Lives Of Patients Research Articles

Evaluation of Health-Related Quality of Life in Adult Patients on Hemodialysis.

Background:Hemodialysis in end-stage renal disease patients causes disability in different domains of patient's lives, leading to impaired (quality of life [QOL]). Studies measuring the QOL in patients on renal replacement therapy are limited in the Indian scenario.Aims:To evaluate the QOL in adult patients on maintenance hemodialysis by applying the World Health Organization QOL (WHOQOL)-BREF scale.Material and Methods and Study Design:Health-related QOL was evaluated in 100 adult patients on maintenance haemodialysis for 3 months or more in Dayanand Medical College and Hospital, Ludhiana. The WHOQOL-BREF was applied in these patients and the physical, psychological, social, and environmental health domains were assessed.Results:Most common age group was 31–60 years (56%) with a mean age of 54.44 years, male: 74%. Patients with age more than 60 years had better QOL scores in the social domain which was statistically significant (P = 0.005). Male patients had better scores in all four domains and was significant in the social domain (P = 0.025). Married patients had better QOL scores in social domain. Duration of dialysis had a reverse correlation with QOL scores in physical domain with better scores in dialysis duration of <12 months. Frequency of dialysis did not significantly affect the QOL scores. QOL scores were directly related to the monthly family income in all four domains with the highest income group showing better scores (P < 0.05).Conclusion:The present study provided an insight into the factors that affect the QOL in hemodialysis patients. Patients with age >60 years had better QOL scores in the social domain. Female gender, low serum proteins, HD duration of more than 1 year, and low monthly income were found to be associated with impaired QOL domains in patients undergoing maintenance hemodialysis.

COLD CASE: MYXEDEMA COMA TRIGGERED BY PNEUMONIA

TOPIC: Critical Care TYPE: Fellow Case Reports INTRODUCTION: Myxedema coma is severe hypothyroidism with associated hypothermia, altered mental status and multi-organ dysfunction. Mortality is over 60% and cases usually occur after a precipitating incident in patients with untreated hypothyroidism. CASE PRESENTATION: The patient is a 78 year old male with a history of congestive heart failure, diabetes, CKD, bronchiectasis, prior adenocarcinoma s/p right middle lobectomy, and untreated hypothyroidism who presented to the hospital with altered mental status. Six months prior, the patient was admitted to the hospital for pseudomonas pneumonia and had an elevated TSH at that time. On presentation, the patient was reported to have had upper respiratory symptoms for three days with generalized weakness. When he arrived to the hospital, he was found to be lethargic (GCS 6), bradycardic (35-55 bpm), hypotensive (82/36), hypoxic (50% on 2L home nasal cannula), and hypothermic (33.5C). He was given multiple doses of atropine with slight improvement in his heart rate and was started on norepinephrine and epinephrine. The patient was started on cefepime and vancomycin for antibiotic coverage after a chest x-ray was concerning for bilateral pneumonia. He was subsequently intubated for respiratory failure and altered mental status. Upon admission to the intensive care unit, the patient's condition remained unchanged despite appropriate interventions. A TSH was ordered and returned at 94.6 mU/L with a T4 of 0.04 ng/dl. He was given 300mcg of levothyroxine and 100mg of hydrocortisone IV. The patient was weaned off of pressors that day and transferred to the floor two days later. Both medications were continued during his hospital stay. Unfortunately, the patient ended up developing end stage renal disease that hospitalization and subsequently passed away while on hospice. DISCUSSION: This case offers a classic presentation of myxedema coma. In this case, the patient had known hypothyroidism but had gone untreated for months. He presented lethargic, hypotensive, hypoxic, bradycardic, and edematous. He was refractory to treatment and rapidly improved once levothyroxine was administered. The mortality for myxedema though is quite high and this patient unfortunately did not survive long term. Typical dosing of T4 should be 4mcg/kg IV (100-400mcg) and continued at 100mcg daily, which was done in this case. T3 can also be administered at 5-20mcg IV followed by 2.5-10mcg q8h, but was not done in this case. Steroids were given for this patient and are used for associated adrenal insufficiency. Typical dosing of hydrocortisone is 100mg q8h IV, but dexamethasone can be given as well. CONCLUSIONS: Myxedema coma is a rare but severe complication from hypothyroidism. An intensivist should remain vigilant about patients with hypothyroidism that present critically ill with symptoms described in this case. Early recognition and treatment is key to saving these patient's lives. REFERENCE #1: Jonklaas J, Bianco AC, Bauer AJ, et al. Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid. 2014;24(12):1670-1751. doi:10.1089/thy.2014.0028 REFERENCE #2: Ono Y, Ono S, Yasunaga H, Matsui H, Fushimi K, Tanaka Y. Clinical characteristics and outcomes of myxedema coma: Analysis of a national inpatient database in Japan. J Epidemiol. 2017;27(3):117-122. doi:10.1016/j.je.2016.04.002 REFERENCE #3: Kim JJ, Kim EY. Myxedema coma precipitated by diabetic ketoacidosis after total thyroidectomy: a case report. J Med Case Rep. 2019;13(1):50. Published 2019 Mar 4. doi:10.1186/s13256-019-1992-0 DISCLOSURES: No relevant relationships by Kyle Gronbeck, source=Web Response

Adverse childhood experiences among previously homeless African American women.

To learn how adverse childhood experiences (ACEs) impacted the life course trajectory of formerly homeless and at-risk African American women. Intersectionality and life course theory informed this qualitative pilot study, based on an instrumental case study design. Forty previously homeless and at-risk African American women, who were graduates from a long-term transitional living facility in Milwaukee, Wisconsin. Focus group interviews and one individual interview provided data about participants' life experiences prior to, during, and following their time at the transitional living facility, which provided supportive wrap-around services. Interviews were audiotaped, transcribed, and line-by-line thematic analysis was conducted to identify themes. Fifteen focus group participants also completed ACE questionnaires. Participants reported a high prevalence of multiple ACEs, and three themes were identified: childhood experiences with family conflict, childhood experiences of abuse, and negative coping mechanisms. One-hundred percent of women had experienced at least one ACE, based on ACE questionnaire responses. ACEs affect various parts of patient's lives as adults. For nurses and other healthcare professionals, connecting with community resources provides the opportunity to strategically approach health improvement with wrap-around resources to improve health outcomes.

A Comprehensive Review of Intranasal Insulin and Its Effect on the Cognitive Function of Diabetics.

Diabetes mellitus continues to be a disease that affects a good percentage of our population. The majority affected need insulin on a day-to-day basis. Before the invention of the first manufactured insulin in 1978, dealing with diabetes took a significant toll on patient's lives. As technology and human innovation prevail, significant advancements have taken place in managing this chronic disease. Patients have an option to decide their mode of insulin delivery. Intranasal insulin, one such form, has a rapid mode of action while effectively controlling postprandial hyperglycemia. It has also been proven to reduce hypoglycemia and insulin resistance problems, which seem to be the main adverse effects of using conventional insulin regularly. However, due to the large dosages needed and high incurring costs, Intranasal Insulin is currently being used as adjunctive therapy along with conventional insulin. We conducted a literature search in PubMed indexed journals using the medical terms "Intranasal insulin," "diabetes," and "cognitive impairment" to provide an overview of the mechanism of action of Intranasal Insulin, its distinctive cognitive benefits, and how it can be compared to the standard parenteral insulin therapy. One unique feature of intranasal insulin is its ability to directly affect the central nervous system, bypassing the blood-brain barrier. Not only does this help in reducing the peripheral side effects of insulin, but it has also proven to play a role in improving the cognitive function of diabetics, especially those who have Alzheimer's or mild cognitive impairment, as decreased levels of insulin in the brain has been shown to impact cognitive function negatively. However, it does come with its limitations of poor absorption through the nasal mucosa due to mucociliary clearance and proteolytic enzymes, our body's natural defence mechanisms. This review focuses on the efficacy of intranasal insulin, its potential benefits, limitations, and role in cognitive improvement in people with diabetes with pre-existing cognitive impairment.

Emerging Technologies for Non-invasive Monitoring of Treatment Response to Immunotherapy for Brain Tumors.

Glioblastoma is the most common primary malignant brain tumor and one of the most aggressive tumors across all cancer types with remarkable resistance to any treatment. While immunotherapy has shown a robust clinical benefit in systemic cancers, its benefit is still under investigation in brain cancers. The broader use of immunotherapy in clinical trials for glioblastoma has highlighted the challenges of traditional methods of monitoring progression via imaging. Development of new guidelines, advanced imaging techniques, and immune profiling have emerged to counter premature diagnoses of progressive disease. However, these approaches do not provide a timely diagnosis and are costly and time consuming. Surgery is currently the standard of care for diagnosis of pseudoprogression in cases where MRI is equivocal. However, it is invasive, risky, and disruptive to patient's lives and their oncological treatment. With its increased vascularity, glioblastoma is continually shedding tumor components into the vasculature including tumor cells, genetic material, and extracellular vesicles. These elements can be isolated from routine blood draws and provide a real-time non-invasive indicator of tumor progression. Liquid biopsy therefore presents as an attractive alternative to current methods to guide treatment. While the initial evaluation of liquid biopsy for brain tumors via identification of mutations in the plasma was disappointing, novel technologies and use of alternatives to plasma cell-free DNA analytes provide promise for an effective liquid biopsy approach in brain tumors. This review aims to summarize developments in the use of liquid biopsy to monitor glioblastoma, especially in the context of immunotherapy.

Dupuytren's Disease: An Outcomes-Focused Update.

Dupuytren's disease (DD) remains a common fibroproliferative condition with significant sequelae and impact on patient's lives. The etiology of DD is poorly understood, and genetic predisposition is thought to be a strongly associated factor. Despite remarkable strides in improving our molecular understanding of DD, clinical treatment options have not yet overcome the frequently encountered challenge of recurrence. Recurrence rates continue to shape the prognosis of this fibrotic condition. In this outcomes-focused article, the various treatment modalities are reviewed. This further emphasizes the importance of patient education and providing them with the information to make informed decisions about their treatment.

Assessing quality of life in patients with mastocytosis: development of the disease-specific questionnaire.

IntroductionAppropriate and targeted psychological care, as well as psychoeducation covering the disease causes, symptoms, and their management are crucial elements of the therapeutic process in patients with mastocytosis. This care is based on the identification of problematic areas that are of the greatest importance for patients. The quality of life questionnaires available in Poland are designed for the general population; therefore, they do not encompass the specificity of difficulties experienced by people suffering from mastocytosis.AimTo develop a questionnaire measuring the quality of life in patients with mastocytosis, and including the issues and symptoms typical for this group.Material and methodsThe study involved 85 patients (57 women and 28 men) suffering from mastocytosis.ResultsThe analyses revealed that the Quality of Life in Mastocytosis Scale (QLMS) is a reliable and valid tool for measuring the quality of life, and it takes into account the specific difficulties experienced by patients with mastocytosis. Apart from the measurement of the global quality of life, QLMS offers a deeper assessment of the quality of patient’s lives, including the difficulties in professional life, everyday life, leisure time, or those associated with protective behaviours.ConclusionsThe presented questionnaire completes a gap in quality–of-life studies by allowing to plan psychoeducation and offering a tool for a precise diagnosis of the quality of life in patients with mastocytosis.

Circular RNA Circ_ANKMY2 Regulates Temporal Lobe Epilepsy Progression via the miR-106b-5p/FOXP1 Axis

Temporal lobe epilepsy (TLE) is common intractable epilepsy that affects the patient's lives. The circular RNA circ_ANKMY2 (circ_ANKMY2) has been reported to be abnormally expressed in TLE. Nevertheless, the role and mechanism of circ_ANKMY2 in TLE are unclear. A human neuroblastoma cell line (SK-N-AS) was used for a series of studies. Expression levels of circ_ANKMY2, miR-106b-5p, and Forkhead Box Protein 1 (FOXP1) mRNA in TLE tissues were assessed through quantitative real-time polymerase chain reaction (qRT-PCR). Cell colony formation, proliferation, and apoptosis were determined by cell colony formation, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT), or flow cytometry assays. The levels of FOXP1 protein, Ki67, B cell lymphoma (Bcl-2), Bcl-2 Associated X (Bax), and Cleaved caspase-3 were evaluated by western blot analysis. The relationship between circ_ANKMY2 or FOXP1 and miR-106b-5p was verified with dual-luciferase reporter assay. We observed that circ_ANKMY2 and FOXP1 expression were reduced while miR-106b-5p expression was increased in TLE tissues. Overexpression of circ_ANKMY2 decreased spontaneous recurrent seizures (SRSs) in rat TLE model and blocked cell colony formation, proliferation, and induced cell apoptosis in SK-N-AS cells. Importantly, circ_ANKMY2 was verified as a sponge for miR-106b-5p. In addition, miR-106b-5p mimics abolished circ_ANKMY2 elevation-mediated effects on colony formation, proliferation, and apoptosis of SK-N-AS cells. Also, FOXP1 served as a target for miR-106b-5p. And FOXP1 silencing overturned the effects of miR-106b-5p inhibitors on the colony formation, proliferation, and apoptosis of SK-N-AS cells. In sum, circ_ANKMY2 modulated TLE advancement via regulation of FOXP1 expression through sponging miR-106b-5p, and circ_ANKMY2 might be an underlying target for the improvement of TLE.

Role of Molecular Hydrogen in Skin Diseases and its Impact in Beauty.

In today's society, healthy skin and a beautiful appearance are considered the foundation of general well-being. The skin is the largest organ of the body and plays an important role in protecting it against various hazards such as environmental, physical, chemical, and biological hazards. These factors include mediators that lead to oxidation reactions that produce reactive oxygen/nitrogen species and additional oxidants in the skin cells. An increase in oxidants beyond the antioxidant capacity of its defense system causes oxidative stress and chronic inflammation in the body. This response can cause further disruption of collagen fibers and hinder the functioning of skin cells that may result in the development of various skin diseases including psoriasis, atopic dermatitis, and aging. In this review, we summarized the present information related to the role of oxidative stress in the pathogenesis of dermatological disorders, and its impact on physical beauty and the daily lives of patients. We also discussed how molecular hydrogen exhibits a therapeutic effect against skin diseases via its effects on oxidative stress. Furthermore, findings from this summary review indicate that molecular hydrogen might be an effective treatment modality for the prevention and treatment of skin-related illnesses.

Social media and young people's health

Social media has become a pervasive part of modern society especially for adolescents and young adults. However, paediatric and psychiatric history taking has not always kept up with this rapid change. Social media can play a huge role in our patient's lives (both positive and negative) and so our history taking should reflect this. Peer beliefs and influence play a significant role in young people's view of the world so asking the right questions about their virtual interactions can provide vital information on the impact of online activity on their mental and directly and indirectly on their physical health. Evidence of the effects of social media on physical and mental health in the paediatric group is emerging. In this article we examine what the evidence says and how you should approach asking about social media use in paediatric clinical practice e.g. outpatient clinic and what advice we should be giving young people/parents. We provide an approach to getting a good history in line with the evidence available and follow this through with initial advice and signposting for the young person and their carer.

P2X3-Containing Receptors as Targets for the Treatment of Chronic Pain.

Current therapies for the treatment of chronic pain provide inadequate relief for millions of suffering patients, demonstrating the need for better therapies that will treat pain effectively and improve the quality of patient's lives. Better understanding of the mechanisms that mediate chronic pain is critical for developing drugs with improved clinical outcomes. Adenosine triphosphate (ATP) is a key modulator in nociceptive pathways. Release of ATP from injured tissue or sympathetic efferents has sensitizing effects on sensory neurons in the periphery, and presynaptic vesicular release of ATP from the central terminals can increase glutamate release thereby potentiating downstream central sensitization mechanisms, a condition thought to underlie many chronic pain conditions. The purinergic receptors on sensory nerves primarily responsible for ATP signaling are P2X3 and P2X2/3. Selective knockdown experiments, or inhibition with small molecules, demonstrate P2X3-containing receptors are key targets to modulate nociceptive signals. Preclinical studies have identified that P2X3-containing receptors are critical for sensory transduction for bladder function, and clinical studies have shown promise in treatment for bladder pain and pain associated with osteoarthritis. Further clinical characterization of antagonists to P2X3-containing receptors may lead to improved therapies in the treatment of chronic pain.

Pulmonary Hypertension Support Group: A Year in Review

A Pulmonary Hypertension (PH) support group fills a need for both patients and caregivers. The initial development of a support group community can be challenging. Our center sought to create a PH support group that met the needs of this unique community as well as see if attendance at support group improved adherence to treatment. The PH team sought to use a patient centered approach throughout development and continuation of the support group. Motivational interviewing using standard scripting helped determine best meeting times, spaces and topics. Post-initiation, a non-experimental design using a purposeful sample was used. A nurse researcher developed a survey determining what topics the participants were interested in, how they heard about the support group and benefits the meetings provided. Support group meetings were held quarterly and were open to all patients and caregivers, regardless of PH center. Attendance at quarterly PH clinic appointments was then retrospectively reviewed and compared between patients who had attended support groups and those who had not. After compiling the initial motivational interviews, the support group's timing was adjusted and food was provided to attendees. All of our participants stated that the support group was beneficial to them. We were given valuable feedback on improvement: Better temperature controlled room, parking passes, speaker system, PP slides, and more frequent meetings. Most importantly, our research demonstrated that those of our patients who attended one or more support group meetings within one year showed 88% compliance with follow up clinic visits, compared with 59% compliance for those patients who did not attend a support group meeting. This study demonstrated that attendance of support group meetings were correlated to the pulmonary hypertension patient's clinic attendance. This may suggest that support groups can positively impact patient's lives by helping patients to stay motivated to manage chronic conditions and stick to treatment plans. The potential of PH support groups should be further studied for their impact on overall quality of life in PH patients.

Advances in the Treatment of Drug-Resistant Pediatric Epilepsy.

Epilepsy is a common disorder in children and adults that causes significant morbidity and affects many aspects of a patient's lives. Two-thirds of patients with epilepsy are controlled with established antiseizure medications, leaving a significant number of patients searching for other options. The purpose of this review is to provide an overview of recent advancements in the management of treatment-resistant epilepsy in pediatric patients. Recent publications have shown the efficacy of new pharmaceutical options such as fenfluramine and cannabidiol, some of which have been tested specifically in patients with childhood-onset epilepsy syndromes such as Dravet's syndrome and Lennox-Gastaut's syndrome. Furthermore, recent approval by the U.S. Food and Drug Administration of stiripentol has made available a previously difficult-to-obtain option for patients with Dravet's syndrome. Finally, implanted responsive neurostimulation devices for direct cortical stimulation and deep brain stimulation have shown efficacy in adult patients and may represent a thrilling new horizon for pediatric patients.

Kadrovska organizacija/struktura i funkcionisanje centara za transplantaciju matičnih ćelija - kako optimizovati program transplantacije?

There are four stem cell (SC) transplant centers in Serbia that carry out their activities within the European Group for Blood and Marrow Transplantation (EBMT). They are positioned in the Clinical Center of Serbia, Military Medical Academy, Institute for Mother and Child Healthcare "Dr. Vukan Čupić" and in the Clinical Center of Vojvodina. The aim of this paper is to analyze the basic approaches and aspects, as well as main parameters and guidelines - related to the optimization of the functioning of SC transplantation centers. The existence of a competent and motivated professional employees of the transplant center, as well as an adequate operational locality/area and up to date equipments are imperative for the successful performance of this specific and complex procedure. The current tendency - and in the near future an obligation or requirement - is for each transplant center within the EBMT to be fully staffed and structurally equipped and ready to be included in the accreditation process by the Joint Accreditation Committee International. Begining the accreditation process implies, in addition to the implementation of education and training of employees, the establishment and implementation of specific quality control standards (ISO 9001: 2015, ISO 13485, ISO 13485: 2016, ISO 15189: 2007, ISO 17025, ISO / IEC 7025: 2005). The activity indicators of every transplant center have to be transparent and presented by: the number of treated patients, the rate of transplant mortality, the duration and quality of patient's lives. Also important parameters are various methods of economic analyses - different specific cost-benefit analyses. In conclusion, in order to achieve consistent/comparable therapeutic effects and outcomes for patients globally - it is imperative that transplant centers and related organizations work together on the quality system assurance, using a continuous and adequate "educational and organizational-structural models".

Facial Cellulitis and Erysipelas with Cutaneous Portal of Entry: Five Cases in Brazzaville, Congo

Background: More than 50% of the world’s population is infected with H. pylori (Helicobacter pylori). Its prevalence continues to increase and is more prevalent in developing countries and those living in unsanitary conditions. On the other hand; Vitiligo is a progressive disease of unknown etiology, poorly responding to treatment and has a severe impact on patient's lives. Objectives: This study is aimed to determine the prevalence of vitiligo variants and to detect whether or not there is an association between vitiligo and H. pylori infection. Patients and Methods: An observational case finding hospital-based study was carried out over a period of 3 months from October 2011-December 2011. A total of 64 vitiligo patients attended the clinic in Al Jawda Medical Centre in Khartoum; the patients had a thorough medical history taken from them and underwent a complete physical examination, and were tested for H. pylori using different laboratory methods. Questionnaires with relevant information have been completed. Results: H. pylori showed 53 positive cases out of the total number of 64 vitiligo cases which revealed an H. pylori prevalence of (82.8 %) which is considered as very high incidence rate. However, statistically, a p-value of more than 0.05 (p-value 0.729) renders it statistically insignificant and therefore an association between vitiligo and H. pylori is unlikely. The commonest vitiligo variant diagnosed in those with a positive H. pylori infection was Vitiligo vulgaris which constituted 64.2% of the total number of cases. Conclusion: There was a very high prevalence rate of H. pylori among vitiligo patients, and this should urge further larger scale research specifically well-designed case controls or cohorts regarding the association between vitiligo and H. pylori infection.

GR02.01 How Can We Incorporate Exercise Practices into Patient's Lives?

GR02.01 How Can We Incorporate Exercise Practices into Patient's Lives?

The point of pain in head and neck cancer.

Head and neck cancer (HNC) can have a devastating impact on patient's lives as both disease and treatment may affect the ability to speak, swallow and breathe. These conditions limit the oral intake of food and drugs, reduce social functioning and impact on patient's quality of life. Up to 80% of patients suffering from HNC have pain due to the spread of the primary tumor, because of consequences of surgery, or by developing oral mucositis, dysphagia or neuropathy as toxic side effects of radiotherapy, chemotherapy or both. All healthcare professionals caring for HNC patients should assess palliative and supportive care needs in initial treatment planning and throughout the disease, with awareness when specialist palliative care expertise is needed. This paper focuses on assessment, characterizations and clinical management of pain in advanced HNC patients undergoing surgery, chemotherapy and radiotherapy, also underlining the importance of symptom assessment in HNC survivors and the need of clinical research in this field.

Quality of care in inflammatory bowel diseases: What is the best way to better outcomes?

Inflammatory bowel disease (IBD) is a lifelong, progressive disease that has disabling impacts on patient’s lives. Given the complex nature of the diagnosis of IBD and its management there is consequently a large economic burden seen across all health care systems. Quality indicators (QI) have been created to assess the different façades of disease management including structure, process and outcome components. Their development serves to provide a means to target and measure quality of care (QoC). Multiple different QI sets have been published in IBD, but all serve the same purpose of trying to achieve a standard of care that can be attained on a national and international level, since there is still a major variation in clinical practice. There have been many recent innovative developments that aim to improve QoC in IBD including telemedicine, home biomarker assessment and rapid access clinics. These are some of the novel advancements that have been shown to have great potential at improving QoC, while offloading some of the burden that IBD can have vis-a-vis emergency room visits and hospital admissions. The aim of the current review is to summarize and discuss available QI sets and recent developments in IBD care including telemedicine, and to give insight into how the utilization of these tools could benefit the QoC of IBD patients. Additionally, a treating-to-target structure as well as evidence surrounding aggressive management directed at tighter disease control will be presented.

Assessment of neurogenic bowel dysfunction impact after spinal cord injury using the International Classification of Functioning, Disability and Health.

Bowel function is frequently compromised after spinal cord injury (SCI). Regardless of this crucial importance in patients' lives, there is still scarce literature on the Neurogenic Bowel Dysfunction (NBD) deleterious impact on SCI patient's lives and only few studies correlating NBD severity with quality of life (QoL). To our knowledge there are no studies assessing the impact of NBD on the context of ICF domains. To assess NBD after SCI using ICF domains and to assess its impact in QoL. Retrospective data analysis and cross-sectional phone survey. Outpatient spinal cord injury setting. Portuguese adult spinal cord injury patients. Retrospective analysis of demographic data, lesion characteristics and bowel management methods at last inpatient discharge. Cross-sectional phone survey assessing current bowel management methods, the Neurogenic Bowel Dysfunction Score and a Likert Scale questionnaire about the impact on ICF domains and QoL. Sixty-four patients answered the questionnaire. The majority was male (65.6%), mean age 56.6±15.6 years, AIS A lesion (39.1%), with a traumatic cause (71.9%). The main bowel management methods were contact laxatives, suppositories and osmotic laxatives. 50.1% of patients scored moderate or severe NBD. Considering ICF domains, the greatest impact was in personal and environmental factors, with 39.1% reporting impact in financial costs, 45.3% in need of assistance, 45.3% in emotional health and 46.9% in loss of privacy. There was a significant association between severity of NBD and negative impact on QoL (P<0.05). The study confirms the major impact of NBD on personal and environmental factors of ICF and on the quality of life of SCI population. These findings confirm that it is relevant to identify the main ICF domains affected by NBD after SCI in order to address targeted interventions, working toward changes in health policies and psychosocial aspects.

A Prospective Evaluation of Health-Related Quality of Life following Lymphaticovenular Anastomosis for Upper and Lower Extremities Lymphedema.

Lymphedema is a progressive disease that negatively affects body image and physical, psychological, and social functions. There is lack of evidence in the present literature about the impact of super microsurgical lymphaticovenular anastomosis (LVA) on health-related quality of life (HRQoL). The aim of this prospective study is to report the outcomes of patients' HRQoL after LVA for lower and upper extremities lymphedema. Between September 2015 and February 2017, 74 patients with upper or lower limb lymphedema (ULL or LLL) underwent LVA at our center. Quality of life (QoL) was assessed by lymphedema QoL questionnaire (LyMQoL), which is a validated disease-specific instrument to measure the impact of lymphedema on patient's lives, covering four domains: function, body image, symptoms, and mood. All patients were evaluated preoperatively, 1 month after surgery, and every 3 months up to 1 year. Additionally, we evaluated the episodes of lymphangitis and the need for conservative therapy before and after surgery. After a mean follow-up of 8.5 months (range: 2-21 months), we observed an increase of 2.3 points in the overall QoL average for upper limb and 2.6 points for lower limb (p < 0.001). A statistically significant improvement in all four domains (p < 0.01) was reported after surgery, being present from the first postoperative months for both upper and lower extremities. Our study shows that lymphaticovenular anastomosis improves HRQoL in patients affected by ULL and LLL. Additionally, both a reduction of episodes of lymphangitis and a decrease in the need of conservative therapy were observed in this cohort of patients.