The role of physical status versus mental status in predicting the quality of life of patients with lumbar disk herniation

Purpose: To explore the role of physical status versus mental status in predicting the quality of life (QOL) of patients with lumbar disk herniation (LDH).

Method: In this correlative study 51 patients with LDH were recruited in their conservative stage of treatment. After profiling their physical status, all participants reported about pain level (according to VAS), pain perception using the Pain Catastrophizing Scale (PCS), and disability level (according to Oswestry Low Back Pain Disability Questionnaire). Their mental status was evaluated using the Spielberger’s State-Trait Anxiety Inventory (STAI) and the Beck Depression Inventory (BDI-II). Their QOL was evaluated by the World Health Organization Quality of Life Questionnaire, brief version (WHOQOL-BREF).

Results: Physical status/disability level correlated with anxiety and depression. While Physical status predicted physical QOL, mental status, and mainly anxiety and depression were the significant predictors of psychological, social, and environmental QOL.

Conclusions: Mental status may play a significant role in reducing most QOL domains among patients with LDH. The evaluation and intervention process should consider both physical and mental status and their relation to the person's QOL. Since QOL is a major parameter in determining intervention type and success this elaborated perspective may contribute to the intervention planning and outcomes.

• Implications for rehabilitaion

• A significant mental distress may accompany the physical disability of patients with LDH.

• The role of this mental distress in reducing the QOL of patients with LDH may be greater than that of their physical disability.

• The evaluation and intervention for patients with LDH should refer to both physical and mental status and explore their impacts on quality of life in order to elevate intervention success.

     

Mifepristone-misoprostol abortion: a trial in rural and urban Maharashtra,India

As several important policy questions remain regarding the use of medical abortion in developing countries, we investigated the safety, efficacy, and acceptability of mifepristone-misoprostol abortion in the outpatient family planning departments of two urban hospitals and one rural hospital in India. Nine-hundred women (with gestations of < or =63 days in the urban sites and < or =56 days in the rural site) received 600 mg mifepristone followed 48 h later by 400 microg oral misoprostol in the clinic. Four point four percent or fewer urban women and 1.0% rural women were lost to follow-up. Perfect and typical-use failure rates were low at all sites. While rural women reported fewer side effects at all sites, the vast majority of women were satisfied with their medical abortions. Medical abortion can be offered safely, effectively, and acceptably in the outpatient family planning departments of urban and rural hospitals in India.     

The effect of erythropoietin therapy and hemoglobin levels on the immune response to Engerix-B vaccination in chronic kidney disease

BACKGROUND: Patients undergoing chronic hemodialysis have an increased risk of acquiring hepatitis B infection. Only 43-66% of dialysis patients develop effective anti-HBs titers after vaccination. AIM: To evaluate the effect of recombinant erythropoietin (rEPO) therapy and basal hemoglobin levels on the outcome of the immune response to four doses of IM 40 microg Engerix-B vaccination in hemodialysis and chronic kidney disease (CKD) patients before starting replacement therapy. SUBJECTS AND METHODS: One hundred and three patients were included in the study: 34 hemodialysis patients treated with rEPO (Group A), 36 predialytic patients who did not treated with rEPO (Group B) and 33 predialytic patients treated with rEPO (Group C). Plasma creatinine in predialytic patients was 2-7 mg/dL. All patients' HBsAg and anti-HBs antibodies were negative. Patients were immunized with IM 40 microg Engerix-B at 0, 1, 3, and 6 months. Anti-HBs titers were measured at 7th month. RESULTS: Eighty seven point one percent of patients from group C developed protective anti-HBs titers compared with 69.4% from group B and 44.1% from group A (p = 0.001). Patients from all groups with baseline hemoglobin levels above 11 gr/dL developed protective anti-HBs titers significantly more than patients with baseline hemoglobin levels below 11 gr/dL (p < 0.05). CONCLUSION: Predialytic patients treated with rEPO and with hemoglobin levels higher than 11 gr/dL had significantly better immune response outcomes to Engerix-B vaccination. Immunization against hepatitis B infection should be considered at early stages of CKD prior to the deterioration in kidney functions and the development of renal anemia.     

Sensory processing abilities and their relation to participation in leisure activities among children with high-functioning autism spectrum disorder (HFASD)

Children with autism may have atypical sensory processing abilities, which are known to impact child's performance and participation. However, lack of information exists regarding the expression of these abilities in specific groups on the spectrum, as children with high-functioning autism spectrum disorder (HFASD). This study aimed to characterize the sensory processing abilities of children with HFASD and examine their relationship to participation in leisure activities. Participants were 50 children aged 6–11 years: 25 children with HFASD and 25 with typical development. Sensory processing abilities were examined by the short sensory profile (SSP). Participation was assessed by the children's assessment of participation and enjoyment (CAPE). Children with HFASD had atypical sensory processing abilities. They also had lower participation in leisure activities expressed in limited range of activities, performed less often, mainly alone and at home. Their atypical sensory processing patterns were correlated with lower participation, specifically in social, physical and informal activities. In conclusion, children with HFASD may have atypical sensory processing abilities and restricted participation. Intervention should refer to each of these parameters and to the relationship between them in order to enable optimal inclusion of children with HFASD in society.     

To trim or replant: A matter of cost

Many factors are involved in the decision whether to complete the amputation of an injured digit and trim the stump or to replant the amputated member. This paper compares the cost of these two treatments so that this financial aspect might be included among the many factors which influence the surgeon's decision. The cost of these treatments was separated into two aspects. First, the overall cost of the medical and surgical expenses was calculated. Second, the cost which the Israeli social security granted the injured worker due to the disability was calculated. By comparing the total surgical and medical costs of amputations and replantations, trimming is far less expensive than replantation. In the long run, the compensation the insurer owes the disabled trimmed patient is far higher than the compensation given to those who were successfully replanted, provided the injured worker has a certain number of working years to retirement and has a yearly income of a certain level. Thus, in most cases, replantation is recommended from the cost benefit aspect.

---

Resumen Muchos factores resultan involucrados cuando uno se enfrenta a decidir si debe completar una amputación digital y revisar el muñion, o reimplantar el miembro amputado. El présente artículo se refiere al costo de estas dos modalidades de tratamiento, las cuales compara, con el objeto de definir si el aspecto financiero debe quedar incluido entre los multiples factores que pueden influenciar la decisión del cirujano. El costo de estas dos modalidades de tratamiento fue discriminado en dos aspectos: se calculó el costo global de los gastos médicos y quirúrgicos; luego se calculó el costo que la seguridad social de Israel asigna al trabajador lesionado según la incapacidad. Al comparar los costos totales de las amputaciones y reimplantaciones apareció evidente que la revisión del muñon es mucho menos costoso en cuanto a los gastos médicos y quirúrgicos. Sin embargo, a largo plazo resulta bastante más alta la compensación que el asegurador otorga al paciente que aquella que se otorga a quien haya sido exitosamente reimplantado, siempre y cuando el trabajador tenga por delante un cierto número de años de trabajo hasta su jubilación y su nivel de ingreso sea de cierto nivel. Por ello en la mayoría de los casos se recomienda la reimplantación también por razones de costo beneficio.

---

Résumé Bien des facteurs doivent être pris en considération avant de décider quelle amputation partielle de doigt mérite d'être complétée, quel moignon régularisé, ou quelle amputation complète réimplantée. Cet article traite du coût des types de traitement et les compare afin de déterminer si l'aspect financier pourrait également être un facteur qui influence la décision chirurgicale. Le coût de ces traitements comporte deux aspects. Premièrement, il faut calculer le coût global des dépenses médicales et chirurgicales. Ensuite entre en ligne de compte le coût de la compensation accordée par la Sécurité Sociale basée sur l'incapacité de travail. En comparant ces coûts pour chaque type de lésion, il était évident que la régularisation d'une amputation était bien moins chère qu'une réimplantation. Par contre, à la longue, les pensions versées au blessé régularisé mais handicapé étaient de loin plus coûteuses que le prix d'une réimplantation à condition que l'ouvrier ne soit pas près de la retraite et que son salaire annuel atteigne un certain niveau. Ainsi calculé, il ressort que la réimplantation est recommandée d'un point de vue économique global.

     

Stevens–Johnson syndrome and toxic epidermal necrolysis induced by amifostine during head and neck radiotherapy

Amifostine is an organic thiophosphate prodrug used for cytoprotection against toxic effects of radiotherapy and chemotherapy. In a European prospective study of SJS/TEN, six patients were suspected to have SJS/TEN associated with amifostine. Our findings suggest that the risk of life-threatening cutaneous adverse reactions to amifostine could be significantly increased.     

Interleukin 1 gene polymorphism and susceptibility to disease

The Interleukin 1 (IL-1) family plays a central role in the generation and regulation of inflammatory responses, in both innate and adaptive immunity. Although the IL-1 molecules are traditionally considered to be classical proinflammatory cytokines, their functions are not restricted to inflammation, and they have also been shown to play a key role in a wide range of additional physiological and pathological functions, including learning modulation, sleep, pregnancy, depression, appetite, hematopoiesis, metabolism, and many others. Since their effect as cytokines and regulators of inflammation is so pleiotropic, any shift of the biological balance between agonistic and antagonistic signals has the potential to cause disease. Here, we consider the genetic influence of interleukin-1 gene polymorphism in the context of susceptibility to human diseases. We review known single nucleotide polymorphisms (SNP) of IL-1 genes linked to human diseases, and suggest how exploring biological effects of IL-1 gene cluster polymorphism may lead to new directions in understanding and diagnostic of disease and effective treatment.     

Unusual presentation of gallstones

Gallstones are usually asymptomatic in the majority of patients. Gallstones can migrate through a cholecysto-duodenal fistula and may cause an intestinal obstruction anywhere along the gastrointestinal tract. The obstruction usually occurs at the level of the ileocecal valve. In most cases, the clinical presentation includes symptoms related to the intestinal obstruction including abdominal pain and vomiting. We report an unusual case of gallstones presented with acute prerenal azotemia as the major manifestation.