Relationships between exercise capacity and anxiety,depression, and cognition in patients with heart failure

Background

Symptoms of anxiety, depression, and cognitive impairment are common in heart failure (HF) patients, but there are inconsistencies in the literature regarding their relationship and effects on exercise capacity.

Concomitant Functional Gastrointestinal Symptoms Influence Psychological Status in Korean Migraine Patients

Background/Aims

Migraine is frequently accompanied by symptoms consistent with functional gastrointestinal disorders (FGIDs). This study evaluated the prevalence of functional gastrointestinal symptoms and assessed the symptoms'' relationship with the concomitant functional symptoms of anxiety, depression, and headache-related disability.

Methods

This prospective study included 109 patients with migraine who were recruited from a headache clinic at a teaching hospital. The participants completed a self-administered survey that collected information on headache characteristics, functional gastrointestinal symptoms (using Rome III criteria to classify FGID), anxiety, depression, and headache-related disability.

Results

In total, 71% of patients met the Rome III criteria for at least one FGID. In patients with FGID, irritable bowel syndrome was the most common symptom (40.4%), followed by nausea and vomiting syndrome (24.8%) and functional dyspepsia (23.9%). Depression and anxiety scores were significantly higher in patients meeting the criteria for any FGID. The number of the symptoms consistent with FGID in individual patients correlated positively with depression and anxiety.

Conclusions

FGID symptoms defined by the Rome III criteria are highly prevalent in migraine. These symptoms correlate with psychological comorbidities, such as depression and anxiety.     

Effect of symptoms on physical performance in COPD

Background

Chronic obstructive pulmonary disease (COPD) patients experience multiple symptoms including dyspnea, anxiety, depression, and fatigue, which are highly correlated with each other. Together, those symptoms may contribute to impaired physical performance.

Does Anxiety or Waiting Time Influence Patients' Tolerance of Upper Endoscopy?

Background/Aims:

Endoscopy is an essential and very commonly used procedure for the evaluation of a multitude of gastrointestinal symptoms. Although it is increasingly required, patients often wait on arrival at the endoscopy unit until they are called for the procedure. It is not clear whether or not this waiting time may have an impact on patient''s tolerance during upper endoscopy. Our study attempts to address this.

Patients and Methods:

We studied consecutive outpatients who underwent endoscopy from September to December, 2013. Gender, age, body mass index (BMI), previous endoscopic experiences, antidepressant therapy, and the time interval between arrival at the endoscopy unit and the onset of examination was recorded. Anxiety before the procedure, pain, and discomfort were rated by a numeric rating scale (0 = no pain/discomfort encountered to 10 = extremely painful/uncomfortable).

Results:

One hundred and five consecutive outpatients (male = 52; mean age = 45.3 years; age range = 20–86 years) were included in the study. The mean BMI was 25 ± 4.8; mean waiting time from registration to the procedure was  172 min (time range = 30 - 375 mins). Mean patients'' pre-examination anxiety level was 3 ± 3.84, mean discomfort score was 4.3 ± 3.09 and mean pain score was 3.4 ± 3.03. The level of pain and discomfort was significantly higher in patients with higher levels of pre-procedure anxiety. No differences were found in terms of anxiety, pain and discomfort among patients divided according to waiting time.

Conclusions:

According to our data, waiting time does not have a significant impact on the perception of pain and discomfort related to the endoscopic procedure. On the other hand, high pre-procedural levels of anxiety were associated with a low tolerance. Further multicenter randomized trials are needed to clarify the impact of waiting time.     

Is there an association between symptoms of anxiety and depression and quality of life in patients with chronic obstructive pulmonary disease?

BACKGROUND:

In addition to symptoms, such as dyspnea and fatigue, patients with chronic obstructive pulmonary disease (COPD) also experience mood disturbances.

OBJECTIVE:

To explore the relationships between health-related quality of life measures collected from patients with stable COPD and a commonly used measure of depression and anxiety.

METHODS:

The present analysis was a retrospective study of patients with COPD enrolled in a pulmonary rehabilitation program. Hospital Anxiety and Depression Scale (HADS), Chronic Respiratory Disease Questionnaire (CRQ), Medical Research Council dyspnea scale and 6 min walk test data were collected. Statistical analyses were performed using Spearman’s correlations, and categorical regression and categorical principal component analysis were interpreted using the biplot methodology.

RESULTS:

HADS anxiety scores retrieved from 80 patients were grouped as ‘no anxiety’ (n=43 [54%]), ‘probable anxiety’ (n=21 [26%]) and ‘presence of anxiety’ (n=16 [20%]). HADS depression scores were similarly grouped. There was a moderate relationship between the anxiety subscale of the HADS and both the emotional function (r=−0.519; P<0.01) and mastery (r=−0.553; P<0.01) domains of the CRQ. Categorical regression showed that the CRQ-mastery domain explained 40% of the total variation in anxiety. A principal component analysis biplot showed that the highest distance between the groups was along the mastery domain, which separated patients without feelings of anxiety from those with anxiety. However, none of the CRQ domains were able to discriminate the three depression groups.

CONCLUSIONS:

The CRQ-mastery domain may identify symptoms of anxiety in patients with COPD; however, the relationship is not strong enough to use the CRQ-mastery domain as a surrogate measure. None of the CRQ domains were able to discriminate the three depression groups (no depression, probable and presence); therefore, specific, validated tools to identify symptoms of depression should be used.     

Echocardiographic diagnoses in HIV-infected patients presenting with cardiac symptoms at Muhimbili National Hospital in Dar es Salaam, Tanzania

Objective

To determine the pattern of echocardiographic diagnoses in HIV-infected patients presenting with cardiac symptoms at Muhimbili National Hospital in Dar es Salaam, Tanzania.

Methods

Patients known to be HIV positive and with cardiac complaints were prospectively recruited from the Hospital’s care and treatment centre as well as from the medical wards. Clinical assessment, laboratory tests and echocardiography were performed.

Results

A total of 102 patients were recruited from September 2009 to April 2010. The patients’ mean age was 42.4 years and 68.6% were women. The most common diagnosis was pericardial effusion present in 41.2% of the patients. The effusion was large in 5.9% and small in 35.3% of the patients. Hypertensive heart disease was diagnosed in 34.3%, while pulmonary hypertension and dilated cardiomyopathy were present in 12.7 and 9.8%, respectively.

Conclusion

Cardiac abnormalities are common in HIV-infected patients, particularly when they present with symptoms.     

Patient activation with respect to advanced heart failure therapy in patients over age 65 years

Background

Clinical and ethical issues persist in determining candidacy for advanced heart failure (HF) therapies in elderly patients. Selection takes many factors into account, including “activation” (engagement and ability to self-manage).

Seroprevalence of hepatitis B virus among hemodialysis patients in Bushehr province, southern Iran: HBV seroprevalence in hemodialysis patients

Background

Hepatitis B virus (HBV) infection is still reported from adult hemodialysis units.

Objectives

To determine the prevalence of anti-HBs antibody in hemodialysis patients and the correlation between levels of anti-HBs antibody with other factors.

Patients and Methods

HBsAg, anti-HBs and anti-HBc antibodies level in 119 hemodialysis patients were evaluated by enzyme-linked immunosorbent assay.

Results

Seroconversion (anti-HBs antibody >10 IU/L) was found in 22 patients. Minimum protective antibody level was found in patients aged ≥60 years. Statistically significant correlation was not found between anti-HBs antibody and gender. Ten (8.4%) patients had abnormal ALT and/or AST. Prevalence of HBsAg, anti-HBc antibody, HBeAg and anti-HBe antibody were found in 8 (6.72%), 24 (25.16%), 2 (1.68%) and 3 (2.52%) patients, respectively.

Conclusions

Periodic assessment of anti-HBs antibody level is strongly recommended in patients undergoing hemodialysis.     

Prevalence of microalbuminuria in hypertensive patients and its associated cardiovascular risk in clinical cardiology: Moroccan results of the global i-SEAR CH survey – a sub-analysis of a survey with 21 050 patients in 26 countries worldwide

Objectives

To determine the prevalence of microalbuminuria (MAU) in hypertensive outpatients visiting a cardiologist’s office or clinic and to describe the relationship between MAU and cardiovascular risk factors.

Methods

This was an international, observational, cross-sectional study of 22 282 patients, with 457 subjects from Morocco in 40 cardiology centres. Inclusion criteria were: male and female outpatients aged ≥ 18 years with currently treated or newly diagnosed hypertension (≥ 140/90 mmHg at rest on the day of the study visit) and no reason for false positive microalbuminuria dipstick tests.

Outcome measures

Prevalence of microalbuminuria assessed using a dipstick test, co-morbid cardiovascular risk factors or disease and their relationship with the presence of MAU, and role of pharmacotherapy in modulating the prevalence of MAU.

Results

The prevalence of microalbuminuria in hypertensive patients in Morocco (67.8%) was high compared to the worldwide prevalence (58.3%). Despite the fact that all physicians regarded MAU as important for risk assessment and therapeutic decisions, routine MAU measurement was performed in only 35% of the practices. In clinical cardiology, MAU is highly correlated with a wide variety of cardiovascular risk factors and cardiovascular disease.While angiotensin receptor blockers (ARBs) appeared to be associated with the lowest risk of MAU, calcium channel blockers (CCBs) were more often used in this patient group.

Conclusions

Hypertensive, high-risk cardiovascular patients are common in clinical cardiology. Given the high prevalence detected, screening of MAU in addition to more aggressive multi-factorial treatment to reduce blood pressure as well as other cardiovascular risk factors is required.     

Increased relative wall thickness is a marker of subclinical cardiac target-organ damage in African diabetic patients

Objective

To assess the prevalence and covariates of abnormal left ventricular (LV) geometry in diabetic outpatients attending Muhimbili National Hospital in Dar es Salaam, Tanzania.

Methods

Echocardiography was performed in 61 type 1 and 123 type 2 diabetes patients. LV hypertrophy was taken as LV mass/height^2.7 > 49.2 g/m^2.7 in men and > 46.7 g/m^2.7 in women. Relative wall thickness (RWT) was calculated as the ratio of LV posterior wall thickness to end-diastolic radius and considered increased if ≥ 0.43. LV geometry was defined from LV mass index and RWT in combination.

Results

The most common abnormal LV geometries were concentric remodelling in type 1 (30%) and concentric hypertrophy in type 2 (36.7%) diabetes patients. Overall, increased RWT was present in 58% of the patients. In multivariate analyses, higher RWT was independently associated with hypertension, longer isovolumic relaxation time, lower stress-corrected midwall shortening and circumferential end-systolic stress, both in type 1 (multiple R² = 0.73) and type 2 diabetes patients (multiple R² = 0.66), both p < 0.001. These associations were independent of gender, LV hypertrophy or renal dysfunction.

Conclusion

Increased RWT is common among diabetic sub-Saharan Africans and is associated with hypertension and LV dysfunction.     

Temperament and character profiles of male COPD patients

Background

Chronic obstructive pulmonary disease (COPD) is a respiratory disorder, and is characterized by persistent airflow obstruction. These patients are exposed to severe physical limitations and substantial psychosocial trouble. The aims of this study were to determine the temperament and character profiles of personality in patients with COPD and to compare the results with those of healthy controls.

Methods

Thirty-nine male COPD patients and 67 age- and gender-matched healthy controls completed the self-administered 240-item temperament and character inventory (TCI) and 14-item hospital anxiety and depression scale. The relationships between temperament and character personality profiles and clinical factors such as severity of COPD, anxiety, and depression were evaluated.

Results

COPD patients had significantly higher mean scores of Harm avoidance and lower mean score of Self-directedness than those of healthy controls. In the COPD patients, the anxiety score was significantly higher (P=0.03) and the depression score was found to be insignificantly higher than that of control group. The TCI profiles were not correlated with the severity of COPD. In COPD patients, Self-directedness and Cooperativeness traits of TCI character negatively correlated with anxiety, but any of traits did not correlate with depression.

Conclusions

The present study defined the Harm avoidance score was higher and Self-directedness was lower in COPD patients and the COPD severity did not correlate with any of the personality trait. We suggest that during evaluation of COPD patients for treatment, personality trait should also be considered in clinical practice.KEY WORDS : Temperament, character, personality, chronic obstructive pulmonary disease (COPD)     

Anxiety,Depression, and Health-Related QOL in Patients Diagnosed with PAH or CTEPH

Background

Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are life-threatening diseases with a high burden of symptoms. Although depression, anxiety, and reduced health related quality of life (HRQOL) have also been reported, a comparative analysis which explores these traits and their underlying factors was lacking.

Methods

A retrospective analysis of depression, anxiety, and health related QOL was conducted using a Hospital anxiety and depression scale (HADS) as well as the SF-36 HRQOL questionnaire. Results from these tools were compared with haemodynamic and functional parameters in 70 PAH and 23 CTEPH outpatients from a German tertiary care center specializing in pulmonary hypertension.

Results

Although HRQOL was reduced in both cohorts of patients, individuals diagnosed with CTEPH scored lower in nearly all SF-36 parameters. Significance was noted in both “mental health” (p = 0.01) and “mental component summary score” (MCS) (p = 0.02). Depression was also more frequent in patients with CTEPH (56%) than in patients with PAH (30%), (p = 0.03). Overall, depression and anxiety correlated with most SF-36 scales in both PAH and CTEPH. In CTEPH, depression also correlated with the Borg Dyspnea Scale (r = 0.44, p = 0.01). These patients also had significantly lower pCO₂ levels than the PAH cohort reflecting more severe ventilation/perfusion mismatch. All other haemodynamic and functional parameters did not differ across the groups.

Conclusion

While both cohorts of patients suffer from a reduced HRQOL as well as depression and anxiety, decreases in mental health parameters are more pronounced in the CTEPH cohort. This suggests a strong effort to improve early detection, especially in dyspneic patients with classical risk factors for CTEPH and PAH and argues for mental illness interventions alongside routine clinical care provided to patients diagnosed with PAH or CTEPH.

     

Correlates of memory loss and depression among myocardial infarction patients in Al-Qassim,Saudi Arabia

Background

After myocardial infarction (MI), patients have an elevated risk for depression, which has a negative impact on morbidity and mortality for patients. As depression and memory function are associated, we examined them in the context of one another. Our objectives were to determine the proportion of patients with either depression only, memory loss only, or both depression and memory loss and to examine the correlates with each outcome.

Association Between Race, Depression, and Antiretroviral Therapy Adherence in a Low-Income Population with HIV Infection

Background

Racial disparities exist in many aspects of HIV/AIDS. Comorbid depression adds to the complexity of disease management. However, prior research does not clearly show an association between race and antiretroviral therapy (ART) adherence, or depression and adherence. It is also not known whether the co-existence of depression modifies any racial differences that may exist.

Objective

To examine racial differences in ART adherence and whether the presence of comorbid depression moderates these differences among Medicaid-enrolled HIV-infected patients.

Design

Retrospective cohort study.

Setting

Multi-state Medicaid database (Thomson Reuters MarketScan®).

Participants

Data for 7,034 HIV-infected patients with at least two months of antiretroviral drug claims between 2003 and 2007 were assessed.

Main Measures

Antiretroviral therapy adherence (90 % days covered) were measured for a 12-month period. The main independent variables of interest were race and depression. Other covariates included patient variables, clinical variables (comorbidity and disease severity), and therapy-related variables.

Key Results

In this study sample, over 66 % of patients were of black race, and almost 50 % experienced depression during the study period. A significantly higher portion of non-black patients were able to achieve optimal adherence (≥90 %) compared to black patients (38.6 % vs. 28.7 %, p < 0.001). In fact, black patients had nearly 30 % decreased odds of being optimally adherent to antiretroviral drugs compared to non-black patients (OR = 0.70, 95 % CI: 0.63–0.78), and was unchanged regard less of whether the patient had depression. Antidepressant treatment nearly doubled the odds of optimal ART adherence among patients with depression (OR = 1.92, 95 % CI: 1.12–3.29).

Conclusions

Black race was significantly associated with worse ART adherence, which was not modified by the presence of depression. Under-diagnosis and under-treatment of depression may hinder ART adherence among HIV-infected patients of all races.KEY WORDS: HIV, adherence, depression, race, Medicaid     

Bilateral thoracoscopic sympathectomy for primary hyperhydrosis: a review of 335 cases

Objective

The goal of this retrospective study was to evaluate the outcomes of bilateral video-assisted thoracoscopic sympathectomy for primary hyperhydrosis.

Methods

Between January 2007 and December 2011, a total of 335 patients (192 male, 143 female, mean age 28.3 years) who underwent bilateral thoracoscopic sympathectomy for primary hyperhydrosis were reviewed retrospectively.

Results

Hyperhydrosis occurred in the palmar and axillary region in 175 (52.23%) patients, in only the palmar region in 52 (15.52%), in the craniofacial region in 44 (13.13%), in only the axillary region in 42 (12.53%), and in the palmar and pedal regions in 22 (6.56%) patients. Bilateral thoracoscopic sympathectomy was performed in all patients. The mean follow-up period was 24 (6–48) months. The initial cure rate was 95% and the initial satisfaction rate was 93%. There was no mortality in this study. The complication rate was 15.82% in 53 patients.

Conclusion

Video-assisted thoracoscopic sympathectomy for the treatment of primary hyperhydrosis was effective, with low rates of morbidity and mortality. Despite the appearance of postoperative complications, such as compensatory sweating, patient satisfaction with the procedure was high and their quality of life improved.     

Depression in newly diagnosed type 2 diabetes

Objective:

To investigate the incidence of depression in newly diagnosed type 2 diabetes. Materials and

Methods:

One hundred newly diagnosed (4 – 12 weeks) T2DM participants were evaluated for depressive symptoms by using the Self-Rating Depression Scale (SDS). Blood glucose (HBA1C), urinary albumin, BMI, and blood pressure were measured. Sexual function was evaluated by a self-score on IIEF-5 Questionnaires in male participants below 60 years of age.

Results:

Twenty-eight (28%) of these had depressive scores, 18 (18%) had mild scores, six (6%) had moderate scores, and four had (4%) severe ones. In those who took oral medication, the percentage of depression was 18.5% (10/54) and in those who were treated by insulin the percentage was 39.1% (18/46). The levels of fasting blood glucose (FBG), HBA1c, and urinary albumin were higher in those with depression. The SDS score was negatively correlated with age and annual household income (r = 0.151,0.139, P < 0.05); 17% of the (8/48) males below 60 years of age was diagnosed with erectile dysfunction (ED) by II EF-5score < 20 and the severity of depressive symptoms was negatively correlated with II EF-5score (r = 0.131, P < 0.05).

Conclusion:

These findings indicated that depressive symptoms are common in newly diagnosed type 2 diabetics. A variety of factors could be influencing the severity of depressive symptoms.     

The effect of combined resistance and home-based walking exercise in type 2 diabetes patients

Aims:

The aim of this study was to evaluate the effect of combined resistance and home-based walking exercise on glycemic and metabolic control, depression and quality of life in type-2 diabetes patients.

Methods:

This prospective study was conducted at a private hospital in Turkey. Thirty-six type-2 diabetic patients participated in the study. Subjects were randomly distributed in one 8 week exercise intervention or in one control group. Exercise program consisted of resistance training and home-based walking. Before and after the training program, muscular strength, fasting blood glucose, hemoglobin A1C, (HbA1C) and plasma lipid values, quality of life and symptoms of depression of the patients were assessed.

Results:

Exercise group''s baseline HbA1C was significantly higher than the control groups (p< 0.05); other blood parameters were similar between the two groups (p>0.05). At the baseline no significant differences were observed in the depression and four subscales (physical function, physical role, bodily pain, and general health perceptions) of the SF-36 between the exercise and control groups (p>0.05). The exercise group had higher scores of emotional role, vitality and mental health subscales than the control groups after the training programs (p<0.05).

Conclusion:

Exercise training which included resistance training and home- based walking could be safe, effective and beneficial in diabetic patients.     

Depression,anxiety, stress,and motivation over the course of smoking cessation treatment

Objective:

To evaluate changes in the levels of patient anxiety, depression, motivation, and stress over the course of smoking cessation treatment.

Methods:

This cohort study involved patients enrolled in a smoking cessation program in Cuiabá, Brazil. We selected patients who completed the program in six months or less (n = 142). Patient evaluations were conducted at enrollment (evaluation 1 [E1]); after 45 days of treatment with medication and cognitive-behavioral therapy (E2); and at the end of the six-month study period (E3). Patients were evaluated with a standardized questionnaire (to collect sociodemographic data and determine smoking status), as well as with the University of Rhode Island Change Assessment scale, Beck Anxiety Inventory, Beck Depression Inventory, and Lipp Inventory of Stress Symptoms for Adults. The data were analyzed with the nonparametric Wilcoxon test for paired comparisons. To compare treatment success (smoking cessation) with treatment failure, the test for two proportions was used.

Results:

Among the 142 patients evaluated, there were improvements, in terms of the levels of anxiety, depression, motivation, and stress, between E1 and E2, as well as between E1 and E3. In addition, treatment success correlated significantly with the levels of motivation and anxiety throughout the study period, whereas it correlated significantly with the level of depression only at E2 and E3.

Conclusions:

We conclude that there are in fact changes in the levels of patient anxiety, depression, motivation, and stress over the course of smoking cessation treatment. Those changes appear to be more pronounced in patients in whom the treatment succeeded.     

Down syndrome and congenital heart disease: why the regional difference as observed in the Libyan experience?

Background

Children with Down syndrome (DS) have about a 40 to 50% incidence of congenital heart disease (CHD). The objectives of this study were to evaluate the distribution and frequency of CHD patterns in Libyan children with DS.

Methods

All patients with DS who were referred to the cardiology clinic between January 1995 and December 2008 were reviewed.

Results

Of the 1 193 patients reviewed, 537 (45%) had an associated CHD. Overall there were 349 (65%) patients who had a single cardiac lesion, and 188 (35%) had multiple cardiac lesions. The most common isolated cardiac lesion was atrial septal defect (ASD), found in 125 (23%) patients, followed by atrioventricular septal defect (AVSD) in 103 (19%), and ventricular septal defect (VSD) in 76 (14%).

Conclusion

Atrial septal defect was the most common cardiac lesion. The distribution of CHDs in Libyan children with DS was similar to what has been reported internationally, but the frequency was not compared with international rates.