Greater Quality Of Life Impairment Research Articles

Quality of life in patients with atrial fibrillation and multimorbidity, and their caregivers: results from the AFFIRMO international online survey

Abstract Introduction Patients with atrial fibrillation (AF) often have additional concomitant chronic conditions that affect their clinical management and quality of life (QoL). The AFFIRMO study aims to examine ways of optimising care and self-management for AF patients with multimorbidity. Methods An online survey open to AF patients and their caregivers was distributed to five countries (UK, Italy, Denmark, Romania and Spain) between June 2022 and January 2023. QoL among patients was assessed using the EQ-5D-3L questionnaire, while life changes for caregivers was assessed using the Bakas Caregiving Outcome Scale (BCOS). Results 659 patients (47.2% males, mean age: 70.9 [SD 10.2] years), and 201 caregivers (26.9% males, mean age 58.3 [SD 15.2] years) participated in the survey. Patients reported significant sex differences in health status (Table 1), with men reporting an overall higher QoL, while women reported greater impairment in mobility and usual activities, with higher levels of pain/discomfort. Patients aged >65 years reported greater impairment in QoL compared to the younger ones, with patients from Southern Europe reporting greater impairment in self-care than those from Eastern or Northern Europe. Patients with higher education reported better QoL. Among caregivers (Table 2), men reported less negative life changes compared to women, with the latter also reporting more pain/discomfort. Caregivers aged <65 years reported greater impairment in mobility and usual activities than those aged ≥65 years, and those aged <50 years reported a higher level of anxiety/depression. Caregivers aged <75 years reported greater negative life changes than those aged ≥75 years. Caregivers from Spain reported less negative life changes compared to caregivers from other countries. Caregivers with further education level reported better overall quality of life and greater negative life changes compared to caregivers with lower levels of education. Conclusions The QoL of patients with AF and multimorbidity seems to be compromised especially in females and in the older ones. The caregivers of these patients also experience negative life changes, in particular those with younger age. The results of the AFFIRMO study will help in the development of better clinical and self-management strategies for AF patients with multimorbidity to reduce the negative impact on QoL.Differences in patients' QoLDifferences in caregivers' QoL

The Burden of Pediatric Atopic Dermatitis: Quality of Life of Patients and Their Families.

(1) Background: Atopic dermatitis (AD) is one of the most common inflammatory skin conditions, thus having a significant impact on the quality of life (QoL) of patients and their families. We performed a survey to gather more data to help describe the burden of AD in Lithuania and to help expand the treatment plan to this important aspect of the disease. (2) Methods: A cross-sectional study was conducted involving healthy and AD pediatric patients. The assessment instruments used were the Patient-Oriented Eczema Measure (POEM), QoL, and original questionnaires (the original questionnaire was designed by the authors to determine the demographics, medical history, and treatment methods of the respondents). (3) Results: This study included 302 participants in total: 247 AD patients (51% boys) and 55 non-AD patients (51% boys). The mean age for AD patients was 6.8 ± 4.4. years, and this was 10.5 ± 3.1 years for the control patients. A significant difference was found between the QoL questionnaire scores and the Family Dermatology Life Quality Index (FDLQI) score for the atopic dermatitis group (QoL: 6.3 ± 5.6; FDLQI: 7.1 ± 6.9) and controls (QoL 0.5 ± 1.1; FDLQI 2.1 ± 5.9) (p = 0.000). The mean QoL questionnaire score for severe AD was 14.3 ± 6.2 (very large effect), that for moderate AD was 6.9 ± 4.4 (moderate effect), and that for mild AD was 4.4 ± 4.2 (small effect) (p = 0.000). (4) Conclusions: Our study revealed a moderate effect of AD on dermatology-related QoL in patients and their families. It has been shown that increased disease severity was associated with a greater impairment of QoL in both patients and patient's parents. The burden of AD in children and their parents is considerable and should be taken into account in the management of atopic dermatitis.

Quality of life in patients with vitiligo in North Macedonia

Vitiligo is an acquired depigmentation deficit with a high prevalence, ranging from 0.5% to 7.8%. The aim of the study was to measure the quality of life (QL) of patients with vitiligo, expressed through the Dermatological Quality of Life Index (DLQI). Materials and methods: This cross-sectional study was realized in a period of 1 year. Two questionnaires were used in the study. Тhe first questionnaire contains data from the DLQI, designed for use in adults over 16 years of age, taken from the Cardiff University in the UK. The second questionnaire contains demographic and clinical characteristics of patients (age, gender, place of residence, marital status, education), activity, comorbid diseases and BMI, age at onset, site of onset of lesions, duration of disease, family history, type, activity, natural course, body mass index (BMI) and therapy. Results: Among 71 subjects included in the study, the total score of the DLQI ranged from 0 to 28 (from a maximum of 30 points), and the average was 11.70 ± 5.7. Female patients had greater QL impairment (total mean value of 8.03) than men (5.99); there was a statistically significant difference between both sexes (P = 0.019). The total score of QL in terms of symptoms related to the condition in the six domains strongly affected QL of 45.1% of patients. The QL was significantly worse in the studied group of 16-30 years (13.85 ± 5.3) compared to the population of 51-60 and over 60 years (6.75 ± 5.7, and 7.0 ± 2.3). As the age of patients advanced, the QL improved. Subjects with higher education had a higher score (14.41 ± 6.6; p=0.001). Conclusion: Female patients with vitiligo have impaired QL in comparison to male. With age, the QL in patients with vitiligo improves. Patients with a lower degree of education have a better QL

Sex Differences in the Combined Ablation and Left Atrial AppendageClosure: Results From LAACablation Registry.

More than 40% of left atrial appendage closure (LAAC) procedures were combined with atrial fibrillation (AF) ablation in China. This study aimed to assess the sex differences in the combined radiofrequency catheter ablation and LAAC procedures. Data from the LAACablation (Left Atrial Appendage Closure in Combination With Catheter Ablation) registry, which enrolled AF patients who underwent the combined procedure between 2018 and 2021, were analyzed. Procedural complications, long-term outcomes, and quality of life (QoL) were compared between sexes. Of 931 patients, 402 (43.2%) were women. Compared with men, women were older (age 71.3 ± 7.4 years vs 68.7 ± 8.1 years; P< 0.001), presented more often with paroxysmal AF (52.5% vs 42.7%; P< 0.003), and had higher CHA2DS2-VASc scores (4.1 ± 1.5 vs 3.1 ± 1.5; P< 0.001), but received less often linear ablation and had shorter total procedural times and radiofrequency catheter ablation times. Women had similar rates of total and major procedural complications but presented with a higher incidence of minor complications than men (3.7% vs 1.3%; P=0.027). Follow-up over 1,812 patient-years revealed similar adverse events between women and men, including all-cause death (HR: 0.89; 95%CI: 0.43-1.85; P=0.754), thromboembolic events (HR: 1.17; 95%CI: 0.54-2.52; P=0.697), major bleeding (HR: 0.96; 95%CI: 0.38-2.44; P=0.935), and their composite (HR: 0.85; 95%CI: 0.56-1.28; P=0.434). The recurrence rates of atrial tachyarrhythmia were also comparable between sexes presenting either paroxysmal or persistent AF. Women were seen with greater QoL impairment at baseline, but the sex gap narrowed at 1-year follow-up. In AF patients who underwent the combined procedure, women had similar procedural safety and long-term efficacy to men and presented greater QoL improvement. (Left Atrial Appendage Closure in Combination With Catheter Ablation [LAACablation]; NCT03788941).

Frontal Fibrosing Alopecia Quality of Life Index: A Validated Disease-Specific Questionnaire Involving Women.

Quality of life (QoL) can be affected in patients with alopecia. The few studies that evaluate QoL in FFA use unspecific questionnaires. The aim of this report was to design and validate a specific questionnaire to assess the impairment of QoL in FFA patients. A specific questionnaire, called the Frontal Fibrosing Alopecia Quality of Life Index (FFA-QLI), was designed and validated using the Dermatology Life Quality Index (DLQI). One-hundred and one women with FFA were included. Cronbach's alpha value was 0.865, and the intraclass correlation coefficient between all the items in the questionnaire was 0.870. The FFA-QLI correlated positively with the DLQI (r = 0.729, p < 0.001). Patients with severe FFA showed a higher FFA-QLI (19.72) score compared to those with a mild disease (14.11) (p = 0.002), and the area under the curve for identifying severe disease was greater in the FFA-QLI than in the DLQI. The cut-off points were used to select patients with mild, moderate, and severe impairment in QoL. A score < 21 in the FFA-QLI corresponded to a low impact on QoL; values > 35 matched with greater QoL impairment; and values ranging from 21 to 35 corresponded to moderate QoL alteration. To conclude, a validated disease-specific questionnaire to assess QoL in FFA patients is here presented, with a greater power to discriminate severe cases of FFA than the DLQI.

Clinical characteristics, management, and quality of life of psoriasis patients with coexistent lupus erythematosus: Data from the Malaysian Psoriasis Registry.

To describe the clinical characteristics, management and quality of life of psoriasis patients with and without coexistent lupus erythematosus (LE). This retrospective cross-sectional study uses data from the Malaysian Psoriasis Registry (MPR) from January 2007 to December 2018. Of 21 735 psoriasis patients, 34 (0.16%) had coexistent LE. The male to female ratio among psoriasis patients with coexistent LE was 1:5.8 versus 1.3:1 in patients with psoriasis but without LE. Nearly 70% presented with LE preceding psoriasis. Psoriasis patients with LE had an earlier age of psoriasis onset (27.56 ± 11.51 versus 33.31 ± 16.94 years, P=0.006), a higher rate of psoriatic arthropathy (26.5% versus 13.0%, P=0.02), and a significantly greater impairment of quality of life (Dermatology Quality of Life Index >10; 57.6% versus 40.3%, P=0.04) compared with psoriasis patients without LE. The majority (87.5%) had systemic LE. The incidences of lupus nephritis (72.7% versus 40%) and hematological abnormalities (50% versus 20%) were higher among patients with LE preceding psoriasis compared with those with psoriasis preceding LE. Antinuclear antibody and double-stranded DNA were positive in 59.4% and 28.1% of psoriasis patients with LE, respectively. Hydroxychloroquine triggered the onset of psoriasis in 7 (24.1%) patients. Patients with LE were more likely to receive systemic treatment for psoriasis compared with those without LE (30.3% versus 14.2%, P=0.008). Psoriasis patients with coexistent LE were uncommon, displayed a female preponderance, were more likely to have joint involvement, and had greater quality of life impairment than those without LE. LE preceded psoriasis in most of these patients, and systemic LE was the most common subtype.

Otoneurological assessment and quality of life of individuals with complaints of dizziness and temporomandibular disorders: a case-control study

ObjectivesTo evaluate the impact of temporomandibular disorders on the quality of life of patients with dizziness. MethodsAn observational, case-control study evaluated 60 individuals with dizziness (20 cases and 40 controls), who were matched for gender and age. The individuals underwent to anamnesis, overall physical and otoneurological examination, tonal and vocal audiometry and impedanciometry, video head impulse test and the dizziness handicap inventory questionnaire. ResultsThe otoscopy was normal for all patients. There was an association between the presence of temporomandibular disorders and aural fullness (p < 0.01) and otalgia (p < 0.01). Audiometry was normal in 90% of the patients in the case group, with a significant association between temporomandibular disorders and normal audiometry (p < 0.01). The video head impulse test findings were normal in 66% of the patients in the case group and 45% of the control group, and there was no association between having temporomandibular disorders and vestibular alterations at the video head impulse test (p = 0.12). There were significant differences in total dizziness handicap inventory and in the functional and emotional domains (p < 0.01), with higher scores in the control group. ConclusionAural fullness and otalgia symptoms are associated with temporomandibular disorders in patients with dizziness, and there is an association between normal complementary audiological tests and temporomandibular disorders. Vestibular alterations are not associated with temporomandibular disorders. However, patients with dizziness and without temporomandibular disorders showed greater quality of life impairment. Level of evidence3. Original case-control study.

Abstract 15773: Differences in Atrial Fibrillation Symptoms, Quality of Life, and Response to Therapy Across Race-ethnicity

Introduction: Atrial fibrillation (AF) guidelines are heavily predicated on assessing the severity of symptoms experienced by individual patients when selecting either rate or rhythm control strategy. While the severity of symptoms can be highly variable, it remains unclear if race-ethnicity influences AF symptoms and quality-of-life (QoL). We sought to determine whether race-ethnicity modulates severity of AF symptoms, QoL and response to therapy. Methods: A prospective cohort study of 415 patients diagnosed with new-onset AF enrolled over a 30-month period in a clinical-genetic registry. Baseline assessment of patients prior to treatment initiation included a detailed patient history and the validated 20-item Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) questionnaire. We divided the cohort into groups based on race-ethnicity (African American[AA], European American[EA], Hispanic/Latino[H/L]) and treatment strategy (rate or rhythm control). Results: Of 306 consecutive patients with AF, 113 (36.9%) were AA, 108 (35.3%) EA and 85 (27.8%) H/L. The mean age was 61.9±13.0 years, and 105 (34.3%) were female with 154 (50.3%) patients treated with rate control versus 152 (49.7%) with rhythm control therapy. Both AA (52.1%) and H/L (65.9%) patients were more likely to be initiated on rate control therapy as compared with EAs (36.1%; P=0.0002) despite lower baseline AFEQT scores (AA: 72.9.9±23.2; H/L: 75.1±20.7; and EA: 80.2±17.9; P=0.24) and greater impairment of QoL. The overall AFEQT scores and QoL improved significantly in AAs (Δscore: 10.4±28.2; P&lt;0.0001) and EAs (Δscore: 11.9±20.1; P&lt;0.0001) and was mostly associated with improvement in activities of daily living. Multivariate predictors of improvement in QoL in patients with AF included not only rhythm control therapy but also a history of both coronary artery disease and obesity. Conclusion: The severity and perception of AF symptoms is highly variable in individual patients. Our study showed that ethnic minorities with AF are more likely to receive rate control therapy when compared to patients of European descent despite poorer QoL. Our findings may have important clinical implications for the assessment of symptoms and management of AF in AAs and H/Ls.

Does gender matter: sex-specific aspects of symptoms, outcome, and therapy of obstructive sleep apnea.

Obstructive sleep apnea (OSA) has historically been considered as a male disease. As a result, female individuals with OSA were often under-diagnosed and under-treated compared with male individuals. However, recent data suggest that several OSA-associated adverse cardiovascular outcomes are more pronounced in women. This review provides a summary of the most relevant recent evidence with regard to sex-specific OSA characteristics, including atypical symptoms, greater quality of life impairment and several more pronounced adverse outcomes in female individuals compared with male individuals. It also provides updated evidence on the influence of female gender on under-treatment of OSA with limited evidence supporting gender differences in the effects of OSA treatment. There is evidence suggesting gender-based differences in the frequency, severity, clinical presentation, and outcomes of OSA. The recognition of these gender differences could improve screening with development of female-specific screening instruments, early diagnosis, and individualized therapeutic plans towards better disease management and its outcomes.

Anxiety and depression in a sample of UK college students: a study of prevalence, comorbidity, and quality of life

Objective This study sought to estimate the prevalence of depression and anxiety in UK college students and examine associations between mental health symptoms and quality of life (QoL). Associations between psychiatric comorbidity and degree of QoL impairment were also investigated. Participants: Participants (N = 286) were recruited from a UK university (76.1% ≤20 years-old; 86.8% female; 71.1% White). Methods: Self-report measures of depression, anxiety, and QoL were completed online. Group differences and within-group associations were examined with Chi-square analyses, linear regressions, and ANOVAs. Results: Prevalence rates were in line with global estimates and suggest female students are at elevated risk of mental health problems. Symptom severity and comorbidity were associated with greater QoL impairment. Conclusions: Presence of depression, anxiety, or both was associated with QoL impairment. Findings develop understanding of the impact of mental health problems on QoL and could inform appropriate screening and effective interventions for student mental health.

Quality of life associated with maternal anxiety disorder in Russian children and adolescents with food allergy.

Food allergy negatively impacts the quality of life (QoL) and has been associated with increased maternal anxiety. There is currently a lack of data assessing QoL of food-allergic children and adolescents in Russia. We aimed to evaluate the performance of the Food Allergy Quality of Life Questionnaire (FAQLQ) measures in a Russian sample of children, adolescents, and mothers and to investigate association between child QoL and maternal general anxiety. FAQLQ and Food Allergy Independent Measures (FAIM) were translated to Russian to be completed by participants. Mothers also filled the General Anxiety Disorder (GAD-7) questionnaire. Reliability, construct, and discriminant validity of the FAQLQs and association between FAQLQ scores and general anxiety were assessed. A total of 142 participants completed FAQLQ and FAIM. In total, 126 mothers completed GAD-7 questionnaire. All FAQLQs showed excellent internal consistency (α>0.94). The means for the FAQLQ-PF, FAQLQ-CF, and FAQLQ-TF varied according to the number of foods avoided, severity of symptoms, and FAIM and GAD scores (ηp2 0.40 P<.001). One in 5 mothers had GAD-7 score indicative of moderate-to-severe anxiety. Association strength between GAD and FAQLQ increased with age. GAD score was associated with FAQLQ-PF score, controlling for multiple confounders. The FAQLQ showed good reliability and validity in Russian. This study identified number of foods avoided and reported reaction severity being associated with greater QoL impairment in Russian children and adolescents affected by food allergy. The significant association found between general anxiety in parents and QoL in children and adolescents has practice, screening, and resource implications.

Assessment of Sex Differences in the Initial Symptom Burden, Applied Treatment Strategy, and Quality of Life in Japanese Patients With Atrial Fibrillation

The clinical characteristics and outcomes of women and men with atrial fibrillation (AF) are reported to be different. However, whether sex-related differences extend to patients' symptom burden and perceived quality of life (QOL) or the management pattern of AF has been rarely studied, particularly in Asian countries. To assess the differences in symptoms, treatment, and QOL between Japanese female and male patients with AF. Retrospective cohort study using data from the multicenter outpatient registry Keio Interhospital Cardiovascular Studies-Atrial Fibrillation (KiCS-AF), which collects information regarding health status and the treatment of patients with newly diagnosed or referred AF. One-year follow-up data were available for 1534 patients at 11 referral centers in the Tokyo, Japan, area who were enrolled between September 2012 and December 2015. All data available up to the 1-year follow-up examination through July 31, 2017, were included. Sex, symptoms, AF treatment, and QOL as determined by Atrial Fibrillation Effect on Quality of Life (AFEQT) questionnaires at their initial visit and 1 year later. Of 1534 patients, 1076 (70.1%) were men. Compared with men, women were more likely to be older (median age, 73 years [interquartile range {IQR}, 65-78 years] vs 65 years [IQR, 57-73 years], P < .001) and have higher median brain-type natriuretic peptide levels (102.8 pg/mL [IQR, 47.3-235.5 pg/mL] vs 74.1 pg/mL [IQR, 28.5-150.5 pg/mL], P < .001). Women also had lower median AFEQT overall summary scores than men (75 [IQR, 61-85] vs 80 [IQR, 69-90]; P < .001) but similar treatment satisfaction at baseline. During follow-up, women were less likely to be treated with a rhythm control strategy (48.1% [n = 214] vs 58.0% [n = 621], P < .001), including catheter ablation of AF (adjusted hazard ratio, 0.77 [95% CI, 0.62-0.95]; P = .02). At 1-year follow-up, women and men had improved QOL scores, regardless of their baseline characteristics (eg, age or brain-type natriuretic peptide levels) or treatment strategies, yet the sex gap persisted and grew (adjusted change in AFEQT overall summary score during 12 months, 5.89 [95% CI, 2.24-9.54] in women vs 8.94 [95% CI, 5.59-12.30] in men; P = .02). In contemporary Japanese clinical practice among unselected patients with AF, women were initially seen with greater QOL impairment, and the sex gap grew 1 year after presentation. The present study underscores the need for focused efforts to better understand and close this observed sex gap over the initial year of treatment for patients with AF.

A Qualitative Study of Chronic Pain and Self-Management in Adults with Sickle Cell Disease

Acute, intermittent vaso-occlusive pain is the hallmark of sickle cell disease (SCD) and is associated with substantial morbidity and impaired quality of life (QOL). The subgroup of adults with SCD who transition from recurrent, acute pain to chronic, persistent pain have even greater QOL impairment and higher rates of healthcare utilization. Self-management is central to SCD management; however, its role in chronic pain management is not established. This qualitative study was conducted to answer the following research questions: (1) What is the chronic pain experience of adults with SCD? (2) What self-management strategies do adults with SCD use for chronic pain? and (3) Do adults with SCD have any needs in the self-management of chronic pain? Eighteen Black adults with SCD completed a demographics questionnaire and an interview. The majority of the participants were 21–30 years of age (mean 33.5, SD 7.6), female (61.1%), employed at least part-time (61.1%), single/never married (72.2%), and had a SCD type of sickle cell anemia (55.5%). Interview analysis revealed three major themes: (1) the chronic pain experience; (2) strategies for managing chronic pain; and (3) challenges and needs in managing chronic pain. Study findings can be used to support chronic pain management among adults with SCD. Further research is needed to devise and implement effective strategies for the prevention and management of chronic SCD pain.

The relationship between quality of life, cognition, and thyroid status in Graves' disease.

To assess quality of life (QoL) and cognitive function among Graves' disease (GD) patients with different thyroid status, with and without ophthalmopathy. This is a cross-sectional clinic-based study involving 154 patients with GD (81.27% were female, mean age 45.6 ± SD 11.2 years) and 54 (35.06%) had ophthalmopathy. Data were collected after an informed consent from all patients was obtained. All patients completed the 36-Item Short Form Health Survey and Mini-Mental State Examination. Patients with ophthalmopathy also completed the Graves' Orbitopathy Quality of Life Questionnaire. Patients with hyperthyroidism presented a greater impairment in QoL when compared to euthyroidism group. A lower score in physical role functioning was found in both subgroups with active disease (hyperthyroidism and euthyroidism using thionamides). A lower score was also seen in visual function, only in patients with hyperthyroidism, without difference in appearance. No difference was found in cognition between patients. Younger ages at diagnosis, male sex, euthyroidism and absence of ophthalmopathy were factors associated with better QoL, as well as a shorter disease duration was associated with better recall, attention and calculation. An impairment in QoL among patients with active GD was evidenced, even in those receiving thionamides and in euthyroidism. Ophthalmopathy was a factor associated with a poor QoL and no clear evidence of cognitive impairment was demonstrated.

Quality of life in individuals with spinocerebellar ataxia type 10: a preliminary study.

Spinocerebellar ataxia type 10 (SCA10) is characterized by gait ataxia, dysarthria, nystagmus, epilepsy, reduced cognitive ability and depression, which lead to functional loss and behavioral changes. These signs gradually evolve and may interfere with the physical, emotional, and social aspects of quality of life (QoL). To assess the self-perception of quality of life and its association with disease duration, severity of ataxia, balance and functional independence. This study focused on the disease duration, ataxia severity (SARA), balance (Berg Balance Scale), functionality (FIM, Lawton IADL) and QoL (SF-36 v.2) of 15 individuals with SCA10. The population sample consisted of eight females and seven males, with a mean age of 43.8 (± 8.2) years, mean age of symptom onset of 33.1 (± 8.9) years and mean disease duration of 9.8 (± 11.2) years. The mean Berg Balance Scale score was 47.2 (± 12), mean SARA score (n = 14) 11.5 (± 7.3), mean Lawton IADL score 20.4 (± 1.8) and mean FIM score 120.3 (± 5.4). Individuals with SCA10 had a greater impairment of QoL in the "role-physical" domain (p = 0.04). The longer the disease duration (p = 0.02), risk of falling (p = 0.04), severity of ataxia (p = 0.00) and functional dependence in activities of daily living (p = 0.03) and instrumental activities of daily living (p = 0.00), the worse the QoL was in the "physical functioning" domain, with a decrease of 1.62 points for each year of disease duration. In this sample, the greatest impairment of QoL in individuals with SCA10 was observed in "physical functioning" and "physical role".

Hand eczema in nurses, nursing auxiliaries and cleaners-A cross-sectional study from a tertiary hospital in western India.

Healthcare workers have a high risk of developing hand eczema. To determine the prevalence and severity of dermatologist-determined hand eczema among healthcare workers, carry out patch testing, and correlate the findings with impairment in quality of life (QoL) and demographic and vocational factors. Seven hundred and ten healthcare workers (279 nurses, 246 cleaners, and 185 nursing auxiliaries) were screened for the presence of hand eczema. Severity of eczema was calculated with the Hand Eczema Severity Index (HECSI), and QoL was measured with the Dermatology Life Quality Index (DLQI). Individuals with hand eczema were also patch tested. The point and 1-year prevalences of hand eczema were 7.2% and 18.9%, respectively. Hand eczema was significantly associated with atopic dermatitis. The mean HECSI score was 9.39; it was significantly higher in patients with atopic dermatitis and those with recurrent hand eczema. The mean DLQI score was 5.37. Cleaning staff had significantly greater impairment in QoL. HECSI and DLQI scores were positively correlated. Patch testing showed that thiuram mix, antibiotics and cleansers as sensitizers were over-represented in healthcare workers as compared with controls. Hand eczema was particularly common in hospital cleaners and staff with atopic dermatitis. Further studies are needed to address the burden of occupational hand eczema and develop guidelines for its management at a national level.

Assessment of quality of life in patients of urethral stricture on clean intermittent catheterization following direct vision internal urethrotomy.

Context:Clean intermittent catheterization (CIC) after direct vision internal urethrotomy (DVIU)Aims:The aim is to assess the quality of life (QOL) in patients with urethral strictures on CIC following DVIU.Settings and Design:Prospective study.Materials and Methods:This prospective study was conducted between August 2013 and July 2015 in the Department of Urology at KGMU, Lucknow. We included patients above the age of 18 years with stricture urethra, who were on CIC following direct visual internal urethrotomy. Patients below the age of 18 years, noncompliance, concomitant neurogenic voiding dysfunction, multiple strictures, pan anterior strictures, and posterior stenosis were excluded from the study. A 16 French Foley catheter was used for CIC following DVIU. Patients were evaluated at follow-up visit at 3, 6, and 12 months. At each follow-up visits, patients were assessed using CIC-QOL questionnaire, maximum urine flow rate and complications related to CIC if any.Statistical Analysis Used:Unpaired t-test was used to compare continuous data, and Fisher's exact test was used to analyze categorical data.Results:Among total 144 male patients evaluated, we included 97 patients, who underwent DVIU. Mean age of the study population was 37.7 ± 14.03 years. Most urethral strictures were idiopathic (64.02%) followed by postinflammatory (24.25%). A significant number of patients reported difficulty in performing CIC, which hampered daily activities. No major procedure related complications were reported. Patients who were compliant to CIC reported no stricture recurrence till 6 months follow-up.Conclusions:CIC following DVIU remains a reasonable adjunctive option. All the parameters of CIC-QOL questionnaire had improved on continuing CIC. Young men on CIC had greater impairment of QOL when compared to aged patients.

Correlating Impairment of Quality of Life and Severity of Melasma: A Cross-sectional Study of 141 Patients.

Background:The relationship between impaired quality of life (QoL) due to melasma and its clinical severity remains equivocal despite several studies.Aim:The aim was to study the correlation, if any, between the clinical severity and the impairment in QOL due to melasma.Methods:This cross-sectional, questionnaire-based study was conducted on a cohort of 141 patients of melasma attending the outpatient department of our referral hospital. A physician measured the severity of melasma using the melasma area and severity index (MASI), while melasma-related QoL (MELASQOL) score was calculated utilizing the validated Hindi version of the MELASQOL questionnaire filled by the patients. Correlations of these two scores with each other and with components of the demographic data were attempted using the Statistical Package for the Social Sciences, version 20.Results:Significantly greater impairment in QoL was found in patients with a history of prior use of triple combination therapy and in patients with hirsutism and/or polycystic ovarian disease. The severity of melasma was found to be significantly higher in patients with a history of recurrence and tobacco chewing.Limitations:The sample size could have been larger. Ultrasonography could have been carried out in all cases of hirsutism.Conclusion:The severity of melasma does not correlate with the impairment in QoL.

The Contribution of Malodour in Quality of Life of Patients With Hidradenitis Suppurativa.

Malodourous discharge in patients with hidradenitis suppurativa (HS) has a strong psychosocial impact and is often reported as a source of embarrassment, low self-esteem, social stigma, and barriers to interpersonal relationships. Malodour is a maker of bacterial colonization, and its role in HS is understudied. The aim of this study is to assess the relationship between severity of malodourous discharge and quality-of-life impairment in patients with HS. This is a cross-sectional study of 51 patients recruited from the Women's College Hospital and the York Dermatology Centre. Quality of life was assessed using both the Dermatology Life Quality Index (DLQI) and the Skindex-29 instruments. Severity of odour significantly predicts the total Skindex score after controlling for disease severity as measured by the Hurley stage and Sartorius score ( R2 = 0.39, F = 8.11, P < .0001). However, odour severity is not a predictor of DLQI ( R2 = 0.17, F = 2.63, P = .064). There was no difference in mean DLQI scores for the low- vs high-odour groups, but patients with high odour had a greater quality of life impairment as measured by the Skindex tool ( t = -4.19, df = 43, P < .0001, mean difference = -18.87). Malodour is a common symptom that significantly impairs quality of life in patients with HS. The fact that this effect is captured in Skindex and not the DLQI may be attributed to the nonspecificity of the DLQI in terms of unique disease characteristics. It is important to address odour in the management of patients with HS.

Occurrence and impact of sinusitis in patients with asthma and/or allergic rhinitis

Objective: The occurrence of radiological sinusitis in patients with asthma without any obvious nasal symptoms could possibly increase the severity of asthma. We investigated the occurrence and impact of sinusitis on computed tomography of the paranasal sinuses (CT-PNS) in patients with asthma and/or allergic rhinitis. Effect of sinusitis on the quality of life (QoL) was also assessed. Methods: All subjects underwent spirometry with reversibility, CT-PNS, intradermal test against common aeroallergens and responded to Symptom Severity Score and Rhinosinusitis Disability Index (RSDI). Of the 216 consecutive patients, 27 had asthma without nasal symptoms (Group 1), 58 had asthma with allergic rhinitis (Group 2) and 131 had allergic rhinitis (Group 3). Thirty normal healthy controls without atopy were also included (Group 4). Results: 20/27 (74%) patients in Group 1 had sinusitis on CT-PNS. 48/58 (82%) patients in Group 2 and 88/131 (67%) patients in Group 3 had chronic rhinosinusitis (CRS) as confirmed on CT-PNS. 6/30 (20%) healthy controls in Group 4 had mucosal thickening. Asthmatics with radiological sinusitis in Group 1 and with CRS in Group 2 had significantly lower FEV1, FEV1/FVC ratio, were more symptomatic and had a greater impairment of QoL. The mean sinus severity score was significantly higher in Group 2. In Group 3, sinusitis occurred significantly higher in “blockers” than “sneezers-runners” (41/79 versus 47/52, p = 0.045). Conclusions: Occurrence of radiological sinusitis on CT-PNS in asthmatics without nasal symptoms and CRS in allergic rhinitis with or without asthma increases the severity of the disease and affects the QoL.