Usefulness of the C2HEST Score in Predicting the Clinical Outcomes of COVID-19 in Diabetic and Non-Diabetic Cohorts.

BACKGROUND: Diabetes mellitus is among the most frequent comorbidities worsening COVID-19 outcome. Nevertheless, there are no data regarding the optimal risk stratification of patients with diabetes and COVID-19. Since individual C2HEST components reflect the comorbidities, we assumed that the score could predict COVID-19 outcomes. MATERIAL AND METHODS: A total of 2184 medical records of patients hospitalized for COVID-19 at the medical university center were analyzed, including 473 diabetic patients and 1666 patients without any glucose or metabolic abnormalities. The variables of patients' baseline characteristics were retrieved to calculate the C2HEST score and subsequently the diabetic and non-diabetic subjects were assigned to the following categories: low-, medium- or high-risk. The measured outcomes included: in-hospital mortality; 3-month and 6-month all-cause mortality; non-fatal end of hospitalization (discharged home/sudden-deterioration/rehabilitation) and adverse in-hospital clinical events. RESULTS: A total of 194 deaths (41%) were reported in the diabetic cohort, including 115 in-hospital deaths (24.3%). The 3-month and 6-month in-hospital mortality was highest in the high-risk C2HEST stratum. The C2HEST score revealed to be more sensitive in non-diabetic-group. The estimated six-month survival probability for high-risk subjects reached 0.4 in both cohorts whereas for the low-risk group, the six-month survival probability was 0.7 in the diabetic vs. 0.85 in the non-diabetic group-levels which were maintained during whole observation period. In both cohorts, receiver operating characteristics revealed that C2HEST predicts the following: cardiogenic shock; acute heart failure; myocardial injury; and in-hospital acute kidney injury. CONCLUSIONS: We demonstrated the usefulness and performance of the C2HEST score in predicting the adverse COVID-19 outcomes in hospitalized diabetic subjects.

Itch in Elderly People: A Cross-sectional Study.

Ageing is associated with numerous medical afflictions, including dermatological symptoms and diseases. Chronic itch (CI) in elderly people is a frequent symptom of diverse aetiology. This study assessed the prevalence and detailed clinical features of CI among 153 elderly patients hospitalized in the geriatric ward, including associations with comorbidities and pharmacotherapy. CI affected 35.3% of subjects, most commonly due to cutaneous conditions, mixed aetiology and neurological disorders (53.7%, 25.9% and 11.1% of pruritic subjects, respectively). The mean itch intensity assessed with the 4-Item Itch Questionnaire (4IIQ) was 6.6 ± 2.8 points. Viral hepatitis (p = 0.02), higher serum creatinine concentration (p = 0.02) and coexistent purpuric lesions (p = 0.002) were associated with higher 4IIQ scores. In logistic regression analysis CI correlated positively with female sex, atopic dermatitis, immobility, rheumatoid arthritis and ischaemic neurological diseases, while low-molecular-weight heparins, antipruritic drugs, allergy, rosacea and higher haemoglobin concentration had the contrary effect. CI is a frequent and interdisciplinary problem among elderly subjects, which requires a holistic clinical approach.

Predictors of mortality in older patients admitted to a geriatric hospital.

AIM: The identification of older patients at risk of mortality is important to provide properly tailored care and effectively manage healthcare resources. The present study aimed to identify predictors of all-cause mortality related to geriatric patients' clinical, functional and sociodemographic status at admission. METHODS: A retrospective study was carried out of patients admitted to a geriatric hospital from January to May 2013. A total of 208 patients were enrolled in the study. The outcome measure was 4-year mortality. RESULTS: The mortality rate was 26%. We found that age, red blood cells count and white blood cells count, as well as C-reactive protein level, albumin level and high-density lipoprotein cholesterol level significantly correlated with mortality. Furthermore, the presence of clinical symptoms, such as pressure ulcers and depressed level of consciousness, was predictive of poor outcome. Multidimensional aspects of aging that are assessed in the Comprehensive Geriatric Assessment - activities of daily living, instrumental activities of daily living, Barthel scale, Mini-Mental State Examination and The Clock Drawing Test - appeared to be strong predictors of 4-year mortality. The expression to estimate the probability of mortality based on the examined variables correctly classified nearly 85% of the analyzed cases. CONCLUSIONS: Early detection of high-risk patients is of particular significance to reach a better survival rate among older adults. Clinicians should put more stress on the comprehensive surveillance of geriatric patients, rather than focusing solely on the treatment of chronic diseases. Geriatr Gerontol Int 2019; 19: 70-75.

Impact of Birth Weight and Smoking on Lung Function in Patients with Asthma, COPD, and Healthy Volunteers.

BACKGROUND: Birth weight (BW) is an important factor for determining the development of the respiratory system. The majority of research analyzed the impact of BW on lung function in youth. BW influence and smoking on lung function in adults with asthma and COPD is an interesting issue. OBJECTIVES: The aim of the study was to investigate relationships between BW, smoking, and lung function in adult healthy individuals and diagnosed with asthma or COPD. MATERIAL AND METHODS: Four hundred seventy-nine subjects were divided into 5 groups: 123 healthy non-smokers, 180 healthy smokers, 72 non-smoking asthmatics, 57 smoking asthmatics, and 47 COPD patients. Relationships between 4 BW quartiles and lung function was analyzed with respect to smoking. RESULTS: Impact analyzes of BW, smoking, and asthma on FVC% revealed that asthma is the only significant differentiating factor in this spirometric parameter (p < 0.01). FEV1% was significantly influenced by asthma and BW, and FEV1/ FVC% was exclusively influenced by asthma. Spirometric parameters increased proportionally to particular BW quartiles in healthy non-smokers group; however optimal BW quartile predicting increase of parameters was 2751-3250 g. In asthma, BW quartile predicting the increase of spirometric parameters was 3251-3750 g, but BW quartile predicting decrease of FEV1/FVC% was 2751-3250 g. The comparison of results between COPD group and results from other 4 groups showed that values of all parameters in patients with COPD did not change proportionally to all quartiles of BW. In terms of FEV1/FVC%, the proportional increase of parameter in BW quartile 2751-3250 g was observed. CONCLUSIONS: BW, as independent factor influences on spirometric parameters of healthy individuals, patients with asthma, COPD in a differentiated manner depending on quartile of BW rather than on simple linear increase of BW, regardless of smoking.

Occurrence of fibronectin-fibrin complexes in plasma of patients with multimorbidity due to the inflamm-aging phenomenon.

BACKGROUND: Multimorbidity is the co-occurrence of chronic diseases associated with low-grade chronic inflammation of connective tissue. AIM OF STUDY: Frequency of occurrence and relative amounts of fibronectin (FN) complexes with fibrin (FN-fibrin) and FN monomer were analyzed in 130 plasma samples of 18 to 94-year-old multimorbid patients in relation to concentrations of FN and extra domain A (EDA)-FN, and C-reactive protein (CRP) as well as to age, number of coexisting chronic diseases and presence of specified diseases. RESULTS: Immunoblotting revealed, besides FN dimer, the presence of FN monomer, and 750-, 1000-, and 1300-kDa FN-fibrin complexes in the multimorbid plasmas. The FN-fibrin complexes appeared more frequently and in higher relative amounts, but FN monomer less frequently and in a lower relative amount in the groups of elderly multimorbid patients, with a higher number of coexisting diseases and with dominance of cardiovascular diseases and osteoarthrosis, and with CRP concentration of 3-5mg/l. In contrast, the normal plasma contained only the FN-fibrin complex of 750 kDa in a lower relative amount, but with an increasing amount with normal aging. Moreover, FN concentration increased and EDA-FN decreased with the number of co-existing diseases and aging of patients, although both concentration values were lower than in the age-matched normal groups. FN concentration was the lowest in the exacerbation of a chronic disease and EDA-FN in the stable chronic disease groups. CONCLUSION: The alterations in plasma FN molecular status were associated with micro-inflammation and micro-coagulation, as well as multimorbidity of subjects and their physiological aging.

Identification of soluble supramolecular FN-fibrin complexes in human plasma.

SDS-agarose FN immunoblotting of 257 normal and pathological human plasma samples revealed the ladder pattern of multiple plasma FN bands which corresponded to FN monomer and dimer, and 5 FN-fibrin bands with increasing molecular masses. The FN-fibrin bands of about 750 kDa, 1000 kDa, 1300 kDa, 1600 kDa, and 1900 kDa appeared more frequently and in significantly higher relative amounts in the pathological samples (P < 0.000) than in relatively healthy individuals. The revealing of high-molecular FN-fibrin complexes by SDS-agarose FN immunobloting might have the potential to become a laboratory biomarker of some diseases in which the coagulation system is triggered.

[Birth weight as a factor determining lung function among healthy persons and its relation with chronic pulmonary disease]. / Urodzeniowa masa ciala jako czynnik determinujacy funkcje pluc osób zdrowych i jej zwiazek z przewleklymi schorzeniami ukladu oddechowego.

Low lung function is associated with increased risk of morbidity and mortality in the population. Lung development seems to be important factor in pathogenesis of respiratory disorders. Airway development is a complex process. Birth weight (BW) is one of perinatal factors which influences development of pulmonary system and multiorgan function of the body. Aforementioned relationships are visible especially at first years of life. However, not very many studies have examined the associations between birth weight and lung function in later age then childhood and adolescence. The aim of this review is to discuss relationships between BW and lung function parameters in healthy individuals and patients with lung disease in childhood and adulthood.

Chronic disease in the elderly: a vital rationale for the revival of internal medicine.

The phenomenon of population aging has led to a significant rise in the chronic disease rate compared to other human pathologies. Elderly people are usually affected by > or =2 chronic diseases concomitantly, mainly cardiovascular, pulmonary, and central nervous system diseases, metabolic disturbances and cancer. Chronic comorbidities in elderly patients may worsen their clinical status, making both the diagnosis and treatment more difficult. Meanwhile, contemporary medicine is focused on its subspecialties, thus turning away from the tradition of great, academic-based, general internal medicine. Clinical practice is dominated by a specific approach to a single disease rather than a patient with comorbidities. Therefore, an accurate diagnosis, ensuring effective treatment in the case of a complex and ambiguous clinical picture, is based on an attempt to combine multiple expert consultations rather than make a holistic evaluation, so characteristic of traditional internal medicine. For that reason, pathophysiology and clinical picture of a chronic disease in the elderly requires the revival of internal medicine, which is also essential to the development of geriatrics.

[The diagnostic differences of asthma in the elderly]. / Odrebnosci diagnostyczne astmy oskrzelowej u osób w podeszlym wieku.

Asthma is a common disease among elderly persons. The prevalence of asthma in subjects aged over 65 years is 6.5-17%. The diagnosis of asthma is based on typical symptoms with confirmatory information gained from physical examination and laboratory studies. Respiratory symptoms are less specific in older people. Additionally the clinical manifestations of asthma is complicated by co-morbidities, polypragmasy, underreporting of symptoms, cognitive impairment. Moreover, elderly patients are sometimes unable to perform pulmonary function tests. Consequently, discriminating asthma from chronic obstructive pulmonary disease is difficult in this group of patients. The difficulties in differential diagnosis of asthma in older adults entails that disease in the elderly is often underdiagnosed and inadequately treated.

[The relationships between aging and disease in the elderly asthma]. / Relacje miedzy starzeniem sie a astma wieku podeszlego.

In developed countries, the population aged 65 and over has been increasing. Asthma is a common disease among older persons and it may appear de novo above the age of 65. The prevalence of the disease in elderly people is estimated to be between 6.5% and 17%. Available data about older asthma patients are limited by a small numbers of studies reports. Asthma beginning late during the lifetime seems to be more severe, but the natural history of this disease appears to be variable. The characteristics of asthma in older patients is being complicated by the changes related to aging. Aging of the respiratory system is a natural process associated with its structural and functional changes. These changes may influence the expression of asthma. Differentiating physiological ageing from pathological changes related to disease can be difficult. Interactions of some of these mechanisms in asthma in the elderly are analyzed in this article.

[Asthma in the elderly]. / Astma u osób starszych.

A population aged 65 and over has been increasing in the developed countries. The prevalence of asthma in elderly patients is estimated between 6.5 and 17%. Asthma is an important cause of morbidity and mortality in the elderly. Moreover, death due to asthma occurs mostly in elderly patients. Only a few studies have reported the characteristics of asthma in the elderly patients. Two distinct clinical presentations of asthma have been described in the elderly. There are differences both in the pathophysiology and the clinical manifestation of asthma between elderly patients with a long-standing disease and those with late-onset disease. Additionally, aging of the respiratory system influences the asthma presentation. Asthma has been presented for many years may lead to persistent obstructive ventilatory defect and can mimic chronic obstructive pulmonary disease. Irreversible obstruction is commonly observed in elderly patients with asthma. The differential diagnosis of asthma is difficult in older adults and asthma is underrecognized and undertreated in the older population. Undertreatment is common in elderly asthmatics which largely is related to diagnostic issues.

[Anxiety and depressive symptoms in patients treated due to haematologic malignancies]. / Objawy lekowe i depresyjne u pacjentów leczonych na nowotwory hematologiczne.

BACKGROUND: Haematological treatment is associated with excessive distress due to side effects of cytostatics and due to severe life consequences of the illness. It could be a cause of anxiety or depressive states in vulnerable persons. AIM: The purpose of the study was to assess prevalence of depression, anxiety disorders, and distress among patients treated due to haematologic malignancies. METHODS: 45 patients with leukaemia or lymphoma, 29 treated due to other internal diseases and 28 healthy persons were assessed. The following research instruments were used: the Present State Examination (PSE), the General Health Questionnaire (GHQ-30), criteria scales (ICD-10) for depression and anxiety. RESULTS: Depression was diagnosed in 29% of the patients with hematological illnesses and in 11% of patients with other internal illnesses. Prevalence of GAD was appropriately 11% and 9%. Generally, psychiatric disorders were present in a half of the patients in every group. About 1/4 th of the haematologic patients had much more severe depressive symptoms than others. CONCLUSION: The groups of patients have much higher, depressive and distress scores than controls. Psychiatric or psychotherapeutic treatment could be considered as part of the treatment of malignant haematologic cancers.

Enteropathogenic activity and invasion of HEp-2 cells by Aeromonas caviae clinical isolates.

Twenty Aeromons caviae isolates from stool of children with diarrhea symptoms were examined for virulence-associated properties: production of cytotoxic and cytotonic toxins, and invasive ability. Most of A. caviae strains were cytotoxic to Vero and CHO cells and produced cytotonic toxins which caused elongation of CHO cells. Moreover, five of A. caviae strains revealed invasive ability towards HEp-2 cells.