THE BERMUDA TRIANGLE: AGING, MULTIMORBIDITY, AND AUTOIMMUNE RHEUMATIC DISEASES

Rapid aging of population in recent years has been accompanied by accumulation of multimorbid conditions. Chronic diseases often share common risk factors. As an example, autoimmune rheumatic diseases often evolve in combination with other autoimmune conditions. High rates of inflammatory disorders and rheumatic diseases are common multimorbidities in the elderly. A lack of practice guidelines for the management of multimorbidities, particularly in the elderly population and those with rare rheumatic diseases, has led to the inadequate treatment and added burden on the healthcare system. This opinion piece aims to draw attention on rising multimorbidity in the aging population prone to autoimmune rheumatic diseases and justify further research in this field

COVID-19 breakthrough infections in type 1 diabetes mellitus: a cross-sectional study by the COVID-19 Vaccination in Autoimmune Diseases (COVAD) Group

To investigate the frequency, profile, and severity of COVID-19 breakthrough infections (BI) in patients with type I diabetes mellitus (T1DM) compared to healthy controls (HC) after vaccination. The second COVID-19 Vaccination in Autoimmune Diseases (COVAD-2) survey is a multinational cross-sectional electronic survey which has collected data on patients suffering from various autoimmune diseases including T1DM. We performed a subgroup analysis on this cohort to investigate COVID-19 BI characteristics in patients with T1DM. Logistic regression with propensity score matching analysis was performed. A total of 9595 individuals were included in the analysis, with 100 patients having T1DM. Among the fully vaccinated cohort, 16 (16%) T1DM patients had one BI and 2 (2%) had two BIs. No morbidities or deaths were reported, except for one patient who required hospitalization with oxygen without admission to intensive care. The frequency, clinical features, and severity of BIs were not significantly different between T1DM patients and HCs after adjustment for confounding factors. Our study did not show any statistically significant differences in the frequency, symptoms, duration, or critical care requirements between T1DM and HCs after COVID-19 vaccination. Further research is needed to identify factors associated with inadequate vaccine response in patients with BIs, especially in patients with autoimmune diseases

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Bibliometrics of the 100 most-cited articles on refugee populations

Background: Bibliometrics is a form of quantitative analysis that employs peer-reviewed research, journal articles and citation counts to examine the content of current literature on a particular topic. The authors aim to identify the major academic disciplines that dominate the landscape of published materials and research endeavors on the topic of refugees.  Methods: : Using the Web of Science, a database of most-cited articles was created by a team with expertise in bibliometrics. Results: : Citations ranged between 1,493 and 105; averaging 203 citations per article. The publications spanned the years from 1973 to 2010. The year 2004 had the highest number of publications. All articles were published by 45 journals. In total, 294 investigators authored these articles. Psychiatry, psychology and public health constituted the top three fields of affiliation, with the most investigated feature being the mental health of refugees. Single investigators authored a quarter of all articles. Conclusion: This bibliometric evaluation allowed a multi-dimensional outlook on the conditions of refugee populations across the globe, through collation of relevant peer-reviewed research journal articles. This specialized form of assessment has resulted in a multi-disciplinary compendium of publications on the subject

Knowledge of otic barotrauma among air travelers in Sialkot, Pakistan

Background: Otic barotrauma (OBT) is defined as traumatic inflammation in human middle ear that occurs at the time of avian drop. However, it can be avoided using its adequate knowledge. The objective of present study was to evaluate the knowledge of the trauma among air travelers in Sialkot city of Punjab, Pakistan. Material and Methods: This cross-sectional study enlisted male adult International air travelers (n=50) from Sialkot city, Pakistan between November 2018 and April 2019 using purposive sampling technique. A specially developed questionnaire (Cronbach’s alpha = .82) having 12 close-ended items on barotrauma (total possible score 12) was administered to the participants at their home. Level of knowledge was categorized as inadequate (score 0-6), moderate (7-9) and adequate (10-12). Pearson’s chi-squared test was used to see the association between adequate knowledge on the OBT and sociodemographic variables using a P-value &lt; .05 as statistically significant. Results: Mean age of the participants was 47.60±9.9 years. Most of them (n=36; 72%) travelled for work reason. Almost all i.e. 46 (92%) gave correct response against item 1 (information provider about air trauma) and 12 (treatment of otic barotrauma) of the administered questionnaire. The rate of adequate knowledge on OBT was found to be higher among those having more than two-time travelling experience (82.9%, P = .02). However, there was no significant difference in knowledge of the barotrauma between people having less than or more than 12 years of science education (P = .59). All the business tourists (n = 5) had adequate knowledge of barotrauma followed by jobbers (n=25) and pilgrims (n=3), respectively. Conclusions: Business tourists have adequate knowledge on otic barotrauma associated with air travel than jobbers or Hajj/Umrah pilgrims

Game Theoretical Demand Response Management and Short-Term Load Forecasting by Knowledge Based Systems on the basis of Priority Index

Demand Response Management (DRM) is considered one of the crucial aspects of the smart grid as it helps to lessen the production cost of electricity and utility bills. DRM becomes a fascinating research area when numerous utility companies are involved and their announced prices reflect consumer&#8217;s behavior. This paper discusses a Stackelberg game plan between consumers and utility companies for efficient energy management. For this purpose, analytical consequences (unique solution) for the Stackelberg equilibrium are derived. Besides this, this paper presents a distributed algorithm which converges for consumers and utilities. Moreover, different power consumption activities on the basis of time series are becoming a basic need for load prediction in smart grid. Load forecasting is taken as the significant concerns in the power systems and energy management with growing technology. The better precision of load forecasting minimizes the operational costs and enhances the scheduling of the power system. The literature has discussed different techniques for demand load forecasting like neural networks, fuzzy methods, Na&#239;ve Bayes, and regression based techniques. This paper presents a novel knowledge based system for short-term load forecasting. The algorithms of Affinity Propagation and Binary Firefly Algorithm are integrated in knowledge based system. Besides, the proposed system has minimum operational time as compared to other techniques used in the paper. Moreover, the precision of the proposed model is improved by a different priority index to select similar days. The similarity in climate and date proximity are considered all together in this index. Furthermore, the whole system is distributed in sub-systems (regions) to measure the consequences of temperature. Additionally, the predicted load of the entire system is evaluated by the combination of all predicted outcomes from all regions. The paper employs the proposed knowledge based system on real time data. The proposed scheme is compared with Deep Belief Network and Fuzzy Local Linear Model Tree in terms of accuracy and operational cost. In addition, the presented system outperforms other techniques used in the paper and also decreases the Mean Absolute Percentage Error (MAPE) on a yearly basis. Furthermore, the novel knowledge based system gives more efficient outcomes for demand load forecasting

Listening to patients, for the patients: The COVAD study-vision, organizational structure, and challenges

Background: The pandemic presented unique challenges for individuals with autoimmune and rheumatic diseases (AIRDs) due to their underlying condition, the effects of immunosuppressive treatments, and increased vaccine hesitancy.Objectives: The COVID-19 vaccination in autoimmune diseases (COVAD) study, a series of ongoing, patient self-reported surveys were conceived with the vision of being a unique tool to gather patient perspectives on AIRDs. It involved a multinational, multicenter collaborative effort amidst a global lockdown.Methods: Leveraging social media as a research tool, COVAD collected data using validated patient-reported outcomes (PROs). The study, comprising a core team, steering committee, and global collaborators, facilitated data collection and analysis. A pilot-tested, validated survey, featuring questions regarding COVID-19 infection, vaccination and outcomes, patient demographics, and PROs was circulated to patients with AIRDs and healthy controls (HCs).Discussion: We present the challenges encountered during this international collaborative project, including coordination, data management, funding constraints, language barriers, and authorship concerns, while highlighting the measures taken to address them.Conclusion: Collaborative virtual models offer a dynamic new frontier in medical research and are vital to studying rare diseases. The COVAD study demonstrates the potential of online platforms for conducting large-scale, patient-focused research and underscores the importance of integrating patient perspective into clinical care. Care of patients is our central motivation, and it is essential to recognize their voices as equal stakeholders and valued partners in the study of the conditions that affect them

Characteristics of emerging new autoimmune diseases after COVID-19 vaccination: A sub-study by the COVAD group

Background: Despite the overall safety and efficacy of COVID-19 vaccinations, rare cases of systemic autoimmune diseases (SAIDs) have been reported post-vaccination. This study used a global survey to analyze SAIDs in susceptible individuals\u27 post-vaccination.Methods: A cross-sectional study was conducted among participants with self-reported new-onset SAIDs using the COVID-19 Vaccination in Autoimmune Diseases (COVAD) 2 study dataset-a validated, patient-reported e-survey-to analyze the long-term safety of COVID-19 vaccines. Baseline characteristics of patients with new-onset SAIDs and vaccinated healthy controls (HCs) were compared after propensity score matching based on age and sex in a 1:4 ratio.Results: Of 16 750 individuals, 74 (median age 52 years, 79.9% females, and 76.7% Caucasians) had new-onset SAID post-vaccination, mainly idiopathic inflammatory myopathies (IIMs) (n = 23, 31.51%), arthritis (n = 15; 20.53%), and polymyalgia rheumatica (PMR) (n = 12, 16.40%). Higher odds of new-onset SAIDs were noted among Caucasians (OR = 5.3; 95% CI = 2.9-9.7; p \u3c .001) and Moderna vaccine recipients (OR = 2.7; 95% CI = 1.3-5.3; p = .004). New-onset SAIDs were associated with AID multimorbidity (OR = 1.4; 95% CI = 1.1-1.7; p \u3c .001), mental health disorders (OR = 1.6; 95% CI = 1.3-1.9; p \u3c .001), and mixed race (OR = 2.2; 95% CI = 1.2-4.2; p = .010), where those aged \u3e60 years (OR = 0.6; 95% CI = 0.4-0.8; p = .007) and from high/medium human development index (HDI) countries (compared to very high HDI) reported fewer events than HCs.Conclusion: This study reports a low occurrence of new-onset SAIDs following COVID-19 vaccination, primarily IIMs, PMR, and inflammatory arthritis. Identified risk factors included pre-existing AID multimorbidity, mental health diseases, and mixed race. Revaccination was well tolerated by most patients; therefore, we recommend continuing COVID-19 vaccination in the general population. However, long-term studies are needed to understand the autoimmune phenomena arising post-vaccination

COVID-19 breakthrough infections in type 1 diabetes mellitus: A cross-sectional study by the COVID-19 Vaccination in Autoimmune Diseases (COVAD) Group

To investigate the frequency, profile, and severity of COVID-19 breakthrough infections (BI) in patients with type I diabetes mellitus (T1DM) compared to healthy controls (HC) after vaccination. The second COVID-19 Vaccination in Autoimmune Diseases (COVAD-2) survey is a multinational cross-sectional electronic survey which has collected data on patients suffering from various autoimmune diseases including T1DM. We performed a subgroup analysis on this cohort to investigate COVID-19 BI characteristics in patients with T1DM. Logistic regression with propensity score matching analysis was performed. A total of 9595 individuals were included in the analysis, with 100 patients having T1DM. Among the fully vaccinated cohort, 16 (16%) T1DM patients had one BI and 2 (2%) had two BIs. No morbidities or deaths were reported, except for one patient who required hospitalization with oxygen without admission to intensive care. The frequency, clinical features, and severity of BIs were not significantly different between T1DM patients and HCs after adjustment for confounding factors. Our study did not show any statistically significant differences in the frequency, symptoms, duration, or critical care requirements between T1DM and HCs after COVID-19 vaccination. Further research is needed to identify factors associated with inadequate vaccine response in patients with BIs, especially in patients with autoimmune diseases

Genetic and antiretroviral drug resistance mutations analysis of reverse transcriptase and protease gene from Pakistani people living with HIV-1

Background Antiretroviral therapy (ART) effectiveness is compromised by the emergence of HIV drug resistance mutations (DRM) and can lead to the failure of ART. Apart from intrinsic viral factors, non-compliance with drugs and/or the use of sub-optimum therapy can lead to the emergence of DRMs. In Pakistan HIV currently exists as a concentrated epidemic, however, ART coverage is very low, and drug adherence is poor. ART is selected assuming without baseline genotyping. Pakistan has recently seen a rise in treatment failures, but the country’s actual burden of DRM is still unknown. In this study, we perform the genetic and drug resistance analysis of the pol gene from Pakistani HIV-positive ART-naïve and ART-experienced individuals. Methods In this study, HIV-1 pol was sequenced from 146 HIV-1 positive individuals, divided into ART-naïve (n = 37) and ART-experienced (n = 109). The sequences were also used to determine HIV-1 subtypes, the prevalence of DRM, and pol genetic variability. Results DRM analysis identified numerous DRMs against reverse transcriptase inhibitors in both ART-naïve and ART-experienced groups, including a few that are classified as rare. Additionally, the ART-experienced group showed mutations associated with resistance to protease inhibitors. Genetic analysis showed negative selection pressure in both groups, but a higher rate of evolution in the ART-naïve group. Conclusion High prevalence of DRMs, especially against previous first-line treatment in ART- naïve and the accumulation of DRMs in ART-experienced groups is concerning and warrants that a more extensive DRM survey be carried out to inform first-line and second-line ART regimen recommendations