Impacts of Comorbidity and Mental Shock on Organic Micropollutants in Surface Water During and After the First Wave of COVID-19 Pandemic in Wuhan (2019–2021), China

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。

Tuberculosis-diabetes comorbidities: Mechanistic insights for clinical considerations and treatment challenges

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.

Diabetes mellitus and comorbidities in elderly people from the Lugu community:A critical-reflective analysis

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.

Interleukin-mediated therapies in liver diseases and comorbidity effects

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.

The Prevalence of Overweight/Obesity and Related Comorbidities among HIV-Positive and HIV-Negative Patients Attending the Same Clinics in Gaborone, Botswana

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.

Prostatic Adenomectomy and Comorbidities: Frequency and Management at the Urology Department of the Ignace Deen National Hospital in Conakry

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.

Incidence,prevalence,and comorbidities of chronic pancreatitis:A 7-year population-based study

BACKGROUND Chronic pancreatitis(CP)is a fibroinflammatory syndrome leading to reduced quality of life and shortened life expectancy.Population-based estimates of the incidence,prevalence,and comorbidities of CP in China are scarce.AIM To characterize the incidence,prevalence,and comorbidities of CP in Sichuan Province,China,with population-based data.METHODS Data on CP from 2015 to 2021 were obtained from the Health Information Center of Sichuan Province.During the study period,a total of 38090 individuals were diagnosed with CP in Sichuan Province.The yearly incidence rate and point prevalence rate(December 31,2021)of CP were calculated.The prevalence of comorbid conditions in CP patients was estimated.The annual number of CPrelated hospitalizations,hospital length of stay,and hospitalization costs for CP were evaluated.Yearly incidence rates were standardized for age by the direct method using the permanent population of Sichuan Province in the 2020 census as the standard population.An analysis of variance test for the linearity of scaled variables and the Cochran-Armitage trend test for categorical data were performed to investigate the yearly trends,and a two-sided test with P<0.05 was considered statistically significant.RESULTS The 38090 CP patients comprised 23280 males and 14810 females.The mean age of patients at CP diagnosis was 57.83 years,with male patients(55.87 years)being younger than female patients(60.11 years)(P<0.001).The mean incidence rate of CP during the study period was 6.81 per 100000 person-years,and the incidence of CP increased each year,from 4.03 per 100000 person-years in 2015 to 8.27 per 100000 person-years in 2021(P<0.001).The point prevalence rate of CP in 2021 was 45.52 per 100000 individuals for the total population,with rates of 55.04 per 100000 individuals for men and 35.78 per 100000 individuals for women(P<0.001).Individuals aged 65 years or older had the highest prevalence of CP(113.38 per 100000 individuals)(P<0.001).Diabetes(26.32%)was the most common comorbidity in CP patients.The number of CP-related hospitalizations increased from 3739 in 2015 to 11009 in 2021.The total costs for CP-related hospitalizations for CP patients over the study period were 667.96 million yuan,with an average of 17538 yuan per patient.CONCLUSION The yearly incidence of CP is increasing,and the overall CP hospitalization cost has increased by 1.4 times during the last 7 years,indicating that CP remains a heavy health burden.

Development of a model based on the age-adjusted Charlson comorbidity index to predict survival for resected perihilar cholangiocarcinoma

BACKGROUND Perihilar cholangiocarcinoma(pCCA)has a poor prognosis and urgently needs a better predictive method.The predictive value of the age-adjusted Charlson comorbidity index(ACCI)for the long-term prognosis of patients with multiple malignancies was recently reported.However,pCCA is one of the most surgically difficult gastrointestinal tumors with the poorest prognosis,and the value of the ACCI for the prognosis of pCCA patients after curative resection is unclear.AIM To evaluate the prognostic value of the ACCI and to design an online clinical model for pCCA patients.METHODS Consecutive pCCA patients after curative resection between 2010 and 2019 were enrolled from a multicenter database.The patients were randomly assigned 3:1 to training and validation cohorts.In the training and validation cohorts,all patients were divided into low-,moderate-,and high-ACCI groups.Kaplan-Meier curves were used to determine the impact of the ACCI on overall survival(OS)for pCCA patients,and multivariate Cox regression analysis was used to determine the independent risk factors affecting OS.An online clinical model based on the ACCI was developed and validated.The concordance index(C-index),calibration curve,and receiver operating characteristic(ROC)curve were used to evaluate the predictive performance and fit of this model.RESULTS A total of 325 patients were included.There were 244 patients in the training cohort and 81 patients in the validation cohort.In the training cohort,116,91 and 37 patients were classified into the low-,moderate-and high-ACCI groups.The Kaplan-Meier curves showed that patients in the moderate-and high-ACCI groups had worse survival rates than those in the low-ACCI group.Multivariable analysis revealed that moderate and high ACCI scores were independently associated with OS in pCCA patients after curative resection.In addition,an online clinical model was developed that had ideal C-indexes of 0.725 and 0.675 for predicting OS in the training and validation cohorts.The calibration curve and ROC curve indicated that the model had a good fit and prediction performance.CONCLUSION A high ACCI score may predict poor long-term survival in pCCA patients after curative resection.High-risk patients screened by the ACCI-based model should be given more clinical attention in terms of the management of comorbidities and postoperative follow-up.

Age,blood tests and comorbidities and AIMS65 risk scores outperform Glasgow-Blatchford and pre-endoscopic Rockall score in patients with upper gastrointestinal bleeding

BACKGROUND Upper gastrointestinal(GI)bleeding is a life-threatening condition with high mortality rates.AIM To compare the performance of pre-endoscopic risk scores in predicting the following primary outcomes:In-hospital mortality,intervention(endoscopic or surgical)and length of admission(≥7 d).METHODS We performed a retrospective analysis of 363 patients presenting with upper GI bleeding from December 2020 to January 2021.We calculated and compared the area under the receiver operating characteristics curves(AUROCs)of Glasgow-Blatchford score(GBS),pre-endoscopic Rockall score(PERS),albumin,international normalized ratio,altered mental status,systolic blood pressure,age older than 65(AIMS65)and age,blood tests and comorbidities(ABC),including their optimal cut-off in variceal and non-variceal upper GI bleeding cohorts.We subsequently analyzed through a logistic binary regression model,if addition of lactate increased the score performance.RESULTS All scores had discriminative ability in predicting in-hospital mortality irrespective of study group.AIMS65 score had the best performance in the variceal bleeding group(AUROC=0.772;P<0.001),and ABC score(AUROC=0.775;P<0.001)in the non-variceal bleeding group.However,ABC score,at a cut-off value of 5.5,was the best predictor(AUROC=0.770,P=0.001)of inhospital mortality in both populations.PERS score was a good predictor for endoscopic treatment(AUC=0.604;P=0.046)in the variceal population,while GBS score,(AUROC=0.722;P=0.024),outperformed the other scores in predicting surgical intervention.Addition of lactate to AIMS65 score,increases by 5-fold the probability of in-hospital mortality(P<0.05)and by 12-fold if added to GBS score(P<0.003).No score proved to be a good predictor for length of admission.CONCLUSION ABC score is the most accurate in predicting in-hospital mortality in both mixed and non-variceal bleeding population.PERS and GBS should be used to determine need for endoscopic and surgical intervention,respectively.Lactate can be used as an additional tool to risk scores for predicting inhospital mortality.

Acoustic radiation force impulse predicts long-term outcomes in a large-scale cohort:High liver cancer,low comorbidity in hepatitis B virus

BACKGROUND Acoustic radiation force impulse(ARFI)is used to measure liver fibrosis and predict outcomes.The performance of elastography in assessment of fibrosis is poorer in hepatitis B virus(HBV)than in other etiologies of chronic liver disease.AIM To evaluate the performance of ARFI in long-term outcome prediction among different etiologies of chronic liver disease.METHODS Consecutive patients who received an ARFI study between 2011 and 2018 were enrolled.After excluding dual infection,alcoholism,autoimmune hepatitis,and others with incomplete data,this retrospective cohort were divided into hepatitis B(HBV,n=1064),hepatitis C(HCV,n=507),and non-HBV,non-HCV(NBNC,n=391)groups.The indexed cases were linked to cancer registration(1987-2020)and national mortality databases.The differences in morbidity and mortality among the groups were analyzed.RESULTS At the enrollment,the HBV group showed more males(77.5%),a higher prevalence of prediagnosed hepatocellular carcinoma(HCC),and a lower prevalence of comorbidities than the other groups(P<0.001).The HCV group was older and had a lower platelet count and higher ARFI score than the other groups(P<0.001).The NBNC group showed a higher body mass index and platelet count,a higher prevalence of pre-diagnosed non-HCC cancers(P<0.001),especially breast cancer,and a lower prevalence of cirrhosis.Male gender,ARFI score,and HBV were independent predictors of HCC.The 5-year risk of HCC was 5.9%and 9.8%for those ARFI-graded with severe fibrosis and cirrhosis.ARFI alone had an area under the receiver operating characteristic curve(AUROC)of 0.742 for prediction of HCC in 5 years.AUROC increased to 0.828 after adding etiology,gender,age,and platelet score.No difference was found in mortality rate among the groups.CONCLUSION The HBV group showed a higher prevalence of HCC but lower comorbidity that made mortality similar among the groups.Those patients with ARFI-graded severe fibrosis or cirrhosis should receive regular surveillance.

Ten-year multicentric retrospective analysis regarding postoperative complications and impact of comorbidities in hemorrhoidal surgery with literature review

BACKGROUND Hemorrhoidal disease(HD)is considered a low-severity pathology by both general population and physicians,but the lengthy conservative therapy and postoperative complications suggest otherwise.AIM To assess the effectiveness of different treatment options,both conservative and surgical,in contrast with some preexisting comorbidities.METHODS We conducted a retrospective,10-yearlong study between January 2011 and December 2021 in two surgical centers,a private and a state-owned hospital.We compared the efficacy and safety of several treatment options,such as open hemorrhoidectomy,stapled hemorrhoidopexy,rubber band ligation and infrared coagulation in terms of complication rates and types and their correlation with different preexisting comorbidities such as inflammatory bowel disease(IBD),use of anticoagulant medication(AM)and liver cirrhosis.We also conducted a 20-years long PubMed research(1.263 articles)for relevant comparisons.RESULTS Our study recorded 10940 patients with HD,10241 with conservative and 699 with surgical treatment.Out of these,the male-to-female ratio of 1.3,and a peak in age distribution between 59 and 68 years old(32%of patients).For the entire study,we recorded a 90%incidence of immediate pain,immediate bleeding in 1.5%(11 cases),delayed bleeding in 1.0%(7 cases),and 0.6%surgical site infections.Urinary retention was also present,with 0.2%of patients,anal stricture in 1%and fecal incontinence for 0.5%of patients(4 cases).We recorded no severe complications such as Fournier`s gangrene or rectovaginal perforations.IBD accounted for 6%of the patients,with ulcerative colitis in 12%and Chron`s disease in 10.5%.6.6%of the patients had AM,determining 4%immediate and 2%delayed bleeding,in surgically treated patients.CONCLUSION Our study determined that most common complications(pain,urinary retention,bleeding,and stricture)are correlated with each surgical technique and pre-existing comorbidities.

Integrated analysis of comorbidity, pregnant outcomes, and amniotic fluid cytogenetics of fetuses with persistent left superior vena cava

BACKGROUND Persistent left superior vena cava(PLSVC)is the most common venous system variant.The clinical characteristics and amniotic fluid cytogenetics of fetuses with PLSVC remain to be further explored.AIM To develop reliable prenatal diagnostic recommendations through integrated analysis of the clinical characteristics of fetuses with PLSVC.METHODS Cases of PLSVC diagnosed using prenatal ultrasonography between September 2019 and November 2022 were retrospectively studied.The clinical characteristics of the pregnant women,ultrasonic imaging information,gestational age at diagnosis,pregnancy outcomes,and amniocentesis results were summarized and analyzed using categorical statistics and the chi-square test or Fisher’s exact test.RESULTS Of the 97 cases diagnosed by prenatal ultrasound,49(50.5%)had isolated PLSVC and 48(49.5%)had other structural abnormalities.The differences in pregnancy outcomes and amniocentesis conditions between the two groups were statistically significant(P<0.05).No significant differences were identified between the two groups in terms of advanced maternal age and gestational age(P>0.05).According to the results of the classification statistics,the most common intrac-ardiac abnormality was a ventricular septal defect and the most common extrac-ardiac abnormality was a single umbilical artery.In the subgroup analysis,the concurrent combination of intra-and extracardiac structural abnormalities was a risk factor for adverse pregnancy outcomes(odds ratio>1,P<0.05).Additional-ly,all abnormal cytogenetic findings on amniocentesis were observed in the comorbidity group.One case was diagnosed with 21-trisomy and six cases was diagnosed with chromosome segment duplication.CONCLUSION Examination for other structural abnormalities is strongly recommended when PLSVC is diagnosed.Poorer pregnancy outcomes and increased amniocentesis were observed in PLSVC cases with other structural abnor-malities.Amniotic fluid cytogenetics of fetuses is recommended for PLSVC with other structural abnormalities.

An overview of the mechanism of acupuncture and moxibustion in treating depression comorbidities insomnia

Depression and insomnia have become a frequent disease in the clinic.Clinically,depression and insomnia occur synchronously.Most researchers believe acupuncture treats insomnia and depression comorbidity through mechanisms such as inflammation theory,HPA axis theory,neurotransmitter theory,nervous system structure theory,immunoregulation theory,etc.Acupuncture has a clear effect on depression and insomnia comorbidity,and is two-way,specific,and integral.Therefore,a summary on the mechanism of using acupuncture to treat depression and insomnia comorbidity is made,to provide reference for future clinical application and laboratory research.

Research on Effects of Comorbidities Disease on Anticoagulation and Bleeding Disorders Risk in Patients with Overdosage of Vitamin K Antagonist Anticoagulant

Objectives: Research on effects of comorbidities disease on anticoagulation overdose in patients receiving anticoagulant therapy with vitamin K antagonists anticoagulant (VKAs) drugs at HaiPhong-VinhBao International General Hospital. Methods: Description and Prospective study. Research on 79 patients receiving anticoagulant therapy with VKAs who have an INR testing index of more than anticoagulation dose with VKAs and check INR every 4 weeks. Results: The average research age is 65.65 ± 12.17 years [33: 85], most of the elderly group. The Male group is lower than the female group (p > 0.05). Patients with hemorrhage signs account for 22.8%. The INR testing index has an average value is 5.88 ± 3.0 [3.02 - 23.95];The group of INR > 5 level is a higher risk of bleeding than the group of INR ≤ 5 levels, there is statistical difference (p Conclusion: All most patients with anticoagulation overdose are in the elderly group. The group with INR > 5 levels has a higher risk of bleeding than the group with INR ≤ 5 levels, it’s the statistical significance (p 1 but p > 0.05);Patients used VKAs drugs on the background of kidney failure or arthritis pathology are the cause of the increased risk of bleeding, it’s statistical significance (p < 0.05).

Prevalence of Comorbidities in the Urological Patients at the Former Military Teaching Hospital of Cotonou

Background: Comorbidities are additive diseases and care burdens in urological patients. Determining the epidemiologic profile of comorbidities in urological patients in our setting may help us to better the management of urological disease. Objective: To evaluate the prevalence of comorbidities in urological patients. Patient and Method: We collected comorbidity, urological disease and demographic data in all urological patients managed at the former Military Teaching Hospital of Cotonou from January 1, 2012, to December 31, 2020. We used the software R 4.2.2 to perform descriptive and bi-varied data analysis. Student’s t test was used to compare means. Results: The prevalence of comorbidities was 14.2%, i.e., 601 comorbidity-affected among 4242 patients. The comorbidities predominantly affected men: the sex ratio was 13:1. The presence of comorbidity was correlated with patients’ age (p < 0.001). The comorbidities observed in the 601 affected patients were hypertension (84.5%), diabetes (26.5%), asthma (2%), and heart failure (1.2%). Hypertension (p = 0.001) and asthma (p = 0.030) were correlated with age. No comorbidity was associated with gender. The comorbidities’ prevalence was highest in patients aged 40 - 80 years who presented urological diseases such as BPH (68.9%), Erectile dysfunction (ED) and ejaculatory disorders, overactive bladder (OAB) and neurogenic lower urinary tract dysfunction (LUTD), renal cyst (5%), inguinal hernia (4.2%), urinary stones (2.8%), and prostate cancer (2.3%). Conclusion: The comorbidities’ prevalence was 14.2% in the urological patients. The main comorbidities were hypertension (84.5%) and diabetes mellitus (26.5%).

焦虑与抑郁的合病(Comorbidity)

抑郁与焦虑两组症状群之间的关系很早就已为人所注意。早在1934年,Lewis就提出过两组症状之间的连续性,认为焦虑症状从整体上或部分上是抑郁的一部分。英国Newcastle学派的领袖Roth(1981)也把两组症状群之间的联系看做是情感障碍的核心组成部分。但是,后来Newcastle学派的Mountjoy与Roth(1982)一系列研究结果表明,抑郁与焦虑应清楚地区分开来。

Comorbidity in inflammatory bowel disease

Patients with inflammatory bowel disease (IBD) can be affected by other unrelated diseases. These are called comorbid conditions, and can include any secondary health problem that affects a person suffering from a primary or main disease, and which is neither linked physiopathologically to the primary condition, nor is it due to the treatments used for the primary condition or to its long-term anatomical or physiological consequences. Different comorbid conditions, as well as their influence on IBD, are discussed.

Disease Risk Comorbidity Index for Patients Receiving Haploidentical Allogeneic Hematopoietic Transplantation

We aimed to develop a disease risk comorbidity index(DRCI)based on disease risk index(DRI)and Hematopoietic Cell Transplantation-Specific Comorbidity Index(HCT-CI)in patients receiving haploidentical hematopoietic stem cell transplantation(haplo-HSCT).We identified the prognostic factors of disease-free survival(DFS)in a training subset(n=593),then assigned a weighted score using these factors to the remaining patients(validation subset;n=296).The multivariable model identified two independent predictors of DFS:DRI and HCT-CI before transplantation.In this scoring system,we assigned a weighted score of 2 to very high-risk DRI,and assigned a weighted score of 1 to high-risk DRI and intermediate-and high-risk HCT-CI(i.e.,haplo-DRCI).In the validation cohort,the three-year DFS rate was 65.2%(95%confidence interval(CI),58.2%–72.2%),55.8%(95%CI,44.9%–66.7%),and 32.0%(95%CI,5.8%–58.2%)for the low-,intermediate-,and high-risk group,respectively(P=0.005).Haplo-DRCI can also predict DFS in disease-specific subgroups,particularly in acute leukemia patients.Increasing score was also significantly predictive of increased relapse,increased non-relapse mortality(NRM),decreased DFS,and decreased overall survival(OS)in an independent historical cohort(n=526).These data confirmed that haplo-DRCI could effectively risk stratify haplo-HSCT recipients and provide a tool to better predict who will best benefit from haplo-HSCT.

Neuroinflammation and comorbidities are frequently ignored factors in CNS pathology

Virtually all drug interventions that have been successful pre-clinically in experimental stroke have failed to prove their efficacy in a dinical setting. This could be partly explained by the complexity and heterogeneity of human diseases as well as the associated co-morbidities which may render neuroprotective drugs less efficacious in dinical practice. One aspect of crucial importance in the physiopathology of stroke which is not completely understood is neuroinflammation. At the pres- ent time, it is becoming evident that subtle, but continuous neuroinflammation can provide the ground for disorders such as cerebral small vessel disease. Moreover, advanced aging and a number of highly prevalent risk factors such as obesity, hypertension, diabetes and atherosclerosis could act as ＂silent contributors＂ promoting a chronic proinflammatory state. This could aggravate the out- come of various pathological entities and can contribute to a number of subsequent post-stroke complications such as dementia, depression and neurodegeneration creating a pathological vicious cycle. Moreover, recent data suggests that the inflammatory process might be dosely linked with multiple neurodegenerative pathways related to depression. In addition, pro-inflammatory cyto- kines could play a central role in the pathophysiology of both depression and dementia.

Association of comorbidities with increasing severity of peripheral neuropathy in diabetes mellitus

AIM: To analyze a large population of patients with diabetes and peripheral neuropathy(PN) to determine other meaningful comorbid etiologies for PN.METHODS: Peripheral Neuropathy is a common complication of type 1 and 2 diabetes mellitus;however,other potential causes for PN may be co-existing in patients with diabetes.A prospective cohort study was performed to assess patients with diabetes and PN.We compared patients having PN due solely to diabetes with patients possessing co-existing comorbidities,performing clinical(Toronto Clinical Scoring System and the Utah Early Neuropathy Scale),laboratory and electrophysiological assessments in all patients.RESULTS: Patients with either type 1 or 2 diabetes mellitus and co-existing comorbidities did not have more severe clinical or electrophysiological PN phenotypes overall.However,in patients with type 1 diabetes,presence of a lipid disorder was associated with greater PN severity.In type 2 diabetes patients,both a lipid disorder and cobalamin deficiency were associated with greater PN severity.There was no additive effect upon PN severity with presence of three or more comorbid etiologies.CONCLUSION: The presence of specific,and not general,comorbidities in patients with type 1 or 2 diabetes corresponds with greater PN severity.