Functional Status Of Patients Research Articles

Efficacy of a 3-Month Oral Function Management Protocol Incorporating Provision of Dietary Advice for Older Outpatients: A Randomised Controlled Trial.

This study aimed to examine the effects of an oral hypofunction management protocol incorporating oral function training and provision of dietary advice for 3 months on the nutritional status and oral function of older patients diagnosed with oral hypofunction. Oral hypofunction is associated with poor nutritional status, emphasising the need for management protocols incorporating provision of nutritional guidance and dietary advice. However, the efficacy of such protocols remains unclear. This quasi-randomised controlled clinical trial included 80 patients (age ≥ 65 years) diagnosed with oral hypofunction who were divided into two groups (intervention and control). The intervention group was provided with dietary advice and instructed to perform daily oral function training. The patients' nutritional status and oral function were evaluated every 1.5 months. Intergroup and intragroup comparisons were made. The intervention group exhibited a significant increase in the mean Mini Nutritional Assessment score over the study period (baseline: 25.4 ± 3.2; after 3 months: 26.3 ± 3.0), whereas no significant difference was observed in the control group (baseline: 26.4 ± 2.4; after 3 months: 26.4 ± 2.7). The mean number of symptoms of poor oral function was 4.0 ± 1.0 and 3.9 ± 0.9 at baseline and 2.8 ± 1.3 and 3.0 ± 1.3 after 3 months in the intervention and control groups, respectively, with a significant difference within the groups. Management protocols incorporating provision of nutritional advice effectively improved the oral function and nutritional status of older patients with oral hypofunction.

Correlation of Global Longitudinal Strain with Functional Status of Patients with Left Ventricular Systolic Dysfunction

Correlation of Global Longitudinal Strain with Functional Status of Patients with Left Ventricular Systolic Dysfunction

The Hungarian adaptation of the functional status questionnaire: Examination of validity and reliability.

In the international literature, several questionnaires measuring everyday activities are known with the aim of examining patients' quality of life. In the Hungarian language, few validated questionnaires focus on daily activities, examining both basic and moderately difficult physical activity, as well as mental health. Our goal was to translate the Functional Status Questionnaire (FSQ) into Hungarian and examine its reliability and validity.The validation of the questionnaire into Hungarian followed the six-step principle formulated in 2000. In our cross-sectional study, 376 participants took part. For convergent validity, we used the 36-Item Short Form Survey (SF-36) and the Functional Independence Measure (FIM) questionnaires. The examination of internal consistency was performed through Cronbach's alpha calculations. Test-retest reliability within the class was assessed with the intraclass correlation coefficient (ICC). We conducted discriminant validity for pain and general health. Internal consistency values demonstrated reliability. Participants' demographic data showed that the majority live in cities and have secondary education. The individuals included in the study exhibited unusually high levels of sports activity compared to the Hungarian average. Convergent validity examinations revealed significant relationships between dimensions of health-related quality of life of the different measurement tools. The validated Hungarian questionnaire is valid and reliable. Similar to the original questionnaire, it is quickly and easily completed, allowing healthcare professionals in clinical settings to assess the patient's functional status before initiating examinations.

The effects of whole-body vibration exercises with and without conventional physical therapy modalities in patients with knee osteoarthritis: A prospective, randomized-controlled study

Objectives: This study aims to examine the effects of whole-body vibration (WBV) therapy + home-based exercise (HBE) therapy; physical therapy modalities (PTMs)+HBE; and WBV+PTM+HBE on pain severity, physical performance, and functional status in patients with knee osteoarthritis (OA). Patients and methods: This single-center, single-blind, three-armed, prospective, randomized-controlled study included a total of 65 patients (3 males, 62 females; mean age: 56.0±6.3 years; range, 45 to 70 years) who were diagnosed with knee OA between February 2014 and July 2014. The participants were randomly divided into three groups. Group 1 (n=22) received WBV+HBE, Group 2 (n=22) received WBV+PTM+HBE, and Group 3 (n=21) received PTM+HBE alone. The primary outcome measure was functional physical performance, while the secondary outcome measures were pain intensity and functional status. All the measurements were evaluated by a single blinded investigator before and after treatment. Results: All the functional physical performance tests (p<0.01), pain intensity (p<0.01), and functional status (p<0.01) showed statistically significant effects in terms of time and group × time interaction, but no significant difference was observed among the groups (p>0.05). We observed statistically and clinically significant improvement in all of the functional physical performance tests, pain, and functional status for Group 2. There was a statistically and clinically significant improvement only in the functional physical performance tests for Group 1. In Group 3, no clinical or statistical significance was achieved in any outcome measurements. Conclusion: Treatment program consisting of WBV+PTM+HBE can yield clinically and statistically favorable results by improving all of the pain, functional status and physical performance parameters of the patients with knee OA, while WBV+HBE can be clinically and statistically effective only in the physical performance parameters of the patients.

The Effect of Intradermal Injection with Two Different Injection Techniques on Pain and Functional Status in Patients with Chronic Nonspecific Neck Pain

The Effect of Intradermal Injection with Two Different Injection Techniques on Pain and Functional Status in Patients with Chronic Nonspecific Neck Pain

Post-COVID Quality of Life and Functional Status in Patients with and Without Diabetes Mellitus

Post-COVID Quality of Life and Functional Status in Patients with and Without Diabetes Mellitus

Frailty as a predictor of mortality and morbidity after cholecystectomy: A systematic review and meta-analysis of cohort studies.

Although cholecystectomy is a common surgery, it carries higher risks of postoperative complications and mortality for older adults. Age alone is not a reliable predictor of postoperative outcomes, whereas frailty may provide a more accurate assessment of a patient's health and functional status. Frailty, characterized by physical deterioration and reduced resilience, has been shown to predict mortality, prolonged recovery, and morbidity after various surgeries, including cholecystectomy. Thus, incorporating frailty evaluations into preoperative assessments can improve patient outcomes by individualizing treatment strategies. This systematic review and meta-analysis aims to evaluate how well frailty predicts postoperative outcomes following cholecystectomy. In accordance with PRISMA guidelines, we searched PubMed, Embase, and Web of Science on August 14th, 2024, without restrictions on publication year or language. The quality of the studies was assessed using the Newcastle-Ottawa scale, and meta-analysis was conducted using odds ratios with 95% confidence intervals as the effect size, employing a random-effects model. Nine cohort studies comprising a total of 128,421 participants were included. The pooled results showed significantly higher odds of short-term mortality (OR: 5.54, 95% CI: 1.65-18.60, p = 0.006), postoperative morbidity (OR: 2.65, 95% CI: 1.51-4.64, p = 0.001), major morbidity (OR: 3.61, 95% CI: 1.52-8.59), and respiratory failure (OR: 3.85, 95% CI: 1.08-13.79) among frail patients. Additionally, frail patients had longer hospital stays (mean difference: 2.98 days, 95% CI: 1.91-4.04) and significantly higher odds of postoperative infection and sepsis. However, no association was evident with reoperation rates. This study highlights the value of utilizing frailty assessment tools in preoperative settings for predicting outcomes after cholecystectomy. These tools could improve decision-making in both emergency and elective situations, aiding in the choice between surgical and medical management, as well as between open and laparoscopic procedures tailored to each patient.

Effect of endoscopic submucosal dissection on gastrointestinal function and nutritional status in patients with early gastric cancer.

Gastric cancer (GC) endangers the survival and prognosis of patients worldwide. Improving the prognosis of patients with early GC (EGC) is crucial to prolong their survival time. To analyze the effects of endoscopic submucosal dissection (ESD) on gastrointestinal function and nutritional status in patients with EGC. Eighty patients with EGC between January 2021 and January 2024 were divided according to different surgical protocol into following two groups: 42 patients who underwent ESD in the ESD group and 38 patients treated with endoscopic mucosal resection (EMR) in the EMR group. Two groups were compared in the operative indices, lesion resection rate, postoperative recovery of gastrointestinal function, nutritional status, and incidence of surgical complications. The overall resection rate of the lesion in the ESD group was higher. The operative bleeding volume and operation time were higher and gastrointestinal ventilation time was shorter in the ESD group than those in the EMR group (P< 0.05). The nutritional statuses of the two groups decreased after operation; however, the levels of albumin, prealbumin, hemoglobin, and transferrin were higher in the ESD group than in the EMR group (P < 0.05). The post-operative pepsinogen (PG) I level in the ESD group was higher than that in the EMR group, and the PG II level was lower than that in the EMR group (P < 0.05). The incidence of postoperative complications was compared between the two groups (P > 0.05). ESD can promote the immediate recovery of patient's postoperative gastrointestinal function, improve their nutritional level, and signifies its application in patients with EGC.

Abstract 4136745: How do sleep quality and heart failure symptoms impact functional status among patients with heart failure?

Background: Patients with heart failure (HF) frequently experience poor sleep quality and multiple HF symptoms, both of which are linked to diminished functional status. Poor sleep quality can manifest as prolonged latency, short duration, low efficiency, or difficulty staying asleep. HF symptoms encompass different dimensions: presence, frequency, severity, and distress of HF symptoms. Different dimensions of sleep quality and HF symptoms may uniquely influence functional status, necessitating tailored interventions, yet how individual dimensions of sleep quality and HF symptoms impact functional status remains unexplored. Research Question: how do individual dimensions of sleep quality and HF symptoms impact functional status in patients with HF? Methods: We studied 197 adults with HF (male: 66%, age: 62±11 yrs). The Pittsburgh Sleep Quality Index was used to assess seven dimensions of sleep quality: subjective sleep quality, latency, duration, efficiency, sleep disturbances, use of sleeping medications, and daytime dysfunction over the last month. Four dimensions (i.e., presence, frequency, severity, distress) of 7 HF symptoms (e.g., shortness of breath, fatigue, swelling) were assessed using the Symptom Status Questionnaire-HF. Functional status was measured using the Duke Activity Status Index. Correlations and two multiple linear regression models (1 st model: 7 dimensions of sleep quality on functional status, and 2 nd model: 4 dimensions of HF symptoms on functional status) were conducted for data analysis. Results: Worse subjective sleep quality, longer latency, more sleep disturbances, use of sleeping medications, and higher levels of daytime dysfunction were correlated with poor functional status. All four dimensions of HF symptoms were negatively correlated with functional status. In the 1 st multiple linear regression model, more sleep disturbances (B=-3.91, p =.006) and higher daytime dysfunction (B=-5.70, p &lt;.001) were predictive of poor functional status (model R 2 =0.23, p &lt;.001). In the 2 nd multiple linear regression model, only higher frequency of HF symptoms (B=-.70, p =.022) predicted poor functional status (model R 2 =0.34, p &lt;.001). Conclusion: Increased sleep disturbances, daytime dysfunction, and frequency of HF symptoms were associated with poorer functional status in patients with HF. These findings underscore the importance of developing tailored interventions to address individual sleep problems and HF symptoms to improve functional status.

Abstract 4112944: A diagnostic challenge overcome with persistent clinical suspicion in a case of cardiac AL amyloidosis

Case: A 62-year old male with a history of chronic kidney disease and paroxysmal atrial fibrillation presented with several months of fatigue, a progressive decline in functional status (NYHA IIIb-IV), weight loss, and intermittent lower extremity swelling. Blood pressure was 92/72 mmHg on presentation, and heart rate was 90 bpm. Physical examination revealed a jugular venous pressure of 12-14 cm H2O and 2+ bilateral lower extremity edema with mild wheezing. Methods/workup: Laboratories are shown in Table 1 and were notable for a serum free light chain ratio of 0.14. Transthoracic echocardiogram (figure 1) revealed a left ventricular (LV) ejection fraction of 33% with increased LV wall thickness and severe bi-atrial enlargement. Bone marrow biopsy revealed 2% lambda restricted plasma cells without evidence of amyloid deposits; metastatic bone survey was negative. A fat pad biopsy and endomyocardial biopsy stained negative for amyloid with Congo red. Cardiac MRI showed diffuse, circumferential subendocardial late gadolinium enhancement, most compatible with cardiac amyloidosis (figure 2). The patient also had a chest CT scan that demonstrated a few patchy nodular pulmonary infiltrates. Given his extensive negative workup, he was referred to pulmonary and endobronchial biopsy was positive for amyloid on Congo red staining (figure 3). Biopsy tissue typing revealed Lambda subtype AL amyloidosis. Management: The patient was started on Daratumumab, Cyclophosphamide, Bortezomib, and Dexamethasone by Hematology. Unfortunately, about a month after his diagnosis, he developed worsening heart failure despite treatment. He was admitted to an outside hospital with refractory cardiogenic shock and passed away during that admission. Discussion: The diagnosis of AL amyloidosis requires a high index of suspicion for prompt diagnosis and treatment. We present a case in which cardiac amyloidosis was suspected based on the patient’s clinical picture and cardiac imaging; however, multiple initial biopsies were negative. An expedited, multimodal and interdisciplinary diagnostic assessment is imperative as prognosis with chemotherapy is highly dependent on extent of AL disease, patient functional status, and presence of cardiac compromise. Elevated natriuretic peptides, troponins, autonomic dysfunction, and hypotension are negative prognostic features.

Abstract 4129729: Relationship Between Inflammatory Biomarkers and Quality of Life in Black Adults Living with Heart Failure: A Pilot Study

Introduction: Heart failure (HF) impacts quality of life considerably, with inflammatory biomarkers potentially playing a significant role in this relationship. The purpose of this study is to examine the relationship between NYHA Class, inflammatory biomarkers, and quality of life in Black adults living with HF. Methods: Black adults living with HF (N=41) were enrolled in this study. NYHA Class was extracted from the medical record. Health-related quality of life was measured using the Kansas City Cardiomyopathy Questionnaire (KCCQ), a 23-item questionnaire that quantifies physical function, symptoms, social function, and health-related quality of life in HF. Scores are transformed to a range of 0-100, with higher scores reflecting better health status. One-way ANOVA and correlation analyses were used to assess associations between NYHA class, inflammatory biomarkers (XO activity, IL-1β, IL-15, and CCL-19), and KCCQ scores. Results: Participants were 57±11 years of age and 66% female, with mean LVEF 33±14%. NYHA Class ranged from I (20%) to IV (12%), with the majority of participants in Class II (34%) and III (22%). Mean KCCQ Clinical Summary Score was 85± 21. NYHA Class I had significantly lower scores on the KCCQ Clinical Summary Score compared to Class III and IV (p &lt; .001, η 2 = 0.54), KCCQ Physical Limitation compared to Class II, III, and IV (p &lt; .001, η 2 = 0.53), and KCCQ Symptom Frequency compared to Class IV (p = .001, η 2 = 0.39). The KCCQ Clinical Summary Score was negatively associated with XO activity (r = -0.440, p = .046), IL-1β (r = -0.407, p = .043), IL-15 (r = -0.427, p = .033), and CCL-19 (r = -0.559, p = .004). Similar negative associations were observed for the KCCQ subscales. Conclusion: The negative association between XO activity and health-related quality of life (KCCQ) in individuals with HF highlights the potential impact of oxidative stress on these patients' subjective well-being and functional status. Understanding this relationship could underscore the importance of mitigating oxidative stress pathways to improve the overall quality of life and symptom burden experienced by individuals with HF. The KCCQ and subscales were also negatively associated with markers of inflammation, highlighting the potential impact of systemic inflammatory processes on subjective well-being and functional status in persons with HF. Targeting inflammatory pathways may improve quality of life and mitigate the burden of symptoms in HF.

Higher Preoperative Serum Neuropeptide Y Concentration May Be Associated with a Better Prognosis After Surgery for Colorectal Cancer.

The early identification of patients at risk of peri-procedural complications and poor prognosis is particularly important. We conducted our study to determine whether serum orexigenic neuropeptide Y (NPY) concentration is associated with nutritional status and prognosis among patients undergoing surgery for colorectal cancer (CRC). A cohort study with a 3-month follow-up was conducted with 84 consecutive inpatients who underwent elective surgery in one center between 2016 and 2019 for primary CRC. The clinical characteristics and nutritional status of all patients were assessed. In long-term follow-ups (median; IQR: 1322; 930-1788 days; average 3.6 years), the patients' survival status was also checked during a telephone consultation. Before CRC surgery, patients with serum NPY concentrations equal to or higher than the median value (661.70 pg/mL) had higher scores in their Mini Nutritional Assessment, Barthel, and Instrumental Activities of Daily Living (IADL) questionnaires, greater handgrip strength, a lower score in the Patient-Generated Subjective Global Assessment, and almost a three-times lower risk of perioperative complications, as well as higher Barthel and IADL scores and larger calf circumference at the 3-month follow-up visit in comparison to individuals with lower serum NPY concentrations. A higher serum NPY concentration was predictive of a low Nutritional Risk Screening 2002 score at the 3-month visit, and this was also found to have significantly influenced the patients' survival during the 1200 days after CRC surgery. A higher preoperative serum NPY concentration may be related to lower nutritional risk, more favorable patient nutritional and functional status, and better survival, but further studies are required.

Oral function status of older patients seeking dental implant treatment.

In recent years, dental implant treatment has become an option for prosthetic treatment for missing teeth and is often performed in older patients. However, the complex oral functional decline in old age presents challenges in terms of frailty prevention, making oral function management after prosthetic treatment crucial. Nonetheless, the actual status of oral function in older patients seeking dental implant treatment remains unclear. In this study, we aimed to assess the oral function status of older patients seeking dental implant treatment. Among patients receiving prosthetic treatment for missing teeth, 227 older patients (111 in the pre-dental implant group and 116 in the pre-bridge/denture group) who underwent a thorough examination of their oral function were included in this study. Age, sex, comorbidities, smoking status, number of functional teeth, and occlusal support status were obtained from the medical records. Statistical analyses were performed using the t-test, chi-square test, and logistic regression (p < 0.05). Compared with the pre-bridge/denture group, the pre-dental implant group had significantly better oral hygiene, occlusal force, tongue-lip motor function, tongue pressure, masticatory function, and swallowing function and a significantly lower prevalence of oral hypofunction. Older age and decreased occlusal support were associated with the diagnosis of oral hypofunction, even after adjusting for confounding factors including prosthetic treatment. Although older patients seeking dental implant treatment have a higher oral function than those seeking general prosthetic treatment, older age and a lower number of occlusal supports suggest that appropriate oral function management is needed.

Natural Language Processing of Clinical Documentation to Assess Functional Status in Patients With Heart Failure

Serial functional status assessments are critical to heart failure (HF) management but are often described narratively in documentation, limiting their use in quality improvement or patient selection for clinical trials. To develop and validate a deep learning natural language processing (NLP) strategy for extracting functional status assessments from unstructured clinical documentation. This diagnostic study used electronic health record data collected from January 1, 2013, through June 30, 2022, from patients diagnosed with HF seeking outpatient care within 3 large practice networks in Connecticut (Yale New Haven Hospital [YNHH], Northeast Medical Group [NMG], and Greenwich Hospital [GH]). Expert-annotated notes were used for NLP model development and validation. Data were analyzed from February to April 2024. Development and validation of NLP models to detect explicit New York Heart Association (NYHA) classification, HF symptoms during activity or rest, and frequency of functional status assessments. Outcomes of interest were model performance metrics, including area under the receiver operating characteristic curve (AUROC), and frequency of NYHA class documentation and HF symptom descriptions in unannotated notes. This study included 34 070 patients with HF (mean [SD] age 76.1 [12.6] years; 17 728 [52.0]% female). Among 3000 expert-annotated notes (2000 from YNHH and 500 each from NMG and GH), 374 notes (12.4%) mentioned NYHA class and 1190 notes (39.7%) described HF symptoms. The NYHA class detection model achieved a class-weighted AUROC of 0.99 (95% CI, 0.98-1.00) at YNHH, the development site. At the 2 validation sites, NMG and GH, the model achieved class-weighted AUROCs of 0.98 (95% CI, 0.96-1.00) and 0.98 (95% CI, 0.92-1.00), respectively. The model for detecting activity- or rest-related symptoms achieved an AUROC of 0.94 (95% CI, 0.89-0.98) at YNHH, 0.94 (95% CI, 0.91-0.97) at NMG, and 0.95 (95% CI, 0.92-0.99) at GH. Deploying the NYHA model among 182 308 unannotated notes from the 3 sites identified 23 830 (13.1%) notes with NYHA mentions, specifically 10 913 notes (6.0%) with class I, 12 034 notes (6.6%) with classes II or III, and 883 notes (0.5%) with class IV. An additional 19 730 encounters (10.8%) could be classified into functional status groups based on activity- or rest-related symptoms, resulting in a total of 43 560 medical notes (23.9%) categorized by NYHA, an 83% increase compared with explicit mentions alone. In this diagnostic study of 34 070 patients with HF, the NLP approach accurately extracted a patient's NYHA symptom class and activity- or rest-related HF symptoms from clinical notes, enhancing the ability to track optimal care delivery and identify patients eligible for clinical trial participation from unstructured documentation.

ITACARE-P/SIGG/SIGOT/SICGE position paper: referral of elderly cardiac patient from geriatrics to cardiac rehabilitation.

Cardiac rehabilitation (CR) is Class IA indication in patients after an acute cardiovascular (CV) event, with efficacy confirmed even in elderly or frail CV patients CV and geriatric outcomes. However, rate of referral and admission to CR of elderly CV patients remains very low. CV patients admitted in geriatric wards are often complex, multimorbid and frail. Therefore, the present position paper addressees their possible referral to CR, since many have various forms of CV diseases amenable to improve with CR. The multidisciplinary and comprehensive model of CR is applicable to these patients where evaluation and interventions should be tailored to the patient functional and clinical status, aiming to appropriate targets. Cardiologist, Geriatrician and other professionals, should synergistically integrate their competences, thus outlining also the new paradigm of "Cardiogeriatric Rehabilitation and Prevention", possibly leading to an increased awareness of the beneficial effect of CR and to an increased referral to CR from Geriatric departments. Operative recommendations are given, based on appropriateness and priority of indications, clinical risk and frailty level, integrating different expertise to reach more effective programs of care.

Relationship between NT-proBNP, echocardiographic abnormalities and functional status in patients with subclinical diabetic cardiomyopathy

Abstract Background Persons with diabetes are at risk for developing a cardiomyopathy through several pathophysiological mechanisms independent of traditional risk factors for heart failure. Among those with so-called diabetic cardiomyopathy (DbCM), the relationship between natriuretic peptides, cardiac structural abnormalities and functional capacity is largely unknown. Purpose This study aimed to evaluate associations between NT-proBNP concentrations, clinical characteristics, echocardiographic findings, health status and activity, and outcomes from cardiopulmonary exercise testing Methods The Aldose Reductase Inhibition for Stabilization of Exercise Capacity in Heart Failure Trial (ARISE-HF) trial is evaluating the effects of AT-001, a novel aldose-reductase inhibitor in participants with DbCM without a prior history of heart failure (1). Participants were included if they had a known diagnosis of type 2 diabetes and age ≥60 (or ≥45 with a duration of diabetes of ≥10 years or estimated glomerular filtration rate ≤60 mL/min/1.73m2). Participants were required to have evidence of one of: structural cardiac abnormality, elevated cardiac biomarkers, or impaired exercise tolerance, defined as a peak oxygen uptake (VO2) ≤75% of predicted. In this prespecified subgroup analysis of the ARISE-HF trial, 685 participants with baseline echocardiography data, laboratory investigations, and functional assessment were included. Participants were stratified by N-terminal pro-B type natriuretic peptide (NT-proBNP) quartiles, and correlation with echocardiographic and functional parameters were assessed using Spearman correlation test. Results The mean age of participants was 67.4 years and 50% were female. The mean duration of type 2 diabetes was 14.5 years with a mean hemoglobin A1c of 6.98. The median NT-proBNP was 71 (Q1, Q3: 33, 135) ng/L. No association was observed between NT-proBNP concentrations and echocardiographic parameters of either diastolic or systolic dysfunction including global longitudinal strain, left ventricular ejection fraction, left ventricular mass index, left atrial volume index, E/e’, or right ventricular systolic pressure (Figure 1). In contrast, NT-proBNP was significantly correlated with components of the Kansas City Cardiomyopathy Questionnaire (P&amp;lt;0.001), the Physical Activity Scale in the Elderly (P=0.004), duration of cardiopulmonary exercise testing (P&amp;lt;0.001), peak VO 2 (P&amp;lt;0.001), and ratio of minute ventilation/carbon dioxide production (P=0.002; Figure 2). Conclusion Among highly selected patients with subclinical DbCM, elevated NT-proBNP concentrations are associated with worse health status, lower activity levels, and reduced functional capacity, but not with cardiac structural abnormalities. These findings suggest that regardless of cardiac structural abnormalities, biomarker concentrations reflect important deterioration in functional capacity in affected individuals.

Orbital decompression improves visual function and macular blood perfusion status in patients with thyroid-related eye disease.

Orbital decompression surgery is a treatment option for Thyroid-associated Ophthalmopathy (TAO). However, its effects on visual function and macular perfusion status remain unclear. This study examined how orbital decompression surgery affects visual acuity and macular blood flow in TAO patients and the variation between these two factors. This study involved cross-sectional and longitudinal analyses of 54 TAO patients, who were categorized into a normal vision group (n = 40) and an impaired vision group (n = 14) based on the presence of visual impairment before surgery (LogMAR BCVA >0.097). Among the participants, 20 underwent orbital decompression surgery (normal vision group: n = 13, impaired vision group: n = 7). BCVA and IOP were assessed at baseline in patients with TAO, and macular retinal blood perfusion indices were measured using OCTA. One month post-operatively, changes in these indices were compared between the two groups, and the correlation between visual acuity and macular perfusion indices was analyzed. The LogMar BCVA in the visual impairment group was significantly worse than that in the normal vision group (p < 0.001), while the W-MVD was significantly lower (p = 0.01). In the visual impairment group, post-operative LogMar BCVA improved significantly (p = 0.038), and W-MVD increased significantly (p = 0.008) compared to baseline. However, there were no significant changes in LogMar BCVA, S-MVD, D-MVD, or W-MVD in the normal vision group from preoperative to postoperative assessments. A strong negative correlation was found between the changes in W-MVD and changes in LogMar BCVA in the eyes of the visual impairment group treated with orbital decompression (Pearson correlation coefficient, R = -0.812, p = 0.05). This study found that TAO patients with visual impairment had lower macular blood flow perfusion than those with normal vision. Endoscopic orbital decompression surgery was found to improve both the best-corrected visual acuity and macular blood flow perfusion in TAO patients with visual impairment, and the improvement in visual acuity was correlated with the improvement in macular blood flow perfusion.

Hemodynamic effects of intra-aortic balloon pump in patients with advanced heart failure and cardiogenic shock waiting heart transplant

Abstract Background The use of intra-aortic ballon pump (IABP) as a bridge therapy in patients with advanced heart failure (HF) and cardiogenic shock (CS) waiting heart transplant (HTx) remains under debate. IABP can be an available device to improve hemodynamic conditions of these patients until HTx. Purpose Evaluate the hemodynamic effects of IABP and its efficacy in patients with advanced HF and CS waiting HTx. Methods We retrospectively analyzed from a single center intensive care unit, between 2009 and 2020, patients with advanced HF with optimized intravenous drugs that required IABP placement before HTx. Changes in oxygen central venous saturation (ScvO2), arterial lactate, renal function, and use of vasoactive drugs before and 96 hours after IABP insertion were evaluated. Patients with acute myocardial infarction and implant of ventricular assist device before HTx were excluded. Results A total of 199 patients (mean age 46,5 ± 12 years) were included. Median time of IABP onset to HTx was 20 days. Mean left ventricle ejection fraction was 23,5 ± 5,9%, 53,7% of patients had moderate to severe right ventricular dysfunction and the most frequent etiology was Chagas disease (47,2%, n=94). Before the IABP placement, 97,47% of patients were using dobutamine, 19,29% milrinone, 58,08% nitroprusside and 17,7% norepinephrine. Clinical and laboratory data were compared before and 96 hours after IABP therapy. ScvO2 increased from 49,9% to 66,85% (p&amp;lt;0,001), lactate decreased from 21,91 mg/dl to 12,6 mg/dl (p&amp;lt;0,001), creatinine decreased from 2,04 mg/dL to 1,72 mg/dL (p=0,301) and urine output increased from 1690,12 mL/24h to 2193,12 mL/24h (p&amp;lt;0,001). These differences were maintained until the day before HTx. Use of nitroprusside increased from 58,08 to 63,59% (p=0,154), and the use of norepinephrine decreased from 17,7% to 6,63% (p&amp;lt;0,001). Conclusion IABP improves tissue perfusion, renal function, and hemodynamic status in patients with advanced HF and CS and can be an effective method of circulatory support as a bridge therapy to HTx.Laboratory data pre and post-IABPVasoactive Drugs pre and post-IABP

Thyroid function status in patients with hypothyroidism on thyroxine replacement and associated factors: a retrospective cohort study in primary care

BackgroundLong-term management of patients with hypothyroidism on thyroxine replacement requires thyroid function test (TFT) monitoring once every six–12 months as recommended by clinical practice guidelines. This study determined their thyroid function status during two-year follow-up visits in primary care, and the factors influencing their thyroid status, and assessed the optimal interval for TFTs.MethodsA retrospective cohort study was conducted on adults with a clinical diagnosis code for hypothyroidism in their electronic health records taken from a group of polyclinics in Singapore between July 2017 and June 2020. The follow-up thyroid status was categorized as under-replacement (TSH ≥ 3.70mIU/L), over-replacement (TSH ≤ 0.65mIU/L) or euthyroid (TSH 0.65–3.70mIU/L). The patients’ demographic, clinical and TFT data were analyzed using appropriate statistical tests during the two-year follow-up. Stepwise logistic regression analysis identified the factors associated with suboptimal thyroid control. Kaplan–Meier analysis was used to compare their thyroid function status in association with the interval between TFT monitoring.ResultsData from 5,749 eligible subjects (mean age 62.1 ± 13.29 years; 79% female; 79.7% Chinese) were analyzed. After a two-year follow-up, 61.9% (n = 3558) of all subjects were euthyroid, with 29.5% (n = 1694) being under-replaced and 8.6% (n = 497) over-replaced. However, thyroid status did not differ significantly with the various dose regimen (daily, segmented, or alternate days) (p = 0.193). Stepwise logistic regression showed that thyroxine under-replacement was significantly associated with the male gender (AOR = 1.25,95%CI = 1.03–1.51,p = 0.02) and obesity (AOR = 1.34,95%CI = 1.08–1.66,p = 0.008). Every unit (μg/kg body weight) increase in the mean daily thyroxine dose was associated with 2.72 times greater odds of over-replacement. When comparing thyroid function monitoring at intervals of 13-24 months, monitoring at shorter intervals (≤ 12 months) was less likely to detect thyroxine under-replacement (AOR = 0.57,95%CI = 0.44–0.74,p < 0.001) and over-replacement (AOR = 0.62,95%CI = 0.41–0.97,p = 0.033). Among the 3,312 adults who were euthyroid at baseline, 22.2%, 41.7% and 59.6% had suboptimal thyroid control at 6, 12 and 24 months respectively (Kaplan–Meier analysis).ConclusionAround six in ten patients were euthyroid with thyroxine replacement for hypothyroidism in primary care over two years. Thyroxine under-replacement was associated with male gender and obesity. The proportion of euthyroid patients developing abnormal thyroid function doubled with TFTs at six, 12 and 24-month intervals.

Results of tendon transfers for stabilization of wrist joints for patients with rheumatoid arthritis

Objectives. The high incidence of damage to small joints of the hand in rheumatoid arthritis (RA), leading to persistent disability, is an important problem in rheumatoidology. A common operation for arthrodesis of the wrist joint to correct emerging deformities is traumatic and limits the function of the hand. In recent years, at the V.A. Nasonova Research Institute of Rheumatology, it has been replaced by new soft tissue joint-saving operations, which allow maintaining good hand function and preventing the development of severe deformities in the future. Target. Comparison of the results of performing soft tissue stabilizing operations on transposition of the tendons of the long radial and ulnar extensor carpi and arthrodesis of the wrist joint in patients with RA. Methods. The study included 69 patients operated on at the V.A. Nasonova Federal State Budgetary Institution NIIR in the period from 2018 to 2023. 24 patients underwent transposition of the long radial and ulnar extensor carpi (transposition ECU + ECRL - extensor carpi ulnaris and extensor carpi radialis longus) with subsequent tenodesis. The control group consisted of 45 patients who underwent arthrodesis of the wrist joint. The DASH questionnaire was used to assess functional status before and after surgery. To assess quality of life - EQ-5D index, pain - VAS, disease activity was assessed using the DAS28 index. The average follow-up period for patients after surgery was 6 months. Results. The functional status of patients after surgery, assessed by the DASH scale, was significantly better in the group of patients who underwent transposition of the tendons of the long radial and extensor carpi ulnaris 39.41±10.17 compared to the control group of wrist arthrodesis 46.4±15.8 (p0.05). Conclusions: ECU+ECRL tendon transpositions are an effective method for stabilizing the wrist joints and correcting hand deformities, but they have a number of limitations, the most important of which is the degree of damage to the wrist joints and the severity of the deformities.