Presence Of Concurrent Illness Research Articles

Current state and influencing factors of social alienation in patients with stress urinary incontinence

ObjectiveTo understand the current level of social alienation among patients with stress urinary incontinence (SUI) and analyse the influencing factors to provide a foundation for better clinical support for patients’...

Nasal vestibulitis as an under-recognized and undertreated side effect of cancer treatment.

219 Background: Dryness, crusting, and bleeding of the nares due to inflammation, termed nasal vestibulitis (NV), is infrequently reported as a side effect of cancer treatments. However, one study described 115 patients who developed NV while undergoing targeted therapies; many were treated with bacitracin ointment (Ruiz et al Sup Care Cancer 2015). Methods: This study surveyed 94 patients regarding the presence of nasal symptoms during cancer treatments. Participants were consented for the study if they had undergone at least 6 weeks of cancer-directed therapy in the Mayo Clinic Chemotherapy Unit. They were asked about types of nasal symptoms, severity, and symptom treatments. A chart review was then conducted to determine documentation of symptoms, the presence of concurrent illnesses, and cancer treatment regimens. Results: Ninety-four patients completed questionnaires, with 41% reporting unpleasant nasal symptoms that they attributed to cancer treatments. Of the symptomatic patients, 46% had dryness, 33% had discomfort, 54% had bleeding, and 46% had scabbing. Average severity was 1.9 on a scale from 1 to 3 (1 = mild, 3 = severe). Symptoms were noted in patients undergoing a variety of cancer treatment regimens, with the highest frequency in patients undergoing a taxane-containing regimen (46%). 62% of patients with symptoms said they reported them to their provider, but only 41% of chart notes (for 16 patients) contained documentation of such, most frequently described as “allergies” or “epistaxis.” Only 10% of symptomatic patients had nasal swabs; all of which were obtained during respiratory illness or pre-op. 49% of patients with nasal symptoms reported treating their symptoms. Antihistamines (7 patients), nasal saline (6 patients), or nasal lubricants (i.e. Vaseline; 7 patients) were used; 2 patients applied bacitracin. 18% of symptomatic patients had providers who recommended treatments, including 2 patients who were thought to have concurrent infection and were treated with antibiotics. Conclusions: NV symptoms are prevalent among oncology patients, but infrequently recorded or treated by providers.

Five observations of a third morphologically distinct feline Demodex mite

Feline demodicosis is caused by infestation with Demodex cati and/or Demodex gatoi. These two mites have distinctive morphological appearances. To describe five observations of a morphologically distinct feline Demodex mite in 10 cats. All cats were in or adopted from an animal shelter. A mite with blunted ends longer than D. gatoi but shorter than D. cati was observed in one or multiple cats from animal shelters. Mean mite size was 139 ± 4.5 μm (n = 41 mites). Similar features among the cases included a history of recent recovery or presence of concurrent illness at the time of diagnosis. Pruritus was variable. Hairs were easily epilated in large amounts, and mites were found on either skin scrapings or hair trichograms; mites were most commonly found on the proximal third of hairs examined via trichogram. Reports of this mite are uncommon but when present tend to be in cats with concurrent illnesses. Awareness of this mite morphology will hopefully provide other investigators with specimens for molecular testing to determine whether this is a third species or a variant of D. gatoi or D. cati.

Early nutritional support is associated with decreased length of hospitalization in dogs with septic peritonitis: A retrospective study of 45 cases (2000–2009)

To determine whether the timing and route of nutritional support strategy affect length of hospitalization in dogs with naturally occurring septic peritonitis. Retrospective study encompassing cases from 2000 to 2009. University teaching hospital. Forty-five dogs that survived septic peritonitis. None. Nutritional strategy for each dog was categorized as either enteral nutrition (EN: free choice voluntary eating or assisted tube feeding) or central parenteral nutrition (CPN). Early nutritional support was defined as consistent caloric intake initiated within 24 hours postoperatively. Consistent caloric intake occurring after 24 hours was defined as delayed nutritional support. Data reflective of nutritional status included body condition score, serum albumin concentration, and duration of inappetence before and during hospitalization. Body weight change from the beginning to the end of hospitalization was calculated. A modified Survival Prediction Index 2 score was calculated for each dog at admission. Additional clinical data recorded for comparison of illness severity included indicators of severe inflammation (eg, presence of toxic changes in neutrophils and immature neutrophils), coagulopathy (eg, prolonged prothrombin time and activated partial thromboplastin time), the use of vasopressors and blood transfusions, and presence of concurrent illnesses. Nutrition-related complications were classified as mechanical, metabolic, or septic complications. Multivariate linear regression analyses were used to determine the relationship of nutritional strategy with hospitalization length, while considering the presence of nutrition-related complications, the nutritional status- and illness severity-related variables. While controlling for other variables, dogs that received early nutrition had significantly shorter hospitalization length (by 1.6 days). No statistically significant association was found between route of nutrition and hospitalization length. The presence of concurrent illnesses and nutrition-related metabolic complications were also associated with longer hospitalization length (by 2.1 and 2.4 days, respectively). Early nutritional support in dogs with septic peritonitis is associated with a shorter hospitalization length.

Skull Base Osteomyelitis: The Effect of Comorbid Disease on Hospitalization

Skull base osteomyelitis is a rare disease that has a high morbidity and mortality rate if diagnosis and treatment are delayed. Our objective was to perform a more detailed analysis of skull base osteomyelitis in the inpatient population. We also provide a more comprehensive evaluation of comorbid disease and severity of illness in this population and describe their effects on the duration and cost of hospital stay. Review of the California Hospital Discharge Database between the years 1990 and 2000. Information evaluated included age, race, insurance, charges and length of hospital stay, comorbid disease, severity of illness, and disposition. Data were analyzed using analysis of variance and linear regression analysis. The overall incidence of skull base osteomyelitis ranged from 57 to 95 cases annually (median 75.5). Whites (69.3%) were more likely to present with the disease than Native Americans (13.2%), African Americans (6.5%), or Asians (2.9%). The majority of patients diagnosed with skull base osteomyelitis had Medicare or public assistance (62%) compared with those with Preferred Provider Organization or Health Maintenance Organization insurance (27%). Increased length of hospital stay and increased charges incurred during hospitalization were significantly associated (P < .05) with aplastic anemia, renal disease, arteriosclerosis, facial nerve dysfunction, and diabetes. Severity of illness and the presence of one or more comorbid conditions also significantly affected the duration and charges incurred during hospital stay (P < .05). The presence of concurrent illness with skull base osteomyelitis significantly affects the duration of hospital stay and the charges incurred during hospitalization.

Sexualität bei Patienten mit koronarer Herzkrankheit und Herzinsuffizienz

When a cardiologist is speaking about sexual disorder with a patient with coronary artery disease (CAD) or heart failure (HF) mostly the male sexual disorder is the point. Questions about sexual physical stress and the use of Viagra or MUSE are dominant in the first step. But usually sexual disorders of men and women are a challenge for the cardiologist: is there not another problem behind? Is sexual disorder only a "common symptom"? Is there a need for psychotherapy? There are patients with a "well functioning" of all sexual functions but however feeling unhappy and not satisfied because lacking in sexual fulfilling [32]. The most common questions in my opinion deal with male patients after CABG or valve replacement surgery or after myocardial infarction (MI) or percutaneous transluminal coronary angioplasty (PTCA). Those patients often are concerned about future sexual activity or about a diminished libido. Some fear of failing during intercourse. The risk of having severe complications during sexual activity is far less than many of the patients and their partners or we the cardiologists would have expected. In only about 0.9% of patients with MI sexual activity was a likely contributor to the onset of MI [27]. Regular exercise reduces the risk of MI by sexual activity. Even in high risk CAD-patients the risk for MI or death are low with 20 chances per million per hour with known CAD [14]. One of the largest and longest during newer studies is the Massachusetts Male Aging Study (MMAS) asking men with an age of 40-69 years. There was a prevalence of ED (3 levels: mild, moderate, complete) of 39% in the 40 years old and of maximal 67% in men with 69 years of age [16]. Common risks for ED are lower education, diabetes, heart disease, hypertension, cigarette smoking, obesity [22]. As early as possible we should reinforce patients (or even "non-yet-patients") to adopt healthy lifestyles with more physical activity to modify risk for sexual malfunction and for heart disease as well [15]. The prevalence seems to be the same as in men. The most common complaints depending upon their age include decreased libido, vaginal dryness, pain with intercourse, decreased genital sensation and difficulty or inability to achieve orgasm [5]. One of the most important problems for older women are the availability of a sexually active partner and the presence of concurrent illnesses. We should ask for sexual history in older women because the need of love and sexual intimacy does not diminish with age [25]. The risks for FSD are age related as well as para-aging: level of education, history of sexual abuse or sexually transmitted disease, the "integrity" of physical health as well as the overall state general happiness [19]. DEPRESSION AS A RISC FACTOR FOR CAD AND IMPAIRMENT OF SEXUALITY: As cardiologists know sexual dysfunction may be a risk indicator for arteriosclerosis and for heart disease or even a consequence of heart disease. Depression is meanwhile recognized as a independent risk factor for MI. But the connexion of depression and sexual dysfunction is a common problem for psychiatrists', gynaecologists', urologists' and cardiologists' consulting-hours [2, 3, 18, 20, 21, 23]. There is very little data available on this topic. Data are dealing with the need of information for patients and partners on the physical stress during sexual activity [33]. The examples for clinical status are given in a simple scheme of the Princeton Consensus Panel. Patients with low risk (the large majority of patients) can be safely encouraged to initiate or resume sexual activity or to receive treatment for sexual dysfunction. In group 2 patients with an intermediate risk should undergo cardiologic evaluation before restratification into low- or high-risk category. In the high-risk patients there is a precondition before resuming sexual activity: stabilisation by specific treatment [13]. Think on the sexual dysfunction when treating female and male cardiologic patients. Work together with other disciplines (gynaecology, psychiatry, sexual medicine, urology) when evaluating a treatment plan. As early as possible try to reinforce lifestyle change for risk factor modification. The absolute risk for death or MI during sexual activity is very low even in patients with known CAD.

Sexuality in Older Women

A host of biological and psychosocial factors play an important role in age-related changes of female sexuality. The most important of these are the availability of a sexually active partner and presence of concurrent illnesses. Some of the age-related changes in physiological indicators of sexual function, such as vaginal blood flow, are the result of estrogen deficiency, and as such are essentially reversible. Despite the inherent limitations of many studies in female sexuality, a significant degree of objective measurements has been reported in the literature. Future research should focus on developing appropriate techniques for quantitative estimation of sexual response in women. The need for love and sexual intimacy does not diminish with age, and sexual history should be part of the clinical evaluation of older patients.