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Sample records for chronic aphasic patients

  1. Idiom Comprehension in Aphasic Patients

    ERIC Educational Resources Information Center

    Papagno, Costanza; Tabossi, Patrizia; Colombo, Maria Rosa; Zampetti, Patrizia

    2004-01-01

    Idiom comprehension was assessed in 10 aphasic patients with semantic deficits by means of a string-to-picture matching task. Patients were also submitted to an oral explanation of the same idioms, and to a word comprehension task. The stimuli of this last task were the words following the verb in the idioms. Idiom comprehension was severely…

  2. Audiological findings in aphasic patients after stroke

    PubMed Central

    Onoue, Solange Satie; Ortiz, Karin Zazo; Minett, Thaís Soares Cianciarullo; Borges, Alda Christina Lopes de Carvalho

    2014-01-01

    Objective To outline the audiological findings of aphasic patients after cerebrovascular accidents. Methods This is a cross-sectional study performed between March 2011 and August 2012 in the Speech, Language, and Hearing Pathology Department of the Universidade Federal de São Paulo. A total of 43 aphasic subjects (27 men) were referred for audiological evaluation after stroke, with mean age of 54.48 years. Basic audiological evaluation tests were performed, including pure tone audiometry, speech audiometry (speech recognition threshold and word recognition score), immittance measures (tympanometry and contralateral acoustic reflex), and transient otoacoustic emissions. Results Sensorineural hearing loss was prevalent (78.6%). Speech recognition threshold and word recognition score were not obtained in some patients because they were unable to perform the task. Hearing loss was a common finding in this population. Conclusion Comprehension and/or oral emission disruptions in aphasic patients after stroke compromised conventional speech audiometry, resulting in the need for changes in the evaluation procedures for these patients. PMID:25628193

  3. Improvement of language functions in a chronic non-fluent post-stroke aphasic patient following bilateral sequential theta burst magnetic stimulation.

    PubMed

    Vuksanović, Jasmina; Jelić, Milan B; Milanović, Sladjan D; Kačar, Katarina; Konstantinović, Ljubica; Filipović, Saša R

    2015-01-01

    In chronic non-fluent aphasia patients, inhibition of the intact right hemisphere (RH), by transcranial magnetic stimulation (TMS) or similar methods, can induce improvement in language functions. The supposed mechanism behind this improvement is a release of preserved left hemisphere (LH) language networks from RH transcallosal inhibition. Direct stimulation of the damaged LH can sometimes bring similar results too. Therefore, we developed a novel treatment approach that combined direct LH (Broca's area (BA)) stimulation, by intermittent theta burst stimulation (TBS), with homologue RH area's inhibition, by continuous TBS. We present the results of application of 15 daily sessions of the described treatment approach in a right-handed patient with chronic post-stroke non-fluent aphasia. The intervention appeared to improve several language functions, but most notably propositional speech, semantic fluency, short-term verbal memory, and verbal learning. Bilateral TBS modulation of activation of the language-related areas of both hemispheres seems to be a feasible and promising way to induce recovery in chronic aphasic patients. Due to potentially cumulative physiological effects of bilateral stimulation, the improvements may be even greater than following unilateral interventions. PMID:24579976

  4. Improvement of language functions in a chronic non-fluent post-stroke aphasic patient following bilateral sequential theta burst magnetic stimulation.

    PubMed

    Vuksanović, Jasmina; Jelić, Milan B; Milanović, Sladjan D; Kačar, Katarina; Konstantinović, Ljubica; Filipović, Saša R

    2015-01-01

    In chronic non-fluent aphasia patients, inhibition of the intact right hemisphere (RH), by transcranial magnetic stimulation (TMS) or similar methods, can induce improvement in language functions. The supposed mechanism behind this improvement is a release of preserved left hemisphere (LH) language networks from RH transcallosal inhibition. Direct stimulation of the damaged LH can sometimes bring similar results too. Therefore, we developed a novel treatment approach that combined direct LH (Broca's area (BA)) stimulation, by intermittent theta burst stimulation (TBS), with homologue RH area's inhibition, by continuous TBS. We present the results of application of 15 daily sessions of the described treatment approach in a right-handed patient with chronic post-stroke non-fluent aphasia. The intervention appeared to improve several language functions, but most notably propositional speech, semantic fluency, short-term verbal memory, and verbal learning. Bilateral TBS modulation of activation of the language-related areas of both hemispheres seems to be a feasible and promising way to induce recovery in chronic aphasic patients. Due to potentially cumulative physiological effects of bilateral stimulation, the improvements may be even greater than following unilateral interventions.

  5. Comprehension of Sentences with Stylistic Inversion by French Aphasic Patients

    ERIC Educational Resources Information Center

    Rigalleau, Francois; Baudiffier, Vanessa; Caplan, David

    2004-01-01

    Three French-speaking agrammatic aphasics and three French-speaking Conduction aphasics were tested for comprehension of Active, Passive, Cleft-Subject, Cleft-Object, and Cleft-Object sentences with Stylistic Inversion using an object manipulation test. The agrammatic patients consistently reversed thematic roles in the latter sentence type, and…

  6. EEG Delta Band as a Marker of Brain Damage in Aphasic Patients after Recovery of Language

    ERIC Educational Resources Information Center

    Spironelli, Chiara; Angrilli, Alessandro

    2009-01-01

    In this study spectral delta percentage was used to assess both brain dysfunction/inhibition and functional linguistic impairment during different phases of word processing. To this aim, EEG delta amplitude was measured in 17 chronic non-fluent aphasic patients while engaged in three linguistic tasks: Orthographic, Phonological and Semantic.…

  7. Orthographic Effects in the Word Substitutions of Aphasic Patients: An Epidemic of Right Neglect Dyslexia?

    ERIC Educational Resources Information Center

    Berndt, Rita Sloan; Haendiges, Anne N.; Mitchum, Charlotte C.

    2005-01-01

    Aphasic patients with reading impairments frequently substitute incorrect real words for target words when reading aloud. Many of these word substitutions have substantial orthographic overlap with their targets and are classified as ''visual errors'' (i.e., sharing 50% of targets' letters in the same relative position). Fifteen chronic aphasic…

  8. Testing Idiom Comprehension in Aphasic Patients: The Effects of Task and Idiom Type

    ERIC Educational Resources Information Center

    Papagno, C.; Caporali, A.

    2007-01-01

    Idiom comprehension in 15 aphasic patients was assessed with three tasks: a sentence-to-picture matching task, a sentence-to-word matching task and an oral definition task. The results of all three tasks showed that the idiom comprehension in aphasic patients was impaired compared to that of the control group, and was significantly affected by the…

  9. Comprehension of Co-Speech Gestures in Aphasic Patients: An Eye Movement Study

    PubMed Central

    Eggenberger, Noëmi; Preisig, Basil C.; Schumacher, Rahel; Hopfner, Simone; Vanbellingen, Tim; Nyffeler, Thomas; Gutbrod, Klemens; Annoni, Jean-Marie; Bohlhalter, Stephan; Cazzoli, Dario; Müri, René M.

    2016-01-01

    Background Co-speech gestures are omnipresent and a crucial element of human interaction by facilitating language comprehension. However, it is unclear whether gestures also support language comprehension in aphasic patients. Using visual exploration behavior analysis, the present study aimed to investigate the influence of congruence between speech and co-speech gestures on comprehension in terms of accuracy in a decision task. Method Twenty aphasic patients and 30 healthy controls watched videos in which speech was either combined with meaningless (baseline condition), congruent, or incongruent gestures. Comprehension was assessed with a decision task, while remote eye-tracking allowed analysis of visual exploration. Results In aphasic patients, the incongruent condition resulted in a significant decrease of accuracy, while the congruent condition led to a significant increase in accuracy compared to baseline accuracy. In the control group, the incongruent condition resulted in a decrease in accuracy, while the congruent condition did not significantly increase the accuracy. Visual exploration analysis showed that patients fixated significantly less on the face and tended to fixate more on the gesturing hands compared to controls. Conclusion Co-speech gestures play an important role for aphasic patients as they modulate comprehension. Incongruent gestures evoke significant interference and deteriorate patients’ comprehension. In contrast, congruent gestures enhance comprehension in aphasic patients, which might be valuable for clinical and therapeutic purposes. PMID:26735917

  10. Syntactic-Semantic Relationships in the Mental Lexicon of Aphasic Patients

    ERIC Educational Resources Information Center

    Erdeljac, Vlasta; Sekulic, Martina

    2008-01-01

    This paper examines the relative values of syntactic-semantic relationships in the mental lexicon of aphasic patients, which were tested within syntagmatic and paradigmatic networks of lexical relations. Semantic relations, such as synonymy, antonomy, and hyperonymy, as well as collocational and coordinational syntactic-semantic relations, were…

  11. Training in rapid auditory processing ameliorates auditory comprehension in aphasic patients: a randomized controlled pilot study.

    PubMed

    Szelag, Elzbieta; Lewandowska, Monika; Wolak, Tomasz; Seniow, Joanna; Poniatowska, Renata; Pöppel, Ernst; Szymaszek, Aneta

    2014-03-15

    Experimental studies have often reported close associations between rapid auditory processing and language competency. The present study was aimed at improving auditory comprehension in aphasic patients following specific training in the perception of temporal order (TO) of events. We tested 18 aphasic patients showing both comprehension and TO perception deficits. Auditory comprehension was assessed by the Token Test, phonemic awareness and Voice-Onset-Time Test. The TO perception was assessed using auditory Temporal-Order-Threshold, defined as the shortest interval between two consecutive stimuli, necessary to report correctly their before-after relation. Aphasic patients participated in eight 45-minute sessions of either specific temporal training (TT, n=11) aimed to improve sequencing abilities, or control non-temporal training (NT, n=7) focussed on volume discrimination. The TT yielded improved TO perception; moreover, a transfer of improvement was observed from the time domain to the language domain, which was untrained during the training. The NT did not improve either the TO perception or comprehension in any language test. These results are in agreement with previous literature studies which proved ameliorated language competency following the TT in language-learning-impaired or dyslexic children. Our results indicated for the first time such benefits also in aphasic patients. PMID:24388435

  12. Analysis of Spoken Narratives in a Marathi-Hindi-English Multilingual Aphasic Patient

    ERIC Educational Resources Information Center

    Karbhari-Adhyaru, Medha

    2010-01-01

    In a multilingual country such as India, the probability that clinicians may not have command over different languages used by aphasic patients is very high. Since formal tests in different languages are limited, assessment of people from diverse linguistic backgrounds presents speech- language pathologists with many challenges. With a view to…

  13. Eye Gaze Behavior at Turn Transition: How Aphasic Patients Process Speakers' Turns during Video Observation.

    PubMed

    Preisig, Basil C; Eggenberger, Noëmi; Zito, Giuseppe; Vanbellingen, Tim; Schumacher, Rahel; Hopfner, Simone; Gutbrod, Klemens; Nyffeler, Thomas; Cazzoli, Dario; Annoni, Jean-Marie; Bohlhalter, Stephan; Müri, René M

    2016-10-01

    The human turn-taking system regulates the smooth and precise exchange of speaking turns during face-to-face interaction. Recent studies investigated the processing of ongoing turns during conversation by measuring the eye movements of noninvolved observers. The findings suggest that humans shift their gaze in anticipation to the next speaker before the start of the next turn. Moreover, there is evidence that the ability to timely detect turn transitions mainly relies on the lexico-syntactic content provided by the conversation. Consequently, patients with aphasia, who often experience deficits in both semantic and syntactic processing, might encounter difficulties to detect and timely shift their gaze at turn transitions. To test this assumption, we presented video vignettes of natural conversations to aphasic patients and healthy controls, while their eye movements were measured. The frequency and latency of event-related gaze shifts, with respect to the end of the current turn in the videos, were compared between the two groups. Our results suggest that, compared with healthy controls, aphasic patients have a reduced probability to shift their gaze at turn transitions but do not show significantly increased gaze shift latencies. In healthy controls, but not in aphasic patients, the probability to shift the gaze at turn transition was increased when the video content of the current turn had a higher lexico-syntactic complexity. Furthermore, the results from voxel-based lesion symptom mapping indicate that the association between lexico-syntactic complexity and gaze shift latency in aphasic patients is predicted by brain lesions located in the posterior branch of the left arcuate fasciculus. Higher lexico-syntactic processing demands seem to lead to a reduced gaze shift probability in aphasic patients. This finding may represent missed opportunities for patients to place their contributions during everyday conversation. PMID:27243612

  14. Testing idiom comprehension in aphasic patients: the effects of task and idiom type.

    PubMed

    Papagno, C; Caporali, A

    2007-02-01

    Idiom comprehension in 15 aphasic patients was assessed with three tasks: a sentence-to-picture matching task, a sentence-to-word matching task and an oral definition task. The results of all three tasks showed that the idiom comprehension in aphasic patients was impaired compared to that of the control group, and was significantly affected by the type of task and type of idiom. Whilst performance on the oral definition and sentence-to-picture matching tasks was similarly impaired, the patients performed significantly better on the sentence-to-word matching task. The results confirm the relevance of task and idiom type in drawing conclusions about figurative language interpretation in brain-damaged patients. PMID:16487581

  15. An Exploratory Investigation of E-Rest: Teletherapy for Chronically Aphasic Speakers.

    PubMed

    Ruiter, Marina B; Rietveld, Toni C M; Hoskam, Vera; VAN Beers, Marijn M A

    2016-01-01

    Delivering aphasia therapy via telecommunication may provide a means to deliver intensive therapy in a cost-effective way. Teletherapy, remotely-administered (language) treatment, may support the repetitive drill practices that people with chronic aphasia need to perform when learning to compensate for their lasting language difficulties. The use of teletherapy may allow speech and language pathologists (SLPs) to focus in-person sessions more strongly on the generalisation of therapy effects to daily life. This single subject study is an investigation whether a teletherapy application called e-REST meets the criteria of accessibility, user-friendliness, as well as effectiveness. e-REST, the teletherapy version of the Dutch and adapted Reduced Syntax Therapy, teaches chronically aphasic speakers of Dutch who experience difficulties in sentence production to convey their messages in a kind of telegraphic style. The results obtained suggest that it is reasonable to conduct a larger study into the user-friendliness, accessibility, effectiveness, and cost-effectiveness of e-REST. PMID:27563388

  16. An Exploratory Investigation of E-Rest: Teletherapy for Chronically Aphasic Speakers

    PubMed Central

    RUITER, MARINA B.; RIETVELD, TONI C.M.; HOSKAM, VERA; VAN BEERS, MARIJN M.A.

    2016-01-01

    Delivering aphasia therapy via telecommunication may provide a means to deliver intensive therapy in a cost-effective way. Teletherapy, remotely-administered (language) treatment, may support the repetitive drill practices that people with chronic aphasia need to perform when learning to compensate for their lasting language difficulties. The use of teletherapy may allow speech and language pathologists (SLPs) to focus in-person sessions more strongly on the generalisation of therapy effects to daily life. This single subject study is an investigation whether a teletherapy application called e-REST meets the criteria of accessibility, user-friendliness, as well as effectiveness. e-REST, the teletherapy version of the Dutch and adapted Reduced Syntax Therapy, teaches chronically aphasic speakers of Dutch who experience difficulties in sentence production to convey their messages in a kind of telegraphic style. The results obtained suggest that it is reasonable to conduct a larger study into the user-friendliness, accessibility, effectiveness, and cost-effectiveness of e-REST. PMID:27563388

  17. Beta EEG band: a measure of functional brain damage and language reorganization in aphasic patients after recovery.

    PubMed

    Spironelli, Chiara; Manfredi, Mirella; Angrilli, Alessandro

    2013-01-01

    Functional reorganization of language was investigated in a group of eleven non-fluent aphasic patients after linguistic recovery and in a group of matched healthy adults. The ElectroEncephaloGram (EEG) was recorded from 38 scalp electrodes and high-beta band (21-28 Hz), an index of cognitive cortical arousal, was computed as normalized percentage across 0-100 Hz spectral range in six electrode clusters during three linguistic tasks: Phonological, Semantic and Orthographic/visuo-perceptual. During the Phonological task, controls showed greater beta activation on left versus right central cluster, whereas aphasic patients exhibited an inverted pattern of lateralization. In addition, patients' left central cluster, located over the core lesion, showed reduced beta activity with respect to controls. A similar inhibited activation was found in aphasics' left posterior cluster located over undamaged areas. At left anterior locations, aphasics, unlike controls, exhibited larger left versus right beta activity during both Phonological and Orthographic/visuo-perceptual tasks. Results point to substantial reorganization of language in recovered non-fluent aphasics at left prefrontal sites located anterior to the damaged Broca's area and inhibited language-related activation in left posterior undamaged, but disconnected, regions. PMID:23810123

  18. The recognition of gender-marked nouns and verbs in Polish-speaking aphasic patients.

    PubMed

    Perlak, Danuta; Jarema, Gonia

    2003-06-01

    In the present study, we investigated the on-line recognition of gender-marked lexical items by three aphasic patients and eighteen matched control participants, all native speakers of Polish. Polish is unique in that it allows investigating grammatical gender across the major categories of nouns and verbs. Patients and their controls were tested using a simple visual lexical decision paradigm in which gender, number and grammatical category were manipulated. Results show that, while response latencies were markedly slower for aphasic patients, gender did not yield differential results in either grammatical category, for both patients and control participants. Plural forms, on the other hand, showed significantly slower response latencies than singular forms in both brain-damaged and unimpaired participants, but only for nouns. We interpret these findings in terms of the inherent vs. contextual, i.e. underspecified, nature of gender and number in the two grammatical categories. This study suggests that while gender can be impaired in off-line performance in aphasia, on-line recognition patterns parallel the performance of non-brain-damaged individuals, confirming the preservation of access procedures in automatic word recognition. PMID:12870818

  19. Syntactic-semantic relationships in the mental lexicon of aphasic patients.

    PubMed

    Erdeljac, Vlasta; Sekulić, Martina

    2008-01-01

    This paper examines the relative values of syntactic-semantic relationships in the mental lexicon of aphasic patients, which were tested within syntagmatic and paradigmatic networks of lexical relations. Semantic relations, such as synonymy, antonomy, and hyperonymy, as well as collocational and coordinational syntactic-semantic relations, were examined simultaneously. Twenty-five subjects diagnosed with nominal aphasia were tested, as well as a control group of 20 healthy subjects. The control group was matched with the aphasic group in terms of dominant hemisphere, age, sex, and job. A naming test based on semantic context was used in this research. The test was presented orally to subjects. After the examiner had read a sentence, subjects were supposed to finish it with a target word (the word which was, through context, in a syntactic-semantic relationship with the rest of the sentence). Sentences were composed of highly frequently occurring words. The categories used in the test were randomly patterned. The resultant data were analysed according to adequate semantic relations of the answers in the given context, and according to the type of the semantic-syntactic relation in 'wrong' answers. Results of this analysis are interpreted according to current psycholinguistic theories.

  20. ERP correlates of word production before and after stroke in an aphasic patient.

    PubMed

    Laganaro, Marina; Morand, Stéphanie; Michel, Christoph M; Spinelli, Laurent; Schnider, Armin

    2011-02-01

    Changes in brain activity characterizing impaired speech production after brain damage have usually been investigated by comparing aphasic speakers with healthy subjects because prestroke data are normally not available. However, when interpreting the results of studies of stroke patients versus healthy controls, there is an inherent difficulty in disentangling the contribution of neuropathology from other sources of between-subject variability. In the present work, we had an unusual opportunity to study an aphasic patient with severe anomia who had incidentally performed a picture naming task in an ERP study as a control subject one year before suffering a left hemisphere stroke. The fortuitous recording of this patient's brain activity before his stroke allows direct comparison of his pre- and poststroke brain activity in the same language production task. The subject did not differ from other healthy subjects before his stroke, but presented major electrophysiological differences after stroke, both in comparison to himself before stroke and to the control group. ERP changes consistently appeared after stroke in a specific time window starting about 250 msec after picture onset, characterized by a single divergent but stable topographic configuration of the scalp electric field associated with a cortical generator abnormally limited to left temporal posterior perilesional areas. The patient's pattern of anomia revealed a severe lexical-phonological impairment and his ERP responses diverged from those of healthy controls in the time window that has previously been associated with lexical-phonological processes during picture naming. Given that his prestroke ERPs were indistinguishable from those of healthy controls, it seems highly likely that the change in his poststroke ERPs is due to changes in language production processes as a consequence of stroke. The patient's neurolinguistic deficits, combined with the ERPs results, provide unique evidence for the role of

  1. Acquired dyslexia in three writing systems: study of a Portuguese-Japanese bilingual aphasic patient.

    PubMed

    Senaha, Mirna Lie Hosogi; de Mattos Pimenta Parente, Maria Alice

    2012-01-01

    The Japanese language is represented by two different codes: syllabic and logographic while Portuguese employs an alphabetic writing system. Studies on bilingual Portuguese-Japanese individuals with acquired dyslexia therefore allow an investigation of the interaction between reading strategies and characteristics of three different writing codes. The aim of this study was to examine the differential impact of an acquired brain lesion on the reading of the logographic, syllabic and alphabetic writing systems of a bilingual Portuguese-Japanese aphasic patient (PF). Results showed impaired reading in the logographic system and when reading irregularly spelled Portuguese words but no effects on reading regular words and nonwords in syllabic and alphabetic writing systems. These dissociations are interpreted according to a multi-route cognitive model of reading assuming selective damage in the lexical route can result in acquired dyslexia across at least three different writing codes.

  2. Morphological-compound dysgraphia in an aphasic patient: "A wild write through the lexicon".

    PubMed

    Bormann, Tobias; Romani, Cristina; Olson, Andrew; Wallesch, Claus-W

    2014-01-01

    We describe the case of a dysgraphic aphasic individual--S.G.W.--who, in writing to dictation, produced high rates of formally related errors consisting of both lexical substitutions and what we call morphological-compound errors involving legal or illegal combinations of morphemes. These errors were produced in the context of a minimal number of semantic errors. We could exclude problems with phonological discrimination and phonological short-term memory. We also excluded rapid decay of lexical information and/or weak activation of word forms and letter representations since S.G.W.'s spelling showed no effect of delay and no consistent length effects, but, instead, paradoxical complexity effects with segmental, lexical, and morphological errors that were more complex than the target. The case of S.G.W. strongly resembles that of another dysgraphic individual reported in the literature--D.W.--suggesting that this pattern of errors can be replicated across patients. In particular, both patients show unusual errors resulting in the production of neologistic compounds (e.g., "bed button" in response to "bed"). These patterns can be explained if we accept two claims: (a) Brain damage can produce both a reduction and an increase in lexical activation; and (b) there are direct connections between phonological and orthographic lexical representations (a third spelling route). We suggest that both patients are suffering from a difficulty of lexical selection resulting from excessive activation of formally related lexical representations. This hypothesis is strongly supported by S.G.W.'s worse performance in spelling to dictation than in written naming, which shows that a phonological input, activating a cohort of formally related lexical representations, increases selection difficulties.

  3. Comprehension of Lexical Subcategory Distinctions by Aphasic Patients: Proper/Common and Mass/Count Nouns.

    ERIC Educational Resources Information Center

    Shapiro, Lewis P.; And Others

    1989-01-01

    The study with 10 agrammatic aphasic (Broca) adults examined their difficulties using determiners in sentence comprehension. Results included the findings that printed rather than spoken presentation yielded significant improvement for the proper noun/common noun distinction, and that performance was poorer for the mass noun/count noun…

  4. Paradoxical switching to a barely-mastered second language by an aphasic patient.

    PubMed

    Leemann, B; Laganaro, M; Schwitter, V; Schnider, A

    2007-06-01

    Polyglot speakers who become aphasics are not necessarily affected to the same extent in each language. In some cases there is a mixing of the different languages or a switching between languages and in very rare cases the switch is to the language seldom if ever used in everyday live. We report a French-speaking aphasic, who switched paradoxically from his mother tongue (French) to a second language (German) which he had learned at school but barely mastered and hardly ever spoke, and kept using German most of the time. We tried to understand the mechanism responsible for that phenomenon by reviewing the actual hypothesis of multi-language organization. We concluded, in line with previous reports, that our case used his metalinguistic knowledge to compensate for his inability to access his linguistic skills. PMID:17786781

  5. Task-induced brain activity in aphasic stroke patients: what is driving recovery?

    PubMed

    Geranmayeh, Fatemeh; Brownsett, Sonia L E; Wise, Richard J S

    2014-10-01

    The estimated prevalence of aphasia in the UK and the USA is 250 000 and 1 000 000, respectively. The commonest aetiology is stroke. The impairment may improve with behavioural therapy, and trials using cortical stimulation or pharmacotherapy are undergoing proof-of-principle investigation, but with mixed results. Aphasia is a heterogeneous syndrome, and the simple classifications according to the Broca-Wernicke-Lichtheim model inadequately describe the diverse communication difficulties with which patients may present. Greater knowledge of how intact neural networks promote recovery after aphasic stroke, either spontaneously or in response to interventions, will result in clearer hypotheses about how to improve the treatment of aphasia. Twenty-five years ago, a pioneering study on healthy participants heralded the introduction of functional neuroimaging to the study of mechanisms of recovery from aphasia. Over the ensuing decades, such studies have been interpreted as supporting one of three hypotheses, which are not mutually exclusive. The first two predate the introduction of functional neuroimaging: that recovery is the consequence of the reconstitution of domain-specific language systems in tissue around the lesion (the 'perilesional' hypothesis), or by homotopic cortex in the contralateral hemisphere (the 'laterality-shift' hypothesis). The third is that loss of transcallosal inhibition to contralateral homotopic cortex hinders recovery (the 'disinhibition' hypothesis). These different hypotheses at times give conflicting views about rehabilitative intervention; for example, should one attempt to activate or inhibit a contralateral homotopic region with cortical stimulation techniques to promote recovery? This review proposes that although the functional imaging data are statistically valid in most cases, their interpretation has often favoured one explanation while ignoring plausible alternatives. In our view, this is particularly evident when recovery is

  6. Recovery process and prognosis of aphasic patients with left putaminal hemorrhage: relationship between hematoma type and language modalities.

    PubMed

    Komiya, Keiji; Sakai, Yasujiro; Horikoshi, Toru; Naganuma, Hirofumi

    2013-02-01

    To elucidate the precise recovery process and prognosis of language functions in aphasic patients with left putaminal hemorrhage, we investigated 48 aphasic patients classified into 4 groups according to the location and extent of hematoma. The hematoma extended to the corona radiata in all patients, extracapsular in type I (12 cases), to the anterior limb in type II (10 cases), to the posterior limb in type III (12 cases), and to both limbs in type IV (14 cases). The Standard Language Test for Aphasia was performed at 1 month, 3 months, and 6 months after the attack. The type II, III, and IV patients were divided into 2 groups, with and without ventricular rupture of the hemorrhage. At 3 and 6 months after the attack, the type I, II, and III patients showed significant improvement (P < .05) in all language modalities compared with the type IV patients. Most improvement in language modalities occurred in the first 3 months. The evaluation of patients with ventricular rupture after 6 months revealed poor recovery (P < .05) in oral commands, visual commands, confrontation naming, sentence repetition, narratives, verbal fluency, and writing in type II and III patients. In type IV patients, this evaluation showed poor recovery (P < .05) only in oral and written naming (kanji words). No significant difference in prognostic outcome was observed between the surgical treatment group and the nonsurgical treatment group. The classification of hemorrhage may be useful in predicting the outcome of aphasia with putaminal hemorrhage and in guiding clinicians in providing effective instructions to patients and their relatives. PMID:21903420

  7. Recovery process and prognosis of aphasic patients with left putaminal hemorrhage: relationship between hematoma type and language modalities.

    PubMed

    Komiya, Keiji; Sakai, Yasujiro; Horikoshi, Toru; Naganuma, Hirofumi

    2013-02-01

    To elucidate the precise recovery process and prognosis of language functions in aphasic patients with left putaminal hemorrhage, we investigated 48 aphasic patients classified into 4 groups according to the location and extent of hematoma. The hematoma extended to the corona radiata in all patients, extracapsular in type I (12 cases), to the anterior limb in type II (10 cases), to the posterior limb in type III (12 cases), and to both limbs in type IV (14 cases). The Standard Language Test for Aphasia was performed at 1 month, 3 months, and 6 months after the attack. The type II, III, and IV patients were divided into 2 groups, with and without ventricular rupture of the hemorrhage. At 3 and 6 months after the attack, the type I, II, and III patients showed significant improvement (P < .05) in all language modalities compared with the type IV patients. Most improvement in language modalities occurred in the first 3 months. The evaluation of patients with ventricular rupture after 6 months revealed poor recovery (P < .05) in oral commands, visual commands, confrontation naming, sentence repetition, narratives, verbal fluency, and writing in type II and III patients. In type IV patients, this evaluation showed poor recovery (P < .05) only in oral and written naming (kanji words). No significant difference in prognostic outcome was observed between the surgical treatment group and the nonsurgical treatment group. The classification of hemorrhage may be useful in predicting the outcome of aphasia with putaminal hemorrhage and in guiding clinicians in providing effective instructions to patients and their relatives.

  8. Cognitive and Language Function in Aphasic Patients Assessed With the Korean Version of Mini-Mental Status Examination

    PubMed Central

    Kang, Eun Kyoung; Jeong, Hyun Sun; Moon, Eun Rhan; Lee, Joo Young

    2016-01-01

    Objective To assess the clinical usefulness of the relatively short instrument, the Korean version of the Mini-Mental State Examination (MMSE-K), for testing the association between cognition and language function in subacute post-stroke aphasia patients. Methods Medical charts of 111 post-stroke patients (65 men; age 69.6±10.0 years; 124.6±80.6 days post-onset) were reviewed retrospectively. All patients were assessed longitudinally for aphasia using the validated Korean version of the Western Aphasia Battery (K-WAB) and for cognition using the MMSE-K. Patients were categorized and analyzed according to 3 aphasia-severity clusters. Results All subscales of the K-WAB showed significant improvement in follow-up assessments in all groups (p<0.05 or p<0.01). Only the scores of orientation, language function, and total score of MMSE-K showed significant improvement in all groups (p<0.01). The more severely impaired group showed stronger Pearson correlation coefficients between cognition and language function. Additionally, comparisons between correlation coefficients showed that the association of improvement in orientation with that of fluency and AQ% (aphasia quotient %) was significant in the more severely impaired group. Conclusion Among subacute post-stroke aphasic patients, patients with more severe aphasia showed greater impairments to cognitive function; in addition, recovery of orientation may be related to recovery of language function. PMID:26949682

  9. Brain regions essential for improved lexical access in an aged aphasic patient: a case report

    PubMed Central

    Meinzer, Marcus; Flaisch, Tobias; Obleser, Jonas; Assadollahi, Ramin; Djundja, Daniela; Barthel, Gabriela; Rockstroh, Brigitte

    2006-01-01

    Background The relationship between functional recovery after brain injury and concomitant neuroplastic changes is emphasized in recent research. In the present study we aimed to delineate brain regions essential for language performance in aphasia using functional magnetic resonance imaging and acquisition in a temporal sparse sampling procedure, which allows monitoring of overt verbal responses during scanning. Case presentation An 80-year old patient with chronic aphasia (2 years post-onset) was investigated before and after intensive language training using an overt picture naming task. Differential brain activation in the right inferior frontal gyrus for correct word retrieval and errors was found. Improved language performance following therapy was mirrored by increased fronto-thalamic activation while stability in more general measures of attention/concentration and working memory was assured. Three healthy age-matched control subjects did not show behavioral changes or increased activation when tested repeatedly within the same 2-week time interval. Conclusion The results bear significance in that the changes in brain activation reported can unequivocally be attributed to the short-term training program and a language domain-specific plasticity process. Moreover, it further challenges the claim of a limited recovery potential in chronic aphasia, even at very old age. Delineation of brain regions essential for performance on a single case basis might have major implications for treatment using transcranial magnetic stimulation. PMID:16916464

  10. Processing ambiguity in a linguistic context: decision-making difficulties in non-aphasic patients with behavioral variant frontotemporal degeneration

    PubMed Central

    Spotorno, Nicola; Healey, Meghan; McMillan, Corey T.; Rascovsky, Katya; Irwin, David J.; Clark, Robin; Grossman, Murray

    2015-01-01

    Some extent of ambiguity is ubiquitous in everyday conversations. For example, words have multiple meaning and very common pronouns, like “he” and “she” (anaphoric pronouns), have little meaning on their own and refer to a noun that has been previously introduced in the discourse. Ambiguity triggers a decision process that is not a subroutine of language processing but rather a more general domain resource. Therefore non-aphasic patients with limited decision-making capability can encounter severe limitation in language processing due to extra linguistic limitations. In the present study, we test patients with behavioral variant frontotemporal degeneration (bvFTD), focusing on anaphora as a paradigmatic example of ambiguity resolution in the linguistic domain. bvFTD is characterized by gray matter (GM) atrophy in prefrontal cortex, but relative sparing of peri-Sylvian cortex. A group of patients with parietal disease due to corticobasal syndrome (CBS) was also tested here in order to investigate the specific role of prefrontal cortex in the task employed in the current study. Participants were presented with a pair of sentences in which the first sentence contained two nouns while the second contained a pronoun. In the experimental (ambiguous) condition, both nouns are plausible referents of the pronoun, thus requiring decision-making resources. The results revealed that bvFTD patients are significantly less accurate than healthy seniors in identifying the correct referent of a pronoun in the ambiguous condition, although CBS patients were as accurate as healthy seniors. Imaging analyses related bvFTD patients’ performance to GM atrophy in ventromedial prefrontal cortex (vmPFC). These results suggest that bvFTD patients have difficulties in decision processes that involve the resolution of an ambiguity. PMID:26578928

  11. LANGUAGE DEFICITS, LOCALIZATION, AND GRAMMAR: EVIDENCE FOR A DISTRIBUTIVE MODEL OF LANGUAGE BREAKDOWN IN APHASIC PATIENTS AND NEUROLOGICALLY INTACT INDIVIDUALS

    PubMed Central

    Dick, Frederic; Bates, Elizabeth; Wulfeck, Beverly; Utman, Jennifer; Dronkers, Nina; Gernsbacher, Morton Ann

    2015-01-01

    Selective deficits in aphasics patients’ grammatical production and comprehension are often cited as evidence that syntactic processing is modular and localizable in discrete areas of the brain (e.g., Y. Grodzinsky, 2000). The authors review a large body of experimental evidence suggesting that morphosyntactic deficits can be observed in a number of aphasic and neurologically intact populations. They present new data showing that receptive agrammatism is found not only over a range of aphasic groups, but is also observed in neurologically intact individuals processing under stressful conditions. The authors suggest that these data are most compatible with a domain-general account of language, one that emphasizes the interaction of linguistic distributions with the properties of an associative processor working under normal or suboptimal conditions. PMID:11699116

  12. Association between Therapy Outcome and Right-Hemispheric Activation in Chronic Aphasia

    ERIC Educational Resources Information Center

    Richter, Maria; Miltner, Wolfgang H. R.; Straube, Thomas

    2008-01-01

    The role of the right hemisphere for language processing and successful therapeutic interventions in aphasic patients is a matter of debate. This study explored brain activation in right-hemispheric areas and left-hemispheric perilesional areas in response to language tasks in chronic non-fluent aphasic patients before and after constraint-induced…

  13. A Computer-Aided Evaluation of Error Patterns in Aphasic Speech

    ERIC Educational Resources Information Center

    Chan, Sharon; Tsigka, Styliani; Boschetti, Federico; Capasso, Rita

    2010-01-01

    The objective of this research is to provide an improved automated computational tool to study aphasic production. Using the speech production of Italian aphasic patients, the present study demonstrates the possibility of applying an integrated algorithm to automatically assess and generate error patterns typical of aphasic speech. Philological…

  14. Brain plasticity in aphasic patients: intra- and inter-hemispheric reorganisation of the whole linguistic network probed by N150 and N350 components.

    PubMed

    Spironelli, Chiara; Angrilli, Alessandro

    2015-07-28

    The present study examined linguistic plastic reorganization of language through Evoked Potentials in a group of 17 non-fluent aphasic patients who had suffered left perisylvian focal lesions, and showed a good linguistic recovery. Language reorganisation was probed with three linguistic tasks (Phonological, Semantic, Orthographic), the early word recognition potential (N150) and the later phonological-related component (N350). Results showed the typical left-lateralised posterior N150 in healthy controls (source: left Fusiform Gyrus), that was bilateral (Semantic) or right sided (Phonological task) in patients (sources: right Inferior/Middle Temporal and Fusiform Gyri). As regards N350, controls revealed different intra- and inter-hemispheric linguistic activation across linguistic tasks, whereas patients exhibited greater activity in left intact sites, anterior and posterior to the damaged area, in all tasks (sources: Superior Frontal Gyri). A comprehensive neurofunctional model is presented, describing how complete intra- and inter-hemispheric reorganisation of the linguistic networks occurs after aphasic damage in the strategically dominant left perisylvian linguistic centres.

  15. Brain plasticity in aphasic patients: intra- and inter-hemispheric reorganisation of the whole linguistic network probed by N150 and N350 components

    PubMed Central

    Spironelli, Chiara; Angrilli, Alessandro

    2015-01-01

    The present study examined linguistic plastic reorganization of language through Evoked Potentials in a group of 17 non-fluent aphasic patients who had suffered left perisylvian focal lesions, and showed a good linguistic recovery. Language reorganisation was probed with three linguistic tasks (Phonological, Semantic, Orthographic), the early word recognition potential (N150) and the later phonological-related component (N350). Results showed the typical left-lateralised posterior N150 in healthy controls (source: left Fusiform Gyrus), that was bilateral (Semantic) or right sided (Phonological task) in patients (sources: right Inferior/Middle Temporal and Fusiform Gyri). As regards N350, controls revealed different intra- and inter-hemispheric linguistic activation across linguistic tasks, whereas patients exhibited greater activity in left intact sites, anterior and posterior to the damaged area, in all tasks (sources: Superior Frontal Gyri). A comprehensive neurofunctional model is presented, describing how complete intra- and inter-hemispheric reorganisation of the linguistic networks occurs after aphasic damage in the strategically dominant left perisylvian linguistic centres. PMID:26217919

  16. [Evaluation of intelligence with non-verbal tests in aphasic patients].

    PubMed

    Ceschin, J S; Melaragno Filho, R; Brauer, M J; Parente, M A

    1979-09-01

    Eight patients with cerebral vascular disease and aphasia were studied just after the stroke. The clinical, neuropsychiatric, EEG and neuro-radiological aspects were evaluated. The patients were submitted to the psychological and phonoaudiological studies. The authors correlated the neurological lesions to the structural alteration of the intelligence, to the praxic and estheognostic alterations and also to the language disturbances. The criterions adopted by the World Health Organization and the genetics classification of Jean Piaget were used for the intellectual level classification. The results suggest that the intelligence evaluated through Leither's non-verbal test is better preserved in some asphasics.

  17. [Evaluation of intelligence with non-verbal tests in aphasic patients].

    PubMed

    Ceschin, J S; Melaragno Filho, R; Brauer, M J; Parente, M A

    1979-09-01

    Eight patients with cerebral vascular disease and aphasia were studied just after the stroke. The clinical, neuropsychiatric, EEG and neuro-radiological aspects were evaluated. The patients were submitted to the psychological and phonoaudiological studies. The authors correlated the neurological lesions to the structural alteration of the intelligence, to the praxic and estheognostic alterations and also to the language disturbances. The criterions adopted by the World Health Organization and the genetics classification of Jean Piaget were used for the intellectual level classification. The results suggest that the intelligence evaluated through Leither's non-verbal test is better preserved in some asphasics. PMID:533383

  18. Aphasic Patients Exhibit a Reversal of Hemispheric Asymmetries in Categorical Color Discrimination

    ERIC Educational Resources Information Center

    Paluy, Yulia; Gilbert, Aubrey L.; Baldo, Juliana V.; Dronkers, Nina F.; Ivry, Richard B.

    2011-01-01

    Patients with left hemisphere (LH) or right hemisphere (RH) brain injury due to stroke were tested on a speeded, color discrimination task in which two factors were manipulated: (1) the categorical relationship between the target and the distracters and (2) the visual field in which the target was presented. Similar to controls, the RH patients…

  19. Aphasic Dystextia as Presenting Feature of Ischemic Stroke in a Pediatric Patient

    PubMed Central

    Sachdeva, Alok; Mahajan, Supriya; Bass, Nancy

    2016-01-01

    Aphasia is an important presenting symptom of acute stroke. With increasing reliance on electronic communication, incoherent texting or “dystextia,” which is a subset of aphasia that is reflected in text messages, can be a useful tool for symptom recognition and analysis. It can be a red flag for the family and therefore can help in early identification of an acute neurological deficit. It is also useful for providers to reliably analyze the deficit as well as establish a timeline of evolution of symptoms. There have been case reports where dystextia has been the presenting feature of stroke or complicated migraine and in one case of meningioma. We present the case of a teenage patient that in our knowledge is the youngest reported case of dystextia, whose aphasia recorded in a text message assisted with stroke localization. This also adds to the literature of dystextia which so far has only seven other cases reported. PMID:27579197

  20. Aphasic Dystextia as Presenting Feature of Ischemic Stroke in a Pediatric Patient.

    PubMed

    Lakhotia, Arpita; Sachdeva, Alok; Mahajan, Supriya; Bass, Nancy

    2016-01-01

    Aphasia is an important presenting symptom of acute stroke. With increasing reliance on electronic communication, incoherent texting or "dystextia," which is a subset of aphasia that is reflected in text messages, can be a useful tool for symptom recognition and analysis. It can be a red flag for the family and therefore can help in early identification of an acute neurological deficit. It is also useful for providers to reliably analyze the deficit as well as establish a timeline of evolution of symptoms. There have been case reports where dystextia has been the presenting feature of stroke or complicated migraine and in one case of meningioma. We present the case of a teenage patient that in our knowledge is the youngest reported case of dystextia, whose aphasia recorded in a text message assisted with stroke localization. This also adds to the literature of dystextia which so far has only seven other cases reported. PMID:27579197

  1. Different patterns of spoken and written word comprehension deficit in aphasic stroke patients.

    PubMed

    Crutch, Sebastian J; Warrington, Elizabeth K

    2011-09-01

    This study presents neuropsychological evidence for differences in the semantic representations underpinning spoken and written word comprehension. Potential modality-based discrepancies in the semantic system were examined by testing whether spoken word (auditory-verbal input) and written word (visual-verbal input) comprehension exhibited the same effect profile on variables typically used to distinguish so-called access and storage disorders (e.g., response consistency, sensitivity to item frequency). The study was based on the premise that damage to a common set of semantic representations should have an equivalent impact upon comprehension performance irrespective of input modality, whereas damage to partially dissociable semantic representations may give rise to different qualities of deficit (access/storage) in the comprehension of stimuli presented in different input modalities (spoken/written). The study involved two patients with global aphasia following left middle cerebral artery stroke (F.B.I. and H.O.P.). The two patients showed matched performance on conventional tests of single word comprehension with clear evidence of semantic impairment for stimuli presented in both the spoken and written input modalities. However, in H.O.P., spoken and written word comprehension was affected in the same way by variations in stimulus category, frequency, and multiple stimulus presentations, whilst in F.B.I., there were clear differences between input modalities with all three variables. More specifically, F.B.I.'s written word comprehension was significantly affected by category (living > nonliving) and frequency (high > low) but not multiple presentations (single = multiple), more consistent with degradation of stored representations (storage deficit). By contrast, his spoken word comprehension was unaffected by category (living = nonliving) and frequency (high = low) but was affected by multiple presentations (single > multiple; serial

  2. Different patterns of spoken and written word comprehension deficit in aphasic stroke patients.

    PubMed

    Crutch, Sebastian J; Warrington, Elizabeth K

    2011-09-01

    This study presents neuropsychological evidence for differences in the semantic representations underpinning spoken and written word comprehension. Potential modality-based discrepancies in the semantic system were examined by testing whether spoken word (auditory-verbal input) and written word (visual-verbal input) comprehension exhibited the same effect profile on variables typically used to distinguish so-called access and storage disorders (e.g., response consistency, sensitivity to item frequency). The study was based on the premise that damage to a common set of semantic representations should have an equivalent impact upon comprehension performance irrespective of input modality, whereas damage to partially dissociable semantic representations may give rise to different qualities of deficit (access/storage) in the comprehension of stimuli presented in different input modalities (spoken/written). The study involved two patients with global aphasia following left middle cerebral artery stroke (F.B.I. and H.O.P.). The two patients showed matched performance on conventional tests of single word comprehension with clear evidence of semantic impairment for stimuli presented in both the spoken and written input modalities. However, in H.O.P., spoken and written word comprehension was affected in the same way by variations in stimulus category, frequency, and multiple stimulus presentations, whilst in F.B.I., there were clear differences between input modalities with all three variables. More specifically, F.B.I.'s written word comprehension was significantly affected by category (living > nonliving) and frequency (high > low) but not multiple presentations (single = multiple), more consistent with degradation of stored representations (storage deficit). By contrast, his spoken word comprehension was unaffected by category (living = nonliving) and frequency (high = low) but was affected by multiple presentations (single > multiple; serial

  3. Cognitive control and its impact on recovery from aphasic stroke

    PubMed Central

    Warren, Jane E.; Geranmayeh, Fatemeh; Woodhead, Zoe; Leech, Robert; Wise, Richard J. S.

    2014-01-01

    Aphasic deficits are usually only interpreted in terms of domain-specific language processes. However, effective human communication and tests that probe this complex cognitive skill are also dependent on domain-general processes. In the clinical context, it is a pragmatic observation that impaired attention and executive functions interfere with the rehabilitation of aphasia. One system that is important in cognitive control is the salience network, which includes dorsal anterior cingulate cortex and adjacent cortex in the superior frontal gyrus (midline frontal cortex). This functional imaging study assessed domain-general activity in the midline frontal cortex, which was remote from the infarct, in relation to performance on a standard test of spoken language in 16 chronic aphasic patients both before and after a rehabilitation programme. During scanning, participants heard simple sentences, with each listening trial followed immediately by a trial in which they repeated back the previous sentence. Listening to sentences in the context of a listen–repeat task was expected to activate regions involved in both language-specific processes (speech perception and comprehension, verbal working memory and pre-articulatory rehearsal) and a number of task-specific processes (including attention to utterances and attempts to overcome pre-response conflict and decision uncertainty during impaired speech perception). To visualize the same system in healthy participants, sentences were presented to them as three-channel noise-vocoded speech, thereby impairing speech perception and assessing whether this evokes domain general cognitive systems. As expected, contrasting the more difficult task of perceiving and preparing to repeat noise-vocoded speech with the same task on clear speech demonstrated increased activity in the midline frontal cortex in the healthy participants. The same region was activated in the aphasic patients as they listened to standard (undistorted

  4. Neighbourhood Density Effects in Auditory Non-Word Processing in Aphasic Listeners

    ERIC Educational Resources Information Center

    Janse, Esther

    2009-01-01

    This study investigates neighbourhood density effects on lexical decision performance (both accuracy and response times) of aphasic patients. Given earlier results on lexical activation and deactivation in Broca's and Wernicke's aphasia, the prediction was that smaller neighbourhood density effects would be found for Broca's aphasic patients,…

  5. A computer-aided evaluation of error patterns in aphasic speech.

    PubMed

    Chan, Sharon; Tsigka, Styliani; Boschetti, Federico; Capasso, Rita

    2010-11-01

    The objective of this research is to provide an improved automated computational tool to study aphasic production. Using the speech production of Italian aphasic patients, the present study demonstrates the possibility of applying an integrated algorithm to automatically assess and generate error patterns typical of aphasic speech. Philological studies and aphasia studies share one common point: errors (or variants) are informative, and the intention of the authors (in the case of philology) or of the patients (in the case of aphasiology) is to be established. For this precise reason, the present study adapts a tool, originally used in computational philology for the alignment of textual variants (Boschetti, 2007, 2008), and puts it to use for assessing aphasic patient's speech error patterns. As is demonstrated, this tool is effective and analytical. The authors expect this to be beneficial for the use of analysing aphasic production in both clinical and academic settings. PMID:20964509

  6. Improved Neural Processing Efficiency in a Chronic Aphasia Patient Following Melodic Intonation Therapy: A Neuropsychological and Functional MRI Study

    PubMed Central

    Tabei, Ken-ichi; Satoh, Masayuki; Nakano, Chizuru; Ito, Ai; Shimoji, Yasuo; Kida, Hirotaka; Sakuma, Hajime; Tomimoto, Hidekazu

    2016-01-01

    Melodic intonation therapy (MIT) is a treatment program for the rehabilitation of aphasic patients with speech production disorders. We report a case of severe chronic non-fluent aphasia unresponsive to several years of conventional therapy that showed a marked improvement following intensive 9-day training on the Japanese version of MIT (MIT-J). The purpose of this study was to verify the efficacy of MIT-J by functional assessment and examine associated changes in neural processing by functional magnetic resonance imaging. MIT improved language output and auditory comprehension, and decreased the response time for picture naming. Following MIT-J, an area of the right hemisphere was less activated on correct naming trials than compared with before training but similarly activated on incorrect trials. These results suggest that the aphasic symptoms of our patient were improved by increased neural processing efficiency and a concomitant decrease in cognitive load.

  7. Improved Neural Processing Efficiency in a Chronic Aphasia Patient Following Melodic Intonation Therapy: A Neuropsychological and Functional MRI Study

    PubMed Central

    Tabei, Ken-ichi; Satoh, Masayuki; Nakano, Chizuru; Ito, Ai; Shimoji, Yasuo; Kida, Hirotaka; Sakuma, Hajime; Tomimoto, Hidekazu

    2016-01-01

    Melodic intonation therapy (MIT) is a treatment program for the rehabilitation of aphasic patients with speech production disorders. We report a case of severe chronic non-fluent aphasia unresponsive to several years of conventional therapy that showed a marked improvement following intensive 9-day training on the Japanese version of MIT (MIT-J). The purpose of this study was to verify the efficacy of MIT-J by functional assessment and examine associated changes in neural processing by functional magnetic resonance imaging. MIT improved language output and auditory comprehension, and decreased the response time for picture naming. Following MIT-J, an area of the right hemisphere was less activated on correct naming trials than compared with before training but similarly activated on incorrect trials. These results suggest that the aphasic symptoms of our patient were improved by increased neural processing efficiency and a concomitant decrease in cognitive load. PMID:27698650

  8. Making Non-Fluent Aphasics Speak: Sing along!

    ERIC Educational Resources Information Center

    Racette, Amelie; Bard, Celine; Peretz, Isabelle

    2006-01-01

    A classic observation in neurology is that aphasics can sing words they cannot pronounce otherwise. To further assess this claim, we investigated the production of sung and spoken utterances in eight brain-damaged patients suffering from a variety of speech disorders as a consequence of a left-hemisphere lesion. In Experiment 1, the patients were…

  9. Polyglot aphasics and language mixing: a comment on Perecman (1984).

    PubMed

    Grosjean, F

    1985-11-01

    Perecman (1984) Brain and Language, 23, 43-63, proposes that language mixing (and especially utterance level mixing) in polyglot aphasics reflects a linguistic deficit and that spontaneous translation indicates a prelinguistic processing deficit. It is argued in this comment that both language mixing (including utterance-level mixing) and spontaneous translation are also found in normal polyglots, and that they may not therefore always be reflecting language deficit in aphasics. Only a good assessment of the patient's language and speech before and after the injury will determine if these behaviors do indeed reflect deficits. PMID:4084770

  10. Melodic intonation therapy in the verbal decoding of aphasics.

    PubMed

    Popovici, M

    1995-01-01

    Melodic Intonation Therapy is a well-known method exploring the verbal encoding of aphasics but within this study, it was used to investigate the verbal decoding (the auditory comprehension). Two separate groups, 240 cases each, were investigated, the former with MIT and the latter with other therapy methods. Each group included three subgroups according to the three frequent types of aphasia (Wernicke, Broca and Anomia). The method of semantic fields was associated to treat the second group since it is usually used in the treatment of aphasics with auditory decoding disturbances. All patients were tested twice, before and after therapy. PMID:7547372

  11. Contrasting Effects of Phonological Priming in Aphasic Word Production

    ERIC Educational Resources Information Center

    Wilshire, Carolyn E.; Saffran, Eleanor M.

    2005-01-01

    Two fluent aphasics, IG and GL, performed a phonological priming task in which they repeated an auditory prime then named a target picture. The two patients both had selective deficits in word production: they were at or near ceiling on lexical comprehension tasks, but were significantly impaired in picture naming. IG's naming errors included both…

  12. Contrasting patterns of comprehension for superordinate, basic-level, and subordinate names in semantic dementia and aphasic stroke patients.

    PubMed

    Crutch, Sebastian J; Warrington, Elizabeth K

    2008-06-01

    It is well established that patients with semantic memory impairment show a relative sparing of general superordinate information as compared with more detailed item-specific information. The objective of the current study was to examine whether or not this superordinate superiority effect is also reliably observed in individuals with stroke. The participants were 3 patients with a diagnosis of semantic dementia (SD) and 4 left middle cerebral artery stroke patients. In the first experiment, participants were administered a series of spoken-word-picture matching tasks, in which picture identity was probed under two conditions: item name (e.g., goose, beetle, shark, hedgehog) and superordinate name (e.g., bird, insect, fish, mammal). The SD patients showed the predicted pattern of performance, identifying stimuli significantly more accurately by their superordinate term than by their specific name. By contrast, the stroke patients showed the reverse pattern of inferior performance in the superordinate condition in all versions of the experimental task. In a second experiment comparing comprehension ofbasic-level names (e.g., dog, bird, fish) and subordinate-level names (e.g., Dalmatian, sparrow, trout), stroke patients also showed a reversal of the normal basic-level effect, showing less accurate comprehension of basic-level names. The pattern of results documented among the stroke patients cannot be accommodated obviously or readily by existing models of conceptual knowledge. These contrasting abilities of SD patients, stroke patients, and normal healthy participants to process subordinate, basic-level, and superordinate names are considered in relation to disorders of executive processing and taxonomic categorization. PMID:19086203

  13. Phonological, lexical, and semantic errors produced by impairment at the output buffer in a Spanish aphasic patient.

    PubMed

    Dominguez, Alberto; Socas, Rosario; Marrero, Hipólito; León, Nieves M; Cuetos, Fernando

    2015-01-01

    We present a single case of a right-handed female patient, RH, who was categorized as suffering from conduction aphasia. She presented no articulatory problems during spontaneous speech but made a significant number of phonological paraphasias in naming and repetition tasks. The number of errors increased for long words and pseudowords. This pattern of results points to damage in the "Phonological Output Buffer" (POB) as the basis of this disorder. However, this patient did not make mistakes when reading words and pseudowords aloud, even when we introduced a delay between the presentation of the word and its production to test the working memory resources of the phonological buffer. Furthermore, the patient's ability to name objects, repeat words, and write to dictation improved with her degree of familiarity with the items. The damage could be situated at the point where phonemes are selected and ordered to produce words. We posit that the deficits observed in this patient, and the differences encountered between her performance and that of others described in the literature, in particular in reading tasks, can be explained by considering POB damage to be gradual in nature. According to this explanation, the performance of patients with damage to the POB will depend on the amount of information provided by the stimulus (word/nonword), the language particularities (regular/irregular), and the nature of the task demands (repetition, writing, naming, or reading). PMID:24832136

  14. Pragmatic-mode mediation of sentence comprehension among aphasic bilinguals and hispanophones.

    PubMed

    Schnitzer, M L

    1989-01-01

    A test of sentence comprehension administered in four input-output modality combinations to a group of aphasic bilinguals and monolingual hispanophones provides evidence that aphasics tend to use pragmatic-mode (in the sense of Givón, 1979, On understanding-grammar, New York, Academic Press) strategies in approaching this task. When five factors were identified and dichotomized with respect to the pragmatic-mode-syntactic-mode dimension, the patients performed significantly better on items classified as pragmatic than on those classified as syntactic, in both languages. The results support a vertical/hierarchical view of aphasic language dissolution.

  15. Evidence for cognition without grammar from causal reasoning and 'theory of mind' in an agrammatic aphasic patient.

    PubMed

    Varley, R; Siegal, M

    2000-06-15

    Understanding the inter-relationship between language and thought is fundamental to the study of human cognition [1] [2] [3]. Some investigators have proposed that propositions in natural language serve to scaffold thinking, by providing, for example, a sequential structure to a massively parallel process [4]. Others have maintained that certain thoughts, such as inferring the mental states of others, termed 'theory of mind' (ToM) reasoning, and identifying causal relationships, necessarily involve language propositions [5]. It has been proposed that ToM reasoning depends upon the possession of syntactic structures such as those that permit the embedding of false propositions within true statements ('Mary knows that John (falsely) thinks chocolates are in the cupboard') [6]. The performance on reasoning tasks of individuals with severe agrammatic aphasia (an impairment of language following a lesion of the perisylvian areas of the language-dominant hemisphere) offers novel insights into the relation between grammar and cognition. We report the unusual case of a patient with agrammatic aphasia of such severity that language propositions were not apparently available at an explicit processing level in any modality of language use. Despite this profound impairment in grammar, he displayed simple causal reasoning and ToM understanding. Thus, reasoning about causes and beliefs involve processes that are independent of propositional language.

  16. Parallel recovery in a bilingual aphasic: a neurolinguistic and fMRI study.

    PubMed

    Marangolo, Paolo; Rizzi, Christina; Peran, Patrice; Piras, Fabrizio; Sabatini, Umberto

    2009-05-01

    In bilingual aphasics, the neural correlates of rehabilitation benefits and their generalization across languages are still scarcely understood. The authors present the case of a highly proficient bilingual woman (Flemish, L1/Italian, L2) with chronic aphasia who, in the presence of the same pattern of impairment in both languages, showed parallel recovery in both languages after long-term rehabilitation therapy in L2. The authors postulated that this recovery was due to the engagement of the same neural substrates. To confirm this the authors used an event-related functional magnetic resonance imaging (fMRI) paradigm to explore cortical activation during an overt picture naming task, performed in both Flemish and Italian once before and once after 2 weeks of training in L2. Behaviorally, the patient showed complete recovery of both languages. The fMRI results indicated that the same cerebral regions were recruited for both languages before and after training. Increasing activations were observed perilesionally and in homologous contralesional areas. Our data, in agreement with previous results of fMRI studies in healthy bilinguals, indicate a promising direction for future research on the neural mechanisms associated with recovery in bilingual aphasics.

  17. Patients with chronic pulmonary disease.

    PubMed

    Hong, Caron M; Galvagno, Samuel M

    2013-11-01

    Chronic pulmonary disease is common among the surgical population and the importance of a thorough and detailed preoperative assessment is monumental for minimizing morbidity and mortality and reducing the risk of perioperative pulmonary complications. These comorbidities contribute to pulmonary postoperative complications, including atelectasis, pneumonia, and respiratory failure, and can predict long-term mortality. The important aspects of the preoperative assessment for patients with chronic pulmonary disease, and the value of preoperative testing and smoking cessation, are discussed. Specifically discussed are preoperative pulmonary assessment and management of patients with chronic obstructive pulmonary disease, asthma, restrictive lung disease, obstructive sleep apnea, and obesity. PMID:24182721

  18. Conversations with chronic schizophrenic patients.

    PubMed

    Morgan, R

    1979-02-01

    An account is given of some of the topics discussed during a small informal weekly open group meeting of chronic schizophrenic patients, based on occasional notes compiled over eleven years. The main feature of the patients' condition as displayed was poverty--clinical, social, behavioural, material and financial--and certain features suggested an organic aetiology. Reasons are given for considering that the patients' condition was predominantly caused by schizophrenia rather than by institutionalism.

  19. MRI findings in aphasic status epilepticus.

    PubMed

    Toledo, Manuel; Munuera, Josep; Sueiras, Maria; Rovira, Rosa; Alvarez-Sabín, José; Rovira, Alex

    2008-08-01

    Ictal-MRI studies including diffusion-weighted imaging (DWI), perfusion-weighted imaging (PWI), and MR-angiography (MRA) in patients with aphasic status epilepticus (ASE) are lacking. In this report, we aim to describe the consequences of the ASE on DWIs and its impact on cerebral circulation. We retrospectively studied eight patients with ASE confirmed by ictal-EEG, who underwent ictal-MRI shortly after well-documented onset (mean time delay 3 h). ASE consisted in fluctuating aphasia, mostly associated with other subtle contralateral neurological signs such as hemiparesia, hemianopia, or slight clonic jerks. In MRI, six patients showed cortical temporoparietal hyperintensity in DWI and four of them had also ipsilateral pulvinar lesions. Five patients showed close spatial hyperperfusion areas matching the DWI lesions and an enhanced blow flow in the middle cerebral artery. Parenchymal lesions and hemodynamic abnormalities were not associated with seizure duration or severity in any case. The resolution of DWI lesions at follow-up MRI depended on the length of the MRIs interval. In patients with ASE, lesions on DWI in the temporo-parietal cortex and pulvinar nucleus combined with local hyperperfusion can be observed, even when they appear distant from the epileptic focus or the language areas. PMID:18522643

  20. Evaluation of adult aphasics with the Pediatric Speech Intelligibility test.

    PubMed

    Jerger, S; Oliver, T A; Martin, R C

    1990-04-01

    Results of conventional adult speech audiometry may be compromised by the presence of speech/language disorders, such as aphasia. The purpose of this project was to determine the efficacy of the speech intelligibility materials and techniques developed for young children in evaluating central auditory function in aphasic adults. Eight adult aphasics were evaluated with the Pediatric Speech Intelligibility (PSI) test, a picture-pointing approach that was carefully developed to be relatively insensitive to linguistic-cognitive skills and relatively sensitive to auditory-perceptual function. Results on message-to-competition ratio (MCR) functions or performance-intensity (PI) functions were abnormal in all subjects. Most subjects served as their own controls, showing normal performance on one ear coupled with abnormal performance on the other ear. The patterns of abnormalities were consistent with the patterns seen (1) on conventional speech audiometry in brain-lesioned adults without aphasia and (2) on the PSI test in brain-lesioned children without aphasia. An exception to this general observation was an atypical pattern of abnormality on PI-function testing in the subgroup of nonfluent aphasics. The nonfluent subjects showed substantially poorer word-max scores than sentence-max scores, a pattern seen previously in only one other patient group, namely young children with recurrent otitis media. The unusually depressed word-max abnormality was not meaningfully related to clinical diagnostic data regarding the degree of hearing loss and the location and severity of the lesions or to experimental data regarding the integrity of phonologic processing abilities. The observations of ear-specific and condition-specific abnormalities suggest that the linguistically- and cognitively-simplified PSI test may be useful in the evaluation of auditory-specific deficits in the aphasic adult. PMID:2132591

  1. Sentence interpretation in normal and aphasic Hindi speakers.

    PubMed

    Vaid, J; Pandit, R

    1991-08-01

    In interpreting a sentence, listeners rely on a variety of linguistic cues to assign grammatical roles such as agent and patient. The present study considered the relative ranking of three cues to agenthood (word order, noun animacy, and subject-verb agreement) in normal and aphasic speakers of Hindi. Because animacy plays a grammatical role in Hindi (determining the nature and acceptability of sentences without accusative marking), this language is relevant to the claim that Broca's aphasia involves a dissociation between grammar and semantics. Results of Study 1 with normal Hindi-dominant speakers showed that animacy is the strongest cue in this language, while agreement is the weakest cue. In Study 2, Hindi-English bilinguals were tested in both their languages. Most showed the normal animacy-dominant monolingual pattern in Hindi, with a mixture of strategies from both languages in their interpretation of English. A substantial minority showed mixed strategies in both languages. Only 5 of 48 subjects displayed a complete separation between languages, with animacy dominance in Hindi and word order dominance in English. In Study 3, two Hindi-English bilinguals with Broca's aphasia were tested in both languages. Results indicate (a) greater use of animacy in Hindi than in English and (b) greater use of word order in English than in Hindi. The strategies displayed by these patients fall well within the range observed among bilingual normals. We conclude that the use of animacy in sentence interpretation by these aphasic patients reflects preservation of normal, language-specific processing strategies; it cannot be interpreted as a nonlinguistic strategy developed to compensate for receptive agrammatism. Results are discussed in light of other cross-linguistic evidence on sentence comprehension in monolingual and bilingual aphasics.

  2. Spontaneous translation and language mixing in a polyglot aphasic.

    PubMed

    Perecman, E

    1984-09-01

    The literature on language mixing in polyglot aphasics is reviewed and a case report of a patient with spontaneous translation is presented. A microgenetic model of language processing provides an interpretive framework for language mixing and spontaneous translation as symptoms of polyglot aphasia. It is suggested that language mixing reflects a deficit at the linguistic level while spontaneous translation reflects a deficit at the prelinguistic level of language processing. A hypothesis about the organization of multiple languages in a single speaker is proposed. PMID:6206915

  3. Enhancing the Sensory Integration of Aphasic Students

    ERIC Educational Resources Information Center

    DePauw, Karen Pamelia

    1978-01-01

    Investigated was the effect on the sensory integration of 24 aphasic students, of a 7-month sensorimotor program-designed to stimulate the tactile, vestibular, and proprioceptive systems; motor planning ability; bilateral integration; postural and equilibrium responses; visual form and space perception; and motor development. ( DLS)

  4. The Effects of Homogeneous versus Heterogeneous Stimuli on the Confrontation-Naming Performance of Aphasics.

    ERIC Educational Resources Information Center

    Williams, Sarah E.; Wright, Judith M.

    1985-01-01

    The effect of semantic grouping on confrontation-naming performances of 16 fluent and 10 nonfluent aphasic adults was examined. Performances were not uniformly facilitated in one naming condition over the other. Some patients, however, did appear to display performance discrepancies between the two conditions. (Author/CL)

  5. Contrasting effects of phonological priming in aphasic word production.

    PubMed

    Wilshire, Carolyn E; Saffran, Eleanor M

    2005-02-01

    Two fluent aphasics, IG and GL, performed a phonological priming task in which they repeated an auditory prime then named a target picture. The two patients both had selective deficits in word production: they were at or near ceiling on lexical comprehension tasks, but were significantly impaired in picture naming. IG's naming errors included both semantic and phonemic paraphasias, as well as failures to respond, whereas GL's errors were mainly phonemic and formal paraphasias. The two patients responded very differently to phonological priming: IG's naming was facilitated (both accuracy and speed) only by begin-related primes (e.g. ferry-feather), whereas GL benefited significantly only from end-related primes (e.g. brother-feather), showing no more than a facilitatory trend with begin-related primes. We interpret these results within a two-stage model of word production, in which begin-related and end-related primes are said to operate at different stages. We then discuss implications for models of normal and aphasic word production in general and particularly with respect to sequential aspects of the phonological encoding process. PMID:15629473

  6. An Investigation of Luria's Hypothesis on Prompting in Aphasic Naming Disturbances.

    ERIC Educational Resources Information Center

    Li, Edith Chin; Canter, Gerald J.

    1987-01-01

    The study investigated A. R. Luria's hypothesis that aphasic subgroups (Broca's, conduction, Wernicke's, and anomic aphasics) would respond differentially to phonemic prompts. Results, with the exception of the anomic aphasic group, supported Luria's predictions. (Author/DB)

  7. Functional lateralisation of pitch accents and intonation in Norwegian: Monrad-Krohn's study of an aphasic patient with altered "melody of speech".

    PubMed

    Moen, I

    1991-11-01

    The present article provides a linguistic analysis of Monrad-Krohn's famous description of a patient with deviant prosody (1947). Monrad-Krohn found it particularly striking that the patient's "melody of speech" had been damaged although her musical abilities showed no impairment. The patient had suffered a traumatic motor aphasia as the result of a shrapnel wound in Broca's area. In East Norwegian, accented syllables are associated with one of two pitch patterns, either a fall in pitch or a low-level pitch. The patient had trouble producing the distinction between these two accents. Monrad-Krohn's description also suggests that she may have accented words in contexts where they should have been unaccented, with the result that these syllables (erroneously) received one of the two pitch patterns. It is suggested that her apparently deviant sentence intonation could, in some cases, be the "secondary" result of a tendency to produce full vowels in positions where a reduced vowel would be expected, thus abnormally prolonging an otherwise appropriate rising pitch pattern.

  8. Revisiting "The Influence of Literacy in Paraphasias of Aphasic Speakers"

    ERIC Educational Resources Information Center

    Colaco, Dora; Mineiro, Ana; Leal, Gabriela; Castro-Caldas, Alexandre

    2010-01-01

    Literature suggests that illiterate subjects are unaware of the phonological structure of language. This fact may influence the characteristics of aphasic speech, namely the structure of paraphasias. A battery of tests was developed for this study to be used with aphasic subjects (literate and illiterate), in order to explore this topic in more…

  9. The Influence of Topic and Listener Familiarity on Aphasic Discourse.

    ERIC Educational Resources Information Center

    Williams, Sarah E.; And Others

    1994-01-01

    Thirty-two subjects (5 Broca's, 7 conduction, and 10 anomic aphasics and 10 normal controls) performed story retell and procedural discourse tasks containing familiar and unfamiliar topics, with familiar and unfamiliar listeners. Results indicated that topic familiarity significantly influenced verbal output in both normal and aphasic subjects.…

  10. Prevalence of chronic pain in psychiatric patients.

    PubMed

    Chaturvedi, S K

    1987-05-01

    Five hundred consecutive patients attending a psychiatric clinic were examined in order to ascertain the prevalence of chronic pain in various psychiatric illnesses and demographic categories. Chronic pain was found to be a frequent symptom in anxiety neurosis (60%), neurotic depression (45%) and hysteria (24.3%). Less than 3% of psychotic patients reported chronic pain. Females and those patients who had entered further education beyond secondary level were found to have significantly higher (P less than 0.001) representation as compared to the psychiatric population without pain. The results are in accordance with certain earlier studies carried out almost two decades ago. Chronic pain was found to be a common symptom of psychiatric illness, reported by 18.6% patients, especially those diagnosed as having neurosis. It was also reported more often by females and by those with a higher education. The reasons for these observations require investigation.

  11. Promethazine use among chronic pain patients

    PubMed Central

    Lynch, Kara L.; Shapiro, Brad J.; Coffa, Diana; Novak, Scott P.; Kral, Alex H.

    2015-01-01

    Background Concomitant use of opioids and promethazine has been reported in various subpopulations, including methadone maintenance patients, injection drug users, and at-risk teenagers. Promethazine is thought to potentiate the “high” from opioids. However, to date, the prevalence of promethazine use has not been determined among patients prescribed opioids for chronic pain. Methods Urine samples from 921 patients prescribed opioids for chronic pain were analyzed for promethazine. Demographic data, toxicology results, and opioid prescription information were obtained through medical record abstraction. We assessed the prevalence and factors associated with promethazine use with bivariable and multivariable statistics. Results The prevalence of promethazine-positive urine samples among chronic pain patients was 9%. Only 50% of promethazine-positive patients had an active prescription for promethazine. Having benzodiazepine-positive urine with no prescription for a benzodiazepine was statistically associated with promethazine use. Also, having a prescription for methadone for pain or being in methadone maintenance for the treatment of opioid dependence were both statistically associated with promethazine use. Chronic pain patients prescribed only a long-acting opioid were more likely to have promethazine-positive urines than patients prescribed a short-acting opioid. Conclusions The study provides compelling evidence of significant promethazine use in chronic pain patients. Promethazine should be considered as a potential drug of abuse that could cause increased morbidity in opioid-using populations. PMID:25754939

  12. Assessment of patients with chronic pain

    PubMed Central

    Dansie, E. J.; Turk, D. C.

    2013-01-01

    Summary Chronic pain is a public health concern affecting 20–30% of the population of Western countries. Although there have been many scientific advances in the understanding of the neurophysiology of pain, precisely assessing and diagnosing a patient's chronic pain problem is not straightforward or well-defined. How chronic pain is conceptualized influences how pain is evaluated and the factors considered when making a chronic pain diagnosis. There is no one-to-one relationship between the amount or type of organic pathology and pain intensity, but instead, the chronic pain experience is shaped by a myriad of biomedical, psychosocial (e.g. patients' beliefs, expectations, and mood), and behavioural factors (e.g. context, responses by significant others). Assessing each of these three domains through a comprehensive evaluation of the person with chronic pain is essential for treatment decisions and to facilitate optimal outcomes. This evaluation should include a thorough patient history and medical evaluation and a brief screening interview where the patient's behaviour can be observed. Further assessment to address questions identified during the initial evaluation will guide decisions as to what additional assessments, if any, may be appropriate. Standardized self-reported instruments to evaluate the patient's pain intensity, functional abilities, beliefs and expectations, and emotional distress are available, and can be administered by the physician, or a referral for in depth evaluation can be made to assist in treatment planning. PMID:23794641

  13. Assessment of patients with chronic pain.

    PubMed

    Dansie, E J; Turk, D C

    2013-07-01

    Chronic pain is a public health concern affecting 20-30% of the population of Western countries. Although there have been many scientific advances in the understanding of the neurophysiology of pain, precisely assessing and diagnosing a patient's chronic pain problem is not straightforward or well-defined. How chronic pain is conceptualized influences how pain is evaluated and the factors considered when making a chronic pain diagnosis. There is no one-to-one relationship between the amount or type of organic pathology and pain intensity, but instead, the chronic pain experience is shaped by a myriad of biomedical, psychosocial (e.g. patients' beliefs, expectations, and mood), and behavioural factors (e.g. context, responses by significant others). Assessing each of these three domains through a comprehensive evaluation of the person with chronic pain is essential for treatment decisions and to facilitate optimal outcomes. This evaluation should include a thorough patient history and medical evaluation and a brief screening interview where the patient's behaviour can be observed. Further assessment to address questions identified during the initial evaluation will guide decisions as to what additional assessments, if any, may be appropriate. Standardized self-reported instruments to evaluate the patient's pain intensity, functional abilities, beliefs and expectations, and emotional distress are available, and can be administered by the physician, or a referral for in depth evaluation can be made to assist in treatment planning.

  14. [Disease management for chronic heart failure patient].

    PubMed

    Bläuer, Cornelia; Pfister, Otmar; Bächtold, Christa; Junker, Therese; Spirig, Rebecca

    2011-02-01

    Patients with chronic heart failure (HF) are limited in their quality of life, have a poor prognosis and face frequent hospitalisations. Patient self-management was shown to improve quality of life, reduce rehospitalisations and costs in patients with chronic HF. Comprehensive disease management programmes are critical to foster patient self-management. The chronic care model developed by the WHO serves as the basis of such programmes. In order to develop self-management skills a needs orientated training concept is mandatory, as patients need both knowledge of the illness and the ability to use the information to make appropriate decisions according to their individual situation. Switzerland has no established system for the care of patients with chronic diseases in particular those with HF. For this reason a group of Swiss experts for HF designed a model for disease management for HF patients in Switzerland. Since 2009 the Swiss Heart Foundation offers an education programme based on this model. The aim of this programme is to offer education and support for practitioners, patients and families. An initial pilot evaluation of the program showed mixed acceptance by practitioners, whereas patient assessed the program as supportive and in line with their requirements.

  15. Chronic stress in myofascial pain patients.

    PubMed

    Schmitter, Marc; Keller, Livia; Giannakopoulos, Nikolaos; Rammelsberg, Peter

    2010-10-01

    Although myofascial pain has often been described as being associated with psychosocial stress, detailed evidence in support of this assumption, either from standardized clinical examination or from validated chronic stress questionnaires, is absent. The hypothesis of the present study was that some stressors lead to higher scores in patients suffering from chronic myofascial pain than in pain-free controls and in patients suffering from chronic facial pain. One hundred and fifty subjects were included in the study, and depending on clinical findings, divided into three groups: exclusively chronic myofascial pain group, controls with chronic facial pain but without temporomandibular disorders (TMD), and controls without pain or TMD. Chronic stress was assessed on nine subscales by use of a validated questionnaire. Myofascial pain patients have a significantly higher stress score for "social isolation" than pain-free controls (t-test, p = 0.003). However, they do not have higher scores than patients suffering from facial pain (t test, p = 0.169). Thus, the hypothesis of this study could not be completely rejected. PMID:19705168

  16. Strategies for Classifying Chronic Orofacial Pain Patients

    PubMed Central

    Turk, Dennis C.

    1990-01-01

    To communicate, understand, and prescribe treatment, it is essential that some consensually validated criteria be used to describe groups of patients who share a set of relevant attributes. Several classification systems have been developed to described relatively homogeneous subgroups of chronic pain patients. These systems have been based on theoretical perspectives of chronic pain syndromes tied to physical pathology. Alternative systems based on a priori psychological categories or empirically derived classifications also have been proposed. Some of the strengths and weaknesses of deductive and inductive approaches to classification are described, and the advantages of polydiagnostic and multiaxial approaches are described as alternatives to the traditional classification. Research on an empirically derived multiaxial classification for chronic pain is described and related to chronic orofacial pain. PMID:2085195

  17. Frequency of anemia in chronic psychiatry patients

    PubMed Central

    Korkmaz, Sevda; Yıldız, Sevler; Korucu, Tuba; Gundogan, Burcu; Sunbul, Zehra Emine; Korkmaz, Hasan; Atmaca, Murad

    2015-01-01

    Purpose Anemia could cause psychiatric symptoms such as cognitive function disorders and depression or could deteriorate an existing psychiatric condition when it is untreated. The objective of this study is to scrutinize the frequency of anemia in chronic psychiatric patients and the clinical and sociodemographic factors that could affect this frequency. Methods All inpatients in our clinic who satisfied the study criteria and received treatment between April 2014 and April 2015 were included in this cross-sectional study. Sociodemographic data for 378 patients included in the study and hemoglobin (Hb) and hematocrit values observed during their admission to the hospital were recorded in the forms. Male patients with an Hb level of <13 g/dL and nonpregnant female patients with an Hb level of <12 g/dL were considered as anemic. Findings Axis 1 diagnoses demonstrated that 172 patients had depressive disorder, 51 patients had bipolar disorder, 54 patients had psychotic disorder, 33 patients had conversion disorder, 19 patients had obsessive-compulsive disorder, 25 patients had generalized anxiety disorder, and 24 patients had other psychiatric conditions. It was also determined that 25.4% of the patients suffered from anemia. Thirty-five percent of females and 10% of males were considered as anemic. The frequency of anemia was the highest among psychotic disorder patients (35%), followed by generalized anxiety disorder patients (32%), and obsessive-compulsive disorder patients (26%). Anemia was diagnosed in 22% of depressive disorder patients, 25% of bipolar disorder patients, and 24% of conversion disorder patients. Results The prevalence of anemia among chronic psychiatry patients is more frequent than the general population. Thus, the study concluded that it would be beneficial to consider the physical symptoms and to conduct the required examinations to determine anemia among this patient group. PMID:26543367

  18. Negative symptom assessment of chronic schizophrenia patients.

    PubMed

    Raskin, A; Pelchat, R; Sood, R; Alphs, L D; Levine, J

    1993-01-01

    A new scale for assessing negative symptoms in schizophrenia, the Negative Symptom Assessment (NSA), was administered to 101 male chronic, inpatient schizophrenia patients. Factor analysis of the NSA yielded seven factors, but most of the explained variance resided in Factor 1, Restricted Affect/Emotion. The factors that emerged from this study closely resembled NSA factors derived from an earlier study of outpatient schizophrenia patients, which indicates the factor structure of the NSA is robust. A constellation of variables reflecting long-term or chronic illness were significantly related to six of the seven factors. These results suggest that "institutionalism" may play a role in the evolution of some negative symptoms.

  19. Attitudes toward patient expertise in chronic illness.

    PubMed

    Thorne, S E; Ternulf Nyhlin, K; Paterson, B L

    2000-08-01

    Although it has become an accepted standard to acknowledge the patient as a full partner in health care decisions, replacing traditional authoritative relationships with those based on an emancipatory model, the experiences of persons living with chronic illness confirm that this paradigm shift is not yet apparent in many health care relationships. In this paper, the authors present a qualitative secondary analysis of combined data sets from their research into chronic illness experience with two quite different chronic diseases - Type I Diabetes (a socially legitimized chronic disease) and Environmental Sensitivities (a disease which is currently treated with considerable scepticism). Comparing the experiences of individuals with diseases that are quite differently socially constructed, it becomes possible to detect common underlying health professional values and attitudes that powerfully influence the experience of living with and negotiating health care for a chronic illness. In the discussion of findings from this study, the authors examine the implications of the spiral of behaviors that fuels mutual alienation in chronic illness care relationships if professionals are unable to value patient expertise.

  20. Individualized treatment with transcranial direct current stimulation in patients with chronic non-fluent aphasia due to stroke

    PubMed Central

    Shah-Basak, Priyanka P.; Norise, Catherine; Garcia, Gabriella; Torres, Jose; Faseyitan, Olufunsho; Hamilton, Roy H.

    2015-01-01

    While evidence suggests that transcranial direct current stimulation (tDCS) may facilitate language recovery in chronic post-stroke aphasia, individual variability in patient response to different patterns of stimulation remains largely unexplored. We sought to characterize this variability among chronic aphasic individuals, and to explore whether repeated stimulation with an individualized optimal montage could lead to persistent reduction of aphasia severity. In a two-phase study, we first stimulated patients with four active montages (left hemispheric anode or cathode; right hemispheric anode or cathode) and one sham montage (Phase 1). We examined changes in picture naming ability to address (1) variability in response to different montages among our patients, and (2) whether individual patients responded optimally to at least one montage. During Phase 2, subjects who responded in Phase 1 were randomized to receive either real-tDCS or to receive sham stimulation (10 days); patients who were randomized to receive sham stimulation first were then crossed over to receive real-tDCS (10 days). In both phases, 2 mA tDCS was administered for 20 min per real-tDCS sessions and patients performed a picture naming task during stimulation. Patients' language ability was re-tested after 2-weeks and 2-months following real and sham tDCS in Phase 2. In Phase 1, despite considerable individual variability, the greatest average improvement was observed after left-cathodal stimulation. Seven out of 12 subjects responded optimally to at least one montage as demonstrated by transient improvement in picture-naming. In Phase 2, aphasia severity improved at 2-weeks and 2-months following real-tDCS but not sham. Despite individual variability with respect to optimal tDCS approach, certain montages result in consistent transient improvement in persons with chronic post-stroke aphasia. This preliminary study supports the notion that individualized tDCS treatment may enhance aphasia

  1. Rights of chronic renal failure patients undergoing chronic dialysis therapy.

    PubMed

    Andreucci, Vittorio E; Kerr, David N S; Kopple, Joel D

    2004-01-01

    The Patient Advocacy Committee of the International Federation of Kidney Foundations (IFKF) has developed a document proposing a set of rights for individuals with end stage renal failure (ESRF). These rights have been approved by the Board of Directors of the IFKF. Twenty rights have been developed and are organized into the following categories: (i) need of treatment and choice of patients; (ii) treatment of ESRF by haemodialysis; (iii) treatment of ESRF by peritoneal dialysis; and (iv) renal transplantation. It is the hope of this Committee and the IFKF that this document will provide a stimulus to more scientific inquiry and discussion as to what rights do patients possess with regard to treatment of chronic kidney disease, regardless of where they live or what may be their economic, social, ethnic or political status.

  2. Chronic prostatitis in spinal cord injury patients.

    PubMed

    Wyndaele, J J

    1985-06-01

    Six spinal cord injury patients with chronic prostatitis were reviewed, all of whom had been treated with an indwelling Foley catheter during the phase of spinal shock. The 3 glass urine specimen test, the bladder wash-out test, a study of antibody coated bacteria and urethrography had limited diagnostic value. A specific diagnostic 5 glass specimen test proved to be useful and reliable. Longterm antibiotic treatment was successful in only one patient. Injection of antibiotics into the prostate gland was ineffective in the five patients in whom it was carried out. During a follow up from 1 to 5 years urological complications were rare in all five patients who remained infected.

  3. Patient concerns regarding chronic hepatitis C infections.

    PubMed

    Minuk, G Y; Gutkin, A; Wong, S G; Kaita, K D E

    2005-01-01

    Counselling of patients with chronic hepatitis C infections is often limited to discussions regarding how the virus is transmitted and what can be done to decrease the risk of transmission to others. The purpose of the present study was to document the principal concerns of newly diagnosed and follow-up patients with chronic hepatitis C, and thereby enhance counselling strategies and content. Seventy newly diagnosed and 115 follow-up patients with chronic hepatitis C virus (HCV) infection were initially asked in an open-ended manner (volunteered concerns) and then to prioritize from a prepared list of seven potential concerns (prioritized concerns), to identify those concerns that were of utmost importance to them. The most common volunteered concerns of newly diagnosed patients in decreasing order were: disease progression (27%), premature death (19%), infecting family members (13%), side-effects of treatment (11%) and miscellaneous others. In decreasing order, prioritized concerns included: infecting family members, development of liver cancer, infecting others, development of cirrhosis, social stigma of having liver disease, need for liver transplant and loss of employment. The principal volunteered and prioritized concerns of follow-up patients were similar to those of newly diagnosed patients. Volunteered and prioritized concerns were relatively consistent across the different genders, age groups, ethnic backgrounds, education level, marital status, employment, modes of viral acquisition and in the case of follow-up patients, duration of follow-up. These results indicate that health care providers who focus counselling efforts exclusively on viral transmission are unlikely to address other important concerns of newly diagnosed and follow-up patients with chronic HCV infection. PMID:15655048

  4. Predicting subjective disability in chronic pain patients.

    PubMed

    Kröner-Herwig, B; Jäkle, C; Frettlöh, J; Peters, K; Seemann, H; Franz, C; Basler, H D

    1996-01-01

    Subjective disability is considered as the variable that reflects the impact of chronic pain on a patient's life. This study examines the questions of which syndrome or patient characteristics determine subjective disability and whether there are differences between samples of patients with chronic headaches and low back pain. Direct pain variables and depression, pain coping strategies, and pain-related self-statements (including catastrophizing) are introduced into multivariate regression analyses as potential predictors of disability using a sample of 151 pain patients. Disability is not predicted by pain severity in patients with headaches or back pain. Psychological variables, especially coping strategies, are far more influential. Coping explains more variance in disability in the headache sample than in the chronic law hack pain group, whereas depression is more relevant for the degree of disability in the back pain sample. In this study, we present a critical analysis of possible interpretations of our results. We point to an overlap of concepts underlying some of the variables used: this overlap also considerably invalidates conclusions drawn from a multitude of studies done in this field, including the one presented. We strongly argue for a conceptual clarification, and consequently for the revision of assessment instruments, before further empirical work in this area is done.

  5. Chronic pain patient-spouse behavioral interactions predict patient disability.

    PubMed

    Romano, J M; Turner, J A; Jensen, M P; Friedman, L S; Bulcroft, R A; Hops, H; Wright, S F

    1995-12-01

    Based on behavioral theory, it has been hypothesized that spouse solicitous responses to the pain behaviors of chronic pain patients may contribute to the maintenance of pain behaviors and disability. Self-report data support this hypothesis, but direct observational measures have not been used to study this association. In this study, 50 chronic pain patients and their spouses were videotaped while engaging in common household activities. and patient pain behaviors and spouse solicitous behaviors were coded from the tapes. Spouse solicitous responses to non-verbal pain behaviors were significant predictors of physical disability in the more depressed patients, and were significant predictors of rate of non-verbal pain behavior in patients who reported greater pain. Spouse solicitous responses did not predict psychosocial dysfunction or total self-reported pain behaviors. The result support behavioral theory and indicate the need for further study of the association between spouse solicitousness and patient pain behaviors/disability.

  6. Comprehension of wh-questions in two Broca's aphasics.

    PubMed

    Hickok, G; Avrutin, S

    1996-02-01

    This study investigated comprehension of wh-questions in two Broca's aphasics. Patients were presented for comprehension with two types of wh-questions: questions headed by which and questions headed by who. These two types were chosen because according to recent syntactic analyses they give rise to different types of syntactic "chains." These questions were presented in both subject gap versions (e.g., which cat chased the dog?) and object gap versions (e.g., which cat did the dog chase?). Comprehension of which questions was asymmetric, with subject gap versions comprehended significantly better than object gap versions, the latter yielding chance-level performance. This finding is consistent with previous reports of subject-object asymmetries in comprehension of relative clauses and clefts, as well as active-passive comprehension asymmetries. In contrast, comprehension of who questions was symmetrical over subject gap and object gap versions: Both patients performed equally well (significantly better than chance) on subject gap and object gap who questions. These findings are inconsistent with current formulations of "chain" or "trace"-based theories of agrammatic comprehension which assume a deficit that affects both types of syntactic chains. We suggest that linguistic descriptions of agrammatic comprehension should be limited to deficits involving only one type of chain. We also suggest that there are processing differences underlying the syntactic distinctions between which-type and who-type questions and that this may account for different patterns of comprehension on these and other constructions. PMID:8811962

  7. Social skills training for chronic mental patients.

    PubMed

    Liberman, R P; Massel, H K; Mosk, M D; Wong, S E

    1985-04-01

    Social skills training has proved to be effective in increasing the social competence of chronic mental patients. The authors describe three models of social skills training, all of which involve role playing by the patient and modeling, prompting, feedback, and reinforcement by the therapist. Many patients can benefit from the basic training model. For patients functioning at a higher level, the problem-solving model provides general strategies for dealing with a variety of social situations. The attention-focusing model, designed for highly distractible and withdrawn patients, teaches skills through constant repetition of tasks and minimizes demands on cognitive abilities. The authors emphasize the importance of taking steps to ensure that the skills learned during training are generalized to other situations and settings.

  8. Proper name anomia in poststroke aphasics: evidence from a multiple-case study.

    PubMed

    Vitali, Paolo; Rouleau, Isabelle; Deschaintre, Yan; Mina, Diana; Brazeau, Marthyne; Lanthier, Sylvain; Montembeault, Maxime; Brambati, Simona Maria

    2015-01-01

    We aimed to characterize difficulties in famous face naming in three poststroke aphasic patients with a lesion limited to the left mid-posterior temporal language regions, sparing the anterior temporal lobe. The patients did not present semantic deficits specific to known people. Nonetheless, they showed difficulties naming famous buildings in addition to famous faces, but they were comparable to healthy controls in generating proper names. Our results support the critical role of the mid-posterior temporal language regions in the lexical retrieval of proper names, namely from pictorial stimuli, in absence of semantic impairments.

  9. [Anticoagulation in patients with chronic renal failure].

    PubMed

    Niksic, L; Saudan, P; Boehlen, F

    2006-03-01

    Anticoagulation may be difficult to implement in patients suffering from chronic renal failure on account of platelet disorders and impaired clearance of some anticoagulant drugs. Although no adjustment of heparin and coumarin dosage is necessary, more frequent testing of coagulation pathways may be required when these drugs are used in patients with renal failure. Long-term use of LMWH should be implemented cautiously with regular testing of anti-factor Xa activity and a half-dose may be advocated in patients with a creatinine clearance < 30 ml/mn. Danaparoid and thrombin inhibitors should be used mainly in patients suffering from renal failure and heparin-induced thrombocytopenia with regular monitoring of coagulation tests. PMID:16562602

  10. [Group therapy of patients with chronic pain].

    PubMed

    Rosén, G; Kvåle, A; Husebø, S

    1990-11-20

    51 patients suffering chronic pain, with different diagnoses, were treated in groups as outpatients using a cognitive behavioural approach. Groups of 7-8 patients met for two hours a week for six weeks. The groups were led by a team consisting of a clinical psychologist, a physiotherapist and a doctor. The patients learned about different aspects of pain, self-exercise and relaxation by selfhypnosis. Group dynamics was used to strengthen self-esteem, facilitate learning and encourage a change of attitude towards pain. Each patient answered a questionnaire about activities, level of pain, drugs and psychological symptoms before and immediately after treatment, and at follow-up one year later. At follow-up, 43% were less depressed, 70% felt less pain and 50% were more active and used less drugs.

  11. Nasal Consonant Production in Broca's and Wernicke's Aphasics: Speech Deficits and Neuroanatomical Correlates

    ERIC Educational Resources Information Center

    Kurowski, Kathleen M.; Blumstein, Sheila E.; Palumbo, Carole L.; Waldstein, Robin S.; Burton, Martha W.

    2007-01-01

    The present study investigated the articulatory implementation deficits of Broca's and Wernicke's aphasics and their potential neuroanatomical correlates. Five Broca's aphasics, two Wernicke's aphasics, and four age-matched normal speakers produced consonant-vowel-(consonant) real word tokens consisting of [m, n] followed by [i, e, a, o, u]. Three…

  12. This chronic patient becomes a humanistic patient who helps clinicians.

    PubMed

    Achenbaum, W Andrew

    2012-11-01

    A historian of aging, privileged to work with an interdisciplinary team of caregivers and researchers in a division of geriatric and palliative care of a major medical school and teaching hospital, discovers that his history of chronic illnesses secures him a useful role as a humanistic patient who helps clinicians to respond to the concerns, fears, and needs of aging Boomers.

  13. [Clinical integration in the chronic patient].

    PubMed

    Carretero-Alcántara, Luis; Comes-Górriz, Natividad; Borrás-López, Agustina; Rodríguez-Balo, Alberto; Seara-Aguilar, Germán

    2014-01-01

    Castilla-La Mancha Health Service is developing the integration of care levels due to the challenge of an aging population in the region. Aging is associated with chronic diseases and an increasing number of concomitant diseases. This poses a major care challenge care, with more fragile patients and new needs. This also requires a sustainable approach: the concurrence of several chronic diseases affects the cost of care, which is especially acute in times of severe economic crisis. One of the pillars of the strategy for dealing with chronic diseases in our region is care integration, in an effort to adapt the organization to the new needs. The Balanced Scorecard or Integrated Scorecard of the integration process was introduced as it has been designed. The integration of primary and hospital care at an organizational level has already been completed, and the development of integrated care processes has also been performed in order to achieve real integration at care level. To help finance this, a prospective capitation system is gradually being implemented, achieving a convergence of per capita costs in the different health areas integrated. Nurses has a key role in this process, their skills as educators and trainers in self-care, in the role of case managers of patients with particularly complex conditions, and the role of professional liaison to improve the transition between care areas and units.

  14. [Clinical integration in the chronic patient].

    PubMed

    Carretero-Alcántara, Luis; Comes-Górriz, Natividad; Borrás-López, Agustina; Rodríguez-Balo, Alberto; Seara-Aguilar, Germán

    2014-01-01

    Castilla-La Mancha Health Service is developing the integration of care levels due to the challenge of an aging population in the region. Aging is associated with chronic diseases and an increasing number of concomitant diseases. This poses a major care challenge care, with more fragile patients and new needs. This also requires a sustainable approach: the concurrence of several chronic diseases affects the cost of care, which is especially acute in times of severe economic crisis. One of the pillars of the strategy for dealing with chronic diseases in our region is care integration, in an effort to adapt the organization to the new needs. The Balanced Scorecard or Integrated Scorecard of the integration process was introduced as it has been designed. The integration of primary and hospital care at an organizational level has already been completed, and the development of integrated care processes has also been performed in order to achieve real integration at care level. To help finance this, a prospective capitation system is gradually being implemented, achieving a convergence of per capita costs in the different health areas integrated. Nurses has a key role in this process, their skills as educators and trainers in self-care, in the role of case managers of patients with particularly complex conditions, and the role of professional liaison to improve the transition between care areas and units. PMID:24468496

  15. Verb-noun double dissociation in aphasic lexical impairments: the role of word frequency and imageability.

    PubMed

    Luzzatti, Claudio; Raggi, Rossella; Zonca, Giusy; Pistarini, Caterina; Contardi, Antonella; Pinna, Gian-Domenico

    2002-01-01

    Neurolinguistic studies have provided important evidence regarding the organization of lexical representations and the structure of underlying conceptual knowledge; in particular, it has been shown that the retrieval of verbs and nouns can be damaged selectively. Dissociated lexical damage is proof of an independent mental organization of lexical representations and/or of the underlying processes. The aim of the present study is to estimate the rate of dissociated impairments for nouns and verbs on a large sample of mild to moderate aphasic patients and to investigate the mechanisms underlying such phenomena. In addition, the authors wished to verify to what degree the impairment for nouns and verbs is related to a specific type of language disorder. A confrontation naming task for verbs and nouns was administered to 58 aphasic patients. The major lexical (word frequency and age of acquisition) and semantic variables (familiarity and imageability of the underlying concept) were considered for each noun and verb used in the task. Verbs were distinguished by major functional classes (transitive, intransitive, and ergative verbs). The data collected from this task were analyzed twice: (i) as a group study comparison of major aphasic subgroups and (ii) as a multiple single case study to evaluate the differences on the naming of verbs and nouns and the effect of the lexical semantic variables on each individual patient. The results confirm the existence of dissociated naming impairments of verbs and nouns. Selective impairment of verbs is more frequent (34%) than that of nouns (10%). In many cases, the dissociated pattern of naming impairment disappeared when the effect of the concomitant variables (word frequency and imageability) was removed, but in approximately one-fifth of the cases the noun or verb superiority was preserved. Noun superiority emerged in five of six agrammatic patients. Both the naming of verbs (n = 9) or of nouns (n = 6) could be impaired

  16. [Telemedicine for patients with chronic intestinal failure].

    PubMed

    Nauta, Sjoukje; Feibig, Doreen; Wanten, Geert

    2014-01-01

    Telemedicine is a valuable extension of the ways in which patients with chronic diseases can be contacted. Patients can easily contact their caregivers within the safe environment of the digital waiting room. Telemedicine especially offers an advantage for those forms of care where the visual aspect is important. Care should be taken with respect to its implementation into the disease management process with careful synchronisation between all involved parties, e.g. patient, caregiver, and organisation. The effectiveness of telemedicine and the savings that can be achieved should be properly established in order to justify the funding of a telemedicine project. Rather than focusing on the possible drawbacks of telemedicine, e.g. safety concerns and the user-friendliness of the system, we should highlight the possibilities that information technology offers. PMID:25515390

  17. How to engage the right brain hemisphere in aphasics without even singing: evidence for two paths of speech recovery

    PubMed Central

    Stahl, Benjamin; Henseler, Ilona; Turner, Robert; Geyer, Stefan; Kotz, Sonja A.

    2012-01-01

    There is an ongoing debate as to whether singing helps left-hemispheric stroke patients recover from non-fluent aphasia through stimulation of the right hemisphere. According to recent work, it may not be singing itself that aids speech production in non-fluent aphasic patients, but rhythm and lyric type. However, the long-term effects of melody and rhythm on speech recovery are largely unknown. In the current experiment, we tested 15 patients with chronic non-fluent aphasia who underwent either singing therapy, rhythmic therapy, or standard speech therapy. The experiment controlled for phonatory quality, vocal frequency variability, pitch accuracy, syllable duration, phonetic complexity and other influences, such as the acoustic setting and learning effects induced by the testing itself. The results provide the first evidence that singing and rhythmic speech may be similarly effective in the treatment of non-fluent aphasia. This finding may challenge the view that singing causes a transfer of language function from the left to the right hemisphere. Instead, both singing and rhythmic therapy patients made good progress in the production of common, formulaic phrases—known to be supported by right corticostriatal brain areas. This progress occurred at an early stage of both therapies and was stable over time. Conversely, patients receiving standard therapy made less progress in the production of formulaic phrases. They did, however, improve their production of non-formulaic speech, in contrast to singing and rhythmic therapy patients, who did not. In light of these results, it may be worth considering the combined use of standard therapy and the training of formulaic phrases, whether sung or rhythmically spoken. Standard therapy may engage, in particular, left perilesional brain regions, while training of formulaic phrases may open new ways of tapping into right-hemisphere language resources—even without singing. PMID:23450277

  18. How to engage the right brain hemisphere in aphasics without even singing: evidence for two paths of speech recovery.

    PubMed

    Stahl, Benjamin; Henseler, Ilona; Turner, Robert; Geyer, Stefan; Kotz, Sonja A

    2013-01-01

    There is an ongoing debate as to whether singing helps left-hemispheric stroke patients recover from non-fluent aphasia through stimulation of the right hemisphere. According to recent work, it may not be singing itself that aids speech production in non-fluent aphasic patients, but rhythm and lyric type. However, the long-term effects of melody and rhythm on speech recovery are largely unknown. In the current experiment, we tested 15 patients with chronic non-fluent aphasia who underwent either singing therapy, rhythmic therapy, or standard speech therapy. The experiment controlled for phonatory quality, vocal frequency variability, pitch accuracy, syllable duration, phonetic complexity and other influences, such as the acoustic setting and learning effects induced by the testing itself. The results provide the first evidence that singing and rhythmic speech may be similarly effective in the treatment of non-fluent aphasia. This finding may challenge the view that singing causes a transfer of language function from the left to the right hemisphere. Instead, both singing and rhythmic therapy patients made good progress in the production of common, formulaic phrases-known to be supported by right corticostriatal brain areas. This progress occurred at an early stage of both therapies and was stable over time. Conversely, patients receiving standard therapy made less progress in the production of formulaic phrases. They did, however, improve their production of non-formulaic speech, in contrast to singing and rhythmic therapy patients, who did not. In light of these results, it may be worth considering the combined use of standard therapy and the training of formulaic phrases, whether sung or rhythmically spoken. Standard therapy may engage, in particular, left perilesional brain regions, while training of formulaic phrases may open new ways of tapping into right-hemisphere language resources-even without singing.

  19. How to engage the right brain hemisphere in aphasics without even singing: evidence for two paths of speech recovery.

    PubMed

    Stahl, Benjamin; Henseler, Ilona; Turner, Robert; Geyer, Stefan; Kotz, Sonja A

    2013-01-01

    There is an ongoing debate as to whether singing helps left-hemispheric stroke patients recover from non-fluent aphasia through stimulation of the right hemisphere. According to recent work, it may not be singing itself that aids speech production in non-fluent aphasic patients, but rhythm and lyric type. However, the long-term effects of melody and rhythm on speech recovery are largely unknown. In the current experiment, we tested 15 patients with chronic non-fluent aphasia who underwent either singing therapy, rhythmic therapy, or standard speech therapy. The experiment controlled for phonatory quality, vocal frequency variability, pitch accuracy, syllable duration, phonetic complexity and other influences, such as the acoustic setting and learning effects induced by the testing itself. The results provide the first evidence that singing and rhythmic speech may be similarly effective in the treatment of non-fluent aphasia. This finding may challenge the view that singing causes a transfer of language function from the left to the right hemisphere. Instead, both singing and rhythmic therapy patients made good progress in the production of common, formulaic phrases-known to be supported by right corticostriatal brain areas. This progress occurred at an early stage of both therapies and was stable over time. Conversely, patients receiving standard therapy made less progress in the production of formulaic phrases. They did, however, improve their production of non-formulaic speech, in contrast to singing and rhythmic therapy patients, who did not. In light of these results, it may be worth considering the combined use of standard therapy and the training of formulaic phrases, whether sung or rhythmically spoken. Standard therapy may engage, in particular, left perilesional brain regions, while training of formulaic phrases may open new ways of tapping into right-hemisphere language resources-even without singing. PMID:23450277

  20. A new test battery to assess aphasic disturbances and associated cognitive dysfunctions -- German normative data on the aphasia check list.

    PubMed

    Kalbe, Elke; Reinhold, Nadine; Brand, Matthias; Markowitsch, Hans J; Kessler, Josef

    2005-10-01

    Aphasia, defined as an acquired impairment of linguistic abilities, can be accompanied by a diversity of neuropsychological dysfunction. Accordingly, the necessity to include cognitive testing in the diagnosis of aphasia is increasingly recognized. Here we present the Aphasia Check List (ACL), a new test battery for the assessment of aphasic and associated cognitive disorders. The language part of the battery provides a differentiated profile of important linguistic abilities. In addition, the ACL includes nonverbal screening tests for three neuropsychological domains: memory, attention, and reasoning. Dysfunctions in these domains have been observed in aphasic patients and can have an impact on language function. The ACL is applicable to patients with language disturbances of different etiologies, different stages of disease, and to patients with mild to severe aphasia. As the entire test duration is only about 30 minutes, the ACL is also economically valuable. It thus presents an adequate starting point in aphasia diagnosis for a wide range of patients. Here we describe the construction of the ACL, and the normative study of its original German version with 154 aphasic patients and 106 healthy comparison subjects. The ACL cognition part revealed additional neuropsychological dysfunction in the aphasia group. We present the patterns of these dysfunctions and their correlations with language deficits.

  1. A fatal encephalopathy in chronic haemodialysis patients.

    PubMed

    Burks, J S; Alfrey, A C; Huddlestone, J; Norenberg, M D; Lewin, E

    1976-04-10

    A distinct neurological syndrome in twelve chronic haemodialysis patients is described. This syndrome is currently the leading cause of death in one Denver dialysis unit. The hallmarks of this syndrome are progressive speech difficulties, mental changes, and a markedly abnormal electroencephalogram which may be present months before the clinical signs appear. Additional clinical features including seizures, myoclonus, asterixis, apraxia, focal neurological signs, and psychiatric symptoms may also be observed. Neuropathological changes are slight and non-specific. The aetiology of this syndrome is unknown but the clinical and pathological features suggest a toxic/metabolic disorder. To date, this disorder has been refractory to several therapeutic measures.

  2. Transcranial direct current stimulation improves word retrieval in healthy and nonfluent aphasic subjects.

    PubMed

    Fiori, Valentina; Coccia, Michela; Marinelli, Chiara V; Vecchi, Veronica; Bonifazi, Silvia; Ceravolo, M Gabriella; Provinciali, Leandro; Tomaiuolo, Francesco; Marangolo, Paola

    2011-09-01

    A number of studies have shown that modulating cortical activity by means of transcranial direct current stimulation (tDCS) affects performances of both healthy and brain-damaged subjects. In this study, we investigated the potential of tDCS to enhance associative verbal learning in 10 healthy individuals and to improve word retrieval deficits in three patients with stroke-induced aphasia. In healthy individuals, tDCS (20 min, 1 mA) was applied over Wernicke's area (position CP5 of the International 10-20 EEG System) while they learned 20 new "words" (legal nonwords arbitrarily assigned to 20 different pictures). The healthy subjects participated in a randomized counterbalanced double-blind procedure in which they were subjected to one session of anodic tDCS over left Wernicke's area, one sham session over this location and one session of anodic tDCS stimulating the right occipito-parietal area. Each experimental session was performed during a different week (over three consecutive weeks) with 6 days of intersession interval. Over 2 weeks, three aphasic subjects participated in a randomized double-blind experiment involving intensive language training for their anomic difficulties in two tDCS conditions. Each subject participated in five consecutive daily sessions of anodic tDCS (20 min, 1 mA) and sham stimulation over Wernicke's area while they performed a picture-naming task. By the end of each week, anodic tDCS had significantly improved their accuracy on the picture-naming task. Both normal subjects and aphasic patients also had shorter naming latencies during anodic tDCS than during sham condition. At two follow-ups (1 and 3 weeks after the end of treatment), performed only in two aphasic subjects, response accuracy and reaction times were still significantly better in the anodic than in the sham condition, suggesting a long-term effect on recovery of their anomic disturbances.

  3. [Treatment of patients with chronic lymphocytic leukemia].

    PubMed

    Mucsi, Orsolya

    2016-06-01

    Chronic lymphocytic leukemia (CLL) is the most common leukemia in the Western countries. The abnormal B lymphocytes progress into the blood and infiltrate the bone marrow, liver, spleen and lymph nodes. CLL is a disease of the adults and older individuals who often have coexisting conditions. It usually progresses slowly, but in patients who need treatment, CLL eventually returns. For relapsed, refractory patients treatment options are limited. The only curative treatment is bone marrow transplantation. However, the new, alternative therapeutics show superior efficacy in CLL than standard regimens. The aim of this review is to summarize the most important therapeutic aspects of CLL and to give an insight into the novel treatment options. PMID:27275639

  4. Complementary therapeutic practices in patients with chronic sinusitis.

    PubMed

    Krouse, H J; Krouse, J H

    1999-11-01

    Understanding patient use of alternative and complementary modalities to treat chronic health conditions is an important component to providing holistic care. This study sought to identify traditional and complementary therapies used by patients with chronic sinusitis. Eighty-one percent of patients with chronic sinusitis engaged in physical exercise to relieve symptoms. Additional complementary therapies utilized included herbal therapy (32%), chiropractic therapy (16%), biofeedback (13%), acupuncture (11%), and chelation therapy (7%). Medications were commonly used by patients (60%), especially those with severe symptoms. By recognizing and incorporating effective complementary therapies into care for chronic sinusitis, nurse practitioners may help patients to improve their clinical outcomes.

  5. APHASIC CHILDREN, IDENTIFICATION AND EDUCATION BY THE ASSOCIATION METHOD.

    ERIC Educational Resources Information Center

    MCGINNIS, MILDRED A.

    THIS BOOK IS DESIGNED TO DEFINE APHASIA AND ITS CHARACTERISTICS, TO PRESENT A PROCEDURE FOR TEACHING LANGUAGE TO APHASIC CHILDREN, AND TO APPLY THIS PROCEDURE TO ELEMENTARY SCHOOL SUBJECTS. OTHER HANDICAPPING CONDITIONS WHICH COMPLICATE THE DIAGNOSIS OF APHASIA ARE PRESENTED BY MEANS OF CASE STUDIES. CHARACTERISTICS OF TWO TYPES OF…

  6. Syllable Structure and Sonority in Language Inventory and Aphasic Neologisms

    ERIC Educational Resources Information Center

    Stenneken, Prisca; Bastiaanse, Roelien; Huber, Walter; Jacobs, Arthur M.

    2005-01-01

    Phonological theories have raised the notion of a universally preferred syllable type which is defined in terms of its sonority structure (e.g., Clements, 1990). Empirical evidence for this notion has been provided by distributional analyses of natural languages and of language acquisition data, and by aphasic speech error analyses. The present…

  7. Tacit integration and referential structure in the language comprehension of aphasics and normals.

    PubMed

    Rosenthal, V; Bisiacchi, P

    1997-09-01

    Aphasics, brain-damaged patients with no language deficit, neurologically intact elderly subjects, and university undergraduates matched pictures to sentences having compelling tacit implications (e.g., the sentence The fox grabs the hen strongly invites one to assume that the fox will eat the hen). All groups made, for the same sentences, qualitatively similar referential errors consisting in choosing a tacit implication picture. Two auxiliary experiments using the same target sentences in other interpretive situations permitted ruling out the possibility that these errors were due to the putative intrinsic semantic properties of the sentences, showing that the sentences which were most liable to elicit integrative error varied from task to task. These results are interpreted within the conceptual framework which posits that reliable directions for interpretation are couched by the speaker in the very structure of his utterances (the utterance's referential structure) providing the hearer with means to restructure the relevant personal knowledge integrated into the interpretive process in accordance with the speaker's communicative intent. The determination of the referential structure (RSD) of utterances thus seems critical to their correct or, more precisely, conventional interpretation, and, along with the tacit integration of relevant sources of personal knowledge, constitutes the principal cognitive device enabling us to understand each other. But this device appears to be easily corruptible. It is suggested that many errors made by aphasics in language interpretation are due to a failure to follow all referential instructions, but that qualitatively similar failures also occur in normal subjects, though to a lessen degree. Language interpretation is a fallible process and aphasic errors provide remarkable clues for the understanding of its subtle referential mechanisms. PMID:9329206

  8. Chronic Rhinosinusitis in Patients with Cystic Fibrosis.

    PubMed

    Hamilos, Daniel L

    2016-01-01

    Chronic rhinosinusitis (CRS) is highly prevalent in patients with cystic fibrosis (CF) and accounts for significant morbidity and contribution to CF lung disease. Mutations of the cystic fibrosis transmembrane regulator gene occur with increased prevalence in patients with CRS without CF, suggesting some contribution to CRS pathophysiology. Nasal polyps (NPs) occur with increased prevalence in patients with CF of all ages and have a more neutrophilic appearance with fewer eosinophils and increased submucosal glandular elements in comparison to NPs from patients without CF. Mainstays of medical treatment include isotonic saline irrigations and topical intranasal glucocorticoids, with some evidence that topical intranasal glucocorticoids reduce NP size. Although inhaled hypertonic saline (7%) has been widely studied as a mucolytic agent for CF lung disease, there are no reports of its use in CF CRS. Mucolytics have also not been studied as a treatment for CRS in CF, and most evidence does not support their use for CF lung disease. Nasally nebulized dornase alfa (recombinant human deoxyribonuclease) following sinus surgery shows promise for treatment. Other unproven therapies include addition of baby shampoo to isotonic saline to potentially thin mucus and help prevent biofilm formation. There are no data to support the use of low-dose oral macrolide antibiotics or the use of prophylactic oral antibiotics for CRS in patients with CF. However, there is some support for the use of topical antibiotics, including colistimethate sodium or tobramycin, administered as a sinus irrigation or antral lavage in patients following sinus surgery when susceptible bacteria are cultured. Key components of CF sinus surgical management include extensive surgery to ensure that the maxillary, frontal, sphenoid, and ethmoid sinuses are all widely opened with smoothing of bony overhangs to prevent mucus retention and bacterial recolonization, postoperative meticulous daily nasal irrigations

  9. Chronic aseptic meningitis in a patient with systemic lupus erythematosus.

    PubMed

    Lancman, M E; Mesropian, H; Granillo, R J

    1989-08-01

    Chronic aseptic meningitis is a rare manifestation of systemic lupus erythematosus. It may occur early in the course of the disease and sometimes may be the initial symptom. We report a patient with chronic aseptic meningitis associated with systemic lupus erythematosus. Magnetic resonance imaging showed several ischemic lesions and an appearance which was compatible with chronic inflammation of the ependyma of the lateral ventricles.

  10. [Cerebral arachnoiditis in patients with chronic rhinosinusitis].

    PubMed

    Gushchin, A N

    1994-01-01

    The examination and treatment of 66 patients with rhinosinusogenic cerebral arachnoiditis (RCA) were performed using otorhinolaryngological and neurological tests with special emphasis on pneumoencephalography to provide objective assessment of the brain layers and ventricles. It is shown that RCA occurs most frequently in subjects suffering from chronic purulent axillary sinusitis or recurrent polysinusitis. RCA manifestations depend on the duration of rhinosinusitis and its recurrence rate. RCA onset is usually not acute and takes place at the time of rhinosinusitis exacerbation. There are also mild frontal headaches, pathological changes in the coats of the anterior cranial fossa. The above abnormalities were most pronounced at the side of rhinosinusitis or most affected sinus. The treatment should be first of all oriented on elimination of maxillary infection in line with pathogenetic treatment of RCA. An individual approach to treatment policy is advocated.

  11. Firstline treatment for chronic phase chronic myeloid leukemia patients should be based on a holistic approach.

    PubMed

    Breccia, Massimo; Alimena, Giuliana

    2015-02-01

    New selective and more potent drugs for the cure of chronic phase chronic myeloid leukemia patients are now available: physicians in some countries must decide the best option, selecting one of the drugs available. What the main prognostic factors are in order to make this selection remains a matter of discussion. Introducing a 'holistic approach' for the first time in chronic myeloid leukemia, as practiced in other diseases, and looking at the patient in a complete picture, considering several variables, such as comorbidities, age, concomitant drugs, lifestyle and patient expectations, may be of help to understand, patient by patient, the best therapeutic strategy.

  12. Firstline treatment for chronic phase chronic myeloid leukemia patients should be based on a holistic approach.

    PubMed

    Breccia, Massimo; Alimena, Giuliana

    2015-02-01

    New selective and more potent drugs for the cure of chronic phase chronic myeloid leukemia patients are now available: physicians in some countries must decide the best option, selecting one of the drugs available. What the main prognostic factors are in order to make this selection remains a matter of discussion. Introducing a 'holistic approach' for the first time in chronic myeloid leukemia, as practiced in other diseases, and looking at the patient in a complete picture, considering several variables, such as comorbidities, age, concomitant drugs, lifestyle and patient expectations, may be of help to understand, patient by patient, the best therapeutic strategy. PMID:25431965

  13. Burnout in Patients with Chronic Whiplash-Associated Disorders

    ERIC Educational Resources Information Center

    Clementz, Gunilla; Borsbo, Bjorn; Norrbrink, Cecilia

    2012-01-01

    This study sought to assess burnout and its relation to pain, disability, mood and health-related quality of life in a group of patients with chronic whiplash-associated disorders (WAD). Forty-five patients with chronic WAD ([greater than or equal to] 3 months) referred to a multidisciplinary rehabilitation centre were included. A questionnaire…

  14. Where is the effect of frequency in word production? Insights from aphasic picture naming errors

    PubMed Central

    Kittredge, Audrey K.; Dell, Gary S.; Verkuilen, Jay; Schwartz, Myrna F.

    2010-01-01

    Some theories of lexical access in production locate the effect of lexical frequency at the retrieval of a word’s phonological characteristics, as opposed to the prior retrieval of a holistic representation of the word from its meaning. Yet there is evidence from both normal and aphasic individuals that frequency may influence both of these retrieval processes. This inconsistency is especially relevant in light of recent attempts to determine the representation of another lexical property, age of acquisition or AoA, whose effect is similar to that of frequency. To further explore the representations of these lexical variables in the word retrieval system, we performed hierarchical, multinomial logistic regression analyses of 50 aphasic patients’ picture-naming responses. While both log frequency and AoA had a significant influence on patient accuracy and led to fewer phonologically related errors and omissions, only log frequency had an effect on semantically related errors. These results provide evidence for a lexical access process sensitive to frequency at all stages, but with AoA having a more limited effect. PMID:18704797

  15. Macroscopic evidence for Abrikosov-type magnetic vortexes in MnSi A-phase.

    PubMed

    Lobanova, I I; Glushkov, V V; Sluchanko, N E; Demishev, S V

    2016-01-01

    Intrinsic phase coherence between individual topologically stable knots in spin arrangement - skyrmions - is known to induce the crystalline-like structure in the A-phase of non-centrosymmetric MnSi with chiral spin-orbit interaction. Here we report the experimental evidence for two types of the skyrmion lattice (SL) inside the A-phase of MnSi, which are distinguished by different coupling to the anisotropic magnetic interactions. The transition between these SLs is shown to induce a change in magnetic scattering between isotropic MR discovered in the area inside the A-phase (the A-phase core) and anisotropic MR found on the border of the A-phase. We argue that the SL in the A-phase core corresponds to the dense skyrmion state built from individual skyrmions in a way similar to Abrikosov-type magnetic vortexes. PMID:26915818

  16. Macroscopic evidence for Abrikosov-type magnetic vortexes in MnSi A-phase

    PubMed Central

    Lobanova, I. I.; Glushkov, V. V.; Sluchanko, N. E.; Demishev, S. V.

    2016-01-01

    Intrinsic phase coherence between individual topologically stable knots in spin arrangement – skyrmions – is known to induce the crystalline-like structure in the A-phase of non-centrosymmetric MnSi with chiral spin-orbit interaction. Here we report the experimental evidence for two types of the skyrmion lattice (SL) inside the A-phase of MnSi, which are distinguished by different coupling to the anisotropic magnetic interactions. The transition between these SLs is shown to induce a change in magnetic scattering between isotropic MR discovered in the area inside the A-phase (the A-phase core) and anisotropic MR found on the border of the A-phase. We argue that the SL in the A-phase core corresponds to the dense skyrmion state built from individual skyrmions in a way similar to Abrikosov-type magnetic vortexes. PMID:26915818

  17. Review article: hepatitis vaccination in patients with chronic liver disease.

    PubMed

    Reiss, G; Keeffe, E B

    2004-04-01

    Evidence regarding the outcomes of viral super-infection in patients with chronic liver disease and practical strategies for hepatitis A and B vaccination of these individuals are reviewed. Patients with acute hepatitis A and chronic hepatitis B have a more severe clinical course and a higher death rate compared with otherwise healthy individuals with hepatitis A, and these differences are most pronounced in older patients and those with histological evidence of chronic hepatitis or cirrhosis, rather than in asymptomatic hepatitis B carriers. Patients with acute hepatitis A super-infection and chronic hepatitis C have an increased risk of fulminant hepatitis and death. In addition, patients with other chronic liver diseases also appear to be at increased risk for more severe disease with superimposed hepatitis A. Patients with chronic hepatitis B and hepatitis C virus co-infection have more severe laboratory abnormalities, more severe histological disease, a greater frequency of cirrhosis and complications of cirrhosis, and a higher incidence of hepatocellular carcinoma. Vaccines for both hepatitis A and B are safe and effective if used early in the course of chronic liver disease. Hepatitis A and B vaccination should be part of the routine management of patients with chronic liver disease, preferably as early as possible in the natural course of their disease.

  18. Managing chronic sorrow: experiences of patients with multiple sclerosis.

    PubMed

    Isaksson, Ann-Kristin; Ahlström, Gerd

    2008-06-01

    The goals of this study were to describe the ways in which patients with multiple sclerosis (MS) manage chronic sorrow and to apply this information to the theoretical model of chronic sorrow. This descriptive study involved 38 participants with MS who were experiencing chronic sorrow. Using the theoretical model of chronic sorrow, we applied content analysis to participants' accounts of how they attempted to manage this sorrow. The findings showed that discomfort resulted from ineffective management of chronic sorrow, reflecting the vulnerability these patients experience and the lack of understanding of their needs and appropriate support from family, friends, and healthcare personnel. In some cases, however, the losses and emotional distress caused by MS were managed effectively, which led to increased comfort through personal growth and a greater appreciation of life, greater confidence, and hope for the future. The theoretical model was valuable in helping to describe participants' patterns of managing chronic sorrow. Healthcare personnel should acknowledge chronic sorrow as one aspect of psychological distress in MS. Knowledge of patients' experiences of chronic sorrow should be included in the education for neuroscience nurses. Furthermore, it is necessary to develop support interventions for patients with chronic sorrow and their families.

  19. [The physician-patient relationship in chronic disease management].

    PubMed

    Ginies, P

    2008-07-01

    The relationship between patients and clinicians is a key element in the management of chronic diseases. With the objective of a more efficient communication, the clinician should know his own personality but also the patient personality. The organisation of the consultation, of the waiting room and of the secretary has to facilitate this relationship. The amelioration of this relationship is usefulness only for the clinician in particularly complicated cases but also for the patients suffering from chronic diseases.

  20. Subclinical intestinal inflammation in chronic granulomatous disease patients.

    PubMed

    Broides, Arnon; Sagi, Orli; Pinsk, Vered; Levy, Jacov; Yerushalmi, Baruch

    2016-02-01

    Chronic granulomatous disease is a primary immunodeficiency caused by impaired neutrophil production of reactive oxygen species. Non-infectious colitis is common in chronic granulomatous disease, and high levels of antimicrobial antibodies that are associated with Crohn's disease are common even without colitis. Fecal calprotectin concentration is a marker for intestinal inflammation. We sought to determine whether subclinical intestinal inflammation occurs in asymptomatic chronic granulomatous disease patients. Asymptomatic chronic granulomatous disease patients without overt gastrointestinal symptoms suggestive of colitis at the time of enrollment were studied for fecal calprotectin concentration, antibodies associated with Crohn's disease and systemic inflammatory markers. Eight patients were included, aged 54-176 months. In 7/8 (87.5 %) fecal calprotectin concentration was normal (<50) and elevated (137 mg/kg) in only one patient. This patient later developed colitis. In 7/8 (87.5 %) anti-Saccharomyces cerevisiae antibody was positive. C-reactive protein, albumin, complete blood count and p-anti-neutrophil cytoplasmic antibody were normal in all 8 patients. Subclinical colitis is not evident in most asymptomatic chronic granulomatous disease patients; however, in some patients, fecal calprotectin concentration may be elevated, possibly indicating the presence of subclinical colitis and predicting the occurrence of clinically relevant colitis. Serum anti-Saccharomyces cerevisiae antibody concentrations do not seem to correlate with fecal calprotectin concentration in asymptomatic chronic granulomatous disease patients.

  1. Subclinical intestinal inflammation in chronic granulomatous disease patients.

    PubMed

    Broides, Arnon; Sagi, Orli; Pinsk, Vered; Levy, Jacov; Yerushalmi, Baruch

    2016-02-01

    Chronic granulomatous disease is a primary immunodeficiency caused by impaired neutrophil production of reactive oxygen species. Non-infectious colitis is common in chronic granulomatous disease, and high levels of antimicrobial antibodies that are associated with Crohn's disease are common even without colitis. Fecal calprotectin concentration is a marker for intestinal inflammation. We sought to determine whether subclinical intestinal inflammation occurs in asymptomatic chronic granulomatous disease patients. Asymptomatic chronic granulomatous disease patients without overt gastrointestinal symptoms suggestive of colitis at the time of enrollment were studied for fecal calprotectin concentration, antibodies associated with Crohn's disease and systemic inflammatory markers. Eight patients were included, aged 54-176 months. In 7/8 (87.5 %) fecal calprotectin concentration was normal (<50) and elevated (137 mg/kg) in only one patient. This patient later developed colitis. In 7/8 (87.5 %) anti-Saccharomyces cerevisiae antibody was positive. C-reactive protein, albumin, complete blood count and p-anti-neutrophil cytoplasmic antibody were normal in all 8 patients. Subclinical colitis is not evident in most asymptomatic chronic granulomatous disease patients; however, in some patients, fecal calprotectin concentration may be elevated, possibly indicating the presence of subclinical colitis and predicting the occurrence of clinically relevant colitis. Serum anti-Saccharomyces cerevisiae antibody concentrations do not seem to correlate with fecal calprotectin concentration in asymptomatic chronic granulomatous disease patients. PMID:26603166

  2. Assessing and Managing Sleep Disturbance in Patients with Chronic Pain.

    PubMed

    Cheatle, Martin D; Foster, Simmie; Pinkett, Aaron; Lesneski, Matthew; Qu, David; Dhingra, Lara

    2016-06-01

    Chronic pain is associated with symptoms that may impair a patient's quality of life, including emotional distress, fatigue, and sleep disturbance. There is a high prevalence of concomitant pain and sleep disturbance. Studies support the hypothesis that sleep and pain have a bidirectional and reciprocal relationship. Clinicians who manage patients with chronic pain often focus on interventions that relieve pain, and assessing and treating sleep disturbance are secondary or not addressed. This article reviews the literature on pain and co-occurring sleep disturbance, describes the assessment of sleep disturbance, and outlines nonpharmacologic and pharmacologic treatment strategies to improve sleep in patients with chronic pain. PMID:27208716

  3. Virtual reality as a distraction technique in chronic pain patients.

    PubMed

    Wiederhold, Brenda K; Gao, Kenneth; Sulea, Camelia; Wiederhold, Mark D

    2014-06-01

    We explored the use of virtual reality distraction techniques for use as adjunctive therapy to treat chronic pain. Virtual environments were specifically created to provide pleasant and engaging experiences where patients navigated on their own through rich and varied simulated worlds. Real-time physiological monitoring was used as a guide to determine the effectiveness and sustainability of this intervention. Human factors studies showed that virtual navigation is a safe and effective method for use with chronic pain patients. Chronic pain patients demonstrated significant relief in subjective ratings of pain that corresponded to objective measurements in peripheral, noninvasive physiological measures.

  4. [A new method for treating patients with chronic prostatitis].

    PubMed

    Boĭko, M I

    1995-01-01

    A new preparation is reported for treatment of chronic inflammation of the prostate, which substantially lowers rates of patients' complaints and depresses the secretion leucocyte reaction. Prostatilen was shown to be capable of normalization of immunity status of the chronic prostatitis patients thus lowering the microbial index of the cultured prostate secretion microorganisms. The following new nonantibacterial strategy of treatment of chronic prostatitis patients is proposed: prostatilen given as a single agent or in combination with immunomodulators and physiotherapeutic methods. Antibacterial therapy is to be instituted on a short-term basis only during the period of exacerbation of the inflammatory process.

  5. Assessing and Managing Sleep Disturbance in Patients with Chronic Pain.

    PubMed

    Cheatle, Martin D; Foster, Simmie; Pinkett, Aaron; Lesneski, Matthew; Qu, David; Dhingra, Lara

    2016-06-01

    Chronic pain is associated with symptoms that may impair a patient's quality of life, including emotional distress, fatigue, and sleep disturbance. There is a high prevalence of concomitant pain and sleep disturbance. Studies support the hypothesis that sleep and pain have a bidirectional and reciprocal relationship. Clinicians who manage patients with chronic pain often focus on interventions that relieve pain, and assessing and treating sleep disturbance are secondary or not addressed. This article reviews the literature on pain and co-occurring sleep disturbance, describes the assessment of sleep disturbance, and outlines nonpharmacologic and pharmacologic treatment strategies to improve sleep in patients with chronic pain.

  6. [Chronic critically ill patients from a gastroenterological perspective].

    PubMed

    Bittinger, M; Messmann, H

    2013-05-01

    From a gastroenterological point of view, for chronic critically ill patients a differentiation has to be made between general gastroenterological problems, which are important in many or all chronic critically ill patients and patients with gastroenterological diseases which are the reason for the chronic critically ill status. General gastroenterological problems are, for example the nutrition of these patients and also considerations about ulcer prophylaxis or gastroenterological complications, such as antibiotic-associated colitis. Gastroenterological diseases as the reason for a chronic critically ill status are more in the minority. Diseases which should be taken into consideration are advanced liver cirrhosis and short bowel syndrome. This manuscript is intended to discuss gastroenterological problems in this selected group of patients and to show possible solutions and treatment options. PMID:23423578

  7. Evaluation of etiological factors in patients with chronic urticaria.

    PubMed

    Colgecen, Emine; Ozyurt, Kemal; Gul, Ali Irfan; Utas, Serap

    2015-01-01

    In the last few decades, increasing understanding of the pathomechanisms involved in chronic urticaria has highlighted the heterogeneity of different subtypes, and chronic urticaria is now classified as chronic spontaneous urticaria and inducible urticaria. Although many factors are thought to be involved in chronic urticaria, the etiology is yet to be clarified. The purpose of this study was to investigate etiological factors in patients with chronic urticaria. Five hundred patients with chronic urticaria, 351 women and 149 men, were studied for etiological factors. The autologous serum skin test was performed on 197 patients. Provocation testing for physical urticaria was performed on 354 patients. Patients with acute urticaria were excluded from the study. We determined at least one focus of infection that might be involved in the etiology of the disease in 18.8% of cases. Patients with infections were treated, and symptoms resolved after treatment in six cases (5.3%). Autologous serum skin tests were positive in 125 patients (63.5%). Provocation tests for physical urticaria were positive in 131 (37%) patients with urticaria. We suggest that physical stimuli and autoantibodies play an important role in the etiopathogenesis of urticaria.

  8. Neural mechanisms of verb argument structure processing in agrammatic aphasic and healthy age-matched listeners

    PubMed Central

    Thompson, C.K.; Bonakdarpour, B.; Fix, S.F.

    2010-01-01

    Processing of lexical verbs involves automatic access to argument structure entries entailed within the verb's representation. Recent neuroimaging studies with young normal listeners suggest that this involves bilateral posterior perisylvian tissue, with graded activation in these regions based on argument structure complexity. The aim of the present study was to examine the neural mechanisms of verb processing using functional magnetic resonance imaging (fMRI) in older normal volunteers and patients with stroke-induced agrammatic aphasia, a syndrome in which verb, as compared to noun, production often is selectively impaired, but verb comprehension in both on-line and off-line tasks is spared. Fourteen healthy listeners and five age-matched aphasic patients performed a lexical decision task, which examined verb processing by argument structure complexity, i.e., one-argument (i.e., intransitive (v1)); two-argument (i.e., transitive (v2)), and three-argument (v3) verbs. Results for the age-matched listeners largely replicated those for younger participants studied by Thompson et al. (2007): v3-v1 comparisons showed activation of the angular gyrus in both hemispheres and this same heteromodal region was activated in the left hemisphere in the (v2+v3)-v1 contrast. Similar results were derived for the agrammatic aphasic patients, however, activation was unilateral (in the right hemisphere for 3 participants) rather than bilateral likely because these patients' lesions extended to the left temporoparietal region. All performed the task with high accuracy and, despite differences in lesion site and extent, they recruited spared tissue in the same regions as healthy normals. Consistent with psycholinguistic models of sentence processing, these findings indicate that the posterior language network is engaged for processing verb argument structure and is crucial for semantic integration of argument structure information. PMID:19702460

  9. Evaluation of serum ceruloplasmin in aggressive and chronic periodontitis patients

    PubMed Central

    Harshavardhana, B.; Rath, S. K.; Mukherjee, Manish

    2013-01-01

    Background: Pro-inflammatory markers are seen to increase in inflammatory diseases like periodontitis. Detecting an increase in these markers is one of the diagnostic modality. One such marker, which can be detected, is the ceruloplasmin. Ceruloplasmin induces hypoxia and generates oxygen radicals at the site of aggressive periodontitis. It also causes a state of hypoferremia leading to increase in the natural resistance of the body. The aim of this study was to evaluate the serum levels of cerruloplasmin in both aggressive and chronic periodontitis patients. Materials and Methods: Blood samples were collected from aggressive periodontitis patients (n = 20), chronic periodontitis patients (n = 20) and periodontally healthy patients (n = 20). The serum was extracted from all the blood samples and ceruloplasmin levels were spectroscopically evaluated through a new kinetic method, which used a norfloxacin based reagent. Results: Serum ceruloplasmin levels were found to be significantly higher in aggressive periodontitis patients (P > 0.05) than in chronic periodontitis patients (P > 0.05) even though increase in the level of ceruloplasmin was found in chronic periodontitis. Periodontally healthy patients did not show increase in the levels of serum ceruloplasmin. The levels of serum ceruloplasmin also increased with the disease severity whose manifestations were increased bleeding on probing, increased pocket depth and increased attachment loss. Conclusion: Serum ceruloplasmin levels increased in both aggressive and chronic periodontitis patients, but more in aggressive periodontitis patients making it a potential marker for diagnosis of periodontitis. PMID:24049334

  10. Management of chronic pain with chronic opioid therapy in patients with substance use disorders.

    PubMed

    Chang, Yu-Ping; Compton, Peggy

    2013-12-16

    Substance use disorders (SUDs), whether active or in remission, are often encountered in patients with chronic nonmalignant pain. Clinicians are challenged when managing chronic pain while facing substance abuse issues during the course of chronic opioid therapy (COT). Further, the interrelated behavioral symptomatology of addiction and chronic pain suggests that if one disorder is untreated, effective treatment of the other in not possible. Incomplete understanding of the overlapping presentations of the two disorders, coupled with insufficient management of both conditions, leads to undertreated pain and premature discharge of SUD patients from pain treatment. In order to achieve pain relief and optimal functionality, both conditions need to be carefully managed. This paper reviews the prevalence of SUDs in chronic pain patents; the overlapping presentation of the two disorders; risk factors and stratification for addiction; identification of addiction in the chronic pain population; and suggestions for treating patients with COT, with an emphasis on relapse prevention. With appropriate assessment and treatment, COT for chronic pain patients with a history of SUD can be successful, leading to improved functionality and quality of life.

  11. Action Naming in Anomic Aphasic Speakers: Effects of Instrumentality and Name Relation

    ERIC Educational Resources Information Center

    Jonkers, Roel; Bastiaanse, Roelien

    2007-01-01

    Many studies reveal effects of verb type on verb retrieval, mainly in agrammatic aphasic speakers. In the current study, two factors that might play a role in action naming in anomic aphasic speakers were considered: the conceptual factor instrumentality and the lexical factor name relation to a noun. Instrumental verbs were shown to be better…

  12. Quality of Life in Chronic Disease Patients

    PubMed Central

    Megari, Kalliopi

    2013-01-01

    During the past decades there was an increasing predominance of chronic disorders, with a large number of people living with chronic diseases that can adversely affect their quality of life. The aim of the present paper is to study quality of life and especially Health-related quality of life (HRQoL) in chronic diseases. HRQOL is a multidimensional construct that consists of at least three broad domains – physical, psychological, and social functioning – that are affected by one’s disease and/or treatment. HRQoL is usually measured in chronic conditions and is frequently impaired to a great extent. In addition, factors that are associated with good and poor HRQoL, as well as HRQoL assessment will be discussed. The estimation of the relative impact of chronic diseases on HRQoL is necessary in order to better plan and distribute health care resources aiming at a better HRQoL. [«All the people perceive the concept of living good or being well, that is the same as being happy». (Aristotle. 384-322 BC. Ethica Nichomachea)] PMID:26973912

  13. Hormones and arterial stiffness in patients with chronic kidney disease.

    PubMed

    Gungor, Ozkan; Kircelli, Fatih; Voroneanu, Luminita; Covic, Adrian; Ok, Ercan

    2013-01-01

    Cardiovascular disease constitutes the major cause of mortality in patients with chronic kidney disease. Arterial stiffness is an important contributor to the occurrence and progression of cardiovascular disease. Various risk factors, including altered hormone levels, have been suggested to be associated with arterial stiffness. Based on the background that chronic kidney disease predisposes individuals to a wide range of hormonal changes, we herein review the available data on the association between arterial stiffness and hormones in patients with chronic kidney disease and summarize the data for the general population.

  14. The chronic illness problem inventory: problem-oriented psychosocial assessment of patients with chronic illness.

    PubMed

    Kames, L D; Naliboff, B D; Heinrich, R L; Schag, C C

    1984-01-01

    Two studies are presented which describe the development of a problem-oriented psychosocial screening instrument for use in health care settings. Reliability and validity data are presented on the Chronic Illness Problem Inventory (CIPI) which demonstrate its ability to document accurately patient's specific problems in areas of physical limitations, psychosocial functioning, health care behaviors and marital adjustment. A study is also presented which compares the problems of patients with three distinct chronic illnesses: pain, obesity, and respiratory ailments. Results indicate a significantly greater severity of problems for pain patients and especially patients with multiple pain complaints. Problem areas common to all three illness groups are discussed in the context of providing better comprehensive treatment for chronically ill patients. PMID:6735596

  15. Patient-Staff Interactions and Mental Health in Chronic Dialysis Patients

    ERIC Educational Resources Information Center

    Swartz, Richard D.; Perry, Erica; Brown, Stephanie; Swartz, June; Vinokur, Amiram

    2008-01-01

    Chronic dialysis imposes ongoing stress on patients and staff and engenders recurring contact and long-term relationships. Thus, chronic dialysis units are opportune settings in which to investigate the impact of patients' relationships with staff on patient well-being. The authors designed the present study to examine the degree to which…

  16. Chronic coinfections in patients diagnosed with chronic Lyme disease: a systematic literature review

    PubMed Central

    Lantos, Paul M.; Wormser, Gary P.

    2014-01-01

    Purpose The controversial diagnosis of chronic Lyme disease is often given to patients with prolonged, medically unexplained physical symptoms. Many such patients are also treated for chronic co-infections with Babesia, Anaplasma, or Bartonella in the absence of typical presentations, objective clinical findings, or laboratory confirmation of active infection. We have undertaken a systematic review of the literature to evaluate several aspects of this practice. Methods Five systematic literature searches were performed using Boolean operators and the PubMed search engine. Results The literature searches did not demonstrate convincing evidence of 1) chronic anaplasmosis infection, 2) treatment responsive symptomatic chronic babesiosis in immunocompetent persons in the absence of fever, laboratory abnormalities and detectable parasitemia, 3) either geographically widespread or treatment responsive symptomatic chronic infection with Babesia duncani in the absence of fever, laboratory abnormalities and detectable parasitemia, 4) tick-borne transmission of Bartonella species, or 5) simultaneous Lyme disease and Bartonella infection. Conclusions The medical literature does not support the diagnosis of chronic, atypical tick-borne coinfections in patients with chronic, nonspecific illnesses. PMID:24929022

  17. Care of the patient with chronic pain: Part I.

    PubMed

    Wells-Federman, C L

    1999-07-01

    Chronic nonmalignant pain is estimated to affect over 50 million Americans. It frequently results in significant physical, behavioral, psychological, social, and spiritual problems for patients and their families. In spite of its prevalence and consequences, chronic pain is often misunderstood and inadequately managed by healthcare professionals. Advanced practice nurses who are knowledgeable about chronic pain and the complex biopsychosocial-spiritual needs of this patient population serve an important role in recognizing these patients and intervening appropriately in their care. The purpose of this two-part article is to provide that information. Part I outlines the pathophysiology, assessment, biopsychosocial-spiritual aspects, and pharmacological treatment of chronic pain. Part II addresses a variety of nonpharmacologic and self-management interventions one can use in the primary care setting to treat these difficult health problems. PMID:10711057

  18. Smoking Cessation in Chronically Ill Medical Patients.

    ERIC Educational Resources Information Center

    Sirota, Alan D.; And Others

    1985-01-01

    Followed eight male smokers with chronic pulmonary or cardiac disease through a smoking cessation program of gradual nicotine withdrawal, self-management, and relapse prevention. At one year, half remained abstinent, while relapsers smoked substantially less than before treatment. Reductions in carbon monoxide and thiocyanate levels were…

  19. Mitochondrial DNA deletions in patients with chronic suppurative otitis media.

    PubMed

    Tatar, Arzu; Tasdemir, Sener; Sahin, Ibrahim; Bozoglu, Ceyda; Erdem, Haktan Bagis; Yoruk, Ozgur; Tatar, Abdulgani

    2016-09-01

    The aim of this study was to investigate the 4977 and 7400 bp deletions of mitochondrial DNA in patients with chronic suppurative otitis media and to indicate the possible association of mitochondrial DNA deletions with chronic suppurative otitis media. Thirty-six patients with chronic suppurative otitis media were randomly selected to assess the mitochondrial DNA deletions. Tympanomastoidectomy was applied for the treatment of chronic suppurative otitis media, and the curettage materials including middle ear tissues were collected. The 4977 and 7400 bp deletion regions and two control regions of mitochondrial DNA were assessed by using the four pair primers. DNA was extracted from middle ear tissues and peripheral blood samples of the patients, and then polymerase chain reactions (PCRs) were performed. PCR products were separated in 2 % agarose gel. Seventeen of 36 patients had the heterozygote 4977 bp deletion in the middle ear tissue but not in peripheral blood. There wasn't any patient who had the 7400 bp deletion in mtDNA of their middle ear tissue or peripheral blood tissue. The patients with the 4977 bp deletion had a longer duration of chronic suppurative otitis media and a higher level of hearing loss than the others (p < 0.01). Long time chronic suppurative otitis media and the reactive oxygen species can cause the mitochondrial DNA deletions and this may be a predisposing factor to sensorineural hearing loss in chronic suppurative otitis media. An antioxidant drug as a scavenger agent may be used in long-term chronic suppurative otitis media.

  20. Jackson's Parrot: Samuel Beckett, Aphasic Speech Automatisms, and Psychosomatic Language.

    PubMed

    Salisbury, Laura; Code, Chris

    2016-06-01

    This article explores the relationship between automatic and involuntary language in the work of Samuel Beckett and late nineteenth-century neurological conceptions of language that emerged from aphasiology. Using the work of John Hughlings Jackson alongside contemporary neuroscientific research, we explore the significance of the lexical and affective symmetries between Beckett's compulsive and profoundly embodied language and aphasic speech automatisms. The interdisciplinary work in this article explores the paradox of how and why Beckett was able to search out a longed-for language of feeling that might disarticulate the classical bond between the language, intention, rationality and the human, in forms of expression that seem automatic and "readymade". PMID:26922435

  1. 240 Mold Sensitization in Chronic Rhinosinusitis Patients

    PubMed Central

    Gawlik, Radoslaw; Czecior, Eugeniusz

    2012-01-01

    Background It is estimated that about 10% of the population have IgE antibodies to common inhalant molds. Exposure to fungal allergens could be linked to the presence and persistence of asthma, rhinitis and atopic dermatitis. Mold sensitization is a risk factor for development and deterioration of upper airway allergy, especially chronic rhinosinusitis. We addressed the incidence of mold allergy measured as specific IgE to molds and skin prick tests in chronic sinusitis patients. We assessed prevalence of allergic reactions to mould among surgery treated chronic sinusitis patients. Methods A group of 28 chronic sinusitis patients after surgery were included into the study. Routine medical examination, skin prick tests with common inhaled allergens and extended mold panel (Alternaria alternate, Cladosporium herbarium, Aspergilus fumigatus, Candida albicans, Mucor mucedo, Botrytis cinerea, Rhisopus nigricans, Penicilliumi notatum, Fusarum moniliforme Pullularia pullulans (Allergopharma, Germany), tIgE, asIgE measurement were performed (Phadia, Sweden). All investigated patients were consulted by laryngologist and mycological examination was performed. Results We found that sensitization to at least one allergen was present in 43.8(14/32) of sinusitis patients. The most prevalent was sensitization to house dust mite Dermatophagoides pt., found in 21.8 % (7/32) patients. Positive results of skin prick tests with Candida albicans we observed in 18.8% (6/32), with Alternaria alternate in 15,6% (5/32), Cladosporium herbarium in 6,3% (2/32), Aspergilus fumigatus in 3,13 % (1/32). None of investigated patients presented sensitization to other mold allergens. Microbiological methods demonstrated fungal infection only in 2 patients. Conclusions Almost half of chronic sinusitis patients presented sensitization to at least one allergen. Fungal allergy is relatively rare in chronic sinusitis patients.

  2. Behavior Modification with an Aphasic Man

    ERIC Educational Resources Information Center

    Ince, Laurence P.

    1973-01-01

    Techniques based upon operant conditioning were employed with a male patient who had sustained a cerebrovascular accident with consequent right hemiplegia and expressive asphasia. A combination of positive verbal reinforcement and feedback of progress were utilized to improve language fluency and speed of typing. (Author)

  3. Importance of Social Relationships in Patients with Chronic Respiratory Diseases.

    PubMed

    Kurpas, Donata; Szwamel, Katarzyna; Mroczek, Bozena

    2016-01-01

    The literature lacks reports on the role of the social relationships domain (SRD) of quality of life (QoL) in shaping care for patients with chronic respiratory diseases in primary care. In this study we examined a group of 582 patients with chronic respiratory diseases and chronic non-respiratory diseases recruited from 199 primary care centers. In the patients with chronic respiratory diseases, higher SRD correlated with more frequent patient visits due to medical issue, fewer district nurse interventions over the past 12 months, less frequent hospitalizations over the past 3 years, and fewer chronic diseases. In these patients, a high SRD was most effectively created by high QoL in the Psychological, Environmental, and Physical domains, and the satisfaction with QoL. Programs for preventing a decline in SRD should include patients with low scores in the Psychological, Environmental, and Physical domains, those who show no improvement in mental or somatic well-being in the past 12 months, those with a low level of positive mental attitudes, unhealthy eating habits, and with low levels of met needs. Such programs should include older widows and widowers without permanent relationships, with only primary education, living far from a primary care center, and those whose visits were not due to a medical issue.

  4. Causes of Chronic Cough in Non-smoking Patients.

    PubMed

    Dąbrowska, M; Grabczak, E M; Arcimowicz, M; Domeracka-Kołodziej, A; Domagała-Kulawik, J; Krenke, R; Maskey-Warzęchowska, M; Tarchalska, B; Chazan, R

    2015-01-01

    Chronic cough is a common medical problem. The aim of the study was to analyze chronic cough causes in non-smoking patients and to search for demographic factors associated with different cough reasons. The etiology of cough was determined by medical history, diagnostic tests and response to specific treatment. Patients with significant abnormalities in the chest radiograph or spirometry were not included. The study included 131 non-smoking patients; median age 54 years, 77 % female. The most frequent causes of cough were gastroesophageal reflux disease (GERD) (62 %) and upper airway cough syndrome (UACS) (46 %). Cough variant asthma and non-asthmatic eosinophilic bronchitis (NAEB) were diagnosed in 32 (25 %) and 19 (15 %) patients, respectively. Other cough causes were found in 27 patients (21 %). Asthma was a significantly more common cause of chronic cough in women than in men (31 % vs. 3 %, p = 0.005). A reverse relationship was demonstrated for UACS (39 % vs. 67 %, p = 0.01). Patients with chronic cough aged >50 yrs were more likely to be diagnosed with less common cough causes. In conclusion, the most common chronic cough reasons are GERD and UACS. Asthma-related cough is diagnosed more frequently in females, while UACS-related cough is more frequent in males.

  5. Importance of Social Relationships in Patients with Chronic Respiratory Diseases.

    PubMed

    Kurpas, Donata; Szwamel, Katarzyna; Mroczek, Bozena

    2016-01-01

    The literature lacks reports on the role of the social relationships domain (SRD) of quality of life (QoL) in shaping care for patients with chronic respiratory diseases in primary care. In this study we examined a group of 582 patients with chronic respiratory diseases and chronic non-respiratory diseases recruited from 199 primary care centers. In the patients with chronic respiratory diseases, higher SRD correlated with more frequent patient visits due to medical issue, fewer district nurse interventions over the past 12 months, less frequent hospitalizations over the past 3 years, and fewer chronic diseases. In these patients, a high SRD was most effectively created by high QoL in the Psychological, Environmental, and Physical domains, and the satisfaction with QoL. Programs for preventing a decline in SRD should include patients with low scores in the Psychological, Environmental, and Physical domains, those who show no improvement in mental or somatic well-being in the past 12 months, those with a low level of positive mental attitudes, unhealthy eating habits, and with low levels of met needs. Such programs should include older widows and widowers without permanent relationships, with only primary education, living far from a primary care center, and those whose visits were not due to a medical issue. PMID:27358182

  6. Brain atrophy in chronic alcoholic patients: a quantitative pathological study.

    PubMed Central

    Harper, C; Kril, J

    1985-01-01

    There are essentially no objective neuropathological data on brain atrophy in chronic alcoholic patients despite numerous neuroradiological studies which show a high incidence of shrinkage or atrophy. Therefore measurements were made of the intracranial volume (ICV) and brain volume (BV) in a necropsy study of 25 chronic alcoholic patients and 44 controls. The pericerebral space (PICS) was calculated according to the formula (formula; see text) The PICS will increase in patients with brain atrophy since the ICV remains constant throughout life. The mean PICS value was 8.3% in controls, 11.3% in the alcoholic group, 14.7% in alcoholics with superimposed Wernicke's encephalopathy (thiamine deficiency) and 16.2% in those alcoholics with associated liver disease. Thus there was a statistically significant loss of brain tissue in chronic alcoholic patients which appeared to be more severe in those with associated nutritional vitamin deficiencies or alcoholic liver disease. Images PMID:3981189

  7. Role of Myeloperoxidase in Patients with Chronic Kidney Disease

    PubMed Central

    Kisic, Bojana; Miric, Dijana; Dragojevic, Ilija; Rasic, Julijana; Popovic, Ljiljana

    2016-01-01

    Chronic kidney disease (CKD) is a worldwide public health problem. Patients with CKD have a number of disorders in the organism, and the presence of oxidative stress and systemic inflammation in these patients is the subject of numerous studies. Chronic inflammation joined with oxidative stress contributes to the development of numerous complications: accelerated atherosclerosis process and cardiovascular disease, emergence of Type 2 diabetes mellitus, development of malnutrition, anaemia, hyperparathyroidism, and so forth, affecting the prognosis and quality of life of patients with CKD. In this review we presented the potential role of the myeloperoxidase enzyme in the production of reactive/chlorinating intermediates and their role in oxidative damage to biomolecules in the body of patients with chronic kidney disease and end-stage renal disease. In addition, we discussed the role of modified lipoprotein particles under the influence of prooxidant MPO intermediates in the development of endothelial changes and cardiovascular complications in renal failure. PMID:27127544

  8. Dermatological diseases in patients with chronic kidney disease

    PubMed Central

    Gagnon1, Amy L.; Desai, Tejas

    2013-01-01

    Context: There are a variety of dermatological diseases that are more commonly seen in patients with chronic kidney disease (CKD) and renal transplants than the general population. Evidence Acquisitions: Directory of Open Access Journals (DOAJ), Google Scholar, Pubmed (NLM), LISTA (EBSCO) and Web of Science has been searched. Results: Some cutaneous diseases are clearly unique to this population. Of them, Lindsay’s Nails, xerosis cutis, dryness of the skin, nephrogenic systemic fibrosis and acquired perforating dermatosis have been described in chronic kidney disease patients. The most common malignancy found in all transplant recipients is non-melanoma skin cancer. Conclusions: It is important for patients and physicians to recognize the manifestations of skin disease in patients suffering from chronic kidney disease to mitigate the morbidity associated with these conditions. PMID:24475435

  9. Time-Limited Group Counseling for Chronic Home Hemodialysis Patients

    ERIC Educational Resources Information Center

    Wilson, Charles J.; And Others

    1974-01-01

    Compared effects of six sessions of group counseling of nine chronic home hemodialysis patients with a comparable no treatment control group. Comparisons revealed no significant differences between groups. Subsequent testing a year later suggested that hemodialysis patients use the defensive mechanism of denial in adapting to their condition.…

  10. Sarcopenia and Physical Inactivity in Patients With Chronic Kidney Disease

    PubMed Central

    Hirai, Keiji; Ookawara, Susumu; Morishita, Yoshiyuki

    2016-01-01

    Sarcopenia and physical inactivity synergistically progress in patients with chronic kidney disease (CKD) and are strong predictors of mortality in this population. Exercise training and essential amino acids and vitamin D supplements may contribute to improving sarcopenia and physical inactivity in CKD patients. PMID:27570755

  11. Diagnosis of sickle cell disease in chronically transfused patients.

    PubMed

    Oliveri, D R; Ober, C L; Horwitz, A L

    1992-01-01

    Standard electrophoretic methods for the diagnosis of hemoglobinopathies are confounded in individuals chronically transfused. We present the accurate diagnosis of sickle cell disease in two such transfused patients by the application of polymerase chain reaction technology to analyze patient's hemoglobin beta-chain genes directly.

  12. Managing diabetes in hospitalized patients with chronic kidney disease.

    PubMed

    Iyer, Shridhar N; Tanenberg, Robert J

    2016-04-01

    Because few randomized trials have been done, little is known about appropriate glycemic control in hospitalized patients with chronic kidney disease (CKD) and diabetes mellitus. These patients are at high risk of hypoglycemia. It is prudent to monitor glucose closely, set less-stringent blood sugar goals, avoid oral antidiabetic agents, and possibly reduce insulin dosage. PMID:27055204

  13. Chronic disease management for patients with respiratory disease.

    PubMed

    Bryant, Elizabeth

    National and international awareness of the heavy burden of chronic disease has led to the development of new strategies for managing care. Elisabeth Bryant explains how self-care, education and support for more patients with complex needs should be built into planned care delivery, and emphasises that the patient is the key member of the care team.

  14. Sarcopenia and Physical Inactivity in Patients With Chronic Kidney Disease.

    PubMed

    Hirai, Keiji; Ookawara, Susumu; Morishita, Yoshiyuki

    2016-05-01

    Sarcopenia and physical inactivity synergistically progress in patients with chronic kidney disease (CKD) and are strong predictors of mortality in this population. Exercise training and essential amino acids and vitamin D supplements may contribute to improving sarcopenia and physical inactivity in CKD patients. PMID:27570755

  15. [Cognitive disorders in patients with chronic mercury intoxication].

    PubMed

    Katamanova, E V; Shevchenko, O I; Lakhman, O L; Denisova, I A

    2014-01-01

    To assess severity of cognitive disorders in chronic mercury intoxication, the authors performed claster and discrimination analysis of neuropsychologic and neurophysiologic research data from workers exposed to mercury during long length of service, from patients with early and marked stages of chronic mercurial intoxication. Cognitive disorders in chronic mercurial intoxication have three severity degrees, in the light degree disorders patients demonstrate lower amplitude of cognitive evoked potentials, poor long-term memory and associative thinking. Moderate cognitive disorders are characterized by decreased visual, long-term memory, concentration of attention, poor optic and spatial gnosis. Marked cognitive disorders with chronic mercurial intoxication present with more decreased long-term, short-term, picturesque memory, poor intellect, optic and spatial gnosis and associative thinking. PMID:25051667

  16. [Chronic heart failure in the elderly patient].

    PubMed

    Chivite, David; Franco, Jhonatan; Formiga, Francesc

    2015-01-01

    The prevalence and incidence of heart failure (HF) is increasing, especially in the elderly population, and is becoming a major geriatric problem. Elderly patients with HF usually show etiopathogenic, epidemiological, and even clinical characteristics significantly different from those present in younger patients. Their treatment, however, derives from clinical trials performed with only a few elderly subjects. Moreover, beyond the cardiovascular disease itself, it is essential to evaluate the patient as a whole, given the interrelationship between HF and the characteristic geriatric syndromes of the elderly patient. This review examines the peculiarities in the most prevalent "real world" HF patient.

  17. [Chronic eosinophilic pneumopathy in a black African patient].

    PubMed

    Brancaleone, P; Roy, T; Fally, P; Dorzée, J; Fastrez, J; Castelain, T; d'Odemont, J P

    1998-02-01

    The authors report a case of a black African patient who suffers from a chronic eosinophilic pneumonia. In view of the lack of precise reporting in the literature of such a case in black Africans, the initial difficulty of strictly excluding a parasitologic etiology is discussed. From the comparison of paraclinical and clinical data with those of the literature, the authors emphasize the close relationship between asthma and chronic eosinophilic pneumonia and the role of alveolar eosinophils in the physiopathology of that illness.

  18. A new Internet resource for chronic kidney disease patients.

    PubMed

    Ormandy, P; Vlaminck, H; Harrington, M; Forest, M; Visser, R

    2006-01-01

    This paper focuses on the development of a portal in the World Wide Web (WWW), which captures and locates quality information for patients with chronic kidney disease (CKD). It examines the problems patients face when accessing and understanding information gleaned from Web sites and describes an idea from a Research Board Member to facilitate patient access to quality information. The idea germinated into the development of a patient specific Web site, providing one stop access and links to appropriate CKD information, assessed by patients and health professionals. Collaboration between the EDTNA/ERCA Research Board and CEAPIR the European Federation of Kidney Patients has enhanced the project. PMID:16700172

  19. Patient Experiences of Depression and Anxiety with Chronic Disease

    PubMed Central

    DeJean, D; Giacomini, M; Vanstone, M; Brundisini, F

    2013-01-01

    Background Depression and anxiety are highly prevalent in patients with chronic disease, but remain undertreated despite significant negative consequences on patient health. A number of clinical groups have developed recommendations for depression screening practices in the chronic disease population. Objectives The objective of this analysis was to review empirical qualitative research on the experiences of patients with chronic disease (e.g., COPD, diabetes, heart disease, stroke) and comorbid depression or anxiety, and to highlight the implications of the screening and management of anxiety and/or depression on chronic disease outcomes. Review Methods We performed literature searches for studies published from January 2002 to May 2012. We applied a qualitative mega-filter to nine condition-specific search filters. Titles and abstracts were reviewed by two reviewers and, for the studies that met the eligibility criteria, full-text articles were obtained. Qualitative meta-synthesis was used to integrate findings across relevant published primary research studies. Qualitative meta-synthesis produced a synthesis of evidence that both retained the original meaning of the authors and offered a new, integrative interpretation of the phenomenon through a process of comparing and contrasting findings across studies. Results The findings of 20 primary qualitative studies were synthesized. Patients tended to experience their chronic conditions and anxiety or depression as either independent or inter-related (i.e., the chronic disease lead to depression/anxiety, the depression/anxiety lead to the chronic disease, or the two conditions exacerbated each other). Potential barriers to screening for depression or anxiety were also identified. Limitations A wider array of issues might have been captured if the analysis had focused on broader psychological responses to the chronic disease experience. However, given the objective to highlight implications for screening for anxiety

  20. Brain morphological alternation in chronic pain patients with neuropathic characteristics

    PubMed Central

    Sugimine, Satomi; Kawamichi, Hiroaki; Obata, Hideaki; Saito, Shigeru

    2016-01-01

    Background Neuropathic characteristics are highly involved in the development of chronic pain both physically and psychologically. However, little is known about the relationship between neuropathic characteristics and brain morphological alteration. Objectives The aim of this study is to investigate the mechanisms of chronic pain development by examining the above-mentioned relationships by voxel-based morphometry in patients with chronic pain. Methods First, we assessed neuropathic characteristics using the painDETECT Questionnaire in 12 chronic pain patients. Second, to assess the gray matter volume changes by voxel-based morphometry, we conducted magnetic resonance imaging of the brain. We applied multiregression analysis of these two assessment methods. Results There were significant positive correlations between painDETECT Questionnaire scores and the gray matter volume in the bilateral anterior cingulate cortex and right posterior cingulate cortex. Conclusions Our findings suggest that neuropathic characteristics strongly affect the brain regions related to modulation of pain in patients with chronic pain and, therefore, contribute to the severity of chronic pain. PMID:27284013

  1. Hyperuricemia in patients with chronic plaque psoriasis.

    PubMed

    Gisondi, Paolo

    2014-11-01

    Psoriasis is frequently associated with obesity, which may favor the development of hyperuricemia. Hyperuricemia predisposes patients to gout arthritis and is an emerging cardiovascular risk factor. In this study, we investigated the prevalence of hyperuricemia and serum uric acid (SUA) levels in psoriatic patients. SUA was measured in consecutive psoriatic patients (n = 338) and prevalence of hyperuricemia was estimated. Hyperuricemia was defined as SUA ≥7 mg/dL in men and ≥6 mg/dL in women. Hyperuricemia affected 20% (67 out 338) of patients with psoriasis. SUA levels were 5.8 ± 1.6 (mean ± SD) in patients with psoriasis. Levels of SUA were significantly higher in obese patients compared to non-obese patients (6.1 ± 1.5 vs 5.2 ± 1.4, P < 0.05). Levels of SUA showed a significant, positive correlation with body mass index (r = 0.30; P < 0.01) and serum triglycerides (r = 0.31; P < 0.01) but they were not significantly associated with age, sex, psoriasis duration or Psoriasis Area Severity Index score. Hyperuricemia is a common finding in psoriatic patients. Dosing levels of SUA could be appropriate in the global management of patients with psoriasis, particularly in those who are obese and with serum triglycerides upper the normal range.

  2. Online Patient Education for Chronic Disease Management: Consumer Perspectives.

    PubMed

    Win, Khin Than; Hassan, Naffisah Mohd; Oinas-Kukkonen, Harri; Probst, Yasmine

    2016-04-01

    Patient education plays an important role in chronic disease management. The aim of this study is to identify patients' preferences in regard to the design features of effective online patient education (OPE) and the benefits. A review of the existing literature was conducted in order to identify the benefits of OPE and its essential design features. These design features were empirically tested by conducting survey with patients and caregivers. Reliability analysis, construct validity and regression analysis were performed for data analysis. The results identified patient-tailored information, interactivity, content credibility, clear presentation of content, use of multimedia and interpretability as the essential design features of online patient education websites for chronic disease management. PMID:26846749

  3. Online Patient Education for Chronic Disease Management: Consumer Perspectives.

    PubMed

    Win, Khin Than; Hassan, Naffisah Mohd; Oinas-Kukkonen, Harri; Probst, Yasmine

    2016-04-01

    Patient education plays an important role in chronic disease management. The aim of this study is to identify patients' preferences in regard to the design features of effective online patient education (OPE) and the benefits. A review of the existing literature was conducted in order to identify the benefits of OPE and its essential design features. These design features were empirically tested by conducting survey with patients and caregivers. Reliability analysis, construct validity and regression analysis were performed for data analysis. The results identified patient-tailored information, interactivity, content credibility, clear presentation of content, use of multimedia and interpretability as the essential design features of online patient education websites for chronic disease management.

  4. Motivational interviewing to engage patients in chronic kidney disease management.

    PubMed

    Martino, Steve

    2011-01-01

    Patients with chronic kidney disease (CKD) must manage numerous medical treatments and lifestyle changes that strain their treatment adherence. An important strategy to improve adherence is to activate the patients' motivation to manage their CKD. This article describes an approach for enhancing patients' motivation for change, called motivational interviewing (MI), a treatment that is increasingly being used in health care settings to counsel patients with chronic diseases. Its basic principles, techniques, empirical support, published applications for improving CKD patients' self-management, and how to learn MI are presented. Research is needed to determine the efficacy and mechanisms of MI for CKD treatment as well as the development of innovative ways to deliver it to patients and train busy health care practitioners in the approach.

  5. 181 Olfactory Disfunctions in Patients with Chronic Rhinosinusitis

    PubMed Central

    Sánchez Vallecillo, María Victoria; Fraire, María Emilia; Baena-Cagnani, Carlos E.; Zernotti, Mario

    2012-01-01

    Background There are several factors that could produce olfactory dysfunction. The chronic inflammation of the upper air tract, especially allergic rhinitis is mentioned as a trigger factor. The aim of this study is assess the prevalence and identify clinical features associated with olfactory dysfunction in patients with chronic rhinosinusitis. Methods A prospective, analytical and observational study in adult patients (> 18 years) with chronic rhinosinusitis during the period May-October of 2010. We used the CCCRC (Connecticut Chemosensory Clinical Research Center smell test) Results A total of 33 patients were investigated. In the group of patients between 18 and 39 years, 73% of patients suffer from hyposmia and 18% anosmia; for the group of 40 to 64 years, 63% with hyposmia and 37% anosmia; patients older than 65 years, 67% hyposmia and 33% with anosmia. In the smokers group the 11% of patient presented hyposmia and 13% anosmia (P < 0.05); 5% in both cases had a history of nasal endoscopic surgery. In patients with chronic rhinosinusitis with nasal polyps have 18% with hyposmia and 19% with anosmia (P < 0.05). A 20% with allergic rhinitis had hyposmia while anosmia in 22% (P < 0.05). Septal deviation patients had 20% of hyposmia (P < 0.001) and 12% anosmia. Patients with turbinate hypertrophy had 22% hyposmia (P < 0.001) and 13% anosmia while in the group of patients with Asthma, the 4% had hyposmia and 16% anosmia (P < 0.001). Conclusions Nasal polyposis, septal deviation, turbinate hypertrophy, smoke, allergic rhinitis and asthma are negative predictors factors of olfactory dysfunction in patients with CRS. A previous endoscopic surgery, age and sex would not intervene in the olfactory loss.

  6. Graves' disease in a dialysis dependent chronic renal failure patient

    PubMed Central

    Nair, C. G.; Jacob, P.; Menon, R.; Babu, M. J. C.

    2014-01-01

    Thyroid hormone level may be altered in chronic renal failure patients. Low levels of thyroxine protect the body from excess protein loss by minimizing catabolism. Hyperthyroidism is rarely encountered in end-stage dialysis dependent patients. Less than 10 well-documented cases of Graves' disease (GD) are reported in literature so far. We report a case of GD in a patient on dialysis. PMID:25484538

  7. Care of the patient with chronic pain: part II.

    PubMed

    Wells-Federman, C L

    2000-01-01

    Chronic nonmalignant pain frequently results in significant physical, behavioral, psychological, social, and spiritual issues for patients and their families. It is often misunderstood and unsuccessfully managed. Advanced practice nurses who are knowledgeable about chronic pain and the complex biopsychosocial-spiritual needs of this patient population serve an important role in recognizing these patients and intervening appropriately in their care. The purpose of this two-part article is to provide that information. Part I [Clinical Excellence for Nurse Practitioners, 3 (4), 192-204] outlined the pathophysiology, assessment, biopsychosocial-spiritual aspects, and pharmacologic treatment of chronic pain. In Part II, a variety of nonpharmacologic and self-management interventions one can use in the primary care setting to treat these difficult health problems are introduced. PMID:11858295

  8. Investigation of Anxiety and Depression in Patients with Chronic Diseases

    PubMed Central

    Gerontoukou, Evangelia-Ioanna; Michaelidoy, Sofia; Rekleiti, Maria; Saridi, Maria; Souliotis, Kyriakos

    2015-01-01

    The health of an individual depends on both his/her physical and psychological condition. In recent years it has been observed that chronic patients have frequently an affected psycho-emotional state. The purpose of this study is to investigate anxiety and depression in patients with chronic diseases and the correlation of the results with daily physical activity levels and individual health levels, as well comorbidity. This study included patients with chronic diseases that were treated in a local general hospital or were visiting often outpatient clinics of the same hospital due to their condition. The sample in this particular study included 204 patients; 118 of them were women and 86 men. From the total sample that participated in our research, 118 (57.8%) were females and the majority of the participants were secondary/basic education graduates (67%), married (71%), living in urban areas (53%). Hypertension was the most frequent chronic disease in our sample, followed by hypercholesterolemia and diabetes mellitus. Comparing the occurrence of depression and anxiety symptoms in both questionnaires in relation to the expected frequency in the general population, significant levels of depression and anxiety symptoms were recorded. Taking into consideration the findings of this research, anxiety and depression symptoms can have profound effects regarding the control of chronic diseases, the patients’ quality of life and their general health. PMID:26973961

  9. Revascularization options in patients with chronic kidney disease.

    PubMed

    Ashrith, Guha; Elayda, MacArthur A; Wilson, James M

    2010-01-01

    Cardiovascular disease is the leading cause of death in patients who have chronic kidney disease or end-stage renal disease and are undergoing hemodialysis. Chronic kidney disease is a recognized risk factor for premature atherosclerosis. Unfortunately, most major randomized clinical trials that form the basis for evidence-based use of revascularization procedures exclude patients who have renal insufficiency. Retrospective, observational studies suggest that patients with end-stage renal disease and severe coronary occlusive disease have a lower risk of death if they undergo coronary revascularization rather than medical therapy alone. Due to a lack of prospective studies, however, the relative merits of percutaneous versus surgical revascularization are merely a matter of opinion. Several small, retrospective studies have shown that coronary artery bypass grafting is associated with higher procedural death but better long-term survival than is percutaneous coronary intervention. This difference appears to result from poor long-term results of percutaneous coronary intervention in patients who have chronic kidney disease or end-stage renal disease.Because randomized trials comparing percutaneous coronary intervention and coronary artery bypass grafting have included patients undergoing balloon angioplasty and placement of bare-metal stents, their conclusions are suspect in the era of drug-eluting stents. In this review, we discuss different revascularization options for patients with chronic kidney disease, the outcomes of revascularization procedures, and the risk factors for adverse outcomes.

  10. Contact laser prostatectomy in a patient on chronic anticoagulation

    NASA Astrophysics Data System (ADS)

    Mueller, Edward J.

    1995-05-01

    The `gold standard' therapy for patients with symptomatic bladder outlet obstruction secondary to benign prostatic hyperplasia has always been electrocautery TURP. However, in patients with medical problems requiring chronic anticoagulation, this procedure is contraindicated due to the extreme risk of hemorrhage, both during the procedure and the immediate post operative period. With the recent development of contact laser prostatectomy the patient on chronic anticoagulation can safely undergo the procedure. Herein, I present a case of a 60 year old with significant bladder outlet obstruction yielding an AUA symptom score of 18. The patient had a history of multiple episodes of deep venous thrombosis of the left leg with three prior pulmonary emboli. He was maintained on chronic anticoagulation with alternating days of 3.5 mg. and 5.0 mg. of warfarin sodium (coumadin). Preoperative cystoscopy showed a 4 cm prostatic fossa obstructed by tri-lobar hypertrophy, with large kissing lateral lobes and visual obstruction from the verumontanum. The patient underwent a contact laser prostatectomy with the SLT Nd:YAG laser at 50 watts. There was minimal bleeding both during the procedure and in the immediate postoperative period. At three months post-op the AUA symptom score had decreased to 2. This case demonstrated that contact laser prostatectomy can be safely and effectively performed in patients on chronic anticoagulation.

  11. The use of the picture–word interference paradigm to examine naming abilities in aphasic individuals

    PubMed Central

    Hashimoto, Naomi; Thompson, Cynthia K.

    2015-01-01

    Background Although naming deficits are well documented in aphasia, on-line measures of naming processes have been little investigated. The use of on-line measures may offer further insight into the nature of aphasic naming deficits that would otherwise be difficult to interpret when using off-line measures. Aims The temporal activation of semantic and phonological processes was tracked in older normal control and aphasic individuals using a picture–word interference paradigm. The purpose of the study was to examine how word interference results can augment and/or corroborate standard language testing in the aphasic group, as well as to examine temporal patterns of activation in the aphasic group when compared to a normal control group. Methods & Procedures A total of 20 older normal individuals and 11 aphasic individuals participated. Detailed measures of each aphasic individual's language and naming skills were obtained. A visual picture–word interference paradigm was used in which the words bore either a semantic, phonological, or no relationship to 25 pictures. These competitor words were presented at stimulus onset asynchronies of −300 ms, +300 ms, and 0 ms. Outcomes & Results Analyses of naming RTs in both groups revealed significant early semantic interference effects, mid-semantic interference effects, and mid-phonological facilitation effects. A matched control-aphasic group comparison revealed no differences in the temporal activation of effects during the course of naming. Partial support for this RT pattern was found in the aphasic naming error pattern. The aphasic group also demonstrated greater SIEs and PFEs compared to the matched control group, which indicated disruptions of the phonological processing stage. Analyses of behavioural performances of the aphasic group corroborated this finding. Conclusions The aphasic naming RTs results were unexpected given the results from the priming literature, which has supported the idea of slowed or

  12. A holistic program for chronic schizophrenic patients.

    PubMed

    Lukoff, D; Wallace, C J; Liberman, R P; Burke, K

    1986-01-01

    A 10-week, inhospital holistic health program for male schizophrenic patients was compared with an equally intense social skills training program. The holistic program included training in the stress reduction techniques of exercise and meditation as well as education in stress management. Patients were also encouraged to explore the growth potential of their psychotic experiences and to develop positive beliefs about the outcome of their illness. Both groups showed similar significant decreases in psychopathology from admission to discharge, but the use of medication and a token economy milieu by all patients confounds the interpretability of this finding. After the holistic patients were discharged into the community, there was no maintenance of any of the holistic techniques. The 2-year relapse rate did not differ significantly between the two treatments. Findings from various studies associating schizophrenic relapse with stressful life events and familial tension make further experimentation with stress reduction techniques for the treatment of schizophrenia worthwhile.

  13. Socio-economic status of chronic arsenicosis patients in Bangladesh.

    PubMed

    Sikder, M S; Maidul, Z M; Ali, M; Rahman, M H

    2005-01-01

    The study showed that the maximum number of arsenicosis patients (71%) belonged to low income group and 29% belong to middle class income group but none was found in high income group and all these patients were from rural areas of the country. Majority of all these patients was related with the traditional occupation of the country like cultivation (53%) in addition to lower level of educational background (81.5%). Most of the patients of chronic arsenicosis were suffering from malnutrition (91%). The present study which reflects that the vast majority of patients of chronic arsenicosis in the country belonged to low income group, but also to low educational background and individuals, who had been suffering from malnutrition, needs a special consideration in the management of the problem. Emphasis has been given to have access to arsenic-free water and protein rich diet to people of arsenic affected areas.

  14. Alexithymia and Early Maladaptive Schemas in chronic pain patients.

    PubMed

    Saariaho, Anita S; Saariaho, Tom H; Mattila, Aino K; Karukivi, Max; Joukamaa, Matti I

    2015-08-01

    Psychological factors have an impact on subjective pain experience. The aim of this study was to explore the occurrence of alexithymia and Early Maladaptive Schemas in a sample of 271 first visit chronic pain patients of six pain clinics. The patients completed the study questionnaire consisting of the Toronto Alexithymia Scale-20, the Finnish version of the Young Schema Questionnaire short form-extended, the Beck Depression Inventory-II, and pain variables. Alexithymic patients scored higher on Early Maladaptive Schemas and had more pain intensity, pain disability and depression than nonalexithymic patients. Both alexithymia and depression correlated significantly with most Early Maladaptive Schemas. The co-occurrence of alexithymia, Early Maladaptive Schemas and depression seems to worsen the pain experience. Screening of alexithymia, depression and Early Maladaptive Schemas may help to plan psychological treatment interventions for chronic pain patients. PMID:26040835

  15. [Microbiologic study of bacteremia and fungemia in chronic hemodialysis patients].

    PubMed

    Zárate, M S; Jordá Vargas, L; Lanza, A; Relloso, S; Díaz, C; Smayevsky, J

    2005-01-01

    Microbiologic study of bacteremia and fungemia in chronic hemodialysis patients. Bloodstream infections are the second cause of death in patients in chronic hemodialysis (CHD), and the knowledge of the epidemiology is useful to establish proper empiric therapies. The aim of this study was to evaluate the frequency and distribution of microorganisms, in bacteremia and fungemia in 530 patients in CHD. Two hundred and forty eight blood culture series from 114 patients with suspected bacteremia were processed; 44% of them were positive from which 71% (n=78) were clinically significative and belonged to 58 patients. Sixty eight percent of these isolates were gram-positive cocci (n:53), and 22% gram-negative rods (n:17). Staphylococcus aureus was the most prevalent pathogen showing 23% of methicillin-resistance. Candida spp. was the fourth pathogen most common in frequency.

  16. Enhanced emotional reactions in chronic head trauma patients.

    PubMed Central

    Fordyce, D J; Roueche, J R; Prigatano, G P

    1983-01-01

    The emotional characteristics of head injury patients referred for neuropsychological testing were examined as a function of the time since injury. Patients referred more than 6 months from injury were more emotionally distressed on the MMPI and Katz Adjustment Scale (relatives form) compared to those tested 6 months or earlier. The more chronic head trauma patients were more anxious and depressed, more confused in their thinking, and more socially withdrawn compared to the acute patient group. These differences in emotional functioning appeared to be independent of level of neuropsychological impairment and the initial length of coma. Premorbid personality and increased awareness of impaired functioning with the passage of time are discussed as possible mediators of enhanced emotional distress in some chronic head injury patients. PMID:6886698

  17. Multidisciplinary Care of the Patient with Chronic Obstructive Pulmonary Disease

    PubMed Central

    Kuzma, Anne Marie; Meli, Yvonne; Meldrum, Catherine; Jellen, Patricia; Butler-Lebair, Marianne; Koczen-Doyle, Debra; Rising, Peter; Stavrolakes, Kim; Brogan, Frances

    2008-01-01

    The National Emphysema Treatment Trial used a multidisciplinary team approach to implement the maximum medical care protocol, including adjustment of medications and outpatient pulmonary rehabilitation for all patients and nutritional and psychological counseling as needed. This article discusses the benefits of such an approach in the care of the patient with chronic obstructive pulmonary disease. Team member roles complement each other and contribute to the goal of providing the highest-quality medical care. The primary focus of the team is to reinforce the medical plan and to provide patient education and support. This article reviews the elements of the initial patient assessment and the functional and nutritional assessment. Patient education focuses on medication use, recognition and management of chronic obstructive pulmonary disease exacerbation symptoms, smoking cessation, advance directives, and travel. PMID:18453373

  18. Peripheral artery occlusive disease in chronic phase chronic myeloid leukemia patients treated with nilotinib or imatinib.

    PubMed

    Kim, T D; Rea, D; Schwarz, M; Grille, P; Nicolini, F E; Rosti, G; Levato, L; Giles, F J; Dombret, H; Mirault, T; Labussière, H; Lindhorst, R; Haverkamp, W; Buschmann, I; Dörken, B; le Coutre, P D

    2013-06-01

    Several retrospective studies have described the clinical manifestation of peripheral artery occlusive disease (PAOD) in patients receiving nilotinib. We thus prospectively screened for PAOD in patients with chronic phase chronic myeloid leukemia (CP CML) being treated with tyrosine kinase inhibitors (TKI), including imatinib and nilotinib. One hundred and fifty-nine consecutive patients were evaluated for clinical and biochemical risk factors for cardiovascular disease. Non-invasive assessment for PAOD included determination of the ankle-brachial index (ABI) and duplex ultrasonography. A second cohort consisted of patients with clinically manifest PAOD recruited from additional collaborating centers. Pathological ABI were significantly more frequent in patients on first-line nilotinib (7 of 27; 26%) and in patients on second-line nilotinib (10 of 28; 35.7%) as compared with patients on first-line imatinib (3 of 48; 6.3%). Clinically manifest PAOD was identified in five patients, all with current or previous nilotinib exposure only. Relative risk for PAOD determined by a pathological ABI in first-line nilotinib-treated patients as compared with first-line imatinib-treated patients was 10.3. PAOD is more frequently observed in patients receiving nilotinib as compared with imatinib. Owing to the severe nature of clinically manifest PAOD, longitudinal non-invasive monitoring and careful assessment of risk factors is warranted.

  19. Chronic Lyme disease: misconceptions and challenges for patient management

    PubMed Central

    Halperin, John J

    2015-01-01

    Lyme disease, infection with the tick-borne spirochete Borrelia burgdorferi, causes both specific and nonspecific symptoms. In untreated chronic infection, specific manifestations such as a relapsing large-joint oligoarthritis can persist for years, yet subside with appropriate antimicrobial therapy. Nervous system involvement occurs in 10%–15% of untreated patients and typically involves lymphocytic meningitis, cranial neuritis, and/or mononeuritis multiplex; in some rare cases, patients have parenchymal inflammation in the brain or spinal cord. Nervous system infection is similarly highly responsive to antimicrobial therapy, including oral doxycycline. Nonspecific symptoms such as fatigue, perceived cognitive slowing, headache, and others occur in patients with Lyme disease and are indistinguishable from comparable symptoms occurring in innumerable other inflammatory states. There is no evidence that these nonspecific symptoms reflect nervous system infection or damage, or that they are in any way specific to or diagnostic of this or other tick-borne infections. When these symptoms occur in patients with Lyme disease, they typically also subside after antimicrobial treatment, although this may take time. Chronic fatigue states have been reported to occur following any number of infections, including Lyme disease. The mechanism underlying this association is unclear, although there is no evidence in any of these infections that these chronic posttreatment symptoms are attributable to ongoing infection with B. burgdorferi or any other identified organism. Available appropriately controlled studies indicate that additional or prolonged courses of antimicrobial therapy do not benefit patients with a chronic fatigue-like state after appropriately treated Lyme disease. PMID:26028977

  20. Myofascial Pain Syndrome in Chronic Back Pain Patients

    PubMed Central

    Nizar, Abd Jalil

    2011-01-01

    Background Myofascial pain syndrome (MPS) is a regional musculoskeletal pain disorder that is caused by myofascial trigger points. The objective of this study was to determine the prevalence of MPS among chronic back pain patients, as well as to identify risk factors and the outcome of this disorder. Methods This was a prospective observational study involving 126 patients who attended the Pain Management Unit for chronic back pain between 1st January 2009 and 31st December 2009. Data examined included demographic features of patients, duration of back pain, muscle(s) involved, primary diagnosis, treatment modality and response to treatment. Results The prevalence of MPS among chronic back pain patients was 63.5% (n = 80). Secondary MPS was more common than primary MPS, making up 81.3% of the total MPS. There was an association between female gender and risk of developing MPS (χ2 = 5.38, P = 0.02, O.R. = 2.4). Occupation, body mass index and duration of back pain were not significantly associated with MPS occurrence. Repeated measures analysis showed significant changes (P < 0.001) in Visual Analogue Score (VAS) and Modified Oswestry Disability Score (MODS) with standard management during three consecutive visits at six-month intervals. Conclusions MPS prevalence among chronic back pain patients was significantly high, with female gender being a significant risk factor. With proper diagnosis and expert management, MPS has a favourable outcome. PMID:21716607

  1. [Preoperative Management of Patients with Bronchial Asthma or Chronic Bronchitis].

    PubMed

    Hagihira, Satoshi

    2015-09-01

    Bronchial asthma is characterized by chronic airway inflammation. The primary goal of treatment of asthma is to maintain the state of control. According to the Japanese guidelines (JGL2012), long-term management consists of 4 therapeutic steps, and use of inhaled corticosteroids (ICS) is recommended at all 4 steps. Besides ICS, inhalation of long-acting β2-agonist (LABA) is also effective. Recently, omalizumab (a humanized antihuman IgE antibody) can be available for patients with severe allergic asthma. Although there is no specific strategy for preoperative treatment of patients with asthma, preoperative systemic steroid administration seemed to be effective to prevent asthma attack during anesthesia. The most common cause of chronic bronchitis is smoking. Even the respiratory function is within normal limits, perioperative management of patients with chronic bronchitis is often troublesome. The most common problem is their sputum. To minimize perioperative pulmonary complication in these patients, smoking cessation and pulmonary rehabilitation are essential. It is known that more than 1 month of smoking cessation is required to reduce perioperative respiratory complication. However, even one or two weeks of smoking cessation can decrease sputum secretion. In summary, preoperative optimization is most important to prevent respiratory complication in patients with bronchial asthma or chronic bronchitis. PMID:26466493

  2. Chronic Lyme disease: misconceptions and challenges for patient management.

    PubMed

    Halperin, John J

    2015-01-01

    Lyme disease, infection with the tick-borne spirochete Borrelia burgdorferi, causes both specific and nonspecific symptoms. In untreated chronic infection, specific manifestations such as a relapsing large-joint oligoarthritis can persist for years, yet subside with appropriate antimicrobial therapy. Nervous system involvement occurs in 10%-15% of untreated patients and typically involves lymphocytic meningitis, cranial neuritis, and/or mononeuritis multiplex; in some rare cases, patients have parenchymal inflammation in the brain or spinal cord. Nervous system infection is similarly highly responsive to antimicrobial therapy, including oral doxycycline. Nonspecific symptoms such as fatigue, perceived cognitive slowing, headache, and others occur in patients with Lyme disease and are indistinguishable from comparable symptoms occurring in innumerable other inflammatory states. There is no evidence that these nonspecific symptoms reflect nervous system infection or damage, or that they are in any way specific to or diagnostic of this or other tick-borne infections. When these symptoms occur in patients with Lyme disease, they typically also subside after antimicrobial treatment, although this may take time. Chronic fatigue states have been reported to occur following any number of infections, including Lyme disease. The mechanism underlying this association is unclear, although there is no evidence in any of these infections that these chronic posttreatment symptoms are attributable to ongoing infection with B. burgdorferi or any other identified organism. Available appropriately controlled studies indicate that additional or prolonged courses of antimicrobial therapy do not benefit patients with a chronic fatigue-like state after appropriately treated Lyme disease.

  3. Chronic Lyme disease: misconceptions and challenges for patient management.

    PubMed

    Halperin, John J

    2015-01-01

    Lyme disease, infection with the tick-borne spirochete Borrelia burgdorferi, causes both specific and nonspecific symptoms. In untreated chronic infection, specific manifestations such as a relapsing large-joint oligoarthritis can persist for years, yet subside with appropriate antimicrobial therapy. Nervous system involvement occurs in 10%-15% of untreated patients and typically involves lymphocytic meningitis, cranial neuritis, and/or mononeuritis multiplex; in some rare cases, patients have parenchymal inflammation in the brain or spinal cord. Nervous system infection is similarly highly responsive to antimicrobial therapy, including oral doxycycline. Nonspecific symptoms such as fatigue, perceived cognitive slowing, headache, and others occur in patients with Lyme disease and are indistinguishable from comparable symptoms occurring in innumerable other inflammatory states. There is no evidence that these nonspecific symptoms reflect nervous system infection or damage, or that they are in any way specific to or diagnostic of this or other tick-borne infections. When these symptoms occur in patients with Lyme disease, they typically also subside after antimicrobial treatment, although this may take time. Chronic fatigue states have been reported to occur following any number of infections, including Lyme disease. The mechanism underlying this association is unclear, although there is no evidence in any of these infections that these chronic posttreatment symptoms are attributable to ongoing infection with B. burgdorferi or any other identified organism. Available appropriately controlled studies indicate that additional or prolonged courses of antimicrobial therapy do not benefit patients with a chronic fatigue-like state after appropriately treated Lyme disease. PMID:26028977

  4. Your patient has chronic leukemia: Now what?

    PubMed

    Kalaycio, Matt

    2016-08-01

    Although still in their infancy, biologic therapies for hematologic cancers are making rapid strides, diminishing the role of chemotherapy and offering long-term remission. More patients are surviving cancer and therefore are increasingly being seen by primary care physicians, who must be aware of complications of standard and newer treatments and how to manage them. PMID:27505878

  5. Study of Hepatic Osteodystrophy in Patients with Chronic Liver Disease

    PubMed Central

    Karoli, Yogesh; Fatima, Jalees; Manhar, Mohammad

    2016-01-01

    Introduction Chronic Liver Disease (CLD) is a major cause of morbidity and mortality worldwide. It involves haemodynamic and metabolic complications. Hepatic Osteodystrophy is a metabolic bone disease that may occur in individuals with chronic liver disease. It can significantly affect morbidity and quality of life of these patients. Fractures are also associated with an excess mortality. It has been an under recognized and inadequately studied complication among Indian population. An early diagnosis is essential to correct reversible risk factors which predispose to bone mass loss. Aim To assess the prevalence of metabolic bone disease and identify the risk factors associated with hepatic osteodystrophy in patients with cirrhosis. Materials and Methods This was an observational, cross-sectional, hospital based study conducted at a medical college hospital. All patients more than 20-year-old, diagnosed with chronic liver disease/Cirrhosis were enrolled. They were subjected to haematological, biochemical investigations, evaluation of Vitamin D and other hormonal parameters. Bone Mineral Density (BMD) was estimated by Dual Energy X-ray Absorptiometry (DEXA). Results A total of 72 patients with mean age 50.04±11.24 years were included in the study. Amongst causes of chronic liver disease were alcoholic liver disease 22 (30.6%), CLD due to hepatitis B 24 (33.3%) and chronic hepatitis C 26 (36.1%). Twenty one (29.2%) patients had normal BMD while 51 (70.8%) had a low BMD. Out of these 51 patients, 36 (70.6%) were diagnosed of osteopenia and 15 (29.4%) others were found to have osteoporosis. Vitamin D levels and severity of liver disease had correlation with low BMD. Conclusion Low BMD is highly prevalent in patients with chronic liver disease of variable aetiologies. We advocate more randomised and prospective studies to be conducted on homogeneous groups with chronic liver disease in its various stages. In view of numerous therapeutic options available both for liver

  6. Management of hepatitis C in patients with chronic kidney disease

    PubMed Central

    Carvalho-Filho, Roberto J; Feldner, Ana Cristina CA; Silva, Antonio Eduardo B; Ferraz, Maria Lucia G

    2015-01-01

    Hepatitis C virus (HCV) infection is highly prevalent among chronic kidney disease (CKD) subjects under hemodialysis and in kidney transplantation (KT) recipients, being an important cause of morbidity and mortality in these patients. The vast majority of HCV chronic infections in the hemodialysis setting are currently attributable to nosocomial transmission. Acute and chronic hepatitis C exhibits distinct clinical and laboratorial features, which can impact on management and treatment decisions. In hemodialysis subjects, acute infections are usually asymptomatic and anicteric; since spontaneous viral clearance is very uncommon in this context, acute infections should be treated as soon as possible. In KT recipients, the occurrence of acute hepatitis C can have a more severe course, with a rapid progression of liver fibrosis. In these patients, it is recommended to use pegylated interferon (PEG-IFN) in combination with ribavirin, with doses adjusted according to estimated glomerular filtration rate. There is no evidence suggesting that chronic hepatitis C exhibits a more aggressive course in CKD subjects under conservative management. In these subjects, indication of treatment with PEG-IFN plus ribavirin relies on the CKD stage, rate of progression of renal dysfunction and the possibility of a preemptive transplant. HCV infection has been associated with both liver disease-related deaths and cardiovascular mortality in hemodialysis patients. Among those individuals, low HCV viral loads and the phenomenon of intermittent HCV viremia are often observed, and sequential HCV RNA monitoring is needed. Despite the poor tolerability and suboptimal efficacy of antiviral therapy in CKD patients, many patients can achieve sustained virological response, which improve patient and graft outcomes. Hepatitis C eradication before KT theoretically improves survival and reduces the occurrence of chronic graft nephropathy, de novo glomerulonephritis and post-transplant diabetes

  7. Oral Tori in Chronic Peritoneal Dialysis Patients

    PubMed Central

    Hsu, Chia-Lin; Hsu, Ching-Wei; Chang, Pei-Ching; Huang, Wen-Hung; Weng, Cheng-Hao; Yang, Huang-Yu; Liu, Shou-Hsuan; Chen, Kuan-Hsing; Weng, Shu-Man; Chang, Chih-Chun; Wang, I-Kuan

    2016-01-01

    Background The pathogenesis of oral tori has long been debated and is thought to be the product of both genetic and environmental factors, including occlusal forces. Another proposed mechanism for oral tori is the combination of biomechanical forces, particularly in the oral cavity, combined with cortical bone loss and trabecular expansion, as one might see in the early stages of primary hyperparathyroidism. This study investigated the epidemiology of torus palatinus (TP) and torus mandibularis (TM) in peritoneal dialysis patients, and analyzed the influences of hyperparathyroidism on the formation of oral tori. Method In total, 134 peritoneal dialysis patients were recruited between July 1 and December 31, 2015 for dental examinations for this study. Patients were categorized into two subgroups based on the presence or absence of oral tori. Demographic, hematological, biochemical, and dialysis-related data were obtained for analysis. Results The prevalence of oral tori in our sample group was high at 42.5% (57 of 134), and most patients with oral tori were female (61.4%). The most common location of tori was TP (80.7%), followed by TP and TM (14.0%), then TM (5.3%). All 54 TP cases were at the midline, and most were <2 cm (59.3%), flat (53.7%), and located in the premolar region (40.7%). Of the 11 TM cases, all were bilateral and symmetric, mostly <2 cm (81.9%), lobular (45.4%), and located at premolar region (63.6%). Interestingly, patients with oral tori had slightly lower serum levels of intact parathyroid hormones than those without oral tori, but the difference was not statistically significant (317.3±292.0 versus 430.1±492.6 pg/mL, P = 0.126). In addition, patients with oral tori did not differ from patients without tori in inflammatory variables such as serum high sensitivity C-reactive protein levels (6.6±8.2 versus 10.3±20.2 mg/L, P = 0.147) or nutritional variables such as serum albumin levels (3.79±0.38 versus 3.77±0.45 g/dL, P = 0

  8. [Anesthetic Management of Three Patients with Chronic Inflammatory Demyelinating Polyradiculoneuropathy].

    PubMed

    Maruyama, Naoko; Wakimoto, Mayuko; Inamori, Noriko; Nishimura, Shinya; Mori, Takahiko

    2015-08-01

    Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a chronically progressing or relapsing disease caused by immune-mediated peripheral neuropathy. We report the anesthetic management of three CIDP patients who underwent elective orthopedic surgeries. Owing to the risk of neuraxial anesthetics triggering demyelination, general anesthesia was selected to avoid epidural or spinal anesthesia or other neuraxial blockade. It was also judged prudent to avoid prolonged perioperative immobilization, which might compress vulnerable peripheral nerves. For Patient 1, general anesthesia was induced with propofol, remifentanil, and sevoflurane, and was maintained with sevoflurane and remifentanil. For Patients 2 and 3, general anesthesia was induced and maintained with propofol and remifentanil. For tracheal intubation, under careful monitoring with peripheral nerve stimulators, minimal doses of rocuronium (0.6-0.7 mg x kg(-1)) were administered. When sugammadex was administered to reverse the effect of rocuronium, all patients rapidly regained muscular strength. Postoperative courses were satisfactory without sequelae.

  9. The Effect of Redundant Cues on Comprehension of Spoken Messages by Aphasic Adults.

    ERIC Educational Resources Information Center

    Venus, Carol A.; Canter, Gerald J.

    1987-01-01

    Aphasic adults (N=16) with severe auditory comprehension impairment were evaluated for comprehension of redundant and nonredundant spoken and/or gestured messages. Results indicated redundancy was not reliably superior to spoken messages alone. (Author/DB)

  10. [Health maintenance, relaxation and hypnosis for chronic pain patients].

    PubMed

    Boiron, Clare

    2014-10-01

    The treatment of chronic pain patients integrates more and more complementary therapies such as relaxation and hypnosis, implemented by specially trained nurses. These techniques are offered on the basis of nurses' diagnoses carried out in the framework of a clinical approach.

  11. Bacillary angiomatosis in a patient with chronic lymphocytic leukemia.

    PubMed

    Petersen, K; Earhart, K C; Wallace, M R

    2008-10-01

    Bacillary angiomatosis is a cutaneous or visceral infection with Bartonella henselae or Bartonella quintana. Cases usually occur in HIV infected individuals. We present a 60-year-old man with chronic lymphocytic leukemia and neutropenic fever caused by bacillary angiomatosis. The nine BA cases in oncology patients are reviewed.

  12. [Health maintenance, relaxation and hypnosis for chronic pain patients].

    PubMed

    Boiron, Clare

    2014-10-01

    The treatment of chronic pain patients integrates more and more complementary therapies such as relaxation and hypnosis, implemented by specially trained nurses. These techniques are offered on the basis of nurses' diagnoses carried out in the framework of a clinical approach. PMID:25518140

  13. [Echocardiographic alterations in patients with chronic kidney failure undergoing hemodialysis].

    PubMed

    Barberato, Silvio Henrique; Pecoits-Filho, Roberto

    2010-01-01

    Changes in cardiac structure and function detected by echocardiography are common in patients with chronic kidney disease undergoing hemodialysis, and have been recognized as key outcome predictors. This review attempts to summarize recent evidence pointing to the usefulness of the method in the detection of clinical and subclinical cardiac dysfunction, stratification of cardiovascular risk and assessment of intervention strategies.

  14. Endovascular Treatment of Chronic Mesenteric Ischemia: Results in 14 Patients

    SciTech Connect

    Chahid, Tamam; Alfidja, Agaicha T.; Biard, Marie; Ravel, Anne; Garcier, Jean Marc; Boyer, L.

    2004-11-15

    We evaluated immediate and long-term results of percutaneous transluminal angioplasty (PTA) and stent placement to treat stenotic and occluded arteries in patients with chronic mesenteric ischemia. Fourteen patients were treated by 3 exclusive celiac artery (CA) PTAs (2 stentings), 3 cases with both Superior Mesenteric Artery (SMA) and CA angioplasties, and 8 exclusive SMA angioplasties (3 stentings). Eleven patients had atheromatous stenoses with one case of an early onset atheroma in an HIV patient with antiphospholipid syndrome. The other etiologies of mesenteric arterial lesions were Takayashu arteritis (2 cases) and a postradiation stenoses (1 case). Technical success was achieved in all cases. Two major complications were observed: one hematoma and one false aneurysm occurring at the brachial puncture site (14.3%). An immediate clinical success was obtained in all patients. During a follow-up of 1-83 months (mean: 29 months), 11 patients were symptom free; 3 patients had recurrent pain; in one patient with inflammatory syndrome, pain relief was obtained with medical treatment; in 2 patients abdominal pain was due to restenosis 36 and 6 months after PTA, respectively. Restenosis was treated by PTA (postirradiation stenosis), and by surgical bypass (atheromatous stenosis). Percutaneous endovascular techniques are safe and accurate. They are an alternative to surgery in patients with chronic mesenteric ischemia due to short and proximal occlusive lesions of SMA and CA.

  15. Analysis of A-phase transitions during the cyclic alternating pattern under normal sleep.

    PubMed

    Mendez, Martin Oswaldo; Chouvarda, Ioanna; Alba, Alfonso; Bianchi, Anna Maria; Grassi, Andrea; Arce-Santana, Edgar; Milioli, Guilia; Terzano, Mario Giovanni; Parrino, Liborio

    2016-01-01

    An analysis of the EEG signal during the B-phase and A-phases transitions of the cyclic alternating pattern (CAP) during sleep is presented. CAP is a sleep phenomenon composed by consecutive sequences of A-phases (each A-phase could belong to a possible group A1, A2 or A3) observed during the non-REM sleep. Each A-phase is separated by a B-phase which has the basal frequency of the EEG during a specific sleep stage. The patterns formed by these sequences reflect the sleep instability and consequently help to understand the sleep process. Ten recordings from healthy good sleepers were included in this study. The current study investigates complexity, statistical and frequency signal properties of electroencephalography (EEG) recordings at the transitions: B-phase--A-phase. In addition, classification between the onset-offset of the A-phases and B-phase was carried out with a kNN classifier. The results showed that EEG signal presents significant differences (p < 0.05) between A-phases and B-phase for the standard deviation, energy, sample entropy, Tsallis entropy and frequency band indices. The A-phase onset showed values of energy three times higher than B-phase at all the sleep stages. The statistical analysis of variance shows that more than 80% of the A-phase onset and offset is significantly different from the B-phase. The classification performance between onset or offset of A-phases and background showed classification values over 80% for specificity and accuracy and 70% for sensitivity. Only during the A3-phase, the classification was lower. The results suggest that neural assembles that generate the basal EEG oscillations during sleep present an over-imposed coordination for a few seconds due to the A-phases. The main characteristics for automatic separation between the onset-offset A-phase and the B-phase are the energy at the different frequency bands.

  16. [Chronic Salmonella typhimurium diarrhea in an immunocompetent patient].

    PubMed

    Mellado-Ferreiro, M; Jarne-Betrán, V; Arteaga-Mazuelas, M; Abínzano-Guillén, M L

    2016-01-01

    Chronic diarrhea caused by infection in immunocompetent patients is an infrequent condition in developed countries, although certain pathogens,generally parasites (Giardia lamblia, Isospora belli,Cryptosporidium, Cyclospora, Strongyloides, Ameba,Trichuris and Schistosoma) and some bacteria (Aeromonas,Plesiomonas, Campylobacter, Clostridium difficile, Salmonella or Mycobacterium tuberculosis)can cause persistent diarrhea.We present the case of a patient who showed Salmonella typhimurium in his stool culture and recovered following treatment with levofloxacin for 7 days. PMID:27125610

  17. Implementing a patient-led service for chronic conditions.

    PubMed

    Pope, Denise; Tipler, Sue; Kirwan, John; Hewlett, Sarah

    Many chronic conditions with fluctuating levels of disease activity are traditionally managed by lifelong regular medical reviews. However, this means appointments do not always coincide with patient need, while the volume of reviews makes it difficult to respond quickly to requests for help. Research in rheumatoid arthritis suggests that hospital-initiated reviews can be replaced by patient-initiated reviews, supported by nurse-led initiatives.

  18. The Expert Patient and Chronic Respiratory Diseases

    PubMed Central

    Boulet, Louis-Philippe

    2016-01-01

    The concept of “expert patient” has been developed in the last two decades to define a patient who has a significant knowledge of his/her disease and treatment in addition to self-management skills. However, this concept has evolved over the last years, and these patients are now considered, not only to be more efficient in the management of their own condition and communicating effectively with health professionals, but to also act as educators for other patients and as resources for the last, provide feedback on care delivery, and be involved in the production and implementation of practice guidelines, as well as in the development and conduct of research initiatives. There are some barriers, however, to the integration of this new contributor to the health care team, and specific requirements need to be considered for an individual to be considered as an expert. This new player has, however, a potentially important role to improve current care, particularly in respiratory health. PMID:27445572

  19. Core strength training for patients with chronic low back pain.

    PubMed

    Chang, Wen-Dien; Lin, Hung-Yu; Lai, Ping-Tung

    2015-03-01

    [Purpose] Through core strength training, patients with chronic low back pain can strengthen their deep trunk muscles. However, independent training remains challenging, despite the existence of numerous core strength training strategies. Currently, no standardized system has been established analyzing and comparing the results of core strength training and typical resistance training. Therefore, we conducted a systematic review of the results of previous studies to explore the effectiveness of various core strength training strategies for patients with chronic low back pain. [Methods] We searched for relevant studies using electronic databases. Subsequently, we evaluated their quality by analyzing the reported data. [Results] We compared four methods of evaluating core strength training: trunk balance, stabilization, segmental stabilization, and motor control exercises. According to the results of various scales and evaluation instruments, core strength training is more effective than typical resistance training for alleviating chronic low back pain. [Conclusion] All of the core strength training strategies examined in this study assist in the alleviation of chronic low back pain; however, we recommend focusing on training the deep trunk muscles to alleviate chronic low back pain.

  20. Core strength training for patients with chronic low back pain

    PubMed Central

    Chang, Wen-Dien; Lin, Hung-Yu; Lai, Ping-Tung

    2015-01-01

    [Purpose] Through core strength training, patients with chronic low back pain can strengthen their deep trunk muscles. However, independent training remains challenging, despite the existence of numerous core strength training strategies. Currently, no standardized system has been established analyzing and comparing the results of core strength training and typical resistance training. Therefore, we conducted a systematic review of the results of previous studies to explore the effectiveness of various core strength training strategies for patients with chronic low back pain. [Methods] We searched for relevant studies using electronic databases. Subsequently, we evaluated their quality by analyzing the reported data. [Results] We compared four methods of evaluating core strength training: trunk balance, stabilization, segmental stabilization, and motor control exercises. According to the results of various scales and evaluation instruments, core strength training is more effective than typical resistance training for alleviating chronic low back pain. [Conclusion] All of the core strength training strategies examined in this study assist in the alleviation of chronic low back pain; however, we recommend focusing on training the deep trunk muscles to alleviate chronic low back pain. PMID:25931693

  1. Personal Health Records for Patients with Chronic Disease

    PubMed Central

    Rozenblum, R.; Park, A.; Dunn, M.; Bates, D.W.

    2014-01-01

    Summary Background Personal health records (PHRs) connected to a physician’s electronic health record system hold substantial promise for supporting and engaging patients with chronic disease. Objectives: To explore how U.S. health care organizations are currently utilizing PHRs for chronic disease populations. Methods A mixed methods study including semi-structured interviews and a questionnaire was conducted. A purposive sample was developed of health care organizations which were recognized as exemplars for PHRs and were high performers in national patient satisfaction surveys (H-CAHPS or CAHPS). Within each organization, participants were health IT leaders or those managing high-risk or chronic disease populations. Results Interviews were conducted with 30 informants and completed questionnaires were received from 16 organizations (84% response rate). Most PHRs allowed patients to access health records and educational material, message their provider, renew prescriptions and request appointments. Patient generated data was increasingly being sought and combined with messaging, resulted in greater understanding of patient health and functioning outside of the clinic visit. However for chronic disease populations, there was little targeted involvement in PHR design and few tools to help interpret and manage their conditions beyond those offered for all. The PHR was largely uncoupled from high risk population management interventions and no clear framework for future PHR development emerged. Conclusion This technology is currently underutilized and represents a major opportunity given the potential benefits of patient engagement and shared decision making. A coherent patient-centric PHR design and evaluation strategy is required to realize its potential and maximize this natural hub for multidisciplinary care co-ordination. PMID:25024758

  2. Endocrine Abnormalities in Patients with Chronic Kidney Disease.

    PubMed

    Kuczera, Piotr; Adamczak, Marcin; Wiecek, Andrzej

    2015-01-01

    In patients with chronic kidney disease the alterations of the endocrine system may arise from several causes. The kidney is the site of degradation as well as synthesis of many different hormones. Moreover, a number of concomitant pathological conditions such as inflammation, metabolic acidosis and malnutrition may participate in the pathogenesis of endocrine abnormalities in this group of patients. The most pronounced endocrine abnormalities in patients with chronic kidney disease are the deficiencies of: calcitriol, testosterone, insulin-like growth factor and, erythropoietin (EPO). Additionally accumulation of several hormones, such as: prolactin, growth hormone and insulin frequently also occur. The clinical consequences of the abovementioned endocrine abnormalities are among others: anemia, infertility and bone diseases.

  3. [Asymptomatic celiac disease in patient with chronic acalculous cholecystitis].

    PubMed

    Parfenov, A I; Dolgasheva, G M; Krums, L M; Bystrovskaia, E V; Sabel'nikova, E A; Gudkova, R B; Vorob'eva, N N; Lishchinskaia, A A

    2011-01-01

    We described a patient 40 years old, admitted to the clinic with periodic attacks of pain in the right upper quadrant. With ultrasound it was confirmed chronic acalculous cholecystitis, and at endoscopy and multiple biopsies revealed atrophy of the mucosa of the duodenum (DM), corresponding to celiac disease (stage III in the Marsh classification). Titer of antibodies to gliadin (AGA) and tissue transglutaminase (AtTG) were higher: 60 and 110 units/ml, respectively, at a rate of 10 units/ml. The patient was assigned a lifetime adherence to a gluten-free diet, serologic test and a control endoscopy with biopsy at 6 months. The important role of the doctor-endoscopist in the diagnosis of latent forms of celiac disease. The significance of DM atrophy in the pathogenesis of patients with chronic cholecystitis. PMID:21695960

  4. Endocrine Abnormalities in Patients with Chronic Kidney Disease.

    PubMed

    Kuczera, Piotr; Adamczak, Marcin; Wiecek, Andrzej

    2015-01-01

    In patients with chronic kidney disease the alterations of the endocrine system may arise from several causes. The kidney is the site of degradation as well as synthesis of many different hormones. Moreover, a number of concomitant pathological conditions such as inflammation, metabolic acidosis and malnutrition may participate in the pathogenesis of endocrine abnormalities in this group of patients. The most pronounced endocrine abnormalities in patients with chronic kidney disease are the deficiencies of: calcitriol, testosterone, insulin-like growth factor and, erythropoietin (EPO). Additionally accumulation of several hormones, such as: prolactin, growth hormone and insulin frequently also occur. The clinical consequences of the abovementioned endocrine abnormalities are among others: anemia, infertility and bone diseases. PMID:27442377

  5. Altered Interhemispheric Functional Coordination in Chronic Tinnitus Patients

    PubMed Central

    Chen, Yu-Chen; Xia, Wenqing; Li, Xiaowei; Zhang, Jian; Feng, Xu; Wang, Cong-Xiao; Cai, Yu; Wang, Jian; Teng, Gao-Jun

    2015-01-01

    Purpose. Recent studies suggest that tinnitus may be due in part to aberrant callosal structure and interhemispheric interaction. To explore this hypothesis we use a novel method, voxel-mirrored homotopic connectivity (VMHC), to examine the resting-state interhemispheric functional connectivity and its relationships with clinical characteristics in chronic tinnitus patients. Materials and Methods. Twenty-eight chronic tinnitus patients with normal hearing thresholds and 30 age-, sex-, education-, and hearing threshold-matched healthy controls were included in this study and underwent the resting-state fMRI scanning. We computed the VMHC to analyze the interhemispheric functional coordination between homotopic points of the brain in both groups. Results. Compared to the controls, tinnitus patients showed significantly increased VMHC in the middle temporal gyrus, middle frontal gyrus, and superior occipital gyrus. In tinnitus patients, a positive correlation was found between tinnitus duration and VMHC of the uncus. Moreover, correlations between VMHC changes and tinnitus distress were observed in the transverse temporal gyrus, superior temporal pole, precentral gyrus, and calcarine cortex. Conclusions. These results show altered interhemispheric functional connectivity linked with specific tinnitus characteristics in chronic tinnitus patients, which may be implicated in the neuropathophysiology of tinnitus. PMID:25789314

  6. Neurocognitive performance in first-episode and chronic schizophrenic patients.

    PubMed

    Moritz, Steffen; Andresen, Burghard; Perro, Christian; Schickel, Marc; Krausz, Micheal; Naber, Dieter

    2002-02-01

    Previous research on neuropsychological disturbances in first-episode and chronic schizophrenic patients has provided mixed results which can be partially attributed to methodological inconsistencies. For the present study, 70 schizophrenic patients (40 with chronic and 30 with first-episode schizophrenia) were compared to 30 healthy controls on a large battery of neuropsychological tests. Special attention was paid to potential confounds such as differences in psychopathology, age and educational level between the schizophrenic sub-samples. Healthy controls performed better than both first-episode and chronic patients in almost all cognitive domains (P < 0.01), while the patient samples did not differ in any of the tasks. Results were confirmed in a second series of analyses in which patient subgroups were equated for sociodemographic background variables. The present results confirm recent data collected in longitudinal studies, thus, lending further support for a neurodevelopmental model of schizophrenia. It is suggested that neuropsychological disturbances occur early in schizophrenia and do not worsen in the course beyond age-related decrement. Possible reasons why previous research has produced contradictory findings are discussed.

  7. Neurocognitive performance in first-episode and chronic schizophrenic patients.

    PubMed

    Moritz, Steffen; Andresen, Burghard; Perro, Christian; Schickel, Marc; Krausz, Micheal; Naber, Dieter

    2002-02-01

    Previous research on neuropsychological disturbances in first-episode and chronic schizophrenic patients has provided mixed results which can be partially attributed to methodological inconsistencies. For the present study, 70 schizophrenic patients (40 with chronic and 30 with first-episode schizophrenia) were compared to 30 healthy controls on a large battery of neuropsychological tests. Special attention was paid to potential confounds such as differences in psychopathology, age and educational level between the schizophrenic sub-samples. Healthy controls performed better than both first-episode and chronic patients in almost all cognitive domains (P < 0.01), while the patient samples did not differ in any of the tasks. Results were confirmed in a second series of analyses in which patient subgroups were equated for sociodemographic background variables. The present results confirm recent data collected in longitudinal studies, thus, lending further support for a neurodevelopmental model of schizophrenia. It is suggested that neuropsychological disturbances occur early in schizophrenia and do not worsen in the course beyond age-related decrement. Possible reasons why previous research has produced contradictory findings are discussed. PMID:12056580

  8. Anticoagulation in chronic kidney disease patients-the practical aspects.

    PubMed

    Hughes, Stephen; Szeki, Iren; Nash, Michael J; Thachil, Jecko

    2014-10-01

    There is an increasing awareness about the risks of arterial and venous thromboembolism (TE) in hospital patients and general public which has led to consideration of thrombosis prevention measures in earnest. Early recognition of the symptoms of TE disease has led to timely administration of antiplatelet and anticoagulant drugs, translating to better outcome in many of these patients. In this respect, patients with chronic kidney disease (CKD) represent a special group. They indeed represent a high-risk group for thrombosis both in the cardiovascular territory and also in the venous circulation. At the same time, abnormalities in the platelet membranes put them at risk of bleeding which is significantly more than other patients with chronic diseases. Anticoagulation may be ideal to prevent the former, but the co-existing bleeding risk and also that the commonly used drugs for inhibiting coagulation are eliminated by renal pathways pose additional problems. In this review, we try to explain the complex thrombotic-haemorrhagic state of chronic kidney disease patients, and practical considerations for the management of anticoagulation in them with a focus on heparins. PMID:25878775

  9. Palliative care for patients with advance chronic kidney disease.

    PubMed

    Douglas, C A

    2014-01-01

    Over the past three decades there has been a dramatic rise in the number of patients with advanced chronic kidney disease. The fastest expanding group receiving dialysis has been the elderly. However, for those patients who are very elderly with co-morbidity, dialysis may not offer a survival advantage. Therefore, active conservative management is a growing service offered by many renal units in the UK and focuses on non-dialytic correction of fluid and electrolyes, management of renal anaemia, and assessment and management of symptoms. The five-year survival of a patient over 75 years of age starting dialysis is 20% and if a patient is over 75 years, has co-morbidity, or a poor performance status, dialysis may not offer any survival advantage. Whether a patient is managed by dialysis or by conservative management the symptom burden suffered is high. These symptoms are under-recognised and often managed poorly because of increased drug toxicity in renal failure. This complex group of patients require close working between renal, palliative care, medicine for the elderly, and community teams, to allow best quality of life and end of life care. This review describes some of the challenges in providing Advanced Care Planning for dialysis and conservatively managed patients, highlights the symptom burden of patients with advanced chronic kidney disease, and offers guidance in how to manage the symptoms effectively.

  10. Hyperhidrosis and sympathetic skin response in chronic alcoholic patients.

    PubMed

    Tugnoli, V; Eleopra, R; De Grandis, D

    1999-02-01

    Palmoplantar hyperhidrosis is frequently observed in patients with a clinical history of chronic abnormal alcoholic intake. It can be related to peripheral or central mechanisms such as abnormal spontaneous activity in peripheral damaged fibres; receptor hypersensitivity; compensatory incremented activity in segmentary anhidrosis; or impairment of central sweat control. With the aim of quantifying this phenomenon and of identifying its possible origin, sympathetic skin response (SSR) analysis was performed in 20 chronic alcoholic patients with clinical diffuse acral hyperhidrosis, compared with 30 normal subjects and 2 patients affected by primary palmoplantar hyperhidrosis (PPH). SSRs were recorded by disc electrodes place on the hands and feet, simultaneously. At the hand level two recording sites were selected: palm-dorsum proximally and ventral-dorsal tip of the third finger distally. Attention was paid to the number of SSR after a single endogenous or exogenous stimulus. The alcoholic patients were divided into two groups, with and without mild polyneuropathy. Both patient groups showed synchronous SSR at recording sites, with the same pattern and the normal delay between upper and lower arms. In the control group one response was generally related to a single stimulus; if more responses were elicited an evident adaptation was shown; in the two groups of patients an increase of the waves was observed in all the recording sites without any adaptation. The SSR profile described in alcoholic patients was observed also in PPH. The pattern of SSR waves in alcoholic patients seems to suggest a possible central origin of this type of hyperhidrosis. PMID:10212744

  11. Skin autofluorescence predicts cardiovascular mortality in patients on chronic hemodialysis.

    PubMed

    Kimura, Hiroshi; Tanaka, Kenichi; Kanno, Makoto; Watanabe, Kimio; Hayashi, Yoshimitsu; Asahi, Koichi; Suzuki, Hodaka; Sato, Keiji; Sakaue, Michiaki; Terawaki, Hiroyuki; Nakayama, Masaaki; Miyata, Toshio; Watanabe, Tsuyoshi

    2014-10-01

    Tissue accumulation of advanced glycation end products (AGE) is thought to contribute to the progression of cardiovascular disease (CVD). Skin autofluorescence, a non-invasive measure of AGE accumulation using autofluorescence of the skin under ultraviolet light, has been reported to be an independent predictor of mortality associated with CVD in Caucasian patients on chronic hemodialysis. The aim of this study was to assess the predictive value of skin autofluorescence on all-cause and cardiovascular mortality in non-Caucasian (Japanese) patients on chronic hemodialysis. Baseline skin autofluorescence was measured with an autofluorescence reader in 128 non-Caucasian (Japanese) patients on chronic hemodialysis. All-cause and cardiovascular mortality was monitored prospectively during a period of 6 years. During the follow-up period, 42 of the 128 patients died; 19 of those patients died of CVD. Skin autofluorescence did not have a significant effect on all-cause mortality. However, age, carotid artery intima-media thickness (IMT), serum albumin, high-sensitivity C-reactive protein (hsCRP), skin autofluorescence and pre-existing CVD were significantly correlated with cardiovascular mortality. Multivariate Cox regression analysis showed skin autofluorescence (adjusted hazard ratio [HR] 3.97; 95% confidence interval [CI]1.67-9.43), serum albumin (adjusted HR 0.05; 95% CI 0.01-0.32), and hsCRP (adjusted HR 1.55; 95% CI 1.18-2.05) to be independent predictors of cardiovascular mortality. The present study suggests that skin autofluorescence is an independent predictor of cardiovascular mortality in non-Caucasian (Japanese) patients on chronic hemodialysis.

  12. Skin autofluorescence predicts cardiovascular mortality in patients on chronic hemodialysis.

    PubMed

    Kimura, Hiroshi; Tanaka, Kenichi; Kanno, Makoto; Watanabe, Kimio; Hayashi, Yoshimitsu; Asahi, Koichi; Suzuki, Hodaka; Sato, Keiji; Sakaue, Michiaki; Terawaki, Hiroyuki; Nakayama, Masaaki; Miyata, Toshio; Watanabe, Tsuyoshi

    2014-10-01

    Tissue accumulation of advanced glycation end products (AGE) is thought to contribute to the progression of cardiovascular disease (CVD). Skin autofluorescence, a non-invasive measure of AGE accumulation using autofluorescence of the skin under ultraviolet light, has been reported to be an independent predictor of mortality associated with CVD in Caucasian patients on chronic hemodialysis. The aim of this study was to assess the predictive value of skin autofluorescence on all-cause and cardiovascular mortality in non-Caucasian (Japanese) patients on chronic hemodialysis. Baseline skin autofluorescence was measured with an autofluorescence reader in 128 non-Caucasian (Japanese) patients on chronic hemodialysis. All-cause and cardiovascular mortality was monitored prospectively during a period of 6 years. During the follow-up period, 42 of the 128 patients died; 19 of those patients died of CVD. Skin autofluorescence did not have a significant effect on all-cause mortality. However, age, carotid artery intima-media thickness (IMT), serum albumin, high-sensitivity C-reactive protein (hsCRP), skin autofluorescence and pre-existing CVD were significantly correlated with cardiovascular mortality. Multivariate Cox regression analysis showed skin autofluorescence (adjusted hazard ratio [HR] 3.97; 95% confidence interval [CI]1.67-9.43), serum albumin (adjusted HR 0.05; 95% CI 0.01-0.32), and hsCRP (adjusted HR 1.55; 95% CI 1.18-2.05) to be independent predictors of cardiovascular mortality. The present study suggests that skin autofluorescence is an independent predictor of cardiovascular mortality in non-Caucasian (Japanese) patients on chronic hemodialysis. PMID:24456287

  13. [Therapeutic patient education in chronic hand dermatitis].

    PubMed

    Gelot, P; Avenel-Audran, M; Balica, S; Bensefa, L; Crépy, M-N; Debons, M; Ammari, H; Milpied, B; Raison, N; Vigan, M; Weibel, N; Stalder, J-F; Bernier, C

    2014-06-01

    Hand dermatitis (HD) is usually due to a combination of various interacting factors. It involves significant impairment of the quality of life with psychological and socioeconomic impact. A therapeutic education program in HD.was elaborated by 19 health professionals (dermatologists, occupational clinical physicians, nurses, psychologists, environmental medical advisor) with experience in therapeutic education or skills in HD, according to the recommendations of Haute Autorité de Santé. The program includes an individual medical consultation to perform educational diagnostic, two collective workshops and a medical evaluation consult. Two group workshops "the disease, irritant factors and its treatments" and "the experiences and feelings" were elaborated with learning objectives and educative tools. Different scores were proposed to evaluate the program and acquired skills. Therapeutic education is an efficient way to help patients to adopt skin protection measures essential to healing. We propose a guideline of therapeutic education in HD including skills and educative tools and intended for health professionals to serve as working basis.

  14. Nutritional Risk Screening in patients with chronic kidney disease.

    PubMed

    Tan, Rongshao; Long, Jianting; Fang, Shi; Mai, Haiyan; Lu, Wei; Liu, Yan; Wei, Jianrui; Yan, Feng

    2016-01-01

    Knowledge concerning nutritional status of patients with chronic kidney disease (CKD) is limited. Nutritional Risk Screening-2002 (NRS-2002) has been used to evaluate the nutritional aspects of patients according to the recommendation of European Society for Clinical Nutrition and Metabolism. Here we aim to assess the prevalence and characteristics of nutritional risk in CKD patients by using NRS-2002. NRS-2002 scores of 292 CDK patients were recorded in first 24 hours subsequent to their admission to hospital. All patients have never been on dialysis. BMI, weight and various biochemical parameters were also characterized for these patients. Possible correlations between these parameters and NRS-2002 score were investigated. The overall prevalence of nutritional risk was 44.9% (53.6% in CKD stage 4-5 patients and 38.3% in stage 1-3 patients). Statistically significant differences were found in serum Albumin, Haemoglobin B, and lymphocyte counts between patients with or without increased nutritional risk. Under the situation that attending physicians were completely unaware of NRS-2002 scores, only 35.1% of the patients at risk received nutritional support. The nutritional risk status was associated with CKD stages but independent from primary diagnosis type. More attention should be paid to the nutritional status in CKD patients (including early stage patients). We recommended using NRS-2002 for nutritional risk assessment among non-dialysis CKD patients in routine clinical practice. PMID:27222407

  15. Behaviour of urinary dipeptidase in patients with chronic renal failure.

    PubMed

    Fukumura, Y; Kera, Y; Oshitani, S; Ushijima, Y; Kobayashi, I; Liu, Z; Watanabe, T; Yamada, R; Kikuchi, H; Kawazu, S; Yabuuchi, M

    1999-03-01

    Renal dipeptidase (EC 3.4.13.19) activity in serum and urine from healthy volunteers (n = 20), patients with diabetes (n = 18) and patients with chronic renal failure (n = 5) was measured using glycyl-D-alanine as substrate. The assay was highly specific for the enzyme and was not affected by the various aminopeptidases present in serum and urine. No difference in serum renal dipeptidase activity was observed between the groups. The enzyme activity (U/L) in urine was higher than that in serum, irrespective of the group, suggesting the urine concentration was not affected by the serum concentration. The mean renal dipeptidase activities in urine were 2.56, 2.46 and 0.78 U/mol creatinine for healthy subjects, patients with diabetes and patients with chronic renal failure, respectively. The renal dipeptidase activity was significantly lower in the chronic renal failure group. The urinary excretion of dipeptidase (U/mmol creatinine) showed significant inverse correlations with that of beta 2-microglobulin, albumin and alpha 1-microglobulin, and with serum concentrations of creatinine, beta 2-microglobulin and alpha 1-microglobulin. We suggest that urine dipeptidase may be a useful marker of renal diseases.

  16. Disrupted Brain Functional Network Architecture in Chronic Tinnitus Patients

    PubMed Central

    Chen, Yu-Chen; Feng, Yuan; Xu, Jin-Jing; Mao, Cun-Nan; Xia, Wenqing; Ren, Jun; Yin, Xindao

    2016-01-01

    Purpose: Resting-state functional magnetic resonance imaging (fMRI) studies have demonstrated the disruptions of multiple brain networks in tinnitus patients. Nonetheless, several studies found no differences in network processing between tinnitus patients and healthy controls (HCs). Its neural bases are poorly understood. To identify aberrant brain network architecture involved in chronic tinnitus, we compared the resting-state fMRI (rs-fMRI) patterns of tinnitus patients and HCs. Materials and Methods: Chronic tinnitus patients (n = 24) with normal hearing thresholds and age-, sex-, education- and hearing threshold-matched HCs (n = 22) participated in the current study and underwent the rs-fMRI scanning. We used degree centrality (DC) to investigate functional connectivity (FC) strength of the whole-brain network and Granger causality to analyze effective connectivity in order to explore directional aspects involved in tinnitus. Results: Compared to HCs, we found significantly increased network centrality in bilateral superior frontal gyrus (SFG). Unidirectionally, the left SFG revealed increased effective connectivity to the left middle orbitofrontal cortex (OFC), left posterior lobe of cerebellum (PLC), left postcentral gyrus, and right middle occipital gyrus (MOG) while the right SFG exhibited enhanced effective connectivity to the right supplementary motor area (SMA). In addition, the effective connectivity from the bilateral SFG to the OFC and SMA showed positive correlations with tinnitus distress. Conclusions: Rs-fMRI provides a new and novel method for identifying aberrant brain network architecture. Chronic tinnitus patients have disrupted FC strength and causal connectivity mostly in non-auditory regions, especially the prefrontal cortex (PFC). The current findings will provide a new perspective for understanding the neuropathophysiological mechanisms in chronic tinnitus. PMID:27458377

  17. ISCHEMIA in chronic kidney disease: improving the representation of patients with chronic kidney disease in cardiovascular trials.

    PubMed

    Wyatt, Christina M; Shineski, Matthew; Chertow, Glenn M; Bangalore, Sripal

    2016-06-01

    Despite the high cardiovascular risk associated with chronic kidney disease, a recent systematic review confirmed that patients with kidney disease remain underrepresented in cardiovascular trials. Two ongoing trials are assessing the risk:benefit of aggressive evaluation and intervention for ischemic heart disease in patients with advanced chronic kidney disease.

  18. Chronic cholecystitis with Cystoisospora belli in an immunocompetent patient.

    PubMed

    Takahashi, Hideo; Falk, Gavin A; Cruise, Michael; Morris-Stiff, Gareth

    2015-01-01

    A 47-year-old woman presented with a history of vague abdominal pain for several years, which worsened over the past 2 months, with pain more prominent in the right upper quadrant. She also had a history of peptic ulcer disease. The ultrasound scan of right upper quadrant revealed normal gallbladder and oesophagogastroduodenoscopy was unremarkable. A (99m)technetium labelled hepato iminodiacetic acid (HIDA) scan with cholecystokinin provocation demonstrated a decreased gallbladder ejection fraction (EF) of 32%. On this basis, the patient was diagnosed with biliary dyskinesia and underwent an elective laparoscopic cholecystectomy. Histopathological analysis revealed chronic cholecystitis with Cystoisospora belli identified in the gallbladder wall. Cystoisospora has been identified to cause an opportunistic acalculous cholecystitis among immunocompromised hosts, especially those with AIDS. This is the first case report of chronic cholecystitis due to C. belli in an immunocompetent patient. PMID:26065551

  19. Chronic macrocheilia: a clinico-pathological study of 28 patients.

    PubMed

    Handa, S; Saraswat, A; Radotra, B D; Kumar, B

    2003-05-01

    Chronic macrocheilia has a multifactorial aetiology and is often a diagnostic and therapeutic challenge. Epidemiological information on this condition is scarce, most of the data reported relating only to granulomatous cheilitis. We have performed a detailed clinico-pathological analysis of all patients with chronic macrocheilia presenting to us during the last 6.5 years. Of the 28 patients identified, 13 (46.4%) had granulomatous cheilitis (GC), six (21.4%) had tuberculosis of the lip, three (10.7%) had leprous macrocheilia, two (7.1%) had multiple endocrine neoplasia type IIb, and one each had Ascher's syndrome and non-Hodgkin's lymphoma. Two patients were diagnosed as 'nonspecific cheilitis'. Histopathological differentiation between tuberculosis and GC was often not possible; but PCR for Mycobacterium tuberculosis was positive in all patients with tuberculosis and negative in four patients with GC in whom M. tuberculosis was sought. In spite of detailed clinical examination and investigations, a therapeutic trial was required to confirm the diagnosis in five (17.9%) patients. We have reviewed the available literature on this subject, and to our knowledge this study is the first of its kind. More such studies from other centres will help physicians to make an accurate aetiological diagnosis and treat this uncommon but disfiguring condition with confidence.

  20. Giant Pyogenic Granuloma in a Patient with Chronic Lymphocytic Leukemia

    PubMed Central

    Plovanich, Molly; Tsibris, Hillary C.; Lian, Christine G.; Mostaghimi, Arash

    2014-01-01

    Pyogenic granuloma, also known as lobular capillary hemangioma, is a common benign vascular proliferative lesion that can present at any age on the skin or mucous membranes. Most lesions do not exceed 2 cm, but there are a handful of giant cutaneous pyogenic granulomas that have been reported, often in individuals with underlying immune dysfunction. Here, we report the first giant pyogenic granuloma in a patient with a hematological malignancy, chronic lymphocytic leukemia. PMID:25408651

  1. Evidence for severe atherosclerotic changes in chronic hemodialysis patients: comparative autopsy study against cardiovascular disease patients without chronic kidney disease.

    PubMed

    Suzuki, Chigure; Nakamura, Satoko; Ishibashi-Ueda, Hatsue; Yoshihara, Fumiki; Kawano, Yuhei

    2011-02-01

    Atherosclerosis is a major cause of mortality and morbidity among hemodialysis patients, but whether it is more severe in hemodialysis patients than in cardiovascular disease patients without chronic kidney disease is unclear. We examined 46 autopsy patients who had undergone hemodialysis, and age and sex-matched 46 patients with cardiovascular disease and an eGFR of >60 mL/min/1.73 m(2). There was no difference in the prevalence of diabetes or hypertension between the groups. We divided the aorta into four segments: A, ascending artery to arch; B, descending artery to diaphragm; C, suprarenal; and D, infrarenal. We used the classification of the American Heart Association to evaluate atherosclerosis progression. Distribution was scored by the extent to which each segment was damaged: 0, none; 1, less than 1/3; 2, more than 1/3 to less than 2/3; 3, more than 2/3. Histological examination revealed that the progression score (P < 0.05) and distribution score (P<0.005) were more severe in the hemodialysis group, especially in segment A. Regression analysis showed that atherosclerosis of segment A was related to age, gender, dyslipidemia, smoking, hemodialysis therapy, and hemodialysis duration. In hemodialysis patients, atherosclerotic changes in the aorta were more severe than in cardiovascular disease patients with an eGFR of >60 mL/min/1.73 m(2). Aortic atherosclerosis was aggravated by traditional and chronic kidney disease-related risk factors.

  2. Occurrence of periodontal pathogens among patients with chronic periodontitis

    PubMed Central

    Farias, B.C.; Souza, P.R.E.; Ferreira, B.; Melo, R.S.A.; Machado, F.B.; Gusmão, E.S.; Cimões, R.

    2012-01-01

    The aim of the present study was to evaluate the presence of the periodontal pathogens that form the red complex (Tannerella forsythia, Porphyromonas gingivalis and Treponema denticola) and Aggregatibacter actinomycetemcomitans in patients with chronic periodontitis. The sample consisted of 29 patients with a clinical and radiographic diagnosis of chronic periodontitis based on the criteria of the American Academy of Periodontology (3). Samples for microbiological analysis were collected from the four sites of greatest probing depth in each patient, totaling 116 samples. These samples were processed using conventional polymerase chain reaction, which achieved the following positive results: 46.6% for P. gingivalis, 41.4% for T. forsythia, 33.6% for T. denticola and 27.6% for A. actinomycetemcomitans. P. gingivalis and T. forsythia were more prevalent (p < 0.05) in periodontal pockets ≥ 8 mm. The combinations T. forsythia + P. gingivalis (23.2%) and T. forsythia + P. gingivalis + T. denticola (20.0%) were more frequent in sites with a probing depth ≥ 8 mm. Associations with the simultaneous presence of A. actinomycetemcomitans + P. gingivalis, A. actinomycetemcomitans + T. forsythia, P. gingivalis + T. forsythia and T. forsythia + T. denticola were statistically significant (p < 0.05). It was concluded that the red complex pathogens are related to chronic periodontitis, presenting a higher occurrence in deep periodontal pockets. Moreover, the simultaneous presence of these bacteria in deep sites suggests a symbiotic relationship between these virulent species, favoring, in this way, a further progression of periodontal disease. PMID:24031906

  3. Subclinical microbial infection in patients with chronic plaque psoriasis.

    PubMed

    Bartenjev, I; Rogl Butina, M; Potocnik, M

    2000-01-01

    Epidemiological evidence implicates bacterial infection as a common triggering stimulus for psoriasis. Recent studies suggest that continuing, subclinical streptococcal and staphylococcal infections might be responsible not only for relapse of acute guttate psoriasis but also for a new episode of chronic plaque psoriasis. In this study 195 patients suffering from a severe form of chronic plaque psoriasis hospitalized between 1996 and 1998 were examined. The presence of subclinical microbial infection of the upper respiratory tract was studied by the cultivation of pathogens from this area. Patients with other provoking factors, such as a positive history of taking any drugs that may exacerbate psoriasis, endocrine and metabolic factors, alcohol abuse, trauma, dental focus and clinically evident bacterial infection, were excluded. Subclinical streptococcal and/or staphylococcal infections were detected in 68% of tested patients and in only 11% of the control group. The results of this study indicate that subclinical bacterial infections of the upper respiratory tract may be an important factor in provoking a new relapse of chronic plaque psoriasis. Searching for, and eliminating, microbial infections could be of importance in the treatment of psoriasis.

  4. Tipifarnib in Treating Patients With Chronic Myeloid Leukemia, Chronic Myelomonocytic Leukemia, or Undifferentiated Myeloproliferative Disorders

    ClinicalTrials.gov

    2016-07-20

    Accelerated Phase of Disease; Atypical Chronic Myeloid Leukemia, BCR-ABL1 Negative; Chronic Myelogenous Leukemia, BCR-ABL1 Positive; Chronic Myelomonocytic Leukemia; Chronic Phase of Disease; Myelodysplastic/Myeloproliferative Neoplasm, Unclassifiable; Recurrent Disease

  5. Epidemiology of acute infections among patients with chronic kidney disease.

    PubMed

    Dalrymple, Lorien S; Go, Alan S

    2008-09-01

    The objectives of this review were (1) to review recent literature on the rates, risk factors, and outcomes of infections in patients who had chronic kidney disease (CKD) and did or did not require renal replacement therapy; (2) to review literature on the efficacy and use of selected vaccines for patients with CKD; and (3) to outline a research framework for examining key issues regarding infections in patients with CKD. Infection-related hospitalizations contribute substantially to excess morbidity and mortality in patients with ESRD, and infection is the second leading cause of death in this population. Patients who have CKD and do not require renal replacement therapy seem to be at higher risk for infection compared with patients without CKD; however, data about patients who have CKD and do not require dialysis therapy are very limited. Numerous factors potentially predispose patients with CKD to infection: advanced age, presence of coexisting illnesses, vaccine hyporesponsiveness, immunosuppressive therapy, uremia, dialysis access, and the dialysis procedure. Targeted vaccination seems to have variable efficacy in the setting of CKD and is generally underused in this population. In conclusion, infection is a primary issue when caring for patients who receive maintenance dialysis. Very limited data exist about the rates, risk factors, and outcomes of infection in patients who have CKD and do not require dialysis. Future research is needed to delineate accurately the epidemiology of infections in these populations and to develop effective preventive strategies across the spectrum of CKD severity. PMID:18650409

  6. Anaesthesia for patient with chronic obstructive pulmonary disease

    PubMed Central

    Duggappa, Devika Rani; Rao, G Venkateswara; Kannan, Sudheesh

    2015-01-01

    The chronic obstructive pulmonary disease has become a disease of public health importance. Among the various risk factors, smoking remains the main culprit. In addition to airway obstruction, the presence of intrinsic positive end expiratory pressure, respiratory muscle dysfunction contributes to the symptoms of the patient. Perioperative management of these patients includes identification of modifiable risk factors and their optimisation. Use of regional anaesthesia alone or in combination with general anaesthesia improves pulmonary functions and reduces the incidence of post-operative pulmonary complications. PMID:26556916

  7. Skin cancer in patients with chronic radiation dermatitis

    SciTech Connect

    Davis, M.M.; Hanke, C.W.; Zollinger, T.W.; Montebello, J.F.; Hornback, N.B.; Norins, A.L.

    1989-04-01

    The cases of 76 patients with chronic radiation dermatitis resulting from low-dose ionizing radiation for benign disease were reviewed retrospectively for risk factors leading to the development of neoplasia. The patients were studied with respect to original hair color, eye color, sun reactive skin type, benign disease treated, area treated, age at treatment, and age at development of first skin cancer. Analysis of data showed 37% of patients had sun-reactive skin type I, 27% had type II, and 36% had type III. Types IV through VI were not represented. There appeared to be an overrepresentation of types I and II. Increased melanin pigmentation may therefore be either directly or indirectly protective against the development of skin cancers in patients who have received low-dose superficial ionizing radiation for benign disease. The sun-reactive skin type of patients with chronic radiation dermatitis may be used as a predictor of skin cancer risk when the total dose of ionizing radiation is not known.

  8. Enteral nutrition in the chronic obstructive pulmonary disease (COPD) patient.

    PubMed

    DeBellis, Heather F; Fetterman, James W

    2012-12-01

    Chronic obstructive pulmonary disease (COPD) is a progressive, chronic disease, in which malnutrition can have an undesirable effect. Therefore, the patient's nutritional status is critical for optimizing outcomes in COPD. The initial nutrition assessment is focused on identifying calorically compromised COPD patients in order to provide them with appropriate nutrition. Nutritional intervention consists of oral supplementation and enteral nutrition to prevent weight loss and muscle mass depletion. Evaluation of nutritional status should include past medical history (medications, lung function, and exercise tolerance) and dietary history (patient's dietary habits, food choices, meal patterns, food allergy information, and malabsorption issues), in addition to physiological stress, visceral proteins, weight, fat-free mass, and body mass index. The current medical literature conflicts regarding the appropriate type of formulation to select for nutritional intervention, especially regarding the amount of calories from fat to provide COPD patients. This review article focuses on the enteral product formulations currently available, and how they are most appropriately utilized in patients with COPD.

  9. [Concept analysis of medication adherence in patients with chronic disease].

    PubMed

    Huang, Jen-Ying; Chen, Hsing-Mei

    2014-06-01

    Pharmacotherapy plays an important role in the management of chronic diseases. However, many patients with chronic disease do not adhere to their medication regimen. This results in worsening symptoms and frequent re-hospitalizations. As a result, healthcare providers may view these patients as bad. Medication adherence is a complex concept. Analyzing this concept may assist nurses to improve patient-centered care. This paper uses Walker & Avant's method to conduct a concept analysis of medication adherence. Results show the defining attributes of medication adherence as: (1) knowing and agreeing to the medication; (2) communicating and negotiating the regimen; and (3) active, continuous involvement in and appraisal of the treatment effect. Identified antecedents of medication adherence included the patient having: (1) a prescribed medication regimen; (2) cognitive and action abilities in her / his role as a patient; and (3) level of preparation for medication treatment. Identified consequences of medication adherence include: (1) improving symptom control; (2) decreasing re-hospitalizations and mortality; (3) reducing medical care costs; (4) restoring self-esteem; and (5) diminishing depression. It is hoped that this concept analysis provides a reference for nurses to achieve a better understanding of medication adherence and further improve nursing practice. PMID:24899565

  10. Quinapril therapy in patients with chronic mitral regurgitation.

    PubMed

    Schön, H R; Schröter, G; Barthel, P; Schömig, A

    1994-05-01

    Pre- and afterload reduction is known to have beneficial effects in patients with chronic mitral regurgitation. To date, no controlled study has been reported analyzing the long term influence of angiotensin-converting enzyme inhibitor treatment on patients with chronic mitral regurgitation. Therefore the aim of this study was to assess the effects of one year angiotensin-converting enzyme inhibition with quinapril on myocardial performance in patients with chronic mitral regurgitation. Twelve patients with moderate to severe isolated chronic mitral regurgitation and no coronary disease on coronary angiography were studied under control conditions and followed up until one year of quinapril therapy (10-20mg/day) using echocardiography and simultaneous right heart catheterization, and radionuclide ventriculography at rest and exercise. As the result of a significant pre- and afterload reduction after one year quinapril treatment regurgitant fraction fell from 0.43 +/- 0.10 at control before therapy to 0.25 +/- 0.08 (p = 0.0001), left ventricular end-diastolic volume was reduced from 146 +/- 26 to 109 +/- 24 ml/m2 (p = 0.0001) and end-systolic volume decreased from 63 +/- 43 to 47 +/- 29 ml/m2 (p = 0.02). Left ventricular ejection fraction at control averaged 0.59 +/- 0.20 at rest, increased to 0.65 +/- 0.21 with maximum exercise and was unchanged after one year quinapril therapy. After one year treatment left ventricular mass was reduced by 15% (p = 0.0004) and septal wall thickness decreased from 11.8 +/- 0.7 to 10.8 +/- 0.8 mm (p = 0.0006). Moreover, there was significant functional improvement of nearly one NYHA class after one year quinapril therapy. In conclusion, in patients with chronic mitral regurgitation long term angiotensin-converting enzyme inhibition with quinapril reduces regurgitation and decreases left ventricular size and mass thereby demonstrating functional improvement. In addition, these data suggest that angiotensin-converting enzyme inhibition

  11. Celiac territory ischemic syndrome in a patient on chronic hemodialysis.

    PubMed

    Ori, Y; Korzets, A; Neyman, H; Herman, M; Baytner, S; Gafter, U; Atar, E

    2007-10-01

    Mesenteric ischemia among chronic dialysis patients is usually of the nonocclusive type. Chronic occlusive mesenteric ischemia has been reported rarely in the dialysis population. The subset of"celiac-territory ischemic syndrome" has not been described in dialysis. The current report involves a 66-year-old female on chronic dialysis for 11 years. She experienced abdominal pain following sessions of hemodialysis, that later became more pronounced after eating. Abdominal angiography showed heavily calcified aorta, celiac trunk and superior mesenteric artery (SMA), with a 50% narrowing of the celiac and superior mesenteric arteries. During the following 9 months the symptoms worsened and weight loss set in. She was admitted with an episode of upper abdominal pain. Acalculous cholecystitis was found, along with multiple gastric and duodenal erosions including the second part, with an antral ulcer and multiple duodenal bulb ulcers. Repeated abdominal angiography showed progression of the stenotic lesions with significant narrowing of both the celiac trunk and the SMA. A stent was placed in the SMA. Following the procedure, the patient noted marked symptomatic improvement. On follow-up gastroduodenoscopy, all ischemic ulcers had healed completely. Serum albumin rose from a nadir of 31 to 40 g/l, and an extremely elevated c-reactive protein of 205,000 microg/l returned to normal (8,000 microg/l). The diagnosis of chronic occlusive mesenteric ischemia should be suspected among dialysis patients with post-prandial pain and weight loss in the face of calcified vessels. Predominant celiac territory ischemic syndrome presents as gastric and duodenal erosions and ulcers with or without acalculous cholecystitis. PMID:17969495

  12. Pulmonary Hypertension in Patients with Chronic Fibrosing Idiopathic Interstitial Pneumonias

    PubMed Central

    Hoeper, Marius M.; Behr, Juergen; Held, Matthias; Grunig, Ekkehard; Vizza, C. Dario; Vonk-Noordegraaf, Anton; Lange, Tobias J.; Claussen, Martin; Grohé, Christian; Klose, Hans; Olsson, Karen M.; Zelniker, Thomas; Neurohr, Claus; Distler, Oliver; Wirtz, Hubert; Opitz, Christian; Huscher, Doerte; Pittrow, David; Gibbs, J. Simon R.

    2015-01-01

    Background Pulmonary hypertension (PH) is a common finding in patients with chronic fibrosing idiopathic interstitial pneumonias (IIP). Little is known about the response to pulmonary vasodilator therapy in this patient population. COMPERA is an international registry that prospectively captures data from patients with various forms of PH receiving pulmonary vasodilator therapies. Methods We retrieved data from COMPERA to compare patient characteristics, treatment patterns, response to therapy and survival in newly diagnosed patients with idiopathic pulmonary arterial hypertension (IPAH) and PH associated with IIP (PH-IIP). Results Compared to patients with IPAH (n = 798), patients with PH-IIP (n = 151) were older and predominantly males. Patients with PH-IIP were treated predominantly with phosphodiesterase-5 inhibitors (88% at entry, 87% after 1 year). From baseline to the first follow-up visit, the median improvement in 6MWD was 30 m in patients with IPAH and 24.5 m in patients with PH-IIP (p = 0.457 for the difference between both groups). Improvements in NYHA functional class were observed in 22.4% and 29.5% of these patients, respectively (p = 0.179 for the difference between both groups). Survival rates were significantly worse in PH-IIP than in IPAH (3-year survival 34.0 versus 68.6%; p<0.001). Total lung capacity, NYHA class IV, and mixed-venous oxygen saturation were independent predictors of survival in patients with PH-IIP. Conclusions Patients with PH-IIP have a dismal prognosis. Our results suggest that pulmonary vasodilator therapy may be associated with short-term functional improvement in some of these patients but it is unclear whether this treatment affects survival. Trial Registration clinicaltrials.gov NCT01347216 PMID:26630396

  13. Platelet and other hemostatic characteristics in patients with chronic urticaria.

    PubMed

    Isiksacan, Nilgun; Koser, Murat; Cemsitoglu, Ferhan; Kucuksezer, Umut C; Gurdol, Figen

    2015-04-01

    Several publications have pointed out the importance of coagulation and fibrinolysis in the occurrence of chronic urticaria (CU), but only a few indicated the direct role of platelets. We assessed platelet aggregation and evaluated parameters of coagulation and fibrinolysis in patients with CU. Patients (n = 34) diagnosed as having CU and 36 healthy controls were enrolled. Platelet aggregation was assayed using an impedance aggregometer and adenosine diphosphate, arachidonic acid, thrombin receptor-activating peptide (TRAP), and ristocetin as agonists. In patients with CU, significantly decreased platelet aggregation to some agonists (ristocetin and TRAP) was observed. The D-dimer levels were elevated, mean platelet volume was decreased, but no alteration was observed in other coagulation assays. Elevated D-dimer levels indicated that coagulation and fibrinolysis are activated in the patients with CU. Evaluation of platelet function may contribute to identify the role of these cells in the pathogenesis of CU.

  14. Medication misuse, abuse and dependence in chronic pain patients.

    PubMed

    Kouyanou, K; Pither, C E; Wessely, S

    1997-11-01

    We report the prevalence of drug use, misuse, abuse, and dependence in 125 chronic pain patients attending specialist pain clinics in South London. A total of 110 patients (88%) were taking medications for their pain problem. Opioid analgesics (69.6%), nonopioids (48%), antidepressants (25%), and benzodiazepines (17.6%) were the drugs most frequently used. Psychoactive substance abuse or dependence (DSM-III-R) was diagnosed in 12%. A total of 9.6% of the patients met the DSM-III-R criteria for substance abuse or dependence in remission. Data are also presented on the misuse and abuse of nonpsychoactive drugs, qualitative information on how patients use drugs, and the information they have received about medication.

  15. Evaluation of thyroid hormone levels in chronic kidney disease patients.

    PubMed

    Rajeev, Gandham; Chickballapur Rayappa, Wilma Delphine Silvia; Vijayalakshmi, Ravella; Swathi, Manchala; Kumar, Sunil

    2015-01-01

    We attempted in this study to determine the thyroid hormone levels in 45 adult chronic kidney disease (CKD) patients and 45 ageand sex-matched healthy subjects as controls. The serum thyroid hormone levels were measured by a radioimmunoassay. Serum concentrations of creatinine, urea, electrolytes and total proteins and albumin were measured as well. There was a significant decrease in the levels of serum total T3, total T4 and total protein and albumin levels in CKD patients when compared with the controls. There was a significant increase in the level of thyroid stimulating hormone in the CKD patients compared with the controls. Our study suggests that CKD leads to significant changes in the thyroid hormone levels, which need to be interpreted carefully in these patients.

  16. Dysregulation of male sex hormones in chronic hepatitis C patients.

    PubMed

    El-Serafi, A T; Osama, S; El-Zalat, H; EL-Deen, I M

    2016-02-01

    Chronic hepatitis C (HCV) infection is a serious problem all over the world and has a special importance in Egypt, where the prevalence of infection is 14.7% of population. In males, HCV is associated with sexual dysfunction and changes in the semen parameters. This study aimed at estimation of a panel of the most important related hormones in the serum of patients and illustration of their correlation to the routine laboratory investigations. The four studied hormones showed alteration in the patients in comparison with the controls. While androstenedione, prolactin and testosterone were significantly increased in patients, dehydroepiandrosterone sulphate was decreased. These changes in the hormones were not related to the liver functions, pathological grade or even viral load. We hypothesised a model of how HCV can induce these hormonal changes and recommended to add these hormones to the follow-up panel of male patients with HCV.

  17. Prevalence of psychiatric comorbidities in chronic obstructive pulmonary disease patients

    PubMed Central

    Chaudhary, Shyam Chand; Nanda, Satyan; Tripathi, Adarsh; Sawlani, Kamal Kumar; Gupta, Kamlesh Kumar; Himanshu, D; Verma, Ajay Kumar

    2016-01-01

    Introduction: Psychiatric disorders, especially anxiety and depression have been reported to have an increased prevalence in chronic obstructive pulmonary disease (COPD) patients, but there is a paucity of data from India. Aims and Objectives: Aim of our study is to study the frequency of psychiatric comorbidities in COPD patients and their correlation with severity of COPD, as per global initiative for obstructive lung disease guidelines. Materials and Methods: This study was conducted in outpatient department of a tertiary care hospital (King George's Medical University). A total of 74 COPD patients were included in this study and compared with 74 controls. The diagnosis and severity of COPD were assessed by spirometry. Psychiatric comorbidities were assessed using the Mini International Neuropsychiatric Interview questionnaire. Results: The frequency of psychiatric comorbidities was significantly higher (P < 0.05) in COPD patients (28.4%) as compared to controls (2.7%). As regards to severity, the frequency was significantly increased in severe and very severe COPD. The frequency of psychiatric comorbidities in COPD patients increased significantly with the increase in duration of symptoms being present in 67% of patients with duration of symptoms more than 10 years and only 23% of patients with duration of symptoms ≤5 years. Conclusion: The frequency of psychiatric comorbidities is increased in COPD patients as compared to controls. We recommend that all patients with COPD should be screened for psychiatric comorbidity, if any. PMID:27051106

  18. [Patient education for children and adolescents with chronic diseases].

    PubMed

    Tubiana-Rufi, Nadia

    2009-12-01

    The education of children with chronic diseases and of their parents is a treatment procedure that must be integrated into the management of the child's disease: it is essential for his or her physical and psychological health and quality of life. This continuous process is part of long-term follow-up and of the child's development; it is not a procedure that can be carried out once and for all. The program must include initial, follow-up, and advanced education. Treatment education for parents occurs simultaneously with the child's medical management and has the same requirements as that of the child (which means that the time spent in this education requires financial support). The role of the pediatrics departments serving these children is essential, and they must work with other participants, whose roles are not identical to they perform in education for adult patients. Pediatric patient education requires an interdisciplinary pediatric team with specific skills and appropriate liaison with those involved in other aspects of the child's life (e.g., daycare and school). The child's psychological development is central to the design and implementation of pediatric patient education programs. Knowledge of child development is critical in providing these services for children and adolescents; training in this field is required in addition to that necessary for adult patient education. Epidemiologic findings of the increased incidence of several chronic diseases in children must be considered in decisions about the resources allocated to coping with them. The particularities and requirements of adolescence and its interactions with chronic disease must also be considered in specific patient education programs for adolescents, and in the training and skills of healthcare professionals.

  19. Prevalence of Actinomyces spp. in patients with chronic periodontitis.

    PubMed

    Vielkind, Paul; Jentsch, Holger; Eschrich, Klaus; Rodloff, Arne C; Stingu, Catalina-Suzana

    2015-10-01

    This study investigated the prevalence of Actinomyces spp. in shallow, deep and very deep pockets of patients with chronic periodontitis compared to healthy controls and correlated the results with clinical status. Twenty patients with chronic periodontitis and 15 healthy subjects were enrolled in this study. Clinical indices were recorded in a six-point measurement per tooth. From each patient samples of supra and subgingival plaque were taken separately from teeth with shallow, deep and very deep pockets. Samples of supragingival plaque and sulcular microflora were collected from the healthy subjects. All the samples were cultivated on different media at 37̊C in an anaerobic atmosphere for 7 days. All the suspect colonies were identified using a rapid ID 32 A system (bioMèrieux) and MALDI-TOF-MS analysis using an Autoflex II Instrument (Bruker Daltonics) together with in house developed identification software and a reference spectra database. A total of 977 strains were identified as Actinomyces. Actinomyces naeslundii/oris/johnsonii (430 isolates) was the most prevalent species and was found in all patients and in almost all of the healthy subjects. Significant differences (p=0.003) between the groups were found for Actinomyces odontolyticus/meyeri and Actinomyces israelii which were associated with periodontitis patients. Actinomyces dentalis was found in higher percentage (p=0.015) in the periodontitis group. Actinomyces gerencseriae and Actinomyces massiliensis were significantly more often found supragingivally than subgingivally (p=0.004, p=0.022, respectively) in the periodontitis group. Whether some Actinomyces species, definitely important plaque formers, are actively involved in the pathogenicity of chronic periodontitis needs further investigation.

  20. Prevalence of Actinomyces spp. in patients with chronic periodontitis.

    PubMed

    Vielkind, Paul; Jentsch, Holger; Eschrich, Klaus; Rodloff, Arne C; Stingu, Catalina-Suzana

    2015-10-01

    This study investigated the prevalence of Actinomyces spp. in shallow, deep and very deep pockets of patients with chronic periodontitis compared to healthy controls and correlated the results with clinical status. Twenty patients with chronic periodontitis and 15 healthy subjects were enrolled in this study. Clinical indices were recorded in a six-point measurement per tooth. From each patient samples of supra and subgingival plaque were taken separately from teeth with shallow, deep and very deep pockets. Samples of supragingival plaque and sulcular microflora were collected from the healthy subjects. All the samples were cultivated on different media at 37̊C in an anaerobic atmosphere for 7 days. All the suspect colonies were identified using a rapid ID 32 A system (bioMèrieux) and MALDI-TOF-MS analysis using an Autoflex II Instrument (Bruker Daltonics) together with in house developed identification software and a reference spectra database. A total of 977 strains were identified as Actinomyces. Actinomyces naeslundii/oris/johnsonii (430 isolates) was the most prevalent species and was found in all patients and in almost all of the healthy subjects. Significant differences (p=0.003) between the groups were found for Actinomyces odontolyticus/meyeri and Actinomyces israelii which were associated with periodontitis patients. Actinomyces dentalis was found in higher percentage (p=0.015) in the periodontitis group. Actinomyces gerencseriae and Actinomyces massiliensis were significantly more often found supragingivally than subgingivally (p=0.004, p=0.022, respectively) in the periodontitis group. Whether some Actinomyces species, definitely important plaque formers, are actively involved in the pathogenicity of chronic periodontitis needs further investigation. PMID:26324012

  1. Mental status in patients with chronic bacterial prostatitis

    PubMed Central

    Banyra, Oleg; Ivanenko, Olha; Nikitin, Oleg

    2013-01-01

    Introduction Chronic prostatitis is a widespread urological disease with a lengthy course and a propensity to frequent recurrences. Adequate response to anti–inflammatory therapy is lacking in a high percentage of patients, which causes them to seek medical advice from different doctors. Thus, the physicians are challenged to look for other reasons causing the pathological symptoms. Material and methods We have reviewed the patients with treatment–resistant chronic bacterial prostatitis (CBP) from the perspective of psychosomatic medicine. For the evaluation of primary mental status and treatment control we used standard approved questionnaires. All 337 CBP patients initially underwent therapy aimed at pathogen eradication. If psychopathological symptoms were evident and dominated over urological ones, the patients were referred to psychiatric evaluation and treatment. Results The frequency of concomitant psychosomatic disorders (PSD) in patients with CBP was 28.2% and neurotic disorders – 26.4%. Adequate multimodal anti–inflammatory therapy followed by a few sessions of psychotherapy decreased the manifestations of PSD in 30.5%, neurotic disorders in 51.7%, and premature ejaculation in 60.5% of patients with CBP. The addition of pharmacotherapy to psychotherapy is effective in treatment–resistant cases. However, after multimodal treatment, 31.5% of pts. with PSD and 13.5% of pts. with neurotic disorders still remain treatment–resistant and required in–depth long–term psychiatric care. Conclusions A significant portion of CBP patients were diagnosed with neurotic, psychosomatic, and/or depressive disorders. Antibacterial and anti–inflammatory therapy, when followed by appropriate psychotherapy and pharmacotherapy, significantly decrease the manifestations of mental disorders in CBP patients. PMID:24579003

  2. A 28-year-old man with headache, visual and aphasic speech disturbances.

    PubMed

    Frank, Stephan; Cordier, Dominik; Tolnay, Markus; Rosenblum, Marc K

    2009-01-01

    A 28-year-old man presented with a short history of headache, visual and aphasic speech disturbances. MR scans revealed a large, partly cystic, contrast-enhancing lesion of the left temporal lobe that upon microscopic examination was diagnosed as pleomorphic xanthoastrocytoma (PXA) with anaplastic features (WHO grade III). Remarkably, this tumor featured an unusual gliovascular, rosette-like histoarchitecture, which had previously been hypothesized to possibly indicate a greater likelihood of PXA recurrence. Indeed, only 14 months later, the patient presented with a recurrent lesion, which contained the previous histology, but now also featured a distinct fibrosarcoma-like component replete with numerous osteoclast-type giant cells. In addition, whereas eosinophilic granular bodies were plentiful at the lesion's periphery, numerous CD34 - positive satellite cells were found in the adjacent non-infiltrated cortex. Regarding the origin of this recurrent tumor and in reflection of its composition of distinct PXA as well as sarcomatous components, the diagnosis of a pleomorphic xanthoastrosarcoma, to be conceptually considered as a gliosarcoma subtype, was made.To our knowledge, this is an unprecedented case of sarcomatous transformation of a PXA. Particular attention should be given to gliovascular pseudopapillary structures in PXAs, the presence of which may potentially herald a more aggressive clinical behavior. PMID:19076784

  3. Halting aphasic interaction: creation of intersubjectivity and spousal relationship in situ.

    PubMed

    Aaltonen, Tarja; Laakso, Minna

    2010-01-01

    This article discusses a communicative phenomenon that is relatively less studied: getting stuck in an aphasic conversation. Although aphasia as a medical and linguistic condition has been widely examined, the more social and participatory aspects of the symptom are not so well-known. Aphasia forms a threat to the emergence of a shared understanding, as well as to the experience of being in the shared, i.e., in the intersubjective, social world. In our analysis, we closely explore how understanding is constructed in the sequential organization of conversation. We use two data corpora when analysing the halting interaction. In our data, we detected two kinds of interactive halts that emerged in connection with aphasic word searching. First, 'real halts' were caused by the aphasic person's inability to find correct words and the co-participants were also not able to resolve the problem. Second, 'exam halts' occurred when the co-participant did not provide the missing words despite knowing what the aphasic speaker was trying to say. We discuss how this halting phenomenon is linked with the notions of intersubjectivity and face-work and conclude that real halts are more directly caused by the aphasic condition, whereas exam halts reflect the spousal relationship in the form of face-work.

  4. Deep vein thrombosis in patients with chronic kidney disease.

    PubMed

    Daneschvar, H Leon; Seddighzadeh, Ali; Piazza, Gregory; Goldhaber, Samuel Z

    2008-06-01

    Deep vein thrombosis (DVT) is a poorly understood complication of chronic kidney disease (CKD). The objective of our analysis was to profile DVT patients with and without CKD. We defined CKD as patients requiring dialysis or patients having nephrotic syndrome. We compared 268 patients with CKD (184 patients with dialysis-dependent renal disease and 84 with nephrotic syndrome) to 4,307 patients with preserved renal function from a prospective United States multicenter deep venous thrombosis (DVT) registry. Compared with non-CKD patients, CKD patients with DVT were younger (median age 62 vs. 69 years, p < 0.0001), more often African-American (p < 0.0001), and more often Hispanic (p = 0.0003). CKD patients underwent surgery more frequently in the three months prior to developing DVT (48.9% vs. 39.0%, p = 0.001) and more often had concomitant congestive heart failure (20.9% vs. 14.6%, p = 0.005). CKD patients suffered upper extremity DVT more frequently (30.0% vs. 10.8%, p < 0.0001). Patients with CKD presented less often with typical DVT symptoms of extremity discomfort (42.9% vs. 52.4%, p = 0.003) and difficulty ambulating (5.4% vs. 10.1%, p = 0.01). Prophylaxis rates prior to DVT were similarly low in CKD and non-CKD patients (44.2% vs. 38.0%, p = 0.06). Future studies of DVT in CKD patients should explore novel strategies for improving prophylaxis utilization and the detection of DVT in this special population. PMID:18521505

  5. [The use of prostatilen in treating patients with chronic prostatitis].

    PubMed

    Tkachuk, V N; Gorbachev, A G; Khavinson, V Kh

    1991-01-01

    Conventional methods of chronic prostatitis treatment aimed at destruction of pathogenic microflora have certain shortcomings. A promising approach is biologic control of prostatic function. A trial was performed of a new drug prostatilen which is a polypeptide isolated from the animal prostate. The study included 307 patients with chronic prostatitis of 4 mon to 36 years duration. Their age ranged from 18 to 74 years. The drug dose of 5-10 mg was administered once a day i.m. for 5-10 days. The immediate effect and long-term one were measured upon the treatment completion and 4-6 months later. A clinical effect manifested following 2-3 injections and grew to maximal values after 5-6 ones. In rare cases the treatment lasted up to 8-10 injections. The drug promoted disappearance or attenuation of the symptoms in 96.7% of the patients. Positive shifts were achieved in pain complaints, diuresis, sexual function, sleep, general condition. The subjective response agreed with objective laboratory and urodynamic evidence. Prostatilen proved effective for chronic prostatitis because it is tolerable, induces no side effects, beneficial in combinations with other modalities in management of this persistent and prone to recurrences disease.

  6. Uncontrolled chronic disease: patient non-compliance or clinical mismanagement?

    PubMed

    Javors, Jonathan R; Bramble, Judith E

    2003-01-01

    A study group of 30 individuals was randomly chosen from 1,379 beneficiaries predicted to be at risk for health care complications at a large, Midwest, industrial company currently experiencing increased health care costs. All 30 individuals had one or more chronic illness, primarily diabetes, cardiovascular disease, or asthma. Through analysis of medical records, a self-reporting health risk assessment survey, and personal contact with both patients and clinicians, each study individual was assessed as to whether his disease(s) was under control, the individual was compliant with his treatment protocol, and whether the supervising clinician was following nationally accepted standards of care. Fewer than 50% of the individuals in the study group had their chronic illness(es) under control. Those individuals whose treatment adhered to national guidelines were significantly more likely to have their disease under control (p < 0.001). For this study, patient compliance was high and unrelated to whether their disease was under control. Behavioral (external) barriers were most often cited as the reason a clinical practitioner did not follow the appropriate national standard of care. Most clinicians were aware of and familiar with the guidelines; a few either did not agree with or misunderstood the guidelines. The results of this study suggest that changing clinical practice behaviors to better ensure compliance to national standards of care may make a substantial difference in chronic disease control.

  7. Uncontrolled chronic disease: patient non-compliance or clinical mismanagement?

    PubMed

    Javors, Jonathan R; Bramble, Judith E

    2003-01-01

    A study group of 30 individuals was randomly chosen from 1,379 beneficiaries predicted to be at risk for health care complications at a large, Midwest, industrial company currently experiencing increased health care costs. All 30 individuals had one or more chronic illness, primarily diabetes, cardiovascular disease, or asthma. Through analysis of medical records, a self-reporting health risk assessment survey, and personal contact with both patients and clinicians, each study individual was assessed as to whether his disease(s) was under control, the individual was compliant with his treatment protocol, and whether the supervising clinician was following nationally accepted standards of care. Fewer than 50% of the individuals in the study group had their chronic illness(es) under control. Those individuals whose treatment adhered to national guidelines were significantly more likely to have their disease under control (p < 0.001). For this study, patient compliance was high and unrelated to whether their disease was under control. Behavioral (external) barriers were most often cited as the reason a clinical practitioner did not follow the appropriate national standard of care. Most clinicians were aware of and familiar with the guidelines; a few either did not agree with or misunderstood the guidelines. The results of this study suggest that changing clinical practice behaviors to better ensure compliance to national standards of care may make a substantial difference in chronic disease control. PMID:14570385

  8. Magnetic Resonance Imaging of Patients With Chronic Lateral Epicondylitis

    PubMed Central

    Qi, Liang; Zhang, Yu-Dong; Yu, Rong-Bin; Shi, Hai-Bin

    2016-01-01

    Abstract The aim of the study is to determine the inter-reliability and intra-observer reliability of magnetic resonance imaging (MRI) for lateral epicondylitis and investigate whether there is a potential relationship between MRI abnormalities of the common extensor tendon (CET) and its clinical symptom. The study group comprised 96 consecutive patients (46 men and 50 women) with a clinical diagnosis of chronic lateral epicondylitis, which were examined on 3.0 T MR. An MRI scoring system was used to grade the degree of tendinopahty. Three independent musculoskeletal radiologists, who were blinded to the patients’ clinical information, scored images separately. Clinical symptoms were assessed using the Patient-Rated Tennis Elbow Evaluation (PRTEE). Of all the patients, total 96 elbows had MRI-assessed tendinopathy, including 38 (39.6%) with grade 1, 31 (32.3%) with grade 2, and 27 (28.1%) with grade 3. Inter-observer reliability and intra-observer agreement for MRI interpretation of the grades of tendinopathy was good, and a positive correlation between the grades of tendinopathy and PRTEE was determined. MRI is a reliable tool in determining radiological severity of chronical lateral epicondylitis. The severity of MR signal changes positively correlate with the patient's clinical symptom. PMID:26844506

  9. DIABCARD a smart card for patients with chronic diseases.

    PubMed

    Engelbrecht, R; Hildebrand, C

    1997-01-01

    Within the European Union-sponsored project DIABCARD, the core of a chip-card-based medical information system for patients with chronic diseases, exemplified on diabetes mellitus, has been developed. The long-term goal of the project is to improve the medical record and the quality of care for patients with chronic diseases. The basic idea is to have a portable electronic medical record on a smart card. This will improve the communication between the different healthcare personnel and between different institutions and, at the same time, promote shared care. The DIABCARD chip-card-based medical information system will offer controlled access to the necessary and up-to-date patient record to everyone involved in the patient's treatment, and it will help reduce the constantly rising healthcare expenditure. The system first was implemented in a small version. The system architecture contains hardware, software, and orgware. It considers especially the memory of the chip card, the processor, the data structure, security functions, the operating system on the chip card, the interface between the chip card and the application, and various application areas. The DIABCARD dataset was defined via an information model, which describes the different communication processes, via acknowledged diabetes datasets and medical scenarios. It includes, among others, emergency data, data for quality assurance, and data for blood glucose self-monitoring. The first prototype has been developed, and a pilot was run for 3 months. PMID:10167214

  10. Food Allergy in Korean Patients with Chronic Urticaria

    PubMed Central

    Chung, Bo Young; Cho, Yong Se; Kim, Hye One

    2016-01-01

    Background The etiology of chronic urticaria (CU) remains unknown in most patients. Possible causes in some cases include food, but the role of allergy to food antigens in patients with CU remains controversial. Objective The aim of this study was to evaluate the association between food allergy and CU. Methods Korean patients with CU were assessed for a previous history of food allergy that caused symptoms of CU. Blood samples were taken from 350 patients to measure food allergen-specific IgE. Based on history and laboratory results, open oral food challenge (OFC) tests were performed. Results Of 350 participants, 46 (13.1%) claimed to have experienced previous food hypersensitivity. Pork (n=16) was the main food mentioned, followed by beef (n=7), shrimp (n=6), and mackerel (n=6). We found that 73 participants (20.9%) had elevated levels of food-specific IgE, with pork (n=30), wheat (n=25), and beef (n=23) being the most common. However, when the open OFC tests were conducted in 102 participants with self-reported food hypersensitivity or raised levels of food-specific IgE, only four participants showed a positive reaction to pork (n=3) or crab (n=1). Conclusion Although some participants claimed to have a history of CU related to food intake, when an open OFC test was conducted, few of them had positive results. We therefore conclude that food allergy is an uncommon cause of chronic CU. PMID:27746634

  11. Pulmonary Rehabilitation for Patients with Chronic Airways Obstruction.

    PubMed

    Nici, Linda; ZuWallack, Richard

    2015-01-01

    Pulmonary rehabilitation is a patient-centered and interdisciplinary intervention with major components of exercise training and self-management education. Although having no direct effect on lung function, this intervention often results in substantial improvements in respiratory symptoms, functional status, and health status. It probably also reduces subsequent health care utilization, especially when provided after a hospitalization for an exacerbation of airways disease. The beneficial effects of pulmonary rehabilitation reflect its ability to reduce the impact of systemic consequences of chronic respiratory disease and to improve patients' self-efficacy through promoting collaborative self-management. Pulmonary rehabilitation is indicated for patients with respiratory diseases (regardless of specific diagnosis) who have persistent symptoms or functional or health status limitation despite otherwise optimal medical therapy. Those patients with severe asthma (particularly those with airways remodeling) or asthma-chronic obstructive pulmonary disease overlap who have daily symptoms and substantial functional/health status limitation despite controller and bronchodilator therapy would be appropriate candidates for pulmonary rehabilitation.

  12. DIABCARD a smart card for patients with chronic diseases.

    PubMed

    Engelbrecht, R; Hildebrand, C

    1997-01-01

    Within the European Union-sponsored project DIABCARD, the core of a chip-card-based medical information system for patients with chronic diseases, exemplified on diabetes mellitus, has been developed. The long-term goal of the project is to improve the medical record and the quality of care for patients with chronic diseases. The basic idea is to have a portable electronic medical record on a smart card. This will improve the communication between the different healthcare personnel and between different institutions and, at the same time, promote shared care. The DIABCARD chip-card-based medical information system will offer controlled access to the necessary and up-to-date patient record to everyone involved in the patient's treatment, and it will help reduce the constantly rising healthcare expenditure. The system first was implemented in a small version. The system architecture contains hardware, software, and orgware. It considers especially the memory of the chip card, the processor, the data structure, security functions, the operating system on the chip card, the interface between the chip card and the application, and various application areas. The DIABCARD dataset was defined via an information model, which describes the different communication processes, via acknowledged diabetes datasets and medical scenarios. It includes, among others, emergency data, data for quality assurance, and data for blood glucose self-monitoring. The first prototype has been developed, and a pilot was run for 3 months.

  13. [Preparing patients with chronic pulmonary disease for air travel].

    PubMed

    Felkai, Péter; Böszörményi Nagy, György; Gyarmati, Ildikó

    2013-03-01

    Flying is the most important way of travelling in the continually growing international tourism. Number of passengers and those with preexisting diseases, mainly with cardiopulmonary problems, is increasing over years. One of the main tasks of the pre-travel advice is to assess tolerance to hypoxia of the traveler, and specify the necessity, as well as the type and volume of supplementary oxygen therapy. It is indispensable to know the cabin-environment and impact of that on the travelers' health. Travel medicine specialist has to be aware of the examinations which provide information for the appropriate decision on the fit-to-fly condition of the patient. The physician who prepares the patient with chronic obstructive pulmonary disease for repatriation by regular flight and the escorting doctor have to be fully aware of the possibilities, modalities, advantages and contraindications of the on-board oxygen supply and therapy. In this review, the authors give a summary of literature data, outline the tools of in-flight oxygen therapy as well as discuss possibilities for the preflight assessment of patients' condition including blood gas parameters required for safe air travel, as recommended in international medical literature. The preparation process for repatriation of patients with chronic obstructive pulmonary disease is also discussed. PMID:23434882

  14. [Nurses interacting therapeutically with elderly patients in chronic depression].

    PubMed

    Osinaga, V L; Scatena, M C; Rodrigues, A R

    1998-01-01

    In a humanist care model we searched to analyse experiences lived by nurses interacting with chronic depression patients. There was a female patient who was being assisted by Psycho-social Support Nucleus (NAP), 60 years old, presenting depressive symptoms, proper for her age, probably stressed by her suffering experiences in life. It was a therapeutic interaction as matters of the patient's interest (not the nurses interest) have been presented; the pace of communication has been determined b the patient herself; the nurse (except in the very beginning when the patient was a little anxious) followed her communication, physically approaching her whenever it was necessary; intervened only at necessary moments; inspired confidence that was necessary for the patient to talk about her intimate feelings; helped her to recover when she was out of control; conducted her safely, but with comprehensive attitude until the patient felt easy to leave her; demonstrated that she could help her in other moments if she thought it was necessary. Interaction achieved its aims helping the patient and being technically adequate for therapeutic and diagnosis aspects. PMID:10776300

  15. [Integrated care for patients with advanced chronic obstructive pulmonary disease].

    PubMed

    Jassem, Ewa; Górecka, Dorota; Krakowiak, Piotr; Kozielski, Jerzy; Słomiński, J Marek; Krajnik, Małgorzata; Fal, Andrzej M

    2010-01-01

    Chronic obstructive pulmonary disease (COPD) is the third cause of mortality and disability (assessed by DALY) among patients above 60 year old. Severe and very severe COPD (FEV(1) = equal or less than 50% and 30% of expected value, respectively) is estimated at 20% of all COPD patients. Advanced COPD usually leads to physical and mental deterioration, the patients often manage with the problems caused by the disease and other comorbidities poorly. This leads to increased risk of COPD exacerbations and further deterioration of the patient's status, increased costs of medical care and eventually increased risk of death. Current organization of medical care for those patients does not provide adequate health and social support for them. However, it seems that introducing an integrated approach proposed by World Health Organization, could improve the situation of advanced COPD patients. In Poland, this kind of care has been provided in advanced cancer patients throughout stationary palliative care units and hospices during the last several years. This experience should be helpful in integrating actions of general practitioners and specialized nurses, as well as providing access for the specialists' consultations according to the individual needs of the patients. It should also allow for broad cooperation with auxiliary staff, such as social workers, medical assistants and volunteers, as well as psychologists and clergymen (especially in the terminal phase of the disease).

  16. Neural underpinnings for model-oriented therapy of aphasic word production.

    PubMed

    Abel, Stefanie; Weiller, Cornelius; Huber, Walter; Willmes, Klaus

    2014-05-01

    Model-oriented therapies of aphasic word production have been shown to be effective, with item-specific therapy effects being larger than generalisation effects for untrained items. However, it remains unclear whether semantic versus phonological therapy lead to differential effects, depending on type of lexical impairment. Functional imaging studies revealed that mainly left-hemisphere, perisylvian brain areas were involved in successful therapy-induced recovery of aphasic word production. However, the neural underpinnings for model-oriented therapy effects have not received much attention yet. We aimed at identifying brain areas indicating (1) general therapy effects using a naming task measured by functional magnetic resonance imaging (fMRI) in 14 patients before and after a 4-week naming therapy, which comprised increasing semantic and phonological cueing-hierarchies. We also intended to reveal differential effects (2) of training versus generalisation, (3) of therapy methods, and (4) of type of impairment as assessed by the connectionist Dell model. Training effects were stronger than generalisation effects, even though both were significant. Furthermore, significant impairment-specific therapy effects were observed for patients with phonological disorders (P-patients). (1) Left inferior frontal gyrus, pars opercularis (IFGoper), was a positive predictor of therapy gains while the right caudate was a negative predictor. Moreover, less activation decrease due to therapy in left-hemisphere temporo-parietal language areas was positively correlated with therapy gains. (2) Naming of trained compared to untrained words yielded less activation decrease in left superior temporal gyrus (STG) and precuneus, bilateral thalamus, and right caudate due to therapy. (3) Differential therapy effects could be detected in the right superior parietal lobule for the semantic method, and in regions involving bilateral anterior and mid cingulate, right precuneus, and left middle

  17. [Endocrine abnormalities in patients with chronic renal failure - part II].

    PubMed

    Krysiak, Robert; Kędzia, Agnieszka; Krupej-Kędzierska, Joanna; Kowalska, Beata; Okopień, Bogusław

    2015-05-01

    The kidneys play a crucial role in maintaining homeostasis of fluids and electrolytes, acid-base balance, and volume regulation. In subjects with chronic renal failure, particularly at its later stages, these adaptive responses are impaired and some of these alterations are of clinical relevance. The ways in which chronic renal failure affects function of endocrine organs include impaired secretion of kidney-derived hormones, altered peripheral hormone metabolism, disturbed binding to carrier proteins, accumulation of hormone inhibitors, as well as abnormal target organ responsiveness. Apart from secondary hyperparathyroidism, thyroid dysfunction and impaired growth, reviewed in our previous study, endocrine disturbances that most frequently affect this group of patients include: abnormal functioning of the hypothalamic-pituitary-adrenal and hypothalamicpituitary- gonadal axes, bone loss and gynecomastia. The clinical picture and laboratory findings of these endocrine disturbances depend on the treatment strategy.

  18. A Swelling in the Mouth in a Chronic Hemodialysis Patient

    PubMed Central

    Devresse, Arnaud; Raptis, Alexandros; Claes, Anne-Sophie

    2016-01-01

    Oral manifestations of severe secondary hyperparathyroidism include maxillary and mandibular deformities, brown tumors, dental abnormalities, and metastatic calcification of soft tissues. We report on a chronic hemodialysis (HD) woman with severe, uncontrolled secondary hyperparathyroidism and a painful, nontender mass in the floor of her mouth. The most likely clinical diagnosis was a bone tumoral lesion of the oral cavity, secondary to renal osteodystrophy. Unexpectedly, pathological examination showed characteristic features of ossifying fibroma (OF) of the jaw, a rare, benign fibroosseous lesion characterized by the replacement of normal bone by collagen and fibroblasts containing varying amounts of mineralized substance. The occurrence of an OF in chronic HD patients is exceptional. Differential diagnosis must be made with bone tumoral lesions secondary to renal osteodystrophy. Surgical removal is the treatment of choice. The pathogenesis of OF in the setting of secondary hyperparathyroidism remains unknown. Parathyroidectomy may not be necessary to avoid OF recurrence after surgical removal. PMID:27800197

  19. [The bioregulatory therapy of patients with chronic pyelonephritis].

    PubMed

    al-Shukri, S Kh; Gorbachev, A G; Kuz'min, I V

    1997-01-01

    Prostatilen (5 mg/day i.m. for 5 days) was given to 46 patients with chronic pyelonephritis in the latent inflammation phase. The treatment resulted in relief of clinical symptoms, positive trend in laboratory indices characterizing activity of renal inflammation, albumin-globulin ratio. There was a decrease in leukocyturia, bacteriuria, ESR, blood fibrinogen and ceruloplasmin levels. Prostatilen reduced hypercoagulation and enhanced fibrinolytic activity of blood. The immunograms showed prostatilen-induced correction of immunity: T-lymphocyte count and functional activity increased, proportion of T-cell subpopulations returned to normal, metabolic activity of phagocyte oxygen-dependent substances became more intensive. The ability of prostatilen to initiate normalization of hemocoagulation and immunity is thought to be an essential factor of its therapeutic efficacy in chronic pyelonephritis.

  20. Determinants of survival among HIV-infected chronic dialysis patients.

    PubMed

    Rodriguez, Rudolph A; Mendelson, Michael; O'Hare, Ann M; Hsu, Ling Chin; Schoenfeld, Patricia

    2003-05-01

    Over 100 HIV-infected patients have initiated chronic dialysis at San Francisco General Hospital (SFGH) since 1985. This study employed retrospective analysis to identify determinants of and trends in survival among HIV-infected patients who have initiated chronic dialysis at SFGH from January 1, 1985 to November 1, 2002 (n = 115). Cohort patient survival was compared with survival after an AIDS-opportunistic illness in all HIV-infected patients in San Francisco during the study period. Higher CD4 count (hazard ratio [HR], 0.86 per 50 cells/mm(3) increase; 95% confidence interval [CI], 0.80 to 0.93) and serum albumin (HR, 0.53 per 1 g/dl increase; CI, 0.36 to 0.78) at initiation of dialysis were strongly associated with lower mortality. Survival for those initiating dialysis during the era of highly active antiretroviral therapy (HAART) was 16.1 mo versus 9.4 mo for those initiating dialysis before this time, but this difference was not statistically significant. In adjusted analysis, only a non-statistically significant trend toward improved survival during the HAART era was noted (HR, 0.59; CI, 0.34 to 1.04). By comparison, survival for all HIV-infected patients after an AIDS-opportunistic illness in San Francisco increased from 16 mo in 1994 to 81 mo in 1996. The dramatic improvement in survival that has occurred since the mid-1990s for patients with HIV appears to be greatly attenuated in the sub-group undergoing dialysis. Although this may partly reflect confounding by race, injection drug use and HCV co-infection, future attempts to improve survival among HIV-infected dialysis patients should focus on barriers to the effective use of HAART in this group.

  1. Incidence of persistent/late chronic anemia in newly diagnosed patients with chronic myeloid leukemia responsive to imatinib.

    PubMed

    Latagliata, Roberto; Volpicelli, Paola; Breccia, Massimo; Vozella, Federico; Romano, Angela; Montagna, Chiara; Molica, Matteo; Finsinger, Paola; Carmosino, Ida; Serrao, Alessandra; Zacheo, Irene; Santopietro, Michelina; Salaroli, Adriano; Alimena, Giuliana

    2015-02-01

    In patients with chronic myeloid leukemia (CML) responsive to imatinib, it is still unknown whether the long-lasting treatment could induce the appearance of a persistent/late chronic anemia. To highlight this issue, we revised 128 patients with CML (M/F 64/64, median age at diagnosis 56.9 years, interquartile range 43.0-69.3) treated at our Institution with 1st line imatinib for at least 36 months and in stable complete cytogenetic response. At the 36th month of imatinib, a chronic anemia (Hb < 12 g/dl for > 6 months) was present in 38/128 patients (29.6%): the anemia was moderate (Hb > 8 ≤ 10 g/dl) in 12 patients (9.3%) and mild (Hb > 10 < 12 g/dl) in 26 patients (20.3%). All patients with persistent/late chronic anemia had a low reticulocyte count and 8/38 a condition of iron deficiency without clinical and instrumental signs of chronic blood loss. Four out of 38 patients (10.5%) needed red cell transfusions during the follow-up. At a landmark analysis from the 36th month of imatinib treatment, cumulative 4-year overall survival (OS) for patients with chronic anemia was 94.4% (CI 95% 83.8-100) compared to 93.5% (CI 95% 87.2-99.8) for patients without chronic anemia (P = 0.617). In conclusion, the occurrence of a late chronic anemia during long-lasting treatment with imatinib has been observed in about 30% of our responsive patients: its occurrence does not seem to affect OS, but its real impact should be evaluated on a larger cohort of patients.

  2. Incidence of persistent/late chronic anemia in newly diagnosed patients with chronic myeloid leukemia responsive to imatinib.

    PubMed

    Latagliata, Roberto; Volpicelli, Paola; Breccia, Massimo; Vozella, Federico; Romano, Angela; Montagna, Chiara; Molica, Matteo; Finsinger, Paola; Carmosino, Ida; Serrao, Alessandra; Zacheo, Irene; Santopietro, Michelina; Salaroli, Adriano; Alimena, Giuliana

    2015-02-01

    In patients with chronic myeloid leukemia (CML) responsive to imatinib, it is still unknown whether the long-lasting treatment could induce the appearance of a persistent/late chronic anemia. To highlight this issue, we revised 128 patients with CML (M/F 64/64, median age at diagnosis 56.9 years, interquartile range 43.0-69.3) treated at our Institution with 1st line imatinib for at least 36 months and in stable complete cytogenetic response. At the 36th month of imatinib, a chronic anemia (Hb < 12 g/dl for > 6 months) was present in 38/128 patients (29.6%): the anemia was moderate (Hb > 8 ≤ 10 g/dl) in 12 patients (9.3%) and mild (Hb > 10 < 12 g/dl) in 26 patients (20.3%). All patients with persistent/late chronic anemia had a low reticulocyte count and 8/38 a condition of iron deficiency without clinical and instrumental signs of chronic blood loss. Four out of 38 patients (10.5%) needed red cell transfusions during the follow-up. At a landmark analysis from the 36th month of imatinib treatment, cumulative 4-year overall survival (OS) for patients with chronic anemia was 94.4% (CI 95% 83.8-100) compared to 93.5% (CI 95% 87.2-99.8) for patients without chronic anemia (P = 0.617). In conclusion, the occurrence of a late chronic anemia during long-lasting treatment with imatinib has been observed in about 30% of our responsive patients: its occurrence does not seem to affect OS, but its real impact should be evaluated on a larger cohort of patients. PMID:25349084

  3. ST2 and patient prognosis in chronic heart failure.

    PubMed

    Bayes-Genis, Antoni; Zhang, Yuhui; Ky, Bonnie

    2015-04-01

    Biomarkers of cardiovascular diseases are indispensable tools for diagnosis and prognosis, and the use of several biomarkers is now considered the standard of care. New markers continue to be developed, but few prove to be substantially better than established markers. Suppression of tumorigenicity 2 (ST2) is a marker of cardiomyocyte stress and fibrosis that provides incremental value to natriuretic peptides for risk stratification of patients with a wide spectrum of cardiovascular diseases. On the basis of all available data, the 2013 American College of Cardiology and American Heart Association guidelines now recommend measurement of ST2 for additive risk stratification in patients with acute or chronic ambulatory heart failure (HF). This report provides an up-to-date overview of the clinical studies that led to the endorsement of ST2 as a cardiovascular prognostic marker in chronic HF. The presented data suggest that the addition of ST2 to a model that includes established mortality risk factors, including natriuretic peptides, substantially improves the risk stratification for death and HF hospitalization in patients with HF. ST2's prognostic value remains strong even in the subset of patients with renal insufficiency and is superior to other remodeling-fibrosis biomarkers currently being evaluated. In conclusion, these results have been repeatedly validated; thus, ST2 could be rapidly incorporated into clinical practice for risk prediction. Indeed, the body of evidence supporting the use of ST2 in chronic HF stratification continues to grow, with consistent data from cohorts around the world in single-center (Barcelona, Brussels, and San Diego cohorts) and multicenter (Penn Heart Failure Study [PHFS] and Muerte Subita en Insuficiencia Cardiac [MUSIC]) studies and in post hoc studies from clinical trials (Prospective Randomized Amlodipine Survival Evaluation 2 [PRAISE-2], Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training [HF

  4. ST2 and patient prognosis in chronic heart failure.

    PubMed

    Bayes-Genis, Antoni; Zhang, Yuhui; Ky, Bonnie

    2015-04-01

    Biomarkers of cardiovascular diseases are indispensable tools for diagnosis and prognosis, and the use of several biomarkers is now considered the standard of care. New markers continue to be developed, but few prove to be substantially better than established markers. Suppression of tumorigenicity 2 (ST2) is a marker of cardiomyocyte stress and fibrosis that provides incremental value to natriuretic peptides for risk stratification of patients with a wide spectrum of cardiovascular diseases. On the basis of all available data, the 2013 American College of Cardiology and American Heart Association guidelines now recommend measurement of ST2 for additive risk stratification in patients with acute or chronic ambulatory heart failure (HF). This report provides an up-to-date overview of the clinical studies that led to the endorsement of ST2 as a cardiovascular prognostic marker in chronic HF. The presented data suggest that the addition of ST2 to a model that includes established mortality risk factors, including natriuretic peptides, substantially improves the risk stratification for death and HF hospitalization in patients with HF. ST2's prognostic value remains strong even in the subset of patients with renal insufficiency and is superior to other remodeling-fibrosis biomarkers currently being evaluated. In conclusion, these results have been repeatedly validated; thus, ST2 could be rapidly incorporated into clinical practice for risk prediction. Indeed, the body of evidence supporting the use of ST2 in chronic HF stratification continues to grow, with consistent data from cohorts around the world in single-center (Barcelona, Brussels, and San Diego cohorts) and multicenter (Penn Heart Failure Study [PHFS] and Muerte Subita en Insuficiencia Cardiac [MUSIC]) studies and in post hoc studies from clinical trials (Prospective Randomized Amlodipine Survival Evaluation 2 [PRAISE-2], Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training [HF

  5. Problems and concerns of patients receiving chronic opioid therapy for chronic non-cancer pain.

    PubMed

    Sullivan, Mark D; Von Korff, Michael; Banta-Green, Caleb; Merrill, Joseph O; Saunders, Kathleen

    2010-05-01

    The value of chronic opioid therapy (COT) for chronic non-cancer pain (CNCP) patients is determined by a balance of poorly understood benefits and harms. Traditionally, this balance has been framed as the potential for improved pain control versus risks of iatrogenic addiction, drug diversion, and aberrant drug-related behaviors. These potential harms are typically defined from the providers' perspective. This paper seeks to clarify difficulties with the long-term use of opioids for CNCP from the patients' perspective. We used the Prescribed Opioids Difficulties Scale (PODS) to assess current problems and concerns attributed to opioid use by 1144 adults receiving COT. Subjects were grouped into low (56.9%), medium (25.6%) and high (17.5%) PODS scorers. Among patients with high PODS scores, 64% were clinically depressed and 78% experienced high levels of pain-related interference with activities, compared to 28% depressed and 60% with high interference with activities among those with low PODS scores. High levels of opioid-related problems and concerns were not explained by differences in pain intensity or persistence. Patients with medium to high PODS scores were often concerned about their ability to control their use of opioid medications, but prior substance abuse diagnoses and receiving excess days supply of opioids were much less common in these patients than depression and pain-related interference with activities. These results suggest two types of potential harm from COT attributed by CNCP patients to opioids: psychosocial problems that are distinct from poor pain control and opioid control concerns that are distinct from opioid misuse or addiction. PMID:20334974

  6. Patient access to complex chronic disease records on the Internet

    PubMed Central

    2012-01-01

    Background Access to medical records on the Internet has been reported to be acceptable and popular with patients, although most published evaluations have been of primary care or office-based practice. We tested the feasibility and acceptability of making unscreened results and data from a complex chronic disease pathway (renal medicine) available to patients over the Internet in a project involving more than half of renal units in the UK. Methods Content and presentation of the Renal PatientView (RPV) system was developed with patient groups. It was designed to receive information from multiple local information systems and to require minimal extra work in units. After piloting in 4 centres in 2005 it was made available more widely. Opinions were sought from both patients who enrolled and from those who did not in a paper survey, and from staff in an electronic survey. Anonymous data on enrolments and usage were extracted from the webserver. Results By mid 2011 over 17,000 patients from 47 of the 75 renal units in the UK had registered. Users had a wide age range (<10 to >90 yrs) but were younger and had more years of education than non-users. They were enthusiastic about the concept, found it easy to use, and 80% felt it gave them a better understanding of their disease. The most common reason for not enrolling was being unaware of the system. A minority of patients had security concerns, and these were reduced after enrolling. Staff responses were also strongly positive. They reported that it aided patient concordance and disease management, and increased the quality of consultations with a neutral effect on consultation length. Neither patient nor staff responses suggested that RPV led to an overall increase in patient anxiety or to an increased burden on renal units beyond the time required to enrol each patient. Conclusions Patient Internet access to secondary care records concerning a complex chronic disease is feasible and popular, providing an increased

  7. Anomia training and brain stimulation in chronic aphasia.

    PubMed

    Cotelli, Maria; Fertonani, Anna; Miozzo, Antonio; Rosini, Sandra; Manenti, Rosa; Padovani, Alessandro; Ansaldo, Ana Ines; Cappa, Stefano F; Miniussi, Carlo

    2011-10-01

    Recent studies have reported enhanced performance on language tasks induced by non-invasive brain stimulation, i.e., repetitive transcranial magnetic stimulation (rTMS), or transcranial direct current stimulation (tDCS), in patients with aphasia due to stroke or Alzheimer's disease (AD). The first part of this article reviews brain stimulation studies related to language recovery in aphasic patients. The second part reports results from a pilot study with three chronic stroke patients who had non-fluent aphasia, where real or placebo rTMS was immediately followed by 25 minutes of individualised speech therapy. Real rTMS consisted of high-frequency rTMS over the left dorsolateral prefrontal cortex (BA 8/9) for 25 minutes. Each patient underwent a total of four weeks of intervention. P1 underwent four weeks of real rTMS (5 days/week) where individualised speech therapy was provided for 25 minutes immediately following each rTMS session. P2 and P3 each underwent two weeks of placebo rTMS, followed immediately by individualised speech therapy; then two weeks of real rTMS, followed immediately by individualised speech therapy. Assessments took place at 2, 4, 12, 24 and 48 weeks post-entry/baseline testing. Relative to entry/baseline testing, a significant improvement in object naming was observed at all testing times, from two weeks post-intervention in real rTMS plus speech therapy, or placebo rTMS plus speech therapy. Our findings suggest beneficial effects of targeted behavioural training in combination with brain stimulation in chronic aphasic patients. However, further work is required in order to verify whether optimal combination parameters (rTMS alone or speech therapy alone) and length of rTMS treatment may be found.

  8. Reintegration of chronic mental patients into the Malaysian community.

    PubMed

    Krahl, W

    1982-01-01

    This paper describes a rehabilitation programme for male chronic mental patients, with the aim of reintegrating them into the community. Since in Malaysia about 50% of the work force are stilling earning their living in the agricultural sector, the programme concentrates on training in farming and animal rearing. Since the patients are very institutionalised, resocialisation training is also provided that involves learning to communicate, to mix with others, to know how to use money, to make one's own demands, and to cope with more personal freedom. When a patient is trained well enough to be employed outside, a job is found for him that provides food, lodging and payment. After discharge from the hospital, he is regularly followed up by the social worker. PMID:7107135

  9. Accelerated atherosclerosis in patients with chronic inflammatory rheumatologic conditions

    PubMed Central

    Hong, Jison; Maron, David J; Shirai, Tsuyoshi; Weyand, Cornelia M

    2015-01-01

    Atherosclerosis is a complex inflammatory disease involving aberrant immune and tissue healing responses, which begins with endothelial dysfunction and ends with plaque development, instability and rupture. The increased risk for coronary artery disease in patients with rheumatologic diseases highlights how aberrancy in the innate and adaptive immune system may be central to development of both disease states and that atherosclerosis may be on a spectrum of immune-mediated conditions. Recognition of the tight association between chronic inflammatory disease and complications of atherosclerosis will impact the understanding of underlying pathogenic mechanisms and change diagnostic and therapeutic approaches in patients with rheumatologic syndromes as well as patients with coronary artery disease. In this review, we provide a summary of the role of the immune system in atherosclerosis, discuss the proposed mechanisms of accelerated atherosclerosis seen in association with rheumatologic diseases, evaluate the effect of immunosuppression on atherosclerosis and provide updates on available risk assessment tools, biomarkers and imaging modalities. PMID:27042216

  10. Knowledge management for chronic patient control and monitoring

    NASA Astrophysics Data System (ADS)

    Pedreira, Nieves; Aguiar-Pulido, Vanessa; Dorado, Julián; Pazos, Alejandro; Pereira, Javier

    2014-10-01

    Knowledge Management (KM) can be seen as the process of capturing, developing, sharing, and effectively using organizational knowledge. In this context, the work presented here proposes a KM System to be used in the scope of chronic patient control and monitoring for distributed research projects. It was designed in order to enable communication between patient and doctors, as well as to be usedbythe researchers involved in the project for its management. The proposed model integrates all the information concerning every patient and project management tasks in the Institutional Memory of a KMSystem and uses an ontology to maintain the information and its categorization independently. Furthermore, taking the philosophy of intelligent agents, the system will interact with the user to show him the information according to his preferences and access rights. Finally, three different scenarios of application are described.

  11. Temperament and character profiles of patients with chronic idiopathic urticaria

    PubMed Central

    Canan, Fatih; Karakaş, Ayşe Akman; Geçici, Nihal

    2015-01-01

    Introduction Psychosocial factors have been implicated as being important in the onset and/or exacerbation of urticaria. Aim To examine both personality factors of patients with chronic idiopathic urticaria (CIU) and the correlations between illness duration, severity of itching, urticaria activity score (UAS) and temperament-character dimensions. Material and methods A total number of 70 CIU patients and 60 healthy individuals were included in the study. The Temperament and Character Inventory (TCI) was administered individually. The relationship between UAS, illness duration and severity of pruritus and TCI subscales were evaluated. Results The CIU group had significantly higher scores of novelty seeking and lower scores of cooperativeness, reward dependence and self-directedness than the control group. Conclusions The current study shows that CIU patients have distinctive temperament and character dimensions when compared with the control group. We suggest that evaluation and treatment of CIU should also include psychosomatic approaches in clinical practice. PMID:26161056

  12. Hyperphosphatemia Management in Patients with Chronic Kidney Disease.

    PubMed

    Shaman, Ahmed M; Kowalski, Stefan R

    2016-07-01

    Hyperphosphatemia in chronic kidney disease (CKD) patients is a potentially life altering condition that can lead to cardiovascular calcification, metabolic bone disease (renal osteodystrophy) and the development of secondary hyperparathyroidism (SHPT). It is also associated with increased prevalence of cardiovascular diseases and mortality rates. To effectively manage hyperphosphatemia in CKD patients it is important to not only consider pharmacological and nonpharmacological treatment options but also to understand the underlying physiologic pathways involved in phosphorus homoeostasis. This review will therefore provide both a background into phosphorus homoeostasis and the management of hyperphosphatemia in CKD patients. In addition, it will cover some of the most important reasons for failure to control hyperphosphatemia with emphasis on the effect of the gastric pH on phosphate binders efficiency. PMID:27330380

  13. Nutrition supplementation in patients with acute and chronic pancreatitis.

    PubMed

    Scolapio, J S; Malhi-Chowla, N; Ukleja, A

    1999-09-01

    Acute pancreatitis is a hypermetabolic state characterized by increased protein catabolism, lipolysis, and glucose intolerance. Most patients presenting with acute pancreatitis are better within 5 to 7 days and can be resume a regular diet. Patients with severe pancreatitis and who are unable to eat within 7 to 10 days should receive nutritional support. The decision to use parenteral or enteral nutrition is controversial. More recent data suggest that jejunal feedings are just as beneficial, if not better, than parenteral nutrition. Marked weight loss and abdominal pain are the features of chronic pancreatitis. Steatorrhea develops when greater than 90% of pancreatic exocrine dysfunction occurs. Treatment focuses on pain control and pancreatic enzyme replacement. Pancreatic enzymes should be given with meals. Patients with refractory steatorrhea may benefit from the addition of an H2 antagonist or proton-pump inhibitor with pancreatic enzyme replacement. Micronutrients, including antioxidants, should be replaced if serum levels suggest a deficiency.

  14. Overcoming the Influence of Chronic Pain on Older Patients' Difficulty with Recommended Self-Management Activities

    ERIC Educational Resources Information Center

    Krein, Sarah L.; Heisler, Michele; Piette, John D.; Butchart, Amy; Kerr, Eve A.

    2007-01-01

    Purpose: Many older patients with common chronic conditions also experience chronic pain. We examined how chronic pain affects patients' difficulty with recommended self-management activities and the potential intervening role of self-efficacy (the level of confidence in one's own ability to perform a specific task). Design and Methods: We…

  15. Electroencephalogram characteristics in patients with chronic fatigue syndrome

    PubMed Central

    Wu, Tong; Qi, Xianghua; Su, Yuan; Teng, Jing; Xu, Xiangqing

    2016-01-01

    Objective To explore the electroencephalogram (EEG) characteristics in patients with chronic fatigue syndrome (CFS) using brain electrical activity mapping (BEAM) and EEG nonlinear dynamical analysis. Methods Forty-seven outpatients were selected over a 3-month period and divided into an observation group (24 outpatients) and a control group (23 outpatients) by using the non-probability sampling method. All the patients were given a routine EEG. The BEAM and the correlation dimension changes were analyzed to characterize the EEG features. Results 1) BEAM results indicated that the energy values of δ, θ, and α1 waves significantly increased in the observation group, compared with the control group (P<0.05, P<0.01, respectively), which suggests that the brain electrical activities in CFS patients were significantly reduced and stayed in an inhibitory state; 2) the increase of δ, θ, and α1 energy values in the right frontal and left occipital regions was more significant than other encephalic regions in CFS patients, indicating the region-specific encephalic distribution; 3) the correlation dimension in the observation group was significantly lower than the control group, suggesting decreased EEG complexity in CFS patients. Conclusion The spontaneous brain electrical activities in CFS patients were significantly reduced. The abnormal changes in the cerebral functions were localized at the right frontal and left occipital regions in CFS patients. PMID:26869792

  16. Nutritional supplementation in patients with chronic obstructive pulmonary disease.

    PubMed

    Hsieh, Meng-Jer; Yang, Tsung-Ming; Tsai, Ying-Huang

    2016-08-01

    Malnutrition in patients with chronic obstructive pulmonary disease (COPD) is associated with cachexia, sarcopenia, and weight loss, and may result in poorer pulmonary function, decreased exercise capacity, and increased risk of exacerbations. Providing nutritional supplementation is an important therapeutic intervention, particularly for severely ill COPD patients with malnutrition. Higher calorie intake through nutritional supplementation significantly increases body weight and muscle strength, and improves quality of life in malnourished COPD patients. Difficulties may be experienced by these COPD patients, who are struggling to breathe and eliminate CO2 from the lungs, resulting in dyspnea, hypercapnia, hypoxia, and respiratory acidosis, which exacerbates muscle loss through oxidative stress and inflammatory responses. To overcome these problems, nutritional supplements should aim to reduce metabolic CO2 production, lower respiratory quotient, and improve lung function. Several studies have shown that high-fat supplements produce less CO2 and have lower respiratory quotient value than high-carbohydrate supplements. In addition, high-fat supplements may be the most efficient means of providing a low-volume, calorie-dense supplement to COPD patients, and may be most beneficial to patients with prolonged mechanical ventilation where hypercapnia and malnutrition are most pronounced. Further studies are required to investigate the optimal nutritional supplements for COPD patients according to their disease severity. PMID:26822811

  17. Patient education for phosphorus management in chronic kidney disease

    PubMed Central

    Kalantar-Zadeh, Kamyar

    2013-01-01

    Objectives: This review explores the challenges and solutions in educating patients with chronic kidney disease (CKD) to lower serum phosphorus while avoiding protein insufficiency and hypercalcemia. Methods: A literature search including terms “hyperphosphatemia,” “patient education,” “food fatigue,” “hypercalcemia,” and “phosphorus–protein ratio” was undertaken using PubMed. Results: Hyperphosphatemia is a strong predictor of mortality in advanced CKD and is remediated via diet, phosphorus binders, and dialysis. Dietary counseling should encourage the consumption of foods with the least amount of inorganic or absorbable phosphorus, low phosphorus-to-protein ratios, and adequate protein content, and discourage excessive calcium intake in high-risk patients. Emerging educational initiatives include food labeling using a “traffic light” scheme, motivational interviewing techniques, and the Phosphate Education Program – whereby patients no longer have to memorize the phosphorus content of each individual food component, but only a “phosphorus unit” value for a limited number of food groups. Phosphorus binders are associated with a clear survival advantage in CKD patients, overcome the limitations associated with dietary phosphorus restriction, and permit a more flexible approach to achieving normalization of phosphorus levels. Conclusion: Patient education on phosphorus and calcium management can improve concordance and adherence and empower patients to collaborate actively for optimal control of mineral metabolism. PMID:23667310

  18. Quality of life in patients with chronic thromboembolic pulmonary hypertension.

    PubMed

    Mathai, Stephen C; Ghofrani, Hossein-Ardeschir; Mayer, Eckhard; Pepke-Zaba, Joanna; Nikkho, Sylvia; Simonneau, Gérald

    2016-08-01

    Patients with chronic thromboembolic pulmonary hypertension (CTEPH) experience debilitating symptoms that have a negative impact on their quality of life (QoL) in terms of physical capability, psychological wellbeing and social relationships. The use of QoL measurement tools is important in the assessment of treatment efficacy and in guiding treatment decisions. However, despite the importance of QoL, particularly to the patient, it remains under-reported in clinical studies of CTEPH therapy. CTEPH is unique in pulmonary hypertension in that it is potentially curable by surgery; however, a proportion of patients either have residual PH following surgery or are not operable. Although some patients with CTEPH have been treated off-label with pulmonary arterial hypertension-specific therapies, there have been few randomised controlled trials of these therapies in patients with CTEPH. Moreover, in these trials QoL outcomes are variably assessed, and there is little consistency in the tools used. Here we review the assessment of QoL in patients with CTEPH and the tools that have been used. We also discuss the effect of surgical intervention and medical therapies on QoL. We conclude that further studies of QoL in patients with CTEPH are needed to further validate the optimal QoL tools.

  19. Outcomes of patients with chronic lymphocytic leukemia after discontinuing ibrutinib

    PubMed Central

    Jain, Preetesh; Keating, Michael; Wierda, William; Estrov, Zeev; Ferrajoli, Alessandra; Jain, Nitin; George, Binsah; James, Danelle; Kantarjian, Hagop; Burger, Jan

    2015-01-01

    Ibrutinib is a Bruton tyrosine kinase inhibitor approved for the treatment of patients with relapsed refractory chronic lymphocytic leukemia (RR-CLL). We describe the characteristics, causes of discontinuation, and outcomes in patients who discontinued treatment with ibrutinib. One hundred twenty-seven patients were enrolled in various clinical trials of ibrutinib, with or without rituximab, at our center. Thirty-three (26%) patients have discontinued ibrutinib to date. The majority of those patients had high-risk features: 94% with unmutated immunoglobulin heavy chain variable gene rearrangement, 58% with del(17p) by fluorescence in situ hybridization, and 54% with a complex karyotype. Causes of discontinuation were disease transformation (7), progressive CLL (7), stem cell transplantation (3), adverse events (11), serious adverse events/deaths (3), and miscellaneous reasons (2). Twenty five patients (76%) died after discontinuing ibrutinib; the median overall survival was 3.1 months after discontinuation. Most patients with RR-CLL who discontinued ibrutinib early were difficult to treat and had poor outcomes. PMID:25573991

  20. Hyporeninemic hypoaldosteronism in diabetic patients with chronic renal failure.

    PubMed

    Grande Villoria, J; Macias Nunez, J F; Miralles, J M; De Castro del Pozo, S; Tabernero Romo, J M

    1988-01-01

    Plasma renin activity, plasma aldosterone levels and renal tubular capacity to excrete hydrogen ions were studied in 13 patients suffering from diabetes mellitus with a creatinine clearance of less than 40 ml/min. The results were compared with those obtained in a control group, in a group of nondiabetic subjects with chronic renal failure (CRF) and in a group of diabetic patients without CRF. Twelve of the thirteen diabetic patients with CRF had data characteristic of hyporeninemic hypoaldosteronism associated with type IV renal tubular acidosis. On comparing the results with those of the other two groups of patients, it was observed that the manifestations of the latter two groups considered separately were different from those of the problem group, although in the diabetic patients with normal glomerular filtration rate (GFR) hyporeninism but not hypoaldosteronism was present accompanied by a lower net acid excretion (p less than 0.001) due to a lower excretion of NH4 (p less than 0.05) and titratable acid (p less than 0.001) when the patients were challenged with an NH4Cl overload. We believe that a conjunction of diabetes and renal failure is necessary for the diabetic patients with a decrease in GFR to show hyporeninemic hypoaldosteronism and type IV tubular acidosis.

  1. [Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease].

    PubMed

    Barberán, José; Mensa, José

    2014-01-01

    Invasive pulmonary aspergillosis (IPA) is a common infection in immunocompromised patients with hematological malignancies or allogenic stem cell transplantation, and is less frequent in the context of chronic obstructive pulmonary disease (COPD). Mucociliary activity impairment, immunosuppression due to the inhibition of alveolar macrophages and neutrophils by steroids, and receiving broad-spectrum antibiotics, play a role in the development of IPA in COPD patients. Colonized patients or those with IPA are older, with severe CODP stage (GOLD≥III), and have a higher number of comorbidities. The mortality rate is high due to the fact that having a definitive diagnosis of IPA in COPD patients is often difficult. The main clinical and radiological signs of IPA in these types of patients are non-specific, and tissue samples for definitive diagnosis are often difficult to obtain. The poor prognosis of IPA in COPD patients could perhaps be improved by faster diagnosis and prompt initiation of antifungal treatment. Some tools, such as scales and algorithms based on risk factors of IPA, may be useful for its early diagnosis in these patients.

  2. Quality of life in patients with chronic thromboembolic pulmonary hypertension

    PubMed Central

    Ghofrani, Hossein-Ardeschir; Mayer, Eckhard; Pepke-Zaba, Joanna; Nikkho, Sylvia; Simonneau, Gérald

    2016-01-01

    Patients with chronic thromboembolic pulmonary hypertension (CTEPH) experience debilitating symptoms that have a negative impact on their quality of life (QoL) in terms of physical capability, psychological wellbeing and social relationships. The use of QoL measurement tools is important in the assessment of treatment efficacy and in guiding treatment decisions. However, despite the importance of QoL, particularly to the patient, it remains under-reported in clinical studies of CTEPH therapy. CTEPH is unique in pulmonary hypertension in that it is potentially curable by surgery; however, a proportion of patients either have residual PH following surgery or are not operable. Although some patients with CTEPH have been treated off-label with pulmonary arterial hypertension-specific therapies, there have been few randomised controlled trials of these therapies in patients with CTEPH. Moreover, in these trials QoL outcomes are variably assessed, and there is little consistency in the tools used. Here we review the assessment of QoL in patients with CTEPH and the tools that have been used. We also discuss the effect of surgical intervention and medical therapies on QoL. We conclude that further studies of QoL in patients with CTEPH are needed to further validate the optimal QoL tools. PMID:27076580

  3. Lung cancer screening in patients with chronic obstructive pulmonary disease

    PubMed Central

    Gonzalez, Jessica; Marín, Marta; Sánchez-Salcedo, Pablo

    2016-01-01

    Lung cancer and chronic obstructive pulmonary disease (COPD) are two intimately related diseases, with great impact on public health. Annual screening using low-dose computed tomography (LDCT) of the chest significantly reduces mortality due to lung cancer, and several scientific societies now recommend this technique. COPD, defined by the presence of airflow obstruction [forced expiratory volume and forced vital capacity (FVC) ratio less than 0.70], and their clinical phenotypes, namely emphysema and chronic bronchitis, have been associated with increased lung cancer risk. Several epidemiological studies, including lung cancer screening trials, have found a 2- to 4-fold increase in lung cancer risk in patients with COPD when compared to individuals without airflow obstruction. Part of the risk attributed to airflow obstruction appears to be derived from the presence of radiographic emphysema. The latter has proven to be an important lung cancer risk factor in smokers without airflow obstruction and even in never smokers. This evidence supports the idea of including patients with COPD and/or emphysema in lung cancer screening programs. There is evidence that lung cancer screening in this population is effective and can potentially reduce mortality. Specific lung cancer risk scores have been developed for patients with COPD [COPD lung cancer screening score (LUCSS) and COPD-LUCSS-diffusing capacity for carbon monoxide (DLCO)] to identify those at high risk. A multidisciplinary approach for an adequate patient selection, especially of patients with severe disease, is key to maximize benefits and reduce harms from lung cancer screening in this population. Patients with COPD included in lung cancer screening programs could also benefit from other interventions, such as smoking cessation and adequate treatment. PMID:27195278

  4. Patients with chronic obstructive pulmonary disease and chronically colonized with Haemophilus influenzae during stable disease phase have increased airway inflammation

    PubMed Central

    Tufvesson, Ellen; Bjermer, Leif; Ekberg, Marie

    2015-01-01

    Background Some patients with chronic obstructive pulmonary disease (COPD) show increased airway inflammation and bacterial colonization during stable phase. The aim of this study was to follow COPD patients and investigate chronic colonization with pathogenic bacteria during stable disease phase, and relate these findings to clinical parameters, inflammatory pattern, lung function, and exacerbations. Methods Forty-three patients with COPD were included while in a stable state and followed up monthly until exacerbation or for a maximum of 6 months. The patients completed the Clinical COPD Questionnaire and Medical Research Council dyspnea scale questionnaires, and exhaled breath condensate was collected, followed by spirometry, impulse oscillometry, and sputum induction. Results Ten patients were chronically colonized (ie, colonized at all visits) with Haemophilus influenzae during stable phase. These patients had higher sputum levels of leukotriene B4 (P<0.001), 8-isoprostane (P=0.002), myeloperoxidase activity (P=0.028), and interleukin-8 (P=0.02) during stable phase when compared with other patients. In addition, they had lower forced vital capacity (P=0.035) and reactance at 5 Hz (P=0.034), but there was no difference in forced expiratory volume in 1 second (FEV1), FEV1 % predicted, forced vital capacity % predicted, exhaled breath condensate biomarkers, C-reactive protein, or Clinical COPD Questionnaire and Medical Research Council dyspnea scale results. Three patients had intermittent colonization (colonized at only some visits) of H. influenzae during stable phase, and had lower levels of inflammatory biomarkers in sputum when compared with the chronically colonized patients. The difference in airway inflammation seen during stable phase in patients chronically colonized with H. influenzae was not observed during exacerbations. Conclusion Some COPD patients who were chronically colonized with H. influenzae during stable phase showed increased airway

  5. PTCH1 expression at diagnosis predicts imatinib failure in chronic myeloid leukaemia patients in chronic phase.

    PubMed

    Alonso-Dominguez, Juan M; Grinfeld, Jacob; Alikian, Mary; Marin, David; Reid, Alistair; Daghistani, Mustafa; Hedgley, Corinne; O'Brien, Stephen; Clark, Richard E; Apperley, Jane; Foroni, Letizia; Gerrard, Gareth

    2015-01-01

    The tyrosine kinase inhibitor (TKI) imatinib has revolutionized the management of chronic myeloid leukaemia (CML). However, around 25% of patients fail to sustain an adequate response. We sought to identify gene-expression biomarkers that could be used to predict imatinib response. The expression of 29 genes, previously implicated in CML pathogenesis, were measured by TaqMan Low Density Array in 73 CML patient samples. Patients were divided into low and high expression for each gene and imatinib failure (IF), probability of achieving CCyR, progression free survival and CML related OS were compared by Kaplan-Meier and log-rank. Results were validated in a second cohort of 56 patients, with a further technical validation using custom gene-expression assays in a conventional RT-qPCR in a sub-cohort of 37 patients. Patients with low PTCH1 expression showed a worse clinical response for all variables in all cohorts. PTCH1 was the most significant predictor in the multivariate analysis compared with Sokal, age and EUTOS. PTCH1 expression assay showed the adequate sensitivity, specificity and predictive values to predict for IF. Given the different treatments available for CML, measuring PTCH1 expression at diagnosis may help establish who will benefit best from imatinib and who is better selected for second generation TKI. PMID:25250944

  6. Interleukin-6 may mediate malnutrition in chronic hemodialysis patients.

    PubMed

    Kaizu, Y; Kimura, M; Yoneyama, T; Miyaji, K; Hibi, I; Kumagai, H

    1998-01-01

    Studies were performed to investigate the relationship between serum interleukin-6 (IL-6) and the nutritional status in chronic hemodialysis patients. Serum IL-6 in 45 patients (21 men and 24 women), each with chronic renal failure and having undergone hemodialysis for more than 3 years, was measured before and after a dialysis session. The nutritional status of each patient was evaluated by measuring body mass index (BMI), body weight loss for 3 years, midarm muscle area (MAMA), serum albumin, prealbumin, and insulin-like growth factor-1. Serum IL-6 was significantly higher in the patients undergoing hemodialysis (11.7 +/- 2.8 pg/mL) than in healthy volunteers (< 0.6 pg/mL). There was no further increase in serum IL-6 after a dialysis session when the extracellular water volume was corrected by the ultrafiltrate volume. Predialytic serum IL-6 was significantly correlated with serum albumin (r = -0.4, P = 0.006), cholinesterase (r = -0.51, P = 0.001), body weight change for 3 years (r = -0.48, P = 0.001) and MAMA r = -0.39, P = 0.05). With the patients divided into two groups, a high serum IL-6 (>10 pg/mL) group and low serum IL-6 (<10 pg/mL) group, the body weight loss for 3 years (-4.60% +/- 1.39% v 0.76 +/- 0.75%, P < 0.01) was significantly higher, and the serum albumin level (3.66 +/- 0.10 g/dL v 3.96 +/- 0.05 g/dL, P < 0.05) was significantly lower in those patients with high serum IL-6 than in those with low serum IL-6. The results of a multiple regression analysis indicated that the serum IL-6 level was dependent on the duration of hemodialysis, age, and the dialysis membrane properties. These results suggest that the nutritional status in chronic hemodialysis patients was affected, at least in part, by the circulating IL-6 level. Multiple factors, such as long-term hemodialysis, aging, and the use of a regenerated cellulose membrane dialyzer, were associated with this increased level of IL-6.

  7. [Isosporiasis in an elderly patient with chronic diseases: case report].

    PubMed

    Ünal, Nevzat; Güney, Akif Koray; Bilgin, Kemal; Yavuz, Yücel; Hökelek, Murat; Günaydın, Murat

    2013-01-01

    Isospora belli is a coccidian protozoon that can cause serious diarrhea especially in immunocompromised patients. The laboratory diagnosis depends primarily on the identification of oocysts in stool specimens by direct microscopic examination with iodine or special stains. This case is presented in order to draw attention to isosporiasis among the diarrheas that can be seen in elderly patients with several chronic diseases. A 81 year-old debilitated male, who had a history of hypertension, Alzheimer's disease, previous cerebrovascular accident and right hemiplegia, was admitted to our hospital complaining of malaise, anorexia, chills, abdominal pain, dysuria, cough, sputum and diarrhea of ten days duration. I. belli oocysts were detected by microscopic examination of the sample with iodine after concentration by formalin-ethyl acetate sedimentation. Then, modified acid-fast and trichrome stains were performed and I. belli oocysts were detected with both methods. Similar to this case, infections caused by I. belli can occur in elderly immunocompromised patients with several chronic diseases and inadequate nutrition and care. Consequently, in individuals with persistent diarrhea, examinations and tests should be carried out by taking their immune status into consideration and stool examinations should be done at frequent intervals using the concentrations methods and special stains.

  8. Relationship of aluminum to neurocognitive dysfunction in chronic dialysis patients

    SciTech Connect

    Sprague, S.M.; Corwin, H.L.; Tanner, C.M.; Wilson, R.S.; Green, B.J.; Goetz, C.G.

    1988-10-01

    Aluminum has been proposed as the causative agent in dialysis encephalopathy syndrome. We prospectively assessed whether other, less severe, neuropsychologic abnormalities were also associated with aluminum. A total of 16 patients receiving chronic dialytic therapy were studied. The deferoxamine infusion test (DIT) was used to assess total body aluminum burden. Neurologic function was evaluated by quantitative measures of asterixis, myoclonus, motor strength, and sensation. Cognitive function was assessed by measures of dementia, memory, language, and depression. There were four patients with a positive DIT (greater than 125 micrograms/L increment in serum aluminum) that was associated with an increase in the number of neurologic abnormalities observed, as well as an increase in severity of myoclonus, asterixis, and lower extremity weakness. Patients with a positive DIT also showed significant impairment in memory; however, no differences were noted on tests of dementia, depression, or language. There was no significant correlation between sex, age, presence of diabetes, mode of dialysis, years of chronic renal failure, years of dialysis or years of aluminum ingestion and any neurologic or neurobehavioral measurement, serum aluminum level, or DIT. These changes may represent early aluminum-associated neurologic dysfunction.

  9. Thalamic Reorganization in Chronic Patients With Intracerebral Hemorrhage

    PubMed Central

    Jang, Sung Ho; Chang, Chul Hoon; Kim, Seong Ho; Jung, Young Jin; Hong, Ji Heon

    2015-01-01

    Abstract The aim of this study was to investigate changes of synaptic area of the spinothalamic tract and its thalamocortical pathway (STT) in the thalamus in chronic patients with putaminal hemorrhage. Twenty four patients with a lesion in the ventral posterior lateral nucleus (VPL) of the thalamus following putaminal hemorrhage were recruited for this study. The subscale for tactile sensation of the Nottingham Sensory Assessment (NSA) was used for the determination of somatosensory function. Diffusion tensor tractography of the STT was reconstructed using the Functional Magnetic Resonance Imaging of the Brain Software Library. We classified patients according to 2 groups: the VPL group, patients whose STTs were synapsed in the VPL; and the non-VPL group, patients whose STTs were synapsed in other thalamic areas, except for the VPL. Thirteen patients belonged to the VPL group, and 8 patients belonged to the non-VPL group. Three patients were excluded from grouping due to interrupted integrity of the STTs. The tactile sensation score of the NSA in the non-VPL group (10.50 ± 0.93) was significantly decreased compared with that of the VPL group (19.45 ± 1.33) (P < 0.05). We found that 2 types of patient had recovered via the VPL area or other areas of the STT. It appears that patients who showed shifting of the thalamic synaptic area of the STT might have recovered by the process of thalamic reorganization following thalamic injury. In addition, thalamic reorganization appears to be related to poorer somatosensory outcome. PMID:26313781

  10. Functioning of patients with chronic idiopathic axonal polyneuropathy (CIAP).

    PubMed

    Erdmann, Peter G; Teunissen, Laurien L; van Genderen, Frank R; Notermans, Nicolette C; Lindeman, Eline; Helders, Paul J M; van Meeteren, Nico L U

    2007-09-01

    Although patients with Chronic Idiopathic Axonal Polyneuropathy (CIAP) report a slow deterioration of sensory and motor functions, the impact of this deterioration on daily functioning has not yet been investigated in detail. The first aim of this cross-sectional study involving 56 patients with CIAP was, therefore, to assess patients' functioning with use of the International Classification of Functioning, Disability and Health (ICF). The second aim was to find determinants of walking ability, dexterity, and autonomy. Fatigue and limited walking ability were present in most patients and differed considerably. In regression models, age, muscle strength, and fatigue together explained 63% of the variance in walking ability, which by itself explained almost 50% of the variance in patients' autonomy indoors and outdoors (42% and 49%, respectively). Muscle strength and sensory function scores together explained 30% of the variance in dexterity scores, which in turn explained only 13% of the variance in autonomy indoors. The diminished autonomy of patients with CIAP might be improved by reducing fatigue, by means of training, and by improving walking ability. PMID:17385078

  11. Basophil activation test with food additives in chronic urticaria patients.

    PubMed

    Kang, Min-Gyu; Song, Woo-Jung; Park, Han-Ki; Lim, Kyung-Hwan; Kim, Su-Jung; Lee, Suh-Young; Kim, Sae-Hoon; Cho, Sang-Heon; Min, Kyung-Up; Chang, Yoon-Seok

    2014-01-01

    The role of food additives in chronic urticaria (CU) is still under investigation. In this study, we aimed to explore the association between food additives and CU by using the basophil activation test (BAT). The BAT using 15 common food additives was performed for 15 patients with CU who had a history of recurrent urticarial aggravation following intake of various foods without a definite food-specific IgE. Of the 15 patients studied, two (13.3%) showed positive BAT results for one of the tested food additives. One patient responded to monosodium glutamate, showing 18.7% of CD203c-positive basophils. Another patient showed a positive BAT result to sodium benzoate. Both patients had clinical correlations with the agents, which were partly determined by elimination diets. The present study suggested that at least a small proportion of patients with CU had symptoms associated with food additives. The results may suggest the potential utility of the BAT to identity the role of food additives in CU.

  12. Patient autonomy in chronic care: solving a paradox

    PubMed Central

    Reach, Gérard

    2014-01-01

    The application of the principle of autonomy, which is considered a cornerstone of contemporary bioethics, is sometimes in obvious contradiction with the principle of beneficence. Indeed, it may happen in chronic care that the preferences of the health care provider (HCP), who is largely focused on the prevention of long term complications of diseases, differ from those, more present oriented, preferences of the patient. The aims of this narrative review are as follows: 1) to show that the exercise of autonomy by the patient is not always possible; 2) where the latter is not possible, to examine how, in the context of the autonomy principle, someone (a HCP) can decide what is good (a treatment) for someone else (a patient) without falling into paternalism. Actually this analysis leads to a paradox: not only is the principle of beneficence sometimes conflicting with the principle of autonomy, but physician’s beneficence may enter into conflict with the mere respect of the patient; and 3) to propose a solution to this paradox by revisiting the very concepts of the autonomous person, patient education, and trust in the patient–physician relationship: this article provides an ethical definition of patient education. PMID:24376345

  13. Restless Legs Syndrome in Patients With Chronic Kidney Disease.

    PubMed

    Novak, Marta; Winkelman, John W; Unruh, Mark

    2015-07-01

    Symptoms of restless legs syndrome (RLS) are common in patients with chronic kidney disease (CKD) on dialysis; symptoms of RLS are estimated to affect up to 25% of patients on dialysis when the international RLS diagnostic criteria are applied. RLS is a neurologic disorder with a circadian rhythmicity characterized by an overwhelming urge to move the legs during rest, which can be relieved temporarily by movement. RLS has been associated with an increase in sleep disturbance, higher cardiovascular morbidity, decreased quality of life, and an increased risk of death in patients with CKD. Although the exact pathophysiology of RLS is unknown, it is thought to involve an imbalance in iron metabolism and dopamine neurotransmission in the brain. The symptoms of moderate to severe RLS can be treated with several pharmacologic agents; however, data specific to patients on dialysis with RLS are lacking. The purpose of this article is to examine the relationship between, and complications of, RLS and CKD both in dialysis and nondialysis patients, and discuss the treatment options for patients on dialysis with RLS.

  14. Basophil Activation Test with Food Additives in Chronic Urticaria Patients

    PubMed Central

    Kang, Min-Gyu; Song, Woo-Jung; Park, Han-Ki; Lim, Kyung-Hwan; Kim, Su-Jung; Lee, Suh-Young; Kim, Sae-Hoon; Cho, Sang-Heon; Min, Kyung-Up

    2014-01-01

    The role of food additives in chronic urticaria (CU) is still under investigation. In this study, we aimed to explore the association between food additives and CU by using the basophil activation test (BAT). The BAT using 15 common food additives was performed for 15 patients with CU who had a history of recurrent urticarial aggravation following intake of various foods without a definite food-specific IgE. Of the 15 patients studied, two (13.3%) showed positive BAT results for one of the tested food additives. One patient responded to monosodium glutamate, showing 18.7% of CD203c-positive basophils. Another patient showed a positive BAT result to sodium benzoate. Both patients had clinical correlations with the agents, which were partly determined by elimination diets. The present study suggested that at least a small proportion of patients with CU had symptoms associated with food additives. The results may suggest the potential utility of the BAT to identity the role of food additives in CU. PMID:24527415

  15. Kinetics of parathyroid hormone after parathyroidectomy in chronic hemodialysis patients.

    PubMed

    Skalli, Z; Elouazzani, H; Alhamany, Z; Mattous, M; Benamar, L; Bayahia, R; Belkouchi, M; El Malki, HadjOmar; Ouzeddoun, N

    2015-11-01

    Secondary hyperparathyroidism is a common complication in chronic renal failure. The treatment in some cases requires parathyroidectomy. The kinetics of the parathyroid hormone (PTH) levels after surgery helps to evaluate the efficacy of parathyroidectomy. Prospective analysis was made of the kinetics of intact PTH (iPTH) after parathyroidectomy in 10 chronic hemodialysis (HD) patients who had secondary hyperparathyroidism. We determined the levels of iPTH before surgery and its evolution after parathyroidectomy at regular intervals: Day 0, D7, D15, D30 and D90. The mean age of our patients was 40 ± 13 years, with a sex ratio of 1. The mean duration on HD was 122 ± 63 months. The duration of secondary hyperparathyroidism varied from one year to 12 years. All patients had received medical treatment for hyperparathyroidism. The indications for parathyroidectomy included resistance to medical treatment in seven cases, development of brown tumors in two cases and soft tissue calcifications in one case. All patients had radiographic evidence of hyperparathyroidism. The parathyroidectomy was sub-total in all patients, 6/8 in four cases and 7/8 in six cases. The mean iPTH level was 2341 ± 1946 pg/mL before surgery. A sharp drop in this level was noticed on D0, with a median of 92 pg/mL and, thereafter, the levels were 79 pg/mL on D7, 25 pg/mL on D15 and 36 pg/mL after 1 month. At 3 months post-surgery, the mean iPTH level was 302 pg/mL. Histological examination of the resected gland showed parathyroid hyperplasia in all patients. In our series, the efficacy of sub-total parathyroidectomy was satisfactory with rapid normalization of PTH, which is consistent with the literature data. Sub-total parathyroidectomy still has a place in the treatment of secondary hyperparathyroidism in chronic renal failure. Its indications should be limited to cases resistant to medical treatment and, in particular, in cases with occurrence of complications. PMID:26586059

  16. Inflammatory mechanisms in patients with chronic obstructive pulmonary disease.

    PubMed

    Barnes, Peter J

    2016-07-01

    Chronic obstructive pulmonary disease (COPD) is associated with chronic inflammation affecting predominantly the lung parenchyma and peripheral airways that results in largely irreversible and progressive airflow limitation. This inflammation is characterized by increased numbers of alveolar macrophages, neutrophils, T lymphocytes (predominantly TC1, TH1, and TH17 cells), and innate lymphoid cells recruited from the circulation. These cells and structural cells, including epithelial and endothelial cells and fibroblasts, secrete a variety of proinflammatory mediators, including cytokines, chemokines, growth factors, and lipid mediators. Although most patients with COPD have a predominantly neutrophilic inflammation, some have an increase in eosinophil counts, which might be orchestrated by TH2 cells and type 2 innate lymphoid cells though release of IL-33 from epithelial cells. These patients might be more responsive to corticosteroids and bronchodilators. Oxidative stress plays a key role in driving COPD-related inflammation, even in ex-smokers, and might result in activation of the proinflammatory transcription factor nuclear factor κB (NF-κB), impaired antiprotease defenses, DNA damage, cellular senescence, autoantibody generation, and corticosteroid resistance though inactivation of histone deacetylase 2. Systemic inflammation is also found in patients with COPD and can worsen comorbidities, such as cardiovascular diseases, diabetes, and osteoporosis. Accelerated aging in the lungs of patients with COPD can also generate inflammatory protein release from senescent cells in the lung. In the future, it will be important to recognize phenotypes of patients with optimal responses to more specific therapies, and development of biomarkers that identify the therapeutic phenotypes will be important. PMID:27373322

  17. Fanconi syndrome and chronic renal failure in a chronic hepatitis B monoinfected patient treated with tenofovir.

    PubMed

    Magalhães-Costa, Pedro; Matos, Leopoldo; Barreiro, Pedro; Chagas, Cristina

    2015-07-01

    Tenofovir disoproxil fumarate (TDF) is one of the first-line treatment options in chronic hepatitis B (CHB). Despite its efficacy in suppressing viral load and a high resistance barrier, long life maintenance therapy is required. Registration studies demonstrated TDF to be a safe drug. However, post-marketing experience reported cases of serious nephrotoxicity associated with hypophosphatemia, osteomalacia and, even more recently, Fanconi syndrome associated with TDF therapy in CHB monoinfected patients.Here the authors report a case of a 40 year-old male, with a CHB monoinfection, that, three years after TDF therapy, developed a progressive chronic kidney disease with a serious hypophosphatemia and a secondary osteomalacia that was manifested by bone pain and multiple bone fractures. Further investigational analyses unveiled a proximal renal tubular dysfunction, which fulfilled most of the diagnostic criteria for a Fanconi syndrome. After TDF withdrawal and oral supplementation with phosphate and calcitriol, his renal function stabilized (despite not returning to normal), proximal renal tubular dysfunction abnormalities resolved as well as osteomalacia. In conclusion, physicians should be aware that, in CHB monoinfected patients under TDF therapy, serious renal damage is possible and preventable by timely monitoring serum creatinine and phosphate. PMID:26228957

  18. Managing acute back pain patients to avoid the transition to chronic pain.

    PubMed

    Chou, Roger; McCarberg, Bill

    2011-01-01

    Chronic back pain is a major source of disability, decreased quality of life and healthcare costs. Treating chronic back pain is difficult, with even effective therapies only being modestly effective. Helping patients avoid the transition from acute to chronic low back pain is a promising strategy for preventing suffering and reducing healthcare utilization. The biopsychosocial model provides a useful framework for understanding factors that contribute to chronicity in low back pain, and are important targets for interventions. This article reviews recent research on predictors of chronicity and treatment strategies in higher risk patients that may be helpful for preventing chronicity. PMID:24654586

  19. Right anterior superior temporal activation predicts auditory sentence comprehension following aphasic stroke.

    PubMed

    Crinion, Jenny; Price, Cathy J

    2005-12-01

    Previous studies have suggested that recovery of speech comprehension after left hemisphere infarction may depend on a mechanism in the right hemisphere. However, the role that distinct right hemisphere regions play in speech comprehension following left hemisphere stroke has not been established. Here, we used functional magnetic resonance imaging (fMRI) to investigate narrative speech activation in 18 neurologically normal subjects and 17 patients with left hemisphere stroke and a history of aphasia. Activation for listening to meaningful stories relative to meaningless reversed speech was identified in the normal subjects and in each patient. Second level analyses were then used to investigate how story activation changed with the patients' auditory sentence comprehension skills and surprise story recognition memory tests post-scanning. Irrespective of lesion site, performance on tests of auditory sentence comprehension was positively correlated with activation in the right lateral superior temporal region, anterior to primary auditory cortex. In addition, when the stroke spared the left temporal cortex, good performance on tests of auditory sentence comprehension was also correlated with the left posterior superior temporal cortex (Wernicke's area). In distinct contrast to this, good story recognition memory predicted left inferior frontal and right cerebellar activation. The implication of this double dissociation in the effects of auditory sentence comprehension and story recognition memory is that left frontal and left temporal activations are dissociable. Our findings strongly support the role of the right temporal lobe in processing narrative speech and, in particular, auditory sentence comprehension following left hemisphere aphasic stroke. In addition, they highlight the importance of the right anterior superior temporal cortex where the response was dissociated from that in the left posterior temporal lobe.

  20. [Therapeutic exercise for patients with chronic low-back pain].

    PubMed

    Grazio, Simeon; Grgurević, Lovorka; Vlak, Tonko; Perić, Porin; Nemčić, Tomislav; Vrbanić, Tea Schurrer Luke; Kadojić, Mira; Gnjidić, Zoja; Grubišić, Frane; Balen, Diana; Vuga, Katarina Lohman; Ćurković, Boždiar

    2014-01-01

    Low Back Pain (LBP) is a major medical and socio-economical problem in the industrialized countries. Exercise therapy is the keystone of conservative treatment for chronic low back pain (CLBP). Numerous randomized trials and clinical practice guidelines have supported that exercise diminishes disability and pain severity while improving fitness and occupational status in patients with CLBP, as well as decrease its recurrence rate. However, there is no significant evidence that one particular type of exercise is clearly more effective than others. Here we present a descriptive review of different types of exercise for therapeutic or prevention purposes in patients with CLBP. Studies suggest that individually tailored, supervised exercise programs are associated with the best outcomes. High quality clinical trials are needed to determine the effectiveness of specific interventions (type, time, intensity and other characteristics) aimed at individuals and/or specific target groups.

  1. [Planning of cardiothoracic surgery for chronic kidney disease patients].

    PubMed

    Okamoto, Yasuhisa; Nohmi, Tosihiro; Seki, Koichiro; Higa, Yuki

    2013-11-01

    Chronic renal failure (CRF) is related to cardiac diseases. Cardiac surgery is also related to postoperative acute kidney injury (AKI). It means heart and kidney have close relationship. We analyzed recent published data to understand how to manage CRF patients undergoing cardiovascular surgeries. We compared endovascular surgery and open procedure for aortic aneurysm, especially about contrast media-related renal damage, On or Off CABG or PCI for ischemic heart disease. We also discussed the relation between cardiopulmonary bypass and AKI and the risk factors causing AKI after CPB. Finally, we discussed prevention and treatment options of CPB related AKI, including furosemide, hANP mannitol, and statin. Published evidence in this area is still insufficient, but many studies are still carried out focusing on postoperative AKI. In the future we may be able to find the best answer for managing CRF patients undergoing cardiovascular surgeries.

  2. Vegetarianism: advantages and drawbacks in patients with chronic kidney diseases.

    PubMed

    Chauveau, Philippe; Combe, Christian; Fouque, Denis; Aparicio, Michel

    2013-11-01

    Vegetarian diet is a very old practice that is liable to confer some health benefits. Recent studies have demonstrated that modification of the dietary pattern with a reduction of animal protein intake and increased consumption of plant-based foods could influence cardiovascular risk profile and mortality rate. Moreover, phosphate bioavailability from plant proteins is reduced. These statements could lead to some benefits for chronic kidney disease (CKD) patients. This review summarizes the characteristics and benefits of vegetarian diets in the general population and the potential beneficial effects of such a diet on phosphate balance, insulin sensitivity, and the control of metabolic acidosis in CKD patients. Potential drawbacks exist when a vegetarian diet is associated with protein intake that is too restrictive and/or insufficient energy intake, justifying an early and regular nutritional follow-up jointly assumed by a nephrologist and a renal dietitian.

  3. Treatment failure in patients with chronic Blastocystis infection.

    PubMed

    Roberts, Tamalee; Ellis, John; Harkness, John; Marriott, Deborah; Stark, Damien

    2014-02-01

    This article reports long-term infection and treatment failure in 18 symptomatic individuals infected with Blastocystis spp. Patients were initially treated with either metronidazole, iodoquinol or triple combination therapy consisting of nitazoxanide, furazolidone and secnidazole. Following treatment, resolution of clinical symptoms did not occur and follow-up testing revealed ongoing infection with the same subtype. Patients then underwent secondary treatment with a variety of antimicrobial agents but remained symptomatic with Blastocystis spp. still present in faeces. Sequencing of the SSU rDNA was completed on all isolates and four subtypes were identified in this group: ST1, ST3, ST4 and ST5. This study highlights the lack of efficacy of several commonly used antimicrobial regimens in the treatment of Blastocystis and the chronic nature of some infections. It also demonstrates the need for further research into treatment options for Blastocystis infection. PMID:24243286

  4. Diets for patients with chronic kidney disease, should we reconsider?

    PubMed

    Mitch, William E; Remuzzi, Giuseppe

    2016-01-01

    Here we revisit how dietary factors could affect the treatment of patients with complications of chronic kidney disease (CKD), bringing to the attention of the reader the most recent developments in the field. We will briefly discuss five CKD-induced complications that are substantially improved by dietary manipulation: 1) metabolic acidosis and the progression of CKD; 2) improving the diet to take advantage of the benefits of angiotensin converting enzyme inhibitors (ACEi) on slowing the progression of CKD; 3) the diet and mineral bone disorders in CKD; 4) the safety of nutritional methods utilizing dietary protein restriction; and 5) evidence that new strategies can treat the loss of lean body mass that is commonly present in patients with CKD. PMID:27401192

  5. The older female patient with a complex chronic dissociative disorder.

    PubMed

    Kluft, Richard P

    2007-01-01

    Dissociative disorders are rarely considered in the diagnostic assessment of older women, despite the fact that the existence, appearance and characteristics of certain dissociative disorders in older populations has been known and described since the 1980s. This communication reviews the core phenomena of Dissociative Identity Disorder and related forms of Dissociative Disorder Not Otherwise Specified, the natural history of their phenomena from youth to old age, and describes common presentations of Dissociative Disorders in older women. It also reviews the treatment of complex chronic dissociative disorders and discusses alternative approaches to their psychotherapy in the older female patient. It is crucial to recognize and respect the importance of appreciating individual differences among older dissociative patients and to individualize their treatments accordingly.

  6. Home Telehealth for Patients With Chronic Obstructive Pulmonary Disease (COPD)

    PubMed Central

    Franek, J

    2012-01-01

    Executive Summary In July 2010, the Medical Advisory Secretariat (MAS) began work on a Chronic Obstructive Pulmonary Disease (COPD) evidentiary framework, an evidence-based review of the literature surrounding treatment strategies for patients with COPD. This project emerged from a request by the Health System Strategy Division of the Ministry of Health and Long-Term Care that MAS provide them with an evidentiary platform on the effectiveness and cost-effectiveness of COPD interventions. After an initial review of health technology assessments and systematic reviews of COPD literature, and consultation with experts, MAS identified the following topics for analysis: vaccinations (influenza and pneumococcal), smoking cessation, multidisciplinary care, pulmonary rehabilitation, long-term oxygen therapy, noninvasive positive pressure ventilation for acute and chronic respiratory failure, hospital-at-home for acute exacerbations of COPD, and telehealth (including telemonitoring and telephone support). Evidence-based analyses were prepared for each of these topics. For each technology, an economic analysis was also completed where appropriate. In addition, a review of the qualitative literature on patient, caregiver, and provider perspectives on living and dying with COPD was conducted, as were reviews of the qualitative literature on each of the technologies included in these analyses. The Chronic Obstructive Pulmonary Disease Mega-Analysis series is made up of the following reports, which can be publicly accessed at the MAS website at: http://www.hqontario.ca/en/mas/mas_ohtas_mn.html. Chronic Obstructive Pulmonary Disease (COPD) Evidentiary Framework Influenza and Pneumococcal Vaccinations for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Smoking Cessation for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Community-Based Multidisciplinary Care for Patients With Stable Chronic Obstructive

  7. INTESTINAL PARASITES IN PATIENTS WITH CHRONIC ABDOMINAL PAIN.

    PubMed

    Omran, Eman Kh; Mohammad, Asmaa N

    2015-08-01

    Information about intestinal parasites in Sohag (Upper Egypt) in patients with chronic abdominal pain is scarce. This study determined the intestinal parasites symptoms in 130 patients with chronic abdominal pain and cross-matched 20 healthy persons. Parasitic infection was confirmed by stool analysis.The most commonest clinical data with stool analysis was as following: 1-Entamoeba histolytica associated with nausea 20 (3 7.74%) followed by anorexia 19 (35.85%), 2-Entamoeba coli associated with diarrhea 3 (100%) followed by nausea 2 (66.67%) and vomiting 2 (66.67%), 3-Enetrobius vermicularis associated with nausea 2 (66.67%), diarrhea 2 (66.67%) followed by flatulence 1(33.33%), 4-Giardia lamblia associated with anorexia 3 (42.86%), vomiting 3 (42.86%) followed by diarrhea 2 (28.57%)., 6-Hymenolepis nana associated with anorexia 10 (40.00%) followed by flatulence 9 (36.00%), 7-Taenia saginata associated with dyspepsia 3 (60.00%) followed by flatulence 2 (40.00%), and 8-Ancylostoma duodenal associated with anorexia 2 (66.67%) and diarrhea 2 (66.67%). PMID:26485858

  8. Stance Postural Strategies in Patients with Chronic Inflammatory Demyelinating Polyradiculoneuropathy

    PubMed Central

    Missori, Paolo; Trompetto, Carlo; Fattapposta, Francesco

    2016-01-01

    Introduction Polyneuropathy leads to postural instability and an increased risk of falling. We investigated how impaired motor impairment and proprioceptive input due to neuropathy influences postural strategies. Methods Platformless bisegmental posturography data were recorded in healthy subjects and patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Each subject stood on the floor, wore a head and a hip electromagnetic tracker. Sway amplitude and velocity were recorded and the mean direction difference (MDD) in the velocity vector between trackers was calculated as a flexibility index. Results Head and hip postural sway increased more in patients with CIDP than in healthy controls. MDD values reflecting hip strategies also increased more in patients than in controls. In the eyes closed condition MDD values in healthy subjects decreased but in patients remained unchanged. Discussion Sensori-motor impairment changes the balance between postural strategies that patients adopt to maintain upright quiet stance. Motor impairment leads to hip postural strategy overweight (eyes open), and prevents strategy re-balancing when the sensory context predominantly relies on proprioceptive input (eyes closed). PMID:26977594

  9. [Self-Management in Patients With Chronic Kidney Disease].

    PubMed

    Chiou, Chou-Ping; Lu, Yung-Chuan; Hung, Shih-Yuan

    2016-04-01

    Chronic kidney disease (CKD) patients typically self-manage their disease-care program. Self-management requires the investment of considerable time and energy in health management and in following the multifaceted CKD treatment regimen. CKD, a progressive disease, is classified into five stages that correspond to the five stages of decline in kidney function, as measured using the glomerular filtration rate (GRF). Each of these stages requires that a patient modify his / her lifestyle and shoulder the responsibility for day-to-day health management tasks. Key to promoting self-management is the partnership and collaboration between healthcare providers and patients. Tasks in this partnership include patient assessment and communication, regimen adherence, emotional management, negotiation of care plans, and the enhancement of self-efficacy, with the aims of creating positive changes in behavior, promoting correct symptoms interpretation and reporting, and promoting the appropriate use of resources. Nurses may help patients maneuver this initially frightening and sometimes difficult terrain with strategies that are tailored to each CKD stage.

  10. Hypertension management: special considerations in chronic kidney disease patients.

    PubMed

    Smith, James P; Lewis, Julia B

    2004-12-01

    It has been estimated that approximately 11% of the US adult population has chronic kidney disease (CKD), and it has been demonstrated that the prevalence of hypertension rises significantly as renal function declines. Even mild CKD significantly increases mortality risk, and cardiovascular disease remains the main cause of death among these patients. Although CKD patients have generally been excluded from trials testing the effect of lowering blood pressure on cardiovascular outcomes, guidelines suggest lowering blood pressure in hopes of reducing cardiovascular mortality and slowing the progression of renal disease. The preferred antihypertensive agents among these patients are drugs that block the renin-angiotensin system. In most hypertensive CKD patients, however, multiple agents are necessary to reach blood pressure targets. In general, diuretics and calcium channel blockers are added subsequently as adjunctive therapy. Hopefully, with increased recognition of the unique aspects of treating hypertension in this population, end-stage renal disease and cardiovascular morbidity and mortality will be delayed or avoided in the millions of patients with CKD.

  11. Psychological characteristics of patients treated by chronic maintenance hemodialysis.

    PubMed

    Pop-Jordanova, Nada D; Polenakovic, Momir H

    2013-02-01

    Studies related to psychological aspects of dialysis patients show that depression and anxiety are the most common characteristics. The aim of our study was to analyze the personality profile in patients on chronic maintenance dialysis and to evaluate more specifically the level of depression. The total number of patients was 68 (30 females and 38 males), with mean age 62.3 and 56.5 for females and males respectively. Mean duration of dialysis was 6.73 years for females and 6.68 years for men (the period varied from 0.5 to 18 years). For the evaluation of psychological characteristics, we used two psychometric instruments: Minnesota Multiphase Personality Inventory (MMPI- 201) and Beck Depression Inventory. The obtained results confirmed the presence of depression in patients treated with hemodialysis. The level of depression is variable (minimal is present in 21.43%; mild in 35.71%; moderate in 17.85% and severe in 14.28% of patients). The depression is significantly positively correlated with age (p<0.05) as well as with educational level, and negatively with the duration of dialysis. Specific characteristics of personality obtained with MMPI are hypersensitivity, depressive mood, and withdrawal from friends and relatives. More specific emotional traits are the accentuated anxiety, low level of hostility, but very high passive aggression which destroys their social communications. Some response measures for depression such as relaxation training, psychological support, music therapy, or peripheral biofeedback are recommended. PMID:23335381

  12. Indirect self-destructive behavior in chronic hemodialysis patients.

    PubMed

    Gerber, K E; Nehemkis, A M; Farberow, N L; Williams, J

    1981-01-01

    As one of a series of investigations of indirect self-destructive behavior, a pilot study was conducted with a group of 32 chronic hemodialysis patients for those characteristics of such behavior which had emerged as most salient in earlier studies: self-esteem, locus of control, rigidity, impulsivity, futurity, risk-taking and denial. Using an average of ratings of cooperativeness obtained from the head nurse, physician, dietician, technician, and staff nurse, the group was divided into two subgroups of more and less cooperative patients, and the demographic, medical, and psychological data from the two groups were compared. The findings suggest that the less cooperative hemodialysis patients have experienced the illness as a more severe blow to their self-concept and have failed to integrate their illness into an effective adaptive life pattern. The uncooperative patients feel less valued and less appreciated not only by their family but also by fellow patients and by hospital staff. They show significantly more anger and withdrawal than the more cooperative group and appear to have compensated for a significantly greater sense of powerlessness by the development of manipulative behaviors in relating to their medical caretakers.

  13. [Hyperhomocysteinemia as a vascular risk factor in chronic hemodialysis patients].

    PubMed

    Trimarchi, Hernán; Young, Pablo; Díaz, María L; Schropp, Juan; Forrester, Mariano; Freixas, Emilio

    2005-01-01

    Homocysteine is an independent risk factor for cardiovascular disease in the general population. In addition, it plays a main role in the development of atherogenesis and thrombosis, particularly in end-stage renal disease patients. Therefore, hemodialysis patients are under the burden of homocysteine toxic effects, present in nearly 90% of dialysis patients. Our group found that folic acid is an efficient therapeutic approach to decrease homocysteine levels, and the addition of intravenous methylcobalamin potentiates this effect; however, methylcobalamin alone was unsuccessful to normalize homocysteine levels. With time a group of patients required a higher dose of folic acid to reduce hyperhomocysteinemia. Patients homozygous and, to a lesser extent heterozygous, to the C677T thermolabile variant of methylenetetrahydrofolate reductase (MTHFR) presented a reduced catalytic activity and required a higher folic acid dose. Vascular-access thrombotic events were similar in all patients according to the variants of the enzyme, suggesting that treating hyperhomocysteinemia was the key to lower the risk of thromboses. Noteworthy, hypohomocysteinemia, generally acompanying malnourishment, is associated to higher mortality. Albeit hyper-homocysteinemia is considered a vascular risk factor in renal failure patients, it has not yet been established in this population if its correction is associated with a decrease in the rate of vascular disease and thrombosis. However, given the mentioned evidence about the low risk and good tolerance of vitamin therapy, we believe it useful to know folate, cobalamin and homocysteine blood levels in chronic renal patients and start a prompt treatment, which may proof adequate to maintain homocysteine levels of 10 +/- 5 micromol/l. PMID:16433478

  14. Predictors of Olfactory Dysfunction in Patients with Chronic Rhinosinusitis

    PubMed Central

    Litvack, Jamie R.; Fong, Karen; Mace, Jess; James, Kenneth E.; Smith, Timothy L.

    2009-01-01

    Objectives To measure the prevalence of and identify clinical characteristics associated with poor olfactory function in a large cohort of patients with chronic rhinosinusitis (CRS). Study Design Multi-institutional, cross sectional analysis. Methods An objective measure of olfactory dysfunction, the Smell Identification Test (SIT), demographic data, clinical factors and co-morbidity data were collected from a cohort of 367 patients who presented with CRS at three tertiary care centers. Data was analyzed using univariate and multivariate analyses. Results Sixty-four percent of men and women aged 18 to 64 had olfactory dysfunction whereas 95% of patients ≥ 65 years had olfactory dysfunction (p<0.001); no significant difference was noted by gender. By multivariate logistic regression analysis, patients with nasal polyposis (OR 2.4, 95% confidence interval (CI) 1.3, 4.2; p=0.003) and patients ≥ 65 years (OR 10.0, 95% CI 2.3, 43.7; p=0.002) were at increased risk of hyposmia. Patients with nasal polyposis (OR 13.2, 95% CI 5.7, 30.7; p<0.001), asthma (OR 4.2, 95% CI 1.8, 9.8; p=0.001), ≥ 65 years (OR 15.6, 95% CI 2.3, 104.9; p=0.005), and smokers (OR 7.6, 95% CI 1.8, 31.6; p=0.005) were at increased risk of anosmia. Conclusions Poor olfactory function is common in patients with CRS. Age, nasal polyposis, smoking, and asthma were significantly associated with olfactory dysfunction in patients with CRS. Neither prior endoscopic sinus surgery nor a history of allergic rhinitis was associated with olfactory dysfunction. Septal deviation and inferior turbinate hypertrophy were associated with normal olfactory function. PMID:19029858

  15. Potential drug-drug interactions in hospitalized patients with chronic heart failure and chronic obstructive pulmonary disease

    PubMed Central

    Roblek, Tina; Trobec, Katja; Mrhar, Ales

    2014-01-01

    Introduction Polypharmacy is common in patients with chronic heart failure (HF) and/or chronic obstructive pulmonary disease (COPD), but little is known about the prevalence and significance of drug-drug interactions (DDIs). This study evaluates DDIs in hospitalized patients. Material and methods We retrospectively screened medical charts over a 6-month period for diagnosis of chronic HF and/or COPD. Potential DDIs were evaluated using Lexi-Interact software. Results Seven hundred and seventy-eight patients were included in the study (median age 75 years, 61% men). The median number of drugs on admission and discharge was 6 (interquartile range (IQR) 4–9) and 7 (IQR 5–), respectively (p = 0.10). We recorded 6.5 ±5.7 potential DDIs per patient on admission and 7.2 ±5.6 on discharge (p = 0.2). From admission to discharge, type-C and type-X potential DDIs increased (p < 0.05 for both). Type X interactions were rare (< 1%), with the combination of a β-blocker and a β2 agonist being the most common (64%). There were significantly more type-C and type-D potential DDIs in patients with chronic HF as compared to patients with COPD (p < 0.001). Patients with concomitant chronic HF and COPD had more type-C and type-X potential DDIs when compared to those with individual disease (p < 0.005). An aldosterone antagonist and ACE inhibitor/ARB were prescribed to 3% of chronic HF patients with estimated glomerular filtration rate < 30 ml/(min × 1.73 m2). Conclusions The DDIs are common in patients with chronic HF and/or COPD, but only a few appear to be of clinical significance. The increase in potential DDIs from admission to discharge may reflect better guideline implementation rather than poor clinical practice. PMID:25395943

  16. Glucose abnormalities in Asian patients with chronic hepatitis C.

    PubMed

    Bo, Qingyan; Orsenigo, Roberto; Wang, Junyi; Griffel, Louis; Brass, Clifford

    2015-01-01

    Many studies have demonstrated a potential association between type 2 diabetes (T2D) and hepatitis C virus infection in Western countries, while similar evidence is limited in Asia. We compared the prevalence of glucose abnormalities (impaired fasting glucose [IFG] and T2D) and their risk factors between Asian and non-Asian chronic hepatitis C (CHC) patients, and evaluated whether glucose abnormalities impacted the viral responses to peginterferon plus ribavirin treatment (current standard of care in most Asian countries). This study retrospectively analyzed data of 1,887 CHC patients from three Phase II/III studies with alisporivir (DEB025) as treatment for CHC. The chi-square test was used to compare the prevalence of IFG/T2D between Asian and non-Asian CHC patients, and logistic regression was used to adjust for sex, age, and cirrhosis status. Risk factors for IFG/T2D were evaluated using univariate and multivariate analysis. Our results indicated that the prevalence of IFG/T2D was high in both Asian and non-Asian CHC patients (23.0% vs 20.9%), and no significant difference was found between these two populations (adjusted odds ratio: 1.3, 95% confidence interval: 0.97, 1.7; P=0.08). Age, sex, and cirrhosis status were risk factors for IFG/T2D in both populations, while body mass index was positively associated with IFG/T2D in non-Asian but not in Asian participants. No significant differences in sustained virological response rates were seen between patients with normal fasting glucose and patients with IFG/T2D for both populations. These results demonstrate that the prevalence of glucose abnormalities in Asian CHC patients was similar to that in non-Asians, and glucose abnormalities had no impact on viral response to peginterferon plus ribavirin.

  17. Glycaemic changes in patients with chronic kidney disease.

    PubMed

    De'Marziani, Guillermo; Soler Pujol, Gervasio; Obregón, Liliana Miriam; Morales, Elisa Mabel; Gonzalez, Claudio Daniel; Gonzalez Paganti, Luciana; Cacciagiú, Leonardo; Lopez, Graciela; Schreier, Laura; Elbert, Alicia

    2016-01-01

    In Argentina, there have been no studies aimed at establishing the prevalence of dysglycaemia (impaired fasting glucose [IFG], impaired glucose tolerance [IGT] and diabetes mellitus [DM]) in patients with chronic kidney disease (CKD). Our group decided to conduct an observational study to evaluate the frequency with oral glucose tolerance test (OGTT) in CKD patients with no previous data for dysglycaemia in their medical records. OGTT was performed in 254 patients (60.62% male) with stage 3, 4 and 5 CKD under conservative treatment, haemodialysis or transplantation. Results for DM were found in 10 patients according to fasting glucose alone (3.94%; 95% CI: 1.35-6.53%), 11 patients with exclusively the second hour criterion (4.33%; 95% CI: 1.63-7.03%), 15 with both criteria (5.91%; 95% CI: 2.81-9.00%) and 36 patients with at least one criteria (14.17%; 95% CI: 9.69-18.66%). In a multivariate analysis, DM was associated with waist circumference (OR=1.033 per cm; 95% CI, 1.005 to 1.062; P=.019) and with conservative treatment vs. replacement therapy (OR=0.41; 95% CI: 0.19-0.92; P=.028). IGT was evident in 24.6% and 20.3 on conservative vs. replacement therapy, with no statistically significant difference. IFG (ADA criteria) was 19.75 vs. 9.24% in conservative vs. replacement therapy, with a statistically significant difference. OGTT is suggested for all CKD patients since it is able to detect the full range of unknown dysglycaemias, which avoids underdiagnoses and favours performing treatments to prevent progression in DM risk groups (IFG and/or IGT). It also aids in the selection of the most appropriate medication for transplantation or treatment initiation in new cases of undiagnosed DM to decrease morbidity and mortality.

  18. Glycaemic changes in patients with chronic kidney disease.

    PubMed

    De'Marziani, Guillermo; Soler Pujol, Gervasio; Obregón, Liliana Miriam; Morales, Elisa Mabel; Gonzalez, Claudio Daniel; Gonzalez Paganti, Luciana; Cacciagiú, Leonardo; Lopez, Graciela; Schreier, Laura; Elbert, Alicia

    2016-01-01

    In Argentina, there have been no studies aimed at establishing the prevalence of dysglycaemia (impaired fasting glucose [IFG], impaired glucose tolerance [IGT] and diabetes mellitus [DM]) in patients with chronic kidney disease (CKD). Our group decided to conduct an observational study to evaluate the frequency with oral glucose tolerance test (OGTT) in CKD patients with no previous data for dysglycaemia in their medical records. OGTT was performed in 254 patients (60.62% male) with stage 3, 4 and 5 CKD under conservative treatment, haemodialysis or transplantation. Results for DM were found in 10 patients according to fasting glucose alone (3.94%; 95% CI: 1.35-6.53%), 11 patients with exclusively the second hour criterion (4.33%; 95% CI: 1.63-7.03%), 15 with both criteria (5.91%; 95% CI: 2.81-9.00%) and 36 patients with at least one criteria (14.17%; 95% CI: 9.69-18.66%). In a multivariate analysis, DM was associated with waist circumference (OR=1.033 per cm; 95% CI, 1.005 to 1.062; P=.019) and with conservative treatment vs. replacement therapy (OR=0.41; 95% CI: 0.19-0.92; P=.028). IGT was evident in 24.6% and 20.3 on conservative vs. replacement therapy, with no statistically significant difference. IFG (ADA criteria) was 19.75 vs. 9.24% in conservative vs. replacement therapy, with a statistically significant difference. OGTT is suggested for all CKD patients since it is able to detect the full range of unknown dysglycaemias, which avoids underdiagnoses and favours performing treatments to prevent progression in DM risk groups (IFG and/or IGT). It also aids in the selection of the most appropriate medication for transplantation or treatment initiation in new cases of undiagnosed DM to decrease morbidity and mortality. PMID:26873550

  19. Provider-sponsored virtual communities for chronic patients: improving health outcomes through organizational patient-centred knowledge management.

    PubMed

    Winkelman, Warren J; Choo, Chun Wei

    2003-12-01

    Patients with long-term chronic disease experience numerous illness patterns and disease trends over time, resulting in different sets of knowledge needs than patients who intermittently seek medical care for acute or short-term problems. Health-care organizations can promote knowledge creation and utilization by chronic patients through the introduction of a virtual, private, disease-specific patient community. This virtual socialization alters the role of chronic disease patients from external consumers of health-care services to a 'community of practice' of internal customers so that, with the tacit support of their health-care organization, they have a forum supporting the integration of knowledge gained from the experiences of living with chronic disease in their self-management. Patient-centred health-care organizations can employ the virtual community to direct and support the empowerment of chronic patients in their care.

  20. Associations between perceived chronic care quality, perceived patient centeredness, and illness representations among persons with diabetes.

    PubMed

    Thomas, Joseph; Iyer, Neeraj N; Collins, William B

    2014-01-01

    Patient beliefs about their illness can motivate behaviors consistent with good disease management. Perceived high-quality chronic care would be expected to increase likelihood of having such beliefs. Associations between perceived quality of chronic care and illness representations, and associations between patient centeredness and illness representations were assessed among persons with diabetes. A mail survey of diabetic patients visiting a multispecialty physician network serving urban and suburban populations in a large midwestern city was conducted. The Patient Assessment of Chronic Illness Care-5A questionnaire was used to assess perceived chronic care quality and patient centeredness. The Brief Illness Perception Questionnaire was used to assess illness representations. Of 500 mailed surveys, 89 completed surveys were returned. The sample consisted mostly of retirees (61%), Whites (81%), and women (60%). Higher perceived chronic care quality was associated with better disease understanding of diabetes (0.24, p = .05). Patients reporting higher patient centeredness (or lower patient-centeredness scores) indicated better disease understanding (-0.26, p = .04) and those reporting higher patient centeredness (or lower patient-centeredness scores) perceived less impact of illness (0.29, p = .02). Chronic care quality as defined in the Chronic Care Model and consistency of chronic care with patient expectations (patient centeredness) was associated with illness representations favorable for good self-care management.

  1. Psychological nursing support for elderly patients undergoing chronic regular haemodialysis.

    PubMed

    Triantaphillopoulou, E; Iphou, A; Arvaniti, P; Michalopoulos, D; Nousis, T; Tserkezis, G; Velissari, E; Iphos, C

    1998-01-01

    The elderly constitute a continuously increasing social group of the Hellenic, but also of the global population. This phenomenon is also evident in the haemodialysis patient population, which grows continually. Faced with this reality, Nursing is obliged to adapt itself and, in this effort that it is putting forward it has achieved many positive steps (geriatric nursing). It is imperative however for nursing that there is a particular way of dealing with the elderly, especially those that undergo chronic periodic haemodialysis, which regards as much the problems stemming from the disease, as it regards their grave psychological condition. The objective of our study was to develop the need for the presence of the Nephrology Nurse in the psychological support of the elderly renal patient and we have been able to define: level of communication, level of dietetic information, psycho-social condition and restrictions imposed by the disease. 30 patients (age 65-80, mean 72.92 years) were included with an observation time of 3 years, less than 60% responded positively to the efforts for psychological support, on the basis of the studied factors. The rest did not show any willingness to answer. We conclude that psychological support is of paramount importance for these patients but also that the Nephrology Nurse has not yet discovered and detected some unknown aspects of the different problems arising due to insufficient knowledge of geriatric caring.

  2. Sleep disorders in pediatric chronic kidney disease patients.

    PubMed

    Stabouli, Stella; Papadimitriou, Eleni; Printza, Nikoleta; Dotis, John; Papachristou, Fotios

    2016-08-01

    The prevalence of sleep disorders during childhood has been estimated to range from 25 to 43 %. The aim of this review is to determine the prevalence of sleep disorders and possible associations with chronic kidney disease (CKD)-related factors and health-related quality of life (HRQOL) in children with CKD. An electronic systematic literature search for sleep disorders in children with CKD in Pubmed, Embase and the Cochrane Library Databases identified seven relevant articles for review, all of which reported an increased prevalence of sleep disorders in children with CKD. Five studies included children with CKD undergoing dialysis, and two studies included only non-dialysis patients. In all studies the presence of sleep disturbances was assessed by questionnaires; only one study compared the results of a validated questionnaire with laboratory-based polysomnography. The prevalence of any sleep disorder ranged from 77 to 85 % in dialysis patients, to 32-50 % in transplanted patients and 40-50 % in non-dialysis patients. The most commonly studied disorder was restless legs syndrome, which presented at a prevalence of 10-35 %. Three studies showed significant associations between presence of sleep disorders and HRQOL. We found consistent evidence of an increased prevalence of sleep disturbances in children with CKD, and these seemed to play a critical role in HRQOL.

  3. Febuxostat for hyperuricemia in patients with advanced chronic kidney disease.

    PubMed

    Akimoto, Tetsu; Morishita, Yoshiyuki; Ito, Chiharu; Iimura, Osamu; Tsunematsu, Sadao; Watanabe, Yuko; Kusano, Eiji; Nagata, Daisuke

    2014-01-01

    Febuxostat is a nonpurine xanthine oxidase (XO) inhibitor, which recently received marketing approval. However, information regarding the experience with this agent among advanced chronic kidney disease (CKD) patients is limited. In the current study, we investigated the effects of oral febuxostat in patients with advanced CKD with asymptomatic hyperuricemia. We demonstrated, for the first time, that not only the serum levels of uric acid (UA) but also those of 8-hydroxydeoxyguanosine, an oxidative stress marker, were significantly reduced after six months of febuxostat treatment, with no adverse events. These results encouraged us to pursue further investigations regarding the clinical impact of lowering the serum UA levels with febuxostat in advanced CKD patients in terms of concomitantly reducing oxidative stress via the blockade of XO. More detailed studies with a larger number of subjects and assessments of the effects of multiple factors affecting hyperuricemia, such as age, sex, and dietary habits, would shed light on the therapeutic challenges of treating asymptomatic hyperuricemia in patients with various stages of CKD. PMID:25210423

  4. Distinctive personality profiles of fibromyalgia and chronic fatigue syndrome patients

    PubMed Central

    Zohar, Ada H.; Zaraya-Blum, Reut; Buskila, Dan

    2016-01-01

    Objective The current study is an innovative exploratory investigation, aiming at identifying differences in personality profiles within Fibromyalgia Syndrome (FMS) and Chronic Fatigue Syndrome (CFS) patients. Method In total, 344 participants (309 female, 35 male) reported suffering from FMS and/or CFS and consented to participate in the study. Participants were recruited at an Israeli FM/CFS patient meeting held in May 2013, and through an announcement posted on several social networks. Participants were asked to complete a research questionnaire, which included FMS criteria and severity scales, and measures of personality, emotional functioning, positivity, social support and subjective assessment of general health. In total, 204 participants completed the research questionnaire (40.7% attrition rate). Results A cluster analysis produced two distinct clusters, which differed significantly on psychological variables, but did not differ on demographic variables or illness severity. As compared to cluster number 2 (N = 107), participants classified into cluster number 1 (N = 97) showed a less adaptive pattern, with higher levels of Harm Avoidance and Alexithymia; higher prevalence of Type D personality; and lower levels of Persistence (PS), Reward dependence (RD), Cooperation, Self-directedness (SD), social support and positivity. Conclusion The significant pattern of results indicates at least two distinct personality profiles of FM and CFS patients. Findings from this research may help improve the evaluation and treatment of FM and CFS patients, based on each patient’s unique needs, psychological resources and weaknesses, as proposed by the current trend of personalized medicine. PMID:27672497

  5. Detection of mycotoxins in patients with chronic fatigue syndrome.

    PubMed

    Brewer, Joseph H; Thrasher, Jack D; Straus, David C; Madison, Roberta A; Hooper, Dennis

    2013-04-11

    Over the past 20 years, exposure to mycotoxin producing mold has been recognized as a significant health risk. Scientific literature has demonstrated mycotoxins as possible causes of human disease in water-damaged buildings (WDB). This study was conducted to determine if selected mycotoxins could be identified in human urine from patients suffering from chronic fatigue syndrome (CFS). Patients (n = 112) with a prior diagnosis of CFS were evaluated for mold exposure and the presence of mycotoxins in their urine. Urine was tested for aflatoxins (AT), ochratoxin A (OTA) and macrocyclic trichothecenes (MT) using Enzyme Linked Immunosorbent Assays (ELISA). Urine specimens from 104 of 112 patients (93%) were positive for at least one mycotoxin (one in the equivocal range). Almost 30% of the cases had more than one mycotoxin present. OTA was the most prevalent mycotoxin detected (83%) with MT as the next most common (44%). Exposure histories indicated current and/or past exposure to WDB in over 90% of cases. Environmental testing was performed in the WDB from a subset of these patients. This testing revealed the presence of potentially mycotoxin producing mold species and mycotoxins in the environment of the WDB. Prior testing in a healthy control population with no history of exposure to a WDB or moldy environment (n = 55) by the same laboratory, utilizing the same methods, revealed no positive cases at the limits of detection.

  6. Physical training in patients with chronic heart failure

    PubMed Central

    Senden, P.J.; Mosterd, A.; Brügemann, J.

    2004-01-01

    Chronic heart failure (CHF) can be defined as a complex of symptoms and signs caused by cardiac dysfunction. Dyspnoea on exertion, fatigue, reduced exercise tolerance and fluid retention are hallmarks of the syndrome. Reduced peripheral blood flow, endothelial dysfunction, alterations in skeletal muscle structure and function, an increased activity of the muscle ergoreflex, as well as autonomic and neurohormonal activation reduce exercise performance, ultimately leading to physical deconditioning in CHF patients. The beneficial effects of physical training for CHF patients are increasingly acknowledged. Based on European and American guidelines on physical training in CHF, results from controlled randomised trials (summarised in this paper) and expert opinions, the Dutch Committee on Cardiac Rehabilitation has formulated statements on physical training in CHF. In addition, recommendations implementing physical training programmes in CHF patients are given. The selection criteria, contraindications and methods, and duration of a physical training programme in heart failure are discussed. Concomitant with the training programme, a multidisciplinary intervention programme is needed to stimulate patients to adopt and maintain an active and healthy lifestyle. PMID:25696346

  7. Distinctive personality profiles of fibromyalgia and chronic fatigue syndrome patients

    PubMed Central

    Zohar, Ada H.; Zaraya-Blum, Reut; Buskila, Dan

    2016-01-01

    Objective The current study is an innovative exploratory investigation, aiming at identifying differences in personality profiles within Fibromyalgia Syndrome (FMS) and Chronic Fatigue Syndrome (CFS) patients. Method In total, 344 participants (309 female, 35 male) reported suffering from FMS and/or CFS and consented to participate in the study. Participants were recruited at an Israeli FM/CFS patient meeting held in May 2013, and through an announcement posted on several social networks. Participants were asked to complete a research questionnaire, which included FMS criteria and severity scales, and measures of personality, emotional functioning, positivity, social support and subjective assessment of general health. In total, 204 participants completed the research questionnaire (40.7% attrition rate). Results A cluster analysis produced two distinct clusters, which differed significantly on psychological variables, but did not differ on demographic variables or illness severity. As compared to cluster number 2 (N = 107), participants classified into cluster number 1 (N = 97) showed a less adaptive pattern, with higher levels of Harm Avoidance and Alexithymia; higher prevalence of Type D personality; and lower levels of Persistence (PS), Reward dependence (RD), Cooperation, Self-directedness (SD), social support and positivity. Conclusion The significant pattern of results indicates at least two distinct personality profiles of FM and CFS patients. Findings from this research may help improve the evaluation and treatment of FM and CFS patients, based on each patient’s unique needs, psychological resources and weaknesses, as proposed by the current trend of personalized medicine.

  8. Managing Inflammatory Manifestations in Patients with Chronic Granulomatous Disease.

    PubMed

    Magnani, Alessandra; Mahlaoui, Nizar

    2016-10-01

    Chronic granulomatous disease (CGD) is a primary immunodeficiency caused by lack of phagocyte nicotinamide adenine dinucleotide phosphate (NADPH) oxidase, which results in inflammatory dysregulation and increased susceptibility to infections. Patients with CGD may develop severe obstructive disorders of the digestive tract as a result of their dysregulated inflammatory response. Despite a growing focus on inflammatory manifestations in CGD, the literature data on obstructive complications are far less extensive than those on infectious complications. Diagnosis and management of patients with concomitant predispositions to infections and hyperinflammation are particularly challenging. Although the inflammatory and granulomatous manifestations of CGD usually respond rapidly to steroid treatment, second-line therapies (immunosuppressants and biologics) may be required in refractory cases. Indeed, immunosuppressants (such as anti-tumor necrosis factor agents, thalidomide, and anakinra) have shown some efficacy, but the value of this approach is controversial, given the questionable risk-to-benefit ratio and the small numbers of patients treated to date. Significant progress in allogeneic hematopoietic stem cell transplantation (the only curative treatment for CGD) has been made through better supportive care and implementation of improved, reduced-intensity conditioning regimens. Gene therapy may eventually be an option for patients lacking a suitable donor; clinical trials with new, safer vectors are ongoing at a few centers. PMID:27299584

  9. Hurricane Katrina and chronic dialysis patients: better tidings than originally feared?

    PubMed

    Vanholder, Raymond C; Van Biesen, Wim A; Sever, Mehmet S

    2009-10-01

    Besides victims with acute kidney injury, disasters may also affect the destiny of chronic dialysis patients. This Commentary discusses the article by Kutner et al. describing the outcome of chronic dialysis patients who were victims of Hurricane Katrina. The importance of advance disaster plans, including instructions to chronic dialysis patients, is emphasized. In addition, it is expected that specific recommendations, which are currently being prepared, will offer ad hoc advice to rescuers.

  10. Metabolic syndrome in hospitalized patients with chronic obstructive pulmonary disease

    PubMed Central

    Slavova, Yanina; Tsakova, Adelina; Genova, Marianka; Kostadinov, Dimitar; Minchev, Delcho; Marinova, Dora

    2015-01-01

    Introduction. The metabolic syndrome (MS) affects 21–53% of patients with chronic obstructive pulmonary disease (COPD) with a higher prevalence in the early stages of COPD, with results being highly variable between studies. MS may also affect natural course of COPD—number of exacerbations, quality of life and lung function. Aim. To examine the prevalence of MS and its correlation with comorbidities and COPD characteristics in patients with COPD admitted for exacerbation. Material and methods. 152 patients with COPD admitted for exacerbation were studied for presence of MS. All of them were also assessed for vitamin D status and diabetes mellitus type 2 (DM). Data were gathered for smoking status and exacerbations during the last year. All patients completed CAT (COPD assessment test) and mMRC (Modified Medical Research Council Dyspnea scale) questionnaires and underwent spirometry. Duration of current hospital stay was recorded. Results. 25% of patients have MS. 23.1% of the male and 29.5% of the female patients have MS (p > 0.05). The prevalence of MS in this study is significantly lower when compared to a national representative study (44.6% in subjects over 45 years). 69.1% of all patients and 97.4% from MS patients have arterial hypertension. The presence of MS is associated with significantly worse cough and sleep (1st and 7th CAT questions; p = 0.002 and p = 0.001 respectively) and higher total CAT score (p = 0.017). Average BMI is 27.31. None of the patients have MS and BMI <25. There is a correlation between the presence of MS and DM (p = 0.008) and with the number of exacerbations in the last year (p = 0.015). There is no correlation between the presence of MS and the pulmonary function. Conclusion. This study among hospitalized COPD patients finds comparable but relatively low prevalence of MS (25%) compared to previously published data (21–53%) and lower prevalence compared to general population (44.6%). MS may impact quality of life and the

  11. The Linguistic Interpretation of Aphasic Syndromes: Aggrammatism in Broca's Aphasia, An Example

    ERIC Educational Resources Information Center

    Kean, Mary-Louise

    1977-01-01

    A hypothesis for the aphasic syndrome of aggramatism--the omission of function words and inflectional morphemes--is presented. The author tests and illustrates the efficacy of closely observing substantive universals of grammatical structure in proposing accounts of linguistic defects. (Author/MV)

  12. Effects of Nonlinguistic Auditory Variations on Lexical Processing in Broca's Aphasics

    ERIC Educational Resources Information Center

    Kittredge, Audrey; Davis, Lissa; Blumstein, Sheila E.

    2006-01-01

    In a series of experiments, the effect of white noise distortion and talker variation on lexical access in normal and Broca's aphasic participants was examined using an auditory lexical decision paradigm. Masking the prime stimulus in white noise resulted in reduced semantic priming for both groups, indicating that lexical access is degraded by…

  13. A Taiwanese Mandarin Main Concept Analysis (TM-MCA) for Quantification of Aphasic Oral Discourse

    ERIC Educational Resources Information Center

    Kong, Anthony Pak-Hin; Yeh, Chun-Chih

    2015-01-01

    Background: Various quantitative systems have been proposed to examine aphasic oral narratives in English. A clinical tool for assessing discourse produced by Cantonese-speaking persons with aphasia (PWA), namely Main Concept Analysis (MCA), was developed recently for quantifying the presence, accuracy and completeness of a narrative. Similar…

  14. Mimicking Aphasic Semantic Errors in Normal Speech Production: Evidence from a Novel Experimental Paradigm

    ERIC Educational Resources Information Center

    Hodgson, Catherine; Lambon Ralph, Matthew A.

    2008-01-01

    Semantic errors are commonly found in semantic dementia (SD) and some forms of stroke aphasia and provide insights into semantic processing and speech production. Low error rates are found in standard picture naming tasks in normal controls. In order to increase error rates and thus provide an experimental model of aphasic performance, this study…

  15. Grammatical Morpheme Development in an Aphasic Child: Some Problems with the Normative Model.

    ERIC Educational Resources Information Center

    Cousins, Andrea

    Major findings are reported of a longitudinal, naturalistic study of grammatical morpheme development in an aphasic child from 5;5 to 6;1. The majority of the morphemes were not acquired in the same order nor at the same mean length of utterance (MLU) levels reported for normal children. As an alternative to the normal acquisition model, based on…

  16. Chronic daily headaches: clinical profile in Indian patients.

    PubMed

    Chakravarty, A

    2003-06-01

    Chronic daily headache (CDH) remains a relatively unexplored entity in India. Misconceptions are common, unnecessary investigations often done and inappropriate therapy prescribed. Analgesic overuse is seldom recognized. The present report appears to be the first of its kind from India. CDH has been defined as headaches occurring more than 15 days per month for more than 3 months (secondary causes excluded). Over 2 years (1998-1999) 849 cases (49.6% of all primary headaches) were seen. More than 1 year's follow-up data were available in 205 subjects (M 34; F 171). The distribution of these was as follows: (i), chronic tension-type headache (CTH), 33 (16.1%); (ii), chronic/transformed migraine (TM), 169 (82.4%); (iii), new persistent CDH, 3 (1.5%). There were 169 cases of TM (M : F 1 : 4.7; age 26-58 years). History of past episodic migraine was present in all. Transformation had been gradual (89.4%) or acute (10.6%). Possible factors in transformation included psychological stress (44.4%), analgesic overuse (28.4%), ergot overuse (4.1%). HRT seemed to be implicated in three female subjects. Analgesic overuse was limited between intake of 600 and 2400 mg of aspirin equivalent per day (mean 735 mg). Ergot overuse varied between 1 and 3 mg/day of ergotamine for > or = 3 days/week. With medical therapy approximately 70% TM and 40% CTH patients noted significant improvement. About 80% of these relapsed on therapy withdrawal. CDH in India is not uncommon. Analgesic/ergot overuse needs to be recognized early. The average dose of analgesic implicated in CDH seems much less compared with that reported in the West. PMID:12780764

  17. [State of local immunity in patients with chronic generalized parodontitis].

    PubMed

    Schmidt, D V; Schmagel; Mozgovaia, L A; Beliaeva, O V

    2008-01-01

    The aim of this work was the determination of the state of local immunity in periodontal complex in patients with chronic generalized periodontitis (CGP). 96 individuals were examined (mean age 43.6+/-1.2 years). All the patients were divided into 2 groups: basic group with CGP patients (76 persons) and comparative group - individuals with intact periodontium (20 persons). To evaluate local immunity in dentogingival fluids the determination of concentrations of IgG, IgM, and IgA immunoglobulins has been used, as well as TNF-alpha, IL-1, IL-6, IL-8, INF-gamma, IL-1ra, IL-10, and IL-4 cytokines, and also factors controlling the state of bone tissue, namely, osteoprotegerine (OPG), and RANK-ligand. In gingival fluid of CGP patients the increase in both pro-, and anti-inflammatory mediators with indication to Th2-deviation (decrease of INF-gamma level and elevation of IL-4 level) was observed. CGP patients exhibited in their periodontal complex marked increase of IgG, IgM, and IgA concentrations that apparently evidenced to the consequence of local polyclonal activation of B-lymphocytes. Gingival fluid of CGP patients showed the elevation of RANKL, TNF-alpha, and IL-1 levels, and the decrease in OPG concentration that could be the reason for osteoclast activation and subsequent destruction of bone tissue. In case of CGP in the zone of periodontium developed inflammation that is characterized by elevated level of IL-8 and predominance of neutrophil number over the quantity of other types of leukocytes.

  18. A comparison of the codeswitching patterns of aphasic and neurologically normal bilingual speakers of English and Spanish.

    PubMed

    Muñoz, M L; Marquardt, T P; Copeland, G

    1999-02-01

    Conversational discourse samples were obtained from four aphasic and four neurologically normal Hispanic bilinguals in monolingual English, monolingual Spanish, and bilingual contexts to identify codeswitching patterns. Analysis of the samples based on the Matrix Language Frame (MLF) Model (Myers-Scotton, 1993a) revealed consistent matching of the language context by the aphasic and normal subjects. The aphasic subjects demonstrated a greater frequency of MLF constituents and codeswitching patterns not evident in the speech samples of the normal subjects. Results suggest an increased dependence on both languages for communication following neurological impairment.

  19. Readmission patterns in patients with chronic obstructive pulmonary disease, chronic heart failure and diabetes mellitus: an administrative dataset analysis.

    PubMed

    Brand, C; Sundararajan, V; Jones, C; Hutchinson, A; Campbell, D

    2005-05-01

    Comprehensive disease management programmes for chronic disease aim to improve patient outcomes and reduce health-care utilization. Readmission rates are often used as an outcome measure of effectiveness. This study aimed to document readmission rates, and risk for early and late readmission, for patients discharged from the Royal Melbourne Hospital with a disease diagnosis of chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD) or diabetes mellitus compared to those with other general medical conditions. Eighty five (8.6%) of patients were readmitted within 28 days and 183 (20.8%) were readmitted between 29 and 180 days. No risk factors for early readmission were identified. Patients with a primary disease diagnosis of CHF and COPD are at increased risk of late readmissions (29-180 days).

  20. Chronic kidney disease is associated with a higher 90-day mortality than other chronic medical conditions in patients with sepsis

    PubMed Central

    Mansur, Ashham; Mulwande, Evelyn; Steinau, Maximilian; Bergmann, Ingo; Frederik Popov, Aron; Ghadimi, Michael; Beissbarth, Tim; Bauer, Martin; Hinz, José

    2015-01-01

    According to previous studies, the clinical course of sepsis could be affected by preexisting medical conditions, which are very common among patients with sepsis. This observational study aimed at investigating whether common chronic medical conditions affect the 90-day mortality risk in adult Caucasian patients with sepsis. A total of 482 patients with sepsis were enrolled in this study. The ninety-day mortality was the primary outcome; organ failure was the secondary outcome. Sepsis-related organ failure assessment (SOFA) scores and the requirements for organ support were evaluated to assess organ failure. A multivariate Cox regression model for the association between the 90-day mortality risk and chronic preexisting medical conditions adjusted for all relevant confounders and mortality predictors revealed the highest hazard ratio for patients with chronic kidney disease (CKD) (hazard ratio, 2.25; 95% CI, 1.46-3.46; p = 0.0002). Patients with CKD had higher SOFA scores than patients without CKD (8.9 ± 4.0 and 6.5 ± 3.4, respectively; p < 0.0001). Additionally, an analysis of organ-specific SOFA scores revealed higher scores in three organ systems (kidney, cardiovascular and coagulation). Patients with CKD have the highest 90-day mortality risk compared with patients without CKD or with other chronic medical conditions. PMID:25995131

  1. [Apple powder in the treatment of patients with chronic enteritis].

    PubMed

    Valenkevich, L N

    1993-01-01

    A manifest clinical response has been achieved in 38 patients with chronic enteritis kept on apple diet in the form of apple powder produced from apple juice refuse. Carbohydrate loading with starch (polysaccharide), saccharose (disaccharide), glucose (monosaccharide), d-xylose made it clear that the apple powder improves hydrolysis and carbohydrate absorption: by 30%, 23%, 32% and 40% for starch, saccharose, glucose and d-xylose, respectively. Attenuation of the inflammation in the small intestine was also evident from the tendency to normalization of some fecal intestinal enzymes activity (entero-kinase, alkaline phosphatase). Changes in the systems PGE-cAMP and PGF-cGMP are suggested to play a role in the emergence of malabsorption syndrome, diarrhea, structural lesions in small intestinal mucosa.

  2. Enveloped particles in the serum of chronic hepatitis C patients

    SciTech Connect

    Petit, Marie-Anne . E-mail: petit@lyon.inserm.fr; Lievre, Marjory . E-mail: marjory.lievre@free.fr; Peyrol, Simone . E-mail: peyrol@laennec.univ-lyon1.fr; De Sequeira, Sylvie . E-mail: desequeira@lyon.inserm.fr; Berthillon, Pascale . E-mail: berthillon@lyon.inserm.fr; Ruigrok, Rob W.H. . E-mail: ruigrok@embl-grenoble.fr; Trepo, Christian . E-mail: trepo@lyon.inserm.fr

    2005-06-05

    HCV particles were isolated from the plasma of chronically infected patients. The virus was analysed by sucrose density gradient centrifugation. The fractions were tested for viral RNA, core antigen and envelope proteins by using a monoclonal antibody directed against the natural E1E2 complex (D32.10). Two populations of particles containing RNA plus core antigen were separated: the first with a density of 1.06-1.08 g/ml did not contain the envelope proteins; the second with a density between 1.17 and 1.21 g/ml expressed both E1 and E2 glycoproteins. Electron microscopy of the enveloped population after immunoprecipitation with D32.10 showed spherical particles with a rather featureless surface and with a diameter around 40 nm. Immuno-gold staining gave evidence that the E1E2 complex was indeed positioned at the surface of these particles.

  3. [Optimization of energy metabolism in patients with chronic heart failure].

    PubMed

    Korzh, A N

    2010-01-01

    Nowadays particular interest of clinicians is attracted by metabolic therapy of patients with chronic heart failure (CHF). The objective of this study was to investigate the influence of complex therapy with addition of Vasonat on the dynamics of remodeling indexes of left ventricle and functional class of CHF on classification of NYHA. It has been shown that application of metabolic modulator Vasonat in addition to conventional therapy of CHF facilitated the clinical improvement and significant decline of functional class. Vasonat use resulted in the meaningful improvement of the contractive function of myocardium and increase of tolerance to the physical exercise. Moreover, high efficiency of Vasonat has been demonstrated in the control of the syndrome of oxidizing stress, by decrease in intensity of free-radical processes and activation of the antioxidant defense system. PMID:21265120

  4. [Meaning and spirituality in patients with chronic somatic illness].

    PubMed

    Mehnert, A

    2006-08-01

    Issues of the meaning of life and spirituality are particularly important subjects given the threat of a serious illness and the confrontation with the finiteness of one's own life. Thus, addressing questions of meaning and spiritual domains of supportive care has been identified as essential by patients as well as by health care professionals. In recent years more research has focussed on theoretical conceptualization, empirical examination as well as on the development of meaning-centred interventions in somatically ill patients. Theoretical models for the understanding, development and adaptation of concepts and interventions addressing meaning and spirituality in the chronically ill are offered by the philosophical tradition of existentialism, logotherapy as well as by cognitive and developmental psychology, in particular studies on autobiographical memory and life story. However, the current state of empirical research focussing on the association between meaning, spirituality and physical as well as mental health and underlying mechanisms is not sufficient to draw reliable conclusions. With regard to psychosocial care, meaning-centred interventions have been developed in recent years primarily within the context of palliative care. These interventions are intended to support patients to find meaning in life in the face of a serious illness and to experience their life as fulfilled.

  5. Complementary/alternative medicine use among chronic pain clinic patients.

    PubMed

    Konvicka, James J; Meyer, Tricia A; McDavid, Andrew J; Roberson, Charles R

    2008-02-01

    Complementary and alternative therapies have enjoyed increasingly widespread use in recent years. Because of this trend, we were eager to obtain a better grasp on the actual number of people in our hospital's pain clinic who have used these modalities. In an effort to explore the use of complementary/alternative medicine (CAM) by patients seen in an anesthesiology chronic pain clinic, we conducted a study using a questionnaire. This questionnaire contained two sections, one covering complementary/alternative modalities and the other dealing with herbals or nutraceuticals. More than 400 patients were surveyed, 41% of whom were male and 59% of whom were female. Comparing alternative therapies by gender revealed no statistical difference in males versus females. The most commonly chosen modalities overall were nutraceuticals, massage therapy, and acupuncture. In terms of age, we found that the patients surveyed who were older than 60 years of age preferred nutraceuticals, and that the younger age group preferred more interactive relaxation techniques, such as meditation and massage.

  6. Lipidomic profiling of sinus mucosa from patients with chronic rhinosinusitis

    PubMed Central

    Fazlollahi, Farbod; Kongmanas, Kessiri; Tanphaichitr, Nongnuj; Gopen, Quinton; Faull, Kym F.; Suh, Jeffrey D.

    2014-01-01

    Sinusitis is a cause of significant morbidity, substantial healthcare costs, and negative effects on quality of life. The primary objective of this study is to characterize the previously unknown lipid profile of sinonasal mucosa from patients with chronic rhinosinusitis (CRS) and from controls. Sinus mucosa samples were analyzed from 9 CRS patients with concomitant nasal polyps, 11 CRS patients without polyps, and 12 controls. Ten lone polyp samples were also analyzed. Samples were subjected to a modified Bligh/Dyer lipid extraction, then high performance thin layer chromatography (HPTLC), combined gas chromatography/electron impact-mass spectrometry (GC/EI-MS), and flow-injection/electrospray ionization-tandem mass spectrometry (FI/ESI-MS/MS). Data was analyzed for identification and profiling of major components. HPTLC revealed an array of species reflecting the lipid complexity of the samples. GC/EI-MS revealed cholesterol and several fatty acids. FI/ESI-MSMS revealed numerous lipid species, namely a host of phosphatidylcholines, phosphatidylethanolamines, ceramides and cholesteryl esters, but no detectable amounts of phosphatidyinositols or sulfated lipids. These results are a first step to uncover unique molecular biomarkers in CRS. PMID:25588779

  7. [Long-term management of patients with chronic renal failure].

    PubMed

    Brunner, F P

    1989-07-01

    Any type of chronic renal disease is associated with functional deterioration of the kidney due to progressive glomerulosclerosis with interstitial fibrosis and tubular atrophy. This process is thought to be predominantly due either to glomerular hyperfiltration or mesangial overload with macromolecules. Antihypertensive therapy, particularly with ACE inhibitors, and protein restriction have been found to retard progressive glomerulosclerosis in animal experiments. There is no doubt that patients with renal disease benefit from antihypertensive therapy through both preservation of renal function and prevention of secondary organ damage due to hypertension. However, the value of protein restricted diets with or without supplements of essential amino acids or ketoacids is less clear. A patient treated with protein restriction is presented and the investigations necessary to monitor compliance, renal function and nutrition are discussed. Monthly to quarterly controls of renal function, blood pressure and mineral metabolism are suggested, particularly in the case of severe hypertension and of prophylactic treatment for renal osteodystrophy with phosphate binders and vitamin D metabolites. Finally, guidelines are provided for planning of renal replacement therapy by dialysis and renal transplantation in the individual patient.

  8. Prevalence of chronic itch and associated factors in haemodialysis patients: a representative cross-sectional study.

    PubMed

    Weiss, Melanie; Mettang, Thomas; Tschulena, Ulrich; Passlick-Deetjen, Jutta; Weisshaar, Elke

    2015-09-01

    Chronic itch is a common symptom in haemodialysis (HD) patients, which is often underestimated. The aim of this cross-sectional study was to investigate the prevalence and factors associated with chronic itch in HD patients. A total of 860 HD patients from a randomly selected cluster-sample of patients attending dialysis units in Germany were included. The patients' mean?±?SD age was 67.2?±?13.5 years, 57.2% were male. The point prevalence of chronic itch was 25.2% (95% CI 22.4-28.1), 12-month prevalence was 27.2% (95% CI 24.1-30.3) and lifetime prevalence was 35.2% (95% CI 31.9-38.3). Chronic itch was significantly less prevalent in patients with secondary glomerulonephritis as primary renal disease. A history of dry skin, eczema, and age chronic itch. General health status and quality of life were significantly more impaired in subjects with chronic itch. This is the first representative cross-sectional study using a precise definition of chronic itch and using different prevalence estimates of chronic itch in HD patients. It demonstrates that chronic itch is a long-lasting burden significantly impairing patients' health. PMID:25740325

  9. Applying a coping with stress questionnaire for cancer patients to patients with non-cancer chronic illnesses.

    PubMed

    Orive, Miren; Quintana, Jose M; Vrotsou, Kalliopi; Las Hayas, Carlota; Bilbao, Amaia; Barrio, Irantzu; Matellanes, Begoña; Padierna, Jesús A

    2013-06-01

    One of the few instruments to evaluate coping skills among patients with chronic illnesses is the Cuestionario de Afrontamiento al Estrés para Pacientes Oncológicos (CAEPO), created initially for cancer patients. We evaluate how well CAEPO applies to patients with non-cancer chronic illnesses. A total of 344 patients (115 with chronic hepatitis C, 120 with inflammatory bowel disease and 109 with recurrent vertigo) completed the CAEPO. Exploratory factor analysis and Cronbach's alpha provide only partial support for the seven factors suggested by the original CAEPO. A streamlined version with fewer dimensions and items may be a better solution for identifying coping strategies among these patients.

  10. Evidence for brain glial activation in chronic pain patients.

    PubMed

    Loggia, Marco L; Chonde, Daniel B; Akeju, Oluwaseun; Arabasz, Grae; Catana, Ciprian; Edwards, Robert R; Hill, Elena; Hsu, Shirley; Izquierdo-Garcia, David; Ji, Ru-Rong; Riley, Misha; Wasan, Ajay D; Zürcher, Nicole R; Albrecht, Daniel S; Vangel, Mark G; Rosen, Bruce R; Napadow, Vitaly; Hooker, Jacob M

    2015-03-01

    Although substantial evidence has established that microglia and astrocytes play a key role in the establishment and maintenance of persistent pain in animal models, the role of glial cells in human pain disorders remains unknown. Here, using the novel technology of integrated positron emission tomography-magnetic resonance imaging and the recently developed radioligand (11)C-PBR28, we show increased brain levels of the translocator protein (TSPO), a marker of glial activation, in patients with chronic low back pain. As the Ala147Thr polymorphism in the TSPO gene affects binding affinity for (11)C-PBR28, nine patient-control pairs were identified from a larger sample of subjects screened and genotyped, and compared in a matched-pairs design, in which each patient was matched to a TSPO polymorphism-, age- and sex-matched control subject (seven Ala/Ala and two Ala/Thr, five males and four females in each group; median age difference: 1 year; age range: 29-63 for patients and 28-65 for controls). Standardized uptake values normalized to whole brain were significantly higher in patients than controls in multiple brain regions, including thalamus and the putative somatosensory representations of the lumbar spine and leg. The thalamic levels of TSPO were negatively correlated with clinical pain and circulating levels of the proinflammatory citokine interleukin-6, suggesting that TSPO expression exerts pain-protective/anti-inflammatory effects in humans, as predicted by animal studies. Given the putative role of activated glia in the establishment and or maintenance of persistent pain, the present findings offer clinical implications that may serve to guide future studies of the pathophysiology and management of a variety of persistent pain conditions.

  11. Attention deficits in stroke patients with aphasia.

    PubMed

    Korda, R J; Douglas, J M

    1997-08-01

    Attentional capacity and sustained attention were investigated in 21 aphasic stroke patients and 21 non-brain-damaged patients. Attentional capacity was assessed using a series of reaction time (RT) tasks. The aphasic patients demonstrated impaired attentional capacity as shown by slower processing speed than the non-brain-damaged group (p < .01) and greater increases in RT with increased processing load (p < .05). Similar patterns were found for both verbal and spatial material. There was no significant relationship between severity of auditory comprehension deficits and attentional capacity. Sustained attention was assessed using a cognitive vigilance task requiring identification of a target letter presented infrequently over 32 minutes. Both the aphasic and the non-brain-damaged group demonstrated a decline in performance with time on task as shown by a steady increase in RTs (p < .0001), but the decline was equivalent across the groups. Thus, the aphasic group did not show a specific deficit in the ability to sustain attention. PMID:9342688

  12. Bacterial Communities Vary between Sinuses in Chronic Rhinosinusitis Patients.

    PubMed

    Joss, Tom V; Burke, Catherine M; Hudson, Bernard J; Darling, Aaron E; Forer, Martin; Alber, Dagmar G; Charles, Ian G; Stow, Nicholas W

    2015-01-01

    Chronic rhinosinusitis (CRS) is a common and potentially debilitating disease characterized by inflammation of the sinus mucosa for longer than 12 weeks. Bacterial colonization of the sinuses and its role in the pathogenesis of this disease is an ongoing area of research. Recent advances in culture-independent molecular techniques for bacterial identification have the potential to provide a more accurate and complete assessment of the sinus microbiome, however there is little concordance in results between studies, possibly due to differences in the sampling location and techniques. This study aimed to determine whether the microbial communities from one sinus could be considered representative of all sinuses, and examine differences between two commonly used methods for sample collection, swabs, and tissue biopsies. High-throughput DNA sequencing of the bacterial 16S rRNA gene was applied to both swab and tissue samples from multiple sinuses of 19 patients undergoing surgery for treatment of CRS. Results from swabs and tissue biopsies showed a high degree of similarity, indicating that swabbing is sufficient to recover the microbial community from the sinuses. Microbial communities from different sinuses within individual patients differed to varying degrees, demonstrating that it is possible for distinct microbiomes to exist simultaneously in different sinuses of the same patient. The sequencing results correlated well with culture-based pathogen identification conducted in parallel, although the culturing missed many species detected by sequencing. This finding has implications for future research into the sinus microbiome, which should take this heterogeneity into account by sampling patients from more than one sinus. PMID:26834708

  13. Bacterial Communities Vary between Sinuses in Chronic Rhinosinusitis Patients

    PubMed Central

    Joss, Tom V.; Burke, Catherine M.; Hudson, Bernard J.; Darling, Aaron E.; Forer, Martin; Alber, Dagmar G.; Charles, Ian G.; Stow, Nicholas W.

    2016-01-01

    Chronic rhinosinusitis (CRS) is a common and potentially debilitating disease characterized by inflammation of the sinus mucosa for longer than 12 weeks. Bacterial colonization of the sinuses and its role in the pathogenesis of this disease is an ongoing area of research. Recent advances in culture-independent molecular techniques for bacterial identification have the potential to provide a more accurate and complete assessment of the sinus microbiome, however there is little concordance in results between studies, possibly due to differences in the sampling location and techniques. This study aimed to determine whether the microbial communities from one sinus could be considered representative of all sinuses, and examine differences between two commonly used methods for sample collection, swabs, and tissue biopsies. High-throughput DNA sequencing of the bacterial 16S rRNA gene was applied to both swab and tissue samples from multiple sinuses of 19 patients undergoing surgery for treatment of CRS. Results from swabs and tissue biopsies showed a high degree of similarity, indicating that swabbing is sufficient to recover the microbial community from the sinuses. Microbial communities from different sinuses within individual patients differed to varying degrees, demonstrating that it is possible for distinct microbiomes to exist simultaneously in different sinuses of the same patient. The sequencing results correlated well with culture-based pathogen identification conducted in parallel, although the culturing missed many species detected by sequencing. This finding has implications for future research into the sinus microbiome, which should take this heterogeneity into account by sampling patients from more than one sinus. PMID:26834708

  14. Optic Nerve Injury in a Patient with Chronic Allergic Conjunctivitis

    PubMed Central

    Hazin, Ribhi; Elia, Christopher J.; Putruss, Maria; Bazzi, Amanda

    2014-01-01

    Manipulation of the optic nerve can lead to irreversible vision changes. We present a patient with a past medical history of skin allergy and allergic conjunctivitis (AC) who presented with insidious unexplained unilateral vision loss. Physical exam revealed significant blepharospasm, mild lid edema, bulbar conjunctival hyperemia, afferent pupillary defect, and slight papillary hypertrophy. Slit lamp examination demonstrated superior and inferior conjunctival scarring as well as superior corneal scarring but no signs of external trauma or neurological damage were noted. Conjunctival cultures and cytologic evaluation demonstrated significant eosinophilic infiltration. Subsequent ophthalmoscopic examination revealed optic nerve atrophy. Upon further questioning, the patient admitted to vigorous itching of the affected eye for many months. Given the presenting symptoms, history, and negative ophthalmological workup, it was determined that the optic nerve atrophy was likely secondary to digital pressure from vigorous itching. Although AC can be a significant source of decreased vision via corneal ulceration, no reported cases have ever described AC-induced vision loss of this degree from vigorous itching and chronic pressure leading to optic nerve damage. Despite being self-limiting in nature, allergic conjunctivitis should be properly managed as extreme cases can result in mechanical compression of the optic nerve and compromise vision. PMID:25317346

  15. Evaluating bone quality in patients with chronic kidney disease

    PubMed Central

    Malluche, Hartmut H.; Porter, Daniel S.; Pienkowski, David

    2013-01-01

    Bone of normal quality and quantity can successfully endure physiologically imposed mechanical loads. Chronic kidney disease–mineral and bone disorder (CKD–MBD) adversely affects bone quality through alterations in bone turnover and mineralization, whereas bone quantity is affected through changes in bone volume. Changes in bone quality can be associated with altered bone material, structure, or microdamage, which can result in an elevated rate of fracture in patients with CKD–MBD. Fractures cannot always be explained by reduced bone quantity and, therefore, bone quality should be assessed with a variety of techniques from the macro-organ level to the nanoscale level. In this Review, we demonstrate the importance of evaluating bone from multiple perspectives and hierarchical levels to understand CKD–MBD-related abnormalities in bone quality. Understanding the relationships between variations in material, structure, microdamage, and mechanical properties of bone in patients with CKD–MBD should aid in the development of new modalities to prevent, or treat, these abnormalities. PMID:24100399

  16. Role of spleen elastography in patients with chronic liver diseases

    PubMed Central

    Giunta, Mariangela; Conte, Dario; Fraquelli, Mirella

    2016-01-01

    The development of liver cirrhosis and portal hypertension (PH), one of its major complications, are structural and functional alterations of the liver, occurring in many patients with chronic liver diseases (CLD). Actually the progressive deposition of hepatic fibrosis has a key role in the prognosis of CLD patients. The subsequent development of PH leads to its major complications, such as ascites, hepatic encephalopathy, variceal bleeding and decompensation. Liver biopsy is still considered the reference standard for the assessment of hepatic fibrosis, whereas the measurement of hepatic vein pressure gradient is the standard to ascertain the presence of PH and upper endoscopy is the method of choice to detect the presence of oesophageal varices. However, several non-invasive tests, including elastographic techniques, are currently used to evaluate the severity of liver disease and predict its prognosis. More recently, the measurement of the spleen stiffness has become particularly attractive to assess, considering the relevant role accomplished by the spleen in splanchnic circulation in the course of liver cirrhosis and in the PH. Moreover, spleen stiffness as compared with liver stiffness better represents the dynamic changes occurring in the advanced stages of cirrhosis and shows higher diagnostic performance in detecting esophageal varices. The aim of this review is to provide an exhaustive overview of the actual role of spleen stiffness measurement as assessed by several elastographic techniques in evaluating both liver disease severity and the development of cirrhosis complications, such as PH and to highlight its potential and possible limitations. PMID:27672283

  17. Role of spleen elastography in patients with chronic liver diseases.

    PubMed

    Giunta, Mariangela; Conte, Dario; Fraquelli, Mirella

    2016-09-21

    The development of liver cirrhosis and portal hypertension (PH), one of its major complications, are structural and functional alterations of the liver, occurring in many patients with chronic liver diseases (CLD). Actually the progressive deposition of hepatic fibrosis has a key role in the prognosis of CLD patients. The subsequent development of PH leads to its major complications, such as ascites, hepatic encephalopathy, variceal bleeding and decompensation. Liver biopsy is still considered the reference standard for the assessment of hepatic fibrosis, whereas the measurement of hepatic vein pressure gradient is the standard to ascertain the presence of PH and upper endoscopy is the method of choice to detect the presence of oesophageal varices. However, several non-invasive tests, including elastographic techniques, are currently used to evaluate the severity of liver disease and predict its prognosis. More recently, the measurement of the spleen stiffness has become particularly attractive to assess, considering the relevant role accomplished by the spleen in splanchnic circulation in the course of liver cirrhosis and in the PH. Moreover, spleen stiffness as compared with liver stiffness better represents the dynamic changes occurring in the advanced stages of cirrhosis and shows higher diagnostic performance in detecting esophageal varices. The aim of this review is to provide an exhaustive overview of the actual role of spleen stiffness measurement as assessed by several elastographic techniques in evaluating both liver disease severity and the development of cirrhosis complications, such as PH and to highlight its potential and possible limitations. PMID:27672283

  18. Resting Metabolic Rate Analysis in Chronic Hemiparesis Patients

    PubMed Central

    de Sant’Anna, Mauricio; Eboli, Leonardo Coelho; Silva, Julio Guilherme; dos Santos, Alan Gomes; Lourenço, Michele; Moreno, Adalgiza Mafra; de Freitas, Gabriel Rodriguez; Orsini, Marco

    2014-01-01

    The objective of the present study was to compare resting metabolic rate (RMR) of chronic hemiparetic patients to sedentary health individuals. The sample was composed of 16 individuals, that were divided into two groups. The first group had eight hemiparetic patients and the second group was formed by eight sedentary individuals. To access and analyze the gases information a VO2000 analyzer was used. The following variables were measured: VO2, VCO2, VE, QR, grams of fat (GrFAT), grams of carbohydrate. RMR was calculated based on Weir’s equation. There was a significant shift on ventilation variables: VE (P<0.0003), VO2 (P<0.0004) and VCO2 (P<0.0001) on hemiparetic individuals group when compared to control group. When the energetic substrate used behavior is observed, it shows that fat consumption (represented by GrFAT) is higher on the hemiparetic group when compared to controls (P<0.0001) significant differences were observed for RMR between groups (P<0.0001). RMR showed a correlation to VO2 on the hemiparetic group (r=0.9277, P=0.0022). To sum up, it was observed through the results that individuals with hemiparesis as a sequel of stroke showed a RMR larger than normal individuals. PMID:25568736

  19. Role of spleen elastography in patients with chronic liver diseases

    PubMed Central

    Giunta, Mariangela; Conte, Dario; Fraquelli, Mirella

    2016-01-01

    The development of liver cirrhosis and portal hypertension (PH), one of its major complications, are structural and functional alterations of the liver, occurring in many patients with chronic liver diseases (CLD). Actually the progressive deposition of hepatic fibrosis has a key role in the prognosis of CLD patients. The subsequent development of PH leads to its major complications, such as ascites, hepatic encephalopathy, variceal bleeding and decompensation. Liver biopsy is still considered the reference standard for the assessment of hepatic fibrosis, whereas the measurement of hepatic vein pressure gradient is the standard to ascertain the presence of PH and upper endoscopy is the method of choice to detect the presence of oesophageal varices. However, several non-invasive tests, including elastographic techniques, are currently used to evaluate the severity of liver disease and predict its prognosis. More recently, the measurement of the spleen stiffness has become particularly attractive to assess, considering the relevant role accomplished by the spleen in splanchnic circulation in the course of liver cirrhosis and in the PH. Moreover, spleen stiffness as compared with liver stiffness better represents the dynamic changes occurring in the advanced stages of cirrhosis and shows higher diagnostic performance in detecting esophageal varices. The aim of this review is to provide an exhaustive overview of the actual role of spleen stiffness measurement as assessed by several elastographic techniques in evaluating both liver disease severity and the development of cirrhosis complications, such as PH and to highlight its potential and possible limitations.

  20. Epidemiology and management of chronic constipation in elderly patients

    PubMed Central

    Vazquez Roque, Maria; Bouras, Ernest P

    2015-01-01

    Constipation is a common functional gastrointestinal disorder, with prevalence in the general population of approximately 20%. In the elderly population the incidence of constipation is higher compared to the younger population, with elderly females suffering more often from severe constipation. Treatment options for chronic constipation (CC) include stool softeners, fiber supplements, osmotic and stimulant laxatives, and the secretagogues lubiprostone and linaclotide. Understanding the underlying etiology of CC is necessary to determine the most appropriate therapeutic option. Therefore, it is important to distinguish from pelvic floor dysfunction (PFD), slow and normal transit constipation. Evaluation of a patient with CC includes basic blood work, rectal examination, and appropriate testing to evaluate for PFD and slow transit constipation when indicated. Pelvic floor rehabilitation or biofeedback is the treatment of choice for PFD, and its efficacy has been proven in clinical trials. Surgery is rarely indicated in CC and can only be considered in cases of slow transit constipation when PFD has been properly excluded. Other treatment options such as sacral nerve stimulation seem to be helpful in patients with urinary dysfunction. Botulinum toxin injection for PFD cannot be recommended at this time with the available evidence. CC in the elderly is common, and it has a significant impact on quality of life and the use of health care resources. In the elderly, it is imperative to identify the etiology of CC, and treatment should be based on the patient’s overall clinical status and capabilities. PMID:26082622

  1. Characterization of hepatitis B virus genotypes in chronically infected patients.

    PubMed

    Basaras, M; Arrese, E; Blanco, S; Sota, M; de las Heras, B; Cisterna, R

    2007-12-01

    Genomic mutations occurring during reverse transcription of hepatitis B virus (HBV) could explain its genetic diversity and account for 8 genetically distinct genotypes that are geographically distributed quite differently. The main objectives of this study were to determine the prevalence of hepatitis B virus genotypes in patients with chronic hepatitis B and to see if there was a relationship between genotypes and risk factors for transmission based on HBeAg status. A total of 14 serum samples were analyzed using INNO-LIPA HBV genotyping assay. Genotype D was the most prevalent (64.3%) followed by genotype A (28.6%). There was one case of co-infection (D/E genotypes) that was confirmed by PCR sequencing. All patients except one were HBeAg-negative and anti-HBe-positive. The risk factors for HBV transmission were unknown in half of the cases; in the other half, sexual, transfusion, maternal or interfamilial transmission were observed. The results show that genotype D is the most prevalent genotype in our hospital, followed by genotype A. On the other hand, no relationship was found between HBeAg status and genotype.

  2. Role of spleen elastography in patients with chronic liver diseases.

    PubMed

    Giunta, Mariangela; Conte, Dario; Fraquelli, Mirella

    2016-09-21

    The development of liver cirrhosis and portal hypertension (PH), one of its major complications, are structural and functional alterations of the liver, occurring in many patients with chronic liver diseases (CLD). Actually the progressive deposition of hepatic fibrosis has a key role in the prognosis of CLD patients. The subsequent development of PH leads to its major complications, such as ascites, hepatic encephalopathy, variceal bleeding and decompensation. Liver biopsy is still considered the reference standard for the assessment of hepatic fibrosis, whereas the measurement of hepatic vein pressure gradient is the standard to ascertain the presence of PH and upper endoscopy is the method of choice to detect the presence of oesophageal varices. However, several non-invasive tests, including elastographic techniques, are currently used to evaluate the severity of liver disease and predict its prognosis. More recently, the measurement of the spleen stiffness has become particularly attractive to assess, considering the relevant role accomplished by the spleen in splanchnic circulation in the course of liver cirrhosis and in the PH. Moreover, spleen stiffness as compared with liver stiffness better represents the dynamic changes occurring in the advanced stages of cirrhosis and shows higher diagnostic performance in detecting esophageal varices. The aim of this review is to provide an exhaustive overview of the actual role of spleen stiffness measurement as assessed by several elastographic techniques in evaluating both liver disease severity and the development of cirrhosis complications, such as PH and to highlight its potential and possible limitations.

  3. Chronic treatment with modafinil may not be beneficial in patients with chronic fatigue syndrome.

    PubMed

    Randall, Delia C; Cafferty, Fay H; Shneerson, John M; Smith, Ian E; Llewelyn, Meirion B; File, Sandra E

    2005-11-01

    Fourteen patients (7 male, 7 female, 22-63 years), classified as having chronic fatigue syndrome (CFS), but without concurrent major depression, significant sleepiness or use of psychoactive medication, completed a double-blind, placebo-controlled, crossover study of the effects of the selective wakefulness-promoting agent, modafinil (200 and 400mg/day). The treatment periods were each 20 days, with washout periods of 2 weeks. The primary aim was to determine effects on cognition and the secondary aim was to determine effects on self-ratings of fatigue, quality of life and mood. Modafinil had mixed effects in two cognitive tasks. In a test of sustained attention, treatment with 200mg reduced the latency to correctly detect sequences, but 400mg increased the number of missed targets. In a test of spatial planning, the 200mg dose resulted in a slower initial thinking time for the easiest part of the task, whereas 400mg reduced the initial thinking time for the hardest part of the test. Lastly, in a test of mental flexibility and one of motor speed, patients performed worse whilst on modafinil (400mg), compared with the placebo period. No effects were observed on the performance of other psychometric tests or on self-ratings of fatigue, quality of life or mood, but this may have been due to insufficient statistical power. It is discussed whether the limited and mixed cognitive effects that we observed could have occurred by chance, or whether a subgroup of CFS patients with daytime sleepiness would have shown greater benefits.

  4. Toward an Empirically Derived Taxonomy of Chronic Pain Patients: Integration of Psychological Assessment Data.

    ERIC Educational Resources Information Center

    Turk, Dennis C.; Rudy, Thomas E.

    1988-01-01

    Developed and cross-validated an empirically derived classification system of chronic pain patients. Identified three unique subgroups of chronic pain patients, labeled dysfunctional, interpersonally distressed, and minimizers/adaptive copers. Cross-validated and confirmed the uniqueness and accuracy of the taxonomy in a second study. Offers…

  5. [Improvement of tumoral calcinosis of the right hand after parathyroidectomy in a patient on chronic hemodialysis].

    PubMed

    El Maghraoui, Jaouad; Hammou, Mohamed; Kabbali, Nadia; Arrayhani, Mohamed; Houssaini, Tariq Sqalli

    2016-01-01

    Periarticular tissue calcifications are common in patients with chronic renal failure undergoing hemodialysis. We report the case of a patient on chronic hemodialysis for 10 years with significant improvement of isolated pseudotumoral calcinosis of the right hand after parathyroidectomy The aim of this study was to show the impact of parathyroidectomy on pseudotumoral calcinosis. PMID:27583094

  6. Assessing United States Patient and Dermatologist Experiences with Severe Chronic Hand Eczema

    PubMed Central

    Baranowski, Eileen; Zelt, Susan; Reynolds, Maria; Sherrill, Beth

    2015-01-01

    Objective: Patients with severe chronic hand eczema often have persistent symptoms that interfere with daily activities, social functioning, and employment. Many patients are refractory to topical corticosteroids. This survey-based study was performed to characterize treatment experiences, impact on productivity, and quality of life of patients with severe chronic hand eczema; understand dermatologists’ severe chronic hand eczema treatment patterns. Design: A web-based survey in the United States queried pre-identified patients with severe chronic hand eczema regarding symptoms, treatment history, quality of life, work productivity, treatment satisfaction, and healthcare utilization. In a separate survey, dermatologists were asked about treatment patterns and satisfaction with currently available therapies. Results: The most commonly reported symptoms currently experienced by patients (n=163) were dryness/flaking (81%), itchiness (75%), and cracking/tearing of the skin (71%). Over the last three months, 84 percent of patients with severe chronic hand eczema self-reported using topical steroids, and 30 percent used systemic corticosteroids or retinoids. Approximately 30 percent reported impairment while working and productivity loss. Patient quality of life was negatively impacted. Dermatologists (n=125) reported most often treating severe chronic hand eczema with topical corticosteroids (99%), followed by topical immunomodulators (71%) and systemic treatments (70%). Only two percent were very satisfied with currently available products. Conclusion: Patients with severe chronic hand eczema experience symptoms that negatively impact work productivity and quality of life. Few dermatologists are very satisfied with currently available severe chronic hand eczema treatment options. PMID:26705436

  7. Acupuncture for patients with chronic urticaria: a systematic review protocol

    PubMed Central

    Yao, Qin; Ye, Yongming; Liu, Xiaoxu; Qin, Zongshi; Liu, Zhishun

    2015-01-01

    Introduction This systematic review protocol aims to describe a meta-analysis to assess the effectiveness and safety of acupuncture therapy for patients with chronic urticaria. Methods and analysis We will electronically search the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, the Web of Science, Traditional Chinese Medicine, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Chinese Scientific Journal Database (VIP database) and Wan-Fang Database from their inception. Other sources will also be searched, including the reference lists of identified publications and conference proceedings. Any clinical randomised controlled trials related to acupuncture for treating chronic urticaria without restriction of publication status and languages will be included. Study selection, data extraction and assessment of study quality will be performed independently by 2 researchers. Data will be synthesised by either the fixed-effects or random-effects model according to a heterogeneity test. Improvement in pruritus and wheals will be assessed as the primary outcomes. Adverse events, quality of life and the recurrence rate after at least 3 months of the treatment will also be evaluated as secondary outcomes. RevMan V.5.2 statistical software will be used for meta-analysis, if possible. If it is not appropriate for a meta-analysis, then a descriptive analysis or a subgroup analysis will be conducted. The results will be expressed as a risk ratio for dichotomous data and mean difference (MD) or standardised MD for continuous data. Dissemination and ethics The protocol of this systematic review will be disseminated in a peer-reviewed journal and presented at relevant conferences. It is not necessary for a formal ethical approval because the data are not individualised. Trial registration number PROSPERO CRD42015015702. PMID:26338683

  8. Patients' and partners' perspectives of chronic illness and its management.

    PubMed

    Checton, Maria G; Greene, Kathryn; Magsamen-Conrad, Kate; Venetis, Maria K

    2012-06-01

    This study is framed in theories of illness uncertainty (Babrow, A. S., 2007, Problematic integration theory. In B. B. Whaley & W. Samter (Eds.), Explaining communication: Contemporary theories and exemplars (pp. 181-200). Mahwah, NJ: Erlbaum; Babrow & Matthias, 2009; Brashers, D. E., 2007, A theory of communication and uncertainty management. In B. B. Whaley & W. Samter (Eds.), Explaining communication: Contemporary theories and exemplars (pp. 201-218). Mahwah, NJ: Erlbaum; Hogan, T. P., & Brashers, D. E. (2009). The theory of communication and uncertainty management: Implications for the wider realm of information behavior. In T. D. Afifi & W. A. Afifi (Eds.), Uncertainty and information regulation in interpersonal contexts: Theories and applications, (pp. 45-66). New York, NY: Routledge; Mishel, M. H. (1999). Uncertainty in chronic illness. Annual Review of Nursing Research, 17, 269-294; Mishel, M. H., & Clayton, M. F., 2003, Theories of uncertainty. In M. J. Smith & P. R. Liehr (Eds.), Middle range theory for nursing (pp. 25-48). New York, NY: Springer) and health information management (Afifi, W. A., & Weiner, J. L., 2004, Toward a theory of motivated information management. Communication Theory, 14, 167-190. doi:10.1111/j.1468-2885.2004.tb00310.x; Greene, K., 2009, An integrated model of health disclosure decision-making. In T. D. Afifi & W. A. Afifi (Eds.), Uncertainty and information regulation in interpersonal contexts: Theories and applications (pp. 226-253). New York, NY: Routledge) and examines how couples experience uncertainty and interference related to one partner's chronic health condition. Specifically, a model is hypothesized in which illness uncertainty (i.e., stigma, prognosis, and symptom) and illness interference predict communication efficacy and health condition management. Participants include 308 dyads in which one partner has a chronic health condition. Data were analyzed using structural equation modeling. Results indicate that there

  9. Ponatinib as first-line treatment for patients with chronic myeloid leukaemia in chronic phase: a phase 2 study

    PubMed Central

    Jain, Preetesh; Kantarjian, Hagop; Jabbour, Elias; Gonzalez, Graciela Nogueras; Borthakur, Gautam; Pemmaraju, Naveen; Daver, Naval; Gachimova, Evguenia; Ferrajoli, Alessandra; Kornblau, Steven; Ravandi, Farhad; O’Brien, Susan; Cortes, Jorge

    2015-01-01

    Summary Background Ponatinib has shown efficacy in patients with refractory chronic myeloid leukaemia (CML) and in those with CML with a Thr315Ile mutation. We aimed to investigate the activity and safety of ponatinib as first-line treatment for patients with chronic-phase CML. Methods We did a single-arm, phase 2 trial at MD Anderson Cancer Center in Houston, TX, USA. Between May 3, 2012, and Sept 24, 2013, we enrolled patients with early (<6 months) chronic-phase CML and treated them with oral ponatinib once a day. Patients enrolled before July 25, 2013, were given a starting dose of 45 mg per day; we lowered this due to tolerability issues and patients enrolled after this date were given a starting dose of 30 mg per day. After a warning by the US Food and Drug Administration (FDA) in Oct 6, 2013, for vascular complications with ponatinib, we started all patients on aspirin 81 mg daily and reduced the dose of ponatinib to 30 mg or 15 mg per day for all patients. The primary endpoint was the proportion of patients who achieved complete cytogenetic response by 6 months in the per-protocol population. This trial is registered with ClinicalTrials.gov, number NCT01570868. Findings We enrolled 51 patients. Median follow-up was 20.9 months (IQR 14.9–25.2). 43 patients were started on 45 mg ponatinib every day; eight patients were started on 30 mg per day. 43 (94%) of 46 evaluable patients achieved complete cytogenetic response at 6 months. Most frequent toxicities included skin-related effects (n=35; 69%) and elevated lipase (n=32; 63%). Cardiovascular events (mainly hypertension) occurred in 25 (49%) patients. Grade 3–4 myelosuppression occurred in 15 (29%) patients. Five (10%) patients developed cerebrovascular or vaso-occlusive disease. 43 (85%) patients needed treatment interruptions at some time and 45 (88%) needed dose reductions. The study was terminated June 18, 2014, at the recommendation of the FDA due to concern about the increased risk of thromboembolism

  10. Extracellular volume fraction in coronary chronic total occlusion patients.

    PubMed

    Chen, Yin Yin; Zhang, Wei Guo; Yang, Shan; Yun, Hong; Deng, Sheng Ming; Fu, Cai Xia; Zeng, Meng Su; Jin, Hang; Guo, Liang

    2015-08-01

    (1) To assess extracellular volume fraction (ECV) and regional systolic function in patients presenting with coronary chronic total occlusion (CTO) in areas without significant late gadolinium enhancement (LGE), and (2) to investigate the correlation between angiography collateral flow and ECV in territories supplied by CTO vessels. A total of 50 angiographically documented CTO patients and 15 age- and sex-matched normal controls were recruited to the study. Myocardial ECV, was calculated in infarcted, global non-infarcted and the entire myocardium respectively. Segmental ECV was calculated from myocardial segments within the perfusion territory of a CTO vessel. The global and regional systolic function was evaluated using ejection fraction and percent systolic thickening. ECVs in global myocardium and global non-infarcted myocardium were significantly elevated in comparison with that in controls (29.1 ± 4.2% and 26.6 ± 2.6% vs. 23.3 ± 2.0%, all P < 0.005). Global ECV significantly correlated with LV ejection fraction (r = -0.56, P < 0.001) and ECV inversely correlated with systolic thickening in global non-infarcted myocardium (r = -0.31, P < 0.05). The lower segmental ECV was associated with the presence of well-developed collaterals (P = 0.004), and multivariate binary logistic analysis demonstrated that mean segmental ECV and course of disease were the independent discriminator of collateral flow with overall diagnostic accuracy of 74.4%. In patients with CTO, ECV is found to be increased beyond that observed with LGE, and correlates with LV regional wall motion abnormality, which appears to reflect diffuse myocardial fibrosis. Mean segmental ECV value, combined with course of disease, may serve as good predictors of collateral flow. PMID:25985941

  11. Antineutrophil Cytoplasmic Antibody Frequency in Chronic Hepatitis B Patients

    PubMed Central

    Calhan, Turan; Kahraman, Resul; Altunoz, Mustafa Erhan; Ozbakır, Fatma; Ozdil, Kamil; Sokmen, Hacı Mehmet

    2014-01-01

    Background. Chronic hepatitis B (CHB) is a viral disease, common across the world, and associated with several extraintestinal manifestations including vasculitis. Antineutrophil cytoplasmic antibodies (ANCAs) are sensitive and specific markers for vasculitides. There is limited data available in the literature on whether ANCA formation is stimulated by CHB infection. In the present study we aimed to identify the frequency of ANCA in CHB patients. Methods. A total of 174 subjects were included in the study (87 CHB patients, 87 control subjects). Perinuclear-ANCA (P-ANCA), cytoplasmic-ANCA (C-ANCA), myeloperoxidase ANCA (MPO-ANCA), and proteinase 3-ANCA (PR3-ANCA) were studied. IFA was used for P-ANCA and C-ANCA assays, and ELISA was used for MPO-ANCA and PR3-ANCA assays. Results. ANCA positivity was high in both groups (31% in the CHB group and 26% among controls). There were no significant differences between the groups for P-ANCA and MPO-ANCA (P = 0.6 and P = 0.6, resp.). Frequency of borderline positive C-ANCA and all positive PR3-ANCA (positive + borderline positive) was significantly higher in the CHB group (P = 0.009 and P = 0.005, resp.). Conclusions. In the present study, the frequency of ANCA was high in both groups. The CHB group had a relatively higher frequency of ANCA positivity compared to controls. Borderline positive C-ANCA and positive PR3-ANCA were significantly higher in the CHB group. These results suggest that ANCA may have a high prevalence in Turkey. Patients with CHB should be evaluated particularly for C-ANCA and PR3-ANCA in the presence of vasculitic complaints and lesions. PMID:25161336

  12. Genomic imbalances in pediatric patients with chronic kidney disease

    PubMed Central

    Verbitsky, Miguel; Sanna-Cherchi, Simone; Fasel, David A.; Levy, Brynn; Kiryluk, Krzysztof; Wuttke, Matthias; Abraham, Alison G.; Kaskel, Frederick; Köttgen, Anna; Warady, Bradley A.; Furth, Susan L.; Wong, Craig S.; Gharavi, Ali G.

    2015-01-01

    BACKGROUND. There is frequent uncertainty in the identification of specific etiologies of chronic kidney disease (CKD) in children. Recent studies indicate that chromosomal microarrays can identify rare genomic imbalances that can clarify the etiology of neurodevelopmental and cardiac disorders in children; however, the contribution of unsuspected genomic imbalance to the incidence of pediatric CKD is unknown. METHODS. We performed chromosomal microarrays to detect genomic imbalances in children enrolled in the Chronic Kidney Disease in Children (CKiD) prospective cohort study, a longitudinal prospective multiethnic observational study of North American children with mild to moderate CKD. Patients with clinically detectable syndromic disease were excluded from evaluation. We compared 419 unrelated children enrolled in CKiD to multiethnic cohorts of 21,575 children and adults that had undergone microarray genotyping for studies unrelated to CKD. RESULTS. We identified diagnostic copy number disorders in 31 children with CKD (7.4% of the cohort). We detected 10 known pathogenic genomic disorders, including the 17q12 deletion HNF1 homeobox B (HNF1B) and triple X syndromes in 19 of 419 unrelated CKiD cases as compared with 98 of 21,575 control individuals (OR 10.8, P = 6.1 × 10–20). In an additional 12 CKiD cases, we identified 12 likely pathogenic genomic imbalances that would be considered reportable in a clinical setting. These genomic imbalances were evenly distributed among patients diagnosed with congenital and noncongenital forms of CKD. In the vast majority of these cases, the genomic lesion was unsuspected based on the clinical assessment and either reclassified the disease or provided information that might have triggered additional clinical care, such as evaluation for metabolic or neuropsychiatric disease. CONCLUSION. A substantial proportion of children with CKD have an unsuspected genomic imbalance, suggesting genomic disorders as a risk factor for

  13. Congruence or Discrepancy? Comparing Patients' Health Valuations and Physicians' Treatment Goals for Rehabilitation for Patients with Chronic Conditions

    ERIC Educational Resources Information Center

    Nagl, Michaela; Farin, Erik

    2012-01-01

    The aim of this study was to test the congruence of patients' health valuations and physicians' treatment goals for the rehabilitation of chronically ill patients. In addition, patient characteristics associated with greater or less congruence were to be determined. In a questionnaire study, patients' health valuations and physicians' goals were…

  14. Transitional coordinator nurses focus on at-risk patients with chronic diseases.

    PubMed

    2016-03-01

    Tucson Medical Center keeps its readmission rates low by having transitional coordinators work closely for patients with chronic disease who are at risk for readmissions. An analysis of readmitted patients determined that many who were rehospitalized were elderly with chronic diseases. The transitional coordinators are three experienced nurses with knowledge of chronic disease who work closely with the care team and follow patients for up to 30 days after discharge. The hospital arranges for post-acute providers to come to the hospital to see the patients referred to them for services.

  15. Dasatinib for the treatment of chronic myeloid leukemia: patient selection and special considerations

    PubMed Central

    Keskin, Dilek; Sadri, Sevil; Eskazan, Ahmet Emre

    2016-01-01

    Dasatinib is one of the second-generation tyrosine kinase inhibitors used in imatinib resistance and/or intolerance, as well as in the frontline setting in patients with chronic myeloid leukemia-chronic phase, and also in patients with advanced disease. It is also utilized in Philadelphia chromosome-positive acute lymphocytic leukemia. While choosing the appropriate tyrosine kinase inhibitor (ie, dasatinib) for each individual patient, comorbidities and BCR-ABL1 kinase domain mutations should always be taken into consideration, among other things. This review mainly focuses on patient selection prior to dasatinib administration in the treatment of chronic myeloid leukemia. PMID:27784993

  16. Persistence behavior of chronic low back pain patients in an acute pain situation.

    PubMed

    Schmidt, A J; Brands, A M

    1986-01-01

    The test behavior of 24 chronic low back pain patients was compared with the behavior of 24 healthy control Ss., matched for age and sex, in an experimental, acute pain situation (cold pressor-test). Chronic low back pain patients showed poorer persistence behavior and reported more pain. Thus, elements of typical chronic low back pain behavior were also present in an acute pain situation. These findings are discussed within the framework of stimulus-generalization theory. In addition, the effect of different coping strategies on pain tolerance was reconfirmed. The chronic low back pain group and the control group did not cope differently.

  17. Evaluation of D-dimer serum levels among patients with chronic urticaria, psoriasis and urticarial vasculitis*

    PubMed Central

    Criado, Paulo Ricardo; Antinori, Lidi Che Leon; Maruta, Celina Wakisaka; dos Reis, Vitor Manoel Silva

    2013-01-01

    BACKGROUND It has been demonstrated that neutrophils, eosinophils and monocytes, under appropriated stimulus, may express tissue factor and therefore, activate the extrinsic pathway of coagulation. We performed a transversal and case-control study of patients with chronic urticaria and patients with psoriasis, in our outpatient clinic to evaluate the production of D-dimer. OBJECTIVE To evaluate D-dimer serum levels in patients with chronic urticaria and its possible correlation with disease activity. PATIENTS AND METHODS The study was conducted from October 2010 until March 2011. We selected 37 consecutive patients from our Allergy Unit and Psoriasis Unit, and divided them into three groups for statistical analysis: (i) 12 patients with active chronic urticaria (CU); (ii) 10 patients with chronic urticaria under remission and (iii) 15 patients with psoriasis (a disease with skin inflammatory infiltrate constituted by neutrophils, lymphocytes and monocytes). Another five patients with urticarial vasculitis were allocated in our study, but not included in statistical analysis. The serum levels of D-dimer were measured by Enzyme Linked Fluorescent Assay (ELFA), and the result units were given in ng/ml FEU. RESULTS Patients with active chronic urticaria had the highest serum levels of D-dimer (p<0.01), when compared to patients with CU under remission and the control group (patients with psoriasis). CONCLUSIONS Patients with active chronic urticaria have higher serum levels of D-dimer, when compared to patients with chronic urticaria under remission and patients with psoriasis. We found elevated serum levels of D-dimer among patients with urticarial vasculitis. PMID:23793207

  18. Treatment for Chronic Pain in Patients With Advanced Cancer

    ClinicalTrials.gov

    2010-11-07

    Chronic Myeloproliferative Disorders; Leukemia; Lymphoma; Multiple Myeloma and Plasma Cell Neoplasm; Myelodysplastic Syndromes; Pain; Precancerous/Nonmalignant Condition; Small Intestine Cancer; Unspecified Adult Solid Tumor, Protocol Specific

  19. Dysfunctional pain inhibition in patients with chronic whiplash-associated disorders: an experimental study.

    PubMed

    Daenen, Liesbeth; Nijs, Jo; Roussel, Nathalie; Wouters, Kristien; Van Loo, Michel; Cras, Patrick

    2013-01-01

    Inefficient endogenous pain inhibition, in particular impaired conditioned pain modulation (CPM), may disturb central pain processing in patients with chronic whiplash-associated disorders (WAD). Previous studies revealed that abnormal central pain processing is responsible for a wide range of symptoms in patients with chronic WAD. Hence, the present study aimed at examining the functioning of descending pain inhibitory pathways, and in particular CPM, in patients with chronic WAD. Thirty-five patients with chronic WAD and 31 healthy controls were subjected to an experiment evaluating CPM. CPM was induced by an inflated occlusion cuff and evaluated by comparing temporal summation (TS) of pressure pain prior to and during cuff inflation. Temporal summation was provoked by means of 10 consecutive pressure pulses at upper and lower limb location. Pain intensity of first, fifth, and 10th pressure pulse was rated. During heterotopic noxious conditioning stimulation, TS of pressure pain was significantly depleted among healthy controls. In contrast, TS was quite similar prior to and during cuff inflation in chronic WAD, providing evidence for dysfunctional CPM in patients with chronic WAD. The present study demonstrates a lack of endogenous pain inhibitory pathways, and in particularly CPM, in patients with chronic WAD, and hence provides additional evidence for the presence of central sensitization in chronic WAD.

  20. Disparities in periodontitis prevalence among chronic kidney disease patients.

    PubMed

    Ioannidou, E; Swede, H

    2011-06-01

    Because of adverse effects of uremia in the innate and adaptive immune systems, we hypothesized that chronic kidney disease (CKD) patients would have higher prevalence of moderate periodontitis compared with individuals without CKD. We examined this hypothesis using the NHANES III dataset, including 12,081 adults stratified by Race-Ethnicity. We followed the American Academy of Periodontology/Centers for Disease Control and Prevention definition for moderate periodontitis. Estimated glomerular filtration rate (GFR) was calculated based on calibrated serum creatinine levels according to the Modification of Diet in Renal Disease Study formula. Analyses incorporated NHANES sampling weights. Overall, 14.6% of individuals with CKD were classified as having moderate periodontitis, compared with 8.7% in the non-CKD group (p = 0.001). A significant dose-response association (p = 0.001) was observed between prevalence of moderate periodontitis and CKD stages among non-Hispanic Blacks and Mexican-Americans, but not so for non-Hispanic Whites. Prevalence of periodontitis among participants with CKD was substantially higher among non-Hispanic Blacks (38.9%) and Mexican-Americans (37.3%) compared with non-Hispanic Whites (12.9%). Multivariate logistic regression models showed that Mexican-Americans and non-Hispanic Blacks with CKD were approximately 30% to 60% more likely to have moderate periodontitis compared with those without CKD, after adjustment for diabetes status and other potential confounders.

  1. [CHARACTERISTIC OF ALTERATIONS OF ARTERIES IN PATIENTS WITH ISCHEMIC HEART DISEASE AND CHRONIC HEPATITIS C].

    PubMed

    Guliaev, N I; Kuznetsov, V V; Poltareĭko, D S; Qleksiuk, I B; Gordienko, A V; Barsukov, A V

    2015-01-01

    The article presents an assessment of degree and type of atherosclerosis of coronary and non-coronary vessels in old patients with ischemic heart disease associated with chronic viral hepatitis C (VHC), the incidence of myocardial infarction and the possibility of participation chronic VHC in atherogenesis. Patients with ischemic heart disease have correlation of atherosclerosis of arteries with age, hypercholesterinemia. Patients without chronic VHC more often give a higher risk of myocardial infarction, especially in early period (1-1,5 years) of onset of ischemic heart disease clinical implications. Patients with ischemic heart disease associated with chronic viral hepatitis C more often have generalized alterations in vessels, multifocal type of alteration. So, participation of VHC in atherogenesis is most probably connected with maintenance of chronic immune inflammation in vascular endothelium.

  2. Tracheo-oesophageal fistula in a patient with chronic sarcoidosis.

    PubMed

    Darr, A; Mohamed, S; Eaton, D; Kalkat, M S

    2015-10-01

    Sarcoidosis is a common multisystem granulomatous condition of unknown aetiology, predominantly involving the respiratory system. Tracheal stenosis has been described but we believe that we present the first case of a tracheo-oesophageal fistula secondary to chronic sarcoidosis. A 57-year-old woman with sarcoidosis, a known tracheal stricture and a Polyflex(®) stent in situ presented with stridor. Bronchoscopy confirmed in-stent stenosis, by exuberant granulation tissue. The stent was removed and the granulation tissue was resected accordingly. Postoperatively, the patient was noticed to have an incessant cough and video fluoroscopy raised the suspicion of a tracheo-oesophageal fistula. A repeat bronchoscopy demonstrated marked granulation tissue, accompanied by a fistulous connection with the oesophagus at the mid-lower [middle of the lower] third of the trachea. Three Polyflex(®) stents were sited across the entire length of the trachea. Sarcoidosis presents with varying clinical manifestations and disease progression. Tracheal involvement appears to be a rare phenomenon and usually results in stenosis. To date, there has been little or no documented literature describing the formation of a tracheo-oesophageal fistula resulting from sarcoidosis. Early reports documented the presence of sarcoidosis induced weakening in the tracheal wall, a process termed tracheal dystonia. Weaknesses are more apparent in the membranous aspect of the trachea. Despite the rare nature of such pathology, this case report highlights the need to consider the presence of a tracheo-oesophageal fistula in sarcoidosis patients presenting with repeat aspiration in the absence of an alternate pathology.

  3. Late appearance of chronic pericardial disease in patients treated by radiotherapy for Hodgkin's disease

    SciTech Connect

    Applefeld, M.M.; Cole, J.F.; Pollock, S.H.; Sutton, F.J.; Slawson, R.G.; Singleton, R.T.; Wiernik, P.H.

    1981-03-01

    Radiation-induced chronic pericardial disease was recognized in nine patients 53 to 124 months (mean, 88 months) after radiotherapy for Hodgkin's disease. Depending on whether abnormal cardiac hemodynamics occurred before or after a fluid challenge, patients were considered to have either constrictive pericarditis (Group I) or occult constrictive pericarditis (Group II). There were no differences between these groups in various radiotherapy data, the use of chemotherapy, or the interval after treatment when the diagnosis of chronic pericardial disease was made. There were no consistent noninvasive variables to support the diagnosis of radiation-induced chronic pericardial disease before cardiac catheterization. Four patients underwent pericardiectomy. Two of the four operated patients had an excellent surgical result; a third patient died 4 months postoperatively of drug-induced granulocytopenia; the fourth patient has persistent visceral constrictive pericarditis 18 months after surgery. Speculation over the causes of radiation-induced chronic pericardial disease is made and our recommendations for its treatment given.

  4. Selective impairment of masculine gender processing: evidence from a German aphasic.

    PubMed

    Seyboth, Margret; Blanken, Gerhard; Ehmann, Daniela; Schwarz, Falke; Bormann, Tobias

    2011-12-01

    The present single case study describes the performance of the German aphasic E.M. who exhibited a severe impairment of grammatical gender processing in masculine nouns but relatively spared performance regarding feminine and neuter ones. This error pattern was assessed with tests of gender assignment to orally or visually presented words, with oral or written responses, and with tests of gender congruency decision on noun phrases. The pattern occurred across tasks and modalities, thus suggesting a gender-specific impairment at a modality-independent level of processing. It was sensitive to frequency, thus supporting the assumption that access to gender features as part of grammatical processing is frequency sensitive. Besides being the first description of a gender-specific impairment in an aphasic subject, the data therefore have implications regarding the modelling of representation and processing of grammatical gender information within the mental lexicon. PMID:22813070

  5. Mn vacancy defects, grain boundaries, and A-phase stability of helimagnet MnSi.

    PubMed

    Ou-Yang, T Y; Shu, G J; Lin, J-Y; Hu, C D; Chou, F C

    2016-01-20

    Mn vacancy defect and grain size are shown to modify the magnetic phase diagram of MnSi significantly, especially near the critical regime of A-phase (skyrmion lattice) formation and the helimagnetic phase transition. Crystals grown using controlled nonstoichiometric initial precursors creates both grain boundaries and intrinsic Mn vacancy defect of various levels in MnSi. The results of combined transport, specific heat, and AC spin susceptibility measurements are compared for MnSi single crystal samples of various manganese deficiency levels and grain sizes. The finite-size effect and Mn vacancy level dependent helical phase transition temperature T(c) have been identified and verified. The stability of A-phase in H-T phase space has been examined through AC spin susceptibility data analysis.

  6. Mn vacancy defects, grain boundaries, and A-phase stability of helimagnet MnSi

    NASA Astrophysics Data System (ADS)

    Ou-Yang, T. Y.; Shu, G. J.; Lin, J.-Y.; Hu, C. D.; Chou, F. C.

    2016-01-01

    Mn vacancy defect and grain size are shown to modify the magnetic phase diagram of MnSi significantly, especially near the critical regime of A-phase (skyrmion lattice) formation and the helimagnetic phase transition. Crystals grown using controlled nonstoichiometric initial precursors creates both grain boundaries and intrinsic Mn vacancy defect of various levels in MnSi. The results of combined transport, specific heat, and AC spin susceptibility measurements are compared for MnSi single crystal samples of various manganese deficiency levels and grain sizes. The finite-size effect and Mn vacancy level dependent helical phase transition temperature {{T}\\text{c}} have been identified and verified. The stability of A-phase in H-T phase space has been examined through AC spin susceptibility data analysis.

  7. Cytomegalovirus-induced Hemorrhagic Colitis in a Patient with Chronic Myeloid Leukemia (Chronic Phase) on Dasatinib as an Upfront Therapy

    PubMed Central

    Yassin, Mohamed A; Nashwan, Abdulqadir J; Soliman, Ashraf T; Yousif, Anil; Moustafa, Afra; AlBattah, Afaf; Mohamed, Shehab F; Mudawi, Deena S; Elkourashy, Sarah; Asaari, Deena-Raiza; Gutierrez, Hope-Love G; Almusharaf, Mohamed; Hussein, Radwa M; Moustafa, Abbas H; Derhoubi, Hatim El; Boukhris, Sarra; Kohla, Samah; AlDewik, Nader

    2015-01-01

    Dasatinib is a kinase inhibitor indicated for the treatment of newly diagnosed adults with Philadelphia chromosome–positive (Ph+) chronic myeloid leukemia (CML) in chronic phase and accelerated (myeloid or lymphoid blast) phase, and CML with resistance or intolerance to prior therapy including imatinib and in adults with Ph+ acute lymphoblastic leukemia1 The most common adverse reactions (≥15%) in patients with newly diagnosed chronic-phase (CP) CML include myelosuppression, fluid retention, and diarrhea, whereas in patients with resistance or intolerance to prior imatinib therapy, side effects include myelosuppression, fluid retention, diarrhea, headache, dyspnea, skin rash, fatigue, nausea, and hemorrhage. We report a 39-year-old Ethiopian female patient who received dasatinib as upfront therapy for the treatment of CP-CML who experienced chronic diarrhea for two months, which progressed to hemorrhagic colitis due to cytomegalovirus (CMV) infection of the colon. To our knowledge, this is the first case of CMV colitis in a patient receiving dasatinib as upfront therapy. PMID:26379451

  8. Patient counseling program to improve the compliance to imatinib in chronic myeloid leukemia patients.

    PubMed

    Moon, Joon Ho; Sohn, Sang Kyun; Kim, Shi Nae; Park, Seon Yang; Yoon, Sung Soo; Kim, In Ho; Kim, Hyeoung Joon; Kim, Yeo Kyeoung; Min, Yoo Hong; Cheong, June Won; Kim, Jin Seok; Jung, Chul Won; Kim, Dong Hwan

    2012-06-01

    To achieve successful therapeutic outcomes in chronic myeloid leukemia (CML), continuous and adequate imatinib (Gleevec(®), Glivec(®), Novartis Pharmaceuticals, Basel, Switzerland) dosing is essential. Here, we report a patient counseling program ("Care club", "Happy club" in Korea) performed to improve patient compliance with imatinib. From January 2006 to December 2008, patients diagnosed with chronic phase CML and taking imatinb were eligible for this retrospective study. A total of 114 patients from 4 centers in Korea were recruited at a 50:50 ratio for Happy club group versus non-Happy club group at each center. During 36-month follow-up, persistency (the number of days of imatinib prescribed versus 1 year) was higher in the Happy club group (98.2 ± 0.03%) than in the non-Happy club group (79.3 ± 0.16%, P = 0.001), whereas dose compliance (miligrams of imatinib that were actually taken versus miligrams that should have been taken) was not different between two groups; 96.5 ± 0.6% and 96.6 ± 0.7% in the Happy club and non-Happy club (P = 0.958). Overall compliance (the product of persistency and dose compliance) improved in the Happy club group (93.0 ± 2.3%) compared with the non-Happy club group (76.2 ± 7.4%, P = 0.001). The patient counseling program was efficient especially in patients who needed high-dose imatinib (>400 mg/day), and overall compliance was 87.8 ± 6.0% in the Happy club group versus 65.5 ± 16.1% in the non-Happy club group (P = 0.017). In conclusion, the patient counseling program was effective in persisting imatinib medication, resulting in the improvement of overall compliance.

  9. Ab interno laser sclerostomy in aphakic patients with glaucoma and chronic inflammation.

    PubMed

    Wilson, R P; Javitt, J C

    1990-08-15

    Five patients with aphakia, glaucoma, and chronic inflammation were treated with ab interno sclerostomy by using the continuous wave Nd:YAG laser focused through a sapphire probe. After a follow-up period of 24 to 28 months, three of five patients had good intraocular pressure control. The sclerostomy failed in one patient when it was occluded by vitreous. The second failure was attributed to closure of the sclerostomy because of chronic intraocular inflammation.

  10. [Chagas' disease in patients in chronic hemodialysis. Prevalence and risk of transmission by blood transfusion].

    PubMed

    Lorca, M; Lorca, E; Atías, A; Plubins, L

    1989-06-01

    A serologic study of Chagas disease was performed in 110 patients submitted to chronic hemodialisis and blood transfusions. Immunofluorescence antibody testing (IgG and IgM) was positive in 6 out of 62 patients receiving multiple blood transfusions (9.7%), but negative in all 48 subjects without transfusions. Thus, repeated blood transfusion is a significant risk for T cruzi infection in chronic hemodialized patients. PMID:2501847

  11. [Effect of reflex therapy on the dynamics of cognitive impairment in patients with chronic vertebrobasilar insufficiency].

    PubMed

    Tian, V N; Goĭdenko, V S; Bigdareva, O A

    2011-01-01

    Effectiveness of reflex therapy on the dynamics of cognitive impairment was assessed during the observation and treatment of 77 patients with chronic vertebrobasilar insufficiency. The inclusion of acupuncture and biodynamic correction in the complex therapy of patients with chronic vertebrobasilar insufficiency increases the effectiveness of integrated treatment compared with conventional therapy that was confirmed by neuropsychological studies of patients with discirculatory encephalopathy caused by vertebral pathology.

  12. Can Incentives Improve Medicaid Patient Engagement and Prevent Chronic Diseases?

    PubMed

    Hoerger, Thomas J; Perry, Rebecca; Farrell, Kathleen; Teixeira-Poit, Stephanie

    2015-01-01

    Under the Medicaid Incentives for the Prevention of Chronic Diseases model, 10 states are testing whether incentives can encourage Medicaid beneficiaries to lose weight, stop smoking, work to prevent diabetes, or control risk factors for other chronic diseases. This commentary describes these incentive programs and how they will be evaluated. PMID:26510225

  13. Engaging Patients in Online Self-Care Technologies for Chronic Disease Management.

    PubMed

    Picton, Peter; Wiljer, David; Urowitz, Sara; Cafazzo, Joseph A

    2016-01-01

    A common perception is that the use of Internet-based self-care systems is best suited for a younger, tech-proficient population, and that these systems will increase the burden on patients with complex chronic conditions. The study stratified patients with diabetes into three regimens of use of an Internet-based diabetes self-care portal. Results show that patients were more likely to adhere to a diurnal regimen than a variable regimen, and older patients, over the age of 60, were more adherent than younger patients, regardless of regimen. This suggests that common misconceptions should be reconsidered when prescribing Internet-based interventions for patients with chronic illness.

  14. Serum Autoantibodies in Chronic Prostate Inflammation in Prostate Cancer Patients

    PubMed Central

    Schlick, Bettina; Massoner, Petra; Lueking, Angelika; Charoentong, Pornpimol; Blattner, Mirjam; Schaefer, Georg; Marquart, Klaus; Theek, Carmen; Amersdorfer, Peter; Zielinski, Dirk; Kirchner, Matthias; Trajanoski, Zlatko; Rubin, Mark A.; Müllner, Stefan; Schulz-Knappe, Peter; Klocker, Helmut

    2016-01-01

    Background Chronic inflammation is frequently observed on histological analysis of malignant and non-malignant prostate specimens. It is a suspected supporting factor for prostate diseases and their progression and a main cause of false positive PSA tests in cancer screening. We hypothesized that inflammation induces autoantibodies, which may be useful biomarkers. We aimed to identify and validate prostate inflammation associated serum autoantibodies in prostate cancer patients and evaluate the expression of corresponding autoantigens. Methods Radical prostatectomy specimens of prostate cancer patients (N = 70) were classified into high and low inflammation groups according to the amount of tissue infiltrating lymphocytes. The corresponding pre-surgery blood serum samples were scrutinized for autoantibodies using a low-density protein array. Selected autoantigens were identified in prostate tissue and their expression pattern analyzed by immunohistochemistry and qPCR. The identified autoantibody profile was cross-checked in an independent sample set (N = 63) using the Luminex-bead protein array technology. Results Protein array screening identified 165 autoantibodies differentially abundant in the serum of high compared to low inflammation patients. The expression pattern of three corresponding antigens were established in benign and cancer tissue by immunohistochemistry and qPCR: SPAST (Spastin), STX18 (Syntaxin 18) and SPOP (speckle-type POZ protein). Of these, SPAST was significantly increased in prostate tissue with high inflammation. All three autoantigens were differentially expressed in primary and/or castration resistant prostate tumors when analyzed in an inflammation-independent tissue microarray. Cross-validation of the inflammation autoantibody profile on an independent sample set using a Luminex-bead protein array, retrieved 51 of the significantly discriminating autoantibodies. Three autoantibodies were significantly upregulated in both screens, MUT

  15. Juvenile fibromyalgia in an adolescent patient with sickle cell disease presenting with chronic pain.

    PubMed

    Ramprakash, Stalin; Fishman, Daniel

    2015-10-01

    Juvenile fibromyalgia in children with sickle cell disease has not been reported in the literature. We report an adolescent patient with sickle cell whose pain symptoms progressed from having recurrent acute sickle cell pain crisis episodes to a chronic pain syndrome over several years. He was eventually diagnosed with juvenile fibromyalgia based on the clinical history and myofascial tender points and his pain symptoms responded better to multidisciplinary strategies for chronic fibromyalgia pain. Chronic pain in sickle cell disease is an area of poor research, and in addition there is inconsistency in the definition of chronic pain in sickle cell disease. Central sensitisation to pain is shown to occur after recurrent painful stimuli in a genetically vulnerable individual. In a chronic pain condition such as fibromyalgia central sensitisation is thought to play a key role. Fibromyalgia should be considered as one of the main differential diagnosis in any sickle cell patient with chronic pain.

  16. Early maladaptive schemas in Finnish adult chronic pain patients and a control sample.

    PubMed

    Saariaho, Tom Harri; Saariaho, Anita Sylvia; Karila, Irma Anneli; Joukamaa, Matti I

    2011-04-01

    Engel (1959) suggested that negative physical or emotional experiences in childhood predispose to the development of chronic pain. Studies have shown that physical and sexual abuse in early life is connected with chronic pain. Emotional adversities are much less studied causes contributing to the development of chronic pain and disability. Early emotional abuse, neglect, maltreatment and other adversities are deleterious childhood experiences which, according to Young's schema theory (1990), produce early maladaptive schemas (EMSs). The primary goal of this study was to examine whether early adversities were more common in chronic pain patients than in a control group. A total of 271 (53% women) first-visit chronic pain patients and 331 (86% women) control participants took part in the study. Their socio-demographic data, pain variables and pain disability were measured. To estimate EMSs the Young Schema Questionnaire was used. Chronic pain patients scored higher EMSs reflecting incapacity to perform independently, catastrophic beliefs and pessimism. The most severely disabled chronic pain patients showed an increase in all the EMSs in the Disconnection and Rejection schema domain, namely Abandonment/Instability, Mistrust/Abuse, Emotional Deprivation, Defectiveness/Shame and Social Isolation/Alienation EMSs. The results of the study suggested that chronic pain patients had suffered early emotional maltreatment. PMID:21054422

  17. Early maladaptive schemas in Finnish adult chronic pain patients and a control sample.

    PubMed

    Saariaho, Tom Harri; Saariaho, Anita Sylvia; Karila, Irma Anneli; Joukamaa, Matti I

    2011-04-01

    Engel (1959) suggested that negative physical or emotional experiences in childhood predispose to the development of chronic pain. Studies have shown that physical and sexual abuse in early life is connected with chronic pain. Emotional adversities are much less studied causes contributing to the development of chronic pain and disability. Early emotional abuse, neglect, maltreatment and other adversities are deleterious childhood experiences which, according to Young's schema theory (1990), produce early maladaptive schemas (EMSs). The primary goal of this study was to examine whether early adversities were more common in chronic pain patients than in a control group. A total of 271 (53% women) first-visit chronic pain patients and 331 (86% women) control participants took part in the study. Their socio-demographic data, pain variables and pain disability were measured. To estimate EMSs the Young Schema Questionnaire was used. Chronic pain patients scored higher EMSs reflecting incapacity to perform independently, catastrophic beliefs and pessimism. The most severely disabled chronic pain patients showed an increase in all the EMSs in the Disconnection and Rejection schema domain, namely Abandonment/Instability, Mistrust/Abuse, Emotional Deprivation, Defectiveness/Shame and Social Isolation/Alienation EMSs. The results of the study suggested that chronic pain patients had suffered early emotional maltreatment.

  18. Relevance of Colonic Gas Analysis and Transit Study in Patients With Chronic Constipation

    PubMed Central

    Park, Seon-Young; Park, Hyun-Bum; Lee, Ji-Myung; Lee, Ho-Jun; Park, Chang-Hwan; Kim, Hyun-Soo; Choi, Sung-Kyu; Rew, Jong-Sun

    2015-01-01

    Background/Aims Colon transit time (CTT) is a useful diagnostic tool in chronic constipation, but requires good patient compliance. We analyzed the correlation between the gas volume score (GVS) and CTT in patients with chronic constipation. Methods The study included 145 consecutive patients (65 men) with chronic constipation. The primary outcome was the correlation between the colon GVS and CTT. Secondary outcomes were the differences in colon GVS according to CTT and subtypes of chronic constipation. Results There were 81 patients with “CTT < 45 hours” and 64 patients with “CTT ≥ 45 hours.” In addition, 88 patients were classified as having functional constipation and 57 were classified as having constipation predominant irritable bowel syndrome (IBS-C). There was no significant correlation between CTT and colon GVS. However, the right colon GVS showed a positive correlation with right CTT (r = 0.255, P = 0.007). The median total colon GVS was significantly higher in patients with “CTT ≥ 45 hours” than in those with “CTT < 45 hours” (5.65% vs 4.15%, P = 0.010). There were no significant differences in colon GVS between the functional constipation and IBS-C. Conclusions We were unable to detect a correlation between GVS and CTT in patients with chronic constipation. However, total colon GVS may be a method of predicting slow transit in patients with chronic constipation. PMID:26058876

  19. Family functioning in families of first-episode psychosis patients as compared to chronic mentally ill patients and healthy controls.

    PubMed

    Koutra, Katerina; Triliva, Sofia; Roumeliotaki, Theano; Stefanakis, Zacharias; Basta, Maria; Lionis, Christos; Vgontzas, Alexandros N

    2014-11-30

    The present study aimed to investigate possible differences in family environment among patients experiencing their First Episode of Psychosis (FEP), chronic patients and controls. Family cohesion and flexibility (FACES-IV) and psychological distress (GHQ-28) were evaluated in families of 50 FEP and 50 chronic patients, as well as 50 controls, whereas expressed emotion (FQ) and family burden (FBS) were assessed in families of FEP and chronic patients. Multivariable linear regression analysis, adjusted for confounders, indicated impaired cohesion and flexibility for families of FEP patients compared to controls, and lower scores for families of chronic patients compared to those of FEP patients. Caregivers of chronic patients scored significantly higher in criticism, and reported higher burden and psychological distress than those of FEP patients. Our findings suggest that unbalanced levels of cohesion and flexibility, high criticism and burden appeared to be the outcome of psychosis and not risk factors triggering the onset of the illness. Furthermore, emotional over-involvement both in terms of positive (i.e. concern) and negative behaviors (i.e. overprotection) is prevalent in Greek families. Psychoeducational interventions from the early stages of the illness should be considered to promote caregivers' awareness regarding the patients' illness, which in turn, may ameliorate dysfunctional family interactions.

  20. Simultaneous bilateral quadriceps tendon rupture in patient with chronic renal failure.

    PubMed

    Lee, Yunseok; Kim, Byounggook; Chung, Ju-Hwan; Dan, Jinmyoung

    2011-12-01

    Simultaneous bilateral spontaneous rupture of the quadriceps tendon is a very rare condition and only a few cases have been reported in the literature. The etiology is not clear yet. But it occurs infrequently in patients with chronic metabolic disorders. A 30-year-old female patient with simultaneous bilateral spontaneous quadriceps tendon rupture visited our hospital. She had chronic renal failure and her parathyroid hormone level was elevated due to parathyroid adenoma. We report a surgical repair of both quadriceps tendons of a patient with chronic renal failure as well as management of hyperparathyroidism.

  1. [Evoked potentials and brainstem reflex activity in patients of young and middle age with chronic headache].

    PubMed

    Kuznetsova, E A; Iakupov, E Z

    2011-01-01

    Neurophysiological peculiarities of functional state of afferent systems, including brain evoked potentials of different modalities and brainstem reflex activity, in patients of young and middle age with chronic headaches have been studied. In young patients, there was the increased reflex activity of visual and trigeminal systems, somatosensory cortex and brainstem structures that indicated the main role of the generator of pathologically increased excitation (GPIE) of different levels in the pathogenesis of chronic pain. In patients of middle age, we observed the predominant role of conduction delay on the supraspinal level. The revealed age-related neurophysiological peculiarities determine the pathogenetic therapy of chronic headaches.

  2. The chronic disease self-management program--A pilot study in patients undergoing hemodialysis.

    PubMed

    Slesnick, Nate; Pienkos, Shawn; Sun, Sumi; Doss-McQuitty, Sheila; Schiller, Brigitte

    2015-04-01

    A strong emphasis on self-management for health maintenance in a variety of chronic diseases has been shown to benefit patients' outcomes and quality of life. However, little has been published on such programs in patients with chronic kidney disease. We studied the feasibility and effectiveness of the Chronic Disease Self-Management Program (CDSMP) in 14 patients with ESRD undergoing conventional hemodialysis. This program is designed to enhance skills in the areas of medical, emotional, and role management. Outcome measures in health status, self-management behaviors, self-efficacy, and health care utilization were evaluated through use of questionnaires at baseline and after six months. PMID:26263750

  3. Providing Care for Patients with Chronic Migraine: Diagnosis, Treatment, and Management.

    PubMed

    Dougherty, Carrie; Silberstein, Stephen D

    2015-09-01

    Chronic migraine, a subtype of migraine defined as ≥ 15 headache days per month for ≥ 3 months, in which ≥ 8 days per month meet criteria for migraine with or without aura or respond to migraine-specific treatment, is a disabling, underdiagnosed, and undertreated disorder associated with significant disability, poor health-related quality of life, and high economic burden. The keys to caring for chronic migraine patients include: (1) making a proper diagnosis; (2) identifying and eliminating exacerbating factors; (3) assessing for medication overuse (patients with chronic headache often overuse acute medications); and (4) continued management. Communication between patient and physician about treatment goals is important. The patient management guidelines presented in this article should help physicians improve treatment success and proactively address common comorbidities among their patients with chronic migraine.

  4. MODELING CHRONIC DISEASE PATIENT FLOWS DIVERTED FROM EMERGENCY DEPARTMENTS TO PATIENT-CENTERED MEDICAL HOMES

    PubMed Central

    Diaz, Rafael; Behr, Joshua; Kumar, Sameer; Britton, Bruce

    2016-01-01

    Chronic Disease is defined as a long lasting health condition, which can develop and/or worsen over an extended time, but which can also be controlled. The monetary and budgetary toll due to its persistent nature has become unsustainable and requires pressing actions to limit their incidence and burden. This paper demonstrates the utility of the System Dynamics approach to simulate the behavior of key factors involved in the implementation of chronic disease management. We model the patient flow diversion from emergency departments (ED) to patient-centered medical homes (PCMH), with emphasis on the visit rates, as well as the effect of insurance coverage, in an effort to assure continuity of quality care for Asthma patients at lower costs. The model is used as an evaluative method to identify conditions of a maintained health status through adequate policy planning, in terms of resources and capacity. This approach gives decision makers the ability to track the level of implementation of the intervention and generate knowledge about dynamics between population demands and the intervention effectiveness. The functionality of the model is demonstrated through the consideration of hypothetical scenarios executed using sensitivity analysis. PMID:26770663

  5. Integrated care for chronic migraine patients: epidemiology, burden, diagnosis and treatment options.

    PubMed

    Diener, Hans-Christoph; Solbach, Kasja; Holle, Dagny; Gaul, Charly

    2015-08-01

    Migraine is a common neurological disorder, characterised by severe headaches. Epidemiological studies in the USA and Europe have identified a subgroup of migraine patients with chronic migraine. Chronic migraine is defined as ≥15 headache days per month for ≥3 months, in which ≥8 days of the month meet criteria for migraine with or without aura, or respond to treatment specifically for migraine. Chronic migraine is associated with a higher burden of disease, more severe psychiatric comorbidity, greater use of healthcare resources, and higher overall costs than episodic migraine (<15 headache days per month). There is a strong need to improve diagnosis and therapeutic treatment of chronic migraine. Primary care physicians, as well as hospital-based physicians, are integral to the identification and treatment of these patients. The latest epidemiological data, as well as treatment options for chronic migraine patients, are reviewed here.

  6. Dietary Intake Assessment and Biochemical Characteristics of Blood and Urine in Patients with Chronic Gastritis

    PubMed Central

    Kang, Myung-Hwa

    2015-01-01

    Chronic gastritis is a prevalent gastroentestinal disease in Korea. The purpose of this study was to investigate status of foods and nutrients intake and health related biochemical indicators in the patients with chronic gastritis. Daily food and nutrient intake, blood lipids, and antioxidant indicators in the urine, were compared between a group of 19 patients diagnosed with chronic gastritis and a control group of 27 subjects having normal gastroscopy. No significant differences were found in age, height, weight, body mass index, and blood pressure between the two groups. Daily energy intakes were 1900.6 kcal for the chronic gastritis patient group, and 1931.8 kcal for the normal control group without significant difference. No significant difference was found between the two groups in all nutrient intakes except for cholesterol. The chronic gastritis patients consumed lower amount of sugars and sweeteners but greater amount of starchy food groups such as potatoes and legumes than subjects of control group consumed. Also the chronic gastritis patients showed higher serum triglyceride concentration than the normal subjects. These results indicate that the dietary pattern of chronic gastritis patients may have relation to a change in the serum lipid level; however, more systematic research with a larger samples size is required. PMID:25954729

  7. Nilotinib 300 mg twice daily: an academic single-arm study of newly diagnosed chronic phase chronic myeloid leukemia patients

    PubMed Central

    Castagnetti, Fausto; Breccia, Massimo; Gugliotta, Gabriele; Martino, Bruno; D’Adda, Mariella; Stagno, Fabio; Carella, Angelo Michele; Avanzini, Paolo; Tiribelli, Mario; Trabacchi, Elena; Visani, Giuseppe; Gobbi, Marco; Salvucci, Marzia; Levato, Luciano; Binotto, Gianni; Capalbo, Silvana Franca; Bochicchio, Maria Teresa; Soverini, Simona; Cavo, Michele; Martinelli, Giovanni; Alimena, Giuliana; Pane, Fabrizio; Saglio, Giuseppe; Rosti, Gianantonio; Baccarani, Michele

    2016-01-01

    The introduction and the extended clinical use of nilotinib in the first-line treatment of chronic myeloid leukemia have been based on company-sponsored trials. Independent confirmations are extremely important. We report an investigator-sponsored study of nilotinib 300 mg twice daily in 130 chronic myeloid leukemia patients in early chronic phase. A deep molecular response was achieved in 46% (MR4.0) and 17% (MR4.5) of patients at 2 years; 58% of the enrolled patients achieved a MR4.0 at least once, with a sustained MR4.0 in 52% of them. With a median observation of 29 months (range 24–37 months), 77% of patients were still on treatment with nilotinib. The reasons for permanent discontinuation were: 3% progression, 5% failure or suboptimal response, 8% adverse events, 1% treatment-free remission, and 5% other reasons. Thirteen thrombotic arterial events were reported in 12 patients. A prospective evaluation of metabolic effects showed an increase of fasting glucose without significant variations of glycated hemoglobin, an increase of total cholesterol (both low density lipoprotein and high density lipoprotein fractions) and a decrease of triglycerides. This study confirms a high and rapid efficacy of nilotinib 300 mg twice daily and provides detailed information on the type and incidence of non-hematologic and metabolic adverse events (clinicaltrials.gov identifier: 01535391). PMID:27470600

  8. Antibiotic-induced release of endotoxin in chronically bacteriuric patients.

    PubMed Central

    Hurley, J C; Louis, W J; Tosolini, F A; Carlin, J B

    1991-01-01

    A novel in vivo model for the study of antibiotic-induced release of endotoxin from gram-negative bacteria is described. The model uses the chronically colonized urinary tracts of patients whose spinal cords have been injured. At baseline, the organisms were present in the range of 1 x 10(3) to 2 x 10(7) CFU/ml, and the concentration of endotoxin ranged from 2 x 10(-1) to 1 x 10(3) ng/ml in 44 studies. In 10 control studies, the concentration of endotoxin and the numbers of viable gram-negative bacteria over time changed by an average of less than 0.15 log10 units from the baseline values. At 2 h after antibiotic administration, the average decrease in CFU was 0.93 log10 units, and because antibiotics cause the release of endotoxin, an average increase in endotoxin concentration of 0.59 log10 units was noted in 21 studies with susceptible bacteria. Similar changes in response to antibiotic exposure were seen in studies with susceptible Pseudomonas bacteria in comparison with those seen in studies with susceptible members of the family Enterobacteriaceae. These results provide evidence that this novel model may be useful for comparing the effects of antibiotics with different modes of action, both as single agents and in combination, on the concentration of endotoxin in relation to changes in the numbers of bacteria, under conditions of bacterial replication and antibiotic exposure more closely resembling those found in vivo than is possible in other models. PMID:1804012

  9. Cognitive status among patients with chronic obstructive pulmonary disease

    PubMed Central

    Roncero, Carlos; Campuzano, Ana Isabel; Quintano, Jose Antonio; Molina, Jesús; Pérez, Joselín; Miravitlles, Marc

    2016-01-01

    Purpose We investigated the association between cognitive impairment and chronic obstructive pulmonary disease (COPD), taking into account demographic and clinical variables evaluated during routine practice. Patients and methods We performed a post hoc analysis of a cross-sectional study that included subjects with stable COPD. Sociodemographic and clinical information was recorded using the Body mass index, airflow Obstruction, Dyspnea and Exacerbations index and the Charlson comorbidity index. Cognitive performance was studied by the mini-mental state examination, with a score less than 27 indicating clinical impairment. Depressive symptoms, physical activity, and quality of life (EuroQoL-5 dimensions and COPD Assessment Test) were also evaluated. Results The analysis included 940 subjects. The prevalence of cognitive impairment was 39.4%. Multivariate logistic regression models revealed that cognitive impairment was associated with educational level (odds ratio [OR] =0.096, 95% confidence interval [CI] =0.011–0.447) and poorer quality of life measured by the EuroQoL-5 dimensions social tariff (OR =0.967, 95% CI =0.950–0.983). When questionnaires were not included in the analysis, cognitive impairment was associated with educational level (OR =0.063, 95% CI =0.010–0.934), number of exacerbations (OR =11.070, 95% CI =1.450–84.534), Body mass index, airflow Obstruction, Dyspnea and Exacerbations index score (OR =1.261, 95% CI =1.049–1.515), and the Charlson comorbidity index (OR =1.412, 95% CI =1.118–1.783). Conclusion Cognitive impairment is common in COPD and is associated with low educational level, higher disease severity, and increased comorbidity. This could have therapeutic implications for this population. PMID:27042043

  10. Etanercept treatment in rheumatoid arthritis patients with chronic kidney failure on predialysis.

    PubMed

    Cho, Soo-Kyung; Sung, Yoon-Kyoung; Park, Songree; Bae, Sang-Cheol

    2010-09-01

    Rheumatoid arthritis (RA) patients with chronic kidney failure are intolerant to most disease-modifying antirheumatic drugs (DMARDs) and NSAIDs due to their potential toxicities. Although the tumor necrosis factor (TNF) inhibitors have emerged as a highly effective treatment for RA, their safety and efficacy in RA patients with chronic kidney failure have not been well reported. We retrospectively evaluated the safety and efficacy of etanercept treatment in RA patients with chronic kidney failure. We describe three RA patients with chronic kidney failure who had been treated with DMARDs, steroids and NSAIDs, but were discontinued from these classical agents due to several side effects and nephrotoxicity. The patients were treated with 25 mg of etanercept once or twice a week. We evaluated disease activity and used decreasing renal function and increasing number of infections to monitor safety. All three patients improved after starting etanercept treatment and their steroid requirements were decreased. Linear relationships between Modification of Diet in Renal Disease study equation (MDRD) glomerular filtration rate (GFR) and time were observed. Thus, in all patients, the changes in GFR did not represent superimposed acute drug toxicity, but rather chronic progressive renal failure. These cases show that etanercept may be a safe and effective treatment option for RA patients with chronic kidney failure.

  11. Bone mineral density among elderly patients with chronic obstructive pulmonary disease patients in India

    PubMed Central

    Hattiholi, Jyothi; Gaude, Gajanan S.

    2013-01-01

    Background: Osteoporosis is one of the major extra-pulmonary manifestations of chronic obstructive pulmonary disease (COPD), which limits the physical activity. The present study was undertaken to study the bone mineral density (BMD) and osteoporosis in the elderly COPD patients. Materials and Methods: This was a cross-sectional study carried out among elderly COPD patients. After a detailed clinical history spirometry was done to stage the severity of COPD. DEXA scan of the lumbar spine was performed using bone densitometer to determine osteoporosis. Statistical analysis was based on Chi-square test. Risk factors were identified by univariate and multivariate logistic regression analysis. Results: A total of 70 elderly COPD patients were included. Fourty-six patients (65.7%) had osteoporosis and 13 (18.6%) had osteopenia. Majority of the osteoporosis patients had stage III or stage IV COPD disease (77.2%). As the severity grade of COPD increased, the risk of osteoporosis also increased. Also, with the increasing severity of COPD, BMD decreased. Patients with lower body mass index (BMI) had higher prevalence of osteoporosis (45.7%). Using multivariate regression analysis, stage IV COPD, number of acute exacerbations >3 and steroid cumulative dose >1000 mg were independent risk factors for osteoporosis in elderly COPD patients. Conclusions: The prevalence of osteoporosis was 65.7%, and 18.6% had osteopenia. Stage III and IV patients had significantly lower BMI in elderly COPD patients. High clinical suspicion and early diagnosis and treatment are required in the evaluation of osteoporosis in elderly COPD patients. PMID:24403704

  12. Depression among Chronic Pain Patients: Cognitive-Behavioral Analysis and Effect on Rehabilitation Outcome.

    ERIC Educational Resources Information Center

    Kerns, Robert D.; Haythornthwaite, Jennifer A.

    1988-01-01

    Examined relevance of depression to chronic pain. Found significant differences among 131 depressed, mildly depressed, and nondepressed chronic pain sufferers on instrumental activities and coping skills, with more depressed subjects reporting lower levels of functioning and less support. Depressed pain patients showed greater tendency to drop out…

  13. Pain Patients and Their Partners: The Role of Collusion in Chronic Pain.

    ERIC Educational Resources Information Center

    Delvey, Joseph, Jr.; Hopkins, Linda

    1982-01-01

    Uses the concept of collusion to explain the formation and persistence of patient-caretaker dyads which may help explain the role of family dynamics in cases of chronic pain. Suggests the caretaking role may be extreme and contibute to the maintenance of a chronic pain role. (Author/JAC)

  14. Intrathecal Dexmedetomidine for Anaesthetic Management of a Patient with Chronic Inflammatory Demyelinating Polyneuropathy

    PubMed Central

    Srinivasalu, D

    2016-01-01

    Chronic demyelinating disorders have multifactorial origin but common important physiologic and anaesthetic considerations. Choice of anaesthesia technique and the drugs used, undertanding the pros and cons of using central neuraxial blocks will help in successful management of such patients. We describe the anaesthetic management of a 34-year-old male with chronic inflammatory demyelinating polyneuropathy posted for cystolithotripsy. PMID:27790558

  15. Serum amylase isozymes in patients with chronic pancreatitis with hyperamylasemia.

    PubMed

    Wakabayashi, A; Saeki, M; Mori, R; Oshiba, S

    1977-01-01

    In order to clarify the relationship between hyperamylasemia and clinical states in chronic pancreatitis, serum amylase isozymes were studied in 39 cases of chronic pancreatitis including 13 cases of alcoholic pancreatitis. Hyperamylasemia in chronic pancreatitis is generally due to high pancreatic type isoamylase (P-amylase) activity in acute exacerbation, sometimes accompanied by a transient elevation in salivary type isoamylase (S-amylase). On remission, however, hyperamylasemia due to high S-amylase activity has been found. These were cases of advanced alcoholic pancreatitis, which exhibited a characteristic pattern of low serum P-amylase and high serum S-amylase activities while the clearance ratio (Cam/Ccr) was normal despite high S-amylase activity. It should be noted that hyperamylasemia in chronic pancreatitis may be caused by high S-amylase activity in addition to high P-amylase activity, especially in alcoholic pancreatitis.

  16. Changes of Some Hormones Levels in Patients With Hepatitis B Virus-Related Chronic Liver Disease

    PubMed Central

    Serin, Ayfer; Akarsu, Mesut; Akpinar, Hale; Simsek, Ilkay

    2013-01-01

    Background The purpose of the study was to evaluate some of the hormones in patients with chronic liver disease and cirrhosis. Methods The men patients with chronic hepatitis B (Group 1), liver cirrhosis secondary to hepatitis B (Group 2), were included in this study. Additionally, a control group of healthy volunteers (Group 3) was formed. We investigated serum levels of Follicle-stimulating hormone (FSH), Luteinizing hormone (LH), Total testosterone (T. TES), Free-testosterone (F. TES), Estradiol (E2), Androstenedione (ANDR), Dihydroepiandrosterone (DHEA), Progesterone (PPOGES), Prolactin (PRL), Sex hormone binding protein (SHGB) were measured by radioimmunoassay and chemiluminescent immunoassay methods. Result A total of 73 patients with chronic liver disease and cirrhosis were included in the study. Patients were grouped as cirrhosis (n = 28), chronic hepatitis B (n = 41) according to the type of their chronic liver disease. Serum F.TEST level in patient groups (group 1, group 2) was found to be lower than control group (P = 0.045, P = 0.047). Serum LH value was found to be higher in patient group (group 2) than control group (P = 0.048). Serum estradiol was higher in the group 2 compared to the control group (P = 0.046). Conclusions The described disturbances of some of the observed hormones (LH, E2, F. TES) are complex, particularly in their relationship by which the clinical picture of the hepatitis B related cirrhotic patients and chronic liver disease can be explained.

  17. Qualitative assessment of red blood cell parameters for signs of anemia in patients with chronic periodontitis

    PubMed Central

    Khan, Nubesh S.; Luke, Roji; Soman, Rino Roopak; Krishna, Praveen M.; Safar, Iqbal P.; Swaminathan, Senthil Kumar

    2015-01-01

    Aim: Anemia of chronic disease is defined as anemia occurring in chronic infections and inflammatory conditions that is not caused by marrow deficiencies or other diseases and in the presence of adequate iron stores and vitamins. The present case control study was aimed to assess the red blood cell parameters for signs of anemia in patients with mild, moderate, and severe chronic periodontitis. Materials and Methods: A simple random sampling method was used to select 80 healthy male patients, who were divided into four groups based on full mouth periodontal examination as follows: group I patients comprised the control group (n = 20), which included patients with a clinically healthy periodontium, group II patients (n = 20) were diagnosed with mild chronic periodontitis, group III (n = 20) included moderate chronic periodontitis patients, and patients with severe chronic periodontitis formed group IV (n = 20). Laboratory blood investigations included total number of erythrocytes, hemoglobin concentration, packed cell volume, mean corpuscular volume, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration. Results: Data analysis showed a statistically significant decrease in red blood cell parameters with increase in different grades of periodontitis. Conclusion: Results of the present study show a substantial decrease in red blood cell parameters with increase in the severity of periodontal destruction. PMID:26759801

  18. Early molecular response predicts outcomes in patients with chronic myeloid leukemia in chronic phase treated with frontline nilotinib or imatinib

    PubMed Central

    Saglio, Giuseppe; Kantarjian, Hagop M.; Guilhot, François; Niederwieser, Dietger; Rosti, Gianantonio; Nakaseko, Chiaki; De Souza, Carmino Antonio; Kalaycio, Matt E.; Meier, Stephan; Fan, Xiaolin; Menssen, Hans D.; Larson, Richard A.; Hochhaus, Andreas

    2014-01-01

    We explored the impact of early molecular response (EMR; BCR-ABL ≤10% on the international scale [BCR-ABLIS] at 3 or 6 months) on outcomes in patients with newly diagnosed chronic myeloid leukemia in chronic phase treated with nilotinib or imatinib based on 4 years of follow up in Evaluating Nilotinib Efficacy and Safety in Clinical Trials—Newly Diagnosed Patients. Patients (n = 846) received nilotinib 300 mg twice daily, nilotinib 400 mg twice daily, or imatinib 400 mg once daily. At 3 months, more patients had EMR failure (ie, BCR-ABLIS >10%) on imatinib (33%) than on nilotinib (9%-11%); similarly at 6 months, 16% of patients in the imatinib arm vs 3% and 7% in the nilotinib arms had EMR failure. In all arms, EMR failure was associated with lower rates of molecular response, an increased risk of progression, and lower overall survival compared with EMR achievement. We also analyzed patient and treatment characteristics associated with EMR and found distinct patterns in the nilotinib arms vs the imatinib arm. High Sokal risk score was associated with a high rate of EMR failure on imatinib, but not on nilotinib. In contrast, reduced dose intensity and dose interruptions were strongly associated with EMR failure in nilotinib-treated, but not imatinib-treated, patients. This study is registered at www.clinicaltrials.gov as #NCT00471497. PMID:24335106

  19. Early molecular response predicts outcomes in patients with chronic myeloid leukemia in chronic phase treated with frontline nilotinib or imatinib.

    PubMed

    Hughes, Timothy P; Saglio, Giuseppe; Kantarjian, Hagop M; Guilhot, François; Niederwieser, Dietger; Rosti, Gianantonio; Nakaseko, Chiaki; De Souza, Carmino Antonio; Kalaycio, Matt E; Meier, Stephan; Fan, Xiaolin; Menssen, Hans D; Larson, Richard A; Hochhaus, Andreas

    2014-02-27

    We explored the impact of early molecular response (EMR; BCR-ABL ≤10% on the international scale [BCR-ABL(IS)] at 3 or 6 months) on outcomes in patients with newly diagnosed chronic myeloid leukemia in chronic phase treated with nilotinib or imatinib based on 4 years of follow up in Evaluating Nilotinib Efficacy and Safety in Clinical Trials-Newly Diagnosed Patients. Patients (n = 846) received nilotinib 300 mg twice daily, nilotinib 400 mg twice daily, or imatinib 400 mg once daily. At 3 months, more patients had EMR failure (ie, BCR-ABL(IS) >10%) on imatinib (33%) than on nilotinib (9%-11%); similarly at 6 months, 16% of patients in the imatinib arm vs 3% and 7% in the nilotinib arms had EMR failure. In all arms, EMR failure was associated with lower rates of molecular response, an increased risk of progression, and lower overall survival compared with EMR achievement. We also analyzed patient and treatment characteristics associated with EMR and found distinct patterns in the nilotinib arms vs the imatinib arm. High Sokal risk score was associated with a high rate of EMR failure on imatinib, but not on nilotinib. In contrast, reduced dose intensity and dose interruptions were strongly associated with EMR failure in nilotinib-treated, but not imatinib-treated, patients. This study is registered at www.clinicaltrials.gov as #NCT00471497.

  20. [Correction of dyslipidemia in patients with chronic hepatitis C, combined with diabetes type 2].

    PubMed

    Derbak, M; Boldizhar, P

    2014-01-01

    The article shows the results of treatment of 118 patients with chronic hepatitis C (CHC) which is associated with type 2 diabetes mellitus (DM). When planning therapeutic interventions in chronic hepatitis C in patients with diabetes, it is considered the presence of visceral obesit , dyslipidemia, and hepatic steatosis. The efficacy of different treatment regimens was studied. Found that the usage of ursodeoxycholic acid and ademetionin in HCV patients with diabetes type 2 receiving standard antiviral therapy (SAVT), significantly make a positive effect on the level of dyslipidemia. The normalization of lipid profile allows for a full course of SAVT, which reduces the frequency of relapse. It is also noted that the simultaneous use of ademetionin and ursodeoxycholic acid in treatment of chronic hepatitis C leads to a reduction of side effects of SAVT. Metabolic therapy may be recommended for patients with chronic hepatitis C in combination with type 2 diabetes in case of SAVT, and at its contraindications or intolerance.

  1. [Correction of dyslipidemia in patients with chronic hepatitis C, combined with diabetes type 2].

    PubMed

    Derbak, M; Boldizhar, P

    2014-01-01

    The article shows the results of treatment of 118 patients with chronic hepatitis C (CHC) which is associated with type 2 diabetes mellitus (DM). When planning therapeutic interventions in chronic hepatitis C in patients with diabetes, it is considered the presence of visceral obesit , dyslipidemia, and hepatic steatosis. The efficacy of different treatment regimens was studied. Found that the usage of ursodeoxycholic acid and ademetionin in HCV patients with diabetes type 2 receiving standard antiviral therapy (SAVT), significantly make a positive effect on the level of dyslipidemia. The normalization of lipid profile allows for a full course of SAVT, which reduces the frequency of relapse. It is also noted that the simultaneous use of ademetionin and ursodeoxycholic acid in treatment of chronic hepatitis C leads to a reduction of side effects of SAVT. Metabolic therapy may be recommended for patients with chronic hepatitis C in combination with type 2 diabetes in case of SAVT, and at its contraindications or intolerance. PMID:24523328

  2. Cognitive-Somatic Anxiety Response Patterning in Chronic Pain Patients and Nonpatients.

    ERIC Educational Resources Information Center

    DeGood, Douglas E.; And Others

    1985-01-01

    Examined group differences in self-reporting anxiety for one hundred chronic pain patients, an equal number of college students, and two smaller comparison samples. Pain patients, relative to nonpatients, acknowledged dramatically fewer total signs of anxiety. Also, pain patients endorsed significantly more somatic than cognitive indicators of…

  3. A Review and Investigation of Family Factors in the Treatment of Chronic Pain Patients.

    ERIC Educational Resources Information Center

    Bailis, Karen L.

    Chronic pain is a syndrome which forces many changes upon the patient and upon the family system. To examine the relationship between patients' and their spouses' psychosocial functioning, questionnaire data were collected from 28 male and 18 female patients referred for evaluation to an outpatient pain management program. The Minnesota…

  4. Oral health promotion in patients with chronic renal failure admitted in the Intensive Care Unit.

    PubMed

    Miranda, Alexandre Franco; Lia, Erica Negrini; de Carvalho, Tatiane Maciel; Piau, Cinthia Gonçalves Barbosa de Castro; Costa, Priscila Paganini; Bezerra, Ana Cristina Barreto

    2016-01-01

    Oral hygiene deficiency is common in patients treated in ICUs and it enables biofilm colonization by microorganisms that lead to respiratory infections. A 30-year-old female patient with chronic renal failure was hospitalized. Dental procedures were performed in the ICU and contributed to the patient's health after a few days.

  5. Disintegration of a pancreatic duct stone with extracorporeal shock waves in a patient with chronic pancreatitis.

    PubMed

    Sauerbruch, T; Holl, J; Sackmann, M; Werner, R; Wotzka, R; Paumgartner, G

    1987-09-01

    We report the case of a 33-year-old woman with chronic calcifying pancreatitis in whom an intraductal pancreatic stone with a diameter of 8 mm was successfully disintegrated with extracorporeal shock waves, permitting subsequent endoscopic extraction of the fragments. The patient had a mild attack of pancreatitis after the treatment. We conclude that shockwave lithotripsy of a pancreatic duct stone in patients with chronic pancreatitis is possible. It should, however, be viewed with reservation until further experience has been gained.

  6. Emergency anaesthetic management of a severely anaemic, chronic schizophrenic patient with history of neuroleptic malignant syndrome

    PubMed Central

    Chellam, Shrividya; Rajwade, Dhanwanti S; Tavri, Snehlata O

    2011-01-01

    Administering anaesthesia to a patient with chronic schizophrenia is a challenge due to the increased risk of various perioperative complications. Neuroleptic agents are highly effective drugs used for the treatment of psychiatric disorders, but are rarely associated with neuroleptic malignant syndrome (NMS). Here, we describe the successful anaesthetic management of a patient of chronic schizophrenia with past history of NMS who presented in emergency with active bleeding per rectum and haemoglobin of 3 gm%. PMID:22223911

  7. Patient-reported Outcomes in Asian Patients With Chronic Hepatitis C Treated With Ledipasvir and Sofosbuvir

    PubMed Central

    Younossi, Zobair M.; Stepanova, Maria; Chan, Henry L.Y.; Lee, Mei H.; Yu, Ming-Lung; Dan, Yock Y.; Choi, Moon S.; Henry, Linda

    2016-01-01

    Abstract Prevalence of chronic hepatitis C (CH-C) infection in patients of Asian ancestry ranges between 1% and 20%. Interferon (IFN)- and ribavirin (RBV)-containing regimens for CH-C have a negative impact on patient-reported outcomes (PROs) during treatment. The aim of this study was to assess the impact of IFN-free RBV-free sofosbuvir (SOF)-based regimens on PROs in CH-C patients of Asian ancestry. In this observational retrospective study, the PRO data from 12 multicenter multinational phase 3 clinical trials (2012–2015, conducted in Europe, North America, Australia, and New Zealand) of SOF-based regimens with and without IFN, ledipasvir (LDV), and/or RBV were used. At baseline, during treatment, and post-treatment, patients completed 4 validated PRO questionnaires (SF-36, CLDQ-HCV, FACIT-F, and WPAI:SHP). The resulting PROs in Asian patients were compared across the treatment regimens. Of 4485 of the trials’ participants, 106 patients were of Asian ancestry (55.7% male, 69.8% treatment-naïve, 17.0% cirrhotic). In comparison with other patients, the Asian CH-C cohort was younger, had lower BMI, and lower rates of pre-treatment psychiatric comorbidities (anxiety, depression, sleep disorders) (all P < .05). At baseline, Asian patients also had lower SF-36 physical functioning scores (on average, by −5.6% on a normalized 0–100% PRO scale, P = .001). During treatment, Asian CH-C patients experienced a decline in their PRO scores while receiving IFN and/or RBV-containing regimens (up to −19.6%, P < .001). In contrast, patients receiving LDV/SOF experienced no PRO decrement and improvement of some PRO scores during treatment (+9.0% in general health of SF-36, P = .03). After achieving SVR-12, some of the PRO scores in Asian patients improved regardless of the regimen (up to +9.3%, P < .001). In multivariate analysis of Asian patients, the use of LDV/SOF was independently associated with higher PRO scores during and soon after the end of

  8. Differential Neural Processing during Motor Imagery of Daily Activities in Chronic Low Back Pain Patients

    PubMed Central

    Vrana, Andrea; Hotz-Boendermaker, Sabina; Stämpfli, Philipp; Hänggi, Jürgen; Seifritz, Erich; Humphreys, B. Kim; Meier, Michael L.

    2015-01-01

    Chronic low back pain (chronic LBP) is both debilitating for patients but also a major burden on the health care system. Previous studies reported various maladaptive structural and functional changes among chronic LBP patients on spine- and supraspinal levels including behavioral alterations. However, evidence for cortical reorganization in the sensorimotor system of chronic LBP patients is scarce. Motor Imagery (MI) is suitable for investigating the cortical sensorimotor network as it serves as a proxy for motor execution. Our aim was to investigate differential MI-driven cortical processing in chronic LBP compared to healthy controls (HC) by means of functional magnetic resonance imaging (fMRI). Twenty-nine subjects (15 chronic LBP patients, 14 HC) were included in the current study. MI stimuli consisted of randomly presented video clips showing every-day activities involving different whole-body movements as well as walking on even ground and walking downstairs and upstairs. Guided by the video clips, subjects had to perform MI of these activities, subsequently rating the vividness of their MI performance. Brain activity analysis revealed that chronic LBP patients exhibited significantly reduced activity compared to HC subjects in MI-related brain regions, namely the left supplementary motor area and right superior temporal sulcus. Furthermore, psycho-physiological-interaction analysis yielded significantly enhanced functional connectivity (FC) between various MI-associated brain regions in chronic LBP patients indicating diffuse and non-specific changes in FC. Current results demonstrate initial findings about differences in MI-driven cortical processing in chronic LBP pointing towards reorganization processes in the sensorimotor network. PMID:26569602

  9. Differential Neural Processing during Motor Imagery of Daily Activities in Chronic Low Back Pain Patients.

    PubMed

    Vrana, Andrea; Hotz-Boendermaker, Sabina; Stämpfli, Philipp; Hänggi, Jürgen; Seifritz, Erich; Humphreys, B Kim; Meier, Michael L

    2015-01-01

    Chronic low back pain (chronic LBP) is both debilitating for patients but also a major burden on the health care system. Previous studies reported various maladaptive structural and functional changes among chronic LBP patients on spine- and supraspinal levels including behavioral alterations. However, evidence for cortical reorganization in the sensorimotor system of chronic LBP patients is scarce. Motor Imagery (MI) is suitable for investigating the cortical sensorimotor network as it serves as a proxy for motor execution. Our aim was to investigate differential MI-driven cortical processing in chronic LBP compared to healthy controls (HC) by means of functional magnetic resonance imaging (fMRI). Twenty-nine subjects (15 chronic LBP patients, 14 HC) were included in the current study. MI stimuli consisted of randomly presented video clips showing every-day activities involving different whole-body movements as well as walking on even ground and walking downstairs and upstairs. Guided by the video clips, subjects had to perform MI of these activities, subsequently rating the vividness of their MI performance. Brain activity analysis revealed that chronic LBP patients exhibited significantly reduced activity compared to HC subjects in MI-related brain regions, namely the left supplementary motor area and right superior temporal sulcus. Furthermore, psycho-physiological-interaction analysis yielded significantly enhanced functional connectivity (FC) between various MI-associated brain regions in chronic LBP patients indicating diffuse and non-specific changes in FC. Current results demonstrate initial findings about differences in MI-driven cortical processing in chronic LBP pointing towards reorganization processes in the sensorimotor network. PMID:26569602

  10. Capsule Expression and Genotypic Differences among Staphylococcus aureus Isolates from Patients with Chronic or Acute Osteomyelitis▿

    PubMed Central

    Lattar, Santiago M.; Tuchscherr, Lorena P. N.; Caccuri, Roberto L.; Centrón, Daniela; Becker, Karsten; Alonso, Claudio A.; Barberis, Claudia; Miranda, Graciela; Buzzola, Fernanda R.; von Eiff, Christof; Sordelli, Daniel O.

    2009-01-01

    There is ample evidence that Staphylococcus aureus capsular polysaccharide (CP) promotes virulence. Loss of capsule expression, however, may lead to S. aureus persistence in a chronically infected host. This study was conducted to determine the relative prevalence of nonencapsulated S. aureus in patients with chronic and acute osteomyelitis. Only 76/118 (64%) S. aureus isolates from patients with osteomyelitis expressed CP, whereas all 50 isolates from blood cultures of patients with infections other than osteoarticular infections expressed CP (P = 0.0001). A significantly higher prevalence of nonencapsulated S. aureus was found in patients with chronic osteomyelitis (53%) than in those with acute osteomyelitis (21%) (P = 0.0046). S. aureus isolates obtained from multiple specimens from five of six patients with chronic osteomyelitis exhibited phenotypic (expression of CP, α-hemolysin, β-hemolysin, slime, and the small-colony variant phenotype) and/or genotypic (pulsed-field gel electrophoresis and spa typing) differences. Nonencapsulated S. aureus was recovered from at least one specimen from each chronic osteomyelitis patient. Fourteen isolates obtained from two patients with acute osteomyelitis were indistinguishable from each other within each group, and all produced CP5. In conclusion, we demonstrated that nonencapsulated S. aureus is more frequently isolated from patients with chronic osteomyelitis than from those with acute osteomyelitis, suggesting that loss of CP expression may be advantageous to S. aureus during chronic infection. Our findings on multiple S. aureus isolates from individual patients allow us to suggest that selection of nonencapsulated S. aureus is likely to have occurred in the patient during long-term bone infection. PMID:19273557

  11. A Fatal Strongyloides Stercoralis Hyperinfection Syndrome in a Patient With Chronic kidney Disease

    PubMed Central

    Qu, Ting-ting; Yang, Qing; Yu, Mei-hong; Wang, Jie

    2016-01-01

    Abstract Strongyloides stercoralis hyperinfection syndrome is a rare but fatal disease, which occurs commonly in immunocompromised patients. Strongyloidiasis among patients with chronic kidney disease is rarely reported. A 55-year-old Chinese male presented to hospital with diarrhea and abdominal pain. He developed acute respiratory failure and progressed to diffuse alveolar hemorrhage owing to disseminated strongyloidiasis immediately. The bronchoalveolar lavage revealed filariform larvae of Strongyloides stercoralis. This patient was diagnosed with Strongyloides hyperinfection syndrome. Although albendazole, mechanical ventilator support, fluid resuscitation, vasopressor support, extracorporeal membrane oxygenation, hydrocortisone, and broadspectrum antimicrobials were actively used, the patient eventually died. Similar cases in patients with chronic kidney disease in the literature are also reviewed. Through literature review, we recommend that strongyloidiasis should be routinely investigated in patients with chronic kidney disease who will undergo immunosuppressive therapy. PMID:27175679

  12. Temsirolimus and Imatinib Mesylate in Treating Patients With Chronic Myelogenous Leukemia

    ClinicalTrials.gov

    2013-01-11

    Accelerated Phase Chronic Myelogenous Leukemia; Blastic Phase Chronic Myelogenous Leukemia; Chronic Myelogenous Leukemia, BCR-ABL1 Positive; Chronic Phase Chronic Myelogenous Leukemia; Relapsing Chronic Myelogenous Leukemia

  13. Hypercalcaemia Secondary to Hypervitaminosis A in a Patient with Chronic Renal Failure

    PubMed Central

    Hammoud, D; El Haddad, B; Abdallah, J

    2014-01-01

    Vitamin A toxicity is a well-described medical condition with a multitude of potential presenting signs and symptoms. It can be divided into acute and chronic toxicity. Serum vitamin A concentrations are raised in chronic renal failure even with ingestion of less than the usual toxic doses. Hypercalcaemia can occasionally be associated with high levels of vitamin A but it is rare. In this report, we describe a 67- year old female patient with chronic kidney disease who was taking vitamin A supplements for approximately 10 years. The patient had worsening of her chronic kidney disease over the last years and developed chronic hypercalcaemia. Her vitamin A level was elevated with a daily intake of 7000 IU. The vitamin A supplement was stopped. A few months later, vitamin A level diminished substantially and serum calcium levels returned to normal. PMID:25303202

  14. Hypercalcaemia secondary to hypervitaminosis a in a patient with chronic renal failure.

    PubMed

    Hammoud, D; El Haddad, B; Abdallah, J

    2014-01-01

    Vitamin A toxicity is a well-described medical condition with a multitude of potential presenting signs and symptoms. It can be divided into acute and chronic toxicity. Serum vitamin A concentrations are raised in chronic renal failure even with ingestion of less than the usual toxic doses. Hypercalcaemia can occasionally be associated with high levels of vitamin A but it is rare. In this report, we describe a 67- year old female patient with chronic kidney disease who was taking vitamin A supplements for approximately 10 years. The patient had worsening of her chronic kidney disease over the last years and developed chronic hypercalcaemia. Her vitamin A level was elevated with a daily intake of 7000 IU. The vitamin A supplement was stopped. A few months later, vitamin A level diminished substantially and serum calcium levels returned to normal. PMID:25303202

  15. Multiple Chronic Conditions Among Outpatient Pediatric Patients, Southeastern Michigan, 2008–2013

    PubMed Central

    Pollock, Martha

    2015-01-01

    Studies investigating the prevalence of multiple chronic conditions (MCCs) and their associated health care cost and use among pediatric populations have been limited. Among 14,404 pediatric patients receiving outpatient care in southeastern Michigan from 2008 through 2013, 82.1% had 0 chronic conditions, 16.2% had 1 chronic condition, and 1.6% had 2 or more chronic conditions. Greater numbers of chronic conditions significantly predicted outpatient cost (β = 581.7, P < .001), visit frequency (β = 9.1, P < .001), and days between appointments (β = −33.9, P < .001). Further study of MCCs among pediatric patients is needed given their increasing prevalence and their associated health care cost and use. PMID:25674677

  16. Longterm decrease in the CD57 lymphocyte subset in a patient with chronic Lyme disease.

    PubMed

    Stricker, Raphael B; Burrascano, Joseph; Winger, Edward

    2002-01-01

    Lyme disease is a tickborne illness caused by the spirochete Borrelia burgdorferi. In a previous report we described a decrease in the CD57 lymphocyte subset in patients with chronic Lyme disease. We have now identified a patient with chronic relapsing and remitting symptoms of Lyme disease who had decreased levels of CD57 lymphocytes over 10 years. This observation represents the longest duration of an immunologic abnormality ever documented in chronic Lyme disease. The CD57 lymphocyte subset appears to be a useful marker of longterm infection with the Lyme disease spirochete.

  17. Effects of ankle balance taping with kinesiology tape for a patient with chronic ankle instability

    PubMed Central

    Kim, Byeong-Jo; Lee, Jung-Hoon; Kim, Chang-Tae; Lee, Sun-Min

    2015-01-01

    [Purpose] To report the effects of ankle balance taping for a patient with chronic ankle instability (CAI). [Subject] A 33-year-old man with a 10 year history of chronic ankle stability. [Methods] ABT with kinesiology tape was performed for 2 months (average, 16 h/day) around the right ankle. [Results] At the end of two months, no ankle instability was noted when ascending and descending the stairs, jumping, turning, operating the pedals while driving, and lifting heavy objects. [Conclusion] The repeated use of kinesiology tape in ankle balance taping may be an effective treatment for recovering the ankle stability of patients with chronic ankle instability. PMID:26311206

  18. Effects of ankle balance taping with kinesiology tape for a patient with chronic ankle instability.

    PubMed

    Kim, Byeong-Jo; Lee, Jung-Hoon; Kim, Chang-Tae; Lee, Sun-Min

    2015-07-01

    [Purpose] To report the effects of ankle balance taping for a patient with chronic ankle instability (CAI). [Subject] A 33-year-old man with a 10 year history of chronic ankle stability. [Methods] ABT with kinesiology tape was performed for 2 months (average, 16 h/day) around the right ankle. [Results] At the end of two months, no ankle instability was noted when ascending and descending the stairs, jumping, turning, operating the pedals while driving, and lifting heavy objects. [Conclusion] The repeated use of kinesiology tape in ankle balance taping may be an effective treatment for recovering the ankle stability of patients with chronic ankle instability.

  19. Frontline nilotinib in patients with chronic myeloid leukemia in chronic phase: results from the European ENEST1st study

    PubMed Central

    Hochhaus, A; Rosti, G; Cross, N C P; Steegmann, J L; le Coutre, P; Ossenkoppele, G; Petrov, L; Masszi, T; Hellmann, A; Griskevicius, L; Wiktor-Jedrzejczak, W; Rea, D; Coriu, D; Brümmendorf, T H; Porkka, K; Saglio, G; Gastl, G; Müller, M C; Schuld, P; Di Matteo, P; Pellegrino, A; Dezzani, L; Mahon, F-X; Baccarani, M; Giles, F J

    2016-01-01

    The Evaluating Nilotinib Efficacy and Safety in Clinical Trials as First-Line Treatment (ENEST1st) study included 1089 patients with newly diagnosed chronic myeloid leukemia in chronic phase. The rate of deep molecular response (MR4 (BCR-ABL1⩽0.01% on the International Scale or undetectable BCR-ABL1 with ⩾10 000 ABL1 transcripts)) at 18 months was evaluated as the primary end point, with molecular responses monitored by the European Treatment and Outcome Study network of standardized laboratories. This analysis was conducted after all patients had completed 24 months of study treatment (80.9% of patients) or discontinued early. In patients with typical BCR-ABL1 transcripts and ⩽3 months of prior imatinib therapy, 38.4% (404/1052) achieved MR4 at 18 months. Six patients (0.6%) developed accelerated or blastic phase, and 13 (1.2%) died. The safety profile of nilotinib was consistent with that of previous studies, although the frequencies of some nilotinib-associated adverse events were lower (for example, rash, 21.4%). Ischemic cardiovascular events occurred in 6.0% of patients. Routine monitoring of lipid and glucose levels was not mandated in the protocol. These results support the use of frontline nilotinib, particularly when achievement of a deep molecular response (a prerequisite for attempting treatment-free remission in clinical trials) is a treatment goal. PMID:26437782

  20. Once-monthly paliperidone palmitate in recently diagnosed and chronic non-acute patients with schizophrenia

    PubMed Central

    Hargarter, L; Bergmans, P; Cherubin, P; Keim, S; Conca, A; Serrano-Blanco, A; Bitter, I; Bilanakis, N; Schreiner, A

    2016-01-01

    ABSTRACT Objective: To explore the treatment response, tolerability and safety of once-monthly paliperidone palmitate (PP1M) in non-acute patients switched from oral antipsychotics, stratified by time since diagnosis as recently diagnosed (≤3 years) or chronic patients (>3 years). Research design and methods: Post hoc analysis of a prospective, interventional, single-arm, multicentre, open-label, 6-month study performed in 233 recently diagnosed and 360 chronic patients. Main outcome measures: The proportion achieving treatment response (defined as ≥20% improvement in Positive and Negative Syndrome Scale [PANSS] total score from baseline to endpoint) and maintained efficacy (defined as non-inferiority in the change in PANSS total score at endpoint [Schuirmann’s test]). Results: 71.4% of recently diagnosed and 59.2% of chronic patients showed a ≥20% decrease in PANSS total score (p = 0.0028 between groups). Changes in PANSS Marder factors, PANSS subscales, and the proportion of patients with a Personal and Social Performance scale (PSP) total score of 71–100 were significantly greater in recently diagnosed compared with chronic patients. PP1M was well tolerated, presenting no unexpected safety findings. Conclusion: These data show that recently diagnosed patients treated with PP1M had a significantly higher treatment response and improved functioning, as assessed by the PSP total score, than chronic patients. PMID:27042990

  1. The Experiences of Advanced Practice Nurses Caring for Patients with Substance Use Disorder and Chronic Pain.

    PubMed

    St Marie, Barbara

    2016-10-01

    Management of chronic pain is a challenge shared by healthcare providers in various clinical settings. The epidemic of opioid misuse has escalated this challenge. A gap exists in understanding barriers and facilitators to practices of advanced practice registered nurses (APRNs) caring for patients with chronic pain and substance use disorder (SUD). The purpose of this study was to examine the APRNs' experiences while caring for patients with coexisting SUD and chronic pain to help envision better ways to manage pain and direct educational initiatives. Qualitative narrative method. Telephone interviews. Twenty APRNs caring for patients with coexisting SUD and chronic pain were recruited nationwide through the American Society for Pain Management Nursing list serve. Semistructured interviews with thematic analysis. Participants identified 1) a shift of patients from other healthcare providers into the APRNs' practices; 2) barriers to accessing nonmedical modalities for managing pain, including insurance coverage, geographic location, and the patient's desire for only medication management; 3) the role of the APRN in caring for this population contained subthemes of educating and guiding patients through a process of change, applying risk strategies to keep patients safe, and educating colleagues on implementing risk management strategies while prescribing opioids. The APRNs identified barriers to providing care for patients with coexisting SUD and chronic pain. They also described the role of APRNs in providing focused education regarding risk management strategies for assessment, prescribing opioids to manage pain, and minimizing risk. PMID:27567096

  2. How to Assess a New Patient for a Multidisciplinary Chronic Pain Rehabilitation Program: A Review Article

    PubMed Central

    Malaty, Adham; Sabharwal, Josephine; Lirette, Lesley Smallwood; Chaiban, Gassan; Eissa, Hazem; Tolba, Reda

    2014-01-01

    Background Chronic pain is a debilitating condition that affects people all over the world. To effectively treat chronic pain patients, assignment to patient-centered functional restoration and psychological pain rehabilitation programs at an early stage is essential. Methods This article describes the initial patient screening and evaluation process for an interdisciplinary chronic pain rehabilitation program and highlights the relevant points that should be covered in each section of the initial assessment. Results A thorough, detailed history that includes an evaluation of the patient's pain, functional limitations, prior medications, prior procedures/interventions, substance abuse, and psychiatric disorders, as well as the patient's social, legal, and developmental histories, are key to the proper screening and appropriate treatment of patients with chronic pain. Conclusion Thorough initial evaluation of patients is essential for proper enrollment in a chronic pain rehabilitation program. Such programs allow early treatment and reduce unnecessary health costs. Future prospective studies are needed to identify additional screening methods and triage tools to allow early admission of appropriate patients to these rehabilitation programs. PMID:24688340

  3. [Effect of exercise training on rehabilitation of the chronic critical illness patients].

    PubMed

    Gu, Guosheng; Ren, Jianan

    2016-07-01

    Over the past decades, the evolution of the techniques used in the intensive care has led on one side to better survival rates in ICU patients. On the other side, it has resulted in a growing number of patients who survive an acute event to chronic condition, and who then become dependent on one or more life support treatments. Such patients are called chronic critical illness(CCI) patients. Even these patients can dismiss from intensive care unit (ICU) or transfer to specialized rehabilitation care settings, the mortality of these patients is still very high. Therefore, how to promote the rehabilitation of CCI patients is one of the most important research points of epidemiology, public health and social economics. Exercise training can promote rehabilitation, improve quality of life and independent functional status in these patients, which should be used as one of the standard treatment protocols for CCI patients. PMID:27452749

  4. La perception des morphemes grammaticaux chez les aphasiques (The Perception of Grammatical Morphemes in Aphasics). Montreal Working Papers in Linguistics, Vol. 2.

    ERIC Educational Resources Information Center

    Goodenough, Cheryl; And Others

    Studies have indicated that agrammatical aphasics tend to better realize morphemes with a high level of semantic value. A study sought to examine the effect of the variation of the information content of the article on its comprehension by the aphasic. The appropriate and the significant nature of the function words "the" and "a" were varied with…

  5. Influenza and Pneumococcal Vaccinations for Patients With Chronic Obstructive Pulmonary Disease (COPD)

    PubMed Central

    Sehatzadeh, S

    2012-01-01

    Executive Summary In July 2010, the Medical Advisory Secretariat (MAS) began work on a Chronic Obstructive Pulmonary Disease (COPD) evidentiary framework, an evidence-based review of the literature surrounding treatment strategies for patients with COPD. This project emerged from a request by the Health System Strategy Division of the Ministry of Health and Long-Term Care that MAS provide them with an evidentiary platform on the effectiveness and cost-effectiveness of COPD interventions. After an initial review of health technology assessments and systematic reviews of COPD literature, and consultation with experts, MAS identified the following topics for analysis: vaccinations (influenza and pneumococcal), smoking cessation, multidisciplinary care, pulmonary rehabilitation, long-term oxygen therapy, noninvasive positive pressure ventilation for acute and chronic respiratory failure, hospital-at-home for acute exacerbations of COPD, and telehealth (including telemonitoring and telephone support). Evidence-based analyses were prepared for each of these topics. For each technology, an economic analysis was also completed where appropriate. In addition, a review of the qualitative literature on patient, caregiver, and provider perspectives on living and dying with COPD was conducted, as were reviews of the qualitative literature on each of the technologies included in these analyses. The Chronic Obstructive Pulmonary Disease Mega-Analysis series is made up of the following reports, which can be publicly accessed at the MAS website at: http://www.hqontario.ca/en/mas/mas_ohtas_mn.html. Chronic Obstructive Pulmonary Disease (COPD) Evidentiary Framework Influenza and Pneumococcal Vaccinations for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Smoking Cessation for Patients With Chronic Obstructive Pulmonary Disease (COPD): An Evidence-Based Analysis Community-Based Multidisciplinary Care for Patients With Stable Chronic Obstructive

  6. [Salivary glands and oral mucous membrane status in patients with chronic hepatitis].

    PubMed

    Afanas'ev, V V; Muromtsev, A V; Derkach, N V

    2008-01-01

    The status of salivary glands and oral mucous membrane was investigated in 50 patients with chronic active hepatitis against the background of chronic alcoholism. The check up disclosed sialadenosis in 38% of patients and in 54% of patients - such diseases of oral mucous membrane as stomatitis, candidosis and geographic tonque. Besides there were disclosed such disturbances as big and small salivary glands secretion reduction, mixed saliva viscosity increase, increase of protein, P, K, Na and catalase content in it, glycogen hyperaccumulation in gingival tissues. The received data indicated the necessity of dispensary supervision of such patients and their treatment in stomatologist.

  7. Tyrosine Kinase Inhibitors for the Treatment of Chronic-Phase Chronic Myeloid Leukemia: Long-Term Patient Care and Management

    PubMed Central

    Bauer,1, Stephanie; Buchanan,2, Susan; Ryan,3, Irene

    2016-01-01

    Several tyrosine kinase inhibitors (TKIs) are now approved for the treatment of chronic myeloid leukemia in chronic phase. The efficacy of these drugs has been repeatedly demonstrated, as has their tolerability in most patients. However, late and chronic toxicities become an important issue for many patients facing long-term TKI exposure. For patients on long-term imatinib, gastrointestinal events, fluid retention, muscle cramps, fatigue, and hepatotoxicity are among the most common and most clinically relevant adverse events (AEs). A few of these have also emerged as important AEs with some of the newer TKIs. Distinct long-term toxicity concerns have emerged for dasatinib (pleural effusion, pulmonary hypertension, headache, and dyspnea) and nilotinib (rash, headache, myalgia, alopecia, and hyperglycemia), whereas due to the recent approval of bosutinib and ponatinib, their long-term toxicity profiles have not been fully characterized. Clinical experience with each of these drugs is accumulating, and ensuring proper adherence and monitoring for potential AEs is essential for effective treatment. PMID:27713843

  8. Chronic inflammatory demyelinating polyradiculoneuropathy in a patient with Crohn's disease.

    PubMed

    Ohyagi, Masaki; Ohkubo, Takuya; Yagi, Yousuke; Ishibashi, Satoru; Akiyama, Junko; Nagahori, Masakazu; Watanabe, Mamoru; Yokota, Takanori; Mizusawa, Hidehiro

    2013-01-01

    Crohn's disease (CD) is a chronic inflammatory disorder of the gastrointestinal tract that is frequently accompanied by systemic complications. Neuropathologies have not been well investigated as extraintestinal manifestations of CD. We herein report the case of a 36-year-old man with CD who presented with progressive weakness and numbness. A neurological examination and the results of a nerve conduction study and a sural nerve biopsy led to a diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Plasma exchanges were initially effective; however, the effects gradually declined starting 10 days after the plasma exchange (PE). These results suggest that humoral factors may play an important role in CIDP associated with CD.

  9. Endovascular Aortic Stenting in Patients with Chronic Traumatic Aortocaval Fistula

    PubMed Central

    2013-01-01

    This study aimed to present the treatment of a case of delay presenting of traumatic aortocaval fistula (ACF) and its effect on hemodynamic problem. A 59-year-old man was admitted to our hospital with heart failure due to a 41-year-old traumatic ACF. ACF closure was performed by endovascular aortic stenting. His hospital course after procedure was complicated by severe bradycardia and torsades de pointes and excessive diuresis. We concluded the endovascular technique provided an attractive alternative to open surgical methods for repair of chronic ACF. However, in chronic cases, complications such as severe bradycardia (Nicoladoni-Branham sign) and excessive diuresis must be anticipated. PMID:24386026

  10. Early maladaptive schema factors, chronic pain and depressiveness: a study with 271 chronic pain patients and 331 control participants.

    PubMed

    Saariaho, Tom; Saariaho, Anita; Karila, Irma; Joukamaa, Matti

    2012-01-01

    Chronic pain and depression are coexisting entities with high simultaneous prevalence. Both are linked with early adversities. Early maladaptive schemas (EMS) can be seen as a reflection of these adversities. EMSs extensively indicate underlying psychic patterns and provide a good opportunity to detect covert processes and psychic shapes (latent factors), which create the basis of how people rate their schemas. The purpose of this study was to explore these latent, higher order schema factors (SF) and to find out how they are associated with pain intensity or depression in chronic pain patients and a control sample. The study subjects consisted of 271 first-visit pain patients and 331 control participants. Sociodemographic and pain data were gathered by questionnaire; 18 EMSs were measured with the Young Schema Questionnaire (short form) and depressiveness was measured with the Beck Depression Inventory, Version II. Exploratory factor and regression analyses were used. The chronic pain patient group showed two SFs. The first SF showed a shameful, defective, socially isolated, failure, emotionally inhibited, deprived, submissive and resigned pattern. The second SF showed a demanding, approval seeking, self-sacrificing and punitive pattern. SF1 predicted more than half of the depressiveness in the pain patient sample. A three-factor structure was found in the control sample, and SFs 1 and 3 together predicted almost one-third of depressiveness. The pain patient and the control groups had a different, higher order factor structure. We assume that SF1 in the pain patients reflected a rather serious, undefined early psychic trauma and was also associated with their depressiveness. PMID:21210495

  11. Utilisation of health care system by chronic pain patients who applied for disability pensions.

    PubMed

    Højsted, J; Alban, A; Hagild, K; Eriksen, J

    1999-09-01

    The objective of this study was to investigate how economic compensation for disability (disability pensions) to chronic pain patients affected their utilisation of health care services. The study was carried out as a register investigation. Inclusion of 144 study patients was based on records from 1989 and 1990 of the Rehabilitation and Pension Board in the Municipality of Copenhagen. Only patients of Danish origin with chronic non-malignant pain were included. The study period was divided into three: Subperiod 1: The year preceding the submission of the application for a disability pension. Subperiod 2: The period from the submission of the application to the decision was made. Subperiod 3: The year following the final decision of the health authorities. The patients were divided into 4 Subgroups according to whether disability pensions was awarded or rejected, or whether the patients accepted or appealed the decision. Based on number and charges of visits to the GPs the total costs of care in the primary sector were calculated. By means of number of bed days, visits to outpatients clinics, operations, blood samples, and various investigations, the total costs of hospital care were calculated. We found that application for a disability pension in chronic pain patients significantly influenced the health care utilisation. Chronic pain patients had a significantly lower health care utilisation after receiving a disability pension than before the pension was awarded. Chronic pain patients who did not get a disability pension and those who were not satisfied with the level of the pension awarded, maintained their health care utilisation after the decision. The mean health care use by the patients who appealed the level of the pension was three times higher than the mean health care use by the patients who accepted the level of the pension awarded. The study may indicate that lack of or insufficient economic compensation from the social system in chronic pain patients

  12. Effects of Auricular Acupressure on Body Weight Parameters in Patients with Chronic Schizophrenia

    PubMed Central

    Ching, Han-Yi; Wu, Shang-Liang; Chen, Wen-Chi; Hsieh, Ching-Liang

    2012-01-01

    Auricular acupressure is widely used in complementary and alternative medicine to reduce body weight, but little is known about the effects of auricular acupressure on body weight parameters in patients with chronic schizophrenia. The purpose of this study was to evaluate the effects of auricular acupressure on body weight parameters in patients with chronic schizophrenia. Eighty-six inpatients with schizophrenia were recruited from chronic wards in a psychiatric center. The participants were randomly divided into experimental (acupressure at 4 acupuncture sites: hunger, stomach, shenmen and endocrine) and control groups, and body weight parameters were determined weekly for 8 weeks. There was no significant difference between the experimental and control groups in mean body weight, waist circumference, or body fat percentage at the pretest or during the entire 8-week study period. Therefore, auricular acupressure did not cause body weight reduction in patients with chronic schizophrenia. PMID:22997527

  13. Emergency and disaster preparedness for chronically ill patients: a review of recommendations.

    PubMed

    Tomio, Jun; Sato, Hajime

    2014-01-01

    Recent disasters, especially those in developed countries, have highlighted the importance of disaster preparedness measures for chronic diseases. A number of surviving patients experienced the exacerbation of a chronic illness, such as hypertension, diabetes, cancer, and chronic respiratory diseases, due to disaster-related stress, interruption of care, or both; for some patients, these exacerbations resulted in death. Here, we review reports from recent disasters in developed countries and summarize the recommendations for disaster preparedness of chronically ill patients. A considerable number of recommendations based on the lessons learned from recent disasters have been developed, and they provide practical and essential steps to prevent treatment interruption during and after a disaster. To improve preparedness efforts, we suggest that health care providers should be aware of the following three suggestions: 1) recommendations should be evidence-based; 2) recommendations should contain consistent messages; and 3) recommendations should be feasible.

  14. Emergency and disaster preparedness for chronically ill patients: a review of recommendations

    PubMed Central

    Tomio, Jun; Sato, Hajime

    2014-01-01

    Recent disasters, especially those in developed countries, have highlighted the importance of disaster preparedness measures for chronic diseases. A number of surviving patients experienced the exacerbation of a chronic illness, such as hypertension, diabetes, cancer, and chronic respiratory diseases, due to disaster-related stress, interruption of care, or both; for some patients, these exacerbations resulted in death. Here, we review reports from recent disasters in developed countries and summarize the recommendations for disaster preparedness of chronically ill patients. A considerable number of recommendations based on the lessons learned from recent disasters have been developed, and they provide practical and essential steps to prevent treatment interruption during and after a disaster. To improve preparedness efforts, we suggest that health care providers should be aware of the following three suggestions: 1) recommendations should be evidence-based; 2) recommendations should contain consistent messages; and 3) recommendations should be feasible. PMID:27147882

  15. [EFFICACY OF CYCLOFERON LINIMENT IN THE COMBINED TREATMENT OF CHRONIC GINGIVITIS IN PATIENTS WITH CHRONIC INFECTIOUS DISEASES].

    PubMed

    Soboleva, L A; Shul'dyakov, A A; Bulkina, N V

    2015-01-01

    In order to study the clinical-pathogenetic efficacy of using cycloferon liniment in the combined therapy of patients with gingivitis on the background of chronic infectious diseases (HIV infection, hepatitis C, brucellosis), medical examination and treatment of 42 patients with this diagnosis has been carried out. It is established, that the use of cycloferon liniment in the combined therapy decreases the infection load in periodontal recess and manifestation of local inflammation, normalizes the immunity indices, and reduces the level of endogenous intoxication. All these factors provide acceleration of the recuperation processes and decrease the frequency of recidivating.

  16. [EFFICACY OF CYCLOFERON LINIMENT IN THE COMBINED TREATMENT OF CHRONIC GINGIVITIS IN PATIENTS WITH CHRONIC INFECTIOUS DISEASES].

    PubMed

    Soboleva, L A; Shul'dyakov, A A; Bulkina, N V

    2015-01-01

    In order to study the clinical-pathogenetic efficacy of using cycloferon liniment in the combined therapy of patients with gingivitis on the background of chronic infectious diseases (HIV infection, hepatitis C, brucellosis), medical examination and treatment of 42 patients with this diagnosis has been carried out. It is established, that the use of cycloferon liniment in the combined therapy decreases the infection load in periodontal recess and manifestation of local inflammation, normalizes the immunity indices, and reduces the level of endogenous intoxication. All these factors provide acceleration of the recuperation processes and decrease the frequency of recidivating. PMID:26591207

  17. Serum amylase determinations and amylase to creatinine clearance ratios in patients with chronic renal insufficiency.

    PubMed

    Tedesco, F J; Harter, H R; Alpers, D H

    1976-10-01

    Patients with severe chronic renal failure may have significant hyperamylasemia in the absence of clinical symptoms or signs of acute pancreatitis. Amylase to creatinine clearance (CA/CC) ratios were usually elevated in patients with chronic renal failure and were not helpful in evaluating the possibility of acute pancreatitis. The mean amylase to creatinine clearance ratio for the controls with normal renal function was 1.24 +/- 0.13. In patients with chronic renal failure, it was 3.17 +/- 0.42 (P less than 0.001). Serum amylase isoenzyme patterns revealed no difference in salivary to pancreatic isoenzyme ratios between normals (1.04 +/- 0.12) and patients with severe renal insufficiency without evidence of pancreatic disease (1.07 +/- 0.13). The isoenzymes were helpful in excluding the diagnosis of pancreatic in 1 renal failure patient whose hyperamylasemia was primarily salivary in origin and in confirming the diagnosis in another who had only a pancreatic band.

  18. [Methodic approaches to treatment of the chronic generalized parodontitis in elderly and senile patients].

    PubMed

    Iordanishvili, A K; Soldatov, S V; Moskalev, A V; Soldatova, L N; Ryzhak, G A

    2011-01-01

    A comprehensive treatment with Likopid of chronic generalized parodontitis in 114 elderly and senile patients was carried out. The state of mechanisms of innate immunity (phagocytosis mechanisms) as well as the profile of proinflammatory cytokines was assessed. The effect of antibiotic-resistant strains of prior microflora on the combined therapy of patients of different age with chronic generalized parodontitis was studied. It is established that due to presence of various types of opportunistic pathogens in patients of different age with parodontitis using the prophylactic antibiotics for the empirical (to determine the antibiotic resistance), a combination of Metronidazole and Lincomycin with the mandatory appointment of immunomodulatory drugs for activation of monocyte-phagocytic system of the patient elderly is most advisable. Use of the drug , "Likopid" significantly improves the results of treatment the elderly and old patients with chronic generalized parodonthitis. PMID:22184987

  19. Clinical application of transient elastography in patients with chronic viral hepatitis receiving antiviral treatment.

    PubMed

    Kim, Jun Hyung; Kim, Mi Na; Han, Kwang-Hyub; Kim, Seung Up

    2015-04-01

    Accurate evaluation of the degree of liver fibrosis in patients with chronic liver diseases (CLD) is crucial, as liver fibrosis is important in determining the prognosis of liver diseases. Currently, liver biopsy (LB) is considered the gold standard for staging liver fibrosis or cirrhosis. However, utilization of LB in clinical practice is often limited because of its invasive nature, sampling error and interobserver variability. Recently, transient elastography (TE) was introduced as a noninvasive, highly reproducible technique for assessing the degree of liver fibrosis. After extensive studies, TE is now regarded as a reliable surrogate marker for grading the severity of liver fibrosis in patients with CLD. In the past few years, the role of TE in monitoring liver stiffness and determining prognosis in patients with chronic hepatitis B (CHB) or chronic hepatitis C (CHC) who are undergoing antiviral treatment has been investigated. In patients with CHB, liver stiffness values decrease with antiviral treatment. TE can also be used to predict the incidence of liver-related events during antiviral treatment. In patients with CHC, TE can be used to monitor potential regression of liver fibrosis after antiviral treatment and may predict the treatment outcome of CHC. In addition, TE is an adjunct tool for distinguishing inactive hepatitis B virus carriers from patients with chronic active hepatitis. This review article discusses the important findings from recent studies focusing on the clinical application of TE in patients with chronic viral hepatitis who are undergoing antiviral treatments. PMID:24976523

  20. Major depressive disorder and sleep disturbance in patients with chronic pain

    PubMed Central

    Emery, Patricia C; Wilson, Keith G; Kowal, John

    2014-01-01

    BACKGROUND Disturbed sleep is a common problem in both chronic pain and major depressive disorder (MDD). Moreover, many patients with chronic pain are depressed. OBJECTIVES: To examine the effects of depression on the sleep behaviour of chronic pain patients by comparing patients who did or did not meet diagnostic criteria for MDD. METHODS: A total of 60 patients with chronic musculoskeletal pain underwent structured diagnostic interviews for MDD and insomnia, and completed questionnaires assessing pain severity, disability, sleep quality, beliefs and attitudes about sleep, and sleep hygiene. For four consecutive days, they also completed a sleep diary, and reported on sleep hygiene practices and presleep arousal. RESULTS: Thirty-three patients (55%) met diagnostic criteria for MDD, most of whom (n=32 [97%]) also fulfilled criteria for insomnia disorder. Insomnia was also common among patients without MDD (21 of 27 [78%]). Participants with MDD had higher self-reports of pain, disability, dysfunctional beliefs about sleep, and, on a prospective basis, greater presleep arousal and poorer sleep hygiene. However, diary assessments of specific sleep parameters (eg, sleep onset latency, total sleep time, sleep efficiency) did not differ between the groups. DISCUSSION: Chronic pain patients with comorbid MDD exhibited more dysfunctional beliefs about sleep, poorer sleep hygiene practices and greater presleep arousal; however, diary-recorded sleep characteristics may not differ from those of patients without MDD. Chronic pain itself may disturb sleep so extensively that MDD introduces little additive effect. CONCLUSION: MDD in chronic pain may be related to the cognitive and behavioural aspects of insomnia, rather than to an incremental disturbance in the initiation or maintenance of sleep. PMID:24367795

  1. Intradiscal Electrothermal Treatment for Chronic Lower Back Pain Patients with Internal Disc Disruption

    PubMed Central

    Park, Si-Young; Moon, Seong-Hwan; Park, Moon Soo; Kim, Hak-Sun; Choi, Youn-Jin

    2005-01-01

    Chronic lower back pain is one of the most common musculoskeletal problems; it is also the most expensive industrial injury. Not surprisingly, many treatments have been developed to combat this expensive and debilitating condition. One of these, intradiscal electrothermal treatment (IDET), was developed for patients with chronic discogenic lower back pain who failed to improve with any of the wide variety of non-surgical treatments. The present study sought to evaluate the efficacy of IDET for patients with chronic lower back pain. Twenty-five patients were enrolled in this prospective study; the patients received IDET between June 2001 and June 2003. MRI was used to confirm the diagnosis of internal disc disruption in all patients. The patients then underwent a pre-operative provocative test and discography. The follow-up duration was at least 1 year in all cases, and the visual analogue scale, recovery rate, and satisfaction of each patient were evaluated. The average age of the patients was 32 years (age range 18 to 49 years), and the patient group was 33% male and 67% female. Of the 25 patients, 5 underwent lumbar fusion surgery within 1 year of IDET. After IDET, 8 patients (32%) reported more pain than before, 14 patients (56%) reported less pain, and 3 patients (12%) experienced no change. Twelve patients (48%) were satisfied with IDET, 11 (44%) were dissatisfied, and 2 (8%) were undecided about the treatment. At least 1 year after IDET, nearly half the study patients were dissatisfied with their medical outcome. Consequently, 5 patients (20%) underwent fusion surgery at 1 year after IDET. Although other studies have shown good results with IDET for at least 2 years, this investigation suggests the IDET may be somewhat less effective. In order to firmly establish the efficacy of IDET for treating chronic discogenic lower back pain, additional studies with larger numbers of patients evaluated over longer time periods are recommended. PMID:16127780

  2. Molecular epidemiology of HBV infection in chronic hepatitis B virus infected patients in northeast India.

    PubMed

    Saikia, Anjan; Bose, Moumita; Barman, Narendra Nath; Deka, Manab; Thangkhiew, Rangsan Singh; Bose, Sujoy

    2015-09-01

    The present study aimed to evaluate the molecular epidemiology of HBV in chronic HBV infected cases from northeast India (NEI), since scanty data are available from the region which has a predominant ethnically distinct tribal population. A total of 523 clinically diagnosed index chronic HBV infected cases and 172 asymptomatic patients (based on family screening) were enrolled with informed consent. Patients were stratified based on serology, imaging, pathology, and clinical data and grouped as chronic HBV and cirrhotic cohorts. Analysis for serum HBV DNA levels and HBV genotyping was performed, and was statistically co-related with disease severity. Males were more prone to chronic HBV infection. Majority of the patients who had Chronic HBV infection based on family screening were females (59.88%), majorly wives of index patients. Mean viral load in Chronic HBV patients was almost 4.5-folds higher than cirrhosis patients, and was significantly associated with e-antigen positive status(P < 0.001) in both groups. HBV genotype D was the most prevalent genotype (62.30%) in NEI. Mixed genotype infection of A + D was found from Assam, along with C + D cases (1.29%) cumulatively. There is a high prevalence of HBV genotype C (13.96%) in our studied cohort which was found to be associated with higher viral load(P = 0.018), e-antigen positivity(P = 0.043), and increased cirrhosis risk compared to Chronic HBV cases [OR = 1.670]. Family contacts in NEI are prone to infection with HBV and development of Chronic HBV. Higher presence of e-positive cases and genotype C along with the mixed genotypes in NEI is unique and of significance with reference to predisposition to disease severity and even response to antiviral therapy.

  3. Increased morbidity associated with chronic infection by an epidemic Pseudomonas aeruginosa strain in CF patients

    PubMed Central

    Al-Aloul, M; Crawley, J; Winstanley, C; Hart, C; Ledson, M; Walshaw, M

    2004-01-01

    Background: Chronic pulmonary infection with transmissible Pseudomonas aeruginosa strains in individuals with cystic fibrosis (CF) has been reported, raising issues of cross infection and patient segregation. The first such strain to be described (the Liverpool epidemic strain, LES) is now widespread in many UK CF centres. However, whether such infection carries a worse prognosis is unknown. To address this, the clinical course of a group of CF patients chronically infected by LES was compared with that in patients harbouring unique strains. Methods: Using P aeruginosa strain genotyping, two cohorts of CF patients attending the Liverpool CF service were identified who were LES positive or negative in 1998 and remained so until 2002. From these, two groups of 12 patients were matched in 1998 for age, spirometric parameters, and nutritional state and their clinical course was followed for 5 years. Patients chronically infected with Burkholderia cepacia were excluded. Results: Patients chronically infected with LES had a greater annual loss of lung function than those not chronically infected by LES (mean difference between groups -4.4% (95% CI -8.1 to -0.9; p<0.02)), and by 2002 their percentage predicted forced expiratory volume in 1 second (FEV1) was worse (mean 65.0% v 82.6%, p<0.03). Their nutritional state also deteriorated over the study period (mean difference between groups in body mass index -0.7 (95% CI -1.2 to -0.2; p<0.01)), such that by 2002 they were malnourished compared with LES negative patients (mean BMI 19.4 v 22.7, p<0.02). Conclusions: Chronic infection with the Liverpool epidemic P aeruginosa strain in CF patients confers a worse prognosis than infection with unique strains alone, confirming the need for patient segregation. Since this strain is common in many CF units, strain identification in all CF centres is essential. This can only be carried out using genomic typing methods. PMID:15047956

  4. Validation of a Chinese version of the Chronic Pain Acceptance Questionnaire (CAPQ) and CPAQ-8 in chronic pain patients.

    PubMed

    Liu, Yaqun; Wang, Lei; Wei, Yibo; Wang, Xiaolin; Xu, Tianming; Sun, Jinhai

    2016-08-01

    Acceptance of chronic pain has increasingly become a significant issue in the field of pain management. Many researchers have suggested that patients with better acceptance of pain are more likely to have better functioning both in physical and psychological status. In many countries, the Chronic Pain Acceptance Questionnaire (CPAQ) and CPAQ-8 have been validated and utilized frequently to measure the pain acceptance of patients with chronic pain. However, the CPAQ and CPAQ-8 yet have not been introduced and validated in Mainland China.In this study, we aimed to translate the English version of the CPAQ into simplified Chinese, make proper cross-cultural adaptations, and validate the psychometric properties of the Chinese version of the CPAQ and the CPAQ-8.The English version of the CPAQ was first linguistically translated and cross-culturally adapted to formulate a Chinese version. Then, we recruited 224 patients from a pain clinic and every participant was asked to finish a series of questionnaires. Finally, statistical analysis was performed to test the psychometric properties of the CPAQ and the CPAQ-8.Both confirmatory factor analysis (CFA) and principal component analysis (PCA) confirmed a 2-factor structure for the CPAQ and the CPAQ-8. Nine out of 10 of the hypotheses were validated for construct validity. The overall intraclass correlation coefficient (ICC) value for the CPAQ and CPAQ-8 were 0.92 and 0.89, respectively. In addition, the Cronbach α values for both the CPAQ and the CPAQ-8 showed excellent test-retest reliability.In conclusion, the original CPAQ was successfully developed into the Chinese version of the CPAQ and CPAQ-8 with excellent validity and reliability. The scores of the CPAQ or CPAQ-8 might be a strong predictor for the physical and psychological function of chronic pain patients. In addition, to improve the satisfaction of surgery patients, we recommend measuring patients' pain acceptance using the CPAQ or CPAQ-8 before and after the

  5. Nurse case management program of chronic pain patients treated with methadone.

    PubMed

    Lamb, Louise; Pereira, John Xavier; Shir, Yoram

    2007-09-01

    Methadone treatment in chronic pain patients is still limited owing to misconceptions about addiction, safety, and its unique pharmacokinetic and pharmacodynamic properties. Nevertheless, patients with chronic noncancer pain are frequently treated with methadone at our Pain Centre either as the first opioid of choice, for specific pain conditions, or as a second-line opioid in patients developing tolerance or intractable side effects with other opioids. The aim of this study was to examine whether a nurse case management program of chronic pain patients treated with methadone is feasible and safe in trying to improve patients' care in an ambulatory setting. This program consisted of three phases: initial primary education session, telephone follow-up during methadone titration, and a subsequent maintenance period. The nurse case manager functioned autonomously and when required reported to and consulted the physician. The study included 75 subjects and was done over a nine-month period by completing follow-up questionnaires for every call. Of a total of 194 recorded calls, 41% were unscheduled. Forty-four percent of phone calls resulted in a methadone increase and 11% led to a decrease or cessation of methadone. No patients developed serious morbidity or mortality. Fifty-seven percent of patients were either satisfied or very satisfied with their treatment. A nurse-led case management program of methadone in chronic pain patients can improve patient care in an ambulatory setting. PMID:17723930

  6. Building consensus for provision of breathlessness rehabilitation for patients with chronic obstructive pulmonary disease and chronic heart failure.

    PubMed

    Man, William D-C; Chowdhury, Faiza; Taylor, Rod S; Evans, Rachael A; Doherty, Patrick; Singh, Sally J; Booth, Sara; Thomason, Davey; Andrews, Debbie; Lee, Cassie; Hanna, Jackie; Morgan, Michael D; Bell, Derek; Cowie, Martin R

    2016-08-01

    The study aimed to gain consensus on key priorities for developing breathlessness rehabilitation services for patients with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). Seventy-four invited stakeholders attended a 1-day conference to review the evidence base for exercise-based rehabilitation in COPD and CHF. In addition, 47 recorded their views on a series of statements regarding breathlessness rehabilitation tailored to the needs of both patient groups. A total of 75% of stakeholders supported symptom-based rather than disease-based rehabilitation for breathlessness with 89% believing that such services would be attractive for healthcare commissioners. A total of 87% thought patients with CHF could be exercised using COPD training principles and vice versa. A total of 81% felt community-based exercise training was safe for patients with severe CHF or COPD, but only 23% viewed manual-delivered rehabilitation an effective alternative to supervised exercise training. Although there was strong consensus that exercise training was a core component of rehabilitation in CHF and COPD populations, only 36% thought that this was the 'most important' component, highlighting the need for psychological and other non-exercise interventions for breathlessness. Patients with COPD and CHF face similar problems of breathlessness and disability on a background of multi-morbidity. Existing pulmonary and cardiac rehabilitation services should seek synergies to provide sufficient flexibility to accommodate all patients with COPD and CHF. Development of new services could consider adopting a patient-focused rather than disease-based approach. Exercise training is a core component, but rehabilitation should include other interventions to address dyspnoea, psychological and education needs of patients and needs of carers. PMID:27072018

  7. Phenomenological correlates of metabolic activity in 18 patients with chronic schizophrenia

    SciTech Connect

    Volkow, N.D.; Wolf, A.P.; Van Gelder, P.; Brodie, J.D.; Overall, J.E.; Cancro, R.; Gomez-Mont, F.

    1987-02-01

    Using (11C)-deoxy-D-glucose and positron emission tomography (PET), the authors measured brain metabolism in 18 patients with chronic schizophrenia to assess which of the metabolic measures from two test conditions was more closely related to the patients' differing clinical characteristics. The two conditions were resting and activation, and an eye tracking task was used. Patients with more negative symptoms showed lower global metabolic rates and more severe hypofrontality than did the patients with fewer negative symptoms. Differences among the patients were distinguished by the task: sicker patients failed to show a metabolic activation response. These findings suggest that cerebral metabolic patterns reflect clinical characteristics of schizophrenic patients.

  8. Managing multimorbidity in primary care in patients with chronic respiratory conditions

    PubMed Central

    Morrison, Deborah; Agur, Karolina; Mercer, Stewart; Eiras, Andreia; González-Montalvo, Juan I; Gruffydd-Jones, Kevin

    2016-01-01

    The term multimorbidity is usually defined as the coexistence of two or more chronic conditions within an individual, whereas the term comorbidity traditionally describes patients with an index condition and one or more additional conditions. Multimorbidity of chronic conditions markedly worsens outcomes in patients, increases treatment burden and increases health service costs. Although patients with chronic respiratory disease often have physical comorbidities, they also commonly experience psychological problems such as depression and anxiety. Multimorbidity is associated with increased health-care utilisation and specifically with an increased number of prescription drugs in individuals with multiple chronic conditions such as chronic obstructive pulmonary disease. This npj Primary Care Respiratory Medicine Education Section case study involves a patient in a primary care consultation presenting several common diseases prevalent in people of this age. The patient takes nine different drugs at this moment, one or more pills for each condition, which amounts to polypharmacy. The problems related with polypharmacy recommend that a routine medication review by primary care physicians be performed to reduce the risk of adverse effects of polypharmacy among those with multiple chronic conditions. The primary care physician has the challenging role of integrating all of the clinical problems affecting the patient and reviewing all medicaments (including over-the-counter medications) taken by the patient at any point in time, and has the has the key to prevent the unwanted consequences of polypharmacy. Multimorbid chronic disease management can be achieved with the use of care planning, unified disease templates, use of information technology with appointment reminders and with the help of the wider primary care and community teams. PMID:27629064

  9. Managing multimorbidity in primary care in patients with chronic respiratory conditions.

    PubMed

    Morrison, Deborah; Agur, Karolina; Mercer, Stewart; Eiras, Andreia; González-Montalvo, Juan I; Gruffydd-Jones, Kevin

    2016-01-01

    The term multimorbidity is usually defined as the coexistence of two or more chronic conditions within an individual, whereas the term comorbidity traditionally describes patients with an index condition and one or more additional conditions. Multimorbidity of chronic conditions markedly worsens outcomes in patients, increases treatment burden and increases health service costs. Although patients with chronic respiratory disease often have physical comorbidities, they also commonly experience psychological problems such as depression and anxiety. Multimorbidity is associated with increased health-care utilisation and specifically with an increased number of prescription drugs in individuals with multiple chronic conditions such as chronic obstructive pulmonary disease. This npj Primary Care Respiratory Medicine Education Section case study involves a patient in a primary care consultation presenting several common diseases prevalent in people of this age. The patient takes nine different drugs at this moment, one or more pills for each condition, which amounts to polypharmacy. The problems related with polypharmacy recommend that a routine medication review by primary care physicians be performed to reduce the risk of adverse effects of polypharmacy among those with multiple chronic conditions. The primary care physician has the challenging role of integrating all of the clinical problems affecting the patient and reviewing all medicaments (including over-the-counter medications) taken by the patient at any point in time, and has the has the key to prevent the unwanted consequences of polypharmacy. Multimorbid chronic disease management can be achieved with the use of care planning, unified disease templates, use of information technology with appointment reminders and with the help of the wider primary care and community teams. PMID:27629064

  10. The Main Concept Analysis in Cantonese Aphasic Oral Discourse: External Validation and Monitoring Chronic Aphasia

    ERIC Educational Resources Information Center

    Kong, Anthony Pak-Hin

    2011-01-01

    Purpose: The 1st aim of this study was to further establish the external validity of the main concept (MC) analysis by examining its relationship with the Cantonese Linguistic Communication Measure (CLCM; Kong, 2006; Kong & Law, 2004)--an established quantitative system for narrative production--and the Cantonese version of the Western Aphasia…

  11. Does health status influence acceptance of illness in patients with chronic respiratory diseases?

    PubMed

    Kurpas, D; Mroczek, B; Brodowski, J; Urban, M; Nitsch-Osuch, A

    2015-01-01

    The level of illness acceptance correlates positively with compliance to the doctor's recommendations, and negatively with the frequency and intensity of complications of chronic diseases. The purpose of this study was to determine the influence of the clinical condition on the level of illness acceptance, and to find variables which would have the most profound effect on the level of illness acceptance in patients with chronic respiratory diseases. The study group consisted of 594 adult patients (mean age: 60 ± 15 years) with mixed chronic respiratory diseases, recruited from patients of 136 general practitioners. The average score in the Acceptance of Illness Scale was 26.2 ± 7.6. The low level of illness acceptance was noted in 174 (62.6 %) and high in 46 (16.6 %) patients. Analysis of multiple regressions was used to examine the influence of explanatory variables on the level of illness acceptance. The variables which shaped the level of illness acceptance in our patients included: improvement of health, intensity of symptoms, age, marital status, education level, place of residence, BMI, and the number of chronic diseases. All above mentioned variables should be considered during a design of prevention programs for patients with mixed chronic respiratory diseases.

  12. Model construction for the intention to use telecare in patients with chronic diseases.

    PubMed

    Huang, Jui-Chen; Lee, Yii-Ching

    2013-01-01

    Objective. This study chose patients with chronic diseases as study subjects to investigate their intention to use telecare. Methods. A large medical institute in Taiwan was used as the sample unit. Patients older than 20 years, who had chronic diseases, were sampled by convenience sampling and surveyed with a structural questionnaire, and a total of 500 valid questionnaires were collected. Model construction was based on the Health Belief Model. The reliability and validity of the measurement model were tested using confirmatory factor analysis (CFA), and the causal model was explained by structural equation modeling (SEM). Results. The priority should be on promoting the perceived benefits of telecare, with a secondary focus on the external cues to action, such as promoting the influences of important people on the patients. Conclusion. The findings demonstrated that patients with chronic diseases use telecare differently from the general public. To promote the use and acceptance of telecare in patients with chronic diseases, technology developers should prioritize the promotion of the usefulness of telecare. In addition, policy makers can strengthen the marketing from media and medical personnel, in order to increase the acceptance of telecare by patients with chronic diseases. PMID:23533392

  13. Model Construction for the Intention to Use Telecare in Patients with Chronic Diseases

    PubMed Central

    Huang, Jui-Chen; Lee, Yii-Ching

    2013-01-01

    Objective. This study chose patients with chronic diseases as study subjects to investigate their intention to use telecare. Methods. A large medical institute in Taiwan was used as the sample unit. Patients older than 20 years, who had chronic diseases, were sampled by convenience sampling and surveyed with a structural questionnaire, and a total of 500 valid questionnaires were collected. Model construction was based on the Health Belief Model. The reliability and validity of the measurement model were tested using confirmatory factor analysis (CFA), and the causal model was explained by structural equation modeling (SEM). Results. The priority should be on promoting the perceived benefits of telecare, with a secondary focus on the external cues to action, such as promoting the influences of important people on the patients. Conclusion. The findings demonstrated that patients with chronic diseases use telecare differently from the general public. To promote the use and acceptance of telecare in patients with chronic diseases, technology developers should prioritize the promotion of the usefulness of telecare. In addition, policy makers can strengthen the marketing from media and medical personnel, in order to increase the acceptance of telecare by patients with chronic diseases. PMID:23533392

  14. Central sensitization: a biopsychosocial explanation for chronic widespread pain in patients with fibromyalgia and chronic fatigue syndrome

    PubMed Central

    Meeus, Mira

    2006-01-01

    In addition to the debilitating fatigue, the majority of patients with chronic fatigue syndrome (CFS) experience chronic widespread pain. These pain complaints show the greatest overlap between CFS and fibromyalgia (FM). Although the literature provides evidence for central sensitization as cause for the musculoskeletal pain in FM, in CFS this evidence is currently lacking, despite the observed similarities in both diseases. The knowledge concerning the physiological mechanism of central sensitization, the pathophysiology and the pain processing in FM, and the knowledge on the pathophysiology of CFS lead to the hypothesis that central sensitization is also responsible for the sustaining pain complaints in CFS. This hypothesis is based on the hyperalgesia and allodynia reported in CFS, on the elevated concentrations of nitric oxide presented in the blood of CFS patients, on the typical personality styles seen in CFS and on the brain abnormalities shown on brain images. To examine the present hypothesis more research is required. Further investigations could use similar protocols to those already used in studies on pain in FM like, for example, studies on temporal summation, spatial summation, the role of psychosocial aspects in chronic pain, etc. PMID:17115100

  15. Experiences of patients identifying with chronic Lyme disease in the healthcare system: a qualitative study

    PubMed Central

    2014-01-01

    Background Chronic Lyme disease is a term that describes a constellation of persistent symptoms in patients with or without evidence of previous Borrelia burgdorferi infection. Patients labeled as having chronic Lyme disease have a substantial clinical burden. Little is known about chronic Lyme disease patient experiences in the healthcare system and their relationships with healthcare providers. The purpose of this study was to gather insights about the experiences of patients who carry a diagnosis of chronic Lyme disease in the United States healthcare system. Methods Qualitative, phenomenological study in 12 adult participants who identified themselves as having chronic Lyme disease. Semi-structured face-to-face in-depth interviews were conducted, 60–90 minutes in length, focusing on perceptions of disease burden and of their healthcare providers, using the dimensions of the Health Belief Model. Transcribed interviews were analyzed for emergent topics and themes in the categories of beliefs/understanding, personal history/narrative, consequences/limitations, management, and influences on care. Results Enrollment continued until theoretical saturation was obtained. Four major themes emerged from participants’ descriptions of their experiences and perceptions: 1) changes in health status and the social impact of chronic Lyme disease, 2) doubts about recovery and the future, 3) contrasting doctor-patient relationships, 4) and the use of unconventional therapies to treat chronic Lyme disease. Conclusions Participants reported a significant decline in health status associated with chronic Lyme disease and were often unsatisfied with care in conventional settings. Negative experiences were associated with reports of dismissive, patronizing, and condescending attitudes. Positive experiences were associated with providers who were reported to be attentive, optimistic, and supportive. Consultations with CAM practitioners and use of CAM therapies were common. Actively

  16. Retinopathy and the risk of cardiovascular disease in patients with chronic kidney disease (from the Chronic Renal Insufficiency Cohort study).

    PubMed

    Grunwald, Juan E; Pistilli, Maxwell; Ying, Gui-Shuang; Maguire, Maureen; Daniel, Ebenezer; Whittock-Martin, Revell; Parker-Ostroff, Candace; Mohler, Emile; Lo, Joan C; Townsend, Raymond R; Gadegbeku, Crystal Ann; Lash, James Phillip; Fink, Jeffrey Craig; Rahman, Mahboob; Feldman, Harold; Kusek, John W; Xie, Dawei

    2015-11-15

    Patients with chronic kidney disease (CKD) experience other diseases such as cardiovascular disease (CVD) and retinopathy. The purpose of this study was to assess whether retinopathy predicts future CVD events in a subgroup of the participants of the Chronic Renal Insufficiency Cohort (CRIC) study. In this ancillary investigation, 2,605 participants of the CRIC study were invited to participate, and nonmydriatic fundus photographs were obtained in 1,936 subjects. Using standard protocols, presence and severity of retinopathy (diabetic, hypertensive, or other) and vessel diameter caliber were assessed at a central photograph reading center by trained graders masked to study participant's information. Patients with a self-reported history of cardiovascular disease were excluded. Incident CVD events were adjudicated using medical records. Kidney function measurements, traditional and nontraditional risk factors, for CVD were obtained. Presence and severity of retinopathy were associated with increased risk of development of any CVD in this population of CKD patients, and these associations persisted after adjustment for traditional risk factors for CVD. We also found a direct relation between increased venular diameter and risk of development of CVD; however, the relation was not statistically significant after adjustment for traditional risk factors. In conclusion, the presence of retinopathy was associated with future CVD events, suggesting that retinovascular pathology may be indicative of macrovascular disease even after adjustment for renal dysfunction and traditional CVD risk factors. Assessment of retinal morphology may be valuable in assessing risk of CVD in patients with CKD, both clinically and in research settings.

  17. [Structural state of the pancreas and coprogram parameters for assessment patients with chronic pancreatitis after cholecystectomy].

    PubMed

    Babinets', L S; Nazarchuk, N V; Kytsaĭ, K Iu

    2014-11-01

    Reviewed by a structural condition of the pancreas by ultrasound and scores from the Marseille-Cambridge classification in patients with chronic biliary pancreatitis, including those who had a history of cholecystectomy. Found that after cholecystectomy gland size decreased slightly, but significantly fibrosis is increased. Chronic inflammation and fibrosis of the gland leads to inhibition of both acinar and ductal secretory function, leads to its external and internal secretion deficiency. In assessing coprogram found that most patients with CP present with signs of exocrine insufficiency, including steatorrhea and kreatorrhea that are most pronounced in patients with CP after open cholecystectomy.

  18. Life threatening hyperkalemia chronic kidney diseases patients treated with trimethoprim-sulfamethoxazole: a case series.

    PubMed

    Calderón-Ortiz, Ricardo; Colton-Verge, Pedro; Muñiz-Ortega, Myrna; Lespier, Laura; Córdova, Héctor

    2011-01-01

    We report a case series of patients that develop severe life threatening hyperkalemia after use of a commonly prescribe oral antibiotic, Trimethoprim-Sulfamethoxazole. The three patients required acute hemodialysis to normalize serum potassium levels after development of hypotension and heart block due to hyperkalemia. All had preexisting chronic kidney disease. Some of them were on medications that interfere with the effects of aldosterone. Patients with chronic kidney disease, particularly those receiving other medications that may also contribute to the development of hyperkalemia, should be closely monitored for this complication when Trimethoprim-containing antibiotic is needed. In these cases, other antibiotic therapy alternatives should be considered.

  19. [Evaluation and related factors in coronary artery calcification in chronic dialysis patients].

    PubMed

    Iseki, Kunitoshi; Tokashiki, Kaori; Fujimoto, Naoko

    2004-06-01

    Electron beam CT (EBCT) has been used to measure coronary artery calcification score (CACS). We have been studied CACS on chronic dialysis patients and examined the relationship between CACS and laboratory variables, incidence of ischemic heart disease, and survival. High CACS is often observed in patients with high serum phosphate, high calcium phosphate product, and dyslipidemia. Several factors for calcification both stimulating and suppressing have been playing a role in chronic dialysis patients. CACS is a surrogate marker of adequate control of uremia. PMID:15577062

  20. [The color test: psychodiagnostic opportunities for the patients presenting with chronic somatic diseases].

    PubMed

    Aĭvazian, T A; Zaĭtsev, V P

    2014-01-01

    The objective of the present study was to estimate the diagnostic potential of the Luscher color test. A total of 1083 patients presenting with chronic somatic diseases were available for the psychodiagnostic examination. It was shown that the color test makes it possible to evaluate clinically significant psychological characteristics as well as dynamics of anxiety and stress-resistance in this group of patients. Specifically, in the cases of chronic somatic diseases, the test can be used as one of the psychodiagnostic methods especially for mass screening and in the situations when the application of the standard questionnaires encounters difficulties (for example, in the patients with disturbed cognitive functions). PMID:25536750

  1. Anti-inflammatory effects of simvastatin in patients with chronic heart failure.

    PubMed

    Pinchuk, T V; Fedulaev, Yu N; Khairetdinova, G A; Denisova, N N; Chura, O V; Logunova, I Yu

    2014-09-01

    Proinflammatory markers were evaluated in patients with chronic heart failure of ischemic origin and essential hypertension with preserved left-ventricular ejection fraction before and after a 6-month course of simvastatin therapy (20 mg/day). The study was carried out in 125 patients with diastolic dysfunction manifested as impaired relaxation and pseudonormalization. The main group received standard therapy for chronic heart failure and simvastatin, controls received only standard therapy. In addition, the results in the main group were compared in patients with different types of left-ventricular diastolic dysfunction. Simvastatin therapy significantly reduced the levels of C-reactive protein and IL-6. PMID:25257410

  2. Conflicting voices: Withhold treatment or not for a patient with chronic self-destructive behavior?

    PubMed

    Badger, James M; Ekman Ladd, Rosalind

    2011-01-01

    Patients with a history of chronic self-destructive and self-injurious behavior present many difficulties to healthcare providers. These patients often have related substance abuse and personality disorders that complicate their medical care. Treatment encounters initially may be related to medical treatment of episodic substance intoxicated states with or without self-inflicted injuries. Patients later can develop comorbid medical illnesses associated with nonadherence of treatment or iatrogenic conditions, both of which result in complex end-of-life-care decisions. Institutional familiarity of repeat patients often leaves healthcare providers feeling responsible for the patient despite having little influence over the patients' ultimate behavioral outcomes. This article describes a patient with chronic alcohol abuse, treatment noncompliance, severe personality disorder, recurrent suicidal ideation, self-injurious behavior, alcoholic cirrhosis, and suicide attempt resulting in multisystem injuries leading to an ethical conflict regarding end-of-life care.

  3. [Electrophysiological examinations (ABR and DPOAE) of hearing organ in hemodialysed patients suffering from chronic renal failure].

    PubMed

    Gierek, Tatiana; Markowski, Jarosław; Kokot, Franciszek; Paluch, Jarosław; Wiecek, Andrzej; Klimek, Dariusz

    2002-01-01

    Deterioration of function of hearing organ is one of the most important clinical problem in uremic patients with chronic renal failure. The present study aimed to assess the function of hearing organ using the brainstem auditory evoked responses (ABR), impedance audiometry and distortion product otoacoustic emission cochlear function (DPOAE) in 31 haemodialysed patients with chronic renal failure (16 females and 15 males, mean age 43.0 years). The control group consisted of 15 healthy subjects. The latency of the waves I, III, V and I-V interpeak in evoked response audiometry were significantly longer in the patients with CRF (chronic renal failure) compared to the control group. Measurement of DPOAE showed decrease of DPOAE level in patients suffering from CRF. A influence of single hemodialysis and treatment of hemodialysis by 6 months on ABR latencies and DPOAE values were not observed. PMID:12094644

  4. Sudden cardiac death in patients with diabetes mellitus and chronic heart failure.

    PubMed

    Walker, Andrew Mn; Cubbon, Richard M

    2015-07-01

    In patients with diabetes mellitus, around 50% of deaths due to cardiovascular causes are sudden cardiac deaths. The prevalence of diabetes in cohorts with chronic heart failure is increasing, and while sudden cardiac death is an increasingly rare mode of death in chronic heart failure patients as a whole, the risk of this outcome remains high in those with diabetes. This review summarises the current knowledge on the incidence of sudden cardiac death in patients with diabetes and chronic heart failure, before discussing the causes of the excess risk seen in those with these coexistent conditions. We then describe current strategies for risk stratification and prevention of sudden cardiac death in these patients before discussing the priorities for further study in this area.

  5. [Oral status and oral mucosa blood circulation changes in patients with chronic heart failure].

    PubMed

    Orekhova, L Iu; Rybakova, M G; Barmasheva, A A; Kuznetsova, I A; Semernin, E N; Shirshova, N A; Shliakhto, E V; Gudkova, A Ia

    2013-01-01

    The objective of this study was to characterize dental status and oral mucosa blood flow in patients with chronic heart failure and amyloid deposits in oral mucosa. Histological and immunohistochemical analysis of 80 oral mucosa biopsies taken from patients aged 32-72 years with chronic heart failure I-IV NYHA functional class was carried out. It detected a systemic amyloidosis in 15.7% of cases; a local amyloid deposition in oral mucosa was found in 58.5% of cases. Amyloid deposition in oral mucosa was associated with severe chronic generalized periodontitis in more than a half of cases. Amyloid deposits in oral mucosa were revealed more often in patients with metabolic syndrome (63.5%). The article describes dental status and oral mucosa blood flow in patients with heart failure.

  6. Modern wound care - practical aspects of non-interventional topical treatment of patients with chronic wounds.

    PubMed

    Dissemond, Joachim; Augustin, Matthias; Eming, Sabine A; Goerge, Tobias; Horn, Thomas; Karrer, Sigrid; Schumann, Hauke; Stücker, Markus

    2014-07-01

    The treatment of patients with chronic wounds is becoming increasingly complex. It was therefore the aim of the members of the working group for wound healing (AGW) of the German Society of Dermatology (DDG) to report on the currently relevant aspects of non-interventional, topical wound treatment for daily practice. -Beside necessary procedures, such as wound cleansing and débridement, we describe commonly used wound dressings, their indications and practical use. Modern antiseptics, which are currently used in wound therapy, usually contain polyhexanide or octenidine. Physical methods, such as negative-pressure treatment, are also interesting options. It is always important to objectify and adequately treat pain symptoms which often affect these patients. Modern moist wound therapy may promote healing, reduce complications, and improve the quality of life in patients with chronic wounds. Together with the improvement of the underlying causes, modern wound therapy is an important aspect in the overall treatment regime for patients with chronic wounds.

  7. Management of hyperglycemia in patients with diabetes mellitus and chronic renal failure.

    PubMed

    Sampanis, Ch

    2008-01-01

    Diabetes mellitus is recognized as a leading cause of chronic kidney disease and end-stage renal failure. Chronic renal failure is associated with insulin resistance and, in advanced renal failure, decreased insulin degradation. Both of these abnormalities are partially reversed with the institution of dialysis. Except for diet with protein restriction, patients with diabetes should be preferably treated with insulin. The management of the patients with hyperglycemia and chronic renal failure calls for close collaboration between the diabetologist and the nephrologists. This collaboration is very important so that the patient will not be confused and will not lose confidence to the doctors. Furthermore good glycemic control in these patients seems to reduce microvascular and macrovascular complications. PMID:18923754

  8. Management of hyperglycemia in patients with diabetes mellitus and chronic renal failure

    PubMed Central

    Sampanis, Ch

    2008-01-01

    Diabetes mellitus is recognized as a leading cause of chronic kidney disease and end-stage renal failure. Chronic renal failure is associated with insulin resistance and, in advanced renal failure, decreased insulin degradation. Both of these abnormalities are partially reversed with the institution of dialysis. Except for diet with protein restriction, patients with diabetes should be preferably treated with insulin. The management of the patients with hyperglycemia and chronic renal failure calls for close collaboration between the diabetologist and the nephrologists. This collaboration is very important so that the patient will not be confused and will not lose confidence to the doctors. Furthermore good glycemic control in these patients seems to reduce microvascular and macrovascular complications. PMID:18923754

  9. Illness Perception and Information Behaviour of Patients with Rare Chronic Diseases

    ERIC Educational Resources Information Center

    Katavic, Snježana Stanarevic; Tanackovic, Sanjica Faletar; Badurina, Boris

    2016-01-01

    Introduction: This study examined possible correlations between health information behaviour and illness perception among patients with rare chronic diseases. Illness perception is related to coping strategies used by patients, and some health information behaviour practices may be associated with better coping and more positive perception of…

  10. Chronic Mental Patients after Deinstitutionalization: Trends in Living Independence and Vocational Status.

    ERIC Educational Resources Information Center

    Farkas, Marianne; And Others

    Many studies have followed the living and work situations of discharged mental patients in the community. To add to this knowledge base, a study of 52 chronic inpatients was conducted over a 3 1/2 year period to examine the effects of deinstitutionalization on the living situations and vocational status of long-hospitalized patients. The patients…

  11. Web-Based Self-Management in Chronic Care: A Study of Change in Patient Activation

    ERIC Educational Resources Information Center

    Solomon, Michael R.

    2010-01-01

    Web-based self-management interventions (W-SMIs) are designed to help a large number of chronically ill people become more actively engaged in their health care. Despite the potential to engage more patients in self-managing their health, the use of W-SMIs by patients and their clinicians is low. Using a self-management conceptual model based on…

  12. BCR-ABL transcript variations in chronic phase chronic myelogenous leukemia patients on imatinib first-line: Possible role of the autologous immune system.

    PubMed

    Clapp, Geoffrey D; Lepoutre, Thomas; Nicolini, Franck E; Levy, Doron

    2016-05-01

    Many chronic myelogenous leukemia (CML) patients in chronic phase who respond well to imatinib therapy show fluctuations in their leukemic loads in the long-term. We developed a mathematical model of CML that incorporates the intervention of an autologous immune response. Our results suggest that the patient's immune system plays a crucial role in imatinib therapy in maintaining disease control over time. The observed BCR-ABL/ABL oscillations in such patients provide a signature of the autologous immune response. PMID:27467931

  13. Intramuscular deoxygenation during exercise in patients who have chronic anterior compartment syndrome of the leg

    NASA Technical Reports Server (NTRS)

    Mohler, L. R.; Styf, J. R.; Pedowitz, R. A.; Hargens, A. R.; Gershuni, D. H.

    1997-01-01

    Currently, the definitive diagnosis of chronic compartment syndrome is based on invasive measurements of intracompartmental pressure. We measured the intramuscular pressure and the relative oxygenation in the anterior compartment of the leg in eighteen patients who were suspected of having chronic compartment syndrome as well as in ten control subjects before, during, and after exercise. Chronic compartment syndrome was considered to be present if the intramuscular pressure was at least fifteen millimeters of mercury (2.00 kilopascals) before exercise, at least thirty millimeters of mercury (4.00 kilopascals) one minute after exercise, or at least twenty millimeters of mercury (2.67 kilopascals) five minutes after exercise. Changes in relative oxygenation were measured with use of the non-invasive method of near-infrared spectroscopy. In all patients and subjects, there was rapid relative deoxygenation after the initiation of exercise, the level of oxygenation remained relatively stable during continued exercise, and there was reoxygenation to a level that exceeded the pre-exercise resting level after the cessation of exercise. During exercise, maximum relative deoxygenation in the patients who had chronic compartment syndrome (mean relative deoxygenation [and standard error], -290 +/- 39 millivolts) was significantly greater than that in the patients who did not have chronic compartment syndrome (-190 +/- 10 millivolts) and that in the control subjects (-179 +/- 14 millivolts) (p < 0.05 for both comparisons). In addition, the interval between the cessation of exercise and the recovery of the pre-exercise resting level of oxygenation was significantly longer for the patients who had chronic compartment syndrome (184 +/- 54 seconds) than for the patients who did not have chronic compartment syndrome (39 +/- 19 seconds) and the control subjects (33 +/- 10 seconds) (p < 0.05 for both comparisons).

  14. Modelling Estimates of Norovirus Disease in Patients with Chronic Medical Conditions

    PubMed Central

    Verstraeten, Thomas; Jiang, Baoguo; Weil, John G.; Lin, Jennifer H.

    2016-01-01

    Background The burden of disease due to norovirus infection has been well described in the general United States population, but studies of norovirus occurrence among persons with chronic medical conditions have been limited mostly to the immunocompromised. We assessed the impact of norovirus gastroenteritis on health care utilization in US subjects with a range of chronic medical conditions. Methods We performed a retrospective cohort study using MarketScan data from July 2002 to December 2013, comparing the rates of emergency department visits, outpatient visits and hospitalizations among patients with chronic conditions (renal, cardiovascular, respiratory, immunocompromising, gastrointestinal, hepatic/pancreatic and neurological conditions and diabetes) with those in a healthy population. We estimated the rates of these outcomes due to norovirus gastroenteritis using an indirect modelling approach whereby cases of gastroenteritis of unknown cause and not attributed to a range of other causes were assumed to be due to norovirus. Results Hospitalization rates for norovirus gastroenteritis were higher in all of the risk groups analyzed compared with data in otherwise healthy subjects, ranging from 3.2 per 10,000 person-years in persons with chronic respiratory conditions, to 23.1 per 10,000 person-years in persons with chronic renal conditions, compared to 2.1 per 10,000 among persons without chronic conditions. Over 51% of all norovirus hospitalizations occurred in the 37% of the population with some form of chronic medical condition. Outpatient visits for norovirus gastroenteritis were also increased in persons with chronic gastrointestinal or immunocompromising conditions. Conclusion Norovirus gastroenteritis leads to significantly higher rates of healthcare utilization in patients with a chronic medical condition compared to patients without any such condition. PMID:27438335

  15. Effect of Tramadol/Acetaminophen on Motivation in Patients with Chronic Low Back Pain.

    PubMed

    Tetsunaga, Tomoko; Tetsunaga, Tomonori; Tanaka, Masato; Nishida, Keiichiro; Takei, Yoshitaka; Ozaki, Toshifumi

    2016-01-01

    Background. The contribution of apathy, frequently recognized in individuals with neurodegenerative diseases, to chronic low back pain (LBP) remains unclear. Objectives. To investigate levels of apathy and clinical outcomes in patients with chronic LBP treated with tramadol-acetaminophen. Methods. A retrospective case-control study involving 73 patients with chronic LBP (23 male, 50 female; mean age 71 years) treated with tramadol-acetaminophen (n = 36) and celecoxib (n = 37) was performed. All patients were assessed using the self-reported questionnaires. A mediation model was constructed using a bootstrapping method to evaluate the mediating effects of pain relief after treatment. Results. A total of 35 (55.6%) patients met the criteria for apathy. A four-week treatment regimen in the tramadol group conferred significant improvements in the Apathy scale and numerical rating scale but not in the Rolland-Morris Disability Questionnaire, Pain Disability Assessment Scale, or Pain Catastrophizing Scale. The depression component of the Hospital Anxiety and Depression Scale was lower in the tramadol group than in the celecoxib group. The mediation analysis found that the impact of tramadol-acetaminophen on the change in apathy was not mediated by the pain relief. Conclusions. Tramadol-acetaminophen was effective at reducing chronic LBP and conferred a prophylactic motivational effect in patients with chronic LBP. PMID:27445626

  16. The role of optimism and pessimism in chronic pain patients adjustment.

    PubMed

    Ramírez-Maestre, Carmen; Esteve, Rosa; López, Alicia E

    2012-03-01

    This study analyses the relationships between patients' dispositional optimism and pessimism and the coping strategies they use. In addition, the coping strategies repercussions on adjustment to chronic pain were studied. Ninety-eight patients with heterogeneous chronic pain participated. The assessment tools were as follows: Life Orientation Test (LOT), the Vanderbilt Pain Management Inventory (VPMI), the McGill Pain Questionnaire (MPQ), Hospital Anxiety and Depression Scale (HADS), and the Impairment and Functioning Inventory for Chronic Pain Patients (IFI). The hypothetical model establishes positive relationships between optimism and the use of active coping strategies, whereas pessimism is related to the use of passive coping. Active coping is associated with low levels of pain, anxiety, depression and impairment and high levels of functioning. However, passive coping is related to high levels of pain, anxiety, depression and impairment and low levels of functioning. The hypothetical model was empirically tested using the LISREL 8.20 software package and the unweighted least squares method. The results support the hypotheses formulated regarding the relations among optimism, pessimism, coping and adjust of chronic pain patients. By analysing optimism among chronic pain patients, clinicians could make better predictions regarding coping and adjustment. PMID:22379718

  17. Effect of Tramadol/Acetaminophen on Motivation in Patients with Chronic Low Back Pain.

    PubMed

    Tetsunaga, Tomoko; Tetsunaga, Tomonori; Tanaka, Masato; Nishida, Keiichiro; Takei, Yoshitaka; Ozaki, Toshifumi

    2016-01-01

    Background. The contribution of apathy, frequently recognized in individuals with neurodegenerative diseases, to chronic low back pain (LBP) remains unclear. Objectives. To investigate levels of apathy and clinical outcomes in patients with chronic LBP treated with tramadol-acetaminophen. Methods. A retrospective case-control study involving 73 patients with chronic LBP (23 male, 50 female; mean age 71 years) treated with tramadol-acetaminophen (n = 36) and celecoxib (n = 37) was performed. All patients were assessed using the self-reported questionnaires. A mediation model was constructed using a bootstrapping method to evaluate the mediating effects of pain relief after treatment. Results. A total of 35 (55.6%) patients met the criteria for apathy. A four-week treatment regimen in the tramadol group conferred significant improvements in the Apathy scale and numerical rating scale but not in the Rolland-Morris Disability Questionnaire, Pain Disability Assessment Scale, or Pain Catastrophizing Scale. The depression component of the Hospital Anxiety and Depression Scale was lower in the tramadol group than in the celecoxib group. The mediation analysis found that the impact of tramadol-acetaminophen on the change in apathy was not mediated by the pain relief. Conclusions. Tramadol-acetaminophen was effective at reducing chronic LBP and conferred a prophylactic motivational effect in patients with chronic LBP.

  18. Effect of Tramadol/Acetaminophen on Motivation in Patients with Chronic Low Back Pain

    PubMed Central

    Tetsunaga, Tomoko; Tetsunaga, Tomonori; Tanaka, Masato; Nishida, Keiichiro; Takei, Yoshitaka; Ozaki, Toshifumi

    2016-01-01

    Background. The contribution of apathy, frequently recognized in individuals with neurodegenerative diseases, to chronic low back pain (LBP) remains unclear. Objectives. To investigate levels of apathy and clinical outcomes in patients with chronic LBP treated with tramadol-acetaminophen. Methods. A retrospective case-control study involving 73 patients with chronic LBP (23 male, 50 female; mean age 71 years) treated with tramadol-acetaminophen (n = 36) and celecoxib (n = 37) was performed. All patients were assessed using the self-reported questionnaires. A mediation model was constructed using a bootstrapping method to evaluate the mediating effects of pain relief after treatment. Results. A total of 35 (55.6%) patients met the criteria for apathy. A four-week treatment regimen in the tramadol group conferred significant improvements in the Apathy scale and numerical rating scale but not in the Rolland-Morris Disability Questionnaire, Pain Disability Assessment Scale, or Pain Catastrophizing Scale. The depression component of the Hospital Anxiety and Depression Scale was lower in the tramadol group than in the celecoxib group. The mediation analysis found that the impact of tramadol-acetaminophen on the change in apathy was not mediated by the pain relief. Conclusions. Tramadol-acetaminophen was effective at reducing chronic LBP and conferred a prophylactic motivational effect in patients with chronic LBP. PMID:27445626

  19. Quality of Care for Patients with Chronic Respiratory Diseases: Data for Accreditation Plan in Primary Healthcare.

    PubMed

    Kurpas, Donata; Szwamel, Katarzyna; Mroczek, Bożena

    2016-01-01

    There are scarce reports in the literature on factors affecting the assessment of the quality of care for patients with chronic respiratory diseases. Such information is relevant in the accreditation process on implementing the healthcare. The study group consisted of 133 adult patients with chronic respiratory diseases and 125 adult patients with chronic non-respiratory diseases. In the present study, the level of satisfaction from healthcare provided by the primary healthcare unit, disease acceptance, quality of life, health behaviors, and met needs were examined, as well as associations between variables with the use of correspondence analysis. The results are that in patients with chronic respiratory diseases an increase in satisfaction depends on the improvement of well-being in the mental sphere. The lack of problems with obtaining a referral to a specialist and a higher level of fulfilled needs also have a positive effect. Additionally, low levels of satisfaction should be expected in those patients with chronic respiratory diseases who wait for an appointment in front of the office for a long time, report problems with obtaining a referral to additional tests, present a low level of health behaviors, and have a low index of benefits.

  20. Improvement in chronic low back pain in an obese patient with topiramate use.

    PubMed

    Gupta, Anita; Kulkarni, Archana; Ramanujam, Vendhan; Zheng, Lu; Treacy, Erin

    2015-06-01

    The objective of this study was to demonstrate efficacy, benefit, and potential use of topiramate in treating obese patients with chronic low back pain. This is a case report from an outpatient academic pain multidisciplinary clinical center. The patient was a 30-year-old morbidly obese (body mass index [BMI]: 61.4 kg/m(2)) female suffering from chronic low back pain. With a known association between obesity and chronic low back pain, and a possible role of topiramate in treating both simultaneously, the patient was started on a therapeutic trial of topiramate. Over a period of a 12-week topiramate therapy, the patient experienced clinically meaningful and significant weight loss as well as improvement in her chronic low back pain and functionality. With more substantial evidence, pain physicians may start considering using topiramate in the multimodal management of obesity-related chronic low back pain based on their thoughtful consideration of the drug's efficacy and side effects and the patient's comorbidities and preferences.