Displaying publications 161 - 180 of 366 in total

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  1. Woon, L.S., Hazli Z., Gan, L.L.Y.
    MyJurnal
    Comorbid adult attention-deficit hyperactivity disorder (ADHD) and stimulant dependence is widely recognized, but efficacy of pharmacotherapy in this patient population is not well established. We aimed to review whether pharmacotherapy is efficacious in reducing ADHD symptoms and stimulant use in comorbid adult ADHD and stimulant use disorder. English articles until June 2017 were systematically searched in electronic databases (MEDLINE and PsycINFO), an online clinical trials register (ClinicalTrial.gov), and through hand-search of article references. Randomized, double-blind, placebo-controlled trials that studied efficacy of pharmacotherapy in adults with comorbid ADHD and stimulant dependence were included. Two reviewers assessed studies for inclusion and extracted data; disagreements were resolved by consensus. Study outcomes included were changes in ADHD symptom severity, substance abstinence, treatment retention rates and safety. From the 1394 records identified, five trials (n=358) were included. Four studies involved methylphenidate; in another study extended-release mixed amphetamine were used. The comorbid stimulant was cocaine in three studies, and amphetamines in the rest. All were short-term studies involving predominantly young male adults conducted in outpatient settings. There is early promising but mixed evidence for therapeutic efficacy in improving ADHD symptoms. Stimulant medications did not worsen stimulant dependence or adverse effects of stimulant medications. Side effects were mild and tolerable. High attrition rates and small sample size limited the generalizability of findings. Current limited evidence suggests that stimulant treatment for comorbid adult ADHD and stimulant dependence is feasible. Welldesigned trials with adequate power are needed for more robust evidence on ADHD and stimulant use outcomes.
    Matched MeSH terms: Comorbidity
  2. Tan KC, Chang CT, Cheah WK, Vinayak CR, Chan HK
    Med J Malaysia, 2019 Jun;74(3):215-218.
    PMID: 31256176
    INTRODUCTION: This study was designed to determine the influence of bariatric surgery on changes in the body mass index (BMI), and the control of diabetes, hypertension and dyslipidaemia among obese patients in Malaysia.

    MATERIALS AND METHODS: This was a retrospective cohort study undertaken at a public tertiary care centre in the state of Perak, Malaysia. Information of obese patients who underwent bariatric surgery was obtained from their medical records. The changes in the BMI, HbA1C, systolic and diastolic blood pressure (SBP and DBP), and lipid levels between three months before and after the surgery were assessed.

    RESULTS: The patients (n=106) were mostly Malay (66.0%), had at least one comorbidity (61.3%), and had a mean age of 40.38±11.75 years. Following surgery, the BMI of the patients was found to reduce by 9.78±5.82kg/m2. For the patients who had diabetes (n=24) and hypertension (n=47), their mean HbA1C, SBP and DBP were also shown to reduce significantly by 2.02±2.13%, 17.19±16.97mmHg, and 11.45±12.63mmHg, respectively. Meanwhile, the mean total cholesterol, triglyceride and low-density lipoprotein levels of those who had dyslipidaemia (n=21) were, respectively, lowered by 0.91±1.18mmol/L, 0.69±1.11mmol/L and 0.47±0.52mmol/L.

    CONCLUSION: The findings suggest that in addition to weight reduction, bariatric surgery is helpful in improving the diabetes, hypertension and dyslipidaemia control among obese patients. However, a large-scale trial with a control group is required to verify our findings.

    Matched MeSH terms: Comorbidity
  3. Moy FM, Atiya AS
    JUMMEC, 2005;8:33-38.
    Malaysia has undergone rapid pace of industrialization and urbanization in recent decades and this has brought about imminent changes in the lifestyle of Malaysians. This is a cross-sectional study which attempts to examine the lifestyle practices and the prevalence of obesity of a group of security guards and their spouses of the University of Malaya, Kuala Lumpur. Data collection was conducted by both the methods of face-to-face interview and self-administered questionnaire. The respondents were surveyed on lifestyle practices such as smoking habits, exercise and eating pattern. Anthropometric measurement such as weight and height were also taken to establish the extend of obesity by using Body Mass Index (BMI). This study reveals that the community did have some unhealthy lifestyle practices such as smoking (27.7%; 95%CI 20.2%, 36.2%), low prevalence of adequate exercise (13.8%; 95%CI 8.4%, 21.0%); high prevalence of overweight and obesity (64%; 95%CI 55.1%, 72.3%); and high prevalence of co-morbidities such as diabetes mellitus and cardiovascular diseases. In conclusion, the community is considered to be a vulnerable and high-risk group for morbidity and mortality with the above predisposed risk factors. KEYWORDS: Lifestyle practices, overweight and obesity
    Matched MeSH terms: Comorbidity
  4. Bahar-Moni AS, Abdullah S, Fauzi H, Chee-Yuen SY, Abdul-Razak FZ, Sapuan J
    Malays Orthop J, 2019 Nov;13(3):53-59.
    PMID: 31890111 DOI: 10.5704/MOJ.1911.009
    Introduction: Carpal tunnel syndrome (CTS) is the most commonly encountered neuropathy. The entrapment of the median nerve at the wrist can be corrected with a carpal tunnel release (CTR) procedure. The objective of this retrospective study was to determine the demographic, medical, and surgical characteristics of the patients with CTS who presented for CTR surgery in a tertiary hospital in Malaysia. Materials and Methods: Malaysians patients with CTS who had undergone a CTR during the period from 1st June 2017 to 31st December 2017 were enrolled into the study. Each patient had a minimum follow-up of three months. The demographic data of age, gender, race and occupation, and the comorbid illnesses and associated risk factors were recorded. The prevalence and occurrence of CTS in the dominant or non-dominant hand and the effectiveness of surgical intervention were also noted. Data was collected, analysed and stored in Microsoft Excel and SPSS 25. Results: There was a total of 76 cases of CTR surgeries done in 62 patients in the study. Eighty percent of the patients were female, and most of the patients belonged to the age group of 41-60 years. Malays constituted 74.2% of the patients, and 34% were housewives. Hypertension, dyslipidaemia and diabetes mellitus were the three major comorbidities. Cervical spondylosis was seen in one-fourth of the patients. Bilateral hand involvement was present in 54.8% of patients. 59.7% of CTR surgery was done on the dominant hand alone, 17.7 % CTR on the non-dominant hand alone and 22.6% CTR on both hands. Numbness and pain (50%) were the predominant presenting symptoms. The most positive signs were the Durkan test (77.6%), followed by the Tinel sign at the carpal tunnel and the Phalen's test. At follow-up, three months or more, after the surgery, 75% of the patients showed a satisfactory improvement. Conclusion: Patients, who had undergone CTR, had a higher prevalence of pre-morbid conditions, and a quarter of them presented with associated cervical spondylosis. The most common presentation was a combination of numbness and pain. Many obtained satisfactory improvement post-surgery and thus open surgery could be considered a reliable treatment for CTS.
    Matched MeSH terms: Comorbidity
  5. Isa NMM, Aziz AFA
    Korean J Fam Med, 2020 Jul;41(4):256-262.
    PMID: 32019295 DOI: 10.4082/kjfm.19.0012
    BACKGROUND: Lower urinary tract symptoms (LUTS) are common among elderly men. However, seeking help for this problem is mostly delayed until complications arise. Primary care clinics serve as the first point of contact for a person's health needs throughout their life. This study aimed to determine the prevalence of LUTS among primary care attendees, and the factors that influence seeking medical intervention at primary care clinics.

    METHODS: Using a universal sampling technique, 460 male patients aged 60 and above visiting an urban based public primary care clinic were recruited. An interviewer administered the questionnaire which used International Prostate Symptoms Score and International Consultation on Incontinence Modular Questionnaire-Lower Urinary Tract Symptoms-Quality of Life.

    RESULTS: The prevalence of any LUTS and clinically significant LUTS were 89.8% and 20.5%, respectively. Among the 385 participants who completed the study, only 41.8% had consulted a doctor for LUTS. Among those with moderate/severe symptoms only 57.6% had sought medical intervention. Multiple logistic regression analysis showed that the presence of more than two comorbidities (P=0.004; odds ratio [OR], 4.695; 95% confidence interval [CI], 1.632-13.508) and quality of life (P=0.002; OR, 1.271; 95% CI, 1.091-1.481) were independent factors significantly associated with seeking help.

    CONCLUSION: Prevalence of LUTS among elderly men undergoing primary care is high, but more than half of the patients had not sought medical attention. Increasing comorbidities and impact on quality of life influenced elderly men with LUTS to seek help.

    Matched MeSH terms: Comorbidity
  6. Teh CL, Cheong YK, Wan SA, Ling GR
    Reumatismo, 2019 Oct 24;71(3):154-159.
    PMID: 31649384 DOI: 10.4081/reumatismo.2019.1225
    Treat-to-target (T2T) for gout has been established recently to improve its management, which has been reported to be sub-optimal with significant gaps between the goals of treatment and day-to-day clinical practice. T2T recommended a goal of serum urate (SUA) target of <360 μmoI/L in all patients with gout and <300 μmoI/L in patients with tophaceous or severe gout. T2T strategy was applied in the management of gout patients in two Rheumatology clinics from 1 January 2016 onwards. We performed a clinical audit to assess T2T of SUA in gout patients and to identify causes for failure to achieve target SUA among them. There were a total of 304 patients for our analysis. They were of multi-ethnic origin with male predominance (88.8%). They had a mean age of 57.7+13.7 years and mean disease duration of 10.1+8.7 years. The most common comorbidities were hypertension (76.2%), dyslipidemia (52.5%) and diabetes mellitus (DM) (27.4%). Our patients' body mass indexes showed that 47.7% were obese while 34.2% were overweight. Up to 62.4% of our patients had tophi and 42.6% had joint deformities. Only 34.9% of patients achieved target SUA. Nonadherence (52.3%) was the main reason identified for failure to achieve target SUA. The independent predictors for failure to achieve target SUA were nonadherence (HR=7.84, p=0.000) and presence of tophi (HR=1.95, p=0.001).
    Matched MeSH terms: Comorbidity
  7. Wong JJM, Abbas Q, Chuah SL, Malisie RF, Pon KM, Katsuta T, et al.
    Am J Trop Med Hyg, 2021 Jun 15;105(2):413-420.
    PMID: 34129517 DOI: 10.4269/ajtmh.21-0299
    There is a scarcity of data regarding coronavirus disease 2019 (COVID-19) infection in children from southeast and south Asia. This study aims to identify risk factors for severe COVID-19 disease among children in the region. This is an observational study of children with COVID-19 infection in hospitals contributing data to the Pediatric Acute and Critical Care COVID-19 Registry of Asia. Laboratory-confirmed COVID-19 cases were included in this registry. The primary outcome was severity of COVID-19 infection as defined by the World Health Organization (WHO) (mild, moderate, severe, or critical). Epidemiology, clinical and laboratory features, and outcomes of children with COVID-19 are described. Univariate and multivariable logistic regression models were used to identify risk factors for severe/critical disease. A total of 260 COVID-19 cases from eight hospitals across seven countries (China, Japan, Singapore, Malaysia, Indonesia, India, and Pakistan) were included. The common clinical manifestations were similar across countries: fever (64%), cough (39%), and coryza (23%). Approximately 40% of children were asymptomatic, and overall mortality was 2.3%, with all deaths reported from India and Pakistan. Using the multivariable model, the infant age group, presence of comorbidities, and cough on presentation were associated with severe/critical COVID-19. This epidemiological study of pediatric COVID-19 infection demonstrated similar clinical presentations of COVID-19 in children across Asia. Risk factors for severe disease in children were age younger than 12 months, presence of comorbidities, and cough at presentation. Further studies are needed to determine whether differences in mortality are the result of genetic factors, cultural practices, or environmental exposures.
    Matched MeSH terms: Comorbidity
  8. Thai LT, Li YL, Kig TY, Muhammad Afiq R, Shoen CC, Sing HC, et al.
    Med J Malaysia, 2020 05;75(3):204-208.
    PMID: 32467533
    INTRODUCTION: The knowledge of pre-existing medical illnesses and their follow up status among active pulmonary tuberculosis (PTB) subjects can help in tuberculosis (TB) control programme. The aims of our study were to examine: the prevalence of pre-existing chronic medical illnesses, the follow up status of known pre-existing co-morbid and to distinguish between diagnosed and undiagnosed preexisting tuberculosis related chronic medical illnesses among our active PTB subjects.

    METHODS: We conducted a retrospective review of demographic and clinical data of active PTB subjects that were diagnosed between January 2015 and June 2017 in the district of Manjung, Perak, Malaysia. Among the 302 TB clinical notes reviewed, 253 patients were included. Subjects below the age of 18 years and whose follow up centres for their medical illnesses that were located outside of Manjung were excluded. Demographic and clinical data were collected using pre-tested data collection form by trained investigators. The data was analysed using SPSS Version 20.0.

    RESULTS: We identified diabetes mellitus as the most prevalent pre-existing co-morbid (77 cases) and almost 90% (68 cases) of these diabetic subjects were diagnosed prior to active PTB diagnosis. This was followed by Human Immunodeficiency Virus and Hepatitis C infection which accounted for 12.0% (30 cases) of the study populations. Among 132 subjects who had pre-existing chronic medical illnesses, only 74 subjects (29%) were under regular follow up at healthcare facilities in Manjung prior to PTB diagnosis.

    CONCLUSION: Overall, our research provides evidence on the existence of wide variation of clinical background among active PTB subjects.
    Matched MeSH terms: Comorbidity
  9. Islam MA, Alam F, Gan SH, Cavestro C, Wong KK
    Cephalalgia, 2018 03;38(3):568-580.
    PMID: 28952322 DOI: 10.1177/0333102417694881
    Background The occurrence of antiphospholipid antibodies (aPLs) and headache comorbidity in the presence or absence of underlying autoimmune diseases remains unclear. Aim The aim of this review was to summarize the relationship between headache and aPLs based on evidences from cohort studies and case reports, in addition to examining the treatment strategies that resolved headache in aPLs-positive individuals.
    Methods A comprehensive literature search was conducted through PubMed, ISI Web of Science and Google Scholar. A total of 559 articles were screened and the appropriate articles were selected based on quality and level of evidence.
    Results Cohort studies (n = 27) from Europe, North America and Asia demonstrated comorbidity of aPLs and headache in antiphospholipid syndrome, systemic lupus erythematosus (SLE) and neuropsychiatric SLE patients. Significantly higher association between migraine and aPLs was observed (n = 170/779; p 
    Matched MeSH terms: Comorbidity
  10. Mazlan AM, Ayob Y, Hussein AR, Namasiwayam TK, Wan Mohammad WMZ
    Asian J Transfus Sci, 2017 Jul-Dec;11(2):95-101.
    PMID: 28970674 DOI: 10.4103/ajts.AJTS_51_16
    CONTEXT: Coronary artery bypass graft (CABG) operation is associated with high frequency of allogeneic blood transfusion due to the acquired hemostatic challenges in patients undergoing CABG. However, allogeneic blood transfusion carries risks of infection, adverse reaction, and mortality as well as prolonged hospital stay and increased hospital cost. It is important to identify patients who require blood transfusion to mitigate their risk factors and reduce the chance of exposure to allogeneic blood.

    AIMS: This study was conducted to evaluate factors that influence the decision to transfuse red cell in first-time elective CABG patients.

    SETTINGS AND DESIGN: This was a cross-sectional study based on a retrospective record review. The study was done in the National Heart Institute.

    MATERIALS AND METHODS: All patients who underwent first-time elective CABG were included in this study. Variables analyzed include age, gender, body weight, preoperative hemoglobin (Hb) level, patients' comorbidities, and other clinical parameters.

    STATISTICAL ANALYSIS USED: Data were analyzed using SPSS software version 20.

    RESULTS: A total of 463 patients underwent first-time elective CABG during the period of the study. Three hundred and eighty-six (83.4%) patients received red cell transfusion. From multiple logistic regression analysis, only age (odds ratio [OR] = 1.040, 95% confidence interval [CI]: 1.003, 1.077, P = 0.032), body weight (OR = 0.951, 95% CI: 0.928, 0.974, P < 0.001), Hb level (OR = 0.500, 95% CI: 0.387, 0.644, P < 0.001), and cardiopulmonary bypass time (OR = 1.013, 95% CI: 1.004, 1.023, P < 0.001) were the significant independent predictors of red cell transfusion.

    CONCLUSIONS: By stratifying patients according to their risk factor for red cell transfusion, the high-risk patients could be recognized and should be enrolled into effective patient blood management program to minimize their risk of exposure to allogeneic blood transfusion.
    Matched MeSH terms: Comorbidity
  11. Termizy HM, Mafauzy M
    Singapore Med J, 2009 Apr;50(4):390-4.
    PMID: 19421683
    INTRODUCTION: The increased prevalence of metabolic syndrome worldwide is closely related to the rising obesity epidemic. The objectives of the study were to determine the prevalence and identify the associated and prognostic factors that influence the risk of metabolic syndrome among obese patients attending the Obesity Clinic at Hospital Universiti Sains Malaysia.
    METHODS: A study was conducted involving 102 obese persons who attended the Obesity Clinic from January 1 to December 31, 2005. Metabolic syndrome was defined according to the International Diabetes Federation criteria.
    RESULTS: The overall prevalence of metabolic syndrome among obese patients was 40.2 percent. The prevalence was higher in females (43.7 percent) than in males (32.3 percent). The prevalence of metabolic syndrome was noted to increase with increasing body mass index class, from class 1 to class 2. However, the prevalence was lower in obesity class 3. The prevalence of metabolic comorbidities of raised blood pressure, reduced high density lipoprotein, high triglyceride and raised fasting blood glucose was 42, 40, 36 and 17 percent, respectively. A quarter of obese patients in this study had no other comorbidity. Based on logistic regression multivariable analysis, age was the only significant associated factor that influenced the risk of having metabolic syndrome.
    CONCLUSION: The prevalence of metabolic syndrome was high and the highest comorbidity was high blood pressure. Age was the only significant risk factor of having this syndrome.
    Matched MeSH terms: Comorbidity
  12. Hamidon BB, Raymond AA, Norlinah MI, Jefferelli SB
    Singapore Med J, 2003 Jul;44(7):344-6.
    PMID: 14620725
    Infection is a frequent complication after an acute stroke and may affect stroke outcome. We identified predictors of early infection, type of infection, their relation to initial disability, and the eventual outcome during the inpatient period.
    Matched MeSH terms: Comorbidity
  13. Nordin RB, Soni T, Kaur A, Loh KP, Miranda S
    Singapore Med J, 2019 Jan;60(1):40-47.
    PMID: 29774359 DOI: 10.11622/smedj.2018049
    INTRODUCTION: Erectile dysfunction (ED) is a serious global burden that affects men as well as their partners. This study aimed to determine the prevalence and predictors of ED among male outpatient clinic attendees in Johor, Malaysia.

    METHODS: We conducted a cross-sectional study of Malaysian men aged ≥ 18 years attending two major outpatient clinics in Johor Bahru and Segamat in Johor, Malaysia, between 1 January 2016 and 31 March 2016. Subjects were chosen via simple random sampling and 400 patients were recruited. The study instrument was a survey form that consisted of three sections: sociodemographic and comorbid profile, validated English and Malay versions of the 15-item International Index of Erectile Function, and the 21-item Depression Anxiety Stress Scale.

    RESULTS: The overall prevalence of self-reported ED was 81.5%. The prevalence of ED according to severity was as follows: mild (17.0%), mild to moderate (23.8%), moderate (11.3%) and severe (29.5%). Multivariate analysis showed that ED was associated with increasing age (odds ratio [OR] 4.023, 95% confidence interval [CI] 1.633-9.913), Indian as compared to Malay ethnicity (OR 3.252, 95% CI 1.280-8.262), secondary as compared to tertiary education (OR 2.171, 95% CI 1.203-3.919), single as compared to married status (OR 6.119, 95% CI 2.542-14.734) and stress (OR 4.259, 95% CI 1.793-10.114).

    CONCLUSION: ED has significant prevalence and severity among adult male outpatient clinic attendees in Johor. Increasing age, Indian ethnicity, lower educational level, singlehood and stress were significant predictors of ED.

    Matched MeSH terms: Comorbidity
  14. Aranjani JM, Manuel A, Abdul Razack HI, Mathew ST
    PLoS Negl Trop Dis, 2021 Nov;15(11):e0009921.
    PMID: 34793455 DOI: 10.1371/journal.pntd.0009921
    Coronavirus Disease 2019 (COVID-19), during the second wave in early 2021, has caused devastating chaos in India. As daily infection rates rise alarmingly, the number of severe cases has increased dramatically. The country has encountered health infrastructure inadequacy and excessive demand for hospital beds, drugs, vaccines, and oxygen. Adding more burden to such a challenging situation, mucormycosis, an invasive fungal infection, has seen a sudden surge in patients with COVID-19. The rhino-orbital-cerebral form is the most common type observed. In particular, approximately three-fourths of them had diabetes as predisposing comorbidity and received corticosteroids to treat COVID-19. Possible mechanisms may involve immune and inflammatory processes. Diabetes, when coupled with COVID-19-induced systemic immune change, tends to cause decreased immunity and an increased risk of secondary infections. Since comprehensive data on this fatal opportunistic infection are evolving against the backdrop of a major pandemic, prevention strategies primarily involve managing comorbid conditions in high-risk groups. The recommended treatment strategies primarily included surgical debridement and antifungal therapy using Amphotericin B and selected azoles. Several India-centric clinical guidelines have emerged to rightly diagnose the infection, characterise the clinical presentation, understand the pathogenesis involved, and track the disease course. Code Mucor is the most comprehensive one, which proposes a simple but reliable staging system for the rhino-orbital-cerebral form. A staging system has recently been proposed, and a dedicated registry has been started. In this critical review, we extensively analyse recent evidence and guidance on COVID-19-associated mucormycosis in India.
    Matched MeSH terms: Comorbidity
  15. Roychoudhury S, Das A, Sengupta P, Dutta S, Roychoudhury S, Choudhury AP, et al.
    PMID: 33333995 DOI: 10.3390/ijerph17249411
    The twenty-first century has witnessed some of the deadliest viral pandemics with far-reaching consequences. These include the Human Immunodeficiency Virus (HIV) (1981), Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) (2002), Influenza A virus subtype H1N1 (A/H1N1) (2009), Middle East Respiratory Syndrome Coronavirus (MERS-CoV) (2012) and Ebola virus (2013) and the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) (2019-present). Age- and gender-based characterizations suggest that SARS-CoV-2 resembles SARS-CoV and MERS-CoV with regard tohigher fatality rates in males, and in the older population with comorbidities. The invasion-mechanism of SARS-CoV-2 and SARS-CoV, involves binding of its spike protein with angiotensin-converting enzyme 2 (ACE2) receptors; MERS-CoV utilizes dipeptidyl peptidase 4 (DPP4), whereas H1N1 influenza is equipped with hemagglutinin protein. The viral infections-mediated immunomodulation, and progressive inflammatory state may affect the functions of several other organs. Although no effective commercial vaccine is available for any of the viruses, those against SARS-CoV-2 are being developed at an unprecedented speed. Until now, only Pfizer/BioNTech's vaccine has received temporary authorization from the UK Medicines and Healthcare products Regulatory Agency. Given the frequent emergence of viral pandemics in the 21st century, proper understanding of their characteristics and modes of action are essential to address the immediate and long-term health consequences.
    Matched MeSH terms: Comorbidity
  16. Lazarus JV, Safreed-Harmon K, Kamarulzaman A, Anderson J, Leite RB, Behrens G, et al.
    Nat Commun, 2021 07 16;12(1):4450.
    PMID: 34272399 DOI: 10.1038/s41467-021-24673-w
    Health systems have improved their abilities to identify, diagnose, treat and, increasingly, achieve viral suppression among people living with HIV (PLHIV). Despite these advances, a higher burden of multimorbidity and poorer health-related quality of life are reported by many PLHIV in comparison to people without HIV. Stigma and discrimination further exacerbate these poor outcomes. A global multidisciplinary group of HIV experts developed a consensus statement identifying key issues that health systems must address in order to move beyond the HIV field's longtime emphasis on viral suppression to instead deliver integrated, person-centered healthcare for PLHIV throughout their lives.
    Matched MeSH terms: Comorbidity
  17. Tam LS, Tanaka Y, Handa R, Li Z, Lorenzo JP, Louthrenoo W, et al.
    Int J Rheum Dis, 2021 Jun;24(6):733-745.
    PMID: 33945214 DOI: 10.1111/1756-185X.14124
    AIM: To update previous guidance of the Asia Pacific League of Associations for Rheumatology (APLAR) on the management of patients with rheumatic and musculoskeletal diseases (RMD) during the coronavirus disease 2019 (COVID-19) pandemic.

    METHODS: Research questions were formulated focusing on diagnosis and treatment of adult patients with RMD within the context of the pandemic, including the management of RMD in patients who developed COVID-19. MEDLINE was searched for eligible studies to address the questions, and the APLAR COVID-19 task force convened 2 meetings through video conferencing to discuss its findings and integrate best available evidence with expert opinion. Consensus statements were finalized using the modified Delphi process.

    RESULTS: Agreement was obtained around key aspects of screening for or diagnosis of COVID-19; management of patients with RMD without confirmed COVID-19; and management of patients with RMD with confirmed COVID-19. The task force achieved consensus on 25 statements covering the potential risk of acquiring COVID-19 in RMD patients, advice on RMD medication adjustment and continuation, the roles of telemedicine and vaccination, and the impact of the pandemic on quality of life and on treatment adherence.

    CONCLUSIONS: Available evidence primarily from descriptive research supported new recommendations for aspects of RMD care not covered in the previous document, particularly with regard to risk factors for complicated COVID-19 in RMD patients, modifications to RMD treatment regimens in the context of the pandemic, and COVID-19 vaccination in patients with RMD.

    Matched MeSH terms: Comorbidity
  18. Momtaz YA, Ibrahim R, Hamid TA, Chai ST
    Am J Alzheimers Dis Other Demen, 2015 Jun;30(4):405-11.
    PMID: 25260596 DOI: 10.1177/1533317514552318
    INTRODUCTION: Previous studies have shown conflicting results on the association between smoking and cognitive function. This study aims to examine the relationship of smoking with cognitive function.

    METHODOLOGY: Data for the study, consisting of 2553 older adults aged 60 years and older, were drawn from a nationwide household survey entitled "Determinants of Wellness among Older Malaysians: A Health Promotion Perspective" conducted in 2010.

    RESULTS: Current smokers had lower rates of cognitive impairment compared to never smokers (17.4% vs 25.9%), while cognitive function in former or ex-smokers was almost similar to that of the never smokers. Findings from multiple logistic regression analysis showed that current smokers were 37% less likely to be cognitively impaired, compared to the never smokers (odds ratio [OR] = .63; 95% confidence interval [CI]: .46-.86) while controlling for potential confounders. No difference in cognitive function was observed between former smokers and never smokers (OR = .94; 95% CI: .71-1.25).

    CONCLUSION: Although the findings indicated a negative association between cigarette smoking and cognitive impairment, we are unable to conclude whether this relationship is causal or affected by other unmeasured confounding factors, especially survival bias.

    Matched MeSH terms: Comorbidity
  19. Liptzin DR, Pickett K, Brinton JT, Agarwal A, Fishman MP, Casey A, et al.
    Ann Am Thorac Soc, 2020 Jun;17(6):724-728.
    PMID: 32109152 DOI: 10.1513/AnnalsATS.201908-617OC
    Rationale: Neuroendocrine cell hyperplasia of infancy (NEHI) is an important form of children's interstitial and diffuse lung disease for which the diagnostic strategy has evolved. The prevalence of comorbidities in NEHI that may influence treatment has not been previously assessed.Objectives: To evaluate a previously unpublished NEHI clinical score for assistance in diagnosis of NEHI and to assess comorbidities in NEHI.Methods: We performed a retrospective chart review of 199 deidentified patients with NEHI from 11 centers. Data were collected in a centralized Research Electronic Data Capture registry and we performed descriptive statistics.Results: The majority of patients with NEHI were male (66%). The sensitivity of the NEHI Clinical Score was 87% (95% confidence interval [CI], 0.82-0.91) for all patients from included centers and 93% (95% CI, 0.86-0.97) for those with complete scores (e.g., no missing data). Findings were similar when we limited the population to the 75 patients diagnosed by lung biopsy (87%; 95% CI, 0.77-0.93). Of those patients evaluated for comorbidities, 51% had gastroesophageal reflux, 35% had aspiration or were at risk for aspiration, and 17% had evidence of immune system abnormalities.Conclusions: The NEHI Clinical Score is a sensitive tool for clinically evaluating NEHI; however, its specificity has not yet been addressed. Clinicians should consider evaluating patients with NEHI for comorbidities, including gastroesophageal reflux, aspiration, and immune system abnormalities, because these can contribute to the child's clinical picture and may influence clinical course and treatment.
    Matched MeSH terms: Comorbidity
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