The effect of comorbidities on the clinical profile and outcomes of surgery for carpal tunnel syndrome

<b><br>Introduction:</b> The results of some studies show that predictors of less favourable outcomes of surgery for carpal tunnel syndrome might include the presence of comorbidities, such as diabetes and thyroid gland diseases. The role of these factors has not been clearly determined, but in most trials the patients burdened with comorbidities conducive to CTS are excluded from the analysis.</br> <b><br>Aim:</b> The aim of this study was to investigate the effect of concomitant diseases on the clinical profile and outcomes of surgery for carpal tunnel syndrome.</br> <b><br>Material and methods:</b> The study group consisted of 1117 patients - 909 women (81%) and 208 men (19%) - at a mean age of 63 years. A total of 972 patients (87%) declared having at least one comorbidity, whereas 145 patients (13%) declared no comorbidities. The measurements were performed preoperatively and at 6 months postoperatively; they included pain intensity, total grip and key-pinch strength, digital sensibility and hand function with Levine's questionnaire.</br> <b><br>Results:</b> At baseline, the patients with comorbidities had significantly worse digital sensiblility, weaker total grip strength and greater functional impairment of the hand, but only grip strength reached the minimal important difference (3.5 kg). Carpal tunnel release resulted in significant improvement in the tested variables for all patients, although the outcomes at 6 months were less favourable for those with comorbidities with regard to digital sensiblility, total grip and pinch strength and function of the hand. All these differences were statistically significant, but only grip strength reached the minimal important difference (2.9 kg).</br> <b><br>Conclusion:</b> The results of this study show that comorbidities in patients suffering from CTS had a statistically and clinically significant negative effect only on the total grip strength pre- and postoperatively, and no significant effect on the outcome of surgery, which was satisfactory in all patients.</br>.

Survival Rates in Elderly Patients on Continuous Ambulatory Peritoneal Dialysis

Purpose

The present study aimed at evaluating the survival rate, its associated factors, and the causes of death in elderly patients undergoing continuous ambulatory peritoneal dialysis (CAPD) in Vietnam.

Patients and Methods

This is a retrospective, observational study conducted among patients aged ≥65 years who underwent CAPD at Thong Nhat Hospital, Ho Chi Minh City, Vietnam, from April 2012 to December 2020. The Kaplan-Meier method was used to calculate the cumulative survival rate, and the Log rank test was used to analyze the factors associated with the survival rate of patients.

Results

This study enrolled a total of 68 patients with a mean age of 71.93 ± 7.44 years at the initiation of CAPD. The most common complication among kidney failure patients was diabetic nephropathy (39.71%). The rate of concomitant cardiovascular diseases was 58.82%. The average survival rate was 45.59 ± 4.01 months. Peritonitis was the most common factor causing death (31.25%), followed by cardiovascular diseases (28.12%) and malnutrition (25%). The factors that impacted the survival rate included concomitant cardiovascular diseases, low serum albumin (<35 g/dL), and an indication of CAPD due to exhausted vascular access for hemodialysis at baseline. The main factor associated with a shorter survival time was concomitant cardiovascular diseases.

Conclusion

It is necessary to improve the survival time beyond 5 years for elderly patients undergoing CAPD, especially for those with concomitant cardiovascular diseases. Besides the prevention of peritonitis, adequate measures to protect from cardiovascular diseases and malnutrition will reduce the mortality rate in patients on CAPD.

Functional bowel symptoms in the general population (Review)

Several patients with irritable bowel syndrome (IBS) do not seek medical attention for their symptoms. When patients with IBS seek help, the majority of them are handled at primary healthcare centers, whereas research studies are performed at tertiary healthcare centers. The present study aimed to summarize findings from >4,000 participants of the general population included in the Malmö Offspring Study (inclusion rate 46.7%). The participants were clinically examined, their blood and fecal samples collected, and their questionnaires completed. The participants were divided into subjects with or without self‑reported IBS and those having functional gastrointestinal (GI) symptoms in the past 2 weeks. The presence of IBS and GI symptoms in the participants were associated with each other. Zonulin levels did not differ between participants with or without GI diseases and were not associated with the degree of GI symptoms. The parameters low body weight at birth and small for gestational age were associated with the degree of the symptoms' influence on daily life. IBS and GI symptoms were positively associated with Blautia abundance. Beta‑diversity differed between participants with or without these two conditions. Positive correlations were noted between the degree of diarrhea and the mean 24‑h measurements of systolic blood pressure, diastolic blood pressure, and heart rate. Both IBS and GI symptoms were associated with female sex, smoking, stress, poor sleeping habits, unemployment, drug use, and a family history of GI diseases, whereas younger age was inversely associated with IBS and its associated symptoms. In conclusion, only a limited number of medical findings could be identified in participants with IBS and GI symptoms, whereas sociodemographic and environmental conditions were associated with these entities.

The small bowel microbiome changes significantly with age and aspects of the ageing process

Gut microbiome changes have been associated with human ageing and implicated in age-related diseases including Alzheimer's disease and Parkinson's disease. However, studies to date have used stool samples, which do not represent the entire gut. Although more challenging to access, the small intestine plays critical roles in host metabolism and immune function. In this paper (Leite et al. (2021), Cell Reports, doi: 10.1016/j.celrep.2021.109765), we demonstrate significant differences in the small intestinal microbiome in older subjects, using duodenal aspirates from 251 subjects aged 18-80 years. Differences included significantly decreased microbial diversity in older subjects, driven by increased relative abundance of phylum Proteobacteria, particularly family Enterobacteriaceae and coliform genera Escherichia and Klebsiella. Moreover, while this decreased diversity was associated with the 'ageing process' (comprising chronologic age, number of medications, and number of concomitant diseases), changes in certain taxa were found to be associated with number of medications alone (Klebsiella), number of diseases alone (Clostridium, Bilophila), or chronologic age alone (Escherichia, Lactobacillus, Enterococcus). Lastly, many taxa associated with increasing chronologic age were anaerobes. These changes may contribute to changes in human health that occur during the ageing process.

[The alteration of the structure of mortality of endocrine system diseases, nutrition disorders and metabolic disturbances in individuals of able-bodied age and older in conditions of pandemic]

The elderly age and endocrine diseases are among death risk factors at contamination with new coronavirus infection. To reply the question of how the influence of these risk factors is summing up, differences were determined concerning patterns of changes in structure of mortality of endocrine system diseases, nutrition disorders and metabolic disturbances in individuals of able-bodied age and older against the background of COVID-19 pandemic. on the basis of information from the Moscow database of deaths of endocrine system diseases, nutrition disorders and metabolic disturbances, the changes in contribution of individual diseases to the death causes structure in 2019-2021 were analyzed. The groups of individuals of able-bodied age and older were compared. It was established that in both groups rate of indicating SARS-CoV-2 virus infection as concomitant disease decreased while rate of indicating concomitant diseases at death of COVID-19 increased. The group differences in changes of structure of death causes were established in 2021. The percentage of undetermined forms of diabetes and obesity in structure of death causes increased in the elderly, while in individuals of able-bodied age increased. The percentage of obesity as concomitant disease of death of COVID-19 in individuals of able-bodied age increased and did no change were detected in the elderly group. The input of poly-glandular dysfunction as consequence of old infection into mortality is five times higher among individuals of able-bodied age. On the basis of received results, assumption was made SARS-CoV-2 virus contamination ruinously affects development of pathological process under endocrine diseases regardless of age, while age affects spreading of endocrine diseases and degree of resistance to development of infectious process directly. The differences in patterns of changes of structure of death causes of population of able-bodied age and older are associated with low quality of diagnostics of death causes in individuals of elder age groups.

Age and the aging process significantly alter the small bowel microbiome

Gut microbial diversity decreases with aging, but existing studies have used stool samples, which do not represent the entire gut. We analyzed the duodenal microbiome in 251 subjects aged 18-35 (n = 32), 36-50 (n = 41), 51-65 (n = 96), and 66-80 (n = 82). Decreased duodenal microbial diversity in older subjects is associated with combinations of chronological age, number of concomitant diseases, and number of medications used, and also correlated with increasing coliform numbers (p < 0.0001). Relative abundance (RA) of phylum Proteobacteria increases in older subjects, with increased RA of family Enterobacteriaceae and coliform genera Escherichia and Klebsiella, and is associated with alterations in the RA of other duodenal microbial taxa and decreased microbial diversity. Increased RA of specific genera are associated with chronological age only (Escherichia, Lactobacillus, and Enterococcus), number of medications only (Klebsiella), or number of concomitant diseases only (Clostridium and Bilophila). These findings indicate the small intestinal microbiome changes significantly with age and the aging process.

Prevalence and Clinical Features of Idiopathic Parkinson's Disease in Western Turkey

Introduction

We aimed to determine the prevalence and risk factors of idiopathic Parkinson's disease (IPD) in Western Turkey, which encompasses Edirne and its surrounding districts.

Methods

In this study, 9887 individuals, able to communicate and agreed to participate in the study, were evaluated. The data was obtained by answering a face-to-face questionnaire consisting of 53 questions from volunteers living at 30 randomly selected family health centers in Edirne and its counties. The questionnaire included demographic information, questions to evaluate potential concomitant conditions, and questions regarding the symptomatology used in IPD diagnosis. Following the questionnaire, it was planned to determine the degree of IPD with the Unified Parkinson's Disease Rating Scale (UPDRS) and the Hoehn and Yahr scale (HY) clinical rating scale in patients diagnosed with IPD to assess disease severity in patients diagnosed with IPD.

Results

Of the 9887 individuals, 118 were diagnosed with IPD according to the questionnaire results from Edirne and its districts, and the prevalence of IPD was 1.2%. Approximately, 58.4% of the patients with IPD were male and 41.6% were female, which was not significantly different (p=0.214). Non-motor symptoms such as difficulty urinating, anxiety, depression, fatigue, REM sleep behavior disorder, and difficulty falling asleep or staying asleep were also examined in patients diagnosed with IPD. Depression was identified in 45.7% of the cases, while the control group was 4.3% (p=0.001). Fatigue was identified in 46.8% of the cases and control group was 3.5% (p=0.002).

Conclusions

IPD prevalence studies will increase the awareness in the community and provide early diagnosis and treatment as well as serve as a basis to increased life expectancy, reduce morbidity, and improve life quality.

Clinical features and survival analysis of 97 coronavirus disease 2019 (COVID-19) patients

BACKGROUND

We aim to investigate the clinical characteristics and survival rate of coronavirus disease 2019 (COVID-19) patients.

METHODS

Ninety-seven COVID-19 patients were enrolled. The laboratory results, lung imaging and medical treatment were compared. Patients were followed up after 1 year, and the Kaplan-Meier test was used for survival analysis.

RESULTS

Compared with the non-severe group, the age of the severe group was older, and the proportion of concomitant diseases were higher. As fever was the primary clinical manifestation, dyspnea and anorexia were more common in severe patients. Lung imaging manifestations and laboratory indicators were worse in the severe group. Accordingly, the treatment of glucocorticoid, antibiotics, and advanced life support were in high proportion. Of the 97 patients with COVID-19, 4 severe patients died within one month during the 1-year follow-up, with the median survival time of 47.0 weeks (95% CI: 45.1-48.9).

CONCLUSIONS

Severe cases of COVID-19 are characterized by advanced age, more concomitant diseases and complications, which lead to a decreased short-term survival rate. However, there were no deaths after one month, which implied a good prognosis if the risk period were passed smoothly.

Clinical outcomes of non-alcoholic fatty liver disease: Polish-case control study

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is becoming the most common cause of chronic liver disease worldwide, affecting up to 30% of population. Non-alcoholic fatty liver disease can lead to non-alcoholic steatohepatitis (NASH), fibrosis, cirrhosis, and hepatocellular carcinoma. Age, obesity, insulin resistance, type 2 diabetes, and dyslipidemia are important risk factors for developing hepatic steatosis. Concomitant diseases, especially cardiovascular, are discussed as important causes of death in NAFLD patients.

OBJECTIVES

The objective of this study was to conduct a retrospective comparison of the frequency of concomitant diseases in NAFLD patients and controls, especially metabolic syndrome and cardiovascular disease (CVD).

MATERIAL AND METHODS

A total of 1,058 (558 NAFLD patients and 500 controls). Diagnosis of NAFLD was established with ultrasound examination in the absence of other causes of fatty liver. The control group included patients with no history of liver disease, normal liver image in ultrasound examination and normal liver laboratory tests.

RESULTS

Overweight and/or obesity were diagnosed in 80.8% of patients in the study group and 40.8% in the controls (p < 0.001). Metabolic syndrome was present in 48.7% patients in the study group compared with 14.4% controls, (p < 0.001). In the study group, we found higher prevalence of hypertension (56.1% vs 37%; p < 0.001), type 2 diabetes mellitus (24.4% vs 8.6%; p < 0.001), decreased concentration of serum HDL (35.1% vs 19.5%; p < 0.001), elevated serum triglycerides (36.5% vs 15.4%; p < 0.001). Cardiovascular disease was found in 13.6% of individuals in the study group and in 15% controls (NS, p = 0.32). The most frequent concomitant gastrointestinal disease present in the study group was gastroesophageal reflux disease (GERD) (31.9% vs 22.8%; p < 0.001) followed by colonic diverticulosis (23.7% vs 15.8%; p < 0.005).

CONCLUSIONS

Metabolic syndrome with its components is more common in NAFLD patients compared to matched controls. Additionally, NAFLD patients are more often affected by GERD and colonic diverticulosis but not by CVD.

[Minimally invasive surgery for colorectal cancer in advanced age patients]

AIM

To evaluate the role of laparoscopic surgery for colorectal cancer in advanced age patients.

MATERIAL AND METHODS

290 patients with colorectal cancer were enrolled including 121 patients with rectal cancer and 169 patients with colon cancer. Main group consisted of 171 patients over 60 years old, control group - 119 patients younger 60 years old.

RESULTS

Radical advanced procedures on different parts of colon including laparoscopic approach were performed in the majority of advanced age patients. Outcomes were considered as good, we did not notice serious complications (5.4% after rectal surgery, 3.9% after colon surgery). Differences were not significant compared with younger patients including laparoscopic interventions for emergency indications. Nevertheless, surgical treatment of advanced age patients with colorectal cancer makes special demands for equipping of the clinic and physicians' qualification.

CONCLUSION

Advanced age is not a serious limitation in choice of laparoscopic access in both elective and emergency surgery in patients with colorectal cancer.

The pharmacotherapy preferred by doctors in treatment of patients diagnosed with asthma or chronic obstructive pulmonary disease or allergic rhinitis and concomitant diseases: an epidemiological analysis

INTRODUCTION

The clinical course of asthma and chronic obstructive pulmonary disease (COPD) is influenced by the co-occurrence of other chronic diseases and their pharmacotherapy. There are no data associated with the doctors' pharmacotherapy preferences in treatment of patients with asthma, COPD or allergic rhinitis and concomitant diseases.

AIM

The assessment of doctors' preferences in pharmacotherapy of asthma, COPD or allergic rhinitis in relation to concomitant diseases.

MATERIAL AND METHODS

General practitioners, pulmonologists, allergists, laryngologists and paediatricians (n = 319) participated in a questionnaire survey concerning their preferences in pharmacotherapy of asthma, COPD and allergic rhinitis in relation to concomitant diseases enrolling 11,310 patients with asthma, COPD and allergic rhinitis.

RESULTS

The concomitant diseases were reported in 58.5% of patients with asthma, 80.8% of patients with COPD and 46.4% of patients with allergic rhinitis. Patients with asthma were most frequently treated with inhaled glucocorticosteroids. However, in the subgroups with concomitant diseases, an increased usage of inhaled long-acting β2-mimetics was noted. Regardless of comorbidities, patients with COPD were most frequently treated with inhaled long-acting β2-mimetics whereas patients with allergic rhinitis - with nasal glucocorticosteroids and third-generation antihistamines.

CONCLUSIONS

The co-occurrence of chronic diseases was most frequent among patients diagnosed with COPD. The treatment of asthma, COPD and allergic rhinitis is consistent with international recommendations and the occurrence of concomitant diseases did not significantly influence therapeutic preferences and decisions.

[The management for pediatric chronic rhinosinusitis with upper respiratory tract concomitant diseases]

Objective:To analyze the clinical impact of upper respiratory tract concomitant diseases in pediatrics chronic rhinosinusitis(CRS) and treatment methods, efficacy and timing of the concomitant diseases.Method:Two hundred and sixty-seven cases with CRS at a tertiary children's medical center from March 2013 to March 2015 were included in this study. The cases were divided into two groups according to the concomitant diseases. 66 cases without concomitant diseases were allocated into group A；201 cases with concomitant diseases were classified into group B. Group B was further divided into two subgroups according to treatment methods: subgroup B1(97 cases) and subgroup B2(104 cases). Group A and B1 were given the same basic treatment for 3 months，while Group B2 was given the basic plus targeted treatment for the same duration. Comprehensive evaluation was conducted at 3, 6 and 15-months after commencement of treatment. Result:The therapeutic effect of Group A was significantly superior to Group B1 in 3 months（P<0.05）.The clinical efficacy of Group A decreased slightly while Group B1 showed significantly reduced efficacy at 6 and 15-months （all P<0.05）. Comparing Group B1 and B2, the comprehensive effect of Group B2 was considerably better than Group B1 at 3 months（P<0.05）. Furthermore, Group B2 showed no decrease in efficacy while Group B1 decreased significantly at 6 and 15-month. Conclusion:Recurrent upper respiratory tract infections, allergic rhinitis, adenoid hypertrophy and chronic tonsillitis, were common the upper respiratory tract accompanying diseases in children with CRS, and they had significant influence on the efficacy and recurrence of CRS. The basic plus targeted treatment can improve the efficacy and reduce recurrence.

Asthma-chronic obstructive pulmonary disease overlap syndrome in Poland. Findings of an epidemiological study

Introduction

Recent years have seen an increased interest in asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS).

Aim

In 2012, Takeda Polska conducted a non-interventional epidemiological study aimed at identifying the typical phenotype of ACOS patients receiving pulmonary care.

Material and methods

The study enrolled a total of 12,103 of smoking patients above 45 years of age (mean age: 61.5 years; mean duration of smoking: 28.4 pack-years). A total of 68.6% of patients represented the frequent-exacerbation phenotype (mean number of exacerbations during 12 months: 2.11), and 56.4% of patients from the group comprising 12,103 participants were hospitalized at least once during their lifetime due to a respiratory system disease (mean number: 3.82 ±3.76).

Results

The most commonly found asthma symptoms included paroxysmal dyspnoea with wheezing, and good response to inhaled steroids. The most frequently identified COPD-associated symptoms were: long-lasting reduction in forced expiratory volume in 1 s (FEV₁) (< 80% after administering a bronchodilator) and chronic productive cough. Eighty-five percent of patients were diagnosed with concomitant diseases, predominantly arterial hypertension (62.9%) and metabolic diseases (metabolic syndrome, obesity, type 2 diabetes – 46.4% in total).

Conclusions

A clinically severe course of ACOS and the presence of concomitant diseases should be regarded as factors justifying an individual selection of inhalation therapy which specifically takes into account anti-inflammatory treatment and patient safety.

Microscopic Colitis is Associated with Several Concomitant Diseases

Microscopic colitis (MC) is a disease with intestinal mucosal inflammation causing diarrhea, affecting predominantly middle-aged women. The etiology is unknown, but increased prevalence of autoimmune diseases in these patients has been described, although not compared with controls or adjusted for confounding factors. The aim of this study was to examine the prevalence of common diseases in patients with MC and controls from the general population. Hypertension, rheumatoid arthritis, asthma or bronchitis, ischemia, and diabetes mellitus were more prevalent in patients than in controls. The prevalence of gastric ulcer and cancer did not differ between the groups. Besides corticosteroids, many patients were also being treated with proton pump inhibitors, antidepressant drugs, angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists, statins, thyroid hormones, and beta-blockers. More patients than controls were former or current smokers (72.5% versus 57.7%). Thus, MC patients have an increased prevalence of several diseases, not only of autoimmune origin.

Alopecia areata and autoimmunity: a clinical study

Alopecia areata (AA) frequently occur in association with other autoimmune diseases such as thyroid disorders, anemias and other skin disorders with autoimmune etiology. Despite numerous studies related to individual disease associations in alopecia areata, there is paucity of literature regarding comprehensive studies on concomitant cutaneous and systemic diseases. The present study has been designed to determine if there is a significant association between alopecia areata and other autoimmune diseases. This study covers 71 patients with the diagnosis of alopecia areata as the case group and 71 patients with no evidence of alopecia areata as the control group. Among the cutaneous diseases associated with AA, atopic dermatitis (AD) showed maximum frequency with an O/E ratio of 2.5, which indicates that it is two to three times more common in patients with alopecia areata. In our study, thyroid disorders showed the highest frequency with on O/E ratio of 3.2 and a P value of 0.01, which is statistically highly significant. Among the thyroid disorders, hypothyroidism was the most frequent association (14.1%) in our study. Since systemic involvement is not infrequent in patients with alopecia areata, it is imperative to screen these patients for associated disorders, particularly atopy, thyroid diseases, anemias and other autoimmune disorders, especially if alopecia areata is chronic, recurrent and extensive.