The direct and indirect impact of the COVID-19 pandemic on the care of patients with pituitary disease: a cross sectional study

Pituitary - The coronavirus disease 2019 (COVID-19) pandemic is widely believed to have had a major impact on the care of patients with pituitary disease. The virus itself may directly result in...     

Prevalence and correlates of dizziness in community-dwelling older people: a cross sectional population based study

Background

Dizziness is a common complaint among older adults and has been linked to a wide range of health conditions, psychological and social characteristics in this population. However a profile of dizziness is still uncertain which hampers clinical decision-making. We therefore sought to explore the relationship between dizziness and a comprehensive range of demographic data, diseases, health and geriatric conditions, and geriatric syndromes in a representative sample of community-dwelling older people.

Methods

This is a cross-sectional, population-based study derived from FIBRA (Network for the Study of Frailty in Brazilian Elderly Adults), with 391 elderly adults, both men and women, aged 65 years and older. Elderly participants living at home in an urban area were enrolled through a process of random cluster sampling of census regions. The outcome variable was the self-report of dizziness in the last year. Several feelings of dizziness were investigated including vertigo, spinning, light or heavy headedness, floating, fuzziness, giddiness and instability. A multivariate logistic regression analysis was conducted to estimate the adjusted odds ratios and build the probability model for dizziness.

Results

The complaint of dizziness was reported by 45% of elderly adults, from which 71.6% were women (p=0.004). The multivariate regression analysis revealed that dizziness is associated with depressive symptoms (OR = 2.08; 95% CI 1.29–3.35), perceived fatigue (OR = 1.93; 95% CI 1.21-3.10), recurring falls (OR = 2.01; 95% CI 1.11-3.62) and excessive drowsiness (OR = 1.91; 95% CI 1.11–3.29). The discrimination of the final model was AUC = 0.673 (95% CI 0.619-0.727) (p< 0.001).

Conclusions

The prevalence of dizziness in community-dwelling elderly adults is substantial. It is associated with other common geriatric conditions usually neglected in elderly adults, such as fatigue and drowsiness, supporting its possible multifactorial manifestation. Our findings demonstrate the need to expand the design in future studies, aiming to estimate risk and identify possible causal relations.     

Prevalence of significant liver disease in human immunodeficiency virus-infected patients exposed to Didanosine: A cross sectional study

AIM To identify significant liver disease [including nodular regenerative hyperplasia(NRH)] in asymptomatic Didanosine(DDI) exposed human immunodeficiency virus(HIV) positive patients.METHODS Patients without known liver disease and with 6 mo previous DDI use had liver stiffness assessed by transient elastography(TE). Those with alanine transaminase(ALT) above upper limit normal and/or TE 7.65 k Pa underwent ultrasound scan(U/S). Patients with:(1) abnormal U/S; or(2) elevated ALT plus TE 7.65 k Pa;or(3) TE 9.4 k Pa were offered trans-jugular liver biopsy(TJLB) with hepatic venous pressure gradient(HVPG) assessment.RESULTS Ninety-nine patients were recruited, median age 50 years(range 31-70), 81% male and 70% men who have sex with men. Ninety-five percent with VL 50 copies on antiretroviral therapy with median CD4 count 639 IU/L. Median DDI exposure was 3.4 years(range 0.5-14.6). Eighty-one had a valid TE readings(interquartile range/score ratio 0.3): 71(88%) 7.65 k Pa, 6(7%) 7.65-9.4 k Pa and 4(6%) 9.4 k Pa. Seventeen(17%) met criteria for TJLB, of whom 12 accepted. All had HVPG 6 mm Hg. Commonest histological findings were steatosis(n = 6), normal architecture(n = 4) and NRH(n = 2), giving a prevalence of previously undiagnosed NRH of 2%(95%CI: 0.55%, 7.0%).CONCLUSION A screening strategy based on TE, liver enzymes and U/S scan found a low prevalence of previously undiagnosed NRH in DDI exposed, asymptomatic HIV positive patients. Patients were more likely to have steatosis highlighting the increased risk of multifactorial liver disease in this population.     

Reduced health-related quality of life in older patients with congenital heart disease: A cross sectional study in 2360 patients

Objective

Health-related quality of life questionnaires are frequently used to involve patients' impressions and feelings in the outcome evaluation. In patients with congenital heart disease (CHD) methodological heterogeneities, assessment in different age and diagnostic groups led to controversial findings. This study aims to give a comprehensive answer to the health-related quality of life in patients with CHD.

Patients and methods

From July 2001 to June 2013, 2360 patients (1058 female, 28.6 ± 11.2 years, range 14–75 years) with various kinds of CHD underwent a quality of life assessment with the SF-36 questionnaire and underwent a cardiopulmonary exercise test as part of their routine follow-up.

Results

Physical component summary score (PCS) develops from 96.1 %predicted in patients younger than 20 years, to 96.2 %predicted in patients aged 20 to 30 years, 92.3 %predicted in patients aged 30 to 40 years, and 92.6 %predicted in patients 40 years or older (r = − .114; p < .001). The decline was more prominent in the mental component summary score (MCS) declining from 104.1 %predicted in patients younger than 20 years, to 103.4 %predicted, 99.9 %predicted, and 97.5 %predicted (r = − .132; p < .001). Exercise capacity was impaired with 80.1 ± 23.0 %predicted and also declined slowly with age (r = − .084; p < .001).

Conclusions

Health-related quality of life in patients with CHD is progressively reduced in older age-groups. The decline is small, but more prominent in the mental components. This should be considered in the interpretation of studies, and strategies have to be developed to reduce this effect in future.     

Radiological cervical spine involvement in patients with rheumatoid arthritis: a cross sectional study

OBJECTIVE: To investigate the frequency and the severity of radiological cervical spine involvement in patients with rheumatoid arthritis (RA). METHODS: We investigated 165 consecutive unselected patients with RA who fulfilled the revised American College of Rheumatology criteria for RA. All patients had a complete physical and laboratory evaluation. Patients had a radiological evaluation that included hand and wrist radiographs, as well as cervical spine radiographs in anteroposterior, lateral, and lateral in full flexion views. Hand radiographs were evaluated according to the Larsen criteria, while cervical radiographs were evaluated according to Winfield classification. RESULTS: There were 143 women and 22 men, with a mean age of 59.6 +/- 12.5 and disease duration 12.3 +/- 13.9 years. Positive rheumatoid factor was found in 63.6% of patients. One hundred forty-six patients presented radiological findings related to cervical spine involvement: atlantoaxial subluxations were found in 20.6% and erosions of the odontoid process in 2.4%; none presented vertical subluxation. Subaxial subluxations were found in 43.6%, disc space narrowing at C2-C3, C3-C4, C4-C5 levels in 66.1%, and vertebral plate sclerosis and erosions in 43.6%. CONCLUSION: Cervical spine radiological involvement is a frequent finding in our patients with RA, but the severity of the disease is rather mild, possibly related to the ethnic background.     

Anti-CCP in systemic lupus erythematosus patients: a cross sectional study in Brazilian patients

Recently, it has been found that some lupus patients may have anti-cyclic citrullinated peptide antibodies (anti-CCP), although the clinical significance of such finding is not well established. Systemic lupus erythematosus (SLE) patients may have joint complaints that are very similar to those observed in rheumatoid arthritis (RA). In early stages of disease, this form of arthritis can be difficult to differentiate from RA, so it is not rare that some SLE patients are initially misdiagnosed to have this disease. This study aims to investigate the prevalence of anti-CCP in SLE patients from Southern Brazil and its association with clinical and serological profiles. One hundred nine SLE patients were studied for anti-CCP and compared with data of 156 RA patients and 100 healthy volunteers. Comparison of clinical and autoantibody profile of anti-CCP-positive and anti-CCP-negative SLE patients was done. All SLE patients positive of anti-CCP were submitted to hand and feet X-rays. Anti-CCP was positive in 15 of 109 SLE patients, and one of them had confirmed the diagnosis of rhupus. This prevalence was significantly higher than in healthy controls (p?=?0.0004) and lower than in RA patients (p?<?0.0001). No relationship could be found with clinical profile, including joint complaints. SLE patients with anti-CCP had higher prevalence of anti-Ro (p?=?0.02) and anti-La (p?=?0.004) autoantibodies, in comparison with those negative to anti-CCP. We found that 13.7 % of Brazilian patients with SLE have positive anti-CCP. Patients with anti-CCP showed higher prevalence of anti-Ro and anti-La autoantibodies than those negative for anti-CCP. Only a careful and prolonged follow-up will reveal the real clinical value of these markers in each patient individually.     

Cardiovascular evaluation in patients with systemic lupus erythematosus—a cross sectional study

ObjectivesMore than 50% of patients with SLE experience clinical cardiovascular involvement during the course of the illness. We studied the relationship between disease duration, SLE disease activity index (SLEDAI), steroid use and cardiovascular abnormalities, and documented the extent of dyslipidaemia in SLE.MethodsEighty-two consecutive patients suffering from SLE were recruited in this cross sectional study. Lipid parameters, SLEDAI, ECG and echocardiography were obtained in all patients, and treadmill test (TMT) and coronary angiogram (CAG) were performed in selected patients. Chi-square test and Fisher's exact test was applied to determine the relation between cardiovascular status and steroid dose. Mann-Whitney U test and unpaired T test were applied in other cases.ResultsWe did not find any influence of disease duration (P = 0.129), SLEDAI (P = 0.429) or steroid use (P = 0.287) on the cardiovascular abnormalities observed in ECG, echocardiogram, CAG or TMT. Steroid doses influenced the serum triglycerides (P = 0.000029) and HDL-C (P = 0.00826) but not LDL-C (P = 0.3720) or total cholesterol (P = 0.2488) levels. There was high prevalence of dyslipidaemia (60%) and cardiovascular abnormalities (58.5%) in patients with SLE.ConclusionsProper clinical evaluation and investigations can unveil cardiac abnormalities in most patients with SLE who do not have symptoms at early stage of disease. Further studies are needed to determine the risk factors.     

The prevalence of osteoporosis in patients with chronic obstructive pulmonary disease: a cross sectional study

Chronic obstructive pulmonary disease (COPD) is a complex disease, where the initial symptoms are often cough as a result of excessive mucus production and dyspnea. With disease progression several other symptoms may develop, and patients with moderate to severe COPD have often multiorganic disease with severely impaired respiratory dysfunction, decreased physical activity, right ventricular failure of the heart, and a decreased quality of life. In addition osteoporosis might develop possibly due to a number of factors related to the disease. We wanted to investigate the prevalence of osteoporosis in a population of patients with severe COPD as well as to correlate the use of glucocorticoid treatment to the occurrence of osteoporosis in this population. Outpatients from the respiratory unit with COPD, a history of forced expiratory volume in 1s (FEV1) less than 1.3 L, with FEV1% pred. ranging from 17.3% to 45.3% (mean 31.4%, standard deviation (sd) 7.3%). Patients between 50 and 70 years were included. Other causes of osteoporosis were excluded before inclusion. At study entry spirometry, X-ray of the spine (to evaluate presence of vertebral fractures), and bone mineral density of lumbar spine and hip were performed. Of 181 patients invited by mail, 62 patients were included (46 females and 16 males). All had symptoms of COPD such as exertional dyspnea, productive cough, limitations in physical activity etc. The mean FEV1 was 0.90 L (sd: 0.43 L) and the mean FEV1% pred. of 32.6% (sd: 14.1%). All had sufficient daily intake of calcium and vitamin D. In 15 patients, X-ray revealed compression fractures previously not diagnosed. Bone density measurements showed osteoporosis in 22 patients and osteopenia in 16. In total, 26 of the COPD patients were osteoporotic as evaluated from both X-ray and bone density determinations. Thus 68% of the participants had osteoporosis or osteopenia, but glucocorticoid use alone could not explain the increased prevalence of osteoporosis. A large fraction of these needed treatment for severe osteoporosis in order to prevent further bone loss and to reduce future risk of osteoporotic fractures. Thus, there is a significant need to screen patients with COPD to select the individuals in risk of fracture and to initiate prophylaxis or treatment for the disease.     

Serum cholesterol is a significant and independent mortality predictor in liver cirrhosis patients

Background and Aim. Accurate assessment of cirrhotic patient’s prognosis is essential for decisions regarding the course of treatment. Therefore we aimed to confirm and quantify the predictive value of serum cholesterol and serum triglycerides in liver cirrhosis patients.Material and methods. We performed a retrospective observational cohort study on consecutive patients with liver cirrhosis (n = 191). Relevant clinical and laboratory variables were obtained from patients‘ charts and patients were followed for two months. Mortality was the main outcome.Results. Thirty-eight patients died in the follow-up period. Significant difference was observed in the level of total serum cholesterol between surviving and deceased patients (2.27 ± 1.02 mmol/L vs. 2.97 ± 1.00 mmol/L, P < 0.0001 respectively). Cholesterol was confirmed as a significant predictor of mortality in univariate logistic regression analysis, and independent predictor beside bilirubin, creatinine and MELD score in multivariate logistic regression analysis. Addition of serum cholesterol level to a prognostic model based on total bilirubin, creatinine and INR increased its accuracy by 4%. Adding cholesterol to the MELD score improved prediction accuracy by 3%. There was no significant difference in serum levels of triglycerides between surviving and deceased patients.Conclusion. Serum cholesterol is a routinely measured parameter, which has independent prognostic value in patients with liver cirrhosis.     

Non-inflammatory joint pain in patients with inflammatory bowel disease is prevalent and has a significant impact on health related quality of life

OBJECTIVE: To describe the prevalence and characteristics of non-inflammatory joint pain (NIJP) in patients with chronic inflammatory bowel disease (IBD) and its impact on patients' health related quality of life (HRQOL). METHODS: In a population based cohort, 521 patients (80%) were clinically investigated 6 years after onset of IBD. NIJP was defined as a history of joint pain during the last 3 months prior to examination and the absence of concomitant signs or symptoms of inflammatory or degenerative joint disease or chronic pain syndromes. HRQOL was registered by the generic Medical Outcome Study Short Form 36 (SF-36) and by the disease specific IBDQ. RESULTS: NIJP was reported by 85 (16%) patients and significantly more often in conjunction with Crohn's disease (CD, 22%) compared to ulcerative colitis (UC, 14%). The prevalence of NIJP was similar in men and women. No correlation with extension of intestinal disease, use of systemic medication, or frequency of surgery was found. NIJP exerted significant impact on HRQOL measured by SF-36 and IBDQ. CONCLUSIONS: NIJP occurs frequently in IBD and more often in CD than in UC. NIJP significantly alters HRQOL and should be taken into account in trials estimating outcome in IBD and in clinical practice by attending clinicians.     

Diagnostic and treatment delay among pulmonary tuberculosis patients in Ethiopia: a cross sectional study

Background  

Delayed diagnosis and treatment of tuberculosis (TB) results in severe disease and a higher mortality. It also leads to an increased period of infectivity in the community. The objective of this study was to determine the length of delays, and analyze the factors affecting the delay from onset of symptoms of pulmonary tuberculosis (PTB) until the commencement of treatment.     

Relationship between pulmonary function and physical activity in daily life in patients with COPD

BACKGROUND: It remains unclear how closely the physical inactivity observed in patients with Chronic Obstructive Pulmonary Disease (COPD) relates to the severity of their airflow limitation. Furthermore, it is unknown whether spirometric variables such as maximal voluntary ventilation (MVV) and inspiratory capacity (IC) reflect the level of physical activity in daily life better than the forced expiratory volume in the first second (FEV(1)), the main spirometric variable used to determine the severity of COPD. The objective of the present study was to investigate the relationship between physical activity in daily life and the severity of COPD assessed by different spirometric variables: MVV, IC and FEV(1). METHODS: Forty patients with COPD (21 men; 68+/-7 years; FEV(1) 41+/-14% predicted) were performed spirometry and assessment of the physical activity level in daily life using an accelerometer (SenseWear Armband). RESULTS: MVV was significantly correlated to total energy expenditure per day, energy expenditure per day in activities demanding more than 3 metabolic equivalents (METs), number of steps per day and time spent per day in moderate and vigorous activities (0.42相似文献   

The impact of change in exercise tolerance on activities of daily living and quality of life in COPD: a patient's perspective

Patient-centered outcomes are a critical goal in the management of COPD. This personalized patient account of living with COPD indicates the importance of health-related quality of life (HRQoL) when considering the profound impact of reduced exercise tolerance on activities of daily living. The recognition of breathlessness indicating damage to the lungs from smoking and exacerbations of dyspnea associated with activity avoidance sent this patient to her clinician for a diagnosis of COPD. The eventual acceptance of her condition led to her attendance in a pulmonary rehabilitation program that made a "tremendous difference" for both the exercise and the social support it offered, and it reinforced her determination to maintain her independence and mobility that seem to contribute to a positive attitude in dealing with this challenging disease.