Impaired Quality Of Life Research Articles

Patients’ Acceptance of Psoriasis Depends on Disease Severity, Itch Intensity, and the Patients’ Quality of Life: A Cross-Sectional Study

Background/Objectives: Psoriasis is a chronic skin disorder affecting over 60 million people worldwide, with both physical and psychological impacts due to the visible lesions and associated somatic symptoms. This study aimed to assess disease acceptance among psoriasis patients and to explore its correlation with disease severity, itch intensity, and quality of life (QoL) Methods: The study included 166 psoriasis patients, comprising 101 men and 65 women, all with a disease duration of at least one year. Clinical and psychological aspects of psoriasis were comprehensively assessed using various standardized tools, along with a demographic questionnaire. Results: The study found that psoriasis patients had a mean illness acceptance score of 25.1 points, with most respondents (44%) exhibiting a moderate level of acceptance. A high level of acceptance was observed in 28% of participants, while an equal proportion of patients (28%) demonstrating low acceptance, with no significant gender-based differences. Acceptance was negatively correlated with disease severity (PASI score), quality of life impairment (DLQI), and itch intensity (NRS), indicating that lower acceptance was linked to more severe symptoms. Additionally, a slight negative correlation was observed between acceptance and disease duration, while acceptance levels were unaffected by factors such as education, relationship status, or age of disease onset. Conclusions: A comprehensive approach to psoriasis treatment should address not only the physical aspects but also the psychological challenges faced by patients, with a particular focus on improving disease acceptance as a coping strategy. Reducing itch intensity may contribute to better disease acceptance.

Systemic Oxidative Stress Correlates with Sarcopenia and Pruritus Severity in Primary Biliary Cholangitis (PBC): Two Independent Relationships Simultaneously Impacting the Quality of Life—Is the Low Absorption of Cholestasis-Promoted Vitamin D a Puzzle Piece?

Background: Unlike other chronic liver disorders, in primary biliary cholangitis (PBC), systemic oxidative stress (SOS) worsens along with liver disease progression status (DPS), influencing muscle metabolism, muscle quantity (MQ), and itch pathways. Synergistically, cholestasis contributes to reduced vitamin D absorption, with a negative impact on MM and SOS. Despite this evidence, the prevalence of sarcopenia in PBC, and the SOS-MQ relationship comparing PBC with other CLDs, has never been investigated. Moreover, the relationship between vitamin D and MQ-SOS, and the correlation between SOS and pruritus severity, remains unexplored in PBC. Methods: A total of 40 MASLD, 52 chronic HBV infections, 50 chronic HCV infections, and 41 ursodeoxycholic acid/antioxidant-naïve PBC patients were enrolled. Biochemical, nutritional, and liver stiffness (LSM) data were collected, and sarcopenia was assessed after a normalizing 3-month dietetic–physical exercise regimen. The d-ROMs/BAP tests evaluated SOS. The validated “PBC-40 questionnaire” estimated pruritus and quality of life (QoL). Results: Unlike other CLDs, in PBC patients, sarcopenia was more prevalent in initial mild fibrosis (PBC: 57.10% vs. MASLD: 30.76%, HBV: 22.60%, HCV: 20.70%, all p < 0.0001), and SOS significantly correlated with MQ (dROMs-ASM/h2, p: 0.0002; BAP-ASM/h2: p: 0.0092). PBC patients presented lower vitamin D levels and a significant correlation of these with SOS and MQ (all p < 0.0001). SOS also correlated with pruritus severity (dROMs, R: 0.835; BAP, R: −0.775, p < 0.0001). QoL impairment was significantly more represented in PBC individuals with sarcopenia, SOS imbalance, and relevant pruritus (p: 0.0228). Conclusions: In PBC, SOS correlates with MQ impairment and pruritus severity, configuring two independent relationships simultaneously impacting QoL.

Evaluation of the Immunological and Hematological parameters of Systemic Lupus Erythematosus in Iraqi Women

Systemic lupus erythematosus is an autoimmune disease involving several systems, mainly affects young adult women, and causes a significant deterioration in quality of life. Different environmental aspects are known to facilitate the development of lupus in predisposed individuals. Hemoglobin concentration (HB), granulocyte level, hemoglobin level, saturation (ESR), and platelets (PLT) were among the clinical blood indicators that were found to be associated with the beginning of SLE in adults and teenagers. Blood PLT levels in both SLE patients were significantly lower than in the G1 control group (P< 0.001). When compared to the control group, G1, the two SLE patient groups (G2 & G3) had noticeably higher ESRs (P < 0.01). The study employed many immunological markers, such as C-reactive protein (CRP), antinuclear antibody (ANA), Anti-double stranded DNA (Anti-dsDNA), complement components C3 and C4 levels. Serum CRP levels were significantly higher in G2 and G3 SLE patients (P<0.001) than in the G1 control group. Research revealed that two SLE patient groups (G2 & G3) had blood levels of ANA and Anti-double stranded DNA (Anti-dsDNA) that were considerably higher than those of the control group (G1).

P85 Genital psoriasis in Asians: impact on quality of life and sexual health

Abstract Genital involvement and sexual dysfunction are common amongst patients with psoriasis; however, most patients do not discuss their genital rashes or sexual health with their doctor. The aim of this study was to evaluate the impact of genital psoriasis on quality of life (QoL) and sexual health in adult Asian psoriasis patients with genital psoriasis, an entity that is poorly understood, under-recognized and undertreated. We performed an observational study on adult Asian psoriasis patients attending psoriasis subspecialty clinics at a tertiary dermatology centre over 1 year. Participants underwent clinical examination of the whole-body surface, with particular attention to the genitalia, and questionnaires to evaluate QoL and psychosexual health were administered. Patients received a small renumeration for their participation. The study received no commercial funding. A total of 62 patients participated. Most participants were male (82.3%) and Chinese (59.7%) with a mean age of 41.7 years [standard deviation (SD) 12.5]. The commonest site involved was the suprapubis (61.3%). Perianal, glutaeal cleft and perineum involvement were more common amongst females (P < 0.05). The mean psoriasis area and severity index (PASI) score was 7.0 (SD 4.3) with a mean Dermatology Life Quality Index (DLQI) score of 9.8 (SD 6.7), indicating moderately impaired QoL. Higher PASI scores were associated with increasing QoL impairment on DLQI (P = 0.021). Males in whom genital psoriasis prevented sexual intercourse or diminished their libido reported more sexual dysfunction. Females reported greater severity in terms of symptomatic burden and feelings of embarrassment (P = 0.038) yet were less likely to be on treatment (37.5 vs. 45.0%). Perceived efficacy of treatment was low and younger patients fared poorer on the Patient Health Questionnaire-9 depression questionnaire (P = 0.047). Genital involvement may be a key contributor to the lower QoL compared with psoriasis patients without genital involvement. Although patients desire more efficacious treatment, they may be reluctant to discuss their genital rashes or sexual health when not prompted leading to under-recognition and under-treatment, particularly amongst female patients. More studies need to be performed with age and gender-matched control groups using validated QoL and sexual health questionnaires for genital psoriasis. Nonetheless, clinicians should proactively evaluate for and treat genital psoriasis, as disease control has been shown to restore both QoL and sexual function.

Neuropsychological Effects of the Lockdown Due to the COVID-19 Pandemic on Patients with Alzheimer’s Disease and Their Caregivers: The “ACQUA” (Alzheimer–COVID QUArantine Questionnaire) Study

Background: The lockdown due to the COVID-19 pandemic, imposed in many countries in 2021, led to social isolation and the interruption of many activities that were useful in stimulating cognition. The impact of these changes has been particularly severe in older subjects with cognitive impairment. Methods: The present study aimed to investigate the effects of lockdown on Alzheimer’s disease patients (in cognition, behavior, and autonomy) and on their caregivers (in emotions, burden, and quality of life). We created a questionnaire and performed an extensive semi-structured telephone interview with each caregiver. The main outcomes were (1) changes in cognitive and behavioral symptoms and autonomy levels in the patients and (2) effects on caregivers’ emotions, burden, and quality of life. Results: The lockdown severely impaired patients’ cognition and independence and worsened behavioral and psychological symptoms of dementia. These effects contributed to increasing caregivers’ burden and stress levels, with a significant perceived deterioration in quality of life among caregivers with higher education levels (p = 0.047). Conclusions: This study might contribute to our understanding of the impact of lockdown on Alzheimer’s disease patients and their caregivers, to guide future public health interventions aimed at preventing and/or reducing the consequences of similar extraordinary events in frail subjects.

Quality of Life of Hospitalized Patients with Hematological Diseases

Hematological diseases have a wide age range of disease onset, repeated hospitalizations, long periods of treatments and hospitalization, special hospitalization conditions, isolation that lead to restrictions to their social life and impaired quality of life. The hospital is the place where patients, families, nurses and doctors come together for a common purpose, the restoration of the patient’s health. Ensuring a quality of life in the hospital environment requires the participation of all the healthcare team and building a “healing environment”. Nursing priorities for improving the quality of life in the hospital include ensuring comfort, psychosocial support, providing palliative and patient centered care and patient centered environment. A patient centered environment responds holistically to the needs of its users, including accessibility, safety, privacy and dignity, comfort and wellbeing, personal choice and control. The inclusion of arts, music, exercise and festivities improve quality of life during hospitalization. Family members also are welcomed to stay and care for the patients during long periods of hospitalization. Patients hospitalized for hematological diseases are a unique population with complex needs. So, research, innovation, and initiatives are needed to incorporate new methods to improve their quality of life during hospitalization.

Need for individualized counseling regarding psoriasis systemic therapy in women of childbearing age: analysis of the PsoFem study at the University Medical Center Hamburg.

For patients with moderate-to-severe psoriasis and current childbearing/pregnancy, the choice of therapy is limited. The present study compared the disease burden and treatment choices in women of childbearing age (WoCBA) with and without a current wish for pregnancy. Female patients aged 18 to 45 years, with moderate-to-severe psoriasis vulgaris, were consecutively recruited. The patients reported on sociodemographic/reproductive characteristics and quality of life impairments. The physicians assessed disease severity, comorbidities, and current treatment(s). Both patients' and dermatologists' perceptions of shared decision-making for the current systemic treatment were surveyed. Participants were 145 WoCBA with psoriasis: 73 were pregnant or reported a desire to conceive (group CB+) and 72 reported no wish to have (more) children (group CB-). Patients without childbearing wishes were older and often had previous children; no significant differences in clinical features or quality of life impairments were found. A significantly higher proportion of patients in the CB+ group were prescribed tumor necrosis factor alpha blockers, particularly certolizumab pegol. This treatment option was associated with previous children and the desire to conceive, but not with disease variables. Family planning was more often discussed and considered in the clinical decision for the CB+ group, but patient-doctor agreement for shared decision-making was fair-to-moderate. The small sample size prevented comparative analyses between patients planning a pregnancy in the short- vs long-term future. In addition, specific variables related to the decision-making process for the current therapy need to be assessed and examined in more detail in further research. For WoCBA with childbearing wishes, tumor necrosis factor alpha blockers were most frequently prescribed, in accordance with current guidelines/recommendations. Decision-making for continuing or changing systemic therapy during pregnancy must take into account medication specificities and the vulnerable stages in pregnancy, as well as the limited amount of pregnancy-compatible drugs.

Expression of Major Basic Protein and Endothelial Adhesion Molecules in Chronically Inflamed Mucosa of the Ethmoid Labyrinth.

Tissue remodeling, including dense eosinophil infiltration, is essential for forming inflammatory nasal polyps (NPs) and the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP). Toxic eosinophil major basic protein (MBP) damages the sinus mucosa epithelium and lamina propria, which initiates reparative processes leading to tissue remodeling. MBP specifically binds to BMK-13 antibodies allowing immunohistochemical (IHC) tissue staining for eosinophils. This study evaluated the association between NP stromal BMK-13 and endothelial adhesion molecule staining, and clinical parameters of NP patients compared to IHC expression and clinical parameters in subjects with healthy nasal mucosa. We included 30 patients with bilateral NPs who were selected for endoscopic ethmoidectomy. The control group was of 30 subjects with non-inflamed nasal mucosa but with middle turbinate aeration, chosen for surgery. All participants were clinically scored before surgery, according to quality of life (QoL) outcome and symptoms. The degree of disease extension on computed tomography scans of the paranasal sinuses was also evaluated. Tissue samples after surgery were IHC stained for BMK-13 and endothelial proliferation markers CD31 and CD34. Expression of BMK-13, CD31, and CD34 in tissues of NPs was higher than in healthy nasal mucosa. Positive correlations were observed between BMK-13 expression, impaired QoL, and radiologically assessed extension of inflammation in NP patients. Apart from the fact that the NP tissue has, as expected, more intense eosinophilic infiltration, the proliferation of blood vessels is more pronounced in the NP tissue than in the tissue of healthy nasal mucosa. Expression of MBP in the tissue of ethmoidal NPs could serve as a potential marker of the degree of expansion of CRSwNP and indicate the severity of the disease. None, because it was a cross-sectional study.

The Psychological and Cognitive Landscape of Adult Idiopathic Intracranial Hypertension: A Scoping Review.

Idiopathic intracranial hypertension (IIH) is a chronic headache disorder with increasing prevalence. Although characterized by raised intracranial pressure causing papilledema with a risk of visual impairment, psychological symptoms such as depression, anxiety, and cognitive impairment are frequently seen but are understudied and under-reported. Together, these can negatively affect quality of life. These were explored through a systematic PRISMA scoping review. OVID, EMBASE, Cochrane, and PubMed databases were searched in April 2023, limited to those in English and published during January 2000-March 2023. PROSPERO ID CRD42023399410. From 454 identified studies, 24 relevant articles were identified from a range of countries including the United Kingdom, the United States, Israel, Egypt, Canada, Germany, and Brazil. Data on study design, participants, tests performed, and outcomes were collated. There is a considerable burden of psychiatric, affective, and cognitive conditions, as well as impaired quality of life, in adult patients with IIH. Notably, these were independently correlated with the presence of headache in a number of studies and with obesity in others. Aside from optimizing symptom control, including reducing the severity of headaches and protecting visual function, clinicians should be mindful of the biopsychosocial difficulties and potential cognitive impairments patients with IIH face. Assistance may be required with managing concurrent depression and anxiety, as well as optimizing cognitive function. Incorporating neuropsychological assessment and individualized management strategies may be beneficial at the point of diagnosis and throughout the illness.

Cognitive Behavioral Therapy in the Treatment of Sleep Disorders: Theoretical Foundations, Research Methods and Analysis of Effectiveness

Sleep disorders are not just a disruption of a person’s normal recovery process and a deterioration in life quality. It has been repeatedly demonstrated that insomnia is an independent factor that worsens the course of somatic diseases and leads to psycho-emotional disorders of varying severity. Research into cognitive behavioural therapy for insomnia aims to provide answers to these questions. The most effective non-pharmacological treatments for insomnia are behavioural and psychotherapeutic methods that improve sleep and do not cause side effects or addiction. The chosen research topic is also relevant in the context of the increasing prevalence of insomnia due to the profound shocks of the Russian-Ukrainian war among internally displaced persons, various other stresses and interpersonal conflicts. All these and many other factors can cause acute insomnia. Patients with insomnia often have increased emotional reactivity, which can also lead to disorders. The findings of the research help understand the psychological factors involved in the processes of researching cognitive behavioural therapy for sleep disorders and can be used by practitioners who are faced with the need to treat patients with insomnia; it will help to understand traumatic experiences and emotional needs better. In conclusion, cognitive behavioural therapy is a practical, non-pharmacological approach to the treatment of sleep disorders, including insomnia. The study highlights the importance of addressing psychological factors, such as emotional reactivity and traumatic experiences, which are often associated with insomnia. As well as providing valuable information for practitioners, this study highlights the importance of individualised therapeutic interventions, particularly in high-stress environments such as those resulting from war and displacement. cuments in various Scopus indexed journals was examined bibliometrically, for the years 2014-2024.

Developing a utility value set for the Gambling Quality of Life Scale-Brief (GQoLS-Brief) using a discrete choice experiment.

The Gambling Quality of Life Scale -brief (GQoLS-Brief) assesses the impact of gambling disorder (GD) on quality of life (QoL). Preference-based measures are essential for obtaining the quality adjustment weight (i.e. utility score) needed to calculate quality-adjusted life years (QALYs) in economic evaluations. We aimed to derive a value set for the GQoLS-Brief. We employed a discrete choice experiment for preference elicitation. An online survey was administered (n = 928). Respondents completed 10 choice tasks, each presenting two GQoLS-Brief health states alongside life expectancy. Conditional logit regression, parameterized to fit the QALY framework, was used for data analysis. QALY weights for each health state defined by the GQoLS-Brief were calculated. The estimated coefficients from the conditional logit models aligned with expectations: utility increased with survival time and decreased with QoL impairment. Utility values for health states ranged from -1.48 (worse than death) to 1.0. "Financial difficulties" exhibited the highest utility decrement, followed by "Sleep disturbance related to financial difficulties." This reference set facilitates the calculation of QALYs for economic evaluations of GD interventions. The weight of subjective financial difficulties underscores the need for therapeutic interventions to target this aspect.

Identification and characterization of alopecia areata subgroups regarding quality of life impairment based on demographic, clinical, psychological, and social factors

ABSTRACT The benign dermatological hair condition Alopecia Areata (AA) is known to impair Quality of Life (QoL), especially mental and social health, due to the accompanying visible appearance changes. Previous studies have identified demographic, clinical, social, and psychological variables related to QoL. Yet, the novelty of this study lies in examining how QoL differences in AA relate to (combinations of) these variables. The aim of the current study is to identify and characterize subgroups of AA persons with less or more QoL impairment by means of (combinations of) demographic, clinical, psychological, and social factors, including both potential risk (perceived stigmatization, avoidant coping, physical identity definition) and protective factors (disclosure, social support, emotion-focused coping and non-physical identity definition). An online questionnaire was filled out by 322 persons with AA, including the Dermatology Life Quality Index (DLQI) as QoL measure, Perceived Stigmatization Questionnaire (FSQ), brief COPE, Social Support Survey, a newly developed identity-definition measure, clinical characteristics, and demographics. Classification and Regression Tree (CART) analysis identified subgroups based on QoL outcome. Lowest QoL impairment was found in persons with low feelings of being flawed combined with low secretiveness. Low QoL impairment was also found in persons feeling flawed combined with low avoidant coping, low sensitivity to others’ opinions and older age. QoL impairment was intermediate in persons perceiving more social support in those with a younger age, and defining identity less on physical appearance in those sensitive to others’ opinions. Highest QoL impairment was characterized by feeling flawed combined with an avoidant coping style. Current findings provide indications for the identification of risk and protective profiles for QoL impairment and which factors to address in interventions to improve QoL in AA.

Limb Preservation Program and Peripheral Arterial Disease

Limb – derived from the old English ‘Lim’. A paired parts (Arm, Leg and Wing) of human that stick out/extends from the trunk of a body. Limb preservation refers to the crucial steps taken in order to save a damaged limb from amputation. Amputation of a limb may be needed when there is serious infection a wound that won’t heal or poor circulation that causes tissue to die. Patients with vascular disease are at high risk for foot and leg wounds that do not heal and may ultimately require amputation to save their lives. Severe cases of Peripheral Artery Disease (PAD) can cause irreversible tissue damage and increase the risk for amputation if not treated. The Limb Preservative Program focuses on saving limbs and also on the overall health and well being of the patient. Limb-Preservation Program (LPP) requires coordinated effort by clinicians, nurses, allied health professionals and administrators dedicated to the cause of saving and maintaining functional limbs. This is a significant consideration because over 1.5 million people live after the loss of a limb; this number is expected to increase due to the aging of the population and the worldwide exponential rise in diabetes mellitus. Peripheral Arterial Disease (PAD) is one the important cause of limb amputation. The prevalence of PAD continues to increase worldwide. It is important to identify patients with PAD because of the increased risk of myocardial infarction, stroke and cardiovascular death and impaired quality of life because of a profound limitation in exercise performance. Lower extremity PAD affects approximately 10% of population, with 30% to 40% of these patients presenting with claudication symptoms. Peripheral arterial disease is common, but the diagnosis frequently is overlooked because of subtle physical findings and lack of classic symptoms. Screening based on the ankle brachial index using doppler ultrasonography may be more useful than physical examination alone. Noninvasive modalities to locate lesions include duplex scanning, computed tomography angiogram, magnetic resonance angiography and invasive modalities peripheral angiogram is the gold standard. Major risk factors for peripheral arterial disease are cigarette smoking, diabetes mellitus, older age (Older than 40 years) hypertension, hyperlipidemia and hyperhomocystinemia. Intermittent claudication may be improved by risk-factor modification, exercise and pharmacologic therapy. Based on available evidence, a supervised exercise program is the most effective treatment. Effective drug therapies for peripheral arterial disease include aspirin (With or without dipyridamole) clopidogrel, cilostazol, and pentoxifylline. By contrast, Critical Limb Ischemia (CLI) is considered the most severe pattern of peripheral artery disease. It is defined by the presence of chronic ischemic rest pain, ulceration or gangrene attributable to the occlusion of peripheral arterial vessels. It is associated with a high risk of major amputation, cardiovascular events and death. The management of CLI should include an exercise program, guideline-based medical therapy to lower the cardiovascular risk. Most of the cases, revascularization is indicated to save limbs, an “Endovascular First” approach and lastly surgical approach if all measures were failed. The choice of the intervention is dependent on the anatomy of the stenotic or occlusive lesion, percutaneous interventions are appropriate when the lesion is focal and short but longer lesions must be treated with surgical revascularization to achieve acceptable long-term outcome. A LPP should include a patient support group as there is a significant mental component to loss of limb or living with a foot ulcer. A patient support group can be very important both preoperatively and postoperatively in helping patients deal with the clinical situation in maintaining functionality and mentaloutlook. Education can be incorporated into the program in the form of seminars for patients and referring physicians. Education is critical to achieve the goal of limb preservation through the reduction of amputation and enhancement of the patient’s quality of life. The LPP also provides a format for research that is increasingly important to the healthcare system. Chatt Maa Shi Hosp Med Coll J; Vol.22 (2); July 2023; Page 1-2

Anxiety depression levels, anxiety sensitivity, and quality of life in children with chronic spontaneous urticaria: A cross-sectional study

Existing literature offers some insights into the prevalence of anxiety and depression in children with chronic spontaneous urticaria (CSU). However, the literature on anxiety sensitivity (AS) and quality of life (QoL) in these children remains poorly understood. This study aimed to evaluate psychiatric diagnoses, anxiety and depression levels, AS, and QoL in children with CSU compared to healthy controls. The CSU group consisted of 44 children aged 8 to 17 years who were diagnosed with CSU, while the control group consisted of 44 healthy children. A child psychiatrist conducted the psychiatric assessment of the children. The Revised Child Anxiety and Depression Scales (RCADS), the Childhood Anxiety Sensitivity Index (CASI), and the Children’s Dermatology Life Quality Index (CDLQI) were administered. Multiple linear regression analysis was conducted to identify independent predictors of QoL, considering several potential factors, including the urticaria activity score, duration of urticaria, presence of a psychiatric diagnosis, scores on the RCADS major depression disorder, RCADS-total anxiety, and total CASI. A significantly higher prevalence of psychiatric diagnoses and anxiety disorders was observed in the CSU group (P < .05). In the CSU group with a psychiatric diagnosis, CASI-total (0.011), CASI-physical (0.049), CASI-social (0.022), and CDLQI scores (P < .001) were significantly higher than those without a psychiatric diagnosis. In the multiple linear regression analysis, only the presence of a psychiatric diagnosis was found to be a significant predictor of CDLQI scores (OR, 5.918; 95% CI, 2.505–9.330; P: .001). This study indicated that children with CSU exhibited a higher prevalence of psychiatric diagnoses than controls. Additionally, children with psychopathology in the CSU group demonstrated higher AS and greater impairment of QoL than those without psychiatric diagnoses. Furthermore, the most significant predictor of a decline in QoL was the presence of a psychiatric diagnosis.

Effect of systemic ozone therapy added to pharmacological treatment on brain-derived neurotrophic factor (BDNF) and cognitive status in post-COVID patients

BACKGROUND: Treatment is required for post-COVID cognitive impairment associated with functional limitations, reduced work capacity, and significant deterioration in quality of life. Pharmacological treatment is ineffective. In this context, physical therapy, especially systemic ozone therapy with potential neuroprotective effects, appears promising. AIM: The aim of the study was to evaluate the effect of systemic ozone therapy added to pharmacological treatment on plasma brain-derived neurotrophic factor (BDNF) levels and cognitive status in patients with post-COVID cognitive impairment. MATERIALS AND METHODS: A total of 140 patients aged 18-45 years with post-COVID asthenic syndrome were evaluated and treated. They were randomized into two groups: an experimental group with 70 subjects who received systemic ozone therapy in addition to pharmacological treatment and the comparator group with 70 subjects who received pharmacological treatment only. Pre- and post-treatment outcomes were assessed using plasma BDNF levels and the Montreal Cognitive Assessment (MoCa) score. RESULTS: Statistically significant differences in BDNF levels (р=0.034) and MoCa scores (р=0.002) were found between the compared groups at the end of therapy (day 30). In our study, adding systemic ozone therapy to pharmacological treatment in patients with post-COVID cognitive impairment normalized BDNF levels and completely improved clinical manifestations of cognitive impairment in 95% of subjects. CONCLUSION: Therefore, systemic ozone therapy can be considered as one of the effective and pathogenetically proven strategies for comprehensive treatment of patients with post-COVID cognitive impairment in the outpatient setting.

Incidence, disease burden and clinical presentation of patients newly diagnosed with inflammatory bowel disease in a population-based inception cohort.

Emerging data indicate a stabilizing incidence of inflammatory bowel diseases (IBD), including ulcerative colitis (UC), Crohn's disease (CD), and IBD unclassified (IBDU) in Western countries. We aimed to investigate the incidence of IBD, its initial clinical presentation, and patient-reported burden. Copenhagen IBD Inception Cohort is a prospective, population-based cohort of patients with newly diagnosed IBD according to the ECCO guidelines in the period between May 2021 and May 2023, within a catchment area covering 20% of the Danish population. Based on 554 patients (UC: 308, CD: 201, and IBDU: 18), the incidence rates per 100,000 person-years were: IBD: 23.4 (95% confidence interval, 21.5-25.4), UC: 14.0 (12.6-15.6), CD: 8.6 (7.4-9.8), and IBDU: 0.8 (0.5-1.3). The median diagnostic delay was significantly shorter for UC (2.5 months (interquartile range [IQR] 1-6)) than for CD (5 months (IQR 1.5-11), p<0.01). Moderate-to-severe disability was reported by 34% of CD patients and 22% of UC patients (p=0.01), severe fatigue by 30% and 26% (p=0.43), and severely impaired health-related quality of life (HRQoL) by 43% and 30% of patients, respectively (p=0.01). Hospitalization rates (UC: 20%, CD: 34%, p<0.01), and need for immunomodulators, biologics, or surgery within three months of diagnosis, were high in both UC (3%, 7%, and 37%, respectively) and CD (31%, 18%, and 10%, respectively). We found a high incidence of IBD in Copenhagen with a substantial disease burden characterized by early and high requirement for advanced therapies and high rates of fatigue, disability and impaired HRQoL at diagnosis.

Assessment of Dyspnea, ECOG and Karnofsky Performance Scaleafter VATS Pleurodesis in Patients with Malignant Pleural Effusions

Background: Malignant pleural effusions (MPE) are a pathological build-up of fluid and cancer cells within the pleural space. Patients have a significantly impaired quality and quantity of life, as this condition usually indicates an advanced disease. Video-assisted thoracoscopic (VATS) pleurodesis is a minimally invasive and effective treatment modality for patients with MPE.Material and Methods: We conducted a retrospective study of 60 patients with MPE treated with VATS pleurodesis. Success rates within a one-month follow-up, the intensity of dyspnea, Karnofsky and ECOG Performance Status Scales before and after the procedure, and length of hospital stay were observed. Results: VATS pleurodesis had a high success rate at the end of a one-month follow-up. A statistically significant difference was observed regarding the intensity of dyspnea, Karnofsky, and ECOG Performance Status before and after VATS pleurodesis. The average length of hospital stay was 7.5 days for these patients.Conclusion: Video-assisted thoracoscopic (VATS) pleurodesis is associated with low morbidity and a high success rate and is a reliable treatment modality for patients with MPE.

Effectiveness of Mindfulness-Based Stress Reduction on Anxiety Disorder: A Systematic Review

Anxiety disorders, including generalized anxiety disorder (GAD), social anxiety disorder (SAD), panic disorder, and specific phobias, are significant public health concerns that affect millions worldwide and lead to substantial impairments in daily functioning and quality of life. Traditional treatments may not suit everyone, highlighting the need for alternatives like Mindfulness-Based Stress Reduction (MBSR), which emphasizes mindfulness meditation. This systematic review evaluates the effectiveness of MBSR in reducing anxiety symptoms across various anxiety disorders by synthesizing research findings from studies published between January 2013 and April 2024. A comprehensive search was conducted in electronic databases, including PubMed, Semantic Scholar, ScienceDirect, PsycINFO, and Web of Science, using keywords such as “Mindfulness-Based Stress Reduction,” “MBSR,” “anxiety disorder,” and “effectiveness.” Peer-reviewed studies assessing the efficacy of MBSR on anxiety disorders were included, with data extraction and quality assessment performed following PRISMA 2022 guidelines. The search identified 1095 articles, with 13 studies meeting the inclusion criteria for the final analysis, encompassing a total sample size of 751 participants. The studies varied in design, sample size, participant demographics, and targeted anxiety disorders. Findings consistently showed significant reductions in anxiety symptoms among participants receiving MBSR compared to control groups. For GAD, studies reported improvements in anxiety and stress measures such as the Beck Anxiety Inventory (BAI) and Hamilton Anxiety Rating Scale (HAM-A). For SAD, reductions in social anxiety symptoms were observed, with some studies showing comparable effectiveness to CBT. This review presents compelling evidence supporting the efficacy of MBSR in reducing symptoms associated with anxiety disorders. Future research should focus on the long-term effects, impact on diverse demographic groups, and specific mechanisms to improve its clinical applicability.

Incremental hemodialysis transition in veterans and nonveterans with kidney failure.

Initiation of hemodialysis treatment with a thrice-weekly prescription is currently the standard of care irrespective of patients' residual kidney function (RKF), comorbidities, and preferences. Each year ∼12 000 Veterans with advanced kidney disease progress to end-stage kidney disease (ESKD) requiring dialysis and comprise greater than 10% of the US incident ESKD population. Dialysis is costly and is associated with impaired health-related quality of life (HRQOL) and high mortality risk, especially in the first year of treatment. Evidence suggests an incremental dialysis transition using twice-weekly hemodialysis provides various benefits, including more dialysis-free time, longer RKF preservation, less vascular access damage, and lower patient burden. Pragmatic studies are needed to inform the efficacy and safety of incremental hemodialysis as a personalized dialysis regimen, and could inform its consideration as a conservation strategy during times of supply shortages. Broadly implementing twice-weekly hemodialysis could also potentially allow more Veterans to receive care within VA-based dialysis units. The VA IncHVets Trial is a pragmatic, multicenter, randomized controlled trial comparing the efficacy and safety of twice-weekly incremental vs. thrice-weekly hemodialysis among Veterans transitioning to ESKD. Further research is needed to determine whether incremental hemodialysis is well tolerated, effective, and facilitates a more favorable transition to dialysis.

Post-COVID-19 pneumonia: Long-term radiographic and spirometric outcomes

Objectives: This study aimed to evaluate the long-term radiographic and spirometric outcomes in patients who survived Coronavirus Disease 2019 (COVID-19) pneumonia in Brazzaville, with a focus on identifying the prevalence and contributing factors to persistent pulmonary sequelae. Materials and Methods: A cross-sectional study was conducted in multiple COVID-19 treatment centers in Brazzaville. A total of 52 patients, with a median age of 49.5 years, were assessed at least six months after recovery. Thoracic computed tomography (CT) scans were used to evaluate radiographic abnormalities, while spirometry assessed ventilatory function. Factors contributing to these abnormalities were analyzed, including age, comorbidities, and the severity of the acute illness. Results: Radiographic analysis revealed that 42.3% of patients had abnormal thoracic CT scans, with common findings including ground-glass opacities (52.2%), atelectasis (39.1%), and traction bronchiectasis (13%). Spirometric analysis revealed that 71.1% of patients had ventilatory disorders and predominantly restrictive patterns (51.4%). Advanced age, comorbidities (such as diabetes and hypertension), and the use of mechanical ventilation were significantly associated with radiographic abnormalities. Persistent respiratory symptoms, including chronic cough and dyspnea, were reported by 32.7% of patients, and 44.2% experienced impaired quality of life. Conclusion: These findings underscore the importance of long-term follow-up for COVID-19 pneumonia survivors, particularly those with persistent symptoms or comorbidities. Regular monitoring of respiratory function through spirometry and imaging is essential to managing long-term sequelae and improving patients’ quality of life.