Medical Conditions Of Patients Research Articles

Coronary Heart Disease Risk Factors

Coronary heart disease (CHD) risk factor reduction is required to maximize the benefits to be gained from coronary artery bypass grafting. Risk factor reduction after surgery, however, is often incomplete and adherence rates are poor. The health behaviors of the cardiac partner can be supportive or can act to undermine the patient's motivation for change in risk factors. Concordance in health behaviors in couples can make it more difficult for patients to engage in positive lifestyle changes. The aims of this study were to increase understanding of the role of concordance in CHD risk factors and common medical conditions in patients and partners before and 4 months after bypass grafting and to examine changes in the pattern of concordance over time. A prospective study of patients' and partners' CHD risk factors was conducted in the outpatient clinic before and at home 4 months after bypass grafting. There was significant concordance for preoperative physical activity, body mass index, and diabetes mellitus, and postoperatively, there was significant concordance for smoking status, physical activity, body mass index, cholesterol, and diabetes mellitus. There were significant associations between patients' preoperative and postoperative physical activity and cholesterol and between the partners' preoperative and postoperative physical activity. There was a significant change in the pattern of concordance for physical activity from preoperation to postoperation, with more patients but not partners increasing their physical activity levels. Results revealed significant concordance in CHD risk factors and common medical conditions in patients and partners before and 4 months after coronary artery bypass grafting. This indicates that the behaviors of some couples can make it more difficult for patients to change their lifestyle. The health professionals involved in educating patients before and after bypass grafting need to target the patient and partner as a couple to help achieve more successful risk factor reduction.

Graft-Versus-Tumor Effect After Allogeneic Stem Cell Transplantation in HIV-Positive Patients With High-Risk Hematologic Malignancies

Allogeneic hematopoietic stem cell transplantation (Allo-HSCT) is a well-established therapeutic option for hematological malignancies. Combination antiretroviral therapy (cART) has enabled the treatment of medical conditions in patients infected with the human immunodeficiency virus (HIV) in the same way as in the general population. Moreover, improvements in supportive care have allowed HIV-infected patients with life-threatening hematological disorders to be treated with Allo-HSCT. We report on four HIV-infected patients with hematological malignancies receiving an Allo-HSCT in our institution, and on the use of donor lymphocyte infusions to successfully treat post-Allo-HSCT relapse. Of note, one of them is the first HIV(+) patient to receive a "dual transplant" (unrelated umbilical cord blood stem cells combined with mobilized T cell-depleted CD34(+) stem cells from a mismatched third party donor). cART drugs interactions were satisfactorily managed. This approach provided long-term control of the hematological disease. Nevertheless, despite adequate immune reconstitution, infections were the main cause of morbidity and mortality after Allo-HSCT.

Comorbidity as an Independent Risk Factor in Patients With Cancer

This study determined the prevalence of medical conditions in patients with cancer and their impact on outcome. We evaluated a cohort of 37,411 patients diagnosed with cancer between 2000 and 2008 in Taiwan, collecting the cancer diagnosis and chronic disease diagnoses. The severity of the comorbid condition was correlated with the cancer diagnosis and outcome. Overall, 71.9% of the study population had 1 or more comorbid conditions. Patients with none (n = 10 508), 1 (n = 8881), 2 (n = 6583), and 3 or more (n = 11 439) comorbid conditions had mortality rates of 11.49%, 15.99%, 19.61%, and 29.39%, respectively. Older patients with comorbid conditions had a significantly higher chance of death. Dementia, heart disease, or cerebrovascular diseases were associated with the highest mortality. Cancer patients with comorbid conditions have a significantly higher risk of death. Prevention and better medical management of comorbid conditions is likely to result in improved outcomes for patients with cancer.

General Medical Conditions Are Associated With Delay to Treatment in Patients with Bipolar Disorder

Bipolar disorder (BPD) is associated with worse physical health. Indeed patients with BPD more frequently suffer from medical conditions such as cardiovascular illness, hypertension, diabetes, hypothyroidism, respiratory disease, liver disease, peptic ulcer, and arthritis. Since some clinical characteristics have been associated with worse course and outcome of BPD, it is possible that they might also bring to an increased medical burden in patients with BPD. The aim of the present report is to assess the prevalence of medical conditions in patients with BPD, and to determine the clinical variables associated with the presence of a medical condition. Charts of patients with BPD I and II were reviewed: socio-demographic and clinical information were collected. Medical conditions were classified by the ICD-10 and grouped according to the Cumulative Illness Rating Scales in: cardiac, vascular, hematopoietic, respiratory, ear/nose/throat, upper and lower gastrointestinal, hepatic, renal, genitourinary, musculoskeletal, neurologic, endocrine/metabolic. The associations between the presence of medical conditions and demographic/clinical variables of BPD were then analyzed. Charts of 309 patients were included in the study. 170 (55%) patients had at least one medical condition. The most common were endocrine/metabolic disease (23%), and vascular disease (21%). Having a medical condition was associated with longer duration of untreated illness and female gender. Patients with BPD have high rates of medical conditions, especially hypertension and metabolic disorders. A longer duration of untreated illness is associated with having a medical condition, probably due to the long-lasting adoption on unhealthy lifestyles not counterbalanced by treatment and psychoeducation.

A Preliminary Report of Medical Comorbidities Associated With Obstructive Sleep Apnea in a Presurgical Cohort

The prevalence of medical conditions in patients with obstructive sleep apnea (OSA) is well known; however, there are few reports detailing the comorbidity profile of OSA patients undergoing maxillomandibular advancement (MMA). The population of patients presenting for MMA may differ significantly from patients followed in Sleep Medicine departments. We hypothesize that patients scheduled for MMA will have a different comorbidity profile than the general OSA population. The purpose of this study was to document the presence of medical comorbidities in surgical patients.

2009 H1N1: risk factors for hospitalization in a matched case-control study

In order to compare sociodemographical data and preexisting risk medical conditions in patients requiring hospital admission for 2009 pandemic influenza A (H1N1) virus infection and those managed on an outpatient basis, a prospective observational, matched case-control study in 36 hospitals of the Spanish National Health Service was conducted from July 2009 to February 2010. Cases were patients aged 6 months to 18 years hospitalized for influenza syndrome, in whom 2009 influenza A (H1N1) virus infection was confirmed using real-time reverse-transcription polymerase chain reaction. Controls were patients aged 6 months to 18 years with confirmed 2009 influenza A (H1N1) infection managed on an outpatient basis. There were 195 cases and 184 controls. In a multivariate model, hospitalization was more frequent in children aged <2 years (odds ratio (OR), 13.8; 95% confidence interval (CI), 1.7-106.4), those with neurological and/or neuromuscular diseases (OR, 3.0; 95% CI, 1.1-8.2), and those whose parents had less than a secondary educational level (OR, 2.7; 95% CI, 1.4-5.2). Children aged <2 years, children with neurological diseases, and children from families with a lower educational status had a higher risk of hospitalization due to influenza A (H1N1) 2009 infection.

Medical problems and oral care of patients with Down syndrome: a literature review

When planning the dental treatment of patients with Down syndrome (DS), dental practitioners should always consider their general health, in order to achieve a holistic and interdisciplinary approach. This article presents a literature review of the primary medical conditions in patients with DS that may affect their general health care and the appropriate clinical delivery of oral health care.

Accuracy of self-reported medical problems in patients with alcohol dependence and co-occurring schizophrenia or schizoaffective disorder

BackgroundSchizophrenia and alcohol dependence (AD) are both major risk factors for a variety of medical problems, yet little is known about the medical status of patients in whom both conditions coexist. ObjectiveThe objectives of this study are to assess accuracy of self-reported medical problems and to compare the accuracy reports in patients with schizophrenia or schizoaffective disorder and co-occurring AD compared to patients with AD only and to controls. Our hypothesis was that medical problems are under-reported in patients with co-occurring disorders, possibly due to the combination of alcohol use and symptoms of schizophrenia. MethodsSelf-reported medical diagnoses were recorded and compared to medical records obtained from all area hospitals in 42 patients with schizophrenia and AD, 44 patients with schizoaffective disorder and AD, 41 patients with AD only, and 15 control subjects. Patients underwent medical history, physical examination, and review of medical records. ResultsPatients with schizophrenia or schizoaffective disorder and co-occurring AD underreported their medical problems significantly more than patients with AD only and controls. Accuracy of self report was significantly lower in patients with schizophrenia-spectrum disorders plus co-occurring alcohol dependence than in AD alone or in controls. The most commonly underreported diagnoses included coronary artery disease, chronic renal failure, seizure disorder, hyperlipidemia, asthma and hypertension. DiscussionIn order to detect potentially unreported medical conditions in patients with co-occurring schizophrenia/schizoaffective disorder and alcohol dependence, the use of targeted screening questionnaires is recommended in addition to physical examination and thorough review of medical records.

Associated Morbidity of Blepharitis

To evaluate the prevalence of systemic medical conditions in patients with blepharitis. A retrospective observational case-control study. All the members who were diagnosed with blepharitis in the Central District of Clalit Health Services in Israel (years 2000-2009; n=16706) and 16706 age- and gender-matched controls randomly selected from the district members. Analysis of the prevalence of various ocular and systemic conditions, risk factors, age, gender, marriage status, country of origin, place of residency, and socioeconomic status. The prevalence of any associated morbidity. Demographically, a significantly higher tendency to develop blepharitis was found in populations of lower socioeconomic class, populations living in urban areas, and Ashkenazi Jews. A significant association of P<0.001 was found with some inflammatory diseases (gastritis, peptic ulcer, asthma, arthropathy, and ulcerative colitis), psychologic conditions (anxiety, irritable bowel syndrome, neuroses, and depression), hormonal conditions (hypothyroidism and prostatic hypertrophy), cardiovascular diseases (carotid artery disease, hyperlipidemia, hypertension, and ischemic heart disease), and other eye conditions (chalazion, pterygium). The strongest associations found were between blepharitis and chalazia (odds ratio [OR] 4.7; confidence interval [CI], 3.8-5.7), rosacea (OR 3; CI, 2.1-4.3), pterygia (OR 2.0; CI, 1.5-2.6), ulcerative colitis (OR 2.3; CI, 1.2-4.2), irritable bowel syndrome (OR 1.8; CI, 1.3-2.5), anxiety (OR 1.6; CI, 1.4-1.9), and gastritis (OR 1.6; CI, 1.4-1.7). Some ocular and systemic conditions are more prevalent among patients with blepharitis. Better understanding of the pathophysiologic association between those diseases and blepharitis may help in its treatment and prevention. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

A profle on health status and medical conditions of patients staying longer than the set norm at a district hospital in South Africa

The average length of hospital stay is regarded as a key determinant of greater hospital costs. The objectives of this quantitative, retrospective, descriptive study were to determine the health status and medical conditions of patients with increased length of stay at a district hospital in Limpopo Province. A total of 609 patients’ records with longer than average length of stay, from January to December 2007, were selected by stratifed random sampling. The most prevalent diseases for staying longer were infectious and parasitic diseases, symptoms, signs etc, and injury, poisoning and consequences of causes yielding more than a third (36% and 12%, respectively, for each classifcation). Neoplasm-related admissions, in which cancer was identifed as the most prevalent, stayed in hospital for an average of 14.6 days. The average length of stay for all disease classifcations ranged from 7.1 days to 14.6 days. The length of stay at Elim Hospital is mostly infuenced by the type of health conditions which are d...

Preoperative Risk Evaluation and Assessment

The primary goal of fast track protocols is to enhance postoperative recovery by decreasing morbidity, mortality, length of stay, and return to full function. An important component of limiting postoperative morbidity and mortality is evaluating and assessing preoperative risk. The underlying medical conditions of patients as well as their functional status form a big component of preoperative risk, which in turn is a determinant of postoperative outcomes. The preoperative history and physical examination form the backbone of preoperative risk assessment. This will direct which further tests are necessary to complete the preoperative evaluation. The underlying conditions that pose the greatest risk include cardiovascular disease, pulmonary disease, diabetes mellitus, underlying immunosuppression, incident infections, and functional status. There are various disease-specific risk assessment tools and indexes that help to risk-stratify patients in each disease category. Based on these indexes, several algorithms have been developed to help determine what preoperative testing is required, if any. The accurate evaluation and assessment of preoperative risk will ensure that patients are optimized before surgery to decrease the incidence of postoperative morbidity and mortality, and thereby enhance recovery.

Association of fatigue and psychological distress with quality of life in patients with a previous venous thromboembolic event

Health-related quality of life (QoL) has been associated with several social and medical conditions in patients with deep vein thrombosis (DVT) and pulmonary embolism (PE). To the best of our knowledge, there is no study investigating the relationship of QoL with psychological variables in this patient population. We assumed as a hypothesis an association between heightened levels of fatigue and psychological distress, as well as decreased QoL in patients with an objectively diagnosed venous thromboembolic event. Study participants were 205 consecutively enrolled out-patients (47.4 years, 54.6% men) with DVT and/or PE. Approximately 10 days before blood collection for thrombophilia work-up, QoL, fatigue, and psychological distress were assessed using the Short Form Health Survey (SF-12), the Multidimensional Fatigue Symptom Inventory Short Form (MFSI-SF) as well as the Hospitality Anxiety and Depression scale (HADS). After controlling for demographic and medical factors, fatigue (p < 0.01) but not psychological distress (p>0.05) was negatively associated with physical QoL, explaining 11.0% of the variance. Fatigue (p < 0.001) and psychological distress (p < 0.001) were significant predictors of mental QoL, explaining an additional 36.2% and 3.6% of the variance. Further analyses revealed that all subscales of the HADS (e.g. anxiety and depression) and of the MFSI-SF (e.g. general fatigue, physical fatigue, emotional fatigue, mental fatigue and vigor) were significant predictors of mental QoL. MFSI-SF subscales also predicted physical QoL. The findings suggest that fatigue and psychological distress substantially predict QoL in patients with a previous venous thromboembolic event above and beyond demographic factors.

Clinical Implications of the CATIE Schizophrenia Trials: Day-to-Day Management Lessons for Australasian Psychiatrists

The aim of this paper was to review whether the $50m spent by the US National Institute of Mental Health in doing the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) trials found any useful evidence to change the clinical management of schizophrenia by psychiatrists. The CATIE trials were conducted in the US on 1460 enrolled patients in an effort to track how the drugs used to treat schizophrenia actually work in clinical practice (rather than in 6-week clinical trials). In a complex 3-phase design, patients were randomized to various types of (mostly) atypical antipsychotic drugs. Some 69-74% of patients switched antipsychotics for one reason or another during the 18 months of treatment. Some of the results were expensive confirmations of known prior results; of the commonly prescribed drugs, clozapine was the most effective, and olanzapine and ziprasidone caused the most and fewest metabolic side effects, respectively. The most stunning finding was that psychiatrists tend to ignore life-threatening, treatable medical conditions in patients presenting for treatment with schizophrenia. Of patients entering the study, 45% had untreated diabetes, 89% had untreated hyperlipidemias and 62% had untreated hypertension. This study failed to reveal anything of significant importance in the psychopharmacological treatment of schizophrenia, but did expose a woeful standard in the medical management of schizophrenia offered by psychiatrists. Psychiatrists should learn to properly treat diabetes, hyperlipidemia and hypertension when detected.

Public attitudes to life‐sustaining treatments and euthanasia in dementia

Issues surrounding end of life care, such as how aggressively to treat life threatening medical conditions in patients with dementia and when, if ever, to withhold or withdraw treatment require further scrutiny and debate. We conducted a cross-sectional survey to elicit the views of the general public on euthanasia and life-sustaining treatments in the face of dementia. Seven hundred and twenty-five members of the general public completed this questionnaire throughout London and the South East. In the face of severe dementia, less than 40% of respondents would wish to be resuscitated after a heart attack, nearly three-quarters wanted to be allowed to die passively and almost 60% agreed with physician assisted suicide. Respondents were more likely to be in favour of life-sustaining treatments for their partner than for themselves and the opposite was true regarding euthanasia. White respondents were significantly more likely to refuse life-sustaining treatment and to agree to euthanasia compared with black and Asian respondents. Our survey suggests that a large proportion of the UK general public do not wish for life-sustaining treatments if they were to become demented and the majority agreed with various forms of euthanasia.

Effects of Opioid Prescription Medication Dependence and Detoxification on Pain Perceptions and Self-Reports

The purpose of this work is to document whether prescription opioid medications used for pain enhanced or worsened pain syndromes from medical conditions in patients who received a diagnosis of prescription opioid dependence as determined by a diagnosis by Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria. Further, whether detoxification improved or worsened pain perceptions and self-reports in patients who chronically administered prescription opioid medications. Our study consisted of a retrospective sample of patients taken from the Addiction Treatment Unit at St Lawrence Hospital in Lansing, MI. Patients were selected from those who voluntarily sought detoxification from opioid medications in an inpatient setting. Selection criteria for the study consisted of a DSM-IV diagnosis of opioid prescription medication dependence, willingness to undergo medical detoxification, cooperation with self-report scales, and abstinence from opioid medications. Study patients were randomly selected from discharges in patient census for the years 2001 to 2003. The significant findings were that self-reported pain scores improved during the detoxification from admission to discharge, from a mean of 5.5 at admission to mean of 3.4 at discharge (0 is no pain and 10 is the most pain). The detoxification period extended to an average of 5 days. Whereas oxycodone CR (OxyContin) produced higher levels of self-reported pain at admission than at discharge, and these patients experienced significant levels of pain reduction with decremental opioid doses as with other opioid medications. Patients with a DSM-IV diagnosis of prescription opioid dependence reported (self) less pain with detoxification and abstinence from the opioid medications.

The burden of general medical conditions in patients with bipolar disorder

We reviewed the current literature on medical comorbidity burden in bipolar disorder. Overall, current studies suggest that numerous medical conditions may occur disproportionately within bipolar disorder patient populations, including hypertension, hyperlipidemia, and hepatitis C infection. In addition, the determinants of increased burden of medical comorbidity in patients with bipolar disorder include metabolic-related factors, health care access barriers, and patient behavioral and treatment factors. Overall, interventions specifically designed to reduce the burden of medical comorbidity in bipolar disorder are needed, especially those that emphasize changes at the health system level to facilitate coordination of medical and psychiatric care.

Management of co-morbidities and general medical conditions in patients with rheumatoid arthritis

Rheumatologists, in addition to providing subspecialty care, are frequently called to treat general medical conditions in their patients with rheumatoid arthritis (RA). Co-morbid medical problems are common in the RA population and may require a different approach from standard practice recommendations. In this paper, we review the evaluation and treatment of cardiovascular disease, chronic kidney disease, gastrointestinal disease, depression, and metabolic bone disease in patients with RA. Appreciation of the unique interaction between arthritis and common medical co-morbidities may have a significant impact on management and outcomes of RA.

Previously undiagnosed medical conditions in patients undergoing bariatric risk assessment

Purpose: Gastric bypass is used to successfully treat the medical complications of morbid obesity. During the extensive preoperative evaluation and risk assessment, new medical conditions are often diagnosed. A four-year retrospective review of a single surgeon’s experience was used to determine the incidence of previously unidentified medical conditions and their relative frequencies.

Ruffled hair and fever in an old woman with Alzheimer’s disease

In patients with dementia, the clinical presentation of unrelated medical conditions may be concealed or atypical, and symptoms difficult to interpret, or confounded by existing cognitive deterioration or by medications. These difficulties pose an extraordinary challenge to clinicians, and may contribute to the disturbing evidence of inadequate assessment and treatment of medical conditions in patients with dementia. Here, we report the case of an 82-year old woman diagnosed with Alzheimer's disease, whose MMSE score started to deteriorate rapidly after six years of steady decline as a result of a temporal arteritis. Temporal arteritis, a diagnosis which is often made several months after the onset of symptoms even in the general population, can be difficult to identify in patients with pre-existing dementia.

CORTICOSTEROID USE IN PATIENTS WITH CLOSTRIDIUM DIFFICILE INFECTION

Purpose: Corticosteroids are commonly used to treat ulcerative colitis and Crohn's colitis; however, their effects on patients with Clostridium difficile colitis may be detrimental. The aim of this study was to determine if corticosteroids are associated with an increased risk of developing severe outcomes leading to surgery and/or death. Methods: A case control study based on review of charts and our hospital's information system of 181 patients aged 18 years or older who were confirmed to have C difficile infection from May 1, 2001 to May 31, 2003, at St. Vincent Charity Hospital, Cleveland, OH. The main outcome measures were the number of patients who had severe outcomes, leading to colectomy and/or death, comparing patients who received corticosteroids to those who did not. Results: Of the 181 confirmed case of C difficile infection, 126 patients did not receive corticosteroids, whereas 55 patients received them for treatment of other medical problems. Patients who developed severe outcomes in both groups were generally older. Serum albumin levels were lower in patients who required a colectomy and/or expired, however there was no significant difference whether they had received corticosteroids or not, p = .777. Out of 126 patients who did not receive corticosteroids (control group), there were 20 deaths (15.87%), compared to 22 out of 55 deaths (40%), in the corticosteroid group [odds ratio (OR) = 4.752; 95% confidence interval [CI]: 2.329 to 9.695;p <.001]. In the control group there were 4 out of 126 patients (3.17%) who required a colectomy compared to 9 out of 5 5 patients (16.36%) in the corticosteroid group [OR = 5.967; CI: 1.752 to 20.328; p <.004]. In the control group, 1 out of 4 patients who had a colectomy expired after surgery (25%), compared to 6 out of 9 patients (66.66%) in the corticosteroid group [OR = 6; CI: 0.422 to 85.252]. Conclusions: Our study shows that when corticosteroids are used for treatment of other medical conditions in patients with C difficile colitis there is increased risk for the development of severe outcomes leading to colectomy and/or death. Further studies would be warranted to test the validity of these findings and to determine whether corticosteroid reduction or IV immunoglobulin administration would be helpful in severe cases of C difficile colitis.