NEW COVID-19 CORONAVIRUS INFECTION IN A PATIENT WITH AUTOIMMUNE POLYGLANDULAR SYNDROME (clinical case)

Background.More than half of those infected with the new coronavirus infection COVID­19 carry the disease in a mild or asymptomatic form. Patients over 60 years of age and those with comorbid chronic diseases, such as respiratory, cardiovascular, diabetes, oncological and autoimmune diseases, are susceptible to more severe forms of the disease. Aim.The aim of the study was to demonstrate the stages of clinical picture development, methods of diagnosis and treatment of the new coronavirus infection COVID­19. Material and methods. We present a clinical case of a new coronavirus infection COVID­19 in a 73­year­old patient with autoimmune polyglandular syndrome. Results and its discussion. Aggravating background represented by arrhythmic syndrome and autoimmune polyglandular syndrome contributed to the development of a severe form of new coronavirus infection COVID­19 in the patient. Complex multivector therapy aimed at pathogenetic and symptomatic treatment, according to the guidelines, in combination with magnesium and potassium medications, as well as immune­modulating therapy contributed to the patient’s recovery and rehabilitation. Conclusion. Treatment with glucocorticoids for new COVID­19 coronavirus infection significantly improves the outcome of the disease. At the same time, glucocorticoid therapy can lead to progression of arrhythmic syndrome, development of drug­induced hypercorticoidism, and «withdrawal» syndrome. Prevention and treatment of heart rhythm disturbances is the application of potassium and magnesium medications in sufficient doses. Gradual withdrawal of glucocorticoids over a long time under the supervision of an endocrinologist will help to restore the hypothalamic­pituitary­adrenal axis.

Comorbid Chronic Diseases and Health-related Quality of Life in the Obese Population: a Longitudinal Analysis of a Nationally Representative Household Survey in Australia

ObjectiveThis study aims to examine the relationship between nine comorbid chronic conditions and HRQoL separately, along with the number of chronic diseases among the Australian obese population.MethodsData for this study were sourced from three waves (waves 9, 13 and 17) of the Household, Income and Labour Dynamics in Australia (HILDA) survey. The paper studies 9,444 person-year observations from 5,524 individuals over the years 2009, 2013, and 2017. The outcome variable of HRQoL was measured through the 36-Item Short Form Health Survey (SF-36), and the main variables of interest were nine chronic conditions and the number of chronic diseases. Generalized estimating equations (GEE) were used to test the association between comorbid chronic diseases and HRQoL. ResultsThis study found a negative relationship between the number of comorbid chronic conditions and sub-scale, summary measures, and health utility index of the SF-36. Obese adults with 1, 2, 3, and 3+ comorbid chronic diseases scored lower points on the SF-36 physical component summary (b = -2.83, b = -7.37, b = -11.15, b = -14.29, respectively), mental component summary (b = -1.46, b = -2.34, b = -3.66, and b = -6.34, respectively), and in the short-form six-dimension utility index (SF-6D) scale (b = -0.030, b = -0.063, b = -0.099, and b = -0.138, respectively) compared to obese peers without comorbid chronic diseases. The number of chronic conditions was associated with reductions in the score of all eight dimensions of the SF-36. Obese people with any of the nine studied comorbid chronic diseases (heart disease, circulatory disease, hypertension, type 1 diabetes, type 2 diabetes, asthma, bronchitis, arthritis, and cancer) were associated with lower HRQoL compared to peers without that particular comorbid chronic disease.ConclusionsComorbid chronic diseases in obese individuals are associated with lower HRQoL. Increasing the number of comorbid chronic conditions is associated with a further reduction in all dimensions and summary measures of the SF-36. The findings, therefore, call for improved holistic management of obesity and interventions to reduce obesity-related comorbidities to improve HRQoL of obese Australian.

Role of Vitamin D in Risk Reduction of COVID-19: A Narrative Review

The world is in the midst of the COVID-19 pandemic. In addition to quarantine, public health interventions which can reduce the risk of infection and death are urgently required. This article discusses the roles of vitamin D in reducing the risk of COVID-19, and how vitamin D supplementation may be a useful risk reduction measure. Vitamin D can reduce the risk of infections through a variety of mechanisms: induction of cathelicidins and defensins that can lower the rate of viral replication and decrease the concentrations of pro-inflammatory cytokines, which are responsible for induction of inflammation, injuring lining of lungs and contributing to developing pneumonia. Evidence supporting the role of vitamin D in reducing the incidence of COVID-19 includes a) winter outbreak; b) a timeframe when concentrations of 25-hydroxyvitamin D (25(OH)D) are lowest; c) a small number of cases in the southern hemisphere toward the end of summer; d) a vitamin D deficiency found to lead to acute respiratory distress syndrome (ARDS); e) and a rise in case-fatality rates with increasing age and comorbid chronic diseases, both of which are associated with lower concentrations of 25(OH)D. It is recommended that people at risk of COVID-19 consider taking 10,000 IU/d of vitamin D3 for a few weeks to rapidly increase 25(OH)D concentrations, followed by 5,000 IU/d to reduce the risk of infection. Higher doses of vitamin D3 may be useful for treating people who are infected with COVID-19. To test these guidelines, randomized controlled trials and comprehensive population studies should be performed.

COVID‑19 and comorbid chronic diseases

ABSTRACT. This literature review includes the latest studies and meta-analyses, dedicated to the problem of comorbidity in coronavirus disease (COVID‑19). The most often comorbid conditions that accompany severe and fatal cases of COVID‑19 include arterial hypertension (AH), diabetes mellitus (DM), ischemic heart disease (IHD), brain infarction, chronic bronchitis /сhronic obstructive lung disease. These diseases share some common features like proinflammatory condition and the deterioration of innate immunity. Mechanisms of unfavorable influence of DM, AH, IHD and chronic obstructive pulmonary disease on the course of COVID‑19 include the imbalance of biochemical cascades of angiotensin-converting enzyme 2 and so-called cytokine storm, induced by glucolipid metabolic disturbances. Revealing of causality between chronic diseases and severe course of COVID‑19 in future studies can help health system providers to find the susceptible population, to estimate the risk of deterioration of clinical condition and to prescribe the preventive measures (for instance, vaccination of high-risk individuals from influenza and, in the future, from COVID‑19). Severe course of COVID‑19 and high mortality in multimorbid patients underline the need in the strict control of their basic biological parameters (arterial pressure, fasting plasma glucose etc.). Apart from that, with the aim of minimization of infection risk these patients need to imply stricter quarantine and shielding measures than the relatively healthy people. Medical workers should also emphasize on telemedicine technologies in management of such patients.

Characteristics of U.S. adults taking prescription antipsychotic medications, National Health and Nutrition Examination Survey 2013–2018

Background Global 12-month psychosis prevalence is estimated at roughly 0.4%, although prevalence of antipsychotic use in the U.S. is estimated at roughly 1.7%. Antipsychotics are frequently prescribed for off label uses, but have also been shown to carry risk factors for certain comorbid conditions and with other prescription medications. The study aims to describe the socio-demographic and health characteristics of U.S. adults taking prescription antipsychotic medications, and to better understand the association of antipsychotic medications and comorbid chronic diseases. Methods The study pools 2013–2018 data from the National Health and Nutrition Examination Survey (NHANES), a nationally representative cross-sectional survey of non-institutionalized U.S. residents (n = 17,691). Survey staff record prescription medications taken within the past 30 days for each respondent, from which typical and atypical antipsychotic medications were identified. Results Prevalence of antipsychotic use among U.S. adults was 1.6% (n = 320). Over 90% of individuals taking antipsychotics reported having health insurance and a usual place for care, significantly more than their counterparts not taking antipsychotics. Further, those taking antipsychotics reported higher prevalence of comorbid chronic diseases and took an average of 2.3 prescription medications more than individuals not taking antipsychotics. Individuals taking antipsychotics were more likely to sleep 9 or more hours per night, be a current smoker, and have a body mass index greater than 30 kg/m2. Conclusions U.S. adults who take antipsychotic medications report more consistent health care access and higher prevalence of comorbid chronic diseases compared to those not taking antipsychotics. The higher comorbidity prevalence and number of total prescriptions highlight the need for careful assessment and monitoring of existing comorbidities and potential drug-drug interactions among adults taking antipsychotics in the U.S.

Determinants of Sleep Quality in Inflammatory Bowel Diseases

The causes of disordered sleep, frequently reported by patients with inflammatory bowel diseases (IBD), are poorly understood. The study aimed to evaluate sleep quality in IBD patients and to identify factors affecting their sleep. IBD patients (n = 133) and healthy controls (HC; n = 57) were included in the study and completed sleep questionnaires (Pittsburgh Sleep Quality Index (PSQI), Athens insomnia scale (AIS), and Epworth sleepiness scale (ESS)), Beck Depression Inventory (BDI), and pain scales (Visual Analogue Scale and Laitinen Pain Scale). IBD patients attained higher scores in all sleep questionnaires compared to HC: PSQI, AIS, and ESS (all p < 0.001). They also had prolonged sleep latency (p < 0.001) with reduced sleep efficiency (p < 0.001). Patients in exacerbation of IBD had higher scores in PSQI (p = 0.008), ESS (p = 0.009), but not in AIS, compared to those in remission. Participants with comorbid chronic diseases had higher scores in PSQI and AIS, but not in ESS, compared to others. Multiple regression revealed that the sleep questionnaire results were significantly affected by mood level (BDI), but not by the aforementioned pain scales. Sleep impairment in IBD patients is a common problem that deserves attention in everyday clinical practice and mood level seems to be the main factor affecting the quality of sleep in IBD patients.

Health-Related Quality of Life among Patients with Hepatitis C Virus Infection: A Cross-Sectional Study in Jianping County of Liaoning Province, China

Background. Patients with chronic liver disease (CLD) have extrahepatic manifestations and impaired health-related quality of life (HRQOL), and hepatitis C virus (HCV) infection is a leading cause of CLD, cirrhosis, and hepatocellular carcinoma (HCC). This study is aimed at assessing HRQOL in patients with HCV infection in the rural areas and identifying factors associated with impairment of HRQOL. Methods. A cross-sectional study was conducted in a county of Liaoning Province in northeast China. HRQOL of patients with HCV infection was assessed using the chronic liver disease questionnaire (CLDQ) and EuroQol-5 dimensions (EQ-5D). Data were transformed to score comparisons of six major CLDQ domains, EQ index, and visual analog scale (VAS). Results. A total of 397 (93.4%) subjects, including 67 healthy subjects (HSs), 314 patients with chronic hepatitis C (CHC), and 16 patients with liver cirrhosis (LC) completed the study. The overall quartile CLDQ scores for HSs, patients with CHC, and patients with LC were 6.4 (6.0, 6.7), 5.8 (4.6, 6.4), and 4.1 (3.0, 6.0), respectively. The quartile scores of EQ index for the three groups were 1.0 (1.0, 1.0), 1.0 (0.8, 1.0), and 0.9 (0.6, 1.0), respectively. The median scores of EQ VAS for the three groups were 85.0, 60.0, and 60.0, respectively. Female sex, patients with family history of hepatitis, other comorbid chronic diseases, drinking, and disease duration≥10 years were associated with significant improvement in overall CLDQ scores, and family history of hepatitis and other comorbid chronic diseases were considered predictive factors for EQ index and VAS, respectively. Conclusions. Compared with HSs, HCV infection had a greater negative impact on HRQOL in patients with CHC and LC. The significant factors associated with HRQOL include female sex, patients with a family history of hepatitis, other comorbid chronic diseases, drinking, and disease duration≥10 years. Patients with HCV infection in the rural areas should be paid careful attention regarding their HRQOL with proper health education and disease management.