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- The effect of irritable bowel syndrome on carotid intima-media thickness, pulse wave velocity, and heart rate variability. [Journal Article]
- Anadolu Kardiyol Derg 2014 Sep; 14(6):525-30.
Irritable bowel syndrome (IBS), a subgroup of functional somatic disorders, may be associated with autonomic dysfunction (AD). Heart rate variability (HRV), a measure of autonomic dysfunction, may predict survival. The aim of this study was to investigate the effect of IBS on HRV parameters, carotid intima-media thickness (CIMT) and carotid-femoral pulse wave velocity (cf-PWV) as surrogates of AD, subclinical atherosclerosis and arterial stiffness, respectively.Our study was cross-sectional and observational. Thirty consecutive patients with IBS and 30 control participants underwent 24-hour Holter monitoring, cf-PWV assessment and CIMT measurement. The diagnosis of IBS was based on Rome III criteria. There were 24 patients with IBS-Constipation (80%), 4 patients with IBS-Diarrhea (13.3%), and 2 patients with IBS-Mixed (6.7%) in IBS group. Student t-test and χ2 test were utilized in order to compare continuous and categorical variables between two groups, respectively.Biochemical parameters did not differ between groups except for slightly increased creatinine in patients with IBS. cf-PWV and CIMT values were similar between groups. SDNN index and RMSSD were significantly impaired in patients with IBS compared to controls. Frequency analyses revealed lower LF, HF, and VLF in subjects with IBS.We demonstrated decreased parasympathetic modulation in patients with constipation predominant IBS. However, we could not demonstrate any changes in vascular structure and functions measured by carotid intima-media thickness and pulse wave velocity. Our results do not support accelerated atherosclerosis in IBS population.
- Herbal medicine for hospitalized patients with severe depressive episode: A retrospective controlled study. [JOURNAL ARTICLE]
- J Affect Disord 2014 Aug 27.:71-77.
Herbal medicine is increasingly used in depressed patients. The purpose of this retrospective controlled study was to evaluate the efficacy and safety of herbal medicine treatment of severe depressive episode. A total of 146 severely depressed subjects were selected from patients who were admitted to the Department of Psychosomatics of Tongde Hospital at Hangzhou, China between 1st September 2009 and 30th November 2013. While all were medicated with psychotropic drugs, 78 received additional individualized herbal medicine. The severity of depressive symptoms was measured using 24-item Hamilton Rating Scale for Depression (HAMD-24) at admission and thereafter once weekly during hospital stay. The proportion of patients achieving clinical response and remission and incidence of adverse events were compared. The two groups had similar average length of hospital stay for approximately 28 days and were not different in the use of psychotropic medications. Survival analysis revealed that patients with herbal medicine had significantly higher chance of achieving clinical response [relative risk (RR)=2.179, P<0.001] and remission (RR=5.866, P<0.001) compared to those without herbal medicine. Patients with herbal medicine experienced remarkably fewer incidences of physical tiredness, headache, palpitation, dry mouth and constipation, but had a significantly higher incidence of digestive discomfort compared to patients without herbal medicine. These results indicate that additional treatment with individualized herbal medicine enhances antidepressant response and reduces certain side effects associated with psychotropic medications. Herbal medicine is an effective and relatively safe therapy for severe depressive episode (Trial Registration: ChiCTR-OCH-13003864).
- Mutant of leucine-rich repeat kinase 2 is not associated with non-motor symptoms in Chinese Parkinson's disease patients. [Journal Article]
- Int J Clin Exp Med 2014; 7(8):2253-7.
Non-motor symptoms (NMS) are common in patients with Parkinson's disease (PD). However, little is known about NMS in patients with mutant of leucine-rich repeat kinase 2 (LRRK2). This study aimed to elucidate the relationship between NMS in Chinese PD patients and to ascertain if there were differences in NMS between PD patients and mutant of LRRK2. 200 sporadic PD (sPD) patients were recruited from a Provincial Hospital Affiliated to Shandong University. The Non-motor Symptom Questionnaire (NMSQ) was used to screen for the presence of NMS. A mean of 9.73 NMS (SD=4.53) was reported per patient. Forgetfulness, constipation and daytime sleepiness were found to be the most frequent NMS. No differences were found in 9 domains analysis between PD with and without LRRK2 variants. Non-motor symptoms in PD are too important to remain undetected. There are no Clinical characteristics of NMS tend to be similar between LRRK2 variants carriers and non-carriers in Chinese sPD patients.
- Assessment of a Stool Symptom Screener and Understanding the Opioid-Induced Constipation Symptom Experience. [JOURNAL ARTICLE]
- Patient 2014 Sep 18.
Many patients with chronic opioid-induced constipation (OIC) seek treatment to relieve their symptoms. A symptom screener may be useful in identifying symptomatic OIC patients.The aims of this study were to assess patient understanding of Stool Symptom Screener content and to evaluate how patients described their constipation experience, to better understand the relationship between constipation symptoms and patterns of laxative use.Adult OIC patients were recruited through five clinical sites across the USA. Patients were classified as either frequent or non-frequent laxative users. Patients participated in a semi-structured interview to assess their understanding of a Stool Symptom Screener and to discuss their constipation symptoms and laxative use experience. Interview transcripts were reviewed using content analysis. Descriptive statistics were used to characterize the sample.Sixty-six OIC patients participated: 39 frequent laxative users (mean age 53.3 years) and 27 non-frequent laxative users (mean age 55.5 years). Both patient groups described high levels of symptom burden on the Stool Symptom Screener as well as anecdotally. Both patient groups generally understood the Stool Symptom Screener items and felt the questions were relevant to their symptom experience. Most (95.5 %) reported that they could remember their constipation symptoms "easily" over the previous 2 weeks. No qualitative differences were found between frequent and non-frequent laxative users in how they described their OIC symptom experience.OIC patients understood this Stool Symptom Screener, and its content was relevant to this highly symptomatic patient sample. Pain and bloating may be considered as additional symptoms for future versions of the screener. An emerging conceptual model of the OIC experience, laxative use, and symptoms is presented.
- Resistance to thyroid hormone. [Journal Article]
- Endocr Dev 2014.:118-29.
Resistance to thyroid hormone (RTH) or thyroid hormone action defect (THAD) is the most frequent form of syndromes of reduced sensitivity to thyroid hormone. It is characterized by variable tissue hyposensitivity to thyroid hormone. RTHβ (formerly only RTH) is caused by mutations in the thyroid hormone receptor β gene (THRB). The clinical phenotype reflects the dysbalance between resistance of tissues predominantly expressing the thyroid hormone receptor β-isoforms 1 and 2 and the overstimulation of tissues mainly expressing the thyroid hormone receptor α-isoform to thyroid hormones. The hallmark of RTHβ is goiter, sinus tachycardia, attention deficit hyperactivity disorder in the context of increased levels of triiodothyronine/free thyroxine and nonsuppressed thyroid-stimulating hormone. Only recently have mutations in the thyroid hormone receptor α gene (THRA) been identified causing a new form of RTH, RTHα. The few patients described so far suffered from mental retardation of variable degree, short stature with decreased subischial leg length, chronic constipation and bradycardia. This review provides an overview of clinical, biochemical and genetic aspects of RTHα and RTHβ relevant for diagnosis, treatment and counseling of affected patients and families. © 2014 S. Karger AG, Basel.
- How to Perform and Assess Colonic Manometry and Barostat Study in Chronic Constipation. [JOURNAL ARTICLE]
- J Neurogastroenterol Motil 2014 Sep 19.
Management of chronic constipation with refractory symptoms can be challenging. Although new drugs and behavioral treatments have improved outcome, when they fail, there is little guidance on what to do next. At this juncture, typically most doctors may refer for surgical intervention although total colectomy is associated with morbidity including complications such as recurrent bacterial overgrowth. Recently, colonic manometry with sensory/tone/compliance assessment with a barostat study has been shown to be useful. Technical challenges aside, adequate preparation, and appropriate equipment and knowledge of colonic physiology are keys for a successful procedure. The test itself appears to be safe with little complications. Currently, colonic manometry is usually performed with a 6-8 solid state or water-perfused sensor probe, although high-resolution fiber-optic colonic manometry with better spatiotemporal resolutions may become available in the near future. For a test that has evolved over 3 decades, normal physiology and abnormal findings for common phenotypes of chronic constipation, especially slow transit constipation, have been well characterized only recently largely through the advent of prolonged 24-hour ambulatory colonic manometry studies. Even though the test has been largely restricted to specialized laboratories at the moment, emerging new technologies and indications may facilitate its wider use in the near future. (J Neurogastroenterol Motil, published online September 19, 2014).
- Lifestyle and health conditions of adults with spinal cord injury. [Journal Article]
- Invest Educ Enferm 2014 Jul; 32(2):244-51.
Objective.To describe the lifestyle of adults with spinal cord injury and explore its relation with some health conditions. Methodology. Cross sectional study, in which a questionnaire containing sociodemographic, habits and health conditions variables was used. Forty-seven people with spinal cord injury participated and answered the self-report questionnaire.
Results.The group under study was predominantly male (92%), under 40 years of age (47%), and had low educational level (76%). The most frequent risk factors related to the lifestyle were: smoking (28%), alcohol consumption (36%), coffee consumption (92%) and being physically inactive (64%). Association was found between having four or more risk factors related to lifestyle and the loss of appetite, as well as constipation.
Conclusion.The actual inadequate lifestyle is associated with the health conditions of patients, and the nursing team should pay special attention to the education and promotion of health related to people with spinal cord injury.
- 19q13.32 microdeletion syndrome: Three new cases. [JOURNAL ARTICLE]
- Eur J Med Genet 2014 Sep 13.
A previous report described a unique phenotype associated with an apparently de novo 732 kb 19q13.32 microdeletion, consisting of intellectual disability, facial asymmetry, ptosis, oculomotor abnormalities, orofacial clefts, cardiac defects, scoliosis and chronic constipation. We report three unrelated patients with developmental delay and dysmorphic features, who were all found to have interstitial 19q13.32 microdeletions of varying sizes. Both the previously reported patient and our Patient 1 with a larger, 1.3-Mb deletion have distinctive dysmorphic features and medical problems, allowing us to define a recognizable 19q13.32 microdeletion syndrome. Patient 1 was hypotonic and dysmorphic at birth, with aplasia of the posterior corpus callosum, bilateral ptosis, oculomotor paralysis, down-slanting palpebral fissures, facial asymmetry, submucosal cleft palate, micrognathia, wide-spaced nipples, right-sided aortic arch, hypospadias, bilateral inguinal hernias, double toenail of the left second toe, partial 2-3 toe syndactyly, kyphoscoliosis and colonic atony. Therefore, the common features of the 19q13.32 microdeletion syndrome include facial asymmetry, ptosis, oculomotor paralysis, orofacial clefting, micrognathia, kyphoscoliosis, aortic defects and colonic atony. These findings are probably related to a deletion of some combination of the 20-23 genes in common between these two patients, especially NPAS1, NAPA, ARHGAP35, SLC8A2, DHX34, MEIS3, and ZNF541. These candidate genes are expressed in the brain parenchyma, glia, heart, gastrointestinal tract and musculoskeletal system and likely play a fundamental role in the expression of this phenotype. This report delineates the phenotypic spectrum associated with the haploinsufficiency of genes found in 19q13.32.
- Constipation-related direct medical costs in 16 887 patients newly diagnosed with chronic constipation. [JOURNAL ARTICLE]
- Eur J Gastroenterol Hepatol 2014 Sep 16.
Chronic constipation is a common condition, but the exact impact on healthcare budgets in Western Europe is poorly documented.The aim of this study was to (a) investigate chronic constipation-related direct medical costs in patients with newly diagnosed chronic constipation and (b) study differences in costs according to natural history.We identified 16 887 patients newly diagnosed with chronic constipation in a Dutch health insurance database (∼1.3 million patients) in 2006-2009. Individuals with chronic constipation were selected on the basis of chronic laxative use (≥90 days/year) and diagnostic related groups for chronic constipation. On the basis of the episodes of laxative use and diagnostic related groups, individuals were categorized as having persistent, episodic, and nonrecurrent disease. Unadjusted costs for laxatives and hospital care for chronic constipation and constipation-related comorbidities were assessed and compared between patients with nonrecurrent, episodic, and persistent disease. Factors associated with costs were identified using Cox regression analyses.The mean total chronic constipation-related direct medical costs in the first year after diagnosis were &OV0556;310±845 and consisted of laxatives (45%) and hospital care for chronic constipation (26%) as well as constipation-related comorbidities (29%). Costs were highest in patients with persistent disease (&OV0556;367±882) compared with patients with episodic (&OV0556;292±808) and nonrecurrent (&OV0556;263±613) disease (P<0.01). Male sex was associated with higher costs, whereas increasing age, diabetes, and use of opioids were associated with lower costs.Pharmacy costs and hospital care costs for chronic constipation-related comorbidities were the largest cost drivers for total constipation-related direct medical costs in patients with newly diagnosed chronic constipation. Direct medical costs differed according to patient characteristics.
- The most common nursing diagnosis among adults/seniors hospitalised with cancer: integrative review. [Journal Article, Review]
- Ecancermedicalscience 2014.:462.
The nursing process, with emphasis on the diagnosis phase, is essential to oncology hospital services due to a high frequency of physical and psychological problems that compromise the quality of life of patients undergoing cancer treatment. The goal of this study was to identify, according to NANDA International, the most common nursing diagnosis among adults/seniors with cancer who are hospitalised. This study is an integrative review of the literature completed in 2013 using five electronic databases, resulting in the selection and analysis of nine articles. This review identified the following eight actual diagnoses and two risk diagnoses that are more common among hospitalised adults/seniors with cancer: anxiety, deficient knowledge, constipation, self-care deficit for bathing/hygiene, body image disturbance, acute/chronic pain, fear, disturbed sleep pattern, risk of infection, and risk of deficient fluid volume. The heterogeneity of the studies used in this review may not have allowed the identification of all the common nursing diagnoses in the practice of oncology nursing in hospitals. However, even though the results are not based on the highest possible level of scientific evidence, their correlation to clinical practice can contribute to the enhancement of the nursing process in oncology services provided by hospitals.