Analogue Scale Research Articles

Cannabis medicinal como recurso terapéutico: estudio preliminar

Introduction: Cannabis sativa L products have a known therapeutic efficacy since ancient times, although their pharmacological classification dates from the mid-twentieth century. Recently its use was regularized in Uruguay.Objective: to analyze a preliminary therapeutic clinical experience with medicinal cannabis (CM) with a high content of cannabidiol (CBD).Method: an observational and retrospective epidemiological study of a cohort of 355 patients who attended to spontaneously consult CM in a private clinic between August 2016 and December 2017. During the first interview demographic data, clinical history, pharmacological, expectations and experience were collected previous with cannabis. Cannabis was indicated mostly with high CBD content (5.25% CBD and 0.2% tetrahydrocannabinol [THC]). In subsequent consultations, access to the CM was investigated and its response and adverse effects were assessed using analog scales. Descriptive statistics was used. Results: in the cohort studied, women with an average age of 67 years, tertiary education level predominated. The consultation pathologies were neurological (38%), rheumatic or arthro-degenerative diseases (37%), neoplasms (13%), psychiatric (4%) and miscellaneous (8%). The majority of these cases (60.6%) reported improvement of their symptoms and only 16.3% of the population studied presented mild side effects. The high costs and difficult management to achieve CM were causes for not starting or abandoning treatment. Conclusions: our preliminary study reflects a positive therapeutic response without significant adverse effects to CM with high CBD content. 60.6% of treated patients reported improvement of their symptoms. The decisive factors for a successful treatment are aimed at facilitating access to the CM, improving management to obtain it and reducing costs for greater accessibility.

Low‐ versus high‐dose intraoperative opioids: A systematic review with meta‐analyses and trial sequential analyses

Opioid-induced hyperalgesia is a state of nociceptive sensitisation secondary to opioid administration. The objective of this meta-analysis was to test the hypothesis that high-dose intraoperative opioids contribute to increased post-operative pain and hyperalgesia when compared with a low-dose regimen in patients under general anaesthesia. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines and rated the certainty of evidence with the Grading of Recommendations, Assessment, Development and Evaluation system. Only trials investigating pain outcomes and comparing two different dosages of the same intraoperative opioid in patients under general anaesthesia were included. The primary outcome was pain score (analogue scale, 0-10) at 24post-operative hours. Secondary outcomes included pain score and cumulative intravenous morphine equivalents (mg) consumed at 2post-operative hours, together with mechanical pain threshold (g·mm-2 ). Twenty-seven randomised controlled trials, including 1630 patients, were identified. Pain score at rest at 24post-operative hours was increased in the high-dose group (mean difference [95% CI]: -0.2 [-0.4, -0.1]; trial sequential analysis-adjusted CI: -0.4, -0.02; low certainty of evidence). Similarly, at 2post-operative hours, both pain score (mean difference [95% CI]: -0.4 [-0.6, -0.2]; low certainty of evidence) and cumulative intravenous morphine equivalents consumed (mean difference [95% CI]: -1.6mg [-2.6, -0.7]; low certainty of evidence) were significantly higher in the high-dose group. Finally, the threshold for mechanical pain was significantly lower in the high-dose group (mean difference to pressure [95% CI]: 3.8g·mm-2 [1.8, 5.8]; low certainty of evidence). There is low certainty of evidence that high-dose intraoperative opioid administration increases pain scores in the post-operative period, when compared with a low-dose regimen.

A preliminary molecular phylogeny for New Zealand sheet-web spiders (Cambridgea) and comparison of web-building behaviour

ABSTRACT Spider webs vary in size to meet the nutritional requirements of the resident spider with the resident’s body size strongly informing these requirements. In this way, the effect of body size on web-building behaviour should be apparent across species. To determine whether the size of analogous web structures scales with body size across closely related species, we first measured mainsheet area and adult female body size of 12 sheet-web spider species (Cambridgea). Using these species, we then generated alignments from the cytochrome c oxidase subunit I (COI) and histone 3 (H3) gene regions. These alignments were phylogenetically analysed using Bayesian inference and maximum likelihood methods. While phylogenetic trees for the COI gene suggested that Cambridgea is monophyletic relative to sampled outgroups, H3 did not. Combining our COI phylogenetic tree’s branch lengths with data on web-building behaviour, we used phylogenetic least squares to determine whether web size scales with spider size across species. While we found evidence that larger species generally build larger webs, the variation in web size across even similarly sized species suggests that environmental characteristics which influence site selection and prey type may play a role in determining the optimal web size for different species.

Evaluation of the Impacting Factors on Sustainable Mining Development, Using the Grey-Decision Making Trial and Evaluation Laboratory Approach

Due to great effect of mining operation on environment and dependent sides, paying attention to the aspects of sustainable development (SD) is important. A conjugation of Grey theory and Decision-Making Trial and Evaluation Laboratory (DEMATEL) is able to find out cause and effect relations among the triple mining SD components and their effective factors. Grey–DEMATEL approach has been used in order to effectively quantify indicators of sustainable development of a copper mine located in south east Iran. This systematic approach transformed the quantitative and qualitative information into a analogous scale and measured the interrelationships among the SD components and their factors. Hierarchical Grey-based DEMATEL compensated the incomplete and uncertain environmental and socio-economic information. The obtained results indicated that social component with an R value of 10 is relatively strong direct influencer on the other components and the economic component is the least direct influencer with R= 8.49. Among the social impacting factors, employment of local work forces is the most important factor that needs to be consider with sustainable development objectives.

“Using the implicit relational assessment procedure (IRAP) to explore common humanity as a dimension of self-compassion”

Self-compassion encompasses three factors: self-kindness, mindfulness, and common humanity. This study aimed to explore the factor of common humanity (the belief that suffering is a shared human experience) and whether people tend to identify with this factor more in relation to their own experiences or those of others. Previously, it has been suggested that when applying compassion, people tend to be harsher on themselves and more compassionate toward others. Most research in self-compassion has typically used explicit measures, which can be scientifically limiting. The present study employed an implicit measure, the Implicit Relational Assessment Procedure (IRAP) to explore this domain. Participants (N = 55) completed the IRAP and its analog scale as well as Neff's self-compassion scale. Results showed that explicitly, participants reported high levels of common humanity and lack of isolation for both themselves as well as others. Implicitly, however, while they showed similar patterns in three of these four trial-types (i.e., common humanity regarding self and others and isolation with respect to others) they were neutral regarding self-isolation. Implications and limitations are discussed.

Effect of ABCB1 C3435T genetic polymorphism on efficacy of postoperative analgesia

Objective To evaluate the effect of ATP-binding cassette B subfamily member 1 transporter (ABCB1) C3435T genetic polymorphism on the efficacy of postoperative analgesia. Methods One hundred American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients, aged 18-60 yr, scheduled for elective thoracoscopic lobectomy under general anesthesia, were enrolled in this study.The gene mutation of ABCB1 C3435T was detected, and the patients were divided into 3 groups according to the genotypes: wild homozygote group (CC group), mutation heterozygote (CT group) and mutation homozygote group (TT group). Patient-controlled intravenous analgesia was performed with sufentanil after operation.Visual analogue scale (VAS) scores at 24 and 48 h after operation, postoperative consumption of sufentanil, sleep quality score at 24 h after operation and state-trait anxiety score were recorded. Results Compared with CC group, VAS scores at 24 h after operation and postoperative consumption of sufentanil were significantly decreased in TT and CT groups, and the state-trait anxiety score was significantly decreased in TT group and increased in CT group (P 0.05). Conclusion ABCB1 C3435T genetic polymorphism may be one of the mechanisms of the individual variation in the efficacy of postoperative analgesia. Key words: Polymorphism, single nucleotide; Analgesia; Pain, postoperative

Surgical Treatment of Osteoporotic Vertebral Fracture Associated with Diffuse Idiopathic Skeletal Hyperostosis along with Comparative Assessment of the Levels of Affected Vertebra or Anterior Column Reconstruction.

Introduction Surgical treatment of osteoporotic vertebral fracture (OVF) often involves older patients with various comorbidities; thus, attending physicians must pay special attention to the invasiveness of surgical procedures and possible perioperative complications. In this retrospective observational study, we investigated the relationship between OVF and diffuse idiopathic skeletal hyperostosis (DISH) by examining the clinical characteristics and surgical outcomes. Methods Subjects comprised 26 patients (14 men, 12 women) who underwent surgical treatment for OVF complicated by DISH. Vertebral injuries affected the thoracolumbar transitional vertebrae in 18 patients and the middle and lower lumbar vertebrae in eight patients. The clinical characteristics, surgical results, radiological assessments, and outcomes were evaluated on the basis of the levels of affected vertebrae and whether anterior column reconstruction (ACR) was performed. Results Visual Analog Scale (VAS) measurements improved from an average of 69.7 mm before surgery to 21.3 mm after surgery. 14 patients had neurological deficits, who exhibited improvements by one or more steps on the Frankel scale after surgery. Activities of daily living (ADLs) were maintained during the six-month period following surgery in 23 patients. Comorbidity was observed in 22 patients. 14 patients had perioperative complications, and six required additional surgery. Both operating time and blood loss volume were significantly higher in patients in the middle and lower lumbar vertebrae and ACR groups. Postoperative correction loss was also significantly lower in the ACR group. Conclusions Favorable degrees of improvement in neurological deficits and VAS were observed following surgery in patients with OVF complicated by DISH, and postoperative ADLs were maintained in 92% of the patients. Elderly men frequently presented with comorbidities, and the frequencies of patients with perioperative complications and those requiring additional surgery were high.

Use of a navigation system in endonasal surgery: Impact on surgical strategy and surgeon satisfaction. A prospective multicenter study

ObjectivesSurgical navigation systems (SNS) are now widely used in endoscopic endonasal surgery. Benefit, however, has not been fully studied. The objective of this study was to evaluate the impact of an SNS in terms of performance of the surgical procedure and of surgeon satisfaction, in a prospective multicenter study. Materials and methodsA multicenter prospective study included patients undergoing endoscopic endonasal surgery using the electromagnetic DigiPointeur® (DGP) SNS in 16 French hospitals. An observation form, completed by the surgeon immediately at end of procedure, included type of procedure, and any changes in strategy or extent of surgery related to use of the SNS. Surgeon satisfaction was rated on an analog scale, with self-assessment of stress experienced during the procedure. ResultsThe study included 311 patients operated on by 36 surgeons in 16 French hospitals. Ethmoidectomy was the most frequent procedure (90%); tumor resection was performed in 5.1% of cases. The SNS enabled more extensive surgery in 81% of cases, in particular by identifying and opening additional cells (57% of cases). Mean satisfaction was 8.6/10; surgeons reported decreased surgical stress thanks to the SNS in 95% of cases. ConclusionIn this observational study, the use of an SNS increased the extent of surgery in 81% of cases, and had a positive impact on the stress perceived by the surgeon in 95% of cases.

Association of Diabetes Mellitus With Health Status Outcomes in Young Women and Men After Acute Myocardial Infarction: Results From the VIRGO Study.

BackgroundDiabetes mellitus increases the risk of mortality after acute myocardial infarction (AMI). However, little is known about the association of diabetes mellitus with post‐AMI health status outcomes (symptoms, functioning, and quality of life) in younger adults.Methods and ResultsWe investigated the association between diabetes mellitus and health status during the first 12 months after AMI, using data from 3501 adults with AMI (42.6% with diabetes mellitus) aged 18 to 55 years enrolled in the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study. Health status was measured with Seattle Angina Questionnaire (SAQ), 12‐item Short‐Form Health Survey, and EuroQol‐Visual Analogue Scale at baseline hospitalization, 1‐month, and 12‐months post‐AMI. At baseline, patients with diabetes mellitus had significantly worse SAQ‐angina frequency (81±22 versus 86±19), SAQ‐physical limitations (77±28 versus 85±23), SAQ‐quality of life (55±25 versus 57±23), 12‐item Short‐Form Health Survey mental (44±13 versus 46±12)/physical functioning (41±12 versus 46±12), and EuroQol‐Visual Analogue Scale (61±22 versus 66±21) than those without diabetes mellitus. Over time, both groups (with and without diabetes mellitus) improved considerably and the differences in health status scores progressively narrowed (except for 12‐item Short‐Form Health Survey physical functioning). In the linear‐mixed effects models, adjusted for sociodemographics, cardiovascular risk factors, comorbidities, clinical characteristics, psychosocial factors, healthcare use, and AMI treatment, diabetes mellitus was associated with worse health status at baseline but not after discharge, and the association did not vary by sex.ConclusionsAt baseline, young adults with diabetes mellitus had poorer health status than those without diabetes mellitus. After AMI, however, they experienced significant improvements and diabetes mellitus was not associated with worse angina, SAQ‐physical limitations, mental functioning, and quality of life, after adjustment for baseline covariates.Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT00597922.

Clinical Diagnosis Scale for Pain Lumbar of Facet Origin: Systematic Review of Literature and Pilot Study

Abstract INTRODUCTION Lumbar pain affects between 60% and 90% of people. Pain may be generated by different anatomical structures such as the facet joint. However, nowadays, the pain produced by the facet joint has no clinical diagnosis. Therefore, the purpose of this study is to propose a clinical diagnostic scale for lumbar facet syndrome. METHODS A systematic review was made on signs and symptoms of lumbar facet pain, these were then submitted to the consideration of a group of experts and the most important ones were extracted, a questionnaire was later made with the most important signs and symptoms, which were applied to a group of patients subjected to percutaneous blockade for facet pain, and, finally, the pre- and postsurgical results were related to the positive signs, proposing a clinical scale of diagnostic evaluation. RESULTS A total of 36 signs and symptoms were found for the diagnosis of lumbar facet syndrome, which were submitted to the group of experts, where a total of 12 (8 symptoms and 4 signs) were included for the final survey. A total of 31 patients underwent selective lumbar facet blockade, mostly women, with an average of 60 ± 11.5 yr, analogous visual scale of preoperative pain of 8/10, and postoperative of 1.7/10. The 3 signs and 3 symptoms most frequently found included in a diagnostic scale were as follows: (symptoms) (1) axial or bilateral axial lumbar pain, (2) improvement with rest, and (3) absence of root pattern, which may have a pseudoradicular pattern; however, the pain is more lumbar than pain in the leg; and (signs) (1) Kemp sign, (2) pain induced in the joint or transverse process, and (3) facet stress sign or Acevedo sign. CONCLUSION The clinical diagnosis of lumbar facet pain is still debated. A few diagnostic scales have been postulated, with little or no external validity, so the present study proposes a diagnostic scale consisting of 3 symptoms and 3 clinical signs.

A Supplement Supporting Appetite Based on Olfactory Stimulation

An olfactory supplements are used to influence the smell of foodstuffs in such a way as to make them olfactorily more attractive. The authors suggest the supplement for olfactory stimulation in patients with parenteral nutrition. The 25 panellists did not know what aromata were contained in the bottles, their concentrations, or the number of different samples presented to the panel. The aromata of the olfactory supplement were selected in such a way as to cover, due to its popularity, all spectrum of panellists: smoked ham, tangerine, Niva cheese and placebo. The parameters were evaluated either visually by an analogue scale from -10 to +10: pleasantness, smell, the sensation produced by the supplement, or the selection of the best corresponding verbal descriptor of the smell. The data were evaluated statistically. Comparison of the set was performed using the Mann-Whitney U test at the level of significance of alpha 0.05. All aromata under evaluation differed statistically significantly from placebo. Of the offered possibilities, however, only Tangerine was evaluated as pleasant: Z(4.5) for the supplement concentration of 1% and/or Z(5.2) for the 0.3% solution. The pleasantness of Niva cheese and smoked ham aromata were evaluated as not statistically different from placebo. No difference was found in olfactory preference in males and females.

Health Utilities and Costs for Motor Neurone Disease

BackgroundMotor neurone disease (MND) places a significant burden on patients, their carers, and healthcare systems. ObjectivesTo estimate health utilities and costs of MND within the UK setting. MethodsPatients with MND, recruited via 22 regional clinics, completed a postal questionnaire of a cost and quality-of-life survey. Health outcome assessment included the EuroQoL (EQ)-5D-5L, EQ-5D-visual analogue scale, Amyotrophic Lateral Sclerosis Utility Index, and the Amyotrophic Lateral Sclerosis Functional Rating Scale–Revised. Clinical staging was based on the Kings and Milano-Torino (MiToS) systems. The questionnaire asked about patients’ use of primary, secondary, and community care services in the previous 3 months. Variability in total costs was examined using regression models. Results595 patients were included in the health utility analysis, of whom 584 patients also completed a resource use questionnaire. Mean health utility decreased and costs increased between consecutive Kings stages, from 0.76 (95% CI 0.71-0.80) and £1096 (£757-£1240) in Kings stage 1, to 0.50 (0.45-0.54) and £3311 (£2666-£4151) in stage 4, respectively. The changes by MiToS stages were from 0.71 (0.69-0.73) and £1115 (£937-£1130) in MiToS stage 0, to 0.25 (0.07-0.42) and £2899 (£2190-£3840) in stage 2. Kings stages 3 and 4 and MiToS stages 1 and 2, respectively, were significant in explaining variability in total costs. ConclusionsThe impact of MND on health utilities and costs differs by disease severity. The data provided here can be used in cost-effectiveness analyses and to inform decision-making regarding healthcare provision for people with MND.

Systematic review and meta-analysis of the effects of treatment modalities for vestibulodynia in women

Objective: To quantify the effects of available treatments of vestibulodynia.Methods: Systematic review of randomised controlled trials (RCTs) in six search engines until December 2018, comparing any intervention vs. placebo or sham in women with vestibulodynia. Primary outcome was dyspareunia assessed with visual analogue (VAS) or numeric rating (NRS) scales. Secondary outcomes were daily vestibular symptoms (DVS), McGill Pain Questionnaire (MPQ) and Index of Sexual Satisfaction (ISS). Effects were described as mean differences (MDs) with their 95% confidence intervals (CIs). Traditional and frequentist network meta-analyses (NMA) were performed using random effect models.Results: Four RCTs (n = 275) were included evaluating vaginal cream of conjugated oestrogens, oral desipramine with or without topical lidocaine, topical lidocaine, laser therapy and transcranial direct current. In traditional MA, interventions did not reduce dyspareunia (MD = 0.08; 95%CI = −0.49 to 0.64), DVS (MD = −0.04; 95%CI = −0.31 to 0.24; 4 interventions), or MPQ (MD = −0.17; 95%CI = −2.16 to 1.81; 4 interventions). ISS was significantly improved (MD = −5.14; 95%CI = −9.52 to −0.75). In NMA, oral desipramine with or without lidocaine significantly improved ISS vs. other treatments.Conclusions: Several existing interventions were not associated with improvements in vestibulodynia. There only was improvement of sexual function with oral desipramine with or without lidocaine.

Omalizumab as an adjuvant therapy for treating severe atopic dermatitis in children. A serie of cases.

Atopic dermatitis (AD) is a chronic skin disease that affects 5-20% of children. This disease compromises the quality of life. Omalizumab offers a promising role in the treatment of severe atopic dermatitis. To share our experience with the use of omalizumab for treating severe AD in children. A retrospective review of the cases of pediatric patients with severe atopic dermatitis who were treated with omalizumab as an adjuvant therapy in an outside allergy service. Patients under 18 who had been treated for at least 6 months were included. 19 patients were included. At the beginning of the study, all patients reported a compromise of life quality of 8/10 or more on a analogue scale. A majority of patients had previously received either systemic steroids or other immunosuppressive therapies without obtaining symptom control. At maximum treatment time, the obtained SCORAD scores revealed that the disease in 85.7% of the patients was mild/moderate while, in 14% of the patients, the disease was severe. The Children's Dermatological Life Quality Index (CDLQI) was consistent with the SCORAD scores. From the beginning of treatment to the last visit to the doctor's office, no patient required systemic steroid therapy. Omalizumab appears promising for treating severe atopic dermatitis in pediatric patients. That results shows that omalizubam improves the quality of life, also decreases the severity of the disease and the need for systemic steroid and immunosuppressive therapy, which decreases the side effects that are caused by these medications.

Assessment of efficiency of therapy at patients with the gastroesophageal reflux disease in age aspect

The demand of work is connected with prevalence a gastroesophageal reflux disease (GERB) against the background of insufficient study of age features of a course of this disease in the senior age groups. The research cohort made 96 patients with GERB. All patients were divided by method of randomization into two equal groups by quantity: the first – the persons receiving пантопразол 40 mg/days, the second – омепразол in a dose of 20 mg/days. Comparative study of efficiency of reception of an omeprazol and pantoprazol in age aspect at patients with GERB from positions of assessment of indicators of the quality of life (QL) was carried out. Indicators of KZh estimated on a visual and analog scale and the questionnaire of SF-36. Direct correlation connection between the level of health of patients and the following factors is established: existence of heartburn, the general time рН <4.0, number of refluxes in a minute, duration of the most long reflux in minutes. It was reasoned it is shown that at persons of the senior age groups in treatment of GERB пантопразол is more effective medicine, than омепразол. Patients of young and average age of the convincing proof have advantages of a pantoprazol before omeprazoly is not found. The result of the carried-out therapy in many respects is defined by degree of commitment of the patient. Therefore the choice of optimum approach to purpose of concrete medicine has to be carried out taking into account assessment of its safety, availability and the acceptability from the point of view of the patient.

Combined kyphoplasty and intraoperative radiotherapy (Kypho-IORT) versus external beam radiotherapy (EBRT) for painful vertebral metastases - a randomized phase III study

BackgroundThe spine is the most frequent location of bone metastases. Local treatment aims at palliation of pain and, given the increased likelihood of long-term cancer survival, at local control. Kyphoplasty and intraoperative radiotherapy (Kypho-IORT) provided instantaneous pain relief in 70% of patients at the first day after the intervention and resulted in local control rates of > 93% at 1 year in a recently conducted phase I/II trial. To assess its clinical value, we designed a phase III trial which tests Kypho-IORT against the most widespread standard-of-care, external beam radiotherapy (EBRT), in patients with painful vertebral metastases.MethodsThis phase III study includes patients ≥50 years of age with up to 4 vertebral metastases and a pain score of at least 3/10 points on the visual/numeric analogy scale (VAS). Patients randomized into the experimental arm (A) will undergo Kypho-IORT (Kyphoplasty plus IORT with 8 Gy prescribed to 13 mm depth). Patients randomized into the control arm (B) will receive EBRT with either 30 Gy in 10 fractions or 8 Gy as a single dose. The primary end point is pain reduction defined as at least − 3 points on the VAS compared to baseline at day 1. Assuming that 40% of patients in the Kypho-IORT arm and 5% of patients in the control arm will achieve this reduction and 20% will drop out, a total of 54 patients will have to be included to reach a power of 0.817 with a two-sided alpha of 0.05. Secondary endpoints are evaluation of the percentage of patients with a pain reduction of at least 3 points at 2 and 6 weeks, local tumor control, frequency of re-intervention, secondary fractures/sintering, complication rates, skin toxicity/wound healing, progression-free survival (PFS), overall survival (OS) and quality of life.DiscussionThis trial will generate level 1 evidence on the clinical value of a one-stop procedure which may provide instantaneous pain relief, long-term control and shortened intervals to further adjuvant (systemic) therapies in patients with spinal metastases.Trial registrationRegistered with ClinicalTrials.gov, number: NCT02773966 (Registration date: 05/16/2016).

Botulinum toxin type A in chronic neuropathic pain in refractory leprosy

Neuropathic pain is a chronic syndrome that is difficult to treat and often affects patients with leprosy. Recommended treatment includes the the use of analgesic drugs, codeine, tricyclic antidepressants, neuroleptics, anticonvulsants and thalidomide, but without consensus on uniform dose and fully satisfactory results. To analyze botulinum toxin type A (BoNT-A) effectiveness in treatment of chronic neuropathic pain in refractory leprous patients, as well as evaluate and compare the quality of life of patients before and after using the medication. We used a specific protocol including clinical, demographic, DN4 protocol, analogue scale (VAS), sensory evaluation and evaluation of the WHOQOL-BREF. Therapeutic intervention was performed with BOTOX® BTX-A 100U administered subcutaneously. Fifteen patients were evaluated on days 0, 10 and 60. Patients on VAS showed pain between 5 and 10, in one case there was complete pain relief in 60 days, while others showed improvement in the first week with the return of symptoms with less intensity after this period. WHOQOL-BREF's domains Quality of Life and Physical to have a significant increase in QOL. BoNT-A proved to be a good therapeutic option in relieving pain with improved quality of life for these patients.

Real-World Impact of Physician and Patient Discordance on Health-Related Quality of Life in US Patients with Acute Myeloid Leukemia.

IntroductionThere is limited understanding concerning the health-related quality of life (HRQoL) in acute myeloid leukemia (AML) patients. Due to an overlap of symptoms, it can be difficult to separate disease versus treatment-related effects. Study objectives were to understand the impact of factors that might influence patients’ HRQoL, assess the degree of concordance in symptom reporting by patients and physicians, and assess the impact of any discordance on HRQoL in AML patients.MethodsPhysicians in the USA captured demographics, current AML treatment and symptoms for 82 AML patients who completed the Functional Assessment of Cancer Therapy-Leukemia (FACT-Leu), 5-Dimension EuroQol Questionnaire (EQ-5D-3L) and Cancer Treatment Satisfaction Questionnaire (CTSQ). Effect size (ES) and clinically meaningful differences between AML subgroups were assessed, as was the impact of disagreement between patients and physicians regarding symptom recognition.ResultsClinically meaningful lower overall FACT-Leu scores were observed for: relapsed/refractory versus non-relapsed/refractory AML patients (92.5 vs. 103.7; P = 0.09; ES = 0.439), hypomethylating agent (HMA) monotherapy versus other therapies in patients with low treatment intensity (89.9 vs. 112.9; P = 0.0021; ES = 0.971) and presence/absence of FLT3-ITD mutation (85.5 vs. 100; P = 0.148; ES = 0.816). Differences in health state were also clinically meaningful between patients with/without FLT3-ITD; EQ-5D-Visual Analog Scale (VAS) (47.6 vs. 63.7; P = 0.0428; ES = 0.816). Patients were more likely than physicians to report bruising (κ = 0.1292), fatigue (κ = 0.0836), bleeding (κ = 0.0177), weight loss (κ = 0.0821) and appetite loss (κ = − 0.0246). FACT-Leu was associated with patient-physician discordance on bleeding (difference − 14.12; P = 0.046), weight loss (− 21.22; P = 0.001) and appetite loss (− 12.58; P = 0.027).ConclusionsHRQoL is generally low for AML patients, especially for particular subgroups. Discordance in symptom reporting between patients and physicians was common and associated with further negative impacts on HRQoL. There may be many reasons for this but better communication between physicians and patients may lead to shared objectives and improvement in patients’ HRQoL.FundingAstellas Pharma, Inc.Electronic supplementary materialThe online version of this article (10.1007/s40487-019-0094-x) contains supplementary material, which is available to authorized users.

Predictors for development of major cardiovascular events in elderly patients with severe and extremely severe chronic obstructive pulmonary disease in combination with early stages of chronic kidney disease

A prospective 6-month open, comparative study originally included600patients with IHD and stable angina who received chronic therapy with different forms of aspirin. In the prospective part of the study, these patients were subdivided into four groups: group 1 consisted of 200 patients switched to Aspirin Cardio; group 2 - 200pa - tients receiving chronic therapy with this drug; group 3 - 100 patients continuing on the Trombo Ass treatment; and group 4 - 100 pa - tients who had been treated with Cardiomagnyl for a long time. Efficacy, safety and compliance to the treatment were evaluated using standard tests and analogue scales; symptoms of dyspepsia were evaluated with a study-specific questionnaire. Switching to Aspirin Cardio (group 1) was on discretion of the physician in charge based on the history of gastrointestinal (GI) complications or significant manifestations of dyspepsia. The efficacy in prevention of cardiovascular events was similar in all groups. No "major" or "minor, clinically significant" bleeding (ISTH) were observed. Proportions of patients with "minor" bleeding were similar in all groups with a tendency towards their decrease under the Aspirin Cardio treatment. After switching to Aspirin Cardio, positive changes inseverity of GI symptoms by results of the questionnaire: a significant improvement of compliance by the treatment satisfaction index in group 1and 2; and a 1.7 time decrease in the proportion of ASA-noncompliant patients were observed. According totheresults ofROC analysis an average GI symptom score ≥3 predicted an improvement of compliance in case of switching to Aspirin Cardio with a diagnostic sensitivity of 72.3% and specificity of 51.1% (р=0.012) as well as alleviation of GI symptoms (sensitivity, 74.5%; specificity, 63.8%, р=0.001). Different dosage forms of ASA are characterized with similar efficacy in prevention of cardiovascular events and effects on the risk of bleeding. Aspirin Cardio showed a better tolerability due to a less effect on GI symptoms. Itprovided a better compliance to chronic treatment. This study confirmed advisability of using the proposed questionnaire to evaluate GI symptoms for specification of prediction and modification of therapy.

Estimation of milkfish physical weighting as fishery industry support system using image processing technology

The Milkfish prices in many marketplaces influenced by physical weight. The weighting is determined using an analog scale and must be delivered in real time for good marketing for the fishery industry, restaurant and to the final consumer. This paper presents a computer vision system with image processing technology that allows Milkfish scales data to be directly stored in computer databases. The system designed in the form of measuring instruments of physical weight and directly presented on the user’s computer. The computer vision approach implemented by determined the measurement pattern to find the parameters (HSVHS) and using contour detection to obtaining object edges as a bounding box. Each bounding box edges measured using pixels scale and formulation using Weight Fish Estimation equation. Accuracy performance of image processing was measured using ROC approach. The results showed the accuracy of weight estimation using 20 fish samples reached by 86.66% and the accuracy of object detection by 95% with error rate measurement by 1 centimeter (cm) from the actual length. This result highly recommended to applied to the fishery field and it can be a tool for fishpond farmers or fishermen to detect fish weight in fish marketing.