proportional hazards models to assess pneumonia risk and logistic regression to evaluate risk factors.RESULTS In the primary analysis of 5620 matched participants,IBD was not independently associated with increased pneumonia risk[hazard ratio(HR)=1.07,95%CI:0.84-1.35]when matched for all factors.However,participants with IBD had significantly higher risk(HR=2.08,95%CI:1.56-2.78)when matched only for demographics and lifestyle factors.Within the IBD cohort,a high comorbidity burden(Charlson Comorbidity Index≥10)[odds ratio(OR)=12.20,95%CI:6.69-23.00]and systemic steroid use(OR=2.26,95%CI:1.21-4.64)were independently associated with increased pneumonia risk.CONCLUSION Comorbidities and systemic steroids,rather than IBD itself,drive pneumonia risk.Management should focus on these factors and prioritize vaccination in high-risk patients.
基金supported by the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(No.2017-12M-3-002)the National Key R&D Program of China(No.2020YFC2008100).
文摘Background Based on the China-VHD database,this study sought to develop and validate a Valvular Heart Disease-specific Age-adjusted Comorbidity Index(VHD-ACI)for predicting mortality risk in patients with VHD.Methods&Results The China-VHD study was a nationwide,multi-centre multi-centre cohort study enrolling 13,917 patients with moderate or severe VHD across 46 medical centres in China between April-June 2018.After excluding cases with missing key variables,11,459 patients were retained for final analysis.The primary endpoint was 2-year all-cause mortality,with 941 deaths(10.0%)observed during follow-up.The VHD-ACI was derived after identifying 13 independent mortality predictors:cardiomyopathy,myocardial infarction,chronic obstructive pulmonary disease,pulmonary artery hypertension,low body weight,anaemia,hypoalbuminaemia,renal insufficiency,moderate/severe hepatic dysfunction,heart failure,cancer,NYHA functional class and age.The index exhibited good discrimination(AUC,0.79)and calibration(Brier score,0.062)in the total cohort,outperforming both EuroSCORE II and ACCI(P<0.001 for comparison).Internal validation through 100 bootstrap iterations yielded a C statistic of 0.694(95%CI:0.665−0.723)for 2-year mortality prediction.VHD-ACI scores,as a continuous variable(VHD-ACI score:adjusted HR(95%CI):1.263(1.245-1.282),P<0.001)or categorized using thresholds determined by the Yoden index(VHDACI≥9 vs.<9,adjusted HR(95%CI):6.216(5.378-7.184),P<0.001),were independently associated with mortality.The prognostic performance remained consistent across all VHD subtypes(aortic stenosis,aortic regurgitation,mitral stenosis,mitral regurgitation,tricuspid valve disease,mixed aortic/mitral valve disease and multiple VHD),and clinical subgroups stratified by therapeutic strategy,LVEF status(preserved vs.reduced),disease severity and etiology.Conclusion The VHD-ACI is a simple 13-comorbidity algorithm for the prediction of mortality in VHD patients and providing a simple and rapid tool for risk stratification.
文摘Obese individuals who subsequently sustain a traumatic brain injury(TBI)exhibit worsened outcomes including longer periods of rehabilitation(Eagle et al.,2023).In obese individuals,prolonged symptomology is associated with increased levels of circulato ry pro-inflammatory marke rs up to 1 year postTBI(Eagle et al.,2023).
文摘Tuberculosis(TB)remains a leading cause of death among infectious diseases,particularly in poor countries.Viral infections,multidrug-resistant and ex-tensively drug-resistant TB strains,as well as the coexistence of chronic illnesses such as diabetes mellitus(DM)greatly aggravate TB morbidity and mortality.DM[particularly type 2 DM(T2DM)]and TB have converged making their control even more challenging.Two contemporary global epidemics,TB-DM behaves like a syndemic,a synergistic confluence of two highly prevalent diseases.T2DM is a risk factor for developing more severe forms of multi-drug resistant-TB and TB recurrence after preventive treatment.Since a bidirectional relationship exists between TB and DM,it is necessary to concurrently treat both,and promote recommendations for the joint management of both diseases.There are also some drug-drug interactions resulting in adverse treatment outcomes in TB-DM patients including treatment failure,and reinfection.In addition,autophagy may play a role in these comorbidities.Therefore,the TB-DM comorbidities present several health challenges,requiring a focus on multidisciplinary collaboration and integrated strategies,to effectively deal with this double burden.To effectively manage the comorbidity,further screening in affected countries,more suitable drugs,and better treatment strategies are required.
文摘Background:Chitinase-3-like protein-1(CHI3L1),also known as human cartilage glycoprotein-39(HC-gp39),plays a role in several biological processes,including oxidative damage,apoptosis,inflammatory vesicle activation,macrophage formation,and fibroblast proliferation.Purpose:The potential of CHI3L1 as a biomarker and therapeutic target in allergic disorders and respiratory comorbidities.It also discusses CHI3L1-specific inhibitors and highlights the need for further research on their safety,efficacy,and interactions with other medications.Recent findings:The crucial roles of CHI3L1 in antigen-induced helper T cell 2(Th2)response,antigen sensitization,and IgE production highlight its importance in allergic diseases.Elevated CHI3L1 expression has been noted in various allergic conditions,including asthma,allergic rhinitis,and allergic dermatitis.Plasma CHI3L1 levels are strongly correlated with disease incidence and progression,making it valuable for predicting disease onset and prognosis.Consequently,CHI3L1 has been studied as a potential therapeutic target and diagnostic marker.Conclusion:This review highlights the growing importance of CHI3L1 as a biomarker for allergic diseases,with particular emphasis on its potential in asthma,where it correlates with disease severity.
基金supported by the National Natural Science Foundation of China(52221004,52091542,and 51820105011)the Scientific Research Project of China Three Gorges Corporation(201903139)the Research Fund of Vanke School of Public Health(2021JC009),Tsinghua University.
文摘The first pandemic wave of coronavirus disease 2019(COVID-19)induced a considerable increase in several antivirals and antibiotics in surface water.The common symptoms of COVID-19 are viral and bacterial infections,while comorbidities(e.g.,hypertension and diabetes)and mental shock(e.g.,insomnia and anxiety)are nonnegligible.Nevertheless,little is known about the long-term impacts of comorbidities and mental shock on organic micropollutants(OMPs)in surface waters.Herein,we monitored 114 OMPs in surface water and wastewater treatment plants(WWTPs)in Wuhan,China,between 2019 and 2021.The pandemic-induced OMP pollution in surface water was confirmed by significant increases in 26 OMP concentrations.Significant increases in four antihypertensives and one diabetic drug suggest that the treatment of comorbidities may induce OMP pollution.Notably,cotinine(a metabolite of nicotine)increased 155 times to 187 ngL1,which might be associated with increased smoking.Additionally,the increases in zolpidem and sulpiride might be the result of worsened insomnia and depression.Hence,it is reasonable to note that mental-health protecting drugs/behavior also contributed to OMP pollution.Among the observed OMPs,telmisartan,lopinavir,and ritonavir were associated with significantly higher ecological risks because of their limited WWTP-removal rate and high ecotoxicity.This study provides new insights into the effects of comorbidities and mental shock on OMPs in surface water during a pandemic and highlights the need to monitor the fate of related pharmaceuticals in the aquatic environment and to improve their removal efficiencies in WWTPs。
文摘Ageing has a close relationship with chronic non-communicable diseases,such as diabetes mellitus and high blood pressure.These pathologies are often associated with changes in eating habits and promote crucial physiological changes which act silently in the long term in the elderly population.Due to the speed of urban development and technological advances,there has been an increase in the population's life expectancy.However,it is essential to know the socio-demographic profile and prevalent comorbidities of the elderly population,which can provide a reliable and broad database to enable the outline of strategies and the promotion of efficient health policies.In this sense,the purpose of this editorial is to contribute to the debate surrounding the article that analysed epidemiological data from the Lugu community.Diabetes mellitus,hypertension and cardiovascular pathologies and their comorbidities were the most prevalent conditions in this community.Such data could contribute to develop public policies constructively and assertively,allowing investments in the prevention and treatment of these pathologies.
文摘Cytokines like interleukins(ILs)play important roles in inflammation and innate immune.Yang and Zhang carried out an interesting study related to ILs and hepatic diseases.They described the role of ILs in the pathogenesis and resolution of hepatic disorders.The authors summarized alcohol-related liver disease and virus-induced hepatitis,as far as clinical studies a fortiori carried out on ILmediated treatments pertaining to these dysfunctions.This editorial contributes to the review by Yang and Zhang titled,"Interleukins in liver disease treatment",and focuses on therapies mediated by ILs in comorbid liver diseases.The documentary search was conducted on recent pertinent literature,primarily using the Google Scholar and PubMed databases.
文摘Context: Antiretroviral therapy (ART) helps restore the health status of people living with HIV (PLHIV). Likewise, it increases the risk of overweight/obesity and related comorbidities among the recipients. In countries like Botswana where ±84% of PLHIV is on ART, the paucity of data comparing overweight/obesity between HIV-positive on ART and HIV-negative patients may impede clinical and policy decision-making. This study sought to estimate and compare: i) the prevalence of overweight/obesity between HIV-positive on ART and HIV-negative patients;ii) the prevalence of hypertension (HTN), diabetes mellitus (DM)/coronary heart disease (CHD) between HIV-positive patients on ART and HIV-negative patients attending same outpatient departments of general clinics in Gaborone, Botswana. Patients and Methods: Five hundred eighty-one (581) outpatients were recruited in four major clinics of Gaborone, Botswana, between June and July 2019;294 or 51% of them were HIV-negative and 287 or 49% were HIV-positive on ART. The prevalence of overweight/obesity and of HTN and DM/CHD were calculated and examined using stratified analysis. Subgroups were compared using Chi-square analysis with Yates correction or Fisher exact test and t-student test for continuous data. Results: Major findings after stratification of the study population by HIV status were: i) the prevalence of all categories of (BMI), including overweight/obesity, were comparable between HIV-negative-patients and HIV-positive. In fact, there were 24 (8.0%) cases of underweight among HIV-negative-Patients and 15(5%) cases among HIV-positive patients, p = 0.2;145 (49%) HIV-negative-patients and 128 (45%) HIV-positive, p = 0.07 cases of normal weight;72 (25%) HIV-negative-patients and 87 (30%) HIV-positive, p = 0.08, were overweight;53 (18%) HIV-negative-patients and 57 (20%) HIV-positive, p = 0.12, were obese;125 (43%) HIV-negative patients and 144 (50%) HIV-positive, p=0.06 were overweight/obese;ii) the prevalence of HTN and DM/CHD among HIV-positive-patients were significantly lower (p < 0.05) compared to HIV-negative patients: There were 32 (10.9%) cases of HTN among HIV-negative patients compared to 18 (6.3%) cases of HTN among HIV-positive patients, p = 0.001;32 (11%) cases of DM/CHD HIV-negative patients compared to 4 (1.4%) cases of DM/CHD among HIV-positive patients, p = 0.001. Conclusion: the prevalence of overweight/obesity observed between HIV-negative and HIV-positive patients may suggest that the two groups shared the same exposure factors. That HTN and DM/CHD prevalence was lower among HIV-positive compared to HIV-negative patients, is possibly due to interplay factors of ART, HIV or the host population. Further studies are, however, recommended for clarifications.
基金2023 Hubei Provincial Key Laboratory Open Project-Nursing Special Project:2023KFH017Current Status Survey and Interventional Research on Alexithymia in Elderly Cancer Patients(Chaired by Lili Zhang)+3 种基金Wuhan University Clinical Nursing Special Research Cultivation Fund Project:LCHL202307Constructing a Long-Term Care Model Based on Narrative Transport Model to Identify and Reduce the Vulnerability of Psychological Crises in Elderly Patients with Comorbidities(Chaired by Lili Zhang)2022 Hubei Provincial Key Laboratory Open Project-Nursing Special Project:2022KFH030Empirical Study on the Construction and Application of a Frailty Risk Warning Model for Hospitalized Elderly Patients(Chaired by Jiaojiao Wu).
文摘Background:With the rapid aging of China’s population and the increasing prevalence of comorbidities in the elderly,psychological crises have become more common.This study aims to investigate the present status of psychological vulnerability,aging attitudes,and life meaning in elderly patients with comorbidities.Methods:A total of 685 elderly inpatients and outpatients at Renmin Hospital of Wuhan University between July and December 2022 were selected using the simple random sampling method.Social demographic data were collected,and the Attitudes to aging Questionnaire(AAQ),the Chinese Life Meaning Questionnaire(C-MLQ),and the Psychological Vulnerability Scale(C-PVS)were used for the analysis.A total of 685 questionnaires were received,and 602 valid questionnaires were collected,with an effective rate of 87.88%.Data analysis was performed using SPSS V25.0 and AMOS V24.0.Results:The total scores of psychological vulnerability,aging attitudes,and life meaning were 69.4±12.8,80.2±13.5 and 39.2±8.3,respectively.The psychological vulnerability was significantly negatively correlated with life meaning and aging attitudes(r=-0.351,-0.264;p<0.01).There was a significant positive correlation between aging attitudes and life meaning(r=0.515;p<0.01).Life meaning played a partial mediating role between psychological vulnerability and aging attitudes(β=3.070,p<0.05).Conclusion:This study found that the psychological vulnerability in elderly patients with comorbidities was at the lower level,which was related to the elderly patients’aging attitudes and their current status of life meaning.The level of psychological vulnerability in elderly patients with senile-related comorbidities needs to be further improved.Medical workers should pay attention to the psychological vulnerability of elderly patients and improve the identification of psychological crises of such patients.
文摘Introduction: 2019 coronavirus disease, also known as COVID-19, is a highly contagious respiratory disease, rapidly expanding, caused by a new human coronavirus (SARS-COV-2). COVID-19, the main public health problem in Benin since March 2020, is marked by its impact on morbidity and mortality, and its significant socio-economic consequences worldwide. When associated with comorbidity, it can be fatal for the patient. The aim of this work is to study the profile of patients infected with the new coronavirus and presenting one or more associated comorbidities in Benin’s CTEs. Method: This study was carried out in the three (03) CTEs of Benin. It was a retrospective and descriptive study on patients infected with the new coronavirus and presenting at least one associated comorbidity over 11-month period from August 2020 to June 2021. We carried out a thorough recruitment of all patients who tested positive by PCR and were admitted to these centers, presenting at least one comorbidity and whose records were more or less complete during the study period. Results: Out of 819 hospitalized patients during the study period, 516 patients had at least one comorbidity. The hospital prevalence of COVID cases associated with comorbidities in the care centers was 63%. The male gender predominated (57.75%), with a sex ratio (M/F) of 1.37. The over-60 age group was the most represented (49.80%). Comorbidities were dominated respectively by arterial hypertension (68.60%), diabetes (40.31%), obesity (11.05%) and chronic renal failure (7.75%). The symptomatology was polymorphous, but respectively dominated by asthenia (57.56%), fever (51.55%), dyspnea (45.93%) and cough (45.16%). Patient treatment was based on two protocols: one using chloroquine and the other using antiretrovirals (ARVs). The progression was favorable for 76.74% of patients. Conclusion: It is therefore important to reinforce the means of combating comorbidities, in particular hypertension, diabetes, obesity, HIV and chronic renal failure. A particular attention must be paid to the old individuals.
文摘Introduction: Graves’ disease associated with comorbidities can increase morbidity and mortality. Our objective was to describe the epidemiological, clinical, therapeutic and evolutionary aspects of comorbidities associated with Graves’ disease at the Abass hospital center, Ndao. Methods: This was a cross-sectional and descriptive study conducted from January 2020 to December 2020. It focused on patients followed for Graves’ disease at Abass hospital, Ndao de Dakar. Epidemiological, clinical, therapeutic and evolutionary data were evaluated. Results: Three hundred and three eighteen (318) cases were collected, 70 of which had comorbidities (51.15%). The average age was 38.45 years with extremes ranging from 15 to 71 years. Women represented 91.42% of patients. A consultation delay of more than one year was noted in 24.29%. Cardiovascular comorbidities were dominated by hypertension with 30%. Graves’ disease was associated with an evolving pregnancy in 10 women. Endocrine comorbidities were dominated by type 1 diabetes noted in 8.57% each. Biermer’s disease was noted in 2 patients. Female gender was the most common etiological factor of Graves’ disease noted in 64 patients (91.42%). A hereditary predisposition existed in 4 patients (5.71%), stress was noted in 7 patients (10%). 43 patients were under thyrozol (61.42%), 41 patients were on propranolol (58.57%), 14 patients were on carbimazole (20%). A good balance was noted in 44 cases (68.75%) after 9 months of treatment. Conclusion: Graves’ disease is a public health problem with nonspecific signs. It requires screening and treating comorbidities to reduce morbidity and mortality.
文摘Goal: To determine the type of comorbidity and highlight the complications of adenomectomy and comorbidities. Material and Methods: This is a prospective, descriptive, cross-sectional study lasting six (6) months, from July 1, 2022 to December 31, 2022. Patients with BPH on comorbidity condition taken care of during the study period AND have agreed to participate in the study. Results: During our study, 49 cases of benign prostatic hypertrophy with comorbidities were collected, representing a frequency of 29%. The average age ranges for the patients were 43 - 70 years. The age group most affected was 70 to 79 years old (38.80%). Nocturnal urinary frequency was the main reason for consultation present in all our patients. The most frequent comorbidity was hypertension, i.e. 83.70%. The PSA rate between 4 and 10 was the most represented, i.e. 42.86%. The prostate volume was between 61 and 100 ml in 40.82% of patients. Histology showed that it was a benign adenomatous hypertrophy of the prostate in 85.70% and a prostatic adenomyoma in 14.29%. Trans-bladder adenomectomy alone was the most performed technique, i.e. 49%, followed by trans urethral resection of the prostate, i.e. 38.80%. Retention of urine after removal of the catheter was the most observed complication, i.e. 12.20%. Conclusion: Benign prostatic hypertrophy with comorbidities constitutes a frequent association. Because their presence can affect effectiveness and lead to complications.
