Does nutrition affect the prognosis of aged hemodialysis patients?

Most authors agree that the prevalence of malnutrition is increased in patients treated by dialysis, particularly in the elderly. Malnutrition is a powerful risk factor for mortality; however, the strong association between nutritional status and mortality does not mean a causal relationship. It has been proposed that nutritional disorders that may occur in dialysis patients are mainly related to two different mechanisms. The first type of malnutrition is associated with a low protein and energy intake due to uremic toxicity, to physical changes and to psychosocial and psycho economic factors frequently found in the elderly. The second type of malnutrition is associated with increased protein catabolism from inflammatory origin. In the later case there are strong interactions between atherosclerotic cardiovascular disease, inflammation and nutritional parameters. Up to now the treatments have aimed at improving nutritional intake by increasing dialysis doses in association with dietary counselling and protein/calories supplementation. Complementary anti-inflammatory therapies acting on the inflammatory component of malnutrition may have a beneficial effect on the outcome of these patients.     

Does fibromyalgia affect the outcomes of local steroid treatment in patients with carpal tunnel syndrome?

Carpal tunnel syndrome (CTS) and fibromyalgia (FM) are common diseases in adult women. The aim of this study was to investigate the effect of FM on the outcome of local steroid treatment in patients with CTS. Forty-eight female patients with CTS and 26 female patients with CTS who also met the 1990 American College of Rheumatology (ACR) criteria for FM were enrolled the study. All patients underwent single steroid injections into the carpal tunnel. Response to injection was measured using Boston Questionnaire (BQ) and electrophysiological tests. The BQ scores and electrophysiological findings showed significant improvement 3 months after the treatment in both groups ( P<0.001). However, less improvement in BQ symptom severity scores was observed in the FM group than the other group ( P<0.05). Bilateral CTS was also more common in the FM group ( P<0.05). The present data suggest that FM must be kept in mind in patients with CTS giving poor response to local steroid treatment.     

Does the treatment of peritonitis affect residual renal function in CAPD?

The aim of the study was a retrospective analysis of potentially negative influence of aminoglycosides on RRF in patients with peritonitis in course of CAPD program. From the group of 47 patients of our center who were treated because of peritonitis in years 1991-2000 we finally selected 11 persons with preserved RRF in whom 16 incidents of peritonitis were revealed. The mean value of RRF in this group was 1.55 (+/- 2.0) ml/min before the treatment and 1.44 (+/- 2.2) ml/mi after the treatment of peritonitis. There was no statistical difference between these values (p = 0.32). It was also revealed that in 5 cases (31%) RRF decreased after the peritonitis treatment while in 7 cases (44%) no change of RRF value was observed and in 4 cases (25%) RRF value was increased after the treatment of peritonitis. The efficacy of treatment with the standard protocol in observed group was 93.75%. On the base of performed analysis no negative influence of peritonitis therapy with aminoglycosides and I-st generation cephalosporines was observed. It was stated that aminoglycosides may still be used in peritonitis therapy under the condition that precise monitoring of RRF will be introduced.     

Does the omission of vincristine in patients with diffuse large B cell lymphoma affect treatment outcome?

The standard treatment for diffuse large B cell lymphoma (DLBCL) is rituximab with CHOP (cyclophosphamide, doxorubicin, vincristine (VCR), and prednisone). Maintaining high dose intensity of cytotoxic treatment has been associated with better outcome but little is known about the role of maintaining VCR. This study aimed to answer whether the omission of vincristine due to neurotoxicity affects patient outcome. A Swedish cohort of patients primarily treated with curative intent for DLBCL or high-grade malignant B cell lymphoma was retrospectively analyzed. In total, 541 patients treated between 2000 and 2013 were included. Omission of VCR was decided in 95 (17.6%) patients and was more often decided during the last three cycles (n?=?86, 90.5%). The omission of VCR did not affect disease-free or overall survival neither in the whole cohort nor in elderly patients. On the contrary, the relative dose intensity of doxorubicin was associated with overall survival (p?=?0.014). Kidney or adrenal involvement (p?=?0.014) as well as bulky disease (p?=?0.037) was found to be associated with worse overall survival. According to our results, clinicians can safely decide to omit VCR in case of severe neurotoxicity due to VCR but should be aware of the importance of giving adequate doses of doxorubicin during treatment given the growing body of evidence on the role of dose intensity on survival. Considering the association of bulky disease and kidney/adrenal manifestation of lymphoma on survival, further studies should focus on whether the treatment options for these subgroups need to be individualized.     

Does socioeconomic status affect blood pressure goal achievement?

Hypertension is a major cause of disease burden in all racial, ethnic, and socioeconomic groups in developing and developed regions and countries. Differences in blood pressure likely begin early in life and reflect a complex relationship of biologic, genetic, social, and environmental interactions. The relationship between socioeconomic status and hypertension is complex and difficult to measure. Instituting lifestyle changes for the primary prevention and treatment of hypertension among the general population would decrease prevalence, improve blood pressure control, and be effective in eliminating many socioeconomic differences in risk factors for cardiovascular disease. Health care providers can potentially impact blood pressure control by incorporating knowledge of socioeconomic factors and mechanisms in care delivery. This review highlights socioeconomic status in the prevalence and incidence of hypertension and identifies contributing factors associated with blood pressure control.     

Does inspiratory behaviour affect the efficiency of non-invasive ventilation in COPD patients?

Non-invasive ventilation (NIV) is more and more used. Some failures of the technique have been reported, and efforts are needed to understand them. Collaboration (inspiratory behaviour) of the patient during NIV could play a role in the success of this technique. We have studied the influence of this one on the efficiency of NIV. While ventilating 10 stable chronic obstructive pulmonary disease patients with a nasal pressure support ventilation (PSV), we measured their flow and volume with a pneumotachograph and oesophageal and gastric pressures during three different respiratory voluntary behaviours: relaxed inspiration, active inspiratory effort and resisted inspiration. We showed that when compared with the relaxed inspiration: (a) Active inspiratory effort increases slightly minute ventilation from 14.8 +/- 4.7 to 15.41 +/- 4.19 during PSV 10/0 without change of breathing frequency but with an important increase of inspiratory work (W(OB)) from 14.47 +/- 9.43 to 28.55 +/- 25.35 J/min (P=0.008). PEEPi increases with active behaviour during PSV but not during BiPAP. (b) A resisted inspiration decreases inspiratory work (to 7.53 +/- 8.6 J/min) at the price of a decrease of the minute ventilation to 11.47 +/- 4.20 l/min (P=0.06). Results of ventilation, PEEPi and work parameters were identical during the bilevel pressure support (15/5 cm H2O). The aims of NIV being to increase ventilation and unload the inspiratory muscles, our results suggest that during NIV, a relaxed spontaneous breathing is preferable. These differences between the inspiratory behaviours could affect the expected benefits of PSV in acutely ill patients.     

Hypertension and dementia: Does blood pressure control favorably affect cognition?

Dementia and aging are not synonymous. Dementia is a progressive deterioration in cognitive and social and/or occupational functions that can eventually impair a patient’s ability to live independently. Alzheimer’s disease is the most common form of dementia. It accounts for 50% to 70% of all patients with dementia. Vascular dementia, responsible for up to 15% of all diagnosed cases, is the second most common form of dementia. Hypertension remains a significant risk factor for vascular dementia. The optimal level of blood pressure control for the prevention of dementia and whether one particular class of antihypertensive drug is more beneficial than another remains uncertain.     

Does the mode of inhalation affect the bronchodilator response in patients with severe COPD?

Spacing devices improve lung deposition of aerosols from metered dose inhalers (MDI) but it is sometimes difficult for dyspnoeic patients to perform maximal breaths with breath-holds needed to inhale the aerosols from them. Our aim was to determine whether the response to bronchodilators (BD) depended on the method of inhalation. We studied 20 patients with moderately severe chronic obstructive pulmonary disease (COPD) with a mean age of 68 years and a mean of forced expiratory volume in 1 sec (FEV1) of 41% predicted. In a randomized, cross-over fashion they inhaled terbutaline 1.5 mg (six puffs) followed by ipratropium 120 microg (six puffs) via MDI and nebuhaler with either two inspirations to total lung capacity and a 10-sec breath-hold per puff or with six tidal breaths per puff. Before and after BDs we measured FEV1, forced vital capacity (FVC), airways resistance using interrupter method (Rint) and 6-min walking distance (6MWD). Subsequently, we re-tested nine of these patients with the two methods of inhalation, before and after conventional doses (terbutaline 500 microg+ipratropium 40 microg), then after terbutaline 1 mg and ipratropium 80 microg and finally after nebulized terbutaline 5 mg and ipratropium 500 microg to sec whether there was a dose-dependent difference in effect between the two methods. Spirometry, slow vital capacity (SVC). inspiratory capacity and shuttle walking tests were monitored. In the original 20 patients there were highly significant improvements in all parameters after inhalers, with no significant difference between methods of inhalation. Median improvements after BDs were: FEV1 0.221 and 0.191, FVC 0.501 and 0.381 and 6MWD 40 m and 44 m, for maximal breaths and tidal breathing, respectively. For nine patients, tidal and maximal breaths produced similar effects on lung function and exercise tolerance at both doses of BDs. Nebulized BDs only improved shuttle distances slightly when compared with either method of inhalation from MDI and spacer but had no additional effect on lung function. In conclusion, in patients with moderately severe COPD, BDs given by metered dose inhaler via nebuhaler have similar effects whether given by six easy tidal breaths or the more difficult two maximal breaths with breath-hold. This holds true at small or larger doses of BD. Either method of inhaling six puffs of the BDs can be used as an effective alternative to nebulized aerosol.     

Does age bias the aggressive treatment of elderly patients with rheumatoid arthritis?

OBJECTIVE: Age bias has been reported to result in undertreatment of elderly patients with various medical conditions. We investigated whether a similar bias exists in the treatment of elderly patients with rheumatoid arthritis (ELDRA) compared to matched younger controls (YRA). METHODS: We performed an analysis of our RA clinical research registry to determine whether any differences exist between ELDRA and YRA patients with respect to use of combination disease modifying antirheumatic drugs (DMARD), biologic agents, corticosteroids, and nonsteroidal antiinflammatory drugs (NSAID). We also determined whether any difference in clinical status could be identified. RESULTS: Forty-nine female ELDRA subjects (age > 70 yrs) with insurance were matched for sex, insurance status, and duration of disease to YRA subjects (< 60 yrs). No statistically significant difference was noted in number of DMARD currently in use (1.24 +/- 0.78 vs 1.24 +/- 0.69, p = 1.00), or number of patients using biologic agents (25 vs 30; p = 0.31), corticosteroids (16 vs 11; p = 0.26), or NSAID (26 vs 36; p = 0.06). ELDRA and YRA patients also reported similar pain (judged using a visual analog scale, VAS; 3.5 +/- 2.6 cm vs 3.4 +/- 2.2 cm), fatigue (VAS 3.2 +/- 2.7 cm vs 3.9 +/- 2.9 cm), global assessment (VAS 2.8 +/- 2.2 cm vs 3.5 +/- 2.6 cm), and Health Assessment Questionnaire disability scores (0.82 +/- 0.5 vs 0.73 +/- 0.5). CONCLUSION: In this cohort of elderly patients with RA, we detected no bias in the use of RA treatment compared with younger controls. Clinical RA measures also showed that these elderly patients with RA were faring at least as well as the younger controls; they were not relatively undertreated.     

Does atopy affect the course of viral pneumonia?

Background

The presence of atopy is considered as a risk factor for severe respiratory symptoms in children. The objective of this study was to examine the effect of atopy on the course of disease in children hospitalised with viral pneumonia.

Does aging affect the use of shifting standards?

Prior research on the use of stereotypes in social judgments has shown that whether young adults make stereotype-consistent or -inconsistent judgments depends in part upon the response scale that is used. This shifting standards effect in stereotype use was examined in the present study to determine whether older adults, who tend to rely on stereotypes more than younger adults, would also show a similar effect. Young and older adults evaluated the height of male and female targets using either an objective or subjective scale. No age differences were found, with both age groups producing stereotype-consistent judgments (i.e., men are taller than women) on an objective scale, but stereotype-inconsistent judgments (i.e., men and women are equally tall) on a subjective scale. These results suggest that the shifting standards effect holds across the adult life span.     

Does claudication affect the development of coronary collaterals?

Atherothrombosis is a generalized disease process that affects large- and medium-diameter arteries throughout the arterial tree. In this study, we aimed to evaluate the correlation between collaterals in different vascular beds. Patients who had undergone digital subtraction angiography for symptomatic lower extremity peripheral arterial disease and coronary angiography after an acute anterior myocardial infarction (MI) were compared with a control group composed of those patients who were hospitalized for acute anterior MI and underwent coronary angiography but had no claudication and had an ankle-brachial index of greater than 0.9 in both legs. In claudicants, stenosis in the left anterior descending artery (LAD) (90.3 ± 17.5 vs 78.6 ± 13.8, P = 0.005) was greater compared with the patients without claudication. The collaterals to the LAD (88% vs 37.5%, P = 0.001) and the collateral grades (1.7 ± 0.7 vs 0.7 ± 0.9, P = 0.001) were higher in the patients with claudication compared with those without claudication. A previous history of angina (52.2% vs 16.3%, P = 0.001), claudication (39.1% vs 4.6%, P = 0.001), and peripheral collaterals (45.7% vs 6.9%, P = 0.001) were higher in the patients with coronary collaterals than in those without. The factors affecting the development of coronary collaterals were claudication [relative risk (RR): 8.8; 95% confidence interval (CI): 2.1–39.8], peripheral collaterals (RR: 1.1; 95% CI: 1.1–1.3), and LAD stenosis (RR: 1.2; 95% CI: 0.03–29.1). Our results suggest that the presence of collateralization or angiogenesis in one vascular bed highly predicts collateralization in another arterial bed.