Serum apelin is associated with affective disorders in peritoneal dialysis patients

Objective: Depression and anxiety are prevalent affective disorders in peritoneal dialysis (PD) patients. Recent research has proposed a potential role of apelinergic system in pathogenesis of depression. The present study aimed to evaluate the frequency of depression and anxiety and their potential relation with serum apelin levels among PD patients.

Methods: A total of 40 PD patients were enrolled into the study. Depressive symptoms and anxiety were assessed with the Beck’s Depression Inventory and the Beck’s Anxiety Inventory. Serum apelin-12 levels were measured by immunoenzymatic assays using commercially available ELISA kit for standard human apelin.

Results: Of the patients, 16 (40%) had depression, 20 (50%) had anxiety. The patients with depression and anxiety had a significantly longer time on dialysis (p?<?0.001 for both), significantly higher serum apelin (p?<?0.001 for both) and C-reactive protein levels (p?<?0.001 for both) than those without depression and anxiety. In multivariate analysis, serum apelin was the only parameter associated independently with depression and anxiety scores.

Conclusions: A substantial number of PD patients had depression and anxiety. Increased levels of serum apelin may constitute a significant independent predictor of development of depression and anxiety in PD patients.     

Serum Fetuin-A: A Novel Potential Link Between Post-adolescent Acne and Insulin Resistance

BackgroundPost-adolescent acne is acne in patients aged older than 25 years. It is more common in women, suggesting an underlying hormonal imbalance. It has been postulated that insulin resistance (IR) may play a role in pathogenesis.ObjectiveTo explore the relationship between fetuin-A, IR, and post-adolescent acne.MethodsSerum fetuin-A levels were assessed using an ELISA technique in 50 female patients with post-adolescent acne and 50 healthy controls, and IR was calculated using the Homeostasis Model Assessment of Insulin Resistance Index (HOMA-IR).ResultsStudied patients had significantly higher HOMA-IR indices and serum fetuin-A levels than control subjects (P=0.001 and <0.001, respectively) and they were significantly increased in patients with severe lesions (P<0.001).ConclusionWe found that IR was more significantly prevalent among studied patients, especially those with more severe acne grades, and that could be attributed to higher serum fetuin-A levels. Fetuin -A might be a predictor for acne severity and associated metabolic comorbid conditions, such as IR. However, further large-scale studies will be needed.     

Sleep disturbances and restless legs syndrome in postmenopausal women with early breast cancer given adjuvant aromatase inhibitor therapy

IntroductionWhether adjuvant therapy with aromatase inhibitors (AIs) causes sleep disturbances or not in postmenopausal women with early breast cancer (EBC) is still a controversial issue.MethodsBetween March 2014 and November 2017, validated questionnaires for assessing insomnia, anxiety, depression, quality of life (QoL) and restless legs syndrome (RLS) were administered to 160 EBC patients at baseline and after 3, 6, 12, and 24 months of AI therapy.ResultsAI therapy significantly decreased the patients’ QoL, but did not influence insomnia, anxiety or depression. However, it significantly increased the frequency and severity of RLS. Patients with RLS at baseline (19%) or who developed RLS during AI therapy (26.3%) reported statistically lower quality of sleep, higher anxiety and depression, and worse QoL compared to patients who never reported RLS (54.7%).ConclusionAlthough AI therapy does not affect sleep quality, it may increase RLS frequency. The presence of RLS could identify a group of EBC patients who may benefit from psychological support.     

What Is the Impact of the COVID-19 Pandemic on Quality of Life and Other Patient-reported Outcomes? An Analysis of the Hand-Wrist Study Cohort

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic, and its associated lockdowns in many parts of the world, have changed our daily lives and may have a psychological impact on around the globe. However, it is unknown how this influences the patient-reported outcome measures (PROMs) of patients involved in ongoing clinical research and medical care. For both the current and potential future lockdowns, it is important to determine if PROMs collected during such a period can be interpreted with confidence.Questions/purposes(1) Is there a difference in quality of life between patients in the COVID-19 period group (March 23, 2020 to May 4, 2020) and patients in a reference period group (from the same period in 2018 or 2019)? (2) Is there a difference in pain, hand function, anxiety, depression, and illness perception between patients in the COVID-19 period group and patients in the reference period group?MethodsThis study was part of a large cohort study with routine outcome measures of patients with hand and wrist conditions. To answer our research questions, we analyzed two samples because not all PROMs were sent to participants at the same time points after treatment. The first sample consisted of all participants who completed PROMs on quality of life (QoL), pain, and hand function at their final follow-up time point, which was either 3, 6, or 12 months post-treatment. The second sample consisted of participants who completed PROMs 3 months post-treatment on anxiety, depression, and illness perception. Each sample consisted of two groups: a COVID-19 period group and a reference period group. We included 1613 participants in the first sample (COVID-19 period group: n = 616; reference period group: n = 997) and 535 participants in the second sample (COVID-19 period group: n = 313; reference period group: n = 222). The primary outcome was QoL, expressed in the EuroQol 5-Dimensions questionnaire (EQ-5D) index score. Secondary outcomes were the other domains on the EQ-5D, as well as pain, hand function, anxiety, depression, and illness perception.ResultsWe found no between-group differences in the EQ-5D index score (standardized mean difference 0.035; p = 0.98). Furthermore, there were no between-group differences in PROM scores for hand function, anxiety, or depression. There were, however, a few small differences in subdomain items regarding pain and illness perception, but we believe in aggregate that these are unlikely to make a clinically important difference in our main finding.ConclusionThe COVID-19 pandemic and its associated lockdown had no influence on QoL and had little influence on secondary outcomes in participants who were part of the Hand-Wrist Study Cohort. This finding implies that PROMs data collected during this period can be used with confidence in clinical research. Our findings indicate that when a pandemic like this occurs again, we can continue to use PROMs for analysis in clinical research or routine outcome measures.Level of EvidenceLevel III, therapeutic study.     

Anxiety and depression are common in rheumatoid arthritis and correlate with poor quality of life in Indian patients

ObjectivesWe planned this study to assess the prevalence of anxiety and depression in rheumatoid arthritis (RA) patients and its correlation with quality of life (QOL) in these patients.Material and methodsEighty-eight patients (76 females) were included in this cross-sectional study. The Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression. Quality of life was measured using the World Health Organization WHOQOL-BREF. The severity of pain was measured by 100-millimetre-long Visual Analogue Scale (VAS), and functional disability was measured by using the Indian version of the Health Assessment Questionnaire (HAQ). The disease activity was measured by Disease Activity Score for 28 joints with 3 variables.ResultsProbable anxiety and depression were seen in 61 (69%) and 68 (77%) of the patients, respectively. Patients with anxiety had more severe pain (VAS 53.8 ±26.4 vs. 39.7 ±26.1, p < 0.05), and significantly lower scores in all the 4 domains of the WHOQOL-BREF. Patients with depression had more pain (VAS 54.2 ±25.2 vs. 33.5 ±27.3, p < 0.01), higher HAQ scores (1.0 ±0.7 vs. 0.5 ±0.7, p < 0.01), and lower QOL scores. Both anxiety and depression scores had a negative correlation with all the 4 domains of the WHOQOL-BREF. Anxiety had a significant negative effect on psychological (β = –0.58, p < 0.001) and environmental domains (β = –0.39, p < 0.001), while depression had a significant negative effect on psychological (β = –0.57, p < 0.001) and environmental domains (β = –0.53, p < 0.001). Both anxiety and depression predicted more pain in RA patients (β = 0.24, p < 0.001 and β = 0.44, p < 0.001, respectively).ConclusionsAnxiety and depression correlated with poor QOL in all 4 domains of the WHOQOL-BREF. Higher HADS scores had a negative effect on all the domains of the WHOQOL-BREF and predicted more severe pain in RA patients. Thus, patients with RA need to be screened and treated for underlying anxiety and depression to improve their QOL, pain, and functional status.     

“Il faut continuer à poser des questions” patient reported outcome measures in cystic fibrosis: An anthropological perspective

BackgroundPeople with cystic fibrosis (pwCF) are central in the development of patient-led assessment tools. Qualitative analysis of a frequently used CF-specific patient-reported outcome measure (PROM) sought patient recommendations for development of a new quality of life (QoL) tool.MethodsWe performed an inventory of PROMs, symptom-report and QoL tools used in clinical trials within the European Cystic Fibrosis Society Clinical Trial Network (ECFS-CTN) and in routine clinical practice among Cystic Fibrosis Europe and ECFS members. A qualitative study using cognitive interviews with pwCF and their caregivers reviewed the Cystic Fibrosis Questionnaire (CFQ), the French initial form of the Cystic Fibrosis Questionnaire-Revised (CFQ-R).ResultsSurvey results from 33 countries revealed over 70 tools used in routine clinical practice, utilized by clinical specialists (n=124), pwCF/parents/carers (n=49) and other allied health professionals (n=60). The CFQ-R was the main PROM used in clinical trials. The qualitative study enrolled 99 pwCF, 6 to 11 years (n=31); 12 to 18 years (n=38); >18 years (n=30) and 26 parents. Inductive thematic analysis based on the CFQ, revealed 19 key themes. Themes common across all cohorts included burden of treatment, impact of disease on day-to-day life, relationships/family, stress/mood, and nutrition. Themes unique to individual groups included, treatment when not symptomatic for the paediatric group; education/studies and planning for the future for adolescents, impact of anxiety and depression on day-to-day life for adults, and for parents, questions addressing anxiety and their role as carers.ConclusionsPatient-centeredness is paramount in development of an up-to-date PROM in the era of novel therapies.     

Mental health and quality of life after feminizing genitoplasty

PurposeThe aim of the study was to evaluate mental health and quality of life (QoL) aspects in women operated on because of disorders of sexual differentiation (DSDs) in childhood.MethodsQuestionnaires were mailed to 45 women older than 15 years who had been operated on because of DSD, of which 24 patients (53%) responded. Of these, 16 had been prenatally exposed to androgens. Eight females had 46,XY karyotype. Mental health was measured with the 90-item Symptom Checklist, QoL with the 20-item Life Situation Survey questionnaire, and health-related QoL (HRQoL) with the 15D questionnaire.ResultsThe QoL and HRQoL scores appeared normal in most of the patients. Furthermore, mental health of the patients was similar or better compared with previously published scores of a Finnish community sample in all dimensions (somatization, obsessive compulsivity, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism). However, 5 patients had poorer scores in some of the 3 questionnaires. These 5 had either distressful memories because of a too-late operation, the operative treatment itself, or current poor sexual function.ConclusionsThe QoL, HRQoL, and overall mental health of female patients with DSD are usually normal.     

Evaluación del impacto de la sintomatología urinaria en la calidad de vida de los pacientes con síndrome de vejiga dolorosa/dolor pélvico crónico y cistitis rádica: estudio EURCIS

ObjectivesTo evaluate the impact of urinary symptoms of Painful Bladder/Pelvic Pain Syndrome and Radiation Cystitis (PBCPPS) on the Quality of Life, and self-esteem of the patient.Material and methodsAn observational, multicenter, epidemiological and cross-sectional study was performed on patients with Painful Bladder/Chronic Pelvic Pain Syndrome and Radiation Cystitis. Data was recorded on severity of urinary symptoms and QoL impairment using the PUF Score. The patients evaluated the QoL deterioration grade through the King's Health Questionnaire (KHQ), and the level of their anxiety and self-esteem with the Goldberg's Anxiety Scale (GAS) and Rosenberg's Self-Esteem Scale (RSES), respectively. Post-hoc comparisons were performed between the results of the KHQ of this study and a sample of patients with urinary incontinence (UI). Results on RSES were analyzed with data from the general population and from patients with erectile dysfunction.ResultsA total of 530 cases, mostly female patients, who had been diagnosed with PBCPPS, were analyzed. High levels of deterioration in QoL were described: KHQ scores were significantly higher when compared with patients with UI (P < .01). Involvement of self-esteem was higher in patients with RC and men, who obtained scores similar to those of patients with erectile dysfunction.ConclusionsPatients with Painful Bladder Syndrome/Chronic Pelvic Pain Syndrome and Radiation Cystitis present high levels of anxiety, and significant reductions in both quality of life and self-esteem. Especially for men, this affectation is similar to that caused by erectile dysfunction.     

Validity of Self-rating Screening Scales for the Diagnosis of Depression and Anxiety in Adult Patients With Bronchiectasis

BackgroundThere are no previous studies aimed at assessing the validity of the screening scales for depression and anxiety in adult patients with bronchiectasis.AimsTo analyze the psychometric properties of Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI) and Hamilton Anxiety Scale and to evaluate the concordance for the diagnosis of depression and anxiety between these screening scales and the structured clinical interview in adult patients with bronchiectasis.MethodCross sectional study. 52 patients with bronchiectasis completed HADS, BDI and Hamilton Anxiety Scale; afterwards, were individually interviewed by a mental health care professional using the structured Mini International Neuropsychiatric Interview (MINI), which evaluates for depression and anxiety according to DSM-IV criteria.ResultsBased on MINI, 18 subjects (34.6%) had a diagnosis of depression and 25 (48.1%) had anxiety. Optimal cut-off values to detect depression were ≥9 for the HADS-D (sensitivity 0.833, specificity 0.971, AUC 0.962 [95% CI 0.918–1]), and 17 for BDI (sensitivity 0.889, specificity 0.912, AUC 0.978 [95% CI 0.945–1]). Optimal cut-off values to detect anxiety were ≥4 for the HADS-A (sensitivity 0.960, specificity 0.593, AUC 0.833 [95% CI 0.723–0.943]), and 17 for Hamilton Anxiety Scale (sensitivity 0.800, specificity 0.852, AUC 0.876 [95% CI 0.781–0.970]).ConclusionThe self-rating screening scales HADS, BDI and Hamilton Anxiety Scale are reliable tools to screen for depression and anxiety in adult patients with bronchiectasis. However, the use of specific cut-off values may improve the diagnostic accuracy of the previous scales in this specific group of patients.     

Socially desirable responding by bariatric surgery candidates during psychological assessment

BackgroundMost bariatric surgery programs in the United States require preoperative psychological evaluations for candidates for surgery. Among those who perform these evaluations is concern that many patients engage in “impression management” or minimizing the symptoms of distress to receive a recommendation to proceed with surgery from the mental health professional. We sought to assess the prevalence of socially desirable responding and its associations with measures of psychological functioning among bariatric surgery candidates at 2 academic medical centers in the United States.MethodsThe participants were male (n = 66) and female (n = 293) bariatric surgery candidates who presented for psychological evaluation. The participants completed 2 measures of socially desirable response styles (Marlowe-Crowne Social Desirability Scale and Personality Assessment Inventory Positive Impression Management scale) and standardized measures of anxiety, depression, and alcohol-related problems.ResultsThe participants exhibited elevated scores on the social desirability indicators, with 33.3–39.8% scoring above the recommended cut-score on the Personality Assessment Inventory Positive Impression Management scale and 62.3–67% scoring 1 standard deviation above the standardization mean on the Marlowe-Crowne Social Desirability Scale. Scores on the Marlowe-Crowne Social Desirability Scale and Personality Assessment Inventory Positive Impression Management scale correlated inversely with the clinical measures of anxiety and depression, and the high/low scorers on the social desirability indices exhibited significant differences in anxiety and depression. Thus, elevated scores on the social desirability indices were associated with underreporting of certain clinical symptoms.ConclusionA substantial proportion of bariatric surgery candidates appear to present themselves in an overly favorable light during the psychological evaluation. This response style is associated with less reporting of psychological problems and might interfere with the accurate assessment of patient functioning.     

Oral Zinc as a Novel Adjuvant and Sparing Therapy for Systemic Isotretinoin in Acne Vulgaris: A Preliminary Comparative Study

BackgroundSystemic isotretinoin is the most effective treatment for acne vulgaris (AV). However, numerous side effects are associated with isotretinoin. Oral zinc has a better safety profile and has been used to treat AV with variable results. ObjectiveWe sought to evaluate the safety and efficacy of combining oral zinc to low-dose systemic isotretinoin in AV patients.MethodsSixty AV patients were divided into two groups. Group A received oral zinc sulfate plus low-dose isotretinoin and Group B received the standard isotretinoin dosage. At each visit acne severity, photos, side effects, and patient-reported satisfaction were recorded.ResultsIn the two groups, no significant difference in reduction of lesion count and Global Acne Grading System scores. The frequency of treatment-related side effects was (20%) in Group A and (76.7%) in Group B. Furthermore, there was no difference regarding the relapse rates between both groups (p>0.05). Finally, the patients’ satisfaction rates did not differ between the two groups.ConclusionOral zinc plus low-dose isotretinoin resulted in satisfactory improvement in AV patients with fewer side effects. Further studies are recommended to compare the efficacy of other zinc preparations if combined with systemic isotretinoin at different concentrations.     

Psychological distress in men with prostate cancer receiving adjuvant androgen-deprivation therapy

ObjectivesTo compare the occurrence of depression, anxiety, self body image perception, sleep disturbances, and diminished quality of life in prostate cancer patients undergoing adjuvant androgen-deprivation therapy (ADT) as opposed to patients in follow-up alone.Methods and materialsHospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, Restless Legs Syndrome Study Group essential diagnostic criteria, Body Image Scale and Functional Assessment of Cancer Therapy Prostate were administered to consecutive prostate cancer patients who underwent radical prostatectomy or radiation therapy and are presently either under adjuvant ADT or included in a follow-up program.ResultsOf the 103 patients enrolled, 49 (47.6%) were receiving adjuvant ADT and 54 (52.4%) were not. Compared with the controls, the patients undergoing ADT showed higher levels of depression (P = 0.002), worse self body image perception (P = 0.001), worse quality of life (P = 0.0001) and worse sleep quality (P = 0.04). ADT was significantly associated with depression at multivariate analysis after adjustment for age, stage, Gleason score, as well as demographic and social variables (P = 0.001). Depression scores showed a strong inverse correlation with quality of life scores (P < 0.01).ConclusionsAdjuvant ADT is associated with depression, worse quality of life, and altered self body image in prostate cancer patients.     

Social impact of peripheral nerve injuries

BackgroundDisorders involving the peripheral nervous system can have devastating impacts on patients’ daily functions and routines. There is a lack of consideration of the impact of injury on social/emotional well-being and function.MethodsWe performed a retrospective database and chart review of adult patients presenting between 2010 and 2012 with peripheral nerve compression, brachial plexus injury, thoracic outlet syndrome (TOS), or neuromas. At the initial assessment, patients completed a questionnaire used to obtain demographic and psychosocial variable data including the (1) average level of pain over the last month, (2) self-perceived depression, (3) how much pain impacts quality of life (QoL), (4) current level of stress, and (5) ability to cope with stress. Statistical analyses were used to assess the differences between the dependent variables and diagnostic and demographic groups.ResultsThis study included 490 patients (mean age 50 ± 15 years); the most common diagnosis was single nerve compression (n = 171). Impact on QoL was significantly greater in patients with TOS, cutaneous peroneal compressions, and neuroma versus single site nerve compressions. Average pain, impact on QoL, and stress at home were significantly higher in females versus males. Impact on QoL was correlated with average pain, depression, stress at home, and ability to cope with stress at home.ConclusionsOur study demonstrates that patients with single site nerve compression neuropathies experience fewer negative psychosocial effects compared to patients with more proximal upper extremity peripheral nerve disorders and neuromas. The impact on QoL was strongly correlated with pain and depression, where patients with neuromas and painful peroneal nerve entrapments reported greater detriments to QoL.     

Gender differences in quality of life and psychological impact of facial burn scars in a tertiary care center

AimTo compare the quality of life and psychological impact of cases of facial burn scar between male and female patients.Study typeAn observational cross sectional study done in a tertiary care university level teaching hospital, on a hospital based sample over a period ranging from January 2018 to July 2019.MethodologyThe study was carried out on 32 patients of facial burn scar, who were screened for psychiatric diagnoses by MINI International Neuropsychiatric Interview; severity of depression and anxiety assessed by HDRS and HAM A; assessed for QoL and scar ratings of both patient and observer. QoL was assessed using the WHO QOL BREF questionnaire. The scar assessment was done with the help of POSAS by interviewing the patient and examination of the scar.ResultsNone of other socio-demographic variables patient showed any significant association with the number of psychiatric diagnoses of the patient or QoL domains; barring years of schooling, which had a significant positive correlation with the psychological domain score of QoL. Being male or female also did not show any significant differences with the anxiety or depression severity. No burn or scar related variable could reach significant association, except scar itching, stiffness scores of POSAS P and overall scar opinion score of POSAS O, with the number of psychiatric diagnoses of the patient. Extent of scar had significant negative associations with the physical and psychological domains of QoL. Significant negative correlations were found between scar variables like stiffness, pigmentation, relief, pliability, and overall opinion and QoL domain scores. The total observer score of POSAS and the overall opinion of observer had much stronger negative correlation than the patient score; the latter having a significant association with the depression severity as well.ConclusionNo statistically significant gender difference in QoL and psychological impact of patients with facial burn scar were found. However educational level was found to positively influence the psychological well-being of the patients; whereas scar extent was found to negatively affect the physical and psychological domains of QoL.     

Do Cohabitants Reliably Complete Questionnaires for Patients in a Terminal Cancer Stage when Assessing Quality of Life,Pain, Depression,and Anxiety?

BackgroundPatients with bone metastases often are unable to complete quality of life (QoL) questionnaires, and cohabitants (such as spouses, domestic partners, offspring older than 18 years, or other people who live with the patient) could be a reliable alternative. However, the extent of reliability in this complicated patient population remains undefined, and the influence of the cohabitant’s condition on their assessment of the patient’s QoL is unknown.Questions/purposes(1) Do QoL scores, measured by the 5-level EuroQol-5D (EQ-5D-5L) version and the Patient-reported Outcomes Measurement Information System (PROMIS) version 1.0 in three domains (anxiety, pain interference, and depression), reported by patients differ markedly from scores as assessed by their cohabitants? (2) Do cohabitants’ PROMIS-Depression scores correlate with differences in measured QoL results?MethodsThis cross-sectional study included patients and cohabitants older than 18 years of age. Patients included those with presence of histologically confirmed bone metastases (including lymphoma and multiple myeloma), and cohabitants must have been present at the clinic visit. Patients were eligible for inclusion in the study regardless of comorbidities, prognosis, prior surgery, or current treatment. Between June 1, 2016 and March 1, 2017 and between October 1, 2017 and February 26, 2018, all 96 eligible patients were approached, of whom 49% (47) met the selection criteria and were willing to participate. The included 47 patient-cohabitant pairs independently completed the EQ-5D-5L and the eight-item PROMIS for three domains (anxiety, pain, and depression) with respect to the patients’ symptoms. The cohabitants also completed the four-item PROMIS-Depression survey with respect to their own symptoms.ResultsThere were no clinically important differences between the scores of patients and their cohabitants for all questionnaires, and the agreement between patient and cohabitant scores was moderate to strong (Spearman correlation coefficients ranging from 0.52 to 0.72 on the four questionnaires; all p values < 0.05). However, despite the good agreement in QoL scores, an increased cohabitant’s depression score was correlated with an overestimation of the patient’s symptom burden for the anxiety and depression domains (weak Spearman correlation coefficient of 0.33 [95% confidence interval 0.08 to 0.58]; p = 0.01 and moderate Spearman correlation coefficient of 0.52 [95% CI 0.29 to 0.74]; p < 0.01, respectively).ConclusionThe present findings support that cohabitants might be reliable raters of the QoL of patients with bone metastases. However, if a patient’s cohabitant has depression, the cohabitant may overestimate a patient’s symptoms in emotional domains such as anxiety and depression, warranting further research that includes cohabitants with and without depression to elucidate the effect of depression on the level of agreement. For now, clinicians may want to reconsider using the cohabitant’s judgement if depression is suspected.Clinical RelevanceThese findings suggest that a cohabitant’s impressions of a patient’s quality of life are, in most instances, accurate; this is potentially helpful in situations where the patient cannot weigh in. Future studies should employ longitudinal designs to see how or whether our findings change over time and with disease progression, and how specific interventions—like different chemotherapeutic regimens or surgery—may factor in.     

The use of virtual reality in reducing anxiety during cast removal: a randomized controlled trial

PurposeWhile virtual reality (VR) has been shown to be an effective distractor in children across a range of procedures, no studies have looked at its use within paediatric orthopaedics. The purpose of this study was to look at the use of VR in reducing anxiety levels in children during cast removal. In addition, the study aimed to find ways to enhance the efficiency of future VR trials in paediatrics.MethodsA non-blinded randomized control trial took place in children aged four to 18 years. Intraprocedural anxiety was measured using the Children’s Emotional Manifestation Scale (CEMS), while pre- and post-procedural anxiety was measured using the Short State Anxiety Inventory Scale. Additional data was collected on trait anxiety, nausea levels, desire for future VR use and areas of improvement for future VR studies.ResultsA total of 90 subjects were included in the study (control n = 45, intervention n = 45) with a mean age of 10.25 years (sd 3.35). Post-procedural anxiety and intraprocedural anxiety were 18% (p = 0.03) and 24% (p = 0.01) lower in the VR group, respectively, with the CEMS facial component showing a 31% (p < 0.001) reduction in the VR group. In all, 99% (n = 89) of subjects experienced no nausea, with one patient experiencing mild nausea that may have been present prior to VR use. Finally, 90% (n = 81) of subjects said they would like to use VR again, 1% (n = 1) said ‘no’ and 9% (n = 8) said ‘maybe’.ConclusionVR appears to be an effective distraction technique in reducing anxiety levels in children during cast removal.     

Deterioration in quality of life and depressive symptoms during radiation therapy for head and neck cancer.

OBJECTIVE: The aim of this study was to assess the quality of life and psychologic profile during radiation therapy for head and neck cancer. STUDY DESIGN AND SETTING: The University of Washington QoL instrument and the Hospital Anxiety and Depression Scale were administered to 202 patients at two or three time points during radiation therapy. RESULTS: A total of 118 (54.6%) patients completed the questionnaires at the beginning and at the end of the study. A mid-treatment dataset was also available for 67 (31.0%) patients. There was a statistically significant deterioration in composite QoL scores (P < 0.000) and a statistically significant increase in depression (P < 0.000). There was no difference in anxiety levels (P = 0.276). CONCLUSION: Patients undergoing radiation are increasingly depressed as treatment progresses, with worsening QoL during the treatment. SIGNIFICANCE: This study underlines the need for good psychologic support during radiation therapy in head and neck cancer.     

A Comparison of Microneedling versus Glycolic Acid Chemical Peel for the Treatment of Acne Scarring

BackgroundAcne vulgaris is a common skin disease that frequently results in scarring. Scars secondary to acne can lead to physical disfigurements and a profound psychological impact. Early and effective treatment is the best means to minimize and prevent acne scarring. In patients with darker skin tones, current acne scar treatments pose complications, including dyspigmentation, further scarring, and overall unsatisfactory clinical outcomes.ObjectiveWe sought to compare the efficacy of microneedling versus 35% glycolic acid chemical peels for the treatment of acne scars.MethodsSixty patients with Fitzpatrick Skin Phototype IV to VI with atrophic acne scars were randomized into two groups: Group A underwent microneedling every two weeks for a total of 12 weeks and Group B received chemical peels every two weeks for a total of 12 weeks. Acne scar treatment efficacy was represented by an improvement greater than one grade from baseline according to the Goodman and Baron Scarring Grading System, measured two weeks after the completion of the last treatment session.ResultsGroup A demonstrated more improved outcomes in acne scar treatment compared to Group B; 73.33% (n=22) of patients in Group A achieved treatment efficacy while 33.33% (n=10) in Group B did the same. Additionally, 26.67% (n=8) in Group A showed no efficacy after treatment compared to 66.67% (n=20) in Group B.ConclusionMicroneedling provided better treatment outcomes compared to 35% glycolic acid peels for acne scar treatment in our patient population with Fitzpatrick Skin Phototypes IV to VI.     

Effective Intense Pulsed Light Protocol in the Treatment of Moderate to Severe Acne Vulgaris of the Chest and Back

Background Acne is defined as a chronic inflammatory disease of the pilosebaceous units, mainly affecting the face of young adults, but the chest and back can be involved as well. Oral antibiotics, topical retinoids, azelaic acid, benzoyl peroxide, and isotretinoin represent the most common treatment used for the treatment of acne, but several adverse effects and a lack of durable remission, with poor adherence by the patients, have been reported thus far. Lasers have been shown to be effective and safe to treat acne; intense pulsed light (IPL) demonstrates high efficacy rates, minimal discomfort, rapid recovery times, and excellent cosmetic and therapeutic outcomes.ObjectiveIn this prospective study, we assessed the efficacy, safety, and reproducibility of a novel IPL protocol as a monotherapy in the treatment of acne of the chest and back.MethodsWe included patients (N=50) aged 14 to 30 who presented with moderate papulopustular acne sited on the chest and back (Cook’s Acne Grading Scale method 4–6, Pillsbury Scale III–IV). We performed four IPL sessions at two-week intervals on each patient.ResultsAn excellent outcome was achieved in 50 percent of the patients and a good outcome in the 35 percent of the patients. Patients experienced light erythema and mild burning as the most common side effects, which spontaneously resolved within 24 to 96 hours.ConclusionConsistent with previous reports, our study demonstrated IPL to be a safe and effective treatment for severe cases of acne on the chest and back, providing excellent aesthetic and therapeutic results in 85 percent of treated patients.