Comorbidity

In medicine, comorbidity describes the effect of all other conditions an individual patient might

have other than the primary condition of interest.

The term can indicate either a condition existing simultaneously, but independently with another

condition or a related medical condition. The latter sense of the term causes some overlap with the

concept of complications. For example, in longstanding diabetes mellitus, the extent to

which coronary artery disease is an independent comorbidity versus a diabetic complication is not

easy to measure, because both diseases are quite multivariate and there are likely aspects of both

simultaneity and consequence. The same is true of intercurrent diseases in pregnancy. In other

examples, the true independence or relation is not ascertainable

because syndromes and associations are often identified long before pathogenetic commonalities

are confirmed (and, in some examples, before they are even hypothesized). In psychiatric

diagnoses it has been argued in part that this "'use of imprecise language may lead to

correspondingly imprecise thinking', [and] this usage of the term 'comorbidity' should probably be

avoided." However, in many medical examples, such as comorbid diabetes mellitus and coronary

artery disease, it makes little difference which word is used, as long as the medical complexity is

duly recognized and addressed.

Many tests attempt to standardize the "weight" or value of comorbid conditions, whether they are

secondary or tertiary illnesses. Each test attempts to consolidate each individual comorbid

condition into a single, predictive variable that measures mortality or other outcomes. Researchers

have validated such tests because of their predictive value, but no one test is as yet recognized as

a standard.
The term "comorbid" has three definitions:

1. to indicate a medical condition existing simultaneously but independently with another

condition in a patient (this is the older and more "correct" definition)

2. to indicate a medical condition in a patient that causes, is caused by, or is otherwise related

to another condition in the same patient (this is a newer, nonstandard definition and less

well-accepted).

3. to indicate two or more medical conditions existing simultaneously regardless of their

causal relationship

ETIOLOGY

Etiology (/iːtiˈɒlədʒi/; alternatively aetiology or ætiology) is the study of causation, or origination.

The word is derived from the Greek αἰτιολογία, aitiología, "giving a reason for" (αἰτία, aitía,

"cause"; and -λογία, -logía). More completely, etiology is the study of the causes, origins, or

reasons behind the way that things are, or the way they function, or it can refer to the causes

themselves. The word is commonly used in medicine, (where it is a branch of medicine studying

causes of disease) and in philosophy, but also in physics, psychology, government, geography,

spatial analysis, theology, and biology, in reference to the causes or origins of various phenomena.

In the past, when many physical phenomena were not well understood or when histories were not

recorded, myths often arose to provide etiologies. Thus, an etiological myth, or origin myth, is a

myth that has arisen, been told over time or written to explain the origins of various social or

natural phenomena. For example, Virgil's Aeneid is a national myth written to explain and glorify
the origins of the Roman Empire. In theology, many religions have creation myths explaining the

origins of the world or its relationship to believers.

In medicine, the etiology of an illness or condition refers to the frequent studies to determine one

or more factors that come together to cause the illness. Relatedly, when disease is widespread,

epidemiological studies investigate what associated factors, such as location, sex, exposure to

chemicals, and many others, make a population more or less likely to have an illness, condition,

or disease, thus helping determine its etiology. Sometimes determining etiology is an imprecise

process. In the past, the etiology of a common sailor's disease, scurvy was long unknown. When

large, ocean-going ships were built, sailors began to put to sea for long periods of time, and often

lacked fresh fruit and vegetables. Without knowing the precise cause, Captain James Cook

suspected scurvy was caused by the lack of vegetables in the diet. Based on his suspicion, he forced

his crew to eat sauerkraut, a cabbage preparation, every day, and based upon the positive outcomes,

he inferred that it prevented scurvy, even though he did not know precisely why. It took about

another two hundred years to discover the precise etiology: the lack of vitamin C in a sailor's diet.

3. PROGNOSIS

Prognosis (Greek: πρόγνωσις "fore-knowing, foreseeing") is a medical term for predicting the

likely or expected development of a disease, including whether the signs and symptoms will

improve or worsen (and how quickly) or remain stable over time; expectations of quality of life,

such as the ability to carry out daily activities; the potential for complications and associated health

issues; and the likelihood of survival (including life expectancy). A prognosis is made on the basis

of the normal course of the diagnosed disease, the individual's physical and mental condition, the

available treatments, and additional factors. A complete prognosis includes the expected duration,
function, and description of the course of the disease, such as progressive decline, intermittent

crisis, or sudden, unpredictable crisis.

When applied to large statistical populations, prognostic estimates can be very accurate: for

example the statement "45% of patients with severe septic shock will die within 28 days" can be

made with some confidence, because previous research found that this proportion of patients died.

This statistical information does not apply to the prognosis for each individual patient: additional

information is needed to determine whether a patient belongs to the 45% who will die, or to the

55% who survive.

4.DIAGNOSIS

Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used

in many different disciplines, with variations in the use of logic, analytics, and experience, to

determine "cause and effect". In systems engineering and computer science, it is typically used to

determine the causes of symptoms, mitigations, and solutions.

Medical diagnosis (abbreviated Dx or DS) is the process of determining which disease or condition

explains a person's symptoms and signs. It is most often referred to as diagnosis with the medical

context being implicit. The information required for diagnosis is typically collected from a history

and physical examination of the person seeking medical care. Often, one or more diagnostic

procedures, such as medical tests, are also done during the process. Sometimes posthumous

diagnosis is considered a kind of medical diagnosis.

Diagnosis is often challenging, because many signs and symptoms are nonspecific. For example,

redness of the skin (erythema), by itself, is a sign of many disorders and thus does not tell the

healthcare professional what is wrong. Thus differential diagnosis, in which several possible

explanations are compared and contrasted, must be performed. This involves the correlation of

various pieces of information followed by the recognition and differentiation of patterns.

Occasionally the process is made easy by a sign or symptom (or a group of several) that is

pathognomonic.

Diagnosis is a major component of the procedure of a doctor's visit. From the point of view of

statistics, the diagnostic procedure involves classification tests.