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Purpose: This study explores the association of the American Society of Anesthesiologists (ASA) score with 90-day mortality in complicated mild traumatic brain injury (mTBI) patients, and in trauma patients without a TBI. Methods: This retrospective study was conducted using a cohort of trauma patients treated at a level III trauma center in Stockholm, Sweden from January to December 2019. The primary endpoint was 90-day mortality. The population was identified using the Swedish Trauma registry. The Trauma and Injury Severity Score (TRISS) was used to estimate the likelihood of survival. Trauma patients without TBI (NTBI) were used for comparison. Data analysis was conducted using R software, and statistical analysis included univariate and multivariate logistic regression. Results: A total of 244 TBI patients and 579 NTBI patients were included, with a 90-day mortality of 8.2% (n = 20) and 5.4% (n = 21), respectively. Deceased patients in both cohorts were generally older, with greater comorbidities and higher injury severity. Complicated mTBI constituted 97.5% of the TBI group. Age and an ASA score of 3 or higher were independently associated with increased mortality risk in the TBI group, with odds ratios of 1.04 (95% 1.00–1.09) and 3.44 (95% CI 1.10–13.41), respectively. Among NTBI patients, only age remained a significant mortality predictor. TRISS demonstrated limited predictive utility across both cohorts, yet a significant discrepancy was observed between the outcome groups within the NTBI cohort. Conclusion: This retrospective cohort study highlights a significant association between ASA score and 90-day mortality in elderly patients with complicated mTBI, something that could not be observed in comparative NTBI cohort. These findings suggest the benefit of incorporating ASA score into prognostic models to enhance the accuracy of outcome prediction models in these populations, though further research is warranted. [ABSTRACT FROM AUTHOR]

Eating disorders (EDs) are often accompanied by gastrointestinal (GI) distress. Anxiety sensitivity is the tendency to interpret sensations of anxiety as threatening or dangerous, and includes both broad physical symptoms (e.g., elevated heartrate) and GI‐specific symptoms. Physical and GI‐specific anxiety sensitivity may be important risk and maintaining factors in EDs. This study tested the hypothesis that greater reductions in both types of anxiety sensitivity during the first month of treatment would predict lower ED symptoms and trait anxiety at discharge and 6‐month follow‐up. Patients (n = 424) in ED treatment reported physical and GI‐specific anxiety sensitivity, ED symptoms, and trait anxiety at treatment admission, 1‐month into treatment, discharge, and 6‐month follow‐up. Analyses were conducted with hierarchical linear regression with imputation, controlling for relevant covariates. Results indicated that early reduction in GI‐specific but not general physical anxiety sensitivity predicted both lower ED symptoms and lower trait anxiety at discharge and 6‐month follow‐up. These findings demonstrate the importance of GI‐specific anxiety sensitivity as a potential maintaining factor in EDs. Developing and refining treatments to target GI‐specific anxiety sensitivity may have promise in improving the treatment not only of EDs, but also of commonly co‐morbid anxiety disorders. Highlights: Anxiety sensitivity, the fear of symptoms of anxiety, is common in eating disorders (EDs), and may predict treatment outcomes.In this study, greater reduction in anxiety sensitivity for gastrointestinal symptoms within the first month of ED treatment predicted lower ED symptoms and anxiety at discharge from treatment but not 6‐month follow‐up. By contrast, reduction in more general physical anxiety sensitivity did not predict ED symptoms or anxiety at discharge or follow‐up.Findings highlight the importance of targeting anxiety about body sensations in treatment for EDs. [ABSTRACT FROM AUTHOR]

Purpose: Chronic obstructive pulmonary disease and obstructive sleep apnea are two common respiratory diseases. Chronic obstructive pulmonary disease patients co-morbid with obstructive sleep apnea are associated with increased cardiovascular adverse events, frequent acute exacerbations, and higher mortality. Only a few studies on obstructive sleep apnea among patients with chronic obstructive pulmonary disease are available in Vietnam. The study aims to determine the prevalence of obstructive sleep apnea in patients with chronic obstructive pulmonary disease in Vietnam. Methods: This is a cross-sectional study in patients with chronic obstructive pulmonary disease at multi-sites in Vietnam: the People's Hospital of Gia Dinh, Bach Mai Hospital, Phoi Viet Clinics, and Lam Dong Medical College using type 3 sleep monitoring device at sleep labs to diagnose obstructive sleep apnea in all study participants. Results: Two hundred seventy-eight patients with chronic obstructive pulmonary disease were enrolled. Among the patients, 93.2% were male, with an average age of 66.9 ± 9.3 and a BMI of 21.9 ± 3.8 kg/m2; 82.0% were symptomatic including 44.6% in group B and 37.4% in group D with average post-FEV1 of 49.8 ± 18.3% predicted values. One hundred seventeen patients (42.1%) with chronic obstructive pulmonary disease presented obstructive sleep apnea defined by AHI ≥ 15 events/h. Conclusions: The prevalence of obstructive sleep apnea in patients with chronic obstructive pulmonary disease in Vietnam was 42.1% for an AHI of ≥ 15 events/h. [ABSTRACT FROM AUTHOR]

Introduction: Since the outbreak of Coronavirus Disease 2019 (COVID-19) in China, the epidemic has rapidly spread all over the world in just a few months. Different steroids have been proven effective in treating COVID-19 pneumonia. However, comparative efficacy data between different steroids have been evaluated in a few studies from various parts of the world. To date, no study with a large number of patients has been conducted in the eastern part of India. Aim: To compare the efficacy of dexamethasone and methylprednisolone in terms of outcomes and disease progression in COVID-19 pneumonia patients. Materials and Methods: This retrospective cohort study included 377 patients with moderate and severe COVID-19 pneumonia admitted to Medical College and Hospital from May 2020 to December 2020, Kolkata, West Bengal, India. Patient records were divided into two groups based on the type of steroids administered (dexamethasone and methylprednisolone). Clinical, laboratory, treatment, and outcome data were tabulated for analysis. Demographic patterns in the two groups were compared, and efficacy was analysed in terms of hospital course (hospital stay length, type of respiratory support received) and final outcome (cured or death) in both groups. The data collected were analysed using Statistical Package for Social Sciences (SPSS) software version 29.0. Qualitative variables were expressed as counts and percentages, while quantitative variables were presented as mean±Standard Deviation (SD). Results: There were no significant differences between the two treatment groups based on demographic features (age, sex), co-morbidities (diabetes, hypertension, etc.), disease severity (hypoxia, hypotension) on admission day, and smoking status. The study showed that methylprednisolone significantly reduced the requirement for high-flow oxygen (p-value=0.002), Non Invasive Ventilation (NIV) (p-value=0.001), and invasive ventilation (p-value=0.001) compared to dexamethasone. However, there was no significant difference (p-value=0.800) in the duration of hospital stay between the methylprednisolone and dexamethasone treatment groups. Kaplan-Meier survival analysis also showed a significant survival benefit among patients who received methylprednisolone compared to dexamethasone (log-rank p-value=0.039). Conclusion: The present study concludes that in COVID-19 pneumonia, the administration of methylprednisolone leads to a significant reduction in mortality and the need for high-flow oxygen, NIV, and invasive ventilation compared to dexamethasone. [ABSTRACT FROM AUTHOR]

Background: The transitional state between normal aging and dementia is known as Cognitive impairment (CI) where a person has memory complaints and objective evidence of CI but no evidence of dementia. With the globe undergoing a "demographic transition," the magnitude of neurodegenerative disorders is rising. In India, 27.3% of older persons with comorbidities had CI. Early identification of CI will likely help initiate proper remedial intervention, leading to better overall outcomes. In order to determine the prevalence of CI in older persons and whether it is associated with co-morbid conditions, this study was designed. Methods: A descriptive cross-sectional study was conducted among 350 older adults aged ≥60 residing in rural areas of Lucknow, selected using multistage cluster sampling. The Hindi Mental State Examination (HMSE) scale was used to assess cognitive function. A pretested semi-structured questionnaire was used to collect information on sociodemographic characteristics and comorbidity status. Results: Among 350 participants, with mean ± SD age 70.66 ± 9.53 years, the prevalence of CI as per HMSE (<23) was 24.9%. Overall, the mean HMSE score was less in individuals with (25.2) than without (27.19) comorbidities. Those with comorbidities had significantly lower mean scores in all individual domains of HMSE. Conclusion: CI affects one-fourth of the older adult population. Risk increases with the presence of comorbidities. Hence, screening, and early treatment are recommended. [ABSTRACT FROM AUTHOR]

Obesity is known to increase overall disease burden but does obesity management actually help reduce disease burden? To investigate the effects of weight loss on disease burden in people with obesity using the National Health Insurance Service-Health Screening Cohort (NHIS-HEALS) in Korea. Pure longitudinal observational study using Nationwide cohort database. Out of 514,866 NHIS-HEALS cohort, participants with class II obesity in Asia-Pacific region (30 ≤ body mass index [BMI] < 35) who underwent health check-up provided by NHIS during 2003–2004 (index date) were included. All final participants continued to receive a total of 5 biennial health check-ups over the next 10 years without missing. A group-based trajectory model (GBTM) was used to categorize subjects based on 10-year BMI change patterns. The changes of co-morbidities, healthcare resource utilization, and medical cost were analyzed. The final study subjects (9857) were categorized into 3 trajectory clusters based on the pattern of BMI (kg/m2) change: maintenance (57.35%) with an average change of −.02 ±.06, loss (38.65%) with −.04 ±.08, and substantial loss (4.0%) with −.10 ±.18. The annual increases in the number of co-morbidities per subject in each cluster were.18,.18, and.16 (all P <.001), respectively. The increase of healthcare resource utilization over time was lowest for the substantial loss compared to maintenance and loss. With each passing year, the average annual total healthcare cost increased by ₩21,200 ($16.48, P =.034) and ₩10,500 ($8.16, P =.498) in the maintenance and loss, respectively, but decreased by ₩62,500 ($48.59, P =.032) in the substantial loss. Weight loss in people with obesity was associated with a reduced burden of disease, as evidenced by lower co-morbidity, healthcare resource utilization rate, and decreased medical costs. This study highlights the potential positive long-term impact on Korean society when actively managing weight in individuals with obesity. • People with obesity was categorized according to 10-year body mass index (BMI) change patterns. • Increase of co-morbidities was the slowest in substantial weight loss group. • Use of healthcare resource was the lowest in substantial weight loss group. • Overall healthcare cost was decreased in substantial weight loss group. [ABSTRACT FROM AUTHOR]

Background: HIV/AIDS is a major cause of infant and childhood morbidity and mortality in Africa. It is also an escalating problem of frightening proportions in Nigeria. Objectives: To determine the mode of transmission, clinical presentation, co-morbidity and the outcome among children with HIV/AIDS at the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt. Methods: From January 2003 to December 2007, all children with HIV infection who registered in our clinic were followed up prospectively. Clinical and laboratoryevaluation were performed at presentation, the children were managed according to standard treatment guidelines and the outcome noted. Results: Of the 384 children with HIV infection, 190 (49.5 percent) were males and 194 (50.5 percent) females; a M: F ratio of 0.98:1. Their ages ranged from five months to 180 months. Two hundred and sixty three (68.5 percent) of the children were less than 18 months of age at presentation. Three hundred and forty six (90.1 percent) of the children acquired the infection vertically. The common symptoms at presentation in the 336 (87.5 percent) of the children who were symptomatic included fever in 75.3 percent, cough in 64.9 percent, weight loss in 41.1 percent and diarrhoea in 40.8 percent. The common signs were generalized lymphadenopathy in 44.1 percent, pallor in 39.3 percent and hepatomegaly in 38.1 percent. Common co-morbidities included tuberculosis in 23.7 percent and pneumonia in 15.4 percent. Majority (66.9 percent) presented in WHO stage 3 and 4. Twenty seven (7.0 percent) have died while 67 (17.4 percent) have been lost to follow up. Age specific mortality was highest among those aged below 18 months. The greatest contributors to case fatality were pneumonia (44.4 percent) and malnutrition (33.3 percent). Conclusion: Paediatric HIV/AIDS is predominantly transmitted from mother to child and constitutes a significant cause of childhood morbidity and mortality at the UPTH. In view of a high rate of those lost to follow up, it is advocated that strategies such as support groups and expert patient training should be put in place to track down defaulters.

Introduction: Since the outbreak of Coronavirus Disease 2019 (COVID-19) in China, the epidemic has rapidly spread all over the world in just a few months. Different steroids have been proven effective in treating COVID-19 pneumonia. However, comparative efficacy data between different steroids have been evaluated in a few studies from various parts of the world. To date, no study with a large number of patients has been conducted in the eastern part of India. Aim: To compare the efficacy of dexamethasone and methylprednisolone in terms of outcomes and disease progression in COVID-19 pneumonia patients. Materials and Methods: This retrospective cohort study included 377 patients with moderate and severe COVID-19 pneumonia admitted to Medical College and Hospital from May 2020 to December 2020, Kolkata, West Bengal, India. Patient records were divided into two groups based on the type of steroids administered (dexamethasone and methylprednisolone). Clinical, laboratory, treatment, and outcome data were tabulated for analysis. Demographic patterns in the two groups were compared, and efficacy was analysed in terms of hospital course (hospital stay length, type of respiratory support received) and final outcome (cured or death) in both groups. The data collected were analysed using Statistical Package for Social Sciences (SPSS) software version 29.0. Qualitative variables were expressed as counts and percentages, while quantitative variables were presented as mean±Standard Deviation (SD). Results: There were no significant differences between the two treatment groups based on demographic features (age, sex), co-morbidities (diabetes, hypertension, etc.), disease severity (hypoxia, hypotension) on admission day, and smoking status. The study showed that methylprednisolone significantly reduced the requirement for high-flow oxygen (p-value=0.002), Non Invasive Ventilation (NIV) (p-value=0.001), and invasive ventilation (p-value=0.001) compared to dexamethasone. However, there was no significant difference (p-value=0.800) in the duration of hospital stay between the methylprednisolone and dexamethasone treatment groups. Kaplan-Meier survival analysis also showed a significant survival benefit among patients who received methylprednisolone compared to dexamethasone (log-rank p-value=0.039). Conclusion: The present study concludes that in COVID-19 pneumonia, the administration of methylprednisolone leads to a significant reduction in mortality and the need for high-flow oxygen, NIV, and invasive ventilation compared to dexamethasone.

Introduction: Depression is a significant co-morbid condition for diabetics. Co-morbid depression results in worsened diabetes complications, deleterious effects on self-care activities, non adherence, and poor treatment outcomes. Aim: To assess the prevalence of depression among type 2 diabetic patients attending a tertiary hospital and to find its association with socio-demographic and lifestyle factors. Materials and Methods: A hospital-based cross-sectional study was done in the diabetic clinic of Government Stanley Medical College and Hospital, Chennai, Tamil Nadu, India between June 2016 and August 2016, involving 500 patients with Type II Diabetes Mellitus (T2DM) of less than five years’ duration. The prevalence of depression was calculated using Beck’s Depression Inventory Scale for a period of three months. The results were expressed in proportions, and the association of factors was tested using the Chi-square test and multivariable logistic regression analysis. A p-value

Context: As per the national policy, two doses of COVID-19 vaccine at least four weeks apart were available for administration to all HCW’s since January 2021. A small proportion of individuals will contract COVID-19 despite complete vaccination. Healthcare workers (Health Care Providers) represent a very high-risk group for contracting COVID-19 infection. Aim: To determine the breakthrough infection rate of COVID-19 among vaccinated healthcare providers and students. Methodology: The present cross-sectional study was conducted at All India Institute of Medical Sciences, Nagpur from August to December 2022. The sample size of 308 was achieved through proportionate stratified sampling among different cadres of employees working at the institute. Statistical Analysis: Chi-square test was used for significance. Fischer’s Exact test was used wherever necessary. A P value < 0.05 was considered statistically significant. Strength of the association was estimated using odds ratio. Results: The mean (SD) age of participants in our study was 29.26 (±8.64) years. Prevalence of COVID breakthrough infection was found to be 28.25% [95% CI: 23–33]. It was found that those participants having one or more co-morbidities and are directly involved in COVID patient care were likely to suffer more from COVID-19 breakthrough infection. Conclusion: Predictors of COVID-19 breakthrough infection found to be a presence of one or more co-morbidities, direct involvement with COVID-19 patients and not observing respiratory hygiene. There is increased risk among participants with comorbidities and involving directly in patient care. Therefore, it is recommended that vaccine policy needs to focus on high-risk group.

Introduction: The outbreak of Coronavirus Disease 2019 (COVID-19) affected a large number of people worldwide within a short period of time. The mortality rate was high, and there was no specific medicine available to cure it. Therefore, the situation demanded the rapid development of a vaccine. When the vaccines were introduced, there was limited knowledge about their efficacy, side-effects, and duration of protection. Hence, a detailed study was conducted in these areas. Aim: To study the immunological responses following Covishield vaccination and determine the duration of protection offered by the vaccine. Materials and Methods: The present study is a prospective observational study conducted at Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India from March 2021 to May 2023, involving the staff members of the hospital and college who were above 18-year-old. Individuals with immunodeficiency, those on immunosuppressive medication, or anyone with proof of COVID-19 were excluded. The total sample size was 56. Blood samples were collected before administering the vaccine, at 0, 3, and 12 months, and tested for Complete Blood Count (CBC), COVID-19-specific Immunoglobulin G (IgG), Cluster of Differentiation (CD) 45, CD3, CD4, CD8, etc. The findings were statistically analysed using Statistical Packages of Social Sciences (SPSS) software version 22.0 and STATA software version 10. Results: A total of 154 volunteers initially provided the first blood samples. However, only 129 of them provided blood samples 2nd time and received two doses of the vaccine. Out of these, only 56 participants completed the fourth time blood test. The results consistently demonstrated a rise in IgG levels over time, with consistently higher levels observed in females. Participants above 45 years exhibited higher IgG levels. Individuals with co-morbidities also showed an increase in IgG levels. The research revealed that individuals who were initially IgG negative experienced a greater fold increase in IgG levels after the first dose of vaccination. The incidence and duration of side-effects post-vaccination reduced with each successive vaccine dose. Conclusion: All the volunteers developed adequate IgG antibodies. Two doses of Covishield effectively resulted in lasting immunity in 94.64% of cases, and three doses achieved 100% immunity. Females and participants above 45 years consistently exhibited higher antibody levels. Individuals with co-morbidities also developed antibodies, albeit at slightly lower levels. The side-effects were mild and short-lived. No long-term after effects were detected even after two years and two months following vaccination.

Turner syndrome (TS) affects 50 per 100 000 females. TS affects multiple organs through all stages of life, necessitating multidisciplinary care. This guideline extends previous ones and includes important new advances, within diagnostics and genetics, estrogen treatment, fertility, co-morbidities, and neurocognition and neuropsychology. Exploratory meetings were held in 2021 in Europe and United States culminating with a consensus meeting in Aarhus, Denmark in June 2023. Prior to this, eight groups addressed important areas in TS care: (1) diagnosis and genetics, (2) growth, (3) puberty and estrogen treatment, (4) cardiovascular health, (5) transition, (6) fertility assessment, monitoring, and counselling, (7) health surveillance for comorbidities throughout the lifespan, and (8) neurocognition and its implications for mental health and well-being. Each group produced proposals for the present guidelines, which were meticulously discussed by the entire group. Four pertinent questions were submitted for formal GRADE (Grading of Recommendations, Assessment, Development and Evaluation) evaluation with systematic review of the literature. The guidelines project was initiated by the European Society for Endocrinology and the Pediatric Endocrine Society, in collaboration with members from the European Society for Pediatric Endocrinology, the European Society of Human Reproduction and Embryology, the European Reference Network on Rare Endocrine Conditions, the Society for Endocrinology, and the European Society of Cardiology, Japanese Society for Pediatric Endocrinology, Australia and New Zealand Society for Pediatric Endocrinology and Diabetes, Latin American Society for Pediatric Endocrinology, Arab Society for Pediatric Endocrinology and Diabetes, and the Asia Pacific Pediatric Endocrine Society. Advocacy groups appointed representatives for pre-meeting discussions and the consensus meeting. [ABSTRACT FROM AUTHOR]

While motor and psychiatric phenotypes in idiopathic dystonia are increasingly well understood, a few studies have examined the rate, type, and temporal pattern of other clinical co-morbidities in dystonia. Here, we determine the rates of clinical diagnoses across 13 broad systems-based diagnostic groups, comparing an overall idiopathic dystonia cohort, and sub-cohorts of cervical dystonia, blepharospasm, and dystonic tremor, to a matched-control cohort. Using the SAIL databank, we undertook a longitudinal population-based cohort study (January 1st 1994–December 31st 2017) using anonymised electronic healthcare records for individuals living in Wales (UK), identifying those diagnosed with dystonia through use of a previously validated algorithm. Clinical co-morbid diagnoses were identified from primary health care records, with a 10% prevalence threshold required for onward analysis. Using this approach, 54,166 dystonia cases were identified together with 216,574 matched controls. Within this cohort, ten of the main ICD-10 diagnostic codes exceeded the 10% prevalence threshold over the 20-year period (infection, neurological, respiratory, gastrointestinal, genitourinary, dermatological, musculoskeletal, circulatory, neoplastic, and endocrinological). In the overall dystonia cohort, musculoskeletal (aOR: 1.89, aHR: 1.74), respiratory (aOR: 1.84; aHR: 1.65), and gastrointestinal (aOR: 1.72; aHR: 1.6) disorders had the strongest associations both pre- and post-dystonia diagnosis. However, variation in the rate of association of individual clinical co-morbidities was observed across the cervical, blepharospasm, and tremor dystonia groups. This study suggests an increased rate of specific co-morbid clinical disorders both pre- and post-dystonia diagnosis which should be considered during clinical assessment of those with dystonia to enable optimum symptomatic management. [ABSTRACT FROM AUTHOR]

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AbstractLimited research exists regarding the impact of the Ukrainian War on mental distress among refugees or the presentation of post-traumatic stress disorder (PTSD) as a co-morbidity. This study analyzes the mental distress experienced by displaced Ukrainian refugees, including exposure to war-related trauma, PTSD, psychological distress based on socio-demographic factors, prevalence of concurrent mental illnesses, and associated risk factors. Ukrainian refugees in Israel were included in the study shortly after their arrival. Participants completed questionnaires on socio-demographic information, exposure to war-related events, presence of PTSD, depression, anxiety, and current life satisfaction. The 128 participants reported an average of 6.4 traumatic events (SD = 2.97). Among them, 69.5% (n = 89) met the criteria for probable PTSD, 36.7% (N = 47) for depression, and 53.1% (N = 68) for anxiety. The “comorbidity” cohort, consisting of refugees with PTSD and depression/anxiety or both, included 65 participants (53.3%), the “only PTSD” group was 24 participants (19.7%), and 33 (27%) had “no probability”. Women and those who had left family members behind were 2.9 and 3.2 times more likely to experience comorbidity, respectively. Refugees with comorbidity reported higher distress and functional impairments compared to the “only PTSD” group, and lower life satisfaction than those with “no probability”. This study highlights the significant traumatology experienced by Ukrainian refugees, with attention to the unique impact of comorbidity on functional and subjective well-being among refugees. Therefore, a comprehensive approach is necessary to appropriately diagnose and support refugees, considering the interconnected impact of PTSD, anxiety, and depression. [ABSTRACT FROM AUTHOR]

Introduction: Depression is a significant co-morbid condition for diabetics. Co-morbid depression results in worsened diabetes complications, deleterious effects on self-care activities, non adherence, and poor treatment outcomes. Aim: To assess the prevalence of depression among type 2 diabetic patients attending a tertiary hospital and to find its association with socio-demographic and lifestyle factors. Materials and Methods: A hospital-based cross-sectional study was done in the diabetic clinic of Government Stanley Medical College and Hospital, Chennai, Tamil Nadu, India between June 2016 and August 2016, involving 500 patients with Type II Diabetes Mellitus (T2DM) of less than five years' duration. The prevalence of depression was calculated using Beck's Depression Inventory Scale for a period of three months. The results were expressed in proportions, and the association of factors was tested using the Chi-square test and multivariable logistic regression analysis. A p-value <0.05 was considered statistically significant. Results: The study included 500 participants, of whom the majority (276, 55%) were female, with a mean age of 46.2 years. The prevalence of depression was 55 (11%). It was found that being female, illiterate, and unemployed were significantly associated with depression. Among disease-related factors, diabetes duration of 3-5 years, insulin injection usage, and the presence of diabetic complications were significantly associated with depression. Regarding lifestyle factors, the prevalence of depression was significantly higher among those who were non adherent to dietary modification practices and those with family worries and work-related tension. Multivariable logistic regression analysis revealed that the independent predictors of depression among diabetics were the presence of diabetic complications {Odds Ratio (OR)-2.48 (1.27-4.84)}, family worries {OR-2.54 (1.34-4.80)}, non adherence to follow-up {OR-2.61 (1.37-4.99)}, and non compliance with dietary modifications {OR-2.93 (1.43-5.99)}. Conclusion: The present study revealed that about one in 10 (11%) diabetics with less than five years' duration have associated depression, with significant independent predictors being non compliant behaviours, the presence of complications, and family issues. Hence, diabetics should be screened simultaneously for depression, giving due attention to those with complications, family issues, and non compliant behaviours. [ABSTRACT FROM AUTHOR]

Introduction: The outbreak of Coronavirus Disease 2019 (COVID-19) affected a large number of people worldwide within a short period of time. The mortality rate was high, and there was no specific medicine available to cure it. Therefore, the situation demanded the rapid development of a vaccine. When the vaccines were introduced, there was limited knowledge about their efficacy, side-effects, and duration of protection. Hence, a detailed study was conducted in these areas. Aim: To study the immunological responses following Covishield vaccination and determine the duration of protection offered by the vaccine. Materials and Methods: The present study is a prospective observational study conducted at Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India from March 2021 to May 2023, involving the staff members of the hospital and college who were above 18-year-old. Individuals with immunodeficiency, those on immunosuppressive medication, or anyone with proof of COVID-19 were excluded. The total sample size was 56. Blood samples were collected before administering the vaccine, at 0, 3, and 12 months, and tested for Complete Blood Count (CBC), COVID-19-specific Immunoglobulin G (IgG), Cluster of Differentiation (CD) 45, CD3, CD4, CD8, etc. The findings were statistically analysed using Statistical Packages of Social Sciences (SPSS) software version 22.0 and STATA software version 10. Results: A total of 154 volunteers initially provided the first blood samples. However, only 129 of them provided blood samples 2nd time and received two doses of the vaccine. Out of these, only 56 participants completed the fourth time blood test. The results consistently demonstrated a rise in IgG levels over time, with consistently higher levels observed in females. Participants above 45 years exhibited higher IgG levels. Individuals with co-morbidities also showed an increase in IgG levels. The research revealed that individuals who were initially IgG negative experienced a greater fold increase in IgG levels after the first dose of vaccination. The incidence and duration of side-effects post-vaccination reduced with each successive vaccine dose. Conclusion: All the volunteers developed adequate IgG antibodies. Two doses of Covishield effectively resulted in lasting immunity in 94.64% of cases, and three doses achieved 100% immunity. Females and participants above 45 years consistently exhibited higher antibody levels. Individuals with co-morbidities also developed antibodies, albeit at slightly lower levels. The side-effects were mild and short-lived. No long-term after effects were detected even after two years and two months following vaccination. [ABSTRACT FROM AUTHOR]

Introduction: Clinical decision support (CDS) systems (CDSSs) that integrate clinical guidelines need to reflect real-world co-morbidity. In patient-specific clinical contexts, transparent recommendations that allow for contraindications and other conflicts arising from co-morbidity are a requirement. In this work, we develop and evaluate a non-proprietary, standards-based approach to the deployment of computable guidelines with explainable argumentation, integrated with a commercial electronic health record (EHR) system in Serbia, a middle-income country in West Balkans. Methods: We used an ontological framework, the Transition-based Medical Recommendation (TMR) model, to represent, and reason about, guideline concepts, and chose the 2017 International global initiative for chronic obstructive lung disease (GOLD) guideline and a Serbian hospital as the deployment and evaluation site, respectively. To mitigate potential guideline conflicts, we used a TMR-based implementation of the Assumptions-Based Argumentation framework extended with preferences and Goals (ABA+G). Remote EHR integration of computable guidelines was via a microservice architecture based on HL7 FHIR and CDS Hooks. A prototype integration was developed to manage chronic obstructive pulmonary disease (COPD) with comorbid cardiovascular or chronic kidney diseases, and a mixed-methods evaluation was conducted with 20 simulated cases and five pulmonologists. Results: Pulmonologists agreed 97% of the time with the GOLD-based COPD symptom severity assessment assigned to each patient by the CDSS, and 98% of the time with one of the proposed COPD care plans. Comments were favourable on the principles of explainable argumentation; inclusion of additional co-morbidities was suggested in the future along with customisation of the level of explanation with expertise. Conclusion: An ontological model provided a flexible means of providing argumentation and explainable artificial intelligence for a long-term condition. Extension to other guidelines and multiple co-morbidities is needed to test the approach further. [ABSTRACT FROM AUTHOR]

The double burden of tuberculosis (TB) and diabetes mellitus (DM) represents a major public health challenge that demands urgent and integrated approaches. The interplay between these two chronic conditions presents unique clinical and public health management challenges, as well as social and economic implications. We explored the bidirectional relationship between TB and DM, emphasizing how DM increases susceptibility to TB and complicates its management, while TB may exacerbate glycemic control in diabetic patients. This review underscores the challenges associated with the management of both diseases, obstacles in screening TB patients for DM and TB preventive therapy for DM since inadequate glycemic control can impact treatment outcomes. Several studies have investigated the disease interplay; however, the results have been equivocal, and this may be exerting negative impacts on the disease prevention and treatment. TB-diabetes comorbidity has been linked to poor treatment outcomes whereas TB prevention in people with DM at present is a dilemma. In addition to highlighting how urgent it is to address this comorbidity, this review offers a road map for better prevention, treatment, and control of several factors underlying the TB-diabetes syndemic interaction.

Background: Aging, longevity, advanced health care, and demographic transition have altered the quality of life (QOL) among the elderly. This study was planned to assess the QOL among the elderly and the associated factors in rural Bihar. Methods: This community-based cross-sectional study among 395 elderlies residing in rural Bihar adopted a multistage sampling technique and a standard WHO-QOL BREF tool to assess the QOL. A multivariable linear regression analysis was performed and an adjusted beta-coefficient was reported to determine the factors determining the QOL. Results: A total of 33 [8.4% (95% CI: 6-11.5%)] out of 395 elderlies had poor QOL. Age [adjusted B= -0.19 (-0.3 to -0.07)], Females [adjusted B= -1.89 (-3.5 to -0.25)], No. of drugs consumed [adjusted B=1.7 (0.4 to 2.99)], presence of any of the comorbidity [adjusted B=-5.9 (-10.8 to -1.1)], presence of Polymorbidity [adjusted B=-3.5 (-6.6 to -0.4)] were found to be independent correlates of QOL scores among elderly. Conclusion: Almost one in ten elderlies had poor QOL. The physical domain of QOL was affected the most among all the domains. Increasing age, female gender, presence of any co-morbidity, presence of poly-morbidity, and more drug consumption were associated with decreasing QOL scores among the elderly.

Abstract Objectives Longitudinal evidence documenting health conditions in spousal caregivers of people with dementia and whether these influence caregivers’ outcomes is scarce. This study explores type and number of health conditions over two years in caregivers of people with dementia and subgroups based on age, sex, education, hours of care, informant-rated functional ability, neuropsychiatric symptoms, cognition of the person with dementia, and length of diagnosis in the person with dementia. It also explores whether over time the number of health conditions is associated with caregivers’ stress, positive experiences of caregiving, and social networks Methods Longitudinal data from the IDEAL (Improving the experience of Dementia and Enhancing Active Life) cohort were used. Participants comprised spousal caregivers (n = 977) of people with dementia. Self-reported health conditions using the Charlson Comorbidity Index, stress, positive experiences of caregiving, and social network were assessed over two years. Mixed effect models were used Results On average participants had 1.5 health conditions at baseline; increasing to 2.1 conditions over two years. More health conditions were reported by caregivers who were older, had no formal education, provided 10 + hours of care per day, and/or cared for a person with more neuropsychiatric symptoms at baseline. More baseline health conditions were associated with greater stress at baseline but not with stress over time. Over two years, when caregivers’ health conditions increased, their stress increased whereas their social network diminished Discussion Findings highlight that most caregivers have their own health problems which require management to avoid increased stress and shrinking of social networks

Abstract Background Poisoning injuries is an increasing concern among older people, and so is the repetition of intentional poisonings. To date, few studies have documented the pattern and individual risk factors for repeated poisonings. This national study aims to shed light on the burden, pattern, and health-related risk factors of repeated intentional poisoning leading to hospitalization or death among older Swedish adults (50 years and older), with a focus on the year following a first event. Methods We conducted a nationwide register-based cohort study of people aged 50–100, hospitalized for intentional poisoning (ICD10: X60-69) during 2006–2016 (n = 15,219) and re-hospitalized by poisoning of any intent within a year (n = 1710), i.e., up to the end of 2017. We considered in turn, the distribution of the second poisoning in 30-day intervals stratified by intent; poisoning lethality within a month and a year; and the sex-specific association between health conditions and being re-hospitalized for intentional poisoning within one year as compared to being hospitalized only once using logistic regression (odds ratios (OR) with 95% confidence intervals (95% CI)). Results Following an intentional poisoning, re-hospitalization within a year was predominantly for a new intentional poisoning (89.7%) and occurred most typically within a month (median 4 days). Death within 30 days occurred in similar proportion for the first and second poisoning (2.3% vs. 2.1% respectively). Among both men and women, comorbidity of psychiatric illness was strongly associated with re-hospitalization for intentional poisoning (adjusted ORs = 1.70; 95% CI = 1.45–2.01 and 1.89 (95% CI = 1.60–2.19) respectively). Conclusion Most re-hospitalizations within a year after intentional poisoning are also for intentional poisoning and occur most typically within days. Re-hospitalization is associated with several conditions that are characteristic of poor mental health and there are more similarities than differences between men and women in that respect.

Gambling disorder can be treated with cognitive behavioral therapy (CBT), but treatment is under-dimensioned in many settings. For example, in Sweden, a setting with mixed responsibility for addiction treatment between health care and social services, treatment for gambling disorder has only recently been introduced in the responsibilities of public institutions. After the introduction of gambling in treatment legislation in 2018, few studies have assessed the real-world feasibility of such treatment. In addition, treatment in social services specifically has not been documented or evaluated, and therefore, in a pioneer gambling treatment facility in such a setting, this study aimed to investigate treatment outcome in patients with gambling disorder six months after completed CBT treatment within a social service setting. Twenty patients receiving CBT treatment during 2018–2020 were followed with respect to gambling habits at end of treatment and at follow-up six months after treatment. The National Opinion Research Center DSM Screen for Gambling Problems (NODS) was used as screening tool. Rates of gambling abstinence, as well as subjective experience of the treatment, are reported. Ninety percent of the patients were abstinent from gambling at six-month follow-up, and 95 percent of the patients no longer fulfilled criteria of a gambling disorder. In conclusion, these pilot results suggest that CBT treatment is a feasible method for treatment of gambling disorder also in a social service setting. However, due to the limited sample size of this pilot study, and the limited background information of clients who could not be reached, future studies with larger sample sizes are needed.

Context: As per the national policy, two doses of COVID‑19 vaccine at least four weeks apart were available for administration to all HCW’s since January 2021. A small proportion of individuals will contract COVID‑19 despite complete vaccination. Healthcare workers (Health Care Providers) represent a very high‑risk group for contracting COVID‑19 infection. Aim: To determine the breakthrough infection rate of COVID‑19 among vaccinated healthcare providers and students. Methodology: The present cross‑sectional study was conducted at All India Institute of Medical Sciences, Nagpur from August to December 2022. The sample size of 308 was achieved through proportionate stratified sampling among different cadres of employees working at the institute. Statistical Analysis: Chi‑square test was used for significance. Fischer’s Exact test was used wherever necessary. A P value < 0.05 was considered statistically significant. Strength of the association was estimated using odds ratio. Results: The mean (SD) age of participants in our study was 29.26 (±8.64) years. Prevalence of COVID breakthrough infection was found to be 28.25% [95% CI: 23–33]. It was found that those participants having one or more co‑morbidities and are directly involved in COVID patient care were likely to suffer more from COVID‑19 breakthrough infection. Conclusion: Predictors of COVID‑19 breakthrough infection found to be a presence of one or more co‑morbidities, direct involvement with COVID‑19 patients and not observing respiratory hygiene. There is increased risk among participants with comorbidities and involving directly in patient care. Therefore, it is recommended that vaccine policy needs to focus on high‑risk group. [ABSTRACT FROM AUTHOR]

Background: Mortality due to chronic obstructive pulmonary disease (COPD) is increasing. However, dead space fractions at rest (VD/VTrest) and peak exercise (VD/VTpeak) and variables affecting survival have not been evaluated. This study aimed to investigate these issues. Methods: This retrospective observational cohort study was conducted from 2010-2020. Patients with COPD who smoked, met the Global Initiatives for Chronic Lung Diseases (GOLD) criteria, had available demographic, complete lung function test (CLFT), medication, acute exacerbation of COPD (AECOPD), Charlson Comorbidity Index, and survival data were enrolled. VD/VTrest and VD/VTpeak were estimated (estVD/VTrest and estVD/VTpeak). Univariate and multivariable Cox regression with stepwise variable selection were performed to estimate hazard ratios of all-cause mortality. Results: Overall, 14,910 patients with COPD were obtained from the hospital database, and 456 were analyzed after excluding those without CLFT or meeting the lung function criteria during the follow-up period (median (IQR) 597 (331-934.5) days). Of the 456 subjects, 81% had GOLD stages 2 and 3, highly elevated dead space fractions, mild air-trapping and diffusion impairment. The hospitalized AECOPD rate was 0.60 ± 2.84/person/year. Forty-eight subjects (10.5%) died, including 30 with advanced cancer. The incidence density of death was 6.03 per 100 person-years. The crude risk factors for mortality were elevated estVD/VTrest, estVD/VTpeak, =2 hospitalizations for AECOPD, advanced age, body mass index (BMI) <18.5 kg/m², and cancer (hazard ratios (95% C.I.) from 1.03 [1.00-1.06] to 5.45 [3.04-9.79]). The protective factors were high peak expiratory flow%, adjusted diffusing capacity%, alveolar volume%, and BMI 24-26.9 kg/m². In stepwise Cox regression analysis, after adjusting for all selected factors except cancer, estVD/VTrest and BMI <18.5 kg/m² were risk factors, whereas BMI 24-26.9 kg/m² was protective. Cancer was the main cause of all-cause mortality in this study; however, estVD/VTrest and BMI were independent prognostic factors for COPD after excluding cancer. Conclusions: The predictive formula for dead space fraction enables the estimation of VD/VTrest, and the mortality probability formula facilitates the estimation of COPD mortality. However, the clinical implications should be approached with caution until these formulas have been validated. [ABSTRACT FROM AUTHOR]

Purpose: Lophomoniasis is a chronic protozoan respiratory disease in humans with main clinical symptoms such as chronic cough, productive sputum, breath shortness, and occasionally hemoptysis. Differentiation diagnosis of lophomoniasis from tuberculosis (TB) and asthma is crucial. Methods: In this study, 210 participants with suspected TB referred to tuberculosis laboratories in Mazandaran province, northeastern Iran, were enrolled during 2021. All patients showed low grade fever, chronic cough or sputum on referral. Sputum specimens were collected from the participants, and Lophomonas DNA was detected through a conventional genus-specific polymerase chain reaction (PCR). Results: Out of 210 participants, 67 (31.9%) had Lophomonas spp., infection, 38 (18.1%) had TB (Smear and culture-positive), and 20 (9.5%) had both TB and Lophomonas co-infection. Conclusion: Based on our results, a relatively high occurrence of Lophomonas infection was found among patients suspected of having TB. Accordingly, due to the high similarity of clinical symptoms between both pulmonary diseases, it is highly recommended to accurately and early diagnose the parasite in the sputum specimen. [ABSTRACT FROM AUTHOR]

Objectives: Longitudinal evidence documenting health conditions in spousal caregivers of people with dementia and whether these influence caregivers’ outcomes is scarce. This study explores type and number of health conditions over two years in caregivers of people with dementia and subgroups based on age, sex, education, hours of care, informant-rated functional ability, neuropsychiatric symptoms, cognition of the person with dementia, and length of diagnosis in the person with dementia. It also explores whether over time the number of health conditions is associated with caregivers’ stress, positive experiences of caregiving, and social networks Methods: Longitudinal data from the IDEAL (Improving the experience of Dementia and Enhancing Active Life) cohort were used. Participants comprised spousal caregivers (n = 977) of people with dementia. Self-reported health conditions using the Charlson Comorbidity Index, stress, positive experiences of caregiving, and social network were assessed over two years. Mixed effect models were used Results: On average participants had 1.5 health conditions at baseline; increasing to 2.1 conditions over two years. More health conditions were reported by caregivers who were older, had no formal education, provided 10 + hours of care per day, and/or cared for a person with more neuropsychiatric symptoms at baseline. More baseline health conditions were associated with greater stress at baseline but not with stress over time. Over two years, when caregivers’ health conditions increased, their stress increased whereas their social network diminished Discussion: Findings highlight that most caregivers have their own health problems which require management to avoid increased stress and shrinking of social networks [ABSTRACT FROM AUTHOR]

Background: Poisoning injuries is an increasing concern among older people, and so is the repetition of intentional poisonings. To date, few studies have documented the pattern and individual risk factors for repeated poisonings. This national study aims to shed light on the burden, pattern, and health-related risk factors of repeated intentional poisoning leading to hospitalization or death among older Swedish adults (50 years and older), with a focus on the year following a first event. Methods: We conducted a nationwide register-based cohort study of people aged 50–100, hospitalized for intentional poisoning (ICD10: X60-69) during 2006–2016 (n = 15,219) and re-hospitalized by poisoning of any intent within a year (n = 1710), i.e., up to the end of 2017. We considered in turn, the distribution of the second poisoning in 30-day intervals stratified by intent; poisoning lethality within a month and a year; and the sex-specific association between health conditions and being re-hospitalized for intentional poisoning within one year as compared to being hospitalized only once using logistic regression (odds ratios (OR) with 95% confidence intervals (95% CI)). Results: Following an intentional poisoning, re-hospitalization within a year was predominantly for a new intentional poisoning (89.7%) and occurred most typically within a month (median 4 days). Death within 30 days occurred in similar proportion for the first and second poisoning (2.3% vs. 2.1% respectively). Among both men and women, comorbidity of psychiatric illness was strongly associated with re-hospitalization for intentional poisoning (adjusted ORs = 1.70; 95% CI = 1.45–2.01 and 1.89 (95% CI = 1.60–2.19) respectively). Conclusion: Most re-hospitalizations within a year after intentional poisoning are also for intentional poisoning and occur most typically within days. Re-hospitalization is associated with several conditions that are characteristic of poor mental health and there are more similarities than differences between men and women in that respect. [ABSTRACT FROM AUTHOR]

Background: The co‐disease of depression and gout is becoming more common in the modern era. However, the relationship between the severity of depressive symptoms and gout prevalence and treatment rate was still unclear. Objective: This study aimed to determine the relationship between the prevalence, treatment rate of gout, and the severity of depression in the United States. Method: The cross‐sectional analysis of the 2007–2018 National Health and Nutrition Examination Survey (NHANES) for participants with depression was performed. According to their Patient Health Questionnaire‐9 (PHQ‐9) scores, participants were categorized as none, mild, moderate, moderately severe, and severe. To learn the correlation between the severity of depressive symptoms and the prevalence and treatment rate of gout using multivariate logistic regression to control for confounder interference. Results: A total of 25 022 patients were included in this study. As the severity of the depressive symptoms worsened (Mild, Moderate and Moderately severe), the risk of gout increased in non‐adjusted model and model 1,2,3 (p‐value for trend =.01 in non‐adjusted model, <.0001 in model 1, <.01 in models 2 and 3; prevalence group in Model 1, aOR1.71, 95% CI (1.40, 2.08) in the mild group, aOR1.68, 95% CI (1.19, 2.39) in the moderate group, aOR1.31,95% CI (0.82, 2.11) in the moderately severe group, aOR1.21, 95% CI (0.62, 2.38) in the severe group). However, the lower gout prevalence trend has no statistical significance after adjusting all factors in Model 4(p‐value for trend =.98). Compared with patients without depression, only a few patients received treatment, especially patients with severe depression (none, 80.1%; severe, 0.2%). The more severe the depression, the lower the treatment rate (p‐value for trend: non‐adjusted model, p <.001; model 1, p =.05; model 2, p =.02; model 3, p =.03). Conclusion: Compared with patients without depression, the patients with depression had a higher risk of gout. With the aggravation of depression, the prevalence of gout and the rate of treatment both were decreased. Patients with gout and depression need to receive multidisciplinary care after diagnosis. However, currently, treatment cannot meet the needs of the current patients. [ABSTRACT FROM AUTHOR]

Objective Musculoskeletal pain is a common risk factor for co-morbid conditions and might increase the risk of poor outcomes. The objective was to determine whether patients with pre-existing musculoskeletal pain have an increased risk for mortality following a new diagnosis of a co-morbid condition. Methods Patients aged ≥45 years with a new diagnosis of acute coronary syndrome (ACS), stroke, cancer, dementia or pneumonia recorded in a UK electronic primary care database linked to hospital and mortality records were examined. The association of mortality with musculoskeletal pain (inflammatory conditions, OA and regional pain) was determined. Results The sample size varied from 128 649 (stroke) to 406 289 (cancer) by cohort, with 22–31% having pre-existing musculoskeletal conditions. In the ACS cohort, there was a higher rate of mortality for all musculoskeletal types. There were also higher unadjusted mortality rates in patients with inflammatory arthritis compared with those without musculoskeletal pain in the stroke, cancer and dementia cohorts and for patients with OA in the stroke and cancer cohorts. After adjustment for the number of prescribed medications and age, the increased risk of mortality remained only for patients with inflammatory arthritis in the ACS cohort (adjusted hazard ratio = 1.07; 95% CI 1.03, 1.10). Conclusion Older adults with inflammatory arthritis and OA have increased risk of mortality when they develop a new condition, which seems to be related to the prescription of multiple medicines. Pre-existing musculoskeletal pain is an indicator of a complex patient who is at risk of poorer outcomes at the onset of new illnesses. [ABSTRACT FROM AUTHOR]

BackgroundSome occupational and environmental exposures could increase the risk of chronic obstructive pulmonary disease (COPD) and hypertension in various work and living environments. However, the effect of exposure to multiple exogenous harmful substances on COPD and hypertension co-morbidities remains unclear.MethodsParticipants were selected from eight hospitals in five provinces in China using a multistage cluster sampling procedure. Participants' demographic, exposure, and disease information were collected through questionnaires, spirometry, and blood pressure examinations. Demographic data were used as matching factors, and 1:1 matching between the exposed and non-exposed groups was performed by employing propensity score matching (PSM) to minimize the influence on the results. A one-way chi-squared analysis and multifactorial logistic regression were used to analyze the association between the exposure to exogenous harmful substances (metals and their compound dust, inorganic mineral dust, organic chemicals, and livestock by-products) and the co-morbidity of COPD and hypertension.ResultsThere were 6,610 eligible participants in the final analysis, of whom 2,045 (30.9%) were exposed to exogenous harmful substances. The prevalence of co-morbidities of COPD and hypertension (6.0%) in the exposure group was higher than their prevalence in the total population (4.6%). After PSM, exogenous harmful substance exposure was found to be a risk factor for the co-morbidity of COPD and hypertension [odds ratio (OR) = 1.347, 95% confidence interval (CI): 1.011–1.794], which was not statistically significant before PSM (OR = 1.094, 95% CI: 0.852–1.405). Meanwhile, the results of different outcomes showed that the association between hypertension and exogenous harmful substance exposure was not statistically significant (OR = 0.965, 95% CI: 0.846–1.101). Smoking (OR = 4.702, 95% CI: 3.321–6.656), history of a respiratory disease during childhood (OR = 2.830, 95% CI: 1.600–5.006), and history of respiratory symptoms (OR = 1.897, 95% CI: 1.331–2.704) were also identified as risk factors for the co-morbidity of COPD and hypertension.ConclusionThe distribution of exogenous harmful substance exposure varies in the population, and the prevalence of co-morbidities is generally higher in susceptible populations. Exposure to exogenous harmful substances was found to be a key risk factor after adjusting for demographic confounders.

Aim: To determine whether patients with chronic painful temporomandibular disorder (TMD) had abnormal diaphragm function compared to healthy controls and to explore the correlation between diaphragm contractility, psychological status, and pain characteristics. Methods: A single-blinded, case-control study was conducted involving 23 chronic painful TMD patients and 22 healthy volunteers. The examination and diagnosis were performed according to the Diagnostic Criteria for Temporomandibular Disorders, and questionnaires were used to evaluate pain, depression, anxiety, and physical symptoms status. B-mode ultrasound was used to measure diaphragm thickness and contractility. The sonographer responsible for measuring the diaphragm was blinded to group membership. Results: 1. Depression, anxiety, and physical symptoms scores were significantly higher in the patients than in the controls (p

Abstract Introduction Clinical decision support (CDS) systems (CDSSs) that integrate clinical guidelines need to reflect real‐world co‐morbidity. In patient‐specific clinical contexts, transparent recommendations that allow for contraindications and other conflicts arising from co‐morbidity are a requirement. In this work, we develop and evaluate a non‐proprietary, standards‐based approach to the deployment of computable guidelines with explainable argumentation, integrated with a commercial electronic health record (EHR) system in Serbia, a middle‐income country in West Balkans. Methods We used an ontological framework, the Transition‐based Medical Recommendation (TMR) model, to represent, and reason about, guideline concepts, and chose the 2017 International global initiative for chronic obstructive lung disease (GOLD) guideline and a Serbian hospital as the deployment and evaluation site, respectively. To mitigate potential guideline conflicts, we used a TMR‐based implementation of the Assumptions‐Based Argumentation framework extended with preferences and Goals (ABA+G). Remote EHR integration of computable guidelines was via a microservice architecture based on HL7 FHIR and CDS Hooks. A prototype integration was developed to manage chronic obstructive pulmonary disease (COPD) with comorbid cardiovascular or chronic kidney diseases, and a mixed‐methods evaluation was conducted with 20 simulated cases and five pulmonologists. Results Pulmonologists agreed 97% of the time with the GOLD‐based COPD symptom severity assessment assigned to each patient by the CDSS, and 98% of the time with one of the proposed COPD care plans. Comments were favourable on the principles of explainable argumentation; inclusion of additional co‐morbidities was suggested in the future along with customisation of the level of explanation with expertise. Conclusion An ontological model provided a flexible means of providing argumentation and explainable artificial intelligence for a long‐term condition. Extension to other guidelines and multiple co‐morbidities is needed to test the approach further.

Introduction: Elizabethkingia meningoseptica (E. meningoseptica) is an emerging pathogen that causes bloodstream infections, especially among immunocompromised or critically ill patients. Due to its multidrug resistance, limited antibiotic treatments are available. Therefore, correct identification with a proper susceptibility report is compulsory to reduce mortality and morbidity caused by this rare pathogen. Aim: To analyse the clinical features, underlying comorbidity, outcomes, and antibiotic resistance potential of E. meningoseptica causing bacteraemia. Materials and Methods: This cross-sectional study was conducted in Department of Microbiology, Rajshree Medical Research Institute (RMRI), Bareilly, Uttar Pradesh, India. The study spanned three years from August 2020 to July 2023. All patients with E. meningoseptica bacteraemia were identified from blood culture reports and included in the study. As it was a duration-based study, all consecutive patients identified with E. meningoseptica bacteraemia were enrolled. The total sample size was 43. Blood samples growing gram negative, non fermenting, non motile isolates that were positive for the oxidase reaction were further identified using the Vitek 2 compact system (Biomerieux, France). All relevant data regarding demographic and clinical characteristics, underlying diseases, and antibiotic treatments were collected from the hospital information system. Patient demographics were presented as mean ± standard deviation. Clinical characteristics and co-morbid conditions were presented as frequency and percentages. Results: The majority of patients were elderly males admitted to the Intensive Care Unit (ICU). The most common underlying co-morbidity was malignancy in 12 (27.9%), and pneumonia in 12 (48.8%) was the major diagnosis among these bacteraemic patients. A total of 10 (23.25%) infections were polymicrobial, with common concomitant pathogens being Pseudomonas aeruginosa and Methicillin-Resistant Staphylococcus aureus (MRSA). Co-trimoxazole, fluoroquinolones, and Piperacillin/ Tazobactam were the most effective antibiotics. Thirty-nine (90.7%) patients recovered completely, while four patients (9.3%) died of complications. Conclusion: Improper antimicrobial therapy increases resistance and mortality among patients with E. meningoseptica infections. It is imperative that clinicians remain vigilant about this rare pathogen and advise antimicrobial susceptibility testing for appropriate treatment, leading to favourable outcomes.