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Journal of Hepatology Jul 2018Over the last decade, liver transplantation of sicker, older non-hepatitis C cirrhotics with multiple co-morbidities has increased in the United States. We sought to...
BACKGROUND AND AIMS
Over the last decade, liver transplantation of sicker, older non-hepatitis C cirrhotics with multiple co-morbidities has increased in the United States. We sought to identify an easily applicable set of recipient factors among HCV negative adult transplant recipients associated with significant morbidity and mortality within five years after liver transplantation.
METHODS
We collected national (n = 31,829, 2002-2015) and center-specific data. Coefficients of relevant recipient factors were converted to weighted points and scaled from 0-5. Recipient factors associated with graft failure included: ventilator support (five patients; hazard ratio [HR] 1.59; 95% CI 1.48-1.72); recipient age >60 years (three patients; HR 1.29; 95% CI 1.23-1.36); hemodialysis (three patients; HR 1.26; 95% CI 1.16-1.37); diabetes (two patients; HR 1.20; 95% CI 1.14-1.27); or serum creatinine ≥1.5 mg/dl without hemodialysis (two patients; HR 1.15; 95% CI 1.09-1.22).
RESULTS
Graft survival within five years based on points (any combination) was 77.2% (0-4), 69.1% (5-8) and 57.9% (>8). In recipients with >8 points, graft survival was 42% (model for end-stage liver disease [MELD] score <25) and 50% (MELD score 25-35) in recipients receiving grafts from donors with a donor risk index >1.7. In center-specific data within the first year, subjects with ≥5 points (vs. 0-4) had longer hospitalization (11 vs. 8 days, p <0.01), higher admissions for rehabilitation (12.3% vs. 2.7%, p <0.01), and higher incidence of cardiac disease (14.2% vs. 5.3%, p <0.01) and stage 3 chronic kidney disease (78.6% vs. 39.5%, p = 0.03) within five years.
CONCLUSION
The impact of co-morbidities in an MELD-based organ allocation system need to be reassessed. The proposed clinical tool may be helpful for center-specific assessment of risk of graft failure in non-HCV patients and for discussion regarding relevant morbidity in selected subsets.
LAY SUMMARY
Over the last decade, liver transplantation of sicker, older patient with multiple co-morbidities has increased. In this study, we show that a set of recipient factors (recipient age >60 years, ventilator status, diabetes, hemodialysis and creatinine >1.5 mg/dl) can help identify patients that may not do well after transplant. Transplanting sicker organs in patients with certain combinations of these characteristics leads to lower survival.
Topics: End Stage Liver Disease; Female; Graft Survival; Humans; Liver Transplantation; Male; Middle Aged; Morbidity; Postoperative Period; Prognosis; Retrospective Studies; Risk Factors; Survival Rate; Transplant Recipients; United States
PubMed: 29454069
DOI: 10.1016/j.jhep.2018.02.004 -
ESC Heart Failure Dec 2018In an aging population, the number of patients affected by heart failure and cancer is constantly increasing and together these two conditions account for more than 50%... (Review)
Review
In an aging population, the number of patients affected by heart failure and cancer is constantly increasing and together these two conditions account for more than 50% of all deaths worldwide. Both diseases share similar risk factors including smoking, obesity, and hypertension. Presenting symptoms may also be similar, with patients frequently complaining of dyspnea, fatigue, and anorexia. Many affected patients, especially those with more advanced heart failure or cancer, suffer also from metabolic disorders. These can lead eventually to muscle wasting, sarcopenia, and cachexia. These complications are associated with increased morbidity, a poorer quality of life, a worse prognosis and indeed they represent an independent risk factor for the advancement of the underlying disease itself. Very few therapeutic options have been established to treat these co-morbidities. For sarcopenia the only validated treatment is resistance training. Moreover, there is currently no guideline recommended therapy for the treatment of cachexia. New treatment strategies are urgently needed to prevent and treat muscle and wasting disorders in patients with chronic diseases such as cancer and chronic heart failure.
Topics: Global Health; Heart Failure; Humans; Metabolic Diseases; Morbidity; Neoplasms; Prognosis
PubMed: 30570226
DOI: 10.1002/ehf2.12389 -
Revista Espanola de Cardiologia... Nov 2018
Topics: Adolescent; Child; Child, Preschool; Female; Humans; Incidence; Male; Morbidity; Pediatric Obesity; Public Health; Spain
PubMed: 30190188
DOI: 10.1016/j.rec.2018.05.042 -
Journal of Affective Disorders Jun 2015Long-term symptomatic status in persons with major depressive and bipolar disorders treated clinically is not well established, although mood disorders are leading... (Review)
Review
BACKGROUND
Long-term symptomatic status in persons with major depressive and bipolar disorders treated clinically is not well established, although mood disorders are leading causes of disability worldwide.
AIMS
To pool data on long-term morbidity, by type and as a proportion of time-at-risk, based on published studies and previously unreported data.
METHODS
We carried out systematic, computerized literature searches for information on percentage of time in specific morbid states in persons treated clinically and diagnosed with recurrent major depressive or bipolar I or II disorders, and incorporated new data from one of our centers.
RESULTS
We analyzed data from 25 samples involving 2479 unipolar depressive and 3936 bipolar disorder subjects (total N=6415) treated clinically for 9.4 years. Proportions of time ill were surprisingly and similarly high across diagnoses: unipolar depressive (46.0%), bipolar I (43.7%), and bipolar II (43.2%) disorders, and morbidity was predominantly depressive: unipolar (100%), bipolar-II (81.2%), bipolar-I (69.6%). Percent-time-ill did not differ between UP and BD subjects, but declined significantly with longer exposure times.
CONCLUSIONS
The findings indicate that depressive components of all major affective disorders accounted for 86% of the 43-46% of time in affective morbidity that occurred despite availability of effective treatments. These results encourage redoubled efforts to improve treatments for depression and adherence to their long-term use.
Topics: Bipolar Disorder; Depressive Disorder, Major; Humans; Morbidity
PubMed: 25797049
DOI: 10.1016/j.jad.2015.02.011 -
Chronic Illness Mar 2022To describe morbidity and multimorbidity patterns among adults readmitted to an Australian regional health service, in terms of occurrence of the same and different...
OBJECTIVES
To describe morbidity and multimorbidity patterns among adults readmitted to an Australian regional health service, in terms of occurrence of the same and different morbidities at index admission and readmission.
METHODS
This cohort study used hospital admissions data for patients admitted between 1 July 2014 and 30 June 2016 to estimate proportions of unplanned readmissions ('early' within 30 days and 'late' within 1-6 months) with the same and different morbidities as the index admission. Readmission rates were estimated by selected sociodemographic, admission and diagnostic characteristics.
RESULTS
The majority of early and late readmissions were in different diagnostic groups and for different primary morbidities to the index admission. Only 38.8% of readmissions were in the same major diagnostic group as the index admission and 18.4% in the same Adjacent Diagnosis-Related Group. Twenty one percent of admitted patients were readmitted within six months, with this increasing to 35.3% among multimorbid patients.
CONCLUSION
With increasing prevalence of multimorbidity, particularly among those at increased risk of readmission, it is essential to step away from a single disease focus in the design of both hospital avoidance and chronic disease management programmes. Holistic interventions and strategies that address multiple chronic conditions are required.
Topics: Adult; Australia; Cohort Studies; Health Services; Humans; Morbidity; Multimorbidity; Patient Readmission; Retrospective Studies; Risk Factors
PubMed: 32036681
DOI: 10.1177/1742395319899459 -
Reproduction in Domestic Animals =... Sep 2023The neonatal period may be defined as the first month of the calf's life; it may be considered part of the fourth trimester. It is the most hazardous due to the... (Review)
Review
The neonatal period may be defined as the first month of the calf's life; it may be considered part of the fourth trimester. It is the most hazardous due to the immaturity of the neonate's immune system and the environmental challenge from infections, the main causes of both bovine neonatal morbidity and mortality. The five most common morbidities causing mortality in neonatal calves are, in descending order, gastrointestinal infections, respiratory infections, abomasal disorders, umbilical infections and developmental abnormalities. This review describes the aetiology, incidence, risk factors and sequelae of these common morbidities and highlights current preventive strategies both at farm and national levels.
Topics: Animals; Cattle; Incidence; Cattle Diseases; Risk Factors; Animals, Newborn
PubMed: 37128970
DOI: 10.1111/rda.14369 -
Endocrinology and Metabolism Clinics of... Sep 2021The number of adults living with diabetes has increased substantially globally over the past 40 years, driven by a combination of increased age-standardized prevalence,... (Review)
Review
The number of adults living with diabetes has increased substantially globally over the past 40 years, driven by a combination of increased age-standardized prevalence, population growth, aging, and increases in obesity prevalence. Patients with diabetes in high-income countries are living longer, with large declines in vascular disease mortality rates. This appears to be resulting in a diversification of cause of death, complications, and comorbidities that those with diabetes live with. This has large implications for prevention and management approaches, which should be reviewed to update the breadth of conditions that patients with diabetes are at excess risk of throughout their life. These trends have not yet been seen in low- and middle-income countries, where evidence is also more scarce.
Topics: Adult; Diabetes Mellitus; Humans; Morbidity; Mortality; Obesity; Prevalence
PubMed: 34399950
DOI: 10.1016/j.ecl.2021.05.001 -
Medical Sciences (Basel, Switzerland) May 2021Sleep complaints can be both common and complex in the older patient. Their consideration is an important aspect of holistic care, and may have an impact on quality of... (Review)
Review
Sleep complaints can be both common and complex in the older patient. Their consideration is an important aspect of holistic care, and may have an impact on quality of life, mortality, falls and disease risk. Sleep assessment should form part of the comprehensive geriatric assessment. If sleep disturbance is brought to light, consideration of sleep disorders, co-morbidity and medication management should form part of a multifaceted approach. Appreciation of the bi-directional relationship and complex interplay between co-morbidity and sleep in older patients is an important element of patient care. This article provides a brief overview of sleep disturbance and sleep disorders in older patients, in addition to their association with specific co-morbidities including depression, heart failure, respiratory disorders, gastro-oesophageal reflux disease, nocturia, pain, Parkinson's disease, dementia, polypharmacy and falls. A potential systematic multidomain approach to assessment and management is outlined, with an emphasis on non-pharmacological treatment where possible.
Topics: Aged; Comorbidity; Humans; Morbidity; Quality of Life; Sleep; Sleep Wake Disorders
PubMed: 34063838
DOI: 10.3390/medsci9020031 -
Neurosurgery Aug 2022Firearm-related injury is a significant cause of morbidity and mortality in pediatric populations. Despite a disproportionate role in the most morbid outcomes in both...
BACKGROUND
Firearm-related injury is a significant cause of morbidity and mortality in pediatric populations. Despite a disproportionate role in the most morbid outcomes in both traumatic brain injury and firearm-related injury populations, firearm-related traumatic brain injury (frTBI) is an understudied epidemiological entity. There is need to increase understanding and promote interventions that reduce this burden of disease.
OBJECTIVE
To assess the evidence characterizing pediatric frTBI to highlight trends and gaps regarding burden of disease and interventions to reduce frTBI.
METHODS
We conducted a scoping review under Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review (PRISMA-ScR) guidelines on peer-reviewed studies across 5 databases (Medline OVID, EMBASE, Web of Science Legal Collection, PsychINFO, and Academic Search Complete). English studies examining pediatric frTBI epidemiology, prevention, and/or social or legal policy advocacy were included. Articles were excluded if they more generally discussed pediatric firearm-related injury without specific analysis of frTBI.
RESULTS
Six studies satisfied inclusion criteria after screening and full-text assessment. Limited studies specifically addressed the burden of disease caused by frTBI. There was an increased risk for both injury and death from frTBI in men, preteenage and teenage youths, minorities, and individuals in firearm-owning households. Further study is required to ascertain if suggested methods of targeted patient screening, firearm-injury prevention counseling, and advocacy of safety-oriented policy tangibly affect rates or outcomes of pediatric frTBI.
CONCLUSION
By understanding published epidemiological data and areas of intervention shown to reduce frTBIs, neurosurgeons can become further engaged in public health and prevention rather than strictly treatment after injury.
Topics: Adolescent; Brain Injuries, Traumatic; Child; Firearms; Humans; Male; Mass Screening; Morbidity; Policy
PubMed: 35535986
DOI: 10.1227/neu.0000000000002025 -
Indian Journal of Pediatrics Oct 2021Psychiatric morbidity and behavioral problems are quite common in children and adolescents with bronchial asthma, yet they remain underexplored and often ignored in...
OBJECTIVES
Psychiatric morbidity and behavioral problems are quite common in children and adolescents with bronchial asthma, yet they remain underexplored and often ignored in clinical settings. This can impact the child's overall quality of life. There seems to be a dearth of Indian literature and so the current study was planned to assess psychological impact of asthma on the pediatric population.
METHODS
Thirty children and adolescents, attending the Pediatric Chest Clinic at a tertiary care hospital in North India in the age group of 8-15 y having moderate to severe asthma formed the study group and matched healthy controls formed the other group. Sociodemographic and clinical details were obtained. Mini International Neuropsychiatric Interview (M.I.N.I. KID) and Child Behavior Checklist (CBCL) were applied.
RESULTS
Irregular attendance at school was reported by 23.33% of the participants with asthma. About 17% of the thirty study-participants were diagnosed with specific phobia, 10% with conduct disorder, and 7% with attention deficit hyperactivity disorder (ADHD). Participants in the study group had significantly more behavioral problems in the syndrome domain anxious/depressed and attention problems. Total CBCL scores were significantly higher in the study group as compared to the control group (t = 3.816, p = 0.0003), indicating the presence of more behavioral problems in pediatric population with bronchial asthma.
CONCLUSION
Children and adolescents with bronchial asthma have co-morbid psychiatric morbidities and behavioral problems.
Topics: Adolescent; Asthma; Attention Deficit Disorder with Hyperactivity; Child; Humans; Morbidity; Problem Behavior; Psychiatric Status Rating Scales; Quality of Life
PubMed: 33625668
DOI: 10.1007/s12098-021-03661-4