Hospital Anxiety Depression Score Research Articles

Comparison of dolutegravir and efavirenz on depression, anxiety and sleep disorders in pregnant and postpartum women living with HIV.

Both dolutegravir and efavirenz are known to be effective in pregnancy and postpartum to prevent vertical transmission of HIV and to maintain maternal health. Both drugs have also been associated with neuropsychiatric symptoms. To what extent, these symptoms occur in pregnant and postpartum women, however, is not yet known. This was a secondary analysis of the DolPHIN2 study, a multicentre randomized trial among women presenting late in pregnancy with untreated HIV - who received either a dolutegravir-containing or efavirenz-containing regimen. Longitudinal measures of depression, anxiety and sleep quality were analysed during pregnancy and up to 48 weeks postpartum. Among 268 women, median (IQR) Edinburgh Post Natal Depression Score (EPDS) scores were 8 (3-11) and highest at enrolment. In the dolutegravir and efavirenz arm, respectively, 23.7 and 25.6% had an EPDS score above 9, indicating possible or probable depression. Abnormal Hospital Anxiety Depression scores (HADS) (above 11) were seen at least once during follow-up in 42 of patients (15.7%), although no differences were seen between treatment arms. No association was found between EPDS, suicidality and HADS scores and the assigned regimen ( P = 0.93, 0.97 and 0.18 respectively). Median (IQR) Pittsburgh Sleep Quality index (PSQI) scores for dolutegravir and efavirenz were 6 (5-7) and 5 (5-6.5), respectively, P = 0.70. No statistically significant differences were observed between efavirenz-containing or dolutegravir-containing regimens. Rates of depression were high, but decreased over the course of time and confirm the need for psychological support after initial HIV diagnosis in pregnancy.

Preoperative pain sensitivity predicts postoperative pain severity and analgesics requirement in lumbar fusion surgery – a prospective observational study

BACKGROUND CONTENTThe goal of postoperative pain management is to facilitate the patient's return to normal activity and decrease the detrimental effects of acute postsurgical pain. In order to provide more tailored and successful pain treatment, it is necessary to identify individuals who are at a high risk of experiencing severe postoperative pain. The most precise way to assess pain sensitivity is by determining the pressure pain threshold and heat pain threshold by objective methods using a digital algometer and neurotouch respectively. PURPOSEThe primary aim of the study is to assess the preoperative pain threshold and its influence on postoperative pain severity and analgesics requirements in patients undergoing lumbar fusion surgeries. STUDY DESIGNProspective, observational study. PATIENT SAMPLESixty patients requiring a single-level lumbar fusion surgery. OUTCOME MEASURESPostoperative pain intensity and the amount of postoperative analgesics consumption. METHODSIn our patients, preoperative pain sensitivity was assessed by pressure pain threshold measurements with the help of a digital algometer, and heat pain threshold using a neurotouch instrument. In addition, pain sensitivity questionnaires (PSQ) were used in all our patients to determine pain sensitivity. Preoperative psychosocial and functional assessments were performed by Hospital anxiety-depression scores (HADS), and Oswestry disability index (ODI) respectively. Preoperative visual analog scale (VAS) score was determined at three instances of needle prick (phlebotomy, glucometer blood sugar, and intradermal antibiotic test dose) and during the range of movements of the lumbar spine region. Postoperative VAS score and postoperative breakthrough analgesic requirements were recorded in all of these patients from day 0 to day 3. RESULTSThe average age of the patients was 51.11±13.467 years and 70% were females. Females had lower mean algometry values (72.14±7.56) compared to males (77.34±6.33). Patients with higher HADS (p<.0016), higher PSQ (p<.001), higher ODI scores(p<.001), and female gender significantly correlated with a lower algometer average indicating high pain sensitivity. Patients with lower preoperative VAS scores and with higher neurotouch scores showed lower postoperative VAS scores at different time periods. Preoperative VAS scores, algometer average scores, neurotouch scores, and HADS scores were considered as independent variables (predictors) for postoperative VAS at 6 hours period. By the multivariate analysis, factors like preoperative VAS scores, algometer average scores, and HADS scores were statistically significant (p<.05). There was a significant correlation between algometer average scores (p<.001) with the breakthrough analgesics. CONCLUSIONPreoperative assessment of pain sensitivity can predict postoperative analgesic requirements and aid in recovery. Patients with a lower pain threshold should be counseled preoperatively and also receive a better titration of analgesics perioperatively.

EVALUATION OF QUALITY OF LIFE SCALES ACCORDING TO DISEASE ACTIVITY IN RHEUMATOID ARTHRITIS

Objective: In addition to disease activity in rheumatoid arthritis patients; variables such as pain, fatigue, depression, anxiety, and sleep quality are also associated with quality of life. We aimed to evaluate the relationship between disease activity and quality of life scales in rheumatoid arthritis. &#x0D; Methods: In this cross-sectional study, 92 consecutive rheumatoid arthritis patients who applied to Ankara City Hospital Rheumatology outpatient clinic in January-December 2020 were included. Demographic, clinical features and laboratory data were recorded. DAS28 for disease activity and pain-visual analogue score(VAS) and fatigue-VAS, hospital anxiety-depression(HAD), Pittsburgh Sleep Quality Index (PSQI), and Nottingham Health Profile (NHP) forms for quality of life assessment were filled by one-on-one interviews. Patients were grouped according to disease activity such as: “Low-DAS28 group” and “High-DAS28 group”.&#x0D; Results: In comparison with DAS28, pain-VAS, and fatigue-VAS, and some NHP scores (such as the total score and pain, physical activity, and fatigue subgroup scores) were statistically significantly higher in the High-DAS28 group than the Low-DAS28 group. However, no difference was found in HAD scores. Except the sleep disorder subgroup was higher in the High-DAS28 group, total and other subgroups scores of the PSQI were similar.&#x0D; Conclusion: Improving the quality of life in patients with rheumatoid arthritis is one of the main objectives of treatment. A high disease activity seems to be more affecting the patients in terms of pain-VAS, fatigue-VAS, NHP total scores and NHP-pain, NHP physical activity subgroups than other the quality of life scales in patients with rheumatoid arthritis.

Impact of Acute Lumbar Disk Herniation on Sexual Function in Male Patients.

Study DesignProspective observational study.PurposeIn this study, we determined the effects of lumbar disk herniation (LDH) on male sexual activity and whether surgical intervention improved any related sexual dysfunction.Overview of LiteratureThe impact of surgery on sexual activity has been extensively studied in arthroplasty, uro-gynecological surgery, and stroke, but there are relatively few studies on spine surgery, and none involve an Asian population to the best of our knowledge.MethodsWe evaluated sexually active male patients (n=22, 40.8±6.8 years) admitted for microdiscectomy with a questionnaire for assessing sexual function before and 8 weeks after surgery. The questionnaire included the Oswestry Disability Index, Hospital Anxiety Depression Score, and Brief Sexual Function Inventory (BSFI), as well as questions about perceived sexual dysfunction (frequency, performance, satisfaction).ResultsThe average preoperative Visual Analog Scale (VAS) score was 4.36±2.59 (n=18) for low back pain (LBP) and 6.81±2.1 (n=22) for leg pain. The mean preoperative BSFI score was 27.8±11.2. Among the five BSFI components, sexual drive was reduced in 63.0% of patients, while erection and ejaculation were affected in 40.9% and 31.8%, respectively. The VAS score for LBP had a negative correlation with the preoperative BSFI score (p<0.03). After LDH onset, 54.5% of patients noted a decrease in frequency, and 77.2% described a decrease in desire and satisfaction. At 8 weeks after surgery, the mean BSFI score significantly improved to 33.23 (p=0.002). Sexual drive was normal in 77.7% of patients, and erection and ejaculation were normal in 77.7% and 91.0%, respectively. Overall, 59.1% had resumed sexual intercourse within 6 weeks of surgery.ConclusionsLDH resulted in sexual dysfunction in up to 77% of patients, which significantly improved after surgery. By 6 weeks, the majority had resumed sexual activity without undue discomfort. Therefore, this study supports counseling for patients with LDH about sexual function.

Patient reported outcome measures in a cohort of patients at high risk of breast cancer treated by bilateral risk reducing mastectomy and breast reconstruction

<h2>Summary</h2><h3>Background</h3> Many women with increased lifetime risk of developing breast cancer, due to pathogenic gene variants or family history, choose to undergo bilateral risk reducing mastectomies (BRRM). Patient reported outcome measures (PROMS) are an increasingly important part of informed consent but are little studied in women undergoing BRRM. <h3>Methods</h3> We used a validated PROMS tool for breast reconstruction (BREAST-Q) in 297 women who had BRRM and breast reconstruction, 81% of whom had no malignancy (Benign Group, BG) and 19% in whom a perioperative breast cancer was diagnosed (Cancer Group, CG). 128 women also completed a Hospital Anxiety & Depression Score (HADS) questionnaire to test if preoperative HADS score could predict PROMS outcomes. <h3>Results</h3> Women in the CG had lower PROMS scores for satisfaction with their breasts, nipple reconstruction and sexual wellbeing. Both groups reported equal satisfaction with BRRM outcome and psychosocial well-being. Physical well-being PROMS of the abdomen and chest were high in women in both groups as were scores for satisfaction with the care they received. The CG group reported suboptimal quality of patient information. A higher presurgical HADS anxiety score predicted less favourable postoperative psychosocial well-being despite similar levels of satisfaction with aesthetic outcome. <h3>Conclusion</h3> We show a high degree of patient reported satisfaction by woman undergoing BRRM and reconstruction. There was a negative association with a cancer diagnosis on quality of life PROMS and higher preoperative anxiety levels negatively affected postoperative psychosocial well-being. These important findings should be part of the informed consent process during preoperative counselling.

Psychological Assessment of Doctors Working in a Pandemic Condition in Dhaka Medical College Hospital

Introduction: The outbreak of COVID-19 is taking an unprecedented mental toll on health workers worldwide. So it comes as no surprise that the mental well-being of health care workers of Bangladesh too is in serious jeopardy. This survey was aimed to assess the immediate psychological impact on doctors working in largest Covid-19 dedicated facility in Bangladesh, Dhaka Medical College Hospital.&#x0D; Methods: This cross sectional study was conducted in a single-centre with response received from participating doctors between 31st May to 3rd June, 2020. Mental health variables were assessed via the Athens Insomnia Scale (AIS) and Hospital Anxiety Depression Score (HADS).&#x0D; Results: We received 192 completed questionnaires (response rate, 64.43%) among whom around 50% of the participating doctors reportedly have depression and anxiety symptoms respectively. Among them 104 doctors (54.17%) responded to have insomnia. Around 56% of the responding subjects perceived the highly contagious nature of the SARS-CoV-2 as the most striking threat of COVID-19.&#x0D; Conclusion: Agonizing disease process, high death toll, highly contagious nature of the responsible virus is taking a serious mental toll on physicians in the background of their heightened concern about personal health and family health, scarcity in PPE and adequate hospital facility. Psychological protective measures implemented by the hospital could be helpful.&#x0D; J Bangladesh Coll Phys Surg 2020; 38(0): 50-55

Phase II trial of monoamine oxidase inhibitor phenelzine in biochemical recurrent prostate cancer.

94 Background: Monoamine oxidase A (MAOA) influences prostate cancer growth and metastasis in pre-clinical models. We examined effects of phenelzine (a monoamine oxidase inhibitor) in patients with biochemical recurrent castrate-sensitive prostate cancer. Methods: An open-label single arm clinical trial enrolled subjects with biochemical recurrent prostate cancer defined by: PSA ≥ 0.4 ng/ml (post-prostatectomy) or PSA ≥ 2 ng/ml above nadir (post-radiation therapy); no evidence of metastasis on imaging; and normal androgen levels. Subjects received phenelzine 30 mg orally twice daily. Mood symptoms were assessed with the hospital anxiety depression score (HADS) questionnaire. The primary endpoint was the proportion of patients who achieved a PSA decline of ≥50% from baseline. Results: Characteristics of the 20 eligible patients enrolled included: mean ± SD age 66.9 ± 4.8 years and PSA 4.7 ± 5.8 ng/dl. Maximal PSA declines ≥ 30% and ≥ 50% were observed in 25% (n=5/20) and 10% (n=2/20) of subjects, respectively. At 12 weeks, 17 subjects remained on treatment with PSA declines ≥ 30% and ≥ 50% of 24% (n=4/17) and 6% (n=1/17), respectively. Common toxicities observed included dizziness (grade 1 = 45%, grade 2= 35%), hypertension (grade ≥ 2 =30%), and edema (grade 1=25%, grade 2=10%). There was 1 episode of grade 4 hypertension (cycle 4) and 2 episodes of grade 3 syncope (cycle 12 and cycle 14) requiring treatment discontinuation. HADS questionnaires demonstrated a significant decrease in anxiety with no change in depressive symptoms on treatment. Conclusions: Phenelzine demonstrated efficacy in patients with biochemical recurrent castrate sensitive prostate cancer. Most treatment related toxicities were mild, but rare significant and reversible cardiovascular toxicities were observed. Therapies directed at MAOA may represent a new avenue for treatment in patients with recurrent prostate cancer. Clinical trial information: NCT02217709.

Increased Heart Rate Variability following Elective Percutaneous Coronary Intervention in Patients with Stable Coronary Artery Disease and Preprocedural Anxiety.

Background There is a strong association between chronic ischemia and autonomic imbalance. Percutaneous coronary intervention (PCI) may restore autonomic balance in patients with stable coronary artery disease (SCAD), which is characterized by increased heart rate variability (HRV). Anxiety is often found in patients who are going to undergo invasive procedures and has been identified to induce autonomic imbalance. The aim of our study is to identify the impact of preprocedural anxiety on increased HRV following an elective PCI. Methods Our study was a pretest and post-test correlation study involving 44 SCAD patients who underwent elective PCI at Cipto Mangunkusumo National Hospital. The HRV was measured before and after PCI. Anxiety symptoms were evaluated using Hospital Anxiety Depression Score (HADS) questionnaires. Results We found a higher increase on HRV parameter following the PCI of subjects in the nonanxiety group compared with the anxiety group (median = 9.11 vs. 2.83; U = 154.00; p=0.043). Conclusions Preprocedural anxiety may inhibit HRV increase following PCI procedure.

Increased Risk of Abdominal Aortic Aneurysms in Individuals with Depressive Symptoms: A Population-based Prospective Study in Norway: A Hunt Study

Introduction - Depression has been associated with earlier onset of cardiovascular disease and increased cardiovascular morbidity and mortality [1-3]. Individuals with a Hospital Anxiety Depression Score (HADS) ≥ 8 have been found to more often present with depressive symptoms, such as feelings of hopelessness and fatigue [5]. The aim of this study was to investigate if a HADS score ≥8 is associated with development of abdominal aortic aneurysm (AAA), which recently has been stated as a possibility [4]. Methods - The study population comprised 50,930 participants who had complete HADS-data on at least one follow-up. They were part of the prospective, population-based Nord-Trøndelag health study (HUNT) in Norway. The Chi-square test was used for comparing incidence proportions of AAA between individuals with and without depressive symptoms, as measured by a HADS ≥8, and < 8 respectively. The hazard of AAA was assessed in unadjusted and adjusted Cox regression models. Attained age was defined as the time scale (entry at age ≥50), whereas HADS (<8 vs. ≥8), gender, smoking, coronary heart disease, hypertension, body mass index and diabetes were included in the model as categorical risk factors. Results - A total of 6203 individuals (12%) had a HADS ≥8, and 735 individuals (201 women) developed an AAA during a median follow-up of 16.5 years (age 50-100 years). The incidence proportion of AAA was significantly higher in individuals with a HADS ≥8 (18% vs. 12%, p<0.001). In the unadjusted Cox regression model, individuals with a HADS ≥8 had approximately 50% higher risk of AAA than individuals with a HADS <8 (hazard ratio (HR) 1.51; 95% CI 1.24-1.84). The association remained significant in the adjusted analyses (HR 1.36 (1.1-1.7)). Current smoking (HR 8.4 (6.3-11.3)), past smoking (HR 3.6 (2.6-4.8)), male gender (HR 2.2 (1.9-2.7)), coronary heart disease (HR 2.3 (1.9-2.8)) and hypertension (HR 1.45 (1.2-1.8)) were also significantly associated with development of AAA. Conclusion - Individuals with elevated HADS as a sign of depressive symptoms have an increased risk of AAA development.

Long-term health-related quality of life of critically ill patients with haematological malignancies: a prospective observational multicenter study

BackgroundAlthough outcomes of critically ill patients with haematological malignancies (HMs) have been fully investigated in terms of organ failure and mortality, data are scarce on health-related quality of life (HRQOL) in this population. We aim to assess post-intensive care unit (ICU) burden and HRQOL of critically ill patients with HMs and to identify risk factors for quality-of-life (QOL) impairment.ResultsIn total, 1011 patients with HMs who required ICU admission in 17 ICUs in France and Belgium were included in the study; 278 and 117 patients were evaluated for QOL at 3 months and 1 year, respectively, after ICU discharge. HRQOL was determined by applying the interview form of the Short Form 36 (SF-36) questionnaire. Psychological distress symptoms were evaluated using the Hospital Anxiety Depression Score (HADS) and the Impact of Event Scale (IES). In-hospital mortality rates at 3 months and 1 year were, respectively, 39.1, 50.7 and 57.2%, respectively. At 3 months, median [IQR] physical and mental component summary scores (PCS and MCS) (SF-36) were 37 [28–46] and 51 [45–58], respectively. PCS was lower in ICU patients with HMs when compared to general ICU septic patients (52 [5–13], p = 0.00001). The median combined HAD score was 8 [5–13], and the median IES score was 8 [3–16]. However, recovery during the first year after ICU discharge was not consistent in all dimensions of HRQOL. Three months after ICU discharge, the maximum daily Sequential Organ Failure Assessment score and status of the underlying malignancy at ICU admission were significantly associated with MCS impairment (− 0.54 points [95% CI − 0.99; − 0.1], p = 0.018 and − 4.83 points [95% CI − 8.44; − 1.22], p = 0.009, respectively).ConclusionHRQOL is strongly impaired in critically ill patients with HMs at 3 months and 1 year after ICU discharge. Organ failure and disease status are strongly associated with QOL. The kinetic evaluation of QOL at 3 months and 1 year offers the opportunity to focus on QOL aspects that may be improved by therapeutic interventions during the first year after ICU discharge.

Self-reported anxiety and depression unchanged after endoscopic sinus surgery for chronic rhinosinusitis.

Prior research has established that anxiety and depression, as measured by the Hospital Anxiety Depression Score (HADS), are strongly correlated with disease-specific quality of life (Rhinosinusitis Disability Index - RSDI) in chronic rhinosinusitis (CRS). We hypothesized that anxiety and depression would decrease after functional endoscopic sinus surgery (FESS), and furthermore that HADS would predict improvement in RSDI following surgery. The study cohort from 2014 consisted of 99 CRS patients who underwent nasal endoscopy, RSDI, and HADS evaluation. The cohort was segregated by whether or not they underwent FESS and an updated HADS was administered. For 44 surgical patients, pre- and post-operative RSDI (n=38), Lund-Kennedy (LK) (n=34) and HADS (n=18) scores were compared. Delta RSDI was compared between patients with varying levels of anxiety and depression. Lund-Kennedy scores improved from 5.8 ± 4.1 to 3.2 ± 2.6 following surgery, as did total RSDI (39.3 ± 26.8 to 24.6 ± 29.2). Total HADS (9.8 ± 6.4 to 11.3 ± 7.4) and depression and anxiety subscores were unchanged. Linear regression did not reveal a correlation between HADS and change in RSDI following FESS. Delta RSDI was not significantly different between patients with varying levels of anxiety and depression. Despite improvements in objective evidence of sinonasal inflammation (LK) and disease-specific quality of life (RSDI), neither depression nor anxiety improved after FESS, nor did the magnitude of psychological comorbidity predict post-operative improvement in quality of life. Improvement in RSDI was not different among patients with varying levels of anxiety and depression. Levels of depression and anxiety may be hard-wired, and therefore not influenced by changes in objective or perceived sinonasal disease burden.

Evaluation of the effectiveness of home based or hospital based calisthenic exercises in patients with ankylosing spondylitis.

The aim of this study is to evaluate the effects of calisthenic exercises on functionality, mobility, disaese activity, quality of life, and psychological status in patients with Ankylosing spondylitis (AS). Prospective analysis of forty patients diagnosed with AS were randomized into two exercise groups. AS patients having diagnosis based on 1984-modified New York criteria were involved. Patients were given 8 weeks calisthenic exercise program. Outcome measures including the Bath AS Functional Index (BASFI), Bath AS Disease Activity Index (BASDAI), Bath AS Metrology Index (BASMI), AS Quality of Life Questionnaire (ASQoL), Bath AS Patient Global Score (BAS-G) Hospital Anxiety Depression Score (HADS), erythrocyte sedimentation rate (ESR) and the serum C-reactive protein (CRP) levels were assessed at the baseline and at 8 weeks. Thirty-seven participants completed the exercise programme. After the 8-week exercise programme, the home-based exercise group showed significant improvement in ESR levels and hospital-based exercise group showed significant improvements in terms of the BASMI and HADS-A scores. Calisthenic exercises can be easily performed both at home and in hospital setting. In patients with AS, calisthenic exercises performed at the hospital may improve the mobility, and psychological status (anxiety).

Self-Reported Quality of Life and Symptom Burden in Ambulatory Patients With Multiple Myeloma on Disease-Modifying Treatment.

Knowledge of health-related quality of life (QoL) of patients with multiple myeloma on disease-modifying treatments is limited. (1) Determine symptom prevalence in patients with multiple myeloma on disease-modifying treatment. Identify the range and nature of these symptoms within the dimensions of physical, psychological, social, and financial well-being. (2) Measure self-reported QoL. (3) Compare the above-mentioned parameters to the general population and patients with advanced cancer. Adults with multiple myeloma on disease-modifying treatment, attending the hematology day unit in a tertiary referral center from November 2012 to January 2013, were eligible for inclusion in a cross-sectional quantitative survey. Consenting patients completed 2 validated questionnaires, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) supplemented by the myeloma-specific module (EORTC QLQ-MY20) and the Hospital Anxiety Depression Score (HADS). Forty-one patients were included for analysis: 59% were male and 41% were female. Mean age was 63.7 years (range 46-86, standard deviation 11.24). The QoL scores were significantly lower than the general population and comparable to those with advanced cancer. The most commonly reported physical symptoms were pain (66%), fatigue (63%), and dyspnea (51%). About 54% of the patients were burdened by financial worries. Anxiety (30%) and depression (37%) were prevalent. Patients with myeloma on disease-modifying treatment have a lower QoL than the general population and are symptomatic across physical, psychological, financial, and social domains. A holistic approach to patient care is warranted, and patients may benefit from specialist palliative care input.

Can Intraoperative Text Messages Reduce Parental Anxiety of Children Undergoing Posterior Spinal Fusion Surgery for Adolescent Idiopathic Scoliosis?

A prospective, nonrandomized study. To evaluate the effectiveness of periodic intraoperative text messages (SMS) in reducing parental anxiety level during posterior spinal fusion (PSF) surgery for adolescent idiopathic scoliosis (AIS) patients. No studies have reported the use of intraoperative SMS to reduce level of anxiety in parents of patients who are undergoing AIS corrective surgery. Parents of 50 AIS patients were studied at two centers. Group 1 did not receive any SMS whereas those in Group 2 received periodic SMS. Parents' anxiety were assessed using a validated Visual Analog Scale for anxiety (VAS-A) and the anxiety component of the Hospital Anxiety Depression Score (HADS). The assessment was carried out at five different periods: (P1) 6 hours before the surgery; (P2) at separation in the operation theatre; (P3) 1 hour after commencement of surgery; (P4) immediately after completion of surgery; (P5) 1 day postsurgery. A total of 96 parents (47 fathers, 49 mothers) were involved in this study. Both groups were comparable in terms of demographics and education level. The mean VAS for Group 1 peaked at P2 and the HADS scores peaked at P3. The anxiety level of Group 1 remained high at P2, P3, and P4. There was a steady decline in parental anxiety in Group 2 from P1 to P5. There were significantly lower mean VAS score and HADS score for both father and mother in Group 2 during P3 and P4. The mean HADS scores for parents in Group 1 at P2 and P3 were higher than 8, which indicate abnormal anxiety. The anxiety levels of parents receiving the SMS were significantly lower than parents who did not receive any messages. Thus, intraoperative SMS is an effective intervention to decrease parental anxiety of AIS patients undergoing PSF surgery. 3.

PTU-179 The clinical significance of sensory abnormalities in irritable bowel syndrome

<h3>Introduction</h3> Altered pain appreciation and autonomic function are features of Irritable Bowel Syndrome (IBS); these are controlled by the lateral medulla (LM). Abnormal vasomotor control, sweating, cardiac rhythm, blood pressure and gut motility have all been reported in the LM Syndrome. Our aim was to study LM features and characterise these in IBS patients and healthy controls. <h3>Method</h3> Patients attending a specialist Motility clinic were asked to complete the Rome III and the Hospital anxiety/depression (HAD) questionnaires. Sensory abnormalities were assessed with a temperature appreciation (TA) test; reporting on cold sensation by holding a glass of ice-cold water in each hand consecutively for 5 s. The age, sex, blood pressure, heart rate, Rome III and HAD questionnaires were recorded along with TA. Medical students served as healthy controls. Data was analysed and compared between the patients and students. The chi-square and Mann-Whitney tests were used to assess the association between IBS and sensory abnormalities and IBS and HAD scores respectively. <h3>Results</h3> 133 patients (116 females: 17 males; mean age 51 years: range 19–89) and 35 students (23 females:12 males; mean age 23 years: range 19–27) completed the ROME III questionnaires. IBS-M (mixed type) was the most common with 43 patients (32%), followed by 39 patients (29%) with IBS-C (constipation), 29 patients (21%) with IBS-D (diarrhoea) and 22 patients had other functional disorder (18%). 28 (80%) students had no IBS symptoms, but 3 had IBS-M (8.5%), 3 had IBS-C (8.5%) and 1 had IBS-D (3%). IBS patients had higher anxiety (8 vs 4; p &lt; 0.005) and depression (6 vs 1; p &lt; 0.005) scores as compared to the non-IBS students. 94 IBS patients undertook the TA test: 41 experienced equal (44%) and 53 reported unequal (56%) sensation in their hands, whereas 27 students reported equal (96%) and only 1 unequal (4%) sensation. The null hypothesis that there is no association between IBS and sensory abnormalities was rejected (P &lt; 0.005). <h3>Conclusion</h3> The ROME III Criteria is useful for identifying IBS subtypes. We found a significantly higher degree of both anxiety and depression and altered temperature appreciation in this group of IBS patients. The clinical significance of the latter is unclear. Further studies are warranted to determine whether the findings are organic or functional. <h3>Disclosure of interest</h3> None Declared.

QUALITY OF LIFE AND PSYCHO-COGNITIVE CONDITION IN PATIENTS AFTER CORONARY ARTERY BYPASS GRAFT SURGERY

Aim. To study psychic, cognitive status and life quality of petients underwent coronary bypass grafting (CABG). Material and methods. Totally 81 patient with CHD studied (80% men, 20% women) with the age 56,3±1 y. o., underwent planned CABG. On 7–8th day after CABG the 6-minute walk test (WT) was done and the Hospital anxiety-depression score used, Hamilton anxiety-depression score, Spielberger anxiety score and other methods to assess asthenia and cognitive status (MMSE, MoCA). Life Quality (LQ) assessed with 10-points visual-analogue scale; coping behavioural strategies studied. Results. Values by WT were 415±130 m, LQ — 6±0,3 points. In 35% patients there was lowering of cognitive functioning. In 20% there were affective disorders and the negative correlation of WT with anxiety (r= –0,3; p<0,01), affective disorders with LQ (r= –0,53; p<0,05). Anxiety was comorbid to depression (r=0,91; p<0,05). Moderate and prominent asthenia registered in 36% and 18% of patients, asthenia was linked with affective (r=0,96; р<0,02) and cognitive (r=0,97; р<0,001) disorders. 46% patients used non-constructive and relatively constructive coping strategies. Conclusion. On 7–8th days after CABG in 35% patients there is lowering of cognitive functioning and not less than 20% show signs of affective disorders, that impacts LQ of patients and tolerability of physical exertion. The anxiety and depression revealed were associated not only with each other but with asthenisation of patients to. Cognitive disorders and emotional dyscomfort, experiencing by patients, may affect adaptation leading to non-constructive coping strategies. The found specifics of psychic and cognitive status must be taken into account for elaboration of individualized patient-centered programs of rehabilitation after CABG.

AB0912 The introduction of ankylosing spondylitis annual review clinics at a london teaching hospital

BackgroundNational U.K recommendations1 have led to the introduction of annual review clinics for patients with rheumatoid arthritis. We considered the benefits of ankylosing spondylitis annual review clinics.ObjectivesReview the diagnosis of...

Su2026 PPI Use and Small Intestinal Bacterial Overgrowth Detected on Lactulose Breath Testing: Results of a Prospective Cross Sectional Study Among U.S. Veterans With Irritable Bowel Syndrome

Background/Aims: Proton Pump Inhibitors (PPIs) have been proposed to be the missing link in the controversy surrounding Small Intestinal Bacterial Overgrowth (SIBO) and Irritable Bowel Syndrome (IBS). Recent studies examining the relationship between PPIs and SIBO have been limited by retrospective analysis and failure to control for confounding factors such as somatization which may be common to both PPI use and SIBO. Consequently, the aims of this prospective cross sectional study were: 1) To calculate adjusted Odds Ratios (ORs) for hydrogen (H2) and methane (CH4) SIBO based upon PPI use 2) To determine the impact of PPI use on Lactulose Breath Testing (LBT) parameters. Methods: 149 nondiabetic veterans (67 PPI users, 82 non-users, 82% male, mean age 45) meeting Rome III IBS criteria undergoing LBT were recruited. Data on IBS subtype and severity (IBS Severity Scoring System), bloating, depression/anxiety (Hospital Anxiety Depression Score) and somatization (Psychosomatic Symptom Checklist) were obtained by questionnaire. Use of PPIs, fiber, laxatives, probiotics, H2-Blockers, anti-cholinergics, diagnoses of GERD and BMI were obtained from the medical record. LBT's were defined as positive using different criteria: 1) Two H2 Peaks (Increase .20 ppm over the baseline by 90 min with a single peak occurring at least 15 min prior to the second peak with a trough after the first peak of . 5ppm) 2) Increase in H2 by . 20 ppm by 90 min. 3) Any CH4 . 5 ppm 4) Rise in CH4 by. 20 ppm by 90 min. Adjusting for confounding factors using logistic regression, adjusted ORs for PPI use and SIBO were calculated. LBT parameters including baseline H2 and CH4, amplitude of rise to first H2 peak (P1), and time to P1 were compared between PPI and non-PPI groups using Wilcoxon rank sum and t-tests. Results: The prevalence of H2-SIBO using Two H2 Peak criteria was 36.9% in PPI vs. 17.9% in Non-PPI groups (p=0.01). Adjusted OR for PPI Use and Two Peak H2-SIBO was 4.3 (95% CI 1.4-12.9, p=0.01). PPI use of . 180 days was found to be associated with Two Peak H2-SIBO with OR 3.2 (95% CI 1.2-8.9, p=0.02). ORs for PPI use and SIBO were not statistically significant using the other H2 or CH4 criteria (Table). Among LBT parameters, there was a trend towards a shorter time to P1 in the PPI group (Fig 1). However, a statistically significant difference was found in time to P1 when comparing PPI use of .180 days vs. , 180 days (58.7 vs. 75.7 min, p=0.02) (Fig 1). Comparisons between PPI vs. Non-PPI groups did not find differences in baseline H2 (0 vs. 0 ppm, p=0.45), CH4 (1 vs.1.2 ppm, p=0.70) or amplitude to P1 (50 vs. 45 ppm, p=0.55). Conclusions: PPI use is associated with an increased prevalence of H2-SIBO on LBT but only when using the Two H2 Peak criteria. This may be caused by an earlier rise in H2 in the proximal small bowel seen with prolonged PPI use. (Table) Adjusted Odds Ratios for PPI Use and SIBO Using Different H2 and CH4 Criteria

Does spinal anesthesia increase the pain and anxiety after total knee arthroplasty? a randomized prospective study

In this study, postoperative pain and anxiety level of the patients who were scheduled for spinal anesthesia (SA) and remained awake during the operation and patients who were scheduled for general anesthesia (GA) and were asleep during the operation were assessed. Thirty-six patients who underwent total knee arthroplasty in our clinic were randomly divided into two groups. The first group (SA group) was given spinal anesthesia during operation (heavy marcaine), while the second group (GA group) underwent general anesthesia (propofol + nitric oxide). Hospital anxiety-depression (HAD) scores and visual analog scale (VAS) scores of the patients were calculated postoperatively. The patients were asked to score anxiety by the physicians. The mean postoperative HAD score was 24.68 in GA group, and 29.62 in SA group (p>0.05). The physicians score for patients' anxiety after surgery was 1.05 in GA group, and 1.69 in SA group (p<0.05). The mean postoperative VAS of the patients was 8.42 in GA group, and 8.87 in SA group (p>0.05). No statistically significant differences were found between the SA group and GA group in terms of HAD scores. No significant differences were found between the mean postoperative VAS scores of the groups. A statistically significant difference was found between the two groups for the physician's score for patients' postoperative anxiety. Our study results showed that total knee arthroplasty under spinal anesthesia was not associated with mood changes in patients and no increase in postoperative pain was seen.

Anxiety and depression in primary and secondary dystonia: A burden on health related quality of life

Dystonia is a reason of visible chronic motor and/or psychological disability that may influence the quality of life. Our aim was to investigate depression and anxiety in patients with primary and secondary dystonia, and to evaluate their effects on the quality of life. Patients with primary and secondary dystonia, and age-matched healthy volunteers were enrolled in the study. Anxiety and depression was evaluated with Hospital Anxiety Depression (HAD) scale. Short Form-36 was used to assess the quality of life in both study groups. Both mean anxiety and depression subscales scores were found to be increased in the patients with dystonia, when compared with the control group (p<0.05). There were no statistically significant differences in the HAD scores patients with primary and secondary dystonia (p>0.05). When compared with controls, all domains of SF-36 were found to be decreased in patients with dystonia contributing to a deterioration in the HR-QoL (p<0.05). Among dystonia patients, a statistically significant decrease was found in all domains of SF-36, except vitality and mental health in secondary dystonia (p<0.05). Multiple regression analysis revealed that secondary dystonia, long term disease, depression and anxiety have a great impact on quality of life of patients with dystonia. Dystonia can be considered as an important risk factor for anxiety and depression which leads to a deterioration in the quality of life of patients.