Co-Morbidities Associated with Prematurity in Two Referral Hospitals in Cameroon

Introduction: Prematurity is the leading cause of neonatal death in Africa. More than a million children die each year due to co-morbidities related to prematurity. In addition to being one of the causes of neonatal deaths, the health problems associated with prematurity can also lead to severe lifelong impairment in those who survive. Objectives: This paper aims to determine the epidemiology and identify co-morbidities of prematurity in the neonatology units of the Douala General Hospital (DGH) and the Laquintinie Hospital of Douala (LHD). Patients and Methodology: We conducted an analytical retrospective cohort study from January 2015 to January 2018 in the neonatology department of the GDH and the LHD, which are considered reference hospitals for the management of preterm babies in Cameroon. We included all newborns aged less than 37 weeks admitted to the neonatology units of the GDH and the LHD. The descriptive component was based on the analysis of quantitative variables using measures of central tendency. The analytical component was evaluated using Spearman correlations and the Chi-square and Fisher tests. Simple and multiple logistic regressions measured factors predictive of mortality. The Kaplan Meier survival curve used the Log Rank test and significance at p ≤ 0.05. Results: We recorded 908 preterm newborns in neonatal service and 1,124 preterm deliveries in maternity, representing an incidence of 32.5% in neonatal unit and 10.6% in maternity. 51% of whom were girls, given a sex ratio M/F of 0.9. Hypertension was the main prenatal pathology (9.1%), while premature rupture of membranes: PROM (35.5%) and eclampsia/pre-eclampsia (18.6%) were the most common obstetrical pathologies. 75.9% of deliveries were vaginal with 65.2% being performed in our referral hospitals. Gestational age ranged from 22 to 36 weeks, with a mean of 32.4 weeks. Late preterm birth rate was 53.7%, and birth weight varied between 590 and 3200 g with an average of 1747 ± 479 g. The percentage of low birth weight (1500 - 2499 g) preterm infants was predominant (65.3%), and the intrauterine growth restriction (IUGR) was estimated to be 12.4%. The majority (96.7%) had pathologies in the neonatal period, the most common being neonatal infection (86.9%). The case-fatality rate was 27.4%, compared to 72.6% live births. Factors influencing mortality are risk of premature labour, gestational age ≤ 32 SA, premature birth in hospitals other than our two referral hospitals, birth weight ≤ 1500 g, Apgar at the 10th minute, late secondary anaemia, hospital resuscitation, oxygen therapy, and duration of hospitalization Conclusion: The incidence of prematurity and the mortality rate remains high in neonatal units in Cameroon. Adequate monitoring of pregnancies and management of preterm infants remains a challenge in our context.

Treatment of psychological co-morbidities in common gastrointestinal and hepatologic disorders

Anxiety and depressive disorders frequently coexist with gastrointestinal and hepatologic conditions.Despite their high prevalence,approach to treating these co-morbidities is not always straightforward.This paper aims to review the current literature into etiology of psychological comorbidities and their treatment in three conditions commonly encountered at gastroenterology outpatient clinics,namely inflammatory bowel disease(IBD),irritable bowel syndrome(IBS) and chronic hepatitis C(HepC).The paper demonstrates that although psychotherapy(and cognitive-behavioural therapy in particular) has been established as an effective treatment in IBS,more studies are needed in HepC and IBD.Antidepressants have been recognized as an effective treatment for psychological and somatic symptoms in IBS and for depression in HepC,but good quality studies in IBD are lacking despite the promising preliminary findings from animal models and case studies.Further studies in this area are needed.

A Physician Suffering from COVID-19 with Multiple Co-Morbidities Have Delayed Viral Clearance: A Case Report from Bangladesh

Background: Novel corona virus (SARS-Coronavirus-2 SARS-CoV-2) which emerged in China has spread to multiple countries rapidly. Little information is known about delayed viral clearance in mild to moderate COVID-19 pa-tients. As it is highly contagious, health care workers including physicians are high risk of being infected in hospital care. Case Report: A 37 years old Bangladeshi physician working in a paediatric unit of a medical college hos-pital with multiple co-morbidities, hypertension, diagnosed axial spondy-loarthropathy (ankylosing spondylitis) taking disease modifying anti rheu-matic drugs— DMARDs (Salfasalazine) from 2016 till now, chronic persis-tent bronchial asthma on medication developed sore throat, increasing breathlessness and cough admitted to his own hospital on 22 April, 2020. He had a history of contact with a relapse nephrotic syndrome (glomerulone-phritis) patient admitted with severe respiratory distress later confirmed as COVID-19 following RT PCR test on 14 April, 2020. After 3 days of contact with the patient, the physician also developed the symptoms mentioned above. The RT PCR test result of the physician came positive on 18 April, 2020. The physician primarily taken only azithromycin 500 mg once daily along with other regular drugs. On 5, 12 and 18 May, 2020, his sample was taken for re-test and came positive subsequently. After that he started Iver-mectin (0.15 mg/kg) once daily for 3 days and doxycycline 100 mg BD for 7 days. He gave samples again on 27 and 29 May, 2020 which were came nega-tive after 39 days. On full recovery he was discharged from hospital on day 40. We choose the patient because presence of co-morbidities may be asso-ciated with delayed viral clearance and physicians with co-morbidities working in a hospital have high risk of being infected.

Metabolic co-morbidities and psoriasis: The chicken or the egg?

Accumulating evidence supports that psoriasis may be a potential multisystem inflammatory disease associated with a range of co-morbidities showing an overlapping pathology and an important health impact such as metabolic diseases.Psoriasis is associated with an increased risk of obesity,metabolic syndrome(Mets)and diabetes mellitus type 2,following a"dose-response"relationship from mild to severe psoriasis.Conversely,recent evidence from large prospective studies suggests that obesity constitutes a risk factor for psoriasis and psoriatic arthritis.Also,a dyslipidemic profile may precede psoriasis onset.Both obesity,Mets and psoriasis,characterized as chronic inflammatory states,stem from a shared underlying pathophysiology exhibiting common genetic predisposition and risk factors such as high caloric intake,physical inactivity and psychological stress.Excess weight may potentiate the inflammation of psoriasis through the deregulation of adipocytokines while,at the same time,it may help the development of Mets.Interestingly,recent translational data has shown that psoriasis,through increased T-helper inflammatory cytokines in skin and sera,may exert a plethora of effects on insulin regulation and lipid metabolism.Largerpopulation-based prospective cohort and longitudinal studies are needed to unravel the association between psoriasis and metabolic co-morbidities.The recognition of the intricate complex interplay between psoriasis and metabolic co-morbidities may help dermatologists to be aware of associated metabolic co-morbidities in order to screen for metabolic diseases and manage holistically and effectively the psoriatic patient.

Preliminary Investigation of Sex Differences in Procedural Skill Learning in Veterans with Co-Morbidities

Sex differences in procedural skill learning have not been well characterized. Skill learning is an important area to explore in clinical settings that involve rehabilitation and deficit remediation, especially for returning Veterans that have a range of co-morbid conditions (traumatic brain injury, posttraumatic stress disorder, and depression) and possess impairments in multiple domains. Sixty-five (55 males, 10 females) Veterans completed two procedural learning tasks and answered self-report questionnaires. Participants’ performance and total learning slope were analyzed to determine sex differences in learning. Our results revealed sex differences in both tasks demonstrating females tend to perform better than males with a large effect size for these mean differences. While females performed better on the procedural learning tasks compared to males, their rate of learning was equivalent. Skill learning is an important requisite for rehabilitation, as skill learning is necessary to perform daily activities in new settings. Ultimately, these results provide insight into skill learning in Veterans with a range of co-morbid conditions and provide support for further investigation of sex differences in procedural learning.

Population-based study of health service deficits in US adults with depression: Does chronic disease co-morbidity and/or rural residency make a difference?

Introduction: Rural residents are at higher risk for a depressive disorder than their non-rural counterparts. Recent research has indicated that co-morbidities are also associated with depression. Health service deficits (HSDs) is an analytic concept that facilitates the examination of how a population uses health services relevant to their condition. A HSD is present when, over the preceding 12 months, an individual has had no health insurance, no specified health care provider, deferred medical care due to cost, or did not have a routine medical exam. Research has shown a high prevalence of HSDs in populations with individual chronic conditions. No study that we know of has examined if there is an association between the constellation of chronic conditions of depression and the co-morbidities of asthma, arthritis, and diabetes, with HSDs. Methods: 2011 Behavioral Risk Factor Surveillance Survey (BRFSS) data were analyzed to identify important dimensions of the epidemiology of depression by ascertaining whether there were differences in the prevalence of health service deficits in rural versus non-rural adults with depression and at least one additional chronic disease (arthritis, asthma, or diabetes). Data analyses entailed both bivariate and multivariate techniques. All analyses were performed on weighted data. Results: Logistic regression analysis performed using the presence of at least one HSD as the dependent variable yielded that for US adults with lifetime depression those who were African American, Hispanic and other/multiracial in comparison to Caucasian had higher odds of having at least one health service deficit. Low socioeconomic status (SES) and middle SES in comparison to high SES were also risk factors for US adults with lifetime depression having at least one HSD. Rural residency in comparison to non-rural residency also emerged as an independent risk factor (for US adults with lifetime depression having at least one HSD. Chronic disease, however, emerged as protective against US adults with lifetime depression having at least one health service deficit. Conclusions: This study demonstrated that race/ethnicity, SES, and rural residency are important predictors of health service deficits for individuals with a lifetime diagnosis of depression while having one or more chronic conditions for these same individuals was protective.

Psychiatric Co-Morbidity and Quality of Life in Egyptian Type 2 Diabetic Patients

Background: Diabetes is a risk factor for depression, but little is known about anxiety and other psychiatric disorders and quality of life. The aim of this study was to assess the prevalence of depression, anxiety in diabetic patients in our locality and to assess the quality of life in type 2 DM. Subjects & Methods: This study was a cross-sectional study and was carried out in outpatient clinics of specialized medical hospital, Mansoura university for a period of one year. From 217 diabetes mellitus subjects, only 202 patients were matched with 247 healthy people as a control group. All subjects were examined by using socioeconomic data, clinical data, and anthropometric examinations to assess body mass index and waist circumference. All patients were interviewed by using the Mini-International Neuropsychiatric Interview (MINI) version 5, MINI, Hospital Anxiety and Depression scale (HAD) and health-related quality of life (HRQOL) scales. Laboratory investigation in the form of fasting and two-hour postprandial blood sugar (FBS & 2hpp) and HbA1C levels were done. Results: 18.3% were found to be major depressive disorder;and 2.5% panic disorder, 1% other phobia. Generalized anxiety disorder and obsessive-compulsive disorder were found in one patient, no patients were found to be diagnosed as Bipolar disorder, schizophrenia, or substance abuse. Although there was no statistically significant difference between subjects and control groups regarding height, there was statistically significant difference between weights, BMI, with more scores among DM group. Moreover our study showed that HbA1c, fasting blood sugar, two hours post prandial blood sugar were more among DM patients and control groups. Anxiety, depression, and poorer quality of life were found to be more prevalent among DM patients than control groups. Conclusion: DM is associated with depression anxiety disorder with poorer quality of life.

Univariate and multivariate analysis of risk factors for severe clostridium difficile-associated diarrhoea: Importance of co-morbidity and serum C-reactive protein

AIM: To investigate risk factors for severe clostridium difficile associated diarrhoea (CDAD) in hospitalised patients. METHODS: We analysed risk factors for severe CDAD (associated with systemic signs of hypovolemia) in 124 hospitalised patients by retrospective chart review. RESULTS: Severe CDAD was present in 27 patients (22%). Statistical analysis showed a significant association with a higher 30-d mortality (33% vs 4%, P < 0.001) and a higher proportion of longer hospital stay exceeding 14 d (74% vs 52%, P = 0.048). Charlson co-morbidity score (OR 1.29 for 1 point increment, P < 0.05) and serum C-reactive protein at diagnosis (OR 1.15 for 10 mg/L increment, P < 0.001) were independent predictors of severe CDAD. CONCLUSION: Patients with a severe level of co- morbidity and high serum C-reactive protein levels at the time of diagnosis should receive particular attention.

Reconsidering Co-Morbid Traits in Explanatory Models of High Dental Anxiety Using a Comparison of Psychiatric and Normal Patient Samples

Explanatory models of co-morbid traits related to dental anxiety (DA) as described in the literature were tested and relative strengths analyzed in two groups of Danish adults, one with psychiatric diagnoses (n = 108) and the other healthy incoming patients at a large dental school teaching clinic (n = 151). Dental Anxiety Scale (DAS) and self-report measures representing three co-morbidity explanatory models, 1) presence of other fears;2) anxiety sensitivity and 3) feelings of vulnerability specific to dental treatment, were collected in subscales of a 53-item questionnaire. Other items identified gender, age, education, income, avoidance behavior and dental symptoms. Frequency, chi-square, odds ratio and logistic regression analyses were performed. Results: All individuals with high DA (DAS > 13) regardless of group, demonstrated significant differences in avoidance of treatment (>2 yr.) versus lower or no anxiety. Patients with psychiatric diagnoses were three times more likely to have high DA and nearly two times more likely to have avoided dental treatment >2 yr.;25.9% reported extreme DA, compared to 9.3% of controls. Models of high general fear levels, predisposing anxiety sensitivity and vulnerability all demonstrated significant and strong association with intensity of dental anxiety in bivariate analyses. Feelings of vulnerability were the strongest predictor of DAS high anxiety, according to logistic regression analyses. Conclusion: Co-morbidity explanatory models as represented in present trait measures appear not to be competitive, but rather explain different aspects of a vulnerability model in high dental anxiety. Higher incidence of DA and treatment avoidance in psychiatric patients requires special attention.

The association between body composition and self-reported co-morbidity in subjects with chronic obstructive pulmonary disease

Background: Differences in body composition are extensively investigated in subjects with COPD as low muscle mass was independently associated with increased morbidity and mortality. Also cardio-vascular co-morbidity is often reported in COPD and the contribution of fat mass in COPD related co-morbidity is gaining interest. We hypothesized that the prevalence of low muscle mass and high fat mass is higher in subjects with COPD compared to a group of current and former smokers without COPD, which result in higher reported cardiovascular co-morbidity in the COPD group. Methods: In 954 subjects with COPD and 955 subjects without COPD, body composition was assessed by bio-electrical impedance analysis and information on self-reported co-morbidity was collected. Participants were stratified for low fat free mass index and high fat mass index (resp. fat free mass index 50th percentile of the subjects without COPD). Results: Subjects with COPD were more likely to have low fat free mass index than current and former smokers without COPD. The prevalence of high fat mass index was comparable between the groups. The percentage of self-reported co-morbidity was higher in subjects with COPD, but only reports of myocardial infarction were disease specific. Conclusion: Low fat free mass index was more common in COPD, but the prevalence of high fat mass index was comparable between subjects with and without COPD. Nevertheless, subjects with COPD reported more myocardial infarction, implying that other factors than the amount of fat mass are involved in the increased co-morbidity in COPD.

Incidence of Diabetes in Hepatitis C Patients in Remote Areas of Pakistan:Effect of Co-Morbidity on HCV Treatment Outcomes at Selected Secondary Care Hospitals

The management of Hepatitis C(HCV)varies greatly due to co-morbidities.Association of Type II Diabetes Mellitus(T2DM)and HCV infection is momentous,however,only limited studies available from remote areas of Pakistan.This study aimed to assess the incidence of T2DM in Hepatitis C patients,and to measure the treatment outcomes of anti-HCV therapy in co-morbidity of diabetic patients in remote areas of Khyber Pakhtunkhwa Pakistan.A cross-sectional retrospective analysis of HCV patients(n=449)was conducted in the District Hospitals of Bannu and Lakki Marwat,Pakistan.Patients diagnosed of HCV infection and having T2DM as comorbidity were included in the study.The demographic information and laboratory parameters,such as viral load(VL),hemoglobin(Hb),alanine amino transferase(ALT),and platelet count were collected to measure treatment outcomes.T2DM was found in 33.18%of patients and significant association(p˂0.05)was found with HCV infection as a co-morbidity.Sofosbuvir(SOF)and Ribavirin(RBV)therapy reduced the mean(SD)VL(×10^(3))from baseline 357.1±26.23 IU/mL to 14±2.3 IU/mL and 1.3±0.3 IU/mL at 3rd and 6th months of therapy,respectively.Conventional Interferon and Ribavirin(RBV)therapy reduced VL from a baseline 234.57±13.5 IU/mL to 72±7.9 IU/mL and 62±3.7 IU/mL at 3rd and 6th months of therapy,respectively.PEG-Interferon+Ribavirin(RBV)therapy reduced baseline VL from 337±16.27 IU/mL to 18±2.8 and 4±1 at 3^(rd) and 6^(th) month of therapy,respectively.Similarly,Hb,ALT,and platelet count showed variations in all the studied groups.T2DM was highly prevalent and significantly associated with HCV in patients of 40 years or above and SOF+RBV combination therapy showed a better response,both in the diabetic and non-diabetic HCV patients compared to earlier the therapies.To further confirm the finding,a study using a larger population of HCV patients with T2DM should be conducted.

Viruses and autism: A Bi-mutual cause and effect

Autism spectrum disorder(ASD)is a group of heterogeneous,multi-factorial,neurodevelopmental disorders resulting from genetic and environmental factors interplay.Infection is a significant trigger of autism,especially during the critical developmental period.There is a strong interplay between the viral infection as a trigger and a result of ASD.We aim to highlight the mutual relationship between autism and viruses.We performed a thorough literature review and included 158 research in this review.Most of the literature agreed on the possible effects of the viral infection during the critical period of development on the risk of developing autism,especially for specific viral infections such as Rubella,Cytomegalovirus,Herpes Simplex virus,Varicella Zoster Virus,Influenza virus,Zika virus,and severe acute respiratory syndrome coronavirus 2.Viral infection directly infects the brain,triggers immune activation,induces epigenetic changes,and raises the risks of having a child with autism.At the same time,there is some evidence of increased risk of infection,including viral infections in children with autism,due to lots of factors.There is an increased risk of developing autism with a specific viral infection during the early developmental period and an increased risk of viral infections in children with autism.In addition,children with autism are at increased risk of infection,including viruses.Every effort should be made to prevent maternal and early-life infections and reduce the risk of autism.Immune modulation of children with autism should be considered to reduce the risk of infection.

From bariatric to metabolic surgery:Looking for a"diseasemodifier"surgery for type 2 diabetes

In this review the recent evolution of the comprehension of clinical and metabolic consequences of bariatric surgery is depicted. At the beginning bariatric surgery aim was a significant and durable weight loss. Later on, it became evident that bariatric surgery was associated with metabolic changes, activated by unknown pathways, partially or totally independent of weight loss. Paradigm of this "metabolic" surgery is its effects on type 2 diabetes mellitus(T2DM). In morbid obese subjects it was observed a dramatic metabolic response leading to decrease blood glucose, till diabetes remission, before the achievement of clinically significant weight loss, opening the avenue to search for putative antidiabetic "intestinal" factors. Both proximal duodenal(still unknown) and distal(GLP1) signals have been suggested as hormonal effectors of surgery on blood glucose decrease. Despite these findings T2 DM remission was never considered a primary indication for bariatric surgery but only a secondary one. Recently T2 DM remission in obese subjects with body mass index(BMI) greater than 35 has become a primary aim for surgery. This change supports the idea that "metabolic surgery" definition could more appropriate than bariatric, allowing to explore the possibility that metabolic surgery could represent a "disease modifier" for T2 DM. Therefore, several patients have undergone surgery with a primary aim of a definitive cure of T2 DM and today this surgery can be proposed as an alternative therapy. How much surgery can be considered truly metabolic is still unknown. To be truly "metabolic" it should be demonstrated that surgery could cause T2 DM remission not only in subjects with BMI > 35 but also with BMI < 35 or even < 30. Available evidence on this topic is discussed in this mini-review.

Major comorbid disease processes associated with increased incidence of acute kidney injury

Acute kidney injury （AKI） is commonly seen amongst critically ill and hospitalized patients. Individuals with certain co-morbid diseases have an increased risk of developing AKI. Thus, recognizing the co-morbidities that predispose patients to AKI is important in AKI prevention and treatment. Some of the most common co-morbid disease processes that increase the risk of AKI are diabetes, cancer, cardiac surgery and human immunodefciency virus （HIV） acquired immune defciency syndrome （AIDS）. This review article identifies the increased risk of acquiring AKI with given co-morbid diseases. Furthermore, the pathophysiological mechanisms underlying AKI in relation to co-morbid diseases are discussed to understand how the risk of acquiring AKI is increased. This paper reviews the effects of various co-morbid diseases including： Diabetes, cancer, cardiovascular disease and HIV AIDS, which all exhibit a significant increased risk of developing AKI. Amongst these co-morbid diseases, inflammation, the use of nephrotoxic agents, and hypoperfusion to the kidneys have been shown to be major pathological processes that predisposes individuals to AKI. The pathogenesis of kidney injury is complex, however, effective treatment of the co-morbid disease processes may reduce its risk. Therefore, improved management of co-morbid diseases may prevent some of the underlying pathology that contributes to the increased risk of developing AKI.

Assessment of visual outcomes of cataract surgery in Tujia nationality in Xianfeng County, China

AIM: To evaluate the visual outcome and factors influencing visual outcome of manual small incision cataract surgery(MSICS) in the rural area in the Xianfeng County.METHODS: Eighty-two eyes of 82 patients who underwent cataract surgery performed by using MSICS technique were identified. Data collected included each patient’s age, gender, the level of education. Uncorrected and corrected distance visual acuity(UDVA and CDVA) at presentation and at 1, 6, 8wk postoperatively, pre-existing eye disease, operative findings and complications, the risk factors were evaluated.RESULTS: In 82 patients, the average age was 69.6±0.6y, illiterate were 52(63.4%). Of 82 eyes, pseudophakia was present in 77 eyes(93.9%). At 1wk postoperatively,47 eyes(57.3%) had the UDVA of ≥6/18, and 52 eyes(63.4%) had the CDVA of ≥6/18. At 6 to 8wk postoperatively, 50 eyes(61.0%) had UDVA of ≥6/18, and57 eyes(69.5%) had the CDVA of ≥6/18. Postoperative visual status was significantly related to the co-morbidities, such as corneal pathology, glaucoma(P 【0.001).Operative complications, such as posterior capsule opacity and cystoid macular edema were main operative cause for the poor visual outcome.CONCLUSION: MSICS provides a good visual recovery in our study but the vision outcome did not fulfill the standards proposed by WHO, which highlights the need for an improvement in local socioeconomic understanding, population education and surgery quality.

The influence of obesity duration on left ventricular mass, volume and function: A pilot study

Introduction: Despite the bulk of evidence between obesity and cardiovascular complications, the effect of the duration of obesity (DOO) on cardiac function has so far received limited attention. The aim of the study is to study the relationship between a new, American Heart Association (AHA) and World Health Organization (WHO)-adapted formula for reporting DOO with echocardiographic findings and comorbidities in a large cohort of individuals whose BMI ranged from normal (·m﹣2) to morbid obesity (>40 Kg·m﹣2) and had been obese for varying lengths of time. Methods: 198 (M60/F138) asymptomatic patients were recruited. Patients were classified according to their reported DOO. The normal weight group (N = 92 (40/F52) was formed by those patients who did not recall maintaining a BMI > 30 Kg·m﹣2 from age 18 while those recalling maintenance of a BMI > 30 Kg·m﹣2 since age 18 and thereafter formed the obese group (N = 106 (M20/F86)). A detailed clinical, echo-cardiographic and analytical study was performed. Results: DOO in our series disclosed a significant correlation with left ventricular architecture and hemodynamics, left ventricular mass, cardiac output as well as the prevalence of diabetes mellitus, hypertension and insulin resistance. Stepwise multiple regression analysis revealed that almost 54% of the interventricular septum thickness’s variance can be independently predicted by a model including DOO, gender, hypertension and logtransformed HOMA. Conclusions: Our formula for estimating the duration of obesity provides a simple, user-friendly tool whose utilization in bariatric preoperative assessments and in advanced nursing practice deserves prospective studies.

Childbirth Complications among Adolescent Mothers at Mbala General Hospital in Mbala District, Zambia

Aim: The study aim was to explore childbirth complications among adolescent mothers at Mbala General Hospital, Zambia. Method: A descriptive cross-sectional study design of 138 adolescent mothers aged between 10-19 years was carried out over a period of five months at a referral hospital (Mbala General Hospital) in Mbala District, in the Northern Province of Zambia, Central Africa. Results: Maternal age prevalence was 31.1% for all admissions. The childbirth complications identified on admission were prolonged labour (42%);during Labour-Cephalopelvic Disproportion (CPD) (59.7%), prolonged labour (20%), in the post-partum period, Post-Partum Hemorrhage (PPH) due atonic uterus at 20%. The most prevalent co-morbidity was Anemia (55.6%). A statistically significant association was observed between childbirth complications and parity with a P-value of 0.001. Conclusion: Our study demonstrates an association between childbirth complications and parity while the childbirth complications of prolonged labour, Contracted Pelvic Disproportion, premature rupture of membrane and PPH were observed.

Acute upper gastrointestinal bleeding in octοgenarians:Clinical outcome and factors related to mortality

AIM: To evaluate the aetiology, clinical outcome and factors related to mortality of acute upper gastrointestinal bleeding (AUGIB) in octogenarians. METHODS: We reviewed the records of all patients over 65 years old who were hospitalised with AUGIB in two hospitals from January 2006 to December of 2006. Patients were divided into two groups: Group A (65-80 years old) and Group B (> 80 years old). RESULTS: Four hundred and sixteen patients over 65 years of age were hospitalized because of AUGIB. Group A included 269 patients and Group B 147 patients. Co-morbidity was more common in octogenarians (P = 0.04). The main cause of bleeding was peptic ulcer in both groups. Rebleeding and emergency surgery were uncommon in octogenarians and not different from those in younger patients. In-hospital complications were more common in octogenarians (P = 0.05) and more patients died in the group of octogenarians compared to the younger age group (P = 0.02). Inability to perform endoscopic examination (P = 0.002), presence of high risk for rebleeding stigmata (P = 0.004), urea on admission (P = 0.036), rebleeding (P = 0.004) and presenceof severe co-morbidity (P < 0.0001) were related to mortality. In multivariate analysis, only the presence of severe co-morbidity was independently related to mortality (P = 0.032). CONCLUSION: While rebleeding and emergency surgery rates are relatively low in octogenarians with AUGIB, the presence of severe co-morbidity is the main factor of adverse outcome.

Impact of age-related comorbidity on results of colorectal cancer surgery

AIM: To analyze the correlation between preexisting comorbidity and other clinicopathological features, short-term surgical outcome and long-term survival in elderly patients with colorectal cancer (CRC). METHODS: According to age, 403 patients operated on for CRC in our department were divided into group A (< 70 years old) and group B (≥ 70 years old) and analyzed statistically. RESULTS: Rectal localization prevailed in group A (31.6% vs 19.7%, P = 0.027), whereas the percentage of R0 resections was 77% in the two groups. Comorbidity rate was 46.2% and 69.1% for group A and B, respectively (P < 0.001), with a huge difference as regards cardiovascular diseases. Overall, postoperative morbidity was 16.9% and 20.8% in group A and B, respectively (P = 0.367), whereas mortality was limited to group B (4.5%, P = 0.001). In both groups, patients who suffered from postoperative complications had a higher overall comorbidity rate, with preexisting cardiovascular diseases prevailing in group B (P = 0.003). Overall 5-year survival rate was significantly betterfor group A (75.2% vs 55%, P = 0.006), whereas no signif icant difference was observed considering disease-specif ic survival (76.3% vs 76.9%, P = 0.674). CONCLUSION: In spite of an increase in postoperative mortality and a lower overall long-term survival for patients aged ≥ 70 years old, it should be considered that, even in the elderly group, a signif icant number of patients is alive 5 years after CRC resection.

Transcranial magnetic stimulation: potential treatment for co-occurring alcohol, traumatic brain injury and posttraumatic stress disorders

Alcohol use disorder （AUD）, mild traumatic brain injury （mTBI）, and posttraumatic stress disorder （PTSD） commonly co-occur （AUD ＋ mTBI ＋ PTSD）. These conditions have overlapping symptoms which are, in part, reflective of overlapping neuropathology. These conditions become problematic because their co-occurrence can exacerbate symptoms. Therefore, treatments must be developed that are inclusive to all three conditions. Repetitive transcranial magnetic stimulation （rTMS） is non-invasive and may be an ideal treatment for co-occurring AUD ＋ mTBI ＋ PTSD. There is accumulating evidence on rTMS as a treatment for people with AUD, mTBI, and PTSD each alone. However, there are no published studies to date on rTMS as a treatment for co-occurring AUD ＋ mTBI ＋ PTSD. This review article advances the knowledge base for rTMS as a treatment for AUD ＋ mTBI ＋ PTSD. This review provides background information about these co-occurring conditions as well as rTMS. The existing literature on rTMS as a treatment for people with AUD, TBI, and PTSD each alone is reviewed. Finally, neurobiological findings in support of a theoretical model are discussed to inform TMS as a treatment for co-occurring AUD ＋ mTBI ＋ PTSD. The peer-reviewed literature was identified by targeted literature searches using PubMed and supplemented by cross-referencing the bibliographies of relevant review articles. The existing evidence on rTMS as a treatment for these conditions in isolation, coupled with the overlapping neuropathology and symptomology of these conditions, suggests that rTMS may be well suited for the treatment of these conditions together.