Assessment of health-related quality of life,anxiety and depression in patients with early rheumatoid arthritis

Aim of the workTo assess the effect of clinical manifestations, disease activity and medications on health-related quality of life (HRQoL) among patients with early rheumatoid arthritis (RA).Patients and methodsTwenty-six early RA patients (mean age 43.31 ± 10.51 years, disease duration: 16.5 ± 5.2 months) diagnosed according to the 2010 RA classification criteria were recruited from the outpatient clinic of the Rheumatology and Rehabilitation Department, Sohag University, and 22 age and sex matched healthy persons participated in a case control study. Demographic data were taken from all participants in the study. The 36-item short-form health survey (SF-36) and Hamilton Anxiety Rating Scale (HAM-A) were assessed as measures of HRQoL and psychiatric comorbidity for both patients and controls. Disease activity in RA was assessed using the disease activity score (DAS28). Scoring algorithms were applied to produce the physical and mental component scores (PCS and MCS).ResultsThere was statistically significant difference in the total SF36 score, anxiety and depression scores of HAM-A scale between patients and controls. The PCS showed the highest significant difference (p < 0.0001), followed by SF36 (p = 0.01) and MCS (p = 0.024). There were no significant differences according to the age, gender, occupation or level of education of the patients. Anxiety and depression scores significantly correlated with the bodily pain and DAS28 scores and inversely with the PCS and MCS. The DAS28 strongly negatively correlated with the PCS and MCS.ConclusionRheumatoid arthritis has a major impact on many areas of an individual’s life and tends to have a profound impact on the health-related quality of life.     

Síndrome de desgaste proteico energético en la enfermedad renal crónica avanzada: prevalencia y características clínicas específicas

Introduction

Protein-energy wasting (PEW) is associated with increased mortality and differs depending on the chronic kidney disease (CKD) stage and the dialysis technique. The prevalence in non-dialysis patients is understudied and ranges from 0 to 40.8%.

Searching for Inflammatory and Oxidative Stress Markers Capable of Clustering Severe Asthma

ObjectiveAsthma inflammation may feature an imbalance between oxidative stress and antioxidant defenses. Oxidative stress induces propagation of airways inflammation and corticosteroid insensitivity contributing to poor asthma control, and frequent severe acute exacerbations. This study assessed inflammation and oxidative stress in severe asthmatic subjects and evaluated the possible correlations between inflammatory and oxidative stress markers investigated and asthma severity.Material and methodFifty-three patients with severe asthma, 11 patients with mild-moderate asthma and 12 healthy subjects were enrolled and underwent fractional exhaled nitric oxide (FENO) analysis and blood and sputum count cell collection. The content of mitochondrial DNA (MtDNA) and nuclear DNA (nDNA) was measured in exhaled breath condensate (EBC) by Real Time PCR and the ratio between MtDNA/nDNA was calculated. We detected MtDNA/nDNA in the EBC of severe asthmatics.ResultsWe found higher exhaled MtDNA/nDNA in severe asthmatics respectively compared to mild-moderate ones and to healthy controls (10.4 ± 2.2 vs 7.9 ± 2.5, p < 0.05 and 10.4 ± 2.2 vs 6.51 ± 0.21, p < 0.05). The level of exhaled MtDNA/nDNA was significantly higher in Non-T2 endotype severe asthmatics than T2 (14.07 ± 10. 8 vs 6.5 ± 5.5, p < 0.05).ConclusionOxidative stress marker (MtDNA/nDNA) is increased significantly with asthma severity and may be useful for endotyping severe asthma.     

Prevalence and clinical profile of difficult-to-control severe asthma in children: Results from pneumology and allergy hospital units in Spain

BackgroundSevere asthma is often poorly controlled and its prevalence in Spanish children is unknown. The aim was to determine the prevalence of difficult-to-control severe asthma in children, the agreement of asthma control between physicians and Spanish Guidelines for Asthma Management (GEMA), and the health-related quality of life (HRQoL) for children and parents.MethodsObservational, cross-sectional, two-phase, multicentre study. In the first phase, all children who attended pneumology and allergy units during a three-month period were classified according to physicians’ criteria as patients with: asthma, severe asthma, or difficult-to-control severe asthma. Patients aged 6–14 years with severe asthma (difficult-to-control or controlled) were included in the second phase.Results12,376 asthmatic children were screened in the first phase. According to physicians’ criteria, 8.8% (95% CI 8.3–9.3%) had severe asthma. Of these, 24.2% (95% CI, 21.7–26.8%) had difficult-to-control severe asthma. 207 patients with severe asthma (mean age 10.8 ± 2.3 years; 61.4% male; mean of 5.5 ± 3.4 years since asthma diagnosis) were included in the second phase. Compared to the patients with controlled asthma, children with difficult-to-control asthma had a higher number of exacerbations, emergency room or unscheduled primary care visits in the previous year (p < 0.0001, all) and poor HRQoL (p < 0.0001, both children and caregivers). 33.3% of patients with controlled asthma according to physicians’ criteria were poorly controlled according to GEMA.ConclusionsAround one in four asthmatic children with severe disease had difficult-to-control asthma, although one third was underestimated by physicians. Children with difficult-to-control severe asthma had a poor HRQoL that also affected their parents.     

Factores asociados a la calidad de vida y su predicción en pacientes renales en hemodiálisis

Background and objectiveThe present study aims to analyze the levels of health-related quality of life (HRQL) in patients with end-stage kidney disease (ESKD) in haemodialysis, and to explore what demographic, medical and psychological variables are associated with HRQL and contribute to its prediction.Matrials and methodsCross-sectional study with 302 patients with advanced chronic kidney disease (ACKD) on haemodialysis. They were assessed: (1) HRQoL (Shorter Form Health Survey Questionnaire); (2) Anxiety and depression (Goldberg Anxiety and Depression Scale); (3) Sociodemographic data and (4) Medical data. Correlational analyses, means comparison and path analyses with latent variables (PALV) were conducted.ResultsThe PALV showed that 42% of the variance in the HRQL could be explained by the variables evaluated (χ²/df = 2.10; GFI = .938; IFI = .920; CFI = .918; RMSEA = .062; SRMR = .056). Depression was the strongest predictor of HRQL (?.71; p = .002), followed by physical activity (?.19; p = .044). Age (?.122; p = .034) and comorbidity (?.206; p = .001) were weakly associated with physical HRQL. The practice of regular physical activity is related to the physical HRQoL (r = .21; p = .00) and mental (r = .12; p = .028).ConclusionsA high percentage of the variance in HRQoL is explained by the levels of depression and physical activity. Interventions to promote HRQoL in patients with ESKD should focus in promoting physical activity and taking care of patient's mental health.     

Association of Indoxyl Sulfate With Fibroblast Growth Factor 23 in Patients With Advanced Chronic Kidney Disease

BackgroundProtein-bound uremic toxins–indoxyl sulfate (IS) and p-cresyl sulfate (PCS)–can not only predict clinical outcomes but also may relate to bone-mineral disorders in patients with chronic kidney disease (CKD). However, the relationship between protein-bound uremic toxins and fibroblast growth factor 23 (FGF23) has not been studied before. The objective of this study was to explore the association of IS and PCS with FGF23 in a CKD-based cohort.MethodsThis is a cross-sectional study that enrolled 80 stable CKD stage 3 to 5 patients who met the inclusion criteria in a single medical center. Serum levels of IS, PCS and FGF23 were measured concurrently. General biochemistry and patient background were also investigated.ResultsSerum FGF23 and IS concentrations were elevated commensurately with deteriorating renal function. Pearson's analysis showed that FGF23 levels were significantly associated with blood urea nitrogen (r = 0.381, P < 0.05), creatinine (r = 0.632, P < 0.01), estimated glomerular filtration rate (r = –0.447, P < 0.05), phosphate (r = 0.543, P < 0.01), intact parathyroid hormone (r = 0.543, P < 0.01), IS (r = 0.432, P < 0.01) and PCS (r = 0.318, P < 0.05). After adjusting other confounding factors by stepwise multiple linear regression analysis, only creatinine (β = 0.82, P < 0.01), phosphate (β = 0.28, P = 0.02) and IS (β = 0.39, P = 0.04) retained statistically significant associations with FGF23. Moreover, serum levels of IS were higher in patients with high FGF23 concentration (> 90 pg/mL, median value) than those with lower FGF23 (P < 0.01).ConclusionsResults indicated that only IS but not PCS correlated independently with FGF23 in worsening CKD. IS may be an independent factor involved in regulation of bone-mineral metabolism.     

L’hypo-albuminémie contribue-t-elle à l’aggravation de l’insuffisance cardiaque ?

BackgroundHypoalbuminemia has now emerged as a powerful prognosticator in heart failure regardless of age, clinical presentation, left ventricular ejection fraction and usual prognostic markers. Growing evidence is that this prognostic value persists after adjusting for causative factors for hypoalbuminemia such as malnutrition, inflammation and liver dysfunction.ObjectiveTo address the prognostic relevance of hypoalbuminemia in frail elderly patients with well-characterized cardiogenic pulmonary edema at high risk for adverse outcome, beyond causative factors for low serum albumin levels. Serum albumin was measured after clinical stabilization to avoid hypervolemia.ResultsIn all, 67 patients with a mean age of 86 years were included. Hospital mortality was 30%. Patients who died and who survived were similar in age, ejection fraction, BNP concentration, serum creatinine, serum hemoglobin, total bilirubin and prealbumin. Patients who died had lower serum albumin levels (P < 0.001), higher blood urea nitrogen (P = 0.03) and higher C-reactive protein (P = 0.02). In multivariate analysis, serum albumin was the sole independent predictor of hospital death (P < 0.01), after adjusting for malnutrition (prealbumin P = ns), inflammation (C-reactive protein P = ns) and liver dysfunction (total bilirubin P = ns).ConclusionSerum albumin is a powerful prognosticator in frail elderly patients with acute cardiogenic pulmonary edema even after adjusting for main causative factors. These results suggest that hypoalbuminemia may contribute to the worsening of heart failure given the physiological properties of serum albumin that includes antioxidant activity and plasma colloid osmotic pressure action. Further studies are critically needed to address the relevance of prevention and correction of hypoalbuminemia in heart failure.     

Randomization to a low-carbohydrate diet advice improves health related quality of life compared with a low-fat diet at similar weight-loss in Type 2 diabetes mellitus

AimsTo compare the effects on health-related quality of life (HRQoL) of a 2-year intervention with a low-fat diet (LFD) or a low-carbohydrate diet (LCD) based on four group-meetings to achieve compliance. To describe different aspects of taking part in the intervention following the LFD or LCD.MethodsProspective, randomized trial of 61 adults with Type 2 diabetes mellitus. The SF-36 questionnaire was used at baseline, 6, 12 and 24 months. Patients on LFD aimed for 55–60 energy percent (E%) and those on LCD for 20 E% from carbohydrates. The patients were interviewed about their experiences of the intervention.ResultsMean body-mass-index was 32.7 ± 5.4 kg/m² at baseline. Weight-loss did not differ between groups and was maximal at 6 months, LFD: −3.99 ± 4.1 kg, LCD: −4.31 ± 3.6 kg (p < 0.001 within groups). There was an increase in the physical component score of SF-36 from 44.1 (10.0) to 46.7 (10.5) at 12 months in the LCD group (p < 0.009) while no change occurred in the LFD group (p < 0.03 between groups). At 12 months the physical function, bodily pain and general health scores improved within the LCD group (p values 0.042–0.009) while there was no change within the LFD group.ConclusionsWeight-changes did not differ between the diet groups while improvements in HRQoL only occurred after one year during treatment with LCD. No changes of HRQoL occurred in the LFD group in spite of a similar reduction in body weight.     

Metabolic syndrome and impaired health-related quality of life and in non-Hispanic White,non-Hispanic Blacks and Mexican-American Adults

ObjectiveWe examined the relationship between metabolic syndrome (MetS) and impaired health-related quality of life (HRQoL) in non-Hispanic Whites (NHW), non-Hispanic Black (NHB), and Mexican-Americans (MA).MethodsData (n = 5170) from 2009–2010 NHANES were used. Subjects perceived poor overall health (POH), poor physical health (PPH), and poor mental health (PMH) status in the past 30 days were used as indices of impaired HRQoL. Race/ethnic-specific associations between MetS and indices of HRQoL were determined using prevalence odds ratios (POR) from logistic regression models. Statistical adjustments were made for age, sex, education, marital status, income and smoking.ResultsRates of POH, PPH and PMH in the past 30 days increased linearly with increased number of components of MetS in NHW, NHB and MA. MetS was associated with increased odds of PPH in NHW (POR = 2.34; 95% CI = 1.73–3.17) and MA (POR = 1.65; 95% CI = 1.09–2.50); increased odds of PPH in NHW (POR = 1.65; 95% CI = 1.18–2.31), NHB (POR = 1.83; 95% CI = 1.01–3.35), and MA (POR = 1.67; 95% CI = 1.09–2.83); and increased odds of PMH in NHW (POR = 1.50; 95% CI = 1.08–2.08), NHB (POR = 2.28; 95% CI = 1.29–4.01), and MA (POR = 1.44; 95% CI = 0.80–2.59). Upon adjustment for other independent variables, smoking and lack of education were found associated with increased odds of impaired HRQoL.ConclusionsMetS is associated with POH, PPH, and PMH in American adults. From clinical standpoint, this study further suggests that HRQoL should be considered in the management of subjects with MetS. Robust public health programs designed to reduce the prevalence of MetS may help in reducing impaired HRQoL, including POH, PPH, and PMH in American adults who have MetS.     

IGF-IR/ERK content and response to IGF-I and insulin in adipocytes from small for gestational age children

Background/AimsThe GH-IGF-I axis plays an important role on pre/postnatal growth in humans, and IGF-I regulates cell proliferation, differentiation, and metabolic homeostasis. The adipose tissue has an important function in energy storage, and plays an endocrine role through the production of several hormones and growth factors. There are few studies in humans regarding IGF-I and Insulin receptor signaling in adipocytes, particularly from AGA and SGA children.MethodsWe studied 22 healthy prepubertal children (6.1 ± 0.4 years), born at term (11 SGA and 11 AGA), and normal BMI at the time of the study. Primary cell cultures were established from subcutaneous adipose tissue biopsies. Preadipocytes were differentiated and stimulated with IGF-I or insulin and we studied IGF-IR, IR, AKT, and ERK content and phosphorylation.ResultsThe SGA children were shorter than the AGA children (height SDS ?2.14 ± 0.11 vs. 0.02 ± 0.19, p < 0.05). A lower content of IGF-IR, IR, AKT, and ERK was observed in adipocytes from SGA compared with AGA children. IGF-I stimulation increased IGF-IR and ERK phosphorylation in adipocytes from AGA, but not from SGA children.ConclusionThe lower content and reduced phosphorylation of IGF-I signaling observed in adipocytes from SGA children may be related to the metabolic abnormalities described in these children.     

Preadmission predictors of severe COVID-19 in patients with diabetes mellitus

ObjectiveTo explore predictors of severe COVID-19 disease in patients with diabetes hospitalized for COVID-19.MethodsThis is a retrospective observational study of adults with diabetes admitted for COVID-19. Bivariate tests and multivariable Cox regression were used to identify risk factors for severe COVID-19, defined as a composite endpoint of intensive care unit admission/intubation or in-hospital death.ResultsIn 1134 patients with diabetes admitted for COVID-19, more severe disease was associated with older age (HR 1.02, p < 0.001), male sex (HR 1.28, p = 0.017), Asian race (HR 1.34, p = 0.029 [reference: white]), and greater obesity (moderate obesity HR 1.59, p = 0.015; severe obesity HR 2.07, p = 0.002 [reference: normal body mass index]). Outpatient diabetes medications were not associated with outcomes.ConclusionsAge, male sex, Asian race, and obesity were associated with increased risk of severe COVID-19 disease in adults with type 2 diabetes hospitalized for COVID-19.SummaryIn patients with type 2 diabetes hospitalized for COVID-19 disease, we observed that age, male sex, Asian race, and obesity predicted severe COVID-19 outcomes of intensive care unit admission, intubation, or in-hospital death. The risk conferred by obesity increased with worsening obesity. Outpatient diabetes medications were not observed to be significant predictors of study outcomes.     

Risk factors for three-month mortality after discharge in a cohort of non-oncologic hospitalized elderly patients: Results from the REPOSI study

BackgroundShort-term prognosis, e.g. mortality at three months, has many important implications in planning the overall management of patients, particularly non-oncologic patients in order to avoid futile practices. The aims of this study were: i) to investigate the risk of three-month mortality after discharge from internal medicine and geriatric wards of non-oncologic patients with at least one of the following conditions: permanent bedridden status during the hospital stay; severely reduced kidney function; hypoalbuminemia; hospital admissions in the previous six months; severe dementia; ii) to establish the absolute risk difference of three-month mortality of bedridden compared to non-bedridden patients.MethodsThis prospective cohort study was run in 102 Italian internal medicine and geriatric hospital wards. The sample included all patients with three-months follow-up data. Bedridden condition was defined as the inability to walk or stand upright during the whole hospital stay. The following parameters were also recorded: estimated GFR ≤ 29 mL/min/1.73 m²; severe dementia; albuminemia ≪2.5 g/dL; hospital admissions in the six months before the index admission.ResultsOf 3915 patients eligible for the analysis, three-month follow-up were available for 2058, who were included in the study. Bedridden patients were 112 and the absolute risk difference of mortality at three months was 0.13 (CI 95% 0.08–0.19, p ≪ 0.0001). Logistic regression analysis also adjusted for age, sex, number of drugs and comorbidity index found that bedridden condition (OR 2.10, CI 95% 1.12–3.94), severely reduced kidney function (OR 2.27, CI 95% 1.22–4.21), hospital admission in the previous six months (OR 1.96, CI 95% 1.22–3.14), severe dementia (with total or severe physical dependence) (OR 4.16, CI 95% 2.39–7.25) and hypoalbuminemia (OR 2.47, CI 95% 1.12–5.44) were significantly associated with higher risk of three-month mortality.ConclusionsBedridden status, severely reduced kidney function, recent hospital admissions, severe dementia and hypoalbuminemia were associated with higher risk of three-month mortality in non-oncologic patients after discharge from internal medicine and geriatric hospital wards.     

Hypoalbuminemia and Lymphocytopenia in Patients With Decompensated Biventricular Failure

BackgroundIn patients hospitalized with decompensated biventricular failure having hypoalbuminemia and lymphocytopenia without underlying hepatic or renal disease, we addressed the presence of a protein-losing enteropathy (PLE).MethodsWe studied 78 patients having a dilated cardiomyopathy, who were hospitalized with congestive heart failure (CHF) and hypoalbuminemia of uncertain origin. In the first 19 patients, we investigated the presence of PLE using Tc-Dex⁷⁰ scintigraphy together with serum albumin 2 to 4 weeks later when compensation had been restored. In the next 59 patients, presenting with reduced serum albumin and relative lymphocyte count at admission, these parameters were again monitored (2–4 weeks) later when symptoms and signs of CHF had resolved.ResultsPLE, documented by Tc-Dex⁷⁰ scintigraphy, was found in 10 of 19 patients and whose hypoalbuminemia (2.7 ± 0.1 g/dL, mean ± standard error of mean) were corrected (3.3 ± 0.1 g/dL; P < 0.05) with the resolution of CHF, whereas in the 9 patients without a PLE, reduced baseline serum albumin (2.6 ± 0.1 g/dL) failed to improve on follow-up (2.6 ± 0.2 g/dL) in keeping with malnutrition. Relative lymphocyte count was reduced (14.6 ± 1.5%) in patients with PLE but was normal (21.4 ± 3.3%; P < 0.05) in those without PLE. Serum albumin and relative lymphocyte count were each reduced at admission (2.8 ± 0.1 g/dL and 14.4 ± 1.0%, respectively) in 59 patients and increased (P < 0.05) to normal values (3.5 ± 0.1 g/dL and 24.9 ± 1.0%) 2 to 4 weeks after they were compensated.ConclusionsEnteral losses of albumin and lymphocytes account for the reversible hypoalbuminemia and lymphocytopenia found in patients hospitalized with CHF having splanchnic congestion.     

Epicardial adipose tissue volume as a marker of coronary artery disease severity in patients with diabetes independent of coronary artery calcium: Findings from the CTRAD study

AimsThe association between epicardial adipose tissue (EAT) volume and coronary artery disease (CAD) severity was evaluated, independent of traditional risk factors and coronary artery calcium (CAC) scores, in patients with diabetes type 2 (DM-2) using cardiac computed tomography angiography (CTA).MethodsA multivariate analysis was utilized to assess for an independent association after calculating EAT volume, CAD severity, and calcium scores in 92 patients with DM-II from the CTRAD study. We graded CAD severity as none (normal coronaries), mild-moderate (<70% stenosis), and severe (70% or greater stenosis).ResultsA total of 39 (42.3%) asymptomatic patients with diabetes did not have CAD; 30.4% had mild/moderate CAD; and 27.1% had severe CAD. Mean EAT volume was highest in patients with severe CAD (143.14 cm³) as compared to mild/moderate CAD (112.7 cm³), and no CAD (107.5 cm³) (p = 0.003). After adjustment of clinical risk factors, notably, CAC score, multivariate regression analysis showed EAT volume was an independent predictor of CAD severity in this sample (odds ratio 11.2, 95% confidence interval 1.7–73.8, p = 0.01).ConclusionsIncreasing EAT volume in asymptomatic patients with DM-II is associated with presence of severe CAD, independent of BMI and CAC, as well as traditional risk factors.     

Clinical characteristics and prognostic significance of serum albumin changes in an internal medicine ward

BackgroundThe prognostic significance of hypoalbuminemia and the dynamic changes in serum albumin during hospitalization in internal medicine wards has not been sufficiently investigated.MethodsDemographic, clinical and laboratory data were collected from 276 patients admitted to our internal medicine ward for a variety of acute disorders. Following discharge, all-cause mortality was recorded. These data were compared between patient groups, according to levels of albumin: hypoalbuminemia or normoalbuminemia (serum albumin < 34 g/l and ≥ 34 g/l, respectively), on admission and discharge.ResultsHypoalbuminemia on admission and on discharge was found in 46% and 54% of patients, respectively. Anemia, renal dysfunction, malignant disease, hypocholesterolemia, lymphopenia and albuminuria were more prevalent in patients with hypoalbuminemia, compared to those with normoalbuminemia (p ≤ 0.03). During a median follow-up period of 23 months, 107 of 276 patients died. Mortality was significantly higher (p < 0.001) in patients with hypoalbuminemia than normoalbuminemia on admission (52.0% vs. 27.5%) and on discharge (53.7% vs. 21.2%), including those admitted with normoalbuminemia and discharged with hypoalbuminemia (43.6%). Survival rate was higher for patients admitted with hypoalbuminemia and discharged with normoalbuminemia than for those remaining with hypoalbuminemia (82.4% vs. 42.8%, p = 0.004). The level of albumin on discharge (each 10 g/l decrement) was the most powerful predictor of shortened survival (relative risk 2.79, 95% confidence interval 2.04–3.70).ConclusionsHypoalbuminemia on admission, as well as persistence or development of hypoalbuminemia throughout hospitalization, was associated with poor prognosis. Treatment aimed at increasing low albumin or maintaining its normal level may improve survival.     

Variation in the perilipin gene (PLIN) affects glucose and lipid metabolism in non-Hispanic white women with and without polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women. It is characterized by chronic anovulation, hyperandrogenism, obesity and a predisposition to type 2 diabetes mellitus (T2DM). Since obesity plays an important role in the etiology of PCOS, we sought to determine if variants in the perilipin gene (PLIN), a gene previously implicated in the development of obesity, were also associated with PCOS. We typed six single nucleotide polymorphisms (haplotype tagging and/or previously associated with obesity or related metabolic traits) in PLIN in 305 unrelated non-Hispanic white women (185 with PCOS and 120 without PCOS). None of the variants was associated with PCOS (P < 0.05). However, the variant rs1052700*A was associated with increased risk for glucose intolerance (impaired glucose tolerance or T2DM) in both non-PCOS (OR = 1.75 [1.02–3.01], P = 0.044) and PCOS subjects (OR = 1.67 [1.08–2.59], P = 0.022). It was also associated with increased LDL (P = 0.007) and total cholesterol levels (P = 0.042). These results suggest that genetic variation in PLIN may affect glucose and lipid metabolism in women both with and without PCOS.     

Obstructive sleep apnoea syndrome and the metabolic syndrome in an internal medicine setting

BackgroundObstructive sleep apnoea syndrome (OSAS) is widely accepted as a cardiovascular risk factor. Lately it has been considered in turn as both a component and one of the causes of the metabolic syndrome (MS).MethodsWe studied 281 heavy snorers of both sexes consecutively attending a metabolic clinic. Aim was to evaluate the association of OSAS and MS in a large series of patients within an internal medicine setting. Patients underwent a clinical and biochemical work up and performed unattended polysomnography.ResultsOf 226 non-diabetic snorers, 48 had primary snoring; 54 mild, 51 moderate, and 73 severe OSAS. A positive association was found between OSAS severity, central obesity indices and the mean metabolic score (p = 0.016). Prevalence of hypertension increased with OSA severity (p = 0.010). Polysomnographic indices were correlated with the metabolic score, insulin levels and central obesity indices.At regression analysis, male sex (t = 3.92; p = 0.000) and waist circumference (t = 3.93; p = 0.000) were independently associated with AHI (apnoea/hypopnoea index), while ODI (oxygen desaturation index) and waist circumference were the independent predictors (t = 2.16; p = 0.033 and t = 3.74; p = 0.000 respectively) of the metabolic score.Prevalence of OSA was 83% in 55 patients with diabetes and 34% had severe OSA. Almost all diabetics with OSA had MS. The metabolic score was higher in diabetic OSA as compared to non-diabetic OSAS (p = 0.000).ConclusionsOur findings show a high prevalence of OSAS among patients referred to a metabolic outpatient clinic because of suspected metabolic disorders and heavy snoring and suggest a strong bidirectional association between OSAS and MS.     

Validation of the IMPACT-III quality of life questionnaire in Swiss children with inflammatory bowel disease

Background and aimsInflammatory bowel disease (IBD) frequently manifests during childhood and adolescence. For providing and understanding a comprehensive picture of a patients' health status, health-related quality of life (HRQoL) instruments are an essential complement to clinical symptoms and functional limitations. Currently, the IMPACT-III questionnaire is one of the most frequently used disease-specific HRQoL instrument among patients with IBD. However, there is a lack of studies examining the validation and reliability of this instrument.Methods146 paediatric IBD patients from the multicenter Swiss IBD paediatric cohort study database were included in the study. Medical and laboratory data were extracted from the hospital records. HRQoL data were assessed by means of standardized questionnaires filled out by the patients in a face-to-face interview.ResultsThe original six IMPACT-III domain scales could not be replicated in the current sample. A principal component analysis with the extraction of four factor scores revealed the most robust solution. The four factors indicated good internal reliability (Cronbach's alpha = .64–.86), good concurrent validity measured by correlations with the generic KIDSCREEN-27 scales and excellent discriminant validity for the dimension of physical functioning measured by HRQoL differences for active and inactive severity groups (p < .001, d = 1.04).ConclusionsThis study with Swiss children with IBD indicates good validity and reliability for the IMPACT-III questionnaire. However, our findings suggest a slightly different factor structure than originally proposed. The IMPACT-III questionnaire can be recommended for its use in clinical practice. The factor structure should be further examined in other samples.