Quality Of Life Impairment In Patients Research Articles

Reliability and responsiveness of the D12 and validity of its scores as a measure of dyspnoea severity in patients with rheumatoid arthritis-related interstitial lung disease

BackgroundInterstitial lung disease due to rheumatoid arthritis (RA-ILD) affects a substantial minority of patients with RA, inducing life-altering symptoms, impairing quality of life (QOL) and forcing patients to confront the...

Influencing Factors in Tunisian Rheumatoid Arthritis Patients' Quality of Life: Burden and Solutions.

Rheumatoid Arthritis (RA) is a disease with a heavy functional, psychological, and socioeconomic impact. The management of Quality of Life (QoL) as a therapeutic objective is a fairly recent notion, especially in Tunisia. We aimed to evaluate QoL in RA patients and to identify its affecting factors. This was a cross-sectional study in a Tunisian rheumatology center. To assess QoL, we used the Short Form Health Survey (SF-36) and the Arthritis Impact Measurement Scales Short Form (AIMS2-SF). Health Assessment Questionnaire Disability Index (HAQ), the Hospital Anxiety and Depression Scale (HAD) for psychological disorders, Visual Analog Scale for Pain (VAS Pain), and for fatigue (VAS Fatigue) were also used. Disease activity was assessed by the Disease Activity Score (DAS28 CRP). We enrolled 120 established RA, the mean age of our patients was 56.9 ± 11.4 years, with a predominance of women (83.3%). The mean disease duration was 10.97 ± 7.7 years. According to the HAD scale, 27% of our patients presented anxiety, and 26.7% had depressive disorders. There was significantly impaired QoL in patients with low educational level, dependent financial situation, long disease duration, high disease activity, high pain and fatigue levels, poor therapeutic education, functional disability, and psychological disorders (p < 0.001). A strong negative correlation was detected between inflammatory markers, structural damage, and the scores of QoL. Patients under biologics scored significantly higher in the SF36 mental health domain (p < 0.001). QoL is significantly poor in Tunisian RA. These patients should be managed using a multidisciplinary approach involving the patients themselves.

Health-related quality of life analyses in nonfunctioning pituitary macroadenoma patients identifies at-risk populations.

The quality of life (QoL) impact of multidisciplinary treatment for patients with nonfunctioning pituitary macroadenomas (NFPMA) is unclear. We sought to investigate associations between patient factors, clinical data, and patient-reported QoL in patients with NFPMA. Patients with treated NFPMA and > 1 year of follow up after transsphenoidal surgery (TSS) and with no evidence of progressive disease were evaluated utilizing the following patient-reported outcome measures: RAND-36-Item Health Survey, Multidimensional Fatigue Inventory, Cognitive Failures Questionnaire. 229 eligible patients completed QoL questionnaires a median of 7.7 years after initial transsphenoidal surgery (TSS). 25% of participants received radiation therapy (RT) a median of 2.0 years (0.1-22.5) after initial TSS. Patients who received RT were younger (median age 46 v 58, p < 0.0001), had larger tumors (28mm v 22mm, p < 0.0001), were more likely to have visual symptoms (65% v 34%, p = 0.0002), and were more likely to have hypopituitarism (93% v 62%, p < 0.0001). Patients with hypopituitarism reported worse energy and fatigue and cognitive function (p < 0.03). Patients who received RT reported significantly worse general health, physical health, physical fatigue and cognitive functioning (p < 0.05). The largest QoL differences were in patients who experienced a financial stressor, independent of treatment type. Hypopituitarism, radiation therapy after TSS, and financial stressors are associated with more impaired QoL in patients with NFPMA. Awareness of these factors can better guide use and timing of radiation therapy in addition to identifying patients who can benefit from multidisciplinary surveillance.

Psychosocial Implications and Quality of Life in Patients with Hidradenitis Suppurativa Compared to Those With Atopic Dermatitis and Psoriasis: a Cross-sectional Case-control Study.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that has been reported to have the greatest negative impact on quality of life (QoL) and psychosocial factors when compared with other skin conditions. To assess psychosocial impact and QoL impairment in patients with HS. This cross-sectional case-control study included a case group with HS and a control group with psoriasis or atopic dermatitis diagnosed by a dermatologist at a public hospital in Jeddah, Saudi Arabia from 2016 to 2019. Data were obtained from medical records at a ratio of 1:2. Patients were contacted via telephone and asked to complete Arabic-validated questionnaires (Dermatology Life Quality Index [DLQI], Rosenberg Self-Esteem Scale, and Hospital Anxiety and Depression Scale) and a survey containing pictures to identify Hurley stage. The study included 46 patients and 101 controls (eczema, 50; psoriasis, 51). Patients had significantly higher DLQI and depression scores than did controls (P < 0.05). Anxiety and depression scores were significantly higher in women than men (P < 0.05). Cases with Hurley stage 3 had significantly higher DLQI scores than those with Hurley stages 1 and 2. Controls had a significantly higher percentage of employed participants (P < 0.05). HS had a greater psychosocial impact on QoL than psoriasis or atopic dermatitis and was associated with a lower employment rate. Women were more affected by the disease than men. Therefore, we recommend paying close attention to the psychosocial aspects of the disease and establishing educational programs and support groups for patients with HS.

Disseminated superficial porokeratosis: Impact on quality of life

Disseminated superficial actinic porokeratosis (DSAP) is typically progressive and lifelong,1-3 but little data are available regarding the impact of DSAP on quality of life (QoL). We sought to identify the overall impairment of QoL in patients with DSAP, assess correlations in QoL impairment, and measure the impact of treatment on QoL.

Предикторы снижения качества жизни пациентов с синдромом старческой астении и пароксизмальной формой фибрилляции предсердий

The aim of the research. To determine the predictors of a decrease in the quality of life of patients with the senile asthenia syndrome and paroxysmal atrial fibrillation. Material and methods. A total of 45 patients aged over 65 with paroxysmal atrial fi brillation (AF) and senile asthenia (SA) syndrome were selected and constituted the main group. A control group of 43 apparently healthy individuals was formed as well. Th e search for predictors of a decrease in the quality of life (QoL) in patients with SA syndrome and paroxysmal AF was carried out based on standardised laboratory and instrumental studies. Results. Th e QoL of patients with SA syndrome and paroxysmal AF is declined according to indicators relevant for apparently healthy individuals comparable in age and gender characteristics. In comparison to men, women have demonstrated a decrease of the QoL according to three of the four scales of physical health: PF, RP, GH, and on two scales of psychosocial health: RE and MH. In the age group of subject aged over 75, mainly the indicators of physical status – PF, RP and GH – were reduced. With GFR lowering to less than 60 ml/min, there is predominantly a decline in the physical aspect of the QoL as well as a decrease in vital activity. Deterioration in the QoL was determined on two scales of the physical aspect of health – PF and RP – against the background of HR higher than 80 bpm, while no changes in the psychosocial aspect were diagnosed. Conclusion. The quality of life of patients with the senile asthenia syndrome and paroxysmal AF has the worst values on absolutely all scales of the physical aspect of health, whereas the psychosocial sphere is less involved and only vital activity and role-based emotional functioning are reduced. Predictors of QoL deterioration in patients with the SA syndrome and paroxysmal AF are: the age of 75 or older, the female gender, a decrease in GFR down to 60 ml/min and an increase in the heart rate to over 80 bpm. Thus, rational nephroprotective therapy and heart rate control contribute to the improvement in the quality of life of patients with the SA syndrome and paroxysmal AF.

Patient perspectives of the influence of severe and non-severe asthma on their quality of life: A national survey of asthma patients in Spain.

IntroductionLittle is known about adult asthma patients' perspective of their disease burden. This study aimed to obtain a comprehensive picture of patient needs, evaluate their knowledge, source of information, and perception of the severity of their asthma, and compare these variables between severe (SA) and non‐severe (NSA) asthma patients.MethodsWe conducted an online cross‐sectional survey in Spain among asthma patients aged ≥18 years. A bespoke questionnaire was used to collect sociodemographic data, asthma characteristics, treatments, disease burden, patient's perception of disease severity, and asthma information sources. Patients were classified as SA and NSA according to GINA 2020 treatment steps recommendations. To compare populations, 600 participants (200 SA and 400 NSA) were randomly selected to complete the survey.ResultsParticipants were mostly women, mean age >38 years. SA patients underestimated the severity of their asthma; 52% judged it as mild, and only 2% considered their asthma severe. Overall, 50% of NSA and 96% of SA patients had experienced ≥1 exacerbation the previous year (p < 0.001). Fewer asthma exacerbations (SA) and improved quality of life (QoL) (NSA) were the most frequently expected therapy outcomes. NSA patients believe that asthma impacts their daily life (37%) and worsens QoL (34%) to a lesser degree than SA (67% and 59%, respectively; p < 0.001). Patient‐preferred sources of information were specialists (NSA:42%; SA: 38%) and primary care physicians (NSA: 41%; SA: 33%).ConclusionsDespite the effective therapies currently available, the results of this study still show a significant emotional burden and QoL impairment in patients with severe asthma.

Predictive factors of quality of life in temporal and extratemporal lobe epilepsy: association with affective temperament profiles and psychiatric comorbidities.

Investigating predictive factors of reduced quality of life (QOL) of patients and their association with focal epilepsy can improve management and treatment strategies. This study aimed to investigate the relationship between affective temperaments, depression, anxiety, disease characteristics, and QOL and to explore the predictors of QOL in patients with temporal lobe epilepsy (TLE) and extratemporal lobe epilepsy (ETLE). A total of 50 patients with TLE, 51 patients with ETLE, and 70 controls were enrolled. Affective temperaments were evaluated using the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A). QOL was assessed by the Short-Form Health Survey (SF-36). Beck Depression Inventory and Beck Anxiety Inventory were used to explore depression and anxiety severity, respectively. Compared with the controls, patients with TLE and ETLE had significantly higher scores on all TEMPS-A scales, except on hyperthymic temperament. All the SF-36 subscale scores were lower in the TLE and ETLE groups. Linear regression analysis revealed that depressive symptoms, anxiety, depressive and irritable temperament, and seizure frequency were significant predictors of QOL in TLE. Patients with ETLE with temperamental disturbances, depressive symptoms, and polytherapy had a poorer QOL. Affective temperaments, psychiatric disorders, and clinical factors may predict impaired QOL in patients with TLE and ETLE. Further studies are needed to identify predictors of QOL in various epilepsy subtypes.

Features Associated With Quality of Life Impairment in Hidradenitis Suppurativa Patients.

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease with an adverse impact on patients' quality of life (QoL).Objectives: To quantify QoL impairment in patients in Germany suffering from HS and to identify the parameters associated with QoL impairment.Methods: A non-interventional, cross-sectional, mono-centric study with 500 HS patients. QoL data (measured using the Dermatology Life Quality Index; DLQI) and demographic, anamnestic, clinical, and blood parameters were collected. All patients were examined by dermatologists that documented the skin alterations. QoL data from 462 HS patients were available and evaluated.Results: The mean (± standard deviation) DLQI score of HS patients was 13.18 ± 7.99. Approximately 40% and 20% of HS patients declared very large and extremely large QoL impairment, respectively. The degree of QoL disturbance correlated with the severity of skin alterations, blood leucocyte count and, in particular, with anogenital localization and the presence of nodules and fistulas. Furthermore, QoL impairment was associated with specific comorbidities, such as adiposity and back pain, but not with HS family history. QoL impairment was not influenced by whether or not the patients had undergone resection surgery or antibiotic treatment but was more severe in HS patients that had undergone abscess lancing compared to patients without such treatment in the past.Limitations: It was a mono-centric study and most data were obtained from self-administered patient questionnaires. The association of QoL with type of treatment was analyzed for abscess lancing, resection surgery, and antibiotic treatment. Further therapeutic modalities recommended in the guidelines were not investigated.Conclusion: A profound impairment in QoL was present in patients with HS, and this was higher than that observed in other studied dermatoses. The degree of impairment correlated with the extent of cutaneous and some extra-cutaneous alterations. Surgical and conventional medicamentous therapies of HS were not associated with long-lasting reduction of QoL impairment. Our data support the implementation of patient-reported outcome measures for the assessment of therapy responses.

The mediating role of epileptic seizures, irritability, and depression on quality of life in people with epilepsy

PurposePsychiatric comorbidity is common in epilepsy and has a considerable impact on patient quality of life (QoL). This study aimed to analyze the relationship between seizure frequency, irritability, and depression and describe how they mediate each other's effect on QoL in epilepsy. MethodsThis is a cross-sectional study of consecutive adults seen at an outpatient epilepsy clinic of a tertiary hospital in Barcelona, Spain. All the patients were evaluated for psychiatric comorbidity and administered the State–Trait Anger Expression Inventory–2 (STAXI-2), the Hospital Anxiety and Depression Scale (HADS), and the Quality Of Life in Epilepsy Inventory-10 (QOLIE-10). Mediation analysis with multiple linear regression followed by the Sobel test was performed. ResultsWe studied 157 patients. Seizure frequency (R = −0.193, P = .053), irritability (R = 0.216, P = .039), and depression (R = −0.598, P < .001) had all a negative effect on QoL. In the adjusted linear regression model, depression was the only independent predictor of impaired QoL (B = −2.453 [95% confidence interval (CI): −3.161, −1.744], P < .001). The Sobel test showed that depression exerted a significant mediating effect on seizure frequency (Z = −1.984; P = .047) and irritability (Z = −3.669; P < .001) in their influence on QoL. ConclusionDepression is an independent predictor of worse QoL and significantly mediated the effects of irritability and poor seizure control on QoL impairment in patients with epilepsy.

Cross sectional quality of life assessment in patients with androgenetic alopecia.

Assessment of quality of life (QOL) of patients with androgenetic alopecia (AGA) has become increasingly important, both in order to evaluate the influence of the disease on patients and the therapy they require. We aimed to assess QOL in subjects complaining from AGA and evaluated the effects of various sociodemographic factors affecting their QOL. QOL was assessed in 400 patients with AGA and 100 controls using the World Health Organization Quality of life (WHOQOL-BREF) questionnaire. Four domains (physical, psychological, social, and environmental) and two items (overall perception of QOL and health) of the WHOQOL-BREF were the primary end points of this study. Patients had a lower QoL and less general satisfaction in all four domains of assessment than controls. The social impact was significantly higher in patients < 30 years of age (P = .003). Patients with severer form of AGA significantly had higher scores in all domains compared to those with less severe forms. Disease severity negatively impacted all the four domains significantly (P = .021). AGA harmfully affected the patient's QOL which warns the physicians to pay more attention to QOL impairment in patients of AGA for the better understanding of the disease burden on individual patients.

MON-268 Factors Associated With QoL Impairment In Patients With Acromegaly In The Elderly

Background: With rapid aging in the society and the improvement of prognosis in patients with acromegaly, treatment goals have been changed. In elderly patients with acromegaly, improvement in the quality of life (QoL) is one of the most important treatment goals. However, factors associated with QoL in elderly patients with acromegaly remains unclear. Objective: To clarify the differences in the QoL in patients with acromegaly between the young and elderly, and to identify the factors associated with the impairment in the elderly. Patients and Methods: This is a retrospective cross-sectional single-center study. Eighty patients with acromegaly (male 49%, the mean age 59.6±12.6 years, mean IGF-I SD score 0.7±2.3), who had been followed up in the outpatient clinic at Kobe University Hospital, were enrolled. Patients were divided into following 2 groups; Elderly group (E group); 65 years of age or more (n =34, male 41%, mean age 71.4±4.1 years), or Young group (Y group); younger than 65 years old (n =46, male 50.9%, mean age 50.9±9.2 years). We evaluated QoL using AcroQoL and analyzed the associated factors by multivariate analysis. Results: In the comparison of E and Y group, IGF-I SD score (0.4±1.6 in E group vs. 0.9±2.7 in Y group) and the way of treatment (surgery; 65% vs 72%, current medical therapy; 56% vs 43%, past radiation therapy; 15% vs 9%) were comparable, while disease duration was longer in E than Y group (13.7±10.9 vs 8.3±8.1 years, p =0.02). Arthropathy was more frequent in E group (50% vs 11%, p <0.01).In total, current medical therapy and hydrocortisone replacement were associated with lower total scale (β =-0.27, p =0.01 and β =-0.35, p <0.01). Then, we separately analyzed the associated factors in each E and Y group. In Y group, current medical therapy and hydrocortisone replacement were associated with lower total (β =-0.48, p <0.01, and β =-0.35, p <0.01) and physical scales (β =-0.40, p <0.01, and β =-0.31, p <0.01). Past radiotherapy for the pituitary tumor was also associated with lower mental scale (β =-0.40, p <0.01). On the other hand, in E group, arthropathy and high BMI were associated with lower total scale (β =-0.41, p =0.02, and β =-0.40, p =0.02) and current hydrocortisone replacement was associated with lower physical scale (β =-0.36, p =0.03). Conclusions: AcroQoL score was impaired both in E and Y group in patients with acromegaly. In total, current medical therapy and hydrocortisone replacement were associated with lower QoL scale as previously reported; however, when stratified by age, arthropathy and high BMI were associated with lower QoL scale in the elderly. These data clearly indicate that the factors influence on QoL are different depending on the age. Although causal relationship remains unclarified, these data suggest that when treat the patients, it may be important to avoid these complications.

Nonmotor-Related Quality of Life in Parkinson’s Patients with Subjective Memory Complaints: Comparison with PDQ-39

Background Parkinson's disease (PD) is associated with cognitive decline, progressing from subjective memory complaints (SMC) via mild cognitive impairment (MCI) to dementia. SMC are only measurable by an interview and thus rely on individuals reporting a subjectively perceived worsening of cognitive functioning. Cognitive decline is accompanied by a reduction in quality of life (QoL); however, the extent to which SMC manifest a reduction of QoL remains unclear. Objective To determine the association between SMC and deterioration of QoL in patients suffering from PD. Methods A total of 46 cognitively unimpaired PD patients (29 men and 17 women) completed PDQ-39, two assessments to measure SMC (Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and a Self-Assessment questionnaire), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Multiple regression modelling was conducted to investigate the confounding effect of depression and anxiety. Results The PDQ-39 domain cognitions, but not the PDQ-39 sum score, correlated significantly with the SMC Self-Assessment questionnaire (r = 0.57; p < 0.001). The conducted regression model indicates a significant confounding effect of depression and anxiety (p < 0.001, R2 = 0.55). Conclusion In our study, SMC is significantly related to a reduction of cognitive QoL. In addition, we observed significant relation to anxiety and depression levels. In contrast to our main hypothesis, we found no association with overall QoL; this lack of association could be due to unstandardized questionnaires and emphasizes the need of validated tools for evaluating SMC.

Quality of Life Assessment in Patients with Androgenetic Alopecia.

Background:Male-pattern alopecia (MPA) or androgenetic alopecia (AGA) is a commonly encountered dermatological condition present in males and is less common among females. Although AGA is a physiological condition, its impact on person's self-esteem is so great that it cannot be ignored. It has a significant affect over a variety of physiological and social aspects of one's life and even on the individual's overall quality of life (QOL).Aims and Objectives:The aim of this study is to study the clinical profile of 200 male patients having MPA and to access its impact on QOL using the Dermatology Life Quality Index (DLQI) and hair-specific Skindex-29.Materials and Methods:Clinical profiles of 200 patients were studied, and QOL assessment was done using the DLQI and hair-specific Skindex-29 scales.Results:Of 200 cases of MPA, majority (41.5%) of the patients belonged to the age group of 21–30 years. Smoking, alcoholism, dietary habits, nature of work, and seasonal variation did not seem to affect the incidence of MPA. Positive family history of MPA was observed in 50% of patients. A mean DLQI score of 13.52 was recorded in the study. The main affected parameter was personal relations with mean score of 2.3. Maximum number of patients had DLQI score between 11 and 20. MPA was observed in 50% of patients. In the study, the mean hair-specific Skindex-29 score was found to be 75.62. The different subscale parameters in Skindex-29 were symptoms, functions, emotions; with respective score of 22.1 ± 5.025, 25.89 ± 4.814, and 27.73 ± 5.942. The major subscales affected were symptoms with a mean score of 3.14. Both hair-specific Skindex-29 and DLQI had a significant correlation, thereby suggesting that AGA significantly affects patient's QOL.Conclusion:AGA harmfully affected the patient's QOL which warns the physicians to pay more attention to QOL impairment in patients of AGA for the better understanding of the disease burden on individual patients.

Understanding the disease burden and unmet needs among patients with cutaneous lupus erythematosus: A qualitative study.

BackgroundCutaneous lupus erythematosus (CLE) is a rare dermatologic autoimmune disease marked by photosensitive lesions that can vary in appearance depending on the subtype. The extent to which CLE affects a patient’s quality of life (QoL) has not been fully characterized. Focus groups were conducted to explore patients’ perspectives of how CLE has affected their lives and to understand the unmet needs in regards to CLE treatment and care.MethodsThis qualitative study involved three focus groups with a total of 19 patients with CLE. A moderator guide containing open-ended questions was used to assess how CLE affects overall QoL. The focus groups were audio-recorded with notetaking. Data were content-analyzed to identify emergent themes.ResultsFour themes emerged as important to patients with CLE: disease sequelae, social interactions, functioning, and unmet needs. Most patients reported decreased QoL due to signs and symptoms such as dyspigmentation and scarring. Having CLE negatively affected patients’ mental health and personal relationships and led to negative coping strategies, such as recreational drug use. Issues related to body image were also elicited by patients. Patients cited unmet needs including lack of treatments to improve chronic skin lesions of CLE and inadequate patient education on living with CLE.ConclusionsProviders can look for signs of QoL impairment in patients with CLE by asking questions related to body image, mental health, social isolation, and coping mechanisms. Future QoL measures can include the effect of CLE-specific attributes such as scarring and dyspigmentation to empower patients’ voices in determining therapeutic efficacy in future clinical trials. Findings from our study have added a new understanding of daily experiences that were elicited directly from patients with CLE.

Quality of life and sexual health in patients with hidradenitis suppurativa.

BackgroundHidradenitis suppurativa (HS) is a chronic, recurrent, debilitating follicular disease. The effect of HS on physical and psychological aspects of sexual function is not well understood.ObjectiveThe objective of this study is to investigate the contribution of sexual dysfunction to the quality of life (QoL) of patients with HS and to investigate the extent to which sexual health predicts the QoL in these patients.MethodsThis is an observational cross-sectional study of 50 patients with HS and 50 healthy volunteers who completed questionnaires to measure QoL and sexual functioning using four validated tools.ResultsMale patients experienced higher sexual dysfunction and a reduced quality of sexual life, while female patients reported higher sexual distress, compared with control groups. In male patients, sexual QoL and erectile dysfunction predicted a 72% decline in QoL. In female patients, sexual distress and sexual dysfunction predicted 46% variability in QoL index scores, beyond the effects of disease severity.ConclusionDisruptions to sexual functioning greatly contribute to QoL impairments in patients with HS regardless of genital lesions. Health care professionals should inquire about and pay close attention to sexual health concerns in patients with HS.

Factors affecting quality of life in patients with vitiligo: a nationwide study.

Little is known about factors affecting the quality of life (QoL) of patients with vitiligo, and previous studies have shown conflicting results. To explore the QoL of patients with vitiligo and to identify factors affecting QoL. A nationwide questionnaire-based study was conducted with 1123 patients with vitiligo recruited from 21 hospitals in Korea from July 2015 to June 2016. Data were collected using a structured questionnaire for demographic information and the Skindex-29 instrument. Mild or severely impaired QoL in patients with vitiligo was assessed according to each domain (symptoms, functioning and emotions) of Skindex-29. Multivariate logistic regression analyses were performed to determine the factors associated with QoL. Of the enrolled participants, 609 were male and 514 female, with a mean age of 49·8 years (range 20-84). The median duration of disease was 3·0 years (range 0-60). Using multivariate logistic regression modelling, the involvement of visible body parts and a larger affected body surface area were consistently associated with QoL impairment in all three domains of Skindex-29. Additionally, the QoL of patients aged 20-59 years, who potentially had a more active social life than older patients, was associated with functional impairment. Furthermore, a higher educational background was associated with emotional impairment. A multitude of factors significantly influence the QoL of patients with vitiligo. A better appreciation of these factors would help the management of these patients.

Quality of life in patients with implantable cardioverter-defibrillator: systematic review of randomized controlled trials.

Implantable cardioverter-defibrillator (ICD) therapy significantly improves the survival of patients who are at high risk for sudden cardiac death. However, it is unclear whether this survival is accompanied by impairment on quality of life (QoL). This systematic review sought to describe whether ICD therapy, as compared with standard treatment, can have an impact on QoL outcomes. Extensive literature searches were carried out in PubMed, EMBASE, LILACS and Cochrane Library. Eligible studies were randomized controlled trials (RCTs) of ICD versus medical therapy that reported valid and reliable measures of QoL. Included studies were reviewed to determine baseline patient characteristics, mean duration of follow-up, questionnaires used to assess QoL and association between QoL scores and ICD shock therapy. Seven studies, enrolling a total of 5,701 patients, were included in this review. The analyzed trials showed conflicting results about the impact of ICD on QoL outcomes. Among the secondary prevention studies, CIDS reported a clear benefit from ICD and AVID showed no difference between ICD and amiodarone groups. Of the primary prevention trials, AMIOVIRT, MADIT II, DEFINITE, and SCD-HeFT found no evidence of impaired QoL in patients with an ICD. Evidence for an association between ICD shocks and QoL was mixed and seemed to depend on the interval between shocks and QoL assessment. There was no evidence of impaired QoL in patients with an ICD. However, ICD patients must be educated of all possible risks and benefits, including transitory declines in QoL after ICD shocks.

Long-term prognosis of hematogenous vertebral osteomyelitis: Mortality, quality of life, and pain.

Hematogenous vertebral osteomyelitis (HVO) has a generally favorable prognosis if appropriate treatment is initiated in its early phase; however, some intractable cases with HVO can develop neurological impairment as well as spinal deformity during the course of treatment and these sequelae may lead to impaired quality of life (QOL). In this study, we aimed to evaluate the long-term relapse rate, mortality, and QOL of patients with HVO. In this retrospective case series study, medical records of 60 patients with HVO with a mean follow-up period of 8 years (5-23 years) were reviewed to assess demographic data, details of infection, and clinical course. Mortality rate was assessed using a Kaplan-Meier plot. QOL was measured using the EuroQol 5 Dimension (EQ-5D) questionnaire and residual pain using a numeric rating scale (NRS). HVO relapsed in 4 of 60 patients (7%). Overall 5-year survival rate in 60 patients with HVO was 85%. The factors associated with increased mortality were malignant tumor, diabetes mellitus, chronic use of glucocorticoids, and drug-resistant strains of staphylococcus. Female-to-male ratio, NRS, prevalence of neurological impairment were significantly higher in patients with low EQ-5D score (poor health) compared to those with high EQ-5D score (good health). Patients with HVO have shorter life expectancy if they have malignancy, diabetes mellitus, chronic use of glucocorticoids, and a history of drug-resistant strains of staphylococcus infection. Female gender, residual neurological defects and persistent back pain are associated with impaired QOL in patients with HVO.

Quality of life in patients with adrenal insufficiency correlates stronger with hydrocortisone dosage, than with long-term systemic cortisol levels

In patients with adrenal insufficiency (AI) a higher hydrocortisone intake has been associated with more impairment in quality of life (QoL). Irrespective of age, sex and severity of AI the dosage of hydrocortisone is titrated around 20mg/D in all patients with AI based on physical and mental signs and symptoms. However, until now it is unknown whether these QoL impairments are related to increased systemic cortisol exposure. Measurement of hair cortisol levels (CORThair) can be used to assess chronic systemic cortisol exposure. This study aimed to explore whether QoL in patients with AI is associated with CORThair and daily hydrocortisone intake. We performed a cross-sectional study in 120 patients with AI on stable hydrocortisone replacement, in whom hair samples and QoL data were collected. CORThair were measured with ELISA, and QoL was assessed with validated questionnaires (SF-36, EQ-5D, HADS, MFI-20). Patients reported impairments in 14 of 15 QoL subscales (p<0.001). More impairments in physical aspects of QoL correlated with higher CORThair and higher daily hydrocortisone intake (p<0.05), an effect that was more pronounced in female patients. Regression analyses including both CORThair and hydrocortisone intake revealed a significant negative contribution of higher hydrocortisone intake on physical aspects of QoL (p≤0.046), whereas no significant contribution was found for CORThair.The present study showed that patients with AI report several impairments in QoL which are associated with hydrocortisone intake, and to a lesser extent reflected by chronic systemic cortisol exposure as measured by hair cortisol. This suggests that QoL impairments in patients with AI are not per se the effect of prolonged exposure to elevated systemic cortisol levels.