High Comorbidity Burden in Patients with SLE: Data from the Community-Based Lupus Registry of Crete.

Comorbidities and multimorbidity, often complicating the disease course of patients with chronic inflammatory rheumatic diseases, may be influenced by disease-intrinsic and extrinsic determinants including regional and social factors. We analyzed the frequency and co-segregation of self-reported comorbid diseases in a community-based Mediterranean registry of patients (n = 399) with systemic lupus erythematosus (SLE). Predictors for multimorbidity were identified by multivariable logistic regression, strongly-associated pairs of comorbidities by the Cramer's V-statistic, and comorbidities clusters by hierarchical agglomerative clustering. Among the most prevalent comorbidities were thyroid (45.6%) and metabolic disorders (hypertension: 24.6%, dyslipidemia: 33.3%, obesity: 35.3%), followed by osteoporosis (22.3%), cardiovascular (20.8%), and allergic (20.6%) disorders. Mental comorbidities were also common, particularly depression (26.7%) and generalized anxiety disorder (10.7%). Notably, 51.0% of patients had ≥3 physical and 33.1% had ≥2 mental comorbidities, with a large fraction (n = 86) displaying multimorbidity from both domains. Sociodemographic (education level, marital status) and clinical (disease severity, neurological involvement) were independently associated with physical or mental comorbidity. Patients were grouped into five distinct clusters of variably prevalent comorbid diseases from different organs and domains, which correlated with SLE severity patterns. Conclusively, our results suggest a high multimorbidity burden in patients with SLE at the community, advocating for integrated care to optimize outcomes.

Cognitive Enhancement Through Mathematical Problem-Solving.

Nowadays, modern lifestyle along with the ever-growing technological and scientific advancement, especially in developed countries, has led to a significant increase of the middle age and elderly population. As a consequence, a substantial rise in neurodegenerative diseases has been reported, such as mild cognitive impairment, Alzheimer's disease, and other types of dementia. The aim of this paper is to study the impact of mathematical problem-solving on cognitive enhancement of adults. Moreover, the possible applicability of mathematical problem-solving as part of a treatment in cases of adults suffering from different levels of cognitive decline due to neurodegenerative diseases has been taken into consideration. For the needs of this study, a qualitative research was conducted in a sample of 16 participants, in order to confirm the effect of the mathematical problem-solving process on their cognition and its reinforcement, as stated by the participants. The results of this research, as interpreted, indicate a positive effect of mathematical problem-solving on adult cognition and on cognitive processes in general. Nonetheless, there are certain limitations to this research, deriving from its nature, while others derive from the measures enforced during the SARS-CoV-2 outbreak. Therefore, this chapter suggests that a more thorough quantitative research should be conducted in order to specifically measure the magnitude, as well as the time span of the impact of mathematical problem-solving on adult cognitive enhancement. Moreover, it is proposed that future studies should concentrate on the usefulness of mathematical problem-solving as a component in both invasive and noninvasive cognitive treatments used to cure or alleviate the aforementioned cognitive impairments.

Colistin heteroresistance in Acinetobacter spp.: systematic review and meta-analysis of the prevalence and discussion of the mechanisms and potential therapeutic implications.

BACKGROUND: Colistin is one of the few remaining options for carbapenem-resistant Acinetobacter baumannii (A. baumannii); however, emergence of resistance from heteroresistant populations is possible. This review aimed to systematically search and consolidate the literature on the prevalence, mechanisms and therapeutic implications of colistin heteroresistance in Acinetobacter spp. METHODS: A systematic search was conducted in PubMed and Scopus. The pooled prevalence of colistin heteroresistance was calculated using meta-analysis of proportions with the Freeman-Tukey transformation and the random-effects (DerSimonian and Laird) method. RESULTS: Based on 15 studies the prevalence of colistin heteroresistance was 33% (95% CI 16-53%) but considerable heterogeneity was observed (I2 = 96%, P < 0.001). Prior exposure to colistin was associated with a higher proportion of resistant subpopulations. Colistin heteroresistance may result from chromosomal mutations in resistant subpopulations (predominantly in PmrAB and lpx genes) resulting in lipopolysaccharide modification or loss, or overexpression of efflux pumps. No dosage scheme of colistin monotherapy can prevent the emergence of resistant subpopulations in vitro, but few studies have reported in vivo emergence of resistance from heteroresistant A. baumannii during treatment, and studies examining the correlation between heteroresistance and clinical/microbiological outcomes are lacking. Several colistin-based combinations have been shown in vitro to prevent the emergence of the resistant subpopulations but none have been translated so far into clinical benefit. Reasons for this discrepancy are discussed. CONCLUSIONS: Colistin heteroresistance was common but highly variable between studies. The impact of colistin heteroresistance (frequency of emergent resistance during treatment and correlation with treatment outcomes) requires further study.