Interleukin-6 in epilepsy and its neuropsychiatric comorbidities: How to bridge the gap

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.

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.

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.

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.

The Relationship between Psychological Vulnerability,Aging Attitudes and Life Meaning in Elderly Patients with Comorbidities

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.

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.

Inhibitory gamma-aminobutyric acidergic neurons in the anterior cingulate cortex participate in the comorbidity of pain and emotion

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.

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.

Association of Overlapped and Un-overlapped Comorbidities with COVID-19 Severity and Treatment Outcomes: A Retrospective Cohort Study from Nine Provinces in China

Objective Several COVID-19 patients have overlapping comorbidities. The independent role of each component contributing to the risk of COVID-19 is unknown, and how some non-cardiometabolic comorbidities affect the risk of COVID-19 remains unclear.Methods A retrospective follow-up design was adopted. A total of 1,160 laboratory-confirmed patients were enrolled from nine provinces in China. Data on comorbidities were obtained from the patients’ medical records. Multivariable logistic regression models were used to estimate the odds ratio(OR) and 95% confidence interval(95% CI) of the associations between comorbidities(cardiometabolic or non-cardiometabolic diseases), clinical severity, and treatment outcomes of COVID-19.Results Overall, 158(13.6%) patients were diagnosed with severe illness and 32(2.7%) had unfavorable outcomes. Hypertension(2.87, 1.30–6.32), type 2 diabetes(T2 DM)(3.57, 2.32–5.49),cardiovascular disease(CVD)(3.78, 1.81–7.89), fatty liver disease(7.53, 1.96–28.96), hyperlipidemia(2.15, 1.26–3.67), other lung diseases(6.00, 3.01–11.96), and electrolyte imbalance(10.40, 3.00–26.10)were independently linked to increased odds of being severely ill. T2 DM(6.07, 2.89–12.75), CVD(8.47,6.03–11.89), and electrolyte imbalance(19.44, 11.47–32.96) were also strong predictors of unfavorable outcomes. Women with comorbidities were more likely to have severe disease on admission(5.46,3.25–9.19), while men with comorbidities were more likely to have unfavorable treatment outcomes(6.58, 1.46–29.64) within two weeks.Conclusion Besides hypertension, diabetes, and CVD, fatty liver disease, hyperlipidemia, other lung diseases, and electrolyte imbalance were independent risk factors for COVID-19 severity and poor treatment outcome. Women with comorbidities were more likely to have severe disease, while men with comorbidities were more likely to have unfavorable treatment outcomes.

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.

Health Resource Utilization and Comorbidities in Patients with Mental Disorders: Analysis Based on Health Insurance Claim Data

The number of patients with mental disorders is increasing all over the world and they have a high prevalence of physical complications. To analyze and compare the cost of mental disorders with the total medical costs such as mental disorders and physical disorders, we analyzed the cost that patients with mental disorders incurred. We investigated the distribution of medical costs and the characteristics of diseases by using the health insurance claims of people in City A, Japan from March 2013 to February 2014. The subjects had one or more of 4 mental disorders: schizophrenia, alcohol related disorders, bipolar disorder, and depressive episode. As a result, the total number of patients who met inclusion criteria per year was 7403 (6522 outpatients and 881 inpatients). It was revealed that the hospitalization rate of patients with mental disorders increased with age, and many inpatients stayed in hospital for a long time. Also, it was revealed that many patients with mental disorders were in complicated condition with more than one mental or physical disorders and incurred medical costs for these comorbidities. In conclusion, this analysis indicated that many patients with mental disorders switch from attending the outpatient department to hospitalization as they become older. Further, they incurred a lot of medical expenses for complication management. To improve their QOL, comprehensive assessment of their mental/ physical health, self-management education, coordination of services, and support for decision making regarding treatment are necessary.

Hepatitis C comorbidities affecting the course and response to therapy

Several studies have demonstrated that the outcome of chronic hepatitis C (CHC) infection is profoundly influenced by a variety of comorbidities. Many of these comorbidities have a significant influence on the response to antiviral therapy. These comorbidities negatively affect the course and outcome of liver disease, often reducing the chance of achieving a sustained virological response with PEGylated interferon and ribavirin treatments. Comorbidities affecting response to antiviral therapy reduce compliance and adherence to inadequate doses of therapy. The most important comorbidities affecting the course of CHC include hepatitis B virus coinfection, metabolic syndrome, and intestinal bacterial overgrowth. Comorbidities affecting the course and response to therapy include schistosomiasis, iron overload, alcohol abuse, and excessive smoking. Comorbidities affecting response to antiviral therapy include depression, anemia, cardiovascular disease, and renal failure.

Regional disease characteristics and comorbidities of patients with schizophrenia in the Ziprasidone Observational Study of Cardiac Outcomes (ZODIAC): Findings from an international large simple trial

Background: Using baseline data from the Ziprasidone Observational Study of Cardiac Outcomes (ZODIAC), we assessed disease characteristics and prevalence of select comorbidities among subjects with schizophrenia in different clinical settings across 18 countries. ZODIAC was a randomized, open-label, one-year, large simple trial (LST) that enrolled 18,239 individuals with schizophrenia. Methods: Subjects were randomized to open-label treatment with ziprasidone (n = 9120) or olanzapine (n = 9119) in naturalistic (usual care) settings and followed for one year. Study sites (n = 749) applied minimal selection criteria in an attempt to make the study population as representative as possible of those receiving treatment in “real world” circumstances across the countries. Results: Mean patient age was 41 years, 55% were male, 34% were markedly ill or presented with more severe disease, and 66% of subjects had one or more select comorbid conditions [i.e. heart attack, stroke, hypertension, CAD/angina, high cholesterol/triglycerides, diabetes, or overweight (BMI ≥ 25)] at baseline. History of suicide attempt was greatest in the US (38%), compared with Sweden (34%), Brazil/South America (26%), Asia (23%), and Eastern Europe (20%). Overweight or obesity was the most prevalent comorbid risk factor, representing 60% of enrolled subjects, 70% of US subjects compared with 30% in Asia and 52% - 64% in the other regions studied. High cholesterol/triglycerides levels were found in 23% of US subjects compared with a relatively low prevalence in other countries (3% - 11%). History of cardiovascular or diabetes-related comorbidities was found in 31% of subjects. Current smoking (46.5%) and past smoking (11.8%) were common with men dominating the proportion of current smokers: US (61%);Asia (60%);Sweden (50%);Eastern Europe (49%);and Latin America (44%). Conclusions: Our findings indicate substantial baseline variations across countries in demographics, comorbid conditions, and psychiatric disease history. These data provide an international epidemiologic picture of schizophrenia and may help guide future research and treatment initiatives.

Autism medical comorbidities

Medical comorbidities are more common in children with autism spectrum disorders(ASD)than in the general population.Some genetic disorders are more common in children with ASD such as Fragile X syndrome,Down syndrome,Duchenne muscular dystrophy,neurofibromatosis type I,and tuberous sclerosis complex.Children with autism are also more prone to a variety of neurological disorders,including epilepsy,macrocephaly,hydrocephalus,cerebral palsy,migraine/headaches,and congenital abnormalities of the nervous system.Besides,sleep disorders are a significant problem in individuals with autism,occurring in about 80%of them.Gastrointestinal(GI)disorders are significantly more common in children with ASD;they occur in 46%to 84%of them.The most common GI problems observed in children with ASD are chronic constipation,chronic diarrhoea,gastroesophageal reflux and/or disease,nausea and/or vomiting,flatulence,chronic bloating,abdominal discomfort,ulcers,colitis,inflammatory bowel disease,food intolerance,and/or failure to thrive.Several categories of inborn-errors of metabolism have been observed in some patients with autism including mitochondrial disorders,disorders of creatine metabolism,selected amino acid disorders,disorders of folate or B12 metabolism,and selected lysosomal storage disorders.A significant proportion of children with ASD have evidence of persistent neuroinflammation,altered inflammatory responses,and immune abnormalities.Anti-brain antibodies may play an important pathoplastic mechanism in autism.Allergic disorders are significantly more common in individuals with ASD from all age groups.They influence the development and severity of symptoms.They could cause problematic behaviours in at least a significant subset of affected children.Therefore,it is important to consider the child with autism as a whole and not overlook possible symptoms as part of autism.The physician should rule out the presence of a medical condition before moving on to other interventions or therapies.Children who enjoy good health have a better chance of learning.This can apply to all children including those with autism.

Medical comorbidities at admission is predictive for 30-day in-hospital mortality in patients with acute myocardial infarction： analysis of 5161 cases

Background The present study investigated the prognostic value of medical comorbidities at admission for 30-day in-hospital mortality in patients with acute myocardial infarction （AMI）. Methods A total of 5161 patients with AMI were admitted in Chinese PLA General Hospital between January 1, 1993 and December 31, 2007. Medical comorbidities including hypertension, diabetes mellitus, previous myocardial infarction, valvular heart disease, chronic obstructive pulmonary disease （COPD）, renal insufficiency, previous stroke, atrial fibrillation and anemia, were identified at admission. The patients were divided into 4 groups based on the number of medical comorbidities at admission （0, 1, 2, and ≥3）. Cox regression analysis was used to calculate relative risk （RR） and 95% confidence intervals （CI）, with adjustment for age, sex, heart failure and percutaneous coronary intervention （PCI）. Results The mean age of the studied population was 63.9 ± 13.6 years, and 80.1% of the patients were male. In 74.6% of the patients at least one comorbidity were identified. Hypertension （50.7%）, diabetes mellitus （24.0%） and previous myocardial infarction （12%） were the leading common comorbidities at admission. The 30-day in-hospital mortality in patients with 0, 1, 2, and ≥3 comorbidities at admission （7.2%） was 4.9%, 7.2%, 11.1%, and 20.3%, respectively. The presence of 2 or more comorbidities was associated with higher 30-day in-hospital mortality compared with patients without comorbidity （RR： 1.41, 95% CI： 1.13-1.77, P = 0.003, and RR： 1.95, 95% CI： 1.59-2.39, P = 0.000, respectively）. Conclusions Medical comorbidities were frequently found in patients with AMI. AMI patients with more comorbidities had a higher 30-day in-hospital mortality might be predictive of early poor outcome in patients with AMI.

Comparative profile for COVID-19 cases from China and North America: Clinical symptoms, comorbidities and disease biomarkers

BACKGROUND Large inter-individual and inter-population differences in the susceptibility to and outcome of severe acute respiratory syndrome coronavirus 2 or coronavirus disease 2019(COVID-19)have been noted.Understanding these differences and how they influence vulnerability to infection and disease severity is critical to public health intervention.AIM To analyze and compare the profile of COVID-19 cases between China and North America as two regions that differ in many environmental,host and healthcare factors related to disease risk.METHODS We conducted a meta-analysis to examine and compare demographic information,clinical symptoms,comorbidities,disease severity and levels of disease biomarkers of COVID-19 cases from clinical studies and data from China(105 studies)and North America(19 studies).RESULTS COVID-19 patients from North America were older than their Chinese counterparts and with higher male:Female ratio.Fever,cough,fatigue and dyspnea were the most common clinical symptoms in both study regions(present in about 30%to 75%of the cases in both regions).Meta-analysis for the prevalence of comorbidities(such as obesity,hypertension,diabetes,cardiovascular diseases,chronic obstructive pulmonary disease,cancer,and chronic kidney diseases)in COVID-19 patients were all significantly more prevalent in North America compared to China.Comorbidities were positively correlated with age but at a significantly younger age range in China compared to North American.The most prevalent infection outcome was acute respiratory distress syndrome which was 2-fold more frequent in North America than in China.Levels of C-reactive protein were 4.5-fold higher in the North American cases than in cases from China.CONCLUSION The differences in the profile of COVID-19 cases from China and North America may relate to differences in environmental-,host-and healthcare-related factors between the two regions.Such inter-population differences-together with intrapopulation variability-underline the need to characterize the effect of health inequities and inequalities on public health response to COVID-19 and can assist in preparing for the re-emergence of the epidemic.

Survival and comorbidities in lung cancer patients:Evidence from administrative claims data in Germany

Lung cancer is the most common cancer type worldwide and has the highest and second highest mortality rate for men and women respectively in Germany.Yet,the role of comorbid illnesses in lung cancer patient prognosis is still debated.We analyzed administrative claims data from one of the largest statutory health insurance(SHI)funds in Germany,covering close to 9 million people(11%of the national population);observation period was from 2005 to 2019.Lung cancer patients and their concomitant diseases were identified by ICD-10-GM codes.Comorbidities were classified according to the Charlson Comorbidity Index(CCI).Incidence,comorbidity prevalence and survival are estimated considering sex,age at diagnosis,and place of residence.Kaplan Meier curves with 95%confidence intervals were built in relation to common comorbidities.We identified 70,698 lung cancer incident cases in the sample.Incidence and survival figures are comparable to official statistics in Germany.Most prevalent comorbidities are chronic obstructive pulmonary disease(COPD)(36.7%),followed by peripheral vascular disease(PVD)(18.7%),diabetes without chronic complications(17.4%),congestive heart failure(CHF)(16.5%)and renal disease(14.7%).Relative to overall survival,lung cancer patients with CHF,cerebrovascular disease(CEVD)and renal disease are associated with largest drops in survival probabilities(9%or higher),while those with PVD and diabetes without chronic complications with moderate drops(7%or lower).The study showed a negative association between survival and most common comorbidities among lung cancer patients,based on a large sample for Germany.Further research needs to explore the individual effect of comorbidities disentangled from that of other patient characteristics such as cancer stage and histology.

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.

Extraskeletal symptoms and comorbidities of diffuse idiopathic skeletal hyperostosis

Diffuse idiopathic skeletal hyperostosis(DISH) is a noninflammatory disease characterized by calcification and ossification of soft tissues, mainly enthesis and spinal ligaments. The clinical presentation primarily includes spinal involvement-induced pain and range of motion. Although rare, life-threatening gastrointestinal, respiratory or neurological events or severe morbidity due to bone compression on the adjacent structures may develop. There is a limited amount of data on DISHrelated events in the literature. In recent years, comorbid metabolic disorders are of great interest in patients with DISH. The early diagnosis of these conditions as well as rare entities allows an effective multidisciplinary approach for the treatment of DISH. In this article, we review extraskeletal symptoms and associated comorbidities in patients with DISH.