Direct Questioning Of Patients Research Articles

Subjective cognitive complaints and objective cognitive impairment in patients suspected of obstructive sleep apnea who underwent polysomnography.

Obstructive sleep apnea (OSA) is linked to cognitive impairment. We aimed to investigate subjective cognitive complaints (SCCs) and objective cognitive scores and their relation to polysomnography (PSG) parameters in patients suspected of having OSA. A prospective cohort cross-sectional study was conducted at Siriraj Hospital. Patients suspected of OSA who were scheduled for PSG were recruited. Cognition was assessed using the Montreal Cognitive Assessment (MoCA) and Color Trails Test (CTT). The Memory Index Score (MIS) was calculated from the MoCA. Subjective cognitive complaint presence was assessed through direct questioning of patients and by employing the Cognitive Change Index rated by self or informants (CCI-I). Patients with severe dementia were excluded. Among 258 patients (mean age 61.46±7.05years, 51.2% female), the mean MoCA score was 23.89±3.89. Based on PSG results, patients were categorized into groups as follows: those without OSA or with mild OSA (combined total of 20.1%), moderate OSA (28.3%), or severe OSA (51.6%). Cognitive Change Index rated by self and CCI-I scores correlated significantly (r=0.238, p=0.019) but not with the MoCA score or CTT time. Objective cognitive scores were associated with PSG parameters: total sleep time (TST), sleep onset latency, wake after sleep onset, sleep stages, mean O2 saturation, and time spent with SaO2 below 90% (all p<0.05). Subjective cognitive scores were not associated with PSG parameters, except CCI-I with TST. Participants with objective cognitive impairment had lower education, higher body mass index, more comorbidities, and lower SCC percentage (all p<0.05). Patients with moderate to severe OSA had a higher proportion of objective cognitive impairment (64.1%) but a lower incidence of SCC (38.3%) than patients with no OSA or mild OSA. Thirty patients with severe OSA and cognitive impairment received continuous positive airway pressure (CPAP) treatment for a mean of 12.2months. These patients showed MoCA and MIS improvement, but no significant changes were observed in their CTT and Cognitive Change Index scores. Most patients with OSA had objective cognitive impairment, but SCC was less frequent in patients with more severe OSA. Several PSG parameters correlated with cognitive scores but not with subjective cognitive scores. Patients with severe OSA may benefit cognitively from CPAP treatment.

Effect of Giving Polyphytopharmaca on Improvement in The Degree of Asthma Control through Reduction of Eosinophils and Interleukin-13 Uncontrolled Asthma Patients

Backgrounds: Bronchial asthma is a heterogeneous disease characterized with chronic airway inflammation. The level of asthma control is an indicator of asthma management outcomes. It is influenced by a complex immunological mechanism, included the role of IL-13 as a key biomarker of inflammation. We investigate the effect of Poly-Phytopharm (Kleinhovia hospita 100 mg, Curcuma xanthorriza 75 mg, Nigella sativa 100 mg and Ophiocephalus striatus 100 mg) on the level of asthma control tests (ACT) score, blood eosinophils, and serum IL-13 on not fully controlled asthma stable patients.&#x0D; Methods: This study used quasi-experimental pre and post test methods, in 15 stable asthma patients who were not fully controlled at the pulmonary outpatient clinic of Dr. Saiful Anwar General Hospital, Malang. Assessment of ACT score, blood eosinophils, and serum IL-13 are carried out before and after supplementation of Poly-Phytopharm three times a day, two capsules respectively for 12 weeks. The ACT was scored by the investigator by direct questioning of patients, the blood eosinophil was measured with blood analysis, and the IL-13 in serum was detected with qPCR method.&#x0D; Results: There is significant increase of ACT score (18.07±2.57 to 22.06±1.83; P=0.001). In subject with baseline eosinophils ≥300 pg/mL (n=9), there were significant reduction in blood eosinophils (653.15±276.77/µL to 460.66±202.04/µL; P=0.038), and a decrease of serum IL-13 (17.69±9.901 pg/ml to 16.17±12.438 pg/ml; P=0.609).&#x0D; Conclusions: The administration of poly-phytopharm for 12 weeks improves ACT level, decreases blood eosinophils, and decrease serum IL-13 on not fully controlled asthma stable patients. (J Respir Indo. 2020; 40(3): 130-8)

Poly-Phytopharm Increases Act Score and Serum miR-126 Relative Expressions, and Decreases Blood Eosinophil Levels in Asthma Patients

Background: The levels of asthma control is an indicator of asthma management outcomes. A complex immunological mechanism influences it. We aimed to investigate the effect of Poly-Phytopharm on the asthma control tests (ACT) score, blood eosinophil levels, and miR-126 relative expressions in asthma patients. &#x0D; Methods: Quasi experimental method is used in 15 stable asthma patients who were not fully controlled at the pulmonary outpatient clinic of Dr. Saiful Anwar General Hospital Malang. Assessment of ACT score, blood eosinophil levels, and miR-126 relative expressions are carried out before and after supplementation of Poly-Phytopharm that consist of Nigella sativa 100 mg, Kleinhovia hospita 100 mg, Curcuma xanthorrhiza 75 mg, and Ophiocephalus striatus 100 mg extract, three times a day, two capsules respectively for 12 weeks. The ACT was scored by the investigator by direct questioning of patients, the blood eosinophil level was measured with blood analysis, and the relative expressions of miR-126 was detected with qPCR. &#x0D; Results: There were significant increase of ACT score (18.07±2.57 to 22.06±1.83, P=0.001), decrease in blood eosinophil levels (653.15±276.15 pg/mL to 460.66±202.04 pg/mL, P=0.038), and enhancement of serum miR-126 relative expressions (1.83±1.89 to 5.89±1.34, P=0.038). &#x0D; Conclusion: The administration of Poly-Phytopharm increases ACT score, decreases blood eosinophil levels and increases serum miR-126 relative expressions in not fully controlled stable asthma patients. (J Respir Indo. 2019; 39(4): 231-7)

Cost-effectiveness of targeted screening for abdominal aortic aneurysm in siblings.

Population screening for abdominal aortic aneurysm (AAA) in 65‐year‐old men has been shown to be cost‐effective. A risk group with higher prevalence is siblings of patients with an AAA. This health economic model‐based study evaluated the potential cost‐effectiveness of targeted AAA screening of siblings. A Markov model validated against other screening programmes was used. Two methods of identifying siblings were analysed: direct questioning of patients with an AAA (method A), and employing a national multigeneration register (method B). The prevalence was based on observed ultrasound data on AAAs in siblings. Additional parameters were extracted from RCTs, vascular registers, literature and ongoing screening. The outcome was cost‐effectiveness, probability of cost‐effectiveness at different willingness‐to‐pay (WTP) thresholds, reduction in AAA death, quality‐adjusted life‐years (QALYs) gained and total costs on a national scale. Methods A and B were estimated to reduce mortality from AAA, at incremental cost‐effectiveness ratios of €7800 (95 per cent c.i. 4627 to 12 982) and €7666 (5000 to 13 373) per QALY respectively. The probability of cost‐effectiveness was 99 per cent at a WTP of €23 000. The absolute risk reduction in AAA deaths was five per 1000 invited. QALYs gained were 27 per 1000 invited. In a population of ten million, methods A and B were estimated to prevent 12 and 17 AAA deaths, among 2418 and 3572 siblings identified annually, at total costs of €499 500 and €728 700 respectively. The analysis indicates that aneurysm‐related mortality could be decreased cost‐effectively by applying a targeted screening method for siblings of patients with an AAA.

Possibilities and limits of patient-reported outcome exemplified by systemic lupus erythematosus and the LuLa study

Over the last three decades patient reported outcomes (PRO) have become increasingly more important for the assessment of the course of diseases and therapy response. It represents the generic term for instruments which elicit information on various disease dimensions by direct questioning of patients and thereby collate subjective estimations and perceptions. This article presents the current situation with respect to the utilization of PRO. The advantages and disadvantages of individual instruments are discussed exemplified by systemic lupus erythematosus (SLE) and the LuLa study. The PRO instrument collates subjective estimations of various aspects of diseases directly from the patients. The PRO is mainly used to survey (health-related) quality of life but can also be used to reflect other disease-associated aspects. Various institutions promote the use of PRO in clinical trials for assessment of approval for pharmaceutical and medical products because ultimately only benefits for the patients are of relevance. The development of PRO instruments requires the same extensive psychometric testing as physicians instruments to measure clinical endpoints. Because of the heterogeneous sociodemographic composition of patient collectives, particular attention has to be given to cultural and linguistic adaptation. In addition to common challenges, such as missing values, under-reporting, over-reporting and response shift, subjective opinions can be influenced by other contextual factors, such as life situations unrelated to the disease. Alteration of internal standards or conceptualization can lead to interpretation difficulties in the long-term. Determinants of discordant estimations between physicians and patients need to be considered when using PRO but none of the aspects is generally better than the other.

One year follow up of a cohort of suspected leprosy cases: findings from a Leprosy ‘Selective Special Drive’ in Gadchiroli District, Maharashtra, India

The study involves a follow-up visit in 2010, to hyper-endemic Gadchiroli district of Maharashtra, India, to evaluate the current status of those suspected in 2009 of having skin/nerve lesions suggestive of leprosy, and to study the interactions between such people and the State leprosy programme. The study cohort comprised of those confirmed with leprosy (n = 151 and 157/233 absentee 'suspects' who were not examined by the study team in 2009 in 14 of 45 Primary Health Centres (PHCs). At follow-up, the treatment status of the confirmed cases was checked from PHC registers and cross-checked by direct questioning of patients and their views were sought on PHC leprosy services. The 157 absentee 'suspects' were queried about the reasons for their absence. Thirty nine 'absentee suspects' were found to have leprosy. A notable feature of the follow-up visit was that 114 people in the communities, other than those listed as 'suspects' by Community Health Workers (CHWs), voluntarily sought out the team for their opinion on hypopigmented/anaesthetic lesions, which resulted in a further 39 new cases being brought to light. (Total new cases = 78). The follow-up revealed discrepancies (100% vs. 75%) between PHC records and testimonies of the registered patients about regularity of treatment; irregularity of MDT supply was cited by some for dropping out of treatment. Other reasons proffered for irregularity were lepra reaction, fear of stigma, ignorance about leprosy and preference for faith healers. Medical Officers of PHCs were not trained in the management of lepra reactions; that task, along with disability care being entrusted to a paramedical worker of an NGO during periodic visits. There are remediable lacunae in the recording and dispensing of MDT by the State apparatus, as well as a need for refresher training in leprosy diagnosis for PHC staff, and in lepra reaction management for medical officers. The large number (78) of new cases detected in the follow-up, in part of Gadchiroli district strongly suggests more to-be-discovered cases in the communities.

Peliosis Hepatis in an Adult Patient with a History of Childhood Ulcerative Colitis

Purpose: JB was diagnosed with ulcerative colitis (UC) as a child when she presented with failure to thrive. She was started on sulfasalazine for UC. She was also treated with growth hormones for her short stature, although neither the patient nor her mother acknowledged this fact until a later date. At her adult presentation, the patient appeared well, except her height was 4'10”. Baseline lab results revealed an alkaline phosphatase of 344 IU/L (nl 25-150) and an ALT of 56 IU/L (nl 0-40). The remainder of labs, including autoimmune work-up, was unremarkable. Magnetic resonance imaging with MRCP revealed no evidence of biliary or parenchymal abnormality. Suspecting primary sclerosing cholangitis, endoscopic retrograde cholangiopancreatography was attempted but was unsuccessful; the patient refused another attempt. Therefore, a large core (18g) liver biopsy was obtained, without immediate complication. One week later, the patient presented complaining of right upper quadrant pain. Computed tomography confirmed a large heterogenous mass in the right lobe of the liver, consistent with a hepatic hematoma. Due to continuing transfusion requirements, the patient underwent embolization, which showed “innumerable foci of punctuate extravasation from the branches of the right hepatic artery,” and “several foci of extravasation from the peripheral branches of the left hepatic artery” (see image below). Gelfoam infusion was used to stop the bleeding. The patient was discharged several days later. Post hoc review of the images led to a radiographic diagnosis of peliosis hepatis. Peliosis is characterized by the gross appearance of multiple cyst-like, blood-filled cavaties within parenchymal organs. Peliosis has been associated with the use of anabolic and androgenic steroids. Prior to her biopsy, both the patient and her mother failed to disclose that she had taken growth hormones. Direct questioning of patients about past use of growth hormones, especially those with obvious short stature and/or a history of chronic childhood illness, should be regular practice, especially before proceeding with invasive procedures.Figure: [978]

Deep topical fornix nerve block versus peribulbar block in one-step adjustable-suture horizontal strabismus surgery

We compared the efficacy of deep topical fornix nerve block anaesthesia (DTFNBA), which does not paralyse the extraocular muscles, with peribulbar block in patients undergoing one-step adjustable-suture horizontal strabismus surgery. Patients with a vertical, oblique squint were excluded from the study. We studied 100 patients, allocated randomly to two groups. Group 1 (n=50) received peribulbar block with 5 ml of 1:1 mixture of 0.5% plain bupivacaine and 2% lignocaine supplemented with hyaluronidase 300 i.u. ml(-1). Group 2 (n=50) received DTFNBA with placement of a sponge soaked in 0.5% bupivacaine deep into the conjunctival fornices for 15 min. No sedation was given to either group. Analgesia was assessed by direct questioning of patients during the procedure. A three-point scoring system was used (no pain = 0, discomfort = 1, pain =2). If the pain score was 1, the patient was asked to look in the opposite direction to decrease the tension on the periosteal attachment of the muscle to relieve discomfort. If the pain score was 2 at any stage of the operation, general anaesthesia was given. In Group 2, significantly more patients (15) experienced discomfort than in Group 1 (no patients) (P<0.05), but general anaesthesia was not needed. DTFNBA is a useful technique for intraoperative adjustable-suture strabismus surgery. It does not alter muscle tone, thus allowing the surgeon to adjust the muscle sutures intraoperatively, and reducing the incidence of under- or over-correction of the squint in the immediate postoperative period.

Sludge, stones and sickle cell anaemia

A total of ninety-seven paediatric and adult patients with sickle cell anaemia and fourty-eight control subjects were investigated with the aim of determining the content of the gallbladder. The patients and control subjects were categorised according to the presence or otherwise of gallbladder stones, and, or sludge. The age last birthday, PCV and number of crises per year were recorded in order to determine their influence on the development of gallbladder stones and sludge. The gallbladder contents were examined using ultrasonographic technique. The age and number of crises per year was determined from the clinical record files and direct questioning of patients. Seventy patients had normal gallbladder content while eighteen had sludge, six had stones, and three had a combination of sludge and stones. None of the control subjects had sludge or stone. The age of patients increased from progressively from those with normal content through those with sludge to those with stones. The PCV and number of crises per year only differentiated between normal and abnormal gallbladder contents. While the prevalence of gallbladder stones in this study falls within the range in previous studies, a high prevalence of sludge was observed. The association between the occurrence of sludge and stones with age, PVC and number of crises per year suggests the need for a larger series and that they may identify a group of patients requiring closer monitoring.

Efficacy and Safety of Quinfamide versus Secnidazole in the Management of Amoebic Non-Dysenteric Colitis in Children

To compare the efficacy and safety of single doses of quinfamide and secnidazole in the treatment of amoebic non-dysenteric colitis in children. This was a prospective, longitudinal, double-blind, randomised, comparative study. The participants were students or relatives of students at two urban elementary schools in Celaya, Guanajuato, Mexico. Patients aged between 2 and 15 years of age with cysts of Entamoeba histolytica in stool samples for 3 consecutive days as detected by Faust's concentration method were enrolled in this study. Single doses of quinfamide 4.3 mg/kg or secnidazole 30 mg/kg were administered. Patients were asked about the acceptability of the flavour of the drugs. Efficacy was evaluated by the presence or absence of E. histolytica cysts in stool samples on the fifth, sixth and seventh days after administration of the drugs. Adverse events were evaluated by direct questioning of patients. 734 patients were evaluated by coproparasitoscopy, of whom 239 (32.6%) had E. histolytica cysts. 112 patients were randomised to receive quinfamide and 127 to receive secnidazole. Differences in age, bodyweight, size and gender distribution were not statistically significant between the groups. 108 patients (96%) in the quinfamide group and 15 patients (12%) in the secnidazole group reported the flavour as good (p < 0.0001). 95 patients (85%) in the quinfamide group and 93 patients (73%) in the secnidazole group had negative stool samples at the end of treatment (p = 0.04). Nausea (p < 0.0001), abdominal pain (p < 0.05) and unpleasant taste (i.e. metallic taste 3 to 5 days after administration of secnidazole) in mouth (p < 0.0001) were more common in the secnidazole group than in the quinfamide group. Quinfamide is an excellent option for amoebic non-dysenteric colitis because of its high parasitoscopic efficacy, minimum adverse effects and good acceptance by children. The single-dose schedule guarantees completion of treatment.