Vascular comorbidity is associated with lower brain volumes and lower neuroperformance in a large multiple sclerosis cohort

Objective: The objective of this study is to assess the association between vascular comorbidity burden with clinical and imaging features of disease burden in a large population of people with multiple sclerosis (MS). Methods: We included participants from the MS Partners Advancing Technology Health Solutions (MS PATHS) cohort. We evaluated if vascular comorbidities (diabetes, hypertension, and dyslipidemia) or a composite sum of comorbidities was associated with MS characteristics, including objective neurologic function assessments and quantitative brain magnetic resonance imaging (MRI) measurements in propensity score–weighted models. Results: In total, 11,506 participants (6409 (55%) with brain MRI) were included. Individuals with 2+ vascular comorbidities had slower walking speed (standard deviation (SD) = −0.49; 95% confidence interval (CI) = −0.78, −0.19; p = 0.001), slower manual dexterity (SD = −0.41; 95% CI = −0.57, −0.26; p < 0.0001), and fewer correct scores on cognitive processing speed (SD = −0.11; 95% CI = −0.20, −0.02; p = 0.02) versus those with no comorbidities. Those with 2+ had lower brain parenchymal (−0.41%, 95% CI = −0.64, −0.17) and gray matter fractions (−0.30%, 95% CI = −0.49, −0.10), including reduced cortical (−10.10 mL, 95% CI = −15.42, −4.78) and deep (−0.44 mL, 95% CI = −0.84, −0.04) gray matter volumes versus those with no comorbidity. Conclusion: Increased vascular comorbidity burden was associated with clinical and imaging markers of neurologic dysfunction and neurodegeneration in MS. Strategies to optimize comorbidity management in people with MS are warranted.

Chronic cerebral ischemia: review of published works, pathogenetic approaches to therapy

Chronic сеrebral ischemia is one of the leading causes of morbidity, mortality and disability in the Republic of Kazakhstan. According to the data from Ministry of Healthcare of the Republic of Kazakhstan, the overall morbidity of the country’s population due to diseases of the circulatory system registered in health care organizations has increased almost three times from 1998 to 2017 over the past 20 years. According to world publications, on average, the incidence of Chronic сеrebral ischemia in the world is relatively high among the elderly, occurring in two-thirds of people over 65 years of age. It is also observed in 50% of people aged 50 to 65 years and in 25% of people aged 45 to 50 years. Purpose. To review of epidemiological data, risk factors, causes, pathogenetic mechanisms, diagnostic algorithms and principles of treatment of Chronic сеrebral ischemia. Material and methods. The literature review on Chronic сеrebral ischemia data was conducted using the Pubmed search engine in Medline electronic databases from 2009 to 2019. Results and discussion. A total of 45 research papers were included. This review examines epidemiological data, risk factors, causes, pathogenetic mechanisms, diagnostic algorithms and principles of therapy for Chronic сеrebral ischemia disease. In the etiopathogenesis of Chronic сеrebral ischemia, a significant part is played by the combination of risk factors known as vascular comorbidity and being the main cause of deaths. Vascular comorbidity is characterized by the involvement into a single pathological process of all risk factors that form Chronic сеrebral ischemia, which lead to a change in cerebral circulation with hypoxia of the brain substance and a cascade of biochemical changes, and subsequently results in diffuse, multi-focal changes in the brain substance. In a case of comorbidity of the atherosclerotic process with dyslipidemia, narrowing of the lumen of the arteries with an increase in the permeability of their wall membranes can be observed, with further damage to the endothelium, activation of synthesis by leukocytes, platelets, endotheliocytes of chemotaxis factors, kinins, growth factors, with the accumulation of active oxygen, peroxidation with the formation of oxidative stress. Chronic сеrebral ischemia therapy with vascular comorbidity, in which all risk factors are В тексте переправлены стилистические и ортографические ошибки. involved in a single pathological process, provides the prevention of polypragmasia, and the assignment of certain pathogenetic drugs aimed at the same pathogenesis that leads to the formation of Chronic сеrebral ischemia. Conclusion. It is most rational to use an antioxidant/antihypoxant in therapy. Such pathogenetic drugs include antioxidant therapy. Among other antioxidants/antihypoxants used in routine practice, Mexidol (ethylmethylhydroxypyridine succinate) is characterized with the strongest evidence base. Keyword: chronic brain ischemia, chronic cerebral circulatory insufficiency, vascular comorbidity, ethylmethylhydroxypyridine succinate, Mexidol.

30-day mortality and morbidity in COVID-19 versus influenza: A populationbased study

Background As of July 2020, COVID-19 has caused 500,000 deaths worldwide. However, large-scale studies of COVID-19 mortality and new-onset comorbidity compared to influenza and individuals tested negative for COVID-19 are lacking. We aimed to investigate COVID-19 30-day mortality and newonset comorbidity compared to individuals with negative COVID-19 test results and individuals tested for influenza. Methods and findings This population-based cohort study utilized electronic health records covering roughly half (n=2,647,229) of Denmark's population, with nationwide linkage of microbiology test results and death records. All individuals ≥18 years tested for COVID-19 and individuals tested for influenza were followed from November 1, 2017 to June 30, 2020. The main outcome was 30-day mortality after a test for either COVID-19 or influenza. Secondary outcomes were major comorbidity diagnoses 30-days after the test for either COVID-19 or influenza. In total, 224,639 individuals were tested for COVID-19. Among inpatients positive for COVID-19, 356 of 1657 (21%) died within 30 days, which was a 3.0 to 3.1-fold increased 30-day mortality rate, when compared to influenza and COVID-19-negative inpatients (all p<0.001). For outpatients, 128 of 6,263 (2%) COVID-19-positive patients died within 30 days, which was a 5.5 to 6.9-fold increased mortality rate compared to influenza and COVID-19-negative patients, respectively (all p<0.001). Compared to hospitalized patients with influenza, new-onset ischemic stroke, diabetes and nephropathy occurred more frequently in inpatients with COVID-19 (all p<0.05). Conclusions In this population-based study comparing COVID-19 with influenza, COVID-19 was associated with increased rates of major systemic and vascular comorbidity and substantially higher mortality, which is likely even higher than the stated 3.0 to 5.5-fold increase owing to more extensive testing for COVID-19.

Small bowel angioectasia as a marker of frailty and poor prognosis

Background and study aims This study aimed to establish 5-year survival of patients diagnosed with bleeding small bowel (SB) angioectasia, with the hypothesis that many will suffer deaths relating to comorbidity rather than gastrointestinaI bleeding. Patients and methods SB capsule endoscopy (SBCE) procedures, performed for suspected SB bleeding or iron deficiency anemia, with angioectasia isolated as the cause of SB bleeding and at least 5 years of follow-up data were isolated (n = 125) along with an age-matched group with “normal” SBCE procedures (n = 125). These were retrospectively analysed with further information on mortality and comorbidity gathered through hospital records. Results Those with angioectasia had a median age of 72.7 years and comorbidities were common. The 5-year survival was 64.0 % (80/125) compared to 70.4 % (88/125) in those with “normal” SBCE. Those with significant cardiac or vascular comorbidity had a poorer survival (52.9 % (37/70) at 5 years) but anticoagulation/antiplatelets/ number of lesions or requirement endoscopic treatment seemed to make little difference. In those with SB bleeding secondary to angioectasia none of the subsequent deaths were directly attributable to gastrointestinal bleeding. Conclusions In this cohort, SB angioectasia did not lead to any deaths but the 5-year survival was poor due to those diagnosed often being older and having comorbidities. This would support the hypothesis that a diagnosis of SB bleeding secondary to angioectasia suggests frailty.

The effect of cardiovascular diseases on the course of multiple sclerosis (review of literature)

Comorbidity is one of the factors determining the course of multiple sclerosis. Cardiovascular pathology is one of the most common in the population as a whole, especially in age groups over 50. Several studies showed that arterial hypotension and dyslipidemia affected the course, progression rate, and neuroimaging characteristics of patients with multiple sclerosis. An important issue is the effect of disease modifying therapy on the course of concomitant diseases in patients with multiple sclerosis and the effect of concomitant diseases on the effectiveness and safety of disease modifying therapy. The question of the use of statins in multiple sclerosis remains controversial. This review presents data on vascular comorbidity in multiple sclerosis, including the prevalence of risk factors for cardiovascular pathology and concomitant vascular diseases in the population of patients with multiple sclerosis. Data on the effect of cardiovascular pathology on the course and treatment of multiple sclerosis were also analyzed.

Fractional excretion of phosphorus and vascular calcification in stage 3 chronic kidney disease

The role of renal excretion of Pi in relation to vascular calcification (VC) in patients in the early stages of chronic kidney disease (CKD) is controversial. Thus, we determine the relation between fractional excretion of phosphorus (FEP) and VC, measured using two methods in a cross-sectional study of patients with stage 3 CKD. We recorded demographic data, anthropometry, comorbidities and active treatment. We measured 24-hour urine FEP and, in serum, measured fibroblast growth factor 23 (FGF23), α-Klotho, intact parathyroid hormone (iPTH), calcium and phosphorus. VC was measured by lateral abdominal radiography (Kauppila index (KI)) and CT of the abdominal aorta (measured in Agatston units). In 57% of subjects, abnormal VC was present when measured using CT, and in only 17% using lateral abdominal radiography. Factors associated with VC using CT were age, cardiovascular risk factors, vascular comorbidity, microalbuminuria and levels of FGF23, phosphorus and calcium x phosphorus product (CaxP); although only age (OR 1.25, 95% CI 1.11 to 1.41), smoking (OR 21.2, CI 4.4 to 100) and CaxP (OR 1.21, CI 1.06 to 1.37) maintained the association in a multivariate analysis. By contrast, only age (OR 1.35, 95% CI 1.07 to 1.74), CaxP (OR 1.14, CI 1.13 to 1.92) and FEP (OR 1.07,95% CI 1004 to 1.14) were associated with abnormal VC in the lateral abdominal radiography. In conclusion, in patients with stage 3 CKD, the detection of VC by abdominal CT is more sensitive than conventional X-rays. Moreover, CaxP is associated with cardiovascular risk factors and vascular comorbidity; quantification of FEPi in these patients provides additional clinical information in advanced VC detected by KI.