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Almeida SS, Christensen MC, Simonsen K, Adair M. Effectiveness of vortioxetine in patients with major depressive disorder and co-morbid generalized anxiety disorder in routine clinical practice: A subgroup analysis of the RELIEVE study. J Psychopharmacol 2022; 37:279-288. [PMID: 36377523 PMCID: PMC10076342 DOI: 10.1177/02698811221132468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Generalized anxiety disorder (GAD) is commonly co-morbid with major depressive disorder (MDD) and is associated with greater functional impairment and poorer treatment outcomes than MDD alone. However, studies on treatment with drugs for depression in patients with MDD and co-morbid GAD are limited. AIMS To examine the effectiveness of vortioxetine treatment in patients with MDD and co-morbid GAD in a subgroup analysis of the real-world RELIEVE study. METHODS The analysis included outpatients diagnosed with MDD and co-morbid GAD who initiated vortioxetine treatment at their physician's discretion in the 24-week, observational RELIEVE study. Primary outcome was patient functioning (Sheehan Disability Scale (SDS)) after 12 and 24 weeks of vortioxetine treatment; secondary outcomes included depression severity (9-item Patient Health Questionnaire (PHQ-9)), cognitive symptoms (5-item Perceived Deficits Questionnaire - Depression (PDQ-D-5)) and cognitive performance (Digit Symbol Substitution Test (DSST)). RESULTS Overall, 180 patients with MDD and co-morbid GAD were included in the analysis. Following vortioxetine initiation, clinically significant improvements in patient functioning (SDS total score) were observed at week 12 (least-squares (LS) mean reduction from baseline, 7.5 points), sustained through week 24 (9.2 points) (both p < 0.0001). LS mean PHQ-9, PDQ-D-5 and DSST scores improved by 7.9, 4.8 and 7.4 points at week 24, respectively (all p < 0.0001 vs baseline). Adverse events were reported by 33.9% of patients (most commonly nausea, 13.3%). CONCLUSIONS In routine clinical practice, vortioxetine was associated with clinically meaningful, sustained improvements in functioning, and depressive and cognitive symptoms, in patients with MDD and co-morbid GAD. CLINICAL TRIALS REGISTRY NAME AND IDENTIFIER Real-life Effectiveness of Vortioxetine in Depression (RELIEVE) (NCT03555136) https://clinicaltrials.gov/ct2/show/NCT03555136.
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Leader G, Whelan S, Chonaill NN, Coyne R, Tones M, Heussler H, Bellgard M, Mannion A. Association between early and current gastro-intestinal symptoms and co-morbidities in children and adolescents with Angelman syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2022; 66:865-879. [PMID: 36052644 PMCID: PMC9826167 DOI: 10.1111/jir.12975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 07/22/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Angelman syndrome (AS) is a neurogenetic disorder that causes severe intellectual disability, expressive language deficits, motor impairment, ataxia, sleep problems, epileptic seizures and a happy disposition. People with AS frequently experience gastrointestinal (GI) symptoms. METHOD This study used data from the Global Angelman Syndrome Registry to explore the relationship between early and current GI symptoms and co-morbidity in children and adolescents with AS (n = 173). Two groups that experienced a high (n = 91) and a low (n = 82) frequency of GI symptoms were examined in relation to feeding and GI history in infancy, sleep and toileting problems, levels of language and communication and challenging behaviours. Predictors of GI symptoms were then investigated using a series of logistic regressions. RESULTS This analysis found that constipation and gastroesophageal reflux affected 84% and 64%, of the sample, respectively. The high frequency of GI symptoms were significantly associated with: 'refusal to nurse', 'vomiting', 'arching', 'difficulty gaining weight', gastroesophageal reflux, 'solid food transition', frequency of night-time urinary continence and sleep hyperhidrosis during infancy. GI symptoms were not significantly associated with sleep, toileting, language or challenging behaviours. Significant predictors of high frequency GI symptoms were gastroesophageal reflux and sleep hyperhidrosis. CONCLUSIONS Future research needs to investigate the association between AS and GI co-morbidity in adults with AS.
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Munisankar S, Rajamanickam A, Balasubramanian S, Muthusamy S, Menon PA, Ahamed SF, Whalen C, Gumne P, Kaur I, Nadimpalli V, Deverakonda A, Chen Z, Otto JD, Habitegiyorgis T, Kandaswamy H, Babu S. Prevalence of proximate risk factors of active tuberculosis in latent tuberculosis infection: A cross-sectional study from South India. Front Public Health 2022; 10:1011388. [PMID: 36276400 PMCID: PMC9583021 DOI: 10.3389/fpubh.2022.1011388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/14/2022] [Indexed: 01/27/2023] Open
Abstract
The prevalence of proximate risk factors for active tuberculosis (TB) in areas of high prevalence of latent tuberculosis infection (LTBI) is not clearly understood. We aimed at assessing the prevalence of non-communicable multi-morbidity focusing on diabetes mellitus (DM), malnutrition, and hypertension (HTN) as common risk factors of LTBI progressing to active TB. In a cross-sectional study, 2,351 adults (45% male and 55% female) from villages in the Kancheepuram district of South India were enrolled between 2013 and 2020. DM was defined as HbA1c >6.4%, undernutrition was defined as low body mass index (LBMI) <18.5 kg/m2, obesity was classified as BMI ≥25 kg/m2, HTN was reported as systolic pressure >130 mmHg, and LTBI was defined as positive (≥ 0.35 international units/ml) by QuantiFERON Gold In-Tube assay. A total of 1,226 individuals (52%) were positive for LTBI out of 2351 tested individuals. The prevalence of DM and pre-diabetes mellitus (PDM) was 21 and 35%, respectively, HTN was 15% in latent tuberculosis (LTB)-infected individuals. The association of DM [odds ratio (OR)]; adjusted odds ratio (aOR) (OR = 1.26, 95% CI: 1.13-1.65; aOR = 1.19, 95% CI: 1.10-1.58), PDM (OR = 1.11, 95% CI: 1.0-1.35), and HTN (OR = 1.28, 95% CI: 1.11-1.62; aOR = 1.18, 95% CI: 1.0-1.56) poses as risk factors of LTBI progression to active TB. The prevalence of LBMI 9% (OR = 1.07, 95% CI: 0.78-1.48) and obesity 42% (OR = 0.85, 95% CI: 0.70-1.03) did not show any statistically significant association with LTB-infected individuals. The present evidence of a high burden of multi-morbidity suggests that proximate risk factors of active TB in LTBI can be managed by nutrition and lifestyle modification.
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Varkonyi-Sepp J, Freeman A, Ainsworth B, Kadalayil LP, Haitchi HM, Kurukulaaratchy RJ. Multimorbidity in Difficult Asthma: The Need for Personalised and Non-Pharmacological Approaches to Address a Difficult Breathing Syndrome. J Pers Med 2022; 12:jpm12091435. [PMID: 36143220 PMCID: PMC9500722 DOI: 10.3390/jpm12091435] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/21/2022] Open
Abstract
Three to ten percent of people living with asthma have difficult-to-treat asthma that remains poorly controlled despite maximum levels of guideline-based pharmacotherapy. This may result from a combination of multiple adverse health issues including aggravating comorbidities, inadequate treatment, suboptimal inhaler technique and/or poor adherence that may individually or collectively contribute to poor asthma control. Many of these are potentially "treatable traits" that can be pulmonary, extrapulmonary, behavioural or environmental factors. Whilst evidence-based guidelines lead clinicians in pharmacological treatment of pulmonary and many extrapulmonary traits, multiple comorbidities increase the burden of polypharmacy for the patient with asthma. Many of the treatable traits can be addressed with non-pharmacological approaches. In the current healthcare model, these are delivered by separate and often disjointed specialist services. This leaves the patients feeling lost in a fragmented healthcare system where clinical outcomes remain suboptimal even with the best current practice applied in each discipline. Our review aims to address this challenge calling for a paradigm change to conceptualise difficult-to-treat asthma as a multimorbid condition of a "Difficult Breathing Syndrome" that consequently needs a holistic personalised care attitude by combining pharmacotherapy with the non-pharmacological approaches. Therefore, we propose a roadmap for an evidence-based multi-disciplinary stepped care model to deliver this.
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Etkind SN, Li J, Louca J, Hopkins SA, Kuhn I, Spathis A, Barclay SIG. Total uncertainty: a systematic review and thematic synthesis of experiences of uncertainty in older people with advanced multimorbidity, their informal carers and health professionals. Age Ageing 2022; 51:6670562. [PMID: 35977149 PMCID: PMC9385183 DOI: 10.1093/ageing/afac188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES uncertainty pervades the complex illness trajectories experienced by older adults with multimorbidity. Uncertainty is experienced by older people, their informal carers and professionals providing care, yet is incompletely understood. We aimed to identify and synthesise systematically the experience of uncertainty in advanced multimorbidity from patient, carer and professional perspectives. DESIGN systematic literature review of published and grey qualitative literature from 9 databases (Prospero CRD 42021227480). PARTICIPANTS older people with advanced multimorbidity, and informal carers/professionals providing care to this group. Exclusion criteria: early multimorbidity, insufficient focus on uncertainty. ANALYSIS weight-of-evidence assessment was used to appraise included articles. We undertook thematic synthesis of multi-perspective experiences and response to uncertainty. RESULTS from 4,738 unique search results, we included 44 articles relating to 40 studies. 22 focused on patient experiences of uncertainty (n = 460), 15 on carer experiences (n = 197), and 19 on health professional experiences (n = 490), with 10 exploring multiple perspectives. We identified a shared experience of 'Total Uncertainty' across five domains: 'appraising and managing multiple illnesses'; 'fragmented care and communication'; 'feeling overwhelmed'; 'uncertainty of others' and 'continual change'. Participants responded to uncertainty by either active (addressing, avoiding) or passive (accepting) means. CONCLUSIONS the novel concept of 'Total Uncertainty' represents a step change in our understanding of illness experience in advanced multimorbidity. Patients, carers and health professionals experienced uncertainty in similar domains, suggesting a shared understanding is feasible. The domains of total uncertainty form a useful organising framework for health professionals caring for older adults with multimorbidity.
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Wu Y, Zheng Y, Wang J, Zhang T. Specific type of childhood trauma and borderline personality disorder in Chinese patients. Front Psychiatry 2022; 13:936739. [PMID: 35958646 PMCID: PMC9360314 DOI: 10.3389/fpsyt.2022.936739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022] Open
Abstract
Background Childhood maltreatment (CM) is a known risk factor for the development of mental disorders. An extensive body of literature about CM and mental health has been developed in wealthy countries, but information about this connection is lacking in developing countries including China. Aims To explore the possible relationship between specific types of CM and borderline personality disorder (BPD) in patients with mental disorders in China. Methods A survey was conducted in 2006, involving over 3,402 Chinese individuals aged 18-60 years who were randomly selected from the outpatients in the Shanghai Mental Health Center. The patients were screened with the Personality Diagnostic Questionnaire and CM was assessed using the Childhood Trauma Questionnaire. The final sample comprised 178 patients with BPD, 178 patients with other personality disorders (PDs), and 178 patients without PDs. Results In Chinese patients, compared to other PDs, patients with BPDs are more likely to have experienced CM. Emotional maltreatment (emotional abuse and neglect) was the strongest predictor of BPD. Female gender and sexual abuse are significant predictors of the self-harm/suicidal risk of BPD patients. Conclusion This is a pioneering study conducted on a large set of Chinese clinical samples with paired controls to establish and compare the associations between specific CM and BPD. Further studies in this field are necessary to elucidate the mechanism of how various types of childhood trauma have influenced PDs.
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Kanarik M, Grimm O, Mota NR, Reif A, Harro J. ADHD co-morbidities: A review of implication of gene × environment effects with dopamine-related genes. Neurosci Biobehav Rev 2022; 139:104757. [PMID: 35777579 DOI: 10.1016/j.neubiorev.2022.104757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 06/25/2022] [Accepted: 06/26/2022] [Indexed: 02/07/2023]
Abstract
ADHD is a major burden in adulthood, where co-morbid conditions such as depression, substance use disorder and obesity often dominate the clinical picture. ADHD has substantial shared heritability with other mental disorders, contributing to comorbidity. However, environmental risk factors exist but their interaction with genetic makeup, especially in relation to comorbid disorders, remains elusive. This review for the first time summarizes present knowledge on gene x environment (GxE) interactions regarding the dopamine system. Hitherto, mainly candidate (GxE) studies were performed, focusing on the genes DRD4, DAT1 and MAOA. Some evidence suggest that the variable number tandem repeats in DRD4 and MAOA may mediate GxE interactions in ADHD generally, and comorbid conditions specifically. Nevertheless, even for these genes, common variants are bound to suggest risk only in the context of gender and specific environments. For other polymorphisms, evidence is contradictory and less convincing. Particularly lacking are longitudinal studies testing the interaction of well-defined environmental with polygenic risk scores reflecting the dopamine system in its entirety.
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Dong B, Li D, Baker GB. Hikikomori: A Society-Bound Syndrome of Severe Social Withdrawal. PSYCHIAT CLIN PSYCH 2022; 32:167-173. [PMID: 38764869 PMCID: PMC11099621 DOI: 10.5152/pcp.2022.22429] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/12/2022] [Indexed: 05/21/2024] Open
Abstract
Background Hikikomori, a severe and often prolonged social withdrawal observed primarily in young people, was first described in Japan, but cases have now been reported in many other countries. Methods A review paper on hikikomori has been prepared following the literature searches in 3 databases. Search terms related to hikikomori included epidemiology, globalization, diagnosis, treatment, comorbidity, and COVID-19. Conclusions Hikikomori was first reported in Japan and has been described in detail by researchers there, but there are now reports in many countries of hikikomori-like cases. It occurs primarily in young people, often men in their late teens and early twenties who isolate themselves, sometimes confining themselves to their homes for months or even years. It has been proposed that hikikomori has increased in recent years in part because of advances in information technology that result in decreased socialization. Hikikomori was originally considered a non-psychotic phenomenon, but comorbidity with psychiatric disorders is often present and should be considered during diagnosis. Considerable efforts have been made in recent years to establish reliable, widely applicable guidelines for the diagnosis and treatment of hikikomori. There is very little information with regard to neurobiology, although involvement of the immune system, oxidative stress, and the social brain network has been proposed. It is widely agreed that hikikomori must be treated in a multi-dimensional fashion, with family support very important. Lessons learned from these treatment approaches are relevant to the potential increased risk of social withdrawal arising from COVID-19 pandemic lockdowns.
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Rockson SG, Zhou X, Zhao L, Hosseini DK, Jiang X, Sweatt AJ, Kim D, Tian W, Snyder MP, Nicolls MR. Exploring disease interrelationships in patients with lymphatic disorders: A single center retrospective experience. Clin Transl Med 2022; 12:e760. [PMID: 35452183 PMCID: PMC9028099 DOI: 10.1002/ctm2.760] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The lymphatic contribution to the circulation is of paramount importance in regulating fluid homeostasis, immune cell trafficking/activation and lipid metabolism. In comparison to the blood vasculature, the impact of the lymphatics has been underappreciated, both in health and disease, likely due to a less well-delineated anatomy and function. Emerging data suggest that lymphatic dysfunction can be pivotal in the initiation and development of a variety of diseases across broad organ systems. Understanding the clinical associations between lymphatic dysfunction and non-lymphatic morbidity provides valuable evidence for future investigations and may foster the discovery of novel biomarkers and therapies. METHODS We retrospectively analysed the electronic medical records of 724 patients referred to the Stanford Center for Lymphatic and Venous Disorders. Patients with an established lymphatic diagnosis were assigned to groups of secondary lymphoedema, lipoedema or primary lymphovascular disease. Individuals found to have no lymphatic disorder were served as the non-lymphatic controls. The prevalence of comorbid conditions was enumerated. Pairwise co-occurrence pattern analyses, validated by Jaccard similarity tests, was utilised to investigate disease-disease interrelationships. RESULTS Comorbidity analyses underscored the expected relationship between the presence of secondary lymphoedema and those diseases that damage the lymphatics. Cardiovascular conditions were common in all lymphatic subgroups. Additionally, statistically significant alteration of disease-disease interrelationships was noted in all three lymphatic categories when compared to the control population. CONCLUSIONS The presence or absence of a lymphatic disease significantly influences disease interrelationships in the study cohorts. As a physiologic substrate, the lymphatic circulation may be an underappreciated participant in disease pathogenesis. These relationships warrant further, prospective scrutiny and study.
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Mårtensson S, Johansen KS, Krarup J, Düring SW. REDD-PAC Cohort Description: Researching Dual Diagnosis - Prognosis and Characteristics. J Dual Diagn 2022; 18:111-122. [PMID: 35363594 DOI: 10.1080/15504263.2022.2055250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Evidence from real-world integrated dual diagnosis treatment programs is limited. In 2017 we decided to establish the REDD-PAC cohort with the aim to provide more in-depth information regarding the effect of integrated treatment. METHODS The REDD-PAC cohort includes more than 2,500 patients with dual diagnosis that have been treated at an in-patient department specializing in the integrated treatment of both psychiatric illness and substance use disorder in Denmark in the period from 2002 to 2017. The collected data included information on diagnosis as well as patient-completed questionnaires regarding anxiety, depression, self-worth, and use of substances. Data regarding medications prescribed and administered, weight, height, and blood pressure were also included. RESULTS The primary diagnosis was psychosis spectrum disorder (37.0%), followed by affective disorders (18.8%). More than two-thirds of the patients were male, and most patients had a weak connection to the labor market and basic schooling. Patients were generally very motivated for treatment. CONCLUSIONS Further linking the data to Danish national register data makes it possible to follow individual trajectories pre- and post-admission as well as to access complete follow-up data regarding long-term outcomes, e.g., use of health services, mortality, morbidity, crime, and social circumstances. This article describes both the overarching aims of the REDD-PAC cohort and the basic diagnostic and sociodemographic characteristics of the cohort.
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Davenport A. Comparison of frailty, sarcopenia and protein energy wasting in a contemporary peritoneal dialysis cohort. Perit Dial Int 2022; 42:571-577. [PMID: 35289199 DOI: 10.1177/08968608221077462] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND More elderly frail patients are now treated by peritoneal dialysis (PD). Frailty, sarcopenia and protein energy wasting (PEW) are all associated with increased mortality. Simple screening tools are required to identify patients to allow for interventions. As such, we wished to review the prevalence of frailty and compare frailty with sarcopenia and PEW in a contemporary PD population. PATIENTS AND METHODS We used the Clinical Frailty Score (CFS) to determine frailty, bio-impedance body composition and hand grip strength (HGS) to determine sarcopenia and combining laboratory, body composition and protein nitrogen appearance rate (PNA) to assess PEW. RESULTS Records of 368 PD patients, 61% male, mean age 60.9 ± 16.1 years, body mass index (BMI) 26.2 ± 5.1 kg/m2 were reviewed, with 71 classified as frail (19.3%; CFS > 4), and frailty associated with age (odds ratio (OR) 1.047, 95% confidence interval (CL) 1.01-1.085, p = 0.012), Stoke-Davies co-morbidity (OR 1.808, 95%CL 1.129-2.895, p = 0.014) and negatively with HGS (OR 0.906, 95% CL 0.897-0.992, p = 0.033); 17.7% met muscle loss and HGS criteria for sarcopenia, with fair agreement with frailty (kappa 0.24 (CL 0.09-0.38)). Only two patients (0.5%) met all four criteria for PEW, 26.1% met the reduced BMI criteria, 4.6% the serum albumin, 32.9% the PNA and 39.4% the reduced muscle mass. HGS correlated with lean muscle mass (r 2 = 0.42, p < 0.001). CONCLUSION Using the CFS, 19.3% of patients were classified as frail, compared to 17.7% with sarcopenia and <1% with PEW. The CFS requires no special equipment or laboratory tests and was associated with age, co-morbidity and HGS weakness.
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Alexander CM, Martyr A, Clare L. Changes in awareness of condition in people with mild-to-moderate dementia: Longitudinal findings from the IDEAL cohort. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5702. [PMID: 35294792 PMCID: PMC9314100 DOI: 10.1002/gps.5702] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/01/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Awareness of difficulties shown by people with dementia is known to vary, but few studies have explored changes in awareness over time. Investigating this could further the understanding of surrounding concepts and reasons for impaired awareness. Recognising emerging or diminishing awareness could facilitate discussions about diagnosis and appropriate post-diagnostic support. METHODS Using longitudinal data from the Improving the experience of Dementia and Enhancing Active Life (IDEAL) cohort, awareness in community-dwelling people with mild-to-moderate dementia was assessed at three timepoints over 2 years. A validated checklist was used to evaluate awareness of difficulties associated with dementia. We examined changes in awareness for people with low awareness at baseline, and used case-matching to describe differences in characteristics between people who gained awareness, and those who continued with low awareness. RESULTS At baseline, 83 people from a sample of 917 showed low awareness. The majority of those remaining in the study at later timepoints had gained awareness, some as late as four or more years after diagnosis. Case-matched comparisons revealed few distinguishing characteristics: cases with stable low awareness had similar or better cognitive and functional ability than those who gained and retained awareness at 12 and 24 months, but may have had more co-morbidities. CONCLUSIONS Self-reported awareness of difficulties can change and may increase over time in people with mild-to-moderate dementia. There may be individual reasons for ongoing low awareness, not explained by cognitive or functional ability. This challenges the view that a single record of low awareness represents a fixed disease-related symptom, and highlights the complex, individual and dynamic nature of awareness.
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Araya S, Tsegay YG, Atlaw A, Aragaw M, Tadlo G, Tsegaye N, Kahase D, Gebreyohanes Z, Bitew M, Berhane N. Organ function biomarker abnormalities, associated factors and disease outcome among hospitalized patients with COVID-19. Biomark Med 2022; 16:417-426. [PMID: 35234521 PMCID: PMC8890361 DOI: 10.2217/bmm-2021-0681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: The aim of this study was to determine the magnitude of abnormal organ function tests and biomarkers in hospitalized patients with confirmed COVID-19 and to define the association among markers of organ failure, disease severity and its outcome in hospitalized COVID-19 patients in Ethiopia. Methods: A prospective cohort study was conducted among COVID-19 patients admitted to Millennium COVID-19 Treatment Center from December 2020 to June 2021. Results: The median age of the 440 study participants was 60.3 ± 1.3 years, and from these 71.3% of patients were male. Disease severity: p-value: 0.032; adjusted odds ratio (AOR) (95% CI): 4.4 (0.022-0.085); and the presence of any co-morbidity; p-value: 0.012; AOR (95% CI): 0.80 (0.47-0.83) was significantly associated with mortality. Aspartate transaminase, alanine transaminase and alkaline phosphatase parameter values of patients overall, were elevated - mainly among critical patients (56.9 ± 57.7, 58.5 ± 63 and 114.6 ± 60, respectively).
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Dotan M, Zion E, Bilavsky E, Nahum E, Ben‐Zvi H, Zalcman J, Yarden‐Bilavsky H, Kadmon G. Adenovirus can be a serious, life-threatening disease, even in previously healthy children. Acta Paediatr 2022; 111:614-619. [PMID: 34862832 DOI: 10.1111/apa.16207] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 12/27/2022]
Abstract
AIM Adenovirus infections are exceedingly common in childhood. However, little is known of the clinical characteristics of children admitted with severe infection to the paediatric intensive care unit (PICU). METHODS Clinical data on children hospitalised with adenovirus infection between January 2005 and March 2020 were collected. We compared data between children hospitalised in the PICU and those who were not in a 1:2 ratio. RESULTS During the study period, 69 children with adenovirus infection were admitted to the PICU, representing 5% of all hospitalised children with adenovirus. Thirty-four (49%) were previously healthy children. Mortality occurred in 5 patients, and all had an underlying illness. Cidofovir was used in 21 children, including 11 who were previously healthy. No side effects were attributed to the treatment. During 2005-2014, viral co-infection rates were 42% in the PICU group and 11% in the control group (p = 0.002). However, during 2015-2020, when the viral panel became widespread in our institution, the rates of co-infection were similar in the two groups (32% and 34%, p = 1.0). CONCLUSION Our findings suggest that adenovirus may present as a serious, life-threatening disease even in previously healthy children.
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Hoshen M, Shkalim Zemer V, Ashkenazi S, Grossman Z, Gerstein M, Yosef N, Cohen M, Cohen HA. How to increase COVID-19 vaccine uptake among children? determinants associated with vaccine compliance. Front Pediatr 2022; 10:1038308. [PMID: 36714648 PMCID: PMC9880470 DOI: 10.3389/fped.2022.1038308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/30/2022] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE Three aims: to elucidate determinants associated with COVID-19 vaccine uptake in children and the association with parental vaccination; to compare rates of PCR-positive SARS-CoV-2 results between vaccinated and unvaccinated children; to estimate the rate of parental COVID-19 vaccination and its association with the vaccination rate of their children. METHODS We performed a retrospective chart review of all children aged 5-11 years registered at a central district in Israel from November 21st, 2021 to April 30th, 2022, and characterized COVID-19 vaccinated vs. unvaccinated individuals. Data retrieved from the electronic medical files included: demographics [age, gender, sector, socioeconomic status (SES)]; COVID-19 vaccination (first and second doses) and influenza vaccination status; co-morbidities; and parental vaccinations for COVID-19. We divided the population into three distinct demographic groups: non-ultra-orthodox Jews (43,889 children), ultra-orthodox Jews (13,858 children), and Arabs (4,029 children). RESULTS Of the 61,776 children included in the study, 20,355 (32.9%) received at least one dose of the COVID-19 vaccine. Vaccination rates were similar amongst males and females and were higher in children aged 9-11 years compared to children aged 5-6 years. Multivariate analysis identified five independent determinants that were significantly (p < 0.001) associated with low vaccination rates: Arab and ultra-orthodox sectors (odds ratios: 0.235 and 0.617, respectively); children aged 5-8 years; children of low SES; and children who had not received previous seasonal influenza vaccination. Relatively high vaccination rates were noted amongst children with the following medical co-morbidities: treatment with biological agents (42.9%); solid tumor transplantation (42.9%); type 1 diabetes mellitus (38.5%), asthma (38.2%), and attention deficit and hyperactivity disorder (ADHD) (37.6%). Regarding the uptake of two vaccine doses among children with co-morbidities, it was highest in those with type 1 diabetes mellitus, heart failure, treatment with biological agents, asthma and obesity. CONCLUSION This study highlights several pediatric sub-populations with low and high vaccine uptake. It is essential to focus on determinants associated with low vaccination rates.
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Cao S, Dong F, Okekpe CC, Dombrovsky I, Valenzuela GJ, Roloff K. Common Combinations of Pregestational Diagnosis and Pregnancy Complications. Cureus 2021; 13:e19239. [PMID: 34877216 PMCID: PMC8642143 DOI: 10.7759/cureus.19239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 01/03/2023] Open
Abstract
Objective Single pregestational diagnoses have been demonstrated to be associated with pregnancy-related complications. But, the effect of multiple diagnoses is understudied. The objective of this study is to determine the most common combinations of pregestational diagnoses and to determine if specific combinations increase the risk of pregnancy-related complications. Study design We performed a cross-sectional study of the 2016 Healthcare Cost and Utilization Project’s National Inpatient Sample (HCUP NIS) database. Inclusion criteria were: Diagnosis-related groups assumed to be associated with delivery, and three or fewer International Classification of Diseases, Tenth Revision (ICD-10), clinical modification codes with a prevalence greater than or equal to 0.5%, or clinically important risk factors in Bateman’s co-morbidity index. Chi-squared analysis of combinations of pregestational diagnoses was performed to assess the relative risk of pregnancy-related complications. Results The 2016 database included 255,233 delivered pregnancies. The most common combinations of pregestational diagnoses involved advanced maternal age, prior cesarean delivery, obesity, and tobacco use. Most combinations did not demonstrate an increased risk for complications greater than the risk with a single diagnosis. In those with statistically significant risk, all were 3-fold or less except we noted a 4.4-fold higher risk (95% CI: 3.16-6.15) of preeclampsia in obese patients of advanced maternal age compared to patients who were only of advanced maternal age. Conclusion Our results revealed that common combinations of pregestational diagnoses, in general, do not increase the risk for common pregnancy-related complications greater than the risk with a single diagnosis. This is reassuring, given that women entering pregnancy with multiple co-morbidities are becoming more common.
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Wong YNS, Sng CCT, Ottaviani D, Patel G, Chowdhury A, Earnshaw I, Sinclair A, Merry E, Wu A, Galazi M, Benafif S, Soosaipillai G, Chopra N, Roylance R, Shaw H, Lee AJX. Systemic Anti-Cancer Therapy and Metastatic Cancer Are Independent Mortality Risk Factors during Two UK Waves of the COVID-19 Pandemic at University College London Hospital. Cancers (Basel) 2021; 13:6085. [PMID: 34885194 PMCID: PMC8657102 DOI: 10.3390/cancers13236085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/18/2021] [Accepted: 11/26/2021] [Indexed: 12/15/2022] Open
Abstract
An increased mortality risk was observed in patients with cancer during the first wave of COVID-19. Here, we describe determinants of mortality in patients with solid cancer comparing the first and second waves of COVID-19. A retrospective analysis encompassing two waves of COVID-19 (March-May 2020; December 2020-February 2021) was performed. 207 patients with cancer were matched to 452 patients without cancer. Patient demographics and oncological variables such as cancer subtype, staging and anti-cancer treatment were evaluated for association with COVID-19 mortality. Overall mortality was lower in wave two compared to wave one, HR 0.41 (95% CI: 0.30-0.56). In patients with cancer, mortality was 43.6% in wave one and 15.9% in wave two. In hospitalized patients, after adjusting for age, ethnicity and co-morbidities, a history of cancer was associated with increased mortality in wave one but not wave two. In summary, the second UK wave of COVID-19 is associated with lower mortality in hospitalized patients. A history of solid cancer was not associated with increased mortality despite the dominance of the more transmissible B.1.1.7 SARS-CoV-2 variant. In both waves, metastatic disease and systemic anti-cancer treatment appeared to be independent risk factors for death within the combined cancer cohort.
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Interpreting Developmental Surface Dyslexia within a Comorbidity Perspective. Brain Sci 2021; 11:brainsci11121568. [PMID: 34942870 PMCID: PMC8699141 DOI: 10.3390/brainsci11121568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/19/2021] [Accepted: 11/25/2021] [Indexed: 11/16/2022] Open
Abstract
Recent evidence underlines the importance of seeing learning disorders in terms of their partial association (comorbidity). The present concept paper presents a model of reading that aims to account for performance on a naturalistic reading task within a comorbidity perspective. The model capitalizes on the distinction between three independent levels of analysis: competence, performance, and acquisition: Competence denotes the ability to master orthographic–phonological binding skills; performance refers to the ability to read following specific task requirements, such as scanning the text from left to right. Both competence and performance are acquired through practice. Practice is also essential for the consolidation of item-specific memory traces (or instances), a process which favors automatic processing. It is proposed that this perspective might help in understanding surface dyslexia, a reading profile that has provoked a prolonged debate among advocates of traditional models of reading. The proposed reading model proposes that surface dyslexia is due to a defective ability to consolidate specific traces or instances. In this vein, it is a “real” deficit, in the sense that it is not due to an artifact (such as limited exposure to print); however, as it is a cross-domain defect extending to other learning behaviors, such as spelling and math, it does not represent a difficulty specific to reading. Recent evidence providing initial support for this hypothesis is provided. Overall, it is proposed that viewing reading in a comorbidity perspective might help better understand surface dyslexia and might encourage research on the association between surface dyslexia and other learning disorders.
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Katakam BK, Munisamy M, Rao TN, Chiramel MJ, Panda M, Gupta S, Pss R, Seetharam KA. Recommendations for Management of Childhood Psoriasis. Indian Dermatol Online J 2021; 12:S71-S85. [PMID: 34976883 PMCID: PMC8664175 DOI: 10.4103/idoj.idoj_965_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/09/2021] [Accepted: 05/22/2021] [Indexed: 12/17/2022] Open
Abstract
Childhood psoriasis is recognized as a potential multisystem disorder and hence it is imperative to optimize disease management to arrest progression, minimize psychological burden and evolution of metabolic syndrome. Clinical practice recommendations are necessary to assist practitioners in appropriate decision making based on available evidence. Owing to the lack of Indian recommendations on childhood psoriasis, the SIG Pediatric Dermatology under IADVL Academy undertook an evidence-based approach based on published literature on the topic, between January 2000 and July 2020 to frame the recommendations.
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Harish R, Kazi FN, Sharma JVP. Efficacy of Subcutaneous Closed Suction Drain in Reduction of Postoperative Surgical Site Infection. Surg J (N Y) 2021; 7:e275-e280. [PMID: 34660890 PMCID: PMC8510787 DOI: 10.1055/s-0041-1735900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/22/2021] [Indexed: 12/03/2022] Open
Abstract
Background
Surgical site infections (SSIs) are the infections of wound after an invasive operative approach. It remains to be a major morbidity for patients undergoing surgeries although there have been tremendous improvements in the surgical techniques.
Different interventions to suppress the selective serotonin reuptake inhibitors have been proposed. Many of them have been routinely used by surgeons like minimizing shaving, hand washing, and preoperative antibiotics and these are well accepted. Drains are used in major abdominal surgeries, hernia repairs, breast surgeries reducing collections in closed areas.
1
Hematoma, serous fluid, and dead space in surgical incision wounds raise the risk of infection as they serve as the platform for microbial growth. Studies have proved that the usage of subcutaneous drains has lowered the chances of infection.
Results
The patients in the case group had lower incidence of SSI compared with the control group. The patients in the case group had subcutaneous drain which drained any collection that developed in the subcutaneous space. When the incidence of SSI was compared between the emergency cases and elective cases, the emergency cases showed higher propensity for SSI and increased rate for patients who had co-morbidities like diabetes mellitus, hypertension, etc. The most common organism isolated from the SSI was found to be
Escherichia coli
. It was also noted that the mean number of days of hospital stay was comparatively higher for the patients who developed SSI compared with patients who did not develop SSI.
Conclusion
Thus the presence of SSI adds morbidity to the patient and the patients who undergo major surgeries are likely to develop SSI postoperatively. The presence of subcutaneous closed suction drain helps in reducing the SSI to a certain extent.
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Gill TK, Caughey GE, Wesselingh S, Inacio MC. Impact of musculoskeletal conditions among those in residential aged care in Australia. Australas J Ageing 2021; 41:e41-e49. [PMID: 34611957 DOI: 10.1111/ajag.13001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 07/18/2021] [Accepted: 08/18/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the prevalence of musculoskeletal conditions, co-morbidity and functional limitations in older people in residential aged care in Australia and the association of musculoskeletal conditions with mortality. METHODS A retrospective cohort study using data from 490 325 people in the Registry of Senior Australians was conducted between 2004 and 2014. The association of co-morbidity, health risk factors and functional limitations with musculoskeletal conditions was evaluated using logistic regression. Cox regression was used to examine the association with mortality. RESULTS Overall, 40.2% [95% CI 40.1-40.4]) of residents had a musculoskeletal condition, which was associated with limited social (OR 1.16 [95% CI 1.14-1.19]) and domestic activities (OR 1.44 [95% CI 1.39-1.49]). Residents with musculoskeletal conditions had a 15% lower risk of mortality (aHR 0.85 [95% CI 0.85-0.86], P < 0.001) compared to residents without. CONCLUSION The presence of musculoskeletal conditions in older people in residential aged care negatively impacts activities of daily living and quality of life rather than mortality.
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Snider B, Patel B, McBean E. Corrigendum: Insights Into Co-Morbidity and Other Risk Factors Related to COVID-19 Within Ontario, Canada. Front Artif Intell 2021; 4:759022. [PMID: 34589702 PMCID: PMC8473988 DOI: 10.3389/frai.2021.759022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 08/18/2021] [Indexed: 11/15/2022] Open
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Chia AYT, Ang GWX, Chan ASY, Chan W, Chong TKY, Leung YY. Managing Psoriatic Arthritis With Inflammatory Bowel Disease and/or Uveitis. Front Med (Lausanne) 2021; 8:737256. [PMID: 34604268 PMCID: PMC8481670 DOI: 10.3389/fmed.2021.737256] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/20/2021] [Indexed: 12/15/2022] Open
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory disease that presents with psoriasis (PsO), peripheral and axial arthropathy. The heterogeneity of disease presentation leads to the term "psoriatic disease (PsD)" which is thought to better encompass the range of clinical manifestations. PsA is associated with several comorbidities such as cardiovascular diseases, metabolic syndrome and other extra-articular manifestations including uveitis, and inflammatory bowel disease (IBD). While novel therapeutics are being developed following advances in our understanding of the pathogenesis of the disease, the diverse combinations of PsA with its various comorbidities still pose a clinical challenge in managing patients with PsA. This article reviews our current understanding of the pathogenesis of PsA and how various pathways in the pathogenesis lead to the two comorbid extra-articular manifestations - uveitis and IBD. We also review current evidence of treatment strategies in managing patients with PsA with comorbidities of uveitis and/or IBD.
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Tew YY, Chan JH, Keeling P, Shenkin SD, MacLullich A, Mills NL, Denvir MA, Anand A. Predicting readmission and death after hospital discharge: a comparison of conventional frailty measurement with an electronic health record-based score. Age Ageing 2021; 50:1641-1648. [PMID: 33770164 PMCID: PMC8437069 DOI: 10.1093/ageing/afab043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND frailty measurement may identify patients at risk of decline after hospital discharge, but many measures require specialist review and/or additional testing. OBJECTIVE to compare validated frailty tools with routine electronic health record (EHR) data at hospital discharge, for associations with readmission or death. DESIGN observational cohort study. SETTING hospital ward. SUBJECTS consented cardiology inpatients ≥70 years old within 24 hours of discharge. METHODS patients underwent Fried, Short Physical Performance Battery (SPPB), PRISMA-7 and Clinical Frailty Scale (CFS) assessments. An EHR risk score was derived from the proportion of 31 possible frailty markers present. Electronic follow-up was completed for a primary outcome of 90-day readmission or death. Secondary outcomes were mortality and days alive at home ('home time') at 12 months. RESULTS in total, 186 patients were included (79 ± 6 years old, 64% males). The primary outcome occurred in 55 (30%) patients. Fried (hazard ratio [HR] 1.47 per standard deviation [SD] increase, 95% confidence interval [CI] 1.18-1.81, P < 0.001), CFS (HR 1.24 per SD increase, 95% CI 1.01-1.51, P = 0.04) and EHR risk scores (HR 1.35 per SD increase, 95% CI 1.02-1.78, P = 0.04) were independently associated with the primary outcome after adjustment for age, sex and co-morbidity, but the SPPB and PRISMA-7 were not. The EHR risk score was independently associated with mortality and home time at 12 months. CONCLUSIONS frailty measurement at hospital discharge identifies patients at risk of poorer outcomes. An EHR-based risk score appeared equivalent to validated frailty tools and may be automated to screen patients at scale, but this requires further validation.
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Said A, Esmail M, Abdel Naiem E, Zaki Z, Raouf R. Clinical outcomes of chronic obstructive pulmonary disease phenotypes. One center prospective study. Adv Respir Med 2021; 89:369-377. [PMID: 34494240 DOI: 10.5603/arm.a2021.0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 06/22/2021] [Accepted: 07/19/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The clinical outcome of different chronic obstructive pulmonary disease (COPD) phenotypes is still unclear. OBJECTIVES This study was designed to detect the effect of different COPD phenotypes on disease outcomes. MATERIAL AND METHODS One hundred stable COPD patients were included. They were divided into 3 phenotypes; 45 patients in exacerbator phenotype, 37 patients in non-exacerbator, and 18 patients in asthma COPD overlap (ACO) phenotype. Patient demo-graphics, respiratory symptoms, grading of COPD, co-morbidities, spirometry, six minute walk test, and systemic inflammatory markers were measured. Also, exacerbation frequency and severity were assessed throughout the study period. RESULTS COPD Assessment Test (CAT) score was significantly higher in exacerbator phenotype versus the other phenotypes(14.7 ± 1.5; p = 0.04).In addition, about 60% and 42% of exacerbator phenotype were in Global Initiative for Chronic Obstructive Lung Disease (GOLD) class D and C respectively which were significantly higher than the other phenotypes(p = 0.001), while 58% and 50% of non-exacerbator and ACO patients respectively were in class B of GOLD. Twenty eight percent of patients of ACO had no comorbidity and this was significantly higher versus the other phenotypes (p = 0.03), while 40% of non-exacerbator had one comorbidity (p = 0.003) and 86% of exacerbator had ≥ 2 comorbidities (p = 0.002). COPD comorbidity index was significantly higher in exacerbator phenotype (2.5 ± 0.8; p = 0.01). Although patients of exacerbator phenotype had more and severe form of exacerbations than the other phenotypes, no significant difference in in-hospital outcome was found (p = 0.3). CONCLUSIONS Exacerbator phenotype has worse disease outcome than those of non-exacerbator and ACO phenotypes. These results support the need for more treatment options to alleviate the morbidity of COPD especially among exacerbator phenotype.
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